目的：观察加味五苓肾气汤治疗脾肾阳虚型糖尿病黄斑水肿（DME）的临床疗效，并探究相关机制。方法：将120例DME患者按随机数字表法分为观察组和对照组各60例。两组患者均予黄斑区格栅光凝治疗，观察组在此基础上予加味五苓肾气汤治疗，两组均以1周为1个疗程，共治疗4个疗程。比较两组治疗后的临床疗效，以及治疗前后中医证候积分、视网膜中央动脉（CRA）血流动力学参数[收缩期峰值流速（PSV）、舒张末期血流速度（EDV）、阻力指数（RI）]、最佳矫正视力（BCVA）、黄斑中心凹视网膜厚度（CRT）、疾病相关因子[白细胞介素-1β(IL-1β)、载脂蛋白B/载脂蛋白A-1(ApoB/ApoA-1)]水平。结果：治疗后，观察组总有效率95.00%，高于对照组（P<0.05）；两组中医证候积分、CRT、IL-1β水平、ApoB/ApoA-1均低于本组治疗前（P<0.05），且观察组低于对照组（P<0.05）；两组PSV、BCVA均高于本组治疗前（P<0.05），且观察组高于对照组（P<0.05）。结论：加味五苓肾气汤治疗DME疗效确切，可有效缓解患者中医症状、提升视力，其机制可能与改善视网膜血流动力学、减轻机体炎症及调节脂代谢紊乱有关。

Objective:To observe the therapeutic effect of Modified Wuling Shenqi Decoction（加味五苓肾气汤） in treating diabetic macular edema(DME) caused by spleen-kidney yang deficiency,and to explore the related mechanisms. Methods:A total of 120 DME patients were divided into an observation group and a control group by the random number table method,with 60 cases in each group. Both groups received macular grid photocoagulation treatment,and the observation group was additionally treated with Modified Wuling Shenqi Decoction. Each course of treatment lasted for 1 week,and a total of 4 courses were administered. Comparisons were made between the two groups in terms of therapeutic effect after treatment,as well as traditional Chinese medicine(TCM) syndrome scores,hemodynamic parameters of central retinal artery(CRA) [peak systolic velocity(PSV),end-diastolic velocity(EDV),resistance index(RI)],best corrected visual acuity(BCVA),central retinal thickness(CRT) in macular fovea,and levels of disease-related factors [interleukin-1β(IL-1β),apolipoprotein B/apolipoprotein A-1(Apo B/Apo A-1)] before and after treatment. Results:After treatment,the total effective rate in the observation group(95.00%) was higher than that in the control group(P<0.05). The TCM syndrome scores,CRT,IL-1β level and Apo B/Apo A-1 in both groups were decreased after treatment,with the observation group showing a more significant decrease compared to the control group(P<0.05). The levels of PSV and BCVA in both groups were increased after treatment,with the observation group showing a more significant increase compared to the control group(P<0.05). Conclusions:The Modified Wuling Shenqi Decoction has definite therapeutic effect in treating DME. It can effectively relieve the patients ' TCM symptoms and enhance their visual acuity. The mechanism may be related to improving retinal hemodynamics,reducing inflammation,and regulating lipid metabolism disorder.