金明秀治疗类风湿性关节炎经验

Jin Ming-xiu′s Experience of Treating Rheumatoid Arthritis

金明秀教授认为,类风湿性关节炎(rheumatoid arthritis,RA)为本虚标实之证,本虚为肝肾不足,标实为风寒湿热之邪。金教授治疗RA,注重滋补肝肾壮筋骨,常用六味地黄丸为基础方加减。若RA患者关节疼痛为游走性,以风胜致痹者,多用防风、羌活、独活、威灵仙等;若关节疼痛剧烈,遇寒加重,形寒肢冷,以寒胜致痹者,多在温肾助阳的基础上加用附子;若症见关节酸楚疼痛,肿胀明显,身体沉重,以湿胜致痹者,常用泽泻、茯苓、猪苓配桂枝;若关节肿胀明显者,加车前子;若关节红肿疼痛,自觉关节局部灼热,加用金银花、连翘、蒲公英、紫花地丁;若湿热之邪致病者,采用二妙丸加味。金教授常强调先消肿后止痛的治疗原则,消肿之关键在于利湿,常用桃红四物汤加减,另加用虫类药、藤类药通络止痛。金教授在祛邪的同时兼顾扶正,若见乏力、汗出明显者,多用生黄芪,配当归以补血益气;若见纳呆、便溏者酌加健脾和胃之品,如焦山楂、焦神曲、焦麦芽、白术、山药等;以当归配川芎、熟地黄、鸡血藤以养血行血。金教授还重视引经药物的使用,依部位辨证用药,重视日常调护,嘱患者避风寒、慎起居、调饮食、畅情志、做到动静相宜。

Professor Jin Ming-xiu thinks that rheumatoid arthritis(RA)has the syndrome of deficiency as primary and excess as secondary.Deficiency as primary is manifested as insufficient liver and kidney,while excess as secondary is manifested as wind and cold and dampness-heat pathogens.Professor Jin pays attention to nourishing liver and kidney,strengthening muscles and bones in the treatment of RA.He often uses Six-Ingredient Rehmannia Pill as the basic formula.If the joint pain of RA patients is wandering,the arthralgia caused by wind should be treated with Fangfeng(Radix Saposhnikoviae),Qianghuo(Radix et Rhizoma Notopterygii),Duhuo(Radix Angelicae Pubescentis)and Weilingxian(Radix et Rhizoma Clematidis).If the joint pain is severe,and aggravated due to cold,the limbs are cold,the arthralgia caused by cold should be treated with Fuzi(Radix Aconiti Lateralis Preparata)on the basis of warming the kidney and helping yang.In case of joint pain,swelling and heavy body,the arthralgia caused by dampness should be treated with Zexie(Rhizoma Alismatis),Fuling(Poria),Zhuling(Polyporus)combined with Guizhi(Ramulus Cinnamomi).If joint swelling is obvious,Cheqianzi(Semen Plantaginis)can be used.If the joint is red,swollen and painful,and hot,Jinyinhua(Flos Lonicerae Japonicae),Lianqiao(Fructus Forsythiae),Pugongying(Herba Taraxaci)and Zihuadiding(Herba Violae)can be used.If RA is caused by dampness and heat,Flavored Two Mysterious Pill should be used.Professor Jin often emphasizes the treatment principle of first resolving swelling and then pain relief.The key to resolving swelling lies in draining dampness,so Modified Peach Kernel and Carthamus Four Substances Decoction is commonly used,and insect drugs and rattan drugs are also used to unblock collaterals and relieve pain.Professor Jin not only dispels pathogenic factors,but also strengthens healthy qi.If fatigue and perspiration are obvious,he often uses raw Huangqi(Radix Astragali)and Danggui(Radix Angelicae Sinensis)to replenish blood and qi.For anorexia,and loose stools,drink,he often adds drugs for activating the spleen and harmonizing the stomach,such as stir-baked Shanzha(Fructus Crataegi),stir-baked Shenqu(Massa Fermentata Medicinalis),stir-baked Maiya(Fructus Hordei Germinatus),Baizhu(Rhizoma Atractylodis Macrocephalae),Shanyao(Rhizoma Dioscoreae),etc.Besides,Danggui(Radix Angelicae Sinensis)combined with Chuanxiong(Rhizoma Chuanxiong),Shudihuang(Radix Rehmanniae Praeparata),and Jixueteng(Caulis Spatholobi)is often used to nourish blood and promote blood circulation.Professor Jin also pays attention to the use of meridian-guiding drugs,medication according to the location of syndrome differentiation,and daily care.He tells the patients to avoid wind and cold,be careful in daily life,adjust diets,smooth emotions,and make the movement and rest appropriate.