当代医家治疗痛风性关节炎经验拾萃

A collection of experience of contemporary doctors in treating gouty arthritis

痛风性关节炎是最常见的炎性关节炎,随着人民生活水平的提高及现代饮食结构的改变,它成为我国继糖尿病后第二大代谢疾病。现代医学对该病的具体病因和发病机制尚未明确,治疗效果亦未能达到预期。在现行的治疗方案中,中医遵循整体观念以及辨证论治的基本原则,对于改善患者症状具有独特优势。近些年来,当代医家和学者在继承前人的思想基础上,结合自身临床经验,对痛风性关节炎的病因病机进一步认识与探究,提出了不同观点,分析研究这些医家的思路和方法,有利于丰富和完善该病的病因病机体系内容。本文通过探讨众多现代医家的临床经验及学术思想,认为痛风性关节炎的主要病因病机为脏腑失调,邪气滞留,瘀久化毒,阻滞经脉,经脉痹阻,气血运行不畅,不通则痛。通过分析其病因病机的特点,总结了两大诊疗思路。其一为从脏腑论治,即从脾、胃、肝、肾、肺等脏腑论治,具体治法为健脾护胃、疏肝解郁、补肺益肾等,注重脏腑论治,从而达到补虚固本、除病祛邪的目的。其二为从“毒”论治,有浊毒、瘀毒、湿毒、热毒,强调祛邪重要性,对不同的毒邪辨证施药。讨论分析现代医家在痛风性关节炎病因病机、治法、遣方用药上的见解和发挥,对痛风性关节炎的治疗具有重要的指导意义。

Gouty arthritis is the most common inflammatory arthritis.With the improvement of people’s living standards and the change of modern diet structure,it has become the second largest metabolic disease after diabetes in China.The specific etiology and pathogenesis of the disease in modern medicine are not yet clear,and the therapeutic effect has not reached expectations.In the current treatment plan,traditional Chinese medicine follows the basic principles of holistic concept and syndrome differentiation and treatment,which has unique advantages in relieving the symptoms of patients.In recent years,on the basis of inheriting the thoughts of predecessors and combining with their own clinical experience,contemporary doctors and scholars have further understood and explored the etiology and pathogenesis of gouty arthritis,put forward different views,and analyzed the ideas and methods of these doctors,which is conducive to enrich and improve the content of the etiology and pathogenesis system of the disease.By discussing the clinical experience and academic thoughts of many modern doctors,this paper believes that the main etiology and pathogenesis of gouty arthritis are viscera disorders,retention of evil Qi(气),stasis for a long time,blockage of meridians,obstruction of meridians,poor circulation of Qi and blood,and pain caused by obstruction.By analyzing the characteristics of its etiology and pathogenesis,two diagnosis and treatment ideas are summarized.One is to treat from the viscera,that is,from the spleen,stomach,liver,kidney,lung and other viscera,the specific treatment is to strengthen the spleen and protect the stomach,sooth the liver and relieve depression,tonify the lung and kidney,etc.,and pay attention to the treatment of the viscera,so as to achieve the purpose of tonifying deficiency and consolidating the root,and eliminating the evil.The second is to treat from“toxin”,including turbidity toxin,stasis toxin,dampness toxin and heat toxin,emphasizing the importance of dispelling the evil,and applying medicine according to syndrome differentiation for different toxins.To discuss and analyze the modern physicians’views and roles in the etiology and pathogenesis of gouty arthritis,prescription medication and the treatment of gouty arthritis has important guiding significance for the treatment of ghe disease.