当代名医论治类风湿关节炎规律探讨

Exploration on Laws of Syndrome Differentiation and Treatment of Rheumatoid Arthritis by Contemporary Famous Doctors

目的:对当代名医治疗类风湿关节炎(Rheumatoid arthritis,RA)的经验,探求类风湿关节炎的治疗规律,以更好地指导临床。方法:对19位国家中医药管理局首批全国继承名老中医专家学术经验指导老师治疗RA经验的相关文献及著作,应用内容分析法进行搜集、整理、分析、归纳,对病因病机、证候特点、治则治法采用描述性分析;同时将当代名医治疗RA的经验方进行分析,将相关方药记录汇总,并录入数据库,建立数据库系统,运用数理统计方法,对其用药进行分析归纳。结果:当代名医治疗RA 151篇文献中病因病机可分为:外感邪气、脏腑亏虚、气血亏虚、阴阳虚弱、营卫不和、瘀血、痰浊7种,其中以外感邪气最常见。治疗RA的经验方及病案中所用方药,共收集110条,其中使用了药物188种,共计1 326药次,平均每方用药数为12.05种,超过或等于3次的药物共有95种。最常用的药物是当归、桂枝、甘草、白芍、黄芪、威灵仙、防己、薏苡仁、蜈蚣、川乌、熟地黄、鸡血藤、青风藤。结论:病邪侵袭、病理产物闭阻、正气虚弱三者共同作用是RA的主要病因病机。治疗以祛邪宣痹、化痰祛瘀、扶正培本三大类法则联合使用。最常用的药物类别是祛风湿散寒药、袪风湿清热药、活血调经药、熄风止痉药、补气药及补血药。

Objective ： To explore the treatment laws of rheumatoid arthritis through summary the experience of contemporary famous doc- tors treatment of rheumatoid arthritis, so as to guide the clinic better. Medthods ： Studied the literatures which about experience in the treatment of RA regard about famous veteran doctors of the first batch of national experts of Chinese medicine which were promulgated by State Administration of Traditional Chinese Medicine, and applied content analysis method to collect, collate, analyze, and draw con- elusions. Used the descriptive analysis in analyzing of disease pathogenesis, syndrome characteristics, the therapeutic principles and methods. At the same time, analyzed empirical formula and prescription of contemporary famous doctors treatment of RA, recorded and summarized the related recipe and herbs, established a database system, and used mathematical statistics method so as to analyze and conclude the drug use. Results：The etiology and pathogenesis of contemporary famous veteran doctors treatment of RA in 151 articles literatures can be divided into 7 ： the invasion of exogenous pathogenic factor, deficiency of the viscera, deficiency of the qi and blood, deficiency of yin and yang, disharmony of nutrient qi with defensive qi, blood stasis obstructing the collaterals, accumulation of phlegm- dampness obstructing the collaterals. Among them, the most common is the invasion of exogenous pathogenic factor. Empirical formula and prescriptions used in the medical cases treatment of RA gathered 110 items in total, among which 188 kinds of drugs were used, a total of 1 326 times, the average number of drugs per prescription was 12.05, and the drugs used more than or equal to 3 times have a total of 95. The most commonly used drugs are Angelica, ramulus einnamomi, liquorice, Radix Paeoniae Alba, Radix Astragali, Radix Clematidis, fourstamen stephania root, semen coieis, centipede, common monkshood mother root, prepared rhizome of rehmannia, sube- rect spatholobus stem, orientvine stem. Conclusion：The etiology and pathogenesis of RA mainly are the combined effect of blockage of pathogenic factor, blockage of pathological product, deficiency of healthy qi. Expelling pathogenic factor to alleviate pain, resolving phlegm and eliminating stasis, strengthening healthy qi and supporting body resistance are often the treatment of three main types of combined use of the principle. The most commonly used herb categories are ： herbs for eliminating and dampness wind to dispersing cold, herbs for eliminating and dampness wind to removing heat, herbs for promoting blood circulation to restore menstrual flow, herbs for expelling wind to relieve convulsion herbs for invigorating qi and enriching blood.