张鸣鹤教授治疗类风湿性关节炎临证经验概要

Summary of professor Zhang Minghes clinical experience in the treatment of rheumatoid arthritis

目的类风湿性关节炎的治疗仍为临床一大难题。本文总结张鸣鹤教授治疗类风湿性关节炎临床经验。方法2019年9月-2020年3月跟随张鸣鹤教授临证侍诊,收集相关医案,并整理张鸣鹤教授处方及诊间评语,附以临床诊治完整病案1例。查阅相关文献,采取定性研究的方法,总结不同证型患者的处方特点,挖掘张鸣鹤教授类风湿性关节炎辨证论治及特色疗法的临证经验。结果张鸣鹤教授对类风湿性关节炎的临床经验有热痹为多、辨证治疗、药物运用以及关节变形防治等4个方面。其中辨证临床以热痹为多,前期应注重风湿热邪的轻重比较,佐以活血化瘀、滋阴清热,后期以扶正为主,补益肝肾、清解余毒。张鸣鹤教授在药物运用中注重其归经和特殊作用,对类风湿性关节炎临床药物选用有其独到的见解。植物类药物运用较为频繁,强调不同的药物可用于相对应的症状及发病部位。虫类药物使用较少,但在通络治疗上有点睛作用。同时提出,类风湿性关节炎应防治结合,规范用药;对关节变形但骨质尚未融合的患者提出牵拉矫形的治疗方法,显著提升患者的生存质量。结论运用中医理论体系宏观分析类风湿性关节炎中医治疗经验,热痹理论以及用药规律在临床辨证治疗过程中取得显著疗效,对比其他名中医治疗经验,体现出中医"天人合一、三因制宜"的思想,以期在中医治疗类风湿性关节炎时有所借鉴。

Objective To summarize professor Zhang Minghes elinical experience in the treatment of rheumatoid arthri-tis.Methods Followed professor Zhang Minghes elinical consultation,collected relevant medical cases,and sorted out professor Zhang Minghes prescriptions and comments,with 1 case of complete clinical diagnosis and treatment.By refer-ring to relevant literature and adopting qualitative research method,the prescription characteristics of patients with differ-ent syndrome types were summarized,and the clinical experience of professor Zhang Minghe s dialectical treatment and characteristic therapy of rheumatoid arthritis was explored.Results Professor Zhang Minghe s clinical experience in rheumatoid arthritis includes four aspects:clinical dialectical treatment,drug application,and prevention and treatment of joint deformation.Dialectical clinical pyretic arthralgia for the most part,early should pay attention to the weight of rheumatic heat evil comparison,assisted by huoxue to remove blood stasis,nourishing Yin clearing heat,later to support the main,nourishing the liver and kidney,clearing the residual poison.Professor Zhang Minghe pay attention to its re-gression and special function in the application of drugs,and had his unique views on the selection of elinical drugs for rheumatoid arthritis.The use of plant drugs was frequent,emphasizing that different drugs can be used for the corre-sponding symptoms and the location of disease.Insect drugs were seldom used,but they have a punchline efect in the treatment of collaterals.At the same time,rheumatoid arthritis should be combined with prevention and treatment,stand-ardized drug use.For patients with deformities of joints but not yet bone fusion,a method of traction orthopedic treatment was proposed,which significantly improved the quality of life of the patients.Conclusion On the basis of the theory of traditional Chinese medicine system macro analysis rheumatoid arthritis treatment experience of TCM.Compared with oth-er Chinese medieine treatment experience,pyretic arthralgia theory and drug laws in the process of elinical dialctical treatment have made significant efficacy,rflect the traditional Chinese medicine"nature and humanity,three due to the following"thinking,in order to the reference when the doctor of traditional Chinese medicine treatment of rheumatoid ar-thritis.