从气一元论探讨痹证的病因病机

Discussion on the etiology and pathogenesis of Bi syndrome from Qi monism

风湿类疾病属中医学的“痹证”范畴,“痹”的病名,最早见于《黄帝内经》,《素问·痹论》指出“风寒湿三气杂至,合而为痹,其风气胜者为行痹,寒气胜者为痛痹,湿气胜者为着痹也。”历来认识的发病原因是以内因为本、外邪为标。卫生部药政司于1987年根据痹病临床表现的主证、舌脉、次证的不同分为8类证候。近年来,各医家对痹病的辨证分型虽然各有差异,而且从尪痹特有的关节僵直、肿大畸形、久久不愈的临床表现有提出痰瘀互结、湿热留恋、血分热毒、肝肾阴虚等证型,病位在关节筋脉肌肉,病理性质是本虚标实,在临床上取得了一定疗效,但仍不出上述分类原则,临床治愈率仍然很低,说明对内在病因病机的认识还有偏差,需进一步研究。反观当代临床大家李可老中医,却用自创的大乌头汤治愈了数十例类风湿关节炎,且大乌头汤不是按历代认识的寒湿痹阻、风湿痹阻等病机进行组方的。这就提示我们:“风寒湿三气杂至,合而为痹也”的病因病机说并不单是历来所认识的寒湿痹阻、风寒湿阻等。况且,《黄帝内经》既言“风寒湿三气杂至,合而为痹也”,又言“风能胜湿,寒能胜热”,如此风寒湿三气何以杂至、合而为痹?这说明“风寒湿三气杂至,合而为痹也”,应当还有内在深层次机理,需要重新研究和探讨。为此本文从六气为一气的变现立论,当机体正常时一元气的运行在不同方位体现不同的性质和作用而不显现,机体异常时则一元气运行规律被打破,风寒湿火热燥六气显现变为内生六邪,在诱因作用形成经脉不通、寒湿凝结、关节肿大疼痛的格局,则风寒湿三气,杂合显现,痹阻经络关节间而发生痹病。

Rheumatic diseases belong to the category of"Bi syndrome"in traditional Chinese medicine.The name of"Bi"can be found in Huangdi Neijing(the classic Chinese classic).The cause of disease has always been known as the internal major cause,and is combined with external evil,which is as the standard.According to the clinical manifestations of arthralgia syndrome of the main syndrome,tongue pulse,secondary syndrome,the Department of Medicine and Administration of the Ministry of Health divided it into eight categories of symptoms in 1987.In recent years,although there are differences in the syndrome differentiation and classification of arthralgia,and from the unique clinical manifestations of arthralgia,such as joint stiffness,swelling deformity,long-lasting syndrome,such as phlegm and blood stasis,dampness and heat nostalgia,blood heat toxin,liver and kidney yin deficiency,etc.,the disease is located in the muscles of the joint veins,veins,the pathological nature of this deficiency is true,which has achieved a certain clinical effect,but it still is included in the above classification principle,the clinical cure rate is still very low,indicating that there is a deviation in the understanding of internal etiology and pathogenesis,which needs further study.Li Ke,a contemporary clinical practitioner,has cured dozens of cases of rheumatoid arthritis with self-created Dawutou decoction(大乌头汤),and Dawutou decoction is not based on the pathogenesis of cold dampness obstruction,rheumatism obstruction,etc.This indicates that wind-cold dampness combined with arthralgia is also“the etiology and pathogenesis”,which is not only known as cold dampness obstruction.Moreover,there should be a deep mechanism,which needs to be re-studied and discussed.This article proposes the realization of six Qi into one Qi theory,when the normal operation of Qi is in different directions to reflect different properties and functions do not show,when the body is abnormal,the operation of one Qi is broken,wind,cold,dampness,heat,dryness,six Qi appear to be endogenously six evil,in the inducement to form meridian impassable,cold and dampness condensation,joint swelling pain pattern,wind,cold and dampness,heterozygosity show,arthralgia appears between the meridian and arthralgia.