虫类药治疗类风湿关节炎的临床要旨

Clinical Essentials of Treating Rheumatoid Arthritis with Insect Drugs

[目的]总结使用虫类药治疗类风湿关节炎的临床要旨。[方法]通过查阅并梳理虫类药治疗类风湿关节炎的文献资料,整理出相关理论基础、临床使用关键点及使用注意事项,并列举医案一则予以佐证。[结果]类风湿关节炎病机复杂,属于中医痹病范畴,且痹病必挟瘀,瘀既是主要的发病因素,又作为主要的病理因素贯穿于疾病始终。虫类药长于治风,有搜风通络、解毒止痛之功,其效宏力专,可用于治疗痹病、历节。临床治疗类风湿关节炎时,无论病程新久,皆可使用虫类药,同时要注意抓住主症,随证加减,但使用虫类药时在煎服法和用量上都有注意事项,尤其要注意长期应用的不良反应或使用虫类药过敏等问题。所举医案患者有10余年类风湿关节炎病史,素体阳虚,又感受寒邪,出现关节疼痛加剧,治以温经通络、蠲痹止痛。根据痹病必挟瘀的原则,处方中用水蛭搜剔络邪、活血祛瘀、推陈致新,同用温经通络等药物,取得较好疗效。[结论]临床上使用虫类药治疗类风湿关节炎,抓住主症辨证使用,并掌握注意事项,可增加类风湿关节炎的临床疗效。

[Objective]To summarize the clinical essentials of using insect drugs in the treatment of rheumatoid arthritis(RA).[Methods]Through consulting and combing the literature on the treatment of RA with insect drugs,the relevant theoretical basis,key points of clinical use and precautions were sorted out,and one medical case was listed for evidence.[Results]The pathogenesis of RA is complex,belonging to the category of arthralgia disease in traditional Chinese medicine,and arthralgia disease must be accompanied by blood stasis.Blood stasis is not only the main pathogenic factor,but also the main pathological factor exists throughout the disease.Insect drugs are good at treating wind,which have the functions of searching wind,dredging collaterals,detoxifying and relieving pain,and the effect is macro and special,it can be used to treat arthralgia and Lijie disease.When treating RA in clinic,insect drugs can be used regardless of the duration of the disease.Moreover,attention should be paid to grasping the main symptoms and use of insect drugs along with the syndrome.However,when using insect drugs,attention should be paid to the decocting method and dosage,especially the problems such as long-term application or allergy to insect drugs.The patient in the medical records cited had a history of RA for more than 10 years.She had deficiency of Yang Qi,felt cold evil,and aggravated joint pain.The treatment was warming meridians and dredging collaterals,removing arthralgia and relieving pain.According to the principle that arthralgia disease must be accompanied by blood stasis,Leeches are used to search and remove collateral pathogens,promote blood circulation and remove blood stasis,promote the old and bring forth the new,and drugs such as warming meridians and dredging collaterals are used at the same time.[Conclusion]Clinical use of insect drugs for treating RA can increase the clinical efficacy as long as the main symptoms are grasped according to the syndrome differentiation and the precautions are mastered.