从湿热瘀互结探讨类风湿关节炎相关性疲劳的病机特点

Rheumatoid arthritis-related fatigue resulting from the pathogenesis of binding of damp,heat and stasis

疲劳是类风湿关节炎(RA)的常见症状,患者自觉身心俱疲,呈“压倒性”不适,休息后难以缓解,严重影响生活质量,但临床关注度相对较低,治疗效果欠佳。中医在整体观念和辨证施治的指导下,重视患者主观症状,在降低疾病活动度的同时,有效改善RA患者疲劳症状。通过临床观察发现,湿热瘀互结是RA相关性疲劳的病机要点,不同于从虚证辨治疲劳。本文通过阐释湿、热、瘀各自的内涵及在RA相关性疲劳中的发病机制,深入分析三者的相互关系和互结病机,总结湿、热、瘀相互胶结是RA相关性疲劳的核心病机。针对此病机要点,临床确立清热除湿,活血行气为治疗大法,同时结合病邪之特性、病情之轻重,随证加减,以期为临床诊断与治疗RA相关性疲劳提供思路。

Fatigue is a common symptom of rheumatoid arthritis(RA).Patients with RA feel physically and mentally exhausted,presenting with an“overwhelming”discomfort,which is difficult to relieve by rest and seriously affects the quality of life.However,the clinical attention to RA is relatively low and the treatment effect is insufficient.Under the guidance of holism and pattern differentiation and treatment,traditional Chinese medicine pays attention to the subjective symptoms of patients,which can effectively improve the fatigue symptom of RA patients while reducing disease activity.Clinical observation has shown that the mutual entanglement of damp,heat and stasis is key to the pathogenesis of RA-related fatigue.In contrast to deficiency syndrome differentiation and treatment of fatigue,we explain the connotations of dampness,heat and stasis and their pathogenesis in RA-related fatigue.By conducting an in-depth analysis of the relationship between the three and the pathogenesis of mutual adhesion,we conclude that the mutual adhesion of dampness,heat and stasis is the core pathogenesis of RA-related fatigue.Considering these key points,the clinical treatment method of clearing heat,and removing dampness,and promoting blood circulation and qi was established.Clinical physician could modify decoction based on syndrome differentiation according to the characteristics of the damp,heat or blood stasis,and the severity of the disease.These provide ideas for the diagnosis and treatment of clinical RA-related fatigue.