中医辨证治疗痛风性关节炎30例临床效果分析

Clinical Effect Analysis of TCM Syndrome Differentiation in Treatment of 30 Cases of Gouty Arthritis

目的:探讨中医辨证治疗痛风性关节炎的临床效果。方法:选取2019年1月—2021年12月贵州省湄潭湄江佘继先中西医结合诊所治疗的30例痛风性关节炎患者作为研究对象,根据1994年6月国家中医药管理局发布的痛风性关节炎证候表现及病因病机进行分型,分为肝肾阴虚型3例,痰浊阻滞型4例,瘀热阻滞型6例,湿热蕴结型17例。痰浊阻滞型治疗原则为健脾除湿,化浊通络,治疗方剂为薏苡仁汤加味;瘀热阻滞型治疗原则为清热活血,散瘀止痛,治疗方剂为枝藤汤加减;肝肾阴虚型治疗原则为益精填髓,泄浊化瘀,治疗方剂为杞菊地黄汤加减;湿热蕴结型治疗原则为清热除湿,通络止痛,治疗方剂为白虎加桂枝汤合二妙散。观察患者红细胞沉降率(ESR)、C反应蛋白(CRP)、血尿酸(UA)变化及治疗效果。结果:各证型患者治疗后ESR、CRP、UA均低于治疗前,差异有统计学意义(P<0.05)。30例患者痊愈23例,显效4例,有效2例,无效1例,总有效率为96.67%;其中瘀热阻滞型、痰浊阻滞型、肝肾阴虚型总有效率均为100.00%,湿热蕴结型总有效率为94.12%。结论:中医辨证治疗痛风性关节炎疗效显著。

Objective:To explore the clinical effect of TCM syndrome differentiation in the treatment of gouty arthritis.Methods:From January 2019 to December 2021,30 patients with gouty arthritis treated in She Ji-xian Integrated Traditional Chinese and Western Medicine Clinic in Meijiang Town of Meitan County of Guizhou Province were selected as the study subjects.According to the symptoms manifestation,etiology and pathogenesis of gouty arthritis released by the National Administration of Traditional Chinese Medicine in June 1994,the patients were classified into 3 cases of liver and kidney yin deficiency type,4 cases of phlegm-turbidity blockade type,6 cases of static blood and heat blockade type,and 17 cases of dampness-heat amassment type.The treatment principle of phlegm-turbidity blockade type is to strengthen the spleen and dehumidify,dissolve turbidity and dredge collateral,and the treatment formula is modified coix seed decoction;The treatment principle of static blood and heat blockade type is to clear heat and activate blood,disperse stasis and relieve pain,and the treatment formula is modified Zhiteng decoction;The treatment principle of liver and kidney yin deficiency type is to nourish the essence and supplement the marrow,disperse turbidity and remove stasis,and the treatment formula is modified Qiju Dihuang decoction;The treatment principle of dampness-heat amassment type is to clear heat and dehumidify,dredge collateral and relieve pain,and the treatment formula is Baihu and Guizhi decoction plus Ermiaosan.The changes of erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),blood uric acid(UA)and treatment effect were observed.Results:The ESR,CRP and UA of patients with all types after treatment were lower than those before treatment,and the differences were statistically significant(P<0.05).Among 30 patients,23 cases were cured,4 cases were significantly effective,2 cases were effective,and 1 case was ineffective,and the total effective rate was 96.67%;Among them,the total effective rate of static blood and heat blockade type,phlegm-turbidity blockade type,and liver and kidney yin deficiency type was 100.00%,and the total effective rate of dampness-heat amassment type was 94.12%.Conclusion:TCM syndrome differentiation is significantly effective in treating gouty arthritis.