基于《素问·痹论》探析沈津湛教授治疗痹证的证治规律

Analyse the Syndrome and Treatment Rules of Professor SHEN Jinzhan in the Treatment of Arthralgia Syndrome Based on Plain Questions·Arthralgia Theory

[目的]总结沈津湛教授依据《素问·痹论》治疗痹证的临床思路与经验。[方法]通过跟师临证学习,从沈师对《素问·痹论》原文的解读,对痹证病因、病机、病位、治法、用药、传变、预后等方面的理解运用,以及对固本培元派、温补学派诸位医家治痹经验的继承,总结整理沈师治疗痹证的临床经验与方药特色,并选取一则系统性硬皮病验案进行佐证。[结果]沈师认为,痹证为风寒湿邪侵袭所致,其根本病因为正气虚弱,包括营卫不足、运行异常与精血亏损、阳气不足两方面,病位多在脾、肾。发病之初尚在五体,是治疗绝佳期,久而入络,转为脏腑痹,则为难治。治疗上,沈师主要继承固本培元派及温补学派多位医家的治痹思路,以脾、肾为核心,将扶正贯穿整个治疗过程。邪在肌表及痹证发作期,以除邪为先,祛风散寒除湿,通络止痛,兼以扶正;邪入经络、脏腑后,以养正为要,依据侵邪之偏重施以补剂,风盛补血,寒甚补火,湿重补气。所举验案乃阳虚寒甚之系统性硬皮病,沈师先治以温阳散寒、除痹止痛,四诊后主以养正温阳、补益气血,取得较好疗效。[结论]沈师系统解读《素问·痹论》,认为治痹当“养正为要,除邪为先”,以温阳、益气、养血、除邪、止痛、通络六法治疗痹证,疗效尚佳,对临床有较好的指导作用。

[Objective] To summarize the clinical thinking and experience of Professor SHEN Jinzhan in the treatment of arthralgia syndrome based on Plain Question·Arthralgia Theory. [Methods] By learning from the teacher's clinical experience,from Professor SHEN's interpretation of the original text of Plain Question·Arthralgia Theory,the understanding and application of the etiology,pathogenesis,location,treatment,medication,transmission and prognosis of arthralgia syndrome,and the inheritance of the experience of enhancing the body resistance and supporting vitality school and warming-reinforcing school in treating arthralgia syndrome,the clinical experience and prescription characteristics of Professor SHEN were summarized,and a systemic scleroderma case was selected for evidence. [Results]Professor SHEN believes that arthralgia syndrome is caused by the invasion of wind,cold and dampness. The fundamental cause of the disease is the deficiency of healthy Qi,including the deficiency of Ying and Wei,abnormal circulation,loss of essence and blood,and deficiency of Yang Qi,and the disease is mostly located in the spleen and kidney. At the beginning of the disease,it is still in the skin,which is the best time for teatment,then into tendon,bone or muscle,which is the best period for treatment. When it enters the collateral for a long time,into the viscera,it is difficult to treat. In terms of treatment,Professor SHEN mainly inherits the ideas of many doctors of enhancing the body resistance and supporting vitality school and warming-reinforcing school to treat arthralgia,he takes the spleen and kidney as the core,and penetrates the whole treatment process. Evil in the skin,muscle,or arthralgia attacking period,takes eliminating evil first,then dispelling wind and cold dehumidification,dredging collaterals and relieving pain,and strengthening the body;after the evil enters the meridians and Zang-Fu organs,it is necessary to nourish the body,according to the emphasis of the invasion of the evil,the tonic is applied,enriching blood when the wind is strong,warming Yang when it is cold,supplementing the vital energy when it is wet enough. The case was of a systemic scleroderma of Yang deficiency and cold. Professor SHEN first treated with warming Yang and dispelling cold,removing arthralgia and relieving pain. After four visits,he mainly used nourishing vital Qi and warming Yang,tonifying Qi and blood,and achieved good results. [Conclusion] Professor SHEN systematically interprets Plain Questions·Arthralgia Theory,and believes that the treatment of arthralgia syndrome should“take nourishing the healthy Qi as the most important,and eliminating pathogenic factors as the first”,and the six methods of warming Yang,supplementing Qi,nourishing blood,eliminating pathogenic factors,relieving pain and dredging collaterals are used. The curative effect is good and has a good guiding role in clinical practice.