基于“初病湿热在经,久则瘀热入络”探讨风湿性多肌痛的证治

Exploring the pattern differentiation and treatment of polymyalgia rheumatica based on“dampness-heat invading the channels at early stage,static-heat invading the collaterals at later stage”

风湿性多肌痛以颈部、肩部及髋部肌肉疼痛和僵硬为主要临床表现,随着疾病进展常可合并血管病变,继而出现动脉炎性表现。风湿性多肌痛可归属于中医学“肌痹”范畴,若辨证准确,于早期干预疗效较好。根据本病的发病特点可从“初病湿热在经,久则瘀热入络”认识其病机的演变规律。风湿性多肌痛的发病责之于内外合邪,外感邪气为标、湿热内蕴为本,总因卫分之邪郁闭肌表,郁热不解渐传营血而成瘀热入络之证。针对本病及其变证,可进行分期论治,急性期外透内清,以祛邪为主;缓解期和解表里,以缓图收功;变证期以象之谓,凉血化瘀为务;此外,因其具有迁延性、反复性和难治性的特点,贵在效不更方,有方有守,持之以恒。

Polymyalgia rheumatica is a clinical syndrome characterized by stiff pain in neck,scapular and pelvic muscles.Arterial inflammation often occurs with vascular involvement as the disease progresses.Polymyalgia rheumatica can be classified as“muscle arthralgia”in traditional Chinese medicine.If the syndrome differentiation is accurate,the intervention effect will be satisfied in the early stage.According to the characteristics of polymyalgia rheumatica,our team can discuss its pathogenetic mechanism from the point of view“dampness-heat invading the channels at early stage,static-heat invading the collaterals at later stage”.The main cause of polymyalgia rheumatica is the combination of internal and external pathogenic factors.Among them,the external evil qi invasion is the manifestation,and the internal dampness-heat is the root.All in all,when the evil qi invades the defensive qi,it can obstruct the skin surface.Hence,static-heat can’t be resolved,and then transfers into the ying blood gradually.Finally,it leads to the formation of static-heat invading the collaterals.In view of its manifestations and deteriorated cases,it can be treated in different stage from the following three angles.In the acute stage,venting the exterior and clearing out interior-heat should be chosen,in order to dispel the evil qi by decoction.In the stable stage,harmonizing the exterior and interior should be chosen in a gentle treatment way.And in the deteriorated stage,the treatment method should be based on the manifestations,so cooling the blood and dissolving stasis is necessary.In addition,rheumatism is chronic,recurrent and refractory.The most important thing is not to change the original formula after the formula takes effect.