基于“发汗理论”探究桂枝治疗类风湿关节炎功用

An analysis of the effect of Guizhi on rheumatoid arthritis based on the theory of diaphoresis

类风湿关节炎是一种以慢性多关节炎症为主要表现的风湿免疫性疾病,多隐匿起病、病程长、致残率高,可累及心、肺、肾、消化系统及血液系统,目前无法根治。中医学将其归属于痹证的“历节”范畴。考阅历代医家文献,结合临证经验,发现正气亏损,风、寒、湿等外邪趁虚而入是其重要发病原因。中医药治疗历节病具有悠久的历史,汗法是中医内治八法之一,具有驱邪外出功效。桂枝乃发汗之药也,为治疗风湿病常用药之一,可扶心阳通经脉,使风、寒、湿等外邪从汗而出,且兼顾正气。汉代张机(字仲景)擅长用桂枝发汗,以桂枝类方治疗关节痹痛较多,如使用了桂枝附子汤、桂枝芍药知母汤、黄芪桂枝五物汤等经典方。历代医家用桂枝治疗历节病的临床经验及现代中药药理学研究均证实桂枝可明显改善类风湿关节炎患者的关节肿痛等临床症状,其机制可能是通过发汗发挥抗炎作用。文章基于“历节宜发汗”理论,从类风湿关节炎的病因病机、微汗治疗方法等方面简要阐述,以进一步探究桂枝治疗类风湿关节炎的功用,为进一步探索桂枝抗类风湿关节炎的作用机制提供新的思路。

Rheumatoid arthritis is a kind of rheumatic immune disease with chronic polyarthritis as the main manifestation.It is characterized by insipid onset,long course of disease,and high disability rate.The disease can implicate the heart,lung,kidney,digestive system and blood system,and cannot be cured at present.The disease belongs to Lijie(历节)category of Bi syndrome(痹证)in TCM.Through consulting TCM literature in past dynasties,combined with clinical experience,it is found that the invasion of wind,cold,dampness and other external pathogenic factors after the loss of healthy Qi(气)are the important causes of the disease.TCM has a long history of treating Lijie disease.Diaphoresis is one of the eight internal therapies in TCM,which has the effect of driving away external pathogenic factors.Guizhi(Ramulus Cinnamomi)is a medicine for sweating,one of the common medicines for the treatment of rheumatic diseases,can warm Yang(阳)in the heart and dredge the meridians,make wind,cold,dampness and other external pathogenic factors out by perspiration,and take into account the healthy Qi.ZHANG Ji in the Han Dynasty was good at sweating with Guizhi,and the decoctions related Guizhi,such as the Guizhi Fuzi decoction(桂枝附子汤),the Guizhi Shaoyao Zhimu decoction(桂枝芍药知母汤)and the Huangqi Guizhi Wuwu decoction(黄芪桂枝五物汤)were mainly used to treat joint arthralgia.The clinical experience in treating Lijie disease with Guizhi of physicians in past dynasties and the modern pharmacology study of TCM medicinal materials have confirmed that Guizhi can significantly relieve the clinical symptoms of rheumatoid arthritis patients such as joint swelling and pain,and the mechanism may be an anti-inflammatory effect through sweating.In the article,based on the theory of diaphoresis,the etiology and pathogenesis of rheumatoid arthritis and the treatment method of microhidrosis are briefly expounded to further investigate the effect of Guizhi on rheumatoid arthritis and provide new ideas for further exploring the action mechanism of Guizhi on rheumatoid arthritis.