类风湿关节炎与代谢综合征的中医诊疗特点

Characteristics of TCM diagnosis and treatment of rheumatoid arthritis and metabolic syndrome

类风湿关节炎(Rheumatoid Arthritis,RA)与代谢综合征(Metabolic Syndrome,MS)均为慢性全身性疾病,RA早期表现为关节肿胀、疼痛甚至关节变形,患者出现一系列活动受限症状,其病理本质是滑膜的炎性病变。MS早期表现为体力降低,身体沉重,头脑发昏等,进而出现功能受损症状,其核心特征为胰岛素抵抗。但RA与MS进入疾病后期均可出现肢体肿胀,腰膝酸软,胸闷气短,心悸失眠等临床症状。笔者通过查阅相关研究文献及收集大量临床诊疗经验可得知,RA与MS发病的病因病机与肝、脾、肾三脏密切相关。肝失疏泄,肝失所养,脾失健运,脾气虚弱,肾精亏虚等均可导致RA与MS的发生。本文将首先从肝、脾、肾三脏的角度出发,着重探讨RA与MS的发病机制。此外,肝、脾、肾受损日久可导致病理产物痰、湿、瘀血的产生,痰、湿、瘀血痹阻关节筋骨可加重RA患者的疼痛,痹阻日久还可使患者代谢功能受损,进而导致MS的发生。故可得知RA与MS病因病机其本在肾,与肝脾关系密切,其标为痰、湿、瘀血,属于本虚标实之病。临床中采用肝脾肾同调,痰湿瘀共治的标本兼治,消补兼施的中医特色治疗,可达到较好的治疗效果。

Both rheumatoid arthritis and metabolic syndrome are chronic systemic diseases.In the early stage,rheumatoid arthritis presents joint swelling,pain and even joint deformation,and patients have a series of symptoms of limited activity.The pathological nature of rheumatoid arthritis is inflammatory lesion of synovial membrane.The early manifestations of metabolic syndrome are reduced physical strength,heavy body,dizziness,etc.,then the symptoms of impaired function appear,and its core feature is insulin resistance.However,when rheumatoid arthritis and metabolic syndrome enter the later stage of the disease,there may be common clinical symptoms such as limb swelling,waist and knee tenderness,chest tightness,shortness of breath,palpitation and insomnia.Through consulting relevant research literature and collecting a lot of clinical diagnosis and treatment experience,the author can know that the etiology and pathogenesis of rheumatoid arthritis and metabolic syndrome are closely related to the three viscera of liver,spleen and kidney.Liver dysfunction,liver displacement,spleen dysfunction,spleen deficiency,kidney essence deficiency and so on can lead to the occurrence of rheumatoid arthritis and metabolic syndrome.This article will focus on the pathogenesis of rheumatoid arthritis and metabolic syndrome from the perspective of liver,spleen and kidney.In addition,the liver,spleen and kidney damage for a long time can lead to the production of pathological products of phlegm,dampness and blood stasis,and the phlegm,dampness and blood stasis blocking the joints and bones can aggravate the pain of patients with rheumatoid arthritis,and the metabolic function of patients can be impaired for a long time,leading to the occurrence of metabolic syndrome.Therefore,it can be known that the etiology and pathogenesis of rheumatoid arthritis and metabolic syndrome are mainly in the kidney,which is closely related to the liver and spleen.The symptoms of rheumatoid arthritis are phlegm,dampness and blood stasis,and it is asthenia in origin and asthenia in superficiality.In clinical practice,the same modulation of liver,spleen and kidney,and the co-treatment of both symptoms and root are given,which combines elimination and tonification of traditional Chinese medicine treatment and can achieve better therapeutic effects.