基于“心受气于脾”论治类风湿关节炎累及心脏病变

Study on the Teartment of Rheumatoid Arthritis Involving Heart Disease Based on“Heart Receiving Qi from Spleen”

类风湿关节炎累及心脏病变属于复合病证,根据其发病过程与临床表现,可归属于中医学“脏痹-心痹”。心痹为痹证日久缠绵不愈,复感风、寒、湿邪,向内传入于心所致。该文基于“心受气于脾”理论探讨其病因、病机与治疗。通过梳理古代文献,发现类风湿关节炎累及心脏病变的病因为脾气不足,卫阳不固,外感风、寒、湿邪气侵入机体,瘀血顽痰阻滞发为心痹。其病机为脾气不足,营卫虚弱;脾阳不足,痰浊内生;脾失健运,痰瘀互结。现代研究表明,细胞免疫失调、血脂异常以及血凝与类风湿关节炎合并心脏病变关系密切,这与中医病机一致。在治疗时选用补益卫阳,和营通痹;温阳散寒,化痰逐饮;益气活血,健脾祛痰之法,代表方剂分别为黄芪桂枝五物汤、苓桂术甘汤、赤茯苓汤。该文提出“心受气于脾”理论,为临床治疗类风湿关节炎累及心脏病变提供思路与指导。

Rheumatoid arthritis involving heart disease belongs to compound syndrome.According to its pathogenesis and clinical manifestations,it can belong to“visceral arthralgia-heart arthralgia”in traditional Chinese medicine.Heart arthralgia was caused by arthralgia lingering for a long time,which re-infected exogenous wind,cold and dampness.Finally it was introduced into the heart to caused heart arthralgia.In the paper,it was based on the theory of“heart Receiving Qi from spleen”to study the etiology,pathogenesis and treatment of rheumatoid arthritis involving heart disease.It was found the etiology of rheumatoid arthritis involving heart disease by combing the ancient literature.Deficiency of spleen Qi due to defensive Yang failed to protect the body,which re-infected exogenous wind,cold and dampness invading the constitutional insufficient body with blood stasis and stubborn phlegm blocked.The pathogenesis of heart arthralgia was deficiency of spleen Qi due to deficiency of nutrient blood and defensive Qi;deficiency of spleen yang due to endogenesis of phlegm and turbidity;and dysfunction of spleen in transportation due to phlegm and blood stasis.Modern studies have shown that cellular immune disorders,dyslipidemia and hemagglutination are closely related to rheumatoid arthritis complicated with heart disease.Which was consistent with the pathogenesis of traditional Chinese medicine.In the treatment,we chose the methods of benefiting defensive Yang and harmonizing nutrient blood to treat arthralgia;warming yang to dispel cold resolving phlegm and fluid;and benefiting Qi and activating blood circulation,invigorating spleen and removing phlegm.The representative prescriptions were Huangqi Guizhi Wuwu Decoction(黄芪桂枝五物汤),Linggui Zhugan Decoction(苓桂术甘汤)and Chifuling Decoction(赤茯苓汤).The paper put forward the theory of“heart receiving Qi from spleen”to provide the thought and guidance for clinical treatment of rheumatoid arthritis involving heart disease.