田波运用滋阴健脾法治疗痹证经验

Tian Bo′s Experience in Treating Arthralgia Syndrome with the Method of Nourishing Yin and Invigorating the Spleen

类风湿关节炎是一种以慢性滑膜炎和软骨破坏为主要特征的难治性自身免疫性疾病,属中医“痹证”范畴,病机复杂,病情多变,究其病因,不外乎风、寒、湿“三气”,由外感与内生“三气”相互交织而致。田波教授认为,湿邪为痹证的致病核心,治疗应以健脾化痰除湿为核心治法,同时重视滋阴活血除痹。临证时,当湿邪停滞于关节时,治疗上不能一味地化湿,也不主张直接使用大量祛风药、祛寒药;当关节发生僵硬、畸形、骨间肌肉萎缩,并呈现“梭形”肿大时,在健脾的同时,加用知母、石斛、玉竹、天冬、麦冬、玄参等滋阴药物;当关节肿胀,但僵硬程度不重,尚有一定活动度时应重点使用健脾化湿类药物,如白术、茯苓、薏苡仁等,同时还可加入活血化瘀药物,如当归、鸡血藤、三七、红花、桃仁、苏木、豨莶草等活血化瘀以改善关节功能。

Rheumatoid arthritis(RA)is a refractory autoimmune disease characterized primarily by chronic synovitis and cartilage destruction.In TCM,it falls under the category of"arthralgia syndrome,"which has a complex pathogenesis and variable symptoms.The primary external causes are the"three evils"of wind,cold,and dampness,which intertwine with internal factors.Professor Tian Bo believes that"dampness"is the core pathogenic factor in arthralgia syndrome,and the primary treatment should focus on invigorating the spleen,resolving phlegm,and eliminating dampness,as well as emphasizing the importance of nourishing yin,promoting blood circulation,and dispelling the obstruction.Clinically,when dampness stagnates in the joints,treatment should not solely focus on eliminating dampness,nor should large doses of wind-dispelling or cold-expelling drugs be used indiscriminately.When joint stiffness,deformities,and muscle atrophy between the bones are observed,accompanied by"fusiform"swelling,nourishing yin,promoting blood circulation and invigorating the spleen should be prioritized.Drugs such as Zhimu(Rhizoma Anemarrhenae),Shihu(Caulis Dendrobii),Yuzhu(Rhizoma Polygonati Odorati),Tiandong(Radix Asparagi),Maidong(Radix Ophiopogonis),Xuanshen(Radix Scrophulariae),etc.can be added.When joints are swollen but still retain some mobility and the stiffness is not severe,spleen-invigorating and dampness-eliminating drugs like Baizhu(Rhizoma Atractylodis Macrocephalae),Fuling(Poria),and Yiyiren(Semen Coicis)are emphasized.Blood-activating and stasis-dissolving drugs such as Danggui(Radix Angelicae Sinensis),Jixueteng(Caulis Spatholobi),Sanqi(Radix et Rhizoma Notoginseng),Honghua(Flos Carthami),Taoren(Semen Persicae),Sumu(Lignum Sappan),and Xixiancao(Herba Siegesbeckiae)can also be added to improve joint function by promoting blood circulation and removing stasis.