基于“固本清源”分期诊治痛风

Staged Diagnosis and Treatment of Gout based on"Consolidating the Root and Clearing the Source"

认为痛风以脾肾亏虚为本,湿热浊毒痰瘀为源,治疗应以健脾益肾以固本,利湿化浊、清热解毒、散瘀化痰以清源。并根据正虚邪实关系转化进行分期治疗,急性期以湿热毒蕴为急,治以清热解毒,方用自拟秦皮痛风方加减;痛风间歇期以湿浊内蕴为主,治以利湿化浊,方用除湿茯苓汤加减;慢性期以脾虚湿热和痰瘀痹阻为要,治以健脾清热利湿和化痰散瘀,分别用清热渗湿汤加减及二陈汤合桃红四物汤加减;痛风肾病期以脾肾亏虚为本,夹痰夹瘀夹毒,治疗以健脾益肾,兼以化痰行瘀解毒,方用补脾益肾汤加减。

It is believed that gout is rooted in spleen-kidney depletion,and damp-heat,turbidity toxin,and phlegm stasis are the sources.The treatment principle should be fortifying the spleen and boosting the kidney to consolidate the root,while draining dampness and removing turbidity,clearing heat and resolving toxins,relieving stasis and dissolving phlegm to clear the source.Staged treatment based on the relationship and transition between healthy qi deficiency and excess pathogen is recommended.For intercritical gout when there is internal accumulation of damp turbidity mainly,the treatment method should be draining dampness and removing turbidity by Chushi Fuling Decoction(除湿茯苓汤)with modifications.During the acute stage of gout when damp-heat toxin accumulation is the most urgent,it is recommended to clear heat and resolve toxins with self-made Qingpi Tongfeng Formula(清皮痛风方)with modifications.During the chronic stage of gout,when spleen deficiency and damp-heat and phlegm-stasis obstruction are the predominant,the method of fortifying spleen,clearing heat and draining dampness,as well as dissolving phlegm and dissipating stasis should be implemented,by using self-made Qingre Shenshi Decoction(清热渗湿汤)with modifications and Erchen Decoction and Taohong Siwu Decoction(二陈汤合桃红四物汤)with modifications,respectively.For gouty nephropathy,when spleen-kidney depletion is the root,and phlegm,stasis and toxin are accompanied,it is recommended to fortify spleen and boost kidney,and dissolve phlegm,move stasis and resolve toxins using self-made Bupi Yishen Decoction(补脾益肾汤)with modifications.