| 张全爱,李晓宇,张奇文,等.方剑乔教授针药结合治疗类风湿性关节炎的临床思辨特色与治疗经验[J].浙江中医药大学学报,2023,47(6):608-612. |
| 方剑乔教授针药结合治疗类风湿性关节炎的临床思辨特色与治疗经验 |
| The Characteristics of Diagnostic Principle and Treatment Experience of Professor FANG Jianqiao for Treating Theumatoid Arthritis Using Acupuncture and Herbs |
| DOI：10.16466/j.issn1005-5509.2023.06.005 |
| 中文关键词: 类风湿性关节炎 针药结合 电针参数 思辨特色 名医经验 方剑乔 |
| 英文关键词: rheumatoid arthritis combination of acupuncture and herbs electric needle parameters characteristics of diagnostic principle famous doctor experience FANG Jianqiao |
| 基金项目:全国中医临床优才项目(人教函﹝2022﹞239号)；2020年度国家本科一流专业(针灸推拿学)建设点(教高厅函〔2021〕7号) |
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| 中文摘要: |
| [目的] 介绍方剑乔教授针药结合治疗类风湿性关节炎的临床思辨特色及其临证经验。[方法] 通过整理、回顾、分析方教授治疗类风湿性关节炎的相关文献及医案，从中医病因病机和治则治法等方面，总结归纳方教授治疗类风湿性关节炎的学术经验，并列举医案一则予以佐证。[结果] 临床思辨上，方教授认为“痰、瘀、虚交错”为该病的基本病机，治疗宜针药结合，主要起到同效相须、异效互补和反效制约的作用。临证治疗上，方教授强调，针刺宜整体治疗与局部穴位兼顾，须重视经络辨证。合理应用电针，疼痛急性发作期电针频率多选择“先高后低”，先100 Hz/10～15 min，后2 Hz/30 min；慢性疼痛期电针治疗多选择疏密波(2/100 Hz)。用药强调精准辨证，在该病四种基本证型的基础上提出了阴虚湿热兼证的概念，确立了滋阴清热、通络止痛的治疗大法。倡导适时采用经皮穴位电刺激治疗，其操作简单，携带方便，在镇痛方面具有明显的优势。所举病案采用西药甲氨蝶呤片抑制免疫，稳定病情；中药以祛风除湿为主，佐以藤类药通络行窜、祛风止痛；电针治疗选择频率为2/100 Hz的疏密波调和气血、通络止痛。经治疗后，患者症状缓解，相关指标趋于正常。[结论] 方剑乔教授根据本病的病因病机及临床特点进行辨证论治，针药并重，中西医取长补短，临床特色鲜明，治疗效果显著，值得临床借鉴和推广。 |
| 英文摘要: |
| [Objective] To introduce the the characteristics of diagnostic principle and treatment experience of Professor FANG Jianqiao for treating rheumatoid arthritis(RA) with combination of acupuncture and herbs. [Methods] By sorting out， reviewing and analyzing Professor FANG’s medical article and cases related to the treatment of RA， this paper summarizes Professor FANG’s academic experience in the treatment of RA from the aspects of etiology， pathogenesis， treatment principles and methods of traditional Chinese medicine， and lists one medical case to prove. [Results] Professor FANG believes that “phlegm， stasis and deficiency interlacing” was the basic pathogenesis of the disease. During the onset of the disease， because of the interlacing of phlegm， stasis and deficiency， phlegm and blood stasis， the disease is easy to reoccur and resistant to treatment. Therefore， acupuncture and Chinese herbal medicine can merge to complement each other’s strengths while overcoming inherent weaknesses. During the treatment， Professor FANG emphasizes， for acupuncture treatment， both holistic approaches and local acupoints should be considered， and the proper use of electroacupuncture is essential. Reasonable application of electric needles， for acute onset of pain， the frequency of electroacupuncture stimulation should be “first high and then low”， that is 100 Hz for 10～15 min， then 2 Hz for 30 min; and the density wave (2/100 Hz) should be selected for chronic stage. He puts forward the concept of Yin deficiency and damp heat syndrome， and establishes the treatment of nourishing Yin and clearing heat， dredging collaterals and relieving pain. He advocates to use transcutaneous electrical acupoint stimulation(TEAS) in a timely manner， which is simple to operate and convenient to carry， and has obvious clinical advantages in rheumatoid analgesia. This case used western medicine methotrexate tablets to suppress immunity， and stabilize the condition; traditional Chinese medicine mainly focused on dispelling wind and removing dampness， supplemented by vine like herbs to dredge collaterals， promote channeling， dispel wind and relieve pain; electro-acupuncture therapy with frequency is 2/100 Hz sparse waves to reconcile Qi and blood， dredge collaterals and relieve pain. After treatment， the symptoms were relieved and the indexes were normal gradually. [Conclusion] Professor FANG carries out syndrome differentiation and treatment according to the etiology， pathogenesis and clinical characteristics of this disease. Acupuncture and medicine are equally important， and the clinical medication characteristics are distinct. The combination of Chinese and western medicine is effective in treating RA， which is worthy of clinical reference and promotion. |
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