| 丁云飞,温成平.温成平教授运脾益肾解毒通络法治疗类风湿关节炎晚期的经验探讨[J].浙江中医药大学学报,2023,47(7):737-741, 747. |
| 温成平教授运脾益肾解毒通络法治疗类风湿关节炎晚期的经验探讨 |
| Professor WEN Chengping’s Experience in Treating Advanced Rheumatoid Arthritis with the Method of Invigorating the Spleen， Tonifying the Kidney， Detoxifying and Dredging Collaterals |
| DOI：10.16466/j.issn1005-5509.2023.07.005 |
| 中文关键词: 类风湿关节炎 邪气 病机 运脾益肾 解毒通络 标本兼顾 临证经验 |
| 英文关键词: rheumatoid arthritis pathogenic Qi pathogenesis invigorate the spleen and tonify the kidney detoxify and dredge collaterals balance manifestation and root cause of disease clinical experience |
| 基金项目:国家重点研发计划项目(2018YFC1705501) |
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| 中文摘要: |
| [目的] 总结温成平教授使用运脾益肾解毒通络法治疗类风湿关节炎晚期的临证经验。[方法] 通过学习温师治疗类风湿关节炎晚期患者的遣方思路，从发病机制、理论依据、治则治法、验案举隅四方面分析温师运脾益肾解毒通络治疗法的精髓。[结果] 类风湿关节炎晚期的病机以“正虚邪实”为主，表现为肝脾肾精气渐趋虚衰，痰瘀伏邪渐入于里，故在疾病晚期，以运脾益肾、解毒通络的填虚攘邪策略是该阶段治疗的总体思路。温师强调，运用此法治疗类风湿关节炎晚期，要灵活权变，而不是简单相叠，攻补之用应依据证候变化发展而适时调治，如此才能“祛邪不伤正，扶正不敛邪”，即在给邪出路的同时充养虚惫的精气。所举验案为风湿痹阻兼肾阳不足型，治宜解毒通络、运脾益肾祛湿，方选乌头汤合防己黄芪汤为底，随证加减，疗效显著。[结论] 温师治疗类风湿关节炎晚期谨守扶正与蠲痹灵活并用的运脾益肾解毒通络法，辨证清晰，药源于法，燮理阴阳，标本兼顾，其经验具有较高临床价值，值得思考、学习与推广。 |
| 英文摘要: |
| [Objective] To summarize Professor WEN Chengping’s clinical experience in treating advanced rheumatoid arthritis with the method of invigorating the spleen and tonifying the kidney， detoxifying and dredging collaterals. [Methods] Through learning from Professor WEN’s idea of prescription and medication in treating advanced rheumatoid arthritis， the essence of the therapeutic method of invigorating the spleen and tonifying the kidney， detoxifying and dredging collaterals was analyzed from four aspects: pathogenesis， theoretical basis， therapeutic principles and methods， and case study. [Results] The pathogenesis of the advanced rheumatoid arthritis is mainly characterized by “deficiency of healthy Qi and excess of pathogenic Qi”. The specific manifestation is that the essence of the liver， spleen and kidney gradually declines， and phlegm， blood stasis and pathogens gradually attack. Therefore， it is the general idea to treat the advanced rheumatoid arthritis by invigorating the spleen and tonifying the kidney， detoxifying and dredging collaterals and filling the deficiency and expelling the pathogenic Qi. Professor WEN stresses that the use of this method to treat advanced rheumatoid arthritis should be flexible， rather than simply overlapping. The use of attack and tonicity should be timely adjusted according to the changes and development of syndromes， so as to “expel the pathogenic Qi without harming the healthy Qi， and strengthen the healthy Qi without trapping the pathogenic Qi”， that is， to nourish the essence of asthenia and exhaustion while giving way to the pathogenic factor. The medical case cited was rheumatism with obstruction of arthralgia and deficiency of kidney-Yang syndrome， the treatment of detoxicating， dredging collaterals， invigorating the spleen， tonifying the kidney and removing dampness was adopted， and the prescription was based on Wutou Decoction and Fangji Huangqi Decoction， added and subtracted according to the syndrome， and achieved a significant effect. [Conclusion] In the treatment of advanced rheumatoid arthritis， Professor WEN strictly follows the method of invigorating the spleen and tonifying the kidney， detoxifying and dredging collaterals， flexibly in combination with strengthening the body and removing arthralgia， with clear differentiation of symptoms and signs， medication originated from the method， and give consideration to Yin and Yang， symptoms and root causes. His experience has high clinical value and is worth thinking， learning and promoting. |
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