基于络病学说探讨当归拈痛汤治疗类风湿关节炎的组方原理  

Composition of Danggui Niantong Decoction in the treatment of rheumatoid arthritis based on the theory of collateral disease

作　　者：何杰敏 刘桂余 林鸿鑫 张榆雪 赵艺婷 刘刚[2] 袁立霞[1,3] He Jiemin;Liu Guiyu;Lin Hongxin;Zhang Yuxue;Zhao Yiting;Liu Gang;Yuan Lixia(School of Traditional Chinese Medicine,Southern Medical University,Guangdong 510515,China;Nanfang Hospital of Southern Medical University,Guangdong 516006,China;No.5 Hospital Affiliated to Southern Medical University,Guangdong 510920,China)

机构地区：[1]南方医科大学中医药学院,广州510515 [2]南方医科大学南方医院 [3]南方医科大学第五附属医院

出　　处：《北京中医药大学学报》2021年第10期889-893,共5页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(No.81673875,No.81774382);南方医科大学2020年度大学生创新创业训练计划项目(No.202012121023)。

摘　　要：类风湿关节炎(Rheumatoid arthritis, RA)是一种病程长、进行性发展的临床常见自身免疫性疾病,中医将其归于"痹证"范畴,以对称性多关节炎为主要临床表现。由于RA病程迁延,可出现久病久痛、病久内舍于脏的表现,这与络病久病入络、久痛入络的发展规律相符合。张元素在《医学启源》中创制出当归拈痛汤一方治疗风湿热痹,后代在临床实践中深入探讨该方的组方原理并逐渐拓展、丰富其组方配伍理论。本文通过分析络脉的生理及络病病机,结合类风湿关节炎的发病特点,认为RA可辨证在络,进而分析RA的病因病机及临床表现,认为可以络病学说为理论指导并提出病变早期、中期、晚期分别以疏风驱邪通络、理气消痰化瘀通络、补虚通络三法,就此探讨当归拈痛汤在病变不同时期的组方原理,从而丰富当归拈痛汤的组方配伍理论,据此扩展当归拈痛汤的临床指导意义,为其临床应用提供一个思考方向。Rheumatoid arthritis(RA)is a long-term and progressive autoimmune disease,which falls into the category of bi-syndrome in Traditional Chinese Medicine(TCM),with symmetrical polyarthritis as the main clinical characteristic symptom.With a prolonged course,RA may result in prolonged pain and involvement of viscera,which resemble collateral disease as chronic diseases and pain would affect collaterals.Zhang Yuansu in the Jin Dynasty composed a prescription called Danggui Niantong decoction to treat“wind-damp-heat bi-syndrome”in Yixue Qiyuan(Origin of Medicine).The composition of this formula has been subjected to in-depth analysis in clinical practice,contributing to the theory of its composition compatibility.Based on the analysis of the physiology and pathogenesis of collateral disease,combined with the pathogenic characteristics of rheumatoid arthritis,the disease location of RA is in the collateral.According to the etiology,pathogenesis and clinical manifestations of RA,it is believed that the theory of collateral disease can be used as a theoretical guide and three methods of treatment are put forward at the early,intermediate and late stages of the disease,namely,dredging collateral by dispersing wind and expelling evil,regulating qi with eliminating phlegm and removing blood stasis,and tonifying deficiency respectively.In this paper,the composition of prescription of Danggui Niantong decoction at different stages of disease is discussed,which will enrich the theory of compatibility of Danggui Niantong decoction,expand the clinical guiding significance of Danggui Niantong decoction,and provide another perspective for clinical application.

关 键 词：类风湿关节炎 当归拈痛汤 络病学说 组方原理 

分 类 号：R289.51[医药卫生—方剂学]