国医大师卢芳辨治成人斯蒂尔病发热经验  

Experience of Traditional Chinese Medicine Master LU Fang in Treating Fever of Adult-onset Still’s Disease

作　　者：刘佳明[1] 朴勇洙 刘庆南 霍佳敏 钟霞媛 陈翠萍 LIU Jiaming;PIAO Yongzhu;LIU Qingnan(Heilongjiang University of Chinese Medicine,Harbin(150040),China;The First Affiliated Hospital of Heilongjiang University of Chinese Medicine)

机构地区：[1]黑龙江中医药大学,哈尔滨150040 [2]黑龙江中医药大学附属第一医院

出　　处：《浙江中医药大学学报》2023年第2期153-156,166,共5页Journal of Zhejiang Chinese Medical University

基　　金：国家中医药管理局第三届国医大师传承工作室及全国名中医传承工作室项目(中国医药办人教函[2018]119号)。

摘　　要：[目的]总结卢芳教授治疗成人斯蒂尔病(adult-onset Still’s disease,AOSD)发热的临床经验。[方法]通过临床跟师、记录医案及查阅文献,从理论来源、辨证思路、治则治法、方剂中药四个层面总结卢老治疗AOSD的临床经验,并附医案佐证。[结果]卢老认为,AOSD以发热为主要症状,且发热具有明显的节律性,热退则诸症缓解。卢老指出,AOSD病机为脏腑功能失衡,阴阳不谐而致发热,当以恢复脏腑的正常功能及气血阴阳平衡为要,故根据多年临证经验,总结出以发热为辨证论治的中心,按患者发热时间确定基础方,根据其他症状加减用药的中医综合诊疗方法。文中所举验案卢老辨证为湿热蕴结证,以三仁汤加减治疗,上举清阳、下利湿热,恢复气机的正常运行,则热退而诸症缓解。[结论]卢老以发热为中心辨治AOSD,强调辨病与辨证相结合,根据患者症状加减用药,在临床取得了稳定的疗效,丰富了AOSD的辨证论治体系,便于临床应用及推广。[Objective] To summarize Professor LU Fang’s clinical experience in treating adult-onset Still’s disease(AOSD) fever. [Methods]Through clinical shadowing, recording medical cases and reviewing literature, summarizing Professor LU’s clinical experience in treating AOSD from four levels: theoretical sources, identification ideas, treatment rules and methods, and prescriptions and herbs, by supporting medical cases. [Results] Professor LU believes that fever is the main symptom of AOSD, and the fever has obvious rhythm, when the fever subsides, all the symptoms will be relieved. Professor LU also points out that the pathogenesis of AOSD is the imbalance of the function of the internal organs and the disharmony of Yin and Yang resulting in fever, so the main focus should be to restore the normal function of the internal organs and the balance of Qi and blood, Yin and Yang. Therefore, based on many years of clinical experience, Professor LU summarizes the comprehensive Chinese medicine treatment method of taking fever as the center of diagnosis and treatment, determining the basic formula according to the time of fever, and adding and subtracting medicines according to other symptoms. In the case cited,Professor LU identified it as dampness and heat accumulation syndrome, and adopted Sanren Decoction with addition and subtraction to raise clear Yang, eliminate dampness and heat, and restore the normal circulation of Qi, then the heat subsided and the symptoms were relieved. [Conclusion] Professor LU takes fever as the center of diagnosis and treatment of AOSD, emphasizing the combination of disease differentiation and syndromes differentiation, adding and subtracting medicine according to the patient’s symptoms, which has achieved stable clinical efficacy and enriched the diagnosis and treatment system of AOSD, facilitating clinical application and promotion.

关 键 词：成人斯蒂尔病 发热 辨证论治 医案 名医经验 卢芳 

分 类 号：R255[医药卫生—中医内科学]