从清肝化浊论治痛风性关节炎的临床经验  

Clinical experience in treating gouty arthritis by Qinggan Huazhuo method

作　　者：王一格 朱维平 孙亚楠 王舒[1] 范嘉怡 WANG Yige

机构地区：[1]山东中医药大学,山东济南250355 [2]青岛市中医医院,山东青岛266033

出　　处：《中医临床研究》2024年第17期109-114,共6页Clinical Journal Of Chinese Medicine

基　　金：全国名老中医药专家传承工作室建设项目(石曾淑全国名老中医药专家传承工作室,No.国中医药人教函[2019]41号);国家中医药管理局第七批全国老中医药专家学术经验继承工作项目(国中医药人教函[2022]76号);山东省中医药科技项目任务书(Q-2022008)。

摘　　要：痛风性关节炎是一种临床常见的代谢性风湿病,可累及身体多个系统。随着人们生活水平的不断提高,痛风性关节炎的患病率呈逐年上升趋势。现代医学对于本病的治疗局限于降尿酸及解热镇痛,疾病复发率较高。临床研究表明,中医治疗除改善患者症状外还可有效减少病情反复。文章总结了朱维平教授治疗痛风性关节炎的学术观点和临床经验。朱教授认为痛风性关节炎是由于先天脾肾不足、后天久病伤脾耗肾导致脾脏的绝对亏虚;或因平素喜食膏粱厚味致使脾胃功能受损,导致脾脏功能的相对不足。二者最终致使脾虚水湿运化无权,进而酿湿成浊生毒,浊毒羁留肝经,流注关节、筋脉从而发为痛风性关节炎。朱教授认为其中脾、肾、肝功能失调,水液代谢异常是痛风性关节炎的主要病机;浊毒羁留肝经为标,肝、脾、肾功能失调为本;病位在足厥阴肝经。治疗上,朱教授主张从肝论治痛风,以清肝化浊法为主,通过对于急性期及缓解期酒大黄用量的把握以达祛邪而不伤正,扶正而不留邪之效。文章分享案例一则,介绍朱教授从清肝化浊论治痛风性关节炎及对于酒大黄这味药的遣药经验,以期为临床提供参考。Gouty arthritis is a common clinical metabolic rheumatism that can involve multiple systems of the body.With the continuous improvement of people’s living standard,the prevalence of gouty arthritis is increasing year by year.Modern medicine for the treatment of this disease is limited to reducing uric acid and antipyretic analgesia,the disease recurrence rate is high.Clinical studies have shown that in addition to improving the symptoms of patients,traditional Chinese medicine treatment can effectively reduce the recurrence of disease.The paper summarizes Professor ZHU Weiping’s academic views and clinical experience in the treatment of gouty arthritis.Professor ZHU believes that gouty arthritis is caused by congenital deficiency of spleen and kidney,and acquired chronic illness damages spleen and kidney,leading to absolute deficiency of spleen.Or the spleen function is damaged due to the greasy and surfeit flavour,resulting in the relative insufficiency of spleen function.Both of which ultimately lead to the spleen deficiency water wet transport has no right,and then the wet into turbiditis,turbiditis fetters the liver channel,and flows into the joints and muscles,resulting in gouty arthritis.Professor ZHU believes that the dysfunction of the spleen,kidney and liver and the abnormal metabolism of water and fluid are the main pathogenesis of gouty arthritis.Turbid poison detained liver channel as the symptom,liver,spleen and renal dysfunction was the basis.The disease was located in the liver channel of the foot Jueyin(厥阴).In terms of treatment,Professor ZHU advocated the treatment of gout from the liver,mainly used the Qinggan Huazhuo method(清肝化浊法),through the grasp of the amount of wine processing Dahuang(Radix et Rhizoma Rhei)in the acute phase and the relief period to achieve the effect of eliminating evil without damaging the resistibility,and maintaining the resistibility without leaving the evil.The article shared one case to introduce Professor ZHU’s treatment of gouty arthritis from c

关 键 词：痛风性关节炎 高尿酸血症 肝经浊毒流注 清肝化浊法 清肝化浊饮 

分 类 号：R26[医药卫生—中医外科学]