基于“络以通为用”理论探讨藤类药在治疗类风湿关节炎中的运用  

Discussion on Application of Rattan Drugs in Treatment of Rheumatoid Arthritis Based on Theory of"Unobstructed Collateral Being Normal

作　　者：李如 姚澜 胡玉馨 闻竹[2] 高丽娟[1,2] LI Ru;YAO Lan;HU Yuxin;WEN Zhu;GAO Lijuan(Heilongjiang University of Chinese Medicine,Harbin 150040,Heilongjiang,China;First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Harbin 150040,Heilongjiang,China)

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

出　　处：《中华中医药学刊》2024年第8期128-131,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(81973604);黑龙江省第二批省级名中医师承工作继承人项目(黑中医药发[2020]55号)。

摘　　要：类风湿关节炎(rheumatoid arthritis,RA)属中医“痹病”范畴,以周身关节肿痛为主要临床表现。叶天士在《临证指南医案》中提出络病学说,其阐述的“久病入络”“久痛入络”思想揭示了痹病疼痛的本质,“不通则痛”则被认为是尪痹疼痛的病机关键,“络毒蕴结”“络脉失养”则是尪痹的辨治关键。藤类药多具有通络散结的功效特点,可有效针对类风湿关节炎“不通则痛”的病机进行治疗,不同的藤类药又因性味归经不同具有各自的功效偏重及特点。常用的八种通络藤类药中,雷公藤、青风藤、海风藤偏于祛风除湿;鸡血藤、大血藤偏于活血通络;忍冬藤、络石藤偏于清热通络;首乌藤可养血安神。基于此,将“络以通为用”作为类风湿关节炎的基本治疗思想,根据临床辨证合理应用藤类药对治疗类风湿关节炎具有重要意义。Rheumatoid arthritis belongs to“Bi syndrome”in traditional Chinese medicine,with swelling and pain of joints around the body as the main clinical manifestation.YE Tianshi proposed the theory of collateral diseases in Clinical Guidelines for Medical Records,which expounded the idea of“prolonged illness entering the collaterals”and“prolonged pain entering the collaterals”,revealing the essence of pain in arthralgia disease.“Obstruction leading to pain”is the key to the pain pathogenesis of Wangbi syndrome,while“toxins accumulation in collateral”and“loss of nourishment of collaterals”are the key to the syndrome differentiation and treatment of Wangbi syndrome.Most rattan drugs have the efficacy characteristics of dredging collaterals and dispersing nodules,which can effectively treat rheumatoid arthritis due to“obstruction leading to pain”.Different rattan drugs have their own efficacy and characteristics due to their different natures,tastes and meridians.Among the eight commonly used rattan drugs for dredging collaterals,Leigongteng(Tripterygii Radix et Rhizoma),Qingfengteng(Sinomenii Caulis)and Haifengteng(Piperis Kadsurae Caulis)tend to remove wind and dampness;Jixueteng(Spatholobi Caulis)and Daxueteng(Sargentodoxae Caulis)tend to promote blood circulation and collaterals;Rendongteng(Lonicerae Japonicae Caulis)and Luoshiteng(Trachelospermi Caulis et Folium)tend to clear heat and unblock collaterals;Shouwuteng(Polygoni Multiflori Caulis)can nourish blood and calm the nerves.Based on this,it is of great significance to treat rheumatoid arthritis by using“unobstructed collateral being normal”as the basic treatment idea,and rationally applying rattan drugs based on clinical syndrome differentiation.

关 键 词：类风湿关节炎 藤类药 络病理论 

分 类 号：R255.6[医药卫生—中医内科学] R593.22[医药卫生—中医学]