基于“扶阳通痹”理论探讨乌梅丸治疗围绝经期类风湿关节炎经验  

Exploring the treatment experience of Wumei Pills for perimenopausal rheumatoid arthritis based on the theory of “reinforcing yang to relieve impediment”

作　　者：朱丽[1] 隋歌川 ZHU Li;SUI Gechuan(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053;Beijing First Hospital of Integrated Traditional Chinese and Western Medicine)

机构地区：[1]中国中医科学院广安门医院,北京100053 [2]北京市第一中西医结合医院

出　　处：《现代中医临床》2024年第5期46-49,共4页Modern Chinese Clinical Medicine

基　　金：国家重点研发计划项目(No.2019YFC1708404)。

摘　　要：围绝经期类风湿性关节炎是较为难治的一种疾病,其发病机制复杂,迁延难愈,可归属于中医“痹症”范畴,历代医家多从肝肾阴虚和调理气血等角度论治,而忽视了阳气在其中的重要作用。本文通过阐述阳气与痹症之间的密切关系,提出天癸渐竭、阳虚水寒是围绝经期RA患者发病重要病理基础,并在此基础上可演化为卫外失固,中脘失煦,肝阳虚馁,阳郁化热,痰瘀内生之寒热错杂的复杂病机。因此,治疗时要注意温补肾阳、通达肝阳、清除郁热的重要性,以达“扶阳通痹”之效果。临证可通过选用乌梅丸加减以温肾达肝、祛瘀通络,以期取得良好的临床疗效。Perimenopausal rheumatoid arthritis(RA) is a refractory disease with complex pathogenesis and prolonged recovery.It can be classified within the scope of bi syndrome(impediment syndrome) in traditional Chinese medicine(TCM).Historically,medical experts have mainly focused on treating liver and kidney yin deficiency and regulating qi and blood,while overlooking the important role of yang qi.This article elaborates on the close relationship between yang qi and bi syndrome.It proposes that the depletion of tiangui(the essence of the kidney) and yang deficiency leading to water-cold syndrome are important pathological bases for the onset of perimenopausal RA patients.This condition can evolve into a complex pathogenesis involving the loss of wei qi's ability to protect the body,the loss of warmth around Zhongwan(CV12),liver yang deficiency,transformation of stagnant liver qi into heat,and the complicated interaction of phlegm and stasis generating cold and heat.Therefore,treatment should focus on warming and tonifying kidney yang,promoting liver yang circulation,and clearing stagnant heat to achieve the effect of “reinforcing yang to relieve impediment”.Clinically,modified Wumei Pills(Mume Pill) can be effective by warming the kidneys,restoring the free action of the liver,dispelling stasis,and opening collaterals,with the aim of achieving satisfactory clinical result.

关 键 词：扶阳通痹 乌梅丸 围绝经期类风湿关节炎 温肾阳 达肝阳 

分 类 号：R259[医药卫生—中西医结合]