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难治性类风湿关节炎正虚毒蕴病机论

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难治性类风湿关节炎属中医学"顽痹""尫痹"等范畴,认为"毒邪"是其重要致病因素,"正虚毒蕴"为核心病机.毒邪可分为伏毒和内毒,其中伏毒包括先天伏毒和后天外感及药毒之伏邪,内毒由机体脏腑功能障碍直接产生,或湿浊痰瘀转化为毒.毒邪可流注经络,迅蚀骨节,戕害五脏,暗耗正气,蕴结盘踞.据此确立"扶正解毒"之治则,强调治疗关键在于益正气之本源,击毒邪之惰归.临证应溯本求源,审因论治,在扶助正气的基础上,运用清热解毒、利湿解毒、祛风解毒、散寒解毒、化痰解毒、散瘀解毒等法,扶正祛邪兼施,以提高临床疗效.
Pathogenesis of Refractory Rheumatoid Arthritis with Healthy Qi Deficiency and Toxins Accumulation
Refractory rheumatoid arthritis belongs to the category of"stubborn bi(痹)"and"lame bi"in tradi-tional Chinese medicine.It is believed that pathogenic toxin is an important pathogenic factor of refractory rheumatoid arthritis,and"healthy qi deficiency and toxins accumulation"is its core pathogenesis.Pathogenic toxin can be divided into latent and internal toxin,among which latent toxin includes congenital latent toxin and acquired exogenous and drug-induced latent toxin;and internal toxin is directly produced by the dysfunction of the body's zang-fu(脏腑)organs,or is transformed from dampness,turbidity,phlegm and stasis.Pathogenic toxin can flow into the meridians and collaterals,quickly corrode the bones and joints,harm the five zang organs,secretly consume the body's healthy qi,and accumulate and entrench.Based on this,the treatment principle of"reinforcing healthy qi and resolving toxins"has been established,emphasizing that the key is to strengthen the origin of the body's healthy qi and to attack the pathogenic toxin from its weakness.In clinical practice,it is suggested to trace the root cause,and treat the disease based on the cause.Besides reinforcing the body's healthy qi,the methods such as clearing heat to resolve toxins,draining dampness to resolve toxins,dispelling wind to remove toxins,dispersing cold to resolve toxins,dissolving phlegm to resolve toxins,and dispersing stasis to resolve toxins can be supplemented,so as to reinforce the healthy qi and dispel pathogens simultaneously and thereby improving the clinical efficacy.

refractory rheumatoid arthritispathogenesishealthy qi deficiency and toxins accumulationreinforce healthy qi and resolve toxinslatent toxins

刘维、卡玉秀、陈婌娟

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天津中医药大学第一附属医院,天津市西青区昌凌路88号,300193

国家中医针灸临床医学研究中心

难治性类风湿关节炎 病机 正虚毒蕴 扶正解毒 伏毒

2024

中医杂志
中华中医药学会 中国中医科学院

中医杂志

CSTPCD北大核心
影响因子:1.464
ISSN:1001-1668
年,卷(期):2024.65(22)