文献类型：期刊文献

中文题名：马鸿斌主任医师运用宣痹汤治疗痛风经验总结

英文题名：Summary of Director MA Hongbin’s experience in treating gout with Xuanbi decoction

作者：何彩苹[1];马鸿斌[2];魏锦慧[2];李根生[1];马海兰[1];翟书玲[1]

第一作者：何彩苹

机构：[1]甘肃中医药大学,甘肃兰州730000;[2]甘肃中医药大学附属医院,甘肃兰州730000

第一机构：甘肃中医药大学

年份：2023

卷号：15

期号：27

起止页码：100

中文期刊名：中医临床研究

外文期刊名：Clinical Journal Of Chinese Medicine

基金：甘肃省名中医传承工作室建设项目(甘财社[2022]105号)。

语种：中文

中文关键词：宣痹汤;痛痹;痛风性关节炎;中医药治疗

外文关键词：Xuanbi decoction;Painful Bi syndrome;Gouty arthritis;Traditional Chinese medicine treatment

摘要：痛风性关节炎是一种单钠尿酸盐沉积所致的晶体相关性关节病,与嘌呤代谢紊乱及/或尿酸排泄障碍所致的高尿酸血症直接相关,本病是肾脏疾病中多发的临床疾病之一,具有病机复杂、疗效差、复发率高等特点,以脚踝关节或脚趾、手臂、手指关节处肿胀、发红,伴有剧烈疼痛为主要临床表现,严重者关节会伴有痛风石,进一步导致关节变形等。根据病因病机和主要临床表现,本病属于中医“痹病”“历节”“白虎历节”“痛痹”等范畴。中医对该病的认识由来已久,早在《素问·痹论篇》中就有“风寒湿三气杂至,合而为痹也”这样的认识,张机(字仲景)在《伤寒论》中对本病也多有论述。目前西医对本病的治疗以非布司他等降尿酸药物为主,但存在不良反应较大等弊端;中医则秉持张机“观其脉症,知犯何逆,随证治之”原则,以病机为核心,治以清热利湿,宣痹止痛,具有扶助正气、标本兼治、不良反应小等优势。马鸿斌主任认为本病是由于症状反复发作,日久不愈,导致湿热瘀毒、痰浊等邪流注于关节肌肉之间,邪气凝滞不通,不通则发为疼痛。故而临床除温阳化湿,散寒止痛之外,还常以清热利湿,祛瘀解毒为治,方药以宣痹汤为基础方进行加减化裁,临床疗效颇著。
Gouty arthritis is a crystal associated arthropathy caused by monosodium urate deposition,which is directly related to hyperuricemia caused by purine metabolism disorder and/or uric acid excretion disorder.Gouty arthritis is one of the most common clinical diseases in kidney diseases,with the characteristics of complex pathogenesis,poor efficacy and high recurrence rate.The main clinical manifestations are swelling,redness and severe pain in the ankle joints,feet and fingers,arms and finger joints.In severe cases,the joints will be accompanied by tophus,which further leads to joint deformation.According to its etiology,pathogenesis and main clinical manifestations,this disease belongs to the categories of“Bi syndrome(痹证)”,“multiple arthralgia”,“white tiger multiple arthralgia”and“painful Bi syndrome”in traditional Chinese medicine.Arthralgia has been recognized by traditional Chinese medicine for a long time.Arthralgia has been recognized as early as Suwen(素问)On Bi Syndrome:“Arthralgia is caused by the combination of wind,cold and dampness.”This interpretion is also illustrated by ZHANG Ji in Shanghan Lun(《伤寒论》).At present,the treatment of this disease in Western medicine is mainly based on uric acid-lowering drugs such as febuxostat,but there are disadvantages such as large adverse reactions.Traditional Chinese medicine adheres to ZHANG Ji’s principle of“observing the pulse and the symptoms,understanding the causes,and treating it according to the syndrome”.It takes the pathogenesis as the core,and treats by clearing heat and dampness,relieving obstruction and pain,which has the advantages of supporting Qi(气),treating both symptoms and root causes,and minimizing adverse reactions.Director MA Hongbin believes that the disease is due to repeated episodes of symptoms that are not cured and prolongs for a long time,resulting in dampness,heat,blood stasis,poison,phlegm and other pathogenic factors flowing between the joints and muscles,and the pathogenic Qi is stagnant,which in turn causes pain.Therefore,in addition to warming Yang(阳)and eliminating dampness,dispelling cold and relieving pain,the prescription is often used to clear heat and dampness,remove blood stasis and detoxify.The prescription is modified based on Xuanbi decoction(宣痹汤),of which the clinical effect is quite good.