摘要
强直性脊柱炎是风湿免疫科一种常见疾病,主要累及中轴及外周关节,严重者可发生脊柱畸形强直,与人类白细胞抗原(Human Leukocyte Antigen,HLA)-B27阳性密切相关,且具有家族聚集倾向。中医在强直性脊柱炎的治疗上积累了丰富的经验,治疗方面占据独特优势。中医将强直性脊柱炎归为“大偻”范畴,普勇斌老师认为其病机以肝肾亏虚、气血不足为内因,风、寒、湿邪为外因,病程中夹杂瘀、热、痰,其中瘀血阻络贯穿始终,且伏邪在疾病发生中起到重要作用,为导致疾病迁延反复的原因。治疗上,普老师主张以补益肝肾、荣筋祛邪为主,同时注重心理辅导与功能锻炼。普老师将强直性脊柱炎分为三个时期:潜伏期、发作期和临床缓解期。潜伏期,病情隐匿,难以诊断;发作期时,应以中西医疗法稳定病情为主;临床缓解期则需补益肝肾、顾护脾胃,防止复发。普老师常用的方剂包括独活寄生汤、附子桂枝汤、桂枝芍药知母汤和补肾强督清化汤等,常在方剂基础上加用藤类、虫类药物以提高疗效。笔者通过跟随普勇斌老师门诊,学习普勇斌老师治疗有效的医案,简要总结了普勇斌老师诊治强直性脊柱炎的经验,对其遣方用药及中医调理特色予以概括,并举案例佐证。
Ankylosing Spondylitis(AS)is a common disease in the field of rheumatology and immunology,primarily affecting Athe axial and peripheral joints,and in severe cases,it can lead to spinal deformity and rigidity.It is closely related to the positivity of HLA-B27 and has a familial predisposition.Traditional Chinese Medicine has accumulated rich experience in the treatment of AS and holds a unique advantage in this aspect.In TCM,AS is categorized under the“Dalou”(大偻)syndrome.Teacher PU Yongbin believes that the pathogenesis of AS is mainly due to internal factors such as deficiency of the liver and kidney,and insufficiency of Qi(气)and blood.External factors include wind,cold,and dampness,with blood stasis,heat,and phlegm interwoven throughout the disease course.Among these,blood stasis and obstruction of the collaterals are present throughout,and latent pathogenic factors play a significant role in the onset of the disease,leading to its chronic and relapsing nature.In treatment,teacher PU advocates for the strengthening of the liver and kidney and the elimination of pathogenic factors,while also focusing on psychological counseling and functional exercise.Teacher PU divides AS into three stages:the latent period,the acute attack period,and the clinical remission period.During the latent period,the condition is hidden and difficult to diagnose.In the acute attack period,the main approach should be to stabilize the condition with by the combination of traditional Chinese medicine and Western medicine.In the clinical remission period,it is necessary to nourish the liver and kidney and protect the spleen and stomach to prevent recurrence.The commonly used prescriptions by Teacher PU include the Duhuo Jisheng decoction(独活寄生汤),the Fuzi Guizhi decoction(附子桂枝汤),the Guizhi Shaoyao Zhimu decoction(桂枝芍药知母汤),the Bushen Qiangdu Qinghua decoction(补肾强督清化汤),etc.,often supplemented with vine and insect-based medicinals to enhance the therapeutic effect.In this article,through following Teacher PU Yongbin’s outpatient clinic,effective medical cases treated by Teacher PU were studied and summarized,teacher PU Yongbin’s experience in diagnosing and treating ankylosing spondylitis were briefly summarized,and his unique characteristics in prescription medication and traditional Chinese medicine conditioning were summarized.An example case was supported as follow.
出处
《中医临床研究》
2024年第20期95-98,共4页
Clinical Journal Of Chinese Medicine
基金
云南省2020年高层次中医药人才培养对象(【2021】1)。
关键词
强直性脊柱炎
临床经验
伏邪
Ankylosing spondylitis
Clinical experience
Latent pathogen
