作者简介:谭维勇(1973�),男,主治医师,上海中医药大学附属龙华医院(上海�200032)。学术探讨风湿病辨治探讨谭维勇��摘要:风湿病属中医痹证范畴。其主要病因病机是:患者先天禀赋不足或后天失养,气血不足,腠理空虚,风、寒、湿、热诸外邪侵袭,气血运行不畅,经络痹阻,筋脉关节脏腑失于濡养而致;既病之后,又易与内生痰、瘀等内外合邪;后期转归复杂,多表现为虚实夹杂、寒热互见、阴阳失调。临证应结合病因、病程、病种辨证治疗;用药注意调和阴阳、切中病机、顾护胃气;把握辨病与辨证结合的原则,合理应用祛风与祛湿药。关键词:风湿病;辨治;思路中图分类号:R593�文献标识码:A�文章编号:1000-7156(2009)03-0001-04ApproachofRheumatisminDeterminationofTreatmentBasedonDifferentiationofSyn�dromes�TANWei�yong(Long-huaHospitalAffiliatedtoShanghaiUniversityofChineseMedi�cine,Shanghai,200032,China)Abstract:RheumatismbelongstoarthromyodyniacategoryinTCM.Itsetiologicalfactormainlyareinnatedeficiencyandlossofpostnatalnurse.Soinsufficiencyofqiandbloodandvacuityofstriaeoftheskincouldleadtodiseasesattackingaswellaswind,coldness,wetnessandhotnessraiding.Afterdiseaseoccurs,endogenoussputumandstasisstrikefromwithoutandinsidewithaboveevils.Theturnoverinlaterstageisverycomplicated,andsymptomsareinclusionofastheniaandsthenia,coldnessandhotnessshowingupatthesametimeandimbal�anceofyinandyang.Inclinicalpracticedifferentiationofsymptomsandsignstodecidetreatmentshouldbeac�cordingtodifferentetiologicalfactorandpathogenesis,differentstagesanddifferentdiseases.Medicationsouldlaystressonharmonizingyinandyang,soastoshootatetiologicalfactorthatistosayshootingthearrowatthetar�ge.tGastricqishouldbeattendedinanytimesoadvancementandretreatmentathome.Thefollowinglawshouldbeabidedbythatsyndromedifferentiationiscapitalanddifferentialdiagnosisofdiseasesislesser.Theadvantagesanddisadvantagesofthedrugsofeliminatingwindanddispellingdampnessshouldbepaidattentiontoandspeciesanddosageshouldbeadjustedintime.Keywords:rheumatism,determinationoftreatmentbasedondifferentiationofsymptomsandsigns,thinkingway��风湿病是指风湿免疫病,属结缔组织病,泛指一切发生于皮肤、筋膜、肌腱、关节及肌肉和内脏结缔组织的与自身免疫功能紊乱有关而不能用感染、肿瘤、外伤等原因解释的疾病。风湿病属中医痹证范畴。中医很早就认识到风湿病引起系统损害的情况,如!内经∀中提及的#五脏痹∃。下面结合文献研究与临证体会,对风湿病的辨治进行探讨。1�病因病机风湿病病因不外风、寒、湿、热等外因,先天禀赋不足及后天摄养失司等内因,但病变基础和病程变化均为内外合邪,胶着为害。基本病机为正虚邪凑,留滞筋骨血脉,正虚为本,以肺卫不足、肝肾阴虚、脾肾阳虚为主,随着病程进展则见阴阳俱损、五脏皆虚。邪气为标,风、寒、湿、热诸邪气具有致病特异性和选择性,并因五脏阴阳偏颇,而侵袭不同脏腑经络。风邪易侵袭肌表肺卫,寒入肾脏,湿易困脾,火热犯心,在外表现为筋骨肌表关节不利,在内则表现为脏腑功能失调。此外,尚有伏气致病之说[1]。风湿病不仅病因病机复杂,而且转归不同。表现为阴阳寒热的不同趋向,以及虚实夹杂、寒热互见的病理变化和缠绵不愈、病程漫长的临床特点。��1山西中医�2009年3月第25卷第3期����������SHANXIJOFTCM�Mar�2009Vol�25No�3�2�辨证方法2�1�辨病因风湿病总由风、寒、湿、热为外因,所谓的辨因就是详析外因作用于机体后所呈现出的由邪气特质和脏腑虚实状况共同作用的致病趋向的综合概括。2�1�1�风湿寒痹:表现为非热性的痹证,即阴痹。感受风寒湿邪,寒凝筋脉,以关节筋脉冷痛为主,遇寒加重,遇暖则缓,形寒肢冷,四肢不温,关节肿胀疼痛而无红热。2�1�2�风湿热痹:表现为非寒性的痹证,即阳痹。感受风湿热邪,或寒邪瘀久化热,热雍筋脉,以关节红肿热痛为主,甚则手不能近,触之痛甚。...
