基于“初病湿热在经，久则瘀热入络”探讨风湿性多肌痛的证治

朱文; 汪悦

doi:10.3969/j.issn.1006-2157.2023.11.004

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基于“初病湿热在经，久则瘀热入络”探讨风湿性多肌痛的证治

“中医药防治风湿病”专题 | 更新时间：2023-12-08

- 基于“初病湿热在经，久则瘀热入络”探讨风湿性多肌痛的证治
- Exploring the pattern differentiation and treatment of polymyalgia rheumatica based on "dampness-heat invading the channels at early stage, static-heat invading the collaterals at later stage"
- 北京中医药大学学报 2023年46卷第11期页码：1505-1509
- 作者机构：
  
  1.南京中医药大学第一临床医学院　南京　210029
  2.江苏省中医院
  3.南京中医药大学附属医院
- 作者简介：
  
  朱文，男，博士，讲师
  # 汪悦，男，博士，主任医师，博士生导师，主要研究方向：中医药治疗风湿病基础与临床研究，E-mail: wangyue@njucm.edu.cn
- 基金信息：
  
  国家自然科学基金面上项目(82274454);江苏省研究生科研与实践创新项目(KYCX21_1682)
- DOI：10.3969/j.issn.1006-2157.2023.11.004
  中图分类号： R259.3
- 收稿：2023-06-29，
  
  网络首发：2023-10-20，
  
  纸质出版：2023-11-30
- 稿件说明：
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朱文, 汪悦. 基于“初病湿热在经，久则瘀热入络”探讨风湿性多肌痛的证治[J]. 北京中医药大学学报, 2023,46(11):1505-1509.

ZHU Wen, WANG Yue. Exploring the pattern differentiation and treatment of polymyalgia rheumatica based on "dampness-heat invading the channels at early stage, static-heat invading the collaterals at later stage"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(11): 1505-1509.
朱文, 汪悦. 基于“初病湿热在经，久则瘀热入络”探讨风湿性多肌痛的证治[J]. 北京中医药大学学报, 2023,46(11):1505-1509. DOI： 10.3969/j.issn.1006-2157.2023.11.004.

ZHU Wen, WANG Yue. Exploring the pattern differentiation and treatment of polymyalgia rheumatica based on "dampness-heat invading the channels at early stage, static-heat invading the collaterals at later stage"[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023, 46(11): 1505-1509. DOI： 10.3969/j.issn.1006-2157.2023.11.004.

摘要

风湿性多肌痛以颈部、肩部及髋部肌肉疼痛和僵硬为主要临床表现，随着疾病进展常可合并血管病变，继而出现动脉炎性表现。风湿性多肌痛可归属于中医学“肌痹”范畴，若辨证准确，于早期干预疗效较好。根据本病的发病特点可从“初病湿热在经，久则瘀热入络”认识其病机的演变规律。风湿性多肌痛的发病责之于内外合邪，外感邪气为标、湿热内蕴为本，总因卫分之邪郁闭肌表，郁热不解渐传营血而成瘀热入络之证。针对本病及其变证，可进行分期论治，急性期外透内清，以祛邪为主；缓解期和解表里，以缓图收功；变证期以象之谓，凉血化瘀为务；此外，因其具有迁延性、反复性和难治性的特点，贵在效不更方，有方有守，持之以恒。

Abstract

Polymyalgia rheumatica is a clinical syndrome characterized by stiff pain in neck

scapular and pelvic muscles. Arterial inflammation often occurs with vascular involvement as the disease progresses. Polymyalgia rheumatica can be classified as "muscle arthralgia" in traditional Chinese medicine. If the syndrome differentiation is accurate

the intervention effect will be satisfied in the early stage.According to the characteristics of polymyalgia rheumatica

our team can discuss its pathogenetic mechanism from the point of view "dampness-heat invading the channels at early stage

static-heat invading the collaterals at later stage". The main cause of polymyalgia rheumatica is the combination of internal and external pathogenic factors. Among them

the external evil qi invasion is the manifestation

and the internal dampness-heat is the root. All in all

when the evil qi invades the defensive qi

it can obstruct the skin surface. Hence

static-heat can’t be resolved

and then transfers into the ying blood gradually. Finally

it leads to the formation of static-heat invading the collaterals. In view of its manifestations and deteriorated cases

it can be treated in different stage from the following three angles. In the acute stage

venting the exterior and clearing out interior-heat should be chosen

in order to dispel the evil qi by decoction. In the stable stage

harmonizing the exterior and interior should be chosen in a gentle treatment way. And in the deteriorated stage

the treatment method should be based on the manifestations

so cooling the blood and dissolving stasis is necessary. In addition

rheumatism is chronic

recurrent and refractory. The most important thing is not to change the original formula after the formula takes effect.

关键词

Keywords

references

HEMMIG AK , GOZZOLI D , WERLEN L , et al . Subclinical giant cell arteritis in new onset polymyalgia rheumatica A systematic review and meta-analysis of individual patient data [J/OL]. Semin Arthritis Rheum , 2022 , 55 ： 152017 [ 2023-04-28 ]. https://www.sciencedirect.com/science/article/pii/S0049017222000683?via%3Dihub .

叶天士．临证指南医案 [M]. 北京：中国中医药出版社， 2008 .

尤怡．金匮翼 [M]. 张印生，韩学杰，张兰芹，校注．北京：中医古籍出版社， 2003 ： 186 .

沈金鳌．杂病源流犀烛 [M]. 田思胜，整理．北京：人民卫生出版社， 2006 .

巢元方．诸病源候论 [M]. 北京：中国医药科学技术出版社， 2018 .

叶桂，薛雪，王士雄 . 温热湿热集论 [M]. 张志斌，刘悦，校点．福州：福建科学技术出版社， 2010 ： 55 .

BERNATSKY S , JOSEPH L , PINEAU CA , et al . Polymyalgia rheumatica prevalence in a population-based sample [J]. Arthritis Rheum , 2009 ， 61 ( 9 )： 1264 - 1267 .

BRAULT C , RIIS AH , MOR A , et al . Does low risk of infections as a marker of effective immunity predict increased risk of subsequent giant cell arteritis or polymyalgia rheumatica? A Danish population-based case-control study [J]. Clin Epidemiol , 2018 ， 16 ( 10 )： 1533 - 1543 .

林佩琴 . 类证治裁 [M]. 李德新，整理 . 北京：人民卫生出版社， 2005 ： 305 .

LUNDBERG IE , SHARMA A , TURESSON C , et al . An update on polymyalgia rheumatica [J]. J Intern Med , 2022 ， 292 ( 5 )： 717 - 732 .

GONZÁLEZ-GAY MA , VICENTE-RABANEDA EF , HERAS-RECUERO E , et al . Polymyalgia rheumatica: when should we suspect an underlying large vessel vasculitis？ [J]. Clin Exp Rheumatol , 2023 ， 41 ( 4 )： 774 - 776 .

吴昆．医方考 [M]. 洪青山，校注．北京．中国中医药出版社 . 1998 ： 215 .

顾靖远 . 顾松园医镜 [M]. 袁久林，校注 . 北京：中国医药科技出版社， 2014 ： 209 .

贾红伟，赵宁，张皖东，等．宣发膜原方对胶原诱导性关节炎大鼠血清中TNF-α、IFN-γ、IL-6和IL-10影响的研究 [J]. 中国中医基础医学杂志， 2005 ， 11 ( 11 )： 23 - 25 .

叶天士．叶天士医学全书 [M]. 太原：山西科学技术出版社， 2012 ： 303 .

陈倩，陈伟民，冯超逸，等．眼部受累的巨细胞动脉炎临床及影像特征分析 [J]. 中国眼耳鼻喉科杂志， 2022 ， 22 ( 1 )： 20 - 24 .

DING C , LI YZ , SUN Y , et al . Sinomenium acutum: A Comprehensive Review of its Botany, Phytochemistry, Pharmacology and Clinical Application [J]. Am J Chin Med , 2022 ， 50 ( 5 )： 1219 - 1253 .

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