类风湿性关节炎的组方用药及其配伍规律研究

【作者】 金渊光；

【导师】 张民庆；

【作者基本信息】 南京中医药大学 ， 方剂学， 2005， 博士

【摘要】 类风湿性关节炎(RA)是一种以关节滑膜炎症为特征的慢性全身性消耗性自身免疫疾病，目前尚无根治措施。 本文通过对历代文献资料的回顾与复习，说明正虚、邪侵、痰瘀是RA发生、发展及转归过程中的三个重要环节。RA活动期以邪实为主，治宜疏风散寒、清热除湿以宣散病邪；缓解期以正虚为主，治宜扶助先天、后天以充养阴阳气血，而各期均应适当配以化瘀、祛痰等法以疏通气血。 对465首治疗RA方剂用药频次进行分析，列前四位的依次是补益药、解表药、祛湿药和活血祛瘀药。在药次比例大于99％可信区间的65味药中，祛风寒湿药、疏风散寒药、活血通经药、益气补脾药列药次前四位。65味药中当归、甘草等17味药更为常用(祛风寒湿药最多)，具有镇痛、抗炎、免疫调节等药理作用。17味药在465首方剂中以1～7味药组合多见，2～3味最多；1味药以乌头、苍术频次高，多味药以当归、乌头、乳香、没药、苍术、白术、甘草配伍较频，祛邪或扶正祛邪是遣药组方的主要目的。结果表明祛风寒湿药、活血通经药及益气补血药、补肝肾强筋骨药为治疗RA常用药物。 辨证论治是中医临床治疗RA的主要手段。观察32例病人，从病人来源看，风寒湿痹者更为多见；从临床疗效看，在关节疼痛、压痛、肿胀、晨僵、舌脉及ESR、RF等方面，治疗后比治疗前均有不同程度地改善或好转。结果证实辨证治疗RA可取得较好疗效。更多还原

【Abstract】 Rheumatoid arthritis is a chronic systemic consumed self-immunity disease, it is character by arthritis synovitis and has not a effect radical cure at present.In the theoretical review, This article illuminates that deficiency of the vital-qi,exopathic affection and sputum and blood stasis is the three important factors in occur,progress and prognosis of rheumatoid arthritis by analysing the relevant literature past dynasties. It is give priority to accumulation of pathologic factor in progressing and treated by dispersing wind-cold,heat-clearing and eliminating dampness to promoting pathogenic factors, in reviving it is give priority to deficiency of vital-qi and treated by tonify congenital and after birth for nourishing yin,yang,qi and blood .In every expect we should match resolving phlegm and removing blood stasis for regulating qi and blood.According to analyzing drugs frequency in 465 recipes prescription for RA,indicates the forward 4 is tonics ,drugs for treating exterior syndromes ,drugs for eliminating dampness and drugs for promoting blood circulation and removing blood stasis in turn . In 65 drugs frequency proportion over 99% reliability scale, the forward 4 is drugs for eliminating wind-cold-dampness, drugs for dispersing cold, expelling wind, drugs for promoting blood circulation and removing blood stasis and drugs for replenishing the vital-qi and reinforcing the spleen .And Chinese Angelica Root, Licorice Root etc seventeen drugs of 65 prescripted in common (drugs for antirheumatoid is most), drugs has ease pain, antiinflammating and regulating immunity affection etc. In these seventeen drugs of 465 recipe,1-7drugs compatibilities more and 2-3 most; In the application of single drug, Lateral Root of Aconite and Atractylodes Rhizome frequency are more time, but in compatibility application Chinese Angelica Root ,Lateral Root of Aconite,Myrrh,Frankincense, Atractylodes Rhizome, White Atractylodes Rhizome and Licorice Root are applicated more times. It is the most purpose to dispel pathologic factor or reinforce vital-qi and dispel pathologic. As a result, drugs for eliminating wind-cold-dampness, drugs for dispersing cold ,drugs for promoting blood circulation and removing blood stasis and drugs for replenishing the vital-qi and tonifying the blood and drugs for nourishing the liver and kidney, strengthening the bones and muscles are more applicated for treating RA.Differentiation of syndromes and treatment is the mostly measure in TCM clinical treating, in the clinical research, we observed 32 patients; wind-cold-dampness syndrome is in more patients according to source. According to joint ache, press ache,swell,morning stiff, picture of tongue and pulse condition and so on, there is more distinct improve and mend before treating than after. It indicates that differentiation of syndromes and treatment obtains preferably curative effect in RA treatment更多还原