基于圆运动理论探讨类风湿关节炎的病机与治疗

Exploration on the Pathogenesis and Treatment for Rheumatoid Arthritis Based on the Circular Motion Theory

摘要:

本文基于圆运动理论，阐释类风湿关节炎（RA）“轴滞轮停”的核心病机本质，梳理“中焦失调-圆运动失衡-痹阻关节”的病机演变规律，结合现代医学的RA 分期（活动期、缓解期），分析中医3 个分期（早期、中期、晚期） 的病机特点，据此拟定“运轴以行轮、疏维以调圆、复圆以求衡”的中医分期治疗策略。早期（活动期） 病机以中气亏虚、轴失运转为主，治以运轴复枢，方选理中汤、逐痹丹等；中期（活动期与缓解期交替） 病机以肝木升阻、疏泄失调为主，治以疏维调圆，方选肝肾同补汤、小柴胡汤化裁；晚期（缓解期或低活动度） 病机以水火不济、寒热错杂为主，治以复圆平衡，方选独活寄生汤合肾四味、十全大补汤等。通过寒湿痹阻、肝郁脾虚、肝肾亏虚证3则典型医案，证实该理论框架用于诊治不同分期、不同证候RA的实用价值。

Abstract:

Abstract： Based on the circular motion theory， this paper expounds the core pathogenesis of rheumatoid arthritis （RA） as "axis stagnation and wheel arrest"， sorts out the pathogenesis evolution patterns of "dysfunction of middle jiao-imbalance of circular motion-blockage in joints"，and formulates the traditional Chinese medicine （TCM） staged treatment strategy of "regulating the axis to move the wheel， soothing the dimensions to harmonize the circle， and restoring the circle to achieve balance" based on an analysis of the pathogenesis characteristics of TCM stages （early，middle，late） in relation to the modern medical staging of RA （active stage and remission stage）. In the early active stage，the pathogenesis mainly lies in deficiency of middle qi and failure of axis rotation，so the treatment focuses on regulating the axis and restoring the pivots，with prescriptions such as Lizhong Decoction and Zhubi pellets. In the middle stage （alternation of active stage and remission stage），the pathogenesis is mainly the obstruction of the ascending of liver qi movement， the failure of the liver to ensure free movement of qi， so the treatment focuses on dredging the dimensions to harmonize the circle，with modified Ganshen Tongbu Decoction and Xiaochaihu Decoction. In the late stage （remission stage or low activity stage），the pathogenesis is mainly incoordination between water and fire，intermingled cold and heat，so the treatment focuses on restoring the circle to balance，with prescriptions such as Duhuo Jisheng Decoction plus Shensiwei and Shiquan Dabu Decoction. Three typical medical cases of cold-damp obstruction，stagnation of liver qi and spleen deficiency and liver-kidney deficiency confirm the practical value of this theoretical framework for diagnosis and treatment of RA of different stages and different syndromes.