强直性脊柱炎的中医治疗进展
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摘要
强直性脊柱炎中医病因病机有内因和外因之分,内因为肾督两虚、阳失布化,外因多为风寒湿热之邪侵袭。中医治疗方法多样,内治疗法以辨证论治为基础,遵循"急则治其标,缓则治其本"的原则,急性期以祛风寒湿之邪,缓解期则补肾强督,活血通络。寒湿痹阻者温经散寒;湿热痹阻者清热利湿;肾虚督寒者温肾壮督;肾虚血瘀者补肾活血;或辨证联合西药治疗,能延缓疾病进展,改善预后;外治疗法有针灸、中药熏洗、穴位贴敷及其他疗法,如运动疗法等,具有操作安全、不良反应小等优势。中医治疗强直性脊柱炎可改善患者的症状和生活质量,减少西药不良反应,有助于患者恢复自信及促进功能康复。
TCM etiology and pathogenesis of ankylosing spondylitis can be divided into internal and external causes. Internal causes are deficiency of both kidney and governor channel, loss of yang distribution, and external causes are mostly attacked by wind, cold, dampness and heat. There are many kinds of TCM therapies. Internal therapies are based on syndrome differentiation and treatment. They follow the principle of "treating the target as soon as possible, treating the root as slowly", dispelling the pathogenic factors of wind, cold and dampness in acute stage, tonifying the kidney and strengthening the governorchannel in remission stage, activating blood circulation and dredging collaterals. Those with cold-dampness obstruction can warm meridians and disperse cold, those with dampness-heat obstruction can clear away heat and diff use dampness, those with kidney deficiency and cold, those with kidney deficiency and blood stasis can invigorate kidney and promote blood circulation; or dialectical combined with western medicine treatment can delay the progress of disease and improve prognosis.External treatment methods include acupuncture, herbal fumigation, acupoint application and other sports therapies, which are safe to operate and have adverse reactions. Should be small, significantly improve the advantages of joint function. Chinese medicine treatment of ankylosing spondylitis can improve the symptoms and quality of life of patients, reduce adverse reactions of Western medicine, help patients to restore self-confidence and promote functional rehabilitation.
TCM etiology and pathogenesis of ankylosing spondylitis can be divided into internal and external causes. Internal causes are deficiency of both kidney and governor channel, loss of yang distribution, and external causes are mostly attacked by wind, cold, dampness and heat. There are many kinds of TCM therapies. Internal therapies are based on syndrome differentiation and treatment. They follow the principle of "treating the target as soon as possible, treating the root as slowly", dispelling the pathogenic factors of wind, cold and dampness in acute stage, tonifying the kidney and strengthening the governorchannel in remission stage, activating blood circulation and dredging collaterals. Those with cold-dampness obstruction can warm meridians and disperse cold, those with dampness-heat obstruction can clear away heat and diff use dampness, those with kidney deficiency and cold, those with kidney deficiency and blood stasis can invigorate kidney and promote blood circulation; or dialectical combined with western medicine treatment can delay the progress of disease and improve prognosis.External treatment methods include acupuncture, herbal fumigation, acupoint application and other sports therapies, which are safe to operate and have adverse reactions. Should be small, significantly improve the advantages of joint function. Chinese medicine treatment of ankylosing spondylitis can improve the symptoms and quality of life of patients, reduce adverse reactions of Western medicine, help patients to restore self-confidence and promote functional rehabilitation.
引文
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[10]熊源胤.张荒生教授益气祛瘀通络法治疗风湿痹病的学术思想及临床经验[D].武汉:湖北中医药大学,2015.
[11]肖勇洪,杨磊,汪学良,等.彭江云辨治强直性脊柱炎肾亏督寒证诊疗特色[J].长春中医药大学学报,2017,33(4):557-559.
[12]王玉明.王为兰治疗强直性脊柱炎学术思想及代表方药[J].世界中西医结合杂志,2014(7):694-696.
[13]冯兴华,姜泉,刘宏潇,等.中医辨证治疗强直性脊柱炎的临床疗效评价[J].中国中西医结合杂志,2013(10):1309-1314.
[14]刘本勇,刘宏潇,冯兴华.补肾活血法治疗强直性脊柱炎的理论基础[J].吉林中医药,2014,34(12):1189-1191.
[15]邓长财,鞠中斌.张鸣鹤治疗活动期强直性脊柱炎经验探讨[J].山东中医药大学学报,2006(5):372-373.
[16]祁辉,李永旺.中西医结合治疗强直性脊柱炎临床观察[J].四川中医,2015(6):104-106.
[17]张璐,刘云,马东红,等.中西医结合治疗强直性脊柱炎临床疗效[J].陕西中医,2017,38(4):475-477.
[18]杨华娟,王颖,鲁缨,等.中西医结合治疗强直性脊柱炎并骨质疏松探讨[J].中外医疗,2014,33(34):157-158.
[19]王海军,曹玉霞,冀来喜.新九针疗法为主综合治疗强直性脊柱炎[J].中华中医药杂志,2015,30(4):1137-1138.
[20]涂新生.中医针灸综合治疗强直性脊柱炎的临床研究[J].中国实用医药,2015,10(6):209-210.
[21]许超尘,游玉权,郑辉福,等.中药离子导入治疗强直性脊柱炎40例临床疗效观察[J].世界中医药,2010,5(1):26-27.
[22]侯丰枝.化痰活血方穴位贴敷治疗强直性脊柱炎临床研究[J].新中医,2018,50(1):81-84.
[23]魏艳林,吕青,李秋霞,等.运动疗法联合重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白治疗强直性脊柱炎的临床疗效[J].中山大学学报(医学科学版),2015,36(1):6-11.
[24]韩清森,谢卫平,李彦枝,等.补肾强督方联合小针刀治疗强直性脊柱炎临床研究[J].陕西中医,2018,39(8):1141-1143.
[25]周亚美,茹晋丽,赵华明.运动疗法在强直性脊柱炎治疗中的应用[J].中国康复理论与实践,2013,19(12):1144-1146.
[26]贾峻,沙明波.补肾通督推拿法治疗强制性脊柱炎60例临床观察[J].天津中医药,2015,32(8):484-487.
[2]王占欣,王鸽,张彩霞,等.病毒感染与强直性脊柱炎的相关病理研究[J].中华医院感染学杂志,2014(1):168-170.
[3]WARD M M,DEODHAR A,AKL E A,et al.American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis[J].Arthritis Rheumatol,2016,68(2):282-298.
[4]翟佳羽,吕青,赵敏菁,等.甲氨蝶呤和柳氮磺吡啶治疗强直性脊柱炎安全性和有效性的meta分析[J].中山大学学报(医学科学版),2015(1):42-54.
[5]WANG Y,YI X D,LU H L.Infl uence of CYP2C9 and COX-2 Genetic Polymorphisms on Clinical Efficacy of NonSteroidal Anti-Inflammatory Drugs in Treatment of Ankylosing Spondylitis[J].Medical Science Monitor:International Medical Journal of Experimental and Clinical Research,2017(23):1775-1782.
[6]GOSSEC L,DOUGADOS M,PHILLIPS C,et al.Dissemination and evaluation of the ASAS/EULAR recommendations for the management of ankylosing spondylitis:results of a study among 1507rheumatologists.Annals of the Rheumatic Diseases,2008,67(6):782-788.
[7]焦树德.“大偻”病机分析与辨治[N].中国中医药报,2003-02-13(02).
[8]顾军花,茅建春,周时高,等.陈湘君运用扶正法治疗强直性脊柱炎经验撷菁[J].上海中医药杂志,2008(3):16-17.
[9]李满意,刘红艳,娄玉钤.娄多峰教授治疗强直性脊柱炎经验总结[J].风湿病与关节炎,2014,3(7):52-56.
[10]熊源胤.张荒生教授益气祛瘀通络法治疗风湿痹病的学术思想及临床经验[D].武汉:湖北中医药大学,2015.
[11]肖勇洪,杨磊,汪学良,等.彭江云辨治强直性脊柱炎肾亏督寒证诊疗特色[J].长春中医药大学学报,2017,33(4):557-559.
[12]王玉明.王为兰治疗强直性脊柱炎学术思想及代表方药[J].世界中西医结合杂志,2014(7):694-696.
[13]冯兴华,姜泉,刘宏潇,等.中医辨证治疗强直性脊柱炎的临床疗效评价[J].中国中西医结合杂志,2013(10):1309-1314.
[14]刘本勇,刘宏潇,冯兴华.补肾活血法治疗强直性脊柱炎的理论基础[J].吉林中医药,2014,34(12):1189-1191.
[15]邓长财,鞠中斌.张鸣鹤治疗活动期强直性脊柱炎经验探讨[J].山东中医药大学学报,2006(5):372-373.
[16]祁辉,李永旺.中西医结合治疗强直性脊柱炎临床观察[J].四川中医,2015(6):104-106.
[17]张璐,刘云,马东红,等.中西医结合治疗强直性脊柱炎临床疗效[J].陕西中医,2017,38(4):475-477.
[18]杨华娟,王颖,鲁缨,等.中西医结合治疗强直性脊柱炎并骨质疏松探讨[J].中外医疗,2014,33(34):157-158.
[19]王海军,曹玉霞,冀来喜.新九针疗法为主综合治疗强直性脊柱炎[J].中华中医药杂志,2015,30(4):1137-1138.
[20]涂新生.中医针灸综合治疗强直性脊柱炎的临床研究[J].中国实用医药,2015,10(6):209-210.
[21]许超尘,游玉权,郑辉福,等.中药离子导入治疗强直性脊柱炎40例临床疗效观察[J].世界中医药,2010,5(1):26-27.
[22]侯丰枝.化痰活血方穴位贴敷治疗强直性脊柱炎临床研究[J].新中医,2018,50(1):81-84.
[23]魏艳林,吕青,李秋霞,等.运动疗法联合重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白治疗强直性脊柱炎的临床疗效[J].中山大学学报(医学科学版),2015,36(1):6-11.
[24]韩清森,谢卫平,李彦枝,等.补肾强督方联合小针刀治疗强直性脊柱炎临床研究[J].陕西中医,2018,39(8):1141-1143.
[25]周亚美,茹晋丽,赵华明.运动疗法在强直性脊柱炎治疗中的应用[J].中国康复理论与实践,2013,19(12):1144-1146.
[26]贾峻,沙明波.补肾通督推拿法治疗强制性脊柱炎60例临床观察[J].天津中医药,2015,32(8):484-487.