范永升应用金匮肾气丸加减治疗强直性脊柱炎经验举隅
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摘要
[目的]总结范永升教授应用金匮肾气丸加减治疗强直性脊柱炎(ankylosing spondylitis,AS)的经验。[方法]跟师临诊学习和收集范老师应用金匮肾气丸加减治疗AS的医案,分析范老师对强直性脊柱炎病因病机的认识以及治疗经验,并列举两则医案予以佐证。[结果]范老师认为肾精不足、督脉失养为强直性脊柱炎主要病机,风寒湿邪瘀滞经络是诱发本病的外在条件。本病症状主要表现在腰骶、脊柱,腰为肾之府,有赖于肾之温煦濡养,督脉"贯背属肾",若肾精不足,外邪乘虚而入,或气化不行,寒湿内生,痹阻筋脉,流注关节,则易发为本病。故范老师认为"补肾温督"应贯穿本病治疗始终,根据病因病机的变化,灵活运用金匮肾气丸加减,佐以通络、化湿、祛风、化痰、活血。两则医案,一属脾肾阳虚、寒湿阻络,一属肾精亏虚、寒湿闭阻,均以金匮肾气丸加减温肾通络化湿,获得良好疗效。[结论]导师范永升教授运用金匮肾气丸加减,以温肾通络化湿之法治疗强直性脊柱炎,疗效颇著,值得借鉴。
[Objective] To summarize the experience of Professor FAN Yongsheng who uses the herbal prescription "modified Golden Chamber Kidney-Qi Pill"to treat ankylosing spondylitis. [Method] To study and collect the medical records of Teacher FAN in treating ankylosing spondylitis with Golden Chamber Kidney-Qi Pill, analyze Teacher FAN's understanding of the etiology and pathogenesis of ankylosing spondylitis and treatment experience, and enumerate the cases of Teacher FAN in treating ankylosing spondylitis. [Result] Teacher FAN believed that the main pathogenesis of ankylosing spondylitis was deficiency of kidney essence and lack of nourishment of governor vessels. The external conditions inducing ankylosing spondylitis were stagnation of pathogenic blood stasis meridians due to wind, cold and dampness. The symptoms of this disease are mainly manifested in the lumbosacrum and spine, but the waist is the home of kidney, which depends on the warm and moistening of the kidney. If the kidney essence is insufficient, the external pathogens multiply deficiency, or the vaporization is not feasible, the cold and dampness endogenous, the obstruction of the arteries and veins,and the flow of the joints, the disease is prone to occur. Teacher FAN believes that "invigorating the kidney and warming the governor" should run through the treatment of this disease,according to the cause, changes in the pathogenesis of flexible application of Golden Chamber Kidney-Qi Pill addition and subtraction, dredge meridian, dissipate dampness, Qufeng, reduce phlegm and blood circulation, so as to achieve dialectical treatment, with the addition and subtraction. There are two medical cases, one is spleen and kidney Yang deficiency, cold and dampness obstruction collateral, the other is kidney essence deficiency, cold and dampness blocking. Both of them have good curative effect by"modified Golden Chamber Kidney-Qi Pill"to warm the kidney, dredge collaterals and remove dampness. [Conclusion] Teacher FAN Yongsheng uses "modified Golden Chamber Kidney-Qi Pill" to treat ankylosing spondylitis has achieved good clinical efficacy, worthy of clinical study and reference.
[Objective] To summarize the experience of Professor FAN Yongsheng who uses the herbal prescription "modified Golden Chamber Kidney-Qi Pill"to treat ankylosing spondylitis. [Method] To study and collect the medical records of Teacher FAN in treating ankylosing spondylitis with Golden Chamber Kidney-Qi Pill, analyze Teacher FAN's understanding of the etiology and pathogenesis of ankylosing spondylitis and treatment experience, and enumerate the cases of Teacher FAN in treating ankylosing spondylitis. [Result] Teacher FAN believed that the main pathogenesis of ankylosing spondylitis was deficiency of kidney essence and lack of nourishment of governor vessels. The external conditions inducing ankylosing spondylitis were stagnation of pathogenic blood stasis meridians due to wind, cold and dampness. The symptoms of this disease are mainly manifested in the lumbosacrum and spine, but the waist is the home of kidney, which depends on the warm and moistening of the kidney. If the kidney essence is insufficient, the external pathogens multiply deficiency, or the vaporization is not feasible, the cold and dampness endogenous, the obstruction of the arteries and veins,and the flow of the joints, the disease is prone to occur. Teacher FAN believes that "invigorating the kidney and warming the governor" should run through the treatment of this disease,according to the cause, changes in the pathogenesis of flexible application of Golden Chamber Kidney-Qi Pill addition and subtraction, dredge meridian, dissipate dampness, Qufeng, reduce phlegm and blood circulation, so as to achieve dialectical treatment, with the addition and subtraction. There are two medical cases, one is spleen and kidney Yang deficiency, cold and dampness obstruction collateral, the other is kidney essence deficiency, cold and dampness blocking. Both of them have good curative effect by"modified Golden Chamber Kidney-Qi Pill"to warm the kidney, dredge collaterals and remove dampness. [Conclusion] Teacher FAN Yongsheng uses "modified Golden Chamber Kidney-Qi Pill" to treat ankylosing spondylitis has achieved good clinical efficacy, worthy of clinical study and reference.
引文
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[14]罗俊华,姜辉,吴娜.金樱子对阿霉素肾病大鼠尿蛋白排泄的影响[J].当代医学,2013,19(10):27-28.
[2]张仲景.金匮要略[M].北京:人民卫生出版社,2006.
[3]吴琪,吴倩,周晓红,等.丹皮酚对强直性脊柱炎模型小鼠Wnt和BMP/Smad信号转导通路的影响[J].中国药房,2018,29(11):1500-1504.
[4]黄元御.玉楸药解[M].北京:人民卫生出版社,2015:105.
[5]潘亚磊,翟远坤,牛银波,等.杜仲防治骨质疏松症的研究进展[J].化学与生物工程,2013,30(7):6-9.
[6]缪希雍.本草经疏[M].北京:中国医药科技出版社,2011:253.
[7]刘颖,袁晓美,毕亚男,等.补骨脂对维甲酸诱导的大鼠骨质疏松的治疗[J].实验动物科学,2018,35(1):44-47.
[8]李时珍.本草纲目[M].南京:江苏人民出版社,2011:125.
[9]蒋福升,马哲龙,陈金印,等.乌梢蛇水提物对大鼠佐剂性关节炎作用的实验研究[J].中国中医药科技,2013,20(4):367-368.
[10]努尔比耶·奥布力喀斯木.艾叶挥发油抗真菌活性成分和白僵蚕对大鼠紫癜性肾炎治疗作用的研究[D].乌鲁木齐:新疆医科大学,2017:37-109.
[11]倪朱谟.本草汇言[M].北京:中医古籍出版社,2005:85.
[12]Wang N,Wei R B,Li Q P,et al.Protective effects of astragaloside in rats with adriamycin nephropathy and underlying mechanism[J].Chinese Journal of Natural Medicines,2016,14(4):270-277.
[13]汪昂.本草备要[M].北京:人民卫生出版社,2017:238.
[14]罗俊华,姜辉,吴娜.金樱子对阿霉素肾病大鼠尿蛋白排泄的影响[J].当代医学,2013,19(10):27-28.