昆断蝎子汤合薏鲫汤治疗活动期类风湿关节炎的临床疗效观察
|
摘要
目的：
客观评价昆断蝎子汤合薏鲫汤治疗活动期类风湿关节炎的临床疗效
方法：
选择60例符合纳入标准的类风湿关节炎患者随机分为治疗组与对照组。治疗组：昆明山海棠45克、全蝎5克、川断15克,煎服法：昆明山海棠、全蝎加水500m1先煎三个半小时,再加入川断同煎半小时,一共煎四小时,煎至150m1,分三次饭后温服,日一剂；薏苡仁50克、鲫鱼500克、猪脊骨250克,加水500m1煮至150m1,分两次服用,共服六周。对照组：昆明山海棠45克、全蝎5克、川断15克,煎服法同上,共服六周。观察治疗后六周关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数、晨僵时间、平均握力、VAS评分、HAQ指数等临床症状、体征；观察类风湿因子、C反应蛋白及血沉等实验室指标：监测血常规、肝肾功能；同时详细记录治疗过程中出现的不良反应。
结果：
治疗六周后,治疗组总有效率为86.7%,对照组总有效率为76.7%,治疗组的疗效与对照组比较有统计学差异(P<0.05),治疗组优于对照组。
临床研究结果显示,治疗组与对照组的DAS28评分改善情况与治疗前比较均有统计学意义(P<0.05)：组间比较：治疗组与对照组相比有统计学意义(P<0.05),治疗组优于对照组。说明昆断蝎子汤合薏鲫汤和单用昆断蝎子汤均能明显降低活动期类风湿关节炎患者的疾病活动度,而且联合应用方案优于单用。
在症状体征改善方面,治疗组：关节压痛总数、关节压痛指数、关节肿胀总数、关节肿胀指数、晨僵时间、平均握力、患者对疼痛的VAS评分及HAQ与治疗前比较均有统计学意义(P<0.05)。对照组：关节压痛总数、关节压痛指数、关节肿胀总数、关节肿胀指数及患者对疼痛的VAS评分与治疗前比较均有统计学意义(P<0.05),晨僵时间、平均握力及HAQ与治疗前比较无统计学意义(P>0.05)。治疗组与对照组对比：两组间关节压痛总数、关节压痛指数、关节肿胀总数及关节肿胀指数比较有统计学意义(P<0.05),治疗组优于对照组。两组问患者对疼痛的VAS评分比较无统计学意义(P>0.05)。
在实验室指标方面,治疗组与对照组的RF、CRP及ESR与治疗前比较均有统计学意义(P<0.05),治疗组的CRP与对照组相比有统计学意义(P<0.05),治疗组优于对照组。
在治疗过程中,共出现药物副反应7例。其中治疗组3例,有1例患者出现恶心呕吐、暖气返酸、腹胀腹泻等消化系统症状,经服用制酸护胃药后症状可以缓解；有1例患者肝转氨酶升高,经护肝治疗后,肝功能基本恢复正常：有1例女性患者出现月经紊乱：余未见明显不良反应。对照组4例,有1例患者服药后出现呃逆的消化道不适反应,后自行好转。有1例患者肝转氨酶升高,经护肝治疗后,肝功能基本恢复正常；有2例女性患者出现月经紊乱；余未见明显不良反应。两组患者均未出现严重不良反应。
结论：
昆断蝎子汤合薏鲫汤和单用昆断蝎子汤对活动期类风湿关节炎的疗效是肯定的,而且联合应用能更好地控制病情,可以作为中药联合食疗模式应用于临床。短期用药不良反应无明显差异。
Object i ve
To evaluate the therapeutic effect of Himalayan Teasel Root Radix seu Caul is Celastri Orbiculati Scorpion decoction and Semen Coicis Carassius Auratus decoction in the therapy of rheumatoid arthritis (RA).
Method
Sixty RA patients fulfilling including criteria were randomly dividing into therapeutic group and control group. Patients in therapeutic group were administrated decoctions as follow:(1) to decoct Radix seu Caul is Celastri Orbiculati45g and Scorpion5g for3.5hours, then plus Himalayan Teasel Root15g and decoct for0.5hours, this decoction was taken once per day;(2) to decoct Semen Coicis50g, Carassius Auratus500g, porcine vertebral column500g from4bowls of water to1bowl of decoction, this decoction was taken twice per day, half bowl of decoction per time. Patients in control group were just administrated decoction (1) of therapeutic group. Course of treatment in both groups was6weeks. Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index, time of morning stiffness, average hand strength, VAS score, HAQ index, RF, CRP, ESR, were observed after6weeks after therapy. Blood routine test, hepatic renal test, and side effects were monitored during therapy.
Resule
Total effective rate was86.7%and76.7%in therapeutic group and control group respectively. Total effective rate in therapeutic group was significantly higher than control group (P<0.05).
DAS28score in both therapeutic group and control group were improved significantly after therapy (P<0.05). DAS28score in therapeutic group was significantly higher than control group after therapy (P<0.05). Both combinative therapy and Himalayan Teasel Root Radix seu Caul is Celastri Orbiculati Scorpion decoction can decrease activity in acute phase of RA. Combinative therapy had better effect than Himalayan Teasel Root Radix seu Caulis Celastri Orbiculati Scorpion decoction alone.
Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index, time of morning stiffness, average hand strength, VAS score and HAQ index significantly improved after therapy in therapeutic group (P<0.05). Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index and VAS score in control group significantly improved after therapy (P<0.05). Time of morning stiffness, average hand strength and HAQ index didn't have significant improvement after therapy in control group. Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index in therapeutic group improved significantly than control group after therapy (P<0.05). There was no statistical significance in VAS score between two groups.
RF, CRP, ESR levels in both groups decreased after therapy. CRP levels in therapeutic group were significantly decreased in therapeutic group than control group.
There were3patients in therapeutic group and4patients in control group had side effect during therapy. In therapeutic group, one patient had digestive symptoms of nausea and vomiting, epigastic upset and eructation, abdominal distension and diarrhea, these symptoms were relieved after antacid agent administration; one patient had increased transaminase level, and relieved after hepatic protective agent administration; one female patient had amenorrhea. In control group, one patient had singultous and recovered automatically; one patient had increased transaminase level, and relieved after hepatic protective agent administration; two female patients had amenorrhea. All patients did not have server side effect.
Conclusion
Himalayan Teasel Root Radix seu Caulis Celastri Orbiculati Scorpion decoction and combinative therapy with Semen Coicis Carassius Auratus decoction had pronounced therapeutic effect to RA. Combinative therapy has better effect to RA and can be applied to clinical treatment in the mode of Chinese medicine combine with dietary therapy. Side effects between two groups had no statistically significant difference.
客观评价昆断蝎子汤合薏鲫汤治疗活动期类风湿关节炎的临床疗效
方法：
选择60例符合纳入标准的类风湿关节炎患者随机分为治疗组与对照组。治疗组：昆明山海棠45克、全蝎5克、川断15克,煎服法：昆明山海棠、全蝎加水500m1先煎三个半小时,再加入川断同煎半小时,一共煎四小时,煎至150m1,分三次饭后温服,日一剂；薏苡仁50克、鲫鱼500克、猪脊骨250克,加水500m1煮至150m1,分两次服用,共服六周。对照组：昆明山海棠45克、全蝎5克、川断15克,煎服法同上,共服六周。观察治疗后六周关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数、晨僵时间、平均握力、VAS评分、HAQ指数等临床症状、体征；观察类风湿因子、C反应蛋白及血沉等实验室指标：监测血常规、肝肾功能；同时详细记录治疗过程中出现的不良反应。
结果：
治疗六周后,治疗组总有效率为86.7%,对照组总有效率为76.7%,治疗组的疗效与对照组比较有统计学差异(P<0.05),治疗组优于对照组。
临床研究结果显示,治疗组与对照组的DAS28评分改善情况与治疗前比较均有统计学意义(P<0.05)：组间比较：治疗组与对照组相比有统计学意义(P<0.05),治疗组优于对照组。说明昆断蝎子汤合薏鲫汤和单用昆断蝎子汤均能明显降低活动期类风湿关节炎患者的疾病活动度,而且联合应用方案优于单用。
在症状体征改善方面,治疗组：关节压痛总数、关节压痛指数、关节肿胀总数、关节肿胀指数、晨僵时间、平均握力、患者对疼痛的VAS评分及HAQ与治疗前比较均有统计学意义(P<0.05)。对照组：关节压痛总数、关节压痛指数、关节肿胀总数、关节肿胀指数及患者对疼痛的VAS评分与治疗前比较均有统计学意义(P<0.05),晨僵时间、平均握力及HAQ与治疗前比较无统计学意义(P>0.05)。治疗组与对照组对比：两组间关节压痛总数、关节压痛指数、关节肿胀总数及关节肿胀指数比较有统计学意义(P<0.05),治疗组优于对照组。两组问患者对疼痛的VAS评分比较无统计学意义(P>0.05)。
在实验室指标方面,治疗组与对照组的RF、CRP及ESR与治疗前比较均有统计学意义(P<0.05),治疗组的CRP与对照组相比有统计学意义(P<0.05),治疗组优于对照组。
在治疗过程中,共出现药物副反应7例。其中治疗组3例,有1例患者出现恶心呕吐、暖气返酸、腹胀腹泻等消化系统症状,经服用制酸护胃药后症状可以缓解；有1例患者肝转氨酶升高,经护肝治疗后,肝功能基本恢复正常：有1例女性患者出现月经紊乱：余未见明显不良反应。对照组4例,有1例患者服药后出现呃逆的消化道不适反应,后自行好转。有1例患者肝转氨酶升高,经护肝治疗后,肝功能基本恢复正常；有2例女性患者出现月经紊乱；余未见明显不良反应。两组患者均未出现严重不良反应。
结论：
昆断蝎子汤合薏鲫汤和单用昆断蝎子汤对活动期类风湿关节炎的疗效是肯定的,而且联合应用能更好地控制病情,可以作为中药联合食疗模式应用于临床。短期用药不良反应无明显差异。
Object i ve
To evaluate the therapeutic effect of Himalayan Teasel Root Radix seu Caul is Celastri Orbiculati Scorpion decoction and Semen Coicis Carassius Auratus decoction in the therapy of rheumatoid arthritis (RA).
Method
Sixty RA patients fulfilling including criteria were randomly dividing into therapeutic group and control group. Patients in therapeutic group were administrated decoctions as follow:(1) to decoct Radix seu Caul is Celastri Orbiculati45g and Scorpion5g for3.5hours, then plus Himalayan Teasel Root15g and decoct for0.5hours, this decoction was taken once per day;(2) to decoct Semen Coicis50g, Carassius Auratus500g, porcine vertebral column500g from4bowls of water to1bowl of decoction, this decoction was taken twice per day, half bowl of decoction per time. Patients in control group were just administrated decoction (1) of therapeutic group. Course of treatment in both groups was6weeks. Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index, time of morning stiffness, average hand strength, VAS score, HAQ index, RF, CRP, ESR, were observed after6weeks after therapy. Blood routine test, hepatic renal test, and side effects were monitored during therapy.
Resule
Total effective rate was86.7%and76.7%in therapeutic group and control group respectively. Total effective rate in therapeutic group was significantly higher than control group (P<0.05).
DAS28score in both therapeutic group and control group were improved significantly after therapy (P<0.05). DAS28score in therapeutic group was significantly higher than control group after therapy (P<0.05). Both combinative therapy and Himalayan Teasel Root Radix seu Caul is Celastri Orbiculati Scorpion decoction can decrease activity in acute phase of RA. Combinative therapy had better effect than Himalayan Teasel Root Radix seu Caulis Celastri Orbiculati Scorpion decoction alone.
Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index, time of morning stiffness, average hand strength, VAS score and HAQ index significantly improved after therapy in therapeutic group (P<0.05). Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index and VAS score in control group significantly improved after therapy (P<0.05). Time of morning stiffness, average hand strength and HAQ index didn't have significant improvement after therapy in control group. Total number of articular tenderness, articular tenderness index, number of joint swelling, joint swelling index in therapeutic group improved significantly than control group after therapy (P<0.05). There was no statistical significance in VAS score between two groups.
RF, CRP, ESR levels in both groups decreased after therapy. CRP levels in therapeutic group were significantly decreased in therapeutic group than control group.
There were3patients in therapeutic group and4patients in control group had side effect during therapy. In therapeutic group, one patient had digestive symptoms of nausea and vomiting, epigastic upset and eructation, abdominal distension and diarrhea, these symptoms were relieved after antacid agent administration; one patient had increased transaminase level, and relieved after hepatic protective agent administration; one female patient had amenorrhea. In control group, one patient had singultous and recovered automatically; one patient had increased transaminase level, and relieved after hepatic protective agent administration; two female patients had amenorrhea. All patients did not have server side effect.
Conclusion
Himalayan Teasel Root Radix seu Caulis Celastri Orbiculati Scorpion decoction and combinative therapy with Semen Coicis Carassius Auratus decoction had pronounced therapeutic effect to RA. Combinative therapy has better effect to RA and can be applied to clinical treatment in the mode of Chinese medicine combine with dietary therapy. Side effects between two groups had no statistically significant difference.
引文
[1]娄玉钤.中国风湿病学[M],北京：人民卫生出版社,2001,738-74.
[2]工洪图.工洪图内经讲稿[M],北京：人民卫生出版社,2008,3358-349.
[3]李今庸.李今庸金匮要略讲稿[M],北京：人民卫生出版社,2008,628-72.
[4]汪明忠.类风湿性关节786病机分析[J].新中医,1989,(9)：128-13.
[5]王振亮.从肝论治类风湿关节炎[J].浙江中医药大学学报,2008,32(5)：622-624.
[6]董新民.类风湿关节炎的中医病因病机探讨[J].南京中医药火学学报,1996,12(4)：98-100.
[7]刘渡舟.金匮要略诠解[M],天津：科学技术出版社,1984,49.
[8]焦树德.虺痹的辨证论治[J].中医杂志,1992,3：118-13.
[9]汪红.除痹方法治疗中晚期类风关临床观察[J].山东中医药大学学报,2001,24(2)：107-110.
[10]贾顺利.活血通络启痹汤治疗类风湿性关节炎65例[J].光明中医,2007,22(3)：79-80.
[11]李凤莲,曹子成.顽痹通治疗类风湿关节炎60例疗效观察[J].现代中西医结合杂志,2004,12(6)：739-740.
[12]刘征堂,周学平.清络通痹汤治疗类风湿性关节炎热痹证的临床研究[J].国医论坛,2004,19(2)：23-25.
[13]聂志伟.蚂蚁制剂治疗类风湿关节炎的疗效对比观察[J].辽宁中医杂志,1995,22(7)：304.
[14]韩建中.“顺势伏针法”治疗类风湿性关节炎30例[J].江苏中医,1990,20.
[15]叶玉霞.针灸治疗类风湿关节炎14例[J].针灸临床杂志,2003,21(6)：21.
[16]蒋赛金,范伏元.针灸治疗类风湿性关节炎40例临床观察[J].湖南中医药导报,2003,10：41-42.
[17]冷钮玲.穴位埋线加中药治疗类风湿性关节炎48例[J].时珍国医国药,2000,11(12)：11-12.
[18]段昭侠.脐疗治疗类风湿性关节炎的疗效观察[J].中医外治杂志,2005,14(3)：21.
[19]隋丽,赵晓刚.蒸气透皮法治疗类风湿关节炎57例疗效观察[J].黑龙江医学报,2004,28(9)：703.
[20]岳玉烈.中药药物熏蒸结合温针治疗痹证[J].针灸临床杂志,2005,21(1)：28-30.
[21]刘光珍.通痹洗剂治疗类风湿性关节炎临床观察[J].山西职工医学院学报,2004,14(4)：43-45.
[22]纪英莲.中药外敷治疗活动期类风湿关节炎效果观察[J].护理学杂志,2008,4(23)：7.
[23]曹炜,焦娟,姜泉.复方雷公藤外敷治疗活动期类风湿关节炎的临床疗效观察[J].中华中医药杂志,2007,22(7)：433-435.
[24]徐力.巴斯特关节止痛膏治疗风寒湿性关节痛33例[J].中医杂志,2006,(1)：41.
[25]方红,陆拯.辨治痹的经验[J].浙江中医杂志,2002,11.
[26]曹莎丽,刘宇佳.类风湿性关节炎的饮食护理.中医护理,2005,2(27)：140.
[27]何永生,朱渊红.类风湿性关节炎患者的饮食调养.山西中医,2004,4(20)：58-59.
[28]刘健.类风湿性关节炎患者的食疗保健.第四届世界养生大会论文集,208-209.
[29]何永生.类风湿性关节炎门诊中的病人教育(一).河南中医,2003,23(10)：78-79.
[30]徐志锐,林昌松.饮食起居话类风湿性关节炎.家庭医生中国民间疗法,2009,5(17)： 64.
[31]张爱霞,纪磊,十爱玉.类风湿性关节炎的饮食疗法.内蒙古中医药,2004,23(2)：9.
[32]琪东.类风湿性关节炎的饮食疗法[J].药膳食疗,2004,5(13)：50.
[33]苏冠群.类风湿性关节炎诊疗与护理[M],内蒙占科学技术出版社,2003,19.
[34]J. S. H. Gastonetal. Rheumatology International,1982 Dec, Vol 2, Nr 4:158～ 159.
[35]蒋连泓.类风湿关节炎研究进展[M],天津科学技术出版社,1993,215.
[36]余氏.中药治疗类风湿关节炎研究进展[J].安徽医药杂志,2007,11：458-460.
[37]汪亚东,向月应.类风湿性关节炎患者下丘脑-垂体一肾上腺轴功能检测及其意义[J].国外医学临床生物化学与检验学分册,1997,18(3)：108-110.
[38]李梦涛,姚中强,于孟学.重新评价糖皮质激素对类风湿关节炎的治疗作用及不良反应[J].北京医学,2005,27(12)：748-751.
[39]Hall J,Morand EF, MedbakSetal. Abnormal hypothalamic-pituRary-adrenal axis function inrheumatoid arthritis. Effects of nonsteroidal anti—inflammatory drugs and water immersion P]Arthritis Rheum,1994,37(1136-1137).
[40]蒋万梅,痹病临床研究[M],科学出版社,1995,126.
[41]苏志东.类风湿性关节炎诊断与治疗[M],内蒙古科学技术出版社,2002,41.
[42]纵瑞凯,刘健.类风湿关节炎关节外病变研究进展[J].中医药临床杂志,2010,22(9)：833-836.
[43]张奉春.风湿病学新进展[G],北京：中华医学电子音像出版社,2005,148-15.
[44]董振华.类风湿关节炎的小区预防及健康指导[J].中国全科医学,2002,5(9)：683-684.
[45]张缪佳.风湿性疾病诊断流程与治疗策略[M],北京：科学出版社,2007,18-20.
[46]张新梅.类风湿性关节炎免疫治疗研究进展.医学综述,10(2)：115.
[47]韩星海.生物制剂在类风湿关节炎中的应用.中·华风湿病学杂志,2003,7(5)：3008-301.
[48]赵延红.生物制剂在RA治疗中的应用.陕西中医学院学报,2004,27(2)：69.
[49]鲍春德.类风湿性关节炎治疗的现状及展望.上海医学,2003,26(7)：449.
[50]梁岩,王云.仲景药后护理方法探讨.四川中医,2002,20(4)：18-19
[51]孙思邈著 李景荣等校释.备急千金要方.人民卫生出版社,1997.
[52]施奠邦主编.中医饮食营养学.人卫授权,知音出版社出版,1996.
[53]黄太康.现代本草纲目,北京：中国医药科技出版社,2001,1859-1860.
[54]唐丽香.福建穿山龙抗炎镇痛作用的实验研究[J].海峡药学,2000,12 ( 3)：38-40
[55]肖长虹,顾为望,张嘉宁.昆明山海棠醇提取物对类风湿关节炎滑膜增生和软骨侵蚀及降解作用的抑制作用.南方医科大学学报,2007,27(7)：948-950.
[56]杨蒙蒙,咚丽,陈育尧.昆明山海棠不同提取部位的抗炎作用试验研究.中药新药与临床药理,2004,15(4)：341-343.
[57]杨蒙蒙,咚丽,陈育尧.昆明山海棠乙醇提取物抗炎镇痛作用的试验研究.中医药学刊,2005,23(1)：51-52.
[58]Dirsch VM, Kiemer AK, WagnerH, et al. The triterpenoid quinonemethide pristimerin inhibits induction of inducible nitric oxide synthase in murine macrophages. Eur J Pharmaeol,1997; 336(2-3):216-217.
[59]Isao Ket al. Anti-inflammatory effects of Root of pale Bittersweet. Engl Med,1990; 29(1):338-340.
[60]王蕊,邱明才.单剂量补肾中药防治去卵巢大鼠骨质疏松的骨形态计量学研究[J].天津 医药,1999,273：131-134.
[61]刘崇铭.东亚钳蝎毒及其成分抗癫痫肽的抗癫痫作用.沈阳药学院学报,1989,6(2)：96-97.
[62]李芳,陆苏南,潘励山.蝎毒的身体依赖性实验评价[J].中国药理与毒理学杂志,1997,11(2)：154.
[63]李宁,房春燕,工尊哲.蝎毒镇痛组分对受损神经修复与再生过程超微结构的影响[J].中国临床康复,2004,8(16)：3094-3095.
[64]李宁,吕欣然.蜗毒素-A中枢镇痛作用的研究[J].潍坊医学院学报,1997,19(3)：180-182.
[65]林秋红,李新新,李明媚.辽宁产东亚钳蝎毒的中枢镇痛作用[J].中华中医药学刊,2008,26(5)：1104-1105.
[66]李新新,崔凤芝.辽宁产东亚钳蝎毒对躯体痛作用的影响[J].辽宁中医药大学学报,2006,8(4)：142.
[67]Shao J, Kang N, Liu Y, Song S, et al. Purification and characterizationof an analgesic peptide from Buthus martensii Karsch[J]. BiomedChromatogr,2007,21 (12):1266～ 1271.
[2]工洪图.工洪图内经讲稿[M],北京：人民卫生出版社,2008,3358-349.
[3]李今庸.李今庸金匮要略讲稿[M],北京：人民卫生出版社,2008,628-72.
[4]汪明忠.类风湿性关节786病机分析[J].新中医,1989,(9)：128-13.
[5]王振亮.从肝论治类风湿关节炎[J].浙江中医药大学学报,2008,32(5)：622-624.
[6]董新民.类风湿关节炎的中医病因病机探讨[J].南京中医药火学学报,1996,12(4)：98-100.
[7]刘渡舟.金匮要略诠解[M],天津：科学技术出版社,1984,49.
[8]焦树德.虺痹的辨证论治[J].中医杂志,1992,3：118-13.
[9]汪红.除痹方法治疗中晚期类风关临床观察[J].山东中医药大学学报,2001,24(2)：107-110.
[10]贾顺利.活血通络启痹汤治疗类风湿性关节炎65例[J].光明中医,2007,22(3)：79-80.
[11]李凤莲,曹子成.顽痹通治疗类风湿关节炎60例疗效观察[J].现代中西医结合杂志,2004,12(6)：739-740.
[12]刘征堂,周学平.清络通痹汤治疗类风湿性关节炎热痹证的临床研究[J].国医论坛,2004,19(2)：23-25.
[13]聂志伟.蚂蚁制剂治疗类风湿关节炎的疗效对比观察[J].辽宁中医杂志,1995,22(7)：304.
[14]韩建中.“顺势伏针法”治疗类风湿性关节炎30例[J].江苏中医,1990,20.
[15]叶玉霞.针灸治疗类风湿关节炎14例[J].针灸临床杂志,2003,21(6)：21.
[16]蒋赛金,范伏元.针灸治疗类风湿性关节炎40例临床观察[J].湖南中医药导报,2003,10：41-42.
[17]冷钮玲.穴位埋线加中药治疗类风湿性关节炎48例[J].时珍国医国药,2000,11(12)：11-12.
[18]段昭侠.脐疗治疗类风湿性关节炎的疗效观察[J].中医外治杂志,2005,14(3)：21.
[19]隋丽,赵晓刚.蒸气透皮法治疗类风湿关节炎57例疗效观察[J].黑龙江医学报,2004,28(9)：703.
[20]岳玉烈.中药药物熏蒸结合温针治疗痹证[J].针灸临床杂志,2005,21(1)：28-30.
[21]刘光珍.通痹洗剂治疗类风湿性关节炎临床观察[J].山西职工医学院学报,2004,14(4)：43-45.
[22]纪英莲.中药外敷治疗活动期类风湿关节炎效果观察[J].护理学杂志,2008,4(23)：7.
[23]曹炜,焦娟,姜泉.复方雷公藤外敷治疗活动期类风湿关节炎的临床疗效观察[J].中华中医药杂志,2007,22(7)：433-435.
[24]徐力.巴斯特关节止痛膏治疗风寒湿性关节痛33例[J].中医杂志,2006,(1)：41.
[25]方红,陆拯.辨治痹的经验[J].浙江中医杂志,2002,11.
[26]曹莎丽,刘宇佳.类风湿性关节炎的饮食护理.中医护理,2005,2(27)：140.
[27]何永生,朱渊红.类风湿性关节炎患者的饮食调养.山西中医,2004,4(20)：58-59.
[28]刘健.类风湿性关节炎患者的食疗保健.第四届世界养生大会论文集,208-209.
[29]何永生.类风湿性关节炎门诊中的病人教育(一).河南中医,2003,23(10)：78-79.
[30]徐志锐,林昌松.饮食起居话类风湿性关节炎.家庭医生中国民间疗法,2009,5(17)： 64.
[31]张爱霞,纪磊,十爱玉.类风湿性关节炎的饮食疗法.内蒙古中医药,2004,23(2)：9.
[32]琪东.类风湿性关节炎的饮食疗法[J].药膳食疗,2004,5(13)：50.
[33]苏冠群.类风湿性关节炎诊疗与护理[M],内蒙占科学技术出版社,2003,19.
[34]J. S. H. Gastonetal. Rheumatology International,1982 Dec, Vol 2, Nr 4:158～ 159.
[35]蒋连泓.类风湿关节炎研究进展[M],天津科学技术出版社,1993,215.
[36]余氏.中药治疗类风湿关节炎研究进展[J].安徽医药杂志,2007,11：458-460.
[37]汪亚东,向月应.类风湿性关节炎患者下丘脑-垂体一肾上腺轴功能检测及其意义[J].国外医学临床生物化学与检验学分册,1997,18(3)：108-110.
[38]李梦涛,姚中强,于孟学.重新评价糖皮质激素对类风湿关节炎的治疗作用及不良反应[J].北京医学,2005,27(12)：748-751.
[39]Hall J,Morand EF, MedbakSetal. Abnormal hypothalamic-pituRary-adrenal axis function inrheumatoid arthritis. Effects of nonsteroidal anti—inflammatory drugs and water immersion P]Arthritis Rheum,1994,37(1136-1137).
[40]蒋万梅,痹病临床研究[M],科学出版社,1995,126.
[41]苏志东.类风湿性关节炎诊断与治疗[M],内蒙古科学技术出版社,2002,41.
[42]纵瑞凯,刘健.类风湿关节炎关节外病变研究进展[J].中医药临床杂志,2010,22(9)：833-836.
[43]张奉春.风湿病学新进展[G],北京：中华医学电子音像出版社,2005,148-15.
[44]董振华.类风湿关节炎的小区预防及健康指导[J].中国全科医学,2002,5(9)：683-684.
[45]张缪佳.风湿性疾病诊断流程与治疗策略[M],北京：科学出版社,2007,18-20.
[46]张新梅.类风湿性关节炎免疫治疗研究进展.医学综述,10(2)：115.
[47]韩星海.生物制剂在类风湿关节炎中的应用.中·华风湿病学杂志,2003,7(5)：3008-301.
[48]赵延红.生物制剂在RA治疗中的应用.陕西中医学院学报,2004,27(2)：69.
[49]鲍春德.类风湿性关节炎治疗的现状及展望.上海医学,2003,26(7)：449.
[50]梁岩,王云.仲景药后护理方法探讨.四川中医,2002,20(4)：18-19
[51]孙思邈著 李景荣等校释.备急千金要方.人民卫生出版社,1997.
[52]施奠邦主编.中医饮食营养学.人卫授权,知音出版社出版,1996.
[53]黄太康.现代本草纲目,北京：中国医药科技出版社,2001,1859-1860.
[54]唐丽香.福建穿山龙抗炎镇痛作用的实验研究[J].海峡药学,2000,12 ( 3)：38-40
[55]肖长虹,顾为望,张嘉宁.昆明山海棠醇提取物对类风湿关节炎滑膜增生和软骨侵蚀及降解作用的抑制作用.南方医科大学学报,2007,27(7)：948-950.
[56]杨蒙蒙,咚丽,陈育尧.昆明山海棠不同提取部位的抗炎作用试验研究.中药新药与临床药理,2004,15(4)：341-343.
[57]杨蒙蒙,咚丽,陈育尧.昆明山海棠乙醇提取物抗炎镇痛作用的试验研究.中医药学刊,2005,23(1)：51-52.
[58]Dirsch VM, Kiemer AK, WagnerH, et al. The triterpenoid quinonemethide pristimerin inhibits induction of inducible nitric oxide synthase in murine macrophages. Eur J Pharmaeol,1997; 336(2-3):216-217.
[59]Isao Ket al. Anti-inflammatory effects of Root of pale Bittersweet. Engl Med,1990; 29(1):338-340.
[60]王蕊,邱明才.单剂量补肾中药防治去卵巢大鼠骨质疏松的骨形态计量学研究[J].天津 医药,1999,273：131-134.
[61]刘崇铭.东亚钳蝎毒及其成分抗癫痫肽的抗癫痫作用.沈阳药学院学报,1989,6(2)：96-97.
[62]李芳,陆苏南,潘励山.蝎毒的身体依赖性实验评价[J].中国药理与毒理学杂志,1997,11(2)：154.
[63]李宁,房春燕,工尊哲.蝎毒镇痛组分对受损神经修复与再生过程超微结构的影响[J].中国临床康复,2004,8(16)：3094-3095.
[64]李宁,吕欣然.蜗毒素-A中枢镇痛作用的研究[J].潍坊医学院学报,1997,19(3)：180-182.
[65]林秋红,李新新,李明媚.辽宁产东亚钳蝎毒的中枢镇痛作用[J].中华中医药学刊,2008,26(5)：1104-1105.
[66]李新新,崔凤芝.辽宁产东亚钳蝎毒对躯体痛作用的影响[J].辽宁中医药大学学报,2006,8(4)：142.
[67]Shao J, Kang N, Liu Y, Song S, et al. Purification and characterizationof an analgesic peptide from Buthus martensii Karsch[J]. BiomedChromatogr,2007,21 (12):1266～ 1271.