基于“分消走泄”理论探讨温胆汤加减应用于湿热蕴结型痛风性关节炎的治疗思路

Exploring the Treatment Ideas of Applying Modified Wendan Decoction in Damp Heat Accumulation Type Gouty Arthritis Based on the Theory of “Elimination of Pathogens through Purgation and Diuresis”

摘要: 痛风性关节炎(gouty arthritis, GA)属中医“痹病”的范畴，以突发关节红肿发热为主要的临床表现。“湿热”是痛风性关节炎致病的重要因素，湿热蕴结型痛风性关节炎是由感受外邪、饮食等因素所导致三焦气机不畅，郁而化热，湿热之邪痹阻经络，致使本病反复发作。叶天士在《温热论》中提出运用“分消走泄”理论治疗湿热病症，亦明确在《外感温热篇》中提出以温胆汤作为其理论治法的代表方药，用于诊治外感湿邪留恋三焦气分之病症。基于此，将“分消走泄”作为湿热蕴结型痛风性关节炎基本的治疗思想，探析温胆汤的药物组方在其治疗运用当中，根据临床病症合理应用温胆汤加减对湿热蕴结型痛风性关节炎的治疗具有重要意义。

Abstract: Gouty arthritis (GA) belongs to the category of “arthromyodynia” in traditional Chinese medicine, with sudden joint redness, swelling, and pain as the main clinical manifestations. “Damp heat” is an important pathological factor in the pathogenesis of gouty arthritis. Damp heat accumulation type gouty arthritis is caused by factors such as feeling external pathogens and diet, which lead to abnormal movement of the Sanjiao and stagnation result in Heat. The evil of damp heat obstructs the meridians, causing the disease to recur. Ye Tianshi proposed the use of the theory of “elimination of pathogens through purgation and diuresis” to treat damp heat diseases in his book “Treatise on Epidemic Febrile Diseases”, and also explicitly stated in his book “Exogenous Warm and Heat” that “Wendan decoction” is a representative prescription of the method, used to treat the evil of external dampness heat and the syndrome of stagnation of the Sanjiao. Based on this, the basic treatment concept of treat damp heat accumulation type Gouty arthritis is to use “elimination of pathogens through purgation and diuresis”, and to explore the drug composition of Wendan decoction in its treatment application. It is of great significance to modify Wendan decoction according to clinical application in the treatment of damp heat accumulation type gouty arthritis.