湿热入络病机指导下祛湿降浊饮治疗慢性痛风性关节炎的临证思路探讨

Discussion on the Clinical Approach of Treating Chronic Gouty Arthritis with Qushi Jiangzhuo Yin under the Guidance of Damp-Heat Entering the Meridians

摘要: 基于“湿热入络”病机，探讨笔者自拟的祛湿降浊饮(国家发明专利号ZL202210497323.0)治疗慢性痛风性关节炎思路。慢性痛风性关节炎常伴关节肿痛畸形、痛风石。脾虚湿热是慢性痛风性关节炎常见证型。脾虚失运导致湿浊内生，久则化热、酿痰、成瘀，最终深伏络脉，形成“虚–湿–热–痰–瘀–络阻”的慢性病理链条。脾虚是湿浊内伏的始动与基础，湿热络瘀是络脉损伤的关键环节。祛湿降浊饮的方药组成包括太子参、车前子、茵陈、茯苓、陈皮、丹参、炙甘草，其配伍紧扣病机。以健脾益气治其本，清热利湿与活血通络治其标，体现标本兼顾，祛邪扶正的原则。文章旨在通过分析方药组成与病机的关联，探讨其治疗机制，为临床应用提供理论依据，并为慢性痛风性关节炎辨证论治提供新思路。

Abstract: Based on the pathogenesis of “damp-heat entering the meridians”, this paper explores the idea of treating chronic gouty arthritis with the self-proposed Qushi Jiangzhuo Yin (National Invention Patent No. ZL202210497323.0) by the author. Chronic gouty arthritis is often accompanied by joint swelling, pain, deformity and tophi. Spleen deficiency with damp-heat is a common witness type of chronic gouty arthritis. Spleen deficiency and loss of transportation lead to the internal generation of dampness and turbidity. Over time, this can generate heat, produce phlegm, and form blood stasis. Eventually, it deeply conceals the meridians, creating a chronic pathological chain of “deficiency-dampness-heat-phlegm-blood stasis-blocked meridians”. Spleen deficiency is the initiation and foundation of internal dampness and turbidity, while damp-heat and blood stasis in the meridians are the key links in the damage of the collaterals. The composition of the formula for the Qushi Jiangzhuo Yin includes Pseudostellaria heterophylla, Plantago asiatica seeds, Artemisia capillaris, Wolfiporia extensa, dried tangerine peel, Salvia miltiorrhiza, and honey-fried licorice. The combination of these ingredients closely follows the pathogenesis of the disease. To address the root cause by strengthening the spleen and benefiting qi, and to treat the symptoms by clearing heat and promoting diuresis as well as activating blood circulation and unblocking meridians, the principle of taking both the symptoms and the root cause into account and eliminating pathogenic factors to support the body’s resistance is reflected. This article aims to explore its therapeutic mechanism by analyzing the association between the composition of prescriptions and drugs and the pathogenesis, providing a theoretical basis for clinical application and offering new ideas for the syndrome differentiation and treatment of chronic gouty arthritis.