从“久病入络”探讨痛风性关节炎证治机制

Exploring the Mechanism of Treatment of Gouty Arthritis from “Chronic Diseases Transforming to Collaterals”

摘要: 本文以痛风性关节炎(GA)为研究对象，探讨其中西医发病机制及治疗策略，并重点引入中医“久病入络”理论以指导临床诊治。GA是由尿酸钠晶体沉积引起的炎症性疾病，现代医学认为其涉及免疫紊乱、细胞焦亡等多重机制，常用抗炎及降尿酸药物治疗，但存在不良反应且难以根治。中医将GA归属于“痹证”“白虎历节”等范畴，认为其病机本质为正虚邪恋，湿热痰瘀阻滞经络，符合“久病入络”的病理演变过程。该理论强调病邪由气入血、由经至络的传变特点，指出络脉瘀阻是疾病迁延难愈的关键。文章进一步提出以“活血化瘀通络”为核心的中医治法，并推荐相应中药，旨在为GA的中西医结合治疗提供理论依据与临床新思路。

Abstract: This paper takes gouty arthritis (GA) as the research object, explores the pathogenesis and treatment strategy of traditional Chinese and Western medicine, focuses on the introduction of traditional Chinese medicine theory of “chronic diseases transforming to collaterals” to guide clinical diagnosis and treatment. GA is an inflammatory disease caused by the deposition of acid sodium crystals. Modern medicine believes that it involves multiple mechanisms such as immune disorders and cell pyroptosis, and is usually treated with anti-inflammatory and hypouremic drugs, but there are adverse reactions and it is difficult to eradicate. Traditional Chinese medicine classifies GA into the categories of “bi syndrome”, “white tiger and li jie”, and believes that its pathogenesis is essentially due to deficiency of vital qi and evil addiction, damp-heat phlegm and blood stasis blocking the merians, which conforms to the pathological evolution process of “chronic diseases transforming to collaterals”. This theory emphasizes the transmission characteristics of pathogenic factors from qi to, and from meridians to collaterals, and points out that the blockage of collaterals is the key to the prolonged illness. The paper further proposes the traditional medicine treatment method of “activating blood circulation to remove blood stasis and dredge collaterals” as the core, and recommends the corresponding traditional Chinese medicine, aiming to theoretical basis and new clinical ideas for the combined treatment of GA with traditional Chinese and Western medicine.