从“痹证”到“络病”：类风湿性关节炎中医病机演变与新范式

From “Bi Zheng” to “Luo Bing”: A New Paradigm of TCM Pathogenesis in Rheumatoid Arthritis

摘要: 类风湿性关节炎(RA)是一种慢性、系统性、进展性自身免疫疾病，表现为对称性多关节滑膜炎并可累及多系统，严重影响患者生活质量。传统中医学多归属于“痹证”，在祛风除湿、清热通络、活血化瘀、补益肝肾等方面积累了丰富经验，但难以全面揭示RA的复杂病机。近年来提出的“络病”理论，强调络脉损伤、气血失调、痰瘀互结及微循环障碍在慢性顽固性疾病中的关键作用，与现代医学关于免疫失衡、血管内皮功能障碍及炎症因子失衡等机制具有相对应之处，体现出二者在系统调控层面的内在联系。本文系统梳理RA从“痹证”到“络病”的病机演变，整合临床与实验研究证据，提出“络病型痹证”新范式，构建“经络–微循环–免疫–炎症”病机模型，并阐明其在分期辨证、多靶点综合干预及客观化评价体系构建中的指导意义，为RA的中医辨证论治提供更加科学、系统的理论框架与实践路径，并为未来多学科融合和创新疗法开发提供参考。

Abstract: Rheumatoid arthritis (RA) is a chronic, systemic, and progressive autoimmune disease characterized by symmetrical polyarticular synovitis and multi-organ involvement, leading to substantial impairment in patients’ quality of life. In Traditional Chinese Medicine (TCM), RA is primarily classified as “Bi syndrome”, with well-established therapeutic strategies focusing on dispelling wind and dampness, clearing heat, unblocking collaterals, invigorating blood, and tonifying the liver and kidneys. However, this traditional framework alone does not fully capture the complexity of RA pathogenesis. The emerging theory of “Collateral disease” highlights the pivotal roles of collateral vessel injury, Qi-blood dysregulation, phlegm-stasis interlocking, and microcirculatory disturbance in chronic and refractory conditions. These concepts align closely with modern findings of immune imbalance, endothelial dysfunction, microvascular injury, and cytokine dysregulation, revealing an intrinsic convergence between TCM and modern immunopathology. This review systematically traces the evolution of RA pathogenesis from “Bi syndrome” to “Collateral disease”, integrating evidence from clinical and experimental research to propose a novel paradigm— “Collateral-type Bi syndrome.” A mechanistic model of “Meridian - Microcirculation - Immunity - Inflammation” is established, providing new insights into stage-based syndrome differentiation, multi-target integrative interventions, and objective evaluation systems. This paradigm offers a more scientific and systematic framework for TCM management of RA and contributes to interdisciplinary integration and the innovation of therapeutic strategies.