基于《温病条辨》“热痹”理论探讨成人Still病的病机与防治思路

Exploring the Pathogenesis and Prevention of Adult-Onset Still’s Disease Based on the Theory of “Heat Arthralgia” in the Treatments of Warm Diseases

摘要: 成人Still病(Adult-Onset Still’s Disease, AOSD)是以高峰热、一过性多形性皮疹、关节炎或关节痛为主要临床表现的一组临床综合征，中医辨证为“热痹”。目前，临床诊断指标应用尚不规范，缺乏统一的诊断金标准，对其治疗手段更是缺少系统治法。因其临床表现为高峰热、一过性皮疹和关节炎等症状，同时具有温病和痹症的双重特点，因此本文基于《温病条辨》“热痹”理论，探索AOSD的诊疗思路与中医理论内涵。归纳提出AOSD的邪、虚、瘀三因致痹理论，遵循温病转变规律并结合“三因致痹”论，从“固卫”“散气”“护营”三个角度辨析热痹的治则治法，以期为AOSD的临证提供诊疗思路。

Abstract: Adult-Onset Still’s Disease (AOSD) is a group of clinical syndromes with the main clinical manifestations of peak fever, transient polymorphic rash, arthritis or arthralgia. The syndrome differentiation of traditional Chinese medicine is “heat arthralgia”. At present, the application of clinical diagnostic indicators is not yet standardized, and there is a lack of a unified gold standard for diagnosis and a lack of systematic treatment for its treatment. Because its clinical manifestations are peak fever, transient rash, arthritis and other symptoms, as well as the dual characteristics of febrile disease and arthralgia syndrome, this paper explores the diagnosis and treatment of AOSD and the connotation of traditional Chinese medicine theory based on the theory of “heat arthralgia” in the Treatments of Warm Diseases. The theory of pathogenic factors, deficiency factors and blood stasis causing arthralgia in AOSD is summarized and put forward. Following the transformation law of febrile diseases and combining the theory of “arthralgia caused by three factors”, the therapeutic principles and methods of heat arthralgia are analyzed from the three perspectives of “strengthening health”, “dispersing qi” and “protecting camp”, so as to provide a diagnostic and therapeutic idea for the clinical symptoms of AOSD.