摘要
中医按风、寒、湿、热、燥这五淫病因分类风湿性疾病,热痹即是感受热邪而致的痹病。热痹的病机多寒热夹杂、虚虚实实,临证治疗复杂棘手。中国中医科学院广安门医院保定医院骨科田斌武主任临床多年,治疗热痹证经验丰富。他认为,临床遇寒热错杂、虚实难辨的热痹患者,应详询其病史、诱因,依据舌脉及兼症以辨证论治。田斌武主任强调,如果遇疗效不佳时,要及时反思,更换治疗方向,特别是阳虚久痹患者,绝不是单纯清热即可,要治病求本,兼顾表证和兼证的调节。他提醒临证还需注意避免长期或过用寒凉药物,时刻注意顾护胃气。田斌武主任回归经典,立足实际,透过表证辨别真假、虚实、寒热,活用反治思维,以白虎桂枝汤和桂枝芍药知母汤灵活加减辨证治疗表寒里热、热多寒少之实热痹和真寒假热之虚热痹,获得了满意疗效。文章通过验案两则介绍田主任治疗热痹经验,以期为临床提供参考。
According to the five excesses of wind,cold,dampness,heat and dryness,traditional Chinese medicine classifies arthralgia diseases.Heat impediment is a arthralgia disease caused by the invasion of heat pathogenic factors.The pathogenesis of heat impediment is mixed with cold and heat,deficiency and excess,and the clinical treatment is complex and difficult.TIAN Binwu,a chief physician of the Department of orthopedics,Baoding hospital,Guang’anmen Hospital,Chinese Academy of traditional Chinese medicine,has been treating heat impediment for many years and has rich experience.He believed that in clinical cases of heat impediment patients with mixed cold and heat types,their medical history should be inquired in detail,and they should be treated based on syndrome differentiation according to the pulse condition of the tongue and concurrent symptoms.He stressed that if the curative effect is not good,we should reflect on it in time and change the treatment direction,especially for patients with Yang(阳)deficiency and chronic arthralgia.It is not only necessary to clear away heat,but also to treat the root cause and strive to treat both the exterior and interior.He remindes that the clinical treatment also needs to avoid long-term or excessive use of cold drugs,and always pay attention to regulating stomach Qi(气).Chief Physician Tian uses the Baihu Guizhi decoction(白虎桂枝汤)and the Guizhi Shaoyao Zhimu decoction(桂枝芍药知母汤)to treat heat impediment flexibly and dialectically,and achieves satisfactory results.This article introduces TIAN’s experience in treating heat impediment through two proven cases,in order to provide reference for clinical practice.
出处
《中医临床研究》
2024年第20期112-115,共4页
Clinical Journal Of Chinese Medicine
基金
2021年保定市科学技术研究与发展指导计划项目(2141ZF275)
2021年保定市第一中医院院内师承项目。
关键词
寒热错杂
热痹
名医经验
验案
Cold-heat complex
Heat impediment
Famous doctors’experience
Proven case
