摘要
目的：导师吉海旺教授从事医疗、教学、科研工作30多年,德技双馨,桃李天下。导师存心仁爱,立志以医术活人,平素修身养性,宁静致远,宽待他人。自青年起悬壶济世,遍诊中医杂症,尤其擅长风湿病的治疗,积累了丰富的临床经验。他遵循古方古法,但反对教条的继承,汇通中、西医理论和方法,始终认为在疾病的诊疗中应将辨病与辨证有机结合,中西合参。吉海旺教授擅于将脏腑辨证理论运用于疾病的诊断、治疗,强调脾、肾两脏的功能对疾病发生、演变和预后的重要意义。结合中医理论,积极开展“治未病”工作。
吉海旺教授推崇《黄帝内经》的脏腑辨证思想,在研究、继承前人理论的基础上,通过数十年临床实践和不断的总结、创新,形成了自己以“脾、肾为核心”、“脾、肾论治”的学术思想,提出以“脏腑为经,以气、血、精、津液为纬”的诊疗观点,认为脾、肾两脏对机体活动的重要作用,主要在于对气、血、精、津液功能的影响。在临证中,导师提倡依据疾病的表现,从脾、肾与气、血、精、津液失调中确定症结所在,辨证治疗。
现代医学认为痛风是一组嘌呤代谢紊乱所致的慢性疾病,主要临床特点是体内尿酸产生过多或肾脏排泄尿酸减少,引起血中尿酸升高,形成高尿酸血症以及反复发作的急性痛风性关节炎、痛风石、慢性痛风性关节炎和关节畸形。痛风属于中医“痹证”、“痛风”、“历节病”范畴。在痛风的诊疗中,导师重视脾、肾功能对本病发病各个阶段病理因素的影响,选方施药,均从调理脾胃、顾护肾精出发,补虚、泻实有章有据、灵活恰当。导师认为脾肾亏虚是发病的基础,痰浊、热毒、血瘀是痛风不同阶段的病理因素。治疗采取病证结合的方法,将脏腑辨证和分期论治相结合,将本病按急性期发作期、间歇发作期、慢性稳定期及高尿酸血症分别辨证、立法、设方施治。导师提出急性痛风性关节炎归属“湿热瘀毒证”,邪热炽盛,痰浊瘀滞是急性痛风性关节炎的病机关键,痰浊、热毒、血瘀是重要的病理因素。治疗原则为“急则治其标”,有攻邪存正之意,从泻火解毒、祛湿通络立法,创立了“息痛散”方,对急性痛风性关节炎的治疗有满意的疗效。
论文旨在全面地学习和传承导师的学术思想和经验,对导师治疗痛风的临床经验进行系统性研究,并通过导师治疗急性痛风性关节炎的经验方“息痛散”的对比研究,为导师治疗痛风的临床经验及运用“息痛散”治疗急性痛风性关节炎提供实验研究依据。
方法：对导师的学术渊源和学术思想进行探讨、总结；收集导师治疗痛风病例150例,对导师治疗痛风的临床经验进行回顾性研究,通过对痛风各期病证、基础方及用药特点的统计分析,验证导师分期、分证辨治痛风的经验及用药规律；对导师经验方“息痛散”治疗急性痛风性关节炎“湿热蕴结证”进行临床研究,采用随机、开放、对照的方法,设“息痛散”治疗组、痛风定组、双氯芬酸钠组,对各组治疗前后关节指数、中医证候以及实验指标进行对照分析,并对治疗后安全性进行评价。
结果：①导师辨治痛风经验研究结果痛风各期病证规律：无症状高尿酸血症期,脾虚湿阻证占83.3%；急性期发作期,湿热瘀毒证占80.7%；间歇发作期,阴虚血瘀证占57.1%；慢性期,脾肾亏虚,痰瘀痹阻证占56.2%,与其他证差异显著,P<0.05。
处方研究结果显示：无症状高尿酸血症期治法健脾清热除湿,健脾化湿方为基础方(占60.5%)；急性期治法泻火解毒、祛湿通络,息痛散为基础方(占80.7%)；间歇发作期治法滋补肝肾、活血通络,解毒化瘀汤为基础方(占60%)；慢性期治法益肾健脾、活血化痰,以风湿2号为基础方(占65%),与使用的其他方剂比较,有统计学差异,P<0.05。
用药特点研究,生石膏主要用于痛风急性期治疗(占86.5%),用量在50至70克之间(65%),P<0.05。
②“息痛散”临床研究结果“息痛散”在缓解急性痛风性关节炎湿热蕴结证关节疼痛、减轻关节红肿、降低关节肿痛综合指数方面有显著疗效,与双氯芬酸钠组无统计学差异(P>0.05),优于痛风定组(P<0.05)；在降低中医证候量化评分、中医证候疗效上,明显优于对照组(P<0.01),中医证候总有效率为95.2%；“息痛散”能有效降低炎性指标(ERS、CRP),与双氯芬酸钠组有无统计学差异(P>0.05),明显优于痛风定组(P<0.01)。治疗前后各组UA水平无显著降低；治疗组未出现副作用。
结论：①推崇脏腑辨证、注重脾、肾辨治是导师学术思想的集中体现。
②脾虚湿阻证、湿热瘀毒证、阴虚血瘀证,脾肾亏虚,痰瘀痹阻证是导师治疗痛风不同期的代表病证；健脾化湿方、息痛散、解毒化瘀汤、风湿2号片分别是导师治疗痛风不同期的代表方剂。使用生石膏量大力专,是导师治疗急性痛风性关节炎的特点。
③导师的经验方“息痛散”治疗急性痛风性关节炎湿热蕴结证,在缓解急性痛风性关节炎的关节疼痛、减轻关节红肿程度方面与西药对照组相当,对包括改善发热、口干苦等中医证候方面有明显优势,并能有效降低炎症指标血沉(ESR)、C-反应蛋白(CRP),未发现不良反应及明显的毒副作用,安全、有效。推测本方可能有抗炎和免疫抑制作用、镇痛作用、有效改善炎症组织的微循环作用,其机理还有待进一步的研究论治。
虽然目前从脾肾治疗痛风已取得一定疗效,但在降低尿酸水平、防止尿酸波动、预防复发以及中药剂型改进等方面还有待提高。笔者认为注重肝、脾、肾同治可能会收到更理想的效果。从肝、脾、肾调治治疗是痛风今后进一步研究和思考的着基点。
Objective:Profenssor Ji Haiwang has undertaken the work of medical treatment, teaching and scientific research for30years. He is a person of good quality and excellent skills, with thousands of students. Profenssor Ji Haiwang is so kind-hearted that he makes up his mind to save people from diseases. He always cultivates his mind in daily life so that he is so broad-minded and tolerant with other people.He helps to treat miscellaneous diseases since he was young, especially rheumatism. He has accumulated rich clinical experience. He follows the ancient prescriptions and methods, but never rigidly adhere to the doctrine. On the contract, he uses both traditional and western medicine theories and methods while treating. He holds the view that disease and syndrome should be integrated properly, which is called "Integrated Chinese and Western Medicine". Also, he is very good at using the visceral syndrome differentiation to diagnose and treat diseases. He emphasizes the great significance of the function of the spleen and kidney during the occurrence and change of diseases as well as prognosis. Through combining the theory of TCM, he carries out actively the work of "Prevention Theory".
Profenssor Ji Haiwang speaks highly of the idea of the visceral syndrome differentiation in Huang di's Canon of Medicine. After years'of clinical experience and continuous summaries and creation, he forms his own academic thought that the treatment of the spleen and kidney which takes the spleen and kidney as key based on studying and inheriting ancient physician's theories. He puts forward the view that viscera is meridian, and qi, blood, essence, body fluid are collaterals. Also, he thinks that the spleen and kidney play an important role in the activities of body. The function of them lies in the influence on qi, blood, essence and body fluid. For example, we can treat rheumatoid arthritis by treating kidney, treat digestive disorders and respiratory diseases by treating the spleen.
Modern medicine considers gout as a kind of chronic disease caused by metabolic disorder of a group of purine. Its main clinical character is the excessive production of uric acid in the body or the reductive excretion of uric acid in the kidney, causing high concentration of uric acid in the blood and the formation of hyperuricemia, repeated attacks of acute gouty arthritis, gouty tophus, chronic gouty arthritis and joint deformity.
Gout pertains to "BiZheng","TongFeng","LiJiebing" in traditional Chinese medicine (TCM). While diagnosing and treating the gout, attention must be paid to the influence of the function of the spleen and kidney to the pathogenic factors at all stages. Both selecting the prescription and applying the medicine are based on regulating the spleen and stomach and protecting kidney essence. Tonifying deficiency and reducing excess are reasonable and flexible. Profenssor Ji Haiwang thinks gout has a close relationship with the kidney and spleen. Phlegm stagnation, toxic heat, blood stasis, deficiency of healthy qi are the pathogenic factors of gout at different stages. The treatment of gout adopts the method of combination of disease and syndrome, that is to say, the combination of visceral syndrome differentiation with treatment of different phases. Gout can be divided into the following four phases:acute phase, intermittent phase, chronically stabilized phase and hyperuricemia. Profenssor Ji Haiwang considers that acute gouty arthritis pertains to toxic dampness heat syndrome.Exuberant pathogenic heat and stagnated phlegm are the key pathogenesis to it. Phlegm stagnation, toxic heat, blood stasis are important pathogenic factors. The therapeutic principle "relieving the secondary symptoms first in treating acute disease" means to attack pathogenic factor and protect healthy qi. By inducing fire to detoxicate poison and expelling dampness to smooth collaterals, he created the prescription named "Powder for Relieving Pain ",which has a satisfying effect on the treatment of acute gouty arthritis.
The passage tries to learn and inherit the academic thought and experience on the whole and systematically studies the clinical experience on treating the gout. Through the comparative study among the experienced prescription "Powder for Relieving Pain" used to treat gouty arthritis, Chinese patent drug "Tong Feng Ding" and diclofenac sodium, we mean to provide experimental research data for professor to treat acute gouty arthritis by using "Powder for Relieving Pain"
Method:We summary and study the academic origin and thought;collect150cases gouty patients treated by professor; do a statistical analysis about the syndrome, fundamental prescription, and the usage of the gypsum; discuss the clinical experience about the differentiation treatment of gout at different phases. According to the clinical research of the experienced prescription "Powder for Relieving Pain" in treating toxic dampness heat syndrome of professor.We adopt a random, open, contrasted method. We divide the patients into three groups as follows:the "Powder for Relieving Pain" group, the Tong Feng Ding group, the diclofenac sodium group. We analysis the joint index, TCM syndrome and criterion of test in the three groups and evaluate the safety.
Results:The syndrome differentiation and treatment research of gout shows that deficiency of spleen and dampness retention are the main syndromes in the high uric acid hematic period(83.3%);toxic dampness heat pathogenesis is the main syndrome in the acute period(80.7%); yin deficiency and blood stasis are the main syndromes in the intermittent period(57.1%); deficiency of spleen and kidney and phlegm stasis are the main syndromes in the chronic period(56.3%). It's better to treat the disease by strengthening the spleen and clearing away the dampness in the high uric acid hematic period without symptoms. In this period, strengthening the spleen and clearing away the dampness is the fundamental prescription(65.6%). In the acute period, Xi Tong Powder is the fundamental prescription(60%), but it's better to clear away heat to remove toxin and dispel dampness to smooth the collaterals. In the intermittent period, the decoction of removing toxin and eliminating stasis is the fundamental prescription(60%), but it's better to nourish and tonify liver and kidney, activate the blood to smooth the collaterals. In the chronic period, NO.2gout is the fundamental prescription(65%), but it's better to benefit kidney and strengthen the spleen, and activate blood to remove phlegm. Gesso is frequently used in the acute period(86.5%) and the dosage is from50g to70g.(80%), p<0.05.
The clinical research shows that "Powder for Relieving Pain" has a significant effect in alleviating joint pain, reducing joint swelling and pain. There is no statistical differences (p>0.05) compared with the diclofenac sodium group. And it's superior to the Tong Feng Ding group (p<0.05). The total effectiveness rate of TCM is95.2%. Thus, it's clear that "Powder for Relieving Pain" is superior to the control group (p<0.01) in reducing the quantitative score of the TCM syndrome."Powder for Relieving Pain" can effectively reduce the inflammatory index (ERS, CRP). There is no statistical differences (p<0.05) compared with the diclofenac sodium group. And it's superior to the Tong Feng Ding group (p<0.05). The level of UA doesn't decrease obviously. There is no side effect in the treatment group.
Conclusion:Profenssor Ji Haiwang speaks highly of the visceral syndrome differentiation and his academic thought focus on spleen and kidney treatment. Spleen deficiency, toxic dampness heat, yin deficiency and blood stasis, spleen and kidney deficiency and phlegm stasis are the typical syndromes in treating the gout. Strengthening spleen to remove dampness,"Powder for Relieving Pain", the decoction of removing toxin and eliminating stasis, NO.2gout pill are the typical prescriptions used to treat gout in different phases. The high dosage of gypsum is also the characteristic in treating acute gouty arthritis.
Professor's experienced prescription "Powder for Relieving Pain" has almost the same effect with the control group in alleviating joint pain and reducing joint swelling and pain. Its apparent advantages are improving fever, bitter and dry mouth and it can reduce the inflammation index blood sedimentation (ERS), C-reactive protein (CRP). There is no adverse reaction and side effect. On the contrary, it's safe and effective. It's predicted that this prescription may have the function of anti-inflammatary, immune-inhibition action, analgesic action and the effective improvement of the microcirculation of the inflammatory tissue. The mechanism needed to be studied and discussed further.
Although we have made progress in treating gout through the treatment of spleen and kidney, it still should be improved in reducing the uric acid level in order to prevent fluctuation of the uric acid level and recurrence. TCM dosage forms still need to be improved. The author thinks that we may get an ideal effect if the disease is treated through the treatment of liver, spleen and kidney. Researchers should make a further study to treat gout through the treatment of liver, spleen and kidney.
引文
[1]李东垣,文魁,丁国华整理.脾胃论.北京：人民卫生出版社,2005.P44.
[2]李中梓.医宗必读.天津：天津科学技术出版社,1999,P82.
[3]张景岳.张景岳医学全书.北京：中国中医药出版社,1999：P269.
[4]欧阳新.运用补中益气汤治疗疑难杂症经验.中医药导报.2011,17(7)：14-15.
[5]郑桂明.攻补兼施治疗肝硬化腹水探析.浙江中医药大学学报.2006,30(4)：399-400.
[6]谢席胜.冯志荣主任医师治疗疑难杂症经验简析.中医药学刊.2006,24(2)：211.
[7]韩雨航,冯晓纯.南征教授治疗疑难杂证的验案.世界中西医结合杂志.2008,3(1)：11-12.
[8]焦树德.诊治类风湿关节炎的体会.中医杂志,1982.(1)：16-19.
[9]占宏伟,项柏康,陈芝芸,等.肠易激综合征不同中医证型前列腺素E2和环核苷酸的变化及意义.浙江中医学院学报,2000,24(3)：16-19：
[10]周健伟,张凡,肖鸣.药条灸对脾虚证患者血清胃泌素、D木糖排泄率及T细胞亚群的影响.中国针灸,1998,18(1)：15.
[11]Jianqing Zhuang, Ruixin Guo。 "kidney producingmedul-la"and functions of central nervous system中医临床康复,2003,9(22):3029.
[12]朱飞鹏,李冬华.肾主骨理论的现代理解与补肾法研究.上海中医药杂志.2003,37(6)：10.
[13]程士德,孟景春.黄帝内经讲义.上海：上海科学技术出版社,1985.P37
[14]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P739.
[15]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P41.
[1]程士德,孟景春.黄帝内经讲义.上海：上海科学技术出版社,1984.P175.
[2]马烈光,张新渝主编.黄帝黄帝内经·素问.成都：四川科学技术出版社,2008.P57-58.
[3]李培生,刘渡舟.伤寒论讲义.上海：上海科学技术出版社,1984.P161.
[4]程士德,孟景春.内经讲义.上海：上海科学技术出版社,1985.P37
[5]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P739.
[6]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P41.
[7]吉海旺,姚淑莲,罗强,等.补肾活血法为主治疗类风湿性关节炎43例临床观察.中医杂志,2001,22(1)：609-610.
[8]衣蕾,雷瑗琳.吉海旺治疗类风湿性关节炎经验.中国中医基础医学杂志,2010，16(7)：582：-583.
[9]雷瑗琳,衣蕾.虚瘀同治论治类风湿性关节炎心脏损害临床经验.陕西中医,2010,31(2)：200-201.
[10]吉海旺,姚淑莲.浅论调补脾胃法的临床应用.陕西中医,2002,22(1)：29-30.
[11]雷瑗琳.吉海旺主任医师治疗慢性胃炎痞满证临床经验.陕西中医,2010,31(12)：1642-1643.
[12]雷瑗琳.吉海旺主任治疗咳嗽经验.陕西中医,2011,32(3)：315-317.
[13]雷瑗琳,吉海旺.吉海旺治疗痛风经验.中医杂志,2011,52(12)：1062-1063.
[14]程士德,孟景春.黄帝内经讲义.上海：上海科学技术出版社,1984.P175.
[15]灵枢经.北京：人民卫生出版社,1956.P24.
[16]李东垣.文魁,丁国华整理.脾胃论.北京：人民卫生出版社,2005.P63-65
[17]李东垣.文魁,丁国华整理.脾胃论.北京：人民卫生出版社,2005.P63-62
[18]李梃.何永,韩文霞校注.医学入门.北京；中国医药科技出版社,2011.P67.
[19]巢元方等.丁光迪主编.诸病源候论.北京：人民卫生出版社,1991.P420.
[20]周健伟,张凡,肖鸣.药条灸对脾虚证患者血清胃泌素、D木糖排泄率及T细胞亚群的影响.中国针灸,1998,18(1)：15.
[21]陈芝喜,刘小斌,周名璐等.健脾补肾药对脾虚大鼠细胞因子水平的影响.放射免疫学杂志,2003,16(4)：217-219.
[22]杨冬花,李家邦,郑爱华等.脾气虚证模型大鼠Th1/Th2细胞因子的失衡以及四君子汤的干预作用.中国医师杂志,2004,6(2)：181-183.
[23]程士德,孟景春.黄帝内经讲义.上海：上海科学技术出版社,1985.P125.
[24]程士德,孟景春.黄帝内经讲义.上海：上海科学技术出版社,1985.P43.
[25]程士德,孟景春.黄帝内经讲义.上海：上海科学技术出版社,1985.P29.
[26]灵枢经.北京：人民卫生出版社.1956.P80.
[27]程国彭,王键,郜峦校注.医学心悟.北京：中国中医药出版社.2009.P186.
[28]王承德,沈丕安,胡荫奇主编.实用中医风湿病学.北京：人民卫生出版社,2009.P583-584.
[29]Hochberg MC,SilmanAJ,Smolen JS,et al.Rheumatology[M].3rd ed. New York:Mosby,2003.
[30]范国荣,宗文九,朱方石,等.老年人肾虚的T细胞亚群及对免疫调控的影响.中国中西医结合杂志1992,12(8)：478.
[31]朱萱萱,丁杨,倪文澎等.补肾活血方对肾阴虚小鼠免疫功能的实验研究中华中医药学刊,2009,27(2)：297-298.
[32]李东垣.文魁,丁国华整理.脾胃论.北京：人民卫生出版社,2005.P8.
[33]冯世纶,张长恩.金贵要略传真.北京：人民卫生出版社,2010.P76.
[34]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P27.
[35]张介宾.李继明,王大淳等整理.景岳全书.北京：人民卫生出版社,2007.P719-720.
[36]龚延贤.张效霞整理.万病回春.北京：人民卫生出版社,2007.P306.
[37]张介宾.李继明,王大淳等整理.景岳全书.北京：人民卫生出版社,2007.P261.
[38]李梃.何永,韩文霞校注.医学入门.北京；中国医药科技出版社,2011.P66.
[39]巢元方等.丁光迪主编.诸病源候论.北京：人民卫生出版社,1991.P314.
[40]陈锦芳,吴成,柳丽娟.慢性乙型肝炎湿热蕴脾证和脾胃气虚证与TNF-α及IL-6相关性研究.中国中西医结合杂志,2003,23(1)：28-31.
[41]陈锦芳,李丹,潘晨,等.慢肝湿热蕴脾证血瘀的研究.福建中医学院学报,2000,10(3)：35.
[42]吉海旺,姚淑莲.中医学结合治疗痛风性关节炎37例.中国中医药信息杂志.1996,3(特集)：118-120.
[43]黄彦弘,吕艳伟,李东,等.痛风的临床危险因素Logistic研究.Chinese Cenreal Practice,2011,13(1):52-56.
[44]莫蓉,梁柳琴,叶玉津等.痛风性关节炎262例临床分析及诊治体会.国际内科学杂志.2008,35(5)：249-251.
[45]雷瑗琳,吉海旺.吉海旺治疗痛风经验.中医杂志,2011,52(12)：1062-1063.
[46]王焘.王淑民校注.外台秘要方.北京：中国医药科技出版社,2011.P219.
[47]朱震亨.王英,竹剑平,江凌圳整理.丹溪心法.北京；人民卫生出版社,2005.P213.
[48]雷瑗琳,吉海旺.吉海旺治疗痛风经验.中医杂志,2011,52(12)：1062-1063.
[49]吉海旺,姚淑莲.中医学结合治疗痛风性关节炎37例.中国中医药信息杂志.1996,3(特集)：118-120.
[50]于征淼,陈 晶,刘志辉等.清瘟败毒饮对兔全身炎症反应综合症IL-1、6、10、18、TNF-α、IFN-γ的影响.中药药理与临床2009；25(1)：3-6.
[51]刘甘泉,姚愈忠,张金梅.石膏注射液中枢镇痛作用的实验研究.中药药理与临床,1995(5)：22.
[52]忽思慧.刘光华校注.饮膳正要.北京.中国医药科技出版社,2011.P29.
[53]高颖,房德敏.骨碎补黄酮类化合物的研究进展与开发前景.中草药,2009,40(2)：323-326.
[54]陈军梅.清热活血通痹汤治疗活动期类风湿性关节炎30例.陕西中医,2007,28(8)：1009-1010.
[55]程士德,孟景春.黄帝内经讲义.上海：上海科学技术出版社,1984.P181.
[56]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P287.
[57]清.程国彭撰,王键,郜峦校注.医学心悟.北京：中国中医药出版社.2009.P3.
[58]唐.孙思邈著,焦振廉等校注.备急千金要方.北京：中国医药科技出版社,2011.P3.
[59]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P35.
[60]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P374.
[61]雷瑗琳,吉海旺.吉海旺治疗痛风经验.中医杂志,52(12)：1062-1063.
[62]郑志忠.难治性风湿病.上海：上海科学技术出版社,2007.P256.
[1]王承德,沈丕安,胡荫奇.实用中医风湿病学.北京：人们卫生出版社,2009：P585.
[2]国家中医药管理局.中医病证诊断疗效标准[S].南京：南京大学出版社,1994：P50-51.
[3]国家中医药管理局.中医病证诊断疗效标准[S].南京：南京大学出版社,1994：P50.
[1]吉海旺.中医学结合治疗痛风性关节炎37例.中国中医药信息杂志.1996,3(特集)：118-120.
[2]郑志忠.难治性风湿病.上海：上海科学出版社.2007.P257.
[3]国家中医药管理局.中医病证诊断疗效标准[S].南京：南京大学出版社,1994：P46.
[4]国家中医药管理局.中医病证诊断疗效标准.南京：南京大学出版社,1994：P50.
[5]郑筱萸.中药新药临床研究指导原则.北京：中国医药科技出版社,2002：P128.
[6]缪希雍.李玉清,成建军主校.神农本草经疏.北京：中国医药科技出版社.2011.P72
[7]陶弘景.尚志钧辑校,名医别录.北京；人民卫生出版社.1986.P104.
[8]陈士铎.本草新编.太原；山西科学技术出版社,2011.P229.
[9]陈士铎.本草秘录.太原；山西科学技术出版社,2011.P25l
[10]倪朱谟.戴慎,陈仁寿,虞舜点校.本草汇言.上海；上海科学技术出版社,2005.P478
[11]李时珍；柳长华,柳璇校注.本草纲目.北京；中国医药科技出版社,2011.P697.
[12]张仲景.何任等整理.金匮要略.北京；人民卫生出版社,2005.P44.
[13]李梃.何永,韩文霞校注.医学入门.北京；中国医药科技出版社,2011.P167.
[14]危亦林.金芬芳校注.世医得救方.北京；中国医药科技出版社,2011.P184-185.
[15]张璐.本经逢原.北京；中国医药科技出版社,2011.P147.
[16]贾所学.张瑞贤等校注.药品化义.北京；学苑出版社,2011.P44
[17]张山雷.程东旗点校.本草正义.福州；福建科学技术出版社,2006.P105.
[18]张介宾.李继明,王大淳等整理,景岳全书.北京：人民卫生出版社,2007.P689.
[19]兰茂原.于乃义,于兰馥整理主编,滇南本草.昆明；云南科学技术出版社,2004.P578.
[20]周莉.痛风的发病机制.医学综述,2007,13(21)：1626.
[21]李灿东,李延平,俞洁.高尿酸血症中医证素特点的临床研究.中华中医药学会第九次中医诊断学术会议论文集.60-63.
[22]李东晓,迟家敏.高尿酸血症与代谢综合征.国外医学·内分泌分册,2004,24(6)：P386-388.
[23]董汉良.试谈痰瘀相关.中医杂志,1998；(9)：7-10.
[24]宋剑南,刘东远,牛晓红,等.高脂血症与中医痰浊关系的实验研究.中国中医基础医学杂志,1995,1(1)：49-51.
[25]宋剑南.从生物化学角度看痰及痰瘀相关.中国中医基础医学杂志,2000：3(3)：40-43.
[26]王琦,叶加农.肥胖人痰湿型体质的血液流变学及甲皱微循环研究.中国中医基础医学杂志,1995：1(1)：52.
[27]李佃贵,李峻峡,李振彬,等.冠心病患者冠脉病变程度与中医证型的关系.中国中医药信息杂志,2001：8(12)：57-58.
[28]江波,杨崇青,曹克光.痰瘀毒虚与痛风机制的关系探讨.中国中医基础医学杂志,2011,32(4)：13-14.
[29]王殿俊,等.热毒血瘀证动物模型的研制.南京中医学院学报1992；8(1)：18-21.
[30]邵沛,黄星涛,张帆.痛风急性发作期中医辨证分型与血流变及血小板活化功能关系的研究.广州医药,2006,37(5)：65-68.
[31]潘媛,徐立,时乐等.痛风性关节炎的发生与尿酸盐结晶沉积.安徽医药,2009,13(11)：1307.
[32]李彤,赵亮,张智伟,等.中医痛风与西医痛风性关节炎相关性研究.长春中医 药大学学报,2009,25(3)：343-4.
[33]张永生.姜良铎教授治疗痛风经验.北京中医药大学学报,2002,25(2)：61-62.
[34]王焘.王淑民校注.外台秘要方.北京：中国医药科技出版社,2011.P48.
[35]杨进,陆平成.家兔“热毒血瘀证”系列动物模型.南京中医药大学学报,1995,11(2)：70.
[36]梁爱华,黄璐琦,于长安,等.LPS/Ca诱导血栓形成与血瘀证病证结合模型的炎症机制.中国中药杂志,2007,32(1)：45-47.
[37]王雄彪.发热研究的新近展.中华医学信息报,1999(13)：3-5.
[38]关雪峰,刘元禄.清热解毒方药对兔膝急性痛风性关节炎细胞因子TNF-α和IL-1 β·影响的实验研究.中华中医药学刊,2009,27(4)：829-831.
[39]方策,刘元禄,张治宇.清热祛湿法对实验性痛风兔膝关节液IL-Iβ、TNF-α水平的影响.中医正骨,2002,14(4)：6-8.
[40]王秀华,张治宇,侯斌,等.清热祛湿法对兔膝关节急性痛风性关节炎细胞因子IL-1β和NO的影响.中医正骨,2001,13(4)：3-5.
[41]金晨宇,孙梅,温成平等.祛浊通痹颗粒对急性痛风模型炎症因子的调节作用.中草药,2007,38(8)：1223-1225.
[42]黄建华,陈金春,黄建武等.清热祛湿通痹法对急性痛风性关节炎IL-1、IL-6、IL-8的影响.中医正骨,2008,20(8)：5-7.
[43]周敏,李翠云,段淑.痹清胶囊对痛风性关节炎大鼠IL-1β、IL-8影响的实验研究.中国中医药科技,2008,15(5)：371.
[44]谢宗万.全国中草药汇编.第2版.北京：人民卫生出版社,1994.259.
[45]Fushimi Hirotoshi, Oda Shinobu, Ito Takashi, et al. Quantitative analysis of Chinese crude drug, Shigao (Gypsum) extract by atomic absorption spectrometry[J]. Journal of TraditionalMedicines,2005,22 (1):24-28.
[46]柳诗全.不同比例石膏知母配伍对Ca2+浓度关系.医药论坛杂志,2007,26(14)：24-26.
[47]谭兴贵.白虎汤作用机理研究.湖南医学杂志,1980(3)：54.
[48]于征淼,陈晶,刘志辉,等清瘟败毒饮对兔全身炎症反应综合症IL-1、6、10、18、TNF-α、IFN-γ的影响.中药药理与临床2009,25(1)：3-6.
[49]刘禄江.类风湿性关节炎分期辨治.2008全国中医药“名院、名科、名医、名 店、名药、名厂”品牌发展战略论坛
[50]夏建龙.周福贻教授治疗痛风性关节炎的经验.江苏中医,2000,21(12)：22.
[51]邱全瑛,谭允育,赵岩松,等.黄柏和小檗碱对小鼠免疫功能的影响.中国病理生理杂志,1996,24(6)：610.
[52]吕燕宁,邱全瑛.黄柏对小鼠DTH及其体内几种细胞因子的影响.北京中医药大学学报,1999,22(6)：48.
[53]杨澄,朱继孝,王颖,等.盐制对黄柏抗痛风作用的影响.中国中药志,2005,30(2)：145.
[54]周德文,周立勇.术类的药理和药效[J].国外医药-植物药分册,1996,11(3)：120-122.
[55]许立,倪正,方泰惠,等.苍术胶囊抗炎免疫作用研究.陕西中医,2005,26(7)：721.
[56]李育浩,梁颂名,山原条二,等.苍术的抗缺氧作用及其活性成分.中药材,1991,14(6)：41.
[57]Yamahava J. Chem Pharm Bull,1990,38(7):2033.
[58]刘甘泉,姚愈忠,张金梅.石膏注射液中枢镇痛作用的实验研究.中药药理与临床,1995,(5)：22.
[59]李学林,李威,陈国华,等.牛膝活血作用的实验研究.中医研究,1990,3(2)：27.
[60]陈红,石圣洪.中药川、怀牛膝对小鼠微循环及大鼠血液流变学的影响.中国微循环,1998,2(3)：182.
[61]孙备,吕凌,陆忠祥,等.三妙丸中牛膝对关节炎大鼠引药作用的机制研究.中国中药杂志,2008,33(24)：2946.
[62]王勇.二妙散对类风湿关节炎大鼠抗炎免疫效果研究.中国民族民间医药(论著).2010,18：24.
[63]许立,倪正,方泰惠,等.苍术胶囊抗炎免疫作用研究.陕西中医,2005,26(7)：721.
[64]许伏新,侯士良.三妙散镇痛抗炎作用的实验研究.基层中药杂,1999,13(1)15-17.
[65]杨澄,朱继孝,王颖,等.盐制对黄柏抗痛风作用的影响.中国中药杂志,2005,30(2)：145.
[1]郭姣,朴胜华,贝伟剑.再论肝在高脂血症发病中的地位和作用.新中医,2011,43(2)：1-3.
[2]闫琰.精神因素对消渴的重要影响.光明中医,2008,23(12)：1994.
[1]陶弘景.陶弘景集,尚志钧辑校.名医别录.北京：人民卫生出版社,1986.P38.
[2]张丽君,丁侃校注.医学正传.北京：中国医药科技处版社,2011.P140.
[3]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P370.
[4]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P374.
[5]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P295.
[6]灵枢经.北京：人民卫生出版社,1956.P62.
[7]灵枢经.北京：人民卫生出版社,1956.P108.
[8]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P27.
[9]灵枢经.北京：人民卫生出版社,1956.P95.
[10]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P374.
[11]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P374.
[12]灵枢经.北京：人民卫生出版社,1956.P95.
[13]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P377.
[14]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P231.
[15]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P370.
[16]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P298.
[17]马烈光,张新渝主编.黄帝内经·素问.成都：四川科学技术出版社,2008.P377.
[18]李克光,杨百葬.金匮要略讲义.上海：上海科学技术出版社,1985.P61-63.
[19]巢元方.丁光迪主编.诸病源候论.北京：人民卫生出版社,1991.P40.
[20]巢元方.丁光迪主编.诸病源候论.北京：人民卫生出版社,1991.P28.
[21]孙思邈.焦振廉等校注.备急千金要方.北京：中国医药科技出版社,2011.P153.
[22]孙思邈.焦振廉等校注.备急千金要方.北京：中国医药科技出版社,2011.P153.
[23]王焘.王淑民校注.外台秘要方.北京：中国医药科技出版社,2011.P219-220.
[24]唐.王焘著,王淑民校注.外台秘要方.北京：中国医药科技出版社,2011.P219.
[25]张从正.王雅丽校注.儒门事亲.北京：中国医药科技出版社,2011.P6.
[26]朱震亨.王英,竹剑平,江凌圳整理.丹溪心法.北京：人民卫生出版社,2005.P211.
[27]朱丹溪著.格致余论.局方发挥.北京：中国医药科技出版社,2011.P23.
[28]朱震亨.王英,竹剑平,江凌圳整理.丹溪心法.北京：人民卫生出版社,2005.P211-212.
[29]李东垣.文魁,丁国华整理.脾胃论.北京：人民卫生出版社,2005.P4.
[30]李东垣.文魁,丁国华整理.脾胃论.北京：人民卫生出版社,2005.P64.
[31]李东垣.文魁,丁国华整理.脾胃论.北京：人民卫生出版社,2005.P65.
[32]李东垣.文魁,丁国华整理.脾胃论.北京：人民卫生出版社,2005.P40-41.
[33]顾靖远.顾松园医镜.郑州；河南科技出版社,1986.P58.
[34]叶天士.宋白杨校注,吴少祯主编.临证医案指南.北京：中国医药科技出版社,2011.P219.
[35]王肯堂.余瀛鳌,林菁等编选.证治准绳精华本.北京；科学出版社,1998.P124.
[36]尤怡.张印生等校注.金匮翼.北京；中医古籍出版社,2003.P148.
[37]叶天士.宋白杨校注,吴少祯主编.临证医案指南.北京：中国医药科技出版社,2011.P252.
[38]姚祖培,陈建新.朱良春治疗痛风的经验.中医杂志,1989,30(3)：16.
[39]张钟爱,钱伟.从湿论治痛风病的体会.江苏中医药,2006,27(4)：28.
[40]陆艳萍,舒荣,崔刘福.补肾健脾利湿法治疗高尿酸血症临床观察.中国中医基础医学杂志,2005,11(7)：557.
[41]吴志财.中医辨证分期治疗痛风性关节炎36例.中医研究,1999,12(2)：22.
[42]谢明,李威.中成药治疗痛风病现状调查.辽宁中医杂志,2006,33(4)：461-462.
[43]王兆明.中国中西医结合风湿病学.北京：中医古籍出版社,1997.P480.
[44]王袁志,王隆川.痛风性关节炎治疗体会.黑龙江中医药,2001,(5)：29-30.
[45]钟洪.原发性痛风证治规律探讨.湖北中医杂志,1992,14(6)：5.
[46]杨彩霞,金明秀.金明秀教授治疗痛风性急性关节炎经验.中医药学刊,2006,24(8)：1425-1426.
[47]廖竹芬,罗秋莲.四妙散治疗痛风性关节炎43例.新中医,2002,34(7)：59.
[48]雷瑗琳,吉海旺.吉海旺治疗痛风经验.中医杂志,52(12)：1062-1063.
[49]朱维平,赵云升,张茂全.肝经浊毒流注与原发性痛风关系探讨.世界中西医结合杂志,2008(8)：491.
[50]沈庆法.痛风的中西医诊治.中国临床医生,2009,37(10)：66-68.
[41]宋绍亮,孙秀霞,李嘉庆.痛风论治新探.山东中医学院学报,1995,19(4)：244.
[52]鞠华,鞠萍,许秀芳等.痛风的辨证施治简析.实用中医内科杂志,2005,19(3)：224-225.
[53]刘尊荣,詹利霞,何世东.痛风汤治疗痛风性关节炎36例.福建中医药2004,35(1)：28-29.
[54]范琴书.痛风病机与分期证治探讨.浙江中医杂志,2007,42(2)：74.
[55]沈庆法.痛风的中西医诊治.中国临床医生,2009,37(10)：66-68.
[56]黄秀珍,陶雨药.辨证治疗痛风性关节炎56例临床观察.湖南中医杂志,2003,19(2)：23-24.
[57]蒋唯强.试论痛风从脏腑辨证论治.浙江中医杂志,2000,35(4)：168.
[58]李兆福.吴生元诊治痛风的经验.全国第九届中西医结合风湿病学术会议论文汇编,2011,114-115.
[59]阎冬梅,阎小萍.痛风性关节炎的中医辨治.中国临床医生,2003,31(5)：52-54.
[60]石向欣.加味四妙汤治疗急性痛风性关节炎的疗效分析.中国热带医学,2009,9(6)：1154.
[61]裴广玉.四妙散加味治疗原发性痛风疗效观察.中医药学刊,2006,24(3)：524.
[62]邓伟忠,徐继建.加味四妙丸治疗痛风37例临床疗效观察.广西医学,2008,30(7)：1017-1018.
[63]何冠.加味白虎汤治疗急性痛风.中国中医急症,2008,17(3)：400.
[64]刘鹏.焦天才治疗痛风性关节炎经验举隅.山西中医,2009,10(25)：7.
[65]眭承志,柯岩.活血利水法治疗痛风性关节炎.四川中医,1997,15(10)：21.
[66]龙华君,周珂,旷惠桃.痛风克颗粒剂对急性痛风性关节炎的临床疗效观察.中国民康医学,2007,19(10)：883-884
[67]赖世兴,邓晓莉.益肾蠲痹丸治疗急性痛风验案体会.黑龙江中医药,2009,2：31-32
[68]夏忠诚.季德胜蛇药片治疗急性痛风性关节炎举隅.江苏中医药,2010,42(1)：49.
[69]张锡玮,胡莹.中药膏剂外敷治疗湿热瘀阻型原发性急性痛风性关节炎疼痛32例.陕西中医,2009,30(10)：1341.
[70]陈廷生.中药外洗法治疗急性痛风性关节炎128例临床观察.中医外治杂志,2008,17(5)：39-40.
[71]洒玉萍,文绍敦.火针放血配合中药治疗急性痛风关节炎67例.陕西中医,2008.29(2)：216.
[72]胡丰村,孙蓓伟,陈婵.火针点刺放血疗法治疗急性痛风的中医护理.现代中 西医结合杂志,2008,17(6)：913-914.
[73]吴洲红.穴位注射治疗急性痛风性关节炎80例疗效观察.中国中医药科技,2009,16(6)：431
[74]李文华.电针治疗急性痛风性关节炎63例.中医外治杂志,2009,18(4)：57.
[75]张春艳,杨效华,刘慧.激光针刀配合中药治疗急性痛风性关节炎30例.论著与经验交流,中国临床医生杂志,2008,36(2)：45-46
[76]陈文照,林坚,金策,等.痛风宁对尿酸钠致大鼠关节炎下丘脑单胺类神经递质的影响.中国中医骨伤科杂志,2001,(1)：17.
[77]陈文照,姜宏,刘延龄,等.痛风宁消炎镇痛的实验研究.中国中医骨伤科杂志,1999,7(4)：1.
[78]张史昭,黄蔚霞,李学铭.痛风洗剂对尿酸钠诱导大鼠痛风性关节炎的防治作用.中国中医药科技,2001,8(3)：154-155.
[1]吴炜戎,郭阶明,杨薇等.广州市社区痛风和高尿酸血症患病现状调查.中华全科医学,2008,6(7)：728-729.
[2]郑志忠主编.难治性风湿病[M].上海：上海科学技术出版社,2007.P254.
[3]周莉.痛风的发病机制.医学综述,2007,13(21)：P1626.
[4]Hochberg MC,SilmanAJ,Smolen JS,et al.Rheumatology[M].3rd ed. New York:Mosby,2003.
[5]Enomoto A,Kimura H,Chairoungdua A,et al.Molecular identification of a renal urate anion exchanger thatregulates blood urate levels[J]. Nature,2002,417(5):447-452.
[6]Mikuls TR, Farrar J T, Bilker WB, et al.Suboptimal physieian adherence To quality indieators for themanagement of gout and asymptomatic hyPerurieae:results from theUK General Praetice Research Dat-abase GPRD[J].Rheumatology oxford, 2005,448:1038-1042.
[7]薛耀明,李晨钟.痛风的诊断与治疗[M].北京：人民军医出版社,2004.P34.
[8]李东,曹丽华,张惠英,等.高尿酸血症370例分析.中华风湿病学杂志,1999,3(4)：244-246.
[9]Getting SJ, Flower RJ, Parente L,et al.Molecular determinants ofmonosodium urate crystal-induced murine peritonitis:a role for endoge-nous mast cells and a distinct requirement for endothelial-derived selec-tins[J].J Pharmacol Exp Ther,1997,283(1):123-130.
[10]黄火高,韩星海,韩春光,等.PPARγ激动剂吡格列酮对尿酸钠晶体诱导炎症的防治作用[J].中华风湿病学杂志,2005,9(8)：4632-468.
[11]周莉.痛风的发病机制.医学综述,2007,13(21)：1626.
[12]MARTINON F, PETRILLI V, MAYOR A, et al. Gout asso-ciated uric acid crystals activate the NALP3 inflammasome[J].Nature,2006,440:237-241.
[13]DEREVIAUKO A, DAMICO R, SIMMS H. Polymorphonu-clear Leucocyte (PMN)-derived inflammatory cytokines-regu-lation by oxygen tension and gastric epithelial cells:effect as-sociated with the impairment of gastric epithelial barrier func-ion[J]. DigDisSci,1997,42(6):1210-1215.
[14]谷祖华,苗志敏,李长贵.Caspase-1抑制剂对大鼠急性痛风性关节炎的作用.青岛大学医学院学报,2009,45(5)：483.
[15]王洁颖.痛风性关节炎.中国临床医生,2009,37(1)：25.
[16]黄旋珠,王丽莹,肖学吕,等.痛风急性发作诱因分析及护理对策[J].现代护理,2005,11(14)：1121-1122.
[17]郑志忠主编.难治性风湿病[M].上海：上海科学技术出版社,2007.P256.
[18]王雄彪.发热研究的新近展.中华医学信息报,1999(13)：3-5.
[19]江瀛,徐领城.痛风的药物治疗进展.海峡药学,2010,22(1)：101.
[20]Takano Y,Hase-Aoki K,et al Selectivity of febuxostat,a novel non-purineinhibitor ofxanthine oxidase/xanthinedehydrogenase[J]LifeSci,2005,76:1835-1847.
[21]马培奇.降尿酸药物研究进展.上海医药,2012,33(3)：19.
[22]张忠辉.痛风与高尿酸血症的进展.重庆医学,2007,36(10)：985-988.