基于“三辨”模式探讨强直性脊柱炎的中医辨治思路

来源:用户上传      作者:朱爽 齐继鹏 张志娇 吴洋

　　 摘要：强直性脊柱炎是一种全身性免疫性疾病，发病原因和机制尚不明确，炎症的发生以中轴关节和肌腱韧带骨附着点炎为主。该病具有缠绵难愈，易反复发作的特点，严重影响患者的生活质量。“三辨”模式是基于中医体质学说相关与传统的中医辨治相结合而构建的一种诊疗模式，从“辨病-辨体-辨证”出发，系统总结强直性脊柱炎的诊断和治疗。强调临证时首先辨病确定其中西医病名，把握其病因病机;其次辨体预估疾病发方向，指导临床组方用药;然后辨证确立具体证型，随势辨证。运用此模式辨治强直性脊柱炎，为中医治疗该病提供新的诊治思路。
　　关键词：强直性脊柱炎;三辨模式;中医辨治
　　中图分类号：R684.3 文献标志码：A 文章编号：1007-2349（2022）01-0019-04
　　Discussion on TCM Differential Treatment Ideas of Ankylosing Spondylitis Basedon the Model of “Three Differentiations”
　　ZHU Shuang1， QI Ji-peng1， ZHANG Zhi-jiao1， WU Yang2
　　（1. The First Clinical Medical College of Yunnan University of Traditional Chinese Medicine， Kunming 650650 China;2. Yunnan Hospital of Traditional Chinese Medicine/The First Affiliated Hospital of Yunnan Universityof Traditional Chinese Medicine， Kunming 650021， China）
　　【Abstract】Ankylosing spondylitis is a systemic immune disease. The cause and mechanism of the pathogenesis are not clear. The inflammation is mainly caused by inflammation of axial joints and tendon-ligament bone attachment points. The disease has the characteristics of lingering， difficult to heal and recurring， which seriously affects the patient's quality of life. The “Three Differentiations” model is a diagnosis and treatment model based on the combination of TCM constitution theory and traditional TCM differential treatment. Starting from the “differentiation-disease， differentiation-body and differentiation-syndrome”， the diagnosis and treatment of ankylosing spondylitis are systematically summarized. It is emphasized that when clinical syndromes are diagnosed， the names of western medical diseases should be determined first， and its etiology and pathogenesis should be grasped， and secondly， the disease direction should be estimated by body differentiation to guide the clinical prescription and medication， and then actual syndrome type should be established by the differentiation which followed by tend. The use of this model to diagnose and treat ankylosing spondylitis may provide new diagnosis and treatment ideas for TCM treatment of the disease.
　　【Key words】Ankylosing Spondylitis; Three-Differentiation Model; TCM Differential Treatment
　　直性脊柱炎（ankylosing spondylitis，AS）是一种以侵犯中轴关节为主的慢性进展的炎性脊柱关节病，临床表现主要为炎性腰背部疼痛、晨僵、脊柱畸形以及活动受限等症状，伴或不伴周围关节炎、肌腱端附着点炎、关节外表现[1-3]。本病临床呈现青壮年男性群体患病率较高、病程缠绵难愈、易反复发作、致残率较高、严重影响患者工作和生活的特点[4-5]。本病的发病原因和机制尚不明确，西医主要以非甾体抗炎药、免疫抑制剂、生物制剂等治疗为主，疾病后期可手术治疗，可不同程度的缓解和控制病情，改善患者的生活质量，但长期使用西药毒副作用较大、疗效不稳定、价格昂贵等缺点[6-9]。中医药治疗本病具有一定优势，
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