Lu Zhizheng (1920.12-) was the first Master of Traditional Chinese Medicine and chief physician of the Chinese Academy of Chinese Medical Sciences
The main link of the onset of gout is uric acid metabolism disorders and /or uric acid excretion caused by excessive blood uric acid, when the urate concentration exceeds its saturation solubility, can be deposited in joints, soft tissues, cartilage, epiphyseum, kidneys and other tissues and cause a variety of clinical manifestations, mainly divided into acute attack period, asymptomatic intermittent period, chronic stage. Tophi is a characteristic manifestation of chronic gout, and survey data show that tophi develops after 11.6 years of onset. Tophi is softer in the initial formation, and as the fibrous hyperplasia texture becomes harder and harder, at this time, if arthritis cannot be effectively treated and recurrent attacks enter the chronic stage, kidney disease can be complicated, and joint deformities and renal insufficiency can occur in severe cases.
Gout is both a chinese medicine disease name and a Western medicine disease name, Lu Zhizheng verified that gout originated in the mainland and was established by Zhu Danxi in the Yuan Dynasty. Lu Zhizheng, a master of traditional Chinese medicine, pointed out that chinese medicine has unique advantages in the treatment of gout, especially in the chronic gout period, which can significantly reduce the number of attacks, control the frequency of attacks, improve systemic symptoms, and then improve prognosis through traditional Chinese medicine treatment. The treatment experience of Lu Lao is introduced as follows to serve colleagues.
Pathogenesis
Lu Zhizheng started from the changes in the dietary structure, living conditions and living habits of modern people, deeply studied the pathogenesis of gout, and believed that eating disorders and damage to the spleen and stomach are the key factors in the onset of gout, and spleen and stomach disorders are the crux of chronic gout. Lu Zhizheng pointed out that the dialectic of chronic gout should focus on the root cause of the disease, and conditioning the spleen and stomach is its cure, which is the so-called "spleen and stomach are adjusted, then the qi and machines around the body are adjusted; if the spleen and stomach are healthy, the internal organs are healthy", that is, "holding the center to reach the four sides" Principle.
Lu Zhizheng agreed with Danxi's understanding of the causes and mechanisms of gout, mainly emphasizing internal causes, while external evils such as wind, cold, summer, humidity, heat, and poison were only precipitating factors under the premise of internal causes, which was very different from ordinary rheumatism (including the White Tiger Calendar Festival, etc.). Lu Zhizheng believes that the onset of the disease may be due to internal blood fever, external wind and cold, wading in water and wetness; or due to poor diet, fat and sweet, excessive drinking, damage to the spleen and stomach; or due to overwork, thinking about injuring the spleen. Spleen deficiency and stomach weakness, lifting and falling out of the division, water transport loss into wet, water wet connotation, over time will turn heat, internal and external evil leads, it is easy to induce the disease.
Lu Zhizheng believes that the acute stage of this disease is mostly based on evil facts, when treating its symptoms, you can use the method of clearing heat and dispelling dampness, activating blood and dispelling stasis, and dissolving phlegm, then the pain and swelling can be eliminated; the chronic period is positive and evil, cold and heat are mixed, when the symptoms are treated together, with the method of strengthening the spleen and wetness, supplementing the kidney network, and relieving the wind and fixing pain, the paralysis can be removed.
In the chronic gout phase, although the joint redness and swelling disappear, it is still painful or severe, the swelling is not very good, and the course of the disease is prolonged. Illness and evil long-term love, righteous qi dark consumption, spleen, kidney, trifocal dysfunction. Positive and false, phlegm stasis, deep into the bones and muscles, can cause joint stiffness and deformation. Sputum and blood condensation, over time to form, then see tonic stone. Lu Zhizheng proposed that healthy spleen and dampness removal and comprehensive treatment should be the great method for diagnosing and treating chronic gout.
Therapeutic heart method
● Regulate the spleen and stomach, strengthen the spleen and dissolve wetness
After the acute phase of gout is relieved, although the swelling and pain subside, the joints are still painful and intolerable, so it is not uncommon for patients to see the doctor. Evil deep long-term love, cutting down righteous qi, temper damage, manifested as local joint swelling, pain or severe pain, rainy, windy and cold weather, symptoms aggravated, joints are not red and not swollen, accompanied by warm and cold, fatigue, less stuffiness, waist and knee soreness and other symptoms.
"Shuowen Jiezi" Yun: "Paralysis, wet disease also." "Su Qing Zhen Zhi Da Ren" says: "All wet and swollen, all belong to the spleen ... All spasms are strong, all are wet. "Wet evil has a distinction between inside and outside, which is closely related to the occurrence and development of rheumatism, and is the direct cause of joint swelling and pain.
Lu Zhizheng in the treatment of chronic gout pays attention to the conditioning of the spleen and stomach, so that the temper is healthy, the water is wet, and commonly used prescriptions such as anti-self astragalus soup, sanren soup, Huopu Xia Ling soup, flat stomach powder and so on. Spleen deficiency and dampness, diffuse swelling and heavy, reuse astragalus, Cangshu, coix kernel, can add amaranth, papaya, late silkworm sand, etc.; medium focus wet obstruction, sullen and dull, can add herbs, Su stems, lotus stems to aromatic vaporization wet; if the wind is evil, pain wandering, you can add windproof, Spirit Immortal, sea breeze vine and other wind and dampness, through the network to relieve pain; yang deficiency and cold, cold pain dark purple, reuse guizhi, appendage, fine spices and other warm passage to disperse the cold.
Guizhi
● Regulate the spleen and stomach, do not forget to replenish the kidneys
The kidney is the innate foundation, the essence of tibet, the main bone marrow; the spleen is the foundation of the acquired nature, the source of qi and blood biochemistry. "Medical Jiao" said: "Xia Jiao is the root of Middle-earth, and the kidney life is the basis of water and fire." The kidneys are closely related to the occurrence, development and prognosis of paralysis, and Zhang Jingyue of the Ming Dynasty said: "All the paralysis are in the yin, and there is always a true yin that is weak and the sperm and blood are lost, so the three qi can be multiplied, and for this reason the evidence ... It is the method of curing paralysis, the most appropriate way to supplement the true yin, so that the flesh and qi are popular. ”
Lu Zhi is in the process of treating chronic gout, in addition to toning the spleen and stomach, the day after the day to supplement the congenital, but also attaches great importance to the kidney tonic, often dialectical application of kidney qi, solid essence filling, strong muscles and bones and other methods, fang selection of liuwei dihuang pills, jinkui kidney qi pills, duhuo parasitic soup and other addition and subtraction cuts.
The general course of chronic gout is prolonged, and it will hurt the kidney qi for a long time, and the kidney qi deficiency is unfavorable to gasification, the turbidity is not distinguished, the opening and closing is lost, the subtle leakage is seen in the turbidity, nocturnal urinary frequency, edema and other symptoms, and the clinical changes are common in gouty nephropathy. At this time, while strengthening the spleen, you should not forget to supplement the kidneys, and you can choose cooked yellow, yam, dogwood, female virgin, pigweed, poria, corn whiskers and other medicines. For example, if the kidney qi is deficient and the lower limbs are weak, reuse the ox knee, mulberry parasitism, Sichuan continuum and other kidney strength, circulation and pain relief.
Cow's knee
Elderly patients with gout are often accompanied by signs of kidney sperm depletion such as waist and soft legs, tendon and vein cramps, sperm leakage, dizziness and forgetfulness, night sweats and tinnitus, etc., often accompanied by flesh and blood sentient products, such as turtle and deer two immortal glue. However, the kidney tonic products are more nourishing and greasy, and there is a risk of hindering the spleen, at this time, Lu Zhi is normal shaosha ren, Luo Luozi and other spicy spleen products to take care of the spleen and stomach, so that the supplement is not delayed.
● Activate blood and dissolve phlegm, loosen knots and communicate
Damp heat for a long time, burning fluid, refining liquid into phlegm, blood turbidity into stasis, sputum stasis cemented, qi and blood paralysis blocked, limb joint tendons and veins are not honored, disease and evil deep into the bone skeleton, so you can see pain such as needle prick, joint stiffness, deformation, restraint, numbness, flexion and extension unfavorable, or there are gout nodules in the fingertips, metatarsal toes, pinnacles and other places, which is the image of phlegm stasis.
Sputum stasis as a pathological product of spleen and stomach damage, can further aggravate the spleen and stomach damage, so Lu Zhi is in the treatment of chronic gout, emphasizing the adjustment of the spleen and stomach at the same time, but also pay attention to blood stasis, phlegm dispersion, so that the evil to go to The right, often choose double dispersion, Danxi upper and lower common gout formula and so on. Double combination of powder with peach red four things soup to activate blood stasis, two Chen soup plus white mustard seeds polyester phlegm communication, so the name of the double combination, is to remove stasis, phlegm with the same application, for the treatment of phlegm stasis mutual knots of the recipe. If you are also caught with rheumatism, you can give Danxi up and down the general gout formula, which can not only dispel rheumatism, dissolve phlegm stasis, but also eliminate stagnation and medium, and treat the same treatment of three focal points, and can be used for paralysis pain in the upper and lower parts. If the subcutaneous nodule is broken, seborrheic pus comes out, and the person who has not healed for a long time should reuse astragalus to improve the gas to detoxify and drain the pus, add soap horn to sting the poison and penetrate the pus, and remove the saprophytic muscle.
Soap horn thorn
● External treatment of traditional Chinese medicine, direct pounding of the sick house
Lu Zhizheng on the treatment of gout on the basis of traditional Chinese medicine internal administration, must be accompanied by traditional Chinese medicine external treatment method, in order to effectively alleviate joint swelling and pain and other symptoms, to prevent its recurrence of acute attack. Chen Shigong said: "The principle of external treatment is the principle of internal treatment, the medicine of external treatment is the medicine of internal treatment, and the different one is the ear." Lu Zhizheng is well versed in this principle, making good use of external washing prescriptions to treat gout, through drug washing, the medicinal power can be directly reached the hospital, coupled with the warming effect of water vapor, can make the qi and blood smooth, meridian communication, both internal and external treatment, can significantly shorten the course of treatment.
External washing prescription medicine: Lu Zhizheng likes to use rhubarb licorice soup, verbena, welling immortal, etc. Among them, verbena clears heat and detoxifies, activates blood and disperses stasis, and reduces swelling, "Materia Medica" is said: "Verbena, this is a medicine for cold blood and blood... The blood is cold and pyrolysis, and the filthy ones are broken and gone. Lu Zhizheng chose this drug mainly because the drug can target the main cause of acute gout, that is, damp heat poison stasis, and verbena can play a role in cooling blood stasis, clearing heat and dampness, reducing swelling and pain. Modern pharmacological studies of traditional Chinese medicine have shown that verbena mainly contains cycloenne terpenoids, and its water and alcohol extracts have anti-inflammatory effects on the inflammation caused by mustard oil dripping into the conjunctival sac of rabbits.
The Spirit Immortal can pass through the Twelve Meridians, as stated in the "Medicine of Righteousness": "Spirit Immortals, fierce in nature, cover and go without keeping, and publicize the Twelve Meridians." Indications for the treatment of rheumatic, wet, sputum, stagnation in the meridians, resulting in gout, bone joint pain, or swelling, or numbness. "Soap horn thorn, bone-penetrating grass, frankincense, myrrh, self-defense, stone vine and other anti-wind and dehumidification, through the network pain relief is also good, can be added or subtracted with the evidence."
Wellings
Specific usage: Instruct the patient to smoke 1 to 2 times a day, wash locally first, soak for half an hour, with a slight sweat as the degree, so that the Xuanfu is smooth, the old cloth is new, the qi and blood circulation, and the paralysis can be removed. Or fry the juice and apply it warmly to the affected area with gauze dipped in the juice.
Typical medical cases
Wu Mou, male, was 37 years old at the time. Date of initial consultation: 24 March 2011. The patient complains of intermittent swelling and pain in the first metatarsophalangeal joint of the left foot for 3 years. After drinking heavily 3 years ago, I developed redness, swelling, heat and pain in the first metatarsophalangeal joint, the pain was unbearable, it was difficult to walk, and the symptoms gradually eased after taking painkillers on my own. Posterior joint swelling and pain recurred, more than after exertion, visited the local hospital, checked uric acid 570 μmol/L, the diagnosis was "gout". After the patient controls the diet, the blood uric acid decreases, but when the joints are swollen and painful, the pain is tolerable.
Diagnosis: slight swelling and pain in the first metatarsophalangeal joint of the left foot, generalized joint muscle wandering pain, tiredness, poor sleep, dizziness, night sweats, no headache, naco, two can be. Previous hypertension, dyslipidemia (now taking valsartan capsules to control blood pressure). The tongue has dark red edges with ecchymosis, the moss is thin and yellow, and the veins are smooth and thin.
Diagnosis: (deficiency of qi and blood, wet evil depression type) gout.
Treatment: improve qi and blood, loosen wind and dampness.
Wind
Prescription: Anti-hexane astragalus soup combined with four mysterious pills cut. Raw astragalus 20g, windproof 12g, self-defense 15g, fried white art 15g, Wellingxian 12g, guizhi 12g, white peony 12g, red peony 12g, fried Cangshu 15g, salt yellow cedar 12g, Amaranth 15g, late silkworm sand (package) 20g, fried coix kernel 30g, chicken inner gold 12g, large belly skin 10g, large belly skin 10g, Liuyishan (package) 30g. Decoction, 1 dose daily.
External washing: bitter ginseng 12g, verbena 30g, soap horn thorn 15g, Welling xian 15g, windproof 15g, anti-self 15g, vinegar yanhusso 12g, glauber's salt 15g. 7 doses, topical smoking, 1 dose a day.
After 7 doses of drug follow-up, the patient's joint pain disappeared, dizziness and tiredness disappeared, night sweats were significantly reduced, and sleep improved. The former 14 doses are made into granules orally, 9 g each time, 2 times a day, to consolidate. Patients are advised to avoid fatty, sweet and thick taste and raw and cold products.
Press: The patient did not eat well before the disease, which harmed the spleen and stomach. The spleen and stomach are the foundation of the day after tomorrow, the source of qi and blood biochemistry, coupled with the paralysis for a long time, it consumes the body's righteous qi, so it is tired, poor sleep, dizziness, night sweats and other signs of deficiency of qi and blood.
Defend yourself
Deficiency of qi and blood is the loss of limb muscles, so see fatigue; qi deficiency is that the qingyang does not rise, the qing qi is out of health and the spirit is atrophied, and the dizziness is dizzy; the blood does not nourish the spirit, so the sleep is poor; the temper is deficient, the transportation is derelict, the water and liquid are stopped, the wet evil is obstructed, and the stagnant joint is swollen and painful; the qi is powerless to rate the blood line, then the pulse is fine; the qi deficiency and blood stasis can be seen in the tongue is red and dark, and there are bruises on the side; the qi deficiency is water metabolism disorder, the water liquid is not transformed, the clothing disorder, the wet evil is suffering from the pulse string slippery and the tongue is greasy; the qi deficiency is long, the chemical source is insufficient, resulting in the deficiency of qi and yin, and the yin does not control the yang. If the guard is not solid, there are night sweats, and if the yin blood is insufficient, the internal wind is born.
When the patient presents with the spring equinox season, the internal and external winds are combined, and the wet walk is seen, so wandering pain is seen. The group is to prevent the astragalus soup from strengthening the spleen and gasifying the moisture to cure the qi deficiency, and the four magic pills to clear the heat and dampness to dehumidify the standard. Medicinal astragalus and white frying techniques to strengthen the spleen and dampness; windproof and self-repellent to dispel wind and dehumidification; coix kernels and amaranth water seeped wet; yellow cedar clear and dry; fried Cang technique is dry and wet, and can also raise the yang qi in the stomach; guizhi warm and yang qi, with the white peony one by one, to reconcile the camp blood; talc, June 1 scatter, late silkworm sand, Wei Lingxian to remove dampness; the skin of the large abdomen into the spleen and stomach and wide in the middle and lower qi to stagnate, chicken jin jian stomach consumption, always do not forget to take care of the spleen and stomach.
Zheng reiterated that:
Since each person's constitution and condition are different, the prescription drugs and dosages in this case are only applicable to the patient's condition at that time. The prescriptions and dosages in this case may not be copied without the dialectical diagnosis and treatment of Chinese medicine practitioners. If necessary, the majority of readers should go to a regular hospital for diagnosis and treatment to avoid delaying the disease. ■
[Source: China Traditional Chinese Medicine News,
Excerpt from the fifth edition of China Journal of Traditional Chinese Medicine, May 9, 2022, Han Man, Jiang Quan, Tang Xiaopo, Yang Fengzhen, Guang'anmen Hospital, China Academy of Chinese Medical Sciences]