中医怎样看痛风

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进补需依据体质、年龄、性别等具体情况有针对性地补，不可滥补。

身体管理·全科医生
2023·11一种既急又
慢的疾病“痛风”是一种症如其名
的疾病，是一种既“急”又
“慢”的疾病。

它最典型的表现为急性关节炎时期的“红、肿、热、痛”、痛风石、慢性关节炎、关节畸形、慢性间质性肾炎和尿酸性尿路结石等。

为什么说它症如其名呢？首先“痛”就是疼痛；“风”有两层含义：一是来得
快，去得快，一般持续时间7-10天不等，所谓来去如风。

二是疼痛的程度很重，被风吹过都好像会疼痛难忍。

那么痛风到底有多痛呢？有的足部痛风的患者会
形容自己的脚好似被车碾过一样，轻微的颤动都会引起钻心的疼痛，甚至疼痛发作时，恨不得用一把刀子把它剁掉。

那么，为什么说它既是急性病又是慢
性病呢？因为痛风发病急骤，有时毫无预兆，但是经过正规治疗，症状消失的又快，所以说“急”；同时它又是一种迁延不愈的
病，有些患者甚至携带终生，所以说“慢”。

这些原因会导致痛风发作首先，我们要知道，痛风和
高尿酸血症是密不可分的，都是因嘌呤代谢障碍引起的代谢性疾病。

尿酸是嘌呤
的代谢物，所以当血液里的
尿酸水平过高，过多的尿酸
排不出去，最后结晶析出沉积在
关节等组织，就会引起痛风疾病。

尿酸盐沉淀于关节软骨和骨质内，逐渐增多，突破关节面，刺激滑膜，即发生急
性炎症，滑液增加，关节红肿就会发生痛风。

同时还会因尿酸盐沉积在耳轮、趾
跖、指间和掌指关节出现痛风石。

痛风初次发作，大部分是在脚趾、大
脚趾的根部，当然整个脚疼是比较常见
的。

指关节、手腕、手背、手肘、膝盖、脚踝、脚跟等都是容易发生痛风的部位。

越是远离躯体的关节越是容易发生痛风。

越是靠近躯体的关节（像肩关节髋
关节）越少发生痛风。

如何诊断痛风
临床上通常使用以下方法诊断痛风：
1、通过查验血里的尿酸水平来确诊患者是否患有高尿酸血症。

正常血尿酸浓
中医怎样看痛风□文/董雪（北京市西城区西长安街社区卫生服务中心）
家庭科学·新健康
身体管理康点通
痛风是一种常见
且复杂的疾病，
中医通过辨证论治、遣方用药，可帮助患
者远离痛风困
扰。

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全科医生
·身体管理2023·11健一家庭科学·新健康
康点通
度：男性为150-380μmol／L ，女性为100-300μmol／L ，更年期后接近男性。

如果男性和绝经期女性血尿酸>420μmol／L 、女性>357μmol／L 诊断为高尿酸血症；2、从关节腔里抽出关节液或痛风石活检，看是否有尿酸结晶的存在；3、X 线检查、CT 或MRI 扫描；4、中老年男性如出现特征性关节炎表现、尿路结石或肾绞痛发作，伴有高尿酸血症可考
虑痛风。

痛风“重男轻女”临床上仅有部分高尿酸血症患者会发展为痛
风，确切原因不清。

性别、吸烟、饮酒、偏好食用海鲜、饮食荤素不均衡、高盐饮食、精神紧张抑郁均有可能成为痛风发作的高风险因素。

因此，沿海城市一直是痛风高发地区之一。

痛风有个特点是“重男
轻女”，男性痛风患病率高是因为女性的雌性激素能
够促进尿酸的排泄，所以女性绝经后发病率会增加。

另外，血尿酸增高，除了会导致痛风发作以外，对于人体的其他器官也会造成不同程度的危害。

有研究
表明，血尿酸每增加1mg/dL 高血压发生风险增13%，冠心病死亡风险增加12%，心衰发生风险增加19%。

同时尿酸水平升高，也会使肾脏病发生风险提高49%，
血尿酸越高，急性心梗短期和中长期结局越差。

中医辨证施治疗效显著痛风病名最早见于《刘涓子鬼遗方》，文献中的“痹证”、“中风历节病”、“白虎风”等病的描述与痛
风的临床表现有相似之处。

中医认为痛风的病机分为以下几种：1、因血气虚劳从而导致关节失养、经络空虚、腠理不密，致使风湿内侵而发病。

2、有瘀血在内滞留不去，复又感风寒，气血瘀滞，邪气注入经络而成痛风。

3、涉水冒雨被风寒湿邪侵袭，又逢正气虚衰，邪入肾经，气血瘀滞而致痛风。

4、肥胖型患者，饮食无节制，多食肥
甘厚味，致脏腑气化功能受障碍，脾胃功能失于通调，形成痰湿，流注关节而发病。

上述不同证型的痛风，所表现出的症状、体征都
有所不同，中医药的“同病异治”这一特色，可以得到很好的发挥。

中医对痛风的治疗以发作期治标，缓
解期治本为原则，根据不同的临床表现辨证施治：
1.湿热蕴结
☞证候特点：局部关节红肿热痛，发病急骤，多
兼有发热、恶风、烦闷不安或头痛汗出、小便短黄，舌红苔黄，或黄腻，脉弦滑数。

治法：清热利湿，通络止痛。

【推荐方剂】三妙散合当归拈痛汤加减。

2.风寒湿痹
☞证候特点：关节肿痛，屈伸不利，可见皮下结
节。

风邪偏胜则关节游走疼痛；寒邪偏胜则关节冷
痛剧烈，痛有定处；湿邪偏胜者，则肢体关节重着疼痛，痛有定处，肌肤麻木不仁。

舌苔薄白或白腻，脉
弦紧或濡。

治法：祛风散寒，除湿通络。

【推荐方剂】薏苡仁汤加减。

3.痰瘀痹阻
☞证候特点：关节疼痛反复发作，时轻时重，或
呈刺痛、固定不移，甚至屈伸不利，强直畸形，皮下结节，或皮色紫黯，甚溃破成瘘管，脉弦或沉涩，舌淡胖或紫黯，苔薄白或白腻。

治法：活血化瘀，涤痰通络。

【推荐方剂】身痛逐瘀汤加减。

4.肝肾不足
☞证候特点：关节肌肉疼痛，僵硬变形肿大，屈
伸不利，腰膝酸软，关节发凉，畏寒，舌红，苔白薄，脉沉弱。

治法：补益肝肾，蠲痹通络。

【推荐方剂】独活寄生汤加减。

除了规范的治疗以外，预防痛风的发生发展，对
于提高痛风患者的生活质量更重要。

痛风患者需谨
记避免诱发因素，如过度疲劳、受凉、行走过多、外伤等，保持心情舒畅。

注意饮食调养。

急性期时应注
意卧床休息，可局部冷敷，抬高患肢，关节制动。

多喝水，每日饮水应在2000ml 以上，少食盐，禁酒，禁食高嘌呤类食物。

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