| 引用本文: |
王岩, 戴铭.从“主客交-络病”理论探讨“透法”在强直性脊柱炎的辨治应用[J].湖南中医药大学学报,2026,46(7):1476-1481[点击复制] |
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| 从“主客交-络病”理论探讨“透法”在强直性脊柱炎的辨治应用 |
| 王岩,戴铭 |
| (广西中医药大学, 广西 南宁 530001) |
| 摘要: |
| 强直性脊柱炎（AS）为临床常见的慢性进展性免疫性疾病，以中轴关节慢性炎症与骨性强直为主要特征，其病程缠绵难愈。本文基于“主客交-络病”理论，认为本病以肾督亏虚为本、邪伏脊络为标，贯穿其发生与发展的全过程。病机演变呈递进之势：初期主气失固，邪潜督络，为病之始；中期则客邪炽盛，主客交争，为病之盛；晚期主客交结，络虚骨损，为病之终。三期相因，正虚邪陷、邪伏难透，终致筋骨僵固、脊柱强直。治疗以“透法”为纲，提出宣透以开郁、搜透以化结、托透以荣络三大治则，贯通扶正与祛邪、形与络并调之旨。方药以青娥丸合桂枝芍药知母汤、四妙勇安汤合身痛逐瘀汤、龟鹿二仙胶合大黄䗪虫丸为代表，形成理、法、方、药一体的辨治体系。该体系以“透”为核心，揭示AS由浅入深、由虚转实、终致虚实夹杂的病机本质，为中医药系统干预免疫性疾病提供新的辨治思路。 |
| 关键词: 强直性脊柱炎|主客交|络病|透法|分期辨治 |
| DOI：10.3969/j.issn.1674-070X.2026.07.022 |
| 投稿时间：2026-03-19 |
| 基金项目:国家中医药管理局《中华医藏》提要编纂项目（KJS-ZHYC-2020-009）。 |
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| Differentiation and treatment of ankylosing spondylitis with "penetrating therapy" based on the "host-guest intermingling-collateral disease" theory |
| WANG Yan, DAI Ming |
| (Guangxi University of Chinese Medicine, Nanning, Guangxi 530001, China) |
| Abstract: |
| Ankylosing spondylitis (AS) is a common chronic progressive autoimmune disease, characterized by chronic inflammation of the axial joints and bony ankylosis, accompanied by a lingering and refractory clinical course. Based on the "host-guest intermingling-collateral disease" theory, this paper holds that deficiency of the kidney and the Du meridian constitutes the root cause of ankylosing spondylitis, while pathogenic factors lurking in spinal collaterals serve as the manifestation, which runs through the whole onset and progression of the disease. The pathogenic evolution develops progressively in three phases. In the initial stage, defensive qi fails to secure the exterior, and pathogenic factors lurk in the collaterals of the Du meridian, marking the onset of the disease. In the middle stage, pathogenic qi surges and contends fiercely with healthy qi, representing the acute progressive phase of the disorder. In the late stage, healthy qi and pathogenic factors bind tightly in intermingling state, collaterals become deficient and bones are damaged, which is the terminal stage of illness. The three phases are mutually influential. Long-term healthy qi deficiency drives pathogenic factors to sink deep and hard to be eliminated, eventually resulting in stiff tendons and rigid bones as well as spinal ankylosis. This paper takes penetrating therapy as the core therapeutic guideline, and proposes three major therapeutic principles: ventilating penetration to disperse stagnation, searching penetration to resolve masses, and supporting penetration to nourish collaterals. Such principles integrate reinforcing healthy qi and eliminating pathogens, and regulate both bodily structures and collateral network simultaneously. Corresponding representative formulas include Qing'e Pill combined with Guizhi Shaoyao Zhimu Decoction, Simiao Yong'an Decoction combined with Shentong Zhuyu Decoction, and Guilu Erxian Glue combined with Dahuang Zhechong Pill, forming an integrated differentiation and treatment system that unifies pathogenesis theory, therapeutic methods, formulas and medicinal herbs. Centered on the therapeutic thought of "penetration", this system elaborates the essential pathogenesis of ankylosing spondylitis: the disease develops from superficial to deep locations, transforms from deficiency to excess patterns, and finally presents simultaneous deficiency and excess, providing a novel differentiation and treatment idea for systematic intervention of autoimmune disease via Chinese medicine. |
| Key words: ankylosing spondylitis|host-guest intermingling|collateral disease|penetrating therapy|stage-based differentiation and treatment |
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