中医杂志

总结张震教授运用自拟益髓生血汤加减治疗类风湿关节炎合并贫血的临床经验。认为本病的核心病机以脾肾亏虚、精血不足为本，湿邪痹阻、瘀血内停为标。治疗以补益脾肾、填精益髓、养血生血为核心，兼顾除湿通络、活血化瘀，据此拟定益髓生血汤为基础方，并根据证型及临床表现灵活加减。气血两虚兼湿浊证配伍益气养血、健脾祛湿、轻宣痹阻之品；风寒湿痹证配伍祛风散寒、除湿通络之品；湿热痹阻证配伍清热利湿、通络宣痹之品；瘀血阻络证配伍活血化瘀、通络止痛之品；阴虚内热证配伍滋阴清热、凉血通络之品。

This paper summarized professor ZHANG Zhen's clinical experience in treating rheumatoid arthritis(RA) complicated with anemia using self-formulated Yisui Shengxue Decoction （益髓生血汤） with modifications. It is proposed that the core pathogenesis of this condition is rooted in spleen and kidney depletion with insufficiency of essence and blood, while pathogenic dampness obstruction and internal blood stasis accumulation are the branches. The treatment principle focuses on tonifying the spleen and kidney, replenishing essence and nourishing the marrow, and enriching and generating blood, while simultaneously removing dampness and unblocking collaterals, activating blood and dissolving stasis. Based on this approach, Yisui Shengxue Decoction is used as the basic prescription, with flexible modifications according to syndrome patterns and clinical manifestations. For deficiency of both qi and blood combined with damp turbidity syndrome, medicinals that tonify qi and nourish blood, fortify the spleen and eliminate dampness, and mildly disperse obstruction are added. For wind-cold-dampness bi （痹） syndrome, medicinals that dispel wind and disperse cold, remove dampness and unblock the collaterals are incorporated. For wind-dampnessheat bi syndrome, medicinals that clear heat and eliminate dampness, unblock the collaterals and relieve bi are selected. For blood stasis obstructing the collaterals syndrome, medicinals that activate blood and resolve stasis, unblock the collaterals and relieve pain are combined. For yin deficiency with internal heat syndrome, medicinals that nourish yin and clear heat, cool blood and unblock the collaterals are prescribed.