来源：风湿病与关节炎,2022,11（6）:11-14,19.

桂枝芍药知母汤合白虎汤加味联合西药治疗寒热错杂型类风湿关节炎急性活动期30例临床观察（临床研究）

桂　兵，田　杰，吴鸿霞

　　【摘　要】目的：观察桂枝芍药知母汤合白虎汤加味联合西药治疗寒热错杂型类风湿关节炎急性活动期的临床疗效和安全性。方法：将60例寒热错杂型类风湿关节炎急性活动期患者随机分为治疗组和对照组，每组30例。对照组给予来氟米特每次20 mg，每晚1次，口服；艾拉莫德每次25 mg，每日2次，口服；醋酸泼尼松每次7.5 mg，每日1次，口服；塞来昔布每次0.2 g，每日1次，按需要口服。治疗组在对照组治疗基础上加用桂枝芍药知母汤合白虎汤加味方。2组均根据疼痛程度酌情使用塞来昔布胶囊。2组均以15 d为1个疗程。观察2组西医临床疗效、中医证候疗效，以及治疗前后实验室指标、DAS28评分、中医证候评分、GH疼痛评分。结果：治疗组西医临床疗效、中医证候疗效总有效率分别为63.33%、83.33%，均优于对照组的53.33%、70.00%，差异有统计学意义（P < 0.05）。治疗后，2组C反应蛋白、红细胞沉降率、类风湿因子、DAS28评分、中医证候评分、GH疼痛评分较治疗前均降低（P < 0.05），且治疗组低于对照组（P < 0.05）。结论：桂枝芍药知母汤合白虎汤加味联合西药治疗寒热错杂型急性活动期类风湿关节炎较单用西药，能进一步改善患者实验室指标及关节功能，减轻疼痛，临床疗效与安全性更优。

　　【关键词】　类风湿关节炎；寒热错杂型；桂枝芍药知母汤；白虎汤；艾拉莫德；临床疗效

Clinical Observation on 30 Cases of Rheumatoid Arthritis of Cold and Heat in Complexity in Acute Active Phase Treated by Guizhi Shaoyao Zhimu Tang（桂枝芍药知母汤）and Modified Baihu Tang（白虎汤）Combined with Western Medicine

GUI Bing,TIAN Jie,WU Hong-xia

　　【ABSTRACT】Objective:To observe the clinical efficacy and safety of Guizhi Shaoyao Zhimu Tang（桂枝芍药知母汤）and modified Baihu Tang（白虎汤）combined with western medicine in the treatment of acute active rheumatoid arthritis of cold and heat in complexity（RA）.Methods:Sixty patients with acute active rheumatoid arthritis of cold and heat in complexity were randomly divided into a treatment group and a control group,with 30 cases in each.The control group was given leflunomide（20 mg each time）,once a night,orally;Ilamod（25 mg each time）,twice a day,orally;Prednisone acetate（7.5 mg each time）,once a day,orally;Celecoxib（0.2 g each time）,once a day,orally as required.The treatment group was treated with Guizhi Shaoyao Zhimu Tang and modified Baihu Tang on the basis of the treatment as in the control group,and the two groups were treated with celecoxib capsules according to the degree of pain.Fifteen days was as a course of treatment for both groups.The western medicine clinical efficacy,TCM syndrome efficacy,laboratory indexes,DAS28 scores TCM syndrome score,GH pain score before and after trseatment were observed.Results:The total effective rates of Western medicine and TCM syndrome in the treatment group were 63.33% and 83.33% respectively. All were better than 53.33% and 70.00% of the control group, the difference was statistically significant（P < 0.05）.After treatment,C-reactive protein,erythrocyte sedimentation rate,rheumatoid factor,DAS28 score, TCM syndrome score,GH pain score in the two groups were significantly lower than those before treatment（P < 0.05）,and the treatment group was lower than that in the control group（P < 0.05）.Conclusion:Guizhi Shaoyao Zhimu Tang and modified Baihu Tang combined with western medicine in the treatment of acute active rheumatoid arthritis of cold and heat in complexity can further improve the laboratory indicators and joint function of patients,reduce pain,and have better clinical efficacy and safety than western medicine alone.

　　【Keywords】 rheumatoid arthritis;type of cold and heat in complexity;Guizhi Shaoyao Zhimu Tang（桂枝芍药知母汤）;Baihu Tang（白虎汤）;Eilamod;clinical efficacy