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一、诊断 （一）疾病诊断 1．中医诊断标准：参照中华人民共和国中医药行业标准《中医病证诊断疗效标准》（ZY/T001.1-94） （1）多以单个趾指关节，卒然红肿疼痛，逐渐疼痛剧如虎咬，昼轻夜甚，反复发作。可伴发热，头痛等症。 （2）可有痛风家族史。常因劳累，暴饮暴食，吃高嘌呤食物，饮酒及外感风寒等诱发。 （3）初起可单关节发病，以第一跖趾关节多见。继则足踝、跟、手指和其它小关节，出现红肿热痛，甚则关节腔可有渗液。反复发作后，可伴有关节周围及耳廓、耳轮及趾、指骨间出现“块瘰”（痛风石）。 （4）血尿酸升高。发作期白细胞总数可增高。 （5）必要时作肾B超探测，尿常规，肾功能等检查，以了解痛风后肾病变情况。X线摄片检查：可示软骨缘邻近关节的骨质有不整齐的穿凿样圆形缺损。 2．西医诊断标准： 2.1 1977年美国风湿病学会（ACR）的分类标准。 （1）关节液中有特异性的尿酸盐结晶体。 （2）有痛风石，用化学方法(murexide试验)或偏振光显微镜观察证实含有尿酸盐结晶。 （3）具备下列临床、实验室和X线征象等12条中6条者： ①1次以上的急性关节炎发作。 ②炎症表现在l日内达到高峰。 ③单关节炎发作。 ④观察到关节发红。 ⑤第一跖趾关节疼痛或肿胀。 ⑥单侧发作累及第一跖趾关节。 ⑦单侧发作累及跗骨关节。 ⑧可疑的痛风石。 ⑨高尿酸血症。 ⑩关节内非对称性肿胀(x线片)。 ⑪不伴骨质侵蚀的骨皮质下囊肿(x线片)。 ⑫关节炎症发作期间关节液微生物培养阴性。 上述（1）、（2）、（3）项中，具备任何一项即可诊断。 2.2 2015年ACR/EULAR痛风分类标准 如有外周关节肿痛发作史，尿酸盐结晶检测阳性，可直接诊断痛风，如无尿酸盐结晶，需进一步评分： 标准 分类 评分 临床表现 受累关节 踝关节/足中段 1分 累及第一跖趾关节 2分 症状特征 受累关节皮肤发红 1分 受累关节触痛明显 1分 受累关节活动障碍 1分 发病病程 1次典型发作史（反复关节痛≥2次，抗感染治疗无效，疼痛24小时内达峰，14天内症状缓解，疼痛间歇期疼痛完全缓解） 1分 多次典型发作史 2分 痛风石 存在 4分 实验室检查 血清尿酸 血尿酸<4mg/dl（0.24mmol/L） -4分 血尿酸6-8mg/dl（0.36-0.48mmol/L） 2分 血尿酸8-10mg/dl（0.48-0.6mmol/L） 3分 血尿酸≥10mg/dl（≥0.6mmol/L） 4分 尿酸盐结晶 关节液尿酸盐结晶阴性 -2分 影像学检查 关节B超见双轨征或双能量CT检测到尿酸盐结晶 4分 其影像学检查提示痛风相关关节损伤 4分 总分≥8分可诊断为痛风性关节炎。 （二）证候诊断 1.湿热痹阻证：局部关节红肿热痛，发病急骤，病及一个或多个关节，多数为下肢的关节，多兼有发热、恶风、口渴、烦闷不安或头痛汗出，小便短黄，舌红苔黄,或黄腻，脉弦滑数。 2.脾虚湿阻证：无症状期，或仅有轻微的关节隐痛，或见身困倦怠，头昏头晕，纳食减少，脘腹胀闷，舌质淡胖，苔白或白腻，脉细或弦滑等。 3.寒湿痹阻证：关节疼痛，肿胀不甚，局部不热，痛有定处，屈伸不利，或见皮下结节或痛风石，舌苔薄白或白腻，脉弦或濡缓。 4.瘀热阻滞证：关节红肿刺痛，局部肿胀变形，屈伸不利，病灶周围或有块瘰硬结，肌肤干燥，皮色暗黧，发热。舌质紫暗或有瘀斑，苔薄黄，脉细涩或沉弦。 5.痰瘀痹阻证：关节疼痛反复发作，日久不愈，时轻时重，或呈刺痛，固定不移，关节肿大，甚至强直畸形，屈伸不利，皮下结节，或皮色紫暗，脉弦或沉涩。 其中，湿热痹阻证型、寒湿痹阻证型、脾虚湿阻证可兼有血瘀，血瘀兼证可见夜间痛甚、刺痛、舌质紫暗、脉弦涩等症状。 二．鉴别诊断 1.假性痛风 假性痛风是指焦磷酸钙双水化物结晶沉着于关节软骨所致的疾病。急性发作与痛风酷似，原发性少见，多见于甲状腺激素替代治疗的老年人，常为单关节炎，多发生于老年膝关节，慢性时可侵犯多关节，呈对称性，进展缓慢，与骨关节炎相似。常累及膝、髋、肩、肘等大关节，四肢小关节较少受累，很少累及第一跖趾关节。临床表现与痛风相似，但症状较轻。血尿酸水平不高，关节滑液中可发现二水焦磷酸钙(CPPD)结晶，X线检查可见关节软骨成点状或线状钙化。 2.化脓性关节炎 化脓性关节炎是一种由化脓性细菌直接感染，并引起关节破坏及功能丧失的关节炎。好发于儿童、老年体弱和慢性困节疾病患者。男性多见，常见于10岁左右儿童。90%为单关节炎，成人多累及膝关节，儿童多累及髋关节。突发寒战、高热等中毒表现。关节红、肿、热、痛，压痛明显，活动受限。有原发感染病的症状和体征。血尿酸水平一般正常。关节腔积液细菌培养阳性。关节滑囊液检查无尿酸盐结晶。 3.急性蜂窝织炎 急性痛风性关节炎发作时，关节周围软组织常呈明显红肿，极易误诊为急性蜂窝织炎或丹毒。急性痛风性关节炎多有进食高嘌呤食物或饮酒史，多在夜间发作，疼痛在几小时可达高峰，部分病人可有畏寒、发热、全身不适等症状，疼痛可在几天内自行缓解。痛风性关节炎肿胀以关节为中心，压痛点以关节处最重，滑液中有尿酸盐结晶，血尿酸升高。蜂窝织炎可以发生在人体各个部位，局部皮下软组织肿胀明显，但多为暗红色，周围较淡，边缘不清，压之可退色，红肿范围不以关节为中心，疼痛副烈，病变向四周扩展迅速，常有化脓，关节疼痛往往不明显，发病时伴有怕冷、发热，全身不舒服，病灶附近的淋巴结常有肿痛。 4.丹毒 丹毒为链球菌感染所致，沿淋巴管走行，局部皮肤为鲜红色，周围边界清楚，累及关节时关节处压痛并非是最重处。丹毒病情严重因可有高热寒战，血白细胞计数升高，取血及脓做培养可以发现病原菌，应用抗生素治疗有效。滑液中无尿酸盐结晶，血尿酸不高，不经治疗症状不会自行消失，对秋水仙碱对其无效，可与痛风性关节炎相鉴别。 5.创伤性关节炎 创伤或劳累易诱发痛风发作，因此有时误诊为创伤性关节炎，但后者持续时间长，与创伤有密切关系，且无血尿酸值升高。在慢性痛风性关节炎结节破溃或急性发作关节红肿时，易与化脓性关节炎混淆，有时亦误诊为结核性关节炎。但两者滑囊液及分泌物中均无尿酸钠盐结晶，而有大量白细胞，培养发现有致病菌。 6.风湿热 该病病前一般有A族溶血性链状菌感染病史，主要影响心脏和关节，下述特点可资鉴别；青少年多见；起病前1～4周常有溶血性链球菌感染如扁桃体炎病史；常侵犯膝肩肘踝等关节并且具有游走性、对称性；④常伴有心肌炎环形红斑和皮下结节等表现；⑤抗溶血性链球菌抗体升高如ASO＞500U，抗链球菌激酶＞80U，抗透明质酸酶〉1280；⑥水杨酸国制剂治疗有效；⑦血尿酸含量正常。 7.类风湿关节炎 呈对称性多关节受累，晚期关节畸形包括掌指关节尺侧偏移。纽扣花样畸形。 天鹅颈。样畸形等。皮下结节软硬，较固定，不破溃，见于皮肤易受摩擦部位，与疾病活动相关、可检测到类风湿关节炎相关的自身抗体，如类风湿因子、抗角蛋白抗体、抗核周因子和抗瓜氨酸多肽抗体等，血尿酸正常。 8.骨关节炎 主要累及远端指间关节及负重关节如膝和髋等，关节痛较轻，早期往往为运动痛，而红肿热痛等炎症表现较轻，血尿酸水平多正常。 9.银屑病关节炎 有特征性银屑病皮肤病变及“顶针样”指甲改变，很少出现皮下结节，无急性关节炎反复发作史，X线检查显示关节“笔帽征”，近端指骨增生，还可出现末端骨吸收，造成短指畸形，血尿酸水平多正常。 10.强直性脊柱炎 多见于男性青壮年，以非对称性下肢大关节炎为主，小关节很少受累，往往侵犯骶髂关节，X线检查有骶髂关节炎，晚期可出现椎体“竹节样改变”，90%以上HLA-B27阳性，血尿酸多正常。 11.骨肿瘤 由于痛风时尿酸钠盐在骨内沉积，多处骨质穿凿样破坏以致骨折，加之痛风结节肿胀畸形，因此易误诊为骨肿瘤而截指（趾）或截肢，但后者病程持续，无发作性红肿剧痛及明显高尿酸血症，活检两者即可鉴别。 三、治疗常规 （一）常规检查 1.必需的检查项目 （1）血常规、尿常规、便常规 （2）血沉、C反应蛋白 （3）肝功能、肾功能、血脂、血尿酸、尿尿酸 （4）心电图 （5）双肾、输尿管膀胱彩超（入院前三个月曾经检查过，且正常者，不需要检查，如有必要则检查）。 2.可选择的检查项目：根据病情需要而定，如类风湿因子、抗“O”、血粘稠度、肌酶谱、糖化血红蛋白、乙丙肝炎，抗核抗体谱，AKA、APF、抗CCP抗体、HLA-B27、肝胆脾胰超声、主要受累关节 X 线片、关节彩超、肺CT、关节MRI、关节液、痛风石检查等。 （二）治疗目的 1.迅速控制痛风性关节炎的急性发作； 2.预防急性关节炎复发； 3.纠正高尿酸血症，促使组织中沉积的尿酸盐晶体溶解，并防止新的晶体形成，从而逆转和治愈痛风； 4.治疗其他伴发的相关疾病。 痛风最佳治疗方案应包括非药物治疗和药物治疗两大方面。必要时可选择剔除痛风石、对残毁关节进行矫形手术治疗，以提高生活质量。 （三）基础治疗 1.急性发作期要卧床休息，防治剧烈运动，抬高患肢，注意保护受累关节。 2.低嘌呤饮食，限酒（尤其是啤酒和白酒），减少富含果糖饮料的摄入，规律饮食。 3.防止突然受凉。 4.大量饮水，每日2000ml以上。 5.控制体重。 6.规律作息。 7.规律运动。 8.戒烟。 四、中医治疗 （一）辨证选择口服中药汤剂、中成药 1.湿热痹阻证： 治法：清热利湿，通络止痛。 （1）推荐方药：四妙散加减。 苍术10-30g 黄柏10-30g 牛膝10-30g 薏苡仁10-30g 兼见血瘀，治疗的方药中可适当加入虫类、蛇类药物，如水蛭、土虫、乌梢蛇、蜈蚣等。 （2）中成药： 痛风定胶囊一次4粒，日3次口服。 外捈雪山金罗汉涂膜剂外用，适量，每日2-3次。 2.脾虚湿阻证： 治法：健脾利湿，益气通络。 （1）推荐方药：黄芪防已汤加减。 黄芪15-30g 防已10-25g 桂枝10-30g 细辛3g 当归10-30g 独活10-30g 羌活10-30g 白术10-25g 防风10-25g 淫羊藿10-15g 薏苡仁10-30g 土茯苓10-30g 萆薢10-15g 甘草10-15g （2）中成药： 补中益气颗粒一次3克，一日2-3次口服。 3.寒湿痹阻证： 治法：温经散寒，除湿通络 （1）推荐方药：乌头汤加减。 黑顺片5-10g 生麻黄5-10g 生黄芪10-30g 生白芍10-30g 苍术10-25g 生白术10-20g 羌活10-30g 片姜黄10-15g 当归10-30g 土茯苓10-30g 萆薢10-15g 甘草10-15g 兼见血瘀，治疗的方药中可适当加入虫类、蛇类药物，如水蛭、土虫、乌梢蛇、蜈蚣等。 4.瘀热阻滞证： 治法：活血化瘀、清热通痹。 （1）推荐方药：桃红饮合白虎加桂枝汤加减。 桃仁10-20g 红花10-15g 当归10-30g 川芎10-20g 威灵仙10-30g 石膏10-15g 知母10-15g 粳米15-30g 甘草10-15g 桂枝10-30g 丹参10-20g 牡丹皮15-20g （2）中成药： 痛风定胶囊一次4粒，日3次口服。 四妙丸一次6-9g，日2次口服。 新身痛逐瘀合剂口服，一次50ml，日2-3次。 外捈雪山金罗汉涂膜剂外用，适量，每日2-3次。 水调散外用。 5.痰瘀痹阻证： 治法：活血化瘀，化痰散结 （1）推荐方药：双合汤加减。 半夏10-20g 陈皮15-25g 茯苓15-12g 桃仁10-15g 红花15-25g 熟地黄12-25g 当归10-25g 赤芍10-25g 川芎10-25g 白芥子10-25g 甘草15-25g （2）中成药 新身痛逐瘀合剂口服，一次50ml，日2-3次。 祖师麻膏药外用。 （二）中医特色疗法 1. 中药外敷 （1）止痛散外敷 作用：温经散寒，除湿通络 操作：取关节疼痛部位，上敷我院自制中药止痛散，用远红外线灯照射 疗程：每次20分钟，每日1次，1周为1疗程，可酌情应用1-2疗程。 （2）清痹散外敷： 作用：清热除湿、通络止痛 操作：取关节疼痛部位，上敷我院自制中药清痹散，用绷带固定。 疗程：每次1-2小时，每日1次，1周为1疗程，可酌情应用1-2疗程。 五、西医治疗 （一）急性痛风性关节炎治疗 1.非甾体类抗炎药（NSAIDs） （1）口服 美洛昔康7.5-15mg，每日1次，口服。 依托考昔片120或60mg，每日1次。 塞来昔布，第一天400mg口服1次，如必要时家用200mg口服；维持剂量，如需要，200mg日2次。 双氯芬酸75 mg日1次或75mg日2次口服。 萘普生250-500mg，每日2次口服。 萘丁美酮1000mg，每日1-2次口服。 依托度酸400-1000mg，每日1次，口服。 吲哚美辛75mg日1次或日2次口服。 舒林酸0.2g，早晚各1次口服。 （2）肛塞：吲哚美辛栓一枚，日1次肛塞。 2.秋水仙碱：是有效治疗急性发作的传统药物。 推荐：首剂为1.0mg，1h后再用0.5mg，12h后0.5mg日2次或0.5mg日3次口服，连续用药至痛风急性症状完全缓解。 肾功能不全时的应用 内生肌酐清除率（ml/min) 秋水仙碱用量 ≥50 0.5mg每日2次 35-89 0.5mg每日1次 10-34 0.5mg,2-3日1次 ≤10 禁用 3.糖皮质激素：口服每日30mg，3d。为避免停药后症状“反跳”，停药时可加用小剂量秋水仙碱。 4.碱化尿液药物 碳酸氢钠片：0.5-2g日3次口服。定期监测尿PH值，使之保持在6.2-6.8之间。 （二）肾脏病变的治疗：除积极控制血尿酸水平外，碱化尿液，多饮多尿，十分重要。对于痛风性肾病，在使用利尿剂时应避免使用影响尿酸排泄的噻嗪类利尿剂、速尿、利尿酸等，可选择螺内酯（安体舒通）等。对于尿酸性尿路结石，大部分可溶解、自行排出，体积大且固定者可体外碎石或手术治疗。对于急性尿酸性肾病，除使用别嘌醇积极降低血尿酸外，应按急性肾功能衰竭进行处理。对于慢性肾功能不全可行透析治疗，必要时可作肾移植。 （三）臭氧自血疗法 操作：方式主要利用临时制备的臭化合水开展清创，关节腔注射治疗。医用臭氧高浓度（30-70ug/ml）时可导致组织结构破坏，中等浓度（20-30ug/ml）时主要发挥调节作用，低浓度（0-20ug/ml）时主要发挥增加氧供的作用。1-2周1次，根据病情制定疗程。 六、调摄与护理 （一）饮食护理 保持理想体重，适当限制脂肪，限制食盐摄入，限酒（尤其是啤酒和白酒）禁烟，限制果糖摄入、低嘌呤饮食，减少富含果糖饮料摄入，增加新鲜蔬菜的摄入，烹调食物最好采取煮、熬、烩、蒸，不用煎法、炒、炸等方法，可服用低脂奶制品，可增加维生素C摄入。通过健康教育使病人了解常见食物的酸碱性及嘌呤含量，使之能够合理地安排日常饮食。 （二）饮水护理 要求病人大量饮水（每日2000ml）以上，以增加尿量，促进尿酸排泄。适当饮水还可降低血液粘稠度。 1.饮水习惯：坚持每日饮一定量的水，不可平时不饮、临时暴饮。 2.饮水时间：不宜饭前半小时内和饱餐后立即饮大量的水，饮水最佳时间是两餐之间及晚间和清晨。 3.饮水与口渴：痛风病人应采取主动饮水的积极态度，不能等有口喝感时才饮水，因为口喝明显时体内已处于缺水状态，这时才饮水对促进尿酸排泄效果较差。 4.饮茶：痛风病人可用饮茶代替饮白开水，但茶含有鞣酸，易和食物中的铁相结合，形成不溶性沉淀物影响铁的吸收。另外，茶中鞣酸尚可与某些蛋白质相结合，形成难以吸收的鞣酸蛋白，所以餐后立即饮茶会影响营养物质的吸收和易造成缺铁性贫血等，较好的方法是餐后1h开始饮茶，且以淡茶为宜。 （三）规律运动 1.个性化原则 对于日常生活中没时间运动的人，建议其将交通工具改为自行或步行，对于年龄较大、体重较重、体质 较弱的患者剂量选择低强度的有氧运动；对病情较轻或者痛风高发人群可增大有氧运动的强度；急性痛风期则不适合运动，宜静卧休息，疼痛缓解72h后可开始适当运动。 2.适宜负荷原则 痛风患者在运动过程中，建议有氧运动，使用偏低的运动强度，同时，伴有高血压、高血脂、肥胖及糖尿病等合并疾病的患者，宜适当延长运动时间，但应注意防止疲劳出现。痛风患者忌剧烈或过度运动，这会引起乳酸堆积、尿酸升高，引发急性痛风的发作。 3.循序渐进原则 循序渐进原指运动时运动负荷安排要由小到大，逐渐增加；动作由易到难，休息次数由多到少、休息时间由长到短，动作重复次数复次数由少到多。在运动初期，运动负荷和运动量要小，经过锻炼身体适应后再逐步增加并达到适宜的运动负荷和运动量。 2. 适时调整原则 人体的生理功能及承受运动负荷的能力会因时间、环境、天气、身体状况的变化而发生变化。对痛风患者尤为如此，病情会受饮食、用药、作息时间的极大影响，容易反复。因此，痛风患者在进行运动时，应根据身体状况增减运动。 3. 运动方式的选择 适合痛风患者的有氧运动很多，如时间限制的快走、均匀慢跑、原地节奏跑、太极拳、健身气功、广播操、健美操、医疗体操、跳舞、踢毽子、打门球、跳绳、游泳，非对抗性的打乒乓球、篮球、排球等。 4. 运动时间及频率 低运动强度的时间为20-60min。每天运动时间选择下午为宜。可运动3d休息1d或运动2d休息1d的方式。 （四）中医辨证施护 对湿热痹阻型痛风患者，应力戒烟酒，避免进食辛辣刺激食物，局部配合清痹散等外敷：对寒湿痹阻型痛风患者，在季节变化时注意调节饮食起居，避免风寒湿邪外侵，发作时可局部热敷或中药熏蒸或止痛散外敷加TDP神灯；急性发作期，须严格卧床休息，并适当抬高患肢，以利血液回流，避免受累关节负重。直至疼痛缓解72h后开始适当轻微活动，促进新陈代谢和改善血液循环；间歇期，病人应注意鞋子的选择，尽量穿柔软舒适的鞋子，避免足部磨损造成感染。冬天避免受凉，室温保持在20～22℃，对年老体弱者应注意保暖。 （五）心理护理 由于反复关节炎发作，常导致患者情绪焦虑不安，护理人员要及时对患者进行心理安慰，解释病情，帮助其了解痛风的病因及防治对策，增加配合治疗的信心。 （六）健康教育 1.节制饮食，控制高嘌呤食物，不食或少食。多饮水，避免暴饮暴食。节制烟酒、不宜喝大量浓茶或咖啡。 2.积极减肥，减轻体重。避免饥饿疗法，坚持适当的运动量。 3.生活有规律，按时起居。注意劳逸结合，避免过度劳累、紧张与激动，保持心情舒畅，情绪平和。注意保暖和避寒，鞋袜宽松。 4.在医师指导下坚持服药，以控制痛风急性及反复发作，维持血尿酸在正常范围。不宜使用抑制尿酸排出的药物：双氢克尿塞、速尿。 5.定期检测血尿酸值，调整用药期间须1-2周1次，剂量稳定后可1～3个月检测1次，以便调整用药和防治尿酸性结石。 6.继发性痛风的预防主要是积极治疗多发性骨髓瘤、慢性肾病等原发病。 七、入院标准 （一）本病的急性活动期（如发热，关节肿痛，活动受限，血沉、CRP及血、尿尿酸等实验室指标增高，骨侵蚀的加剧和功能的快速减低等）。 （二）合并感染，或新近发生肾脏受累表现。 （三）疑似本病门诊不能确诊者。 八、疗效评价 （一）评价标准 参照中华人民共和国中医药行业标准《中医病证诊断疗效标准》（ZY/T001.1-94），1994年《中药新药临床研究指导原则》痛风相关疗效评价标准进行疗效评估。 （二）评价方法 症状积分分级量化指标： （1）11点疼痛程度数字等级量表(NRS-11) ：0分表示无疼痛，1O分表示能够想象到的最严重疼痛；1～3分表示轻度疼痛，但仍可从事正常活动；4～6分表示中度疼痛，影响工作．但能生活自理；7～9分表示比较严重的疼痛，生活不能自理；10分表示剧烈疼痛，无法忍受。 （2）关节肿胀：0分：关节无肿胀或肿胀消失；1分：关节肿胀、皮色红；2分：关节显著肿胀、皮色发红；3分：关节高度肿胀、皮色暗红； （3）活动受限：0分：关节活动正常；1分：关节活动受限；2分：关节活动明显受限；3分：关节活动严重受限。 （4）患者本人及医生对病情的VAS评分。 临床控制：关节疼痛、红肿等症状消失，关节活动正常，积分减少≥95％。 显效：关节疼痛、红肿等症状消失，关节活动不受限，积分减少≥70％，＜95％。 有效：关节疼痛、红肿等症状基本消除，关节活动轻度受限，积分减少≥30％，＜70％。 无效：关节疼痛、红肿等症状与关节活动无明显改善，积分减少＜30％。 注：计算公式（尼莫地平法）：[(治疗前积分—治疗后积分)]÷治疗前积分]×100% 九、难点分析 对于急性痛风性关节炎的治疗应是迅速控制炎症，缓解症状和恢复功能。目前常用药物包括非甾体类消炎止痛药、秋水仙碱和糖皮质激素三大类。非甾体类消炎止痛药虽然止痛效果好，但因为其胃肠道副作用及心血管安全性方面等问题迫使许多患者停药；秋水仙碱严重的肝毒性及胃肠道反应，使许多患者不愿意接受此药的治疗；糖皮质激素有引起骨质疏松、血糖及血脂升高等副作用，更使患者望而生畏。另有报道，近年来提出的生物制剂抗IL-1单抗、抗TNF-α单抗对急性痛风发作的改善有特效，但仍处于研究阶段且价格高昂，在国内也难以被患者接受。中医对痛风的防治有独特的优势，现代中医大多认为痛风是本虚标实之证，《湿热病篇》：“太阴内伤，湿饮停聚，客邪再至，内外相引，故病湿热。”急性发作期以湿热痹阻证型最为常见，湿热之邪，犯病多黏滞、缠绵，病情反复，清热容易伤脾生湿，除湿容易助热，临床如何掌握好用药配伍、用量及疗程是治疗的关键也是难点。痛风目前尚缺乏有效的根治措施，但据临床观察，患者如能遵医嘱有效地控制进食含高嘌呤类饮食，戒烟限酒，调节好生活，工作，就可减少复发。对患者教育，使患者保持良好的依从性也是重中之重。
2026年1月16日 下午6:36
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