五脏及五体（筋、脉、肉、皮、骨）可通过气血、经络相互联系，互为表里，在生理和病理上相互影响。“五体痹”与 “五脏痹”可互为因果。痛风可归属于中医的“痹证”。痹证之受损不仅在肢体，脏腑也受到一定的损伤。外邪侵犯人体， 有形实邪瘀积肢体关节；脏腑功能失调，失其职、乱其司，气血化生、运行障碍，正气虚弱，内邪渐生。五脏与五体通过 气血、经络相联系，二者在病理上互为影响，形成痛风。故以疏通肢体经络与调理脏腑相结合是治疗痛风的基本原则。痛 风初期，风袭皮毛，先发体痹，治疗重在疏风通络、健脾化湿，佐以补益正气之品；中期风邪挟湿流注关节间，痰浊郁而 化热，伤津耗液，损及他脏，体痹及脏，治疗重在清热降火、活血化瘀，佐以健脾化痰之品；后期风火伤津耗液，消烁痰 浊成石，久病及肾，体脏合痹，治疗重在熄风降火，佐以活血化瘀、益肾祛浊之品。 从“体脏合痹”的角度探讨湿、痰、 瘀病理因素在痛风之病程演变中的作用及痛风患者的分期辨治，可为痛风的临证治疗提供思路。

The five zang-organs （heart， liver， spleen， lung， kidney） and five body constituents （tendons， vessels，muscles，skin，bones） are interconnected exteriorly and interiorly through qi-blood，and meridians and collaterals，forming an interdependent physiological and pathological relationship. Five-body-constituent blockage and five-zang-organ blockage may mutually influence each other as cause and effect. Gout can be classified under the category of blockage syndrome in traditional Chinese medicine （TCM）. The pathology of blockage syndrome involves not only the limbs but also zang-fu organs. External pathogens invade the body，leading to the stagnation and accumulation of tangible excessive pathogens in the joints. The visceral dysfunction disrupts qi-blood production and circulation，resulting into the weakness of healthy qi and the generation of internal pathogens. The mutual pathological interaction between the five zang-organs and five body constituents through qi-blood and meridians contributes to the pathogenesis of gout. Therefore，the fundamental therapeutic principle for gout is to dredge meridians of the limbs and to regulate visceral function. In the early stage of gout，wind pathogen attacks the skin and muscles，primarily manifesting as somatic blockage，and the treatment should focus on dispelling wind and unblocking collaterals，fortifying the spleen to resolve dampness，supplemented by qi-tonifying herbs. In the middle stage of gout， wind pathogen complicated with dampness accumulates in the joints， phlegmturbidity formed and then transformed into heat， which consumes body fluids and damages other organs，progressing to visceral blockage. Treatment for the middle stage of gout should focus on clearing heat and purging fire，activating blood to resolve stasis，supplemented by spleen-strengthening and phlegm-resolving herbs. In the late stage of gout，wind-fire pathogens further deplete fluids，and then condense phlegm-turbidity into calculi. For prolonged illness involves the kidneys，late gout develops into integrated visceral-somatic blockage. Treatment for the late stage of gout should prioritize extinguishing wind and reducing fire， supplemented with bloodactivating and stasis-resolving herbs and kidney-tonifying and turbidity-eliminating herbs. The exploration of the roles of dampness，phlegm，and stasis in gout progression and the implementation of staging treatment from the perspective of integrated somatic-visceral blockage will provide valuable insights for clinical management of gout.

R259.897

广东省基础与应用基础研究基金项目（2022A1515220069，2023A1515220052）；广东省中医院中西结合优势病种临床研究院内 专项（编号：YN2023MS24）；广东省医学科学技术研究基金项目（编号：A2024563）；广州中医药大学研究生创新培养专项（广中医校办 〔2022〕 173号）；范冠杰广东省名中医传承工作室建设项目（粤中医办函[2020]1号）；广东省中医院名中医药专家学术经验传承工作室项目 （编号：Y0054.E54101）