基于多年临床实践，并结合岭南地区的气候特征以及痛风的病症特点，刘敏教授提出“少阴阳虚，寒湿痹阻”为痛 风的核心病机，即少阴肾阳虚为本，寒湿浊毒痹阻关节筋骨为标，局部常因寒湿浊毒郁久化热而表现为红肿热痛。治疗以 温阳泄浊为大法。温阳泄浊法主要适用于痛风辨证属少阴阳虚、寒湿内阻的患者：常见于痛风的慢性期或缓解期，亦可见 于痛风的急性期，其表现为寒热错杂但以阳虚为本。处方用药以附子汤为基础方，通常将附子汤中的茯苓改成土茯苓，加 用威灵仙；附子及威灵仙的最大剂量均可用至 60 g。根据痛风的临床表现和病邪特点，佐以清热利湿、祛风除湿、化痰软 坚、活血化瘀等药物。该诊疗思路可有效改善关节肿痛、降低血尿酸水平，对痛风及痛风石治疗具有良好效果，可为中医 治疗痛风提供参考。

Based on years of clinical practice and by considering the climatic characteristics of the Lingnan region and the pathological features of gout， Professor Liu Min proposes that the core pathogenesis of gout is due to shaoyin yang deficiency complicated with cold-dampness obstruction， i. e.， the root cause lies in the yang deficiency of the shaoyin（kidney），while the symptoms are manifested as the obstruction of joints and tendons by cold，dampness，turbidity，and toxin. Local redness，swelling，heat，and pain are often presented after the persistent stagnation of cold-dampness-turbidity-toxin transforms into heat. The therapeutic principle centers on warming yang and discharging turbidity. This method is primarily suitable for gout patients differentiated as the syndrome of shaoyin yang deficiency complicated with internal cold-dampness obstruction， which is commonly seen in the chronic or remission phases of gout，and also occur in the acute phase when the presentation involves a mixture of cold and heat syndromes but with yang deficiency as the fundamental root cause. The prescription is based on the Fuzi Decoction（Decoction of Aconiti Lateralis Radix Praeparata）， typically by the modification through replacing Poria with Smilacis Glabrae Rhizoma and with Clematidis Radix et Rhizoma added. The maximum dosage for both Aconiti Lateralis Radix Praeparata and Clematidis Radix et Rhizoma can reach 60 g. Adjunctive herbs for clearing heat and draining dampness，dispelling wind and eliminating dampness，resolving phlegm and softening hardness， or activating blood and removing stasis are added according to the clinical manifestations and pathogenic characteristics of gout. This approach is effective on improving joint swelling and pain and reducing serum uric acid level，and shows good efficacy in treating gout and tophi，providing a valuable reference for the TCM treatment of gout.

R259.897

广东省中医药局面上项目（编号：20251315，20241281）；深圳市医疗卫生三名工程项目（编号：SZZYSM202311004）