目的：探讨三妙丸中二妙丸配伍牛膝的合理性。方法：首次采用高尿酸血症致尿酸盐结晶沉积于关节的急性痛风关节炎大鼠模型，观察三妙及缺牛膝三妙丸对血尿酸值、炎症因子IL-1β和IL-6 及关节病理组织的影响；HPLC-ESI-MS/MS 分析给药模型大鼠血清和关节中移行成分及其离子峰强度的相对变化。结果：三妙及缺牛膝三妙丸均有显著的抗急性痛风炎症及降血尿酸作用，而三妙丸抑制痛风大鼠足肿胀、保护关节组织的炎症损伤及抑制炎症因子IL-1β水平优于缺牛膝三妙丸；三妙及缺牛膝三妙丸给药血清均检测出5 个移行成分，关节中1 个移行成分，其中2 个为黄柏生物碱代谢物、2 个为苍术糖苷类成分代谢物，且三妙方血清及关节中移行成分离子强度均高于缺牛膝三妙方。结论：牛膝有促进二妙丸中黄柏生物碱及苍术倍半类成分在血液及关节中的分布，增强抗急性痛风关节炎药作用。

This article was aimed to discuss the reasonability of combined use of Achyranthes bidentata and Er -Miao-Wan (EMW) in San-Miao-Wan (SMW). Urate crystals caused by hyperuricemia deposited in the joint rat model was established for the first time. The serum uric acid level, inflammatory factors of IL-1βand IL-6, pathological tissues of joint of SMW and SMW lacked A . bidentata (EMW) were investigated by acute gouty arthritis rat model.HPLC-ESI-MS/MS method was used to analyze constituents absorbed in serum and joints which were obtained from the rat model after oral administration of SMW and EMW. Comparison was made on the intensity of ion peaks of constituents between SMW and EMW. The results showed that SMW and EMW had prominent effect in treatment of acute gouty arthritis and reducing serum uric acid level. SMW had better effect on the inhibition of swollen limbs and inflammatory factor IL-1β as well as the protection of inflammatory injury of joint tissues compared with EMW.Five constituents in the serum and one constituent in joints were detected from the rat models after oral administration of SMW and EMW. Two of them were metabolites of alkaloid constituents in Phellodendron Chinese and two of them were metabolites of glycoside constituents in Atractylodes lancea. The intensity of ion peaks of SMW was higher than EMW. It was concluded that A . bidentata can promote the distribution of alkaloids components in Phellodendron Chinese and glycoside components in A . lancea in EMW in the blood and joints, which enhanced the anti-inflammatory effect of acute gouty arthritis.

江苏省科技厅自然科学基金面上项目（BK2002033）：抗痛风加味四妙丸有效部位筛选及有效部位群研究，负责人：尹莲；江苏省方剂研究重点实验室开放项目（02202104010）：二妙丸类方物质基础与生物效应关联研究，负责人：尹莲。