摘要
膝骨关节炎与年龄、肥胖、炎症、创伤及遗传等因素相关,在发生、发展过程中涉及多条信号通路,但其具体发病机制未明。中医药治疗膝骨关节炎可改善患者症状、延缓病情发展,但缺乏规范、统一的辨证分型名称,相关治法不尽相同,各有侧重。结合膝骨关节炎的研究进展及发病特点,本文提出膝骨关节炎存在“虚、瘀、毒”病机特点。因脾、肝、肾脏腑虚损,不能对膝关节进行正常的濡养,则肌肉不充,筋骨不坚,髓海失养,髓枯骨痿,发为本病,即“因虚致痹”;因气血亏虚,瘀血内生,痰湿内聚,以及跌打损伤,或长期慢性劳伤,即“因瘀致痹”;又可因风、寒、湿等外毒侵袭,以及因机体正气不足,内毒即生,内外之邪毒,痹着筋骨,即“因毒致痹”。同时,膝骨关节炎中“虚、瘀、毒”三者又可相互影响,如因脏腑虚损,瘀血内生,感毒加剧,即“因虚、毒致瘀”;或因机体正气不足,瘀血内阻,内毒即生,即“因虚、瘀致毒”;又可因内、外毒,筋骨痹阻,导致脾、肝、肾气虚损,即“因毒、瘀致虚”。因此,“虚、瘀、毒”三者紧密关联,共同存在于膝骨关节炎的发生、发展中。在对膝骨关节炎进行中医病机阐述、临床选方用药、预后康复时,应掌握“虚、瘀、毒”病机特点,方可取得较好疗效。
Knee osteoarthritis is related to age,obesity,inflammation,trauma,and genetic factors, involving multiple signaling pathways in the process of occurrence and development.However,its specific pathogenesis is unknown.Traditional Chinese medicine treatment could improve the symptoms and delay the disease development in patients with knee osteoarthritis.However,due to lack of standard and unified syndrome differentiation name,there are many treatment methods with different focus for each.In this paper,the pathogenesis characteristics of "deficiency,stagnation and toxin"were proposed for knee osteoarthritis by considering the research progress and pathogenesis characteristics.The knee joint gets no normal support because of deficient of spleen,liver and kidney,leading to insufficient muscles,weak physique,innutritious marrow,flaccid pulp and bone."arthralgia caused by deficiency";in case of deficiency ofqi and blood,blood stasis,internalaccumulation of phlegm,injury,or long-term chronic fatigue."arthralgia caused by stagnation",in case of exogenous evil,such as wind,coldness,dampness,as well as lack of Qi,i.e."arthralgia caused by toxin". Meanwhile,deficiency,stagnation and toxin could influence each other.For example,deficient of viscera could lead to blood stasis and aggravated toxin."stagnation caused by deficiency and toxin",loss of vital Qi and blood stasis could produce endogenetic toxins."toxin caused by deficiency and stagnation",exogenous evil,endogenetic toxins and obstructed bones and muscles could lead to deficiency of spleen,liver and kidney."toxin caused by deficiency and stagnation".Therefore,deficiency,stagnation and toxin are closely related to each other,and co- exist with the occurrence,development of knee osteoarthritis.It is important to understand the pathogenesis characteristics of "deficiency,stagnation and toxin"in knee osteoarthritis during pathogenesis of traditional Chinese medicine,selection of clinical medication,prognosis and rehabilitation.
作者
谭旭仪
邝高艳
卢敏
TAN Xu-yi;KUANG Gao-yan;LU Min(Hunan University of Chinese Medicine,Changsha 410208,China;Hunan Academy of Chinese Medicine,Changsha 410006,China;The First Hospital of Hunan University of Chinese Medicine,Changsha 410007,China)
出处
《中国实验方剂学杂志》
CAS
CSCD
北大核心
2018年第24期201-206,共6页
Chinese Journal of Experimental Traditional Medical Formulae
基金
国家自然科学基金面上项目(81574004)
湖南省自然科学基金项目(14JJ2109)
湖南省中医药管理局课题项目(201408)
关键词
膝骨关节炎
病机
虚
瘀
毒
knee osteoarthritis
pathogenesis
deficiency
stagnate
toxin
