调和气血法防治慢性筋骨病的应用与发展  

Application and development of therapy of reconciling qi and blood in the prevention and treatment of chronic musculoskeletal diseases

作　　者：王拥军[1,2,3,4] 梁倩倩[1,2,3] 崔学军[1,2,3] 李晨光[1,2,3] 莫文[1,2,3,4] 胡志俊[1,2,3,4] 唐德志[1,2,3] 舒冰[1,2,3] 卞琴[1,2,3] 叶秀兰[1,2,3,4] 叶洁[1,2,3,4] 李晓锋[1,2,3] 王晶[1,2,3] 王腾腾[1,2] 赵东峰[1,2,3] 徐浩[1,2,3] 唐占英[1,2,3] 杨燕萍[1,2,3] 张岩[1,2] 卢盛[1,2,3] 赵永见[1,2,3] 施杞[1,2,3,4] 

机构地区：[1]上海中医药大学附属龙华医院骨伤科,上海200032 [2]上海中医药大学脊柱病研究所,上海200032 [3]上海中医药大学附属龙华医院石筱山伤科学术研究中心,上海200032 [4]上海中医药大学附属龙华医院施杞名中医工作室,上海200032

出　　处：《上海中医药杂志》2017年第6期1-4,12,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金重点项目(81330085);科技部重点领域创新团队计划项目(2015RA4002);科技部国家重点基础研究发展计划("973"计划)项目(2010CB530400);教育部创新团队计划项目(IRT16R50);教育部重点实验室项目[教技(2009)98号];国家中医药管理局名老中医传承工作室建设项目[国中医药人教发(2011)41号]

摘　　要：气血理论是辨证施治的重要理论基础之一。施杞教授根据慢性筋骨病"正气亏虚、外邪侵袭、经络闭阻"的病机特点,形成了"调和气血法"防治慢性筋骨病的原则。以圣愈汤作为基础方,意在传承"以气为主,以血为先"的伤科学术精髓,并形成了以益气化瘀为核心的13个协定方。通过临床与基础研究,"以气为主"通过益气恢复气的推动、防御、营养等功能,可以调节激素水平、改善骨代谢、促进骨细胞增殖、延缓细胞凋亡、促进基质蛋白多糖和胶原合成、提高细胞黏附功能,从而维持骨结构与功能;还可抑制炎症介质,调节细胞因子,提高免疫功能。"以血为先"通过祛瘀达到行气的目的,可以改善骨的血液动力学和血液流变学,以利于营养物质进入骨骼,并调节血钙、碱性磷酸酶。"调和气血法"指导临床辨证施治,疗效显著提高。The theory of qi and blood is one of the important theoretical bases of syndrome differentiation and treatment. According to the pathogenesis characteristics of chronic musculoskeletal diseases as＂vital qi deficiency, exogenous pathogen invasion, meridian block and obstruction＂, Professor Shi Qi puts forward the therapy of ＂reconciling qi and blood ＂ for prevention and treatment of chronic musculoskeletal diseases. Shengyu Decoction is taken as the basic prescription, and 13 new prescriptions that focus on benefiting qi and removing blood stasis as the core are created, which intend to inherit the academic essence of traumatology as＂ giving priority to qi and taking blood as the first＂. Through the clinical and basic research, the principle of ＂giving priority to qi＂ refers to recovering the function of qi in promotion,defense and nutrition by benefiting qi, which could regulate hormone levels, improve bone metabolism, promote osteoblast proliferation, delay cell apoptosis,promote proteoglyean and collagen synthesis, improve cell adhesion function and thus maintain the bone structure and function, inhibit inflammatory mediators and regulate cytokines, improve immune function. The principle of ＂ taking blood as the first＂ means that eliminating blood stasis to promote the circulation of qi,which could improve the henmdynamics and hemorheology of bone and benefit for nutrients into the skeleton, and regulate serum calcium and alkaline phosphatase level. The therapy of ＂reconciling qi and blood＂ guide the clinical syndrome differentiation and treatment and significantly enhance the efficacy.

关 键 词：慢性筋骨病 气血理论 以气为主 以血为先 

分 类 号：R274.9[医药卫生—中西医结合]