从筋论治膝骨关节炎的新思考  

New thoughts on the treatment of knee osteoarthritis from tendon

作　　者：潘富伟 陈元川[1,3] 张旻 杨光月[1,3] 李正言[1,3] 陆洁航 詹红生[1,2,3] PAN Fu-wei;CHEN Yuan-chuan;ZHANG Min;YANG Guang-yue;LI Zheng-yan;LU Jie-hang;ZHAN Hong-sheng(SHIs’Center of Orthopedics and Traumatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Institute of Traumatology&Orthopedics,Shanghai Academy of Traditional Chinese Medicine,S hanghai 201203,China;ZHAN Hong-sheng Studio of Academic Experience of Shanghai Famous TCM Doctors,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院石氏伤科医学中心,上海201203 [2]上海市中医药研究院骨伤科研究所,上海201203 [3]詹红生上海市名中医学术经验研究工作室,上海201203

出　　处：《中华中医药杂志》2022年第6期3040-3044,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目(No.82074466,No.81973875);上海市临床重点专科“中医骨伤科学”(No.shslczdzk03901);上海市慢性筋骨病临床医学研究中心(No.20MC1920600);促进市级医院临床技能与临床创新三年行动计划(2020-2022年)重大临床研究项目(No.SHDC2020CR1051B);上海市中西医临床协作试点项目[No.ZXYXZ-201703,No.ZY(2018-2020)-FWTX-1007];2020年度上海中医药大学预算内科研项目(No.2020LK046);2021年度上海中医药大学“研究生创新培养专项”(No.Y2021088)。

摘　　要：膝骨关节炎(KOA)是一种发病率、致残率较高的慢性筋骨病损伤类疾病,主要临床表现为关节的僵硬、疼痛、活动不利,甚至关节畸形、功能丧失等。随着社会人口的老龄化,该病的发病率急剧升高,业已成为患者慢性疼痛、功能障碍乃至丧失劳动能力的主要因素。文章基于詹红生教授“筋主骨从、筋为骨用”的学术思想,通过回顾KOA的认识历程,即最初认为该病是软骨退变引起的“磨损性关节炎”,进而认识到“炎症性关节炎”“全膝关节病”等,重新审视KOA“筋伤”这一关键病因病机,强调从筋论治的科学性、合理性以及重要性,阐述区分主次、以筋为要、身心同治的“四以相和”的医药综合治筋策略的临床意义。Knee osteoarthritis(KOA)is one of the diseases of chronic muscle and bone with high incidence and disability rate.The main clinical manifestations are stiffness and pain of joint,movement disorde,even leading to joint deformity and losing function.With the aging of the social population,the incidence of the disease has increased sharply,and it has become the main factor of chronic pain,dysfunction and even loss of labor ability of patients.Based on professor ZHAN Hong-sheng’s academic thought of‘tendon governing and serving the bone’,this paper has reviewed cognitive process of KOA.Therefore,we initially thought that the disease was‘abrasive arthritis’caused by cartilage degeneration,as well as‘inflammatory arthritis’,‘total knee arthropathy’,and so on.We emphasized the scientificity,rationality and importance of treatment in tendon,summarizing the clinical significance of‘four phases to harmony’comprehensive treatment strategy of traditional Chinese medicine.To be specifically,the first is distinguishing the primary and secondary,then taking the tendon as the key point,finally treating both the physical and mental.

关 键 词：慢性损伤 膝骨关节炎 从筋论治 詹红生 四以相和 病机 筋伤 

分 类 号：R274.9[医药卫生—中西医结合]