从《正体类要》浅析膝骨关节炎的脏腑内治思想  

Analysis of Zang-Fu Organs Internal Treatment Thought of Knee Osteoarthritis from Perspective of Zhengti Leiyao

作　　者：张书铭 许金海[1] 莫文[1] ZHANG Shuming;XU Jinhai;MO Wen(Department of Orthopedics and Traumatology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院骨伤科,上海200032

出　　处：《辽宁中医杂志》2023年第8期62-65,共4页Liaoning Journal of Traditional Chinese Medicine

基　　金：上海市科学技术委员会项目(21S21900500);上海中医药大学附属龙华医院第五批龙医学者(KC2022006);上海市浦东新区卫生健康委员会联合攻关项目(PW2021D-11);申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划项目(SHDC2020CR4048)。

摘　　要：膝骨关节炎(knee osteoarthritis,KOA)是一种关节退行性疾病,疼痛、肿胀、弹响、关节僵硬和运动功能障碍是其主要临床表现,中医学属“痿证”“痹证”范畴。目前尚无能有效阻止该病进展的治疗药物与方法,减轻关节疼痛,改善关节功能,提高生活质量仍是治疗核心,以汤药内服为代表的中医药综合治疗目前已成为我国临床治疗KOA的首选方案。明代薛己所著《正体类要》是一部对外损的辨证论治、理法方药探讨全面的伤科专著,此书对于KOA的脏腑内治思想亦有启发和奠基作用。该文以《正体类要》建立的伤科脏腑辨治体系为理论基础,对KOA的脏腑内治思路进行讨论,在整体论治的基础上着重探讨脾胃、肝、肾与KOA发生发展的关系,并提出以壮脾健胃、疏肝化瘀、滋补肾命为主要治疗方法来调整脏腑功能,再兼以祛邪,达到膝关节平衡,做到既祛除邪气又不伤正气,增强了治疗顺应性,从而取得良好的KOA临床疗效。Knee osteoarthritis(KOA)is a degenerative joint disease.Pain,swelling,popping,joint stiffness and motor dysfunction are its main clinical manifestations.It belongs to the category of“paralysis syndrome”and“Bi syndrome”in TCM.At present,there are no effective treatment drugs or methods to prevent the progression of the disease.Reducing joint pain,improving joint function and improving quality of life are still the core of treatment.Comprehensive treatment of traditional Chinese medicine represented by decoction for internal administration has become the preferred treatment for KOA in China.Zhengti Leiyao,written by XUE Ji of the Ming Dynasty,is a comprehensive treatise on the treatment of external injury based on syndrome differentiation and theory and prescription.This book also inspired and laid the foundation for Zang-Fu organs internal treatment of KOA.Based on the theory of the system of syndrome differentiation based on Zang-Fu organs and treatment in the department of traumatology set up in Zhengti Leiyao,this paper discussed the Zang-Fu organs internal treatment of KOA.On the basis of holism treatment,it focused on the relationship between the development of spleen,stomach,liver,kidney and KOA,and put forward the main treatment methods of strengthening spleen and stomach,soothing liver and removing blood stasis,and nourishing kidney to adjust the function of Zang-Fu organs,and also combined with the method of eliminating pathogenic factors to achieve the balance of the knee joint,so as to eliminate evils without damaging the healthy Qi.It has enhanced the treatment compliance and achieved good clinical efficacy in KOA.

关 键 词：薛己 《正体类要》 膝骨关节炎 脏腑辨证 

分 类 号：R684.3[医药卫生—骨科学]