基于“虚气留滞”理论探讨原发性骨质疏松症的病机及论治  

Study on pathogenesis and treatment of primary osteoporosis based on the theory of“Deficiency-Qi Stagnation”

作　　者：段航 曾凡 卢敏[2] DUAN Hang;ZENG Fan;LU Min(Hunan University of Chinese Medicine,Changsha 410208,China;First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha 410007,China)

机构地区：[1]湖南中医药大学,湖南长沙410208 [2]湖南中医药大学第一附属医院,湖南长沙410007

出　　处：《时珍国医国药》2023年第11期2718-2721,共4页Lishizhen Medicine and Materia Medica Research

基　　金：国家自然科学基金(81874476);第六批名老中医药专家学术经验继承指导(rsk-011-14);湖南省研究生创新课题(CX20220804,CX20220814);湖南省中医药管理局“十四五”第一批中医药领军人才培养项目(rsk-023-01)。

摘　　要：原发性骨质疏松症是一种缓慢起病、病程呈持续发展的慢性筋骨疾病,临床以骨矿物质密度降低,骨微结构恶化,脆性骨折风险增加为特征。影响该病发生的作用因素众多,且病理机制尚未完全阐释清楚,中医药治疗尽管有良好的临床疗效,但缺乏核心的病机理论,基于前期文献研究及临床实践发现原发性骨质疏松症的病因病机与“虚气留滞”病机理论相吻合。虚气表现为元气不足,留滞体现在瘀血痰湿阻滞,故提出补虚化瘀、行气通滞作为本病的治疗总则,以补虚固本为先,因涉及肝脾肾多个脏腑,故文章分别阐述了补肾生髓壮骨、补脾益气生津、滋补肝肾填精的临床应用思路和方法,以化瘀通滞为要,化瘀可分行气活血、补肾活血、活血健脾化痰三类,旨在说明在临床治疗本病时补虚不忘行气活血、散寒通络,化瘀不忘补肾培元、益气养血。Primary osteoporosis is a chronic skeletal disease with a slow onset and continuous progression.It is clinically characterized by decreased bone mineral density,deterioration of bone microstructure,and an increased risk of brittle fractures.There are many factors that affect the occurrence of this disease,and the pathological mechanism has not been fully explained.Although traditional Chinese medicine treatment has good clinical efficacy,it lacks the core pathogenesis theory.Based on previous literature research and clinical practice,it is found that the etiology and pathogenesis of primary osteoporosis are consistent with the pathogenesis theory of"deficiency Qi retention".Deficiency of Qi is manifested in deficiency of vital energy,and stagnation is manifested in stagnation of blood stasis and phlegm and dampness.Therefore,the general principles for the treatment of this disease are to supplement deficiency and remove stasis,and to promote the circulation of Qi and remove stagnation.The first principle is to supplement deficiency and consolidate the essence.Since it involves multiple viscera of the liver,spleen and kidney,this article separately expounds the clinical application ideas and methods of tonifying the kidney,marrow and bone,supplementing the spleen,replenishing Qi and promoting fluid production,and nourishing the liver and kidney to replenish essence.To remove stasis and remove stagnation,blood stasis can be divided into three categories:Qi and blood circulation,kidney and blood circulation,and blood circulation,spleen and phlegm.It is intended to explain that in the clinical treatment of this disease,we should not forget to invigorate Qi and blood circulation,dissipate cold and unblock collaterals,remove blood stasis and not forget to invigorate the kidney and nourish the blood.

关 键 词：原发性骨质疏松症 补虚化瘀 虚气留滞 中医理论 

分 类 号：R247[医药卫生—中医临床基础]