基于“痿痹一体”探析骨质疏松症、膝骨性关节炎共病辨治  

Differentiation and Treatment of Co-morbidity of Osteoporosis and Knee Osteoarthritis based on the Concept of "Wei (痿) and Bi (痹) Unity"

作　　者：崔玉石 吴红飞 高云 赖润民 张兴平 张帅 王明远 李亚敏 CUI Yushi;WU Hongfei;GAO Yun;LAI Runmin;ZHANG Xingping;ZHANG Shuai;WANG Mingyuan;LI Yamini(Eye Hospital,China Academy of Chinese Medical Sciences,Beijing,100040;Xiyuan Hospital,China Academy of Chinese Medical Sciences;National Digital Center of Traditional Chinese Medicine,China Academy of Chinese Medical Sciences)

机构地区：[1]中国中医科学院眼科医院,北京市100040 [2]中国中医科学院西苑医院 [3]中国中医科学院中医药数据中心

出　　处：《中医杂志》2024年第15期1565-1570,共6页Journal of Traditional Chinese Medicine

基　　金：中国中医科学院科技创新工程(CI2021A02012);国家中医药管理局中医药国际合作专项中心类项目(0610-2040NF020931)。

摘　　要：骨质疏松症与膝骨性关节炎常常共病或伴发,二者在流行病学、临床症状、发病机制等多个层面联系紧密,将二者进行共病管理、整体辨治十分必要。从中医学“痿”与“痹”的整体关系出发,认为骨质疏松症、膝骨性关节炎共病以髓减骨枯为共病的核心病机,微骨折为共病的中心病理环节,整体治疗以益肾填髓强骨为本。针对共病过程中的“微骨折”病理表现,并依据共病不同的痿、痹虚实特征划分“痿现痹轻”“痿痹并进”“痿痹并重”三型论治。痿现痹轻型即骨质疏松症前期,以传统导引术干预为主;痿痹并进型又分为三期论治,膝关节疼痛发作期、缓解期、康复期分别以桃红四物汤、补肾活血方、自拟补肾强骨方为主方治疗;痿痹并重型以临床经验方强骨止痛方为主方治疗。Osteoporosis and knee osteoarthritis often co-occur and are closely related in terms of epidemiology,clinical symptoms,pathogenesis and other aspects.Therefore,it is necessary to manage the co-morbidity and treat the two as a whole.Based on the overall relationship between wei(痿)and bi(痹)in TCM,it is believed that osteoporosis and knee osteoarthritis have marrow loss and bone atrophy as the core pathogenesis of co-morbidity,and microfractures as the central pathological link.The overall treatment is rooted in boosting kidney,supplementing marrow and strengthening the bones.According to the pathological manifestations of microfractures in the process of co-morbidity,and the different deficiency and excess characteristics of wei and bi,it can be divided into three types,"wei emerging with mild bi","wei and bi progressing simultaneously",and"emphasis on both wei and bi",for treatment.In terms of"wei emerging with mild bi",that is the early stage of osteoporosis,the traditional Daoyin(导引)is the main therapy.For"wei and bi progressing simultaneously",it can be divided into three stages further,including the onset stage,remission stage,and recovery stage of knee pain,treated with Taohong Siwu Decoction(桃红四物汤),Bushen Huoxue Formula(补肾活血方)and self-made Bushen Qianggu Formula(补肾强骨方)as the main formula respectively.For"emphasis on both wei and bi",the proven formula,Qianggu Zhitong Formula(强骨止痛方),is taken as the main prescription.

关 键 词：骨质疏松症 膝骨性关节炎 共病 痿证 痹证 

分 类 号：R259[医药卫生—中西医结合] R274.9[医药卫生—中医内科学]