基于“血不利则为水”探讨膝骨关节炎关节积液形成的病机与辨治  

Exploring the pathogenesis and differentiation treatment of joint effusion formation in knee osteoarthritis based on the theory of “blood stasis can produce water retention”

作　　者：郭进发 吴宇翔 马玮玮 李文娴 GUO Jinfa

机构地区：[1]厦门市中医院,福建厦门361015 [2]福建中医药大学,福建福州350122 [3]湖北中医药大学,湖北武汉430061 [4]厦门莲前社区卫生服务中心,福建厦门361008

出　　处：《中医临床研究》2024年第23期47-51,共5页Clinical Journal Of Chinese Medicine

摘　　要：膝骨关节炎是一种发生在膝关节的慢性退行性病变。基于“血不利则为水”理论,本研究阐明膝骨关节炎关节积液形成的病机和辨证论治。取象比类是中医理论的核心思维方式,将四诊信息概括,常通过类比自然事物的特征理解人体的证象。在取象比类视角中,“血不利则为水”理论的解释为“血不利”为血行不畅而呈现出瘀血状态之意,“水”是由于血行不畅而导致的水液输布失常的病理状态,在膝骨关节炎的发病中会导致关节积液的产生。膝骨关节炎发病以人体阳气不足为本,兼有脾失运化、肾虚阴阳失衡、肝失疏泄,脾、肾、肝功能失调,引起阴性静而凝太过,从而使血滞为瘀,导致血行不利,瘀阻经脉而水不循经,水聚为病,进而导致关节积液,整个过程伴随“气”“血”“液”失调。本病需根据疾病特点进行分期治疗,以温阳为本,善用活血之法,并以健脾、疏肝、益肾为辅,使阳气得以恢复,瘀血、水饮得以消除。急性期治疗的关键在于活血利水,根据辨证辅以益气、行气、清热之法;缓解期侧重于活血化瘀,健脾补肾以扶正祛邪,同时可用虫类药物来通络活血。以辨病与辨证相结合为原则,以求达到更好的疗效。Knee osteoarthritis(KOA) is a chronic degenerative disease of the knee. This study elucidates the pathogenesis of joint effusion formation in KOA and the differentiation-based treatment based on the theory of blood stasis can produce water retention. Analogy is the core mode of thinking of traditional Chinese medicine theory. It generalizes the information of the four diagnostic methods and often understands the syndromes of the human body by analogy with the characteristics of natural phenomena. From the perspective of traditional Chinese medicine, blood stasis can produce water retention, and is the cause of KOA. The disease's onset is primarily due to the deficiency of Yang(阳), combined with the spleen's failure in transformation and transport, an imbalance of Yin(阴) and Yang due to kidney deficiency, and the liver's failure to maintain the smooth flow of Qi(气) and blood. This dysfunction in the spleen, kidney, and liver causes an excessive accumulation of Yin fluids, leading to blood stasis, impeded blood circulation, and consequently, the accumulation of fluids which manifests as disease, alongside an imbalance of Qi, blood, and fluids. Treatment should be stage-specific, focusing on warming Yang and promoting blood circulation, supported by strengthening the spleen, dredging the liver, and nourishing the kidney to restore Yang and eliminate blood stasis and fluid retention. In the acute phase, the key of the treatment is to promote blood circulation and fluid metabolism, supplemented by methods to augment Qi, promote Qi circulation, and clear heat. In the remission phase, the focus is on promoting blood circulation to remove blood stasis, strengthening the spleen and kidney to support the body's essential energy and expel pathogenic factors, with the use of insect-based medicines to unblock the channels and promote blood circulation. The principle of combining disease identification with syndrome differentiation aims to achieve better therapeutic effects.

关 键 词：血不利则为水 膝骨关节炎 关节积液 活血 利水 

分 类 号：R274[医药卫生—中医骨伤科学]