基于黄元御“土湿水寒木郁”论治膝骨关节炎  

Study on Treating Knee Osteoarthritis Based on the Theory of"Earth Dampness and Water Coldness Leading to Wood Depression"by Huang Yuanyu

作　　者：朱受权 童思文 刘楚 陈镜任 欧志学[2] ZHU Shouquan;TONG Siwen;LIU Chu;CHEN Jingren;OU Zhixue(Guangxi University of Chinese Medicine,Nanning,Guangxi,China,530002;Guilin Hospital of Traditional Chinese Medicine,Guilin,Guangxi,China,541002)

机构地区：[1]广西中医药大学,广西南宁530002 [2]桂林市中医医院,广西桂林541002

出　　处：《河南中医》2025年第2期200-204,共5页Henan Traditional Chinese Medicine

基　　金：广西壮族自治区中医药适宜技术开发与推广项目(GZSY21-78)。

摘　　要：黄元御认为,人身之病,实为气病,诸气运转正常,则病气不现。膝骨关节炎(knee osteoarthritis, KOA)由内外邪气相合而致,根本病机为土湿水寒木郁,土湿失运,外气不圆,四象失常,癸水寒生,乙木风起,外感风寒湿邪。临证治疗KOA可用桂枝芍药知母汤燥土祛湿、降火暖水、疏木熄风,若病剧,则加黄芪通行经络,乌头祛湿逐寒;亦可用大乌头汤从中土、四象、在表之荣卫三层调控,以达到三轮气圆之效果。经行人身,经得六气,故针刺、艾灸亦可调气,但艾灸之法重在制寒,若求治病于本,仍需以中药内服及针刺治疗作为主要调气之法,使升降往复,阴阳和合,病趋康复。Huang Yuanyu believed that diseases in the human body are actually disorders of qi.When all kinds of qi flow normally,disease-causing qi will not manifest.The pathogenesis of knee osteoarthritis(KOA)is the combination of internal and external pathogenic factors,with dampness in the earth,coldness in water leading to depression in wood.If the earth dampness causes improper transportation,the external qi is not harmonious,the four images are out of balance,coldness arises in the water element(represented by the character"Gui"),and wind stirs in the wood element(represented by the character"Yi"),then external pathogenic factors of wind,cold,and dampness can also be involved.Therefore,Cinnamon Twig and Peony and Rhizoma Anemarrhenae Decoction can be used to dry earth,remove dampness,reduce fire,warm water,and soothe the liver to subdue wind.If the condition is severe,Huangqi(Radix Scutellariae)can be added to promote the circulation of the meridians,and Wutou(Aconitum carmichaelii Debeaux)can be used to dispel dampness and cold.Major Radix Aconiti Decoction can also be used to regulate the three layers of the middle earth,the four images,and nutrient and defense qi of the exterior of the body,so as to achieve the effect of the three rounds of qi being harmonious.The meridians run through the human body,and can sense the six qi,so acupuncture and moxibustion can also regulate qi.However,the key to moxibustion is to control cold,which can be combined with acupuncture and medicine.If treating the disease at its core,it is still necessary to use Chinese medicinals orally and acupuncture as the main methods of regulating qi,so as to make the rise and fall of qi back and forth,harmonize yin and yang,and promote the recovery of the disease.

关 键 词：膝骨关节炎 “土湿水寒木郁” 桂枝芍药知母汤 大乌头汤 黄元御 

分 类 号：R274.984.3[医药卫生—中西医结合]