乌头汤在骨科的临床应用  

Clinical Applications of Aconiti Decoction in Orthopedics

作　　者：于玟路 张虹 YU Wenlu;ZHANG Hong(Hunan University of Chinese Medicine,Changsha,Hunan,China,410208;Luoyang Orthopedic-Traumatological Hospital of Henan Province,Henan Provincial Orthopedic Hospital,Luoyang,Henan,China,471002)

机构地区：[1]湖南中医药大学,湖南长沙410208 [2]河南省洛阳正骨医院,河南省骨科医院,河南洛阳471002

出　　处：《河南中医》2025年第3期325-330,共6页Henan Traditional Chinese Medicine

基　　金：河南省中医药科学研究专项课题项目(2023ZY3078,2022ZY1137)。

摘　　要：乌头汤在骨科应用广泛,但目前的研究尚存在以下问题:(1)毒性成分与临床应用安全性:乌头汤中含有的双酯型二萜生物碱如乌头碱、新乌头碱、次乌头碱等,具有显著的药理活性,同时也是其毒性成分,这些成分的治疗剂量和中毒剂量非常接近,导致临床治疗窗较窄,容易发生不良反应和中毒事件。因此,如何保证乌头汤临床使用的安全有效是未来研究的关键问题。(2)作用机制的探索:乌头汤在改善类风湿关节炎关节炎症、肿胀、疼痛等方面有较好的疗效,但作用机制尚不明确。研究显示,乌头汤可以调节炎症细胞因子的表达,降低类风湿关节炎患者自身免疫抗体的水平,调节T细胞亚群之间的平衡。未来的研究应进一步探索乌头汤在抗炎、镇痛、免疫调节以及抑制血管生成等方面的作用,探讨其对炎症网络和特定信号通路的调控作用。(3)治疗方案的优化:正确的配伍和煎服方法可以降低毒性,提高疗效,未来的研究应致力于优化治疗方案,包括药物配比、煎煮方法和用药剂量等,以提高治疗效果并降低药物毒性。(4)质量控制和评价标准的建立:结合传统经验与现代分析技术,建立更加科学合理的质量控制及评价标准,促进乌头类中药的现代化研究,使其更加合理、科学地应用于临床。总之,未来的研究应聚焦于乌头汤的安全性评估、作用机制的深入探索、治疗方案的优化、治疗效果的提升以及毒性风险的降低,同时建立科学的质量控制和评价体系,以确保乌头汤在临床中的应用安全有效。Aconiti Decoction is widely utilized in orthopedic practice,yet current research faces the following challenges:(1)Toxicity and Clinical Safety:The diester-diterpenoid alkaloids in Aconiti Decoction,such as aconitine,mesaconitine,and hypaconitine,exhibit significant pharmacological activity but also pose toxicity risks.Their therapeutic and toxic doses are closely aligned,resulting in a narrow therapeutic window and a high risk of adverse reactions or poisoning,so ensuring safe and effective clinical application remains a critical issue.(2)Mechanistic Exploration:Although Aconiti Decoction demonstrates efficacy in alleviating inflammation,swelling,and pain in rheumatoid arthritis,its mechanisms remain unclear.Studies suggest it modulates inflammatory cytokines,reduces levels of RA-associated autoimmune antibodies,and balances T-cell subsets.Future research should focus on its anti-inflammatory,analgesic,immunomodulatory,and anti-angiogenic effects,particularly its regulation of inflammatory networks and specific signaling pathways.(3)Optimization of Treatment Regimens:The correct formulation and decoction methods can reduce toxicity and enhance therapeutic effects.Future research should focus on optimizing treatment plans,including drug ratios,decoction methods,and dosages,so as to improve treatment outcomes and reduce drug toxicity.(4)Establishment of Quality Control and Evaluation Standards:By integrating traditional experiences with modern analytical techniques,more scientific and reasonable quality control and evaluation standards should be established to promote the modern research of aconite-based Chinese medicinals and ensure their more rational and scientific applications in clinical practice.In conclusion,future research should focus on the safety assessment of Aconite Decoction,in-depth exploration of its mechanism of action,optimization of treatment regimens,improvement of therapeutic effects,and reduction of toxicity risks.At the same time,a scientific quality control and evaluation system should be e

关 键 词：乌头汤 骨科 坐骨神经痛 颈椎病 腰椎间盘突出症 强直性脊柱炎 膝骨关节炎 肩关节周围炎 骨癌疼痛 类风湿关节炎 《金匮要略》 张仲景 

分 类 号：R222.3[医药卫生—中医基础理论]