从“水郁折之”辨治股骨头坏死并发骨髓水肿  

Differentiation and Treatment of Femoral Head Necrosis Complicated by Bone Marrow Edema from"Shui Yu Zhe Zhi"

作　　者：徐韩博 赵汝顺 郝阳泉[2] 鲁超 XU Hanbo;ZHAO Rushun;HAO Yangquan;LU Chao(Shaanxi University of Chinese Medicine,Xianyang Shaanxi China 712000;Red Cross Hospital Affiliated to Xi′an Jiaotong University,Xi′an Shaanxi China 710054)

机构地区：[1]陕西中医药大学,陕西咸阳712000 [2]西安交通大学附属红会医院,陕西西安710054

出　　处：《中医学报》2025年第5期991-995,共5页Acta Chinese Medicine

基　　金：陕西省中医药管理局中西医结合临床协作创新项目(2020-ZXY-010)。

摘　　要：水郁是因水气受抑,郁于体内,郁久可引发多种疾病,其本质是五行中的胜复关系。水郁极,必侮其所胜,乘其所不胜,水侮火乘土为水郁致病的五行乘侮机制,扶阳和实土为其不可缺少的两个治疗原则。血不利则为水,水气病可从瘀论治。股骨头坏死并发骨髓水肿与肝、脾、肾等脏失调有关,血瘀贯穿疾病整个过程,精准辨证对其治疗有引领性作用。若见肾阳虚衰、水失所主,治疗需以“温”为法,通过温补肾阳来调节水液代谢,使机体气血和水液正常运行;若见脾胃虚弱、脾失健运,治疗应以“补”为法,通过补益脾胃、祛湿利水法调节气机、水液代谢平衡,以改善气血运行、祛除湿邪;若见血行不畅、水湿内阻,治疗应以“消”为法,通过活血散瘀、祛湿行气法调节气血运行和水液代谢平衡,以促进体内气血循环,防止瘀血、水湿停滞;若见肝失疏泄、肝气郁结,治疗应以“和”为法,调节气血运行和肝脏疏泄的功能,以维持人体水液代谢、气血运行和阴阳平衡,达到治疗疾病的目的。Shui Yu(Water depression)is caused by the suppression of Water Qi,which is stored in the body,and can cause many kinds of diseases after long time of depression.In essence,it is the Sheng Fu relationship in Five-Element system.When Water is extremely depressed,it will insult what it has won and what it has been won.Water insulting Fire and Earth is the mechanism of the Five Elements for the disease caused by Water depression,therefore the two indispensable therapeutic principles are supporting the Yang and strengthening the Earth.Blood stasis would induce Water stagnation,so blood Qi disease can be treated from the perspective of blood stasis.Bone marrow edema complicating femoral head necrosis is related to the imbalance of Liver,Spleen,Kidney and others,in which blood stasis runs through the whole process of the disease,and accurate diagnosis has a leading role in its treatment.If the Kidney Yang is weak and the Water is out of control,the treatment method should be"warming"to regulate the metabolism of Water and Fluid by warming and tonifying the Kidney Yang,so that the Qi,blood and Water can run normally;if the Spleen and Stomach are weak,the treatment should be"tonifying"to regulate the Qi,Water and blood by strengthening the Spleen and Stomach and Water metabolism to improve Qi and blood circulation to eliminate Dampness;if there is poor blood circulation and internal obstruction of Water and Dampness,the treatment should be"eliminating",through invigorating blood circulation and dispersing stasis and Dampness as well as promoting Qi and regulating the balance of Qi and blood operation and water metabolism,to promote Qi and blood circulation in the body,and to prevent stasis,Water and Dampness from stagnation.If the Liver Qi is stagnant,the treatment method should be"harmonizing",to regulate the functions of Qi and blood circulation and Liver Qi activity,to maintain the balance of Water-Fluid metabolism,Qi and blood circulation as well as Yin and Yang balance in human body,so as to achieve the purpose of tr

关 键 词：股骨头坏死 骨髓水肿 “水郁折之” 温法 补法 消法 和法 

分 类 号：R274.9[医药卫生—中西医结合]