基于“肝主筋”探讨膝骨关节炎筋痿的病理特点
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摘要
膝为筋之府,为肝所主,增龄衰老所引发肝血不足、疏泄失调,导致筋失所养,是膝骨关节炎的重要病理特征。在外邪侵袭、肝不荣筋等内外因素作用下,引发筋的病变,并随疾病的进展累及至骨,从而影响膝关节内外应力的动态平衡,最终导致膝骨关节炎。本文基于"肝主筋"理论,探讨膝骨关节炎筋痿的病因病理特点及治疗方法,旨在丰富膝骨关节炎的病因病机理论,为临床治疗提供参考依据。
Knee joint as the "Jin Zhi Fu" is governed by the "Gan" in Traditional Chinese Medicine.It is a crucial pathological feature of knee osteoarthritis(KOA) that with the developing of aging induces the deficiency of "Gan Xue" and the imbalance of "Shu Xie" led to the malnutrition of Jin.There are external and internal factors such as exogenous invasion and liver failure to nourish Jin to affect the function of Jin,and then affect the function of Gu with the development of KOA.It breaks the dynamic balance of the internal and external mechanical stress of the knee joint led to KOA.It is to enrich the etiology and pathogenesis theory of KOA and provide the evidence for clinical treatment by the exploration of the pathological characteristics and treatment methods of the Jin-Wei.
Knee joint as the "Jin Zhi Fu" is governed by the "Gan" in Traditional Chinese Medicine.It is a crucial pathological feature of knee osteoarthritis(KOA) that with the developing of aging induces the deficiency of "Gan Xue" and the imbalance of "Shu Xie" led to the malnutrition of Jin.There are external and internal factors such as exogenous invasion and liver failure to nourish Jin to affect the function of Jin,and then affect the function of Gu with the development of KOA.It breaks the dynamic balance of the internal and external mechanical stress of the knee joint led to KOA.It is to enrich the etiology and pathogenesis theory of KOA and provide the evidence for clinical treatment by the exploration of the pathological characteristics and treatment methods of the Jin-Wei.
引文
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[25]何睦,姚卫峰,蔡秀江,等.代谢组学在肝肾损伤研究中的应用[J].中国临床药理学与治疗学,2012,17(8):924-930.
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[28]陈舰舰,周临东,谢林.基于“肝主筋”理论治疗椎间盘退变探讨[J].浙江中医药大学学报,2013,37(6):832-834.
[29]齐立卿,杜景华,王金榜.养元柔肝法治疗膝骨关节炎64例[J].四川中医,2009,27(3):92-93.
[30]田旭东,舒劲,武正权,等.王自立“治肝必柔肝,柔肝先养肝”思想探悉[J].中国中医药信息杂志,2008,15(2):85-86.
[2]李西海,陈后煌,叶蕻芝,等.补肾柔肝法治疗骨关节炎筋骨失养的作用探讨[J].风湿病与关节炎,2016,5(6):40-42.
[3]张蓉,李峰,王常海,等.经筋理论在膝关节骨性关节炎发病机制及治疗中的作用[J].中国康复医学杂志,2007,22(7):644-646.
[4]韩清民,王跃辉,黄旭东,等.膝骨关节炎从筋论治思路探讨[J].新中医,2009,41(1):5-6.
[5]谢兵,范志勇,王卫强,等.从筋束骨理论探讨膝骨关节炎模型的构建[J].成都中医药大学学报,2013,36(1):104-106.
[6]叶朝辉.《黄帝内经》论治筋伤探讨[J].河南中医,2013,33(10):1620-1623.
[7]周丽,皮明钧,谭达全.“筋”理论探析[J].湖南中医药大学学报,2007,27(5):10-11.
[8]原林,钟世镇.人体自体检测与调控系统(筋膜学)--经络有关的解剖学基础[J].天津中医药,2004,21(5):356-359.
[9]贺振泉,原林.从经络筋膜学说看脉象形成机理[J].中国中医基础医学杂志,2005,11(7):489-491.
[10]吕和,陈锋,周先明,等.腰椎退变后黄韧带、关节软骨改变的研究进展[J].浙江中医药大学学报,2017,41(6):548-552.
[11]李志,张晓刚.骨关节炎发病机制中生物力学因素的研究现状[J].中医药学刊,2006,24(2):307-308.
[12]李西海,梁文娜,党传鹏,等.补肾壮筋汤抑制炎性细胞因子表达延缓骨关节炎软骨退变的研究[J].风湿病与关节炎,2014,3(5):20-25.
[13]孙贵香,郭艳幸,何清湖,等.平乐正骨筋骨互用平衡论--平乐正骨理论体系之平衡理论研究(二)[J].中医正骨,2012,24(10):73-77.
[14]李西海,梁文娜,叶蕻芝,等.独活寄生汤调控风寒湿痹型骨关节炎软骨下骨重建失衡的作用机制探讨[J].风湿病与关节炎,2014,3(8):62-64.
[15]钟雯,曹锐.筋骨辨证-筋骨并重[J].实用中医内科杂志,2017,31(2):73-76.
[16]赵勇,秦伟凯,顾力军,等.从经筋论治膝骨关节炎疼痛临证思维[J].中国中医药信息杂志,2012,19(3):92-93.
[17]尹龙,侯晓强,何克剑.从肝论治类风湿关节炎探讨[J].世界中医药,2015,10(11):1697-1700.
[18]叶朝辉.《黄帝内经》论治筋伤探讨[J].河南中医,2013,33(10):1620-1623.
[19]樊永平.痿证理论的源流梳理[J].北京中医药大学学报,2011,34(1):12-17.
[20]衷敬柏.从《黄帝内经》肝主筋论慢性疲劳病因病机与证治[J].中国中医基础医学杂志,2016,22(12):1587-1594.
[21]王子正,董宝强,林星星.从整体观角度探讨经筋与中医肝系统关系[J].辽宁中医药大学学报,2017,19(8):119-121.
[22]张媛,于清宏.肝主筋理论对类风湿关节炎发病的临证意义[J].实用中医内科杂志,2011,25(1):33-34.
[23]丁琼浩,敖亮,潘正刚,等.膝骨性关节炎的病因病机及用药分析[J].中医临床研究,2014,6(7):14-17.
[24]韩清民,黄旭东,王跃辉.运用肝脾相关理论治疗膝骨关节炎探讨[J].时珍国医国药,2010,21(8):2010-2019.
[25]何睦,姚卫峰,蔡秀江,等.代谢组学在肝肾损伤研究中的应用[J].中国临床药理学与治疗学,2012,17(8):924-930.
[26]Johnson D R,Ang C,Bednar A J,et al.Tungsten effects on phosphate-dependent biochemical pathways are species and liver cell line dependent[J].Toxicol Sci,2010,116(2):523-532.
[27]黄涛,秦波.肝源性胰岛素抵抗的研究进展[J].世界华人消化杂志,2008,16(6):653-657.
[28]陈舰舰,周临东,谢林.基于“肝主筋”理论治疗椎间盘退变探讨[J].浙江中医药大学学报,2013,37(6):832-834.
[29]齐立卿,杜景华,王金榜.养元柔肝法治疗膝骨关节炎64例[J].四川中医,2009,27(3):92-93.
[30]田旭东,舒劲,武正权,等.王自立“治肝必柔肝,柔肝先养肝”思想探悉[J].中国中医药信息杂志,2008,15(2):85-86.