膝骨关节炎经筋辨证研究进展
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摘要
对膝骨关节炎(KOA;中医归属为"膝痹")经筋病变的理论基础、KOA的筋痹与骨痹的关联、KOA经筋病变实质的现代研究、KOA经筋病变的治疗等进行了综述。KOA经筋病变主要涉及足太阳经筋、足少阳经筋、足阳明经筋和足三阴经经筋。KOA筋痹与骨痹的关系表现为膝痹病情的轻重,筋痹尚未及骨,而骨痹必定伴有筋痹,筋痹至骨痹的发展过程是KOA病变进展的过程。KOA经筋病变实质的现代研究涉及病灶命名及分布、膝关节周围软组织的变化、生物力学改变、影像学改变及患者步态差异等。KOA经筋病变的治疗方式有多种,包括艾灸、点穴、经筋刺法、经筋手法、经筋贴敷疗法、经筋微创疗法等。以上研究成果可为经筋疗法在KOA临床治疗的推广运用提供理论依据。
This article reviewed the theoretical foundations of knee osteoarthritis(KOA;knee-blockage syndromein traditional Chinese medicine)muscle-along meridian affections,association of muscle-blockage(Jinbi)andbone-blockage(Gubi)in knee-blockage syndrome,the achievements in the modern research of the essence ofKOA muscle-along meridian affections,therapies for KOA muscle-along meridian affections,etc. KOA muscle-along meridian affections involve the muscle-along Foot-Taiyang Meridian,the muscle-along Foot-Shaoyang Meridian,the muscle-along Foot-Yangming Meridian and the muscle-along Foot Triple-Yin Meridians. Jinbi and Gubi reflect the illness severity of knee-blockage syndrome, Jinbi has not affected the bone, while Gubi wasdefinitely companied by Jinbi. Jinbi developing into Gubi is the progression of KOA. The modern research of theessence of KOA muscle-along meridian affections covered the nomination and distribution of the foci of KOAmuscle-along meridian affections, the pathological changes in soft tissues around the knee, biomechanicalmodification,medical image features,gait variation,etc.. Therapies for KOA muscle-along meridian affectionsvaried, including moxibustion, acupoint pricking, muscle-along meridian needling, muscle-along meridianmanipulations, muscle-along meridian herbal application, and muscle-along meridian minimally-invasivetherapy. The research achievements will supply theoretical evidence for the clinical popularization of muscle-alongmeridian therapies for KOA.
This article reviewed the theoretical foundations of knee osteoarthritis(KOA;knee-blockage syndromein traditional Chinese medicine)muscle-along meridian affections,association of muscle-blockage(Jinbi)andbone-blockage(Gubi)in knee-blockage syndrome,the achievements in the modern research of the essence ofKOA muscle-along meridian affections,therapies for KOA muscle-along meridian affections,etc. KOA muscle-along meridian affections involve the muscle-along Foot-Taiyang Meridian,the muscle-along Foot-Shaoyang Meridian,the muscle-along Foot-Yangming Meridian and the muscle-along Foot Triple-Yin Meridians. Jinbi and Gubi reflect the illness severity of knee-blockage syndrome, Jinbi has not affected the bone, while Gubi wasdefinitely companied by Jinbi. Jinbi developing into Gubi is the progression of KOA. The modern research of theessence of KOA muscle-along meridian affections covered the nomination and distribution of the foci of KOAmuscle-along meridian affections, the pathological changes in soft tissues around the knee, biomechanicalmodification,medical image features,gait variation,etc.. Therapies for KOA muscle-along meridian affectionsvaried, including moxibustion, acupoint pricking, muscle-along meridian needling, muscle-along meridianmanipulations, muscle-along meridian herbal application, and muscle-along meridian minimally-invasivetherapy. The research achievements will supply theoretical evidence for the clinical popularization of muscle-alongmeridian therapies for KOA.
引文
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[16]董宝强,张文静,徐佳宴,等.膝骨性关节炎超声经筋定位研究[J].中华中医药杂志,2014,29(10):3319.
[17]王跃辉,韩清民,刘洪江,等.膝骨性关节炎影像学分析与经筋辨证关系研究[J].新中医,2008,40(5):66.
[18]王常海,李峰,张蓉,等.步态分析技术在膝骨性关节炎经筋辨证中的应用研究[J].中国针灸,2010,30(3):183.
[19]赵姗姗,李春日,董宝强.艾灸循经筋阿是穴治疗膝骨关节炎疗效评价[J].山东中医杂志,2012,31(1):40.
[20]董宝强,张书剑,李春日,等.艾灸循经筋阿是穴对膝骨关节炎RANKL和OPG调控机制研究[J].辽宁中医药大学学报,2013,15(10):5.
[21]吕亚南,李荣祝,王小燕,等.点穴经筋疗法对膝骨关节炎软骨损伤修复作用的研究[J].广西医学,2014,36(3):297.
[22]吕亚南,李荣祝,王小燕,等.点穴经筋疗法对膝骨关节炎关节积液作用的临床研究[J].中国临床新医学,2014,7(4):299.
[23]袁菱梅,李艳明,李希.经筋刺法结合温针灸治疗膝关节骨性关节炎32例[J].针灸临床杂志, 2016,32(1):44.
[24]赵海丰,张茉莉,董宝强,等.循经筋阿是穴排刺法治疗膝骨关节炎的疗效观察[J].航空航天医学杂志,2016,27(1):126.
[25]刘立会,董宝强,王树东.针刺循经筋阿是穴配合中药治疗膝骨性关节炎疗效观察[J].辽宁中医药大学学报,2016,18(3):57.
[26]嵇征鸿,唐玲玲,吕秀玉.经筋针刺法结合中药外敷治疗膝痹[J].中国中医药现代远程教育, 2015,13(5):65.
[27]刘敏,陆鹏,胡幼平.针刺结筋病灶点治疗膝关节骨性关节炎的临床随机对照试验[J].针灸临床杂志,2015,31(10):23.
[28]顾青.经筋刺法治疗膝骨关节炎87例临床观察体会[J].中国初级卫生保健,2014,28(1):123.
[29]冯学烽,邹伟民,陈永韶.经筋手法治疗太阳经筋型膝骨关节炎临床观察[J].新中医,2015, 47(1):206.
[30]吴康郁,朱群娣,黄伟斌,等.温性经筋通贴膏治疗关节炎的临床观察[J].中药材,2015,38(6):1331.
[31]易志勇,韩清民,黄旭东.经筋贴敷疗法治疗膝骨关节炎疗效观察[J].陕西中医,2014,35(8):1067.
[32]侯春福,韦嵩,陈志煌,等.经筋微创疗法联合药物治疗膝骨性关节炎60例临床观察[J].中国中西医结合杂志,2015,35(6):678.
[33]曾意荣,樊粤光,刘少军,等.补肾活血中药治疗肾虚血瘀型膝骨性关节炎的临床研究[J].广州中医药大学学报,2007,24(4):276.
[2]吴金鹏.中医“经筋”及“膜原”实质的筋膜理论探讨[J].北京中医,2007,26(5):283.
[3] Sharma L,Dunlop D,Cahue S,et al. Quadriceps strength and osteoarthritis progression in malaligned and lax knees[J]. Ann Intern Med,2003,138(8):613.
[4] Anan M, Shinkoda K, Suzuki K, et al. Dynamic frequency analyses of lower extremity muscles during sit-to-stand motion for the patients with knee osteoarthritis[J]. PLoS One, 2016, 11(1):e147496.
[5] Mchugh M P,Tyler T F,Nicholas S J,et al. Electromyographic analysis of quadriceps fatigue after anterior cruciate ligament reconstruction[J]. J Orthop Sports Phys Ther,2001,31(1):25.
[6] Okada Y. Histochemical study on the atrophy of the quadriceps femoris muscle caused by knee joint injuries of rats[J]. Hiroshima J Med Sci,1989,38(1):13.
[7] Henneman E,Somjen G,Carpenter D O. Functional significance of cell size in spinal motoneurons[J]. J Neurophysiol,1965,28:560.
[8] Johnson M A, Polgar J, Weightman D, et al. Data on the distribution of fibre types in thirty-six human muscles:An autopsy study[J]. J Neurol Sci,1973,18(1):111.
[9] Lutz G E, Palmitier R A, An K N, et al. Comparison of tibiofemoral joint forces during open-kinetic-chain and closedkinetic-chain exercises[J]. J Bone Joint Surg Am, 1993, 75(5):732.
[10] Piva S R,Goodnite E A,Childs J D. Strength around the hip and flexibility of soft tissues in individuals with and without patellofemoral pain syndrome[J]. J Orthop Sports Phys Ther,2005,35(12):793.
[11]黄旭东,韩清民.基于经筋辨证对膝骨关节炎发病中膝后侧牵拉痛临床研究[J].新中医,2016,48(8):135.
[12] Forestier R, Francon A, Briole V, et al. Prevalence of generalized osteoarthritis in a population with knee osteoarthritis[J]. Joint Bone Spine,2011,78(3):275.
[13]黄旭东,韩清民.膝骨关节炎足太阳经筋证腘绳肌柔韧性的临床对照研究[J].广州中医药大学学报,2016,33(4):502.
[14]张亦廷,刘农虞.经筋针法治疗膝骨性关节炎的文献研究[J].中国针灸,2015,35(S1):102.
[15]王常海,栗彦芳,李峰,等.膝骨性关节炎经筋证型分布规律研究及其生物力学机理分析[J].中华中医药学刊,2010,28(5):970.
[16]董宝强,张文静,徐佳宴,等.膝骨性关节炎超声经筋定位研究[J].中华中医药杂志,2014,29(10):3319.
[17]王跃辉,韩清民,刘洪江,等.膝骨性关节炎影像学分析与经筋辨证关系研究[J].新中医,2008,40(5):66.
[18]王常海,李峰,张蓉,等.步态分析技术在膝骨性关节炎经筋辨证中的应用研究[J].中国针灸,2010,30(3):183.
[19]赵姗姗,李春日,董宝强.艾灸循经筋阿是穴治疗膝骨关节炎疗效评价[J].山东中医杂志,2012,31(1):40.
[20]董宝强,张书剑,李春日,等.艾灸循经筋阿是穴对膝骨关节炎RANKL和OPG调控机制研究[J].辽宁中医药大学学报,2013,15(10):5.
[21]吕亚南,李荣祝,王小燕,等.点穴经筋疗法对膝骨关节炎软骨损伤修复作用的研究[J].广西医学,2014,36(3):297.
[22]吕亚南,李荣祝,王小燕,等.点穴经筋疗法对膝骨关节炎关节积液作用的临床研究[J].中国临床新医学,2014,7(4):299.
[23]袁菱梅,李艳明,李希.经筋刺法结合温针灸治疗膝关节骨性关节炎32例[J].针灸临床杂志, 2016,32(1):44.
[24]赵海丰,张茉莉,董宝强,等.循经筋阿是穴排刺法治疗膝骨关节炎的疗效观察[J].航空航天医学杂志,2016,27(1):126.
[25]刘立会,董宝强,王树东.针刺循经筋阿是穴配合中药治疗膝骨性关节炎疗效观察[J].辽宁中医药大学学报,2016,18(3):57.
[26]嵇征鸿,唐玲玲,吕秀玉.经筋针刺法结合中药外敷治疗膝痹[J].中国中医药现代远程教育, 2015,13(5):65.
[27]刘敏,陆鹏,胡幼平.针刺结筋病灶点治疗膝关节骨性关节炎的临床随机对照试验[J].针灸临床杂志,2015,31(10):23.
[28]顾青.经筋刺法治疗膝骨关节炎87例临床观察体会[J].中国初级卫生保健,2014,28(1):123.
[29]冯学烽,邹伟民,陈永韶.经筋手法治疗太阳经筋型膝骨关节炎临床观察[J].新中医,2015, 47(1):206.
[30]吴康郁,朱群娣,黄伟斌,等.温性经筋通贴膏治疗关节炎的临床观察[J].中药材,2015,38(6):1331.
[31]易志勇,韩清民,黄旭东.经筋贴敷疗法治疗膝骨关节炎疗效观察[J].陕西中医,2014,35(8):1067.
[32]侯春福,韦嵩,陈志煌,等.经筋微创疗法联合药物治疗膝骨性关节炎60例临床观察[J].中国中西医结合杂志,2015,35(6):678.
[33]曾意荣,樊粤光,刘少军,等.补肾活血中药治疗肾虚血瘀型膝骨性关节炎的临床研究[J].广州中医药大学学报,2007,24(4):276.