阎小萍教授辨治风湿病学术思想和临床经验研究
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摘要
目的：追溯第四批全国名老中医专家阎小萍教授辨治风湿病学术渊源,整理与研究阎小萍老师辨治风湿病的学术思想和临床经验；重点梳理、提炼阎小萍老师基于“肾虚”的“寒热为纲”辨治膝骨痹(膝骨关节炎)方案,研究骨痹通方加减的疗效和安全性。
方法：理论及经验总结方面：采用经典古籍和文献整理的方法,总结、梳理、提炼阎老师辨治风湿病的学术思想和临床经验；临床研究方面：采用前瞻性、随机、阳性药物对照的方法,120例膝骨关节炎患者随机分为骨痹通方治疗组和盐酸氨基葡萄糖对照组,将阎老师辨治强直性脊柱炎已日臻成熟的“寒热为纲”的学术思想创新性地引入膝骨关节炎的辨治中,在辨治膝骨关节炎“肝肾亏虚”共性的基础上,依据“寒热为纲”的学术思想深入辩证,形成基于“肾虚”的“寒热为纲”辨治方案,以骨痹通方为基础进行加减。分别于治疗前及疗程结束后测定和记录患者疼痛、关节僵硬、关节功能障碍的平均骨关节炎指数(WOMAC),临床症状改善情况,患者和医生对病情的总体平均评价,检测ESR、CRP水平,进行血、尿常规、肝肾功能检查,记录服药期间的不良反应。将中药骨痹通方治疗组按中医辨证标准进一步分为肾虚寒湿和肾虚湿热两个亚组,分别在患者疼痛、关节僵硬、关节功能障碍的平均骨关节炎指数(WOMAC),中医证候积分,患者和医生对病情的总体平均评价,ESR、CRP,安全性指标,药物的不良反应等方面与对照组加以比较。
结果：理论及经验总结方面：从阎老师治疗风湿病思想可见其学术渊源,主要来源于经典古籍、焦树德学术经验、临床经验总结,具体体现在阎老帅名医之路、继承之路、探索和创新之路。阎老师主张从经典中来,到临床中去。经典当推《黄帝内经》、《伤寒论》、《金匮要略》、《温病条辨》、《温热经纬》、《本草从新》等。从老师辨治风湿病学术思想可见经典端倪,体现在辨风湿病病证共性—补肝肾、祛风湿是治痹之要；“邪入邪出”之所---调和营卫；风寒湿痹和风湿热痹---“寒热为纲”辨治渊源等诸多方面。阎老师总结、传承焦老学术思想临床经验主要体现在精研辨证论治,提出“四必须”、“五强调”,创议“旭痹”及诊治规律,辨析胸痹、心痹异同,探究心痹诊治,发展燮枢理论,创组燮枢汤方等方面。阎老师秉承恩师焦树德教授旨意,进一步发扬焦老学术思想的同时,结合自已多年的临床经验和众多经典、现代文献,不断探索,推陈出新,对名师的学术思想、理论、方药在继承的基础上进行深入研究,并加以升华、提炼,推动学科研究和中医理论的创新,主要体现在传承的结晶——“大偻”的渊源及辨证论治体系的形成,提出风湿病循经辨证理论,阎小萍治疗风湿病疗效与机理系列研究等方面。与各家学说分析比较,阎老师辨治膝骨痹(膝骨关节炎)从病因病机、辨证论治、中医内治、中医外治、综合治疗等方面,既有共同之处,又有不同之点；临床研究方面：发现治疗前后测患者的平均WOMAC骨关节炎指数、VAS患者和医生对病情的总体评价有统计学差异,骨痹通方组较对照组改善WOMAC指数更为明显,使用非甾类抗炎药剂量显著减少,两组ESR、CRP水平及不良反应未显示差异,血、尿常规、肝肾功能检查治疗前后均未见异常。肾虚寒湿和肾虚湿热两亚组均可改善骨关节炎指数VAS评分(WOMAC),且在改善膝膝骨痹(膝骨关节炎)中医证候量化积分、减少双氯芬酸钠消耗量上优于对照组。
结论：理论及经验总结方面：整理与研究阎小萍老师学术思想和临床经验,共有十得：倡导“一论”、“两观”,即“寒热为纲”的辨治论、“平衡观”和“趋势观”,以简驭繁,寒热为纲论治风湿病,凸显实用价值,“寒热为纲”辨治论必须基于中医风湿病的辨病共性,这一共性是肝肾不足,风湿之邪深侵,引起风寒湿或风湿热邪痹阻经络,治疗则在“补肝肾、祛风湿”的治疗大法之上,执简驭繁,--寒者热之,热者寒之”,分别采用“祛风除湿驱寒”和“祛风除湿清热”,不仅用于风湿病的中药内服,还用于中医外治,并可结合现代技术形成中医特色疗法；推脏腑辨证,重在协和、协调脏腑功能—“和”法,在遵循协调阴阳的基础上,根据疾病的特点,分别采用攻补兼施、扶正祛邪,调和阴阳,调理寒热,调和营卫,燮和肝胆,调理脾胃,调和气血,燮理气机等治法治疗风湿病,临床取得良好疗效；“五连环”的中医特色疗法,包括健康教育、医疗体育、中药为主、内外兼治、中西合壁五项内容；综合强化序贯疗法包含综合、强化、序贯三个层次的含义,综合各种治疗方法,强调不同方法的组合效应,以最大为目标,以最大疗效为目的,强化各种治疗方法的作用,以强度为目标,以改善病情程度为目的,追求临床效果的最大化,序贯应用各种治疗方法,以时间性为目标,以连续性为目的,交替进行,强化增强疗效,强化维持疗效。在疾病急性期,缓解肌肉、关节的疼痛、压痛、酸胀、麻木等症状,在功能恢复阶段,使肌肉、关节持续处于松弛、缓解状态；“痹病欲尫”的治未病思想,阎老师总结尫痹诊治经验,探索具有临床证候、治疗原则、和处方用药的独特规律性,指出一旦出现骨损、筋挛、肉削的尫痹特征,疾病将变得缠绵难愈,因此老师提出“痹病欲尫”的概念,意在强化痹病的早诊断,早治疗,当痹病出现关节持续性肿胀、痛发骨内、屈伸不能、夜间疼痛剧烈等症时,虽关节尚未变形,应警惕其有可能向尫痹传变；循经辨证—寓于脏腑辨证的羽翼,寓循经辨证于脏腑辨证之中,强调风湿病具体的出现症状部位应和相应的经络循行部位相合,以便正确使用相应引经药物；调和营卫—“扶正祛邪”的必由之途,风寒湿诸邪气侵犯人体,与营卫之气合则闭阻经络,气血运行不畅为痹证,营卫为“邪入”之所,补肝肾、祛风湿,驱邪外出,则营卫为经过之途,营卫为“邪出”之所,故调和营卫是中医风湿病治疗的重要法则之一；活血通络—贯穿风湿病辨治的始终,风湿病病程漫长,反复发作,迁延难愈,日久必入血入络,形成瘀血,瘀血证贯穿风湿病整个病程,活血通络法贯穿于治疗始终；生脾胃阳气,顾护后天脾土—风湿病辨治的重要环节,风湿病的基本病机为风寒湿(或热)合而为痹,其中湿邪至关重要,湿性粘滞,往往使风湿病缠绵难愈,调理脾胃有助于湿邪的祛除,又以后天养先天,有利于补肝肾,风湿病病程冗长,易反复发作,往往需要长期用药,顾护后天脾胃,使长期治疗成为可能,是一切治疗的基础；中医适宜技术和诊疗方案—基于疗效的辨治风湿病体现。临床研究方面：骨痹通方具有缓解和改善疼痛、僵硬、关节功能障碍的作用,是治疗膝骨关节炎安全且行之有效的方剂。采取在膝骨关节炎辨证共性的基础上,依据基于“肾虚”的“寒热为纲”辨治膝骨关节炎的辨治方法指导深入辨证,对骨痹通方进一步加减相结合的方法,可明显改善骨关节炎指数VAS评分(WOMAC)、膝骨痹(膝骨关节炎)中医证候量化积分、减少非甾体消炎药消耗量,可适用于膝骨关节炎的辨治。
Objective:To trace the academic origin of Professor YAN Xiao-ping, who was one of the4th batches of national famous senior TCM doctors. To arrange and study the academic thought and clinical experiences of teacher YAN Xiao-ping. To study the efficacy and safety of Gubitong recipe which was a experience prescription treating osteoarthritis made by teacher YAN.
Methods:in the aspect of theories and clinical experiences summary:using methods of studying classical books and arranging literatures, the academic thought and clinical experiences of teacher YAN were summarized, arranged and refined. In the aspect of clinic study:using the methods of prospective, random, positive medicine in control,120osteoarthritis patients were arranged in two groups:the treatment group was treated with Gubitong recipe, the control group was treated with Glucosamine hydrochloride. The observation contents included patient's pain degree, joint stiffness, joint movement dysfunction, WOMAC, clinic syndromes, the whole assessment of patients and doctors. The laboratory tests included:ESR, CRP, the blood, urine, liver and kidney function tests. The side effects were recorded during the treatment periods. All these were recorded in advance of the experiment and after it respectively. In the Gubitong recipe treatment group, all patients were divided into kidney deficiency with cold-dampness invading syndrome and kidney deficiency with heat-dampness invading syndrome, the patients with these two syndromes were compared with the control group in each aspects, including patient's pain degree, joint stiffness, joint movement dysfunction, WOMAC, clinic syndromes, the whole assessment of patients and doctors, ESR, CRP, the safety tests, the side effects test and so on.
Results:in the aspect of theories and clinical experiences summary:from the academic thought of treating Bi syndrome, we could deem that the major academic origin of teacher YAN was originated in the ancient classics books, JIAO Shude academic experience and own clinic experiential accumulation. In concretely speaking, the origin of teacher YAN reflected as the road of famous TCM doctors, the roads of medical inheritance, the roads of exploration and innovation. Teacher Yan had advocated that'from clincal experience, back to clincal experience'in studying TCM, which is said that we should study the TCM Calssics, expecially'the Canon of Internal Medicine','treatise on febrile diseases','synopsis of golden chamber','Item Differentiation of Warm Febrile Diseases','wen re jing wei','ben cao cong xin'and so on. In the course of studying, we could see that the academic thought of teacher Yan in treating Rheumatology were from the TCM Calssics, for example, teacher Yan thought that the main point in treating rheumatology included tonifying liver and kidney,expelling wind and dampness, adjusting ying and wei, the principle in treating rheumatology is cold syndrome and heat syndrome. In summarizing the academic thoughts of professor Jiao, teacher Yan had pointed out that the academic thoughts of professor Jiao including four necessities, five poinpoints, creating wang bi syndrome, reachering xin bi syndrome, developing axis therory and so on. On the basis of professor Jiao, teacher Yan had advocated many new therories, as the origin of da Iv, the syndrome differentiation and treatment of da lv, advancing the theories of according channel sites in Syndrome Differentiation and Treatment of rheumatology. In the treatment of osteoarthritis, teacher Yan had many unique thoughts in comparing with other doctors, as the knowledge of pathology, pathogenesis, Syndrome Differentiation and Treatment, internal treatment of TCM, external treatment of TCM, synthesizing treatment and so on.In the aspect of clinic study:after the treatment, WOMAC and the global assessment of patients and doctors had decreased, and had remarkable differences. Compared to the control group, in the treatment group, the improvement of WOMAC had remarkable differences, the usage amount of NSAIDs was less, and had remarkable differences, the lever of ESR and CRP had no differences. In two groups, the adverse effects, as the blood, urine, liver and kidney function tests, did not show differences in before and after treatment.
Conclusion:in the aspect of theories and clinical experiences summary:in the course of arranging and studying the academic thought and clinic experience of teacher YAN Xiao-ping, I had10outcomes:(1) advocate one theory and two concep(?): the cold and heat synopsis theory, balance concept and tendency concept. The principles of cold syndrome and heat syndrome must base on a basic fundamental, which is tonifying liver and kidney, expelling wind and dampness. In treating rheumatology, the methods of "expelling wind, cold and dampness" and "expelling wind, heat and dampness" would be used respectively. Besides, the internal treatment and external treatment would be used intergrated;(2) emphasize the importance of the differentiation symptoms and signs from Zang-Fu and he method in it, in other words, coordinating the function of Zang and Fu;(3)5consistem ring TCM unique remedy;(4)integration, intensification ana continuum remedy,(5) regard differentiate syndrome following channel and meridian, which supply the differentiation syndrome from Zang-Fu Zang-Fu;(6) Preventive Treatment of Disease academic thought-Bi syndrome which would be Wang Bi;(7) the necessary method for Strengthening Healthy Qi to Eliminate Pathogens-coordinating Ying Qi and Wei Qi;(8) motivate the blood and dredge channel-a method should be used in rheumatic disease all the way;(9) an important aspect in treating rheumatic disease-ascending Yang Qi of spleen and stomach, protecting spleen which is the origin of the acquired constitution;(10) TCM useful technique for treatment, diagnosis and treatment regimen. In the aspect of clinic study:Gubitong recipe had the function of easing the pain and stiffness symptom, of improving joint dysfunction, it was a safe and effective prescription role in the treatment of knee osteoarthritis.
方法：理论及经验总结方面：采用经典古籍和文献整理的方法,总结、梳理、提炼阎老师辨治风湿病的学术思想和临床经验；临床研究方面：采用前瞻性、随机、阳性药物对照的方法,120例膝骨关节炎患者随机分为骨痹通方治疗组和盐酸氨基葡萄糖对照组,将阎老师辨治强直性脊柱炎已日臻成熟的“寒热为纲”的学术思想创新性地引入膝骨关节炎的辨治中,在辨治膝骨关节炎“肝肾亏虚”共性的基础上,依据“寒热为纲”的学术思想深入辩证,形成基于“肾虚”的“寒热为纲”辨治方案,以骨痹通方为基础进行加减。分别于治疗前及疗程结束后测定和记录患者疼痛、关节僵硬、关节功能障碍的平均骨关节炎指数(WOMAC),临床症状改善情况,患者和医生对病情的总体平均评价,检测ESR、CRP水平,进行血、尿常规、肝肾功能检查,记录服药期间的不良反应。将中药骨痹通方治疗组按中医辨证标准进一步分为肾虚寒湿和肾虚湿热两个亚组,分别在患者疼痛、关节僵硬、关节功能障碍的平均骨关节炎指数(WOMAC),中医证候积分,患者和医生对病情的总体平均评价,ESR、CRP,安全性指标,药物的不良反应等方面与对照组加以比较。
结果：理论及经验总结方面：从阎老师治疗风湿病思想可见其学术渊源,主要来源于经典古籍、焦树德学术经验、临床经验总结,具体体现在阎老帅名医之路、继承之路、探索和创新之路。阎老师主张从经典中来,到临床中去。经典当推《黄帝内经》、《伤寒论》、《金匮要略》、《温病条辨》、《温热经纬》、《本草从新》等。从老师辨治风湿病学术思想可见经典端倪,体现在辨风湿病病证共性—补肝肾、祛风湿是治痹之要；“邪入邪出”之所---调和营卫；风寒湿痹和风湿热痹---“寒热为纲”辨治渊源等诸多方面。阎老师总结、传承焦老学术思想临床经验主要体现在精研辨证论治,提出“四必须”、“五强调”,创议“旭痹”及诊治规律,辨析胸痹、心痹异同,探究心痹诊治,发展燮枢理论,创组燮枢汤方等方面。阎老师秉承恩师焦树德教授旨意,进一步发扬焦老学术思想的同时,结合自已多年的临床经验和众多经典、现代文献,不断探索,推陈出新,对名师的学术思想、理论、方药在继承的基础上进行深入研究,并加以升华、提炼,推动学科研究和中医理论的创新,主要体现在传承的结晶——“大偻”的渊源及辨证论治体系的形成,提出风湿病循经辨证理论,阎小萍治疗风湿病疗效与机理系列研究等方面。与各家学说分析比较,阎老师辨治膝骨痹(膝骨关节炎)从病因病机、辨证论治、中医内治、中医外治、综合治疗等方面,既有共同之处,又有不同之点；临床研究方面：发现治疗前后测患者的平均WOMAC骨关节炎指数、VAS患者和医生对病情的总体评价有统计学差异,骨痹通方组较对照组改善WOMAC指数更为明显,使用非甾类抗炎药剂量显著减少,两组ESR、CRP水平及不良反应未显示差异,血、尿常规、肝肾功能检查治疗前后均未见异常。肾虚寒湿和肾虚湿热两亚组均可改善骨关节炎指数VAS评分(WOMAC),且在改善膝膝骨痹(膝骨关节炎)中医证候量化积分、减少双氯芬酸钠消耗量上优于对照组。
结论：理论及经验总结方面：整理与研究阎小萍老师学术思想和临床经验,共有十得：倡导“一论”、“两观”,即“寒热为纲”的辨治论、“平衡观”和“趋势观”,以简驭繁,寒热为纲论治风湿病,凸显实用价值,“寒热为纲”辨治论必须基于中医风湿病的辨病共性,这一共性是肝肾不足,风湿之邪深侵,引起风寒湿或风湿热邪痹阻经络,治疗则在“补肝肾、祛风湿”的治疗大法之上,执简驭繁,--寒者热之,热者寒之”,分别采用“祛风除湿驱寒”和“祛风除湿清热”,不仅用于风湿病的中药内服,还用于中医外治,并可结合现代技术形成中医特色疗法；推脏腑辨证,重在协和、协调脏腑功能—“和”法,在遵循协调阴阳的基础上,根据疾病的特点,分别采用攻补兼施、扶正祛邪,调和阴阳,调理寒热,调和营卫,燮和肝胆,调理脾胃,调和气血,燮理气机等治法治疗风湿病,临床取得良好疗效；“五连环”的中医特色疗法,包括健康教育、医疗体育、中药为主、内外兼治、中西合壁五项内容；综合强化序贯疗法包含综合、强化、序贯三个层次的含义,综合各种治疗方法,强调不同方法的组合效应,以最大为目标,以最大疗效为目的,强化各种治疗方法的作用,以强度为目标,以改善病情程度为目的,追求临床效果的最大化,序贯应用各种治疗方法,以时间性为目标,以连续性为目的,交替进行,强化增强疗效,强化维持疗效。在疾病急性期,缓解肌肉、关节的疼痛、压痛、酸胀、麻木等症状,在功能恢复阶段,使肌肉、关节持续处于松弛、缓解状态；“痹病欲尫”的治未病思想,阎老师总结尫痹诊治经验,探索具有临床证候、治疗原则、和处方用药的独特规律性,指出一旦出现骨损、筋挛、肉削的尫痹特征,疾病将变得缠绵难愈,因此老师提出“痹病欲尫”的概念,意在强化痹病的早诊断,早治疗,当痹病出现关节持续性肿胀、痛发骨内、屈伸不能、夜间疼痛剧烈等症时,虽关节尚未变形,应警惕其有可能向尫痹传变；循经辨证—寓于脏腑辨证的羽翼,寓循经辨证于脏腑辨证之中,强调风湿病具体的出现症状部位应和相应的经络循行部位相合,以便正确使用相应引经药物；调和营卫—“扶正祛邪”的必由之途,风寒湿诸邪气侵犯人体,与营卫之气合则闭阻经络,气血运行不畅为痹证,营卫为“邪入”之所,补肝肾、祛风湿,驱邪外出,则营卫为经过之途,营卫为“邪出”之所,故调和营卫是中医风湿病治疗的重要法则之一；活血通络—贯穿风湿病辨治的始终,风湿病病程漫长,反复发作,迁延难愈,日久必入血入络,形成瘀血,瘀血证贯穿风湿病整个病程,活血通络法贯穿于治疗始终；生脾胃阳气,顾护后天脾土—风湿病辨治的重要环节,风湿病的基本病机为风寒湿(或热)合而为痹,其中湿邪至关重要,湿性粘滞,往往使风湿病缠绵难愈,调理脾胃有助于湿邪的祛除,又以后天养先天,有利于补肝肾,风湿病病程冗长,易反复发作,往往需要长期用药,顾护后天脾胃,使长期治疗成为可能,是一切治疗的基础；中医适宜技术和诊疗方案—基于疗效的辨治风湿病体现。临床研究方面：骨痹通方具有缓解和改善疼痛、僵硬、关节功能障碍的作用,是治疗膝骨关节炎安全且行之有效的方剂。采取在膝骨关节炎辨证共性的基础上,依据基于“肾虚”的“寒热为纲”辨治膝骨关节炎的辨治方法指导深入辨证,对骨痹通方进一步加减相结合的方法,可明显改善骨关节炎指数VAS评分(WOMAC)、膝骨痹(膝骨关节炎)中医证候量化积分、减少非甾体消炎药消耗量,可适用于膝骨关节炎的辨治。
Objective:To trace the academic origin of Professor YAN Xiao-ping, who was one of the4th batches of national famous senior TCM doctors. To arrange and study the academic thought and clinical experiences of teacher YAN Xiao-ping. To study the efficacy and safety of Gubitong recipe which was a experience prescription treating osteoarthritis made by teacher YAN.
Methods:in the aspect of theories and clinical experiences summary:using methods of studying classical books and arranging literatures, the academic thought and clinical experiences of teacher YAN were summarized, arranged and refined. In the aspect of clinic study:using the methods of prospective, random, positive medicine in control,120osteoarthritis patients were arranged in two groups:the treatment group was treated with Gubitong recipe, the control group was treated with Glucosamine hydrochloride. The observation contents included patient's pain degree, joint stiffness, joint movement dysfunction, WOMAC, clinic syndromes, the whole assessment of patients and doctors. The laboratory tests included:ESR, CRP, the blood, urine, liver and kidney function tests. The side effects were recorded during the treatment periods. All these were recorded in advance of the experiment and after it respectively. In the Gubitong recipe treatment group, all patients were divided into kidney deficiency with cold-dampness invading syndrome and kidney deficiency with heat-dampness invading syndrome, the patients with these two syndromes were compared with the control group in each aspects, including patient's pain degree, joint stiffness, joint movement dysfunction, WOMAC, clinic syndromes, the whole assessment of patients and doctors, ESR, CRP, the safety tests, the side effects test and so on.
Results:in the aspect of theories and clinical experiences summary:from the academic thought of treating Bi syndrome, we could deem that the major academic origin of teacher YAN was originated in the ancient classics books, JIAO Shude academic experience and own clinic experiential accumulation. In concretely speaking, the origin of teacher YAN reflected as the road of famous TCM doctors, the roads of medical inheritance, the roads of exploration and innovation. Teacher Yan had advocated that'from clincal experience, back to clincal experience'in studying TCM, which is said that we should study the TCM Calssics, expecially'the Canon of Internal Medicine','treatise on febrile diseases','synopsis of golden chamber','Item Differentiation of Warm Febrile Diseases','wen re jing wei','ben cao cong xin'and so on. In the course of studying, we could see that the academic thought of teacher Yan in treating Rheumatology were from the TCM Calssics, for example, teacher Yan thought that the main point in treating rheumatology included tonifying liver and kidney,expelling wind and dampness, adjusting ying and wei, the principle in treating rheumatology is cold syndrome and heat syndrome. In summarizing the academic thoughts of professor Jiao, teacher Yan had pointed out that the academic thoughts of professor Jiao including four necessities, five poinpoints, creating wang bi syndrome, reachering xin bi syndrome, developing axis therory and so on. On the basis of professor Jiao, teacher Yan had advocated many new therories, as the origin of da Iv, the syndrome differentiation and treatment of da lv, advancing the theories of according channel sites in Syndrome Differentiation and Treatment of rheumatology. In the treatment of osteoarthritis, teacher Yan had many unique thoughts in comparing with other doctors, as the knowledge of pathology, pathogenesis, Syndrome Differentiation and Treatment, internal treatment of TCM, external treatment of TCM, synthesizing treatment and so on.In the aspect of clinic study:after the treatment, WOMAC and the global assessment of patients and doctors had decreased, and had remarkable differences. Compared to the control group, in the treatment group, the improvement of WOMAC had remarkable differences, the usage amount of NSAIDs was less, and had remarkable differences, the lever of ESR and CRP had no differences. In two groups, the adverse effects, as the blood, urine, liver and kidney function tests, did not show differences in before and after treatment.
Conclusion:in the aspect of theories and clinical experiences summary:in the course of arranging and studying the academic thought and clinic experience of teacher YAN Xiao-ping, I had10outcomes:(1) advocate one theory and two concep(?): the cold and heat synopsis theory, balance concept and tendency concept. The principles of cold syndrome and heat syndrome must base on a basic fundamental, which is tonifying liver and kidney, expelling wind and dampness. In treating rheumatology, the methods of "expelling wind, cold and dampness" and "expelling wind, heat and dampness" would be used respectively. Besides, the internal treatment and external treatment would be used intergrated;(2) emphasize the importance of the differentiation symptoms and signs from Zang-Fu and he method in it, in other words, coordinating the function of Zang and Fu;(3)5consistem ring TCM unique remedy;(4)integration, intensification ana continuum remedy,(5) regard differentiate syndrome following channel and meridian, which supply the differentiation syndrome from Zang-Fu Zang-Fu;(6) Preventive Treatment of Disease academic thought-Bi syndrome which would be Wang Bi;(7) the necessary method for Strengthening Healthy Qi to Eliminate Pathogens-coordinating Ying Qi and Wei Qi;(8) motivate the blood and dredge channel-a method should be used in rheumatic disease all the way;(9) an important aspect in treating rheumatic disease-ascending Yang Qi of spleen and stomach, protecting spleen which is the origin of the acquired constitution;(10) TCM useful technique for treatment, diagnosis and treatment regimen. In the aspect of clinic study:Gubitong recipe had the function of easing the pain and stiffness symptom, of improving joint dysfunction, it was a safe and effective prescription role in the treatment of knee osteoarthritis.
引文
[1]李宁华.中老年人群骨关节炎的流行病学特征[J].中国临床康复,2005,9(38)：133-135.
[2]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国临床医生杂志,2008,36,1(28)：28-30
[3]Hochberg MC,Altman RD,Brandt KD,et al.Guidelines for the medical management of osteoarthritis[J].Part Ⅱ:osteoarthritis of the knee J. Arthritis Rheum,1995,24:118-120
[4]TAO Qing-wen, XU Yuan, JIN Di-er, and YAN Xiao-ping. Therapeutic Effect and Safety of Gubitong Recipe in Treating Osteoarthritis of Knee Joint[J]. Chin J Integr Med,2009,15(6):458-461
[5]陈龙全,郝双阶.复方竹节参片配合穴位注射治疗膝骨性关节炎82例[J].陕西中医,2004,25(8)：716
[6]林俊宏.综合治疗膝关节骨性关节炎62例[J].长春中医学院学报,2002,18(1)：29-30
[7]朱洪民,宁显明.黄芪桂枝五物胶囊治疗膝骨关节炎临床研究[J].福建中医药,2002,33(3)：15-16
[8]李平,韩明向,孔秀蝇.肾虚络阻是骨关节炎的病机特点[J].中医药临床杂志。2006,18(1)：89
[9]叶芳,叶胥华.辨证施治膝骨性关节炎81例[J].陕西中医,2005,26(12)：1302-1303
[10]刘洪旺。退行性膝关节骨性关节病的中医辨证施治[J].中国骨伤,1997,10(4)：27
[11]陆智.四妙散合独活寄生汤加减治疗风湿性膝关节炎104例[J].四川中 医,1996,14(10)：38
[12]杨业清.中西医结合治疗骨关节炎40例[J].新中医,2001,33(8)：34-35
[13]杜天信,韩新峰,高书图.寒湿痹颗粒治疗寒湿痹阻型风湿病的临床观察[J].中医正骨,2002,14(3)：10-12
[14]邓伟.补脾益肾化瘀法治疗膝骨关节炎[J].中药材,2003,26(7)：535
[15]吴泽.益气养血法治疗退行性膝关节炎120例[J].四川中医,1998,16(5)：24-25
[16]陶庆文,路平,阎小萍.寒痹外用方对强直性脊柱炎肾虚督寒证的近期止痛作用观察[J].中国骨伤,2007,20(7)：492-493
[17]郑昱新,詹红生,张琥,等.奇正青鹏膏剂治疗膝骨关节炎的随机对照临床研究[J].中国骨伤,2006,19(5)：316
[18]颜玉莲,熊桂仙,王宗春,等.二鸟离子导入液治疗膝关节骨性关节炎疗效观察[J].中国药师,2000,3(3)：179
[19]查振刚,宋炎成,赵明杰,等.丹参和透明质酸钠恢复膝关节功能的对比研究[J].中国临床康复,2002,6(24)：3746
[20]杨道银,谢小庆,唐中尧,等.复元活血膏治疗膝关节退行性骨关节炎的临床及药效学观察[J].四川中医,2006,24(5)：63-64
[21]付勇,康明非,陈日新,等.无痛化脓灸治疗膝关节骨性关节炎疗效观察[J].中国针灸,2007,27(7)：51 3
[22]蒋生云.推拿治疗膝关节骨关节炎50例体会[J].按摩与导引,2003,19(1)：36
[23]成钢.挑罐法治疗脊椎退变性腰腿痛临床报告[J].针灸临床杂志,2000,16(7)：33-34
[24]樊粤光,杨俊兴,赵京涛,等.小针刀结合理疗手法治疗老年膝关节骨关节炎35例[J].新中医,2000,32(5)：44
[25]许学猛,邓晋丰,许树柴.中药内外兼治治疗退行性膝关节病的临床研究[J].中国中医骨伤科杂志,2000,8(6)：21
[26]种清治,孙智平,杨芳.手法加中药治疗膝关节退行生骨关节病[J]. 中医正骨,2001,13(7)：49-50
[27]常程峰,付清荣,王荣珍.天王消骨液为主治疗膝关节骨关节炎[J].中医正骨,2001,13(7)：52
[1]Minicuci N, Noale M, Bardage C, et al. Cross-national determinants of quality of life from six longitudinal studies on aging:the CLESA project[J]. Aging Clin Exp Res,2003,15(3):187-202.
[2]贺宪,魏春山,蔡智刚,等.膝骨性关节炎的病机和防治机制探讨[J].山东中医杂志,2005(2)：73-75.
[3]徐传毅,樊粤光,宁显明.肾虚血瘀与膝骨性关节炎关系初探[J].新中医,2002(3)：7-9.
[4]陈赛红.新癀片与仙灵骨葆合用治疗中老年骨关节退行性变的临床观察[J].中国中西医结合杂志,2002(8)：586.
[5]叶芳,叶胥华,叶欣.辨证施治膝骨性关节炎81例[J].陕西中医,2005(12)：1302-1303.
[6]杜双庆,杜景华,张晶.养血清润汤治疗原发性膝关节骨性关节炎173例[J].四川中医,2002(12)：62.
[7]邬亚军,赵治友,何永生.中药治疗膝关节骨关节炎的临床观察[J].四川中医,2006(6)：80-81.
[8]万荣,杨庆铭,邓廉夫.黑虎丹治疗兔骨关节炎的实验研究[J].中国骨伤,2001(2)：21-23.
[9]沈霖,沈耀,杨述华.丹参注射液对维甲酸诱导的软骨细胞凋亡的影响 [J].中国中医骨伤科杂志,2002(5).
[10]汪青春,董蕙芳,沈培芝,等.中药对膝骨关节炎黑鼠血清SOD、HA、NO水平的影响[J].中医正骨,1 999(5)：6-8.
[11]毛小兵,邹季.风湿骨痛药酒药槌外治法防治关节软骨退变的实验研究[J].中国骨伤,2002(4).
[12]魏玉玲,刘营杰,梁克玉.中药消痹灵对软骨细胞—氧化氮合成的影响[J].中医正骨,2002(10)：5-6.
[13]高文香,刘元禄,李永生,等.补肾法防治兔膝关节骨性关节炎的病理形态学观察[J].中医正骨,1999(12)：13-15.
[14]汪青春,石印玉,沈培芝,等.中药对膝骨关节炎小鼠关节软骨IL-1、iNOS基因表达的影响[J].山西医药杂志,1999(5)：381-383.
[15]郭建刚,冯坤,赵然,等.壮筋活血汤对骨性关节炎软骨退变防治作用的生化研究[J].中国骨伤,1999(5)：17-19.
[16]潘海乐,曲波,王耶.参麦注射液对骨关节炎动物模型血液中白细胞介索1水平的影响[J].中国中医骨伤科杂志,,2000(1)：19-20.
[17]俞杰,明顺培,张秀芬.针刀疗法对兔膝骨关节炎关节液中IL-1 β、IL-6、TNF-α水平的影[J].中国中医骨伤科杂志,2002(4).
[18]陈飞雁,顾湘杰,钟明康,等.威灵仙注射液对骨关节炎关节液与软骨白介素-1水平的影响[J].中国矫形外科杂志,2004(7)：43-45.
[19]黄涛,徐传毅,邹季,等.活血止痛汤治疗早期骨“性关节炎的实验研究[J].中医正骨,1999(5)：3-5.
[20]杜见斌.益肝补肾通络法为主治疗骨性关节炎96例[J].山东中医杂志,1992(1)：19-20.
[21]高学礼.加味苍柏汤治疗增生性关节炎65例[J].山东中医杂志,1991(1)：22-23.
[22]马素英.应用马氏骨刺丸治疗骨性关节炎216例[J].北京中医,1993(3)：49.
[23]邢锋.自制复方风湿康治疗骨关节炎68例临床观察[J].安徽中医临床杂志,1998(6)：371-372.
[24]宋绍亮,付新利.张鸣鹤主任医师治疗关节病的经验[J].山东中医杂志,1991(3)：44-45.
[25]杜秀兰.增生消痛汤治疗增生性膝关节病55例[J].山东中医杂志,1994(1)：14.
[26]卢勇,吕发明,孟庄才.天龙镇痛浴液治疗膝关节骨性关节炎356例报告[J].中医正骨,1996(5)：26.
[27]李凤海,许超,潘述平.熏蒸疗法治疗膝关节骨性关节炎90例[J].山东中医杂志,1999(2)：111-112.
[28]徐波,卢进宝.复方三生膏治疗膝关节骨性关节炎的临床研究[J].临床医学,2000(9)：13-14.
[29]孟繁涛.针刺加拔火罐治疗增生性膝关节炎[J].针灸临床杂志,2000(3)：36-37.
[30]樊松龄.药物穴位注射治疗退行性膝关节炎60例[J].中国针灸,1995(6)：15-16.
[31]樊粤光,杨俊兴,赵京涛,等.小针刀结合理伤手法治疗老年膝关节骨 关节炎35例[J].新中医,2000(5)：44-45.
[32]王学荣.推拿治疗膝关节骨性关节炎100例[J].浙江中医杂志,1995(5)：209.
[33]滕蔚然,杜宁,史炜镔.手法治疗膝骨关节病对膝关节功能改善的研究[J].中国中医骨伤科杂志,2000(5)：48-50.
[34]Berman B. A 60-year-old woman considering acupuncture for knee pain[J]. JAM A,2007,297(15):1697-1707.
[35]Manheimer E, Linde K, Lao L, et al. Meta-analysis:acupuncture for osteoarthritis of the knee[J]. Ann Intern Med,2007,146(12):868-877.
[36]White A, Foster N E, Cummings M, et al. Acupuncture treatment for chronic knee pain:a systematic review[J]. Rheumatology (Oxford),2007,46(3):384-390.
[37]Reinhold T, Witt C M, Jena S, et al. Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain[J]. Eur J Health Econ,2008,9(3):209-219.
[38]Mitchell S M, Trowbridge C A, Fincher A L, et al. Effect of diathermy on muscle temperature, electromyography, and mechanomyography[J]. Muscle Nerve,2008,38(2):992-1004.
[39]Cetin N, Aytar A, Atalay A, et al. Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees:a single-blind, randomized, controlled trial[J]. Am J Phys Med Rehabil,2008,87(6):443-451.
[40]Leung M S, Cheing G L. Effects of deep and superficial heating in the management of frozen shoulder[J]. J Rehabil Med,2008,40(2):145-150.
[41]Straub R H, Pongratz G, Hirvonen H, et al. Acute cold stress in rheumatoid arthritis inadequately activates stress responses and induces an increase of interleukin 6[J]. Ann Rheum Dis,2009,68(4):572-578.
[42]Kopanski Z, Grabowska M, Tabak J, et al. [An attempt to precise indications for treatment with systemic cryotherapy of patients with rheumatoid arthritis][J]. Przegl Lek,2008,65(4):172-176.
[43]中华医学会编著.临床诊疗指南,风湿病分册[M].北京：人民卫生出版社.2005.16.
[44]Davies N M, Wallace J L. Nonsteroidal anti-inflammatory drug-induced gastrointestinal toxicity:new insights into an old problem[J]. J Gastroenterol,1997,32(1):127-133.
[45]Richy F, Bruyere O, Ethgen O, et al. Time dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use:a consensus statement using a meta-analytic approach[J]. Ann Rheum Dis,2004,63(7):759-766.
[46]Mukherjee D, Nissen S E, Topol E J. Risk of cardiovascular events associated with selective COX-2 inhibitors[J]. JAMA,2001,286(8):954-959.
[47]曹月龙,郑昱新,石印玉,等.养血软坚胶囊治疗膝骨关节炎疗效及安全性评价的随机对照试验[J].中国药物与临床,2004(6)：423-427.
[48]盛太平,冯俊奇,武玉明.中药离子导入治疗膝骨关节炎的影像观察[J].中医正骨,2010(10)：3-5.
[49]刘驰,袁秀丽,姜艳,等.内服外熏敷中药治疗膝骨性关节炎[J].中医 正骨,2007(5)：36.
[1]中华医学会编著.临床诊疗指南,风湿病分册[M].北京：人民卫生出版社,2005：16.
[2]Davies N M, Wallace J L. Nonsteroidal anti-inflammatory drug-induced gastrointestinal toxicity:new insights into an old problem[J]. J Gastroenterol,1997,32(1):127-133.
[3]Richy F, Bruyere O, Ethgen O, et al. Time dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use:a consensus statement using a meta-analytic approach[J]. Ann Rheum Dis,2004,63(7):759-766.
[4]Mukherjee D, Nissen S E, Topol E J. Risk of cardiovascular events associated with selective COX-2 inhibitors[J]. JAMA,2001,286(8):954-959.
[5]曹月龙,郑昱新,石印玉,等.养血软坚胶囊治疗膝骨关节炎疗效及安全性评价的随机对照试验[J].中国药物与临床,2004(6)：423-427.
[6]Tao Q W, Xu Y, Jin D E, et al. Clinical efficacy and safety of Gubitong Recipe in treating osteoarthritis of knee joint[J]. Chin J Integr Med,2009,15(6):458-461.
[7]盛太平,冯俊奇,武玉明.中药离子导入治疗膝骨关节炎的影像观察[J].中医正骨,2010(10)：3-5.
[8]刘驰,袁秀丽,姜艳,等.内服外熏敷中药治疗膝骨性关节炎[J].中医正骨,2007(5)：36.
[9]Aluman RD. Classification of disease Osteoarthritis. Sem in Arthritis J Rheum,1991,20:40-47.
[10]中华医学会风湿病学分会.骨关节炎诊治指南.中华风湿病学杂志,2003,7(11)：702-704.
[11]Dawson J, Linsell L, Doll H, et al. Assessment of the Lequesne index of severity for osteoarthritis of the hip in an elderly population[J]. Osteoarthritis Cartilage,2005,13(10):854-860.
[12]Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC:a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol,1988 Dec;15(12):1833-40.
[13]中华医学会骨科学分会.骨关节炎诊治指南(2007年版).中国临床医生杂志,2008,36,1(28)：28-30.
[14]Hochberg MC,Altman RD,Brandt KD,et al.Guidelines for the medical management of osteoarthritis.Part Ⅱ:osteoarthritis of the knee J.Arthritis Rheum,1995,24:118-120.
[15]PavelkaK,Gatterova J,Olejarova M,et al.Arch Intern Med,2002;162(18):2113-2123.
[16]江艳,李荣亨,曹文富.骨关节炎中药治疗研究进展.实用中医药杂志,2007,23(5)：336-337.
[17]姚共和,刘向前.膝关节骨关节炎基本证候及其分布特点的研究.中医药学刊,2005,9：1553-1554.
[18]Creame P,Hochberg MC. Osteoarthritis Lancet.1997,350-369
[19]Hovland J. Bone Miner.1991,15:139-161.
[20]Reboul P,Pelletier JP,Tardif G, et al.The new Collagenase, Collagenase-3 is experessed and Synthesized by human chondrocyte but not by synoriocytes a role in osteoarthritis[J], J Clin Invest,1996,97(9):2022.
[21]Redini F,Mauviel A,Pronost S,et al.Transforming growth factor exerts oppoisete effects from ubterleuken-1 on cultured rabbit articular chondrocytes through reduction of interleukin-1 recepter expression, [J]. Arthritis and Rheumtism.1993,36(8):44-46.
[22]Connor JR,Manning PT,Settle SL,et al.Suppression of adjuvant induced arthritis by selective inhibition of inducible nitric oxide synthase [J].Eur J Phamacol, 1995,273:15-24.
[23]潘伟军,梁祖建.补肾活血方对骨关节炎关节软骨保护作用的临床研究,福建中医学院学报,2007,17(3)：44-45.
[24]胡阿威,张磊,吕建芳,等.复方健骨关节汤治疗骨关节炎的实验研究.中国中医骨伤科杂志,2007,15(2)：42-44.
[25]刘英杰,马利杰,王相利.独活寄生汤对兔膝股关节炎关节液白细胞介素-1和肿瘤坏死因子的影响.河北中医,2007,29(8)：748-750.
[2]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J].中国临床医生杂志,2008,36,1(28)：28-30
[3]Hochberg MC,Altman RD,Brandt KD,et al.Guidelines for the medical management of osteoarthritis[J].Part Ⅱ:osteoarthritis of the knee J. Arthritis Rheum,1995,24:118-120
[4]TAO Qing-wen, XU Yuan, JIN Di-er, and YAN Xiao-ping. Therapeutic Effect and Safety of Gubitong Recipe in Treating Osteoarthritis of Knee Joint[J]. Chin J Integr Med,2009,15(6):458-461
[5]陈龙全,郝双阶.复方竹节参片配合穴位注射治疗膝骨性关节炎82例[J].陕西中医,2004,25(8)：716
[6]林俊宏.综合治疗膝关节骨性关节炎62例[J].长春中医学院学报,2002,18(1)：29-30
[7]朱洪民,宁显明.黄芪桂枝五物胶囊治疗膝骨关节炎临床研究[J].福建中医药,2002,33(3)：15-16
[8]李平,韩明向,孔秀蝇.肾虚络阻是骨关节炎的病机特点[J].中医药临床杂志。2006,18(1)：89
[9]叶芳,叶胥华.辨证施治膝骨性关节炎81例[J].陕西中医,2005,26(12)：1302-1303
[10]刘洪旺。退行性膝关节骨性关节病的中医辨证施治[J].中国骨伤,1997,10(4)：27
[11]陆智.四妙散合独活寄生汤加减治疗风湿性膝关节炎104例[J].四川中 医,1996,14(10)：38
[12]杨业清.中西医结合治疗骨关节炎40例[J].新中医,2001,33(8)：34-35
[13]杜天信,韩新峰,高书图.寒湿痹颗粒治疗寒湿痹阻型风湿病的临床观察[J].中医正骨,2002,14(3)：10-12
[14]邓伟.补脾益肾化瘀法治疗膝骨关节炎[J].中药材,2003,26(7)：535
[15]吴泽.益气养血法治疗退行性膝关节炎120例[J].四川中医,1998,16(5)：24-25
[16]陶庆文,路平,阎小萍.寒痹外用方对强直性脊柱炎肾虚督寒证的近期止痛作用观察[J].中国骨伤,2007,20(7)：492-493
[17]郑昱新,詹红生,张琥,等.奇正青鹏膏剂治疗膝骨关节炎的随机对照临床研究[J].中国骨伤,2006,19(5)：316
[18]颜玉莲,熊桂仙,王宗春,等.二鸟离子导入液治疗膝关节骨性关节炎疗效观察[J].中国药师,2000,3(3)：179
[19]查振刚,宋炎成,赵明杰,等.丹参和透明质酸钠恢复膝关节功能的对比研究[J].中国临床康复,2002,6(24)：3746
[20]杨道银,谢小庆,唐中尧,等.复元活血膏治疗膝关节退行性骨关节炎的临床及药效学观察[J].四川中医,2006,24(5)：63-64
[21]付勇,康明非,陈日新,等.无痛化脓灸治疗膝关节骨性关节炎疗效观察[J].中国针灸,2007,27(7)：51 3
[22]蒋生云.推拿治疗膝关节骨关节炎50例体会[J].按摩与导引,2003,19(1)：36
[23]成钢.挑罐法治疗脊椎退变性腰腿痛临床报告[J].针灸临床杂志,2000,16(7)：33-34
[24]樊粤光,杨俊兴,赵京涛,等.小针刀结合理疗手法治疗老年膝关节骨关节炎35例[J].新中医,2000,32(5)：44
[25]许学猛,邓晋丰,许树柴.中药内外兼治治疗退行性膝关节病的临床研究[J].中国中医骨伤科杂志,2000,8(6)：21
[26]种清治,孙智平,杨芳.手法加中药治疗膝关节退行生骨关节病[J]. 中医正骨,2001,13(7)：49-50
[27]常程峰,付清荣,王荣珍.天王消骨液为主治疗膝关节骨关节炎[J].中医正骨,2001,13(7)：52
[1]Minicuci N, Noale M, Bardage C, et al. Cross-national determinants of quality of life from six longitudinal studies on aging:the CLESA project[J]. Aging Clin Exp Res,2003,15(3):187-202.
[2]贺宪,魏春山,蔡智刚,等.膝骨性关节炎的病机和防治机制探讨[J].山东中医杂志,2005(2)：73-75.
[3]徐传毅,樊粤光,宁显明.肾虚血瘀与膝骨性关节炎关系初探[J].新中医,2002(3)：7-9.
[4]陈赛红.新癀片与仙灵骨葆合用治疗中老年骨关节退行性变的临床观察[J].中国中西医结合杂志,2002(8)：586.
[5]叶芳,叶胥华,叶欣.辨证施治膝骨性关节炎81例[J].陕西中医,2005(12)：1302-1303.
[6]杜双庆,杜景华,张晶.养血清润汤治疗原发性膝关节骨性关节炎173例[J].四川中医,2002(12)：62.
[7]邬亚军,赵治友,何永生.中药治疗膝关节骨关节炎的临床观察[J].四川中医,2006(6)：80-81.
[8]万荣,杨庆铭,邓廉夫.黑虎丹治疗兔骨关节炎的实验研究[J].中国骨伤,2001(2)：21-23.
[9]沈霖,沈耀,杨述华.丹参注射液对维甲酸诱导的软骨细胞凋亡的影响 [J].中国中医骨伤科杂志,2002(5).
[10]汪青春,董蕙芳,沈培芝,等.中药对膝骨关节炎黑鼠血清SOD、HA、NO水平的影响[J].中医正骨,1 999(5)：6-8.
[11]毛小兵,邹季.风湿骨痛药酒药槌外治法防治关节软骨退变的实验研究[J].中国骨伤,2002(4).
[12]魏玉玲,刘营杰,梁克玉.中药消痹灵对软骨细胞—氧化氮合成的影响[J].中医正骨,2002(10)：5-6.
[13]高文香,刘元禄,李永生,等.补肾法防治兔膝关节骨性关节炎的病理形态学观察[J].中医正骨,1999(12)：13-15.
[14]汪青春,石印玉,沈培芝,等.中药对膝骨关节炎小鼠关节软骨IL-1、iNOS基因表达的影响[J].山西医药杂志,1999(5)：381-383.
[15]郭建刚,冯坤,赵然,等.壮筋活血汤对骨性关节炎软骨退变防治作用的生化研究[J].中国骨伤,1999(5)：17-19.
[16]潘海乐,曲波,王耶.参麦注射液对骨关节炎动物模型血液中白细胞介索1水平的影响[J].中国中医骨伤科杂志,,2000(1)：19-20.
[17]俞杰,明顺培,张秀芬.针刀疗法对兔膝骨关节炎关节液中IL-1 β、IL-6、TNF-α水平的影[J].中国中医骨伤科杂志,2002(4).
[18]陈飞雁,顾湘杰,钟明康,等.威灵仙注射液对骨关节炎关节液与软骨白介素-1水平的影响[J].中国矫形外科杂志,2004(7)：43-45.
[19]黄涛,徐传毅,邹季,等.活血止痛汤治疗早期骨“性关节炎的实验研究[J].中医正骨,1999(5)：3-5.
[20]杜见斌.益肝补肾通络法为主治疗骨性关节炎96例[J].山东中医杂志,1992(1)：19-20.
[21]高学礼.加味苍柏汤治疗增生性关节炎65例[J].山东中医杂志,1991(1)：22-23.
[22]马素英.应用马氏骨刺丸治疗骨性关节炎216例[J].北京中医,1993(3)：49.
[23]邢锋.自制复方风湿康治疗骨关节炎68例临床观察[J].安徽中医临床杂志,1998(6)：371-372.
[24]宋绍亮,付新利.张鸣鹤主任医师治疗关节病的经验[J].山东中医杂志,1991(3)：44-45.
[25]杜秀兰.增生消痛汤治疗增生性膝关节病55例[J].山东中医杂志,1994(1)：14.
[26]卢勇,吕发明,孟庄才.天龙镇痛浴液治疗膝关节骨性关节炎356例报告[J].中医正骨,1996(5)：26.
[27]李凤海,许超,潘述平.熏蒸疗法治疗膝关节骨性关节炎90例[J].山东中医杂志,1999(2)：111-112.
[28]徐波,卢进宝.复方三生膏治疗膝关节骨性关节炎的临床研究[J].临床医学,2000(9)：13-14.
[29]孟繁涛.针刺加拔火罐治疗增生性膝关节炎[J].针灸临床杂志,2000(3)：36-37.
[30]樊松龄.药物穴位注射治疗退行性膝关节炎60例[J].中国针灸,1995(6)：15-16.
[31]樊粤光,杨俊兴,赵京涛,等.小针刀结合理伤手法治疗老年膝关节骨 关节炎35例[J].新中医,2000(5)：44-45.
[32]王学荣.推拿治疗膝关节骨性关节炎100例[J].浙江中医杂志,1995(5)：209.
[33]滕蔚然,杜宁,史炜镔.手法治疗膝骨关节病对膝关节功能改善的研究[J].中国中医骨伤科杂志,2000(5)：48-50.
[34]Berman B. A 60-year-old woman considering acupuncture for knee pain[J]. JAM A,2007,297(15):1697-1707.
[35]Manheimer E, Linde K, Lao L, et al. Meta-analysis:acupuncture for osteoarthritis of the knee[J]. Ann Intern Med,2007,146(12):868-877.
[36]White A, Foster N E, Cummings M, et al. Acupuncture treatment for chronic knee pain:a systematic review[J]. Rheumatology (Oxford),2007,46(3):384-390.
[37]Reinhold T, Witt C M, Jena S, et al. Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain[J]. Eur J Health Econ,2008,9(3):209-219.
[38]Mitchell S M, Trowbridge C A, Fincher A L, et al. Effect of diathermy on muscle temperature, electromyography, and mechanomyography[J]. Muscle Nerve,2008,38(2):992-1004.
[39]Cetin N, Aytar A, Atalay A, et al. Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees:a single-blind, randomized, controlled trial[J]. Am J Phys Med Rehabil,2008,87(6):443-451.
[40]Leung M S, Cheing G L. Effects of deep and superficial heating in the management of frozen shoulder[J]. J Rehabil Med,2008,40(2):145-150.
[41]Straub R H, Pongratz G, Hirvonen H, et al. Acute cold stress in rheumatoid arthritis inadequately activates stress responses and induces an increase of interleukin 6[J]. Ann Rheum Dis,2009,68(4):572-578.
[42]Kopanski Z, Grabowska M, Tabak J, et al. [An attempt to precise indications for treatment with systemic cryotherapy of patients with rheumatoid arthritis][J]. Przegl Lek,2008,65(4):172-176.
[43]中华医学会编著.临床诊疗指南,风湿病分册[M].北京：人民卫生出版社.2005.16.
[44]Davies N M, Wallace J L. Nonsteroidal anti-inflammatory drug-induced gastrointestinal toxicity:new insights into an old problem[J]. J Gastroenterol,1997,32(1):127-133.
[45]Richy F, Bruyere O, Ethgen O, et al. Time dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use:a consensus statement using a meta-analytic approach[J]. Ann Rheum Dis,2004,63(7):759-766.
[46]Mukherjee D, Nissen S E, Topol E J. Risk of cardiovascular events associated with selective COX-2 inhibitors[J]. JAMA,2001,286(8):954-959.
[47]曹月龙,郑昱新,石印玉,等.养血软坚胶囊治疗膝骨关节炎疗效及安全性评价的随机对照试验[J].中国药物与临床,2004(6)：423-427.
[48]盛太平,冯俊奇,武玉明.中药离子导入治疗膝骨关节炎的影像观察[J].中医正骨,2010(10)：3-5.
[49]刘驰,袁秀丽,姜艳,等.内服外熏敷中药治疗膝骨性关节炎[J].中医 正骨,2007(5)：36.
[1]中华医学会编著.临床诊疗指南,风湿病分册[M].北京：人民卫生出版社,2005：16.
[2]Davies N M, Wallace J L. Nonsteroidal anti-inflammatory drug-induced gastrointestinal toxicity:new insights into an old problem[J]. J Gastroenterol,1997,32(1):127-133.
[3]Richy F, Bruyere O, Ethgen O, et al. Time dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use:a consensus statement using a meta-analytic approach[J]. Ann Rheum Dis,2004,63(7):759-766.
[4]Mukherjee D, Nissen S E, Topol E J. Risk of cardiovascular events associated with selective COX-2 inhibitors[J]. JAMA,2001,286(8):954-959.
[5]曹月龙,郑昱新,石印玉,等.养血软坚胶囊治疗膝骨关节炎疗效及安全性评价的随机对照试验[J].中国药物与临床,2004(6)：423-427.
[6]Tao Q W, Xu Y, Jin D E, et al. Clinical efficacy and safety of Gubitong Recipe in treating osteoarthritis of knee joint[J]. Chin J Integr Med,2009,15(6):458-461.
[7]盛太平,冯俊奇,武玉明.中药离子导入治疗膝骨关节炎的影像观察[J].中医正骨,2010(10)：3-5.
[8]刘驰,袁秀丽,姜艳,等.内服外熏敷中药治疗膝骨性关节炎[J].中医正骨,2007(5)：36.
[9]Aluman RD. Classification of disease Osteoarthritis. Sem in Arthritis J Rheum,1991,20:40-47.
[10]中华医学会风湿病学分会.骨关节炎诊治指南.中华风湿病学杂志,2003,7(11)：702-704.
[11]Dawson J, Linsell L, Doll H, et al. Assessment of the Lequesne index of severity for osteoarthritis of the hip in an elderly population[J]. Osteoarthritis Cartilage,2005,13(10):854-860.
[12]Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC:a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol,1988 Dec;15(12):1833-40.
[13]中华医学会骨科学分会.骨关节炎诊治指南(2007年版).中国临床医生杂志,2008,36,1(28)：28-30.
[14]Hochberg MC,Altman RD,Brandt KD,et al.Guidelines for the medical management of osteoarthritis.Part Ⅱ:osteoarthritis of the knee J.Arthritis Rheum,1995,24:118-120.
[15]PavelkaK,Gatterova J,Olejarova M,et al.Arch Intern Med,2002;162(18):2113-2123.
[16]江艳,李荣亨,曹文富.骨关节炎中药治疗研究进展.实用中医药杂志,2007,23(5)：336-337.
[17]姚共和,刘向前.膝关节骨关节炎基本证候及其分布特点的研究.中医药学刊,2005,9：1553-1554.
[18]Creame P,Hochberg MC. Osteoarthritis Lancet.1997,350-369
[19]Hovland J. Bone Miner.1991,15:139-161.
[20]Reboul P,Pelletier JP,Tardif G, et al.The new Collagenase, Collagenase-3 is experessed and Synthesized by human chondrocyte but not by synoriocytes a role in osteoarthritis[J], J Clin Invest,1996,97(9):2022.
[21]Redini F,Mauviel A,Pronost S,et al.Transforming growth factor exerts oppoisete effects from ubterleuken-1 on cultured rabbit articular chondrocytes through reduction of interleukin-1 recepter expression, [J]. Arthritis and Rheumtism.1993,36(8):44-46.
[22]Connor JR,Manning PT,Settle SL,et al.Suppression of adjuvant induced arthritis by selective inhibition of inducible nitric oxide synthase [J].Eur J Phamacol, 1995,273:15-24.
[23]潘伟军,梁祖建.补肾活血方对骨关节炎关节软骨保护作用的临床研究,福建中医学院学报,2007,17(3)：44-45.
[24]胡阿威,张磊,吕建芳,等.复方健骨关节汤治疗骨关节炎的实验研究.中国中医骨伤科杂志,2007,15(2)：42-44.
[25]刘英杰,马利杰,王相利.独活寄生汤对兔膝股关节炎关节液白细胞介素-1和肿瘤坏死因子的影响.河北中医,2007,29(8)：748-750.