膝骨关节炎经筋贴敷疗法的初步研究
摘要
目的：以膝骨关节炎患者为研究对象,采用病例对照的临床研究方法,严格质量控制,对诊断对象的纳入标准,排除标准及疗效标准等进行严格规范,采用以中药巴布贴为主,辅以药物内服等的综合治疗方案,评价其有效性、安全性,并系统整理膝骨关节炎经筋贴敷方法。应用经筋理论来指导膝关节骨关节炎的巴布剂贴敷疗法,以确定经筋贴敷疗法的方法。
方法：本研究于2009年2月-2010年2月期间对广州中医药大学附属骨伤科医院门诊和住院的膝骨关节炎患者进行调查,从115例膝关节骨关节炎患者中,按照骨关节炎诊治指南(2007年版)膝关节OA的诊断标准和经筋辨证理论,选取90例足阳明经筋KOA患者,应用经筋贴敷疗法。以膝骨关节炎经筋辨证理论为指导,给予巴布贴外敷,又随机分为3小组,分别按经筋贴敷表贴1,2,3块药膏。使用WOMAC功能评估,每星期测定一次,连续观察一个月,1月后总结1次功能状况。本次临床观察的足阳明经筋病变组,参照国家卫生部发布的《中药新药临床研究指导原则》,采用SPSS11.5软件建立数据库,并运用方差分析及秩和检验。通过临床观察,分析这种最常见经筋病变在经筋理论指导下的贴敷疗效,以求初步归纳常见经筋病变的贴敷方法,为下一步研究提供依据。
结果：本次调查共获得有效资料115份,其中足阳明经筋型膝骨关节炎病人90例,其中4例因皮肤过敏合而不能完成临床观察。分析结果如下：
1.治疗4周后WOMAC评分A、B、C三组组均较治疗前显著降低,B组和C组有效率数高于A组,组间比较,差异有显著意义(P＜0.01)；
2.A、B、C三组治疗前疼痛评分、僵直评分、活动难度评分和总评分,经过方差分析,P>0.05,无明显差异性,具有可比性。A、B、C三组治疗后疼痛评分、活动难度评分和总评分,经过方差分析,P<0.01,提示有显著差别；僵直评分治疗后评分对比,P>0.05,提示无差别。
3.足阳明经筋在膝部广布髌骨周围,我们在临床上发现的,很多KOA患者前期表现多以髌股关节的病变为主,主要表现为膝前方髌骨周围和膝关节内侧疼痛。
结论：本研究调查了90例足阳明经筋痹症KOA患者应用经筋理论贴敷疗法,得出如下结论：
1.膝骨关节炎患者存在足阳明经筋、足太阳经筋、足少阳经筋、足三阴经筋四种单一经筋证型和多种复合证型,在上述所有经筋病变中,足阳明经筋病变最广,故我们重点针对该经筋进行临床观察和治疗；
2.在临床实践中,我们运用经筋辨证指导运用中药巴布贴外治膝骨关节炎,除了根据“以痛为腧”行痛点外敷,还在根据其经筋传变规律,在其传变经筋的循行部位再贴一、二贴药膏,以阻止其传变。根据这种方法,我们在临床运用时取得了不错的疗效。相比单一按照痛点外敷疗法有其优越性,疗效更加明确,尤其在缓解膝关节疼痛和功能活动方面。
3.鉴于本次研究的病例数有限,而且病程长、病情重的患膝多为几条经筋联合病变,分析起来很复杂,为使问题简化,提高研究的可行性,故选取本次辨证中最常见的足阳明经筋病变进行临床观察,初步归纳足阳明经筋病变的疼痛和病灶主要是膝前方髌骨周围和膝关节内侧为主,但是仍需要长期的临床观察及科学的多中心临床实验研究,才能系统地建立完整的经筋辨证体系。
Objective:Patients with knee osteoarthritis study, using case-control clinical research methods, strict quality control, the object of the inclusion criteria for diagnosis, exclusion criteria and efficacy standards strictly regulate, adopt the practice of Chinese medicine Babu posted mainly supported by, acupuncture, medicine Oral and other comprehensive treatment program, evaluate its effectiveness, safety, and the system order by the tendons of knee osteoarthritis sticking method. Application of theory to guide the knee joint by tendons osteoarthritis Babu sticking therapy to determine the method of treatment by the tendons sticking.
Methods:In this study, in February 2009-February 2010 during the Traditional Chinese Medicine University Affiliated Orthopaedic Hospital outpatient and hospitalization in patients with knee osteoarthritis to investigate, from 115 cases of patients with knee osteoarthritis, according to osteoarthritis Treatment Guidelines (2007 edition) diagnostic criteria for knee OA and dialectical theory by the tendons, selected 90 patients with KOA Meridian tendons were applied by the tendons sticking therapy. With osteoarthritis of the knee by tendons syndrome theory as a guide, Babu affixed to external application, then randomly divided into 3 groups, respectively, by the tendons sticking by SMD 1,2,3 block cream. Assessed using the WOMAC function, tested once a week, continuous observation of one month, January 1, after summing up functional status. The clinical observation of the Stomach Meridian tendon lesion group, according to the national Ministry of Health issued the "Guidelines for clinical research new Chinese medicine,& quot; SPSS11.5 software used to establish a database, and using analysis of variance and rank sum test. In the third section, through clinical observation, analysis of this most common disease in the meridians by the tendons under the guidance of sticking effects, in order to summarize common initial lesion by the tendons sticking method, provide a basis for further study.
Results:The survey obtained 115 valid data, which Meridian is osteoarthritis of the knee tendons were 90 cases of illness,4 cases of skin allergies and can not complete the clinical observation combined. The results are as follows:
1. After 4 weeks, WOMAC score A, B, C three groups were significantly lower than before treatment, B group and C group was higher than the number of group A, group, the difference was significant (P<0.01);
2. A, B, C three groups before treatment, pain score, stiffness score, activity score and total score of difficulty, after analysis of variance, P>0.05, no significant differences, comparable. A, B, C three groups after treatment, pain score, activity score and total score of difficulty, after analysis of variance, P<0.01, suggest a significant difference; stiffness score score after treatment comparison, P>0.05, suggest no difference.
3. Stomach Meridian widespread patellar tendons around the knee, we found clinically that many patients with early manifestations of KOA to the main patellofemoral lesions, mainly around the knee in front of the patella and the medial pain
Conclusion:This study investigated 90 cases of polio KOA Meridian tendon meridians sticking patients with therapy, the following conclusions:
1. Patients with knee osteoarthritis Meridian bar, full sun by the tendons, Foot Shaoyang meridians, the four feet of Yin Meridian tendon tendon syndrome after single and multiple complex syndrome, in all these meridians lesions, tendon lesions Meridian most extensive, so we were focusing on the meridians of clinical observation and treatment;
2. In clinical practice, we guide the use of dialectical meridians of Chinese medicine Babu posted outside the rule of knee osteoarthritis, In addition under the'pain as the Meridian'line topical pain points, Also changed according to the law by the tendon transfer, changes in its transmission line through parts of paste through the tendons of one or two creams to prevent the trans-mission change. Under this approach, we have made in the clinical use of a good time effect. According to pain compared to a single point of topical therapy has its advantages, effects more clearly, especially in the relief of knee pain and functional activities.
3. Given the number of cases in this study is limited, and the long course, the condition of heavy knees after a few more bars for the joint disease, analysis of them is very complex, in order to simplify the problem and improve the feasibility study, so select this syndrome The most common tendon lesions Meridian clinical observation, the initial induction Meridian tendon lesions of knee pain and lesions mainly around the front of the patella and medial-based, but still require long-term clinical observation and scientific multi-center clinical trials research, to systematically build a complete system of mer-idians syndrome.
方法：本研究于2009年2月-2010年2月期间对广州中医药大学附属骨伤科医院门诊和住院的膝骨关节炎患者进行调查,从115例膝关节骨关节炎患者中,按照骨关节炎诊治指南(2007年版)膝关节OA的诊断标准和经筋辨证理论,选取90例足阳明经筋KOA患者,应用经筋贴敷疗法。以膝骨关节炎经筋辨证理论为指导,给予巴布贴外敷,又随机分为3小组,分别按经筋贴敷表贴1,2,3块药膏。使用WOMAC功能评估,每星期测定一次,连续观察一个月,1月后总结1次功能状况。本次临床观察的足阳明经筋病变组,参照国家卫生部发布的《中药新药临床研究指导原则》,采用SPSS11.5软件建立数据库,并运用方差分析及秩和检验。通过临床观察,分析这种最常见经筋病变在经筋理论指导下的贴敷疗效,以求初步归纳常见经筋病变的贴敷方法,为下一步研究提供依据。
结果：本次调查共获得有效资料115份,其中足阳明经筋型膝骨关节炎病人90例,其中4例因皮肤过敏合而不能完成临床观察。分析结果如下：
1.治疗4周后WOMAC评分A、B、C三组组均较治疗前显著降低,B组和C组有效率数高于A组,组间比较,差异有显著意义(P＜0.01)；
2.A、B、C三组治疗前疼痛评分、僵直评分、活动难度评分和总评分,经过方差分析,P>0.05,无明显差异性,具有可比性。A、B、C三组治疗后疼痛评分、活动难度评分和总评分,经过方差分析,P<0.01,提示有显著差别；僵直评分治疗后评分对比,P>0.05,提示无差别。
3.足阳明经筋在膝部广布髌骨周围,我们在临床上发现的,很多KOA患者前期表现多以髌股关节的病变为主,主要表现为膝前方髌骨周围和膝关节内侧疼痛。
结论：本研究调查了90例足阳明经筋痹症KOA患者应用经筋理论贴敷疗法,得出如下结论：
1.膝骨关节炎患者存在足阳明经筋、足太阳经筋、足少阳经筋、足三阴经筋四种单一经筋证型和多种复合证型,在上述所有经筋病变中,足阳明经筋病变最广,故我们重点针对该经筋进行临床观察和治疗；
2.在临床实践中,我们运用经筋辨证指导运用中药巴布贴外治膝骨关节炎,除了根据“以痛为腧”行痛点外敷,还在根据其经筋传变规律,在其传变经筋的循行部位再贴一、二贴药膏,以阻止其传变。根据这种方法,我们在临床运用时取得了不错的疗效。相比单一按照痛点外敷疗法有其优越性,疗效更加明确,尤其在缓解膝关节疼痛和功能活动方面。
3.鉴于本次研究的病例数有限,而且病程长、病情重的患膝多为几条经筋联合病变,分析起来很复杂,为使问题简化,提高研究的可行性,故选取本次辨证中最常见的足阳明经筋病变进行临床观察,初步归纳足阳明经筋病变的疼痛和病灶主要是膝前方髌骨周围和膝关节内侧为主,但是仍需要长期的临床观察及科学的多中心临床实验研究,才能系统地建立完整的经筋辨证体系。
Objective:Patients with knee osteoarthritis study, using case-control clinical research methods, strict quality control, the object of the inclusion criteria for diagnosis, exclusion criteria and efficacy standards strictly regulate, adopt the practice of Chinese medicine Babu posted mainly supported by, acupuncture, medicine Oral and other comprehensive treatment program, evaluate its effectiveness, safety, and the system order by the tendons of knee osteoarthritis sticking method. Application of theory to guide the knee joint by tendons osteoarthritis Babu sticking therapy to determine the method of treatment by the tendons sticking.
Methods:In this study, in February 2009-February 2010 during the Traditional Chinese Medicine University Affiliated Orthopaedic Hospital outpatient and hospitalization in patients with knee osteoarthritis to investigate, from 115 cases of patients with knee osteoarthritis, according to osteoarthritis Treatment Guidelines (2007 edition) diagnostic criteria for knee OA and dialectical theory by the tendons, selected 90 patients with KOA Meridian tendons were applied by the tendons sticking therapy. With osteoarthritis of the knee by tendons syndrome theory as a guide, Babu affixed to external application, then randomly divided into 3 groups, respectively, by the tendons sticking by SMD 1,2,3 block cream. Assessed using the WOMAC function, tested once a week, continuous observation of one month, January 1, after summing up functional status. The clinical observation of the Stomach Meridian tendon lesion group, according to the national Ministry of Health issued the "Guidelines for clinical research new Chinese medicine,& quot; SPSS11.5 software used to establish a database, and using analysis of variance and rank sum test. In the third section, through clinical observation, analysis of this most common disease in the meridians by the tendons under the guidance of sticking effects, in order to summarize common initial lesion by the tendons sticking method, provide a basis for further study.
Results:The survey obtained 115 valid data, which Meridian is osteoarthritis of the knee tendons were 90 cases of illness,4 cases of skin allergies and can not complete the clinical observation combined. The results are as follows:
1. After 4 weeks, WOMAC score A, B, C three groups were significantly lower than before treatment, B group and C group was higher than the number of group A, group, the difference was significant (P<0.01);
2. A, B, C three groups before treatment, pain score, stiffness score, activity score and total score of difficulty, after analysis of variance, P>0.05, no significant differences, comparable. A, B, C three groups after treatment, pain score, activity score and total score of difficulty, after analysis of variance, P<0.01, suggest a significant difference; stiffness score score after treatment comparison, P>0.05, suggest no difference.
3. Stomach Meridian widespread patellar tendons around the knee, we found clinically that many patients with early manifestations of KOA to the main patellofemoral lesions, mainly around the knee in front of the patella and the medial pain
Conclusion:This study investigated 90 cases of polio KOA Meridian tendon meridians sticking patients with therapy, the following conclusions:
1. Patients with knee osteoarthritis Meridian bar, full sun by the tendons, Foot Shaoyang meridians, the four feet of Yin Meridian tendon tendon syndrome after single and multiple complex syndrome, in all these meridians lesions, tendon lesions Meridian most extensive, so we were focusing on the meridians of clinical observation and treatment;
2. In clinical practice, we guide the use of dialectical meridians of Chinese medicine Babu posted outside the rule of knee osteoarthritis, In addition under the'pain as the Meridian'line topical pain points, Also changed according to the law by the tendon transfer, changes in its transmission line through parts of paste through the tendons of one or two creams to prevent the trans-mission change. Under this approach, we have made in the clinical use of a good time effect. According to pain compared to a single point of topical therapy has its advantages, effects more clearly, especially in the relief of knee pain and functional activities.
3. Given the number of cases in this study is limited, and the long course, the condition of heavy knees after a few more bars for the joint disease, analysis of them is very complex, in order to simplify the problem and improve the feasibility study, so select this syndrome The most common tendon lesions Meridian clinical observation, the initial induction Meridian tendon lesions of knee pain and lesions mainly around the front of the patella and medial-based, but still require long-term clinical observation and scientific multi-center clinical trials research, to systematically build a complete system of mer-idians syndrome.
引文
[1]陈百成,张静.骨关节炎[M].人民卫生出版社.2004年10月第一版.P1-3.
[2]肖林榕,郑红.明清医家论治骨痹(骨关节炎)临床理论的发展[J].中医文献杂志,2003；(2)：10-12.
[3]杜双庆,杜景华.养血清润汤治疗原发性膝关节骨关节炎173例[J].四川中医,2002；20(12)：62.
[4]曹向阳,李无阴,郭艳锦等.壮筋活血汤治疗膝骨关节炎152例[J].上海中医药杂志,2004；38(6)：30-31.
[5]王和鸣,葛继荣,殷海波等.复方杜仲健骨颗粒治疗膝关节骨关节炎Ⅱ期临床试验总结[J].中国中医骨伤科杂志,2004；12(3)：6.
[6]王春秋.骨痹通治疗膝关系骨性关节炎92例[J].四川中医,2003；21(4)：67-68
[7]陈泽文,喻友军.骨痹汤治疗膝关节炎82例总结[J].湖南中医杂志,2002；18(3)：22.
[8]康杰,李宁,吴滨.膝骨关节炎的治疗措施：随机对照试验及系统评价分析[J].中国临床康复,2005,9(37)：27-30.
[9]王大忠,马雯,余正红.膝关节骨关节炎患者生存质量及其证候分布关系分析[J].中医正骨,2005,9(17)：18-20.
[10]杨丽美.《内经》经筋理论的应用[J].宁夏医学院学报,2006,28(3)：262-263.
[11]黄敬伟,陈胜伟.中华经筋疗法的发掘研究[J].甘肃中医,1994,7(4)：44-45.
[12]曾昭荣.“激痛点”在颈肩腰腿痛上的诊治意义[J].颈腰痛杂志,1982,2(2)：8-11.
[13]李晶,刘辉.增生性膝关节炎结筋病灶点的临床观察[J].中国针灸,2002,22(8)：533-534.
[14]陈日高,胡一梅,何洪阳.膝关节骨关节炎的中医治疗概况[J].现代中西医结合杂志,2006,15(7)：973-976.
[15]黄国松.经筋手疗法初探[J].广西中医药,1999,22(11)：64-65.
[16]孙钢.膝关节骨关节炎的手法治疗[J].中国骨伤,2002，15(5)：318-320.
[17]黎明,韩红.推拿治疗膝关节骨关节炎105例效果分析[J].现代康复,2000,3(6)：906.
[18]杨宏.按摩治疗膝关节骨关节病[J].中国骨伤,2002,15(8)：461.
[19]刘金洪.《灵枢·经筋》治筋痹法浅析[J].四川中医,1999,17(3)：11-12.
[20]旷秋和.火针治疗膝关节骨关节炎50例疗效观察[J].针灸临床杂志,2006,22(5)：19-20.
[21]刘立安,马春燕,姜文.温针灸治疗老年性膝骨关节炎病的临床观察[J].中国针灸,2003,23(10)：579-580.
[22]裘敏蕾.电针膝眼穴治疗膝关节骨关节炎的临床研究[J].中医正骨,2006,18(3)：15-16.
[23]马晓晶,刘元石,薛立功.长圆针治疗膝关节骨关节炎60例临床观察[J].中国临床医生,2006,34(7)：39-40.
[24]蒋戈利,肖蕾,李健将,等.四步针药疗法治疗膝关节骨关节炎378例临床观察[J].四川中医,2004,22(1)：93-94.
[25]吕桂芬.小针刀与温针灸结合治疗膝关节骨关节炎58例[J].辽宁中医学院学报,2004,6(6)：482.
[26]徐建武,丁建中.早期症状性膝关节骨关节炎的诊治研究[J].中国骨伤,2003,16(8)：508-509.
[27]刘金文,冯立科,许少健.金桂外洗方对膝骨关节炎患者生存质量的改善作用[J].中医药临床杂志,2004,16(1)：47.
[28]周启慧.通痹止痛膏治疗原发性骨性关节炎120例总结[J].湖南中医杂志，2002,18(1)：13.
[29]张桂红,梅伟,霍风梅等.骨友灵贴膏(巴布剂)治疗骨质增生临床研究[J].中医药信息,2002,19(2)：50.
[30]陈志维,张志华.好及施巴布荆在骨科疾病中的临床应用[J].中国中医骨伤科杂志,2003,11(6)：45.
[31]唐良平,程泽,谭邦贵等.颈肩腰腿一贴灵基质配比研究[J].时珍国医国药,2001,12(4)：289.
[32]孟舒,杨丹,张振秋等.玄丹巴布剂的制备及临床应用[J].中国医院药学杂志,2006,26(12)：1561.
[33]李飞跃,奚小冰,傅文或.改良消肿散(巴布剂)治疗急性软组织损伤临床研究[J].中成药,2005，27(3)：312-314.
[34]张琼,肖京,邓磊.麝香通痹巴布膏治疗骨性关节炎(肝肾不足,筋脉瘀滞证)的临床研究Chin J Clin Pharmacol Ther 2005 Aug;10(8):953-956
[35]郭继锋,杜志谦,鲍铁周,仇湘中,许学猛,罗毅文,贺启荣,章建华.芎芷痛瘀消散贴治疗膝骨关节炎膝关节痛临床研究World Journal of Integrated Traditional and Western Medicine 2008,3(8):468-470.
[36]尹建平,王海燕.活血通络凝胶剂合扶元乳膏剂治疗膝关节骨关节炎60例疗效观察Journal Of New Chinese Medicine 2008,4(4):69-70.
[37]谢利民.张涛研究员治疗膝关节软骨退行性疾病的手法特点[J].中医正骨,1999；11(5)：51.
[38]谢利民,张涛.张氏推拿法治疗膝关节软骨退行性疾病的临床疗效评价[J].中医正骨,2000；12(4)：8-10.
[39]胡平安,张利萍.小针刀治疗膝关节骨关节炎68例[J].中国中医药科技,2003；10(3)：135.
[40]马晓晶,刘元石,薛立功.长圆针治疗膝骨关节炎60例疗效观察[J].中国临床医生,2006；34(7)：39-40.
[41]张长青.COX-2抑制剂与心血管疾病[J].国外医学骨科学分册，2002；23：57259.
[42]Takahashi K, Hashimoto S, Kubo T, et al. Effect of hyaluronan on chon -drocyte apoptosis and nitric oxide production in experimentally apoptosis and nitric oxide production in experimentally induced osteoarthritis[J]. J Rheumatol,2000; 27:1713-1720.
[43]许鹏,张银刚,姚建锋等.透明质酸钠治疗膝骨关节炎的Ⅰ临床效果及分析[J].中国修复重建外科杂志,2005；19(3)：210-214.
[44]DD Frisbie, SC Ghivizzani, PD Robbins, et al. Treatment of esp rimen taleqione osteoarthritis by in vivo delivery of the equine interleukin-1 rec-eptor antagonist gene[J].Gene Ther,2002; 9:12-20.
[45]Chemajovsky Y, Adams G, Podhajcer C, et al. Inhibition of transfer ofcollagen-induced arthritis into SCID mice by es vivo infection of spleen cells with retroviruses expressing soluble tumor necrosis factor receptor[J]. Gene Trer,1995; 2:731-732.
[46]Ikeda T, Kubo T, Arai Y,et al. Adenovirus mediated gene delivery to the joints of guinea pigs[J].J Rheumatol,1998; 25:1666-1673.
[47]Kang R, Marui T, Ghivizzani SC, et al. Ex vivo gene transfer to chondrocytes in full-thickness articular cartilage defects:A eassibility study [J]. Osteo-arthritis Cartilage,1997; 5:139-143.
[48]Doherty PJ, Zhang H, Manolopoulos V, et al. Adhesion of. transplanted chondrocytes onto cartilage in vitro and in vivo[J].J Rheumatol,2000; 27:1725-1731.
[49]Oligino T, Ghivzzani S, Wolfe D, etc. Intra-articular delivery of a herpes simplex virus IL-1 Ra gene vector induces inflammation in a rabbit model of arthritis[J]. Gene Ther,1999; 6:1713-1720.
[50]Tomita T.Hashimoto H, Tomita H. et al. In vivo direct gene transfer into articular cartilage by intra-ariticular injection mediated by HVJ(sandal) virus and liposome[J].Arthritis Rheum,1997; 40:901-906.
[51]Frisbie DD, Mc wraith CW. Evaluation of gene therapy as a treatment for equine traumatic arthritis and osteoarthritis[J]. Clin Orthop,2000; 379: S273-S287.
[52]管宏钟,薛立功教授经筋理论及长圆针疗法概述[J].中国针灸,2006；4(26)：297-298
[53]薛立功.经筋辨治膝退行性变合并膝痛364例分析[J].中医药学报,2003；8(21)：1377-1388
[54]田辉.经筋理论与腰椎间盘突出症发病机理探析[J].辽宁中医学院学报,2005；7(3)：209-210.
[55]何生华.经筋理论在治疗颈椎病中的作用探讨[J].时珍国医国药,2005；16(3)：181-182
[56]刘军,张崇耀.经筋排刺配合走罐治疗腰背肌筋膜炎72例[J].中国民间疗法,2005；13(4)：18-19.
[57]于学平.经筋刺法对中风上肢痉挛病肌电F波的影响[J] 中医药学报,2004；32(2)：23
[58]岳增辉,经筋刺法治疗脑卒中后痉挛状态及疗效评价研究[J] 中国中医药信息杂志，2001；8(4)：85
[59]黄敬伟.中华经筋疗法的临床发掘应用研究[J] 中国针灸,1997；7：413-414
[60]梁沛华,崔建峰,邓斌.从经筋论治疗Ⅲ型前列腺炎的临床研究[J].广州中医药大学学报,2005；22(5)：348-351.
[61]黄敬伟主编.经筋疗法[M].第1版.北京.中国中医药出版社.2002；65-85,133-140.
[62]陈戈义.近年来中医治疗膝关节骨关节炎概况[J].浙江中医杂志,2001,538-541.
[63]李全成,李继庆,林世生等.膝关节腔注射玻璃酸钠与痛点神经阻滞结合治疗膝关节骨关节炎[J].中国疼痛医学杂志,2003,9(1)：45.
[64]马玲,宋文阁,赵松云.重症骨性骨关节炎的综合治疗(附58例临床观察)[J].疼痛学杂志,1993,6(4)：150.
[65]刘向前,姚共和,杨少锋等.624例膝关节骨关节炎流行病学分析[J].湖南中医学院学报,2005,25(5)：57-59.
[66]杜宁,施荣庭.手法治疗原发性膝关节骨关节病37例疗效观察[J].中医正骨,1994,6(4)：9-12.
[67]阎冬梅编译.针灸压痛点治疗变形性膝关节炎[J].国外医学中医中药分册,2003,25(5)：286-287.
[68]施桂英主编.关节炎概要[M].北京：中国医药科技出版社,2005：434.
[69]周奉皋；唐小波,曾勇.髌下脂肪垫损伤与全膝痛关系的临床研究[J].中医正骨,2005,17(10)：26-27.
[70]韩清民.膝骨关节炎影像学分析及经筋辨证关系研究[J].新中医,2008；40(5)：66-67
[2]肖林榕,郑红.明清医家论治骨痹(骨关节炎)临床理论的发展[J].中医文献杂志,2003；(2)：10-12.
[3]杜双庆,杜景华.养血清润汤治疗原发性膝关节骨关节炎173例[J].四川中医,2002；20(12)：62.
[4]曹向阳,李无阴,郭艳锦等.壮筋活血汤治疗膝骨关节炎152例[J].上海中医药杂志,2004；38(6)：30-31.
[5]王和鸣,葛继荣,殷海波等.复方杜仲健骨颗粒治疗膝关节骨关节炎Ⅱ期临床试验总结[J].中国中医骨伤科杂志,2004；12(3)：6.
[6]王春秋.骨痹通治疗膝关系骨性关节炎92例[J].四川中医,2003；21(4)：67-68
[7]陈泽文,喻友军.骨痹汤治疗膝关节炎82例总结[J].湖南中医杂志,2002；18(3)：22.
[8]康杰,李宁,吴滨.膝骨关节炎的治疗措施：随机对照试验及系统评价分析[J].中国临床康复,2005,9(37)：27-30.
[9]王大忠,马雯,余正红.膝关节骨关节炎患者生存质量及其证候分布关系分析[J].中医正骨,2005,9(17)：18-20.
[10]杨丽美.《内经》经筋理论的应用[J].宁夏医学院学报,2006,28(3)：262-263.
[11]黄敬伟,陈胜伟.中华经筋疗法的发掘研究[J].甘肃中医,1994,7(4)：44-45.
[12]曾昭荣.“激痛点”在颈肩腰腿痛上的诊治意义[J].颈腰痛杂志,1982,2(2)：8-11.
[13]李晶,刘辉.增生性膝关节炎结筋病灶点的临床观察[J].中国针灸,2002,22(8)：533-534.
[14]陈日高,胡一梅,何洪阳.膝关节骨关节炎的中医治疗概况[J].现代中西医结合杂志,2006,15(7)：973-976.
[15]黄国松.经筋手疗法初探[J].广西中医药,1999,22(11)：64-65.
[16]孙钢.膝关节骨关节炎的手法治疗[J].中国骨伤,2002，15(5)：318-320.
[17]黎明,韩红.推拿治疗膝关节骨关节炎105例效果分析[J].现代康复,2000,3(6)：906.
[18]杨宏.按摩治疗膝关节骨关节病[J].中国骨伤,2002,15(8)：461.
[19]刘金洪.《灵枢·经筋》治筋痹法浅析[J].四川中医,1999,17(3)：11-12.
[20]旷秋和.火针治疗膝关节骨关节炎50例疗效观察[J].针灸临床杂志,2006,22(5)：19-20.
[21]刘立安,马春燕,姜文.温针灸治疗老年性膝骨关节炎病的临床观察[J].中国针灸,2003,23(10)：579-580.
[22]裘敏蕾.电针膝眼穴治疗膝关节骨关节炎的临床研究[J].中医正骨,2006,18(3)：15-16.
[23]马晓晶,刘元石,薛立功.长圆针治疗膝关节骨关节炎60例临床观察[J].中国临床医生,2006,34(7)：39-40.
[24]蒋戈利,肖蕾,李健将,等.四步针药疗法治疗膝关节骨关节炎378例临床观察[J].四川中医,2004,22(1)：93-94.
[25]吕桂芬.小针刀与温针灸结合治疗膝关节骨关节炎58例[J].辽宁中医学院学报,2004,6(6)：482.
[26]徐建武,丁建中.早期症状性膝关节骨关节炎的诊治研究[J].中国骨伤,2003,16(8)：508-509.
[27]刘金文,冯立科,许少健.金桂外洗方对膝骨关节炎患者生存质量的改善作用[J].中医药临床杂志,2004,16(1)：47.
[28]周启慧.通痹止痛膏治疗原发性骨性关节炎120例总结[J].湖南中医杂志，2002,18(1)：13.
[29]张桂红,梅伟,霍风梅等.骨友灵贴膏(巴布剂)治疗骨质增生临床研究[J].中医药信息,2002,19(2)：50.
[30]陈志维,张志华.好及施巴布荆在骨科疾病中的临床应用[J].中国中医骨伤科杂志,2003,11(6)：45.
[31]唐良平,程泽,谭邦贵等.颈肩腰腿一贴灵基质配比研究[J].时珍国医国药,2001,12(4)：289.
[32]孟舒,杨丹,张振秋等.玄丹巴布剂的制备及临床应用[J].中国医院药学杂志,2006,26(12)：1561.
[33]李飞跃,奚小冰,傅文或.改良消肿散(巴布剂)治疗急性软组织损伤临床研究[J].中成药,2005，27(3)：312-314.
[34]张琼,肖京,邓磊.麝香通痹巴布膏治疗骨性关节炎(肝肾不足,筋脉瘀滞证)的临床研究Chin J Clin Pharmacol Ther 2005 Aug;10(8):953-956
[35]郭继锋,杜志谦,鲍铁周,仇湘中,许学猛,罗毅文,贺启荣,章建华.芎芷痛瘀消散贴治疗膝骨关节炎膝关节痛临床研究World Journal of Integrated Traditional and Western Medicine 2008,3(8):468-470.
[36]尹建平,王海燕.活血通络凝胶剂合扶元乳膏剂治疗膝关节骨关节炎60例疗效观察Journal Of New Chinese Medicine 2008,4(4):69-70.
[37]谢利民.张涛研究员治疗膝关节软骨退行性疾病的手法特点[J].中医正骨,1999；11(5)：51.
[38]谢利民,张涛.张氏推拿法治疗膝关节软骨退行性疾病的临床疗效评价[J].中医正骨,2000；12(4)：8-10.
[39]胡平安,张利萍.小针刀治疗膝关节骨关节炎68例[J].中国中医药科技,2003；10(3)：135.
[40]马晓晶,刘元石,薛立功.长圆针治疗膝骨关节炎60例疗效观察[J].中国临床医生,2006；34(7)：39-40.
[41]张长青.COX-2抑制剂与心血管疾病[J].国外医学骨科学分册，2002；23：57259.
[42]Takahashi K, Hashimoto S, Kubo T, et al. Effect of hyaluronan on chon -drocyte apoptosis and nitric oxide production in experimentally apoptosis and nitric oxide production in experimentally induced osteoarthritis[J]. J Rheumatol,2000; 27:1713-1720.
[43]许鹏,张银刚,姚建锋等.透明质酸钠治疗膝骨关节炎的Ⅰ临床效果及分析[J].中国修复重建外科杂志,2005；19(3)：210-214.
[44]DD Frisbie, SC Ghivizzani, PD Robbins, et al. Treatment of esp rimen taleqione osteoarthritis by in vivo delivery of the equine interleukin-1 rec-eptor antagonist gene[J].Gene Ther,2002; 9:12-20.
[45]Chemajovsky Y, Adams G, Podhajcer C, et al. Inhibition of transfer ofcollagen-induced arthritis into SCID mice by es vivo infection of spleen cells with retroviruses expressing soluble tumor necrosis factor receptor[J]. Gene Trer,1995; 2:731-732.
[46]Ikeda T, Kubo T, Arai Y,et al. Adenovirus mediated gene delivery to the joints of guinea pigs[J].J Rheumatol,1998; 25:1666-1673.
[47]Kang R, Marui T, Ghivizzani SC, et al. Ex vivo gene transfer to chondrocytes in full-thickness articular cartilage defects:A eassibility study [J]. Osteo-arthritis Cartilage,1997; 5:139-143.
[48]Doherty PJ, Zhang H, Manolopoulos V, et al. Adhesion of. transplanted chondrocytes onto cartilage in vitro and in vivo[J].J Rheumatol,2000; 27:1725-1731.
[49]Oligino T, Ghivzzani S, Wolfe D, etc. Intra-articular delivery of a herpes simplex virus IL-1 Ra gene vector induces inflammation in a rabbit model of arthritis[J]. Gene Ther,1999; 6:1713-1720.
[50]Tomita T.Hashimoto H, Tomita H. et al. In vivo direct gene transfer into articular cartilage by intra-ariticular injection mediated by HVJ(sandal) virus and liposome[J].Arthritis Rheum,1997; 40:901-906.
[51]Frisbie DD, Mc wraith CW. Evaluation of gene therapy as a treatment for equine traumatic arthritis and osteoarthritis[J]. Clin Orthop,2000; 379: S273-S287.
[52]管宏钟,薛立功教授经筋理论及长圆针疗法概述[J].中国针灸,2006；4(26)：297-298
[53]薛立功.经筋辨治膝退行性变合并膝痛364例分析[J].中医药学报,2003；8(21)：1377-1388
[54]田辉.经筋理论与腰椎间盘突出症发病机理探析[J].辽宁中医学院学报,2005；7(3)：209-210.
[55]何生华.经筋理论在治疗颈椎病中的作用探讨[J].时珍国医国药,2005；16(3)：181-182
[56]刘军,张崇耀.经筋排刺配合走罐治疗腰背肌筋膜炎72例[J].中国民间疗法,2005；13(4)：18-19.
[57]于学平.经筋刺法对中风上肢痉挛病肌电F波的影响[J] 中医药学报,2004；32(2)：23
[58]岳增辉,经筋刺法治疗脑卒中后痉挛状态及疗效评价研究[J] 中国中医药信息杂志，2001；8(4)：85
[59]黄敬伟.中华经筋疗法的临床发掘应用研究[J] 中国针灸,1997；7：413-414
[60]梁沛华,崔建峰,邓斌.从经筋论治疗Ⅲ型前列腺炎的临床研究[J].广州中医药大学学报,2005；22(5)：348-351.
[61]黄敬伟主编.经筋疗法[M].第1版.北京.中国中医药出版社.2002；65-85,133-140.
[62]陈戈义.近年来中医治疗膝关节骨关节炎概况[J].浙江中医杂志,2001,538-541.
[63]李全成,李继庆,林世生等.膝关节腔注射玻璃酸钠与痛点神经阻滞结合治疗膝关节骨关节炎[J].中国疼痛医学杂志,2003,9(1)：45.
[64]马玲,宋文阁,赵松云.重症骨性骨关节炎的综合治疗(附58例临床观察)[J].疼痛学杂志,1993,6(4)：150.
[65]刘向前,姚共和,杨少锋等.624例膝关节骨关节炎流行病学分析[J].湖南中医学院学报,2005,25(5)：57-59.
[66]杜宁,施荣庭.手法治疗原发性膝关节骨关节病37例疗效观察[J].中医正骨,1994,6(4)：9-12.
[67]阎冬梅编译.针灸压痛点治疗变形性膝关节炎[J].国外医学中医中药分册,2003,25(5)：286-287.
[68]施桂英主编.关节炎概要[M].北京：中国医药科技出版社,2005：434.
[69]周奉皋；唐小波,曾勇.髌下脂肪垫损伤与全膝痛关系的临床研究[J].中医正骨,2005,17(10)：26-27.
[70]韩清民.膝骨关节炎影像学分析及经筋辨证关系研究[J].新中医,2008；40(5)：66-67