从“因虚致瘀”论原发性骨质疏松症病机
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摘要
原发性骨质疏松症临床症状隐匿,并发症严重,致死率高。我国历代医家在"骨枯"、"骨痿"、"骨蚀"、"骨极"、"骨痹"等中医病症中均有阐述,"肾主骨髓"可谓其辨证之根基。当前医家对于该病中医病机辨证阐述繁琐、复杂,笔者在临床实践中,结合老年人的体质特点,从"虚"、"瘀"两方面辨证,提出"因虚致瘀理论",虚、瘀作为该病病机辨证的基本点,以脏腑辨证为基础,以精、气、血辨证为关键,强调精气血虚与气滞血瘀两方面辨证结合。
The symptoms of primary osteoporosis are not easy to diagnose. Primary osteoporosis has serious complications which lead to higher mortality. The understanding of the traditional Chinese medicine on primary osteoporosis can refer to the "bone wilting", "desiccated bone", "bone erosion", "extreme of the bone" and "bone impediment". The major pathogenesis of primary osteoporosis is "Shen nourishes the bone marrow". There are a lot of theories about causes of osteoporosis, so the pathomechanism of osteoporosis is very cumbersome and complex. The stasis and deficiency are the main features of constitution in the elderly. The stasis and deficiency are the basic point in the syndrome differentiation of primary osteoporosis. The differentiation of Zang and Fu is the basis of syndrome differentiation of primary osteoporosis. Essence, Qi, Blood are the key factors in the syndrome differentiation of osteoporosis. Both deficiency of Essence, Qi and blood, Qi stagnation and blood stasis should be combined with each other in the syndrome differentiation of primary osteoporosis. Therefore, we think that " the Theory of Stasis Caused by Deficiency" is beneficial to the prevention and treatment of osteoporosis.
The symptoms of primary osteoporosis are not easy to diagnose. Primary osteoporosis has serious complications which lead to higher mortality. The understanding of the traditional Chinese medicine on primary osteoporosis can refer to the "bone wilting", "desiccated bone", "bone erosion", "extreme of the bone" and "bone impediment". The major pathogenesis of primary osteoporosis is "Shen nourishes the bone marrow". There are a lot of theories about causes of osteoporosis, so the pathomechanism of osteoporosis is very cumbersome and complex. The stasis and deficiency are the main features of constitution in the elderly. The stasis and deficiency are the basic point in the syndrome differentiation of primary osteoporosis. The differentiation of Zang and Fu is the basis of syndrome differentiation of primary osteoporosis. Essence, Qi, Blood are the key factors in the syndrome differentiation of osteoporosis. Both deficiency of Essence, Qi and blood, Qi stagnation and blood stasis should be combined with each other in the syndrome differentiation of primary osteoporosis. Therefore, we think that " the Theory of Stasis Caused by Deficiency" is beneficial to the prevention and treatment of osteoporosis.
引文
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[3] 张智海, 刘忠厚, 石少辉, 等. 中国大陆地区以-2.5 SD 为诊断的骨质疏松症发病率文献回顾性研究[J]. 中国骨质疏松杂志, 2015, 21(1): 1-7.
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[7] 胡年宏, 刘庆思. 补肾健脾活血法防治骨质疏松症的研究概况[J]. 中医正骨, 2004, 16(5): 53-54.
[8] 汪静, 张光海, 米绍平, 等. 孙同郊辨治骨质疏松症经验[J]. 中医杂志, 2013, 54(5): 376-378.
[9] 葛继荣, 郑洪新, 万小明, 等. 中医药防治原发性骨质疏松症专家共识 (2015)[J]. 中国骨质疏松杂志, 2015, 21(9): 1023-1028.
[10] 李旭云, 孙峰, 李静伟, 等. 益气温经方强骨饮治疗原发性骨质疏松症的研究进展[J]. 中国骨质疏松杂志, 2014, 20(8): 1003-1006.
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[24] 孙悦礼, 姚敏, 崔学军, 等. 慢性筋骨病的中医认识与现代理解[J]. 中医杂志, 2014, 55(17): 1447-1451.
[25] 任之强, 阎晓霞, 晋大祥, 等. 原发性骨质疏松症血瘀与骨代谢关系研究[J]. 中华中医药杂志, 2015, 30(5): 1838-1840.
[2] 申浩, 谢雁鸣. 骨质疏松性骨折的危险因素及中医证候要素风险评估研究现状[J]. 中国骨伤, 2014, 27 (3): 261-265.
[3] 张智海, 刘忠厚, 石少辉, 等. 中国大陆地区以-2.5 SD 为诊断的骨质疏松症发病率文献回顾性研究[J]. 中国骨质疏松杂志, 2015, 21(1): 1-7.
[4] 刘军, 孙明宇, 谷贵山, 等. 长春市 1 740 例中老年人骨质及骨质疏松防治情况分析[J]. 中国老年学杂志, 2007, 27(24): 2421-2423.
[5] 马伟, 牟慧琴, 马占洋. 绝经后骨质疏松症中医病因病机研究概况[J]. 中医杂志, 2012, 53(13): 1152-1154.
[6] 张绍文, 李盛华, 樊成虎. 原发性骨质疏松症的中医辨证诊治进展[J]. 中国骨质疏松杂志, 2013, 19(12): 1318-1322.
[7] 胡年宏, 刘庆思. 补肾健脾活血法防治骨质疏松症的研究概况[J]. 中医正骨, 2004, 16(5): 53-54.
[8] 汪静, 张光海, 米绍平, 等. 孙同郊辨治骨质疏松症经验[J]. 中医杂志, 2013, 54(5): 376-378.
[9] 葛继荣, 郑洪新, 万小明, 等. 中医药防治原发性骨质疏松症专家共识 (2015)[J]. 中国骨质疏松杂志, 2015, 21(9): 1023-1028.
[10] 李旭云, 孙峰, 李静伟, 等. 益气温经方强骨饮治疗原发性骨质疏松症的研究进展[J]. 中国骨质疏松杂志, 2014, 20(8): 1003-1006.
[11] 汉·许慎. 说文解字 [M]. 北京: 中华书局, 北京: 1963.
[12] 清·唐容川. 中西汇通医经精义[M]. 太原: 山西科学技术出版社, 2013: 23.
[13] 清·潘楫. 何源编校. 医灯续焰[M]. 北京: 中国中医药出版社, 1997: 268.
[14] 唐·孙思邈. 高文柱编校. 备急千金要方[M]. 北京: 学苑出版社, 2016: 594.
[15] 清·陈士铎. 柳璇编校. 辨证录[M]. 北京: 中国医药科技出版社, 2011: 143.
[16] 金·李杲. 程传浩编校. 脾胃论[M]. 北京: 人民军医出版社, 2005: 8.
[17] 隋·巢元方. 宋白杨编校. 诸病源候论[M]. 北京: 中国医药科技出版社, 2011: 20, 27.
[18] 明·朱棣. 普济方[M]. 北京: 人民卫生出版社, 1959: 30-31.
[19] 明·李梴. 高登灜编校. 医学入门[M]. 上海: 上海科学技术文献出版社, 1997: 197.
[20] 明·张景岳. 梁宝祥编校. 景岳全书[M]. 山西: 山西科学技术出版社, 2006: 296.
[21] 清·王清任. 李天德编校. 医林改错[M]. 北京: 人民卫生出版社, 1991: 44.
[22] 清·唐容川. 谷建军编校. 血证论[M]. 北京: 中国医药科技出版社, 2011: 20-21.
[23] Shu B, Shi Q, Wang Y-J. Shen (Kidney)-tonifying principle for primary osteoporosis: to treat both the disease and the Chinese medicine syndrome[J]. Chin J Integr Med, 2015, 21(9): 656-661.
[24] 孙悦礼, 姚敏, 崔学军, 等. 慢性筋骨病的中医认识与现代理解[J]. 中医杂志, 2014, 55(17): 1447-1451.
[25] 任之强, 阎晓霞, 晋大祥, 等. 原发性骨质疏松症血瘀与骨代谢关系研究[J]. 中华中医药杂志, 2015, 30(5): 1838-1840.