“益气养阴、逐瘀化痰”法治疗老年性脊柱结核的思路初探
|
摘要
脊柱结核属于中医学"骨痨""龟背痰""流痰"范畴,当人体正气处于亏虚时痨虫侵袭,蚀骨腐肉为脓,常在背部作痛作肿,气血凝滞、毒邪深伏,病程迁延而溃于体表,邪痰流出窦道易损伤其筋骨而成龟背之状。本文基于老年患者人群的特点,分析本病发病的主要内外病因,并以中医整体观念和辨证论治为指导原则,探讨基于"益气养阴、逐瘀化痰"法在治疗老年性脊柱结核患者中的机理,并重视老年患者气阴两虚、痰毒瘀阻的证候特点,以整体兼顾、随症加减,同时脏腑辨证考虑发病与肾脾两脏的密切关系,补肾强骨,健脾强督,以扶正败脓、改善临床症状、提高临床疗效,为中医治疗脊柱结核提供更广阔的思路和依据。
Spinal tuberculosis belongs to the category of ‘bone sputum',‘turtleback'and ‘flowing sputum'in traditional Chinese medicine. When the human body is inflated,the mites invade,the bone decay is pus,and painful swelling and blood stagnation often occur in the back,the disease duration and collapse on the surface,the evil spirits out of the sinus,easy to damage their bones and formed turtle shape. Based on the characteristics of the elderly population,this article analyzes the main internal and external factors of the disease,the emptyness of the Governor's pulse" as internal causes,and based on the overall concept of TCM and syndrome differentiation and treatment as the guiding principles,to explore the mechanism of "Benefiting qi,nourishing yin,and removing silt by removing stagnation"in the treatment of senile patients with spinal tuberculosis,and pay attention to qi and yin deficiency and diarrhea in elderly patients with spinal tuberculosis. Symptoms of resistance syndrome,with the addition and subtraction of the disease,to take into account the overall,while organ syndrome differentiation consider the close relationship between the onset of the kidney and spleen,but also kidney strong bones,spleen and strong Du mehdian,and actively improve the clinical symptoms and improve efficacy for the clinical treatment of traditional Chinese medicine to provide a broader basis.
Spinal tuberculosis belongs to the category of ‘bone sputum',‘turtleback'and ‘flowing sputum'in traditional Chinese medicine. When the human body is inflated,the mites invade,the bone decay is pus,and painful swelling and blood stagnation often occur in the back,the disease duration and collapse on the surface,the evil spirits out of the sinus,easy to damage their bones and formed turtle shape. Based on the characteristics of the elderly population,this article analyzes the main internal and external factors of the disease,the emptyness of the Governor's pulse" as internal causes,and based on the overall concept of TCM and syndrome differentiation and treatment as the guiding principles,to explore the mechanism of "Benefiting qi,nourishing yin,and removing silt by removing stagnation"in the treatment of senile patients with spinal tuberculosis,and pay attention to qi and yin deficiency and diarrhea in elderly patients with spinal tuberculosis. Symptoms of resistance syndrome,with the addition and subtraction of the disease,to take into account the overall,while organ syndrome differentiation consider the close relationship between the onset of the kidney and spleen,but also kidney strong bones,spleen and strong Du mehdian,and actively improve the clinical symptoms and improve efficacy for the clinical treatment of traditional Chinese medicine to provide a broader basis.
引文
[1]GLOBAL TUBERCULOSIS REPORT 2017. World Health Organization,2017.
[2]安晋宇,李大伟,崔旭,等.老年性脊柱结核的特点及保守治疗疗效观察[J].中国骨伤,2013,26(3):210-213.
[3]彭成.中药防治耐药菌感染创新药物发现模式:“方-病证-菌、药-病证-菌、部位-病证-菌、成分-病证-菌、物质结构-网络关系-作用靶标”[J].中药与临床,2017,8(2):1-4.
[4]李思阳,季兴跃,李卓荣.抗结核中药有效成分研究进展[J].中国抗生素杂志,2013,38(10):725-729.
[5]MUHEREMU A,MA Y,MA Y,et al. Halo-pelvic traction for severe kyphotic deformity secondary to spinal tuberculosis[J].Medicine(Baltimore),2017,96(28):7491.
[6]杨虹,李雪霜,陆通,等.CT与MRI对脊柱结核的诊断价值[J].磁共振成像,2016,7(8):593-597.
[7]邓强,李军杰,张彦军,等.脊柱结核的微创外科治疗研究新进展[J].中国中医骨伤科杂志,2017,25(4):79-82.
[8]张嘉利,李大伟,马远征,等.多节段胸腰椎脊柱结核外科治疗的回顾性研究[J].中国防痨杂志,2013,35(5):305-308.
[9]王拥军,卞琴,崔学军,等.“肾主骨”理论研究的思路与方法[J].上海中医药大学学报,2010,24(1):8-12.
[10]高海军,滑东方,焦最婵,等.三位一体、治疗骨结核诊疗体会[J].临床肺科杂志,2010,15(8):1128-1130.
[11]邓强,李军杰,张彦军,等.从督脉论治胸腰椎结核并不全瘫的临床观察[J].中国中医骨伤科杂志,2018,26(2):23-27.
[12]刘庆银,张伟.从治痨先实脾论培土生金在肺痨病中的应用[J].长春中医药大学学报,2016,32(4):733-735.
[13]冯前进.从“六淫致病论”到生态病因学[J].山西中医学院学报,2007,8(1):14-14.
[14]张向伟,柳红芳.《内经》中汗证理论临证探讨[J].北京中医药,2013,32(4):252-255.
[15]李初勤.阳和汤加味联合西药治疗骨与关节结核41例[J].中国药物与临床,2015,15(1):110-111.
[16]医学正传——中医古籍名著文库[M].虞抟,郭瑞华,等点校.北京:中医古籍出版社,2002.
[17]邓建平,周敏,李凫坚.从脾论治肺痨盗汗[J].中华中医药学刊,2014,32(5):997-999.
[18]兰汀隆,秦世炳.严格掌握脊柱结核手术指征并选择合适的手术时机和方式[J].中国防痨杂志,2017,39(4):327-328.
[19]王琦,马远征.胸腰椎结核保守与手术治疗的合理选择[J].中国骨与关节杂志,2017,6(2):150-154.
[20]徐倍倍.史济柱治疗骨关节结核经验[J].中医文献杂志,1999(4):28-29.
[21]欧炯昆.中医药治疗骨与关节结核的近况[J].浙江中医杂志,2001,36(10):432-434.
[22]范顺武,胡子昂.重视脊柱结核化学药物治疗的重要性[J].中国骨伤,2017,30(9):783-786.
[2]安晋宇,李大伟,崔旭,等.老年性脊柱结核的特点及保守治疗疗效观察[J].中国骨伤,2013,26(3):210-213.
[3]彭成.中药防治耐药菌感染创新药物发现模式:“方-病证-菌、药-病证-菌、部位-病证-菌、成分-病证-菌、物质结构-网络关系-作用靶标”[J].中药与临床,2017,8(2):1-4.
[4]李思阳,季兴跃,李卓荣.抗结核中药有效成分研究进展[J].中国抗生素杂志,2013,38(10):725-729.
[5]MUHEREMU A,MA Y,MA Y,et al. Halo-pelvic traction for severe kyphotic deformity secondary to spinal tuberculosis[J].Medicine(Baltimore),2017,96(28):7491.
[6]杨虹,李雪霜,陆通,等.CT与MRI对脊柱结核的诊断价值[J].磁共振成像,2016,7(8):593-597.
[7]邓强,李军杰,张彦军,等.脊柱结核的微创外科治疗研究新进展[J].中国中医骨伤科杂志,2017,25(4):79-82.
[8]张嘉利,李大伟,马远征,等.多节段胸腰椎脊柱结核外科治疗的回顾性研究[J].中国防痨杂志,2013,35(5):305-308.
[9]王拥军,卞琴,崔学军,等.“肾主骨”理论研究的思路与方法[J].上海中医药大学学报,2010,24(1):8-12.
[10]高海军,滑东方,焦最婵,等.三位一体、治疗骨结核诊疗体会[J].临床肺科杂志,2010,15(8):1128-1130.
[11]邓强,李军杰,张彦军,等.从督脉论治胸腰椎结核并不全瘫的临床观察[J].中国中医骨伤科杂志,2018,26(2):23-27.
[12]刘庆银,张伟.从治痨先实脾论培土生金在肺痨病中的应用[J].长春中医药大学学报,2016,32(4):733-735.
[13]冯前进.从“六淫致病论”到生态病因学[J].山西中医学院学报,2007,8(1):14-14.
[14]张向伟,柳红芳.《内经》中汗证理论临证探讨[J].北京中医药,2013,32(4):252-255.
[15]李初勤.阳和汤加味联合西药治疗骨与关节结核41例[J].中国药物与临床,2015,15(1):110-111.
[16]医学正传——中医古籍名著文库[M].虞抟,郭瑞华,等点校.北京:中医古籍出版社,2002.
[17]邓建平,周敏,李凫坚.从脾论治肺痨盗汗[J].中华中医药学刊,2014,32(5):997-999.
[18]兰汀隆,秦世炳.严格掌握脊柱结核手术指征并选择合适的手术时机和方式[J].中国防痨杂志,2017,39(4):327-328.
[19]王琦,马远征.胸腰椎结核保守与手术治疗的合理选择[J].中国骨与关节杂志,2017,6(2):150-154.
[20]徐倍倍.史济柱治疗骨关节结核经验[J].中医文献杂志,1999(4):28-29.
[21]欧炯昆.中医药治疗骨与关节结核的近况[J].浙江中医杂志,2001,36(10):432-434.
[22]范顺武,胡子昂.重视脊柱结核化学药物治疗的重要性[J].中国骨伤,2017,30(9):783-786.