见骨损而非独责之于肾
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摘要
受"肾主骨"理论的影响,在类风湿关节炎骨破坏的病机论述上多不离肾。通过梳理痹证骨损的中医论治思路以及后世发展变化,阐述各医家中医整体观念下的多角度辨证思路,提出见骨损而非独责之于肾的观点。认为湿热瘀阻、伏邪、毒邪、肝脾失调等均与类风湿关节炎骨破坏相关。治疗上应多系统合参、虚实同治、标本兼治,抓主要病机,解决主要矛盾。
Under the influence of the theory of "kidney governing bone",the discussion on the pathogenesis of bone damage of rheumatoid arthritis( RA) is mainly about kidney. This paper combed the ideological context of traditional Chinese medicine( TCM) treatment of bone damage of RA syndrome and the development and change of later generations,and expounded the syndrome differentiation thinking of multi-angle under the holism concept of TCM in various medical families. This paper put forward the view that "bone damage of rheumatoid arthritis is not only the cause by kidney". It is believed that dampness and heat stagnation,hidden pathogen,toxin,liver and spleen disorders are related to bone damage of RA. Treatment should be combined with multi-system,both treatments for deficiency and excess,the symptoms and the root causes,grasp the main pathogenesis,and resolve the main contradictions.
Under the influence of the theory of "kidney governing bone",the discussion on the pathogenesis of bone damage of rheumatoid arthritis( RA) is mainly about kidney. This paper combed the ideological context of traditional Chinese medicine( TCM) treatment of bone damage of RA syndrome and the development and change of later generations,and expounded the syndrome differentiation thinking of multi-angle under the holism concept of TCM in various medical families. This paper put forward the view that "bone damage of rheumatoid arthritis is not only the cause by kidney". It is believed that dampness and heat stagnation,hidden pathogen,toxin,liver and spleen disorders are related to bone damage of RA. Treatment should be combined with multi-system,both treatments for deficiency and excess,the symptoms and the root causes,grasp the main pathogenesis,and resolve the main contradictions.
引文
[1]陈灏珠,陆再英,钟南山.内科学[M]. 8版.北京:人民卫生出版社,2013:808.
[2]张卓莉,李光韬,邓雪蓉.新型影像技术:类风湿关节炎诊治的重要辅助手段[J].中国医学前沿杂志(电子版),2012,41(1):35-38.
[3]巩勋,姜泉,曹炜,等.湿热瘀阻与活动期类风湿关节炎骨侵蚀[J].中医杂志,2014,55(14):1189-1192.
[4]周新尧,吕爱平,姜泉,等.清热活血类方药对类风湿关节炎骨破坏影响的研究与思考[J].中国中西医结合杂志,2016,36(7):891-895.
[5]路志正,焦树德.痹病论治学[M].北京:人民卫生出版社,1989:22-23.
[6]朱良春.朱良春医集[M].长沙:中南大学出版社,2006:109-111.
[7]陈伟,焦树德.补肾化瘀法阻止类风湿关节炎骨质破坏的研究现状与展望[J].中国中医药信息杂志,2002,9(10):9-11.
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[9]王义军.关于中医药阻止类风湿性关节炎骨侵蚀的几点思考[J].中国中医基础医学杂志,2005,13(5):365-366.
[10]田娟,龙丽,周彬.类风湿关节炎骨侵蚀研究进展[J].实用医院临床杂志,2017,14(2):133-137.
[11]姜泉,蒋红,曹炜,等. 475例类风湿关节炎患者中医临床证候分析[J].中医杂志,2007,48(3):253-255.
[12]姜泉,周新尧.从湿热瘀论治类风湿关节炎[J].世界中西医结合杂志,2010,5(4):279-280,287.
[13]姜泉,殷海波,罗成贵,等.清热活血方药治疗类风湿关节炎骨破坏2年期放射学研究[J].世界中西医结合杂志,2012,7(4):343-347.
[14]刘吉人.伏邪新书[M]//裘庆元,辑.三三医书(第二集).张年顺等,主校.北京:中国中医药出版社,1998:183.
[15]徐愿,陶庆文,王艳,等.基于伏邪学说辨治类风湿关节炎[J].北京中医药大学学报,2018,41(3):181-185.
[16]刘蔚翔,施雨,邱明山,等.从膜原论治类风湿关节炎[J].风湿病与关节炎,2016,5(11):47-48,55.
[17]王建,巩勋,姜泉.从伏邪理论探讨类风湿关节炎病因病机[J].浙江中医药大学学报,2017,41(9):719-723.
[18]刘维.毒痹论[J].中国中医基础医学杂志,2007,13(1):15.
[19]张磊,吴沅皞,王朝旭,等.从毒论治风湿病骨与软骨损害的临床探析[J].天津中医药,2017,34(4):232-235.
[20]尹龙,侯晓强,何克剑.从肝论治类风湿关节炎探讨[J].世界中医药,2015,10(11):1697-1700.
[21]魏晓广,高春献,古劼劼,等.从肝脾失调论治类风湿性关节炎的理论探讨[J].实用中医内科杂志,2011,25(8):70-71.
[22]王建,巩勋,唐晓颇,等. 1602例类风湿关节炎患者中医证候分布特点的多中心横断面调查[J].中医杂志,2018,59(11):963-967.
[23]员晶,唐晓颇,姜泉.路志正教授治疗类风湿关节炎的临床举例[J].浙江中医药大学学报,2014,38(7):851-852.
[24]庞爱梅,刘淑玲,姜萍.肝脾失调型早期类风湿关节炎影像学征象与RANK/RANKL/OPG系统相关性研究[J].中国中西医结合影像学杂志,2018,16(3):248-251.
[2]张卓莉,李光韬,邓雪蓉.新型影像技术:类风湿关节炎诊治的重要辅助手段[J].中国医学前沿杂志(电子版),2012,41(1):35-38.
[3]巩勋,姜泉,曹炜,等.湿热瘀阻与活动期类风湿关节炎骨侵蚀[J].中医杂志,2014,55(14):1189-1192.
[4]周新尧,吕爱平,姜泉,等.清热活血类方药对类风湿关节炎骨破坏影响的研究与思考[J].中国中西医结合杂志,2016,36(7):891-895.
[5]路志正,焦树德.痹病论治学[M].北京:人民卫生出版社,1989:22-23.
[6]朱良春.朱良春医集[M].长沙:中南大学出版社,2006:109-111.
[7]陈伟,焦树德.补肾化瘀法阻止类风湿关节炎骨质破坏的研究现状与展望[J].中国中医药信息杂志,2002,9(10):9-11.
[8]朱俊岭,阎小萍.阎小萍教授治疗类风湿关节炎经验撷菁[J].实用中医内科杂志,2008,22(5):12-13.
[9]王义军.关于中医药阻止类风湿性关节炎骨侵蚀的几点思考[J].中国中医基础医学杂志,2005,13(5):365-366.
[10]田娟,龙丽,周彬.类风湿关节炎骨侵蚀研究进展[J].实用医院临床杂志,2017,14(2):133-137.
[11]姜泉,蒋红,曹炜,等. 475例类风湿关节炎患者中医临床证候分析[J].中医杂志,2007,48(3):253-255.
[12]姜泉,周新尧.从湿热瘀论治类风湿关节炎[J].世界中西医结合杂志,2010,5(4):279-280,287.
[13]姜泉,殷海波,罗成贵,等.清热活血方药治疗类风湿关节炎骨破坏2年期放射学研究[J].世界中西医结合杂志,2012,7(4):343-347.
[14]刘吉人.伏邪新书[M]//裘庆元,辑.三三医书(第二集).张年顺等,主校.北京:中国中医药出版社,1998:183.
[15]徐愿,陶庆文,王艳,等.基于伏邪学说辨治类风湿关节炎[J].北京中医药大学学报,2018,41(3):181-185.
[16]刘蔚翔,施雨,邱明山,等.从膜原论治类风湿关节炎[J].风湿病与关节炎,2016,5(11):47-48,55.
[17]王建,巩勋,姜泉.从伏邪理论探讨类风湿关节炎病因病机[J].浙江中医药大学学报,2017,41(9):719-723.
[18]刘维.毒痹论[J].中国中医基础医学杂志,2007,13(1):15.
[19]张磊,吴沅皞,王朝旭,等.从毒论治风湿病骨与软骨损害的临床探析[J].天津中医药,2017,34(4):232-235.
[20]尹龙,侯晓强,何克剑.从肝论治类风湿关节炎探讨[J].世界中医药,2015,10(11):1697-1700.
[21]魏晓广,高春献,古劼劼,等.从肝脾失调论治类风湿性关节炎的理论探讨[J].实用中医内科杂志,2011,25(8):70-71.
[22]王建,巩勋,唐晓颇,等. 1602例类风湿关节炎患者中医证候分布特点的多中心横断面调查[J].中医杂志,2018,59(11):963-967.
[23]员晶,唐晓颇,姜泉.路志正教授治疗类风湿关节炎的临床举例[J].浙江中医药大学学报,2014,38(7):851-852.
[24]庞爱梅,刘淑玲,姜萍.肝脾失调型早期类风湿关节炎影像学征象与RANK/RANKL/OPG系统相关性研究[J].中国中西医结合影像学杂志,2018,16(3):248-251.