魏合伟辨治肩痹经验

Experience of WEI He-Wei in Treating Shoulder Arthralgia

魏合伟教授结合历代医家对肩痹临床症状的描述及自身临证经验,认为“肩痹”不应只包含现代医学的“冻结肩”“肩周炎”“肩峰下滑囊炎”等范畴,还应包括“肩袖损伤”“肩峰下撞击综合征”等疾病,其发病外因与感受外邪、劳损、外伤有关,内因与肾、肝、脾功能失调密切相关;肩痹的主要病机可归结为肝肾亏虚、气滞血瘀、风寒湿热邪气痹阻经脉;治疗可根据病情采用中药内服、中医外治、肩关节镜松解术、功能锻炼等疗法。中药内服以补益肝肾、理气活血、祛风除湿(热)、舒筋通络止痹为法,自拟临床经验方羌活寄生汤;中医外治可采用中药外敷、中药熏洗等方法;对保守治疗无效及病情严重的冻结肩患者,宜实施肩关节镜松解术;功能锻炼需筋骨并重,动静结合。

Based on the descriptions of the clinical symptoms of shoulder arthralgia by the physicians of past generations and by combining with his own clinical experience,Professor WEI He-Wei believes that shoulder arthralgia should not only include the categories of frozen shoulder,scapulohumeral periarthritis,and subacromial bursitis,but also cover the categories of rotator cuff injury and subacromial impingement syndrome.The external etiology of shoulder arthralgia is associated with the attack of external pathogens,overstrain,and traumatic injuries,while the internal etiology of shoulder arthralgia is closely related with the dysfunction of kidney,liver and spleen.Its primary pathogenesis is due to the insufficiency of liver and kidney,qi stagnation and blood stasis,and the obstruction of meridians by the pathogens of wind,cold,damp,and heat.For the treatment of shoulder arthralgia,the therapies of oral use of Chinese medicine,external treatment with traditional Chinese medicine,shoulder arthroscopic release,and functional training are recommended based on the illness state.Oral use of Chinese medicine follows the methods of tonifying liver and kidney,regulating qi and activating blood,expelling wind and removing damp and heat,and relaxing tendons and unblocking collaterals for relieving arthralgia,and the self-prescribed formula Qianghuo Jisheng Decoction can be used.External treatment with traditional Chinese medicine can be achieved by external application of Chinese medicine,fumigation and washing with Chinese medicine.For the severe frozen shoulder failing in conservative treatment,shoulder arthroscopic release should be performed.The functional training should follow the principles of paying equal attention to sinew and bone,and combination of motion and fixation.