膝骨关节炎六经辨治思路探讨

Ideas on Six-Meridian Syndrome Differentiation and Treatment for Knee Osteoarthritis

《伤寒论》六经辨证以三阴三阳六经经络及其相互络属的脏腑生理、病理变化作为物质基础。膝骨关节炎(KOA)病机以肝脾肾亏虚为主,与其他脏腑密切相关,而六经与脏腑相连,十二经络中足三阳、足三阴经络的走行均绕膝关节,KOA与经络病变密切相关,故可从六经辨治KOA。KOA发病之初多因六经外感所致,病在三阳,病性多实;病变后期,多及三阴,病性多虚。因此,其治疗原则可概括为:病在三阳,发汗祛邪、调和营卫、利湿化瘀、通络止痛治其标;病在三阴,温经养血、调畅气机、温补脾肾、强筋壮骨治其本。临床可根据患者病情分别从太阳、阳明、少阳、太阴、少阴、厥阴具体辨治。

The physical and pathological changes of six meridians(three yang meridians and three yin meridians) and their interlinked organs are the material basis of six-meridian syndrome differentiation in Treatise on Cold Damage Diseases(《伤寒论 》). The major pathogenesis of knee osteoarthritis(KOA) is deficiency of liver,spleen and kidney and is also closely related to other organs. Since the six meridians are interlinked with organs and their transmission routes all encompass the knee joint,KOA is closely related to the pathological changes of six meridians. Therefore,KOA can be treated from the six meridians. At the beginning of the onset of KOA,it is mostly caused by exogenous pathogenic factors attacking six meridians. The location of the disease is in the three yang meridians and the property of the disease is excessive. In the late stage of the disease,the three yin meridians are involved and the property of the disease is deficient. Therefore,the treatment principles can be summarized as follows:Treating the tip when the disease is in the three yang meridians,with methods of promoting sweating to eliminate pathogenic factors,harmonizing the nutrient and defense,draining dampness and resolving blood stasis,unblocking the meridian to relieving pain.Treating the root when the disease is in the three yin meridians,with methods of warming the meridian to nourish blood,regulating qi movement,warming spleen and kidney,strengthening tendons and bones. According to the clinical condition of the patient,the disease can be treated from the taiyang,yangming,shaoyang,taiyin,shaoyin,and jueyin meridian.