国医大师周仲瑛养血活血法治疗骨关节炎经验撷菁

Experience of Traditional Chinese Medicine Master ZHOU Zhongying in the Treatment of Osteoarthritis by Nourishing Blood and Promoting Blood Circulation

[目的]介绍国医大师周仲瑛应用养血活血法治疗骨关节炎的经验,为临床辨治骨关节炎提供思路。[方法]通过整理并分析周老治疗骨关节炎的验案,从病因病机、治则治法、临床用药等方面介绍其治疗骨关节炎的临床经验,并选取一则典型医案加以阐述。[结果]周老认为骨关节炎的病机特点为肾虚血亏、经络痹阻。血虚、血瘀是其病理特点,并贯穿于疾病的始终,肝肾精血同源,精不足则血亏虚;血瘀既是病理产物,又是骨痹的致病因素。血虚与血瘀互为因果,血虚则血脉不得充盈,血行涩滞;瘀血不去,则新血无以为生。治疗上重视养血活血,使用鸡血藤、川芎等养血活血,土鳖虫、赤芍等祛瘀生新,黄精、地黄等益精生血。所举医案中患者确诊为骨关节炎,证属肝肾下虚、痰瘀痹阻,治疗以平补肝肾为本,重在养血活血,治疗后获满意疗效。[结论]国医大师周仲瑛强调以病机为主导辨治疾病,治疗骨关节炎主张在平补肝肾的同时,以养血活血法为要,临床应用每获良效,其经验值得进一步传承推广,拓宽临床辨治骨关节炎的思路。

[Objective] To introduce the experience of ZHOU Zhongying, the master of traditional Chinese medicine(TCM), in the treatment of osteoarthritis by nourishing blood and promoting blood circulation, and provide ideas for clinical diagnosis and treatment of osteoarthritis. [Methods] Through the collation and analysis of Professor ZHOU’s medical cases in the treatment of osteoarthritis, this paper introduced his clinical experience in the treatment of osteoarthritis from the aspects of etiology, pathogenesis, principles and methods of treatment and clinical medications, and selected a typical medical case to elaborate. [Results] Professor ZHOU believes that the pathogenesis of osteoarthritis is characterized by kidney deficiency, blood deficiency and blockage of the meridians;blood deficiency and blood stasis are its pathological characteristics and run through the disease all the time. Liver and kidney have the same source of essence and blood, insufficient essence will result in blood deficiency;blood stasis is not only a pathological product, but also a pathogenic factor of osteoarthritis. Blood deficiency and blood stasis are mutually of cause and effect, blood deficiency means that the blood vessels cannot be filled, and the blood flow is astringent and stagnant;if blood stasis is not removed, new blood will not be born. The treatment is based on nourishing blood and promoting blood circulation, and differentiating syndrome to identify pathogenesis, using Spatholobus suberectus, Rhizoma Chuanxiong, etc. to nourish blood and promote blood circulation, Eupolyphaga Seu Steleophaga, Paeoniae Radix Rubra, etc. to remove blood stasis and promote tissue regeneration, and Polygonatum sibiricum and Rehmanniae Radix etc. to invigorate essence and generate blood. In the medical record, the patient was diagnosed as osteoarthritis, and the syndrome was deficiency of the liver and kidney, phlegm and stasis obstruction. The treatment was based on replenishing the liver and kidney, focusing on nourishing blood and promoting blood circulation. After the treatment, satisfactory results were obtained. [Conclusion] ZHOU Zhongying, the master of TCM, emphasizes that the pathogenesis is the leading factor in treating diseases, advocates that despite replenishing the liver and kidney, the method of nourishing blood and promoting blood circulation should be the key point in the treatment of osteoarthritis. Many clinical applications have achieved good results, and his experiences are worthy of further inheritance and promotion, so as to broaden the clinical thinking of treating osteoarthritis.