衰老视角阐释膝骨关节炎虚实夹杂病机的科学内涵

Scientific Connotation of Pathogenesis with Mixed Deficiency and Excess of Knee Osteoarthritis from Senescence Perspective

膝骨关节炎是骨伤科常见的退行性疾病,症状以膝关节疼痛、肿胀、活动受限为主。既往中医并无关节炎病名,对此病的认识多依据症状,早期归入“痹证”“膝痹”,后期归入“痿证”范畴。病因病机方面总体认为本病属于本虚标实,本虚主要是肝肾不足、气血亏虚,标实主要是气血痹阻、寒凝痰结等。因此,在治法方面,各家经验虽然治法、用药不一,但多数强调治法的攻补兼施。膝骨关节炎本质上是骨关节的衰老,结合中医对于衰老的认识,以及现代医学对于组织细胞衰老的认识,从细胞衰老及其在组织间扩散的机制认识膝骨关节炎“虚实夹杂”的科学内涵,对临床和科研具有启发性意义。

Knee osteoarthritis is a common degenerative disease in orthopedics.The symptoms are mainly knee-joint pain,swelling,and limited movement.In the past,there was no name for arthritis in traditional Chinese medicine.The understanding of arthritis was based on symptoms,which were classified as arthralgia syndrome and paralysis syndrome in the early stage and impotence syndrome in the later stage.In terms of etiology and pathogenesis,it is generally considered that this disease is characterized by a deficiency of the liver and kidney and deficiency of qi and blood in origin and by obstruction of qi and blood,cold coagulation,and phlegm accumulation in superficiality.Therefore,for the treatment,although doctors have different treatment and drug use methods,most of them emphasize the combination of tonification and purgation.Knee osteoarthritis essentially reflects the senescence of bone and joints.By combining the understanding of senescence in traditional Chinese medicine and the understanding of tissue cell senescence in modern medicine,it is instructive for clinical and scientific research to understand the scientific connotation of mixed deficiency and excess in knee osteoarthritis from the mechanism of cell senescence and its diffusion in tissue.