基于不通则痛理论治疗膝骨关节炎的内涵及外延

Connotation and Extension of Treatment of Knee Osteoarthritis Based on Theory of Pain Caused by Obstruction

膝骨关节炎(knee osteoarthritis, KOA)是一种常见且发病率极高的骨关节疾病,其病理改变往往导致关节软骨破坏以及骨质增生,临床上表现为膝关节疼痛、肿胀以及活动功能障碍。KOA的治疗原则以改善患者症状,恢复膝关节正常功能为主,其病理机制复杂多变,致病因素繁杂。不通则痛理论最早由明代医家李中梓提出,该理论是指由于各种病理因素导致人体气血经脉运行不畅,阻滞于关节、经络、脏腑而引发疼痛。中医学对不通则痛理论的认识有很长的历史源流,该理论已被多数学者所认同,同时也广泛的运用于临床中,具有很好的理论指导作用。治疗“不通”则应以“通”法论治,广义的“通法”是指祛除病邪,消除气血津液运行阻滞,协调脏腑功能的方法。以不通则痛理论为指导,应用“通”法治疗KOA可以有效缓解患者膝关节症状,阐明其作用机理。为KOA的治疗及其发病本质的认识提供理论基础。文章从“不通则痛”理论的内涵及现代科学研究层面探讨了KOA的发病机理和治疗方法,在理论上具有可行性,为KOA的临床治疗提供了理论依据。

Knee osteoarthritis(KOA)is a common bone and joint disease with a high incidence rate.Its pathological changes often lead to destruction of articular cartilage and bone hyperplasia,which are clinically manifested as pain,swelling and dysfunction of the knee.The treatment principle of KOA is mainly to improve patient symptoms and restore normal knee joint function.Its pathological mechanism is complex and varied,and the pathogenic factors are complex.The theory of pain caused by obstruction was first proposed by LI Zhongzi,a medical expert in the Ming dynasty.This theory refers to the pain caused by various pathological factors that hinder the smooth operation of the body's Qi and blood meridians,blocking the joints,meridians,and organs.The understanding of the theory of pain when obstructed in traditional Chinese medicine has a long history,which has been recognized by many scholars and widely used in clinical practice,with good theoretical guidance.The treatment of“obstruction”should be based on the“unblocking”method,which broadly refers to the method of eliminating pathogenic factors,eliminating blockages in the circulation of Qi,blood,and body fluids,and coordinating the functions of the organs.Guided by the theory of pain if obstructed,the application of the“dredging”method in the treatment of KOA can effectively alleviate knee joint symptoms in patients,clarify its mechanism of action,and provide a theoretical basis for the treatment of KOA and the understanding of its pathogenesis.This article explores the pathogenesis and treatment methods of KOA from the perspective of the theory of“pain if obstructed”and modern scientific research.It is theoretically feasible and provides a theoretical basis for the clinical treatment of KOA.