【作者】 李宝锋；

【导师】 欧阳兵；

【作者基本信息】 山东中医药大学 ， 中医医史文献， 2013， 博士

【摘要】 目的：探讨古今文献对于骨折、骨折延迟愈合病因病机的认识，以及骨折、骨折延迟愈合的治法源流。基于对《内经》“肾主骨生髓”理论的认识，提出骨折、骨折延迟愈合的基本病机和促进骨折愈合的基本治法，以期为骨伤科临床实践提供更好的辨治思路，提高中医治疗本病的疗效。方法：中医传统文献学与现代临床试验相结合的方法，系统整理历代文献中与骨折、骨折延迟愈合相关的病证记载，从古代文献中总结出补肾生髓以促进骨折愈合的经验方，通过临床对比试验验证补肾生髓法促进骨折愈合的有效性。结果：基于“肾主骨生髓”的生理病理、补肾中药壮骨生髓的功效及药理学机制、骨折愈合与胚胎期形成的类似机制、骨折延迟愈合的生物学机制、补肾生髓法促进骨折愈合的临床试验研究，发现肾虚影响骨、髓的生长、发育、充实，肾虚是影响骨折愈合、造成骨折延迟愈合的主要病机，提出补肾生髓法在中医骨伤科中促进骨折愈合的重要作用。结论：肾虚是影响骨折、骨折延迟愈合的基本病机。补肾生髓法是促进骨折愈合的基本治法，在补肾生髓促进骨折愈合理论指导下的补肾生髓接骨方对于促进骨折愈合有很好的临床效果。更多还原

【Abstract】 Objectives: To explore the previous understandings on the etiology and pathogenesisof fracture and delayed union and their treatment origin in ancient and modern literatures;to clarify the basic pathogenesis of fracture and delayed union and to propose the principaltreatment to promote the union based on the theory of “the kidney generating marrow anddominating bone" in the Internal Canon of Medicine, with a prospect to provide a bettertreatment with syndrome differentiation and improve the therapeutic effects in the clinicalpractice of orthopedics and traumatology.Methods: Collecting traditional literatures of TCM and modern clinical tests arecombined to: the cases related to fracture and delayed union, which are recorded in ancientliteratures, are collected systematically to summarize the empirical formula for “tonifyingkidneys and generating marrow", which would in turn promote the union; clinical tests arecarried out to test the effectiveness of the empirical formula.Results: The major pathogenesis of delayed union is found based on thepathophysiological mechanism of “the kidney generating marrow and dominating bone",the therapeutic effects and pharmacological mechanism of kidneys-tonifying-formula intonifying bones and generating marrow, the mechanism of fracture union’s being similar tothe embryonic stage, the biological mechanism of delayed union, and the clinical tests, thepathogenesis lies in the deficiency of the kidney, which manifests itself in the growth,mature and enrichment of the bones and marrow, and causes delayed union. Therefore,“tonifying kidneys and generating marrow" plays a vital role in promoting the union inorthopedics and traumatology.Conclusion: The deficiency of the kidney is the potential pathogenesis of fracture and the basin pathogenesis of delayed union.“Tonifying kidneys and generating marrow" is theprincipal treatment in promoting union, which has been proved by the clinical tests underthe guidance of related TCM theory.更多还原