【作者】 张玉洁（Yujhieh Chang）；

【导师】 马健；

【作者基本信息】 南京中医药大学 ， 中医临床基础， 2013， 博士

【摘要】 绝经后骨质疏松症(PMOP)是绝经后妇女的常见病和多发病,本文通过查阅大量古今文献后,系统整理和归纳了现代医学对PMOP的发病机制、诊断和治疗的研究情况。现代医学治疗PMOP的药物一般分为两类：一类为抑制骨吸收、防止骨丢失、维持骨量的药物,如钙剂、雌激素、降钙素、双膦酸盐及活性维生素D(钙三醇)等；另一类为促进骨形成、增加骨密度的药物,如雄激素、氟化物、钙制剂、生长激素、合成蛋白同化激素等。虽然现代医学在防治PMOP取得了较大进展,具有疗效显着,见效快,服用方便等优点,但其副作用较大,有的药物长期服用可能具有诱发癌变等风险,这些副作用也一直困扰着人们。古代中医虽然没有绝经后骨质疏松症这一病名,但相关描述并不少见。尤其是近年来随着中医药对PMOP研究的逐渐深入,对其中医病因病机的论述较多,现在一般认为其病因病机多与肾精亏虚、脾胃虚弱、肝郁血虚、瘀血阻滞、感受外邪等有关。治疗方法既有专方专药,又有分型施治、序贯治疗、饮食疗法等,均取得很好的疗效。本文在整理和归纳古今大量有关PMOP论述的基础上,在导师的指导下,认为肾虚血瘀是本病的基本病机,提出以补肾通络法为治疗本病的基本方法。研究对象是本人在台湾的门诊患者,收集30例符合诊断标准的病例。治疗方法：肾阳虚兼瘀阻证用右归丸加紫河车、骨碎补、鸡血藤、怀牛膝；肾阴虚兼瘀阻证用左归丸加紫河车、骨碎补、鸡血藤；服药时间为3个月,同时结合饮食调养。结果发现30例患者的主症均治愈或明显改善,临床治疗评估有效率达100%。显示补肾壮骨,益精填髓,兼以活血化瘀通络法能治疗因为骨质疏松症引发之腰背膝腿疼痛等各种症状,值得我们以后进一步深入研究。更多还原

【Abstract】 Postmenopausal osteoporosis (PMOP) is a common and frequently encountered disease. After a systematic review of plenty of ancient and modern literatures, this paper aims to present a research summary of pathogenesis, diagnosis and treatment of PMOP from the perspective of modern medicine. Western medical drugs for the treatment of PMOP are classified into two groups:one is to inhibit osteolysis, prevent bone loss and maintain bone mass, like calcium, estrogen, thyrocalcitonin, bisphosphonates and activated vitamin D (calcitriol); the other is to promote bone formation, increase bone density, like androgen, fluoride, growth hormone and synthesized protein anabolic hormone. It is admitted that modern medicine has made great progress on the treatment of PMOP, which has quick and obvious effects and is convenient in use. However, modern medicine has side effects which bother people all along as long-term use of drugs may increase the risk of canceration.There’s no certain name for PMOP in Chinese medicine, but related descriptions could be found, especially further research on PMOP from the perspective of Chinese medicine have been carried out in recently years. Currently the pathogenesis of PMOP is considered to be related to the deficiency of kidney essence, deficiency of spleen and stomach, stagnation of liver qi and blood, obstruction of blood stasis and attack of pathogenic factors. Various treating methods are found effective like specific prescriptions and drugs, treatment based on syndrome patterns, sequential therapy and dietotherapy.This paper believes that the pathogenesis of PMOP is the kidney deficiency and blood stasis on the basis of collected literatures, thus proposing that the basic treating method is to tonify the kidney and remove blood-stasis in channels. Thirty subjects were my outpatients in Taiwan’s clinic collected on the basis of diagnostic criteria of PMOP. Method:You Gui Wan (restoring the right kidney bolus) plus zi he che (placenta hominis), gu sui bu (Rz Drynari), ji xue teng (Canlis Milletliae) and huai niu xi (Rx Achyranthis Bidentatae) was for patients with kidney yang deficiency and blood stasis; Zuo Gui Wan (restoring the left kidney bolus) plus zi he che (placenta hominis), gu sui bu (Rz Drynari), ji xue teng (Canlis Milletliae) and huai niu xi (Rx Achyranthis Bidentatae) was for patients with kidney yin deficiency and blood stasis. Both groups received treatment for3months, supported by dietotherapy. Result:Main syndromes of 30patients were cured or significantly improved. The evaluation of clinical efficacy reached100%. This result indicates that the method to tonify the kidney and essence-blood, strengthen bones, promote blood circulation and remove blood stasis should be further studied as lumbago and back pain, gonyalgia and skelalgia caused by PMOP could be released after treatment.更多还原