【作者】 曲艺；

【导师】 肖林榕；

【作者基本信息】 福建中医学院 ， 中医医史文献， 2004， 硕士

【摘要】 骨关节炎(简称OA)，是一种严重危害中老年人生活质量的慢性进行性骨关节病，发病呈世界趋势，并且逐年增加。目前西医对此病尚无特效疗法，多以抗炎镇痛药缓解症状，且毒副作用较大。虽然国内外对其进行了大量研究，但至今仍然没有找到一种真正有效的防治途径。本病属于中医“骨痹”、“痹证”等范畴，祖国医学对本病的认识较早，并积累了丰富的经验。由于唐宋元时期是我国文化及医疗事业最繁荣的时期，因此，从唐宋元医家的文献资料入手，搜集并整理有关医家对骨痹(骨关节炎)的认识及治疗经验，建立唐宋元医家治疗骨痹(骨关节炎)的相关数据库，并总结出这一时期治疗骨痹(骨关节炎)的用药规律，对指导现代临床用药具有十分重要的意义。 本课题在查阅了大量古今中医文献的基础上，以唐宋元医家论治骨痹(骨关节炎)的著作、方药、医案为主要辨析依据，通过对其文献的搜集、整理，并建立相关数据库系统，运用数理统计方法、分析归纳法，对261首治疗骨痹(骨关节炎)方药的用药规律进行了深入探讨。结果发现，唐宋元医家治疗骨痹(骨关节炎)的药性以辛、苦、甘、温、平为主；药物归经定位在肝、脾、肾，并且兼顾到胃；药物类别以温里药、活血祛瘀药、解表药为主，体现了唐宋元医家对骨痹(骨关节炎)的论治是从虚、邪、瘀的角度认识的；所选药物的功效集中在祛风湿止痹痛、助阳、活血祛瘀、补肝肾强筋骨等；在整个骨痹(骨关节炎)用药的频次中，以附子、肉桂、牛膝、防风、当归等最高。运用R型系统聚类分析法，得出了骨痹及腰痹、膝痹等各部位痹痛的基本处方用药。并总结出唐宋元医家治疗骨痹(骨关节炎)的用药特点在于：突出外来药、香药、虫类药、制剂及酒剂的应用。通过对唐宋元时期骨痹(骨关节炎)方药文献的研究结果，预期能为当今中医治疗骨关节炎的配伍组方、筛选用药等，提供新的思路和借鉴。更多还原

【Abstract】 Osteoarthritis (OA) is a progressively developed chronic osteopathy which seriously influences the living quality of aged and middle-aged people. The incidence is rising world-widely year after year. However, specific therapeutic methods haven’t been found so far in western medicine. Common therapy adopted these days is only the usage of anti-inflammatory medication and pain relief to lessen symptoms, with which severe toxic side-effects have been identified. Even though a wide range of studies have been carried out, effective therapeutic methods and preventive interventions with high reliability are still yet to be determined. In Traditional Chinese Medicine (TCM), osteoarthritis belongs to the categories of "Gu Bi (arthralgia)", "Bi Zheng" and was recognized earlier than in western medicine. As a result, more treating experiences were accumulated with TCM. The period of Tang, Song and Yuan dynasties is thought to be the booming phase of Traditional Chinese Medicine and Chinese culture and thus it is crucial to summarise the prescribing rules, establish relevant database for the therapeutic experiences through the analysis of literatures in these three dynasties. This may also conduct the modern clinic prescription.Based on the reference of a large amount of ancient and recent TCM literature, particularly the masterpieces, prescriptions and case histories regarding the management of OA, which were written by herbalists in Tang, Song and Yuan Dynasties, an in-depth study was carried out on prescribing rules in the treatment of arthralgia (OA) through the statistical analysis and induction of 261 prescriptions. Furthermore, a database was set up by the collection and rearrangement of those documents. The results show (1) herbs that were used in Tang, Song and Yuan Dynasties were predominantly pungent, bitter, sweet, warm, and mild in properties; (2) channel-tropisms are mostly in liver, spleen and kidney, as well as further association to stomach; (3) the majority of the herbs used in the prescription belong to the class for warming interior, promoting blood circulation and dissipating stasis, and relieving exterior syndrome, which indicates that the treatment of "arthralgia (OA) was from the aspects of deficiency, evil (pathogenic factor), and blood stasis; (4) the functions of selected herbs were basically focused on dispelling wind and damp and eliminating pain, replenishing Yang, promoting blood circulation and dissipating stasis, and nourishing liver and kidney and strengthening ligaments and bones; (5) Fu zi (Cyperes rotundus), Rou gui (Cinnamomumcassia) Niu xi {Achyranlhes bidentata), Fang feng (Saposhnikoviae divaricatae) and Dang gui {Angelicae sinensis) form the top part of the frequency table for herbs being used to treat arthralgia., In addition, collection of basic prescriptible herbs for OA in different joints, such as in lumbar and knees, were produced by employing R-type systems classification analysis, and prescribing features of the treatment of arthralgia used by Tang, Song and Yuan herbalists were also summarized as the emphasis of the application of introduced herbs, fragrant herbs and worms, the technique of preparation and the reasonable usage of medicinal wine. Finally, the results of this study are expected to provide novel thoughts and references to modern treatment of OA in TCM.更多还原