【作者】 郭钰安；

【导师】 严灿；

【作者基本信息】 广州中医药大学 ， 中医学， 2009， 硕士

【摘要】 《内经》早在两千多年前就认为肾与人体骨骼的生长发育密切相关,《内经》中“肾藏精”、“肾主骨”、“骨者髓之府”、“肾生骨髓,髓生肝”、“肝藏血”等理论,以及指出因肾虚而造成一些有关骨方面之疾患的相关性及其治法,如《医经精义》指出:“肾藏精,精生髓,髓生骨,故骨者肾之所合也;髓者,肾精所生,精足则髓足,髓在骨内,髓足则骨强。”若肾气虚,肾精亏则骨髓失养而痿软,髓无以得生。这些都表明了肾、精、骨、髓、血之间的关系是十分密切的。中医临床遵循以上的理论,以补肾为主的治疗方法来治疗骨病时来已久,且均有极大之效果。本论文即针对古代之理论及现代科学之研究,对肾—精—骨—髓—血理论体系在骨科临床实践中的运用做一系统性的探讨。第一部分我们对肾—精—骨—髓—血理论体系构建的古代文献进行了研究整理,分别从《内经》及古代医家对《内经》中“肾藏精”、“肾主骨”、“肾生骨髓,髓生肝”、“肝藏血”等之诠释,进行了理论的阐述,再通过古代经典医籍及现代科学研究结果,针对“肾藏精”、“肾主骨”、“肾生骨髓”、“髓生肝(血)”等理论进行系统性的探讨,从而建立起肾—精—骨—髓—血完整的理论体系。第二部分从古代经典医籍及现代科学研究文献报导治疗骨科疾病用药的统计和分析、治疗骨科疾病常用的方剂分析、治疗骨科疾病古代文献整理与现代临床运用结果、及骨科疾病的预防研究四个方面,针对肾—精—骨—髓—血理论体系在骨科临床实践中的运用做一系统性的探讨。结果表明,从古代经典记载之中医理论及现代科学对中医中药理论之研究,证实了肾、精、骨、髓、血之间的关系密切,因此我们建立起了肾—精—骨—髓—血理论体系。中医临床上遵循肾—精—骨—髓—血理论体系,利用补肾填精,壮骨生髓补血之类中药,及由此类中药组成的方剂治疗骨科疾病,是有其科学上之意义,而且临床运用上也获得极大之疗效。在骨科的病人,不管是骨折病人由于外伤的伤精耗血,还是骨病的病人由于病程迁延,久病体虚耗伤正气,都可以使肾所藏之精不足,从而出现骨骼空虚、骨疏筋萎,如肾虚性腰痛、老年退行性骨关节炎、妇女更年期腰腿痛等病人中,我们常常可以观察到病人精神不振、形寒肢冷、腰酸腿软、尿频清长、遗精泄泻等肾阳虚衰的症状,我们在这时以补肾的方法,给予生精填髓、壮骨补血的药物,就能使肾精足,骨髓旺,从而有利于骨科疾病的治疗。更多还原

【Abstract】 The "Yellow Emperor’s Internal Classic",about 2,000 B.C.,said that kidney is associated with bone growth and development.Examples like "kidney stores essence", "kidney governs bone","bone is the house of marrow","kidney engenders marrow to derive liver" and "liver stores blood".The similar delineation in "Essence of Medical Classics" is "as kidney stores essence,essence produces marrow and marrow grows bone, bone is associated with kidney.Marrow,product of essence,adequacy when essence abundance,just like the bone strength is basic on marrow enrich.On the contrary, deficiency of kidney ’qi’ and essence result in malnourished marrow and lead to limb weaknesses." All those descriptions demonstrate the deep connections among kidney, essence,bone,marrow and blood.To follow these principles,traditional Chinese medicine (TCM) doctors treat bone disorders with kidney supplementation and obtain satisfactory results.Regarding this,we conducted a systematic study of the orthopaedic application of "kidney-essence-bone-marrow-blood system" theory by reviewing relevant modern researches and TCM literature.The first part of this article we reviewed and unscrambling the theories of "kidney stores essence","kidney governs bone","kidney engenders marrow which engenders liver’ and "liver stores blood" in TCM literatures such as the "Internal Classic".Then give the interpretations and utilities from modern researches and establish the theory of "kidney-essence-bone-marrow-blood system".The second part we investigate the "kidney-essence-bone-marrow-blood system" theory from four different directions:statistical analysis of commonly-prescribed Chinese medicines used in orthopedics disease from both ancient and modern literatures,frequently used formulas,therapeutic efficacies and the researches on the prevention.Finally,by analyzing the related TCM theories in ancient literature as well as the results from modern researches,we demonstrate the strong connections among kidney, essence,bone,marrow and blood.Construct the "kidney-essence-bone-marrow-blood system" theory.Then we can apply this principle to orthopaedics so kidney-tonifying, essence-replenishing,bone-strengthening,marrow-engendering,and blood-enriching medicines as well as formulas can be served as regular treatment which can spell perfect results.In orthopaedics,no mater it is acute blood loss to essence damage in new fractures or chronic depleted original qi in prolonged bony disorders,all may lead to a decreased kidney essence,result in some symptoms like low back pains,osteoarthritis and aching legs in postmenopausal women.Concomitant symptoms as decreased vitality,cold extremities, aching backs and legs,copious clear urine and emissions all indicat kidney yang deficiency.At this time if we provide further evidence and use supplementation to marrow, bone or blood.In order to replenish kidney essence,nourish the marrow and may accordingly facilitate the orthopaedic treatments.更多还原