王鸿度教授关于“少阳主骨”学术思想和临床经验总结（附“和解少阳”法对膝骨性关节炎合并骨质疏松的临床研究）

发布时间：2018-09-12 14:17

【摘要】：研究目的：当前骨重塑失偶联性骨病的药物治疗,通常采用单纯抑制骨吸收或刺激骨形成的疗法,但多年尝试而效果不尽人意。原因是单方面抑制骨吸收会阻碍骨形成,同理,单方面刺激骨形成也会伴随骨吸收增强。说明人为地单一干扰或影响骨重塑的破骨或成骨过程,会破坏骨重塑偶联的平衡机制。所以,晚近学界提出“协同”(synergetic)概念,呼吁应致力开发能够重建骨重塑偶联平衡的新型治疗措施。本研究以全国第五批名老中医专家王鸿度教授倡导的“少阳主骨”理论为核心,追溯和整理王鸿度老师“少阳主骨”学说及其运用“和解少阳”法治疗“骨繇症”(骨重塑失偶联性骨病,如骨质疏松)的学术思想和临床经验,为骨重塑失偶联性骨病提供新的治疗方案和理论依据。研究方法：1.跟师学习：跟师临证,持之以恒,细心体察老师对望、闻、问、切的运用,认真仔细做好学习笔记；诊后反复思考,撰写学习心得、体会,总结病案,思考老师的辨证思路与用药依据。2.研读老师的论著：认真仔细研究学习老师已发表的论著,将论著中的学术观点与跟师临证所得结合,让理论和实践紧密结合,倘有疑惑,则问之于师,以能更深层次体会老师的学术思想。3.学习老师学术理论渊源相关书目：精读老师所列书目,追溯老师学术理论渊源,知其然更要知其所然,以期更全面理解老师的学术理论。4.学以致用：将老师的学术理论结合临床实际灵活运用于临床,参与老师的自然科学基金项目的实验工作,并在老师前期研究的基础上,以随机对照的方式,选用敏感的骨吸收和骨形成指标及其它相关指标开展临床实验,以临床研究的形式反馈于理论,实现理论——临床——理论的过程。研究内容：1.王鸿度教授发掘“少阳主骨”理论的学术思想渊源及“骨繇症”(骨重塑失偶联性骨病,最常见骨质疏松)的研究进展王鸿度老师长于将经络辨证、八纲辨证及脏腑辨证融于一炉,运用针灸和中药综合治疗骨骼肌肉关节疾病。老师倡导的“少阳主骨”学术思想源于《黄帝内经》,通过梳理该学说散在于各篇的经文,汇集历代知名注家观点,对其进行了系统整理和研究,汲取现代医学对骨生物学及骨病的最新成果,在验证学术观点、阐释病理生理学机制以及临床实践中,将二者巧妙地结合起来,形成其独特的骨病治疗和研究的思想与方法,并通过包括国家自然科学基金项目在内的一系列科研课题,从动物实验到临床研究,客观完整揭示其神秘内涵,使之复归现实临床,还原其理论地位和使用价值。上世纪九十年代,国际骨生物学界对骨重塑的破骨细胞和成骨细胞的偶联过程获得突破性进展。如果骨重塑失偶联(decoupled),其平衡失和调,就演变为多种代谢性骨病共同的病理基础。如癌性溶骨性损害、类风湿关节炎、骨质疏松症等,均是破骨细胞功能异常活跃而相对成骨细胞功能不足所致；而强直性脊柱炎、牛皮癣性关节炎、糖尿病夏科氏关节病等,还有家族基因缺陷的常染色体隐性遗传病,如硬化性狭窄(sclerosteosis)及范布切姆病(Van Buchen disease),却是由于成骨能力超过了破骨能力。多年来药物治疗上述某些骨病,只能采用单纯抑制骨吸收或刺激骨形成的疗法。但因单方面抑制骨吸收会阻碍骨形成：而单方面刺激骨形成也会伴随骨吸收增强,故效果均不尽人意。以骨质疏松症为例：二膦酸类虽能有效抑制骨吸收、增加骨量,但骨折率并未降低：长疗程更引起衰弱易碎的骨生成,不仅使骨折修复困难,而且抵抗骨合成代谢药物；若使用骨合成代谢药物,如甲状旁腺素(PHT),持续使用既增强骨形成同时也增强骨吸收且占优势,结果仍然骨量丢失。所以,晚近学术界提出“协同”(synergetic)概念,呼吁应致力开发能够重建骨重塑偶联平衡的新型治疗措施。中医治疗各种骨病,强调“肾主骨”,所以无论中医方药或针灸治疗各种骨病几乎都从此立意。而动物和人体实验也显示其有抑制骨吸收的效应,又有研究涉及成骨细胞功能,但多数从一些细胞因子对OB单方面影响入手,而未涉及平衡骨重塑相偶联的复杂功能。2.王鸿度教授“少阳主骨”理论学术思想及临床经验整理与研究王鸿度教授从《黄帝内经》“少阳主骨”出发,发掘并验证少阳经穴与全身骨骼系统的骨强度的病理生理联系,阐明其机理是“和调”骨重塑过程的平衡,即《内经》“少阳为枢”的观点；提出少阳主骨所生病者即“骨繇症”的临床特征之骨痛,应是多部位的且具有普周性的特点；深入阐述了少阳经与骨骼系统之间的生理、病理联系、“少阳主骨”与“肾主骨”的关系及少阳“终”“折”之“骨繇症”在真实世界客观存在的情况。梳理“少阳主骨”学说的历史浮沉、厘清其生理病理内涵和意义、以及临床对应的疾病原型等,构建出相应的理论验证模型,将湮没千年的“少阳主骨”学说引入现代科学研究领域；并选择适当动物模型和实验室指标,以“和解少阳”为大法,设计了相关的电针足少阳经穴和以经典“小柴胡汤”为主方的基础和临床实验,选择多种机能和形态学指标,证明电针足少阳和小柴胡汤的相关干预对大鼠骨重塑的影响；证明少阳经昼夜节律与骨重塑过程有关。建立以“和解少阳”为主要治疗措施的骨病治疗新模式,并将临床治疗范围拓展到原发性骨质疏松症、骨平衡紊乱性膝骨关节炎,以及氟性骨关节炎等。形成以“和解少阳”为大法,内治与外治结合、中药与针灸并用,综合治疗骨重塑失偶联性骨病的新局面。3.“和解少阳”法对膝骨性关节炎合并骨质疏松症的临床研究本研究以王鸿度老师所倡导的“少阳主骨”学说为指导,从临床实验的角度呼应“阴阳自和”、“和为圣度”及“少阳为枢”的观点,采用Lysholm膝关节评分系统和WOMAC评分系统结合骨代谢生化指标(BALP、BGP、TRACP、IL-1及TNF-a等),进一步验证“少阳主骨”的机理是“和调”骨重塑过程的观点。结论：1.在中医学术界,“少阳主骨”学说一直是千古谜题,王鸿度老师论证“复活”《内经》的“少阳主骨”学说,汇聚历代注家还原“少阳主骨”其本来面目,在理论层次上将足少阳经的功能与骨骼的生理、病理、治则及治疗方案等紧密结合,并系统化,从而构建和推演出有别于以脏象为中心的“肾主骨”理论的“少阳主骨”学说。2.以科学实验对“少阳主骨”学说进行谨严的验证,并在临床应用上初步阐明其机理；提出与之对应的“骨繇症”,在临床表现上跟现代医学所谓“骨重塑失偶联性骨病”极为类似,扩展其适应病种。这些研究工作,拓展了足少阳经及其经穴特性和用途的新知识,丰富了中医基础理论、骨生理病理等内容。3.根据“阴阳自和”、“和为圣度”及“少阳为枢”的观点,结合足少阳经穴以及“和解少阳”的小柴胡汤对骨重塑失偶联性骨病的实验研究,提出“少阳主骨”的机理是“和调”骨重塑过程。该“和调”机制,为骨质疏松、糖尿病足及癌瘤溶骨损害等多种骨重塑失偶联性骨病(骨繇症)提供新型“协同”防治方法。4.临床研究表明,以“少阳主骨”为指导,着眼于“和调”,可以调节骨重塑偶联,调其阴阳,损有余补不足,重新构建骨吸收与骨形成的动态平衡,这有利于解决目前单纯使用抗骨吸收剂或促骨合成剂所面临的困局,为今后多种骨病的中医针灸及药物治疗开拓一条新途径。
[Abstract]:OBJECTIVE: Current therapies for bone remodeling uncoupled osteopathy are usually based solely on inhibition of bone resorption or stimulation of bone formation, but they have been tried for many years with unsatisfactory results. The reason is that unilateral inhibition of bone resorption can hinder bone formation. Similarly, unilateral stimulation of bone formation can accompany enhanced bone resorption. In recent years, the concept of "synergetic" has been put forward, which calls for the development of new therapeutic measures to rebuild the coupling balance of bone remodeling. With the theory of bone as the core, this paper traces back and sorts out Mr. Wang Hongdu's theory of "Shaoyang dominates bone" and his academic thought and clinical experience in the treatment of "osteoporosis" (bone remodeling uncoupled osteopathy, such as osteoporosis) with the method of "reconciling Shaoyang" so as to provide a new treatment plan and theoretical basis for bone remodeling uncoupled osteopathy. Learning: follow the teacher, persevere, carefully observe the teacher's observation, smell, ask, cut the use of careful and careful study notes; after the diagnosis of repeated thinking, write learning experience, experience, summarize medical records, thinking about the teacher's dialectical thinking and medication basis. 2. Read the teacher's works: seriously and carefully study the teacher's published works, will be on the book. The combination of academic viewpoints with the teacher's clinical experience makes the theory and practice closely integrated. If in doubt, ask the teacher for a deeper understanding of the teacher's academic thinking. Understanding the teacher's academic theory. Research Contents: 1. Professor Wang Hongdu excavates the academic thought origin of the theory of "Shaoyang Main Bone" and the research progress of "osteoporosis" (bone remodeling uncoupling osteopathy, the most common osteoporosis) Professor Wang Hongdu is good at differentiating meridians and collaterals. The academic thought of "Shaoyang Zhugu" advocated by the teacher originated from the Yellow Emperor's Internal Classic. Through sorting out the texts scattered in various chapters, the author collected the views of famous annotators of past dynasties, systematically collated and studied them, and drew on modern medicine. The latest achievements in osteobiology and osteopathy have been cleverly combined in verifying academic viewpoints, elucidating pathophysiological mechanisms and clinical practice to form their unique ideas and methods for the treatment and research of osteopathy. Through a series of scientific research projects including the National Natural Science Foundation of China, they have ranged from animal experiments to clinical trials. In the 1990s, the international osteobiology community made a breakthrough in the coupling process of osteoclasts and osteoblasts in bone remodeling. If bone remodeling is decoupled, its imbalance will become more and more. The common pathological basis of various metabolic osteopathy, such as carcinolytic lesion, rheumatoid arthritis, osteoporosis, etc., is the abnormal activity of osteoclasts and the relative inadequacy of osteoblast function; while ankylosing spondylitis, psoriatic arthritis, diabetic Charcot's arthropathy, and other family genetic defects of autosomal recessive Sexually transmitted diseases, such as sclerosteosis and Van Buchen disease, are due to osteogenesis that exceeds osteoclasts. For many years, drugs have been used to treat some of these diseases by simply inhibiting bone resorption or stimulating bone formation. Osteoporosis, for example, can effectively inhibit bone resorption and increase bone mass, but the fracture rate does not decrease: long-term treatment causes weakened and fragile bone formation, which not only makes fracture repair difficult, but also resists bone synthesis and metabolism drugs; if bone synthesis is used Metabolic drugs, such as parathyroid hormone (PHT), continue to be used to enhance bone formation and bone resorption, and as a result, bone mass is still lost. Animal and human experiments also show that it has the effect of inhibiting bone resorption, and some studies involve osteoblast function, but most of them start from the unilateral effect of some cytokines on OB, and do not involve the complex function of balanced bone remodeling coupling. Professor Wang Hongdu's academic thought and clinical experience on the theory of "Shaoyang is the main bone" are summarized and studied. Professor Wang Hongdu explores and verifies the pathophysiological relationship between the points of Shaoyang meridian and the bone strength of the whole skeletal system from the point of "Huangdi Neijing", "Shaoyang is the main bone", and clarifies that the mechanism is the balance of the process of bone remodeling, that is, the "Neijing", "Shaoyang is the main bone." It is pointed out that the clinical characteristics of ostealgia caused by Shaoyang's dominant bone should be multi-site and universal; the physiological and pathological relationship between Shaoyang's meridian and skeletal system, the relationship between Shaoyang's dominant bone and kidney's dominant bone, and the ostealgia caused by Shaoyang's "terminal" and "fracture" are expounded in depth. In the real world, this paper combs the historical ups and downs of the theory of Shaoyang's main bone, clarifies its physiological and pathological connotation and significance, as well as the corresponding clinical disease prototype and so on, constructs the corresponding theoretical verification model, and introduces the theory of Shaoyang's main bone which has been annihilated for thousands of years into the field of modern scientific research; and selects the appropriate animal model and the appropriate animal model. Laboratory indicators, with "reconciliation of Shaoyang" as the major method, designed the relevant electro-acupuncture points of the Foot Shaoyang meridian and the classic "Xiaochaihu Decoction" as the main basic and clinical experiments, select a variety of functional and morphological indicators, prove that electro-acupuncture foot Shaoyang and Xiaochaihu Decoction related intervention on bone remodeling in rats; prove that the Shaoyang meridian circadian rhythm and night. Establish a new model of bone disease treatment with "reconciling Shaoyang" as the main treatment, and expand the scope of clinical treatment to primary osteoporosis, disordered bone balance knee osteoarthritis, and osteoarthritis fluoride, etc. The clinical research of "reconciling Shaoyang" method on knee osteoarthritis with osteoporosis guided by the theory of "Shaoyang is the main bone" advocated by Professor Wang Hongdu, echoes the viewpoints of "Yin and Yang are harmonious", "harmony is holy" and "Shaoyang is the center" from the perspective of clinical experiment. The Lysholm knee scoring system and WOMAC scoring system were combined with bone metabolism biochemical indexes (BALP, BGP, TRACP, IL-1 and TNF-a) to further validate the viewpoint that the mechanism of Shaoyang bone is to "reconcile" the process of bone remodeling. The theory of "Shaoyang Ruling Bone" in "Resurrection" and "Neijing" brings together the annotators of the past dynasties to restore the true nature of "Shaoyang Ruling Bone" and integrates the function of the Foot-Shaoyang meridian with the physiology, pathology, treatment principles and treatment plan of the bones on the theoretical level, so as to construct and deduce the theory of "kidney Ruling Bone" which is different from the theory of "kidney Ruling Bone" centering on viscera-image. The theory of "Shaoyang dominates the bone" is rigorously verified by scientific experiments and its mechanism is preliminarily clarified in clinical application. The corresponding "osteoporosis" is proposed, which is very similar to the so-called "bone remodeling uncoupling osteopathy" in clinical manifestation and expands its adaptability. The new knowledge of the characteristics and uses of the Foot-Shaoyang meridian and its meridians and points has enriched the basic theory of traditional Chinese medicine and bone physiology and pathology. The mechanism of "Shaoyang Zhugu" is "regulating" bone remodeling process. This "regulating" mechanism provides a new "synergistic" prevention and treatment method for osteoporosis, diabetic foot and osteolytic lesion caused by cancer. Reconstructing the dynamic balance between bone resorption and bone formation by remodeling and coupling the joint bones, adjusting its Yin and yang, damaging the excess and compensating the deficiency, is beneficial to solve the predicament faced by the simple use of anti-bone resorption agents or bone-promoting synthesizers at present, and opens up a new way for acupuncture and medicine treatment of various bone diseases in the future.
【学位授予单位】：成都中医药大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R249;R274

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