骨质疏松症中医脾虚病机认识的现代医学基础

现代医学的研究表明,骨质疏松症是遗传因素和环境因素共同参与的多因素复杂疾病.环境因素中,营养、运动、饮酒等个人后天生活方式是决定疾病发生与发展的重要因素,因此在骨质疏松症的预防方面,尤宜重视营养与运动等生活方式.这些环境因素在中医看来,它们与中医"脾主运化"及"脾合肌肉主四肢"的生理机能密切相关,与中医对骨质疏松症是以脾虚为本的病机认识趋于一致.本文从现代医学认为的引起骨质疏松的环境因素方面,探讨了脾虚在骨质疏松发生和发展中的关键作用,目的 在于促进对骨质疏松症的中西医认识与沟通,深化中医对骨质疏松症是以脾虚为本的病机认识,为提高中医防治骨质疏松症的防治效果提供参考与帮助.     

筋骨平衡在骨质疏松症防治中的意义

筋骨并重理论是中医骨伤科学重要的基础理论，阐释了筋骨之间生理联系、病理相关的机制，对中医学“以筋养骨”等治疗理念起到了推动性的作用，“筋束骨利关节”高度概括了两者的关系。骨质疏松症(osteoporosis, OP)筋-骨系统力学生物学特性失衡，这与现代医学所讲的力学源性平衡因素改变如出一辙。本文通过对人体力学平衡特点和OP患者筋骨失衡的力学源性分析，综述了力学对OP患者骨生物力学特性的改变，以此为临床上通过力学干预OP提供了可靠依据，并在“筋骨并重”“动静结合”等理论指导下，更好地应用于临床，具有一定意义。     

基于生命四时调理脾胃探析骨质疏松症“治未病”理念

骨质疏松症发病广泛,其"治未病"意义重大。生命四时,少、壮、中、老,长、壮、衰、亡,构成阳气升降一生命循环,为四季变化之延长。其中,脾土主四时,掌生命终始。生命中期之前,脾土顺阳气之升发,承载筋骨生长,奠定基石,防变于先,生命中期之后,脾土顺阳气潜藏,厚纳以封藏精微,稳固筋骨,缓病之势。故生命四时不同,脾胃所主不一,形成了骨质疏松症独特的"未病先防、既病防变"理念。笔者认为,儿少发陈,温升脾土,条达肝木;壮硕之年,温补脾阳,助阳宣泄;中老之年,润脾降胃,容平阳气;年老之时,酸甘敛藏,固元纳气,防病之要义。     

国医大师张琪教授治疗肾病注重调脾胃的学术思想

<正>张琪教授重视调脾胃的理论,起源于《黄帝内经》。《内经》云:"人以胃气为本,有胃气则生,无胃气则死"。脾胃为后天之本,为气血生化之源,为人体气机升降之枢纽。《内经》云:"胃为水谷之海,气血生化之源,脏腑经络之根。""五脏六腑皆禀气于胃"。因此,张琪教授临证中,非常注重对脾胃的调护。1诊病问疾,首调脾胃张琪教授临证问诊,以问消化为先,常问大便及饮食情况,若有脾胃不和,则先调脾胃。脾胃健旺,水     

从“治痿独取阳明”论治脾肾两虚型老年性骨质疏松症

老年性骨质疏松症(senile osteoporosis,SOP)是一种以骨量减少和骨微结构破坏为特征的老年全身退化性骨病,以致骨的强度降低,骨脆性增加,骨折发生风险较高。SOP属于祖国医学中"骨痿"、"痿证"、"骨枯"等范畴,该病以肝、脾、肾三脏虚损为本,脾肾两虚证是SOP较为常见的证型。目前关于脾肾两虚型SOP是以肾虚为主要病机,补肾健骨成为主要治法,而从脾胃方面论治本病的相关研究较少。本文首次从"治痿独取阳明"角度论治脾肾两虚型SOP,补益中焦脾胃以益肾,并滋养脏腑,改善机体营养状况,为防治本病提供新的思路。     

补土派对骨伤科的影响

土者生万物而法天地,李东垣认为土为万物之母,脾胃为生化之源。人之一身,生死系乎脾胃,脾为后天之本,人以胃气为本。所以东垣独重脾胃,引经立论,并擅于温补脾胃之法,世人称为补土派,东垣为其主要代表。     

中医从脾论治原发性骨质疏松症的研究进展

骨质疏松症是一种以骨量低下,骨微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病。当前实验研究及临床观察对原发性骨质疏松症以肾虚为主要病机,补肾为主要治法形成普遍认识,而脾虚对本病的影响研究相对较少。根据中医学对骨质疏松症病因病机特点的认识,结合现代医学对中医药治疗骨质疏松症的研究,对骨质疏松症的防治要按照中医的理法方药进行辩证论治,因证施治,不能简单地治疗某一脏一腑,要看到骨质疏松症的复杂性和难治性。从传统医学中脾对骨质疏松症的认识到脾脏与骨质疏松症关系的实验研究再到健脾补肾的临床观察,无不表明脾虚在原发性骨质疏松症的重要地位。肾虚为骨质疏松症的主要病机,补肾滋肾的治疗总则固然重要,与此同时必须要重视补益脾胃。     

基于“重阳思想”论原发性骨质疏松症的病因病机与治疗

原发性骨质疏松症是一种常见的慢性代谢性疾病,严重影响中老年人群的生存质量。但西药治疗原发性骨质疏松症不良反应较多,因此应当发挥中医药治疗原发性骨质疏松症的优势。中医认为肾为先天之本,藏精,生髓,在体合骨;脾为后天之本,在体合肉,主四肢,为气血生化之源;脾肾二脏具有先后天相互资助的关系,二者功能的正常发挥有赖于阳气的激发、推动。"重阳思想"作为中医认识疾病的重要思想理论之一,其核心思想为阳主阴从观,认为治疗疾病应注重顾护阳气,并善用温阳之品。该文从"重阳思想"的角度出发探讨脾肾阳虚与原发性骨质疏松症发生的关系,结合现代医学对温肾健脾中药治疗原发性骨质疏松症的疗效及作用机制进行阐释,认为治疗原发性骨质疏松症应重视温肾健脾。由于目前相关作用机制的研究尚且不足,认为今后可以加强对温肾健脾中药治疗原发性骨质疏松症作用机制的研究,并发掘中医理论与现代科学的结合之处,以发扬中医药理论的优势。     

“健脾胃”应贯穿于损伤治疗的始末

脾胃为后天之本,“脾主运化,胃主受纳。”脾胃功能健全与否与损伤的恢复至关重要。《素问·太阳阳明论篇第二十九》说：“脾病不能为胃行其津液,四肢不得禀水谷气,筋骨肌肉,皆无气以生,故不用焉。”皮肉乃人身之门户,损伤之症皮肉首当其冲,内治不是用辛温有毒之品活血祛瘀,就是过用寒凉凉血止血。内伤外损而致脾胃虚弱,饮食减少,化源不足,经脉失养,组织难于康复。笔者认为,在治疗损伤的临床实践中要自始至终注意健脾胃,下面略述管见。     

中医药从脾论治骨质疏松症

摘要：中医药防治骨质疏松症是医学领域研究的热点，临床从脾、肾论治多获良效，其机制研究也逐渐开展。脾虚是骨质疏松症发病的基础，益气健脾法以“资四肢形骸、丰肌肉筋骨”为旨，在缓解临床症状、改善骨密度、调节骨代谢平衡等方面具有显著作用。愈来愈多的基础研究表明，益气健脾法可通过调节内分泌、神经、运动、消化、循环等系统发挥抗骨质疏松作用。为进一步挖掘从脾论治骨质疏松症的临床价值与科学内涵，笔者从中医经典理论、临床研究与基础实验方面综述益气健脾法抗骨质疏松的疗效及可能机制，以期拓宽中医药防治骨质疏松症的研究思路。     

Pulsating varicose veins!! The diagnosis lies in the heart

Right heart failure is associated with increased systemic venous pressure, which can be diagnosed clinically with the findings of elevated jugular venous pressure, pulsatile liver and distinctive cardiac murmurs (precordial systolic). Severe tricuspid regurgitation (TR) has occasionally been known to lead to marked pulsation of varicose veins. We report three cases that were referred to the vascular clinic of Royal Perth Hospital in which the patients involved had unilateral (right leg) varicose veins and chronic venous ulcers. On clinical examination all three patients had pulsations along the course of the varicose long saphenous vein up to the mid calf. The main differential diagnosis was arterio-venous malformation, which was excluded by compression of the sapheno-femoral junction and demonstrating absence of pulsation in the long saphenous vein. A venous duplex scan showed a grossly incompetent sapheno-femoral junction with abnormal wave forms. Two of the cases were managed conservatively with compression dressing. The option of sapheno-femoral junction ligation was reserved in one patient who had unsettling cellulitis and oedema of the lower limb in spite of compression dressing and optimal conservative management. All three patients had improvement in ulcer size at 3-month follow up with compression therapy. This article highlights that in cases of right heart failure the venous pressures can be felt as low as the mid calf level and that can be a cause of the venous ulcers. There should be a high suspicion of right heart failure in patients with late onset venous insufficiency.     

True lies — photographic misinterpretation in plastic surgery

Consistent photographic technique pre and postoperatively is essential in plastic surgery. Poor and nonuniform technique can give misleading results or some tricks can be used on purpose to improve results. For a plastic surgeon it is important to know and recognize these tricks to objectively evaluate photographs. The most important factors for uniform photographic technique are: light, lens, distance, background, and patient's position. In the future 3D cameras connected to a personal computer will give more possibilities to objectively quantify results in plastic surgery.This paper was presented at the 7th euraps (innsbruck Australia 16.-19.5.96) and at the XXVI Scandinavian. Congress of Plastic Surgery (Stockholm, Sweden 13.16.6.96).