基于平调阴阳理论防治糖皮质激素性骨质疏松症

糖皮质激素性骨质疏松症（glucocorticoid osteoporosis,GIOP）是长期或过量使用糖皮质激素,从而影响骨重建过程造成的。依据糖皮质激素在体内的生理病理作用和动态变化,中医学认为糖皮质激素造成的机体阴阳失衡是GIOP发病的根本原因;病变关键在肾,肾阴阳失衡是病机发展转化的核心,表现为“肾阴虚-肾阳虚-肾阴阳两虚”的演变规律;脏腑亏虚,气血阻滞,骨骼失养是核心病机,病理变化始终强调动态性和复合性。据此确立“平调阴阳”的治疗大法,基于平调肾阴阳理论防治GIOP,一方面强调平调阴阳一定是一个动态平衡过程,另一方面在平调肾阴阳的同时调节一身阴阳的平衡以病证结合、辨证论治,并平调原发病之阴阳以治未病,最终达到阴阳平衡、血脉通利、筋骨得养的状态。现代研究表明细胞自噬是阴阳动态平衡的微观机制,是“平调阴阳”法改善GIOP的防治靶点。可见,平调阴阳是临床防治GIOP的一个重要思路。

Prevention and treatment of glucocorticoid osteoporosis based on the theory of regulating Yin and Yang

Glucocorticoid osteoporosis (GIOP) is caused by long-term or excessive use of glucocorticoids, which affects the process of bone reconstruction. This paper summarizes the research progress of GIOP from the physiological and pathological functions of glucocorticoids, as well as its dynamic changes. It is found that the imbalance of yin and Yang caused by glucocorticoids was the root cause of the onset of GIOP. The key of pathological changes is kidney. The imbalance of kidney yin and Yang is the core of pathogenesis development and transformation, which shows the evolution law of "deficiency of kidney yin - deficiency of Kidney Yang - deficiency of kidney yin and Yang". The keys of GIOP are three: deficiency of internal Zang-Fu, stagnation of Qi and blood, loss of nourishment of bones. Stage and compound are emphasized throughout this process. According to the research above, the treatment method of "regulating yin and Yang horizontally" is established. On the one hand, we emphasize that regulating yin and Yang horizontally must be a dynamic balance process. On the other hand, to achieve the balance of yin and Yang of the whole body at the same time of regulating kidney yin and Yang horizontally, and regulate the Yin and Yang of the primary disease. Finally, the balance of yin and Yang, the circulation of qi and blood, the nourishment of muscles and bones are achieved. It has been confirmed that autophagy is the micro mechanism of the dynamic balance of yin and Yang, and it is also the target of "regulating yin and Yang equally" to improve the prevention and treatment of GIOP. Therefore, regulating yin and Yang is an important way to prevent and treat GIOP.