基于“阳化气，阴成形”理论探讨阳和汤加减治疗阳虚寒凝型膝关节骨关节炎

Discussion on Modified Yanghe Decoction in Treating Knee Osteoarthritis of Yang Deficiency and Cold Coagulation Pattern Based on the Theory of “Yang Transforms Qi, Yin Forms Shape”

摘要: 膝骨性关节炎(Knee osteoarthritis, KOA)是一种常见的慢性、退行性骨关节疾病，临床上主要表现为关节疼痛、肿大、活动受限等，严重的还影响着患者的健康及生活质量。古人并没有膝骨性关节炎这一病名，虽历代名称不同但对其临床表现的认识基本一致，将其归于“膝痛”“腿疼”“膝痹”等范畴。基于《黄帝内经》中“阳化气，阴成形”的理论，认识到阴阳的平衡是人体不生病的关键。若阴阳失去平衡，机体则发病。本文立足于此理论，发现阳化气不足、阴成形太过是KOA发病的关键病机。针对此类证型的膝关节炎患者，临床治疗中温通阳气应贯穿始终，同时针对“阴成形”太过，还应散寒通络。

Abstract: Knee osteoarthritis (KOA) is a common chronic degenerative osteoarthropathy, clinically manifested mainly as joint pain, swelling and limited movement, which seriously impairs patients’ physical health and quality of life. There was no specific nomenclature for knee osteoarthritis in ancient Chinese medical texts, and it was categorized under knee pain, leg pain, knee bi syndrome and other syndromes in different dynasties despite variant names, yet ancient physicians held consistent understandings of its clinical manifestations. Based on the Huangdi Neijing theory of “Yang Transforms Qi, Yin Forms Shape”, the balance between yin and yang is the core prerequisite for human body to stay free of diseases; imbalance of yin and yang will trigger illness. Rooted in this theory, this paper proposes that insufficient yang transforming qi and excessive yin forming shape are the core pathogenesis of KOA. For KOA patients presenting this pattern, warming and unblocking yang qi should run through the whole course of treatment, and dispersing cold and unblocking collaterals should be supplemented to counteract excessive “yin forms shape”.