以唐宋方书探析中药治疗膝骨关节炎的地域差异研究

Exploring Regional Differences in Traditional Chinese Medicine Treatment for Knee Osteoarthritis Based on Tang and Song Dynasty Formulary Literature

摘要: 目的：挖掘唐宋时期膝痹南北地域用药差异，为膝骨关节炎中医因地制宜辨证施治提供文献依据。方法：以《备急千金要方》《外台秘要》《太平圣惠方》《圣济总录》《济生方》《普济本事方》唐宋医籍中膝痹相关内服方剂为研究对象，按照纳入、排除标准筛选有效方剂186首，其中北方方剂98首，南方方剂88首。建立药物数据库，规范药名，统计南北区域高频药物、药类构成与核心药对，对比地域病机及用药规律。结果：北方膝痹以阳虚寒湿为主要病机，高频药物多为温阳散寒、祛风燥湿、补肾壮骨之品；南方膝痹以湿热痹阻、阴血亏虚为核心，高频药物集中于清热利湿、舒筋通络、养血养阴类；牛膝为南北共用高频引经药。结论：唐宋医家治疗膝痹体现“天人相应、因地施治”思想，南北病机与方药配伍差异显著，可为当代膝骨关节炎个体化、地域化辨证治疗提供古文献参考。

Abstract: Objective: To explore the regional differences in medication for knee impediment (knee bi) between northern and southern China during the Tang and Song dynasties, and to provide textual evidence for syndrome-based treatment tailored to local conditions in contemporary knee osteoarthritis management. Methods: We selected 186 oral formulas for knee impediment from six Tang–Song medical texts (Beiji Qianjin Yaofang, Waitai Miyao, Taiping Shenghui Fang, Shengji Zonglu, Jisheng Fang, and Puji Benshi Fang), among which 98 were from northern regions and 88 from southern regions. A drug database was established, with standardized drug names. We statistically analyzed high-frequency drugs, drug category compositions, and core drug pairs in both regions, and compared regional pathogenic mechanisms and medication patterns. Results: In the north, the core pathogenesis of knee impediment was Yang deficiency with cold‑dampness, and high‑frequency drugs were mainly those that warm Yang, disperse cold, expel wind and dry dampness, and tonify the kidney and strengthen bones. In the south, the predominant pathogenesis was damp‑heat obstruction and yin‑blood deficiency, with high‑frequency drugs concentrated in clearing heat and draining dampness, relaxing sinews and unblocking collaterals, and nourishing blood and yin. Achyranthes root (Niuxi) was the common high‑frequency guiding herb in both regions. Conclusion: Tang–Song physicians treated knee impediment in accordance with the principle of “correspondence between heaven and humanity and treatment according to locality.” The significant differences in pathogenesis and herbal compatibility between north and south provide ancient textual references for individualized and regionally‑adapted syndrome differentiation in contemporary knee osteoarthritis care.