李东垣“骨痿”病与肾性骨病临证探讨

许勇镇1，丘余良 2，阮诗玮 2

1.福建中医药大学，福建 福州 350108；2.福建中医药大学附属人民医院，福建 福州 350004摘要：李东垣著述多处论及“骨痿”发病及治疗。本文对李氏所论骨痿发病机理予以阐发并总结，指出李氏所论骨痿病机分湿热成痿、阴盛阳极、阴盛阳虚三端。结合临床实际观察，认为李氏所论“骨痿”在病名、临床表现及发病机制方面，均与慢性肾病并发肾性骨病有相似之处，故提出肾性骨病可从骨痿进行论治，具体以升阳除湿、清燥救肾、补益元气、泻其阴火、升阳举陷、祛风除湿为治法。关键词：李东垣；骨痿；肾性骨病；临证探讨

DOI：10.3969/j.issn.1005-5304.2017.11.026

中图分类号：R272.968 文献标识码：A 文章编号：1005-5304(2017)11-0106-04

Discussion on LI Dong-yuan’s Theory of “Atrophic Debility of Bones” and TCM Clinical Syndrome of Renal Osteopathy

XU Yong-zhen1, QIU Yu-liang2, RUAN Shi-wei2 (1. Fujian University of Traditional Chinese Medicine, Fuzhou 350108, China; 2. Fujian Province People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China)

Abstract: LI Dong-yuan discussed the pathogenesis and treatment of “atrophic debility of bones” in his writings. This article explained and summarized the pathogenesis of atrophic debility of bones in LI’s works. LI held that the pathogenesis of atrophic debility of bones is divided into damp-heat, overabundant yin leading to yang hyperactivity, and overabundant yin leading to insufficient yang. Combined with clinical observation, this article considered that the LI’s atrophic debility of bones is similar to renal osteopathy in terms of disease name, clinical manifestation and pathogenesis. Therefore it put forward to the treatment of renal osteodystrophy from LI’s theory. The methods of treatment were invigorating splenic yang and dehumidify, moistening dryness and tonifying kidney, replenishing qi, purging yin fire, raising yang and lifting prolapsed zang-fu organs, and expeling wind and removing dampness.

Key words: LI Dong-yuan; atrophic debility of bones; renal osteopathy; discussion on clinical syndromes

肾性骨病及矿物质代谢紊乱不仅是慢性肾功能衰竭（chronic renal failure，CRF）特别是透析患者的常见并发症，也是导致多系统损害的重要原因，严重影响患者的生活质量及疾病预后。目前现代医学主要 针对肾性骨病的症状及钙磷代谢紊乱进行治疗，虽能部分改善患者症状，但临床远期疗效不理想，且存在药物价格昂贵等诸多问题。因此，如何在肾性骨病的防治上发挥中医药治疗优势显得十分重要。纵观李东垣著述，多有对“骨痿”发病及治疗的阐发，而肾性骨病在症状表现、病因及病机方面与李氏所论“骨痿”亦有诸多类似之处，故笔者结合李氏观点对肾性骨病的治疗作进一步探析，以期对肾性骨病临证有所裨益。