Dr. KangEditor | ShiwufollowKnee osteoarthritis (KOA)As the most common orthopedic disease, its incidence increases with age

Dr. Kang

Editor | Shiwu

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Knee osteoarthritis (KOA)As the most common orthopedic disease, its incidence increases with age.

It is reported that the prevalence of KOA in China is 8.1%, and women are higher than men. The Disease burden is gradually rising with the increase of years.

This disease belongs to the categories of "tendon obstruction" and "bone obstruction" in traditional Chinese medicine.

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Yang deficiency, as one of the constitutional types in traditional Chinese medicine, refers to a type of constitution characterized by insufficient Yuanyang in the body, with the main symptoms of deficiency cold such as fear of cold and lukewarm hands and feet,Mainly manifested in the loose and weak muscles of the body, susceptibility to wind, cold, dampness, and other aspects.

The "Su Wen Bi Lun" states: "Wind, cold, and dampness are mixed together to form Bi.

Yang deficiency constitution is the predisposing constitution of KOA. Yang deficiency constitution is one of the reasons for inducing the high expression of Sox9 gene and Co12al gene in KOA patients. In addition, Protein kinase C gene is associated with the high incidence of KOA in yang deficiency constitution.

It indicates that insufficient Yuanyang in the body can easily lead to KOA and cause imbalance of qi, blood, and body fluids.

Based on this, this article will discuss the pathogenesis, prevention and treatment of Yang deficiency KOA from three aspects: qi, blood, and body fluid.

The identification of traditional Chinese medicine constitution takes the overall constitution of a person as the research object,Conforming to the "holistic concept" of traditional Chinese medicine.

Traditional Chinese medicine constitution is divided into 9 types: peaceful constitution, qi deficiency constitution, and yang deficiency constitution.

The "Su Wen Qi Tong Tian Lun" states: "Yang Qi is like the sky and the sun," referring to the importance of Yang Qi to the human body, just like the sun, emphasizing the importance of Yang Qi to human health.

The "Su Wen Bi Lun Pian" states: "For those who are cold, there is less Yang Qi and more Yin Qi, which are beneficial to the disease, so cold is also present." It refers to the fact that cold knee Bi is caused by insufficient Yang Qi inside the body, relatively excessive Yin Qi, and the combination of external cold evil. It can be seen that the Yang deficiency constitution is closely related to KOA.

By searching CNKI, VIP Chinese science and technology journal database and Wanfang knowledge data service platform, from 2017 to now, "TCM constitution" and "knee osteoarthritis or knee Osteoarthritis or knee osteoarthritis" are the search words.

Finally, 7 epidemiological studies on traditional Chinese medicine constitution and KOA were included,The conclusion is that KOA patients have the most yang deficiency constitution, followed by blood stasis, phlegm dampness, and qi deficiency constitution.

Due to differences in factors such as geography, gender, weight, and body mass index, there are differences in research results, which are related to the simultaneous effects of innate endowment and acquired physical fitness.

1. Qi - internal yang deficiency and decline, external cold invasion

The flexible part of the human yang qi can nourish the meridians.

From this, it can be seen that the pathological manifestations of Yangqi deficiency and Yangxu qualitative KOA are interrelated.

There are two reasons. One is that the internal yang qi of the body is weakened, and qi deficiency is unable to stimulate blood flow in the limbs. The tendons lose their vitality and nourishment, leading to the loss of flexibility in the knee joint tendons and the development of KOA.

And yang deficiency leads to poor luck, and qi and blood lose nourishment,One of the typical causes of pain and stiffness in KOA is the internal cause, which leads to "pain if not honored".

According to the "Classification of Symptoms and Treatments", "All types of Bi are caused by the deficiency of the camp and the guard, the lack of dense striae, the internal invasion of wind, cold, and dampness, and the formation of Bi over time.

Professor Li Shenghua believes that after middle age, the deficiency of yang qi weakens, and the failure of the Rongwei to solidify is the internal foundation. Wind, cold, dampness, and evil factors, taking advantage of the deficiency, attack the joints and block the muscles and veins, which is an external condition that leads to KOA.

However, the deficiency of body yang cannot timely warm up the pathogenic factors of cold and dampness, causing the accumulation of water, dampness, phlegm, and blood stasis, and obstruction of muscles and veins. Over time, it eventually forms tangible pathogenic factors such as phlegm, blood stasis, and stones, leading to the formation of knee joint effusion, osteophytes, and other forms. "Failure to do so leads to pain," which is an external cause.

2. Blood - loss of yang circulation in blood, deficiency and stasis cementation

This indicates that the joints of the limbs are nourished by blood and can function normally.

If prolonged illness results in Qi and blood depletion or insufficient blood production, and muscles and joints lack Qi and blood for warmth and nourishment, resulting in limb weakness and weakness.

The book "Origin and Flow of Miscellaneous Diseases: Rhinoceros Candle - Origin and Flow of Various Bi Diseases" states: "Bi is the source of obstruction. The three Qi are mixed and block the meridians, causing Qi and blood to fail. Over time, it becomes Bi", which corresponds to the viewpoint proposed in "Medical Forest Correction of Errors" that "stasis of blood leads to Bi".

The clinical manifestations of yang deficiencyCommon features such as a pale complexion, pale lips, and lukewarm hands and feet are often related to the lack of blood nourishment,Therefore, the KOA of yang deficiency can be demonstrated from the perspective of "blood".

There are three reasons for this: one is kidney water: blood does not fill the bone, and the bone is not aligned. The kidney governs the bone, and kidney yang is the foundation of a body's yang energy. "The" Simple Questions - Meridian Essentials "section states:" The bone is the mansion of the marrow, and cannot stand for a long time. If it moves, it will be shaken off, and the bone will be exhausted

Essence and blood are of the same origin. Deficiency of kidney yang results in insufficient essence and blood to replenish, while deficiency of essence and blood results in weak bones and unstable movements. This is called deficiency: Yuanyang is not warm, blood stasis occurs in the veins, and there is no way to nourish the bone marrow, which is called stasis,As a result, it causes symptoms such as fatigue, pain, and limited mobility in KOA patients.

Both liver wood: blood does not nourish tendons, and tendons are not soft.

The liver governs the tendons, and the liver is the organ that stores blood. The normal function of the tendons cannot be achieved without the nourishment and nourishment of the blood. KOA patients with yang deficiency syndrome have a lukewarm yuan yang, inappropriate gasification, and insufficient qi and blood transformation. The liver's blood storage function is not regulated, and it cannot nourish the tendons and meridians normally.

Deficiency: Yang deficiency leads to loss of circulation, blood stasis in the liver but not in the liver, resulting in blood stasis,As a result, the tendon loses its flexibility, causing cartilage wear and tendon and ligament damage in KOA patients.

The spleen soil of the three: blood does not fill the flesh, and the flesh is not healthy. The spleen governs the muscles, and serves as the source of qi and blood biochemistry. Spleen yang deficiency leads to the transformation of qi and blood into a source of deficiency, and the inability to nourish the muscles leads to deficiency, leading to common knee joint weakness and weakness in KOA.

In addition, the spleen governs the circulation and transformation, spleen yang deficiency, and imbalance in the circulation and transformation of water and dampness accumulate in the joints, resulting in blood stasis,Induce knee joint pain and swelling.

3. Body fluid - Yang does not transform fluid, evil stagnates bone joints

According to the book "Lingshu Jue Qi", "When the valley enters, the Qi fills the swamp and is injected into the bones. The bones belong to the category of flexion and extension, which is called liquid

The spleen governs the circulation of body fluids, and the spleen governs the limbs. Jin is a relatively clear and thin water in the body that plays a moisturizing role, while fluid is a relatively thick part that plays a lubricating role. Knee joint fluid is relatively viscous and perfused into the joint cavity, playing a lubricating and buffering role in the joints. Therefore, joint fluid is closely related to the spleen.

Insufficient joint fluid in the joint cavity,The friction between bones increases, accelerating cartilage degeneration, and making the patient's pain more pronounced, leading to an aggravation of KOA.

Therefore,Yang deficiency KOA is mainly related to spleen and soil based on the differentiation of "body fluid".

The spleen governs fluid circulation, promotes fluid metabolism, balances spleen yang, and is sufficient to warm up water and qi, transport body fluids, and maintain normal body fluid metabolism. The joint fluid is abundant, sufficient to smooth joints and ensure normal circulation.

KOA patients with yang deficiency syndrome have insufficient spleen yang, abnormal warming, and insufficient body fluid circulation, resulting in a scarcity of joint fluid and insufficient lubrication of the joints, leading to joint wear and degradation.

Deficiency: Yang deficiency is bad, body fluid metabolism is abnormal, and the constant stimulation of wear causes Osteoarthritis Synovitis,Pathological synovial fluid accumulation leads to joint swelling and pain, resulting in blood stasis.

1. Qi - warming yang and tonifying qi, dispelling cold and unblocking arthralgia

The "Su Wen Bi Lun Pian" states: "Any type of Bi, when encountering cold, it is urgent, and when encountering heat, it is longitudinal" refers to any type of Bi disease. When encountering cold, it is urgent, and when encountering heat, it is relaxed,It is suggested that warming yang and tonifying qi, dispelling cold and unblocking obstruction should be used as the treatment method for KOA due to yang deficiency.

In terms of internal treatment, Yang Gongxu believes that KOA can be used to treat yang deficiency caused by aversion to cold and increased pain in the knee jointGuizhi Fuzi TangAdding or subtracting can warm the yang and dispel evil, and harmonize the camp and health.

Professor Deng Jinfeng believes that the occurrence of KOA due to Yang deficiency is more common in cold arthralgia, and advocates the use of Cinnamomum twig, Aconite, Asarum, Ephedra, and Ginger to warm and dissipate cold, enhance Yang Qi, and improve Yang deficiency constitution.

Jin Wei et alThe use of Juanbi Tang, which can warm yang and replenish fire, disperse cold and remove dampness, has achieved certain results in the treatment of mild to moderate KOA with cold dampness obstruction type.

In terms of external governance, the Huangdi Neijing believes that.

KOA.

Therefore,KOAThe main treatment methods include warming yang, tonifying qi, dispelling cold and unblocking arthralgia.

2. Blood - warming yang, nourishing blood, promoting blood circulation and resolving stasis

The basic pathogenesis of Yang deficiency in KOA is the loss of blood circulation and the consolidation of deficiency and stasis, which is treated from the perspective of "blood",.

KOA.

In terms of internal treatment, Professor Li Shenghua often supplements kidney tonifying therapy with regulating qi and dispersing cold for KOA with blood stasis and obstruction,.

KOA.

In terms of external treatment, Jiao Yong and others discovered that.

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Therefore,KOA.

3. Body fluid - Warm Yang Hua Ye, Yun Hua Xie Zhi

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In terms of internal treatment, Ma Zengwei uses a self-designed formula for promoting blood circulation and promoting diuresis, which is composed of Poria cocos, Alisma orientalis, tangerine peel, Chuanxiong, Achyranthes bidentata, turmeric, licorice, etc,KOA.

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Therefore,KOA.

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Actively using warming yang and tonifying qi, promoting blood circulation and resolving stasis, promoting diuresis and reducing swelling as the core treatment methods, and using Xin Gan divergent warming yang products for internal treatment to support Yuanyang,External treatment: acupuncture, moxibustion, fire dragon moxibustion, warm acupuncture and moxibustion, traditional Chinese medicine fumigation and washing.

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KOA.

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