[1]赵千乐,袁普卫△,刘德玉,等.基于《金匮要略》血痹理论探讨线粒体自噬与氧化应激调节在膝骨关节炎治疗中的作用[J].中国中医骨伤科杂志,2026,34(08):72-78.[doi:10.20085/j.cnki.issn1005-0205.260810]
 ZHAO Qianle,YUAN Puwei,LIU Deyu,et al.Exploring the Role and Mechanism of Mitophagy and Oxidative Stress Regulation in the Treatment of Knee Osteoarthritis Based on the Blood Impediment Theory in Synopsis of the Golden Chamber[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2026,34(08):72-78.[doi:10.20085/j.cnki.issn1005-0205.260810]
点击复制

基于《金匮要略》血痹理论探讨线粒体自噬与氧化应激调节在膝骨关节炎治疗中的作用()

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第34卷
期数:
2026年08期
页码:
72-78
栏目:
经验交流
出版日期:
2026-08-10

文章信息/Info

Title:
Exploring the Role and Mechanism of Mitophagy and Oxidative Stress Regulation in the Treatment of Knee Osteoarthritis Based on the Blood Impediment Theory in Synopsis of the Golden Chamber
文章编号:
1005-0205(2026)08-0072-07
作者:
赵千乐1袁普卫1△刘德玉2康武林2杨波2董佩1赵泽龙1李学同1尚辉1
1陕西中医药大学(陕西 咸阳,712046)
2陕西中医药大学附属医院
Author(s):
ZHAO Qianle1YUAN Puwei1△LIU Deyu2KANG Wulin2YANG Bo2DONG Pei1ZHAO Zelong1LI Xuetong1SHANG Hui1
1Shaanxi University of Chinese Medicine,Xianyang 712046,Shaanxi China; 2Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,Shaanxi China.
关键词:
膝骨关节炎 金匮要略 血痹理论 线粒体自噬 氧化应激 中医药治疗
Keywords:
knee osteoarthritis Synopsis of the Golden Chamber blood impediment theory mitophagy oxidative stress traditional Chinese medicine treatment
分类号:
R684.3
DOI:
10.20085/j.cnki.issn1005-0205.260810
文献标志码:
A
摘要:
膝骨关节炎是全球高发的慢性退行性关节疾病,其临床发病机制尚未完全阐明。近年研究表明,软骨细胞线粒体自噬失调与氧化应激失衡形成的恶性循环,是膝骨关节炎进展的核心病理环节。中医药在膝骨关节炎治疗中具有独特优势,《金匮要略》血痹理论以 “本虚标实” 为核心病理模型,其中 “本虚” 可对应线粒体功能衰退、抗氧化能力下降的病理基础,“标实” 则与线粒体自噬及氧化应激失衡的病理状态相契合。基于血痹理论,结合现代医学研究成果,通过文献梳理与理论推演,推测中医药可能通过调节线粒体自噬与氧化应激平衡、打破二者恶性循环发挥干预作用,以期为膝骨关节炎的中医药治疗思路拓展及机制研究提供参考。
Abstract:
Knee osteoarthritis(KOA)is a globally prevalent chronic degenerative joint disease,whose clinical pathogenesis has not been fully elucidated.Recent studies have shown that the vicious cycle formed by the dysregulation of chondrocyte mitophagy and the imbalance of oxidative stress constitutes the core pathological link in the progression of KOA.Traditional Chinese medicine(TCM)has unique advantages in the treatment of KOA.The blood stasis theory from Synopsis of the Golden Chamber takes “deficiency at the root and excess in branch” as its core pathological model,wherein “deficiency in root” can correspond to the pathological basis of mitochondrial dysfunction and decreased antioxidant capacity,while “excess in branch” reflects the pathological state of mitophagy dysregulation and oxidative stress imbalance.Based on the blood impediment theory and combined with modern medical research findings,this paper—through a literature review and theoretical analysis—proposes that TCM may exert therapeutic effects by regulating the balance between mitophagy and oxidative stress and disrupting their vicious cycle,thereby providing a theoretical foundation for expanding TCM treatment strategies and mechanistic research on KOA.

参考文献/References:

[1] 中华医学会物理医学与康复学分会,四川大学华西医院.中国膝骨关节炎康复治疗指南(2023版)[J].中国循证医学杂志,2024,24(1):1-14.
[2] CHENG N T,MENG H,MA L F,et al.Role of autophagy in the progression of osteoarthritis:the autophagy inhibitor,3-methyladenine,aggravates the severity of experimental osteoarthritis[J].International Journal of Molecular Medicine,2017,39(5):1224-1232.
[3] 裘宗华,杨泽,夏永良,等.从营卫理论探讨血痹证治与病传规律[J].浙江中医药大学学报,2023,47(11):1275-1279.
[4] 王亚东,杜义斌.戴丽三自拟姜桂苓半汤治疗血痹证经验总结[J].中国民族民间医药,2017,26(16):75-76.
[5] 李西海,刘献祥.骨关节炎的核心病机——本痿标痹[J].中医杂志,2014,55(14):1248-1249.
[6] 中华中医药学会.膝骨关节炎中西医结合诊疗指南(2023年版)[J].中医正骨,2023,35(6):1-10.
[7] SHIN H J,PARK H,SHIN N,et al.Pink1-mediated chondrocytic mitophagy contributes to cartilage degeneration in osteoarthritis[J].Journal of Clinical Medicine,2019,8(11):1849.
[8] CAO H,ZHOU X C,XU B W,et al.Advances in the study of mitophagy in osteoarthritis[J].Journal of Zhejiang University:Science B,2024,25(3):197-211.
[9] ZHANG S L,ZHANG K S,WANG J F,et al.Corresponding changes of autophagy-related genes and proteins in different stages of knee osteoarthritis:an animal model study[J].Orthopaedic Surgery,2022,14(3):595-604.
[10] TAMATTA R,PAI V,JAISWAL C,et al.Neuroinflammaging and the immune landscape:the role of autophagy and senescence in aging brain[J].Biogerontology,2025,26(2):52.
[11] GUO P C,ALHASKAWI A,ADEL ABDO MOQBEL S,et al.Recent development of mitochondrial metabolism and dysfunction in osteoarthritis[J].Frontiers in Pharmacology,2025,16:1538662.
[12] LI L,LI J,LI J J,et al.Chondrocyte autophagy mechanism and therapeutic prospects in osteoarthritis[J].Frontiers in Cell and Developmental Biology,2024,12:1472613.
[13] DENG Y G,HOU M Z,WU Y B,et al.SIRT3-PINK1-PKM2 axis prevents osteoarthritis via mitochondrial renewal and metabolic switch[J].Bone Research,2025,13:36.
[14] XING L F,CHEN X L,GUO C Q,et al.Electroacupuncture exerts chondroprotective effect in knee osteoarthritis of rabbits through the mitophagy pathway[J].Journal of Pain Research,2023,16:2871-2882.
[15] YE H X,LI D Q,WEI X,et al.Focused low-intensity pulsed ultrasound alleviates osteoarthritis via restoring impaired FUNDC1-mediated mitophagy[J].iScience,2023,26(10):107772.
[16] ANSARI M Y,BALL H C,HAQQI T M.Mitochondrial dysfunction in osteoarthritis:from risk factors to therapeutic targets[J].Frontiers in Aging,2024,5:1344892.
[17] LIAO C R,WANG S N,ZHU S Y,et al.Advanced oxidation protein products increase TNF-α and IL-1β expression in chondrocytes via NADPH oxidase 4 and accelerate cartilage degeneration in osteoarthritis progression[J].Redox Biology,2020,28:101306.
[18] WEI Y Y,QIAN H,ZHANG X Y,et al.Progress in multi-omics studies of osteoarthritis[J].Biomarker Research,2025,13(1):26.
[19] KIM D,CHOI K N,PARK J I,et al.Role of advanced glycation end products and mitohormesis in cancer development and progression[J].Antioxidants,2025,14(10):1165.
[20] MA Y Y,PANG Y D,LIU C L,et al.Mitochondria relay cholesterol signal exacerbates osteoarthritis in mice[J].Nature Communications,2025,16:10123.
[21] TAN S Y,SUN Y J,LI S X,et al.The impact of mitochondrial dysfunction on osteoarthritis cartilage:current insights and emerging mitochondria-targeted therapies[J].Bone Research,2025,13:77.
[22] PALADA V,SIDDIQAH AHMED A,HUGO A,et al.Expression of mitochondrial TSPO and FAM173B is associated with inflammation and symptoms in patients with painful knee osteoarthritis[J].Rheumatology,2021,60(4):1724-1733.
[23] HE G,ZHANG Y,LI X,et al.ROS-mediated apoptosis in IL-1β-induced mouse chondrocytes:implications for osteoarthritis[J].Journal of Orthopaedic Research,2025,43(3):456-465.
[24] DURÁN-SOTUELA A,FERNANDEZ-MORENO M,SUÁREZ-ULLOA V,et al.A meta-analysis and a functional study support the influence of mtDNA variant m.16519C on the risk of rapid progression of knee osteoarthritis[J].Annals of the Rheumatic Diseases,2023,82(7):974-984.
[25] 张城铭.黄芪桂枝五物汤加减治疗膝骨性关节炎(气滞血瘀型)疗效观察[D].济南:山东中医药大学,2024.
[26] ZHAO J L,LIANG G H,PAN J K,et al.Efficacy of Duhuo Jisheng decoction for treating cold-dampness obstruction syndrome-type knee osteoarthritis:a pooled analysis[J].BioMed Research International,2022:2350404.
[27] 谷金玉,李凯明,林承宇,等.独活寄生汤治疗膝骨关节炎的Meta分析[J].世界中医药,2023,18(3):355-360.
[28] 吴琨,李博,闫秀娟,等.七福饮合通窍活血汤对气血亏虚型血管性痴呆老年患者的治疗效果及其对神经功能、脑血流量的影响[J].川北医学院学报,2023,38(12):1685-1688.
[29] 张杼惠.基于ROS/TXNIP/NLRP3通路介导的心肌细胞焦亡探讨柴胡三参胶囊对心肌缺血再灌注损伤的作用机制[D].长沙:湖南中医药大学,2022.
[30] 刘小峰,刘亚兰,储旭东,等.线粒体相关功能障碍在骨代谢研究中的作用机制进展[J].中国骨质疏松杂志,2025,31(8):1212-1217.
[31] HU Y S,ZHOU Q L,LIU T L,et al.Coixol suppresses NF-κB,MAPK pathways and NLRP3 inflammasome activation in lipopolysaccharide-induced RAW 264.7 cells[J].Molecules,2020,25(4):894.
[32] XU Q Q,KONG H X,REN S,et al.Coix seed oil alleviates synovial angiogenesis through suppressing HIF-1α/VEGF-A signaling pathways via SIRT1 in collagen-induced arthritis rats[J].Chinese Medicine,2023,18(1):119.
[33] HAN C Y,KANG Y X,FAN G T,et al.Protective effects of smilax glabra roxb on carbon tetrachloride induced rat acute liver injury by inhibiting the activation of the NLRP3 inflammasome[J].Indian Journal of Pharmaceutical Sciences,2021,83(2):269-277.
[34] 唐小丽,潘海燕,汪英.温针灸联合黄芪桂枝五物汤治疗膝骨关节炎临床疗效及对关节软骨的影响[J].上海针灸杂志,2021,40(6):703-708.
[35] 熊浪平.黄芪桂枝五物汤治疗膝关节炎的临床疗效分析[J].医药前沿,2021,11(17):166-168.
[36] 赵婷.基于LncRNA-UFC1/miR-34a/MMP-13轴探讨益气养血方干预骨关节炎软骨退变的机制[D].昆明:云南中医药大学,2023.
[37] 马勇.膝骨关节炎的辨证分型和中草药治疗——《膝骨关节炎中医诊疗指南(2020年版)》解读[J].中医正骨,2021,33(9):1-2.
[38] JI X Y,YANG M B,OR K H,et al.Tissue accumulations of toxic aconitum alkaloids after short-term and long-term oral administrations of clinically used radix aconiti lateralis preparations in rats[J].Toxins,2019,11(6):353.
[39] PENG F,ZHANG N,WANG C T,et al.Aconitine induces cardiomyocyte damage by mitigating BNIP3-dependent mitophagy and the TNFα-NLRP3 signalling axis[J].Cell Proliferation,2020,53:e12701.
[40] LU X H,ZHANG L,LI P Y,et al.The protective effects of compatibility of Aconiti Lateralis Radix Praeparata and Zingiberis Rhizoma on rats with heart failure by enhancing mitochondrial biogenesis via Sirt1/PGC-1α pathway[J].Biomedicine & Pharmacotherapy,2017,92:651-660.
[41] 周君,黄夏荣,钟培瑞,等.电针通过下调PINK/Parkin依赖的线粒体自噬抑制软骨细胞铁死亡改善老年膝骨关节炎大鼠软骨退变[C]// 2024中国针灸学会年会论文集.北京:中国针灸学会,2024.
[42] 王俊龙,刘爱峰,张超,等.温针灸对膝关节炎模型大鼠促炎因子及基质金属蛋白酶的影响[J].中国中医骨伤科杂志,2025,33(4):7-10.
[43] 张果,贾洋洋,陈洒洒,等.独活醇提物对膝骨关节炎大鼠软骨的影响[J].中国中医骨伤科杂志,2025,33(12):22-29.
[44] 靳荃.甘草附子汤合黄芪桂枝五物汤对骨关节炎治疗作用研究[D].太原:山西中医药大学,2021.
[45] 黄龙.蠲痹汤加味治疗寒湿痹阻型膝骨性关节炎的临床研究[D].南宁:广西中医药大学,2021.
[46] LU J S,YANG M,HAN Z G,et al.Therapeutic potential of traditional Chinese medicine for inflammatory bone diseases:elucidating molecular mechanisms and insights[J].World Journal of Orthopedics,2025,16(9):108629.
[47] WU B Y,YANG Z,DUAN J H,et al.Duhuo Jisheng decoction alleviates osteoarthritis progression by mitigating ferroptosis in chondrocytes via the nuclear factor erythroid 2-related factor 2/glutathione peroxidase 4 axis[J].Journal of Ethnopharmacology,2025,353:120441.
[48] 王丽娟,孟美辰,王志远,等.基于网络药理学探讨金藤清痹颗粒对大鼠膝骨关节炎的影响及与促进线粒体自噬改善铁死亡的相关性[J].中草药,2025,56(4):1244-1253.
[49] 周海东.化湿祛瘀法治疗膝骨性关节炎(湿瘀痹阻型)的临床疗效观察[D].南昌:江西中医药大学,2023.
[50] 龚幼波,张琥,杜敏,等.痹祺胶囊治疗肝肾亏虚型膝关节炎疗效及对患者红细胞免疫功能变化的影响[J].中国中医骨伤科杂志,2019,27(8):15-19.
[51] LU B C,CHEN Y F,CAI J J,et al.FoxO1/PINK1/Parkin-dependent mitophagy mediates the chondroprotective effect of Guzhi Zengsheng Zhitong decoction in osteoarthritis[J].Phytomedicine,2025,148:157322.
(收稿日期:2025-11-27)

备注/Memo

备注/Memo:
基金项目:国家中医药管理局2018年全国名老中医药专家传承工作室建设项目(国中医药人教函〔2018〕134号)
长安医学关中李氏骨伤学术流派传承工作室建设项目(陕中医药发〔2018〕40号)
陕西省教育厅科研项目(陕教函〔2025〕96号)
通信作者 E-mail:spine_surgeon@163.com
更新日期/Last Update: 2026-08-15