[1]李启源,卜献忠,汪利合△,等.“骨-筋-肉协同失衡”视角下膝骨关节炎的中西医结合诊疗与预防体系[J].中国中医骨伤科杂志,2026,34(08):79-85.[doi:10.20085/j.cnki.issn1005-0205.260811]
　LI Qiyuan,BU Xianzhong,WANG Lihe,et al.Discussion on the Diagnosis and Treatment Strategies for Knee Osteoarthritis Based on “Synergistic Imbalance of Bone,Tendon,and Muscle”[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2026,34(08):79-85.[doi:10.20085/j.cnki.issn1005-0205.260811]
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“骨-筋-肉协同失衡”视角下膝骨关节炎的中西医结合诊疗与预防体系()

《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:
79-85
栏目:
经验交流
出版日期:
2026-08-10

文章信息/Info

Title:
Discussion on the Diagnosis and Treatment Strategies for Knee Osteoarthritis Based on “Synergistic Imbalance of Bone,Tendon,and Muscle”
文章编号:
1005-0205(2026)08-0079-07
作者:
李启源1; 2; 卜献忠2; 3; 汪利合2; 3△; 徐文博4; 麻蒙凡1; 2; 栗昊1; 2; 吴毅彤1; 2
1河南中医药大学(郑州,450046)
2河南中医药大学第一附属医院
3河南省中医骨伤特色技术与装备工程研究中心
4郑州市骨科医院
Author(s):
LI Qiyuan1; 2; BU Xianzhong2; 3; WANG Lihe2; 3△; XU Wenbo4; MA Mengfan1; 2; LI Hao1; 2; WU Yitong1; 2
1Henan University of Chinese Medicine,Zhengzhou 450046,China; 2The First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450003,China; 3Henan Provincial Engineering Research Center for Characteristic Traditional Chinese Medicine Orthopedics Technol-ogy and Equipment,Zhengzhou 450016,China; 4Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China.
关键词:
膝骨关节炎;  骨为干;  筋为刚;  肉为墙;  补骨;  强筋;  壮肉;  协同失衡;  中西医结合;  临床疗效
Keywords:
knee osteoarthritis;  bone serves as the framework;  tendons provide rigidity;  muscle acts as a protective barrier;  tonify bone;  strengthen tendons;  fortify muscle;  loss of coordination and balance;  integrated traditional Chinese and Western medicine;  clini
分类号:
R684.3
DOI:
10.20085/j.cnki.issn1005-0205.260811
文献标志码:
A
摘要:
基于《黄帝内经·灵枢·经脉》提出的“骨为干、筋为刚、肉为墙”理论,对骨为干、筋为刚、肉为墙在膝骨关节炎发病机制与治疗上的意义进行了全面的探析,以期为临床提供新的诊疗思路和治疗方法。膝骨关节炎是一种常见的中老年慢性关节疾病,其发病机制与肝、脾、肾三脏功能障碍密切相关,“骨不干,筋不刚,肉不墙”,从骨为干、筋为刚、肉为墙的含义出发阐述骨与关节、筋与关节、肉与关节协同作用,并认为肾精亏损导致骨失所养、肝血亏虚导致筋失所养、脾失健运导致肉失充养为膝骨关节炎的主要病机。治疗上提出补骨、强筋、壮肉三者并重,多途径干预(如中药、推拿、针灸、功能锻炼等),以求达到恢复筋-骨-肉平衡的目的,临床研究显示,在该理论指导下纳入320例早中期膝骨关节炎患者(肝肾亏虚型168例,脾失健运型152例),纳入标准:1)年龄≥40岁; 2)晨僵时间<30 min; 3)关节活动时有骨响声; 4)膝部检查示骨性肥大; 5)有骨压痛; 6)滑膜无明显升温; 7)X线片示膝关节间隙变窄,骨端边缘有骨赘形成; 满足以上7项中的3项即可纳入。排除标准:1)骨性关节炎程度严重,关节间隙明显狭窄或关节强直者; 2)膝关节骨折、肿瘤、类风湿、痛风、结核及化脓性感染者; 3)严重的血象异常或严重的心、肝、肾等器官疾病及糖尿病; 4)3个月内曾使用激素治疗; 5)妊娠及哺乳期妇女; 6)有活动性或复发性溃疡史; 7)对同类药物有过敏史; 8)未按规定治疗者。总有效率的具体判定依据参照《中医病证诊断疗效标准》。临床治愈:疼痛视觉模拟量表(VAS)评分≤2分,WOMAC评分降低≥70%。显效:VAS评分降低4～6分,WOMAC评分降低50%～69%。采用中药+推拿+功能锻炼综合治疗12周,VAS评分从(6.3±1.2)分降至(3.5±0.8)分,VAS评分较治疗前降低(2.8±0.7)分; WOMAC评分从(58.6±8.5)分降至(26.1±6.3)分,降低(32.5±5.2)分; 总有效率为92.3%,显著优于单纯口服赛来昔布组(0.2 g,1次/d,口服12周; 总有效率为76.5%),差异有统计学意义(P<0.05)。首次系统构建了“骨-筋-肉协同失衡”病机模型,提出了“补骨-强筋-壮肉”联合治疗+“运动-饮食”联合预防的一体化方案,完善了膝骨关节炎中西医结合防治系统。
Abstract:
Based on the theory proposed in Huangdi Neijing·Lingshu·Meridians that “bones serve as the framework,tendons as the reinforcement,and muscles as the walls”,this paper comprehensively explores the significance of this concept in the pathogenesis and treatment of knee osteoarthritis(KOA).KOA is a common chronic joint disease among middle-aged and elderly individuals,and its pathogenesis is closely associated with dysfunction of the liver,spleen,and kidneys.The concept of “bones failing to serve as the framework,tendons failing to act as reinforcement,and muscles failing to function as walls” elucidates the synergistic relationships between bones and joints,tendons and joints,and muscles and joints.It is proposed that the depletion of kidney essence leading to inadequate nourishment of bones,deficiency of liver blood resulting in insufficient nourishment of tendons,and the impairment of spleen function causing inadequate replenishment of muscles are the main pathological mechanisms of KOA.In terms of treatment,this study emphasizes a balanced approach focusing on tonifying bones,strengthening tendons,and fortifying muscles.Multi-faceted interventions,such as herbal medicine,massage,acupuncture,and functional exercises,are recommended to restore the balance among bones,tendons,and muscles.Clinical studies have shown that under the guidance of this theory,320 patients with early to moderate KOA(168 cases of liver-kidney deficiency type and 152 cases of spleen deficiency type)were enrolled.This study enrolled patients with KOA who were aged ≥40 years old and met at least three of the following seven criteria:morning stiffness lasting <30 min,crepitus during joint movement,bony enlargement observed upon knee examination,bone tenderness,no significant warmth over the synovium,radiographic evidence of narrowed knee joint space,and osteophyte formation at the bone margins.Exclusion criteria included severe osteoarthritis with marked joint space narrowing or ankylosis; knee joint fractures,tumors,rheumatoid arthritis,gout,tuberculosis,or suppurative infections; significant hematological abnormalities or severe cardiac,hepatic,renal,or other organ diseases,including diabetes; use of hormonal therapy within the past three months; pregnancy or lactation; a history of active or recurrent ulcers; known hypersensitivity to similar drugs; and failure to adhere to the prescribed treatment protocol.Efficacy was evaluated according to the Criteria for Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine:clinical cure was defined as a visual analogue scale(VAS)scores ≤2 points and a reduction in the Western Ontario and McMaster Universities osteoarthritis index(WOMAC)score ≥70%,while marked effectiveness was defined as a VAS score reduction of 46 points and a WOMAC score reduction of 50%69%.Following 12 weeks of comprehensive treatment combining Chinese herbal medicine,massage,and functional exercise,the VAS score decreased from(6.3±1.2)points to(3.5±0.8)points,with a reduction of(2.8±0.7)points,and the WOMAC scores decreased from(58.6±8.5)points to(26.1±6.3)points,with a reduction of(32.5±5.2)points.The total effective rate was 92.3%,which was significantly superior to that of the control group receiving only oral celecoxib(0.2 g once daily for 12 weeks),and had a total effective rate of 76.5%(P<0.05).Furthermore,this research systematically established—for the first time—the “bone-tendon-muscle coordination imbalance” pathogenetic model and proposed an integrated protocol combining a three-dimensional therapeutic approach of “tonifying bone,strengthening tendons,and reinforcing muscles” with a two-level prevention strategy focusing on “exercise and diet”,thereby refining the integrated traditional Chinese and Western medicine prevention and treatment system for KOA.

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(收稿日期:2025-10-24)

备注/Memo

备注/Memo:
基金项目:国家自然科学基金青年科学基金项目(82405439)
河南省卫生健康委员会国家中医药传承创新中心联合共建科研专项课题(2024ZXZX1090)
河南省中医药科学研究专项课题(2023ZY2046)
△通信作者 E-mail:wanglihe0222@sina.com
更新日期/Last Update: 2026-08-15