Clinical Analysis of "Different Diseases Saring Same Syndrome" Concept in End Stage of Different Hip Diseases

Rong-tian WANG; Xiang-Dong TIAN; Guang-yu ZHU; Tai-xian LI; Na LIN; Wei-heng CHEN

doi:10.13422/j.cnki.syfjx.20201536

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Clinical Analysis of "Different Diseases Saring Same Syndrome" Concept in End Stage of Different Hip Diseases

Academic Discussion | 更新时间：2020-09-09

- Clinical Analysis of "Different Diseases Saring Same Syndrome" Concept in End Stage of Different Hip Diseases
- Chinese Journal of Experimental Traditional Medical Formulae Vol. 26, Issue 17, Pages: 184-189(2020)
- 作者机构：
  
  1.北京中医药大学第三附属医院，北京 100029
  2.中国中医科学院中药研究所，北京 100700
- 作者简介：
- 基金信息：
- DOI：10.13422/j.cnki.syfjx.20201536
  CLC： R2-0;R289
- Published Online：09 April 2020，
  
  Published：05 September 2020
- 稿件说明：
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王荣田,田向东,朱光宇等.不同髋关节骨病晚期“异病同证”临证探析[J].中国实验方剂学杂志,2020,26(17):184-189.

WANG Rong-tian,TIAN Xiang-Dong,ZHU Guang-yu,et al.Clinical Analysis of "Different Diseases Saring Same Syndrome" Concept in End Stage of Different Hip Diseases[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(17):184-189.
王荣田,田向东,朱光宇等.不同髋关节骨病晚期“异病同证”临证探析[J].中国实验方剂学杂志,2020,26(17):184-189. DOI： 10.13422/j.cnki.syfjx.20201536.

WANG Rong-tian,TIAN Xiang-Dong,ZHU Guang-yu,et al.Clinical Analysis of "Different Diseases Saring Same Syndrome" Concept in End Stage of Different Hip Diseases[J].Chinese Journal of Experimental Traditional Medical Formulae,2020,26(17):184-189. DOI： 10.13422/j.cnki.syfjx.20201536.

摘要

“异病同证”是中医学对病证关系的特殊认识，起初是指不同的病具有相同的病机，从而表现出相同的证候，反映了中医学辨证论治的特点，在临证中主要体现在一方用于治疗多种病证。随着病证结合诊疗模式的形成，“异病同证”的含义也发生了变化，多指西医诊断不同疾病在其发展的过程中出现了相同的病机，从而表现出相同的证候。股骨头坏死、髋骨关节炎、类风湿性髋关节炎是发于髋关节骨骼、软骨及滑膜的3个不同解剖组织的3种疾病，在疾病的晚期出现了髋关节疼痛、活动受限的症状和腰膝酸软、行走无力的证候，无论是症状体征或中医证候，均表现出其相似性，体现着中医学“异病同证”的思想，本文从临床症状、影像变化、中医证候特点、病因病机及临床治疗方面探析3种疾病的趋同性和差异性，结果发现，除了临床症状体征相似，3种髋关节骨病晚期均见关节软骨退变、关节间隙狭窄、关节积液、滑膜增厚、骨质增生及软骨下骨囊变等相似X射线表现；肾藏精、主骨生髓，只有肾精充足，筋骨方可得以骨髓充养，肝藏血、主筋，肝血充足筋骨才能濡养，病至晚期，3种疾病与肝肾脏腑功能失常密切相关，肝肾不足、经脉筋骨失养是3种髋关节骨病晚期的共同病机，肝肾亏虚、腰膝酸软、行走无力亦成为其共同证候。不仅为“同证”提供理论依据，也有助于“异病”的鉴别诊断、提高髋关节疾病的诊断水平、丰富中医学“异病同证”的内涵。

Abstract

The traditional Chinese medicine (TCM) concept that "different diseases may share the same TCM syndrome" is a unique theory explaining the relationship between diseases and TCM syndromes

which originally means that different diseases sharing the same TCM pathogenesis may develop the same syndrome. It accords with the theory of treatment based on syndrome differentiation. In clinical practices

this concept explains why the same herbal formula can be used to treat different diseases. With the development of a novel strategy to integrate the disease diagnosis and TCM syndrome differentiation

the meaning of "different diseases may share the same TCM syndrome" has also changed. It means that different diseases share the same TCM pathogenesis during their progression may show the same syndrome. Osteonecrosis of the femoral head （ONFH）

hip osteoarthritis (HOA)

and hip rheumatoid arthritis (HRA) are three different diseases that occur in the bones

cartilage

and synovium of the hip joint

respectively. However

they share similar clinical symptoms and TCM symptoms if they had progressed to the end-stage. In the end-stage of the disease

hip pain

restricted activity

signs of waist and knee pain

and weakened walking function

whether it is symptoms or signs or TCM syndromes

all show their similarities

reflecting the concept of different diseases may share the same TCM syndrome. This article discusses the similarity of the three diseases from the aspects of syndrome characteristics

radiographic findings

syndrome differentiation

etiology and pathogenesis

as well as clinical treatments. We found that

in addition to similar clinical signs and symptoms

the three hip osteoarthropathies in the end-stage see articular cartilage degeneration

joint space stenosis

joint effusion

synovial thickening

bone hyperplasia

and subchondral bone cystic degeneration

etc. similar X-ray performance， kidney sperm

bone marrow

only kidney sufficiency

muscles and bones can be filled with bone marrow

liver blood

main muscles

liver and blood are sufficient to support the muscles and bones

and the disease is in the advanced stage， ONFH， HOA and HRA are closely related to liver and kidney dysfunction. Insufficient liver and kidney

meridian muscle

and bone malnutrition are three common pathological mechanisms of late hip bone disease. Deficiency

waist and knee weakness

and weakness in walking have also become common symptoms. It not only provides a theoretical basis for the "same syndrome"

but also helps the differential diagnosis of "different diseases"

improves the fracture level of hip diseases

and enriches the connotation of "different diseases sharing the same syndrome" in Chinese medicine.

关键词

Keywords

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