毛书歌从三期三型辨证论治膝关节滑膜炎经验OA

Professor Mao Shuge proposes that the etiological and pathogenetic evolution of knee synovitis follows the progression:"exter-nal trauma and overstraining-struggle between pathogen and healthy qi-stasis,dampness,heat,and toxin-chronic illness involving the vis-cera".The acute stage is dominated by exuberant pathogenic factors(dampness,heat,stasis,and toxin),typically manifesting as the dampness-heat stasis obstruction type.The remission stage features subsided pathogenic factors with lingering qi stagnation,blood stasis and collateral obstruction,mostly manifesting as the stasis and collateral obstruction type.The chronic stage presents with prolonged con-sumption of healthy qi and zang-fu visceral dysfunction.Spleen-kidney deficiency serves as the root cause,often accompanied by residu-al dampness and static blood,manifesting as the spleen-kidney deficiency type.Building on the academic heritage of Professor Mao Ti-andong,Professor Mao Shuge has established a systematic diagnosis and treatment framework named"three-stage and three-type syn-drome differentiation"combined with"three-dimensional synergistic therapy".It takes"classifying disease progression by stage,identif-ying pathogenesis by syndrome type,intervening through three-dimensional coordination,and emphasizing both sinews and bones"as its core principle.Knee synovitis is divided into three stages:acute stage,remission stage and chronic stage,corresponding to three syn-drome types:dampness-heat stasis obstruction type,stasis and collateral obstruction type,and spleen-kidney deficiency type.Treatment integrates three dimensions:oral administration of Chinese medicinals,external interventions,and functional rehabilitation,forming a closed-loop architecture of"passive treatment-active rehabilitation"that achieves combination of disease differentiation and syndrome differentiation,simultaneous elimination of pathogens and support of healthy qi,and coordinated management of local and systemic as-pects.Professor Mao Shuge selects the core drugs from Professor Mao Tiandong's empirical formula Synovitis Decoction as the founda-tional formula for treating knee synovitis,with modifications based on the identified syndrome.For the dampness-heat stasis obstruction type,add Jinyinhua(Lonicerae Japonicae Flos)20 g,Lianqiao(Forsythiae Fructus)20 g,Bajiangcao(Patriniae Herba)30 g,Daqingye(Isatidis Folium)30 g,along with an increased dose of Tufuling(Smilacis Glabrae Rhizoma).For the stasis and collateral ob-struction type,add Rendongteng(Lonicerae Japonicae Caulis)20 g,Jixueteng(Spatholobi Caulis)20 g,and Chuanbixie(Dioscoreae Septemlobae Rhizoma)15 g.For the spleen-kidney deficiency type,add Huangqi(Astragali Radix)25 g,Baizhu(Atractylodis Macro-cephalae Rhizoma)10 g,Fuling(Poria)15 g,and Dangshen(Codonopsis Radix)10 g.Professor Mao proposes that after oral intake of the decoction,the remaining herbal residue can be reboiled to prepare a solution for external lavage and hot compress on the affected knee.He also attaches importance to the therapeutic value of skin traction for knee synovitis,and implements traction treatment based on syndrome differentiation according to disease stages.In the remission and chronic stages,for knee synovitis secondary to patellofemoral joint lesions or knee osteoarthritis,he adopts the five-dragon patella-grasping three-step manipulation and other techniques to address the associated lesions.