基于“脾肾为本、血瘀为标”论绝经后骨质疏松症的病机及防治

绝经后骨质疏松症主要是由于绝经后妇女卵巢功能逐渐衰退，雌激素水平下降，使破骨细胞骨吸收的速度快于成骨细胞骨形成，从而引发进行性骨质流失。肾主骨生髓，为先天之本；脾主肉，为后天之本，运化水谷精微，共同促进骨骼的生长，绝经后骨质疏松症（postmenopausal osteoporosis，PMOP）多以脾肾渐虚为本，又因元气亏虚、肝气郁结、久病入络而致血行瘀滞，形成本虚标实之证。因此，笔者基于“脾虚为本、血瘀为标”思想探讨PMOP的病因病机，并凝练出“补肾-健脾-活血化瘀”之治则，从现代医学角度探讨这一治则的合理性，并在此治则的指导下探讨治未病3个阶段的防治思路，最后对中药和针灸防治PMOP进行综述，以期扩展临床思维。

Discussion on the pathogenesis and prevention and treatment of postmenopausal osteoporosis based on the theory of invigorating the spleen and kidney accompanied by removing blood stasis

Postmenopausal osteoporosis (PMOP) is mainly due to the gradual decline of ovarian function and estrogen levels in postmenopausal women, so that the rate of bone resorption by osteoclasts is faster than that of osteoblasts, thereby causing progressive bone loss. The kidney governs bone and marrow, serving as the congenital foundation. The spleen controls muscle, which is the foundation of the acquired constitution and transports water and grain essence. Therefore, the kidney and the spleen play an important role in promoting the growth of the bone. PMOP is mostly based on the gradual deficiency of the spleen and kidney, blood stasis caused by Qi deficiency, liver stagnation, and chronic disease entering the collaterals, which cause syndromes of deficiency and excess. Therefore, this article discusses the etiology and pathogenesis of PMOP based on the thought of invigorating the spleen and kidney accompanied by removing blood stasis. Hence, this generalizes the treatment principle of tonifying the kidney- strengthening the spleen-promoting blood circulation and removing blood stasis. This paper discusses the rationality of the treatment principle and discusses the three stages of prevention and treatment of the disease under the guidance of the treatment principle. Finally, we summarize the prevention and treatment of PMOP with traditional Chinese medicine and acupuncture, thus expanding clinical thinking.