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余奕, 蒋浩波, 杨雷, 段嘉豪, 杨少锋.基于“诸寒收引，皆属于肾”理论探讨腰椎管狭窄症的病机与辨治[J].湖南中医药大学学报英文版,2026,46(8):1706-1712.[Click to copy
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| 基于“诸寒收引，皆属于肾”理论探讨腰椎管狭窄症的病机与辨治 |
| 余奕,蒋浩波,杨雷,段嘉豪,杨少锋 |
| (湖南中医药大学第一附属医院, 湖南 长沙 410007) |
| 摘要: |
| 腰椎管狭窄症（LSS）是由于椎管内骨性或软组织结构退变，导致管腔狭窄及神经根或马尾神经受压所致的临床综合征。基于“诸寒收引，皆属于肾”理论，结合肾与腰椎的关系，认为LSS以肾阳虚衰为本，寒湿收引、痰瘀阻络为标，其病机可分为肾阳虚损、寒湿痹阻、阳虚血瘀三个阶段。以扶阳通络为基本原则，早期扶阳化气、散寒畅络，方选金匮肾气丸合苓桂术甘汤加减；中期扶阳化湿、涤痰通络，方选阳和汤合当归四逆汤加减；晚期扶阳化瘀、填髓荣络，方选自拟海马全蝎丸加减。本文从寒、肾、骨络三者的关系来阐释LSS的病机演变与分期辨治，以期为中医药临床分期辨治本病提供一定的理论依据与参考思路。 |
| 关键词: 腰椎管狭窄症|诸寒收引，皆属于肾|扶阳|骨络|络以通为用|分期辨治 |
| DOI：10.3969/j.issn.1674-070X.2026.08.025 |
| Received:March 20, 2026 |
| 基金项目:湖南省科技创新计划重点研发计划项目（2024JK2123）；湖南省卫生健康科研课题重点课题（20257828）。 |
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| Pathogenesis and pattern differentiation and treatment of lumbar spinal stenosis based on the theory of “all cold with contraction is ascribed to the kidney” |
| YU Yi, JIANG Haobo, YANG Lei, DUAN Jiahao, YANG Shaofeng |
| (The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 410007, China) |
| Abstract: |
| Lumbar spinal stenosis (LSS) is a clinical syndrome caused by degeneration of osseous or soft tissue structures within the spinal canal, resulting in narrowing of the spinal canal and compression of the nerve roots or cauda equina. Based on the theory that "all cold with contraction is ascribed to the kidney" and the relationship between the kidney and lumbar spine, LSS is considered to be rooted in kidney yang deficiency, with contraction due to cold-dampness and obstruction of the collaterals by phlegm and blood stasis as the manifestations, and its pathogenesis can be divided into three stages: kidney yang deficiency, cold-dampness obstruction, and yang deficiency with blood stasis. Accordingly, a basic treatment principle based on reinforcing yang and unblocking the collaterals is proposed. In the early stage, treatment focuses on reinforcing yang to promote qi transformation, dispelling cold, and unblocking the collaterals, with Jingui Shenqi Pill (JGSQP) and modified Linggui Zhugan Decoction (MLGZGD); in the intermediate stage, treatment focuses on reinforcing yang to resolve dampness, eliminating phlegm, and unblocking the collaterals, with Yanghe Decoction and modified Danggui Sini Decoction (MDGSND); in the late stage, treatment focuses on reinforcing yang to transform blood stasis, replenishing marrow, and nourishing the collaterals, with self-drafted modified Haima Quanxie Pill (MHMQXP). Based on the relationships among cold, the kidney, and bone collaterals, this article elucidates the pathogenetic progression and staged pattern differentiation and treatment of LSS, providing a theoretical basis and reference for the clinical staged pattern differentiation and treatment of LSS with Chinese medicine. |
| Key words: lumbar spinal stenosis|all cold with contraction is ascribed to the kidney|reinforcing yang|bone collaterals|free flow as the basis for collateral function|stage-based pattern differentiation and treatment |
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