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title="醫(yī)學(xué)教育網(wǎng)" class="a1">醫(yī)學(xué)教育網(wǎng)</a> </div> <a href="javascript:void(0)" onclick="window.external.AddFavorite(location.href,document.title);" target="_self" class="collection ico fr"></a>  <div id="6166661" class="fen fr">|</div> <div id="6666166" class="font_size fr ico"><a href="javascript:void(0);" target="_self" class="big lan ico">大</a><a href="javascript:void(0);" target="_self" class="small ico">小</a></div> </div> </div> </div>  <div style="width: 800px;text-align: left;margin: 0 auto;margin-bottom: 20px;"> <div style="width:800px; height:90px;"> <a href="http://thedailypurge.net/zhiyeyishikaoshi/shichengzhuanchang2019.htm?gg=news_tb"target="_blank"> <img title="傳統(tǒng)師承/確有專長備考培訓(xùn)課程" src="http://thedailypurge.net/upload/resources/image/2021/04/02/253636.png" width="800" height="90" style="border:0px;"></a> </div> </div>  <div id="1111661" class="news_con"> <div id="6161666" class="jxbox clearfix"> <p style="text-align: left;">腰椎增生性脊柱炎屬于老年退行性腰痛，發(fā)病時(shí)間長，病程進(jìn)展緩慢，無明顯外傷病史，但與長期勞損有關(guān)。</p><p style="text-align: left;">腰椎增生性關(guān)節(jié)炎，俗稱“腰椎骨刺”，是一種以軟骨退變、骨質(zhì)增生為主的骨關(guān)節(jié)炎。本病多見于中老年人，男性略多于女性，胖人、體力勞動(dòng)者及體育運(yùn)動(dòng)員等發(fā)病較早。造成退行性改變的病因是椎體及其周圍組織老化，使椎休軟骨變性，椎體下沉，椎間隙變窄，椎體邊緣骨剌形成，椎間小關(guān)節(jié)增生等，這與長期負(fù)重，慢性積累性勞損及運(yùn)動(dòng)外傷有密切關(guān)系。另外，也與老年人肥胖、內(nèi)分泌障礙有一定關(guān)系。</p><p style="text-align: left;">中醫(yī)把腰椎增生性脊柱炎歸為慢性腰痛的范疇。認(rèn)為中年以后體質(zhì)漸弱，腎氣漸衰，氣血精津漸虧，再兼外傷、勞損等則致筋骨不堅(jiān)，關(guān)節(jié)韌帶松弛痿軟，椎間盤退化變碎，則骨刺形成。若再兼外惑風(fēng)寒濕邪，則致腰腿疼痛，反復(fù)發(fā)作。故《諸病源候論·腰痛候》說：“夫腰痛，皆由傷腎氣所為?！薄陡山鸱健芬舱f：“腎虛，役用傷腎是以痛?！笨梢娔昀闲萑酢⒛I氣虛弱、筋骨不堅(jiān)退化是內(nèi)在因素，而外傷勞損、外感風(fēng)寒濕邪則是外在原因。</p><p style="text-align: left;">（一）問診要點(diǎn)</p><p style="text-align: left;">本病屬于老年退行性腰痛，發(fā)病時(shí)間長，病程進(jìn)展緩慢，無明顯外傷病史，但與長期勞損有關(guān)。一般表現(xiàn)為慢性腰背酸痛，疼痛并不劇烈，腰部呈鈍痛不適，轉(zhuǎn)、側(cè)、屈、伸有失靈敏，早晨起床或久坐站行時(shí)，疼痛不適感更為明顯，而稍事活動(dòng)，癥狀可減輕，過度勞累后腰痛癥狀加劇。有時(shí)疼痛可向大腿或臀部放射。嚴(yán)重者，可見有駝背（主要是圓背），叩擊痛，兩側(cè)腰肌緊張兒痛，下肢麻木、怕冷，雙膝酸冷無力等，若在此基礎(chǔ)上復(fù)感風(fēng)寒濕邪或從傷，則癥狀更為典型。</p><p style="text-align: left;">（二）分型問診</p><p style="text-align: left;">1.腎陽不足</p><p style="text-align: left;">問診：老年體弱，腰膝酸軟疼痛，畏寒肢冷，面色晄白，小便清利。</p><p style="text-align: left;">治法：溫陽散寒，強(qiáng)筋壯骨。方用八味腎氣丸加味。</p><p style="text-align: left;">2.腎陰不足</p><p style="text-align: left;">問診：年老體弱，形體消瘦，腰膝酸軟疼痛，面色潮紅，五心煩熱。</p><p style="text-align: left;">治法：滋陰補(bǔ)腎，強(qiáng)筋壯骨。方用六味地黃丸加味。</p><p style="text-align: left;">3.肝陰不足</p><p style="text-align: left;">問診：腰膝痿弱，下肢無力，麻木不仁，甚至出現(xiàn)經(jīng)脈拘攣。</p><p style="text-align: left;">治法：滋陰養(yǎng)肝，強(qiáng)筋壯骨。方用健骨虎潛丸加味。</p><p style="text-align: left;">4.腎氣不足復(fù)感風(fēng)寒</p><p style="text-align: left;">問診：腰背素來隱隱作涌，突然感受風(fēng)寒濕邪，疼痛加重，甚至不能轉(zhuǎn)側(cè)，加之年老體弱，恢復(fù)緩慢。</p><p style="text-align: left;">治法：溫陽補(bǔ)腎，祛風(fēng)散寒。方用八味腎氣丸加獨(dú)活寄生湯加減。</p><p style="text-align: left;">5.腎氣不足復(fù)外力所傷</p><p style="text-align: left;">問診：腰背素來隱隱作痛，纏綿不愈。突然外傷所傷，或挫或閃，以致腰背突然疼痛加重，不能轉(zhuǎn)側(cè)，腰部肌肉痙攣，壓痛叩擊痛明顯，痛有定所。</p><p style="text-align: left;">治法：舒筋活血，補(bǔ)益肝腎。方用舒筋活血片加溫補(bǔ)之傷，如八味地黃丸或六味地黃丸等。</p><p style="text-align: left;">查看匯總：<a href="http://thedailypurge.net/zhongyiyishi/shicheng/fudao/su2104181364.shtml" articlerela="4422441" target="_blank" style="text-decoration-line: none; color: rgb(0, 0, 255); outline: none; text-indent: 32px;">四肢（關(guān)節(jié)、手臂、肩、腰、髖、腿、足）中醫(yī)問診——中醫(yī)師承考點(diǎn)</a></p><p style="text-align: left;">以上是醫(yī)學(xué)教育網(wǎng)小編整理的“腰椎增生性脊柱炎的問診（天津師承人員模考）”相關(guān)內(nèi)容，想了解更多傳統(tǒng)師承和確有專長醫(yī)師資格考試知識(shí)，請(qǐng)持續(xù)關(guān)注醫(yī)學(xué)教育網(wǎng)傳統(tǒng)師承和確有專長醫(yī)師資格考試欄目。</p> </div> </div>  <div style="margin-bottom:10px;"> <p align="center"> <img 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