| 365 | 0 | 137 |
| 下载次数 | 被引频次 | 阅读次数 |
肌少症表现为肌肉质量、力量及躯体功能的进行性下降，病理改变与肌肉、骨骼、肌腱等组织密切相关。五脏对五体有主导作用，骨、筋、肉作为运动系统的核心，与肝脾肾三脏关系密切，三脏协同作用共同维持躯体正常运动功能。肝脾肾三脏虚损，则会导致骨筋肉失养，从而诱发肌少症等退行性疾病。脾运化主肉、肾藏精主骨、肝藏血主筋，三脏协同维持运动系统的生理稳态。衰老导致的肝脾肾三脏虚损是肌少症“骨弱-筋枯-肉萎”的核心病机。临证基于中医骨筋肉整体观，提出“肝脾肾同调、骨筋肉并治”的肌少症干预策略，采取中药复方内服联合针灸、传统功法等外治手段，改善肌肉萎缩、躯体功能下降等症状，通过协同肝脾肾三脏调节精血津液的化生与输布，改善骨筋肉失养的病理状态。
Abstract：Sarcopenia is characterized by the progressive decline of muscle mass,strength,and physical function,and its pathological changes are closely related to tissues such as muscles,bones,and tendons. The five organs dominate the five bodily tissues. Bones,tendons,and muscles,as the core of the musculoskeletal system,are closely related to the liver,spleen,and kidneys. The coordination of these three organs maintains normal physical function. Deficiency or damage in the Liver,Spleen,and Kidney can lead to malnutrition of bones,tendons,and muscles,thereby inducing degenerative diseases such as sarcopenia. The Spleen governs the transformation and transportation of flesh,the Kidney stores Essence and governs bones,and the Liver stores blood and governs tendons. The three organs coordinate to maintain the physiological balance of the musculoskeletal system. Age-related deficiency of the Liver,Spleen,and Kidney is the core pathogenesis of sarcopenia,described as "weak bones-withered tendons-atrophied muscles". Clinically,based on the holistic view of bones,tendons,and muscles in traditional Chinese medicine,an intervention strategy for sarcopenia is proposed: "harmonize the Liver,Spleen and Kidney,and treat bones,tendons,and muscles simultaneously". This approach uses internal administration of Chinese herbal formulas combined with external treatments such as acupuncture,moxibustion and traditional Gongfu exercises,aimed at improving muscle atrophy and functional decline. It works by coordinating the Liver,Spleen and Kidney to regulate the production and distribution of Essence,blood and body Fluid,thereby ameliorating malnutrition in bones,tendons and muscles.
[1]SAYER A A,COOPER R,ARAI H,et al. Sarcopenia[J].Nat Rev Dis Primers,2024,10:68.
[2]SAYER A A,CRUZ-JENTOFT A. Sarcopenia definition,diagnosis and treatment:consensus is growing[J]. Age Ageing,2022,51(10):220.
[3]PAPADOPOULOU S K,PAPADIMITRIOU K,VOULGARIDOU G,et al. Exercise and nutrition impact on osteoporosis and sarcopenia:the incidence of osteosarcopenia:a narrative review[J]. Nutrients,2021,13(12):4499.
[4]孙嘉禾，史冀鹏，朱天瑞，等．运动对肌少症及其合并症老年人影响的Meta分析[J]．中国组织工程研究，2026,30(4):997-1007.
[5]黄琴，安振梅．老年肌少症的营养干预研究进展[J]．四川医学，2025,46(4):457-461.
[6]CLYNES M A,GREGSON C L,BRUYèRE O,et al. Osteosarcopenia:where osteoporosis and sarcopenia collide[J].Rheumatology(Oxford),2021,60(2):529-537.
[7]DONG Y C,YUAN H Y,MA G X,et al. Bone-muscle crosstalk under physiological and pathological conditions[J]. Cell Mol Life Sci,2024,81(1):310.
[8]齐鹏坤，侯德才，吕艳芳，等．基于“骨肉不相亲”理论探讨肌少症与骨关节炎关系[J]．中华中医药学刊，2024,42(12):189-193.
[9]HE C,HE W Z,HOU J,et al. Bone and muscle crosstalk in aging[J]. Front Cell Dev Biol,2020,8:585644.
[10]COLAIANNI G,STORLINO G,SANESI L,et al. Myokines and osteokines in the pathogenesis of muscle and bone diseases[J]. Curr Osteoporos Rep,2020,18(4):401-407.
[11]KAJI H. Crosstalk between muscle and bone[J]. J Bone Miner Metab,2024,42(4):391-398.
[12]CHEN S P,XU X,GONG H P,et al. Global epidemiological features and impact of osteosarcopenia:a comprehensive meta-analysis and systematic review[J]. J Cachexia Sarcopenia Muscle,2024,15(1):8-20.
[13]YOSHIMOTO Y,OISHI Y. Mechanisms of skeletal muscletendon development and regeneration/healing as potential therapeutic targets[J]. Pharmacol Ther,2023,243:108357.
[14]STANCZAK M,KACPRZAK B,GAWDA P. Tendon cell biology:effect of mechanical loading[J]. Cell Physiol Biochem,2024,58(6):677-701.
[15]VILA POUCA M C P,PARENTE M P L,JORGE R M N,et al. Injuries in muscle-tendon-bone units:a systematic review considering the role of passive tissue fatigue[J]. Orthop J Sports Med,2021,9(8):23259671211020731.
[16]HEΒT,MILANI T L,STOLL J,et al. Running and jumping after muscle fatigue in subjects with a history of knee injury:what are the acute effects of wearing a knee brace on biomechanics?[J]. Bioengineering,2025,12(6):661.
[17]MATSUSHIMA T,HIROSHI A. Molecular mechanisms of mechanosensing and plasticity of tendons and ligaments[J]. J Biochem,2024,176(4):263-269.
[18]AVEY A M,BAAR K. Muscle-tendon cross talk during muscle wasting[J]. Am J Physiol Cell Physiol,2021,321(3):C559-C568.
[19]GRIMA-TERRéN M,CAMPANARIO S,RAMíREZPARDO I,et al. Muscle aging and sarcopenia:The pathology,etiology,and most promising therapeutic targets[J].Mol Aspects Med,2024,100:101319.
[20]GUMUCIO J P,MENDIAS C L. Atrogin-1,MuRF-1,and sarcopenia[J]. Endocrine,2013,43(1):12-21.
[21]LEXELL J,TAYLOR C C,SJOSTROM M. What is the cause of the ageing atrophy? Total number,size and proportion of different fiber types studied in whole vastus lateralis muscle from 15-to 83-year-old men[J]. J Neurol Sci,1988,84(2/3):275-294.
[22]崔志洁，高铸烨，姜众会，等．基于“脾主肌肉”理论探讨线粒体质量控制在心力衰竭合并肌少症中医药治疗中的价值[J]．陕西中医，2025,46(6):795-799.
[23]HE M C,XIA S H,PAN H,et al. Chaihu-Shugan-San ameliorated osteoporosis of mice with depressive behavior caused by chronic unpredictable mild stress via repressing neuroinflammation and HPA activity[J]. Drug Des Devel Ther,2024,18:5997-6015.
[24]徐勤，郑永智，宋二林，等．养血强筋膏治疗肝肾亏虚型膝骨关节炎临床观察及对血清炎症因子影响[J]．亚太传统医药，2022,18(12):95-100.
[25]柴焱，张涛，范引科，等．养血柔肝丸对多因素诱导的肝纤维化大鼠模型TGFβ1/Smad信号通路的影响[J]．临床肝胆病杂志，2022,38(9):2040-2045.
[26]李品，臧凝子，宫成军，等．基于“脾主运化，在体合肌”理论探析T2DM肌少症骨骼肌细胞铁死亡发病机制及辨证论治[J]．世界科学技术:中医药现代化，2024,26(7):1668-1674.
[27]王乾，施杞，唐德志．中医“骨肉不相亲”理论分析肌肉与老年骨质疏松性骨折的关系[J]．中国骨质疏松杂志，2023,29(5):734-738.
[28]孙世容，黄佳．基于脾虚理论探讨肌少症病机治法[J]．中医药临床杂志，2023,35(12):2345-2349.
[29]陈欣．补中益气汤联合八段锦辅以强化营养支持治疗老年肌少症效果观察[J]．实用中医药杂志，2022,38(2):179-180.
[30]YAKABE M,HOSOI T,SASAKAWA H,et al. Kampo formula hochu-ekki-to(Bu-Zhong-Yi-Qi-Tang,TJ-41)ameliorates muscle atrophy by modulating atrogenes and AMPK in vivo and in vitro[J]. BMC Complement Med Ther,2022,22(1):341.
[31]王艺，张月宇，马贤德，等．基于AMPK/SIRT1/PGC-1α信号通路探讨补中益气汤对5-FU诱导的肌少症的调节作用[J/OL]．海南医学院学报，2025:1-15[2025-03-06]. https://link. cnki. net/doi/10. 13210/j. cnki.jhmu. 20250306. 002.
[32]侯佳佳，董旭，冯涛．基于“脾主肌肉”理论治疗肌少症的中西医研究进展[J]．中医研究，2024,37(7):87-91.
[33]敖惠沛，郝世兴，李慧聪，等．宣肺益脾方治疗老年肌少症的临床疗效及对患者微炎症状态的影响[J]．广州中医药大学学报，2024,41(11):2931-2936.
[34]何盼，陈磊，连让平，等．中医药防治肌少症的研究进展[J]．中草药，2025,56(10):3729-3738.
[35]NIU K X,CHANG L P,ZHANG R T,et al. Bazi Bushen mitigates age-related muscular atrophy by alleviating cellular senescence of skeletal muscle[J]. J Tradit Complement Med,2024,14(5):510-521.
[36]黄研，邢三丽，胡怡然，等．补肾还精方通过调节铁死亡干预小鼠肌少症的效应和机制研究[J]．上海中医药杂志，2022,56(7):74-82.
[37]马江涛，黄润龙，周文明，等．金天格防治肌少-骨质疏松症的作用机制[J]．中国骨质疏松杂志，2022,28(9):1282-1289,1329.
[38]孙雯，丁劼，王培歌，等．密骨胶囊通过NF-κB和AKTm TOR信号通路对肌少症的作用机制[J]．中国骨质疏松杂志，2023,29(7):942-948.
[39]韩家豪．地黄饮子对2型糖尿病合并肌少症患者肝肾亏虚证的疗效观察[D]．济南:山东中医药大学，2020.
[40]方雅静，杨熙，李昕怡，等．肉苁蓉提取物对地塞米松诱导小鼠肌少症的治疗效果及作用机制研究[J]．西华大学学报:自然科学版，2025,44(4):1-10.
[41]赖朋，方雅静，李昕怡，等．巴戟天提取物对地塞米松诱导小鼠肌少症的治疗效果及作用机制研究[J]．西华大学学报:自然科学版，2024,43(4):110-122.
[42]WANG D,QI W H,MAO X N,et al. Gui Qi Zhuang Jin Decoction ameliorates mitochondrial dysfunction in sarcopenia mice via AMPK/PGC-1α/Nrf2 axis revealed by a metabolomics approach[J]. Phytomedicine,2024,133:155908.
[43]张乃心，徐天舒，王钐，等．女贞子防治肌少-骨质疏松症的中医理论探讨[J]．中国中医基础医学杂志，2024,30(10):1747-1750.
[44]马素凡，吕万勇，张彩荣，等．基于脾主肌肉探讨肌少症的电针治疗[J]．按摩与康复医学，2022,13(17):10-13,17.
[45]刘碧原，王景信，张艳，等．痿三针联合康复训练改善肌少症下肢运动功能和平衡及步行能力[J]．临床研究，2020,28(10):136-137.
[46]YUE S N,ZHANG J,LI J X,et al. A study protocol for a randomized controlled trial to assess the efficacy of Baduanjin exercise on older adults with sarcopenia in China[J].BMC Complement Med Ther,2022,22(1):298.
[47]NIU K,LIU Y L,YANG F,et al. Efficacy of traditional Chinese exercise for sarcopenia:a systematic review and metaanalysis of randomized controlled trials[J]. Front Neurosci,2022,16:1094054.
基本信息:
DOI：10.16368/j.issn.1674-8999.2025.12.392
中图分类号:R274.9
引用信息:
[1]史依婷,赵培源,刘喜红,等.基于骨筋肉相关探讨“肝脾肾同调、骨筋肉并治”的肌少症干预策略[J].中医学报,2025,40(12):2506-2512.DOI:10.16368/j.issn.1674-8999.2025.12.392.
基金信息:
河南省中医药科研专项课题重大专项项目(2025ZKY007);河南省中医药科研专项课题重点课题项目(2025ZY1030,2024ZY1027);河南省中医药科研专项课题项目(2024ZY2157); 河南省科技攻关项目(252102520042,242102310497,242102310521)