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基于“乙癸同源，肝肾同治”理论探讨四至丸治疗绝经后骨质疏松症的作用机理
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Abstract:
“乙癸同源，肝肾同治”理论为探究四至丸治疗绝经后骨质疏松症(PMOP)的作用机理提供了独特视角。现代药物治疗PMOP常伴有诸多不良反应，且难以根本改善骨代谢，中医整体辨证论治优势凸显。该理论源于《黄帝内经》，经发展明确了肝肾在生理与病理上的紧密联系，为PMOP治疗开拓新思路。肝肾亏虚是PMOP发病的主因，会造成骨量及结构异常，引发疼痛、骨折、脊柱畸形等症状。四至丸在二至丸基础上加当归、淫羊藿。女贞子、墨旱莲滋阴，当归补血活血，淫羊藿温阳，共同促进肝肾机能，与上述理论契合。药理研究显示，其成分可调节骨代谢。临床依滋补肝肾、调和气血、燮理阴阳、防治兼施四大核心思想应用四至丸，能提升骨密度、缓解围绝经期症状、降低骨折风险，疗效获临床观察与实验证实。当前，四至丸治疗PMOP的研究在多成分协同机制、人体药代动力学特征等方面有待深化拓展，这为后续研究指明方向。
The theory of “Homology of the Liver (Yi) and Kidney (Gui), Simultaneous Treatment of the Liver and Kidney” has provided a unique perspective for exploring the efficacy of Si Zhi Wan in the treatment of postmenopausal osteoporosis (PMOP). In contrast to modern drug therapies for PMOP, which are plagued by numerous adverse reactions and face challenges in fundamentally improving bone metabolism, the holistic syndrome differentiation and treatment approach of traditional Chinese medicine exhibits distinct advantages. Stemming from the “The Inner Canon of the Yellow Emperor”, this theory, over time, has elucidated the physiological and pathological interconnections between the liver and the kidney, thus opening up a new avenue for PMOP treatment. Liver-kidney deficiency is a pivotal factor in the pathogenesis of PMOP. It gives rise to abnormalities in bone mass and structure. Common pathological manifestations include fractures, pain, and spinal deformities. Si Zhi Wan is composed by adding Angelica sinensis (Oliv.) Diels and Epimedium brevicornu Maxim. to Er Zhi Wan. Ligustrum lucidum Ait. and Eclipta prostrata L. in Si Zhi Wan nourish yin, Angelica sinensis enriches and promotes blood circulation, while Epimedium brevicornu Maxim. warms the yang and enhances the functions of the liver and kidney. Pharmacological studies have demonstrated that the components of Si Zhi Wan can regulate bone metabolism. In clinical practice, based on four core principles, namely nourishing the liver and kidney, regulating qi and blood, balancing yin and yang, and integrating prevention and treatment, Si Zhi Wan has been shown to increase bone density, alleviate perimenopausal symptoms and reduce the risk of fractures. Its effectiveness has been corroborated by both clinical observations and experimental studies. However, it is evident that many crucial aspects of the research on Si Zhi Wan for treating PMOP, such as the synergistic mechanisms of its multiple components and its
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