气滞血瘀型腰椎间盘突出诊断和治疗的 研究进展

Research Advances in Diagnosis and Treatment of Lumbar Disc Herniation of Qi-Stagnation and Blood-Stasis Type

摘要: 气滞血瘀型是腰椎间盘突出症常见的证型之一，其核心病机为气血运行不畅、瘀血痹阻经络、不通则痛。本文通过四个维度对该证型的诊治现状进行系统梳理与评析。在古代医家认识层面，系统梳理了从《黄帝内经》“恶血归之”到王清任创立身痛逐瘀汤的理论发展脉络。在椎间盘结构层面，阐述了髓核、纤维环及软骨终板的解剖特点。在现代诊断层面，通过文献质量评析表格总结关键研究的样本量、设计及局限性，归纳了影像学特征及神经电生理表现。在治疗层面，归纳了中药内服、针灸外治、中医特色疗法、手法及功能锻炼等疗法的临床研究进展。在此基础上，本文着力构建了“气滞血瘀”证的现代生物学整合模型，将影像学、电生理学发现与中医病机进行深层对接，并在展望部分提出了基于影像–病理机制的具体可验证研究假说，以期为该领域的精准化诊疗提供参考。

Abstract: Qi-stagnation and blood-stasis type is one of the most common syndromes of lumbar disc herniation. Its core pathogenesis is the impeded flow of Qi and blood, leading to blood stasis obstructing the meridians and resulting in pain. This article systematically reviews the current status of diagnosis and treatment of this syndrome from four dimensions. In terms of ancient medical understanding, the theoretical development from “accumulation of stagnant blood” in the Yellow Emperor’s Inner Canon to Wang Qingren’s creation of Shentong Zhuyu Decoction is systematically analyzed. Regarding the structural basis of the intervertebral disc, the anatomical features of the nucleus pulposus, annulus fibrosus, and cartilaginous endplate are elucidated. In the modern diagnostic dimension, a literature quality assessment table is constructed to summarize the sample size, design, and limitations of key studies, and imaging features and neuroelectrophysiological manifestations are summarized. In the treatment dimension, the clinical research progress of oral Chinese medicine, acupuncture and moxibustion, characteristic external therapies, manipulation, and functional exercise is reviewed. On this basis, this article endeavors to construct an integrated modern biological model of the “Qi-stagnation and blood-stasis” syndrome, deeply integrating imaging and electrophysiological findings with the pathogenesis theory of traditional Chinese medicine. In the outlook section, specific and testable research hypotheses based on imaging-pathological mechanisms are proposed, aiming to provide a reference for precision diagnosis and treatment in this field.