腰肌劳损的中医药治疗进展

Progress in Traditional Chinese Medicine Treatment of Lumbar Muscle Strain

摘要: 腰肌劳损是一种由腰部肌肉、筋膜、韧带等软组织慢性损伤引起的非特异性腰痛，临床表现为腰部酸胀、隐痛或钝痛，劳累后加重，休息后缓解，属于中医学“腰痛”“痹证”范畴。现代医学认为其发病机制涉及肌筋膜–生物力学失衡、外周与中枢神经敏化、无菌性炎症及心理社会因素，形成“肌筋膜–神经–心理”三维交互模型。尽管非甾体抗炎药和阿片类药物常用于治疗，但存在不良反应多、长期疗效不确定等问题。中医药基于“不通则痛”与“不荣则痛”的核心病机，强调标本兼治，采用中药内服(如补益利腰汤、独活寄生汤)、针灸(毫针、电针、温针、针刀)、推拿及康复训练等多种手段，在改善疼痛、恢复腰椎功能方面显示出确切疗效。研究表明，中药可活血化瘀、补益肝肾；针灸能疏通经络、散寒除湿；推拿有助于松解粘连、调和气血；康复训练则增强核心肌群稳定性。临床观察显示，中医药疗法在缓解症状、降低复发率及提升生活质量方面优于或等效于西医疗法，且具有安全性高、成本低、便于推广的优势。未来研究应加强“经筋–肌筋膜”整合假说的机制探索，结合功能影像与分子生物学技术，深化中医整体观与现代生物–心理–社会医学模式的融合，推动个体化综合治疗方案的优化与应用。

Abstract: Lumbar muscle strain is a type of non-specific low back pain caused by chronic injury to soft tissues such as muscles, fascia, and ligaments of the lumbar region. Its clinical manifestations include soreness, dull pain, or aching in the lower back, which worsens after exertion and relieves with rest. In traditional Chinese medicine (TCM), it falls under the categories of “lumbago” and “bi-impediment syndrome”. Modern medicine believes that its pathogenesis involves myofascial-biomechanical imbalance, peripheral and central neuronal sensitization, sterile inflammation, and psychosocial factors, forming a three-dimensional “myofascial-nerve-psychological” interaction model. Although non-steroidal anti-inflammatory drugs and opioids are commonly used in treatment, they are associated with numerous adverse reactions and uncertain long-term efficacy. Based on the core TCM pathogenesis of “pain due to obstruction” and “pain due to insufficiency”, TCM emphasizes addressing both the root cause and symptoms. Various approaches such as oral herbal medicine (e.g., Buyi Liyao Decoction, Duhuo Jisheng Decoction), acupuncture (filiform needle, electroacupuncture, warm needling, acupotomy), tuina (Chinese therapeutic massage), and rehabilitation training have shown definite efficacy in relieving pain and restoring lumbar function. Research indicates that Chinese herbs can promote blood circulation, remove stasis, and tonify the liver and kidneys; acupuncture can unblock meridians, dispel cold, and eliminate dampness; tuina helps release adhesions and harmonize qi and blood; rehabilitation training strengthens core muscle stability. Clinical observations demonstrate that TCM therapies are superior or equivalent to Western medicine in alleviating symptoms, reducing recurrence rates, and improving quality of life, with advantages of high safety, low cost, and easy promotion. Future research should strengthen the mechanistic exploration of the “meridian sinew-myofascia” integration hypothesis, combine functional imaging and molecular biology techniques, deepen the integration of TCM holism with the modern biopsychosocial medical model, and promote the optimization and application of individualized comprehensive treatment regimens.