腰椎间盘突出症的中医治疗临床进展

Research Progress on Traditional Chinese Medicine in Treating Lumbar Disc Herniation

摘要: 腰椎间盘突出症(LDH)是临床常见的脊柱退行性疾病，发病率逐年攀升，严重影响患者生活质量。本文综述了近年来中医治疗LDH的研究进展。在理论层面，中医基于“肝肾亏虚、气血瘀滞”病机，通过针灸、推拿及中药内服外敷等综合疗法，体现了“整体观念”与“辨证论治”的特色，与现代医学在缓解症状及机制研究上形成了互补。在实践层面，中医非药物疗法(如针灸、整脊、督脉灸)具有非侵入性、安全性高及医疗成本低等优势，结合八段锦等导引功法，在缓解疼痛、改善功能及预防复发方面疗效确切。目前，国内研究虽在针灸参数优化、整脊手法创新及经方应用上成果显著，但仍面临临床试验样本量小、操作及疗效评价标准不统一、长期随访数据缺失等瓶颈；国外研究则侧重于循证医学验证，通过多中心随机对照试验证实了针灸联合物理疗法的科学性，为中医国际化提供了借鉴。展望未来，亟需加强多学科交叉的基础机制研究，建立统一的规范化诊疗与评价体系，并利用人工智能等技术推动个体化精准治疗，以期形成更为完善的中西医结合诊疗模式。

Abstract: Lumbar Disc Herniation (LDH) is a prevalent degenerative spinal disorder with an increasing incidence rate, significantly impairing patients’ quality of life. This paper reviews recent advances in the traditional Chinese medicine (TCM) treatment of LDH. Theoretically, based on the TCM pathogenesis of “liver-kidney deficiency and qi-blood stasis”, comprehensive therapies—including acupuncture, tuina (Chinese therapeutic massage), and internal/external herbal medicine—embody the principles of “holistic concept” and “syndrome differentiation-based treatment”. These approaches complement modern medicine regarding symptom relief and mechanistic research. Practically, non-pharmacological therapies such as acupuncture, spinal manipulation, and Du meridian moxibustion offer advantages including minimal invasiveness, high safety, and cost-effectiveness. When combined with Daoyin exercises like Baduanjin, these therapies demonstrate significant efficacy in alleviating pain, improving physical function, and preventing recurrence. Currently, domestic research has yielded substantial achievements in optimizing acupuncture parameters, innovating spinal manipulation techniques, and applying classical herbal formulas. However, challenges persist, including limited sample sizes in clinical trials, inconsistent operational standards and outcome evaluation criteria, and a lack of long-term follow-up data. In contrast, international research emphasizes evidence-based validation, with multicenter randomized controlled trials confirming the scientific validity of acupuncture combined with physical therapy, providing valuable insights for the globalization of TCM. Future endeavors should prioritize multidisciplinary basic research to elucidate underlying mechanisms, establish standardized diagnostic and therapeutic protocols, and leverage artificial intelligence to facilitate personalized precision medicine. This will foster the development of a more robust integrated TCM-Western medicine model for managing LDH.