基于“筋骨平衡”理论探讨颈肩部推拿松解术治疗肌源性耳鸣的作用机制与临床思路

Exploring the Mechanisms and Clinical Approach of Cervicoscapular Tuina Release Technique in Treating Myogenic Tinnitus Based on the “Sinew-Bone Balance” Theory

摘要: 肌源性耳鸣(颈源性耳鸣)是神经性耳鸣中具有明确肌肉骨骼系统病因的一类特殊亚型，以耳鸣与颈肩部肌群紧张、颈椎功能失调密切相关为临床特征，在长期低头伏案人群中发病率呈逐年上升趋势。现代医学多以营养神经、改善微循环药物对症治疗，但对肌源性耳鸣核心病理环节——颈肩部肌群痉挛所致神经血管物理性卡压——缺乏直接干预作用。中医推拿疗法通过松解颈肩部痉挛肌群、消散筋结、整复轻微关节紊乱、疏通经络气血，直接针对肌源性耳鸣的病理根源发挥作用。文章基于“筋骨平衡”与经筋理论，系统梳理颈肩部推拿松解术治疗肌源性耳鸣的理论依据、临床应用与疗效证据，重点从机械力学解压、血流动力学改善、外周–中枢神经调控及系统性自稳调节四个层面阐释其作用机制，并提出机制深化研究与临床规范化推广的未来方向，以期为肌源性耳鸣的精准化、规范化推拿治疗提供理论参考。

Abstract: Myogenic tinnitus (cervicogenic tinnitus) is a distinct subtype of neurogenic tinnitus with a clear musculoskeletal etiology, characterized by a close association between tinnitus and cervicoscapular muscle tension as well as cervical spine dysfunction. Its incidence has been increasing annually among populations engaged in prolonged sedentary work with neck flexion. Contemporary medical management primarily relies on neurotrophic agents and microcirculatory enhancers, yet these interventions fail to directly address the core pathophysiological mechanism of myogenic tinnitus—the physical neurovascular compression induced by cervicoscapular muscle spasm. As a core external therapy in traditional Chinese medicine, Tuina manipulation directly targets the pathological root of myogenic tinnitus by relaxing spasmodic cervicoscapular muscles, dispersing myofascial trigger points, reducing mild joint dysfunction, and unblocking meridians and qi-blood circulation. Grounded in the “Sinew-Bone Balance” theory and the Meridian Sinew theory, this article systematically reviews the theoretical rationale, clinical application, and efficacy evidence of cervicoscapular tuina release techniques in treating myogenic tinnitus. The mechanisms of action are elaborated from four dimensions: mechanical decompression, hemodynamic improvement, peripheral-central neural regulation, and systemic homeostatic modulation. Furthermore, future directions for mechanistic exploration and clinical standardization are proposed, aiming to provide a theoretical foundation for the precise and standardized Tuina management of myogenic tinnitus.