推拿联合头针治疗腰椎间盘突出症：现状、挑战与机制假说

Current Status, Challenges, and Mechanism Hypotheses of Tuina Combined with Scalp Acupuncture in the Treatment of Lumbar Disc Herniation

摘要: 目的：系统梳理推拿联合头针治疗腰椎间盘突出症的临床研究进展，探讨其可能的协同机制，为临床实践与后续研究提供参考。方法：检索中国知网、万方数据、维普中文科技期刊数据库收录的相关文献，纳入推拿联合头针治疗腰椎间盘突出症的临床研究、系统评价及机制研究，对现有证据进行归纳与整合分析。结果：现有直接证据表明，推拿联合头针在改善腰椎间盘突出症患者疼痛程度及腰椎功能方面优于单纯推拿治疗，且具有一定的炎症调节作用。推拿联合针刺类疗法的间接证据亦支持“推拿–针法协同”模式的临床价值。然而，该方向高质量随机对照试验数量有限，头针操作方案缺乏统一标准，联合方案的协同机制尚待阐明。现有直接证据中无一项采用孙氏头针作为干预方案，本文将其作为未来研究标准化的参照方向加以讨论。结论：推拿联合头针治疗腰椎间盘突出症具备初步的临床有效性与可行性，但证据等级有待提升。未来应开展设计严谨的大样本随机对照试验，以孙氏头针为标准化参照推进头针操作规范化，并通过动物实验与神经影像学技术验证协同机制假说。

Abstract: Objective: To systematically review the clinical research progress of Tuina combined with scalp acupuncture in the treatment of lumbar disc herniation (LDH), explore its possible synergistic mechanism, and provide reference for clinical practice and future research. Methods: Relevant literature was retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Chinese Science and Technology Periodical Database. Clinical studies, systematic reviews, and mechanism studies on Tuina combined with scalp acupuncture for LDH were included, and the existing evidence was summarized and integratively analyzed. Results: Existing direct evidence indicates that Tuina combined with scalp acupuncture is superior to Tuina alone in improving pain levels and lumbar function in patients with LDH, and exhibits certain anti-inflammatory regulatory effects. Indirect evidence from Tuina combined with acupuncture also supports the clinical value of the “Tuina-acupuncture synergistic” model. However, the number of high-quality randomized controlled trials in this field is limited; there is a lack of standardized scalp acupuncture operation protocols, and the synergistic mechanism of the combined regimen remains to be elucidated. No existing direct evidence has used Sun’s scalp acupuncture as an intervention; the present paper discusses it as a reference direction for future research standardization. Conclusion: Tuina combined with scalp acupuncture shows preliminary clinical efficacy and feasibility in the treatment of LDH, but the level of evidence needs to be improved. Future research should conduct rigorously designed large-sample randomized controlled trials, use Sun’s scalp acupuncture as a standardized reference to promote the standardization of scalp acupuncture operations, and verify the synergistic mechanism hypothesis through animal experiments and neuroimaging techniques.