基于“筋骨平衡”理论探讨苗医弹筋手法联合整脊手法治疗腰椎间盘突出症的临床研究
A Clinical Study on Miao Medicine Tendon-Plucking Manipulation Combined with Spinal Manipulation for Lumbar Disc Herniation Based on the “Tendon-Bone Balance” Theory
摘要: 目的：探讨苗医弹筋手法联合整脊手法治疗腰椎间盘突出症的疗效。方法：选取遵义市中医院2025年1月~2026年2月收治的76例腰椎间盘突出症患者作为研究对象，按照随机数字表法进行分组，分为对照组、观察组，每组38例。对照组采用腰部推拿治疗，观察组采用苗医弹筋手法联合整脊手法治疗。两组治疗前后，分别记录Oswestry功能障碍指数(ODI)评分、腰椎功能日本骨科协会(JOA)评分、疼痛视觉模拟量表(VAS)评分、腰椎曲度值、白介素6 (IL-6)，并进行相关分析。结果：通过对比分析发现，观察组的治疗总有效率更高(P < 0.05)。治疗2周后，相较于对照组，观察组Oswestry功能障碍指数(ODI)评分、VAS评分、白介素6 (IL-6)水平明显更低(P < 0.05)，JOA评分更高(P < 0.05)。治疗4周后，观察组腰椎曲度值较前改善。结论：基于“筋骨平衡”理论指导下的苗医弹筋手法联合整脊手法治疗腰椎间盘突出症，能有效改善患者临床症状，降低炎症因子水平，恢复腰椎曲度，提高临床疗效。
Abstract: Objective: To evaluate the clinical efficacy of Miao medicine tendon-plucking manipulation combined with spinal manipulation in the treatment of lumbar disc herniation (LDH). Methods: A total of 76 patients with lumbar disc herniation who were admitted to Zunyi City Hospital of Traditional Chinese Medicine between January 2025 and February 2026 were enrolled in this study. The patients were randomly assigned, using a random number table, to a control group and an observation group, with 38 patients in each group. The control group received lumbar massage therapy, whereas the observation group was treated with Miao medicine tendon-plucking manipulation combined with spinal manipulation. Before and after treatment, the Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score for lumbar function, Visual Analog Scale (VAS) score for pain, lumbar curvature, and interleukin-6 (IL-6) levels were assessed. Correlation analyses were subsequently performed to investigate the associations among the relevant clinical indicators. Results: Comparative analysis showed that the observation group had a significantly higher overall clinical response rate than the control group (P < 0.05). After 2 weeks of treatment, the Oswestry Disability Index (ODI) score, Visual Analog Scale (VAS) score, and interleukin-6 (IL-6) level were significantly lower in the observation group than in the control group (all P < 0.05), whereas the Japanese Orthopaedic Association (JOA) score was significantly higher (P < 0.05). After 4 weeks of treatment, lumbar curvature in the observation group was improved compared with that before treatment. Conclusion: Miao medicine tendon-plucking manipulation combined with spinal manipulation, guided by the theory of “Tendon-Bone Balance”, can effectively alleviate the clinical symptoms of patients with lumbar disc herniation, reduce inflammatory factor levels, restore lumbar curvature, and improve overall clinical efficacy.
文章引用：李国栋, 吴文旭, 张文博, 陈在飞. 基于“筋骨平衡”理论探讨苗医弹筋手法联合整脊手法治疗腰椎间盘突出症的临床研究[J]. 医学诊断, 2026, 16(5): 570-577. https://doi.org/10.12677/md.2026.165074

参考文献

[1] 梁小雨, 黄丽梅, 江昌政, 等. 基于“筋束骨”理论探讨带脉腹部推拿干预腰椎间盘突出症的研究进展[J]. 河北中医, 2026, 48(8): 1398-1402.
[2] Deyo, R.A. and Mirza, S.K. (2016) Herniated Lumbar Intervertebral Disk. New England Journal of Medicine, 374, 1763-1772.
https://doi.org/10.1056/nejmcp1512658
[3] 国家中医药管理局. 中医病证诊断疗效标准(ZY/T 001.1~001.9) [S]. 南京: 南京大学出版社, 1994.
[4] 薛金, 薛丽莉. 手法整脊配合电针治疗腰椎盘突出症的临床研究及对腰椎生理曲度变化的影响[J]. 湖南中医杂志, 2018, 34(7): 94-96.
[5] 吕峰, 朱立帆, 吴卫东, 等. 体外冲击波联合整脊手法治疗老年腰椎间盘突出症的疗效[J]. 中国老年学杂志, 2024, 44(11): 2646-2649.
[6] 李增, 雷寿斌, 肖欢, 等. 基于“筋骨并重, 以衡为用”整脊治疗腰椎间盘突出症的临床研究[J]. 中国医药科学, 2025, 15(16): 80-84+131.
[7] 曹奔, 张帅攀, 郭光昕, 等. 基于“筋骨失衡, 以筋为先”推拿防治腰椎间盘突出症经验[J]. 中华中医药杂志, 2022, 37(3): 1504-1507.
[8] Bao, T., Wang, C., Wang, Y., Wang, T., Zhang, Q., Gao, F., et al. (2024) Relationship between Paravertebral Muscle Degeneration and Spinal-Pelvic Sagittal Parameters in Patients with Lumbar Disc Herniation. Scientific Reports, 14, Article No. 192.
https://doi.org/10.1038/s41598-023-50836-4
[9] 曾楚华, 胡玉萍, 袁德培. 苗医弹筋疗法治疗腰肌劳损的理论探讨[J]. 辽宁中医杂志, 2014, 41(8): 1602-1603.
[10] 李家权. 苗医弹筋疗法治疗慢性腰肌劳损的临床及机理研究[D]: [硕士学位论文]. 恩施: 湖北民族大学, 2014.
[11] 赵凯林. 弹筋拨络点穴手法治疗神经根型颈椎病的临床研究[D]: [硕士学位论文]. 广州: 广州中医药大学, 2019.
[12] 龚成, 谢瑛, 郭伟, 等. 脊柱定点旋转复位手法治疗对613例腰椎间盘突出症患者腰椎活动度及活动度对称性的影响[J]. 中华中医药杂志, 2021, 36(1): 599-601.
[13] 马伟. 定点脊柱旋转复位法结合推拿治疗腰椎间盘突出症60例临床观察[J]. 新疆中医药, 2020, 38(5): 25-26.
[14] 赵明宇, 张向东, 赵启, 等. 筋骨辨证中的动与静[J]. 中医正骨, 2020, 32(9): 57-59.
[15] 王国慧, 赵继荣, 赵宁. 杜仲腰痛丸联合电针刺激治疗腰椎间盘突出症的临床观察[J]. 中国中医急症, 2019, 28(3): 522-524.
[16] 邢涛, 乔小万, 赵继荣. 基于“筋骨并重”理论探讨脊柱定点旋转复位法在腰椎间盘突出症治疗中的应用[J]. 中医正骨, 2021, 33(6): 54-56+59.
[17] Blamoutier, A. (2019) Nerve Root Compression by Lumbar Disc Herniation: A French Discovery? Orthopaedics & Traumatology: Surgery & Research, 105, 335-338.
https://doi.org/10.1016/j.otsr.2018.10.025
[18] 卢旭晖, 曹罗元, 郑秀霞. 腰椎间盘突出症血清TNF-α, MMP-2表达水平及其与中医证型的关系[J]. 湖北中医药大学学报, 2020, 22(6): 94-97.