基于“太阳主筋”理论探讨腰椎间盘突出症的病机及治疗原则

Based on the Theory of “Taiyang Governing the Tendons”: An Exploration of the Pathogenesis and Therapeutic Principles of Lumbar Disc Herniation

摘要: 腰椎间盘突出症(Lumbar Disc Herniation, LDH)是骨科常见病、多发病，主要表现为腰部疼痛、下肢放射性疼痛。中医经筋理论中足太阳膀胱经的经筋分布与腰椎间盘突出症的发病部位在解剖学上具有密切关系。《灵枢·经脉》提出“膀胱足太阳之脉……是主筋所生病者”，提示足太阳经与“筋”的密切关系。腰椎生理曲度及稳定性依赖于足太阳经筋的维系，该病多因劳损外伤、风寒湿邪侵袭足太阳经，致气血痹阻、筋失濡养，“筋出槽、骨错缝”而成。本文基于“太阳主筋”理论，系统阐述LDH的中医病机，并提出相应的治疗原则，以期为临床提供理论指导。

Abstract: Lumbar disc herniation (LDH) is a common and frequently encountered orthopedic disorder characterized primarily by low back pain and radiating leg pain. In traditional Chinese medicine (TCM), the meridian sinew (jingjin) theory holds that the anatomical distribution of the foot Taiyang bladder meridian sinew closely corresponds to the affected sites in LDH. The Lingshu∙Jingmai states that “the foot Taiyang bladder meridian… governs diseases of the tendons”, highlighting the intimate relationship between the foot Taiyang meridian and the “tendons”. The physiological curvature and stability of the lumbar spine depend on the support of the foot Taiyang meridian sinew. LDH predominantly arises from overuse or traumatic injury and invasion of wind, cold, and dampness into the foot Taiyang meridian, leading to qi and blood stagnation, loss of tendon nourishment, and consequent “tendon displacement and bone misalignment”. Based on the theory of “Taiyang governing the tendons”, this article systematically elucidates the TCM pathogenesis of LDH and proposes corresponding therapeutic principles, aiming to provide theoretical guidance for clinical practice.