推拿调控腰椎间盘突出症神经损伤的外周-中枢镇痛机制探讨

Discussion on peripheral-central analgesia mechanism of Tuina regulating nerve injury in lumbar disc herniation

腰椎间盘突出症(LDH)是推拿科临床常见腰痛及功能障碍类病症。LDH迁延难愈,严重影响患者的工作和生活。临床90%以上患者多采取保守治疗,推拿治疗LDH优势明显,且疗效得到大量临床试验的证实。而目前推拿治疗LDH的作用机制尚不完全明确。前期研究提示调整腰椎筋骨功能态可能是推拿手法治疗退行性腰椎病起效机制的关键环节;并证实推拿可显著改善LDH引发脊神经损伤外周局部炎性微环境变化、调控脊髓神经疼痛相关离子通道表达、调控中枢脑疼痛矩阵网络进而发挥镇痛效果。通过对前期研究结论的总结梳理,笔者团队提出“调整腰椎筋骨功能态-改善外周炎性微环境-调控神经离子通道-影响脑‘疼痛网络’映射是推拿解决腰突症疼痛和功能障碍的关键路径”的假说,为丰富中医“通则不痛”理论和传统非药物疗法“外治内应”镇痛效应提供科学依据。

Lumbar disc herniation(LDH)is a common disease of low back pain and dysfunction in Tuina department.LDH is difficult to recover and seriously affects the work and life of patients.More than 90%patients take conservative treatment,and a large number of clinical trials confirmed that Tuina has obvious characteristics and the curative effect.However,the mechanism of Tuina in the treatment of LDH is not completely clear.Previous studies of the research suggested that adjusting the functional state of lumbar muscles and bones may be the key in the effective mechanism of Tuina therapy for degenerative lumbar disease.It also confirmed that Tuina can significantly improve the peripheral local inflammatory microenvironment changes,regulate the expression of spinal nerve pain related ion channels,and regulate the central brain pain matrix network,so as to play an analgesic effect.Based on the summary of previous research results,our team put forward the hypothesis that:adjusting the functional state of lumbar muscles and bones-improving the peripheral inflammatory microenvironment-regulating the neural ion channels-influencing the mapping of brain‘pain network’is the key path for Tuina to solve the pain and dysfunction of lumbar process syndrome.This also enrich the theory of‘no stagnation pattern,no pain sensation’in traditional Chinese medicine,and provide a scientific evidence for the analgesic effect of‘external treatment and internal response’in traditional Tuina therapy.