基于“脾主肉,肝主筋”论青少年特发性脊柱侧弯的中医治疗

TCM treatment of adolescent idiopathic scoliosis based on the theory of spleen governing muscles and liver nourishing tendons

青少年特发性脊柱侧弯是青少年在脊柱骨骼发育定型之前出现的脊柱结构整体异常,伴有背部肉薄不坚,筋不束骨,影响整体美观、躯体运动,甚至脏腑功能。目前,临床上针对青少年特发性脊柱侧弯的治疗分为非手术治疗和手术治疗。手术具有创伤大、术后并发症多、神经损伤风险高、治疗效果不佳等问题。非手术治疗包括中医治疗、运动疗法、支具治疗以及电刺激等。其中,支具配合体操治疗青少年特发性脊柱侧弯疗程较长,患者依从性较差,疗效不确切、并发症多、生活质量低。青少年特发性脊柱侧弯可归属于中医学的“龟背”范畴,也称“小儿驼背”,但尚未有明确的辨证分型。文章通过中医理论——“脾主肉,肝主筋”,对脊柱侧弯相关的理论内涵进行分析,探讨“脾主肉,肝主筋”这一理论与青少年特发性脊柱侧弯病因病机之间的联系,以及部分现代医家在治疗青少年特发性脊柱侧弯中临床应用。基于“脾主肉,肝主筋”理论治疗青少年特发性脊柱侧弯主要体现在揉筋正骨和健脾养肝两个方面,揉筋正骨突出外治,健脾养肝重在内调,内外同治,标本兼顾,为中医治疗青少年特发性脊柱侧弯提供了新的辨证思路与方法。因此,针对青少年特发性脊柱侧弯的中医治疗并非只有理筋整脊之类的外治法,还可以从整体出发,根据辨证论治,以健脾养肝、益气养血为主,提高并巩固临床治疗效果。

Adolescent idiopathic scoliosis is an overall structural abnormality of the spine that occurs in adolescents before the development of the spinal skeleton,accompanied by thin,unfirm back muscles and soft body,affects the overall beauty,physical movement,and even the function of the viscera.At present,the clinical treatment of adolescent idiopathic scoliosis is divided into non-surgical treatment and surgical treatment.Surgery has problems such as large trauma,many postoperative complications,high risk of nerve damage,and poor treatment effects.Non-surgical treatments include TCM treatment,exercise therapy,brace therapy and electrical stimulation.Among them,the brace combined with gymnastics in the treatment of adolescent idiopathic scoliosis has a long course of treatment,poor patient compliance,inaccurate efficacy,many complications,low quality of life and other adverse reactions.Adolescent idiopathic scoliosis can fall under the category of hunchback in TCM medicine,also known as pediatric hunchback,but there is no clear dialectical classification.This paper analyzes the connotation of the theory that spleen governing muscles and liver nourishing tendons and the spine,discusses the relationship between this theory and the etiology and pathogenesis of adolescent idiopathic scoliosis,as well as the clinical application of modern doctors in the treatment of adolescent idiopathic scoliosis.The treatment of adolescent idiopathic scoliosis from spleen governing muscles and liver nourishing tendons is mainly reflected in two aspects:kneading tendon and bone setting and strengthening the spleen and nourishing the liver.The external treatment of kneading tendon and bone setting is prominent,strengthening the spleen and nourishing the liver focuses on internal regulation,both specimens are taken into account,which also provides a new idea and method for TCM treatment of adolescent idiopathic scoliosis.Therefore,the TCM medicine treatment for adolescent idiopathic scoliosis is not only the external treatment method such as tendon-regulation and orthopaedic-spinal,but also from the whole,according to the dialectical treatment,to strengthen the spleen and liver,Qi(气)and blood,improve and consolidate the clinical treatment effects.