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Article(id=1322926524625728189, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926492627378659, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.09.020, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339862257, onlineDateStr=2026-10-30, pubDate=1757433600000, pubDateStr=2025-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339862257, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339862257, creator=13701087609, updateTime=1793339862257, updator=13701087609, issue=Issue{id=1322926492627378659, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='9', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1757433600000', pubDateStr='2025-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339854628, creator='13701087609', updateTime=1793340762858, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930302095590169, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926492627378659, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930302095590170, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926492627378659, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=115, endPage=119, ext={EN=ArticleExt(id=1322926525229707966, articleId=1322926524625728189, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Mechanism of Therapeutic Effect of Resolving Blood Stasis and Regulating Tendons Acupuncture Combined with Zhuyu Zhitong Decoction（逐瘀止痛汤）on Lumbar Disc Herniation, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the therapeutic mechanism of resolving blood stasis and regulating tendons acupuncture combined with Zhuyu Zhitong Decoction（逐瘀止痛汤）in the treatment of lumbar disc herniation.

Methods

Eighty-six patients diagnosed with lumbar disc herniation were selected and divided into two groups according to random number table. Forty-three cases in the reference group were treated with resolving blood stasis and regulating tendons acupuncture，and the other forty three cases in the study group were treated with resolving blood stasis and regulating tendons acupuncture and Zhuyu Zhitong Decoction. The clinical efficacy，TCM syndrome scores，inflammatory factor levels and lumbar function of the two groups were observed and compared.

Results

The total effective rate of the study group was 95.35%，higher than that（74.42%）of the control group. The difference was statistically significant（P<0.05）. After treatment，the lumbar function in the study group was higher than that in the reference group，and the difference was statistically significant（P<0.05）. After treatment，the levels of interleukin-6（IL-6），interleukin-17（IL-17）and tumor necrosis factor-α（TNF-α）in the study group were lower than those in the reference group，and the difference was statistically significant（P<0.05）. After treatment，compared with those of the reference group，VAS score and muscle strength were higher and ODIscore was lower in the study group，and the differences were statistically significant（P<0.05）. After treatment，compared with those of the reference group，the pelvic lateral inclination，pelvic tilt angle and sagittal plane flat axis of the study group were smaller，and the lumbar lordosis angle was larger. The differences were statistically significant（P<0.05）.

Conclusion

The patients with lumbar disc herniation were treated by resolving blood stasis and regulating tendons acupuncture and Zhuyu Zhitong Decoction，which can effectively improve the function of the lumbar spine，reduce the inflammatory response of the body and promote the recovery of the patients，and have high clinical application value.

, authors=Wenjuan BAO, Junxiang HU, Jia HU, Qunyan LE, Hongkan LOU, authorsList=Wenjuan BAO, Junxiang HU, Jia HU, Qunyan LE, Hongkan LOU, authorCompany=null, correspAuthors=Hongkan LOU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322926528207663817, articleId=1322926524625728189, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=化瘀理筋揿针法联合逐瘀止痛汤治疗腰椎间盘突出症的疗效机制研究, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

研究化瘀理筋揿针法联合逐瘀止痛汤治疗腰椎间盘突出症的疗效机制。

方法

选取浙江中医药大学附属医院宁波市中医院86例被确诊为腰椎间盘突出症的患者，按随机数字表分为两组，参考组43例予以化瘀理筋揿针法治疗，研究组43例予以化瘀理筋揿针法、逐瘀止痛汤治疗。观察比较两组患者的临床疗效、中医证候积分、炎症因子水平以及腰椎功能情况。

结果

研究组总有效率与参考组相比，95.35%高于74.42%，差异有统计学意义（P<0.05）。治疗后，与参考组相比，研究组腰椎功能更高，差异有统计学意义（P<0.05）。治疗后，与参考组相对比，研究组白细胞介素-6（interleukin 6，IL-6）、白细胞介素-17（interleukin 17，IL-17）以及肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）水平低于对照组，差异具有统计学意义（P<0.05）。治疗后，研究组视觉模拟评分（visual analogue scale，VAS）、肌力表现高于参考组，功能障碍ODI评分（Oswestry disability index，ODI）低于参考组，差异有统计学意义（P<0.05）。治疗后，与参考组相对比，研究组骨盆侧倾、骨盆倾斜角、矢状面平直轴更小，腰椎前凸角更大，差异有统计学意义（P<0.05）。

结论

患有腰椎间盘突出症的患者通过化瘀理筋揿针法、逐瘀止痛汤联合治疗后，临床效果显著，能有效改善患者的腰椎功能，减轻机体炎性反应，促进患者恢复，临床应用价值较高。

, authors=包文娟, 胡俊翔, 胡佳, 乐群雁, 楼红侃, authorsList=包文娟, 胡俊翔, 胡佳, 乐群雁, 楼红侃, authorCompany=null, correspAuthors=楼红侃, authorNote=

包文娟（1990-），女，山东菏泽人，主治医师，研究方向：中医药临床疗效。

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楼红侃（1983-），男，浙江东阳人，副主任中医师，硕士，研究方向：中医药对脊柱退行性疾病。E-mail：。
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包文娟（1990-），女，山东菏泽人，主治医师，研究方向：中医药临床疗效。

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包文娟（1990-），女，山东菏泽人，主治医师，研究方向：中医药临床疗效。

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articleTitle=香附化学成分和药理作用研究进展及质量标志物（Q-Marker）预测分析, refAbstract=null), Reference(id=1322926537074422553, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, doi=null, pmid=null, pmcid=null, year=2023, volume=2, issue=2, pageStart=119, pageEnd=124, url=null, language=null, rfNumber=[32], rfOrder=31, authorNames=苏倩榕, 桂雄斌, 韦旭日, journalName=基层中医药, refType=null, unstructuredReference=苏倩榕，桂雄斌，韦旭日，等. 中药土鳖虫药理活性成分及其临床应用的研究进展［J］. 基层中医药，2023，2（2）：119-124., articleTitle=中药土鳖虫药理活性成分及其临床应用的研究进展, refAbstract=null), Reference(id=1322926537162502938, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, doi=null, pmid=null, pmcid=null, year=2021, volume=48, issue=5, pageStart=162, pageEnd=164, url=null, language=null, rfNumber=[33], rfOrder=32, authorNames=陆天宸, 吴耀持, 张峻峰, journalName=辽宁中医杂志, refType=null, unstructuredReference=陆天宸，吴耀持，张峻峰，等. 针刺联合肾痹汤加味治疗腰椎间盘突出症肾虚血瘀证的疗效以及对血清IL-6、IL-17水平的影响［J］. 辽宁中医杂志，2021，48（5）：162-164., articleTitle=针刺联合肾痹汤加味治疗腰椎间盘突出症肾虚血瘀证的疗效以及对血清IL-6、IL-17水平的影响, refAbstract=null), Reference(id=1322926537238000411, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, doi=null, pmid=null, pmcid=null, year=2021, volume=39, issue=9, pageStart=66, pageEnd=69, url=null, language=null, rfNumber=[34], rfOrder=33, authorNames=刘婷, 付娟, 张莎, journalName=中华中医药学刊, refType=null, unstructuredReference=刘婷，付娟，张莎. 通络益肾方联合针灸治疗腰椎间盘突出症对清除氧自由基能力分析［J］. 中华中医药学刊，2021，39（9）：66-69., articleTitle=通络益肾方联合针灸治疗腰椎间盘突出症对清除氧自由基能力分析, refAbstract=null), Reference(id=1322926537321886492, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, doi=null, pmid=null, pmcid=null, year=2022, volume=28, issue=8, pageStart=1259, pageEnd=1263, url=null, language=null, rfNumber=[35], rfOrder=34, authorNames=郑丽娅, 贾松涛, 乔兆辉, journalName=中国中医基础医学杂志, refType=null, unstructuredReference=郑丽娅，贾松涛，乔兆辉，等. 调督理筋针法联合揿针对腰椎间盘突出症大鼠Akt/GSK3β通路及痛觉过敏的影响［J］. 中国中医基础医学杂志，2022，28（8）：1259-1263., articleTitle=调督理筋针法联合揿针对腰椎间盘突出症大鼠Akt/GSK3β通路及痛觉过敏的影响, refAbstract=null)], funds=[Fund(id=1322926532741706488, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, awardId=国中医药人教发〔2016〕42号, language=CN, fundingSource=国家中医药管理局全国名老中医药专家传承工作室建设项目(国中医药人教发〔2016〕42号), fundOrder=null, country=null), Fund(id=1322926532825592569, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, awardId=2022S086, language=CN, fundingSource=宁波市社会公益研究项目(2022S086), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322926528425767626, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, xref=null, ext=[AuthorCompanyExt(id=1322926528463516363, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, companyId=1322926528425767626, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Orthopedics and Traumatology，Ningbo Traditional Chinese Medicine Hospital，Affiliated Hospital of Zhejiang Chinese Medical University，Ningbo 315000，Zhejiang，China), AuthorCompanyExt(id=1322926528471904972, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, companyId=1322926528425767626, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=浙江中医药大学附属医院宁波市中医院，浙江 宁波 315000)])], figs=[ArticleFig(id=1322926530271261420, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效一般无效总有效
参考组4318（41.86）14（32.56）11（25.58）32（74.42）
研究组4325（58.14）16（37.21）2（4.65）41（95.35）
χ2值---7.340
P值---0.007
), ArticleFig(id=1322926530338370285, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, language=CN, label=表1, caption=

两组腰椎间盘突出症患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数显效一般无效总有效
参考组4318（41.86）14（32.56）11（25.58）32（74.42）
研究组4325（58.14）16（37.21）2（4.65）41（95.35）
χ2值---7.340
P值---0.007
), ArticleFig(id=1322926530409673454, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间主观症状临床体征日常生活能力
参考组43治疗前3.58±1.212.28±0.474.09±1.11
治疗后5.45±1.333.99±0.558.14±1.24
t值6.82015.49915.958
P值0.0000.0000.000
研究组43治疗前3.59±1.232.27±0.484.04±1.13
治疗后7.45±1.555.01±0.8811.25±1.98
t值12.79217.92420.739
P值0.0000.0000.000
两组治疗前t值0.0380.0980.207
两组治疗前P值0.9700.9230.837
两组治疗后t值6.4216.4458.729
两组治疗后P值0.0000.0010.001
), ArticleFig(id=1322926530497753839, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, language=CN, label=表2, caption=

两组腰椎间盘突出症患者腰部功能活动情况的比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间主观症状临床体征日常生活能力
参考组43治疗前3.58±1.212.28±0.474.09±1.11
治疗后5.45±1.333.99±0.558.14±1.24
t值6.82015.49915.958
P值0.0000.0000.000
研究组43治疗前3.59±1.232.27±0.484.04±1.13
治疗后7.45±1.555.01±0.8811.25±1.98
t值12.79217.92420.739
P值0.0000.0000.000
两组治疗前t值0.0380.0980.207
两组治疗前P值0.9700.9230.837
两组治疗后t值6.4216.4458.729
两组治疗后P值0.0000.0010.001
), ArticleFig(id=1322926530590028528, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间IL-6/（ng/L）IL-17/（ng/L）TNF-α/（μg/L）
参考组43治疗前122.59±14.22652.34±60.546.89±2.23
治疗后105.64±11.35203.88±20.714.14±1.16
t值6.10945.9607.174
P值0.0000.0000.000
研究组43治疗前123.25±14.21650.36±60.186.26±2.19
治疗后87.36±9.52140.73±16.692.75±0.79
t值13.76053.5119.886
P值0.0000.0000.000
两组治疗前t值0.2150.1521.322
两组治疗前P值0.8300.8800.190
两组治疗后t值8.09215.5696.495
两组治疗后P值0.0000.0000.000
), ArticleFig(id=1322926530661331698, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, language=CN, label=表3, caption=

两组腰椎间盘突出症患者炎症因子水平的比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间IL-6/（ng/L）IL-17/（ng/L）TNF-α/（μg/L）
参考组43治疗前122.59±14.22652.34±60.546.89±2.23
治疗后105.64±11.35203.88±20.714.14±1.16
t值6.10945.9607.174
P值0.0000.0000.000
研究组43治疗前123.25±14.21650.36±60.186.26±2.19
治疗后87.36±9.52140.73±16.692.75±0.79
t值13.76053.5119.886
P值0.0000.0000.000
两组治疗前t值0.2150.1521.322
两组治疗前P值0.8300.8800.190
两组治疗后t值8.09215.5696.495
两组治疗后P值0.0000.0000.000
), ArticleFig(id=1322926530741023475, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间VAS评分/（分）ODI评分/（分）肌力/（级）
参考组43治疗前6.14±1.1434.95±5.112.32±0.45
治疗后3.99±0.7424.15±4.743.68±0.55
t值10.373 310.160 912.549 5
P值0.000 00.000 00.000 0
研究组43治疗前6.10±1.1034.97±5.122.33±0.42
治疗后2.87±0.6418.24±4.354.54±0.35
t值16.643 016.329 226.507 2
P值0.000 00.000 00.000 0
两组治疗前t值0.165 60.018 10.106 5
两组治疗前P值0.868 90.985 60.915 4
两组治疗后t值7.506 76.023 88.650 4
两组治疗后P值0.000 00.000 00.000 0
), ArticleFig(id=1322926532435522293, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, language=CN, label=表4, caption=

两组腰椎间盘突出症患者临床指标的比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间VAS评分/（分）ODI评分/（分）肌力/（级）
参考组43治疗前6.14±1.1434.95±5.112.32±0.45
治疗后3.99±0.7424.15±4.743.68±0.55
t值10.373 310.160 912.549 5
P值0.000 00.000 00.000 0
研究组43治疗前6.10±1.1034.97±5.122.33±0.42
治疗后2.87±0.6418.24±4.354.54±0.35
t值16.643 016.329 226.507 2
P值0.000 00.000 00.000 0
两组治疗前t值0.165 60.018 10.106 5
两组治疗前P值0.868 90.985 60.915 4
两组治疗后t值7.506 76.023 88.650 4
两组治疗后P值0.000 00.000 00.000 0
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组别例数时间LL/（°）LPT/（mm）PT/（°）PI/（°）SS/（°）SVA/（mm）
参考组43治疗前37.91±3.903.13±2.3013.83±3.2446.12±10.3230.40±9.1031.72±9.41
治疗后40.21±3.811.23±0.3211.03±4.1240.90±3.1034.30±3.2026.30±4.11
t值2.766 35.365 33.503 13.176 62.651 23.461 2
P值0.007 00.000 00.000 70.002 10.009 60.0008
研究组43治疗前37.90±3.893.14±2.3113.90±3.1446.09±10.3730.10±10.1131.89±9.34
治疗后44.13±3.380.62±0.509.08±3.7436.89±2.7036.50±2.2421.23±4.81
t值7.927 56.991 76.472 45.629 94.052 86.653 7
P值0.000 00.000 00.000 00.000 00.000 10.000 0
两组治疗前t值0.011 90.020 10.101 70.013 40.144 60.084 1
两组治疗前P值0.990 50.984 00.919 20.989 30.885 40.933 2
两组治疗后t值5.047 06.738 22.298 06.396 43.693 35.254 8
两组治疗后P值0.000 00.000 00.024 00.000 00.000 40.000 0
), ArticleFig(id=1322926532620071671, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926524625728189, language=CN, label=表5, caption=

两组腰椎间盘突出症患者脊柱-骨盆矢状面参数的比较（±s）

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组别例数时间LL/（°）LPT/（mm）PT/（°）PI/（°）SS/（°）SVA/（mm）
参考组43治疗前37.91±3.903.13±2.3013.83±3.2446.12±10.3230.40±9.1031.72±9.41
治疗后40.21±3.811.23±0.3211.03±4.1240.90±3.1034.30±3.2026.30±4.11
t值2.766 35.365 33.503 13.176 62.651 23.461 2
P值0.007 00.000 00.000 70.002 10.009 60.0008
研究组43治疗前37.90±3.893.14±2.3113.90±3.1446.09±10.3730.10±10.1131.89±9.34
治疗后44.13±3.380.62±0.509.08±3.7436.89±2.7036.50±2.2421.23±4.81
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P值0.000 00.000 00.000 00.000 00.000 10.000 0
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两组治疗后t值5.047 06.738 22.298 06.396 43.693 35.254 8
两组治疗后P值0.000 00.000 00.024 00.000 00.000 40.000 0
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化瘀理筋揿针法联合逐瘀止痛汤治疗腰椎间盘突出症的疗效机制研究
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包文娟 , 胡俊翔 , 胡佳 , 乐群雁 , 楼红侃
中华中医药学刊 | 国家项目点击 2025,43(9): 115-119
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中华中医药学刊 |国家项目点击 2025 , 43 (9) : 115 -119
化瘀理筋揿针法联合逐瘀止痛汤治疗腰椎间盘突出症的疗效机制研究
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包文娟, 胡俊翔, 胡佳, 乐群雁, 楼红侃
作者信息
  • 浙江中医药大学附属医院宁波市中医院，浙江 宁波 315000
通讯作者:
楼红侃（1983-），男，浙江东阳人，副主任中医师，硕士，研究方向：中医药对脊柱退行性疾病。E-mail：。
作者简介:

包文娟（1990-），女，山东菏泽人，主治医师，研究方向：中医药临床疗效。

Mechanism of Therapeutic Effect of Resolving Blood Stasis and Regulating Tendons Acupuncture Combined with Zhuyu Zhitong Decoction（逐瘀止痛汤）on Lumbar Disc Herniation
Wenjuan BAO, Junxiang HU, Jia HU, Qunyan LE, Hongkan LOU
Affiliations
  • Department of Orthopedics and Traumatology，Ningbo Traditional Chinese Medicine Hospital，Affiliated Hospital of Zhejiang Chinese Medical University，Ningbo 315000，Zhejiang，China
出版时间: 2025-09-10 doi: 10.13193/j.issn.1673-7717.2025.09.020
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摘要
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目的

研究化瘀理筋揿针法联合逐瘀止痛汤治疗腰椎间盘突出症的疗效机制。

方法

选取浙江中医药大学附属医院宁波市中医院86例被确诊为腰椎间盘突出症的患者，按随机数字表分为两组，参考组43例予以化瘀理筋揿针法治疗，研究组43例予以化瘀理筋揿针法、逐瘀止痛汤治疗。观察比较两组患者的临床疗效、中医证候积分、炎症因子水平以及腰椎功能情况。

结果

研究组总有效率与参考组相比，95.35%高于74.42%，差异有统计学意义（P<0.05）。治疗后，与参考组相比，研究组腰椎功能更高，差异有统计学意义（P<0.05）。治疗后，与参考组相对比，研究组白细胞介素-6（interleukin 6，IL-6）、白细胞介素-17（interleukin 17，IL-17）以及肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）水平低于对照组，差异具有统计学意义（P<0.05）。治疗后，研究组视觉模拟评分（visual analogue scale，VAS）、肌力表现高于参考组，功能障碍ODI评分（Oswestry disability index，ODI）低于参考组，差异有统计学意义（P<0.05）。治疗后，与参考组相对比，研究组骨盆侧倾、骨盆倾斜角、矢状面平直轴更小，腰椎前凸角更大，差异有统计学意义（P<0.05）。

结论

患有腰椎间盘突出症的患者通过化瘀理筋揿针法、逐瘀止痛汤联合治疗后，临床效果显著，能有效改善患者的腰椎功能，减轻机体炎性反应，促进患者恢复，临床应用价值较高。

腰椎间盘突出症  /  化瘀理筋揿针法  /  逐瘀止痛汤
Objective

To study the therapeutic mechanism of resolving blood stasis and regulating tendons acupuncture combined with Zhuyu Zhitong Decoction（逐瘀止痛汤）in the treatment of lumbar disc herniation.

Methods

Eighty-six patients diagnosed with lumbar disc herniation were selected and divided into two groups according to random number table. Forty-three cases in the reference group were treated with resolving blood stasis and regulating tendons acupuncture，and the other forty three cases in the study group were treated with resolving blood stasis and regulating tendons acupuncture and Zhuyu Zhitong Decoction. The clinical efficacy，TCM syndrome scores，inflammatory factor levels and lumbar function of the two groups were observed and compared.

Results

The total effective rate of the study group was 95.35%，higher than that（74.42%）of the control group. The difference was statistically significant（P<0.05）. After treatment，the lumbar function in the study group was higher than that in the reference group，and the difference was statistically significant（P<0.05）. After treatment，the levels of interleukin-6（IL-6），interleukin-17（IL-17）and tumor necrosis factor-α（TNF-α）in the study group were lower than those in the reference group，and the difference was statistically significant（P<0.05）. After treatment，compared with those of the reference group，VAS score and muscle strength were higher and ODIscore was lower in the study group，and the differences were statistically significant（P<0.05）. After treatment，compared with those of the reference group，the pelvic lateral inclination，pelvic tilt angle and sagittal plane flat axis of the study group were smaller，and the lumbar lordosis angle was larger. The differences were statistically significant（P<0.05）.

Conclusion

The patients with lumbar disc herniation were treated by resolving blood stasis and regulating tendons acupuncture and Zhuyu Zhitong Decoction，which can effectively improve the function of the lumbar spine，reduce the inflammatory response of the body and promote the recovery of the patients，and have high clinical application value.

lumbar disc herniation  /  resolving blood stasis and regulating tendons acupuncture method  /  Zhuyu Zhitong Decoction（逐瘀止痛汤）
包文娟, 胡俊翔, 胡佳, 乐群雁, 楼红侃. 化瘀理筋揿针法联合逐瘀止痛汤治疗腰椎间盘突出症的疗效机制研究. 中华中医药学刊, 2025 , 43 (9) : 115 -119 . DOI: 10.13193/j.issn.1673-7717.2025.09.020
Wenjuan BAO, Junxiang HU, Jia HU, Qunyan LE, Hongkan LOU. Mechanism of Therapeutic Effect of Resolving Blood Stasis and Regulating Tendons Acupuncture Combined with Zhuyu Zhitong Decoction（逐瘀止痛汤）on Lumbar Disc Herniation[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (9) : 115 -119 . DOI: 10.13193/j.issn.1673-7717.2025.09.020
正文
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现如今，随着人们生活和工作性质的影响，导致腰椎间盘突出症的发病率逐年增长，并且呈年轻化趋势发展[1]。腰椎间盘突出症属于临床常见病，是腰腿痛的常见原因，该病主要是由于各种诱因导致腰椎间盘的纤维环破裂，髓核突出刺激、椎间盘变性等压迫神经根和马尾神经导致的一种临床综合征[2]。腰椎间盘突出症好发于20～50岁人群，是骨科较为常见、高发的疾病。从中医的角度上看，腰椎间盘突出症属于“痹证”“腰腿痛”等范畴，其病因虚实夹杂，主要是由于风、寒、湿、热等邪气侵袭经络，腰部的气血运行失常、经脉痹阻，致使经脉失养而发病[3-4]，其中以气滞血瘀型较为常见。因此，治疗时应以活血化瘀、疏通经络为主。逐瘀止痛汤属于中药汤剂，具有活血化瘀、舒筋通络的功效，对治疗腰椎间盘突出症具有较好疗效。化瘀理筋揿针法属于中医特色疗法，起效快，具有舒经活络、消肿止痛等功效[5]。基于此，为探讨化瘀理筋揿针法、逐瘀止痛汤单一或联合用药治疗给腰椎间盘突出症患者带来的临床效果，选取浙江中医药大学附属医院宁波市中医院86例被确诊为腰椎间盘突出症的患者作为研究对象，现报道如下。
1　临床资料
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1.1　一般资料
选取2022年5月—2023年12月在浙江中医药大学附属医院宁波市中医院骨伤科收入治疗的腰椎间盘突出症患者86例作为研究对象，按随机数字表法划分组别，各43例。研究组男23例，女20例；年龄28～52岁，平均（39.44±10.72）岁；病程2～9个月，平均（5.15±2.51）月；病变部位：L3～L4椎间盘突出有15例患者，L4～L5椎间盘突出有15例，L5～S1椎间盘突出有13例。参考组男22例，女21例；年龄34～58岁，平均（37.12±10.40）岁；病程3～8个月，平均（5.21±2.12）月；病变部位：L3～L4椎间盘突出有14例，L4～L5椎间盘突出有13例，L5～S1椎间盘突出有16例。两组比较，差异无统计学意义（P>0.05）。
1.2　诊断标准
①符合《腰椎间盘突出症诊疗指南》[6]中对腰椎间盘突出症的诊断标准；②经CT或MRI被确诊的患者。
1.3　中医辨证标准
参考《中医病证诊断疗效标准》[7]中对该病的辨证，伴腰腿疼痛，痛有定处，局部拒按，腰部活动不利。舌质黯紫或瘀斑，苔薄白，脉弦紧或细涩。
1.4　纳入标准
①符合腰椎间盘突出症的诊断标准；②患者年龄在20岁以上；③患者及家属对研究知情，签署相关同意书。
1.5　排除标准
①对研究治疗存在禁忌的患者；②合并风湿性关节炎、腰椎滑脱、腰椎骨折等腰椎疾病的患者；③腰部皮肤存在破溃、感染的患者；④妊娠期、哺乳期的患者；⑤严重心脑血管疾病、肝肾功能异常的患者。
2　治疗方法
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2.1　参考组
予以化瘀理筋揿针法进行治疗，操作如下：在进行揿针治疗前，需先行化瘀理筋，揉按腰夹脊穴、双侧大肠俞穴、双侧肾俞穴以及患侧秩边穴、环跳穴、委中穴、足三里穴、阳陵泉穴，以局部穴位微热为度。再对双侧竖脊肌进行推揉，对韧带及腰肌进行弹拨、推拿，治疗时间为30 min。在治疗过程中，手法力度柔和，切忌过度用力。完成上述治疗后，予以揿针治疗。选穴：双侧大肠俞穴、双侧肾俞穴、患侧委中穴、足三里穴以及阿是穴。将上述穴位常规消毒处理后，使用镊子将0.25 mm×2.0 mm揿针（吴江市神龙医疗保健品有限公司；苏械注准20172270269）拆下后揿入腧穴，按压使得揿针黏附在皮肤上，按压至患者出现酸胀感。留针1 d，每4 h按压1次，3次/d。每周进行3次。以1周为1个疗程，连续治疗两个疗程。
2.2　研究组
在参考组的基础上予以逐瘀止痛汤治疗，方药如下：当归20 g，丹参20 g，牛膝15 g，枳壳10 g，红花15 g，延胡索15 g，骨碎补30 g，五灵脂10 g，没药15 g，酒大黄15 g，续断20 g，香附10 g，三七3 g，土鳖虫15 g。水煎服，2日1剂，1日2次，一次150 mL，早晚温服。以1周为1个疗程，连续按医嘱服用两个疗程（2周）。
3　观察指标与统计学方法
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3.1　观察指标
（1）临床疗效。（2）治疗前后腰部功能活动情况。采取腰椎功能JOA评定量表对患者腰部功能进行评定，评定内容包括3个维度，分值0～29分。主观症状总分值为9分，临床体征总分值6分，日常活动能力总分值14分。分值越高，患者腰部功能越好。（3）炎症标志物的水平变化。本研究中，患者在接受治疗前后进行了空腹静脉血采集，随后通过离心处理。为了评估炎症反应的变化，我们采用酶联免疫吸附测定（ELISA）方法，对白细胞介素-6（interleukin 6，IL-6）、白细胞介素-17（interleukin 17，IL-17）和肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）的水平进行定量分析。（4）治疗前后临床指标变化。①在治疗前后采用视觉模拟评分（visual analogue scale，VAS）对患者进行了疼痛程度评定。VAS评分可以直观量化评估患者疼痛状况的变化。评分范围从0～10分，分值越高表示患者感受到的疼痛程度越严重。②功能障碍评定：采取Oswestry功能障碍指数（Oswestry disability index，Oswestry，ODI）评估腰痛对患者日常生活影响，共10个部分，每个部分的评分为0～5，总分值为0～50分，分数越高，障碍程度越严重。③肌力评定：指导患者进行蹲下、站立、行走、踢脚等活动，评估肌肉的力量。肌力分0～5级进行评估，5级表示正常肌力，0级表示完全无肌力。（5）治疗前后影像学检测情况。采取影像学检测患者脊柱-骨盆矢状面参数，内容包括腰椎前凸角（LL）、骨盆侧倾（LPT）、骨盆倾斜角（PT）、骨盆射角（PI）、骨倾斜角（SS）、矢状面平直轴（SVA）。
3.2　统计学方法
采用Excel收集患者相关资料，应用SPSS 22.0对采集的86例患者数据进行统计分析。计量资料以均值±标准差（）表示，采用t检验分析比较；计数资料以率（%）表示，采用卡方检验（χ2检验）。P<0.05表示差异有统计学意义。
4　疗效标准与治疗结果
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4.1　疗效标准
参照《中医病证诊断疗效标准》[7]制定疗效标准：若患者腰部疼痛等症状基本消失，腰部功能活动正常，即为显效；若患者腰部疼痛等症状较前改善，腰部功能活动改善，即为有效；若患者腰部疼痛等症状以及功能活动较前无改善，即为无效。治疗总有效率为显效率与有效率总和。
4.2　临床疗效
连续治疗两个疗程后，研究组总有效率与参考组相比，95.35%（41/43）高于74.42%（32/43），经统计分析，两组结果差异具有统计学意义（χ2＝7.340，P=0.007）。详见表1。
4.3　腰部功能活动情况比较
治疗前，两组患者腰部功能活动情况比较差异无统计学意义（主观症状t＝0.038，P=0.970；临床体征t＝0.098，P=0.923；日常生活能力t＝0.207，P=0.837）；治疗后，与参考组相比，研究组患者腰椎功能更高，差异有统计学意义（主观症状t＝6.421，P=0.000；临床体征t＝6.445，P=0.001；日常生活能力t＝8.729，P=0.001）。详见表2。
4.4　炎症因子水平比较
治疗前，参考组和研究组患者炎症因子水平（IL-6、IL-17、TNF-α）比较差异无统计学意义（P>0.05）；连续治疗两个疗程后，与参考组相比，研究组患者血清IL-6、IL-17以及TNF-α更低，差异有统计学意义（P<0.05）。详见表3。
4.5　临床指标比较
治疗前，两组患者VAS评分、ODI评分以及肌力比较差异无统计学意义（P>0.05）；连续治疗两个疗程后，研究组患者的VAS评分、肌力（级）值比参考组高，ODI评分则低于参考组患者，两组结果相比较，差异有统计学意义（P<0.05）。详见表4。
4.6　脊柱-骨盆矢状面参数比较
治疗前，两组患者脊柱-骨盆矢状面参数比较差异无统计学意义（P>0.05）；治疗两个疗程后，研究组患者的骨盆侧倾、骨盆倾斜角、矢状面平直轴比参考组的参数更小，腰椎前凸角参数更大，两组研究结果相比差异具有统计学意义（P<0.05）。详见表5。
5　讨论
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腰椎间盘突出症主要是由于腰椎间盘出现退行性改变导致的骨科疾病，其次还与长期伏案工作、重体力劳作、外伤等有关[8]。有研究发现[9-10]，腰椎间盘突出症好发部位为L4～L5椎间盘、L5～S1椎间盘，约占总发病人数的98%。患者病发后，会出现腰部疼痛，下肢出现放射性疼痛、无力、麻木，导致腰椎功能活动障碍，甚至出现肌肉萎缩或肌力下降的情况，严重威胁患者的身体健康，影响患者的日常生活和工作。近年来，随着中医技术的不断发展和提高，加上人们对自身健康的重视，越来越多的人认识到了中医治疗的重要性，更易接受中医技术进行治疗。
中医认为[11]，腰椎间盘突出症主要是由于外伤、过度劳损、肝肾不足、气血不足等导致外邪侵袭机体，使其经脉失养、壅阻经脉、气滞血瘀，不通则痛，进而导致患者出现腰腿部疼痛、麻木等一系列临床症状。其病位在腰椎，病程较长，急性期的患者疼痛较为明显，瘀血内生，病情由于各种诱因极易反复发作，进而导致瘀血去而又生[12]。因此，治疗时应以活血化瘀、疏通经络为主。化瘀理筋揿针法是临床治疗腰椎间盘突出症的常见方式，将化瘀理筋法和揿针法结合，在进行揿针法之前进行化瘀理筋，对疾病相关的主要穴位进行按揉，对腰肌、竖脊肌等进行推拿，能够松解病变部位的僵硬肌肉，减轻局部组织的粘连情况，促进得气。与传统针刺法相比，揿针法属于新型埋针治疗，其针体较细，可以防止由于长时间在机体留置出现的血管损伤，通过揿针刺入局部腧穴，对腧穴进行持续性和柔和的刺激，促进局部血液的循环，纠正失衡的脊柱力学，达到治疗腰椎间盘突出症的目的。其中，腰夹脊穴[13]具有活血止痛、消肿化瘀的功效；阿是穴[14]以痛为腧；大肠俞[15]具有舒筋通络、理气止痛的功效；肾俞[16]具有局部治疗的作用，可活血通络、补益肝肾，对治疗腰部疾病具有较好功效；委中穴[17]属于腰背疾病的主要穴位，具有化瘀止痛、疏经通络的作用；足三里[18]属于保健穴位，可起到活血消肿、化瘀、补益中气等作用。中医认为，治疗腰椎间盘突出症时应当标本兼治，在活血止痛、消肿化瘀的同时还需要补益肝肾，因此单一采取化瘀理筋揿针法疗效并不理想，需联合中药汤剂调节机体肝肾不足。逐瘀止痛汤中，丹参[19]具有活血调经、凉血散瘀、止痛等功效；当归[20]属于生血、活血的药物，具有补血活血、调经止痛的功效；牛膝[21]可活血通络、强筋骨、补肝肾；枳壳[22]破气消积；三七[23]化瘀止痛、活血化瘀；红花[24]能活血通经、祛瘀止痛；五灵脂[25]具有活血止痛、化瘀止血的功效；酒大黄[26]逐瘀通经、泻下攻积；骨碎补[27]可补肾、活血、续伤；没药[28]活血止痛；续断[29]补肝肾、续筋骨；延胡索[30]活血行气止痛；香附[31]调经止痛，理气调中；土鳖虫[32]续筋接骨、破血除瘀。诸药合用，可达到活血止痛、行气散瘀、补肝肾的功效。在本研究中，研究组总有效率更高，腰椎功能更好，说明采取化瘀理筋揿针法联合逐瘀止痛汤治疗腰椎间盘突出症的疗效更高，缓解患者的一系列临床症状，能有效提高患者的腰椎功能。IL-17会促进髓核中的炎性介质分泌，使细胞外基质的代谢失衡，导致椎间盘细胞的凋亡，属于腰椎间盘突出症的促进因子[33]。而IL-6参与椎间盘退行性变的过程，属于重要的炎性介质[34]，IL-17会促使IL-6分泌，加重机体炎性反应，进而加剧腰椎间盘的退行性改变进程。而TNF-α的增高会抑制骨细胞形成，促使破骨细胞进行增殖、分化，加快对骨质的破坏，间接促使腰椎间盘退行性改变[35]。与参考组相比，研究组患者IL-6、IL-17以及TNF-α更低，差异有统计学意义（P<0.05），说明采取化瘀理筋揿针法联合逐瘀止痛汤治疗后，能有效减轻机体炎性反应，进而减轻患者的疼痛。与参考组相对比，研究组VAS评分、肌力更高，ODI评分更低，差异有统计学意义（P<0.05）。说明采取联合治疗后可有效减轻患者的疼痛，改善患者的功能障碍情况，提高肌力。脊柱-骨盆矢状面参数与腰椎间盘突出的关系密切，与患者的临床表现及预后相关。治疗后与参考组相比，研究组患者骨盆侧倾、骨盆倾斜角、矢状面平直轴更小，腰椎前凸角更大，差异有统计学意义（P<0.05），说明联合治疗能改善患者的脊柱-骨盆平衡。
结果显示在课题组的这项临床研究中，腰椎间盘突出症患者通过化瘀理筋揿针法联合逐瘀止痛汤治疗后，临床效果好，能有效改善患者的腰椎功能，减轻患者的机体炎症反应，缓解患者的疼痛不适症状，对减轻患者痛苦、加速患者康复过程有积极作用。本项研究的治疗方法在临床实践中具有较高的应用价值，未来可扩大样本进一步进行相关研究。
基金
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  • 国家中医药管理局全国名老中医药专家传承工作室建设项目(国中医药人教发〔2016〕42号)
  • 宁波市社会公益研究项目(2022S086)
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doi: 10.13193/j.issn.1673-7717.2025.09.020
  • 首发时间：2026-10-30
  • 出版时间：2025-09-10
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基金
国家中医药管理局全国名老中医药专家传承工作室建设项目(国中医药人教发〔2016〕42号)
宁波市社会公益研究项目(2022S086)
作者信息
    浙江中医药大学附属医院宁波市中医院，浙江 宁波 315000

通讯作者:

楼红侃（1983-），男，浙江东阳人，副主任中医师，硕士，研究方向：中医药对脊柱退行性疾病。E-mail：。
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Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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