目的 观察腰舒汤联合针灸推拿治疗气滞血瘀型腰椎间盘突出（LDH）的临床效果。方法 选取2023年1月～2025年12月收治的气滞血瘀型LDH患者104例，采用计算机随机分为参考组（52例采用针灸推拿治疗，因擅自使用方案外的药物剔除1例，）和综合组（52例采用腰舒汤联合针灸推拿治疗，因主动退出脱落1例）。比较两组中医证候评分、疼痛视觉模拟（VAS）评分、核因子-κB（NF-κB）信号通路指标、日本矫形外科学会（JOA）评分、腰背肌生物力学性能、脊旁肌横截面积（CSA）以及不良反应/事件发生率。结果 两组基线时中医证候评分、VAS评分、NF-κB信号通路指标、JOA评分比较差异不显著（P>0.05）；两组治疗后JOA评分均较基线时升高，同时综合组高于对应时间参考组（P<0.05）；两组治疗后中医证候评分、NF-κB信号通路指标、VAS评分均较基线时降低，同时综合组低于对应时间参考组（P<0.05）。两组基线时60°/s角速腰背肌生物力学性能比较差异不显著（P>0.05）；两组治疗后W、PT均较基线时升高，同时综合组高于对应时间参考组（P<0.05）；两组治疗后F/E均较基线时降低，同时综合组低于对应时间参考组（P<0.05）。两组基线时脊旁肌CSA比较差异不显著（P>0.05）；两组治疗后L3、L4、L5的Sm/Sv均较基线时降低，同时综合组低于对应时间参考组（P<0.05）；两组治疗后L3、L4的Se/Sv较基线时升高，同时综合组高于对应时间参考组（P<0.05）；两组治疗后L5的Se/Sv以及L3、L4、L5的Sp/Sv与基线时比较差异不显著（P>0.05）。两组不良反应/事件发生率比较，差异不显著（P>0.05）。结论 腰舒汤联合针灸推拿治疗气滞血瘀型腰椎间盘突出可缓解症状、抑制炎症、改善腰背肌功能与形态，且安全性相当。

巨大/破裂型腰椎间盘突出症（G/RLDH）是腰椎间盘突出症的严重类型，可致剧烈根性疼痛及神经功能障碍。推拿作为非药物中医疗法，广泛应用于腰椎间盘突出症，但治疗G/RLDH的疗效与安全性尚存争议。近年发现G/RLDH具有较高的椎间盘自然重吸收率，为推拿干预提供了病理基础。本文系统检索相关文献，从中医病机、现代医学机制、临床应用及安全性争议等方面进行综述，旨在指导临床诊治并为未来研究提供参考。

Giant/ruptured lumbar disc herniation (G/RLDH) is a severe type of lumbar disc herniation that can cause intense radicular pain and neurological dysfunction. As a non-pharmacological therapy in traditional Chinese medicine, tuina is widely used for lumbar disc herniation; however, its efficacy and safety in treating G/RLDH remain controversial. Recent studies have revealed a relatively high rate of spontaneous resorption of herniated discs in G/RLDH, which provides a pathological basis for tuina intervention. This article systematically reviews the relevant literature, summarizing the traditional Chinese medicine pathogenesis, modern medical mechanisms, clinical application, and safety controversies, aiming to guide clinical diagnosis and treatment and to provide a reference for future research.

目的 探讨穴位推拿联合稳定肌训练对颈椎病患者的康复效果。方法 回顾性选取我院收治的102例颈椎病患者（选例时间：2025年1月-2026年3月）为研究对象，根据干预方案分为参照组（51例，给予稳定肌训练）、联合组（51例，给予穴位推拿联合稳定肌训练）。对比两组临床疗效，干预前、后颈椎功能障碍指数（NDI）评分、视觉模拟量表（VAS）评分、中医证候积分、颈椎活动度、基底动脉血流动力学指标［基底动脉舒张期血流速度（EDV）、收缩期血流速度（PSV）、血管搏动指数（PI）、血流平均速度（Vm）］、健康调查简表（SF-36）评分。结果 联合组总有效率为94.12%，高于参照组的78.43%（P＜0.05）；与参照组相比，干预后联合组各中医证候积分均较低（P＜0.05）；联合组干预后VAS、NDI评分较参照组低（P＜0.05）；联合组干预后颈椎活动度较参照组大（P＜0.05）；干预后联合组基底动脉EDV、PSV、Vm较参照组大，PI值较参照组小（P＜0.05）；联合组干预后SF-36评分高于参照组（P＜0.05）。结论 穴位推拿联合稳定肌训练可提高颈椎病患者康复效果，减轻临床症状、疼痛程度，改善颈椎功能与血流动力学，提高生活质量。

目的 探究对神经根型颈椎病(CSR)患者开展悬吊运动疗法+推拿的临床价值。方法 选择2020年1月—2021年7月100例神经根型颈椎病患者,参考“数字双盲法”,分为对照组和观察组(均n=50);对照组患者为推拿治疗,观察组基于对照组基础+悬吊运动疗法;对比治疗结果。结果 观察组临床总有效率94.00%较对照组80.00%高(P＜0.05)。2组治疗后VAS疼痛评分较治疗前均下降,且观察组较对照组更低(P＜0.05)。治疗前120°/s的等速度运动状态下2组峰力距(PT)、平均功率(AP)、屈肌峰力距/伸肌峰力距(F/E)比较(P＞0.05),经治疗后2组均显著改善,且观察组PT、AP、F/E指标较对照组均更优(P＜0.05)。2组治疗后颈椎功能障碍指数(NDI)评分、颈椎病临床评价量表(CASCS)评分较同组治疗前均改善,且观察组较对照组NDI评分更低,CASCS评分更高。结论 针对CSR患者开展悬吊运动疗法+推拿治疗,有利于调节患者颈部肌群协调能力,减轻疼痛感,改善临床症状,促进颈椎功能恢复,实现理想的治疗效果。

Objective To explore the clinical value of sling exercise therapy (SET) and massage in patients with cervical spondylotic radiculopathy (CSR). Methods From January 2020 to July 2021, 100 patients with CSR were selected and divided into control group and observation group (both n=50). The patients in the control group were treated with massage, and the observation group was treated with massage+SET, the treatment results were compared. Results The total clinical effective rate of 94.00% in the observation group was significantly higher than 80.00% in the control group (P<0.05). The VAS pain scores of the two groups after treatment were lower than those before treatment, and the VAS pain score of the observation group was lower than that of the control group (P<0.05). The peak torque (PT), average power (AP) and flexor peak force distance/extensor peak force distance (F/E) of the two groups were significantly improved after treatment, and the PT, AP and F/E indexes of the observation group were better than those of the control group (P<0.05). After treatment, the neck disability index (NDI) score and clinical assessment scale of cervical spondylosis (CASCS) score of the two groups were significantly improved compared with those before treatment, and the NDI score of the observation group was lower and the CASCS score was higher in the observation group. Conclusions SET+massage therapy for patients with CSR is helpful to adjust the coordination ability of cervical muscle group, reduce pain, improve clinical symptoms, promote the recovery of cervical function and achieve ideal therapeutic effect.

目的 探讨与分析推拿联合补肾祛瘀针刺法治疗慢性腰肌劳损恢复期患者对腰部疼痛及表面肌电图的影响。方法 选择2019年9月—2022年4月我院收治的72例慢性腰肌劳损恢复期患者为研究对象,根据随机1∶1数字表法,分为联合组与对照组各36例。对照组给予推拿治疗,联合组在此基础上,给予补肾祛瘀针刺法治疗,2组均治疗并观察4周,评价腰部疼痛及表面肌电图变化情况。结果 治疗后联合组与对照组的总有效率分别为97.2%和75%,联合组高于对照组（P<0.05）;治疗前,2组患者的视觉类比疼痛评分法（VAPS）和下腰痛失能问卷（OPDG）评分比较差异无统计学意义,治疗后,2组患者的VAPS和OPDG评分均降低,且联合组低于对照组（P<0.05）;2组治疗后的腰椎前屈力度都高于治疗前（P<0.05）,且联合组更高（P<0.05）;2组治疗后的表面肌电图神经根振幅和潜伏期均低于治疗前（P<0.05）,且联合组更低（P<0.05）。联合组与对照组治疗后的血清5-HT含量均高于治疗前（P<0.05）,联合组更高（P<0.05）。结论 推拿联合补肾祛瘀针刺法在慢性腰肌劳损恢复期患者中的应用具有良好的安全性,有效改善患者的腰椎功能,缓解患者疼痛,提高整体治疗效果,也能改善患者的表面肌电图状况,促进血清5-HT的释放。

Objective To explore and analyze the effects of massage combined with kidney tonifying and blood stasis removing acupuncture on lumbar pain and surface electromyography in patients with chronic lumbar muscle strain in the recovery period．Methods From September 2019 to April 2022, 72 cases of patients in the recovery period of chronic lumbar muscle strain treated in our hospital were selected as the research objects, and were divided into the combined group and the control group with 36 cases in each group by the random 1∶1 number table method．The control group were given massage therapy, and the combination group were given kidney tonifying and stasis removing acupuncture additionally．Results After treatment, the total effective rates of combined group and control group were 97.2% and 75%, respectively, and the combined group was significantly higher than the control group（P<0.05）．Before treatment, there was no significant difference in the visual analogue pain scale（VAPS）and Oswestry low pain & disability questionnaire（OPDG）scores between the two groups, but after treatment, the scores of the two groups were significantly decreased, and the combined group was significantly lower than the control group（P<0.05）．The lumbar flexion intensity after treatment was significantly higher in both groups than before treatment（P<0.05）, and higher in combination group（P<0.05）．The amplitude and latency of surface electromyogram nerve roots after treatment were significantly lower in both groups than before treatment（P<0.05）, and even lower in combination group（P<0.05）．The serum 5-HT content in combination group and control group after treatment was significantly higher than that before treatment（P<0.05）, and that in combination group was higher（P<0.05）．Conclusions The application of massage combined with kidney tonifying and blood stasis removing acupuncture in patients recovering from chronic lumbar muscle strain has good safety, which can improve the lumbar function of patients, relieve the pain of patients, improve the overall therapeutic effect, improve the surface electromyography of patients and promote the release of serum 5-HT．

目的 探讨自拟补肝益肾壮腰汤联合脊柱推拿、牵引对腰椎间盘突出症(LDH)患者肌电图和腰椎功能的影响及临床效果。方法 选取106例LDH患者采用随机数字表法分为观察组和对照组各53例。对照组行脊柱推拿及牵引治疗,观察组在此基础上加用自拟补肝益肾壮腰汤。记录2组患者治疗前及治疗3个月后的腰椎功能程度[Oswestry功能障碍指数(ODI)]、肌电图[平均功率频率(MPF)、中位频率斜率(MFs)、平均肌电波幅(AEMG)]、运动功能障碍程度[日本骨科协会下腰痛量表(JOA)]及疼痛程度[视觉模拟评分法(VAS)]评估结果差异。结果 治疗3个月后,2组JOA评分、VAS评分及各项肌电图参数(MPF、MFs、AEMG)均较治疗前有提升,且观察组均高于对照组(P均＜0.05);ODI评分则较治疗前下降(P均＜0.05),且观察组低于对照组(P＜0.05)。结论 自拟补肝益肾壮腰汤联合脊柱推拿及牵引能明显改善LDH患者腰椎功能,促进肌力恢复、缓解肌肉疲劳、减轻疼痛,有较高的临床实用价值。

Objective To investigate the effect of self-made Bugan Yishen Zhuangyao decoction combined with spinal massage and traction on electromyography and lumbar function and clinical efficacy in patients with lumbar disc herniation (LDH). Methods A total of 106 patients with LDH were randomly divided into observation group and control group. The control group was treated with spinal massage and traction, and the observation group was treated with self-made Bugan Yishen Zhuangyao decoction on this basis. The degree of lumbar spine function [Oswestry disability index (ODI)], electromyography [mean power frequency (MPF), median frequency slope (MFS), average EMG amplitude (AEMG)], the degree of motor dysfunction [Japanese Orthopaedic Association (JOA) score] and the degree of pain [visual analog scale (VAS)] before and 3 months after treatment were recorded and compared. Results After 3 months of treatment, JOA score, VAS score and EMG parameters (MPF, MFS and AEMG) in the two groups were significantly higher than those before treatment, and those in the observation group were higher (P<0.05); ODI score was significantly lower than that before treatment (all P<0.05), and the observation group was significantly lower than the control group (P<0.05). Conclusions The self-made Bugan Yishen Zhuangyao decoction combined with spinal massage and traction can significantly improve the lumbar function of patients with LDH, promote the recovery of muscle strength, relieve muscle fatigue and pain, and with high clinical practical value.