腰椎間盤突出癥的中醫(yī)治療研究進展

王馨 張智達 胡國強

【摘要】腰椎間盤突出癥（Lumbar disc herniation，LDH）是指腰椎間盤發(fā)生退行性改變，在外力作用下，纖維環(huán)部分或全部破裂，單獨或者連同髓核、軟骨終板向外突出，刺激或壓迫神經(jīng)根而導致的以腰腿疼痛為主的一種病理改變。隨著當代人們工作方式與生活方式的改變，腰椎間盤突出癥的發(fā)病率逐漸升高。根據(jù)流行病學調查，我國腰腿痛患病率高達1.5%～13.6%，而LDH患者至少占腰腿疼痛患者的10%。在臨床診療工作中，中醫(yī)藥療法在治療LDH中彰顯出極大優(yōu)勢。現(xiàn)結合相關文獻報道，對臨床采用中醫(yī)藥治療LDH的方法及進展進行總結分析。

【關鍵詞】腰椎間盤突出癥；中醫(yī)藥療法；針灸治療

Research Progress in the treatment of Lumbar Disc Herniation with Chinese Medicine

WANG Xin1， ZHANG Zhida1， HU Guoqiang2

1.Graduate School of Hebei North University， Zhangjiakou， Hebei 075000， China 2.Shijiazhuang Traditional Chinese Medicine Hospital， Shijiazhuang， Hebei 050000， China

【Abstract】Lumbar disc herniation （LDH） refers to a pathological change in the lumbar disc that undergoes degenerative changes.Under external force，the fibrous ring partially or completely ruptures，and either alone or in conjunction with the nucleus pulposus and cartilage endplate protrudes outward，stimulating or compressing the nerve roots，resulting in a pathological change mainly characterized by waist and leg pain.With the change of work and life style of contemporary people，the incidence rate of lumbar disc herniation has gradually increased. According to epidemiological survey，the prevalence rate of low back and leg pain in China was as high as 1.5%to13.6%，and LDH patients accounted for at least 10% of low back and leg pain patients.In clinical diagnosis and treatment，traditional Chinese medicine therapy has shown great advantages in treating LDH.Based on relevant literature reports，this article summarizes and analyzes the methods and progress of using traditional Chinese medicine to treat LDH in clinical practice.

【Key Words】Lumbar disc herniation； Therapy of traditional Chinese medicine； Acupuncture therapy

1.中醫(yī)對LDH病名及病因病機的認識

雖然在古醫(yī)籍中未提及腰椎間盤突出癥的病名，但對該病有著悠久的認識，在中醫(yī)傳統(tǒng)疾病中，LDH在中醫(yī)古代文獻中多稱為“痹癥”“腰痛”“腰胯痛”，歷代醫(yī)家均十分重視對腰痛的研究，在病名及分類上各有見地，有按部位劃分稱之為腰痛、腰背痛、腰脊痛等；有按病因劃分者，文獻中涉及瀝血腰痛、跌撲閃挫腰痛、寒腰痛等[1]。

隨著社會變革及中醫(yī)文化的不斷發(fā)展，歷代醫(yī)家對腰痛病因病機的認識日趨完善。邪阻經(jīng)脈，腰府失養(yǎng)為其基本病機。“其人身體重，腰中冷，如坐水中，形如水狀……腰以下冷痛，腹重如帶五千錢”，論述了寒濕之邪致人腰痛之病因；陳無擇在《三因極一病證方論》言道：“夫腰痛，雖屬腎虛，亦涉三因所致，在外臟腑經(jīng)絡受邪，內(nèi)有憂思恐怒，以至房勞墜墮，皆能致之。