[1]刘爱峰△,郭天赐,宋佳伟,等.从“五体痹”视域探讨腰椎间盘突出症的病机演变与分期辨治策略[J].中国中医骨伤科杂志,2026,34(07):84-89.[doi:10.20085/j.cnki.issn1005-0205.260711]
　LIU Aifeng,GUO Tianci,SONG Jiawei,et al.Exploring the Pathogenesis Evolution and Treatment Strategy of Lumbar Disc Herniation from the Perspective of the “Five-Tissue Bi” Theory[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2026,34(07):84-89.[doi:10.20085/j.cnki.issn1005-0205.260711]
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从“五体痹”视域探讨腰椎间盘突出症的病机演变与分期辨治策略()

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第34卷
期数:
2026年07期
页码:
84-89
栏目:
学者论坛
出版日期:
2026-07-15

文章信息/Info

Title:
Exploring the Pathogenesis Evolution and Treatment Strategy of Lumbar Disc Herniation from the Perspective of the “Five-Tissue Bi” Theory
文章编号:
1005-0205(2026)07-0084-06
作者:
刘爱峰1; 2△; 郭天赐1; 2; 宋佳伟1; 2; 王继达1; 2; 刘佳进1; 2
1天津中医药大学第一附属医院(天津,300381)
2中医国家临床医学研究中心
Author(s):
LIU Aifeng1; 2△; GUO Tianci1; 2; SONG Jiawei1; 2; WANG Jida1; 2; LIU Jiajin1; 2
1First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China; 2National Clinical Research Center for Chinese Medicine,Tianjin 300381,China.
关键词:
腰椎间盘突出;  五体辨证;  五体痹;  阶梯治疗;  病机演变
Keywords:
lumbar disc herniation;  Five-tissue syndrome differentiation;  Five-tissue Bi;  stepwise care;  pathogenesis evolution
分类号:
R681.5
DOI:
10.20085/j.cnki.issn1005-0205.260711
文献标志码:
A
摘要:
腰椎间盘突出症(LDH)是引起下腰痛及肢体功能障碍常见的脊柱退行性疾病,针对目前腰椎间盘突出症阶梯化诊疗中早期干预靶点模糊及中西医结合切入点难量化的瓶颈,回归经典,系统梳理《黄帝内经》“五体痹”理论,结合历代医家论述与现代“慢性筋骨病”病理机制,构建腰椎间盘突出症全周期诊疗新范式。阐释了腰椎间盘突出症病机遵循由“皮肉”之卫外失固(急性期),经“筋脉”之瘀阻不通(缓解期),终至“骨髓”之本元亏虚(康复期)的由浅入深演变逻辑; 据此提出“急性期调皮柔筋、缓解期通脉解结、康复期正骨安脊”的分期辨治策略,并结合影像学与生物标志物实现“五体痹”的量化评估,旨在为提升中西医结合骨科临床决策的精准度提供理论依据。
Abstract:
Lumbar disc herniation(LDH)is a common degenerative spinal disease that causes significant functional impairment.Addressing the limitations in current stepwise care—namely,ambiguous early intervention targets and non-quantifiable integration of traditional Chinese medicine and Western medicine—this paper establishes a novel full-cycle management paradigm.Grounded in the “Five-tissue Bi” theory from the Huangdi Neijing and aligned with the modern pathology of chronic musculoskeletal disorders,we delineate the pathogenesis of LDH.The disease trajectory follows a deepening course:from “skin and flesh” defensive instability(acute phase),to “sinew and vessel” stasis(remission phase),and finally to “bone and marrow” essence deficiency(rehabilitation phase).Based on this,we propose a stage-specific treatment protocol:regulating the skin and softening the sinews during the acute phase,unblocking vessels in the remission phase,and correcting bone alignment in the rehabilitation phase.By incorporating imaging and biomarkers data to quantify “Five-tissue Bi” patterns,this paradigm aims to improve the precision and efficacy of integrative orthopedic clinical decisions.

参考文献/References:

[1] WU A M,MARCH L,ZHENG X Q,et al.Global low back pain prevalence and years lived with disability from 1990 to 2017:estimates from the Global Burden of Disease Study 2017[J].Annals of Translational Medicine,2020,8(6):299.
[2] 中华医学会骨科学分会脊柱外科学组,中华医学会骨科学分会骨科康复学组. 腰椎间盘突出症诊疗指南[J]. 中华骨科杂志,2020,40(8):477-487.
[3] KREINER D S,HWANG S W,EASA J E,et al.An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy[J].The Spine Journal,2014,14(1):180-191.
[4] 田传玺,吕天宜,郝瑞,等.“皮脉肉筋骨” 靶位理论构建的基础和临床应用[J].中华中医药杂志,2024,39(8):4076-4079.
[5] 许建文,桂裕昌.腰椎间盘突出症运动康复的专家共识[J].中国矫形外科杂志,2025,33(20):1825-1833.
[6] 戴娜,何兰,胡晶,等.“脾主肌肉”的理论探讨及其临床意义[J].中医杂志,2018,59(2):95-99.
[7] 李晓锋,莫文,胡志俊,等.施杞诊治慢性筋骨病思路与方法[J].中医杂志,2017,58(17):1453-1457.
[8] 刘建文,康斯文,张锡玮.基于《黄帝内经》 “五体痹” 理论探讨针刺治疗腰痛[J].医学理论与实践,2025,38(6):941-944.
[9] MODIC M T,STEINBERG P M,ROSS J S,et al.Degenerative disk disease:assessment of changes in vertebral body marrow with MR imaging[J].Radiology,1988,166(1):193-199.
[10] 秦晓宽,孙凯,徐卫国,等.腰椎间盘突出症中医循证实践指南[J].西部中医药,2024,37(5):1-15.
[11] 羊妹琴,邓忠民,余丽金,等.基于《内经》“皮脉肉筋骨理论”浅析针刺治疗软组织损伤[J].四川中医,2018,36(7):42-45.
[12] 王拥军,梁倩倩,唐德志,等.施杞防治慢性筋骨病学术思想与研究[J].上海中医药杂志,2017,51(4):1-5.
[13] HILDEBRANDT M,FANKHAUSER G,MEICHTRY A,et al.Correlation between lumbar dysfunction and fat infiltration in lumbar multifidus muscles in patients with low back pain[J].BMC Musculoskeletal Disorders,2017,18(1):12.
[14] 张敏,姜宏宁,元唯安,等.腰椎间盘突出症与多裂肌退变相关性的定量影像学研究[J].中国中西医结合影像学杂志,2019,17(1):13-15.
[15] CHEN X L,CUI P,LI Y J,et al.Links among MRI features in paraspinal muscles,inflammatory processes,and related back pain in patients with lumbar disc herniation[J].JOR Spine,2023,7(1):e1310.
[16] DUDLI S,FIELDS A J,SAMARTZIS D,et al.Pathobiology of modic changes[J].European Spine Journal,2016,25(11):3723-3734.
[17] 蔺福辉,何正保,计姜逊,等.基于红外热成像技术对不同证型腰椎间盘突出症患者相关经穴皮肤温度变化的分析[J].中国中医骨伤科杂志,2022,30(6):12-15.
[18] SARMAST A,KIRMANI A,BHAT A.Evaluation of role of electrophysiological studies in patients with lumbar disc disease[J].Asian Journal of Neurosurgery,2018,13(3):585-589.
[19] XU T,CHEN G Z,LI J,et al.Exploring causal correlations between inflammatory cytokines and intervertebral disc degeneration:a Mendelian randomization[J].JOR Spine,2024,7(3):e1349.
[20] BATTAGLIA P J,MAEDA Y,WELK A,et al.Reliability of the Goutallier classification in quantifying muscle fatty degeneration in the lumbar multifidus using magnetic resonance imaging[J].Journal of Manipulative and Physiological Therapeutics,2014,37(3):190-197.
[21] LI Z,CHEN J R,YANG J,et al.Relationship between paraspinal muscle properties and bone mineral density based on QCT in patients with lumbar disc herniation[J].BMC Musculoskeletal Disorders,2024,25(1):360.
[22] 王列.针刺“激痛点”对肌筋膜疼痛综合征大鼠疼痛敏化调控的机制研究[D].沈阳:辽宁中医药大学,2020.
[23] 李鸿鹏,张迪,刘志祥,等.筋膜触发点浮针治疗对腰椎间盘突出症患者疼痛及腰部活动度影响的随机对照研究[J].针刺研究,2024,49(5):512-518.
[24] WANG X Q,ZHENG J J,YU Z W,et al.A meta-analysis of core stability exercise versus general exercise for chronic low back pain[J].PLoS One,2012,7(12):e52082.
[25] 王平,周鑫,刘爱峰,等.靶点射频消融联合脉冲射频治疗腰椎间盘 突出症的临床研究[J].中国疼痛医学杂志,2019,25(9):699-702.
[26] GADJRADJ P S,RUBINSTEIN S M,PEUL W C,et al.Full endoscopic versus open discectomy for sciatica:randomised controlled non-inferiority trial[J].BMJ,2022,376:e065846.
[27] HEO D H,SON S K,EUM J H,et al.Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique:technical note and preliminary clinical results[J].Neurosurgical Focus,2017,43(2):E8.
(收稿日期:2025-12-09)

备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(82474538)
天津市津门医学英才项目(TJSJMYXYC-D2-028)
△通信作者 E-mail:draifeng@163.com
更新日期/Last Update: 2026-07-15