【目的】 探讨舒腰活血通络汤联合循经点穴按摩治疗气滞血瘀型腰椎间盘突出症（LDH）患者的临床疗效，并分析其对血 清学指标的影响。【方法】 选取 2023年 12月至 2024年 12月期间广州中医药大学惠州医院收治的 120例被确诊为气滞血瘀型 LDH的患者作为研究对象，按随机数字表法将患者随机分为对照组和研究组，每组各60例。对照组给予实施常规治疗（包括 腰椎牵引和药物治疗）及循经点穴按摩治疗，研究组在实施常规治疗及循经点穴按摩的基础上加用舒腰活血通络汤治疗。观 察 2组患者治疗前后中医证候积分、疼痛视觉模拟量表（VAS）评分、腰椎功能日本骨科协会（JOA）评分、Oswestry功能障碍 指数（ODI）评分及血清肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）的变化情况，并比较2组患者的临床疗效。【结果】（1）疗效 方面，治疗20 d后，研究组的总有效率为95.00%（57/60），对照组为81.67%（49/60），组间比较（χ2 检验），研究组的疗效明显 优于对照组（P＜0.05）。（2）中医证候积分方面，治疗后，2组患者的中医证候积分均较治疗前降低（P＜0.01），且研究组对中 医证候积分的降低幅度明显优于对照组（P＜0.01）。（3）疼痛程度评估方面，治疗后，2组患者的疼痛 VAS评分均较治疗前降 低（P＜0.01），且研究组的降低幅度明显优于对照组（P＜0.01）。（4）腰椎功能评估方面，治疗后，2组患者的JOA评分均较治 疗前升高（P＜0.05），ODI评分均较治疗前降低（P＜0.05），且研究组对JOA评分的升高幅度及对ODI评分的降低幅度均明显 优于对照组（P＜0.05）。（5）血清炎性因子指标方面，治疗后，2组患者的血清 IL-6、TNF-α水平均较治疗前降低（P＜0.05）， 且研究组对血清IL-6、TNF-α水平的降低幅度均明显优于对照组（P＜0.05）。【结论】 相较于单一的循经点穴按摩疗法，舒腰 活血通络汤与循经点穴按摩的联合应用能够更显著地改善气滞血瘀型LDH患者的临床症状，降低血清炎性因子水平，提升 整体治疗效果。

Objective To investigate the clinical efficacy of Shuyao Huoxue Tongluo Decoction combined with meridian acupoint massage in treating lumbar disc herniation （LDH） patients with qi-stagnation and blood-stasis syndrome， and to analyze its effects on serological indicators. Methods A total of 120 LDH patients with qistagnation and blood-stasis syndrome admitted to Huizhou Hospital of Guangzhou University of Chinese Medicine from December 2023 to December 2024 were enrolled. The patients were randomly divided into control group and study group using a random number table，with 60 cases in each group. The control group received conventional treatment （including lumbar traction and drug therapy） combined with meridian acupoint massage，while the study group received additional Shuyao Huoxue Tongluo Decoction based on the treatment for the control group. Before and after treatment，the scores of traditional Chinese Medicine （TCM） syndrome，Visual Analogue Scale （VAS） scores for pain，Japanese Orthopedic Association （JOA） scores for lumbar function，Oswestry Disability Index （ODI） scores，and serum levels of tumor necrosis factor α（TNF-α） and interleukin 6（IL-6） in the two groups were compared. After treatment，the clinical efficacy was evaluated between groups. Results （1） After 20 days of treatment，the total effective rate was 95.00% （57/60） in the study group versus 81.67% （49/60） in the control group （tested by chi-square test，P＜0.05），demonstrating significantly superior therapeutic effects in the study group.（2） After treatment，both groups showed significant reduction in TCM syndrome scores （P＜0.01），and the study group exhibited markedly decrease compared to the control group （P＜0.01）.（3） After treatment，the VAS scores for pain in both groups were significantly decreased compared to those before treatment （P＜0.01）， and the study group exhibited obvious decrease of the scores than the control group （P＜0.01）.（4） After treatment， JOA scores for lumbar function in both groups were increased （P＜0.05），while Oswestry Disability Index （ODI） scores were decreased （P＜0.05），compared to those before treatment，and the study group demonstrated more significant improvements in both JOA score elevation and ODI score reduction （P＜0.05）. （5） For serum inflammatory factors， interleukin-6（IL-6） and tumor necrosis factor- α（TNF- α） levels in both groups were significantly reduced （P＜0.05） after treatment，and the study group showed more pronounced decrease in both markers （P＜0.05）. Conclusion Compared with meridian acupoint massage alone， the combined therapy of Shuyao Huoxue Tongluo Decoction and meridian acupoint massage is effective on significantly alleviating clinical symptoms， reducing serum inflammatory factors， and enhancing overall therapeutic outcomes in LDH patients with qi-stagnation and blood-stasis syndrome.

R274.9

广东省中医药局科研项目（编号：20202218）