基于"久痛入络"理论探析中医推拿改善中枢痛觉敏化的"化瘀通络"机制OA

Neuropathic pain(NPP)includes chronic pain resulting from central or peripheral nervous system injury.Central sensitization(CS)is the core driving factor for the delayed cure of NPP,and its clinical diagnosis and treatment are facing challenges.The theory of"Chronic Pain Entering Collaterals"of traditional Chinese medicine(TCM)is highly consistent with the pathological characteristics of NPP,which provides important theoretical support for its diagnosis and treatment.Based on this theory,combined with ancient literature and modern research,this paper systematically explains the TCM pathogenesis of NPP central sensitization and the regulatory mechanism of TCM tuina in"resolving stagnation and dredging collaterals".Firstly,from the perspective of the convergence of traditional Chinese and Western medicine,the internal relationship between"Chronic Pain Entering Collaterals"and CS was revealed.The"peripheral-central sensitization"pain evolution model in modern medicine aligns with the"meridian-collateral"hierarchical cognition of TCM."Meridian disease"corresponds to the dysfunction of peripheral sensitization,and"collateral disease",especially stasis of Yin and collaterals,corresponds to the pathological changes of CS in both the spinal cord and supraspinal area.Secondly,the central pathological network of"collateral-stasis sensitization"was analyzed,and it was confirmed that the modern mechanism,such as the degradation of peripheral neuronal network(PNNs)in the spinal dorsal horn and the inflammatory cascade caused by the activation of microglia and astrocytes,is the microscopic expression of"marrow collateral obstruction caused by phlegm and blood stasis"and"marrow collateral deficiency and loss of vitality"in TCM.On this basis,the multi-level regulation pathway of Chinese tuina has been clarified:peripheral release can be performed by oscillatory manipulation,microcirculation homeostasis can be reconstructed by mechanical stimulation,and abnormal transmission of peripheral pain signals can be inhibited;The middle layer pivot adjustment was performed by the repair manipulation correcting the imbalance of spinal mechanical imbalance and dredging the Qi of the governor vessel.The deep collaterals searching through acupoint pressing and kneading can stimulate the Yang Qi of the governor vessel and remove the stasis of the marrow and collaterals,and finally realize the systematic regulation from the peripheral to the central pain network.This study bridges the cognitive gap between TCM and Western medicine in the field of chronic pain,clarifies the modern scientific connotation of"resolving stagnation and dredging collaterals"mechanism by tuina,and highlights its intervention advantages of"non-drug,multi-target,and holistic".It provides innovative ideas and practical paradigms for the basic research and clinical diagnosis and treatment of NPP,highlighting the unique academic value of"external treatment for internal disease"of TCM.