推拿“以痛为腧”干预膝骨关节炎“肌肉力学—痛觉中枢”调控机制研究

膝骨关节炎（KOA）是国内外常见难治性疾病，迁延难愈，疼痛和步态障碍为主症，早期中医病机以“筋痹”为主；KOA临床防治方法众多，疗效不一，但推拿干预特色成效肯定；针对KOA研究已形成诸多学说，但“经筋”力学获效机制仍存瓶颈。课题组前期已开展推拿“筋痹”KOA下肢步态障碍肌群力学机制研究。本研究针对疼痛和步态障碍主症，基于中医“以痛为腧”理论，提出“推拿通过有效作用膝周‘筋痹’痛点，改善膝周经筋肌肉力学性能，从而激活大脑痛觉中枢调控下行抑制而获效”假说，拟开展：①KOA患者膝周“筋痹”疼痛与步态功能障碍、肌肉力学与大脑痛觉中枢的特征研究；②推拿手法干预KOA患者步行中主要功能肌群力学性能与大脑痛觉中枢之间变化规律研究；③中医推拿“以痛为腧”干预KOA疼痛行为学、肌肉力学和大脑痛觉中枢调控下行抑制作用机制研究。为探讨中医经筋“束骨利关节”力学基础和“通则不痛”大脑痛觉中枢调控机制提供科学依据。

Knee osteoarthritis (KOA) is a common refractory disease in the worldwide. The main symptoms are characteristic for painful and dysfunction, which is persistent and duration. The early pathogenesis of TCM is mainly “ Jin Bi”; In clinical , it shows uncertain curative effect with many methods to prevent and treat the disease for the KOA patients, but the affection of the Tui Na intervention are affirmative; Even though many theories have been formed for the KOA research, the effective mechanism still unknown completely. Our group had unfolded the mechanics mechanism of the muscle group of the KOA with lower limb gait disorder on the previous research. This study will aim at the main symptoms of pain and gait disorder, which is based on the Tradition Chinese Medicine theory called "Yi Pain Wei Shu". At the same time, we propose a hypothesis that "Tui Na can effectively improve the mechanical properties of the knee muscles through the effective action of the knee joint "tendons impediment" pain point, thereby activating the central nervous system. According to hypothesis we proposed three projects. First part, we will explain the characteristics of KOA patients among the three areas: knee joint "muscle" pain and gait dysfunction, muscle mechanics and brain pain sensation ; Second part, we will explore the correlation between mechanical properties of functional muscle group and the cerebral pain sensation center though Tui Na intervention to KOA walking patients ; Third part, we will carry out a mechanism research, including pain behavior affected by Tui Na, which is based on theory "Yi Pain Wei Shu", muscle mechanics and brain pain sensation central inhibition down-regulation. In conclusion, we can provide a scientific evidence for exploring the "Restrict Bone and Harmonize Joints" TCM meridians theory with the mechanical basis and the mechanism of the "Tong Ze No Pain" theory with brain center regulation.