[Mechanism of traditional Chinese medicine manipulation in the treatment of lumbar disc herniation:a new perspective of mechanics and biochemistry].

Lumbar disc herniation (LDH) is a prevalent spinal disorder. As a non-pharmacological therapy in traditional Chinese medicine (TCM), manipulation is widely employed in the conservative management of LDH and has garnered considerable attention due to its notable clinical efficacy. This paper aims to review the mechanism of TCM manipulation in the treatment of LDH, and analyze the existing evidence from the multi-dimensional integration of "biomechanical stimulation, cell signal transduction, system physiological response". At the biomechanical level, TCM manipulation can adjust the spinal force line, improve the relative position relationship between nerve roots and protrusions, and relieve mechanical compression by applying precise tensile, rotational and shear forces. At the level of cell signal transduction, mechanical stimulation is sensed by mechanoreceptors such as integrins and Piezo1/2 channels on the membrane of nucleus pulposus and annulus fibrosus, and starts Ca2+ influx and intracellular cascade reaction. By regulating Hippo/Yes-associated protein, etracellular signal-regulated kinase1/2 and other key pathways, mechanical signals are transformed into chemical signals, thereby inhibiting cell apoptosis, promoting extracellular matrix synthesis, and regulating inflammatory response. At the level of system physiological response, TCM manipulation intervention can regulate the nerve immune two-way network and alleviate chemical nerve root inflammation;At the same time, by reducing peripheral noxious input, it can reverse the structural and functional remodeling of the central nervous system in patients with LDH, thus breaking the vicious circle of "pain-dysfunction". In conclusion, TCM manipulation exerts therapeutic effects through a multi-level integrated mechanism involving mechanical decompression, regulation of cellular signal transduction, modulation of neuroimmune inflammation, and central functional remodeling. This paper also points out the existing problems and challenges in this research field, and provides suggestions for future research directions. This review provides a richer scientific basis for the clinical application of TCM manipulation and promotes its popularization and application.