The Role of Traditional Chinese Medicine Therapies in Intervertebral Disc Degeneration

Abstract

Intervertebral disc degeneration (IVDD) is one of the leading causes of chronic low back pain worldwide. Its onset and progression involve multiple pathological processes, including inflammatory activation, oxidative stress, ferroptosis, cellular senescence, extracellular matrix degradation, biomechanical imbalance, and endplate microcirculation dysfunction. Traditional Chinese medicine (TCM) therapies—such as acupuncture, Tuina (spinal manipulation), external herbal application, fumigation, and thermal therapy—have a long history of use in musculoskeletal disorders. Increasing modern evidence indicates that these interventions can delay IVDD progression by suppressing the NLRP3 inflammasome, modulating NF-κB activity, alleviating Piezo1-mediated mechanotransduction, and activating the Nrf2–HO-1 antioxidant pathway, thereby providing a solid biological basis for their therapeutic effects. This review systematically summarizes the modern mechanisms, experimental findings, and clinical evidence supporting acupuncture, Tuina, and external herbal therapies in IVDD, highlighting their potential as disease-modifying treatments. Furthermore, by integrating insights from multi-omics technologies and extracellular vesicles (EVs), this review explores future directions for combining TCM-based interventions with regenerative medicine.