Acupuncture for Intervertebral Lumbar Disc Prolapse: Case Studies and Clinical Experience Abstract Intervertebral lumbar disc prolapse is a very common disease in our clinic, especially among 20 to 50 year olds.Most do not need surgery and there are many effective conservative treatments, of which acupuncture is one of the best. In our clinic we have treated hundreds of cases of this kind and have found acupuncture to be outstandingly effective. Here we present two typical cases followed by some clinical notes based on our own experience. Case 1 Mr. Li, a 42 year old Chinese chef came to the clinic because he had been suffering from acute lumbago pain for three daysand could not work. When he came, he was unable to stand up straight and complained of sharp pain in the left leg, particularly on the lateral side. Even with many painkillers, he still was in serious pain.A CT scan identified L5-S1 Intervertebral lumbardisc prolapse oppressing the nerve root. Physical examination revealed severe tenderness and percussion pain about 1 cm to the left side of L5-S1, and the spine was visibly shifted to the left. The straight-leg-raising test on the left side was positive(< 30) and the radiating pain was aggravated when he coughed. The tongue was pale but with a darkish hue, with tooth prints on the edges and a thin layer of white coating. His pulse was thready and uneven. Pattern differentiation was stagnation of qi, blood stasis and Kidney deficiency. Acupuncture treatment was given to activate bloodand qi, resolve stasis, relieve the pain, nourish the Kidneys and strengthen the waist.The following points were used: Shenshu BL-23,Dachangshu BL-25, Weizhong BL-40, Taixi KID-3,Kunlun BL-60, Yanglingquan GB-34, XuanzhongGB-39 and the most tender ahshi point. The ahshi point was pricked and then cupped to extract a few drops of blood. Shenshu BL-23 and DachangshuBL-25 were reinforced and all the other points were reduced. Wherever possible the needle sensation was induced to radiate to the leg or foot. The needles were retained for about 40 minutes.After acupuncture the pain was greatly relieved. However, Mr. Li could still not straighten the spine or walk properly so I performed an oblique pulling manipulation on the spine and after that, Mr. Li was able to stand straight.The patient was advised to: 1. Continue treatment for ten sessions, once every two days.2. Sleep on a hard surface.3. Refrain from sex during the course of treatment.4. After completion of the ten treatments, to start exercises to benefit the lumbar region, for exampleTaijiquan.At the second visit the patient told me that the painwas much relieved. I repeated the treatment as before,but without the pricking and cupping of the ahshipoint.After 10 sessions, Mr. Li felt fine and returned towork. Case 2 Mr. S, 40-years old. Two years ago, Mr. S’s L4-5 intervertebral disc was removed because of intervertebral lumbar disc prolapse. However,after surgery, the lumbar and leg pain remained,particularly the left leg which was numb and showed muscle loss. Mr. S. was unable to lead a normal life or to work. The pain was located mainly on the lateral side of the thigh and lower leg. There was sharp tenderness about 1 cm to the left side of L4-5. No radiating percussion pain appeared and there was no radiating pain on coughing. The straight-leg-raising test showed 60 and the left leg was obviously more atrophied than the right leg.The pulse was weak and somewhat thready and the tongue was slightly enlarged and purple, and displayed several dark spots on the edges. Mr. Shad tried many different treatments already but had found no relief at all.According to differentiation of channels, all of the symptoms and signs were caused by the shaoyang channel being blocked by qi stagnation,accompanied by blood deficiency.The treatment consisted of clearing obstruction in the channel and nourishing blood. I chose the following points: Shenshu BL-23, Dachangshu BL-25, HuantiaoGB-30, Fengshi GB-31, Yanglingquan GB-34, XuanzhongGB-39, Qiuxu GB-40, Zusanli ST-36 and the most tenderahshi point.Shenshu BL-23 and Zusanli ST-36 were reinforced, the ahshi point was pricked to bleed, and all the other points were reinforced. Wherever possible the needle sensation was induced to transmit along the painful leg.After 40 minutes, Mr. S. stood up and tried to move his back and leg. He was surprised to find he felt no pain at all. However, the numbness was still there and I explained to him that the numbness would require repeated treatment. After five further treatments using the same points,but without the bleeding of the ahshi point, he was no longer suffering either pain or numbness. I decided that he had no further need of acupuncture, but asked him to take Tao Hong Si Wu Tang (Four-Substance Decoction with Safflower and Peach-Pit) tablets After two further months, the patient was so satisfied that he expressed his appreciation to me for the excellent curative effect of acupuncture in a letter. Clinical experience 1. The combination of points according to channel and pattern differentiation can offer the best curative effect. Intervertebral lumbar disc prolapse often affects the GallBladder and Bladder channels (i.e. the lateral and posterior sides of the leg). If the pain is caused by blockage of the GallBladder channel, the points to treat are Huantiao GB-30,Fengshi GB-31, Yanglingquan GB-34 and Qiuxu GB-40.When the Bladder channel is blocked, the relevant points are Dachangshu BL-25, Weizhong BL-40 and KunlunBL-60. If the pain is aggravated by cold or dampness, the application of moxibustion is required. 2. In cases of obvious blood stasis, bleeding therapy on the ahshi point has a great effect on pain relief. 3. In case of chronic pain, points to nourish the Kidneys and activate blood should be added, for example ShenshuBL-23, Mingmen DU-4, Xuehai SP-10 and Geshu BL-17.4. If there is severe lumbar pain, choose Renzhong DU-26 to relieve the pain effectively. 5. If there is severe leg pain, local acupuncture should not be performed at the early stage of treatment. Instead,the upper extremities should be treated first, for example:Houxi SI-3, Wangu SI-4, Yemen SJ-2 and Zhongzhu SJ-3.Once the leg pain is somewhat relieved, points on the legcan be needled. 6. If pain remains in the lumbar region and leg after surgery, Pishu BL-20 and Zusanli ST-36 can be added to tonify qi and nourish blood. 7. When accompanied with abdominal pain and the patient cannot bend forward or backward, the problem is caused by blockage of the Conception and Governing vessels. Guanyuan REN-4, Qihai REN-6 and MingmenDU-4 should be needled. 8. If the patient suffers from constipation, the problem is caused by blockage of the intestinal qi and the following points can be chosen: Tianshu ST-25 and ShangjuxuST-37. 9. If there is acute incontinence of urine and faeces, surgery is the best choice, but acupuncture can be of great help in chronic cases. Points to use are Tianshu ST-25,Qihai REN-6, Zhongji REN-3 and Dachangshu BL-25. 10. In case of impairment of sexual function, the tongue needs to be checked. If it is reddish with a thick yellow coating (indicating damp-heat), select Ganshu BL-18,Taichong LIV-3 and Sanyinjiao SP-6. If the tongue is pale or white or shows tooth prints on the edges and the tongue coating is thin and white (indicating Kidney yang deficiency) choose Taixi KID-3, Mingmen DU-4, CiliaoBL-32 and Qihai REN-6. Conclusion 1. Acupuncture is useful for the syndrome of intervertebral lumbar disc prolapse. It can relieve pain,relax the muscles and restore nerve function. 2. The results of a CT-scan or MRI, whilst important, donot replace careful physical examination. 3. Correct identification of the affected channels is thefoundation for point selection and can obtain outstandingresults. Dr. Yin is a consultant traditional Chinese medicine doctor working in London. He also is a director of the Qingdao Acupuncture Association, and is in charge of the Qingdao Tuina committee. He specialises in treating spinal, musculo-skeletal and skinproblems by acupuncture, tuina therapy and herbal medicine. |
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