J. Acupunct. Tuina. Sci. 2011, 9 (2): 123-126 DOI: 10.1007/s11726-011-0489-1

Clinical Study

Tuina Treatment of 150 Cases with Lumbar Intervertebral Disc Herniation 推拿治疗腰椎间盘突出症 150 例 Lei Longming (雷龙鸣), Huang Jinjun (黄锦军), He Yufeng (何育风), Duan Wenkui (段文魁), Tang Hongliang (唐宏亮), Gan Wei (甘炜) Tuina Department, No. 1 Hospital Affiliated to Guangxi College of Traditional Chinese Medicine, Nanning 530023, P. R. China

【Abstract】Objective: To observe the clinical efficacy of tuina treatment for lumbar intervertebral disc herniation. Methods: 150 cases with lumbar intervertebral disc herniation were treated with tuina, followed by a retrospective analysis and summarization on the clinical efficacy. Results: 43 cases obtained clinical recovery, 67 cases had a marked effect, 34 cases had improvement and 6 cases failed. The total effective rate was 96.0%. Conclusion: Tuina is effective for lumbar intervertebral disc herniation. 【Key Words】Intervertebral Disc Displacement; Low Back Pain; Tuina; Massage 【摘要】目的：观察推拿治疗腰椎间盘突出症的临床疗效。方法：对 150 例腰椎间盘突出症门诊患者采 用推拿治疗，并对其临床疗效进行回顾性的分析和总结。结果：临床痊愈 43 例，显效 67 例，有效 34 例， 无效 6 例，总有效率为 96.0%。结论：推拿对腰椎间盘突出症具有较好的疗效。 【关键词】椎间盘移位；腰痛；推拿；按摩 【中图分类号】R244.1 【文献标志码】B We have treated 150 lumbar intervertebral disc herniation cases with tuina. The results are now reported as follows.

1 Clinical Data All the 150 cases were from the tuina department, No.1 Hospital Affiliated to Guangxi College of Traditional Chinese Medicine. They were diagnosed on the basis of clinical symptoms, signs and confirmed by CT scan and MRI. Of the 150 cases, there are 82 males and 68 females, aged from 18-67 years, with an average age of (37±12). The duration lasted from 2 d to 24 years. As for the affected lumbar segments, 7 cases had disc herniation of L3-4, 50 cases L4-5, 40 cases L5-S1 and 53 cases multiple segments. Fund Item: 2009 Leading Scientific Research Project of Health Department, Guangxi Autonomous Region [GWKJ (2009) No29, file No: Z200937] Author: Lei Longming, master of medicine，associate chief physician, [email protected]

2 Treatment Method The treatment method involves three steps: Relaxing muscle spasm, invigorating blood circulation and correcting the subluxation. Relaxing the muscle spasm: Standing to one side of the patient in a prone position, with the low back exposed (Fig.1), apply edible sesame oil to the exposed area and conduct approximately 10 min of Gun-rolling manipulation, along with Tui-pushing, Rou-kneading and Ca-rubbing manipulation to the healthy (first) and affected sides, especially the affected side, until the local skin turns warm (Fig.2).

Fig.1. Expose the low back

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J. Acupunct. Tuina. Sci. 2011, 9 (2): 123-126

Invigorating the blood circulation: Apply approximately 25 min of Gun-rolling, An-pressing, Bo-plucking and digital pressure to the back, low back, buttocks and stomach as well as the Three Yin Meridians of the Foot on the lower limbs.

Fig.2. Apply palm Tui-pushing to the low back

Huantiao (GB 30), Chengfu (BL 36), Weizhong (BL 40), Chengshan (BL 57) and Kunlun (BL 67) (Fig.5); Tan-pluck the lumbar vertebrae, Tui-push the spinous processes and spine; apply perpendicular pressure to the spinous processes of the lumbar vertebrae using crossed hands, press the vertebrae from top to bottom 8-10 times, repeat the procedure 3 times, followed by 3 times of Tui-pushing the spinous processes towards the contralateral sides (Fig.5); and finally, apply 8-10 times of Tui-pushing using the base of the palm from the thoracic vertebrae towards the sacral vertebrae (Fig.6). Standing to one side of the patient in a supine position, press and pluck the pathways along the Stomach and the Three Yin Meridians of the Foot, particularly the lower leg, followed by digital pressure using the thumbs to bilateral Zusanli (ST 36), Yanglingquan (GB 34), Sanyinjiao (SP 6), Taixi (KI 3) and Yongquan (KI 1) (Fig.7 and 8).

Fig.3. An-pressing the low back with thumbs

Fig.5. An-pressing the low back with palms

Fig.4. Gun-rolling manipulation to the lower limbs

Standing to one side of the patient in a prone position without exposing the low back, An-press and Tan-pluck the first lateral lines of the Bladder Meridian 5-7 times using the thumbs; apply 5-7 times of Gun-rolling manipulation respectively to the bilateral aspects of the low back, buttocks, posterior aspects of the thigh and posterior and lateral aspects of the lower leg (Fig.3); apply 5-7 times of An-pressing and Tan-plucking respectively to the bilateral aspects of the buttocks and pathways along the Gallbladder and Liver Meridians in the lower limbs using thumbs (Fig.4); apply digital pressure using the thumbs or elbows to Ashi points or bilateral ●

Fig.6. Tui-pushing the low back

Fig.7. An-pressing the Stomach Meridian

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J. Acupunct. Tuina. Sci. 2011, 9 (2): 123-126

Correcting the subluxation: Apply approximately 5 min of straight leg raising extension, oblique pulling of the low back and pressing Ashi points using the elbow.

Pressing Ashi points using the elbow: With a prone position of the patient, the practitioner presses the Ashi points (often located inferior to the spinous processes of the affected vertebrae, or refer to the CT scan or MRI findings, for example, press the most painful area on the left side of the L4 for a left-sided herniation of L4-5). Conduct pressing for 1 min and gradually increase the force (Fig.12)

Fig.8. An-pressing the Three Yin Meridians of the Foot

Straight leg raising extension: Standing to one side of the patient in a supine position, hold the lower part of the affected thigh, allowing a passive straight leg raising movement as well as an extension and pulling of the lower limb towards the thigh. Repeat this 3-5 times within the limit of the patient’s tolerance (Fig. 9).

Fig.10. Posture for Ban-pulling manipulation

Fig.11. Oblique pulling of the lower back

Fig.9. Extending a straight leg raising

Oblique pulling of the lower back: With a side-lying position (of the patient), placing the healthy limb over the affected one which is naturally extended to form a slight arc of the spine (Fig.10), the practitioner supports the anterior part of the patient’s shoulder with one hand and the patient’s buttock with the other hand, then shakes the torso for a while, rotate the lower back to the maximum limit and pull towards the contralateral side, often followed by a crack sound (Fig.11).

Fig.12. An-pressing the Ashi points using the elbow

The whole treatment process takes approximately 40 min. Conduct the treatment once a day; 5 times constitute one course of treatment, allowing a 2-day interval between the two courses. The treatment effect was observed after 4 courses of treatment.

3 Results The evaluation was made on the basis of the Guiding Principles for Clinical Study of New Chinese Medicines[1].

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Clinical recovery: Almost absence of lower back and leg pain, a negative result of straight leg raising test and restoration to normal work. Marked effect: Partial absence of lower back pain and obvious tenderness, a negative result of straight leg raising test and almost restoration to normal work Improvement: Mild lower back and leg pain, a probable positive result of straight leg raising test and occasional restoration to normal work. Failure: No improvement of the lower back and leg pain, a positive result of straight leg raising test and failure to perform normal work In summary, of the 150 cases, 43 cases resulted in clinical recovery, 67 cases marked effect, 34 cases improvement and 6 cases failure. As a result, the total effective rate was 96.0%. Following a conservation therapy of integrated Chinese and Western medicine, of the 6 failure cases, 4 obtained marked effects and 2 improvement.

4 Discussion Most cases can obtain clinical recoveries following conservative therapy. Of all conservation therapies, acupuncture and tuina are privileged options [2-5]. Chinese medicine asserts that "obstruction causes pain" and "malnourishment causes pain". However, malnourishment causes pain only because it also results in obstruction of the qi, blood, vessels and meridians. Consequently, obstruction is the underlying cause for lower back and leg pain due to lumber intervertebral disc herniation. Accordingly, we

come up with the three "unblocking" tuina methods via relaxing muscle spasm, invigorating blood circulation and correcting the subluxation. By relaxing muscles, adjust the relative position between the herniated intervertebral disc and compressed nerve root, invigorating blood circulation and tonifying qi and invigorating blood circulation, good effects have been achieved. In addition, applying manipulation to the pathways along the Stomach Meridian and Three Yin Meridians of the Foot can facilitate in supplementing qi and blood and nourishing the tendons and bones and, therefore, improving the treatment results.

References [1] Ministry of Health of the People’s Republic of China. Guiding Principles for Clinical Study of New Chinese Medicines. Beijing: China Medico-Pharmaceutical Science & Technology Publishing House, 1997: 145-146. [2] Zhang ZY. Therapeutic effect observation on acupuncture and tuina for lumbar intervertebral disc herniation. Shang Hai Zhen Jiu Za Zhi, 2002, 21 (3): 15-16. [3] Zhu WM, Wu YC, Zhang JF, Li SS, Fan YZ. Clinical research on tuina plus hydro-acupuncture for lumbar intervertebral disc herniation. J Acupunct Tuina Sci, 2010, 8 (1): 44-46. [4] Cui X. Prof. Wu Yaochi’s experience in treating lumbar intervertebral disc herniation by phases. Shang Hai Zhen Jiu Za Zhi, 2008, 27 (1): 4-5. [5] Chen W, Wang JX. Therapeutic evaluation of tuina and hyperbaric oxygen for prolapsed of lumbar intervertebral disc. J Acupunct Tuina Sci, 2011, 9(1): 58-61. Translator: Han Chouping (韩丑萍) Received Date: December 18, 2010

● Book Review ●

Introduction to Acupuncture Treatment for 54 Disorders Acupuncture Treatment for 54 Disorders was written by Huang Qinfeng and Qi Lizhen, and published by Shanghai Science and Technology Press in 2002. The book collected 54 common disorders in clinic from about 5 451 articles published in hundreds journals between 1980 and 2000. The status of clinical acupuncture was analyzed considerably based upon a big sample, and the rule of acupuncture on various disorders was summarized. Therefore, it could be used in clinic research and teaching.

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