Journal of Acupunctureand Tuina Science.2004, Vol. 2, No.5

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Treatment of 96 Cases of Prolapse of Lumbar Intervertebral Disc of Posterior Protrusion Type by the Comprehensive Therapy LIU Kong-jiang(~t'l~iL'.Lr-),LU Jian-hu(lt~ti~), SONG Ling(~ .V~-~ ) Nanjing TCM Hospital, Jiangsu, China, 210001

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Abstracts: Ninety-six cases of prolapse of lumbar intervertebral disc of posterior protrusion type were

divided randomly into observation group including 50 cases and control group including 46 cases. Patients in observation group were treated with combined use of acupuncture, traction and Tuina, and patients in control group were only treated with acupuncture. After treatment, the significant difference was tbund between the observation group and control group in therapeutic affect. The comprehensive therapy is definitely effective and simple in the treatment of prolapse of lumbar intervertebral disc of posterior protrusion type, which has guiding significance to the clinical practice. K e y W o r d s : Acupuncture Therapy; Tuina; Massage; Traction; Intervertebral Disc, Displacement

Lumbar intervertebral disc protrusion is a condition associated with the raptured annulus fibrosus, which is responsible for about 15% of patients with low back and leg pain in out-patient departmentE~J. At present, the study on the mechanism of this disease has enhanced its clinical therapeutic effect, and the treatment principle has been converted from relieving pressure on the nerve root by surgical therapy to the non-surgical therapy, leading to the decrease of the treatment rate of surgical therapy, and the non-surgical therapy for this disease has become the first choice r-~l.TCM holds that most of patients may be treated by the non-surgical therapy and acupuncture is the common treatment method. In clinic, because of the thin and narrow posterior longitudinal ligament, some patients with posterior protruding abnormalities of the physiological lordosis of the vertebral column often suffers from the lumbar intervertebral disc protrusion due to the raptured tissue of the intervertebral disc caused by improper force, and the central protrusion is most common. The authors adopted the comprehensive

therapy to regulate spinal column, correct the posterior protrusion, improve the pressure between lumbar intervertebral discs, so as to repair the annulus fibrosus, replace the tissue of intervertebral disc. Clinical Materials

Ninety-six cases were in-patients of our hospital from December of 1995 to October of 2003, including 49 males and 47 females, with the youngest being 20 years old and the oldest being 65 years old, the duration of disease being from 1 month to 3 years. They were definitely diagnosed as the lumbar intervertebral disc protrusion by CT or MRI scanning. Most patients often work with the head holding in a bent position or longterm repeated bending of the spine, they had received the routine single treatment with no obvious effect. Ninety-six cases of patients were randomly divided into the observation group including 50 cases and control group including 46 cases. No significant differences

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were found in sex, age and duration of disease between two groups.

Journal of Acupunctureand Tuina Science.2004, Vol. 2, No. 5 10 times being a course of treatment, generally, the patient was given 2-5 courses of treatment. 2. Control group

Therapeutic Methods 1. Observation group

a.Acupuncture Acupoint: Jiaji (Ex-B 2), Dachangshu (BL 25), Guanyuanshu (BL 26), Qihaishu (BL 24), Shenshu (BL 23), Weizhong (BL 40), Zhibian (BL 54), Huantiao (GB 30), Feiyang (BL 58) and Kunlun (BL 60). Operation: Puncture Jiaji (Ex-B 2), Dachangshu (BL 25), Guanyuanshu (BL 26), Qihaishu (BL 24), Shenshu (BL 23), Weizhong (BL 40), Feiyang (BL 58) and Kunlun (BL 60) perpendicularly with the filiform needles of 40ram in length and 0.30 mm in diameter, puncture Zhibian (BL 54), Huantiao (GB 30) deeply with the filiform needles of 75 mm in length and 0.30 mm in diameter, the needles were retained for 30 min, with 10 times being a course of treatment, generally, the patient was given 2-5 courses of treatment. b.Traction The patient lied on the electric traction bed for pelvic traction, with traction weight being 40 kg and traction lasting time being 20-30 rain each time, the traction is done 1-2 times a day, 5 days a week, and 10 times consisted of a course of treatment, generally, 2-5 courses of treatment was given for each patient. The traction weight and lasting time may be adjusted depending on the patient's condition, tolerance ability, and the degree of posterior protrusion of the spine vertebrae. c.Tuina With the patient in prone, apply An-pressing with palm gently to the first to fifth lumbar vertebrae, repeat up and down, the pressing weight and pressing lasting time may be adjusted depending on the patient's tolerance. And then Tui-pushing, Gun-rolling, and Dian-finger pressing were carried on the M. spinalis of two sides as supplementary manipulation. d.Cupping With the patient in prone, the doctor applied successive flash cupping with bamboo cup over the areas along the both sides of the spinal column from up to down, when the cup became hot, retain it on the Ashi point for 5-10 min. the treatment was conducted 5 times a week, with

Acupoint: Dachangshu (BL 25), Guanyuanshu (BL 26); Shenshu (BE 23), Weizhong (BE 40), Huantiao (GB 30), Chengfu (BL 36) and Kunlun (BL 60). Operation: Puncture above acupoints perpendicularly with the filiform needles of 40 mm in length and 0.30 mm in diameter by even method, retain the needles for 30 min, with 10 times being a course of treatment, generally, the patient was given 2-5 courses of treatment. Therapeutic Effect 1. Criteria for therapeutic effect

Cured: Symptoms and signs disappeared; function restored to normal; the posterior protrusion of spinal column restore to its original position, no relapse in one year's follow-up. Markedly effective: Symptoms and signs disappeared basically; the slight pain might occasionally occur on wet or rainy day; function restored to normal basically; the posterior protrusion of spinal column also restore to normal basically. Effective: Symptoms and signs may occur after overwork; function restored to normal most partially; the posterior protrusion of spinal column was improved to certain degrees. Ineffective: Symptoms and function had not any significant improvement after treatment. 2.Therapeutic results Table 1. Therapeutic result in two groups

Groups

n

Cured ME

Effective Ineffective

Observation

50

35

8

5

2

Control

46

6

11

15

14

Notes: ME, markedlyeffective. It can be seen from table 1 that the total effective rate was 96.6% in observation group and 69.6% in control group, and a significant difference was found in the total effective rate and cure rate between two groups, indicating that the combined use of acupuncture, traction, Tuina and cupping was better than single acupuncture in

Journal of Acupuncture and Tuina Science. 2004, Vol. 2, No.5

the treatment of lumbar intervertebral disc protrusion.

Discussion Lumbar intervertebral disc protrusion is a condition associated with the ruptured annulus fibrosus due to the chronic strain and degeneration of the lumbar intervertebral disc, which results in the nucleus pulposus bulging out to compress nerve root or the cauda equina, and then initiates a series of symptoms, or it is caused by chemical factor stimulation and autoimmune reaction leading to the pain on waist, buttock and lower limbs or sciatica, which may also result from the secondary changes of yellow ligament, articular process and vertebral canal TM. The annulus fibrosus's structure is stronger, and the normal fibrosis of intervertebral disc doesn't easily lead to the rupture of annulus fibrosus. Thus, this disease is not only associated with the ruptured annulus fibrosus, and it's very hard to be treated. Lumbar intervertebral disc protrusion, belonging to the category of "lumbar pain" in traditional Chinese medicine, results from the injuries of muscles and tendons and intervertebral disc caused by the long-term sustained uncoordinated positions and the improper force. Acupuncture, traction, Tuina and cupping all have the actions of activating blood circulation to resolve the blood stasis, dredging the meridians and collaterals to stop pain. The combined use of acupuncture, traction, Tuina and cupping might activate qi and blood of meridians and collaterals, regulate the vertebral column, so as to improve the edema of the soft tissue surrounding the intervertebral disc, replace the intervertebral disc, relieve the pressure on the spinal nerve. When An-pressing technique is applied to the patient, small amplitude is required in the beginning, and the force should be suitable and increased gradually according to an individual patient's constitution. The degrees of posterior protrusion of the vertebral column and severity of disease, violently forceful maneuvers should be carefully done on the patients who are old, weak, and suffer from ankylosing spondylitis, tuberculous spondylitis, which may induce bad effect on the vertebral column. Manipulation can gradually correct the physiological lordosis of the spinal column, promote the

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replacement of the prolapsed disclose the pressure of intervertebral disc on the nerve root, repair the ruptured area of the annulus fibrosus, make the intervertebral space become wide in the anterior part and narrow in the posterior part, so as to facilitate the replacement of the protruded nucleus pulposus. The traction can loosen the pressure on the lumbar intervertebral disc, and the longitudinal traction can enlarge the intervertebral foramen, regulate the width of the intervertebral space, relax the muscular spasm, decrease the local adhesion and edema, restore the normal dynamic balance of vertebral column, reduce the pressure between the lumbar vertebrae, alleviate pain, promote reduction of aseptic inflammation surrounding nerve root [41. The traction weight should be lighter, the continuous bed traction, in conjunction with Tuina manipulation, can effectively correct the deformed the vertebral column, restore the prolapsed intervertebral disc to its original position, and have outstanding synergistic effects. The authors hold that this comprehensive therapy could avoid the traumatic pain and be accepted easily by the patients.

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~.,~-~ I~-,~,,~,.2004.36 ( 1 ) 5-6. LIU Xiang-qian, YAO Gong-he. Thoughts and Methods of the Treatment of Lumbar Intervertebral Disc Protrusion by TCM. New TCM Journal, 2004, 36(1):5-6. [4]'~'~, ~,J ~.~, J~ ~.~l~+-l-~,J-%~+l~.~~ ~g~~.~l:Po.~l~,~.~, 2004; 13(2). 91. XIAO Hua-qiang, LIU Jian, TANG Yu. Comparison of Therapeutic Effect Between Traction plus Acupuncture and Traction plus Tuina in the Treatment of Cervical Spondylopathy of the Vertebral Artery Type. Journal of Emergency in TCM, 2004,13(2): 91. Translator:

ZHU Zhong-chun ( ~ , ~ )