Disc and Pain

Mr. C, 63-year-old

1^st visit: 08-04-28

Visited me in March for the lower back pain. At that time, he could not sit for a little longer. Ct scan showed the disc problem on L5~S1. After 2 times of acupuncture treatments, the pain was completely gone. One week ago, after played table tennis, he got the pain on lower back and right hamstring. A chiropractor said it was pinched nerve. He could not sit down, even disturbed his sleep.

EX: lumbar pressing pain (-), tightness and pain on right hamstring. Deep strength less pulse and dark tongue.

TR: Massage lower back and leg; acupuncture right JuLiao and RouLi, both DaZhong and ShenShu, quick needle on right of L4~5.

2^nd visit: 08-05-07

There was still pain, but could lie face up or down, coulde not lie on the side. Better when was on the hard area. No pain on the lower back, pressing pain on right FuXi and YinMen area.

TR: massage the lower back; acupuncture on FuXi, FeiYang and L4~5 (all on the right side); cupping on the lower back.

3^rd visit: 08-05-14

Burning pain on the right hamstring, no problem when walking, running or standing, but painful when sitting and lying on the side. Tightness on right hamstring.

TR: massage the hamstring, and acupuncture on the two AShi points and cupping after.

4^th visit: 08-05-27

Same as before, burning pain, worse when driving.

TR: massage and 3 Cun needle on the Ashi point.

5^th visit: 08-06-02

A little better. Still burning pain.

TR: Massage and acupuncture on the head, middle, and tail pf hamstring, moxa on the middle one.

6^th visit: 08-06-09

Much better, nearly no pain.

TR: Massage; shallow needles on both ShenShu, 3 Cun needle on the middle of hamstring with moxa.

Cured.

Comment:

This is a simple case but took long time to recover. The reason is the wrong treatment.

First of all, wrong located the problem. Although there is a hernia of disc showed on CT scan, but the pain was on the hamstring and not caused by the lumbar disc. The symptoms are quite similar to the nerve pain, but there was no pressing pain on the lumbar spine.

Second, the moxa should be used earlier, but due to the burning feeling, wasted two treatment sessions.

After all, the lumbar-leg pain is not always caused by the protrusion of the disc, the acupuncture treatment must focus on the true reason to make effect.

An acute cervical spondylosiol case

Ms. Y, 45 2007-09-25

She has left hand tingling and numbness for two months, sharp burning pain for over 10 days.

The numbness appeared on the early August, tried western medicine but no effect. The pain started on the whole left arm on the early September, anti-inflammatory and painkiller didn’t work. She had X-ray at that time, reported degeneration on the C4, 5. Sept. 14 morning, the pain suddenly increased to unbearable, found nowhere to put the arm, and totally could not sleep. She been off work since last week, visited a chiropractor every day. After 3 days treatments, she felt a little better, and then it got even worse.

Now, there is burning pain on the ulnar side of left arm. No extension of the neck, hard to lie face down. No left triceps tendon reflex. The left ulnar skin is more sensitive. Pulse is thin and rapid, and tongue is reddish with peeled coating in the centre.

Treatment:

1) Electric therapy on lower cervical part 20’; acupuncture on right Leique, Wangu

2) Tuina on the shoulders (press Yunmen); acupuncture on left Yanglao (0.18*13mm, cold reducing); press Zhaohai

3) No spicy foods

2007-09-28

After last treatment, for half hour there was nearly no pain then came back but reduced. Now, there is sore pain on the left ulnar arm, numbness on the ulnar fingers. Neck still cannot move freely. Didn’t go chiropractor.

X-ray pictures:

C5 Luschka joint sharp (both); C4, C5 vertebra slight moved backwards, increased C6~7 rear space; Narrow right C4~5, C5~6, C7~T1 foramen, especially C4~5 reduced to half; narrow left C4~5, C5~6, C7~T1foramen, C7~T1 reduced to half.

Impression: C8 never is stimulated.

Treatment:

1) Electric therapy 25’; acupuncture on right Yanglao (0.25*25mm), Zhongzhu (0.18*13mm)

2) Tuina left shoulder and arm, Qian neck (slight crack on the middle cervical vertebrae

2007-10-01

Next day after last treatment, she went to the CT scan. After that the pain increased (posture related?). Numbness and pain on the left ulnar arm and hand, soreness on the elbow and shoulder. The lower nape is tight.

Treatment:

1) Electric therapy on both sides of C6~7; acupuncture on left Wangu, Zhongzhu, Shouwuli, right Yanglao; press Zhaohai

2) Press Quepen, Yunmen (both)

3) Tuina on neck and shoulders (face up), Qian and slight Yao (cracks on C5~6)

[No numbness on the hand, but still worrying]

2007-10-04

Pain was greatly reduced. Feels numb on the ulnar and back of left hand. The hand is easier feeling cold than the right one. There is soreness on the left elbow. Not completely comfortable during sleep. Motion is increased on the neck, but extension still causes tightness. She nearly finished her anti-inflammatory. Tight muscles on both of C7~T1, pain on lower left scapula.

Treatment:

1) Tuina on nape (face down); acupuncture on C7~T1 (both); Ganshu (both); left lower scapula

2) Electric therapy on C7~T1; acupuncture on left Yemen

3) Qian neck, Tuina on arms

[No numbness on palm, still numb on ring and little finger]

Result:

After this treatment, the pain and stiffness disappeared, she went back work later, but the numbness on the fingers remained. Got 4 more treatment, no change of numbness, others are normal.

Case of hypertension & MaHuang, FuZi

Case of Jinguzi from www.mingyi99.com

Translated by Dr.Song

Female, 70, aversion to cold, spontaneous sweating for 2 years. Caught cold two years ago, after IV, fever reduced. Then, temperature is always low (35-36ºC). Aversion wind and cold, spontaneous sweating, running nose, wears thick cloth in summer, joints pain, dizziness, stiff nape, dry in the mouth. She has diabetes and hypertension as while. Taking western medicine. Bp: 180/100 mmHg. Pale tongue, less coating, wiry thin pulse.

TaiYangShaoYang combination disease. MaFuXi *and GuiZhiTang 3 packages.

2^nd visit:

running nose and sweating resolved, aversion to cold reduced. Bp: 150/95 mmHg. TaiYang relieved, cold in ShaoYin. Three more packages. Aversion to cold disappeared, wears normal cloth, Blood pressure is normal, reducing the modern medicine.

Comments:

Using the TCM herbs according to the symptoms and syndromes, not the pharmacological researches. We cannot treat a physical measurement equal to an herbal ingredient. We should put into the illness, put the illness on the person, and put the person into the whole change of Yin-Yang. Also, we’d put the herb into the formula.

[Dr. Song's comment]:

What we learned from the text book about the herbs, and what we researched in labs are different from how the herbs work in a patient's body. If we only follow the words or the modern research, it may limit the use of the TCM herbs and formulas. Basically, the herbs and formulas are found in former practitioners experiences which built up in the past thousands of years. On this point, TCM is an experienced medicine only!

*MaHuangFuZiXiXinTang :

MaHuang 2liang XiXin 2 Liang PaoFuZi 1 pc

original Chinese:

救误一例 <金谷子案,mingyi99.com>

女，70，畏风寒、汗出二年。二年前外感发热后，村医静滴治疗，热退，以后体温低，35-36度，畏风寒、自汗出，流清涕，暑天重衣，关节痛、头昏项强，口干。查有糖尿病、高血压，常服对症西药。诊时血压180／100，舌淡红，苔少，脉弦细。此例起病明确，退热后而起。症状典型，太阳少阴。方用麻附细合桂枝汤三剂。二诊：流涕汗出均解，畏寒减。血压150／95mmHg太阳已解，少阴仍寒,原方三剂。
二诊后病人没来，其女来说，血压正常，已减降压药量，已穿单衣，诸畏风寨症消失。问是否继服，嘱停药观察。半月后，病人没来，代述，复见微流清涕，嘱原方三剂。

体会：有是证用是药，不可因血压高而避麻、附，是见证有药，而不必顾及药理，中药成分的化学药理和传统药征有冲突时，以古来验证的药征为准，而不可执不成熟的一偏之见而避开传统经验，进而误了病情。麻附果升血压乎？本例不但不升，反而降至正常。不可把一个生理上的物理测定值孤立地对应上一个药的单一成分看。要把个一个值，放到病里看，把病放到人身上看，把人放到整体的阴阳盛衰的过程中看。还要把药放到方里去看。

TuiNa used for Lower Back Pain

What is TuiNa 推拿?

TuiNa, also known as Chinese massage, is one of the therapeutic methods of TCM (traditional Chinese medicine), also named as AnMo (massage 按摩). This kind of therapy uses hands and other parts of our body to stimulate the meridian system and treat or heal some diseases by special methods.

Normally Chinese people are used to have TuiNa to relieve the chronic pain of the muscles and joints, some chronic internal medical diseases and for relaxing and keeping healthy for over thousands years. The effects have also been proved by the modern research.

I. Orthopedic Lower Back Pain (LBP)
A. Pain comes from the muscles:
Strain, acute inflammation (sprain, attacked by cold)/myofibrositis
B. Pain comes from the joints (include ligaments, cartilage and bones):
Sprain (twisted/displaced), arthritis (rheumatoid or osteoarthritis/”Bi” syndrome), lumbar spondylolisthesis
C. Pain comes from the bones:
Osteoporosis, bone tumor
D. Pain comes from the nerves:
Protrusion of lumbar intervertebral disc (PLID), spinal canal stenosis

II. Key Points of TuiNa therapy:
A. Chronic muscle pain:
Strains, myofibrositis and myofascitis
Key symptoms and signs: stiff muscles, lower or no elasticity of the muscles, pressing pain on the surface or inside the muscles, nodes or tight strips may be found.
Pathomechanism: chronic inflammations of muscular fibers and fascia. Blongs to “muscle Bi” or Flaccidity syndrome (Wei). There is stagnations of Qi and Blood or no enough nourishment of the muscles.
Goal of the treatment: restore the elasticity of the muscles.
Key points of the manipulations: gentle manipulations are major; drawing and point pressing could be chosen when necessary in the spasm case. Drawing and point pressing may cause side effects.

B. Acute muscle pain:
Sprain, contusion, acute occurring of the chronic pain
Key symptoms and signs: sharp pain, tender spot, swelling feeling, the pain may radiate to the hip, but no shooting pain on the leg and foot, limited motion due to pain and spasm.
Pathomechanism: spasm, swelling or hematoma
Blood stasis, wind-cold-dampness
Goal of the treatment: release spasm, reduce swelling
Key points of the manipulations: combine the gentleness and toughness, local and distal. Special manipulations may be used: pressing, drawing, point pressing.
Common questions: Displaced joint or small muscle spasm;
Deep and thorough of the manipulation;
Instant cure.

C. Displacement of the joint:
Key symptoms and signs: Limited motion on certain way; blocked feeling; fixed pressing pain spot nearby the joint.
Pathomechanism: disorder of the relationship of the joint.
Goal of the treatment: adjust the joint, restore the motion.
Key points of the manipulations: Ban (turning).
The conditions of using turning method;
The functions of the turning method;
The limits and the side effects.

D. Arthritis:
Osteoarthritis and Ankylosing spondylitis.
Key symptoms and signs: chronic pain related to overuse, weather change and rest, deep pressing pain on the lumbar spine; limited motion on all directions.
Pathomechanism: damaged structure of the joints, inflammation
Combined excess and deficiency in TCM. Kidney, Liver, Blood stasis and Wind-Cold-Dampness
Goal of the treatment: stop pain, prevent the further damage on the joints
Key points of the manipulations: relax the soft tissues; drawing and vibrating; be careful on pressing and moving joints methods.

E. Protrusion of lumbar intervertebral disc (PLID):
Key symptoms and signs: shooting pain on the lower leg or foot; abnormal sense on the certain dermal segmentation; reduced strength on certain muscles; approved by CT scan or MRI.
Pathomechanism: mechanical and chemical stimulations on the nerve root; Bladder channel and Gallbladder channel; Blood stasis.
Goal of the treatment: stop pain by removing the stimulations on the nerve root; restore the nerve functions as much as we can; strengthen the lower back.
Key points of the manipulations:
Urgent stage: sharp shooting pain, not reduced during the night or lying down, SLR < 45°. Rest is the major treatment, be careful to do any TuiNa or acupuncture on the lower back area, it may make the pain worse;
Moderate stage: after sharp shooting pain reduced, limited ROM, SLR between 45° ~ 70°. TuiNa is the major method in this period, and Ban (turning) has to be used here to adjust joints and loose the conglutination around the nerve root;
Recovering stage: alternating soreness and pain, usually on the lower back or leg only, reduced sensations, weakness of the muscles, and limited time of actions. TuiNa is used to help the patient to exercise and rebuild muscles. The goal is to restore the strength and flexibility.

III. TuiNa combined with acupuncture:
A. The difference between acupuncture and TuiNa:
Acupuncture TuiNa
Point and meridians Area (big or small)
Easy be too strong Easy be gentle
Better in regulating Qi and Blood Better in relaxing muscle
Better in regulating organs Better in adjusting joint
Stop pain as pain killer N/A
N/A Easy be accepted

B. What is not good for acupuncture?
Very tender and stiff muscles;
Nerve pain;
Weak and tough muscles or tendons;
Patient who is afraid of needles.

C. How to combine acupuncture and TuiNa?
TuiNa – Acupuncture – TuiNa;
TuiNa – Acupuncture;
Acupuncture – TuiNa.
For the big tight muscle or arthritis, acupuncture can be used as the major method; for the other problems, usually use TuiNa as the major one. For electronic needling or warm needling, the effects will depend on the patient’s response.
The acupoints used in the treatments: AShi points are more useful and effective. The secret is the depth and the quantity of the stimulation.

IV. A clinical case:
♀ 46
2004-9-30
Lower back pain for 1 day.
Used to have this kind of pain once or twice a year for 10 - 15 years. Last time pain was 5 months ago. Usually relates to the weather or hard work. Also has tingling on left leg for quite a while. This time pain is more like soreness and hard to bend or straighten up the back.
Examination: Spine (-), Bend forward 10°~ 15°, backward 15°, SLR (-), reflection (-), tight muscles found on left lower back no pressing pain, L4-5, L5-S1 pressing pain (±), left side radiate to the hip.
Idea: muscle pain on the lower back.
Treatment:
1) TuiNa: pressing and point pressing on the lower back;
2) Acupuncture: left ShenShu (UB23), left DaChangShu (UB25), both L4-5 JiaJi
2004-10-7
Getting worse for the whole week, continuous pain on the lower back, especially when standing up after long time sitting. Tight muscles on the left side, L5-S1 pressing pain (+)
Treatment:
1) TuiNa: pressing;
2) Acupuncture: left ShenShu (UB23), left CiLiao (UB32), both L5-S1 JiaJi (moxa on left);
3) Ban (turn) left waist.
2004-10-14
Pain is reduced but still there. Tightness on the back of left thigh. Tight muscles on the both sides of the lower back, no pressing pain point.
Treatment:
1) TuiNa half hour: pressing, grasping and rolling;
2) Acupuncture: Both ShenShu (UB23), QiHaiShu (UB24), DaChangShu (UB25), WeiZhong (UB40)
2004-10-21
Greatly improved, still a little bit pain and tightness feeling. Tight muscles on the lower back and thigh, WeiZhong (UB40) pressing pain (+).
Treatment:
1) TuiNa: Gun (rolling)
2) Acupuncture: both ShenShu (UB23), left L4-5 JiaJi, left WeiYang (UB39)
2004-10-28
No pain, sometimes tightness feeling on the left lower back and thigh. Mild tight muscles on the left lower back, no pressing pain point.
Treatment:
1) TuiNa: on the muscles;
2) Acupuncture: left QiHaiShu (UB24), left sacral-iliac joint Ashi, left WeiZhong (UB40)

V. Final words:
TuiNa is an useful method in lower back problems. Combining with acupuncture, TuiNa can make very good effects. The key points of this therapy are:
1) Combine the meridian therapy and modern anatomy together to find out the exact problem area;
2) Find out the quantity of the stimulation which fits the certain patient;
3) Well trained TuiNa and acupuncture skill.

TuiNa Case of Lower Back Pain

Male, 40+
In the spring of year 2000
He had acute lower back pain for 2 weeks.
The pain came to the lower back in a sudden when he put his coat on in the morning 2 weeks ago. He tried physiotherapy, but no effect. The pain is always there on a fixed spot, and getting worse whenever he moves his back. He had no injury on the back, and no shooting pain down to the legs.
He is used to be quite healthy, and doing office work. He is afraid of needles.
Examinations:
Spine (-); Motions: left 0° right 0° forward 10° backward 10°
SLR (-); Pressing pain (+++) on right side of L4~5, pressing pain (+) on both sides of TianZhu (BL10), WieZhong (BL40); Stiff muscles on both side of lumbar spine.
Diagnosis:
Lower back pain (acute myofibrositis)
Treatments:
1st time:
Rou (knead)/Dian (point-press) TianZhu (BL10), FengMen (BL12), and WeiZhong (BL40) for 20 minutes;
Rou (knead)/Dian (point-press) ZhiShi (BL52), ShenShu (BL23), and ZhiBian (BL54) for 20 minutes;
Rou (knead)/Dian (point-press) FengShi (GB31), KunLun (BL60) for 10 minutes;
Ca (rub) lower back for 10 minutes.

2nd time: 2 days later. No more sensitive spots on the lower back, still feels pain and cannot move freely.
Rou (knead)/Dian (point-press) TianZhu (BL10), FengMen (BL12), and WeiZhong (BL40) for 10 minutes;
Rou (knead)/An (press) lower back for 20 minutes;
Dian (point-press)/Rou (knead) ShenShu (BL23), DaChangShu (BL25) 5 minutes;
Dian (point-press)/Rou (knead) ZhiBian (BL54), KunLun (BL60) for 10 minutes;
Tui (push) lower back and legs for 10 minutes;
Yao (rock)/Dou (shake) lower back for 5 minutes.

3rd time: 3 days later. Getting better, only feels pain when turning the body. The lower back still feels stiff.
Rou (knead)/Dian (point-press) TianZhu (BL10), FengMen (BL12), ShenShu (BL23), DaChangShu (BL25), WeiZhong (BL40), and KunLun (BL60) for 15 minutes;
An (press)/Rou (knead) lower back for 15 minutes;
Dian (point-press)/Rou (knead) ZhiBian (BL54), HuanTiao (GB30) for 10 minutes;
¤Ban (turn) right side of the lower back;
Yao (rock)/Tui (push)/Duo (chop) lower back for 15 minutes;
Qian (draw) lower back, Yao (rock) hip joints for 2 minutes.

4th time: 3 days later. Can move freely, only feels soreness after sitting for long time.
Similar treatment of 2nd time.

5th and 6th time: once a week. Comes for relaxing.