World Journal ofAcupuncture-Moxibustion (WJAM) ELSEVIER
Vol. 25, No.2, 30th Jun. 2015
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Clinical Report Therapy of auricular subcutaneous penetration needling combined with row acupuncture at the meridian sinew in 103 cases of prolapse of lumbar intervertebral disc I+$tf{j1t~1CJ1!Ur!~-%~$1-1FJ1!Ur!yitffJJl*f8]ft~ili~103f9tl HOU Xian-bing <~~*)1,2,3, LIUYing-li (:*tl~~)3,\ WANG Li-chun <.£.:;fIJ~)3,\ LUWei-wei ;j.;j.)4, SONG Shu-chang <*-* ~ )4, JIA Chun-sheng
ARTICLE INFO
ABSTRACT
First author: HOU Xian-bing (1982- ), male,
Objective To observe the clinical efficacy of auricular subcutaneous penetration needling combining with row acupuncture at meridian sinew on prolapse of lumbar intervertebral disc. Methods One hundred and three patients with prolapse of lumbar intervertebral disc were treated with a combined treatment of auricular subcutaneous penetration needling and row acupuncture at meridian sinew. Results Of 103 patients, 46 cases were cured, 33 were markedly effective, 21 effective and 3 ineffective. The total effective rate was 97.1% (100/103). Conclusion The combined treatment of auricular subcutaneous penetration needling and row acupuncture at meridian sinew has a significant efficacy for the treatment of prolapse of lumbar intervertebral disc.
attending physician. Research field: meridian sinew diagnosis and treatment. E-mail:
[email protected] Accepted on March 16, 2015
KEY WORDS: prolapse of lumbar intervertebral disc; auricular subcutaneous penetration needling; row acupuncture at meridian sinew
Prolapse of lumbar intervertebral disc is a kind of disease with pain in the lumbar and leg due to rupture of annulus fibrosus, herniation of nucleus pulposus, and stimulation and oppression on nerve root caused by degeneration of lumbar intervertebral disc and under external force, mainly manifested as lumbago and sciatic nerve radiating pain, which is one of the most common causes for pain in the lumbar and leg clinically. The author had employed auricular subcutaneous penetration needling combining with row acupuncture at meridian sinew for the treatment of this disease in 103 patients. The report is as follows.
CLINICAL DATA All the 103 patients were from "Preventive Treatment of Disease" Center, Hebei Province Cangzhou Hosptital of Integrated Traditional and Western Medicine, from March 2011 to September 2012. They were definitely diagnosed as prolapse of lumbar intervertebral disc by lumbar intervertebral disc CT scan or lumbar MRI scan. Of these patients, there were 53 males and 50 females, with age range of 38-76 years old and disease course of 20 days2 years. The diagnosis met the requirements of "Criteria of Diagnosis and Therapeutic Effect of
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 25, No.2, 30th Jun. 2015
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Diseases and Syndromes in Traditional Chinese Medicine" [1]. Prolapse of lumbar intervertebral disc is mainly manifested as lumbago with lower extremities radiating pain or cauda equina syndrome, etc. Due to limited activity of lower back, some patients may experience obvious scoliosis and show syndromes like limited activity in lower back, scoliosis, and positive results in straight-leg raising test and augmentation test. The lumbar CT showed that disc herniation compressed dural sac and nerve roots.
METHODS (1) Auricular subcutaneous penetration needling proposed by professor JIA Chun-sheng was applied [2] (figure 1). Auricular acupoints were positioned according to National Standard of the People's Republic of China: Nomenclature and Location of Auricular Acupoints published by Standards Press of China in 1992 (GB/Tl3734-l992). Main acupoints included the points in lumbar area. Combined auricular points were additionally used, including buttock, zuogii shenjlng (~ff:f$r£, AH 6) and jiiio gan (3t ~, AH 6a) for patients who had radiating pain in waist and buttock, and kuiin CD, AH 5), Xl (~, AH 4), huai (IDI!, AH 3), gen (m, AH 1), and zhl (ill:, AH 2). Manipulation: at first treatment, auricular points at affected side were selected. After routine disinfection for the skin, the auricle was fixed with the left hand by putting the thumb in the front and index and middle fingers in the back to uphold the acupuncture area, then a filiform needle of 0.16 rom X 10 rom was hold with right thumb, index and middle finger, and inserted into the point in an angle of <10°. After insertion, the needle was pushed forward through the space between the skin and the cartilage to another selected point, and then twisted slightly for 5-7 times. Twisting could be performed for twice or 3 times during needle retention, in order to augment needling sensation. Immediately after completing the acupuncture, the patient was asked to exercise waist, bow, raise affected leg forward (not to bend the knee), and stretch affected leg backward. The more difficult the movements were, the more the movements were exercised. Usually, needle was retained for 30 min. For patients with serious pain, the needle would be retained for 3-6 h by fixing the handle with medical tape, then the patient was asked to pull out needle by themselves. (2) Row acupuncture at meridian sinew a. Selection of acupoints. Taiyang Ck~S EX-HN 5) row acupuncture at meridian sinew was employed. Local tenderness point was selected as primary needle insertion point and the needle of 0.25 rom X 15 rom was obliquely inserted in an angle of 45° for 3-6 cm
Figure 1 Auricular subcutaneous penetration needling for patient of prolapse of lumbar intervertebral disc
aiming at lumbar vertebra. A strong needling sensation was required and a sensation of radiating to the lower limb was preferred. Then other 4-8 needles were inserted in the longitudinal direction of the above needle insertion point based on the course of taiyang meridian sinew. The distance among the needles was about 0.5-2 cm. It was required to row dense needles at first several times of acupuncture, but gradually the amount of needles was reduced as illness was improved. Needles were retained for 20-30 min. For patients without obvious tenderness, the site of 1.53 cm near the midline was selected as needle insertion point. Starting from the upper and lower lumber vertebra of the herniation, other 4-8 needles were obliquely inserted in the longitudinal direction based on the course of taiyang meridian sinew. Needle insertion procedures, distance among the needles, and depth and time of needle retention were as the same as those described above. b. Local point selection. The following acupoints were selected as combined acupoints depending on the patient's conditions: Pishii (M!lftr BL 20), Mingmen (iffr1 GV 4), Shenshii ('lflftr BL 23), Zhishi (iit;~ BL 52), and TaixI (:km KI 3) for patients with spleen and kidney deficiency; DachangshU (*.§lftr BL 25), Yiioyangguiin (JDHS GV 3), ShiqlzhuI EX-B 8), Huantiao (;EfJit)~ GB 30), and WeizhOng (~ ~ BL 40) for patients with cold-stasis obstruction.
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Auricular acupuncture was performed at affected side for the first time and then alternately at bilateral ears for once daily. Row acupuncture at meridian sinew was performed once every day and stopped once every 6 days. Efficacy was statistically analyzed after treatment for 2 weeks.
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World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 25, No.2, 30th Jun. 2015
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RESULTS
later, no relapse was observed.
Efficacy evaluation criteria was developed according to the requirements of Criteria ofDiagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine issued by the State Administration of Traditional Chinese Medicine. Cured: the pain in the lumbar and leg and tenderness or radiating pain beside lumber vertebra disappeared, free movement, raising 70° or more in straightleg test, and recovery of normal activity, there were 46 cases in total. Markedly effective: few conscious symptoms and signs, occasionally dull pain beside lumber vertebra, discomfort and radiating pain, free movement, and being able to participate in easy work, there were 33 cases in total. Effective: the symptoms and signs improved but aggravated after labor, there were 21 cases in total. Ineffective: no improvement in symptom or sign, there were 3 cases in total. The total effective rate was 97.1 %.
EXPERIENCE
TYPICAL CASE
The concept, detailed manipulation and clinical application of auricular subcutaneous penetration needling was firstly proposed in a paper titled Auricular subcutaneous penetration needling and its clinical application by JIA Chun-sheng in 2010[2]. The author of this article slightly changed the manipulation in clinical application by replacing the filiform needle of 0.25 mmX 15 mm to 0.16 mm X 10mm. The reason to use a smaller and shorter needle was that, firstly, this needle can reduce the pain at inserting the needle through the space between the skin and the subcutaneous cartilage and improve patients' compliance; secondly, fine filiform needle was better to pass throughout the whole auricular point area; and thirdly, the filiform needle handle was easier to be fixed to prolong the needle retention. However, the stimulation to auricular points decreased, which was a disadvantage of this filiform needle [31•
A 36 year-old female patients saw a doctor on March 30, 2013. She suffered from pain in the waist and limited activity accompanied with radiating pain in the left lower limb because of getting wind-cold 1 day ago. The patient lacked exercise previously and had a past history of acute lumbar sprain for twice. Physical examination showed the positive results in straight-leg raising test and augmentation test, dull tongue and thick white coating, and pulse was wiry and tight. Waist CT showed slight bulging of L4/L5 disc, protruding of L5/S 1 disc into left intervertebral foramen, and slightly compressed L4-S 1 dural sac with slight narrowed left intervertebral foramen and unsmooth bilateral facet joints. It was diagnosed by western medicine as prolapse of lumbar intervertebral disc. It was diagnosed by traditional Chinese medicine as lumbago (with the pattern of cold-stasis obstruction). Treatment: auricular subcutaneous penetration needling was performed on such the point areas as lumber vertebra, buttock, and AH6 of the left ear. The patient was asked to exercise the waist. Three min later, the pain significantly alleviated and the patient's movements got larger. After the patient was asked to continue exercising for 2 min, she was asked in prone position. The tenderness point beside Guanyrninshii (~5G~ BL 26) was selected as needle insertion point. Then 3 needles were rowed up under the needle insertion point respectively, and GV 3, EX-B 8, GB 30, and BL 40 were selected as combined acupoints. After treatment for 2 weeks, lumbago disappeared and straight-leg raising test showed negative result. During the follow-up visit 3 month
On one hand, internal factors such as inhibited qi and blood circulation, blockage of meridians and collaterals, and malnutrition of meridian sinew caused loosing adjacent ligaments, thin annulus fibrosus, and degenerative intervertebral disc; on the other hand, external factors such as getting wind-cold and acute exertion induced the rupture of annulus fibrosus, and eventually led to prolapse of lumbar intervertebral disc. Analgesia is one major feature of auricular acupuncture which has a good efficacy for the treatment of pain disorders. Based on the analysis of a sequential, paired clinical trial in 92 patients with prolapse of lumbar intervertebral disc by t-test, LID Er-jun, et al[41• concluded that auricular subcutaneous penetration needling had a better rapid analgesic effect for prolapse of lumbar intervertebral disc than auricular perpendicular insertion. Professor JIA Chunsheng also pointed out that auricular acupuncture was more rapid analgesic effect and convenient than conventional auricular perpendicular insertion because that subcutaneous penetration needling penetrated and stimulated the whole auricular point area which not only increased the amount of stimulation but also had no need to find out the tenderness point [5]. Therefore, auricular subcutaneous penetration needling is particularly applicable to acute phase of prolapse of lumbar intervertebral disc. Row acupuncture at meridian sinew has a direct effect on local site. As Suwen:Weizheng (<<~rp] .~iJ.E» ,Plain Questions: Atrophy Diseases) says: Ancestral sinew manages bones and benefits joints, so it can directly improve the running of local qi and blood, dredge meridians
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 25, No.2, 30th Jun. 2015
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and collaterals, and nourish meridian sinew. Hou, et al [6]. put forward that row acupuncture at meridian sinew can improve nerve nutrition, promote nerve tissue metabolism, and also can promote local blood circulation. Therefore, the combination of the two acupunctures can quickly relieve the discomfort caused by prolapse of lumbar intervertebral disc and improve clinical efficacy.
[4]
REFERENCES
[5]
[1]
[2]
[3]
State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine (Chin). Nanjing: Nanjing University Press; 1994: 201. Jia CS. Auricular subcutaneous penetration needling and its clinical application. Chin Acup-Mox (Chin) 2001; 21 (9): 543-545. Hou XB, Liu YL, Wang MY, Hao YZ, Li XF, Jia CS.
[6]
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Auricular subcutaneous penetration needling combining with row acupuncture on 61 patients with Cervical Spondylotic Radiculopathy. Chin Acup-Mox (Chin) 2014; 34(7): 651--u52. Liu EJ, Jia CS, Li XF, Ma XS, Shi J. A comparative study on rapid analgesic effects of different auricular acupunctures for treatment of prolapse of lumbar intervertebral disc. Chin Acup-Mox (Chin) 2010; 30(1): 35-39. Jia CS, Zhang L, Ma XS, Wang SJ. An observational study on analgesic effect of single auricular subcutaneous penetration needling for treatment of acute pain in the lumbar and leg. Sichuan J Tradit Chin Med (Chin) 2003; 21(9): 82-83. Hou LJ, Han SK, Ma HJ, Di HY. Impact of Qizhi Tongluo decoction combining with row acupuncture at meridian sinew on life quality of patients with cervical spondylotic radiculopathy. Sichuan J Tradit Chin Med (Chin) 2014; 32(5): 121-123.
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