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J. Acupunct. Tuina. Sci. 2010, 8 (1): 44-46 DOI: 10.

1007/s11726-010-0044-5

Clinical Study

Clinical Research on Tuina plus Hydro-acupuncture for Lumbar Intervertebral Disc Herniation
ZHU Wei-min (), WU Yao-chi (), ZHANG Jun-feng (), LI Shi-sheng (), FAN Yuan-zhi () No. 6 Peoples Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200233, P. R. China

120 93.3 75.0 P<0.01 AbstractObjective: To observe the clinical effects of tuina plus hydro-acupuncture on lumbar intervertebral disc herniation. Methods: One hundred and twenty cases of lumbar intervertebral disc herniation were randomly divided into an observation group and a control group. Patients in the observation group were treated with tuina plus hydro-acupuncture, and the control group with tuina. Results: The total effective rate was 93.3% and 75.0% respectively in the observation group and the control group, with a significant difference (P<0.01). Conclusion: Tuina plus hydro-acupuncture has better effects than tuina on the lumbar intervertebral disc herniation. Key Words Intervertebral Disk Displacement; Low Back Pain; Tuina; Massage; Hydro-acupuncture CLC NumberR246.2 Document CodeA Lumbar intervertebral disc herniation is caused by extrusive nucleus pulposus compressing and stimulating the nerve root, cauda equine nerve, or spinal cord, due to trauma or anulus fibrosus rupture, manifested by lower back pain, radiated leg pain, and numbness. It could be treated with surgical and/or non-surgical methods. In the non-surgical methods, acupuncture and tuina are most commonly used. The authors compared the effects of tuina plus hydro-acupuncture and single tuina method for lumbar intervertebral disc herniation, and compared the efficacy with single tuina treatment. It was reported as follows.

1 Clinical Data
1.1 Diagnose criteria Lumbar movement is limited. Tenderness, sensitivity to percussion, radiated leg pain, positive straight leg raising test, and dysaesthesia of lower limbs in medical examination. CT or MRI showes extrusive lumbar intervertebral disc. There is no compression on cauda equine nerve, and no central type of intervertebral disc herniation. 1.2 General data All 120 cases were patients with lumbar intervertebral disc herniation in the hospital from February of 2006 to August of 2008, manifested by lower back pain, radiated leg pain, and numbness. One hundred and one cases had unilateral pain and 19 cases had bilateral pain. One hundred and twenty cases were randomly divided into an observation group and a control group based on the visiting

Author: ZHU Wei-min (1968- ), male, associate chief physician Correspondence Author: WU Yao-chi (1961- ), male, chief physician, professor, supervisor of doctor candidate

44 Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010

J. Acupunct. Tuina. Sci. 2010, 8 (1): 44-46

sequence with 60 cases in each group. There was no significant difference between the two groups general data (table 1).
Table 1. Comparison of patients baseline data between the two groups ( x s) Groups Observation Control n 60 60 Gender Male Female 36 40 24 20 Age (years) 50.803.01 50.013.08 Duration (years) 2.000.99 2.090.89

3 Results
3.1 Criteria of therapeutic effects The criteria for lumbar intervertebral disc herniation was based on Shanghai Diagnostic and Therapeutic Guidelines of Traditional Chinese Medicine[1]. Cure: Disappearance of lower back pain and leg pain, more than 70 of straight-leg raising test, normally working. Improvement: Relief of lower back pain and leg pain, and improvement of lumbar movement. No effect: Symptom and sign had no change. 3.2 Treatment results Before treatment, there was no significant difference between the two groups in conduction velocity of the common peroneal nerve, superficial peroneal nerve, and the tibial nerve, but there was a statistic significance in the difference between preand post-treatment in the two groups (P<0.05), indicating that the nerve conduction velocity had a greater improvement in the observation group (table 2, 3, and 4).
Table 2. Comparison of conduction velocity of common peroneal nerve between the two groups (m/s) Groups Before treatment After treatment 38.262.80 38.112.86 40.504.21 37.463.95 Difference 2.231.90 1) -0.651.40 Observation Control

2 Methods
2.1 Observation group 2.1.1 Hydro-acupuncture Acupoints: Jiaji (Ex-B 2) points beside the affected intervertebral disc. Operation: Two mL mecobalamin (0.5 mg /mL) was extracted into a 5 mL injector with a No. 7-sized needle. Patients were in prone position. After the points were sterilized, the needle was inserted perpendicularly, and then lifted and inserted to get the needling sensation. The drug was injected slowly after no blood was withdrawn. Two acupoints were used every treatment, 1 mL for a point. 2.1.2 Tuina After the patient was prostrate, the operator applied manipulation of gun-rolling, rou-kneading, tui-pushing, mo-rubbing, and ba-poking to the lower back, hip, and legs, especially the Gallbladder and Bladder Meridians. Then, Jiaji (Ex-B 2) beside the affected intervertebral disc, Yaoyangguan (GV 3), Shiqizhui (Ex-B 8), and Weizhong (BL 40) were an-pressed and rou-kneaded with thumb or single-finger. The manipulation should be penetrating. The manipulation was done for 20 min, and lumbar oblique pull manipulation was done at both sides. 2.2 Control group Only the same tuina treatment as in the observation group was given. Treatment in both groups was done once every other day. Ten treatments made up one course. After one course the therapeutic effects were observed. Nerve conduction velocity was measured before and after treatment.

Note: Compared with control group, 1) P<0.05. Table 3. Comparison of conduction velocity of superficial peroneal nerve between the two groups (m/s) Groups Observation Control Before treatment After treatment 38.633.94 38.763.80 41.554.43 39.434.01 Difference 2.911.45 1) 0.660.50

Note: compared with control group, 1) P<0.05. Table 4. Comparison of conduction velocity of tibial nerve between the two groups (m/s) Groups Observation Control Before treatment After treatment 33.384.93 33.014.38 35.565.24 33.884.55 Difference 2.181.111) 0.860.34

Note: compared with control group, 1) P0.05.

The total effective rate was 93.3% and 75.0% respectively in the observation group and the control group, and the observation group showed a better result than the control group (2=9.36, P<0.01, table 5).

Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 45

J. Acupunct. Tuina. Sci. 2010, 8 (1): 44-46 Table 5. Comparison of the therapeutic effect between the two groups (Cases) Groups Observation Control n 60 60 Cure Improvement 15 7 41 38 No effect 4 15 Total effective rate (%) 93.3 1) 75.0

Note: Compared with control group, 1)P0.01

4 Discussion
Intervertebral disc herniation occurs on the basis of degeneration of intervertebral disc. The degenerative disc causes rupture of the anulus fibrosus leading to the extrusive nucleus pulposus compressing the nerve root, or the ruptured nucleus pulposus releasing histamine to induce chemical radiculitis[2]. Compression of the nerve root and inflammation lead to demyelination of the perineurium, accompanied by necrosis of the schwann cells and denaturation of part of the axon, affecting conduction function[3]. Tuina treatment has effective results on painful diseases. Manipulation of gun-rolling, an-pressing, rou-kneading, tui-pushing, mo-rubbing, and bapoking at lower back, hip and legs could loosen the spasmodic muscles, enhance the excitability of the affected muscles, and promote local metabolism to diminish inflammation and stop pain[4]. Oblique pulling manipulation and spine rotatory manipulation could balance the disturbance of the lumbar joint, and synovium interposing, and change the location of the extrusive disc and the nerve root to relieve the compression and stimulation on nerve root[5-7]. The hydro-acupuncture method combines the theory of meridian and acupoint as well as injection of drugs to dredge the meridian, in order to promote qi flow and to stop pain, whilst, the drug carries out

its function to treat disease. Mecobalamin could enhance synthesis of nucleic acid, protein, and lecithin to promote regeneration of the axon, to repair the affected nerve, and enhance the conduction velocity. Jiaji (Ex-B 2) beside the affected disc is adjacent to the nerve root, and can increase the drugs effects. In summary, tuina treatment has specific effects on lumbar intervertebral disc herniation, but tuina plus hydro-acupuncture has better effects than single tuina treatment with simple manipulation. Combining the therapies is safe, and is of value in the clinic.

References
[1] Shanghai Municipal Public Health Bureau. Shanghai Diagnostic and Therapeutic Guidelines of Traditional Chinese Medicine. Second Edition. Shanghai: Publishing House of Shanghai University of Traditional Chinese Medicine, 2003: 393-394. [2] HU You-gu. Lumbar Intervertebral disc herniation. 3rd Edition. Beijing: Peoples Health Press, 2004: 411. [3] LIU Yu-jie, ZHANG Xi-feng. Experimental Research of Mecobalamin for Peripheral Nerve Injury. Chinese Journal of Hand Surgery, 2001, 17(1): 15-18. [4] JIE Wang-jun, LI Jun. Discussion of Tuina Manipulation for Lumbar Intervertebral disc herniation. Gansu Journal of Traditional Chinese Medicine, 2008, 21(2): 41-42. [5] CHEN Ji-jun, FEI Jian-zhong, ZHANG Chen-guang. Observation on the Efficacy of Acupuncture plus Massotherapy for Treating Lumbar Intervertebral Disc Protrusion. Shanghai Journal of Acupuncture and Moxibustion, 2005, 24 (9): 17-18. [6] HUANG Jun-qing. Treatment of 78 Cases of Lumbar Intervertebral Dics Displacement with Spine Rotary Manipulation. Traditional Chinese Medicinal Research, 2009.22(1): 42-43. [7] WU Guang-wei, YANG Xiang-yu. Treatment of 89 Cases of Lumbar Intervertebral Disc Herniation with Acupuncture. Journal of Acupuncture and Tuina Science, 2006, 4(4): 246-247. Translator: CUI Xue-jun () Received Date: October 7, 2009

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46 Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010