1. Acupuncture for the syndrome of prolapsed lumbar Intervertebral disc --Case studies and personal experiences By Dr. Yin Hongchun Email: doctoryin@btinternet.com Tel: 07880557407

2. Main point of diagnosis (1) History: acute or chronic injury in the lumbar region. (2) Symptoms and signs: lumbago with pains radiating to the leg. (3) P.E: tender point, percussion pain,Straight leg raising test (+), intensive leg raising test (+), coughing test and abdomen raising test (+), and neck raising and chest pressing test (+). (4) X-ray, CT scan, and MRI.

3. The prolapsed disc

4. The prolapsed Disc

5. Case 1: Acute Lumbago Mr. Li, age 42, a chef. 1.Acute lumbago 3 days and pains radiating to the left leg. 2.The spine apparently shifted to the left. Straight leg raising test (+), percussion pain (+), and tender point on the left side of L5-S1. 3.CT scan: “L5-S1 Prolapsed Lumbar Intervertebral Disc” with an oppressing nerve root. 4.The tongue: pale and dark with teeth prints on the edges and a thin layer of white fur. 5.Pulse: thready and uneven.

6. Diagnosis: Syndrome of prolapsed lumbar Intervertebral disc (L5- S1) Stagnation of Qi, Blood stasis and kidney deficiency

7. Treatment principle and method Active Blood and Qi, resolve stasis, relieve pain, nourish the kidney, strengthen the waist and correct the joint. Acupuncture: 1) shen shu (BL23), Da chang shu (BL25), wei zhong (BL40), Tai xi (Ki3), Kun lun (BL60), Yang ling Quan (GB34) and Jue gu (GB39). All of above should be tranquilised. 2) A-shi point is used for bleeding and cupping therapy. Tuina: 1) relax manipulation 2) oblique pulling manipulation

9. Required for the patient Continue treatment for 10 sessions, once every two days Sleep on a hard surfaced bed Refrain from sex while on treatment Lumbar region exercises are required (after 10 sessions) e.g. Taiji.

10. Result After 10 sessions, Mr. Li is free from pain and went back to work.

11. Case 2, post-operative pain on back and leg Mr. N. S, 40 years L4-5 Intervertebral disc was removed two years ago. Pain and numbness remained on the lateral side of the left leg and lower back pain. No radiating percussion pain, straight-leg-raising test(60). Left leg: muscle atrophy. Tongue: Enlarged and purple, dark spots. Pulse: weak and thready

12. Diagnosis Shao Yang channel being blocked by Qi and blood, with blood deficiency.

13. Treatment: Clearing away the obstruction in the channel, nourish Qi and blood Acupuncture: Shen shu (BL23), Da chang shu (BL25), Huan qiao (GB30), Feng shi (GB31), Yang ling quan (GB34), Jue gu (GB39), Qiu xu (GB40), Zu san li (ST36), and A shi point. Shen shu and zu san li should be tonified, a-shi point requires bleeding therapy. all others need tranquilised. Herbal medicine: Tao hong si wu wan, 3 times daily, 10 pills each time.

15. Result After 6 treatments, no pain, no numbness. Requested he continued to take the herbal tablets two months. After two months, he expressed his appreciation to me and the excellent effect of acupuncture in letter.

16. Clinical experience 1.The combination of points according to channels and differentiation can offer a better curative effect. 2.For obvious blood stasis, bleeding therapy on the a-shi point has a great effect on pain relief. 3.For chronic pain, acupoints to nourish kidneys and activate blood should be added: shen shu…… 4.For serious lumbar pain, choose Ren zhong to relieve the pain

17. Clinical experience 5.If local acupuncture can not be applied first due to serious leg pain, the distant points should be treated instead, e.g. hand points. 6.Post-operation, if pain remains on the lumbar and atrophied leg, should add: pi shu (BL20) and Zu san li (ST36). 7.With stomach-ache, it is caused by blockage of Ren mai and Du mai, Choose Guan yuan,Qi hai and Ming men. 8.With constipation, add Qian shu (ST 25) and Shang ju xu (ST37).

18. Clinical experience 9.With chronic incontinence of urine and faeces, acupuncture can be a great help. 10.If one or two affected parts remain painful or numb, find out which channel it is located in to choose the point. 11.Sexual function disorder, for excessive case choose Gan Shu, Tai Chong and San Yin Jiao. For deficiency case choose Tai Xi, Ming Men, Ci Liao, and Qi Hai. 12.For joint disorder, Tuina treatment should be performed first.

19. Differential diagnosis For the case which are already showed prolapsed disc by CT scan or MRI. The physical examination does not support the diagnosis. The pain was caused by another problem, for example: Ligament damage (Interspinal and Supraspinal ligament). (case) Semi dislocation of sacrum-iliac joint. (case)

22. Summary Acupuncture is useful for the Syndrome of Prolapsed Lumbar Intervertebral Disc. It can relieve the pain, relax the muscle and recover the nerve function. Physical examination is the most important part of diagnosis. Correct identification of affected channels with differentiation to choose the point can obtain outstanding results.

23. Thank you