Back Pain

Recently I treated a patient with low back pain and sciatica caused by herniated disc in the lumbar region. The patient does not want surgery. She found me from searching the Internet. After four sessions with acupuncture and tuina massage her pain level decreased from 8/10 to just 4/10. I hope with more sessions of treatment that I can cure her back pain and sciatica.

The reasons I think acupuncture and tuina massage worked for her is that acupuncture can reduce inflammation and muscle spasm and remove the stagnation in the meridians.

Tuina massage can also help relax the muscles and move the disc back to it’s original position.

Treatment of dysmenorrhea with Acupuncture and Chinese Herbs- A Case Study

1
Yan Lu, L.Ac.
Clinical Case Study #4
Treatment of dysmenorrhea with Acupuncture and Chinese Herbs- A Case Study
ABSTRACT
Background Treatment of dysmenorrhea with pharmaceutical medicine is effective, but
may not prevent recurrence
Object To present a case that demonstrates the effectiveness of acupuncture and
Chinese herbs for dysmenorrhea
Result reliving symptoms of dysmenorrhea in a 28 year-old women using
acupuncture and Chinese herbs after 7 weeks of treatments
Conclusion The positive results in this case indicates that acupuncture and Chinese
herbs may be a viable treatment option in treating dysmenorrhea
BACKGROUND
Biomedicine Perspective
Dysmenorrhea can be divided into primary dysmenorrhea and secondary dysmenorrhea.
Primary dysmenorrhea is menstrual pain associated with ovular cycles without pathologic
findings. The pain usually begins within 1-2 years after the menarche and become more
severe with time. The frequency of cases increases up to age 20 and then decreases with
age and markedly with parity. 50 to 75 percent of women are affected at some time, and
5-6 percent has incapacitating pain. Primary dysmenorrhea is low abdomen pain which is
crampy or colicky or dull ache and radiate to the back or inner thighs. The pain may start
before or with menses, last 1 or more days and may be associated with nausea, diarrhea,
headache, and flushing. The pain is produced by uterine vasoconstriction, anoxia, and
sustained contractions mediated by prostaglandins. The pelvic examination is normal
between menses; examination during menses may produce discomfort, but there are no
pathologic findings. Nonsteroidal anti-inflammatory drugs (ibuprofen, ketoprofen,
mefenamic acid, naproxen) are generally helpful. A drug may be more effective if started
24 to 48 hours before and continued 1 or 2 days after menses begins. If pain continues to
interfere with daily life, suppression of ovulation with low dose estrogen-progesterone
oral contraceptives is advised. But when patients want to get pregnant and stop birthcontrol
pills, dysmenorrhea may come back. NSAIDs cannot prevent recurrence of
dysmenorrhea, too. Secondary dysmenorrhea is menstrual pain for which an organic
cause exists. The common causes are endometrosis and pelvic inflammation. Other
causes include submucous myoma, IUD use, cervical stenosis with obstruction, or blind
uterine horn. (1)
Traditional Chinese Medicine Perspective
Dysmenorrhea in Chinese medicine can be caused by many reasons such as excess or
deficient conditions. The excess conditions may include the following: Qi and blood
stagnations can cause this disease. Depression over period of time can cause liver qi
stagnation, which can cause blood stasis leading to obstruction of flowing of qi and
2
blood, thus cause this disease. Coldness retention in the uterus is another pathogen.
Walking in the rain without a cover, swim in cold water, eating too much cold food
during menses, or living in damp-cold environment can lead to retention of coldness in
the uterus and Chong and Ren channels causing obstruction of flowing of qi and blood;
congenital yang deficiency with yin coldness-excess cause deficient coldness in the
Chong and Ren channels leading to blood stasis and dysmenorrhea. Lower jiao dampheat
disturb qi and blood can also cause dysmenorrhea. The above reasons are mainly
excess conditions that can cause dysmenorrhea (except deficient coldness).
The following reasons are deficient conditions. Deficiency of qi and blood due to
deficiency of spleen and stomach or after severe illness leads to malnourishment of uterus
and Chong and Ren channels, in addition to deficient qi will also cause blood stasis, thus
dysmenorrhea occurs. Liver and kidney deficiency due to congenital condition or overindulgence
in sex activity or giving birth many times cause deficiency of essence and
blood, leading to malnourishment of uterus, Chong and Ren channels, thus
dysmenorrhea.
The formula treatment of dysmenorrhea for qi and blood stasis include ge xia zhu yu
tang, chai hu su gan san, xiao yao san, jing ling zi san, shi xiao san. Formula for coldness
retention include shao fu zhu yu tang, wen jing tang. Formula for damp-heat include qing
jing san, qing re tiao xue tang, dan zhi xiao yao wan, long dan xie gan tang. Formula for
qi and blood deficiency include ba zhen tang, sheng yu tang, wu ji bai feng wan. Formula
for liver and kidney deficiency include tiao gan tang.
Acupuncture points for excess conditions including qi and blood stasis, coldness
retention, and damp-heat retention include CV3, BL32, LI4, SP10, SP8, LIV3, KID14
and ST28. Acupoints for deficient condition include CV4, BL20, BL23, ST36, SP6, PC6
and Sp4. (2)
Research
Wu described treating 40 women with severe dysmanorrhea with Chinese herbal
formula-Tongjing Power and obtained satisfactory result. Tonjing Power consists of 15g
each of dan shen, chi shao, pu huang, wu ling zhi, and 10g each of yan hu suo, chuan
xiong, gui zhi. The patients took Tongjing Power 30g tid three days before onset of
menstruation for 6 days during each cycle, and 3 menstrual cycles constituted a complete
course of treatment. To assess the effectiveness of the treatment, Wu use the methods of
observing clinical symptom changing, checking the blood flow parameter of uterine arties
by Doppler flow imaging and assay of hemorheologic data. Of the 40 patients treated
with Tongjing, 12 showed marked improvement, 24 were somewhat improved, and 4
showed no improvement. The total effectiveness rate was 90% (3).
Li reported treating 52 cases of primary dysmenorrhea with acupuncture and got good
results. Main acupoints included CV3, UB32, SP8 and SP6. Supplementary points for
excess condition included CV4; for deficient condition included BL23, CV4, and ST36.
Of the 52 cases, following 2 sessions of acupuncture treatment, 32 were cured, 17 were
improved and 3 were ineffective, with an effective rate of 94.2% (4).
CASE HISTORY
3
Patient Identification and Chief Complaint
This patient is 28 year-old married female with severe dysmenorrhea.
History of Chief Complaint
The patient started her menses at age 12, her cycle was usually 28 days with 5 days flow.
The patient had severe menstrual cramping with heavy bleeding since June of 2000. She
described the symptoms as feeling “noodle legs”, tingling in her hands and feet, and they
made her not functional. She tried Aleve, Meclofernamate and Naproxen for couple
months (she did not remember exact how long), which did not help, she was then put on
birth control pills until two months ago-July, 2006 when the patient got married to a
TCM student and want to have children. Her dysmenorrhea came back after she stopped
taking birth control pills. Her last period lasts 7 days with severe cramping, heavy
bleeding and clotting. After rethought this case, I think the patient may have secondary
dysmenorrhea, so I asked the patient what happened then and what medical exams had
been done to her, she said nothing. I did not know it was true or she was hiding
something since her husband is my student and was always present during her treatment.
The patient did not have many symptoms according to the 10 TCM questions. Neutral
temperature, no abnormal thirst, no abnormal sweating, no headache or dizziness, no
palpation or short of breath, good appetite, no gas or bloating, no stomach discomfort,
bowel is formed, once a day, urination is fine, sleep is good, good energy, no floaters in
the eyes, no tinnitus, some stress at work.
Exam
Palpation examination reveals no tenderness or abnormal findings in her abdomen. There
is thick white coat on the sides of her tongue. The tongue color is purple and little pale
with scalloped shape. Her pulse is on the thin and weak sides.
Diagnosis
Western medicine: dysmenorrhea
TCM: the main diagnosis for dysmenorrhea is Qi and blood stagnation in liver, Chong
and Ren meridians causing severe menstrual pain. Because the patient felt some stress at
work, which could causes liver qi stagnation and lead to blood stasis in the Chong and
Ren meridians manifested as purple tongue and clotting during menses. The patient also
has mild spleen Qi deficiency with dampness manifested as thin weak pulse and pale
tongue with teeth marks. Stagnated liver qi may attack spleen and cause spleen deficiency
and dampness retention due to failure of spleen in transportation of water.
Treatment
Treatment principle is to move qi and blood and tonify spleen.
I treated the patient’s dysmenorrhea once a week for 7 weeks, after that I treated the
patient to get her ready for pregnancy.
In her first visit, herbal formula1 was given, which included wu ling zhi 6g, dang gui 6g,
tao ren 6g, hong hua 6g, chuan xiong 5g, mu dan pi 5g, wu yao 5g, xiang fu 4g, chi shao
5g, zhi ke 4g, yan hu suo 3g, gan cao 6g. It was granule. The dosage was 3 tid. In formula
1, wu ling zhi, dang gui, tao ren, hong hua, mu dan pi and chi shao moved the blood
4
stasis; while chuan, wu yao, xiang fu, zhi ke and yan hu suo sooth the live and regulate
the Qi. Gan cao harmonized the herbs. Acupoints included Liv3, Li4, Pc6, Sp4, Cv17,
Cv12, Cv6, Cv3 and Zigong. Liv 3 and LI 4 were used to sooth the liver, PC6 and Sp4
were used to open the Cong channel, Cv 17, 12, 6 and 3 were used to open the Ren
channel, Zigong is an local extra point used to move stagnation in the uterus.Electroacupuncture
was applied from Cv6 to Cv3, and from Zigong to Zigong. The frequency
was mixed 100/2. The needles were retained for half an hour.
The second visit occurred 7 days later, the same points and herbal formula were given.
Her period started one day before her third visit, which happened one week after her
second visit. Herbal formula 2 was given, including wu ling zhi 7g, pu huang 7g, chuan
xiong 3g, bai shao 7g, gan cao 3g, san qi 7g, sheng jiang 5g, da zao 5g. It was granule
form. The dosage was 3g tid. In formula 2, san qi, wu ling zhi and pu huang were used to
move blood stasis and stop bleeding since the patient had dysmenorrhea with heavy
bleeding. Bai shao and gan cao were used to relax her muscle and uterus for the pain.
Chuan xiong was used to move qi stagnation. Sheng jiang and da zao were used to
harmonize her stomach. Acupoints given then included Gv20, Bl18, Bl20, Bl23, Bl32,
Sp6, Liv5 and Li4. Electro-acupuncture was connected from Bl23 to Bl32 with frequency
of 100/2 Hz. Gv 20 was used to calm her shen, BL18 was used to sooth her liver, BL20 to
tonify her spleen, EAC from BL23 to BL32 help to move stagnation in the Ren meridian
to ease the pain, Liv5 and LI4 help to move the Qi.
During her 4th visit, the patient described her recent period was less heavy , there was no
clotting, and the pain level was about half as before, herbal formula 1 was given with
modification of sheng jiang 4g, da zao 4g and ban xia 4g for her nausea. The same
formula was given during her 5th and 6th visit. Acupoints in her first visit and her third
visit were used alternatively once a week during her 4th, 5th and 6th visits.
During her 7th treatment, she felt little cramp and her period could start any day. Formula
2 was prescribed and acupoints in her first visits were used. The patient reported her
period started next day. She was also seen at OCOM program one week after her 7th visit
for her dysmenorrhea, both Misha cohen and the patient were happy with her progress.
The same formulae were suggested. The points given then included Pc6, Sp4, Liv3, Li4,
Kid3 and moxa over Cv3 and Cv6. Pc6 Sp 4 to open Cong meridian, Liv3 and LI4 to
sooth the liver, Kid3 to tonify the kidney, Moxa over Cv3 and Cv6 to warm the uterus.
Case management
Because the patient want to get ready for pregnancy and dysmenorrhea did not really
bother her much, I started to tonify qi, blood, liver and kidney. I think her dysmenorrhea
may disappear after she has her babies. If dysmenorrhea returns in the future, I may use
similar protocol by adding ba zhen tang to tonify qi and blood or liu wei di huang wan to
tonify kiver and kidney. Because her pulse is on the thin and weak side suggesting
underline deficiency.
Result
After 3 visits once per week, the patient did not have clotting during her period, the pain
level is about half as before, 4-5/10, and the bleeding is less heavy. After another 4
treatment once per week, her pain level was reduced to 3-4/10 during the following
period and her menses lasted 5 days with moderate bleeding instead of 7 days of heavy
5
bleeding. Her pain level continues to be 3-4/10 during the following 2 cycles, even
though I changed to focus on her pregnancy. Her prognosis is not clear at this point,
because she had unclear biomedical diagnosis. For example, if her dysmenorrhea was
caused by PID, her prognosis was good with proper TCM treatment. If her dysmenorrhea
was caused by endometriosis, her prognosis was fair with proper TCM treatment.
DISCUSSION
Birth control pills can be effective in treating dysmenorrhea, but once it is stopped,
dysmenorrhea may returns. Chinese medicine appears to be of benefit as a
complementary modality in treating dysmenorrhea with less severe symptom recurrence.
This patient was diagnosed with qi and blood stagnation, modified ge xia zhu yu tang was
used after her period stopped until onset of her next period. Modified shi xiao san with
herbs moving blood stasis and stopping bleeding due to her heavy bleeding was used
during her period. Acupoints in the front and back were selected to move qi and blood
with little tonification. Electro-acupuncture over Zigong and BL32 are important to move
stagnation, increase blood flow to the uterus by affecting blood vessels and sacrum
plexus. Pc6 and Sp 4 are the master points for the Chong meridian, which is the key extra
meridian for dysmenorrhea. Of course, the four gates are important to move qi and blood
in the liver channel.
While the result of TCM treatment is encouraging, further biomedical testing is necessary
to differentiate the cause of her dysmenorrhea, which may help her future treatment.
CONCLUSION
Dysmenorrhea treated with birth control pill may return once patients stop taking the
pills. The result in this case with acupuncture and Chinese herbal treatment suggests that
Chinese medicine may be an effective treatment option. Also, in this case, even though I
started to treat the patient for her pregnancy later, acupuncture and Chinese herbs may
still have some effects on her dysmenorrhea. While this result is encouraging, further
high quality clinical trials with larger numbers of objects and adequate follow-up period
are needed.
REFERENCE
(1) Lawrence M. Tierney, jr. Current Medical diagnosis and treatment 2003, Lange
Medical Books; 702.
(2) Class notes from misha cohen L.Ac. for OCOM-DAOM 2005 class.
(3) Wu, Qing-qing. Clinical Observation of Adolescent Dysmenorrhea treated with
Traditional Chinese Medicine. International Journal of Oriental Medicine V2 N1
P49-51, March 1999.
(4) Li, yun-bo. Acupuncture Treatment of 52 cases of Primary Dysmenorrhea.
Internal Journal of Clinical Acupuncture V15 N3 P155-156, 2006.

Treatment of Rheumatoid Arthritis with Acupuncture and Chinese Herbs – A Case Study

Yan Lu, L.Ac.
Case Study 2
Treatment of Rheumatoid Arthritis with Acupuncture and Chinese
Herbs – A Case Study
ABSTRACT
Background Treatment of rheumatoid arthritis with western drugs can have some
serious side effects.
Object To examine the approach and efficiency of acupuncture and Chinese herbs
in the treatment of rheumatoid arthritis in early stage.
Result After 5 treatments the patient had no joints pain.
Conclusion Acupuncture and Chinese herbs appears to be effective in treating
rheumatoid arthritis, and they have little side effect in long term use.
INTRODUCTION
“Rheumatoid arthritis is chronic systemic inflammatory disease of unknown cause,
mainly affecting synovial membranes of multiple joints. This disease is now considered
to be a disease with such strong tendency to shorten life and cause severe disability that
early and aggressive treatment –often with drugs in combination- is referred.” (1)
However, these drugs often have some serious side effect such as damage to the liver,
lung, GI and kidney, etc. such as lung fibrosis, kidney disease, hepatic dysfunction. (2)
This case history describes the treatment of rheumatoid arthritis with acupuncture and
Chinese herbs and illustrates how acupuncture and Chinese herbs can help patients with
rheumatoid arthritis, and the treatment has little side effect comparing with western
drugs.
BACKGROUND
Biomedicine
Rheumatoid arthritis is “ a chronic syndrome characterized by non-specific, usually
symmetric inflammation of the peripheral joints, potentially resulting in progressive
destruction articular and periarticular structures, with or without generalized
manifestations. The cause is unknown. A genetic predisposition has been identified and,
in white populations, localized to a pentapeptide in the HLA-DRB1 locuslocus of Class II
histocompatibility genes. Environmental factors may also play a role. Immunologic
changes may be initiated by multiple factors. About 1 % of all populations are affected,
women two to three times more often than men. Onset may be at any ages, most often
between 25 and 50 years.” The pathogenic findings in the joint include chronic synovitis
with pannus formation. The pannus erodes cartilage, bone, ligaments, and tendons. The
microscope findings are the subcutaneous nodules. Synovial thickening is the most
physical findings and eventually occurs in most involved joints. Patients may have
1.
stiffness in the morning or after prolonged physical work. They may also have fatigue
and malaise. Deformity may develop rapidly. (3)
The common treatment in biomedicine includes nonpharmacologic management,
nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs.
Nonpharmacologic management includes physical and occupational therapies, rest, heat
and cold, assistive devices, splints and weight loss. The primary objectives in treating
rheumatoid arthritis are to reduce inflammation and pain, preserve function, and prevent
deformity. The NASAIDs have analgesic and anti-inflammatory effects, but they are not
able to prevent erosions or alter progression of the disease. NASAIDs includes aspirin,
ibuprofen, diclofenac, oxaprozin, nabumetone, etodolac, ketoprofen, celecoxib, and
rofecoxib. Disease-modifying antirheumatic drugs should be used as soon as the
diagnosis of rheumatoid disease is made. These drugs include methotrexate, tumor
necrosis factor inhibitors, antimalarials, cortocosteroids, sulfasalazine, leflunomide,
azathioprine, minocycline, gold salts and penicillamine. However, there are potential
serious adverse events such as serious damage to the liver, lung, GI and kidney, such as
lung fibrosis, proteinuria, hepatic dysfunction, stomach pain, etc. (4)
Traditional Chinese medicine perspective
Rheumatoid arthritis can be considered as Bi syndrome. It can be caused by wind-dampheat,
wind-damp-cold, stagnation of qi, blood and phlegm. Long-term illness can cause
deficiency of qi and blood, and deficiency of liver and kidney. The treatment for different
types bi syndrome include acupuncture and Chinese herbal medicine:
Differentiation Acupuncture Treatment Herbal Treatment
Damp-heat bi ST36, SP5, GV14, LI11
plus local points.
Xuan bi tang plus er miao
san
Damp-cold bi ST36, SP5, BL23, CV4 plus
local points
Wu tou tang plus yi yi ren
tang.
Heat-toxin bi Bleeding GV14. simiao yong an tang.
Deficiency of liver and
kidney
BL18, BL23 plus local
points
you gui wan.
For general body pain, add SI3, BL62, BL17, SP21, LI15, LI11, LI4, TB4, GB30, GB34,
GB39, ST41.
For shoulder joint pain, add LI15, TB14, SI9 and SI10.
For scapular pain, add SI11, SI12, SI14 and BL43.
For elbow pain, add LI11, LU5, TB10, TB5 and LI4.
For wrist pain, add TB4, LI5, SI5 and TB5.
For finger spasm, add SI5, LI4 and SI3.
For numbness and pain in the fingers, add SI3, LI3 and Baxie.
For hip joints pain, add GB30, GB29 and GB39.
For gluteal pain, add BL54, BL36 and GB34.
For knee joint pain, add Heding, ST35, Neixiyan, GB34 and SP9.
2.
For lower leg numbness and pain, add BL57 and BL58.
For ankle pain, add ST41, SP5, GB40, BL60 and KID3.
For numbness in the toes, add SP4, BL65 and Bafeng. (5) (6)
Research
Several research papers describe the treatment of rheumatoid arthritis with acupuncture
and Chinese herbs.
Zhou reported treating 44 and 43 mid-late stage patients of RA respectively with
Shuguan Wenjing granule and Shuguan Qingluo granule based on the principle of
reinforcing Kidney to treat arthritis, removing phlegm to relieve the stasis. The clinic
results were compared with those of Wangbi granule on 41 mid-late stage patients.
Shuguan wenjing granule were composed of Epimedium brevicornum, Aconitum
carmichaeli praeparatum, Dipsacus asper, Clematis chinensis, Sinapis alba, Eupolyphaga
sinesis, Rehmannia glutinosa praeparata, Scolopendra, Spatholobus suberectus (16.5 g
crude herb per package) 1 package each time in warm water for oral adminiatration, 3
times a day. Shuguan Qingluo granule were composed of Rehmannia glutinosa,
Polygonum multiflorum, Berchemia hypocrysa, Gentiana macrophylla, Euonymus alatus,
Arisaema heterophylla, Nidus vespae, Pheretima aspergillum (12.5 raw herbs per
package) 1 package each time with warm water for oral administration, 3 times a day.
The treatment course was 3 month. The effective rate in Shuguan Wenjing group was
88.64%, the effective rate in Shuguan Qingluo group was 93.02%. (7)
Wang described treating 650 cases of rheumatoid arthritis with acupuncture and obtained
satisfactory result. The points they used for the upper extremity were TB5, LI11, LI4, the
points for lower extremity were SP9, GB39, ST41; the points for dorso-lumbar region
were GV14, GV12, UB11, GV9, GV3, GV4, or Huatuo jiaji. Points may be added or
omit according to syndrome differentiation. The needles were retained for 15 minutes. A
course of treatment consists of 20 acupuncture sessions. After 3 courses the patients rests
for 2-4 weeks, when treatment may be resumed. Among the 650 cases, 76 cases (11.69%)
were cured clinically; 204 cases (31.38%) got excellent results; 349 cases (53.69%) were
improved; 21cases (3.23%) failed. (8)
CASE HISTORY
Patient Identification and Chief Complaint
The patient is 20 year-old female with joints pain all over her body.
History of Chief Complaint
The patient had joints pain all over the body for about one month. It was aching, pain
level was 5-6 out of 10. She had rheumatoid arthritis with rheumatic myocarditis last
year. With treatment of Penicillamine and Prednisone for several months, she had no
symptoms until one month ago. Because of the rainy cold weather, she felt joints pain all
over her body with coldness in her knee joint. She felt heaviness in her shoulder, and the
3.
knee pain became worse with walking, she also felt tired and had poor appetite, her
menses was normal, her sleep was disturbed by the pain, she also had frequent urination.
She had no headache, no abnormal sweating, no palpation or short of breath, bowel
movement is firm, once a day, her emotion is even.
Exam
Palpation examination reveals tenderness in her joints, worse in her knee. There was
slight swelling in her knee.
She had white and greasy tongue coat and red tongue, her pulse was deep, wiry and thin.
Diagnosis
Possible relapse of rheumatoid arthritis in western biomedicine because of the history of
rheumatoid arthritis, pain in her joint bilaterally for one month and slight swelling in her
knees and fatigue.
Wind-damp-cold bi syndrome with kidney deficiency in TCM. Because damp-cold
weather worsened her pain. Heaviness, white and greasy coat also suggested wind-colddamp
invasion. Frequent urination with thin pulse suggested kidney deficiency.
Treatment
Treatment principle is to dispel wind-damp-cold and tonify kidney.
Herbal formula in her first visit included guizhi 18g, zhi fu zi 18g, dan shen 30g, wei ling
xian 18g, qiang huo 18g, qian nian jian 30 g, hai tong pi 18g, bai zhu 10g, fang feng 18g,
yi yi ren 30g, pei lan 18g, du zhong 18g. 3 bags, 1 bag for 2 days. The formula was to
dispel wind-cold-damp and tonify kidney.
Acupuncture points included BL18, BL20, BL23, ST36 (tonifying method), SI3, BL62,
SP21, Ashi in local area, LI15, xiyan, SP5 (reducing method). The needles were retained
for half an hour.
The second treatment occurred 7 days after the first treatment. The patient reported the
pain level was reduced to 4-5 out of 10. I continued using the same herbal formula and
acupuncture points for 3 weeks, with acupuncture treatment once a week. During her 6th
visit, the patient reported the joints pain was almost gone. Her other symptoms were
coldness and frequent urination. I suggested the patient take patent herbal formula du huo
ji sheng wan plus jin gui shen qi wan, 4 pills of each, 3 times a day for 3 months. Jin gui
shen qi wan includes shu di 29.6%, shan Yao 14.8%, shan zhu yu 14.8%, mu dan pi
11.1%, ze xie 11.1%, fu ling 11.1%, fu zi 3.7% and rou gui 3.7%. Du huo ji sheng wan
includes tai zi shen 10.2%, shu di 7.3%, du huo 7.3%, sang ji sheng 7.3%, fang feng
7.3%, xi xin 7.3%, du zhong 7.3%, niu xi 7.3%, rou gui 7.3%, chuan xiong 7.3% and
gang gui 4.9%.
I saw the patient 3 months after, she had no pain but still felt slight cold. I suggested the
patient continue taking jin gui shen qi wan 8 pills tid for 3 months or until her coldness
was gone. Also suggested the patient take du huo ji sheng tang 8 pills tid for one month
when weather became cold and raining. I suggested the patient get acupuncture and
herbal treatment once in a while for tune-up in the future.
4.
Result
After the first treatment, the patient noticed pain reduced to 4-5 of 10, after the 5th
treatment, the patient felt the pain was gone with only slight coldness and frequent
urination. 3 months later, the patient had no pain but still slight coldness. Her prognosis is
good if she continues TCM treatment as tune-up.
DISCUSSION
Western biomedicine can be effective to treat rheumatoid arthritis, however some drugs
have serious adverse effect such as serious damage to the lung, liver, GI, CNS and kidney
causing lung fibrosis, proteinuria, hepatic dysfunction. Acupuncture and Chinese herbal
medicine appears to be of benefit as a complementary modality in treating rheumatoid
arthritis. They have little side effect by literature review. It is, however, difficult to
determine how much of the therapeutic result is contributable to acupuncture treatment
versus Chinese herbal medicine, since both methods were used at the same time during
the treatment. The reality of clinical practice dictates the use of whatever may help the
patient to bring about the most rapid and most complete treatment.
CONCLUSION
Several case series and the case presented in this paper demonstrated the effectiveness of
acupuncture and Chinese herbal medicine in treating rheumatoid arthritis. While these
results are encouraging, further high quality clinical trials such as with control group and
with larger numbers of subjects and adequate follow- up periods are needed.
REFERENCE
(1) Lawrence M. Tierney, jr. Current Medical Diagnosis and Treatment 2003, Lange
Medical Books; 803.
(2) Hand –out by Dr. Andre Barkhuizen from OHSU for OCOM doctoral class 2005.
(3) Mark H. Beers M.D. the Merk Manual, 7th edition, Merk Research Laboratories,
1999; 416-417.
(4) Lawrence M. Tierney, jr. Current Medical Diagnosis and Treatment 2003, Lange
Medical Books; 805-808.
(5) Xinnong Chen. Chinese Acupuncture and Moxabustion 2000, People’s Health
Press; 555-558.
(6) Guiting Chen. Practical Diagnosis and Therapeutics of Integrated Traditional
Chinese and Western Medicine 1995, Chinese Medicine/ Science and Technology
Press; 637-640
(7) Zhou, Xueping. Clinical and experimental study on treatment of mid-late stage of
rheumatoid arthritis with shuguan granules. Chinese Journal of Integrated
Traditional and Western Medicine v5 n3 p165-170, 1999.
(8) Wang, Futian. Acupuncture treatment of rheumatoid arthritis: a report of 650
cases. International Journal of Clinical Acupuncture v4 n2 p123-126, 1993.

Treatment of Sciatica with Electro-Acupuncture and Tuina Massage: A Case Study

TREATMENT OF SCIATICA WITH ELECTRO-ACUPUNCTURE AND TUINA:
A CLINICAL CASE STUDY
By Yan Lu, DAOM, LAC
ABSTRACT
Background Sciatica and back pain can be difficult to treat, especially when it does not have clear
diagnosis from a western biomedical perspective such as negative findings
in a MRI.
Objective To examine the approach and efficiency of electro-acupuncture and Tuina
in the treatment of sciatica and back pain with unclear biomedical diagnosis.
Result After 2 treatments the patient experienced significant decrease of sciatic
pain and numbness
Conclusion Electro-acupuncture and Tuina appear to be effective in treating sciatica and back pain
with unclear biomedical diagnosis
Background
Biomedicine Perspective
Sciatica is pain that radiates along the course of sciatic nerve, most often down the
buttocks and the posterior aspect of the leg to below the knee. It may occur with or
without back pain. It is most commonly caused by peripheral nerve root compression
from intervertebral disc protrusion or intraspinal tumor. Compression may be within the
spinal canal or intervertebral foramen by disc protrusion, tumor, or bony irregularities
( herniated disc, degenerated disc, lumbar spinal stenosis – osteoarthritis, spondylisthesis )
The nerves can be also compressed outside the vertebral column, in the pelvis and
buttocks ( sacroiliac joint dysfunction and piriformis syndrome) . Toxic or metabolic
causes (eg. alchoholism, diabetic neuropathy ) are rare. Such processes are confirmed by
the presence of sensory or motor deficits and by clinical or electrodiagnostic findings.(1).
The common treatment in biomedicine includes using heat/ice, medications, epidural
injections, surgeries, education and exercises. Medications include NSAIDs, opioid and
muscle relaxants such as diazepam, cyclobenzaprine, carisoprodol and methocarbamol.
Rest and back exercise are now known to be ineffective. Epidural injections can provide
short-term relief of sciatica but do not improve functional status or reduce the need for
surgery. Surgical procedures may be necessary to relieve intractable pain or other
neurologic involvement such as herniated disc or spinal stenosis. Classic discectomy with
limited laminotomny for intervertebral disc herniation is standard. Laminectomy can be
used for spinal stenosis. Spinal fusion can be performed for spondylolisthesis. (2).
However it is difficult to treat sciatica with no clear biomedical diagnosis, which is
common in clinic.
Traditional Chinese medicine perspective
Sciatica in TCM can be considered as back pain. The causes of the back pain can be
differentiated as invasion by wind- cold, deficiency of kidney qi, and qi and blood
stagnation due to trauma. The treatment for sciatica usually includes acupuncture, herbs
and Tuina. The acupoints includes BL23 andGV3 to tonify kidney, BL40 to open the
meridians. For damp- cold type, add BL25, BL26; for kidney qi deficiency, add GV4.
Moxibustion can be applied to the acupoints for either of these previous two conditions.
For kidney yin deficiency, add BL52, Kid3; for trauma, add GV26 and yao tong point.
(3)
The following formulas can be prescribed to treat lumbar pain: modified ganjiang lingzhu
tang for damp-cold type. This formula tonifies the spleen, drains the damp, dispels the
cold, and relieves pain. Modified simiao wan can be used for damp-heat type condition.
This formula drains the damp and clears heat. Other herbs such as mu gua, luo shi teng
can be added to increase the efficacy of pain relief. Shen tong zhu yu tang can be used for
blood stasis. This formula moves qi and blood and opens the meridians to stop pain. You
gui wan treats kidney yang deficiency and zuo gui wan treats kidney yin deficiency. (4)
For Tuina treatment, the following Tuina techniques can be used: pointing, pressingkneading,
rolling, stretching, etc. (5), (6), (7).
Research
Several papers describe the treatment of sciatica with acupuncture.
Feng reported successful treatment of 58 cases of nerve trunk type sciatica with catgut (a
special thread made of pig intestines) implanted at acupoints. GB30 and BL54 were
chosen as main points, while BL36, BL 37 and GB34 were chosen as alternate points.
Catgut was implanted in one main point and one alternate point once every 15 days.
Among 58 cases, 35 were cured, 12 showed marked improvement, 7 achieved
effectiveness and 4 did not improve. (8)
Zeng employed a therapy of acupuncture by warming the needle with an ignited moxastick
for 74 cases of sciatica and obtained satisfactory result. Warm needling was
performed at GB30, GB34, and BL57 for wind-cold type. GV4, BL23, BL37, BL54 and
BL40 were used for kidney deficiency. BL24, BL26, BL32, BL57 were used for blood
stasis. Among 74 cases, 31 were cured, 22 showed marked improvement, 21 achieved
effectiveness. (9)
Wang reported treating 455 cases of sciatica with deep needling BL26 and obtained
satisfactory result. Two 4 cun long needles were inserted into BL26 to achieve a
sensation of electric shock. The needle is retained for 30 minutes during which time it is
thrust and lifted 2-3 times. Among the 455 cases, 320 were cured, 83 were markedly
effective, 35 were improved and 17 failed. (10).
Case History
Patient Identification and Chief complaint
The patient is 45 year-old female with sciatica
History of Chief Complaint
The patient started to have right side sciatica 3 years ago. She also sprained her right
ankle twice 6 months before her sciatica started. A MRI scan on her low back was
normal. The patient never received a diagnosis. She was treated with physical therapy,
which helped her. Yoga stretch also helped. Then she got busy and gained some weight,
which made the sciatica worse.
When the patient came for acupuncture treatment, she described the pain was constant
dull pain most times, but can be sharp some times. It was in her low back, gluteal area, radiating
along the back of her leg to the bottom of her foot. She also experienced deep pain in her
right greater trochanter area and numbness in her right last 2 toes. On a scale from 1 to
10, she rated her pain level was 7 or 8. Pain was worsened by sitting and lessened by
lying down with heat or ice on her hip. The patient reported that she felt stress about her
pain.
The patient past’s medical history included sinus surgery for her sinus. Her sinus is fine
now and even her dizziness went away after the surgery. She also had bleeding between
her menses, which her doctor thought was due to perimenopause.
She felt cold. She described that she had nervous stomach with alternating loose stool or
constipation. She felt tired and moody sometimes. Her menses is heavy with bleeding
between. She did not feel particularly thirsty and her urination is normal. She can sleep 7
hours per night, which she felt was normal for her.
Exam
Palpation examination reveals tenderness in her right low back jiaji L5 and S1 area, right SI joint,
right piriformas muscle and in her groin area.
Straight leg lifting test was negative, yeoman’ s test was positive on her right SI joint,
piriformas tension test was positive on her right side, figure “4” test was positive for her
right hip. Manual muscle testing showed weak right adductor muscle. Her right leg was
slight longer.
Her right pulse was wiry and slippery. Her left pulse was slight weak. Her tongue was
pale and scalloped with thin yellow coating.
Diagnosis
Western biomedicine: right SI joint anterior subluxation, piriformas syndrome, right hip
joint subluxarion. (positive orthopedic tests)
Traditional Chinese medicine: Qi and blood stagnation in her Bladder meridian, Qi and
blood deficiency being not able to nourish muscles and tendons.
Her stress and wiry pulse suggest Qi stagnation, which can leads to blood stasis causing
sciatica. Coldness, fatigue, alternating diarrhea and constipation, slight weak pulse on her
left side and pale tongue suggest deficiency of Qi and blood.
Treatment
The treatment principle is to relax muscles, help the recovery of joint subluxation, move
Qi and blood, and tonify Qi and blood.
The patient was treated twice before the case was reported.
Electro acupuncture was applied on trigger points on her right piriformis muscle and
from Jia ji L5 to Ashi point in her right SI joint to relax her muscle. The frequency is
selected by mixed frequency-100/2 and the length of duration is 30 minutes. Other points
being used are: Motor points for her adductor was needled after the electro- acupuncture
was finished to strengthen her adductor, LI 4 and LIV 3 to move Qi and blood, ST 36 and
SP6 to tonify Qi and blood.
Tuina was applied after acupuncture. Rolling, pressing/kneading and pushing were
performed to relax muscles and open the meridians. Stretching the SI joint and hip joint
follows. The Tuina treatment duration per secession is 15 minutes.
Case Management
The patient did not come back for more treatment after the first two treatments. I
recommended the patient continue to receive another eight treatments as one course of
treatment. I also suggested the patient continue yoga stretching and exercising to lose
weight. Pelvic support is recommended to help stabilize the patient’s SI joint if the
patient still has pain after one treatment course. Herbs will also be prescribed if the
patient still has symptoms in the future such as Shen Tong Zhu Yu Tang.
Result
After the first treatment, the patient noticed a decreased pain in her right hip and leg.
After the second treatment, the sciatica and the deep pain in her greater trochanter area
went away, and the numbness in her right last two toes disappeared, too. Her leg length
was equal. All the orthopedic tests became negative.
Discussion
Like many others, this patient did not have a specific biomedical diagnosis when she
came for acupuncture. In my clinical experience, I found that when the sciatica was due
to compression by the soft tissues around the sciatica nerve, and there are no abnormal
changes in imaging tests. It is difficult for biomedicine to make a diagnosis. This
patient’s sciatica is due to compression on the sciatic nerve by piriformis muscle and SI
ligments from SI joint subluxation. Biomedicine does not agree that there is such
condition of SI joint subluxation, because it usually will not show in X- ray or MRI.
However, positive orthopedic test and clinical result suggest that there is such a
condition. Another condition that the patient had was hip joint subluxation due to
imbalance of agonist and antagonist muscles- tight piriformis muscle and weak adductor
muscles. It is one of the advantages of acupuncture and Tuina that they can be used to
treat patients with sciatica who do not have a clear biomedical diagnosis and still provide
relief for them. However it is difficult to determine if the piriformis syndrome or the SI
joint subluxation is causing the patient’s sciatica or if it is both conditions. A combination
of electro-acupuncture and Tuina is the key to treat sciatica due to musculo-skekletal
conditions (piriformis syndrome and SI joint subluxation in this case). Because
acupuncture works well to open meridians and relax piriformis muscle, Tuina works well
on SI joint subluxation as well as on piriformis muscle. Besides orthopedic tests, it will
be of interest to researchers to establish other diagnostic methods to prove that there is SI
joint subluxation causing sciatica due to compression on the sciatic nerve.
Conclusion
Sciatica due to unclear biomedicine diagnosis can be difficult to treat. This case
demonstrated the effectiveness of electro-acupuncture and Tuina in treating sciatica due
to compression on the sciatic nerve by piriformis muscle and SI ligments from SI joint
subluxation. The result is encouraging, further high quality clinical trials with larger
number of subjects and adequate follow-up periods are needed.
5
References
(1) Mark H. Beers M.D. The Merk Manual, 7th edition, Merck Research
Laboratories, 1999; 476.
(2) Lawrence m. Tierney, jr. Current Medical diagnosis and treatment 2003, Lange
Medical Books; 795.
(3) Cheng, Xin-nong Chinese Acupuncture, the people’s medical publisher, the 4th
edition; 554.
(4) Zhang, Bo-yu. Internal Medicine of Traditional Chinese Mediocine, Shanghai
Science and Technology Press, 1985; 246-247.
(5) Zheng, En-qin, Chinese Massage, Publishing House Of Shanghai College of
Traditional Chinese Medicine, 1990; 350-352.
(6) Zheng, Xian-da, Practical Acupuncture and Tuina Therapy in Traumatology,
Sichuan Science and Technology Press, 1997; 154-157, 160-161, 166, 176-177.
(7) Yu, Dafang, Tuina, Shanghai Science and Technology Press, 1995; 123-124, 128.
(8) Feng Leshan, Treatment of Nerve Trunk Type Sciatica by Catgut Implantation at
Acupoints: 58 Cases, Internal journal of Clinical Acupuncture, 2002; 13(2): 131-
131.
(9) Zeng Zhi-jun, Warming Acupuncture in Treating 74 Cases of Sciatica, Internal
Journal of Clinical Acupuncture, 1996; 7(4): 489-491.
(10) Wang Songrong, 355 Cases of sciatica Treated with Deep Needling of
Guanyuanshu, Internal Journal of Clinical Acupuncture, 1993; 4(2): 137-140.