Transcript 2005PresentationYin

Acupuncture for the syndrome of
prolapsed lumbar Intervertebral disc
--Case studies and clinical experiences
By Dr. Yin Hongchun
Email: [email protected]
Tel: 02086722088
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.
The prolapsed disc
The prolapsed Disc
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.
Diagnosis:
• Syndrome of prolapsed lumbar Intervertebral disc (L5S1)
• Stagnation of Qi, Blood stasis and kidney deficiency
Treatment principle and method
Activate 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) relaxing manipulation
2) oblique pulling manipulation
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.
Result
• After 10 sessions, Mr. Li is free from pain and
went back to work.
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
Diagnosis
• Shao Yang channel being blocked by Qi and blood, with
blood deficiency.
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.
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.
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
(BL23)……
4.
For serious lumbar pain, choose Ren zhong
(DM26) to relieve the pain
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(RM4),Qi
hai(RM6) and Ming men(DM4).
8.
With constipation, add Qian shu (ST 25) and
Shang ju xu (ST37).
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(BL18), Tai Chong(LI6) and San
Yin Jiao(SP6). For deficiency case choose Tai
Xi(KI3), Ming Men(DM4), Ci Liao(BL32), and Qi
Hai(RM6).
12. For joint disorder, Tuina treatment should be
Differential diagnosis
For the case which have 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)
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.
Thank you