Case 1

Name: Zhou.

Sex: Female.

Age: 35 years.

Occupation: An advertisement designer.

Chief Complaint: Severe lumbago for 4 days.

History of Present Illness: Four days ago, when the patient was starting her motorcycle, she got a sudden sharp lumbago due to improper exerting her strength. It's a severe lightning pain and radiating to the buttocks and lower extremities, as if being cut and sliced by a sharp knife. It immediately caused her waist and lower extremities couldn't move about at all. Then she was quickly sent to the department of orthopedics of a hospital in Jiangyin City for treatment. Through some common medical examination, it was diagnosed as "Acute Lumbar Sprain" and she was treated with oral taking anodyne, massage and external applying medical plaster onto the painful region. At that time, the lumbago was relieved a little and she then returned home for resting. But only 1 day later, the lumbago became as severe as before, furthermore, it quickly got worse and worse, so that she couldn't stand it. Then she was sent to the specialist's policlinic 0f the hospital again. Through CT scanning examination, it was confirmed as "Prolaps of Lumbar Intervertebral Disc between the 3rd and 4th,the 4th and 5th Lumbar Vertebra. "The doctors of the hospital suggested that the illness should be treated by an 0peration,but the patient herself and her family didn't accept the operation. Then they asked me for treatment on July 1, 1999. After the illness came on, her appetite, urination and defecation were all normal, while she got a bad sleeping due to the sharp pain, it prevented her from sleeping throughout night. There wasn't other complaint.

Physical Examination: The patient was conscious with an acute painful complexion. She stretched herself out on the floor board with continuous groaning. The chest and abdomen were all normal. The both lower extremities couldn't move about at all. She daren't turn over and get up. There was severe tenderness and percussion pain in the lumbosacral portion. The pulse was thready and uneven, the tongue was dark red with a thin layer of white fur. There wash' t other abnormal sign.

Exarmination of CT Scanning: Intervertebral spaces of the 3rd to the 4th, the 4th to 5th lumbar vertebra became more narrow than normal. It showed there was prolaps of lumbar intervertebral disc.

Diagnosis: Prolapse of Lumbar Intervertebral Disc.

Differentiation: This disease, in TCM, belongs to the category of "Injury of Bone and Tendon. " It dosen't belong to the category of "Bi syndrome caused by wind-dampness evil. " It's not common aching pain in the lumbar regions and the knee joints. It was actually caused by improper exerting strength on the lumbar regions, which caused a sudden force acted on the lumbar vertebra and the intervertebral disc violently, then the lumbar vertebra was injured and the intervertebral discs were crashed. As for the intervertebral disc, although it has never been described in the writings of TCM of the past and the present, we should objectively recognize its function and then correctly define its attribute. Because the anatomical position of intervertebral disc nestles closely up to the bones and its function is to assist the bones in moving. So that we can consider that the attribute of intervertebral disc should be the appendage of bone, it should be the tendon attached the bone it's different from the common tendon only in shape. In this case, the improper exerting strength on the lumbar regions caused the intervertebral discs were crushed and the lumbar vertebras were injured, then there were stagnation of qi and blood stasis in the lumbar regions, which obstructed the channels through the lumbar regions and caused the channel qi couldn't flow through the lumbar regions as normal. Because the lumbar region is the movement hub of whole body, it is the necessary road for the channel qi of TaiYang bladder channel to pass through. But the channel in the lumbar regions had been obstructed by the stagnation of qi and blood stasis, then the channel qi of TaiYang bladder channel couldn' t smoothly and normally pass through the lumbar regions, where there is obstruction, there is pain. So that the patient got the insufferable lumbago.

Therapeutic Principle: Treatment of secondary symptoms in emergency: dredging the obstructed channel immediately with acupuncture; treatment of chronic disease aiming at the principal aspect: after the sharp pain was relieved greatly, decoction and pills should be used in order to activating blood to resolve stasis, dredging collaterals to relieve pain and nourish the injured bone.

Acupuncture Method: I pricked the right point of Weizhong (BL54) with a 1.5cun needle, manipulated the needle with flying skill. When the meridian-qi was gathered together around the needle, then I tapped the whole line of TaiYang bladder channel with fingers and stimulated the point of Weizhong(BL54) with continuous flying skill. Such special skill can stimulate the channel qi to flow rapidly along the channel. In this case, it effectively stimulated the needling response to extend upward through the lumbar regions and downward through the feet. This sign showed the whole line of TaiYang bladder channel had been completely dredged unobstructed. The patient felt the sharp lumbago immediately disappeared. She could get up, turn over, sit down and walk about at once, just like a normal one. Her husband and daughter were all amazed at the magic curative effect, they cried with surprise : How wonderful !

Because the lumbago had been greatly relieved, then it's necessary to use decoction in order to activating blood to resolve stasis, keep the channel unobstructed.

Recipe:

HongHua, Safflower 10g

TaoRen,Peach Seed 10g

DangGui,Chinese Angelica Root 6g

ZhiHuangQi,Moxa-prepared Milkvetch Root 18g

XuDuan,Teaset Root 15g

NiuXi,Achyranthis Root 12g

GuSuiBu,Drynaria Rhizome 15g

QianNianJian, Sargentgloryvine 15g

BaiJiangCan, Batryticated Silkworm 15 g

DiLong, Earthworm 9g

ChiShao,Red Peony Root 12g

DiBieChong,Ground Beetle 5g

BaiShao,White Peony Root 15g

GouJi,East Asian Tree Fern Rhizome 12g

ShengGanCao,Raw Liquorice Root 6g

All the above drugs were to be decocted in water for oral taking, 3 doses were prescribed, fat and greasy food was forbidden during the treatment.

Effect Observation: After taking the 3 doses, the lumbago disappeared at all, only a distending sensation was there, the lumbar regions were just like being constricted by something. It caused she couldn' t keep walking, sitting or standing for a long time. All these signs showed the injury of bone and tendon hadn't been cured yet,although the obstructed channel had been dredged unobstructed. Then the followed therapeutic principle should be activating blood to eliminate stagnation, nourishing kidney and liver in order to nourish the injured bone and rejoin the crushed tendon. Because the anatomical position of intervertebral disc was so deep and concealed that the efficacy of the common drugs can not reach there, it's most important to use some insect drugs for they are all good at running through the vertebra and going into the tiniest and deepest place, in order to lead the other drugs into the affected regions. In addition, because the illness was in the chronic stage, it's necessary to use pills slowly in order to cure the disease completely.

Recipe :

ShuiZhi, Leech 5g

JiuXiangChong, Aspongopus 15g

DiLong, Earthworm 15g

BaiJiangCan, Batryticated Silkworm 1S g

QiangLang,Dung Beetle .Sg

ZiRanTong, Pyrite 15g

RuXiang, Frankincense 1Sg

MoYao, Myrrh 15g

GuSuiBu,Drynaria Rhizome 30g

XuDuan,Teasel Root 30g

GouJi,Cibot Rhizome 30g

NiuXi,Achyranthis Root 30g

HongHua, Safflower 15g

TaoRen,Peach Seed 30g

ShuDiHuang,Prepared Rehmannia Root fog

All the above drugs were to be ground into powder and mixed with some water to make pills. She was told to take fig of the pills each time, 3 times a day. In order to prevent the pills from hurting Yin and inducing the production of pathogenic-heat, she should take 5g of the blous of Anemarrhenae Phellodendi and Rehmanniae, 3 times a day; in order to prevent the pills from hurting blood, she should take fg of the blous of Gallus Domesticus each time, 3 times a day. In addition, she was to1d to take the Pill Strengthening Middle Energizer to Nourish Qi in order to promote the blood' s flowing and prevent the blood stasis from being produced, taking 3g of the pill each time, 3 times a day.

During the same period, she was told to apply the external piaster onto the affected regions in order to promote blood circulation and remove blood stasis, dredging the obstructed meridian. Recipe :

ZhiChuanWu,Prepared Sichuan Aconite Root 60g

ZhiCaoWu,Prepared Wild Aconite Root 60g

ZhiNanXing,Prepared Jackinthepulpit Tuber 60g

ZhiZaoCi,Prepared Chinese Honeylocust Spine 60g

ChuanShanJia,Pangolin Scale 5g

DiBieChong,Ground Beetle 30g

HongHua, Safflower 30g

TaoRen,Peach Seed 30g

MaHuang, Ephedra 20g

RouGui,Cassia Bark 20g

LiuHuang, Sulphur 50g

TieFen,Powder of Iron 200g

All the above drugs were to be ground into powder and mixed with some 75%alcohol to make herb plaster. She should apply some plaster onto the affected regions, cover the plaster with a layer of gauze in order to have a fomentation, doing it once a day, more than 40 minutes one time.

After 1 month of such treatment, the patient's living and working became normal completely, she could keep walking, standing or sitting for a long time without any difficulty. All these signs showed the illness had been cured completely. After 2 years' follow-up, the illness didn't recur. Then it's ending.

Case 2

Name: Tang.

Sex: Female.

Age: 24 years.

Occupation: A chemistry teacher.

Chief Complaint: Lumbago for 3 and a half years, aggravation for half a year.

History of Present Illness: Three and a half years ago, the patient's lumbar region was injured in a traffic accident. Because no obvious fracture was found through the immediate roentgeno-gram, the pateint considered there was no trouble on herself. Meanwhile, she had owned a dull lumbago continuously since then, especially when she was doing strenuous exercise or holding a heavy object, it would become more predominant. In recent half a year, it became worse and worse, severe cough,

sneezing and quick walking could aggravate it. So that she couldn't continue writing and reading for 10 minutes, otherwise she must lie down to relieve the lumbago. After 3 years' treatments such as acupuncture, massage and traction there was no obvious curative effect on her. Finally she went to Jiangsu Province¡Á ¡Á Hospital, through CT scanning it was confirmed as "Prolaps of Lumbar Intervertebral Disc" between the 3rd and 4th,the 4th and 5th lumbar vertebre. Then she came to me for treatment on May 1,1997. After the illness came on, she kept her appetite, sleeping, defecation and urination normal all along. There was not other complaint.

Physical Examination: The patient was conscious with a normal general condition. The pulse was thready and uneven, the tongue was red with a thin layer of white fur. The raising test of straight-leg on both sides showed positive. Kerng' s sign was positive too on both legs. Sensation and movement of both legs were all normal. There wasn't other abnormal sign.

Examination of CT Scanning: It showed the intervertebral spaces between the 3rd and 4th, the 4th and 5th the lumbar vertebar were all more narrow than normal. Prolaps of lumbar intervertebar disc could be seen. There wash' t other abnormal sign.

Diagnosis: Prolaps of Lumbar Intervertebar Disc.

Differentiation: This disease, in TCM, belongs to the category of "Injure of Bone and Tendon, "it doesn't belong to the category of "Bi-syndrome. "As for the constant lumbago, it was not caused by the attack of exogenous pathogenic factors such as wind, cold, fire and dampness, actually it was caused by stagnation of qi and blood stasis in the obstructed channel resulting from the injuring of the traffic accident.

Therapeutic Principle: Activating blood to resolve stasis; clearing away obstruction in the channels to relieve pain; tonifying kidney and nourishing bone in order to rejoin the fractured bones and crushed tendon.

Recipe:

ShuiZhi, Leech 5g

JiuXiangChong, Aspongopus 15g

DiLong,Earthworm 15g

BaiJiangCan, Batryticated Silkworm 15 g

QiangLang,Dung Beetle 5g

ZiRanTong, Pyrite 15g

RuXiang, Frankincense 15 g

MoYao,Myrrh 15g

GuSuiBu,Drynaria Rhizome 30g

XuDuan,Teasel Root 30g

GouJi,Cibot Rhizome 30g

NiuXi,Achyranthis Root 30g

HongHua, Safflower 15 g

TaoRen,Peach Seed 30g

ShuDiHuang,Prepared Rehmannia Root 60g

All the above drugs were to be ground into fine powder and mixed with some water to make pills. She should take 6g of the pills each time,3 times a day. Greasy and hot food was forbidden during the treatment. If the patient got dizziness or dry mouth, she should drink the soup of mung bean to relieve it. In the same period, she was told to apply some external drugs onto the affected lumbar region.

Recipe:

ZhiChuanWu,Prepared Sichuan Aconite Root 60g

ZhiCaoWu,Prepared Wild Aconite Root 60g

ZhiNanXing,Prepared Jackinthepulpit Tuber 60g

ZhiZaoCi,Prepared Chinese Honeylocust Spine 60g

ChuanShanJia, Pangolin Scale 15 g

DiBieChong,Ground Beetle 30g

HongHua, Safflower 30g

WaoRen,Peach Seed 30g

MaHuang, Ephedra 20g

RouGui,Cassia Bark 20g

LiuHuang, Sulphur 50g

TieFen,Powder of Iron 200g

All the above drugs were to be ground into powder, she should mix the powder with some 75% alcohol to make herb plaster. When it was used, her friend should expose the painful region, apply some plaster onto the painful region, cover the piaster with a piece of cloth, put a hot water-bag onto the cloth in order to promote the curative effect.

Effect Observation: After 6 days' treatment, the lumbago was relieved greatly. It couldn't be aggravated by severe cough, sneezing and quick walking. The patient could continue reading and writing for an hour and a half. After 20 days' treatment, all the discomfort disappeared. She could hold an object which weighted 15kg without lumbago. After 30 days' treatment, the patient was cured completely. After 2 years' follow up, the illness didn' t recur. Then it' s ending.