Therapeutic Effect Evaluation And Mechanism Study: Tuina Model Of Dredging Bladder Meridians And Du Meridian In Treating Lumbar Intervertebral Disc Protrusion

Objective:Lumbar intervertebral disc protrusion (LIDP) is a common clinical disease, and is the most common etiological factor causing low back pain and sciatica. This study, based on the systematic analysis of clinical literature, aims to evaluate the clinical effect and therapeutic mechanism by Tuina model of Dredge Bladder Meridians and Du Meridian both with clinical research and the experimental study of rat model, so as to format the effective therapeutic model to LIDP which is also easy to promote and be benefit of the patients.Method:1. Clinical researchThe cases were collected during the period March 2009 to march 2010 at Jiangsu provincial TCM Hospital.40 patients suffering from LIDP were randomly divided into two groups: Treatment Group (Tuina model of Dredge Bladder Meridians and Du Meridian) and Control Group (traditional tuina model). Outcomes are evaluated by Sign Symptom Score, McGill pain questionnaire score, plasma TXB2 level, plasma 6-K-PGF1αlevel, TXB2/6-K-PGF1αratio.Results:(1)Sign and Symptom Score:The Treatment Group's outcome of lumbar pain, straight leg raising and General Score of Symptom and Sign are distinctively lower than those of Control Group after 10 days and 20 days treatment, the Treatment Group's outcome of buttock and the lower extremity pain are distinctively lower than those of Control Group after 10 days treatment, which indicate that Treatment Group is better than the Control Group on pain relief and short-term therapeutic effect.(2) McGill pain questionnaire score:the score of the Treatment Group is distinctively lower than those of Control Group after 10 days and 20 days treatment. It shows the Treatment Group has an advantage in pain relieving and a better effect on calm patient's mind.(3) Plasma TXB2 level.6-K-PGF1αlevel and TXB2/6-K-PGF1αratio:the TXB2 level in both groups decreased significantly after respective treatment, the 6-K-PGF1αlevel in Treatment Group increased significantly after treatment, log2(TXB2/6-K-PGF1α) in both groups decreased significantly after respective treatment. It shows that both Tuina model can improve the microcirculation of nerve root.2. Experimental research42 SD rats were divided into Treatment Group. Blank Control Group, sham-operation(sham) group, LIDP Model Group randomly. Rats in LIDP Model received Tuina treatment after 10 days of successful model duplication. The study is evaluated from plasma TXB2,6-K-PGF1αlevel and TXB2/6-K-PGF1αratio, ultra microstructure of local nerve compression after 7 days,14 days treatment.Results:(1)Plasma TXB2 level,6-K-PGF1αlevel and TXB2/6-K-PGF1αratio:compared with blank group, the TXB2 level in Sham group, LIDP Model Group and Treatment Group increased significantly after treatment 7 days, while compared with sham group, the 6-K-PGF1αlevel in Treatment Group increased significantly, and log2 (TXB2/6-K-PGF1α) decreased significant. It shows that Tuina treatment can improve the microcirculation of nerve root.(2)Ultra microstructure of the local nerve compression:compared with the model group, the degree of spinal nerve lesion of the Treatment Group was improved significantly after 7 days and 14 days tuina treatment, which shows that Tuina has satisfactory function on repairing spinal nerve lesion.Conclusions:(1) Kidney deficiency with blood stasis, stagnation of qi and blood in Du and Bladder meridians and urinary bladder meridian are the pathogenesis of LIDP. The Tuina model of Dredge Bladder meridians and Du Meridian, which can promote the flowing of qi and blood in Du meridian, makes free flow of qi movement, balance of qi, blood, yin and yang relationship so as to achieve the goal of replenishing the kidney and dredging Du Meridian, relaxing and activating the tendons, dispelling blood stasis and cure disease.(2) The obstruction of the microcirculation of nerve root is the crucial cause of nerve root pain. Tuina Model of Dredging Bladder Meridians and Du Meridian can improve the nerve root microcirculation of LIDP which is possibly associated with the positive regulation of the plasma TXB2 level,6-K-PGF1αlevel, and log2(TXB2/6-K-PGF1α).(3) Tuina Model of Dredging Bladder Meridians and Du Meridian has comparable good short-term therapeutic effect on treating LIDP on pain relieving besides its calming patient's mind effect.(4) Tuina Model of Dredging Bladder Meridians and Du Meridian has good therapeutic effect on LIDP, is a Tuina model possesses confirmed effects, operability and easily promotion.