| 1. Research purposesLumbar Intervertebral Disc Herniation also known as Lumbar Anular Disruption, is a spinal disease which causes severe pain. The degeneration of lumbar intervertebral disc or the external force cause the imbalance of the intervertebral disc which in turn leads to the rupture of the annulus fibrosus, resulting in the protrusion of the lumbar intervertebral disc nucleus pulposus. This protrusion causes the compression or stimulation of the nerves, blood vessels and Cauda equine etc, further leads to the inflammation in the surrounding tissue, edema, microcirculation and adhesion of fibrous tissue hyperplasia and in turn causes low back pain or even neurological barriers. This study adopts a simple, randomized, controlled study programs designed for the scientific evaluation of efficacy of EA of Jiaji and Ashi points in the treatment of Lumbar Intervertebral disc herniation. By observing the relief of pain through the treatment of EA of Jiaji and Ashi points, we can investigate a easy way to alleviate the pain that caused by this disease and to provide a theoretical basis in the treatment of Lumbar Intervertebral disc herniation by using EA of Jiaji and Ashi points.2. Research methods2.1 The source of the cases and groupingAll cases from Hong Kong University Chinese Medicine Clinical Research Centre, will be diagnosed with lumbar intervertebral disc herniation.60 patients were randomly divided into treatment group (acupuncture Jiaji and Ashi points 30) and the control group (conventional treatment group=30) in this clinical research.2.2 Therapy(1) Acupoints selection The treatment group taking Jiaji and Ashi points, Jiaji:lesion site of the vertebral body and its lower vertebrae Jiaji; Ashi point:the level of spinous process vertebral lesions adjacent to open 3 inches or less to find 2 point of deep tenderness; acupoints along meridians selection: Bladder Meridian of foot-Tai Yang, BL:Zhibian, Chengfu, Yinmen, Weizhong, Chengshan, Kunlun; Gall bladder Meridian of foot-Shao Yang, GB:Huantiao, Fengshi, Yanglingquan, Xiyangguan, Yangfu, Xuanzhong, Zulinqi. Selection with Syndrome Differentiation, cold dampness:Yaoyangguan; Blood Stasis:Shuigou; Yang deficiency of kidney:Mingmen; Ying deficiency of kidney:Sanyinjiao. Control group:regular acupoints of lowback pain and sciatica, main acupoints: Shenshu, Dachangshu, Yaoyangguan; acupoints along meridians selection and Selection with Syndrome Differentiation:the same as control group.(2) Methods of operation Operation of reatment group:75% ethanol with regular skin disinfection Jiaji and Ashi points 0.25 X 50mm stainless steel needle quickly puncture, puncture perpendicularly 40mm; Huantiao, Zhibian and Chengfu 0.25 x 75mm stainless steel needle quickly puncture, puncture perpendicularly 70mm, Yinmen 0.25x 60mm stainless steel needle quickly puncture, puncture perpendicularly 50mm, Yanglingquan, Fengshi, Weizhong and Chengshan 0.25x 50mm stainless steel needle, quickly puncture, puncture perpendicularly 40mm; Kunlun 0.25x 40mm stainless steel needle, quickly puncture, puncture perpendicularly 30mm; Zulinqi 0.25x 25mm stainless steel needle quickly puncture, puncture perpendicularly 20mm. Yaoyangguan and Mingmen 0.25x 40mm stainless steel needle quickly puncture; puncture obliquely 30mm, Shuigou 0.25x 25mm stainless steel needle quickly puncture, puncture perpendicularly 15mm. Sanyinjiao 0.25x 40mm stainless steel needle quickly puncture, puncture perpendicularly 35mm.Puncture each acupoint above with 1 needle and puncture 2 needles for Ashi points. Patient should feel locally tingling sense of expansion, this is called "De Qi". After "De Qi", remain needles for 30 minutes using KWD-8081 type instrument with continuous electricity current. Operation of control group,75% ethanol with regular skin disinfection Shenshu and Yaoyangguan 0.25x 40mm stainless steel needle quickly puncture, puncture obliquely 30mm; Dachangshu 0.25x50mm stainless steel needle quickly puncture, puncture perpendicularly 40mm, other operation remains the same as treatment group. Two groups of patients were treated every other day,3 times as a course of treatment,2 days rest between each course of treatment; Effects were recorded and analysed at the end of the 3 courses of treatments.2.3 Assessment of therapeutic effect and observed indicators Study used in the clinical evaluation system are:State Administration of Traditional enacted in 1994, "low back pain classification table effect," "simplified Mcqill Pain Questionnaire" and "Oswestry dysfunction index". Close monitoring of adverse reactions before and after treatment.3. Study Results3.1 Comparison of the Clinical curative effects of the two groups There were clinical improvements in both groups after the treatment. The curative rate in Treatment group was 90% while in Control group was 80%, indicating that the therapeutic effects in both groups were good. As for Treatment group,17 cases were cured,10 cases showed improvement, while 3 cases showed no effect, therefore, the curative rate was 90%. As for Control group,12 cases were cured,12 cases showed improvement while 6 cases showed no effect and the curative rate was 80%. The Treatment group had better curative rate than the Control group (P>0.05).3.2 Comparison of the clinical efficacy in low back pain of the two groups Before treatment, the difference between the two groups was not statistical significant as (P>0.05). However, there was a significant change after the treatment as the difference became statistical significant. T-test was undergone before and after the treatment in the groups, the result was (P<0.05), indicating that both groups had achieved good clinical effect after the treatment. The score in the Treatment group was better than that in the Control group and the difference was statistical significant (P<0.05), indicating that the Treatment group was better than the Control group.3.3 Comparison of Pain treatment of the two groups Before treatment, statistical analysis showed that the difference was not statistical significant as (P>0.05), in the indicators such as Pain Rating Index(PRI) in Feel Item Score, Emotion Item Score and Total Score, Visual Analog Rating(VAS) and Present Pain Intensity(PPI). There was a change in the indicators after treatment. The difference became statistically significant in the indicators such as Pain Rating Index(PRI) in Feel Item Score, Emotion Item Score and Total Score, Visual Analog Rating(VAS) and Present Pain Intensity(PPI), they were (P<0.05, P<0.01, P<0.001) respectively. It meant that both groups had good therapeutic effect in improving lumbar intervertebral disc herniation symptoms. They could reduce the low back pain of the patients. Also, the Treatment group had higher score than the Control group in the indicators such as Pain Rating Index(PRI) in Feel Item Score, Emotion Item Score and Total Score, Visual Analog Rating(VAS), which was (P<0.05). The PPI was not significant as (P>0.05). This result showed that the Treatment group is better than the Control group in reducing the low back pain symptoms of the lumbar intervertebral disc herniation patients.3.4 Comparison of Dysfunction effects before and after treatment of the two groupsBefore treatment, the two groups had no significant difference in the Oswestry Dysfunction Index as (P>0.05). There was obvious change after treatment as Oswestry Dysfunction Index was descended. It indicated that these two treatment methods could both improve the low back pain symptoms and the quality of life of the lumbar intervertebral disc herniation patients as (P<0.01 or P<0.05). In comparing the effect in the Treatment group and the Control group, the difference was significant as (P<0.05), indicating that the Treatment group was better than the Control in improving the low back pain symptoms and the quality of life of the lumbar intervertebral disc herniation patients.4 ConclusionsThis clinical study showed that electro acupuncture mainly in Jiaji points and Ashi points were better than other conventional acu points in treating lumbar disc herniation. Using electro acupuncture in Jiaji points and Ashi points were curative in this disease and it was highly recommended in clinical use and further investigations.
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