| Content: This is a report on the use of integrated Chinese medicine and Westernmedicine for the treatment of lumbar intervertebale disc protrusion（LIDP）, includinga historical literature review, laboratory experiment and clinical trial. First of all, itdiscusses the original historical references, etiology, pathology and clinicalpresentation based on the fundamental theory of traditional Chinese medicine（TCM）. It states the LIDP has root of deficiency of the kidney in etiology andpathology, however, invasion of wind, cold, dampness as well as trauma are alsocontributing factors, which are the characteristics of LIDP as far as TCM isconcerned. In light of this pathological condition, four diagnostic syndromes/patternsare usually differentiated according to the clinical manifestations of LIDP, such as’pattern of deficiency of the kidney’, ’pattern of cold in combination with dampness’,’pattern of heat in combination with dampness’ and ’pattern of blood stagnation’.Modern medicine in anatomical structure of intervertebral disc, biomechanics ofintervertebral disc, path-physiology of LIDP, and degeneration effect of intervertebraldisc are also reviewed in this report.Although the pathology of protrusion of nucleuspulposus in intervertebral disc has never been thoroughly understood, it is howeverunderstood that the protrusion of lumbar intervertebral disc as the consequence ofreduction of elasticity of lumbar intervertebral disc plays a key role in developmentof this disorder. Adult intervertebral disc is the largest non-blood vessel structure inhuman body. Inside the adult disc, the distance between some cells and theirnearest vessel can be as long as 6 to 8 mm. These vessels reside in the cartilageendplate of the neighboring vertebra. Besides endplate, outside of the fibre circle there is also a network of blood vessels. The center of endplate is the main path oftransportation of metabolite of the disc. Therefore, from anato-biological point ofview, the intervertebral disc’s nutrition is very fragile. The intervertebral disc iseasily affected by various nutrition factors. Appropriate amount of exercise assistsnutrition, but excess amount of exercises and strain will impact the disc cells’nutrition and metabolization, and thus cause degrading of the intervertebraldisc.Other than that, factors of degrading of the intervertebral disc are also relatedto age, bio-mechanics, changed activity of matrix enzyme, autoimmunity, etc. Whilethe cause of LIDP pain is not clear, many believe it’s related to mechanical pressureand stimulation from chemical inflammation media, some electrical physiologymechanism and autoimmunity may also be involved.Secondly, this article providesa comprehensive report on treatment and progress of LIDP, and comparisonbetween surgery and non-surgery therapeutics is also made. The minimallyinvasive technique （including microscope intervertebral disc nucleus pulposusablation, Percutaneous nucleus pulposus ablation, Percutaneous intervertebral discresection, Percutaneous intervertebral disc laser decompression, spinal endoscopicintervertebral disc surgery, chemical nucleus pulposus dissolution） is reviewed. Thebenefits and disadvantages of different treatments are also discussed. Theimportance of Traditional Chinese Medicine in treating LIDP is further clarified andthe special effect of percutaneous hypothermal plasma radio frequency nucleuspulposus ablation and reformation is confirmed.The application of modern minimallyinvasive technique, via percutaneous hypothermal plasma radio frequency nucleuspulposus ablation and reformation in combination with Chinese herbal medicine forILDP in this project is to attempt to replace the traditionalnon-steroidalanti-inflammatorydrugs （NSAIDs） because of its side effects.In clinicalresearch, the percutaneous hypothermal plasma radio frequency nucleus pulposusablation and reformation combined with Chinese herbal medicine in promotingblood circulation and relaxing tendons was used. The herbal formulation was madeand prepared by our hospital and used in the laboratory experiment and clinical trialin orderto understand the mechanism and observe its clinical efficacy Objective: Based on the principle of integration of TCM and modern medicine,this research project was to observe the efficacy of percutaneous hypothermalplasma radio frequency nucleus pulposus ablation and reformation in combinationwith Chinese herbal medicine in promoting blood circulation and relaxing tendons. Italso aimed to resolve the post-surgery pain due to stimulation of remainingchemical inflammation media. It was anticipated that the effect from the combinedtherapies was similar or even better than NSAIDs.Method: This project was divided into two different phases conducted both in alaboratory or clinic. The laboratory study is an animal study by experimenting ratsused with prepared Chinese herbal formula to observe the anti-inflammatory andanalgesic effects. Rats with pain induced by the hot plate, and ear-engorgementinduced by inflammation were conducted. Control groups using MeloxiamDispersible tablets and Prednisolone were set up for comparisons to further verifythe effectiveness of Chinese herbal medicine with natures in promoting bloodcirculation and relaxing tendons. In addition, the acute toxicity test of which withLD50 was also carried out.In clinical research, 60 patients with LIDP were recruitedand randomized into two groups. One group received the precutaneoushypothermal plasma radio frequency nucleus pulposus ablation and reformation incombination with Chinese herbal medicine; the other group was given percutaneoushypothermal plasma radio frequency nucleus pulposus melt combined withMeloxiam Dispersible tablets as control. The whole clinical intervention ranthrough a period of two months. The outcomes of intensity of pain and relevantsymptoms were measured at two end-points, that is prior and post to the clinicalintervention. The data were recorded on Microsoft Excel sheet, and analyzed by theSPSS9.0 statistics software. The P value less than 0.05 was set up as to show anydifference is statistically significant.Result: The Clinical study shows that percutaneous hypothermal plasma radiofrequency nucleus pulposus melt is one of the effective and safe therapies. This technology in combination with the Chinese herbal medicine with natures inpromoting blood circulation and relaxing tendons as developed by our hospital, hasdemonstrated obvious effect with significant relief for post-surgery pain for somepatients with LIDP. This combined treatment may provide innovative thinking andmethod for clinical practice. The study showed that the Chinese herbal medicinewith natures in promoting blood circulation and relaxing tendons may obviouslyextend the pain threshold when the pain induced in rats by the hot plate. Thisdemonstrates its analgesic effect. The high or media dosage of the herbalmedicine showed visible restraint and anti-inflammatory effect to the rat models ofear engorgement caused by dimethylbenzene. In addition, when dosage of herbsincreased into 900 times of human doses was given to the experimental rats, nodeath casualty occurred. It is therefore reasonable to conclude that the Chineseherbal formula is safe, less toxic, and effective. |
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