Clinical Observation Of Acupuncture-Moxibustion On Sciatica

I. Literature reviewSciatic nerve pain (SNP), also called Sciatica, is not a disease but a complex symptom. Sciatica is defined as pain in the passage and distribution region of the sciatic nerve caused by the nerve compression and stimuli that is produced by many different diseases. Traditional Chinese Medicine(TCM) terminology described Sciatica as a kind of "Numbness syndrome" , " thigh and leg pains" , " Spinal Cord Pain" , " lower back pain" or " numbness on one side" . Based on TCM theory, the differential diagnosis of Sciatica can be divided into 4 categories: Syndrome of wind-cold-damp, Syndrome of qi stagnation and blood stasis, Syndrome of heat dampness, and Syndrome of Liver Kidney Deficiency.Congenital Sciatica usually contribute to infection, secondary Sciatica are divided into two categories-- root Sciatica and stem Sciatica. Root Sciatica mostly caused by lumber intervertebral disc herniation, other factors including: compressive spine fracture, sacrum arachnoids, Lumbar spinal stenosis, spondylitis, and Spinal ligament disorder. Stem Sciatica is usually caused by Piriformis syndrome, osteoarthritis, rheumatoid arthritis, uterus fibromyalgia, and Tumors. Sciatica may result from one of three physiologic abnormalities: mechanical deformation of the nerve, inflammation of nerve joints or intervertebral discs, or immunologic factors. Several researches found that substances like serotonin, potassium, histamine and prostaglandin E1/E2 play a vital role in Sciatica.Around 80% to 90% of Sciatica patients can be cured with nonoperative procedure. The non-operative treatments recommend by TCM are:medications, acupuncture, massage, cupping, blood letting, and skin scrapping. For modern medical treatment, it is recommended to use: medications, physical therapy, spine traction, and nerve root block. A very small percentage of cases - when pain is caused by a tumor, an infection, and non-operative treatment unable to release the pain - it is necessary to use surgery to ease the pain and prevent further problems. Chinese medicine believes acupuncture keeps the human bodies normal flow of energy unblocked, which is why acupuncture and moxibustion have been used on Sciatica treatment for centuries. Modern medicine acknowledges the mechanism of acupuncture treatment on nerves including: improve circulation, demolish inflammation, change the sense transfer path, release painkilling molecules, and change spine biomechanics. Many research reports on the reaction of acupuncture treatment are focused on areas like: change of pain endurance, change of biochemical substances (5 —- HT, ACH, 3—EP), and nerve function recovery by electro-stimuli. The physiological effects of Moxibustion therapy are include: demolish inflammation, improve blood circulation, reduce tissue swell, relieve nerve endings pressure by absorbing exudates, dilatation of blood vessels, soothe inner tissue bleeding, etc., all of these effects possess important influence on Sciatica treatment. II. Clinical research:Objective: To study the clinical treatment effect and mechanisms of acupuncture and moxibustion on Sciatica, In the mean time observe the relations between the treatment effect based on sex, vocation, age, duration of illness, combined disease and differential diagnosis.Methods: The patients are randomly divided into treatment groups and control groups, both groups use acupuncture as main therapy. The treatment group adds moxibustion as supplement therapy. Applied acupoint are based on the TCM text book— "Science of Acupuncture and Moxibustion" , we reference to the pain position choose acupoints around CTOvernor channel, Shaoyang Gallbladder channel of foot and Taiyang Bladder channel of foot as dominate treatment points, and reference to differential diagnosis, choose relative supplementary treat point. The treatment effects are evaluated by State Administration of Traditional Chinese Medicine published "Standard of Diagnosis and Treatment Effect of TraditionalChinese Medicine" , McGill pain questionnaire and the 6-point Behavioral Rating Scale (BRS-6).Results: The total effective rate in the treatment group is superior to the control group, the data verified by chi-square test present a statistically significant relationship between the variables(P <0.05). The difference of pain score derived from McGill pain questionnaire and the 6-point Behavioral Rating Scale (BRS-6) before and after treatment verified by Student' s t-test present a statistically significant relationship between the variables(P <0.001). On the observation of patient background, the effect has no relation with the sex, vocation, age, duration of illness and different diagnosis, but has a relation with combined disease, it means combined disease like heart disorder, and diabetes, rheumatic aches and hypertension seriously interfere with Sciatica therapy.Conclusion: Heat intensify the effect of acupuncture therapy, it leads to the conclusion that acupuncture and moxibustion together form a valuable medical treat method.