| Background:Lumbago is a symptom caused by external factors,internal injury,or spraining,resulting in obstruction of qi and blood in the waist or the malnourishment thereof,which in turn causes pain along or around the lumbar vertebrae.It is one of the most common diseases in acupuncture and moxibustion.The incidence of lumbago is high;according to medical journals at home and abroad,80%of the world's population has suffered from lumbago.In western medicine,lumbago can be further divided according to imaging studies,such as lumbar vertebra hyperosteogeny,lumbar disc herniation,lumbar muscle strain,and ankylosing spondylitis.The focus of this paper is aimed at lumbago of chronic lumbar muscle strain.According to Traditional Chinese Medicine(TCM),the waist is the house of the kidneys,while the kidneys control bones and generate marrow;chronic lumbago is thus primarily caused by innate inadequacy,exacerbated by excess strain,prolonged illness,old age,or excessive copulation,resulting in kidney essence deficiency,malnourishment of the lower back and ultimately pain.In Standards of Diagnosis and Treatment:Lumbago,it is written that "If there is wind,dampness,cold,heat,sprain,blood stasis,qi stagnation,or phlegm coagulation,all of these are outward symptoms;kidney deficiency is the source." In Jingyue's Complete Works,it is recorded that "lumbago,drawn-out and worrisome,recurrent and unabating,is of kidney deficiency," which means that chronic,recurring lumbago is caused by kidney deficiency because the waist houses the kidneys.In Basic Questions:Essentials of Pulse Diagnosis it is written,"The waist,mansion of the kidneys;unable to turn[the waist],then the kidneys are fatigued;",in Jade Dragon Songs,it is written,"kidney weakness and back pain is not to be," both of which emphasize that kidney deficiency is the primary cause of lumbago.In regards to TCM treatment,most patients with lumbago choose acupuncture,massage,hyperthermia and other non-surgical treatment methods first;among these options,acupuncture yields notable therapeutic results.Acupoint catgut embedding therapy is a special method of acupuncture;by embedding the line into the body at the acupoint,there is a long-term stimulating effect over normal acupuncture,thus being more time and cost effective.Objective:In this randomized controlled clinical study,the effects of using catgut embedment in Shiqizhui(EX-B8)acupoint for treating kidney-deficiency-type lower back pain was observed.Analgesic effect and function improvement were graded via symptom scoring,sign scoring,numerical rating scale(NRS)score,and Oswestry disabilty index(ODI)dysfunction index.The goal was to provide a new treatment approach for kidney-deficiency-type lower back pain.Method:50 patients were selected from the department of rehabilitation in Beijing University of Chinese Medicine Third Affiliated Hospital between September 2017 to February 2018.They were randomly divided into two groups of 25 patients:the treatment group(catgut embedment in Shiqizhui acupoint)and control group(common acupuncture group).The diagnostic criteria was based on the Standard of Diagnosis of TCM Syndromes and the Criteria for the Diagnosis and Treatment of Lumbago and Leg Pain published by the State Administration of Traditional Chinese Medicine.The clinical effects of treatment were observed and recorded via symptom scoring,sign scoring,NRS score,and ODI dysfunction index.Scores between the two groups were compared before treatment,30 days after treatment,and 60 days after treatment;in addition,a safety analysis was performed.Operation of catgut embedding:Using aseptic techniques,a 1-1.5cm long collagen thread and disposable needle were prepared.The Shiqizhui acupoint was selected,2.5%iodine was used to disinfect the skin,then 75%alcohol was used for deiodination.Doctors washed their hands,disinfected,then used sterilized tweezers to put the 1-1.5cm collagen line into a no.8 injection needle(the line must not exceed the needle).The needle was held in the right hand,the left hand was used for the hand-pressing technique(pressed on the acupoint region),and the needle was then swiftly injected 1.5-2.0cm into the skin at a 90 degree angle perpendicular to the surface of the skin.While the left hand pushed the needle core in,the right hand withdrew the needle,thus resulting in the thread being buried within the subcutaneous tissue or muscle layer of the acupoint(the thread must not be exposed).Afterwards,the injection point was pressed with dry cotton swabs,sterilized,dressed,and then applied with adhesive cloth for 4 hours.The catgut embedding operation was performed once every 10 days for a total of 7 times over 60 days.Operation of normal needling:The skin was routinely sterilized,and then 0.3 x 40mm needles were used to perform acupuncture on Shiqizhui and both Dachangshu acupoints.Needle piercing depth was 1-1.5 inch straight,technique used was uniform reinforcing-reducing manipulation,and the needle was left in the acupoint for 30min after qi-obtaining sensation.Acupuncture was performed once every 10 days for a total of 7 times over 60 days.Results:In the two groups,48 cases were completed altogether,with 24 cases each in the acupoint catgut embedding Shiqizhui group and common acupuncture group having been completed according to research requirements.Complete case reports were written and no adverse reactions were reported.The sex,age,course of disease,symptom scores,sign scores,NRS score,and ODI score of the two groups before treatment were not statistically significantly different;therefore,their treatment results were comparable.1.Intra-group comparisons:Symptom,sign,NRS,and ODI scores were significantly different before and after treatment for both groups at the 30-day and 60-day intervals(p<0.01).2.Inter group comparisons:2.1 Comparison between the treatment and control groups at the 30-day interval:on day 30 of treatment,there was no statistically significant difference between groups for symptom,sign,NRS,and ODI scores and score differences.Treatment effect at this point was equal.2.2 Comparison between the treatment and control groups at the 60-day interval:2.2.1 Symptom score difference for the Shiqizhui acupoint catgut embedding group was significantly greater than the normal acupuncture group at day 60(t=4.649,p=0.001<0.01);symptom score for the Shiqizhui acupoint catgut embedding group was significantly lower than the normal acupuncture group at day 60(t=3.401,p=0.007<0.01);these results indicate that Shiqizhui acupoint catgut embedding is more effective than normal acupuncture in relieving symptoms for kidney deficiency lumbago patients.2.2.2 Sign score differences before treatment and 60 days after were significantly higher in the Shiqizhui acupoint catgut embedding group compared to the normal acupuncture group(t=3.709,p=0.039<0.05).This indicates that Shiqizhui acupoint catgut embedding is more effective than normal acupuncture in reducing physical signs of kidney deficiency lumbago.While sign scores at day 60 were lower in the Shiqizhui acupoint catgut embedding group,the result was not statistically significant(t=2.647,p=0.083>0.05).2.2.3 NRS score differences before treatment and 60 days after were significantly higher in the Shiqizhui acupoint catgut embedding group compared to the normal acupuncture group(t=2.715,p=0.019<0.05);NRS score for the Shiqizhui acupoint catgut embedding group was significantly lower than the normal acupuncture group at day 60(t=2.172,p=0.043<0.05).These results indicate that catgut embedding of Shiqizhui acupoint is superior to normal acupuncture for pain relief.2.2.4 ODI score differences before treatment and 60 days after were significantly higher in the Shiqizhui acupoint catgut embedding group compared to the normal acupuncture group(t=2.097,p=0.047<0.05);ODI score for the Shiqizhui acupoint catgut embedding group was significantly lower than the normal acupuncture group at day 60 t=2.097,p=0.033<0.05).These results indicate that catgut embedding of Shiqizhui acupoint is more effective than normal acupuncture in restoring functional mobility for kidney deficiency lumbago patients.3.Safety evaluation:Among the two groups,48 patients completed the entire clinical treatment process.Basic vital signs were stable throughout.There were no incidents of fainting during acupuncture treatment,broken needles,bleeding,infection,or other adverse reactions;safety was good.Conclusion:1.Shiqizhui acupoint catgut embedding and common acupuncture were all effective in treating kidney deficiency lumbago.At the 30-day interval,there was no statistically significant difference between the two groups for symptom,sign,NRS,and ODI scores and differences,indicating that treatment effect after 30 days is similar.However,at day 60,the scores and differences for the treatment group were markedly improved over the control group,meaning that as treatment progressed,the treatment group showed significantly better therapeutic results as specified above.2.Acupoint catgut embedding Shiqizhui is an effective means of treating lumbago caused by kidney deficiency. |
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