Optimization And Clinical Observation Of Acupoint Selection Based On Lumbar Spine Stability Theory With Warm Needling Moxibustion For Treatment Of Low Back Pain

Purpose: through dissecting the lumbar stable muscle and lumbar ridge point(L1-L5),shenshu point,the tissue structure of the deep and shallow layers of Dachang Yu Pointin cadaveric specimens bylocal anatomy method of lumbosacral portion,to analyze the anatomic level of acupoints and the anatomic coincidence degree of lumbar stable muscle,then adjust the acupuncture point position,needling angle and depth slightly in order to optimize the acupuncture treatment for lower lumbar pain acupoint group;through a randomized controlled clinical trial,to observe and verify the short-term curative effect of the optimized acupoint group prescription combined with warm acupuncture in the treatment of lower lumbar pain and the long-term effect after 1 month follow up.Method: To stain the point path and dissecte by the method of local layer anatomy,To observe and measurethe anatomical level of the depth and angle of acupuncture point,and analyze the anatomic coincidence between the traditional acupoints and the lumbar stable muscle,then slightly adjust the position of acupuncture point,the angle and depth of acupuncture,and formulate the optimized acupoint group prescription forlower lumbar pain.By means of a randomized controlled trial,the patients with lower lumbar pain who met the inclusion criteria were randomly divided into two groups,the traditional acupoint warming acupuncture group,fine-tuned acupoint warming acupuncture group.The traditional acupoint warming acupuncture group was treated with Yaojiaji point,Shenshu point,Dachangshu point,Ashi point,Weizhong point and ranbian point,in which pain side waist Jiaji point,large intestine Shu point and bilateral Shenshu point were used in combination with moxibustion.Thefine-tuned acupoint warming acupuncturegroup were treated with the points of waist Jiaji,Shenshu and Dachang Yu,and the remaining points were the same as those of the traditional acupoint warming acupuncture group and the lumbar Jiaji point,the pain side large Changshu point and the bilateral kidney Yu plus moxibustion were used in the pain segment.The two groups were treated for 4 weeks,once every other day,3 times a week,and followed up for 1 month after the completion of treatment,And do the scale scores separatelybefore treatment,2 weeks after treatment,at the end of treatment and at follow-up.At last,according to the evaluation criteria of therapeutic effect,the short-term curative effect and the long-term effect at follow-up were evaluated,and the curative effect analysis,compliance and safety evaluation were also carried out at the same time.Results1.For the lumbar ridge point,the tip of the needle reaches the middle of the lower vertebrae lamina,and the posterior medial branch of the spinal nerve and its accompanying vessels can be reached through the vertical spinous muscle near the lamina periosteum,and the tip of the needle can prick the lamina,and where is the starting point of the polyfissure muscle.Therefore,if you want to prick the polyfissure muscle,the depth of the needle should be deeper than that of the needle "Acupuncture and moxibustion" 0.3-0.5 Cun,that is 1-2Cun(24.10~43.94mm),it is appropriate to prick the tip of the needle directly to the lamina.2.When the points of Shenshu and Dachang Yu are directly pricked,the tip of the needle reaches the depth of about 1 Cun(25mm)between the longest muscle and the iliac rib muscle,but this depth can not stimulate the starting and ending point of polyfissure muscle and muscle abdomen.Therefore,on the premise of supposing that acupuncture of lumbar stable muscle has better clinical effect than that of conventional acupuncture to change the needling angle,depth or position of acupuncture at Shenshu point and Dachang Yu point,so as to reach the slight adjustment effect.(1)The needle into the position of the original acupoints,change the needle angle to the direction of the spine obliquely about 65.8 degrees-71.7 degrees and the depth of the needle should be about 1.5 Cun(34.60 – 36.20mm)above;(2)Change the position of the needle,that is,the posterior median line spinous process about 2.5 cm,and the direct depth of about 3.3 cm above,at this time under the needle may have a sense of resistance,that is,near the mastoid process.3.It has been completed a total of 90 cases of treatment observation in those two groups,including the treatment group of 45 cases,the control group of 45 cases,all have completed the treatment and follow-upas required,and complete the case report form,there was no adverse events during the whole process of the study.(1)The JOA score,ODI score and VAS score of the two groups after treatment were significantly improved compared with before treatment(P< 0.05),the difference was statistically significant,indicating that the two groups of treatment methods have better clinical efficacy.(2)The difference of JOA scores,ODI score and VAS score between the two groups was statistically significant,which was better in the slight adjustment acupoint warming acupuncture group than that in the the traditional acupoint warming acupuncture group.(3)The difference of average curative effect at each time point was statistically significant,which was better in the slight adjustment acupoint warming acupuncture group than that in the the traditional acupoint warming acupuncture group.Conclusion: the traditional acupoint warming acupuncture group and slight adjustment acupoint warming acupuncture group both have better curative effect onthe improvement of symptoms and signs of lower lumbar pain in 2 weeks,4 weeks and 1 month follow-up;compared with the traditional acupoint warming acupuncture group,the treatment of fine-tuned acupoint warming acupuncture group for 2 weeks,4 weeks and 1 month follow-up,the short-term and long-term treatment effect is much better.