Abstract: In this paper, 92 cases suffering from pain in loin and legs were treated with Wen Zhen Jiu(the therapy of needle warming through moxibustion), and the other 91 cases treated with simple acupuncture as a control group. The results show that the clinical curative effect in group of needle warming through moxibustion is much better than that in group of simple acupuncture. It is worthy to be popularized in clinic.

Key words: Lumbocrural pain, Needle warming through moxibustion, Acupuncture

The therapy of needle warming through moxibustion is a combined treatment method of acupuncture and moxibustion. When it is used in clinic, it not only has the function of dredging the channels and regulating yin and yang of simple acupuncture, but has the function of expelling pathogenic cold due to warming, clearing the channels by warming, promoting the flow of qi and blood circulation and relieving swelling and removing mass of moxibustion. Therefore, it can yield a better action on regulating the flow of qi and removing the obstruction of the channels to relieve pain. Since July 1990, we have treated 92 cases with pain in loin and legs with the therapy if needle warming through moxibustion, and the other 91cases with treatment t of simple acupuncture as a control group. The curative effect was satisfactory. Here is the report.

Clinical data:
In this paper, 183 cases were all from our Out-patient and In-patient Department of Acupuncture and Moxibustion. Among them, male were 98 cases, and females 85 cases; their age ranged from 17 to 72 with an average of 40. 5. The kinds of diseases included acute lumbar sprain, lumbar muscle strain, prolapse of lumbar intervertebral disc and vertebral canal stenosis (see Table 1).All patients Were enrolled according to the Standards in Criteria of Clinical Diagnosis and Curative Effect of Diseases edited by Liu Xinyao.

Table 1. Kinds of Diseases and Duration of Illness

__________________________________________________________

Diseases                                  Cases            shortest          longest                                      
_____________________________________________________________

Acute lumbar sprain              30                     lh                    4 days

Lumbar muscle strain          98                     3 months       11 years

Prolapse of lumbar

intervertebral disc                   43                    4 months         2 years

Vertebral canal stenosis       12                    1 year               6 years
___________________________________________________________

Ttreatment methods:
The patients were randomly divided into two groups, i. e. acupuncture group (group A) and needle warming through moxibustion group (group AM). The same acupoints were selected for two groups of patients.

For acute lumbar sprain: Shenshu(BL 23), Weizhong(BL 54) and Ashixue were selected. For lumbar muscle strain: Shenshu (BL 23), Dachangshu (BL 25 ) and Ashixue were used. For prolapse of lumbar intervertebral disc: Jiaji (EX-B 2), Dachangshu (BL 25), Ciliao(BL 32), Huantiao(GB 30), Yanglingquan(GB 34 ) and Xuanzhong(GB 39) were selected. For vertebral canal stenosis: Jiaji(EX-B 2), Shenshu (BL 23 ), Dachangshu (BL 25 ) and Weizhong(BL 54) were selected.
Four to six points were chosen in accordance with symptoms and signs for treatment of group AM. 1. 5 cun stainless steel filiform needle were used, after insertion and needling sensation(de qi ), a piece of moxa-stick about 2 cm long was lighted at its one end and mounted on the each needle handle(the lighted end was faced to the acupoint), when it was burnt out, the another one was blunted on after cleaning-out ash, two pieces were burnt for each acupoint. The same filiform needles mentioned above were used for treatment of group A. The needles were retained for 20 -- 30 min after needling sensation, during this period the needle was manipulated once every other 5 min with corresponding reinforcing and reducing method, or an electric. Current was applied to the needle with continuous waves.The treatment is given once a day, a therapeutic course is composed of 5 times with an interval of 2 days between courses. If the curative effect is not good after 2 courses of treatment in group A, the treatment may be changed to use the method of needle warming through moxibustion after asking for patients' agreement.

Points for attention:
During the treatment with needle warming through moxibustion, care must be taken to keep patients warm; closely observe the patients' condition; don' t drop mugwort floss to burn the patients' skin or clothes; encountering the patients who are fainting or uncomfortable, the needles should be withdrawn immediately, and it is necessary that the symptomatic treatment is given at the same time. The local skin appears reddish and causterized heat sensation after moxibustion, which is a normal phenomenon, and needs not to be treated.

Criteria of curative effect:
Cure: The symptoms and signs of lumbocrural pain disappear, and functions are recovered.

Improvement: The symptoms and signs are alleviated, and functions are improved.

Ineffectiveness: The symptoms and signs do not improve any.

Results:
The results of the treatment and the comparison of curative effects between group AM and group A are listed in Table 2 and 3.

Table 2. Results of Treatment of Group AM and group A

_____________________________________________________________________

Diseases                   Group          Cases   cured          improved    ineffective
_________________________________________________ ____________________

 Acute lumbar              AM             15           14                1                    0 

 sprain                           A                15          13                 2                   0 

 Lumbar muscle         AM              49           39               10                 0

 strain                            A                49           27               17                 5

 Prolapse of 

 lumbar inter-             AM               22          10                 10               2

 vertebral disc            A                  21           6                   9                 6

 Vertebral

 canal stenosis         AM                 6             2                    2               2

                                      A                   6             1                     1               4
______________________________________________________________________ 

Table 3. Comparison of Curative Effects between two Groups

______________________________________________________________________

                                         Cured           Improved        Ineffective    Total effective rate
                                         ___________________________________________________
                                         cases(%)      cases(% )       cases(% )           cases(%)       
______________________________________________________________________

Group AM(92 cases)    65(70.65)      23(25.00)         4(4. 35)              88(95.65) 

Group A(91 cases)      47(51 .65)      29(31 .87)       15(16.48)            76(83.52)
_______________________________________________________________________

The above results are analysed statistically, there are significant differences in both total effective rates and cure rates between two groups.

A typical case:
Mrs Song, 34 years old, a driver. She came here for medical advice in October 1993. She complained of spraining her lumbar region due to moving a heavy thing. After applying medicated wine of traumatic injury and sticking up' 701' ointment of traumatic analgesia on the affected area, pain was alleviated, but could not return to normal completely. From then on, she felt pain seriously, even it was difficult to bend her waist, and the pain could refer to the posterior side of lower extremities. She had been treated in many hospitals, but the symptoms were sometimes alleviated and sometimes aggravated. Two days ago, after driving for a long time, she felt serious pain in the waist and leg, bent her waist hardly and could not bear it. Then she visited this Department of Acupuncture. Examination showed that it was difficult to bend and rotated her waist, straight leg raising tests on the both sides were(+ ),' 4-word' signs on the both sides (- ), tenderness at both Yaoyan points was evident, and showed pale dark tongue with thin and whitish fur, deep and thready pulse. It was diagnosed as lumbar muscle strain. Then she was treated with the method of needle warming through moxibustion, selecting bilateral Yaoyan, Shenshu and Dachangshu. After one treatment, she felt pain more alleviated, then the treatment was continued. After 2 courses of treatment, all symptoms and signs disappeared, the functions of her waist and legs returned to normal and not recurred following up for one year.

Discussion:
Lumbocrural pain is a frequent encountered disease in clinic. In this paper, the cases included 4 kinds of diseases, i. e. acute lumbar strain, lumbar muscle strain, prolapse of lumbar intervertebral disc and vertebral canal stenosis. Although the causes of disease and pathogenesis of them have nothing in common with each other their main manifestations in clinic are lumbocrural pain and dysfunctions. It is considered in traditional Chinese medicine that the general pathogenesis of the kind of diseases is the stagnation and obstruction of channels induced by various kinds of pathogenic causes, so called" where there is obstruction, there will be pain". The concrete causes of diseases just include traumatic injury, stagnation of qi and blood stasis, stagnation and blockage of channels, qi and blood flowing not smooth; or affection by dampness and heat evils which flow into channels; or deficiencies of the liver and kidney due to protracted disease, leading to loss of nourishing of muscle and bone, and spasm of muscle. Therefore, the treatment of lumbocrural pain must be to eliminate various causes of diseases, dredge the stagnant and obstructive channels, regulate yin and yang, thus arriving at relief of pain, namely where there is no obstruction, there will be no pain. The clinic observation shows that it could effectively relieve the pathogenic causes of lumbocrural pain either treatment with acupuncture only or with the method of needle warming through moxibustion, resulting in alleviating or resolving lumbocrural pain; and that because the method of needle warming through moxibustion is based on the functions of regulating qi of channels, clearing and activating the channels and collaterals of acupuncture therapy to be added of moxibustion which has its unique actions of promoting the flow of qi by warming the channels, activating the flow of qi and blood circulation, expelling dampness and clearing away cold, promoting the subsidence of swelling and resolving masses, and preventing diseases and health care, it can act upon the pathogenic causes of lumbocrural pain, so it is more suitable for treatment of obstinate lumbocrural pain. The results of observation in this paper show that both the cure rate and the total effective rate in group AM are much better than those in group A. The method is simple and easy, it is worthy to be popularized in clinic.

By Chen Xinghua