Bone bi of the lumbar vertebrae is a common and frequently encountered disease in the middle aged and old people. The author of the article treated 60 cases o f bone bi of the lumbar vertebrae complicated with lumbocrural pain with the “long-round" needle which was made according to the description of long-needle ( chang zhen) in Miraculous Pivot (Ling Shu) and the gold needle unearthed from an  ancient tomb of the Western Han dynasty in Mancheng Hebei Province. The therapeutic effect was satisfactory. Details are as follows:   

General Data 
Among 60 cases, 21 were male and 39 female. The youngest was 28 years and the oldest 75 years and the average age of the patients was 56.65 years. There were 40 patients above 50 years. Of the 60 patients, the shortest duration of lumbago was 1 year and the longest 40 years averaging 9.33 years and 22 cases suffered from it for more than 10 years and 13 cases more than  5 years.    

Methods
1. Type of Needle 
The long-round needle was made of stainless steel. Its body was 50 mm in length and 1 mm in diameter wiath a slanting edged tip. Its handle was 50 mm in length and 5 mm in diameter. 

2. Muscular Nodular Spots 
According to the characteristics of distribution of the skeletal muscles and  tendons (jing jin) and their running course from the end of the four limbs towards the heart and their meeting places of joints, neck, loin, etc., the injured muscular nodular spots (i.e. focal points), which were named according to the names of nearby acupoints plus the word “ci", were detected and 1-5 spots were treated each time. In order to reduce possible pain during insertion and manipulation, 0.2 ml of 0.5% Lidocaine was injected at the needle inserting spot and 1 -2 ml at the muscular nodular spot area after routine sterilization over the skin , the doctor inserted the longround needle quickly into the skin and then applied the left right wards scraping-seperating techniques of “Joint Puncturing"(guan ci) at the adhesion part of the muscular nodular spot and the superficial layer of fascia, and/or applied “Relaxing Puncturing"hui ci) by seperating the peripheral adhesion around tendons in which the needle was inserted respectively at each side of the muscular nodular spot deeply to its bottom and then lifted upwards. For periosteal reaction below the coagulated muscle spot, the doctor applied the techniques of “Short Thrust Puncturing"  (duan ci) by inserting  the needle deeply to the periost and rubbing the bone like cutting to decompress periost. The needle was removed after the manipulation and the hole was closed  by pressing it to prevent bleeding. In order to reduce possible bleeding further, 2-3 ml of water for injection (therapeutic medicine may be added) was injected into the manipulated area on each spot at the original inserting hole so as to  make a local pressor. Antiseptic gauze was applied over the needling hole and kept for 2 days.   

Observation Of Therapeutic Effect 
1. Criteria of Therapeutic Effect 
Cured: Disappearance of lumbar swelling lumbago and leg's pain, free lumbar movement.  
Effectiveness: Disappearance of lumbar swelling, obvious alleviation of pain or reoccurrence of mild pain due to overworking after disappearance of pain.  
Failure: No improvement of lumbar swelling and lumbar pain. 

2. Therapeutic Results 
Treatment was given once a week and the patients were treated 1-5 times (averaging 2.33 times). Each patient had 1-20 coagulated muscle spots (averaging 7.60 spots) treated. Among 60 cases, 46 cases (76.67%) were cured; 12 cases (20.00%) were effective and 2 cases (3.33%) were treated without effect. Of the 46 cured cases, three month follow up survey was done in 8 cases, and among them, 6 cases  were perfectly well, 1 kept improving and 1 had a reoccurrence. Six month follow up survey was done in 22 cases, and among them, 17 were perfectly well, 5 kept improving and there was no reoccurrence. One year follow up survey was done i n 6 cases and all of them were perfectly well. Over one year follow up survey was done in 11 patients and among them, 8 were perfectly well, 2 kept improving and had a reoccurrence.   

Typical Cases 
 Case 1. Mr. Lu, aged 43 years, an engineer first visited on the 11th of August, 1998.  Chief complaint: Right side lumbago accompanied with s severe pain in right hip, leg, lateral ankle joint and dorsum of foot. He had been unable to sleep for half a year because of pain and had  a history of lumbocrural pain for 15 years at  that time. A diagnosis of prolapse of lumbar intervertebral discs of L4-5 and L 5-S1 and hyperosteogeny of L3-5 were made according to X-ray test and clinical  examination in another hospital and an operation was suggested. The patient was transferred to our clinic for treatment because of his rejection to operation. 

Clinical examination: Many tender spots along the Foot Taiyang and Foot Shaoyang muscle Tendon Regions (jing jin) and painful cord like coagulated muscle spots  were palpable. 

Treatment: Several treatments were given with long-round needle therapy. 

First treatment on the 11th of August: Spinous processes of L4 and L5, later all Yaoyi ( a standard Extra point located 3 cun lateral to the lower border of t he spinous process of the 4th lumbar vertebra) and lateral Zhongkong (not a standard Extra point located at the mid-point of the line connecting the great trochanter and iliac crest) were selected. Long round needle techniques of “Joint  Puncturing" (guan ci) and  “Relaxing Puncturing"(hui ci) were adopted. 

Second treatment on the 18th of August: Lumbago was alleviated. Points of lateral Shenshu (BL 23), lateral Baihuanshu (BL 30) and Lateral Dachangshu (BL 25) were selected. Long-round needle techniques of “Joint Puncturing" (guan ci) and  “Relaxing Puncturing" (hui ci) were applied. 

Third treatment on the 24th of August: Remarkable remission of lumbar pain was achieved but the patient still felt his lateral side of the leg painful. Points o f lateral Zusanli(ST 36), lateral Lingxia (not a standard Extra point located on  the lateral aspect of the leg, inferior to the lower border of the head of the  fibula) and lateral Zhongfeng (LR 4) were selected. Long-round needle technique s of “Joint Puncturing" (guan ci) and “Relaxing Puncturing" (hui ci) were used . 

Fourth treatment on the 26th of August: Almost no lumbago and no pain occurred at rest after the treatment. But he still felt his leg and ankle painful after 8 minutes walking. Points of lateral Fenglong (ST 40) and lateral Feiyang (BL 58) were selected. Long-round needle techniques of “Joint Puncturing (guan ci) and Relaxing Puncturing (hui ci) were adopted. 

Fifth treatment on the 1st of September: No lumbago and no pain on the lateral aspect of the leg at rest were found but there were sore and distending sensation  upon fatigue. Regular acupuncture was adopted and the points of Zusanli (ST 36) , Fenglong (ST 40), Shangjuxu (ST 37) and Guangming (GB 37) were punctured with  filiform needles with reducing techniques. 

Sixth treatment on the 8th of September: Slight sore sensation in the leg and ankle still existed. Lateral Feiyang (BL 58) selected. Long-round needle techniques of “Relaxing Puncture" (hui ci) manipulated. 

First follow-up survey on 29th of April, 1999 (6 months after the last treatment): Pain completely disappeared within the week after long-needle treatment last  year. The patient resumed normal work. 

Second follow-up survey on the 3rd of December (18 months after the last treatment): No reoccurrence was found after the last treatment last year and the patient was able to do heavy physical labor normally.   

Discussion 
The function of the Muscle-Tendon (jing jin) to “Control the bones and promote  movements of the joints" is the ancient Chinese doctor's summary of regularity  of human myology, syndesmology and their accessory tissues. The initial and ending points of muscles and ligaments and their accessory tissues are the force loading spots in movement as well as the injury spots of unphysiologic activities.  Repeated injury and repair may bring about oppression upon “transvers collateral" (heng luo) of meridian which blocks and presses the meridians to produce blockage of qi and blood and “gathered froth" (ju mo) due to accumulated body fluid. The resultant infiltration of algogenic biochemical substances and pressure on pain sensitive tissues lead to “painful bi". 

Mechanical oppression upon “transvers collateral" (heng luo) often causes intractable long standing “bi syndrome" with deeply-located pathogenic factors. The key treatment to get rid of this kind of intractable “bi syndrome" is to seperate the “transvers collateral" (heng luo), that is to apply the “removing node  (jie jie)" techniques of “Joint Puncturing" (guan ci) and “Relaxing Puncturing" (hui ci) or “Short Thrust Puncturing" (duan ci) at the muscular nodular spots with long-round needles. 

The three Foot Yin and three Foot Yang Muscle Regions (jing jin) form six groups of muscle- ligment systems in the front, back, medial and lateral aspects of the lower limbs and ascend from  the terminal of the lower limbs to their connected lumbar-sacral vertebrae, so that there appear six kinds of Muscle Region (jing jin) injury band in the lumbar, hip and lower limbs. Among 60 cases treated, t he Foot Shaoyang Muscle Region (zu shao yang jing jin) was involved in 45 cases, the Foot Taiyang Muscle Region (zu tai yang jing jin) in 43 cases, the Foot Tai yin Muscle Region (zu tai yin jing jin) in 9 cases, the Foot Shaoyin Muscle Region (zu shao yin jing jin) in 4 cases, the Foot Jueyin Muscle Region (zu jue yin  jing jin) in 3 cases and Foot Yangming Muscle Region (zu yang ming jing jin) in  3 cases respectively. Thorough removal of the dominant or latent muscular nodular spots according to an overall differentiation based on the running course of t he Muscle Regions (jing jin) provides the treatment with an ideal therapeutic effect. 

More cases of hypertrophic change of the lumbar vertibrae (spur) were seen in X-ray examination of the lumbar vertibrae in patients with intractable lumbocrural pain and the formation of spur is more related with the above mentioned repeated injury and calcification of the Muscle Region (jing jin). That is why when there appeat spurs, the key point of diagnosing and treating intractable lumbocrural pain is to find out if the muscular nodular spots at the spur area and in  the related Muscle Region (jing jin) are injured or not.

By Xue Ligong, Zhang Hairong, etc.