Volume 13, Number 3 | Fall 2018

Clinical Report (Acupuncture)
Acute Low Back Pain Following a Holiday
Tsuyoshi HashimotoAssociation
Iwanami Acupuncture and Moxibustion Clinic
Tokyo Medical Welfare Vocational School
Departement of Education for Acupuncture,
Moxibustion and Massage Instructors

fatigue and stiffness of neck and shoulders due todesk work and used to come for treatment once every
two months complaining of low back pain.
Past history
Acute low back pain [an MRI taken about 15 years
ago showed a herniated disk at L4-5]
Life history: no drinking and smoking, little exercise
Current condition: height 180 cm, weight 90 kg,Introduction

blood pressure 156/90 mmHg, pulse rate 92/min

I have learned the acupuncture and moxibustion

Examination findings:

skills from late Mr. Meiyu Okada and Mr. Akizo

The SLR could not be performed because the patient

Okada. These masters used pulse diagnosis andwas too afraid. Chilling of the lower legs and feet +,pattern based treatment, treating the entire bodywithout

using channel therapy. Also, at the pedagogic

numbness of the lower legs (-) and no obvious

institution where I am employed, I strive to clarify

differences in the circumference of the lower legs.

the foundations of channel therapy through lectures

NRS (Numerical Rating Scale): 9and research and I am trying to apply these during

Inspection

my ordinary clinical practice. Low back pain is a

Little facial expression with a dark complexion

symptom of one region of the body, but its treatment(examination of the skin of the medial forearm

essentially requires the comprehension of findings

revealed dark skin and the patient had in general afrom the entire body in order to determine how tonaturally dark skin) and a tendency toward dry skin.

proceed with the treatment. Using this case report I

The patient was large body build and a great

present here the use of channels in diagnostics andabdominal circumference. He walked cautiously

treatment.

bend forward while holding his hand to his back. The

differences

betweenleft

andright,

soles of his feet showed erythematous patches but
Day of treatment: Year XX, May X

the plantar arch area was white.

Patient: male, 44 years

Audio-olfactory examination

Chief complaint: low back pain, left gluteal painHe was almost reticent and when he answered, hisPresent illness

voice was quiet, without force and slightly high-On the 6th of X (during the May holidays) the patient

pitched.

started experiencing low back discomfort and on theInquiry

fourth of X severe pain developed when he went toRecently he tended to be unusually thirsty andwork. He could not think, however, of any triggering

drank much water, micturition frequency slightly

event. In the morning on the third of X he could notincreased (10 times/day), bowel movements (once per

get out of bed and called the company reporting heday) of slightly soft consistency without abdominal

will take a day off. Even during bed rest he sufferedpain. Reportedly a high stress level at the workplace.

from pain radiating from the lumbar region down

Channel palpation

into the left gluteal region and then visited our clinic

The body in general was tense and hard. Due to highbecause these symptoms interfered with his daily

tension spontaneous sweating was observed on thelife.

face, back, lower legs, palms, and soles of the feet.

Two years earlier he had visited our clinic because of

Chilling of the abdomen and lower legs, while chest

chronic low back pain. Later complained about

and head felt feverish, indicating a marked

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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 13, Number 3 | Fall 2018

differences in hot and cold feelings between thewith abundant heat in the chest, while the pulse

upper and lower parts of the body.

characteristics indicated insufficient dispersion ofHands

heart heat.

Taiyin lung channel of hand indentation at LU7:

Pattern:tenderness at LU5, indentation at LU8Kidney deficiency heat pattern, deficiency heat

Yangming

large

intestine

channelofhand:affecting the gallbladder channel, heart heat.

tenderness at LI11, LI10 and LI4
Juejin pericard channel of hand: tenderness at PC6,

Treatment

PC8

Needling:

Shaoyang sanjiao channel of hand: tenderness at

For "floating pulse" mostly shallow needling, for

TE5, TE6"deficient pulse" reinforcement, in case of a "floating,

Shaoyin heart channel of hand: tenderness at HT5,

large and deficient" pattern reinforce the deficiency

HT6, HT7 and HT8

first and later drain the excess.

Taiyang small intestine channel of hand: pinching

The primary treatment channel is the kidney

pain at SI3, left > rightchannel, but on this occasion it was a disease pattern

Feetof the gallbladder and bladder channels. I also used

Taiyin spleen channel of foot: indentation at SP9,

the small intestine channel to drain the heart heat,tenderness at SP8

and used the lung and large intestine channels as

Yangming stomach channel of foot：tenderness at

well

ST36 and ST44, left > rightreinforcement of the kidney channel.

Jueyin liver channel of foot: tenderness at LR8, LR3,Supine position:left > right

GB5, GV20 (needle retention), VC12, ST25, CV15 ~Shaoyang gallbladder channel of foot: tenderness at

hypochondrial

GB34, GB38, GB39 and GB41, left > rightscattered short pricking), LU8, LI11, SI3, TE3, ST37,

Shaoyin kidney channel of foot: indentations at KI10,KI9, KI7 (singular insertion, reinforcement), SP8,KI9, KI7 and KI3, left > rightGB38 (singular insertion, draining)

Taiyang bladder channel of foot: tenderness at BL55,

Prone position:

BL58

Scattered short pricking in the interscapular region,

Abdominal diagnosis:

BL14, BL15, BL43, BL17, BL18, BL22, BL23, BL52,* Discomfort in the hypochondrial region

BL26, left BL53, left BL54, BL55, BL58, BL60

* Lower abdominal weakness, lateral abdominal(needle retention + far infrared irradiation for 25

tensionminutes),

Pulse diagnosis:insertion)

Floating,large

anddeficient,leftchipulse

astheleftspleenregionGB39,channelto(singularBL10,

supportinsertion

GB20

theand(singularSitting position:intermediate, floating, deficient, right cun pulse

Scattered short pricking along the ridge of theslightly floating and deficient, left cun and right cunshoulder.

pulses slightly excessive
Pathology:

Results

A yin deficiency of the kidney channel led to a kidney

At the beginning of the treatment the patientchannel qi deficiency, the deficiency heat of thereported pain even upon lying down and turning in

bladder channel affected the gallbladder channel

bed, but after the treatment the pain rating

leading to upper excess and lower deficiency anddecreased from NRS 9→6. In a sitting posture there

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 13, Number 3 | Fall 2018

was tenderness at GB39 on the gallbladder channel

Discussion

in the lower leg area. Attaching Pyonex 0.3 mm

In the past this patient had been diagnosed with aneedles decreased the NRS to 5, but due to the low

herniated intervertebral disk, but in the absence ofback pain the slow movements did not change. Facialnumbness of the lower leg, no difference in theexpressions

thecircumference of the calf and no atrophy, thepretreatment condition and dressing and walking

condition was considered to be a non-specific low

remained somewhat awkward.

back pain. He usually was performing desk work andimproved

ascompared

toalthough feelings of fatigue and heaviness indicatedCoursea chronic condition, he could not think of any

Second session (+2 days)

triggering events that might have caused a low backOn the day following the treatment the low backpain severe enough to interfere with his social

NRS score dropped to 4. Today he visited our clinic

activities. Studies conducted in recent years indicate

after work and the NRS score has currently beena correlation betweenalleviated to 3. However, there is still no change indepressive mood among possible sociopsychological

the slow movements and the patient keeps worrying

factors" and low back pain in cases of prolonged low

about the condition of his low back. Channel

back pain1). The symptoms of the low back pain that

palpation showed that the lower legs have become

developed in this patient during a string of

warmer and the generalized tension is decreasing.

consecutive holidays were characterized in that they

The 12 channels still showed the same tendencies,

aggravated after returning to work so much, that

but the tenderness at PC6, PC8 has decreased and I

they prevented him from leading his normal social

palpated a deficiency at ST36 a deficiency as well aslife. While treatment alleviated the low back pain, he

an excess at ST40.

could not help being worried about the activities ofPulse:

daily life, suggesting the presence of a mild degree of

Floating, slightly large and deficient, left chi pulse

depressive mood.

was intermediate, slightly floating and deficient, theThe patient had a disposition with a tendencyright cun pulse was slightly floating and deficient,towards kidney deficiency and "fear" as an emotion

the right guan also slightly floating.

associated with the kidney was unstable. Anxiety

Pattern:

actually developed during daily life, preventing him

Kidney deficiency heat pattern, the channel heatfrom taking audacious actions, suggesting theaffecting the gallbladder and stomach channels.

burden on the lower back had increased.

Treatment

Inspection showed a type of dark and dry skin that

Same treatment as during the previous session,

has been mentioned in Chapter 10 of the Jing Mai,

exempting the small intestine channel, reinforced

On Channels in the "Ling Shu", where the disease

and reduced the stomach channel and added 5 cones

produced by the liver channel being referred to as 'Zuof heat penetrating moxibustion at BL23 and BL26.

jue yin gan jing shi dong bing zheng' is characterized"psychological distress,by "non-lustrous complexion as if the face is dusted".
Results

In case the work related stress leads to a tendency

The patient reported "the moxa stimulation seems totowards depression, heat builds up within the chest

have been most effective" and the pain had beingthat may then be difficult to disperse. This does notalmost completely alleviated, so that the treatment

only suggest that the kidney deficiency and heart

was terminated.

heat form an exterior-interior unity, but it is also
possible to view this as a "vexation and fullness"

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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 13, Number 3 | Fall 2018

associated with the liver channel 'Zu jue yin gan jing

Conclusions

Suo sheng bing zheng'. Since the patient requires

The objective findings were rather scant in spite oftime to lie down and worries about turning in bed,

the marked subjective symptoms reported by thethis may be interpreted as a disease produced by thepatient, so that I based the decision whether or not

liver channel described as "low back pain andto proceed with channel therapy mainly on the pulse

difficulty in moving the body" as well as the related

diagnosis and channel palpation. I performed a pulse

diseasechanneldiagnosis at the three bilateral radial pulses anddescribed as "pain in the subcostal region, inabilitybased my judgment of a "heat pattern" on theto turn the body".

evaluation of the classified pulses. Heat was theAlthough in this case the predominant emotion wascentral feature of the disease pattern, but in case of"fear", it is easily conceivable that an insufficiently

reduction of the heat through shallow needling I

smooth dispersion of "anger" may have led to thedecided to "first reinforce the deficiency and later

onset of an acute low back pain as a disease of thereduce the excess". Based on diagnosis of the pulse

gallbladder channel.

differences between the sided the kidney channel

Mr. Meiyu Okada said, that "the effective use of

was the primary treatment channel, but I decided

command points and local needling is sufficient tothat the changes in the gallbladder and bladderachieve recovery from acute but mild conditions

channels too have contributed to the development odepending on the pulse condition"2).

the low back pain. This is a channel combination

The author interprets the denotation of "acute andfrequently encountered in patients with low backmild" as referring to an "acute low back pain, butpain. Combined with anxiety or tension thewithout any signs of neurologic impairments". Mr.

inspection of the patients complexion and the results

Okada mentioned that in this case the "use ofof channel palpation the pulse reveals a close

command points depending on the pulse condition"correlation with the kidney channel, so that theand "local needling" should be sufficient. This

treatment of the kidney channel had in this patient

remark of him is serves as an important suggestion

marked general effects.

producedbythegallbladderregarding the standard treatment guide for low backin channel therapy.
In this case I initially applied comparatively shallow
needling for the yin deficiency heat pathology3,4), but
the pulse condition indicated the need for somewhat
greater insertion depth. In general it is important todiscern the deficiency-excess and cold-heat condition,
perform meticulous channel palpation. After that it
is possible to proceed with the appropriate treatment
based on an evaluation of the responses observed
during the channel palpation as well as thepathology surmised from the pulse condition
regarding yin-yang deficiency-excess.

References
1) Low Back Pain Clinical Practice Guideline 2012:supervision

byTheJapanese

Orthopedic

Association, Japan Low Back Pain Association(Fourth Edition), Nankodo 2013
2) Meiyu Okada: Three cases of low back pain,
channel therapy, Channel Therapy Study Group,1968
3) Motoaki
Japanese

Okabe,

Masakazu

Acupuncture

andIkeda,others:Moxibustion

Medicine, Channel Therapy, Basics, Traditional
Japanese Medicine, 1997
4) Motoaki
Japanese

Okabe,

Masakazu

Acupuncture

andIkeda,others:Moxibustion

Medicine, Channel Therapy, Clinics, Traditional
Japanese Medicine, 1997

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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