Volume 4, Number 4 | Winter 2009

Clinical Report 1 (Japan)
Acupuncture and Moxibustion Treatment – Case Report
Hironori Hatakeyama
Kuretake School of Integrative Medicine

1. Introduction
This case reports describes the observed courseof a patient with lumbar spinal canal stenosis
referred to this clinic from the Kuretake Medical
Clinic (below abbreviated KMC) affiliated withthis school, who was treated a total of 7 times.
2. CasePatient: 64 years, male, runs an opticians store,height: 165 cm, weight: 62 kg
First visit: January 27, 2011
Chief Complaint: low back pain, numbness
extending from the right buttock down theright leg, pain in the buttocks upon sitting
down.
Present illness: At the beginning of December
2010 the patient felt while walking a sudden
pain in the right knee and on the right side of
the waist that quickly disappeared at that time,
but later he occasionally experienced pain, also
during walking, on the right side of the low
back. On December 31 the low back started tohurt on both sides and he went to a groceries
store to purchase and use a low back pain belt
to reduce the pain. On the next day (January 1,2011) upon rising a sharp pain and numbness
in the right lumbar area occurred when he put
his foot on the floor and since then he felt
numbness on the outside of the right leg.
On January 6 of the same year he consulted
the department of orthopedics at the KMC and
was diagnosed with stenosis of the lumbar
spinal canal. Until January 8 of the same year
he had to use a taxi to commute to the KMC,
which is located in his neighborhood, because
he had difficulties walking. At the KMC thetreatment was performed from the day of thefirst visit in the department of rehabilitation

12and included application of heat, traction, lowfrequency current therapy and was alsoprescribed oral drugs (anti-inflammatory
analgesics, muscle relaxants, PG derivatives,
drugs for peptic ulcers). By January 16 of thesame year he had recovered so far, that hecould come walking to the clinic. At this time
he tended to drag the right leg when starting
to walk but still commuted every day. After therehabilitation the dragging sensation of theright leg was somewhat relieved.
When he learned of the parallel establishmentof this facility acupuncture treatment wasinitiated. Although this was going to be his
first acupuncture treatment, he had noconcerns about the treatment nor felt any
resistance to it and was thus referred to theKMC based on his wish to achieve any possible
relief of the symptoms (the form requestingtreatment was received on January 24 of thatyear) and thus started to visit this clinic.
The pain and numbness on the outside of theright lower extremity is particularly strong
upon rising and slightly alleviated by warming
the leg. Since the development of thesymptoms the patients thought that heavy
objects might generate stress and thus does
not carry weights any longer. These last 2-3
days pain started to developed upon sitting ina chair. From his injury until now he had not
had any pain anywhere in his body. Now hecannot sit for a prolonged time during work.
He consumes a moderate amount of alcohol
once a week.
Past history: 22 years ago he was diagnosed withDM (currently he is on therapeuticmedication).
Family history: nothing particularly noteworthy
Personal history: Played soccer from elementary
to high school. Used to walk since thediagnosis of the DM (a course of approximately
3.5 km, requiring 45 minutes)

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

Volume 4, Number 4 | Winter 2009

Findings: blood pressure: 162/80mmHg, pulse
rate 64 (no arrhythmia), body temperature
36.2℃, no scoliosis, slightly decreased lumbar
lordosis, no stepwise deformation.
The motion of the lumbar area is normal, but
movement elicited pain around the insertion of
the erector spinae muscles of the lumbar
region and numbness/pain of the outside of theright lower extremity.
Negative Kemp sign, patellar tendon reflex
normal, Achilles tendon reflex diminished on
the right side, plantar and dorsal flexion of the
big toe were both reduced, the right L5/S1 area
showed positive signs of esthesiodermia(described as the appearance of numbness), theSLR test was negative, so was the Katayama's
Bonnet test.
The region of the lumbar erector spinae
muscles (BL24 (Kikaiyu, Qihaishu), BL25(Daichoyu, Dachangshu), BL26 (Kangenyu,Guanyuanshu) / muscle tension of the glutealregion (left ≒ right), right mid-back (BL18(Kanyu, Ganshu) – BL20 (Hiyu, Pishu)) muscletension.
Assessment of the pathologic condition: The KMC
physician diagnosed a stenosis of the lumbar
spinal canal. Based on the diminished lordosis
the presence of age dependent degenerativechanges can be surmised. It cannot be
definitely stated that only walking is directly
responsible for the development of the present
condition, but an accumulation of daily muscle
fatique, including the portion caused bywalking, may have possibly triggered theonset.
Treatment plan: Needling was performed in anarea from the lumbo-gluteal region down to theright lower extremity in order to achieve asedation of the nervous symptoms throughraising the pain threshold and attempts atrelieving the muscle tension. I expected an
improvement of the lordosis through relievingof the muscle tension. From the next time

modification of the point selection for theneedling depending on the lower extremity
symptoms were also considered.
Treatment: For the needling disposable needles
manufactured by SEIRIN were used.
Needling sites and needles sizes were: 30 mm#16 needles placed at BL18 (Kanyu, Ganshu),
BL20 (Hiyu, Pishu), BL37 (Inmon, Yinmen),
GB34 (Yoryosen, Yanglingquan), GB35 (Yoko,Yangjiao) (all bilaterally, inserted to a depth ofapproximately 7 mm), 40 mm #16 needles
placed at right BL24 (Kikaiyu, Qihaishu), rightBL25 (Daichoyu, Dachangshu), right BL26(Kangenyu, Guanyuanshu), right gluteal
tender point (inserted to a depth between 25and 30 mm), right external BL53 (Hoko,Baohuang), right BL52 (Shishitu, Zhishi), leftBL24(Kikaiyu,Qihaishu), left
BL26(Kangenyu, Guanyuanshu) (inserted to a depth
between 15 and 25 mm). All needles wereretained after insertion for 5 minutes.
Course: Slight improvement of the subjective
symptoms after the treatment.
Second treatment (February 3): After the lasttreatment there was during the 10-minute
walk home no dragging sensation in the rightleg. The numbness, however, reappeared by
the following day. After that the patient wasbarely aware of any lower extremity symptoms
during walking and there were noaggravations. He felt the numbness at rest or
while sitting.
On the day of the treatment muscle tension
was relieved, but by the following day thetension in the lumbar and gluteal had returned.
The tension was worst in the morning andrelieved by warming.
The lumbar motion did not induce any changes
in the degree of numbness and pain. Postive
right Kemp sign, normal tiptoe and heel gait(tensing the muscles in the right lower
extremity was not possible and the patient had
difficulties in balancing), other positive

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

13Volume 4, Number 4 | Winter 2009

findings observed during the examination wereabout the same as those observed during thefirst session. Same treatment as during thefirst session.
Third treatment (February 10): Alleviation oflumbar tension after the last treatment, bodyweight could be more easily shifted onto theright leg, but no improvement in the numbness.
There was still a vague sensation of numbness
in the foot, but now tended on concentrate on
the region around the third digit. Tension of
the hip in the moving was unchanged.
The lumbar motion did not induce any changes
in the degree of numbness and pain. Negativeright Kemp sign (pain in the right buttock),other positive findings observed during theexamination were about the same as thoseobserved during the first session. Sametreatment as during the first session.
Fourth treatment (February 17): On the day of
the treatment the patient felt fine. When thepatient put both feet together on the nextmorning and scoop up water to wash his face,numbness and pain developed in the rightbuttock and along the outside of the right leg(down to the lateral malleolus), so that he had
to wash his face with one hand in a posturewith the right leg drawn backwards. During
this week the constant sensation of numbness
disappeared and if it occurred, the size of theaffected area had started to decrease.
No changes in the lumbar motion induced
numbness and pain. Negative right Kemp sign
(only pain in the right buttock andexamination revealed the same positive
findings that were also found during the firstexamination. Right BL58 (Hiyo, Feiyang),right BL60 (Konron, Kunlun) were added tothe initial treatment menu.
Fifth treatment (February 24): No changes in thepain in both buttocks during sitting in themorning and the numbness during washing14

the face in the right buttock and outside of theleg. Likely appearance of numbness after 20-25
minutes when the patients takes a walk.
The lumbar motion induced numbness andpain were the same except during left rotation.
Negative right Kemp sign (disappearance of
pain in the right buttock) while examination
revealed the same positive findings that werealso found during the first examination. RightBL58 (Hiyo, Feiyang) was added to the initialtreatment menu.
Sixth treatment (March 3): When going for a walkeven after 30 minutes he did not feel numbness
or pain in the right leg any longer. The area ofthe numbness now covered the region from thelateral malleolus to the foot. The pain in both
buttocks during sitting in the morning had
slightly improved.
The lumbar motion induced numbness andpain occurred only during retroflexion.
Negative right Kemp sign while examination
revealed the same positive findings that werealso found during the first examination. Reliefof the lumbar muscle tension. Right BL58(Hiyo, Feiyang) was added to the initial
treatment menu.
Seventh treatment (March 10): The patient
became able to wash his face with both hands
and both feet put together (disappearance ofsymptoms in the right buttock and leg) and thefrequency with which he noted the numbness
and pain in the area from the lateral malleolus
to the foot decreased. The sensation ofdragging the feet during walking had almost
disappeared. The pain in both buttocks during
sitting in the morning had been significantlyalleviated. He also felt that the awareness oflumbar muscle tension had decreased. The
sensation of muscle fatique of the leg too
decreased and he felt a tendency toward
increasing power.

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

Volume 4, Number 4 | Winter 2009

The lumbar motion induced numbness andpain occurred only during retroflexion. Normal
tiptoe and heel gait (no staggering), negative
right Kemp sign (right buttock felt slightly
heavy), right Achilles tendon reflex normal,
plantar flexion and dorsal extension of the big
toe were both weakened on the right side, inthe right L5/S1 region disturbance of the senseof touch. Relief of the lumbar muscle tension.
Right BL58 (Hiyo, Feiyang) was added to theinitial treatment menu.
* After the treatment the chief complaint of thepatient presented during the first examination
had almost completely be alleviated and thepatient
therefore
requested
temporarydiscontinuation of acupuncture treatment,
while integrating the exercise therapy at thedepartment of rehabilitation previously
proposed by the physician of the KMC andsimultaneously increasing the frequency ofgoing out.

therapeutic results.
Normally acupuncture and moxibustion
treatment for stenosis of the lumbar spinal
canal cannot directly be administered within
the spinal canal, but in this case we were able
to achieve alleviation of the symptoms after ashort period of time. This suggests that a clear
identification of the pathologic condition
allowed to obtain an appropriately informed
consent regarding the treatment plan from thepatient.
4. Conclusion:
Examination of western medical physicalfindings by acupuncturists allows to accurately
identify the pathologic condition and correctly
communicate with physicians. The result is,that confirmation of the symptoms is easily
comprehensible for the patient too, helps to
obtain an informed consent for setting goals
and is also considered to improve therapeutic
results.

3. Discussion:
This patient presented with clinically common
degeneration induced symptoms. In thisfacility
weendeavor
toimmediately
communicate information about patientsreferred from the KMC, so that we could visit
the department of orthopedics of the KMC
promptly after the first treatment andinquired about the basis for the diagnosis ofstenosis of the lumbar spinal canal whilereferring to the diagnostic images. Also, by
routinely obtaining the western medical
physical examination items determined by theclinic we were probably also able to compare
our findings with the information from theKMC and thus provide an environment for atreatment that was each time finely adjusted
to the patient's symptoms. This also made thesymptoms easier to comprehend for the patient,
had the advantage of facilitating the setting ofgoals and thus probably led to improved
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

15

Volume 4, Number 4 | Winter 2009Introduction to Kuretake School of IntegrativeMedicine
Kuretake School of Integrative Medicine wasopenedinOmiya-ku,
Saitama-shi,
Saitama-prefecture in April 2009 as the third
school of Kuretake College of Medical Arts andSciences. Kuretake College of Medical Arts andSciences founded in 1926 has dedicated itself over
85 years to the education of Japanese traditional
massage, massage, finger pressure, acupuncture,moxibustion, and Judo-orthopaedics and grownas an institution of systematic practical education
for traditional medicine.
Taking full advantage of educational
techniques developed and built up by all its
existing schools, Kuretake School of Integrative
Medicine proactively tries anything new ordifficult that we deem to be necessary for training
human resources required by the modern age. It
is absolutely imperative that acupuncture andmoxibustion in this day and age have acooperative relationship with Western medicine.
And, views and speculations from the perspectiveof Western medicine are the most important. Inorder to put a great deal of effort in fostering
human resources most appropriate and requiredin the field of such medical care, we adopt the fulltime system for daytime classes. For individuals
who work and study for the national certification,nighttime classes are also offered, responding to
the needs of the local community.
Furthermore, we have established thetreatment centers attached to the school as partof the follow-up system where training courses
are offered to the graduates for further
improvement of their techniques, as well as
students, who can experience clinical sites
through the trainings of clinical practice. Thus,
we provide practical education with our main
focus on fostering practitioners of acupuncture
and moxibustion who will contribute to society.
16

We have also established Kuretake Medical
Clinic in the school facilities, where community
healthcare is being provided in close coordination
with each of the treatment centers for
acupunctureandmoxibustion,andJudo-orthopedics. The clinic complete withstate-of-the art apparatus for medical testing has
different Departments of Internal Medicine,
Kampo
InternalMedicine,Orthopedics,
Rehabilitation, and Gynecology allowing patientsto receive healthcare they want from many
options made available to them throughcooperation among all departments andtreatment centers. The staff members of the clinic
and treatment centers have regular workshops
for the purposes of their better and mutual
understanding of medical matters such as
diagnosing, procedures, and treatment methods
and interacting with physicians, co-medical staff
members, and practitioners/teachers. We are also
putting lots of efforts to reflect the know-how thus
accumulated in the clinical exercises and optionalclasses to further enhance the quality of thelessons.

Kuretake School of Integrative Medicine

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