Volume 13, Number 2 | Summer 2018

Clinical Report (Acupuncture)
A Case of Acute Low Back Pain Assciated with Walking
Difficulties Improved by the Following Day[Subjective symptoms] When the patient visited myShunji Washidabecause of the pain, but did not complain any

Washida Acupuncture Clinic

clinic, he supported his body on the wall. He wasbarely able to move one step at the time forward
numbness of the legs.
[X-Ray] It did not show abnormalities a month before

I. Introduction

his visit.

The number of patients with low back pain is[Oriental Physical Examination]

extremely high and among the complaining ratio,

Inspection: appeared to be very uncomfortable, but

low back pain occupies first place in men and second

had a healthy look; facial complexion was somewhat

in women in Japan. (2010: Comprehensive Survey ofdark and lacked luster.

Living Conditions). Low back pain is classified into

Audio-olfactory examination: weak voice.

acute, subacute and chronic based on the period ofInquiry:time since onset. Low back pain of duration less thanoccupation and did not do anything possibly causing

four weeks is defined as acute phase1). As treatment

particular strain on the low back. The only occasionof acute low back pain, pharmacotherapy is highly

to leave home is visiting the horse race track onrecommended (Grade A) and NSAIDs are frequently

weekends. Otherwise he contrived to join a Mahjong

used. Thermotherapy is considered to be of short-club in order to have a reason to leave home eventerm benefit (Grade B)1). However, currently there isduring the week, but because of his poor skills atlittletoMahjong this on the contrary tended to irritating

As for acupunctureand stopped him from continued attendance. He hadand moxibustion treatment, According to a Cochrane

the habit of drinking about 5-6 cans of beer every

review of 35 RCTs studies published in 2005, amongevening. He drank a lot of alcohol over a period ofthem only three studies dealt with for acute low backseveral weeks prior to the onset and often also

pain, it was concluded that the effectiveness of thestarted drinking during the day. When drinking

treatment remain uncertain,1). Here I report a caseduring the day he rarely went out, became drowsyof acute low back pain successfully treated withand slept, so that he recently spent much time lying

acupuncture and moxibustion treatment..

down. He did realize that excessive drinking andreliable

pharmacotherapy inevidence
general2).

regardingThepatient

wascurrently

withoutlack of exercise is not good. The pain manifested in aII. Case reportway, that he could not put any weight on his spine.

[Case] 66 years, male

The difficulty to fall asleep caused the drinking habit[First visit] July 15, year Xfor many years. His insomnia started when his[Chief complaint] Low back pain

younger brother died of cancer approximately 30[Past Medical history] At the age of 55 partial

years ago. He felt responsible for the death of his

gastrectomy because of gastric cancer

younger brother and this guilt has caused him much

[History of Present illness]suffering.

He has repeated acute low back pain about once a

Palpation: rough, floating pulse, rapid, empty andyear over the last few years. On the morning of hisslightly

first visit to my clinic, he had acute low back pain,

showed liver and kidney deficiency. Abdominal

which unable him to walk to my clinic.

diagnosis showed weakness of the lower abdomen.

[Life history] Single, lives alone

Meridian palpation revealed tenderness from GV3 ~choppy.

Comparative[Current condition] Height 165 cm, weight 50 kg

12

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

pulse

diagnosis

Volume 13, Number 2 | Summer 2018

GV4. The tenderness was also experienced as

he did experience discomfort, but the activities ofdiscomfort.

daily life had significantly improved so much as to[Medical diagnosis]

cause no major problems). The pain along theOne month ago an x-ray had been taken, but did notgoverning vessel (GV3~GV4) had slightly decreased.

show any anomalies.

Inspection: Calm expression; facial complexion had[Oriental medical diagnosis]

become lighter.

The cause of the condition was considered to be

Audio-olfactory examination: Voice had gained inexcessive eating and drinking (excessive alcohol

strength and he was rather talkative.

consume), leading accumulation of damp heat and qi

Palpation: rough pulse, slightly floating, slightlystagnation. The pattern was identified as a liver-rapid, empty, slightly choppy. Comparative pulse

kidney deficiency. Due to the excessive drinking anddiagnosis showed liver-kidney deficiency. Abdominal

resulting decreasing frequency of leaving the house

diagnosis still showed lower abdominal deficiency.

in conjunction with a lack of exercise led to qi

Rootstagnation in the lumbar area. In addition to thatTechnique at LR8 and KI7.

damp heat accumulated in the lumbar region,

FRANC treatment: Zheng Qi Tonifying Technique atconceivably causing the pain.

CV4. Qi Splashing Technique on the governing[Treatment policy] Disperse damp heat and improve

vessel (from the vicinity of GV3~to the vicinity ofthe qi stagnation directly responsible for the pain;

GV4) near the tender regions. Zheng Qi Tonifying

reinforce the deficient liver and kidney qi, thus

Technique at BL23 and BL18. Yin Qi Tonifying

aiming at a recovery of low back function.

Technique and Qi Splashing Technique near BL23

[Treatment] Root and branch treatment (sittingand BL25 as lumbar regions of increased muscle

position): 1 cone of heat-sensing moxibustion each attension. Qi Transfer Technique at BL60. Yin Qi

the 3 locations of the tender GV3, in theTonifying Technique, Qi Splashing Technique and Qi

intervertebral 3rd and 4th spaces and at GV4.

Smoothing Technique in a sitting position for regions

Root treatment (supine position): Transmeridian Qiof strong muscle tension at the sides of the neck,Tonifying Technique at LR8 and KI7.

along the top of the shoulders and the upper back.

FRANC treatment (supine position): Zheng Qi

Third session (July 19): "Activities of daily life do notTonifying Technique at CV4. Branch treatment

cause problems and I take walks depending on my(prone position): Qi retention Technique at GV3, incondition." The tenderness at GV3 still remains.

the intervertebral 3rd and 4th spaces, GV4, BL23 andPalpation: rough pulse, slightly floating, slightly

BL28. Zheng Qi Tonifying Technique at BL18. Qi

rapid, empty, slightly choppy. Comparative pulse

Splashing Technique at BL60. That is the Toho-kai

diagnosis showed liver-kidney deficiency pattern.

style treatment (Meridian therapy) I performed. TheTreatment: same as during the last session.

floating pulse was alleviated, liver-kidney deficiency

Fourth session (July 23): "I spent the whole day

improved and I finished treatment after the pulse

sitting at the horse race track, but was fine. The

had calmed down. Immediately after the treatment

other day I drank alcohol. Four cans of beer. I had

the patient did not report any subjective changes inintended to stop at two, but the excitement after thethe pain. Objectively the walking speed appeared tohorse race kept me going to drink 4 cans."

have slightly increased.

Tenderness at GV3 remains.

[Clinical course]

Palpation: rough, slightly floating pulse, slightly

Second session (July 16): On the day after the first

rapid, empty, slightly choppy. Comparative pulse

visit the patient came by train (walked to the station;

diagnosis showed liver-kidney deficiency pattern.

treatment:

Transmeridian

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

Qi

Tonifying

13Volume 13, Number 2 | Summer 2018

Treatment: same as during the last session.

Due to the improvements in his daily life I ended theFifth session (July 30): "Three days ago I felt sometreatment according to the patient's wish.

discomfort, but that went away in 1 day. Because mysleeping rhythm has fallen into disorder I do sleep
during the day, but then cannot fall asleep at night.
That is why my alcohol consume is increasing andseems also to lead to the development of my low backpain. But unless I drink some alcohol, I cannot fallasleep. That is a habit of mine continuing already formany years. The trouble with falling asleep started
about 30 years ago, when my younger brother died."
There is some tenderness at GV3.
Palpation: rough, slightly floating pulse, slightly
rapid, empty, slightly choppy. Comparative pulse
diagnosis showed lung deficiency pattern.
Treatment: The pattern was identified as lungdeficiency

andtreatedby

Transmeridian

Qi

Tonifying Technique at LU9. Local and symptomatic
treatment same as during the last session.
Sixth session (August 6): "Because my life rhythms
is disorderly, alcohol consume has increased. Therehas been some low back pain, but it is not as severeas the other day." There is some tenderness at GV3.
Palpation: rough, slightly floating pulse, slightly
rapid, empty, slightly choppy. Comparative pulse
diagnosis showed liver-kidney deficiency pattern.
Treatment: The pattern was identified as liverkidney

deficiency

pattern

andtreatedbyTransmeridian Qi Tonifying Technique at LR8 andKI7. Local and symptomatic treatment same as
during the last session.
Seventh session (August 9): "Recently I am fine. I
adjusted my life rhythm and started taking walks."
There is almost no tenderness at GV3.
Palpation: rough, slightly floating pulse, slightlyrapid, empty, slightly choppy. Comparative pulse
diagnosis showed lung deficiency pattern.
Treatment: The pattern was identified as lungdeficiency pattern and treated by Transmeridian Qi
Tonifying Technique at LU9. Local and symptomatic
treatment same as during the last session.

14III. Discussion
The increasing number of people suffering from low
back pain, especially those with acute low back pain,
are looking for immediate effect and prevention ofchronic pain. While pharmacotherapy is highly
recommended for acute low back pain, its effects areoftenlimited.

Acupunctureandmoxibustion

treatment for chronic low back pain is recommended
next to exercise therapy, but many acupuncturists
have also experienced quick efficacy when treating
patients with acute low back pain.
The history of this patient suggests that local heatsensing moxibustion and Qi Retention Techniqueseemed to have been particularly effective for low
back pain caused by damp heat and qi stagnation.
Yet, in conjunction with the adjustment of changes
in the Meridians using remote sites the treatment
overall succeeded without being overly occupied by
local treatment and thus is considered to have led toa favorable outcome. Conceivably the reason for the
improvement on the day following the session wasthat because of the marked deficiency sleep wasneeded for the recovery.
On the other hand, this type of acute low back pain
recurred because of lifestyle habits including adrinking habit, indicative of the suffering of thepatient up to the present. It is difficult for an
acupuncturist to directly help solve the problems
related to the patient's suffering forming thebackground for his complaint. Yet, it is possible toask

thepatientabout

thedetails,

show

understanding and at least one can endeavorbuilding a relationship allowing communication.
Based on this relationship I was able to encourage
the patient during casual conversation to express hissufferings. And through improvements of the flow ofqi and blood via adjustments of the changes in thechannels acupuncture and moxibustion directly
contributed to improvements related to the chief

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

Volume 13, Number 2 | Summer 2018

complaint and conceivably motivated the patient toReferences

improve his lifestyle.

1) The Japanese Orthopedic Association, Clinical
Practice Guideline Commission, Low Back PainIV. Conclusions
This patient with acute low back pain received onlyacupuncture and moxibustion treatment. Although
this is only a case report, it suggest some way tovalidate the effects. In the future I would like to use
a pain evaluation scale, investigate more cases andverify

theusefulnessofacupuncture

moxibustion treatment for acute low back pain.

andClinical Practice Guideline Drafting Commission.
Low Back Pain Clinical Practice Guideline 2012;
Nankodo ISBN: 978-4-524-26942-6
2) Tetsuhiro

Iguchi,

KoichiKasahara,

Aritetsu

Kanemura: EBM of Pharmacotherapy for theTreatment of Low Back Pain. Journal of theJapanese Low Back Pain Society. 11(1): 85-91, 2005

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

15