Volume 11, Number 1 | Spring 2016

Clinical Report 1 (Acupuncture)
Traditional Chinese Acupuncture and Moxibustion inJapan (1) – Pain and Numbness of the Low Back andLower Extremities
Masanori Takashi1) and Katsuhiko Arai2)
1) Tokai University Oiso Hospital,
2) Tokai University School of Medicine

Preface
Japanese acupuncture and moxibustion has its own
characteristic history and while Chinese thoughts
were introduced to Japan during the various periods,

Dr. Takashi in treatment.

Japan has developed its own original techniques andconcepts. The needle tube widely used worldwide
today is an invention made by a Japanese, theIntroduction

delicate treatment form called meridian therapy too

Our office in the Department of Oriental Medicine in

was developed by a Japanese. Yet, today there arestill many acupuncturists in Japan practicing
Traditional Chinese acupuncture and moxibustion.
In this series acupuncturist Masanori Taskashi oftheOiso

HospitalaffiliatedwiththeTokai

University School of Medicine has been establishedin 1984 by late Dr. Kumio Yamashita. The author(Takashi) has been employed at this office since April
2001 and performs here daily acupuncture andthe Oiso Tokai University affiliated hospital will

moxibustion treatment. In March 2008 Dr. Arai

introduce these TCM methodologies and current

joined the treatment and research.

clinical practice in four reports to be published from

We are treating many diseases with acupuncture

No. 1 through No. 4 of Volume 11.

and moxibustion. A part of this series introducessome case reports. We report cases with certain
diseases. In this first part we report a case with pain
and numbness of the low back and lower extremities
as it is commonly encountered in clinical practice.
[Case] 34 years old, male, employee[Chief complaint] Pain and numbness of the low back,numbness of lower extremities[Present illness]
The low back pain started during his senior highschool days when he was a field and track athlete
and for which he consulted a local physician. He wastold his symptoms were due to fatigue. Five years

Tokai University Oiso Hospitalago he visited this acupuncture and moxibustion
clinic because of his low back pain. The treatment
assuming the presence of kidney yang deficiency
slightly alleviated the low back, but it continued to12

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

Volume 11, Number 1 | Spring 2016

recur thereafter in intervals of 1-2 months.

Deep tendon reflexes:

both Achilles tendon reflex

Whenever this happened he underwent acupuncture

and patellar reflex were normal

and moxibustion treatment.

Manual Muscle Testing (MMT)RL

Late in June of this year he experienced a sudden

Tibialis anterior muscle

5－5

onset of low back pain immediately after jumping

Extensor hallucis longus muscle

5－5

into the water during swimming and consulted ourFlexor hallucis longus muscle

55office for that reason. Immediately after thePain was 85 mm on a Visual Analog Scale (VAS) and

acupuncture and moxibustion treatment the pain

numbness on a similar (VAS) 60 mm.

had been reduced to half of its intensity, but thesymptoms improved slower than usual. By themiddle of July some discomfort developed whiledriving a car and during the night of that day severe
pain (as if being squeezed) developed in the low backand region around the sacrum. Since numbness ofthe lower extremities had also newly developed, hevisited our office again walking with a cane. Due tothe pain his posture was bend laterally. Because I
found signs of radiculopathy when I performed aBefore treatment

After treatment
Figure 1physical examination, I referred the patient to theorthopedic outpatient department. The physician
diagnosed based on x-ray and MRI images of thepelvis a prolapsed disk at L5-S1 and prescribed an
antiphlogistic analgetic.
[Past history]
Four years earlier admission due to antibiotic
induced anaphylactic shock[Present status]
A squeezing type of pain of the low back and sacral
regions as well as a heavy, dull pain of the rightbuttock. Numbness of the right leg appeared on theposterior aspect of the thigh and the lateral side ofthe lower leg. The pain caused a tendency toward
insomnia. Micturition frequency was high with 10
times/day.
Pulse:

deep, wiry

Tongue:Western medical findings:
SLR:

Figure 2

tongue body dark red, white coat
MRI findings (Figure 1)

R 20 degrees, L 60 degrees (pain in the right

low back region), no dysfunction of bladder and[TCM diagnosis]
Blood stagnation and channel blocking
Kidney deficiency

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

13Volume 11, Number 1 | Spring 2016[Therapeutic principle]

were almost no impediments to ordinary life. During

Activating Blood and eliminating stagnation

work he put on a corset.

Tonifying the Kidney

Fourth session (1 month later): The score for both[Acupoint selection]

pain and numbness was 0 mm. Two weeks earlier he

BL23 - tonification using twirling

had stopped taking the antiphlogistic analgetic.

BL17 / BL32 /right BL51 / BL54 / BL57 / GB34 / SP6Fifth session (2 month later): No symptoms. Only/ LV3: all neutral supplementation and drainage

development of a feeling of heaviness in the low backright GB30 - lifting-thrusting reduction

region when tired. The acupoint selection focused on

BL17 / BL32 / BL54 – cupping. (Figure 2)

supplementing the kidneys (BL23, BL26, KI3, CV4,Used needles: sterile Seirin acupuncture needles,

ST36, SP6). The herniated L5-S1 disk found on thelength: 1 cun 6 fen, No.3 and 2 cun No.3

MRI images taken 2 weeks before the patient visited[Explanation]

our office had disappeared. By this time we

Based on the concept that the 'low back is theconsideredmansion of the kidney'1) the back transport point ofterminated the treatment.

thecondition

almostcured

andthe kidney BL23 was used to tonify the kidney. To
free the flow of Qi of the bladder channel a[Discussion]

combination of BL322), BL543) and BL574) was used.

Acupuncture and moxibustion treatment led in thisAt BL175) as the meeting point of the blood andpatient to pain relief in the same way Yamashita etBL323) as a point on the greater yang bladderal. have described in “The journal of Japanesechannel in the sacral region as well as BL544) for

Society of Lumbar Spine Disorders” and could

Blood stagnation as its main indication cupping wasimprove activities of daily living7). Conservative

performed

eliminatetreatment of lumbar disk herniation is known to leadstagnation. And the combination of BL17, SP6 andto spontaneous remission. According to a report by

LV3 was needled to strengthen the activation ofDr. Hijiguro et al. the shrinkage or disappearance ofBlood and resolving stasis function6). At GB30 as thelumbar disk herniation (except in cases with ameeting point of the bladder and gallbladderhistory of surgery or spinal canal stenosis) requires

channels we used a 2 cun No.3 needle, inducing a

an average time between 4.0 and 6.6 months8).

needling sensation extending down to the lower leg

Considering that in this case a shrinkage wasto free the flow of Qi between the two channels.

observed in less than 2 months the possibility istoactivate

Bloodandconceivable, that acupuncture and moxibustion[Course]treatment has some influence on the shrinkage ofFirst session: Immediately after the treatment theherniations.

pain score on the VAS changed to 60 mm. Numbness

This patients was diagnosed during his first visit

did not change. Yet, pain increased again during thewith kidney deficiency. Later, since symptoms

night, bringing the VAS score back to 80 mm.

improved and exacerbated several times, theSecond session (next day): Upon arrival in our clinic

condition led to impaired blood circulation and thethe score for both pain and numbness was 40 mm. At

development of Blood stagnation. This matches thethe time he came into the office he used a cane, but

description in "Jing Yue's Complete Works" saying

forgot it when he returned home after the treatment.

'Kidney deficiency is often associated with low backThird session (1 week later): After the treatment thepain. However, this state of deficiency can also bescore for both pain and numbness was 30 mm. There

superimposedbyconditions'9).

14

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

excesspatternpathologicalVolume 11, Number 1 | Spring 2016

Trauma, contusions, Blood-cold, Blood-heat, Qi

Reference

stagnation,

Blood1) Yellow Emperor’s Canon of Internal Medicine

stagnation which then may impair the functionality(Huang di nei ching Su-wen 黄 帝 内 経 素 問 )of the organ and viscera channels. For that reason

Chapter 17 The Essentials and Fundamentals ofthe condition impedes a smooth movement of Blood

Diagnostic Palpation 脈要精微論 (in Chinese)Qi

deficiency

maycausethroughout the body and leads to stagnation.

2) LI Shi-zhen 李世珍: Clinical Elaboration of theThis case presented with the clinical characteristics

Common Shu Points 常用腧穴臨床発揮, P483-490,of Blood stagnation. The pain was of stabbing or else

Peaple’s Medical Publishing House Co., LTD 人民

squeezing nature and its site fixed. Moreover, refusal

衛生出版, 1985 (in Chinese)of pressure (a condition in which application of3) LI Shi-zhen 李世珍: Clinical Elaboration of thepressure at the site of the pain exacerbates the pain)

Common Shu Points 常用腧穴臨床発揮, P491-591,

and nocturnal exacerbation were also observed. In

Peaple’s Medical Publishing House Co., LTD 人民

this case the laterally bend posture was one of the衛生出版, 1985 (in Chinese)

indications suggesting the refusal of pressure. Also,4) LI Shi-zhen 李世珍: Clinical Elaboration of thethe disengagement and prolapse of the nucleus

Common Shu Points 常用腧穴臨床発揮, P502-510,

pulposus too was considered to be the Blood

Peaple’s Medical Publishing House Co., LTD 人民stagnation. Based on these characteristics we

衛生出版, 1985 (in Chinese)presumed the patient condition to be the result of5) HONMA Shohaku 本間祥白: Research of Nan Jing

kidney deficiency and Blood stagnation obstructing

難 経 の 研 究 , 179-180, IDO NO NIPPON SHA,

the channels, administered a suitable treatment and1965 (in Japanese)

therefore obtained good results.

6) KANEKO Asahiko 金子朝彦: Toigakukenkyu 東医学 研 究 , 25-28, Toigakukenkyukai, No.112 (inJapanese)
7) YAMASHITA Hitoshi 山 下 仁 : The journal ofJapanese Society of Lumbar Spine Disorders,
Vol.3 No.1, 27-32, 1997 (in Japanese)
8) HIJIGURO

Taijietal.:

Journalof

Musculoskeletal System, Vol.14 N0.7, 665-668,
2001 (in Japanese)
9) Zhang Jing yue: Collected Treatises of Jing yue(Jing yue quan shu 景岳全書) Vol.25 section ofLow back pain 1640 (in Chinese)

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