Lumbar Disc Herniation
Conditions
Keywords
Lumbar disc herniation, Gua Sha, "Cutaneous Region-Meridian-Visceral" Axis Theory, Bladder Meridian, Shen Period, Randomized Controlled Trial
Brief summary
Based on the "Cutaneous Region-Meridian-Visceral" axis theory, in this study, we investigated clinical efficacy of the Gua Sha intervention on the Bladder Meridian during the Shen Period (3:00-5:00 p.m.) for lumbar disc herniation (LDH) and its regulatory effect on serum C-reactive protein (CRP).This randomized controlled study enrolled 128patients with LDH admitted to the Department of Rehabilitation at Guangdong Hospital of Integrated Traditional Chinese and Western Medicine between January 2023 and December 2024. They were randomly assigned to a control group (n=64) and an observation group (n=64). The control group consisted of standard treatment and care according to the diagnostic and treatment guidelines for LDH. The observation group consisted of standard treatment and care supplemented with Gua Sha on the Bladder Meridian during the Shen Period. The Japanese Orthopedic Association (JOA) scores, Visual Analog Scale (VAS) pain scores, changes in CRP levels, and traditional Chinese medicine (TCM) efficacy evaluations were assessed for both groups before the intervention and at 2-week and 4-week after the intervention.
Detailed description
The control group will receive standard treatment and care including: (1) clinical observation - for patients in the acute phase, monitoring changes in the location and nature of pain, and use of a lumbar support belt when getting out of bed; (2) avoidance of raw, cold, and chilled foods during medication, with medication administered as prescribed; (3) maintenance of a nutritious diet, and avoidance of alcohol, raw, cold, and spicy foods; (4) monitoring of the patient's emotional state. The observation group will receive the same standard treatment and care plus Gua Sha therapy administered along the Bladder Meridian during the Shen Period (3:00-5:00 p.m.) as follows: 1. The patient assumes a seated position. The Gua Sha board is held at 45° to the skin in the direction of the meridian. After applying Gua Sha oil to the treatment area, a Hu Fu copper Gua Sha board (manufactured by Shanghai Wensha Tang, made of pure brass) is used. 2. The fast-scraping technique is used to stimulate the following four acupoints: Da Zhui (GV14), Da Zhu (BL11), Gao Huang (BL43), and Shen Tang (BL44) for approximately 5 minutes. 3. An alternating fast-slow scraping technique is used, focusing primarily on the Bladder Meridian while avoiding the face. First, scraping is performed from top to bottom along both sides of the spine, covering Tian Zhu (BL10), Da Zhu (BL11), and Feng Men (BL12). Then, scraping proceeds as follows: Step 1: Scraping the Back-Shu points corresponding to the viscera - Lung-Shu (BL13), Heart-Shu (BL15), Liver-Shu (BL18), Gallbladder-Shu (BL19), Spleen-Shu (BL20), Stomach-Shu (BL21), Sanjiao-Shu (BL22), Kidney-Shu (BL23), Qihai-Shu (BL24), Large Intestine-Shu (BL25), Guanyuan-Shu (BL26), Small Intestine-Shu (BL27), and Bladder-Shu (BL28) - to stimulate qi flow and regulate internal organ functions. Step 2: Scraping the acupoints in the sacral region, including Shangliao (BL31), Ciliao (BL32), Zhongliao (BL33), and Xialiao (BL34), to promote local blood circulation. Step 3: Along the posterior aspect of the lower limb, scraping from Chengfu (BL36) on the buttocks through Yinmen (BL37) to Weizhong (BL40) at the knee, then down the calf from Heyang (BL55) through Chengshan (BL57) and Feiyang (BL58), continuing to the ankle joint through Fuyang (BL59), Kunlun (BL60), and Pucan (BL61), and further to the lateral foot acupoints - Shenmai (BL62), Shugu (BL65), and Zutonggu (BL66) - finally ending at Zhiyin (BL67) at the tip of the little toe. This entire process includes 58 acupoints and takes approximately 35 minutes. 4. After this, scraping is focused on Weizhong (BL40), Chengshan (BL57), Pucan (BL61), and Shenmai (BL62) for about 5 minutes. 5. The scraping procedure starts from the upper body (trunk) and moves down to the lower limbs in the direction of muscle fibers until petechiae appear. Pressure is applied according to the patient's tolerance. Scraping is performed twice weekly, with an interval of 3-4 days between sessions, and alternated between the left and right Bladder Meridians. The treatment course lasts 4 weeks. If the patient is discharged, they are asked to return to the hospital at the scheduled time for scraping and to undergo monitoring of relevant indicators. 6. Precautions: ① Scraping is performed in the direction of the meridians; ② The patient is kept warm and protected from wind and cold after scraping; ③ Even pressure is applied and adjusted to the patient's tolerance; ④ Scraping is avoided within 1 hour after a meal; ⑤ Areas with broken skin are avoided.
Interventions
OTHERControl group（standard treatment and care）
Patients received the following standard treatment and care in accordance with the Diagnostic and Treatment Guidelines for LDH: (1) Clinical observation: For patients in the acute phase, changes was monitored in the location and nature of pain, and a lumbar support belt was used to stabilize the lower back when getting out of bed; (2) During medication, raw, cold, and chilled foods were avoided, and medication was administered as prescribed; (3) A nutritious diet was maintained; alcohol, raw, cold, and spicy foods were avoided; (4) Changes in the patient's emotional state were monitored.
OTHERObservation group（standard treatment supplemented with Gua Sha）
Gua Sha therapy was given along the Bladder Meridian during the Shen period (3:00-5:00 p.m.). The patient sat; a brass Hu Fu copper board (Shanghai Wensha Tang) was held at 45° along the meridian after applying oil. Fast scraping for 5 min on GV14, BL11, BL43, BL44; then alternating fast-slow on the meridian, avoiding face. First, scrape top-down along spine: BL10, BL11, BL12. Then back-shu points: BL13, BL15, BL18, BL19, BL20, BL21, BL22, BL23, BL24, BL25, BL26, BL27, BL28. Then sacral points BL31-BL34. Then lower limb posterior: from BL36 through BL37 to BL40, then down calf via BL55, BL57, BL58 to ankle, passing BL59, BL60, BL61, then lateral foot BL62, BL65, BL66, ending at BL67. Total 58 points for 35 min. Afterwards, focus on BL40, BL57, BL61, BL62 for 5 min. Scraping proceeds from upper trunk to lower limbs, along muscle fibres until petechiae appear; pressure according to tolerance. Twice weekly, 3-4 days apart, alternating left/right meridians, for 4 weeks.
Sponsors
Guangdong Provincial Hospital of Traditional Chinese Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Randomization and Blinding This study used the random number table method for simple randomization and generated an allocation sequence for enrolled participants in a 1:1 ratio. The allocation sequence was preloaded into sequentially numbered, opaque, and sealed envelopes. The envelope corresponding to each participant's number was then opened to determine their unique group assignment. Due to significant differences in treatment regimens between groups, it was difficult to maintain patient blinding. However, the follow-up scoring process used standardized codes to ensure objective and reliable data evaluation. During the efficacy assessment phase, all evaluators were unaware of the patient group assignments and used only codes to identify patients during the assessment process to avoid assessment bias.
Intervention model description
128
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients meeting the diagnostic criteria for LDH according to Traditional Chinese Medicine and Western Medicine * Stable vital signs and absence of severe complications, including concomitant severe cardiovascular, cerebrovascular, hepatic, renal, or hematological diseases * Patients able to cooperate with the entire course of treatment and sign an informed consent form * Patients unsuitable for surgery and experiencing recurrent episodes following treatment
Exclusion criteria
： * Participants unable to continue treatment * Participants developing other serious illnesses during the trial * Participants whose symptoms worsen to the point that emergency measures are required
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Japanese Orthopedic Association (JOA) Score | * "Baseline" * "The second week after intervention" * ''The fourth week after intervention'' | The JOA score ranges from 0 to 29 points. Nine points are allocated to subjective symptoms (3 points for low back pain, 3 points for leg pain or numbness, and 3 points for walking ability), 6 points for objective signs (2 points each for the SLR test, motor deficits, and sensory deficits), and 14 points for limitations in daily living activities. A higher score indicates better lumbar spine function, whereas a lower score indicates poorer function. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| CRP Sample Collection and Testing | * ''Baseline'' * ''The fourth week after intervention'' | Serum sample was prepared by drawing 3 mL of fasting venous blood into a dry test tube, followed by centrifugation. The specific enzyme-linked immunosorbent assay was used to measure CRP levels according to the manufacturer's instructions. |
Countries
China
Outcome results
None listed