Lumbar disc herniation (LDH) is a major cause of low back pain. Acupuncture combined with tuina is widely used, but whether fascial meridian–guided treatment provides greater benefit than traditional meridian–guided treatment remains unclear.
Methods
This single-center retrospective cohort study included adults aged 18–70 years with MRI-confirmed L4/5 or L5/S1 LDH treated with ≥4 weeks of acupuncture plus tuina (January 2020–December 2023). Patients were categorized by treatment model. Twelve-month outcomes were assessed at follow-up visits or by structured telephone interview. Propensity score matching (1:1) was performed for age, sex, BMI, symptom duration, and baseline visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Primary outcomes were pain relief (VAS reduction ≥50%) and functional improvement (ODI reduction ≥10 points). Secondary outcomes included recurrence, surgery, 36-item Short Form (SF-36) improvement, and adverse events.
Results
Of the 180 patients enrolled, 150 matched patients (75 per group) were analyzed. At 12 months, pain relief occurred in 70% of the fascial group and 66% of the meridian group (risk difference 4.0%, 95% CI −10.8% to 18.8%; p = 0.48) and functional improvement in 62% versus 60% (risk difference 2.7%, 95% CI −12.9% to 18.2%; p = 0.72). Recurrence (22% vs 28%), surgery (12% vs 14%), and SF-36 improvement (64% vs 61%) were similar between groups. Mild adverse events occurred in <5% of patients, with no serious complications.
Conclusions
Fascial and traditional meridian–guided acupuncture combined with tuina were associated with comparable 12-month outcomes and good safety. Prospective randomized studies are warranted.
ChenX. M.WenY.ChenS.JinX.LiuC.WangW.KongN.LingD.-Y.HuangQ.ChaiJ.-E.ZhaoX.-L.LiJ.XuM.-S.JiangZ.DuH.-G. (2023). Traditional Chinese manual therapy (tuina) reshape the function of default mode network in patients with lumbar disc herniation. Frontiers in Neuroscience, 17, 1125677. https://doi.org/10.3389/fnins.2023.1125677
3.
ChengZ. X.ZhengY. J.FengZ. Y.FangH. W.ZhangJ. Y.WangX. R. (2021). Chinese Association for the Study of Pain: Expert consensus on diagnosis and treatment for lumbar disc herniation. World Journal of Clinical Cases, 9(9), 2058–2067. https://doi.org/10.12998/wjcc.v9.i9.2058
4.
DanazumiM. S.NuhuJ. M.IbrahimS. U.FalkeM. A.RufaiS. A.AbduU. G.AdamuI. A.UsmanM. H.Daniel FredericA.YakasaiA. M. (2023). Effects of spinal manipulation or mobilization as an adjunct to neurodynamic mobilization for lumbar disc herniation with radiculopathy: A randomized clinical trial. Journal of Manual & Manipulative Therapy, 31(6), 408–420. https://doi.org/10.1080/10669817.2023.2192975
5.
DengR.HuangZ.LiX.PeiX.LiC.ZhaoJ. (2020). The effectiveness and safety of acupuncture in the treatment of lumbar disc herniation: Protocol for a systematic review and meta-analysis. Medicine (Baltimore), 99(12), e18930. https://doi.org/10.1097/MD.0000000000018930
6.
DowerA.ChatterjiR.SwartA.WinderM. J. (2016). Surgical management of recurrent lumbar disc herniation and the role of fusion. Journal of Clinical Neuroscience, 23, 44–50. https://doi.org/10.1016/j.jocn.2015.04.024
7.
FanZ.JiaS.ZhouX.LiC.ShaoJ.LiuX.LiaoY.XuY.HeD.WuS.ZhangX. (2025). Clinical efficacy of Tuina therapy combined with traditional Chinese exercises in the treatment of symptomatic lumbar disc herniation: A multicentre randomised controlled trial protocol. Frontiers in Neurology, 16, 1497933. https://doi.org/10.3389/fneur.2025.1497933
8.
HincapiéC. A.CassidyJ. D.CôtéP.RampersaudY. R.JadadA. R.TomlinsonG. A. (2018). Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: A belief elicitation study. European Spine Journal, 27(7), 1517–1525. https://doi.org/10.1007/s00586-017-5295-0
9.
HuY.ZhaoX.ChenM.ZhouF.ZhangX.ChenC.WanQ.HeS. (2024). Massage ameliorates lumbar disc herniation-related radicular pain in rats by suppressing TLR4/NLRP3 inflammasome signaling transduction. Journal of Orthopaedic Surgery, 32(1), 10225536241238638. https://doi.org/10.1177/10225536241238638
10.
HuangF.XiaoZ.ZhanX.ZengP.ZhaoS.GuoR.TianQ.FanZ.WuS. (2022). Tuina combined with adjuvant therapy for lumbar disc herniation: A network meta-analysis. Complementary Therapies in Clinical Practice, 49, 101627. https://doi.org/10.1016/j.ctcp.2022.101627
11.
JiangC.HuangH.ChenL.JiangJ.ZhangH.ChenJ.ChenS.LinZ. (2024). Functional magnetic resonance imaging analysis of the clinical effect and cerebral mechanism of tuina in lumbar disc herniation: Protocol for a randomized controlled parallel group trial. JMIR Research Protocols, 13, e63852. https://doi.org/10.2196/63852
12.
LiuZ. F.WangH. R.YuT. Y.ZhangY. Q.JiaoY.WangX. Y. (2022). Tuina for peripherally-induced neuropathic pain: A review of analgesic mechanism. Frontiers in Neuroscience, 16, 1096734. https://doi.org/10.3389/fnins.2022.1096734
13.
MiaoZ.TongZ.YeJ.LengS.WangM.HuA.ZhangJ.DaiX.LiangJ.GengY.ChenL.YeB.DongY. (2021). Tuina for lumbar disc herniation: A protocol for systematic review and meta analysis. Medicine (Baltimore), 100(1), e24203. https://doi.org/10.1097/MD.0000000000024203
14.
MoZ.LiD.ZhangR.ChangM.YangB.TangS. (2019). Comparisons of the effectiveness and safety of Tuina, acupuncture, traction, and Chinese herbs for lumbar disc herniation: A systematic review and network meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2019, 6821310. https://doi.org/10.1155/2019/6821310
15.
MusaG.NamonjeW.SimfukweK.FamiliaK. M.MwelaB. M.NdandjaD. T. K.RamirezM. D. J. E.ChilawaS.SichizyaK. A.ChikoyaL.ChmutinG. E.DemetriadesA. K. (2025). Pediatric lumbar disc herniation: A systematic review of the state of management strategies and outcomes (2010-2024). Journal of Craniovertebral Junction and Spine, 16(1), 34–40. https://doi.org/10.4103/jcvjs.jcvjs_3_25
16.
PojskicM.BissonE.OertelJ.TakamiT.ZygourakisC.CostaF. (2024). Lumbar disc herniation: Epidemiology, clinical and radiologic diagnosis WFNS spine committee recommendations. World Neurosurgery: X, 22, 100279. https://doi.org/10.1016/j.wnsx.2024.100279
17.
QinX.SunK.XuW.GaoJ.JiangH.ChenW.ZhangL.LiZ.LiW.YuanP.YangK.TongP.ZhongY.ZhuX.WanX.HeC.WangY.XuX.HuangY. … ZhuL. (2024). An evidence-based guideline on treating lumbar disc herniation with traditional Chinese medicine. Journal of Evidence-Based Medicine, 17(1), 187–206. https://doi.org/10.1111/jebm.12598
18.
Samuelly-LeichtagG.EisenbergE.ZoharY.AndraousM.EranA.SviriG. E.KeynanO. (2022). Mechanism underlying painful radiculopathy in patients with lumbar disc herniation. European Journal of Pain, 26(6), 1269–1281. https://doi.org/10.1002/ejp.1947
19.
ShokriE.KamaliF.SinaeiE.GhafarinejadF. (2018). Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: A quasi-experimental study. Chiropractic & Manual Therapies, 26, 16. https://doi.org/10.1186/s12998-018-0185-z
20.
SongP.SunW.ZhangH.FangM.LinZ.WuZ.XinZ.ZhizhenL.MinF. (2018). Possible mechanism underlying analgesic effect of Tuina in rats may involve piezo mechanosensitive channels within dorsal root ganglia axon. Journal of Traditional Chinese Medicine, 38(6), 834–841. https://doi.org/10.1016/S0254-6272(18)30982-8
21.
TangS.MoZ.ZhangR. (2018). Acupuncture for lumbar disc herniation: A systematic review and meta-analysis. Acupuncture in Medicine, 36(2), 62–70. https://doi.org/10.1136/acupmed-2016-011332
22.
TragerR. J.DanielsC. J.PerezJ. A.CasselberryR. M.DusekJ. A. (2022). Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: Retrospective cohort study using United States’ data. BMJ Open, 12(12), e068262. https://doi.org/10.1136/bmjopen-2022-068262
23.
WanZ. Y.ZhangJ.ShanH.LiuT. F.SongF.SamartzisD.WangH.-Q. (2023). Epidemiology of lumbar degenerative phenotypes of children and adolescents: A large-scale imaging study. Global Spine Journal, 13(3), 599–608. https://doi.org/10.1177/21925682211000707
24.
WangJ.LiangC.ZengF.FanL.ZhuangJ. (2022). Comparison of needle-warming moxibustion and other physical therapies for lumbar disc herniation: A meta-analysis. Computational and Mathematical Methods in Medicine, 2022, 2986223. https://doi.org/10.1155/2022/2986223
25.
YanL.ZhangJ.WangX.ZhouQ.WenJ.ZhaoH.GuoK.ZengJ. (2024). Efficacy of acupuncture for lumbar disc herniation: Changes in paravertebral muscle and fat infiltration - a multicenter retrospective cohort study. Frontiers in Endocrinology, 15, 1467769. https://doi.org/10.3389/fendo.2024.1467769
26.
YaoY.ZhenniZ.FengqinC.YufeiL.XiangtianP.XuX.SunZ. (2023). Effectiveness of moxibustion alone on lumbar disc herniation: A metaanalysis of randomized controlled trials. Journal of Traditional Chinese Medicine, 43(1), 14–26. https://doi.org/10.19852/j.cnki.jtcm.20221108.001
27.
YuanS.HuangC.XuY.ChenD.ChenL. (2020). Acupuncture for lumbar disc herniation: Protocol for a systematic review and meta-analysis. Medicine (Baltimore), 99(9), e19117. https://doi.org/10.1097/MD.0000000000019117
28.
ZhangW.LiuH.LeX.SongK.YangF.CuiZ.ZhaoW. (2022). Acupuncture for postoperative pain of lumbar disc herniation: A systematic review and meta-analysis. Medicine (Baltimore), 101(49), e32016. https://doi.org/10.1097/MD.0000000000032016
29.
ZhongX.LiuJ.WangY.ZhangL.ZhangH. (2021). Which of the acupuncture treatment regimen for lumbar disc herniation is more effective and safer: A protocol for systematic review and network meta-analysis. Medicine (Baltimore), 100(12), e25199. https://doi.org/10.1097/MD.0000000000025199
30.
ZhongZ.JinK.QinF.NieR. (2024). Huoxue Tongluo decoction combined with acupuncture in the treatment of lumbar disc herniation and its effect on JOA and VAS scores. Journal of Back and Musculoskeletal Rehabilitation, 37(2), 277–283. https://doi.org/10.3233/BMR-220347
31.
ZileliM.OertelJ.SharifS.ZygourakisC. (2024). Lumbar disc herniation: Prevention and treatment of recurrence: WFNS spine committee recommendations. World Neurosurgery: X, 22, 100275. https://doi.org/10.1016/j.wnsx.2024.100275
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