Huoxue Tongluo decoction combined with acupuncture in the treatment of lumbar disc herniation and its effect on JOA and VAS scores

Abstract

BACKGROUND:

Lumbar disc herniation (LDH) is a common clinical disease of the skeletal system, and its prevalence has been on a rise.

OBJECTIVE:

To evaluate the efficacy of Huoxue Tongluo decoction plus acupuncture in the treatment of lumbar disc herniation and its effectiveness in improving the functional recovery of the patients’ affected joints and mitigating their pain.

METHODS:

In this prospective study, 110 patients with lumbar disc herniation enrolled in our Hospital from June 2019 to June 2021 were collected and randomized to receive either conventional treatment (control group) or Huoxue Tongluo Decoction plus acupuncture (study group).

RESULTS:

Huoxue Tongluo Decoction plus acupuncture resulted in more rapid mitigation of lower extremity symptoms and lumbar symptoms versus conventional treatment ( $P<$ 0.05). Patients receiving traditional Chinese medicine (TCM) showed milder inflammatory responses than those with conventional medication, as evidenced by the lower serum concentrations of tumor necrosis factor- $\alpha$ (TNF- $\alpha$ ), interleukin (IL)-6, and high-sensitivity C-reactive protein (hs-CRP) ( $P<$ 0.05). After treatment, the study group had higher Japanese Orthopedic Association (JOA) scores and lower visual analogue scale (VAS) scores than the control group ( $P<$ 0.05), suggesting that the combination of the herbal decoction and acupuncture provided better functional recovery of the affected joints and pain mitigation for the patients. Furthermore, the lower Pittsburgh sleep quality index (PSQI) scores in patients in the study group indicated better sleep quality of patients after TCM intervention than after conventional treatment ( $P<$ 0.05). Huoxue Tongluo Decoction plus acupuncture was associated with a significantly higher efficacy (94.55%) versus conventional treatment (80%) ( $P<$ 0.05).

CONCLUSIONS:

Huoxue Tongluo Decoction combined with acupuncture significantly offers a viable treatment alternative for lumbar disc herniation with promising treatment outcomes, mitigates patients’ limb pain, and improves their lumbar function and sleep quality. Further trials are, however, required prior to general application in clinical practice.

Keywords

Clinical disease effectiveness functional recovery

1. Introduction

Lumbar disc herniation (LDH) is a common clinical disease of the skeletal system, and its prevalence has been on a rise [1]. Percutaneous intervertebral foramen nucleus pulposus extraction has been widely used in the treatment of LDH because of its advantages of small damage and fast recovery after surgery. For patients with initial onset, mild symptoms and self-remission after rest, non-surgical treatment is recommended, among which integrated traditional Chinese and Western medicine therapy is the most commonly used [2]. Clinical studies have found that lumbar disc herniation is mainly attributed to lumbar disc degenerative disease, trauma, strain, and poor sitting posture. In recent years, traditional Chinese medicine (TCM) has shown great advantages in the clinical treatment of lumbar disc herniation, especially in mitigating pain and restoring damaged nerves. In the theory of TCM, the lumbar protrusion is categorized as “arthralgia” and “back pain”. The lumbus is the external house of the kidney, and renal deficiency triggers functional disorders of the bone and results in the incoordination of the muscles and veins and the stagnation of blood; thus, concurrent treatment of the superficial symptoms and the root cause is essential [3, 4]. The pathological mechanism of lumbar disc herniation resulting in back and leg pain is under the combined effect of mechanical compression, inflammatory response, and autoimmunity. Research suggests that the inflammatory response is the main cause of sciatica in patients with lumbar disc herniation and that the early herniated disc tissue produces a large number of immunoinflammatory mediators, such as interleukin 1 (IL-1), interleukin 6 (IL-6), tumor necrosis factor (TNF- $\alpha$ ), Prostaglandin E2 (PGE2), and phospholipases A2 (PLA2). Therefore, the serum level of immunoinflammatory factors can assess the condition of lumbar disc herniation and facilitate the formulation of therapeutic measures.

In the theory of traditional Chinese medicine, it is believed that the cause of LDH lies in the lack of qi and blood, meridian obstruction, and kidney qi deficiency, and the effects of unclogging meridians and regulating qi and blood can be achieved through acupuncture. Huoxue Tongluo Decoction can reduce inflammatory factors and thus mitigate inflammatory reactions. Currently, no relevant research is available on the treatment of LDH using acupuncture combined with Huoxue Tongluo Decoction. Accordingly, this study prospectively analyzed the clinical data of 110 patients with lumbar disc herniation admitted to our hospital and evaluated the clinical efficacy of Huoxue Tongluo Decoction combined with acupuncture in the treatment of lumbar disc herniation.

2. Materials and methods

2.1 Patient screening and grouping

In this prospective study, 110 patients with lumbar disc herniation enrolled in our hospital from June 2019 to June 2021, were collected and randomized to receive conventional Western treatment (control group) or Huoxue Tongluo Decoction plus acupuncture (study group) by random table method. The study was approved by the ethics committee of the Affiliated Hospital of Guilin Medical College (No. 197-017).

2.2 Inclusion criteria

Met the clinical diagnostic criteria for lumbar disc herniation in the “Diagnosis and Curative Effect Standards of Traditional Chinese Medicine” [5]; with first onset; with pain or numbness, muscle tension symptoms in the waist and lower limbs; who provided written informed consent were recruited.

2.3 Exclusion criteria

With lumbar spinal stenosis; with central lumbar disc herniation complicated with obvious symptoms of cauda equina compression; with lumbar tuberculosis, malignant tumors, or osteoporosis; with obvious surgical indications or candidates for conservative management; with severe organ dysfunction; with incomplete clinical data; with cognitive impairment, communication impairment, and physical activity impairment, were excluded.

2.4 Methods

Patients in the control group received conventional treatment: (1) According to the patient’s condition, an appropriate dose of dexamethasone and mannitol was given intravenously twice daily; (2) A 2-level ultrashort wave treatment was applied, with appropriate light of the neon tube, 10 min daily. With the patient lying on a traction bed and the patient’s waist fixed with a belt, longitudinal traction with an initial traction weight of 20–35 kg was given. The weight gradually increased with the patient’s endurance without exceeding the maximum limit. Continuous traction was performed for 10 minutes, followed by 10 minutes of intermittent traction and 10 minutes of resting, once daily [6, 7, 8, 9].

The study group additionally received Huoxuetongluo Decoction and acupuncture therapy on the base of the control group. (1) Huoxue Tongluo Decoction was composed of 15 g each of Angelicae Sinensis Radix, Salviae Miltiorrhizae Radix et Rhizoma, White Paeony Root, and Suberect Spatholobus Stem, 12 g each of Curcumae Rhizoma, Tangerine Pith, Cyathulae Radix, roasted liquorice root, and Acori Tatarinowii Rhizoma, 10 g each of Pericarpium Citri Reticulatae Viride, Sparganii Rhizoma, Safflower, Taxilli Herba, Clematidis Radix et Rhizoma, and Radic Aconiti Kusnezoffii Preparata, and 8 g each of Pawpaw and Aconiti Radix Cocta. The above herbs were decocted with water, with a half dose administered in the morning and a half in the evening. (2) Acupuncture was performed on the Shenshu, Guanyuan, Dachangshu, Yanglingquan, Kunlun, Chengshan, Huantiao and Weizhong points on both sides With the patient in a prone position, a 0.25 $\times$ 40 mm acupuncture needle was used to puncture Yaoshu, Weizhong, Yanglingquan, and Chengshan acupoints with a puncturing depth of 1 inch each by fast acupuncture, and Huantiao and Kunlun acupoints were obliquely punctured with a puncturing depth of 2 inches and 0.6 inches. Through the twisting and lifting technique, in wake of the feeling of soreness in patients, 2 cm moxa sticks were placed on the needle handles of the Dachangshu, Guanyuan, and Shenshu acupoints on both sides, insulation paper was then placed on the acupoints, and the moxa sticks were ignited for moxibustion [10, 11, 12]. All enrollments of the control and study groups received appropriate treatment plans for 3 weeks.

2.5 Observational indicators

The patient’s age, gender, herniation stage, body mass index, radioactive pain sites in the lower limbs, straight leg raise test results, and other general information were recorded, and the time-elapsed before symptom disappearance of the two groups of patients after treatment was analyzed. The serum TNF- $\alpha$ and IL-6 levels were determined by enzyme-linked immunosorbent assay, and the patient’s serum high-sensitivity C-reactive protein (hs-CRP) level was determined by the turbidimetric inhibition immunoassay.

The Japanese Orthopedic Association (JOA) [13] was used to evaluate the patients’ lumbar spine function before and after treatment, with a total score of 29 points. The lower the score, the more serious the patient’s lumbar dysfunction.

The patient’s limb pain was assessed using the visual analogue scale (VAS) [14], with a score of 0 to 10 points indicating means painless to unbearable severe pain, which is scored by the patients based on their subjective feelings. The numbers of 0–10 points on this sliding scale correspond to 0–10 points, respectively.

The Pittsburgh sleep quality index (PSQI) [15] was used to assess the patient’s sleep quality before and after treatment, with a maximum score of 21 points. The higher the score, the worse the patient’s sleep quality.

The clinical efficacy of patients was evaluated based on the “Diagnostic Criteria for Diseases and Syndromes of Traditional Chinese Medicine” [13]. Significantly effective: the patient’s waist and lower limb pain is completely mitigated, the degree of leg raising test is above 70^∘, and daily life and work are not affected. Effective: The patient’s waist and lower limb pain is partially mitigated, and limb movement is slightly restricted. The leg raise test results are improved compared with those before treatment, and daily work without weight-bearing can be completed. Ineffective: The patients’ limb pain symptoms do not improve or worsened, and severely compromise daily life and work.

2.6 Statistical analysis

SPSS 20.0 software was used for data analyses and GraphPad Prism 7 (GraphPad Software, San Diego, USA) was used to plot the graphics. The counting data are expressed as [ $n$ (%)] and analyzed using the chi-square test, and the measurement data are expressed by (mean $\pm$ SD) and analyzed using the students’ $t$ -test. $P<$ 0.05 indicates that the difference is statistically significant.

3. Results

3.1 General information

Table 1
Comparison of general information of the two groups of patients ( $n=$ 55)

Indicators	Control group	Study group	$\chi^{2}/t$	$P$
Age (year)	42.89 $\pm$ 2.86	43.14 $\pm$ 2.91	0.454	0.650
Gender (male/female)	28/27	30/25	0.146	0.702
Herniation stage
L3–4	24 (43.64)	22 (40)	0.150	0.699
L4–5	16 (29.09)	17 (30.91)	0.043	0.835
L5–S1	15 (27.27)	16 (29.09)	0.045	0.832
BMI (kg/m²)	22.73 $\pm$ 7.15	23.18 $\pm$ 6.83	0.336	0.736
Radiation pain in lower limbs
Left lower extremity	16 (29.09)	18 (32.73)	0.170	0.680
Right lower extremity	21 (38.18)	19 (34.55)	0.157	0.692
Both legs	8 (14.55)	7 (12.73)	0.077	0.781
Straight leg raise test			0.165	0.684
Unilateral positive	38 (69.09)	36 (65.45)
Bilateral positive	17 (30.91)	19 (34.55)

Table 2

Comparison of the levels of inflammatory factors between the two groups of patients ( $\bar{x}\pm s$ )

Groups		Control group	Observation	$t$	$P$
TNF- $\alpha$ (pg/ml)	Before treatment	22.89 $\pm$ 5.36	23.15 $\pm$ 5.48	4.236	0.126
	After treatment	12.61 $\pm$ 3.31	10.59 $\pm$ 3.23	3.239	0.002
IL-6 (pg/ml)	Before treatment	23.09 $\pm$ 4.47	22.83 $\pm$ 4.26	2.435	0.544
	After treatment	14.31 $\pm$ 3.19	11.42 $\pm$ 2.74	5.097	$<$ 0.001
hs-CRP (mg/L)	Before treatment	13.33 $\pm$ 2.65	13.41 $\pm$ 2.60	2.354	0.414
	After treatment	10.27 $\pm$ 2.35	9.09 $\pm$ 2.26	2.684	0.008

Figure 1.

Comparison of the disappearance time of clinical symptoms between the two groups of patients ( $\bar{x}\pm s$ ). Note: The abscissa indicates the disappearance of symptoms in the lower limbs and the waist, and the ordinate indicates the time, $d$ ; The disappearance time of lower extremity symptoms and lumbar symptoms in the control group were: (17.39 $\pm$ 2.37) and (18.34 $\pm$ 3.45); The disappearance time of lower limb symptoms and lumbar symptoms in the study group were: (13.80 $\pm$ 2.71) and (16.68 $\pm$ 3.72); ^*indicates a significant difference in the disappearance time of lower extremity symptoms between the two groups ( $t=$ 7.375, $P<$ 0.001); ^**indicates that there is a significant difference in the disappearance time of lumbar symptoms between the two groups ( $t=$ 2.426, $P=$ 0.017).

Figure 2.

Comparison of the VAS scores of the two groups ( $\bar{x}\pm s$ ). Note: The abscissa indicates before and after treatment, and the ordinate indicates the score; The VAS scores of the control group before and after treatment were: (6.73 $\pm$ 1.02) and (2.81 $\pm$ 0.79); The VAS scores of the study group before and after treatment were: (6.77 $\pm$ 1.06) and (1.84 $\pm$ 0.62); ^*indicates a significant difference in VAS scores between the two groups of patients after treatment ( $t=$ 7.163, $P<$ 0.001).

The two groups were well-balanced in terms of general information ( $P>$ 0.05) (Table 1).

3.2 Symptoms disappearance time

Huoxue Tongluo Decoction plus acupuncture resulted in more rapid mitigation of lower extremity symptoms and lumbar symptoms versus conventional treatment ( $P<$ 0.05) (Fig. 1).

3.3 Inflammatory factor levels

Patients receiving TCM showed milder inflammatory responses than those with conventional medication, as evidenced by the lower serum concentrations of TNF- $\alpha$ , IL-6, and hs-CRP ( $P<$ 0.05) (Table 2).

3.4 JOA score

After treatment, the study group had higher JOA scores (24.02 $\pm$ 3.53) than the control group (20.51 $\pm$ 3.14) ( $P<$ 0.05), suggesting that the combination of the herbal decoction and acupuncture provided better functional recovery of the affected joints for the patients.

3.5 VAS score

The VAS scores of the study group after treatment were significantly lower than those of the control group ( $P<$ 0.05) (Fig. 2).

3.6 PSQI score

The lower PSQI scores in patients in the study group indicated better sleep quality of patients after TCM intervention than after conventional treatment ( $P<$ 0.05) (Table 3).

Table 3
Comparison of PSQI scores between the two groups ( $x\pm s$ )

Groups	$n$	Before treatment	After treatment
Control group	55	12.34 $\pm$ 2.18	9.58 $\pm$ 1.27
Study group	55	12.28 $\pm$ 3.15	7.25 $\pm$ 1.13
$t$			10.165
$P$			$<$ 0.001

3.7 Clinical efficacy

All patients completed treatment as per course and did not find any significant adverse effects. In the control group, 11 cases were ineffective, 23 cases were effective, 21 cases were significantly effective, and 44 cases received effective treatment in total. In the study group, 3 cases were ineffective, 15 cases were effective, 37 cases were significantly effective, and 52 cases received effective treatment in total. Huoxue Tongluo Decoction plus acupuncture was associated with a significantly higher efficacy (94.55%) versus conventional Western treatment (80.00%) ( $\chi^{2}=$ 5.238, $P=$ 0.022).

4. Discussion

Pathological injury and physiological degeneration may lead to degeneration of the intervertebral disc and herniated nucleus pulposus tissue, which compresses the cauda equina nerve in the spinal canal or stimulates the local production of inflammatory factors, resulting in pain, weakness, and numbness in the waist and lower limbs [14]. Surgery may increase the risk of intervertebral disc infection and postoperative local adhesions, so non-surgical treatments are recommended [15]. However, research has demonstrated unsatisfactory treatment results after non-surgical treatment methods of Western medicine [16]. Thus, exploration of safe and effective treatments to relieve the symptoms of patients with lumbar disc herniation remains one of the most pressing clinical issues to be addressed. In TCM, “wind, cold, dampness, blood stasis, Qi stagnation” are influencing factors of lumbar disc herniation, with renal-Qi deficiency and blood biochemical disorders being the main causes [17, 18]. The lumbus is the external house of the kidney, and deficiency of the kidney causes the insufficiency of Qi and blood in the lumbus and degenerative diseases such as tendons and spasms. Patients with kidney deficiency are susceptible to external pathogens, such as sedentariness and trauma, which will result in the occlusion of the affected meridian, poor Qi, and repeated pain in the lumbar spine, for which no radical cure has been explored [19, 20, 21, 22]. Therefore, lumbar disc herniation is the internal deficiency of the liver and kidney and the external excess of exogenous pathogens such as cold and rheumatism, which requires the replenishment of the liver and kidney and promotion of blood circulation to clear the collaterals and expel wind and cold, to treat both symptoms and root causes.

In the present study, patients in the study group received self-made Huoxue Tongluo Decoction and acupuncture. In the formula of the decoction, Cyathulae Radix removes blood stasis and clears the menstrual flow, Curcumae Rhizoma promotes qi and relieves pain, Salviae Miltiorrhizae Radix et Rhizoma removes heat in the blood to eliminate carbuncle, Angelicae Sinensis Radix nourishes blood and promotes blood circulation, Suberect Spatholobus Stem invigorates blood circulation and energizes blood circulation, White Paeony Root nourishes blood and softens the liver, and Taxilli Herba nourishes liver and kidney, strengthens muscles and bones. The combined use of these drugs invigorates the liver and kidney, clears evil, nourishes the blood, removes blood stasis, and relieves pain. Acupuncture is a TCM treatment method to promote the body’s righteous Qi, so as to expel chill, remove evil pathogens, and relax muscles and collaterals [23, 24]. Acupuncture at Guanyuan acupoint invigorates blood, relieves pain, warms the kidneys, and reinforces Yang. Stimulation at the Huantiao acupoint clears the meridians of the waist and legs, and stimulation at Yanglingquan point relieves the spasm of the lower limbs. Moreover, acupuncture at the Weizhong acupoint clears the meridian Qi of the Zutaiyang Meridian, and exerts the effects of strengthening muscles and bones, warming the kidney, and dispelling cold. Moxibustion can increase the efficacy of dispelling cold and warming the meridian, with the effect of dredging collaterals and promoting blood circulation.

In the present study, Huoxue Tongluo Decoction plus acupuncture resulted in a more rapid disappearance of lower extremity symptoms and lumbar symptoms and provided better mitigation of pain and inflammatory response than conventional treatment. Lumbar disc herniation triggers non-bacterial inflammation, and IL-6 is an inflammatory mediator that interferes with the metabolism and synthesis of the matrix and aggravates the degeneration of the lumbar disc. TNF- $\alpha$ promotes the release of inflammatory response transmitters, damages related nerves, and leads to low back pain. The results of the present research suggest that Huoxue Tongluo Decoction combined with acupuncture could effectively reduce the inflammatory response in patients. Not withstanding the elusive mechanism of action, related animal studies have revealed that Cyathulae Radix, Curcumae Rhizoma, and Suberect Spatholobus Stem have promising anti-inflammatory effects. In addition, Salviae Miltiorrhizae Radix et Rhizoma and Angelicae Sinensis Radix can eliminate blood circulation obstacles secondary to nerve root compression, and effectively enhance the body’s immunity. Acupuncture also exerts anti-inflammatory and analgesic effects to reinforce the body’s immune function. Furthermore, after treatment, the study group had higher JOA scores in contrast to the control group ( $P<$ 0.05), which is consistent with the research results by Javanshir et al. [25]. Huoxue Tongluo Decoction plus acupuncture resulted in significantly lower PSQI scores in patients versus conventional treatment, and Huoxue Tongluo Decoction plus acupuncture was associated with a significantly higher efficacy (94.55%) versus conventional Western treatment (80%). These results further demonstrated that Huoxue Tongluo Decoction combined with acupuncture could enhance the treatment efficacy of lumbar disc herniation, and improve the lumbar function and sleep quality of patients. The limitation of this study is that the sample size is small, and it is a single-center study, for which the sample size will be expanded to carry out multi-center research in future studies.

5. Conclusion

Ethical approval

The study was approved by the ethics committee of the Affiliated Hospital of Guilin Medical College (No. 197-017).

Funding

The study was supported by ‘The scientific research and technology development plan project in Qinzhou’ (Contract no. 20212609) and ‘The scientific research and technology development plan project in Guilin’ (Contract no. 20210227-7-3).

Informed consent

Written informed consent was obtained from patients involved in the study.

Author contributions

ZZ and KJ designed the research study. FQ performed the research. RN conducted experiments and analyzed the data. All authors contributed to editorial changes in the manuscript and read and approved the final manuscript.

Footnotes

Acknowledgments

Not applicable.

Conflict of interest

The authors declare that they have no competing interests.

References

P-F

Jiang

Liu

J-T

, et al. Traditional Chinese Medicine Treatment for Ruptured Lumbar Disc Herniation: Clinical Observations in 102 Cases. Orthopaedic Surgery. 2014; 6(3): 229-235.

Ahsan

Hossain

Khan

MSI

, et al. Lumbar revision microdiscectomy in patients with recurrent lumbar disc herniation: A single-center prospective series. Surg Neurol Int. 2020; 11: 404.

Cai

Gong

Dong

, et al. Combined Therapies of Modified Taiyi Miraculous Moxa Roll and Cupping for Patients with Lumbar Intervertebral Disc Herniation. Evidence-based Complementary and Alternative Medicine: eCAM. 2018; 2018(4): 6754730.

Zhong

Huang

Y-L

Y-M

, et al. Puerarin alleviate radicular pain from lumbar disc herniation by inhibiting ERK-dependent spinal microglia activation. Neuropeptides: An International Journal. 2018: 7230-37.

Suri

Pearson

Zhao

, et al. Pain Recurrence After Discectomy for Symptomatic Lumbar Disc Herniation. Spine. 2017; 42(10): 755-763.

Yin

Z-H

Zhu

C-X

G-X

, et al. Acupuncture and/or moxibustion for the treatment of lumbar disc herniation:quality assessment of systematic reviews. Traditional medical research. 2020; 5(4): 282-294.

Qin

Liu

Hao

, et al. Percutaneous Endoscopic Lumbar Discectomy Versus Posterior Open Lumbar Microdiscectomy for the Treatment of Symptomatic Lumbar Disc Herniation: A Systemic Review and Meta-Analysis. World Neurosurgery. 2018: 120352-362.

Zhang

Guo

Zhao

, et al. Therapeutic effects of chinese osteopathy in patients with lumbar disc herniation. The American Journal of Chinese Medicine. 2013; 41(5): 983-994.

K-M

Zhang

L-H

, et al. Systematic evaluation and meta-analysis of acupuncture treatment for residual pain after lumbar disc herniation. Journal of Hainan Medical University. 2020; 26(3): 16-21.

10.

Zhang

Chen

, et al. Comparison Between Oblique Pulling Spinal Manipulation and Other Treatments for Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Journal of manipulative and physiological therapeutics: JMPT. 2018; 41(9): 771-779.

11.

Han

Zhang

Yang

, et al. Huoxue-Tongluo-Lishui-Decoction is visual-protective against retinal ischemia-reperfusion injury. Biomedicine & Pharmacotherapy. 2020; 125.

12.

Sun

Zhuo

L-G

Wei

, et al. A Systematic Review and Meta-analysis for Duhuo Jisheng Decoction Combined with Manipulation in Treatment of Lumbar Disc Herniation. Journal of Hainan Medical University. 2020; 26(1): 32-38.

13.

Ishibashi

Adachi

Koga

, et al. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury – Secondary publication. J Orthop Sci. 2020; 25(1): 6-45.

14.

Sung

. The Visual Analogue Scale for Rating, Ranking and Paired-Comparison (VAS-RRP): A new technique for psychological measurement. Behav Res Methods. 2018; 50(4): 1694-1715.

15.

Zhou

Zhao

, et al. Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach for L4/5 and L5/S1 Two-Level Disc Herniation. Orthop Surg. 2021; 13(3): 979-988.

16.

Ahsan

Khan

Zaman

Ahmed

Montemurro

Chaurasia

. Fusion versus nonfusion treatment for recurrent lumbar disc herniation. J Craniovertebr Junction Spine. 2021; 12(1): 44-53.

17.

Moon

M-S

Kim

D-H

Yoon

M-G

, et al. Facet geometry and unilateral lumbar disc herniation. Journal of Musculoskeletal Research. 2016; 19(3): 1650016.

18.

Tsarouhas

Soufla

Tsarouhas

, et al. Molecular profile of major growth factors in lumbar intervertebral disc herniation: Correlation with patient clinical and epidemiological characteristics. Molecular Medicine Reports. 2017; 15(4): 2195-2203.

19.

Lurie

Moses

Tosteson

ANA

, et al. Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation. Spine. 2013; 38(14): 1216-1225.

20.

Radcliff

Freedman

Hilibrand

, et al. Does opioid pain medication use affect the outcome of patients with lumbar disc herniation? Spine. 2013; 38(14): E849-E860.

21.

Tang

Y-Z

Moore-Langston

Lai

G-H

, et al. Anterior herniation of lumbar disc induces persistent visceral pain:discogenic visceral pain. Chinese Journal of Medicine. 2013; 126(24): 4691-4695.

22.

H-H

Wang

X-Q

Zhang

Y-L

, et al. Efficacy evaluation for the treatment of unstable lumbar disc herniation by traditional and modified lamina osteotomy replantation. Chinese Journal of Medicine. 2013; 126(15): 2840-2845.

23.

Ahn

Jang

I-T

Kim

W-K

. Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation. Clinical Neurology and Neurosurgery. 2016: 14711-17.

24.

Sadek

A-R

Dare

McGillion

, et al. Lumbar intravertebral disc herniation secondary to idiopathic calcific discitis. British Journal of Neurosurgery. 2019; 33(5): 586-590.

25.

Naghmeh

Firooz

Javad

, et al. The distribution of infection with Propionibacterium acnes is equal in patients with cervical and lumbar disc herniation. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2017; 26(12): 3135-3140.

Huoxue Tongluo decoction combined with acupuncture in the treatment of lumbar disc herniation and its effect on JOA and VAS scores

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Keywords

1. Introduction

2. Materials and methods

2.1 Patient screening and grouping

2.2 Inclusion criteria

2.3 Exclusion criteria

2.4 Methods

2.5 Observational indicators

2.6 Statistical analysis

3. Results

3.1 General information

Table 1 Comparison of general information of the two groups of patients ( n = 55)

3.3 Inflammatory factor levels

3.4 JOA score

3.5 VAS score

3.6 PSQI score

Table 3 Comparison of PSQI scores between the two groups ( x ± s )

4. Discussion

5. Conclusion

Ethical approval

Funding

Informed consent

Author contributions

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Comparison of general information of the two groups of patients ( $n=$ 55)

Table 3
Comparison of PSQI scores between the two groups ( $x\pm s$ )