A patient with chronic low back pain stratified at the initial visit by the Keele STarT Back Screening Tool and then treated with acupuncture and saibokuto / 全日本鍼灸学会雑誌

[Introduction] Psychosocial factors are associated with chronic low back pain (CLBP), but there are no known reports of screening for psychosocial factors and combined acupuncture and Kampo treatment for this. We present the case of a patient with CLBP with neuralgia of the posterior right thigh whose quality of life (QOL) improved after evaluation of psychological factors and treatment with acupuncture and saibokuto.[Case presentation] A 38-year-old woman developed low back pain with neuralgia in the posterior right thigh in August of the X year. She visited a nearby orthopedic clinic and was diagnosed with a lumbar disc herniation. In November she visited a nearby psychiatric clinic because she noticed dizziness, was diagnosed with an adjustment disorder and was prescribed bromazepam. Six months later, she was diagnosed with sciatica by an orthopedic surgeon at our hospital. In the following month, she visited the psychiatrist at our hospital and was diagnosed with depression in April. In April, she also visited our department, hoping for improvement of her low back pain and neuralgia in the posterior right thigh. Neurological and orthopedic manual examinations showed normal results, but pain in the lumbar region when flexing the trunk and baikakuki and kyo-kyo-kuman were noted. The Keele STarT Back Screening Tool classified her under medium risk, and the Roland-Morris Disability Questionnaire (RDQ) showed a score of 16 with a deviation score of 1.22. We administered acupuncture and saibokuto to improve her symptoms. The acupuncture treatment was performed on the right L2/L3 lateral sacral border, piriformis equivalent area, BL37, and BL40. As a result, after the third acupuncture treatment, her RDQ score improved to 2 points and the deviation score to 50.14 points.[Discussion] Our results suggest that acupuncture and saibokuto may improve the QOL of CLBP patients with neuralgia in the lower limbs who have psychological factors.

Relationship Between Neurological Degenerative Disorders and a Blood Deficiency Using ki-ketsu-sui Score / 日本東洋医学雑誌

We evaluated body constituents patterns of 74 consecutive patients with neurological degenerative disorders. They comprise Parkinson's disease (n = 38), amyotrophic lateral sclerosis (n = 19), and multiple system atro­phy (n = 17). We compared body constituents patterns between them and 149 consecutive patients with other neurological diseases of the same age. We used ki-ketsu-sui scores to evaluate body constituents patterns in all cases. Ki-ketsu-sui scores measure six factors : qi deficiency (kikyo), qi stagnation (kiutsu), qi counterflow (kigyaku), blood deficiency (kekkyo), blood stasis (oketsu), and fluid retention (suitai). As a result of multi­variate analysis, neurological degenerative disorders had large weight of blood deficiency, fluid retention and qi stagnation. Their adjusted odds ratios (95% confidence interval) were 3.02 (1.43-­6.48), 2.37 (1.13-­5.11), 2.33 (1.01-­5.44), respectively. Most relevant factor to neurological degenerative disorders was a blood defi­ciency. Taking into consideration a prescription of “shimotsuto rui” may contribute to alleviate patient's suf­fering. In addition to subjective symptoms, we need an oriental medicine scale such as pulse, tongue, and ab­dominal examinations to judge a therapeutic effect of Kampo medicine.

Characterization of the Body Constituent Patterns for Symptomatic Acute Cerebral Infarction Using qi-ketsu-sui Score / 日本東洋医学雑誌

We evaluated body constituent patterns of 130 consecutive patients with symptomatic acute cerebral infarction. They comprise lacunar infarction (n = 47), atherothrombotic infarction (n = 70), cardiogenic embolism (n = 11), and other type of infarction (n = 2). We compared body constituent patterns between them and 93 consecutive patients with other neurological diseases of the same age. We used qi-ketsu-sui scores to evaluate body constituent patterns in all cases. Qi-ketsu-sui scores measure six factors : qi deficiency (kikyo), qi stagnation (kiutsu), qi counterflow (kigyaku), blood deficiency (kekkyo), blood stasis (oketsu), and fluid retention (suitai). As a result of multivariate model analysis, symptomatic acute cerebral infarction had the largest weight of blood stasis and an adjusted odds ratio (95% confidence interval) was 4.6 (2.45-8.91). Even when gender as a confounding factor was adjusted by stratified analysis, adjusted odds ratios of blood stasis (95% confidence interval) were 7.46 (3.02-20.25) for males and 2.63 (1.02-7.11) for females, and those were maximum. The point (median, interquartile range) of blood stasis was more severe in acute cerebral infarction (24 points, 18-33 points) than other neurological diseases (16 points, 9-23 points). We examined relationships between body constituent patterns and clinical disease type, severity at hospitalization, and sex in patients with symptomatic acute cerebral infarction. Ratio of blood stasis was the largest in any clinical disease type, severity and sex. Blood stasis seemed to be the most important factor in symptomatic acute cerebral infarction.