A 46-year-old man with acute, severe lower back pain and immobility caused by a lumbar sprain and L2 facet joint derangement was successfully managed using a rapid spinal adjustment combined with a Liver/Kidney-tonifying and Damp-Heat-clearing herbal decoction.

Case ID: CHC-0074

Case Summary

This case describes a 46-year-old man who presented to the emergency room with acute, debilitating lower back pain and an inability to move following a lumbar sprain 8 hours prior. The original report documented a conventional diagnosis of an L2 facet joint derangement and a TCM assessment of Lumbar Pain driven by Liver and Kidney Deficiency complicated by Internal Damp-Heat. He was managed through a highly integrative approach utilizing “Zhao’s Balanced Spinal Adjustment” to instantly realign the deviated L2 vertebra, followed by a modified combination of Liuwei Dihuang Wan and Simiao San to repair his underlying essence deficiency and clear the systemic damp-heat.

Patient Presentation

• Patient: 46-year-old male (Surname: Zhang).
• Main Complaint: Lumbar sprain with pain, difficulty turning, and immobility for 8 hours.
• History: The patient sought an initial consultation on June 4, 2023. Eight hours prior, he had sprained his lower back, leading to severe pain and a complete inability to move or turn his body. He did not experience any lower limb numbness.
• Associated Symptoms: He presented with a dry and slightly bitter mouth, alongside general fatigue.

Examination and Diagnosis

• Physical Exam: The lumbar spine showed scoliosis with a straightened physiological curve. The L2 spinous process was slightly deviated to the left and exhibited localized tenderness. Straight leg raise and strengthening tests were negative bilaterally. Lower limb muscle strength, muscle tone, and skin sensation were all completely normal.
• Imaging (X-ray): Confirmed a straightened lumbar physiological curvature and a leftward deviation of the L2 spinous process.
• Conventional Diagnosis: 2nd Lumbar (L2) facet joint derangement.
• TCM Tongue and Pulse: The tongue was pale red with a thin, yellow, greasy coating. The pulse was fine and slippery (脉细滑).

TCM Assessment

The original practitioner interpreted the presentation as Lumbar Pain driven by Liver and Kidney Deficiency with Internal Damp-Heat (腰痛 – 肝肾亏虚，湿热内蕴).

According to the holistic principles of yin and yang Chinese Medicine the lower back is the “mansion of the Kidneys.” In this patient, excessive sexual activity (房劳过度) had gradually depleted his Liver and Kidney essence over time. Because the Liver governs the sinews and the Kidneys govern the bones, this underlying deficiency left his spinal ligaments and joints weak, making him highly susceptible to an acute sprain.

Furthermore, the hot and humid climate of southern China led to an accumulation of internal damp-heat, which manifested as his dry, bitter mouth and the yellow, greasy tongue coating. The fine and slippery pulse provided objective confirmation of this dual pathology: underlying deficiency (fine) complicated by active dampness (slippery).

Treatment Approach

The primary treatment principle was to tonify and benefit the Liver and Kidneys, clear and resolve damp-heat (补益肝肾，清利湿热). The strategy utilized an immediate mechanical bone-setting maneuver to correct the acute vertebral misalignment and stop the severe pain, followed by a 30-day course of internal herbs to rebuild the structural foundation and clear the environmental dampness.

Interventions and Herbal Formulas

• Zhao’s Balanced Spinal Adjustment (Manipulative Therapy):
  • Preparation: The practitioner first applied soft tissue massage (separating sinews, pressing, and kneading) to soothe the severe muscle spasms and invigorate local blood flow.
  • Spinal Adjustment: The practitioner used their right thumb to press firmly against the deviated L2 spinous process. With the left hand supporting the patient’s torso, the practitioner guided the spine into gradual flexion and rotation, bending laterally toward the deviated side. With a coordinated thrust and rotational push, the spinous process was guided back into place. A palpable “popping” or jumping sensation was felt under the thumb as the joint successfully realigned.
  • Result: This immediately restored the joint’s normal anatomical position (achieving “bones closed and sinews in their grooves” – 骨合缝、筋入槽) and released the pressure on the joint capsule. After the maneuver, the patient’s severe back pain was instantly eliminated, and he could move freely.
• Internal Herbal Formula (June 4, 2023): An 11-herb decoction combining the core frameworks of Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and components of Simiao San (Four-Marvel Powder).
  • Tonifying Liver and Kidneys (Three Tonics): Shu Di Huang (Prepared Rehmannia, 30g) is used in a heavy dose as the sovereign herb to deeply nourish Kidney Yin and fill the marrow. Shan Yu Rou (Cornus, 15g) nourishes the Liver and Kidneys, while Shan Yao (Chinese Yam, 15g) tonifies Spleen Yin. Du Zhong (15g) is added to further strengthen the sinews and bones.
  • Draining Turbidity (Three Sedations): Ze Xie (12g) drains dampness to prevent the heavy Shu Di from causing stagnation. Dan Pi (Moutan, 12g) clears ministerial fire, and Fu Ling (Poria, 20g) leaches dampness to support Spleen transport.
  • Clearing Damp-Heat and Unblocking: Huang Bo (9g) and Cang Zhu (12g) powerfully dry dampness and clear heat from the lower body. Yi Yi Ren (Coix Seed, 20g) clears damp-heat from the Yangming channel to benefit the sinews and joints. Niu Xi (15g) invigorates blood, strengthens the bones, and guides all the medicinal effects straight down to the lower back and legs.
  • Administration: 30 doses prescribed, water decocted, taken warm after breakfast and dinner.

Follow-Up

• One Month Later: During a follow-up visit, the patient reported absolutely no lower back pain. His mobility was completely free, and he was able to fully resume his normal daily work and sports activities.

Why This Case Is Interesting (Clinical Reasoning)

This case perfectly illustrates the TCM principle of treating both the “branch” (the acute symptom) and the “root” (the underlying cause) in orthopedic trauma.

The patient presented in extreme, acute pain, unable to move—the branch. Professor Zhao instantly resolved this using a highly precise spinal rotation adjustment, mechanically snapping the L2 facet joint back into alignment and providing immediate pain relief without the use of painkillers or injections. However, he did not stop there. He recognized that a 46-year-old man shouldn’t suffer such a severe structural failure from a simple movement unless his foundational “root” was weak. By prescribing a heavy 30-day course of Liuwei Dihuang Wan and Simiao San, he rebuilt the patient’s depleted Kidney essence and cleared the environmental damp-heat, effectively strengthening the ligaments and joints from the inside out to prevent future sprains.

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Source Original source: Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】招仕富：腰椎小关节紊乱治疗验案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: August 19, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation