A 44-year-old woman with a one-year history of lumbar disc herniation was managed using a combined internal and external herbal strategy to clear damp-heat and unblock the meridians.

Case ID: CHC-0021

Case Summary

This case describes a 44-year-old woman who presented with recurrent lower back pain and left leg numbness for one year, previously diagnosed via MRI as an L4-L5 lumbar disc herniation. The original report documented a TCM assessment of Lumbar Pain driven by Damp-Heat Bi (Impediment) Obstruction. The patient was managed through a dual therapeutic approach, utilizing a systemic internal decoction to clear the damp-heat alongside a localized external herbal compress to vigorously invigorate blood and relieve pain.

Patient Presentation

• Patient: 44-year-old female.
• Main Complaint: Recurrent lower back pain with left leg numbness for one year.
• History: The patient experienced persistent lower back pain that restricted her movement. Notably, the pain worsened during rainy weather and slightly improved after physical activity. She had previously undergone an MRI at another hospital, which revealed an L4-L5 lumbar disc herniation. Prior physical therapy treatments had yielded poor results. Associated symptoms included poor sleep, poor appetite, thirst, and yellow urine. Her bowel movements and menstrual cycle were normal.

Examination and Diagnosis

• Conventional Diagnosis: Lumbar disc herniation.
• TCM Tongue and Pulse: The tongue was red with a slightly yellow, greasy coating. The pulse was slippery and rapid (滑数).

TCM Assessment

The original practitioner interpreted the presentation as Lumbar Pain driven by Damp-Heat Bi Obstruction (腰痛 – 湿热痹阻证).

According to the principles of Yin and Yang Chinese Medicine, the lower back is considered the residence of the Kidneys, and patients over the age of forty often present with underlying Kidney deficiency. However, the original report noted that the patient lived in the Lingnan region (known for its hot and damp climate). External damp-heat invaded her weakened lower back, creating a heavy, stagnant blockage in the meridians.

Because dampness is a heavy, sticky pathogen, her symptoms predictably worsened on rainy days (when environmental dampness increased) and slightly improved after movement (which temporarily stimulated meridian circulation). Furthermore, the red tongue, yellow greasy coating, and yellow urine provided clear objective evidence that the trapped dampness had transformed into pathological heat, resulting in localized inflammation.

Treatment Approach

The primary treatment principle was to clear heat, resolve dampness, unblock the collaterals, and stop pain (清热利湿，通络止痛). To effectively treat the deep-seated blockage, the practitioner employed a two-pronged strategy: internal medicine to change the body’s systemic fluid environment, and external medicine to directly target the localized stasis in the lower back.

Herbal Formulas and Modifications

• Internal Formula (October 14, 2022): The practitioner prescribed a modified version of the classic Si Miao Wan (Four Marvels Pill).
  • Clearing Damp-Heat: Cang Zhu (15g) and Huang Bo (10g) acted as the core pair to dry dampness and clear heat from the lower body. Ze Xie (15g) and Che Qian Cao (15g) were added to drain the damp-heat out through the urine.
  • Guiding and Invigorating: Jiu Chuan Niu Xi (15g) specifically guided the herbal actions downward to the lower back and legs while invigorating blood. Mu Dan Pi (15g) cooled the blood and resolved stasis.
  • Protecting the Spleen: Because heat-clearing herbs can be harsh on digestion, Mu Xiang (10g), Sha Ren (15g), Zhi Shi (10g), and Fu Ling (30g) were strategically included to regulate Qi, strengthen the Spleen, and protect the stomach.
• External Formula: A customized herbal powder designed for warm compresses.
  • It included heavy blood-invigorating, wind-damp dispelling, and pain-stopping herbs such as Shen Jin Cao (30g), Ji Xue Teng (30g), Hong Hua (15g), Gui Zhi (30g), Cu Ru Xiang (15g), and Cu Mo Yao (15g).
  • Application: The herbal powder was placed in a cloth bag, mixed with 500ml of white wine and 500ml of aged vinegar, heated in a microwave, and applied directly to the lower back.

Follow-Up

• October 20, 2022 (Second Visit): After using the internal and external treatments for six days, the source reported a clear reduction in the patient’s lower back pain and left leg numbness. Her dry mouth and thirst also improved. The practitioner continued the exact same internal and external prescriptions.
• Long-Term Outcome: The original report noted that after roughly one month of continuous treatment, 60% to 70% of the damp-heat pathogen was successfully cleared. The practitioner then shifted the formula to tonify her underlying foundational energy, resulting in the basic resolution of all her symptoms.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the sophisticated management of a structural diagnosis (lumbar disc herniation) through the lens of environmental pathogens (damp-heat). While conventional medicine views the herniated disc as a purely mechanical compression, TCM views the resulting pain as an inflammatory “swamp” (damp-heat) trapped around the nerve root.

By actively draining the damp-heat through the urine with the internal decoction, the practitioner effectively “dried up” the localized inflammation. Simultaneously, the external application of hot wine and vinegar mixed with blood-moving herbs physically forced the stagnant blood to circulate, bypassing the digestive tract entirely. This precise combination of internal regulation and external actuation demonstrates a highly effective, classical approach to refractory musculoskeletal pain.

---

What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) (北京中医药大学深圳医院（龙岗）)
• Original title: [【以案说医】王进东：湿热困腰寻良医，内外兼施病痛除]
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 21, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation