A 62-year-old man with a one-year history of severe lower back pain, leg numbness, and intermittent claudication caused by lumbar spinal stenosis was successfully managed using a Liver and Kidney-tonifying herbal strategy combined with spinal adjustment and abdominal acupuncture to avoid surgery.

Case ID: CHC-0068

Case Summary

This case describes a 62-year-old man who presented with a one-year history of lower back pain and severe leg numbness that recently worsened into intermittent claudication (the inability to walk more than 200 meters without resting due to pain). Diagnosed with lumbar disc herniation and spinal stenosis, he refused the conventional recommendation of surgical internal fixation. The original report documented a TCM assessment of Lumbar Impediment (Yao Bi) driven by Liver and Kidney Deficiency with Qi Stagnation and Blood Stasis. He was managed through a highly integrative 10-day inpatient approach combining “Zhao’s Balanced Spinal Adjustment,” abdominal acupuncture, and a custom “Three Dragons” herbal decoction to mechanically open the spinal canal, rebuild his foundational energy, and unblock the deeply stagnant meridians.

Patient Presentation

• Patient: 62-year-old male (Surname: Ou).
• Main Complaint: Lower back soreness, distension, and pain accompanied by numbness and pain in both lower limbs (especially the posterior-lateral calves) and intermittent claudication.
• History: The patient sought consultation on August 20, 2023. Over a year prior, he developed sudden lower back pain following fatigue, followed by leg numbness. Comprehensive treatments at local hospitals yielded no results. One month ago, symptoms worsened significantly: walking just 200 meters aggravated the numbness and pain, forcing him to rest. Five days prior, another hospital diagnosed him with lumbar disc herniation and spinal stenosis, recommending surgery, which he refused.
• Associated Symptoms: Cold hands and feet, aversion to cold, poor appetite and sleep, and frequent night urination.
• Physical Exam: The lumbar physiological curvature was straightened with lumbosacral scoliosis and restricted mobility. Tenderness (+) was present between and beside the L4-S1 spinous processes. The straight leg raise test was restricted (Left 55°, Right 45°) with a positive reinforcement test. Sensation was numb on the outer and back sides of both calves, though muscle strength and tone remained normal.

Examination and Diagnosis

• Imaging (MRI): Confirmed L4-L5 and L5-S1 intervertebral disc herniation with spinal canal stenosis.
• Conventional Diagnosis: 1. Lumbar spinal stenosis; 2. Lumbar disc herniation.
• TCM Tongue and Pulse: The tongue body was pale and puffy (舌质淡胖) with a white coating. The pulse was sunken, fine, and weak (脉沉细无力).

TCM Assessment

The original practitioner interpreted the presentation as Lumbar Impediment driven by Liver and Kidney Deficiency, Qi Stagnation, and Blood Stasis (腰痹 – 肝肾亏虚，气滞血瘀).

According to the holistic principles of yin and yang Chinese Medicine the Kidneys govern the bones and the lower back is the “mansion of the Kidneys.” In this elderly patient, chronic overwork exhausted his foundational Liver and Kidney essence, leading to the structural degeneration of his lumbar spine (disc herniation and stenosis).

Because the foundational Yang energy was deeply deficient (evidenced by his cold limbs, frequent night urination, pale/puffy tongue, and sunken-weak pulse), his body lacked the strength to push blood through the meridians. This resulted in severe, chronic blood stasis in the lower back and legs. The mechanical compression from the stenosis combined with this deep micro-circulatory stasis starved the nerves, causing the debilitating numbness and intermittent claudication.

Treatment Approach

The primary treatment principle was to tonify and benefit the Liver and Kidneys, strengthen the sinews and bones, invigorate blood, and unblock the collaterals (补益肝肾、强筋壮骨，活血通络). The strategy utilized a multi-modal approach: manual spinal adjustments to correct the mechanical misalignment of the vertebrae, abdominal acupuncture to regulate deep core energy, and a heavy herbal decoction to rebuild Kidney Yang and scour out the deep stasis.

Interventions and Herbal Formulas

• Zhao’s Balanced Spinal Adjustment (Manipulative Therapy):
  • The practitioner applied a specialized 6-step lumbosacral sequence tailored to realign the spine: (1) Push-press and traction-shaking; (2) Traction-lift and rhythmic pressing; (3) Pull-push of the lumbar region; (4) Push-shoulder and pull-lumbar maneuver in a side-lying position; (5) Rotational pushing to correct deviated spinous processes; (6) Hip/knee flexion pressing to balance the pelvis.
  • Applied once daily (5 times per course).
• Abdominal Acupuncture:
  • Points selected: Qihai (CV6) and Guanyuan (CV4) to tonify Kidney Yang and invigorate blood; Shuifen (CV9) to regulate fluids and promote the absorption of local edema; Qixue (KI13) and Siman (KI14) to boost Kidney Qi; and points like Huaroumen (ST24), Wailing (ST26), and Xiafengshidian to unblock the meridian Qi in the affected limbs. Retained for 30 minutes daily.
• Internal Herbal Formula (August 20, 2023): A 16-herb decoction, utilizing Professor Zhao’s custom Sanlong Tongbi Tang (Three Dragons Impediment-Unblocking Decoction).
  • Tonifying Liver and Kidneys: Sang Ji Sheng (Taxillus, 12g) and Shu Di Huang (Prepared Rehmannia, 12g) form the Emperor core to deeply nourish the Kidney essence. Shan Yu Rou (10g), Du Zhong (12g), and Niu Xi (10g) strengthen the sinews and bones.
  • Warming Yang and Dispersing Cold: Lu Jiao Shuang (12g), Xian Ling Pi (Epimedium, 10g), Zhi Chuan Wu (Prepared Aconite, 6g), and Gui Zhi (10g) powerfully warm the Kidney Yang to drive out the deep cold and dampness causing his cold limbs and frequent urination.
  • The “Three Dragons” to Unblock Collaterals: Wu Shao She (Zaocys Snake, 12g), Di Long (Earthworm, 10g), and Wu Gong (Centipede, 3 pieces). These three potent animal/insect medicinals are renowned for their ability to forcefully search out wind, penetrate deeply into the joints and spinal canal, and dissolve stubborn phlegm and blood stasis.
  • Moving Blood and Boosting Qi: Dang Gui (10g) and Dan Shen (10g) nourish and move blood, while Huang Qi (Astragalus, 20g) boosts the central Qi. Du Huo (10g) guides the medicine to the lower back.
  • Administration: 5 doses, water decocted, taken warm morning and evening.

Follow-Up

• Day 5: After just 5 days of this integrative inpatient therapy, the patient’s lower back and leg pain, as well as the intermittent claudication, were significantly improved. The numbness was noticeably relieved, he could turn over in bed freely, and his walking distance increased dramatically from 200 meters to 800-1000 meters.
• Day 10 (Discharge): After another 5 days of treatment, the pain and claudication basically disappeared. The lower limb numbness was gone, and he walked freely with satisfactory results. He was discharged.
• One-Year Follow-Up: A follow-up one year later confirmed that his symptoms had not recurred.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the rapid, non-surgical resolution of severe intermittent claudication caused by spinal stenosis.

In Western medicine, when structural stenosis causes walking distances to drop below 500 meters, surgery (decompression and fusion) is often considered the only definitive option. Professor Zhao’s approach highlights that the nerve starvation in stenosis isn’t just about the physical bone narrowing—it is heavily exacerbated by local inflammatory edema and severe micro-circulatory stasis. By utilizing abdominal acupuncture to absorb the local swelling, manual therapy to optimize the remaining spinal space, and the aggressive “Three Dragons” (Snake, Earthworm, Centipede) to chemically dissolve the deep vascular stasis inside the spinal canal, the treatment successfully restored blood flow to the nerves, allowing a 62-year-old man to avoid major spinal surgery and regain his mobility in just 10 days.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine Original title: 【以案说医】招仕富：招氏平衡整脊疗法治疗腰椎椎管狭窄症案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: August 26, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation