A 72-year-old woman with a one-month history of severe back pain following a fall, complicated by severe osteoporosis, was successfully managed using a Kidney-tonifying herbal strategy combined with targeted acupoint injections and spinal therapies.

Case ID: CHC-0072

Case Summary

This case describes a 72-year-old woman who suffered a severe fall, resulting in compression fractures of the T12 and L1 vertebrae. Despite resting at home for a month, her debilitating pain persisted, severely limiting her movement and daily life. The original report documented a conventional diagnosis of subacute osteoporotic thoracolumbar compression fractures and a TCM assessment of Bone Wilting (Gu Wei) driven by Liver and Kidney Deficiency. Recognizing the dangers of prolonged bed rest in the elderly, she was managed through a highly integrative approach combining heavy Kidney-tonifying internal herbal granules, targeted acupoint injections into the spinal muscles, and localized moxibustion/acupuncture to achieve rapid pain relief and restore her mobility within just two weeks.

Patient Presentation

• Patient: 72-year-old female (Surname: Li).
• Main Complaint: Thoracolumbar back pain with difficulty turning over for 1 month following a fall.
• History: The patient sought consultation after a month-long ordeal. One month prior, she slipped and fell on her buttocks while shopping for groceries. She immediately felt severe chest, lumbar, and back pain, making it difficult to turn over. The pain worsened significantly when standing, lifting heavy objects, bending, coughing, or sneezing, and occasionally radiated to her left ribs. The pain was sharp and fixed in location. She rested at home for a month, which provided only slight relief; she still struggled to turn over and experienced recurring pain during daily activities.
• Associated Symptoms: Fatigue, dull complexion, emaciated physique, and slow movements. She did not experience radiating numbness in her legs, perianal sensory changes, or incontinence.

Examination and Diagnosis

• Physical Exam: The patient presented in a forced bedridden posture. She had spinal kyphosis (hunchback) and a flat chest. There was significant tenderness and percussion pain in the lower thoracic and lumbar spine. Neurological exams (leg strength, sensation, reflexes) were all normal.
• Imaging & Labs: DR and CT scans showed thoracolumbar degeneration, osteoporosis, and mild wedge-shaped changes at T12 and L1. An MRI confirmed T12 and L1 vertebral compression fractures (T1WI low signal, T2WI/STIR high signal). A DEXA bone density scan revealed severe osteoporosis with a T-score of -3.2.
• Conventional Diagnosis: 1. T12, L1 vertebral compression fractures (subacute phase); 2. Severe osteoporosis.
• TCM Tongue and Pulse: The tongue was pale with a thin, white coating. The pulse was fine and rapid (脉细数).

TCM Assessment

The original practitioner interpreted the presentation as Bone Wilting driven by Liver and Kidney Deficiency (骨痿 – 肝肾亏虚).

According to the holistic principles of yin and yang Chinese Medicine the Kidneys store essence, essence generates marrow, and marrow generates bone. Because the patient was 72 years old, her foundational Kidney essence was naturally depleted, leading to the severe osteoporosis (Bone Wilting) that made her susceptible to the fracture in the first place.

While the initial fall caused localized trauma and blood stasis, the reason she failed to heal after a month of bed rest was this deep underlying deficiency. Her body simply lacked the vital materials (essence and blood) to repair the bone. Furthermore, the Liver governs the sinews; the lack of nourishment to the local ligaments and muscles resulted in her ongoing stiffness and inability to turn over. The pale tongue, fine pulse, dull complexion, and fatigue all provided objective textbook confirmation of this systemic depletion of Qi, Blood, and Essence.

Treatment Approach

The primary treatment principle was to tonify and benefit the Kidneys and Liver, strengthen the sinews and bones, unblock the collaterals, and stop pain (补益肾肝，强筋健骨，通络止痛). The strategy avoided purely attacking the pain, focusing instead on aggressively supplying the body with the biological “building blocks” (through heavy Kidney tonics) while using local injections and acupuncture to force blood circulation around the fractured vertebrae.

Interventions and Herbal Formulas

• Acupoint Injection & External Therapies:
  • Acupoint Injection: 4ml of Jian Gu (Bone-Strengthening) injection was administered directly into the local muscles at the Hua Tuo Jiaji points beside the fractured vertebrae (twice a week for 2 weeks). This modern preparation enhances local microcirculation, reduces inflammation, and stimulates bone reconstruction.
  • Physical Therapies: The patient received “Zhao’s balanced spinal adjustment” (gentle techniques suitable for her age), warm needle acupuncture at the Jiaji points, and Governing Vessel (Du Mai) moxibustion to infuse deep, penetrating heat into the spine.
• Internal Herbal Formula: A 12-herb prescription utilizing the hospital’s proprietary Bugu (Bone-Tonifying) Granules.
  • Warming Kidney and Stopping Pain (Sovereign): Bu Gu Zhi (Psoralea) and San Qi (Notoginseng) warm Kidney Yang, dissipate the stubborn localized blood stasis, and stop the sharp pain.
  • Tonifying Liver/Kidneys and Benefiting Essence (Minister): Yin Yang Huo (Epimedium), Lu Xian Cao (Pyrola), Gu Sui Bu (Drynaria), and Dang Gui (Angelica Sinensis) aggressively rebuild the Liver and Kidney essence and strengthen the sinews and bones.
  • Assisting Yang and Bone Growth (Assistant): Du Zhong (Eucommia), Lu Jiao Shuang (Degelatined Deer Antler), Rou Cong Rong (Cistanche), Shu Di Huang (Prepared Rehmannia), and Ba Ji Tian (Morinda) amplify the Kidney-tonifying and bone-rebuilding effects.
  • Unblocking Collaterals (Courier): Di Long (Earthworm) acts as a microscopic guide, penetrating deep into the spinal meridians to unblock the stagnated pathways.
  • Administration: 15 daily doses, taken warm morning and evening.

Follow-Up

• Discharge (2 Weeks Later): After just two weeks of this conservative TCM treatment, the patient’s symptoms were significantly relieved. She could turn over in bed freely, and with the support of a waist brace, she was able to get out of bed and walk. The treatment was considered highly successful, allowing her to be discharged and avoid the severe complications of prolonged bed rest.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the rapid conservative mobilization of an elderly patient with a debilitating spinal fracture.

In conventional medicine, osteoporotic compression fractures in the elderly are highly dangerous not just because of the broken bone, but because prolonged bed rest frequently leads to fatal complications like pneumonia, deep vein thrombosis, and bedsores. Professor Zhao emphasizes that treating fractures requires “tonifying the Kidneys first.” By combining internal Bugu Granules to chemically stimulate osteoblast (bone-building cell) activity with targeted Jian Gu acupoint injections to immediately flush out local inflammatory edema, the practitioner rapidly stabilized the micro-environment of the spine. This allowed the 72-year-old patient to safely escape bed rest and walk again in just 14 days, proving the powerful role of TCM in geriatric orthopedics.

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Source Original source: Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】招仕富：治疗老年亚急性骨质疏松性胸腰椎压缩性骨折案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: August 21, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation