AIM: To observe the analgesic effects of the kneading method of taking the tender point as acupoint on back-leg pain induced by lumbar intervertebral disc protrusion (LIDP) in the period of onset, and compare with that of 'obliquely-pulling' therapy. METHODS: Sixty inpatients with one-sided fits of LIDP from February 2003 to April 2004 were selected from the Department of Tuina, Yueyang Hospital Affiliated to Shanghai University of TCM were selected according to single-blind parallel randomized experimental method, and randomly divided into living acupoint treatment group (treatment group) and oblique-pulling control group (control group) (n = 30). Patients in the treatment group were treated with the approach of 'pressing and kneading with the thumb' on the living acupoint and acupoint of Weizhong (B40), while patients in the control group received treatment with approach of oblique pulling on the patient's lumbar vertebra. Patients of both groups were treated once a day and 20 minutes each time for totally 2 courses with 7 days in one course. The efficiency scale of lumbar pain (the total score was 100 points, and the lower the score was, the severer the lumbar pain was) was used to evaluate changes in symptoms and physical signs of patients in both groups before and after treatment. Visual analog scale (VAS) (the total score was 10 points, and the higher the score was the severe the pain was) was adopted to evaluate the pain. Levels of beta-endorphin and substance P were detected in patients of both groups before Tuina and one week after Tuina. RESULTS: A total of 60 patients were involved in the analysis of results. (1) Scores of efficacy of lumbar pain: the scores of patients in the treatment group were higher than those before administration (64.77 +/- 4.14, 40.63 +/- 2.93, p = 0.0), and the scores of patients in the control group were higher than those before treatment (60.70 +/- 5.78; 42.83 +/- 3.63, p = 0.0). The differences before and after treatment between two groups were not significant (p > 0.05). (2) VAS score: the score of treatment group after treatment was lower than that before treatment (4.71 +/- 0.52, 8.99 +/- 0.26, p = 0.01, p < 0.05); lower after treatment than before treatment in the control group (5.59 +/- 0.80, 8.94 +/- 0.27, t = 9.746, p = 0.0). There was no significant differences before and after treatment in two groups (p < 0.05). (3) Level of serum beta-endorphin: that in patients of the treatment group was higher at one week after treatment than that before treatment (55.83 +/- 5.53, 46.07 +/- 5.10 ng/L, p = 0.0), and that in patients of the control group was just the opposite (46.50 +/- 3.72, 49.87 +/- 4.38 ng/L, p = 0.15). The comparison between the D-value of the level of serum beta-endorphin of the two groups before and after treatment was remarkable (p = 0.01). (4) Level of serum substance P: that in patients of the treatment group was lower at one week after treatment than that before treatment (34.73 +/- 4.98, 37.95 +/- 4.66 ng/L, p = 0.01), and that in patients of the control group was just the opposites (42.04 +/- 4.06, 39.92 +/- 3.32 ng/L, p = 0.19). The comparison between the D-value of the level of serum substance P of the two groups before and after treatment was remarkable (p = 0.01). CONCLUSION: (1) Both of kneading method of taking the tender point as acupoint and oblique-pulling method can relieve the pain of patients with LIDP, the analgesic effects of which are significant. (2) Kneading method of taking the tender point as acupoint can obviously enhance the level of beta-endorphin and reduce the level of substance P in patients with LIDP, while the effects of oblique-pulling method are opposite to it, which indicated that the analgesic mechanisms of two methods in the treatment of LIDP are different.

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