BACKGROUND:The currently published literatures about Tuina manipulation for lumbar disc herniation include clinical observations, retrospective study and summary of clinical experience, which have shortcomings in the study design, choice of cases and outcome measures. Reviews may enrol randomized and intended references, and has no analysis or evaluation on the quality of involved literatures, leading to the bias and subjective views.
OBJECTIVE:To research the application laws of Tuina manipulation for treating lumbar disc herniation through literature analysis within 10 years.
METHODS:The key words of“lumbar disc herniation, traditional Chinese medicine, Tuina, manipulation, massage, rehabilitation, poking channels, point pressing, palpating pressing, and finger pressing”in Chinese were used to search the literature about Tuina manipulation in treatment of lumbar disc herniation within recent 10 years published in the Wanfang database, Vip database and CNKI database. The top 20 manipulations of Tuina for lumbar disc herniation were and statistical analyzed with hierarchical clustering statistical method.
RESULTS AND CONCLUSION:The hierarchical clustering analysis results showed that, Tuina manipulations for lumbar disc herniation are as fol ows:(1) manipulations acted on soft tissue, including rol ing, holding, pushing and pressing;(2) manipulations acted on acupuncture point, including Urinary Bladder Meridian of Foot-Taiyang acupuncture points (Shengshu, Dachangshu, Guanyuanshu, Zhibian, Chengfu, Weizhong, Chengshan and Kunlun), Gal Bladder Meridian of Foot-Shaoyang acupuncture points (Huantiao and Yanglingquan), Yaoyangguan point in Du Meridian, Zusanli point in Stomach Meridian of Foot-Yangming, and tender points;(3) manipulations acted on human bones and joints, including waist inclined pul method, waist back-stretching method, pelvic traction method and straight-leg raising method. The findings indicate that the potential application laws of Tuina manipulation for treating lumbar disc herniation are given priority to pressing acupuncture points (Urinary Bladder Meridian of Foot-Taiyang acupuncture point, Gal Bladder Meridian of Foot-Shaoyang acupuncture point, Du Meridian, Stomach Meridian of Foot-Yangming acupuncture point and tender points), at the same time companied with manipulations acted on soft tissue (rol ing, holding, pushing spinal method), and bones and joints (waist inclined pul method, waist back-stretching method, pelvic traction method and straight-leg raising method).

Objective To investigate the clinical effect of angioplasty for symptomatic intracranial atherosclerotic stenosis. Methods Eighty-two patients with symptomatic intracranial atherosclerotic stenosis whom underwent angioplasty after the failure of standard medical therapy were enrolled from Nan-jing Stroke Registry Program from September 2010 to June 2013.Nine of them underwent routine balloon angioplasty alone and 73 underwent intracranial stenting.The median time from onset to surgery was 24.5 days.The occurrence of endpoint events (any stroke ≤30 d after procedure,death and ischemic stroke >30 d in guilty vessels or original stenosis had restenosis and needed to be treated again)was assessed. The incidence of restenosis was followed up with imaging (CTA or DSA). Results (1)In the 82 patients, the success rate of operation was 92.7%(n=72 ),and 78 (95.1%)received follow-up,4 were lost to follow-up.The median follow-up time was 22.5 months (range 9 to 29 months ).Ten patients had an endpoint event,7 of them were ischemic stroke,1 was cerebral hemorrhage,and two were severe asymptomatic restenosis who underwent stenting again.The endpoint events of 3 patients occurred at day 30 after procedure (at ≤24 h after procedure).Kaplan-Meier curves showed that the incidences of cumulative endpoint events at 1,6,12,and 24 months were 3.7%,8.6%,11%,and 13%,respectively.(2)60 patients (73.2%)received imaging examination (11 CTA and 49 DSA ).Restenosis occurred in 17 patients (28.3%),among them the incidence of symptomatic restenosis was 5%(n =3 ),and asymptomatic restenosis was 23.3%(n=14). Conclusion After a comprehensive assessment and a rigorous screening, the safety is high and the mid- and long-term efficacy are satisfactory in patients with symptomatic intracranial arterial stenosis who are treated with angioplasty when their medical treatment is invalid.