Journal of Acupuncture Research 2023; 40(3): 281-292
Published online August 31, 2023
https://doi.org/10.13045/jar.2023.00171
© Korean Acupuncture & Moxibustion Medicine Society
Correspondence to : Young Il Kim
Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, 75, Daedeok-daero 176beon-gil, Seo-gu, Daejeon 35235, Korea
E-mail: omdkim01@dju.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
This study presents the cases of a 67-year-old female with an isolated left sacral fracture and a 69-year-old female with fractures in sacrum 1, 2, and the left pubic bone. Both patients exhibited marked improvement following integrative Korean medicine treatment, encompassing acupuncture, acupotomy, pharmacopuncture, herbal medicine, moxibustion, and cupping therapy. The treatment’s efficacy was assessed using the numerical rating scale (NRS) scores, range of motion (ROM) in the lumbar spine, and alterations in gait and walking distance. Case 1 demonstrated an enhanced ROM and achieved independent walking after 29 days of treatment. Case 2 improved in both ROM and NRS score and could walk independently after 49 days of treatment. Significantly, radiological images showed notable changes in both cases following treatments. The study indicates that integrative Korean medicine treatment could provide clinical advantages to individuals suffering from sacral fractures.
Keywords Acupotomy; Acupuncture; Herbal medicine; Korean traditional medicine; Pharmacopuncture; Spinal fractures
Most sacral fractures are the result of an external force exerted on the pelvis or spine, typically associated with other fractures [1]. They can lead to pelvic ring or spine-pelvis instability, with 25% of such fractures causing nerve injury due to the location of the lumbosacral plexus [2-4]. Radiologically, sacral fractures can be challenging to detect and often present no typical clinical symptoms [4-6]. Concurrent injuries may conceal nerve damage, delaying diagnosis in approximately 30% of sacral fractures if not identified and managed properly [2-8].
Treatment for sacral fractures may be surgical or conservative, depending on the stability of the pelvic fracture and the presence of neurological symptoms [4]. However, a clear consensus on treatment methods and principles is lacking, therefore conservative treatment typically employed if the fracture region does not include unstable pelvic fractures or neurological disorders [1,9].
Studies by Lee et al. [10] and Ha et al. [11] have shown that integrative Korean medicine treatment significantly impacts patients with both sacral and multiple fractures. This makes it challenging to ascertain the specific efficacy of integrative Korean medicine on isolated sacral fractures alone. Moreover, there are no case reports or studies concerning the effect of Korean medicine treatment on isolated sacral fractures or associated radiological changes.
In the present study, integrative Korean medicine treatment was administered in 2 cases: 1 patient diagnosed with an isolated left sacral fracture and another diagnosed with sacral 1 and 2 fractures, accompanied by a left pubic fracture. In both instances, symptoms improved more rapidly than the anticipated immobilization period, allowing for an early return to daily activities. We also observed that the radiological follow-up changes yielded significant treatment results.
Acupuncture treatment involved the use of needles (0.20 × 30 mm or 0.25 × 30 mm, disposable sterilized stainless steel; Dongbang Medical Co., Ltd.), left in position for 15 minutes. The treatment was performed twice daily, in the mornings and afternoons, using acupoints selected from bilateral BL23, BL24, BL25, BL26, BL27, BL28, BL31, BL32, BL33, BL34, BL52, and GB30. For Case 2, which included a left pubic fracture, acupoints were chosen from bilateral CV2, CV3, and KI11.
2) AcupotomyAcupotomy treatment was administered solely in Case 2, using an acupotomy needle 0.75 × 80 mm (disposable sterilized stainless steel, Dongbang Medical Co., Ltd.). Prior to treatment, the possible side effects and precautions were explained, and a signed informed consent form was obtained from the patient (Appendix A). The treatment was performed 4–5 times a week, 23 times in total, once at 9 AM. The adhesive and the hard and soft tissues of the erector spinae muscle near acupuncture points BL24 and BL25 were treated.
3) PharmacopuncturePharmacopuncture was carried out with a disposable syringe 1 mL, 26 G × 13 mm syringe (Becton, Dickinson and Company) and a sterilized needle 30 G × 39 mm (Sungshim Medical Co., Ltd.). So-yeom pharmacopuncture 2 mL (Korean Pharmacopuncture Research Institute) was performed 3–4 times a week in Case 1 and twice a week in Case 2. Cho-o pharmacopuncture 2 mL (Kirin Korean Medicine Industrial Institute,) was administered 4–5 times a week in Case 2. Pharmacopuncture was injected into the acupoints chosen from bilateral BL23, BL24, and BL25, with a total volume of 2 mL, 0.5 mL per acupoint.
4) Herbal medicineHerbal medicine was provided in 3 daily packs (120 mL per pack), taken 1 hour after each meal. Tables 1 and 2 show the duration and composition of the herbal medicines prescribed during the hospitalization period in both cases.
Table 1 . Duration and composition of herbal medicines in Case 1
Dangguisu-san Gami, 2023.2.3. (admission) (1 d) | Dose (g) | Dangguisu-san, 2023.2.4.–2023.2.8. (day 2–6) (5 d) | Dose (g) | Gami gunggui-tang, 2023.2.9.–2023.3.3. (day 7-discharge) (23 d) | Dose (g) |
---|---|---|---|---|---|
Angelicae Gigantis Radix | 6 | Rehmanniae Radix Recens | 8 | Angelicae Gigantis Radix | 20 |
Paeoniae Radix | 4 | Angelicae Gigantis Radix | 6 | Cnidii Rhizoma | 20 |
Linderae Radix | 4 | Paeoniae Radix | 4 | Astragali Radix | 8 |
Cyperi Rhizoma | 4 | Linderae Radix | 4 | Ginseng Radix | 8 |
Sappan Lignum | 4 | Cyperi Rhizoma | 4 | Lycii Fructus | 8 |
Carthami Flos | 3 | Sappan Lignum | 4 | Codonopsis Pilosulae Radix | 4 |
Persicae Semen | 3 | Carthami Flos | 2 | Cuscutae Semen | 4 |
Cassiae Cortex Interior | 2 | Persicae Semen | 2 | Dipsaci Radix | 4 |
Glycyrrhizae Radix et Rhizoma | 2 | Cinnamomi Ramulus | 2 | Dendrobii Caulis | 4 |
Glycyrrhizae Radix et Rhizoma | 2 | Eucommiae Cortex | 4 | ||
Rhei Radix et Rhizoma | 2 | Drynariae Rhizoma | 4 | ||
Carthami Flos | 4 |
Table 2 . Duration and composition of herbal medicines in Case 2
Pyeongjingeonbi-tang, 2023.2.8.–2023.2.13., 2023.2.17., 2023.2.22.–2023.2.23. (admission-day 6, day 10, day 15-day 16) (9 d) | Dose (g) | Gami gunggui-tang, 2023.2.14.–2023.2.16., 2023.2.18.–2023.2.21. (day 7–9, day 11–14) (7 d) | Dose (g) | Gami yangwi-tang, 2023.2.24. (day 17) (1 d) | Dose (g) | Sipjeondaebotang-Gagambang, 2023.2.25.–2023.3.21. (day 18-discharge) (25 d) | Dose (g) |
---|---|---|---|---|---|---|---|
Crataegii Fructus | 6 | Angelicae Gigantis Radix | 20 | Atractylodis Rhizoma | 8 | Ginseng Radix | 5 |
Cyperi Rhizoma | 4 | Cnidii Rhizoma | 20 | Magnoliae Cortex | 4 | Atractylodis Rhizoma Alba | 5 |
Pinelliae Tuber | 4 | Astragali Radix | 8 | Citri Unshius Pericarpium | 4 | Poria Sclerotium | 5 |
Citri Unshius Pericarpium | 4 | Ginseng Radix | 4 | Polyporus | 4 | Glycyrrhizae Radix et Rhizoma | 5 |
Cnidii Rhizoma | 4 | Lycii Fructus | 8 | Alismatis Rhizoma | 4 | Paeoniae Radix | 5 |
Atractylodis Rhizoma | 4 | Codonopsis Pilosulae Radix | 4 | Poria Sclerotium | 4 | Cnidii Rhizoma | 5 |
Atractylodis Rhizoma Alba | 4 | Cuscutae Semen | 4 | Agastachis Herba | 4 | Angelicae Gigantis Radix | 4 |
Ponciri Fructus Immaturus | 4 | Dipsaci Radix | 4 | Poria Sclerotium | 4 | Astragali Radix | 4 |
Agastachis Herba | 4 | Dendrobii Caulis | 4 | Zingiberis Rhizoma | 4 | Longan Arillus | 4 |
Magnoliae Cortex | 4 | Eucommiae Cortex | 4 | Cinnamomi Ramulus | 4 | Atractylodis Rhizoma | 4 |
Amomi Fructus | 4 | Drynariae Rhizoma | 4 | Aucklandiae Radix | 4 | Citri Unshius Pericarpium | 4 |
Massa Medicata Fermentata | 6 | Cervi Cornu | 4 | Zingiberis Rhizoma Recens | 4 | Magnoliae Cortex | 4 |
Hordei Fructus Germinatus | 6 | Zizyphi Fructus | 6 | Cyperi Rhizoma | 4 | ||
Glycyrrhizae Radix et Rhizoma | 4 | Cyperi Rhizoma | 6 | Pinelliae Tuber | 4 | ||
Aucklandiae Radix | 2 | Ponciri Fructus Immaturus | 6 | Crataegii Fructus | 4 | ||
Zingiberis Rhizoma Recens | 12 | Crataegii Fructus | 4 | Drynariae Rhizoma | 4 | ||
Zizyphi Fructus | 8 | Amomi Fructus | 4 | ||||
Longan Arillus | 8 |
During the absolute bed rest (ABR) phase, indirect electric moxibustion therapy (Technoscience) was applied at BL23 once daily for 15 minutes. During the bed rest (BR) phase, indirect moxibustion using charcoal moxa cones (Dongbang Medical Co., Ltd.) was administered at BL23 once daily for 30 minutes.
6) Cupping therapyDry cupping therapy was conducted in the lumbosacral region using a manual vacuum pump for 3 minutes. It was performed twice daily during the ABR phase and once daily during the BR phase.
The numerical rating scale (NRS) scores is used to quantify the subjective severity of pain on a scale of 0 to 10. A score of 10 represents the worst imaginable pain, while 0 indicates a pain-free state [12]. The evaluation was conducted daily at 7 AM.
2) Range of motionRange of motion (ROM) assesses the lumbar spine’s ROM and the presence of pain during active movement. The angles of flexion, extension, lateral bending, and rotation of the lumbar spine were measured daily at 7 AM. A “+” sign was marked if pain was noted during movement.
3) Changes in gait and walking distanceThe patient’s ability to move via wheelchair, walker, or independent ambulation was evaluated. The number of roundtrips made in an approximately 80-m-long hospital corridor was recorded.
4) X-ray and computed tomographyRadiological images were taken after roughly 3 weeks of integrative Korean medicine treatment and were subsequently reviewed by a radiologist.
Female, 67 years old.
2) Principal complaintsLumbosacral pain.
3) Onset and causeThe patient experienced pain subsequent to a traffic accident that occurred while crossing the crosswalk on February 3, 2023.
4) Present illnessOn February 3, 2023, a hospital-conducted X-ray of the lumbar spine revealed no notable findings, and subsequently, the patient was then admitted to the hospital. On February 7, 2023, a lumbar spine computed tomography (CT) performed at the hospital led to the diagnosis of a left sacral fracture.
5) ProgressUpon admission, lumbosacral pain was rated at NRS 7.5, and the patient experienced difficulty sitting in a wheelchair, although ambulation was possible. Acetaminophen 325 mg and tramadol hydrochloride (HCl) 37.5 mg were administered after breakfast and dinner, leading to hospitalization with BR. On day 5, the pain persisted, and a lumbar spine CT revealed a left sacral fracture. The patient was then advised to apply ABR; however, the pain continued. Aceclofenac 100 mg and eperisone HCl 50 mg were additionally administered after breakfast and dinner from days 12 to 20. On day 14, the lumbosacral pain was still NRS 7.5, but the patient could walk 40 m with a walker. By day 21, the pain decreased to NRS 5.5, and acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone HCl 50 mg were administered after breakfast and dinner until day 26. On day 25, the pain further decreased to NRS 4, and the patient could walk 160 m with the walker. Following this, the patient was advised to transition from ABR to BR. From day 27 to discharge, aceclofenac 100 mg and eperisone HCl 50 mg were administered after breakfast and dinner, causing the lumbosacral pain to increase to NRS 6. Upon discharge, the patient could walk independently, but the pain increased to NRS 7. In addition to the oral analgesics described above, diclofenac sodium 37.5 mg or tramadol HCl 25 mg were administered intramuscularly when necessary (Figs. 1, 2; Table 3).
Table 3 . Medications administered during Case 1’s hospitalization
Medication | 2023.2.4.–2023.2.13. (day 2–11) (10 d) | 2023.2.14.–2023.2.22. (day 12–20) (9 d) | 2023.2.23.–2023.2.28. (day 21–26) (6 d) | 2023.3.1.–2023.3.3. (day 27-discharge) (3 d) |
---|---|---|---|---|
Acetaminophen 325 mg, tramadol HCl 37.5 mg | B, D/PC 30 min | B, D/PC 30 min | - | - |
Acetaminophen 162.5 mg, tramadol HCl 18.75 mg | B, D/PC 30 min | - | ||
Aceclofenac 100 mg | B, D/PC 30 min | B, D/PC 30 min | B, D/PC 30 min | |
Eperisone HCl 50 mg | B, D/PC 30 min | B, D/PC 30 min | B, D/PC 30 min | |
Diclofenac sodium 37.5 mg | 02/11 1/d 02/12 2/d | - | - | - |
Tramodol HCl 25 mg | 02/14 1/d 02/16 1/d | - | - |
HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable.
At the time of admission, the ROM of the lumbar spine could not be measured due to pain. However, at discharge, the ROM of the lumbar spine was measured with flexion at 80° (+) and extension at 20° (+), while lateral bending and rotation were within the normal range (Table 4).
Table 4 . Changes in Case 1’s range of motion (before and after treatment)
Lumbar spine ROM | 2023.2.3. (before treatment) | 2023.3.3. (after treatment) |
---|---|---|
Flexion | Unable to measure because of pain | 80° (+) |
Extension | Unable to measure because of pain | 20° (+) |
Lateral bending | Unable to measure because of pain | 35°/35° |
Rotation | Unable to measure because of pain | 45°/45° |
ROM, range of motion; +, sign was marked when there was pain while moving.
On day 2, the patient was diagnosed with a left sacral fracture via a lumbar spine CT scan, and on day 25, a pelvic bone CT showed decreased dislocation of the left sacral fracture (Fig. 3). An X-ray of the lumbosacral spine revealed no sacral fracture. On March 14, 2023, after the patient was discharged, an X-ray of the lumbosacral spine was taken during an outpatient visit to the hospital. The resultant films revealed progressive fusion of the fracture. On April 21, 2023, an X-ray of the sacrococcygeal spine showed additional fusion (Fig. 4).
Female, 69 years old.
2) Principal complaintsLumbosacral and lower extremity pain.
3) Onset and causeThe patient fell on December 22, 2022. By January 24, 2023, her symptoms had worsened, particularly when upright.
4) Present illnessOn February 1, 2023, the patient was diagnosed with fractures in sacrum 1 and 2 through a lumbar spine CT scan at the hospital. On February 7, 2023, the patient was found to have a herniated nucleus pulposus (HNP) of L4–5 and spinal stenosis of L4–5 via a lumbar spine magnetic resonance imaging, as well as fractures in sacrum 1, 2, and the left pubic bone as revealed by a pelvic bone CT scan at the hospital. The patient was hospitalized on February 8, 2023.
5) ProgressUpon admission, the patient’s lumbosacral pain was rated NRS 4 and lower extremity pain was rated NRS 8, making ambulation possible only by wheelchair. The patient struggled to sit in the wheelchair and was hospitalized with ABR, receiving acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone 75 mg after breakfast and dinner. By day 3, the patient could move 160 m while seated in the wheelchair, leading to a recommendation to shift from ABR to BR. On day 7, the lumbosacral pain subsided to NRS 1.5, and lower extremity pain dropped to NRS 4. The medication was adjusted to include acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone HCl 50 mg after meals until day 13. On day 14, the lumbosacral pain remained NRS 1.5, and lower extremity pain further decreased to NRS 3. Aceclofenac 100 mg and eperisone HCl 50 mg were then prescribed after breakfast and dinner until day 20. From day 21 until discharge, analgesics were halted, and on day 28, lumbosacral pain lessened to NRS 1, while lower extremity pain rose to NRS 6. On day 31, the patient could walk 40 m with a walker, and from day 35, the patient could walk 160 m. The average daily distance walked with a walker increased from 424 m to 720 m by discharge. From day 37 until discharge, lumbosacral pain was stable at NRS 1, and lower extremity pain was NRS 2 (Figs. 5, 6; Table 5).
Table 5 . Medications administered during Case 2’s hospitalization
Medication | 2023.2.8.–2023.2.13. (admission-day 6) (6 d) | 2023.2.14.–2023.2.20. (day 7–13) (7 d) | 2023.2.21.–2023.2.27. (day 14–20) (7 d) | 2023.2.28.–2023.3.21. (day 21-discharge) (22 d) |
---|---|---|---|---|
Acetaminophen 162.5 mg, tramadol HCl 18.75 mg | B, D/PC 30 min | B, D/PC 30 min | - | - |
Aceclofenac 100 mg | B, D/PC 30 min | B, D/PC 30 min | B, D/PC 30 min | - |
Eperisone HCl 75 mg | B, D/PC 30 min | - | - | - |
Eperisone HCl 50 mg | B, D/PC 30 min | B, D/PC 30 min | - |
HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable.
At admission, lumbar spine ROM was measured with extension at 0° (+) and lateral bending at 30° (+), with flexion and rotation within the normal range. At discharge, extension was measured at 20° (+), and all other measures were within the normal range (Table 6).
Table 6 . Changes in Case 2’s range of motion (before and after treatment)
Lumbar spine ROM | 2023.2.8. (before treatment) | 2023.3.21. (after treatment) |
---|---|---|
Flexion | 80° | 80° |
Extension | 0° (+) | 20° (+) |
Lateral bending | 30° (+)/30° (+) | 35°/35° |
Rotation | 45°/45° | 45°/45° |
ROM, range of motion; +, pain while moving.
On February 7, 2023, the patient was diagnosed with fractures in sacrum 1 and 2 through a pelvic bone CT scan at the hospital. On day 3, an X-ray of the lumbar spine revealed a dislocation of the sacrum 1 and 2 fractures. On day 24, a subsequent X-ray of the lumbar spine showed progressive fusion of the fractures in sacrum 1 and 2 (Fig. 7).
Sacral fractures are typically treated conservatively unless structural stability is lost, or neurological abnormalities occur [11]. Conventional conservative treatments include BR and mechanical traction. Integrative Korean medicine is known for reducing pain and promoting fracture fusion [13].
Acupuncture is effective in controlling pain, restoring ROM, and preventing stiffness [14]. Acupotomy was also performed in Case 2, as the patient was diagnosed with a HNP of L4–5 and spinal stenosis of L4–5 and had lower extremity pain. Lower extremity pain is a key symptom of HNP and spinal stenosis and began after the patient’s fall. However, HNP and spinal stenosis are often chronic conditions believed to have started before the patient’s fall [15]. Therefore, it seems the fall worsened the patient’s HNP of L4–5 and spinal stenosis of L4–5, revealing the lower extremity pain. Acupotomy is typically used for chronic pain. A past study found acupotomy effective for reducing pain and improving lumbar spine ROM and quality of life in patients with acute lumbosacral pain caused by trauma [16]. Pharmacopuncture combines acupuncture medicine and pharmacotherapy [17]. So-yeom pharmacopuncture exerts anti-inflammatory effects by inhibiting inflammation-related tumor necrosis factor α and interferon γ [18]. Aconitine, the main component of Cho-o pharmacopuncture, demonstrates strong anti-inflammatory and analgesic effects [19]. Depending on the patient’s symptoms, prescriptions of Dagguisu-san, Gami gunggui-tang, and Sipjeondaebotang-Gagambang were made, each with specific and unique efficacies. Dagguisu-san treats early-stage blood stasis and Gami gunggui-tang boosts energy to promote later-stage fracture fusion [20]. Sipjeondaebotang-Gagambang increases blood supply to promote fracture fusion and treats post-traumatic inertia [21]. Case 2 was prescribed Pyeongjingeonbi-tang and Gami yangwi-tang for dyspepsia and vomiting during hospitalization. Moxibustion improves circulation by heating acupoints, and dry cupping relieves pain and removes blood stasis [22].
Case 1 demonstrated improved ROM and could walk independently about 4 weeks (29 days), faster than the typical 6 weeks of immobilization in patients with moderate sacral fractures [23]. Case 2 had a lower NRS score, improved ROM, and could walk independently in 7 weeks (49 days), faster than the expected > 8 week immobilization period for severe sacral and pubic fractures [23]. Integrative Korean medicine treatment is beneficial for patients with sacral fractures by reducing lumbosacral pain while improving ROM. Additionally, radiological examinations taken before and after treatment showed progressive fusion of the fracture in both cases.
However, our results should be interpreted with caution due to several limitations. First, the cases in this study may appear heterogeneous since Case 2 also involved a pubic fracture. Yet, this left pubic fracture was classified as Tile-type A2, signifying a minimally displaced fracture without instability, and the patient did not feel pain in that region [11]. Thus, the study’s results could be considered in the context of integrative Korean medicine treatment for sacral fractures. Second, in Case 1, lumbar spine ROM improved; however, the degree of improvement was non-significant (NRS: 7.5 at admission and 7 at discharge). Conversely, in Case 2, both ROM and NRS scores improved markedly. Since the patients under BR were also undergoing walking rehabilitation to assess their ambulatory status during hospitalization, detecting NRS score changes was challenging. Nevertheless, the treatment appeared effective, as the patients ceased taking analgesics and could walk independently upon discharge. Third, this study includes only 2 cases, and in Case 2, no follow-up was conducted after discharge. Fourth, interpreting the effect of integrative Korean medicine treatment is complex due to analgesics administration and the natural healing ability of non-displaced fractures within 4–6 weeks of BR [1]. Lastly, the NRS score for lower extremity pain dropped (NRS: 8 at admission and 2 at discharge), yet isolating the effect of acupotomy treatment in Case 2 is challenging since other treatments were also applied. However, this result confirms the potential of acupotomy in treating acute lumbosacral and lower extremity pain, an area where studies remain scarce. Overall, a systematic follow-up study with a larger sample population is essential to objectively evaluate the efficacy of integrative Korean medicine treatment for sacral fractures.
Conceptualization: YSK, YIK. Methodology: YSK. Formal investigation: YSK. Data analysis: YSK. Writing – original draft: YSK. Writing – review & editing: All authors.
The authors have no conflicts of interest to declare.
None.
This study was exempt from the Daejeon Korean Medicine Hospital of Daejeon University Institutional Review Board (IRB no.: DJDSKH-23-E-12).
Journal of Acupuncture Research 2023; 40(3): 281-292
Published online August 31, 2023 https://doi.org/10.13045/jar.2023.00171
Copyright © Korean Acupuncture & Moxibustion Medicine Society.
Yeon Soo Kang , Pil Je Park
, So Jeong Kim
, Hyun Jin Jang
, Min Ju Kim
, Hyeon Kyu Choi
, Jeong Kyo Jeong
, Ju Hyun Jeon
, Young Il Kim
Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Korea
Correspondence to:Young Il Kim
Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, 75, Daedeok-daero 176beon-gil, Seo-gu, Daejeon 35235, Korea
E-mail: omdkim01@dju.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
This study presents the cases of a 67-year-old female with an isolated left sacral fracture and a 69-year-old female with fractures in sacrum 1, 2, and the left pubic bone. Both patients exhibited marked improvement following integrative Korean medicine treatment, encompassing acupuncture, acupotomy, pharmacopuncture, herbal medicine, moxibustion, and cupping therapy. The treatment’s efficacy was assessed using the numerical rating scale (NRS) scores, range of motion (ROM) in the lumbar spine, and alterations in gait and walking distance. Case 1 demonstrated an enhanced ROM and achieved independent walking after 29 days of treatment. Case 2 improved in both ROM and NRS score and could walk independently after 49 days of treatment. Significantly, radiological images showed notable changes in both cases following treatments. The study indicates that integrative Korean medicine treatment could provide clinical advantages to individuals suffering from sacral fractures.
Keywords: Acupotomy, Acupuncture, Herbal medicine, Korean traditional medicine, Pharmacopuncture, Spinal fractures
Most sacral fractures are the result of an external force exerted on the pelvis or spine, typically associated with other fractures [1]. They can lead to pelvic ring or spine-pelvis instability, with 25% of such fractures causing nerve injury due to the location of the lumbosacral plexus [2-4]. Radiologically, sacral fractures can be challenging to detect and often present no typical clinical symptoms [4-6]. Concurrent injuries may conceal nerve damage, delaying diagnosis in approximately 30% of sacral fractures if not identified and managed properly [2-8].
Treatment for sacral fractures may be surgical or conservative, depending on the stability of the pelvic fracture and the presence of neurological symptoms [4]. However, a clear consensus on treatment methods and principles is lacking, therefore conservative treatment typically employed if the fracture region does not include unstable pelvic fractures or neurological disorders [1,9].
Studies by Lee et al. [10] and Ha et al. [11] have shown that integrative Korean medicine treatment significantly impacts patients with both sacral and multiple fractures. This makes it challenging to ascertain the specific efficacy of integrative Korean medicine on isolated sacral fractures alone. Moreover, there are no case reports or studies concerning the effect of Korean medicine treatment on isolated sacral fractures or associated radiological changes.
In the present study, integrative Korean medicine treatment was administered in 2 cases: 1 patient diagnosed with an isolated left sacral fracture and another diagnosed with sacral 1 and 2 fractures, accompanied by a left pubic fracture. In both instances, symptoms improved more rapidly than the anticipated immobilization period, allowing for an early return to daily activities. We also observed that the radiological follow-up changes yielded significant treatment results.
Acupuncture treatment involved the use of needles (0.20 × 30 mm or 0.25 × 30 mm, disposable sterilized stainless steel; Dongbang Medical Co., Ltd.), left in position for 15 minutes. The treatment was performed twice daily, in the mornings and afternoons, using acupoints selected from bilateral BL23, BL24, BL25, BL26, BL27, BL28, BL31, BL32, BL33, BL34, BL52, and GB30. For Case 2, which included a left pubic fracture, acupoints were chosen from bilateral CV2, CV3, and KI11.
2) AcupotomyAcupotomy treatment was administered solely in Case 2, using an acupotomy needle 0.75 × 80 mm (disposable sterilized stainless steel, Dongbang Medical Co., Ltd.). Prior to treatment, the possible side effects and precautions were explained, and a signed informed consent form was obtained from the patient (Appendix A). The treatment was performed 4–5 times a week, 23 times in total, once at 9 AM. The adhesive and the hard and soft tissues of the erector spinae muscle near acupuncture points BL24 and BL25 were treated.
3) PharmacopuncturePharmacopuncture was carried out with a disposable syringe 1 mL, 26 G × 13 mm syringe (Becton, Dickinson and Company) and a sterilized needle 30 G × 39 mm (Sungshim Medical Co., Ltd.). So-yeom pharmacopuncture 2 mL (Korean Pharmacopuncture Research Institute) was performed 3–4 times a week in Case 1 and twice a week in Case 2. Cho-o pharmacopuncture 2 mL (Kirin Korean Medicine Industrial Institute,) was administered 4–5 times a week in Case 2. Pharmacopuncture was injected into the acupoints chosen from bilateral BL23, BL24, and BL25, with a total volume of 2 mL, 0.5 mL per acupoint.
4) Herbal medicineHerbal medicine was provided in 3 daily packs (120 mL per pack), taken 1 hour after each meal. Tables 1 and 2 show the duration and composition of the herbal medicines prescribed during the hospitalization period in both cases.
Table 1 . Duration and composition of herbal medicines in Case 1.
Dangguisu-san Gami, 2023.2.3. (admission) (1 d) | Dose (g) | Dangguisu-san, 2023.2.4.–2023.2.8. (day 2–6) (5 d) | Dose (g) | Gami gunggui-tang, 2023.2.9.–2023.3.3. (day 7-discharge) (23 d) | Dose (g) |
---|---|---|---|---|---|
Angelicae Gigantis Radix | 6 | Rehmanniae Radix Recens | 8 | Angelicae Gigantis Radix | 20 |
Paeoniae Radix | 4 | Angelicae Gigantis Radix | 6 | Cnidii Rhizoma | 20 |
Linderae Radix | 4 | Paeoniae Radix | 4 | Astragali Radix | 8 |
Cyperi Rhizoma | 4 | Linderae Radix | 4 | Ginseng Radix | 8 |
Sappan Lignum | 4 | Cyperi Rhizoma | 4 | Lycii Fructus | 8 |
Carthami Flos | 3 | Sappan Lignum | 4 | Codonopsis Pilosulae Radix | 4 |
Persicae Semen | 3 | Carthami Flos | 2 | Cuscutae Semen | 4 |
Cassiae Cortex Interior | 2 | Persicae Semen | 2 | Dipsaci Radix | 4 |
Glycyrrhizae Radix et Rhizoma | 2 | Cinnamomi Ramulus | 2 | Dendrobii Caulis | 4 |
Glycyrrhizae Radix et Rhizoma | 2 | Eucommiae Cortex | 4 | ||
Rhei Radix et Rhizoma | 2 | Drynariae Rhizoma | 4 | ||
Carthami Flos | 4 |
Table 2 . Duration and composition of herbal medicines in Case 2.
Pyeongjingeonbi-tang, 2023.2.8.–2023.2.13., 2023.2.17., 2023.2.22.–2023.2.23. (admission-day 6, day 10, day 15-day 16) (9 d) | Dose (g) | Gami gunggui-tang, 2023.2.14.–2023.2.16., 2023.2.18.–2023.2.21. (day 7–9, day 11–14) (7 d) | Dose (g) | Gami yangwi-tang, 2023.2.24. (day 17) (1 d) | Dose (g) | Sipjeondaebotang-Gagambang, 2023.2.25.–2023.3.21. (day 18-discharge) (25 d) | Dose (g) |
---|---|---|---|---|---|---|---|
Crataegii Fructus | 6 | Angelicae Gigantis Radix | 20 | Atractylodis Rhizoma | 8 | Ginseng Radix | 5 |
Cyperi Rhizoma | 4 | Cnidii Rhizoma | 20 | Magnoliae Cortex | 4 | Atractylodis Rhizoma Alba | 5 |
Pinelliae Tuber | 4 | Astragali Radix | 8 | Citri Unshius Pericarpium | 4 | Poria Sclerotium | 5 |
Citri Unshius Pericarpium | 4 | Ginseng Radix | 4 | Polyporus | 4 | Glycyrrhizae Radix et Rhizoma | 5 |
Cnidii Rhizoma | 4 | Lycii Fructus | 8 | Alismatis Rhizoma | 4 | Paeoniae Radix | 5 |
Atractylodis Rhizoma | 4 | Codonopsis Pilosulae Radix | 4 | Poria Sclerotium | 4 | Cnidii Rhizoma | 5 |
Atractylodis Rhizoma Alba | 4 | Cuscutae Semen | 4 | Agastachis Herba | 4 | Angelicae Gigantis Radix | 4 |
Ponciri Fructus Immaturus | 4 | Dipsaci Radix | 4 | Poria Sclerotium | 4 | Astragali Radix | 4 |
Agastachis Herba | 4 | Dendrobii Caulis | 4 | Zingiberis Rhizoma | 4 | Longan Arillus | 4 |
Magnoliae Cortex | 4 | Eucommiae Cortex | 4 | Cinnamomi Ramulus | 4 | Atractylodis Rhizoma | 4 |
Amomi Fructus | 4 | Drynariae Rhizoma | 4 | Aucklandiae Radix | 4 | Citri Unshius Pericarpium | 4 |
Massa Medicata Fermentata | 6 | Cervi Cornu | 4 | Zingiberis Rhizoma Recens | 4 | Magnoliae Cortex | 4 |
Hordei Fructus Germinatus | 6 | Zizyphi Fructus | 6 | Cyperi Rhizoma | 4 | ||
Glycyrrhizae Radix et Rhizoma | 4 | Cyperi Rhizoma | 6 | Pinelliae Tuber | 4 | ||
Aucklandiae Radix | 2 | Ponciri Fructus Immaturus | 6 | Crataegii Fructus | 4 | ||
Zingiberis Rhizoma Recens | 12 | Crataegii Fructus | 4 | Drynariae Rhizoma | 4 | ||
Zizyphi Fructus | 8 | Amomi Fructus | 4 | ||||
Longan Arillus | 8 |
During the absolute bed rest (ABR) phase, indirect electric moxibustion therapy (Technoscience) was applied at BL23 once daily for 15 minutes. During the bed rest (BR) phase, indirect moxibustion using charcoal moxa cones (Dongbang Medical Co., Ltd.) was administered at BL23 once daily for 30 minutes.
6) Cupping therapyDry cupping therapy was conducted in the lumbosacral region using a manual vacuum pump for 3 minutes. It was performed twice daily during the ABR phase and once daily during the BR phase.
The numerical rating scale (NRS) scores is used to quantify the subjective severity of pain on a scale of 0 to 10. A score of 10 represents the worst imaginable pain, while 0 indicates a pain-free state [12]. The evaluation was conducted daily at 7 AM.
2) Range of motionRange of motion (ROM) assesses the lumbar spine’s ROM and the presence of pain during active movement. The angles of flexion, extension, lateral bending, and rotation of the lumbar spine were measured daily at 7 AM. A “+” sign was marked if pain was noted during movement.
3) Changes in gait and walking distanceThe patient’s ability to move via wheelchair, walker, or independent ambulation was evaluated. The number of roundtrips made in an approximately 80-m-long hospital corridor was recorded.
4) X-ray and computed tomographyRadiological images were taken after roughly 3 weeks of integrative Korean medicine treatment and were subsequently reviewed by a radiologist.
Female, 67 years old.
2) Principal complaintsLumbosacral pain.
3) Onset and causeThe patient experienced pain subsequent to a traffic accident that occurred while crossing the crosswalk on February 3, 2023.
4) Present illnessOn February 3, 2023, a hospital-conducted X-ray of the lumbar spine revealed no notable findings, and subsequently, the patient was then admitted to the hospital. On February 7, 2023, a lumbar spine computed tomography (CT) performed at the hospital led to the diagnosis of a left sacral fracture.
5) ProgressUpon admission, lumbosacral pain was rated at NRS 7.5, and the patient experienced difficulty sitting in a wheelchair, although ambulation was possible. Acetaminophen 325 mg and tramadol hydrochloride (HCl) 37.5 mg were administered after breakfast and dinner, leading to hospitalization with BR. On day 5, the pain persisted, and a lumbar spine CT revealed a left sacral fracture. The patient was then advised to apply ABR; however, the pain continued. Aceclofenac 100 mg and eperisone HCl 50 mg were additionally administered after breakfast and dinner from days 12 to 20. On day 14, the lumbosacral pain was still NRS 7.5, but the patient could walk 40 m with a walker. By day 21, the pain decreased to NRS 5.5, and acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone HCl 50 mg were administered after breakfast and dinner until day 26. On day 25, the pain further decreased to NRS 4, and the patient could walk 160 m with the walker. Following this, the patient was advised to transition from ABR to BR. From day 27 to discharge, aceclofenac 100 mg and eperisone HCl 50 mg were administered after breakfast and dinner, causing the lumbosacral pain to increase to NRS 6. Upon discharge, the patient could walk independently, but the pain increased to NRS 7. In addition to the oral analgesics described above, diclofenac sodium 37.5 mg or tramadol HCl 25 mg were administered intramuscularly when necessary (Figs. 1, 2; Table 3).
Table 3 . Medications administered during Case 1’s hospitalization.
Medication | 2023.2.4.–2023.2.13. (day 2–11) (10 d) | 2023.2.14.–2023.2.22. (day 12–20) (9 d) | 2023.2.23.–2023.2.28. (day 21–26) (6 d) | 2023.3.1.–2023.3.3. (day 27-discharge) (3 d) |
---|---|---|---|---|
Acetaminophen 325 mg, tramadol HCl 37.5 mg | B, D/PC 30 min | B, D/PC 30 min | - | - |
Acetaminophen 162.5 mg, tramadol HCl 18.75 mg | B, D/PC 30 min | - | ||
Aceclofenac 100 mg | B, D/PC 30 min | B, D/PC 30 min | B, D/PC 30 min | |
Eperisone HCl 50 mg | B, D/PC 30 min | B, D/PC 30 min | B, D/PC 30 min | |
Diclofenac sodium 37.5 mg | 02/11 1/d 02/12 2/d | - | - | - |
Tramodol HCl 25 mg | 02/14 1/d 02/16 1/d | - | - |
HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable..
At the time of admission, the ROM of the lumbar spine could not be measured due to pain. However, at discharge, the ROM of the lumbar spine was measured with flexion at 80° (+) and extension at 20° (+), while lateral bending and rotation were within the normal range (Table 4).
Table 4 . Changes in Case 1’s range of motion (before and after treatment).
Lumbar spine ROM | 2023.2.3. (before treatment) | 2023.3.3. (after treatment) |
---|---|---|
Flexion | Unable to measure because of pain | 80° (+) |
Extension | Unable to measure because of pain | 20° (+) |
Lateral bending | Unable to measure because of pain | 35°/35° |
Rotation | Unable to measure because of pain | 45°/45° |
ROM, range of motion; +, sign was marked when there was pain while moving..
On day 2, the patient was diagnosed with a left sacral fracture via a lumbar spine CT scan, and on day 25, a pelvic bone CT showed decreased dislocation of the left sacral fracture (Fig. 3). An X-ray of the lumbosacral spine revealed no sacral fracture. On March 14, 2023, after the patient was discharged, an X-ray of the lumbosacral spine was taken during an outpatient visit to the hospital. The resultant films revealed progressive fusion of the fracture. On April 21, 2023, an X-ray of the sacrococcygeal spine showed additional fusion (Fig. 4).
Female, 69 years old.
2) Principal complaintsLumbosacral and lower extremity pain.
3) Onset and causeThe patient fell on December 22, 2022. By January 24, 2023, her symptoms had worsened, particularly when upright.
4) Present illnessOn February 1, 2023, the patient was diagnosed with fractures in sacrum 1 and 2 through a lumbar spine CT scan at the hospital. On February 7, 2023, the patient was found to have a herniated nucleus pulposus (HNP) of L4–5 and spinal stenosis of L4–5 via a lumbar spine magnetic resonance imaging, as well as fractures in sacrum 1, 2, and the left pubic bone as revealed by a pelvic bone CT scan at the hospital. The patient was hospitalized on February 8, 2023.
5) ProgressUpon admission, the patient’s lumbosacral pain was rated NRS 4 and lower extremity pain was rated NRS 8, making ambulation possible only by wheelchair. The patient struggled to sit in the wheelchair and was hospitalized with ABR, receiving acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone 75 mg after breakfast and dinner. By day 3, the patient could move 160 m while seated in the wheelchair, leading to a recommendation to shift from ABR to BR. On day 7, the lumbosacral pain subsided to NRS 1.5, and lower extremity pain dropped to NRS 4. The medication was adjusted to include acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone HCl 50 mg after meals until day 13. On day 14, the lumbosacral pain remained NRS 1.5, and lower extremity pain further decreased to NRS 3. Aceclofenac 100 mg and eperisone HCl 50 mg were then prescribed after breakfast and dinner until day 20. From day 21 until discharge, analgesics were halted, and on day 28, lumbosacral pain lessened to NRS 1, while lower extremity pain rose to NRS 6. On day 31, the patient could walk 40 m with a walker, and from day 35, the patient could walk 160 m. The average daily distance walked with a walker increased from 424 m to 720 m by discharge. From day 37 until discharge, lumbosacral pain was stable at NRS 1, and lower extremity pain was NRS 2 (Figs. 5, 6; Table 5).
Table 5 . Medications administered during Case 2’s hospitalization.
Medication | 2023.2.8.–2023.2.13. (admission-day 6) (6 d) | 2023.2.14.–2023.2.20. (day 7–13) (7 d) | 2023.2.21.–2023.2.27. (day 14–20) (7 d) | 2023.2.28.–2023.3.21. (day 21-discharge) (22 d) |
---|---|---|---|---|
Acetaminophen 162.5 mg, tramadol HCl 18.75 mg | B, D/PC 30 min | B, D/PC 30 min | - | - |
Aceclofenac 100 mg | B, D/PC 30 min | B, D/PC 30 min | B, D/PC 30 min | - |
Eperisone HCl 75 mg | B, D/PC 30 min | - | - | - |
Eperisone HCl 50 mg | B, D/PC 30 min | B, D/PC 30 min | - |
HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable..
At admission, lumbar spine ROM was measured with extension at 0° (+) and lateral bending at 30° (+), with flexion and rotation within the normal range. At discharge, extension was measured at 20° (+), and all other measures were within the normal range (Table 6).
Table 6 . Changes in Case 2’s range of motion (before and after treatment).
Lumbar spine ROM | 2023.2.8. (before treatment) | 2023.3.21. (after treatment) |
---|---|---|
Flexion | 80° | 80° |
Extension | 0° (+) | 20° (+) |
Lateral bending | 30° (+)/30° (+) | 35°/35° |
Rotation | 45°/45° | 45°/45° |
ROM, range of motion; +, pain while moving..
On February 7, 2023, the patient was diagnosed with fractures in sacrum 1 and 2 through a pelvic bone CT scan at the hospital. On day 3, an X-ray of the lumbar spine revealed a dislocation of the sacrum 1 and 2 fractures. On day 24, a subsequent X-ray of the lumbar spine showed progressive fusion of the fractures in sacrum 1 and 2 (Fig. 7).
Sacral fractures are typically treated conservatively unless structural stability is lost, or neurological abnormalities occur [11]. Conventional conservative treatments include BR and mechanical traction. Integrative Korean medicine is known for reducing pain and promoting fracture fusion [13].
Acupuncture is effective in controlling pain, restoring ROM, and preventing stiffness [14]. Acupotomy was also performed in Case 2, as the patient was diagnosed with a HNP of L4–5 and spinal stenosis of L4–5 and had lower extremity pain. Lower extremity pain is a key symptom of HNP and spinal stenosis and began after the patient’s fall. However, HNP and spinal stenosis are often chronic conditions believed to have started before the patient’s fall [15]. Therefore, it seems the fall worsened the patient’s HNP of L4–5 and spinal stenosis of L4–5, revealing the lower extremity pain. Acupotomy is typically used for chronic pain. A past study found acupotomy effective for reducing pain and improving lumbar spine ROM and quality of life in patients with acute lumbosacral pain caused by trauma [16]. Pharmacopuncture combines acupuncture medicine and pharmacotherapy [17]. So-yeom pharmacopuncture exerts anti-inflammatory effects by inhibiting inflammation-related tumor necrosis factor α and interferon γ [18]. Aconitine, the main component of Cho-o pharmacopuncture, demonstrates strong anti-inflammatory and analgesic effects [19]. Depending on the patient’s symptoms, prescriptions of Dagguisu-san, Gami gunggui-tang, and Sipjeondaebotang-Gagambang were made, each with specific and unique efficacies. Dagguisu-san treats early-stage blood stasis and Gami gunggui-tang boosts energy to promote later-stage fracture fusion [20]. Sipjeondaebotang-Gagambang increases blood supply to promote fracture fusion and treats post-traumatic inertia [21]. Case 2 was prescribed Pyeongjingeonbi-tang and Gami yangwi-tang for dyspepsia and vomiting during hospitalization. Moxibustion improves circulation by heating acupoints, and dry cupping relieves pain and removes blood stasis [22].
Case 1 demonstrated improved ROM and could walk independently about 4 weeks (29 days), faster than the typical 6 weeks of immobilization in patients with moderate sacral fractures [23]. Case 2 had a lower NRS score, improved ROM, and could walk independently in 7 weeks (49 days), faster than the expected > 8 week immobilization period for severe sacral and pubic fractures [23]. Integrative Korean medicine treatment is beneficial for patients with sacral fractures by reducing lumbosacral pain while improving ROM. Additionally, radiological examinations taken before and after treatment showed progressive fusion of the fracture in both cases.
However, our results should be interpreted with caution due to several limitations. First, the cases in this study may appear heterogeneous since Case 2 also involved a pubic fracture. Yet, this left pubic fracture was classified as Tile-type A2, signifying a minimally displaced fracture without instability, and the patient did not feel pain in that region [11]. Thus, the study’s results could be considered in the context of integrative Korean medicine treatment for sacral fractures. Second, in Case 1, lumbar spine ROM improved; however, the degree of improvement was non-significant (NRS: 7.5 at admission and 7 at discharge). Conversely, in Case 2, both ROM and NRS scores improved markedly. Since the patients under BR were also undergoing walking rehabilitation to assess their ambulatory status during hospitalization, detecting NRS score changes was challenging. Nevertheless, the treatment appeared effective, as the patients ceased taking analgesics and could walk independently upon discharge. Third, this study includes only 2 cases, and in Case 2, no follow-up was conducted after discharge. Fourth, interpreting the effect of integrative Korean medicine treatment is complex due to analgesics administration and the natural healing ability of non-displaced fractures within 4–6 weeks of BR [1]. Lastly, the NRS score for lower extremity pain dropped (NRS: 8 at admission and 2 at discharge), yet isolating the effect of acupotomy treatment in Case 2 is challenging since other treatments were also applied. However, this result confirms the potential of acupotomy in treating acute lumbosacral and lower extremity pain, an area where studies remain scarce. Overall, a systematic follow-up study with a larger sample population is essential to objectively evaluate the efficacy of integrative Korean medicine treatment for sacral fractures.
Conceptualization: YSK, YIK. Methodology: YSK. Formal investigation: YSK. Data analysis: YSK. Writing – original draft: YSK. Writing – review & editing: All authors.
The authors have no conflicts of interest to declare.
None.
This study was exempt from the Daejeon Korean Medicine Hospital of Daejeon University Institutional Review Board (IRB no.: DJDSKH-23-E-12).
Table 1 . Duration and composition of herbal medicines in Case 1.
Dangguisu-san Gami, 2023.2.3. (admission) (1 d) | Dose (g) | Dangguisu-san, 2023.2.4.–2023.2.8. (day 2–6) (5 d) | Dose (g) | Gami gunggui-tang, 2023.2.9.–2023.3.3. (day 7-discharge) (23 d) | Dose (g) |
---|---|---|---|---|---|
Angelicae Gigantis Radix | 6 | Rehmanniae Radix Recens | 8 | Angelicae Gigantis Radix | 20 |
Paeoniae Radix | 4 | Angelicae Gigantis Radix | 6 | Cnidii Rhizoma | 20 |
Linderae Radix | 4 | Paeoniae Radix | 4 | Astragali Radix | 8 |
Cyperi Rhizoma | 4 | Linderae Radix | 4 | Ginseng Radix | 8 |
Sappan Lignum | 4 | Cyperi Rhizoma | 4 | Lycii Fructus | 8 |
Carthami Flos | 3 | Sappan Lignum | 4 | Codonopsis Pilosulae Radix | 4 |
Persicae Semen | 3 | Carthami Flos | 2 | Cuscutae Semen | 4 |
Cassiae Cortex Interior | 2 | Persicae Semen | 2 | Dipsaci Radix | 4 |
Glycyrrhizae Radix et Rhizoma | 2 | Cinnamomi Ramulus | 2 | Dendrobii Caulis | 4 |
Glycyrrhizae Radix et Rhizoma | 2 | Eucommiae Cortex | 4 | ||
Rhei Radix et Rhizoma | 2 | Drynariae Rhizoma | 4 | ||
Carthami Flos | 4 |
Table 2 . Duration and composition of herbal medicines in Case 2.
Pyeongjingeonbi-tang, 2023.2.8.–2023.2.13., 2023.2.17., 2023.2.22.–2023.2.23. (admission-day 6, day 10, day 15-day 16) (9 d) | Dose (g) | Gami gunggui-tang, 2023.2.14.–2023.2.16., 2023.2.18.–2023.2.21. (day 7–9, day 11–14) (7 d) | Dose (g) | Gami yangwi-tang, 2023.2.24. (day 17) (1 d) | Dose (g) | Sipjeondaebotang-Gagambang, 2023.2.25.–2023.3.21. (day 18-discharge) (25 d) | Dose (g) |
---|---|---|---|---|---|---|---|
Crataegii Fructus | 6 | Angelicae Gigantis Radix | 20 | Atractylodis Rhizoma | 8 | Ginseng Radix | 5 |
Cyperi Rhizoma | 4 | Cnidii Rhizoma | 20 | Magnoliae Cortex | 4 | Atractylodis Rhizoma Alba | 5 |
Pinelliae Tuber | 4 | Astragali Radix | 8 | Citri Unshius Pericarpium | 4 | Poria Sclerotium | 5 |
Citri Unshius Pericarpium | 4 | Ginseng Radix | 4 | Polyporus | 4 | Glycyrrhizae Radix et Rhizoma | 5 |
Cnidii Rhizoma | 4 | Lycii Fructus | 8 | Alismatis Rhizoma | 4 | Paeoniae Radix | 5 |
Atractylodis Rhizoma | 4 | Codonopsis Pilosulae Radix | 4 | Poria Sclerotium | 4 | Cnidii Rhizoma | 5 |
Atractylodis Rhizoma Alba | 4 | Cuscutae Semen | 4 | Agastachis Herba | 4 | Angelicae Gigantis Radix | 4 |
Ponciri Fructus Immaturus | 4 | Dipsaci Radix | 4 | Poria Sclerotium | 4 | Astragali Radix | 4 |
Agastachis Herba | 4 | Dendrobii Caulis | 4 | Zingiberis Rhizoma | 4 | Longan Arillus | 4 |
Magnoliae Cortex | 4 | Eucommiae Cortex | 4 | Cinnamomi Ramulus | 4 | Atractylodis Rhizoma | 4 |
Amomi Fructus | 4 | Drynariae Rhizoma | 4 | Aucklandiae Radix | 4 | Citri Unshius Pericarpium | 4 |
Massa Medicata Fermentata | 6 | Cervi Cornu | 4 | Zingiberis Rhizoma Recens | 4 | Magnoliae Cortex | 4 |
Hordei Fructus Germinatus | 6 | Zizyphi Fructus | 6 | Cyperi Rhizoma | 4 | ||
Glycyrrhizae Radix et Rhizoma | 4 | Cyperi Rhizoma | 6 | Pinelliae Tuber | 4 | ||
Aucklandiae Radix | 2 | Ponciri Fructus Immaturus | 6 | Crataegii Fructus | 4 | ||
Zingiberis Rhizoma Recens | 12 | Crataegii Fructus | 4 | Drynariae Rhizoma | 4 | ||
Zizyphi Fructus | 8 | Amomi Fructus | 4 | ||||
Longan Arillus | 8 |
Table 3 . Medications administered during Case 1’s hospitalization.
Medication | 2023.2.4.–2023.2.13. (day 2–11) (10 d) | 2023.2.14.–2023.2.22. (day 12–20) (9 d) | 2023.2.23.–2023.2.28. (day 21–26) (6 d) | 2023.3.1.–2023.3.3. (day 27-discharge) (3 d) |
---|---|---|---|---|
Acetaminophen 325 mg, tramadol HCl 37.5 mg | B, D/PC 30 min | B, D/PC 30 min | - | - |
Acetaminophen 162.5 mg, tramadol HCl 18.75 mg | B, D/PC 30 min | - | ||
Aceclofenac 100 mg | B, D/PC 30 min | B, D/PC 30 min | B, D/PC 30 min | |
Eperisone HCl 50 mg | B, D/PC 30 min | B, D/PC 30 min | B, D/PC 30 min | |
Diclofenac sodium 37.5 mg | 02/11 1/d 02/12 2/d | - | - | - |
Tramodol HCl 25 mg | 02/14 1/d 02/16 1/d | - | - |
HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable..
Table 4 . Changes in Case 1’s range of motion (before and after treatment).
Lumbar spine ROM | 2023.2.3. (before treatment) | 2023.3.3. (after treatment) |
---|---|---|
Flexion | Unable to measure because of pain | 80° (+) |
Extension | Unable to measure because of pain | 20° (+) |
Lateral bending | Unable to measure because of pain | 35°/35° |
Rotation | Unable to measure because of pain | 45°/45° |
ROM, range of motion; +, sign was marked when there was pain while moving..
Table 5 . Medications administered during Case 2’s hospitalization.
Medication | 2023.2.8.–2023.2.13. (admission-day 6) (6 d) | 2023.2.14.–2023.2.20. (day 7–13) (7 d) | 2023.2.21.–2023.2.27. (day 14–20) (7 d) | 2023.2.28.–2023.3.21. (day 21-discharge) (22 d) |
---|---|---|---|---|
Acetaminophen 162.5 mg, tramadol HCl 18.75 mg | B, D/PC 30 min | B, D/PC 30 min | - | - |
Aceclofenac 100 mg | B, D/PC 30 min | B, D/PC 30 min | B, D/PC 30 min | - |
Eperisone HCl 75 mg | B, D/PC 30 min | - | - | - |
Eperisone HCl 50 mg | B, D/PC 30 min | B, D/PC 30 min | - |
HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable..
Table 6 . Changes in Case 2’s range of motion (before and after treatment).
Lumbar spine ROM | 2023.2.8. (before treatment) | 2023.3.21. (after treatment) |
---|---|---|
Flexion | 80° | 80° |
Extension | 0° (+) | 20° (+) |
Lateral bending | 30° (+)/30° (+) | 35°/35° |
Rotation | 45°/45° | 45°/45° |
ROM, range of motion; +, pain while moving..
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