About Dr. Shi Qi
Dr. Shi Qi is a leading acupuncture specialist at the Affiliated Hospital of Shanghai University of Traditional Chinese Medicine — one of China's foremost centres for classical acupuncture, pain management, and integrative musculoskeletal care. He is recognised for his expertise in the treatment of chronic pain syndromes, lumbar disc disease, and neurological rehabilitation through classical needle therapy, with a defining commitment to integrating modern diagnostic imaging into traditional acupuncture practice. Dr. Shi's clinical philosophy holds that classical acupuncture achieves its greatest precision when guided by modern diagnostics: the CBCT, the MRI, and the CT scan do not replace the four examinations of traditional Chinese medicine — they complete them, allowing the physician to correlate the pattern identified through pulse, tongue, and inquiry with the anatomical lesion confirmed by imaging, and to select acupoints with both classical and anatomical rationale. His department has established one of Shanghai's most comprehensive integrative pain management programmes, combining classical acupuncture, moxibustion, and structured rehabilitation exercise into a unified care pathway for patients with chronic lumbar pain and radiculopathy.
Case Overview
Mr. David Lawson (pseudonym), a 52-year-old British office worker based in Shanghai, presented with a six-year history of chronic lumbar pain that had significantly worsened over the preceding three months, with radiation to the bilateral gluteal regions and posterior thighs, aggravated by flexion, prolonged sitting, and prolonged standing. Modern imaging confirmed L4–5 disc herniation with thecal sac compression. TCM diagnosis identified Kidney Yang deficiency with Cold-Damp Bi obstruction. Dr. Shi Qi designed a personalised treatment programme combining classical acupuncture at eight primary points with moxibustion and structured lumbar rehabilitation exercise — two courses of ten sessions each over seven weeks. At the conclusion of treatment, lumbar pain had resolved, lower limb numbness had cleared, and straight leg raise had normalised bilaterally. Three-month follow-up confirmed no recurrence.
Patient Background
- Name / Nationality: Mr. David Lawson (pseudonym) — British; 52-year-old office worker based in Shanghai
- Age / Sex: 52-year-old male
- Chief Complaint: Persistent lumbar pain for six years, significantly worsened with activity limitation for three months
- History of present illness: Insidious onset of lumbar aching six years prior, aggravated by fatigue and relieved by rest; no systematic treatment undertaken. Over the preceding three months, pain had intensified markedly with radiation to the bilateral gluteal regions and posterior thighs; aggravated by flexion, prolonged sitting, and prolonged standing; severely affecting daily life and work. NSAIDs self-administered with inadequate effect.
- Past medical history: No hypertension, diabetes, or cardiac disease; no history of lumbar trauma or surgery; no drug allergies
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TCM four examinations:
- Inspection: Sallow complexion; reduced vitality; restricted lumbar movement; slight forward lean on standing to reduce pain
- Auscultation/olfaction: Clear speech; regular respiration; no abnormal odour
- Inquiry: Lumbar aching with preference for warmth and pressure; aggravated by fatigue; associated lower limb numbness; aversion to cold; nocturia; loose stools
- Palpation: Deep, thready pulse (沉细脉); marked tenderness at L4–5 interspinous space and bilateral 1.5-cun paravertebral points; straight leg raise positive at 60° left, 65° right; reinforcement test negative
Diagnostic Workup
Lumbar Spine X-Ray
- Alignment: Loss of normal lumbar lordosis
- Bony changes: Marginal osteophyte formation at L4–5 vertebral bodies
- Disc spaces: Narrowing at L4–5
Lumbar CT
- Disc pathology: L4–5 disc herniation with thecal sac compression confirmed
- Neural structures: No evidence of osseous canal stenosis; nerve root compression at L4–5 level consistent with clinical radiculopathy
Laboratory Investigations
- Full blood count, ESR, and CRP all within normal limits — inflammatory and infective causes excluded
Dr. Shi's pre-treatment assessment: The CT confirms what the pulse and the inquiry already suggested — the problem is at L4–5. The disc herniation is compressing the thecal sac, and that is producing the radicular symptoms in the posterior thigh and the lower limb numbness. But the CT tells me where the anatomical lesion is; the four examinations tell me why this patient's body has failed to resolve it. The pulse is deep and thready — that is Kidney deficiency. The preference for warmth, the aversion to cold, the nocturia, the loose stools — that is Kidney Yang deficiency with Cold-Damp obstruction of the lumbar channels. The treatment must address both: the anatomical compression through precise point selection guided by the imaging, and the constitutional deficiency through warming and tonifying the Kidney Yang. Acupuncture alone at the local points will not hold if the underlying deficiency is not corrected.
TCM Diagnosis and Treatment Strategy
The TCM diagnosis established by Dr. Shi Qi was Lumbar Pain — Kidney Yang Deficiency with Cold-Damp Bi Obstruction (腰痛·肾阳虚衰，寒湿痹阻证). The corresponding Western diagnosis was L4–5 lumbar disc herniation with radiculopathy.
The treatment principle was: warm and tonify Kidney Yang; dispel Cold and resolve Damp; unblock the channels and relieve pain (温补肾阳，散寒除湿，通络止痛).
Primary acupoints: Shenshu (BL 23), Mingmen (GV 4), Yaoyangguan (GV 3), Dachangshu (BL 25), Huantiao (GB 30), Weizhong (BL 40), Yanglingquan (GB 34), Kunlun (BL 60).
Supplementary points (added according to symptom pattern): Guanyuan (CV 4) and Qihai (CV 6) for pronounced aversion to cold; Zhibian (BL 54) and Chengshan (BL 57) for worsening lower limb numbness.
Needling technique: Patient in prone position; standard sterile preparation; 0.30 mm × 40 mm single-use sterile needles. Shenshu, Mingmen, Yaoyangguan, and Dachangshu needled with reinforcing method (补法), depth 1.0–1.5 cun, retained 30 minutes with needle manipulation every 10 minutes to sustain needle sensation. Huantiao needled with lifting-thrusting reinforcing-reducing method until needle sensation radiated to the lower limb; retained 30 minutes. Weizhong, Yanglingquan, and Kunlun needled with even method (平补平泻), depth 0.8–1.2 cun, retained 30 minutes.
Moxibustion: Gentle moxibustion (温和灸) at Shenshu, Mingmen, and Yaoyangguan — 15–20 minutes per point, once daily — to reinforce the warming and tonifying effect of needling.
Rehabilitation exercise: Structured lumbar strengthening programme — prone back extension (飞燕式) and five-point bridge (五点支撑法) — twice to three times daily, 10–15 minutes per session, to strengthen the lumbar musculature and improve spinal stability.
Treatment schedule: Three sessions per week; ten sessions per course; two courses total.
Treatment Course and Outcomes
After Course 1 (Sessions 1–10)
- Lumbar pain significantly reduced; radiation range diminished — only occasional mild bilateral gluteal aching
- Lower limb numbness improved
- Aversion to cold and nocturia reduced
- Straight leg raise: left 70°, right 75°
After Course 2 (Sessions 11–20)
- Lumbar pain resolved; full lumbar range of motion restored; normal work and daily activities resumed
- Lower limb numbness cleared
- Aversion to cold, nocturia, and loose stools markedly improved
- Straight leg raise: left 80°, right 85°; reinforcement test negative
Three-Month Follow-Up
- No recurrence of lumbar pain or radicular symptoms; patient maintaining lumbar rehabilitation exercise programme independently
Dr. Shi's clinical reflection: The outcome in this patient illustrates the complementarity of classical acupuncture and modern diagnostics. The imaging told us the level and the nature of the compression. The four examinations told us the constitutional pattern that had allowed the condition to develop and persist. By addressing both simultaneously — warming the Kidney Yang to correct the constitutional deficiency, and needling the precise anatomical level confirmed by CT to decompress the nerve root — we achieved a result that neither approach alone would have produced as efficiently. The moxibustion was not supplementary — it was essential. In a patient with Kidney Yang deficiency and Cold-Damp obstruction, needling without warming is like opening a window without lighting the fire.
Expert Commentary — Dr. Shi Qi
1. Integrating Modern Diagnostics into Classical Acupuncture Practice
Classical acupuncture was developed without imaging technology, yet its channel and point system encodes a sophisticated anatomical map of the body's pain-generating and pain-modulating structures. The Bladder channel points of the lumbar region — Shenshu, Dachangshu, and their neighbours — correspond anatomically to the paravertebral musculature, the posterior rami of the lumbar spinal nerves, and the facet joint capsules. Needling these points at the correct depth and with the correct technique produces local muscle relaxation, segmental neural modulation, and systemic neurohumoral effects that are now measurable with modern neuroimaging and biochemical assay. What modern diagnostics add to this classical framework is precision: the CT tells us which level is the primary lesion, allowing us to concentrate the most intensive needling at the paravertebral points corresponding to that segment, rather than distributing treatment equally across the lumbar region. This is not a departure from classical acupuncture — it is an extension of the classical principle of identifying the root of the disease and treating it directly.
2. The Kidney Yang Deficiency Pattern in Chronic Lumbar Pain: Clinical Significance
In TCM, the Kidney governs the lumbar region — the classical texts state that the lumbar is the house of the Kidney (腰为肾之府). Kidney Yang deficiency produces a characteristic clinical pattern that is immediately recognisable in the four examinations: deep thready pulse, aversion to cold, preference for warmth and pressure, nocturia, loose stools, and a lumbar pain that is dull and aching rather than sharp and stabbing, worsened by fatigue and cold, relieved by rest and warmth. This pattern is not merely a metaphor — it corresponds to a measurable physiological state of reduced hypothalamic-pituitary-adrenal axis function, impaired local microcirculation in the lumbar tissues, and reduced inflammatory resolution capacity. Warming and tonifying the Kidney Yang through Mingmen, Shenshu, and Yaoyangguan — reinforced by moxibustion — addresses this physiological substrate, improving local tissue perfusion and creating the biological conditions for the disc-related inflammation to resolve. Treating the lumbar pain without correcting the Kidney Yang deficiency is treating the branch without the root: the pain may temporarily improve, but the constitutional vulnerability that allowed it to develop remains, and recurrence is likely.
3. Moxibustion as an Essential Therapeutic Modality, Not an Adjunct
In Western integrative medicine, moxibustion is frequently described as an adjunct to acupuncture — a supplementary warming technique applied after needling. In classical TCM practice, this framing misrepresents the therapeutic logic. For patterns characterised by Cold and Yang deficiency — as in this patient — moxibustion is not supplementary to needling; it is the primary modality for warming, and needling is the primary modality for moving. The two techniques address different aspects of the pathology: needling unblocks the channels and moves the Qi and Blood that have been obstructed by Cold-Damp; moxibustion warms the Yang and dispels the Cold that is the root cause of the obstruction. Applied together at the same points — Shenshu, Mingmen, Yaoyangguan — they produce a synergistic effect that neither achieves alone. The clinical evidence for moxibustion in chronic lumbar pain is now substantial, with multiple randomised controlled trials demonstrating superiority over sham moxibustion and equivalence or superiority to NSAIDs for pain reduction and functional improvement in patients with cold-pattern lumbar Bi syndrome.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Mr. Lawson from initial consultation through three-month follow-up, including: priority appointment coordination with Dr. Shi Qi at the Affiliated Hospital of Shanghai University of Traditional Chinese Medicine, with bilingual review of prior imaging and treatment records; bilingual interpretation throughout all four-examination consultations and treatment planning discussions, ensuring the patient understood both the TCM diagnostic framework and its correspondence with his CT findings; coordination of lumbar X-ray and CT with bilingual results communication and clinical summary for the patient's GP in the UK; bilingual explanation of the needling technique, moxibustion protocol, and rehabilitation exercise programme before each treatment phase; weekly progress summaries communicated to the patient's physiotherapist overseas; and three-month follow-up coordination with comprehensive outcome documentation provided to the patient's GP and occupational health physician.
For international patients with chronic lumbar pain, disc herniation, or musculoskeletal conditions seeking integrative TCM care in Shanghai, Dr. Shi Qi's team at the Affiliated Hospital of Shanghai University of Traditional Chinese Medicine offers classical acupuncture expertise guided by modern diagnostics — combining precise point selection, constitutional treatment, and structured rehabilitation to achieve durable pain resolution. CMCS ensures that expertise is accessible: in the patient's language, with overseas physicians informed at every step, from the first consultation through long-term follow-up.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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