Lumbar myofascitis, also known as myofascial pain syndrome (MPS) is a common clinical condition and the main course of low back pain. It is characterized by diffuse dull pain, localized pain, coldness, skin numbness, muscle spasms and impaired movement.The pain is worse in the morning, mild during the day and aggravated in the evening. The pain is often triggered by physical inactivity or too much activity. This condition has a long duration and is often triggered by fatigue or weather changes. It can affect the patients’quality of life. It is pathologically featured by chronic soft tissue pain in multiple myofascial trigger points[1-2].Pressing these trigger points may produce referred pain.

The concept of trigger point was first proposed by Travell JG[3] in 1952. Till 1981, Simons DG, et al[4-5]confirmed the existence of trigger point and proposed the diagnosis of MPS in 1990. Modern Chinese scholars did some research on the mechanism of fasciitis. Wang YS, et al[6] held that release of 5-HT and histamine caused by soft tissue injury can produce ischemia and neurological sensitization, consequently resulting in shortening of muscle fibers, and inflammatory pain and the corresponding clinical symptoms. According to clinical data, Zhou XG, et al[7] found that myofascitis is closely related to work and lifestyle. It is more common in long-term desk work groups (such as teachers,accountants, designers and engineers). The body maintaining a fixed position for a long time will keep the back muscles in a continuous state of high tension, and it will make the muscles release inflammatory substances, causing ion imbalances. For example, hightension muscles will over-release calcium. High concentrations of calcium ions will in turn lead to sustained muscle contraction. When muscle pressure continues to rise, interstitial vessels are compressed,blocking the blood circulation and increasing tissue ischemia. Finally, there forms up a vicious cycle of pain-contraction-aggravated pain[8].

In order to explore an effective treatment of lumbar myofascitis, this research was to observe the clinical effect of acupuncture plus moving cupping with white mustard oil in treating lumbar myofascitis, and the report is given as follows.

其中：γ为上覆岩层的平均容重，KN/m3；p为均布载荷，kPa；y为底板上任意一点的深度；Ka为主动压力系数，Ka=tan2 (45°-φ/2)；Kp为被动压力系数，Kp=tan2 (45°+φ/2)。

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria were according to the diagnosis of lumbar myofascitis in Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine[1]: trauma after improper treatment, a history of strain or exposure to cold; more in the elderly, especially manual labors; back pain, stiff muscle, a weight-bearing sensation, often associated with weather changes, e.g. overcast and rainy weather may aggravate the symptoms; the back with a fixed tenderness or extensive tender points; back muscle stiffness, and nodule-like changes often can be palpated,along the lines of the sacrospinalis, with limited range of motion of the back; no positive findings by X-ray.

1.2 Inclusion criteria

雕塑的动态是指被封闭在雕塑造型中的动态幻觉，是通过造型的结构、趋势、节奏、秩序等形态的张力串联、制造出一种视觉上的运动感受。

1.3 Exclusion criteria

Lumbar myofascitis falls under the category of‘Bi-impediment syndrome’ and ‘low back pain’ in Chinese medicine. As far as internal factors are concerned, it is caused by deficiency of the liver and kidney and stagnation of qi and blood. As far as exogenous factors are concerned, it is caused by wind,cold and dampness or inappropriately treated or untreated traumatic injuries. Internal and external etiological factors either cause obstruction or malnourishment, both resulting in pain[9-10].

1.4 Statistical methods

The SPSS 22.0 version software was used for statistical analysis. Chi-square test was adopted for gender data; age data in normal distribution with homogeneity of variance were expressed as mean ±standard deviation (x±s), and analyzed by t-test. Visual analog scale (VAS) score and Chinese version of Roland-Morris disability questionnaire (RMDQ) were grading data, and were analyzed by rank-sum test.P＜0.05 indicated a statistically significant difference.

第六、教师自己参加正规的教育管理部门组织的各级教学技能比赛，是对自我教学能力的一个促进，也是对学校、学院的教学风尚的一个促进，应该在综合评价中给予体现。

1.5 General data

A total of 90 patients were enrolled in this study, and all visited Jiaxing Second Hospital of Zhejiang Province for low back pain between January 2016 and December 2016. According to the order of treatment, they were divided into an observation group and a control group,45 cases in each group. There were no significant differences in gender and age between the two groups(both P＞0.05), indicating the comparability between the two groups (Table 1).

Conforming to the above diagnostic criteria; over 18 years old; no abnormality in serum human leukocyte antigen B27 (HLA-B27) and four coagulation indicators,namely, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (FIB) screening. All patients signed the informed consent.

Table 1. Comparison of general data between the two groups

Note: 1) x2 value; 2) t-value

Group n Gender (case) Average age(Male Female x±s, year)Observation 45 14 31 42.4±11.3 Control 45 21 24 42.2±9.3 Statistical value 2.2911) 0.3432)P-value 0.194 0.793

2 Treatment Methods

2.1 Observation group

2.1.1 Acupuncture therapy

三交镇黄河抗旱应急提水工程的实施，能很大限度地减轻旱灾造成的影响和损失，提高了干旱时期人饮应急供水能力，改善城乡居民生活质量，改变现有的被动应急抗旱方式，增强抗旱减灾保障能力，对促进经济社会全面、协调、可持续发展具有重要的现实意义。

Failure: No improvement in symptoms.

Method: The tender points were found and taken as Ashi points. After routine disinfection, needles of 0.30 mm in diameter and 40 mm in length were selected to puncture. After arrival of qi, even reinforcing-reducing manipulation was conducted to make patients to feel soreness, numbness or distention.The needles were retained for 30 min.

2.1.2 Moving cupping method

Moving cupping was used after acupuncture therapy.

Compound white mustard oil configuration: 40%mustard oil, 40% sesame oil, 10% wintergreen oil, and turpentine 10%.

Method: The patient was coated with white mustard oil on the back. The doctor took a special glass cup of a 45 mm in outer diameter, 38 mm in inner diameter of and 70 mm in depth, used flash-fire method to make the cup adsorb onto Dazhui (GV 14), and then moved the cup to slide down along the Governor Vessel [from Dazhui (GV 14) to Yaoyangguan (GV 3)], the first side line [from Dazhu (BL 11) to Qihaishu (BL 24)] and the second side line [from Fufen (BL 41) to Zhishi (BL 52)] of the Bladder Meridian, from top to bottom (single palm held the cup, made the cup body perpendicular to the skin, and pulled the cup to make it slide gently from top to bottom). Repeated the above operation until the local skin was significantly flushing or purple black petechia appeared.

导入开启了一门课程，总结则是完成这门课程。课堂总结在以下方面可以帮助学生，总结关键知识难点，理清课堂知识背景，巩固已学知识，加深记忆。教师可以本单元的教学知识点系统地总结的知识点，包括对内容的回顾 (分别由教师、学生简要概述)，小组总结(允许学生分享小组讨论的结果)，反馈(使用一些反馈设置)，以及对结果的赞扬(承认学生的努力和结果)，应用(如何使用课堂内容)，以及个人意见(学生表达他们的想法)。

2.2 Control group

Points: Same as those used in the observation group.

Methods: The acupuncture method was same as that in the observation group. The moxa stick was cut into small segments of about 2.5 cm in length. Made a hole in the center with a cotton swab and then fixed one moxa segment onto the needle tail, and lit it from the bottom. A paper pad was placed on the skin to prevent burn by falling ash. Paramedics removed ash regularly during the treatment. Three segments for each point,totally lasting about 30 min.

The two groups were treated twice a week. The effect was observed after 4 weeks of treatment in both groups.

3 Observation of Efficacy

3.1 Observation items

Patients of the two groups were assessed with VAS and Chinese version of RMDQ before treatment, and respectively after 1-week and 4-week treatment.

3.1.1 VAS[8]

With a straight line of 10 cm in length, the leftmost mark is 0 cm and the rightmost mark is 10 cm,explained as that 0 cm means no pain, while 10 cm means severe unbearable pain. Patients were asked to point out his pain intensity on the line. The corresponding calibration line pointed by the patient was considered as the score of VAS. The scale must be determined by the patient himself and the researcher should not suspect or have any suggestive behaviors.

3.1.2 Chinese version of RMDQ[2]

钻孔弹模测试根据《水利水电工程岩石试验规程》[15-16](DL/T 5368—2007、SL264—2001)的规定，采用逐级一次加/卸压循环方式，压力一般可分7～10级，其基本测试步骤如下：

There are 24 items in the Chinese version of RMDQ,including walking, standing, bending, work, bed rest,wearing clothes, and self-care ability in many aspects of daily life. Each question entry is calculated as 1 point.The answer to ‘yes’ is 1 point, and the answer to ‘no’ is 0 point. The total score is the sum of all points to ‘yes’.The lowest score is 0 and the highest score is 24. The higher the score, the worse the dysfunction.

1.2 试验方法 试验地点设置在长兴仙山湖库区，根据库区及入库河流水系特点，选取水深较浅、透明度较高的入库河流近岸区域设置样方，分别在库区的北湖设置9个样方N1～N9，平均水深1.5 m，透明度常年可见底；南湖设置3个样方S1～S3，水平水深0.8 m，透明度常年可见底。样方设置为5 m×2 m，四周立杆标记边界。

3.2 Criteria of therapeutic effect

3.3.1 Clinical efficacy

Cure: Back pain disappeared, mobility free, and no recurrence during the treatment.

[14]人们[B门]生活当中，在家里过得时间比较少{CC1不多}[BQ]，两代人应利用{CC2用}这个时间。

Improvement: Back pain reduced, but a little discomfort during activity.

Points: Dazhui (GV 14), Yaoyangguan (GV 3), Ashi points and bilateral Weizhong (BL 40), Yanglingquan(GB 34) and Shenshu (BL 23).

3.3 Results

The efficacy was evaluated according to the therapeutic effect criteria of PMS in the Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine[1].

After 4 weeks of treatment, the overall clinical efficacy of the two groups was compared using rank-sum test (Z=-3.715, P=0.000), suggesting that acupuncture plus moving cupping is better than acupuncture plus warm needling for PMS (Table 2).

3.3.2 VAS score

There was no significant difference in VAS score between the two groups before the treatment (P＜0.05).After one week of treatment, the VAS scores of the two groups were lower than those before the treatment(both P＜0.01), but there was no significant difference between the two groups (P＞0.05). These results suggested that both treatment protocols were effective.After 4-week treatment, compared with those after 1-week treatment, the VAS scores of the two groups continued to decline, there were significant intra-group differences in the two groups (both P＜0.01); the VAS score in the observation group was significantly lower than that in the control group (P＜0.01). These results suggested that acupuncture plus moving cupping can relieve pain better than acupuncture plus warm needling (Table 3).

3.3.3 Chinese version of RMDQ score

Before the treatment, the difference in Chinese version of RMDQ score between the two groups was not statistically significant according to rank-sum test(P＞0.05). After 1-week treatment, the Chinese version of RMDQ scores of both groups were lower than those before the treatment (both P＜0.01), but there was no significant difference between the two groups (P＞0.05).These results suggested that both treatment protocols can improve patient’s dysfunction. After 4 weeks of treatment, the Chinese version of RMDQ scores of both groups continued to decline, with a statistical intragroup difference in each group compared with the score after 1-week treatment (both P＜0.01). The Chinese version of RMDQ score in the observation group was significantly lower than that in the control group(P＜0.05). These results suggested that acupuncture plus moving cupping can improve the dysfunction better than acupuncture plus warm needling (Table 4).

Table 2. Comparison of clinical efficacy between the two groups (case)

Group n Cure Improvement Failure Cure rate (%) Total effective rate (%)Observation 45 25 16 4 55.6 91.1 Control 45 15 24 6 33.3 86.7

Table 3. Comparisons of VAS scores before and after the treatment (average rank)

Group n Before treatment After 1-week treatment Z-value P-value After 4-week treatment Z-value P-value Observation 45 43.80 42.86 -5.810 0.000 38.78 -5.824 0.000 Control 45 47.20 48.14 -5.850 0.000 52.22 -5.549 0.000 Z-value 0.622 -0.972 2.582 P-value 0.537 0.333 0.005

Table 4. Comparisons of Chinese version RMDQ scores before and after the treatment (average rank)

Group n Before treatment After 1-week treatment Z-value P-value After 4-week treatment Z-value P-value Observation 45 44.99 41.44 -5.849 0.000 38.86 -5.562 0.000 Control 45 46.01 49.56 -5.852 0.000 52.14 -5.760 0.000 Z-value -0.186 -1.480 2.532 P-value 0.854 0.140 0.011

4 Discussion

Those with severe life-threatening or infectious diseases; with abrasions and bleeding tendency;pregnant women or those who cannot tolerate acupuncture or moving cupping treatment; those with a history of lumbar surgery or severe lumbar deformity;those who can’t understand the scales or judge their own degree of pain; those with fracture, osteoporosis,lumbar spinal stenosis, spondylolisthesis or spinal tumor or infections.

Modern medicine considers that it is majorly caused by soft tissue strain of the back. The aseptic inflammation of the local soft tissue and the peripheral nerve micro-vascular permeability are the main pathological changes[11]. The main purpose of treatment is to relieve pain[12-15]. Acupuncture plus warm needling is a routine and effective method for myofascitis[16].Moving cupping therapy, a TCM treatment, is based on the cupping therapy[17]. Moving cupping method was first seen in an article entitled ‘Cupping therapy’ in 1956,which was published in Shanghai Zhongyiyao Zazhi(Shanghai Journal of Traditional Chinese Medicine)[18],with the function of dilating local microvessels.Governor Vessel, the sea of yang, can unblock yang in the whole body; the Bladder Meridian, from top to bottom, can link the qi movements of Zang-fu organs.So, moving cupping along the Governor Vessel and Bladder Meridian pathways can induct yang to the surface of the human body, adjust qi movement, and improve human immunity[19].

Ashi points can circulate the local qi and blood to stop pain. Weizhong (BL 40) is the He-Sea point of the Bladder Meridian, and belongs to the earth in five elements. The Bladder Meridian passes the back, so puncturing Weizhong (BL 40) can relax sinews and activate collaterals. Yanglingquan (GB 34), the tendon influential point of the Eight Influential Points, can fortify tendons and bones, dispel wind and resolve dampness. Shenshu (BL 23), as the Back-Shu point of the kidney, can tonify the liver and kidney, strengthen bones, and warm kidney to dispel cold; at the same time, as a local point, it can dredge the local qi and blood, relax sinews and activate collaterals.Yaoyangguan (GV 3) can strengthen tendons and bones,as well as dispel cold and dampness. Dazhui (GV 14) is a crossing point of all yang meridians, can dredge qi and unblock blood of the Governor Vessel, dispel cold and resolve dampness. To combine those points above can unlock the meridians and warm yang to relieve pain.

Bai Jie Zi (Semen Sinapis Albae) can warm the lung to resolve phlegm, regulate qi to resolve stasis, and dredge collaterals to kill pain. It is commonly used in treating cough and asthma due to cold and phlegm, chest and hypochondrium distention and fullness, joint numbness or pain caused by phlegm stagnation, or furuncle/mass due to phlegm and dampness[20-21]. White mustard oil can make the skin hot, and promote deep blood circulation, and has a strong anti-inflammatory analgesic effect[22]. Patients with back pain often have cold back feeling, and feel comfortable after treated with mustard oil. Wintergreen oil, also known as methyl salicylate, is good at releasing swelling to kill pain;turpentine can relax tendons[23-24], dredge collaterals,and promote the penetration of salicylic acid[20]. The combination of the two has a better efficacy. Sesame oil plays a role in lubricating and protecting the skin.

是洞庭湖水把橘红送走的，先把她送到长江，再往东，就把她送到了南京。他每天都对着洞庭湖水说，求你了，进长江后，莫往东走，往北吧，去北京替我把橘红找回来。自从第二次从北京回来后，他几乎天天来一次临湖广场，有时在广场上一呆就是一整天，有时是半天，仿佛是在等待洞庭湖水给他的回信。

From the results of this study, it was shown that after 1 week of treatment, the back pain of both groups was significantly relieved, and the functional improvement of the observation group was more significant than that of the control group. After 4 weeks of treatment, the improvements in pain and activity disorder in the observation group were more significant than those in the control group, and the recovery rate of the observation group was higher than that of the control group. Acupuncture plus moving cupping with white mustard oil has curative effect in treatment of lumbar myofascitis. It can relieve back pain and improve the activity of the back. Therefore, it can be used as a kind of simple and effective treatment for myofascitis.

构图对新闻摄影作品的质量及实效性产生直接影响，良好的构图能够快速吸引观众视线，提升摄影作品的震撼力与影响力。[5]与艺术摄影对构图的要求不同，新闻摄影构图应以营造良好的现场感为主，使图片具有较强的视觉冲击力，需摄影人员良好地应用摄影技巧及艺术手法，提升摄影作品灵活性，使其具有独特的艺术感染力。

Conflict of Interest

站在一边目睹了全程的小青发出一阵爆笑，如芸坐在那儿运气，发誓以后再也不跟他打招呼了。小青则乐不可支地跟每个人宣扬如芸被无视的遭遇，大家纷纷取笑她：“原来美女也是这样的待遇，这下我们可平衡了。”

There was no potential conflict of interest in this article.

This work was supported by Special Department Fund of Jiaxing Second Hospital of Zhejiang Province (浙江省嘉兴市第二医院特色科室基金).

Statement of Informed Consent

Informed consent was obtained from all individual participants in this study.

References

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