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Case Report
Common Peroneal Nerve Entrapment Masked by Acute Lumbar Disc Herniation: Integrated Korean Medicine Treatment with Ultrasound-Guided Pharmacopuncture
Hyunsuk Park1orcid, Jinhyun Kim2orcid, Sungjae Yoo1orcid, Jung-Min Yun3orcid, Kwangchan Song1,*orcid
Perspectives on Integrative Medicine 2024;3(3):177-183.
DOI: https://doi.org/10.56986/pim.2024.10.008
Published online: October 31, 2024

1Department of Korean Medicine Rehabilitation, Bucheon Jaseng Hospital of Korean Medicine, Bucheon, Republic of Korea

2Department of Oriental Neuropsychiatry, Bucheon Jaseng Hospital of Korean Medicine, Bucheon, Republic of Korea

3Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea

*Corresponding author: Kwangchan Song, Department of Korean Medicine Rehabilitation, Bucheon Jaseng Hospital of Korean Medicine, 4F, 17, Buil-ro 191 beon-gil, Wonmi-gu, Bucheon, Gyeonggi-do, Republic of Korea, Email: chan82499@jaseng.org
• Received: September 10, 2024   • Revised: September 23, 2024   • Accepted: September 25, 2024

©2024 Jaseng Medical Foundation

This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/).

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  • The symptoms of common peroneal nerve (CPN) entrapment are similar to the symptoms of lumbar herniated intervertebral disc. We present the successful treatment of CPN entrapment masked by acute lumbar disc herniation. A 49-year-old man presented with low back pain and numbness in his left leg. Following admission, patient history, physical examination, and radiology findings, the patient received integrated Korean medicine (KM) treatment (acupuncture, pharmacopuncture, ultrasound-guided pharmacopuncture, moxibustion and cupping, herbal medicine, and chuna therapy) for lumbar disc herniation. Outcome measures included the numeric rating scale, the European quality of life five dimensions, and the Oswestry disability index. Symptoms persisted, and CPN compression was consequently suspected. On Day 12 of 23, in addition to KM treatment, an ultrasound-guided Shinbaro2 pharmacopuncture (4 mL) was performed on the CPN entrapment site. Significant symptom relief resulted after CPN treatment on Day 12. Improvement was particularly evident in the lower leg and ankle, areas where the pain had previously been misattributed to symptoms of lumbar disc herniation. His low back pain and radiating pain to the back of the left femur started to improve from Day 20 and were mild at discharge. This case highlights the importance of considering peripheral nerve entrapment in patients presenting with symptoms similar to lumbar disc herniation. It also suggests that combining traditional KM with modern diagnostic techniques such as ultrasonography, may be beneficial in the precise location for pharmacopuncture treatment. Further studies are recommended to validate these findings and explore the broader applicability of this approach.
Nerve entrapment is a complex neurological disorder (nerve compression syndrome or trapped nerve) in which space-occupying lesions compress normal nerve pathways and result in damage to the nerve causing paresthesia and pain in the area controlled by the nerve [1]. It is typically caused by overuse of normal structures such as a joint, or thickening of normal tissues such as tendons, ligaments, and fibrous tissue.
The common peroneal nerve (CPN) branches from the sciatic nerve (which is formed by the union of the lumbar nerve roots) and runs down the lateral side of the leg. The CPN provides sensation to the legs and feet, and controls the motor areas required for the movement of ankle and foot muscles. CPN entrapment can cause a range of symptoms, the most common of which being ankle pain and foot numbness. Patients may also experience tingling, burning, or numbness in the ankles, soles of the feet, or outside of the legs, and if motor fibers are damaged the patient may present with foot drop. The symptoms of CPN entrapment are similar to those of a lumbar herniated intervertebral disc and are often overlooked in clinical practice or mistaken for symptoms caused by a lumbar herniated intervertebral disc [2,3].
To relieve neurolysis and compression, conventional medicine treatment for nerve entrapment includes immobilization using a splint, steroid or saline injections into the joint, and tendon and nerve release. Recently, the advancement in high-resolution ultrasound has led to its use in the diagnosis and ultrasound-guided treatment of nerve entrapment [46].
In Korean medicine (KM), various treatments are used for nerve entrapment including acupuncture, pharmacopuncture, herbal medicine, acupotomy, electroacupuncture, thread embedding therapy, and Chuna manual therapy. Amongst these treatments, pharmacopuncture is an effective treatment for nerve entrapment [1]. Pharmacopuncture is a relatively new method of treating conditions/diseases that combines acupuncture theory (by regulating the function of the meridians through needling the acupoints) and the herbal theory (by utilizing the efficacy of herbal medicine) of treating conditions/diseases. Pharmacopuncture is increasingly being utilized by KM hospitals and clinics for patients with musculoskeletal pain [7,8], and with advancements in modern diagnostic technology, the use of ultrasound-guided pharmacopuncture has also been rising which will enhance the efficacy of pharmacopuncture treatment [9,10].
Although there have been increasing reports of ultrasound-guided pharmacopuncture treatment in plantar fasciitis, rib fractures, shoulder joint conditions/diseases, and cervical and lumbar spine conditions/diseases in Korea [9], no case reports of ultrasound-guided pharmacopuncture for nerve entrapment associated with herniated intervertebral disc have been reported.
This study is a retrospective case report of an inpatient who received treatment from 2 KM doctors between April 1, 2024 to April 23, 2024. This study has been reviewed by the Institutional Review Board of Jaseng Hospital of Korean Medicine (no.: JASENG 2024-07-034).
1. Patient information
In February 2024, a 49-year-old male presented with low back pain accompanied by pain and numbness in his left leg, especially during daily activities. He was previously treated using physical therapy, extracorporeal shock wave treatment, oral analgesics (ibuprofen 14 days), and a corticosteroids injection treatment (March 29, 2024) which he received as an outpatient (at another hospital) over a course of approximately 2 months. However, there were no clear signs of improvement and on April 1, 2024 he visited Jaseng Hospital of Korean Medicine.
2. Physical examination
The lumbar range of motion (ROM) was measured, but flexion and extension could not be assessed due to pain. Lateral bending was measured at 30 degrees bilaterally, and rotation was recorded at 45 degrees bilaterally, both within normal limits. The Straight Leg Raise (SLR) test was used to assess nerve root irritation, with results showing 80/40 degrees (right/left) The Patrick test (−/+) was negative on one side and positive on the other, used to evaluate hip and sacroiliac joint function. The Valsalva test (−) was negative, suggesting no issues with spinal pressure. The deep tendon reflexes (DTR) for both patellar (++/++) and Achilles (++/++) were normal, reflecting intact nerve function. Strength tests, including dorsiflexion (Grade 5/Grade 5; G5/G5), big toe extension (G5/G5), and plantar flexion (G5/G5), showed normal strength, with no sensory abnormalities detected.
3. Radiology findings
The patient underwent lumbar spine magnetic resonance imaging (MRI) on April 2, 2024 (Figure 1). MRI finding revealed central focal mild disc protrusion with mild thecal sac compression in L4/5, and in L5/S1 left central-subarticular moderate focal extrusion, caudal disc migration with thecal sac and left spinal nerve root compression, and acute herniated nucleus pulposus.
4. Outcome measures

4.1. Numeric rating scale

The numeric rating scale (NRS) is routinely used in healthcare settings for pain assessment, along with the visual analog scale (VAS). A higher score indicates a higher level of pain with 0 being no pain at all and 10 being the most intense pain imaginable. The NRS was used to measure pain daily at 06:00 hours from the day of admission until the day of discharge on Day 23 [11].

4.2. European quality of life five dimensions

The European quality of life five dimensions (EQ-5D) is a health-related quality of life tool that assesses five domains namely daily activities, mobility, pain and discomfort, self-care, and anxiety and depression. A high score indicating a higher quality of life. This study used the EQ-5D-5L scale scored on a five-point scale for better measurements as compared with the EQ-5D-3L which is scored on a 3-point scale. The EQ-5D-5L index was obtained by using the quality weighting formula from the National Evidence-based Healthcare Collaborating Agency for each level of the five items. The measurements were made 3 times: at admission, on Day 15 of hospitalization, and at discharge on Day 23 [11].

4.3. Oswestry Disability Index

The Oswestry Disability Index (ODI) scale was designed for people with low back pain to measure the improvement or worsening of symptoms in terms of movement and physical function. A total of 10 items regarding self-care, current pain level, lifting, sitting, standing, walking, sleeping, daily social life, sex life, and travel and mobility are scored on a scale from 0 to 5 with a higher number indicating a greater level of difficulty in performing daily activities. The ODI was measured 3 times: at admission, on Day 15 of hospitalization, and Day 23 at discharge [11].
5. Treatments

5.1. Acupuncture

The patient was treated using acupuncture twice a day for a total of 45 sessions throughout his hospitalization (23 days). A standardized disposable stainless-steel needle (0.25 × 30 mm, Dongjik Sphere Manufacturing, Korea) was used. The needles were inserted into acupoints on the affected side and remained for 15 minutes: L4/L5/S1 Huatuojiaji (EX-B2), Sanyinjiao (SP6), Xuanzhong (GB39), Shenshu (BL23), Qihaishu (BL24), Dachangshu (BL25), Huantiao (GB30), and Zhibian (BL54). In addition, electroacupuncture was performed on Shenshu (BL23) and Huantiao (GB30) on the affected side at a frequency of 3 Hz.

5.2. Pharmacopuncture

Pharmacopuncture was performed using a disposable syringe (Kovax-Syringe 2 mL, 26 G × 1) with Shinbaro2 pharmacopuncture solution prepared by Jaseng Herbal Medicine Dispensary. Each procedure was performed on the acupoints L4/L5/S1 Huatuojiaji (EX-B2), 1 mL each, twice daily for the duration of inpatient treatment (23 days), for 45 sessions.

5.3. Ultrasound-guided pharmacopuncture

On Day 12 of hospitalization, ultrasound-guided pharmacopuncture was performed (×1) at the suspected CPN entrapment point. Prior to the procedure, the probe was wrapped in a surgical sterile drape (Steri-Drape; 3M Health Care, Suzhou, China), and the probe contact surface and the affected area were disinfected using povidone-iodine solution. Following drying of the 1st application of povidone-iodine, a 2nd application was applied to the affected area. The suspected CPN entrapment point was palpated with the probe at the popliteal fossa where the CPN branches off from the sciatic nerve. This was to identify the sensitive and painful area before the probe coursed around the fibular head. Subsequently, under ultrasound guidance, 4 mL of Shinbaro2 pharmacopuncture (Jaseng Herbal Medicine Dispensary, Seongnam, Korea) was injected into the CPN entrapment site using a disposable syringe (26-gauge, 90 mm; Sungshim Medical Co., Ltd., Bucheon, Korea; Figure 2, Table 1).

5.4. Moxibustion and cupping

On the days of treatment, instrumental techniques (On tteum, Hansung Medix; 33 × 20 mm) were used to select and treat acupoints such as Yaoyangguan (GV3) and Mingmen (GV4); subsequently. Treatment was performed a total of 45 times during hospitalization (23 days). Dry or wet cupping was applied to the acupoints Shenshu (BL23) and Huantiao (GB30) using disposable cupping cups (Dongbang Medical, 28 mm) starting from the 1st day of treatment to the 23rd day, for a total of 45 times during inpatient treatment.

5.5. Herbal medicine

The patient was prescribed Cheongpajeon-H (CPJ-H) and Cheongshinbaro (CSBR)-hwan by the KM doctors at Jaseng Hospital of Korean Medicine. CPJ-H and CSBR-hwan comprise medicinal ingredients such as Acanthopanax sessiliflorus, Eucommiae Cortex, Saposhnikoviae Radix, Achyranthes bidentata Blume, and Cibotii Rhizoma which exhibit anti-inflammatory and analgesic effects. Considering the patient’s symptoms, the clinical judgment of the KM doctor was to include Bunso-san and Gwanjeoljaesaeng (GJJS)-go in the prescription. The patient took these medications 30 minutes after meals, 3 times a day during hospitalization (23 days). The composition and amounts of medicinal herbs in herbal medicines are presented in Table 2.

5.6. Chuna manual therapy

Using the Ergostyle FX table (Chattanooga, Hixson, TN, USA) the iliac crest correction technique in a prone position, the sacral lumbar joint distraction technique, lumbar distraction technique in a lateral decubitus position, and the JS cervical distraction technique in a supine position were performed. These treatments were given once a day for a total of 23 times from April 1, 2024, to April 23, 2024.
6. Progress and outcome
The patient presented at Jaseng Hospital of Korean Medicine on April 1, 2024 (Day 1 of treatment) with symptoms that had begun 2 months earlier including low back pain, left lower limb radiating pain, and tingling during daily activities. His ROM could not be measured due to low back pain; in addition, he complained of radiating pain to the ankle (Figure 3). On presentation, the patient had a positive straight leg raise test at 40 degrees on the affected side and a positive Patrick test on the affected side. His motor strength and sensation were normal, but he had an EQ-5D-5L index score of 0.523, an ODI score of 66, and a NSR score of 8. On April 3, 2024 (Day 3 of treatment), he complained of severe low back pain and tingling, and pain in the posterior left lower limb overnight, which persisted on Day 3, even at rest. The patient’s treatment included acupuncture, pharmacopuncture, moxibustion, cupping, and chuna therapies. On April 7, 2024 (Day 7 of treatment), his low back pain and tingling in the posterior left lower limb remained, and he complained of symptoms in the lower leg and lateral ankle. He walked with a limp caused by the pain and numbness which was present at rest. His treatment included acupuncture, pharmacopuncture, moxibustion, cupping, and chuna therapies. On April 12, 2024 (Day 12 of treatment), he complained of continued low back pain and radiating pain to the posterolateral aspect of the left lower limb; however, he mentioned that the pain was less than before treatment. His treatment included acupuncture, moxibustion, cupping, and chuna therapies. In addition, a session of ultrasound-guided pharmacopuncture was performed. After which he reported that the symptoms of numbness around the lower leg and ankle had almost disappeared, although numbness around the posterior femoral region persisted. On April 15, 2024 (Day 15 of treatment), he complained of persistent low back pain, and a worse pain which radiated to the posterior aspect of the left femur. He reported that the symptoms around the periarticular area of the lower leg and ankle had resolved. His EQ-5D-5L index score was 0.523, the ODI score was 60, and the NSR score was 5. On April 20, 2024 (Day 20 of treatment), he reported that his back pain was improving and his radiating pain into the posterior left femoral region was worsening. However, the pain was comparatively reduced. On April 23, 2024 (Day 23 of treatment), the day of discharge, he reported that his symptoms from the herniated disc had decreased overall and were now mild. He had a positive SLR test at 70 degrees on the lower extremity on the affected side and a negative Patrick test. His EQ-5D-5L index score was 0.755, the ODI score was 55.56, and the NSR score was 3. Lumbar ROM measurements recovered to within the normal range (90° flexion, 20° extension, 30° lateral bending bilaterally, and 45° rotation bilaterally) in all motions.
Symptoms of CPN entrapment include tingling in the ankle, pain in the foot and ankle, and radiating pain in the lower extremities. CPN entrapment can be clinically confusing owing to its similarity in symptoms to lumbar herniated intervertebral disc. Ultrasound-guided pharmacopuncture has been performed at the CPN entrapment point to reduce numbness in the lower leg and reduce foot pain [2,3]. This case report presents a patient with low back pain and radiating lower extremity pain who was diagnosed with a lumbar herniated intervertebral disc.
The patient was hospitalized for treatment of lumbar herniated intervertebral disc and treated (according to the Korean Medicine Clinical Practice Guideline [12]) using a combination of acupuncture, moxibustion, herbal medicine, pharmacopuncture, chuna, and cupping. On the 12th day, ultrasound-guided pharmacopuncture targeting the CPN was administered to assess whether the lower extremity radicular pain was caused by peripheral nerve entrapment. The patient’s numbness in his left lower leg and ankle pain, initially considered to be part of radicular symptoms, improved notably after treatment, particularly along the distribution of the superficial peroneal nerve [13]. This suggested that the ultrasound-guided pharmacopuncture effectively targeted CPN entrapment as the low back and posterior femoral pain persisted whilst the ankle and lower leg pain resolved without recurrence.
Multiple crush syndrome occurs when nerves are compressed at multiple sites compounding their effects and worsening symptoms [14,15]. In this case, the patient’s lumbar herniated disc and CPN entrapment could be considered as an instance of multiple crush syndrome. However, no studies specifically address CPN entrapment alongside lumbar herniated discs. CPN pathology within multiple crush syndrome was explored by Maejima et al [15], but without lumbar herniated disc involvement. When treating lower limb radiating pain in patients with a lumbar herniated disc, distal nerve entrapment should be considered as a possible factor.
Pharmacopuncture, including bee-venom and Shinbaro, has been used by Lee et al [1] to treat nerve entrapment and the apparent effectiveness observed in this case could be attributed to the anti-inflammatory effects of Shinbaro2. It has been reported that anti-inflammatory effects due to pharmacopuncture alleviate the symptoms of nerve compression [8,10]. The volume of Shinbaro2 used for pharmacopuncture in this current case was 4 mL. The usual prescription of the standard concentration of Shinbaro2 is 1 mL [10]. Injecting a high volume and hence a larger dose during pharmacopuncture has been reported to be effective in relieving inflammation by relieving pressure on the tissue surrounding the nerve and reducing nerve sensitization due to its volume [10,16].
The use of ultrasound in the delivery of different forms of acupuncture has gained much attention recently and is an effective way to improve the safety and effectiveness of these KM interventions [9,10]. The effectiveness of KM interventions is enhanced by the use of ultrasound guidance, with the advantage of avoiding unnecessary nerve and blood vessel damage [9]. In this current case, ultrasound-guided pharmacopuncture was crucial due to the entrapment point locations at the popliteal fossa. This is where the CPN branches from the sciatic nerve [17,18]. Unlike superficial sites like the fibular head, the CPN region is anatomically complex, and involves deep structures such as blood vessels and tendons [19]. Use of ultrasound enables precise targeting of the nerve for delivery of the pharmacopuncture solution, and enhancing safety but allowing visualization of the critical structures[17,18]. This approach not only optimizes the accuracy of pharmacopuncture but also improves treatment efficacy. Further high-quality, evidence-based studies are required to determine the efficacy of ultrasound-guided procedures.
A limitation of this study was that it is a case report of 1 patient, and it did not measure the efficacy of ultrasound-guided pharmacopuncture alone, as the patient was treated with a combination of KM including acupuncture, pharmacopuncture, moxibustion and cupping, herbal medicine, and chuna manual therapy, in addition to ultrasound-guided pharmacopuncture. Other limitations include the retrospective nature of the study and so there was no opportunity to introduce more objective testing with nerve conduction studies, and there was a lack of evidence demonstrating the efficacy of ultrasound-guided pharmacopuncture and no follow-up outpatient observations. Further research is required to address these limitations in future.
After KM treatments and ultrasound-guided pharmaco-puncture targeting CPN entrapment, improvements in numbness and radiating pain in the lower leg and ankle were reported by the patient. In the case of CPN entrapment with a lumbar herniated intervertebral disc, symptoms may be similar to those of a herniated disk as a single condition, and may simply be mistaken for the same condition. However, the possibility of CPN entrapment should always be considered. Additional studies including randomized controlled trials are required to evaluate the clinical safety and efficacy of ultrasound-guided pharmacopuncture.

Author Contributions

Conceptualization: HP and JK. Data curation: HP and SY. Formal analysis: HP. Investigation: JK and SY. Methodology: JMY. Supervision: GS. Writing - original draft: HP. Review and editing: JMY.

Conflicts of Interest

The authors declare no conflicts of interest.

Funding

This research received no external funding.

Ethical Statement

This study has been reviewed by the Institutional Review Board of Jaseng Hospital of Korean Medicine (no.: JASENG 2024-07-034).

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy/ethical restrictions.
Figure 1
Lumbar spine magnetic resonance imaging conducted on April 2, 2024. (A) T2-weighted turbo-spin-echo axial view: the arrow indicates the area where the L5/S1 disc has extruded from the central to left subarticular zone. (B) T2-weighted turbo-spin-echo sagittal view: the arrow indicates the area of the extruded L5/S15 disc.
pim-2024-10-008f1.jpg
Figure 2
Procedure of ultrasound-guided pharmacopuncture. (A) Ultrasound-guided pharmacopuncture at the CPN indicated by the arrow. (B) Probing the site using ultrasound to apply pharmacopuncture.
CPN = common peroneal nerve.
pim-2024-10-008f2.jpg
Figure 3
The timeline of TKM treatments received by the inpatient over 23 days of hospitalization.
pim-2024-10-008f3.jpg
Table 1
Types of Pharmacopuncture
Ultrasound-guided Not ultrasound-guided
Pharmacopuncture solution Shinbaro2 (Cibotium barometz 0.0013 g/mL, Saposhnikovia divaricate 0.0013 g/mL, Eucommia ulmoides 0.0013 g/mL, Acanthopanax sessiliflorus 0.0013 g/mL, Ostericum koreanum 0.0013 g/mL, Angelica pubescens 0.0013 g/mL, Achyranthes japonica 0.0013 g/mL, Paeonia albiflora 0.0027 g/mL, Scolopendra subspinipes 0.0013 g/mL)
Volume 4 mL 1 mL
Needle size 26 gauge × 90 mm 29 gauge × 13 mm
Location of procedure CPN entrapment point L4/L5/S1 Huatuojiaji (EX-B2)

CPN = common peroneal nerve.

Table 2
Composition and Quantity of Medicinal Herbs in Herbal Medicine
Herbal medicine Ingredients Treatment details and frequency
Cheongpajeon-H (CPJ-H) Harpagophytum procumbens 11.25 g
Cibotium barometz 7.5 g
Eucommia ulmoides 7.5 g
Saposhnikovia divaricata 7.5 g
Acanthopanax sessiliflorus 7.5 g
Achyranthes bidentata 7.5 g
Atractylodes japonica 3.75 g
Amomum villosum 3.75 g
Scrophularia ningpoensis 3.75 g
Glycyrrhiza uralensis 2.625 g
Zingiber officinale 1.875 g
Scolopendra subspinipes 0.375 g
30 min after each meal
3×/d
Cheongshinbaro-hwan (CSBR-hwan) Poria cocos 0.578 g
Panax ginseng 0.289 g
Achyranthes bidentata 0.144 g
Asini Gelatinum 0.067 g
Mel 1.156 g
Cibotium barometz 0.100 g
Eucommia ulmoides 0.100 g
Achyranthes bidentata 0.044 g
Acanthopanax sessiliflorus 0.044 g
Scolopendra subspinipes 0.044 g
Atractylodes japonica 0.189 g
Bovis fel 0.100 g
Gwanjeoljaesaeng-go (GJJS-go) Poria cocos 1.411 g
Panax ginseng 0.705 g
Rehmannia glutinosa 0.539 g (Rehmanniae Radix Preparata)
Harpagophytum procumbens 0.539 g
Acyranthes bidentata 0.180 g
Asini Gelatinum 0.090 g
Rehmannia glutinosa 2.828 g (Rehmanniae Radix Recens)
Mel 1.411 g
Bunso-san Atractylodes lancea 0.278 g
Atractylodes japonica 0.278 g
Poria cocos 0.278 g
Citrus unshiu 0.222 g
Magnolia officinalis 0.222 g
Cyperus rotundus 0.222 g
Polyporus umbellatus 0.222 g
Panax ginseng 0.222 g
Alisma orientale 0.111 g
Poncirus trifoliata 0.111 g
Areca catechu 0.111 g
Amomum villosum 0.111 g
Aucklandia lappa 0.111 g
Zingiber officinale 0.111 g
Juncus effusus 0.111 g
Agastache rugosa 0.111 g
Perilla frutescens 0.111 g
Mentha arvensis 0.056 g
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      Common Peroneal Nerve Entrapment Masked by Acute Lumbar Disc Herniation: Integrated Korean Medicine Treatment with Ultrasound-Guided Pharmacopuncture
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      Figure 1 Lumbar spine magnetic resonance imaging conducted on April 2, 2024. (A) T2-weighted turbo-spin-echo axial view: the arrow indicates the area where the L5/S1 disc has extruded from the central to left subarticular zone. (B) T2-weighted turbo-spin-echo sagittal view: the arrow indicates the area of the extruded L5/S15 disc.
      Figure 2 Procedure of ultrasound-guided pharmacopuncture. (A) Ultrasound-guided pharmacopuncture at the CPN indicated by the arrow. (B) Probing the site using ultrasound to apply pharmacopuncture. CPN = common peroneal nerve.
      Figure 3 The timeline of TKM treatments received by the inpatient over 23 days of hospitalization.
      Common Peroneal Nerve Entrapment Masked by Acute Lumbar Disc Herniation: Integrated Korean Medicine Treatment with Ultrasound-Guided Pharmacopuncture
      Ultrasound-guided Not ultrasound-guided
      Pharmacopuncture solution Shinbaro2 (Cibotium barometz 0.0013 g/mL, Saposhnikovia divaricate 0.0013 g/mL, Eucommia ulmoides 0.0013 g/mL, Acanthopanax sessiliflorus 0.0013 g/mL, Ostericum koreanum 0.0013 g/mL, Angelica pubescens 0.0013 g/mL, Achyranthes japonica 0.0013 g/mL, Paeonia albiflora 0.0027 g/mL, Scolopendra subspinipes 0.0013 g/mL)
      Volume 4 mL 1 mL
      Needle size 26 gauge × 90 mm 29 gauge × 13 mm
      Location of procedure CPN entrapment point L4/L5/S1 Huatuojiaji (EX-B2)
      Herbal medicine Ingredients Treatment details and frequency
      Cheongpajeon-H (CPJ-H) Harpagophytum procumbens 11.25 g
      Cibotium barometz 7.5 g
      Eucommia ulmoides 7.5 g
      Saposhnikovia divaricata 7.5 g
      Acanthopanax sessiliflorus 7.5 g
      Achyranthes bidentata 7.5 g
      Atractylodes japonica 3.75 g
      Amomum villosum 3.75 g
      Scrophularia ningpoensis 3.75 g
      Glycyrrhiza uralensis 2.625 g
      Zingiber officinale 1.875 g
      Scolopendra subspinipes 0.375 g
      30 min after each meal
      3×/d
      Cheongshinbaro-hwan (CSBR-hwan) Poria cocos 0.578 g
      Panax ginseng 0.289 g
      Achyranthes bidentata 0.144 g
      Asini Gelatinum 0.067 g
      Mel 1.156 g
      Cibotium barometz 0.100 g
      Eucommia ulmoides 0.100 g
      Achyranthes bidentata 0.044 g
      Acanthopanax sessiliflorus 0.044 g
      Scolopendra subspinipes 0.044 g
      Atractylodes japonica 0.189 g
      Bovis fel 0.100 g
      Gwanjeoljaesaeng-go (GJJS-go) Poria cocos 1.411 g
      Panax ginseng 0.705 g
      Rehmannia glutinosa 0.539 g (Rehmanniae Radix Preparata)
      Harpagophytum procumbens 0.539 g
      Acyranthes bidentata 0.180 g
      Asini Gelatinum 0.090 g
      Rehmannia glutinosa 2.828 g (Rehmanniae Radix Recens)
      Mel 1.411 g
      Bunso-san Atractylodes lancea 0.278 g
      Atractylodes japonica 0.278 g
      Poria cocos 0.278 g
      Citrus unshiu 0.222 g
      Magnolia officinalis 0.222 g
      Cyperus rotundus 0.222 g
      Polyporus umbellatus 0.222 g
      Panax ginseng 0.222 g
      Alisma orientale 0.111 g
      Poncirus trifoliata 0.111 g
      Areca catechu 0.111 g
      Amomum villosum 0.111 g
      Aucklandia lappa 0.111 g
      Zingiber officinale 0.111 g
      Juncus effusus 0.111 g
      Agastache rugosa 0.111 g
      Perilla frutescens 0.111 g
      Mentha arvensis 0.056 g
      Table 1 Types of Pharmacopuncture

      CPN = common peroneal nerve.

      Table 2 Composition and Quantity of Medicinal Herbs in Herbal Medicine


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