A. General: a 57-year-old male referred for evaluation of chronic back pain; obviously irritated and exhausted by the chronic pain; a little overweight with no obvious abnormal gait. He appears quite agitated and uncomfortable.

B. Current Complaint: onset of low back pain for 4 weeks; getting worse; now with radiations into both posterior buttock and thighs for 2 weeks; current PT and Medications have failed to relieve the pain.

C. History: More than 20 years of chronic back pain; moderate exertion or trauma usually cause relapse or exacerbation of pain; taking numerous over the counter NSAIDs in the past and with good relief of the pain; abating or remission for a month or interval of one year;.

D. Conventional examination: Physical examination is generally normal; x-rays reveal mild degenerative changes consisting of spondylosis without disc space narrowing; MRI reveals decreased signal on T2 images at the lower three segments but no disc herniations or stenosis of the central canal or lateral recess.

E. Other Medical Conditions: hypertension for12 years; hypercholesterolemia for 5 years; myocardial infarction 5 years ago.

F. Habits: Daily beer drinker (drinks a beer or two each evening) and smoker (1 pack per day of cigarettes) for decades; denies use of illicit drugs. No routine exercise.

G. Current Medications: Atenolol; Accupril; Lipitor; Baby aspirin.

H. Stress: Physically incapable to fulfill the daily management task as a manager of Wal-Mart; emotionally down because his team and family are restless with his continued disability;

I. Geography: Old house is located in a high moist area of Bay Shore with only one floor.

A therapeutic plan consists of body acupuncture, auricular acupuncture, and Chinese herbs.

A. Acupuncture: twice per week for 4 times. Acupoints of Liver meridian, Large Intestinal Meridian, Bladder Meridian, and Governor Meridian are used to soothe the stagnant Qi/blood, expel dampness/heat in the meridians, and enhance the deficient flow of energy. Local acupoints plus remote acupoints are the principle of acupoints prescription. Specific Points: UB23, UB40, UB60, UB18, UB 20, GV 4, Lv2, Lv3, LI 11.

B. Auricular Acupuncture: Twice per week for 4 times. It enhances the management of pain and especially helps a patient that has durable stress and emotion that involved in his management of pain. Usually Intradermal needles will be placed on the ear acupoints that affect the following areas: Lumbago, Sciatica, Liver, Kidney, Spirit Gate, Spleen, Stomach, Subcortex, etc. Specific auricular points would mainly include the low back area.

C. Traditional Chinese Herbal formula: Du Huo Ji Sheng Tang (to dispel win-dampness) with modifications to clear heat. Twice per day for two weeks. It focuses on balancing Ying/Yang in his Liver and Kidney meridians and expelling dampness/heat in his stomach/intestinal and Heart/Liver meridians. It provides nutrition for nerve regeneration and bone metabolism. It enhances energy/blood circulation and balances the hormone. It also detoxifies the patient’s liver and digestion system and prevents autoimmune reaction.