Acupuncture Combined with Tuina for Lumbar Disc Herniation: A Retrospective Cohort Study Comparing Fascial Meridian and Traditional Meridian Models

Background Lumbar disc herniation (LDH) is a major cause of low back pain. Acupuncture combined with tuina is widely used, but whether fascial meridian–guided treatment provides greater benefit than traditional meridian–guided treatment remains unclear. Methods This single-center retrospective cohort study included adults aged 18–70 years with MRI-confirmed L4/5 or L5/S1 LDH treated with ≥4 weeks of acupuncture plus tuina (January 2020–December 2023). Patients were categorized by treatment model. Twelve-month outcomes were assessed at follow-up visits or by structured telephone interview. Propensity score matching (1:1) was performed for age, sex, BMI, symptom duration, and baseline visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Primary outcomes were pain relief (VAS reduction ≥50%) and functional improvement (ODI reduction ≥10 points). Secondary outcomes included recurrence, surgery, 36-item Short Form (SF-36) improvement, and adverse events. Results Of the 180 patients enrolled, 150 matched patients (75 per group) were analyzed. At 12 months, pain relief occurred in 70% of the fascial group and 66% of the meridian group (risk difference 4.0%, 95% CI −10.8% to 18.8%; p = 0.48) and functional improvement in 62% versus 60% (risk difference 2.7%, 95% CI −12.9% to 18.2%; p = 0.72). Recurrence (22% vs 28%), surgery (12% vs 14%), and SF-36 improvement (64% vs 61%) were similar between groups. Mild adverse events occurred in <5% of patients, with no serious complications. Conclusions Fascial and traditional meridian–guided acupuncture combined with tuina were associated with comparable 12-month outcomes and good safety. Prospective randomized studies are warranted.