Back Pain

Introduction

Analysis

Back pain is the number one problem facing the workforce in the United States today. To illustrate just how big a problem low back pain is, consider these facts:

Low back pain is the second most common cause of missed work days

Low back pain is the leading cause of disability between the ages of 19-45

Low back pain is the number one leading impairment in occupational injuries.

It is estimated that over 80 billion dollars is spent because of back pain each year, and the cost is growing. Eight out of ten people will have a problem with back pain at some time during their lives. Back pain is more likely to occur during the ages of 30 to 50, the most productive period of most people's lives.

Of all conditions of "musculo-skeletal" pains, lower back pain is the one most deeply involved with additional pathologies well-described in the field of acupuncture. Sometimes, these pathologies are actually the leading cause of the pain, explaining some failure in the direct musculo-skeletal therapeutic approach.

Evaluation according to SE - Acupuncture

Evaluation includes support from the Western medical investigations (preferably radiography of the lumbar and lumbo-sacral vertebrae) as well as complete energetic acupuncture approach:

(1) evaluation of the lower back area through palpation of the meridian networks

(2) evaluation of systems corresponding to the meridian networks.

Conditions

  1. Non-irradiating axial lumbar pain
  2. Diffuse axial lumbar pain
  3. Lateralized lumbar pain
  4. Irradiating lumbar pain (i.e. sciatica)
  5. Lumbar sprain
  6. Lumbar pain and periods
  7. Genital herpes
  8. Renal pathology
  9. Functional lumbar pains

Chinese Medicine Approach

Many patients with chronic low back pain find that acupuncture treatment will help not only break the pain cycle, but allow them to reduce pain medications and participate more vigorously in physical daily activities. Lower Back pain in Chinese medicine includes any pain, aching, discomfort or weakness in one or both sides of the lower thoracic, lumbar, sacral or buttock areas.   Lower back ache effects up to 80% of the population at one or more times of their lives.

The Chinese noticed that many disorders affecting the kidneys can easily give rise to low back pain thus calling the lower back the “palace of the kidney”.

 

History of Chinese Medicine Treatment Of Low Back Pain – Lower Back Pain

Traditional Chinese Medicine has been used to successfully treat low back pain for thousands and thousands of years with the use of acupuncture and herbal medicine. When looking at the entire time line of Chinese medicine acupuncture has only been exposed to other areas of medicine for a very short period of time.

 

Sir William Osler, often considered the father of modern medicine said: "For lumbago (lower back pain) acupuncture is, in acute cases, the most efficient treatment." Sir William Osler's Principles and Practice of Medicine, 1892

 

Acupuncture for Lower Back Pain Low Back Pain

How Acupuncture works for low back pain:

Ancient Chinese believe that there is an inner energy or vital force that is more than synapsing neurotransmittors and vibrating molecules. This vital force or inner energy, in Traditional Chinese Medicine, is called "QI" (pronounced chee). Low Back Pain, or any physical dysfunction, is considered in Traditional Chinese Medicine to be due to stagnant Qi in that area.  Back Pain can also be related to Kidney, Liver or Spleen Dysfunction and stagnation.  When using acupuncture, the inserted needles will break up this stagnation allowing Qi to move freely within the channels alleviating low back pain.

 

Acupuncture is very effective for low back pain and generally is the treatment of choice in acute cases.

 

Acute Cases Of Low Back Pain - the principle of treatment is to invigorate Qi and blood to remove stagnation and unblock the channels to stop pain.  The main focus in acute cases is to use distal points with strong stimulation

Chronic Cases Of Low Back Pain - the principle of treatment is to expel any pathogens invading the body, invigorate the circulation of Qi and Blood and tonify any underlying deficiencies.  Generally in Chronic cases points local to the area of pain and distal points would be used in conjunction with each other.

 

Acupuncture Points Used For Low Back Pain:

 

Distal Acupuncture Points For Acute Low Back Pain

  • LR 3, LI 4, DU 26, Yao Tong Xue (N-UE-19), BL 40

Distal Acupuncture Points for Acute Or Chronic Low Back Pain

  • BL 60, BL 58, BL 59, BL 36, BL 37,GB 30, GB 31, GB 34, GB 39, SI 3 BL 62

Local Acupuncture Points for Low Back Pain

  • Ah Shi Points, BL 23, BL 25, BL 54, BL 28, Shi Qi Zhui Xia (M-BW-25), Hua Tuo Jia Ji points

 

 

Lower back Pain and herbs

The most successful herbs for treating low back pain are those which increase qi and blood movement in that area.  The herbs will have to act not only on the lower back pain are but also on the organ which may be involved in chronic cases.

 

Quick Summary of Formulas For Lower Back pain

 

Acute Low Back Pain

  • Cold Damp – Gan Jiang Ling Zhu Tang + Du Huo Ji Sheng Tang
  • Damp Heat – Jia Wei Er Miao San
  • Wind Damp – Qiang Huo Sheng Shi Tang
  • Wind Cold – Jing Fang Bai Du San
  • Wind Heat – Xiao Chai Hu Tang
  • Blood Stagnation – Huo Luo xiao Ling Dan

 

Chronic Low Back Pain

  • Liver Qi Stagnation – Tian Tai Wu Yao San
  • Spleen Deficiency – Bu Zhong Yi Qi Tang
  • Spleen Deficiency with Dampness – Ping Wei San
  • Spleen Deficiency with knee pain and sweating – Fang Ji Huang Qi Tang
  • Spleen Yang Deficiency with cold symptoms and edema – Shi Pi Yin
  • Kidney Yang Deficiency – You Gui Wan
  • Kidney Yin Deficiency – Zuo Gui Wan

 

PATTERNS AND TREATMENT Of Low Back Pain

 

Cold Damp – Low Back Pain

Main manifestations: Low back pain usually occurring after exposure to cold and damp and aggravated on rainy days. Low back feels cold when touched, achy and heavy feeling, pain feels deep and unremitting.. Heavy sensation and stiffness of the muscles in the dorsolumbar region, limitation of extension and flexion of the back, pain radiating downwards to the buttocks and lower limbs, cold feeling of the affected area. Pain does not improve with rest or laying down. White and sticky tongue coating, deep and weak, or deep and slow pulse.

Analysis: Pathogenic cold and damp characterized by viscosity and stagnation block the meridians and collaterals, causing retarded circulation of qi and blood. This produces heaviness, cold sensation and pain in the lumbar region and limitation of extension and flexion of the back. Stagnation of qi and blood becomes worse on cloudy and rainy days, and so does the pain. Accumulation of cold and damp gives rise to the white sticky tongue coating and the deep, weak or deep, slow pulse.

Treatment Principle

expel cold and damp, warm and open the channels and support the kidneys

Formulas

Gan Jiang Ling Zhu Tang With Du Huo Ji Sheng Tang

Acupuncture:

Use Moxa and warm needle technique

 

Damp Heat – Low Back Pain

Low back pain starts with the invasion of damp heat through the tai yang channel or chronic cold damp which stagnation and turns into heat.  The lower back pain will feel sore and hot when touched.  The effected are will be red and swollen and the pain is aggravated  during hot, humid or rainy weather.

General symptoms of the patient may also include feverishness, irritability and thirst

Treatment Principle

Clear heat and dry dampness, ease the tendons and stop lower back pain

Formulas -  Jia Wei Er Miao San

Acupuncture:

Add points KI 7 and GB 34 to mentioned points.

 

 

Wind Damp – Low Back Pain

Acute lower back pain with heaviness, achiness, stiffness and pain is unrelieved by changing position or stretching.  The general symptoms of the patient will be heaviness, headaches, mild fever, chills, possible superficial oedema and a floating pulse.

Treatment Principle

Expel wind and dry dampness to stop lower back pain

Formulas -  Qiang Huo Sheng Shi Tang

Acupuncture

Add Points - LU 6, LI 4, SP 9, RN 12, ST 36

 

 

Wind Cold – Low Back Pain

Acute low back pain not relieved by changing position or stretching with general patient symptoms of a high fever, chills, shivering, myalgia, stiff neck, occipital headache, no sweating, slight cough, nasal obstruction or runny nose, sneezing with a floating and soggy pulse.

Treatment Principle

Disperse wind cold and alleviate low back pain

Formulas -  Jing Fang Bai Du San

Acupuncture

Add points – LI 4, LU 7, GB 20, BL 12 , BL 13, use copping on ah shi points

on lower back.

 

Wind Heat – Low Back Pain

Acute lower back ache accompanied by lower back heat sensations unrelieved by changing positions or stretching.  General patient symptoms include fever, mild sweat, dry mouth, thirsty, sore throat, red tongue tip and a floating rapid pulse.

Treatment Principle

Expel wind heat and alleviate low back pain

Formulas -  Xiao Chai Hu Tang

Acupuncture

DU 14, BL 12, LI 11, LI 4, TH 5, copping on ah shi points on lower back

 

 

Trauma (Blood Stagnation) – Low Back Pain

Common type of low back pain post traumatic injury such as lifting a heavy object or twisting and bending improperly. The pain is usually sharp,intense and worsens with pressure and palpation.

Analysis: Muscular strain in the lumbar region causes retardation of qi and blood and further leads to stagnation of blood in the meridians and collaterals. The result is the fixed severe pain which can be aggravated by pressure. String - taut pulse is associated with pain, dark purplish tongue proper and hesitant pulse are signs of blood stasis.

Treatment

Method: Points are mainly selected from the Du and the Foot - Taiyang Meridians to promote the circulation of qi and blood, to relieve pain, to relax the muscles and to activate the blood circulation in the collaterals. Acupuncture and moxibustion are applied together for cold - damp type. in case of deficiency of the kidney yang, apply needling with reinforcing method and moxibustion. For deficiency of the kidney yin, puncture with reinforcing method. For traumatic low back pain, apply reducing method or pricking to cause bleeding.

Prescription: [BL23 - DU3 - BL40].

Supplementary points:

  • Cold damp: BL25, BL26.
  • Deficiency of the kidney yang: DU4, yaoyan.
  • Deficiency of the kidney yin: BL52, KI3.
  • Traumatic injury: DU26, yaotongxue, ahshi point.

Explanation ; The low back is the dwelling house of the kidney. BL23 can be selected to tonify the qi of the kidney. Moxibustion may also be applied to this point to eliminate cold and damp. DU3 is a local point. BL40 is one of Four Key Points, and an important distal point for the treatment of low back pain. BL25 and BL26 can dispel wind and cold, remove obstruction in meridians, and relieve pain. Combination of acupuncture and moxibustion applied to DU4 and yaoyan (Extra) can tonify the kidney yang and strengthen the kidney essence as well. BL52 and KI3 are selected for the purpose of nourishing the kidney yin. As the Du Meridian travels along the spine, DU26)is a distal point effective for treating rigidity and pain of the lumbar region. Yaotongxue (Extra) is an empirical point used in treating sprain of the lumbar region.

Formulas -  Huo Luo Xiao Ling Dan

Acupuncture

Liver Qi Stagnation – Low Back Pain

This pattern usually has hypertonicity of the muscles (tense, spasm) and usually occours in individuals under high stress or emotional patients.  The lower back pain tends to be aggravated by stress and emotional upsets and often radiates from the lower back to the lower abdomen or hypochondriac regions.  The pain may have a distending quality which may move from place to place or come and go.  General symptoms include irritability, headaches, digestive upset, chest fullness and possible menstrual disorders.  The pulse will generally be wiry and thready while the tongue will be darkish in color with red edges and a thin coat.

Treatment Principle

Regulate liver qi and stop lower back pain

Formulas - Tian Tai Wu Yao San

Acupuncture

Add points LR 3, LI 4, GB 34, MH 6

 

 

Spleen Deficiency with Dampness – Low Back Pain

This pattern usually has hypotonicity of the muscles (weak, emaciated) with a loss of mechanical support and hypermobility of the lumbar spine.  This pattern generally gives rise to aching and heaviness of the lower back region which may be flabby while the patients will be commonly overweight.  They may also have some degree of digestive weakness or fluid retention with a pale, swollen  tongue and a slippery soft pulse.

Treatment Principle

Strengthen spleen and eliminate dampness to alleviate lower back pain

Formulas

Bu Zhong Yi Qi Tang

Ping Wei San – excessive dampness

Fang Ji Huang Qi Tang – easily sweating, mild dampness, knee swelling and

painful

Shi Pi Yin – spleen yang deficiency with pitting edema

Acupuncture

Add points – SP 3, ST 40, ST 36, BL 20

 

Kidney-related pain

Analysis: The lumbar region is said to be the dwelling house of the kidney. The kidney dominates the bones, produces marrow and stores essence. When the kidney has insufficient essence, the bone is lacking of marrow, and the result is soreness and pain in the lumbar region accompanied by weakness of the knees. Over strain and stress consume essence and qi, and make the pain worse. Pain is lessened by bed rest, which makes qi quiescent. In case of deficiency of kidney yang, the kidney fails to warm the lower abdomen and the limbs. This gives rise to cramp - like sensation in the lower abdomen and cold limbs. Deficiency of yang causes pallor, pale tongue, deep thready or deep slow pulse. When yin is deficient, kidney water is unable to ascend to reduce the heart fire. This results in irritability and insomnia. Deficiency of yin causes excessive internal heat, which gives rise to the following symptoms: flushed face, feverish sensation in the chest, palms and soles, dryness of the mouth and throat, reddened tongue with little coating, thready weak or thready rapid pulse.

Kidney Deficiency – Kidney Qi – Kidney Yin – Kidney Yang

The kidneys have a powerful influence over the tissues of the lower back therefore if the kidneys are weak and qi and blood are sluggish then the lower back is easily effected.  Kidney Deficiency will give rise to a chronic lower back ache or low back pain with soreness and weakness which is improved by massage and general rest.  The pain will be recurring and is aggravated after exertion, prolonged standing or sexual activity.  The knees and legs are commonly sore or weak as well in kidney patterns.

Acupuncture

Add points – BL 23, BL 25, DU 4, BL 52, RN 4, RN 6, KI 3, BL 60,

Hua Tuo Jia Ji

Use moxa for kidney yang deficiency.

 

Kidney Qi Deficiency – Low Back Pain

Kidney Deficiency with - clear copious urination, nocturia, pale lustreless complexion, edema of lower extremities, sore knees, pale or pink tongue with a deep thready pulse

Treatment Principle

Tonify kidney qi and strengthen lower back

Formulas  -  You Gui Wan

 

Kidney Yang Deficiency – Low Back Pain

Kidney deficiency with -  clear copious urination, nocturia, pale lustreless complexion, edema of lower extremities, sore knees, generally cold, dislike of cold, wet swollen tongue and a slow pulse.

Treatment Principle

Support and strengthen the lower back and tonify the kidneys and support the

kidney yang.

Formula  -  You Gui Wan

 

Kidney Yin Deficiency – Low Back Pain

Kidney deficiency with – intolerance of heat, occasional urinary irritation, tinnitus, dizziness, facial flushing, nightsweats, sensation of heat in the palms and soles and chest, red tongue with no coat and a thready rapid pulse.

Treatment Principle

Tonify kidneys and nourish kidney yin to strengthen and support lower back

Formulas – Zuo Gui Wan