Coccyx pain (Treatment of Pain with Chinese Herbs and Acupuncture) Part 2

ACUPUNCTURE TREATMENT

Ll-4 Hegu, TE-6 Zhigou, BL-35 Huiyang, BL-40

Weizhong, BL-58 Feiyang, BL-62 Shenmai, BL-66

Zutonggu, GV-3 Yaoyangguan and SI-3 Houxi.

Reducing method is used on these points.

Explanations

•    LI-4, the Source point, and TE-6 dispel External factors, clear Heat and eliminate Damp.

•    BL-40, a commanding point for the back, and BL-58, the Connecting point, promote the free flow of Qi in the channels and harmonise the collateral in order to treat the lower back pain and coccyx pain.

•    BL-66, the Spring point, clears Heat and eliminates Damp in the Lower Burner.

•    BL-35 and GV-3, the local points, harmonise the collateral in the coccyx region and relieve the pain.

•    BL-62 and SI-3 in combination dispel Wind, Cold and Damp, remove blockage in the Governing Vessel and relieve the coccyx pain.

Modifications

1.    If there is a fever, add GV-14 to clear Heat and reduce the fever.

2.    If there is sacral pain, add some local Ah Shi points to harmonise the collateral and arrest the pain.

3.    If there is a severe burning sensation and aversion to heat in the lower back, add BL-67 to clear Heat and relieve the burning sensation,

4.    If there is scanty and painful urination, add BL-32 and KI-4 to promote urination and relieve the urination pain.


5.    If there is a feeling of heaviness in the body, add SP-6 to resolve Damp and eliminate Phlegm from the body.

6.    If the appetite is poor, add BL-20, the Back Transporting point of the Spleen, to activate the Spleen and improve the appetite.

7.    If there is diarrhoea, add SP-3, the Source point, to activate the Spleen, eliminate Damp and relieve the diarrhoea.

8.    If there is profuse leucorrhoea, add GB-27 and GB-41 to eliminate Damp and relieve the leucorrhoea.

DEFICIENCY OF KIDNEY-ESSENCE

Symptoms and signs

Insidious onset of protracted coccyx pain with soreness, which worsens when tired and is alleviated by rest, accompanied by weakness in the lower back, legs and knees.

If the deficiency is of Kidney-Yang, there is also a cold feeling in the lower back, pallor, cold limbs, a normal taste in the mouth, polyuria, a pale tongue and a deep and feeble, or faint, or deep and slow pulse.

If the deficiency is of Kidney-Yin, there is also a dry mouth and throat, a flushed face, a feverish sensation in the chest, palms and soles of the feet, irritability, insomnia, a red tongue with a scanty coating and a thready and weak or thready and rapid pulse.

Principle of treatment

Tonify the Kidney, benefit the Essence and relieve the pain.

HERBAL TREATMENT

Prescription a: for deficiency of Kidney-Yang

JIN GUI SHEN QI WAN

Kidney Qi Pill

Shu Di Huang Radix Rehmanniae Praeparata 12 g

Shan Yao Rhizoma Dioscorcae 15 g

Shan Zhu Yu Fruetus Corni 10 g

Ze Xie Rhizoma Alismatis 10 g

Fu Ling Poria IOg

Gui Zhi Ramulus Cinnamomi 6 g

Fu Zi Radix Aconiti Carmichaeli Praepnratn 6 g, decocted first

Tu Si Zi Semen Cuscutae 10 g Du Zhong Cortex Eucommiae 10 g

Prescription b: for deficiency of Kidney-Yin

ZUO GUI WAN

Restoring the Left Pill

Shu Di Huang Rhizoma Rehmanniae Praeparata 12 g

Shan Yao Rhizoma Dioscoreae 15 g

Shan Zhu Yu Fructus Comi 6 g

Tu Si Zi Semen Cuscutae 10 g

Gou Qi Zi Fructus Lycii 12 g

Chuan Niu Xi Radix Cyathulae 6 g

Lu Jiao Jiao Colla Cervi Cornus 6 g

Gui Ban Jiao Colla Plastri Testudinis 10 g

Explanations

•    In Jin Gui Shen Qi Wan, Shu Di Huang tonifies the Kidney, benefits the Essence and consolidates the bones.

•    Shan Yao and Shan Zhu Yu strengthen the Liver and Spleen to help Shu Di Huang tonify the Kidney.

•    Gui Zhi and Fu Zi tonify the Kidney-Yang and dispel Cold.

•    Ze Xie and Fu Ling remove Damp and promote urination.

•    Tu Si Zi and Du Zhong tonify the Kidney, benefit the Essence and strengthen the back and bones.

•    In Zuo Gui Wan, Shu Di Huang tonifies the Kidney and benefits the Essence.

•    Shan Yao and Shan Zhu Yu strengthen the Liver and Spleen to help Shu Di Huang tonify the Kidney.

•    Gou Qi Zi nourishes the Yin of the Liver and Kidney and benefits the eyes.

•    Gui Ban Jiao, Tu Si Zi and Lu Jiao Jiao tonify the Kidney and strengthen the bones.

•    Chuan Niu Xi has the effect of strengthening the waist and knees and reinforcing the muscles and joints.

Modifications

1.    If there is shortness of breath, lassitude, a low voice, a poor appetite and diarrhoea due to deficiency of the Spleen-Qi, add Dang Shen Radix Codonopsis Pilosulae IOg and Huang Qi Radix Astragali Pilosulae 12 g to tonify the Spleen-Qi.

2.    If there is diarrhoea before dawn with cold in the lower abdomen due to deficiency of Kidney-Yang, add Bu Gu Zhi Fruetus Psoraleae 10 g and Wu Wei Zi Fructus Sehisandrae 10 g to tonify the Kidney-Yang and stop the diarrhoea.

3.    If there is seminal emission, enuresis and frequent nocturnal urination due to deficiency of the Kidney-Qi, add Yi Zhi Ren Fruetus Alpiniae Oxyphyllae 6 g to tonify the Kidney-Qi and arrest the seminal emission.

4.    If there is insomnia due to disharmony between the Heart and Kidney, add Huang Lian Rhizoma Coptidis 5 g and E Jiao Colla Corii Asini 10 g to clear Deficient-Fire, balance the Heart and Kidney and improve sleep.

5.    If there is headache and vertigo due to hyperactivity of Liver-Yang caused by deficiency of the Yin of the Liver and Kidney, add Tian Ma Rhizoma Gastrodiae 10 g and Gou Teng Uncariae cum Uncis 15 g to subdue the Liver-Yang and relieve the vertigo.

6.    If there is a tidal fever or feverish sensation in the palms and soles of the feet due to deficiency of Yin, add Di Gu Pi Cortex Lycii Radicis 12 g to clear Deficient-Heat.

Patent remedies

Jin Gui Shen Qi Wan Kidney Qi Pill for deficiency of Kidney-Yang

Liu Wei Di Huang Wan Six-Flavour Rehmanniae Pill for deficiency of Kidney-Yin

ACUPUNCTURE TREATMENT

BL-23 Shenshu, BL-35 Huiyang, BL-40 Weizhong,

BL-58 Feiyang, GB-39 Xuanzhong, KI-3 Taixi, KI-IO

Yingu, GV-3 Yaoyangguan and SP-6 Sanyinjiao.

Reinforcing method is used on these points.

Explanations

•    BL-23, the Back Transporting point of the Kidney, KI-3, the Source point, and KI-10, the Sea point, tonify the Kidney, and strengthen the back and bones so as to treat the root cause.

•    BL-40, a commanding point for the back, and BL-58, the Connecting point, promote the free flow of Qi in the channels and harmonise the collateral in order to treat pain in the lower back and coccyx.

•    GB-39, the Gathering point for the Marrow, strengthens the tendons and bones so as to consolidate the back and coccyx.

•    SP-6, the crossing point of the three Yin channels of the foot, nourishes the Liver, Spleen and Kidney so as to promote the production of Qi and Blood.

•    BL-35 and GV-3, the local points, harmonise the collateral in the coccyx region and relieve pain.

Modifications

I. If there is a cold sensation in the lower back, add GV-4 with moxibustion and a moxa box on the lower back to warm the lower back and dispel Cold.

2.    If there is weakness in the knees, add GB-34, the Gathering point for the tendons, to strengthen the knees.

3.    If there is impotency, add CV-4 and CV-6 to reinforce the Kidney and improve the potency.

4.    If there is insomnia, add HT-3 and PC-6 to calm the Mind and improve the sleep.

5.    If there is dizziness, add GB-20 to regulate the Qi and Blood in the head and relieve the dizziness.

6.    If there is generalised tiredness, add ST-36 and GV-20 to lift up the energy and relieve the tiredness.

7.    If there is diarrhoea, add BL-20 and BL-25 to strengthen the Spleen and stop the diarrhoea.

8.    If there is constipation, add LI-4 to promote defecation.

9.    If there is profuse night sweating, add HT-6 and KI-2 to clear Deficient-Heat and stop the sweating.

10. If there is nervousness and headache, add LR-2, the Spring point, to clear Heat in the Liver and calm it.

Case history

A 75-year-oId woman had been suffering from coccyx pain for 5 years. The onset was gradual, and the pain mostly occurred when she was tired and resolved after she had rested. Sometimes she suffered from coccyx pain when she walked too much. Other symptoms were heat in the body, a thirst, a dry throat, dry stools, slight night sweating, lower back pain and soreness, weakness in the knees, a poor memory, dizziness, tinnitus in the left ear, irritability, nervousness, occasional headaches, a red tongue with a scanty coating, and one small area of peeled coating on the left edge, and a thready, weak and slightly rapid pulse.

Diagnosis

Coccyx pain due to deficiency of Yin of Liver and Kidney.

Principle of treatment

Nourish Yin, tonify the Kidney and relieve the pain. Acupuncture treatment

BL-23, BL-35, BL-58, GB-20, GB-39, KI-3, KI-7, KI-10,GV-3 and SP-6. Reinforcing method was used on these points. Treatment was given once every 3 days.

Explanations

•    BL-23, the Back Transporting point of the Kidney,KI-3, the Source point, and Kl-10, the Sea point, tonify the Kidney, and strengthen the back and bones so as to treat the root cause.

•    Kl-7, the Metal point, and SP-6, the crossing point of the three Yin channels of the foot, nourish the Yin of the Liver and Kidney and clear Deficient-Heat.

•    BL-58, the Connecting point, harmonises the collateral and relieves the coccyx pain.

•    GB-39, the Gathering point for the Marrow, strengthens the tendons and bones so as to consolidate the back and coccyx.

•    BL-35 and GV-3, the local points, harmonise the collateral in the coccyx region and relieve the pain.

•    GB-20 calms the Mind, smoothes the Liver and tranquillises the Mind.

Herbal treatment

Liu Wei Di Huang Wan Six-Flavour Rehiiinnnine Pill, three times per day, 12 pills each time.

After treatment for I month, her coccyx pain was almost under control. After this, acupuncture was given once every week for another 2 months, by which time her coccyx pain had disappeared. She was followed up a year later and she replied she had experienced no further coccyx pain since the treatment.

STAGNATION OF QI AND BLOOD

Symptoms and signs

A stabbing pain in the coccyx that is aggravated by pressure and worsens at night, with a history of physical trauma to the coccyx or adjacent region, accompanied by rigidity in the lower back, restlessness or insomnia due to the coccyx pain, a dark purplish tongue and a thready or choppy pulse.

Principle of treatment

Promote Qi and Blood circulation, eliminate Blood stasis and relieve the pain.

HERBAL TREATMENT

Prescription

SHEN TONG ZHU YU TANG

Meridian Passage

Dang Gui Radix Angelicae Sinensis 10 g

Chuan Xiong Rhizoma Ligustici Chuanxiong 12 g

Tao Ren Semen Persicae IOg

Hong Hua Flos Carthami 6 g

Mo Yao Resina Myrrhae 6 g

Xiang Fu Rhizoma Cyperi 10 g

Wu Ling Zhi Faeces Trogopterorum 6 g

Chuan Niu Xi Radix Cyathulae 6 g

Di Long Lumbricus 10 g

Gan Cao Radix Clycyrrhizae 6 g

Explanations

•    Dang Gui, Chuang Xiong, Tao Ren and Hong Hua promote the circulation of Blood and eliminate Blood stasis.

•    Mo Yao and Wu Ling Zhi eliminate Blood stasis and sedate coccyx pain.

•    Xiang Fu promotes the circulation of Qi to reinforce the effect of the circulation of Blood.

•    Chuan Niu Xi and Di Long promote the circulation of Blood in the channels and relieve coccyx pain.

•    Chuan Niu Xi guides Blood stasis down and tonifies the back and coccyx.

•    Gan Cao harmonises the actions of the other herbs in the prescription.

Modifications

1.    If there is swelling around the coccyx, add San Qi Radix Notoginseng 10 g to promote the circulation of Blood, eliminate Blood stasis and reduce the swelling.

2.    If there is lower back pain with an aversion to Wind-Damp, add Du Huo Radix Angelicae Pubescentis 10 g to dispel the Wind and relieve the pain.

3.    If there is lower back pain with weakness of the lower back, add Du Zhong Cortex Eucommiae IOg and Shu Di Huang Radix Rehmanniae Praeparata 12 g to tonify the Kidney and relieve the pain.

4.    If there is irregular menstruation due to stagnant Blood, add Yi Mu Cao Herba Leonuri 10 g to regulate the menstruation.

5.    If there are cold limbs, a pale complexion, a deep and slow pulse and a pale tongue, add Gui Zhi Ramulus Cinnamomi 6 g and Gan Jiang Rhizoma Zingiberis 6 g to warm the Kidney-Yang and relieve the pain.


Patent remedy

Te Xiao Yao Tong Ling Special Efficacy Lower Back Pain Pill

ACUPUNCTURE TREATMENT

BL-17 Geshu, BL-35 Huiyang, BL-40 Weizhong, BL-58 Feiyang, BL-62 Shenmai, BL-63 Jinmen, SI-3 Houxi, GV-2 Yaoshu and SP-6 Sanyinjiao. Reducing method is used on these points.

Explanations

• BL-17, the Gathering point for the Blood, and SP-6, the crossing point of the three Yin channels of the foot, promote the circulation of Blood and eliminate Blood stasis.

•    BL-40, a commanding point for the back, BL-58, the Connecting point, and BL-63, the Accumulation point, promote the free flow of Qi in the channels and harmonise the collateral to relieve the pain in the lower back and coccyx.

•    BL-62 and SI-3 in combination open the Governing Vessel and relieve coccyx pain.

•    BL-35 and GV-2, the local points, harmonise the collateral in the coccyx region and relieve pain.

Modifications

1.    If there is a severe coccyx pain, add LI-4 and LR-3 to promote the circulation of Qi and Blood and relieve the pain.

2.    If there is swelling around the coccyx, add some local Ah Shi points to promote the circulation of Qi and Blood and reduce the swelling.

3.    If there is restlessness due to pain, add GB-20 to calm the Mind.

4.    If there is insomnia, add HT-3 and HT-7 to calm the Heart and tranquillise the Mind.

5.    If there is aversion to cold in the lower back, add moxibustion to warm the channel and dispel Cold.

Case history

A 20-year-old man had been suffering from coccyx pain after falling down whilst horse riding 5 days previously. He visited his doctor and was given some painkillers; however, the pain did not improve much.

When he arrived at the clinic, he still had some swelling around the coccyx, together with a big blue spot, which was about 10 x 10 cm, worsening of the pain at night and frequent waking due to pain, restlessness, an inability to sit and lie down and, because of the coccyx pain, he could not easily defecate as usual. His appetite, tongue coating and pulse were normal.

Diagnosis

Coccyx due to stagnation of Blood.

Principle of treatment

Promote circulation of Qi and Blood, eliminate Blood stasis and relieve the pain.

Acupuncture treatment

GV-2, GV-26, BL-17, BL-40, BL-35, BL-58 and SP-6. Reinforcing method was applied for all these points. Treatment was given two times per week.

Explanations

•    GV-2 and BL-35 are the local points to promote the circulation of Qi and Blood, harmonise the collateral and relieve the coccyx pain.

•    Needling at GV-26 with reducing method conducts

the circulation of Qi and Blood in the Governing Vessel, which passes through the sacral region.

•    BL-40, the commanding point for the back, and BL-58, the Connecting point, disperse the stagnation of Blood from the collateral and relieve the pain.

•    BL-17, the Gathering point for the Blood, and SP-6, the crossing point of the three Yin channels of the

foot, were used to promote the circulation of Blood, eliminate Blood stasis and relieve the pain.

After I month of treatment, his coccyx pain had disappeared. Two months later, he was followed up by telephone and he replied he had experienced no pain since the treatment.

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