ACUPUNCTURE TREATMENT
LI-4 Hegu, LR-3 Taichong, BL-17 Geshu, BL-40 Weizhong, BL-64 Jinggu, BL-67 Zhiyin and SP- 6 Sanyinjiao. Reducing method is used on these points.
Explanations
• LI-4 and LR-3 promote the circulation of Qi so as to promote the circulation of Blood. Also, they have the function of sedating the pain.
• BL-17, the Gathering point for the Blood, together with BL-40, the commanding point for the back, and SP-6, the crossing point of the three Yin channels of the foot, promote the circulation of Blood, remove Blood stagnation and relieve the lower back pain.
• BL-64, the Source point, and BL-67, the Well point, promote the circulation of Qi and Blood in the Bladder channel and collateral and sedate the lower back pain.
Modifications
1. Since lower back pain may be caused by blockage in specific channels, various points may need to be added to the above, depending on the specific symptoms (see Wind-Cold-Damp invasion, p. 398).
2. If there is a severe stabbing pain, add some local Ah Shi points and bleeding method on BL-40 to activate the circulation of Blood and relieve the pain.
3. If there is limitation of movement in the lower back, add Extra Shoubeiyaotongdian to promote the circulation of Qi and Blood and relieve pain.
4. If the pain worsens at night, add KI-6 to promote the circulation of Blood at night and relieve the pain.
5. If there is restlessness and insomnia due to the pain, add HT-3 and HT-7 to calm the Mind and improve sleep.
6. If there is a headache, add GB-20 and BL-IO to promote the circulation of Qi and Blood in the head and relieve the headache.
7. If there is constipation, add BL-25, the Back Transporting point of the Large Intestine, to promote defecation and relieve the constipation.
Case history
A 52-year-old woman had been suffering from chronic lower back pain that had worsened during the past 10 days. Her lower back pain had started after she fell off a horse whilst riding 10 years previously. She was sent to the hospital immediately, and tests indicated that she did not have a bone fracture but there was some local soft tissue injury. She received 20 sessions of massage, and her lower back pain was much improved by this treatment. But shortly after the massage treatment the pain came back.
Over the past 10 years, she often took painkillers if she had severe lower back pain. On arrival at the clinic, she was suffering from a stabbing pain in the lower back, mainly on the left side, and the pain sometimes referred down the left leg to the ankle along the Gall Bladder channel. During the previous 10 days, she woke up a few times every night and had to get up to walk around in order to alleviate the pain. The pain was usually worse in the early morning. She also had a thin and white tongue coating and a thready pulse.
Diagnosis
Stagnation of Blood in the Gall Bladder channel.
Principle of treatment
Promote Qi circulation, eliminate Blood stasis and relieve the pain.
Acupuncture treatment
LI-4, BL-17, BL-40, GB-29, GB-30, GB-34, GB-36 and GB-40. Reducing method was used on these points.
Explanations
• LI-4, the Source point, and BL-17, the Gathering point for the Blood, promote the circulation of Blood and eliminate Blood stasis.
• BL-40, the commanding point for the back, removes Qi and Blood stagnation and relieves lower back pain.
• GB-29 and GB-30, the very important local points, harmonise the channel.
• GB-34, the Gathering point for the tendons, GB-36, the Accumulation point, and GB-40, the Source point, together promote the circulation of Qi and Blood and remove Blood stagnation in the Gall Bladder channel so as to relieve lower back pain and pain in the legs.
After I month of acupuncture treatment, her lower back pain disappeared. Two years later, she was followed up by letter, and she replied she had experienced no further pain after the acupuncture treatment.
DEFICIENCY OF KIDNEY-ESSENCE
Symptoms and signs
Insidious onset of protracted lower back pain with soreness, accompanied by lassitude and weakness of the loins and knees, which worsens with fatigue and is alleviated by bed rest, accompanied by poor hearing, dizziness, a poor memory and concentration, loose teeth and generalised tiredness.
If the deficiency is of Kidney-Yang, there is also a cold sensation in the lower back and abdomen, a pale complexion, low potency or impotency, nycturia, cold limbs, an aversion to cold, a pale tongue with tooth marks and a wet coating and a deep and thready or deep and slow pulse.
If the deficiency is of Kidney-Yin, there is also irritability, insomnia, a dry mouth and throat, a flushed face, a feverish sensation in the chest, palms and soles of the feet, constipation, a red tongue with a scanty or peeled coating and a weak or thready and rapid pulse.
Principle of treatment
Nourish the Kidney 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 Dioscoreae 15 g
Shan Zhu Yu Fructus Corni 10 g
Ze Xie Rhizoma Alismatis 10 g
Fu Ling Poria 10 g
Dan Pi Cortex Moutan Radicis 10 g
Gui Zhi Ramulus Cinnamomi 10 g
Fu Zi Radix Aconiti CarmichaeIi Praeparata 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 Corni 6 g
Tu Si Zi Semen Cuscutae 10 g
Gou Qi Zi Fruetus Lycii 12 g
Chuan Niu Xi Radix Cyathulae 6 g
Lu Jiao Jiao Colia Cervi Cornus 6 g
Gui Ban Jiao Colla Plastri Testudinis 10 g
Explanations
• In Jin Gui Shen Qi Wan, Shu Di Huang nourishes the Kidney-Essence.
• Shan Yao and Shan Zhu Yu strengthen the Liver and Spleen to assist Shu Di Huaiig to tonify the Kidney.
• Gui Zhi and Fu Zi warm the Kidney-Yang and dispel interior Cold and Cold in the channels.
• Ze Xie and Fu Ling remove Damp and promote discharge of Damp from the body.
• Dan Pi clears Liver-Fire and coordinates the functions of the other herbs in the prescription so as to control the greasy herbs.
• In Zuo Gui Wan, Shu Di Huang tonifies the Kidney and nourishes the Kidney-Yin.
• Gou Qi Zi nourishes the Yin of the Liver and Kidney and benefits the vision.
• Shan Zhu Yu tonifies the Essence of Liver and Kidney and arrests night sweating.
• Gui Ban Jiao and Lu Jiao Jiao in combination tonify the Essence. The former is good at tonifying the Kidney-Yang; the latter is good at nourishing the Kidney-Yin.
• Tu Si Zi and Chuan Niu Xi strengthen the waist and knees and reinforce the muscles and joints.
• Shan Yao tonifies the Spleen and Kidney.
Modifications
1. If there is a low voice, poor appetite and diarrhoea due to deficiency of Spleen-Qi, add Dang Shen Radix Codonopsis Pilosulae 10 g and Huang Qi Radix Astragali Pilosulae 12 g to tonify the Spleen-Qi and activate the Spleen and Stomach.
2. If there is diarrhoea before dawn with a cold lower abdomen due to failure of the Spleen to be warmed by the Kidney-Yang, add Bu Gu Zhi Fructus Psoraleae 10 g and Wu Wei Zi Fruetus Sehisandme 10 g to tonify the Kidney-Yang and stop the diarrhoea.
3. If there is seminal emission, enuresis and frequent nocturnal urination, add Yi Zhi Ren Fructus Alpiniae Oxyphyllae 6 g to tonify the Kidney and consolidate it.
4. If there is insomnia due to deficiency of Yin of the Heart and Kidney, add Huang Lian Rhizoma Coptidis 10 g and E Jiao Colla Corii Asini 10 g to nourish Yin and calm the Mind.
5. If there is a headache and vertigo due to hyperactivity of the Liver-Yang caused by deficiency of Kidney-Yin, add Tian Ma Rhizoma Gastrodiae 10 g and Gou Teng Uneariae cum Uncis 15 g to nourish the Yin and calm the Liver.
6. If there is a tidal fever or feverish sensation in the palms and soles, add Di Gu Pi Cortex Lycii Radicis 12 g to clear Deficient-Heat and relieve the fever.
Patent remedies
For deficiency of Kidney-Yang:
Jin Gui Shen Qi Wan Kidney Qi Pill Yao Tong Pian Waist Pain ‘Lumbago’ Tablet
For deficiency of Kidney-Yin:
Liu Wei Di Huang Wan Six-Flavour Rehmanniae Pill
ACUPUNCTURE TREATMENT
BL-23 Shenshu, BL-40 Weizhong, GB-34 Yanglingquan, GB-39 Xuanzhong, BL-58 Feiyang, KE-3 Taixi, KI-10 Yingu 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, the commanding point for the back, promotes the circulation of Qi and Blood in the Bladder channel and relieves the lower back.
• BL-58, the Connecting point, harmonises the collateral and sedates the lower back pain.
• GB-34, the Gathering point for the tendons, and GB-39, the Gathering point for the Marrow, strengthen the tendons and bones so as to consolidate the back.
• 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.
Modifications
1. Since lower back pain may be caused by blockage in specific channels, various points may need to be added to the above, depending on the specific symptoms (see Wind-Cold-Damp invasion, p. 398).
2. 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 it and dispel Cold.
3. If there is weakness in the knees, add LR-8 to strengthen the knees.
4. If there is impotency, add CV-4 and CV-6 to reinforce the Kidney and improve the potency.
5. If there is insomnia, add HT-3 and PC-6 to calm the Mind and improve sleep.
6. If there is dizziness, add GB-20 to regulate the Qi and Blood in the head and relieve the dizziness.
7. If there is generalised tiredness, add ST-36 and GV-20 to lift up the energy and relieve the tiredness.
8. If there is diarrhoea, add BL-20 and BL-25 to strengthen the Spleen and stop the diarrhoea.
9. If there is constipation, add LI-4 to promote defecation.
10. If there is profuse night sweating, add HT-6 and KI-2 to clear Deficient-Heat and stop the sweating.
11. If there is nervousness and headache, add LR-2, the Spring point, to clear Heat in the Liver and calm it.
Case history
A 69-year-old woman had been suffering from lower back pain for 4 years. Four years previously, she had started to feel an uncomfortable sensation in her lumbar region. Afterwards, this turned into a lower back pain that was sore in nature and moved up and down. The pain did not radiate to the legs along the Bladder channel, was aggravated after heavy exertion and alleviated by rest, and there was weakness of the loins and knees. Accompanying symptoms included tiredness, poor hearing, hair loss, an aversion to cold, cold hands and feet, a pale complexion, a white and wet tongue coating and a deep and slow pulse.
On examination, there was tenderness both in the lower back and in the Bladder channel on each side, but especially on the right side.
Diagnosis
Deficiency of Kidney-Yang.
Principle of treatment
Tonify Kidney-Yang, warm the channels and relieve the pain.
Acupuncture treatment
BL-23, BL-40, BL-58, KI-3, GB-39, SP-6 and some local Ah Shi points. Reinforcing method was used on these points, and moxibustion was used on BL-23 and KI-3. Treatment was given once every other day.
Explanations
• BL-23, the Back Transporting point of the Kidney, and KI-3, the Source point, tonify the Kidney, and strengthen the back and bones so as to treat the root cause.
• BL-40, the commanding point for the back, promotes the circulation of Qi and Blood in the Bladder channel and relieves pain in the lower back.
• BL-58, the Connecting point, harmonises the collateral and sedates the lower back pain.
• GB-34, the Gathering point for the tendons, strengthens the tendons and bones so as to consolidate the back.
• 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.
• Ah Shi points harmonise the collateral and sedate the local pain.
• Moxibustion warms the channels and dispels interior Cold, as well as promoting the circulation of Qi and Blood in the channels.
After 2 months of treatment, her lower back pain had improved greatly. The acupuncture treatment was stopped but she continued with a patent remedy: Ba Wei Di Huang Wan, taking eight pills three times daily for another 2 months in order to consolidate the therapeutic effect. When she was followed up a year later, she stated she had experienced no further pain after the treatment.
