Lumbar Region and Sciatica

Lumbar Region and Sciatica

Yao Tuí Tong (Lumbar Leg Pain)

In many cases lumbar and sciatica pain are due to protrusions, hernias and/or osteoarthritis of the lumbar region. In these cases they affect only one side or remain in the lumbar region. In people over 70 years it may be stenosis of the lumbar: it can affect both limbs at the same time.

If it is a disc problem it is evaluated according to how it radiates in the leg:

  • L4 Topography (L3-L4): radiates toward iliac crest and anterior thigh.
  • L5 Topography (L4-L5): lumbar pain with lateral leg, inner ankle and big toe.
  • S1 Topography (L5-S1): pain radiation posterior leg, heel and outer foot.

Another origin is muscular and concentrates in the lumbar region. Very good effect is given by Myofascial work (Travell and Simons)

Etiology

Fullness

Bu Tong Ze Tong: "not free circulation is pain".

Cold-Dampness

Obstruction and stagnation due to invasion:

  • Of external cold-dampness.
  • Sweating from physical effort, damp clothes catch cold.
Pain characteristics
  • Fairly acute pain, with cold sensation, heaviness.
  • Difficulty with movements, both rotation and flexion and extension
  • Rest does not improve the pain
  • Heat gives relief
  • Tongue with white coating (can be thick seborrheic)
  • Pulse superficial, slightly slow and tense
Treatment

Very acute: seek distal points

Unblocking points (they must give an immediate action):

Points on the table:

  • BL-23, R mobilizes Yang
  • BL-25, helps eliminate cold-dampness
  • GV-4 to eliminate cold
  • SP-9, to eliminate dampness

Stagnation of Qi/Blood

Due to trauma, bad movement

Characteristics
  • Very sudden onset
  • Very acute pain
  • Pricking, as if a knife were being stuck in
  • Rejects palpation, hurts a lot
  • Many muscle spasms
  • Worse in the morning
  • Cannot sit for long
  • Flexion and extension blocked (can even be rotation)
  • Can radiate posteriorly or laterally
  • The patient doesn't even know how to position themselves (typical of disc crises)
  • Nothing relieves
  • Cyanotic tongue (or spots)
  • Tense pulse (significant pain) or somewhat raspy (stasis)
Treatment

Very acute: seek distal points

Unblocking points (they must give an immediate action):


Points on the table

  • BL-23, BL-17, BL-40 (generic point for back problems, look for small dark superficial capillaries and use the lancet)
  • Significant stasis: BL-17, GV-1
  • SP-4 (Chong Mai) or SP-8

For more medial pain

If there is a context of LR (frustration or stress):

Empty

Bu Rong Ze Tong: "pain from lack of nourishment"

Kidney

Causes:

  • Old age
  • Exhaustion (surmenage: physical, intellectual or sexual). Deficiency of Jing, Qi, Ying/Yang.

Lower back pain is common in both Yin and Yang deficiency


Yang Deficiency
  • Context of exhaustion or old age
  • There is weakness of the lower back
  • Massage relieves
  • Rest improves, worsens throughout the day
  • Physical and mental fatigue, sensation of cold, cold hands and feet, internal muscle spasms. Deep slow pulse...
Yin Deficiency (empty-heat)
  • Nervousness
  • Dry throat/mouth
  • Heat in the five orifices
  • Red tongue, fine and rapid pulse
  • Scanty urine
Treatment

Su Wen

The most important thing is to understand the symptomatology that is on this pathway.

Paul U. Unschuld, Su Wen: Good translation. Chapter 41.

Lower Back Pain of Foot Tai Yang

Lumbago of the Bladder meridian.

  • The pain radiates from the nape to the coccyx involving the entire spine.
  • Sensation of having a heavy weight on the back, like having a heavy sack.
  • Must bleed BL-40, but do not bleed in spring.

Lumbago of Foot Shao Yang GB

Now it is according to the symptomatology of the specific meridian, the previous time it was due to pathway.

  • The pains are like needles that prick, and progressively one doesn't dare to bend or extend the trunk backward.
  • The pain prevents turning the head.
  • In this case needling the Shao Yang at point GB-34, can bleed but do not bleed in summer.

Lumbago of Foot Yang Ming ST

  • The pain prevents turning the neck, doesn't dare to turn the neck.
  • If trying to turn the neck, there is dizziness, and also the patient is sad. A person with lower back pain, when turning the neck, gets a kind of instability, dizziness.
  • Depressed mood, shuts themselves in at home, doesn't want to see anyone. Or sings, naked in the street.
  • Needle ST-36, ST-37, ST-39, that is the three He points. These points can be needled but not bled in autumn. Because the following season is an empty season. Fullness is in its season, but when entering the following season it is not bled because it is a season of weakness for this organ. Bleeding is a very important drainage act, and therefore one does not bleed in the season following the one corresponding to the organ.

Lumbago of Foot Shao Yin

Kidney meridian.

  • The lower back pain is as if coming from inside the spine. The meridian penetrates inside to the second lumbar.
  • In this case needle KI-7. KI-7 is a great point for lumbago. Modern texts indicate more KI-3.
  • Do not bleed in Spring.

Any needling is divided into Heaven, Human and Earth. The needle is sometimes needled very deep to stimulate, and then the greatest stimulation is at the Human level, especially when leaving the needles inserted between Earth and Human.

If I want to avoid drainage, so it doesn't bleed when removing the needle, when removing it before withdrawing it, lower it a little. If there is pathogenic factor, remove it without pushing it down first, so that the energy concentrated in that needle comes out. To avoid drainage, push it in a little, withdraw, and under the skin wait a little and then come out. Or take a dry cotton, and cover the hole when removing the needle. See Acupuncture techniques.

She applies this technique for all Kidney points, because she considers that Kidney is never in fullness, and if it does bleed she uses a little artemisia to recover it.

Lumbago of Foot Jue Yin

Liver.

  • The lower back is rigid like a well-tightened bowstring, when palpating all muscles are tense.
  • Additionally the patient is apathetic and taciturn (implies some bad blood). Taciturn refers to not liking to speak.
  • The classical text proposes needling LR-5.
  • In this part of the leg the Liver meridian is in front of the Spleen. Jue Yin is on the bone, LR-5, is 5 cun above the tibia. At this height there are no points on the Spleen meridian. Palpate where it hurts most above the bone or behind the bone. If needling above the tibia, put it transversely.
  • She for this presentation adds LR-2, if they put LR-5 and LR-2 it will improve a lot.
  • LR-2 and LR-3 is a great point for lumbago, if you see the patient furious, very angry, already has the whole back locked, then also put LR-3.
  • Another great point for contracture is point BL-18 to release Liver Qi and relax the muscles.

Lumbago of Jie Mai

Jie means bifurcation, it is what deviates, what separates, what bifurcates. Mai means meridian, pathway or vessels. It is not possible to define to which meridian it branches, some texts say it is collaterals of the Bladder meridian. The Su Wen has described two symptomatologies:

  • The lower back pain radiates to the shoulder and neck. And often it is also accompanied by blurred vision and urinary incontinence. If you see the symptomatology everything is in the Bladder pathway.

Must associate lumbago symptoms with eye pain and loss of urine, as it is Bladder. Must needle BL-39. When there is loss of urine, use BL-39 because it is the luo of the Triple Burner.

  • Lumbago that radiates circling the waist and looks like a very tight belt, as if the lower back would break.

In this case normally the patient is afraid. It could also be the Dai Mai meridian, etc. This is why a divergence comes. In some ancient texts, they say it starts from BL-40 and reaches the lumbar and then makes a turn at the waist height. Because of this the point proposed for this lumbago point is BL-40.

This point also in these cases must be bled: normally when there is stagnation the blood comes out darker and you must let it bleed until the blood turns red.

Lumbago of Tong Yin Mai

It is also a collateral, Tong Yin Mai (communicates with the Yin pathway), but the pathway comes from Foot Shao Yang. This meridian actually refers to a collateral of Foot Shao Yang that leads to the Yin meridian.

  • The lower back pain looks like a dagger that is stuck in and out, sticks and comes out. Additionally it is a pain that is accompanied by swelling.
  • Put GB-38. which is a point to treat lumbar. In this context it is more interesting. GB-34 when needling, GB-38 when stabbing, Shao Yang both.

Lumbago Yang Wei Mai

  • Lower back pain with sudden swelling, locally it is swollen. Proposes BL-57. Sometimes in people, in the lumbosacral area, it is swollen, or with lumps, put 57V, or BL-33.

Lumbago Heng Luo Mai

Means the collateral meridian, transversal. According to commentators it is thought to be a collateral of the Bladder meridian.

  • Has difficulty with anterior flexion and straightening.
  • If tries to lean backward is afraid of falling.
  • This type of pain in clinical practice is quite common. Has trouble standing straight, after bending down. And when extending backward falls.
  • BL-39 and BL-37, which is a point in the middle of the upper thigh and often this point is found very tender. Most lumbagos in this text are based on Bladder collaterals.

Lumbago of Hui Yin Mai

Yin Meeting. Several think it is a Bladder collateral passing through the anus and urinary meatus, and others think the collateral refers to the meeting of Du Mai and Ren Mai, that is why it is called Hui Yin CV-1.

  • The pain is accompanied by profuse sweating.
  • When sweating stops the patient has pain and also thirst.
  • After drinking has desire to walk.
  • This lumbago occurs in a febrile disease context.

Needle BL-62, corresponds to yang qiao mai, there is agitation. BL-56

Lumbago of Fei Yang Mai

The Fei (Flying) meridian.

  • Point BL-58, which is the Luo point, and its name is Fei Yang. It is the luo of the Bladder meridian that flies toward the Yin meridian (Kidney), or toward the Yin Wei Mai.
  • According to points it is a collateral that connects with the Yin Wei Mai. It is accompanied by restlessness, and in severe cases also sadness, fear, dread. Here there is lumbago with a context of anxiety, anguish, fear, connotations of the Yin Wei Mai.
  • KI-7, PC-6 Yin Wei Mai and Kidney.
  • KI-9 is xi point of Yin Wei Mai, it is a psychically very potent point for anxiety, anguish etc.

Lumbago Tang yang Mai

It is a collateral, some say it refers to Yin Qiao Mai, others say it is a collateral of Foot Shao Yin (Kidney).

  • The lower back pain goes to the chest.
  • Blurred vision.
  • In severe cases, the spine as if breaking backward, one can fall.
  • Also the tongue retracted, cannot speak. The main Kidney meridian, reaches the root of the tongue.
  • Proposes: KI-7, and KI-8 xi point of Yin Qiao Mai and BL-40

Lumbago of San Mai

Dispersed meridian. It is thought to be a collateral of Foot Tai Yin (Spleen) and others think it is the Chong Mai, others think it is a collateral of Stomach as well.

  • We have lower back pain with fever.
  • If this fever is significant, there is mental agitation
  • The lower back pain looks like a bar stuck transversely in the lower back. Chong Mai
  • In severe cases there can be urinary incontinence. Bladder.
  • Must needle SP-8, it is a great point for lumbago with blockage sensation. There is greater blockage in cases of blood stasis. SP-8 is a Xi point, and it is a point that eliminates stasis.
  • Also proposes points of ST-37 and ST-39. in a certain way use the Yang Ming to use this heat that it has. And use BL-11.

The combination of BL-11, ST-37 and ST-39, are points of the Sea of Blood. These three points are also used in Chong Mai context.

Lumbago of Rou Li Mai

Meat-interior-meridian. The meridian comes from inside the meat. They think it is a collateral of Foot Shao Yang.

  • The patient doesn't dare to cough: if coughs, produces contractures, spasms of muscles and tendons, this type of pain is very common.
  • It looks a bit like a disc herniation context.
  • Point GB-38.

Other lumbagos

The above were lumbagos of meridian deviations and collateral branches. These other lumbagos have no title.

  • It is a lumbago in which the pain circles the spine, rises toward the head, with stiffness, blurred vision and with sensation of loss of balance, BL-40
  • Lumbago accompanied by interior heat and shortness of breath. The heat can be a kind of heat in a context of Yin deficiency, of empty heat. The heat rises and tends to attack Metal, therefore it can produce these symptoms of shortness of breath. Treat with KI-1 and KI-4. KI-1 lowers heat, and treats lumbago, and KI-4, has to do with fire that goes toward the chest
  • Lumbago in which the upper part of the body is cold, and there is difficulty turning the head. Needle ST-33 and ST-36. ST-36 for difficulty turning the head. ST-33 treats cold. But if there is heat in the knee put ST-34.
  • In a lumbago in which the upper part of the body is hot, put SP-8.
  • Lumbago accompanied by constipation, go together, "since I have this lumbago I am constipated", it is a point indicated to put KI-1, which is a wood point, releases Qi Ji.
  • Lumbago with sensation of fullness of Shao Fu (lower abdomen), for example with ovarian or intestinal pain, put LR-3.
  • Lower back as if breaking, and one cannot bend forward or backward, doesn't dare nor can raise the arms, must needle Bladder meridian: BL-65 if cannot bend either forward or backward. BL-62 for the arms (Yang Qiao Mai involved) with BL-61 and BL-63.
  • Lower back pain that radiates toward the flanks, between the floating rib and iliac crest. Cannot even bend backward. The classical text says needle the sacrum. Palpate BL-31, BL-32, BL-33, BL-34, the sacral holes. Where there is most pain is needled.

Authors:

Page updated on December 11, 2020

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