Lower back pain is a group of lumbar, sacral, hip and leg pains caused by lower back disorders. The understanding of this group of diseases in Chinese medicine is scattered in the categories of “lumbago”, “paralysis”, “injury to tendons”, “lumbago and leg pain”, etc. “back pain”, “paralysis”, “tendon injury”, “back and leg pain” and other diseases. However, this group of diseases has more commonalities in terms of etiology, symptoms, treatment, prevention and rehabilitation, so it is necessary to make a unified understanding. At the same time, with the continuous development of modern medicine, most patients with lower back pain can show some kind of organic abnormality in imaging, so many patients and some doctors do not know what is suitable for acupuncture treatment and what is not suitable for acupuncture treatment for a wide range of Western medical diagnoses. In this paper, we will make a preliminary exploration of acupuncture treatment for lower back pain on these problems.
I. The concept of lower back pain
The lower lumbar region refers to the anatomical segment centered on the lumbosacral joint, narrowly defined as the segment from the four lumbar vertebrae to the sacrum, and broadly defined as including the second and third lumbar vertebrae as well as the bilateral sacroiliac joints and their adjacent tissues. Since this area contains the cauda equina nerve and the spinal nerve roots that form the sciatic nerve, the range of symptoms involves not only the lumbar region but also the buttocks and lower extremities. Many diseases in internal medicine and gynecology can cause low back pain, but the lower back pain discussed in this article refers to the painful disorders of the lower back itself, which mostly belong to the category of orthopedic and neurological diseases and are common in acupuncture and moxibustion.
In a broad sense, lower back pain can include congenital disorders, degenerative disorders, traumatic disorders, inflammatory disorders, tumor disorders and dozens of other diseases. The indications for acupuncture are mainly the first three types of diseases, especially degenerative disorders. The relationship between these three types of diseases is very close. Modern medicine believes that degenerative changes of the spine, mainly the intervertebral disc, and the action of abnormal stress in the lumbar region are the main pathological basis of lower back pain, and in most cases, they are mutually causal, while abnormal development or congenital defects of the lumbar vertebrae and joints, nerves and other structures are often potential factors in the development of lower back pain.
II. Indications and superiority of acupuncture treatment
Although acupuncture is its specialty in treating pain, with the continuous development and popularity of modern medical diagnostic techniques, many diagnostic reports of imaging tend to bluff patients and doctors into thinking that their disease is not suitable for acupuncture treatment, thus making the position of acupuncture department tends to shrink. For example, there is an X-ray or CT report of some congenital malformation of the lumbosacral region, and it is generally believed that acupuncture cannot treat lower back pain caused by congenital malformations. Another example is when a bone spur is found in a certain area, many people believe that acupuncture cannot eliminate the bone spur and thus cannot treat the pain caused by this condition either. Another example is that many patients who were diagnosed with sciatica in the past and had no obvious abnormalities on X-ray are now found to have lumbar disc herniation by CT or MRI, while many patients and doctors believe that acupuncture cannot treat disc herniation. In fact, these are incorrect perceptions.
As far as congenital deformities are concerned, acupuncture certainly cannot treat severe congenital deformities, but severe deformities are rare and develop early in life. Lighter congenital malformations do not manifest themselves in general, often due to age, injury accumulation, feeling cold and dampness and other factors prompt the onset. Acupuncture treatment can relieve symptoms by removing external evil, adjusting body functions, and unblocking meridians and qi and blood. Although congenital deformities can not be corrected by acupuncture, but the associated pain can often be relieved by acupuncture.
Bone spurs, or osteophytes, are a manifestation of degenerative changes or compensatory effects of bone tissue. The presence or absence of bone spurs or the size of the spur does not correspond exactly to the clinical symptoms. Most people grow bone spurs as they age, but only about 20% of them experience joint pain and immobility. Most of the lower back pain caused by bone spurs can be cured or relieved by proper acupuncture treatment. The mechanism is probably to reduce the inflammatory edema response caused by the bone spur and to encourage the body to adapt to the changes caused by the bone spur as soon as possible, thus achieving a new balance. It is important to emphasize here that the x-ray signs of spinal disease often do not match the clinical presentation. For example, many people with herniated discs do not show significant radiographic signs of spinal degeneration; on the contrary, some people with severe spinal disease have no symptoms of nerve damage even though they have radiographic signs. Therefore, X-rays should only be used for clinical reference.
For lumbar disc herniation, we use acupuncture as the main treatment, and after nearly 20 years of observation, all have satisfactory results, and only a very small number of people need surgery. Many people who are considered by Western medicine to be in need of surgery have also had their pain disappear through acupuncture. Lumbar disc herniation is one of the more difficult conditions in lower back pain, but acupuncture has high efficacy in this condition, which shows that acupuncture has great potential in treating lower back pain. Based on clinical reports and relevant literature combined with the author’s clinical experience, the following conditions causing lower back pain can be treated mainly with acupuncture therapy.
1, mild and moderate congenital deformity disorders: short lumbar deformity, spina bifida, lumbar sacralization and sacral lumbarization, vertebral accessory deformity, congenital, developmental lumbar spinal stenosis, congenital lumbar vertebral collapse and spinal slippage, etc.
2, degenerative disorders: hypertrophic spondylitis (also known as hyperplastic spondylitis, degenerative spondylitis, senile spondylitis), hypertrophy of the ligamentum flavum, senile hunchback with painful symptoms, lumbar disc herniation, secondary lumbar spinal stenosis, lumbar degenerative small joint injury arthritis, degenerative spondylolisthesis and spondylolisthesis.
3, inflammatory disorders: lumbar dorsal fascial fibrillitis, ankylosing spondylitis, inflammation of the sacral joints, secondary adhesive arachnoiditis.
It should be noted that there are many inflammatory disorders causing lower back pain, and acupuncture therapy is mainly suitable for the treatment of aseptic inflammation caused by various irritants such as cold, humidity, ischemia, hypoxia, etc. and collagenous diseases of bone and joint caused by allergic reactions. As for bacterial inflammation, acupuncture therapy is difficult to quickly eliminate the causative bacteria, there is a delay in treatment, so the treatment of such inflammation, acupuncture is generally used only as a complementary treatment method.
4, injury disorders: lumbar muscle sprain, lumbar muscle strain, lumbar ligament injury, etc.. The former is generally suitable for acupuncture treatment, and the latter can be treated with acupuncture for mild cases.
5, other disorders: pear-shaped muscle syndrome, various dry neuralgia of the lumbosacral region, cervical and lumbar syndrome, restless legs, etc..
The above disorders, using acupuncture therapy, after appropriate treatment, most can be cured. For a very small number of people who cannot be cured for a long time or whose condition is aggravated, surgical treatment can be considered.
Acupuncture therapy can not only greatly reduce the rate of surgery for patients with lower back pain and avoid the risks associated with surgery, but also has great superiority over other therapies. Other non-surgical methods for the general treatment of lower back include Chinese and Western drug therapy and tui-na methods. Western medicine is mainly painkillers, but can only temporarily relieve pain; closed therapy has a better pain relief effect, but the treatment means a single, it is difficult to solve the problem at the root. Although Chinese medicine has a good adjustment effect, but the pain relief effect is not as fast as acupuncture therapy, and lower back pain is a lesion of the bones, muscles, tendons and veins, and it is difficult for the drug to effectively play a role in these parts because of the concentration, while acupuncture can directly affect the affected part, the so-called “poison to treat its internal, needle and stone to treat its external” also.
As for tui na, it is also a common method to treat lower back pain. However, since tui na is the use of external force to directly adjust the pathological state of the body, this external force must be used appropriately, if it is used improperly, it often aggravates the disease. We have clinically encountered some cases of herniated intervertebral discs whose symptoms were aggravated by tui na. Inappropriate or overly heavy manipulation can make the intervertebral structure more unstable and even lead to serious consequences such as rupture of the fibrous ring, nerve damage and fracture. Therefore, acupressure methods must be used with caution. In contrast, acupuncture therapy indirectly adjusts the pathological state of the body through acupuncture points and meridians, and works by stimulating the body’s own regulation ability, so acupuncture therapy generally does not have negative effects, which is the greatest advantage of acupuncture therapy.
Diagnosis and differential diagnosis
The western diagnosis of lower back pain can help to determine the prognosis, which can be referred to the relevant medical literature and will not be discussed here. X-ray examination can be used as a routine, most of the patients with tumor have special performance on X-ray film, and a few of the spinal X-ray films may not be positive. Where there is no obvious effect by treatment, the disease develops faster, the pain is very intense at night, and it is impossible to sleep without strong painkillers, tumor is very likely.
Secondly, tuberculosis should be excluded. If the patient is young and has neurogenic pain after a long period of limited pain, accompanied by general symptoms such as slight fever, night sweats, and wasting, it suggests a higher possibility of spinal tuberculosis. Lower back pain due to bacterial infectious disease is usually manifested by fever and elevated white blood cell count. Other attention is paid to exclude local disorders such as fractures, varicose veins in the lower extremities and thrombo-occlusive vasculitis.
Many internal and gynecological diseases can cause lower back pain, which are characterized by: special symptoms of the primary disease in addition to low back pain; low back pain is not affected by lumbar activities; pressure points in the lumbosacral region and buttocks are usually not detected or are not obvious. Lower back pain caused by mental or psychological factors also has similar characteristics.
After excluding the above disorders, the rest are the diseases covered by the concept of lower back pain in this paper. Although there are still dozens of these diseases, and although the clinical manifestations of these diseases vary widely, or leg pain, or back pain first and then leg pain, or leg pain first and then back pain, or leg and back pain at the same time, or radiating pain ……, their pathogenesis and treatment principles have something in common, so they can be discussed together.
Fourth, etiology and pathogenesis
The causes of lower back pain can be divided into three categories.
One is the internal cause, with kidney deficiency as the main cause. The kidney is the master of bone and marrow, and the kidney meridian is “through the spine belongs to the kidney” and “the waist is the capital of the kidney”, so the kidney is mostly to blame for low back pain. As stated in Su Wen? As stated in “The pulse to the essence of the theory”: “The waist, the house of the kidney, can not turn shaking, the kidney will be exhausted.” Low back pain is also related to liver and spleen, liver and kidney are of the same origin, essence and blood produce each other, and liver is the main tendon, liver blood deficiency or depression and anger injury liver, can lead to tendon relaxation and development of low back pain; spleen is the main muscle, transport and transformation of water and grain essence to produce muscle, spleen deficiency, then waist muscle impotence and weakness, or water and dampness, blocking the meridians, can lead to low back pain.
Secondly, external causes are mainly due to wind, cold and dampness. Or sleeping in the cold, or living in a cold and wet place for a long time, the invasion of the evil of cold and dampness, so that the meridians are closed, not pass is pain. The lower back pain caused by the direct feeling of wind and heat is less common, and the heat evidence of back and leg pain is mostly caused by internal heat, or by the wind, cold and dampness of the evil depression and heat.
Three is not internal and external causes. Or overexertion, or improper exertion posture, or fall and impact, injury to the lumbar muscles, spine, tendons and veins, resulting in obstruction to the flow of qi and blood, qi stagnation and blood stasis, ligament blockage and the development of lumbago.
The onset of lower back pain is mostly related to kidney deficiency, as Zhang Jingyue said: “Eight out of ten deficiency certificates of lumbago”. For example, in strong people, even if they are exposed to the evil of wind, cold and damp, they do not develop the disease, as the saying goes, “The brave person is already in the line of qi, but the timid person is also in the disease”. Zhu Danxi said: “kidney gas a deficiency, where the punch cold, damp, cold, heat, blood astringency, gas stagnation, water accumulation, fall injury and loss of will, labor, all kinds of back pain, stacked and layer out.”
V. Treatment principles
Lower back pain can be treated with reference to the Chinese medical treatise on “lumbago” and “paralysis”. The treatment methods are colorful and there are a lot of clinical reports. However, how to overcome the blindness in acupuncture treatment and incorporate the scattered experience into the systematic treatment rules is still a problem that needs to be explored. In this paper, we try to propose five principles for the treatment of lower back pain.
1. Meridian dialectic, unblocking the meridians
Lower back pain is a localized disorder of the lower back, and because it is rich in spinal cord nerves, it is often associated with involvement pain and radiating pain in the lower limbs. The Su Wen? It not only discusses the lumbago of the five meridians of the foot, but also mentions the nine types of pains, such as the “dissolving pulse”, the “pulse of the same yin” and the “pulse of the flesh”. It not only discusses the low back pain of the five foot meridians separately, but also mentions the low back pain of nine types of meridians, such as the “Xie pulse”, the “Tong Yin pulse” and the “Flesh Lane pulse”. Clinically, lumbago of the foot sun and foot shaoyang meridians is most common, and sometimes lumbago of the foot yangming and foot sympathetic meridians can be seen.
Meridian blockage is the basic pathological change of lower back pain, so that the needle sensation is conducted along the diseased meridians, which can achieve the therapeutic effect of unblocking the meridians and making them pass without pain. In clinical practice, we have seen cases of lower back pain patients with poor acupuncture results, mostly due to the lack of identification of meridians and the limitation of needle sensation. As for the specific points, they can be used flexibly according to their respective experience.
2. Pay attention to the Governor’s Vessel, and take the spinal cord nearby
According to the fact that most lower back pain disorders are caused by degenerative lesions of the spine, and that the face of the Governor’s Vessel is located in the spine and is the “sea of Yang meridians”, stimulating the Governor’s Vessel meridian points and the adjacent Huatuo Pinch Spine points can invigorate the function of the Governor’s Vessel and the meridians of the lower extremities, improve local qi and blood flow, and thus achieve the therapeutic purpose of correcting and clearing the origin. The points of the Directing Vessel should be taken from points near the affected vertebrae, or from points far away from the affected area, such as the human body, while the points of the Pinned Spine are usually taken from points adjacent to the affected area. Local pressure points can also be used as appropriate.
3, stimulate the effect points, movement of the affected part
Lower back pain often has local muscle, ligament fiber spasm, tendon, joint misalignment. At this time, if you can stimulate the experienced effective points far away from the affected part (such as sciatica points, lumbago points, commissioning points, etc.), and at the same time make the patient rotate the lower back and gradually increase the range of rotation, you can often achieve immediate results. This combination of acupuncture and movement, presumably through the transmission of information through the meridians, allows the affected part to release spasm and eliminate misalignment during movement, and even return the protruding part of the nucleus pulposus. This is the result of the acupuncture method stimulating the body’s own regulatory ability.
4.Multi-method cooperation, each taking its own strength
Acupuncture therapy has many therapeutic tools, which can be used according to the strengths of different methods. For example, the cold and deficiency evidence can be combined with moxibustion or cupping method; the heat and blood stasis evidence can be treated with bloodletting therapy; the phlegm and dampness evidence can be combined with the spleen and stomach meridian points; the serious chronic diseases can be combined with fire and water acupuncture, etc., and some other methods can be used when necessary.
5. Slowly treat the root cause and consolidate the therapeutic effect
Because lower back pain has kidney deficiency as the root of the disease, so after the disease is relieved, it cannot be “stopped in the middle of the disease”, but should focus on nourishing the kidney and strengthening the waist, as stated in the “Certificate of Treatment”: “For the first pain, it is appropriate to dredge the evil stagnation and manage the meridians and tunnels; for the long pain, it is appropriate to nourish the true essence and nourish the blood.” Acupuncture and moxibustion to tonify Kidney Yu, Life Gate, Guan Yuan, Tai Xi and Fuyao can consolidate the treatment effect.
The above five principles must be applied in an integrated manner to achieve the best therapeutic effect. Clinically, the following one-sided tendencies need to be overcome: First, discarding the theoretical guidance of Chinese medicine, not talking about dialectical treatment. Or headache acupuncture head, lumbago acupuncture waist, only one or two experience acupuncture points. The second is to talk about evidence-based treatment, but do not understand the special nature of acupuncture therapy, the application of internal organs dialectic method of internal medicine and ignore the meridian dialectic, the result is a lack of targeted treatment. The third is to emphasize the meridian dialectic, follow the meridian far from taking, but deny or ignore the local use of acupuncture points. This all affects the efficacy of acupuncture in the treatment of lower back pain. The author’s treatment steps are generally the first needle experience effective points, while moving the patient’s affected part, so that patients see the immediate effect, to build confidence, in order to further cooperate with acupuncture treatment; then acupuncture a number of local points and meridian distant points, so that most patients can achieve good results. If the effect is not good, then with other methods, pay attention to the overall adjustment. After the patient’s pain is relieved, he must be admonished to make consolidation treatment, otherwise he is prone to recurrence. In the later stage, the main focus is on tonifying the kidneys, while paying attention to adjusting the functions of the internal organs. After following the above principles, I feel more confident in treating lower back disorders.
VI. Precautions
In order to better cooperate with the treatment and prevent the recurrence of lower back pain, there are several points that must be understood by patients.
1. Pay attention to rest during the acute period
In acute lower back pain, there is often some degree of injury. Paying attention to rest can avoid further injury and fill up the righteousness so that it can respond positively to treatment. Generally need to sleep on a hard bed, some patients can add lumbar girth.
2.Correcting bad posture
Many of the occurrence of lower back pain is related to poor posture in work and life and sleep, improper posture can make a certain part of the muscles in a state of tension, the balance between the bones and joints is damaged, the stability is weakened, thus prone to sprain and strain injury.
3.Strengthen physical exercise
After the symptoms of lower back pain are relieved, it is advisable to gradually enhance physical exercise for the lumbar region, which can promote blood circulation and enhance the support and protection ability of the lumbar back muscles, forming the so-called “muscle brace”, which can consolidate the treatment effect and prevent the recurrence of lower back pain.