坐骨神经痛 ZUOGUSHENJING TONG - SCIATICA

TCM PERSPECTIVE ON SCIATICA AND LUMBAGO

Arthralgia: joint stiffness, pain and swelling. From the traditional Chinese medical perspective, sciatica belongs to the category of ‘Arthralgia Syndrome’ and the patients who present with this syndrome are diagnosed as suffering from a type of ‘Bi Syndrome.’ Bi syndromes involve blockage and pain and are especially prevalent in the lower half of the body. From the period of the Neijing c.100 BC to the present, bi syndromes are treated as caused by ‘Wind, Cold, and Damp’ and diagnosed as ‘Obstinate Arthralgia, and Tendon Arthralgia.’ Sciatic pain recurs repeatedly and is hard to cure.^[1]

People living in cold and damp areas can be invaded by inclement weather. The cold and damp pathogens can block the channels and cause Qi and blood stagnation, which brings about pain. Because of the location of the pain in the lower body, and the tendency of the pain to radiate downwards, the disorder is frequently attributed to a combination of cold and dampness, which are Yin pathogens that have a natural downward course.^[2] Cold contracts and dampness is viscous, so the patient feels the waist, thigh, and legs cramping, numbness, and painful, difficult in extension and flexion. Wind, an external pathogenic factor of mysterious nature is thought to carry the pathogenic influences into the body and contributes to the moving nature of the pain. Cold and damp pathogens can further affect the tendon and bone, leading to tendon spasm and joint pain.^[3] 

Internally, a deficiency of kidney yang can give rise to cold and damp syndromes affecting the lower body. In this case, external wind may not be a factor in causing the pain, though it can still combine with cold and dampness to exacerbate the underlying condition.  Chinese herbal therapies for sciatica and lumbago usually involve warming the kidney yang, dispelling cold, clearing dampness by invigorating the spleen function, and resolving wind-cold-damp complexes by means of certain antirheumatic herbs.^[4]

Blockage of Qi and blood circulation can cause blood stasis, which manifests as piercing pain in a fixed location. Clinically, the main principle in treating sciatica is to dispel wind and cold and remove damp. For patients with tendon and channel malnutrition and stagnation, it is necessary to nourish the kidney and liver, stimulate the circulation of blood and cause the muscles and joints to relax.

Following are herbs used to treat sciatica and lumbago.^[5][6] 

FU ZI Aconite Root
BAI ZHI Angelica Dahurica
CANG ZHU Rhizoma Atractylodis
WEI LING XIAN Clematis Chinensis
DU ZHONG Eucommia Ulmoides
CHUAN NIU XI Cyathula Officinalis
XI XIN Asarum Sieboldii
DANG GUI Angelica Sinensis
JI XUE TENG Caulis Spatholobi
CHUAN XIONG Ligusticum

Acupuncture points to treat sciatica and lumbago includes among others:

Huantiao GB30 
Yibian UB54
Yinmen UB37 
Weizhong UB40 
Weiyang UB39
Yanglingquan GB34 
Zusanli ST36 
Shensu UB23

BIOMEDICAL PERSPECTIVE ON SCIATICA AND LUMBAGO

Sciatica refers to pain radiating from the buttock and is felt primarily in the back of the thigh, though it may extend the lower back, hip, posterolateral leg, and the lateral foot. The pain originates in the lower spine as a combination of several nerves from the lumbosacral region and the primary cause is the compression of the sciatic nerve by spinal disc herniation. ^[7][8] In addition, cauda equina tumor, spinal stenosis, lumbosacral nerve root inflammation and pregnancy can also induce sciatica. The nerve branches from the spine to the left and right buttocks and then travels down the back of the legs, at about the middle of the thighs, to the feet, but typically, symptoms manifest on only one side of the body.

Sciatica can be divided into two types, Root Sciatica and Trunk Sciatica. In root sciatica there may be a temporary prolapse or extrusion of the disk (or disks) that causes the spinal column to squeeze down on the nerves.  In cases of destruction of the disk, the pain will become chronic. Root sciatica is of acute onset induced by putting forth strength, bending down, or vigorous activity. Pain radiates from the lower back to one hip, posterior thigh, popliteal fossa, lateral leg, and foot. The pain is as if burning and cutting and becomes worse when coughing, having constipation and putting forth strength to achieve bowel movement, and during the night.

 Trunk Sciatica is always induced by cold or injury. The pain radiates from the buttock to the posterior thigh, posterolateral leg, and lateral foot, and it becomes worse when walking or exercising. The current medical treatments for sciatica involve administration of pain relievers and avoidance of stress on the spine by resting and limiting activities.  However, while bed rest may reduce the immediate pain, it has been shown to have minimal effect on the long-term course of sciatica. ^[9] 

Sciatic pain is a spinal problem related to some cases of lower back pain, known as lumbosacral pain, and commonly called lumbago.  Lumbago may arise from similar types of disk problems that do not happen to affect the sciatic nerve, but, instead, remain localized.  Lumbosacral pain may also result from muscle and tendon strains in the lower back, whether they lead to disk compression or protrusion or not. Another pain syndrome, Achilles tendonitis, has a relatively high rate of association with sciatica and lumbago.  It is caused by injuries that may occur more often when the lower back is painful, leading to abnormal gait.

Sciatic pain resolves spontaneously within 3 months for 87% pf patients. Emotional distress, especially job dissatisfaction, has been found to be highly correlated with both the occurrence and persistence of back pain and sciatica. ^{[10][11][12][13]}  Chiropractic therapy has been the subject of randomized controlled trials, but the methodology has been poor and there is no conclusive evidence that it has substantial effects.^[14][15] Surgery is performed in cases that are unresponsive to other treatments, though this is known to be a last resort that can lead to other problems related to scar formation.^[16] 

LOW BACK PAIN

TREATMENTS OFFERED

__________________________________________________________________________________________________________________________REFERENCE
^[1]Personal classroom notes. 2005-2009
^[2]Sun Lanying, Efficacy of acupuncture in treating 100 cases of lumbago, Journal of Traditional Chinese Medicine 1987; 7(1): 23-24.
^[3]Jiang Youguang, et al., Clinical observation on acupuncture treatment of 106 cases of trunk-sciatica, Journal of Traditional Chinese Medicine 1984; 4(3): 183-185.
^[4]Hong-Yen Hsu and Chau-Shin Hsu, Commonly Used Chinese Herb Formulas with Illustrations, 1980 rev. ed., Oriental Healing Arts Institute, Long Beach, CA.
^[5]Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine, vol. 1, 1993 Heilongjiang Education Press, Harbin.
^[6]Bensky D and Barolet R, Chinese Herbal Medicine: Formulas and Strategies, 1990 rev. ed., Eastland Press, Seattle, WA.
^[7]Berkow R (editor-in-chief), The Merck Manual of Medical Information, 1997 Merck and Co., Inc., Whitehouse Station, NJ.
^[8]Clayman CB (medical editor), The American Medical Association Encyclopedia of Medicine, 1989 Random House, New York.
^[9]Vroomen PC, et al., Lack of effectiveness of bed rest for sciatica, New England Journal of Medicine 1999; 340(6): 418-423.
^[10]Pietri-Taleb F, et al., The role of psychological distress and personality in the incidence of sciatic pain among working men, American Journal of Public Health 1995; 85(4): 541-545.
^[11]Croft PR, et al., Psychological distress and low back pain, Spine 1995; 20(24): 2731-2737.
^[12]Soukup MG, et al., The effect of Mensendieck exercise program as secondary prophylaxis for recurrent low back pain, Spine 1999; 24(15): 1585-1591.
^[13]Moffett JK, et al., Randomised controlled trial of exercise for low back pain, British Medical Journal 1999; 319 (7205): 279-283.
^[14]Assendelft JF, et al., The efficacy of chiropractic manipulation for back pain, Journal of Manipulative Physiology and Therapy, 1992; 15(8): 487-494.
^[15]Leerberg E, Chiropractic for low back pain: Efficacy of spinal manipulation for low back pain has not been reliably shown, British Medical Journal 1999; 318(7178): 261-262.
^[16]Gibson JN, Grant IC, and Waddell G, The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis, Spine 1999; 24(17): 1820-1832.

-Above Article Written by Dr. Osorio, Gloria, DAOM, L.Ac. 2012.