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Beth Conroy Compendium - Low Back Pain - Traditional Chinese Medicine

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LOWBACKPAIN

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OVERVIEW
WESTERNMEDICINEDEFINITION Lowbackpain(lumbago)isacommonmusculoskeletaldisordersaffecting80%ofpeopleat somepointintheirlife.Itaccountsformoresickleaveanddisabilitythananyothermedical condition.Itcanbeeitheracute,subacuteorchronicinduration.Mostoften,thesymptomsof lowbackpainshowsignificantimprovementwithinafewweeksfromonsetwithconservative measures.Thecausesoflowerbackpainarevaried.Atraumaticeventmayresultineither muscularpainoravertebralfractures.Atthelowestendofthespine,somepatientsmayhave tailbonepain(coccydynia).Othersmayhavepainfromtheirsacroiliacjoint,wherethespinal columnattachestothepelvis,calledsacroiliacjointdysfunction.Physicalcausesmayinclude osteoarthritis,rheumatoidarthritis,degenerationofthediscsbetweenthevertebraeoraspinal discherniation,avertebralfracture(suchasfromosteoporosis),orrarely,aninfectionortumor. (NationalInstituteofNeurologicalDisordersandStroke,2008) TRADITIONALCHINESEMEDICINEDEFINITION InTCM,lowbackpainisasymptomwhichcanbederivedfromanumberofdisharmoniesand canalsobeasignwhichindicatesthepresenceofanExternalPerniciousInfluence.Mainly, lowbackpaincanthenbeattributedtoexcessivephysicalwork,excessivesexualactivity, preganancy/childbirth,aninvasionofexternalcoldanddampness,beingoverworked,orgetting inadequateexercise. (Maciocia,ThePracticeofChineseMedicine:SecondEdition,2008,pp.10581059)

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Beth Conroy Compendium - Low Back Pain - Traditional Chinese Medicine

SOURCES
LowerBackPainFactSheet.NationalInstituteofNeurologicalDisordersandStroke. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm .Retrieved20080616. Maciocia,G.(2008).ThePracticeofChineseMedicine:SecondEdition.Edinburgh:Churchill Livingstone.

CATEGORIESOFDISHARMONY
RetentionofColdDampness StagnationofQiandBlood KidneyDeficiency LiverQiStagnation

CLINICALMANIFESTATION
RetentionofColdandDampness Acuteorchronicbackachethatisworseinthemorningandslightlybetterwithexercise,better withtheapplicationofheat,worsefromexposuretocoldanddampness,areaofpainfairly large,feelingcoldinthelowerback Tongue:Thickwhitecoating Pulse:TightFullespeciallyontheleftrearposition StagnationofQiandBlood Acuteorchronicbackachethatisslightlybetterwithmovementbutalsoworsewithexcessive exercise,paininfairlysmallarea,rigidityofbackmuscles,historyofrepeatedbouts. Tongue:Nochange Pulse:Wiry,especiallysoontheleftrearposition KidneyDeficiency Historyofchronicbackache,painalleviatedbyrestandaggravatedbyexercise,inmen aggravatedbysexualactivity,inwomanaggravatedduringpregnancyandafterchildbirth, repeatedbouts,weaknessofthelowerback,feelingofcoldofthelowerback,dizziness, tinnitus,weakknees. Tongue:Pale(itmaybewithoutcoatingincaseofKidneyYinDeficiency) Pulse:DeepandWeak LiverQiStagnation Acuteorchronicbackachecominginbouts,oftenelicitedbyemotionalstress,spasm, contraction,andstiffnessofthespinalmuscles,irritability,menstrualirregularitiesinwomen. Tongue:Oftennochangeinseverecases,itmaybeslightlyredonthesides Pulse:Wiry *ALLCITEDFROMMACIOCIA,THEPRACTICEOFCHINESEMEDICINESECOND EDITION,PAGES10641067

TREATMENTPRINCIPLE

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Beth Conroy Compendium - Low Back Pain - Traditional Chinese Medicine

RetentionofColdandDampness:ExpelColdandResolveDampness StagnationofQiandBlood:MoveQiandBlood KidneyDeficiency:TonifytheKidneys LiverQiStagnation:SmooththeLiverQi

TREATMENTSTRATEGIESANDPLAN
Maciociawrites"Fromtheacupunctureperspective,themostimportantaspectsfora successfultreatmentarenotsomuchadifferentiationofpatternsbutaproperselectionof distalandlocalpointswiththeappropriatemanipulationandradiationoftheneedlingsensation. Thechoiceofpointsisguidednotsomuchbyanidentificationofpatternsasbythelocation andnatureofthepain."(page1067) Therefore,therearetwomaintreatmentstrategies:oneforacutepainandoneforchronicpain. AcutePain UsuallyduetoColdandDampnessorStagnationofQiandBloodinthearea. DistalPoints: Inacutecasesthedistalpointsareparticularlyimportant.Theyshouldbeneedledfirstand manipulatedstronglyforsensation.Thechoiceofdistalpointsdependsuponwherethepainis present. BL40:paininthelowback Du26:painonthemidlineorstartingfromthemidlineandspreadingout BL10:painonthemidlineorstartingfromthemidlineandspreadingout SI3:painthatisunilateralandslightlyhigher,roughlylevelwiththeumbilicus BL58:painthatisinthelegbetweentheBladderandGallBladderChannel BL62:painthatisunilateralandradiatesdowntooneleg.Alsoagoodpointwhenpain radiatingdownthelegaffectsmorethanonechannel. BL59:ifwalkingisdifficult LocalPoints: Localpointsareselectedaccordingtotendernessuponpressure.Itisthereforeveryimportant topressandtryvariouspointssystematically. BL26:usuallythemostimportantasitisusuallythemostpainful BL25:ifthepainishigherthanthesacroiliacarea BL54:ifthepainisinthebuttock BL36:ifthepainradiatesdownthebackofthethigh BL37:ifthepainradiatesdownthebackofthethigh Du3:Strengthensthebackandleg Du4:TonifiesKidneyYangandstrengthenstheback Du8:Relaxesthesinewsandrelievesstiffnessandcontractionofthespine Shiqizhuixia:BelowthespinousprocessofL5ontheDuLine.Veryeffectivebackpointfor backacheinthecenterofthelowerback BL32:ifpainisoverthesacrum ChronicPain ChronicLowBackPainisalwaysduetoaKidneyDeficiencythatcanbecombinedwith RetentionofColdandDampnessand/orStagnationofQiandBlood. DistalPoints:SameaswithAcuteCaseswithsomeadditions BL60:veryimportantforchroniclowbackache.Alsoaffectstheupperpartofthebackand theneck. Kid4:simultaneouslytonifiestheKidneysandaffectstheBladder SP3:influencesthespineandisgoodtoselectinchronicbackachewithobviousscoliosisof thespine. Du20:canbeusedasadistalpointtoaffecttheGoverningVesselwhenthepainisonthe lowerpartofthelumbarspine
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Beth Conroy Compendium - Low Back Pain - Traditional Chinese Medicine

HT7:affectsthebackindirectlybecauseofitsrelationwiththeKidneyChannelwithinthe LesserYin. LocalPoints:AremoreimportantinChronicLowBackPaininrelationtoDistalPoints BL23:ShouldbeusedineverycasesincetheyallrevolvearoundsometypeofKidney Deficiency BL54:ifthepainradiatestothebuttocks Tunzhong:Extremelyeffectiveextrapointwhenthereispaininthebuttockthatradiatestothe leg. Yaoyan:goodlocalpointforlowbackacheespeciallyiftenderuponpalpation BL26&Shiqizhuixi:Commontenderareasthatareeffectiveinchroniccases.

PATIENTEDUCATION/RECOMMENDATIONS
Dailystretching(includingyogaifthisisaviableoption)

PROGNOSIS
Foracutecases,acupuncturecanhelptorectifythepainandspasmquickly.Inthesecases, treatmentsshouldbemorefrequentoverashorterdurationoftime.Forchroniccases, acupuncturecanalsobeveryeffective,however,changeswilloccurmoreslowlyand treatmentsshouldbelessfrequent(aboutonceaweek)foralongerdurationoftime.

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