MY UNDERSTANDINGS ABOUT ACUPUNCTURE TREATMENT OF LUMBAGO ACCORDING TO SYNDROME-DIFFERENTIATION (C)

DING Zhi-ming(丁治明)

2　SYNDROME DIFFERENTIATION AND ANALYSIS OF LUMBAGO

2.1　Differentiation of syndromes

Lumbago may be divided into exopathy type and internal injury type. The former mainly manifests as acute onset, more severe pain, etc., accompanied with other symptoms of common cold. If the patient’s pain has no fixed place, accompanied with thin white fur, superficial pulse, it belongs to wind syndrome. If the patient’s lumbago is accompanied with sensations of heaviness and soreness, difficulties in turning the waist, white greasy tongue coating and soft slow pulse, it belongs to damp syndrome. In case of cool-pain in the waist, relieved by warmth and worsened by cold, accompanied with lassitude and muscular spasm in the four limbs, and taunt-tense pulse, it belongs to cold syndrome. If the patient’s lumbago is accompanied with redness, swelling, warmth, untouchable pain and dysfunction of the joints, perspiration, deep yellow urine, yellow dry tongue coating and slippery and rapid pulse, it be- longs to damp-heat syndrome.

Internal injury induced lumbago mainly manifests as slow onset, empty (sore) aching feeling in the waist, accompanied with hypofunction of Zang-fu organs. In case of lumbago with soreness and weakness, relieved by kneading and pressing, and aggravated by tiredness, being lingering in property, it is considered to be kidney-deficiency syndrome; if lumbago is accompanied with lassitude, cold limbs, spermatorrhoea, impotence, pale tongue, deep thready pulse, it is attributed to deficiency of the kidney-yang;and if the lumbago is accompanied with irritability, insomnia, dry mouth, yellow urine, red tongue, taunt, thready and rapid pulse, it is attributed to deficiency of the kidney-yin. The blood stasis type lumbago is mainly marked by pain being stabbing and fixed in the waist, inability to turn the body, purplish dark tongue or petechia of the tongue, thready uneven pulse, or traumatic history in partial patients.

2.2　Symptoms and signs of the meridian

The twelve regular meridians and the Eight Extra Meridians in particular all directly or indirectly pass through the waist. Under normal conditions, the meridian-collateral system functions in transporting qi and blood, and balancing yin and yang. If this system falls into disorders, such as obstruction of meridians, heat-transformation of the accumulated pathogens, hypofunction in carrying qi and blood, mal-regulation or malnutrition of meridians, etc.,pathological changes will appear in the running course of the corresponding meridian, inducing lumbago. Among the different types of meridian-related lumbago, the Governor Vessel, Conception Vessel, Thoroughfare Vessel, Belt Vessel, and the Foot-Taiyin and Foot-Taiyang meridians in particular are often seen. For example, Governor Vessel related lumbago often manifests lumbospinal stiffness and pain, opisthotonus, etc.; Foot-Taiyang related lumbago shows pain involving the neck, back and the sacral bone, being sore in property, and accompanied with joint pain. Foot-Taiyin associated lumbago manifests pain involving the internal side of the spine; Belt Vessel related lumbago presents pain with cool feeling, abdominal fullness, and leucorrhea in women.

In addition, dysfunction of the Yangming Meridian, Shaoyang Meridian and Jueyin Meridian may also lead to lumbago.

2.3　Therapeutic principles

Regarding the pathogenesis of lumbago, the kidney deficiency is the fundamental cause, while colddampness, damp-heat and blood stasis are the incidental causes. In patients with newly occurred lumbago, excess syndrome is often seen, while in patients with chronic lumbago deficiency syndrome is frequently met. Meridian-associated lumbago is often considered to be “neither excessive nor deficient”. For exopathy type lumbago, the treatment is aimed at eliminating pathogenic factors (including wind, cold and dampness) to dredge meridian-collaterals; for internal injury induced lumbago, the treatment aims at reinforcing the kidney-qi; and for blood-stasis type lumbago, the therapeutic principles are accelerating flow of qi and blood, removing stasis and dredging meridian-collaterals. In the treatment of meridian dysfunction induced lumbago, puncture the meridian directly. Generally, in the treatment of lumbago being deficient in the origin and excess in the superficiality, and deficiency complicated with excess, we should differentiate which one, the deficiency or excess, is primary or secondary. In emergency case, treat the acute symptoms first, when these being relieved, treat its fundamental cause, or treat both the primary and secondary aspects simultaneously. But in the treatment of any types of lumbago, when the pain

is relieved, regulating kidney-qi and replenishing kidney-essence are always necessary so as to consolidate the therapeutic effect.

(To be continued.)