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

DING Zhi-ming(丁治明)

3　THERAPEUTIC METHODS FOR LUMBAGO

As those mentioned above, in the treatment of lumbago, the basic principles are determined based on the differentiation of syndromes. Additionally, the acupuncture therapy is quite different from medication in the treatment of lumbago; it gains the therapeutic effect by stimulating the related acupoints and appropriate needling maneuvers produced activation of qi of the corresponding Zang-fu organs and meridians. Acupuncture treatment for lumbago embodies the basic characteristics of “treating the same disease with different methods, and treating different diseases with the same therapeutic principle” of traditional Chinese medicine. The words that “According to the pathogenesis, strictly adopt proper therapeutic principles” recorded in book Su Wen: Zhi Zhen Yao Da Lun (《素问·至真要大论》Plain Questions: Great Treatise of Extremely True Gist) are the theoretical basis for “treating the same disease with different methods, and treating different diseases with the same therapeutic principle”.

In accordance with the properties of lumbago, apply suitable needling maneuvers for reinforcing or reducing, warming or clearing, raising or lowering, and resolving or dispersing. In this point, the ancient Chinese had detailed descriptions early, such as “in treating cases with excess syndrome, the reducing needling method is applied; for treating cases with deficiency, the reinforcing technique applied; for cases with heat, the swift needle-insertion performed; for cases with cold, the needle-retaining method used; for cases with collapse, moxibustion employed; for chronic disorders, the eliminating needling method employed; and for uniform of excess and deficiency, the corresponding meridian is taken”. To sum up, in the treatment of lumbago with acupuncture, only three maneuvers of reinforcing, reducing, and uniform reinforcing and reducing needling are employed.

4　TREATMENT ACCORDING TO DIFFERENTIATION OF SYNDROMES

4.1　Cold-damp type

Main symptoms: Sore (heavy) sensation in the waist accompanied with muscular spasm, or difficulty in turning the body, or pain involving the lower limb and worsened during cloudy, rainy, and cold days, white greasy tongue coating and deep slow pulse.

Therapeutic principles: Dispelling cold and removing dampness, warming and dredging meridian and collaterals. Acupoints: Dazhui (大椎GV 14), Shenshu (肾俞BL 23), Yaoyangguan (腰阳关GV 3), Dachang-shu (大肠俞BL 25), Yaoyan (腰眼EX-B 7) and Weizhong (委中BL 40)

Notes: Dazhui (GV 14) is located at the upper part of the Governor Vessel and also called as “the confluence point of the seven yang meridians”, when punctured, it can invigorate yang-qi to expel pathogenic cold. Combined application of acupuncture and moxibustion to Shenshu (BL 23) and Yaoyangguan (GV 3) can function in dispelling cold and dampness. Dachangshu (BL 25) and Yaoyan (EX-B7), the local acupoints in the focus region, are used to dredge meridian-qi around the lumbar region and relieve pain. Weizhong (BL 40), the remote acupoint selected along the meridian, is used to dredge qi of the Bladder Meridian, which is taken according to the words that “In case of occurrence of disorders in the lumbar and back regions, Weizhong (BL 40) is applied”(“The Four General Acupoints in Verse”).

4.2　Damp-heat type

Main symptoms: Lumbago with warm sensation in the pain site, worsening during hot weather or rainy days and alleviated by movement, yellow greasy tongue coating, uneven and rapid pulse.

Therapeutic principles: Removing damp and clearing away heat, relaxing muscles and tendons to stop pain.

Acupoints: Shenshu (BL 23), Dachangshu (BL25), Yaoyangguan (GV 3), Yinlingquan (阴陵泉SP 9) and Feiyang (飞扬BL 58).

Notes: Shenshu (BL 23) is used to regulate and replenish the kidney-qi, and can also eliminate damp-heat in the waist when stimulated with reducing needling; Dachangshu (BL 25) and Yaoyangguan (GV 3) serve to regulate local meridian-qito relieve pain; Yinlingquan (SP 9) is employed to remove dampness; and Feiyang (BL 58), when stimulated with reducing needling, can function in removing dampness and heat to favor lumbar movement. The aforementioned acupoints used together have effects of eliminating heat and dampness, and relaxing muscles and tendons to relieve pain.

4.3　Kidney deficiency type

Main symptoms: Lumbago with lassitude in the loins and legs, relieved by kneading and pressing as well as rest, aggravated by overwork. In patients with yang-deficiency, cramping sensation of the lower abdomen, pale complexion, cold limbs, pale tongue and deep thready pulse are always seen. In patients with yin-deficiency, irritability, insomnia, dry mouth and throat, flush complexion, feverish in the palms and soles, red tongue, thready and rapid pulse are seen.

Therapeutic principles: Tonifying the kidney to enhance the waist is the general principle. For hypofunction of the kidney-yang, invigorate the kidney yang to strengthen the waist; and for deficiency of the kidney-yin, nourish and replenish the kidney yin.

Acupoints: Shenshu (BL 23), Mingmen (命门GV 4), Taixi (太溪KI 3), Zhishi (志室BL 52), Dachangshu ( BL 25 ), Qihai (气海CV 6 ), Guanyuan (关元CV 4), Weizhong (BL 40) and Fuliu (复溜KI 7).

Notes: The waist is the house of the kidney and Shenshu (BL 23) is taken to reinforce the kidney for strengthening the waist. Acupuncture of Qihai (CV6) and Guanyuan (CV 4) can function in tonifying the kidney and replenishing theYuan(primordial) qi. Mingmen (GV 4) is the Source point of the Governor Vessel and “the fire of life gate is just referred to the kidney-yang”. Acupuncture of Mingmen (GV4) is used to warm the kidney and invigorate yangqi. Taixi (KI 3), the Source point of the Kidney Meridian, serves to nourish the kidney-water. Fuliu (KI 7), an acupoint of the Kidney Meridian, serves to reinforce the kidney. Dachangshu (BL 25) and Zhishi (BL 52) are employed to dredge meridian-qi around the waist. Weizhong (BL 40) may regulate qi of the Bladder Meridian to relieve pain. The above- mentioned acupoints selected and punctured on the basis of the deficiency syndrome of the kidney-yin or kidney-yang may reach the aim of reinforcing kidney yin or kidney-yang correspondingly.

(To be continued.)