 Key Diagnostic Points:
- Sciatica refers to pain in the passage and distribution region of the sciatica nerve.
- It's main manifestation is radiating pain in the lower back and legs. It usually radiates from the lumbar region on just one side from the lumbar region or buttock to the posterior side of the thigh, popliteal fossa, lateral side of the leg and lateral side of the dorsum of the foot.
- Most sciatica is due to prolapse of a lumbar intervertebral disc.
Differential Diagnosis:
1)
Wind-cold-damp
As a Bi syndrome, it is fixed, severe and cold pain in the lumbar region and legs. Movement is limited when bending forward and backward as well as turning. It is aggravated on cloudy, rainy and cold days.
Tongue: White, greasy coat
Pulse: Wiry and floating
2) Kidney Jing Deficiency
Lingering soreness and weakness of the loins and knees, lassitude and listlessness.
Tongue: Pale with white coating.
Pulse: Deep, thin, weak pulse.
3) Blood stasis obstructing the collaterals
Severe fixed prickling pain in the lumbar region and leg, aversion to pressure.
Tongue: Dark purplish, sometimes with purple spots.
Pulse: Deep, uneven
Treatment Principle:
Relax tendons and muscles, activate collaterals, stop pain.
Point and Technique Prescription:
If the pain comes from wind-cold-damp, or blood stasis, then the points are reduced. If due to Kidney Jing Def., they
receive even stimulation.
Lumbar level Hua Too Jia Ji points: These are local points located just above where the posterior branch of the spinal nerves exit the
vertebrae.
GB 30: An extremely important point if the leg pain occurs along the GB channel. This point should be needled at lease 2 cun deep, with the patient lying in a lateral
recumbent position, the affected side facing up. The preferred needling sensation should radiate all the way down to the ankle.
UB 36, 37, 40, 57, and 60: More local points. With UB 36 and 37, again, the needling sensation should radiate down the leg.
GB 34: The influential point of tendons. The sciatica nerve is said to belong to the tendons.
GB 41: Shu stream point for heaviness and pain, especially
useful for pain along the GB channel.
For Wind-cold-damp Bi, add:
Du 14: (even) The crossing point of all the Yang channels, very good for dispelling Wind-cold-damp.
Sp 9: (reduce) He sea point. Belonging to the element of water, it is used to dispel damp.
For Kidney Jing deficiency, add:
UB 23: (reinforce) Kidney Shu point.
Kid 3: (reinforce) Tonifies Kidney Jing. This point is called Tai Xi, or "Great River". It is near the bottom of the Kidney channel, and because of its location, low on the leg, and a deep depression in the tissue, it is believed that Kidney Yin collects here similar to the way in which water will always seek out the lowest place to collect.
Kid 4 (reinforce) Luo connecting point of the Kidney channel. A good distal point to chose where there is underlying Kidney
deficiency. This point simultaneously tonifies the Kidneys and invigorates the channel to which it is connected, the U.B.
For Blood stasis obstructing the collaterals, add:
UB 17: (reduce) The influential point of blood, removes blood stasis.
Ashi points: (reduce)
For more on sciatica, please see:
http://acupuncture.com/html/Acup/sciatica.htm.
More from Dr. Ma at:
Acuherbsonline.com
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