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Case Study of Sciatic Pain

by John Ryan Wahnish, D.Ac., L.Ac.

 

Age: 28                  

Sex: F                  

Treatment Date : 5/13/97         

 

Main Complaint of Treatment: Sciatica pain (lower lumbar pain)

Signs & Symptoms:

Patient experiences complains of "sciatica pain". The onset of pain started three day prior to treatment. The pain "just came out of nowhere". The pain radiates from GB30 to UB40 on the right side. The patient pointed to the Gb30 area and said, "the pain radiates to behind the knee". The radiating sensation does not go below knee. Main site of pain is located at GB30. The quality of the pain is dull. Both heat and electric stimulation applied at the physical therapist’s office exacerbated the pain. No specific actions other than pressure relieved the pain.

Pulse:

                Level:                    Left: Deep                       Right: Deep      

                Speed:                  63 b.p.m

                Rhythm:                Moderate

                Strength:               Left: Forceless                  Right: Slightly stronger than left.

                Overall:                Deep, moderate and rolling

 

Tongue:

Diagnosis: Dampness with Qi and Blood stagnation.

Treatment Principle: Eliminate dampness and transform Qi and blood stagnation.

Acupuncture:

UB17                      UB37                      Si3                           Loo Point (extra point)

UB20                      UB54                      Ki4                          Sciatica Point (ear point)

UB23                      UB40                      GB30                       Hunger (ear point)

 

All needles were inserted bilaterally with the exception on UB37, 54, 40, and GB30. These points were inserted on the right side only. Needles were inserted with a supplementing technique and some stimulation was applied to GB 30.

Moxibustion: Not applied at this treatment

Herbs: Mobility 2 (patent formula Shu Jing Huo Xue Tang from Health Concerns), 2-4 tablets, 3 times daily. Patient did not want to prepare or drink a decoction.

1. Main Complaint

Sciatica pain (lower lumbar pain), the pain radiates from GB30 to UB40 on the right side.

2. Medical History

a. History of Present Illness

Patient has a medical diagnosis of sciatica, and is presently seeing a physical therapist. On 3-16-99 the patient came into the clinic with the chief complaint of sciatic pain. The date of the original onset was report “around a year ago.” The patient reported that the pain was worse with cold weather. The patient‘s pain varied up to nine on the pain scale. Ten, being the most pain and one the least. This pain was inconstant and fluctuated. On 3-27-99, 4-6-99, and 4-13-99 the patient returned to the clinic with the same complaint of sciatica. On 3-27-99 the patient stated cold exacerbated the pain and heat relieved the symptoms. The patient was treated for dampness with qi and blood stagnation during each visit. This treatment on 5-13-99 started with the patient reporting a return in sciatic pain. The onset of this pain occurred three days prior to this acupuncture treatment. The pain now radiates from GB30 to UB40 on the right side. The radiating sensation does not go below the right knee. The main site of the patient’s pain is at GB30. It is a dull radiating pain. The pain is exacerbated by pressure. The pain is not always present and the patient is not aware of any physical actions that initiate the pain.  Changes in the condition are not consistent with changes in weather or time of day.   Both heat and electric stimulation applied at the physical therapist’s office exacerbated the pain.

b. Current Health Status

The patient is a 28-year-old Caucasian female, who has a graduate degree and is presently a mosaic artist. When asked about her energy level, she replied, “pretty good,” then said, “actually it’s been real low lately.” On her first visit and her previous visit patient reported fatigue and energy loss. The patient now reported her sleep as, “ok”. She gets seven or eight hours of well rested sleep a night. The patient drinks at least six glasses of water a day and prefers cold liquids. She actually prefers “cold icy drinks.”  She generally urinates five to six times a day. On her first visit, she reported a recent change in weight. At the patient’s 4-13-99 visit to the clinic her chief complaint was that she was overweight, as well she was in pain from sciatica. The patients diet in the past has been inconsistent. The patient’s diet now consists of no red meat and she limits her dairy (“ice cream”) intake to once a week.  Patient experiences occasional gas and slight bloating. The patient has bowel movements once a day.  About every two weeks, the patient does not have her daily bowel movement. Her bowel movements are well formed. Patient sweats easily upon exertion. When asked about her emotions, she stated that she was “happy” and,  “in a good relationship.” Later in the interview, she said that she does get irritable occasionally. The patient takes vitamins and an oral contraceptive. She reported that had been having a short period, but recently it is longer. Her periods presently last about three days. The flow is light to regular, and the color is a “brownie reddish color.” During menstruation, she occasionally experiences clots around nickel size. The patient also reports breast tenderness during her period. The patient quit smoking last June, which was soon followed by weight gain. The patient has no muscle tone. When she quit smoking she stopped working out and that is when a loss of energy was most prevalent. On her first visit and her previous visit patient reported fatigue and energy loss.

c. Past Medical History

In 1990 the patient terminated a pregnancy. The patient has had previous joint disorders, and spinal curvature problems. In 1997 the patient was diagnosed with a ganglian cyst on her wrist (side not indicated). The Cyst removed at Joint Disease Hospital in NY, NY.. Patient has a past history of sciatica problems.

d. Family Medical History

Patient’s mother and father both have high blood pressure. The patient’s brother has allergies.                                

3. Observation

a. Tongue: see above

         b. Facial Complexion:

The patient’s facial colors reflected a depletion of qi and blood. Her facial complexion was overall pale, dull and lusterless. She has slight pale red to pink cheeks and very slight dark circles under her eyes, with a darkish red color in the outer corner of the eyes. The patient’s facial complexion was very damp in nature with facial puffiness or bloating.

        c. Body Shape & Posture:

Patient is of medium to large build. The patient fits a good description of a water type. The patient has a round face and body with a soft-white skin. Her skin was overly supple with a damp feeling [felt like your fingers where going to just sink right in to her skin (m.o.o)]. Her muscles where not toned. The patient sat in a slouched position. She walks with a sluggish movement, almost dragging her feet.  Her muscles appeared flaccid and fatigued.

         d. Shen:

Shen of the face as well as the spirit appeared dull. .  This dullness in spirit maybe manifested by her pain or her unhappiness with her health and appearance. (m.o.o.)  Shen of the mind seemed busy and consumed with thoughts. She was forthcoming with information but seemed disturbed by other distracting thoughts [later revealed to be about dealing with a recent move in with her boyfriend]. 

4. Listening & Smelling

                   There where no abnormal smells or sounds noticeable.

a. Voice:

Patient’s voice was present, not too soft or overwhelming.

b. Breathing:

          Breathing was slightly sluggish but not laborious.

5. Palpation

a. Pulse: see above

b. Abdomen: Not palpated

c. Channels:

Palpated UB channel on back and buttocks area for repletion or vacuity.

Final point prescription was completed after palpation.

6. Pattern Identification:

a. The location of the disease is internal.

b. The disease has elements of excess and vacuity.

c. The disease is cold in nature.

d. Diagnosis: Dampness with qi and blood stagnation

e. Correspondence of Signs and Symptoms:

               I.   Cold-Dampness

               II.  Blood Stasis

     III. Qi Stagnation

I. Cold-Dampness:

Clinical Manifestations: Cold pain and heaviness of the lower back, difficulty turning the waist, pain alleviated by applications of heat but not diminished by lying quietly and an increase in pain during cold or rainy weather. Tongue appearing white and slimy. Pulse is slow and deep.

Patient Presents: Tongue appears white and slimy, heaviness of the lower back.

II. Blood Stasis:

Clinical Manifestations: Stabbing low back pain of fixed location, aggravation of pain with external pressure, increase in the severity of pain at night, discomfort bending forward and straightening in mild cases and, in severe cases, an inability to twist sideways. Some cases have histories of traumatic injury to the lumbar region. Tongue is dark, purplish, sometime macules on the tongue. Pulse is generally rough.

Patient Presents: Stabbing low back pain of fixed location, aggravation of pain with external pressure, macules on the tongue, discomfort bending forward and straightening in mild cases and, in severe cases, an inability to twist sideways.

III. Qi Stagnation:

Clinical Manifestations: local pain, distention, feelings of oppression, or distending pain of fluctuating intensity and unfixed location, frequent sighing, mood swings, gloomy feeling, mental or emotional disturbance, and occasional tenesmus. Tongue is purple and pulse is wiry or tight. Lumbar pain arising when either anger, depression, thought or anxiety, or sprains and falls cause qi stagnation in the sinews. Pain that stretches into the abdomen and rib-side that seems to wander, and is intermittent characterize Qi stagnation.

            Patient Presents: occasional irritability

7. Pathology:

The patient experiences chronic lumbar pain with sudden attacks of sciatic pain. These acute attacks do not seem to be due to any one particular event but rather due to long term patterns of unstable diet, lack of exercise, improper body mechanics and daily stress. Due to an unstable diet over a long duration and the consumption of too many greasy foods dampness has accumulated in this patient. These foods tend to stagnate and damage the spleen. As well, this patient sweats frequently, which has caused dampness to accumulate. “The precipitating factors may be living in a cold and damp places, exposure to rain or wading in water, or being drenched with sweat.”(CAMpg.437). The patient does not live in a damp environment, but by her frequent sweating, her body is living in its own damp environment. This bodily accumulation of dampness obstructs qi and blood from flowing properly through the channels. This obstruction is a result of dampness and its properties of heaviness, leading to a dull stagnated feeling. Damp is heavy and Yin in nature and affects the lower body first. Dampness affecting the spleen and dampness obstructing the channels causes qi and blood stagnation. The combination of these patterns all lead to lower back pain in this patient with acute attacks of sciatica.

This dampness accumulation has affected the patient’s spleen. The spleen likes warmth and is affected by dampness. The patient displays greasy tongue coating in the center of the tongue or in TCM the spleen and stomach area. This accumulation of dampness over time has adversely affected the patient’s spleenic functions, which relates to the patient’s lower lumbar pain. In Chinese’s medicine, there are several types of qi. The spleen transforms food-qi or Gu qi. When food enters the stomach it is rooted and ripened. Then it is transformed into food qi by the spleen. Since food-qi is extracted from food, it is the starting basis for the production of all qi and blood. This really shows the importance of a proper diet.  When the patient’s spleen was damaged by dampness from malnutrition, the spleen’s function of producing qi was diminished. This lack of qi production in the patient’s body affects her blood as well. In Chinese medicine, qi is considered to be the commander of blood and blood is said to be the mother of qi. This means, qi moves blood and blood nourishes qi. Due to the lack of qi, there is a lack of blood movement in the patient therefore resulting in blood stagnation. This formation of blood stagnation produces pain in the patient lower lumbar area. Also, signs of blood stagnation can be seen in the patient facial complexion, which appears dull and lusterless. The patient’s face is pale and has no shine. Her skin is also very dry which is another sign of a blood deficiency or stagnation. When the blood is stagnant, it cannot nourish the skin therefore the skin becomes dry. As dampness affects the spleen’s ability to produce qi, it also affects blood production in the patient. Blood is produced by construction qi, which is formed in combination with gui qi in the chest. Together blood and qi run through the vessels. This blood deficiency also relates to the muscles. The patient’s muscles can not be properly nourished due to diminished qi and blood in her body. In addition, when dampness effected the spleen, the spleen’s function governing the muscl-es was impaired. This along with a lack of exercise causes the patient to have no muscle tone. Dampness effecting the spleen and stagnating in the spleen has led to a moderate pulse. The lack of qi production due to dampness has led to a low energy level in the patient. The damp stagnation has led to bloating and swelling, especially in the lower body. This can be seen mostly in the lower body of the patient, with lower leg swelling and slight swelling around the ankles.  Dampness invading the channels or joints may lead to aching joints and inhibited bending. This dampness invasion of the channels is seen mainly in the UB and GB channel where her pain is located. “Dampness is clammy, viscous, and persistent. Diseases involving dampness are persistent and difficult to cure”(FCMpg.81). This explains the repetitive reoccurrence of her lower back pain.

“Lumbar pain related to dampness can further be divided into cold-damp or damp-heat” (P.T.pg.192). Even though external heat exacerbates the pain, her lumbar pain is that of the cold-damp pattern. In treatments prior to this one, the patient reported that cold exacerbated the pain; at this visit, she reported that heat exacerbated the pain. (This may be due to the type of heat and the length of time it was applied by her physical therapist.) This patient prefers cold liquids and seems to have a passion for ice cream in the past. The consumption of to many cold or raw foods has affected the spleen as well. This pathogenic cold damp has accumulated, blocking the meridians. Dampness tends to stagnate because it is dull and heavy. Cold constricts and slows down circulation. This combination of cold-damp leads to a reduced circulation of qi and blood.  The effect of cold dampness on the spleen has generated a moderate almost slow pulse in this patient. From excess cold, a white tongue coating has formed. Cold in addition to damp has led to stagnation reflecting in lower back stiffness and pain. The famous Chinese saying, “When cold prevails then there is pain”. Cold dampness stagnates in the channels and obstructs qi and blood flow. This cold dampness causes qi and blood to stagnate, which in addition to the cold damp causes lower back pain.

Finally, a lack of exercise and stress can also lead to qi and blood stagnation. Due to this stagnant lifestyle, the patient’s circulation of blood was slowed. The lack of movement of the body leads to a lack of movement in the blood, causing obstruction in the channels. As we now know, when blood stagnates, the qi will also become stagnant. When qi stagnates in the channels or there is a lack of qi due to spleenic impairment, its function of warming is inhibited causing stiffness. The blood stagnation causes the patient to experiences sharp pain. Due to this dual stagnation of qi and blood, the patient experiences lower back pain, stiffness, and a radiating sensation along the posterior aspect of the right thigh. “Qi invigorates and blood nourishes”(FCMpg22). Since the blood is stagnated, the qi can not invigorate. This stagnation of qi and blood in the Gallbladder and Urinary bladder channels affects the patient’s right side. Lack of flow of qi and blood through these channels produces pain. The patient’s pain radiates from the lateral one-third portion of the center of the right buttock, down the posterior right thigh, to the center of the posterior crease of the right knee. In addition, blood stasis causes the patient to experience a slow menstruation with occasional nickel size blood clots. When there is blood stasis, which affects the menstruation, it has an effect on the liver channel. Due to this connection of blood stasis and liver qi stagnation, the patient experiences occasional irritability. This irritably can cause stress, which can cause pain almost anywhere in the body. This is another reason for the cause of her acute attacks of lower lumbar pain. These combinations of damp, qi and blood stagnation all lead to the symptoms of lower back pain in this patient. “Acute sciatica is mostly Shi, involving qi and blood stagnation and invasion of wind cold damp. Chronic sciatic is mostly shi complicated with xu, involving stagnation of blood, retention of cold damp or malnutrition of the channels from deficiency of qi and blood.” (JCMpg.39) The effects of cold-damp and qi an blood stagnation resulted in both a chronic and acute syndrome in this patient. The damp is the constant dull chronic pain, and the qi and blood stagnation causes the acute sharp pain which both effect the patient’s lower back.

Footnotes:

1.“Practical Therapeutics of Traditional Chinese Medicine”, by Yan Wu and Warren Fisher, (P.T.)

2.“Fundamental of Chinese Medicine”, by Wiseman & Ellis ,(FCM)

3. “Chinese Acupuncture and Moxibustion”, (CAM)

4. “Journal of Chinese Medicine”, number 34, September 1990 (JCM)

 

8. Treatment Principle:

                Eliminate Dampness and Transform Qi and Blood Stagnation.

 

9. Treatment:

a. Acupuncture:

UB17 Geshu Diaphragm Hollow	Eight Influential point of blood; rectify and detriment harmonizes stomach qi. Traditional functions; regulates blood, expels congealed blood. Puncture obliquely 0.5-0.7 cun. Bilaterally
UB20 Pishu Spleen’s Hollow	Back-Shu point of the spleen; supplements the spleen and the stomach, resolves damp, nourishes blood. Puncture obliquely 0.5-0.7 cun. Bilaterally
UB23 Shenshu Kidney Hollow	Back-Shu point of the Kidney; Supplement the kidneys, strengthens the transformative action of Qi, dispels water damp, strengthens the lumbar and the spine.  Puncture perpendicularly 1-1.2 cun Bilaterally
UB37 Yinmen Huge Gate	Strengthens the lumbar and the spine, soothes the sinews and quickens the connecting vessels, relieves pain. Puncture perpendicular 1.0-2.0 cun. Right side only (pain side).
UB54 Zibian Lowermost Edge	Courses the channels and connecting vessels, strengthens the knee and lumbar. Puncture perpendicular 1.5-2.0 cun. Right side only (pain side).
UB40 Weizhong Supporting Middle	Earth point, He-sea point, Four command point of the lower and upper back regions; Clears the blood and discharges heat, soothes the sinews and frees the connecting vessels, dispels wind damp, dis-inhibits the lumbus and knees Puncture perpendicular 0.5-1.0 cun. Right side only (pain side).
Si3 Houxi Back Stream point	Shu-stream point. Tonification point, Master point of Du Mai vessel; relax muscle channels, opens the Du channel. Perpendicular 0.5-0.7 cun. Bilaterally
Ki4 Dazhong Big Bell	Luo of the Kidney;   egulates the kidneys and harmonizes the blood. Puncture perpendicularly 0.3-0.5 cun. Bilaterally.
GB30 Huantiao Jumping Circle	Dissipates wind dampness in the channels and connecting vessels, dis-inhibits the lumbus and the hip, strengthen the lumbus and the legs. Puncture Perpendicular 1.5-2.5 cun. Right side only. Some stimulation applied right.
Sciatica  Ischium (ear point)	At medial 2/3 of the inferior antihelix crus; for sciatica pain.
Hunger (ear point)	Below External nose point on tragus; relieves hunger, diabetes, and compulsive eating.
Loo Point (extra)	Impirical point for lower lumbar pain. This point is located between GB40 and UB62. (Point is named after Dr. Cyrus W. Loo. From an Article “Dramatic response of illness of spinal cord origin treated with SI-3 and Loo point.” From The Journal of Chinese Medicine, by Cyrus W. Loo, M.D., M.S., Ph.D., L.Ac..)

Point Descriptions from Fundamentals of Chinese Acupuncture, by Ellis, Wiseman, and Boss.

 

             b. Acupuncture Analysis:

The main objective of this point prescription is to eliminate dampness and transform qi and blood stagnation. GB30 (huantiao) is a local point and very effective for relieving the patient’s lumbar pain. Not only is it effective as a local point, it intersects with the UB channel, affecting the UB and the GB. This is good for lower back pain because the UB channel runs down the back and the posterior of the legs, and the GB channels runs down the side of the legs. The patient’s pain radiates along both channels. A good point combination with GB30 is GB34. This is a good combination for eliminating cold-wind-damp bi, which affects the lower back. First needle GB30 then GB34, a combination from the “Celestial Emperor’s Secret” (FCApg.317). GB 34 is also one of the eight influential points for tendons. In Chinese medicine the sciatic nerve is considered to be the longest tendon in the body. This is something to try in the next treatment. UB54 (Zibian) is another local point or it can be considered an adjacent point to assist GB30. UB54 courses the channels and connecting vessels, strengthening the patient’s lower back and eliminating lumbosacral pain. UB23 (shen shu) is another local point, which is the Back Shu point of the kidney. This point will aid in relieving the patient’s backache and strengthen her qi by supplementing the kidneys and strengthening the lumbar spine. The Dai channel also connects with the kidneys at UB23 and Du4. The Dai channel is the only channel that flows horizontally and it is described as a belt wrapping around the entire lower abdomen and lower back. Strengthening this belt can have a great effect on lower back pain. K.4 (Dazhong)  is a distal point, which has a strong presence in this formula. K.4 in conjunction with UB23 are used to alleviate chronic lower back pain due to muscular strain and tension. K.4 is also used for disorders involving the entire spinal column. K.4 is the luo point on the kidney channel. This luo collateral bifurcates after separating from the regular kidney channel. One branch immediately connects to the regular UB channel. Even though this point does not have a function of eliminating dampness it may do so through this connection. The other luo collateral follows the regular Kidney channel to the area below the heart. This point has the function of harmonizing the blood, which may help eliminate the qi and blood stagnation. From below the heart, the channel goes inside the body cavity, to the back, then downward through the spinal column. This connection to the spinal column will have a positive effect in the reduction of lower back pain. One of the most important reasons for adding this point to the formula is for balancing reasons. This is the only yin point in the prescription, and it is a great addition to balance and harmonize this formula as a whole. UB37 (Yinmen) will help in relieving the patient’s pain by strengthening the lumbus and quickening the connecting vessel alleviating some of her qi stagnation. UB40 (weizhong) is an earth point, he-sea point, and one of the four command points (command for the back). This point has multiple functions, which will be very useful for this patient. As a he-sea point it regulates rebellious qi and the middle, helping to relieve qi stagnation in the patient. Being the command point for the back, UB40 is especially useful in treating lower back pain. UB40 also clears the blood (FCA pg.220) which is helpful for dissipating blood stagnation. GB30, UB37, and UB40 all work together in regulating qi along the channel. The patient’s pain starts at GB30 and radiates down to UB40 with UB37 in the middle. By needling the beginning, middle, and end of this line of pain, qi stagnation maybe eliminated. Si.3 (Houxi or back stream point) was used in this point prescription for the function of relieving the patient’s lower back pain by opening the Du Channel. Si.3 is the master point of the Du Channel, which runs directly down the spine. Si.3 is also the coupled-paired point with UB62, which is the master point of the Yang Qiao meridian.  The Yang Qiao meridian is related to the UB channel, which is effective for draining dampness. Si.3 is also a shu stream point, which will assistant in eliminating dampness from the patient. UB17 (Geshu) is the influential point of blood.  This point will regulate the blood and expel congealed blood, which will relieve the patient’s pain from blood stasis. The ear point “Sciatica” (Ischum) was added as an empirical point for back pain. Another ear point, “Hunger” was added to help resolve any compulsive eating. Compulsive eating can lead to dampness, which can cause an impediment. The last point added “Loo” an extra point is another point that is an empirical point for pain in the lower lumbar region. The Loo point in combination with SI.3 is effective in the treatment of spinal cord disorders. These points will treat the root of the patient’s problem. By treating her spine with this combination over a period of time may alleviate her sciatic pain.

 

            c. Herbs:                                      

Patent formula Mobility 2. The patient is to take 2-4 tablets, three times a day.

A ‘Health Concerns’ Chinese Traditional Formula formulated by Subhuti Dharmanada, Ph.D.

Herbs	Categories	Taste / Temp Channels	Relating Functions
Dang Gui Angelicae	Supplement Blood	Warm, Acrid, Bitter, Sweet, enters- Sp., Li., Ht..	Tonifiy Blood, Invigorate blood, Relive pain, Constipation
Nu Zhen Zi Ligustri	Supplement	Neutral, Bitter, Sweet. enters- Lv., kidney	Nourishes & tonifies the Liver & Kidneys, Augments the Liver & Kidneys & clears heat from deficiency, Augments the Liver & Kidneys & improves vision.
Bai Shao White Paeoniae	Supplement Blood	Cold, Bitter, enters- Sp., Liver.	Tonify Blood & Nourish Yin, Nourish the Liver Blood & Liver yin to Relieve spasms & pain.
Niu Xi Achyranthis	Invigorate Blood	Neutral, Bitter enters- Lv., Kidney	Invigorates Blood & Expels blood stasis and stagnation, Strengthen the sinews & bones & benefits the joints & tonifies Kidneys & Liver, Guides herbs to lower jiao, Promotes Urination.
Tao Ren Persicae	Invigorate Blood	Neutral, Sweet, Bitter. enters- Lv., Ht., Li., Lg..	Breaks up Blood stasis, Moistens the Intestines & Breaks up the Bowels.
Qin Jiao Gentianae	Dispel Wind Damp	Cold, Biiter, Acrid. enters- Lv., GB., St..	Expels Wind Damp, Relax the sinews.
Fang Feng:     Ledebouriella	Release to Exterior	Warm, Sweet, Bitter, Acrid,  enters- Ub., Lv., Sp..	Dispels Wind & Resolves to the Exterior, Overcomes Dampness & Relieves Pain, Resolves Tetany or Spasm.
Bai Zhi Angelicae	Release to Exterior	Warm, Acrid. enters- Lg., St.	Dispels Wind and Eliminates dampness, Opens Orifices and Relieves Pain, Disperses Swelling and dispels Puss.
Qiang Huo Notopterygii	Release to Exterior	Warm, Arcid, Bitter, Aromatic, enters- Ki., Ub..	Resolves to the Exterior & Dissipates Cold, Dispels wind and Overcomes dampness and Relieves Pain.
Cang Zhu Atractylodis	Dispel Wind Damp	Warm, Acrid, Aromatic enters- St., Sp..	Dries Dampness & fortifies the Spleen, Dampness congestion in the Middle Burner, Promotes Sweating and Dispel Wind Damp, used for Bi syndrome, Wind/Damp/Cold impediment.
Wei Ling Xian Clematidis	Dispel Wind Damp	Warm, Acrid, Salty enters- bladder	Expels wind Dampness and  relives pain and Unblocks the meridians.
Sheng Jiang Zingiberis	Release to Exterior	Warm, Acrid enters- Lg., St., Sp.	Promotes Sweating and resolves to the Exterior, Warms Center, Resolves Toxins.
Chen Pi Citri	Regulate Qi	Warm, Acrid, Bitter, Aromatic, enters- Lg., St., Sp.	Regulate the Qi, Improve the Transportive function of the Spleen, Adjust the middle and relieve the diaphragm, dry damp and Transform phlegm, Helps prevent stagnation.
Han Fang Ji Stephaniae	Drains Dampness	Bitter, Acrid, Cool. enters- K., Ub., Sp.	Dispels Wind Damp and relieves Pain,  Dis-Inhibits Water Swelling.
Fu Ling Poriae	Drains Dampness	Neutral, Sweet, Bland, enters- Sp., Lg., Ht.	Promotes urination and expels damp, Strengthen Spleen and Harmonize Middle Burner, Dispels Water and Percolates Dampness.
Gan Cao Glycyrrhizae	Supplement Qi	Neutral enters- All channels	Tonifies the spleen and Lung Qi, Soothes spasms and stops pain, Moderate and Harmonize the characteristics of other herbs. Harmonizes Formulas and Muscle spasms.
Sheng Di Huang Rehmannae	Clear Heat- Cool Blood.	Cold, Bitter, Sweet enters- Lv., Ki., Ht..	Clears heat and cools the blood, Nourishes the Yin and the Blood and Engender Fluids, Cool the upward blazing of Heart Fire, Skin Disorders, Heat in the Blood, Trauma.

Formula above is listed in order as shown in Chinese Herbal Patent Formulas, by Jake Fratkin. Functions and qualities from Materia Medica, by Bensky and Gamble.

 

            d. Herbal Analysis:

This patent formula is based on the classical prescription Shu Qing Huo Xie Tang. This formula is used for wind-damp joint dysfunction found in arthritis and rheumatism. It is also useful in cases of sciatic pain, numbness of the extremities, edema, and abdominal pain due to blood stagnation.  Mobility 2 has the functions of invigorating the blood, dispelling wind-damp, promoting water circulation, relieving the exterior, and stopping pain. The temperature of this formula is warm which will eliminate cold. “Retention of cold causes pain,” from the Spiritual Axis (Ling Shu Jing). Direct heat on the surface aggravated the situation, but considering it is an internal pattern, the warm herbs should have a better effect. The cold in this patient needs to be treated from an internal aspect, since this pathogen has affected the interior. The bitter properties of this formula help dry and drain dampness from the patient. By draining and drying dampness, her spleen will work more effectively and nourish her muscles. The sweet properties of this formula will supplement and relax as well as harmonizing the balance of the spleen. Sweet herbs have the function of holding up and supporting the spleen with its functions of controlling the muscles and “raising qi”. Harmonizing the center also relates to the blood. The Magic Pivot (Ling Shu, Jue Qi Pian) states; “The middle burner takes in qi, extracts its essence, and turns it into a red substance called blood.” Blood is a vital substance; when it stagnates there is pain. The acrid properties of this formula will help dissipate and move blood stagnation. This will help relieve pain and circulate qi.

Analysis of Formula: Qiang huo acts as the sovereign of this formula, meaning it performs the principle action of the formula and addresses the chief complaint. Qiang huo releases to the exterior, dispels wind and relieves pain. This is a good herb for wind damp cold impediments and body aches due to its warm nature. Qiang huo is harsh and used for cold patterns. This will expel cold from the patient, which will increase circulation and alleviate her symptoms of lower back pain. Bai Zhi and Fang feng are ministers in this formula meaning they provide direct assistance to the sovereign. Both of these herbs resolve the exterior, overcome dampness and relieve pain. Fang feng is more effective for muscle pain; as well, this herb will resolve spasms in the patient. Sheng jiang is also a minister, which aids the sovereign in its function of warming. In addition, Han Fan Ji, Qin Jiao, Wei Ling Xian, Fu Ling, and Cang Zhu play the roles of minister. These herbs focus on resolving dampness and relieving pain. Han fan ji is used for its effectiveness of lower leg swelling and impediment, which the patient displays. Qin jiao is helpful in relaxing the sinews, and since it is cold in nature, it moderates some of the warm of the formula. Wei ling xian is especially usefully in unblocking the meridians, expelling damp and moving Qi. Fu ling and Cang Zhu not only help by eliminating dampness but also strengthening the spleen and the middle burner, which its strongly affected by dampness. Cang zhu is particularly effective for eliminating dampness from the spleen. Dang Gui, Bai Shao, Tao Ren, and Niu Xi are all assistants in this formula. The assistants address any secondary patterns. Bai shao and Dang gui both will tonify the patient’s blood. Although, Bai shao nourishes yin and relieves spasms where Dang Gui invigorates blood. Both are useful for pain due to blood stagnation. Tao ren and Niu xi are both effective in breaking up blood stasis. When blood stasis is dissolved in the patient, qi and blood will flow freely through her channels eliminating her pain. Chen pi is an assistant as well but its secondary function is on the regulation of Qi in the patient. Chen pi, which also resolves damp and helps prevent stagnation, is very useful for this pattern. Considering “Qi is the commander of blood, and blood is the mother of qi,” by focusing on one the other can be resolved. Meaning by relieving blood stagnation, qi stagnation may be freed, or visa versa. In this formula Gan Cao plays several roles, that of a minister, assistant and courier. As a minister gan cao assists the sovereign in soothing spasms and stopping pain. Gan cao is very effective in harmonizing the muscles. Gan cao and Bai shao are an effective combination for treating muscle spasms and pain. This function of harmonizing comes from tonifying the spleen. The spleen controls the muscles and four limbs. The spleen also controls the blood, therefore acting as an assistant. As an assistant gan cao also tonifies lung qi. The lungs play an important factor in regulating water passages. Lastly, gan cao acts as a courier, which directs to all channels harmonizing the formula as a whole. The combination of this formula as a whole will eliminate cold in the patient increasing qi and blood circulation. In addition, this formula will expel dampness in the patient releasing her bodily of heaviness. By expelling cold and damp, qi and blood stagnation will dissolve freeing this patient from her lower lumbar and sciatic pain.

Caution: If preparing this formula or prescribing this formula there are several factors to of concern. Caution should be used whenever using Sheng Jiang in the presence of stomach heat. Large doses of Han fan ji can cause a decrease of urination. Chen pi is contra-indicated when a dry cough from deficiency is present. Caution should be used with Chen pi in the presence of dry excess heat coughs, red tongue, or hot phlegm. Cang Zhu can be very drying, so use with caution in cases of Yin vacuity, heat signs, and sweating.

10. TCM Patterns of Lumbar pain (sciatica):

(From a “ Practical Dictionary of Chinese Medicine,” by Nigel Wismen and Fang Ye and a “Practical Therapeutic of Traditional Chinese Medicine,” by Yan Wu and Warren Fischer.)

a.  Blood Vacuity Lumbar Pain (xue xu yao tong): lumbar pain due to loss of Blood or general vacuity depriving the sinews of nourishment (P.D. pg.39).

b. Damp-Heat Lumbar Pain (shi re yao tong): lumbar pain due to damp heat obstructing the channels and the network vessels. Damp-heat lumbar pain is characterized by lumbar and hip pain with local sensation of heat, associated with a rapid string like pulse and reddish urine (P.D. pg.111).

c. Dampness Damage Lumbar Pain (Shang shi yao tong): lumbar pain arising from living in a cold-damp environment or from expose to rain or dew. Dampness damage lumbar pain is characterized by cold, painful, heavy lumbus that feels as though one were sitting in water. The pain is exacerbated by yin-type (dull wet) weather and by sitting for long periods. The pulse is moderate, and there may also be generalized swelling (P.D. pg.113).

d. Damp Phlegm Lumbar Pain (shi tan yao tong): lumbar pain attributed to damp phlegm pouring into the kidney channel, and characterized by cold heavy painful lumbus stretching into the back and rib side and exacerbated by yin-type (dull wet) weather, and associated with diarrhea and a slippery pulse (P.D. pg.115). 

e. External Contraction Lumbar Pain (wei gan yao tong): Lumbar pain contributed to external evil invading the channels and network vessels. External contraction lumbar pain usually forms a repletion pattern and is treated b dispelling the evil and freeing the network vessels (P.D. pg.185-186).

f. External Injury Lumbar Pain (wai shang yao tong): lumbar pain due to external injury preventing bending and stretching and turning, and even pain when breathing (P.D. pg.186).

g. Internal damage Lumbar Pain (nei shang yao tong): Lumbar pain due to liver, spleen, or kidney vacuity, to damp phlegm or static blood, or else internal injury (P.D. pg.313).

i.  Kidney Vacuity Lumbar Pain (shen xu yao tong): lumbar pain due to kidney vacuity. Limp aching lumbus and knees and lack of strength in the legs exacerbated by exercise and from which rest brings little relief, accompanied by a forceless fine pulse, qi timidity and lack of strength, and clear uninhibited urine together indicated insufficiency of kidney yang. A forceless surging pulse with yellow or reddish urine, and periodic flaming of vacuity fire indicate insufficiency of kidney yin (P.D. pg.332).

j.  Postpartum Lumbar Pain (chan hou yao tong): lumbar pain after child birth. It may arise, if childbirth damages the kidney (the lumbus is the house of the kidney) and waste blood obstructs the girdle (dai) vessel, or when vacuity of true qi is exploited by external evil, or when the lumbus is sprained in postpartum vacuity (P.D. pg.453).

k. Qi Stagnation Lumbar Pain (qi zhi yao tong): Lumbar pain arising when either anger, depression, thought or anxiety, or sprains and falls cause qi stagnation in the sinews. Pain that stretches into the abdomen and rib-side that seems to wander, and is intermittent characterize Qi stagnation (P.D. pg.484).

l.  Static Blood Lumbar Pain (yu xue yao tong): lumber pain due to blood stasis that congeals and accumulates either as a result of knocks and falls or wrenching, or as a result of enduring lumbar pain due to other causes. Static blood lumbar pain is characterized by pain of fixed location, like the piercing of an awl, mild in the day and more severe at night, and accompanied by a rough pulse (P.D. pg.571). Stabbing low back pain of fixed location, aggravation of pain with external pressure, increase in the severity of pain at night, discomfort bending forward and straightening in mild cases and, in severe cases, an inability to twist sideways. Some cases have histories of traumatic injury to the lumbar region. Tongue is dark, purplish, sometime macules on the tongue (P.T. pg.193).

m. Vacuity-Taxation Lumbar Pain (xu lao yao tong): lumbar pain arising when taxation damage causes insufficiency of kidney qi and disturbs qi transformation. The pain spreads into the lesser abdomen and is accompanied by inhibited urination, and a sunken pulse (P.D. pg.651).

n. Wind-Damp Lumbar Pain (feng han yao tang): lumbar pain that arises when, after lying in damp places and contracting wind, the evils stagnate in the channel. The contraction of wind and dampness is often encouraged by kidney vacuity. Wind damp lumbar pain is characterized by hypertonicity of lumbus and back inhibiting movement, and a floating rough pulse. In some cases there may be heat effusion and aversion to wind, or swelling (P.D. pg.684).

o. Wind-Heat Lumbar Pain (feng re yao tong): lumbar pain attributed to wind heat invading the kidney channel. Wind-heat lumbar pain is characterized by acute pain that stretches into the legs and knees, thirst, and a rapid pulse (P.D. pg.688).

11. Western Explanation of Sciatica:

(Sources from; “Dorlands Medical Dictionary edition 28”, “Principles of Anatomy and Physiology”, by Totora, “Physical Examination of the Spine & Extremities”, by Hoppenfeld.)

Sciatica is a syndrome characterized by radiating pain. This radiating pain is due to inflammation along the sciatic nerve. This pain may radiate from the back into the buttock. This radiating sensation may also follow a path down the lower extremities on the posterior and lateral aspects of the lower limbs. As well, this pain can be felt along the posterior aspect of the thigh, extending down to the inside of the leg. This syndrome is most commonly caused by a protrusion of a lower lumbar intervertebral disk. Tenderness along the sciatic nerve may also be attributed to a herniated disc in the lumbar spine, a pyriformis muscle spasm, or direct trauma to the nerve root itself, such as a misplaced injection. The term Sciatica may also refer to pain anywhere along the course of the sciatic nerve. The sciatic nerve is located midway between the greater trochater and the ischial tuberosity. Sciatic pain can easily be confused with ischial burstis (a rare finding). These two structures must be isolated when palpating to avoid error. There is a bursa overlying the ischial tuberosity. Tenderness along the tuberosity may result from ischial burstis. In Western medicine, lower back pain is a result of numerous disorders including renal diseases, rheumatism and rheumatoid conditions, injury to the lower back muscles and vertebral or spinal cord disorders. There are many western treatments for sciatica, depending on the cause. In cases of sciatic pain caused by damaged discs in the spine. This is treated with physical therapy, medication, epidural injections, or surgery. If the sciatica is caused by irritation of the sciatic nerve under the piriformis muscle, then it can be treated with physical therapy and sometimes injections.

 

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