Disease and Condition Overview
Lower back pain is characterized by objective lumbar pain. In Chinese medicine, lumbar pain is caused by attacks of external pathogenic factors, falling, and external injury, sitting in damp places for a prolonged period of time and not yet healed previous incidences of lumbar sprain. These reasons can all lead to qi and blood stagnation in the collaterals. If channels are obstructed they will cause pain. In some cases congenital endowment deficiency, deficiency of blood because of old age or over indulgence in sex exhausts the qi in kidney. Because “lumbar is the residence of the kidney”, all these causes will lead to pain in the lumbar region.
The lumbar region, from the channels point of view, is related to foot-taiyang bladder, Du channel, Dai vessel and kidney channel. Therefore, the obstruction and deficiency of the channels on the back and the tendons are the primary reason for lower back pain.
The etiology for lower back pare is very complex. It is important to differentiate between lumbar soft tissue injury, wind dampness in the muscle, herniated disk and other internal organ lesions, and exclude bone tuberculosis and bone tumor.
Pair-point Treatment Combinations
(1) Dachangshu (BL25), Yinlingquan (SP9) (Fig 141)
Dachangshu (BL25): on the lower back, below the spinous process of the fourth lumbar vertebra (L4), 1.5 cun lateral to the posterior midline.
Yinlingquan (SP9): on the medial side of the lower leg, in the depression posterior and inferior to the medial condyle of the tibia, level with the tuberosity of the tibia.
Dachangshu (BL25) harmonizes and regulates intestine, resolves stagnation, strengthens lumbar and knee. Yinlingquan (SP9) regulates water and reduces swelling. This pair point combination unobstructs and reduces blockage in the channels. This treatment is appropriate for lower back pain caused by cold and dampness.
Needling techniques:
1. Dachangshu (BL25) perpendicular insertion to a depth of 2 cun.
2. Yinlingquan (SP9) towards Yanglingquan (GB34) direction perpendicular insertion to a depth of 1.5 cun.
3. After needling apply moxa for 15 minutes, or directly use warm needle for 20 minutes.
(2) Henggu (Kill), Dadu (SP2)(Fig 142)
Henggu (KI11): on the lower abdomen, 5 cun inferior to the center of the umbilicus, 0.5 cun lateral to the anterior midline.
Dadu (SP2): on the medial aspect of the foot, in the depression distal and inferior to the first metatarso-phalangeal joint, at the junction of the red and white skin.
Henggu (KI11) regulates lower jiao qi and stops pain. Dadu (SP2) strengthens spleen and harmonizes the abdomen. This pair point combination warms yang, resolves qi, reduces distension and stops pain. This treatment is appropriate for lower back pain caused by qi stagnation.
Needling techniques:
1. Henggu (KI 11) perpendicular insertion to a depth of 0.5 cun.
2. Dadu (SP2) perpendicular insertion to a depth of 0.5 cun.
(3) Quchi (LI11), Sanyinjiao (SP6) (Fig 143)
Quchi (LI11): In the depression at the lateral end of the transverse cubital crease, midway between Chize (LU5) and the lateral epieondyle of the humerus, when elbow is half flexed.
Sanyinjiao (SP6): on the medial side of the lower leg, 3 cun superior to the prominence of the medial malleolus, in the depression near the posterior border of the tibia.
Quchi (LI11) regulates qi and blood, opens channels and invigorates luo-connecting channels. Sanyinjiao (SP6) strengthens the middle jiao, harmonizes and regulates lower jiao and also reduces dampness. This points in this combination, one yang and one yin, one active and one still, offset one another and works in conjunction to facilitate qi, invigorate blood, dispel wind and stop pain. This treatment is appropriate for lower back pain caused by wind dampness.
Needling techniques:
1. Quchi (LI11) perpendicular insertion to a depth of 1.5 cun.
2. Sanyinjiao (SP6) perpendicular insertion to a depth of 1 cun.
(4) Huantiao (GB30), Weizhong (BL40) (Fig 144)
Huantiao (GB30): on the postero-lateral side of the hip joint, one third of the distance between the prominence of the great trochanter and the sacro-coccygeal hiatus.
Weizhong (BL40): at the back of the knee, on the midpoint of the popliteal crease, between the tendons of biceps femoris and semitendinosus.
Huantiao (GB30) strengthens lumbar and knees and resolves and stops pain. Weizhong (BL40) soothes tendons, activates luo-connecting channels, unobstructs and stops pain. This pair point combination, one superior and one inferior, disperses and opens qi of taiyang and shaoyang, invigorates blood, resolves spasms and stops pain. This treatment is appropriate for lower back pain and sciatica caused by qi and blood spasms.
Needling techniques:
1. Huantiao (GB30) perpendicular insertion to a depth of 2-3 cun.
2. Weizhong (BL40) perpendicular insertion to a depth of 1 cun, combine with bloodletting.
(5) Mingmen (DU4), Taixi (KI3) (Fig 123)
Mingmen (DU4) tonifies kidney and strengthens lumbar and knee. Taixi (KI3) tonifies yin, strengthens kidney and unobstructs Sanjiao (upper, middle and lower jiao). This pair point combination, one yin and one yang, tonifies kidney, fortifies yuan or congenital qi, tonifies yin, strengthens yang and strengthens lumbar and knee. This treatment is appropriate for lumbar and leg pain and weakness in the knees caused by kidney yin and kidney yang deficiency.
Needling techniques:
1. Mingmen (DU4) perpendicular insertion to a depth of 1 cun, using moxa stick for 10-20 minutes.
2. Taixi (KI3) perpendicular insertion to a depth of 0.5 cun.
(6) Shuigou / Renzhong (DU26), Weizhong (BL40) (Fig 145)
Shuigou (DU26): on the face, at the unction of the upper third and middle third of the philtrum.
Weizhong (BL40): at the back of the knee, on the midpoint of the popliteal crease, between the tendons of biceps femoris and semitendinosus.
Shuigou / Renzhong (DU26) unobstructs orifices, stabilizes shen, dispels wind and stops pain. Weizhong (BL40) disperses and opens lumbar back qi and blood. This pair point combination, one superior and one inferior, one elevating and one lowering, regulates and harmonizes yin and yang, soothes tendons, activates luo-connecting channels, facilitates qi and stops pain. This treatment is appropriate for all types of lumbar back acute pain.
Needling techniques:
1. Shuigou / Renzhong (DU26) towards philitrium direction oblique insertion to a depth of 0.5 cun.
2. Weizhong (BL40) perpendicular insertion to a depth of 1 cun, or prick to release a few drops of blood.
(7) Shenshu (BL23), Weizhong (BL40) (Fig 139)
Shenshu (BL23) tonifies yin, strengthens yang, tonifies marrow and strengthens bones. Weizhong (BL40) disperses and opens qi and blood of the lumbar and back. This pair point combination, one zang organ and one fu organ, one exterior and one interior, works in synergy to tonify kidney, strengthen lumbar, open channels, invigorate luo-connecting channels, facilitate qi and stop pain. This treatment is appropriate for all types of lower back pain.
Needling techniques:
1. Shenshu (BL23) perpendicular insertion to a depth of 1 cun, using moxa sticks 10-20 minutes.
2. Weizhong (BL40) perpendicular insertion to a depth of 1 cun, combine with bloodletting.
(8) Baihuanshu (BL30), Weizhong (BL40) (Fig 146)
Baihuanshu (BL30): on the sacrum, 1.5 cun lateral to the median sacral crest, on the level of the fourth posterior sacral foramen.
Weizhong (BL40): at the back of the knee, on the midpoint of the popliteal crease, between the tendons of biceps femoris and semitendinosus.
Baihuanshu (BL30) regulates qi of lower jiao. Weizhong (BL40) disperses and opens qi and blood of the taiyang channel. This pair point combination, one superior and one inferior, promotes and elevates lumbar sacrum qi and blood. This treatment is appropriate for pain in the lumbar sacrum region.
Needling techniques:
1. Baihuanshu (BL30) perpendicular insertion to a depth of 2-3 cun.
2. Weizhong (BL40) perpendicular insertion to a depth of 1 cun.|
(9) Houxi (SI3), Huantiao (GB30) (Fig 147)
Houxi (SI3): on the ulnar side of the hand, when the fist is formed, it is located at the end of the transverse crease proximal to the fifth metaearpo-phalangeal joint, on the junction of the red and white skin.
Huantiao (GB30): on the postero-lateral side of the hip joint, one third of the distance between the prominence of the great trochanter and the sacro-coceygeal hiatus.
Houxi (SI3) connects to the Du channel, elevates yang, opens the luo-connecting channels and stops pain. Huantiao (GB30) strengthens lumbar and knee, relieves spasms and stops pain. This pair point combination soothes tendons, activates luo-connecting channels, unobstruets blockages and stops pain. This treatment is appropriate for pain in the lumbar, back and lower limbs.
Needting techniques:
1. Houxi (SI3) perpendicular insertion to a depth of 1 cun.
2. Huantiao (GB30) perpendicular insertion to a depth of 2-3 cun.
(10) Houxi (SI3), Kunlun (BL60) (Fig 140)
Houxi (SI3) connects to the Du channel, elevates yang, opens the luo-connecting channels and stops pain. Kunlun (BL60) unobstructs channels, disperses stagnation and strengthens tendon and lumbar. This pair point combination, one superior and one inferior, has great effects on the qi of that channel. It promotes and elevates qi in the lumbar and back regions, disperse stagnation opens the luo-connecting channels and stops pain. This treatment is appropriate for lower back pain situated in the area of taiyang channel.
Needling techniques:
1. Houxi (SI3) perpendicular insertion to a depth of 1 cun.
2. Kunlun (BL60) perpendicular insertion to a depth of 1 cun.
(11) Yinlingquan (SP9), Yanglingquan (GB34) (Fig 148)
Yinlingquan (SP9): on the medial side of the lower leg, in the depression posterior and inferior to the medial condyle of the tibia, level with the tuberosity of the tibia.
Yanglingquan (GB34): on the lateral side of the lower leg, in a depression anterior and inferior to the head of the fibula.
Yinlingquan (SP9) regulates water, reduces swelling and stops pain. Yanglingquan (GB34) soothes tendons, activates luo-connecting channels and stops pain. This pair point combination, one yin and one yang, one interior and one exterior, soothes tendons, activates luo-connecting channels, drains dampness, reduces swelling and stops pain. This treatment is appropriate for pain in the lower knee joint.
Needling techniques:
1. Yinlingquan (SP9) and Yanglingquan (GB34) at opposing angles to a depth of 1-1.5 cun.
Commentaries
Acupuncture treatment of lower back pain has varying results because of different etiologies. Generally, it is most effective for the wind dampness type of lumbar pain and strain. For lumbar pain caused by lumbar lesions and herniated discs, acupuncture can certainly improve the symptoms. For treatment of torn ligaments near the joints, acupuncture is not as effective. For lumbar pain caused by internal diseases, the root cause must be treated first. Lastly, lumbar pain caused by spine tuberculosis and tumor is not within the sphere of acupuncture treatment.
It is important to select the appropriate pair-point based on causes and conditions:
1. Cold dampness at the channel, select Dachangshu (BL25), Yinlingquan (SP9).
2. Qi stagnation, select Henggu (KI11), Dadu (SP2).
3. Wind dampness caused by Lower back pain, select Quchi (LI11), Sanyinjiao (SP6).
4. Qi and blood blockage, select Huantiao (GB30), Weizhong (BL40).
5. Lumbar and leg pain caused by kidney yin, kidney yang deficiency, select Mingmen (DU4), Taixi (KI3).
6. Shuigou / Renzhong (DU26), Weizhong (BL40) and Shenshu (BL23), Weizhong (BL40) are appropriate for all types of lower back pain. Shuigou / Renzhong (DU26) is used during an acute attack and in more severe cases.
In addition, the pair-points should be selected based on the location of the pain.
7. Generally, lumbar sacrum pain, select Baihuanshu (BL30), Weizhong (BL40).
8. Lumbar, back and lower limb, select Houxi (SI3), Huantiao (GB30).
9. Lower back pain along the area of taiyang channel, select Houxi (SI3), Kunlun (BL60).
10. Lower back pain accompanied by lower limb and joint area, select Yinlingquan (SP9), Yanglingquan (GB34).
Further more, besides acupuncture treatment, it is important to use both palms of the hands to rub the lumbar regions, once in the morning and evening: This can reduce and prevent lumbar pain.