Lumbago

WESTERN MEDICINE: Lumbago is pain of the back, such as pain at lumbar, or lumbosacral, or sacroiliac region of the back. It may be accompanied by pain radiating to the legs in the distribution of the sciatic nerve. 

The etiology causes include (1). local mechanical defect; e.g., injury ("acute lower back), structural inadequacy ("chronic lower back"), or intervertebral disk abnormality; (2). specific disease of vertebrae; or (3). physiologic or abnormal function elsewhere in the body. 

SYMPTOMS AND SIGNS: Pain or soreness at lumbar, or lumbosacral, or sacroiliac regions; or pain radiating to the legs. Lumbago usually accompanies those with symptoms of external pathogenic attacking, or interior disorders of internal organs. 

ETIOLOGY AND PATHOLOGY: Lumbago has a very close relationship with the kidney organs. Chinese medicine considers that the lumbar region is the house of kidneys. At the same time, lumbago caused by other factors are also very much emphasized in Chinese medicine. The following are the most commonly seen etiology and pathology of lumbago. 

( 1 ). Lumbago due to the external pathogenic factors: wind, cold, damp and heat factors can easily attack the channels at lumbar region by living in cold and damp areas, working in the rain, or wearing sweaty clothes. The obstructed channels by exogenous factors will cause the abnormal Qi and blood circulation, causing pain. 

(2). Lumbago due to over-exhaustion, or external injuries causes the abnormal Qi and blood circulation inside of channels. 

(3). Lumbago due to the deficiency of kidney: kidney deficiency can be caused by the original kidney deficiency body type; by chronic diseases; by old age; or by excessive sexual activities. Kidney blood or essence deficiency enables the channels to lose their normal nourishment thereby creating lumbago.
Generally speaking, the causative factors of lumbago have both external pathogenic factors or internal pathogenic changes. Its fundamental etiology is the deficiency of kidney, liver and spleen; and those of exogenous factors, injuries, over-working and stressful emotions belong to the causative pathogenic factors. 

DIFFERENTIATIONS: 

1. Lumbago due to the Cold - Dampness:

Indications: Coldness and pain at lumbar region, difficulty in moving around, the pain gradually becomes aggravated, worse when lying down or during rain. White and greasy tongue coating, deep and slow pulse. 

Treatment & Formulas: Eliminate the damp-cold and promote the circulation of channels. 

Products:

    • Gan Jian Ling Zhu Tang (Licorice and Ginger Combination): Its ingredients are the following: 
      • Gan Cao (Licorice, Item No. 1072): 17%
      • Gan Jiang (Dried ginger, Item No. 1198): 33%
      • Fu Ling (Hoelen, Item No. 1133): 33%
      • Bai Zhu (White Atractylodes, Item No.1051): 17%
    • Wu Ji San (Tang - kuei and Magnolia Formula, Item No. 2045): This is a very good formula to treat the lumbago due to the cold-damp factors by its functions of dispelling the accumulations of cold, damp, Qi, blood and phlegm. 

2. Lumbago due to the Damp - Heat: 

Indications: Pain at lumbar or lumbosacral region, hot feeling at local pain areas, aggravated during rain or summer time, better after moving or any other activities, swollen limbs, restlessness, thirsty, scanty yellowish urine, yellow and greasy tongue coating, soft and rapid pulse. 

Treatment & Formulas: Eliminate the damp-heat and promote the circulation of channels so as to stop the pain. 

Products:

    • Er Miao San Jia Wei (Powder of Two Effective Ingredients) plus some other herbs:
      • Huang Bai (Phellodendron, Item No. 1191): 43%
      • Gang Zhu (Atractylodes, Item No.1218): 57%
    • Dang Gui Lian Tong Tang (Tang - kuei and Anemarrhena Combination, Item No. 2234): This is a very popular formula used for lumbago due to the damp-heat factors. It is also applied for purulent and malodorous leukorrhea with moderate inflammation and congestion in subacute or chronic stages. 

3. Lumbago due to the Wind - Cold Factors:

Indications: Spasmodic pain at lumbar region with cold feeling, better when pressed by warm or hot, pain radiates to upper back along spine or to legs, accompanied with fever with aversion to cold. White and thin tongue coating, floating and tight pulse. 

Treatment & formula: Dispel wind - cold factors and promote the circulation of channels. 

Products:

    • Ren Shen Bai Du San (Ginseng and Mentha Formula, Item No. 2004): This formula dispels external wind, cold and dampness; at the same time, it promotes the circulation of Qi by its tonification function. 

4. Lumbago due to the Wind - Heat Factors:

Indications: Pain and hot feeling at lumbar region, hot sensation of urination, fever with slight sweating, thirsty, pain and swollen throat, floating and rapid pulse, thin tongue coating. 

Treatment & Formulas: Dispel the wind - heat factors and promote the circulation to stop pain. 

Products:

    • Xiao Chai Hu Tang (Minor Bupleurum Combination, Item No. 2029) plus Qiang Huo (Item No. 1189), Xu Duan (Item No. 1264) and black bean. 
    • Da Chai Hu Tang (Major Bupleurum Combination, Item No. 2036): This is used for wind heat plus constipation due to the interior heat body type. 
    • Shan Chong Xia Tong Yong Teng Feng Wan (Cinnamon and Angelica Formula, Item No. 2027): It is used for lumbago due to the combination of coldness, dampness and heat factors. So it is often used for various kinds of rheumatism due to these etiological factors. 

5. Lumbago due to the Wind - Dampness:

Indications: Spasmodic sore, heavy or painful at lumbar and back areas, activities are limited, or accompanied with fever and aversion to wind,  or edema of face and limbs. Thin and greasy tongue coating, floating and unsmooth pulse. 

Treatment & Formulas: Dispel wind and eliminate the dampness. 

Products:

  • Du Huo Ji Sheng Tang (Tuhuo and Vaeicum Combination, Item No. 2260): This is atypical formula for lumbago due to wind -dampness.
  • Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon and Anemarrhena Combination, Item No. 2162): This is used for wind - damp factor transformed into the interior heat after a certain period of time. 

6. Lumbago due to the Kidney Deficiency:

Indications: Soreness and weakness, or pain at lumbar region, local area responds well to pressure and massage, weakness of lower legs, worse after working, released by rest, recurs easily; kidney Yang deficiency shows spasmodic feeling at lower abdomen, pale complexion, cold limbs, pale tongue, deep and thready pulse; kidney Yin deficiency shows restlessness, insomnia, thirsty, dry throat, flushed complexion, hot sensation of palms and souls, night sweating, tidal fever, red tongue, wiry, thready and rapid pulse. 

Treatment & Formulas: 

    1. Kidney Yang deficiency: use the Yang tonics.
    2. Kidney Yin deficiency: use the Yin tonics.
For the No. (1) type: 
  • Liu Wei Di Huang Wan (Rehmannia Six Formula, Item No. 2051) 
  • Zhi Po Ba Wei Wan (Anemarrhena, Phellodendron, and Rehmannia Formula, Item No. 2123) 

For the No. (2) type:

7. Lumbago due to the Spleen Dampness:

Indications: Pain and heaviness at lumbar region, pale complexion, poor appetite, loose stool, white and greasy tongue coating, slippery and soft pulse.

Treatment & Formulas: Eliminate the dampness by promoting the function of spleen and stomach. 

Products:

    • Ping Wei San (Magnolia and Ginger Formula Plus, Item No. 2067): This is good for the light case of the spleen damp symptoms.
    • Fang Ji Huang Qi Tang (Stephania and Astragalus Combination, Item No. 2102): This is for the more serious cases due to retention of dampness by its diuretic function and promoting functions of spleen and stomach. 
    • Yin Chen Wu Lin San (Capillaris and Hoelen Five Formula, Item No. 2143): This eliminates the dampness by its diuretic function. 

8. Lumbago due to Liver Stagnation:

Indications: Pain at the lumbar region, radiated to hypochondriac and abdominal regions, the feeling of pain is moving and extended, difficulty standing long. Thin tongue coating, red tongue, wiry and thready pulse, or deep and wiry pulse. 

Treatment & Formula: Regulates the Qi and harmonizes the liver thereby promoting the normal circulation of Qi and blood. 

Products:

    • Wu Yao Shun Qi San (Lindera Formula, Item No. 2164): This is a very good formula for lumbago due to the Qi stagnation combined with coldness. It is also often applied for paralysis, painful arms and shoulders, stroke, cerebral atrophy and hemiplegia. 

9. Lumbago due to the Blood Stasis:

Indications: Lumbago, pain is fixed with needle pricking sensation, in a light case, lumbar region can not be bent, in a serious case, lumbar region can not be moved at all, painful area refuses to be pressed, released at day time, and aggravated at night. Dark purple tongue, or with petechiae, uneven pulse. 

Treatment & Formula: Regulate and resolve blood stasis by promoting the circulation of Qi and blood, eliminate the dampness and cold factors. 

Products:

    • Su Jing Huo Xue Tang (Clematis and Stephania Combination, Item No. 2198): This is a very good formula to treat the lumbago due to the blood stasis combined with Qi stagnation, cold and damp factors. 

COMMENTS: 

1. The method of pressing: warm or cook the following powders of single herbs, than press the localized painful areas. It is specifically good for lumbago due to kidney deficiency.

    • Rou Gui (Cinnamomum Cortex, Item No.1079) 30g
    • Wu Zhu Yu (Evodia Fructus, Item No. 1099) 90g 
    • Sheng Jian (Ginger, Item No. 1071) 120g
    • Hua Jiao (Zenthoxylum) 60g
    • Chong Tou (Onion head) 30g

2. The method of moxibustion: use an ignited moxa stick to warm same local point; or use moxa wool directly on the painful area with ginger or garlic slices between skin and moxa wool. It is specifically good for lumbago with cold feelings at local areas.

3. The method of massage: it is useful for all kinds of lumbago.


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