Yao+Tong+(Low+Back+Pain)

TCM Disease Classification
//Yao Tong// = “lumbar or low back pain” -According to TCM, the low back is the domain of the Kidneys. -Despite the localized manifestation, low back pain can be complicated and pain characteristics can vary depending on the pathogen involved. -Low back pain can radiate to other areas, including the upper back, the hips, and the legs and feet.

Relevant Western Diseases
Rheumatoid spondylitis, Herniated Intervertebral disk, Lumbar vertebral tuberculosis, sprain of the lumbar ligament, strain of the lumbar muscles, glomerulaonephritis, pyelitis, prostatitis

Relevant Anatomy
Lumbar Vertebrae Lumbar Discs Lumbar Facet Joints Lumbar Spinal Nerves

[[image:lumbar_region_muscles.png width="344" height="290" align="right" caption="lumbar_region_muscles.png"]]
Lumbar Spinal Musculature Sacroiliac Joint Quadratus Lumborum Muscle

TCM Etiology and Pathogenesis
Low back pain can be divided into three etiological categories: -Invasion by exogenous pathogens: among these, Dampness is considered a key contributor to low back pain due to its characteristic heaviness, turbidity, and tendency to settle downwards. Cold-Dampness and Damp-Heat are two forms Dampness takes in low back pain; these pathogens are carried into the body by Wind, and obstruct the circulation of Qi and Blood in the low back.

-Trauma, sprain/strain, overuse: these factors obstruct the flow of Qi and Blood in the low back causing pain.

-Constitutional vacuity, aging, chronic illness, or excessive sexual activity: these factors lead to Kidney vacuity with failure to nourish the low back, sinews, and bones.

Identification of Repletion and Vacuity
-Repletion/Excess patterns generally have a more acute onset and are associated with obstruction by exogenous pathogenic factors or trauma, overuse, or sprain/strain. -Vacuity/Deficiency patterns generally have a gradual onset and are associated with Kidney deficiency. -Mixed excess/deficiency patterns are possible.

TCM Differential Diagnosis
Multiple causes of low back pain are possible, some of them quite serious. These have been covered in the biomedical section. One condition to keep in mind is Lin Syndrome (Painful Urination Syndrome), which can present with severe low back pain accompanied by urgent, frequent, and difficult/painful urination. In such a case, the underlying cause – in this case Painful Urination Syndrome – must be treated in order to resolve low back pain. Painful Obstruction Syndrome primarily affects the muscles and joints of the extremities, or it manifests as low back pain WITH additional pain in the joints and extremities.

TCM General Treatment Principles
Early-stage of exogenous invasion: expel pathogenic factors, open the channels and collaterals, relieve pain. Chronic low back pain: supplement the Kidney, relieve pain. Mixed excess and deficiency: treat Root and Branch simultaneously with both supplementation and invigoration.

Low Back Pain Manifesting As Cold-Damp
mild to severe cold pain with heaviness in the low back with decreased range of motion; pain is better with light exercise and heat, worse with rest and exposure to cold and dampness; one cold predominates, pain is more severe and muscles are stiffer and were contracted; when damp predominates, swelling and numbness are possible To strengthen eliminating dampness, warming and unblocking the obstruction in the channels: + Gui Zhi (9g), Xu Duan (9g), Du Zhong (12g), Niu Xi (9g), Sang Ji Sheng (12g) Cold predominating w/ cold pain and spasm: + Fu Zi (9g), Xi Xin Dampness predominating w/ pronounced heaviness: +Cang Zhu (9g), Yi Yi Ren Accompanied by Wind w/ symptoms alternating from side to side, extending to feet or up the back and shoulders, or roving aching joints use Du Huo Ji Sheng Tang
 * Tongue:** white, greasy coat
 * Pulse:** deep, tight or deep, slow
 * Treatment Principles:**Dispel Cold, eliminate Dampness, warm and open the channels and collaterals, relieve pain
 * Herbal Treatment:** Gan Jiang Ling Zhu Tang or Gan Cao Gan Jiang Ling Zhu Tang
 * Modifications:**

Low Back Pain Manifesting As Damp-Heat
mild to severe low back pain with sensation of heat in the area; possible sensation of heaviness; pain aggravated in damp, hot weather + Mu Gua (Chaenomeles fruit) 9g Luo Shi Teng (Star Jasmine stem) 12g Heat predominating w/ thirst, irritability or scanty urination: +Zhi Zi (9g), Ze Xie (9g), Mu Tong (6g) Damp-heat consuming Kidney Yin w/ soreness and weakness of the lower back and knees, 5-palm heat and dry throat: + Nu Zhen Zi (12g), Han Lian Cao (12g)
 * Secondary Symptoms:** bitter taste in the mouth, dark, scanty urine
 * Tongue:** red (possibly) with yellow, greasy coat
 * Pulse:** soft or slippery and rapid
 * Treatment Principles:** Clear Heat, eliminate Dampness, open the channels and collaterals, relieve pain
 * Herbal Treatment:** Si Miao Wan
 * Modifications:**

Low Back Pain Manifesting As Qi Stagnation and Blood Stasis
severe, fixed, stabbing pain that may be better with light movement; pain aggravated by rest, pressure, and at night; decreased range of motion; noticeable muscle spasm; possible history of recent injury Reinforce clearing collaterals and dissolving stasis: + Zhe Chong (9), Wu Shao She Rou (9), Chuan Shan Jia (9) History of Traumatic Injury: + Ru Xiang, Qing Pi, San Qi Complicated by Kidney Deficiency: + Du Zhong (12), Xu Duan (12), Shu Di Huang (12)
 * Tongue:** dark, purplish; may have stasis macules
 * Pulse:** choppy
 * Treatment Principles:** Quicken the Blood, transform stasis, regulate Qi, relieve pain
 * Herbal Treatment:** Sheng Tong Zhu Yu Tang
 * Modifications:**

Low Back Pain Manifesting As Kidney Yang Vacuity
gradual onset and long history of dull, aching pain in the low back that is aggravated by exertion and relieved by rest and pressure; possible cold sensation in low back w/ shortness of breath, fatigue, poor appetite & loose stool: + Huang Qi, Sheng Ma, Dang Shen In chronic cases w/ Spleen Qi deficiency: use Bu Zhong Yi Qi Tang In chronic cases w/out predominance of Kidney Yin or Yang deficiency: use Qing E Wan
 * Additional Symptoms:** cold extremities, pale complexion, nocturia, low libido, sore/weak knees, possible lower body edema
 * Tongue:** pale with thin, white coat
 * Pulse:** deep, thin, weak
 * Treatment Principles:** Warm and supplement Kidney Yang, relieve pain
 * Herbal Treatment:** You Gui Wan (Right-Restoring Pill)
 * Modifications:**

Low Back Pain Manifesting As Kidney Yin Vacuity
gradual onset and long history of dull, aching pain in the low back that is aggravated by exertion and relieved by rest and pressure w/ heat signs: + Da Bu Yin Wan In chronic cases w/out predominance of Kidney Yin or Yang deficiency: use Qing E Wan
 * Additional Symptoms:** insomnia, malar flush, 5 center Heat, dry throat, sore/weak knees
 * Tongue:** red with scanty coat
 * Pulse:** thin, rapid
 * Treatment Principles:** Nourish Kidney Yin, relieve pain
 * Herbal Treatment:** Zuo Gui Wan (Restore the Left Pill)
 * Modifications:**

Acupuncture for Low Back Pain
Main points: BL23, GV3, Hua Tuo Jia Ji, BL 25, BL26, BL28, BL30, BL32, BL54, GV4, Shiqizhuixia, Yaoyan Secondary points: other BL points, GB25, GB30 Distal points: BL40, BL60, BL57, BL58, SI3, BL62, KI3, Yaotongxue, GB34 Acupuncture for Low Back Pain
 * Local points:**

Cold-Dampness: BL40, GV3, SP9 + moxa, BL-25, BL-26 Damp-Heat: BL40, SP9, BL28, LI11 Qi & Blood stagnation: BL40, SP10, SP6, BL17, BL32; acute sprain: GV26 Kidney vacuity: KI3, BL23, GV3, GV4, CV4, CV6, BL52 + moxa Traumatic Injuries: GV-26, Yao Tong Xue, Ashi KI Yin Deficiency: BL-52, KI-3
 * According to pattern:**

Cupping Electroacupuncture
 * Ear Acupuncture:** Lumbar Vertebrae, Sacral Vertebrae, Kidney, Shen Men