Help for Prolapsed Intervertebral Discs of the Lumbar Region (Herniated Discs)
By Skya Abbate,
DOM
Prolapse of intervertebral
discs of the lumbar region, or lumbar herniation, is
a frequent problem for which patients seek treatment. In Oriental medicine, it
has three etiologies:
1.
Injury to the area;
2.
Invasion of wind, cold, or damp to an overtaxed condition;
3.
Liver and kidney deficiency resulting in lack of nourishment to
the channels.
Figure I:
Normally, the intervertebral
disc lies between the vertebral bodies of the spine and forms a mobile joint
called a symphysis, which consists of the nucleus pulposus and annulus fibrosus.
The nucleus is a ball of transparent jelly, collagenous
fibers, cells and mucopolysaccharides. The annulus fibrosus is made up of rings of fibers oriented in
different directions that surround the nucleus with a tough casting.
The discs serve as shock absorbers of the
forces of compression. The ability of the nucleus to become distorted, and of
the annulus fibrosus to bend, gives the vertebral
bodies the ability to move on each other and to distribute the forces of
compression. As we age, the nucleus tends to shrink and become dry, and
therefore to become less elastic and more fibrous. The annulus fibrosus concomitantly thickens and becomes more prone to
rupture.
Figure II: Herniated lumbar disc. Technically speaking,
a prolapsed disc refers to the herniation of the
nuclear material due to tears in the annulus fibrosus.
Pain and inflammation develop from pressure of the nucleated material on the
posterior longitudinal ligament and the dura mater. The nerve root that can be affected is the one
below the vertebra. The vertebral levels most subject to herniation
are L4, L5 and S1. If the nerve root becomes affected, pain may be experienced
in the corresponding dermatomal area, and weakness
and reduced reflexes may develop in the muscles. For an appreciation of this
problem, Figures 1
and 2 depict a normal
and herniated disc, respectively.
The treatment plan for such a condition
involves the breakdown and absorption of the herniated nuclear material and
repair to the torn fibers of the annulus fibrosus and
posterior longitudinal ligament. In Oriental medicine, an effective treatment
strategy for prolapsed intervertebral discs is a
prescription called eight needle technique. Eight
needle technique is a Chinese treatment plan typically
differentiated as clinically effective for kidney qi and yang deficiency resulting in low back pain. It
consists of eight points essentially in the local area of herniation,
or points with energetics primarily centered around remediating kidney qi and yang xu.
These points are BL23 (shensu) [bilateral], GV4 (mingmen),
BL25 (dachangshu)
[bilateral], GV3 (yaoyanguan)
and BL40 (weizhong)
[bilateral]. All of the points are located in the standard Chinese locations
and needled to the standard Chinese depths of insertion. For clinical
convenience, the points, angles, depths of insertion and energetics
are summarized in Table 1.
|
Table 1: The Eight Needle
Points. |
||
|
Points |
Angles and Depths of Insertion |
Energetics |
|
BL23 |
Perpendicularly .8-1 in |
Back shu point of the kidney;
regulates the qi
of the kidney (both kidney yin and yang). Resolves dampness in the lower
burner. Strengthens the back. Nourishes kidney essence, benefits the bones
and marrow. Nourishes blood. |
|
GV4 |
Perpendicularly .5-1 in |
Tonifies the original kidney qi;
that is, the person's condition, vitality and genetic inheritance on a
physical and mental level. Strengthens kidney yang. Strengthens the lower
back; expels cold; dries damp-cold. |
|
BL25 |
Perpendicularly .8-1.5 in |
Back shu point of the large
intestine; eliminates stagnant qi and blood that may cause pain; numbness;
muscular atrophy; and motor impairment of the back and lower extremities.
Removes obstruction from the channel. Benefits the low back; strain; pain in
the sacroiliac joint; and relieves fullness; swelling; and paralysis of the
lower extremities. |
|
GV3 |
Perpendicularly .5-1 in |
Tonifies kidney yang and qi. Strengthens
the lower back and legs. Especially for backache that radiates to the legs;
pain in the lumbosacral region; numbness; muscular
atrophy; motor impairment; weakness of the legs; and knee pain caused by
kidney qi
and yang xu.
Warms cold and dries damp. |
|
BL40 |
Perpendicularly 05-1.5 in |
He-sea point of the bladder
channel. As the earth point, it is the controlling point of the channel.
Clears dampness from the bladder channel. Eliminates blood stasis and channel
obstruction that creates lower leg pain. Relaxes the sinews and tendons;
opens the channel to benefit the lower back, knees, hips and legs. For
chronic or acute, excess or deficiency-type backaches, but most effective for
acute, excess backache that is neither unilateral or
bilateral, but not on the midline. |
Position the patient as comfortably as
possible on a treatment table by having them lie on their stomach. If this
prone position makes the patient's back uncomfortable, put a thick, firm pillow
under the patient's abdomen. This will take the pressure off the low back and
open up the patient's spine to assist in needle insertion.
While Bladder 23 and 25 may be needled in a
perpendicular fashion, clinical experience has shown that an oblique insertion
toward the spine is clinically effective to change the position of the prolapse and the neural roots, thereby reinforcing the
therapeutic effect. All of the back joints additionally have the function of
easing pain; decreasing inflammation; activating blood flow; dredging the meridians;
and stimulating the nerve root directly. In this way, the surrounding edema may
be absorbed and the protrusion of the lumbar intervertebral
disc rectified. The needle technique applied to each point depends upon whether
the point needs to be tonified or dispersed. As in
all cases of tonification and dispersion, needle
retention times will vary, but as a general rule, retain the needles 20
minutes.
If the patient's back pain is correctly
differentiated due to prolapsed intervertebral discs
of the lower extremities and eight needle technique is
applied, results are frequently efficacious and long-lasting, with the added
benefits accrued from tonifying kidney qi and yang
xu, the root qi of the body.1
Reference
1.
Gardner-Abbate S. Holding the Tiger's Tail: An Acupuncture Technique
Manual in the Treatment of Disease.