Experience of treating chronic low back pain with traditional Chinese medicine

Chronic low back pain is a very common painful disease in clinic. Modern medicine calls chronic low back pain lasting for more than one month. It is a disease of pain on one or both sides of the waist or in the middle of the lumbar spine, which is more common in lumbar muscle strain, lumbar disc herniation, ankylosing spondylitis and so on. , and has the characteristics of persistence, repeatability and stubbornness.

Looking through ancient and modern medical records, Chinese medicine mainly treats chronic low back pain by tonifying kidney and eliminating dampness, clearing heat and removing blood stasis, and also treats it from liver, spleen, governor pulse and pulse. Although it can achieve a certain curative effect, it is not universally applicable to all patients with chronic low back pain. Clinically, while tonifying the kidney and strengthening the bones, comprehensive methods such as tonifying the middle energizer, regulating the liver, warming the du and dredging the belt can be used to restore the coordination of "tendon-meat-du-belt", which can significantly improve the curative effect of chronic low back pain.

Low back pain is caused by the imbalance of tendon-muscle-governor-belt functional chain. It is generally believed that chronic low back pain is located in the waist, which is closely related to kidney, kidney meridian of foot shaoyin and bladder meridian of foot taiyang. Its nature is the deficiency of many evils, mainly kidney deficiency. In recent years, although some researchers have realized the significance of liver depression and spleen deficiency, deficiency and cold of du meridian, and dystrophy with pulse in causing chronic low back pain, most of them are one-sided and inevitably biased.

The flexion and extension of the waist depends on the contraction and relaxation of muscles and fascia. The "tendons" in traditional Chinese medicine include fascia, ligament and tendon in modern medicine. "All tendons belong to joints", and all tendons are attached to joints, which are the joint parts of joints and muscles. If "tendons can't move", joint flexion and extension will be blocked, which will lead to low back pain. "Meat is the wall", and "meat" in modern medicine includes muscle and subcutaneous tissue.

In addition, the Du Meridian runs through the middle of the whole spine, which is called "the sea of Yang Meridian". When the Du meridian is diseased, there will be "backache, no pitching" or even "strong spinal syncope". The pulse "crosses the waist, like a belt, so it is always close to the seven pulses in the twelve meridians's and Qi Jing", so it is "sick, the abdomen is full, and if the waist sits in water". "Luo Heng's pulse makes people feel low back pain, so you can't pitch. If you lean back, you will be afraid of your servant and you will be seriously injured. "

Chronic low back pain is not only closely related to kidney, kidney meridian of foot shaoyin and bladder meridian of foot taiyang, but also involves many links in the functional chain of "tendon-flesh-governor-belt". The department of orthopedics and traumatology of traditional Chinese medicine classifies lumbar muscle strain, lumbar disc herniation and sacroiliac joint injury as "lumbosacral tendon injury", which also confirms this point. Even like ankylosing spondylitis, the spinal canal in the center of the spine is a interlocking column composed of spinal cord, spine and intervertebral disc. With the cooperation of spinal nerve roots, muscles and ligaments, fascia and blood vessels, the damage and pathological changes of these tissues and structures will directly or indirectly cause low back pain, which is consistent with our above views.

Regulating liver blood can soften tendons and dredge veins.

The function of tendons depends on the nourishment of liver qi and blood, that is, the meanings of "liver producing tendons" and "liver strengthening tendons". The liver is full of qi and blood, so the muscle strength is strong, so "the liver is the foundation of the pole." If the qi and blood of the liver are insufficient, the muscles and meridians of the waist will contract and relax, which will cause low back pain. "The pulse runs in the branch of Jueyin". If a heavy object hurts the waist and blood stasis blocks the pulse, it will also cause low back pain, which is manifested as backache. Even if it is pulled to the abdomen, the waist and abdomen are painful, just like a belt. It is difficult for the patient to turn over and lie down.

According to Treatise on Febrile Diseases, Shaoyao Gancao Decoction is used to treat leg cramps caused by deficiency of yin and yang, and it is extended to treat lumbago caused by deficiency of liver qi, deficiency of qi and blood, and imbalance of relaxation and contraction of tendons and veins. Clinically, the dosage of Radix Paeoniae Alba and Radix Glycyrrhizae Preparata in the original prescription is adjusted to be 30g and 60g of Radix Paeoniae Alba, 0/0g of Radix Glycyrrhizae Preparata for promoting blood circulation and removing blood stasis and 0/5g of Radix Paeoniae Rubra, and papaya for relaxing muscles and relieving pain.

Zhang's theory of pulse disease in Medical Diseases: "If lumbago is a bundle, it belongs to pulse disease, with pungent taste and loose knot, and sweet taste to relieve pulse." It is also said in "On Blood Syndrome" that "those with blood stasis in the pulse should use Jiaji Tuhua Decoction", that is, Paeonia lactiflora and Glycyrrhiza San Qian, which are named after (Glycyrrhiza uralensis) are willing to enter the blood and can slow down the middle temperature ... Paeonia lactiflora is used to tonify the spleen, and Jiaji Tuhua is also used ". Clinically, we adjusted the dosage of Radix Paeoniae Alba and Radix Glycyrrhizae Preparata according to the above method, and added Chuanxiong, Radix Angelicae Sinensis, Semen Persicae and other products to promote blood circulation and remove blood stasis according to the original prescription of Blood Syndrome.

Supplementing middle qi can strengthen, control and dredge veins.

Spleen and stomach not only govern muscles, but also govern muscles and guide veins. If the spleen and stomach are qi deficient, muscle dystrophy and contraction and expansion disorder can lead to low back pain, which is manifested as falling and swelling low back pain. The patient describes that something is pulled down, sometimes it is light and sometimes it is heavy, and the flexion and extension or activity will be aggravated, and he likes temperature and pressure.

According to the theory of "deficiency is tonic", "loss is warm", "fatigue is warm" and "spleen should be healthy", Buzhong Yiqi decoction, which is good at tonifying middle energizer, is selected for addition and subtraction. Astragalus membranaceus in the prescription "benefits qi, strengthens bones and muscles, grows meat and nourishes blood"; Ginseng helps Astragalus to tonify the middle energizer and replenish qi; Atractylodes macrocephala "cures dead tendons" ... and supplements middle energizer ","It is most beneficial to the waist and umbilicus. If it is beneficial to the waist and umbilicus, the dampness is not in the kidney palace "; Licorice tonifies spleen and qi to "grow muscles". Together, the four herbs tonify middle energizer and strengthen tendons. Angelica sinensis promotes blood circulation and collaterals, "moistening bones and muscles"; Pericarpium Citri Tangerinae regulates qi and energizes the middle energizer, which can make the medicines complement each other without stagnation;

In order to make the power of spleen and stomach reach the waist and kidney, Cimicifuga rhizome and Bupleurum root can be removed, and Achyranthes bidentata, Taxilli, Radix Angelicae Pubescentis and Millennium Health can be added; In order to strengthen the function of spleen and stomach in treating tendons, Shaoyao Gancao Decoction can be used. If lumbago is severe, Coicis Semen and Atractylodis Rhizoma can be added. The pulse is weak and cold, and the back pain is severe in rainy weather. "The abdomen is full and the waist is like sitting water". It is appropriate to warm the middle and strengthen the spleen, dispel cold and relieve pain. Shen Zhu Decoction can be used together; If the pain lasts for a long time, you can consider the method of promoting blood circulation and dredging collaterals, and add and subtract Taohong Siwu Decoction.

Warming Du meridian can strengthen lumbar spine.

"Du meridian is sick and cured, and it is cured on the bone." Therefore, deficiency cold and low back pain should not only tonify the kidney, but also warm the meridians and unblock the collaterals. Ye, a famous doctor in Qing Dynasty, pointed out: "It is necessary to be sweet and warm, supplemented by popular context, to reconcile qi and blood."

A patient with low back pain, surnamed Zhuang, was recorded in Clinical Guide Medical Records, which was diagnosed as being caused by deficiency and cold of Du meridian. Prescription: raw antler slice San Qian (sliced), antler cream for one and a half yuan, wolfberry San Qian for one and a half yuan, raw Eucommia ulmoides for one and a half yuan, sand garden for one and a half yuan, and green salt for three points. "

This recipe has a special place to pay attention to. However, Lycium barbarum, Angelica sinensis, Eucommia ulmoides and Astragalus complanatus are used to nourish liver and kidney, strengthen tendons and bones, and Poria cocos and green salt are used to introduce medicine into human kidney, so antler and antler cream are used for the first time. It can be seen that this side focuses on the deficiency of du meridian. Ye believes: "Lu Xingyang, into the governor vein"; "Velvet antler strengthens the yang of the Du meridian, deer frost passes the qi of the Du meridian, and deer glue supplements the blood of the Du meridian"; "In the past, every time the ancients communicated, they also had amazing classics." If the deficiency and cold of Du meridian is obvious and lumbago affects the waist and buttocks, Shen Rong decoction (ginseng, pilose antler, aconite, fried angelica, fried fennel, dodder and Eucommia ulmoides) in Treatise on Febrile Diseases can be modified.

Chronic lumbar muscle strain, the lesions are in muscles and fascia, mainly to tonify middle qi and regulate liver blood, but also to tonify kidney; Lumbar disc herniation and ankylosing spondylitis are the pathological changes of the spine itself, so tonifying the kidney and strengthening the bones, warming the Du meridian, tonifying the middle energizer and regulating the liver and blood, and adding and subtracting Yanghe decoction and Fuzi decoction can often achieve satisfactory curative effects.