-IBIS-1.5.0-
tx
musculoskeletal system
sciatica
acupuncture

patterns and combinations

after assessing the person and palpating, consider these patterns:
Kidney Yang Xu (Deficiency); Xue Xu (Blood Deficiency); Xue Yu (Blood Stasis); Wind-Damp Bi Syndrome; Damp Hot Bi Syndrome; Cold or Cold-Damp Bi Syndrome; Cold in the Channels; dysfunction or Obstruction of the Du Mai (Governing Vessel) and/or Dai Mai (Girdle Vessel); imbalance or Xu (Deficiency) of the Gall Bladder; Kidney Xu (Deficiency)

» treatment principles: drain Excess; tonify Xu (Deficiency); warm if Cold Obstruction; expel Wind

» therapeutic notes:
• the determination as to which channel is the primary focus of distress often directs point selection in an obvious and effective way, the Bladder and Gall Bladder channels are most typically involved, but the Stomach channel can also be relevant
• palpation is often more important than point actions and attributions when selecting points for needling, esp. since most of the potentially relevant points theoretically have similar effects
• Ion-Pumping Cords connecting GB-41 and TW-5 or SI-3 and UB-62 may significantly improve the effectiveness of the acupuncture
• often most effective when patient lying with effected side up, knee bent; needle ashi (tender) points; afterward patient may be turned to supine position and needled for broader effect, e.g., Du Mai (Governing Vessel) or Dai Mai (Girdle Vessel)
• some teachers emphatically recommend distal treatment to balance effected channels and avoiding local treatment (Tan)
• can apply indirect or direct moxa (three or five cones, red bean size) to most of points listed below if Cold and Stagnation predominate and the pain is severe
• see also: "spinal segmental lesion", "low back pain" and "intervertebral disc disease"

» illustrative combinations:
Ling ku, da bai and zhong bai, all contralaterally to pain, with no local points, for sciatica on lateral aspect of leg, sacroiliac pain, L4-5-type sciatica, and lumbosacral pain. (Tan)
• contraleral Ht-5, with ipsilateral ling ku, contraleral GB-39 and ipsilateral Sp-6 for sciatica, esp. with medial and posterior thigh pain, and contralateral neck and shoulder stiffness (Tan, 1991, p. 96)
• UB-22, UB-23, UB-25, UB-26 and UB-47/52 (+ and D): disperse congestion, relieve pain, strengthen back; needle with lifting and thrust, rotate then retain
• GB-30, UB-49/54, UB-51/37, UB-54/40, UB-57 and UB-58: strengthen low back, benefit hips, and relax sinews
• GB-34, GB-39, St-36 and St-41 (-): if pain radiates down the lateral aspect of the leg; retain 10 mins.
• UB-54/40, UB-56 and UB-57 (-): if pain radiates down posterior aspect of leg; retain 10 mins.
• (1) needle GV-26 and UB-54/40; (2) needle UB-23 on the affected side, and continue with indirect moxa; apply five cones of direct moxa, red bean size, if the condition is severe; (3) needle GB-30 and GB-31, and continue with indirect moxa; apply five cones of direct moxa, red bean size, if the condition is severe; (4) needle GB-34, GB-39 and UB-60; apply five cones of direct moxa, red bean size, if the condition is severe; ("After this the pain will not return."); (5) apply apply three cones of direct moxa, red bean size, to Sp-2, if the condition is severe; (6) apply needle alone, needle with indirect moxa, or direct moxa to any ashi (tender) point (So, 1987, p. 295)
• First stimulate contralaterally GB-30, GB-31 and St-36; then stimulate ipsilaterally UB-27 and UB-25; follow with moxibustion. Divide GB-30, UB-32, St-36, UB-59, Kd-3, GB-31 and UB-23 into two groups and needle one group each day, ipsilaterally. UB-60 should be stimulated during each treatment session. (McWilliams, et al, Lesson 31, p. 141)
• UB-23, UB-30, UB-50/36, GB-30, UB-51/37, UB-54/40 and GB-34 (also consider hua tuo jia ji of L2 through L5, UB-31, UB-32, UB-49/54, UB-57, GB-39, UB-60, GB-41 and pressure points) for sciatica (Lee and Cheung, p. 293)
• GB-30, GB-34, UB-54/40, GB-31, UB-23, UB-60, GB-39 and UB-25 (also consider UB-50/36, UB-57, GV-2, ba liao (UB-31, UB-32, UB-33 and UB-34), GB-43, St-36, St-32, St-34, St-31, yao yan, tun zhong, St-41, UB-58 for sciatica (Lee and Cheung, p. 293)
• GB-30 and GB-34; add: UB-23, UB-25 and the ba liao (UB-31, UB-32, UB-33 and UB-34) for lumbosacral region; and/or UB-50/36, GB-31, UB-51/37, St-32, UB-54/40, St-36, UB-57, GB-39 and UB-60 for lower extremities (Lee and Cheung, p. 293)
• Kd-4 (listed as "Kd-5"), UB-62 and UB-54/40; UB-23, Kd-4 (listed as "Kd-5") and PC-9; GV-4, UB-28, UB-48/53 and UB-49/54; UB-31 to UB-35 for lumbago and/or sciatica (Mann, p. 124)
• hua tuo jia ji, GB-30 UB-57, UB-37/42, UB-54/40, GB-34, GB-40 and UB-64 for sciatica due to Stagnation of Qi and Xue (Blood) from back sprain, resulting in Obstruction of Qi in Bladder and Gall Bladder channels (Jirui and Wang, p. 184)
• UB-30 and UB-54/40 for back pain extending to the waist (Shanghai, p. 215)
• GB-30, GB-31, St-33, UB-54/40, UB-57, UB-60 and UB-62 for lumbar and leg pain (Lee and Cheung, p. 293)
• UB-54/40 and GV-26 for lumbar and leg pain (Lee and Cheung, p. 293)
• UB-31, GB-30, GB-34 and LI-8 for limitation of movement for lumbar and leg (Lee and Cheung, p. 293)
• UB-49/54, UB-51/37 and GB-34 for sciatica extending to the legs (Shanghai, p. 215)
• ling hou, GB-30 and jian xi for sciatica or paralysis of the lower limb (Shanghai, p. 299)
• hua tuo jia ji, esp. L4 and L5 and shi qi hui xia (-): local paraspinal points; benefit lower back
• GV-2 (+ and 3 - 15 cones of direct moxa) with GB-30 (+ and
D) for obstinate Cold-Bi and Wind-Cold conditions (Ellis, et al, 1988, p. 372)
• GB-41 and TW-5: open and regulate the Dai Mai (Girdle Vessel) which regulates the waist and relates strongly to the Gall Bladder channel
• SI-3 and UB-62: open and regulate the Du Mai (Governing Vessel) which regulates, relaxes and strengthens the spine as well as the paravertebral muscles and connective tissue
• navel treatment a la Matsumoto for weak connective tissue and/or Xu (Deficiency) of the Kidney and/or Spleen due to birth trauma induced by improper severing of the umbilical cord causing damage to the ligamentum teres hepatis (Matsumoto)


point analysis

»
palpate and consider:
• GV-4 ( - or + and
D): pacifies the Shen; clears the Brain; strengthens the Kidney; benefits and replenishes the Kidney Yang; restores collapsed Yang; nourishes the Yuan (Original) Qi; relieves mental and physical exhaustion; strengthens the back, esp. benefits the lumbar vertebrae; reinforces and astringes the Jing (Essence); regulates the menses; stops vaginal discharge; distributes Zhong (Ancestral) Qi and Yang to the pelvis to mobilize the Yin of the pelvis; stimulates adrenals, testes and ovaries (Finkelstein, p. 77); frees the channels and invigorates the collateral vessels
• GV-2 (+ and/or d.
D): expels Wind and dissipates Dampness; stimulates parathyroids; treats thyroid imbalance (Matsumoto); warms the Lower Warmer; strengthens lumbar spine and knees; frees the channels and invigorates the collaterals; + and 3 - 15 cones of direct moxa for obstinate Cold-Bi and Wind-Cold conditions (Ellis, et al, 1988, p. 372)
hua tuo jia ji, esp. L4 and L5 (-): local paraspinal points; benefit lower back and joints; restore Qi and Xue (Blood) flow; strengthen and relax the sinews and tendons
• shi qi zhui xia (-): removes Obstructions from the channel; benefits the lower back and regulates the Lower Warmer
gluteal ashi (tender) points: promote circulation of Qi and Xue (Blood); disperse Stagnation; with long needle, retain
• UB-18 (-): moves Stagnant Qi; nourishes and regulates the Xue (Blood); relaxes muscle spasms generally and specifically relieves mid-back tension; Liver Shu Associated point
• UB-19 (-): moves Stagnant Qi; transforms Damp-Heat; influences the ligaments, tendons and other connective tissue; Gall Bladder Shu Associated point
UB-22 (- or + and
D): disperses Stagnation; tonifies the Kidney; resolves Dampness; strengthens the low back; releases back muscle spasms; relieves pain and stiffness; needle with lifting and thrusting, rotate then retain; Triple Warmer Shu Associated point
UB-23 (- or + and
D): tonifies the Kidney and strengthens Yang; resolves Dampness; nourishes Yin, Xue (Blood) and Kidney Jing (Essence); strengthens the lower back; benefits the bones; disperse Stagnation and relieves pain; needle with lifting and thrusting, rotate then retain; Kidney Shu Associated point
UB-47/52 (- or + and
D): tonifies Kidney Qi, Kidney Yang, Kidney Yin, Jing (Essence) and Yuan (Original) Qi; resolves Dampness; disperses Stagnation and relieves pain; strengthens the low back; needle with lifting and thrusting, rotate then retain; Kidney psychospiritual associated point
UB-25 (- or + and
D) : resolves Damp-Heat; warms Cold and dries Damp-Cold; benefits the lower back and knees; disperses Stagnation and relieves pain; strengthens the low back; needle with lifting and thrusting, with the needle angled slightly away from the spine, rotate then retain; Large Intestine Shu Associated point
UB-49/54 (- or + and
D): resolves Damp-Heat; strengthens the lower back; benefits the hips; relaxes the sinews; Large Intestine psychospiritual associated point
UB-26 (- or + and
D): regulates the Lower Warmer; transforms Damp-Stagnation; resolves Dampness and Damp-Heat; warms Cold and dries Damp-Cold; "relates to Kidney Yin" (Finkelstein, p. 45); strengthens the spine, esp. lower back, and knees; disperses Stagnation and relieves pain; needle with lifting and thrust, rotate then retain
• UB-27 (- or + and
D): eliminates Dampness and cools Heat; resolves Dampness; strengthens the lower back; Small Intestine Shu Associated point
UB-28 (- or + and
D): dispels Wind and Dampness; reinforces Yuan (Original) Qi; benefits the back and spine, esp. the lumbar vertebrae; Bladder Shu Associated point
UB-29 (- or + and
D): dispels Wind and Cold; affects Lower Warmer; strengthens the back, esp. sacrum; Extra Associated point of the sacrum (Mann, p. 36)
• UB-30 (- or + and
D): transforms Damp-Heat; consolidates Jing (Essence); sensitizes lumbar and pelvic regions
UB-31 to UB-34 (- or + and
D): invigorate the Xue (Blood); transform Damp-Heat; promote urination; open the pelvis and disperse Lower Warmer Stagnation; strengthen the lower back and legs
UB-51/37 (-): promotes circulation of Qi and Xue (Blood); disperses Stagnation and Obstruction; strengthens low back; benefits hips; relaxes sinews and tendons; "gateway" to local musculature (Lade, p. 156)
UB-54/40 (-): transforms Damp-Heat; controls the renal region (Finkelstein, p. 49); strengthens the low back and waist; relaxes the sinews and muscles; benefits the lower back, hips, legs and knees; specific for acute lumbar sprain, also if pain radiates down the posterior aspect of the leg; retain 10 mins.; Bladder He Sea Uniting and Earth point; Command point of the back (upper and lower); point of departure of divergent channels of Bladder and Kidney
• UB-56 (-): promotes local circulation of Qi and Xue (Blood); disperses Stagnation and Obstruction; if pain radiates down posterior aspect of the leg; retain 10 mins.
• UB-57 (-): dispels Wind and clears Heat; transforms Damp-Heat; strengthens the lower back; benefits the hips; relaxes the sinews and muscles; main point for all physical trauma (Finkelstein, p. 49); disperses Qi in the Bladder channel, according to Mingtang (Finkelstein, p. 49); releases spasms; esp. if pain radiates down the posterior aspect of the leg; retain 10 mins.
UB-58 (- or +): dispels Wind and Wind-Damp; promotes flow of Qi; strengthens Kidney function; eases low back pain; benefits sciatica; frees the channels and invigorates the collateral vessels; sedates pain; Bladder Luo Connecting point
• UB-59 (-): regulates Qi; dispels Wind and clears Heat; promotes flow of Xue (Blood); disperses Damp-Heat; effects the Yang Qiao Mai (Yang Motility Vessel); relaxes the sinews, tendons and muscles; benefits and strengthens the lower back; esp. relieves pain and spasm along the Bladder channel; frees the channels and invigorates the collateral vessels; sedates pain; Xi Cleft Accumulation point of the Yang Qiao Mai (Yang Motility Vessel)
UB-60 (-): disperses Wind; promotes Qi function and Xue (Blood) circulation; reinforces the Kidney; strengthens the lower back; relaxes the sinews, tendons and muscles of the neck, shoulder, waist, back, ankle and foot, esp. the lower back; frees the channels and collateral vessels; relieves pain; Bladder Fire point
UB-62 (- with ion-pumping cords): dispels Wind and Cold; opens and moves the Yang Qiao Mai (Yang Motility Vessel); regulates the Du Mai (Governing Vessel) and benefits Du Mai (Governing Vessel) disorders; soothes sinews, tendons and vessels; relaxes the Muscle channels; Master point of the Yang Qiao Mai (Yang Motility Vessel); Couple point of the Du Mai (Governing Vessel
• UB-64 (-): disperses Wind; clears Heat; pacifies the Shen; cools and clears the Brain; frees the channels and invigorates the collateral vessels; Bladder Yuan Source point
• UB-65 (-): dispels Wind; drains Shi (Excess); relaxes muscles and tendons; invigorates the collateral vessels; esp. for lower leg pain (Zhang), Bladder Wood and Dispersion point
GB-26 (-): regulates the Dai Mai (Girdle Vessel); alleviates Damp-Heat; regulates the waist and relaxes muscles of the lumbar spine, esp. iliopsoas; clears and invigorates the channels; Entry point of the Dai Mai (Girdle Vessel); Jiao Hui Intersecting point of Dai Mai (Girdle Vessel) and Foot Xiao Yang (Gall Bladder) channel
GB-30 (- or + and
D): dispels Wind and Cold; strengthens the lower back; relieves soreness and pain in the lower back, buttocks and hip; regulates and benefits the hip joint; strengthens the thigh; benefits the knee; dissipates Wind-Damp in the channels and connecting vessels; frees the channels and removes Obstructions; relaxes the muscles and tendons; treats Bi, paralysis and atony of the lower extremities; Jiao Hui Intersecting point of the Foot Tai Yang (Bladder) channel on the Foot Xiao Yang (Gall Bladder) channel
GB-31 (- and/or
D): disperses Wind and Cold; clears Heat and transforms Damp; strengthens the waist, thighs and knees; strengthens bones; relaxes and strengthens sinews and tendons; relieves soreness and pain in lower back and leg
GB-34 (+): opens and drains the Gall Bladder to regulate distribution of functional Qi (Finkelstein, p. 68); clears Dampness and cools Heat; facilitates and harmonizes the Liver; strengthens and relaxes sinews and tendons; benefits joints, esp. knees and hips; opens Gall Bladder channel and invigorates the collateral vessels; alleviates pain; Gall Bladder He Sea Uniting and Earth point; Hui Reunion point of Jin (sinews and tendons)
• GB-35 (+): regulates the Gall Bladder; disperses Liver Fire; invigorates the Xue (Blood); soothes the sinews and tendons; relieves pain; Xi Cleft Accumulation point of the Yang Wei Mai (Yang Linking Vessel)
• GB-38 (-): dispels Wind and Dampness; reduces Liver and Gall Bladder; dissipates Heat from the Gall Bladder; frees the channels; invigorates the collateral vessels; Gall Bladder Fire and Dispersion point
GB-39 (-): transforms Damp-Heat; pacifies the Liver and regulates the Gall Bladder; clears Heat and communicates the superficial with the internal of the three Foot Yang channels; relaxes the muscles and sinews; strengthens the Bones; expels Wind-Damp and otherwise frees the channels and connecting vessels; esp. with difficulty rising after sitting and/or with pain and soreness of the lower leg, esp. calf muscles; Hui Reunion point of the Marrow; Jiao Hui Intersecting point of the three primary Yang channels of leg.
• GB-40 (+): drains the Liver and Gall Bladder; spreads the Liver Qi; benefits Gall Bladder; transforms Damp-Heat; treats external trauma, esp. below the waist; benefits the joints; frees the channels; esp. with difficulty rising after sitting; Gall Bladder Yuan Source point
GB-41 (- with ion-pumping cords): dissipates Wind; regulates the Liver and Gall Bladder; removes Stagnancy of Liver Qi; clears and regulates the Dai Mai (Girdle Vessel); clears Wetness (Damp Spleen) by draining into Dai Mai (Girdle Vessel), thereby increasing Spleen Qi and Xue (Blood) production and warming the extremities; dispels Damp-Heat; Gall Bladder Wood and Horary point; Master point of the Dai Mai (Girdle Vessel); Couple point of the Yang Wei Mai (Yang Linking Vessel)
• ling hou (-): facilitates flow of Qi and Xue (Blood); dissipates Wind; disperses Damp and Cold; relaxes and strengthens sinews and tendons; facilitates the joints, esp. the knees; frees the channels and invigorates the collateral vessels
• St-36 (- and/or
D): dispels Cold and expels Wind; regulates and strengthens Qi and Xue (Blood); dispels Dampness; spreads Liver Qi and benefits the Gall Bladder; nourishes the Kidney, Liver and Spleen; clears Heat from the Yang organs and drains Shi (Excess) from the Yang channels; frees the channels and invigorates the collateral vessels; esp. if pain radiates down the lateral aspect of the leg; retain 10 mins.; Stomach He Sea Lower Uniting, Earth and Horary point
• St-41 (-): dispels Wind; removes Obstructions from Stomach channel; transforms Damp Stagnation; sedates spasms; if pain radiates down the lateral aspect of the leg; retain 10 mins.; Stomach Fire and Tonification point

» other points for consideration:
GV-26 (-): dispels Wind; pacifies the Shen and stabilizes the Will; regulates the Du Mai (Governing Vessel); frees the channels and invigorates the Qi circulation; benefits the spine, esp. lumbar and cervical; treats lip tremor
TW-5 (- with ion-pumping cords): dissipates Wind; opens and moves the Yang Wei Mai (Yang Linking Vessel) and regulates the Dai Mai (Girdle Vessel); frees the channels to facilitate the circulation of Qi in the channels; invigorates the collateral vessels; strengthens and relaxes the sinews and tendons; alleviates pain; Triple Warmer Luo Connecting point; Master point of the Yang Wei Mai (Yang Linking Vessel); Couple point of the Dai Mai (Girdle Vessel)
SI-3 (- with ion-pumping cords): opens the Du Mai (Governing Vessel) and regulates the Yang Qiao Mai (Yang Motility Vessel); dispels Dampness and Internal Heat; strengthens the spine; relaxes the sinews and muscles; benefits the joints; releases muscle spasms; invigorates the channels; Small Intestine Wood and Tonification point; Master point of the Du Mai (Governing Vessel); Couple point of the Yang Qiao Mai (Yang Motility Vessel)
• CV-3 (=): alleviates Damp-Heat; tonifies the Kidney Qi and Yang; relieves pain; Bladder Mu Alarm point
• Kd-4 (-): nourishes the Shen and Yin; regulates the Kidney; reinforces the Liver and Kidney, the latter through longitudinal Luo vessels; facilitates the flow of Qi and Xue (Blood); harmonizes the Xue (Blood); Kidney Luo Connecting point
• Sp-2 (d.
D): stimulates the flow of Qi; dispels Exterior symptom-complex; strengthens the Spleen, esp. tonifies Spleen Yang; eliminates Dampness caused by Spleen Xu (Deficiency); three cones of direct moxa, red bean size, if sciatica very severe (So, 1987, p. 295); Spleen Fire and Tonification point

ear: sciatic, shen men, kidney, ischium, adrenal, lumbar vertebrae, sacrum


footnotes