Sciatica

Keywords: Chinese medicine, acupuncture, warm needle acupuncture, cupping, sciatica

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In issue #5, 2004 on page number 27 of Gan Su Zhong Yi (Gansu Chinese Medicine), Song Yu-fang published an article titled, "Observations on the Therapeutic Efficacy of Treating 318 Patients with Sciatic Pain with Warm Needle & Cupping." Because sciatica is a common problem in clinical practice for any practitioner doing physical medicine (acupuncture, chiropractic, physical therapy, massage therapy, osteopathy), a summary of the main points of this article is presented below.

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Cohort description

Altogether, there were 502 patients enrolled in this two-wing comparison study. Of these, 302 were male and 200 were female aged 26-70 years. The course of disease ranged from one half month to 20 years, Two hundred four patients had foot shao yang gallbladder sciatica, 256 had foot tai yang bladder channel sciatica, and 42 had pain on both these channels. These 502 patients were then randomly divided into two groups, a so-called treatment group of 318 patients and a comparison group of 184.

Treatment group: Main points chosen: Shen Shu (BI 23), Da Chang Shu (BI 25), Huan Tiao (BI 30), Yang Ling Quan (GB 34). Additional points depending on symptoms: If there was foot tai yang bladder channel pain, then Kun Lun (BI 60), Wei Zhong (BI 40), and Zhi Bian (BI 54) were added. If there was foot shao yang gallbladder channel pain, Feng Shi (GB 31), Jue Gu (GB 39), and Zu Lin Qi (GB 41) were added. If there was pain on both these channels, then both sets of above points were added. Patients were asked to lie on their side with the affected limb uppermost. After disinfection with alcohol, 28 gauge fine needles were inserted deeply into the respective points. After obtaining the qi, even supplementing-even draining and technique was used. Then, while the needles were retained in situ, 2-2.5cm long sections of moxa roll were affixed to the handles of the needles and burnt. After the moxa burned down, the needles were removed, and fire cupping was used over Shen Shu, Da Chang Shu, and Huan Tiao. Shen Shu and Da Chang Shu were needled 1-1.5 inches deep with the tips of the needles angled towards the spine. Huan Tiao was needled 2-3 inches deep and a sensation of soreness and distention was propagated down the leg. Yang Ling Quan was needled 1-1.5 inches deep with a sensations of soreness and distention propagated to the foot. The cups were retained for 5-15 minutes and produced either redness or a purplish color in the area on which they were affixed. The patients in this group received one treatment per day, and 10 treatments equaled one course. Between each successive course, they were allowed a 3-5 day rest.

Comparison group: Main points chosen: Da Chang Shu (BI 25), Huan Tiao (GB 30), Yang Ling Quan (GB 34). Additional points: If there was foot tai yang bladder channel pain, Zhi Bian (BI 54), Wei Zhong (BI 40), and Kun Lun (BI 60) were added. If there was foot shao yang gallbladder channel pain, Feng Shi (GB 31), Jue Gu (GB 39), and Zu Lin Qi (GB 41) were added. After disinfection, 28 gauge fine needles 1.5-3 inches long were inserted 0.5-2 inches deep and then manipulated with specific supplementation or draining hand technique. After obtaining the qi, the needles were retained for 30 minutes and were restimulated at 10-minute intervals. One such treatment was given per day, and 10 treatments equaled one course.

Study outcomes

Cure was defined as complete disappearance of all the clinical symptoms with an ability to return to normal work and no recurrence on follow-up within half a year. Marked effect was defined as basic disappearance of clinical symptoms. However, there was still some discomfort depending on the weather or after the patient over-worked and became fatigued. These patients were also able to resume their ordinary work. Improvement meant that the clinical symptoms showed improvement. No effect meant that there was no change from before to after treatment. Based on these criteria, in the treatment group, 144 patients were cured, 115 got a marked effect, 48 improved, and 11 got no effect, for a total effectiveness rate of 96.5%. In the comparison group, 66 patients were cured, 48 got a marked effect, 44 improved, and 26 got no effect, for a total effectiveness rate of only 85.5%. Therefore, it was concluded that the protocol using warm needle and cupping was more effective than the acupuncture alone (P < 0.01).

Discussion

According to Dr. Song, sciatica is categorized as an impediment (bi) condition in Chinese medicine and is due to the three types of evil qi of wind, cold, and dampness. If these stagnate and are retained in the channels and network vessels, the qi becomes stagnant and the blood becomes static. Shen Shu, Da Chang Shu, Huan Tiao, and Yang Ling Quan are the main or ruling points in the protocol used on the treatment group. Based on the author's experience, these four points are able to course and free the flow of the channel qi, soothe and extend the qi and blood. Thus qi stagnation is scattered or dissipated and congealed blood is moved. Because it is axiomatic in Chinese medicine that the re-establishment of free flow results in absence of pain, this treatment gets an automatic effect. In addition, warm needling warms the channels and scatters cold, dispels wind and frees the flow of the network vessels, regulates and harmonizes the qi and blood, eliminates dampness and disinhibits the joints. When combined with cupping, the result is to even more effectively free the flow of the channels and network vessels and move the qi and blood, scatter stasis, disperse swelling, and stop pain.

From my point of view, this study underscores the importance of moxibustion and cupping in the over-all practice of "acupuncture." These modalities are not just discretionary adjuncts to needling, but their use in certain instances makes a marked difference in therapeutic effect. In particular, I would make a case for warm needling and cupping specifically freeing the flow in the associated network vessels and more effectively quickening the blood and transforming stasis. Needling of standard acupoints with the so-called "fine needle therapy" that we are all taught in acupuncture school primarily treats diseases affecting the qi located in the channels. However, Dr. Song specifically says that warm needling frees the flow of the network vessels and regulates and harmonizes the qi and the blood and, that the combination of warm needling and cupping, even more effectively frees the flow of the network vessels, moves the qi and blood, and scatters (blood) stasis. In my own experience, many therapeutic failures among Western acupuncturists are due to not adequately addressing the fact that, as Ye Tian-shi said, "enduring diseases enter the network vessels." This means that enduring diseases typically result in the formation of blood stasis in the network vessels, and the majority of Western patients that come for acupuncture are suffering from chronic, enduring diseases. In that case, it is important to add treatments to the protocol which address this blood stasis and free the flow of the network vessels where blood stasis usually lodges, such as Dr. Song has done in this protocol. If you use this protocol with good effect in your patients, please let me know at honora@bluepoppy.com.

abstracted & translated by Honora Lee Wolfe, Dipl. Ac., Lic. Ac., FNAAOM

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