Now, let’s go a little bit deeper into how acupuncture and herbs benefit sciatica pain.
The causes of sciatica
From the biomedical perspective, the cause of sciatic nerve pain is generally considered structural in nature. Whether it is the bones in the spine, the discs between the spines, or even the muscles in the buttocks, each scenario includes some sort of mechanical irritation to the sciatic nerve which exits the spinal cord in the lower back and travels down the leg into the foot.
From the perspective of traditional Chinese medicine, we look at the pain as one of a number of problems.
Sciatica pain that is aggravated by cold or damp weather.
Sometimes cold or damp qi-energy can get into the acupuncture meridians and cause a dull, heavy pain that radiates along the trajectory of one of the meridians from the lower back to the heel, or anywhere in between. This kind of sciatica is aggravated by cold or damp weather. In fact, many aches or pains that are aggravated by cold or damp weather are considered to be the same problem. Many arthritic conditions fall into this category.
Along with acupuncture, moxibustion is often used for this sort of problem. Moxibustion is the application of heat to the meridians or acupoints. Traditionally, the herb Ai Ye (mugwort) is used in the shape of a cigar with the hot part focused on the part of the body that hurts. Moxa comes in many shapes and sizes. The “cigar” style is popular in American clinics, but again it varies widely. Some clinics favor the use of heat lamps or TDK lamps which are a metal plate that radiates heat.
Another weapon against sciatica that is aggravated by cold or damp weather is an herbal formula that is said to be warm and dry in nature. That will help with any pain in the muscles, nerves or joints that is aggravated by cold and/or damp weather. Du Huo Ji Sheng Tang is its name. It tastes something like a cross between hot coffee and Vicks’ Mentholatum.
Sciatica is worse in the evening, better in the morning and aggravated by fatigue.
Another cause of sciatica is called a deficiency of the Liver or Kidney. That doesn’t mean that there’s anything wrong with your liver or kidney from a biomedical perspective. I capitalize the words Liver and Kidney to remind the reader that I’m really talking about different concepts than the usual organs we think of. Fortunately, it doesn’t matter what we call it. The important thing is that we can make you feel better and in the case of a Liver and/or Kidney deficiency we most certainly can help. The only problem with treating deficiency syndromes is that they can take longer than some of the other causes of sciatica. One way to determine if your sciatica is due to deficiency is if the pain is aggravated by fatigue. Deficiency syndromes tend to have a slow onset and a long duration which is to say that this sciatica is a chronic or long-term condition, not something that just popped up one day.
I have some patients who have responded very well to herbal medicines for sciatica that is aggravated by fatigue. Its good to know exactly what is deficient before treating this. Generally the deficiency is going to be one of the four key substances in Chinese medical theory. Qi, Blood, Yin or Yang. Knowing which is the best way to treat this. However lacking the ability to get a diagnosis, it is the next best thing to get the herb formula that most often applies to this sort of sciatica pain. It is called Jin Gui Shen Qi Wan. You’ll notice that it includes the word “Qi” in its name. Guess what its for? Qi primarily but it can also help with the Yang as they’re related. This formula is about 1,800 years old.
Sciatica pain that is worse in the morning and aggravated by sitting still.
The final factor that can give rise to sciatica really is structural in nature. We call it a stagnation of blood due to local trauma which is to say that you pulled a muscle, or you hurt yourself in a car accident, or maybe you have poor posture and you’re sitting in a chair without enough padding on it. Certain structural issues such as bulging disc can fall into this category too.
Something structural is pinching or irritating the sciatic nerve. This could also be muscle spasms are pinching your sciatic nerve as it passes through the butt region. This is a common cause of sciatica, but as you can see, it is one of three possible causes for your sciatic pain. If this is the cause of your sciatic pain, it will probably help to move around. The pain will be worse in the morning because you haven’t moved much in the night and since the problem is all about a lack of movement of qi energy or blood, the fact that the leg hasn’t moved all night will aggravate that condition of stagnation. Movement or activity will help with this kind of pain. This cause of sciatica is the most responsive to acupuncture and responds the quickest to treatment.
An herbal formula often applied to this issue is called Shao Yao Gan Cao Tang. It is used specifically for when you have tight muscles in the lower back or hip/buttocks. Its action doesn’t affect the nerve directly, only the muscles around the nerve. This particular formula has a lot of gan cao in it. That’s licorice root and with long-term use it can cause a rise in blood pressure because it lowers the urinary output just a bit. If you have hypertension, only take this formula if you have the means by which you can monitor your blood pressure. For the rest of us, it should be fine as is.
When the sciatic pain is worse in the absence of movement, we can assume that there is something stuck causing the pain. The difference between qi stagnation and blood stagnation can be thought of as the difference between a pinched nerve due to tight muscles and a pinched nerve due to a bulging disc. There’s a lot of overlap there and even in Chinese medicine the line between qi and blood stagnation isn’t always that clear. Fortunately, when it comes to treating the pain, it doesn’t really matter.
Treatments
Acupuncture
Fine needles, some so thin as to appear more like wires than needles, would be inserted along the pathway of the pain to move the qi energy locally and dissipate the external pathogen as well as activate the movement of the qi energy to remove the pain. Sometimes other points in the body would be used to treat the damp or cold or wind that may have spread out into the rest of the body in addition to the Urinary Bladder meridian.
Electric stimulation (“electro-stim”) can be used on the needles that pass through the leg to provide an even greater amount of stimulation. Electro-stim is a more recent invention applied to acupuncture. While the treatment principle is not at all “traditional Chinese medicine”, it is a commonly used tool within the acupuncture clinic. The reasoning is that with minute pulses of electricity, the local nerves are over stimulated, not with pain, but with a painless electrical shock. This over-stimulation makes the nerves turn down their own sensitivity, and hence, all the other pain that travels through those nerves is also diminished. This is the basis behind acupuncture anesthesia, and this principle applies to sciatica as well.
Ear Acupuncture
Ear Acupuncture can be used for additional assistance in treating the pain associated with sciatica. Once the needles are removed, seeds can be taped into the ears so as to supply on-going stimulation to these points. These seeds or even magnets can be worn for a few days at a time. Of course, care should be given to the condition of the ear’s skin so as to avoid any infection caused by dirt or moisture collecting beneath the tape used to affix the ear seeds. There are a number of products that your acupuncturist will have access to that make use of flesh color tape, not unlike the flesh color Band-Aid bandages. These pieces of tape needn’t look funny in your ears.
In the past, subcutaneous needles have been used instead of ear seeds. Subcutaneous needles are like tiny thumbtacks. They are also effective, but because the skin is broken, and often times, the needles are not changed everyday, the risk of infection increases. For this reason, I don’t personally suggest this treatment. However if you’re in a position to change the little subcutaneous needle everyday and clean the ear, then they can be an effective adjunct to acupuncture for your sciatica pain.
Qi Gong (Chi Kung)
These exercises direct the qi in the body toward the area of the body where the qi energy is either deficient or stagnant. Personally, I think that qi gong exercises and acupuncture have something in common. In qi gong training, it is said that the shen leads the qi. That means that if you’re doing an exercise in which you are focusing your mind (shen) on your lower back, then the qi goes there, and healing takes place. Acupuncture performs the same function. The funny thing about having a needle stuck into your back is that you think about it. You’re acutely aware of it. It forces the mind to become conscious of that area, and so the qi is led to that area. Qi gong exercises are used in between acupuncture treatments.
Qi gong is about as close to yoga as the Chinese get. Like yoga, there are hundreds of kinds. Some qi gongs move, some stand still, some sit, some stand. Some require superhuman patience and strength; others only require a little mental focus.
External Qi Gong
Sometimes, your practitioner will apply qi to your body from his or hers by placing his or her hands onto your body. Often times, their hands will be very warm, signifying that they’ve successfully directed their own qi energy into their hands for “expression” into you.
As with any therapy that requires touching, it is absolutely essential that you feel comfortable with the treatment. If you don’t, your muscles will tighten up and the therapy will produce negative effects. You don’t want that. If you don’t know how you feel about being touched with either external qi gong or even massage, your body will tell you. A muscle tightening up beneath the pressure of a therapist is called a guarding response. Your body is guarding itself from further injury. If your body senses the opportunity for further injury due to the activities of your practitioner you need to honor that body knowledge. Your body’s really smart, and regardless of how much you like the practitioner, or believe in his or her medicine, your body has the last word, and if it doesn’t like what’s happening, then it is best to listen to your body’s wishes.
If you’re uncomfortable with this type of therapy, please tell your practitioner. On the other hand, if you are comfortable with it, you’ll find that with the right practitioner, this can be among the most significant and moving of all therapies. This technique of external qi gong can certainly begin to look much like the more Christian “laying on of hands” and can have some truly divine manifestations in your life.
Chinese Massage or “Tui Na”
Massage therapy for sciatica can’t be underestimated. At the Chinese hospital (from which I’m actually writing this article) there is a department that does nothing but massage chronic, bed-ridden sciatica patients. The massage therapy is given for twenty minutes, once per day. Along with the other therapies listed in this article, I’ve seen patients undergo life-saving changes. Where one patient was literally carried in by family members, a couple of weeks later, he’s walking on his own, with much less pain, obviously.
Massage therapy usually requires daily sessions. Shiatsu, Anma and the other Oriental message techniques are also valuable. There are a variety of western massage techniques that can also assist, but I’m unable to really assess them in this article. Again, have a treatment and your body will tell you if you liked it or not.
Conclusion
Traditional Oriental medicine has been treating sciatica pain as far back as anybody can remember. While TOM identifies a variety of causes and treatments for the variety of issues that can cause sciatica pain, it should be noted that evolutionarily speaking, we haven’t been standing upright so long as to work out all of the kinks. In another thousand generations this entire issue may be a long distant concern as we’ll have likely developed the necessary structural changes to support our upright body. Until then, we’ll have to look to the distant past for non-surgical, holistic, and safe therapies for sciatica pain.
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