Sciatic Pain - Acupuncture can help
 

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Millwoods Acupuncture Center
102, 2603 Hewes Way
Edmonton AB,   Canada

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Sciatic pain

 

坐骨神经痛的中医治疗

Treatment of Sciatic pain by Traditional Chinese Medicine (TCM)

 

坐骨神经痛并不是一个病,而是一个症状。就如同发热不是一个病,而只是一个症状。坐骨神经从脊髓,经腰骶部下传到下肢后方,途径中任何因素对于该神经的压迫,以及神经本身的炎症,肿瘤,等等都会导致腰骶部和下肢后方的疼痛。从脊髓到坐骨神经的全程中,有可能造成对于坐骨神经的压迫的因素可以是炎症,椎管狭窄(如腰椎间盘突出等),外伤,该神经周围肌肉的痉挛,以及肿瘤(包括囊肿)等等。所以,如果医生告诉你,你得的是坐骨神经痛,这并不是一个真正的诊断名词。进一步要诊断的,是什么原因导致了该神经的受压而让你觉得痛。

Sciatic pain is not a diagnostic term. It is only a symptom, similar to shoulder pain, that is also a symptom, not a diagnosis yet. Sciatic nerve goes from spine, through lower back, hip, to the back of the though, outside of the small leg and outside of the feet. Any reasons that press the nerve, such as by enlarged bone structure, spasm or swelling of the soft tissue around the nerve, or the damage or inflammation of the nerve per se, or tumor inside the spine, all can cause the pain on the zones that the nerve distributes to.  Therefore, if your doctor tells you that you suffer from sciatic pain, it is not an exact diagnosis yet. He needs to further more find the reason(s) for the hurt of the nerve.

In clinic, most time, the sciatic pain is due to the spasm of the muscles in the hip and due to the suppress of the nerve by a protruded intervertebral disk. 

坐骨神经痛非常常见。将坐骨神经痛分为根性坐骨神经痛、干性坐骨神经痛、丛性坐骨神经等等对于中医治疗的用处并不大。

It is very common in clinic to see a patient with sciatic pain.  To subgroup the patients as stem type, root type, or shrub type is not so useful for TCM clinic practice. TCM pays more attention to see if the pain is due to Cold, Fire, Wetness, blood-stagnation, Qi-stagnation, or Phlegm accumulation in the area where the nerves goes.

中医治疗坐骨神经痛采用草药疗法,针灸疗法,艾灸以及按摩。对于绝大多数病人来说,疗效很好,个别由于严重的腰椎间盘突出,或脊髓肿瘤造成的坐骨神经痛,则需要手术治疗。一般来说,无论使用草药疗法或针灸,第一次治疗后疼痛就会有不同程度的减轻,疼痛完全多需要一到两个月的疗程。

Chinese medicine uses herbal therapy, acupuncture, moxibustion, or Chinese Tuina massage (you can also call it Chinese chiropractor) therapy for the treatment of sciatic pain. For most cases, it works very well. Generally speaking, no matter to use the herbal therapy or acupuncture, after the first session of treatment, the pain can be reduced to some level. To make the pain complete disappear, it needs one to two months of treatment.

草药疗法

Chinese herbal therapy

草药疗法需要先区分坐骨神经痛是否有明显的外伤史,比如说疼痛发生在用力抬重物,咳嗽,打喷嚏,便秘时用力大便等。如果急性疼痛而且有明显的外伤史,我们多采用陈少冬先生的方剂。

For the use of Chinese herbal therapy, we need to know if the sciatic pain is due to a trauma or not. For example, we need to know if the pain happens after lifting heavy stuff, or cough, or sneeze, or pushing hard during bowel movement, etc. If it comes due to a trauma, we choose the herbal formula established by doctor Shaodong Chen.

如果病人疼痛部位明显,腰椎两侧有压痛点,并可有牵扯性下肢痛。皮部多不红不肿。表情痛苦,或头面汗出,脉多弦紧。此证用整腰汤治疗,或酌情选择活络效灵丹,或桃红通督汤。

If the patient feels mostly pain and there is no clear skin swelling or bruise, the pain is not affected by the weather change, we use herbal formula Zheng Yao Tang, Huo Luo Xiao Ling Dan, or Tao Hong Tong Dou Tang.

腰痛,腰部功能不利,或腰肌红肿。下肢疼痛,口渴,小便黄。舌红,苔黄厚,脉弦数。用知柏泄热化瘀汤。

If the tongue is red in color, the tongue covering is yellow and thick, the pulse feels string-fast, it indicates that there is Fire-Wetness inside the body. Use herbal formula Zhi Bo Xie Re Hua Yu Tang.

腰部酸软疼痛,并可放射至下肢。面色黧黑,头晕,阴冷天气疼痛加重。舌可见瘀斑,脉沉涩。用补肾活血汤加减, 或考虑用肾着汤合独活寄生汤。

If the pain is worse during raining weather, and there is purple color on the tongue, it indicates a Wetness and Blood stagnation inside the body, use Bu Shen Huo Xue Tang or use Shen Zhao Tang plus Du Huo Ji Sheng Tang.

如果病人没有明显的外伤史,则考虑下列情况参考用药:

If the patient has no clear history of a trauma, use the following formula:

如果疼痛剧烈,下肢肌肉紧张拘挛,用芍药甘草汤,或芍药甘草汤合麻黄附子细辛汤。

If the pain is very severe, the muscle on the leg feels spasm, use Shao Yao Gan Cao Tang, or Shao Yao Gan Cao Tang plus Ma Huang Fu Zi Xi Xing Tang.

如果病人身热,喜欢冷饮冰饮,用麻杏石甘汤加伸筋草,木瓜等。或麻杏石甘汤合芍药甘草汤。

If the patient feels hot in the body, and likes to drink cold or ice water, use Ma Xing Shi Gan Tang, plus herb Sheng Jing Cao, Mu Gua, etc. or use Ma Xing Shi Gan Tang plus Shao Yao Gan Cao Tang.

体质强壮,上腹部硬满不适有压痛,用大柴胡汤。体质强壮而下腹部有胀满而不适或痛,或有便秘者,用桃核承气汤。或对于体质强壮者,将大柴胡汤与桃核承气汤合用。

If the patient is strong in body constitution, has hard the tightness feeling on the upper stomach, use Da Chai Hu Tang. For such patient, if the lower abdomen feels tight or discomfort or pain too, or constipation, use Tao He Cheng Qi Tang.

如果阳虚寒结,腹痛便秘,胁下偏痛,发热,手足厥冷,舌苔白腻,脉紧弦。用大黄附子汤。或大黄附子汤合芍药甘草汤。

If the body condition is Yang deficiency and Cold accumulation into a cold mass, the patient feels pain on the side of abdomen too, feels hot in the body but cold in the hands and feet, use Da Huang Fu Zi Tang, or Da Huang Fu Zi Tang plus Shao Yao Gan Cao Tang.

如果病人常手脚冰冷,用当归四逆汤和芍药甘草汤。

If the patient usually feels cold hands and feet, use Dang Gui Si Ni Tang plus Shao Yao Gan Cao Tang.

如果全身酸痛,坐骨神经痛夜晚较剧者, 用疏经活血汤。

If the whole body also feels sour, and the sciatic pain is worse at night, use Shu Jing Huo Xue Tang.

身冷,怕冷,面热,脚冰者,常有小腿拘挛者,用五积散合芍药甘草汤。

If the patient feels cold in the body, and in the feet, but hot on the face, and if the person has spasm in the calf from time to time, use Wu Ji San plus Shao Yao Gan Cao Tang. 

如果病人有妇科疾病,月经不正常,小腹紧张或可触及包块 (子宫肌瘤或卵巢囊肿,或子宫内膜异位症,或慢性阑尾炎等等),用桂枝茯苓丸和芍药甘草汤。

If the patient is with some ganecologic disorders, disorder of menstruation, some mass that can be touched on the lower abdomen (due to tumor from uterus or ovary, or inflammation from intestine, such as chronic appendicitis, or due to endometriosis), use Gui Zhi Fu Ling Wan plus Shao Yao Gan Cao Tang. 

老人腰部神经痛,体虚,特别是糖尿病后继发的坐骨神经痛用八味丸。

If patient, especially for old person, has pain in the lower back, especially the pain might be due to diabetes, use Ba Wei Wan.

如果难以作以上分型,可直接用全蝎红花汤:全蝎 10-20 克,红花5-15克, 威灵仙20-40克,大枣 6-10枚, 红糖 10-20 (兑服)。

If it is really hard to tell which herbal formula should be used, use Quan Xie Hong Hua Tang.

单用草药疗法,一般需要每天服药,连续2-3天可见效(指的是疼痛程度开始减轻)。

For the herbal decoction, it needs to be drunk every day, three times a day. The pain can be reduced from the second day.

针灸也是常用来治疗坐骨神经痛的方法。手法很多,不同的针灸医生可能会用不同的方法。对于轻度到中度腰椎间盘突出造成的坐骨神经痛,针灸有效。常用的穴位是腰骶部和患肢后方的穴位,如肾俞,大肠俞,小肠俞,秩边,环跳,腰阳关,承扶,委中,阳陵泉,阴陵泉,足三里,丘墟,足临泣等等。针灸常常和拔罐,艾灸一同使用。针灸后也会用草药膏布外贴在患处最疼痛的部位。

Acupuncture is another commonly used therapy for sciatic pain. There are many different remedies for the acupuncture, depending on the acupuncturists. It works for slight to medium level of the sciatic pain. The commonly used acupuncture points are those located on the lower back, and back of the legs, such as Shen Shu, Da Chang Shu, Xiao Chang Shu, Zhi Bian, Huang Tiao, Yao Yang Guan, Cheng Fu, Wei Zhong, Yang Ling Quan, Qiu Xu, and Zu Ling Ti, etc. Cupping and Moxibustion is usually used during the acupuncture session too. After acupuncture, we also apply a herbal patch on to the painful place.

针灸需要每天一次,大约2-3次后疼痛会明显减轻。以后每周两次或每周一次维持治疗直至疼痛完全消失。

Acupuncture needs to be performed every day. The pain can start to become less after the fist treatment. Acupuncture should be done at least two to three times a week until the pain is much less and much tolerable. After that, it is needed once a week for two to three weeks for a maintenance.

对于重度的,由于腰椎间盘突出造成的坐骨神经痛,往往需要中医的正骨手法将突出的腰椎间盘复位才行,可惜很难在国外找到有这种能力的正骨医生。正骨复位后仍然需要中医草药和针灸治疗以巩固疗效。

For very severe sciatic pain, especially if it is caused by intervertebral disk protrution, it is better to ask a Chinese style of chiropractor to return the disk back to its normal position. However unfortunately it is difficult to find such chiropractor in the western world. After the treatment of such Chinese style of chiropractor, we still need to use Chinese herbal therapy or acupuncture to reduce swelling or spasm of surrounding tissues that pressed the sciatic nerve.   

治疗坐骨神经痛的过程中,特别是第一次治疗后,有些人,大约5% 的病人可能会觉得疼痛更加剧烈。我们将之称为身体的过度反应。这种加剧的疼痛一般持续半天到一天,之后疼痛往往会比一般人更快地减轻。所以,有这种过度反应是坏事也是好事。极个别情况下,这种加剧的疼痛可能是由于治疗不当或治疗过度所造成的,需要纠正治疗方法。每个病人都需要知道这一点,医生们会尽力治疗以减轻疼痛,但是不是所有的事情都是医生们可以控制的了的。所以,时时保持和医生沟通, 尽量避免过度治疗或不当治疗,争取最快解决疼痛也是医生的愿望。

During the treatment of sciatic pain, especially after the first treatment, there is about 5% of patients who may feel more pain. It is called healing crisis. It usually lasts for half day to one day. After that, the pain would subside much faster than most other patients. Therefore, it is bad for the patient on one side, but it is also a good sign on another. Very rarely, such worse pain is due to a malpractice of the acupuncturist. Everyone should understand this possibility and tell your acupuncturist if you do feel more pain after the treatment, so as to allow the acupuncturist to change his treatment remedies. It is the mutual hope from both patient and the acupuncturist to reduce the sciatic pain as soon as possible.

患坐骨神经痛的病人必须卧床休息而不是继续工作甚至参加体育锻炼。疼痛是身体对我们发出的要求我们休息的信号,而不是要我们作更多躯体的运动。千万不要误解身体对我们的信息。只有等到疼痛基本消失后才能逐渐增加活动量。饮食方面并不需要特别的注意,只要保持大便通畅就可以了。

Patient with sciatic pain must have a break from heavy physical activities. We should know that the pain is the signal from our body asking us to slow down, rather than to move more vigorously. Do not mis-regard the meaning of any signals from our body. We must wait until the pain completely goes away. The treatment for sciatic pain does not need special care for diet. The attention in the diet, if any, is to prevent constipation since it may make the sciatic pain worse during bowel movement.

疼痛消失后,如果注意避免不当的体力活动,如抬重物或激烈的体育运动,一般疼痛不会再发。否则,就如同你本来就没有坐骨神经痛而现在会得坐骨神经痛一样,现在坐骨神经已经受到了损伤,以后不当的躯体运动当然还会造成新的坐骨神经痛。不可能指望这次疼痛消失后就永远不会再有疼痛发作。这样的指望是狠不现实的。

After disappear of the sciatic pain, the person should still be careful not to have heavy physical action, such as lifting heavy stuff, or vigorous exercise. Otherwise, the pain may come back again. You see, before you had the sciatic pain this time, you have no any problem for your lower back and your sciatic nerve. Now your sciatic nerve has been damaged one time, and there would be higher chance that your sciatic nerve is hurt again if you do not care it in future. You cannot expect that your sciatic nerve becomes much stronger than ever so as no future hurt upon similar vigorous physical activities. We must be very realistic.