Back Pain, Lumbago

Crooke, Mikrokosmographia, 1618

“Anything that is useful against cold rheumatic pain
is also useful against back pain“. (Rhazes)

Back pain or Lumbago refers to pain int he back, most specifically lower back. Lower back pain may be acute or chronic. Acute back pain can be from muscle or tendon spasm, acute strain, spinal misalignment following stress such as carrying a heavy weight or bending is an unusual position. In most cases, rest with some massage, stretching, exercise, application or warmth etc. is enough to relieve and it will spontaneously resolve. Acute Back Pain that doesn’t resolve in a couple of days, or that is more severe (painful, limited movement etc) can be classified as follows:

Acute Back Pain

• Heat–Inflammatory pain (worse with movement), feels better with cold applied, area may be red, hot and swollen, pulse will be fast or strong.
• Cold–duller pain, worse in cold, feels better with movement, heat or massage. Area feels cold and clammy, pulse is deep and weak or slow.
• Wind–spasmodic and moving pain, may come and go suddenly
• Blood Stasis–fixed pain associated with Trauma, bruising, may have dark veins or capillaries in the area, and the nailbeds or lips maybe slightly cyanotic (blue).

Chronic Back pain

Usually more severe and especially in the elderly often occurs due to degeneration or chronic inflammation. These cases will require longer and stronger treatment, and often may need long-term use of tonic medicines once pain has been relieved.

In general, chronic back pain can be differentiated into:

• Yin Deficient–lower back pain, nocturnal urination, dry mouth and throat, maybe insomnia and night sweats
• Yang Deficient–lower back pain, clear urine, feels the cold, cold hands and feet, pain worse with cold, better with warmth

Structural Damage

Acute Severe or Chronic Back pain can be associated with serious structual damage such as degeneration, rupturing of a disc, or chronic destructive inflammation. These can sometimes be helped with long-term treatment. Herbs such as Comfrey, Soloman’s Seal, Asparagus root and Eucommia Du Zhong are examples of Kidney strengthening medicines that are used for chronic Lower Back pain such as is seen in the old and weak. The various Rehmannia formulas of TCM (Liu Wei Di Huang Wan, Shen Qui Wan, Zuo Gui Wan, Zuo Gui Yin etc.) are useful for these types of chronic back pain too.

Special mention should be made of Velvet Deer Horn (Lu Rong). This is a special type of horn as it grows quickly within one season before ossifying (turning to bone), then falling. During the growth phase it is blood-rich with growth factors to promote bone growth. It is also rich in collagen and calcium. Because of this, it is regarded as a special medicine to restore damaged and degenerated spine and discs in TCM.

Special Formula

Xiao Sui Hua He Decoction–Ruptured Disc

    Astragalus Huang Qi 
    roasted Astragalus Huang Qi  20 grams ea.
    Stephania Han Fang Ji  
    Dang Gui 
    Ligusticum Chuan Xiong 
    Atractylodes Bai Zhu 
    Earthworm (Di Long)                  10 grams ea.
    Leech (Shui Zhi)                            6 grams
    Clematis Wei Ling Xian
    Pawpaw                                        10 grams ea.
    Mustard seed (Brassica alba)     6 grams
Decocted in water and taken orally for 8–16 week. This was used as a conservative treatment of ruptured Disc in a group of patients in China, along with bed rest for 2–3 weeks, and certain exercises. It has good effect. (See here and here)

Yiqi Buxue Recipe–Ruptured Disc

    Astragalus Huang Qi                     20 grams
    Dang Gui                                         10 grams
    Ligusticum Chuan Xiong 
    Earthworm (Di Long)                     15 grams ea.
    Stephania Fang Ji 
    Chaenomelas Mu Gua                  10 grams ea.
    White Mustard seed (Bai Jie Zi)   6 grams
    Clematis Wei Lin Xian                   10 grams
This was studied and forund effective (see here).

Severe Acute Lower Back Pain

    Centipede (Wu Gong)
    Scorpion (Quan Xie)                        equal parts
These are powdered and taken in doses of 1500mg with wine, or they can be taken along another suitable formula such as Du Huo Ji Sheng Wan.

Research:

1. Efficacy and Safety of Modified Duhuo Jisheng Decoction in the Treatment of Lumbar Disc Herniation: A Systematic Review and Meta-Analysis
2. Yiqi Huoxue Recipe Delayed Intervertebral Disc Degeneration by Activating Autophagy