12/03/2019

Back pain

Case study 1
45 old female patient presents with pain in the lower back and lower
limbs for ten days with no recent trauma. The patient has a history of
recurrent episodes of the same problem. There is also a feeling coldness,
soreness, weakness, numbness and paraesthesia over the same area,
these symptoms becoming worse when the weather is cold and the
pain becoming more severe. The pain is relieved by warmth and there is
no exacerbation of the pain movement.
There is general lassitude and poor memory, but the patient’s appetite is
good. She does not sleep soundly and does not feel refreshed on
wakening. Bowel movements and urination are normal. The patient has
a shallow complexion.
• Tongue: Light red body with dry coating, yellow and thick at the toot
• Pulse: Wiry and forceless

Analysis of symptoms:
Aetiology and pathogenesis

Lower back pain and limbs:

• Stagnation in the meridians
Worse with cold better with warmth:
• Stagnation of cold in the meridian
General latitude, poor memory and poor sleep:
• Deficiency of Qi and Blood
Soreness, weakness, numbness and paraesthesia over
the same areas:
• Deficiency of Qi and Blood
Sallow complexion and weak pulse:
• Deficiency

Diagnosis
Site of disease

• In the meridians with under lying • Invasion of pathogenic cold in the

deficiency of organs meridians

• Qi and Blood deficiency

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Treatment principles

• Move Qi and blood stagnation to • Regulate Du mai 

alleviate the pain. • Dispel stasis and free the flow of the 
meridian Qi
• Tonify Qi and blood • Subsequently strengthen the lower back and 
invigorate the kidney functions, thus 
promoting blood circulation
• Strengthen Qi and Nourish blood

Classic prescription
Origin of the combination

• Ren zhong (GV26)

Clear cold in collaterals & • Wezhong (BL40)
Meridian for back pain • Chize (LU5)

• Zhen Jiu Da Cheng 
• Author – Yang Ji‐zhou ; Ming dynasty

GV26 (Renzhong) BL40 (WeiZhong)

Specificity – Indications –
Specificity – • He‐sea point of the bladder 
Indications – meridian • Pain and stiffness of the 
• The meeting point of Du mai,  • Stiffness and pain of the 
large intestine and stomach  spine • The command lumbar spine
channels • Sprain and pain of lower  point of lumbar • Cold sensation of the 
back region sacrum, coccyx and thigh
• Atrophy disorders, painful 
Functions – • Sudden loss of 
consciousness, coma,  Functions –
obstruction of the lower 
• Benefits the spine, treats  limbs
deviation of the face  • benefits lumbar region and 
acute lumbar sprain and mouth knees • Difficult urination, 
• Restores consciousness and  • Mania, depression • Activates channels, alleviates  haemorrhoid pain
calms the spirit pain
• Epilepsy • Benefits the bladder
• Benefits the face, nose, 
expels wind

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GV26 
• Transport point on the Du meridian  • Needle GV26 first to free the Qi flow in Du meridian
• Its location is close to the termination of the Du meridian; it 
can help to propel stagnation from the opposite end of the  • Then needle BL40 to further strengthen the Kidney
meridian, thus it is used as a main point to treat acute lower  functions and assist to clear any form of stasis in
back pain lumbar region
BL40
• The uniting point of foot Taiyang meridian  • Finally needle LU5 to enhance the free flow of Qi in
• One of the 6 command points to treat conditions occurring in  the meridian
lumbar region
LU5  • After obtaining Qi, allow needles to stay for 30
• Transport point of the hand Taiyin lung meridian minutes
• Treats lumbar conditions due to its location, which can be 
viewed as corresponding point of of BL40 on the upper limb * In the case of acute lumbar sprain with severe pain,
heavily drain GV26 -> bleed BL40->drain LU5

Modification for other specific

conditions
Chronic type of back pain –

Acute type of back pain – • Due to kidney deficiency followed with internal damp‐

• Due to either damp‐cold or stagnation of Qi and blood cold development obstructs the Qi flow and blood 
circulation. 
• Distal points are particularly important  • Add distal points ‐ SI3, BL62, BL60, KI4, SP3, DU20, 
• BL40, DU26, BL10, SI3, BL58, BL62, BL59, Yaotongxu  HT7
(Ex) • Followed by local points with supplementing method
• Distal points are needled first for 15 minutes with  • BL23, BL26, BL54, Yaoyang (Ex)
reducing method
• Then removed, add needles on local points for another 
20 minutes with reducing method –
• DU3, DU4, DU8, BL32, Shiqizhuxiao

Reference

• Cheng, Xinnong, 1999, “Chinese acupuncture and moxibustion”, foreign language

press, Beijing, China
• Flaws, bob, 1998, “Sticking to the point”, blue poppy press
• Li, Xuemei, Zhao, Jingyi, 1993, “Acupuncture pattern & practice”, Eastland press,
Seattle USA
• Maciocia, G, 1994, “The practice of Chinese medicine : the treatment of diseases
with acupuncture and Chinese herbs”, Sydney
• http://www.yinyanghouse.com/acupuncturepoints/point_categories#commandp
oints, viewed July30 2007
• http://www.theqi.com/cmed/oldbook/ZonZon/ZonZon1_16.htmlviewed
July30 2007
• http://www.acup-chiro.com/chinesearticle/parkisonism102803.htm, viewed
July30 2007
• http://www.medicalacupuncture.com/aama_marf/journal/vol11_1/disorder.ht
ml