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Sciatica: 12 channels, 8 vessels, 5 elements & sacro-iliac joint



Acupuncture treatment of lumbar pain and sciatica often rests on a purely symptomatic approach, such as bleeding UB 40. Though this type of treatment is very useful, the results are not always consistent or long lasting. For improved results, one can consider a general treatment addressing the person’s constitution and specific issues, before using symptomatic treatments.

Here is a case to illustrate several issues which often come up with sciatica.


First treatment: mid-december

The patient is a male, in his 40’s. He’s been suffering from sciatica for over 3 weeks (right leg). He hurt his back by turning around in his bed. The pain is intense, the patient cannot sit down, stands through the preliminary interview.

Patient works on construction sites.

Has a history of L3-L4 and L5-S1 disc hernia with disc protrusion; the pain irradiates to the ankle, wakes him up at night.

The hernia and associated pain has been treated with success in the past by ear acupuncture and electric stimulation. The patient tried this treatment again this time but to no avail. Has seen an osteopath who deemed the issue to severe and preferred not to intervene.

The patient mentions that the cartilage in his left knee (opposite side from the sciatica) is completely gone.

Presently treated with cortisone + Daffalgan Codeine + Valium (if the pain becomes too intense).

Patient’s constitution is rather good: fairly lean and muscular, in his 40’s, but obviously tired by hard work and lack of rest; beginning lower Jiao deficiency; lack of sleep because of the pain; general social and work environment is difficult due to the pandemic, though the patient could mostly continue to work throughout the lockdowns. Winter was colder than usual, the patient works outside.


Pulse:

  • Slight Qi and yin deficiency (Carotid & radial pulses)

  • 12 channels: superficial level of pulse is tight (indicates cold or pain), particularly on UB and GB; vibration on UB pulse, on the right side of the artery (=> right UB channel, consistent with the sciatica; indicates Xie Qi in the Bladder channel).

  • 5 elements: pulse is not sinking, Kidney pulse is not deep.

Tongue: pale white coat (cold).


Treatment:

  • Tonify ST. 36 + SP. 6 + DM 14 to address Qi and yin deficiency

  • Treat Dai Mai + Yang Qiao Mai to address leg pain, poor sleep quality, external pathology: in this case, opens the Tai Yang and Shao Yang layers (outer layers) of the body that are deficient and blocked by cold. Dai Mai treatment specifically opens the circulation of energy from the waist down and into the GB channel, whereas Yang Qiao Mai also helps restore proper circulation of energy (Zheng Qi) into the UB channel.

  • Once the Tai Yang and Shao Yang are open and circulating, treat cold invasion (treatment of Tai Yang/Shao yin): Tonify KD 2, drain UB 66, then tonify UB 67 (+ UB 60 if necessary), in that sequence.

Locally:

  • Open the sacro-iliac joint by dispersing the 2 points located on the SI joint (2 painful points located on the PSIS in a dimple outside of UB 27 and outside of UB 30 – on both sides, 4 points in total).

  • Behind the knee, around UB 40, bleed the most prominent, darkest vein.

The patient is relieved immediately, the pain is entirely gone. He is advised to dress warmly and avoid catching cold again, and to do hot foot baths with sea salt every evening before going to bed.


Second treatment: January

The pain and sciatica were completely gone after the first treatment. The patient’s sleep is now good.

However, the patient recently hurt himself again at home (again without lifting anything heavy or any particular movement).

The patient has been working outside, his pulse again indicates cold, particularly on the UB channel.

Again, kidney pulse is not deep and sinking.


Treatment:

  • Dai Mai and cold to expel pathogenic cold energy from the Tai Yang and Shao Yang layers and the UB channel, and restore Zheng Qi.

  • 5 element treatment to restore proper kidney energy in winter: tonify LU 5 + KD 7, then drain SP 3 and KD 3. The kidney pulse becomes deep, sinking; which is its proper quality in winter.

  • The patient is relieved, the sciatica has not come back since.


Issues with sciatica:

Sciatica often happens when cold pathogenic energy invades the UB or GB channel. In both cases, after a general regulation of the person’s blood/energy and Yin/Yang balance, working on the Dai Mai frees energy blockages in the outer and lower part of the body, and in the GB channel.

After treating the sciatica proper, it helps to assess the person’s seasonal 5 element balance. Invasion of pathogenic energy happens only when Zheng Qi is depleted, which in turn usually stems from a 5 element imbalance.

In this case, body temperature is regulated by the Tai Yang (cold) and Shao Yin (heat) channels. Thus when a patient suffers from kidney deficiency, their Shao Yin/Tai Yang channels do not have enough energy to ward off the cold. For example, a lot of people suffer from back aches and sciaticas at the beginning of spring (mid-February or early March), when the energy shifts from kidney to liver: at that time, if a person’s kidney energy was barely sufficient to see them through winter, it becomes depleted, putting the person at risk of getting lumbar pain, a sprained back, or sciatica.

In our case, the patient’s kidney energy is depleted, which is reflected in his pulse: a proper kidney pulse in winter should be deep, sinking. When the kidney pulse is floating, there is a problem between lung and kidney (Xiang Sheng cycle in the five elements); when it is slippery, the problem is excessive control by the spleen (Xiang Ke).

Also, the sacro-iliac joint is involved in a lot of back aches: lumbar pain, hip pain, sciaticas, etc. As an adjuvant to treatment, it helps to check for blockage of the SI joint. The SI joint can be freed by dispersing the 2 points described above, providing instant relief.

Open the sacro-iliac joint by dispersing the 2 points located on the SI joint (2 painful points located on the PSIS in a dimple outside of UB 27 and outside of UB 30 – bilateral, 4 points in total).rnal (deficiency, as in bone cancer).

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