Low back pain/fatigue

[Guest guest]

>I have a married, 44 year old woman (a mother of 5)

>with severe low back pain (and occasional sciatica).

 

The lower back is " the residence of the Kidneys " , lower back pain is always

related to a Kidney pattern.

Amongst others, Kidney functions are to govern reproduction, to produce

marrow/control the bones and to govern water.

 

>She had surgery as a child to correct

>scoliosis, with a steel rod placed in her back which

>remained for 30 years.

 

These 3 patterns might have an influence on her present situation:

a) blood stasis

b) Kidney Deficiency (Yang)

c) Dampness

After having a steel rod in her back + several operations, she is likely to

have blood stasis in this region. Blood stasis, over a long time, also

causes Qi Stasis and Qi depletion, which makes it easy for Cold to invade

the region, etc. Giving birth to 5 children with a Kidney problem already

present depletes the Kidneys even more (Kidneys govern reproduction). After

so much time, there is not a single pattern, but a combination of patterns.

We have to find out which is the most dominant pattern and start from there.

NOTE: Not only the Kidney is affected in this woman, e.g. deficient Kidney

Yang affects Spleen Yang, hence fatigue, probably dampness. But let's take

one step at a time.

 

>About 5 years ago, her pain suddenly reappeared

 

Was she overworked, stressed, under a lot of pressure at the time?

 

>About 3 months ago, she began experiencing severe fatigue and weakness,

>along with some very tender " trigger points " . This weakness persists, and

>I do not know why. I do not think it is a side effect of her medicines.

 

No, but you didn't treat the cause of the pain, and without pain she did

things that she couldn't normally do in her situation. The warning system

was out, but the body reacted after a while.

 

1) Is there a better way to treat her back pain?

 

Treat the root of the problem.

 

2) What can I do for her chronic fatigue (which does not meet the

official criteria for chronic fatigue syndrome nor for fibromyalgia).

 

Everybody with severe lower back pain over a long time (this woman suffers a

lot!), 5 children and a lot of daily problems because of her illness (unable

to have sex with her husband, unable to spend much time out of

bed, unable to care for her children or her house, unable to cook meals

for them, etc) will get worn out, depressed, fatigued. If the root of the

problem, the backpain, is removed, there will be no depression, no fatigue.

You cannot treat the fatigue successfully without treating the root of the

problem. So let's concentrate on the root:

What does this woman tend to (Look in Maciocia, p.252), or are all patterns

represented?

1) Kidney Yang deficiency: sensation of cold in the back, aversion to cold,

weak legs, bright white complexion, weak knees, impotence, tiredness,

abundant clear urination, oedema of the legs, poor appetite, loose stools.

Tongue: pale.

[ Kidney Yin deficiency: night sweating, dry mouth at night, thirst, hot

feeling in the palms and the soles of the feet, dizziness, constipation,

dark-canty urine, nervousness. Tongue: red.]

3)Blood Stagnation: Her back pain is fixed (can be located exactly, pain is

not wandering or in an approximate area) and stabbing (not dull).

4)Dampness: heaviness of limbs and head, increased vaginal discharge

(white), no thirst, loose stools.

Dagmar

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[Guest guest]

Very good job, Dagmar! Thanks.

 

Sam, does this help you in seeing how diagnoses are made in ?

 

>The lower back is " the residence of the Kidneys " , lower back pain is always

>related to a Kidney pattern.

>Amongst others, Kidney functions are to govern reproduction, to produce

>marrow/control the bones and to govern water.

 

is very holistic and looks at the entire situation. One learns

to see patterns in the whole. Note what Dagmar is saying here. The Kidneys

have to do with lower back pain, reproduction, Marrow and bones, governing

water, (libido), (the ears & hearing), (the condition of the hair on the head),

etc. How many of these things are present with this woman? She's had 5

children, she has lower back pain, and there is a problem with her bones (if

there had not been, there would have been no crooked spine and no operation to

place the steel rod in, no history of disk problems). Surgery may temporarily

have corrected the curvature of the spine and later the disk problems, but the

possible underlying problem of Kidney weakness was never addressed. During the

years the underlying problem continued to get worse from neglect and from

further assaults on the Kidney (the bearing of 5 children by a body that was not

up to it, etc.)

 

>After having a steel rod in her back + several operations, she is likely to

>have blood stasis in this region.

 

Whenever someone has been injured and/or suffered some kind of force on the body

like surgery, car wreck, a severe fall, be aware of the possibility of Blood

Stasis. Sometimes a difficult delievary can trigger Blood Stasis, though

there's no mention of difficult delievaries here. I just want you and other

readers to be aware of some of the things which can trigger Blood Stasis.

 

>After

>so much time, there is not a single pattern, but a combination of patterns.

 

This tends to happen when roots are not addressed. They lead to other problems.

It's like a row of dominos going down.

 

>We have to find out which is the most dominant pattern and start from there.

 

A dominant pattern is one that is the most pressing and/or one that is

triggering other patterns.

 

>>About 3 months ago, she began experiencing severe fatigue and weakness,

>>along with some very tender " trigger points " . This weakness persists, and

>>I do not know why. I do not think it is a side effect of her medicines.

>

>No, but you didn't treat the cause of the pain, and without pain she did

>things that she couldn't normally do in her situation. The warning system

>was out, but the body reacted after a while.

 

This is a very important paragraph. Sometimes pain (fever, Fatigue of Excess,

inflammation, etc.) are protective in nature. A good example are people who

can't feel pain. If you or I broke a bone in our feet, the pain would keep us

off it and send us running to a doctor to examine and treat. But in those rare

individuals who don't feel pain, there is no warning system. They just keep

walking, running, etc. on the foot, and the damage mulitplies. Sometimes pain

medication can do the same thing when an underlying imbalance is not corrected

and identified. Part of the warning system isn't working because the medication

for pain has diconnected it. This doesn't mean that you ignore pain in people

and tell them to " bite a bullet " or " just keep a stiff upper lip. " It means

being aware of possible underlying imbalances that also need to be corrected at

the same time you're diminishing the pain. Relieve the pain and strenghten the

body and restore balance at the same time.

 

>What does this woman tend to (Look in Maciocia, p.252), or are all patterns

>represented?

 

When you get your copy of Maciocia's Foundations book, this page is the start of

info on Kidney Yin and Kidney Yang Deficiency. The symptoms and possible

etiologies are listed. I think you're going to find the etiology sections of TCM

syndromes very interesting and helpful.

 

>1) Kidney Yang deficiency: sensation of cold in the back, aversion to cold,

>weak legs, bright white complexion, weak knees, impotence, tiredness,

>abundant clear urination, oedema of the legs, poor appetite, loose stools.

>Tongue: pale.

>[ Kidney Yin deficiency: night sweating, dry mouth at night, thirst, hot

>feeling in the palms and the soles of the feet, dizziness, constipation,

>dark-canty urine, nervousness. Tongue: red.]

 

It is common for both Kidney Yang and Kidney Yin Deficiency to be present at the

same time, but one will be predominate. Because of the nature of the Kidneys

(the source of Yang and Yin for the entire body), when herbalists treat a case

of Kidney Yang Deficiency, they usually include at least one Kidney Yin Tonic

herb in the formula, and when they treat Kidney Yin Deficiency, they include at

least one Kidney Yang Tonic herb in the formula.

 

When both Kidney Yang and Kidney Yin Deficiency are present, some of the

indicators may be mixed. Look at the tongue color of the two. Kidney Yang

Deficiency is characterized by a pale (moist) tongue, and Kidney Yin Deficiency

by a red tongue. Often, one of the Deficiencies will predominate so much that

the tongue will be either pale or red. But in other cases where the degree of

both are very close, the tongue color may be pale red (normal). Other symptoms

also will be mixed. The person may have the extreme adversion to Cold, the

trouble warming up, the abundant clear urine, and the extreme fatigue of Kidney

Yang Deficiency, but also have the night sweats and afternoon Heat of Kidney Yin

Deficiency. If you treat just the Kidney Yang Deficiency, in time the symptoms

of the Kidney Yin Deficiency will become more noticable and more of a problem

for the person.

 

>3)Blood Stagnation: Her back pain is fixed (can be located exactly, pain is

>not wandering or in an approximate area) and stabbing (not dull).

>4)Dampness: heaviness of limbs and head, increased vaginal discharge

>(white), no thirst, loose stools.

>Dagmar

 

If other patterns also have developed, the symptom pattern will be even more

mixed. Some TCM curriculums are geared especially towards teaching students to

be able to spot mulitple patterns.

 

Victoria

 

 

 

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[Guest guest]

Dear Dagmar and Victoria,

 

Dagmar --- I don't have the answers to your questions yet. I have

e-mailed the patient, and am awaiting further information.

 

Victoria wrote:

 

> During the years the underlying problem continued to get worse from

neglect and from further

> assaults on the Kidney (the bearing of 5 children by a body that was

> not up to it, etc.)

 

I forgot to mention it earlier, but she had a hysterectomy a year

ago...due to excessive pelvic pain and vaginal bleeding.

 

I am finding the way you and Dagmar are addressing this poor woman's

problem to be fascinating!

 

 

Sam

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[Guest guest]

Sam,

I am not sure what book is being referring to but with acupuncture and

acupressure many times the patient will feel better immediately or within a

day or so and it will last for a couple of days and the pain will return.

Sometimes it will be worse. Acupuncture is a balancing act and it you

continue you can balance the problem. Actually when there is such a drastic

shift such as that I take it as a good sign that the treatment is working.

When it stays the same or continues in the same area without any movement

then I wonder if acupuncture is what needs to happen. Just a thought. Dagmar

and Victoria are giving you wonderful guidance, I am so happy that you are

open to feedback.

 

Shane

 

In a message dated 5/12/2000 7:28:46 AM Central Daylight Time,

hfitzgerald writes:

 

<< Sam,

I used the book you just received for lower back pain and the routine

went ok. It felt better immediately afterwards. However that night

(before last) the back was distinctly worse. I would recommed the

treatment only for those with a very minor back problem. I stopped the

treatment at once. The back gets better on its own.

 

tmex >>

[Guest guest]

As to the low back pain, unfortunately the book called for two treatments

daily, so I did two before the radical results set in. When it comes to

the back I am beginning to think it should just be left alone. I once

did exercises for the back with these bad repercusions. Since the book

was dealing with pressure I thought it might help. No so. The back is

improving, and will get much better if I avoid unusual remedies.

 

tmex

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[Guest guest]

>I forgot to mention it earlier, but she had a hysterectomy a year

>ago...due to excessive pelvic pain and vaginal bleeding.

 

Dagmar knows a lot more than I do, so hopefully she will jump in if I leave

anything out.

 

Warner J.W. Fan, MD, in A Manual of Chinese Herbal Medicine lists the following

possible causes of abnormal bleeding from the uterus not associated with menses:

 

" a. Deficiency-induced Cold: pale flow, prolonged pelvic pain, cold intolerance,

fatigue.

 

" b. Deficiency-induced Heat: brigh red and copious flow, often flushed face,

warm palms, restlessness, insomnia.

 

" c. Dampness and Heat: purple flow that is viscous and malodorous, gray face and

greasy tongue coating, loss of appetite with epigastric bloating, pelvic

pressure.

 

" d. Blood stasis: purple and clotted flow that is scanty in amount, pelvic

pressure and pain, purple tongue and impeded pulse.

 

" e. Trapped Qi: purple flow with clots, depression, chest tightness and rib

pain; pulse is mostly impeded and stringy. " (pp. 156- 146)

 

Following is some general info on hemorrhaging which is not limited to

metrorrhagia:

 

Spleen Unable to Govern Blood is one of the TCM Syndromes that can manifest as

metrorrhagia (bleeding from the uterus not associated with the period),

menorrhagia (excessive bleeding during periods), blood in the stools, a tendency

to nosebleeds, tendency to easily bruise, and chronic subcutaneous hemorrhaging.

Sometimes you'll see little blood spots in the skin. These look like red

freckles.

 

But Spleen Unable to Govern Blood is not the only TCM syndrome that can result

in abnormal blood loss. Wicke mentions Blood Stagnation (Stasis) and Heat In The

Blood to name just two. (Wicke, vol. 1. p. 106). Spleen Unable to Govern Blood

is derived from the Spleen Qi Deficiency pattern.

 

Maciocia gives the following table for differentiating possible causes of

hemorrhage:

 

Heat In Blood - fresh red or dark colored blood - heavy loss.

 

Blood Stasis - very dark color with clots - scanty loss.

 

Qi Deficiency - pale colored blood - heavy loss, prolonged.

 

Yin Deficiency - bright-red colored blood - scanty loss. (Foundations, p. 195)

 

Wicke gives some more information in volume 2 of his text in the chapter on

" Herbs for Regulating Blood. " This class of herbs is further divided into two

subclasses: Those that stop bleeding (Hemostatics) and those that invigorate the

Blood (get it moving). Some of the Blood Regulating herbs are strictly

Hemostatics and some are strictly for invigorating the Blood. But some of the

herbs in this class - like Rx Pseudoginseng and Pollen Typhae - have properties

of both subclasses. Wicke says that in cases of severe Blood Stagnation (Blood

Stasis and Ecchymosis or BSE), hemorrhaging occurs because blockages force the

Blood to try to take other paths. In cases like these you want an herb like Rx

Pseudoginseng or Pollen Typhae that has properties of both classes because you

want to stop the hemorrhaging but at the same time promote blood flow. In cases

of BSE hemorrhaging is occurring because the blood is not moving as it should

be.

 

In other cases of hemorrhaging, you want an herb that has straight Hemostatic

properties. The particular herb chosen will depend on rather the Root is Hot or

Cold). If it's Hot in nature, you choose a Hemostatic herb with cooling thermal

energy. If the Root is Cold in nature, you choose a Hemostatic herb with warming

energy.

 

Wicke also points out that there is a close association between the Liver and

the Blood in TCM, and because of this most of the Blood Regulating herbs enter

the Liver. (vol. 2, p. 98) BTW, the root of some menstrual problems are in the

Uterus but the root of some are in the Liver. For example, Liver Qi Stagnation

can manifest in women as " menstrual pain, irregular menses, painful breast

swelling expecially during menses " and as " depression, irritability,

inappropriate anger. " (Wicke, vol. 1, p. 113) (Cold can also result in pain and

cramps during periods, but there will be different other symptoms accompanying

the menstrual pain - like feeling cold and having problems warming up. And yes,

it is possible for there to be both Kidney Yang Deficiency (Cold) and Liver Qi

Stagnation at the same time. Talk about suffering before and during periods!)

 

Liver Qi Stagnation frequently leads to Qi and Blood Stagnation throughout the

body.

 

>I am finding the way you and Dagmar are addressing this poor woman's

>problem to be fascinating!

 

We're not really addressing her problems, just giving you insights into what TCM

looks at and considers.

 

Victoria

 

 

 

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Dear Dagmar, Victoria, and Shane,

 

I was able to contact my patient today, and to answer your questions:

 

1) Her fatigue is NOT like the feeling of lead weights

attached to her limbs. She writes: " Many times my 'body' feels better

than the 'inside'. It feels like I

haven't had enough sleep. But sleep never helps. "

 

2) She thinks she is like your option #2:

 

" Kidney Yin deficiency: night sweating, dry

mouth at night, thirst, hot feeling in the palms and the soles of the

feet, dizziness, constipation, dark-canty urine, nervousness. Tongue:

red. "

 

Thanks.

 

Sam

 

 

 

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[Guest guest]

>2) She thinks she is like your option #2:

>

> " Kidney Yin deficiency: night sweating, dry

>mouth at night, thirst, hot feeling in the palms and the soles of the

>feet, dizziness, constipation, dark-canty urine, nervousness. Tongue:

>red. "

 

She may have helped you pinpoint what her current, most pressing problem is from

a TCM standpoint. But I want to caution you that there may be other TCM

syndromes present as well. I'd be surprised if there weren't considering the

length of time she's had problems and the severity of those problems.

 

When a problem goes on for some time and gets so severe, it frequently sets off

other problems. Sometimes just treating the current most pressing, most obvious

problem is not enough. The other problems will have to be treated as well. For

example, Lung Qi Deficiency can lead to Lung Yin Deficiency after a long period

of time. (Maciocia, Foundations, p. 234) Both the Qi Deficiency and the Yin

Deficiency will need to be treated in these cases. Kidney Yin Deficiency can

lead to Kidney Essence (Jing) Deficiency. " Loss of blood over a long period of

time (such as from menorrhagia) can cause deficiency of Liver-Blood which, in

turn, can lead to deficiency of Kidney-Yin. It is said in that

Liver and Kidney share the same root. " (Foundations, p. 252)

 

Sometimes the most obvious, most pressing problem is a good place to start.

Sometimes it's not.

 

Victoria

 

 

 

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