Class 3: Lower Back Pain, Impotence, Seminal emission

1. Class 3: Lower Back Pain, Impotence, Seminal emission Xianhui Li

2. Lower Back Pain (Yao tong) • Definition: • Lower Back Pain is called “Yao Tong” in TCM. It is a disease mainly manifested with acute or chronic pain in the lumbar area. • In Western medicine, Lower Back Pain could include renal disease, rheumatism, rheumatoid conditions, injury to the lower back muscles and vertebral or spinal cord disorders.

3. Etiology and pathogenesis • Invasion of external evils • Damp cold • Internal disruption • Kidney deficiency (yin or yang) • Traumatic injury • Qi stagnation and blood stasis

4. Patterns • Cold dampness • Blood stasis due to Trauma • Kidney yang deficiency • Kidney yin deficiency

5. Cold dampness • Clinical manifestations: • Cold pain and heaviness of the lower back, difficulty turning the waist, pain alleviated by heat and increase by cold or rainy weather. White sticky coating. Slow deep pulse. • Treatment method: dispel cold, remove dampness, warm the channels and free the connections • Acupuncture: UB23 shen shu, UB40 wei zhong, DU3 yao yang guan, UB32 ci liao, UB25 da chang shu, UB26 guan yuan shu • Formula: Gan cao gan jiang ling zhu tang

6. Blood stasis due to trauma • Clinical manifestations: • Stabbing pain at fixed location, aggravated by external pressure, worse at night, difficult bending and twisting. Dark purple tongue, with macules. Rough pulse. • Treatment method: quicken the blood, dissolve stasis, regulate qi, and relieve pain • Acupuncture: UB23 shen shu, UB40 wei zhong, DU3 yao yang guan, DU26 shui gou, SI3 hou xi, N-UE-19 yao tong xue, Ashi points • Formula: Shen tong zhu yu tang

7. Kidney yang deficiency • Clinical manifestations: • Slow onset, frequent recurrence, aching of lower back diminished by pressing, fatigue, weakness of knee, increase in pain after exertion, decrease by bed rest. Physical cold, pale tongue, deep weak pulse. • Treatment method: supplement kidney yang, relieve pain • Acupuncture: UB23 shen shu, UB40 wei zhong, DU3 yao yang guan, DU4 ming men, M-BW-24 yao yan, moxa UB23 and DU4 • Formula: You gui wan

8. Kidney yin deficiency • Clinical manifestations: • Slow onset, frequent recurrence, aching of lower back diminished by pressing, fatigue, weakness of knee, increase in pain after exertion, decrease by bed rest. Irritability, insomnia, dry mouth and throat, red cheeks, vexing heat in five hearts. Red tongue little coating. Rapid thready pulse. • Treatment method: nourish kidney yin, relieve pain • Acupuncture: UB23 shen shu, UB40 wei zhong, DU3 yao yang guan, UB32 ci liao, UB52 zhi shi, KI3 tai xi • Formula: Zuo gui wan

9. Impotence • Impotence is referred to lack of copulative power in males.

10. Etiology and pathogenesis • Emotional disturbance • Indulgent sexual activities • Improper diet

11. Pattern identification • Decline of Mingmen fire • Downward flowing of damp heat

12. Decline of Mingmen fire • Clinical manifestations: • failure of the penis in erection, cold extremities, dizziness, listlessness, soreness and weakness of the loins and knees, frequent urination, pale swollen tongue with thin white coating, deep weak pulse. • Treatment principle: • Tonify kidney and strengthen mingmen fire • Acupuncture: Ren4, Du4, KID3, BL23, SP6, HT7, BL15 • Ren4 is the meeting point of Ren mai and the three foot yin meridians, reinforcing is used to promote the primary qi and invigorate the kidney function • Du4 BL23 and KI3 are used to strengthen the kidney yang • For damage of the qi of the heart and spleen: SP6, HT7 and BL15 are good for activating the qi of the heart and spleen • Herbal treatment: wu zi yan zong wan

13. Downward flowing of damp heat • Clinical manifestations: • Inability of the penis to erect, complicated with bitter taste in the mouth, thirst, hot and dark red urine, heaviness of the extremities, red tongue, yellow sticky tongue coating, slippery pulse • Treatment principle: • Clear damp heat and benefit the kidney • Acupuncture: Ren3, SP6, SP9, ST40, ST36 • Ren3, SP6 and SP9 soothe and regulate qi of spleen to eliminate the damp heat. • ST36 dispel dampness by improving the function of the spleen in transportation and transformation, heat will disappear when dampness is dispelled • ST40 is a good point for dampness and phlegm • Herbal treatment: long dan xie gan tang

14. Seminal Emission • Seminal emission may be divided into two types: nocturnal emission and spermatorrhea. In adult males, occasional emission is not pathological.

15. Etiology • Prolonged illness • Indulgent sexual activity • Emotional disturbance

16. Pathogenesis • Nocturnal emission is due to disharmony between the heart and kidney. If the heart fire fails to descend and control the kidney water, the kidney water can not ascend and cool the heart fire. When water deficiency and fire excess disturb the essence, nocturnal emission happens in dreams • Spermatorrhea is due to kidney qi deficiency after a prolonged illness, indulgent sexual activity, or stubborn nocturnal emission.

17. Patterns • Disharmony between heart and kidney • Kidney deficiency

18. Disharmony between heart and kidney • Clinical manifestations • nocturnal emission in dreams, dizziness, palpitation, listlessness, insomnia, lassitude, scanty yellow urine, red tongue without coating, thin rapid pulse. • Treatment principle: • nourish kidney yin, clear heart fire and harmonize heart and kidney • Acupuncture HT7, BL15, KI3, BL23, PC7 • HT7 and BL15 are needled to lower the heart fire and harmonize the heart and kidney • KI3 is used to activate the kidney, BL23 tonify the kidney and control the essence • PC7 primary yuan and stream shu point of PC. It can clears heart fire. • Herbal treatment: zhi bai di huang wan

19. Kidney deficiency • Clinical manifestations: • frequent spermatorrhea at day or night, particularly if there is a desire for sex, pallor, lassitude, listlessness, pale tongue, and deep weak pulse. • Treatment principle: • nourish kidney yin or yang, secure essence • Acupuncture: KI3, BL23, SP6, Ren4, Ren6 • BL23, KI3 and SP6 can reinforce the kidney qi, • Ren4, the meeting point of the Ren mai and three foot yin meridians and Ren6 are two important points for invigoration. Moxibustion applied to these two points can warm and strengthen the primary yang • Herbal treatment: zuo gui wan or you gui wan

20. Case study • Female, 30 years • Cystitis for two weeks. She has frequent and scanty urine with a hot burning pain during urination. The urine is darker than normal. Fever, thirst prefer cold drink, constipation. Slightly red tongue with a markedly redder tip, yellow tongue coating. Rapid pulse.

21. Diagnosis: • Heat lin • Treatment principle: • Clear heat, drain dampness, and open the water passages • Acupuncture Treatment: Ren3 zhong ji, BL28 pang guang shu, BL22 sanjiaoshu, BL39 weiyang, ST28 shuidao, SP9 yinlingquan,SP6 sanyinjiao, Du14 dazhui, LI11 qu chi • Ren3 and BL28 clear heat and drain dampness from the bladder • BL22 drain dampness from the lower burner • ST28 and SP9 drain dampness from the lower burner • SP6 clears heat and cools blood, drains dampness from the lower burner and calms the spirit • DU14 and LI11 clear heat • BL39: lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner • Herbal treatment: ba zheng san

22. Case study • Male, 50years • Turbid urine for 3 months. He has frequent and painful urination. The urine is scanty, cloudy, and hesitant in coming out. Lower back pain and distention at lower abdomen. Red tongue, Sticky yellow tongue coating with slippery pulse

23. Diagnosis: • Cloudy lin, kidney yin deficiency with dampness • Treatment principle: • tonify qi, strengthen kidneys, drain dampness, separate the clear from the turbid, open the water passages • Acupuncture Treatment: Ren3, BL28, BL22, BL39, ST28, SP9, SP6, KI3, KI6, • Ren3 and BL28 clear heat and drain dampness from the bladder • BL22 drain dampness from the lower burner • ST28 and SP9 drain dampness from the lower burner • SP6 clears heat and cools blood, drains dampness from the lower burner and calms the spirit • BL39: lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner • KI3, KI6 tonify kidney yin • Herbal treatment: gao lin tang