Sciatica - 坐骨神经痛

By Dr. Zhisong Chen, O.M.D., Ph.D., L.Ac.

Sciatica refers to a set of pain symptoms along the path of the sciatic nerve, including the lower back, hip, and various parts of the posterior aspect of the thigh, the posterolateral leg, and the lateral foot. The primary cause is the compression of the sciatic nerve by spinal disc herniation. In addition, cauda equine tumor, spinal stenosis, lumbosacral nerve root inflammation, and pregnancy can also induce sciatica. Sciatica is more common in young adult laborers. Typically, symptoms only manifest on one side of the body. Sciatica can be divided into two types: root sciatica and trunk sciatica. The former is always with acute onset induced by putting forth strength, bending down, or vigorous activity. Pain always radiates from the lower back to one hip, posterior thigh, popliteal fossa, lateral leg, and foot. Pain is like burning and cutting and becomes worse when coughing, putting forth strength, and during the night. To avoid nerve tension and compression, patient always uses special position, for example, lying to the healthy side and curving the hip and knee joints when in sleep, standing on the healthy side. Gradually it causes scoliosis, which is mostly inclined to the healthy side. To avoid the nerve root being compressed, patient tends to be inclined to the healthy side when sitting. Trunk sciatica is always induced by cold or injury. Pain radiates from the buttock to the posterior thigh, posterolateral leg, and lateral foot. Pain becomes worse when walking, exercising, and sciatic nerve is dragged. To reduce the traction of the sciatic nerve trunk, scoliosis is to the affected side.

Sciatica belongs to the category of “arthralgia syndrome” in traditional Chinese medicine. Clinically along the history physicians treat it from the points of “wind, cold, and damp”, “obstinate arthralgia”, and “tendon arthralgia”. People living in cold and damp area can be invaded by inclement weather. The cold and damp pathogens can block channels and cause qi and blood stagnation, which brings about pain. Cold and damp both are yin pathogen. Cold tends to contract and damp is viscous, so patient feels the waist, thigh, and leg cramping and painful, difficult in extension and flexion, and numbness. Pain recurs repeatedly and is hard to cure. Cold and damp pathogens can further affect tendon and bone, leading to tendon spasm and joint pain. Blockage of qi and blood circulation can cause blood stasis, which manifests piercing pain in a fixed location. Clinically, the main principle in treating sciatica is to dispel wind and cold and remove damp. For patients with tendon and channel malnutrition and stagnation, it is necessary to nourish the kidney and liver, stimulate the circulation of the blood and cause the muscles and joints to relax. The main herbs include Aconite Root, Kusnezoff Monkshood Root, angelica dahurica, Rhizoma Atractylodis, Clematis chinensis, Eucommia ulmoides, Cyathula officinalis, Asarum sieboldii, Angelica sinensis, Caulis Spatholobi, Ligusticum chuanxiong, etc. Acupuncture points include Huantiao (GB30), Yibian (BL54), Yinmen (BL37), Weizhong (BL40), Weiyang (BL39), Yanglingquan (GB34), Zusanli (ST36), Shensu (BL23). These methods must be guided by professional practitioners.

Research shows that acupuncture is effective on sciatica. As early as in the 1980’s , it was reported that among 1471 cases of sciatica treated by acupuncture, including body acupuncture, electric acupuncture, moxibustion, catgut implantation at acupoint, high frequency impulse electrotherapy, and acupoint injection, 97.5% were effective and 57.1% were cured.

陈智松医师，北京中医药大学本科，中国中医科学院中西医结合硕士，新加坡国立大学医学院博士，美国国立卫生研究院博士后， 生命科学和国际免疫学杂志特邀审稿专家

坐骨神经痛指坐骨神经病变，沿坐骨神经通路即腰、臀部、大腿后、小腿后外侧和足外侧发生的疼痛症状群。绝大部分是由于腰椎间盘突出压迫坐骨神经所致。此外，马尾肿瘤、腰椎管狭窄症、腰骶神经根炎、以及怀孕等也可导致。本病多见于青壮年男性，体力劳动者。临床上多单侧发病，可分为根性坐骨神经痛和干性坐骨神经痛。前者常在用力、弯腰或剧烈活动等诱因下，急性起病。疼痛常自腰部向一侧臀部、大腿后，腘窝、小腿外侧及足部放射，呈烧灼样或刀割样疼痛，咳嗽及用力时疼痛可加剧，夜间更甚。病人为避免神经牵拉、受压，常取特殊的减痛姿势，如睡时卧向健侧，髋、膝关节屈曲，站立时着力于健侧，日久造成脊柱侧弯，多弯向健侧，坐位时臀部常向健侧倾斜，以减轻神经根的受压。干性坐骨神经痛常因受寒或外伤诱发，急性起病，疼痛常从臀部向股后、小腿后外侧及足外侧放射。行走、活动及牵引坐骨神经时疼痛加重。脊椎侧弯多弯向患侧以减轻对坐骨神经干的牵拉。

坐骨神经痛属于中医学的“痹证”范畴，临床上古今医家多从风寒湿、顽痹及筋痹等论治。寒湿侵袭本病症多因久居严寒之地，缺乏必要防寒措施，或因冲风冒雨。水中作业，日积月累而致寒湿之邪阻滞经脉，气血运行不畅，不通则痛。寒湿均为阴邪，寒主收引，湿性粘滞，故事病腰腿痉挛疼痛，难以屈伸，多麻木发凉，易反复发作，病情缠绵。肝肾亏虚素体虚弱，无力驱邪外出，寒湿之邪逐渐深入。冬病伤阻，致肝肾不足，筋骨失于德养，致筋脉牵扯拘急，骨节疼痛而活动时更甚。气滞血瘀或因外邪侵淫日久，留着筋内，或因跌仆损伤，气血受阻。经脉阻塞，血不能行，久而变生瘀血，停留筋骨之中。血瘀痹阻，故痛有定处，且以刺痛为主。临床治疗以祛风散寒除湿为主，久病筋脉失养，经络瘀阻，则需兼顾补益肝肾，舒筋活络。主要用药有：川乌、草乌、独活、苍术、威灵仙、杜仲、牛膝、细辛、当归、鸡血藤、川芎等。针灸可选环跳、秩边、殷门、委中、委阳、阳陵泉、足三里、肾俞等。这些疗法务必在医师指导下应用。

研究表明针灸对坐骨神经痛得疗效确切。早在八十年代初就有人作过统计，用体针、电针、艾灸、穴位埋线、高频脉冲电刺激、穴位注射等多种方法治疗，共1471例坐骨神经痛病人，其总有效率达97.5％，其中有57.1％的病人获得痊愈。

陈智松博士受到资深中医教育，传承中医精华，应用针灸、中药相互结合辩证治疗坐骨神经痛。欢迎咨询和就诊陈智松博士全科中医针灸诊所。地址：8818 Tuckerman Ln, Potomac, MD, 20854。电话：301-979-9040。Email: info@chennmac.com。网站：www.chennmac.com。