CLINICAL APPLICATIONS

* Back pain due to herniated disk

* Herniated disk, lumbar radiculopathy, prolapsed or bulging disk, or slipped disk with possible severe back pain which may worsen with coughing, straining or laughing, tingling or numbness in the legs or feet, muscle spasm or weakness

* Pain originating from the spinal cord and radiating down the legs

 

WESTERN THERAPEUTIC ACTIONS

* Analgesic effect to relieve pain

* Anti-inflammatory effect to reduce swelling and inflammation

* Spasmolytic effect to relax muscles

* Chondroprotective effect to protect the cartilages

* Osteogenic effect to promote generation of bones

 

CHINESE THERAPEUTIC ACTIONS

* Activates blood circulation and eliminates blood stasis

* Reduces swelling and inflammation

* Strengthens soft tissues and relieves pain

 

DOSAGE

Take 3 to 4 capsules, three times daily, as needed to relieve pain. The dosage may be increased up to 6 to 8 capsules every four to six hours if necessary, especially in the early stages of injury when there is severe and excruciating pain. When the pain subsides, reduce the dosage to 3 or 4 capsules, three times daily. For maximum effectiveness, take the herbs on an empty stomach, with two tall glasses of warm water.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Che Qian Zi (Semen Plantaginis)

Chuan Niu Xi (Radix Cyathulae)

Chuan Xiong (Rhizoma Chuanxiong)

Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae)

Dang Gui (Radix Angelicae Sinensis)

Du Zhong (Cortex Eucommiae)

E Zhu (Rhizoma Curcumae)

Gan Cao (Radix et Rhizoma Glycyrrhizae)

Gui Zhi (Ramulus Cinnamomi)

San Leng (Rhizoma Sparganii)

Shen Jin Cao (Herba Lycopodii)

Yan Hu Suo (Rhizoma Corydalis)

Yi Yi Ren (Semen Coicis)

Ze Xie (Rhizoma Alismatis)

 

BACKGROUND

Herniated disk, also known as slipped, prolapsed or ruptured disk, refers to the damaged disks that cushion the spine. A herniated disk may be caused by acute injuries to, or chronic wear and tear of, the spine. When the disk becomes herniated and presses on a nerve, it can cause pain, swelling, numbness, weakness, and loss of physical functions served by the nerve. Optimal treatment should include use of herbs and acupuncture to relieve pain and swelling, and utilization of physical medicine (tui-na, adjustment, surgery) to correct the underlying problem.

 

FORMULA EXPLANATION

Back Support (HD) is designed to treat herniated disk. It contains herbs to activate blood circulation and eliminate blood stasis, reduce swelling and inflammation, strengthen soft tissue and relieve pain. It is most effective for acute injuries that are mild to moderate in severity.

        Dang Gui (Radix Angelicae Sinensis), Chuan Xiong (Rhizoma Chuanxiong) and Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) tonify blood and activate blood circulation. Yan Hu Suo (Rhizoma Corydalis), San Leng (Rhizoma Sparganii) and E Zhu (Rhizoma Curcumae) are among the strongest pain-relieving herbs that also eliminate blood stasis. Bai Shao (Radix Paeoniae Alba) and Gan Cao (Radix et Rhizoma Glycyrrhizae) nourish yin to relieve muscle spasms and cramps. They also nourish Liver yin and benefit soft tissues. Ze Xie (Rhizoma Alismatis), Che Qian Zi (Semen Plantaginis), and Yi Yi Ren (Semen Coicis) drain water accumulation to reduce swelling and inflammation associated with herniated disk. Shen Jin Cao (Herba Lycopodii) and Gui Zhi (Ramulus Cinnamomi) open the channels and collaterals to unblock obstructions, especially of the extremities to treat radiating pain and/or numbness. Du Zhong (Cortex Eucommiae) and Chuan Niu Xi (Radix Cyathulae) are channel-guiding herbs that direct to the back and strengthen soft tissues, such as muscles, tendons, and ligaments. They also tonify the Kidney, dominate the marrow and directly benefit the bones and disks.

        Back Support (HD) is an excellent formula to treat herniated disk, prolapsed disk, or slipped disk. It is most effective for acute injuries that are mild to moderate in severity.

 

CAUTIONS & CONTRAINDICATIONS

* Because of the blood-invigorating nature of this formula, it is contraindicated during pregnancy and nursing.

* Patients who have pain radiating to the extremities accompanied by a sudden loss of bladder or bowel control may have a pinched nerve or spinal injury and must be referred out to emergency care if they have not already been evaluated by a specialist. This condition, known as cauda equina syndrome, can lead to permanent disability and must be evaluated and treated immediately.

* This herbal formula contains herbs that invigorate blood circulation, such as Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) and Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[1]^,[2],[3]

 

CLINICAL NOTES

* Herniated disk can be caused by a prolapsed or slipped disk pressing on the nerves. As a result, there may be shooting pain that starts from the vertebrae and travels outwards to the extremities. While the use of herbs and acupuncture are helpful to relieve pain and reduce inflammation, physical treatment (such as tui-na or chiropractic adjustments) may be necessary to correct the underlying problem. In overt cases of radiculopathy, manipulation to the spinal area is contraindicated.

* To maximize the therapeutic effect, this formula can be given to patients before acupuncture treatments. The muscle-relaxant influence from the herbs takes effect within about 30 minutes. By relaxing the muscles and invigorating qi and blood circulation, there is less stagnation in the channels, and the acupuncture and tui-na treatments will be more effective.

* Cold packs may be used for acute injuries during the first 24 to 48 hours to reduce swelling and inflammation. Afterwards, hot packs should be used to promote blood circulation and enhance healing in the affected area.

* The most common areas of injury for herniated disk are L4-L5 and L5-S1.

* This formula is an adjunct to acupuncture treatment. Optimal results are obtained when acupuncture, electro-stimulation and herbs are included in the treatment regimen.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* In the neck: guitar string/steel wire tight pulse on, or extending proximal to, the right chi

* In the low back: guitar string / steel wire tight pulse, on extending proximal to, the left chi

 

SUPPLEMENTARY FORMULAS

* For severe back pain, add Back Support (AC) and Herbal ANG.

* For external or traumatic injuries, use with Flex (TMX).

* For acute neck, shoulder and upper back pain, add Neck & Shoulder (AC).

* For neuropathy, add Flex (NP).

* For bone spurs, add Flex (SPR).

* For degeneration of disks, add Osteo 8.

* To enhance and support soft tissues and cartilages, add Flex (MLT).

* With severe inflammation, combine with Astringent Complex.

* With severe blood stagnation, add Circulation (SJ).

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Ah shi points on the back, Yinmen (BL 37), Chengshan (BL 57). Strongly stimulate and remove the needles.

* Shenshu (BL 23), Yaoyangguan (GV 3), Weizhong (BL 40), Huantiao (GB 30), Chengfu (BL 36)

 

Classic Master Tung's Points:

* Needle contralateral to the pain. If the pain is in the center, needle bilaterally or the side with the more ah shi points. If the pain is bilateral, needle bilaterally.

* Linggu (T 22.05), Chongzi (T 22.01), Chongxian (T 22.02), Xiabai (T 22.07), Chengshan (BL 57), Zhengjin (T 77.01), Zhengzong (T 77.02), Zhengshi (T 77.03), Zhongjiuli (T 88.25), Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Zhoushui (T 1010.25)

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Herniated disk: Needle Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14). Bleed popliteal fossa or around fibula head area.

 

Balance Method by Dr. Richard Tan:

* Needle the following points on the side opposite the pain: Hegu (LI 4), Houxi (SI 3), Wangu (SI 4), Linggu (T 22.05), Dabai (T 22.04), Zhongbai (T 22.06), Dazhong (KI 4) or ah shi points nearby, Fuliu (KI 7), Ququan (LR 8) or ah shi points nearby

* Needle the following points on the same side as the pain: All ah shi points nearby Chize (LU 5), Kongzui (LU 6), Shaohai (HT 3) to Lingdao (HT 4), Shugu (BL 65)

* Needle ah shi points around Fengfu (GV 16) to Houding (GV 19).

 

Ear Acupuncture:

* Lower back (search for the most sensitive and painful point), Shenmen, Adrenals

 

Auricular Medicine by Dr. Li-Chun Huang:

* Occiput, Lesser Occiput Nerve, Large Auricular Nerve, Shenmen, Golden, Silver and Bronze triangles, corresponding point of pain. Bleed Ear Apex.

* Sciatic nerve pain: Triangle Area Sciatic Nerve of the Posterior. Bleed Ear Apex.

 

NUTRITION

* Eat whole grain cereals and a wide variety of raw vegetables and fruits to ensure a complete supply of nutrients for the bones, nerves, and muscles.

* Fresh pineapples are recommended as they contain bromelain, an enzyme that is excellent in reducing inflammation. If the consumption of fresh pineapples causes stomach upset, eat it after meals.

* To relieve cramps and spasms, eat plenty of fruits and vegetables, especially those high in potassium, such as bananas and oranges. Also, drink an adequate amount of warm water.

* The following is a folk remedy to treat acute back pain from sprain and strain. Crack open 2 ocean crabs with a wooden stick (do not use a knife or any metal instruments) and put them into a clay pot with enough vodka or whiskey to cover both crabs. Place the clay pot into another bigger pot with water and steam for one hour. Serve the crab meat along with the liquor soup.

* Adequate intake of minerals, such as calcium and potassium, is essential for pain management. Deficiency of these minerals leads to spasms, cramps, and tense muscles.

* Avoid cold beverages, ice cream, caffeine, sugar, tomatoes, milk, and dairy products.

 

LIFESTYLE INSTRUCTIONS

* Stretching and strengthening exercises for the back muscles are essential for long-term recovery.

* Mild exercise such as swimming, yoga, or tai chi chuan * tai ji chuan] on a regular basis is recommended.

* Avoid engaging in activities that may lead to re-injury, such as improper lifting with turning or twisting, or excessive strain on the back. Advise the patient that lifting should involve the use of the knees, not the back. Avoid all strenuous physical activity.

* For those who are overweight, weight loss is strongly recommended to decrease pressure on the joints and relieve pain.

* Finally, adequate rest is essential to recovery. It is wise to review sleeping postures to ensure that the back is appropriately supported and relaxed in sleep. Firm beds are recommended over soft ones.

* Heat pad use is recommended to warm the affected area and provide better blood circulation for pain relief.

 

CASE STUDIES

* R.B., a 70-year-old male, presented with sciatica, causing him to have right leg and hip pain, along with spasms of the lower back. It was noted that it was worse with exercise and better with heat application. Objective findings included pain upon palpation of the piriformis muscle, as well as during extension and flexion of the muscles. The TCM diagnosis was Liver and Kidney yin deficiencies, in addition to qi and blood stagnation. Back Support (HD) was prescribed at 4 capsules two times per day. The patient experienced improvement of his pain after two weeks of taking the herbs. Submitted by M.P., Muskego, Wisconsin.

* K.T., a 52-year-old female, presented with severe low back pain due to traumatic injury along the spine. The practitioner diagnosed this condition as qi and blood stagnation along the Urinary Bladder and Small Intestine channels. Back Support (CR), Back Support (HD), and Herbal ANG were prescribed for treatment. As a result, the patient had reported most relief coming from taking the Back Support (HD). The pain continued to swap between improving and worsening. The patient discontinued taking the herbs before even considering taking only the Back Support (HD) long term. Submitted by B.S., Niceville, Florida.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Back Support (HD) is developed specifically to treat herniated, prolapsed, or slipped disk. It contains herbs with marked analgesic effects to relieve pain, and anti-inflammatory effects to reduce swelling and inflammation. Furthermore, many of these herbs have the effect to treat other related conditions, such as sciatica, arthritis, and neuralgia.

        Yan Hu Suo (Rhizoma Corydalis) is one of the strongest and most potent herbs for treatment of pain. Its effects are well documented in both historical references and modern research studies. According to classical texts, Yan Hu Suo (Rhizoma Corydalis) can be used to treat chest and hypochondriac pain, epigastric and abdominal pain, hernial pain, amenorrhea or menstrual pain, and pain of the extremities. According to laboratory studies, the extract of Yan Hu Suo (Rhizoma Corydalis) has been found to be effective in both acute and chronic phases of inflammation. The mechanism of its anti-inflammatory effect is attributed to its effect to inhibit the release of histamine and pro-inflammatory mediators.[4]^,[5] Furthermore, it has a strong analgesic effect. With adjustment in dosage, the potency of Yan Hu Suo (Rhizoma Corydalis) has been compared to that of morphine. In fact, the analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is so strong and reliable that it has been used with satisfactory anesthetic effect in 98 out of 105 patients (93.4%) who underwent surgery.[6] The analgesic effect can be potentiated further with concurrent acupuncture therapy. In one research study, it is demonstrated that the analgesic effect is increased significantly with concurrent treatments using Yan Hu Suo (Rhizoma Corydalis) and electro-acupuncture, when compared to a control group, which received electro-acupuncture only.[7] Overall, it is well understood that Yan Hu Suo (Rhizoma Corydalis) has a marked effect to treat pain. Though the maximum analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is not as strong as morphine, it has been determined that the herb is much safer, with significantly less side effects, less risk of tolerance, and no evidence of physical dependence even with long-term use.[8]

        In addition to Yan Hu Suo (Rhizoma Corydalis), Back Support (HD) uses other herbs with analgesic effects to relieve pain. Du Huo (Radix Angelicae Pubescentis) has a mild sedative effect and moderate analgesic activity.[9] San Leng (Rhizoma Sparganii) has a marked analgesic effect to inhibit pain.[10] The combination of Bai Shao (Radix Paeoniae Alba) and Gan Cao (Radix et Rhizoma Glycyrrhizae) has a marked analgesic effect to relieve pain. The effectiveness is increased significantly when combined with acupuncture.[11] Clinically, these two herbs have been used successfully to treat conditions such as pain,[12] neuralgia,[13] trigeminal neuralgia,[14]^,[15] neck pain, [16] acute back pain,[17] heel pain,[18] pain in the lower back and legs,[19] sciatica,[20] gastric and abdominal pain,[21] and dysmenorrhea.[22]

        Since herniated disk is often complicated with local swelling and inflammation, Back Support (HD) uses many herbs with anti-inflammatory effects. Dang Gui (Radix Angelicae Sinensis) exerts both analgesic and anti-inflammatory effects through the inhibition of pro-inflammatory mediators, including nitric oxide and prostaglandin E2 in peritoneal macrophages.[23]^,[24] In comparison with acetylsalicylic acid, the anti-inflammatory effect of Dang Gui (Radix Angelicae Sinensis) is approximately 1.1 times stronger, and its analgesic effect is approximately 1.7 times stronger.[25] According to clinical studies, Dang Gui (Radix Angelicae Sinensis) has been used successfully to treat menstrual pain in 112 patients,[26] migraine headache in 35 patients,[27] different types of headache in 36 patients,[28] and general complaint of pain in 105 patients.[29] In addition, Chuan Xiong (Rhizoma Chuanxiong) exerts an anti-inflammatory effect via inhibitory activity on TNF-α production and TNF-α bioactivity, and shows a promising effect to treat inflammation and related diseases.[30] Clinically, it has been used in various formulas to effectively treat various types and causes of headache,[31]^,[32] trigeminal nerve pain,[33] trigeminal neuralgia,[34] and angina.[35]

        To treat local spasms and cramps, Bai Shao (Radix Paeoniae Alba) and Gan Cao (Radix et Rhizoma Glycyrrhizae) are used as they have an excellent muscle-relaxant effect to relax both smooth and skeletal muscles.[36]^,[37] Clinically, these two herbs have been used successfully to treat conditions such as leg cramps in the calf,[38] muscle cramps in hemodialysis,[39] restless leg syndrome,[40] intestinal spasm,[41] facial spasms and twitching,[42] and menstrual cramps and pain.[43]

        Lastly, individuals with herniated disks may also have damages to their cartilage and bones. Chuan Niu Xi (Radix Cyathulae) is an excellent herb to protect the cartilage from repetitive and stress-induced injuries. According to one study, the extract of Chuan Niu Xi (Radix Cyathulae) has a potent effect to inhibit the induction of MMP-13, an important enzyme for the degradation of the cartilage collagen matrix, especially under arthritic conditions. By down-regulating the MMP-13 activity, Chuan Niu Xi (Radix Cyathulae) showed great chondroprotection against cartilage degrading disorders.[44] Dang Gui (Radix Angelicae Sinensis) is an effective herb to promote the generation of bones. According to one study, the water extract of Dang Gui (Radix Angelicae Sinensis) has been found to contribute to the formation of bones and treatment of bone injuries. It directly stimulates the proliferation, alkaline phosphatase activity, protein secretion, and particularly type I collagen synthesis of human osteoprecursor cells in a dose-dependent manner.[45] According to another study, Dang Gui (Radix Angelicae Sinensis) shows a marked stimulatory effect in osteoblast proliferation and differentiation systems, as well as in a fibroblast-secreted hyaluronic acid assay. This herb enhances the deposition of hyaluronic acid and proliferation of osteoblasts in vitro, as well as bone regeneration.[46]

        In summary, Back Support (HD) is developed specifically to treat herniated disk, prolapsed disk, or slipped disk. It contains herbs with marked analgesic effects to relieve pain, anti-inflammatory effects to reduce swelling and inflammation, spasmolytic effects to relax muscles, chondroprotective effect to protect the cartilages and osteogenic promote the generation of bones.

 

COMPARATIVE ANALYSIS

Pain is a basic bodily sensation induced by a noxious stimulus that causes physical discomfort (such as pricking, throbbing, or aching). Pain may be of nociceptive, neuropathic, or psychogenic origin. For neuropathic pain due to herniated disks, drugs [aspirin, non-steroidal anti-inflammatory agents (NSAID) and opioid analgesics] offer few benefits. Use of drugs do not change the underlying condition [herniated disk], they only mask the symptom [pain]. Most patients are simply told to relax at home, stay confined to bed, and take drugs as needed for pain. If the pain persists, more and more drugs are needed, thereby creating more side effects and complications. If the pain becomes worse, invasive treatment such as surgery is often suggested. In other words, Western medicine offers few or no options. [Note: Common side effects of aspirin and NSAIDs include gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness, and headache. Serious side effects of newer NSAIDs, also known as COX-2 inhibitors [such as Celebrex (celecoxib)], include significantly higher risk of cardiovascular events, including heart attack and stroke. Side effects of opioid analgesics [such as Vicodin (APAP/hydrocodone) and morphine] include dizziness, lightheadedness, drowsiness, upset stomach, vomiting, constipation, stomach pain, rash, difficult urination, and respiratory depression resulting in difficult breathing. Furthermore, long-term use of these drugs leads to tolerance and addiction.]

        Treatment of pain is a sophisticated balance of art and science. Proper treatment of pain requires a careful evaluation of the type of disharmony (excess or deficiency, cold or heat, exterior or interior), characteristics (qi and/or blood stagnations), and locations (upper body, lower body, extremities, or internal organs). Furthermore, optimal treatment requires integrative use of herbs, acupuncture and tui-na therapies. All these treatments work together to tonify the underlying deficiencies, strengthen the body, and facilitate recovery from chronic pain. Herbs and acupuncture are effective to treat the symptom (pain), and tui-na is effective to correct the underlying cause (herniation). By addressing both symptom and cause, TCM therapies often achieve immediate and long-term success. Furthermore, TCM therapies are often associated with few or no side effects. However, it is important to also recognize the limitation of TCM therapies. Integrative use of herbs, acupuncture, and tui-na are excellent for initial stages of herniated disks of mild to moderate severity. When applied properly, they are often very successful to treat pain, correct the underlying problem, and restore normal physical functions. However, certain conditions may still require surgical treatment, such as in severe cases of herniated disks (such as ruptured disk) or chronic conditions where all other options have failed.

        Optimal treatment of herniated disks is to understand all available options (from Western and traditional Chinese medicine), and utilize the most effective modality for each specific condition.