CHINESE HERBAL THERAPY FOR
SCIATICA AND LUMBAGO

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Sciatica refers to pain radiating along the sciatic nerve, which originates in the lower spine as a combination of several nerves from the lumbosacral region (1, 2). The nerve branches from the spine to the left and right buttocks and then travels down the back of the legs, at about the middle of the thighs, to the feet. Sciatic pain usually radiates from the buttock and is felt primarily in the back of the thigh, though it may extend to the foot. Usually, only one side is affected. Although the pain is felt in the fleshy part of the body, the origin of the pain is a pinching of one or more of the nerves departing the spinal cord in the area of the intervertebral disks. Initially, there may be a temporary prolapse or extrusion of the disk (or disks) that causes the spinal column to squeeze down on the nerves. In cases of destruction of the disk, the pain will become chronic. Pressure can also be applied on the nerve from damage to the vertebra themselves. If the pressure is sufficiently severe, the nerve transmissions are interrupted and there can be weakness, loss of feeling, and a resultant wasting of the leg. Sciatic pain may worsen whenever a pressure is applied to the affected area, such as results from coughing, sneezing, or straining during defecation, as well as common physical activities.

Therefore, sciatic pain is actually a spinal problem related to some cases of lower back pain, known as lumbosacral pain, and commonly called lumbago. Lumbago may arise from similar types of disk problems that don’t happen to affect the sciatic nerve, but, instead, remain localized. Lumbosacral pain may also result from muscle and tendon strains in the lower back, whether or not they lead to disk compression or protrusion. Another pain syndrome, Achilles tendonitis, has a relatively high rate of association with sciatica and lumbago. It is caused by injuries that may occur more often when the lower back is painful, leading to abnormal gait.

The current medical treatments for damaged disks and vertebrae involve administration of pain relievers and avoidance of stress on the spine by resting and limiting activities. However, while bed rest may reduce the immediate pain, it has been shown to have minimal effect on the long-term course of sciatica (3), which involves spontaneous healing within about 3 months for 87% of patients. Emotional distress, especially job dissatisfaction, has been found to be highly correlated with both the occurrence and persistence of back pain and sciatica (4, 5). Exercise programs can help prevent recurrence of back pain and sciatica (6, 7). Chiropractic therapy has been the subject of randomized controlled trials, but the methodology has been poor and there is no conclusive evidence that it has substantial effects (8, 9). Surgery (e.g., discectomy) is performed in cases that are unresponsive to other treatments, though this is known to be a last resort that can lead to other problems related to scar formation (10).

From the Chinese viewpoint, patients who present lumbago or sciatic pain are usually diagnosed as suffering from a type of bi syndrome (6). Bi syndromes involve blockage and pain and are especially prevalent in the lower half of the body. Bi syndromes are often caused by unknown factors; that is, there may be little apparent reason for the occurrence, though a significant injury to the back would be an obvious cause. From the period of the Neijing (ca. 100 B.C.) to the present, bi syndrome has been said to be induced mainly by the influences of cold, damp, and wind. Because of the location in the lower body, and the tendency of the pain to radiate downwards, the disorder is frequently attributed to a combination of cold and dampness: these are yin factors that have a natural downward course. Wind, an external pathogenic factor of mysterious nature (see: Drawing a concept: Feng), is thought to carry the pathogenic influences into the body and contribute to the variable nature of the pain.

Internally, a deficiency of kidney yang can give rise to cold and damp syndromes affecting the lower body. In this case, external wind may not be a factor in causing the pain, though it can still combine with cold and dampness to exacerbate the underlying condition. Chinese herbal therapies for sciatica and lumbago usually involve warming the kidney yang, dispelling chill, clearing dampness (usually by invigorating the spleen function), and resolving wind-cold-damp complexes (e.g., relying on certain “antirheumatic” herbs). There are a wide range of potentially useful herbs for these categories of therapy, but certain ones have been emphasized in traditional and patent formulas for treating sciatica and lumbago, as shown in Table 1. Other painful conditions of the lower limbs, such as gout and knee arthralgia, are treated with similar herbs and formulations.

TABLE 1: Herbs Used in Treatment of Sciatica and Lumbago. Indications are taken from Oriental Materia Medica (11); the sample formulas are mentioned in this article.

Herb	Indications	Sample Formulas
Yang Tonics, Chill-Dispelling Herbs
Cibotium gouji	supplements liver and kidneys, strengthens tendons and bones, dispels wind-dampness	Yaotong Pian, Juantong Tang
Cinnamon bark/twig rougui/guizhi	reinforces vital yang, warms the spleen and stomach, dispels accumulated chills, invigorates blood vessels	Sanbi Tang, Duhuo Jisheng Tang, Duzhong Fengshi Wan
Deer antler/gelatin lurong/lujiao	supplements yang and kidneys, strengthens bones and tendons, fortifies stomach, nourishes blood, increases jing	Lujioajiao Tang, Renshen Lurong Wan
Eucommia duzhong	supplements liver and kidneys, strengthens muscles and bones	Sanbi Tang, Lujiaojiao Tang, Duhuo Jisheng Tang, Da Fangfeng Tang, Buyin Tang, Renshen Lurong Wan, Yaotong Pian, Duzhong Fengshi Wan, Texiao Yaotong Ling, Juantong Tang
Morinda bajitian	warms kidneys, supplements yang, strengthens muscles and bones, removes cold	Renshen Lurong Wan, Texiao Yaotong Ling
Psoralea buguzhi	supplements kidneys, warms spleen, fortifies jing	Buyin Tang, Yaotong Pian
Yin and Blood Nourishing Herbs
Achyranthes/Cyathula niuxi/chuanniuxi	removes stagnant blood, supplements kidneys and liver, strengthens tendons and bones	Sanbi Tang, Lujiaojiao Tang, Duhuo Jisheng Tang, Da Fangfeng Tang, Buyin Tang, Shujing Huoxue Tang, Renshen Lurong Wan, Yaotong Pian, Duzhong Fengshi Wan, Texia Yaotong Ling, Juantong Tang
Loranthus jisheng	supplements the liver and kidneys, removes wind dampness, strengthens tendons and muscles	Duhuo Jisheng Tang, Duzhong Fengshi Wan
Peony baishao	supplements blood, controls pain	Sanbi Tang, Duhuo Jisheng Tang, Da Fengfeng Tang, Buyin Tang, Shujing Huoxue Tang, Renshen Lurong Wan, Juantong Tang
Rehmannia shoudihuang	nourishes blood and jing, supplements kidneys and liver	Sanbi Tang, Lujiaojiao Tang, Duhuo Jisheng Tang, Da Fangfeng Tang, Buyin Tang, Shujing Huoxue Tang
Tang-kuei danggui	supplements and moves blood	Sanbi Tang, Lujiaojiao Tang, Duhuo Jisheng Tang, Da Fangfeng Tang, Buyin Tang, Shujing Huoxue Tang, Renshen Lurong Wan, Yaotong Pian, Duzhong Fengshi Wan, Texia Yaotong Ling, Juantong Tang
Moisture Resolving Tonic Herbs
Astragalus huangqi	supplements qi, increases yang, delivers water	Sanbi Tang, Renshen Lurong Wan
Atractylodes baizhu	supplements spleen, tonifies qi, dries dampness, delivers water	Lujiaojiao Tang, Da Fangfeng Tang, Shujing Huoxue Tang, Yaotong Pian
Ginseng renshen	replenishes and supplements original qi, expels evil qi	Sanbi Tang, Lujiaojiao Tang, Duhuo Jisheng Tang, Da Fangfeng Tang, Buyin Tang, Renshen Lurong Wan
Hoelen fuling	promotes diuresis, eliminates dampness, strengthens spleen	Sanbi Tang, Lujiaojiao Tang, Duhuo Jisheng Tang, Buyin Tang, Shujing Huoxue Tang, Duzhong Fengshi Wan
Wind-cold, Wind-damp Dispelling Herbs
Asarum xixin	dispels cold and wind	Sanbi Tang, Duhuo Jisheng Tang, Duzhong Fengshi Wan
Chiang-huo qianghuo	dispels wind, resolves surface, expels wind-damp, controls pain	Da Fangfeng Tang, Shujing Huoxue Tang
Chin-chiu qinjiao	removes wind and dampness	Sanbi Tang, Duhuo Jisheng Tang, Shujing Huoxue Tang, Duzhong Fengshi Wan, Texiao Yaotong Ling
Clematis weilingxian	removes wind-dampness, promotes meridian flow, controls pain	Shujing Huoxue Tang, Texiao Yaotong Ling, Juantong Tang
Cnidium chuanxiong	invigorates blood circulation, promotes flow of qi, dispels wind, controls pain	Sanbi Tang, Duhuo Jisheng Tang, Da Fangfeng Tang, Shujing Huoxue Tang, Duzhong Fengshi Wan, Texia Yaotong Ling
Siler fangfeng	dispels wind, removes dampness	Sanbi Tang, Duhuo Jisheng Tang, Shujing Huoxue Tang, Duzhong Fengshi Wan
Tu-huo duhuo	removes wind-dampness, promotes circulation of meridians	Sanbi Tang, Duhuo Jisheng Tang, Juantong Tang

TRADITIONAL FORMULAS USED FOR LUMBAGO AND SCIATICA

Sciatica is relatively rarely mentioned in the Chinese medical literature. Low back pain (yaotong; yao = lower back region; tong = pain) is frequently addressed in a cursory manner, with standard differential diagnosis of syndromes such as kidney yang deficiency, kidney yin deficiency, wind-cold-damp syndrome, blood stasis, and damp-heat accumulation. Kidney deficiency and wind-cold-damp syndromes dominate the discussions, as reflected in the formulas below. Blood-stasis syndrome is usually discussed only in relation to obvious severe traumatic injury, and damp-heat accumulation is considered a rare causative factor. In a clinical report on acupuncture therapy for 100 cases of lumbago (20), it was reported that wind-cold-dampness was the prominent factor in 43% of cases, deficiency of kidney was prominent in 22% of cases, and sprain (physical injury) accounted for 22% of cases. In a similar report involving 106 cases of sciatica (21), 50 cases were attributed to cold, damp, and wind invasion, 49 cases to acute lumbar strain, and 7 cases due to internal cold (kidney yang deficiency). Acute sprain is most often treated by acupuncture (see Appendix 2), whereas chronic cases, especially those due to the other causative factors, are treated mainly by herbal prescriptions.

One of the frequently-cited traditional formulas (12, 13, 14) for all kinds of bi syndrome is San Bi Tang (Decoction for the Three Bi; Chin-chiu and Tu-huo Combination). The ingredients in this, and the other traditional formulas, are presented here according to general therapeutic category (not always following the modern Materia Medica divisions; e.g., cnidium is listed with herbs to dispel wind-chill) to help illustrate the formulation principles.

*San Bi Tang*
Herbs to Warm the Kidney Yang	Herbs to Nourish Kidney Yin and Liver Blood	Herbs to Tonify the Spleen so as to Promote Circulation of Moisture	Herbs to Dispel Wind-Cold-Damp
Eucommia	Achyranthes	Ginseng	Siler
Dipsacus	Rehmannia	Hoelen	Asarum
Cinnamon bark	Tang-kuei	Licorice	Tu-huo
	Peony	Astragalus	Chin-chiu
			Cnidium

This formulation contains nearly all of the key herbs listed in Table 1. For each type of therapeutic action, 3–5 herbs are used. This approach to developing the prescription, producing a somewhat large formula (in this case, 16 herbs), is commonly used in treatments for bi syndrome.

In the book Bi Zheng Tong Lun (General Discussion of Bi Syndromes), a prescription presented for treatment of internally caused cold-damp bi is Lujiaojiao Tang (Deer Antler Glue Decoction), indicated for lumbago and sciatica (15):

*Lu Jiaojiao Tang*
Herbs to Warm the Kidney Yang	Herbs to Nourish Kidney Yin and Liver Blood	Herbs to Tonify the Spleen so as to Promote Circulation of Moisture	Herbs to Dispel Wind-Cold-Damp
Eucommia	Achyranthes	Ginseng	Tiger bone
Deer antler	Rehmannia	Hoelen
Cuscuta	Tang-kuei	Atractylodes
	Tortoise gelatin

Herbs for dispelling wind-cold-damp are not included in this formula except for tiger bone, which is an ingredient no longer in use (sometimes substituted by bones of other animals, but generally replaced by plant materials that are reputed to treat bi syndrome).

Another classic formulation used for pain syndromes in the lower body is Duhuo Jisheng Tang (Tu-huo and Loranthus Combination) which contains:

*Duhuo Jisheng Tang*
Herbs to Warm the Kidney Yang	Herbs to Nourish Kidney Yin and Liver Blood	Herbs to Tonify the Spleen so as to Promote Circulation of Moisture	Herbs to Dispel Wind-Cold-Damp
Eucommia	Achyranthes	Ginseng	Siler
Cinnamon bark	Rehmannia	Hoelen	Asarum
	Tang-kuei	Licorice	Tu-huo
	Peony		Cnidium
	Loranthus

This formula is only a slight modification of San Bi Tang, with astragalus and dipsacus deleted and loranthus added. This ancient prescription has been made as a patent remedy (see patent remedies section below) and is, perhaps, the most frequently mentioned formula in modern Chinese medical literature for bi syndrome.

The formula Da Fangfeng Tang (Major Siler Combination), is a popular one that is used mainly in Japan, indicated for pain in the thighs that occurs intermittently, which describes sciatica quite well:

*Da Fangfeng Tang*
Herbs to Warm the Kidney Yang	Herbs to Nourish Kidney Yin and Liver Blood	Herbs to Tonify the Spleen so as to Promote Circulation of Moisture	Herbs to Dispel Wind-Cold-Damp
Eucommia	Achyranthes	Ginseng	Siler
Aconite	Rehmannia	Atractylodes	Cnidium
	Tang-kuei	Licorice	Chiang-huo
	Peony	Astragalus

This formula relies on aconite as a warming yang tonic, in place of cinnamon bark, dipsacus, or cuscuta as used in other prescriptions.

Buyin Tang (Tang-kuei and Rehmannia Combination) is suited to those whose primary problem is kidney deficiency (both yin and yang), rather than invasion of exogenous factors. It is indicated for lumbago, sciatica, and spondylitis:

*Buyin Tang*
Herbs to Warm the Kidney Yang	Herbs to Nourish Kidney Yin and Liver Blood	Herbs to Tonify the Spleen so as to Promote Circulation of Moisture	Herbs to Dispel Wind-Cold-Damp
Eucommia	Achyranthes	Ginseng	Fennel
Psoralea	Rehmannia	Hoelen
	Tang-kuei	Licorice
	Peony	Citrus
	Anemarrhena

The formula is named for its ability to nourish yin (buyin) and includes anemarrhena and phellodendron (not listed in table) to clear deficiency fire of the kidney. Still, the formula also tonifies yang (eucommia, psoralea) and warms the body (fennel).

Finally, a formula that is focused on clearing dampness, vitalizing blood, and dispelling wind, without warming the kidney, is Shujing Houxue Tang (Clematis and Stephania Combination):

*Shujing Huoxue Tang*
Herbs to Warm the Kidney Yang	Herbs to Nourish Kidney Yin and Liver Blood	Herbs to Tonify the Spleen so as to Promote Circulation of Moisture	Herbs to Dispel Wind-Cold-Damp
[none]	Achyranthes	Atractylodes	Siler
	Rehmannia	Hoelen	Chiang-huo
	Tang-kuei	Citrus	Angelica
	Peony	Fresh ginger	Cnidium
		Licorice	Chin-chiu
			Clematis
			Stephania

The formula also includes persica to vitalize blood. Takahide Kuwaki, in his book Chinese Herbal Therapy (16), says that “The essential formula for the neuralgia which accompanies extravasated blood, especially sciatica, is Clematis and Stephania Combination.”

PATENT REMEDIES

Because lumbago and sciatica are common problems that can usually be resolved by bed rest and use of simple herbal prescriptions (the above formulas have much in common, meaning that they can be summarized in over-the-counter remedies), several pills have been developed to treat these conditions (17, 18).

A formulation similar to the Lujiaojiao Tang is Renshen Lurong Wan (Ginseng-Deer Antler Pills). The full formulation is not always listed on the ingredients panel and there are several manufacturers who produce slightly different prescriptions. Deer antler, eucommia, morinda, ginseng, astragalus, achyranthes, and tang-kuei are commonly mentioned ingredients. A Chinese guidebook to patents also lists psoralea, cuscuta, hoelen, and other ingredients. This formula is indicated for lumbago and sciatica among other syndromes that arise from deficiencies of the spleen and kidney.

Another patent used for pain syndromes in the lower body, including lumbago and sciatica, is Duzhong Fengshi Wan (Eucommia Wind-Damp Pills), for which the label indicates eucommia, achyranthes, tang-kuei, codonopsis, hoelen, cinnamon bark, loranthus, asarum, cnidium, siler, and chin-chiu. This prescription is quite similar to Duhuo Jisheng Tang, which is commonly sold in pill form (Duhuo Jisheng Wan; caution: at least one brand was found to contain acetaminophen as an added ingredient).

Two well-known lumbago formulas are Yao Tong Pian (Lumbago Tablets) and Texiao Yaotong Ling (Specific Lumbagalin). According to the labels the former contains eucommia, dipsacus, psoralea, cibotium, achyranthes, tang-kuei, lycium, and atractylodes, while the latter contains eucommia, achyranthes, tang-kuei, loranthus, morinda, ho-shou-wu cnidium, chin-chiu, and clematis.

A patent called Sciatica Pills has been made available in the U.S. Its ingredients panel lists several herbs that are not frequently used for treatment of lumbago and sciatica, but which are found in formulas for rheumatoid arthritis. It does not appear to be a representative remedy for the disorder, based on traditional approaches.

CLINICAL TRIALS

Chinese medical research literature is relatively silent on the subject of sciatica and lumbago, even compared to the limited information in general texts. This situation is possibly due to the fact that Chinese medicine is already considered to be proven effective for these conditions and, therefore, researchers are not particularly interested in pursuing further research.

One study was found that focused on sciatica, which was treated in 79 patients with Juantong Tang (19). The formula included:

*Juantong Tang*
Herbs to Warm the Kidney Yang	Herbs to Nourish Kidney Yin and Liver Blood	Herbs to Tonify the Spleen so as to Promote Circulation of Moisture	Herbs to Dispel Wind-Cold-Damp
Eucommia	Achyranthes (Cyathula)	Licorice	Clematis
Dipsacus	Rehmannia		Tu-huo
Cibotium	Tang-kuei		Pyrola
	Peony		Chin-chiu
	Millettia		Cnidium

The formula was modified to fit individual situations. The mean treatment time was 17 days; according to the report, all but 3 of the patients had their sciatic pain cured or partially relieved.

REFERENCES

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Soukup MG, et al., The effect of Mensendieck exercise program as secondary prophylaxis for recurrent low back pain, Spine 1999; 24(15): 1585-1591.
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APPENDIX 1: Acupuncture Therapy for Lumbago and Sciatica

In general, lumbago and sciatica are addressed with a small number of acupuncture points, sometimes with just one acupuncture point (bilaterally treated). Treatment methods include traditional acupuncture, blood-letting, cupping, moxibustion, electro-stimulation, and manipulation (e.g., strong push-pull in the region of the point). Most of the Chinese literature makes reference to acute lumbar sprain, as occurs when incorrectly lifting a heavy object. The acute condition can resolve spontaneously, but could lead to chronic lumbosacral pain and/or sciatica in some cases if not effectively treated. The following table summarizes the reports found in the Journal of Traditional Chinese Medicine, involving over 1,000 patients in total. The main points utilized are on the Urinary Bladder Channel (especially BL-40, BL-60, BL-54, BL-32, and the kidney shu point, BL-23), Gallbladder Channel (especially GB-30 and GB-34), and, to a lesser extent, the Small Intestine Channel (mainly SI-3 and SI-6). In some cases, a single treatment is given, but, especially for chronic pain patients, treatment is repeated daily for up to 10 sessions. It is claimed that most patients, usually more than 75% of them, have their pain either entirely or partly relieved by acupuncture. However, some caution should be used in interpreting the claims, as control groups were not included in the studies and there was no long-term follow-up to find out if the pain returned after a few days.

Condition Treated (Reference)	Points Used	Number of Patients, Number of Sessions, Claimed Results
Acute lumbar sprain (23)	zhibian (BL-54)	100 patients. Daily treatment for 3–5 days. Claimed results: 60% cured, 26% markedly improved.
Acute lumbar sprain (24)	weizhong (BL-40) by blood letting huantiao (GB-30), juliao (GB-29), chenfu (BL-36), and weizhong (BL-40) by massage weizhong (BL-40) by 100 Hz electromagnetic stimulation	193 patients. One session for blood-letting; 1–10 sessions for massage and for electromagnetic stimulus. Claimed results: 32% cured, 47% markedly improved.
Acute lumbar sprain (25)	fuyang (BL-59)	135 patients. One session; may be repeated if necessary. Claimed result: 85% cured, 13% markedly improved.
Acute lumbar sprain (26)	houxi (SI-3) or renzhong (GV-26) or experimental lumbago point on back of hand	300 patients. One session, immediate response after treatment monitored. Claimed results: houxi point worked best, with 81% symptoms gone, 18% symptoms improved; renzhong point also effective: 50% symptoms gone, 50% symptoms improved. Experimental point not very effective.
Lumbar pain (27)	yanglao (SI-6)	43 patients. One treatment in most cases; up to four consecutive daily treatments. Claimed results: 83% complete cure in one session; marked improvement in 17%.
Lower back pain (28)	kunlun (BL-60); strong pressing and pulling; acupuncture may be used as follow-up	3 successful cases cited; 1–2 treatments.
Lumbago (20)	Wind-cold-dampness type: weishu (BL-21), weizhong (BL-40), yaoyangguan (GV-3), yinlingquan (SP-9), yanglingquan (GB-34), fengfu (GV-16) Kidney yang deficiency type: shenshu (BL-23), mingmen (GV-4), zhishi (BL-54), taixi (KI-3), qihai (CV-6), weizhong (BL-40) Kidney yin deficiency type: shenshu (BL-23), zhishi (BL-52), yaoyangguan (GV-3), kunlun (BL-60), houxi (SI-3), ciliao (BL-32) Sprain type: shenshu (BL-23), yaoyangguan (GV-3), weizhong (BL-40), ashi points	100 patients. Treated once daily for 5 days, followed by every other day for a total of 12 sessions; repeat treatment as necessary. Claimed results: 57% completely recovered, 21% markedly improved.
Trunk-sciatica (21)	Taiyang channel disease: shenshu (BL-23), zhibian (BL-54), yinmen (BL-37), weizhong (BL-40), chengshan (BL-57), kunlun (BL-60) Shaoyang channel disease: huangtiao (GB-30), fengshi (GB-31), yanglingquan (GB-34), lingxia (extra point), xuanzhong (GB-39) Cold-deficiency disease: zusanli (ST-36), sanyinjiao (SP-6)	106 patients. Treated 3–50 sessions (average of 13 sessions; average treatment duration 28 days). Claimed results: 50% cured, 36% marked improvement.
Sciatica (29)	Taiyang channel disease: dachangshu (BL-25), huantiao (GB-30), kunlun (BL-60), huatuojiaji of L3-5 (Extra 21), yanglingquan (GB-34), chengfu (BL-36) Shaoyang channel disease: huantiao (GB-30), yanglingquan (GB-34), zhibian (BL-54), juegu (GB-39), ciliao (BL-32) Mixed type: dachangshu (BL-25), huantiao (GB-30), yanglingquan (GB-34), kunlun (BL-60), ciliao (BL-32), yinmen (BL-37), weizhong (BL-40)	70 patients. Treated once daily (except acute cases with severe pain, treated 2–3 times daily), total of 10 sessions. Used standard acupuncture therapy or acupoint injection of herb extracts. Claimed results: 46% cured, 23% markedly effective.

December 1999