How TCM understands and treats LDH

Though the exact term of “Lumbar Interverbal Disc Herniation (LDH)” is not recorded in the classics of Traditional Chinese Medicine (TCM), LDH related indications are often discussed such as “waist pain”, “waist and leg pain” and “arthralgia syndrome”. Basing on basic TCM theories and their rich clinical practice experiences, some experts propose that the basic pathogenesis of LDH is kidney energy deficiency and blood stasis, with the deficiency of kidney energy as the root cause and blood stasis as the symptom.

The TCM holds that “the kidney being the origin of congenital constitution”, “the waist is where the kidney locates”, and “the kidney governs the waist and feet”, so pathological changes in kidney are shown in the waist at earliest. As discussed in Plain Questions, on the Profoundness and Subtlety of Pulse Conditions, “the waist is where the kidney locates, so when the waist cannot turn or shake, the exhaustion of kidney energy is indicated,” and in Plain Questions, on the Harmony between Life Energy and Nature, “so strength over-exertion shall do harm to kidney energy, and therefore destruction of lumbar vertebra,” if the congenital constitution is not strong, the kidney energy is often insufficient, accompanied by the drying out of marrow and consequent insufficiency of nutrition. When the bone is under malnutrition, the elasticity of lumbar intervertebral discs decreases to various degrees, and the fragility of fibrous rings increases, causing partial or total rupture of the fibrous ring, thus the nucleus pulposus becomes apt to herniate, causing symptoms such as waist pain and leg pain.

Blood stasis is referred to by the TCM as the condition featuring the blood overflow from meridian vessels and laying up in the inter-tissue space, or blood stasis in meridian vessels and organs due to blood circulation blockage. As the Internal Classics pointed out, trauma caused by external forces or heavy load shall cause waist pain due to “accumulation of bad blood”, as well as the clinical manifestation of “inability to bend or stretch one’s back”. It is also mentioned in the Rumen Shi Qin (Confucians’ Duties to Parents) that, “waist is where the kidney locates; when the blood and qi don’t circulate well in large joints, the consequent sense of heaviness and pain prevent one from turning to either side.” The above descriptions are consistent with the facts that, adding to the endogenous, gradual degeneration of lumbar intervertebral discs, external causes such as trauma, chronic lumbar muscle strain and coldness and humidity, and etc. can together change the structure of lumbar functional units. When the spinal nerve roots are compressed by herniated lumbar intervertebral discs, causing local release of chemicals such as glycoproteins and antihistamines that stimulate nerve roots and neighboring tissues, causing hyperemia, edema, hyperplasia and adhesion, which eventually cause aseptic inflammation that features tissue denaturation, micro-circulation change and pain.

The most frequently applied medicines by TCM for LDH include:

l  Wind expelling and spasm relieving medicines: to relieve lumbar muscle spasm and decrease the sensitivity of nerves to all kinds of stimulants, such as Citri reticulatae pericarpium;

l  Blood activating medicines: to expand the capillary vessels, and to promote local blood circulation and nutrition, such as Ginseng radix et rhizoma, Notoginseng radix et rhizoma and Carthami flos, and etc.;

l  Kidney tonifying medicines: to strengthen the immunity functions, tonify metabolism and improve the structure of bones and tendons, such as Astragali radix and Eucommiae cortex.

Other TCM treatment measures for LDH include medicinal fumigation, traction, manipulative massage and acupuncture, and etc.