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PIRIFORMIS SYNDROME

GENERAL

Clinical Manifestations	Piriformis syndrome is an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. This enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs -- in short, in almost every motion of the hips and legs. The sciatic nerve is a thick and long nerve in the body. It passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet. Nerve compression can be caused by spasm of the piriformis muscle.
Treatment Principle
Herb Formulas
Points	GB-30, UB-54, Ahshi points on the buttocks. After this, burn three cones of warm needle moxibustion on the handles of the needles. At the same time, needle GB-34, UB-40, UB 57, UB-58, UB- 60

WIND-COLD-DAMP

Clinical Manifestations	A cool sensation, heaviness and pain in the low back and buttocks area Difficulty turning the waist Impaired walking Pain worse in damp, cold or changeable weather T: Normal C: Slimy P: Deep and slow
Treatment Principle	Expel Wind Warm Cold Eliminate Dampness Stop pain
Herb Formulas	Juan Bi Tang modified
Points	LI-11, SP-9, UB-40, UB-54, Ahshi points on the affected side With pain radiating to the calf: + UB-57 With pain in the lateral feet: + Bafeng, UB-60

LIVER QI STAGNATION WITH BLOOD DEFICIENCY

Clinical Manifestations	Hip and thigh pain which is worse premenstrually or after prolonged inactivity and is better with exercise Premenstrual breast distention and pain Irritability Fatigue Loose stools Constipation or Alternating dysmenorrhea and constipation Abdominal distention Possible dysmenorrhea T: Pale and dark C: White P:Thready and wiry
Treatment Principle	Regulate the Liver Resolve Stagnation Tonify Qi Nourish the Blood
Herb Formulas	Xiao Yao San modified
Points	LIV-3, UB-17, UB-18, UB-40 (bleed if there are visible veins in the area), UB-54 With marked Spleen Deficiency: + ST-36, UB-20 With Stagnant Heat: + LIV-2 With Yang Ming Heat: + ST-44 With low back pain: + DU-3, UB-23 With pain radiating to the lateral part of the leg: + GB-39 With pain radiating to the calf: + UB-57 With pain in the lateral feet: + Bafeng, UB-60

LIVER AND KIDNEY YIN DEFICIENCY WITH BLOOD STAGNATION

Clinical Manifestations	An enduring condition in an older commonly thin patient The pain is worse in the evening and after periods of inactivity and better with moderate exercise The pain is worse wit excessive activity A liking for pressure or massage in the area Dizziness Insomnia Tinnitus Palpitations Age spots Dry, scaly skin Low back and knee soreness and weakness Muscle withering Weakness in the lower limbs Possible dry mouth and throat T: Red C Little or None P: Thready, wiry and rapid
Treatment Principle	Tonify and nourish the Kidneys and Liver Invigorate the Blood Strengthen the low back
Herb Formulas	Bu Shen Huo Xue Tang modified
Points	KI-7, SP-6, SP-10, UB-40, UB-54, Ahshi points on the affected side With pain radiating to the calf: + UB-57 With pain in the lateral feet: + Bafeng, UB-60

KIDNEY YANG DEFICIENCY WITH WATER FLOODING

Clinical Manifestations	Edema of whole body particularly at and below the waist Pitting edema Low back pain, aching and heaviness Abdominal distention with full sensations Oliguria Cold limbs Face gray and congested or pale Feeling nervous and cold with mental weariness In severe cases: Ascites Edema of scrotum T: Pale and swollen C: Thin, white or Thick, white and sticky P: Deep and thready With Water Flooding the Lungs: Cough with copious, thin watery phlegm Asthma with phlegmy sound (wheezing) Dyspnea Facial edema Edema of limbs Dysuria T: Pale and swollen C: White and moist or White and greasy P: Superficial and tight
Treatment Principle	Warm Kidneys Promote diuresis
Herb Formulas	Zhen Wu Tang
Points	KI-7, REN-6, REN-9, SP-6, SP-9, ST-28, ST-36, UB-20, UB-22, UB-23, UB-39

YANG DEFICIENCY WITH INTERNAL COLD-DAMPNESS

Clinical Manifestations	Aching bones and joints Muscle ache Whole body pain Aversion to Cold, especially at the back Cold limbs Lower abdominal pain and Cold Abdomen feels chilled Maybe fever No thirst T: Normal C: White and slippery P: Deep and faint or Forceless or Choppy and slow or Wiry
Treatment Principle	Dispel Cold Warm the channels Assist Yang Dispel Dampness Relieve pain
Herb Formulas	Fu Zi Tang
Points

QI AND BLOOD STAGNATION

Clinical Manifestations	A history of traumatic injury to the low back and/or hip area Severe pain Enduring pain Fixed pain Pain is worse at night Pain extends from the low back to the thigh, possibly radiating to the lower thigh and lateral leg Pain worse with pressure Possible pain on coughing Possible palpable cords or hardness in the buttock area Possible restricted movement of the lower limbs Possible systemic symptoms of Qi and Blood Stagnation: Irritability Premenstrual breast distention and pain Dysmenorrhea A dark, sooty facial complexion T: Dark and purplish with possible maculae or spots C: White P: Wiry and choppy
Treatment Principle	Move Qi Eliminate Stagnation Invigorate the Blood Break up Stasis
Herb Formulas	Shun Qi Huo Xue Tang
Points	SP-10, UB-54, Ahshi points on the affected side, with a visible purple vein in the area, bleed UB-40 For low back pain: + DU-3, UB-23 For pain radiating to the lateral side of the leg: + GB-34, GB-39 For pain radiating to the calf: + UB-57 For pain in the lateral side of the feet: + Bafeng, UB-60