The Treatment of Modern Western - Biblio.nhat-nam.ru

60PIRIFORMIS SYNDROMEPiriformis syndrome refers to sciatic nerve pain caused byentrapment or pinching of the sciatic nerve as it exits thegreater sciatic notch in the gluteal region. Entrapment in thisarea is due to myospasm or contracture of either the piriformisor gemellus muscles. The main symptoms of this conditionare deep, chronic, nagging aching and pain in the buttockand thigh on the involved side, pain aggravated by sitting,squatting, or walking, possible low back pain, and occasionalpain, numbness, and tingling below the knee and intothe foot. Many weekend athletes and people who spend longhours sitting are prone to this syndrome. In the athlete’s case,it is due to improper stretching and inadequate warm-upexercises as well as over-use during activity. In the case ofthose who sit for prolonged periods of time, inappropriateposture causes contracture of the piriformis muscle. Femalesare more prone to this syndrome by a 6:1 ratio.The Western medical diagnosis of this condition consists offirst ruling out lumbar disk herniation. The affected leg isoften externally rotated when relaxed, such as when lyingface down with one’s feet hanging over the edge of the bed orexamination table. Various physical examination maneuversconfirm the diagnosis (e.g., Freiberg’s maneuver, Pace’smaneuver, Beatty’s maneuver, and the Mirkin test). TheWestern medical treatment of this condition mainly consistsof stopping any offending exercises or activities. While manyclinicians prescribe stretching exercises, the authors of TheMerck Manual say such exercises are “rarely beneficial.” 1Corticosteroids are sometimes injected into the site wherethe piriformis muscle crosses the sciatic nerve, presumablyreducing fat around the muscle.CHINESE DISEASE CATEGORIZATION: Piriformissyndrome is categorized as bi feng, thigh wind, gu tong, thighpain, and yao tui tong, low back and leg pain, in Chinesemedicine.DISEASE CAUSES: External injury and over-taxationcombined with former heaven natural endowment insufficiencyand agingDISEASE MECHANISMS: Traumatic injury may severthe channels and vessels causing blood stasis and qi stagnation,thus resulting in pain. It is also possible for over-taxation,natural endowment insufficiency, and aging to result inmalnourishment of the sinews and vessels, also causing pain.In addition, some Chinese sources also say that piriformissyndrome may be due to wind damp cold impediment hinderingand obstructing the free flow of qi and blood, resultingin pain.TREATMENT BASED ON PATTERNDISCRIMINATION:1. QI STAGNATION & BLOOD STASIS PATTERNMAIN SYMPTOMS: A history of traumatic injury to the lowback and/or hip region, severe pain, enduring pain, painwhich is fixed in location, pain which is worse at night, painextending from the low back to the thigh, possible painwhich radiates from the buttock area to the lower part of thethigh and lateral part of the leg, pressure pain, possible paindue to coughing or if the patient strains on his or her thigh,possible palpable cords or hardness in the buttock area, possiblerestricted movement of the lower limbs, possible systemicsymptoms of qi stagnation and blood stasis, such asirritability, premenstrual breast distention and pain, painfulmenstruation, a dark, sooty facial complexion, a dark, purplishtongue with possible static macules or spots, and a bowstring,choppy pulseTREATMENT PRINCIPLES: Quicken the blood and dispelstasis, move the qi and abduct stagnation