Figure 24.12(499)).
The symptoms consist of back pain which is worse for movement especially extension and
tenderness over the affected joint. The movement of the joints is restricted and the muscles
alongside the spine are stiff and under spasm.
As this is a condition affecting the synovial joints with their cartilage and ligaments, one would
treat the Liver with points such as G.B.-34 Yanglingquan, LIV-8 Ququan, and BL-18 Ganshu.
Spinal Osteoarthritis
This consists in degenerative changes of the vertebrae bodies themselves. These changes cause a
narrowing of the discs and hypertrophy of bone at the joint margins which leads to the formation
of osteophytes (Figure 24.16(500)). Osteoarthritis of the spine can be very severe without
causing any symptoms. In most cases it causes an ache which is worse on exertion and in the
morning. There may be a feeling of stiffness when getting up from a sitting position.
As this condition consists in degeneration of the vertebral bodies themselves, one would treat the
Kidneys and the bones with KI-3 Taixi, BL-23 Shenshu and BL-11 Dashu.
Prolapsed Lumbar Disc
This is the most common cause of nerve-root compression. It is caused by the nucleus pulposus
(the ball of collagenous material inside the disc) bursting through the annulus fibrosus (the tough
and yet elastic fibrocartilaginous ring constituting the outside of the disc). This condition,
illustrated in Figure 24.17(501), is commonly referred to as "slipped disc". This is of course a
misleading term as the disc itself does not move: it is only the central nucleus that bursts through
the outer ring.
The most common discs to prolapse are those at L4/5 and L5/S1. The thinnest part of the annulus
fibrosus is in the posterolateral region of the disc: thus most prolapses occur in this region where
interference with nerve roots is most likely. The nucleus pulposus may also prolapse only
partially: this gives rise to pain without nerve root irritation. Prolapse of the nucleus pulposus is
more frequent in people in their 30s or early 40s when degeneration of the annulus fibrosus
occurs. It is rare later on in life as the nucleus pulposus becomes fibrous and cannot herniate.
The main clinical manifestations of a prolapsed nucleus pulposus are a sudden and severe
shooting pain in the back radiating down to either leg (sciatica). The radiation of the pain follows
the dermatome distribution (Figure 24.18(502)).
It is interesting to note that the location of pain in sciatica follows the distribution of the
acupuncture channels and not necessarily the dermatomes. We must therefore always base our