Traditional Chinese Medicine (TCM) and Back Pain
Reviewed by Ward Gypson, M.D.
Traditional Chinese Medicine (TCM) is a system of medicine that has been practiced for several thousand years in the Orient and has gathered more acclaim in the last decade here in the West. TCM encompasses the modalities of acupuncture, herbal medicine, moxabustion, Tui Na or medical massage and often includes nutritional therapy and breathing therapy or Qi Gong.
In November of 1997 the National Institute of Health published a consensus statement stating there is, in fact, sufficient evidence to support the use of acupuncture (for some conditions). Though, further study of its physiology and clinical value was encouraged, promising results emerged regarding the efficacy of acupuncture in low back pain. I'd like to also note that the use of acupuncture does not preclude the concurrent use of Western medical therapies and often, both are utilized to successfully treat a patient.
The Theory of Traditional Chinese Medicine
When an individual is diagnosed with a "back problem" in Western medicine be it spondylosis, spinal osteoarthritis, prolapsed lumbar disc or muscular/ligamentous lumbar strain the focus is primarily on the lower back region and within the Western medical model the options become therapies like spinal surgery, physical therapy, pharmaceutical intervention and cortisone or epidural type injections. These are perfectly acceptable modalities but what if they don't alleviate the pain? And, what about the underlying cause for the back weakness in the first place? Can that underlying weakness be strengthened? Let us consider this possibility via Chinese medicine.
Though the system of TCM is logical and scientific in it's own way, it is a separate system from modern Western medicine and can't always be explained via Western medical logic. To include the successful system of TCM within our minds, we need to expand the way we think and consider both systems as valid while learning how to accept the similarities and differences within the two systems.
One could say that Chinese medicine was born out of the theory of Yin and Yang. As well as describing that which exists in nature, Yin and Yang perfectly describes all the parts and functions of the body. Yin and Yang are in a constant state of dynamic balance, when this balance is threatened disease is possible. An example in nature of this dynamic balance is the rhythm of the sun (yang) and moon (yin). In a 24-hour period each is unique, change over to the other and require each other for overall balance (from the perspective of earth that is). Yin and Yang each have an individual expression in the body and yet requires the other to exist, for example Yin represents stillness, form and blood whereas, Yang represents activity, function and Qi. Qi needs blood to nourish it and blood needs Qi to move it.
Qi can be described as energy, material force, electromagnetic current, matter, ether, vital force, or life force. Qi travels throughout our entire body in channels or meridians reaching every aspect of our body. These channels are understood to be separate from the pathways of the nervous, vascular and lymph systems in Western medicine. Loosely, when we are born we begin with a gas tank of Qi and when the tank of Qi is empty our life force is gone or in other words, we die. This tank of gas is rooted in the organ system of the Kidneys according to Chinese medicine theory and is distributed throughout our organs, glands and channels in a very systematic way. Because of this intricate channel system within our body when we refer to an organ such as the Kidneys, that includes much more than the organ alone according to anatomy. Each organ system has representations of Yin and Yang, hormone balance as well as specific Qi and blood functions which plays a vital role in connecting, via the channels, with other organ systems and the entire body to render the body a holistic system. In other words, it isn't possible, within TCM, to deem an organ or body part as an isolated problem without considering the whole body system. So, you say, what might this have to do with low back pain?
The Relation of the Kidney System in TCM and Low Back Pain
The low back is the "mansion of the Kidneys" meaning that the low back is most closely related, but not limited to, the health of the Kidney system. It is without question, in low back pain, that the Kidney system be treated in Chinese medicine.
Back on the subject of Qi, it is said in Chinese Medicine:
If there is free flow, there is no pain; If there is no free flow, there is pain. Basically, what this means is if the Qi and/or blood stagnate in the channel(s), specifically through the region of the low back, there will be pain. Imagine a river flowing unimpeded and suddenly a tree falls across the river, we see in our imagination the water no longer flowing freely, but getting blocked by the log, pushing into the banks of the river. The basic concept of acupuncture is to re-open the river, create a circulation so that the log lifts and normal flow is restored.
How does the free flow of Qi and blood in the body become impeded, so as to cause pain?
1. An external invasion of wind, cold, dampness, or heat may invade the lower back region causing pain. If our defensive Qi or immune system is weak we become more susceptible to external invasions through the pores of our skin.
2. The Qi and blood can stagnate due to trauma (i.e. lifting, repetitive strain over time, an accident or similar sprain).
3. There may be an insufficiency of Qi or blood creating a sluggishness or stagnation of flow throughout the channel(s). This is an internal cause or weakness with a number of possible etiologies such as:
Poor diet, insufficient rest coupled with too much activity or overwork (i.e. busy lives, excessive sex*), overuse of drugs, chronic illness, heredity weakness, an excess of the emotions fear and anxiety, and general aging as our Qi is naturally declining.
The Chinese believe that a healthy, moderate amount of sex supports a good flow of Qi and too much sex (specifically ejaculation for men and childbirth for women), depletes the Qi, blood and essence of the Kidneys. Care for your Low Back According to TCM
1. Acupuncture: The use of thin, pre-sterilized, disposable needles to re-establish the proper flow of Qi and blood through the channel(s) of the back. This flow increases circulation allowing for oxygen, blood and lymph to support the bodies healing process. If the channels have been blocked for a long period of time, or if there is pronounced deficiency of Qi and blood, it is necessary to have acupuncture for a longer period of time to assist the body in regaining it¡¯s normal function. Research has shown acupuncture to cause the release of neuro-chemicals such as: endorphins, enkephalins, serotonin and corticosteroids all of which contribute to the reduction of pain and inflammation.
2. Moxabustion: Concentrated herbs that are sprayed or burned above the skin to open and warm the channels.
3. Herbal medicine: The use of herbs from the Chinese herbal pharmacopia also dates back several thousand years. Typically, individual herbs are put together synergistically to create a formula with a specific function (i.e. open the channels or strengthen the Kidneys). Herbs go to specific channels and have specific properties (i.e. sweet, bitter, cold, warm etc.).
4. Tui Na or Chinese massage: Working on the meridians with the hands, using techniques specific to Tui Na. Care must be taken not to exacerbate inflammation if it is present.
5. Proper Diet: If we put vinegar in our finely tuned automobile it won't run, it needs good clean gas. Our bodies "gas tank" needs good clean nutrients. This means a balance of quality protein, good/essential fats, and carbohydrates (5-9 servings of vegetables and fruit with a moderate of whole grains). This means no overeating as our body has a hard time managing the overload, eat meals at regular times, do not eat late at night, minimize or eliminate sugar, processed foods/drinks, alcohol and don't eat any one thing in excess (i.e. dairy products or bread). Drink plenty of water. Contemplate the fact that our body can only be as healthy as the fuel we give it.
6. Qi Gong Breathing: Qi Gong is the art of therapeutic breathing. Breath is Qi, Qi is life. The two substances that fill our Qi tank up are air and nutrients (breathing and healthy foods). To take in a full breath of air into our abdomen is health promoting, yet poor breathing habits have left most of us breathing on the shallow side. To begin with make an effort to remember to breathe deeper, post little notes if necessary that say, ¡°breathe deep¡±. Be aware of inhaling fresh air/Qi in through your nostrils all the way down into your abdomen and exhaling through your mouth. Your abdomen should visibly push outward on the exhale and contract back in on the inhale. As well, there are specific breathing exercises to open the spine, which in turn, supports the flow of cerebral spinal fluid. You may want to get a book or video on breathing exercises to support your health. Deep breathing has far reaching affects in our body by balancing our nervous system, increasing oxygen delivery and keeping the Qi moving. Do not underestimate the value of this simple, yet powerful practice; we have to breathe anyway, why not do it right?
7. Proper Exercise: Exercise promotes the normal flow of Qi and blood. Our bodies were designed to move. I don't believe it's a coincidence that back pain is on the rise in proportion to an increasingly sedentary lifestyle. Regular aerobic activity, regular stretching, keeping the abdominal muscles strong and proper body mechanics when bending and lifting are some of the necessities in back maintenance.
8. Stress Management: Well, this could be an article in and of itself. It has been proven that prolonged stress creates disharmony on many levels: physically, emotionally and spiritually. Explore avenues to keep stress at a minimum in your life. There is an interesting book written by Robert Sapolsky (a professor of science at Stanford) entitled, "Why Zebras Don't Get Ulcers". He depicts with detail and humor, the effects of stress on our body. I recommend it to anyone interested in understanding and successfully managing stress. Learning to meditate is another recommended way of managing stress as well as pain.
9. Proper Rest: Our physiology needs regular sleep and rest balanced with the activity we perform. Rest is Yin, activity is Yang, and attention to both is required to maintain balance. When we push ourselves too hard for too long and ignore the need for rest our Yang consumes our Yin and imbalance ensues. A healthy body can recover from a temporary period of hard work or emotional strain; the imbalance only begins when it goes beyond temporary.
What to Expect in an Acupuncture Treatment
Acupuncture is strictly regulated via individual state medical licensing boards as well as the National committee. Practitioners are typically qualified and trained to provide you with a successful experience. Acupuncture doesn't "hurt" but you may feel sensations that are "different" (like tingling, dull, achy), these sensations are Qi. The thin needles are inserted according to your individual diagnosis and are left in for approximately 20-40 minutes. During this time, most people experience a deep sense of relaxation, in part because of the endorphins that are released during acupuncture. Depending on whether your pain is acute or chronic guides the number of treatments you may need. Your pain may be resolved in a few treatments or it may take several courses, in some cases acupuncture serves primarily as pain management. In any case, your whole body benefits from the affects of acupuncture. I encourage you, if you haven't already, to consider including Chinese medicine as you journey towards a more pain-free and healthier life.