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Traditional
Chinese Medicine (TCM) and Back Pain
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Laurie
Morse, L.Ac., QME
Ward
Gypson, MD
Associate Professor, Department of Orthopaedic Surgery
Director, Department of Orthopaedics Complementary
and Alternative Medicine Services
University
of California
San Francisco
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Why
do so many suffer from pain, specifically low back pain?
This is a question that patients and doctors ask with varying
degrees of frustration. I’d like to provide an alternative
angle of understanding low back pain through the model of
Chinese medicine.
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:
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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.
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