Traditional Chinese Medicine (TCM) and Back Pain
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:
- 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.
Richard D. Guyer, MD
Daniel J. Mazanec, MD, FACP, FACR, FAADEP
Traditional Chinese Medicine (TCM), including acupuncture is based on centuries-old East Asian concepts which are quite foreign to traditional Western scientific thought and research. As the author points out, there is some evidence acupuncture and other needling techniques may affect endorphin levels, potentially offering a "scientific" explanation for relief of pain. Clinical studies of TCM in back pain have focused primarily on acupuncture and have produced inconclusive findings. A recent comparison of massage therapy with traditional Chinese acupuncture and self-care education in persons with chronic low back pain found massage was superior to acupuncture which was no better than self-care. No studies of comprehensive TCM as described by the author in low back pain have been reported in the Western literature. As the author points out, the use of TCM does not preclude traditional medical treatment. Clearly more research is required to better define the role of TCM in spine care
