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15 Articles in Volume 15, Issue #7
Advances in the Diagnosis and Treatment of Chronic Pelvic Pain
Call for Standardization and Quality Assurance for Medical Marijuana Products
Chronic Pain and Falls
Is There a Role for NSAIDs in Patients With Cardiovascular Disease?
Legal Considerations of Medical Marijuana
Letters to the Editor: Antibiotics and Microbiome, Hormone Panel
Marijuana: Does it Cause Cognitive Impairment During Driving?
Medical Marijuana Dispensed by Pharmacists in Connecticut
My Policy on Marijuana
NSAID Sensitivity
Pharmacogenetics and Pain Management
Recommending Medical Marijuana for Pain Conditions
The Inhumane and Dangerous Game of Forced Opioid Reduction
Traditional Chinese Medicine & Acupuncture
Untreated Pelvic Pain Common Among Young Women

Traditional Chinese Medicine & Acupuncture

Traditional Chinese medicine, especially acupuncture, is a popular form of therapy that pain patients have embraced. Pain clinicians should become familiar with these alternative therapies.

Traditional Chinese medicine (TCM) is one of the oldest systems of medicine. It is more than 3,500 years older than traditional Western medicine, which came to exist much more recently, for example with the formation of the American Medical Association in 1847.1 TCM should not be confused with “Oriental medicine,” a catch-all phrase used to describe a set of practices developed not only in Asia but worldwide.2

TCM is a standardized version of the type of Chinese medicine that was practiced before the Chinese Revolution that is based on several ancient beliefs. An important one is the Daoist belief that the human body is a miniature version of the universe. Another belief is that a vital energy, “Qi,” flows through the body and performs multiple functions to maintain health. TCM practitioners believe that chronic pain results from blockage or imbalance of Qi, and that their role is to correct or balance its flow.

Other concepts, such as the Yin/Yang—harmony between opposing, complementary forces that support health—and the Five Element Theories are equally important to TCM.3 In the Yin/Yang theory, practitioners describe the Yin or Yang character of health, such as its location (interior/exterior), temperature (cold/hot), and amount (deficient/excess). The Yin/Yang illustrates polarity and the notion that one characteristic cannot exist without the other. The Five Elements symbolically represent the stages of human life and explain the functioning of the body. Knowledge of these concepts is important to foster an understanding of TCM. However, the purpose of the current tutorial is to examine specific TCM practices and whether they are helpful in chronic pain management.

5 Diagnostic Methods

TCM addresses a wide variety of health needs besides pain and migraines, including immune enhancement/disease prevention, chemical dependency, anxiety, depression, health maintenance and wellness, and rehabilitation. TCM practitioners use 5 basic methods of diagnosis in their assessments: inspection (looking), auscultation (listening), olfaction (smelling), inquiry (asking), and palpation (touching).4

Inspection not only focuses on the patient’s physical appearance and behavior, but during inspection the practitioner also pays particular attention to the tongue. A TCM practitioner’s analysis of the tongue will include its size, shape, tension, color, and coating (For your patients, see Traditional Chinese Medicine & Acupuncture). Often, patients are instructed not to brush their tongue prior to an appointment so as to not render the findings obscure.

Auscultation refers to listening for particular sounds the patient makes, such as his/her voice, respiration, and cough. Olfaction refers to attending to body odor or breath. During an inquiry, the practitioner will ask 10 questions about the regularity, severity, or other characteristics of hot/cold symptoms, perspiration, the head/face, pain, urine/stool, thirst/appetite, sleep, the chest/abdomen, and gynecologic symptoms, if appropriate.5

The final step in assessment includes palpation of the wrist pulses at 3 different locations on the radial artery, as well as areas of pain/tension, and the affected meridians—energy pathways that help coordinate the work of the organs and keep the body balanced by regulating its functions.

Therapeutic Methods

TCM encompasses several methods designed to help patients achieve and maintain health. There are 6 modern therapeutic methods used in TCM, including acupuncture, moxibustion, tui na massage, cupping/scraping, Chinese herbs, and TCM nutrition.6 Acupuncture is the most often practiced component of TCM. 

1. What is Acupuncture?

Acupuncture is one of the oldest and most commonly used complementary and alternative medical treatments in the world. It typically is not considered a stand-alone treatment but a part of TCM. Despite having originated in China during the Shang Dynasty in 1600-1100 B.C., it has only become popular in the Western hemisphere since 1971.1

Acupuncture began with the discovery that stimulating specific areas of the skin affected the physiologic functioning of the body, and it has evolved into a scientific system of healing that restores and maintains health. In 1993, the US Food and Drug Administration estimated that Americans made 12 million visits per year to acupuncture practitioners.7

Acupuncture is the practice of inserting and manipulating needles into the superficial skin, subcutaneous tissue, and muscles of the body at particular acupuncture points. In TCM, there are as many as 2,000 acupuncture points on the human body, which are connected by 12 main meridians.8 These meridians conduct Qi between the surface of the body and its internal organs. Acupuncture is believed to keep the balance between Yin (associated with the parasympathetic nervous system) and the Yang (associated with the sympathetic nervous system). This allows for the normal flow of Qi associated with neural transmission throughout the body and restores health to the mind and body.

At times, electroacupuncture, the process in which an electrical current is applied to the needles once they are inserted, may be used to further stimulate the respective acupuncture points and often can be used to replace manipulation of needles.9 Electroacupuncture has been found to be especially effective in treating neuromuscular disorders.

Scientific Evidence for Acupuncture

There is promising scientific evidence to support the use of acupuncture for chronic pain conditions, such as arthritis and headaches, and limited support for neck pain.10 Acupuncture also tends to provide a short-term, clinically relevant effect when compared with a control or when acupuncture is added to another intervention in the treatment of chronic low back pain.11 Acupuncture generally is safe when administered using clean needles, either disposable or sterilized.12

Many patients express concerns about acupuncture due to their needle phobia. Unlike other needles, acupuncture needles are solid and hair-thin. They generally are inserted no more than a half-inch to an inch depending on the type of treatment being delivered. Acupressure, the application of pressure to key points with the fingers, and auricular acupuncture, the application of small needles, vicaria seeds, pellets, or ear tacks to specific points of the ear, may serve as alternatives for patients with needle phobia.

In TCM, the ear is believed to be a microcosm of the body. There are points throughout the ear, with each point related to an anatomical structure and named for the function of that structure. The most commonly used points are the “hunger” point for weight loss, the “calming” point for stress management, and the “lung” point for smoking cessation. Depending on the seriousness and duration of the condition being treated, the traditional acupuncture visit may take between 30 to 60 minutes. It may take several visits to see significant improvement of the chronic pain condition. While each person experiences acupuncture differently, most people feel only a minimal amount of pain as the needles are first inserted. When practiced by a licensed, trained acupuncturist, acupuncture is extremely safe. Acupuncture often is accompanied by other TCM methods outlined below.

2. What is Moxibution?

Moxibustion is a therapy that involves burning moxa, mugwort root, made from dried Artimesia vulgaris, a spongy herb, to facilitate healing. Burning moxa produces a great deal of smoke and a pungent odor that can be confused with that of cannabis. The purpose of moxibustion is to warm and invigorate the blood, stimulate the flow of Qi, strengthen the kidney Yang, expel wind and disperse cold, and dissolve stagnation.

There are 2 types of moxibustion, direct and indirect. In direct moxibustion, a small, cone-shaped amount of moxa is placed on top of an acupuncture point and burned. The patient will experience a pleasant heating sensation that penetrates deep into the skin using this technique.

Indirect moxibustion is the more popular form of care. In indirect moxibustion, a practitioner lights one end of a moxa stick and holds it close to the area being treated for several minutes until the area turns red. Historically, this therapy had been used to treat menstrual pain.13

A substitute for moxibustion may be the Teding Diancibo Pu (TDP) lamp, another method of using warming therapy. The TDP lamp has become a new fixture in many practices because it is as effective as moxa but does not cause respiratory difficulties in sensitive patients. Unlike a traditional heating lamp, the TDP lamp features a plate coated with a mineral formation consisting of 33 elements.14

3. What Is Tui Na Massage?

The name for this method of TCM comes from two of the actions of the therapy, tui meaning “to push” and na meaning “to lift and squeeze.” Tui na, a combination of massage, acupressure, and other forms of body manipulation, is a form of Asian bodywork therapy that has been used in China for centuries. The details of tui na’s techniques and uses were originally documented in The Yellow Emperor’s Classics of Internal Medicine,15 which was written about 2,500 years ago.

In a typical tui na session, the patient remains clothed and sits on a chair. The practitioner will ask a series of questions and then begin treatment. The type of massage delivered by a tui na practitioner can be quite vigorous at times. Practitioners may sometimes use herbal compresses, ointments, and heat to enhance these techniques. Tui na is best suited for rectifying chronic pain and musculoskeletal conditions. Tui na is considered one of the “external” medical therapies of TCM, another being cupping/scraping.

4. What Is Cupping/Scraping?

Cupping is one of the oldest “external” methods of TCM. The earliest recorded use of cupping dates to the early fourth century, and it is documented in A Handbook of Prescriptions for Emergencies.16 Cupping is a type of Chinese massage, consisting of placing several glass or plastic “cups,” or open spheres, on the body. The cups are warmed using a cotton ball or other flammable substance, which is placed inside the cup to remove all the oxygen. The substance is then removed before the practitioner places the cup against the skin. The air in the cup then cools, creating lower pressure inside the cup, thus creating a vacuum and allowing the cup to stick to the skin. Fleshy sites on the body, such as the back and stomach, are the preferred sites for treatment.

Depending on the condition being treated, the cups will be left in place from 5 to 10 minutes. When combined with massage oil, the cups can be slid around the back while drawing up the skin. Drawing up the skin is believed to stimulate the flow of blood, balance and realign the flow of Qi, break up obstructions, and create an avenue for toxins to be drawn out of the body.

Scraping, or “Gua Sha,” is a folk medicine technique that uses pieces of smooth jade, bone, animal tusks, horns, or smooth stones to scrape along the skin to release obstruction and toxins that are trapped at the surface of the skin. The scraping is done until red spots then bruising cover the treatment area. It is believed that this treatment works for almost any ailment. The red spots and bruising take 3 to 10 days to heal, and may be misconstrued by others as a sign of abuse if they are not informed about the treatment.17

Another method is to release blood from the corresponding point of a diseased part of the body using a plum blossom hammer. The hammer has 2 sides, a dispersed group of needles and a dense group of needles that are “hit” into the affected area of the body to release the trapped blood.18 Practitioners of TCM also may consider using “internal” medical therapies, such as herbs and nutrition.

5. How Effective Is Chinese Herbology?

The term Chinese herbology can be misleading because not all the substances used are herbs. There are over 13,000 different Chinese “medicinals” available around the world. The Chinese Materia Medica is a pharmacological reference book used by TCM practitioners that describes thousands of medicinal substances.19

The most commonly used substances come from the leaves, roots, stems, flowers, and seeds of plants, such as cinnamon bark, ginger, ginseng, licorice, and rhubarb. Ginseng is the most broadly used substance for the broadest set of treatments. Some Chinese medicinal products, such as tiger bones, rhino horns, deer antlers, snake bile,20 human feces, bone, and menstrual blood, and mineral products (arsenic, asbestos, lead, and mercury)—might feel “outlandish” but are considered staple ingredients in TCM.21 If a practitioner recommends Chinese herbology as a treatment, the substances are combined into a formula that can be dispensed as a traditional tea, capsule, liquid extract, granule, or powder.

Chinese herbology came to widespread attention in the United States in the 1970s. However, the effectiveness of Chinese herbology still remains poorly documented.22 Some healthcare professionals have concerns about a number of potentially toxic Chinese herbs, and there is some controversy about the animal and human products being used, especially in the Western hemisphere. There have been reports of Chinese herbs being contaminated with drugs, toxins, or heavy metals or not containing the listed ingredients.

In addition, some of the herbs used in Chinese medicine can interact with prescription drugs, have serious side effects, or be unsafe for people with certain medical conditions.2 Patients should never attempt to take Chinese herbs without proper training or guidance from a licensed practitioner. If they are taking Chinese herbs, they also should ask their primary care provider or pharmacist to check for any potential interactions with their prescription medications.

6. What is Chinese Nutrition?

Chinese nutrition traditionally was thought of as a lifestyle, but now it is considered a mode of dieting rooted in Chinese understandings of the effects of food on the human organism.23 It became a therapy for westerners because of their poor diet. It was the predominant dietary therapy used before the sciences of biology and chemistry allowed the discovery of present physiologic knowledge. Chinese nutrition was introduced and made popular in the Western hemisphere with the release of the book, The Tao of Healthy Eating, and now is considered alternative medicine.24

In Chinese nutrition, a balanced diet is one that includes all 5 tastes—spicy (warming), sour (cooling), bitter (cooling), sweet (strengthening), and salty (cooling). Foods that have a particular taste tend to have particular properties. Food items can be classified as “heating” or “cooling,” revisiting the Yin/Yang concept of TCM. The ratio of these tastes is going to vary according to the individual’s needs and the season of the year. Heating foods (cooked, spicy, or red) include red meat, deep-fried goods, and alcohol. TCM practitioners recommend that heating foods be avoided in the summer and they typically use them to treat “cold” illnesses (chills, low body temperature, and anemia). Cooling foods (green, soothing, or sour) include mostly green vegetables. TCM practitioners recommend that cooling foods be used for “hot” conditions (rashes, heartburns, and sore throat). There are no forbidden foods or “one size fits all” diets in TCM.

In TCM, nutrition is considered the first line of defense in health matters. Without any evidence-based research, it is difficult to determine whether classic TCM diets influence diseases. However, providers can feel confident recommending that their patients choose more uncontaminated produce and select the least processed foods when possible.

Last updated on: May 16, 2016
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Massage Therapy in an Ambulatory Pain Clinic

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