Traditional Chinese Medicine & Acupuncture

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

REFERENCE THIS ARTICLE
Cosio D, Lin E. Traditional Chinese Medicine & Acupuncture. Practical Pain Management. 2015; 15 (7).
16 May 2016
David Cosio, PhD, ABPP
Psychologist, Interdisciplinary Pain Programme
Erica H. Lin, PharmD, BCACP
Pharmacist, Pharmacy/Pain Clinic

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 was created much more recently, for example with the establishment of the American Medical Association in 1847.¹ TCM should not be confused with "Eastern 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 practiced before the Chinese Revolution and is based on many ancient beliefs. One important one is the Taoist belief that the human body is a miniature version of the universe. Another belief is that a vital energy, "Chi", flows through the body and performs multiple functions to maintain health. TCM practitioners believe that chronic pain results from a blockage or imbalance of Qi and that their role is to correct or balance its flow.

Other concepts such as Yin/Yang - harmony between opposing, complementary forces that support health - and the five elements theories are equally important to TCM.³ In Yin/Yang theory, practitioners describe the character of health as Yin or Yang, such as.e.g., such as its location (inner/outer), temperature (cold/hot), and quantity (incomplete/excessive). Yin/Yang illustrates polarity and the idea that one characteristic cannot exist without the other. The Five Elements symbolically represent the stages of human life and explain the function of the body. Knowledge of these concepts is important to enhance understanding of TCM. However, the purpose of the current seminar is to examine specific TCM practices and whether they are useful in chronic pain management.
5 Diagnostic methods

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

The inspection does not only focus on the physical appearance and behaviour of the patient, but during the inspection the doctor also pays special attention to the language. The analysis of the tongue by a TCM practitioner 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 before an appointment to avoid making the findings dark.

Listening refers to listening to specific sounds the patient makes, such as his/her voice, breathing and coughing. Smelling refers to taking care of the smell or breath of the body. During a survey , the doctor will ask 10 questions about the regularity, severity or other characteristics of hot/cold symptoms, sweating, head/face, pain, urine/faeces, thirst/appetite, sleep, chest/abdomen, and gynecological symptoms, if appropriate.5

The last step of the assessment includes palpation of the wrist pulses at 3 different locations in the radial artery, as well as areas of pain/tension and affected meridians - energy pathways that help coordinate the work of the organs and maintain the body's balance.
Therapeutic Methods

TCM includes several methods designed to help patients achieve and maintain health. There are 6 modern healing methods used in TCM, including acupuncture, moxibustion, tui na massage, cupping/scraping, Chinese herbs, and TCM diet.6 Acupuncture is the most commonly 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 is not usually considered a stand-alone treatment but part of TCM. Although it originated in China during the Shang Dynasty in 1600-1100 BC, it only became popular in the Western Hemisphere in 1971.¹

Acupuncture began with the discovery that stimulating specific areas of the skin affected the normal functioning of the body and has evolved into a scientific system of treatment that restores and maintains health. In 1993, the U.S. Food and Drug Administration estimated that Americans made 12 million visits annually 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 specific acupuncture points. In TCM, there are up to 2,000 acupuncture points in the human body, which are connected by 12 main meridians.8 These meridians carry Qi between the surface of the body and its internal organs. Acupuncture is believed to maintain the balance between Yin (associated with the parasympathetic nervous system) and Yang (associated with the sympathetic nervous system). This allows for the normal flow of Qi associated with nerve transmission throughout the body and restores health to the mind and body.

Sometimes, electroacupuncture, the process in which an electric current is applied to the needles once they have been inserted, can be used to further stimulate the corresponding acupuncture points and can often be used to replace needle manipulation.1 Electroacupuncture has been found to be particularly effective in the treatment of neuromuscular disorders.
Scientific Facts about Acupuncture

There is promising scientific evidence supporting 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 compared to a control or when acupuncture is added to another intervention for the treatment of chronic low back pain.11 Acupuncture is generally safe when administered with clean needles, either disposable or sterile.¹²

Many patients express concerns about acupuncture because of their fear of the needle. Unlike other needles, acupuncture needles are solid and thin like hair. They are generally inserted no more than half an inch to an inch depending on the type of treatment provided. Acupuncture, the application of pressure to key points with the fingers, and ear acupuncture, the application of small needles, viburnum seeds, pellets or earplugs to specific points in the ear, may serve as alternatives for patients with acupuncture phobia.

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

2 . What is Moxibution?

Moxibustion is a treatment that involves burning moxa, the root of mugwort, made from dried Artimesia vulgaris , a spongy herb, to facilitate healing. The burning of mugwort produces a lot of smoke and a strong smell that can be confused with that of cannabis. The purpose of moxibustion is to warm and stimulate the blood, stimulate the flow of Qi, strengthen the Yang Kidney, dispel wind and disperse cold and dispel stagnation.

There are 2 types of moxibustion, direct and indirect. In direct moxibustion, a small amount of cone-shaped moxa is placed over 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 most popular form of care. In indirect moxibustion, a practitioner lights one end of a moxa stick and holds it near the area being treated for several minutes until the area turns red. Historically, this treatment was used to treat period pain.13

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

3 . What is Tui Na massage?

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

In a typical tuina session, the patient remains dressed and sits in a chair. The practitioner will ask a series of questions and then begin treatment. The type of massage provided by a tui na practitioner can be quite intense at times. Practitioners may sometimes use herbal compresses, ointments and heat to enhance these techniques. Tui na is best for the rehabilitation of chronic pain and musculoskeletal conditions. Tui na is considered one of the "external" medical treatments of TCM, while another is cupping/scraping.

4 . What is Cupping/Scraping?

Cupping is one of the oldest "external" TCM methods. The earliest recorded use of cupping dates back to the early fourth century and is documented in A Handbook of Prescriptions for Emergency.16 Cupping is a type of Chinese massage that consists of placing several glass or plastic "cups" or open balls on the body. The cups are heated 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 on the skin. The air in the cup is then cooled, creating a lower pressure inside the cup, thus creating a vacuum and allowing the cup to stick to the skin. Fleshy areas on the body, such as the back and stomach, are the preferred sites for treatment.

Depending on the condition being treated, the cups will stay in place for 5 to 10 minutes. When combined with massage oil, the cups can slide around the back while pulling on the skin. The skin pattern is believed to stimulate blood flow, balance and realign the flow of Qi, dissolve obstructions and create an avenue for the removal of toxins from 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 blockage and toxins trapped on the surface of the skin. Scratching is done until red spots and then bruises cover the treatment area. It is believed that this treatment works for almost any condition. Red spots and bruises take 3 to 10 days to heal and may be misinterpreted 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 on a diseased part of the body using a plum blossom hammer. The hammer has 2 sides, a scattered group of needles and a dense group of needles that are "pounded" into the affected area of the body to release the trapped blood.18 TCM practitioners may also consider using "internal" medical treatments, such as herbs and diet.

5 . How effective is Chinese herbalism?

The term Chinese herbalism can be misleading because not all substances used are herbs. There are over 13,000 different Chinese "medicines" 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, liquorice and rhubarb. Ginseng is the most widely 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, bones and menstrual blood, and metal products (arsenic, asbestos, lead and mercury)-may seem "strange" but are considered key ingredients in TCM.²¹ If a practitioner recommends Chinese herbalism as a treatment, the substances are combined in a formula that can be dispensed as a traditional tea, capsule, liquid extract, granule or powder.

Chinese herbalism became widespread in the United States in the 1970s. However, the effectiveness of Chinese herbalism is still poorly documented.²² Some health professionals have concerns about certain potentially toxic Chinese herbs, and there is some controversy about the animal and human products 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 may interact with prescription drugs, have serious side effects, or may 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 should also ask their primary care provider or pharmacist to check for any potential interactions with their prescribed medications.

6 . What is the Chinese Diet?

The Chinese diet was traditionally considered a way of life, but is now considered a way of dieting that is rooted in Chinese beliefs about the effects of food on the human body.²³ It became a cure for Westerners because of their poor diet. It was the dominant dietary therapy used before the sciences of biology and chemistry allowed for the discovery of present physiological knowledge. The Chinese diet was introduced and became popular in the western hemisphere with the release of the book, The Tao of Healthy Eating, and is now considered alternative medicine.²4

In the Chinese diet, a balanced diet is one that includes all 5 tastes-spicy (hot), sour (cool), bitter (cool), sweet (fortifying) and salty (cooling). Foods that have a particular taste tend to have particular qualities. Food items can be classified as "warming" or "cooling", revising the TCM Yin/Yang concept. The ratio of these tastes will vary according to the needs of the individual and the time of year. Hot foods (cooked, spicy or red) include red meat, fried foods and alcohol. TCM practitioners recommend avoiding hot foods in the summer and usually use them to treat "cold" illnesses (chills, low body temperature and anemia). Cooling foods (green, soothing or sour) include mainly green vegetables. TCM practitioners recommend using cooling foods for "hot" conditions (rashes, heartburn and sore throats). 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 affect disease. However, providers can feel confident recommending that their patients choose more uncontaminated products and opt for less processed foods when possible.

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SOURCE: https://www.practicalpainmanagement.com/treatments/complementary/acupuncture/traditional-chinese-medicine-acupuncture