Although acupuncture and Traditional Chinese Medicine (TCM) is used in the treatment of a very wide range of health problems, in the West many people associate it especially with the treatment of back pain. NICE (the National Institute of Health and Care Excellence, the organisation responsible for providing the guidelines to the NHS on treatment options for different conditions) lists a course of acupuncture as one of the recommended ways of treating persistent, non-specific low back pain. Many people have positive experiences of acupuncture relieving their back pain. So why is TCM acupuncture so good at treating back pain?
The simple answer is experience; acupuncture has been used for literally thousands of years in the treatment of back pain, which was, one can assume, almost as much a problem for first century Chinese as it is for twenty-first century Europeans. Over the centuries then, there has developed a sophisticated and effective way of both diagnosing different types of back pain, and of treating that pain in accordance with the diagnosis – the combination of accurate diagnosis and effective treatment is, of course, the key to any successful treatment. Traditional acupuncturists today are the heirs to that body of knowledge; and since acupuncture is used a lot in the treatment of back pain, individual acupuncturists also quickly build up their own personal expertise to augment this inheritance.
Of course back pain has also been treated in the West, one way and another, for hundreds of years; perhaps, however, practical knowledge has been lost or discarded due to the twentieth century enthusiasm for tablets as the cure for everything; in particular a hands-on approach to back pain is no longer in favour. (A clinic I once worked in had a telling cartoon on the noticeboard; an old man sits facing a doctor, who is telling him that he has to expect a few aches and pains at his age, and handing him a prescription for some painkillers. The old man then gets up to go, revealing an arrow protruding from his lower back!) Sometimes indeed one finds remnants of lost skills outside of both conventional and alternative medicine, in the most unlikely of places; some of my patients had very positive experiences of being treated by a lorry driver who had, apparently, considerable intuitive and practical skill in relieving muscular-skeletal pain.
A hands-on exam is a crucial part of the diagnostic process in TCM. This reveals quite a lot of useful information to the skilled clinician, who will notice, amongst other things, points and areas of tenderness, the tone of the musculature, variation in temperature, and so on. (Incidentally, it is often a relief to a patient simply to have their back examined in this kind of way: sometimes it seems that it is only when this happens that they feel their problem is being taken seriously, that their experience is validated.)
However, as well as a thorough exam of your back, the TCM clinician will also be interested in other aspects of your health which (you might think) have not much to do with what has gone wrong in your back. This is part of a holistic approach to back pain which integrates the information gained from the exam together with information gleaned from the patient about how they actually experience the pain, what makes it worse and so on, with an overall picture of the patient’s health. Sometimes, indeed, the back pain is simply the most marked symptom of an underlying disharmony.
The acupuncturist thus arrives at a diagnosis which helps him or her understand what is wrong with your back, and what relation this may have to underlying or systemic disharmonies which may either have caused the back problem or be inhibiting the body’s healing response.
It’s important to understand that this diagnosis is distinct from a western medical diagnosis. A TCM clinician will not tell you that you have a disc prolapse or spondylitis; rather they may say you have a Cold-Damp obstruction of the Tai Yang meridian of the back, Liver Qi Stagnation, or Kidney deficiency! This is confusing to most people who naturally assume that the kind of diagnosis made by a GP or other western health professional is the only real kind of diagnosis there is. To understand this, it may be helpful to use the analogy of a map. You might be used to using one kind of map (a road map perhaps), but this does not mean that any other kind of map (an ordnance survey map, say) is wrong; it simply maps the area in question in a different kind of way. Similarly there are different ways of ‘mapping’ a human being, which can be useful in different situations. So a TCM acupuncturist makes a diagnosis using the TCM map, not the western medical map.
(Of course if you are told, say, you have Cold-Damp obstructing your meridians, you may well feel none the wiser, although in fact you will probably also be none the wiser if your GP tells you that you have spondylitis. In fact, even if they tell you it is arthritis, you will probably only have a very vague idea of what arthritis is! But in brief, back pain means that the flow of Qi in some of the meridians which flow through your back are blocked; in Chinese medicine, this is what pain essentially is, an impairment of the free flow of Qi. Sometimes this blockage is due to cold and damp as it were getting into your back, in much the same way they might get into an old house. This is of course more likely to happen if you live in a cold, wet climate, and if you do not take care to wrap up properly, but it may also be due to poor dietary choices or other such factors.)
Once established, this diagnosis leads to a clear set of treatment principles, aimed at both alleviating the back pain directly and restoring health and wellbeing holistically – which in turn further helps alleviate the pain, promotes healing, and starts to resolve the underlying imbalance behind the pain.
Whilst acupuncture is often the treatment of choice in this treatment programme, the TCM clinician has more than one arrow in his or her quiver, tried and tested treatment modalities which he or she may use in addition to acupuncture, depending on the diagnosis. These include Tuina massage, cupping, moxibustion, herbal ointments, gua-sha and electro acupuncture (a more recent addition to the therapeutic armoury). Furthermore, the diagnosis also may lead to the clinician making specific informed suggestions about things we can do ourselves to speed up the healing process.
This makes it clear that there is a lot more to the treatment of back pain than simply sticking a few needles in the general vicinity of the pain. The reason why TCM is so effective for back pain is that it builds up a sophisticated and accurate diagnosis and then tailors its treatment in the light of that diagnosis.