Back Pain - 15 Tried-and-True Tips from Top TCM Practitioners of Today
BACK PAIN:
15 Tried and True Tips from Top TCM Practitioners
by John K. Chen, Ph.D., Pharm.D., O.M.D., L.Ac.
Published December 13, 2019
Having a successful practice requires mastery in the treatment of back pain. Musculoskeletal and connective tissue injuries are responsible for up to 10 million clinic visits per year in the US alone (1), undoubtedly making back pain one of the most common complaints seen on a daily basis in most acupuncture clinics. This article presents numerous techniques used by master practitioners to diagnose and treat back pain. Implementing some of these techniques will provide you with tools needed to achieve excellent clinical outcomes in the treatment of back pain. Having a variety of treatment methods at hand is essential, because, as we all know, not every patient responds favorably to the same treatment.
The diagnostic aspects presented are based on Dr. Jimmy Chang’s pulse diagnosis and Dr. Li-Chun Huang’s auricular methods. The treatment strategies discussed originate from Master practitioners, specifically Dr. Tung and Dr. Richard Tan, and/or practitioners who have evolved their own systems based on these Master clinicians’ teachings. All the information has been compiled from lectures or books by various eLotus.org speakers.
Whether you are a beginner or a seasoned practitioner, I hope you enjoy this quintessential summary based on the invaluable experience of Master practitioners and the generosity of their teachings.
Additionally, if you'd like to earn continuing education credits, Click here to purchase the article course and earn CEUs!
TYPES OF BACK PAIN
Most cases of back pain are caused by some type of injury or insult to the musculoskeletal and connective tissues. These injuries may be external (sports injuries, car accidents, physical trauma), internal (chronic wear and tear of muscles, ligaments and tendons; bones weakened by osteoporosis), or both. Occupational repetitive strain or strenuous exercise are also a frequent cause of back pain, and can be either external, internal or both.
Acute injuries are characterized by severe pain, swelling and inflammation, and in some cases, internal bleeding. Treatment of acute injuries should focus on relieving pain, reducing swelling and inflammation, and stopping bleeding.
Chronic injuries are characterized by dull pain, stiffness, numbness, as well as decreased muscle mass and strength. Treatment of chronic injuries includes providing pain relief and restoration of physical and physiological functions.
DIAGNOSIS OF BACK PAIN
In addition to patient signs and symptoms, pulse and auricular diagnosis can be used to diagnose back pain. Combining both methods can provide very accurate information about a patient’s condition.
Diagnosis of Back Pain using Dr. Jimmy Wei-Yen Chang’s Pulsynegy Method:
Jimmy Chang, L.Ac., master and creator of Pulsynergy, discovered that the left chi position of the pulse can reveal disorders of the back, hip, and legs. In his pulse system, the cun, guan, and chi positions are felt half a finger’s length proximal to the usual TCM pulse taking positions. In other words, the styloid process is the demarcation line between the cun and guan positions, whereas traditionally, the styloid process is the location of the guan position.
To diagnose back, hip, or leg pain, use your ring finger to feel the left chi position. A pulse extending proximally to the left chi position is an indication of back, hip, or leg discomfort/pain. The more forceful that pulse, the more inflammation and pain the patient is experiencing. The farther the pulse extends proximally towards the elbow, the bigger the area of pain, for example in the case of pain radiating into the hips or legs.
To further diagnose the specific nature of the back problem, one can compare the left chi pulse with other pulse positions. If the vessel feels thick and rounded on top (like a marble), then the pain is due to soft tissue injury. If the vessel feels thin and forceful (like a wire), then the condition is disc or bone spur related. Indistinct or blurry borders to the vessel wall indicate the presence of blood stasis, leading to the conclusion that the most likely cause of pain is physical trauma. A tip on how to better feel the pulse is to use the pads instead of the tips of your fingers. This enables you to feel the shape and force of the pulse more accurately.
While pulse diagnose can tell you that something is wrong with the back, hip, or lower part of the body, it cannot pinpoint the exact location of the problem. Auricular diagnosis, on the other hand, can locate the area of pain very precisely. This will be discussed in the following section.
The left chi position is also used to detect reproductive and hormonal disorders, such as fibroids, cysts, prostate conditions and related conditions. This will be the subject of discussion in future articles.
One of the reasons for Dr. Chang’s clinical success is that he never asks patients to divulge the reasons for their visit. Dr. Chang simply has his patients sit down for a pulse reading and then proceeds to tell them what conditions or issues they have. This has a profoundly positive psychological effect, giving patients confidence in their practitioner’s ability to having a deep insight into their health issues. The result is high compliance and a tremendous boost in patient recovery.
Should you detect any pulse signs extending beyond the left chi position, let your patient know. Using this approach will likely increase patient confidence in your diagnostic skills and treatment strategy, and lead to greater follow through of your recommendations.
Click here to learn more about Dr. Chang’s pulse diagnostic techniques. To intern with Dr. Chang, visit Pulsynergy.com.
Diagnosing Back Pain using Dr. Li-Chun Huang’s Auricular Medicine:
Dr. Li-Chun Huang is the leading expert in Auricular Medicine and has treated the presidents of China, Italy, and Cuba. According to her system, the lower back is located towards the end of the antihelix prior to where it forks into two sections surrounding the triangular fossa. The final, top portion of the antihelix extending to the top of the ear, represents the leg. In the pictures below, you can see several types of back pain reflected on the ear.
Dr. Huang utilizes visual inspection, palpation, and electrical detection for diagnosis. The integrity of the cartilage of the ear represents the health of the vertebrae. Using visual inspection, cartilage in this particular area that is crooked, bumpy, or depressed is indicative of bone or disc issues. Prominent red vessels in this area most likely indicate acute back pain and inflammation. Dark purple vessels are indicative of past injury. An expanded area of visible blood vessels most likely indicates sciatica with radiating pain. Another positive finding for back pain is pain upon pressure with a steel probe, or positive electrical detection with an auricular point detector.
Click here to learn more about Auricular Medicine by Dr. Huang.
The pictures below are taken from Dr. Huang’s book Auricular Diagnosis with Color Photos which is available here.
Based off LiChun Huang’s Auricular Point Diagram, circled ear image represents the back.
The four pictures below all indicate back pain. The area of deformity or vessel protrusion denotes the location of the back disorder as represented on the ear. In general, red vessels indicate acute pain with inflammation, purple means past injury, cartilage protrusion indicate structural deformity of the back.
VARIOUS ACUPUNCTURE STYLES FOR FAST BACK PAIN RELIEF
The goal of Master acupuncturists has always been correct point selection, as well as using the fewest points possible to maximize results. Below is a compilation of some of the best points documented by seasoned practitioners for treating back pain. You will notice that many Masters have come to similar conclusions. A particular point or area can have a multitude of effects due to the body’s holographic nature. Understanding the nature of imaging of different body parts will greatly enhance a practitioner’s understanding as to why Masters have historically chosen the points presented here. For example, the hand or foot reflects (and can treat) the head, the wrist or ankle reflects the neck, the elbow the knee, and the shoulder the hip. Reverse imaging applies equally, making the hand or foot reflect the genitals, and the hip the shoulder and so forth.
Auricular and Abdominal acupuncture are also discussed and follow the same principles. The key to great results lies in finding and treating the correct image.
Learn more on imaging and distal needling concepts by reading Richard Tan’s book Acupuncture 1, 2, 3.
TRADITIONAL TCM ACUPUNCTURE:
☯ Yaotongxue, Huantiao (GB 30), Yaoyan (Extra 9), Shenshu (BL 23), Weizhong (BL 40)
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Ashi points
MASTER TUNG'S ACUPUNCTURE:
Master Tung Ching-Chang’s acupuncture is becoming increasingly famous in the Western world. Known for its simplicity, ease of use, and exceptional clinical efficacy, Master Tung’s Acupuncture was originally passed down exclusively within the family until his first disciple was accepted in 1964. Separate from traditional TCM acupuncture and a complete system in its own right, Master Tung’s acupuncture is famed for its unique set of “magical” points, its own acupuncture channels, diagnostic methods, and needling techniques. These were expanded and refined in over 300,000 clinical cases by Master Tung himself.
Various English speaking teachers and authors for Master Tung’s technique include Drs. Richard Tan, Chuan-Min Wang, Young Wei-Chieh, Esther Su, Robert Chu, Henry McCann, Brad Whisnant, Susan Johnson, James Maher, Jeffrey Russell, and more. Some of these are eLotus speakers and have presented their favourite Tung points for back pain. Below is a summary.
All Master Tung’s acupuncture points listed below can be found on the eLotus CORE website. This site includes more than 300 Master Tung points for your reference for FREE.
Master Tung’s Points and Methods used by Dr. Chuan-Min Wang:
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For acute pain, bleed first then needle.
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For chronic pain, needle first then bleed.
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Mid back pain: Needle contralaterally Chongzi (T 22.01), Chongxian (T 22.02), Zhengjin (T 77.01), Zhengzong (T 77.02). Bleed ipsilaterally popliteal fossa or local tender spot.
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Low back pain: Bleed ipsilaterally popliteal fossa or local tender spot.
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L1-L3 pain: Needle contralaterally Zhongbai (T 22.06), Xiabai (T 22.07).
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L4-L5 pain: Needle contralaterally Dabai (T 22.04), Linggu (T 22.05).
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S1-S2 pain:Needle contralaterally Wanshunyi (T 22.08), Wanshuner (T 22.09).
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Hip pain: Needle contralaterally Jianzhong (T 44.06), Xiaqu (T 44.15), Shangqu (T 44.16), Yunbai (T 44.11), Libai (T 44.12). Bleed ipsilaterally popliteal fossa or local tender spot.
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Sciatic pain: Needle contralaterally Dabai (T 22.04), Linggu (T 22.05), Wanshunyi (T 22.08). Needle ipsilaterally Weizhong (BL 40), Kunlun (BL 60), Zuqianjin (T 77.24), Zuwujin (T 77.25).
Dr. Chuan-Min Wang is a direct disciple of Master Tung and has contributed greatly by translating his work into English as well as by teaching courses for eLotus. Together, we have produced free videos on how to locate and needle the most popular 100 Master Tung points on Youtube, available in Chinese, English, German, French, Spanish and Portuguese.
Click here for books and courses by Dr. Wang.
Master Tung's Points used by Esther Su:
☯ Renzhong (GV 26), Chongzi (T 22.01), Chongxian (T 22.02), Linggu (T 22.05), Dabai (T 22.04), Zhongbai (T 22.06),Xiabai (LU 4) or Xiabai (T 22.07), Wanshunyi (T 22.08), Wanshuner (T 22.09), Huagusan (T 55.04), Huagusi (T 55.05).
1. In this system, the selection of points is subjected to seasonal changes. In addition, the decision as to which side of the body to needle and/or the exact location of these points must be determined by the practitioner according to his or her judgment of the patients’ condition, and by the patients’ response to each needle after it has been inserted. In other words, acupuncture points are determined at the time of treatment based upon the situation and response to each insertion. In this system, a good rule of thumb is to palpate bilaterally and to needle the more responsive/tender side (ah shi point).
2. Tianhuangfu [shenguan] (T 77.18), Wanshunyi (T 22.08), Wanshuner (T 22.09), Shugu (BL 65), Linggu (T 22.05), Dabai (T 22.04), Xiangu (ST 43), Zhongbai (T 22.06), Xiabai (T 22.07), Zhongzhu (TH 3), Xiaxi (GB 43). Bleed Weizhong (BL 40)
3. For herniated disc, Tianhuangfu [shenguan] (T 77.18), Zhengjin (T 77.01), Zhengzong (T 77.02), Huagusan (T 55.04),Huagusi (T 55.05), Renzhong (GV 26). Bleed Weizhong (BL 40).
Esther Su learned Master Tung points from Miriam Lee, one of the pioneers of acupuncture in the U.S., and from Dr. Young Wei-Chieh.
Click here for courses by Esther Su.
Master Tung’s Points used by Dr. Robert Chu:
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Linggu (T 22.05), Dabai (T 22.04), Weizhong (BL 40), Jinmen (BL 63), Shugu (BL 65), Yanglingquan (GB 34), Waiqiu (GB 36), Xuanzhong (GB 39), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21).
Dr. Robert Chu is a Wing Chun Master and a licensed acupuncturist and herbalist specializing in Master Tung Acupuncture methods. Being bilingual, he is able to teach Master Tung’s techniques in a very accurate and precise way. Click here for books and courses by Dr. Chu.
Master Tung’s Points and Techniques used by Dr. Henry McCann:
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Bloodletting: (1) the region of Weizhong (BL 40) which images the occipital zone, (2) Chong Xiao Xue 沖霄穴 (over the sacrum). Bleed ipsilaterally or bilaterally. One can also bleed the chin if small blood vessels are present.
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Acute pain: Shui Qing 水清, Shui Hai 水海, Shui Yuan 水源, Zheng Shui 正水. Choose which point to needle based on palpation.
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Pain due to Kidney insufficiency (deep, thin pulse, especially in the chi positions): Wanshunyi (T 22.08), Wanshuner (T 22.09), Tongshen (T 88.09), Tongwei (T 88.10), Tongbei (T 88.11) (i.e., Shen Tong San Zhen Dao Ma group), Taixi (KI 3), Shuijin (T 1010.20) needled through to Shuitong (T 1010.19). Do not needle all these points in one treatment. Choose which point to needle based on palpation or responsiveness of the pulse.
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Pain with presence of wiry pulse: Wanshunyi (T 22.08), Wanshuner (T 22.09), Taichong (LR 3); in this pulse presentation, Linggu (T 22.05) is also applicable.
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Pain with presence of relaxed or slightly slippery pulse, or in the presence of Spleen patterns or damp presentation: Wanshunyi (T 22.08), Wanshuner (T 22.09), Taibai (SP 3); Zhongbai (T 22.06) and Xiabai (LU 4) are also applicable especially if there is Shao Yang radiation down the legs, or if there is presentation of wind-cold-damp.
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Sacral pain: Zhoushui (T 1010.25), Wangu (SI 4).
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Painful spine: Zhengji (T 44.24) or Guciyi* (T 44.21), Gucier* (T 44.22), Gucisan* (T 44.23).
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Lumbar pain with radiating pain into legs, or due to urolithiasis: Majinshui (T 1010.13), Makuaishui (T 1010.14) Dao Ma group
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For patients who prefer being treated in the prone position needle the horizontal Dao Ma group called ‘Back of the Knee Three Needles’ (後膝三針) – Weizhong (BL 40), Weiyang (BL 39), Wei Yin (described in Dr. McCann’s Integrating the Classics with Tung’s Acupuncture course); also use Shenshu (BL 23) and Fengfu (GV 16) together with this Dao Ma group.
Dr. Henry McCann is an avid practitioner and author of many books on Master Tung’s treatment methods. He is currently a faculty member at PCOM, OCOM, and ACTCM. He has also been involved in martial arts for over 30 years and is a 12th generation lineage disciple of the Chen-style Taijiquan. Click here for books and courses by Dr. McCann. Click here to subscribe to his blog.
Master Tung’s Points by Dr. Brad Whisnant:
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Primary points: Feixin (T 11.11), Erjiaoming (T 11.12), Dabai (T 22.04), Linggu (T 22.05), Zhongbai (T 22.06), Xiabai (T 22.07), Wanshunyi (T 22.08), Wanshuner (T 22.09), Houzhui (T 44.02), Shouying (T 44.03), Guciyi (T 44.21)*, Gucier (T 44.22)*, Gucisan (T 44.23)*, Pianjian (T 44.20)*
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Secondary points: Chongzi (T 22.01), Chongxian (T 22.02), Xinmen (T 33.12), Zhitong (T 44.13), Luotong (T 44.14), Haibao (T 66.01), Zhengjin (T 77.01), Zhengzong (T 77.02), Zhengshi (T 77.03), Sanchayi (T 22.15)*, Sanchaer (T 22.16)*, Sanchasan (T 22.17)*, Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Simazhong (T 88.17), Simashang (T 88.18), Simaxia (T 88.19), Zhongjiuli (T 88.25), Zhoushui (T 1010.25)
Dr. Brad Whisnant learned Master Tung’s acupuncture from various Masters and is now one of the most active teachers of the system. Click here for books and courses by Dr. Whisnant. Click here for hands-on training with him personally.
Master Tung’s Treatments for Back Pain compiled from various Chinese References:
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Needle contralateral to the pain. If the pain is in the center, needle bilaterally or the side with more ah shi points. If the pain is bilateral, needle bilaterally.
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Linggu (T 22.05), Zhongbai (T 22.06), Xiabai (T 22.07), Wanshunyi (T 22.08), Wanshuner (T 22.09), Chongzi (T 22.01), Chongxian (T 22.02), Erjiaoming (T 11.12), Tianhuangfu [Shenguan] (T 77.18), Zhongjiuli (T 88.25), Zhengjin (T 77.01), Zhengzong (T 77.02), Weizhong (BL 40), Majinshui (T 1010.13), Makuaishui (T 1010.14), Shuiqu (T 66.09).
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Bleed Weizhong (BL 40) or dark veins nearby. Bleed painful area on the back with cupping. Bleed prior to needling for best results.
BALANCE METHOD BY DR. RICHARD TAN:
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Needle the following points on contralateral to the pain: Hegu (LI 4), Houxi (SI 3), Wangu (SI 4), Linggu (T 22.05), Dabai (T 22.04), Zhongbai (T 22.06), Dazhong (KI 4) or ah shi points nearby, Fuliu (KI 7), Ququan (LR 8) or ah shi points nearby.
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Needle the following points ipsilaterally to the pain: All ah shi points around Chize (LU 5), Kongzui (LU 6), Shaohai (HT 3) to Lingdao (HT 4), Shugu (BL 65).
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Needle ah shi points around Fengfu (GV 16) to Houding (GV 19).
The late Dr. Richard Tan was a leading authority in our profession. His skills represented the culmination of years of study and treatment of thousands of patients during his 20 years of practice. His mission was to teach his Balance Method, which so effectively explained WHY TCM points are used the way they are.
Dr. Tan’s “Acupuncture 1, 2, 3” is a 3-step strategy providing logical and precise guidance toward needling a minimal number of distal points, a method which avoids aggravating local areas of pain. Click here for books and courses by Dr. Tan.
DISTAL NEEDLING ACUPUNCTURE (DNA) BY ROBERT DOANE:
3.
Steps for DNA treatment: 1) Identify the location of the pain and determine the muscle group involved. 2) Choose a vessel that delivers blood to this jingjin. 3) Choose vessels known to treat the painful muscles 4) Choose the correct area or zone to needle based on imaging.
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In cases of acute back pain the UB channel will be involved. For chronic back pain, the KI channel will be involved.
5.
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Low back pain L1-L5 (Iliocostalis Lumborum/BL Channel): Bilateral - 2 needles on each of the following points: Chize (LU 5), Zhizheng (SI 7), Xiaohai (SI 8), Weizhong (BL 40), Weiyang (BL 39), Yingu (KI 10), Zhubin (KI 9), 5-10 needles on the abdomen at the same level as the back pain.
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Low back pain L1-L5 (Gluteus Maximus/BL Channel): Bilateral - Lieque (LU 7), Jingqu (LU 8), Taiyuan (LU 9), Feiyang (BL 58), Fuyang (BL 59), Kunlun (BL 60), Fuliu (KI 7), Jiaoxin (KI 8), Zhubin (KI 9), Wangu (SI 4), Yanggu (SI 5), Yanglao (SI 6), 5-10 needles on the abdomen at the same level as the back pain.
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Low back pain L1-L5 (Serratus Posterior Inferior, Iliocostalis Lumborum and Thoracis, Latissimus Dorsi/BL Channel): Bilateral - 3 needles evenly spaced from Weizhong (BL 40) to Kunlun (BL 60), Zhaohai (KI 6) to Yingu (KI 10), Wangu (SI 4) to Xiaohai (SI 8), Tianfu (LU 3) to Taiyuan (LU 9), 5-10 needles on the abdomen at the same level as the back pain.
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Low back pain L1-L5 (Intertransversarii, Quadratus Lumborum, Multifidus/KI Channel): Bilateral - 3 needles evenly spaced from Zhaohai (KI 6) to Yingu (KI 10), Weizhong (BL 40) to Kunlun (BL 60), Shaohai (HT 3) to Shenmen (HT 7), Yangxi (LI 5) to Quchi (LI 11), 5-10 needles on the abdomen at the same level as the back pain. This set of points is better for chronic low back pain.
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Low back pain L1-L5 (External and Internal Oblique, Transverse Abdominis/GB Channel): Bilateral - 3 needles evenly spaced from Yangjiao (GB 35) to Qiuxu (GB 40), Zhongfeng (LR 4) to Xiguan (LR 7), Waiguan (TH 5) to Huizong (TH 7), Shenmen (HT 7) to middle of the forearm, 5-10 needles on the abdomen at the same level as the back pain.
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Sacral spine pain (Multifidus, Coccygeus, Iliococcygeus/KI Channel): Bilateral - 3 needles evenly spaced from Yongquan (KI 1) to Zhaohai (KI 6), Kunlun (BL 60) to Zhiyin (BL 67), Shaofu (HT 8) to Shaochong (HT 9), Shangyang (LI 1) to Yangxi (LI 5).
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Sacral spine pain (Piriformis, Gemellus Superior and Inferior, Obturator Internus, Quadratus Femoris, Gluteus Maximus, Iliocostalis Lumborum/BL Channel): Bilateral - 3 needles evenly spaced from Kunlun (BL 60) to Zhiyin (BL 67), Yongquan (KI 1) to Zhaohai (KI 6), Lieque (LU 7) to Shaoshang (LU 11), Qiangu (SI 2) to Yanggu (SI 5).
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Tailbone pain: Bilateral - Yongquan (KI 1), Rangu (KI 2), Shangyang (LI 1), Quchi (LI 11), ah shi points from Jinggu (BL 64) to Zhiyin (BL 67), 3 needles deep into Weizhong (BL 40); Baihui (GV 20), needle either the top, Tiantu (CV 22), or the bottom, Jiuwei (CV 15), of the sternum.
Robert Doane runs one of the most successful acupuncture clinics in the U.S. seeing over 120 patients a day. He learned from Dr. Richard Tan and Dr. Donald Kendall and perfected his own technique, DNA. His point prescriptions are based on Dr. Tan’s Balance Method as well as the Muscle Tendon theories from Dr. Kendall’s book, Dao of Chinese Medicine, where specific muscles are paired with TCM channels.
Click here for hands-on training with Robert Doane.
BODYMAPPING ACUPUNCTURE BY COLE MAGBANUA:
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General back pain: Linggu (T 22.05), Dabai (T 22.04), Houxi (SI 3) to Yanggu (SI 5), deep needling of the SI Joint Point (distal and medial to the styloid process of the ulna into the pisolunar ligament), Feiyang (BL 58) to Kunlun (BL 60), Taixi (KI 3) to Shuiquan (KI 5), Zulinqi (GB 41), Jianzhen (SI 9) to Naoshu (SI 10), Tianliao (TH 15).
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Coccyx pain: Baihui (GV 20).
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Midback pain of the muscles: Chize (LU 5), Kongzui (LU 6) on the opposite side of pain.
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Midback pain on the GV channel: 2-5 needles on Shuifen (CV 9) to Jiuwei (CV 15).
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Lower rib and flank pain: Shaohai (HT 3) on the opposite side of pain.
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Lumbar spinal pain: Linggu (T 22.05), Dabai (T 22.04), Houxi (SI 3), Wangu (SI 4), Yanggu (SI 5) on the opposite side of pain; 1-3 needles on Feiyang (BL 58), Kunlun (BL 60) on the same side of pain; 2-5 needles on Guanyuan (CV 4) to Yinjiao (CV 7).
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Paraspinal pain: 1-3 needles on Chize (LU 5) to Kongzui (LU 6).
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Quadratus Lumborum pain: Zulinqi (GB 41) on the same side.
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Thoracolumbar fascia around sacroiliac joint pain: Tianliao (TH 15)
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12th rib pain: Chize (LU 5) to Kongzui (LU 6), Ganmen (T 33.11), Zulinqi (GB 41) on the opposite side of pain. Feiyang (BL 58), Yanglingquan (GB 34) on the same side of pain.
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Gluteus muscles: Needle the infraspinatus along the spine of the scapula and belly of muscle. Also needle the posterior and lateral deltoid.
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Piriformis, obturator, gemellus: Needle teres minor muscle (needle origin, belly, or insertion as needed).
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Iliotibial pain: Needle the lateral deltoid, 1-10 needles on the TH channel.
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Anterior Superior Iliac Spine pain: Needle the coracoid process.
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Inguinal ligament pain: 1-3 needles on the subclavius with careful oblique insertion.
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Tensor Fasciae Latae pain: Needle the short head of biceps, coracobrachialis.
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Psoas pain: Zulinqi (GB 41) on the same side of pain and pectoralis minor
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Iliacus pain: Zulinqi (GB 41) on the same side of pain
Cole started learning holistic medicine in 1991 with doctors from a variety of medical traditions including Chinese, Korean, Ayurvedic, and Himalayan medicine. His primary TCM teacher was Dr. Richard Tan, and during his 20 years of practice, Cole refined and discovered that channels are not linear but rather zones. Thus, he created BodyMapping Acupuncture. In his classes, books, and charts, each channel is specifically color-coded so practitioners can pinpoint specific channel(s) that are diseased and pick the right zones. Cole mainly uses Systems 1 and 4 from Dr. Tan’s Balance Method as he found these to be the most effective. Click here for books and courses by Cole Magbanua.
TCM AURICULAR ACUPUNCTURE:
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Sciatic pain: Lower Back, Hip, Sciatic, and Pituitary Gland. Embed needles or use ear seeds in both ears, and instruct the patient to massage the points three to four times daily for two to three minutes each time.
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Tailbone injury: Coccyx, Adrenal Gland, Pituitary Gland
AURICULAR MEDICINE BY LI-CHUN HUANG:
Dr. Li-Chun Huang uses ear seeds instead of needles for auricular treatment as she feels it reduces the possibility of infection and the patient can get lasting treatment effect for 7+ days. She uses two seeds per tape to provide stronger stimulation. Below are her point prescription for acute back sprain and strain.
Figure 1. Handbook of Auricular Treatment Prescription & Formulae (P.168) by Li-Chun Huang, OMD, MD and William S. Huang, APOM
Figure 2. Handbook of Auricular Treatment Prescription & Formulae (P.156-157) by Li-Chun Huang, OMD, MD and William S. Huang, APOM
Click here to buy tools for point detection and treatment.
For a color chart of the ear, click here.
Click here for books and courses by Dr. Huang.
ABDOMINAL ACUPUNCTURE BY DAVE SHIPSEY:
Abdominal Acupuncture, created by Dr. Zhiyun Bo, is an easy modality to learn and apply. It is not only gentle and relaxing, but also very effective because it works with the qi in the core of the body. In addition, it directly affects the digestive system.
The following overview to Abdominal Acupuncture is compiled from the online courses by Dave Shipsey (in English), and online resources by Dr. Zhiyun Bo (in Chinese).
Abdominal Acupuncture utilizes a hologram on the abdomen in the image of a tortoise on its back. Abdominal point prescriptions follow the same concept as herbal prescriptions in which there are Jun, Chen, Zuo, Shi (Chief, Deputy, Assistant, Envoy) points, each playing an essential function.
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Chief Points treat the patient’s chief complaints, and regulate and harmonize the organs. Usually 1-2 points are selected.
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Deputy Points enhance the organ regulating effects of the Chief points.
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Assistant Points enhance Chief and Deputy functions, as well as regulate affected channels.
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Envoy Points provide symptomatic relief. They often image the corresponding pain areas, and can also be guiding points.
There are no set number of points to use for each category; however, there usually more Envoy than Chief points are used. Depending on the condition, some point prescriptions may only contain points from one or two of the categories.
Point locations and needling depths are the keys to successful treatment outcomes in this method. Click here for courses in English by Dave.
POINT LOCATIONS WITH CORRESPONDING IMAGING AREAS
The Ren (Conception) channel images the spine. Therefore, the CV points on the abdomen correspond to the vertebra and GV points.
Zhongwan (CV 12) = Images the head – Treats head, brain, and sensory organs
Jianli (CV 11) = Corresponds to C1 or Fengfu (GV 16) area – Used for brain problems and treats C1 vertebra area
Xiawan (CV 10) = Corresponding area is C7 or Dazhui (GV 14) – Helps Zhongwan (CV 12) for SP and ST problems, and treats C7 vertebra area
Shuifen (CV 9) = Corresponds to T7 – Reduces swelling during the acute stages of back/neck pain
Shenque (CV 8) or navel = Corresponds to T12 area; this is the center
Qihai (CV 6) = Corresponds to L1 – Treats all kinds of chronic qi diseases
Guanyuan (CV 4) = L4 & L5 or Yaoyangguan (GV 3)
Zhongji (CV 3) = Sacrum
In addition to the CV points above, there are also points on the abdomen that image the upper and lower extremities.
Huaroumen (ST 24) = Is the Shoulder point – Use for any arm/hand issues. Strengthens the upper back.
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Elbow point (AB1) is ½ cun superolateral to the Shoulder point. This point is also the Upper Rheumatism Point.
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Wrist point (AB2) is 1 cun lateral to the Shoulder point, or ½ cun inferolateral to the Elbow point. This point is also the Upper Lateral Rheumatism Point.
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Thumb point (AB3) is 1 cun superior to the Wrist point. This point is also the Upper Upper Rheumatism Point.
Wailing (ST 26) = Hip point – Use for any back/leg issues. Strengthens the lower back.
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Knee point (AB4) is ½ cun inferolateral to the Hip point. This point is also the Lower Rheumatism Point.
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Medial Knee point (AB5) is ½ cun inferomedial to the Hip point.
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Ankle point (AB6) is ½ cun inferolateral to the Knee point (AB4). This point is also the Lower Rheumatism Point.
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Foot/Toes point (AB7) is ½ cun inferomedial to the Ankle point (AB6).
Abdominal Acupuncture Prescription for Back Pain:
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Zhongwan (CV 12), Xiawan (CV 10), Qihai (CV 6), Guanyuan (CV 4)
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Bilateral Daheng (SP 15), Tianshu (ST 25), ah shi point on Qixue (KI 13)
KOREAN HAND ACUPUNCTURE BY DR. DAN LOBASH:
With over two decades of experience, Dr. Dan Lobash has dedicated his career to the practice and teaching of Korean Hand Therapy (KHT). Below is a summary describing how he treats back pain effectively using the Korean Hand Hologram. The holographic imaging is very much like the concept for Auricular medicine and the Balance Method. For this style of treatment, one needs a steel probe to identify the precise location of effective points. A needle is inserted or a pellet is used on that point. Click here for courses by Dr. Lobash.
The imaging of the back is shown below. The middle finger and the third phalanges are the vertebrae. If the pain is on the spine, the tender corresponding point on the hand would be on the center line. If the back pain is on the sides, then palpate in between the second and the third and the third and the fourth phalanges. Interestingly enough this imaging system is very similar to Master Tung’s points for back pain.
Steps for Korean Hand Acupuncture treatment:
1. Identify the location of the back problem specific to each client by palpation.
2. Determine the correspondence on the middle finger or the sides of the middle finger.
3. Roll over the area and then identify the precise point that elicits a motor reflex.
4. Mark the reflex points discovered with a surgical marking pen.
5. Check immediately for pain reduction and range of motion changes.
6. Search for additional reflex points, stimulate, and request client feedback.
7. Apply stimulators (hand needles, moxa, and pellets, in this sequence).
8. Instruct and provide the client with self-treatment supplies to apply at home.
CONCLUSION
After analyzing all the points from various styles of acupuncture, one must conclude that the body is full of holograms. Mastering the selection of the best image for treatment is a life-long practice. It is said that a medical practice is referred to as a ‘practice’ precisely because one is constantly practicing. No single method can be duplicated with a 100% success rate all the time. Therefore, it is optimal to have a grasp of multiple systems and understand HOW to pick the points in each system. Using the above recommendations found in the various styles of acupuncture presented, we hope will help you to find your own, unique, and effective point prescriptions. Should you discover any new methods or have a clinical breakthroughs, kindly share them with your peers by posting them in the comment section of this article or on our eLotus Facebook group, Acupuncturist Online.
HERBAL TREATMENT FOR BACK PAIN BY DR JOHN CHEN
Herbal treatment for back pain requires a differential zang fu diagnosis and 8 principle differentiation. Below are some of the most popular herbal formulas. Theoretically, as most of us learned in school, there is one herbal treatment for each diagnosis. However, mixed and complicated syndromes present clinically daily. Some syndromes may present with a combination of heat and cold, deficiency and excess, or all of the above. Formula prescription has to take the entire presenting pattern into account, thus it is not unusual to combine several formulas if you are using extract capsules or powder. The same applies to raw herbal formulas which need to be modified accordingly.
Click here to watch a video of how to mix extract formulas and the logic behind it.
Popular Formulas for Back Pain:
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Du Huo Ji Sheng Tang (Angelica Pubescens and Taxillus Decoction) is mostly used for patients who have cold damp bi zheng (painful obstruction syndrome). Pain usually exacerbates with cold or rainy weather.
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You Gui Wan (Restore the Right [Kidney] Pill) is used for back pain due to Kidney yang deficiency. This type of pain usually feels more dull and achy, and may accompany weakness and soreness of the back and knees. Other yang deficient signs may include feeling of cold or intolerance to cold, polyuria or nocturia, a weak pulse, and a pale tongue. Pain exacerbates with exertion or sexual activities. Many times this formula is used with Du Huo Ji Sheng Tang (Angelica Pubescens and Taxillus Decoction) for better results.
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Zuo Gui Wan (Restore the Left [Kidney] Pill) is used for back pain due to Kidney yin deficiency. This type of pain usually feels more dull and achy, and may be accompanied by weakness and soreness of the back and knees. Patient will show associated yin deficient signs such as night sweats, thirst, dry skin, dry hair, a thready, thin pulse, a skinny red tongue, mirror tongue, or tongue with no coating.
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Shu Jing Huo Xue Tang (Relax the Channels and Invigorate the Blood Decoction) is a good formula for back pain due to poor blood flow that may be caused by a sedentary lifestyle or being in one position for too long. It is a good blood mover to help alleviate the pain.
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Zheng Gu Zi Jin Dan (Purple and Gold Pill for Righteous Bones) is best for back pain due to recent trauma, sprain or strain, or for back surgery rehabilitation.
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Jiu Wei Qiang Huo Tang (Nine-Herb Decoction with Notopterygium) is designed for pain associated with wind invasion or damp accumulation. Usually patients who require this formula suffer from wind invasion and have body aches in addition to back pain. This is the least commonly used formula for back pain out of the formulas mentioned.
Popular Single Herbs for Back Pain:
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Chuan Niu Xi (Radix Cyathulae)
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Du Zhong (Cortex Eucommiae)
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Bai Shao (Radix Paeoniae Alba)
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Yan Hu Suo (Rhizoma Corydalis)
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Huang Jin Gui (Caulis Vanieriae)
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Ji Xue Teng (Caulis Spatholobi)
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Liu Zhi Huang (Herba Solidaginis)
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Mo Gu Xiao (Caulis Hyptis Capitatae)
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Mu Gua (Fructus Chaenomelis)
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Wei Ling Xian (Radix et Rhizoma Clematidis)
Gui Zhi (Ramulus Cinnamomi)
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Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle)
SUPPLEMENTARY HERBS AND FORMULAS
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For acute back pain due to herniated disk or bone spurs, add Po Bu Zi Ye (Folium Cordia Dichotoma).
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To enhance the analgesic action, add Yan Hu Suo (Rhizoma Corydalis).
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For back pain associated with osteoporosis, use with Gui Lu Er Xian Jiao (Tortoise Shell and Deer Antler Syrup).
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For back pain with severe cramps, add Shao Yao Gan Cao Tang (Peony and Licorice Decoction).
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For back pain caused by kidney stones, add Hai Jin Sha (Spora Lygodii), Jin Qian Cao (Herba Lysimachiae), Shi Wei (Folium Pyrrosiae), Yan Hu Suo (Rhizoma Corydalis), Chuan Lian Zi (Fructus Toosendan).
PHARMACOLOGICAL AND CLINICAL RESEARCH
Yan Hu Suo (Rhizoma Corydalis) is one of the most potent herbs for the treatment of pain. Its effects are well documented in both historical references and modern research studies. According to classical texts, Yan Hu Suo (Rhizoma Corydalis) has been used to treat chest and hypochondriac pain, epigastric and abdominal pain, hernia pain, dysmenorrhea or menstrual pain, and pain of the extremities. According to laboratory studies, extracts of Yan Hu Suo (Rhizoma Corydalis) have been found to be effective in both acute and chronic phases of inflammation. The mechanism of its anti-inflammatory effect is attributed to its inhibitory activities on the release of histamine and pro-inflammatory mediators.
[i]
[ii]
Furthermore, it has a strong analgesic effect. With adjustment in dosage, the potency of Yan Hu Suo (Rhizoma Corydalis) has been compared to that of morphine. In fact, the analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is so strong and reliable that it has been used with satisfactory anesthetic effect in 98 out of 105 patients (93.4%) who underwent surgery.
[iii]
The analgesic effect can be potentiated further with concurrent acupuncture therapy. One research study demonstrated that the analgesic effects of electro-acupuncture were enhanced significantly with concurrent use of Yan Hu Suo (Rhizoma Corydalis) , when compared to a control group, which received electro-acupuncture only.
[iv]
Overall, it is well understood that Yan Hu Suo (Rhizoma Corydalis) has a marked effect on pain. Though the maximum analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is not as strong as morphine, it has been determined that the herb is much safer, with significantly fewer side effects, less risk of tolerance build up, and no evidence of physical dependency even with long-term use.
[v]
Bai Shao (Radix Paeoniae Alba) and Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) are two of the most effective herbs to relieve pain, reduce inflammation, and alleviate spasms and cramps. Pharmacologically, these two herbs have shown marked analgesic, anti-inflammatory, and muscle-relaxant effect.
[vi]
[vii]
Bai Shao (Radix Paeoniae Alba) exhibits excellent anti-inflammatory effects to treat arthritis by modulating pro-inflammatory mediators production from macrophage-like synoviocytes.
[viii]
Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) posess marked anti-inflammatory effects by enhancing the effect of glucocorticoids through its increased production and secretion, as well as by decreasing its metabolism in the liver, along with increased plasma concentration caused by decreased protein binding.
[ix]
Clinically, these two herbs have been used to treat a wide variety of musculoskeletal disorders. According to one study, use of these herbs via intramuscular injection was associated with an 84.67% effectiveness rate (in 105 out of 124 subjects) for the treatment of pain in general.
[x]
In other studies, these two herbs have also been found to effectively treat pain in the lower back and legs among 33 elderly patients,
[xi]
as well as treat severe pain of the back and legs in 27 patients.
[xii]
Furthermore, the combination of these two herbs was found to be effective in relieving nerve pain (neuralgia) in 30 out of 42 patients.
[xiii]
According to another study, the use of these two herbs was also effective in treating muscle spasms and cramps in various areas of the body, including the treatment of muscle spasms and twitching in the facial region in 11 patients,
[xiv]
intestinal spasms in 254 patients,
[xv]
and intestinal cramps and spasms in 85 patients.
[xvi]
Gui Zhi (Ramulus Cinnamomi) also has an analgesic effect to relieve pain. According to one study, this herb has been used successfully to treat arthritis in a group of 30 patients.
[xvii]
Another study used this herb to effectively treat numbness in 30 patients.
[xviii]
Ji Xue Teng (Caulis Spatholobi) exhibits an anti-inflammatory effects through its inhibitory activities against a panel of key enzymes relating to inflammation, including cyclo-oxygenase, phospholipase, and lipoxygenase.
[xix]
Mu Gua (Fructus Chaenomelis) reduces inflammation and relieves arthritis via the prevention of ultrastructural changes of synoviocytes and the inhibition of the secretion of pro-inflammatory cytokines, such as interleukin-1, tumor necrosis factor-alpha (TNF-α), and prostaglandin E2.
[xx]
Furthermore, Mu Gua (Fructus Chaenomelis) has been shown to effectively treat rheumatic and rheumatoid arthritis by reducing inflammation in subjects with collagen-induced arthritis.
[xxi]
Wei Ling Xian (Radix et Rhizoma Clematidis) exerts a significant anti-inflammatory effect by blocking the production of the pro-inflammatory mediators, nitric oxide, and prostaglandin.
[xxii]
Lastly, Ge Gen (Radix Puerariae Lobatae) has also been shown to have a muscle-relaxant effect and can relieve muscle spasms and cramps.
[xxiii]
COMPARATIVE ANALYSIS
Pain is a basic bodily sensation induced by a noxious stimulus that causes physical discomfort (such as pricking, throbbing, or aching). Pain may be acute or chronic in nature. For acute back pain, two classes of drugs commonly used for treatment include non-steroidal anti-inflammatory agents (NSAIDs) and opioid analgesics. NSAIDs [such as Motrin (ibuprofen) and Voltaren (diclofenac)] are generally used for mild to moderate pain, and are most effective to reduce inflammation and swelling. Though effective, they may cause side effects such as gastric ulcers, duodenal ulcers, gastrointestinal bleeding, tinnitus, blurred vision, dizziness, and headaches. Furthermore, the newer NSAIDs, also known as COX-2 inhibitors [such as Celebrex (celecoxib)], are associated with significantly higher risk of cardiovascular events, including heart attack and stroke. Opioid analgesics [such as Vicodin (APAP/hydrocodone) and morphine] are usually used for severe to excruciating pain. While they may be the most potent agents for pain, they also have very serious risks and side effects, including but not limited to dizziness, lightheadedness, drowsiness, upset stomach, vomiting, constipation, stomach pain, rashes, difficulty with urination, and respiratory depression resulting in difficult breathing. In addition, long-term use of these drugs leads to tolerance and addiction. In brief, it is important to remember that while drugs offer reliable and potent symptomatic pain relief, they should only be used if and when absolutely necessary. Frequent use leads to abuse and unnecessary side effects and complications.
Treatment of pain is a sophisticated balance of art and science. Proper treatment of pain requires a careful evaluation of the type of disharmony (excess or deficiency, cold or heat, exterior or interior), characteristics (qi and/or blood stagnation), and location (upper body, lower body, extremities, or internal organs). Furthermore, optimal treatment requires integrative use of herbs, acupuncture, and tui-na therapies. All these therapies work together to tonify the underlying deficiencies, strengthen the body, and facilitate recovery from chronic pain. TCM pain management targets both the symptom and the cause of pain, and as such, often achieves immediate and long-term success. Furthermore, TCM pain management is often associated with few or no side effects.
In conclusion, for treatment of mild to severe pain due to various causes, TCM pain management offers similar treatment effects to Western medicine with significantly fewer side effects.
CAUTIONS & CONTRAINDICATIONS
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Blood moving herbs for back pain are contraindicated or to be used with caution during pregnancy and nursing.
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If the patient presents with fever and one-sided back pain, consider a possible kidney infection and do not use this type of herbal formula. Patients with acute nephritis should be referred to their medical doctor immediately.
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Patients who have pain radiating to the extremities accompanied by a sudden loss of bladder or bowel control may have a pinched nerve or spinal injury, and must be referred out to emergency care. This condition, known as cauda equina syndrome, and can lead to permanent disability and therefore must be evaluated and treated immediately.
NUTRITION
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Eat a diet with a wide variety of raw vegetables and fruits, and whole grain cereals to ensure a complete supply of nutrients for the bones, nerves, and muscles.
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Adequate intake of calcium is essential for the repair and rebuilding of bones, tendons, cartilage, and connective tissues.
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Fresh pineapples are recommended as they contain bromelain, an enzyme that is excellent in reducing inflammation. If the consumption of fresh pineapples causes stomach upset, eat it after meals.
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To relieve cramps and spasms, eat plenty of fruits and vegetables, especially those high in potassium, such as bananas and oranges. Also drink an adequate amount of warm water.
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Adequate intake of minerals, such as calcium and potassium, is essential for pain management. Deficiency of these minerals will lead to spasms, cramps, and tense muscles.
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Avoid red meat and seafood as they contain high levels of uric acid, which puts added strain on the kidneys.
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Avoid cold beverages, ice cream, caffeine, sugar, tomatoes, milk, and dairy products.
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The following is a folk remedy to treat acute back pain from sprain and strain. Crack open 2 crabs (ocean) with a wooden stick (do not use a knife or any metal instruments) and put them into a clay pot with enough vodka or whiskey to cover both crabs. Place the clay pot into another larger pot with water, and steam it for one hour. Serve the crab meat along with the liquor soup.
LIFESTYLE INSTRUCTIONS
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Patients are advised to bend and use their legs (instead of bending from the waist or back) when lifting heavy objects.
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Patients are encouraged to wear clothing that covers their backs completely and to tuck their shirts into their pants or skirts to avoid any wind exposure to their backs, which will further aggravate the condition.
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Stretching and strengthening exercises for the back muscles are essential for long-term recovery. Strengthening the abdominal muscles is also beneficial to reduce strain on the lower back.
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Mild exercise such as swimming, yoga, or tai chi chuan [tai ji quan] is recommended on a regular basis.
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For those who are overweight, weight loss is strongly recommended to decrease pressure on the joints and relieve pain.
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Proper balance of work and rest is very important. While sitting, make sure the back is straight and the elbows and knees are bent at a 90° angle. Take breaks at least once every hour to alleviate pressure on the vertebrae and discs.
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Adequate rest is essential to recovery. It is wise to review sleeping postures to ensure that the back is appropriately supported and relaxed.
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Hot baths with Ai Ye (Folium Artemisiae Argyi) or Epsom salts help to relax tense muscles, invigorate blood flow and draw toxins from tissues. Rest and relax in the bath for about 15 to 30 minutes, but avoid becoming over-tired from the heat. Mix about 2 to 3 tablespoons of Ai Ye (Folium Artemisiae Argyi) extract powder in the hot water each time.
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Firm beds are recommended over soft ones for patients with back pain.
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We would like to thank all the contributors for submitting their tried-and-true treatment strategies. We hope this article helps you see better results when treating back pain. Please forward this to your colleagues if you find it helpful.
All the contributors are also speakers for eLotus.org and have many archived videos. To further learn from any of them, visit our online learning platform www.eLotus.org. One day when you are ready to watch everything on our platform, we encourage you to explore the Gold Pass. We are confident it will help to transform your practice!
[ii]
Oh YC, Choi JG, Lee YS, Brice OO, Lee SC, Kwak HS, Byun YH, Kang OH, Rho JR, Shin DW, Kwon DY. Tetrahydropalmatine inhibits pro-inflammatory mediators in lipopolysaccharide-stimulated THP-1 cells. Department of Oriental Pharmacy, College of Pharmacy, Wonkwang University Wonkwang Oriental Medicines Research Institute, Iksan, Republic of Korea. J Med Food. 2010 Oct;13(5):1125-32.
[viii]
Zheng YQ, Wei W. Total glucosides of paeony suppresses adjuvant arthritis in rats and intervenes cytokine-signaling between different types of synoviocytes. Int Immunopharmacol. 2005 Sep;5(10):1560-73.
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Li RW, David Lin G, Myers SP, Leach DN. Anti-inflammatory activity of Chinese medicinal vine plants. Australian Centre for Complementary Medicine Education and Research, A Joint Venture of the University of Queensland and Southern Cross University. J Ethnopharmacol. 2003 Mar;85(1):61-7.
[xx]
Dai M, Wei W, Shen YX, Zheng YQ. Glucosides of Chaenomeles speciosa remit rat adjuvant arthritis by inhibiting synoviocyte activities. Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China. Acta Pharmacol Sin. 2003 Nov;24(11):1161-6.
[xxi]
Chen Q. & Wei W. Effects and mechanisms of glucosides of Chaenomeles speciosa on collagen- induced arthritis in rats. Int Immunopharmacol. 2003, 3(4): 593-608.
[xxii]
Park EK, Ryu MH, Kim YH, Lee YA, Lee SH, Woo DH, Hong SJ, Han JS, Yoo MC, Yang HI, Kim KS. Anti-inflammatory effects of an ethanolic extract from Clematis mandshurica Rupr. East-West Bone and Joint Research Center, College of Medicine, Kyung Hee University, Hoegi-1 dong, Dongdaemun-gu, Seoul 130-701, South Korea. J Ethnopharmacol. 2006 Nov 3;108(1):142-7.
About the Author Dr. John K. Chen, PhD, PharmD, OMD, LAc, is the lead author of Chinese Medical Herbology and Pharmacology (2003, Art of Medicine Press), Chinese Herbal Formulas and Applications (2008, Art of Medicine Press), Chinese Herbal Formulas for Veterinarians (2008, Art of Medicine Press), and Chinese Herbal Formulas for Veterinarians (2012, Art of Medicine Press). He is a medical consultant for Evergreen Herbs and may be reached at john.chen@evherbs.com or (626) 810-5530.
To learn more about Dr. John Chen and herbs, click here to view a complete list of courses by Dr. John Chen.
