Traditional Chinese Medicine & Acupuncture
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.
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.