A good portion of patients came for acupuncture because of low back problems. The problems include common back soreness that people suffer from time to time to pain so severe that patient can’t stand up straight. Statistic indicates that everybody experience back pain some time in their life. Some goes away by itself with proper rest and stretching. Some involves more serious problems like stenosis, herniated discs, sciatica pain, scoliosis that need be treated to get better. 

Acupuncture verses other kind of treatments

Back pain is where chiropractors make most of their money and where large sum of money is spent in this country treating this problem.  A great portion of that sum was spent on surgical approach in spite of research findings that challenge its effectiveness. Few people know TCM is incredibly effective in treating the low back problems. The results are often “miraculous” according to patients. It has not been properly recognized because of variety of reasons. Among them is the inability for obtaining consistent results from many some practitioners. The blame is squarely placed on the education. There is not enough of training on new acupuncturist to do this right. The truth is, treating it properly; the result is very satisfactory. The exception is for people who had undergone surgery without success. Some of these cases may be difficult to achieve the long lasting result.

5.1 Why does the low back have so much trouble?

To understand the problem facing us, we have to look at the anatomical structure of the low back first. All of the physical work of the body require( to be exact, any movement) the involvement lumbar spine at  L3, L4 and L5 and the musculatures associated with them.  Of 17 segments of lumbar and thoracic spines, only L3, L4 are allowed to have free rotation. Such ability subjects them to the brunt of any stress- from work, sport and its related injury. With age, the strength of the musculatures and the tissues supporting the discs begin to deteriorate, making it even prone to become overuse. Equally important issue is the uneven use of the muscle groups which results unbalanced  muscle tones in the back. This is particularly true with many sports activities. These misuse, eventually leads to back pain. On top of these issues, many of the intervention, including the back surgery often leads to weakened and injured back. It is not uncommon to see patients whose surgeries to “correct” the back problem made them worse off. 

How does TCM diagnose back pain? 

-Common mistake in TCM

TCM in the modern times often attributes the low back pain to either Kidney disorder or Bi syndrome, provided the disorder was not caused by traumatic injury.  Therefore, TCM doctors frequently prescribe formulas base on Du Huo Ji Sheng Tang for the low back pain. This is due to the fact this formula addresses these two issues. This approach with some variation has been common among TCM practitioner for thousands of years. The result is often slow if effective at all. 

This is a distorted view in approaching low back pain.  According to Yellow Emperor Inner Cannon( Huang Di Nei Jing) which was written more than 2000 years ago,  Kidney Qi should not be a major cause of back pain for most people except for geriatric population or over sexed individuals. In other words, Kidney Qi and Jing should not be a common problem with people below 40 years old.  Yet a great number of patients complaining back problems are under 40s, some are in their 30’s even 20’s. How would prescription formula based on this approach be able to address the problem? It can’t. Even if it does at all, the result will be very slow in coming. Our patients can’t wait that long and should not.

TCM treatment of low back Pain

            In addition to herbal decoction  above, TCM treatment of low back pain includes acupuncture, moxibustion, Tui Na, cupping and external liniment application. Historically, Tui Na has been the most common approach for back pain. It is quite effective in cases such as disc herniation, fusion of muscle tissues, scar formation or mis-alignment of the joints.  Effectiveness of Tui Na largely depends on the skill of the practitioner. It is similar to  chiropractic manipulation in many way with the exception of it also addresses muscles and tendons issues, not just alignment of bones, much like the combination of chiropractic adjustment plus massage. Liniment is good for acute situation. Cupping is not very commonly used for low back issues.

A good portion of patients came for acupuncture because of low back problems. The problems include common back soreness that people suffer from time to time to pain so severe that patient can’t stand up straight. Statistic indicates that everybody experience back pain some time in their life. Some goes away by itself with proper rest and stretching. Some involves more serious problems like stenosis, herniated discs, sciatica pain, scoliosis that need be treated to get better. 

Acupuncture verses other kind of treatments

Back pain is where chiropractors make most of their money and where large sum of money is spent in this country treating this problem.  A great portion of that sum was spent on surgical approach in spite of research findings that challenge its effectiveness. Few people know TCM is incredibly effective in treating the low back problems. The results are often “miraculous” according to patients. It has not been properly recognized because of variety of reasons. Among them is the inability for obtaining consistent results from many some practitioners. The blame is squarely placed on the education. There is not enough of training on new acupuncturist to do this right. The truth is, treating it properly; the result is very satisfactory. The exception is for people who had undergone surgery without success. Some of these cases may be difficult to achieve the long lasting result.

5.1 Why does the low back have so much trouble?

To understand the problem facing us, we have to look at the anatomical structure of the low back first. All of the physical work of the body require( to be exact, any movement) the involvement lumbar spine at  L3, L4 and L5 and the musculatures associated with them.  Of 17 segments of lumbar and thoracic spines, only L3, L4 are allowed to have free rotation. Such ability subjects them to the brunt of any stress- from work, sport and its related injury. With age, the strength of the musculatures and the tissues supporting the discs begin to deteriorate, making it even prone to become overuse. Equally important issue is the uneven use of the muscle groups which results unbalanced  muscle tones in the back. This is particularly true with many sports activities. These misuse, eventually leads to back pain. On top of these issues, many of the intervention, including the back surgery often leads to weakened and injured back. It is not uncommon to see patients whose surgeries to “correct” the back problem made them worse off. 

How does TCM diagnose back pain? 

-Common mistake in TCM

TCM in the modern times often attributes the low back pain to either Kidney disorder or Bi syndrome, provided the disorder was not caused by traumatic injury.  Therefore, TCM doctors frequently prescribe formulas base on Du Huo Ji Sheng Tang for the low back pain. This is due to the fact this formula addresses these two issues. This approach with some variation has been common among TCM practitioner for thousands of years. The result is often slow if effective at all. 

This is a distorted view in approaching low back pain.  According to Yellow Emperor Inner Cannon( Huang Di Nei Jing) which was written more than 2000 years ago,  Kidney Qi should not be a major cause of back pain for most people except for geriatric population or over sexed individuals. In other words, Kidney Qi and Jing should not be a common problem with people below 40 years old.  Yet a great number of patients complaining back problems are under 40s, some are in their 30’s even 20’s. How would prescription formula based on this approach be able to address the problem? It can’t. Even if it does at all, the result will be very slow in coming. Our patients can’t wait that long and should not.

TCM treatment of low back Pain

            In addition to herbal decoction  above, TCM treatment of low back pain includes acupuncture, moxibustion, Tui Na, cupping and external liniment application. Historically, Tui Na has been the most common approach for back pain. It is quite effective in cases such as disc herniation, fusion of muscle tissues, scar formation or mis-alignment of the joints.  Effectiveness of Tui Na largely depends on the skill of the practitioner. It is similar to  chiropractic manipulation in many way with the exception of it also addresses muscles and tendons issues, not just alignment of bones, much like the combination of chiropractic adjustment plus massage. Liniment is good for acute situation. Cupping is not very commonly used for low back issues.

5.2 Wang’s Low back treatment 

In truth, the best approach is based on the mix of acupuncture and moxibustion. Indeed, according to Nei Jing, acupuncture is the quickest way to treat diseases with result. Interestingly, Nei Jing also said that acupuncture is very easy to apply but difficult to be good at. The key components in success are point selection and the mastering the Qi with needles. In any treatment, when the proper Qiarrives at the diseased location, the treatment will be effective. As was stated in Nei Jing, this is easy saying but difficult to grasp. To get the Qi to the diseased location is very easy, to get the Qi properly requires more profound understanding. Once it is understood, the actual treatment is not difficult.

The most common mistake is the preoccupation of the meridian UB or meridian Kd due to the fact that UB meridian covers the majority of low back. The second mistake is the predominate use of  Ashi points to treat the low back by palpating the most painful location(s) and insert needles on them. This is based on the principle that “the painful point is the Shu point of choice”. Because these spots are painful, there is always strong Qi elicited with needling. There is no question that Qi was obtained with needle insertion. Unfortunately, this Qi may or may not be proper. 

Alternatively, another common practice is to seek UB 40, Wei Zhong  for back pain treatment. This was promoted at a later time after Nei Jing’s publication. It became “the rule of thumb” for low back pain.  This is not the original intent of Nei Jing. UB 40, Wei Zhong itself is not always the right choice. More accurately, it reflects the importance of searching the entire popliteal fossa to find best point to address the low back pain. The points of importance include such points as UB 39 Wei Yang, UB40, LV 7, LV 8, sometimes even GB 34, Yang Ling Quan. In Nei Jing, the treatment of low back pain involves the usage of all six foot meridians. 

In clinic setting, I found my approach of diagnosing by the location of pain and treated accordingly to the spirit of Nei Jing seems to work very well. It is more targeted and easy to apply in dealing with back pain of various origins. 

This approach involves dividing the low back in several anatomical zones and selects the pointss according to the zone involved. 

In treatment, the first step is to identify the pain location by asking patient to twist or shake the back gently. This allows the patient to identify the specific location of the pain.  Then confirm the diagnosis by palpation the location. 

Once confirmed the local of the pain, apply needles according to the following rules:

Protocol L-B:

a.   Zone S (for spine), along the spinal column- For pain concentrated in Zone S, needle acupoints on the Du or Ren meridian. For example, Use Du 20, Bai Hui, or Ren 24, Cheng Jiang.

b.     Zone P (para spine), parallel to the spinal column- For zone P pain, needle SI 3, Hou Xi, on the same side as the pain.  This is the master of the Du meridian, closely linked to spinal column function.

c.     Zone I, pain on the inner line of the UB meridian on the back, about 3-4 cm from the spinal column- Stress from this zone travels up. Use the TB meridian to treat it, e.g.  Yao Tong Xue, an empirical acupoint for low back pain.

d.     Zone O (outer UB line), pain on the outer line of the UB meridian on the back, about 6-7 cm from the spine’s center line- Use GB acupoints on the feet, such as GB 42, Di Wu Hui.

e.     Zone G (for gluteus) – pain and soreness in the gluteus- Needle GB34, Yang Ling Quan.

f.      Zone L (for liver meridian). Pain along the liver meridian on the leg- Needle or moxibustion on Lv 7and Lv 8. Moxa tight and tender areas above and below these points. These two acupoints are also good for other cases of LBP.