In relation to acupuncture and back pain
Acupuncture is an ancient treatment, how it works and the philosophy behind it will be discussed and we will explore its effect on back pain and how it is helped by this sector of Traditional Chinese Medicine(TCM). Understanding of where Acupuncture comes from, the philosophy behind it, how there is a relationship yin-yang the connection with meridians and the 5 element theory. Explore what research there is and the evidence supporting this ancient treatment. What the types of techniques are used in acupuncture the application in relation to back pain.
According to Micozzi, M. et al (2008, p.215) acupuncture dates back 2000 years, although some people suggest it may have been around for over 5000 years as stated by Acupuncture.Com – Home of Traditional Chinese Medicine (2011 online) showing the first writing found in the time of the Huang Di Nei Jing which is the classic text of the Yellow Emperor the book of changes thought to be the oldest medical text book in the world. Shen Nung is thought be the founder with his theories of Chinese Medicine. This is even before Europeans had any concept of blood circulation, heart and pulse. Shen Nung had documented these approximately 4000 years ago, he theorized that the body has energy flowing through it and the being called Qi or ch’i pronounced as chee. Our mental, physical, emotional and spiritual are part and parcel of this ch’i. With the concepts of yin and yang, which will be discussed later, a person’s wellbeing is influenced by the flow of qi or the lack of it. Daoism is a philosophy in harmony with nature (zi ran) and points to simplicity (su) Daoist Philosophy (2011 online)
Prior to the Han dynasty around 200 BCE there was no Daoism it was defined in the writings by Laozi, it is thought that female and male lords called daoren, fangshi or daoshi used meditation, diet for longevity which was done in the pursuit of regulating internal energy (qi), Together with practicing stillness in breath, sexual practices, avoiding intake of grains for physical immortality. Koller, J. M. (2006, p.423) states Daoism teachings are to bring balance in the person with its community through the balance of heaven, humanity and earth through peace, harmony and acting in accordance to nature. The name “Laozi” means Old(lao) Master(zi) Koller, J. M. (2006, p.243) goes on to suggest some historians think Laozi is just a legend as there may have been many old masters that travelled around over the centuries promoting their own philosophies. Daoists maintain that following natural the way or Dao of all things whereas Confucianism maintained that moral goodness of people is above all, the key the happiness. It is thought that Dao is a source of heaven and earth that the de or power is both nature and humans functioning in balance. This led to the principles of yin and yang as before this they were never mentioned in any text. Yin and yang are classed as opposites in the universe, dark and light, male and female, cold and warm being and no-being. However, within the concept of yin and yang there is an opposite of the other for instance within dark there is light and within light there is dark.
Billington, R (1997) writes
“Cleary, T. (The Essential Tao) translates that a second sentence from Chapter 42 of the Tao Te Ching ( I-Ching book of Changes) as:
… all things bear yin and embrace yang, with a mellowing energy for harmony. And they are held together in the ch’i of teeming energy”
The author goes on to state that a mountain slope facing the sun has the opposite side in the shade, thus the three necessary truths develop from this, first truth is that neither can be present without the other, that both sides of the mountain are necessary for the picture to be complete, the third being to make it real one cannot be more important than the other. The first mention of yin and yang is noted in the I-ching (the book of changes) Tao is one yin and one yang within the context of the writing from this author he mentions studying the physical world it is known that matter contains negative and positive charges, neutrons and protons. These evolve to combine to create the world as we know it. Dougans. I, (1992, p127) states, Heaven was created by yang and the Earth created with the yin. Yang travels to Heaven and yin travels to Earth therefore in the universe we have Heaven and Earth. The Health concept in Chinese medicine yin and yang have two macro energies (Li- yang) being the energy of the universe and internal energy (qi – yin) these both have an overall influence on health. Prana, as mentioned by What is Prana? (2011, online) means life force this is a form of energy noted mainly by the Asian philosophies.
According to Dougans, I. (1992, p127) yin and yang further divided into forms of fire, metal, wood, earth and water, humans being a product of earth and heaven contain these energies. These energy pathways either increase or generate the energy for the appropriate organ or work in the decrease. Wood represents spring and time of birth, injection of vital life giving qi energy, a well person who is balanced is difficult to uproot, copes with life’s stresses, who plans ahead and functions efficiently. On the other, hand a wood person can feel upset or emotionally stuck, unbalanced and feels a tightness in his chest and throat and this can lead to aggression. The fire element represents summer, warmth that initiates the body’s growth processes in plants, this element also relates to love, forgiveness, happiness and gentleness. The earth element relates to a specific time of year and is a central element and is said to rule the other elements to a certain degree. If the earth element is imbalanced then this could have an effect on breathing, sleep, nervousness and security problems. The metal element relates to autumn, time for harvesting, a time of things slowing down, a person’s metal element that shows weakness may feel less energized, prone to low immune system and suffer from frequent illness. Lastly the water, generally relates to winter, self-confidence, vitality, fluidity with the body, lack of water energy in the body can show as tiredness, fear and lack of confidence.
Yin and yang organs are connected by meridian lines according to Micozzi, M. et al (2008, p217) subtle qi flows through the 12 main meridians, eight minor ones known as extraordinary, there also 12 sinews that are connected to the body’s muscular skeletal system, 15 meridians classed as collateral and 12 classed as divergent. The main meridians are as follows the heart (He), stomach (St), bladder (Ub) which are also part of the central meridian tsubo together with the governor vessel, kidney (Ki), spleen (Sp), Lung (Lu), large intestine (Li), liver (Lv), gall bladder (Gb), pericardium (Pc) known by the following names in different texts, triple heater, warmer (TH) or (TW), master heater (MH). There are 361 acupuncture points that exist together with the main meridians and two minor ones conception vessel (CV) and the governing vessel (GV). With reference to Dougans, I. (1992) it is believed there are strong links to between acupuncture, reflexology and other therapies as they work on meridian lines. It is also the general consensus by the acupuncturist that pain or illness can start when the meridian lines or paths have blockages. It is also stated by the author in approx. AD1017 Dr Wang Wei instigated a production of a bronze human figure which had been marked with all the acupuncture points to help practitioners to treat unwell people. Dr Wang according to Imas Chi Gung (2011 online) was the first to use these principle he had developed, on the emperor Ren Zong to help him heal from his ailments, due the success of this treatment on the emperor acupuncture effectively was given a royal seal of approval and become popular from this time onwards. To encourage appropriate use of the treatment and to help more people the emperor had a special temple built Bian Que. As the popularity of acupuncture spread the Jin dynasty in the north of chine even made demands for a copy of the brass man and the medical technology of acupuncture as dowry for peace. Energy flow in a 24hour cycle through the body starting with the liver meridian at 12 o’clock, 1 o’clock lung meridian, 2 o’clock large intestine meridian, 3 o’clock stomach meridian, 4 o’clock spleen meridian, 5 o’clock heart meridian, 6 o’clock small intestine meridian, 7 o’clock bladder meridian, 8 o’clock kidney meridian, 9 o’clock pericardium meridian, 10 o’clock triple burner meridian and 11 o’clock gall bladder meridian, this 24 hour clock is then split into 2 four hour cycles which denote the highest or peak time of recharge particular meridians. As an example the lung meridian may have peak energy into between 3 and 5am and the lowest energy recharge between 3 and 5pm
Kastner, J. (2004) States for a person health and wellbeing certain number of food regimes are important and should be followed, such as not eating too quickly, enjoy the taste and flavour of food always use quality organic food, enjoy food in a happy environment, have food 3 to 5 times a day, try to drink only small amounts of water whilst eat your meal and not to drink too much water after or prior the meal as this will contribute to diluting the acids of the stomach. Eat seasonal foods, and vegetarians should have diet that includes energy warming components. Stagnation could be a contributing factor for people eating meals in front of the TV (home: work computer), whilst reading, listening to the radio as this effects the flow of qi in the central burner. It is suggested to reduce excess of tropical, cold or raw foods these cool down the kidney organ area function and reduce the energy to the central burner. The spleen, stomach and pancreas qi flow can be effected by iced drinks. Phlegm is usually increased with dairy foods, excess of oily, fatty as well as sugar and sweet flavoured food intake as these are classed as cool energy foods. Avoiding late night suppers, would help avoid weight gain, weakening of the spleen and pancreas system. As the main goal of Chinese medicine is to prevent illness taking hold and contribute the a healthy way of life. Dougans, I. (1992, p.132) also related to the function of the Chinese physician was to keep his patient healthy he was paid on this bases, however, his fees would be stopped if the client fell ill.
Back pain according to HSE, (2011 online) accounts for 4.5 million lost working days related to back pain conditions due to musculoskeletal conditions. The charity Back care suggests this problem impacts on the economy, business and NHS to a tune over £5 billion each year. The report also suggests that 80% of the population may be affected by back pain at some point in their lives. For the treatment of back ache we first need to look at the anatomy of the spine which also known medically as the vertebral column according to Burnie, D. (1997. p36-37) consists of seven cervical vertebras, twelve thoracic vertebras, five lumbers, five sacral and the coccyx. From the lumber to the cervical each to pair of the vertebral bone with soft cartilage called intervertebral discs Layman, D. (2004 p,190) shows these act as shock absorbers between the bones and allow a small amount of movement, however, the combined effect of the spine does have the ability to be quite flexible. The spine provides the bases for muscle attachment for the majority of the axial skeleton. One of the functions of the spinal column is to protect the spinal cord which supplies Burnie, D. (1997. p36-37) a messaging system to and from the brain with the subtle connections of the motor and sensory nerves provide a communication network for the body muscle reflexes. The structure of the muscles Kent Van de Graaff, (2002 p, 50-58) need to be understood for conventional medicine. Muscle fibres are made up of multinucleated striated cells that are elongated structures called myofibrils; these contain even smaller cells that are known as myofilaments these in turn are made up as actin and myosin proteins. This leads onto the sliding filament theory that contraction of muscle fibre leads to the sliding effect of the actin and myosin fibres. The muscle fibres are bound by endomysium which are in groups then the bundles of muscle are bound with perimysium and these bundles collectively grouped and call muscles. Micozzi, M. (2008 p,218) states muscular skeletal problems on patients may suffer other added problems, such lack of sleep, depression due to pain, anxiety, in terms of chronic pain this problem can be quite debilitating. The author states some of the commonly used applications of acupuncture are low back pain, neck pain headaches and migraines. It is indicated that chronic back pain has conclusive positive results, useful complement for neck pain. NHS Choices. (2011 online ) suggests generally the symptoms of back pain is stiffness or tension in the lower back, this can also extent to muscle spasms, this pain may also transfer from the spine to the buttocks to down the leg, which generally denotes a sign of sciatica pain, mobility and range of movement can also be affected. The causes of back pain can be attributed to strains, sprains or injuries that can be triggered from every day activities; it can also develop over a period of time through sitting, lifting incorrectly or standing. Other causes can be from twisting, over stretching, slouching on a chair, bending incorrectly, even driving for long periods. Other risk factor that may increase the development of back pain is being overweight as the extra mass of tissue has a bearing on the whole spine. Being pregnant as the weight distribution may have added strain on the back. Medications in form of corticosteroids have an impact on weakening the bones. Lastly stress and tension has an impact on the muscles being tense and tight. Diagnoses of back pain by the GP will initially be carried with a physical exanimation and questioning to assess the symptoms. Initially medication is prescribed, with a route for physiotherapy if the GP feels this would benefit in mobilizing the muscles. On rare occasions an x-ray or MRI scan is done to rule out and serious conditions such as infections, fracture or cancer of the spine. Nice. 2009 have issued guidelines which treatment options should be provided to people with chronic back pain, suggest that back pain should be treated initially with pain killers and the following options should be made available :- Acupuncture, exercise classes or manual manipulation.
Research according to Furlan, A, D. et al (2005) show that chronic low-back is effectual for improving function mobility and reliving pain than without any treatment for the short term only. The report also states that acupuncture is not any more effective than other conventional treatments and alternative treatments, although it does not specify how this comparison is made and what treatments are compared. Ratcliffe, J et al BMJ (2006 online) states acupuncture if a cost effective solution within the NHS for non-specific low-back pain. PubMed (2011 online) on the other hand shows that although neuropathy pain in the back usually only show slight improvement with conventional medicine, a combination of acupuncture and massage has an effect of easing neuropathy pain. However, for this reason the report calls for larger controlled trials to confirm what effect there for the longer term. Ulett. G A, et al, (1998 p,1) on the other hand through the research results conducted through 10,000 acupuncturists generally practice needle placement on meridian lines with the aim to unblock energies of qi. The scientific research has concluded that the healing process does not occur by adjusting the qi but by neuroelectrical stimulation of the neuropeptides, therefore, the report indicates that needles are not an essential as thought. PubMed (2011 online) in another research article showing that other methods of point stimulation are available although they are little know and tested. Electrical effect electro-acupuncture and pulsed radiofrequency were the objects of this study in assessing the impact and difference to pain relief using a Visual analogue score (VAS) pain score together with the Oswestry disability index (ODI) these were used to measure the clients functional permanent disability. Both electrical stimulations were carried out as randomized controlled trials. From this it was research it was noted that radio frequency had a significant improvement over the electro-acupuncture after a month. However, the latter did show functional mobility improvement in the lumber region on the spine. Another, trial that included 1162 patients with over eight years of chronic low back pain had acupuncture for 30mins person with 2 treatments per week for 6 months compared to a group that had superficial none-needing or drugs, conventional treatment, exercise or physiotherapy. Concluded that lower back pain improved with acupuncture for at least six months. and that acupuncture was 2 times more effective than conventional treatment according to PubMed (2011 online).
Acupuncture techniques are acquired over a long period of time through professional training usually around 5 years of study at degree level in the UK. Only using high quality materials and fully sterile needles that are single use only and disposed of according to local authority guide lines as clinical waste. Function of the needles on particular acupuncture points enable appropriate levels of qi to be increased or decreased. With the depth of penetration dependant in the density of the tissue, particular in close proximity to underlying bone. Moxibustion is another technique the acupuncturist my use as part of the treatment. This involves burning dried Mugwort used as this resembles solar energy, over the acupuncture point to stimulate energy flow over particular acupuncture points. Cupping involves the use of glass cup shapes that have the oxygen used up from a small flame then placed over the appropriate area on the skin to induce blood circulation, dissipates the excess build-up of qi in the area. Micozzi, M. et al (2008, p.218) also states acupuncture comes from the word acus (needle) and punctura (pricking), which was apparently phrased by Jesuit missionaries returning back to their own lands telling the population about thin needles being used to treat people for medical purposes. The bases for acupuncture are the diagnosis by a trained therapist to understand and assess the flow of qi the body system with aim being to bring balance to the flow of qi. There could be differences in the yin and yang, such as cold or heat, more or less, external or internal. The consultation would take a look at the patient’s history, pulse reading, quality of speech, odour, any tenderness, tongue diagnosis, quality of speech; this will help the therapist define the pathology to provide the appropriate course of treatment.
On reflection and conclusion this assignment has shown that although Chinese medicine has been around for over 4000 years, there is still a lot of quality research to be done in the area of back pain using acupuncture. BBC News. (2009 online) National Institute for Health and Clinical Excellence (NICE) have backed the NHS in promoting the use of acupuncture as a cost effective means of treatment where the patient together with the GP can come to a decision on the type of treatment route to be taken. If acupuncture is opted for then the recommended treatment length is 10 sessions over 12 weeks. Independent (2009 online) Stuart Derbyshire who is a senior lecturer at the University of Birmingham’s School of Psychology contradicts
himself when he states:
“I would be less inclined to offer manipulations and acupuncture even though clinical trials have been successful”, but
He goes onto say,
“These things are hard to do in a proper randomized and blinded fashion. But anything that encourages back pain patients to stay active, not go for scans and stay out of the hands of surgeons is generally a good thing.”, from this statement there is still a great deal of confusion regarding alternative therapies like acupuncture because of the lack of documented research.
It is evident the medical institutions will in due course accept NICE finding as this will it is stated have a major positive financial impact on the NHS in line with cost cutting measures. NICE believe millions of low back pain patients will benefit from the new guide lines and reduce number X-ray or MRI scans being taken on this group of sufferers. Although, acupuncture has been used in the east four thousands of year, impacts of it ripples are being felt in the west much more than previously. The simplicity in its treatment has vast effects on the cost effectiveness for institutions as well a holistic wellbeing effect for the client.
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