Traditional Chinese Medicine and Chronic MSK pain

Traditional Chinese Medicine or TCM, as it is commonly referred to, is one of the oldest systems of healing. It is said to have originated sometime in 1766 BC during the Shang dynasty when the first healers documented their work. The system of healing is over 3500 years older than traditional western medicine. Take, for instance, the formation of the American Medical Association in 1847. However, the most common mistake people make is associating traditional Chinese medicine with what's called "oriental medicine," which is a catch-all phrase used to describe mainly practices that weren't only developed in Asia but across the world.


Traditional Chinese Medicine happens to be a standardized version of Chinese medicine that has been practiced since prior to the Chinese revolution. It is mainly rooted in ancient beliefs. One of the most important ones even in this day and age is that of the Daoist belief system that the human body is a smaller version of the universe. There is the belief that vital energy, aka Qi (pronounced “chi”), as it's called, flows through the entire body and is responsible for multiple functions needed to maintain good health. All Traditional Chinese Medicine practitioners believe that chronic pain is mainly caused by a blockage of the Qi or an imbalance, and as doctors, they need to correct the flow of balance, whichever may be the case.


TCM and Chronic Pain


A few other concepts associated with Traditional Chinese Medicine include Yin/Yang, which is the harmony between opposing forces and complementary forces which support health. Then there are the Five Element Theories, which is another significant part of TCM.

Yin/Yang, or Yin and Yang, describe the character of health like its location, i.e., internal and external, temperature (cold and hot), and amount (deficient and excess). Yin and Yang is an illustration of polarity; it is a notion that a single characteristic can't exist without the other. The Five Elements represent various stages of the human life cycle and explain the functioning of the body. Knowing these concepts is essential for anyone who wants to understand TCM. However, in this article, we will examine Traditional Chinese Medicine practices in the context of addressing chronic pain management.


Traditional Chinese Medicine Treatments

All Traditional Chinese Medicine treatments are focused primarily on returning the balance of energy. The treatments are mainly rooted in nutrition, meditation, acupuncture/acupressure, lifestyle, and the use of herbs.

Traditional Chinese Medicine consists of the following types of treatment:

1. Acupuncture

2. Acupressure

3. Herbal treatments to balance Yin and Yang

4. Moxibustion/cupping

5. Meditation

6. Qi Gong/Tai Chi (moving meditations that regulate breathing and the mind-body balance)

7. Dietary treatments to balance Yin and Yang

8. Massage


Acupuncture

Most people reading this are probably already familiar with acupuncture, characterized by the insertion of needles into the superficial skin, muscles, and subcutaneous tissue. The needles are inserted at particular points to manipulate the flow of Qi. In other words, to direct or rectify the flow of Qi by removing 'blocks'.

Traditional Chinese Medicine claims that over two thousand acupuncture points across the human body are connected across by 12 primary meridians. The meridians are used to conduct the energy, or Qi, between the internal organs and the body's surface.

Acupuncture helps to retain the balance between Yin and Yang, which allows for the normal flow of energy throughout the body. The correct flow of Qi helps restore the health of both the mind and body.

Moxibustion

The term 'moxibustion' comes from the fact that the therapy involves burning moxa, mugwort root. Mainly this is made from Artemesia Vulgaris, which is a herb associated with various healing properties. When moxa is burned, it produces a lot of smoke along with a pungent odor, which can easily be confused by the uninitiated as cannabis.

Moxibustion is used to warm up and stimulate the blood and Qi. It primarily helps to strengthen the kidney Yang while expelling wind and dispersing cold to dissolve stagnation in the body. In the old days, moxibustion was often used to treat menstrual pain.


Tui Na Massage

Tui Na is a combination of acupressure, massage, and a few different forms of body manipulation. Think of it as the Asian version of bodywork therapy but one which has been used since ancient times in China. During a typical session, the patient will be fully clothed and will sit on a chair. The Tui Na practitioner will start by asking a series of questions and then start treatment.

The massage depending on what the practitioner considers is needed, can be vigorous. The practitioner will often use ointments, herbal compresses, and heat to help enhance the flow of Qi. Incidentally, Tui Na is the treatment of choice for people who complain of musculoskeletal pain and other forms of chronic pain.




Cupping/Scraping

You can think of cupping as another form of Chinese massage, which mainly works by placing several glass or plastic "cups" across the body. The practitioner will warm these cups up using a cotton ball or another flammable substance which is put inside the cup to remove all the oxygen. The substance is then removed from the cup and it (the cup) is placed on the skin. The air within the cup will cool, create low pressure within it, and then a vacuum that allows the cup to stick to the skin. The process increases blood and Qi flow through the body.

Preferred areas of treatment using cupping are mainly fleshy regions like the stomach and back. Another form of treatment is called "Gua Sha," a folk medicine technique that uses pieces of smooth jade, horns, bone, and animal tusks to scrape the skin to release obstructions and toxins that are trapped within it. The scraping is done until there are red spots, with the treated area being later covered by bruising.


Chinese Herbal Medicine

A big part of traditional Chinese medicine relies on the use of roots, flowers, leaves, stems, and seeds from various plants like licorice, ginger, rhubarb, and ginseng, etc. Speaking of ginseng, it is the most broadly used substance for the broadest of treatments. Suppose the doctor recommends herbology as a form of treatment. In that case, the herbs are often combined into a formulation dispensed in the form of traditional tea, granules, liquid extract, capsules, or powder. Unfortunately, the true effectiveness of Chinese herbology continues to be poorly documented. However, there is growing acceptance and use of it in the West.


Chinese Nutritional Science

Traditional Chinese medicine strongly believes that a good diet is the key to good health and recovering from a myriad of issues. TCM outlines a few different practices which are meant to keep your diet in check. In Chinese nutrition, a balanced diet is defined as one which includes 5 tastes, i.e. sour, spicy, sweet, bitter, and salty. The theory is that foods that taste a particular way have a specific property. For instance, bitter foods have a cooling effect; spicy foods warm the body.

Similar to the eastern diets, even the modern fad diets, there isn't a one-size-fits-all diet that everyone can use. Also, there are no so-called forbidden foods in Chinese nutrition. Practitioners will recommend a diet based on your health and various other factors to improve the flow of Qi in the body and optimize its healing potential.

Even though in the West there is controversy around if classic diets may influence disease, there is universal acceptance that using uncontaminated produce and avoiding processed foods improve health and wellness.


Tongue Diagnosis

Traditional Chinese Medicine practitioners are known for using five methods for diagnosing health issues: smelling, looking, touching, asking, and touching. The inspection focuses not only on the physical appearance of the patient but also on their behavior. However, of particular attention is the tongue.

Traditional Chinese Medicine practitioners will analyze the size, tension, shape, color, and coating on the tongue. It is believed that the tongue has various channels or meridians which correspond to many internal organs.

The tongue has a number of features that indicate numerous functions, such as:

  • The color of the tongue – It mainly indicates the state of organs, Qi, and blood.

  • Tongue body shape – It reflects the state of the blood and Qi. It also highlights deficiency and excess.

  • Tongue body features – For instance, teeth marks on the tongue will indicate that the teeth are resting on the tongue. This is often a sign that the person is suffering from a digestive issue, or it may indicate heat or some type of inflammation.

  • Moisture – The amount of moisture on the tongue will indicate the state of fluids in the body.

  • Tongue coating – It will indicate the state of the current organs, in particular the stomach.

  • The thickness of the coating – A thick coat will indicate an imbalance of the digestive system. However, a peeled look may be associated with an allergic reaction or an autoimmune disease.

  • Cracks in the tongue – Cracks can indicate everything from a yeast infection to a biotin deficiency.

  • The coat on the root will indicate impairment of the organs that aren't attached directly to the surface of the tongue.

Traditional Chinese Medicine practitioners will often ask that patients don't brush their tongue before an appointment to obscure the findings. However, it is fine for people to brush their teeth.


Organs and Emotions in Traditional Chinese Medicine

In Traditional Chinese Medicine, there is an intimate connection between emotions and physical health. The practice ties mind and body together, so for one to improve, the other needs to be treated too. The integrated mind and body approach to health and healing works as a dynamic loop where emotions can impact health and vice versa.

For instance, TCM theory says a person suffering from excessive irritability or anger, may be suffering from liver ailments, or the emotions are caused by an imbalanced liver. The ailments can include a variety of symptoms including redness in the face, dry mouth, and dizziness secondary to the imbalance in the liver which then can cause mood-related issues.


Traditional Chinese Medicine and Chronic MSK pain


The Mind and Body Approach By TCM

So, what does the liver have to do with you having chronic pain? The organ system in TCM will include many Western medical-physiological functions, though they also include a holistic body system. So, the mind and body need to be addressed as a whole.

The liver in TCM is responsible for making sure that energy and blood flow throughout the body. It is also responsible for regulating the secretion of bile, storing blood, and is directly connected with parts like tendons, eyes, and nails.

The liver is also connected to emotions like anger and helps to balance emotions related to stress. If left out of balance, these emotions could become extreme resulting in anxiety or depression. Then, as discussed in earlier blogs, these emotional states or mental states of imbalance can exacerbate chronic pain.

When dealing with ailments, practitioners will try to find and then untangle the imbalances which are contributing to a person's mental and physical conditions. Once those connections are found, they will use the healing tools at their disposal (mentioned earlier) to rectify them.

In addition to a persons' emotions, TCM also believes that there are elements like environmental, dietary, genetic, and lifestyle factors that may contribute to the body's imbalances which then may interfere with the body's ability to heal itself.

Understanding the connections between environmental elements, each associated with an organ, and certain emotions or states of being is considered key to healing using TCM: The Spleen/Stomach

The Spleen/Stomach organ is associated with the earth element. The Stomach gives all the organs what they need to work properly, similar to how “Mother Earth” provides what all living creatures need to survive and grow. These organs are responsible for the digestion of nutrition as well as digesting emotions. Dysfunction can result in chronic stress, worry, and anxiety leading to poor digestion and low metabolism function.


Lung/Large Intestine

The Lung/Large Intestine organ is associated with the metal element. These organs are responsible for “letting go” of wastes such as carbon dioxide from the lungs and waste from the large intestines helping to maintain a healthy immune system. So “letting go” of emotional toxins is also part of these organs’ functions. When there is an imbalance in the Lung or Large Intestine, excessive sadness or grief, inability to process grief in a healthy way may all be associated with poor lung and large bowel function.



Liver/Gallbladder

The Liver/Gallbladder organ is associated with the wood element. The liver is responsible for the smooth flow of blood and Qi throughout the body. Good tendon health, which is the “roots”, flexibility, and agility portion of the muscle, are associated with good liver health, much like the strength of a tree. The roots and trunk are strong and stable. The branches and leaves are flexible. When there is an imbalance in the Liver, one would lose flexibility in their thoughts and emotions and are unable to relax or unwind. Excess stress and intense negative emotions can result in liver dysfunction. The Kidney/Bladder

The Kidney/Bladder organ is associated with the water element. The Kidney and Bladder help to regulate water balance in the body. The Kidney is also the “reserve” for Qi, providing extra energy to the other organs when needed. When the Qi reserves are low in the case of Kidney/Bladder imbalances, the emotion of fear or anxiety can be overwhelming.


The Heart/Small Intestine

The Heart/ Small Intestine organ is associated with the fire element. The Heart organ is responsible for cardiovascular health as well as joy resulting in deep contentment with one’s life. A healthy heart exhibits love, happiness, and peace. In TCM, the Heart is the organ that is protected above all other organs, so the other organs will give their energy to the Heart to protect it. Excessive stress, therefore, as discussed above, will affect the Liver and the Stomach first before affecting the flow of blood and Qi through the heart. In the chronically stressed state, the Liver would not be able to protect the Heart. Therefore, for real cardiovascular health, taking care of the digestive organs is key.


Patients with chronic pain can exhibit many of the emotions or states of being in each organ system. However, the TCM practitioner may be able to prioritize the predominant imbalance and use combinations of healing touch, acupuncture/acupressure, herbs, and nutrition to bring a balanced state of Qi flow using the TCM principles discussed in this article.


Conclusion

TCM is one of the most established, ancient forms of medicine and healing practiced to this day. While modern medical science hasn't yet fully understood TCM, it continues to be a source of healing, motivation, and pain relief for many people. The positive effects of various methods of TCM healing like acupuncture have resulted in implementing what's often referred to as 'alternative medicine' integrating these techniques and methods into the traditional medical model resulting in healing in patients with chronic pain.