How to Treat Low Back Pain: Ancient Neijing Needling Does This Way, TCM Acupuncture Does the Opposite

Low back pain (LBP), mostly chronic, is among the top 10 diseases and injuries that account for the highest number of disability-adjusted life years (DALYs) worldwide (WHO, 2013). The medical doctors (MDs) can do nothing with LBP except using pain pills, injections, or recommending exercises trained by a physio. But the causes of LBP are rarely addressed. Disc surgery remains the last option but the outcomes are disappointing (Phillips FM, 2013).

The Possibilities of the Location of Pain Is Endless

The Global Burden of Disease (GBD) study defines LBP as pain on the posterior aspect of the body from the 12th ribs to the lower gluteal folds ... that lasts for at least one day. That is, LBP can happen anywhere on almost half of the posterior body trunk.

For needle healers treating LBP, where do we place the needles? Ask a newly graduated TCM acupuncture student where he or she will insert needles to treat LBP, I am 99% for sure he or she will choose acupoint BL 40 (a spot at popliteal fossa called Weizhong 委中 in Chinese) without asking back “can you first tell me where the pain is exactly located?” Anyway this is what he or she had been taught in schools.

In the real world, however, LBP can happen at any spot along the T12 – L5 spine bone or muscles such as multifidus, spinalis, longissimus, iliocostalis, or obliques, just to name a few, or at L5/S1, or at sacrum S2 – S5, or at SI joint, or at piriformis on either side or bilateral ..., the possibilities of the location of pain is endless.

So will pricking one or two or even more of the TCM standardized acupoints effectively and reliably relieve the LBP regardless of the exact location of the pain?

The Wonder of Millennia-Old Neijing Acupuncture

The effectiveness of needling therapy millennia ago in China as described in Huangdi Neijing was a magic: the symptom relief happens the instant the needle is in. More importantly, such instant efficacy was highly reliable and reproducible. In Huangdi Neijing, the chapter Suwen 41 (刺腰痛) particularly talked about how to treat a wide variety of low back pain with needles (pricking or bleeding). It listed 26 types of LBP differentiated by the location of pain, the location of radiating pain, and the location of other related symptoms (range of motion, abnormal sensation or feeling etc).

For each type of LBP, this chapter also described the anatomical location of needle insertion or blood-letting such as fabular head (膝外廉之骨独起者), tibial tuberosity ( ?前), superior medial malleolus (内踝上), lateral lower soleus (腨踵鱼腹之外) ...

The chapter further provided a case of instant back pain relief: “For low back pain which radiates to upper quadrant ribs and causes a patient unable to bend backward, needle the sacrum area (between the waist and hip) … pain will go away instantly; always prick the opposite to the pain” (腰痛引少腹控?，不可以仰，刺腰尻交者，兩髁胂上 … 發鍼立已，左取右，右取左). It is noteworthy that Suwen 41 does not tell us the exact spot to insert needles but just a ball-park area “between the waist and hip” which should be considered as the sacrum area including sacroiliac joints.

The same case is also mentioned in Suwen 63, which is a chapter dedicated to tell us where the needles should be inserted to treat any illness when the patient's pulse is normal. In Neijing's view, a normal pulse is an indication of a healthy Jing Mai vessel (i.e., meridian as called in the West). If the Jing Mai vessel is healthy, there is no need to prick the Jing Mai vessel.

How Neijing Acupuncture Treats LBP

The key points of Neijing acupuncture as described in Suwen 41 and 63 in treatment of LBP can be summarized as below:

1. The diagnosis (differentiation) of LBP and the location of needling are solely based on the “LOCATION” of symptoms, including the location of primary pain, the location of radiating pain, and the location of other related symptoms (such as restricted range of motion etc).
2. The location of needling is always distally on the leg from knee to foot (except one case where the sacrum area is pricked when the pain radiates to upper quadrant ribs).
3. The location of needling is always opposite to the pain, that is, pricking is always on the healthy side of the body.
4. The location of needle insertion is not a fixed spot but is an area determined mostly according to palpation and observation of the skin of the opposite leg (from knee to foot).
5. No pulse palpation nor tongue color diagnosis is required.
6. No analysis of qi deficiency / excess of any organ (such as kidney) is required.
7. No yin-yang balancing nor 5-element concept is involved.
8. No herb theory is involved.
9. No need to twist or thrust the needle to force the patient to feel being pricked.
10. The pain can and should be relieved instantly. When you read Neijing, you can always feel intensely the Neijing authors' strong confidence in the efficacy of their needling: if the pain relief is not instant, you just have not done the job correctly.

TCM acupuncture Always Does the Opposite

The book titled “Acupuncture Therapy” with professor Shi Xuemin as editor in chief (Shi Xuemin, 1996) is one of many acupuncture textbooks used in Chinese medical universities in China. As shown in this textbook, the key points of LBP treatment by TCM acupuncture are always the opposite of, or strikingly disparate from its Neijing counterpart:

1. The Types of LBP are based on the herb theory-originated “cause of illness” (病因病机) instead of the location of the symptoms. In contrast to the 26 types of LBP in Neijing, only 3 types of LBP are available in TCM acupuncture: Cold-dampness induced LBP, traumatic injury LBP, and Kidney deficiency LBP.
2. The location of needling is always local (that is, always in the low back and close to the spine) instead of distal on the leg (with only one acupoint called Weizhong, named BL 40 in the West, which is distally on the leg).
3. The location of needling is always on the same side of the pain instead of on the opposite side. This is due to a dogmatic (and misleading) belief in TCM acupuncture community: Wherever the Jing Mai vessel runs, where is the location of needle insertion for a remedy (经脉所过，主治所及).
4. The location of needling is required to be highly “accurate” on the path of a Jing Mai vessels (meridians) instead of being determined case by case in a ballpark area.
5. Pulse palpation and tongue color diagnosis is mandated at least in the class room as a routine.
6. Analysis of deficiency / excess of the organ (kidney) is required as as diagnostic routine.
7. Yin-yang balancing (Kidney yang deficiency) may be involved.
8. Causes of illness (病因病机) originated from herb theory is involved.
9. Aggressively twisting or thrusting the needle is mandatory. The purpose of doing this is to force the patient to feel so-called "de qi" (sensation of being painfully pricked) .
10. Instant pain relief is never expected. Patients usually will not feel any improvement until after being pricked every day for 10 to 15 days (as indicated by the clinical case provided in the textbook).

How Fast Does Mayo Clinic Relieve Back Pain with TCM Needles?

The renowned Mayo Clinic in the US has adopted TCM acupuncture practice nationwide. They advised that in their clinic, not everyone responds to acupuncture; some patients may see improvement after the first treatment (Note: this will usually take at least one hour of time), but others may not until after several treatments. “... if your back pain doesn't begin to improve within 6 to 8 weeks, acupuncture may not be the right treatment for you, ” says a Mayo Clinic article titled “Acupuncture for back pain?” (Brent A. Bauer, 2021).

So, the back pain could be knocked out instantly (usually in a few seconds) every day in every clinic in ancient times millennia ago, but today typically no improvement can be seen until after at least one hour (3,600 seconds) or even weeks, not to mention that this happens in a world famous highly ranked clinic.

Ancient physicians did in a way with constant success. Today's doctors do in the opposite way with constant poor performance. What is wrong today?

References

Brent A. Bauer, M.D., Acupuncture for Back Pain? May 28, 2021, https://www.mayoclinic.org/diseases-conditions/back-pain/expert-answers/acupuncture-for-back-pain/faq-20058329

Phillips FM. Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine (Phila Pa 1976). 2013;38(7):E409

Shi Xuemin 石学敏, Acupuncture Therapy针灸治疗学, 1996, Shanghai Science and Technology Publishers.

The Inner Canon of the Yellow Emperor (Huangdi Neijing): Suwen 41 刺腰痛, Suwen 63 缪刺论.

WHO, 2013, Low back pain, https://www.who.int ? areas ? Ch6_24LBP PDF