The Treatment of Pain with Chinese Herbs and Acupuncture

615 Pages·2002·8.39 MB·English

by  Peilin Sun MD

To myprofessor, Professor Shi Zhongan
To mywife andchildren
ForChurchillLivingstone:
PublishingManager,HealthProfessions:Inta Ozols
ProjectDevelopmentManager:DinahThorn
ProjectManager:Jane Dingwall
Designer:GeorgeAjayi
Con tribu tors
Primary contributors Secondary contributors
Shen XiaoxiongMDPhD YangGuohuaMD
ResearchScientist,DepartmentofEndocrinology, ProfessorofMedicine,BeijingUniversityofTCM and
UniversityofCalifornia, LosAngeles, USA WangJing Hospital, Beijing,China
YaoFengliMD Sun YijunMB
FormerProfessorof Medicine,BeijingUniversityof Lecturerin Medicine,The InternationalTraining
TCM, Beijing,China Centre,BeijingUniversityofTCM, Beijing,China
YangYifanMDMSc MaLiangxiaoMB
PrivatePractitionerand Lecturer,The Netherlands; Lecturerin Medicine,The InternationalTraining
FormerLecturerin Medicine,BeijingUniversityof Centre, BeijingUniversityofTCM, Beijing,China
TCM,Beijing,China
JiangHongbingMD
Professorand Directorof the Institutefor Basic
Education,GuangxiCollegeofTCM,Guangxi,China
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Preface
This bookisaimedat studentsand practitionersof was roughlycompleted.In1996,Isentthis text to the
acupunctureand Chineseherbs,as well as publishersand theyexpressedan interestin
practitionersofWestern medicine. Bothbeginnersin publishingit. However,mytime wasso limited thatI
TCMand experienced practitionerscan usethis book couldnotfinish the bookby myself. Iconsequently
for reference, practice, teachingand research. inviteda few otherauthors,whoarequalified
Mystudentshaveoftenasked me what the professorsand medicaldoctors inbothteachingand
differenceisbetweenBisyndromeandpain clinicalpractice,to join this writingteam. Thanks to
syndrome.Itcan be explainedin this way: the main theeffortsofall the authors, the draft manuscript
complaintof Bisyndromein the earlystagesispain wasfinished beforethe summerof1998.Since thenit
in the jointsandmuscles,butitseldominvolvesthe has takenall my sparetimeto revise, editand modify
internalorgans. The chief causativefactor forBi the contentsand,since the onlytime availablefor me
syndromeisinvasionofa mixtureof Wind, Cold and to workon itwasaftermy practicein the evening,it
Damp.BecauseofthesuccessesofWesternmedicine wasquiteusualfor me to workuntil the middleof
and good healthcare systems,itisunusual to see thenight! Luckily, Ihavecontinuallyreceived the
manypatientswith Bisyndromein the secondor supportof my family overthisperiod.Itwasan
later stages.As aconsequence,treatmentofBi enormous pleasurefor me to see the manuscript
syndromefocuses on dispellingexternal pathogenic finallycompleted.
factors. However, painsyndromecan be caused by Thefirst partof the bookisan intensiveinquiry
manyotherkindsof pathogenicfactors as wellas into the generalaspectsofthe aetiologyof pain,its
Wind,Coldand Damp. In this sense,itcan be said pathology,treatmentprinciples,acupuncturepoint
that pain syndromeactuallyencompasses till' selectionand stepsin treatment.This partservesas a
contentsofBisyndrome. generalguidefor readers.
Theideafor writing this bookcameto me 8years The otherpartsdivide the discussionon paininto
ago when Iwasbusy writingabookon Bisyndrome. 46chaptersaccording toanatomicalregions. These
Duringthe courseof this, Ifound thatmany pain chapters providedescriptionsofnotonlythe
syndromescouldnot be clearly described or included aetiologyand pathologyfor eachtypeofpain,but
in thebook, so Ibegantocollect togetherdata on also the differenttreatments withChineseherbsand
pain controlinTCM and drewon my ownexperience acupuncture. For each topic, key pointsare given
asaclinician and teacheras well as thatofmy tutor, aboutdifferentiation,explanationsofherbsand
Professor ShiZhongan,and my colleagues. Besides acupointsselected for the treatmentand individual
supplyingme with knowledge, theyalso gaveme a modifications,in orderto presentreaderswith
lotofencouragement.Slowlythe bookgraduallytook practicaland easilyaccessibleinformation.
shape. However,becauseof my busyclinicalpractice Sinceit is difficult to find onestandard classic
and extensiveteachingbothat homeand abroad, it herbal formula thatfits all complaints,mostof the
tookmeabout2yearsbeforeone chapterof the book prescriptionsmentioned in the herbal treatments
xviii PREFACE
havebeenmodifiedaccording to the individual Wesincerelyhopethatourcolleagues,friendsand
situation. Moreover,sincenotall thereaderswill readerswill providesuggestionsandcommentsafter
feelconfidentabouttheirknowledgeofindividual readingthis book sothatitcanbemodifiedforany
Chineseherbs,usefulpatentremediesare also futureedition.
suggested. Nevertheless,itshouldbe bornein mind Allthe authorsofthis book wouldfeelhappyif
thatthereisneverone patentremedythatcan this book servesits purposeinhelpingto alleviate
alleviateaspecific painsufficientlywithoutthe pain andtreatillness.
additionofacupuncturetreatmentfor individual
complaints. Belgium, 2002 Sun Peilin
Acknowledgements
Thisbook would not havebeenpublished inits writingstyle in somepartsofthe book. Iam indebted
presentstate withoutthe helpofmanyfriends and toMrs ZhouWeifor continuallyprovidingme with
colleagues. Inparticular,Iam deeply indebtedtomy somuchessentialinformationfor the book, and also
tutor, ProfessorShiZhonganfrom NanjingUniversity toProfessorChenZhiqiangforhis contributionon
ofTraditionalChineseMedicine,China. He acupuncture treatmentin the section on back pain. I
encouragedmeso muchin studying, practisingand am very grateful toMrYaoZhiguofor spendingso
teachingTCMbothinChinaand abroad. He taught muchofhis sparetime in producingthe basic layout
me not onlyhowtostudyat university,butalso how ofthe book, and also to the staffofChurchill
totreatpeople. In particular,Iwould like tothank Livingstone,in particularInta Ozols, DinahThorn
him at the age of84forwritingaforeword and andMartinaPaul, for theirexpertiseandefficiency.
skilfullyundertakingthe ancientstyle ofChinese Finally,lowemuchtomy wife,Yuqing,and my
calligraphyfor the title ofthis book. threechildren,for allowingme todevotea
Iam gratefultoDr Robert Rinehartforhis many considerablepartofmy sparetime tothe bookthat
good suggestionsin writing this bookand also to we wouldotherwisehavespenttogether.
MrJanSchroenand Mrs Ineke vande Hamfortheir
help incheckingthe Englishandcorrectingthe Sun Peilin
In troduction
Discussion on pain
TraditionalChineseMedicine(TCM)isprobablyoneoftheoldestcomplementarytherapiesand
continuouslypractisedsystemsofmedicineinthe world.Developedthroughempiricalobserv
ationby theChineseoverthousandsofyears, thisuniquemedicalsystemisused totreatawide
rangeofdiseases,and isofespecial usein treatingvarious kindsofpain.
Everyonewill, at some time or another, suffer from painor disability. Pain isan unpleasant
experience associated with actual or potential tissue damage. It may arise from accident or
injury,cancer,arthritis,amultitudeofphysicalailmentsorevenemotionaldistress.Itmayaffect
the head,neck,torso orany oftheextremitiesaswellasinternalorgans,causingdifferentkinds
ofpain,such asheadache,neckpain, throatpain,shoulderpain,jointpain, abdominalpain and
lowerbackpain.
No matterwhat the cause, pain, especiallychronic pain, transcends simply physical hurt. It
limits theactivitiesofeverydayliving and canerodethe sufferer'sabilitytofunction. However,
pain is,in reality,nature'sway ofprotectingthe bodyfrom potential tissue damage,becauseit
servesasawarningsignal,alertingthepersonthatsomethingiswrong. Inthissense wecansay
that toavoid pain istoavoidsevere injury.
How do modernmedicine and TCMexplain theoccurrenceofpain? Modernmedicalresearch
has discovered that pain signals are transmitted by specialised nervoussystemcells(receptors),
whicharefound throughouttheskinand otherbodytissues.Thesecellsrespondtoinjury,inflam
mation or tissue damage. Immediatelyafter receiving these messages, the signals travel by elec
tricaland chemical means, from receptors throughsensoryneurons to the spinal cord and then
through interneurons in the spinal cord to the brain, where they are finally interpreted as pain.
TCMtakesadifferent view:that thebody maintainsabalance betweentheprinciples ofYinand
Yang,and betweenQiand Blood.Qiand Bloodtravel throughthebodyalong well-defined path
wayscalledchannels. WhenthereisnotenoughQiandBlood(EmptinessorDeficiency),orwhen
they are stuck inonearea (Fullnessor Excess),there isan imbalancebetweenYinand Yang,the
Internal organs arenot functioning optimally,andillnessand pain develop.
Pain, whetheracute or chronic, could havea varietyofcauses. Acute pain isusuallycharac
terised byacute onset, ashortduration, normalfunctioning ofboth the peripheraland central
nervoussystems,apredictablecourseand, in mostcases, a goodoutcome. In terms ofmodern
medicine, acute painusuallyisthe resultofan injury,surgery, inflammationor medicalillness.
Acute pain often goes awaywiththe healingprocess.
Chronic pain, however, isdifferent; itis the kind of pain thatmost peopleworry aboutas it
lastsbeyondthe expectedtime for healing; thatis,itdoes not go away when itissupposed to.
3
4 GENERAL INTRODUCTION
Chronic pain is often difficult to relieve or cure • toenhancethe qualityoflife
completely, and may occur even if there is no tissue • toreducerelianceon inappropriatemedications.
damageor physicalcause.Theexactcauses ofchronic
pain are not fully understood,or,in otherwords, one Points from different channels are, according to TCM
could say that there is no adequate medical explan theory, energeticallyconnected to specific organs and
ation formanychronicpaincases. body structures. The purpose of acupuncture treat
Pain can be extremely debilitating and frequently mentfor painis to use selected points on these chan
requires uniquetreatmentapproaches.Insomecasesit nels to activateQi and Bloodcirculation, and balance
can be seen that the damaged tissues have been Yinand Yang.Duringthe treatment, moxibustionand
repaired,butnevertheless the paincontinues. Besides pointmassageare also often appliedsimultaneously.
tissuedamage,there aresomeotherclinicalsymptoms Acupuncturetreatmentforpainisvariedandbased
associated with pain, such as muscle tension, spasm, largelyon whatis causing the patient's suffering; the
stiffness, or weakness. There could also be some treatments for acute and chronic pain are often quite
degree of immobilisation of an injured part by the different. In chronic pain patients, treatment that had
patient in order to avoid painfrom movement. It has proved useful for acute pain management may lose
alsobeen observedthat, whateverthecauseofchronic its effectiveness, be inappropriateor even be counter
pain, feelings of frustration, angerand fear make the productive.
pain more intenseand more difficult totreat. The Chinese do not limit the use of Chinese herbs
In short, pain, especially chronic pain, interferes andacupuncturetoalleviatingpain; they use combin
with normallifeandphysicalactivities.Wecouldeven ations of herbs and acupuncture to treat the whole
say that such pain can often diminish the quality of range of diseases that are encountered in association
people's life in terms of their psychology, sociology withthe pain. TheseincludeTCMtherapiesforhyper
and physiology. Itis,finally,one ofthe most frequent tension, hypotension, allergy, asthma, diabetes,
causes ofsufferinganddisabilityin the world today. stomach ulcers, depression, infections, etc. It is clear
that many diseases respond better to modem medi
cine, whereas some may respond better to Chinese
herbal medicines and acupuncture. However, in the
Pain control by TCM majority of cases Chinese herbal medicine and
acupuncturemayeitherbeareasonablealternativefor,
orbe usedin conjunctionwith modem medicine. For
In Western medicineit is quitecommonto find or be
this reason allTCMschools and universitiesin China
told that doctors are unable to find the real cause of
continue to offer courses and training in both TCM
pain in patients even after extensive examination.
and modem medicine at present. During Chinese
Patients are often told: 'There is nothing wrong with
herbalandacupuncturetreatment,itshouldbe kept in
you',or 'Sorry, we cando nothingaboutit,andyou'll
mind that essential contact and communication with
have to learn to live with it' or even 'Itis all in your
otherspecialistsmustbemaintained,forinstancewith
head'. It is poor practice, however, for a doctor to
neurologists,neurosurgeons,orthopaedists,internists,
make such comments to patients; they don't have to
radiologists,andphysicalandoccupationaltherapists,
live in pain. Fortunately, since acupuncture has
so that patientsreceive the necessarysupportat their
acquired a very good reputation as a treatment for
timeofgreatestneed.
relieving pain, many physicians are now referring
In China, increasingly acupuncturists are applying
their patientsforan acupunctureorherbal evaluation,
acupuncture todiminish pain directlyor decrease the
or patients are starting to investigate the potential of
amountofdrugs needed for the control ofpain, even
acupunctureand herbaltreatmentforthemselves.
during surgery. This well-known practice indicates
Intermsofpaincontrol, theeffectsofChineseherbal
that acupuncture potentially has anaesthetic effects.
and acupuncturetreatmentinclude:
After conducting thousands of experiments on both
• torelieve paincompletely,orgiveasmuchrelief animals and people, researchers become firmly con
aspossible vinced that acupuncture was indeed effective in its
• toreducepainlevels own right for anaesthesia. In consequence, acupunc
• toimprovethe ability todeal with pain ture hasbeenused quitesuccessfullyinplaceofchem
• toregulatethe emotions icalanaesthesiaformanytypesofsurgeryinthelast30
• toincrease the energy years in China. It has been shown to be effective in
• toincrease the ability toperformeveryday gastric (YeQianget aI1984), dental (LinGuochuetal
functions 1984)andthyroid surgery(ZhuangXinliang1984).Itis
INTRODUCTION 5
also potentially indicated for those patients unable to lation (i.e,thechannels).Itisanobjective fact that pain
tolerateregularanaesthesia. Becauseofitsefficiencyin is always transmitted along certain pathways. These
acupuncture anaesthesia, doctors in many hospitals, pathways are closely related with channel theory in
especially the affiliated hospitalsofTCMuniversities, TCM. An interesting observation is that when
use acupunctureroutinelyin casesofthyroidectomy. acupunctureneedlingisused inthe treatmentofpain,
Theadvantagesofacupunctureanaesthesiainclude: and when the needle sensation (Deqi) is reported
along a particular channel, the greatest reduction in
• fewer side-effectsthan withchemical anaesthesia
sensitivity to pain is be found in a line along the
• morecooperationfrom the patientduringthe
middle of the channel (Fujian Provincial Research
operation
Institutefor Traditional Chinese Medicine 1979).This
• a lackofdisturbanceofthe brain and memory
reduction in sensitivity decreases gradually as one
following anaesthesia
moves from the centre of the channel to its outer
• the patientremainingalertduringthe procedure
boundary-thatistosay,the more the needleismoved
• rapid recoveryoffunctional activitiesafter the
towards the central line of the channel, the less the
operation,etc..
patientfeelsthe pain. Observationhas alsoshownthat
The disadvantages of acupuncture anaesthesia pain transmission along the course of the channels is
include: greatly diminished when certain methods are used to
promote the circulation of the channel (Li Baojiao
• a feeling ofpullingand tuggingduringthe
1981).Pain transmission along the channels is, con
operation
versely, greatly increased when certain methods are
• inadequacywithchildrenandsome senile patients
used toblock the channelcirculation.
• inabilitytoreplaceall kindsofchemical
anaesthesia
• sometimesaneed forlocalchemicalanaesthesia,etc. Pain-gate theory
Another theory suggests that pain impulses are
Modern research on pain
blocked from reaching the spinal cord or brain at
control by acupuncture various 'gates' within the nervous system. Research
studies have shown that both peripheral and central
nerves are very important in pain relief by aCtlpunc
Over the past thirty years, both patients and profes
ture (Lu Guowei et al 1979,Shanghai no. 1 People's
sionals have been asking questions about how
Hospital1977,WuJianpinget aI1979).
acupuncture works in a modern, scientific sense?
Inthe peripheralnervoussystemacupuncturewhen
What are the mechanisms? Is there any scientificevi
used to treat paincan, firstly,block the conduction of
dencethat supportsthe effectivenessofacupuncture?
sensory fibres in the algetic nerves (Lu Guowei et al
In order to reply to these questions, since the 1970s 1979,Qiu Maolianget al 1989);secondly, it can cause
scientistsand practitionersboth inChinaand in other
downward inhibition of the dorsal horn cell conduc
countrieshave beenconductinganumberofscientific
tion inthespinalcord resultingfrom the noxiousstim
studies and clinical trials, which are described in this
ulation (Qiu Maoliang et al 1989).It is the peripheral
section. This research has tended to substantiate the
nerves that receive and conduct the acupuncture
ancienttheoriesoftraditionalChinesemedicine.Other 'message';the II,IIIand IVfibres could all participate
recent research has revealed that human beings are
in the pain-reliefprocess.
complexbioelectricsystems(Becker1985),and on this In the central nervous system the structures at
basis the mechanicsofacupuncturecan nowbebetter various levels, including the spinal cord, brain stem,
understood. thalamus, caudate nucleus and cortex, participate in
To date, a few theories have been suggested con
the processofpainreliefby acupuncture.
cerning these questions.
SPINALCORD
Transmission ofpain impulses
along acupuncture channels
Scientific research has found that acupuncture can
causepostsynapticinhibitionintheposteriorhomofthe
Thefirst theory isthat mostpain impulsestravelalong spinal cord (Qiu Maoliang et al 1989).It has also been
thesamepathwaysasthoseofthe traditionalQicircu- found that the acupuncture 'message' is conducted to
6 GENERAL INTRODUCTION
the medulla oblongata from the anterior funiculus of medial reticular structure of the brain stem and the
the spinalcord, and then to the medial reticularstruc medianraphenucleiare also veryimportant.
ture (Qiu Maoliang et al 1989).Afterwards, it is con
ducted downwards to the posterior funiculus of the
spinalcord, whereitcauses postsynapticinhibitionby Stimulation of endorphins
depolarising the fine afferent nerve endings. This has
theeffectofpartiallyblockingtheafferentimpulsefrom
A third theory suggests that acupuncture stimulates
thefinefibres.
the brain's production of polypeptides that reduce
painsensitivity.Scientistshavediscovered thatoneof
its possiblemechanismsis thatit increases the release
BRAINSTEMAND PARAFASCICULAR
of natural pain-relieving molecules known as endor
NUCLEUS
phinsby thebrain(QiuMaoliangetaI1989).Theseare
verysimilar to opiates (such as morphine), which are
In the brainstem,electroacupuncturehas been found
potentanaestheticagents.InChinathis workwasper
to control the activity of hyperalgetic neurons in the
formed and directed in the 19708by Professor Han
reticularstructureofthe midbrain(QiuMaoliangetal
Jisheng, an internationally known researcher of
1989). In animal experiments, it was found that
acupuncture, when a research programme to study
electroacupuncture stimulation of the median raphe
acupuncture-inducedanaesthesiawasinitiatedduring
nuclei could raise the pain threshold in the animals,
theCulturalRevolution.His studiesshowedthatelec
improving their ability to resist the pain (Qiu
trical stimulation of inserted acupuncture needles
MaoliangetaI1989). Impairmentofthelocus ceruleus
causedreleaseofdifferentamountsofendorphincom
increased the capacity for pain relief by electro
poundsinto the central nervous system (HanJisheng
acupuncture, whereas activation and stimulation of
et al 1979).This is the key mechanism that is most
this structure decreased its pain-relief capacity.
widely used as explanation for the effect of acupunc
Researches also showed that acupuncture treatment
turetreatmentinrelievingpain. Thisisnotacomplete
led to the release of neural impulses from the grey
explanation, however, of all of acupuncture's pain
matteraroundthe aqueductofthe midbrain,the giant
alleviating mechanisms, because acupuncture has
nucleus in the medial reticular structure of the brain
other physiological effects besides decreasing pain
stemandthe medianraphenuclei(QiuMaoliangetat
sensitivity. For instance, it often increases local blood
1989).From here, ascendingimpulsesinhibitelectrical
circulationinareasofmusclespasm,and candecrease
activity of the hyperalgetic cells in the parafascicular
the muscular contraction that often causes or con
nucleus of the thalamus, and descending impulses
tributestopainfulconditions.Thus,local actionssuch
inhibit the activity of neurons transmitting pain
as decreasing tissueswelling(due to betterblood cir
impulses in the posterior hom of the spinal cord, so
culation) and lessening muscle spasm may, in tum,
relievingthe pain. Theparafascicularnucleushasbeen
release pressure on nerves or interior organs, contri
found to be oneof the importantkey locations in the
butingtothe painrelief.
transmissionofpainimpulses.
Effects onneurotransmitters
CAUDATE NUCLEUS
Research has established that when the caudate Anothertheorysuggestsacentral nervoussystemcon
nucleusis stimulated, the painthreshold isincreased, nectionthatinducestheproductionorsecretionofother
which could increase the pain-relieving effect of chemicals in the body such as neurotransmitters, hor
electroacupuncture,whereasinhibitionofthe caudate mones and lymphokines, etc. Though most of these
nucleus decreases the pain-relieving effect (Qiu chemicals areusedupfairlyquickly,clinicalexperience
Maolianget aI1989). indicates that acupuncture generally has cumulative
Generally speaking, when the pain impulse enters effects.Thus, acupuncturemustprovidesometraining
the central nervous system, it can take a circuitous effectinthebody'sautonomicmechanismsthat control
routetothe cerebrum.Theposteriorhomofthe spinal andregulatethe physiologicalreactions topain.
cord and the parafascicular nucleusare two key loca Acupuncture treatments have been found to affect
tions in the reception and transmission of pain severalneurotransmitters,resultinginchangesintheir
impulses.Thecaudatenucleus,thegreymatteraround blood serum levels. In particular, acupuncture may
the aqueductofthe midbrain, the giantnucleusin the bringaboutthe followingbiochemicalchanges.