Acupuncture points for the treatment of human backpain

INTRODUCTION

Traditionally-trained acupuncturists generally scorn the idea of Cookbook acupuncture (AP), although they often use their own formulae (poor cookbooks! ). They would be horrified at the idea of computerising AP. They claim that the free availability of prescriptions do AP a disservice, allowing it to fall into the hands of untrained, unqualified people. I do not accept this. There is one medicine. The best people to practice AP would be those trained in conventional medicine as well as AP. TP therapy (see below), even without any knowledge of AP, may give 60-70% clinical success. If one adds classical AP points, the success rate can increase by 10-20%. The use of TP therapy brings more professionals into the active AP field than any other arguments or demonstrations. Storage of data on computer makes its analysis and retrieval very easy. Databases can be updated and re-analyzed periodically. Computers do not forget (assuming that files are copied and backed up every time they are updated). Advantages and disadvantages of computer-generated prescriptions are discussed in detail elsewhere (Rogers 1984 a,b).

Backpain may be primary (paravertebral muscle pain, thoracolumbar disc disease, vertebral, sacroiliac or arthrotic), secondary (referred from irritation of thoracic or abdominal organs), or as part of a generalised disorder.

This paper deals with the selection of points for human backpain, using Cookbook methods, based on computer analysis of textbook and other data. If other symptoms or organs are involved, the selection of points must take these into consideration.

It has taken me more than 11 years to set up the database. I ask each of you to treat the material as copyright, not for commercial publication in text, computerised, microfiche form. You are welcome to use it for your own professional purposes and to give it to colleagues, if they agree to respect the copyright.

THE BASICS OF AP

The alphanumeric code and name of each point is shown in Appendix 1. As there is no internationally agreed coding system, you should check my codes (Appendix 1) with the codes which you use, to prevent confusion and error. In human AP, the paravertebral Shu (reflex points for all major thoracic and abdominal organs) are located on the inner line of the bladder (BL) Channel as follows:

Lung (LU), Pericardium (PC), Heart (HT), Governor Vessel (GV), Diaphragm = BL13-17, in area T3-T7 respectively; Liver (LV), Gallbladder (GB), Spleen-pancreas (SP), Stomach (ST) =BL18-21, in area T9-T12 respectively; Triple Heater (TH), Kidney (KI), CHIHAISHU, Large Intestine (LI), KUANYUANSHU = BL22-26, in area L1-L5 respectively; Small intestine (SI), Bladder (BL), CHUNGLUSHU, PAIHUANSHU = BL27-30, in area S1-S4 respectively. These points have diagnostic value (when tender). They help to identify the affected organ. They also have therapeutic value in treating the affected organ and local problems near the points. However, local muscle strain or trauma can also cause Shu point tenderness. Thus, Shu point tenderness need not always indicate disorders of the related organs. Points on the outer line of paravertebral BL points (BL41-54) have similar functions to the related points on the inner line. Irritation of the thoracic or abdominal organs can refer pain to related skin and muscle segments, especially in the paravertebral area. This can establish TPs, as detailed by Travell and Simons (1984) and in the TP Therapy Symposium (1981). Long after the visceral pain has gone, the TPs can remain active. Unless TPs in the thoracosacral muscles are "removed" by AP or other physiotherapy, the function of the back muscles is impaired and performance is impaired.

In human AP, the AhShi point is defined as a point, usually in muscle, which is tender on palpation. AhShi means Ouch! or Ah Yes! There are two kinds of AhShi points: those from which palpation elicits only local tenderness and those which radiate pain to the problem area (the area in which the patient complains of pain). The latter type is the true TP of western medicine. It is the most important point in AP therapy and the patient may unaware of TP tenderness until the point is pressed. TPs may occur almost anywhere in muscle. Scars may also act as TPs. TPs in the paravertebral area often correspond with organ Shu points. For example, in coronary disease, patients may have TPs in the area T3-T6. Patients with kidney or ovary problems may be touchy in the area L1-L3 (BL22-24). The reflex point for the ovary and kidney is BL23.

REFERRED PAIN: Pelvic limb lameness is often due to pain referred from thoracolumbar or lumbosacral nerves, as in sciatica. It may arise also in pain referred from abdominal viscera, such as in a painful kidney, ovary, uterus or colon. Thoracic limb lameness may arise in pain referred from cervical or upper thoracic nerves or from pain in thoracic organs (lung, pericardium, heart). Thus, neck- and back-pain often manifest as pain in the thoracic- or pelvic- limb.

ASSESSMENT OF PATIENTS BEFORE TREATMENT

A complete history is taken, together with any findings of previous investigations. In the clinical examination, attention is paid to any lesions or signs related to all major systems or functions. One tries to identify the primary problem(s) and the location(s) of pain. It is essential to probe or palpate the muscles from head to toe, to locate any TPs. Particular attention is paid to the paravertebral muscles and the large muscles of the neck and limbs. The joints and tendons are also palpated. Patients with signs of pain, stiffness or lameness are seldom free of TPs. Their detection is indicated by an expletives or groans or "Ah Yes! " when they are palpated.

Always check for diagonal relationships. Cain stresses that fore-lameness is often accompanied by tenderness at contralateral lumbosacral or hind-limb points in the horse. Also, hind-lameness is sometimes associated with TPs on the contralateral side of the neck. Be careful to check the paravertebral Shu points in relation to the location of limb pathology, for example BL25 (L4-5, large intestine Shu) in radial forearm pain and BL21 (behind last rib, stomach Shu) in anterolateral pain in the pelvic limb etc. In all local problems (neck, shoulder, elbow, back, thoracolumbar, lumbosacral, hip, knee etc), the TPs must be found. They are recorded and marked as they are located. This helps rapid reassessment of the case on later visits. It also makes it easy for the patient to locate them for massage or other physiotherapy (ultrasound, LASER etc) between AP sessions.