CLINICAL APPLICATIONS

* Acute low back pain (lumbago)

* Back pain from sports or traumatic injuries, sprains and strains, subluxation

* Back pain due to strenuous exercise or repetitive movements (e.g., grocery checkers/packers, warehouse and assembly line workers, and others in similarly demanding occupations)

* Back pain with inflammation, swelling, or redness

* Chronic back pain with acute exacerbation or re-injury

 

WESTERN THERAPEUTIC ACTIONS

* Analgesic influence to relieve pain

* Anti-inflammatory action to reduce pain and inflammation

* Muscle-relaxant effect to alleviate muscle spasms and cramps

 

CHINESE THERAPEUTIC ACTIONS

* Relieves pain

* Opens channels

* Disperses qi and blood stagnation

 

DOSAGE

Take 3 to 4 capsules, three times daily as needed to relieve pain. The dosage may be increased up to 6 to 8 capsules every four to six hours if necessary, especially in the early stages of injury when there is severe and excruciating pain. When the pain subsides, the dosage can then be decreased to 3 or 4 capsules three times daily. For maximum effectiveness, take the herbs on an empty stomach with two tall glasses of warm water.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Chuan Niu Xi (Radix Cyathulae)

Du Zhong (Cortex Eucommiae)

Ge Gen (Radix Puerariae Lobatae)

Gui Zhi (Ramulus Cinnamomi)

Huang Jin Gui (Caulis Vanieriae)

Ji Xue Teng (Caulis Spatholobi)

Liu Zhi Huang (Herba Solidaginis)

Mo Gu Xiao (Caulis Hyptis Capitatae)

Mu Gua (Fructus Chaenomelis)

Wei Ling Xian (Radix et Rhizoma Clematidis)

Yan Hu Suo (Rhizoma Corydalis)

Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle)

 

BACKGROUND

Musculoskeletal and connective tissue injuries lead to over 10 million clinic visits per year in the United States.[1] Causes of these injuries may be external (sports injuries, car accidents, trauma), internal (chronic wear and tear of muscles, ligaments and tendons; bones weakened by osteoporosis), or both. Acute injuries are characterized by severe pain, swelling and inflammation, and in some cases, internal bleeding. Treatment of acute injuries should focus on relieving pain, reducing swelling and inflammation, and stopping bleeding. Chronic injuries are characterized by dull pain, stiffness and numbness, and decreased muscle mass and strength. Treatment of chronic injuries includes relief of pain, and restoration of physical and physiological functions.

 

FORMULA EXPLANATION

Back Support (AC) is formulated specifically to relieve acute low back pain caused by sports or traumatic injuries, strenuous exercise, repetitive movements, or accidents. Back Support (AC) contains herbs that regulate qi and blood circulation, remove qi and blood stagnation, and relieve pain.

        Yan Hu Suo (Rhizoma Corydalis) activates qi and blood circulation, and is one of the strongest analgesic herbs to relieve pain. Mo Gu Xiao (Caulis Hyptis Capitatae), Liu Zhi Huang (Herba Solidaginis) and Huang Jin Gui (Caulis Vanieriae) are indigenous Taiwanese herbs that have anti-inflammatory and analgesic properties and are often used to treat the acute pain associated with traumatic injuries or sprains and strains. Gui Zhi (Ramulus Cinnamomi) warms the channels, facilitates the flow of qi, and relieves painful obstruction. Ge Gen (Radix Puerariae Lobatae) alleviates muscle tightness. Bai Shao (Radix Paeoniae Alba) and Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) nourish the muscles and relieve stiffness and pain of the back. Mu Gua (Fructus Chaenomelis), Wei Ling Xian (Radix et Rhizoma Clematidis) and Ji Xue Teng (Caulis Spatholobi) increase qi and blood circulation to relax the muscles and the tendons. Chuan Niu Xi (Radix Cyathulae) invigorates the blood. Du Zhong (Cortex Eucommiae) is not only a channel-guiding herb to direct the actions of the formula to the lumbar region, it also has the effect of tonifying and strengthening the back.

        Together, these herbs effectively treat acute pain and inflammation affecting the lower back.

 

CAUTIONS & CONTRAINDICATIONS

* Because of the blood-invigorating nature of this formula, Back Support (AC) is not recommended during pregnancy and nursing.

* Back Support (AC) is not designed for long-term use. If the pain lasts for a long period of time and becomes chronic in nature, Back Support (CR) should be used.

* If the patient presents with fever and a one-sided back pain, consider a possible kidney infection and do not use this herbal formula. Patients with acute nephritis should be referred to their medical doctor immediately.

* Patients who have pain radiating to the extremities accompanied by a sudden loss of bladder or bowel control may have a pinched nerve or spinal injury, and must be referred out to emergency care. This condition, known as cauda equina syndrome, can lead to permanent disability and must be evaluated and treated immediately.

 

CLINICAL NOTES

* Take Back Support (AC) with 2 tall glasses of warm water, as back pain can be related to dehydration.

* Many patients may seek treatment for a chronic back condition that has recently been exacerbated. In such cases, Back Support (AC) should be prescribed for one or two weeks to relieve the acute pain. After the pain subsides, switch to Back Support (CR) to consolidate the effect.

* For musculoskeletal injuries to the back, Back Support (AC) can be given to the patient prior to each acupuncture treatment. The muscle-relaxant influence from the herbs will take effect within about 30 minutes. By relaxing the muscles and invigorating qi and blood circulation with the herbs, there will be less stagnation in the channels, and the acupuncture and tui-na treatments will be more effective.

* There are several causes for back pain. This formula is designed to treat back pain due to musculoskeletal injuries. For back pain resulting from other causes, please refer to the Supplementary Formula section for appropriate formulas.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Soft tissue damage: turtle pulse, a convex-shaped pulse on the left chi; the more forceful the pulse, the more recent the injury, with more inflammation and pain

* Bone spurs or disk problems: guitar string / steel wire pulse on the left chi

* Low back pain due to blood stasis from old injuries: dispersing pulse, a pulse in which its border is difficult to perceive, soft, weak, and deep, on the left chi

 

SUPPLEMENTARY FORMULAS

* For acute back pain due to herniated disk, add Back Support (HD).

* To enhance the analgesic action, use with Herbal ANG.

* For acute back pain due to traumatic injuries, sprain and strain with or without bruises and bone fractures, use with Flex (TMX).

* For pain due to bone spurs, add Flex (SPR).

* For back pain associated with osteoporosis, use with Osteo 8.

* For back pain with severe cramps, take with Flex (SC).

* For arthritic pain that worsens during cold and rainy weather, use with Flex (CD).

* For arthritis with redness, swelling and inflammation, use with Flex (Heat).

* For back pain due to menstrual discomfort, use Mense-Ease.

* For back pain aggravated by obesity, use Herbalite for weight loss.

* For back pain caused by kidney stones, use Dissolve (KS) instead.

* For back pain or soreness resulting from chronic nephritis, use Kidney DTX.

* For chronic, stubborn back pain with blood stagnation, add Circulation (SJ).

* With severe inflammation, combine with Astringent Complex.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Yaotongxue, Huantiao (GB 30), Yaoyan (Extra 9), Shenshu (BL 23), Weizhong (BL 40)

 

Classic Master Tung¡¦s Points:

* Needle contralateral to the pain. If the pain is in the center, needle bilaterally or the side with the more ah shi points. If the pain is bilateral, needle bilaterally.

* Linggu (T 22.05), Zhongbai (T 22.06), Xiabai (T 22.07), Wanshunyi (T 22.08), Wanshuner (T 22.09), Chongzi (T 22.01), Chongxian (T 22.02), Erjiaoming (T 11.12), Tianhuangfu [Shenguan] (T 77.18), Zhongjiuli (T 88.25), Zhengjin (T 77.01), Zhengzong (T 77.02), Weizhong (BL 40), Majinshui (T 1010.13), Makuaishui (T 1010.14), Shuiqu (T 66.09)

* Bleed Weizhong (BL 40) or dark veins nearby. Bleed painful area on the back with cupping. Bleed before needling for best result.

 

Master Tung¡¦s Points by Dr. Chuan-Min Wang:

* For acute pain, bleed first then needle.

* For chronic pain, needle first then bleed.

* Mid back pain: Needle contralaterally Chongzi (T 22.01), Chongxian (T 22.02), Zhengjin (T 77.01), Zhengzong (T 77.02). Bleed ipsilaterally popliteal fossa or local tender spot.

* Low back pain: Bleed ipsilaterally popliteal fossa or local tender spot.

¡± L1-L3 pain: Needle contralaterally Zhongbai (T 22.06), Xiabai (T 22.07).

¡± L4-L5 pain: Needle contralaterally Dabai (T 22.04), Linggu (T 22.05).

¡± S1-S2 pain: Needle contralaterally Wanshunyi (T 22.08), Wanshuner (T 22.09).

* Hip pain: Needle contralaterally Jianzhong (T 44.06), Xiaqu (T 44.15), Shangqu (T 44.16), Yunbai (T 44.11), Libai (T 44.12). Bleed ipsilaterally popliteal fossa or local tender spot.

* Sciatic pain: Needle contralaterally Dabai (T 22.04), Linggu (T 22.05), Wanshunyi (T 22.08). Needle ipsilaterally Weizhong (BL 40), Kunlun (BL 60), Zuqianjin (T 77.24), Zuwujin (T 77.25).

 

Balance Method by Dr. Richard Tan:

* Needle the following points on the side opposite the pain: Hegu (LI 4), Houxi (SI 3), Wangu (SI 4), Linggu (T 22.05), Dabai (T 22.04), Zhongbai (T 22.06), Dazhong (KI 4) or ah shi points nearby, Fuliu (KI 7), Ququan (LR 8) or ah shi points nearby

* Needle the following points on the same side as the pain: All ah shi points nearby Chize (LU 5), Kongzui (LU 6), Shaohai (HT 3) to Lingdao (HT 4), Shugu (BL 65)

* Needle ah shi points around Fengfu (GV 16) to Houding (GV 19).

 

Ear Acupuncture:

* Sciatic pain: Lower Back, Hip, Sciatic, and Pituitary Gland. Embed needles or use ear seeds in both ears, and instruct the patient to massage the points three to four times daily for two to three minutes each time.

* Tailbone injury: Coccyx, Adrenal Gland, Pituitary Gland

 

Auricular Medicine by Dr. Li-Chun Huang:

* Occiput, Lesser Occiput Nerve, Large Auricular Nerve, Shenmen. Corresponding area of pain in the lumbar, sacral, sciatic area in the front and back of the ear. Bleed Ear Apex.

 

NUTRITION

* Eat a diet with a wide variety of raw vegetables and fruits, and whole grain cereals to ensure a complete supply of nutrients for the bones, nerves, and muscles.

* Adequate intake of calcium is essential for the repair and rebuilding of bones, tendons, cartilage, and connective tissues.

* Fresh pineapples are recommended as they contain bromelain, an enzyme that is excellent in reducing inflammation. If the consumption of fresh pineapples causes stomach upset, eat it after meals.

* To relieve cramps and spasms, eat plenty of fruits and vegetables, especially those high in potassium, such as bananas and oranges. Also drink an adequate amount of warm water.

* Adequate intake of minerals, such as calcium and potassium, is essential for pain management. Deficiency of these minerals will lead to spasms, cramps, and tense muscles.

* Avoid red meat and seafood in the diet as they contain high levels of uric acid, which puts added strain on the kidneys.

* Avoid cold beverages, ice cream, caffeine, sugar, tomatoes, milk, and dairy products.

* The following is a folk remedy to treat acute back pain from sprain and strain. Crack open 2 crabs (ocean) with a wooden stick (do not use a knife or any metal instruments) and put them into a clay pot with enough vodka or whiskey to cover both crabs. Place the clay pot into another larger pot with water, and steam it for one hour. Serve the crab meat along with the liquor soup.

 

LIFESTYLE INSTRUCTIONS

* Patients are advised to use their legs (instead of bending from the waist or back) when lifting heavy objects.

* Patients are encouraged to wear clothing that covers their backs completely and to tuck their shirts into their pants or skirts to avoid any wind exposure to their backs, which will further aggravate the condition.

* Stretching and strengthening exercises for the back muscles are essential for long-term recovery. Strengthening the abdominal muscles is also beneficial to reduce strain on the lower back.

* Mild exercise such as swimming, yoga, or tai chi chuan [tai ji quan] on a regular basis is recommended.

* For those who are overweight, weight loss is strongly recommended to decrease pressure on the joints and relieve pain.

* Proper balance of work and rest is very important. While sitting, make sure the back is straight and the elbows and knees are bent at a 90¢X angle. Take a break at least once every hour to alleviate pressure on the vertebrae and disks.

* Finally, adequate rest is essential to recovery. It is wise to review the sleeping postures to ensure that the back is being appropriately supported and relaxed.

* Hot baths with Ai Ye (Folium Artemisiae Argyi) or Epsom salts help to relax tense muscles, invigorate blood flow and draw toxins from tissues. Rest and relax in the bath for about 15 to 30 minutes, but avoid becoming over-tired from the heat and soaking. Mix about 2 to 3 tablespoons of Ai Ye (Folium Artemisiae Argyi) extract powder in the hot water each time.

* Firm beds are recommended over soft ones for patients with back pain.

 

CASE STUDIES

* N.I., a 34-year-old patient, presented with muscle spasms and tightness in the lower back, creating difficulty to move or bend over on a daily basis. Upon assessment, there was limited range of motion while bending forward as well as pain upon palpation of erector spinalis and quadratus lumborum muscles. The TCM diagnosis was Kidney yin deficiency and the patient was prescribed Back Support (AC). Within one day the pain had lessened and the range of motion had increased rapidly. After three days of taking the herbal formula the patient was back to normal. Submitted by A.I., Hilo, Hawaii.

* L.S., a 27-year-old male electrician, complained of bad back spasms, which then lead to being unable to stand up straight for two days. This occurred after a recent job he had been bending over for while working and was in extreme pain. This condition was diagnosed as Liver yin deficiency. The patient was treated with Back Support (AC) and Herbal ANG, four capsules three times a day. It took one week for complete recovery, with the pain decreasing in intensity until alleviated during the one week of treatment. Submitted by A.I., Hilo, Hawaii.

* B.B., a 54-year-old female, presented with chronic back spasms, occurring since a discectomy between L2-L3 ten years prior. Complete disabling pain four to five times a day was also present. Objective findings were pain on the right side of the lower back at the inner BL channel, and tension from Xinshu (BL 15) to Dachangshu (BL 25) on the right side. The practitioner diagnosed the condition as qi and blood stagnation in the BL channel of the lower back. The patient was given Back Support (AC), 3 to 4 capsules, four times a day. She took the herbs for four weeks consistently. The patient had a 90% reduction in spasms with occasional flare-ups only if she did activities that she knew would cause it. The patient was able to stand in her kitchen and bake for five hours, which she was unable to do previously. Submitted by L.M., Lafayette, Colorado.

* R.K., 55-year-old female, presented with insomnia due to low back pain and stress. The practitioner diagnosed this condition as qi and blood stagnation in the Urinary Bladder channel and Liver qi stagnation. Calm ZZZ and Back Support (AC) were prescribed. After taking the herbs for two weeks, the back pain resolved temporarily; however, occasional flare-ups of pain will occur due to overuse. Over time, as her back pain decreased, her sleep improved as well. Submitted by B.S., Niceville, Florida.

* A 50-year-old female acupuncturist sustained an injury to her sacrum and coccyx. She fell from a chair hammock 3 to 4 feet above ground onto cement. A sensation similar to a lightening bolt was felt in the sacral area as well as a feeling of electricity from her sacrum to her knees. She was in acute pain and thought she was paralyzed. As an acupuncturist, she diagnosed herself as qi and blood stagnation resulting from trauma. She was immediately treated by a chiropractor. She also took 6 capsules of Back Support (AC) three times a day. After just two doses, the patient experienced tremendous relief. Although the patient still complained of slight lingering pain that persisted for a while, she stated that Back Support (AC) made a remarkable difference in her recovery process. Within one month, the patient improved almost 95%. Submitted by M.T.B., Alpine, California.

* An injury caused by a fall resulted in acute low back pain to a 29-year-old male blackjack dealer. Sequelae included local swelling, redness, and limited lumbar range of motion. Skin and muscle bruising was quite noticeable. The TCM diagnosis of qi and blood stagnation was confirmed through tongue analysis that showed a pale, purple tongue body, a wiry pulse, as well as pain upon palpation. Administration of Back Support (AC) reduced the pain immediately the same day. Low back pain was completely resolved within a week, with full lumbar range of motion recovery within only four days. Submitted by T.G., Albuquerque, NM.

* D.D., a 41-year-old nurse, presented with a work-related injury. She had severe back pain that was the result of a fall from lifting a patient. She said she heard a popping sound in her back when she fell. MRI confirmed her diagnosis of lumbar herniated disc. By the time she came for treatment, she was nine weeks post-injury and had scheduled for steroid epidurals. She refused injections and came to our clinic for ¡¥safe and non-invasive care.¡¦ Her blood pressure was 140/80 mmHg and her heart rate was 80 beats per minute. The TCM diagnoses include qi and blood stagnation and soft tissue damage. Back Support (AC), Flex (SC), and Flex (TMX) were prescribed at 3 capsules each three times a day. After the herbs, the patient was able to reduce Vicodin (APAP/Hydrocodone) use from 2 to 0.5 tablets per day, and none at all on some days. She had increased blood pressure from stress over the injury, which was up to 170/110 mmHg. After the herbs and massage, the blood pressure came down to normal and is staying down. She had received no additional physical therapy. She did remarkably well in a short period of time. Submitted by M.H., West Palm Beach, Florida.

* J.M., a 36-year-old female massage therapist, presented with pain from a recent automobile accident (second accident in six months). She exhibited neck, back, arm, and leg pain. Airbags bent her right thumb. Her blood pressure was 120/70 mmHg and her heart rate was 72 beats per minute. X-rays showed herniation and soft tissue damage. She also complained of muscle spasms, hot sensation on trigger points, inability to move the right thumb and decreased range of motion of the neck and trunk. Flex (TMX), Neck & Shoulder (AC), and Back Support (AC) were all prescribed at 2 capsules each three times daily. J.M. responded quickly to these formulas and acupuncture treatments. Pain levels were reduced by half in a short period of time. Submitted by M.H., West Palm Beach, Florida.

* A 36-year-old female college professor reported back pain for a period of one week. The cause of injury involved her reaching for an item and a sudden severe back pain followed. Tenderness upon palpation was noted at T12 to L2 region along with paraspinal hypertonicity. Although no X-rays were taken, she initially got chiropractic treatment for a slipped disc, which included ultrasound and chiropractic manipulative adjustments. Though her back pain was still present, it was not as severe. Her pulse was wiry, slippery, and slightly weak. The TCM diagnoses for her condition include Liver qi stagnation, local qi and blood stagnation, and qi deficiency. After taking a prescription of Back Support (AC) for a couple of days, the patient noticed slight improvement. By the fourth and fifth day on the formula, her mobility had markedly improved along with a decrease in pain. Submitted by N.M., Torrance, California.

* A 47-year-old female office manager complained of neck pain and low back pain that were aggravated by prolonged sitting. She has a past history of two whiplash injuries that could also have attributed to causing her neck pain. Upon examination, the practitioner found extreme spasms of the erector muscles, bilateral weakness of her sternocleidomastoid muscles and a lack of muscle tone in her lower back. With these symptoms, the patient was diagnosed with right-sided sciatica, arthralgia of the spine and stress-induced muscle spasms. The TCM diagnosis was concluded to be Liver qi stagnation. The treatment included acupuncture, moxa, and infrared heat. Back Support (AC) and Neck & Shoulder (AC) were prescribed for this patient. The results were as follows:

        3/29/01: stress: 8; pain: 9-10 (on a scale of 1 to 10; 10 rating = worse condition)

5/05/01: 50% improvement

5/19/01: 70% improvement

8/16/01: No more pain. However, slight intermittent flaring of her condition was noted.

The practitioner and the patient both concluded that the Back Support (AC) and Neck & Shoulder (AC) have really helped. Submitted by T.W., Santa Monica, California.

* G.A., a 51-year-old female patient, presented with bilateral lower back pain ranging from 7 to 9 out of 10 on a pain scale. She described the pain as stabbing and spasmodic. She could barely walk or sit, and even lying down was uncomfortable. In fact, the patient stated she couldn¡¦t find relief in any position. She¡¦d had intermittent back pain and spasms for much of her adult life, with the first serious episode occurring in her late twenties. The patient had recently missed several days of work and could concentrate on nothing but the pain. Objective findings included X-rays that revealed arthritis at L4 possibly as the result of trauma. The patient reported that she had injured her back when she was in first grade ¡V a classmate had pulled a chair out from under her as she prepared to sit down. Tongue body color was unremarkable with scalloped edges. The tongue coating was thick and white with hairline cracks. Pulse was deep and small on both sides. Her lower back pain was too painful to palpate. The TCM diagnosis was severe qi and blood stagnation in the lower back with mild Kidney qi and yang deficiencies. Back Support (CR) was prescribed at 4 capsules three to four times a day. The practitioner wanted to prescribe Back Support (AC), but had only Back Support (CR) in the pharmacy. Rather than wait a few days for the herbs to arrive, Back Support (CR) was given first to begin the herbal therapy. Back Support (CR) reduced the patient¡¦s pain level dramatically within 24 hours. This case exemplifies the principle of therapeutic diagnosis ¡V the patient¡¦s excellent response to this formula demonstrated the degree to which underlying Kidney deficiency played a role in the pathology. However, she wasn¡¦t conscientious about taking the herbs and when the pain was gone and the bottle was empty, she didn¡¦t resume taking the herbs and the deficiency persisted.

    The same patient returned some months later with another flare-up of stabbing and spasmodic bilateral lower back pain. Again, she could hardly walk nor could she find a position that relieved her pain at all. This time she reported that the pain was probably the result of her new job as an esthetician ¡V she was now spending her workdays sitting on a stool bending to give facials to customers. Her tongue appeared pale and scalloped, and peeled on the edges with thin white coating and hairline cracks. Her pulses were still deep on both sides. The blood pressure was 118/72 mmHg and the heart rate was 62 beats per minute. The TCM diagnosis was severe qi and blood stagnation of the lumbar region, which probably resulted from working under ergonomically unsound conditions. She also suffered from mild Kidney qi and yang deficiencies. This time, Back Support (AC) was prescribed at 4 capsules three to four times a day. Though the patient responded well to Back Support (CR) during her previous lumbar pain flare-up, the practitioner chose to give the patient Back Support (AC) instead this time. Though the formula reduced her pain, it took longer to do so and the pain, though milder, lingered. This case was submitted by the practitioner as an example of the importance of treating the underlying deficiency in chronic cases. Submitted by H.H., San Francisco, California.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Back Support (AC) is formulated to treat low back pain caused by trauma, sports injuries, sprains and strains, or subluxation. The herbs in Back Support (AC) have analgesic influence to relieve pain, anti-inflammatory action to reduce pain and inflammation, and antispasmodic effect to relax muscles and tendons.

        Yan Hu Suo (Rhizoma Corydalis) is one of the most potent herbs for treatment of pain. Its effects are well documented in both historical references and modern research studies. According to classical texts, Yan Hu Suo (Rhizoma Corydalis) has been used to treat chest and hypochondriac pain, epigastric and abdominal pain, hernial pain, dysmenorrhea or menstrual pain, and pain of the extremities. According to laboratory studies, the extract of Yan Hu Suo (Rhizoma Corydalis) has been found to be effective in both acute and chronic phases of inflammation. The mechanism of its anti-inflammatory effect is attributed to its inhibitory activities on the release of histamine and pro-inflammatory mediators.[2]^,[3] Furthermore, it has a strong analgesic effect. With adjustment in dosage, the potency of Yan Hu Suo (Rhizoma Corydalis) has been compared to that of morphine. In fact, the analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is so strong and reliable that it has been used with satisfactory anesthetic effect in 98 out of 105 patients (93.4%) who underwent surgery.[4] The analgesic effect can be potentiated further with concurrent acupuncture therapy. In one research study, it is demonstrated that the analgesic effect is increased significantly with concurrent treatments using Yan Hu Suo (Rhizoma Corydalis) and electro-acupuncture, when compared to a control group, which received electro-acupuncture only.[5] Overall, it is well understood that Yan Hu Suo (Rhizoma Corydalis) has a marked effect to treat pain. Though the maximum analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is not as strong as morphine, it has been determined that the herb is much safer, with significantly less side effects, less risk of tolerance, and no evidence of physical dependence even with long-term use.[6]

        Bai Shao (Radix Paeoniae Alba) and Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) are two of the most effective herbs to relieve pain, reduce inflammation, and alleviate spasms and cramps. Pharmacologically, these two herbs have shown marked analgesic effect, anti-inflammatory effect, and muscle-relaxant effect.[7]^,[8] Bai Shao (Radix Paeoniae Alba) exhibits excellent anti-inflammatory effect to treat arthritis by modulating the pro-inflammatory mediators production from macrophage-like synoviocytes.[9] Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) illustrates marked anti-inflammatory effects by enhancing the effect of glucocorticoids through increased production and secretion as well as decreased metabolism by the liver, along with increased plasma concentration caused by decreased protein binding.[10] Clinically, these two herbs have been used to treat a wide variety of musculoskeletal disorders. According to one study, use of these herbs via intramuscular injection was associated with 84.67% rate of effectiveness (105 out of 124 subjects) to treat the general complaint of pain.[11] More specifically, these two herbs have also been found to effectively treat pain in the lower back and legs among 33 elderly patients,[12] as well as severe pain of the back and legs in 27 patients.[13] Furthermore, the combination of these two herbs was effective in relieving nerve pain (neuralgia) in 30 out of 42 patients.[14] According to another study, the use of these two herbs was also effective for muscle spasms and cramps in various areas of the body, including muscle spasms and twitching in the facial region in 11 patients,[15] intestinal spasms in 254 patients,[16] and intestinal cramps and spasms in 85 patients.[17]

        Lastly, Back Support (AC) contains several herbs for their adjunct effect to alleviate pain, reduce inflammation, and relieve spasms and cramps. Gui Zhi (Ramulus Cinnamomi) has an analgesic effect to relieve pain. According to one study, it has been used successfully to treat arthritis among 30 patients.[18] According to another study, use of this herb is effective to treat numbness among 30 patients.[19] Ji Xue Teng (Caulis Spatholobi) exhibits an anti-inflammatory effect through its inhibitory activities against a panel of key enzymes relating to inflammation, including cyclo-oxygenase, phospholipase, and lipoxygenase.[20] Mu Gua (Fructus Chaenomelis) reduces inflammation and relieves arthritis via prevention of ultrastructural changes of synoviocytes and inhibition of secretion of pro-inflammatory cytokines, such as interleukin-1, tumor necrosis factor-alpha (TNF-£\), and prostaglandin E2.[21] Furthermore, Mu Gua (Fructus Chaenomelis) has been shown to effectively treat rheumatic and rheumatoid arthritis by reducing inflammation in subjects with collagen-induced arthritis.[22] Wei Ling Xian (Radix et Rhizoma Clematidis) exerts its significant anti-inflammatory effect by blocking the production of the pro-inflammatory mediators, nitric oxide, and prostaglandin.[23] Lastly, Ge Gen (Radix Puerariae Lobatae) has also been shown to have a muscle-relaxant effect to relieve muscle spasms and cramps.[24]

        In summary, Back Support (AC) is an excellent formula for acute and severe pain in the lower back region, as it contains herbs with excellent analgesic effect to relieve pain, anti-inflammatory effect to reduce swelling and inflammation, and muscle-relaxant effect to alleviate spasms and cramps.

 

COMPARATIVE ANALYSIS

Pain is a basic bodily sensation induced by a noxious stimulus that causes physical discomfort (such as pricking, throbbing, or aching). Pain may be of acute or chronic state. For acute back pain, two classes of drugs commonly used for treatment include non-steroidal anti-inflammatory agents (NSAID) and opioid analgesics. NSAIDs [such as Motrin (ibuprofen) and Voltaren (diclofenac)] are generally used for mild to moderate pain, and are most effective to reduce inflammation and swelling. Though effective, they may cause such serious side effects as gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness, and headache. Furthermore, the newer NSAIDs, also known as COX-2 inhibitors [such as Celebrex (celecoxib)], are associated with significantly higher risk of cardiovascular events, including heart attack and stroke. Opioid analgesics [such as Vicodin (APAP/hydrocodone) and morphine] are usually used for severe to excruciating pain. While they may be the most potent agents for pain, they also have the most serious risks and side effects, including but not limited to dizziness, lightheadedness, drowsiness, upset stomach, vomiting, constipation, stomach pain, rash, difficult urination, and respiratory depression resulting in difficult breathing. Furthermore, long-term use of these drugs leads to tolerance and addiction. In brief, it is important to remember that while drugs offer reliable and potent symptomatic pain relief, they should only be used if and when needed. Frequent use and abuse leads to unnecessary side effects and complications.

        Treatment of pain is a sophisticated balance of art and science. Proper treatment of pain requires a careful evaluation of the type of disharmony (excess or deficiency, cold or heat, exterior or interior), characteristics (qi and/or blood stagnation), and locations (upper body, lower body, extremities, or internal organs). Furthermore, optimal treatment requires integrative use of herbs, acupuncture, and tui-na therapies. All these therapies work together to tonify the underlying deficiencies, strengthen the body, and facilitate recovery from chronic pain. TCM pain management targets both the symptom and the cause of pain, and as such, often achieves immediate and long-term success. Furthermore, TCM pain management is often associated with few or no side effects.

        In conclusion, for treatment of mild to severe pain due to various causes, TCM pain management offers similar treatment effects as Western medicine with significantly fewer side effects.