Tui Na (or Tuina) Massage: A Minireview of Pertinent Literature, 1970-2017

Background: Tuina massage is a traditional method used effectively in the treatment of various ailments in China since ancient time, and currently it is used around the world. Objective: This minireview aims to describe several aspects of Tuina massage an integral part of Traditional Chinese Medicine in order to fill up the knowledge gap concerning traditional practitioners in Saudi Arabia. Methods: Electronic searches of databases using Boolean operators and keywords were conducted to retrieve data published in English and Chinese literature. Thousands of articles were identified and screened by two independent reviewers using exclusion and inclusion criteria, and 56 articles were finally included in this study. Results: Tuina has a very rich history in Chinese culture since antiquity. With continuous advancements in research, training, regulation and clinical practice, Tuina massage became popular worldwide and now used either alone or in conjunction with other complementary and alternative medicine or conventional therapies in diverse diseases associated with pain and other symptoms with good outcome. Although Tuina has good safety profile with level of evidence (LOE) of I to III, well defined indications and contraindications, a variety of minor adverse effects together with some major complications including deaths have been reported in the literature. Besides continuous training of Tuina practitioners, Tuina massage practice needs regulatory measures and guidelines for avoiding complications and improving the clinical outcome of patients. Conclusion: Evidently, Chinese Tuina massage supported by theory, mechanisms, procedure and included randomized clinical trials snapshots, systematic reviews and meta-analysis with LOE of I to III is reported to be effective in several conditions. Further, rigorous randomized controlled studies with active comparators including other traditional modality or conventional medications or placebo with intensified quality control measures are required to provide further robust evidence-based data to support its efficacy in chronic diseases associated with pain and disabilities

Zheng-syndrome differentiation (Bian zheng in Mandarin) of TCM or a disease diagnosis of conventional medicine (bian bing in Mandarin), Which is more important in TCM practice?

With my own TCM practitioner’s knowledge and experience, I do not think different opinion have obvious correctness or wrong. Only efficacy really matter. It relies on the individual’s situation and whichever method with better effectiveness than the other should be brought to application. I personally believe that if it is a simple case, we stress the importance of diagnosis of Zheng-syndrome in TCM with support of disease diagnosis of conventional medicine. Takes common cold as example, it does matter if it is a wind-heat type or wind-cold type, we usually apply Daqingye or Banglangen because its anti-virus effect. Last issue I recommend Ganmao Qingre Keli plus Banglanggen Chongji for common cold and flu, which is on basis of this theory. When we treat a very complicated case or condition or syndrome without biomedical diagnosis, we should follow TCM Zheng-syndrome differentiation. It is not uncommon that for some cases there is no diagnosis in conventional medicine. This is where we need to rely on our knowledge and experience of TCM. Takes a patient with main complain of eczema, accompanying with hay fever, asthma and IBS, we should deal with all four condition in one prescription, rather than dealing the four conditions separately like conventional medicine, in order to achieve the best result. >(Neijing) tells us to ‘search a cure from the root of illness’. The root is usually identified by TCM Zheng-syndrome differentiation, which enables us to establish a treatment principles. On basis of the treatment principle we are able to decide formulae and choice of medicines or acupoints. Dealing with this kind of complicated cases by applying TCM syndrome differentiation shows the strengths of TCM. Not only me, but all well qualified TCM practitioner, are armed with this strength. In addition, we should mainly rely on disease diagnosis of conventional medicine if it is definite but without any symptoms. For example, hepatitis B virus carrier or pre-clinical diabetes patient, we have no choice but to deal with it on basis of the diagnosis from conventional medicine. Take common cold as an example. To a child, an old, a young strong me or a young pregnancy women catching a cold, the treatment should be different for them, also cold occurring in different season or different region should be treated differently. Although we can apply formula to cover most cases of cold, we still need to take individual’s condition into consideration to tailor our prescription. To simplify a complicated case, we should apply four diagnostic techniques and eight principle differentiation to lead to a unique syndrome pattern, i.e. Zheng of bian zheng lun zhi. In one word, syndrome differentiation is core of TCM practice and the essence of art in TCM system. 　 In essential, this is a question how to deal with the relationship between TCM and conventional medicine. I remembered when I participated in editorial work of a TCM pediatrics textbook in 1990s’, a question was raised to my supervisor Prof. Shaochuan Li on whether the contents of the book should be categorized by diseases of conventional medicine or TCM syndromes. Professor Li’s answer was using diseases of conventional medicine as titles and supplemented by TCM syndromes. As a famous clinician in TCM for sixty years, Profs Li had an open-mind to accept conventional medicine as main stream. In practice he always applied TCM theory into practice and he never gave up TCM principles and techniques. He always believed that TCM and conventional medicine should learn from each other in order to achieve best result for our patients. As early as in 1960s, Mr Li had published research reports about TCM treatment on children’s acute nephritis and nephritic syndrome. Both of acute nephritis and nephritic syndrome belongs to edema-syndrome in TCM but their treatment is quite different. There are so many different methods of TCM syndrome differentiation based on eight principles, zang-fu-theory, Channels (Jingluo), six-channel syndromes (liujing), defence-qi-nutriention-blood system (wei qi ying xue system), three-warmers. If we add a new method like selection of treatment on basis of diagnosis from conventional medicine, I believe it would be a good way for TCM to further develop. This is actually from ancient tradition reflected in Dr Zhang Zhongjing’s > 1800 years ago. Eight and half years ago, when I came to the UK, this is the first question I asked Dr Junkun Bai. Coincidentally, my friend Dr Mingjing Cai, he asked me the same question when he came to the UK one and half years ago. I am hoping my answer have a little help to Dr Cai and my reader who are interested in this topic

Eye acupuncture for pain conditions: a scoping review of clinical studies.

Chinese eye acupuncture, focuses on treating different diseases by applying needle stimulation around the orbit of the eye. Since 1970, it has been used in China for the management of pain-related disorders. This scoping review systematically collected clinical studies on the use of eye acupuncture to treat pain conditions and identify any adverse events. Six databases including PubMed, the Cochrane Library, CNKI, VIP, Wan Fang Data and SinoMed were searched from 1970 to March 2019. Randomized controlled trials (RCTs), clinical controlled trials (CCTs) and case series on eye-acupuncture for pain conditions meeting the inclusion criteria were identified. Data were extracted on patients, interventions, details of eye acupuncture, control treatments and outcomes. Searches identified 81 clinical studies and a trend demonstrating an increasing number of published studies. All studies were conducted in China and published in Chinese. These included, 45 (55.6%) RCTs, 5 (6.2%) CCTs, and 31 (38.3%) case series, treating 7113 patients with 44 different pain-related diseases or symptoms. The most frequently reported conditions were headache (18, 16.2%), acute lumbar pain (7, 6.3%) and lumbar disc herniation (7, 6.3%). Treatment using small needles (φ0.25 × 13 mm), retained ≤30 min, needling the horizontal outer orbital edge and the avoidance of manipulation during treatment were the most frequent descriptions of the interventions used. Eye acupuncture was used alone in about half of the studies and of the remaining studies it was combined with other treatment. All studies suggested some beneficial effects including: pain relief, improved quality of life and mental health, and 18 (22.2%) adverse events. Eye acupuncture, predominantly studied in China, may be a promising intervention for managing diverse pain conditions. However, given the variety of study designs and reported treatment outcomes, conclusions about the evidence for eye acupuncture for specific conditions are not possible at this stage

Acupuncture for quality of life in patients having pain associated with the spine: a systematic review

Background: Pain associated with the spine (PAWS) refers to pain in the neck, thorax, lower back or sacrum. It impacts on patients' Quality of Life (QoL), including working ability, daily functioning, sleep and psychological well-being. A number of clinical trials have demonstrated that acupuncture was beneficial for patients with PAWS. However the overall effect of acupuncture on these patients' QoL is unknown. Aims: The current study aimed to conduct a systematic review (SR) of clinical trials to determine the effect of acupuncture on QoL and pain for patients with PAWS. In addition, a narrative review (NR) was conducted to compare patients' perceived changes (PCC) with the standard QoL instruments used in acupuncture clinical trials for pain. Methods: For the SR, PubMed, Embase (via ScienceDirect), CINAHL (Via EBSCO) and Cochrane Central Register of Controlled Trials were searched. Randomised controlled trials (RCTs) of acupuncture for PAWS condition(s) that include both QoL and pain assessments with a Jadad score of three or greater were included. For the NR, PubMed was searched to identify studies reporting PPC after acupuncture and/or traditional Chinese medicine. Extracted data were grouped and compared with domains of the QoL instruments. Results: In total, 21 RCTs were included and 17 of them had sufficient data for analysis. QoL was measured using 15 different instruments. Randomisation procedures and dropouts were adequately reported in all 17 studies. Four studies compared acupuncture with wait-list or usual-care. Two demonstrated that acupuncture had a superior effect on improving physical and mental components of QoL measured by Short Form-36 health survey questionnaire and pain at the three month follow-up. Studies comparing acupuncture with sham/placebo acupuncture or placebo-TENS found either no difference between the treatments or conflicting results. When acupuncture was compared with active interventions, there was no difference except that at the intermediate-term follow-up massage was better for disability and pain and physiotherapy was better for Northwick Park Neck Pain Questionnaire. Acupuncture was also better than TENS for pain. The combined therapy of acupuncture and an active intervention showed a superior result than the latter alone in the short-term. Six studies were identified for the NR. Patients reported 11 categories of changes after acupuncture, such as reduced reliance on other therapies, enhanced spirituality, prevention of disease. However, these clinical outcomes were not included in any of the QoL instruments used in the included RCTs. Conclusion: There is moderate to strong evidence that acupuncture is more effective than wait-list or usual-care at the short-term follow-up in improving QoL of patients with PAWS. When acupuncture is combined with another therapy, the combined therapy seems to produce a better outcome. Acupuncture is not better than sham/placebo acupuncture or placebo-TENS. Surprisingly, the commonly used QoL instruments do not measure all the changes perceived by patients as a result of acupuncture and/or traditional Chinese medicine. There is a pressing need to design QoL assessments that are suitable for acupuncture research. Further studies should have larger sample sizes and additional validated outcome assessments are required to detect effects of acupuncture

Acupuncture

Acupuncture may have about 4000 years of history, but it has only been clinically accepted in the West for some 40 years. Acupuncture receives both praise from its users and skepticism from its critics. High-quality scientific studies have advanced, but the technique of acupuncture in health services has stagnated. In this current scenario of contrasts, Acupuncture - Resolving Old Controversies and Pointing New Pathways intends to be a modern reference for scholars, without totally exhausting the subject. The editors expect this work to assist with the advancement of the scientific understanding and clinical usage of acupuncture. The authors are well versed in the subject and, along with literature reviews, are able to add their own impressions. In this book, some traditional fundamentals of ancient Asian medicine are translated into the current scientific knowledge of neurophysiology and mechanisms of action. Specific variations of acupuncture, such as the scalp microsystem technique, are discussed and explained. Practical aspects, such as education on acupuncture, are enriched with descriptions of novel treatments. The therapeutic use of acupuncture and related techniques is explored regarding their incorporation into a comprehensive integrative medicine approach. As editors, we thank the contributing authors for their exquisite work, and we congratulate IntechOpen for its efforts in book production. For you, the readers, we hope to match the trust you put in this work, and we hope you find it useful

Detailed diagnoses and procedures, National Hospital Discharge Survey, 1993

Written by Edmund J. Graves."October 1995."Also available via the World Wide Web.Includes bibliographical references (p. 3)

Outpatient Management of Chronic Pain

In this chapter, we provide an overview of the most current techniques in the evaluation, diagnosis, and treatment of pain in the outpatient setting. We performed a targeted literature review by searching for the terms such as “chronic pain” and “pain management.” Relevant articles were cited, and findings were described in the chapter text. Additionally, we supplemented our review with images from the Spine and Pain Associates’ offices at St. Luke’s University Health Network (SLUHN) in Bethlehem, PA, as well as medical illustrations by our authors. We begin the review with a description of pain—its definition, components, complexity, and classifications and then provide a stepwise outline of the pharmacologic approach beyond nonsteroidal anti-inflammatory drugs before delving into newer interventional pain management procedures. Subsequently, this chapter is not comprehensive as it does not provide extensive discussion on older, more established procedures such as epidural steroid injections as well as practices falling out of favor such as discograms and neurolysis. Instead, we focus on newer subacute to chronic nonmalignant pain interventions. Finally, we attempt to highlight future directions of the growing field. Overall, we provide an overview of the management of chronic by providing insights into updates to chronic pain management

Choices and Consequences: An investigation into patient choice of provider and provider interventions for low back pain.

A significant portion of healthcare spending is for the treatment of low back pain (LBP). Treatment for low back pain is variable and interventions depend largely upon the provider. This dissertation sought to examine the influence of the first choice of provider, their choice of interventions and the trajectories of health care utilization and patient outcomes. Using the database from a large insurer, we examined data for services billed from July 2015 through July 2018 and conducted a retrospective cohort analysis of patients seeking care for a new episode of LBP. We identified the first provider chosen and examined total medical utilization and LBP costs over the next year. 29,806 unique individuals were identified. Average total cost of care (TCOC) for all medical costs was lowest in those who first sought care with Chiropractic $7,761 (95$7,306, $8,218) or Physical Therapy$11,612 (95% CI: $10,586,$12,638). Highest average TCOC for all medical costs was seen in those who chose the Emergency Department, $20,028 (95$18,903, $21,154). There appears to be an association between the first choice of provider and future healthcare utilization. Using the previously identified data, we narrowed our focus to those who chose the Emergency Department (ED) as the first choice of provider. The goal was to highlight the differences between guideline based and non-guideline based care. 2,895 individuals were analyzed. 1758 (61$18,839 (95% CI: $17,239,$20,385). Low back related spending per episode was also lowest for concordant care $2,635 (95$2,185, $3,084). There appears to be an association between the care delivered in the ED and future healthcare utilization. Finally, we conducted a systematic review (PROSPERO-CRD42020212006) to investigate face-to-face telehealth evaluations or interventions for LBP. 5 studies met our inclusion criteria. The studies found reinforce the existing literature; PTs can perform comparable evaluations and interventions during in-person interactions and face-to-face telehealth environments

Evaluation of the effectiveness and safety of acupuncture in the management of shoulder pain in adults

Shoulder pain affects 6-26% of the population globally with a substantial health and economic impact on the community. This review was to evaluate the effectiveness and safety of acupuncture in the management of shoulder pain in adults by systematically reviewing the currently available randomised controlled trials (RCTs) and non-randomised controlled trials (non-RCTs). A total of 16 English and Chinese electronic databases were searched from their respective inceptions to 18 September 2012. The data on pain intensity, range of motion and adverse events as well as risk of bias were analysed. Meta-analysis was performed using Review Manager 5.1. A total of 6,609 studies were identified. Thirty-eight RCTs and six non-RCTs met the inclusion criteria and were included in this review. Among the 38 RCTs, 4,115 participants were randomised. There was a high risk of performance bias and an unclear risk of selection, detection, attrition and reporting bias across most RCTs. The pooled data showed that acupuncture was more effective than sham acupuncture to relieve pain and improve abduction degree of the shoulder at the end of treatment and follow-up. There was no significant difference in alleviating pain between acupuncture and Western medication (WM) at the end of treatment period. However, nerve block (Xylocaine) was superior to acupuncture in improving shoulder movement in all directions after one-session treatment. Acupuncture reduced more pain than conventional orthopaedic therapy after three-month treatment and three-month follow-up. Comparing with other therapy (such as Trager psychophysical integration and conventional orthopaedic therapy), the pooled data indicated that acupuncture was more beneficial for improving abduction degree at the end of treatment. However, the synthesised data did not show any significant difference in pain relief or improvement of abduction degree between acupuncture plus WM and WM alone. It demonstrated that acupuncture was more effective to alleviate pain as an adjunct treatment to Tuina at the end of treatment. However, there was no significant difference between acupuncture plus Tuina group and Tuina alone group for abduction degree or between electroacupuncture plus exercise and interferential electrotherapy plus exercise for pain relief after the last treatment. Six non-RCTs involved 570 participants. All the non-RCT studies had a high a risk of selection bias (random sequence generation) and performance bias (blinding of participants). Majority had an unclear risk of selection (allocation concealment), detection, attrition, reporting and other bias. Although all the investigators claimed that the acupuncture treatment group was more effective than the control group, due to lack of data for outcome measures, meta-analysis was not performed. No severe adverse events were observed in either RCTs or non-RCTs. The outcomes from the current project indicate that acupuncture is potentially beneficial and safe for relieving pain and improving abduction movement of the shoulder joint. However, due to the various confounders and high or unclear risk of bias, the findings need to be interpreted with caution. A large scaled, rigorously designed RCT is warranted to confirm the current results