Old TCM Sayings: Treat the Front to Treat the Back
Chinese medicine college was, and always will be, a memorable time. It was a time of massive personal and professional growth. Even though I am creeping on eight years in practice, I remember the old sayings passed down from either oral or written texts like it were yesterday:
- Treat above to treat below.
- Treat the opposite of the affected side.
- Treat contra-laterally.
- Treat the front to treat the back.
Over the years, I've had some success, oftentimes by being exposed to other treatment systems such as Dr. Tan, with understanding these sayings. Almost like a finger pointing to the moon, they remind me of martial art Kuen Kuit – or "Fist Poems" – reminders that realistically need personal reflection and exploration to unlock their secrets.
While I am a fan of most poems and sayings, I dislike: One who treats themselves, has a fool for a patient. I honestly don't believe this to be a Chinese medicine saying, where we are using a system that improves as we age. As we gain more life knowledge, and therefore experience physical and mental conditions and how they are affected by the outer elements and the inner emotions, we become better practitioners. I believe personal exploration and experimentation is the key to succeeding in Chinese martial arts and Chinese medicine. If we are to accept legendary tales of past masters in this medicine, ingesting countless herbs in order to document their effects, we can rest assured that we are practicing a method that allows us to turn inward.
Recently in clinic, I discovered how I could successfully implement treating the front to treat the back. Obviously, the inverse is always true with these TCM sayings – and perhaps makes more sense. In the treatment of shingles, we practitioners generally follow the blemishes along the rib line to the affected nerve at the spine. Therefore, it's very easy to see how treatment at T9 could affect Liver function at a functional level.
Similarly, treating the Lung often responds better using UB13 for function and UB42 for emotion. Cupping over UB13 can also remove Wind and Phlegm. For patients suffering from COPD or emphysema, I have successfully pulled fluid to the surface, leaving small pustules that burst and clear on their own.
I have often pondered the usages of the Front Mu points, along with what acupuncture channels truly are – accepting that Chinese medicine is an all-compassing-theory medicine. Front alarm points are regularly pressed by practitioners to tell them if there is concern with that Chinese medicine organ; however, while having a conversation with a chiropractor about tendon and fascial connections, I began to question if this was their only function.
In a conversation regarding the treatment of back pain, Dr. Denise Wright, DC, told me she uses an iliopsoas release at GB27/28 area to get lumbar pain to subside. When I asked her why, her response was a simple but interesting one: the anterior of the lower vertebrae attach here. I was in awe – of course the erector spinae muscles held the spine in place, and were regularly treated with local UB points – but to treat the front to treat the back clearly sparked the old saying in my memory.
I wondered if there were other connections that the Front Mu and adjacent points had to the vertebrae as well as other internal structures – and so I began to research fascial and tendon attachments. Visiting the Anatomy Trains website is a wild adventure for an acupuncturist. A layer of fascia yields a clear pathway from the feet all the way up the front of the body to the opposite side of the nose. Maybe, just maybe, while the Gallbladder and Urinary Bladder channels of the leg are following a distinct nerve pathway, other acupoints are based on tendon and fascial attachments - and their multiple layers.
The first person I had to try this on was myself. A sufferer of chronic back pain for more than 15 years, I only was able to receive minimal relief over the years with local treatment. One treatment on the entire Dai Mai channel gave me immediate relief after a 20-minute session.
I posited this is also how GB26 is touted as such a great point for menstrual concerns. Not only is it part of the Dai Mai, but perhaps by treating this area, the fascia surrounding the uterus is treated as well.
Now that I had felt comfortable treating myself, I kept these ideas for back pain in my mind for those tough cases that wouldn't respond to conventional local treatment. All patients that I have used these points on have expressed reduced pain in their back, as well as how "open" the lower half of their body felt.
I then started working with other alarm points. If a patient presented with mid-back pain that was around UB18, and was caused by Liver Qi stagnation, I used LV14 with great success. Upper back pain was relieved by using LU1 and REN14. The greatest gain I felt my patients receiving wasn't just the pain relief, but how they expressed how much more "open" the front of their bodies felt – and how this translated to their emotional well-being. And this would make a world of sense if the fascial attachments were allowed to relax from the hunched over position we are mostly in.
In search of personal greatness in the clinic, we must first believe that we were given all the pieces of the TCM puzzle; however, we are to be the ones to put them together. There is no question that mentors speed up this process, but there is a strong sense of ownership that occurs when a personal breakthrough has occurred.
Many things in life are learned via trial and error. Constant refinement. The goal is to fail faster (let go) and try again. In talking with many graduates of Chinese medicine college, it seems that we all share a similar feeling: that school left us with a sense of constant wonder. We must not lose that spark – that constant inquisitiveness – whether it be by going to seminars, reading books or self-imposed isolation (such as Einstein).
From practice management to making sense of old sayings, we are blessed to live in a time where we can refine and share.