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Treatment Modalities in Chinese Medicine

‘If there is free flow, there is no pain; if there is pain, there is lack of free flow.
Where there’s stagnation, there will be pain. Remove the stagnation, and you remove the pain.’

The above quote, taken from the first known treatise on Chinese Medicine, the ‘Huang Di Nei Jing’ or ‘The Yellow Emperor’s Classic of Internal Medicine’ (206 BCE–220 CE) is considered by many to be illustrative of Chinese Medicine’s approach to life, health and wellness.

At its very core, Chinese Medicine – one of the most complex and sophisticated systems of healthcare with a continuous clinical history of at least 2,500 years – is about supporting, nourishing and allowing the flow of our natural system to move freely and on its own accord towards a sustainable and healthier life.

All Chinese Medicine treatment modalities were developed as ways to foster the body’s own ability to function properly by breaking up any stagnation, removing blockages and providing key, targeted nutrition.

A Chinese Medicine physician will use a variety of modalities to help this process along, catering treatments toward the individual and targeting the underlying imbalance rather than solely the symptoms.

In this way, Chinese Medicine can benefit clients at all levels of health from preventative and upstream healthcare to chronic and acute conditions. Importantly, this more holistic and self-healing approach can also alleviate symptoms with an unknown cause in Western Medicine.

Following is an overview of some of the most widely known treatment modalities provided in Chinese Medicine.

  1. Acupuncture
  2. Chinese Herbalism
  3. Tuina Massage
  4. Cupping Therapy

1. Acupuncture

Acupuncture is an ancient medical practice based on a system of meridians and acupoints. Acupoints are measurable, low-impedance points on the body that the Chinese have mapped along meridian lines.

Acupoints are stimulated through the use of micro-fine needles inserted in the skin and generally left in place for between 5 to 40 minutes. Needles can sometimes be gently heated with moxa, once inserted, or lightly stimulated using electro-acupuncture devices to enhance the treatment’s therapeutic effect.

Acupuncture has been practised and refined in China and other Eastern countries for millennia. Its earliest roots might stem back to the Copper Age, approximately 5,300 years ago.

The oldest possible evidence for acupuncture is the 61 tattoos covering the body of Ötzi the Iceman, a spectacularly preserved mummy found in Italy’s Ötztal Alps in 1991.

The look and location of these tattoos have led some researchers to believe that the tattoos could have been a form of marked acupuncture points for self-treatment of pain. If true, then acupuncture might have been around at least 2,000 years earlier than previously thought.

Acupuncture is now widely used and increasingly recognised within standard healthcare worldwide, and it is supported by clinical trials confirming its efficacy in treating a variety of conditions.

The Theory – Needles, Acupoints and Meridians

Acupuncture is based on the theory that the stimulation of acupoints through needling, pressure or heat, will solicit specific responses in the body and result in measurable, clinical improvements.

Discovered and mapped for millennia without machines, it is remarkable that the location of these acupoints can now be confirmed – accurately mirroring points of low electrical impedance on the skin.

A 2018 study (Kovich, Fletcher. The Impedance Profile of Acupuncture Points) located several acupoints electrically and studied their impedance in real-time.

Interestingly, the electrical impedance at acupoints was also found to decrease further in acupoints associated with a diseased Zang-fu organ. Its findings seem to suggest that not only do acupoints exist but also that information might actually be exchanged between them and the associated organ systems ‘in real-time via an electrical wave’.

Acupoints are mapped in Chinese Medicine along 14 major meridians, a network of pathways that conduct energy or facilitate the flow of Qi, throughout the whole body and between its surface and the internal organs.

While acupoints can now be electrically measured, there is no scientific proof that meridians exist as there is no clear-cut explanation of what they are, whether they rely on discrete anatomical structures or not, and how communication or other discreet energies are carried along them.

Over the years, several hypotheses have been proposed and methods attempted to try to explain meridians and provide anatomical evidence for their existence. Some seem more likely than others, but none are conclusive.

For example, research by physicist Dr Shui Yin Lo claims to demonstrate that meridians could be made up of stable clusters of electrically polarized water in its 4th, highly conductive state.

In support of this theory, weakly luminescent pathways have been captured by infrared imaging, providing some initial, yet not consistent enough, evidence of the actual existence of meridians.

Such a novel approach holds promise but requires further investigation and research.

The Mechanics: so, how does it work?

Although the benefits of acupuncture are being increasingly validated by modern research (some trials in footnotes*), the specific mechanism by which it works has yet to be fully understood.

A Neurological Response?

Some modern physiologists, supported by MRI studies, have put forward ’the neural hypothesis’ to explain the effects of acupuncture.

The hypothesis suggests that acupuncture could primarily work through the peripheral and central nervous systems.

The micro-injuries caused by the needles might, in fact, stimulate sensory nerves to send signals to the brain and the spinal cord. This would, in turn, solicit a multi-system response and trigger a cascade of reactions, increasing circulation and blood flow to the area treated and inducing the endocrine system to release chemicals and endorphins, the body’s natural painkillers.

Such physiological responses would likely boost the body’s own ability to heal itself through the inflammatory response and the involvement of the immune system.

Or a Subtler Response?

According to Chinese Medicine, ‘Qi’, traditionally translated as ‘vital energy’, flows through meridians.

Although describing Qi as a ‘substance that flows’ may not be accurate, many forms of information from electrical to mechanical to chemical are constantly transmitted and exchanged within the human body in many subtle ways.

In Chinese Medicine theory, stimulation of acupoints solicits an electrical or another energetic impulse that might travel along these anatomical or non-anatomical pathways, potentially interacting with and eliciting a response by the body.

But does it work and is there any evidence?

How acupuncture works scientifically might remain unclear, and further research and investigation are required, yet numerous studies suggest that acupuncture works for conditions, such as allergic rhinitis, gastrointestinal tract disorders, hypertension, headaches and migraines, anxiety and depression, among many others.

Acupuncture has also been used successfully for centuries in Chinese medicine to treat a wide variety of disorders that are still to be investigated by modern Western research.

More recently, The World Health Organisation (WHO) has recognised Acupuncture’s efficacy for certain conditions and in 2003 released, in collaboration with the National Institutes of Health (NIH) a report gathering some of the most recent research on the topic. You can download it here: ‘Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials. 


2. Chinese Herbalism

There’s an undeniable link between food and health.

Any food we ingest, including plants, herbs or minerals, is assimilated through digestion and converted into substances the body can use. Anything that we consume will go through chemical processes and will inevitably have some pharmacological effect – either positive or negative – on the mind-body system.

“In food, excellent medicine can be found, in food bad medicine can be found; good and bad are relative.” Hippocrates ‘De Alimento’

The idea that food is a form of medicine was acknowledged by Western medicine from its very early Hippocratic roots and it is at the very heart of all traditional medicines. This approach to health has only recently been usurped by more profitable patent medicines usually based on laboratory isolation of chemical compounds from these same foods and plants.

For millennia, traditional medicines have harnessed herbal foods as a powerful way to improve or restore health and prevent disease.

Chinese pharmacology is the most advanced of these herbal therapies and is based on many centuries of continuous empirical studies and practice. Today, we have almost 2,000 years of clearly written records of empirical data on hundreds of herbs – mostly plant and mineral-based – and solid knowledge of their use and therapeutic properties, interactions, contraindications and recommended dosages.

Take Ginseng, for example, a perennial herb of the Araliaceae family. Known as ‘the king of all herbs’ and regarded as one of the most powerful tonics, Ginseng is a highly valued medicinal plant in East Asian countries.

Modern studies now show that Ginseng contains powerful active compounds, collectively known as ginsenosides, providing anti-inflammatory, antioxidant, antibacterial and antiviral properties along with a wide array of pharmacological applications. Moreover, studies found some therapeutic potential in hypertension, stress, and different neurological disorders such as Alzheimer’s and Parkinson’s disease.

Wester Medicine, has acknowledged the pharmacological effects of herbs, using their bioactive compounds in the treatment of many health concerns. Their general approach is to try to isolate the ‘active ingredients’ of these herbs for production into patentable tablets and tinctures.

The Chinese medical approach is to harness the synergistic potential of the whole plant instead of isolated compounds. Furthermore, Chinese Medicine extends the therapeutic potential through combinations of plants, with millennia of study on their interactions for therapeutic effects. A skilled herbalist can also further modulate the therapeutic effects by altering the preparation and cooking methods of the plants.

Chinese Pharmacology: the power of Synergy and the Art of Dosing

Echoing the Aristotelian notion ‘the whole is greater than the sum of its parts’, synergy is generally defined, in the medicinal research field, as ‘the interaction of two or more drugs or compounds that produce a combined effect greater than the sum of the individual agents’.***

The concept of synergy is an intrinsic part of Chinese Medicine. The whole plant is more effective than isolating active ingredients, and the right combination of plants is more powerful than taking a single herb alone.

The complex interaction of herbs in Chinese Medicine prescriptions takes years of study but generally seeks to increase efficacy while maintaining low dosages of any one ingredient to prevent over-reliance and excess. Hence, unlike mainstream pharmacology, Chinese Medicine does not work with single compounds and very rarely prescribes single herbs.

The key skill of a Chinese Medicine herbalist lies in the ability to apply the principles of synergy and dosing to combine the right choice of herbs, in the right dose, into the most effective and safe formula that can suit the subtle nuances of the condition and constitution of the patient.

Chinese Medicine practitioners will most often combine a dozen or so plants in highly individualized, balanced and synergistic ‘formulations’ that enhance the bioavailability of each individual active component while altering the absorption of some and modulating their potential toxicity.

It is important to remember that almost any medicine or food has an inherent potential for toxicity. The difference between having a therapeutic effect instead of a toxic one is primarily related to dose and interactions with other substances – this is the area of expertise of any well-trained doctor.

In order to achieve the desired effects safely, Chinese Medicine herbal formulations are strictly designed following the principle of compatibility and the rule known as ‘Emperor–Minister-Assistant-Courier’, or ‘Jun-Chen-Zuo-Shi’, where:

  • ‘Jun’ or ‘The Emperor’ are the essential herbs in a formula which directly addresses the disease
  • ‘Chen’ or ‘The Minister’ are adjuvant herbs which work closely with ‘the Emperor’ herbs to promote their therapeutic effect or target some of the concurrent symptoms
  • ‘Zuo’ or ‘The Assistant’ are crucial for reinforcing the strength of ‘Emperor and Minister’ herbs while reducing any side effects of the herbal formula
  • ‘Shi’ or ‘The Courier’ are herbs which guide the active ingredients to reach the target Zang-fu organs or harmonize their interactions.

Following this specific process is crucial for the treatment to be both successful and safe. As such, a small change in symptoms might lead to a change in the composition of ‘Jun’ herbs, resulting in a cascade of differences in the whole formula. This is why the prescription for every patient is different, even when prescribed by the same doctor.

Is Chinese Herbalism Safe?

Chinese Medicine has been operating for decades in the UK in a completely unregulated manner – anybody can call themselves a Chinese Medicine Doctor. Yet, even in this unregulated state, it has an exemplary safety record. There has not been a single death proven to be caused by Chinese Medicine prescribed by a qualified practitioner.

However, Chinese herbs are powerful medicines and just like conventional medicines have a potent effect on the body. Therefore, they should be treated with the same care and respect as conventional medicines.

Although rare, some herbs may interact with prescription or over-the-counter medicines. It is advisable that any herbal prescription is provided by an expert who has undergone some Western medicine training and is informed of all the medications the client is currently taking in order to avoid any issues with drug interactions. We strongly advise against self-prescribing of potent herbal medicines.

3. Tuina Massage

Pronounced “twee naa” and generally translated as ‘pinch and pull’, Tui Na or Tuina is a therapeutic form of massage rooted in Chinese Medicine theory and believed to be the oldest system of bodywork, with archaeological evidence that traces its roots back to 2600 BCE.

To this day, Tuina is a standard bodywork treatment used in Chinese Medicine hospitals and clinics throughout Asia to either encourage overall wellness or treat specific conditions.

Tuina is intended to be therapeutic and invigorating. Similarly to Western massage, it works on muscles, bones, tendons and joints and shares some of the techniques and strokes used, such as gliding, kneading, rocking, pulling, friction, and rolling. While it can aid in relaxation after treatment, it would not be considered a relaxing massage.

Unlike Western massage therapy, though, Tuina aims to go beyond muscles, bones, and joints and works deeply with the body to restore physiological and emotional balance using the same principles of acupuncture and concepts of Chinese Medicine. In this way, Tuina can be used to treat conditions which are not musculoskeletal in nature.

Considered a physical variation of acupuncture and often used in combination with it and other Chinese Medicine therapies, Tuina uses fingers and various rhythmic compression and manipulation techniques to stimulate acupoints, ease joint and muscle pain, reduce tension and stagnation and stimulate blood flow.

Its main therapeutic aim is to stimulate blood flow, removing stagnation and correcting imbalances caused by tension, bad habits, and poor health, which can manifest as pain, disease, and emotional issues.

Although research is still preliminary and ongoing, there’s plenty of evidence to back the effectiveness of Tuina massage in treating specific health concerns. See the footnotes**** and it is considered a very effective therapy for arthritis, pain, sciatica and muscle spasms.


4. Cupping Therapy

Cupping is an ancient technique. One of its earliest written documentation is found in ‘A Handbook of Prescriptions for Emergencies’, compiled by Taoist herbalist Ge Hong around 300 CE.

Today it’s a well-recognized traditional therapy used for health promotion and the treatment of a wide variety of conditions, ranging from musculoskeletal pain, such as chronic lower back pain, neck and shoulder pain and fibromyalgia to respiratory and digestive issues, including cough, asthma, the common cold, bloating and gastric reflux. See footnotes.*****

Similarly to Tuina, Cupping is generally combined with acupuncture as a way of clearing stagnation and breaking up blockages to restore the body’s natural flow of energy and alleviate pain.

It involves the use of glass, wooden or plastic cups, that function as suction devices and are applied to soft tissue areas such as the back, shoulders and neck.

Very much like the inverse of massage, rather than applying pressure to muscles, Cupping pulls them upward, drawing the skin and the superficial muscle layers into the cup. For most patients, this is a strange yet relieving sensation.

The suction and negative pressure created in the cup can loosen tight muscles and fascia, and increase blood circulation, encouraging blood flow and blood supply to the surface of the skin while activating the lymphatic system, which helps drain excess fluids and toxins.

Most importantly, Cupping has been shown to aid cell and deep tissue repair and regeneration by intentionally causing micro-damages to the net of capillaries beneath the skin, leaving those distinctive circular bruises the therapy is well known for.

Dry, Wet, Static or Gliding

Cupping can be either Dry or Wet, Static or Gliding.

Dry cupping is the most common type of cupping. Suction is created in the cup by removing the oxygen through a pump mechanism or by fire (a very traditional approach). Cups are placed onto the body at specific points depending on the treatment.

In ‘Static or Stationary Cupping’, once the suction has occurred, the cups are left in place for 5 to 15 minutes. This allows the targeting of a specific localized area of stagnation.

In Gliding Cupping’, oil is applied to the skin to help the cups gently glide across the skin and along meridians or muscle groups. This is normally done for about 5-10 minutes and generally in addition to massage or other treatment modalities. This technique can cover a larger area more quickly hence it is often used on the back and thigh areas.

‘Wet cupping’ is not performed at our clinic. It is a type of bloodletting cupping using very small punctures in specific areas of the body followed by stationary cupping. This allows a small amount of blood to come out through the skin to remove stagnation and encourage a body-healing response in that area.

What about those Cupping marks?

Cupping is well known for causing temporary skin discolouration and leaving distinctive, bruise-like marks on the areas where the cups are applied.

These marks are caused by microdamage to broken capillaries just beneath the skin.

They are completely harmless and not painful and will typically fade away within a week or two, depending on the body’s regenerative ability.

Interestingly, after regular cupping treatments, patients find that the marks visibly become lighter and lighter. According to Chinese Medicine, the marks’ colour and pattern reflect the level of blood and Qi stagnation, and associated toxin accumulation, in that area. The darker the colour, the more stagnation is present, so dark bruises mean that the client is really benefitting from the cupping.

*Studies & Clinical Trials

* Kovich, Fletcher. (2018). The Impedance Profile of Acupuncture Points. Journal of Acupuncture Research. 35. 104-107. 10.13045/jar.2018.00080. 

Bao, H., Si, D., Gao, L., Sun, H., Shi, Q., Yan, Y., Damchaaperenlei, D., Li, C., Yu, M., & Li, Y. (2018). Acupuncture for the treatment of allergic rhinitis: A systematic review protocol. Medicine, 97(51), e13772.

Sung J. J. (2002). Acupuncture for gastrointestinal disorders: myth or magic. Gut, 51(5), 617–619.

Yang, J., Chen, J., Yang, M., Yu, S., Ying, L., Liu, G. J., Ren, Y. L., Wright, J. M., & Liang, F. R. (2018). Acupuncture for hypertension. The Cochrane database of systematic reviews, 11(11), CD008821. 

Molsberger A. (2012). The role of acupuncture in the treatment of migraine. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 184(4), 391–392.

Sniezek, D. P., & Siddiqui, I. J. (2013). Acupuncture for Treating Anxiety and Depression in Women: A Clinical Systematic Review. Medical acupuncture, 25(3), 164–172.

Ratan, Z. A., Haidere, M. F., Hong, Y. H., Park, S. H., Lee, J. O., Lee, J., & Cho, J. Y. (2021). Pharmacological potential of ginseng and its major component ginsenosides. Journal of ginseng research, 45(2), 199–210.

** Im, K., Kim, J., & Min, H. (2016). Ginseng, the natural effectual antiviral: Protective effects of Korean Red Ginseng against viral infection. Journal of ginseng research, 40(4), 309–314.

Komishon AM, Shishtar E, Ha V, Sievenpiper JL, de Souza RJ, Jovanovski E, Ho HV, Duvnjak LS, Vuksan V. The effect of ginseng (genus Panax) on blood pressure: a systematic review and meta-analysis of randomized controlled clinical trials. J Hum Hypertens. 2016 Oct;30(10):619-26. doi: 10.1038/jhh.2016.18. Epub 2016 Apr 14. PMID: 27074879. 

Lee, S., & Rhee, D. K. (2017). Effects of ginseng on stress-related depression, anxiety, and the hypothalamic-pituitary-adrenal axis. Journal of ginseng research, 41(4), 589–594.

Kim, H. J., Jung, S. W., Kim, S. Y., Cho, I. H., Kim, H. C., Rhim, H., Kim, M., & Nah, S. Y. (2018). Panax ginseng as an adjuvant treatment for Alzheimer’s disease. Journal of ginseng research, 42(4), 401–411.

Cho I. H. (2012). Effects of Panax ginseng in Neurodegenerative Diseases. Journal of ginseng research, 36(4), 342–353.

Upton J, Janeka I, Ferraro N. The whole is more than the sum of its parts: Aristotle, metaphysical. J Craniofac Surg. 2014 Jan;25(1):59-63. doi: 10.1097/SCS.0000000000000369. PMID: 24406559.

**** Lee, N. W., Kim, G. H., Heo, I., Kim, K. W., Ha, I. H., Lee, J. H., Hwang, E. H., & Shin, B. C. (2017). Chuna (or Tuina) Manual Therapy for Musculoskeletal Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-based complementary and alternative medicine: eCAM, 2017, 8218139.

Wu, Z., Kong, L., Zhu, Q., Song, P., Fang, M., Sun, W., Zhang, H., Cheng, Y., Xu, S., Guo, G., Zhou, X., & Lv, Z. (2019). Efficacy of tuina in patients with chronic neck pain: study protocol for a randomized controlled trial. Trials, 20(1), 59.

Kong, L. J., Fang, M., Zhan, H. S., Yuan, W. A., Pu, J. H., Cheng, Y. W., & Chen, B. (2012). Tuina-focused integrative Chinese medical therapies for inpatients with low back pain: a systematic review and meta-analysis. Evidence-based complementary and alternative medicine: eCAM, 2012, 578305.

Ai J, Dong Y, Tian Q, Wang C, Fang M. Tuina for periarthritis of shoulder: A systematic review protocol. Medicine (Baltimore). 2020 Mar;99(11):e19332. doi: 10.1097/MD.0000000000019332. PMID: 32176055; PMCID: PMC7220300.

***** Silva HJDA, Saragiotto BT, Silva RS, et al Dry cupping in the treatment of individuals with non-specific chronic low back pain: a protocol for a placebo-controlled, randomised, double-blind study. BMJ Open 2019;9:e032416. doi: 10.1136/bmjopen-2019-032416

Lauche, R., Spitzer, J., Schwahn, B., Ostermann, T., Bernardy, K., Cramer, H., Dobos, G., & Langhorst, J. (2016). Efficacy of cupping therapy in patients with the fibromyalgia syndrome-a randomised placebo controlled trial. Scientific reports, 6, 37316.

Chi, L. M., Lin, L. M., Chen, C. L., Wang, S. F., Lai, H. L., & Peng, T. C. (2016). The Effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomized Controlled Trial. Evidence-based complementary and alternative medicine: eCAM, 2016, 7358918.

Guo, L., Wang, L., Wang, Z., Wei, L., Ding, L., Kong, Y., Liu, Z., Tian, Y., Yang, F., & Sun, L. (2021). Evaluation of the effectiveness and safety of cupping therapy in the treatment of asthma: A protocol for systematic review and meta-analysis. Medicine, 100(41), e27518.

Al-Bedah, A., Elsubai, I. S., Qureshi, N. A., Aboushanab, T. S., Ali, G., El-Olemy, A. T., Khalil, A., Khalil, M., & Alqaed, M. S. (2018). The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of Traditional and Complementary medicine, 9(2), 90–97.