Kim Yong-Suk, Japanese Acupuncture and Moxibustion, 2010; Vol.

6(1): 65-69

The 2 nd JSAM International Symposium on Evidence-based Acupuncture

Acupuncture Treatment for Low Back Pain in Korea

Kim Yong-Suk
Department of Acupuncture & Moxibustion
College of Oriental medicine
Kyung Hee University, Korea

Abstract
Low back pain (LBP) affects as much as 80% of the adult population. A variety of factors can lead to LBP. Vari-
ous treatment options have been proposed to provide relief of symptoms.
Acupuncture is a simple, effective, and conservative pain control modality. It is very effective and simple to use
in LBP. The application of acupuncture consists of the insertion of needles into certain points and the stimulation of
those points either by manipulation or by applying electric pulses or other appliances. In Korea, acupuncture practi-
tioners use disposable stainless steel needles, commonly 40 mm in length and 0.25 mm in diameter. Acupuncture
treatment is point-specific along the meridian, which means the selection of the point is very important. The princi-
ple of acupuncture treatment for low back pain is to select the local points and also a distal point on the meridian
that crosses the painful area. Especially, they may be selected on the base of Sa-Am acupuncture according to the
meridian flow and pain characteristics in Korea. The manipulation of needles includes manual twisting, moving the
needle up and down, and similar techniques which are essential. Other modalities used are moxibustion,
electroacupuncture, laser acupuncture, acupressure, cupping therapy and so on.
The needle would be left for 15-20 minutes. It requires approximately 10 sessions of treatments and 2 to 5 ses-
sions of treatments per week. It usually requires 3-4 sessions whether a patient is likely to respond to acupuncture
and often more than this before any long-term relief is obtained, with this varying according to the condition being
treated and a person's individual response to acupuncture.

Key words: LBP, acupuncture, meridian, electroacupuncture

Introduction cine, many new operative techniques are being devel-

oped, but until now LBP is treated more conservatively.
Because of bipedalism, humans suffer from lower Among many conservative treatments, acupuncture takes
back pain (LBP). Regardless of age and gender, 80% of a big part, and is practiced and researched actively
the population is reported to experience LBP. Sitting around the world.
long hours in work or study weakens the muscles of the Acupuncture is a part of Oriental medicine, and it ex-
back, and reduces flexibility. Bad posture can bring hibits unique merits by way of stimulating an acupunc-
about LBP, and standing for a long time or carrying a ture point through means of acupuncture needle,
heavy load can degenerate joints or result in sprain of the moxibustion, cupping, laser, electric currency,
back muscle. Lack of power and flexibility, instant over- pharmaco-puncture, bee venom, etc. In this paper, I
load, degeneration and deformation of the spine, and would like to introduce the practical application of acu-
trauma can all cause LBP, but the fundamental treatment puncture treatment for LBP in Korea.
is not yet clear. With the progress of conventional medi-

Corresponding author: Kim Yong-Suk

Department of Acupuncture of Moxibustion College of Oriental Medicine, Kyung Hee University
#994-5, Daechi: 2-dong, Gangnam-gu, Seoul 135-501, Korea
E-mail: ackys@hanmail.net
 66
Kim Yong-Suk, Japanese Acupuncture and Moxibustion, 2010; Vol.6(1): 65-69

Definition of low back in Oriental medicine Trauma to the back from heaving objects or by falling
from height can cause pain. The excess burden to the
In Oriental medicine, lower back is described as spines brings about change in inter-vertebral disc, and
"above the groin and underneath the ribcage." It is sup- the muscles and ligaments that support the vertebra con-
posed to the part between the 2 nd lumbar spine and the tracts, strains, and sometimes ruptures while trying to
lumbosacral or sacroiliac joint. The lower back is balance the instability. Simple strain of the muscles and
thought to be under the influence of Kidney. Kidney ligaments is called sprain and the pain is localized to the
stores Essence, and Essence generates Marrow. Marrow lower back, but in serious cases the herniated inter-
nourishes the Bone, therefore when the Essence of Kid- vertebral disc can result in radiating pain to the lower
ney is sufficient there is ample Bone Marrow to grow limb.
and strengthen bones. It is said in Lingshu ( ) 4) Blood stasis type
that "When Kidney is small the viscera are stable and When one fall down or is beaten, bleeding from within
difficult to harm, when Kidney is big it is prone to dis- the skin cannot be absorbed into the system and cause
ease and LBP so that one cannot bow, when Kidney is LBP. Typical symptoms are localized acute pain, worse
low the sacrum hurts, when Kidney is hard there is no in the evening.
back pain, when Kidney is crooked LBP results." This 5) Cold type
demonstrates the close relationship between Kidney and Cold pernicious Qi obstructs circulation of Qi and
the lower back in Oriental medicine. Blood so that one cannot use one's back. Warmth im-
proves the symptom while exposure to cold worsens it.
LBP in Oriental medicine 6) Damp type
Sitting or lying on damp surface for a long time makes
1. Etiology the waist heavy and cold. This kind of LBP occurs a lot
LBP usually results when the body is affected by during rainy season.
Wind, Cold, Dampness or any of the six pernicious fac- 7) Dam-heat type
tors. They obstruct the Bladder meridian. Trauma to the Greasy food induces obesity and LBP as well. A pro-
back by falling from a high place or being hit harms the nounced abdomen or pregnancy brings forward the cen-
muscles and blood vessels and causes Blood stasis. In- ter of weight, and in the effort to extend the back mus-
ternal injury or long ailment can bring about weakness cles backwards they contract and cause pain.
of Kidney Essence, and in cases of old people, insuffi- 8) Qi type
cient Essence and Blood cannot nourish the muscle and If one is setback in business or desire or any such, Qi
blood vessels. becomes stagnant and dysfuction of the Heart Blood
makes one unable to stand or walk for a long time. This
2. Classification is typical of people living in the modern world full of
LBP is divided into 10 different causes in stress, their neck and back muscles all tense. This type of
Dongeuibogam (). LBP is becoming more common than sprain of the back
1) Kidney deficiency type muscles nowadays.
Excessive sexual activity can damage Kidney and the 9) Food accumulation type
Essence and Blood cannot protect and nourish the mus- Indulging in alcoholic beverage and food while work-
cles of the back. The lower back hurts indistinctly and ing an overload harms Kidney, and the resulting Damp-
one cannot hold up objects. This is due to degenerative Heat induces LBP.
changes, in other words, aging process. It occurs fre- 10) Wind type
quently in one's 50's, and in some young adults who Wind hurts Kidney, and the LBP from this pernicious
indulge in sexual activity. Qi shows up on different regions in left and right side of
2) Phlegm type the lower back.
Phlegm is a type of metabolic waste that moves about
the body along meridians around the waist and back and
cause pain.
3) Sprain type
 67
Kim Yong-Suk, Japanese Acupuncture and Moxibustion, 2010; Vol.6(1): 65-69

Practical application of acupuncture & moxibustion The Bladder meridian-type induces radiating pain along
for LBP the posterior part of the lower limb by pressing the nerve
root at L 5~S 1 level, therefore points such as BL 37, BL
Acupuncture treatment is a kind of stimulation, there- 40, BL 56, BL 57, BL 60 are added to the standard acu-
fore the effective factors are the substance acupuncture puncture points used in LBP. In a mixed type of the two
needle is made of, the place acupuncture needle is in- meridians, acupuncture points of the two meridians are
serted, and the method of handling the needle. used. Also, there is a way of selecting treatment point
along anatomical nerve distribution. The majority of
1. Acupuncture needles radicular sciatica is caused by herniated inter-vertebral
The substance acupuncture needle is made of is se- disc. The diagnosis should select specific points from
lected according to the illness and stimulation point, but three parallel meridians along the involved lumbo-sacral
in Korea a disposable stainless-steel needle 40 mm in vertebra: GV, Ex-B 2 (Hua Tuo Jia Ji), and BL meridian.
length and 0.25 mm in diameter is generally used. Ear E.g., in the case of LBP from pressure to L 3 nerve root
acupuncture, subcutaneous acupuncture, Warming acu- (placed between the L 2 and L 3 body), local points of
puncture, Electroacupuncture and laser acupuncture are the GV (GV 4) and BL meridian (BL 23), as well as Ex-
sometimes used. B 2 beside L 2 are treated. Distal points of ST 33, ST 35,
ST 36 on the thigh and leg, LR 3, ST 41, Ex-LE 10 on
2. Posture of patients the foot are used.
LBP patient is treated with acupuncture in supine or 2) Micro-systems acupuncture
prone position. The patient's position is selected accord- The usual micro-systems acupuncture for LBP is ear
ing to the state of the pain, whether it is acute or chronic, acupuncture and Korean hand acupuncture. Correspond-
ipsi-lateral or bilateral. Generally, when applying acu- ing points of painful waist and leg are selected for treat-
puncture to the waist, lying on one's side is the best posi- ment.
tion. When lying face down, having a pillow underneath 3) Selection according to muscle
might be help for patients. When treating the muscles of the painful area, tender
points or Trigger points are used. Commonly used mus-
3. Selection of acupuncture points cles are erector spinae, quadratus lumborum, the
Treatment principle is set and acupuncture points are iliopsoas, abdominal muscle, the gluteus muscle and
selected accordingly, following pattern identification piriformis muscle. Since a man constantly moves, treat-
through observing the characteristic of the LBP in the ment using the muscles must be approached dynamically.
four-kind examination in Oriental medicine. Selecting Therefore there are ways of using the trigger point of a
the acupuncture point in a LBP patient is a very im- single muscle, as well as using the antagonistic and syn-
portant step, just like any other disease. The methods of ergistic muscles. This is called muscle imbalance ap-
selecting acupuncture points are classified into the fol- proach. And there is also chain reaction approach. These
lowing five ways. theories can give the logical basis to using acupuncture
1) Selection according to meridian points of the abdomen and ST 36 and BL 40 for LBP.
This method is a basic way of selecting acupuncture 4) Selection according to pattern identification
point, divided into two kinds. Local points are painful or There are 10 classifications of LBP in Dongeuibogam.
tender place directly on the region of pain, or an acu- - Kidney deficiency type: BL 40, SI 3, BL 60, KI 3, TE
puncture point of nearby meridian. Distal points are 3, BL 23
acupuncture points of meridians related to the LBP, or - Phlegm type: SI 3, BL 62, ST 40, CV 12
points along the neurological distribution. - Food accumulation type: LI 4, PC 6, ST 36, GB 41, SI
The acupuncture treatment of LBP is divided into two 3, BL 62
categories, according to the dermatome and meridian. - Dam-heat type: LI 4, PC 6, ST 36, SP 4, SI 3, BL 62
The Gall Bladder meridian-type manifests pain in the - Qi type: LI 4, ST 36, LR 3, SI 3, BL 62, TE 3, GB 39
lateral side of the lower limb by pressing the nerve root - Sprain type: SI 6, BL 2
at L 4~5 level. Acupuncture points in the GB meridian, - Blood stasis type: SI 6, BL 62, KI 2, SP 6, LR 3
such as GB 31, GB 34, GB 39 and GB 40, are treated. - Wind type: SI 3, BL 62, GB 41
 68
Kim Yong-Suk, Japanese Acupuncture and Moxibustion, 2010; Vol.6(1): 65-69

- Cold type: SI 3, BL 60, ST 36 serving health. This is often done in conjunction with
- Damp type: SI 3, BL 62, ST 36 classical acupuncture to improve the clinical effect, par-
5) Sa-Am acupuncture ticularly in conditions of weakness.
Sa-Am Acupuncture (), which is one of the EA means that following the selection of acupuncture
traditional acupuncture techniques, has been commonly points, inserted needles can be coupled to the electrodes
applied in clinical practice in Korea. Sa-Am was a monk of an electroacupuncture apparatus of specific design.
who lived about 400 years ago and established the Sa- Electroacupuncture units are designed to deliver variable
Am Acupuncture Theory on the basis of the 5 Element amplitudes and frequencies of electrical pulses, while
Theory and Supplementation-Draining Theory of acu- their waveforms are fixed. To obtain pain relief a high
puncture together, for the treatment of Excess- intensity of stimulation, sufficient to produce muscle or
Insufficient symptom and Cold-Hot symptom of dis- muscle fiber contraction, is recommended. Frequencies
eases. The main characteristics of Sa-Am Acupuncture of stimulation between 2 and 5 Hz are used. The large
are taking minimum or few points with great effect, diameter sensory fibers, Ab, are effectively stimulated.
among 60 points on four extremities especially on hand 20-200 Hz is used for low intensity.
and foot. Cupping is another type of treatment. This is a method
The reaction and efficacy of the treatments are very of stimulating acupuncture points by applying suction
prompt and effective without any major side-effects. through a metal, wood or glass jar, in which a partial
The point selection of Sa-Am Acupuncture follows vacuum has been created. This technique produces blood
the principle of the flow of meridians and done accord- congestion at the site, and therefore stimulates it. It is
ing to the kind of pain. In conditions of Insufficient Kid- also called vene-section. Needles like three-edged needle,
ney, Kidney meridian is selected. In cases of sprain, Gall small knife or dermal needle are used to tear the shallow
Bladder & Bladder meridians are used, and in the exis- capillary near the skin surface to drain a small amount of
tence of Blood stasis, Small Intestine meridian is treated. blood. Cupping is used for low back pain, sprains, and
Lung meridian is used to resolve Damp-Heat. When a soft tissue injuries.
patient cannot straighten one's back, Lung or Liver me- Low-energy laser systems, called "soft lasers," are
ridians is selected, and in reverse case, when one cannot sometimes applied to acupuncture points. Laser acu-
bend, Large Intestine meridian is used. When both flex- puncture increases capillary permeability. It also has an
ion and extension are difficult, Kidney and Bladder me- application in wound healing, stimulating fibroblast
ridians are used. production. The main indications for laser acupuncture
are chronic pain conditions and skin diseases.
4. Needling method The Acupressure is massage applied with the finger-
Local points can be used for acupuncture in the treat- tips to acupuncture points, chiefly to relieve acute symp-
ment of LBP, but the excess and deficiency must be toms and relax the muscles and joints.
judged accurately to apply correct supplementation or Bee venom therapy and pharmaco-puncture for low
sedation. Manipulation of needles is essential for acu- back pain are very popular in Korea. They can be useful
puncture treatment. Methods include manually flicking, in pain control.
scratching, twisting, moving the needle up and down,
and similar techniques. The manual stimulation of nee- 5. Needle sensation
dles is varied according to individual's requirement. Needle sensation or De Qi sensation is described as a
Other modalities applied to acupuncture points are feeling of soreness, swelling, heaviness and numbness
moxibustion, electro-acupuncture, laser acupuncture, experienced by the patients as the physician is needling a
ultrasound, and acupressure. point. It means "Qi arrival". Clinical practice has proven
In moxibustion, dried leaves of the Artemisia vulgaris, a close relationship between needle sensation and acu-
a species of chrysanthemum, are processed to give a puncture effect. The PSM is the phenomenon of propa-
similar consistency to that of cotton wool. These are gated sensation along the meridians when meridian
placed over acupuncture points and ignited. This can points are stimulated. The meridians were mapped out in
produce the effect of warming Qi, promoting blood cir- ancient times by subjective measures of needling sensa-
culation for prevention of diseases as well as are pre- tion along the superficial pathways of the body. This led
 69
Kim Yong-Suk, Japanese Acupuncture and Moxibustion, 2010; Vol.6(1): 65-69

to diagrammatic representations of the PSM lines like

traditional acupuncture charts. In many countries, the De
Qi sensation and PSM have been studied for the purpose
of understanding the meridian essence, increasing the
therapeutic effect and explaining the mechanism of acu-
puncture analgesia. But the property of De Qi sensation
and PSM, PSM lines, propagation rate and velocity rate
may have a wide range of variability from individual to
individual.

6. Duration and number of treatment sessions

The needle would be left for 15-20 minutes. It requires
approximately 10 sessions of treatments and 2 to 5 ses-
sions of treatments per week. It usually requires 3-4
sessions whether a patient is likely to respond to acu-
puncture and often more than this before any long-term
relief is obtained, with this varying according to the
condition being treated and a person's individual re-
sponse to acupuncture.

Conclusion

In Korea, LBP is generally treated by acupuncture.

The selection methods of acupuncture points include
local points and distal points as well as various points
according to the pattern identification. Also, traditional
acupuncture and neuro-anatomical and functional mus-
cle approaches are used in Korea, Traditional Korean
style acupuncture, Sa-Am acupuncture is popular and
recently bee venom therapy and pharmaco-puncture are
under active use and clinical study.

References
1) Kim CH, Kim YS, The management of myofascial
pain syndrome, JD publishing, 1996
2) Kim YS et al, Acupuncture and Moxibustion,
Jipmoondang, 2008
3) Kim YS. Acupuncture treatment for low back pain,
Clinical pain, 2001
4) Heo-Jun. Dongeuibogam, DS publishing, 1992
5) Adrian White, Medical Acupuncture, Churchill Liv-
ingstone, 1998
6) Kim KS, Acupuncture and Moxibustion Treatment,
Euisungdang, 2008
7) Lee SH et al, Saam Five Element Acupuncture,
Jipmoondang, 2009