By Mr Ahmed-Ramadan Sadek, Neurosurgeon · Last reviewed October 2026 · 6 min read

What is traditional Chinese medicine?

Traditional Chinese medicine (TCM) is a system of health care that has developed in China over many centuries. In the UK, people with back pain usually meet it in one of four forms: herbal remedies (teas, powders, pills or plasters), cupping, and the movement practices of tai chi and qigong. Acupuncture is also part of TCM but is not covered here. Because these are very different treatments, we look at each in turn.

Tai chi and qigong

Tai chi is a slow, flowing sequence of movements combined with steady breathing and attention to posture. Qigong covers a family of simpler routines, such as Baduanjin (“eight pieces of brocade”), that also mix gentle movement, breathing and relaxation.

One of the better trials, carried out in Sydney, randomised 160 adults with persistent low back pain to 18 group tai chi sessions over 10 weeks or to a waiting list. The tai chi group reported less bothersome symptoms (1.7 points better on a 0 to 10 scale), lower pain intensity and less disability.^[1] A 2026 network meta-analysis of 24 trials (2,067 people) compared six Chinese exercise styles, including tai chi and several types of qigong. It found that adding these exercises to conventional rehabilitation tended to improve pain and function more than conventional treatment alone, but the authors rated the overall quality of evidence as moderate to low.^[2]

The World Health Organization’s 2023 guideline on chronic low back pain supports structured exercise programmes as part of care.^[3] Tai chi and qigong are one way of getting that exercise, and suit people who prefer slow movement. The best exercise for back pain is usually the one you will keep doing.

Tips for tai chi and qigong

• Look for a beginners’ class and tell the instructor about your back.
• The Sydney trial used 18 sessions over 10 weeks, so give it at least a couple of months before judging.
• Deep knee bends and low stances can be scaled back. You can do much of a routine with a higher stance or even seated.
• Mild muscle soreness after a new activity is normal. Sharp or spreading pain is not, and is a reason to stop and seek advice.

Cupping

In cupping, glass, plastic or silicone cups are placed on the skin and suction is created, either with heat or a pump. Dry cupping uses suction alone. Wet cupping also involves making small cuts in the skin so that a little blood is drawn out. Cupping usually leaves round marks that fade over a week or two.

A 2024 systematic review pooled 11 trials (921 people) and found that cupping improved pain at the end of a course of treatment (2 to 8 weeks), but no lasting improvement in pain was seen at one month or at three to six months. Results varied widely between studies, which the authors said raised concerns about how certain the findings are.^[4] In short, some people may get short-term relief, but cupping is not a long-term solution on its own.

If you choose cupping, use a practitioner who works in clean premises with single-use or properly sterilised equipment, particularly for wet cupping, which breaks the skin. Be cautious if you take blood thinners, bruise easily, have fragile skin or have a bleeding disorder, and discuss it with your doctor first.

Chinese herbal medicine

TCM herbal prescriptions usually combine several ingredients into a formula tailored to the individual, which makes them hard to study.

The Cochrane review of herbal medicine for low back pain included 14 randomised trials. The herbs with the most supportive evidence were cayenne pepper (capsicum) cream or plaster, devil’s claw and white willow bark. None of these is a Chinese herbal formula, and even for these the evidence was of moderate quality at best, with poor reporting in many trials.^[5] The WHO guideline later concluded that topical cayenne pepper may be offered, but that devil’s claw and white willow should not be used as part of routine care for chronic low back pain.^[3]

At present there is no reliable evidence that taking Chinese herbal formulas by mouth helps back pain. Any possible benefit has to be weighed against real safety concerns.

Safety and regulation in the UK

In the UK, herbal medicines are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA). A product with a THR (traditional herbal registration) number or a PL (product licence) number on the pack has been assessed for safety, quality and patient information. A THR is based on traditional use, not proof that the product works.^[6] Many remedies bought online, imported informally or made up by practitioners have no such assessment.

The MHRA has highlighted several concerns with unlicensed or unregulated herbal products: variable quality, and deliberate adulteration with heavy metals, arsenic and prescription-only medicines, including drugs that have been banned for safety reasons.^[6] It has also warned that it continues to find products, particularly traditional Chinese medicines, containing Aristolochia (aristolochic acids). These have historically been used for conditions such as arthritis and rheumatism. Aristolochia can cause kidney scarring leading to kidney failure, and some patients have developed cancers of the urinary tract. Its use in herbal medicines has been banned in the UK since 1999, yet it has often been missing from the ingredient list.^[7]

Practical safety checklist

• Prefer products with a THR or PL number on the packaging.
• Avoid remedies without a clear ingredient list in English.
• Do not stop or reduce prescribed medicines because a practitioner suggests it.
• Be especially cautious if you are pregnant, breastfeeding, have kidney or liver disease, or take blood thinners.
• Stop the product and seek medical advice if you develop yellowing of the skin or eyes, dark urine, unusual bruising or bleeding, or feel generally unwell.
• Suspected side effects can be reported to the MHRA through the Yellow Card scheme.

How TCM fits with mainstream care

Tai chi and qigong are reasonable ways to keep active. Cupping may give short-term relief. Chinese herbal medicine has the weakest evidence and the most safety concerns. None of these should replace an assessment of new or worsening pain, particularly if you have leg symptoms such as sciatica.

These can be signs of cauda equina syndrome or another serious condition that needs prompt assessment.

References

1. Hall AM, Maher CG, Lam P, Ferreira M, Latimer J. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res (Hoboken). 2011;63(11):1576-83. Link
2. Huang M, Liu H, Zeng L, Chen J. Comparison of the efficacy of different traditional Chinese exercises in the treatment of chronic non-specific low back pain: a Bayesian network meta-analysis. J Pain Res. 2026;19:590557. Link
3. World Health Organization. Summary: WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: WHO; 2023. Link
4. Zhang Z, Pasapula M, Wang Z, Edwards K, Norrish A. The effectiveness of cupping therapy on low back pain: a systematic review and meta-analysis of randomized control trials. Complement Ther Med. 2024;80:103013. Link
5. Oltean H, Robbins C, van Tulder MW, Berman BM, Bombardier C, Gagnier JJ. Herbal medicine for low-back pain. Cochrane Database Syst Rev. 2014;(12):CD004504. Link
6. Medicines and Healthcare products Regulatory Agency. Herbal products: safety update. Drug Safety Update. August 2009. Link
7. Medicines and Healthcare products Regulatory Agency. Illegal herbal remedies containing Aristolochia: vigilance needed. Drug Safety Update. 2007;1(4):8a. Link
8. Tan CSS, Lee SWH. Warfarin and food, herbal or dietary supplement interactions: a systematic review. Br J Clin Pharmacol. 2021;87(2):352-374. Link

This guide is general information and is not a substitute for advice about your own situation. Please speak to your GP, physiotherapist or specialist before starting a new treatment.