Differentiation of pain into External and Internal types
Generally, treatment will be relatively easy and have relatively good therapeutic results if the pain is caused by External invasion. The principles of treatment in this case are to induce sweating so as to dispel External factors, promote Qi and Blood circulation and so sedate the pain.
If the pain is caused by Internal disorders, however, its treatment will be not so easy, since such disorders are often caused by factors such as emotional disturbance, bad diet, overstrain, and as a result the level of the sickness tends to be deeper than that caused by External invasion. Furthermore, if the Externally derived pathogenic factors are not expelled from the Exterior of the body; they will affect the Interior, giving rise to pain due to Interior disorders. The main principles of treatment in this instance are to harmonise the Zang-Fu organs, tonify the Deficiency, eliminate the Excess, circulate Qi and Blood and so stop the pain.
Cold and Heat
Cold and Heat are the two principles used to differentiate the nature of the pain (Table 5.2).
| Cold | Hot | |
|---|---|---|
| Hands and feet | cold | warm |
| Face | pale, or blue | red |
| Thirst | absent | present |
| Stiffness | yes | no |
| Urine | clear | turbid and deep yellow |
| Stool | mostly diarrhoea | mostly constipation |
| Tongue | pale tongue, white coating | red tongue, yellow coating |
| Pulse | slow | rapid |
If the pain is caused by Cold, it is usually a result of invasion of External Cold, or deficiency of Yang of the body, leading to hypo function of Internal Zang-Fu organs. Its manifestations include aversion to cold and chills, a pale complexion, cold hands and feet, a preference for warmth, an absence of thirst, clear urine, loose stools, a white or wet tongue coating, and a slow pulse. The main principles of treatment here are to dispel the Cold, warm the Yang and stop the pain; cupping and moxibustion are the best ways to relieve pain due to Cold.
If the pain is due to Heat, it is usually caused by invasion of External Heat, or conversion of Cold into Heat because of overlong Cold accumulation, or Excessive-Yang in the body, or the formation of Deficient-Heat resulting from Yin deficiency. Its manifestations are fever, aversion to heat, headache, thirst, deep yellow urine, a red face, warm hands and feet, restlessness, insomnia, constipation, a red tongue with yellow coating and a rapid pulse. The principles of treatment in this case are to clear the Heat, reduce the fever, cool the Blood and stop the pain.
Excess and Deficiency
Excess and Deficiency are the two principles that are used to generalise and distinguish the relative strength of the Defensive Qi and pathogenic factors (Table 5.3). Chapter 28 of the Plain questions states, ‘Excess is due to hyperactivity of the pathogenic factors, and Deficiency is due to over consumption of anti-pathogenic Qi’ (Yellow Emperor’s Classic of Internal Medicine: Simple Questions 1956, p. 62). This differentiation determines whether treatment aims at eliminating the pathogenic factors or tonifying the anti-pathogenic Qi.
| Excess | Deficiency | |
|---|---|---|
| Onset | acute | gradual |
| Duration | short | long |
| Location | fixed | moving |
| Response to touch | dislike of pressure and massage | preference for pressure and massage |
| Intensity | constant | intermittent |
| Pulse | excessive (full) | deficient (empty) |
Qi stagnation and Blood stagnation
The main pathogenic change in pain is stagnation of Qi and Blood. However, it is very important to find out whether the situation is predominantly one of Qi stagnation, or Blood stagnation, or Qi and Blood stagnation in equal proportion, or Qi stagnation occurs firstly, which causes Blood stagnation, or Blood stagnation occurs firstly, which causes Qi stagnation. This differentiation determines whether treatment is geared towards circulating the Qi, or circulating the Blood, or circulating both Qi and Blood together (Table 5.4).
| Qi stagnation | Blood stagnation | |
|---|---|---|
| Location | moving | fixed |
| Nature | distending | stabbing |
| Hardness | soft | hard |
| Fullness | yes | no |
| Time of attack | daytime | night-time |
| Emotion | aggravating pain | no direct influence |
| Tongue | not purplish | purplish |
| Pulse | wiry | choppy |
Damp and Dryness
Damp and Dryness are the two principles that are used to determine the condition of the Body Fluids (Table 5.5).
| Damp | Dryness | |
|---|---|---|
| Lassitude | yes | no |
| Heaviness | yes | no |
| Fullness | yes | no |
| Appetite | disturbed | not disturbed |
| Mouth | watery feeling | dry mouth |
| Nose | nasal discharge | dry nose |
| Throat | phlegm in the throat | dry throat |
| Stool | loose, or diarrhoea | hard, or constipation |
| Tongue | greasy, or wet coating | dry, or peeled coating |
| Pulse | slippery | thready, or choppy |
Damp, whether caused by External invasion or by disorder of Zang-Fu organs, is a pathogenic factor that easily blocks the channels, muscles and Zang-Fu organs, causing pain of the Excess type to occur. The main principles of treatment in this case are to eliminate Damp, activate the Spleen and Stomach, circulate Qi and Blood in the channels, relieve the blockage and so stop the pain.
Dryness is usually caused by External invasion, or deficiency of Yin due to Yang Excess, or excessive vomiting, diarrhoea, sweating or bleeding, or weakness of Zang-Fu organs. The pain caused by Dryness is usually due to under nourishment of the body, leading to contraction of the channels, Blood Vessels, muscles and Zang-Fu organs. The principles of treatment in this situation are to nourish Yin and Blood, promote the secretion of Body Fluids, moisten the Dryness and relieve spasm so as to stop the pain.
Wind, Cold, Damp and Heat
Where the pain is caused by Wind, Cold, Damp or Heat due to either External invasion or Internal disorders, there is often seen to be a predominance of one or two of these pathogenic factors. The differentiation of Wind, Cold, Damp and Heat is the way to distinguish whether treatment should be based on dispelling Wind, warming the Cold, eliminating Damp or clearing Heat.
Pain due to predominance of Wind
Pain due to invasion of External Wind usually is neither very heavy nor constant, but if the pain is caused by internal disorders, it tends to be more severe. Internal Wind can be caused by hyperactivity of Liver-Yang, formation of Wind resulting from Excessive-Heat, and formation of Wind due to deficiency of Blood. The principles of treatment for External Wind are to dispel the Wind and relieve External symptoms; for Internal disorders they are to calm the Liver, suppress the Wind, reduce the Heat and moisten the Blood Dryness.
The symptoms of Wind include the following:
If the pain is due to Internal Wind, it is usually caused by disorder of Liver, including:
Besides the above characteristics, other general symptoms of Wind can occur, such as:
• It is basically moving, wandering, erratic or migratory, coming and going like the wind. The pain is moving continuously – for instance, rheumatic pain occurs first in one joint and then in another, and a headache may occur on the left side one day and on the right the next.
• The type of symptom changes – for example, the quality of pain may sometimes be sharp, sometimes there is soreness, at another time there is numbness, later on there will be distending pain. Different sensations occur, or the sensibility varies.
• Symptoms are often abrupt, appear suddenly, and are acute or paroxysmal – for example, in migraine the headache is acute and very heavy. Wind symptoms can occur suddenly and disappear as rapidly as well.
• There is an aversion to wind and a slight fever where the pain is due to invasion of External Wind.
• Hyperactivity of Liver-Yang, manifesting as restlessness, severe headache, thirst, nervousness, a red tongue with yellow and dry coating and a wiry and rapid pulse.
• Accumulation of Excessive-Heat, manifesting as a high fever, headache, much thirst, restlessness, constipation, a deep red tongue with dry and yellow coating and a rapid and forceful pulse.
• Deficiency of Blood in the Liver, manifesting as slight pain with Intermittent occurrence, trembling of the head and limbs, tiredness, a pale complexion, dry eyes and skin, numbness in the limbs, scanty menstruation or amenorrhoea, a pale tongue with a thin coating and a thready and weak pulse.
• Fear of wind, fear of draught, aggravation when the weather is Windy
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