The Traditional Chinese Medical View of Pain

BillReddyHaving an undergrad in Aerospace Engineering was probably not the best preparation for acupuncture training.  I was taught there were universal “laws” that could be communicated through equations (F=MA, E=Mc2…), and the cosmos operates predictably within those parameters.  And then I was introduced to the concept of “Qi” (pronounced “chee”) that can’t exactly be measured, quantified, or mathematically modeled.  Some call it universal energy, scientists refer to it as biophotonics, others describe it as life force, and they’re all correct.  The Chinese actually have myriad types of Qi supporting the conceptual framework of Traditional Chinese Medicine (TCM).  There’s Gu Qi (aka “grain Qi”) which is the energy contained in food.  (A modern view would be fats, carbohydrates, protein, etc.)  Yuan Qi (“original Qi”) – is the energy you receive from your parents; today we refer to it as DNA.  Jing Qi (or “essence Qi”) is the actual genetic material that’s believed to be stored in the Kidneys.  Wei Qi (or “Defensive Qi”) is visualized as an energetic protective layer on the surface of our bodies, in our muscles and skin – today we would call that our immune system.  There are several others, but you get the point.

In TCM, Qi is considered the commander of Blood, and Blood follows the Qi.  If you have a contusion from an impact injury, a TCM practitioner would refer to that as “Blood stagnation” or Blood stasis.  The Qi fails to move the Blood, thus Qi is “blocked” by the Blood, leading to pain.  There’s a classic Chinese saying:  If there is free flow, there is no pain; If there is no free flow, there is pain.”  If you look at a hematoma, it’s blood that’s extravasated from broken blood vessels (and is no longer moving) and is painful to the touch.  Inserting filiform needles into precise acupoints will promote the free flow of Qi and Blood, and reduce pain.  There are very interesting scientific explanations for how this works, but they’re beyond the scope of this article.

From a western medical point of view, pain is categorized as nociceptive (that due to some kind of noxious insult to the tissue) which is further broken down into somatic and visceral, neuropathic (nerve related due to a lesion or disease in the somatosensory nervous system), and inflammatory.  Similarly, TCM practitioners have various categories of pain that include:

  1. Blood stasis/stagnation (fixed location, sharp/stabbing pain, impact injuries)
  2. Qi stagnation (repetitive motion injuries, pain with emotional basis, paroxysmal pain)
  3. Internal cold (types of arthritis that get worse with cold weather, menstrual cramps)
  4. Heat or Fire (rheumatoid arthritis with redness and warmth, infection, burning eyes, sore throat, etc.)
  5. Dampness (dull, aching pain, fatigue)
  6. Wind Invasion (pain that moves around, like fibromyalgia)

To further complicate matters, you can mix and match some of the above conditions, such as having wind-damp.  Patients can have both internal wind conditions, and those related to external wind (like the common cold, that is further differentiated into “wind cold” and “wind heat”).  This also applies to heat and cold:  you can have both internal and external “invasion” of heat or cold as well as an “excess” or “deficient” condition.  A simple example is a bladder infection; the TCM diagnosis is “damp heat of the bladder,” which corresponds to the symptoms – burning during urination, fever, and fatigue.  There are acupuncture points that “clear heat,” “subdue wind,” or “resolve dampness,” that are applied to various pain conditions.

Acupuncture/electroacupuncture, herbal medicine and moxibustion (burning moxa or mugwort/artimesia vulgaris), cupping, tui na (Chinese therapeutic massage) and gua sha (special scraping technique) are all effective techniques for resolving acute and chronic pain.  Here’s an example to put all this together:

A 55 year-old white male complained of right side facial pain for three months, and was diagnosed with trigeminal neuralgia.  He had severe burning/cutting pain ten to twenty times per day. Physical examination showed a sallow complexion, red tongue with yellow coating, and string-taut, rapid pulse.  His TCM diagnosis was heat of the three yang meridians attacking the head and qi stagnation. Excessive stomach fire combined with a qi stagnation can lead to facial pain. The point prescription was S 44, located on the foot.  Oblique insertion (45 degree angle) to a depth of approximately .5 to .8 inches with rotating manipulation of the needle caused a cool sensation going upward along the lateral aspect of his abdomen, stomach and cheek.  The pain was relieved immediately.  After three treatments, he was greatly improved, and was cured after seven treatments.

Chen, Y., Deng, L.  Essentials of Contemporary Chinese Acupuncturists’ Clinical Experiences. Beijing, China: Foreign Languages Press; 1989