Articles - On Pain
Chinese medicine offers a quite sophisticated classification of pain according to five parameters:
In general, a pain or ache that is dull in nature indicates a Deficiency, whereas a sharp, severe pain is due to a Fullness. There are many different types of pain:
This is a dull ache that usually occurs in the four limbs or trunk. It is usually due to a Deficiency condition.
Pain with a sensation of heaviness
This is also a dull ache but also accompanied by a sensation of heaviness: this usually occurs in the limbs, head or the whole body. It is typical of Dampness or Phlegm.
This is a pain accompanied by a sensation of distension (bloating). Chinese patients often actually say they have a "zhang tong", i.e. a distending pain. No Western patient will ever use this actual expression but this type of pain is very common in Western patients. They will usually say that they have a pain with "bloating": very often they will not mention the bloating unless asked. It is therefore very important to elicit the exact symptoms and character of pain with a proper interrogation. A distending pain is typical of Qi stagnation, especially of the Liver. However, it should be noted that other organs may suffer from Qi stagnation too, notably the Stomach, Spleen and Lungs. Thus, a distending pain in the lower abdomen usually indicates Liver- or Spleen-Qi stagnation, in the hypochondrium Liver-Qi stagnation, in the epigastrium Stomach-Qi stagnation, and in the chest Lung-Qi stagnation (although this last one may also be due to the Liver). "Distension" is both a symptom and a sign, i.e. it indicates the subjective bloating sensation of the patient, but the bloating may also be felt on palpation when the area feels distended like a drum (this is more easily felt in the epigastrium or lower abdomen). In gynaecology, a distending pain is seen in dysmenorrhoea from Liver-Qi stagnation or pre-menstrual breast pain and distension also from Liver-Qi stagnation. Pain with distension is usually of a Full nature. Distending pain is treated with warm-pungent herbs that move Qi.
Pain with a sensation of fullness
This is an ache or pain accompanied by a sensation of fullness: it usually occurs only in the epigastrium or lower abdomen. A sensation of fullness should be distinguished from distension (bloating). With distension, the patient feels bloated (like a drum) and the area feels like a drum on palpation; with fullness, the patient feels very full as one feels after a very heavy meal perhaps also with a slight nausea, and the area feels hard rather than distended on palpation. The distension can actually be seen (and palpated), fullness cannot be seen but can be felt on palpation. Typically, pain with a sensation of fullness indicates retention of food and is related to the Stomach and Spleen. Pain with fullness is usually of a Full nature. Fullness is treated with digestive herbs.
This is a sharp pain of a colicky, spastic, cramping nature: it occurs in the epigastrium or, more usually, lower abdomen. This pain usually indicates Cold in the Intestines, but it may also be due to Blood stasis. In gynaecology, this pain is seen in dysmenorrhoea from Cold in the Uterus. Colicky pain is of a Full nature.
This is a sharp pain accompanied by a sensation of spasm: it usually occurs in the limbs and is related to the sinews and therefore the Liver. It may be due to Liver Blood deficiency in conjunction with Liver-Qi stagnation or Liver-Yang rising. In the latter instance, it may also occur on the head. Spastic pain is either of a Full nature or a combination of Deficiency (of Liver-Blood) and Fullness (stagnation of Qi).
Pain with a distressing feeling
This indicates a pain or ache, usually in the epigastrium or chest, accompanied by a restless, undefined, anxious feeling and perhaps palpitations. It is usually due to retention of Phlegm in the epigastrium affecting the Heart. It is also a typical symptom of rebellious Qi in the Penetrating Vessel (see the explanation of the formula Penetrating Vessel in the Women's Treasure manual). This type of pain is usually due to a combination of Deficiency (of the Liver, Spleen or Kidneys) and
a Fullness (rebellious Qi). In gynaecology, this type of pain is seen in menopausal problems.
Pain with a sensation of stuffiness
This is usually a dull ache accompanied by a feeling of "stuffiness": it usually occurs in the epigastrium or chest. "Stuffiness" may be defined as a mild feeling of fullness with an important objective difference on palpation: fullness may be felt on palpation as hardness, while with stuffiness the epigastrium feels soft on palpation. A feeling of ache and stuffiness is usually due to a combination of Deficiency (of the Spleen) and Fullness (Phlegm).
This is a sharp pain accompanied by a feeling as if something was pushing outwards: it occurs in the hypochondrium or epigastrium and is due to severe Qi stagnation.
This is a sharp pain accompanied by a sensation as if the skin were being pulled: it occurs only on the head and is due to Liver-Wind. It is of a Full nature (although Liver-Wind itself may derive from a Blood or Yin deficiency).
This is a very sharp pain that feels like a knife. It usually occurs in the lower abdomen and is due to Blood stasis. It is definitely Full in nature.
This pain is usually severe and it feels as if there was a throbbing or pulsation. It usually occurs on the head from Liver-Yang rising. It is of a full nature (although Liver-Yang may rise from Blood or Yin deficiency).
This is a severe pain that feels like the point of a knife, a nail or a screw: it is fixed in its location. It is due to Blood stasis and Full in nature. It may occur in the lower abdomen, epigastrium, hypochondrium, chest or head. In gynaecology, it is seen in dysmenorrhoea from Blood stasis.
Time of Pain
Daytime pain is usually due to a dysfunction of Qi or Blood.
Pain at night is due to a dysfunction of Yin or to Blood stasis.
Intermittent pain is due to either Qi deficiency or Qi stagnation.
Continuous pain is due to Blood stasis.
Pain after eating indicates a Full condition (which may be stagnation of Qi, retention of food or Blood stasis).
Pain before eating may indicate a deficiency of the Stomach and Spleen.
Pain after defecation is due to a Deficiency, usually of the Spleen.
Pain before defecation and alleviated after it indicates a Full condition, usually retention of food.
Area of Pain
Localized pain is usually due to Phlegm or Blood stasis.
Moving pain is usually due to Qi stagnation (unless it is due to Wind in the joints).
Response of Pain to Pressure and Temperature
Aggravated by pressure: this indicates a Full condition (which may be Dampness, Phlegm, Qi stagnation, Blood stasis or retention of food).
Ameliorated by pressure: this indicates a Deficiency condition.
Alleviated by warmth: if a pain is alleviated by the application of heat (such as a hot-water bottle), it indicates that it is due to Cold or Yang deficiency. Similarly if the pain is aggravated by cold.
Alleviated by cold: if a pain is alleviated by cold (which could be the application or cold or the consumption of cold foods) it indicates that it is due to Heat. Similarly if the pain is aggravated by heat.
Zangfu versus Channel Pain
Besides the above differentiation, another important one is that between pain due to involvement of the Zangfu with their respective channels and that due to involvement of the channels only. Most pains due to sprains, traumas or Bi syndrome (due to Wind, Cold or Dampness) involve the channels only, whereas most other pains involve the Zangfu and their respective channels. For example, a shoulder or elbow pain along the Large Intestine channel usually involves the channel only and does not derive from a Zangfu involvement; whereas an abdominal pain deriving from constipation or diarrhoea clearly shows the involvement of the Large Intestine. Of course, a channel pain may derive from an internal Zangfu disharmony but it is rare for that to manifest in the channel only without Zangfu symptoms. An important and common exception to this are acute diseases from invasion of exterior pathogenic factors at their beginning stage. In such cases, the channels only are involved and they may also cause symptoms resembling an involvement of a Zangfu. For example, the cough deriving from an invasion of Wind-Heat at the Wei portion of the Lungs in its very beginning stage is due to a Lung-channel involvement and does not derive from a Lung-organ affliction.
Thus, the two most important diagnostic factors when confronted with pain are:
1) whether the pain derives from a Deficiency or a Fullness;
2) whether the pain involves the Zangfu and channels or the channels only.
Three Treasures Remedies
The Three Treasures remedies can treat a variety of pains of internal or external origin, Full or Empty and with Zangfu or channel involvement. They can also treat pains of various different organs. We can therefore classify the remedies according to the following parameters:
- Channel pain
- Zangfu pain
- Deficiency pain
- Fullness pain
- Pain according to various pathogenic factors
- Remedies for pain classified according to area
The Three Treasures remedies treating channel pain are:
- Brocade Sinews
- Nourish the Root and Clear Wind
- Red Stirring (under certain circumstances)
- Welcome Fragrance
- Bend Bamboo
- Clear Yang
- Expel Wind-Cold
- Expel Wind-Heat
Brocade Sinews treats channel pain from Bi syndrome occurring against a background of Blood deficiency. This would be a dull ache occurring in the limbs. It would be aggravated by cold and alleviated by warmth and rest.
Nourish the Root and Clear Wind treats channel pain from Bi syndrome occurring against a background of Yin deficiency, mostly in the elderly.
Red Stirring, a remedy for Blood stasis in the Upper Burner, may treat channel pain in the upper body deriving from long-term Blood stasis in the channels. For example, it may be used to treat a chronic, persistent shoulder pain occurring against a background of Blood stasis in the shoulder channels. This pain would be severe and there would be marked rigidity of the shoulder joint. The tongue might be purple in the front.
Welcome Fragrance treats facial pain deriving from sinusitis occurring against a background of Dampness and/or Fire-Poison (Toxic Heat) in the sinuses.
Bend Bamboo treats headache deriving from Liver-Yang rising: this may be on the temples, the sides of the head or behind the eyes. It is throbbing in nature.
Clear Yang treats headache deriving from Liver-Yang rising and Phlegm.
Expel Wind-Cold treats acute occipital headache deriving from an invasion of Wind-Cold.
Expel Wind-Heat treats acute occipital headache deriving from an invasion of Wind-Heat.
There are many Three Treasures remedies to treat Zangfu pain and we can classify them according to the Zangfu treated:
Bend Bamboo, Break into a Smile, Brighten the Eyes, Drain Fire, Release Constraint, Smooth Passage, Stir Field of Elixir
Stomach and Spleen
Central Mansion, Children's Herbal Sentinel, Drain Fields, Ease the Muscles, Jade Spring, Smooth Passage, Soothe the Centre.
Kidneys and Bladder
Separate Clear and Turbid, Clear the Root
Smooth Passage, Drain Fields, Ease the Muscles
The following is a brief description of the application of each of the above remedies for pain.
This is a variation of a well-known formula to stop pain from Blood stasis of the Heart causing chest pain. This pain would be stabbing and quite severe and it is of a Full nature (although Heart-Blood stasis may occur against a background of Heart-Yang deficiency).
This remedy is for headache deriving from Liver-Yang rising occurring against a background of Liver-Blood deficiency. It may be used for both chronic or acute pain (by increasing the daily dosage in case of acute pain).
Break into a Smile
This is for abdominal pain deriving from Liver-Qi stagnation. It is a variation of Chai Hu Shu Gan Tang which is the prescription for this type of pain. This would be the typical distending pain (see above).
Brighten the Eyes
This is for a dull headache on the forehead or vertex deriving from Liver-Blood deficiency. It is therefore for a Deficiency type of pain.
This is for headache deriving from Liver-Fire. This would definitely be a Full type of pain and it would be severe and throbbing in character. It is, however, also for pain in the Lower Burner, such as pain from cystitis or urethritis.
This is for pain deriving from Liver-Qi stagnation: it is for a Full type of pain when the pulse is Wiry in all positions. This pain could be in the hypochondrium or epigastrium.
This is for abdominal pain from Liver-Qi stagnation and Spleen-Qi deficiency. It is therefore for a mixed Fullness-Deficiency pain.
Stir Field of Elixir
This is for lower abdominal pain from Blood stasis (Full type of pain).
Stomach and Spleen
This is for a dull epigastric pain deriving from Spleen-Qi and Stomach-Yin deficiency: it is a Deficiency-type pain.
Children's Herbal Sentinel
This remedy can be used for epigastric or abdominal pain in children deriving from retention of food. This is for mixed Deficiency-Fullness pain (deficiency of Spleen-Qi and retention of Food).
This is for epigastric pain deriving from Stomach-Yin deficiency. It is a Deficiency pain and is therefore dull in nature and alleviated by intake of food.
This is for abdominal pain deriving from Liver-Qi stagnation and Spleen-Qi deficiency: it is therefore both from a Fullness and a Deficiency. It is specific for irritable bowel pain.
Soothe the Centre
This is for epigastric pain deriving from Spleen-Qi deficiency, Dampness and Qi stagnation: it is therefore a mixed Fullness-Deficiency pain.
This is for epigastric pain deriving from Dampness. It is pain of a Full nature (when the pulse is Slippery and Full). It may also be used for muscle ache in post-viral fatigue syndrome.
Ease the Muscles
This is for epigastric pain deriving from Damp-Heat in the Stomach. It is pain of a Full nature. It may also be used for muscle ache in post-viral fatigue syndrome.
Kidneys and Bladder
Separate Clear and Turbid
This is for urinary pain deriving from Dampness in the urinary passages and Qi deficiency. It is a mixed Fullness-Deficiency pain.
Clear the Root
This is for urinary or prostatic pain deriving from Damp-Heat and Blood stasis. It is definitely of a Full nature.
This is for lower abdominal pain deriving from Liver-Qi stagnation and Spleen Qi deficiency (see above).
This is for abdominal pain deriving from Dampness. It is pain of a Full nature (when the pulse is Slippery and Full). It may also be used for muscle ache in post-viral fatigue syndrome.
Ease the Muscles
This is for abdominal pain deriving from Damp-Heat in the Stomach. It is pain of a Full nature. It may also be used for muscle ache in post-viral fatigue syndrome.
The most important sign to differentiate a Deficiency from a Fullness pain is the pulse: in Deficiency it will be generally Weak, Fine or Choppy while in Fullness, it will be generally Full, Slippery or Wiry. Although chronic conditions are usually characterized by a Deficiency pain, it is not always so. For example, in many cases of post-viral fatigue syndrome, the condition is primarily Full even after many years. Apart from the pulse, Deficiency pain is characterized by a dull ache while Full pain is severe.
The remedies for Deficiency pain are:
- Brighten the Eyes (headache and eye ache)
- Central Mansion (epigastric pain)
- Jade Spring (epigastric pain)
The pain deriving from Fullness is severe and may be acute or chronic. In acute cases, the pain must be from Fullness as a Deficiency cannot cause an acute pain. For example, if a patient suddenly suffers from a severe, colicky pain due to a renal stone, this is certainly due to a Fullness.
The remedies for Fullness pain are:
- Red Stirring (chest pain)
- Break into a Smile (abdominal pain)
- Drain Fire (headache or urinary pain)
- Release Constraint (epigastric or hypochondriac pain)
- Stir Field of Elixir (lower abdominal pain, dysmenorrhoea)
- Drain Fields (muscle ache, epigastric pain)
- Ease the Muscles (muscle ache, epigastric pain)
- Clear the Root (urinary or prostatic pain)
- Welcome Fragrance (sinus pain)
Many patients suffer from a mixed Deficiency-Fullness pain. This is common especially in digestive disorders. For example, a deficiency of Spleen-Qi and stagnation of Liver-Qi often cause epigastric or abdominal pain. In such cases the patient may suffer from a dull, Deficiency-type pain at certain times and a severe, colicky, Full-type pain at others. Another example is that of headaches. Many chronic headaches or migraine are due to Liver-Blood deficiency and Liver-Yang rising: in these cases, the liver-Blood deficiency may cause dull headaches on the forehead, while Liver-Yang rising will cause a severe, throbbing headache on the temples.
The remedies for mixed Deficiency-Fullness pain are:
- Bend Bamboo (headache and migraine)
- Smooth Passage (abdominal pain, irritable bowel)
- Children's Herbal Sentinel (epigastric or abdominal pain)
- Soothe the Centre (epigastric pain)
- Separate Clear and Turbid (urinary pain)
Pain according to Various Pathogenic Factors
Pathogenic factors are a major cause of pain which is by definition of a Full nature. The main pathogenic factors that cause pain (and the relevant remedies) are:
- Dampness (Ease the Muscles, Drain Fields, Soothe the Centre, Smooth Passage, Separate Clear and Turbid, Clear the Root, Welcome Fragrance)
- Stagnation of Qi (Soothe the Centre, Smooth Passage, Release Constraint, Break into a Smile)
- Stasis of Blood (Red Stirring, Stir Field of Elixir)
- Liver-Yang rising (Bend Bamboo)
- Fire-Poison, also called Toxic Heat (Welcome Fragrance, Clear the Root)
- Liver-Fire (Drain Fire)
Remedies for Pain Classified according to Area
It may be useful to classify the Three Treasures remedies according to area of pain treated, irrespective of whether it is a Fullness or a Deficiency type of pain.
Bend Bamboo, Welcome Fragrance, Brighten the Eyes, Clear Yang, Drain Fire, Expel Wind-Cold, Expel Wind-Heat
Soothe the Centre, Release Constraint, Break into a Smile, Jade Spring, Central Mansion, Children's Herbal Sentinel, Drain Fields, Ease the Muscles
Break into a Smile, Release Constraint
Smooth Passage, Break into a Smile, Children's Herbal Sentinel, Stir Filed of Elixir
Separate Clear and Turbid, Drain Fire, Clear the Root.
Brocade Sinews, Nourish the Root and Clear Wind
Women's Treasure Remedies
The classification of Women's Treasure remedies for pain is easier since the main remedies for pain in this line are those for painful periods which are:
Drain Redness (Damp-Heat and Blood Heat)
Free Flow (Liver-Qi stagnation)
Stir Field of Elixir (Liver-Blood stasis)
Warm the Menses (Cold in the Uterus)
Warm the Palace (Cold in the Uterus with Kidney-Yang and Blood deficiency)
The Women's Treasure manual explains the application of these remedies and the type of menstrual pain treated by each. There are, however, a few other remedies in this line which may also treat pain and they are described below.
Drain the Jade Valley
This remedy drains Damp-Heat from the Lower Burner and may be used for vaginal pain or pain on intercourse in the presence of Damp-Heat.
This remedy can treat abdominal, epigastric or chest pain deriving from rebellious Qi in the Penetrating Vessel (Chong Mai).
Clear the Moon
This remedy can treat breast pain deriving from Qi stagnation and Phlegm.
This remedy can treat pre-menstrual abdominal pain occurring against a background of Liver-Qi stagnation and Liver-Blood deficiency.
This remedy can treat breast pain deriving from Liver-Qi stagnation.