Aetiology and pathology of pain (Treatment of Pain with Chinese Herbs and Acupuncture) Part 2


In the West, many people have a tendency to be too Yang, probably because of the following factors:

•    constitutional Yang excess or Yin deficiency from the parents

•    depletion of Liver-Yin and Kidney-Yin due to too much sex, overworking, too much excitement or too much stress

•    too much consumption of warming meats (e.g. pork, lamb, beef or rabbit)

•    too much drinking of milk and eating milk products, such as cheese

•    eating of too much sweet food (e.g. sweets, biscuits and chocolate)

•    too-frequent consumption of fiery food (e.g. too much application of pepper in the cooking)

•    too-frequent consumption of wine or other warming alcohol.

According to TCM theory, the constitution of the parents is largely passed on to the next generation. Constitutional Yang Excess leads to a predisposition to many diseases, and can also predispose to the invasion of External Heat, leading to the development of a mixture of Internal Heat and Exogenous Heat.

Alcohol that is warm or hot in nature can overload the Spleen and Stomach, leading to impedance of their functions of transportation and transformation, and a condition of Phlegm-Heat subsequently develops. Both white wine and red wine are equally warming by nature. However, drinking a certain amount of rice wine from time to time is healthy for the Qi, and specially the Blood, circulation—which is why there are a lot of herbal formulas to be taken at the beginning of winter that need to be decocted in a little wine, or soaked in wine. Rice wine, according to TCM, warms the interiors, dispels Cold, resolves stagnant Blood, smoothes the channels and circulates the collaterals. Many diet therapists also prescribe 10 to 20 ml of wine every day for people suffering from Qi and Yang deficiency. However, it is not advisable to give wine to people with Yin deficiency, Yang Excess, Damp-Heat accumulation, etc.

In addition, prolonged use of some pharmaceutical drugs, such as corticosteroids, may also deplete the Yin of the body, specially that of the Lung, Spleen, Liver and Kidney, leading to the concentration of Body Fluids, and the development of sticky Phlegm, which in turn would cause stagnation of Blood in the body.


An adequate amount of food is necessary to maintain health. Eating too little food may cause malnutrition, causing pain due to undernourishment of the body. Inadequate nourishment can be caused by dysfunction of the Spleen and Stomach; this may be the result of prolonged sickness, or of undereating because of financial shortage or being on a weight-reducing diet. Of course, if it is due to prolonged sickness, different methods should be used to treat the sickness. People who have a financial shortage may need to be helped or given advice to enable them to get enough food. However, nowadays more and more people in the West, specially women, desire to become or remain slim merely by following a strict diet, ignoring inherited differences. Of course, if the overweight were purely caused by overconsumption of food and drink then a fairly strict diet would be one of the best methods to reduce the weight. However, if the cause is Spleen-Qi deficiency, causing weakness of transportation and transformation, such diets can only aggravate this deficiency, as a Damp condition would constantly be precipitated, tending to increase the weight. Once Damp blocks the channels, joints, muscles and Zang-Fu organs, pain also occurs.


Unhygienic food includes not only poisonous food, food that has deteriorated and allergenic food, but also other contaminated food. Although it is not so difficult to avoid the first of these, it is not easy to avoid all contamination. Indeed, with industrial development, these days one can say that pollution exists everywhere—in the air, water and earth. Pollution can also be caused by nuclear weapon testing and use. So the food we eat naturally will sometimes be contaminated. Eating food with traces of contaminants disturbs the physiological functions of the Spleen and Stomach, leading to the development of Damp and Toxin accumulation, which may spread with the Qi and Blood circulation everywhere in the body, causing disorders in other Zang-Fu organs, and in the channels, joints and muscles. Generally speaking, food poisons and pollution first attack the Spleen and Stomach, and because the Spleen dominates the muscles and the limbs, pain from this cause usually occurs in the muscles and the limbs.

Drugs and hormones may be given to farm animals so as to promote their growth and shorten their developmental period. Eating the meat from such animals can, of course, disturb the person’s Spleen, Stomach and especially the Kidney. So this inhibits the physiological function of these organs in transportation and transformation of water, and as a consequence Damp-Phlegm develops. That is why people who frequently eat such meats tend to suffer from body swelling, overweight, body pain, and so on.


In addition to the emotions mentioned earlier, too much stress is also a causative factor in many diseases. In the industrialised countries many people work and live under enormous stress. This could include stress in any of the areas of social and work relationships, sexual relationships, family relationships, living conditions, finances, etc. According to TCM, stress may cause the following disorders:

•    stagnation of the Qi of the Heart, Lung, Liver and Spleen, eventually leading to stagnation of Blood, which is a common causative factor in various kinds of pain

•    depletion of the Qi and Yin, specially the Yin of the Liver and Kidney and the Qi of the Kidney.

This is the causative factor that can cause pain due to deficiency of Qi and Yin, leading to undernourishment of the body.


According to TCM theory, normal and regular physical exercises, combined with adequate rest, are very important for health, because they build up the constitution and help prevent disease. However, overstrain or excessive exercise, or indeed any excessive physical or mental activity, may deplete the energy generally, including the Qi, Blood, Yin and Yang, leading to weakening of the body’s Defensive Qi. This leaves the body more vulnerable to the invasion of Exogenous factors, and to dysfunction of the Zang-Fu organs. For instance, overstudy will deplete the energy in the brain. Since according to TCM the brain substance is formed from the Marrow, which derives from the Kidney-Essence, if there is mental exhaustion then the Kidney-Essence will in turn gradually be depleted, leading to lack of nourishment of the brain and lower back and symptoms such as headache and lower back pain follow. This is the reason why many intellectuals and students suffer from chronic headaches and lower back pain even if they are very conscientious about the degree of physical exertion and sexual activity they undertake. In addition, overheavy labour or making the same physical movements for long periods may lead to weakness and strain of the muscles and tendons in the locality; Qi and Blood circulation will also be impaired. For example, builders often suffer from low back pain due to frequent lifting of too-heavy loads, and players of some sports suffer overexertion of their elbows, causing ‘tennis elbow’.

The other extreme, of too little exertion, or living an excessively comfortable life with lack of physical exercise, can also be a causative factor in pain. According to TCM, this is because these habits may:

•    slow down the Qi and Blood circulation

•    weaken the functions of the Spleen and Stomach

•    soften the muscles, tendons and bones.

All these effects may eventually cause Qi and Blood to stagnate, leading to the development of Damp, weakness in the tendon and bones, etc., and finally the appearance of pain. This situation can be seen in, for example, some people on benefits and old people who may suffer from general body pain that is made worse by more rest and sleep. Once they are advised to take some moderate physical exercise (such as slow walking, running, swimming, as well as light physical work) their pain tends to improve. The reason for this is that once they start to exercise, their Qi and Blood circulation improves, which stimulates the physiological function of the Zang-Fu organs, and the pain then diminishes. Pain caused by too little exertion can typically be seen in patients who lie for too long in bed without enough movement; their limbs can become swollen and purplish in colour, and stiff and painful as muscular atrophy occurs, accompanied by stabbing or contracting pain. As soon as they begin to walk, or even do some physical movements while seated, the muscular atrophy gradually disappears, the stiff joints becomes freer and flexible, and the pain often vanishes by itself, or with the help of some simple treatment.


Traumatic injuries include gunshots, penetrating knife wounds, beating, falling, accidents, scalds, bums, frostbite, muscular sprain caused by sudden or frequent lifting or carrying too-heavy loads, bites by animals or insects, and so on.


Gunshots, incision by knives, beating, falling, accidents, etc., may directly result in muscular swelling, bleeding and haematoma, or joint dislocation or fracture involving the tendons, muscles and bones. There may also be damage to the internal Zang-Fu organs, and shock following on from sudden and severe pain.


Scalds and bums may result from industrial chemicals, boiling water or oil, or fires. If only the superficial layer of the skin is affected then tissue damage may be confined to redness, swelling, heat and blisters, and pain will be severe. However, if scalds or bums are severe, the tendons, deep muscles and even the bones can be damaged, the pain will not necessarily be worse: once the nervous tissue is burned as well, the patient will not feel any pain.

Frostbite may also cause damage of the skin, muscles and even tendons, leading to severe pain. This often occurs in locations where the winter temperatures are very low. Frostbite may affect only the limbs, or the body generally, often attacking those who tend to have deficiency of Yang Qi with poor Blood circulation. In consequence, the body is not sufficiently warmed and protected, and Qi and Blood stagnation develop, causing contraction of the tendons, blood vessels and muscles, and pain develops.


Muscle contraction or sprain due to sudden or quite frequent lifting or carrying too-heavy loads is also a common cause of pain, especially in the limbs and lower back. It leads to disorder of Qi and Blood circulation, damage to the tendons and muscles, abnormal joint movement, and hence to an alteration in the body’s physical structure; this causes Qi and Blood stagnation, and pain follows. The longer stagnation of Qi and Blood persists, the more complications are seen.


Operations can be also be causative factors in pain. In the West, operations are carried out in all hospital departments, most of the time they have positive results, but sometimes the operation is a failure, or may even aggravate the problem. In any event, the operation often necessitates cutting through tissues, so almost inevitably there is some bleeding during the operation, and some blood may be left behind in the body, leading to the development of Blood stagnation.

According to the TCM viewpoint, pain after an operation can be caused by:

•    disturbance of the Qi and Blood circulation

•    a deleterious effect on the physiological functions of the Zang-Fu organs

•    damage to or even complete blockage of channel circulation

•    the persistence of excessive amounts of blood in the body from bleeding during the operation, which then becomes stagnant

•    scar formation.

Pathology of pain

The main pathology: disorder of Qi and Blood circulation

From the above discussion, it can be clearly seen that there are various kinds of causative factors bringing about pain, but the main pathology is either due to blockage and obstruction, or to deficiency. The basic statement about pain, formed almost two thousand years ago, is: if there is free flow, there is no pain; however, if there is a disruption of this free flow then pain occurs. Here ‘free flow’ refers to the free flow of Qi and Blood. The circulation of Qi and Blood in the body should be constant, just like the continual courses of the sun and moon. According to TCM, this circulation depends upon the correct, interdependent functioning of the Ziang-Fu organs, including the Lung, Heart, Liver and Kidney. The Lung disperses Qi to every part of the body, and also connects to the blood vessels, thus keeping the Qi and Blood circulating freely in the body. The Heart is in charge of promoting the circulation of Blcxxi in their Vessels. The Liver is in charge of keeping the Qi circulating freely, which in turn keeps the Blood circulating freely. The circulation of Liver-Qi also promotes the digestive functions of the Spleen and Stomach, and this keeps the water passages clear, so preventing the accumulation of Damp in the body. The Kidney is the root of Yang Qi, which warms the Qi and Blood to maintain their free circulation. Moreover, the Kidney also produces Yuan Qi or Original Qi, which is the root energy for all the Zang-Fu organs. Where there is dysfunction of any of these organs, due to the various kinds of pathogenic factors discussed earlier, there will be retardation of the Qi and Blood circulation, eventually causing pain.

Mechanisms in the disorder of Qi and Blood circulation


The mechanisms causation of the disorder of Qi and Blood circulation vary according to the nature of the pathogenic factor.

When Wind, Heat and Fire, the Yang pathogenic factors, invade the body they accelerate the circulation of Qi and Blood creating an abnormal circulation and local congestion of Qi and Blood. This may cause blockage in the Qi and Blood circulation, and so pain develops.

Cold, a Yin pathogenic factor, may damage the Yang of the body, so that Excess of Yin and Cold develop in the body. Cold is characterised by Stagnation and contraction, so when Cold and Excess Cold invade the body there is a decreased Qi and Blood circulation and also spasm of the channels and Blood Vessels. This slows the circulation of Qi and Blood, and pain eventually results.

Damp is characterised by stagnation and viscosity. The presence of Damp, whether caused by Exogenous invasion or by dysfunction of the Internal Zang-Fu organs, may slow the Qi and Blood circulation because the channels and Blood Vessels become narrowed, or there may even be Qi and Blood stagnation.

Dryness may damage the Lung causing failure of the Lung to disperse the Qi and Body Fluids. As a consequence the channels and blood vessels are not properly nourished, the Qi and Blood circulation slows, and so pain follows.


Emotional disorder may cause direct dysfunction in the Zang-Fu organs, disturbing in turn the Qi and Blood circulation, so that the Qi and Blood stagnate, and pain follows.

Excessive grief may slow the Qi circulation in the Lung, so the Lung cannot properly disperse the Qi and Body Fluids; this causes both stagnation of Qi and Blood and formation of Damp, and pain develops.

Too much anger, frustration, anxiety and stress may prevent the Liver from maintaining a free Qi circulation through the body, and stagnation of Qi as well as of Blood occur, as a consequence. In addition, Qi stagnation in the Liver may cause stagnation of Qi in other organs such as Lung, Heart and Spleen, leading to Blood stagnation and accumulation of Damp as well. AU these situations bring about pain.

Too much meditation may cause the Qi in the Spleen to stagnate, disturbing the transportational and transformative functions of the organ, and so Damp accumulates, or Qi and Blood become deficient, any of which which may result in pain.

Fear and fright may impair the Kidney, leading to sinking of the Qi there; as a consequence the original Qi becomes weak, so it cannot properly promote Qi and Blood circulation in the body, and the Qi and Blood circulation slows.

TCM also holds that the Heart stores the Mind, and a person’s emotional states are a reflection of mental stimulation caused by the External environment, thus the Heart will be affected by all kinds of emotional activities.


Bad diet may disrupt the ascending and descending of Qi in the Middle Jiao, or Middle Burner. This can lead to a slowing down in the Qi circulation, thus Qi stagnates, and pain will be the result. A bad diet may also make the Qi and Blood deficient, or cause Damp to develop in the body. The former may cause undernourishment of the Zang-Fu organs, channels, muscles, tendons, bones and Blood Vessels, and as a result pain of a deficient type may occur. The latter may cause the channels and Blood Vessels to narrow, leading in turn to stagnation of the Qi and Blood. Physic trauma and bites by animals may cause direct injury to the muscles, tendons, bones, channels, and even Internal Zang-Fu organs, also leading to stagnation of Qi and Blood, or damage to body tissues.


Overstrain, overindulgence in sex and excessive study may all exhaust the Qi and Blood, leading to their deficiency; thus pain occurs caused by undernourishment of the body. Too little physical exertion and living too luxuriously may also slow the Qi and Blood circulation, leading to pain resulting from a gradual stagnation of the Qi and Blood.

An explanation for pain resulting from disordered Qi and Blood circulation

It should now be clear that pain is mainly a result of disturbances in the Qi and Blood circulation, and may be caused by stagnation of Qi and Blood, or deficiency of Qi and Blood—but why does this disturbance of Qi and Blood flow cause pain? Which organ is in charge of pain? The reason was stated clearly, two thousand years ago, in the Simple question: ‘all kinds of pain, itching and sores are due to Heart disorder’ (Yellow Emperor’s Classic of Internal Medicine: Simple Questions 1956, p. 190). Why did the ancient texts attribute pain to the Heart? This can be explained as follows.


The Heart promotes normal Blood circulation in the Zang-Fu organs, Blood Vessels, channels and the tissues. Where the Qi and Blood circulation are disordered, a disturbed feedback will be sent to the Heart. In other words, one can say that the Heart is constantly sensitive to the condition of the Qi and Blood circulation.


Modem medicine considers that pain is the body’s way of responding to damaged tissue. For instance, when a bone breaks, nerves send pain messages through the spinal cord to the brain, where they are interpreted. TTie TCM viewpoint is that pain is the reflection of the Mind (Shen) to the stimulation from the environment, and the activity of the Mind is considered to be the result of physiological function of the Heart. When the Qi and Blood circulation are disturbed, this situation will be conveyed to the Heart, and the pain that follows is a response from the Mind to this situation. According to this viewpoint, pain is closely related to the Heart.


How a person responds to pain is determined by many factors, of which emotional states are very important. For example, depression seems to increase a person’s perception of pain and to decrease the ability to cope with both the pain and the treatment. Thus treating the depression treats the pain as well. If pain is not adequately treated, then pain impulses are more readily transmitted to the brain. Therefore, in TCM it is considered that it is more effective to prevent pain than to treat it after it occurs.

In terms of the relationship between the emotions, the interior organs and the Heart, TCM holds that the Heart dominates the emotions and is the root controller of other Zang-Fu organs. For instance, Ling Shu (1963) states: ‘the Heart is the root controller for five Zang organs and six Fu organs, therefore the Heart will be disturbed by grief and meditation’ (p. 69). The same topic points out that: ‘the Heart has the responsibility to all kinds of emotional stimulation’ (p. 23). AU these statements clearly mention that the Heart can be influenced by the dysfunction of other Zang-Fu organs as well the difference emotions, and this may lead to the development of pain.

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