Wind, Cold, Damp and Heat
Where the pain is caused by Wind, Cold, Damp or Heat due to either Exogenous 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 Exogenous Wind usually is not 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 VWnd resulting from Excessive-Heat, and formation of Wind due to deficiency of Blood. The principles of treatment for Exogenous Wnd are to dispel the Mnd 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.
• 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 exogenous Wind.
If the pain is due to Internal Wind resulting from hyperactivity of Liver-Yang, there is restlessness, headache, thirst, nervousness, a red tongue with yellow coating and a wiry and rapid pulse. If the pain is due to accumulation of Excessive-Heat, there is a high fever, headache, much thirst, restlessness, constipation, a deep red tongue with no coating and a rapid and forceful pulse. In case the pain is due to deficiency of Blood in the Liver, there is 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.
Besides the above characteristics, other general symptoms of Wind can occur, such as:
• fear of Wind, fear of draught, aggravation when the weather is Windy
• sweating, which is due to opening of the pores by the invasion of the Wind factor.
PAIN DUE TO PREDOMINANCE OF COLD
Pain can be caused by either invasion of Exogenous Cold or deficiency of Yang Qi in the body; the latter situation is usually a deficiency of Yang of the Heart, Spleen or Kidney. If there is Exogenous Cold invasion then the principles of treatment are to dispel the Cold and relieve the External symptoms; for Internal disorders treatment aims to warm the Interior, strengthen the Heart, activate the Spleen and tonify the Kidney.
The symptoms of Cold include the following.
• Unlike pain that is due to Wind, Coldness freezes Qi and Blood locally, so the pain is fixed, seldom moves and is well localised.
• Since Cold is contracting and blocking, it slows down any movement. If the pain is caused by Cold, then it is rather severe, and very sharp or stabbing as the Cold causes Blood stagnation.
• Another possible symptom accompanying the pain is stiffness due to the freezing effect of the Cold, as in ‘frozen shoulder’.
• The pain is improved by warmth and movement, but is aggravated by cold and rest. It is also aggravated in cold weather or by using cold therapy.
• There is aversion to cold and occasionally a slight fever in cases of invasion of Exogenous Cold.
The Exogenous Cold pathogenic factor has Yin characteristics. However, invasion of the body by Exogenous Cold may cause a Yang reaction in the superficial layers of the body as the skin pores are closed, so the body is not able to sweat. Due to this, the Body Fiuids try to escape out of the body through the urine, thus there is frequent discharge of large quantities of clear urine.
Besides a lack of perspiration, the person shivers to help the body maintain its temperature at a normal level. Muscular fibrillation also produces some warmth, so there can be a degree of fever, but chills and a cold feeling are predominant.
If the Heart-Yang is deficient, there is pain in the chest, an aversion to cold, cold limbs, palpitations, the spirits are low, there is a pale tongue with a thin coating and deep, slow and thready pulse.
If the Spleen-Yang is deficient, there are loose stools, or diarrhoea, abdominal pain, an aversion to cold, cold in the limbs, a feeling of tiredness, a thin and white coating, or even greasy coating, to the tongue and a thready, slow and weak pulse.
If the Kidney-Yang is deficient, there is lower back pain, weakness of the knees, frequent urination, nycturia, a feeling of tiredness, cold hands and feet, low potency, a thin and white tongue coating and a thready, slow and weak pulse.
In summary, generally, in Cold syndromes the following are noted:
• tongue: a thin and white coating, or a pale tongue
• pulse: a tight and superficial pulse if there is exogenous invasion, or a wiry and slow pulse if Yang of the Zang-Fu organs is deficient.
PAIN DUE TO PREDOMINANCE OF DAMP
Pain can be caused either by invasion of Exogenous Damp or by disorder of the Internal Zang-Fu organs, especially the Lung, Spleen or Kidney. The principles of treatment for the former are to dispel the Damp and relieve External symptoms; for the latter the aim is to restore the Zang-Fu organ function, eliminate the Damp and promote urination.
The symptoms of Damp include the following.
• The pain is very localised, and never moves as Damp, which is of the same nature as water, is characterised by heaviness and inertia, therefore there is no movement.
• There is a feeling of heaviness, tiredness and numbness, especially in the lower limbs and lower parts of the body.
• The affected parts are swollen; this swelling may be in the body or in the joints, and there may be an accumulation of liquid under the skin.
• Pain that is due to Damp is never sharp or acute; rather, it is deep, heavy and dull. Also it never appears suddenly, but slowly, gradually and chronically.
• Pain that is due to invasion of Exogenous Damp is aggravated in damp climatic conditions, such as when the weather is foggy, humid, wet or overcast. Wet places, moist walls or houses built on swamps usually also make the pain more severe (this can be compared to miasmatic symptoms in homeopathy). Moreover, this kind of pain is mostly aggravated if it becomes complicated by Wind or Cold factors, as happens in Damp-Bi Syndrome.
• Pain that is due to Damp resulting from Internal disorder is usually aggravated by eating too-fatty and greasy food as well as by eating cold food.
In general, in Damp conditions the following are noted:
• tongue: the coating is thick, sticky, whitish and wet; also it is very wet and never dry, even watery
• pulse: this is weak-floating soft (Ru), or slippery (Hua) and a little slowed down (Huan).
PAIN DUE TO PREDOMINANCE OF HEAT
Heat can be caused either by invasion of Exogenous Heat or by accumulation of Internal Heat resulting from Yang Excess or Yin Deficiency. The principles of treatment for invasion of Exogenous Heat are to dispel the Heat, reduce the fever and relieve the External symptoms. For Yang Excess the aim is to clear the Heat, reduce the Fire and promote defecation in order to induce the Heat out of the body. For Yin Deficiency, it is to nourish Yin, clear the Heat and promote the secretion of Body Fluids.
The symptoms of Heat include the following.
• Heat, like Fire, is a Yang pathogenic factor, which may cause pain accompanied by redness and swelling of the joints and muscles.
• The joints are painful, with a feeling of warmth, and are difficult to move (as seen in acute inflammatory arthritis).
Besides these characteristics of any joint or muscle pain, the following general symptoms of Heat may be observed:
• fever, sometimes with a slight chill, although the fever and hot sensation predominate
• aversion to Heat
• thirst, dryness of the mouth
• irritability, nervousness or restlessness
• tongue: a red tip to the tongue, or the whole body of the tongue, and a yellowish coating; if there is Yin Deficiency a peeled or scanty coating
• pulse: a rapid and superficial pulse if there is invasion of exogenous Heat, rapid and forceful in Yang Excess, and rapid, thready and weak in Yin Deficiency.
At least two circumstances are required for a diagnosis of invasion of Exogenous Heat:
• predominance of Heat among Wind-Heat and Damp;
• the pre-existence of Excessive-Heat or Deficient-Heat in the body, which is usually caused by bad dietary habits, such as eating too much greasy, fatty or hot foods, or too many sweets, or drinking too much alcohol.
Emotional disturbances such as stress, frustration, excessive meditation, pent-up emotions and so on produce Liver-Qi stagnation and hyperactive Liver-Fire, which are manifested as irritability, nervousness, anger, insomnia, hot flushing, etc. Overwork, and infectious or chronic diseases, amongst other things, cause Yin deficiency with Deficient-Heat.
Invasive pathogenic factors can also be transformed into Heat (Huo Hua) if they are of prolonged duration. This transformation is generally incomplete at the beginning of the process, so a mixture of Heat, Wind, Cold and Damp are generally seen, but the Heat predominates.
Differentiation of the characteristics of pain
Sore pain
This kind of pain often occurs in all four limbs and the trunk, especially the lower back and places where there are a lot of soft muscles. It is not very severe, and is accompanied by weakness, soreness, lightness and emptiness. It is mostly caused by deficiency of Qi and Blood.
Distending pain
This type of pain often occurs in the chest and abdomen, and is mostly caused by stagnation of Qi. Because of the stagnation, it fluctuates in intensity and location, and is rather obviously influenced by emotional changes, especially by stress, anger, irritation, nervousness.
Stabbing pain
This is commonly seen in daily practice, and characteristically feels as if a needle or knife were pricking the skin or muscles. The pain occurs always in the same place, but can be worsened during the night or by lying/sitting in a still position; it is better after movement, and is accompanied by swelling or petechiae on the skin, a dislike of pressure, a purplish tongue, and sometimes petechiae on the tongue, and a choppy pulse. This type of pain is typically seen in patients with stagnation of Blood, and after physical trauma, thus to promote Blood circulation can quickly relieve the pain.
Sharp pain
This kind of pain is mostly seen to be caused by acute Qi and Blood stagnation, and especially Qi stagnation, and is due to various factors. It is greatly diminished by treating with methods that circulate the Qi and Blood; however, it is very important to discover and treat the real cause, otherwise the pain will always return.
Throbbing pain
This type of pain is characterised by its rhythmic quality similar to beating of the pulse. It is often seen in patients with migraine, which is normally caused by hyperactivity of Liver-Yang. A throbbing pain is also found in patients with a carbuncle or furuncle of the Yang type, which is caused by invasion or accumulation of Toxic Heat in the body, and is accompanied by a feeling of heat, redness and swelling.
Burning pain
This kind of pain is characterised by pain with very hot feeling, as though the skin were burned, and is typically caused by Heat, either from invasion of exogenous Wind-Heat, Damp-Heat, Dryness-Heat or Toxic Heat, or Internal Heat from dysfunction of the Zang-Fu organs. In most cases, local redness and swelling can be observed.
Prolonged stagnation of Cold, or Qi and Blood, also may gradually produce Heat.
In contrast, in some patients who complain of a subjective burning feeling, nothing can be found physically. In this case, the burning pain is mostly caused by generation of Heat from the interior.
Colic pain
This kind of pain is usually very severe, often occurring in the internal Zang-Fu organs, such as the Small Intestine, Gall Bladder or Uterus. It is caused either by invasion of Exogenous Cold, or by accumulation of Cold, stagnation of Qi, or some substantial blockage such as stones, sand, stagnant Blood or Phlegm.
Hemialgia
This is pain that develops gradually and is confined to either the right or left side of the body. This type of pain often fluctuates in its intensity. Its causes include disharmony of the Nutritive Qi and Defensive Qi system, slowing of the Qi and Blood circulation, and disorder of Yin and Yang—for instance, it can often be seen on those who suffer from the sequelae of a cerebrovascular accident (Zhongfeng).
Pantalgia
This is pain that is experienced over the general body, but mainly in the joints and muscles. It can be caused either by Excessive factors, such as Qi and Blood stagnation or accumulation of Damp, or by deficient factors, for instance a deficiency of Qi and Blood.
Wandering pain
This is pain in the muscles and the joints that comes and goes, and fluctuates in its location. This type of pain is often seen in people suffering from Painful Obstruction Syndrome (Bi Zheng) due primarily to invasion of Wind.
Wandering pain can also be seen in the internal Zang-Fu organs, mostly in the abdomen and chest, and is caused by stagnation of Qi; it is closely related to emotional changes, which means that under conditions of stress, nervousness or anger the pain will be aggravated.
Pain with fixed location
This type of pain can be caused either by stagnation of Blood, or by invasion of Exogenous Damp, or by accumulation of Damp in the body.
If the pain is due to stagnation of Blood there is a stabbing pain, aggravation of the pain at night and when the person remains in a still position. If it is caused by invasion of Exogenous Damp there is an aversion to cold, slight sweating, a feeling of heaviness in the limbs and trunk, and headache. If it is caused by accumulation of Damp in the body there is nausea, poor appetite, loose stool or diarrhoea, a feeling of lassitude, fullness of the chest and abdomen, a greasy coating to the tongue and a slippery pulse.
Pain with spasm
This kind of pain can be caused either by invasion of Exogenous Cold, by deficient Blood in the Liver, by retardation of Blood circulation, or by formation of Deficient-Cold. For instance, acute facial paralysis is often caused by invasion of Wind-Cold, since Cold is characterised by contraction and stagnation.
Deficiency of Blood in the Liver often causes headache with a feeling of spasm. Spasm in the legs, especially in the gastrocnemius muscle, during the night, could be caused by deficiency of Blood in the Liver accompanied by poor Blood circulation, leading to undernourishment of the tendons. This condition is often seen in elderly people.
Pain with a suffocating feeling
This kind of pain is caused by blockage of the Qi circulation due to Qi stagnation or Damp-Phlegm accumulation, often occurring in the chest or abdominal region. For example, Painful Obstruction Syndrome in the chest is usually due to mixture of Qi stagnation and Phlegm accumulation.
Pain with radiation
This kind of pain refers to conditions characterised by pain occurring mainly in one location and radiating to another. It is usually caused either by stagnation of Qi and Blood or by accumulation of stone or sand in the Zang-Fu organs. For instance, stagnation of Qi in the Liver and Gall Bladder often causes hypochondriac pain with radiation of the pain to one shoulder or the upper back. Again, stagnation of Blood in the Heart may cause chest pain radiating to the arms and neck.
Pain with contraction
Since Cold is characterised by contraction, this kind of pain is usually caused by invasion of Exogenous Cold or formation of Deficient-Cold due to deficiency of Yang.
If the pain is caused by invasion of Exogenous Cold, the pain is severe, and accompanied by an aversion to cold, slight fever, headache, anhidrosis, a runny nose with a whitish nose and throat discharge, a thin and white coating to the tongue and a superficial and tight pulse. If it is caused by formation of Deficient-Cold due to deficiency of Yang, the pain tends to be slight and intermittent, and is accompanied by an aversion to cold, a feeling of tiredness, a pale complexion, shortness of breath, cold hands and feet, a pale tongue with a thin coating and a slow and deep pulse.
Pain with heaviness
This kind of pain is normally not very severe, it often occurs in the limbs, chest, epigastric region, abdomen or head, and there is a feeling as if the limbs and the head are bound by a piece of band, or as if the person is suffocating. It is a sign of invasion of Damp or accumulation of Damp in the body.
Pain with swelling
This kind of pain often occurs in the joints and muscles, and is usually caused by stagnation of Blood after trauma, or accumulation of Damp, or of Toxic Heat.
If the cause is stagnation of Blood due to trauma, there is severe pain, limitation of joint movement, a hard swelling with distinct edges, and blue spots on the skin. If it is accumulation of Damp in the joints and muscles, the joints are painful and the muscles have a heavy feeling, there is a soft swelling with indistinct edges, and a feeling of vibration can be obtained under the skin, the tongue has a greasy coating and there is a slippery pulse. If it is accumulation of Toxic Heat, the joints and muscles are swollen and there is redness, heat and severe pain, accompanied by fever, thirst, a feeling of restlessness, a red tongue with yellow coating and a rapid and forceful pulse.
Pain with dislike of pressure and massage
This kind of pain is usually severe and constant, and is caused by Excessive factors such as Qi and Blood stagnation, accumulation of Cold, or stagnation of food. It is accompanied by aggravation of the pain according to emotional changes, or food intake, and there is also rough breathing, constipation and a wiry pulse.
Pain with preference for pressure and massage
This kind of pain is usually slight and intermittent, and is caused by Deficient factors such as deficiency of Qi and Blood, deficiency of Yin or Yang. It is accompanied by a feeling of tiredness, or a weak feeling, it is aggravated by exertion, and there is a weak and thready pulse. After pressure and massage, the pain will disappear for a bit, but then gradually returns.
In addition, in some patients a pain caused by excessive factors may also be alleviated by pressure and massage; this is because pressure and massage disperse the Qi and Blood circulation temporarily so the pain diminishes; however, it quickly returns.
Pain with preference for warmth
When this kind of pain occurs it means that there is too much Yin and Cold in the body. This is caused either by invasion of Exogenous Cold, or by formation of Deficient-Cold due to Yang deficiency. Because warmth can counteract and diminish Tm and Cold, the person prefers warmth.
If the pain is caused by invasion of Exogenous Cold, the onset is usually acute and relatively severe, and is accompanied by an aversion to cold, fever, headache, muscle pain with a contracting feeling, a runny nose with a whitish discharge, cough, a thin and white coating to the tongue and superficial and tight pulse. If it is caused by development of Deficient-Cold due to Yang deficiency, the onset is usually gradual, and is accompanied by an aversion to cold, a feeling of tiredness, a pale complexion, a poor appetite, there is intermittent occurrence of pain, the tongue is pale with a thin coating and there is a deep, thready and slow pulse.
Pain with preference for cold
Cold can clear Heat and reduce fever, so this kind of pain is usually caused either by invasion of Exogenous Heat, or by accumulation of Heat in the body.
If the pain is caused by invasion of Exogenous Heat, there is fever, a slight aversion to cold, a runny nose with a yellow discharge, throat pain with redness and thirst, a thin and yellow tongue coating and superficial and rapid pulse. If it is caused by accumulation of Heat in the body, there would be no External symptoms, but fever, thirst, restlessness, constipation, insomnia, yellow and dry coating, wiry and rapid pulse.
Constant pain
This kind of pain can be caused by all kinds of Excessive factors. It implies that the battle between the Defensive Qi and the pathogenic Qi is still very active and when the Defensive Qi is the stronger one, the pain level diminishes, and when it is the reverse level the pain increases. Treatment is mainly aimed at helping the Defensive Qi to eliminate the pathogenic Qi.
Intermittent pain
This kind of pain is usually caused by a deficiency of Qi, Blood, Yin or Yang, and this implies that the Defensive Qi is weak, so the battle between the Defensive Qi and the pathogenic Qi is not very active. Treatment is mainly aimed at nourishing the Defensive Qi so as to relieve the pain.
Intermittent pain, specially intermittent pain around the navel, can also be caused by accumulation of worms, and is often accompanied by vomiting, even vomiting of worms, and intermittent abdominal pain with sudden aggravation. If the worms are in the Gall Bladder, there is hypochondriac pain, nausea, vomiting, jaundice and fever.
