This topic deals with the occurrence of pain affecting the entire body, including joints, tendons and muscles, which may be accompanied by an aversion to cold, fever, sweating or lack of sweating, fatigue or even dysfunction of the limbs. Pain throughout the body can, according to TCM, be caused by disorders in the Internal organs and disturbance of the channels. There are many factors that may lead to this. They are differentiated in the following way: invasion of External Wind-Cold, invasion of External Wind-Damp, invasion of External Damp-Hea t, stagnation of Liver-Qi, stagnation of Qi and Blood in the channels, deficiency of Qi and Blood, deficiency of Liver-Yin and Kidney-Yin and deficiency of Kidney-Yang. Entire body pain may be attributed to any of the following disorders in Western medicine: the common cold, influenza, leptospirosis, poliomyelitis, polymyalgia rheumatica, chronic fatigue syndrome (CFS), and fibromyalgia, etc.
Aetiology and pathology
Invasion of External Wind-Cold
Invasion of External Wind-Cold is one of the most common causative factors of pain throughout the body. The nature of Cold is contracting, so it may depress the Defensive Qi and lead to obstruction in the channels, muscles and tendons. Wind exists in every season, being able to invade the superficial layers and the upper part of the human body easily. When there is an invasion of External Wind-Cold in the body, the Qi and Blood will not be able to circulate freely to nourish the body and there will be contraction of the channels, muscles and tendons, leading to stagnation of Qi and Blood. This may cause pain throughout the body. Exposure to a cold environment without proper clothing and a direct invasion of Wind-Cold in people who sweat during the course of their work or from playing sports are the major causes.
Invasion of external Wind-Damp
Wind is a Yang pathogenic factor that frequently attacks the human body. It is often combined with other pathogenic factors. Damp is a substantial Yin pathogen; it has a heavy and sticky nature, easily blocking and damaging the circulation of Qi in the muscles. When Wind and Damp are combined together, they may obstruct the circulation of Qi and Blood and pain in the entire body follows.
Invasion of External Damp-Heat
An invasion of Exterior Damp may cause stagnation in the circulation of Qi, and persistence of Damp may cause transformation of Damp into Damp-Heat. Living or working in warm and humid conditions can lead to a direct invasion of External Damp-Heat into the human body. The External Damp-Heat may block the Qi circulation in the channels and muscles, leading to pain in the entire body.
Also, eating too much high-fat and sweet food and dairy products, or drinking too much alcohol, may damage the Spleen and Stomach, leading to the formation of Dampj-Heat in the Middle Burner.
Stagnation of Liver-Qi
The Liver plays an important role in the emotions. It also regulates the Qi circulation and stores the Blood. Negative emotions, such as overstress and frustration, may cause stagnation of Liver-Qi, which in turn causes poor circulation of Blood and Body Fluids. In this way, the muscles and tendons as well as the channels will not be nourished sufficiently and pain in the entire body occurs.
Stagnation of Qi and Blood in the channels
Prolonged persistence of chronic diseases, incomplete dispelling of Wind-Cold, too much emotional disturbance, imbalance between warmth and cold and accumulation of Damp-Phlegm, may all cause a slowing down of the circulation of Blood, leading to Blood stagnation. Too little exercise may also result in stagnation of Qi and Blood. Physical strain and inappropriate operations may directly damage the muscles, tendons and channels, leading to stagnation of Blood. When Blood stasis blocks the muscles, tendons and channels, pain in the entire body occurs.
Deficiency of Qi and Blood
Excessive physical work as well as mental work may cause Spleen-Qi and Kidney-Qi to be consumed. When Spleen-Qi is not strong enough to produce Blood, this may result in deficiency of Blood. In women, chronic excessive blood loss during menstruation may immediately lead to deficiency of Blood. Chronic diseases could also cause a gradual consumption of Qi and Blood, leading to their deficiency. Moreover, excessive sexual activity or giving birth to several children may decrease Kidney-Essence, leading directly to a deficiency of Qi and Blood. In all these conditions, the muscles and tendons will not be nourished properly, leading to pain in the entire body.
Deficiency of Yin of the Liver and Kidney
Chronic febrile disease, improper treatment with hot herbs and even overeating spicy and hot food may gradually consume the Yin in the body. Poor constitution, old age and excessive sexual activities may also cause consumption of the Qi and Yin of the Kidney. The Liver and Kidney share the same origin, so deficiency of Kidney-Yin may cause deficiency of Liver-Yin. Where there is Yin deficiency, there will also be deficiency of Blood, thus the muscles, tendons and channels will not be properly nourished and pain in the entire body will follow.
Deficiency of Kidney-Yang
Long-standing Cold diseases or excessive use of Cold herbs may damage Kidney-Yang. A weak constitution, ageing, too many operations, as well as chronic sickness, may all induce the damage of Kidney-Yang, gradually leading to deficiency. Cold has the characteristics of stagnation and contraction. If there is deficiency of Kidney-Yang, the Qi and Blood in the body will stagnate, the body temperature will decrease and pain in the entire body will follow.
Treatment based on differentiation
Differentiation
Differentiation of External or Internal origin
Entire body pain can be caused either by invasion of external pathogenic factors or by internal disorder.
— If it is caused by invasion of External pathogenic factors, it is usually acute, and accompanied by External symptoms such as headache, fever, an aversion to cold, runny nose, coughing, etc.
— If it is caused by disorder of internal organs, it is chronic in nature and has no External symptoms.
Differentiation of character of the pain
— Entire body pain with an acute onset, fever and aversion to cold is usually caused by External pathological factors, such as Wind-Cold, Wind-Damp or Damp-Heat.
— If entire body pain is accompanied by acute occurrence of severe headache, stiff neck, slight fever, aversion to cold and no sweating, it is often due to invasion of Wind-Cold.
— Acute occurrence of entire body pain with an obvious heavy sensation in the body generally soreness and numbness of the muscles and joints, fever, an aversion to cold, a poor appetite and loose stools, is usually caused by invasion of Wind-Damp.
— Entire body pain with a hot and heavy sensation, swelling of the joints, a poor appetite with bitter taste, fever, an aversion to cold, a thick yellow tongue coating and a slippery and rapid pulse, is usually caused by invasion of Damp-Heat.
— Chronic entire body pain with a wandering nature, which is aggravated by stress or emotional upset, with insomnia, irritability, palpitations, dull stomach or overeating, is caused by stagnation of Liver-Qi.
— Chronic pain in the body with a fixed location, or stabbing pain, history of trauma or operation, with aggravation of the pain at night, is caused by stagnation of Blood.
— Chronic pain in the entire body, soreness of the muscles, fatigue and dizziness is often due to Deficiency. Patients usually have a weak constitution and a history of chronic disease. If the main cause is deficiency of Qi and Blood, there will be shortness of breath, a poor appetite, a pale complexion, and so on. If it is deficiency of Kidney-Yin, there will be a sensation of heat in the palms and the soles of the feet, lower back pain with soreness, a low-grade fever, night sweating, and so on. If it is deficiency of Kidney-Yang, there will be a cold sensation, lassitude, an aversion to cold, cold limbs, a pale complexion, oedema, lower back pain with soreness, and so on.
Treatment
INVASION OF WIND-COLD
Symptoms and signs
Pain in the entire body with an acute onset, headache, stiff neck, back pain, joint pain, aversion to cold, fever, lack of sweating, lack of thirst, clear urine, a pale tongue with a white coating and a floating and tense pulse.
Principle of treatment
Dispel External Cold, promote sweating and relieve the pain.
HERBAL TREATMENT
Prescription
MA HUANG TANG
Ma Huang Combination
Ma Huang Herba Ephedrae 10 g
Gui Zhi Ramulus Cinnamomi 10 g
Xing Ren Semen Armeniacae 10 g
Qiang Huo Rhizoma seu Radix Notopterygii 10 g
Du Huo Radix Angeticae Pubescentis 10 g
Zhi Gan Cao Radix Glyeyrrhizae Praeparata 6 g
Explanations
• Ma Huang promotes sweating and dispels Cold.
• Gui Zhi helps Ma Huang to dispel Cold and warm the channels.
• Xing Ren helps Ma Huang to regulate the circulation of Lung-Qi in order to eliminate the external Cold.
• Qiang Huo and Du Huo dispel Wind-Cold to relieve the superficial symptoms and stop the pain in the entire body.
• Zhi Gan Cao harmonises the actions of the other herbs in the prescription.
Modifications
1. If there is sweating, remove Ma Huang, and add Bai Shao Radix Paeoniae Alba 10 g, Sheng Jiang Rhizoma Zingiberis Reeens 10 g and Da Zao Fructus Ziziphi Jujubae 10 g to harmonise Yin and Yang and to relieve the pain.
2. If there is headache, add Chuan Xiong Radix Ligustici Chuanxiong 10 g and Bai Zhi Radix Angelicae Dahuricae 10 g to eliminate Wind-Cold in the head in order to relieve the headache.
3. If there is a stiff neck, add Ge Gen Radix Puerariae 10 g and Bai Shao Radix Paeoniae Alba 12 g to nourish the tendons and regulate the circulation of Qi.
4. If there is severe pain with a cold sensation, add Gan Jiang Rhizoma Zingiberis 10 g and Yan Hu Suo Rhizoma Corydalis 12 g to warm the channels and relieve the pain.
Patent remedy
Jing Fang Bai Du Pian Schizonepeta and LedebourieIIa Tablets to Overcome Pathogenic Toxin
ACUPUNCTURE TREATMENT
LI-4 Hegu, TE-5 Waiguan, GB-40 Qiuxu, BL-40 Weizhong, BL-60 Kunlun and ST-36 Zusanli. Reducing method is applied for these points. The points on the leg can be treated with moxibustion.
Explanations
• LI-4, the Source point of the Large Intestine channel, regulates the Qi circulation in the channels and relieves pain.
• TE-5, the Connecting (Luo) point of the Triple Burner channel, regulates the Qi circulation in the entire body and relieves the pain.
• GB-40, the Source point of the Gall Bladder channel, regulates the Qi circulation and relieves pain along this channel.
• BL-40, the Sea point of the Bladder channel, promotes the Qi circulation. BL-60, the River point, regulates the circulation of Qi. (These two points are used to relieve the pain along the Bladder channel.)
• ST-36, the Sea point of the Stomach channel, tonifies the Stomach-Qi and relieves pain along the Stomach channel.
• Moxibustion on acupuncture points on the legs may warm the channels and dispel External Wind-Cold and in this way relieve the pain.
Modifications
1. If there is headache, add GB-20 and LU-7 to regulate the Qi circulation and to relieve the headache.
2. If there is a stiff neck, add GB-21 and BL-IO to promote the Qi circulation and to relieve the pain.
3. If there is back pain, add BL-58, the Connecting point, and BL-63, the Accumulating point of the Bladder channel, to regulate the Qi circulation and to relieve the pain.
4. If there is joint pain, add some local Ah Shi points to regulate the Qi circulation and to relieve the pain. Treatment with moxa on these points is recommended.
5. If there is a fever and an aversion to cold, add GV-14 and LI-Il to induce sweating and to reduce fever.
Case history
A 33-year-old woman complained of pain in her entire body that had persisted for 15 days. The pain started after she caught a cold 2 weeks previously. When she visited her doctor he had prescribed some painkillers. She had had no relief of the pain, however, so she asked for acupuncture treatment. When she came to the acupuncture department, she had a low fever, an aversion to cold with no sweating, pain and soreness in the entire body, headache, low back pain, joint pain, cold limbs, a pale tongue with a white coating and a superficial pulse.
Diagnosis
Invasion of Cold in the channels.
Principle of treatment
Dispel External Cold, warm the channels and relieve body pain.
Acupuncture treatment
The points LI-4, LU-7, GB-20, GB-34 and BL-58 were needled daily with reducing method.
Explanations
• LI-4, the Source point of the Large Intestine channel, and LU-7, the Connecting point of the Lung channel, regulate the circulation of the Liver and promote sweating in order to dispel External Wind-Cold from the channels.
• GB-20, the meeting point of the Gall Bladder channel and the Yang Linking channel, promotes the circulation of Qi, dispels External Cold and relieves the headache.
• GB-34, the Gathering point of the tendons, promotes the Qi circulation and relieves the pain.
• BL-58, the Connecting point of the Bladder channel, regulates the Qi circulation and relieves the pain.
After the first treatment, the patient sweated slightly and felt relief of the pain. The pain disappeared completely after the third treatment. Upon consultation a year later she reported having been free of pain since the treatment.
INVASION OF WIND-DAMP
Symptoms and signs
Pain in the entire body with a heavy sensation, soreness and numbness of the muscles, headache with a heavy feeling, painful and swollen joints, low fever, a poor appetite, a thirst without a desire to drink, loose and sticky stools, a white and sticky tongue coating and a deep and slippery pulse.
Principle of treatment
Dispel Wind, eliminate Damp and relieve the pain.
HERBAL TREATMENT
Prescription
QIANG HUO SHENG SHI TAN
Notopterygium Dispelling Dampness Decoction Qiang Huo Rhizoma seu Radix Notopterygii 10 g Du Huo Radix Angelicae Pubescentis 10 g Gao Ben Rhizoma et Radix Ligustici 10 g Fang Feng Radix Lcdebouriellae 10 g
Chuan Xiong Rhizoma Ligustici Chuanxiong IOg
Man Jing Zi Fructus Viticis 15 g
Zhi Gan Cao Radix Giycyrrhizae Praeparata 6 g
Explanations
• Qiang Huo, Du Huo, Fang Feng, Man Jing Zi and Gao Ben promote sweating, dispel Wind and eliminate Damp in order to relieve the pain.
• Chuan Xiong invigorates the circulation of Blood and promotes the circulation of Qi in the channels.
• Zhi Gan Cao harmonises the actions of the other herbs in the prescription.
Modifications
1. If there is headache, add Bai Zhi Radix Angeiicae Dahurieae 10 g and Bo He Herba Menthae 6 g to dispel the Wind and relieve the headache.
2. If there is swelling of the joints, add Fang Ji Radix Stcplmniae Tctrandrae IOg and Fu Ling Poria 15 g to eliminate the Damp and promote urination.
3. If there is soreness of the muscles, add Mu Gua Fruetus Chaenomelis 10 g and Yi Yi Ren Semen Coieis 10 g to eliminate the Damp and regulate the Qi circulation.
4. If there is heavy sensation in the body, add Can Sha Exerementum Bombyeis Mori 10 g and Ze Xie Rhizoma Alismatis 15 g to promote urination and eliminate the Damp.
5. If there is a low fever, add Huo Xiang Herba Agastaehis 6 g and Pei Lan Herba Eupatorii 6 g to promote sweating and reduce the fever.
6. If there is a poor appetite, add Ban Xia Rhizoma Pinelliae IOg and Sha Ren Fruetus Amomi 6 g to dry the Damp and improve the appetite.
Patent remedies
Tian Ma Qu Feng Bu Pian Gastrodia Dispel Wind Formula
Tablet
Feng Shi Pian Wind-Damp Tablet
ACUPUNCTURE TREATMENT
LU-7 Lieque, TE-6 Zhigou, SP-6 Sanyinjiao, SP-9 Yin- lingquan, ST-36 Zusanli, GB-34 Yanglingquan and BL- 60 Kunlun. Reducing method is applied on these points.
Explanations
• LU-7, the Connecting point of the Lung channel, promotes the Qi circulation and dispels the Wind-Damp.
• TE-6 dispels the Wind, promotes urination and eliminates the Damp.
• SP-6, the crossing point of the Spleen, Kidney and Liver channels, and SP-9, the Sea point of the Spleen channel, eliminate the Damp and activate the Spleen.
• ST-36, the Lower Sea point of the Stomach regulates the Stomach-Qi and eliminates the Damp.
• GB-34, the Sea point of the Gall Bladder channel and the Gathering point for the tendons, regulates the Qi circulation and relieves pain in the tendons.
• BL-60, the River point of the Bladder channel, promotes the circulation of Qi and eliminates the Wind-Damp.
Modifications
1. If there is a low fever, add Ll-4 and BL-20 to promote sweating, to eliminate the Wind-Damp and reduce the fever.
2. If there is joint pain, add BL-II, the Gathering point for the bones, BL-20 and local Ah Shi points to regulate the Qi circulation and relieve the pain.
3. If there is headache, add GV-20 and Extra Tai-yang to promote sweating and relieve the headache.
4. If there is a poor appetite, add CV-12, the Front Collecting point, and BL-20, the Back Transporting point of the Stomach, to promote the Qi circulation and improve the appetite.
5. If there is numbness in the muscles, add SP-4, the Connecting point, to activate the Spleen and Stomach and reduce the numbness.
