Pain, is an extremely complex kind of painful experience. All kinds of stimuli will feel pain when they reach the extreme point, but it doesn’t have to be the extreme point, sometimes it hurts when it doesn’t reach the extreme point, there is also the feeling of pain, so the feeling of pain is there for everyone, but there is no way to describe it, anyway, it is pain, you ask him which place hurts? Headache, heartache, how do you really hurt? What is the manifestation of pain? It is very difficult to describe it clearly in words.

The cause of pain, the site of pain, it can be said that any place can be pain, anywhere in the body can appear pain, any cause can also cause pain, so pain is the most common clinical symptoms of a large category.

Pain is also the reason why we often patients come to the clinic as the main complaint, where do you feel uncomfortable? Headache, stomach pain, back pain, joint pain, are often presented with pain as the chief complaint, so this symptom is very common and important.

When asking about pain, pay attention to the location and nature of the pain.

The main question is which part of the pain, he said chest pain, heart pain, the patient said the heart pain is not the real heart pain? In fact, heart pain is not the same as heart pain or pain in the tip of the heart, but rather pain under the junction of the saber, so we must clarify the location of the pain. If the stomach hurts, does it hurt on the surface of the abdominal wall or inside the stomach? We have to clarify the location.

What is the nature of the pain, cold pain or hot pain, distension or stabbing pain? And so on.

The timing of the pain, when does it occur? Under what conditions does the pain appear? What does the pain like? What do not like? At least like to press or dislike to press? Does he like it cold or hot? And so on.

What are the conditions for resting, and under what circumstances can it be better? For example, the patient I talked about a few days ago, when he had heartburn, he was able to relieve his bowel movement without pain, he said that one of the conditions of his relief is to distract his energy, after his mind is distracted, he does not have pain.

Ⅰ.  Causes of pain

The nature of pain can be broadly divided into two categories.

One is pain due to real.

The pain is caused by various real evils, such as wind, cold, heat, moisture, dryness and fire, qi stagnation, blood stasis, phlegm, food, worms, stones, etc. This is the evil that stays in the body and affects the flow of qi and blood, and the qi and blood do not run smoothly.

This kind of pain, which is caused by actual evil, is characterized by a new pain, a sudden pain, not a long-term vague pain, a new pain of heart qi, a more intense pain, a more severe pain, a persistent pain, not a pain after a while, the pain is relieved, it is a persistent pain, the pain refuses to press, especially when the whole body is still relatively good, not very weak, these are some of the characteristics of this kind of pain, we generally judge that it mostly belongs to the actual evidence, which is caused by actual evil.

So if you don’t pass, it hurts, and when it hurts, what is the cause? It is not pass. How to deal with it, to get it through, it will not hurt. “These three phrases are closely linked: “if it does not pass, it hurts, if it hurts, it does not pass, if it passes, it does not hurt. Non-passage leads to pain, the cause of pain is because of non-passage, to relieve this problem, to pass is not pain, pass the pain can be relieved.

Another condition is pain due to deficiency.

Is it true that all pains are due to deficiency? No, there are also pains caused by deficiency, because of weakness, which can also lead to pain, not necessarily all of them are actual evil.

The most common causes, such as Yang Qi deficiency, Yang Qi is not able to warm, essence and blood is not enough, can not be enriched, the organs and meridians lost Yang Qi essence and blood enrichment, so there is called “not glory is pain”.

The pathology of pain caused by deficiency is called “pain due to lack of circulation”, which is the pathology of actual pain; the pathology of pain caused by deficiency is “pain due to lack of glory”, which means that it cannot be glorified and nourished.

The characteristics of pain caused by deficiency, as opposed to pain caused by actual evidence, are that the pain lasts longer; the degree of pain is lighter, not very severe, because it does not get glorified, not blocked; it is continuous and stops when it hurts, and there is also vague pain, long-term vague pain; there is also pain for a while, then slowly relieved, after relieved, after a few days, it hurts again, this is the characteristic of pain.

Generally speaking, it is more deficient to press, and it is more real to refuse to press.

So this kind of pain, the front is to pass is not pain, this kind of treatment is to supplement the deficiency to be able to stop the pain. Insufficient yang qi will warm up yang qi, and insufficient yin blood and essence, we must nourish the essence and fill the essence, through this method of treatment.

Ⅱ. The nature of pain

What kind of pain does the patient have and what are its characteristics? What is the nature of the pain?

(1) Distension pain

It is a painful pain and a feeling of distension, which is the joint existence of distension and pain, so it forms a kind of distension.

It is often seen in the chest, hypochondrium, epigastrium and abdomen. Most of the pain and distention in these areas is due to qi stagnation, and the pain and distention belong to qi stagnation.

There are some special places, such as the head and eyes, where pain and distention can also occur, so the pain and distention at this time is mostly due to Qi and Blood congestion. Liver fire and liver yang force blood to travel, liver yang is hyperactive and liver fire is inflammatory, so head and eye swelling and pain should not be considered as qi stagnation, but mostly as yang-heat disturbance and qi-blood congestion. The head and eyes are often seen to be swollen and painful, there is also phlegm, not only water, water dampness, for example, glaucoma, the fluid in the eye does not run smoothly, eye pressure increases, atrial fluid obstruction, so it can appear the head and eyes swollen and painful, then of course, this is not necessarily liver fire, liver Yang, may also be liver fire, may also be liver Yang, may also be phlegm, water dampness, phlegm, water dampness, which is a common site of swelling and pain.

If it is in the chest, abdomen and cavity, these places are mostly qi stagnation, and the head is mostly liver fire, liver yang, phlegm dampness and these contents.

(2) Stabbing pain

Stabbing pain, some people describe it as needle-like, like a chicken pecking at rice here. In fact, there are many cases what is the cause? The blood vessels are beating there, and when the blood vessels beat, it feels painful, like the stabbing pain of needles. In severe cases, some describe it as a pain like a knife cut, a pain so severe that it is called stabbing pain.

Most of the stabbing pains are stasis of blood and blood blockage. The stabbing pain is blood stasis, while the swelling pain is qi stagnation. Of course, qi stagnation depends on the specific area, but stabbing pain is generally a manifestation of blood stasis regardless of the area.

(3) Cold pain

The so-called cold pain is not only painful but also cold, which is both cold and painful. This cold pain, of course, prefers warmth and will be relieved by warmth.

The most common areas are the lumbar spine, the abdomen, the limbs and the joints. The most common cause of cold pain is either a deficiency of yang energy, yang deficiency, or cold dampness and cold stagnation.

If Yang is deficient, it hurts, and if cold is prevalent, it hurts. This is cold pain, which can be caused by Yang deficiency and can also be caused by cold prevalence.

(4) Burning pain

Burning pain, in addition to the sensation of pain, is also a burning sensation. What are the conditions that often cause burning pain? When you have a sore or boil, it is often a burning sensation, the kind of pain after a burn, that is a kind of burning pain.

In addition to pain, there is also a burning sensation in the patient’s area, which is a burning pain.

The most common cause is yin deficiency and heat. Yin deficiency leads to heat, Yang deficiency leads to cold, Yin deficiency can lead to burning pain, heat and Yang can lead to burning pain. This is the same mechanism as that described in Su Wen, “Yin deficiency leads to cold, Yang deficiency leads to cold, Yang flourishing leads to heat, and Yin flourishing leads to cold”. Yin deficiency and Yang prosperity can lead to burning pain, while Yang deficiency and Yin prosperity can lead to cold pain.

(5) Heavy pain

Heavy pain is not only pain but also a sore and heavy feeling in the body, the body feels heavy, the hands and feet seem to be unable to lift and do not want to move.

Most of the heavy pains are due to dampness blocking the qi flow, which can also be caused by dampness blocking the qi flow and Yang Qi not being able to move.

Heavy pain on the body is most often due to dampness blocking the qi flow, but if the head is heavy and painful, there are several causes.

1, The most common cause is hyperactivity of Liver Yang and congestion of Qi and Blood on the head.

2, I wonder if you have this feeling, if you are too tired, if you have not gone to bed at 2 or 3 o’clock at night, if you feel your head is heavy and you have a headache, then the heavy head and headache at this time are still hyperactivity of Liver Yang and the Qi and Blood rushing upwards. But we do not describe a light pain in the head, we may feel that our head is heavy and we cannot lift it up, actually we are very tired, we cannot lift our head up, it is very heavy, we are very tired, the heavy pain at that time, the swelling and pain in the head, that is a lack of qi and blood, it is not the same as too much qi and blood, there are also such cases.

(6) Soreness and pain

Soreness is the feeling of soreness, what kind of feeling is this soreness? It is not clear, the pain is not obvious, it seems to be sore, very uncomfortable, sore and painful, it is not clear, this is a patient’s experience, we may all have this experience, sore and painful.

Soreness and heavy pain are similar in that they mostly belong to dampness blocking the meridians, muscles and joints, with unfavorable meridian qi and dampness blocking them.

When the kidney is deficient, the essence cannot enrich the bone marrow, so there is soreness and pain in the bones.

(7) Colic

Colic is a pain so severe that it is like a knife twisting inside. Why does colic occur? Most often, it is because a tangible real evil has blocked the qi flow. The most common cause is caused by cold evil, cold condenses qi stagnation, cold tendons and veins collect and draw, tendons and veins contract and draw, colic can occur.

Pain caused by cold evil is usually more severe. For example, true heart pain, which is coronary angina, is called true heart pain or syncopal heart pain in Chinese medicine, and the pain is very obvious. When kidney stones and bile duct stones are obstructed, colic often occurs. There is another kind of pain called qi abdominal pain, the intestinal qi is not smooth, after the cold suddenly stomach cramps, an examination is not intestinal obstruction, nor intestinal perforation, give him some spasm relief drugs, atropine and so on, he does not hurt, this is qi abdominal pain. So qi stagnation and cold condensation can lead to colic, and the nature of the pain is very serious.

(8) Empty pain

Empty pain is a feeling of emptiness, especially in women who feel a feeling of empty pain in the small abdomen after menstruation, which is mostly due to deficiency of qi and blood, lack of yin and essence, and loss of nourishment of the internal organs and meridians.

(9) Occult pain

Vague pain, the degree of pain is relatively mild, the patient does not feel obvious, sometimes there seems to be a little pain, that is, the degree of pain is relatively mild, vague pain.

The pain caused by solid evidence is usually more severe, so this vague pain is mostly a manifestation of deficiency, deficiency of Yang Qi, deficiency of essence and blood, and loss of nourishment of the meridians and internal organs.

(10) Running pain

The pain is irregular, moving from one place to another. What can cause the pain to move around? The most common causes are

1, it is wind paralysis in wind-cold-damp paralysis. Wind has the characteristic of moving around, so that the joint pain goes from this joint to another joint (pain), originally the knee joint pain, now the hand joint pain, after the hand joint pain, and then the foot bunion pain, wandering, most likely a manifestation of wind evil.

2, The other one is qi stagnation, when it does not pass, the pain can be relieved after it passes, if there is belching or intestinal tinnitus or yagging qi, when the qi is temporarily passed. With the movement of the gas, the painful part goes from one place to another, which is most likely a manifestation of qi stagnation.

3, There is also a roundworm in the intestine, which can also cause pain because the roundworm is also moving around in the intestine, and when it moves from this place to another place, the pain will move to another place.

(11) Fixed pain

Fixed pain, that is, the painful area is fixed and does not move, mostly belongs to stasis of blood, when stasis of blood is blocked, when qi and blood are congested, when heat and blood are stagnant, it often manifests as fixed pain and stabbing pain. For example, when a sore is born and is about to turn into pus, most of the time it is fixed and does not move, and it hurts like pins and needles.

Fixed pain is also seen in cold-damp obstruction, cold condensation, cold stagnation, cold evil stagnation, cold-damp, damp-heat paralysis of tendons, bones and joints. For example, wind-cold damp paralysis can be caused by dampness and coldness.

(12) Pain

The pain of pulling is the pain of pulling, pulling, pulling from one place to another, pulling pain.

The most common type of pulling pain is partial paralysis. It is the equivalent of sciatica in Western medicine, which is a line of pain in the back from the waist to the upper and lower leg. The term “paralysis” has been used in Chinese medicine for a long time, since the Ming Dynasty.

Most of the paralysis is said by Western medicine to be a herniated disc, which compresses the sciatic nerve and causes pain along the sciatic nerve in a radioactive manner, which is obviously an involved pain. Why is it painful? Chinese medicine believes that it is a blockage of the meridians.

Another common pain is the pain of the liver meridian, such as kidney stones, from the small abdomen, waist and abdomen down to the pubic apparatus, and even radiating to the inner thighs, up to the ribs and down to the pubic apparatus, this kind of pulling pain is also a kind of pulling pain.

In Western medicine, the pain in the right shoulder can be caused by gallstones and cholecystitis, which are all associated pains, radiating to that area.

Chinese medicine talks about chest paralysis and heart pain, and the book “The Essentials of the Golden Horoscope – Chest Paralysis, Heart Pain and Short Qi Disease” says: “Heart pain is through the back, back pain is through the heart. When the pain in the front is also painful in the back, and when the pain in the back is also painful in the front, this manifestation of chest paralysis also belongs to the switch pain.

Pathological nature of 12 common types of pain

Cold pain, mostly Yang deficiency and cold.
burning pain, mostly Yin deficiency and fire-heat
heavy pains and soreness, most often due to dampness and dampness obstruction; heavy head pains may be hyperactivity of Yang and congestion of Qi and Blood
stabbing pains and fixed pains are blood stasis and may also be cold-evil stagnation
distending pains and scurrying pains are mostly qi pains and stagnation of qi; head and eye distending pains are mostly hyper yang, fire and heat, phlegm; wandering pains in joints are mostly walking paralysis of wind victory.
colic pains are commonly due to cold condensation, qi blockage and stasis.
Empty pains and hidden pains mostly belong to deficiency evidence, deficiency of qi and blood, yin and essence, etc.
Sincere pain is mostly due to blockage of the meridians.

Although the nature of the lesion can be reflected from the nature of the pain, it should be combined with the manifestations of the whole body. Do not conclude that it is blood stasis, qi stagnation, cold and dampness based on the nature of the pain alone. For example, stabbing pain may be blood stasis, but cold clotting can lead to blood stasis, and so can blood heat, which is a consequence of blood stasis only.

The nature of the pain is indicative of the nature of the lesion, but it is also important to refer to the systemic manifestations and not to make a conclusion based solely on a single pain.

Ⅲ. Areas of Pain

Various parts of the body can cause pain. When asking about the site of pain, on the one hand, we need to find out where the exact site of pain is. If a patient says that he has chest pain, where exactly is the pain in his chest, whether it is in the heart, or in the saber process, or in the left or right side of the chest? Whether the back pain is in the middle or on the sides of the waist, above or below, the location should be clarified. Whether the stomach pain is outside or inside the stomach, or on top of the abdominal wall, the exact location should be clarified.

At the same time, we need to clarify what the internal organs of this area are, where the pain is located internally, which organ it reflects, and which organ it is often associated with.

For example, pain in the heart of the eyebrow, pain in the heart of the eyebrow is often considered by Chinese medicine to be pain in the Yangming meridian, and the frontal sinusitis spoken of by Western medicine may appear to be pain in this area of the eyebrow, then we know that this area is related to the frontal sinus.

Pain in the lower right abdomen is more common with intestinal canker sores and appendicitis. If a woman in her childbearing years suddenly has pain in the lower right abdomen, you should consider whether there is an ectopic pregnancy rupture.

Ask about the nature of the pain, focusing on the causes of the pain, such as cold, heat, qi stagnation, blood stasis, phlegm, yang deficiency, yin deficiency, etc. Ask about the location of the pain, focusing on understanding the location of the lesion, what kind of disease it is, and which lesions can cause it.

(1) Headache

Chinese medicine attaches great importance to pain in the head and divides the treatment into meridians and identification according to the location of the headache. The forehead pain, even to the eyebrow bone, belongs to the Yangming meridian, which follows the body and travels on the head and face; the Sun travels behind the head, so the posterior headache belongs to the Sun; Shaoyang travels on both sides of the head, so the headache on both sides belongs to the Shaoyang meridian; and the foot Turk’yin liver meridian crosses the top of the forehead, so the headache on the top of the head belongs to the lesions of the Turk’yin liver meridian. The most common ones are divided in these ways.

As I mentioned earlier, we should also pay attention to what problems of the internal organs are reflected in the pain area. There are many causes of headache, what exactly is the cause? We have no way to open the head, we can only identify the evidence according to the symptoms. Wind, cold, heat, humidity, dryness and fire can be caused by external sensation, which is the most common cause of headache. After a cold or an external sensation, headache often occurs; consumption, consumption, is about tuberculosis, and headache is common in brain consumption. In malaria, the most typical symptoms of malaria patients start with chills and shivers, followed by high fever and headache, and then they sweat out and the pain is so severe that the headache wants to break. (There are also) various kinds of poisoning, trauma and so on, which can cause.

Therefore, there are many causes of headache, and we should pay attention to the division of the Sun, Yangming, Shaoyang, and Conjunctive Yin meridians in Chinese medicine, and also pay attention to the relationship with the ears, eyes, nose, throat, and other organs, because the five senses are all located in the head, and headache may also be caused by lesions of the five senses.

(2) Chest pain

The exact location of chest pain should be clarified. The common lesions of chest pain are syncope, true heart pain, and chest paralysis.

Chest paralysis refers to general coronary heart disease and angina pectoris, while syncope and true heart pain are about the condition of myocardial infarction, which is very serious and can lead to death in the evening, or even death in the evening, and some may not necessarily die in the evening, but may die in half an hour or a few minutes, so the condition of syncope is very serious, so it is called true heart pain and syncope, which is the real pain in the heart area.

But the heart pain that is commonly referred to is not necessarily in the heart, the tip of the heart, but can also be in the place under the jaws of the sword where the pain is.

Lung fever, equivalent to pneumonia and acute pneumonia in Western medicine, also has chest pain. This is the name of the disease in Su Wen – Heat Theory. In Chen Pingbo’s “External Sensation – Wind and Temperature Diseases”, it is also mentioned that wind, temperature and lung fever are equivalent to pneumonia and acute pneumonia in Western medicine. Canker soreness and pains in the ribs are equivalent to intercostal neuralgia, lung cancer, trauma to the chest, etc., all of which can lead to chest pain.

(3) Hypochondriac pain

As the liver and gallbladder reside in the chest, the pathology of the liver and gallbladder, and the pathology of the liver and gallbladder meridians can all lead to chest pain.

Liver disease, gallbladder disease, Western medicine speaks of spleen disease, but we in Chinese medicine say that both sides are liver and gallbladder, the part of the liver meridian belongs to. The most common causes are heat, dampness, fire, yin deficiency, and drink evil stopped in the chest gap (fluid in the chest cavity, called hanging drink in Chinese medicine), and so on, all of which can lead to hypochondriac pain. In particular, lesions of the liver and gallbladder, bile disease, gallstones, biliary distension, liver fever, liver carbuncle, liver accumulation, liver turbidity, liver cancer, all of these can lead to hypochondriac pain.

(4) Stomach and epigastric pain

Pain in the area of the stomach and epigastric region, a little bit below the Jiantu, is most often a stomach ailment, and as a localization, it is most often located in the stomach. But sometimes not only the stomach, but also the gallbladder can be located in this area. The pathogenesis is most often a loss of harmony of the stomach qi and a lack of qi flow.

The pain in the stomach and epigastric region should be divided into deficiency and reality, that is, whether it likes to be pressed or refuses to be pressed, whether it is a vague pain or a severe pain, divided into deficiency and reality. The most common causes, such as gastric ulcer, gastric impotence, such as impotent gastritis, gastric impotence, perforation of the stomach and epigastrium, gastric cancer, cancer of the stomach, etc., can lead to the common, the most common. In addition to that, such as food accumulation, can it be? Is it okay to eat poorly and get cold? After eating spicy food and drinking strong alcohol, even his stomach hurts, all of which can be caused by pain in the stomach and epigastric region, which is usually located in the stomach.

(5) Abdominal pain

The scope of “abdomen” is very wide, and there are some distinctions such as large abdomen, small abdomen, lesser abdomen, and around the umbilicus. According to the location of the pain, the internal organs are determined; according to the nature of the pain, the nature of the lesion is determined. Stabbing pain, swelling pain, wandering pain, scurrying pain, metastatic pain, there is also a metastatic pain in Western medicine, and so on, according to the nature of the pain, to identify the nature of the lesion.

There are many causes and many types of diseases. Intestinal carbuncle, intestinal paralysis, intestinal knot, diarrhea, gas abdominal pain, etc., many, many diseases can cause abdominal pain.

(6) Back pain

The back is the area below the large vertebrae, including the scapula, and above the rib cage. The back is the area where the foot and solar bladder meridians pass through, and in the middle there is the spinal cord, and the Directing Vessel travels in the spine, so it is mostly the area of the bladder meridians, the Directing Vessel, the spinal cord, and the spine.

The most common causes of pain in the back are cold condensation of the solar meridian, cold dampness obstructing the directing meridian, and damage to the meridians. Pain in this area can also diagnose lesions of the internal organs. Since there are acupoints of the internal organs on the back, such as the acupoints of the bladder, large intestine, stomach, gall bladder, kidney, and spleen, which acupoints have pressure and pain points on them may be related to which organs.

(7) Low back pain

The lumbar area is the area below the rib cage and above the buttocks, and the lumbar area is the capital of the kidneys, and the Belt Vessel surrounds the lumbar area, so when there is disease, it is most likely to reflect lesions in these areas. Kidney deficiency, injuries to the tissues of the belt and meridians, fractures of the lumbar vertebrae, etc. can all lead to pain.

(8) Pain in the limbs

Pain in the extremities, hands and feet is still an unfavorable condition of the meridians, meridians, tendons and bones. Depending on which meridian circulation part and which joint the pain is, most of the pain is blocked by the evil of wind, cold, dampness and heat.

Joint pain, limb pain, Chinese medicine believes that most of the time it is the attack of wind, cold and damp evil, in addition to trauma and other causes, a very common cause of wind, cold and damp evil. Western medicine also recognizes that the disease is called rheumatic arthritis, rheumatic myositis. In fact, this name is not very appropriate in Chinese medicine, which believes that paralysis is a combination of three types of evil, wind, cold and damp, and is formed together.

In the Su Wen – Theory of Palsy, it is said that “the three types of wind, cold and dampness come together and become paralysis”. It is cold, but Western medicine does not mention cold, wind-cold-damp does not talk about cold, only about wind-damp, adopted the name of wind-damp, and after adding a word Yan, rheumatic arthritis, rheumatic myositis, Yan is what, two fires, Yan is two fires added there, that is, it is talking about wind-damp heat, therefore, not wind-damp cold, not wind-cold-damp, there is such a difference, the name has such a difference, this may be the time When translating, the problem of not translating well.

The causes of pain in the extremities, in addition to the general wind-cold-damp, can also be caused by phlegm-damp and blood stasis. This is a manifestation of kidney deficiency, and it is not uncommon for this kind of patient to have osteophytes in the heel bone, and for older people to have pain in the heel, or soreness in the tibia or knee joint, or weakness in the waist and knee, which is considered by Chinese medicine to be a manifestation of kidney deficiency.

(9) Circumferential pain

Body pain refers to pain in many parts of the body, body pain, it is not clear where the pain is, but the pain is felt all around the body.

Most of the circumferential pains in new diseases are actual evidence, feeling evil, external sensation, headache and body pains are most common; those who have been ill for a long time and are bedridden for a long time may be deficiency evidence, or may be a manifestation of poor flow of qi and blood.