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Pain: A TCM Perspective

Pain, that unpleasant experience that is capable of taking your joy out of life. Perhaps it causes you to not sleep well at night or suffer from poor focus and concentration. You may live with it on a daily basis, yet only occasionally do you feel it is unbearable. In Chinese Medicine, a person's experience of pain can be an incredibly important aspect of assessment and treatment as there are many different qualities of pain that point different causal factors. In this article I will provide a overview of the categories of pain, possible causes, and ideas for improved health.

First, I would like to provide a brief discussion of pain as empty or full and of hot or cold origin. Empty pain generally relates to deficiency, is relieved by pressure, and displays less intense, [dull] aches and pain. Pain of the full type relates to excess, accumulation and external pathogens; it is aggravated by pressure, and will be sharp, shooting, and localized. Pain that is relieved by cold is considered to be caused by heat, while pain that is relieved by heat is considered to be caused by cold. With this understanding of categories, I will move on to a discussion of specific roots, or causes, of pain.

In this next section, I will discuss 6 primary roots of physical pain in the body. These are qi stagnation, blood stasis, accumulation of dampness, cold, heat, and fire. While there may be shared symptoms and signs, there are also many differences. Discerning the different types of pain is a valuable skill, so as to formulate the best care or “treatment” strategy that will help an individual feel better.

Qi Stagnation

Qi is that immaterial stuff that makes life tick; qi is the motive force of life. Yet, even with qi, it is said that too much of a good thing can be bad. When qi stagnates it impedes the smooth flow of substances in the body, creating excess build up that leads to illness and pain. To illustrate this dynamic, I will use a similar example to the strawberries comparison that instructor Joseph Carter utilizes. This year’s New England gardens yielded inordinate amounts of tomatoes. Everywhere I turn, people are begging to give away their tomatoes. Certainly tomatoes are wonderful, filled with valuable nutrients such as lycopene and vitamin C. However, when one has too many tomatoes, they may turn moldy and rotten before there is time to eat or preserve them. Thus, the tomatoes become uneatable and cease to provide the healthy nutrients and enjoyable flavor for which we love them. In the human body, qi stagnation may cause pain that comes and goes, especially if emotional stressors (e.g. anger, frustration, resentment, worry) play a role. The pain may be dull and persistent or strong and sharp. Excess physical activity leads to qi stagnation as seen in repetitive stress injuries; in such cases, eliminating the activity will help the healing process. On the other hand, a lack of exercise and movement can lead to pain related to qi stagnation for which movement and exercise are beneficial.

Blood Stasis

In other words, the blood stops moving smoothly and freely in a particular area of the body, causing fixed pain that is deep, stabbing, and strong. If qi is stagnant long enough, it can readily lead to blood stasis. Excess cold or heat, Deficient qi or blood, as well as a build up of phlegm, can all cause blood stasis. [Phlegm is especially likely to induce problems in the head or brain, perhaps causing severe headaches.] Physical trauma that causes internal damage, such as broken bones, may lead to internal bleeding. As the blood ceases to circulate, it causes severe pain in the local area where the stasis occurs. When blood stasis is the cause of pain, it is important to improve circulation in the local area through movement or gentle massage in the direction of natural circulation. If cold is the cause, then warmth may be a powerful tool to encourage smooth flow of blood. For instance, this is seen commonly among women applying heat packs during painful menses cramping.

Internal Damp Accumulation

This occurs when fluids are neither moving smoothly for proper uptake into cells nor for elimination. Instead, the excess fluids pool in the body. While fluids in the body are important for well-lubricated joints, supple soft tissue, and healthy elimination, an accumulation of fluids and dampness is counter to health. To illustrate, let’s create an analogy of accumulated dampness to stagnant water. Imagine in the heat of summer, all you want to do is jump into cool refreshing water. However, if your only choice is a stagnant accumulation of murky water, then suddenly remaining hot, sticky, and sweaty sounds better. Stagnant, accumulated fluids cease to nourish the body, but instead create dis-ease and dis-comfort; dry joints and soft tissue, though not healthy, may feel less painful than the excess damp. Dampness occurs in joints, muscle tissue, the skin, and head. Often it is seen in the lower extremities and hands, though it may also occur in the face and chest. Dampness is likely to cause generalized muscle or joint aches, as opposed to unbearable pain that is more common in blood stasis. However, similar to blood stasis, it is important to encourage the healthy circulation and elimination of fluids. In many instances this may include strengthening and motivating qi in the body.

Internal Cold

Capable of generating strong pain with cramping, cold may halt the smooth flow of body fluids, blood and qi in the body. If it is caused by an external source that moves inward, the pain is likely to be quite severe as in a full condition. However, in cases of Yang deficiency, the situation is considered empty and pain will be somewhat more moderate. If you wake in the morning with stiffness and pain, this may relate to internal cold in which the body’s natural warmth is not circulating effectively throughout your system. The deep cold of winter makes it easy to imagine how internal cold may affect the body; during the winter months, muscle pain occurs as we “brace” ourselves and stiffen up to face the cold. Recently, I was swimming in cold ocean water and felt a similar quality of pain with the initial shock of bracing for the cold waves crashing in upon me. In time, my body acclimated, allowing me to relax and enjoy the incredible ebb and flow of waves. However, as I stayed in longer, my toes became cold and slightly painful to move. I then knew it was time to warm up in the sun!

Heat and Fire

Heat and Fire may cause such problems as painful, burning eyes or painful, itchy, dry, or scratchy throat, and burning ulcers of the tongue, mouth, or stomach. Pain from heat will be less severe than pain from the more full condition of fire. In such cases, it is important to eliminate the heat or fire. To illustrate, think about the last time you warmed up by a fire or sat roasting marshmallows by a campfire. You can sit close for a period of time, but eventually, it feels as if your skin and body hair is beginning to burn. The only way to alleviate this discomfort is to remove yourself from the heat or fire source. When heat or fire give rise to body pain, the causes may include emotional stress, dietary (excessive hot spices or greasy foods, excessive alcohol), external conditions (sun, fire, central heat, etc.), or external pathogens (infections).

As you can see from these different qualities and causes of pain, there exist some crossover in how best to alleviate the pain. However, there are many differences as well. For instance if qi stagnation is caused by overuse, the steps for healing would be very different than in qi stagnation caused by lack of exercise and movement. Practitioners of Traditional Chinese Medicine gather information from clients and patients to help identify the roots of pain, so as to apply the best course of “treatment.” In so doing, individuals are often able to find deep and profound improvement of painful conditions.


Kaptchuk, Ted J., O.M.D. The Web That Has No Weaver. Chicago, IL: Contemporary Books, 2000.
Maciocia, Giovanni. The Foundations of Chinese Medicine. 2nd ed. London: Elsevier Limited, 2005.
Wiseman, Nigel and Ellis, Andrew. Fundamentals of Chinese Medicine. Brookline, MA: Paradigm Publications, 1996.

May peace be upon you!