Understanding chronic pain and fatigue from a Chinese medical perspective

Matthew Wagner, C.A., M.S.O.M.

Let’s talk about pain from a Chinese medical perspective. What is it? Why does it occur? How do we manage it? 

First – what is pain?

In broad strokes, pain is the result of lack of movement – in other words, stagnation. The blood and fluids that circulate in both the vessels and the tissues, for whatever reason, stop moving. (We’ll get into why below). This creates congestion and pain.

In Chinese Medicine, pain is categorized in the following way (keep in mind this is simplified):

1) Is the pain “too much” or “too little”. Another way of saying this is – is the lack of movement that is causing pain due to there being too much of something (i.e. something getting in the way), or, is it due to too little (i.e. not enough substance to move in the correct way).

2) Is the pain hot or cold? In other words, is the lack of movement causing pain due to too much heat or too much cold? (Or, is it due to not enough heat, or not enough cold? I know that sounds the same, but it’s not.)

3) What is the nature of the pain? For example, if pain is due to lack of movement, what is it that is not moving? Is it qi or blood? Qi refers to a functional aspect of the body. Blood refers to a nutritive/substantive aspect. Qi is a more rarified dynamic process. Blood is an actual substance. Therefore, the types of pain will be different. The pain of qi stagnation will be dull (it can still be intense), with unclear borders. The pain of blood stagnation is sharp, with clearly defined borders that you can point to.

4) Is the weather/climate a factor? Everybody is profoundly influenced by the environment. So, is the weather a factor? Is the pain worse with cold? Does the area swell with changes in humidity? Is it worse when it’s windy? Do you know when a storm is coming? Etc.

Let’s take some examples.

Patient #1 – Age 60. The patient presents with dull shoulder pain, which is worse with movement, better with heat, and has accompanying loss of strength.

What type of pain is this?

The pain is dull, which means qi stagnation. It’s worse with movement and there is loss of strength. This means the condition is deficient. It is better with heat. This means exactly what it sounds like - there is not enough heat in the area.

This, then, is pain due to qi and blood deficiency with lack of warmth. So we see lots of deficiency. This condition needs to be warmed and supplemented.

Patient #2 – Let’s keep everything the same and change the pain from dull to sharp, and make the pain not only better with heat, but worse with cold.

Age 60. The patient presents with sharp shoulder pain, which is worse with movement, better with heat and worse with cold, and has accompanying loss of strength.

What type of pain is this?

The sharp pain means that now it is due to blood stagnation. Worse with cold means there is excess cold. There is still weakness indicating qi and blood deficiency. This is a mixed excess/deficient condition. This condition needs to be gently moved/dispersed, strongly warmed, and mildly supplemented.

Patient #3 – Age 16. This patient has an acute knee injury. The pain is sharp, with clearly defined borders. The patient cannot extend the leg. There is no loss of strength. The pain is not made better with heat or cold.

What type of pain is this?

This pain is purely due to blood stagnation. This is a pure excess condition. This condition needs to be strongly moved and dispersed.

Patient #4 – Age 45. This patient has rheumatoid arthritis. The pain is in the joints. The pain is sharp. The joints are hot and swollen. There is no loss of strength.

What type of pain is this?

This pain is due to blood stagnation with heat. This presentation is a little bit more complicated than the others due to the swelling. The swelling means there is an additional lack of fluid movement. This condition needs to be moved and cooled, and excess fluids need to be drained.

So, hopefully, these quick examples show you that there are many different types of pain. These different types of pain all have to be treated in a different way. More importantly, treating them incorrectly can make them worse.

Reasons for the body’s susceptibility to pain

Acute pain tends to be much simpler than chronic (although this is not always the case). Chronic pain, by its very nature, tends to be more complicated and slower to resolve. In both cases, however, pain only manifests if there is a bodily weakness that allows it to do so. Of course, we’re not talking about the acute trauma of injury. Rather, we’re talking about the nagging pains that develop over time.

If pain is lack of movement of the fluids on the exterior of the body, what is causing that lack of movement? In acute cases, typically the pain is caused by excess. In other words, something obstructs normal processes. For example, you may get a cold with body aches. Or, maybe you sleep under a drafty window and get a neck ache. This causes obstruction of otherwise normal movement of blood and fluids. Chronic pain is more generally due to deficiency. This means that there is too little fluid on the surface of the body to move correctly. You can think of it like a garden hose. If the faucet is open, the water flows out freely. If the faucet is only partially open, only a trickle will come out and the water doesn’t get to where it needs to be to do its job. In the body, this lack of movement causes pain.

Causes of chronic pain

If chronic pain is due to lack of movement of fluids on the exterior, what is causing this lack of fluids? To answer this question, we need to know where the fluids are generated to begin with.

All fluids – (blood, humor, thick and thin liquids, etc.) – are generated in the interior of the body. In Chinese Medicine, this is the dynamic relationship of metabolism and catabolism. This is how the body breaks some foreign substance apart and builds it into something new as part of the body itself. (This covers lot of different Allopathic medicine concepts of digestive and hormonal functions.) If the interior of the body is too weak to break apart food substances and build healthy fluids out of them, then the exterior of the body will consequently be weak, easily obstructed, and prone to pain. Your body’s ability to generate these healthy fluids depends on the strength of your digestion and your basic bodily vitality (i.e. how well you’ve taken care of yourself over time). You can imagine that the two are very closely related.

Causes of interior weakness

The interior is weakened, or taxed, by stress, diet, and “overdoing”.

Stress is fairly obvious. Anything that puts us into fight or flight mode takes away from calm, healthy internal function. Even stressful thoughts and feelings will shunt healthy blood and resources from your organs to your peripheral muscles. If you’ve ever gotten a stomachache from eating while stressed, you know what this feels like. Over time, this can have some serious consequences.

Diet is a little trickier, because there are so many misconceptions, different points of view, and “one size fits all” ideas out there. From a Chinese medical point of view, a “bad” diet that weakens the interior is a diet filled with things that are hard to digest. These things are mostly things that cold. In other words they take more energy away than they give, and cause lack of strength and tone.

These cold things are:

  • Raw foods (especially vegetables)
    • Especially nightshades, cucumbers, and melons
  • Large amounts of sugar
    • Even large amounts of sugar found in tropical fruits like bananas and pineapples
  • Improperly prepared grains and beans. For example, grains and beans that are not soaked, cooked, or fermented long enough.
  • Dairy. (You can deny it all you want, but deep down, you know this is true)
    • There is a spectrum – fresh milk is worst, aged cheese is not as bad.

Many people have resistance to making dietary changes and may think that some of these things are actually good for them. Salads seem to be particularly hard to come to terms with. It’s true that some of these things may make you feel ok in the moment. However, they will drain you in the long term. So, it’s important to think about how you’ve felt over time. How have you felt over the last several months? The last several years? How about the last few decades?

Overdoing is another commonly misunderstood problem. This definitely includes overwork and under-sleep. However, this also includes two things you may not commonly think about; over-exercising and over-sweating.

In general, the American culture is “more is better”. So, if running a mile is good, running a marathon is better. In fact, I think it’s safe to say that the workout culture in America is one of, “if you don’t hurt after exercise, you’re lazy”. Maybe this is better summed up with the phrase, “no pain, no gain.” However, if you’re reading this article, I’m sure you know for yourself that if you never allow yourself a chance to recover, you’ll quickly burnout. This burnout is not just exhaustion – it’s pain.

Over-sweating is a little more interesting, because it’s not something that people commonly think of, yet, it is hugely impactful. Sweating is the loss of fluid. As was just explained, too little fluid leads to lack of proper movement. Lack of proper movement equals pain. In a young, healthy individual, sweating doesn’t create any problem whatsoever. However, in someone who has weak fluids already, this extra loss of fluid can easily make pain much worse. In this situation, someone may do moderate, or even light cardio and develop calf cramping, insomnia, and widespread aches and pains that same day. This is, in fact, fairly typical of someone suffering from fibromyalgia and chronic fatigue.

Over-sweating happens not just with exercise, however. It can actually happen more easily with hot baths and saunas. This is very important to note, because people in chronic pain typically rely on hot baths and saunas to relieve pain. Unfortunately, while forcing a sweat will momentarily make someone feel better, that constant depletion will make them feel continually worse and worse, setting up a vicious cycle. Worse still, due to the nature of TCM fluid movement in the body, overly draining the exterior will also weaken the interior and make digestion worse over time.

Over-medicating

Another important consideration is the effects of the very medications that are designed to treat pain in the first place. In a TCM framework, these medications (primarily opioids and NSAIDs) are classified as “cold” and “blood moving”. From this point of view, they would work great for intense pain due to acute injury with swelling and inflammation. In fact, herbs with similar effects are often used in exactly this same way.

However, thinking back to our classification of pain, if these medications are “cold” and “blood moving”, they must treat conditions of heat and blood stagnation. What will then happen if they are erroneously given to pain conditions that are due to deficiency and cold? They will further weaken the body, and make the pain worse in the long run, create rebound pain, and eventually create dependency. Just like with over-sweating, they will also weaken the interior of the body and create numerous digestive complaints.

Treatment

Overcoming chronic pain can be a long road, so it is very important to not get discouraged, and to track how you feel over time. Don’t give so much weight to how you feel on a day-to-day basis. Rather, how do you feel over weeks and months? It is often helpful to track this on a calendar.

It is important to make lifestyle changes to break the cycle of pain. Proper diet is essentially. Take this very seriously. Don’t eat foods that weaken and drain you, such as things that are raw and cold. Be sure to get enough dietary fat and protein. Supplement your diet with herbs and spices that improve digestion, such as ginger, fennel, anise, cinnamon, cloves, nutmeg, cumin, and cardamom, etc. You can add herbs that mildly promote the movement of blood, like turmeric.

Stay warm and protected from the cold. Cold causes muscles to constrict and stops blood flow. It will aggravate pain and make it harder to heal. It should be avoided in most cases. Always keep your back and neck warm, as well as your joints, especially if you are out in the wind.

Avoid over-sweating. Especially avoid going outside if you have been sweating, or have just taken a bath or shower.

Consider that pain medication may be getting in your way of being pain free and may be impacting your digestion. Opiates can create rebound pain, making it hard to tell what is actually causing your pain. It may be a good idea to speak with your prescribing physician about what a tapering plan may look like. Strong topical analgesics, such as tiger balm, may help in the interim.

Gentle, prolonged stretching of the muscle will help to relieve pain. Gentle yoga, done at your own pace and comfort level can be very helpful. Qi gong will help, as well.

Light to moderate pressure self-massage will help to move tension and stagnated fluids out of the body. Be careful that the massage is not too intense, or it may make the pain worse.

Acupuncture and Chinese Herbology are essential in the treatment of pain. Chinese Herbology can greatly shorten recovery time, provided the patient is not taking any pharmaceuticals that would prohibit their use. Acupuncture will take longer, and in the beginning, it will require multiple treatments close together. Depending upon how weak a person is, it may be necessary to spend the beginning phase of treatment working on rebuilding energy and vitality, before working on the pain itself. Normally, in the beginning, the effects of acupuncture will last about 3 days. Therefore, it is essential to not go too long between treatments. Our goal is to reduce pain and improve quality of life. To do this, acupuncture therapy builds on momentum.

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If you know of anyone who could benefit from this information, please pass it on!

If you’d like to see how acupuncture and Chinese Medicine can help you, send me an e-mail or give me a call!

Make your acupuncture appointment today with Matthew Wagner, L.Ac. at Medicine Grove Acupuncture Clinic in Madison, Wisconsin.

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