This article is based on the Chinese pathology lecture "Positive Negative Pain" given by Dr. J.D. van Buren of the International College of Oriental Medicine. Special thanks to Pauline van Buren for review of this material.
Oriental medicine teaches that there is a relationship between pain and mental function, as well as wind, cold, moisture, fatigue, eating, drinking, the five seasons, the seven emotions and the meridians (main, tendino-muscular, separate, divergent, and eight extra). The cause of a particular pain can be anywhere in that concept.
Dr. van Buren used the tai chi symbol as the paradigm for the classification of pain, positive or yang pain and yin or negative pain. When we look at the tai chi symbol, we see a circle, a wavy line, two comma-shaped halves (one white, one black) and two dots (one white, one black). The representation is on a flat surface and is seen as flat. Dr. van Buren taught us to see the circle as egg-shaped and with depth, held together by the universal spark, the all-comprehending and all-encompassing entity. The wavy line represents time; time is movement and movement is change. When time moves through space, the tai chi symbol is created. The whole of that circle now becomes divided into yin and yang, with a dot of its opposite. This means that each part has a part of its opposite, into which it can change. As you keep in mind the concept of depth of the tai chi symbol, superimpose the body on it. Compress the shape of the body until it is the tai chi symbol. Imagine the six divisions on top of that. If the body is not strong enough, illness passes through each of the defensive barriers until it arrives at absolute yin, chueh yin, yin within yin. It then comes to the nucleus (of tai qi), which brings it to tai yang (most external). This result is called "yin positive."
In a broad sense, air is yang qi and blood is yin qi. Qi and blood are considered as a complete unit (the whole body) or local, as in local stagnation, with duality in each. Thus, there is yang in yang and yin in yin, which comprise negative pain. Yang in yin and yin in yang comprise positive pain.
Yin and yang also is used to identify both the characteristic and location of pain. This relates to the organ and meridian involved. If yang, as in gall bladder, the illness is more external and less serious. If yin, as in liver problem, it is more internal, more serious. Pain of negative or positive also tells us its amount or acuteness. An example of this is sciatica or the potential for sciatica. In yin pain, symptoms include a dull ache, with nothing acute. In general, it is a stoic pain. The patient feels cold, weak and gloomy. The pulse is slow, sunken, slender and slight. This is yin pain and negative, in that it is not that acute. If positive, it is an active pain. Yang pain is dynamic, dominant and related to heat. There is strong pain, and it is active, acute and hot. The pulse is big, floating, overflowing and smooth. Cold implies yin, heat implies yang. Acute inflammations are yang (positive); chronic conditions are yin (negative). A headache can be due to either of them. A cold headache is yin while a hot headache (from fever, for example) is yang.
The emotions are very powerful. Emotions can change structure and pure structure can change emotions. An aggressive, decisive person always leans forward. Think about yang disharmonies. Wearing certain types of clothing and shoes can produce pathology. For women who wear (or wore) high heels, the backside is extended outwards, the head is out, the knees are bent. This posture will exacerbate or produce kidney yin deficiency. I suggest appropriate lifestyle and footwear changes. Observe the shoes for the wear patterns as organ imbalances influence how the person steps and walks.
Pain From Air
The cause of this pain is unseen. It usually is shock and affects the emotional and mental aspects of the patient. The patient will come to the office with mental pain or so-called "nervous pains" such as headaches or stomach, abdominal and cardiac pain. Patient may state that pain is in the chest, but in reality, it is all over. Very often, patients are not aware of their body and the physician must carefully examine all aspects. It generally is a shock, like the death of a loved one or being in an accident that produces that type of pain. This type of shock starts off with stomach pains. A few days later, the meridians and organs are involved, and the patient may not relate to the accident. In the West, the accident and the mental outlook of the patient are not related. In Oriental medicine, this is pain by air. It is unseen and yet affects the emotional and mental health of the person. Treatment is to use the protocol for shock or the luo points.
Pain by Blood
This is due to an accumulation of blood ("effused") or exhausted blood. We differentiate by asking if the pain preceded the effused blood or did the effused blood produce the pain? The basic difference is that if the pain came first, there is a lack of blood. It is therefore necessary to check which came first. Trauma causing stagnation is part of this category as well.
Pain by Water
This occurs as a result of abnormal water metabolism or local pathological exudation in the upper, middle or lower jiao. Examples are arthritic rheumatic nephrotic edema and edema of cardiac and liver diseases. If you press the area with your finger and the indentation leaves, it is positive swelling and more acute than chronic. If you press and a hollow remains, it is negative. Proper acupuncture treatment is focused on kidney yin and getting the qi moving, as well as treating the lung capacity. Liver massage may be helpful as well. Taiji chuan always is a safe recommendation.
Pain by Season and Organ Time
According to the seasons, the perverse climate enters the patient with that element in deficiency. According to time (Chinese clock), pain will come at a specific time. For example, between 5 a.m. and 7 a.m. is the large intestine (colon) time. Keep in mind the midday-midnight law, which is the large intestine/kidney time. The pain of the large intestine may be over- or underactive and may, therefore, go into its opposite - kidneys. This is common in rheumatism and neuralgia.
Pain by the Seven Emotions Goes by the Five Elements/Transformations
For example, if anger is piled up in the liver, it may overflow to the spleen via the K cycle. If terror is pent up in the kidneys, "the smile of the person is large;" that is, the heart reacts in deficiency. If the patient has problems at home, there will be continuous intractable pain unless the situation is talked about. More often than not, the pain is in the hip. According to Dr. van Buren, the hip is not affected by ordinary rheumatism or arthritis. Sometimes there is arthritis alone, and then it progresses to the hip. Often, arthritis also is due to emotional problems at home and is worse at certain hours and seasons, which may be different for each patient. The illness always will hit where there is a weakness. The first symptoms usually will occur at about age 50. If the conditions at home change, the symptoms can leave. More often, it affects women.
Pericardium points are helpful. Also note which part of the hip is involved. If more external, it is gallbladder and relates to the trigram of water. If more internal, it is spleen and relates to the trigram of fire. Both belong to the creative.
Pain Due to Fatigue, Intemperance of Eating and Drinking
An example of this is sciatica due to the cold and wind in winter. If the patient eats grapefruit, which has cold energy, the condition gets worse. It is one thing if the patient does not know which foods or activities will increase the pain, and another if it is known and chosen anyway. It is the physician's responsibility to counsel and teach what is correct.
As seen from the above, the etiology of pain may be developed from a combination of the preceding factors and may be quite complicated. In my clinical practice, the treatment plan begins with making sure the patient has enough qi and is strong enough to receive treatment. If there was shock, it is important to do the acupuncture protocol to remove shock. If the shock is not removed, it will not allow the greatest capacity of healing to take place. Counsel the patient about diet, lifestyle, exercise and management of emotions. Ascertain the energetic origins of pain according to the stems and branches, and continue with the treatment plan.
Wendy can be reached at wendywilliams@shokanten.com or www.shokanten.com.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
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