3 Inquiry of pain
Pain is a commonly encountered subjective symptom in clinical treatment. Pain may appear at any part of the body. It may be caused by sthenia, such as invasion of exogenous pathogenic factors, or qi stagnation and blood stasis, or stagnation of phlegm, or retention of food, or parasitic infestation which obstruct the meridians, prevent qi and blood from normal circulation and consequently bring apain. It may also be caused by asthenia, such as insufficiency of qi and blood, or consumption of yin essence which deprives the viscera and meridians from nutrition
and cause pain.
Inquiry of pain includes such aspects like the location, nature, degree and time of pain as well as personal aversion and preference.
1,3.3.3.1 Inquiry of the pain location
This can enable one to understand which viscus or meridian the pain is located.
Headache: The three yang meridians of both the hand and foot are directly connected with the head, the liver meridian also extends to the head, the other yin meridians are indirectly connected with the head. The location of pain over the head can enable one to decide which meridian and which viscus are involved. For example, if neck is involved in headache, it is a problem related to the taiyang meridian if pain appears on both sides of the head, it is a problem related to the shaoyang meridian and also connected with the gallbladder and triple energizer; if pain appears over the forehead and supraorbital bone, it is a problem related to the stomach and intestines; if pain appears over the vertex, it is a problem related to the jueyin meridian and connected with the liver. The causes of headache are various. Headache of sthenia syndrome is usually caused by such factors like attack by exogenous wind, cold, summer-heat, dampness, pathogenic fire as well as obstruction or disturbance of the upper orifices by phlegm and blood stasis. Headache of asthenia syndrome is usually due to insufficiency of qi and blood and depletion of essence and marrow which fail to nourish the head. The causes and the types of headache should be analyzed according to the nature of headache and the accompanied symptoms.
Chest pain: The lung is located in the chest, so chest pain is usually seen in heart and lung problems. The precordial pain or pain involving the inner side of the arm indicates that the location of the pain is in the heart due to asthenia of heart yang and qi as well as stagnation of qi and blood; distress and puncturing pain over the precordiurn is usually due to blood stasis in the heart vessels. Pain over the chest means that the location of pain is in the lung due to exogenous pathogenic factors invading the lung or retention of phlegm and fluid in the lung which prevent qi fro smooth flowing ; chest pain with expectoration of foul sputum mingled with pus and blood indicates lung abscess due to exuberance of pathogenic heat in the lung which stagnates qi and blood and putrefies blood to cause abscess.
Hypochondriac pain: The liver and gallbladder are located in the hypochondrium. The liver and gallbladder meridians circulate to the sides. Therefore, hypochondriac pain is often related to liver and gallbladder disorders. For example, hypochondriac pain is often seen in such disorders like liver depression and qi stagnation, damp heat in the liver and gallbladder, exuberant heat in the liver and gallbladder and retention of fluid in the hypochondriurn, etc.
Epigastric pain: Epigastrium refers to the part below the xiphoid process where the stomach is located. Epigastric pain is usually caused by failure of the stomach to descend food and stagnant flow of qi due to cold, heat, retention of food in the stomach and qi stagnation, etc. Stagnation leads to pain. If pain becomes worsened after intake of food, it is a sthenia syndrome; if pain becomes alleviated after intake of food, it is an asthenia syndrome.
Abdominal pain: Abdomen may be further divided into large abdomen, small abdomen and lower abdomen. The part between the epigastrium and the navel is large abdomen; the part between the navel and the margin of pubic region is the small abdomen where the kidney, bladder, intestines and uterus are located; the two sides of the small abdomen are lateral part of small abdomen where the liver meridian penetrates. Besides, pain over the lateral parts of the small abdomen is also related to the large intestine disorder, The causes of abdominal pain are various. Sthenia syndrome of abdominal pain is usually caused by cold stagnation, heat retention, qi obstruction,blood stasis, retention of food and parasitic infestation, while asthenia syndrome of abdominal pain is usually caused by asthenia of qi, blood and yang, etc. In the examination of patients with abdominal pain, inquiry should be done together with pulse taking in order to exactly locate the region of pain and decide the viscera involved and differentiate the cause and nature of the problem.
Backache: Backache with inability to stretch or bend the back is often caused by impairment of the governor vessel; backache involving the neck is usually caused by retention of wind cold in the taiyang meridian; aching pain of the shoulder and back is usually caused by obstruction of wind and dampness which obstruct the meridians.
Lumbago: Pain over the spine or over the waist and sacrum is often caused by obstruction of cold and dampness, or Obstruction of the meridians by blood stasis, or asthenia of the kidney. Lumbago involving the lower limbs is often caused by retention of cold dampness in the meridians which stagnates qi and blood. Stiff and painful loins due to falling or sprain marked by immobility and inflexibility is usually caused by obstruction of blood stasis. Dull pain over the sides of waist with slow onset is usually due to asthenia of the kidney.
Pain of the limbs: Pain of the limbs is usually caused by invasion of wind, cold and dampness, or by accumulation of damp heat which obstructs the circulation of qi and blood. Pain of the limbs may result from weakness of the stomach and the spleen which fail to transport cereal nutrients to the four limbs. Pain over the heel or aching pain over the legs and knees is usually due to asthenia of the kidney, often seen in the aged and weak people.
General pain: General pain in the new disease is usually of sthenia syndrome due to attack by pathogenic wind, cold and dampness. General pain in prolonged disease is of asthenia syndrome due to deficiency of qi and blood which fails to nourish the body.
1.3.3.3.2 Inquiry of the nature of pain
The nature of pain varies due to the cause and pathogenesis. So the inquiry of the nature of pain is helpful for differentiating the cause and pathogenesis of disease. Generally speaking, pain in new disease is serious, constant and unpalpable. Since it is caused by sthenic pathogenic factors, it is of sthenia syndrome. While pain in chronic disease is mild, intermittent and palpable, Since it is caused by asthenic pathogenic factors, it is of asthenia syndrome.
Distending pain: Pain accompanied by distension is caused by qi stagnation. If distending pain appears now and then over the chest, hypochondrium, epigastrium and abdomen, it is caused by qi stagnation. However, distending pain of the head and eyes is usually seen in hyperactivity of liver yang or up flaming of liver fire.
Stabbing pain: Stabbing pain is a sign of blood stasis, usually appearing over the chest, hypochondrium, epigastrium and abdomen due to blood stasis.
Wandering pain: Wandering pain means that the pain is not fixed and is migratory. Wandering pain of joints is usually seen in obstructive disease due to wind and dampness attack. Wandering pain over the chest, hypochondrium, epigastrium and abdomen is often caused by qi stagnation.
Fixed pain: Fixed pain over the chest, hypochondriurn, epigastrium and abdomen is often caused by blood stasis. While fixed pain of the limbs and joints is usually seen in the obstructive disease caused by cold and dampness.
Cold pain: Cold pain means that the pain is accompanied by cold sensation and preference for warmth, aggravated by cold and alleviated by warmth.Serious and unpalpable cold pain is caused by sthenic cold which obstructs the meridians; while mild cold pain with preference for warmth is caused by asthenic cold due to insufficient yangqi which fails to warm the body.
Scorching pain: Scorching pain refers to pain with burning sensation, preference for cold and aversion to heat. Serious and unpalpable scorching pain is of sthenic heat syndrome, usually caused by invasion of pathogenic fire into the meridians; mild scorching pain with preference for palpation is of asthenic heat syndrome, often caused by exuberant fire due to yin asthenia which impairs the viscera and meridians.
Colic pain: Colic pain means sharp pain, often caused by substantial pathogenic factors obstructing the activity of qi or coagulation of pathogenic cold obstructing qi activity. The examples are "angina pectoris" due to obstruction of the heart vessels, small abdominal or lumbar colic pain due to obstruction of the urinary duct by calculus, colic pain of the epigastrium and abdomen due to invasion of pathogenic cold into the stomach and intestines.
Dull pain:Dull pain means that the pain is not sharp and tolerable, but constant. Dull pain often appears over the head, chest, hypochondrium, epigastrium and abdomen due to consumption of essence and blood, or insufficiency of yangqi and endogenous exuberance of yin cold which deprives the body of warmth.
Heavy pain: heavy pain usually appears over the head, limbs and loins due to pathogenic dampness preventing qi from flowing. However, heavy pain of the head may also be caused by hyperactivity of liver yang and accumulation of qi and blood in the upper.
Dragging pain: Dragging pain usually involves other parts of the body due to malnutrition of the meridians or obstruction of the meridians. Since the liver governs the tendons, dragging pain is often caused by liver disorder.
Vacuous pain: Vacuous pain usually appears over the head or small abdomen, often caused by consumption of qi, blood, essence and marrow as well as malnutrition of the viscera and meridians.
