As stated in the previous chapter, pain in TCM is due to the non-free flow of qi and/or blood. When the qi and blood flow freely, there is no pain. Therefore, it is essential to keep our qi and blood full and moving freely for optimal health and well-being and especially for being pain free.
The flow of qi and blood can become inhibited in any and every area of the body: the internal organs, the muscles, the joints, and the low back. For example, when we overeat and have acute indigestion with the accompanying sensations of abdominal fullness, bloating, and distention, these symptoms are due to the stagnation of stomach qi. In this case, the stomach qi cannot move freely through the excessive amount of food and drink in the stomach. Likewise, when we bruise ourselves and blood escapes from the blood vessels and then pools, we experience a mild form of blood stagnation. In both these cases the stagnation is not serious. We feel better within a short time and are free of symptoms when the qi and blood resume their proper functioning and are flowing freely.
According to TCM, the sensations of pain due to qi stagnation or blood stasis are different. Qi stagnation causes a feeling of distention or soreness that fluctuates in intensity and location. Qi stagnation pain often occurs with strong emotional changes. Blood stasis, on the other hand, is characterized by painful swelling or stabbing, sharp pain at a specific, fixed location.
It is also possible for the qi and blood flow to become inhibited because of insufficiency of the qi, blood, or both. In this case, the pain is not severe but is enduring. If due to qi and blood insufficiency, the pain is worse after rest and better after light use. This is because during rest or immoblization there is insufficient qi and blood to keep the qi and blood moving. Movement itself helps to pump the qi and blood through the area mobilized. Therefore, movement tends to make this type of pain better.
If primarily due to qi insufficiency, then the pain is worse at the end of the day or after excessive exercise. In this case use or exercise has used up the qi and left it even more deficient. Blood insufficiency pain tends to be worse at night after it has been consumed by the activities of the day and when it returns to the liver for storage.
In the TCM diagnosis and treatment of low back pain, a practitioner must answer the following questions:
- Is the pain due to blockage or insufficiency?
- If due to blockage, is the pain more characteristic of qi stagnation or blood stasis?
- What is causing this stagnation?
- What channels or network vessels are primarily involved?
The answers to these questions directly determine what sort of treatment the patient will receive from the Chinese medical practitioner. The basic principle of treatment in Chinese medicine is to restore balance. Therefore, the Nei Jing (Inner Classic) says that if a disease is due to too much, it should be drained; if due to too little, it should be supplemented; if due to heat, it should be cooled; if due to cold, it should be warmed; if due to dryness, it should be moistened; and if due to dampness, it should be dried. Therefore, in TCM, two patients with the same Western medical disease may receive different TCM treatment because the cause of their disease is different. This means that every patient in TCM is given an individualized treatment based on the cause and nature of their particular pattern of disharmony.