Pain

Pain is one of the most common symptoms complained of by the patient. Apart from a thorough understanding of the history and accompanying symptoms and signs, the nature and locality of pain must be asked. Differentiation of the nature of the pain is significant for deducing its etiology and pathology, while identification of the locality of the pain helps determine diseased zang - fu organs and meridians.

Nature of the pain

• Distending pain : Distending pain manifesting as severe distension, mild pain and moving from place to place is a typical sign of qi stagnation. It often occurs in the chest, epigastric, hypochondriac and abdominal regions. But headache with a distending sensation in the head is due to upward disturbance by fire and heat.
• Pricking pain : Pricking pain, sharp in nature and fixed in location, is a sign of stagnation of blood. It usually occurs in the chest, epigastric, hypochondriac and lower abdominal regions.
• Weighty pain : Pain with a heavy sensation is a sign of damp blocking qi and blood, as damp is characterized by heaviness. It is often present in the head, four limbs and lumbar region.
• Colicky pain : Colicky pain is a sign of abrupt obstruction of the qi by substantial pathogenic factors.
• Pulling pain : Pulling pain which is spasmodic in nature and short in duration often relates to the disorders of the liver. It is caused by liver wind.
• Burning pain : Pain with a burning sensation and preference for coolness often occurs in the hypochondriac regions on both sides and epigastric region. It results from invasion of the collaterals by pathogenic fire and heat or from excessive yang heat due to ã in deficiency.
• Cold pain : Pain with a cold sensation and preference for warmth often occurs in the head, lumbar, epigastric and abdominal regions. It is caused by pathogenic cold blocking the collaterals or lack of warmth and nourishment in the zang - fu organs and meridians due to deficiency of yang qi.
• Dull pain : Dull pain is not severe. It is bearable lingering and may last for a long time. It is usually present in cold syndromes of deficiency type.
• Hollow pain : Pain with a hollow sensation is caused by deficiency of blood leading to emptiness of vessels and retardation of blood circulation.

Locality of the pain

• Headache : Head is the meeting place of all the yang meridians and brain is the sea of marrow. Qi and blood of the five zang and six fu organs all go up into the head. If the pathogenic factors invade the head and block the clear yang, or if stagnation of qi and blood in endogenous diseases blocks the meridians and deprives the brain of the nourishment, headache will ensure. In cases of deficiency of qi and blood, head fails to be nourished, and the sea of marrow becomes empty ; headache due to this is of deficiency type. Headache due to disturbance of the clear yang by the pathogenic factor is mostly of excess type.
• Chest pain : As the heart and lung reside in the chest, chest pain indicates the pathological changes of the heart and lung.
• Hypochondriac pain : The hypochondriac region is traversed by the Liver and Gallbladder Meridians. Obstruction or undernourishment of these meridians may produce hypochondriac pain.
• Epigastric pain : Epigastrium ( wan ) refers to the upper abdomen in which the stomach situates. It is divided into three regions, namely, Shangwan, Zhongwan and Xiawan ( upper, middle and lower wan respectively ) . Epigastric pain may result from invasion of the stomach by pathogenic cold, retention of food in the stomach or invasion of the stomach by the liver qi.
• Abdominal pain : Abdomen is divided into upper abdomen, lower abdomen and sides of the lower abdomen. The upper abdomen refers to the area above the umbilicus and pertains to the spleen. The area below the umbilicus is the lower abdomen and pertains to the kidney, bladder, large and small intestines and uterus. Both sides of the lower abdomen is traversed by the Liver Meridian of Foot - Jueyin. So according to the locality of the pain, the diseased zang - fu organs and meridians can be identified.
• Abdominal pain caused by retention of cold, accumulation of heat, stagnation of qi, stagnation of blood, retention of food or parasitic diseases is excess in nature, while that caused by deficiency of qi, deficiency of blood or deficiency of cold is deficiency in nature.
• Lumbago : The kidney resides in the lumbar region. Lumbago may result from obstruction of the meridians in the local area ; besides, deficiency of the kidney failing to nourish the lumbar region is often the cause.
• Pain in the four limbs : Pain in the four limbs may involve joints, muscles or meridians. It is caused by retardation of qi and blood circulation due to invasion of the exogenous pathogenic factors.

Besides, the duration of pain and its response to pressure should also be asked. Generally, persistent pain in a recent disease or pain which is aggravated by pressure indicates syndromes of excess type. Intermittent pain in a prolonged illness or pain which is alleviated by pressure often occurs in syndromes of deficiency type.