Pain Management in TCM
June 15 2018 talk at Mead Vale Community Centre
Chinese Approaches to Pain Management
About Sifu Dove
Sifu Dove has been studying Chinese arts for about 30 years directly under Master Lam. Starting in Tai Chi and progressing through various martial, healing and meditative arts. About 7 years ago he started to incorporate Traditional Chinese Medicine (TCM) into his practice under Henry McGrath and George Cooper.
He has taught full time for two years in London and the last 10 in the West Country.
He has specialised in teaching older and disabled students since 2000.
He has worked in health, education and social care settings as a care worker, teacher, project manager and operations manager in hospitals, schools, charities and community education.
He has taught for 4 NHS trusts, in four hospitals, several schools and special schools, for the Parkinson's Society and gives regular talks to interested parties.
When I was thinking about what to focus on in this talk today I reflected on my fundamental approach. What is it that unites all the different aspects of what I do? I teach hard, external martial arts, and quiet, still sitting. I use direct interventions from acupuncture to teaching therapeutic exercise.
There are three main philosophies in China. Philosophy is a better term than religion as it doesn't require loyalty to one at the exclusion of another. You can pick and choose the right idea from the appropriate context for the issue at hand. Confucianism uses a well structured society where everyone knows their role. Buddhism uses a focus on compassion and helping others. Daoism focuses more on allowing the universe to unfold as it does. All three evolved to resolve the same issue - how to live in a complex world. And a world filled with difficulties. There are all sorts of difficulties. These can give rise to suffering and pain. The aim is a reduction in pain and suffering. So the theme is just that. How to reduce suffering. And of all the suffering we experience the one I try to help with on an individual level is pain. So I am going to talk about pain management. New or chronic pain takes all our attention and can become our entire world. A phrase I learnt when I first began teaching older people is-
'When you are young absence of pleasure is pain.
When you are older absence of pain is pleasure.'
I am sure you will find some of this interesting.
What is pain?
In TCM there are three treasures. These are Jing, Qi and Shen. Although they are different they represent different aspects of the same continuum.
This refers to the most material aspect. It includes structures of the body,muscles, bones and blood. It is the chemicals and molecules that Western science easily identifies and studies. We are given Jing by our parents, which is why healthy parents, especially the mother during pregnancy is so important. We replenish it through food and the air we breathe.
Western medicine tends to work on this level, especially with surgery, physiotherapy and pills.
Shen usually translates as spirit, but this is a difficult word. Spirit can refer to something intangible and otherworldly. It can also mean the sum total of our will and fortitude. More like when someone is described as spirited than ghostly. It also includes all aspects of mind and thinking. Things that are undoubted untouchable but also the core of our being. It is built on our experiences and reactions to our experiences. This is replenished through meditation, study, music and walking in the country side.
Western medicine works on this through psychology and psychiatry.
Qi sits between these two. It has both a physical and non-physical element. It is elusive and subtle. There is no real Western equivalent but it is often translated as energy. It is the living movement of the inanimate. It can also refer to our natural constitution. If we have strong digestive Qi our stomachs can take anything. If we have strong Wei Qi we fend of illnesses easily. If they are weak then the opposite may be true. We can replenish Qi from Jing, food and air. We can also do special exercises called Qi Gong. The West has no real ways to do this.
It is like we have two bank accounts, our current and our savings accounts. We are born with our savings account. A gift from our parents and the universe. This is used when our current account is empty. Our current account comes from our Jing, food and air. When our current account is empty we spend our savings.
What do we spend it on? Well, everything we do. And everything has a price. The harder the work the more we spend. More stress costs more. Being ill costs. If you think about it you intuitively know how much everything costs you. As we age we generally become more aware of this as our reserves deplete. We become more cautious of how much we spend and what on.
The phrase used to describe pain in TCM is-
“If there is pain there is no free flow of Qi
If there is no free flow of Qi there is pain”
What this means is that pain is considered a blockage. The Qi circulates in our body in a similar way to traffic in a road system. It is constantly moving. When we have an injury the Qi pools. Like sudden and unexpected road works. A traffic jam starts. This would be felt as initial swelling and bruising after a trauma. Here the first job is to stop the traffic getting worse and disperse it.
Then extra Qi comes to aid the injury. This is secondary swelling. After an injury the swelling may continue to build for quite some time. Effectively the traffic jam really builds up will tail backs and all the side streets fill too. This causes secondary blockages and where there are blockages there is pain.
This story is true for sudden trauma but it is similar for chronic illness. The difference is that slowly the road system degenerates. The traffic flow is sometimes difficult or sometimes clear. This fluctuates depending on how busy we are until the blockage becomes a permanent pain. It goes from a subtle discomfort, to occasional aching to regular and finally non-stop pain.
There are many causes of pain.
Physical injury can be caused by trauma or time. As we age some structures wear out (spend all their Qi). This could be joints or internal organs and blood vessels. The blockages cause pain which is localised and often reduced in certain positions.
Referred pain occurs when an injury causes a chain of tensions which culminate on pressure on a secondary structure. Sciatica is a form of this. A muscle or joint in the back puts pressure on the nerve which sends an incorrect message that the leg is strained.
Illness and disease can also disrupt the free flow of Qi. In TCM these are called External Pathological Factors; Heat, Damp, Wind, and Cold.
Heat is inflammation. It can be systematic but in terms of pain it is usually localised. It will feel hot and appear red. Western treatments often use ice at this stage. However this is not encouraged in China.
Damp will have swelling and a feeling of sluggishness. There may be restriction of movement due to a full feeling. Again this can be systemic but causes pain locally.
Wind is the kind of pain that moves. It causes tremors and stiffness in muscles.
Cold is stationary, worse for cold and dilapidating.
These factors can lead to pathologies known as Stagnation, Deficiency, Excess, and Phlegm.
Stagnation feels sharp and resides in a fixed place. Often experienced as a stabbing pain.
Deficiency feels more dispersed and dull. It may also feel weak and feel much better when supported.
Excess will feel full. Like after over eating or a splitting headache.
Phlegm refers to any nodule or growth. These can be painful directly or by their physical effect on local structures.
So having seen that there are not only many causes of pain, there are also subtle differences in their texture and experience. This means that there will necessarily be different methods to reduce or overcome it. In TCM pain in the body or mind are not considered different and follow similar treatments.
We can also describe their relative strength in terms of a 1-10 scale. This is useful to monitor changes.
In the West we tend to use pills as a first stop for pain. These can have side effects and don't always work. Patches, injections and pumps can also be used. There are pain management clinics both in the NHS and privately. Surgery to cut nerves is often a last resort.
This is massage and gentle manipulation. It is most effective in treating physical injury. Herbs seeped in alcohol are used externally. The herbs are not pain relieving but instead reduce heat or encourage circulation. Different ones are used in different circumstances. Heated bags may also be used. It comes from martial arts and is based on a mother's touch. Something that worked for all of us at one time.
This is the insertion of thin needles in specific points. Local points are known as Asha . These are the places you shout 'Ow Sure' if they are touched. The distal ones are to encourage the traffic away from the injury site. Other points may be used to allieviate causal factors.
This system was recently (in TCM terms recently means the last 20 years or so) taken up by the US military. They have extensively tested it on the battlefield for injured servicemen who do not respond or are allergic to morphine. Small seeds are placed in the ear and massaged. The advantage is they remain in place under tiny plasters.
Chinese herbs are strong and usually used in balanced formulas. Although there are pain relief herbs, most prescriptions concentrate on addressing the underlying causal factors.
A special herb burnt either in cigars near the skin or on the end of needles disperse the accumulated stagnation. By its very nature it is better for Cold conditions. This can be taught for self treatment.
Is a household staple in China. It involves scraping to reduce swelling and stagnation. Unfortunately it leaves bruise like marks which take a few days to dissolve.
This uses gentle flowing movements. Each one works individual areas or long chains throughout the body. The slow, circular and rhythmical nature encourages circulation of blood and other fluids. The soft tissues are gently encouraged to loosen and so the traffic jam disperses by itself. This is especially good for chronic joint pain. It also means that range of movement can be monitored and maintained safely.
The use of static postures may seem odd for reducing pain. It is very useful to build strength where there is deficiency or following trauma. The stillness allows the body time to heal itself.
Ba Duan Jin
This system uses full stretches in all directions of the body. It is very good at breaking blockages. It can also be used for specific areas or internal organs.
A tailored set of exercises for specific conditions can be used. Alternately regular attendance in a class will use a combination of the above to help relieve pain. With time you learn which exercises are the ones that help you. The advantage of exercise is it comes under your own control.
Meditation and Relaxation
There are many methods from simple relaxation to special breathing techniques to help relieve pain. These can be very effective. They are best learnt under supervision as there are many pit falls and you can make matters worse, especially when dealing with emotional pain.
There are many other causes of pain and its severity. The main areas that can affect it are stress, being too busy, emotional problems, too little or too much sleep and diet. Many people also find comfort from their spiritual life.
Emotional and Psychological Pain
As already stated, the Chinese do not separate the mind and body like we do in the West. The Jing can effect the Shen. If you are constantly run down, you will begin to lose will or become depressed. If you are constantly angry your blood pressure will rise and you may suffer headaches.
Using exercise we can use the body to help the mind. It can have a rest while you work out your problems.
There is a concept in China which is not very easy. Old or deep pain requires digging out. Like an old tree stump. This takes hard work. It can also create pain in its own right. In practical terms it means sometimes it gets worse before it gets better. Learning to recognise what kind of pain you are feeling is part of the process.
The best we can hope for is a cessation of the problem, and this is the primary goal.
The next stage is we hope to reduce the problem at least in part.
Following that we aim to maintain what we have.
After that slowing the decay becomes the battle.
Finally we learn to live with the situation and the things we cannot change
We all change throughout life, for life is change. Hopefully using these techniques we will at least be able to make our pain manageable and know we can always do something to reduce our suffering.