Unified Theory of Pain 

In Chinese medicine, pain is explained by the single statement, 通则不痛, 痛则不通 tong ze bu tong, tong ze bu tong “[With] free-flow, there is no pain; pain is a lack of free-flow.” This key statement of fact is masterful wordplay, with two homophonic phrases except for the tones, and visual resonance between tong free flow and 痛 tong pain—two characters which share a common radical portion. Linguistically, this statement evinces the eloquence of the Confucian scholars responsible for the bulk of the historical Chinese medical literature; theoretically, and much more importantly, these paired phrases offer an elegant, unified theory of pain which is highly useful in clinical practice.

The Devil in the Details of Translation

Unfortunately, Western acupuncturists often misunderstand the true technical meaning of this statement by assuming that 不通 bu tong lack of free-flow is equivalent to stagnation. In fact, Chinese medicine defines stagnation or 滞 zhi in Chinese as inhibited movement of qi or an accumulation of stagnant food, while the meaning of free-flow is broader. Specifically, lack of free-flow not only denotes repletion stagnation and/or stasis but also describes vacuity patterns where yin-blood is too vacuous to flow normally through the channels and vessels. If a clinician assumes that pain always requires moving qi and quickening blood, the presumption may lead to draining vacuity, a serious mistake that could either prevent a good result or even make the patient worse. 

Identifying Primary Causes

Creating effective strategies for resolving pain does not, in fact, stop at differentiating vacuity and repletion. It is also crucial to determine whether the lack of free-flow leading to pain is a primary mechanism or a secondary one. With the exception of patients who have suffered some form of trauma that has physically damaged the channels and network vessels, most pain is not directly caused by qi stagnation or stasis. In fact, there are often several patterns implicated in the impairment of free-flow.

In school clinics, random samplings of files seem to suggest that the most common patterns diagnosed are qi stagnation and/or blood stasis. Given the core statement regarding pain and its clinical prevalence, it may seem reasonable that many acupuncturists default to moving qi and blood for many, if not most, of their patients. Better results are possible, however, using a comprehensive analysis which more accurately pinpoints the primary mechanisms leading to lack of free-flow, thus meeting the Chinese physician’s pledge to “seek the root”.

If we take the Western medical condition of osteoarthritis as an example, Chinese medicine will typically reframe this disease as impediment—a Chinese pathology that implies wind-cold-damp blocking and obstructing the flow of qi and blood.  As a species of joint pain, it makes sense to move qi and blood to restore the free-flow in the channels and vessels and decrease pain, but these treatment methods do not address wind, cold, or damp evils. Best practice in these cases involves dispelling wind-cold-damp, without necessarily moving qi and blood. If the wind-cold-damp lodged in the channels and network vessels is resolved, the flow of qi and blood will naturally be restored.

The unified theory of pain in Chinese medicine is one of the shining achievements of Chinese doctors.  In perplexing conditions (like fibromyalgia), this key theory can help craft solutions for medical conditions which elude modern Western medicine.  Nevertheless, there are no easy, one-size-fits-all remedies in Chinese medicine, so this inspired theory of pain can only provide a foundation for the essential tasks of the Chinese doctor: gathering information, synthesizing and analyzing the data, selecting suitable treatment, and providing proper care compassionately and skillfully. Excellence in Chinese healthcare always demands careful examination, thorough analysis, and administration of appropriate, personalized care.