People have often formed their own ideas of what might be causing their pain, and two common notions are:
- Something is "out of place".
- Something is "blocked".
I have a culturally diverse patient base, but within it this idea seems to be quite widely and diffusely prevalent. It is the notion of what is blocked that differs. Among my patients the difference lies along the cultural divide between:
- Those who are significantly influenced by what are called "New Age" ideas.
- Those not significantly influenced by the above.
It is the energetic "folk" explanation which I want to examine. In particular, I want to consider how it compares with (i) an influential branch of oriental medicine, that is, Traditional Chinese Medicine (TCM), and (ii) Western scientific concepts.
The folk explanation, so far as I understand it, is that energy flows through the body, and areas of muscle or joint pain indicate places where the energy is not able to flow through; it is "blocked" and so it accumulates.
In TCM, according to Royston Low*, the Bi syndrome signifies "a blockage and inteference with the circulation of Qi and blood in the meridians, giving rise to pains, aching and stiffness in the muscles, joints, bones and tendons". It is seen to cover "more than purely rheumatic or arthritic conditions, for the pains of sprains and similar traumatic conditions are also due to a blockage in the flow of qi and Blood, and these also will come into this category". If not of frankly traumatic origin, Bi is said to be caused by the invasion of an external influence, specifically wind, cold or damp. Any of these can be transformed in the body into heat, hence inflammation.
In Western medicine, the most common benign forms of musculoskeletal pain are often explained in terms of:
- Sprains and strains: where there is some actual lesioning, gross or microscopic, to soft tissues.
- Inflammation: a consequence of the above, where chemicals are released from damaged tissues to enhance local blood flow and attract white blood cells which scavenge damaged cells.
- Hypertonus: an excessive state of muscle tone. In simple terms, the muscle is more contracted than it should be at rest.
- Neural sensitisation: where nerves conveying pain signals become more sensitive. There does not necessarily have to be actual tissue damage for this to happen, it is enough that the nervous system perceives the potential for damage.
With muscle hypertonus, the muscle tissue becomes locally denser (more mass per unit volume), but on the other hand to keep it that way there is an increased local transformation of energy and its loss to the body as heat. The area of hypertonic muscle does constitute an area of altered mobility, where the transformation of chemical energy to kinetic energy is not well integrated with what is happening in its functionally related parts.
In the above situations, there are various processes going on. It would be simplistic to say, in Western terms, that there is an "energy blockage". Rather, there is a locus of altered energetic transformation.
Neural sensitisation, conversely, is not necessarily confined to the area that is painful. It may concern the length of the nerve supplying that area, or the whole of that region of the body, or the central nervous system (brain and spinal cord). In the affected neural tracts, there is not a "blockage" of information flow but, if anything, the opposite: there is a facilitation of flow of information about pain.
In conclusion, while the folk explanation of an "energy blockage" concurs partially with TCM theory, in the terms of Western science it is inexact and simplistic. On the other hand, a simple and exact explanation which fits with both TCM and Western science is that pain indicates either a locus or domain of altered function. The folk use of the word "energy" provides an illusion of understanding, but it is at odds with physical reality. Moreover, I would argue that, as a concept, it affords little practical therapeutic value.
* Low, R., The Acupuncture Treatment of Musculo-skeletal Conditions: A Practical Handbook for the Practitioner. Harper Collins, 1987.