Chapter contents

INTRODUCTION

Questions about the body concern mostly pain and numbness. Chest and abdomen are discussed in Chapter 38 and limbs in Chapter 39.

WHY WE ASK

Apart from the question regarding lower backache, which I ask every time I suspect a Kidney deficiency, questions about the body concern mostly symptoms affecting the whole body which do not pertain to any specific area, such as pain, numbness or itching of the whole body or loss of weight or obesity.

WHEN WE ASK

Apart from the question about backache, I generally ask questions about the body only if relevant. In particular, the question about gain or loss of weight is important to give us an idea of the state of Blood and Yin and of the Stomach and Spleen.

HOW WE ASK

The questions about the body concerning numbness, pain or itching are self-explanatory.

ACHES IN THE WHOLE BODY

Symptoms and Signs, Chapter 68

By ‘aches in the whole body’, I refer to aching or pain in most of the joints and muscles; it is not a common symptom. The most important distinction is that according to onset. Aching or pain in the whole body with sudden onset is due to invasion of external Wind and it is therefore accompanied by aversion to cold, shivers, fever and a Floating pulse.

In chronic conditions, the most common cause of aches in the whole body is deficiency of Qi and Blood. In this case, it is accompanied by pronounced lassitude and it is ameliorated by rest.

Aches in the muscles of the body and especially the limbs are usually due to retention of Dampness in the muscles and are frequently seen in ME (postviral fatigue syndrome); in this case, the muscle ache is accompanied by a pronounced feeling of heaviness of the limbs and body. Aches in all the muscles with a hot sensation of the body on palpation are due to Stomach-Heat.

Pain in the arms and shoulders experienced only when walking is due to Liver-Qi stagnation.

In women after childbirth, pain in the whole body is due to Blood deficiency if it is dull or to Blood stasis if it is severe and stabbing.

Box 37.1 summarizes the patterns underlying aches in the whole body.

PAIN IN THE JOINTS

Symptoms and Signs, Chapter 68

Pain in the joints is due to invasion of Wind, Dampness or Cold in the channels of the joints. Joint ache from Wind moves from joint to joint; joint pain from Dampness is fixed and is characterized by swelling and numbness; joint pain from Cold is fixed, usually in one joint only and the pain is intense.

In chronic cases, any of the above pathogenic factors can transform into Heat, Dampness is formed and Damp-Heat accumulates in the joints causing chronic pain. Severe stabbing pain in the joints may be due to Blood stasis.

Box 37.2 summarizes the patterns underlying joint pain.

LOWER BACKACHE

Symptoms and Signs, Chapter 67

Acute pain in the lower back is due either to sprain or to invasion of Cold. If it is due to sprain, the pain is intense, with pronounced stiffness, and is improved by rest and aggravated by movement; this pain is due to local stagnation of Qi and Blood. If the pain is due to invasion of Cold, it is worse with rest, usually worse in the mornings, and is alleviated by gentle movement. Chronic lower backache is due to a Kidney deficiency, in which case the backache is alleviated by rest and aggravated by overwork and excessive sexual activity. In many cases of chronic lower backache, there is a combination of the above three factors; for example an underlying Kidney deficiency (causing a chronic dull ache) predisposes the patient to invasion of Cold or to sprain and therefore to periodic acute attacks.

Pain of the lower back extending to the upper back is usually due to a combination of Kidney deficiency and Liver-Qi stagnation.

Box 37.3 summarizes patterns underlying lower backache.

NUMBNESS/TINGLING

Symptoms and Signs, Chapter 68

Numbness or tingling may be due to three main causes: Blood deficiency, Phlegm or internal Wind. With Blood deficiency, there is numbness or tingling of both arms or legs or only hands or feet; this is more common in women. Phlegm may cause numbness or tingling in one or both limbs usually accompanied by a feeling of heaviness. Internal Wind usually causes unilateral numbness in a limb; if it affects the first three fingers in an old person this may indicate the possibility of impending Wind-stroke.

Box 37.4 summarizes the patterns underlying numbness and tingling of the body.

ITCHING

Symptoms and Signs, Chapter 68

The three main causes of itching are generally Wind, Dampness or Heat; these three pathogenic factors cause intense itching. Blood deficiency may also cause itching, which would be less intense than the three above-mentioned pathogenic factors.

Itching caused by Wind is very intense and it occurs either in different parts of the body, moving from one place to another, or in the whole body. The itching due to Wind may be accompanied by a rash but it may also occur without any external skin signs. Itching caused by Wind may also be accompanied by dry skin because Wind itself has a drying effect. In itching caused by Wind the patient has an irresistible desire to scratch; the skin may break and bleed but it heals soon after scratching.

Itching caused by Dampness is more localized, and usually occurs only in specific places such as the axilla, the genital region or the hands or feet. It is accompanied by the appearance of vesicles and the skin breaks after scratching, oozing a fluid that may be white or yellow according to whether the Dampness is associated with Cold or Heat. Itching caused by Damp-Heat is more intense and is characterized by the appearance of yellow vesicles or pustules. In severe, chronic cases the pustules may fester and ooze pus and blood.

Itching caused by Blood-Heat is usually accompanied by a red rash and it may occur either locally or in the whole body.

Itching caused by Blood deficiency is less intense, the skin is dry and scaly and the itching is worse at night.

Itching caused by Toxic Heat is very intense and is accompanied by the appearance of furuncles or festering ulcers which ooze pus and blood. Toxic Heat in the skin is often a complication of chronic eczema when the skin becomes infected.

Under certain circumstances itching can be a normal manifestation that occurs during healing of wounds or ulcers.

Box 37.5 summarizes the patterns underlying itching.

LOSS OF WEIGHT

The two most common causes of loss of weight are Blood or Yin deficiency; other causes include Stomach- and Spleen-Qi deficiency, Stomach-Heat and Liver-Fire. Although Stomach- and Spleen-Qi deficiency normally tend to make a person overweight because they lead to Dampness and Phlegm, in severe cases (such as in anorexia) they may lead to loss of weight because the body is not nourished by the Food Essences.

OBESITY

Symptoms and Signs, Chapter 68

When not due purely to overeating, obesity is generally caused by retention of Damp-Phlegm occurring against a background of Spleen-Qi or Kidney-Yang deficiency, or both.