| Summary: | 博士 === 中國醫藥大學 === 中國醫學研究所 === 96 === “Pain” is an unpleasant feeling and experience commonly shared by human from the past to present and in the East and West. It is not unique, but a symptom that comes along with the abnormal changes in body and mind. Up to now, “Pain” still can not be precisely pinpointed, tested and quantified clinically. Though the “Pain” is universal and objective, the feeling is unique and subjective, and is varied in degree from the awareness to the expression of pain. To the patient, it is more urgent to alleviate the pain than to cure the root causes. This is one of the most difficult problems facing the medical practitioners in their clinical diagnosis and treatment. The study of “pain” in bio-medical science or the disciplines of social humanity is seemly considered ordinary, but in fact is a fairly complicated subject especially in medical science in which “human” is the research object and the study of “pain” is extremely important. In the process of early formation of the Chinese Medicine, “pain” and its relative subjects are the catalyst of cumulative experience and formulation of theories. The primary objective of this thesis is to explore the classical medical science on the visions of various relationship between “pain and life”, and also attempts to discover, from the essence of history, culture and medical science, the people’s attitude and feeling under different time, place and background in coping with the subjects relative to the pain and illness of the body and mind, and the theories and methods of treatment.
Pre-Qin and Han dynasty were regarded as the time when Chinese Medicine took its roots and the theories systemized. This thesis intends to use these eras as a starting point for analysis, and take “pain’ as a core viewpoint to present various pain-related issues, and attempts to answer the following questions: Had the expression and documentation of “pain” evolved along with the degree of the recognition of body? What influence did the subjective interpretation of feeling and experiences have toward the understanding and definition of “pain” in the eras of Early China? What were the differences between the causes of various types of “pain” and the abnormal body feeling? What were the co-relationship between various types of “pain” and various types of body structure as well as Qi (vital force) and blood circulation? What were the concepts that facilitated the techniques of “pain” treatment and the reasoning behind them? And they inter-related, but different in the past and present on “pain” treatment, therapy, and cure.
The research results suggested that “pain” excepted for describing the psychological and emotional discomfort, had gradually been used to express the physical illness in earlier eras. Through the interaction of expression and discomfort, the spirit and body had both been considered as the causes of illness. Also because more attention had been focused on “pain” that occurred in essential body structure, essence and pulse, and the system of internal organs, it had not only accelerated the progress of medical science, but also placed “pain” in a conspicuous and important role in the development of medical science. It also help in understanding the body and co-relationship between inside and outside. The body characters such as gender, “bravery” “fear”, etc. were not necessarily relevant to the degree of pain tolerance. The attention to pain was obviously different in gender and diseases. Physicians used the diagnosis to differentiate the variances in bravery and fear or pain tolerance and to confirm whether the body and mind functioned normally. In addition, due to the differences in the characters of body structure and functions, the causes and symptoms of “pain” varied in body structures. This knowledge continued from the concepts such as “pulse”, “Internal organs”, and “Qi (vital force) and blood”, etc, and to autopsy, observation, and the development of the theories of pathology, which gradually took roots in its depth and sophistication, had changed and continued to break through the medical limitations. At that time, the life elements in human body were categorized into “Qi”, “blood”, and “fluids”, which became an independent, but also interacting and co-existing life system coupling with dominating power of “spirit”. “Pain” occurred as a result of the abnormal stagnation of the activities in Qi, blood and fluids while the control of conscience and cognition remained normal. If the pain was not sensed, then it meant the life elements had lost their normal functions and communication.
This thesis further examined the “body senses” similar to “pain” in the areas of “Bi”(痹), “Chueh”(厥), and “Wei”(痿) and found that“Qi and blood”, which interacted under the different circumstances, had generated various abnormal changes that explained the pathology and symptom in Zan-Fu(viscera), and that they had become the common language in many chapters and verses of the “Nei Jing ”(內經). Through the subtle pattern of changes of “Qi and blood”, the variance of symptoms were distinguished, defined and named. Various similar symptoms, which contained different and similar causes and pathology, except for demonstrating the same attributes of syndrome generated from the same body, suggested for the delicate pursuit of variation in pathology. The reaction to the process of diagnosis was to find the patient’s reaction to various symptoms in body and mind and to explore the trend of changes in illness, especially for strongly subjective case of pain, accurate and objective diagnosis was the most important. This thesis also discussed the examples of inspection and palpation and concluded that both had their merits in utilizing observing measurement and comparison to distinguish the changes in essence and pulse, and vessels and to accurately disclose the conditions of the patient’s body and mind. This was very helpful to the diagnosis of pain. For the same observing object, more information on body and mind could be distinguished and recognized by applying different diagnostic methods, it had broadened the horizon and vision of life in and to Chinese Medicine. Finally, all pain treatments and therapies had been circled around the variation of abnormality on the degree of circulation in body’s Qi, blood, fluids, and the stagnation of interaction between Zan-Fu, essence and pulse. In the post pre-Qin and Han dynasty, the emphasis of pain treatments had gradually shifted from the simple pain suppression and symptom care to simultaneously treating the symptoms and root causes of pain and illnesses, the ability of full-covered diagnosis and treatment.
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