Schule für Shiatsu Hamburg 1 Schule der berührenden Künste Notes on the Treatment of Pain with Shiatsu Paul Lundberg The treatment of pain is a subject both wide 1) “Pain is blockage and blockage is and deep, not only within medicine itself, where pain”. This is pragmatic and precise. Pain is knowledge of its implications is paramount, but always associated with an obstruction of Qi, so in society at large where the question extends to we will need to remind ourselves directly of the include socio-philosophical dimensions. Different possible “causes” of obstruction to see how pain societies have developed widely differing may arise. We should remember that “blockage” attitudes to pain, and individuals within those in referring to Qi may lead all the way back to societies show varying degrees of tolerance. include subtle resistance of the mind and Even if the main consideration is a medical one, holding-on to emotions. Obviously some painful we and our patients/clients will benefit from an conditions could be due to a number of inter- approach that ranges from the pragmatic to the reacting factors. spiritual - and this we find In the Eastern tradition in which Shiatsu has its origins. 2) As practitioners, we should “always try The working title given for this Congress, to touch the person’s pain”. This dictum calls “What is pain from the perspective of for an attentive, thorough and humane approach. Shiatsu?” implies the possibility of a special It does not refer to the necessary touching of view, but I do not think that “Shiatsu” can have a manual treatment (e.g. Shiatsu in itself). It is perspective much different from that of the addressed to all who practice medicine or healing medical and cultural tradition of the East to of whatever discipline. If the patient is describing which it belongs. In the end it is more important any pain as a part of their troubles we can listen to ask “What is pain from the point of view of the attentively and make notes, but it is also an patient / client?”, and to develop our work in a occasion to make contact and affirm our interest congruent manner. in discovering exactly where and how the person is suffering. It is not an occasion to be missed, as the healing process can proceed from such early- I have styled this contribution as “Notes”, established empathic gestures. What is more, we recognising that the subject is too vast to treat in can note the precise nature of the trouble as first detail. To a greater or lesser degree, pain presented, and this will form a reference for any manifests as a part of a host of medical progress or setbacks at a later stage. We will problems. Focussing on Shiatsu as the method of always ask when and how the symptom first treatment may reduce the frame of reference, appeared, what if anything brings relief and what but it still leaves us with considerably more than makes it worse (with pain, especially, this may a short article can ever encompass. My include heat, cold, pressure, movement or rest). experience is that shiatsu is both applicable and Then the moment arrives to ask, “Show me effective in many types of painful condition, mild where it is exactly”, and let the person guide us or severe, acute or chronic. to the site of the pain. We can then ask Because I want to cover all the basic issues, permission to touch and explore with them such my intention is to work through the general subtleties of depth and movement as may seem background of theory and differential diagnosis necessary. and to finish with some typical examples of treatment strategy in different conditions. The conversation goes: “Ah, here?” To begin with I would like set down a couple of general observations and sayings in traditional “No, up a bit – yes, there! All along there.” Oriental (Chinese) Medicine, which for me have “Aha, so that’s where it is.” always helped to orientate my approach to this particular kind of suffering. Schule für Shiatsu Hamburg 2 Schule der berührenden Künste “Yes, that’s it” (The origin of the first and sensitivity and emotional pain, but it runs famous Ah Shi - That’s It! - category of local counter to the expressive impulse and points). the free, harmonious circulation of Qi and Blood which, according to tradition, is the “Does it hurt more to press like this?” natural responsibility and function of the “Yes, a bit”. Liver. In the long term it is harmful. Social conditioning associated with deep “What about movement – worse in this running fears of punishment and direction? I see, and in this rejection are at the root of many direction? - A bit easier. Right, that’s very emotionally caused diseases helpful, now let’s continue.” characterised by internal obstruction and pain, with many Liver characteristics such as depression, frustration, irritability and Good history taking is in any case invaluable outbreaks of anger in the picture. In for the optimal development of all our work but addition we should mention Worry, an this kind of respectful exchange also sets the emotion related to the Spleen and Heart, scene for the patient’s full collaboration as well which has the effect of “Knotting the Qi”. as telling us much about the level of the When a person cannot relax due to obstruction (superficial or deep) and the persistent problems or underlying meridians involved. insecurity, over time their contracted state impedes the flow of Qi. c) Overwork – strain. Everybody has resources; everybody has limits. The Causes of Obstruction Overwork drains constitutional reserves Among the 9 Principal Causes of Disease, and causes deficiency in the long term. It according to TCM, we find the following which is also a common cause of injury, can result in contraction, a naturally yin response occurring in the strong and the weak of the body that can have positive as well as alike. Here we are more concerned with negative connotations, but which can easily lead sudden contractures and sprains resulting to a pathogenic “Obstruction of Qi”. Obstruction from over-effort - lifting and bending or always implies a “Full” condition in terms of the 8 over-exercising in general. As such, this Principal Patterns. category may merge with Trauma (category ‘d’, below). a) The Yin Pernicious Influences, Cold and Damp. Whether penetrating from the exterior or arising in the interior of the d) Traumas – accidents, blows and physical body due to other factors, these cause injuries of all kinds. The first thing to stagnation, contraction and pain. (In the acknowledge here is that there can often former case they are often accompanied be a strong mental and emotional by Exterior Wind whose yang nature component to trauma. This is comes penetrates the body’s defences. The under the heading “Shock” or “Fright” in body’s reaction is still contractive, e.g. the category of Emotional Causes and is neck and shoulder pain). Many kinds of the subject of a separate paper in this “rheumatic” and “arthritic” pains are due congress edition. The mechanism of this to the stagnation of Qi in the Muscle process is different from the physical Meridians or joints. The person’s effect of trauma on the tissues and the Defensive Qi is too weak to expel the circulation of Qi and Blood through the pernicious influence, but it is at least injured region. It is also different from contained in the exterior part and the effect of repressing emotions, prevented from penetrating deeper. This described above. At times their effects “stalemate” situation results in stagnation combine and mutually aggravate one and pain. another, but it is useful to understand them as distinct and treat them accordingly. b) Repressed emotions of any kind. Repressed feelings result in blockage of Qi. Defensive contraction initially reduces Schule für Shiatsu Hamburg 3 Schule der berührenden Künste N.B. Contraction resulting from injury is a especially the Yang Meridians), or if it is in the natural emergency response by the body “Interior” part (which primarily includes the whereby loss of blood is minimised and the Blood and Organs - the Zang Fu, but may also sensation of pain is reduced. This can enable the imply Bones, Marrow, Essence etc.). person to deal with their immediate situation. Diseases originating in the external There is also a secondary stage when the environment may be contained in the exterior response is an increase of blood and fluids at an without much affecting the Internal Organs and injured site, as the body attempts to repair their function, and they can be treated on this damaged tissues. This causes swelling and pain, level, provided that the person has sufficient Qi which in consequence immobilise the affected and Blood. If this is not the case, however, they part and enforce rest, so preventing further may penetrate into the interior in a generally damage from inappropriate use while recovering. worsening scenario. A damp chill affecting the Here we see nature working in our best interests. bladder muscle meridian may initially cause However, the stagnation around the injury may contraction, stiffness and pain in the lower also impede the renewal and repair, lumbar or gluteal muscles. If not treated and if paradoxically producing more pain and the person is “deficient” it could penetrate into preventing full recovery. This is the precarious the main meridian and then to the Bladder itself, nature of Yin-Yang harmony, but it is just at this causing a cystitis with “cold pattern” symptoms point that informed treatment becomes and signs. increasingly useful.