Determining the treatment in accordance with climate and season, geographical location and individual constitution Climatic and

seasonal conditions It was stated in the Ling Shu (1963, p. 27) that in spring the pathogenic factors are most likely to attack the superficial layer. In summer, they are most likely to attack the skin. In autumn, they are most likely to attack the muscles. In winter, they are most likely to attack the Tendons and Bones. When treating such disorders, the clinician should ensure that the techniques used are consistent with the seasons. Generally speaking, in spring and summer the climate is relatively warm, and the Yang Qi of the body is floating at the superficial level of the body, so shallow acupuncture is applied. If herbs are used during these seasons then herbs that are very pungent and warm and have a strong dispelling action should be avoided. But the climate in autumn and winter is colder and the skin pores are closed, the Yang Qi of the body remains deep inside, so the deeper acupuncture is better, and if herbs are applied then those that are relatively pungent and warm and strong in their action should be prescribed in preference. Geographical location The therapeutic method used should be appropriate to the geographical location. Climate and lifestyle vary in different regions, so do the bodys physiological activities and pathological changes, therefore methods of treatment should be varied in accordance with the region. For instance, the weather in Belgium and

Holland is relative cold and humid compared to that in China, so many people suffer from Cold Bi and Damp Bi. In this climate, dispelling the Cold and elimination of the Damp are of relatively greater importance in the treatment determination. In China, very strong manipulation of the needle is often used in patients who have pain caused by Excessive factors; however, if this were used in the West it would cause a bad reaction for many patients, so the even method is used instead of strong needle manipulation. Individual constitution TCM treatment also varies according to a persons age, sex and personal constitutional condition, which is quite logical. For instance, men and women are different in constitution women have menstruation and pregnancy, so called Yin body, while men have more Yang, so-called Yang body, so the treatment method should vary accordingly. Most women will not be able to stand strong herbal treatment and strong manipulation of the needle. A difference also exists between adults and children. Therapeutic steps In modern medicine, there are three usual methods of treating pain: 1. Remove the causes of the pain, such as an ulcer or abscess. 34 general introduction 2. Alleviate the pain by reducing or stopping transmission of the pain impulses from the affected region for instance, by administration

of sedatives, or electricity. Antidepressants are often used as an adjunctive treatment; originally they were used only to treat depression, but studies have shown that these medications can alleviate pain in certain situations (AntkiewiczMichaluk et al. 1991, Ardid & Guilbaud 1992, Ardid et al. 1992, Bank 1994, Danysz et al. 1986). Furthermore, they may have the added benefit of helping the patient to sleep at night. Also anti-seizure medication may help relieve certain types of pain by reducing abnormal electrical discharges in damaged nerves. 3. Reduce reception of the impression of pain in the brain by use of drugs. Medications that are prescribed are usually of two types: painkillers and anti-inflammatory drugs. The first type includes narcotic painkillers, which are often used to treat acute pain or cancer pain and are seldom prescribed for chronic pain. The latter type includes aspirin-like drugs, which are the most commonly used medications of this type. These not only reduce swelling and irritation but can also relieve the pain. In contrast with Western medicine, TCM practice is to take a detailed history from the patient, including sleep, emotions, diet, exercise, and any surgical history, and combine this with an examination of the tongue, pulse, skin colour, stool, urine, hair condition, breathing, and so on, before making a diagnosis. In treatment, herbs and acupuncture can be applied in combination or separately; they are used to stimulate the Qi and Blood circulation in the body. The

treatment aim is to restore the balance between Yin and Yang in the body, and Qi and Blood circulation in the channels as a whole, thereby influencing the persons entire health and dispelling the pain. There is some similarity between the method of treating pain in TCM and in Western medicine, in that, in the latter, sedatives are used to calm the brain, and in TCM the same end is achieved by means of methods to calm the Mind (Shen). To calm the Mind is in fact to regulate the physiological function of the Heart; this is because the Heart is the root of other Internal Zang-Fu organs, and the root of the response to the pain. In view of acupuncture and Chinese herbs in the treatment of pain, acupuncture is relative strong in treating the pain mainly due to disorder in the channels and collaterals, and its effect to tonify the Qi, Blood, Yin and Yang is relative weak compared to the Chinese herbal treatment, while as Chinese herbal treatment is strong in treating the pain due to Internal Zang-Fu organs disorders and has better effect in tonifying the Qi, Blood, Yin and Yang. However, application of both approaches simultaneously is recommended in order to treat the pain successfully. To achieve the therapeutic effect the following aims have to be focused: remove the pathogenic factors, so as to diminish or eliminate the causes of stagnation of Qi and Blood; this is an important step to avoid a vicious circle promote the Qi and Blood circulation, restore Qi and Blood levels and harmonise the Zang-Fu organs and channels

 calm the Mind and regulate the Heart, so as to diminish the pain prevent recurrence of the pain.