Why does my pain keep coming back? -Five internal causes and strategies

In clinical practice, I frequently encounter patients who suffer from persistent, recurrent pain yet only treat the symptoms: they rely on taking Panadol (or other painkillers) for relief, or repeatedly seek massage and manual therapy for temporary comfort—only to have the pain return within days. Some even try acupuncture, but the effect is short-lived. When faced with such stubborn, recurring pain, we must return to the fundamentals of Traditional Chinese Medicine: take the pulse, investigate the internal pathogenic factors, and identify the root cause of pain before prescribing targeted treatment. Only then can we achieve lasting relief.

Below, based on years of clinical experience, I summarize the five most common internal factors (“inner causes”) driving recurrent pain, to help you understand and address chronic pain at its source.

1. Cold Pathogen Stagnation

Characteristics: Floating-tight pulse; pulse feels “cold” at the surface.

• Pathogenesis: Cold contracts and constricts. Exposure to cold causes blockage in tendons and vessels, impeding blood flow and resulting in intense, persistent pain in local or systemic areas.
• Clinical Presentation: Pain aggravated by cold; relieved by warmth or gentle rubbing.
• Treatment Strategy: Dispel exterior cold and restore Yang first. Only after warming the interior can effectively relieve pain; otherwise, any local treatment yields only temporary improvement.

2. Phlegm-Damp Obstruction

Characteristics: Restricted movement, noticeable numbness; slippery or soggy pulse.

• Pathogenesis: Accumulation of phlegm and dampness obstructs channels, blocking qi and blood, resulting in pain.
• Clinical Presentation: Conditions like frozen shoulder present with limited range of motion and difficulty in lifting the arm; may also be accompanied by prickling sensations, numbness, or a heavy, swollen feeling in the affected limb.
• Treatment Strategy: Focus on resolving phlegm and dampness, clearing channels, and alleviating pain, with adjunctive blood-invigorating formulas to fully restore channel patency.

3. Blood Stasis with Stabbing Pain

Characteristics: Fixed location of pain, sharp or stabbing quality; choppy, sinking pulse.

• Pathogenesis: Impeded blood circulation leads to stasis within the vessels, blocking channels and causing localized, intense pain.
• Clinical Presentation: Pain is fixed and stabbing in nature, often worsening at night and disturbing sleep.
• Treatment Strategy: Employ blood-invigorating and stasis-resolving therapies—herbal formulas such as Tao Hong Si Wu Tang with modifications, or localized techniques like bloodletting—to disperse stagnation and relieve pain.

4. Deficiency Syndromes

Deficiency-related pain primarily arises from either Kidney deficiency or Blood deficiency.

1. Kidney-Related Low Back Pain
   • Mechanism: Kidney governs the bone and stores essence. Kidney Yang deficiency fails to nourish the lumbar region, leading to recurrent low back pain.
   • Presentation: Aching and weakness in the lower back, aversion to cold, increased nighttime urination, pale tongue with white coating.
   • Strategy: Tonify Kidney Yang to replenish kidney energy and alleviate pain.
2. Blood Deficiency with Numbness
   • Mechanism: Blood nourishes the channels. Insufficient blood leads to poor nourishment of sinews and vessels, causing numbness or dull pain.
   • Presentation: Dragging pain or numbness, pale complexion, pale tongue with thin pulse.
   • Strategy: Nourish and invigorate the blood to strengthen circulation and sustain channel nourishment.

Many sciatica patients suffer recurrent pain because underlying Kidney or Blood deficiency is unaddressed; without tonifying the whole body’s Qi and Blood, local acupuncture and massage can only provide temporary relief.

5. Qi Stagnation

Characteristics: Wiry pulse; pain often accompanied by distention and emotional fluctuation.

• Pathogenesis: When Qi stagnates, blood cannot flow freely; disrupted qi movement manifests as pain.
• Clinical Presentation: Discomfort or distention under the ribs, pain in the hypochondrial region that worsens with stress, mood swings or depression; the pain feels more distending than stabbing.
• Treatment Strategy: Promote qi circulation and relieve constraint.

Conclusion and Recommendations

1. Accurate Pattern Differentiation
   • Identify whether “Cold,” “Phlegm,” “Stasis,” “Deficiency,” or “Qi stagnation” (or combinations) underlies the pain to guide treatment.
2. Targeted Therapy
   • Select appropriate herbal prescriptions and integrate acupuncture, tuina, and other modalities for a synergistic effect.
3. Consistent and Adequate Treatment Course
   • Internal pathogenic factors require sustained intervention; sporadic treatments offer only transient relief.
4. Comprehensive Lifestyle Adjustments
   • For cold-type patterns, emphasize warmth and warming foods; for phlegm-damp, avoid greasy and cold foods; for blood deficiency, consume blood-nourishing foods; for qi stagnation, practice stress management and gentle exercise.

By accurately diagnosing the internal cause via pulse and symptom analysis, then applying targeted therapies alongside daily care, recurrent pain can be resolved at its root—restoring health and quality of life. I hope this overview of the five key internal drivers of recurrent pain provides clarity for both clinical practice and self-care.