If the Painful Spot Is Actually Cold and Dull

When I examine pain in the consultation room, I touch the painful spot. Not to confirm that it hurts, but to see whether that place is hot or cold.

Though the words are the same "it hurts," to the touch there are two kinds.

One is hot. Red, swollen, quick to respond when pressed, with a sense of heat. The other is cold. Pale or dark in color, dull in sensation, heavy, slow to respond when pressed. It does hurt, but it feels as though the body is not sending any strength to that place.

I see these two differently. Because their directions are opposite.

When You Are Injured, Becoming Hot Is Normal

We are taught that swelling and heat are bad things. Things to be quelled.

But when tissue is damaged, the heat, swelling, and redness are a signal that the body has begun to repair. Blood vessels open, plasma leaks into the tissue, and the cells that clean and mend gather to that place. It is uncomfortable but a necessary process. Up to here is established physiology, exactly what is taught in medical school.

So when I see hot pain in the acute phase, I do not view that response as something to be indiscriminately shut off. If it is excessive it must be regulated, but the response itself is part of recovery.

The Problem Is Tissue That Cannot Become Hot

The side I keep my attention on for a long time is the opposite.

The case where it is injured, yet that place does not become hot.

Touch a spot that has hurt for months or years, and it is cold. The sensation is dull. When pressed, they cannot point precisely and say "right here" but hurt in a vague, undefined way. It is heavier than the surroundings, worsens in winter, and though it tingles when touched, the skin itself does not respond.

This tissue is closer to a state not of excess inflammation, but of being unable to raise even inflammation properly. The power to begin repair does not rise.

Anti-inflammatory drugs do their work on the hot side. But in a place where the response already does not rise well, there may be less to gain from them. I see this as one of the reasons some pain lingers in the same spot for years.

It is not that clinical trials have been organized in the form of "for cold pain, anti-inflammatories are harmful." But in my consultation room, I repeatedly see that the older the pain, the far more common the cold side is over the hot side.

Why Can It Not Become Hot

It cannot be reduced to a single cause. The body is not that simple. But in these spots, several conditions have often collapsed together.

Blood flow does not reach that place sufficiently. Then the oxygen, the materials, and the cells needed for repair fail to arrive.

Venous and lymphatic recovery is blocked. It is not only the incoming path that is the problem. When the outgoing path is blocked, water pools in that place, and pooled tissue becomes heavier and colder.

Sensory signaling has been lowered. The body sends resources to a place only when it receives its signals. A place whose sensation has dulled is pushed down in the body's priorities.

Movement has vanished. Because it hurts, it goes unused. When unused, the muscle pump of that area stops, circulation worsens further, and it hurts more.

These four worsen one another. So releasing just one does not work well. Increasing only blood flow, or only massaging, or using only painkillers, and it returns to where it was. (If it stiffens again after being loosened)

What I Do

For this kind of pain I do not set the goal of making the painful spot quiet. Rather, I look toward making that place able to respond again.

Whether blood flow can enter, whether what has pooled can drain, whether sensation returns, whether movement can begin again. The reason I use herbal medicine lies here too. Not pressing one switch hard, but acting a little on many conditions at once to return the environment of that tissue. When the environment returns, the body does the repair. I do not do it in its place. (What herbal medicine actually does)

So early in treatment, there are patients in whom the once-painful spot actually becomes a little hot and achy. I do not see this only as a bad sign. Because it may be the process of a stalled response rising again. Of course, if that change is severe or lasts long, I adjust the medicine.

Cases Where You Must Go to a Hospital First

This article is not one that asks you to judge pain on your own. The following go to a hospital first, not a Korean medicine clinic.

If a place suddenly swells and flushes red without any wound and a fever comes with it, it may be an infection. If one leg suddenly swells and hurts and the calf is hard, it may be a blood clot. And if weight is dropping, pain wakes you at night, and fever is present as well, that too belongs with a doctor first.

These situations are a race against time. Do not hesitate — get seen first at an emergency room, orthopedics, or internal medicine.

What to separate before reaching for stronger relief

If you divide pain only into "very painful pain" and "less painful pain," there is something you miss.

I first separate hot pain and cold pain. It is about seeing whether the body is sending strength to that place, or has already given up on it. The older the pain, the more often it is the latter, and the more so, what is needed is not stronger analgesia but the work of bringing that place back to life.

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Sources

• Muscle regeneration research showing that the swelling and heat after injury are necessary for recovery — Mediators of Inflammation, 2013
• A review of how oxygen takes part in wound healing — noting that the relationship is not a simple one — International Wound Journal, 2014

Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)