When It Gets Especially Worse in Winter and at Dawn

"Why do I wake up in pain at exactly three or four in the morning?"

Many people ask me this. During the day it's bearable, but at dawn they wake from the pain. In summer they get by well enough, then when the cold wind blows it starts again. The day before it rains, they know it first.

I don't let these words pass by. Because the fact that pain has a timetable means that pain is tied to something.

The body has a rhythm of the day

Our body's core temperature is not the same all day long. From evening it gradually falls, reaching its lowest between 3 and 5 in the morning. And before morning comes, a hormone called cortisol rises, getting the body ready to wake. The autonomic nervous system, too, shifts its center of gravity in this time band.

This is established fact. There's a difference of some tens of minutes from person to person, but the broad flow — that as the night deepens the temperature falls, blood pressure lowers, and circulation slows — is the same.

So three or four in the morning is the time of day when the body's circulation and temperature are at their lowest.

Why it hurts at that time

Healthy tissue holds up even when the temperature drops a little. Because it has margin.

But tissue whose circulation is already poor, tissue already cold and dulled, has no margin. It was barely maintaining itself as it was. In such a spot, the moment the whole body's temperature and circulation dip even slightly, it gives way first. So at the most vulnerable time of day, pain rises there first.

Winter is the same story. When the temperature falls, the body, to protect its core, first clamps down the blood vessels going to the fingertips and toes, the skin, and around the joints. This is not the body doing wrong; it's the right judgment. Because the heart and brain come first. (The misunderstanding behind saying the body is cold)

But a spot that was already on the edge cannot withstand that clamping.

Hurting before it rains sits in a similar place. When atmospheric pressure falls, the pressure relationship inside and outside the tissue shifts minutely. In tissue where water has already pooled and stiffened, I believe that small change can spill over into pain. This part is still a contested area, and I don't present it as established fact.

So the timetable is a clue

When I see this kind of pain, I don't think first about pain relief. I read the timetable itself as a clue.

Worsening at dawn and in winter means the pain is tied to the conditions of temperature and circulation. If it's tied to conditions, we can approach it by changing the conditions.

Conversely, if it hurts at the same intensity regardless of time or season, I suspect something else. If it hurts only in a particular posture during the day, I look at yet another thing. When it hurts tells us as much as where it hurts.

Isn't it enough to just keep warm?

Many people are already doing exactly that. Electric blankets, heat packs, half-body baths, warm clothing.

And yet that night it's a little better, and the next winter it comes again.

Putting heat in from the outside raises the temperature of that moment. But it doesn't raise the ability to maintain temperature and circulation on your own. I think this difference matters.

What I look at is this: whether blood can get into that spot, whether what has pooled can drain out, whether sensation and nerve signals are alive, whether the muscle is moving and serving as a pump, and whether the whole body's metabolism has dropped so low that it collapses at night.

This is also why I use herbal medicine. Touching just one axis doesn't change this timetable easily. Only by acting together on several conditions and gradually reversing the very environment the tissue sits in does the body's margin for withstanding widen. When the margin widens, it withstands that dawn descent.

When you should go to the hospital first

Among dawn pains, there are some you must never wait on.

• Chest pain that constricts or crushes, especially with cold sweat, shortness of breath, or a feeling that radiates to the jaw or left arm — this can be a heart problem. Call emergency services immediately.
• Being short of breath at dawn so that you have to sit up to breathe — the heart or lungs must be checked.
• Waking from pain at night while losing weight and running a fever — infection or tumor must be ruled out.
• Joints that are stiff for more than an hour in the morning, with several joints swelling together — rheumatologic tests are needed.

This article by no means says "if it hurts at dawn, it's a circulation problem." Only after ruling out the dangerous things first can we address what remains.

Finally

If pain arrives on schedule, that is no coincidence.

At the time the body is weakest, the weakest place sends a signal first. I read that signal not as noise to be eliminated, but as a map that tells me where to make repairs.

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