Why It Is Hard to Point Exactly at Where It Hurts

"Where does it hurt?"

When I ask this, there are people who point at a single spot with a finger, and there are people who rub the belly broadly with the palm and say "about here."

I do not simply pass over this difference. It is because the way of pointing is already a finding in itself.

Inside the Body the Sensors Are Set Sparsely

The fingertips know a difference as thin as one sheet of paper. Sensors are laid down closely there, so they tell apart where something touched to the millimetre.

Inside the body it is a different matter. Among the sensory nerves going up to the spinal cord, those coming from the internal organs are fewer than one in ten. In places such as the intestines or the gallbladder the sensors are set that sparsely. So the signal that comes up from there is blurred as to where it came from. It hurts, but a single spot cannot be pointed at.

The gesture of rubbing broadly with the palm comes out for this reason. It is not that the description is clumsy — the signal itself came in broad.

Two Strands of Signal Join into One Line

One more thing lies on top of this.

The nerves coming up from inside the body and the nerves coming up from the skin and muscle enter together at the same segment when they go into the spinal cord. The two strands join into one line, as it were.

Once they have joined, it is hard to tell apart which side the signal came from. The brain reads it as having come from the side that signals ordinarily come up from far more often — that is, from the skin and the muscle. So trouble on the inside shows up as pain in the back, or the shoulder, or the surface of the belly.

You will have heard the account of the left arm going numb when there is trouble with the heart. It is the same principle.

The Muscle at That Place Stiffens Along with It

At the place where the signals join, it is not pain alone that carries over. It carries over toward tensing the muscle of the same segment as well.

When stimulation on the inside continues, the muscle of the back or the belly belonging to that segment stiffens along with it. Feel it and that place alone is unusually hard. The patient feels that the muscle has knotted up, and it is true that it really has stiffened. Only, the reason it stiffened may not lie in that muscle.

This Is Why I Feel the Belly

While learning this structure I became curious about one thing. Why has this medicine felt the belly for so long?

The belly is the place where the organs inside and the surface of the body face each other across a thin distance. If it is the place where a signal that came up from inside shows itself outwardly first, then a hand going to that place is not a strange thing. Even when the reason was not known, the fingertips had been finding their way to that place. (What You Can Tell by Laying a Hand on the Belly)

The place the patient points at, the place that actually hurts when pressed, the place that is hard to the touch — these three are not always the same. The very way the three fall out of line points to which layer the business is happening in.

And this is also the reason I listen to what the patient says as it is, without tidying it up. "It feels heavy about here" and "it stabs sharply right here" are different words, and that difference is information. (Aching, Stinging, Cold — These Are All Different Words)

Why I Do Not Look at the Painful Place Alone

There are times when treating a distant place loosens a near one. This is not a mysterious account. It is because there are places where signals join, and because inside and outside are connected to each other within one segment.

I see this as one piece of the account that the body is made in layers. The picture in which the place that hurts is straightaway the place that has broken down does not fit the body well.

There Is One Thing to Set Down, Though

To say that the place pointed at and the place of the trouble fall out of line means, turned around, that the way they fall out of line tells us something.

If a pain that was not there before has arisen suddenly, or does not settle with rest, or is enough to wake you at night, or if fever or a change in weight comes with it, it is better to have testing first. Such places are not matters to judge by hand.

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We began with the question of where it hurts.

That it is hard to point exactly is not a problem of powers of description. The signals from inside the body come in broad to begin with, and on the way in they join with the signals from outside. That is why the gesture of rubbing with the palm comes out.

So I do not try to correct that gesture for the patient. I see it as it is, and trace back where the signal came up from. I think examination is that work of tracing back.

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References

• The character of visceral sensation — sparse distribution, blurred location, and the referred pain that convergence makes — Molecular Interventions, 2008
• Nerves from the internal organs and nerves from the body surface meet the same nerve cells in the superficial spinal cord — Pain, 2015
• A review gathering cases in which trouble in the internal organs showed up as neck and shoulder pain and sustained muscle contraction — Diagnostics, 2019

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