Concepts Within the Chinese Culture That Influence the Cancer Pain Experience

Lih-Mih Chen, RN, PhD; Christine Miaskowski, PhD, RN, FAAN; Marylin Dodd, PhD, RN, FAAN; Steven Pantilat, MD


Cancer Nurs. 2008;31(2):103-108. 

In This Article

Chinese Perspectives on Pain

Pain is a biochemical phenomenon, a neurophysiological occurrence, a simple sensation, but it is also a complex experience with far-reaching ethico-religious implications.[16–18] However, the Western dichotomy of body and mind is quite alien to the traditional Chinese mode of thinking.[19] From a Chinese perspective, pain is a complex experience that can only be understood through an understanding of several Eastern philosophies and religions (ie, Taoism/energy theory, Buddhism, and Confucianism).

Taoism was organized by a man named Lao-Tzu, who was born in China in about 604 bc. The word Tao has several meanings, including way, path, or discourse. On a spiritual level, Taoism is the way of ultimate reality. It is the way of all nature, the primeval law that regulates all heavenly and earthly matters. To live according to the Tao, one must adapt oneself to the order of nature.[20] Each individual is linked in a chain that consists of concepts related to each other in harmonious balance. Taoism believes that there are 2 polar complements (Yin and Yang) within and between the body and its environment.

As shown in Table 1 , the Chinese divide all natural phenomena into 2 contrary components (eg, day/night, upper/ lower, man/woman, good/bad, and positive/negative).[21] Yin originally meant the shady side of a slope, such as moon, female, cold, rest, responsiveness, passivity, dark, interiority, downwardness, inwardness, decrease, satiation, tranquility, and quiescence. It is the end, completion, and realized fruition. Yang meant the sunny side of a slope, such as sun, male, heat, stimulation, movement, activity, excitement, vigor, light, exteriority, upwardness, outwardness, and increase. It is arousal, beginning, and dynamic potential.[22] The 5 principals for Yin and Yang harmony are the following: (1) All things have 2 facets: a Yin aspect and a Yang aspect; (2) any Yin or Yang aspect can be further divided into Yin and Yang; (3) Yin and Yang mutually create each other; (4) Yin and Yang control each other; and (5) Yin and Yang transform into each other.

The notion of Qi (Chi) is as fundamental to Chinese culture and medical thought as Yin and Yang is. The key point of harmonious balance of the body and its environment is the balance of Qi, “energy field.”[18] For the Chinese, Qi is the pulsation of the cosmos itself, the thread that connects all beings, and a common denominator of all things—from mineral to human. An individual's Qi comes from 3 sources. The first source is Original Qi (Yuan Qi), which is transmitted by parents to their child at conception. The second source is Grain Qi (Gu Qi), which is derived from the digestion of food. The third source is Natural Air Qi (Kong Qi), which is extracted by the lungs from the air we breathe.[22] Qi can be the source of all movement and accompanies all movement, can protect the body, can be the source of harmonious transformation, can ensure stability and govern retention, and can warm the body.[22]

Qi is the source of life and forms the basis for the diagnosis and treatment of illness and for the promotion of health and the prevention of illness. People may become ill if there is any disharmony of Qi.[21] There are 4 types of disharmonies of Qi, namely, deficient Qi, collapsed Qi, stagnant Qi, and rebellious Qi. Deficient Qi may affect the whole person and may cause lethargy, exhaustion, cold, and loss of organ function. Collapsed Qi, a kind of deficient Qi, means that the Qi is too insufficient to hold organs in place. It may cause the prolapse of the uterus or hemorrhoids or loss of motivation or commitment. Stagnant Qi is abnormal Qi movement—the Qi does not flow through the body in a smooth and orderly fashion. Stagnant Qi in the limbs and meridians may be the origin of aches and pain in the body. It can also lead to the impairment of an organ. Rebellious Qi is a particular disharmony in which the Qi is going in the wrong direction. For example, stomach Qi should be downward; if it rebels and goes upward, there may be vomiting and nausea or explosive forms of mania. Deficient Qi and collapsed Qi are Yin conditions. In contrast, stagnant Qi and rebellious Qi are Yang excessive conditions.[22]

Pain is regarded as stagnant Qi in limbs and meridians. Chinese people believed that pain occurs if Qi circulation is blocked. In addition, another disharmony that will lead to pain is named congealed blood. The blood circulates continuously through the body, nourishing, maintaining, and moistening its various parts. Blood moves primarily through blood vessels, but also through meridians. If the blood is not flowing smoothly or becomes obstructed, it often causes sharp, stabbing pain, tumors/cysts, or swelling of organs. On a psychological level, the inability to feel safe, excessive vigilance, suspiciousness, paranoid ideation, and delusion can also be associated with congealed blood.[21,22]

A Chinese proverb says that “there is no pain without a blockage and no blockage without pain.” This phrase means that because every pain is a blockage of Qi/blood, removing the blockage will eliminate the pain. The principals of pain relief are not only to move the blockage of Qi/blood but also to maintain harmony with the universe.

The Chinese have been influenced by Buddhism for several thousand years. Mercy, thriftiness, and humility are the 3 treasures of Buddhism. Buddhists regard pain (rendered as ill, sorrow, turmoil, and suffering) as a defining characteristic of human life. Pain is a part of life, as well as a physical-emotional-mental-spiritual complex that defines the nature of human existence.[19]

If a person experiences pain calmly, without becoming emotionally distressed, he or she can attain greater states of being.[23] Several types of pain/suffering exist in Buddhism. They are called the Noble Truths of pain/suffering (ie, birth, the aging process, sickness, death, to be conjoined with what one dislikes, to be disjoined from what one likes, and to not get what one wants).[24] Pain/suffering is a power, unwanted but existent, that comes from a barrier in the last life (ie, Inn and Ko [cause and effect]); from the objective world; from a person's own sensation; or from other people, animals, and materials.[25] Pain arises from craving for objects that are figments of distorted human minds. The only way to transcend pain/suffering and to experience a lasting spiritual bliss is through enlightenment—the art and joy of the destruction of craving.[19] In Buddhism, 8 ways exist to end the path of pain/suffering ( Table 2 ).[25]

Right view means to see and understand things as they really are and to realize the Noble Truth of suffering.[25] It means to see things through and to grasp the impermanent and imperfect nature of worldly objects and ideas.[24] Because our view of the world forms our thoughts and our actions, right view yields right thoughts and right actions.

Right intention can be described best as a commitment to ethical and mental self-improvement. Buddha distinguishes 3 types of right intentions, namely, (1) the intention of renunciation, which means resistance to the pull of desire; (2) the intention of goodwill, which means resistance to feelings of anger and aversion; and (3) the intention of harmlessness, which means not to think or act cruelly, violently, or aggressively and to develop compassion.[26]

Because words can break or save lives, make enemies or friends, start a war or create peace,[25] Buddha explained right speech as follows: (1) to abstain from false speech, especially not to tell deliberate lies and not to speak deceitfully; (2) to abstain from slanderous speech and not to use words maliciously against others; (3) to abstain from harsh words that offend or hurt others; and (4) to abstain from idle chatter that lacks purpose or depth.

Right action means to abstain from (1) harming sentient beings, especially taking a life (including suicide) and doing harm intentionally or delinquently; (2) taking what is not given, which includes stealing, robbery, fraud, deceitfulness, and dishonesty; and (3) engaging in sexual misconduct.[26]

Right livelihood means that one should earn one's living in a righteous way and that wealth should be gained legally and peacefully.[25] Buddha mentions 4 specific activities that harm other beings and that one should avoid for this reason: (1) dealing in weapons; (2) dealing in living beings (including raising animals for slaughter as well as slave trade and prostitution); (3) working in meat production and butchery; and (4) selling intoxicants and poisons such as alcohol and drugs.

Right effort is in itself an act of the will, whereas misguided effort distracts the mind from its task and results in confusion.[26] Right effort is detailed in 4 ways, namely, (1) to prevent the arising of unarisen unwholesome states, (2) to abandon unwholesome states that have already arisen, (3) to arouse wholesome states that have not yet arisen, and (4) to maintain and perfect wholesome states already arisen.

Right mindfulness is the controlled and perfected faculty of cognition.[24] Buddha accounted for this as the 4 foundations of mindfulness: (1) contemplation of the body, (2) contemplation of feeling (repulsive, attractive, or neutral), (3) contemplation of the state of mind, and (4) contemplation of the phenomena.[26]

Right concentration is described as 1-pointedness of mind, meaning a state where all mental faculties are unified and directed onto 1 particular object. The Buddhist method of choice to develop right concentration is the practice of meditation. The meditating mind focuses on a selected object. Through this practice, it becomes natural to apply elevated levels of concentration in everyday situations.[24]

The right path to relieve pain/suffering is not to seek pleasurable feelings but to develop a disinterested attitude toward it. Pain can extend over many lifetimes, throughout which every individual rebirths to the next life. Pain can strengthen the body, purify the soul, and deepen the spirit. In addition, pain will pause cravings, ignorance, and delusions, and their effects will disappear gradually.[26]

The teachings of Confucius are principals for social interaction, individual morality, and ethics. These teachings have a significant influence on Chinese behavior. Harmony with all others and a lack of self-centeredness, respect for parents, and loyalty to family are the main teachings of Confucianism.[19] Li (ritual, propriety), Hsiao (love of parents for their children and of children for their parents), Yi (righteousness), Chung (loyalty), Xin (honesty and trustworthiness), and Jen (benevolence and humaneness toward others) are the important concepts of Confucianism.[21,27] However, to obtain respect from others, one must practice upright behavior, take care of one's own self, keep one's knowledge current, respect and love one's children, and assist with household and family tasks. The Chinese believe in and seek a satisfying social life as well as happiness and peace to promote health and prevent illness.[21]

A Confucian believes that pain is an essential element of life. If one loses the sensation of pain, one is no longer human. Pain is the best assurance that people are not really numb and insensitive.[28] The experience of pain and suffering not only heightens a person's sensitivity but also reminds a person of his or her humanness.[24] Mencius, a Confucian thinker, believed that humanness is to share with others one's pain/suffering. To share the pain or suffering of another is to achieve the goodness of human nature.[19] To take one's own experience of pain near at hand is the departure to understand the minds and hearts of others. If one suffers from pain, one may derive some comfort from sympathetic relatives and friends, but one must bear the burden alone. The Confucian golden rule predicates that you should not do unto others what you would not want others to do unto you.[28]

Pain, like evil, is something that all individuals wish to avoid. Unlike a gospel, which should be spread by missionary zeal, pain should be controlled, confined, managed, and, hopefully, killed.[19] Thus, to refrain from imposing pain on others is a minimum requirement for cultivating the good life for everyone. In the Chinese culture, pain as a “trial” or “sacrifice” is profoundly meaningful. Therefore, when a person suffers with pain, he or she would rather endure the pain and not report it to a clinician until the pain becomes unbearable. Sometimes, patients will report their pain only to close family members and ask the family members to report the pain to a member of the healthcare team.[27]

In conclusion, Chinese perspectives on pain are influenced mainly by the philosophical and religious beliefs of Taoism/energy theory, Buddhism, and Confucianism. Chinese people view the body as a whole energy field and regard pain as an essential part of life. Chinese try to understand pain from various religious and philosophical perspectives and to use these perspectives to facilitate pain management.


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