Pain is not an enemy to be removed. It is how the body decides where to spend a limited supply of energy. Seen that way, it becomes clear why switching the signal off before you know what caused it is a poor trade — and why the types of pain matter more than its intensity.
In Summary
- Modern medicine sorts the types of pain by mechanism into four: neuropathic, inflammatory, functional and ischaemic.
- Korean Traditional Medicine sorts them by the state of qi into two: bultongjeuktong (不通則痛, it hurts because it is blocked) and bulyeongjeuktong (不樓則痛, it hurts because it is not nourished).
- The two schemes overlap cleanly. Neuropathic, inflammatory and functional pain fall largely under the blocked pattern; ischaemic pain is mostly the unnourished one, with parts of the neuropathic and functional categories straddling it.
- Put together, pain looks like an energy-distribution device. Whether the problem is excess or shortage decides what to do — and the two answers are opposites.
- None of this means enduring pain. It means that switching pain off and addressing what produced it are two different jobs.
The Four Types of Pain in Modern Medicine
Neuropathic pain arises from damage or dysfunction in the nervous system itself — compression, injury, inflammation of nerve tissue. Diabetic neuropathy and post-herpetic neuralgia are the familiar examples.
Inflammatory pain arises from the inflammatory response. Mediators such as cytokines and prostaglandins are released and stimulate pain receptors. Trauma, infection, autoimmune disease and simple overuse all belong here.
Functional pain arises without clear structural damage or identifiable disease. It is attributed to abnormal processing or modulation of pain signals in the nervous system. Migraine and fibromyalgia sit in this group.
Ischaemic pain arises when reduced blood flow leaves tissue short of oxygen and nutrients. Angina is the classic presentation.
Korean Medicine Sorts Them Into Two
In Korean Traditional Medicine (KTM), the traditional healing system of Korea also known as Hanbang (한방), pain is read through the state of qi (氣). There are only two readings.
Bultongjeuktong (不通則痛) — it hurts because it does not flow. Qi is obstructed, or it has surged into one place and stalled there.
Bulyeongjeuktong (不樓則痛) — it hurts because it is not nourished. Qi is insufficient, and the tissue is not being filled.
Two categories against four looks like a loss of resolution. It is better understood as a different question: not what tissue is generating this signal, but is there too much here, or too little.
Where the Two Schemes Meet
What interests me as someone who teaches disease mechanisms is that these two classifications, built in different eras and different languages, do not contradict each other.
The blocked pattern covers neuropathic, inflammatory and functional pain. Each is a state of compression, congestion or excess signalling — something present in surplus and not moving.
The unnourished pattern covers most ischaemic pain, along with part of the neuropathic and part of the functional category. Ischaemia is literally insufficient blood supply, which is close to the definition of bulyeong — not nourished.
This is an interpretive mapping rather than an equivalence anyone has formally validated. But the fit is close enough to be useful, and close enough to suggest the two traditions were looking at the same thing from different angles.
Pain as an Energy-Distribution Device
Combine the two views and a single reading emerges. Pain is a signalling system the body uses to allocate limited energy. It marks where resources should be sent, or where they are being wasted.
Which changes the first question to ask. Not how bad is it, but is this excess or shortage? Pain from blockage needs moving and draining. Pain from depletion needs filling. Apply either approach to the other pattern and nothing improves — and the patient concludes the medicine does not work.
This Is Not an Argument for Enduring Pain
Let me be exact, because this is easy to misread. Nothing here says pain should be tolerated.
Switching pain off and treating what produced it are simply two different jobs. Analgesics do the first, and there are plenty of situations that call for it. Whether and how to take them is a matter for the physician or pharmacist who prescribed them, and nothing in this article is a reason to change what you have been told to do.
The single point is this: pain going quiet does not mean the state that produced it has resolved. If the signal is switched off before the question — excess or shortage — has been asked, the answer is usually never found.
One boundary worth stating plainly: chest pain, sudden and severe pain, pain with fever or neurological symptoms, and pain that is steadily worsening need conventional medical evaluation first, not interpretation.
A Note: What If You Gave an AI Pain?
A question I return to. Giving pain to an AI or a robot is difficult technically and thornier still ethically. But if pain is fundamentally a device for allocating scarce resources efficiently, then any system that has to manage its own limited resources and motivate itself without external instruction may need something structurally equivalent to it.
I know of no better thought experiment for the proposition that pain is not a defect but a design.
In Summary
Pain is a language the body uses. Whether you divide it into four types or two, the question underneath is the same — has too much energy gathered here, or too little? Switch the signal off before answering, and you never learn what the body was trying to say.
Related reading: Pain as Signal: Why KTM Treats Painkillers as Necessary but Insufficient · Is a Headache Too Much Energy, or Too Little?
This article reflects the teaching and research of Professor Seungho Baek, Professor of Korean Medicine at Dongguk University College of Korean Medicine, specializing in Pathology and Oncology.
