Internal, External, and neither External nor Internal causes (Miscellaneous).
"The view of the internal organs as physical-mental-emotional spheres of influence is one of the most important aspects of Chinese medicine. Central to this is the concept of Qi as a matter-energy that gives rise to physical or mental and emotional phenomena at the same time. Thus, in Chinese Medicine, body, mind and emotions are an integrated whole with no beginning or end. 1
While Western Medicine also recognizes the interaction between body and emotions, it does so in a completely different way than Chinese Medicine. Western Medicine tends to consider the influence of the emotions on the organs as having a secondary or excitatory role rather than being a primary causative factor of disease. Chinese Medicine sees the emotions as an integral and inseparable part of the sphere of action of the internal organs, and a potential primary cause of disease. In fact, the seven potential "internal causes" of disease in Chinese Medicine are all "emotions"."
In Traditional Chinese Medicine (TCM) the emotions are not "good" or "bad", they simply are part of being human and alive. There are good reasons to feel fear at times, to be angry, to worry, to feel joy, to feel grief and sadness. These feelings are indicators of our personal and collective relationship with the world and ourselves. In optimal health, our emotions flow freely, are acknowledged, responded to appropriately, and then we move on to the next "feeling". Disharmony and illness only arise when we become "stuck" in our emotions, try to ignore or suppress them. In my clinical practice many clients have come to attribute these "stuck" emotional issues as the primary cause of many diseases, including digestive, respiratory and sexual disorders, colitis/IBS, migraines, hypertension, skin disorders, depression and anxiety. These disorders do need to be addressed at a physical level, but until the underlying emotional issues are resolved/released we do not seem to be able to fully heal.
There is a direct relationship between the emotional life of a person and their physical health. Each organ is associated with a range of emotions. These Organs dominate the expression of particular emotions and they are in turn affected by these same emotions. The emotions exert a negative influence only when they become too intense, strong, unexpressed, excessive or when they dominate the psyche over a long period.
The Chinese recognize seven emotions: anger, joy, pensiveness, grief, fear, and shock. The seventh varies according to the source, but it can be sadness, anxiety (anxiety is thoughts that go round and round, which may shade into worry or be a form of fright or fear). Sadness is closely associated with grief so is best left with that. Fear and fright are closely associated and can be left as one emotion. As for anxiety, it can shade into fear or pensiveness and could be grouped with either of these according to its associated symptoms.
Whatever emotion is selected as the seventh, these emotions should not be interpreted too strictly. Most of the emotions after a long time can produce Fire, because they cause Stagnation of Qi and when Qi is compressed over a period it creates Fire. This may produce signs of Empty Heat, great anxiety and depression. Although Herbal Therapy, Acupuncture, and Asian Bodywork Therapy are definitely appropriate for mental/emotional disharmonies, a body centred psychotherapist may also be instrumental in resolving long-standing emotional disharmony.
Shock or Fright
Shock scatters the Qi and affects both the Kidneys and the Heart and to a certain extent, the Small Intestine. The Qi of the Heart is weakened rapidly, leading to palpitations, breathlessness and insomnia, and requires Kidney-Essence to support it. This puts a strain on the Kidneys, and tonification of the Kidneys helps.
An appropriate sense of instinctive fear is necessary for survival. Fear makes the Qi descend and affects the Kidneys. Excessive or prolonged fear drains the Kidneys. It can also suppress Qi. Fear has a different impact on adults and children. In children, fear causes Qi to descend, resulting in nocturnal enuresis (bedwetting). In adults, fear tends to cause Kidney-Yin deficiency. To some extent, Fear also disturbs the Heart, leading to anxiety. The Kidneys have to be strengthened.
Anger affects the Liver and makes the Qi rise. Anger includes several related emotions: resentment, repressed anger, irritability, frustration, rage, indignation, animosity and bitterness. Sulking and depression are also forms of anger (depression is blocked anger), frustration lies between anger and depression. In depression due to repressed anger or resentment, the tongue is dark red or red and dry.
Anger is sometimes necessary to exert one's authority. However, excessive and inappropriate anger causes Stagnation of Liver-Qi or Liver-Blood, the rising of Liver-Yang or Liver-Fire (which may cause Heart-Fire). These will cause symptoms in the head and neck such as headaches (the most common symptom), tinnitus, dizziness, red blotches in the front of the neck, red face, red tongue and a bitter taste. Anger can also affect the Stomach and Spleen, causing indigestion and other problems: this is the pattern of Liver invading the Spleen or the Stomach. If depression feels better after exercise, it is a Liver depression.
Joy slows down the Qi and affects the Heart. In general, joy is beneficial. Being at peace and filled with happiness calms and slows the Qi. Pleasure and excitement are other forms of joy. Pleasure is moderate joy, and it allows the Qi to settle and sink. Excitement scatters the Qi or slows it down. What are damaging are overexcitement and an abnormal degree of mental stimulation, both forms of excessive joy. It is not, however, an important or common cause of Heart disharmonies.
Worry and Pensiveness
Pensiveness means excessive thinking (overthinking), excessive mental work and studying. This is very common in our society, both in university students and people in intellectual professions, and the problem is compounded if people eat quickly at work or discuss work while eating. Obsessive thinking fraught with concern, brooding and mental worry are also problems. All these forms of pensiveness and worry knot the Qi and affect the Spleen, bringing an accumulation of Dampness. Worry also affects the Lung, leading to anxiety, breathlessness and stiffness of shoulders and neck. Worry may also be a form of fear or anxiety.
Sadness dissolves the Qi and affects the Lungs, leading to Lung Qi deficiency, but it also affects the Heart, in time bringing on Heart Qi deficiency. When the Lungs are overcome by sadness and grief, they are weakened, and this leads to tiredness, breathlessness, depression or crying. In women, this deficiency of Lung-Qi can lead to Blood deficiency. Prolonged sadness can also lead to stagnation of Qi that in turn can transform into Heart-Fire.
1 The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs, Giovanni Maciocia, Churchill Livingston, 1994
External causes of diseases are of a physical nature and are due to climatic factors. They encroach upon the body from the outside environment. They are also called External Pathogenic Factors, Evils, or Excesses. Evils can penetrate the body when the weather is unseasonably excessive or when the Defensive Qi is weak and they cause an imbalance. If our defensive system is strong, it simply repels the invasion or adjusts to the sudden changes; if the defensive system is weak or the Evil unusually strong, an illness develops and may go progressively deeper in the body. Usually there is an aversion to the Evil one is affected by. Evils can appear in combination or alone.
An Evil describes both the cause of the condition and the condition. When a patient is described as suffering from Wind Heat, it does not necessarily mean that it was caused by Wind or Heat. It is the way the body reacts and a description of symptoms. However, Evils tend to be a predominant cause or aggravation of a disease in their related seasons. An Evil can penetrate either via the mouth, the nose or the skin. Heat invades more readily by the nose and mouth.
This term usually suggests a pattern of disharmony rather than a climatic factor. It can appear in any season and it can combine with any other evil. Some people get neck problems from exposure to Wind, and the presence of Wind can worsen the impact of the other climatic factors.
External cold can penetrate the body of those who live or work in cold conditions or cannot dress properly. It causes Qi stagnation and results in contraction of muscles and joints, cramping pain and watery discharge.
External Heat can penetrate the body of those who live or work in hot conditions, and it may combine with external pathogenic factors such as Wind or Damp.
Dryness attacks are usually limited to the respiratory tract or the skin.
Exposure to damp weather, wearing wet clothes, a humid environment can cause External Dampness to invade. It often combines with Heat and Cold.
The person's constitutional strength depends on the health and age of their parents, particularly at the time of conception, because the child's Pre-Heaven Essence is formed by the fusion of the parental Essences. It also depends especially on the mother's health and age during the pregnancy. A severe shock during pregnancy is also detrimental to the health of the child. Many childhood diseases, particularly whooping cough, indicate a weak constitution. Pre-Heaven Essence can be prematurely drained through overwork, inadequate rest, alcohol, excessive sexual activity or can be preserved and enhanced by Tai Qi Quan, meditation, breathing exercise, and Qi Gung. The constitution determines how much Qi you have in reserve to combat any stress factors that might undermine your health. Small ears with short ear lobes, according to the Chinese, show constitutional weaknesses.
Poor dietary habit
From a Chinese point of view, diet can be unbalanced from a quantitative and a qualitative point of view. Malnutrition is such a problem, found all over the world. It seriously weakens the Qi and the Blood and results in Spleen Deficiency. It is caused by eating food with no calorific or nutritive value, or by adhering too strictly to fixed diets. Trying to loose weight by not eating enough is also detrimental.
Over-eating also weakens the Spleen and Stomach, and leads to retention of Food characterized by a bloated feeling in the Stomach, belching, nausea and gastric reflux (heartburn).
Excessive consumption of food that is Hot or Cold in energy can also be detrimental. Large quantities of cooling food (fruits, fruit juice and ice cream, salads) can injure the Yang of the Spleen. Excessive consumption of sweet foods and sugar also blocks the Spleen function and leads to Dampness. Oily, fried and greasy food, including deep-fried food, milk, cheese, butter, cream, ice-cream, bananas, peanuts, fatty meats, should be reduced in amount, as it may cause Dampness. Excessive consumption of hot food (alcohol and spicy food) should be reduced by those who are Yin deficient, especially of the Liver and Stomach.
It is not only what one eats, it is also the way one eats it. Eating in a hurry, going straight back to work after eating, eating late in the evening, eating in a state of emotional tension can lead to Stomach Yin deficiency. The main problem is a lifestyle one, and that is what has to be changed.
This is a frequent problem in the West. Insufficient rest over a period of months or years means that the body has to draw on Jing (Original Essence) for additional strength. There are three types of overwork: mental overwork; physical overwork; excessive physical exercise.
Physical work depletes the Spleen-Qi. Repetitive use of muscles may cause localized Qi or Blood stagnation. Irregular and exhausting exercise depletes the Qi. Excessive lifting can deplete the Kidneys and the lower back, and so does excessive standing.
Mental overwork includes working long hours in conditions of extreme stress, eating irregular meals, being always in a hurry, over a long period. Overthinking depletes the Spleen, while the irregular diet depletes the Stomach-Qi or Stomach-Yin which can lead to a Kidney-Yin deficiency.
Exercise is good for the health, but not when done to the point of exhaustion. However, lack of exercise also leads to stagnation of Qi, and this can lead to Dampness. Yoga and Tai Chi Chuan are good for those deficient in Qi who do not have enough energy for more rigorous exercise.
Excessive sexual activity
Excessive sexual activity depletes one's vital energy. The body draws on Essence at ejaculation and orgasm. Excessive sexual activity depends on the strength of one's Essence which reaches a peak during the twenties and then declines slowly. If the constitution is strong, more activity is possible. Men's ejaculation is more depleting than women's orgasm, but a woman loses Essence through the process of childbirth. Sexual activity not leading to ejaculation in men is thought to be non-detrimental to health
Excessive sexual activity is one that leads to marked fatigue, especially if accompanied by other symptoms such as dizziness, blurred vision, lower backache, weak knees and frequent urination. Sexual activity should be seriously curtailed if there is Qi or Blood deficiency, or especially in the presence of a weakness of the Kidneys. Men are more affected than women by a Kidney weakness (women's sexual energy is more related to Blood than men's which is more related to Essence). Lack of sexual activities is also considered a disease.
Kidney-Yang deficiency may lead to a lack of sexual desire or to an inability to enjoy sex or reach orgasm. In men, it can lead to impotence and premature ejaculation.
Kidney-Yin deficiency may lead to excessive sexual desire that can never be satisfied. The person may also have vivid sexual dreams resulting in nocturnal emissions in men and orgasms in women.
Kidney-Essence and Kidney-Yin are important for the nourishment of the Uterus, and their deficiency may cause infertility in women.
Trauma includes physical accidents such as broken bones and bruising. A slight trauma causes Stagnation of Qi, a more serious one, stasis of Blood. In all cases, it causes pain, bruising and swelling. It may cause long-term stagnation of Qi if combined with other factors such as External Dampness. Shiatsu can help with old injuries by increasing Qi and blood circulation that is often blocked where there is scar tissue.
Parasites and Poisons
Treated with herbal prescriptions.
Too little rest, and a person cannot transform food into Blood and Body Fluids; too much rest, on the other hand, leads to Dampness and Stagnation.
This includes the side effects of any medical treatment, and illnesses caused by medical treatment. In acupuncture or Asian bodywork therapy, this is a minor problem only, as the body can readjust itself after a few days, but with herbal therapy there is a potential risk.
Calvin Dale Smith, BA, MSc, R-TCMP, R-Ac
Registered Traditional Chinese Medical Practitioner
Riverside Acupuncture and Wellness Centre
2211 Riverside Dr., Suite 106
Ottawa, ON K1H 7X5