5. The causes of disease
Chapter contents
History of the causes of disease26
The causes of disease26
The internal causes of disease26
The seven internal causes of disease29
The five emotions and the role of ‘sympathy’31
Diagnosing the emotions32
Other causes of disease33
History of the causes of disease
The Daoists, who were the main creators of Chinese science, were fascinated with nature. Their influence and that of the Naturalists during the Han dynasty ensured that Chinese medicine started to evolve a systematic view of aetiology based on a study of nature. In fact ‘find the causes’ became the watchword of Daoist scientists (Ronan and Needham, 1993, p. 93) For example, in –239, Shi Chun Jiu wrote:
All phenomena have their causes. If one does not know these causes, although one may happen to be right about the facts, it is as if one knew nothing, and in the end one will be bewildered.
(Needham, 1956, p. 55)
Before this time practitioners of Chinese medicine viewed disease as a hostile entity which was external to the body. From the Han dynasty onwards the emphasis moved away from this and towards viewing disease as the ‘breakdown of a state of harmony within the body’ (Lo, 2000). The Nei Jing described the emotions, invasion by climatic factors and poor lifestyle as the main causes of disease. The San-yin Fang, written by Chen Yen in +1174, is the great classic on the causes of disease and it was in this book that the categories were laid down as they are still taught in China today. Chen divided the causes into internal (nei yin), external (wai yin) and ‘miscellaneous’ (bu wai bu nei yin – neither internal nor external) causes.
The causes of disease
Practitioners of Five Element Constitutional Acupuncture place most emphasis on the internal causes of disease. These arise from inside people and directly affect the Organs and Elements. They are anger, joy, sadness, over-thinking, grief, fear and shock. The external causes of disease are due to climatic conditions. They are wind, cold, damp, dryness, summer heat and fire. The miscellaneous causes are predominantly linked with a person’s lifestyle. They are poor constitution, overwork and fatigue, too much or too little exercise, diet, sex (too much or too little), trauma, parasites and poisons and incorrect treatment. The external and miscellaneous causes are discussed in Appendix B. The internal causes of disease are discussed in greater depth in this chapter and also in the chapters on the Elements (Section 2, this volume).
The internal causes of disease
The San-yin Fang and Su Wen are emphatic that people’s spirits are primarily affected by the internal rather than the external or miscellaneous causes. The San-yin Fang states:
In the interior (of the body) reside the jing and the shen, the hun and the po, the mind (chih) and the sentiments (I), mourning (yu) and thoughts. They tend to be harmed by the seven emotions.
(Unschuld, 1988, p. 102)
Su WenChapter 5 is equally clear on the role of the emotions:
The emotions of joy and anger are injurious to the spirit (shen). Cold and heat are injurious to the body.
(Veith, 1972)
Although excessive emotions were perceived as being injurious to the spirit in the first place, there was never any doubt that once a person’s spirit became disturbed, illness was likely to follow.
The shen is the ruler of the whole body. It controls the seven affects. Harming the shen will result in illness.
(Dong Yi Bao Jian)
Apprehension and anxiety, worries and pre-occupations injure the shen … the spirits injured under the effect of fear, one loses possession of oneself, well-rounded forms become emaciated and the mass of flesh is ravaged.
(Ling Shu, Chapter 8; Larre and Rochat de la Vallée, 1995)
Given Five Element Constitutional Acupuncture’s emphasis on the health of the spirit, it is natural that it places more emphasis on the internal causes than on the external and miscellaneous causes. In relatively affluent Western cultures it is distress in people’s spirits that is the cause of so much illness and suffering. This was true amongst the affluent even in ancient China.
The reason that nobility get illness is that they do not harmonise their joys and passions … The reason that lowly people become ill is exhaustion from their labour, hunger and thirst.
(Yinshu; Lo, 2003)
Traditional Chinese Medicine, in contrast, is inclined to focus more of its attention on the external and miscellaneous causes. It does, however, recognise the importance of internal causes but to a lesser degree (see Mole, 1998, for a discussion of changes in attitudes to the internal causes in recent Chinese history).
Emotions as a cause of disease
It is normal for people to experience a variety of emotions in different circumstances. For example, it is normal for people to feel grief when they have lost someone or something. Anger helps people to assert their rights and fear protects them from danger. Appropriate emotional response is the goal. It is when emotions are prolonged, intense, repressed or not acknowledged that they can become a cause of imbalance in a person’s qi. Prolonged or intense emotion creates excessive or disharmonious movement of the qi. Emotions that are consistently suppressed tend to inhibit the normal movement of the qi. In the Han dynasty text, the Li Ji, it says: ‘The movements of the Heart are brought about by things; things affect it, thus there is motion’ (Davis, 1996).
In the Qing dynasty, Shen Jin-ao made clear that it was excessive emotion that was deleterious: ‘Due to having great fear, great joy, great anxiety, great fright, the result is suffering loss of spirit’ (quoted in Flaws and Lake, 2000, p. 18). This is a typically Confucian view, advocating the need to avoid intense emotional states.
Many patients have experienced traumas and situations that have evoked intense emotions. When talking about aspects of their past the practitioner can detect movement in the patient’s face, changes in their body language or a different tone to the voice. Their qi has been unable to return to its previous level of balance. The emotions that arise pervade their spirit and body. Their emotional life and physical function are inevitably affected.
A young child is perhaps the best model of emotional balance and health. Although sadly some babies are born with severe problems, most are born with only slight imbalances in their qi. One of the striking and endearing aspects of young children is their extraordinary vitality in body, mind and spirit and the spontaneity and fluency of their emotions. Often when small children hurt themselves, they go to their mothers for sympathy, but only for the time required to get their needs met. Then suddenly they are off, running and shouting again. A temper tantrum may be all-consuming, but rarely lasts more than a few minutes. The emotion, though it can be passionate, does not become stuck. Anger, joy, fear and sorrow may all be felt intensely by an infant, but only rarely do they become prolonged or habitual.
This emotional balance regrettably does not last. As Wordsworth says in his ode, Intimations of Immortality,
Heaven lies about us in our infancy!
Shades of the prison-house begin to close around the growing boy.
As children become older they begin to lose that wonderful sense of freedom and happiness, that state when all the emotions are available and none has become habitual or entrenched. Even in a young child one can usually perceive that certain emotions are more powerful and intense than others. There may be many reasons for this, but life events and the emotional and mental idiosyncrasies of other family members usually start to take their toll. For example, Ernest Becker has proposed that children never fully recover from the discovery in early childhood that their lives, and those of the people they love and depend upon, will inevitably end in death (see Becker, 1975). Where once the qi of the Five Elements flowed freely, the sheng and ke cycles were in harmony, now the balance of the Elements in the cycle becomes disturbed.
When the Five Elements are united, the five virtues are present and yin and yang form a chaotic unity. Once the Five Elements divide, the distinguishing spirit (shishen) gradually arises, and the encrustation of the senses gradually takes place; truth flees and the false becomes established. Now, even the state of the child is lost.
(Liu I Ming; quoted in Cleary, 2005, p. 66)
In time the effects on the body and spirit can become chronic. Physical illness develops and the spirit is diminished. Patients all have their own personal history, which has formed their unique personality and created imbalances in the Five Elements.
The movement of emotions
The English word ‘emotion’ has the idea of movement inherent in its composition. The Chinese also understood that the emotions create movement and disturbance in a person’s qi. The Chinese character for emotion is qing (Weiger, 1965, lesson 79F). Elisabeth Rochat de la Vallée describes the character:
 |
It is made with two parts, the heart on the left side and the greeny blue colour of life on the right. The right hand side expresses the deep power of life, the richness of the sap flowing or circulating within vegetation. It is made with the character for life (sheng) itself, which is the image of a plant growing up from the earth, and with cinnabar (dan). The first impression of this character is that there is a kind of manifestation of the power of life at the level of the heart.
(Larre and Rochat de la Vallée, 1996, p. 21)
Su Wen describes how the different emotions affect a person’s qi. More yang emotions of joy and anger create upward and expansive movement. More yin emotions, such as sadness and anxiety, generate downward and contracting movement. This can be clearly seen in an acute situation. Shock or fright affects the Heart and Kidneys intensely. Its effects are both yin and yang in nature. If, for example, people become intensely frightened or shocked, their bodies immediately produce a huge surge of adrenaline. The effects of increased adrenaline production have been extensively studied by physiologists. There is an increase in perspiration, heart rate, urination, circulation of blood to the muscles, etc. In short, it prepares the body for physical action. The downward moving aspects of the qi may affect the bladder and bowel. The more upward movement may affect the heart. Although the surge of adrenaline has broadly similar effects, everyone reacts in their own unique way. One person’s heart may become erratic whereas another person is more aware of the need to urinate. One person freezes, while another becomes agitated. The differing response is largely determined by the balance of yin/yang and the Five Elements.
Like the climate sages are numerous and not alike … This being so, physicians of high rank carefully consider the movements of qi, observe their patient’s disposition and take these as the root of illness.
(I Hsien; translated by Wang, 1990)
All emotions have profound effects on the body, which people can experience if the emotion is felt intensely enough. Practitioners working in Western society constantly see patients whose emotional life has been the cause of their illness. Ongoing difficulties in a person’s life chronically unbalance the qi. People’s health deteriorates as a result of failing to come to terms with stressful situations in their life such as divorce, redundancy, loneliness, disappointment or unresolved conflict with somebody close. In extreme cases, such as the death of a spouse, people’s emotions can be so intense that they can lose the will to live. This is a complete negation of what is essential to the character qing; sheng the radical for life itself.
The seven internal causes of disease
In the San-yin Fang, Chen Yen gives seven internal causes of disease. These are anger (nu), joy (xi le), sadness (bei), grief (you), over-thinking (si), fear (kong) and shock (jing). Readers should note that contemporary Chinese books and most written by Western practitioners have changed the classification of internal causes from that proposed by Chen Yen. Where he listed bei, usually translated as sadness and associated with the Fire and Metal Elements, and you, customarily translated as grief and associated with the Metal Element, many writers have amalgamated these two emotions into sadness and given two meanings to the word si. Worry is the usual translation of one aspect of si and over-thinking or pensiveness of the other. In the changed classification both these meanings are included to make the number back up to seven.
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