DIAGNOSING THE CAUSES OF DISEASE

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Chapter 48

imageDIAGNOSING THE CAUSES OF DISEASE

INTRODUCTION

As mentioned earlier, the identification of the possible causes of patients’ disharmony is linked to general enquiries about their emotional life, working life, diet, past history of shocks or traumas, family history and environmental influences. I usually begin by carrying out a specific interrogation to identify the patterns of disharmony before delving into these aspects of a patient’s life. It is important not to confuse the general interrogation to find the causes of disease with the specific interrogation to identify the patterns of disharmony.

Identifying the causes of disease is not easy and therefore not always possible, but to try to do so is important as it is only by finding the causes of disease that we can help the patient to eliminate or minimize them if at all possible. Even if the patient can do nothing about a particular cause that is rooted in the past (such as an earlier accident), its identification is still important in order that we may channel our advice to the patient along the right lines. For example, there is no point in delving deeply into a patient’s emotional life if the cause of the problem is a past accident; vice versa, there is no point in tinkering with a patient’s diet or suggesting strict dietary prohibitions if the cause of the problem is clearly emotional.

One of the strengths of Chinese medicine, when compared with some branches of modern complementary medicine that consider a particular cause of disease to the exclusion of all others, is precisely that it contemplates many different causes of disease without a particular emphasis on one or another.

Traditionally the causes of disease were differentiated according to three broad categories: external (due to climate), internal (due to emotions), and miscellaneous. Nowadays, this classification is no longer relevant (not least because some of the most important causes of disease are in the ‘miscellaneous’ group) and we need not follow it. The main causes of disease, listed in approximate order of their importance and frequency are:

I find that, when identifying a cause or causes of disease, it is helpful to divide a person’s life into five distinct ages (see below). Because each cause of disease is more prevalent during a certain period of life, establishing when the cause arose helps us to identify the disease. There seldom is only one cause of disease; nearly always a disease results from the combination of at least two causes. Usually one cause occurs at a certain point of the patient’s life, then, some years later, another cause intervenes and the combination of the two triggers a disharmony (Fig. 48.1). Some examples will be given below.

INTERACTIONS BETWEEN CAUSES OF DISEASE

THE FIVE STAGES OF LIFE

The patient’s life can be differentiated into five stages:

Of course, the above age limits are intended only as a guideline and individual cases may differ from them according to individual body conditions. For example, a 38-year-old person who is in very poor health could be included in the middle-aged group, whereas a youthful and healthy 42-year-old person could be included in the young adulthood age. The following are the main characteristics and possible aetiology and pathology of these five ages.

Childhood

During early childhood there are only three possible causes of disease, that is, weak hereditary constitution, irregular feeding and climate. Therefore, if a patient has been suffering from a particular complaint since early childhood, this can be due to one of these three causes. We can eliminate climate as a cause because it does not usually cause long-lasting consequences (unless there is a residual pathogenic factor), so the problem can therefore be due only to heredity or irregular feeding. An example of such a problem is early-onset atopic disease (asthma and eczema), which is usually due to a hereditary weakness of the Lungs’ and Kidneys’ Defensive-Qi systems.

A new possible cause of disease in young children is immunizations, which are often the cause of chronic infections, sleep problems or hyperactivity.

Older children’s main causes of disease are primarily diet, climate, emotions and traumas. For example, if a patient has been suffering from persistent headaches since childhood, this could be due either to a trauma to the head or to irregular diet as a child. The emotional life of a child is quite different from that of an adult and a child’s emotional problems are largely the reflection of the family’s emotional state.

Adolescence

Adolescence is a very vulnerable period of life both on a physical and on an emotional level, especially for girls. Taking a careful history will often reveal the onset of a particular problem during adolescence. For example, if a girl has been suffering from headaches since the onset of the menarche (which can be established only with very careful questioning) this most probably indicates Liver-Blood deficiency (resulting in Liver-Yang rising) as the main cause of the problem. This, in turn, is most probably due to dietary irregularity or an injudicious vegetarian diet.

Skin problems from this age may also be due to the aggravation of Blood deficiency with the onset of the menarche. If a young woman has been suffering from painful periods ever since their onset, this almost certainly points to invasion of Cold in the Uterus during early adolescence when the Uterus is in a particularly vulnerable state.

Adolescence is also a vulnerable time from the emotional point of view and deep emotional problems in a young adult often stem from that time.

Young adulthood

Many events characterize the early young adulthood, for example leaving home, change of diet, sexual activity, and infections.

Leaving home often coincides with a deterioration in the young person’s dietary habits characterized by irregular meals, eating ‘fast foods’, and often becoming vegetarian. When practised without a proper understanding of nutrition, a vegetarian diet may lead to Blood deficiency, especially in girls. Therefore, digestive problems later in life often have their root in the early 20s.

Young adulthood is also the time of emotional stress deriving from work, relationships and unresolved family situations. The pulse reflects the emotional cause of disease quite accurately. For example, if the Lung pulse is somewhat full and the patient looks sad, it may be due to sadness or grief which has not been expressed (the fullness of the Lung pulse would indicate this). If the Lung pulse is particularly Weak and without wave and the eyes lack lustre, I may enquire whether events in the patient’s life have caused sadness or grief.

If the Heart pulse is Overflowing and there is a Heart crack on the tongue, I may ask if the patient has suffered from a shock. If the Heart pulse is Choppy, the complexion dull, the eyes lustreless and the voice weak and weepy, it often indicates long-standing sadness.

If the pulse is Wiry on all positions, I may enquire whether there is some situation in the patient’s life that is causing frustration, anger or resentment.

The pulse, complexion and eyes often point to the true emotion underlying the disease, sometimes even contradicting the patient’s own perception. For example, a patient complained of various symptoms which she attributed to the anger she felt at having suffered sexual abuse as a teenager. Her therapist had also identified anger as a cause of her symptoms. However, her very pale complexion, sad eyes and Weak pulse without wave, especially on the Lung position, showed a different picture; in other words, all the signs pointed to sadness and grief as the predominant emotions. I therefore asked her how she felt about her past experiences and she confirmed that those were the predominant emotions.

Another case showed almost the opposite situation. A young woman complained of premenstrual tension and depression; she looked quite sad and her voice was somewhat weepy. However, her pulse was not weak but somewhat full; in particular, it was Moving, especially on the Heart position. I asked her if she had suffered a shock during childhood and she burst into tears, telling me about sexual abuse suffered from an uncle.

Middle age

The main causes of disease in middle age are emotions, overwork and diet.

The emotional state of middle age may take two opposite directions: some people have been able to resolve the emotional problems of their youth and have settled into a way of life that pays attention to the needs of the Self; for others, middle age is a time of crisis and emotional turmoil when every aspect of their life is questioned. Most people overcome this crisis to achieve a better emotional balance.

Overwork is probably the most important cause of disease in middle age. This comes about because middle age is a time when people usually reach the peak of their profession, which imposes the heaviest demands. Unfortunately, this comes at a time when our energy is naturally declining and Kidney-Qi begins to decline too. Most people make unreasonable demands on their own bodies; they expect their energy to be the same as when they were in their 30s or even 20s, and have no idea about the need for rest; they think it is ‘normal’ to get up at 6.30 in the morning, catch a train at 7.30, work all day under conditions of stress, eat a sandwich at their desk for lunch without any interruption from work, and return home at 9 in the evening. This constitutes ‘overwork’ and is a major cause of Kidney deficiency in the Western world.

Old age

Old age is a time when causes of disease have a lesser impact than in any other period of life. Generally speaking, past causes of disease are already well entrenched and usually no new causes of disease play a role. This is not because diet or emotional problems do not affect the elderly but because any cause of disease at this time of one’s life inevitably has its roots in the distant past; for this reason, a change in habits is somewhat less important in the elderly than at any other time of life, particularly with regard to diet. For example, if an 85-year-old man suffers from Phlegm due to a lifelong excessive consumption of greasy foods, a change in diet at this late time of life will have little impact on his organism (although it may still be advisable for him to make these changes). Of course, that is not to say that other changes in life’s habits do not have an impact on a person’s health: for example, it is never too late to explore the root of one’s emotional problems or to take up exercise.

THE CAUSES OF DISEASE

Heredity

The constitutional body condition inherited from our parents depends on three factors:

Any of these factors can affect the body condition and become a cause of disease later in life. If the parents’ Qi and Essence are weak, the child’s resulting Pre-Heaven Essence will also be weak. Similarly, if the mother conceives in later life, this can result in a Kidney or Liver deficiency starting during childhood.

Even though the parents’ general health may be good, if it is poor at the time of the child’s conception (perhaps through overwork, excessive sexual activity, excessive consumption of alcohol, or use of certain medications or drugs such as cannabis or cocaine), this will result in the child’s having a weak constitution. In this case, the weakness will affect not the Kidneys or Liver, but any of the other organs (i.e. Spleen, Lungs or Heart), depending on what particular condition is negatively affecting the parents’ health. For example, if a parent has been overworking at the time of conception, his or her poor health may cause hereditary Spleen weakness in the child; excessive consumption of alcohol or the use of drugs or certain medicines may cause a hereditary weakness of the child’s Heart or Liver.

The mother’s condition during the pregnancy can affect the fetus. For example, an accident to the mother can cause headaches later in the child. A shock during pregnancy can cause a baby to cry during sleep or a child to suffer nightmares (this will also manifest with a bluish tinge on the forehead and chin).

The clinical manifestations of a poor constitution in each of a child’s organs are indicated below. Possible causes arising during pregnancy for each such constitution will be given, but we must obviously bear in mind that the manifestation may result from a constitutional weakness in one or both parents and not necessarily from what happened during pregnancy.

Emotions

Emotions are mental stimuli which influence our affective life. Under normal circumstances, they are not a cause of disease. Indeed, ‘emotions’ should be more appropriately called ‘feelings’ and feelings are a natural expression of human life. Without feelings, we would not be human. Hardly any human being can avoid being angry, sad, aggrieved, worried, or afraid at some time in his or her life. For example, the death of a relative provokes a very natural feeling of grief. It is only when such feelings take over our life inappropriately and disturb our psyche and body that they become pathological; when this happens, feelings have turned into ‘moods’.

Moods often arise precisely when feelings are suppressed; for example, if a certain situation makes us angry and we recognize the anger we can deal with it and perhaps even come to the conclusion that part of the anger was a projection of our own ‘Shadow’. In such a case, the anger is a normal feeling that will probably not have pathological consequences. But if we fail to recognize our anger, this will be driven to deeper levels of our psyche and turn into a ‘mood’ that possesses us. We ‘possess’ feelings, but moods possess us.

Thus, emotions (or ‘feelings’) become causes of disease only when they are excessive, prolonged, suppressed, or unrecognized, in which case they turn into moods. For example, hardly anyone can avoid being angry sometimes, but a temporary state of anger does not lead to disease. However, if a person is constantly angry about a certain situation in life for many years, or, even worse, if the anger is not recognized, this emotion will definitely disturb the Mind and Spirit and cause disease.

In Chinese medicine, ‘emotions’ (the term here signifies causes of disease, not normal feelings) are mental stimuli which disturb the Mind and Spirit and, through these, alter the balance of the Internal Organs and the harmony of Qi and Blood. For this reason, emotional stress is an internal cause of disease which injures the Internal Organs directly. Conversely, and this is a very important feature of Chinese medicine, the state of the Internal Organs affects our emotional state. For example, if Liver-Yin is deficient (perhaps from dietary factors) and causes Liver-Yang to rise, this may result in a person becoming irritable all the time. Vice versa, if a person is constantly angry about a certain situation or with a particular person, this may cause Liver-Yang to rise.

The ‘Spiritual Axis’ in Chapter 8 clearly illustrates the reciprocal relationship between the emotions and the Internal Organs. It says: ‘The Heart’s fear, anxiety and pensiveness injure the Mind … the Spleen’s worry injures the Intellect … the Liver’s sadness and shock injure the Ethereal Soul … the Lung’s excessive joy injures the Corporeal Soul … the Kidney’s anger injures the Will-Power…’.1 On the other hand, further on it says: ‘If Liver-Blood is deficient there is fear, if it is in excess there is anger … if Heart-Qi is deficient there is sadness, if it is in excess there is manic behaviour …’2

These two passages clearly show that, on the one hand, emotional stress injures the Internal Organs and, on the other hand, disharmony of the Internal Organs causes emotional imbalance.

The emotions taken into consideration in Chinese medicine have varied over the years. From a Five-Element perspective, the ‘Yellow Emperor’s Classic’3 considered five emotions, each one affecting a specific Yin organ:

However, these are not by any means the only emotions discussed in the ‘Yellow Emperor’s Classic’. In other passages sadness and shock are added, giving seven emotions:

Other doctors considered other emotions such as grief, love, hatred and desire (craving).

Finally, and interestingly, there is one last emotion which is not usually mentioned in Chinese medicine, and that is guilt. Yet, in my opinion, guilt is very pervasive in Western patients and definitely an emotional cause of disease.

Thus, the list of emotions could be expanded as follows:

The effect of each emotion on a relevant organ should not be interpreted too restrictively. There are passages from the ‘Yellow Emperor’s Classic’ that attribute the effect of emotions to organs other than the ones just mentioned. For example, the ‘Spiritual Axis’ in Chapter 28 says: ‘Worry and pensiveness agitate the Heart’.4 The ‘Simple Questions’ in Chapter 39 says: ‘Sadness agitates the Heart…’5

Furthermore, all emotions, besides affecting the relevant organ directly, affect the Heart indirectly because the Heart houses the Mind. It alone, being responsible for consciousness and cognition, can recognize and feel the effect of emotional tension.

Fei Bo Xiong (1800-1879) put it very clearly when he said:

Yu Chang in ‘Principles of Medical Practice’ (1658) says: ‘Worry agitates the Heart and has repercussions on the Lungs; pensiveness agitates the Heart and has repercussions on the Spleen; anger agitates the Heart and has repercussions on the Liver; fear agitates the Heart and has repercussions on the Kidneys. Therefore all the five emotions [including joy] affect the Heart’.7 Chinese writing clearly bears out the idea that all emotions affect the Heart since the characters for all seven emotions are based on the ‘heart’ radical.

The way that all emotions afflict the Heart also explains why a Red tip of the tongue, indicating Heart-Fire, is so commonly seen even in emotional problems related to other organs.

The first effect of emotional stress on the body is to impair the proper circulation and direction of Qi. Qi is non-substantial and the Mind, with its mental and emotional energies, is the most non-material type of Qi. It is therefore natural that emotional stress affecting the Mind impairs the circulation of Qi first of all.

Each emotion is said to have a particular effect on the circulation of Qi. The ‘Simple Questions’ in Chapter 39 says: ‘ Anger makes Qi rise, joy slows down Qi, sadness dissolves Qi, fear makes Qi descend … shock scatters Qi … pensiveness knots Qi …’8 Dr Chen Yan in ‘A Treatise on the Three Categories of Causes of Diseases’ (1174) says: ‘Joy scatters, anger arouses, worry makes Qi unsmooth, pensiveness knots, sadness makes Qi tight, fear sinks, shock moves.’9

Again, this should not be taken too literally as, in certain cases, emotional pressure may have a different effect on Qi from the one outlined above. For example, fear is said to make Qi descend and it may cause enuresis, incontinence of urine or diarrhoea, since the Kidneys control the two lower orifices (urethra and anus). This is certainly true in cases of extreme and sudden fear, which may cause incontinence of urine or diarrhoea, or in the case of children when anxiety about a certain family situation may cause enuresis. However, the effect of fear on Qi depends also on the state of the Heart. If the Heart is strong, it will cause Qi to descend, but if the Heart is weak, it will cause Qi to rise in the form of Empty-Heat. This is more common in old people and in women. In such cases, fear and anxiety may weaken Kidney-Yin and give rise to Empty-Heat of the Heart with such symptoms as palpitations, insomnia, night sweating, a dry mouth, red face and a Rapid pulse.

Box 48.1 summarizes the relationships between the seven emotions and the Internal Organs.

BOX 48.1   EMOTIONS AND THE INTERNAL ORGANS

Let us now discuss the effects of each emotion individually.

Anger

The term ‘anger’, perhaps more than any other emotion, should be interpreted very broadly to include several other allied emotional states, such as resentment, repressed anger, feeling aggrieved, frustration, irritation, rage, indignation, animosity, or bitterness.

Any of these emotional states can affect the Liver, if they persist for a long time, causing stagnation of Liver-Qi or Blood, rising of Liver-Yang or blazing of Liver-Fire. The effect of anger on the Liver depends, on the one hand, on the person’s reaction to the emotional stimulus and, on the other hand, on other concurrent factors. If the anger is bottled up it will cause stagnation of Liver-Qi, whereas if it is expressed it will cause Liver-Yang rising or Liver-Fire blazing. In women, stagnation of Liver-Qi may easily lead to stasis of Liver-Blood. Those who also suffer from some Kidney-Yin deficiency (perhaps from excessive sexual activity) may develop Liver-Yang rising. Those who, on the other hand, have a tendency to Heat (perhaps from excessive consumption of hot foods) will tend to develop Liver-Fire blazing.

Anger (intended in the broad sense outlined above) makes Qi rise and many of the symptoms and signs will manifest in the head and neck, such as headaches, tinnitus, dizziness, red blotches on the front part of the neck, a red face, thirst, a bitter taste and a Red tongue with red sides.

The ‘Simple Questions’ in Chapter 39 says: ‘Anger makes Qi rise and causes vomiting of blood and diarrhoea.’10 It causes vomiting of blood because it makes Liver-Qi and Liver-Fire rise and diarrhoea because it induces Liver-Qi to invade the Spleen.

Anger does not always manifest outwardly with outbursts of fury, irritability, shouting, a red face, etc. Some individuals may carry anger inside them for years without ever manifesting it. In particular, long-standing depression may be due to repressed anger or resentment. A person who is very depressed may look subdued and pale, walk slowly and speak with a low voice – all signs which one would associate with a depletion of Qi and Blood deriving from sadness or grief. However, when anger rather than sadness is the cause of disease, the pulse and tongue will clearly show it: the pulse will be Full and Wiry and the tongue will be Red with redder sides and with a dry yellow coating. This type of depression is most probably due to long-standing resentment, often harboured towards a member of that person’s family.

In some cases anger can affect other organs, especially the Stomach. This can be due to stagnant Liver-Qi invading the Stomach. Such a condition is more likely to occur if one gets angry at mealtimes, which may happen if family meals become occasions for regular rows. It also happens when there is a pre-existing weakness of the Stomach, in which case the anger may affect only the Stomach without even affecting the Liver.

If one regularly gets angry an hour or two after meals, then the anger will affect the Intestines rather than the Stomach. This happens, for example, when one goes straight back to a stressful and frustrating job after lunch. In this case, stagnant Liver-Qi invades the Intestines and causes abdominal pain, distension and alternation of constipation with diarrhoea.

Finally, anger, like all other emotions, also affects the Heart. This organ is particularly prone to be affected by anger also because, from a Five-Element perspective, the Liver is the mother of the Heart and often Liver-Fire is transmitted to the Heart giving rise to Heart-Fire. Anger makes the Heart full with blood rushing to it. With time, this leads to Blood-Heat affecting the Heart and therefore the Mind. According to Dr J. H. F. Shen, anger tends to affect the Heart particularly when the person does a lot of jogging or exercising; this is because excessive exercise dilates the heart, which is then more prone to be affected by the transmission of Fire from the Liver to the Heart.

In some cases, anger disguises other emotions such as guilt. Some people may harbour guilt inside for many years and be unable or unwilling to recognize it; they may then use anger as a mask for their guilt. Moreover, there are some families in which everyone is perpetually angry. This happens more in Mediterranean countries such as Italy, Spain or Greece. In these families, anger is used as a mask to hide other emotions such as guilt, fear or dislike of being controlled, or to conceal weakness or an inferiority complex. When this is the case, it is important to be aware of this situation as one needs to treat not the anger but the underlying psychological and emotional condition.

Box 48.2 summarizes the effects of anger.

BOX 48.2   ANGER

Joy

A normal state of joy is not in itself a cause of disease; on the contrary, it is a beneficial mental state which favours a smooth functioning of the Internal Organs and their mental faculties. The ‘Simple Questions’ in Chapter 39 says: ‘Joy makes the Mind peaceful and relaxed, it benefits the Nutritive and Defensive Qi and it makes Qi relax and slow down.’11 On the other hand, in Chapter 2 the same book says: ‘The Heart … controls joy, joy injures the Heart, fear counteracts joy.’12

What is meant by ‘joy’ as a cause of disease is obviously not a state of healthy contentment but one of excessive excitement and craving, which can injure the Heart. This happens to people who live in a state of continuous mental stimulation (however pleasurable) or excessive excitement – in other words, a life of ‘hard playing’.

As indicated above, inordinate craving is an aspect of the emotion ‘joy’ and it stirs up the Minister Fire, which overstimulates the Mind.

Joy, in the broad sense indicated above, makes the Heart larger. This leads to excessive stimulation of the Heart, which, in time, may lead to Heart-related symptoms and signs. These may deviate somewhat from the classical Heart patterns. The main manifestations would be palpitations, overexcitability, insomnia, restlessness and talking a lot; the tip of the tongue would be red. The pulse would typically be Slow, slightly Overflowing but Empty on the left Front position.

Joy may also be marked out as a cause of disease when it is sudden; this happens, for example, on hearing good news unexpectedly. In this situation, ‘joy’ is akin to shock. Fei Bo Xiong in ‘Medical Collection from Four Families from Meng He’ says: ‘Joy injures the Heart … [it causes] Yang Qi to float and the blood vessels to become too open and dilated…’13 In these cases of sudden joy and excitement the Heart dilates and slows down and the pulse becomes Slow and slightly Overflowing but Empty. One can understand the effect of sudden joy further if one thinks of situations when a migraine attack is precipitated by the excitement of suddenly hearing good news. Another example of joy as a cause of disease is that of sudden laughter triggering a heart attack; this example also confirms the relationship existing between the Heart and laughter.

Finally, one can also get an idea of the effects of joy as an emotion by considering children, in whom overexcitement usually ends in tears.

Box 48.3 summarizes the effects of joy.

BOX 48.3   JOY

Worry

Worry is one of the most common emotional causes of disease in our society. The extremely rapid and radical social changes that have occurred in Western societies in the past decades have created a climate of insecurity and anxiety in all spheres of life. Of course, there are also people who, because of a pre-existing disharmony of the Internal Organs, are very prone to worry, even about very minor incidents in life. For example, many people appear to be very tense and worry a lot. On close interrogation about their work and family life, often nothing of note emerges. They simply worry excessively about trivial everyday activities and they tend to do everything in a hurry and be pressed for time. This may be due to a constitutional weakness of the Spleen, Heart or Lungs, or a combination of these.

Worry knots Qi, which means that it causes stagnation of Qi, and it affects both the Lungs and the Spleen: the Lungs because when one is worried breathing is shallow, and the Spleen because this organ is responsible for thinking and ideas. Worry is the pathological counterpart of the Spleen’s mental activity in generating ideas.

In a few cases, worry may also affect the Liver as a result of the stagnation of the Lungs; in a Five-Element sense this corresponds to Metal insulting Wood. When this happens, the neck and shoulders will tense up and become stiff and painful.

The symptoms and signs caused by worry will vary according to whether they affect the Lungs or the Spleen. If worry affects the Lungs it disturbs the breathing and the Corporeal Soul (Po); this will cause an uncomfortable feeling in the chest, slight breathlessness, anxiety, tensing of the shoulders, sometimes a dry cough and a pale complexion. The right Front pulse position (of the Lungs) may feel slightly Tight or Wiry, indicating the knotting action of worry on Qi.

If worry affects the Spleen it may cause poor appetite, a slight epigastric discomfort, some abdominal pain and distension, tiredness and a pale complexion. The right Middle pulse position (Spleen) will feel slightly Tight but Weak. If worry affects the Stomach as well (which happens if one worries at mealtimes), the right Middle pulse may be Weak-Floating.

Box 48.4 summarizes the effects of worry.

BOX 48.4   WORRY

Pensiveness

Pensiveness is very similar to worry in its character and effect. It consists in brooding, constantly thinking about certain events or people (even though not worrying), nostalgic hankering after the past and generally thinking intensely about life rather than living it. In extreme cases, pensiveness leads to obsessive thoughts. In a different sense, pensiveness also includes excessive mental work in the process of one’s work or study.

Pensiveness affects the Spleen and, like worry, it knots Qi. It will therefore cause similar symptoms to those outlined above. The only difference will be that the pulse of the right side not only will feel slightly Tight, but will have no wave. One can feel the normal pulse as a wave under the fingers moving from the Rear towards the Front position. The pulse without wave lacks this flowing movement from Rear to Front position and it is instead felt as if each individual position were separate from the others (see Fig. 50.1 on p. 477). In the case of pensiveness, the pulse will lack a wave only on the right Middle position. A pulse without wave in the Front and Middle position indicates Sadness.

Box 48.5 summarizes the effects of pensiveness.

BOX 48.5   PENSIVENESS

Sadness and grief

Sadness includes the emotion of regret, as when someone regrets a certain action or decision in the past and the Mind is constantly turned towards that time. Sadness and grief affect the Lungs and Heart. In fact, according to the ‘Simple Questions’, sadness affects the Lungs via the Heart. It says in Chapter 39: ‘Sadness makes the Heart cramped and agitated; this pushes towards the lungs’ lobes, the Upper Burner becomes obstructed, Nutritive and Defensive Qi cannot circulate freely, Heat accumulates and dissolves Qi.’14 According to this passage then, sadness primarily affects the Heart, and the Lungs suffer in consequence since they are both situated in the Upper Burner. The Lungs govern Qi and sadness and grief deplete Qi. This is often manifested on the pulse as a Weak quality on both left and right Front positions (Heart and Lungs). In particular, the pulse on both Front positions is Short and has no wave, that is, it does not flow smoothly towards the thumb. Other manifestations deriving from sadness and grief include a weak voice, tiredness, pale complexion, slight breathlessness, weeping and a feeling of oppression in the chest. In women, deficiency of Lung-Qi from sadness or grief often leads to Liver-Blood deficiency and amenorrhoea.

Although sadness and grief deplete Qi, and therefore lead to deficiency of Qi, they may also, after a long time, lead to stagnation of Qi, because the deficient Lung- and Heart-Qi fail to circulate properly in the chest.

As mentioned before, each emotion can affect other organs apart from its ‘specific’ one. For example, the ‘Spiritual Axis’ in Chapter 8 mentions injury of the Liver from sadness rather than anger: ‘When sadness affects the Liver it injures the Ethereal Soul; this causes mental confusion … the Yin is damaged, the tendons contract and there is hypochondrial discomfort.’15 This shows how organs can be affected by emotions other than the one ‘specific’ to them. In this case, sadness can naturally affect the Ethereal Soul and therefore Liver-Yin. Sadness has a depleting effect on Qi and it therefore, in some cases, depletes Liver-Yin leading to mental confusion, depression, lack of a sense of direction in life and inability to plan one’s life.

Finally, some doctors consider that grief which is unexpressed and borne without tears affects the Kidneys. According to them, when grief is held in without weeping, the fluids cannot come out (in the form of tears) and they upset the fluid metabolism within the Kidneys. This would happen only in situations when grief had been felt for many years.

Box 48.6 summarizes the effects of sadness and grief.

BOX 48.6   SADNESS AND GRIEF

Fear

‘Fear’ includes both a chronic state of fear and anxiety, and a sudden fright. It depletes Kidney-Qi and makes Qi descend. The ‘Simple Questions’ in Chapter 39 says: ‘Fear depletes the Essence, it blocks the Upper Burner, which makes Qi descend to the Lower Burner.’16 Examples of Qi descending are nocturnal enuresis in children and incontinence of urine or diarrhoea in adults, following a sudden fright.

Situations of chronic anxiety and fear will have different effects on Qi depending on the state of the Heart. If the Heart is strong, it will cause Qi to descend, but if the Heart is weak, it will cause Qi to rise in the form of Empty-Heat. This is more common in women and in old people of either sex as fear and anxiety weaken Kidney-Yin and give rise to Empty-Heat of the Heart with such symptoms as palpitations, insomnia, night sweating, a dry mouth, a malar flush and a Rapid pulse.

If a person has a tendency to a constitutional weakness of the Heart (manifested with a midline crack on the tongue extending all the way to the tip), fear will affect the Heart rather than the Kidneys.

There are, however, other causes of fear that are not related to the Kidneys. Liver-Blood deficiency and a Gall-Bladder deficiency can also make the person fearful.

Box 48.7 summarizes the effects of fear.

BOX 48.7   FEAR

Shock

Mental shock scatters Qi and affects the Heart and Kidneys. It causes a sudden depletion of Heart-Qi, makes the Heart smaller and may lead to palpitations, breathlessness and insomnia. This is often reflected in the pulse with the Moving quality, that is, a pulse that is short, slippery, shaped like a bean, rapid and gives the impression of vibrating as it pulsates.

Shock also ‘closes’ the Heart or makes the Heart smaller. This can be observed in a bluish tinge on the forehead and a Heart pulse which is Tight and Fine.

Shock also affects the Kidneys because the body draws on the Kidney-Essence to supplement the sudden depletion of Qi. For this reason, shock can cause such symptoms as night sweating, a dry mouth, dizziness, or tinnitus.

Box 48.8 summarizes the effects of shock.

BOX 48.8   SHOCK

Love

‘Love’ here means not normal love, such as that of a mother towards her child or that between two lovers, but rather the condition when love becomes an obsession or when it is misdirected, as when a person loves someone who is persistently hurtful. In this context, ‘love’ indicates a rather obsessive love for a particular person, a misdirected emotion focusing on someone who persistently hurts the lover, whether physically or mentally, or narcissistic love. Obsessive jealousy would also fall under this broad category. In these senses, love becomes a cause of disease.

‘Love’ in the sense outlined above affects the Heart and quickens Qi. This will be felt on the left Front position (Heart) with an Overflowing quality, and the pulse will also be rapid. It may cause such symptoms and signs as palpitations, a red tip of the tongue, a red face, insomnia and mental restlessness.

Box 48.9 summarizes the effects of ‘love’.

BOX 48.9   ‘LOVE’

Hatred

Hatred is quite similar to anger but differs from it in so far as it indicates a ‘cold’ and calculating malice rather than the uncontrollable and spontaneous outbursts that are typical of anger. When harboured for many years, hatred is a very damaging and destructive emotion. It affects the Heart and Liver and it knots and slows down Qi. It can be felt on the pulse of the left-hand side with a Wiry but Slow quality. The symptoms and signs caused by hatred include chest pain, hypochondriac pain, insomnia, headache and palpitations. These manifestations include pain in some part of the body as, when hatred is felt for many years, it turns inwards to injure only the person feeling it.

Box 48.10 summarizes the effects of hatred.

BOX 48.10   HATRED

Craving

‘Desire’ means excessive craving. The inclusion of this as a cause of disease reflects the Buddhist influence on Chinese medicine, which began during the Tang dynasty. The ultimate cause of disease according to Buddhist thought is desire, that is, clinging to external objects or other people and always wanting more. This excessive craving, which is one aspect of the emotion of ‘joy’ in Chinese medicine, causes the Minister Fire to blaze upwards and harass the Mind. By this is meant a state of constant craving which is never satisfied. This can include craving for material objects or recognition.

Craving affects the Heart and it scatters Qi. Craving also affects the Pericardium by stirring the Minister Fire. In disease, Minister Fire refers to a pathological Empty-Fire arising from the Kidneys; it affects the Pericardium and therefore the Mind.17 If the Mind is calm, settled and content, the Pericardium follows its direction and there is a happy and balanced life. If the Mind is weak and dissatisfied, the Pericardium follows the demands of the craving and the person constantly desires new objects or new marks of recognition, which, however, even when attained, are never satisfying and leave the person more frustrated. It is for these reasons that both Daoism and Buddhism put the emphasis on reducing craving to prevent the arousal of Minister Fire, which stirs the Mind.

Craving will cause Heart-Fire or Heart Empty-Heat depending on the underlying condition of the person. If there is a tendency to Yin deficiency, which is common in people who tend to overwork, it will lead to Heart Empty-Heat. This will cause palpitations, a malar flush, a dry throat, insomnia and mental restlessness.

Box 48.11 summarizes the effects of craving.

BOX 48.11   CRAVING

Guilt

Guilt is an extremely common emotion and a cause of disease in the West. A feeling of guilt may derive from the transgression of social or religious taboos or from having done something wrong which is later regretted. People who are prone to blame themselves for everything that goes wrong may also suffer an unjustified and subjective sense of guilt.

Guilt affects the Heart and Kidneys and it causes Qi either to stagnate or to sink. It may cause stagnation of Qi in the chest, epigastrium, or abdomen, and its clinical manifestations include an uncomfortable feeling in the chest, epigastric or abdominal pain and distension and a Fine pulse. The tongue will have a red tip and the pulse will be vibrating as it pulsates. The eyes will look unstable and often flap shut while a person is talking.

If it affects the Kidneys, guilt may cause Qi to sink giving rise to urinary problems such as a slight incontinence, dribbling of urine and a bearing-down feeling in the hypogastrium.

In some cases, guilt may also arise from the repression of anger. When anger is repressed and not recognized, it may turn inwards and cause an attitude of self-punishment and guilt. When guilt results from repressed anger, the pulse will be Wiry.

Box 48.12 summarizes the effects of guilt.

BOX 48.12   GUILT

Overwork

By ‘overwork’ I mean not physical work but the habit of working long hours every day without adequate rest, usually accompanied by irregular eating for many years. As stated earlier, someone who ‘overworks’ leaves home perhaps at 7 in the morning, catches a train to work, works under stressful conditions through the lunch hour (eating a sandwich at the desk), and returns home at about 9 in the evening. When such a routine is carried out for many years, it constitutes what I call ‘overwork’. It is an extremely common cause of disease in Western patients about which they need to be educated. Most people who follow such a routine at work are surprised when I suggest to them that they work too much and that their working habits might have something to do with their illness.

Overwork as defined above is probably the most common cause of Yin deficiency in the patients we see. It depletes primarily Kidney-Yin but also Liver- and Stomach-Yin, depending on the circumstances. In women, it is likely to injure Liver-Yin as well as Kidney-Yin; on the other hand, when overwork is associated with an irregular diet (as it often is), it injures Stomach-Yin.

Diet

Diet influences our health in two main ways: first through our choice of foods, and secondly through our eating habits.

Choice of foods

Our choice of foods can become unbalanced in four main ways: eating too much cold food, eating too much hot food, eating too much greasy food, and not eating enough.

Eating too much cold food

‘Cold’ food includes raw fruit, raw vegetables and cold drinks. Patients are often surprised to be told that an excessive consumption of such foods might be detrimental as this advice runs counter to the prevailing view of ‘healthy’ eating, that is, eating lots of fruit and salads in order to secure the maximum intake of vitamins and minerals. It is true that raw foods are rich in vitamins and minerals and a small consumption of such foods is not detrimental and indeed healthy. It becomes detrimental from the point of view of Chinese medicine only when the mainstay of someone’s diet is exclusively raw fruit and vegetables.

Excessive consumption of cold foods (including cold drinks) injures the Spleen and leads to internal Cold in the body. This will cause a pale complexion, loose stools, tiredness, a feeling of cold, and abdominal pain.

Not eating enough

In affluent countries, ‘not eating enough’ is due to following a restrictive diet, often aimed at slimming, and may also result from following a vegetarian diet injudiciously, especially in women. Many young girls become vegetarian and, not having a good knowledge of food combining, they tend to eat a lot of salads and cheese, which injure the Spleen and lead to Dampness. Such girls will tend to be pale and suffer from tiredness, digestive problems, loose stools and menstrual problems; the tongue will be Pale and the pulse Choppy.

Box 48.13 summarizes the effects of diet.

BOX 48.13   DIET – CHOICE OF FOODS

Eating habits

Chinese medicine places stress not only on the range of foods eaten but also, and as important as what foods we eat, on the way that we eat. We may eat a very balanced diet with exclusively organic foods but if our eating habits are chaotic this will lead to disease.

Chinese medicine stresses the importance of routine and regularity in one’s diet. It also stresses the importance of having a short break after eating at lunchtime. Unfortunately, most people who work full-time have very irregular eating habits, which may include any of the following:

Such eating habits injure Stomach-Qi initially and then Stomach-Yin. One of the clearest signs of this, apart from digestive problems, is a tongue with a Stomach crack or scattered Stomach cracks and without coating.

Climate

Invasion of external pathogenic factors is an important cause of disease in Painful Obstruction Syndrome (Bi). The main external pathogenic factors are Wind, Dampness and Cold. Once in the body, any of these pathogenic factors can turn into or combine with Heat.

Heat

Heat originates from any of the previous three types when the exterior pathogenic factor turns into Heat in the Interior and gives rise to Heat Painful Obstruction Syndrome. This happens especially with an underlying deficiency of Yin. Heat is characterized by pain and redness, swelling and heat in the joints (which feel hot to the touch), limitation of movement and severe pain. In acute cases there is thirst, a fever which does not abate after sweating and a Slippery and Rapid pulse. This syndrome is characterized not just by Heat, but Damp-Heat. In fact, Dampness is the primary aspect of this syndrome and Heat the secondary one.

The diagnosis of external pathogenic factors is based on two main factors: the acute onset of the problem and a sensitivity of pain to weather changes.

Besides affecting the joints, climatic pathogenic factors can also affect the Internal Organs directly. This happens when external Cold invades the Stomach (causing acute epigastric pain and vomiting), the Intestines (causing acute abdominal pain and diarrhoea) or the Uterus (causing acute dysmenorrhoea).

Box 48.14 summarizes the climatic factors affecting joints.

BOX 48.14   CLIMATIC FACTORS AFFECTING JOINTS

Trauma

By ‘trauma’ is meant physical trauma. Accidents cause local stagnation of Qi. If the trauma is severe, it also causes local Blood stasis.

The diagnosis of trauma is obvious from the history, except when the trauma occurred several years before and the patient has either forgotten it or not related it to the presenting problem.

If the trauma causes local Blood stasis, this may manifest on the tongue with a single purple spot which (when compared with points) is relatively large. The tongue reflects also areas of the body and the location of the purple spot points to the site of the trauma, which may also be very old (Fig. 48.3).

Thus, for example, a small purple spot on the right side of the tip may indicate a trauma to the right side of the head.

Drugs including immunizations

Medicinal drugs

Obviously medicinal drugs are an important cause of disease in Western patients. A discussion of the side-effects of drugs is beyond the scope of this book. It should be noted, however, that with few important exceptions (such as chemotherapy and steroids), the side-effects of drugs are relatively short lived (once they are stopped) compared with other causes of disease. For example, an antidepressant will have some well-known side-effects but these will stop when the drug is discontinued and will not cause lasting damage. It is different with the other causes of disease such as heredity, emotional stress or diet. For example, an emotional problem dating back to a person’s childhood will have long-lasting effects even after the person has recognized the problem and taken steps to face it and resolve it. Likewise, if a person eats irregularly for some years, the effects of this may be very long lasting even a considerable time after the diet has been rectified.

Immunizations

Immunizations, in my opinion, lead to the formation of Latent Heat. Latent Heat is formed when a pathogenic factor invades the body without causing apparent symptoms; the pathogenic factor penetrates the Interior, turns into Heat and ‘lurks’ in the Interior for some time. After some time (usually weeks or months), the Heat emerges in the form of Latent Heat with symptoms such as sudden weariness, tired limbs, insomnia, thirst, irritability, Red tongue and Rapid pulse. It should be stressed that the fact that the Latent Heat emerges does not mean that it is being expelled but simply that it is manifesting after lurking in the Interior for some time.

In order to understand the effect of immunizations we need to refer to the theory of the Four Levels. According to this theory, an external pathogenic factor invades the body passing through four energetic levels: the Defensive-Qi, Qi, Nutritive-Qi and Blood levels. (See Fig. 104.2 on p. 959.)

The Defensive-Qi level is an exterior level, that is, at this stage the pathogenic factor is on the Exterior of the body. At the Qi level, the pathogenic factor turns into interior Heat. The three levels, Qi, Nutritive-Qi and Blood, are all interior and all characterized by interior Heat but at three different energetic layers, Qi being the most superficial and Blood the deepest. With an immunization, it is as if the ‘pathogenic factor’ (i.e. the vaccine) were injected directly at the Blood level. Once there, it ‘lurks’, turns into Heat and emerges later as Latent Heat.

It is of course impossible to prove, but my impression is that many modern autoimmune diseases, some cancers (such as leukemia) and AIDS manifest as Latent Heat and their growing incidence may partly be due to immunizations.

Excessive sexual activity

By ‘sexual activity’ is meant ejaculation in men and orgasm in women. Excessive sexual activity may weaken the Kidneys because sperm is a direct emanation of the Kidney-Essence (sexual activity not culminating in ejaculation does not deplete the Kidneys). It is difficult to define what is ‘excessive’ because it depends on the age and health of the person. A very rough guide to the recommended frequency of ejaculation in healthy men is to divide the man’s age by five (e.g. every 8 days in a 40-year-old man). It should be stressed that this period should be extended if the man is in poor health and especially if he suffers from a Kidney deficiency.

Excessive sexual activity weakens the Kidney-Essence and may cause backache, dizziness, tinnitus, poor memory and concentration, and weak knees.

I have so far referred to men deliberately because, in my opinion, the effect of sexual activity in women is quite different from that in men. Sperm in men is an emanation of the Kidney-Essence; the equivalent in women is menstrual blood. Sperm and menstrual blood constitute the ‘Tian Gui’ essence which arrives at puberty. Quite simply, men lose sperm during orgasm but women do not lose menstrual blood; therefore, sexual activity and orgasm in women are not weakening to the Kidneys. A cause of disease in women equivalent to excessive ejaculation in men would be a heavy loss of blood after childbirth or a heavy monthly blood loss in a woman suffering from menorrhagia. Some people say that the increased fluid lubrication in the vagina during sexual arousal and orgasm is equivalent to ejaculation in men. I tend to disagree with this view because, in my opinion, such fluids are part of Body Fluids rather than an emanation of the Kidney-Essence.

Finally, it should be mentioned that lack of sexual activity may also be a cause of disease but only when sexual desire is present. If sexual desire is totally absent, then lack of sexual activity has no health repercussions. Sexual desire makes the Minister Fire rise upwards; with orgasm this Fire is discharged downwards. When sexual desire is unfulfilled, the Minister Fire rises up without being discharged during orgasm and it affects the Heart, causing Heart-Fire or stagnation of Heart-Qi.

NOTES

1. Spiritual Axis (Ling Shu Jing image). People’s Health Publishing House: Beijing, 1981:24 First published c. 100 BC

2. Spiritual Axis (Ling Shu Jing image). People’s Health Publishing House: Beijing, 1981; 24.

3. The Yellow Emperor’s Classic of Internal Medicine – Simple Questions (Huang Di Nei Jing Su Wen image). People’s Health Publishing House: Beijing, 1979:36–42 First published c. 100BC.

4. Spiritual Axis, p. 67

5. Simple Questions, p. 221.

6. Xiong, Fei Bo, et al. Medical Collection from Four Families from Meng He (Meng He Si Jia Yi Ji image). Nanjing: Jiangsu Science Publishing House, 1985; 40.

7. Yu Chang 1658 Principles of Medical Practice, cited in Qin, Wang Ke. Theory of the Mind in Chinese Medicine (Zhong Yi Shen Zhu Xue Shuo image). Beijing: Ancient Chinese Medical Texts Publishing House, 1988; 34.

8. Simple Questions, p. 221.

9. Yan, Chen. A Treatise on the Three Categories of Causes of Diseases (San Yin Ji Yi Bing Zheng Fang Lun image), cited in Wang Ke Qin 1988 Theory of the Mind in Chinese Medicine (Zhong Yi Shen Zhu Xue Shuo image). Beijing: Ancient Chinese Medical Texts Publishing House, 1974; 55.

10. Simple Questions, p. 221.

11. Simple Questions, p. 221.

12. Simple Questions, p. 38.

13. Medical Collection from Four Families from Meng He, p. 40

14. Simple Questions, p. 221.

15. Spiritual Axis, p. 24

16. Simple Questions, p. 222.

17. For this reason ‘Minister Fire’ refers both to the physiological or pathological Fire of the Kidneys and to the Pericardium. This accounts for the assignment of the right Rear position on the pulse variously to the Kidney-Yang by some doctors, or to the Pericardium by others

18. Lawrence, DR. Clinical Pharmacology. Edinburgh: Churchill Livingstone, 1973; 14–29.

19. Lawrence, DR. Clinical Pharmacology. Edinburgh: Churchill Livingstone, 1973; 14. 30–14. 31.

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