Internal Causes of Disease
Review and Reflect on What You Learned
Detailed Notes
The “internal” causes of disease are those due to emotional strain. Traditionally, internal emotional causes of disease, injuring the internal organs directly, were contrasted to the external climatic causes of disease which affect the exterior of the body first.
The internal causes of disease are anger, joy, sadness, worry, pensiveness, fear, and shock.
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 matter – energy that gives rise to physical, 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, in which the Internal Organs are the major sphere of influence.
For example, the “Kidneys” of Chinese medicine correspond to the actual kidney organs on an anatomical level, to the Qi and Essence (Jing) associated with the Kidneys, to the Brain, will-power, and drive on a mental level, and to fear on an emotional level. All these levels interact with each other simultaneously.
Please note, that Chinese books (both ancient and modern) usually list these seven emotions as the main internal causes of disease. This should not be taken literally as there are many more emotions than these seven and these seven often encompass others. For example, under “anger” you would include resentment, indignation, and frustration.
Some other examples of emotions beyond the seven include envy, pride, shame, guilt, contempt, hopelessness, indignation, humiliation, regret, remorse, self-contempt, spite, and vanity. At the same time, these seven can encompass each.
Different view of emotions in Chinese and Western medicine
There is a difference in the view of emotions between Chinese and Western medicine. While Western medicine also recognizes interaction between the body and emotions, it does so in a completely different way to Chinese medicine. In Western medicine, the brain is at the top of the body-mind pyramid. The emotions affect the limbic system within the brain, nerve impulses travel down the hypothalamus, through to the sympathetic and parasympathetic nerve centers, finally reaching the internal organs. Thus, a nerve impulse triggered off by an emotional upset is transmitted to the relevant organ.
The view of Chinese medicine is entirely different. The body-mind is not a pyramid but a circle of interaction between the Internal Organs and their emotional aspects.
Whereas Western medicine tends to consider the influence of emotions on the organs as having a secondary or excitatory role rather than being 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 also as direct causes of disease.
The interaction of body and mind in Chinese medicine is also expressed in the Three “Treasures” (i.e., Essence (Jing), Qi, Mind (Shen). Essence is the material basis of Qi and Mind, forming the foundation for a happy and balanced mental and emotional life.
When does an emotion become a cause of disease?
The Chinese term for what we translate as “emotion” is qing ?which is based on the radical for “heart.”
The word “emotion” itself is not a good term to indicate the Chinese view of the “emotional” causes of disease. The word “emotion” derives from Latin and it refers to “e-movere” (i.e., to move out): it is used to indicate any feeling of the mind as distinct from the cognitive or volitional states of consciousness. In this sense, the term “emotion” may refer to any feeling such as fear, joy, hope, surprise, desire, aversion, pleasure, pain, etc.: it is therefore not entirely suitable as a term denoting the motions as understood in Chinese medicine.
It is interesting to note that the word to indicate a suffering of the mind was originally “passion” rather then “emotion.” The word “passion” derives from the Latin verb “patire,” which means “to suffer.” The word “emotion” replaced “passion” only in the time between Descartes and Rousseau, i.e., between 1650 and 1750.
The word “passion” would also convey the idea of mental suffering better than “emotion” because it implies the idea of something that is “suffered,” something that we are subject to. Indeed, feelings such as sadness, fear, and anger become causes of disease when they take over our mind, when we no longer possess them, but they “possess” us. The Chinese expression most Chinese books use to describe the “stimulation” or “excitation” produced by the emotions is ci ji ??, where ji contains the radical for “water” and means to “surge” as a wave does: that is, it denotes the surge of emotions like a wave that carries us away.
Emotions are mental stimuli that influence our affective life. Under normal circumstances, they are not a cause of disease. Hardly any human being can avoid being angry, sad, aggrieved, worried, or afraid at some time in his or her life, but those states will not lead to any disharmony. For example, the death of a relative provokes a very natural feeling of grief.
Emotions become causes of disease only when they are either long-lasting, or very intense, or both. It is only when we are in a particular emotional state for a long time (month or years) that they become a cause of disease. For example, if a particular family or work situation makes us angry and frustrated in an ongoing way, this will affect the Liver and cause an internal disharmony. In a few cases, emotions can become a cause of disease in a very short time if they are intense enough; shock is the best example of such a situation.
Emotions as causes of disease
Chinese medicine is concerned with the emotions only when these are either the cause of disease, or when they themselves are the presenting symptoms. Chinese medicine neither ignores the emotions as causes of disease, nor places too much emphasis on them to the exclusion of other causes.
In Chinese medicine, emotions (intended as causes of disease) are mental stimuli that disturb the Mind (Shen), the Ethereal Soul (Hun) and the Corporeal Soul (Po) and through these alter the balance of the Internal Organs and the harmony of the Qi and Blood. For this reason, emotional stress is an internal cause of disease that injure the Internal Organs directly. Chapter 26 of the “Spiritual Axis” says, “Excessive joy and anger injure the Yin organs…when these are injured the disease is in the Yin.
Emotions are internal causes of disease that cause an internal disharmony directly: this is contrasted with external, climatic factors, which can cause an internal disharmony only after passing through the stage of an Exterior disharmony. For example, sadness and grief deplete Lung-Qi directly and cause Lung-Qi deficiency. External Wind may invade the space between the skin and muscles (called the Exterior), block the circulation of Defensive Qi and cause the typical exterior symptoms of aversion to cold and fever. It is only after passing through the Exterior stage, that the external Wind may become Interior (usually turning into Heat) and deplete Lung-Qi internally.
Interaction of body and mind
A very important feature of Chinese medicine is that 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 cause a person to become irritable all the time, in certain situations, 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.” On the other hand, further on its say: “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 behavior.” These two passages clearly show that on the one hand, emotional stress injure the Internal Organs, and on the other hand, disharmony of the Internal Organs causes emotional imbalance.
Since the body and mind form an integrated and inseparable unit, the emotions cannot only cause disharmony but can also be caused by it. For example, a state of fear and anxiety over a long period of time may cause the Kidneys to become deficient; on the other hand, if the Kidneys become deficient through, say, overwork, this may cause a state of fear and anxiety. It is important in practice to be able to distinguish these two cases, as we should be able to advise and guide the patient. Patients are often reassured to know that their emotional state has a physical basis, or vice versa, to know that their disturbing physical symptoms are caused by their emotions. If we can make this distinction, then we can treat the disharmony properly and advise the patient accordingly.
Positive counterpart of emotions
Each emotion reflects a particular mental energy that pertains to the relevant Yin organ. This, in fact, explains why a certain emotion affects that specific organ: that particular organ already produces a certain mental energy with specific characteristics, which, when subject to emotional stimuli, responds to or “resonates” with a particular emotion. Thus emotions are not something that comes from outside the Internal Organs to attach them: the Internal Organs already have a positive mental energy which turns into negative emotions only when triggered by certain external circumstances.
For example, why does anger affect the Liver? If one considers the Liver’s characteristics of free-going, easy and quick movement, its tendency for its Qi to rise, its correspondence to Spring when the powerful Yang energy bursts upwards and its correspondence to Wood with its expansive movement, it is easy to understand that the Liver would be affected by anger. This emotion, with its quick outbursts, the rising of blood to the head that one feels when very angry, the destructive, expansive quality of rage, mimics, on an affective level, the characteristics of the Liver and Wood outlined above. The same mental and affective qualities of the Liver that may give rise to anger and resentment over many years could be harnessed and used for creative mental development.
The emotions and the internal organs
The emotions taken into consideration in Chinese medicine have varied over the years. From a Five-Element perspective, the Yellow Emperor’s Classic considered five emotions, each one affecting a specific Yin organ: Anger affecting the Liver, Joy affecting the Heart, Pensiveness affecting the Spleen, Worry affecting the Lungs, Fear affecting the Kidneys. Chapter 5 of the “Simple Questions” says “Anger injure the Liver, sadness counteracts anger…Joy injures the Heart, fear counteracts joy…pensiveness injures the Spleen, anger counteracts pensiveness…worry injures the Lungs, joy counteracts worry…fear injures the Kidneys, pensiveness counteracts fear.”
An interesting feature of this passage is that each emotion is said to counteract another along the Controlling Sequence of the Five Elements. For example, fear pertains to the Kidneys and Water, Water controls Fire (heart), the emotion related to the Heart is joy: hence fear counteracts joy. This thinking presents some interesting ideas, which are certainly true in practice, for example, that “anger counteracts pensiveness” or that “fear counteracts joy.
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. Anger affecting the Liver; Joy affecting the Heart; Sadness affecting the Lungs and Heart; Worry affecting the Lungs and Spleen; Pensiveness affecting the Spleen; Fear affecting the Kidneys; Shock affecting the Heart.
Citation: Maciocia, G., (2015). The Foundations of Chinese Medicine, 3rd Ed.