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1. One of the three causes of disease, as described in Sān Yīn Jí Yī Bìng Zhèng Fāng Lùn (三因极一病症方论 Unified Treatise on Diseases, Patterns, and Remedies According to the Three Causes); the seven affects—joy, anger, sadness-anxiety, thought, sorrow, fear, and fright—as causes of disease. The seven affects are normal responses of the individual, but when excessively intense or persistent, they can disturb the yīn-yáng and qì-blood balance and cause diseases of the bowels and viscera. This is known as internal damage or affect damage.

Internal causes are not to be confused with evils that arise internally. (Internal fire and internal wind, for example, may result from affect damage, but they can also develop from insufficiency or from transformation of external evils, which are not internal causes.).

Internal damage to the heart and spirit is characterized by heart palpitation or fearful throbbing, forgetfulness, and insomnia, or by abstraction, sorrow or anxiety with tendency to weep, and visceral agitation with frequent stretching and yawning. It may also take the form of fulminant exuberance of heart fire, characterized by manic agitation or mental derangement..

Internal damage to the liver manifests as depressed liver qì characterized by mental depression, irascibility, pain in the rib-side, belching, and plum-pit qì. In women, this condition may cause swelling of the breasts, painful distension in the lower abdomen, and menstrual irregularities..

Affect-mind disturbance that damages both the heart and spleen takes the form of disquieting of the heart spirit and impairment of spleen-stomach movement and transformation. This is characterized by attacks of abdominal pain, together with retching and nausea; or rumbling intestines and diarrhea. Other patterns include glomus and oppression in the chest and stomach duct, little thought of food and drink, and amenorrhea..

If the spleen fails to manage the blood, flooding and spotting may also occur. Mental and emotional factors have a distinct bearing on physical health. In treating internal damage conditions, a dual approach is necessary.

Patients must be encouraged to deal with their emotional problems, while a proper physical analysis should be made of the state of yīn and yáng, blood and qì, and the organs. See three causes; cause of disease.

2. Internal damage causes, which include the seven affects, dietary irregularities, and excesses of activity and inactivity, the latter two of which, among the three causes, are classed as causes neither external nor internal. See cause of disease.

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