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Internal damage causes
内伤病因 〔內傷病因〕nèi shāng bìng yīn
Any cause of disease originating from:
- seven affects
- dietary irregularities
- excesses of activity and inactivity
Note that the term internal damage cause is not to be confused with internal cause used in
The Seven Affects
Chinese medicine understands mental and emotional states in terms of anger (怒 nù), joy (喜 xǐ), worry (忧 yōu), sorrow (悲 bēi), thought (思 sī), fear (恐 kǒng), and fright (惊 jīng), which are collectively called theseven affects(七情 qī qíng), a term that appears in the Sù Wèn, Chapter 36. Since human beings constantly react mentally and emotionally to external stimuli, the seven affects are normal responses. Joy, the most positive of the seven affects, is beneficial to the body. It keeps qì and blood in harmony and ensures that provisioning and defense are free and uninhibited. However, when any specific mental state, including joy, is of abnormal intensity or duration, this can damage our health.
| The Seven Affects |
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Students should be aware that translations of the terms representing the seven affects differ considerably between English-language writers. For example, 思 sī is variously translated as thought,
worry,
pensiveness.
In contradistinction to the six excesses, which assail the body from outside, the seven affects are internal causes of illness. Internal damage by the seven affects manifests in numerous conditions that are loosely referred to as internal damage by the seven affects
(内伤七情 nèi shāng qī qíng) or simply affect damage.
According to another scheme, described in the Sù Wèn,Chapter 5, there are five minds
(五志 wǔ zhì), namely anger, joy, worry, thought, and fear. These are the same as the seven affects, except that sorrow and fright are missing. In this scheme, sorrow is associated with worry, while fright is associated with fear. Each of the five minds is associated with a viscus: anger with the liver, joy with the heart, worry with the lung, thought with the spleen, and fear with the kidney.
The seven affects and five minds are often referred to generically as
(情志 qíng zhì).
Physical Effects of the Seven Affects
Even under normal circumstances, the seven affects all have physical consequences that are sometimes perceptible to the individual. For example, fright causes breathing to weaken and slow down (or even stop); it can cause the heartbeat to accelerate and give rise to a somber-white complexion and to sweating. Anger can cause our heartbeat to accelerate and blood pressure to rise; it also causes us to sweat. Sorrow and grief can cause weeping and reduced eating. Thus, mental states are clearly related to physiological activity.
| Correspondence of the Seven Affects and Five Minds to the Five Viscera | ||
|---|---|---|
| 情志 | Affect-Mind | Viscus |
| 怒 | Anger | Liver |
| 喜 | Joy | Heart |
| 忧、悲 | Worry, sorrow | Lung |
| 思 | Thought | Spleen |
| 恐 、 惊 | Fear, fright | Kidney |
The Nèi Jīng contains many statements about the seven affects, the most systematic of which are those concerning the effects on the viscera and on qì. These statements figure prominently in discussions of the seven affects as causes of disease.
- Viscera: It posits the notion that
anger damages the liver,
joy damages the heart,
Sorrow and worry damage the lung,
fear and fright damage the kidney.
- Qì: The Sù Wèn (Chapter 39) states,
A hundred diseases arise from qì. Anger causes qì to ascend; joy causes qì to slacken; sorrow causes qì to disperse; fear causes qì to descend; fright causes qì to become deranged; and thought causes qì to bind
(怒则气上，喜则气缓，悲则气消, 恐则气下，惊则气乱，思则气结 nù zé qì shàng, xiě zé qì huǎn, bēi zé qì xiāo, kǒng zé qì xià, jīng zé qì luàn).
In addition, all seven affects affect the heart spirit, and all but joy can cause qì depression and affect the liver.
Joy
| Spirit, Affect, Mind |
|---|
These four terms occur in combinations in symptom descriptions. Spirit-mind (神志 shén zhì): Consciousness and mental faculties, e.g., Essence-spirit (精神 jīng shén): Mental energy, e.g., Affect-mind (情志 qíng zhì): Emotional and mental state (the five minds and seven affects), e.g., Spirit-affect (神情 shén qíng): Mental and emotional state as reflected in general appearance and facial expression. It appears notably in the expression |
Of all the five minds and seven affects, joy (喜 xǐ) is the most positive. It is associated with the yáng qualities of expansiveness, openness, enthusiasm, exuberance, and generosity. It manifests in an urge to spread the limbs, reach out, share positive emotion with others, and engage in positive action. Joy is the spirit of human communion. It is the conviviality of the campfire, so it is related to fire in the five phases. The heart holds the office of the Sovereign, who represents the power and glory of the nation unified under him. Joy more than any other emotion is felt throughout the body, just as the power of the sovereign is felt throughout the land. For further discussion of the connections between the five minds and the viscera, see Chinese Medicine: The Ideas that Shaped It, Chapter 3.
Joy is normally a healthy emotion. The Sù Wèn (Chapter 39) states, When there is joy, qì is in harmony and the will reaches [it goals], and provisioning and defense are free and uninhibited
(喜则气和志达，营卫通利 xǐ zé qì hé zhì dá, yíng wèi tōng lì).
Despite these positive qualities, joy in excess can have negative effects, specifically on the heart. It causes heart qì to dissipate and the heart spirit to fail to keep to its abode. This makes a person lose their collectedness and composure and reduces their ability to concentrate, hence there may be forgetfulness and abstraction. Disquieted heart spirit manifests in insomnia. Joy also causes the heart to race, manifesting in heart palpitation. In severe cases, joy can give rise to mental abnormalities.
For these reasons, it is said that
(喜伤心 xǐ shāng xīn)
(喜则气缓 xǐ zé qì huǎn). The Líng Shū (Chapter 8) says, [When a person is] joyful and happy, the spirit is jittery, disperses, and is no longer stored
(喜乐者，神惮散而不藏 xǐ lè zhě, shén dàn sàn ér bù cáng).
Anger
Anger (怒 nù) is a strong feeling of annoyance, displeasure, or hostility. The association of anger with the liver meshes neatly with other features of the liver-wood that are summed up in the notion of the army general. The army headed by the general represents the sinews and claws of the nation. Anger is the emotion that drives the army into battle.
In the Chinese medical understanding, anger is closely associated with frustration (情志不遂 qíng zhì bù suì), the emotion we feel when we cannot achieve desired results, which can in turn be related to excessive thought and worry. The modern notion of stress is closely related to emotional states that give rise to anger.
Like any affect, anger is a normal healthy reaction. When excessive, prolonged, or habitual, it can have powerful harmful effects, notably on the liver, qì, and blood.
Anger is associated with the liver. Excessive anger can disturb the liver’s free coursing action. Hence, it is said that anger damages the liver
(怒伤肝 nù shāng gān).
Anger assumes different forms. Some modern Chinese textbooks make a distinction between depressed anger
and fulminant anger,
although the distinction between the two is not always clear-cut.
Depressed anger: Depressed anger (郁怒 yù nù) as a cause of illness is habitual grumpiness, bad temper, spitefulness, mental depression, repressed feelings, or frustration stemming from inability to deal with the stresses of daily life. It causes deficient free coursing,
in which liver qì is inhibited. This results in qì depression (depressed liver qì), which manifests in distending pain in the rib-side, frequent sighing, digestive problems, and menstrual irregularities. Qì depression exacerbates the psychological condition, giving rise to an impatient and agitated temperament. In women, it often gives rise to menstrual irregularities. Premenstrual syndrome is usually associated with depressed liver qì.
If depressed qì causes blood stasis, menstrual irregularities are more severe, with clotted discharge, pronounced menstrual pain, amenorrhea, and even abdominal masses.
When depressed liver qì moves cross-counterflow, it affects the spleen and causes abdominal distension and sloppy diarrhea. Alternatively, it affects the stomach causing hiccup, acid swallowing, or vomiting.
Depressed liver qì affecting the spleen’s ability to move and transform water-damp can foster dampness and phlegm.
Fulminant anger: Sudden, violent flights of anger are often referred to as fulminant anger (暴怒 bào nù). This tends to cause excessive free coursing.
Liver qì is said to upbear and effuse,
meaning upward and outward movement. Excessive free coursing results in excessive upbearing movement. For these reasons, it is said that
(怒则气上 nù zé qì shàng).
We all know from experience that a sudden bout of anger causes pressure in the head and face. In English, we speak of people blowing their top.
This is precisely what provides Chinese medicine with its understanding of fulminant anger.
Fulminant anger can cause liver qì to ascend counterflow, causing distension in the head, headache, red face and eyes, fullness in the chest and rib-side, and hasty breathing.
Counterflow qì forces blood upward, or even sudden clouding reversal
that is, a disruption of normal qì flow that manifests in a sudden loss of consciousness (syncope). The Sù Wèn (Chapter 3) states, Great anger causes… the blood to become depressed in the upper body and cause a person forceful reversal (大怒则…血菀于上，使人薄厥 dà nù zé… xuè yùn yú shàng shǐ rén bó jué).
Fulminant anger and excessive free coursing can also cross-counterflow to affect the stomach, it can cause retching of blood.
Fulminant anger damages yīn. Sudden and violent flights of anger cause hyperactivity of yáng qì and the development of intense liver fire that damages yīn, giving rise to clouded head, red eyes, and red tongue. Hence, the Sù Wèn (Chapter 5) states,
(暴怒伤阴 bào nù shāng yīn).
The connection of anger (and other affects) with wind stroke and heart pain (heart attacks), which is recognized in modern medicine, is not clearly visible in the above quotations from the Nèi Jīng.However, as explanations of these conditions developed over the centuries, emotional triggers came to be clearly recognized. This is especially clear in the case of wind stroke, which was originally attributed to external wind, but later with liver wind stirring internally. Anger, as the affect associated with the liver, naturally fit in with the new paradigm as a cause or trigger of the condition.
The Sù Wèn (Chapter 39) states,
(怒则气逆, 甚则呕血及飧泄 nù zé qì nì, shèn zé ǒu xuè jí sūn xiè). Food diarrhea is diarrhea characterized by clean-looking stool containing some undigested food and that often occurs shortly after eating. This quotation captures anger’s ability to cause diarrhea attributable to deficient free coursing and retching of blood due to excessive free coursing.
Counterflowand Reversal |
|---|
Counterflow (逆 nì) and reversal (厥 jué) both describe qì (a) moving in the wrong direction, (b) moving too forcefully in the usual direction, or (c) receding from the extremities. The usage of the terms varies according to context.
counterflowand reversalare largely synonymous. However, only counterflowis used in the context of the lung and stomach. |
Thought
Thought (思 sī) is a mode of mental activity rather than an emotion, so it is considered to one of the five minds and seven affects. It is related to ideation, the spiritual entity stored by the spleen, which is the faculty that produces ideas and intentions. Both are associated with spleen-earth. Earth is the mother of the myriad living things. So, as the most productive and creative aspect of mental activity, thought is naturally associated with earth.
Preoccupation with problems for extended periods without adequate rest and healthy diversions, or obsessive unrealistic thinking can produce various damaging effects. Thought
is often expressed as 思虑 sì lǜ,preoccupation, as with emotional or intellectual questions.
Excessive thought and preoccupation damage the spleen, impairing movement and transformation. This is reflected in the statements When there is thought, the heart has a place to be and the spirit has a place to home to; right qì becomes lodged, hence qì binds
(思则心有所存，神有所归，正气留而不行，故气结矣 sī zé xī yǒu suǒ cún, shén yǒu suǒ guī, zhèng qì liú ér bù xíng, gù qì jié yǐ). This seems to suggest that thought causes the heart spirit to become stuck, so that qì becomes stagnant.
Thought is classically said to damage the spleen; in reality, it damages the spleen and heart. At the same time, it can be associated with liver and kidney problems.
- Spleen: Excessive thought causes the qì dynamic to become depressed and bound, which impairs splenic movement and transformation. This manifests in poor appetite, distension and fullness in the stomach duct, sloppy stool or diarrhea, fatigue and lack of strength, and in severe cases emaciation.
- Heart: Prolonged preoccupation or obsessive concern with problems can also damage heart blood. In mild cases, this can cause heart palpitation, insomnia, and profuse dreaming. In severe cases, it can result in feeblemindedness (dementia). Usually, it damages spleen qì and heart blood at the same time, causing a pattern of dual vacuity of the heart and spleen, which is marked by heart palpitation or fearful throbbing, insomnia, profuse dreaming, poor appetite, abdominal distension, sloppy stool, and fatigue and lack of strength.
- Liver and kidney: When excessive thought is associated with frustration, it can also affect the liver and kidney. In males it can give rise to impotence or seminal emission; in women, it can cause an increase in vaginal discharge or menstrual irregularities. The Sù Wèn (Chapter 44) states,
When thought is endless and wishes are not satisfied, ideation spreads outward… there is sinew wilt (i.e., impotence) and white ooze (i.e., vaginal discharge)
(思想无穷，所愿不得，意淫于外… 为筋痿，为白淫 sī xiǎng wú qióng, suǒ yuàn bù dé, yì yín yú wài… wéi jīn wěi, wéi bái yín).
Worry
Worry (忧 yōu) means concern or preoccupation that causes distress or sadness. However, the precise connotations of the Chinese term require some explanation.
On connotation of 忧 yōu is anxiety or apprehension. Descriptions in Chinese texts often also use the word 愁 chóu,anxiety, which applies specifically to apprehension about future outcomes, often expressed as 忧愁 yōu chóuor 忧虑 yōu lǜ,worry, preoccupation.
Another connotation of the Chinese忧 yōu is sadness or sorrow. In other words, it can be partially synonymous with 悲 bēi (see below). This connotation is seen in compound 忧郁 yōu yù,depression, gloominess, melancholy. (The term 忧郁 yōu yù, it might be noted, has been adopted in modern psychology as the equivalent of depression.
) However, in the context of the seven affects, to the extent that they differ, 忧 yōuimplies concern about things that can possibly be changed, while 悲 bēi implies disconsolateness over irrevocable loss.
Worry, as one of the seven affects, also has an affinity with thought, the mind of the spleen, since both involve fixation with problems. In Chinese, both 忧 yōu,worry, and思 sī, appear in combinations with 虑 lǜ,preoccupation (忧虑 yōu lǜ,worry and preoccupation, 思虑 sī lǜ,thought and preoccupation). Thus, worry occupies a position on the emotional spectrum between sorrow and thought.
Worry in Chinese medicine is associated with the lung. Since 忧 yōu has connotations of gloominess and sadness, it resonates with autumn, the season associated with lung-metal.
Worry causes depression of lung qì, giving rise to oppression in the chest and shortness of breath, in addition to heavy-heartedness and devitalized essence-spirit (lack of mental energy). It can affect the heart, the spleen, and the stomach, causing insomnia and poor appetite.
The similarity between worry and sorrow is underscored by the phrase sorrow and worry damage the lung
(悲忧伤肺 bēi yōu shāng fèi).
The Líng Shū (Chapter 8) states, Worry and anxiety cause qì to be blocked and fail to move
(忧愁者，气闭塞而不行 yōu chóu zhé, qì bì sè ér bù xíng). The Yī Fāng Kǎo (医方考 Medical Remedies Researched
) states, Worry cause qì to be heavy; when it is heavy, it does not flow
(忧则气沉，沉则气不流矣 yōu zé qì chén, chén zé qì bù liú yǐ).
Sorrow
Sorrow (悲 bēi) means sadness, low spirits, or disconsolateness, usually about irrevocable loss or about things that one cannot do anything to help. It is grief over loss, regret about mistakes, and unhappiness and sadness in general. Sorrow is associated with crying and weeping. Sorrow is one of the seven affects but not one of the five minds, but it partly overlaps with worry.
Another term that often appears in Chinese texts in the context of discussions of sorrow is 哀 āi,grief, which is sadness specifically over the death of loved ones.
Sorrow chiefly affects the lung. Excessive sorrow can cause lung qì to disperse and dissipate, giving rise to a low voice and faint breathing, shortness of breath, oppression in the chest, laziness to speak, hoarse voice, lassitude of the spirit and lack of strength, and susceptibility to common cold. Hence it is said that
In the latter phrase, the meaning of the word 消 xiāo is a subject of controversy. It may mean disperse,
but another interpretation of the word is 消沉 xiāo chén,which is downhearted
or depressed.
When sorrow and worry persist, they can cause lung qì to become depressed, causing oppression in the chest, shortness of breath, and inhibited breathing. This view is supported by the 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
), which states, When worry damages the lung; its qì gathers
(忧伤肺, 其气聚 yōu shāng fèi, qí qì jù). The same view is also supported by the line of the Sù Wèn (Chapter 39) that states, When there is sorrow, the heart connector is tense, the lung stretches, its lobes lift, so that the upper burner is stopped, provisioning and defense does not spread, and heat qì lies within; hence qì disperses/becomes depressed
(悲则心系急， 肺布叶举，而上焦不通，营卫不散，热气在中，故气消矣 bēi zé xīn xì jí, fèi bù yè jǔ, ér shàng jiāo bù tōng, yíng wèi bù sàn, rè qì zài zhōng, gù qì xiāo yǐ).
In addition to the lung, excessive sorrow can also damage the heart and spirit, as well as the liver and ethereal soul, causing mania or clouding reversal.
Fear
Extreme or prolonged fear causes qì to descend. This damages kidney qì, making it unable to perform its storage function, which results in insecurity of kidney qì. This manifests in urinary and fecal incontinence, limp wilting legs, and in some cases seminal efflux (severe seminal loss while the patient is awake), vaginal discharge, and habitual miscarriage. Because descending qì carries blood downward, it can cause a somber-white complexion, clouded head that threatens the patient’s balance and, in severe cases, clouding reversal
(sudden loss of consciousness).
The Sù Wèn (Chapter 39) states, Fear causes essence to retreat; when it retreats, the upper burner becomes blocked; when it is blocked, the qì returns to the lower burner]; when it returns, there is distension; hence qì goes downward
(恐则精却，却则上焦闭，闭则气还，还则下焦胀，故气不(下)行 kǒng zé jīng què, què zé qì huán, huán zé xià jiāo zhàng, gù qì xià xíng).
The Líng Shū (Chapter 8) says, Fear that does not resolve causes damage to essence; when essence is damaged, the bones ache and wilt and [there is] reversal, and essence/semen periodically spontaneously descends
(恐惧而不解则伤精，精伤则骨酸痿厥，精时自下 kǒng jù ér bù jiě zé shāng jīng, jīng shāng zé gǔ suān wěi jué, jīng shí zì xià). This means that persistent fear damages essence and damages yáng qì. It makes yáng qì unable to contain essence, causing seminal efflux (involuntary loss of semen while asleep or awake). It also deprives yáng qì of the power to pervade the body, which results in aching of the bones, wilting, and reversal patterns. Reversal
here refers to reversal cold of the limbs, that is, marked cold in the extremities up to the elbows and knees.
Fear can also damage the heart spirit, causing insomnia, profuse dreaming, and in severe cases a clouded and deranged spirit-mind.
Fright
Fright (惊 jīng), which is one of the seven affects but not one of the five minds, is sudden fear, alarm, panic, or shock.
Fright is similar to fear. Fright occurs suddenly and unexpectedly but passes rapidly. Fear, by contrast, occurs with the person’s knowledge and is more persistent. The two may occur together.
Fright is associated with the heart, kidney, liver, and gallbladder. Hence, it is said:
Great fright damages the heart. Sudden fright causes deranged movement of qì and abnormalities of the heart spirit. Clinical signs include panic, dumbstruck expression, incoherent speech, abnormal laughing and weeping, manic raving, heart palpitation, insomnia, and in severe cases deranged spirit-mind. The Sù Wèn (Chapter 39) states, Fright causes the heart to have nothing to depend on, the spirit to have no place to return, and thoughts to have nothing to fix on, hence qì is deranged
(惊则心无所依，神无所归，虑无所定, 故气乱矣 jīng zé xīn wú suǒ yī, shén wú suǒ guī, lǜ wú suǒ dìng, gù qì luàn yǐ).
Fright is said to damage the kidney because, especially when combined with fear, it affects the kidney’s storage function causing instant urinary and fecal incontinence.
Fright is said to damage the liver and gallbladder because it disturbs decision-making power, making a person timid and anxious, a condition often called qì timidity.
Classical Pairings Are Not to Be Taken Rigidly
The Nèi Jīng’s connections between joy and the heart, anger and the liver, worry and the lung, thought and the spleen, and fear and the kidney are only rough guidelines. They are clearly the result of the influence of five-phase theory, which seeks neat one-to-one correspondences between disparate phenomena. However, many lines of the Nèi Jīng suggest that the seven affects each have broader effects than merely on one specific viscus. One affect-mind can affect several viscera. For example, anger can damage the liver but can also damage the spleen. Similarly, thought can damage the spleen but can also damage the kidney. Fright can damage the heart but can also damage the kidney. Conversely, several affect-minds can each damage one specific viscus. For example, all seven affects can damage the heart; anger and sorrow can both damage the liver; worry, thought, and sorrow can all damage the spleen. Clinical observation over successive generations has tended to weaken the earlier paradigm of neat one-to-one connections between each affect and a specific viscus.
| Stress in the Chinese Medical View |
|---|
Psychologically, stress results in anger, worry, frustration, and mental depression. Physiologically, it activates the sympathetic branch of the autonomous nervous system and the release of stress hormones including epinephrine and cortisol. This produces a fight-or-flight response, causing the body to divert blood flow to large muscles as the body prepares to run away from or fight something. Less blood flows to the digestive system and other organs that do not assist in fleeing or fighting, producing dry mouth, motor agitation, sweating, pallor, enlarged pupils and over the long term, insomnia. Although Chinese physicians prior to the modern era never had the concept of stress, they were nevertheless aware that anger, worry, frustration, and mental depression are harmful to the body. Chinese medicine posits that such states often cause a lowering of the liver's free coursing action, which results in depressed liver qì. This manifests in qì stagnation in various parts of the body, especially along the course of the liver channel and in the stomach and spleen. Some overlap between stress and the factors recognized as causing depressed liver qì is therefore obvious. |
Affect-Mind and the Heart Spirit
The seven affects all have special relationships with the heart.
Affects can Only be Perceived Through the Heart
Though each is associated with one specific viscus or more, they are all experienced through the heart.
The Líng Shū (Chapter 8) states,
(所以任物者谓之心 suǒ yǐ rèn wù zhě wèi zhī xīn).
The Líng Shū (Chapter 28): Sorrow, grief, anxiety, and worry stir the heart. When the heart stirs, the five viscera and six bowels all shake
(悲哀愁忧则心动，心动则五脏六腑皆摇 bēi āi chóu yōu zé xīn dòng, xīn dòng zé wǔ zàng liù fǔ jiē yáo).
The Lèi Jīng states, The heart is the great governor of the five viscera and six bowels. It controls the ethereal and corporeal souls and completes the mind and will. When worry stirs the heart, the lung responds; when thought stirs the heart, the spleen responds; when anger stirs the heart, the liver responds; when fear stirs the heart, the kidney responds. This is because the five minds are controlled by the heart
(心为五脏六腑之大主，而总统魂魄，兼该志意，故忧动于心则肺应，思动于心则脾应，怒动于心则肝应，恐动于心则肾应，此所以五为心所使也 xīn wéi wǔ zàng liù fǔ zhī dà zhǔ, ér zǒng tǒng hún pò, jiān gāi zhì yì, gù yōu dòng yú xīn zé fèi yìng, sī dòng yú xīn zé pí yìng, nù dòng yú xīn zé gān yìng, kǒng dòng yú xīn zé shèn yìng, cǐ suǒ yǐ wǔ zhì wéi xīn suǒ shǐ yě).
The Lèi Jīng also says, Affect-mind damage can be apportioned to one or other of the five viscera, but when seeking the cause, there is none that does not start from the heart
(情志之伤，虽五脏各有所属， 然求其所由，则无不从心而发 qíng zhì zhī shāng, suī wǔ zàng gè yǒu suǒ shǔ, rán qiú qí suǒ yóu, zé wú bù cóng xīn ér fā).
All Affects Can Affect the Heart
Though each is associated with a specific viscus or specific viscera, they all affect the heart spirit.
Affect-mind and the spirit can affect each other. Not just joy, but in fact all the seven affects can affect the heart spirit in one way or another. The spirit is affected by excesses of any of the seven affects. Anger causes excitement of the heart spirit, while sorrow can cause lassitude of spirit.
- As the Sù Wèn (Chapter 4) states,
(愁忧恐惧则伤心 chóu yōu kǒng jù zé shāng xīn).Worry and fear damage the heart - Chapter 73 also says,
(忧愁思虑则伤心 yōu chóu sī lǜ zé shāng xīn).Worry, anxiety, thought, and preoccupation damage the heart - Líng Shū (Chapter 8) states,
When there is fear and dread, the spirit becomes jittery and cannot gather itself
(恐惧者，神荡惮而不收 kǒng jù zhě, shén dàng dàn ér bù shōu). - Líng Shū (Chapter 8) also states,
When the heart is scared or preoccupied, it damages the spirit
(心怵惕思虑则伤神 xīn chù tì sī lǜ zé shāng shén).
Qì Depression
In the Nèi Jīng’s descriptions of the effects of the seven affects on qì, thought causes qì to bind
and sorrow causes qì to disperse
both involve stagnation of qì, while anger causes qì to ascend
may involve qì stagnation. The Yī Biǎn (医碥 Stumbling Blocks of Medicine
) states, As to the seven affects, apart from joy causing free movement of qì, worry, thought, sorrow, and anger, all cause binding depression of qì
(至于七情，除喜则气舒畅外，其忧思悲怒，皆能令气郁结 zhì yú qī qíng, chú xǐ zé qì shū chàng wài, qí yōu sī bēi nù, jiē néng lìng qì yù jié). This statement reflects a notion that any emotional or mental state that persists represents a loss of the normal free play of emotions that translates physically into qì stagnation. Normally, the seven affects come and go in response to changing situations. When one of them persists, this means the loss of healthy flexibility.
Except for joy, the seven affects are all negative feelings that result from loss, disappointment, defeat, failure, injustice, violence, coercion, threat, or insecurity. Thus, they have common causes and may all, to a greater or lesser degree, be associated with dissatisfaction and frustration that have a dampening effect on qì. They may all be associated with reduced physical activity, which may worsen the qì depression.
Zhāng Jǐng-Yuè in the Míng Dynasty posited the notion that anger, thought, and worry most easily lead to qì depression, and he called these conditions anger depression
(怒郁 nù yù), thought depression
(思郁 sī yù), and worry depression
(忧郁 yōu yù).
The smooth flow of qì around the body is dependent upon the liver’s free coursing action. Negative emotions in general, not just anger, tend to affect the liver’s free coursing action and free coursing can affect the emotions. While negative states of mind can affect the viscera directly, as described in the Nèi Jīng, they produce many effects by impairing the liver’s free coursing action.
Affect-Mind Depression Causes Deficient Free Coursing
Any depressed mental state frustration, moodiness, or affect-mind depression, as well as the depressed anger
mentioned in the context of anger above, can cause liver qì free coursing action to become deficient, which results in depressed liver qì. This manifests in signs of stagnation on the liver channel and a worsening of the depressed mental state.
Deficient Free Coursing Disturbs the Emotions
Our ability to deal with the challenges of life depends not only their severity but also on our resistance and resilience, which are rooted in our individual temperament and physical health. Normal free coursing action helps to keep our emotions balanced and in check and helps us to ride through the adversities of life. Deficient free coursing reduces our emotional resilience and gets us stuck in bad emotions like anger, frustration, and moodiness.
Secondary Effects
Qì depression has numerous secondary effects.
Dampness and phlegm: The depressed liver qì affecting the spleen’s ability to move and transform water-damp can foster dampness and phlegm.
Blood stasis: When qì becomes depressed and bound, it inhibits the flow of blood, causing blood stasis. Qì depression is a major cause of blood stasis, and blood stasis is often treated with the addition of qì-rectifying medicinals according to the adage that
(气调则血调 qì tiáo zé xuè tiáo).
Fire: When qì is depressed, it can also transform into fire. Exuberant fire in turn can
- stir the blood and cause bleeding;
- boil and concentrate the fluids into phlegm; or
- damage yīn, causing yīn vacuity, which can either cause yáng to become hyperactive or give rise to dual vacuity of yīn and yáng.
Bleeding: Blood stasis and fire both can in turn give rise to bleeding.
Depression Patterns
In Chinese medicine, depression
(郁 yù) is a term that refers to both a depressed state of mind and depressed activity in the body. When qì becomes depressed, it fails to move blood, fluids, and food. Furthermore, its power to generate warmth becomes confined so that heat and fire can develop. Blood stasis, dampness, phlegm, or the failure of food to move through the stomach and intestines is often attributed to depressed qì. Conversely, dampness and phlegm arising from insufficiency of qì can inhibit the movement of qì. Any condition involving qì stagnation in combination with dampness, phlegm, blood stasis, fire, and nonmovement of food are referred to as
(郁证 yù zhèng).
Mania and Withdrawal
Qì depression plays a role in mania and withdrawal.
Mania often results from anger or sorrow damaging the liver and gallbladder, causing qì depression that transforms into fire, boils the fluids so that they bind into phlegm-fire, which rises to harass the spirit and cloud the orifices of the heart.
Withdrawal disease often arises from affect-mind disturbances that cause liver qì to become depressed and damage the spleen, giving rise to the development of phlegm that ascends with qì to cloud the heart spirit.
Effects of Spirit, Qì, and Blood on Affect-Mind
The state of the spirit can affect a person’s affect-mind. The Sù Wèn (Chapter 62) states, When the spirit is superabundant, there is incessant laughing; when the spirit is insufficient, there is sorrow
(神有余则笑不休，神不足则悲 shén yǒu yú zé xiaò bù xiū, shén bù zú zé bēi).
According to the Líng Shū (Chapter 8), the state of qì can influence affect-mind: When liver qì is vacuous, there is fear; when replete, there is anger. When heart qì is vacuous, there is sorrow; when replete there is incessant laughing
(肝气虚则恐，实则怒; 心气虚则悲，实则笑不休 gān qì xū yé kǒng, shí zé nù; xīn xì xū zé bēi, shí zé xiaò bù xiū).
According to the Sù Wèn (Chapter 62), the state of the blood can impact affect-mind: When blood is superabundant, there is anger; when insufficient, there is fear (血有余则怒，不足则恐 xuè yǒu yú zé nù, bù zú zé kǒng).
In general, a bright positive outlook and absence of negative emotions can speed positive developments and recovery in illness. Negative emotions can make a condition worse. Sudden emotional upheavals can cause an illness to worsen rapidly.
Overcoming Relationships Among the Five Minds
The Sù Wèn (Chapter 5) posits the idea that, in accordance with the restraining cycle of the five phases, the excesses of one mind can be reduced by another:
(悲胜怒 bēi shèng nù);
(恐胜喜 kǒng shèng xǐ);
(怒胜思 nù shèng sī);
(喜胜忧 yōu shèng nù);
(悲胜怒 sī shèng kǒng). Since external stimuli generally tend to affect pre-existing emotional states, any emotion has the power to replace any other. Hence, these Sù Wèn theories seems to represent an overly mechanical application of the five-phase doctrines.
Dietary Irregularities (饮食失宜 yǐn shí shī yí)
Chinese medicine distinguishes between three categories of dietary irregularities (饮食失宜 yǐn shí shī yí): excessive hunger or satiety; unclean food; and dietary predilections.
Excessive Hunger and Satiety
Eating too much or too little is called
(饥饱失常 jī bǎo shī cháng). Excessive hunger and satiety problems are common in infants. Infants have weak spleen-stomach function and cannot consciously control their food intake.
When food and drink double, the intestines and stomach are damaged
(饮食自倍，肠胃乃伤 yǐn shí zì bèi, cháng wèi nǎi shāng). This is called food damage
(伤食 shāng shí). Because the spleen and stomach cannot cope, food stagnates in the stomach and intestines; hence, the condition is also called food stagnation
(食滞 shí zhì), food accumulation
(食积 shí jī), or in severe cases abiding food
(宿食 sù shí). In the pattern descriptions of modern diagnostic texts, this is called food stagnating in the stomach and intestines
(食滯胃腸 shí zhì wèi cháng) or food stagnating in the stomach duct.
The result is distension and pain in the stomach duct and abdomen, putrid belching, acid upwelling (welling up of acid into the throat and mouth), aversion to food, retching and vomiting, and diarrhea.
Habitual overeating causes repeated or continuing food stagnation. This damages the stomach and spleen, causes dampness and phlegm to gather, and gives rise to obesity. The term
(痰食 tán shí) refers specifically to food stagnation with gathering phlegm. It can also affect the movement of qì and blood, causing diarrhea, bloody stool or hemorrhoids. It may also be associated with dispersion-thirst or chest impediment.
Overfeeding of infants can cause enduring stagnation that can transform into heat. Feeding children with raw and cold foods can give rise to dampness and phlegm. Enduring stagnation can give rise to gān accumulation
marked by heat in the palms and soles, heart vexation, tendency to cry, distension and fullness in the stomach duct and abdomen, a yellow facial complexion, and emaciation.
Food relapse: In the course of an illness, dietary irregularities can cause the relapse of a previous condition. This is called
For example, in an external contraction from which the patient has just recovered or is just recovering, the spleen and stomach are still weak so that excessive amounts of food (especially food that is difficult to digest) can cause food stagnation that transforms into heat. This can lead to a relapse or the prolongation of the illness.
Unclean Food
Food that is not fresh or not properly cleaned before consumption is called
(饮食不洁 yǐn shí bù jié). The Chinese long ago knew of the need for clean food. The Jīn Guì Yào Lüè states, Eating dirty rice, spoiled fish, and malodorous meat will all damage the person (秽饭、馁鱼、臭肉, 食之皆伤人 huì fǎn、něi yú、chòu ròu, shí zhī jiē shāng rén).
Unclean food can cause pain in the stomach duct and abdomen, retching and vomiting, and diarrhea. Simultaneous vomiting and diarrhea indicate cholera (sudden turmoil
). The passage of pus and blood in the stool indicates dysentery.
Unclean food can also cause worms (i.e., intestinal parasites), which give rise to abdominal pain, desire to eat strange things, yellow face, and emaciation. Some unclean foods can cause food poisoning, which manifests in acute abdominal pain and vomiting and diarrhea.
Dietary Predilections
(饮食偏嗜 yǐn shí piān shì) is a tendency to eat things that one is specifically fond of. The Chinese recognize the importance of a varied diet. The Sù Wèn (Chapter 22) states, The five grains serve to provide nourishment, the five fruits to help them, the five domestic animals to provide an additional boost, and the five vegetables to provide extra filling
(五谷为养，五果为助，五蓄为益，五菜为充 wǔ gǔ wéi yáng, wǔ guǒ wéi zhù, wǔ xù wéi yì, wǔ cài wéi chōng). In other words, the human diet should be based on staples, supplemented by fruits, meat, and vegetables. A tendency to eat one kind of food more than others can have a damaging effect on the body.
Of course, prior to the modern era, the Chinese did not have the detailed understanding of nutrients that nutritional science has today.
- They had no concept of protein, although it is clear from Buddhist dietary tradition that the Chinese did know that bean products were necessary in the absence of meat.
- They had a less clear understanding of the dietary causes of beriberi (Vitamin B1 deficiency), goiter (iodine deficiency), night blindness (Vitamin A deficiency), rickets (impaired calcium and phosphorus metabolism).
- They did not realize that starchy foods convert to sugar and that reducing or avoiding such foods could prevent or treat dispersion-thirst (diabetes mellitus).
- They also had no understanding of the specific properties of different kinds of fats (saturated fats, unsaturated fats, trans fats, etc.).
- The also lacked the modern understanding of excessive sodium intake.
| Nature of Foodstuffs |
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Balanced: Grains, many meats, certain vegetables (mainly root crops).
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Predilections for cold- or hot-natured foodstuffs: Just as medicinals, all foodstuffs are understood to be hot-warm, cold-cool, or balanced in nature. Excessive consumption of cold- or hot-natured foodstuffs can be damaging to health.
- Cool or cold foods in excess can damage the spleen and cause cold-damp to arise internally, manifesting in abdominal pain and diarrhea. Cold-natured foods, such as most green vegetables, are colder in nature when raw than when cooked, and foods that are served cold are colder in nature than if served warm. Chilled and frozen foods, such as refrigerated beverages and ice cream, can be damaging.
- Warm or hot foods, such as roasted, barbecued, deep-fried, and spicy hot foods, when habitually consumed can cause accumulated heat in the intestines, manifesting in thirst, abdominal fullness, distension, pain, constipation, and mouth sores.
The Ling2 Shu1 (Chapter 29) states, In food and drink, hot should not be burning hot, and cold should not be icy cold
(饮食者，热无灼灼，寒无沧沧 yǐn shí zhe3, re4 wú zhuo2 zhuo2, hán wú cāng cāng).
Of course, the suitability of, and conversely, the dangers posed by hot and cold foods depend largely on individual and cultural eating habits, as well as on location, climate, and season.
Predilection among the five flavors: A varied diet provides a balance among the five flavors. Excessive consumption of one specific flavor can lead to internal imbalances. The Nèi Jing1contains theories concerning the effects of flavors on the body, although these are less often the subject of dietary advice that doctors give patients in clinic than hot or cold foods. However, acrid foods tend to be hot in nature, and so patients are often advised not to eat hot spicy foods. Sweet foods are addressed below.
| Dietary Warnings |
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Indulgence in sweet or fatty foods (恣食甘肥 zì shí gān féi): The main injunction concerns sweet and fatty food. Excessive consumption of rich fatty or sweet foods
(过食肥甘厚味 guò shí féi gān hòu wèi) can engender phlegm and transform into heat, giving rise to distension and fullness in the stomach duct and abdomen. Over long periods, it can cause dispersion-thirst (diabetes mellitus), wind stroke, chest impediment, welling-abscesses, and sores. The Sù Wèn (Chapter 47) states, Fatty food causes people to have internal heat; sweet food causes people to have center fullness so that the qì spills upward and converts into dispersion-thirst
(肥者令人内热，甘者令人中满，故其气上溢，转为消渴 féi zhe3 ling4 rén nèi re4, gān zhe3 ling4 rén zhōng mǎn, gù qí qì shang4 yì, zhuǎn wéi xiao1 ke3).
The recent worldwide increase in diabetes is associated with increased sugar intake. Many modern processed foods contain hidden sugars. Canned or bottled soft drinks contain particularly large amounts of sugar. Many nutritionists now believe that the combination of excessive fat and excessive sugar intake is particularly damaging to health.
Modern medicine tells us that alcohol causes dehydration, can spike blood glucose levels, and over a long period may disturb sleep patterns and damage the gut biome. These facts are consistent with the Chinese medical understanding.
| Flavor Theory in the Nèi Jing1 |
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Nèi Jing1 states that sourness enters the liver, bitterness enters the heart, sweetness enters the spleen, acridity enters the lung, and saltiness enters the kidney. According to one Nèi Jing1 theory ,excessive consumption of a given flavor can cause exuberance of the viscus that it enters. Sourness: Excessive consumption of sourness can cause liver exuberance that overwhelms the spleen, causing the skin and flesh to thicken and become wrinkled and the lips to turn up. Bitterness: Excessive consumption of bitterness can cause heart exuberance that overwhelms the lung, causing dry skin and loss of hair. Sweetness: Excessive consumption of sweetness can cause spleen exuberance that overwhelms the kidney, causing a black complexion, oppression in the chest and panting, aching pain in the lumbus and knees, and hair loss. Acridity: Excessive consumption of acridity can cause lung exuberance that overwhelms the liver, causing lusterless nails and hypertonicity of the sinews. Saltiness: Excessive consumption of saltiness can cause kidney exuberance that overwhelms the heart, causing oppression in the chest, shortness of breath, lusterless facial complexion, and stasis and stagnation of blood in the vessels. This scheme is based on the five-phase overwhelming relationship and, like many other schemes of this type, is no longer widely considered useful. |
Imbalance of Activity and Inactivity (勞逸不均 lao2 yì bù jun1)
A key factor in the maintenance of health is a balance between activity and inactivity (勞逸不均 lao2 yì bù jun1). Both excessive activity and excessive inactivity can affect health in manifold ways. The Nèi Jing1 (Chapter 23) states,
(久视伤血，久卧伤气，久坐伤肉，久立伤骨，久行伤筋，是谓五伤所伤 jiǔ shì shāng xue4, jiǔ wò shāng qì, jiǔ zuò shāng ròu, jiǔ lì shāng gǔ, jiǔ xing2 shāng jīn, shì wèi wǔ lao2 suǒ shāng).
The damage that taxation causes to the body is called taxation damage
(劳伤 lao2 shāng) and the general run-down state of the body attributable to these causes is often called taxation fatigue
(劳倦 lao2 juan4).
Taxation can be discussed under three headings— physical taxation, taxation of the spirit, and sexual taxation:
Taxationor Overexertion |
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The Chinese 劳 lao2 means toil or exertion, as well as fatigue. It is sometimes rendered as overexertionin English. Although it usually involves overexertion, this translation is less appropriate in the context of prolonged recumbency and sitting mentioned in the citation from Nèi Jing1 (Chapter 23). Since overexertionimplies physical stress, it is also inappropriate for excessive thought, planning, and use of memory. |
Physical Taxation (劳力过度 lao2 lì guò dù)
Isolated incidences of overexertion cause damage to the sinews, aching pain, and fatigue. Prolonged strenuous physical activity damage the essential qì of the body. Persistent overexertion wears down qì, especially the spleen-stomach qì, which prevents physical damage from healing and causes emaciation, lassitude of spirit and physical fatigue, shortness of breath, faint low voice, faint breathing, spontaneous sweating, sloppy stool, and reduced eating. Hence, the Sù Wèn (Chapter 39) states,
(劳则气耗 lao2 zé qì hào). Qì vacuity can affect blood production, giving rise to dual vacuity of qì and blood. In some cases, overexertion can give rise to heat effusion.
Taxation of the Spirit (劳神过度 lao2 shén guò dù)
Excessive thought, preoccupation, planning, and use of memory can damage splenic movement and transformation, the state of heart blood and heart spirit, and the liver’s free coursing action.
- When excessive taxation of the spirit affects the spleen, symptoms such as poor appetite, abdominal distension, and sloppy stool may arise.
- When it affects the heart, there may be heart palpitation, forgetfulness, insomnia, and profuse dreaming.
- When it affects the liver, patients may suffer from impatience, agitation, and irascibility.
Sexual Taxation (房劳过度 fáng lao2 guò dù)
Excessive sexual activity refers not only to overindulgence in sex but also to multiparity (giving birth to many children). Both may wear kidney essence, thereby weakening the body’s health and increasing vulnerability to disease.
- In men, sexual intemperance (excessive sexual activity), especially when culminating in ejaculation, causes general signs, such as limp aching lumbus and knees, dizziness, tinnitus, lassitude of spirit and lack of strength, forgetfulness, and emaciation. It also leads to sexual dysfunctions, such as impotence, premature ejaculation, and seminal emission.
- In women, excessive childbirth may damage the thoroughfare (chōng) and controlling (rèn) vessels. This manifests in menstrual irregularities, amenorrhea, and vaginal discharge.
Excessive Inactivity (安逸过度 ān yì guò dù)
Excessive inactivity can be a cause of illness. Of the five forms of taxation damage described in the Sù Wèn (prolonged vision damages the blood; prolonged lying damages qì; prolonged sitting damages the flesh; prolonged standing damages the bones; and prolonged walking damages the sinews
), prolonged lying and sitting constitute excessive inactivity rather than excessive activity.
A lack of physical exertion can cause the qì and blood flow to become inhibited. Amongst the viscera, it most easily affects the spleen, slowing down digestion and affecting the production of qì and blood.
- Excessive inactivity affects digestion, causing distension and fullness in the stomach duct and abdomen, and reduced eating.
- When the source of qì and blood formation is affected, signs such as lack of physical strength, devitalized essence-spirit (lack of mental energy), heart palpitation at the slightest exertion, shortness of breath, and spontaneous sweating. The Sù Wèn statement that
prolonged lying damages qì
refers precisely to this. - Lack of exercise in patients who tend to overeat causes obesity.
- When right qì of the body is affected, patients tend to fall ill easily.
- Immobility in bed-ridden patients causes bed sores. These arise in severe illness with severe qì and blood vacuity, which is locally exacerbated by constant pressure on the flesh that obstructs the flow of qì and blood, depriving the skin and flesh of nourishment.
- Lack of mental stimulus causes dullness of essence-spirit.