Miscellaneous causes

Miscellaneous causes are those other than externally contracted causes, internal damage caused, and pathological products. They include external injuries, worms, misuse of drugs, and congenital factors.

External Injuries

External injuries (外伤 wài shāng) include knocks and falls, cuts, burns and scalds, exposure to chemicals, frostbite, stings and bites, bullet wounds, straining, and electric shock. Most injuries involve damage to the skin and flesh, the sinews and bone, and the qì and blood.

Chinese medicine has had long experience with injuries; it has developed effective therapeutic techniques in response, especially in the realm of bone-setting. It also has considerable experience in the use of heat-clearing, toxin-resolving agents in the treatment of snake bites. In recent years, efforts have been made to restore and improve these methods of treatment.

Injuries Attributable to External Forces

Types of injury

• Injuries from knocks and falls (跌打损伤 dié dǎ sǔn shāng)
• Impact injuries (碰撞损伤 pèng zhuàng sǔn shāng)
• Wounds by sharp objects (利器伤 lì qì shāng)
• Bullet wounds (抢弹伤 qiāng dàn shāng)
• Lifting heavy weights (负重 fù zhòng)
• Straining (努责 nǔ zé)
• Crushing (压轧 yā yà[ zhá, gá])

Types of damage to the body that the above result in:

• Grazes (擦伤 cā shāng)
• Lacerations (裂伤 liè shāng)
• Sinew damage (筋伤 jīn shāng)
• Dislocation of joints (关节脱臼 guān jié tuō jiù)
• Bone fractures (骨折 gǔ zhé)
• Bleeding (出血 chū xuè)
• Swelling (肿胀 zhǒng zhàng)
• Bruises (瘀青 yū qīng)
• Static blood (淤血 yū xuè)

Severe bleeding can give rise to qì deserting with the blood resulting in coma and convulsions. If wounds become infected, the toxin can attack the inner body, causing critical states and death.

Burns and Scalds

Burns and scalds (烧烫伤 shāo tàng shāng) cause damage to the skin and flesh and to yīn.

In mild cases, only the skin is affected, the lesions being characterized by redness, swelling, heat, and pain, and a dry surface, in some cases with blisters.

In severe cases, the flesh, sinews, and even bone may be damaged. The affected area assumes a leathery texture or a somber-white and dry or a waxy-yellow or burnt-yellow appearance. Charring is seen in severe cases.

In the worst cases, intense fire toxin attacks the inner body to affect the inner organs and the heart spirit, causing agitation, heat effusion, thirst, scant urine, even absence of urine, abdominal distension, constipation, and delirious speech, and even death.

Exposure to Chemicals

Exposure to chemicals (化学 huà xué shāng) can enter the nose and mouth or affect the skin. Local lesions include burns, redness and swelling, blisters, or ulceration. General signs include headache, dizziness, nausea and vomiting, hypersomnia, delirious speech, convulsions, or even death.

Frostbite

Frostbite (冻伤 dòng shāng) results from exposure to cold environmental temperatures. These can have general effects and affect specific areas, such as the ears, tip of the nose, forehead, hands, and feet.

Localized frostbite

• Mild cases: Hypertonicity of the sinew channels (cold causes contraction and tension); somber-white complexion and numbness and tingling (cold damages yáng qì and causes congealing of qì and blood).
• More severe cases: Green-blue and purple coloration of the skin, with swelling, itching, pain, burning sensation, and blisters of different sizes.
• Most severe cases: The skin of the affected area turns somber-white, with cold pain, numbness and tingling or complete loss of sensation, and dull red swelling. Lesions left after rupture of blisters turn purple and ulcerate. Severe frostbite can damage the flesh, the sinews, and even the bone, causing a black coloration.

General frostbite: Environmental cold causes lowered body temperature, shivering, somber-white complexion, green-blue or purple lips and nails, numbness and tingling of the flesh, lassitude of spirit and lack of strength, hypersomnia, weak breathing, and a pulse that is fine and slow. Without treatment, death can ensue.

Bites and Stings

Bites and stings include venomous snake bites, rabid dog bites, and insect stings and bites.

Snake bites (毒蛇咬伤 dú shé yǎo shāng): Distinction is made between different types of venom: wind toxin; fire toxin; and wind-fire toxin.

• Wind toxin: The bite wound is small, without exudate. Other signs are difficulty breathing and swallowing.
• Fire toxin: The bite wound is marked by redness, swelling, and burning pain. Other signs include shivering, heat effusion, bleeding of various kinds due to frenetic movement of hot blood (nosebleed, vomiting of blood, expectoration of blood, bloody stool, intracranial hemorrhage).
• Wind-fire toxin: Both types of symptoms.

Rabid dog bites (狂犬咬伤 kuáng quǎn yǎo shāng): Signs include local pain bleeding at the wound. After the wound heals, symptoms such as vexation and agitation, fear, and clenched jaw, convulsion, and fear of water and fear of wind appear.

Insect stings and bites (昆虫咬螫伤 dú shé yǎo zhē[ shì] shāng): The most common insect stings are bee stings, wasp stings, and scorpion stings. The most common bites are mosquito bites and centipede bites.

• Bee, wasp, hornet, and scorpion stings: These mostly occur on exposed parts of the face, hands, or feet. They give rise to redness, swelling, burning pain, numbness and tingling, bleeding. Rarely, they can cause static blood and tissue necrosis. There may be generalized signs from severe scorpion stings or from multiple bee or hornet stings.
• Centipede bites: These can cause local redness, swelling, burning sensation, or acute pain. They can cause lymphangitis or lymphadenitis. They can also cause purpura. In severe cases, there may be dizziness, headache, nausea and vomiting, fever, coma, or anaphylactic shock.

Electric Shock

Electric shock (电击伤 diàn jí shāng) can cause burning, hematoma, green-blue or somber-white complexion, faint fine pulse, temporary or enduring loss of consciousness, convulsion, rigidity, and cardiopulmonary arrest.

Worms

The Chinese long ago realized that unclean food could cause intestinal worms. The Zhū Bìng Yuán Hòu Lùn (The Origin and Outcome of Diseases) by Cháo Yuán-Fāng of the Suí Dynasty (610 CE.) states that inch whiteworm [i.e., tapeworm] is a result of eating improperly cooked beef. Chinese physicians also identified numerous medicinals that could kill worms (虫 chóng), such as shǐ jūn zǐ (Quisqualis Fructus), bīng láng (Arecae Semen), and wū méi (Mume Fructus). The theory that dampness and heat cause parasites is attributable to the fact that some intestinal parasites thrive in patients with spleen-stomach damp-heat.

In the past, tooth decay and many skin diseases were attributed to worms or bugs (虫 chóng), even when these were not actually visible to the eye. The discussion in this section is limited to the worms that affect the gastrointestinal tract.

Intestinal worm diseases are traditionally called worm accumulation (虫积 chóng jī). In general, they are characterized by abdominal pain, diarrhea, vomiting, vomiting of worms, passing of worms in the stool, either no thought of food and drink or rapid hungering with increased eating, predilection for strange foods, and anal itch. In prolonged cases, there may be emaciation, withered-yellow complexion, enlarged abdomen with prominent green-blue veins, and puffy swelling. Mild cases may present with no obvious symptoms, in which case the worms may be detected only by modern biomedical testing.

Modern Worm Diseases

Chinese medicine traditionally recognizes several important worm diseases known to modern medicine. And in modern Chinese medicine, other parasites recognized in biomedicine have been incorporated.

Roundworm disease (蛔虫病 huí chóng bìng): A disease caused by a pale-white or yellow worm that is shaped like an earthworm. Roundworm disease is attributed to indiscriminate eating of cold, raw, unclean foods or sweet and fatty foods. It manifests in intermittent abdominal pain. At the painful spot, there is sometimes a lump that wriggles up and down. The face is bright white or mixed yellow and white, sometimes with whitish patches called worm macules. Other signs include emaciation and vomiting of clear fluid, sometimes containing roundworms. In biomedicine, roundworms are called ascarids, typically Ascaris lumbricoides, and the disease is called ascariasis.

Tapeworm disease (绦虫病 tiāo chóng bìng): Classically called inch white worm disease (寸白虫病 cùn bái chóng bìng), this disease is attributed to eating raw or improperly cooked pork or other meat. It is characterized by abdominal distension and pain, diarrhea, and the passing of white segments (known in modern medicine as proglottids) in the stool. Inch white worm is so called because the worm is passed in short segments. In biomedicine, tapeworms are called cestodes, and the disease is called cestodiasis or taeniasis.

Pinworm disease (蛲虫病 náo chóng bìng): A worm disease most common in infants and children, and associated with nighttime anal itch that can affect sleep and produce heart vexation and susceptibility to fright. Pinworms were described in the Zhū Bìng Yuán Hòu Lùn (Origin and Manifestation of Diseases) as being very small and shaped like slugs. In biomedicine, pinworms are called oxyurids, and the disease is called oxyuriasis.

Large intestine fluke infestation (姜片虫病jiāng piàn chóng bìng): In Chinese medical literature, this is traditionally called redworm disease (赤虫病 chì chóng bìng). It is a worm disease caused by worms described as having the appearance of raw meat. It manifests in puffy swelling, rumbling intestines, abdominal pain, diarrhea, and sometimes stool containing pus and blood.

In China, this condition mostly occurs in south-eastern coastal areas (Shànghǎi, Jiāngsū, Zhèjiāng, Fújiàn, and Táiwān). It can be treated effectively with bīng láng (Arecae Semen) without the need to add draining-precipitants. In biomedicine, intestinal flukes can often be traced to an organism of the genus Fasciolopsis; the infestation is called fasciolopsiasis.

Hookworm infestation (钩虫病 gōu chóng bìng): According to biomedical knowledge, hookworm refers to any of numerous bloodsucking nematode worms that have buccal hooks, by which they attach to the intestinal lining.

Traditionally in China the disease was called yellow swelling (黄肿 huáng zhǒng) or yellow obesity (黄胖 huáng pàng) but was not attributed to worms. It can be treated with bīng láng (Arecae Semen), fěi zǐ (Torreyae Semen), kǔ liàn pí (Meliae Cortex), guàn zhòng (Aspidii Rhizoma), and tǔ jīng pí (Pseudolaricis Cortex).

Blood fluke infestation, snail fever (血吸虫病 xuè xī chóng bìng, 罗汉病 luó hàn bìng): According to modern knowledge, blood flukes or schistosomes are an elongated trematode of the genus Schistosoma. The infestation is called schistosomiasis. It is common in tropical and subtropical regions of Africa, South America, the Far East, the Middle East, and the Caribbean.

Blood flukes are parasitic in the portal system and mesenteric veins of the bladder and rectum. Infection is often asymptomatic but can be chronic and debilitating. Depending on the offending species, it can cause intestinal disease, liver disease, portal hypertension, and urinary tract disease (including bladder cancer).

Filariasis (丝虫病 sī chóng bìng): Infection by any of an important group of slender filamentous nematodes that as adults are parasites in the blood or tissues of mammals and as larvae usually develop in biting insects that belong to the Filariidae and related families.

Filariasis is common in tropical and subtropical regions, especially western Africa, India, South-East Asia, and South America. Signs and symptoms vary according to species. Wucheria bancrofti and Brugia malayi are associated with lymphatic obstruction, which may result in elephantiasis and chyluria. Onchocerca volvulus causes river blindness, rashes, and subcutaneous nodules. Draculus medinensis (the guinea worm) causes drancontiasis, which is characterized by bullous lesions.

Misuse of Medicinals

Misuse of Chinese medicinals (用药不当 yòng yào bù dàng) can cause or exacerbate illness in the following ways:

Excessive dose (用药过量 yòng yào guò liàng): Using excessively large doses or using medicinals for an excessively long time.

Inappropriate processing (炮制不当 páo zhì bù dàng): Failure use medicinals that have been correctly processed. For example, toxic medicinals must be duly processed. Wū tóu (Aconiti Radix) is processed by heating or by using honey; fù zǐ (Aconiti Radix Lateralis Praeparata) is processed by soaking in water or boiling; bàn xià (Pinelliae Rhizoma) is treated with ginger. Medicinals that have not been correctly processed can cause poisoning. If conventional processing procedures are not observed, adverse reactions may be observed.

Inappropriate combination (配伍不当 pèi wǔ bù dàng): Failure to combine medicinals appropriately to enhance their effect and reduce their side effects. This often involves failing to observe the eighteen clashes and the nineteen fears.

Inappropriate use (用法不当 yòng fǎ bù dàng): Failure to observe correct preparation procedures, methods of use, and contraindications. It is especially important to observe contraindications. Many medicinals that quicken the blood and transform stasis are contraindicated in pregnancy because they can cause the fetus to be aborted.

Abuse of supplementing medicinals (滥用补药 làn yòng bǔ yào): Many people believe that supplementing medicinals are inherently good for the health and will extend life, not realizing that they are not to be used indiscriminately in repletion patterns, otherwise they can worsen a condition.

Congenital Factors

Congenital factors (先天因素 xiān tiān yīn sù) are causes of disease that are inherited from the parents’ constitution (hereditary factors) or contracted by the fetus from the mother (fetal transmission).

Hereditary factors (遗传因素 yí chuán yīn sù): These include hemophilia, epilepsy, mental disease, diabetes mellitus (dispersion-thirst), polydactylism, hypertension (dizziness and wind stroke), polycystic kidney disesase, color blindness, myopia, and allergies.

Fetal transmission (胎传因素 tài chuán yīn sù): Emotional stimulus, inappropriate medication, poor lifestyle, and dietary irregularities can all affect the development of the fetus, causing symptoms after birth or as the infant develops. For example, qì and blood vacuity in the mother during pregnancy can be passed onto to the child, a condition called fetal feebleness (胎弱 tāi ruò). Virulent forms of heat called fire toxin (火毒 huǒ dú) can also be passed to the child. Modern medicine tells us that syphilis, AIDS, and hepatitis B can all be passed to the fetus.

Toxins

The term toxin (毒 dú) is often cited as a cause of illness. It has the following meanings.

Poisonous substances: The toxin of insect stings, snake bites, rabid dog bites, and certain substances such as lacquer.

Contagiousness: Certain toxins give rise to diseases that are highly contagious.

Virulence: Toxins cause conditions of swift onset and development, manifesting in severe, even life-threatening signs. The terms heat toxin, wind toxin, and damp toxin imply especially virulent forms of heat, wind, and dampness.

• Depth of penetration:Toxins easily penetrate deep into the body to reach the bowels and viscera. For example, visceral toxin affects the intestines.
• Persistence:Toxins tend to give rise to protracted illness sometimes with sequelae (e.g., scarring from pustules) after recovery.
• Fire-heat toxin: This easily damages yīn and cause localized redness and swelling as well as putrefaction of the blood. Other toxins also easily transform into heat or fire. Fire-heat toxin damages the network vessels and causes frenetic movement of hot blood, giving rise to vomiting of blood, or coughing of blood. It can also cause putrefaction of the flesh, giving rise to welling-abscesses and other sores. Warm toxin causes swelling of the face and head, high fever, sweating, thirst, dry tongue, and constipation. The swollen cheeks of mumps are attributed to warm toxin.
• Wind toxin gives rise to violent spasms such as clenched jaw and convulsion, as in lockjaw.
• Damp toxin gives rise to severe damp turbidity. For example, damp toxin vaginal discharge manifests in vaginal discharge that is like rice water and highly malodorous, or green like pus, or multicolored. It is attended by pudendal itch and soreness. It occurs during menstrual periods after childbirth and is attributed to damp toxin exploiting vacuity of the uterine vessels, causing damage to the qì and blood of the thoroughfare (chōng) and controlling (rèn) vessels. It may be a sign of cervical cancer.

One toxin, one disease: Some toxins are associated with different diseases. For example, lacquer toxin and water toxin give rise to specific conditions. For this reason, there is often some degree of synonymy between the name of the toxin and the disease it causes (see diseases below).

Seasonal and geographic nature: Many toxins are associated with specific seasons or geographic areas. For example, miasmic toxin is associated with warm climates (such as that of the south of China).