Cause of Disease in TCM

The Etiology of Disease



We have already established the notion of balance and harmony.  Now we must explore the causative factors of imbalance and disease.  In The Synopsis of the Golden Chamber, which was published in the third century, explained that there were three causes of imbalance and then disease.  These are referred to as the “Three Injuries.”  The first is internal injury to the organs brought about by uncontrolled emotions.  The second category of disease is injury to the organs by external climatic influences that can invade the four extremities, orifices, and pathways.  The third category is a mixed, or miscellaneous category, consisting of wounds, trauma, insect bites, poor diet, lack of exercise, and way-word sexual activities.  These are referred to as the internal pathogenic factors, external pathogenic factors, and miscellaneous pathogenic factors.  In TCM, etiology of imbalance and disease is the study of these pathogenic factors and how they can negatively influence the body to cause disarray to the body.  The end result of these pathogenic factors are what is called symptom complexes, or syndrome complexes.  In TCM, these complexes are the diagnoses that are rendered and treated with acupuncture.   





The body/mind connection has been acknowledged only recently in the Western medicine, but the interaction of emotions with the physical body is an essential aspect of TCM.  The seven basic emotions are anger, worry, pensiveness, sadness, fear, shock, and joy. In discussing the emotional aspect of disease, it is important to remember that it is normal to experience the full range of emotions.  It is only when a particular emotion is expressed over a prolonged period.



The emotion of anger is associated with the LIVER.  By nature the Qi rises or rushes upward when there is anger.  This causes the person to suffer from heavy sensations in the head and light sensations in the feet, ringing in the ear, deafness, a red face, red eyes, headaches, dizziness and pain in the ribs.  This matches the pattern of liver fire rising.  Anger can also attack the SPLEEN producing a lack of appetite, indigestion, and diarrhea ( i.e. a person arguing at the dinner table or eating while your driving).  In more long term anger, suppressed anger or frustration often causes liver Qi to be stagnant resulting in depression or menstrual disorders.  It is essential to avoid the consumption of coffee when treating anger related liver disorders, as coffee heats the liver.


The best points for anger is BL-47, LIV-3, and LI-4 Bilaterally.



Worry is a very common emotion that we encounter every day.  Our society is filled with all sorts of things that will make a person worry – (our debt, children, deadlines, crime, etc.).  It’s normal to worry but, excess worry can deplete the Qi of the SPLEEN causing digestion disturbances, and eventually chronic fatigue.  A weak Spleen  cannot efficiently turn the food into Qi and the LUNG are unable to extract the Qi from the air efficiently.  A good description of a person who worries too much is a person who says that “he/she carries the weight of the world on their shoulders.”  That person is suffering from a weakened Spleen that will eventually lead to dampness in the Spleen.


The best points for worrying are BL-49, SP-6, Yin Tang, LIV-3, and SJ-5.



Too much thinking or obsessing about a topic can also deplete the SPEEN causing stagnation of its Qi.  A person with this condition may exhibit such symptoms as poor appetite, forgetting to eat, bloating after eating (i.e.- eating when you’re excited). Students are often affected by this imbalance.  This can eventually affect the HEART causing the person to dream about the subject at night.


The best points for pensiveness are BL-49, SP-3, SP-6, and Yin Tang.


Sadness or grief affects the LUNG causing fatigue, shortness of breath, crying, or depression.  Normal healthy expression of sadness and grief can be expressed as a sobbing that originates in the depths of the lungs – deep breaths and expulsions of air with the sob.  However, sadness and grief that remains unresolved can create disharmony of the lungs.


The best points for sadness are BL-42, LU-9, and P-6.



Fear is a normal and adaptive emotion, but when there is chronic fear and fright, it affects the KIDNEYS.  When there is extreme fright, the kidneys ability to hold QI may be impaired leading to enuresis.  In children, this can be manifested as bedwetting, which psychologists have linked to insecurity and anxiety.  Long-term anxiety due to worrying about the future can deplete the kidneys of Yin and Yang Qi eventually leading to chronic weakness.  


The best points for fear are BL-52, KI-3, and SP-6.



Shock affects the KIDNEYS.  The flight or fright reaction causes an excess release of the adrenaline from the adrenal glands that sit on top of the kidneys.  This causes the HEART to be affected by responding with palpitations, anxiety, and insomnia.  Severe shock can have a long-term effect on the heart shen


The best points for fear are BL-52, KI-3, and HT-7.



The emotion of joy is connected to the HEART.  This sounds ridiculous, since most people want as much joy as possible.  The disorders from this emotion are not caused by happiness, rather the imbalance comes from to much excitement or stimulation, or sudden good news that comes as a shock to the system.  This excess can lead to heart imbalances with palpitations, anxiety, and insomnia.  A person with heart disturbances can also exhibit emotional symptoms since the heart is the seat of the spirit.  (I.e.  a person who wins the lottery).


The best points for excess joy are HT-7, P-6, and DU-20.







In Chinese medicine there are considered to be six external causes of disease that relate to external climatic conditions.  They are known as the six pernicious influences or the six excess, or six evils. They are wind, cold, heat, dampness, dryness, and summer heat.  The Chinese observed that the body mirrors certain climatic conditions.  So, a diagnosis of wind and cold invading the lung might sound primitive, but this type of diagnosis accurately describes the way certain of pathogen behaves inside the human body.  The wind symptoms act just like wind in nature – they come and go without warning.  Similarly, cold symptoms act as they do in nature – they cause contraction, they slow down functions, and they make a person feel cold. 


The degree of effectiveness in treating this type of  disorder, such as acupuncture, massage, and herbs that will repel wind and scatter cold, is proof that the diagnosis is much more than just a philosophical idea.  Although western medicine can isolate the virus causing the condition, it still has no safe and effective way of  treating the virus, other than relieving the symptoms it causes. 



Wind is a Yang pathogenic condition.  Wind is associated with spring according to the 5 element correspondences.  It affects primarily the Liver and Lungs. Wind in the body is much like the wind in the environment.  Wind is something that abruptly arises and goes through many changes.  One moment symptoms arise and the next thing you know your fine. It’s usually located on the outside of the body and flows in an upward motion.  Symptoms usually appear in the head, body surface, and limbs.  Since the wind enters the body surface, it causes our pores to open and this can lead to sweating.  Wind is characterized by migratory symptoms.  A good example of wind diseases is arthritis.  Its migratory pain in the bone articulations marks arthritic pain.   Its constant movement characterizes wind.  Therefore,  diseases caused by wind sometimes lead to abnormal movements.  Some examples include tremors, tics, convulsions, dizziness, and rigidity of the neck.  Wind stirring is said to be the cause of this abnormal movements.  Wind is easily combined with other pathogenic conditions such as cold, heat, and dampness.   The common symptom complexes of wind include:   Exogenous Wind, Wind-Cold, Wind-Heat, Wind-Warmth, Wind-Dampness, And Endogenous Wind.


The best points to eliminate wind are LI-11, DU-14, GV-20, and LI-4.



The Chinese describe cold as something that stops the movement and warmth and makes the tissues contract. Its 5 element correspondence winter.  Cold can invade and corrupt the Stomach, Spleen, Lung and Kidneys.  When Cold invades the body it leaves its victims with chills, headachy, and a preference to hot and a dislike to cold things.  The pathogenic condition of Cold is considered a Yin evil Qi.  So, it tends to suppress the defensive Yang.  This results in symptoms such as aversion to cold, fever without sweating, aching joints, rigidity and pain in the neck, cough.  The patients pulse will be floating and tight.  Since the cold suppresses the functions of the Yang, the most common result is pain.  The pain is a result of stagnation, or the decrease in blood circulation as well as Qi circulation. Some common symptoms of stagnation include achy body, headaches, and abdominal pain if  the cold attacks the internal organs.  The cold causes the body to contract its blood vessels.  If cold attacks the surface of the body, the pores of the skin and the muscles will tighten. Its nature is to slow down movements, causing contraction, tightness, stagnation, and impaired circulation.  This then leads to further symptoms such as muscular contractions, spasms, and a rigidity of the extremities.  The most commonly affected organ  is the Kidney.  Cold most readily joins forces with dampness leading to low back pain.  Deficient Kidney Yang is also caused by cold.  When cold is an external pathogen it can attack the skin, muscles, and lungs.  When cold is an internal pathogen it can impair the function of the spleen, stomach and kidneys. 


The best points to increase heat in the body are ST-36, SP6, REN-12, and DU-20.


Summer Heat

The evil heat is a direct result of climatic conditions.  It appears only in hot conditions of the summer.  Summer heat is always classified as an external or exogenous pathogenic factor.  The organs that are most commonly affected are the Liver, Lungs, and Stomach.  These  conditions have a great tendency to have symptoms that are rising in nature.  For example Liver heat rising causes symptoms such as dizziness and cephalgia leaving you feeling light at the feet and heavy in the head.  Heat is a Yang pathogenic condition.  Summer heat produces over active Yang qualities leading to fevers, increased thirst, and perspiration.  The pulse will be a overflowing pulse. Heat does the exact opposite than cold.  Heat causes the muscles, tissues, and blood vessels to open.  This may lead to excessive sweating.  The sweating can than result in the loss of the bodies Qi, thus a deficiency can than occur.


The best points to clear heat are DU-20, LI-11, LI-4, P-6, Yin Tang, KI-3, and SP-6.



In TCM, dampness prevails in the late summer.  However, dampness can occur at any season.  Dampness can invade individuals that are working in water, wearing wet clothing from the rain, water, or sweat.  As always, dampness like the rest of the excesses, can originate from the interior.  The main organ that is involved with exogenous dampness is the Spleen.  Diseases of dampness impair the Yang Qi.  It is a Yin pathogenic factor that disrupts the normal flow of Qi, especially the Yang Qi.  Symptoms include:  diarrhea, edema, and ascites.  The dampness produces a characteristic heavy and turbid feeling. The diseases of dampness have a tendency of lingering around and are difficult to treat.


The best points to eliminate dampness are SP-6, ST-40, SP-9, LU-7, and KI-3.



Dryness is the main evil in the fall.  Diseases of dryness have a tendency to deplete bodily fluids causing a sensation of dryness.  Some symptoms include dry nose, mouth, throat, lips, and tongue.  Fluid depletion follows with scanty urine and constipation.  The evil Dryness mainly attacks the Lung and the Kidney organs.


The best points to eliminate dryness are KI-3, SP-6, Ki-6, and P-6.



This is similar to summer heat in the fact that it comes from hot conditions.  Fire, unlike summer heat, can occur at any season.  Fire is a Yang pathogenic factor and thus symptoms appear mainly in the head.  Extreme Fire leads to the internal Wind conditions.  Some examples include high fever, coma, rigidity in the cervical spine, and convulsions.  Fire may cause internal hemorrhaging. The organs that are most commonly affected are the Liver, Lungs, and Stomach.  The fire causes a warming of the blood and increases the flow.  In extreme cases, rapid blood flow forms hemorrhages including hematemesis, epistaxis, hematochezia, and hematuria.  Fire can originate from any of the other fix evils.


The best points to clear fire are P-6, DU-20, LI-11, LI-4, Yin Tang, KI-3, and SP-6.


Miscellaneous Pathogenic Factors

All other diseases that cannot fit into the former two categories are placed in this group.  These include traumatic injuries, insect bites, animal bites, viral, bacterial, and parasitic infections, improper diet, and excess sexual indulgence.











The Seven Emotions - Qi Qing

The Six Pernicious Influences - Liu Qi