Interaction of trauma with climate

A trauma to a knee that occurred at a young age when the patient was playing sports may heal without any apparent consequence but when, years later, the patient is then subject to invasion of Cold and Dampness (when he goes out walking in the rain and remains in wet clothes for the whole day), he may develop Painful Obstruction Syndrome in that knee. A previous trauma, in fact, often explains the unilaterality of a particular joint problem.

Interaction of hereditary weak constitution with diet

A girl is born with a weak Stomach and Spleen constitution, which appears to improve after the age of 7, as often happens. When the girl reaches 14 she becomes a vegetarian. Her diet now consists mainly of cheese and salads; this interacts with the pre-existing weak Stomach and Spleen constitution to cause Spleen-Qi deficiency and possibly also Blood deficiency.

Interaction of emotional problems at puberty and overwork

A girl suffers deep emotional traumas around the time of puberty, owing to family conflicts. These have no apparent effect until she is an older woman. At the age of 27 she is working very hard and for very long hours; the emotional problems at puberty (which affect the Directing and Penetrating vessels) interact with the overwork later in life to cause gynaecological problems, possibly endometriosis.

Interaction of weak Heart constitution and emotional problems

A child is born with a weak Heart constitution manifesting with a nervous disposition, restlessness in sleep and a deep Heart crack on the tongue. At a later age, the young man suffers deep emotional stress owing to relationship difficulties; the interaction of a pre- existing weak Heart constitution and the subsequent emotional problems causes serious Heart patterns and possibly severe anxiety and depression.

Childhood

During early childhood there are only three possible causes of disease, that is, weak hereditary constitution, irregular feeding and climate. Therefore, if a patient has been suffering from a particular complaint since early childhood, this can be due to one of these three causes. We can eliminate climate as a cause because it does not usually cause long-lasting consequences (unless there is a residual pathogenic factor), so the problem can therefore be due only to heredity or irregular feeding. An example of such a problem is early-onset atopic disease (asthma and eczema), which is usually due to a hereditary weakness of the Lungs’ and Kidneys’ Defensive-Qi systems.

A new possible cause of disease in young children is immunizations, which are often the cause of chronic infections, sleep problems or hyperactivity.

Older children’s main causes of disease are primarily diet, climate, emotions and traumas. For example, if a patient has been suffering from persistent headaches since childhood, this could be due either to a trauma to the head or to irregular diet as a child. The emotional life of a child is quite different from that of an adult and a child’s emotional problems are largely the reflection of the family’s emotional state.

Adolescence

Adolescence is a very vulnerable period of life both on a physical and on an emotional level, especially for girls. Taking a careful history will often reveal the onset of a particular problem during adolescence. For example, if a girl has been suffering from headaches since the onset of the menarche (which can be established only with very careful questioning) this most probably indicates Liver-Blood deficiency (resulting in Liver-Yang rising) as the main cause of the problem. This, in turn, is most probably due to dietary irregularity or an injudicious vegetarian diet.

Skin problems from this age may also be due to the aggravation of Blood deficiency with the onset of the menarche. If a young woman has been suffering from painful periods ever since their onset, this almost certainly points to invasion of Cold in the Uterus during early adolescence when the Uterus is in a particularly vulnerable state.

Adolescence is also a vulnerable time from the emotional point of view and deep emotional problems in a young adult often stem from that time.

Young adulthood

Many events characterize the early young adulthood, for example leaving home, change of diet, sexual activity, and infections.

Leaving home often coincides with a deterioration in the young person’s dietary habits characterized by irregular meals, eating ‘fast foods’, and often becoming vegetarian. When practised without a proper understanding of nutrition, a vegetarian diet may lead to Blood deficiency, especially in girls. Therefore, digestive problems later in life often have their root in the early 20s.

Young adulthood is also the time of emotional stress deriving from work, relationships and unresolved family situations. The pulse reflects the emotional cause of disease quite accurately. For example, if the Lung pulse is somewhat full and the patient looks sad, it may be due to sadness or grief which has not been expressed (the fullness of the Lung pulse would indicate this). If the Lung pulse is particularly Weak and without wave and the eyes lack lustre, I may enquire whether events in the patient’s life have caused sadness or grief.

If the Heart pulse is Overflowing and there is a Heart crack on the tongue, I may ask if the patient has suffered from a shock. If the Heart pulse is Choppy, the complexion dull, the eyes lustreless and the voice weak and weepy, it often indicates long-standing sadness.

If the pulse is Wiry on all positions, I may enquire whether there is some situation in the patient’s life that is causing frustration, anger or resentment.

The pulse, complexion and eyes often point to the true emotion underlying the disease, sometimes even contradicting the patient’s own perception. For example, a patient complained of various symptoms which she attributed to the anger she felt at having suffered sexual abuse as a teenager. Her therapist had also identified anger as a cause of her symptoms. However, her very pale complexion, sad eyes and Weak pulse without wave, especially on the Lung position, showed a different picture; in other words, all the signs pointed to sadness and grief as the predominant emotions. I therefore asked her how she felt about her past experiences and she confirmed that those were the predominant emotions.

Another case showed almost the opposite situation. A young woman complained of premenstrual tension and depression; she looked quite sad and her voice was somewhat weepy. However, her pulse was not weak but somewhat full; in particular, it was Moving, especially on the Heart position. I asked her if she had suffered a shock during childhood and she burst into tears, telling me about sexual abuse suffered from an uncle.

Middle age

The main causes of disease in middle age are emotions, overwork and diet.

The emotional state of middle age may take two opposite directions: some people have been able to resolve the emotional problems of their youth and have settled into a way of life that pays attention to the needs of the Self; for others, middle age is a time of crisis and emotional turmoil when every aspect of their life is questioned. Most people overcome this crisis to achieve a better emotional balance.

Overwork is probably the most important cause of disease in middle age. This comes about because middle age is a time when people usually reach the peak of their profession, which imposes the heaviest demands. Unfortunately, this comes at a time when our energy is naturally declining and Kidney-Qi begins to decline too. Most people make unreasonable demands on their own bodies; they expect their energy to be the same as when they were in their 30s or even 20s, and have no idea about the need for rest; they think it is ‘normal’ to get up at 6.30 in the morning, catch a train at 7.30, work all day under conditions of stress, eat a sandwich at their desk for lunch without any interruption from work, and return home at 9 in the evening. This constitutes ‘overwork’ and is a major cause of Kidney deficiency in the Western world.

Old age

Old age is a time when causes of disease have a lesser impact than in any other period of life. Generally speaking, past causes of disease are already well entrenched and usually no new causes of disease play a role. This is not because diet or emotional problems do not affect the elderly but because any cause of disease at this time of one’s life inevitably has its roots in the distant past; for this reason, a change in habits is somewhat less important in the elderly than at any other time of life, particularly with regard to diet. For example, if an 85-year-old man suffers from Phlegm due to a lifelong excessive consumption of greasy foods, a change in diet at this late time of life will have little impact on his organism (although it may still be advisable for him to make these changes). Of course, that is not to say that other changes in life’s habits do not have an impact on a person’s health: for example, it is never too late to explore the root of one’s emotional problems or to take up exercise.

Heredity

The constitutional body condition inherited from our parents depends on three factors:

Any of these factors can affect the body condition and become a cause of disease later in life. If the parents’ Qi and Essence are weak, the child’s resulting Pre-Heaven Essence will also be weak. Similarly, if the mother conceives in later life, this can result in a Kidney or Liver deficiency starting during childhood.

Even though the parents’ general health may be good, if it is poor at the time of the child’s conception (perhaps through overwork, excessive sexual activity, excessive consumption of alcohol, or use of certain medications or drugs such as cannabis or cocaine), this will result in the child’s having a weak constitution. In this case, the weakness will affect not the Kidneys or Liver, but any of the other organs (i.e. Spleen, Lungs or Heart), depending on what particular condition is negatively affecting the parents’ health. For example, if a parent has been overworking at the time of conception, his or her poor health may cause hereditary Spleen weakness in the child; excessive consumption of alcohol or the use of drugs or certain medicines may cause a hereditary weakness of the child’s Heart or Liver.

The mother’s condition during the pregnancy can affect the fetus. For example, an accident to the mother can cause headaches later in the child. A shock during pregnancy can cause a baby to cry during sleep or a child to suffer nightmares (this will also manifest with a bluish tinge on the forehead and chin).

The clinical manifestations of a poor constitution in each of a child’s organs are indicated below. Possible causes arising during pregnancy for each such constitution will be given, but we must obviously bear in mind that the manifestation may result from a constitutional weakness in one or both parents and not necessarily from what happened during pregnancy.

Emotions

Emotions are mental stimuli which influence our affective life. Under normal circumstances, they are not a cause of disease. Indeed, ‘emotions’ should be more appropriately called ‘feelings’ and feelings are a natural expression of human life. Without feelings, we would not be human. Hardly any human being can avoid being angry, sad, aggrieved, worried, or afraid at some time in his or her life. For example, the death of a relative provokes a very natural feeling of grief. It is only when such feelings take over our life inappropriately and disturb our psyche and body that they become pathological; when this happens, feelings have turned into ‘moods’.

Moods often arise precisely when feelings are suppressed; for example, if a certain situation makes us angry and we recognize the anger we can deal with it and perhaps even come to the conclusion that part of the anger was a projection of our own ‘Shadow’. In such a case, the anger is a normal feeling that will probably not have pathological consequences. But if we fail to recognize our anger, this will be driven to deeper levels of our psyche and turn into a ‘mood’ that possesses us. We ‘possess’ feelings, but moods possess us.

Thus, emotions (or ‘feelings’) become causes of disease only when they are excessive, prolonged, suppressed, or unrecognized, in which case they turn into moods. For example, hardly anyone can avoid being angry sometimes, but a temporary state of anger does not lead to disease. However, if a person is constantly angry about a certain situation in life for many years, or, even worse, if the anger is not recognized, this emotion will definitely disturb the Mind and Spirit and cause disease.

In Chinese medicine, ‘emotions’ (the term here signifies causes of disease, not normal feelings) are mental stimuli which disturb the Mind and Spirit and, through these, alter the balance of the Internal Organs and the harmony of Qi and Blood. For this reason, emotional stress is an internal cause of disease which injures the Internal Organs directly. Conversely, and this is a very important feature of Chinese medicine, 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 result in a person becoming irritable all the time. Vice versa, if a person is constantly angry about a certain situation 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…’.¹ On the other hand, further on it says: ‘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 behaviour …’²

These two passages clearly show that, on the one hand, emotional stress injures the Internal Organs and, on the other hand, disharmony of the Internal Organs causes emotional imbalance.

The emotions taken into consideration in Chinese medicine have varied over the years. From a Five-Element perspective, the ‘Yellow Emperor’s Classic’³ considered five emotions, each one affecting a specific Yin organ:

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:

Other doctors considered other emotions such as grief, love, hatred and desire (craving).

Finally, and interestingly, there is one last emotion which is not usually mentioned in Chinese medicine, and that is guilt. Yet, in my opinion, guilt is very pervasive in Western patients and definitely an emotional cause of disease.

Thus, the list of emotions could be expanded as follows:

• anger (and frustration and resentment) affecting the Liver

• joy affecting the Heart

• worry affecting the Lungs and Spleen

• pensiveness affecting the Spleen

• sadness (and grief) affecting the Lungs

• fear affecting the Kidneys

• shock affecting the Kidneys and Heart

• love affecting the Heart

• hatred affecting the Heart and Liver

• craving affecting the Heart

• guilt affecting the Kidneys and Heart.

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