The Causes of Disease in Chinese Medicine.
Chinese Medicine philosophy holds that all disease has either an
Internal or an External cause. External causes
are related to the place or locality, the weather and environment; the
external environmental causes are called
the "six excesses", and are classified as: wind, dryness, cold, fire,
moisture and heat. The internal causes of
disease are considered to be generated by the mental states, and these
are classified into the "Seven Emotions":
joy, anger, anxiety, brooding, sorrow, fear and fright. Chinese Medicine
considers that disease develops due to
a disruption of the flow and quality of Qi which results from being
subjected to an excess of one or more of
these cases of disease.
From then on the seriousness and duration of the disease will be
subject to the strength of the individual's
constitution, and will be governed by the site of the symptoms,
nutritional status, the physical circulation of fluids
and blood, and the strength of Qi.
|The causes of disease according to Chinese
|External causes -
||Wind, dryness, cold,
||moisture, fire, heat.
|Internal causes -
||joy, anger, anxiety,
Internal Causes - Emotions and Qi.
The holistic nature of Chinese Medicine is demonstrated by many of its
approaches and particularly by its
emphasis on the emotional causes of disease. In Chinese Medicine, it is
considered that either excessive
emotional stimulation or emotional suppression will lead to a
disturbance of Qi which may injure the organs or
the blood and thus lead to the development of a disease; this is called
the internal cause of disease. Emotions
are categorised into seven types: Anger, Fright (or shock), Joy (or
pleasure), Fear, Brooding (or depression),
Anxiety (or worry) and Sorrow (or grief).
Effects of the Seven Emotions:
||Effect on Qi
Foundations of the progress of the disease:
||penetration of the disease agent.
||classification of symptoms and constitution of the
|Qi, Blood and body
||pathogenic circulatory disorders.
Disease Progression and the Six Paths.
Chinese Medicine practitioners observed around 1800 years ago that
acute diseases tend to follow a specific course; they divided this course
into six stages: three stages of excess, followed by three
stages of deficiency.
The stages of excess are: Greater Yang, Sunlight Yang, Lesser Yang
and Sunlight Yang; while the three stages of deficiency are: Greater Yin,
Lesser Yin and Absolute Yin.
Greater Yang represents the first stage of an acute illness; its
symptoms include headaches, fever and severe chills.
Sunlight Yang is the second stage, and manifests symptoms such as
severe chills and constipation or diarrhoea.
Lesser Yang indicates either the resolution of the illness or a
deterioration of the condition; its symptoms include
a bitter taste in the mouth, a dry throat, dizziness, and vomiting.
Greater Yin represents a movement towards a
debilitated and more serious condition, it is characterised by intense
diarrhoea, or vomiting together with
Lesser Yin represents a further waning of the physical resistance;
its symptoms include severely
debilitating chills and cold hands and feet.
Absolute Yin is the final stage and is associated with a serious
physical resistance and manifests symptoms such as oliguria, thirst and
Chinese Medicine considers that diseases do not necessarily follow each of
the six stages, but may first manifest at a particular stage, resolve at a
particular stage, or remain (get stuck) at a particular stage. Diseases
may also pass so
quickly through a stage, that its symptoms do not have adequate time to
manifest. Therefore the concept of the
six stages of disease is primarily a foundation system for the
classification of disease that serves as a baseline for
The Eight Conditions of Chinese Medicine.
When determining the nature of a disease in Chinese Medicine, the first
aspect to be considered is whether the
condition is a Yin or a Yang type of disease. Yang type conditions are
those which appear acutely, actively,
progressively and by producing heat (fever). Yin type conditions show
themselves as being cold (e.g., by
producing stasis and cold swellings), slow, passive, debilitating and
degenerating. For example, when a person
contracts a cold, which is a Yang condition, the pulse rate increases, the
temperature rises, and the face looks
red; the throat becomes sore, there are body aches and there is thirst. On
the other hand, in the case of chronic
bronchitis which is a Yin condition, the person loses energy, the pulse
becomes feeble and its rate slows, the
face turns yellow, and there is little fever or inflammation. Yin
conditions take always longer to cure than Yang
conditions and the Chinese Medicine Practitioner will utilise totally
different medicines and approaches for each
type; Yang diseases will be treated by sedating methods of acupuncture and
perspiration inducing or fever
reducing medicines, while Yin diseases are treated with stimulating
methods of acupuncture and tonics.
The Concepts of Hot and Cold.
The concepts of Hot and Cold relate to specific aspects of the symptoms
not necessarily relate to body temperature. Cold symptoms can result from
exposure to one of the six excesses,
namely excessive cold. This may result from exposure to unseasonally cold
weather, from drinking too many
cold beverages, from a lowered vital force with, a lowered metabolism, or
a decrease in energy such as that
experienced in old age. Cold conditions are associated with a generalised
sensation of coldness, a lowered
immune responsive and a reduction in the speed of healing. Cold symptoms
improve with applications of heat
to problem areas, with hot or spicy foods, with warming drinks and with
Hot conditions may
also results from one of the 6 Excesses, namely excessive heat. Excessive
heat may be caused by exposure to
unseasonally hot weather, excessive metabolic activity, or feverish or
inflammatory conditions. Hot conditions
show as: fever, sensation of heat, excessive thirst, flushing of the face,
restlessness, yellow concentrated urine,
dry stools and a bright red tongue with yellow furring. Hot conditions are
treated with cooling applications, cold
food, cold drinks and cool or cold herbs.
|| HOT SIGNS
|fear of the cold
||aversion to heat
|| hot red skin
|lack of thirst
|desire for hot drinks
||desire for cold drinks
|lack of perspiration
|large amount clear urine
||dark, concentrated urine
|loose bowel motions
||hard, dry stool
|slow or tight pulse
|pale, white coated tongue
||red, yellow coated tongue.
The Four Classifications of Disease
Chinese Medicine philosophy also classifies
diseases as external or internal and as empty or full. External diseases
are those that affect parts on the surface
of the body, especially the skin and muscles, and conditions that have not
penetrated to affect internal organs
and structures; while internal disease are those that affect the organs or
internal structures of the body. Empty
and Full describes the amount of Qi in the body during the course of a
disease: Empty diseases are
characterised by lack of strength and muscle tone, a soft pulse, slight
abdominal tension, a soft voice and
depression; while full diseases are characterised by muscle tension, a
rapid pulse, a loud voice and mental
overactivity. These conditions may manifest together and in any
combination, thus giving the four types: external
full, internal empty, external empty or internal full.
The Internal/External qualities, form four compound qualities
in combination with Hot and Cold - these are:
| i. External Cold
||Chills and fever, Acute conditions.
|ii. Internal Cold
|| No fever, Chronic conditions.
||Acute fever with fear of wind.
|iv. Internal Heat
||High fever, more or less chronic, no fear of wind.
The Eight Principles of Treatment.
The formulation of treatment in Chinese Medicine utilises the same
concepts of Yin, Yang, emptiness, fullness,
external, internal, cold and hot. Internal, cold and empty conditions are
considered to be Yin, while external,
hot and full conditions belong to Yang. Even though at first glance this
system appears somewhat simplified, in
its real application complex interactions arise between Yin and Yang
diseases, such as a conditions that are
halfway between External and Internal or Cold and Hot. Further, conditions
can be mixed, that is, there can be
Empty Heat or External Cold.
The Four Diagnostic Methods.
Diagnosis in Chinese Medicine is always done
from a holistic point of view. There are four diagnostic methods in
Chinese Medicine: 1. Observing, 2.
Questioning, 3. Listening and auscultation, and 4. Palpating.
First the practitioner observes the appearance of
the patient, the posture, bone structure, complexion, skin colour and
condition, tongue appearance and coating
and the nails and the eyes. Next the practitioner will then check or ask
about the presence or absence of fever,
and ask about perspiration, sensations of cold or heat, chills, thirst,
headaches, dizziness, tinnitus, digestive
symptoms such as appetite and discomfort, type of excretion and any other
related symptoms. During this time
the practitioner has carefully listened to the quality of the voice and
the frequency and quality of respiration, and
has taken note of any odours of the mouth and body. These three diagnostic
methods will have determined the
patient's subjective complaints. The next and fourth step is to perform
the traditional pulse diagnosis, which in
Chinese Medicine is not only done on the wrist, but may also be done on a
number of other places. The pulse
is diagnosed as to the following qualities: floating or sinking, slow or
fast, long or short, empty or full and soft or
tense. A number of other subtle variations in pulse quality are also
observed, and all these pulse diagnostics are
used to give further insights into, and verify the nature of the disease.
The philosophical concepts of
Chinese Medicine are based on a holistic and spatial perception of the
individual in their environment rather
than upon the simplified cause and effect principles of Western
Aristotelian logic. Thus the patient is seen as
being a part of a continually interacting World, where mental states,
environmental factors, diet and lifestyle play
an important role in health. Ill-health ensues when the natural balance is
disturbed, and the natural energies
supplied by herbs and through treatment by acupuncture and other means
must be utilised in order to restore
health. Although in recent times there has been a greater recognition in
Western Medicine of the interaction
between mind and body in disease, there has not yet been an attempt to
produce the comprehensive holistic
approach which treats the body and the mind as one unit, that is so much a
part of Chinese Medical
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