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 Medicine.
External causes -	Six Excesses:
	Wind, dryness, cold,
	moisture, fire, heat.
Internal causes -	Seven Emotions:
	joy, anger, anxiety,
	brooding, sorrow,
	fear, fright.
Associated cause:	Dietary Imbalance

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:

Emotion	Effect on Qi	Element	Organ affected
Sorrow	Reduces Qi	Metal	Lungs
Fear	Suppresses Qi	Water	Kidneys
Fright	Disturbs Qi	Water	Kidneys
Anger	Stimulates Qi	Wood	Liver
Joy	Calms Qi	Fire	Heart
Anxiety	Obstructs Qi	Earth	Spleen
Brooding	Coagulates Qi	Earth	Spleen

Foundations of the progress of the disease:

Six Paths	penetration of the disease agent.
Eight Conditions	classification of symptoms and constitution of the patient.
Qi, Blood and body	pathogenic circulatory disorders.
Fluids 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 dysentery.
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 loss of physical resistance and manifests symptoms such as oliguria, thirst and complete exhaustion.
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 further diagnostics.

The Eight Conditions of Chinese Medicine.

Yin/Yang

Cold/Hot

Internal/External

Empty/Full

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 and do 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 warming herbs.
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.

COLD SIGNS	HOT SIGNS
fear of the cold	aversion to heat
cold extremities	hot red skin
white face	red face
slow movement	rapid movement
quiet behaviour	excitability
lack of thirst	excessive thirst
desire for hot drinks	desire for cold drinks
lack of perspiration	excessive perspiration
large amount clear urine	dark, concentrated urine
loose bowel motions	dry constipation
watery stool	hard, dry stool
slow or tight pulse	rapid 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:

Conditions:	Symptoms:
i. External Cold	Chills and fever, Acute conditions.
ii. Internal Cold	No fever, Chronic conditions.
iii.External Heat	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.

Summary.

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 philosophy.

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