Epidemic Pathogens.
Internal Impairment by the Seven Emotions
Improper Diet and Imbalance Between Work and Rest
Traumatic Injuries

This refers to a group of pathogens responsible for infectious diseases. They also bear names such as Li Qi, which means they are strenuous and liable to cause severe diseases, Du Qi, which also means that they often impair the body severely, or Yi Qi, which indicates that they are different from the common External pathogenic factors.

It was in the Ming Dynasty that epidemic pathogens were included in TCM. As infectious diseases spread widely and failed to respond to treatment based on the theory of the Six External Pathogens, the ancients summarized the features of epidemic or infectious diseases, and concluded that these diseases were caused by some external pathogens with features different from the Six External Pathogens. So they put forward the concept of epidemic pathogens to explain the mechanism of infectious or epidemic diseases. The special features of epidemic pathogens are:

First, they are obviously epidemic and infectious. Spreading through the air or by contact and entering the body through the nose and mouth, they may cause epidemic diseases that spread rapidly in the community.

Secorrd, the diseases caused by epidemic pathogens usually have a sudden onset, are relatively severe, and have similar manifestations in different individuals.

Third, epidemic pathogens are mostly Warm Heat in nature, so they tend to cause diseases marked by Yang Excess symptoms.

Fourth, the spread and generation of epidemic pathogens are related to seasonal conditions and abnormal changes of climate, extreme Heat, long term draught, and dew or fog.

Fifth, the pathogens often invade the body by polluted air, food and water supply.

3. Internal impairment by the Seven Emotions

A. Concept of the Seven Emotions

Joy, anger, worry, anxiety, sorrow, terror and fright are collectively known as the Seven Emotions, which, under normal conditions, are the physiological responses of the human body to enviropmental stimuli. Therefore, they are not pathogenic factors. However, if the emotional stimuli are too sudden or too strong or last a long time, they will disturb the functional activities of Zang-fu Organs, cause disharmony of Qi in its ascent, descent, entry and exit movements, and eventually result in diseases. They cause internal disorders of the body, so they are also called the Seven Emotional states as pathogens responsible for internal diseases.

In the light of TCM theory, the Seven Emotions are closely related to the Five Zang Organs and the circulation of Qi and Blood. On the one hand, they are dependent upon the functional activities of different Zang-fu Organs for their generation; on the other, they affect the functional states of these organs. Therefore, diseases of Zang-fu Organs may be manifested as abnormal changes of the emotions, and emotional changes in excess, in turn, impair these organs. For exainple, stagnation of Liver Qi often presents as emotional depression or irritability, while excessive anger often stagnates the flow of Liver Qi or induces Liver Qi to rise excessively.

B. Characteristics of the Seven Emotions as pathogenic factors

Different fromthe Six External Pathogens,which usually invade the human body by attacking the Exterior of the body first, the Seven Emotions in EXcess often impair the corresponding organs directly, leading to adverse flow of Qi and disharmony of Qi and Blood of Zangfu Organs with the ensuing occurrence of disease.

B-1. Impairing the internal organs

The Seven Emotions often impair the internai organs directly, and first of all, the Heart. Emotion, as one kind of mental activity, is controlled by the Heart. However, each of the Seven Emotions is ascribed to a different Zang-Fu Organ in TCM, because emotions take Essence Qi for their material basis. TCM believes that the Heart is related to joy, the Liver to anger, the Lung to worry and sorrow, the Spleen to anxiety, and the Kidney to both terror and fright. Therefore, excessive joy impairs the Heart; excessive anger impairs the Liver, excessive worry or sorrow impairs the Lung, excessive anxiety impairs the Spleen; and excessive terror or fright impairs the Kidney.

Of course, the correspondence of Zangfu Organs with emotional activities by no means indicates that a specific emotion only impairs its corresponding organ, in fact, as the Heart controls spirit, any emotional change in Excess will impair the Heart. In addition, one emotion may impair several organs, for the disturbance of one organ may cause disorders of other organs closely related to it. For example, emotional depression will cause disharmony between the Liver and Stomach or the Liver and Spleen as a result of the impairment of the Liver and the transverse attack of Liver Qi on the Stomach and Spleen.

Emotions are produced based on the flow of Qi and Blood. As the Heart governs Blood and spirit, the Spleen, situated in the Middle Jiao and serving as the hub of the ascent and descent of Qi, dominates transformation and transportation, and the Liver stores Blood and dominates dispersion and discharging, diseases caused by emotional disorders are mostly manifested as disorders of Qi and Blood of these organs. For example, worry often impairs both the Heart and the Spleen, leading to mental disorders and dysfunction of the Spleen. Injured by emotional depression, Liver Qi will go up excessively and Blood will follow the rise of Liver Qi to go upward, leading to distending pain in the hypochndriac region, sighing, dysmenorrhea, amenorrhea, or abdominal masses.

B-2. Disturbing flow of Qi

When emotional states are abnormal, they will affect the ascent, descent, entry and exit of Qi. This is because emotional activities depend on the free flow of Qi.

Anger induces Qi to flow upward. This indicates that excessive anger can induce Liver Qi to go up excessively and give rise to the subsequent upward adverse flow of Blood. As Liver Qi tends to go up and anger corresponds to the Liver, excessive anger injures the Liver and disturbs the nornial descent and ascent of Liver Qi. In such cases, it is often manifested as a red face and eyes, dizziness and vertigo, distending pain of the head, or even sudden coma or syncope. Sometimes, hematemesis and diarrhea may also be seen as a result of Blood following the adverse Qi to rise excessively or due to Liver Qi attacking the Spleen.

Joy relaxes Qi. This includes two aspects. In normal conditions, joy can promote the flow of Qi and Blood, thus it can relax mental strain. However, excessive Joy may cause Qi to flow too fast to be controlled, so there are such manifestations as poor concentration of the Mind, or even mania.

Sorrow consumes Qi. This means that deep sorrow is likeiy to consume Lung Qi, leading to chest depression and demoralization. Voice is produced by the flow of Lung Qi through the throat, and depends on sufficient Lung Qi for its material basis. In a state of sorrow, one is liable to cry or weep for a long time, so Lung Qi is consumed and lassitude, a depressed feeling in the chest, as well as demoralization occur as a result of deficient Lung Qi failing to perform the functional activities of the Lung.

Anxiety stagnates the flow of Qi. When thinking, one must concentrate and Vital Qi will remain in place to support the thinking. Therefore, excessive lengthy or intense thinking will lead to stagnation of Qi, especially Spleen Qi, which tends to accumulate. Manifestations of such a morbid state include poor appetite, abdominal distention, constipation, etc., due to.the stagnation of Spleen Qi.

Fright causes disturbed flow of Qi. When one is suddenly frightened, his or her circulation of Qi will be disturbed, leading to palpitations, a distressed mind, inability to concentrate the mind, etc. Terror induces Qi to flow downward. The Kidney is related to
terror and also controls defecation and urination. These mainly depend on the controlling effect of Kidney Qi, which is produced by Kidney Essence. Excessive terror often leads to incontinence feces and urine, as well as weakness of the legs, as a result of the impairment of Kidney Qi and Kidney Essence, which in turn fail to control defecation and urination and to nourish the bones.

B-3. Worsening or deterioration of a disease

As emotional changes often exert an unfavorable influence on the functional activities of Zangfu Organs and the flow of Qi and Blood, they may worsen or cause a disease to deteriorate. For example, patients with hypertension, a disease caused by excessive rising of Liver Yang due to Deficiency of both Kidney Yin and Liver Yin, may suffer from sudden coma or syncope, or even paralysis in the case of being stimulated by sudden and violent rage. This is because the Liver is related to anger, and sudden anger will induce further excessive rising of Liver Yang.

Of the etiologic factors TCM has identified, External diseases are usually caused by the Six External Pathogens, and infernal diseases by the Seven Emotionai changes in excess

4. Improper Diet and. Imbalance Between Work and Rest

Proper diet, workand rest are imperative for the survival of human beings and preservation of their health. Improper diet as well as imbalance between work and rest, however, will disturb the physiological functions of the body, leading to disease.

A. lmproper diet leading to disease

Inadequate intake of food, eating too much, intake of decayed, or toxic food as well as an unbalanced diet can all cause disease.

A-1. Underfeeding or overeating

Proper amounts of food should be taken regularly so that they can be digested and generate Qi and Blood. If one eats too much at one meal or has insufficient food to eat over along period, one is susceptible to disease. Usually, insufficient intake of food will cause Deficiency of Qi and Blood as they are lacking in a source, leading to diseases of Deficiency type. In addition, when Qi and Blood are deficient because of underfeeding, the body's resistance to invasion of pathogens will be lowered; therefore, diseases secondary to Deficiency of Qi and Blood will occur.

Excessive intake of food, as a result of the amount of food exceeding the capacity of the digesting function of Spleen and Stomach, tends to impair the Spleen and Stomach. Sudden indigestion often presents with the symptoms of impairment of the Spleen and Stomach, such as epigastric and abdominal fullness, abdominal pain, acid regurgitation and eructation, disgust at the smell of food, or vomiting and diarrhea. As their Spleen and Stomach are not fully developed, children are more likely to suffer from diseases caused by indigestion. In the case of long term food retention, malnutrition will ensue, which is mainly manifested as Heat in the palms and soles of the feet, restlessness, epigastric and abdominal distention, a sallow face and emaciation, restless sleep, etc. Retained food often obstructs the flow of Qi and Blood and causes blockage of the vessels, causing hemorrhoids. Moreover, excessive intake of fatty and greasy food is apt to induce the generation of Heat in the interior, which may in turn lead to skin infectfons.

A-2. Intake of unclean food

Unclean food may cause a number of diseases of the digestive tract, with abdominal pain, vomiting with diarrhea, or dysentery as the most commonly seen manifestations. Contaminated food may also cause parasitic diseases, which are marked by abdominal pain, preference for unusual food, a sallow appearance and emaciation.If decayed or poisonous food is taken, symptoms of poisoning, including severe abdominal pain, vomiting and diarrbea, or even coma and death, will occur as a consequence.

A-3. Food preference

Physiologically,Yin and Yang of the bodyare kept balanced by eating food which nourishes Yin and supports Yang evenly. If cold foods or foods Cold in nature are taken excessively, they will strengthen Yin and restrict Yang, causing imbalance of yin and Yang and subsequent disease. In a similar way, excessive intake of hot food or food hot in nature will increase Yang of the body, leading to its overrestraint over Yin and the ensuing imbalance of Yin and Yang, thereby causing diseases. For example, excessive intake of raw and cold food and drinks in summer often leads to diarrhea and abdominal pain, indicating that Spleen Yang is impaired by excessive Yin.

According to TCM, the Five Zang Organs require food of different tastes to be nourished so as to maintain the coordination among them. Thus, preference for food of certain tastes will strengthen the organ it corresponds to, leading to disturbance of the organ and disharmony among the five Zang Organs. In such cases, disease will follow. For example, excessive intake of bitter tasting food will lead to hyperactivity of the Heart, which may overrestrict the Lung and lead to withered hair and dry skin. Therefore, TCM stresses that food of different tastes should be eaten in combination, so that relations among the five Zang Organs can be maintained and health preserved.

B. Imbalance between work and rest

Appropriate work or exercise can promote circulation of Qi and Blood and strengthen the constitution, while proper rest can help to relieve fatigue, and restore physical and mental strength; therefore both of them are conducive to health. However, overstrain or undue leisure may be transformed into pathogenic factors and cause diseases.

B-1. Overfatigue

In TCM overfatigue can be classified as excessive physical exercise, excessive mental exertion, or intemperance in sexual life. Excessive physical exercise. Long term overwork may consume too much Qi and Blood and lead to Deficiency of Qi and Blood, from which disease results. Exercise mainly depends on the support of Qi. So overexertion consumes Qi, which may become deficient because it cannot be reinforced quickly enough.

Excessive mental activity. This mainly refers to worry impairing both the Heart and Spleen. As the Heart controls both Blood and mental activity and the Spleen is related to thinking in emotions, excessive mental activity is most likely to impair the heart and Spleen, causing Deficiency of both Heart Blood and Spleen, whicb is usually manifested as palpitations, forgetfulness, insomnia, dream disturbed sleep, loss of appetite, abdominal distention and loose stools.

Intemperance in sexual life will impair the Essence stored in the Kidney. In accordance with TCM theory, Kidney Essence is the most important substance fo rlife; it should be stored more than discharged. Thus, intemperance in sexual life often leads to soreness and weakness of the loins and knees, dizziness and tinnitus, listlessness, decline of sexual capacity, or nocturnal emission, premature ejaculation, or even impotence.

B-2. Inactivity

This refers to excessive ease and comfort without participation in labor or other physical activities. Man must have a certain amount of physical exercise every day; otherwise, his Qi and Blood will fail to flow freely. If he is not engaged in physical labor or exercise for a long time, his Qi and Blood will flow sluggishly, and hypofunctioning of the Spleen and Stomach will occur, so there will be poor appetite, lack of strength, lassitude, weakness of limbs, obesity, palpitation, sweating on exertion and shortness of breath. Obese patients often have constitutions marked by deficiency of Qi and Excess of Damp, because they lack sufficient exercise to metabolize the Yin substance, which then accumulates in the body to cause obesity.

5. Traumatic injuries

Traumatic injuries include gunshot injuries, incised wounds, contusions, sprains, scalds and burns, hypothermia, and injuries inflicted by animal stings or bites. Gunshot injuries, incised wounds, contusions, and sprains directly injure the skin, muscles, bones, joints, tendons, Blood Vessels or Zangfu Organs, leading to Blood Stasis, painful swelling of the skin and muscles, bleeding or laceration of muscles and tendons, fracture and dislocation, or even coma, tics, Yang depletion or prostration Syndrome as a result of massive hemorrhage.

Burns and scalds are caused by high temperature objects, boiling water, scorching oil or fire and so on. Mild burns and scalds may injury only the skin, manifested as redness, swelling, heat and pain in the affected area. In cases of severe wounds, where the surface area is large, there may be complications such as dysphoria,fever, thirst or oliguria. In the case of severe pain or inward attack of Fire toxin, with accompanying evaporation or exudation of Body Fluids, death may occur.

Hypothetmia .refers togeneral or local traumatic wounds due to low temperature.The former results from failure of the deficient Yang Qi to warm the body and to promote circulation of Blood due to its impairment by Cold pathogens, which is usually accompanied by a gradual lowering of the body temperature, pale face, bluish purple lips, tongue and finger nails, shallow breathing, slow and faint pulse, etc. If not treated promptly, it may even cause death. The latter is often seen on the hands, feet, auricullae, etc., and is marked by local pale skin and Cold numbness, followed by swelling and itching pain and scorching heat or blisters of varying sizes. Insect or animal stings and bites include bites by poisonous snakes, wild beasts or rabid dogs, or stings by scorpions and bees. The symptoms in mild cases are usually a local wound accompanied by painful swelling and bleeding. In the case of massive hemorrhage, the internal organs maybe involved and death may occur as a result.

Other related topics:

1. The Six External Pathogens
6. Phlegm Retention and Coagulated Blood
7. Discussion of Difficult Points