Chapter 2

THE CAUSES OF ILLNESS IN CHINESE MEDICAL THEORY

Chinese medical theory traditionally discerns three categories of causes of illness.¹ These are:

1. External factors, or wai yin. This classification encompasses climatic and environmental factors: wind, heat, fire, damp, dryness, and cold, as well as pestilence and epidemics.
2. Internal factors, or nei yin. This category includes both emotional disturbances that weaken the body’s resistance to disease, and unhealthy behaviors such as prolonged malnutrition, overindulgence, inactivity, overstrain, and fatigue.
3. Neither external nor internal factors, or bu nei bu wai yin. Included in this category are injuries; wounds; parasites; insect, snake, and animal bites; and bacterial and viral infections.

WAI YIN, “EXOGENOUS PATHOGENS”

The exogenous pathogens of traditional Chinese medical theory are sudden changes in the environment and climate due either to unseasonal aberrations in the weather or as a result of traveling from one region to another too quickly for the body to adapt. If the latter pathogenic factor was even considered in a time when the fastest means of transport was the horse (the Chinese were never much of a seafaring people), it must be reaching fairly epidemic proportions today as we hop around the planet, jumping several time zones and seasons in a matter of hours.

We are, without doubt, the most adaptable species living on this planet. Our ubiquitousness attests to that. Nevertheless, acclimatization takes time. Too sudden a change in the environment leads to imbalances. In Taoist terms, the Earth and the Water of places differ. The Five Elements within the body and the proportions of Yin and Yang change. Zheng qi (“proper” or “correct” qi, referring to the body’s resistance to disease) is depleted in the effort to restore equilibrium. When qi is weak, illness is the likely outcome.

The climatic changes that are regarded as directly responsible for illness are collectively called the xie qi, or “evil qi.”² They are evil wind (feng), cold (han), damp heat (shu), humidity (shi), intense dryness (zao), and firelike heat (huo). Although the xie qi are principally environmental, or external, factors affecting the body, the symptoms they produce frequently become manifest only when they enter to the very core of the body, affecting the zang and fu organs. When this happens they are considered xie qi syndromes of an internal nature.

  Feng, “evil wind”

Evil wind is a Yang pathogenic factor. As such, it tends to attack the upper body (Yang) first. It is characterized by swift movement affecting various parts of the body in rapid succession, and by outward dispersion. It often operates in conjunction with another of the evil qi, giving rise to wind cold, wind heat, wind dampness, and, especially, wind fire. The latter is the most virulent combination, as wind is said to fan the Fire. The result is acute and persistent fever.

Common effects of a feng syndrome: The common cold, fevers, sweating, joint pains, itchy skin, spasms, and uncontrolled movements of the limbs. Wind tends to attack the liver. When it does, apoplexy, infantile convulsions, paralysis, and Parkinson’s disease can result.

Early clinical manifestations: Headache, sore throat, blocked or runny nose, fever, perspiration, cough.

  Han, “cold”

Han, or cold, is a Yin pathogen. It depletes the Yang of the body, particularly that of blood and qi circulation. It is thus characterized by stagnation and by contracting of the blood vessels and muscles.

Common effects of a han syndrome: Aching muscles and joints, headache, cough, asthma, nasal blockage, pharyngitis. Sometimes a cold syndrome is brought about by the consumption of cold and uncooked food, or by exposure of the abdomen to cold. When this occurs cold tends to attack the spleen and stomach, thus affecting digestion. The effects are vomiting, diarrhea, and abdominal cramps.

Early clinical manifestations: Vomiting, stomachache, general feeling of cold in the extremities and in the abdomen.

  Shu, “summer heat”

Shu, or damp (summer) heat, is a Yang syndrome. It is said to consume Yin and qi. As with all Yang syndromes it affects the upper body, especially the head, giving rise to headaches, dizziness, and excessive sweating.

Common effects of a shu syndrome: Fever, heat sensation on the skin, irritability, rapid pulse, thirst, heavy head, stuffy chest, nausea and vomiting, abdominal distention, diarrhea.

Early clinical manifestations: Thirst, general weakness, yellow and scanty urine, constipation.

  Shi, “damp”

Shi is a Yin pathogen. Its principal action is to obstruct the circulation of zheng qi, the body’s disease-resistant force, resulting in sensations of heaviness, stagnation, and sluggishness. Shi usually attacks the lower half of the body (Yin), causing soreness in the muscles and joints of the lower limbs. It is also said to attack the spleen which, being of the Earth element, is particularly susceptible to humidity. The results are distention and soreness of the trunk and abdomen.

Common effects of a shi syndrome: Rheumatism, indigestion and constipation, skin rashes and fungi.

Early clinical manifestations: Lethargy in the head and body; aching in the limbs; fever; white, viscous-coated tongue; slow pulse.

  Zao, “dryness”

Zao, or dryness, is considered a Yang pathogen. It consumes Yin substance, especially body fluids. It tends to affect the chest, particularly the lungs, which need humidity to function adequately. Dryness may be either cold or hot, external or internal.

Common effects of a zao syndrome: Cold dryness results in symptoms similar to that of han, or cold, syndrome: aching muscles, joints, and head; cough; asthma; nasal blockage; pharyngitis further complicated by insufficient body fluid. Hot dryness causes headaches; a dry, rasping cough; thirst; irritability; red and dry mucous in the mouth and nose. Internal dryness is more serious than external; it can lead to mental instability and emotional distress.

Early clinical manifestations: Dry, rough skin and chapped lips.

  Huo, “fire”

Huo, fire, is both one of the wu xing (Five Elements), and one of the six evil qi. It is a Yang pathogen that tends to flare upward. As a consequence, it consumes Yin fluids in the upper half of the body.

Common effects of a huo syndrome: Fever, thirst, heavy perspiration, ulcers of the tongue and mouth, nosebleed, irritability, anxiety, and insomnia. In extreme cases a fire syndrome can lead to delerium and loss of consciousness.

Early clinical manifestations: Thirst, dry mouth and throat, headache, red and swollen eyes, yellowish urine, dry stool, rapid heartbeat.

NEI YIN, “ENDOGENOUS PATHOGENS”

According to traditional Chinese medical theory the internal factors held responsible for the weakening of zheng qi, and hence the development of disease, are behavioral or emotional in nature. They are:

1. wrong eating habits
2. a stressful lifestyle
3. overindulgence in sex
4. the seven pathogenic emotions

Wrong Eating Habits

The pillar of good health is moderation in all things—exactly what parents always tell their children. Moderation—what amounts to common sense—in China became a working medical hypothesis. This hypothesis eventually became theory, and that theory led to a regimen adopted by every health-conscious individual in the country. In China we believe in the value of a long and healthy life. We therefore stick to moderation in whatever we do.

For most Chinese people, moderation means remembering, first of all, the “five forbiddens” (wu jin) of eating. They are:

1. Refrain from monotony. Do not eat only what appeals to your palate, but vary your diet at every meal.
2. Avoid excesses: eat spicy, sour, fried, salty, and sweet food sparingly.
3. Never eat large amounts at a single sitting. You should rise from the dinner table feeling only two-thirds full.
4. Beware of chemical additives and exotic foods. The latter refers to some Chinese delicacies, so infamous in the West, that we actually eat only as a special culinary adventure. These include snake meat, scorpion, insects, dog, badger, mouse, bear paws, snail, and turtle.
5. Do not overindulge in beverages in place of eating solid food.

In addition to these five forbiddens, Chinese medical tradition points out that overeating leads to stress on the digestive system, inefficient absorption of nutrients, weak qi, and disease. Malnutrition, on the other hand, deprives qi and blood of the nutrients necessary to life. Malnutrition includes eating too little for one’s body weight; consuming a monotonous, poorly balanced diet; eating contaminated, poisonous, or stale food; and consuming cold food and drinks. Finally, overindulgence in intoxicating liquor is seen as a cause of serious imbalances and maladies, with the liver being particularly affected.

Stressful Lifestyle

In China we regard both overstrain and too little physical exertion as factors leading to imbalances and illness.

Overexertion over a long period weakens the body as a whole. It leads to exhaustion, dizziness, sleepiness, fluttering heart, asthma, and low resistance to disease.

Lack of physical exertion causes stagnation in the circulation of qi and blood to the various parts of the body. This results in unhealthy zang and fu organs, weakness, anorexia, dizziness, palpitations, insomnia, and a decreased resistance to the six evil qi exogenous pathogenic factors.

Overindulgence

Excessive sexual activity is considered to be a specific form of strain that consumes the kidney (water) essence and leads to lumbar pains, dizziness, ringing in the ears, listlessness, spermatorrhea, leukorrhea, and, in the long run, impotence in men and frigidity in women. What would be considered excessive sex is, perhaps, a matter of opinion; in China, engaging in sex more than twice a week is considered excessive.

The Seven Pathogenic Emotions

If a stressful lifestyle is considered deleterious to health, stressful emotions are seen as the pathogens that, one after another, get into your body, affect your qi and your internal organs, and, in the long run, lead to disease. So dangerous are they considered that Chinese medical tradition refers to them specifically as the seven pathogenic emotions. These are anger, melancholy, worry, grief, fear, fright, and joy.

The latter emotion may appear out of place—the experience of joy does not seem likely to lead to stress, distress, and a consequent lowering of resistance to disease. Nevertheless, we in China believe that when any of these emotions are too strong or constant, or when the subject is too sensitive to them, they cause imbalances within the body’s zheng qi, and hence lead to disease. Anger is said to make the qi rush upward; joy makes it circulate slowly; grief consumes qi; fear causes it to flow downward; fright makes it flow unevenly; melancholy depletes qi; and worry leads to its stagnation.

A specific relationship is said to exist between each of the principal organ/Elements and the emotions (see table 1). It is recognized, therefore, that anger (Wood) injures the liver (also Wood). Melancholy and grief injure the lungs (Metal), fear injures the kidneys (Water), and joy injures the heart (Fire). It follows also that worry injures the spleen (Earth).

BU NEI BU WAI YIN, “NEITHER ENDOGENOUS NOR EXOGENOUS PATHOGENIC FACTORS”

This category includes wounds; injuries; insect, snake, and animal bites; parasites; fungi; and in our modern day, viruses and germs.

To deal with these factors, including germs and viruses, Chinese medicine resorts to foods and herbs that build qi and strengthen the body’s resistance to disease. Nothing in ancient China was known about bacterial and viral infections. According to classical theory, however, no illness of any kind can enter or perpetuate itself within the body as long as qi is strong and circulates freely. As a result all therapies are aimed exclusively at helping the body defend itself, not at eliminating the external microscopic cause.

In practice this holistic approach works well with all ailments except the most virulent. This is the reason traditional Chinese medicine cannot deal with infections as successfully as modern allopathic (Western) medicine. Nevertheless, even today, when most city dwellers in China turn to allopathy for cures to maladies of a bacterial or viral nature, we invariably follow the dictates of traditional medicine at the same time. We may take antibiotics to cure the flu, but, with the antibiotics, we will take garlic and ginger broth with sugar for its warming effect, consume yin qiao pills to dispel fever, and crawl under a heavy quilt fully dressed for a good diaphoretic sweat.³

CHINESE THEORY AND THE WESTERN PARADIGM

The fact that Taoist theories of Yin and Yang, the Five Elements, and exogenous climatic pathogens do not fit current Western views of the world may be a matter of concern to many people. In the West, certain facts about nature and disease have been discovered that have opened avenues of therapy undreamed of just fifty years ago, and it would seem that any system of medicine that ignores these facts is bound to be deficient in one way or another. However, the two medical systems of allopathy and Chinese tradition are so different that any attempt to relate one to the other on theoretical grounds is futile. It would be rather like trying to compare the styles and techniques of traditional Peking opera with those of Western classical music, wushu boxing with a world heavyweight title bout, or qi gong with athletic training. The two systems simply arise from different traditions that view the world differently and have attributed different labels to reality as they see it.

It is possible, therefore, that traditional Chinese medical theory does not “ignore the facts” known to allopathy—it just looks at them from a different point of view. That point of view may have its own shortcomings, and we shall examine those in a moment. It may, however, also contain insights into humankind’s relationship with nature that people who look at the world through Western eyes are still in the process of discovering.

The Western worldview is confident that disease is caused by exogenous pathogens with strange and exotic Greek and Latin names that can be isolated in laboratories and examined under microscopes. It is ascertained that if any of these exogenous pathogens enter the human body they will cause disease or, at the very least, cause an antipathogenic reaction as the body swings its defense mechanisms into urgent action. The outcome depends as much on the efficiency of the immune system as on the virulence of the external pathogen.

Chinese medicine asserts, on the other hand, that disease is caused by exogenous pathogens (with strange and exotic Chinese names) that twenty-five centuries ago were isolated as functions of nature and have been examined, ever since, in the field of human pathological experience. It is ascertained that if any of these exogenous pathogens enter the body they will cause disease or bring about an antipathogenic reaction. The outcome depends as much on the state of internal health, or balance of all the elements of nature, as on the virulence of the external pathogen.

We do not wish to argue that the traditional Chinese doctors know as much about microbiology and biochemistry as any scientist in the West. They don’t. Some of their ideas are worryingly old-fashioned and apparently impervious to change. What is more, a closed system used in a single country cannot hope to compete with the research going on worldwide, including in China, in all fields of allopathic medicine, microbiology, and genetics. Nonetheless, Chinese medicine does appear to consider aspects of biological nature that are still ignored in the West: our interconnectedness with the environment, for example; the importance of eating and living habits, which allopathic physicians often fail to notice; and the healthy management of the qi or vital energy, which we in China recognize as a universal force that circulates both within us and outside our bodies.

Fundamentally, allopathy tends to distinguish the human being from the causes of his or her disease, separate him or her from the environment, isolate the pathogen, and destroy it. Chinese medicine on the other hand considers causes of illness to arise from the interplay between the forces within the living human body and those in the environment. It does not isolate and destroy; instead, it purifies and strengthens.

The fact, therefore, that the West has been and continues to be in the midst of a dynamic process of discovery does not mean that we must throw out all that came before. As universal human beings we can maintain our skepticism, and our faith in the discoveries of Western medical science, while still benefiting from the ancient wisdom of traditional Chinese remedies.

Theories and strange names aside, traditional Chinese remedies can be seen to work. Ample evidence exists that they do. During the Tang dynasty (A.D. 618–907) an itinerant Chinese doctor named Sun Si Miao recommended the consumption of animal livers to cure night blindness. His assumption, tested by clinical practice, was that because the eyes and the liver are both of the Mu (Wood) Element function, a disease of the eyes could be corrected by strengthening the liver. He also believed, in common with Chinese tradition, that by consuming animal liver the patient’s own liver would be nourished and strengthened.

It may be only a coincidence that Sun Si Miao’s remedy worked, but work it did. We know today that night blindness is caused by a lack of vitamin A, and liver is a rich source of this vitamin. The consumption of liver will thus cure night blindness for reasons totally unknown during Sun Si Miao’s lifetime, or indeed for many centuries after that.

Coincidence may have lain behind Sun Si Miao’s remedies for goiter—caused by lack of iodine—which consisted of kelp, seaweed, and the thyroid glands of both lamb and pork, all of which are extremely rich in iodine. Similarly, his cure for beriberi—vitamin B₁ deficiency—consisting of taking vitamin B₁-rich rice bran and apricot seeds with milk, may have been quite fortuitous. On the other hand, the belief that food and drinks that induce perspiration can cure a cold, or that the consumption of energy-rich sugar and honey promote the reconstruction of the liver after a bout of infectious hepatitis, are both clinically and theoretically sound.

Consider, too, some of the discoveries of Chinese medicine:

• In the last century or two the people of the West have learned about the importance of hygiene and the value of disinfectants. In China we have known about them for two thousand years. The disinfectant properties of garlic, for example, have been recognized since the Han dynasty (206 B.C.–A.D. 220). Furthermore, Chinese people have throughout their entire history been aware of the dangers inherent in dirt, and have always been fastidious about cleanliness.

• In 1928 Alexander Fleming made what has been heralded as the greatest discovery of twentieth-century medical science: a mold, which he called penicillin, is an effective antibiotic, able to destroy many bacterial diseases. In China we have used molds and fungi against infections for at least 1340 years.⁴

• In nineteenth-century Europe it was discovered that a live virus low in virulence, when injected into a healthy person, will produce immunity in that person against the disease; the first vaccine to come into general use was that against smallpox. Chinese people have been vaccinating against smallpox since the Northern Song dynasty (960–1127), and perhaps even earlier.⁵ The earliest technique was to grind some dried scabs taken from a smallpox patient and blow the powder into the nostril of the healthy person to be inoculated. Later, the technique was perfected; the juice of infected pus was transferred instead.⁶

• The first recorded case of the use of an amalgam of mercury for stopping and filling dental cavities was by Regnart, in Europe, in 1818. In China, silver paste was listed as a treatment for filling cavities in a materia medica of A.D. 659. A Ming dynasty materia medica from approximately A.D. 1500 actually specifies the ingredients used in Europe more than three hundred years later: One hundred parts of mercury to forty parts of silver and nine hundred parts of tin to form a paste that solidifies in the cavity.

There may be other examples that are still awaiting discovery by Western medical science.

Whether coincidental or not, forty-five hundred years of systematically recorded clinical practice have given the Chinese people one of the richest traditions of valid health directives and remedies of any country in the world. It is common sense to pay attention to it.