Internal Causes of Disease

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In TCM disease has three broad causes: internal causes of disease, external and others. Each of these is divided into sub-categories.

Internal causes were those which did not arise from what we might call catching a bug or a virus.

In designing a treatment, the patient’s symptoms were and are more important than the original cause of the disease. However, understanding the cause often leads to better prognosis and treatment, so they are connected.

It’s rare that only one internal cause is involved. What is more, different causes of disease affect people at different stages of their lives, and their effect may be noticed only years later, when symptoms are traced back to it.

‘Never well since’ an episode earlier in life often identifies the source.

By the way, you may be interested in the External Causes of Disease.


Inherited factors can play a huge part in an individual’s health.

However, even if someone has a weak constitution, with forethought and self-discipline he may live much longer and more healthily than someone with a robust constitution who squanders his health through poor lifestyle choices.

Specifically, the health we inherit is said to depend on:

  • Each of the parents’ (and grandparents’) general health
  • The parents’ health at or leading up to the moment of conception
  • The mother’s health during pregnancy

One should also consider the age of the parents when the child was conceived. Sperm from an older father may be less virile and the ovum from an older mother less capable. If the mother is older at conception, her reserves of Kidney qi may be reduced with less available for a healthy pregnancy and child.

Nowadays mothers have heard about the ill-effects of smoking and alcohol during pregnancy.

For example, Australian scientists discovered considerable adverse changes in the structure of babies' heads when their mothers consistently drank alcohol during pregnancy. (JAMA Pediatrics, DOI: 10.1001/jamapediatrics.2017.0778)


The effects of trauma are usually immediately noticeable.

However, trauma, for instance a back injury, from which the individual fully recovered in youth, may produce symptoms years later when the individual is exposed to external pathogenic factors that his aging vitality is no longer able to combat.

Then, although the trauma occurred long before, it still counts as one of the internal causes of disease.

Trauma usually cause conditions of Blood Stasis.

Over-exertion and over-work

Commuter Train
ID: 227623
© Marc Johnson | Dreamstime Stock Photos

Over-exertion is relative to the constitution of the individual.

A trained world-class athlete is capable of continued exertion that would be hardly imaginable for a normal individual, yet even such an athlete can, and not infrequently does, over-exert himself.

This leads to a period of lowered energy and need to rest to recuperate.

Usually this is thrust on the athlete by injury. It can also occur where an ageing athlete persists in exertion levels that were appropriate only when younger.

Over-exertion as one of the internal causes of disease includes working too hard, for too long, or working without proper rest. It can include over-exertion of a particular part of the anatomy (eg vision if the individual works too long at a computer; repetitive strain injury where someone repeats a particular movement too often).

Overwork leads to yin deficiency, mainly of Kidney yin, but potentially also of Liver Yin.

Repetitive strain injury leads to Blood Stasis.

Over-use of the eyes leads to deficiency of Liver Blood.

These over-exertion internal causes of disease are often hard to accept when they occur. People understandably believe that they are living busy lives and must work hard.

This doesn't alter the potential for long-term problems.


Traditionally there are seven emotions that, unresolved, can be major internal causes of disease if they persist or are over-indulged in.

A slightly expanded list of these gives: 

  • unrestrained or inappropriate joy, laughter (what we might call hysterical over-excitement): affects the Heart.
  • worrying, over-thinking, obsession: affects mainly the Spleen
  • grief, sadness, worry: mainly affects the Lungs
  • sadness also affects the Heart
  • fear, deep anxiety: affects the Kidney
  • anger, frustration: affects the Liver
  • shock affects the Heart and the Kidneys

However, the connections between emotion and Organ (or Zang-fu) should not be taken too rigidly. Any of the Organs may be affected by any emotion.

Besides, if a particular emotion is held too strongly for too long, it may affect not just the Organ mentioned but also another in the Five Phase or Element diagram (sorry - no page on that, yet).

So prolonged Fear could affect not just the Kidneys but also the Liver, leading to a lack of nerve or of courage. All emotions have an effect on the Heart.

Any emotion, if one of the internal causes of disease, impairs the circulation of qi and blood. In particular it affects the direction of flow of qi.

Specifically, quoting from chapter 39 of the ‘Simple Questions’ (an ancient book on Chinese medicine, still studied and used today):

Anger makes qi rise: this we see in the face, the eyes, the complexion, the tension in the shoulders and neck, the grinding of teeth, the biting of nails or lips and so on.

Joy slows down the movement of Qi: as when someone is speechless from joy or surprise.

Sadness dissolves qi: as when, feeling hopeless sadness we find we lack energy to do anything: we sink, dejected.

Over-thinking ties up (knots up) qi: someone who is thinking about something too much can’t make up their minds about it.

Fear descends qi: involuntarily our knees give way or we defecate or urinate.

Shock scatters qi: we shake, we sweat, we go pale, we can’t stand, our pulse races uncontrolled.

As internal causes of disease, severe emotional trauma can have lifelong effects on health, even after the individual has made serious attempts to accept the trauma and its consequences.

Excessive Sexual activity

Suggesting that this might be a cause of disease has more than once got me into trouble!

As one of the internal causes of disease, this is the least acceptable to many people nowadays - at least in developed countries. Perhaps for the ancient Chinese who lived in uncertain times, in conditions of hygiene we would find unacceptable, with food sources that were often unreliable, guarding their 'essence-qi' was more vital than now.

Woman on Bed: ID252528

Copyright Dave Geffen

Dreamstime Stock Photos

But even now, many people worldwide live in conditions not so different to the ancient Chinese.

On the other hand, many people living in the developed world believe that there is no limit to what they can have health-wise, because their nationalised health service is free, with abundant resources to repair any damage they do to themselves.

Increasingly, women nowadays are demanding abortions if they don't like the sex or probable astrological birth sign of their foetus. ('A Violent, loveless future awaits the world's lonely sons': Sunday Times 31.7.11 News Review p7)

An abortion, in Chinese medicine, can seriously upset the flow of qi and Blood on which the woman's future health depends: it is a surgical procedure which may not only cause Blood Stasis but can drain the woman's Kidney essence.

In any case, ‘Excessive Sexual Activity’ has to be understood in relation to age and health of the individual. People in poor health should indulge less often.

It is said that a rough estimate of how often a man should ejaculate is to divide his age by 5, giving the number of days between ejaculations. For instance, a 30 year old should, according to this recommendation, not ejaculate more often than once every 6 days.

Clearly, however, much depends on the man’s health, commitments and lifestyle. Stress of any kind may impair his ability and drain his energy but sometimes for a healthy man under stress, ejaculation can be cathartic.

Sexual activity for men is easy to describe: it means sperm ejaculation, which in Chinese Medicine is said to use up Kidney Essence.

For women, the question of what excessive sexual activity means is less clear. Normal orgasm for women doesn’t use Kidney essence.

However, any sexual activity that is exhausting must be considered, including, for some, having too many babies close together, without proper recovery between them. Blood loss from the womb that is uncontrolled would have a similar effect, such as in menorrhagia.

Abstention from sex when there is desire may also, long-term, harm the individual. What is called Minister Fire ascends during sexual desire and orgasm sends it down.

If no orgasm then occurs, it may remain ascended and, eventually impair Heart qi or cause Heart Fire. Tantric traditions teach that non ejaculating during sex means that no Kidney essence is used up and can, so long as there is periodical ejaculation, enhance sexual experience.

When in poor health, or recuperating from illness, men should indulge much less in orgasm with ejaculation.


What we eat and how we eat it have major long-term repercussions on our health and can be major internal causes of disease.

There is growing evidence for the benefits of choosing food that is nutritious, fresh, high in vegetables, olive and essential oils, low in meat, alcohol, sugar and grains.

Eat food when sitting, unhurried and not otherwise engaged; chew well; leave time for digestion after meals. Eat regularly, don’t skip meals and don’t eat too close to bedtime or late in the evening.

Chinese medicine stresses that the foods we eat should be appropriate for our metabolism; that we should avoid too much raw and cold or iced food and drink, even if feeling well, let alone if ill.

The same goes for too much very spicy, dairy and greasy food.

Avoid both over- and under-eating.

Short-term deviations from healthy eating probably don’t matter. However, a period of months or years with a bad diet can have life-long effects.

For more on this, read Nutrition and Supplements.


Parasites can be one of the internal causes of disease but this is less common nowadays in developed countries.

Parasites use the body’s supplies of Qi and Blood, so drain Spleen qi and often cause symptoms of Dampness and Heat which themselves favour production of more parasites.

They arise mainly from poor hygiene and diet, though in some countries parasites enter via the eyes, the ureter, anus or vagina, for example when swimming in infested water.

Any diet that weakens the Spleen energy encourages conditions that harbour parasites.

Poisons, medications, drugs and immunisations

As internal causes of disease, the effect of poison and recreational drugs is obvious: so too with medicinal drugs that are taken for too long or in inappropriate quantities.

With recreational drugs, the occasional and limited use of them, where society permits it, is probably not damaging – for most people.

Some people, however, are highly sensitive to even small doses of recreational drugs and this sensitivity leads to such drugs being one of their internal causes of disease.

Regular use long-term of recreational drugs will damage the body's resources into the indefinite future, even after use of the drug has stopped. Cannabis, for example, often seems to scatter the brain’s ability to take clear long-term decisions and to concentrate properly.

Medicinal drugs, used for too long, can have damaging effects, especially with antibiotics, steroids and chemotherapy, which damage Spleen and Stomach qi and Yin, Blood and Body fluids.

Immunisations can cause long-term damage and become important internal causes of disease if the body fails to react properly to them at the time. (Even then, there is the suspicion of ongoing damage, not manifested until many years later.)

An appropriate reaction is usually a mild fever and sweating, possibly with a rash. This shows that the body’s defensive qi has recognised the invasion and, as with any disease invasion, has gone through its inbuilt way of exteriorising it.

Where the reaction either fails to materialise or is so small as to be hardly noticeable, the body will eventually produce Latent Heat. If the reaction is severe, with great fever, thirst etc, one cannot be sure that the body has successfully rid itself of the toxin that may still produce symptoms from Latent Heat in the future.

Latent Heat is, in theory, capable of facilitating the development of many highly debilitating diseases.

Wrong treatment: another of the Internal Causes of Disease

Iatrogenic, ‘doctor-caused’ disease is a major concern in modern medicine. However, wrong treatment can be given in any therapy.

That a therapy is ‘natural’ is irrelevant: herbs, acupuncture, homoeopathic remedies, even manipulation, may all be damaging when used wrongly.

Wrong treatment can also be suppressive, in that it appears to clear the symptoms, but at the price of their return later or, subsequently, in some other, supposedly unrelated form.

For more on this idea, click Suppression.

If you would like to discuss your health with a qualified acupuncturist in SE Scotland or Edinburgh, where the author of this site works, click on Edinburgh Acupuncturist. If you live elsewhere, click BAcC.

Click here to get back from Internal Causes of Disease to Acupuncture Theory. 

Jonathan Clogstoun-Willmott Books

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