Internal or External
Causes of Disease

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Sorry - bit technical, this 'internal or external' page! But vital for doctors and therapists to understand. In fact, it's a cornerstone of Chinese medicine.

The question is whether a disease is inside or outside in origin. Are you ill because you've been 'attacked by something, perhaps a bug, from outside, or has your problem grown from inner weakness?

These classifications (two of the 8 Principles) are opposites and deal mainly not with where a given condition comes from but where it is located in the disease or health-building process of the body.

Camping - Photo by Ivana Cajina on Unsplash

Why is this distinction important? It's because if you mistake an external problem for an internal condition, you might try to strengthen what is called the 'Upright Qi'. Unfortunately this mistake is often made, leading to lots of unnecessary, ongoing, disease.

That could make the illness worse.

Equally, if you mistook an internal condition for an external problem, you might try to clear or dissipate the supposed excess energy. That would weaken the Upright Qi and make recovery much slower.

So whether it's internal or external can be very important.


Someone catches a bug: it could be a virus like a cold, or measles, or AIDS, for example. It could be that an accident caused a huge bruise.

These events arise from outside, so they are classified as External (though the bruise is actually treated as being internal, for convenience and because in this case the problem is 'transmitted' to the inside immediately.)

These external causes are called external pathogenic factors (pathogenic means 'disease-causing') because they don't come from within the body but from its environment.

When you look at the list below, you must remember that 2000 years ago they hadn't discovered bacteria and viruses. But they certainly understood their effects, and how to treat them.

External Pathogenic Factors

These can combine to form, for example, Wind-Heat or Cold-Damp.

All external pathogenic factors are classified as being Excess in their nature (as opposed to being Deficient).

You can find out more about this other very important distinction under Excess or Deficient.


These arise either

  • from some fault in your body's functioning, such as when Spleen Qi is deficient and you begin to get signs such as of Damp or Phlegm OR
  • when an external pathogenic factor is turned into an internal pathogenic factor. For example, when you catch a cold (caused by an external pathogenic factor like Wind-Cold) your body may eventually transform this into internal Heat.

Actually, there are several other possibilities, all caused by Cold (being external Cold) which penetrates to the interior without raising an external response by the body. These are when Cold invades either the Intestines, Stomach or Uterus.

Also, we mentioned trauma - the bruise - above, which leads directly to Blood Stasis, an internal 'full' or 'excess' condition.

Internal Pathogenic Factors

Internal Pathogenic Factors arise without an external pathogenic factor causing them. They come about because your body is already in disharmony and deals with this by producing symptoms such as:

Almost all the above internal pathogenic factors can also be excess conditions, arising from or with an internal deficiency. If so they are classified as being both 'Excess and Deficient' or 'Full and Empty'.

When written the 'and' is omitted, so you get Excess/Deficient or Full/Empty. As I said at the top, some of this page is a bit technical!

Are Emotions Internal or External?

That's by no means all, because our emotions are seen as really important internal causes of disease. These include, for example, anger, worry, fear, grief and over-excitement.

You might think that the expression of your emotions was your human right. Even so, emotions can, if too intense or prolonged, make you ill.

In fact, the first college of acupuncture I attended, for three years, based 90% of its teaching on the results of emotional causes of disease. They taught that recognizing emotions could be crucial in helping people get better. Acupuncture can be very powerful here. Good acupuncturists instinctively recognize whether a disease is internal or external.

Modern medicine acknowledges this, of course, but the Chinese saw it 3000 years ago.

What is more, they made connections between the kind of emotional problem you had and the kind of disease you got.

All this is still highly relevant, and it's an important part of my book on 'Qi Stagnation - Signs of Stress', for reviews of which click here.

Internal or External Symptoms have purpose!

Never suppose that your body produces symptoms of disease, whether internal or external in origin, out of sheer cussedness!

All the symptoms you get throughout your life have one main purpose: to preserve your life as long as possible with the least expenditure of energy.

You may find this hard to believe when you see your child convulsing during a high fever, or a friend's malaria exhausting him to death, or someone dying of cancer. Or what about a mother dying during childbirth, or a child unable to breathe from croup or because of a plug of mucus in his throat arising from diptheria?

Just remember that life on Earth has evolved over the last few million years, and our genes are the blueprints of what has worked to make our (very recent) arrival as Homo Sapiens successful.

During that process, we must accept that unsuccessful mutations failed for one reason or another, that many lives ended because the individuals' bodies couldn't overcome their problems - and also that this still goes on.

But that doesn't mean that our genes got it wrong! They got us here and carry formidable weapons for self-preservation. No doubt we are still evolving, though whether we shall be so successful in the future, when we become increasingly dependent on modern medicine and so don't necessarily need to evolve, is a moot point.

(Talking of which, it is likely that if modern medicine gets better at suppressing acute symptoms, being external - as between internal or external - then more long-term chronic diseases will arise of internal origin: probably harder to treat.)

The main point to take from this is that we suppress symptoms produced by our Upright Qi at our peril. Western medicine is very good at suppressing acute symptoms like fever and inflammation but often does this at the price of weakening the Upright Qi.

Still, in the short term, if you know how to boost the Upright Qi right after you've cleared the Excess, that isn't always a bad thing.

However, if by mistake we suppress the Upright Qi itself, then we do harm - you can read more about this under Suppression.

Concerning 'internal or external', if the problem is external, we certainly don't want to suppress it so that it becomes internal.

What we should do, and the question of interior or exterior (being just two of these important 8 principles) can be crucial in deciding, is to direct our therapy (whether it be modern medicine, ancient acupuncture or another therapy) so as to clear any external pathogenic factor whilst not harming the Upright Qi.

After that, our aim is to clear any internal factor and maintain or strengthen the Upright Qi.

You'd be surprised how many people stop treatment after the pathogenic factor has gone, but before their acupuncturist has had a proper chance to strengthen their Upright Qi!

Get back from this Internal or External page to the 8 Principles.

You should also read about the other 6 principles:

Full Hot or Cold and Empty Heat and Cold

Excess or Deficiency

Yin or Yang

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Jonathan Clogstoun-Willmott Books

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Qi Stagnation - Signs of Stress

Yin Deficiency - Burnout and Exhaustion

Yang Deficiency - Get Your Fire Burning Again!

Yuck! Phlegm! How to Clear Your Phlegm ...

Western Astrology and Chinese Medicine

Published 1986 and, amazingly, still selling. Western Astrology and Chinese Medicine was apparently used back then by at least one acupuncture college to help students understand Chinese medicine! See Reviews.

Seven Reviews so far for Yuck Phlegm. (Despite the lurid cover, it explains the five main types of phlegm and what works best for each type. I hope it's easy to read and will be much more useful than all the websites on the subject.)

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