Basic TCM theory

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The Theory of Chinese Medicine

Intrinsic to many forms of alternative medicine is an implicit interconnectedness. Almost any kind of pain is seen as related to some other aspect of the patient's life or body. What appear to Western medicine as separate problems turn out, in Chinese Medicine, to be part of a single pattern. In the following we explain some of the more important parts of Traditional Chinese Medical theory.

Yin and Yang 
Meridians of Acupuncture 
Qi, Blood 
Zang-fu organ energies
5 Elements
8 Principles 
Causes of Disease - Internal and External

Yin and Yang

Although the basic idea is simple, understanding the ramifications of Yin and Yang is not so easy. Basically, Yin is something that is moved or heated, and Yang is the force or energetic means that moves or heats it. In us, yin is the body, yang the life in it. When we are formed, the two come together. They part when we die.

Yin and Yang mean something only in relation to each other, in the same way we say something is hot: the freezing point of water may be cold to most of us, but is warm to a penguin in the Antarctic winter. In our bodies, the parts that are more stable, that last longer, that are more hard to the touch, are generally more Yin in nature - for example our bones, as compared with those parts that are more quickly changed, such as the skin. Between these two extremes lie the muscles, organs, nerves, circulatory vessels, our brain and spinal tissue, and so on. Our blood is much more yang in nature than our bones, because it moves all the time around within our bodies.

In another way, the upper parts of our body are defined as being more yang, because although our legs carry us around, we do more constant movement with our hands and minds. Equally, from this logic, being further away from the Earth, which is relatively Yin, our heads and the upper portions of our bodies are nearer the sky - the Heavens - which is Yang in nature. Also, warm air rises towards the yang, whereas cold air sinks towards the earth (yin). Consequently cold is more yin, as compared with heat, which is more yang.

In good health, yin and yang work together, neither being uppermost: they interact to each other's benefit. When we work, the intention is yang, and what does the work is yin, the body. Nowadays, in modern Western society, much work is done sitting, using the mind and the hands and the voice. These are relatively yang activities, at least compared with manual work such as making beds, or lifting, carrying, digging, pulling, pushing, hoeing etc. Illness can arise from many causes. One of them is overuse of any particular activity. Modern office work that stops us moving and makes us use only one part of our bodies can easily lead to illness, because health is maintained when energy flows around and between the different parts of us.

Office workers often suffer from tension, caused by a build-up of Yang. This affects our more Yang areas, being the upper part of the body, the head (headaches), the neck and shoulders (tight), the chest (breathing, respiration and circulation) all of which can trap Yang as tension. Conversely, those who sit too much end up with congestion and heaviness in the lower part of the body: hemorrhoid, sore back, varicose veins, painful periods and so on, which are often due to yin energy not being moved around by yang.

Those who spend all their time working with computer or television screens are using up the energy needed by their eyes. The TCM attitude to this is that the yin-like nutritional energy for their eyes, (technically called 'Liver Blood'), gets depleted, leading to either tiredness (lack of qi) or inflammation (excess of yang because of too little yin) or both. Why would one person get tired and another get an inflammation? This usually depends on the intensity with which they work, the brightness of the light, and their basic health. A robust person tends to get inflammation, a more depleted person gets tired, unless the latter is deficient in Yin, in which case they might get inflammation (= yang, because of deficient yin).

We didn't say this was easy!

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So TCM practitioners spend part of the interview discovering, amongst other things, in what ratio of yin, yang, qi and blood the patient's health consists of. Simplifying, problems at the top of the body are more likely to be yang or yang excess in nature: those down below are more yin or yin-excess in nature.

Meridians, Channels and Collaterals, Acupuncture

You may have heard of acupuncture meridians or channels, which appear to traverse the surface of the body. Not only do they extend from end to end of the body, inside and out, they link with one another at different sites, with minor meridians running off the main ones. These are the channels and collaterals. They are distinct from nerves, lymph and blood vessels; almost a separate network. There are grounds for believing that they really do exist, although laboratory proof has been difficult. (But nobody had any idea of electricity before the means were found to measure it, and the TCM theory is that these channels, or meridians, are pathways for energy.)

The location where pain occurs lies on one or more meridians of the body. Pain happens where there is either too much, too little, or the wrong kind of energy, although the problem may not necessarily be at the place where the pain is felt. On which meridian the pain lies can be very important when it comes to diagnosis and treatment.

Acupuncture points lie all over the body: some of them are identical to trigger points identified more recently, but many lie along acupuncture meridians. Many acupuncture points treat not only points along the meridian but also affect the way the body works, and can affect our state of mind, as well as our energy, and the pain we feel.

Acupuncture needles are used in acupuncture. Acupuncture needles are smaller than hypodermic needles, and unlike hypodermic needles, they are solid, but flexible, and thinner. We use each needle only once, after which it is destroyed. When an acupuncture point has been selected for treatment, the needle is inserted very swiftly through the skin with - for most people - a minimum of sensation.

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De Qi 
Once inserted, the needle then 'meets' the energy of the body. A sensation is felt, which varies from being heavy, dull, slightly cramping or bruised, to a mild electrical feeling. Don't be concerned if this is not the feeling you get! People differ! Some people feel nothing!

These sensations, depending upon what the acupuncturist intends, may be transmitted along the meridian, or used to affect the energy in the meridian or in your body.

De Qi means 'the qi grabs' the needle. Your acupuncturist often notices this before you do, and may ask whether you notice anything. In nearly all treatments with acupuncture in Traditional Chinese Medicine, this sensation is important.

Blood and Qi

If Yin and Yang are two theoretical poles of existence, Blood and Qi are the life between them. We can't see Yin or Yang, but we know what blood is, and we can see life in people. Blood and Qi are words used technically and they describe rather more than just the red stuff in our veins, and the party spirit at Christmas.

Defining Qi should be easy, but isn't. It is easier to talk about its deficiency or about what happens when it misbehaves.

Qi Deficiency 
Qi deficiency is tiredness and underfunction: some part or parts of the body fail to do their job. The usual signs of Qi deficiency include a low or weak voice that runs out of breath easily, sweating when there is no obvious reason for it, tiredness, runny stools, and lack of appetite. There are many more specific signs of Qi deficiency, however. For example, if Lung qi isn't working properly we are short of breath, pale, weak voiced, and often catch colds. If Stomach qi under-performs, we lose our appetite, can't taste food properly, feel full too quickly when we eat, get runny or loose stools, and feel weak especially in the morning. Both of these qi deficiencies can lead to general tiredness. When the Heart is Qi deficient, we get palpitations too: each of the Zang-fu has its own picture when Qi deficient.

Qi Sinking 
Qi can also 'sink', which usually means we get a heavy, dragging, or bearing down sensation, and can bring prolapse of an organ, with depressed spirits. Qi can also 'stagnate' see below. It can even 'rebel', which means move in an undesirable direction. For example, if we vomit, stomach qi, which should be taking food downwards, is rebelling and ascending, instead of descending.

Qi Stagnation 
An important cause of many diseases is Qi stagnation. Indeed, one of the greatest of Chinese Doctors (Dr Zhu Dan Xi 1380AD) said that 'All the 10,000 diseases begin with stagnation of Qi'. What he meant was stuckness and stagnation. (Interestingly, a basic premise in Homeopathy is that underlying all disease is Psora, which equates fairly closely with what Zhu Dan XI meant.) Qi stagnation can come from Qi deficiency - which can itself lead to feeling low emotionally, but also from emotional causes.

Acupuncture automatically moves Qi, whereas Chinese Herbs don't: we may need to add other herbs to a herbal formula to make the Qi move. This is one reason why Chinese herbal formulae are made up of many herbs, carefully balanced, to achieve the right effect. Taking just one herb you have heard about may not be a good idea.

When Qi stops moving, life cannot get on, and things build up. A frequent indication of this is abdominal discomfort and bloating; 'bulges' that move around - often due to flatulence. The area feels distended. Or lumps in the breasts or abdomen that feel soft and which move around or come and go. Many cases of what used to be called spastic colon, now more often attributed to 'irritable bowel disease' are at least in part due to Qi stagnation. The main sensation is that of distension, congestion, sometimes swelling, and this comes and goes, or moves around. Accompanying it there is usually frustration, depression, irritability, sadness, boredom, stress, and almost any kind of emotional problem that hangs around too long, with mood swings from time to time.

Qi stagnation occurs before periods in many women's lives.

If Qi flows properly and smoothly, all parts of the body receive what they need, they function harmoniously and within their limits, and there is no room for disease.

Over time, continuous Qi stagnation can lead to Blood stagnation (see below), which becomes more painful, with stabbing stitching pains, and can be more serious: the sensation doesn't move around and there is less of a feeling of distension. This can lead to polyps, varicose veins, tumours, piles, blood clots and so on. These can affect many parts of the body, including the lungs, intestines, heart, brain, limbs, and abdomen. Chinese medicine has developed some very effective strategies for dealing with stagnation of Qi and of Blood.

Qi Stagnation occurs to everyone. If it continues for too long, it brings a huge range of diseases in its wake, sometimes chronic. There is now a whole book about it:

Causes of Qi stagnation 
Emotions that have either over-run their natural course, or been too strong, or have been repressed, are the most common causes in our society in the West: anger, grief, fear, frustration, boredom, worry, and so on - they can all bind our Qi.

Other causes of Qi stagnation include external pathogenic factors like the wind, damp and cold; physical trauma, shock, surgery; an irregular diet or a diet that is too cold in energy - perhaps too much raw or cold/chilled food or drink for our given constitution; food stagnation from over-eating or eating the wrong foods; and not moving our bodies - sheer lack of exercise. Qi stagnation can come from Qi deficiency which acts like a river either suffering from drought - the flow is sluggish, muddy pools appear and disease builds up in the stagnant water - or silted up.

Qi is frequently affected at the onset of many diseases, and Qi stagnation often accompanies disease if it isn't the cause. Ensuring that Qi moves steadily and harmoniously is a prerequisite for successful treatment, and whereas acupuncture nearly always moves Qi by its very nature, herbal formulae often need moving herbs to ensure that the Qi keeps moving.

Causes of Qi Deficiency 
How do we become Qi deficient? Apart from inherited tendencies, we can bring Qi deficiency on ourselves by various means: over-study, over-thinking, too much time spent sitting thinking or concentrating (eg. at a computer); poor diet and what is called an 'irregular' lifestyle, meaning burning the candle both ends and doing everything our grandmothers disapprove of.

Excess Qi 
Can we have too much Qi? We certainly can! If you take Qi tonic herbs such as Chinese Ginseng for too long, or perhaps without other moderating herbs to balance the formula, you can end up feeling jittery, over anxious, and with sudden palpitations and nosebleeds (because the Qi propels the blood out of the blood-vessels). Excess Qi improves by taking exercise. Deficient Qi deteriorates as you take exercise, or later in the day, but is better in the morning after a good sleep: the opposite of excess Qi.

Every part of the body has qi. No part could exist without this life-energy, and Blood is actually another form of qi, just thicker than the 'qi-stuff' that gives us vitality and life. Blood is the mother energy in the body: it makes muscles, bones, brain, tissue and all the rest. It provides a resting place for the qi.

Indeed, the Chinese say that whereas Qi leads the Blood, Blood is the mother of Qi.

So they use the term Blood in a different way from Western Medicine. From the Chinese point of view what we call blood is just a red liquid, unless it has Qi, when it becomes Blood!
How does the red stuff become Blood? The beginning of the process depends on good Stomach Qi to feel hungry, eat, swallow and digest the right food and liquids, transforming them into the red stuff, first stage. This ascends to the Lungs, which move it towards the Heart, giving it energy. But it is only in the Heart that it becomes Blood. Hence the saying in TCM that the 'Heart governs Blood'. The main function of the Blood is to nourish the body, to moisten it and to provide a place for the Mind to dwell and thrive.
Words that describe the actions of Blood include stability, suppleness, good texture, resourcefulness, and good complexion. There are four kinds of Blood disharmony.

Blood Deficiency 
When Blood-deficient, we get pallor, dryness, cracking of joints or nails, uneasiness, irritability, restlessness, poor memory and concentration, falling hair, depression, insomnia, poor sight or tired eyes, impotence or scanty periods and infertility, not to mention dizziness and numbness. (Not necessarily all together! However, some of these problems can occur from other causes in TCM too.) And that is only for starters. Blood deficiency occurs when the Spleen energy is deficient, meaning that our digestion fails to ingest the right food and turn it into blood.
Many diseases are caused by an imbalance between Qi and Blood, or a problem in one or the other. The causes of disease are many and various, and we have listed some of them under Causes of Disease.
Sometimes the problem comes from one of the underlying zang-fu organs failing to function, or from one of the energy reservoirs controlled by the extra meridians working inefficiently. Or Blood may become a cause of disease itself, because of deficiency, heat, or what is called stagnation.

Blood Heat 
Blood Heat frequently comes out as skin disease or bleeding with a sensation of heat. Blood stagnation usually occurs with a dark or purple complexion or eruption, and with the buildup of tumour-like masses. Pain associated with this is usually fixed in position and can stab or stitch. But Blood stagnation often occurs because Qi lets it or makes it stagnate.

Blood Stagnation 
When Blood stagnates, it is said to move more slowly, and so it becomes darker, we look darker, our lips and nails go darker, our menses are darker, with dark blood clots, and we find lumps under our skin, for example in the abdomen, that are impossible to move. The kind of pain we get is stabbing or boring.

Loss of Blood 
Any diseased condition that leads to bleeding, like coughing up blood, hemorrhoids, vomiting blood, heavy or prolonged blood, produces loss of Blood, the symptoms of which are given above under Blood Deficiency. The reason for having this as a separate category is that it has various causes, and to treat it you need to know which kind of Blood Loss you are treating: whether it comes from deficiency or excess, stagnation of Blood or even Yin deficiency. 
Many diseases are explicable in terms of blood syndromes. When the correct action is applied to improve the condition of the Blood, the disease disappears.

Zang-fu - Internal Organs of the body

Whereas Western, Orthodox, medicine sees internal organs such as the heart, kidneys, stomach etc as discrete, occupying anatomically precise locations, Traditional Chinese Medicine sees each Internal Organ as not only the organ itself but also as a range of other factors, such as emotion, colour, faculty, climate, taste and so on. This makes no sense to Western Medicine, but these associations have been verified by observant doctors for thousands of years. In the same way that a Western Doctor might diagnose diabetes from several factors such as polyuria, thirst and debility, a practitioner of Chinese Medicine sees the influence of a particular Zang-fu from the relationship of its presenting symptoms.

There are five Zang and six Fu.

The five zang are the Heart, Spleen, Lungs, Kidneys, and Liver, also known as the solid organs. 
The six Fu are the Small Intestine, the Stomach, the Large Intestine, the Bladder and the Gall-Bladder, also known as the hollow organs. 
Whereas the hollow organs, the fu, merely store and transport energy, the solid organs, or zang, transform it. The Zang organs are said to be or prime importance. Each zang has a related fu organ, to which problems in the paired zang can be transmitted.

Each zang has an important role to play in health.

The Heart zang governs Xue or Blood. 
The Spleen zang governs the transforming of food into Blood and Qi, holds the Blood, and has influence over body fluids. 
The Lung zang control or govern Qi, but also influence the fluids of the body.
The Kidney zang store Life Essence and also influence body fluids. 
The Liver zang stores the Blood and keeps qi flowing smoothly.

Each Zang has a special relationship with one of the sense organs, and with a different body tissue, emotion and weather or climate, and so on. To understand how this works, consider that if you know someone whose main emotional personality is one of over-concern, and/or over-sympathy for others, who has a more than usual desire for sweet foods, who worries a lot, and whose energy perhaps dips during the morning, then probably you have someone whose Spleen and Stomach zang-fu organs are out of balance. He or she will perhaps have digestive and weight problems.
Someone trained to look for these correspondences can often make predictions about health from a few moments with the person concerned.

Five Elements

These correspondences have been arranged into what has become known as the Five Element Diagram. It shows how the different phases or elements inter-react, and makes suggestions for treating people with imbalances. This 'Five Element' system of treating people has been very successful, and a number of Acupuncture Schools emphasise it.
There are, however, a number of other ways of classifying and treating disease, and one of the most important is the system of Eight Principles.

Eight Principles

Whereas the Five Element system explains some of the correspondences which turn up again and again, the Eight Principles system looks more at the overall energy of the body-system and where there are excesses or deficiencies. (For some reason this is always called the Eight Principles but in fact there are really only four!)
Every treatment ultimately aims to balance Yin and Yang, so that the patient becomes symptom-free. This means strengthening where there is deficiency, and dispersing excess. In reading through the following, bear in mind that any situation will be a combination of all 8 principles. For example, a disease may be classified as a full-exterior-cold-yang condition, and another might be a deficient-interior-hot-yin condition.

Disease patterns are either full or empty. A full disease is experienced as being one without sweat, but with severe pain or aches. Here the body is fighting hard to keep the disease at bay. There may or may not be heat or cold. An empty pattern is experienced with sweating and relatively less severe pain (though pain is subjective!)
Fundamentally fullness and emptiness relate to the body's ability to defend itself, and to the source of the pathogenic factor. If someone has good vitality and the source of the illness is external, such as when catching a cold, it is a full pattern. Conversely if the individual has poor health or weak vitality, the condition will be empty. If someone with weak vitality catches a cold, then there will be a situation combining both emptiness on the interior with fullness on the exterior.
This may seem like playing with words, but it is extremely important to distinguish full from empty. If, using TCM, one strengthens a full condition, the person will get worse, the disease will remain longer, and may penetrate deeper. If one disperses an already empty condition, the patient will also get worse, and may take much longer to get better than he would have otherwise, because the effect of dispersing energy in an already empty condition is to make his health weaker and less able to defend itself.
In a combined emptiness and fullness condition, care must be taken to clear the fullness and strengthen the emptiness, in that order.

The question this poses is whether the location of the problem is on the exterior (skin, muscles and channels) or interior (eg. Zang-fu internal organs). Confusingly, you often get an interior pattern disease affecting the outside of the body, as for example in chronic skin disease such as eczema, which is not cured by external applications. But an Exterior pattern of disease, one that comes from an external pathogenic factor like catching a cold, often leads to shivering, with hot and cold sensations and usually comes on quickly. Other kinds of exterior disease pattern can take longer to develop, as they penetrate along the channels. One example is of someone who gets caught in the rain and over the next few days becomes stiff. Here the channels are becoming obstructed as the external pathogenic - the damp - factor pushes further into the body along the channels, or meridians, of acupuncture.
This can, if untreated, or if wrongly treated to remove the symptom but not the disease, become an interior disease. Indeed, the wrong treatment (usually with Western Medicine, but sometimes when incorrectly treated by a practitioner of TCM) suppresses the body's natural means to externalise the disease, and can lead to long-term and chronic problems.
The usual symptoms of an Exterior disease are when the symptoms arrive fairly quickly (an 'acute' disease), with a fever or chill, aches and pains, stiffness, and dislike of cold. Other symptoms depend on whether it is combined with Hot or Cold (see next section).
Usually the correct treatment markedly and quickly improves the condition. On the whole, exterior disease is easy to treat, although with acupuncture a number of treatments in quick succession may be necessary. Herbs work well, too.
Interior problems mean that one or more of the zang-fu organs are affected. Most treatments experienced by patients of TCM in the West are for Interior problems, simply because patients don't seek help early enough and are not aware of how fast alternative therapies such as TCM can benefit Exterior disease. Unfortunately, self-medication with analgesics and anti-inflammatories often prolongs External disease.
The symptoms of interior zang-fu imbalance depend on the particular zang or fu and the nature of the problem. Whole books have been written on the combinations for a single zang, and we can't afford the time to write a website big enough to cover all this! Do look at the bibliography, however.

These may seem self-explanatory, but complications arise depending on whether the condition is full or empty, interior or exterior. For example, many menopausal women experience heat flashes, of 'flushes', which can be extremely uncomfortable, embarrassing and debilitating. The flash can come with flushing and with sweating. You would think this was pretty definitely an exterior full condition. Wrong. Almost certainly it is a deficient internal condition! It just happens that the body disperses the heat on the outside, but its cause is a deficient reaction by one or more of the zang-fu, usually the Kidney, Liver or Heart, which are on the interior.
Even more confusingly, it is possible to have heat in the interior and cold on the exterior! Or vice versa. Recognising and distinguishing these different classifications takes training.

Causes of Disease

TCM breaks these down into categories.

Habit and food 
Trauma, parasite, poison 
Wrong treatment 
Internal - emotions 
External - weather

Constitutional causes of ill-health include inherited conditions, problems arising during pregnancy or childbirth, and a state of health that mirrors what we might call poor genes. Often much can be done to palliate and improve these conditions, but cure is not always possible. Prolonged illness or a series of illnesses, or a severe illness, or other 'insults' to the body or mind, weaken the constitution. (By 'insults' to the body or mind, we mean - for example - frequent drug-taking, or long periods of heavy medication, and other forms of self-abuse.)

Habit and Food 
Non-conducive habits include overwork, over-worry, overstrain (mental or physical), fatigue, excessive or deficient physical exercise, prolonged or excessive sexual activity, or having too many pregnancies or abortions or children.
Non-conducive food habits mean not just poor quality or contaminated food (contaminated by poisons, colours, preservatives, chemicals, antibiotics, steroids, fungicides, pesticides or non-food stuff), but food that isn't fresh or that doesn't suit you. Only during the last hundred years have we really been subjected to food that isn't organic, and now many foods owe as much to the chemist as they do to the farmer. The disadvantage of chemically boosted food is that it may not contain the nutritional qualities which our manipulated taste-buds expect of it, and it may contain new substances which have not been tested over generations for safety, and some of which affect us adversely. In trying to eat a good diet from the Chinese viewpoint, it is easier to take fresh, organic food.
To find out which foods don't suit, you need to know what your health is doing. In acute disease, Hahnemann (the originator of homeopathy - see separately on this website) suggested that, broadly speaking, you should eat whatever you desire - not what you think, or someone else thinks, is good for you. This does not include medication: we are talking about food.
But in chronic disease you can definitely improve your health or chances for better health by eating those foods that balance your constitution. First, therefore, you need to know what your constitution is, and for this you probably need to see a practitioner of Chinese Medicine who knows what she or he is talking about. Otherwise, you have a fair bit of reading to do. See the reading list.
Then you need to know what a food does, since food, from the Chinese point of view, has qualities that go beyond mere vitamins, minerals, protein, carbohydrate and oil. A given food can be warming or cooling, better for blood than qi, dampening, neutral and so on. The Chinese have spent quite a few thousand years working out which does what, and you can make yourself ill if you persistently eat those foods which are unsuitable for your constitution. But they didn't know or think about the intensive farming methods now used, the massive investment in chemical fertilisers and so on. Consequently, the energetic qualities they attributed to foods may not apply to non-organic modern foods or to foods not grown or prepared according to stable, traditional methods.
Other bad food habits include eating at irregular times, or when stressed or rushed or otherwise busy, or eating too fast, not chewing properly, over-eating or eating too frequently, gulping food, or taking food that isn't properly prepared or at the correct temperature. It also includes eating too much food of one type or taste, or excluding certain foodstuffs that you need.
Food is a big subject and there is no doubt that poor food habits contribute to ill-health and lowered immunity to disease. Conversely, eating the right foods can produce staggeringly beneficial results. Our bodies have wonderful health-creating powers, given the right circumstances.

One word of caution concerning raw foods! Chinese medicine recommends that, particularly during disease, food and liquid be taken lightly or appropriately cooked, and warm. This makes is easier to digest and puts less of a load on your system. There are exceptions, but they are rare. Even when healthy, unless you know for sure what your constitution requires, it is better to err on the side of caution, and to take things warm.

Trauma, accident, burn, fall, injury and operation
All these upset the flow of qi in our bodies. Severe trauma also stagnates the movement of blood, and the long-term effects can be dire. Many illnesses can be traced back to an accident or to an operation which, although successful from the surgical point of view, caused some form of stasis in the system, the results of which are felt for many years and which, by weakening the body, make it more susceptible to later diseases.

Parasites, poisoning 
Both of these can be both short and long-term causes of disease.

Wrong Treatment 
Open almost any newspaper these days and you will see reports of adverse effects from standard medical practice in the doctor's or hospital's surgery. Nowadays, manufacturers are required to list the possible expected side effects of drugs, but these are the side effects that were discovered during drug trials or subsequently in clinical practice.
(One should remember that manufacturers are in an impossible situation, because there is no way that every possible side effect for every single person can be listed. You and I might take the same medication and notice effects different from one another and from those listed by the manufacturers during research. The individual response is what matters, and that is not possible to foretell: manufacturers can only generalise. This means that it is possible to have a strong but unlisted drug reaction.)
However, we are not talking about that kind of wrong treatment here, but for example, the effect of dispersing energy when there is already a deficiency, or reinforcing energy when there exists too much already. In other words, receiving the wrong treatment, including Chinese medical treatment.
Fortunately, acupuncture is relatively safe. Even if a wrong treatment is done, it usually corrects itself. But obviously, acupuncture should be carried out by trained individuals who know what they are doing, as it is always possible to do harm if one puts one's mind to it.
Herbs, the other main treatment method, can cause more harm than acupuncture when incorrectly used. Again, the same situation applies: go to someone with knowledge or experience, who is unlikely to stimulate yang when he should be stimulating yin, or vice versa.
However, Chinese herbal medicine is much more gentle than Western and medical drugs. Even when the herbs are wrong, given the range of warnings we give people, and the general advice, it takes someone with unusual determination to continue taking something when it is clearly making them feel worse. And when you stop taking the herbs, the condition usually quickly reverts to the former status quo, unlike the situation with drug medication.
Nevertheless, there are concerns about the effect of Chinese herbs, especially on the liver. For a discussion of this, please see our section on Treatment with Herbs.

Internal Causes of Disease

Inter-reaction between mind, emotion and body is intrinsic to understanding Chinese medicine. Mind, body and emotion all affect each other, and none of them is seen as dominant, from the point of view of deciding how disease enters and spreads, although in any one case, one particular cause will usually predominate. So physical problems can lead to mental conditions, emotional upsets can lead to mental or physical conditions, and any condition can be caused by, or cause, an emotion.
But emotions have more effect on qi because all parts of the body, its energy, blood, bones, brain, muscles, flesh, tendons, arteries and so on are all considered to be different kinds of qi. Of particular importance to the smooth functioning of the organism are the zang-fu, the Internal Organ energies, and it is these which can get upset by emotional causes.
This is not to say that we should avoid emotional expression: stifling or suppressing it is another cause of disease. The problem comes when the emotion is too strong for the organism, or too prolonged for its health. We can also make ourselves emotional by thinking ourselves into it, by 'working ourselves up into a lather', or by reading frightening stories, or watching something that disturbs us. Late-night horror movies and videos come to mind! This is not regarded as being conducive to good health.

Each emotion affects mainly a particular zang Organ. It also affects qi. Traditionally there are seven main emotions, but of course, there are more than this. For example, envy isn't listed. This and other emotions affect one or more of the zang, as follows:-

Anger upsets the Liver and makes qi rise. If you are angry, your shoulders probably rise or tense up, your face goes red, or you feel pressure in your head.

Joy, meaning hysterical laughter, or over-excitement, especially if prolonged, upsets the Heart, and makes qi slow down. People can be immobilised by prolonged hysterical laughter.

Fear upsets the Kidney and makes qi descend. Involuntarily we urinate or have a bowel movement.

Grief or sadness, and worry, upset the Lungs and dissolves qi: it tires us.

Worryover-thinkingover-concern, upset the Spleen and 'knot' the qi: we can't move for worry: it knots us up inside.

Shock affects both the Heart and the Kidney, and is said to scatter the qi. We 'go to pieces'.
All of these emotions, if prolonged inappropriately, lead to stagnation of Liver qi, and then turn into Fire, giving symptoms of 'heat'.
In addition to affecting a particular zang, the emotion can spread to other zang-fu. Anger affects the Liver, but the Liver, when not flowing correctly, affects in turn other organs. People who express anger too freely often suffer from Stomach Fire (eg gastric ulcer or heartburn) and those who suppress it may get gastro-intestinal spasms, colic, spastic colon, irritable bowel etc..

External Causes of Disease

Chinese medicine considers that many diseases start, or are exacerbated by, external causes of disease, by which are meant environmental conditions. Mainly this means the weather, but it includes exposure to drafts, air-conditioning, central heating, dry air as found on long air-flights, humidity, heat from working besides cookers or furnaces, working in refrigerators, and damp working or living conditions. The traditional external conditions are Wind, Summer-Heat, Fire, Damp, Dryness, Cold. 
These pathogenic forces become effective in the body only if they are too strong for the body's own energy to resist. Strong wind can 'penetrate' even a strong body. A weak draft might be too much for someone recovering from illness, or in a state of fatigue. 
Although these are the external factors leading to disease, the disease is defined in terms of the body' reaction to it. So someone who got caught in a cold wind might be expected to be suffering from Wind-Cold: but if their symptoms are those of Wind-Heat, no matter what caused them, they have Wind-Heat. Conversely, someone else might theoretically develop symptoms of Wind-Cold from working beside a furnace! 
External causes of disease enter our bodies via the skin, the nose and the mouth. Most people would accept that it is possible to catches illnesses via the nose: people sneeze; we inhale. But through the mouth? Yet how often have we been told to wash our hands after urinating and/or before eating. (You haven't? Well, you have now!) And of course we can inhale through our mouths. 
What about through the skin? The Chinese have a concept of what is called defensive energy, which circulates just under the skin. This is weakened somewhat when we perspire, because sweating opens the pores, and the Chinese believe that Wind can penetrate through the skin, leading to what in the West is called a 'chill': wind-cold or wind-heat! Also sitting on damp ground or wearing wet clothes for too long lets damp 'penetrate'.
Clothes make a big difference to our susceptibility to external causes of disease. In the West we aren't good at recognising how we should protect ourselves. In a cold wind or Winter, a hat, scarf and warm clothes make sense, even when nipping out for a sandwich at lunch.
Remember that our bodies don't react as fast as our computer screens. It can take anywhere between a few minutes and many hours before you begin to notice that you aren't feeling well from invasion by an external pathogenic factor such as cold or damp.
Finally, because we all have different constitutions which react in their own individual ways to disease, what starts off as one kind of externally caused disease pattern can turn into another kind. Cold can turn to Heat, Heat can lead to Dryness, and so on. So although the pattern is defined in external terms, (eg Wind-Heat) it actually defines a reaction by the body which predetermines the kind of treatment that will be effective. For a Wind-Heat pattern we do this, for a Wind-Cold pattern we do that, etc..

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