Emotions, of themselves, are not a problem. Everyone experiences a range of emotional feeling throughout their lives: Sadness, anger, joy, worry and so forth. They are a natural part of our embodied experience and a normal response to our environment. They are neither positive nor negative. They only become problematic when they are notably intense and excessive and, especially, when prolonged over a long period of time, without expression or acknowledgment. Everyone feels anger at times, but it is normally a strong, but short-lived, response to a direct and immediate stimulus. It is when anger is sustained for months or years that it becomes an endogenous cause of disease.

In the view of Traditional Asian Medicine (TAM), mind and body are interconnected and inseparable. Therefore, extreme emotions can not only cause a disharmony in the functioning of the internal organs of the body but imbalanced organ functions can cause a specific, exaggerated emotional affect. It can be reassuring to realize that body and mind are interrelated — to know that one’s emotional state has a physical basis, or that distressing physical symptoms may be caused by an emotional state. To see this relationship clearly is helpful in deciding upon an effective course of action to restore harmony to body/mind.

The Seven Dragons

According to the Neijing (the main canonical text of Chinese medicine) the seven emotions, or Internal Dragons, are Anger, Joy, Worry, Rumination (Pensiveness), Sadness (Grief), Fear and Shock. These should not be interpreted too narrowly as they are broad categories under which many other related emotions can be included. Each emotion affects the organs primarily through their effect on Qi, and different emotions affect Qi differently. Most emotions, either repressed or prolonged excessively, cause Qi to stagnate. This disruption to the normal flow of Qi typically will eventually cause internal Fire, just as the temperature of a gas rises when its pressure is increased.

The Liver, amongst its multitude of functions, is in charge of “flowing and spreading.” Like a general overseeing his troops, the Liver oversees the flow of interdependent bodily processes; this includes ensuring the smooth flow of Qi and Blood and the harmony of the emotions. In our contemporary society, our livers are extremely overburdened. According to nutrition researcher Paul Pitchford, a typical American’s liver is often twice the size of a healthy liver, due to the storage of residues from excess consumption of meat and other animal products, environmental toxicity, and overeating in general.¹ Mood swings and emotional excesses are often related to the Liver.

Anger is a broad emotional constellation that includes allied states such as resentment, irritability, frustration, rage, indignation, belligerence and bitterness. It is associated with the Wood Phase and affects the Liver. Pathogenic anger causes Qi to rise and many of the signs and symptoms will manifest in the neck and head, such as headaches, tinnitis, dizziness, a flushed red face, reddened eyes, red blotches on the front of the neck, dryness of the throat and thirst, a dry red tongue, and a bitter taste. In women, it can also show up in menstrual irregularities and distending pains or lumps in the breast. Headaches are one of the most common symptoms caused by anger. Over time, anger can result in high blood pressure and can cause problems with the Stomach and Spleen. Long-standing mental depression may be caused by repressed anger or resentment. Empathy and sympathy counteracts anger.

Joy is associated with the Fire Phase and with the Heart. Joy is generally beneficial to emotional well-being. According to Chapter 39 of the Neijing, “Joy makes the Mind peaceful and relaxed, it benefits the Nutritive and Defensive Qi and it makes Qi relax and slow down.” Where joy becomes harmful is when there is an excessive state of excitation or of continuous mental stimulation. “Party hardy” will eventually take its toll. When the Heart, and Shen, is overstimulated, joy becomes manic, with characteristic signs such as incessant chattering, giggling and nervous exhaustion. Unchecked over time, excess joy can lead to severe disorders such as hypoglycemia, anorexia, cystitis, psoriasis, eczema, insomnia, disturbances of speech, low blood pressure, dizziness, irregular or rapid heartbeat, heart palpitations and heart attack. “Cooling it” with grounding, deep abdominal breathing is a helpful first-aid when you feel yourself agitated and heated-up.

Sadness/grief is the emotion of the Metal Phase and is associated with the Lungs. As a pathogenic factor, sadness first affects the Heart, which then causes the Lungs to become obstructed; consequently, Nutritive and Defensive Qi cannot circulate freely and Heat accumulates. The Lungs rule the Qi of the body and sadness depletes Qi, resulting in chronic fatigue. Loss of appetite, emaciation, pallor, breathlessness and a feeling of oppression in the chest, sighing, listlessness, exhaustion, depression and crying may be common symptoms. Joy counteracts sadness and grief.

Worry and Pensiveness are emotions related to the Earth Phase and affect the Spleen/Pancreas. The neutral emotion of the Spleen is sympathy/empathy, a concern for others. But when this becomes excessive, there is anxiety and worry. Worry obsesses about the future or the past, so it takes us out of our body and into our mind. Worry depletes and knots both the Spleen and the Lungs. Common symptoms of the person “sick with worry” include trouble digesting, feelings of heaviness and lethargy, edema, inability to concentrate, ulcers and stiff shoulders and neck. Women often develop menstrual irregularities. Lungs respond to worry with difficulty in breathing. Pensiveness, or excessive thinking or mental work, weakens the Spleen and causes tiredness, lack of appetite and loose stools. Dampness and Phlegm may accumulate, particularly when one eats irregularly or on the run, or while watching television or reading the newspaper.

Fear is associated with the Water Phase and, in the extreme, is damaging to the Kidneys. Pathogenic fear causes the normal upward flow of Kidney Qi to reverse and flow downward. Resulting symptoms include a desire for solitude, listlessness, lumbar soreness, feebleness of the lower limbs, incontinence, and bedwetting (especially among children). Women may have long and irregular menstrual periods. Depletion of Kidney Yin may cause a rising of Heat in the Heart, with resultant night sweats, palpitations, anxiety and insecurity, and a dry mouth and throat.

Shock is not ascribed to a particular organ but it is closely associated with the Heart since it disturbs the Shen. Mental shock abruptly depletes Heart-Qi, which can cause palpitations, a tendency to be easily startled, breathlessness, insomnia and mental restlessness. The Neijing comments, “Shock affects the Heart depriving it of residence, the Mind (Shen) has no shelter and cannot rest, so that Qi becomes chaotic.” In addition to scattering the Qi, severe fright or shock also strains the Kidneys, which must supply Kidney Essence to support the sudden depletion of Qi.

Miscellaneous Causes of Disharmony

In addition to the Exogenous (External) and Endogenous (Internal) causes of disease, there is another broad category described in TAM as “neither inside nor outside.” This traditionally included pestilence, injury, constitutional factors, lifestyle factors and conditions of excess phlegm and stagnant blood.

Pestilential Qi. The concept of Pestilent Qi (li-qi or yi-qi) appears as far back as the Neijing, but it was not until Wu Youxing’s book, Discussion of Warm Epidemics in 1642, that the idea was fully developed. These pestilential pathogenic factors include what contemporary epidemiology classifies as bacteria and viruses. Malaria is an example of what might be considered Pestilential Qi. Diseases arising from pestilential causes are characterized by their rapid onset, consistent symptoms, and high level of contagiousness capable of affecting with great virulence even healthy bodies. Wu Youxing asserted that the nature of the pestilent disease was determined by the nature of the pathogen — one disease, one qi — and that there are innumerable pestilential qi’s.

Trauma and Injury. Since psychological shock is included among the emotional causes of disease, this category is specific to physical traumas and injuries. These traumatic events — violent impact, falls, cuts, abrasions, contusions, strains and tears, burns, frostbite, bites and stings, and so forth — involve damage to bone and sinews, skin and flesh, and Qi and Blood. Due to the long history of martial arts in China and Japan, and the proximate relationship between martial and healing arts, trauma medicine has been highly developed there. It is common for bodywork therapists in China to treat bone fractures with soft-casting and daily manipulation.² Physical trauma causes local stagnation of Qi or Blood. While trauma may appear to be only a transient cause of disharmony, the effects may linger for months or even years and may be a cause for further disease to develop.

Weak Constitution. Each person inherits a constitutional predisposition, conditioned in large part by the overall health of their parents, especially at the time of conception. The mother’s health during pregnancy is also an important determinant in the strength of her child’s constitution. Someone blessed with a robust constitution has energy to spare (for a while, at least) but for someone born with a weak constitution it is important to be particularly heedful of daily lifestyle choices and how qi is used. While constitution for the most part is fixed, it can, to a certain degree, be improved through a healthy and balanced lifestyle, further supported by energy development practices such as Tai Ji Chuan, Qi Gong, and Taoist forms of breathing and meditation practice.

Poor Diet. Food, according to TAM, is the first medicine. A poor diet, on the other hand, can serve as poison, leading to weakness, disharmony and disease. The U.S. Surgeon General in 1988 declared that two-thirds of all deaths are directly affected by improper diet and that poor eating habits play a large role in the country’s prominent killers — coronary heart disease, stroke, atherosclerosis, diabetes and some cancers.

From the perspective of TAM, dietary habits that are unbalanced either quantitatively or qualitatively can become a cause of disease.

There are three principal areas of concern: Improper amounts of food intake, consumption of improper foods and consumption of unsanitary or spoiled food. Food should be ingested in moderate amounts at regular intervals. Recent studies³ have disclosed that nearly two-thirds of U.S., adults are overweight, and nearly one-third are obese; this has serious health consequences, including sleep apnea, osteoarthritis, heart disease, stroke, diabetes, certain types of cancer, gout and gallbladder disease. Just as important, inadequate nutrition leads to a deficiency condition with resulting weak energy levels and a lowered immunity function making the body susceptible to exogenous pathogens.

Over-Exertion. Just as important as adequate exercise is adequate rest. Balance is essential. When we work or exercise, Qi is used up; when we rest and eat well, Qi is restored. Mental overwork, physical overwork and excessive physical exercise can all lead to taxation fatigue. Of course lack of exercise and lack of physical and/or mental stimulation can create their own problems.

Sexual Disharmony. Sexual energy is an incredibly powerful and natural drive for life. It is as essential to our survival as a species, as is proper nutrition and proper rest. But just as overeating (or undereating) or exhaustion can create health problems, so can imbalanced sexual activity. According to TAM, sexual activity depletes Kidney Essence, or Jing. In men, this is closely related to semen, so ejaculation is considered to temporarily exhaust these essential energies (thus, it is common for men to fall asleep after sex). When there is insufficient time between sexual activities for Kidney-Essence to be replenished, a deficiency of Essence can result. For women, depletion of Essence is less strongly connected with orgasm and more directly connected with the uterus and loss of Blood. Heavy bleeding during menses is one way that Jing may be exhausted with women. While sexual activity affects both men and women, women tend to recover quicker than men.

Parasites. We tend to think of parasites as a Third World problem but it has been estimated that 85 percent of the adult population of North America has at least one form of parasite living in their bodies. Some authorities feel the figure may be as high as 95 percent. The most common types of parasites are intestinal worms, such as roundworms, pinworms, hookworms and tapeworms. Parasites may be transmitted through contact with household pets, insect bites, walking barefoot (especially in moist warm climates), poor hygiene amongst infected people, drinking water and eating undercooked meats and fish. They are living off the life energy of their host, usually at the expense of their host. The toxicities produced by parasites cause further injury, playing havoc with the immune system. I also tend to include within this category human parasites — people we are in contact with who have a parasitic interaction with us, draining our energy.

Poisons. Poisons are substances which have a destructive or injurious effect on our health. We are exposed to more poisons on a daily basis than at any other time in history — herbicides, pesticides, preservatives, disinfectants, solvents, air pollution, contaminants in our food and water — the list goes on and on. Our livers and immune systems are on overload. Innumerable things we are exposed to, in seemingly innocuous contacts, may end up affecting us like poisons — the media’s daily serving of news; primetime television programming; the choices of people we associate with; the ways in which we talk about people, and so on. Poisoning can happen on many levels and in subtle ways, but have disasterous consequences to our health and balance.

Wrong Treatment. Another serious cause of disharmony, and even death, is what are called the iatrogenic factors, or medical error. This usually refers to wrong diagnosis or wrong treatment. According to the Quality Interagency Coordination Task Force, “An error is defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Errors can include problems in practice, products, procedures and systems.”⁴ This is an alarmingly large problem. Dr. Barbara Starfield, of the Department of Health Policy and Management at John Hopkins, reported that in 1999 a total of 225,000 deaths were attributable to iatrogenic factors, making medical error the third highest cause of death in the United States after heart disease and cancer.⁵ Deaths from “non-error adverse events of medications” are also startling. The National Center for Health Statistics claimed that one person dies in the United States every 3–5 minutes from the side effects of approved pharmaceutical drugs. These statistics are for deaths and do not reflect other reported and unreported harm that may result from medical error or from non-error use of pharmaceuticals. Of course, iatrogenic causes of disease are not unique to allopathic medicine. However, it is worth considering that the less invasive the treatment, the less severe the risk of potential harm from human error.

Contemporary practitioners of TAM have often subsumed this third category of miscellaneous causes within the two principal categories of exogenous and endogenous pathogenic factors. In this view, external causes of disease include not only the Six Environmental Excesses — Wind, Hot, Cold, Damp, Dry and Summer Heat — but also pestilence, traumatic injuries, insect or animal bites, poisons, parasites and medical error. Internal causes thus include the Seven Dragons — anger, worry, joy, grief, pensiveness, fear and shock — as well as irregular diet, excesses of sexual activity or physical exertion and conditions of excess phlegm or stagnant blood.

The Larger Pattern

It is worth repeating that TAM does not equate the presenting disharmony with the cause of disease. A distinct cause, even something so obvious as a bee sting, is not important in itself. It is how that factor is a piece within the larger pattern of relationships that is significant, and it is the pattern that is treated, not the symptom. The whole person is treated, the individual with their unique in-the-moment constellation of signs and symptoms. It is also important to emphasize that neither the organs of the body nor the pathogenic factors act in isolation. It is common that one pathogenic factor may generate another, and also that one imbalanced Organ will weaken another.

Through an awareness of our constitutional predispositions and an understanding that excesses of weather or emotions, or lifestyle choices, have profound effect on the balanced flow of our Qi and Blood, the conserving of our Jing, and with our emotional well-being, we become more informed participants in that middle path of health. Maintaining balance and preventing disharmony is the aim. When disharmony arises, understanding its causes can help to know how to meaningfully restore balance, not just to ameliorate its symptoms.