Course: Foundations of Chinese Medicine II Date: June 6, 2007 Class #: 7 General Introduction Etiology Wikipedia defines the word etiology as the study of causation in general. But more importantly for the purposes of this class, Dr. Wu defines it this way: Etiology refers to the pathogenic factors causing Yin/Yang disorder (or disharmony) and the internal organ problems resulting in sickness. In TCM imbalance equals sickness. There are three characteristics of Chinese Etiology: A. Cause of disease (pathogenic factors) is a relative term. Why? Because pathogenic factors don t affect every person the same way. Take oak or cedar pollen as an example. If one is allergic, then it is a pathogenic factor. If one is not, then for this person it is not a pathogenic factor. B. Pathogenic factors have their susceptibility There are specific pathogens which tend to attack specific organs. For example, Wind Liver, Cold Lung, Damp Spleen, Anger Liver, Fear Kidney C. Pathogenic factors are closely related to symptomatology Western etiology relies on tests to find pathogens, but oriental medicine does not. Diagnosis in oriental medicine is made based on the set of symptoms. This is a more external forensics type approach which indicates the balance of both Yin/Yang and the Zangfu organs. Categories of Etiology There are three types or categories of etiology in Chinese medicine A. External Pathogens There are six evils in TCM: a. Wind b. Cold c. Heat d. Summer Heat (which is hot + damp kind of like August in Texas!) e. Dry f. Damp There is an incubation period for the external evils. Using Hepatitis A as an example, there is a 15-50 day incubation period for this type of evil. B. Internal Pathogens This refers to the seven emotional disorders. There s no incubation period for this: the effect is direct and instant. These seven emotions come from the five internal organs. Page 1 of 6
C. Non-internal and Non-external Pathogens Example: poor diet, overwork, insect bites, accidents, sports injuries, inadequate sleep or too much sleep, light/sound/smell induced migraines (like chemical smells, bright lights, loud noises which over stimulate the five sense organs), radiation Pathogens at Different Life Periods This is also in the Maciocia textbook. A. Prenatal period Any substance which passes from the mother to the child during pregnancy or during labor and delivery can be a prenatal pathogen. Pay attention to the quantity and quality of Essence, especially Congenital Essence. A child s life-long constitution depends upon the condition of the mother (and to a lesser extent the father as well) at conception! This doesn t just refer to genetic problems, though that is part of this as well. This also refers to hypertension, diabetes, high cholesterol, etc. These, along with genetic dysfunction or damage, are all the result of poor congenital essence passed from the parents to the child. Notes about kiddos: Fetal toxins are poisons from the mother and can include chemicals and drugs. During breast feeding the mother can help counter this by taking tiny amounts of da huang. This herb is good for clearing fetal toxins and toxic heat. This will keep the child from having problems of constipation or skin later on. Abortions or miscarriages reduce the Qi in the mother. Wait 3-5 months afterwards before attempting conception again. The mother should have regular periods at least 3 times to ensure the Kidney Qi has been restored sufficiently to support a fetus. Consider the season: Autumn is the best time to conceive a child as the parental essence is stored at this time, banked up if you will. Shock or upset or divorce during pregnancy, difficult labor or forceps delivery all increase the chance of epilepsy and emotional/mental problems. B. Childhood period There are 3 major types of pathogens that affect a person during childhood. Children s internal organs are fragile and they cannot handle this level of pathogenic activity. a. Six Evils These are the top pathogens during childhood and include cross-infections from other little kids. b. Irregular Diet Cokes, candy, cheese, snacks, lack of vegetables. c. Emotional disorders Abusive parents, parents with relationship problems can produce asthma, adult onset asthma years later, and joint pain. Page 2 of 6
C. Adult Adult is calculated differently for males than for females. The life of a female is calculated in 7 year periods while a male s life cycle is calculated in 8 year periods. The 3 rd period is the beginning of adulthood, so women become adults at the age of 21 and men at the age of 24. The predominant pathogen for adults is that of lifestyle. Lifestyle generates emotional and stress reactions. Diseases that grow from this source include hypertension, high blood sugar, high cholesterol. Zoiks! Emotional Disorders The Seven Emotions These emotions are normal to the human body and only become pathogenic when one or more of them cause problems. These emotions are: Joy Anger Fear Grief Worry Pensiveness Shock How do these normal emotions become abnormal or pathogenic? 1) When the emotion(s) attack the human body suddenly without preparation or are unexpected. Example: Post 9/11 or if you re as old as I am the shock after the Kennedy assassination. 2) When the seven emotions attack is very violent beyond one s tolerance. 3) Chronic emotional stimulation, which is not as violent as the 2 above, but is always there like a muscle that won t relax. All of these interfere with one s life and cause sickness. (Western studies have shown that chronic stress is linked to chronic inflammation for example.) There are 3 common characteristics of the seven emotions: 1) They attack internal organs directly without hesitancy and without an incubation period. The Neijing tells us that the seven emotions derive from the five organs. Examples: Abnormal and constant anger can affect the Liver Postpartum depression can lead to Liver Qi and Blood deficiencies PMS is both the cause and the aggravator of Liver Qi Stagnation. The seven emotions, when out of balance, can then become internal pathogens. 2) They affect the transportation of Qi Normal Qi movements are ascending, descending, entering, exiting, etc. Fear, for example will cause the Qi to descend. Anger causes the Qi to ascend. Worry and pensiveness cause Qi to stagnate. 3) Long-lasting emotional disorders cause heat and fire. When Qi is excessive there is stagnation, which long-term leads to fire. Page 3 of 6
It took me a while to wrap my brain around this one. Think about water. A running stream is always cooler than a swampy non-moving body of water. If it rains hard for instance, the stream of runoff is cool in temperature. But if it pools in a flat spot in your yard and sits there it gets hot and swampy. Happens in the body too. Anywhere there is no circulation there is stagnancy and heat. Note: not only can the emotions cause organ disharmony, emotions can likewise follow based on the condition of the internal organs. Just another fun benefit of the inter-relation between the energy world and the physical world! Disorders of the Seven Emotions A. Anger Anger makes Qi rise and affects the Liver. Qi which ascends too much is rebellion of Qi. The result is Liver Qi Rebellion Syndrome. Here s what that looks like: a. Throbbing headache b. Dizziness and vertigo c. Irritability d. Elevation in blood pressure. This isn t necessarily a diagnosis of high blood pressure like needing medication, but an elevation based on the anger which causes the Liver Qi to skyrocket to the head. e. Red eyes and red face f. Tremor and shaking of the extremities. g. Pulse: wiry h. Tongue: could be normal Treat this with the 4 gates (Liver 3, Large Intestine 4) and Du 20. From a five element standpoint Grief (metal element) will control the Anger (wood element). Per TCM, you can treat an emotion with another emotion. Seems a little harsh to me, but this wisdom has been around a lot longer than I have, so who ya gonna listen to? B. Joy Overjoy slows Qi down and affects the Heart. The Neijing says when Ying Qi and Wei Qi flow smoothly there is happiness. Why would the Qi slow down? Think about laughing a very long time over something that s really funny. Eventually you get weak in the limbs and short of breath, your eyes tear and you might slap your chest, which actually moves the Qi because chest tightness increases when you laugh a long time. Joy in excess makes the Heart Qi scattered which then results in the Shen scattering. If you laugh too long there is cyanosis which reflects the Qi stagnating. Symptoms of an excess of joy: Shortness of Breath Chest tightness or stuffiness Palpitations Pale face turning to purple face Page 4 of 6
Pulse: intermittent or moderate (55-60bpm) or slow pulse, uneven pulse. To treat emotion with emotion from the 5 element standpoint: treat over-joy with fear. C. Worry/Pensiveness Over-worry and pensiveness know the Qi and affect the Spleen. The result is gas, bloating, diarrhea, loose stool. This emotion causes the Spleen Qi and Middle Jiao Qi to stagnate. Symptoms: Decreased appetite, poor appetite, or no appetite. No desire to eat. Gas Bloating Fullness in the abdomen Abdominal distention Loose stool with undigested food or diarrhea Tongue: pale, swollen, white coat Pulse: wiry Emotional disorders can cause colitis, gastritis in the stomach or duodenum, or IBS. D. Sadness and Grief Sadness and grief dissolve Qi and affect the Lungs. After loss one tends to experience grief and sadness on or around the anniversary of a loss. This is normal. After the loss, if depression is constant for years this is abnormal. Treat the Lung by tonifying Lung Qi. Untreated, allergies and shortness of breath can occur among other symptoms you will learn in Diagnostics and Acupuncture Treatment of Disease. Symptoms will improve when Lung Qi is tonified. Sadness can cause the Heart to become cramped and agitated which is pushed to the lobes of the Lungs. Wei Qi and Yin are then blocked creating heat and fire which dissolves Qi. Symptoms Shortness of Breath Soft, weak voice Diminished immunity Easily catch cold Chest tightness and stagnation Sighing from time to time (which is also a Liver Qi stagnation symptom) E. Fear Classic tradition groups Shock and Fear together, but Maciocia separates them so Dr. Wu decided to as well. (Shock is an acute reaction to external stimulus while fear is internal and more chronic.) Page 5 of 6
Fear makes Qi descend and affects the Kidneys. This can cause Kidney Qi Prolapse Syndrome which has the following symptoms. Frequent urination or incontinence Miscarriage Fullness in the lower abdomen with a sinking sensation in the same area. Fatigue Pulse: deep F. Shock Shock scatters Qi and affects the Heart and Kidney. It affects the Heart first, scattering the Shen. The Kidney becomes involved when the Qi scatters. Symptoms include: Acute panic attack Fear of dying, loss of control, fatigue, exhaustion. Incontinence or urine or stool Pulse: indistinctive. Page 6 of 6