Causes of Internal Injury

The causes of internal injury, also known as internal damage, refer to pathogenic factors that arise from emotional disturbances or behaviors that exceed the body’s self-regulatory capacity, directly harming the internal organs and leading to disease. These include internal injuries caused by the seven emotions, improper diet, and imbalance between work and rest. Internal injury causes lead to the imbalance of qi, blood, yin, and yang in the internal organs, resulting in what is termed internal injury disease. Internal injury causes are contrasted with external pathogenic factors, as the disease originates from within rather than from external evils, hence the term internal injury.

1. The Seven Emotions

(1) Basic Concept of the Seven Emotions

The seven emotions refer to the normal emotional activities of joy, anger, worry, thought, sadness, fear, and shock, which are the responses of human consciousness to external stimuli. The seven emotions are closely related to the functional activities of the internal organs. Each of the seven emotions corresponds to one of the five organs, represented by joy, anger, thought, sadness, and fear, collectively known as the five desires.

The seven emotions are different reflections of human responses to objective phenomena, and generally, within normal activity ranges, they do not cause disease. Only when there are sudden, intense, or prolonged emotional stimuli that exceed the normal physiological activity range of the body, leading to disturbances in qi dynamics and imbalances in the yin, yang, and blood of the internal organs, can diseases occur. Therefore, as a pathogenic factor, the seven emotions refer to excessively intense, prolonged, or sudden emotional changes that lead to imbalances in the internal organs’ qi, blood, yin, and yang, resulting in disease. Diseases caused by the seven emotions are termed diseases caused by stagnation. Additionally, certain chronic diseases can lead to long-term dysfunction of the internal organs, causing abnormal emotional states, referred to as diseases causing stagnation. The seven emotions are also related to the body’s tolerance and regulatory capacity. The pathogenicity of the seven emotions differs from the six excesses, as the six excesses primarily invade the body through the mouth, nose, or skin, while the seven emotions directly affect the relevant internal organs, causing disease. The seven emotions can not only trigger the onset of various diseases but also significantly influence the progression of diseases, promoting improvement or deterioration. As the seven emotions are one of the main pathogenic factors causing internal injury diseases, they are also referred to as “internal injury from the seven emotions.”

(2) Relationship Between the Seven Emotions and the Qi, Blood of the Internal Organs

1. Relationship Between the Seven Emotions and the Internal Organs: The emotional activities of the human body are closely related to the internal organs. The basic principle is: the heart governs joy; excessive joy harms the heart; the liver governs anger; excessive anger harms the liver; the spleen governs thought; excessive thought harms the spleen; the lungs govern sadness and worry; excessive sadness and worry harm the lungs; the kidneys govern shock and fear; excessive shock and fear harm the kidneys. This indicates that changes in the internal organs can lead to corresponding emotional responses, and excessive emotional responses can damage the related internal organs. The theory that the seven emotions arise from and harm the five internal organs has significant guiding implications in diagnosis and treatment.

2. Relationship Between the Seven Emotions and Qi, Blood: Qi and blood are the two fundamental substances that constitute the body and maintain life activities. Qi has a warming and promoting effect on the internal organs, while blood nourishes the internal organs. Qi and blood form the material basis for emotional activities, and changes in emotional states are closely related to changes in qi and blood. Therefore, it is said: “When blood is abundant, there is anger; when it is insufficient, there is fear.” The physiological activities of the internal organs must rely on qi and blood as their material foundation, while emotional activities are manifestations of the physiological functions of the internal organs, thus the emotional activities of the human body are closely related to the qi and blood of the internal organs.

(3) Characteristics of Diseases Caused by the Seven Emotions

1. Related to Mental Stimuli: The seven emotions are considered mental pathogenic factors, and their onset is always associated with significant mental stimuli. Throughout the course of a disease, changes in emotions can lead to significant changes in the condition. For example, epilepsy is often caused by emotional injury; depression harms the liver, leading to liver qi stagnation, which damages the spleen, resulting in poor digestion and the internal generation of phlegm, which can confuse the mind and lead to loss of control. Mania is often caused by anger and grief, which harm the liver and gallbladder, leading to repressed emotions that transform into fire, consuming body fluids and forming phlegm-fire, which disturbs the mind and leads to confusion. This illustrates the important role of mental factors in the onset and progression of diseases.

2. Directly Harm the Internal Organs: Excessive emotions can affect the activities of the internal organs and produce pathological changes. Different emotional stimuli can harm different internal organs, resulting in various pathological changes. For instance, joy harms the heart, leading to palpitations, scattered thoughts, and inability to concentrate, and in severe cases, mental disorders. Although excessive emotions can harm the five internal organs, the relationship with the heart and liver is particularly close. The heart is the master of the five internal organs, and all life activities are manifestations of the functions of the five internal organs, which must be unified under the heart’s control. Damage to the heart spirit inevitably involves other internal organs. Liver dysfunction and qi stagnation are also key mechanisms in the onset of emotional diseases.

The heart governs blood and houses the spirit; the liver stores blood and governs the smooth flow; the spleen governs transformation and transportation and is the pivot for the rise and fall of qi, as well as the source of qi and blood generation. Therefore, emotional injuries often harm the heart, liver, and spleen, leading to qi and blood imbalances. For example, excessive joy can damage the heart, leading to anxiety, palpitations, insomnia, restlessness, and even mental disorders, manifesting as uncontrollable laughter and crying, incessant talking, and manic behavior. Unresolved anger can harm the liver, affecting its ability to regulate, leading to rib pain, irritability, sighing, or a sensation of obstruction in the throat, or due to qi stagnation and blood stasis, causing menstrual irregularities, dysmenorrhea, amenorrhea, and masses in women. Sudden anger can cause liver qi to rise, damaging blood vessels, leading to massive vomiting of blood or fainting. Excessive worry can damage the spleen, leading to poor digestion and symptoms such as loss of appetite and abdominal distension. Emotional injuries to the heart, liver, and spleen can occur independently or often interact and compound, such as excessive worry damaging the heart and spleen, unresolved anger leading to liver-spleen disharmony, etc.

Moreover, disturbances in joy, anger, worry, thought, fear, and shock can lead to qi stagnation in the internal organs, transforming into fire, resulting in irritability, anger, insomnia, flushed face, bitter mouth, and symptoms such as vomiting blood and nosebleeds, which are manifestations of fire, termed “five desires transforming into fire.” Emotional disturbances can also lead to “six stagnations” as a disease, meaning qi stagnation leads to dampness, dampness leads to heat, heat leads to phlegm, phlegm stagnation leads to blood stasis, and blood stasis leads to food stagnation. In other words, qi stagnation can lead to blood stasis, phlegm stagnation, dampness stagnation, and food stagnation as diseases.

3. Affect the Qi Dynamics of the Internal Organs: “All diseases arise from qi.” Joy, anger, worry, thought, sadness, fear, and shock are referred to as the seven qi, or seven emotions. Beyond the seven emotions, when combined with cold and heat, they are termed the nine qi. Qi is precious for its harmony; it must flow continuously, rising and falling regularly. Qi enters and exits in an orderly manner, circulating throughout the body without disease. If the seven emotions change excessively, the five desires can become extreme, leading to qi dynamics being disrupted, either causing qi to stagnate and become blocked or leading to irregular rising and falling.

Emotional stagnation can lead to qi not circulating smoothly, resulting in stagnation, or irregular rising and falling. When emotions are not expressed, qi becomes blocked, leading to qi stagnation and blood stasis, qi stagnation can also lead to dampness and phlegm, transforming into fire and injuring yin. This can manifest in the body or in the internal organs, leading to various diseases.

Emotional injuries disrupt the qi dynamics of the internal organs, leading to abnormal blood flow and imbalances in yin and yang. Different emotional changes manifest differently in terms of qi dynamics. Anger causes qi to rise, joy causes qi to relax, sadness causes qi to dissipate, thought causes qi to stagnate, fear causes qi to descend, and shock causes qi to become chaotic.

Anger causes qi to rise: Qi rising means qi dynamics are reversed. Anger is the emotion of the liver. When faced with frustration or dissatisfaction, temporary anger generally does not cause disease. However, if there is violent anger, it can harm the liver, causing liver qi to excessively rise and lead to disease. When liver qi rises, blood follows the qi upward, which can lead to dizziness, headaches, flushed face, tinnitus, and in severe cases, vomiting blood or fainting. Liver qi can also affect the spleen, leading to abdominal distension and diarrhea. Diarrhea, also known as water and grain diarrhea, presents as undigested stools. If it affects the stomach, it can lead to belching and vomiting. Since the liver and kidneys share a source, anger can not only harm the liver but also the kidneys. Kidney damage leads to symptoms such as fear, forgetfulness, and weakness in the lower back. The liver is the thief of the five internal organs; thus, abnormal liver qi can affect the physiological functions of all internal organs, leading to various pathological changes.

Joy causes qi to relax: Qi relaxation means the heart qi is slack. Joy is the emotion of the heart. It includes both the relaxation of tense emotions and the scattering of heart qi. Under normal circumstances, joy can ease tense emotions, making the mood pleasant and qi and blood harmonious, reflecting a healthy state. However, excessive joy can lead to heart disease. Violent joy harms the heart, causing heart qi to scatter, leading to a lack of focus, fatigue, and even palpitations, confusion, or mania.

Sadness causes qi to dissipate: Qi dissipation means the lung qi is consumed. Sadness and worry are the emotions of the lungs. Sadness is a manifestation of feeling hurt and sorrowful. Excessive sadness often consumes lung qi, affecting the heart, liver, and spleen, leading to various diseases. For example, it can weaken qi, leading to shortness of breath, chest tightness, and lethargy.

Sadness and worry can harm the liver, leading to mental confusion, and even muscle spasms and rib discomfort. Excessive sadness can also injure heart qi, leading to palpitations and confusion. Sadness and worry can harm the spleen, leading to stagnation in the three burners, resulting in abdominal distension and weakness in the limbs.

Thought causes qi to stagnate: Qi stagnation means spleen qi is blocked. Thought is the emotion of the spleen. Thinking is a normal physiological activity, but excessive thinking can lead to qi stagnation in the middle burner, causing poor digestion and symptoms such as poor appetite, abdominal distension, and even muscle wasting. Excessive thinking originates from the spleen and manifests in the heart; excessive thought can harm the spleen and also harm heart blood, leading to heart blood deficiency, causing palpitations, anxiety, insomnia, and vivid dreams.

Fear causes qi to descend: Qi descending means the essence qi is sinking. Fear is the emotion of the kidneys. Fear is a psychological response of cowardice and dread. Prolonged fear or sudden fright can damage kidney qi, known as fear harming the kidneys. Excessive fear can lead to kidney qi instability, resulting in symptoms such as incontinence and weakness. Fear harms the kidneys, and when essence qi cannot ascend, the heart and lungs lose nourishment, leading to symptoms such as chest fullness, abdominal distension, anxiety, and insomnia.

Shock causes qi to become chaotic: Qi chaos refers to disordered heart qi. The heart governs blood and houses the spirit; great shock can disrupt heart qi, leading to qi and blood imbalance, resulting in symptoms such as palpitations, insomnia, irritability, and even mental confusion.

4. Emotional Fluctuations Can Alter Disease Conditions: Abnormal emotional fluctuations can exacerbate or rapidly worsen disease conditions. For instance, in patients with dizziness due to yin deficiency and yang excess, if they encounter anger, it can cause liver yang to surge, leading to dizziness, fainting, or even sudden loss of speech, hemiplegia, and facial drooping, resulting in a stroke.

In summary, the seven emotions of joy, anger, worry, thought, sadness, fear, and shock are closely related to the internal organs. Emotional activities must rely on the essence qi of the five internal organs as their material foundation, and various mental stimuli can only reflect emotional changes through the functions of the relevant internal organs. Thus, it is said: “Humans have five internal organs that transform into five qi, giving rise to joy, anger, sadness, worry, and fear.” Emotional diseases primarily injure the five internal organs, mainly causing dysfunction in the qi dynamics of the five organs, leading to disharmony in qi and blood, and imbalances in yin and yang. As for which organ is affected, there are both constants and variations. The seven emotions arise from the five internal organs and correspondingly harm the respective organs, such as joy harming the heart, anger harming the liver, and fear harming the kidneys. However, sometimes a single emotional change can affect multiple organs, such as sadness harming both the lungs and liver, or multiple emotions harming a single organ, such as joy and shock both harming the heart. Clinical practice should analyze specific manifestations and not treat them mechanically.

2. Improper Diet

Diet is a fundamental condition for health. The essence derived from food and drink is essential for generating qi and blood, maintaining growth and development, fulfilling various physiological functions, and ensuring life and health.

Normal diet is one of the main sources for the body to maintain life activities, including qi, blood, yin, and yang. However, improper diet is often a cause of many diseases. The digestive and absorptive functions primarily rely on the spleen and stomach; if the diet is improper, it can first damage the spleen and stomach, leading to dysfunction in their rotting and transforming abilities, causing digestive disorders. Secondly, it can generate heat, phlegm, and dampness, leading to various pathological changes, becoming an important cause of disease.

Improper diet includes irregular eating habits, unclean food, and dietary preferences. Improper diet can lead to the onset of diseases and is one of the main pathogenic factors of internal injury diseases.

(1) Irregular Eating

Eating should be done in moderation. Eating at fixed times and in appropriate amounts is referred to as having a regular diet.

1. Irregular Hunger and Fullness: Eating should be appropriate in quantity; both excessive hunger and excessive fullness can lead to disease. Eating significantly below one’s appropriate amount is termed excessive hunger; eating significantly above one’s appropriate amount is termed excessive fullness. Excessive hunger leads to insufficient intake, lack of transformation, and ultimately results in deficiency of qi and blood. Insufficient qi and blood can lead to weight loss, weakened vital energy, and reduced resistance, making one susceptible to other diseases. Conversely, overeating can exceed the digestive and absorptive capacity of the spleen and stomach, leading to food stagnation, abdominal distension, acid regurgitation, loss of appetite, and vomiting or diarrhea, which are diseases caused by food harming the spleen and stomach. Thus, it is said, “Excessive eating harms the intestines and stomach.”

Irregular hunger and fullness are particularly common in children, as their spleen and stomach are weaker than adults. Prolonged food stagnation can lead to heat transformation; injury from cold and dampness can lead to dampness and phlegm accumulation. In infants and young children, prolonged food stagnation can also lead to symptoms such as hot palms and soles, irritability, abdominal distension, and pale, thin appearance, known as “accumulation disorder.” In adults, prolonged overeating can obstruct the flow of qi and blood in the meridians of the intestines and stomach, leading to diarrhea, blood in the stool, and hemorrhoids. Overindulgence in rich and fatty foods can easily generate internal heat, even leading to abscesses and toxic sores.

In summary, one should not eat excessively when extremely hungry, nor should one overeat; one should not drink excessively when extremely thirsty, nor should one drink too much. Overeating can lead to accumulation; excessive drinking can lead to dampness and phlegm accumulation.

Moreover, during the course of a disease, irregular eating can also alter the condition, hence the saying “food recurrence.” For example, in febrile diseases, when the disease is initially resolved, if the spleen and stomach are still weak, excessive eating or consuming hard-to-digest foods can often lead to food stagnation transforming into heat, combining with residual heat, causing the pathogenic heat to linger and leading to disease recurrence or prolongation.

Eating at irregular times: Eating at fixed times and in a regular manner can ensure that the digestive and absorptive functions operate rhythmically, allowing the spleen and stomach to coordinate effectively, ensuring that the essence of food is transformed and distributed throughout the body in an orderly manner. Since ancient times, there has been a saying: “Breakfast should be substantial, lunch should be filling, and dinner should be light.” If eating is irregular, it can also harm the spleen and stomach, leading to other diseases.

(2) Dietary Preferences

A reasonable dietary structure, with a balance of flavors and moderate temperatures, without preferences, is essential for the body to obtain the necessary nutrition. If dietary preferences or improper dietary structures occur, or if food is excessively cold or hot, or if there is a preference for certain flavors, it can lead to imbalances in yin and yang or nutritional deficiencies, resulting in disease.

1. Preference for Certain Types of Food: A reasonable combination of food types and a balanced dietary structure are necessary to obtain sufficient nutrition to meet the needs of life activities. A person’s dietary structure should include grains, meat, fruits, and vegetables, with grains as the main component, meat as a secondary component, vegetables as a supplement, and fruits as an aid, all combined reasonably according to needs for optimal health. If the structure is inappropriate or the combination is unsuitable, it can lead to imbalances in the internal organs’ functions. For example, excessive consumption of fermented foods can lead to fluid accumulation; excessive consumption of fruits and dairy can lead to internal dampness, resulting in swelling and diarrhea.

2. Preference for Cold or Hot Foods: The diet should be moderate in temperature; otherwise, excessive consumption of cold and raw foods can damage the yang qi of the spleen and stomach, leading to internal cold and symptoms such as abdominal pain and diarrhea. Overindulgence in spicy, warm, or hot foods can lead to internal heat accumulation in the stomach and intestines, resulting in thirst, abdominal distension and pain, constipation, or even hemorrhoids.

3. Preference for Certain Flavors: The spirit, qi, and blood of a person are all nourished by the five flavors. Each flavor has its affinity with the five internal organs: sour nourishes the liver, bitter nourishes the heart, sweet nourishes the spleen, pungent enters the lungs, and salty nourishes the kidneys. If one has a long-standing preference for a certain food, it can lead to an imbalance in the functions of that organ. For example, excessive consumption of salty foods can lead to blood stagnation and a loss of complexion; excessive consumption of bitter foods can lead to dry skin and hair loss; excessive consumption of pungent foods can lead to muscle stiffness and brittle nails; excessive consumption of sour foods can lead to thickened skin and dry lips; excessive consumption of sweet foods can lead to bone pain and hair loss. Additionally, excessive preferences can lead to nutritional deficiencies, lacking certain necessary nutrients, which can harm the internal organs and lead to diseases. For instance, beriberi, night blindness, and goiter are all results of flavor preferences. Therefore, the five flavors should be appropriate, and one should avoid preferences in daily diet. During illness, attention should be paid to dietary restrictions; food should be compatible with the disease, which can assist in treatment and promote recovery; conversely, the disease may worsen. Only by “carefully balancing the five flavors” can one “prolong life.”

(3) Unclean Food

Consuming unclean food can lead to various gastrointestinal diseases, resulting in symptoms such as abdominal pain, vomiting, diarrhea, and dysentery; or it can lead to parasitic diseases, such as ascariasis, pinworm infection, and threadworm infection, with clinical manifestations including abdominal pain, pica, and pale, thin appearance. If ascaris invade the bile duct, it can lead to severe upper abdominal pain, intermittent pain, vomiting of worms, and cold limbs. If spoiled or toxic food is consumed, it can lead to food poisoning, often presenting with abdominal pain and vomiting, and in severe cases, can lead to coma or death.

3. Work and Rest

Work and rest include both excessive labor and excessive leisure. Normal labor and physical exercise help promote the circulation of qi and blood and enhance physical fitness. Necessary rest can eliminate fatigue and restore physical and mental strength, and will not cause disease. Only prolonged excessive labor, whether physical or mental, or excessive leisure, with no labor or exercise, can become pathogenic factors leading to disease.

(1) Overwork

Overwork refers to excessive fatigue, including excessive physical labor, excessive mental strain, and excessive sexual activity.

1. Excessive Physical Labor: Excessive physical labor primarily refers to prolonged inappropriate activities that exceed physical capacity. Excessive physical labor can damage the functions of the internal organs, leading to qi deficiency, resulting in symptoms such as fatigue, weakness, reluctance to speak, mental exhaustion, and weight loss, known as “overwork depletes qi.”

2. Excessive Mental Strain: Excessive mental strain refers to overthinking and worrying. Excessive mental strain can deplete heart blood and damage spleen qi, leading to symptoms such as palpitations, forgetfulness, insomnia, vivid dreams, poor appetite, abdominal distension, and diarrhea, and can even deplete qi and blood, weakening organ functions, leading to chronic illness.

3. Excessive Sexual Activity: Excessive sexual activity refers to unrestrained sexual behavior. Normal sexual activity generally does not harm the body, but excessive sexual activity can deplete kidney essence, leading to symptoms such as weakness in the lower back and knees, dizziness, tinnitus, and mental fatigue, or in men, nocturnal emissions, reduced sexual function, or even impotence.

(2) Excessive Leisure

Excessive leisure refers to a lack of labor and exercise, leading to poor circulation of qi and blood, weak muscles and bones, sluggish spleen and stomach, physical weakness, or obesity, and can lead to other diseases.

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