The causes of internal injury refer to pathogenic factors resulting from abnormal emotional states, diet, and work-rest balance, leading to the imbalance of qi, blood, and body fluids, as well as dysfunction of the internal organs. The causes of internal injury differ significantly from those of external pathogens in terms of sources, invasion pathways, and pathogenic characteristics, primarily including emotional injuries (qi qing nei shang), improper diet (yin shi shi yi), and inappropriate work-rest balance (lao yi shi du).
■ Emotional Injuries
Emotional injuries are common pathogenic factors that arise from excessive emotional states disrupting the qi mechanism of the internal organs, leading to disease. Emotional injuries can directly damage the internal organs and may lead to or trigger various emotional disorders.
(1) Basic Concept of Emotional Injuries
The seven emotions (qi qing) refer to joy, anger, worry, thought, sadness, fear, and shock. Under normal circumstances, these emotions do not lead to disease. However, if a person’s emotional states are excessively intense, prolonged, or extreme, surpassing the physiological and psychological adaptability of the body, or if the body’s righteous qi is weak, leading to a diminished ability to regulate emotional stimuli, these emotions can cause disease or become a trigger for disease, known as “emotional injuries” (qi qing nei shang).
Emotional activities are based on the essence and qi of the internal organs, thus the relationship between emotional activities and the essence of the five organs is particularly close. Firstly, the essence and qi of the five organs determine the emotional changes of the five organs. As stated in the “Su Wen: On the Correspondence of Yin and Yang”: “The human body has five organs that transform into five qi, giving rise to joy, anger, sadness, worry, and fear.” The five organs store essence, which transforms into qi, and qi transforms into spirit. The essence and qi of the five organs can produce corresponding emotional activities, as noted in the “Su Wen: On the Correspondence of Yin and Yang”: “The liver corresponds to anger, the heart to joy, the spleen to thought, the lungs to worry, and the kidneys to fear.” The flourishing or declining essence and qi of the five organs, as well as the smooth flow of qi and blood, play an important role in the generation of emotions. If the yin and yang of the five organs and the flow of qi and blood are imbalanced, abnormal emotional changes may occur. For example, the “Ling Shu: On the Spirit” states: “If the liver qi is deficient, there is fear; if it is excessive, there is anger… If the heart qi is deficient, there is sadness; if it is excessive, there is unending laughter.” The “Su Wen: On Regulating the Menstrual Cycle” states: “If blood is excessive, there is anger; if insufficient, there is fear.”
Secondly, changes in emotions affect the functions of the internal organs. Excessively intense and prolonged emotional changes can also lead to imbalances in the yin and yang of the internal organs and the flow of qi and blood. For instance, excessive joy and shock can harm the heart, excessive anger can harm the liver, excessive worry can harm the spleen, and excessive fear can harm the kidneys. In the generation and change of emotional activities, the heart and liver play particularly important roles.
(2) Pathogenic Characteristics of Emotional Injuries
Emotional activities are closely related to changes in the internal and external environment of the body. Therefore, drastic changes in the living and working environment, poor interpersonal relationships, and weakness of the internal organ essence can all lead to abnormal emotional states, affecting the corresponding organ functions and resulting in disease. Whether emotions can cause disease is related not only to the intensity, manner, and duration of the emotional response but also closely related to the individual’s psychological quality, characteristics, and physiological state. The main pathogenic characteristics of emotional injuries include four aspects:
1. Directly injuring the internal organs
The seven emotions are the seven emotional changes produced by the body in response to changes in the internal and external environment, based on the essence and qi of the internal organs. The heart houses the spirit and is the master of the five organs and six bowels; therefore, emotional injuries must first affect the heart and spirit. Excessive emotional states can directly harm the corresponding internal organs, leading to abnormal essence and qi, resulting in disease.
(1) Primarily affecting the heart and spirit
The heart houses the spirit and is the master of the five organs and six bowels. The heart and spirit are the rulers of life; thus, when excessive emotions harm a person, they primarily act on the heart and spirit, producing abnormal emotional responses and mental states. As stated in the “Ling Shu: On the Spirit”: “Therefore, those who are anxious and worried harm the spirit… Those who are overly joyful scatter the spirit and do not retain it; those who are sorrowful have blocked qi and cannot flow; those who are excessively angry become confused and cannot be treated; those who are fearful have a scattered spirit and cannot be contained.” Excessive joy can lead to a scattered spirit and abnormal mental state; excessive anger can lead to chaotic qi and blood; excessive fear can lead to a loss of spirit and a lack of mental clarity. The “Su Wen: On Pain” states: “When startled, the heart has no place to rely, and the spirit has no place to return.” “When thinking, the heart has a place to reside, and the spirit has a place to return.” This clearly indicates that shock and thought primarily damage the heart and spirit, subsequently affecting the corresponding internal organs. Thus, the “Classics of Diseases: Emotional and Qi Disorders” explains: “Although the injuries of emotions correspond to the five organs, they all originate from the heart.” Qing Dynasty physician Fei Boxiong in “Medical Principles” states: “Although the injuries of the seven emotions are divided among the five organs, they must ultimately return to the heart.”
(2) Damaging the corresponding organs
The seven emotions are closely related to the physiology of the five organs and are the external manifestations of the functional activities of the internal organs’ essence and qi. Excessive emotions can damage the corresponding organs: the heart corresponds to joy, excessive joy harms the heart; the liver corresponds to anger, excessive anger harms the liver; the spleen corresponds to thought, excessive thinking harms the spleen; the lungs correspond to sadness and worry, excessive sadness and worry harm the lungs; the kidneys correspond to fear, excessive fear harms the kidneys.
(3) Easily injuring the heart, liver, and spleen
The heart houses the spirit and is the master of the five organs and six bowels; therefore, all emotional activities occur under the command of the heart, resulting from the coordinated actions of the yin and yang of the essence and qi of the internal organs. Various environmental factors acting on the body can influence the essence and qi of the internal organs and their functions, as well as affect the heart and spirit, leading to corresponding emotional activities. As stated in the “Classics of Diseases: Emotional and Qi Disorders”: “The heart is the master of the five organs and six bowels, governing the soul and spirit, and encompassing intention and will. Therefore, when worry affects the heart, the lungs respond; when thought affects the heart, the spleen responds; when anger affects the heart, the liver responds; when fear affects the heart, the kidneys respond; this is why the five emotions are all governed by the heart.” The liver stores blood and governs the smooth flow of qi, promoting and regulating the circulation of qi and blood; thus, the liver plays an important role in regulating emotional activities and maintaining a pleasant mood. The spleen is the source of the generation of qi and blood, storing nutrients and housing intention; in terms of emotions, it corresponds to thought, and mental activities such as thinking and memory are closely related to the spleen. Therefore, emotional injuries most easily damage the heart, liver, and spleen: excessive shock and joy can harm the heart, leading to unsettled spirit, which may manifest as palpitations, insomnia, forgetfulness, and even mental disorders; excessive anger can harm the liver, leading to liver qi stagnation, which may manifest as pain in the flanks, chest tightness, sighing, a sensation of obstruction in the throat, delayed menstruation, and even dysmenorrhea, amenorrhea, or masses; excessive thinking can harm both the heart and spleen, leading to deficiency of both, which may manifest as palpitations, insomnia with vivid dreams, reduced appetite, abdominal distension, and loose stools.
Emotional injuries can arise from a single excessive emotion or from the interplay of two or more emotions, such as shock and fear, joy and worry, or anger and depression. The intertwining of multiple emotions can damage one or more internal organs. For instance, excessive shock and fear can harm both the heart and kidneys; excessive anger can harm both the liver and affect the heart and spleen; excessive worry and thought can harm the spleen and also affect the heart and lungs.
(4) Easily damaging latent diseases of the internal organs
Latent diseases refer to pathological changes that have already occurred but have not yet manifested clinically. Emotional injuries not only easily damage the heart, liver, and spleen but also readily harm the latent diseases of the internal organs. For patients who have previously suffered from conditions such as chest obstruction, true heart pain, diarrhea, or headaches, although clinical symptoms have disappeared, they are most likely to exhibit the original clinical symptoms upon encountering emotional stimuli.
For example, patients with chest obstruction may easily first experience chest tightness and pain; those with true heart pain may easily experience pain in the precordial area, even radiating to both arms; those with diarrhea may first experience abdominal pain and diarrhea; and those with headaches may easily first experience migraines.
2. Affecting the qi mechanism of the internal organs
The movement and changes of the qi of the internal organs play an important role in the generation of emotional activities and life activities. Therefore, emotional injuries primarily harm the heart and spirit, subsequently affecting the qi mechanism of the internal organs, leading to abnormal ascension and descension of the qi mechanism, resulting in corresponding clinical manifestations. As stated in the “Su Wen: On Pain”: “All diseases arise from qi; anger causes qi to rise, joy causes qi to slow, sadness causes qi to dissipate, fear causes qi to descend… shock causes qi to become chaotic… thinking causes qi to stagnate.”
★ Anger causes qi to rise: This refers to excessive anger leading to excessive liver qi dispersal, causing qi to rise, and in severe cases, blood may follow the qi upwards, resulting in pathological changes. Clinically, this primarily manifests as headaches, facial redness, and in severe cases, vomiting blood or fainting; as stated in the “Su Wen: On the Path of Qi”: “Great anger leads to the cessation of qi, causing blood to accumulate above, leading to fainting.” The “Su Wen: On Pain” states: “Anger causes qi to reverse, and in severe cases, it can lead to vomiting blood and diarrhea.” If liver qi is obstructed, it can affect the spleen and stomach, leading to loss of appetite, abdominal pain, and diarrhea.
★ Joy causes qi to slow: This refers to excessive joy harming the heart, leading to the heart qi becoming scattered and unable to retain, and in severe cases, the heart qi may suddenly escape, causing the spirit to become uncontained. Clinically, this may manifest as inability to concentrate, abnormal mental states, mania, or profuse sweating and weak pulse, as stated in the “Huainanzi: On the Spirit”: “Excessive joy leads to a fall in yang.”
★ Thinking causes qi to stagnate: This refers to excessive thinking harming the spleen, leading to stagnation of spleen qi and failure of its transport functions. The spleen and stomach are located in the middle jiao and are the pivot for the ascension and descension of qi. Stagnation of spleen qi may clinically manifest as mental fatigue, sluggish response, lack of appetite, abdominal distension, and loose stools.
★ Sadness causes qi to dissipate: This refers to excessive sadness harming the lungs, leading to depletion of lung qi and failure of lung function. Clinically, this often manifests as lack of energy, depression, chest tightness, shortness of breath, and lack of desire to speak.
★ Fear causes qi to descend: This refers to excessive fear harming the kidneys, leading to instability of kidney qi and descent of qi. Clinically, this may manifest as incontinence due to excessive fear, and in severe cases, nocturnal emissions. As stated in the “Ling Shu: On the Spirit”: “Fear that is not resolved harms the essence; when the essence is harmed, the bones ache and weaken, and the essence descends.”
★ Shock causes qi to become chaotic: This refers to sudden shock harming both the heart and kidneys, leading to instability of the heart spirit, chaotic qi, and instability of kidney qi. Clinically, this may manifest as palpitations, anxiety, confusion, and in severe cases, loss of consciousness and incontinence. As stated in the “Su Wen: On Pain”: “Shock causes the heart to have no place to rely, the spirit has no place to return, and thoughts have no place to settle, thus qi becomes chaotic.”
Emotional injuries can lead to disturbances in the qi mechanism of the internal organs, and disturbances in the qi mechanism can hinder the qi transformation processes of the internal organs, causing abnormalities in the metabolism of essence, qi, blood, and body fluids, which can subsequently lead to various diseases. For instance, prolonged stagnation of qi can transform into heat or fire; stagnation of qi can lead to the accumulation of essence, fluids, and blood, resulting in pathological products such as phlegm, blood stasis, and stones, and the intermingling of phlegm and blood stasis can lead to conditions such as chest obstruction and masses.
3. Frequently manifesting as emotional disorders
Emotional disorders, a term first mentioned in the Ming Dynasty by Zhang Jiebin in “Classics of Diseases”, refer to diseases related to emotional stimuli, characterized by abnormal emotional expressions. Emotional disorders include: ① diseases triggered by emotional stimuli, such as depression, mania, and insanity; ② diseases induced by emotional stimuli, such as chest obstruction, true heart pain, and dizziness; ③ other diseases caused by different reasons but exhibiting abnormal emotional expressions, such as diabetes, masses, and chronic liver and gallbladder diseases, which often have abnormal emotional manifestations.
4. Affecting the progression of diseases
Changes in the seven emotions have two effects on the progression of diseases: one is beneficial for recovery. Positive and optimistic emotions, appropriate emotional responses, and maintaining a pleasant and calm spirit are conducive to improvement and even recovery from diseases. The other is to exacerbate the condition. Negative emotions, pessimism, or abnormal fluctuations in emotions that cannot be timely regulated can worsen or aggravate the condition. Understanding the positive and negative effects of emotional activities on the progression of diseases is practically significant for grasping the development and changes of diseases and for implementing comprehensive and correct treatments.
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