Why We Experience Dis-Ease? - The Biopsychosocial Causes of Imbalance according to TCM.

疏氣暢神 When the Qi (Energy) courses and the Shen (Spirit) is uninhibited, there will be no discomfort in the body.

通則不痛， 痛則不通 Where there is blockage there will be pain. If no blockage then no pain will be there.

These are common adages we say in TCM when considering the dis-ease or discomfort both physical and mental that we so often encounter with our patients. To have pain in our bodies and to suffer in our minds; these are human universals, but what causes us to have dis-ease? In Medicine this is a discussion of etiologies.

In the Prescriptshens Podcast Eps 1 "Let's Talk Emotions", we stated in passing that when a TCM practitioner looks at you , we see you as an integral system of physical, physiological,and psychological dynamics. This, we call the Three Treasures of Medicine (三寶：精氣神)

Medicine's Three Treasures

1. 精 (Jing/Essense) The Physical

2.氣 (Qi/Energy) The Physiological

3.神 (Shen/Spirit) The Psychological

At any of these levels of the human system, there are causes to imbalance that eventually lead to blockage then pain, suffering, and dis-ease.

In this blog we'll cover in brief the causes of physical and physiological discomfort as this is well covered elsewhere and is common knowledge to most TCM practitioners. then we'll spend a bit more time on the often less discussed etiologies of psychological suffering.

While causes of dis-ease can be a daunting topic, TCM simplifies etiologies into three general categories.

3 Etiologies

1. 外 External causes ; namely 六邪 6 Environmental Energies

2.內 Internal causes; namely 五志七情 5 Emotions and 7 Feelings

3. 不內不外 (neither internal nor external) Lifestyle causes; namely 五勞七傷 5 Labors and 7 Damages

External causes are things we encounter in our physical environment namely the 6 Environmental Energies (Wind, Heat, Summerheat, Damp, Dry, Cold). Internal causes are represented by our internal milieu of the Five Emotions, Seven Feelings (Anger, Joy, Worry, Sad, Fear and additionally Grief and Shock) . Our Lifestyle causes include habits in diet, activities, living conditions, social life, sexual behavior etc often represented by the Five Labors and Seven Damages.

(5 Labors: Prolonged Movement injures Tendons, Observing-Blood, Sitting-Muscles, Laying-Energy, Standing-Bones

7 Damages: Large meals injures Spleen, Outbursts of Anger injures Liver, Frequent Heavy Lifting and Sitting on Damp Ground injure Kidneys, Not keeping warm and frequent Cold Drinks injure Lungs, Hard Labor and Constant Worrying injure Spirit, Exposure to extreme weather injures Body, Fear and Shock injure Willpower.)

At the Psychological level, we likewise have causes of imbalance coming from the External, Internal, and Lifestyle. Apart from the sudden shift in the 6 life circumstances, the Internal and Lifestyle causes of psychological imbalance and suffering are very much linked to our constitutions i.e. our natural tendencies, which in TCM we call the 5 Shen Types.

The Neijing (Yellow Emperor's Classic) states that humans are born with a unique constitutional balance of Yin-Yang energies. Rarely is anyone borned perfectly in balance. Some are naturally more Yang and tend towards extroversion and activities, while others are more Yin and tend towards introversion and rest. In the broadest sense, there are 5 Shen Types, one of balance and four of differing emphasis on Yin and Yang. From this initial difference, habits of lifestyle and moods develop. Small imbalances is a normal part of being alive, but when ingrained overtime and taken to an extreme they become the causes of our psychological suffering that lead to maladaptive Lifestyle behaviors and Internal limiting outlooks on life that do not serve our well-being. Qi manifests from the subtle to the gross level, so what begins at the Psychological will overtime translate into the Physiological and Physical.

It is our work to be aware of our tendencies and cultivate a balance in ourselves. However, it doesn't mean we have to do it alone. The journey is much more pleasant and less turbulent when we work with our psychologists, life coaches, and TCM practitioners.

As we like to say, a little herb can make a huge difference!

3 Etiologies at the Psychological Level

1. External - 六局 6 Circumstances (貴賤富貧樂苦)

2. Internal- 四暴 4 Flareups (暴苦，暴怒，暴樂，暴喜)

3. Lifestyle- 四緒 4 Hangups (絕，離，結，菀)

As there are seasons and weather in Nature, in Society we also have the weather of our circumstances. As a correlate to the 6 Environmental Energies that affect our bodies, there are 6 Circumstances that affect our minds namely High Status, Low Status, Rich, Poor, Social-Acceptance , Social-Rejection (貴賤富貧樂苦) . Much like the weather these External 6-Circumstances come and go, sometimes with little input from us.

What we can control are our actions in Lifestyle and Internal emotional responses. However, since most of us are not aware of our natural tendencies we don't usually consciously respond to our circumstances but rather default to our innate imbalances and react maladaptively. In time, these knee jerk reactions become the causes of our dis-ease.

While the cycle of 5-Emotions are Natural and come and go like the weather; the four states of Yin-Yang imbalance inherent within our constitutions lead to 4 typical "Flareups" reactions. The Chinese character used means explosive or tempestuous, meaning the Internal reaction is out of proportion to the actual event. The 4 Flareups are Feeling Rejected, Rage, Pleasure Seeking, and Complacence (暴苦，暴怒，暴樂，暴喜) .

Likewise, when living without awareness, our Lifestyle habits are not truly life-affirming but they are rather avoidant behaviors driven by one of the 4 Hangups i.e. Fear of missing out, Separation Anxiety, Emotional Complex, Depressive Thoughts (絕，離，結，菀). In essence they are fear based ego drives stemming from our innate constitutional imbalance and are behind many of our unwholesome habits and even addictions! Yang types fear loss of agency, while Yin types, being passive, will project danger and hopelessness into their social situations (seeing circumstances as worse than they really are).

This is why not every life circumstance is equally significant to everyone . Due to our 5 Shen Types of Yin-Yang imbalance, we have our own drives and windows through which we interpret the life circumstances that happen to us. Thus our mental suffering and the resulting compensatory Lifestyle habits will differ.

5 Shen Types is one of the ways we personalize care and tallor herbal formulas for patients. TCM doesn’t just treat the dis-ease we try to understand the psychology, the Shen, of the person behind the clinical presentation.

So much more to talk about, but as the blog is running long. Let's catch up in the next blog. In the meantime, please send us your topic suggestions.

Till next time, Salud!!!

By: Hoang Tran