1. CAUSES OF DISEASE Different concept than ‘cause ’from a biomedical model Concern is not what X caused Y Concern is what is the relationship between X and Y The precipitating factor is woven into the pattern A pattern is a temporary synthesis that is tested in the treatment process.

2. EASTERN/WESTERN LOGIC WESTERN: A=AA cannot be ‘not-A’ (or B) A does not Equal B EASTERN: A~AA can be ‘’not-A’ (or B) A does equal B This logic (way of thinking) influences cultural, political, and scientific thought In each culture.

3. CAUSE IN TCM Cause in TCM is part of the assessment but it quickly becomes part of the landscape or pattern. Cause and effect are not linear but a circle Precipitating Factors or Causes of Disease Environment Emotional Lifestyle Heredity

4. ENVIROMENTAL CAUSES OF IMBALANCE THE SIX PERNICOUS INFLUENCES Wind Cold Heat, Fire Dampness Dryness Summer Heat Climactic factors are manifested in people. Not much different than the climate What makes this possible? Liu xie

5. Pernicious Influences INTERNAL Long term illness (chronic disease) Constitutional patterns The Yin and Yang balance has been disrupted Make up the focus of modern practice of TCM

6. Pernicious Influences EXTERNAL Exposure, come from the outside Can only penetrate if they are very strong: EXCESS the body’s Qi is low: DEFICIENCY Include bacteria, viruses, etc Characterized by sudden onset Treatment aimed at releasing the Exterior to prevent penetration to the Inerior or Releasing the Exterior and Tonifying the Upright Qi

7. WIND EXTERNAL Often combines with Cold Heat Damp Sudden onset, often fever. First appears in the upper body face, head, nose, skin Lungs Resembles biomedical infections or contagious diseases Symptoms have characteristics of the accompanying PI Often consequence of vacuity of Qi INTERNAL Qi of ‘distorted movement’ tremors, shaking,convul. paralysis, diskinetics things move, come & go dizziness,gas, tinnitus, anger, explosive, suspicious over assertive Resonates with the Liver Quick onset even internally generated Often consequence of vacuity of Blood. A Yang phenomenon Affects the body’ just as it moves the branches of a tree’ Kaptchuk

8. COLD EXTERNAL Feels cold More chills than fever Curled up, contracts under activity, slow Blocks pores, no sweat Discharges clear or white In Meridians and muscles contracts causes pain that is cramping, or sharp and severe. Responds to the application of heat Vacuity of Qi: Deficient Cold INTERNAL Feels cold, blankets help hands, feet or whole body Curls up, under active slow movements Slow functions of organs and systems of the body: metabolism digestion Difficulty relating in relationships Pain in organs cramps, sharp Vacuity of Qi, Blood Excess type: diet Deficient type: jing, overwork which leads to deficiency of Qi, Blood, (comes with Wind), blankets no Lacks warmth, creates a slow or immobile landscape Yin or Yang?

9. HEAT EXTERNAL Feels hot More fever than chills No blankets Sweats Discharges red or yellow Color of face,eyes red Fire poisons: inflamation Can dry up or consume the Yin INTERNAL Feels hot, no blankets, sweat Extended posture Fast movement Pain feels like burning If Excess type: restlessness Hyper function of body systems & Organs, Insomnia Dry stool, eyes, profuse bleeding If deficient: anxiety Acute or prolonged emotional problems cause heat. Rising symptoms: BP, migraines YIN OR YANG? Cold & Heat can turn into each other CREATES AN AGITATED LANDSCAPE Heat is a Normal aspect of the body Can feel hot

10. DAMPNESS Not as clear a distinction between Internal and External Dampness Dampness is an external pernicious influence that quickly becomes part of the Landscape and is very difficult to treat. Can also be generated from the Interior. Characteristics include wet, heavy, and slow. Transformations get bogged down Is caused by and affects the Spleen (digestive system): nausea, vomiting, loose stools Lack of appetite, overweight. Combines with Heat in the Exterior of the body and in the Organs Combines with Cold especially in the Organs: uterus, stomach, intestines Manifests in the limbs & lower part of the body: Heavy, numbness, achy, edema, Pain is diffuse without clear boundaries, soft mushy flesh & muscles Non-physical: worry, too many thoughts, holding on, clingy Yin or Yang?

11. PERNICIOUS INFLUENCES DRYNESS Internal & External Landscape & Patterns look dry: Dry skin, hair, stools, cough etc Often related to other problems: Heat external pernicious influence Deficiency of Blood Deficiency of Fluids SUMMER HEAT PI that occurs when exposed to extreme heat. Symptoms include high fever, Heavy sweating and exhaustion.

12. THE EMOTIONS Can cause illness, imbalance, disease (physical, non-physical Always considered to affect the Internal Circular cause/effect logic not linear All emotions are part of a healthy or balanced landscape Of concern only when they are excessive, long lasting habitual or inappropriate. All have a specific affect on the Qi and long term affects on the yin/yang balance of the body. People get sick because they don’t have enough love in their lives Sun Si Miao 590 c.e. Worry,anger,fear,fright,elation,sadness,grief

13. Seven Emotions WORRY: Spleen, causes stagnation of Qi, can result in Dampness ANGER: Liver, causes Qi to rise, Yang Rising ELATION: Joy, Heart, causes Qi to scatter, can injure the Blood SADNESS & GRIEF: Lungs, causes Qi to be consumed, injures Qi FEAR & FRIGHT: Kidneys, makes Qi descend, depletes Essence All can cause Internal Heat, all will eventually affect the Heart Special connection to the 5 Spirits and Virtues

14. LIFESTYLE Includes inherited constitution Culturally defined NOT TO BE CONFUSED WITH MORAL VALUES Practitioner must be careful not to impose own biases Changes in lifestyle are difficult and long processes and must be initiated (desire) and embraced by the individual Best guard is to know your own prejudices

15. DIET Considered important influence on health in TCM Why? THE BALANCED DIET: includes all the flavors sour, bitter, sweet, salty 1. Regularity 2. Eat for the seasons, environment 3. Time of day 4. Over or under eating 5. Quality of food 6. Eat for your pattern

16. EXERCISE Physcial activity should be in harmony with the environment & seasons Appropriate for age, constitution, time of day Yang in nature, must be balanced by yin Not too much, not too little Four types: aerobics, stretching, weight bearing/isometrics and breathing.

17. OTHERS SEXUALITY AND SEXUAL ACTIVITY: medical & moral implications. Often mixed Reproduction and sexuality closely related to the Kidneys Jing is sperm and egg Sensuality is regulated byseveral Organs Spleen: allows sexuality to be nurturing Liver: asserting Heart: affectionate & warm Kidneys: libido Too much or too little sexual activity is a disharmony

18. OTHERS ACCIDENTS & PARASITES burns, bites, traumas Dealt extensively in the literature Left out of Internal/external paradigm IN REALITY CAN BE CATEGORIZED BY YIN AND YANG

19. CAUSES OF DISEASE Maciocia THREE STAGES OF MAXIMUM VULNERABILITY Prenatal Parent’s health at time of conception: old, poor health, drugs Childhood (birth thru teens) Diet: weaning too early, over or under feeding damp producing foods diets, fads, image Emotional: anxiety/stress=headaches, digestive issues Excessive physical activity or not enough Too early sexual activity Adulthood Emotional Lifestyle: diet, overwork, exercise, sexual activity

20. THREE GATEWAYS OR PASSAGES WIDE FLUCTUATIONS OF YIN AND YANG PUBERTY CHILDBIRTH MENOPAUSE