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On the Four Major Causes in Traditional Chinese Medicine Theory

Epidemic Toxins
A highly contagious pathogenic factor. Characterized by sudden onset, severe illness, similar symptoms, and strong infectivity. Transmission occurs via air and contact, entering through the mouth and nose. Regardless of age, strength, or constitution, anyone exposed becomes ill. Epidemics are linked to abnormal natural climates—such as prolonged drought, extreme heat, humid miasmas—and poor environmental and dietary hygiene, as well as social system differences.
Seven Emotions
Refers to seven emotional changes: joy, anger, worry, thought, grief, fear, and shock—psychological factors contributing to disease. Different emotions affect internal organs differently. The *Su Wen·Yin Yang Ying Xiang Da Lun* states: “Anger harms the liver,” “Joy harms the heart,” “Thought harms the spleen,” “Grief harms the lung,” “Fear harms the kidney.” Emotional disturbances damage internal organs primarily by disrupting organ qi flow, causing imbalance in qi ascent and descent and disorder in blood and qi function. While seven emotions can affect all five organs, clinical observation shows they most commonly impact the heart, liver, and spleen.
Diet and Labor/Rest
Diet and labor/rest are essential for human survival and health maintenance. However, moderation is required in both diet and labor/rest; otherwise, resistance decreases or organ function is impaired, leading to disease. Diet-related illnesses mainly arise from three aspects: dietary irregularity, unclean food, and dietary bias. The spleen governs the transportation and transformation of food essence, while the stomach receives and digests food. Thus, dietary damage initially affects the spleen and stomach, then spreads to other organs or gives rise to other diseases.
Excessive physical labor consumes qi; excessive mental labor damages yin and blood; excessive sexual activity depletes kidney essence. Complete idleness, with no labor or physical exercise, also impedes blood and qi circulation, stagnates spleen function, and lowers resistance, leading to secondary diseases.
Phlegm and Blood Stasis
Both are pathological products resulting from organ dysfunction and can directly or indirectly affect certain organs and tissues, thus serving as causative factors.
1. Phlegm and Fluids: Both phlegm and fluids are pathological products arising from local disruptions in fluid metabolism. They are categorized as visible and invisible. Visible phlegm and fluids refer to substances that can be seen or heard—thick, sticky secretions are called phlegm; thin, watery secretions are called fluids. Invisible phlegm and fluids refer to symptoms such as dizziness, nausea, vomiting, unconsciousness, etc., without visible expectoration or tangible phlegm/fluid.
(1) Formation of Phlegm and Fluids: Phlegm and fluids arise from impaired qi transformation in the lung, spleen, and kidney, or disrupted fluid transport in the triple burner, leading to stagnation and accumulation of body fluids.
(2) Syndromes and Characteristics of Phlegm and Fluids: Clinical manifestations vary depending on the location of phlegm and fluids. For example, phlegm and fluids in the lung cause coughing, wheezing, and expectoration; phlegm obscuring the heart causes chest tightness, palpitations, mental confusion, mania, or delirium; phlegm stagnating in the stomach causes nausea, vomiting, and epigastric fullness; phlegm and fluids in the meridians and bones cause lymph node swellings, numbness in limbs, or obstruction in the throat causing a sensation of a lump; phlegm and fluids rising to the head cause dizziness and fainting; fluid overflow onto the skin causes edema; fluid in the thorax and flanks causes chest and flank pain, aggravated by coughing; fluid above the diaphragm causes dyspnea and inability to lie flat; fluid in the intestines causes intestinal rumbling, abdominal distension, and poor appetite.
2. Blood Stasis: Any condition where blood flow is sluggish or extravasated blood fails to dissipate constitutes blood stasis.
(1) Formation of Blood Stasis: Primarily due to qi deficiency, qi stagnation, or cold-blood conditions causing blood to become sluggish and coagulate. Alternatively, internal bleeding from trauma or other causes that fails to dissipate promptly also forms blood stasis.
(2) Characteristics of Blood Stasis Syndromes: Blood stasis syndromes are diverse, varying by location, but share common features: stabbing pain, cyanosis, masses, bleeding, rough skin, and fine涩pulse.

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