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Why do we become ill?

by Peter Mole(more info)

listed in chinese oriental medicine, originally published in issue 13 - July 1996

The Five Elements

Western and Chinese medicine have radically different views about how we become ill. In Western medicine, for example, the notion that the emotional life of the person plays a significant role in a person's physical health is still a controversial hypothesis. Because so little is as yet understood about the complex physiological mechanisms operating, physicians in the West have often denied that physical illnesses frequently have a psychological basis. The word "psychosomatic" has always had pejorative overtones, implying that the patient could get better if only he or she tried hard enough.

The Five Elements

The Sheng and Ke Cycles
The Five Elements and the Sheng and Ke Cycles

"Stress", however, became a fashionable word in the 1980s to explain the cause of all manner of illnesses and yet the Western doctor's Pharmacopoeia did not significantly alter in response to this development. It is a strange paradox that although nowadays GPs often cite stress as the cause of a person's complaint, the main medical text-books do not even list it in their sections on the causes of disease. In Chinese medicine, however, the links between body, mind and spirit have always been recognised and indeed lie at the heart of the system.

The Chinese formulated three main categories of disease causation: External, Internal and "neither external nor internal". The internal causes are emotional and affect the mind and spirit in the first instance. Once the mind/spirit starts to suffer, the person's energetic balance is affected and chronic physical illness is often the result. Diet, climatic factors, congenital abnormalities, injury, lack of exercise, exhaustion and various other causes can all be important factors in a person's health, but one's well-being in mind and spirit is probably the most important. Henri Amiel, the Swiss philosopher, expressed what most people feel to be true "Happiness gives us the energy which is the basis of health".

The Internal Causes of Disease

The ancient Chinese regarded the free expression of emotion as fundamental to human existence. As expressed in Ecclesiastes "To every thing there is a season, and a time to every purpose under the heaven .....a time to weep and a time to laugh: a time to mourn and a time to dance".

How do the emotions cause illness in one's body? It can be most clearly seen in the example of an acute situation. If, for example, you become acutely frightened your body immediately produces a huge surge of adrenaline. The effects of increased adrenaline production upon the body have been extensively studied by physiologists. It is well known that there will be an increase in perspiration, heart rate, urination, circulation of blood to the muscles, etc. In short, it prepares the body for physical action. Different people will react differently; one becomes soaked in sweat whereas another is more aware of the increase in their heart rate, but overall the physiological effects are similar. The emotion of fear has pervaded the person's spirit and this has been bio-chemically manifested in the body. Other emotions also have profound effects upon the body, which you can feel in yourself if you experience any emotion intensely enough.

When the fear-provoking situation has passed, the person's mind and spirit will settle. The body will calm down and physical function will return to a more normal condition. This is the homoeostatic mechanism; the way of nature. For many people, however, fear-provoking situations have been so intense or so frequent that they have been unable to return to their normal physical function. The effects on the body become chronic. In time, illness arises.

Usually small children most closely embody the Chinese notion of emotional health. The easy transition from an emotion such as sorrow or fear to suddenly laughing and shouting is often achieved in a way that is impossible for adults. This emotional freedom is accompanied by a vitality of spirit that makes small children so enriching and enjoyable to be with.

As the child's character becomes more formed by the emotional and behavioural vagaries of their family, the circumstances of their life and genetic inheritance, so one sees them become unable to move in and out of different emotions so freely: certain emotions start to predominate, others become repressed. The child gradually acquires a predisposition to particular emotions. Even in a small child one can usually perceive that certain emotions are more powerful and intense than others. The child loses inner vitality as their Qi becomes imbalanced. Yin or Yang will start to predominate; one or more of the Five Elements will lose balance with the others. It is the development of one's temperament which creates long-term constitutional imbalances in a person's Qi. These imbalances cause one to become, for example, a fearful person, a person chronically lacking joy, irritable, unnecessarily or inexplicably morose.

The practitioner must discern the nature of the constitutional imbalances if they are to treat most chronic symptoms at their true origin.

In the context of the causes of illness, the Chinese narrowed the vast range of human emotions down to seven, but they should not be interpreted too restrictively. Many other emotions could be included under each broad heading; for example irritation, frustration, resentment, fury and bitterness would all come under the heading of anger as a cause of illness. Certain emotions are inclined to affect particular Elements and Organs but it is worth bearing in mind that people by no means always respond to situations as one might expect – for example the emotion of grief is not always the predominant response to the death of a loved one. Profound lack of joy, the need for sympathy and even anger are sometimes felt far more intensely, depending on the long-term imbalances of the person and the nature of the relationship to the deceased.

The following table shows which Elements are primarily affected by each emotion.




Many of us have difficulties with anger. Some people explode, some feel frightened by the potential of their anger, some can rarely express or even feel their own anger. Aristotle has probably described the problem better than anybody else "It is easy to fly into a passion – anybody can do that – but to be angry with the right person to the right extent and at the right time and with the right object and in the right way – that is not easy, and it is not everyone who can do it".

Anger is our attempt to change a situation that we do not like or that we find unbearable. Failure to assert our needs leads to resignation, resentment, frustration or bitterness to some degree or another. The Chinese regard prolonged or unresolved anger as probably the most destructive emotion to our health and this view is echoed by many westerners who work in the area of psychosomatic health and illness.


It may seem incongruous to list such a pleasant emotion as joy as a cause of disease but both an excess of joy and a dearth are detrimental to the Fire Element and, in particular, the Heart. It has been noticeable in recent years that many of the most famous British comedians – people whose jollity is infectious enough to make millions laugh with them – have died from heart trouble. Many people strive to be constantly jolly as though "having a good time" were the be-all and end-all of social intercourse and this places a strain on the meridians of the Fire Element. Jean-Paul Richter, the German satirist, was perceptive enough to write "No-one is more profoundly sad than he who laughs too much".

Joy is a social emotion. One may be content and happy on one's own, but laughter and joy are usually most evident in the company of other people. Loneliness and isolation can erode a person's joyfulness in such a way as to be deleterious to health. Conversely when a person forms a relationship which brings joy and love into their life, it often reveals the difference that the polarity of unhappiness and happiness can make to a person's health.

Worry and Pensiveness

Worry is frequently the result of dysfunction in the Earth Element and yet it can also be the cause of distress to that Element. Worry can gain a hold in someone's mind; going over the same thoughts over and over again, in such a way as to become damaging to health. Some people almost boast that if they have nothing to worry about they will find something. One of the commentators on the I Jing, the ancient Chinese Classic of wisdom and divination, summed up this syndrome when he wrote "All thinking that goes beyond the present situation only serves to make the heart sore".

Over long periods of time or in acute cases, worry can progress to excessive pensiveness, preoccupation or obsession. Some people become so wrapped up in their thoughts that they find it hard to sleep, to concentrate or to be spontaneous with other people. They become increasingly withdrawn as they retreat into the private world of their own thoughts and concerns. One can see this happen frequently in people whose work requires a great deal of thought or in people who become overwhelmed by their troubles. Worry can lead to depression and anxiety; at worst serious mental illness.

Stomach ulcers (the Stomach is one of the organs of the Earth Element) are considered in the West to occur commonly among people who are prone to worry. Acupuncturists regard ulcers as well as hundreds of other physical symptoms as being often caused by worry. Martin Luther clearly understood the deleterious effects of worry when he wrote "Heavy thoughts bring on physical maladies; when the soul is oppressed so is the body".


Although Western medicine has no understanding of the physiological mechanisms involved, the fact that intense grief can shatter a person's health is well-known in all cultures. It is entirely natural to grieve over the death of someone one loves, but after a time it is essential to one's well-being that the sense of loss should diminish in intensity. Some people still feel the loss of someone as keenly years afterwards as they did in the first few weeks and months. This may be evident to the outsider, as the person may still be overtly grief-stricken. However, it is probably more deleterious if a person fails to express the emotion. A Turkish proverb says "She who conceals her grief has no remedy for it" and certainly it is common for physical illness to arise when a person is unable to express or come to terms with their grief.

Sadness sits heavily on many people. A sense of loss, disappointment, regret and melancholia are forms of sadness which can permeate a person's spirit. These are not emotions that are freely displayed to others, but if the practitioner achieves an intimate rapport with the patient it may become apparent that sadness has caused dysfunction in the Metal Element.


Fear predominantly affects the Water Element, the Kidneys and Bladder organs. Earlier in the article I described how fear affects the body: adrenaline production increases, muscle tone tightens, heart rate and perspiration increase. Bed-wetting among children is an example of a symptom often provoked by fearfulness and the escalating spiral of fear leading to tension and pain in childbirth is now receiving much attention.

A sudden fright is very unsettling and can sometimes leave its mark upon a person's Heart or Kidneys, but chronic anxiety is usually far more destructive. Anxiety and fearfulness are extraordinarily unpleasant states as they can permeate nearly all the situations of a person's life, from waking through to sleeping. A Japanese proverb states "Every little yielding to anxiety is a step away from the natural heart of man" but there often seems to be little an individual can do to overcome these feelings. Fearfulness, like the other emotions, is an aspect of one's spirit and cannot usually be rationalised away by one's mind. For example, in the case of someone who is phobic about spiders it does not matter how often they tell themself that spiders cannot actually harm them, the fear remains just as intense. The feeling of being like a rabbit caught in the headlights, trapped in the dilemma of fight or flight, is played out in subtle ways by millions of people countless times a day.

The Chinese concept of following the "Middle Way", avoiding extremes, is fundamental to their view of avoiding illness and promoting longevity. At the heart of their system of medicine lies the realisation that imbalance of an individual's emotions inevitably leads to imbalance of physical functioning. Sadly, this truth has almost become lost in the scientific revolution in Western medicine which has taken place over the last century. Yet it has been well known to perceptive observers of the human condition in all cultures, and at all times. Charles Peguy, the French man of letters, maintained "When a man lies dying, he does not die from the illness alone. He dies from his whole life."


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About Peter Mole

Peter Mole is the Dean of Studies at the College of Integrated Chinese Medicine, Reading (Tel: 01734 508880). He practises in Oxford and is a member of the Executive Council of the British Acupuncture Council. He is the author of Acupuncture, Energy Balancing for Body, Mind and Spirit.

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