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Top Questions I get as a Chinese Physician: #3 What cause my illness?

Updated: Jul 8, 2023



This is the second most question I often encounter after “When will I recover”. It is natural for people to want to know the cause of their illness or problem. There are myriads of diseases so it is impossible for me to go through every single cause but I can give an overview from the TCM perspective so you can have a better idea on what caused your illness.

Before I go on, first understand what is ”Zheng Qi” (正气 zhèng qì) and Evil Qi (邪气 xié qì) and how this relates to the occurrence of diseases.

How disease occurs in TCM

Zheng Qi refers to Qi that protects and defends us from external pathogenic factors or invaders. Evil Qi is often misunderstood as some form of spiritual or superstitious force because 邪 xié is literally translated as evil or demonic associated to shamanic practices. However, Evil Qi (邪气 xié qì) simply refers to pathogenic factors or invaders that cause one to fall sick. As the TCM proverb ”正气内存,邪不可干”goes, it generally means a person with sufficient Zheng Qi is able to protect itself against the Evil Qi or pathogens. A person with strong Zheng Qi tend to have stronger defense against Evil Qi or pathogenic factors and hence, less susceptible to falling sick. A stronger Zheng Qi also meant the person can recover faster. On the other hand, a person with weak Zheng Qi would be susceptible to Evil Qi, falls sick easily and recovers slower. That explains why even within a same household, certain members tend to fall sick or recover slower while some don’t fall sick easily or recover faster. However, if Evil Qi becomes too strong such as in the case of epidemic, a person with sufficient Zheng Qi can also fall sick when attacked. With the understanding that disease occurs due to conflict of Zheng Qi and Evil Qi, let’s learn about Evil Qi, or disease causing factors. In TCM, there are 3 major categories of causes:

A. External:

1. Six Exogenous Pathogens (六淫邪气 liù yín xié qì)

2. Pestilence or Epidemic (疬气 lì qì)


B. Internal:

1. Improper diet

2. Emotional imbalance

3. Improper lifestyle habits


C. Other Causes: traumatic injuries, accidents, cuts, burns, ice burns, insect bites, mistreatment



A. External causes


1. Six Exogenous Pathogens


The Six Exogenous Pathogens are pathogenic factors related to climatic or seasons in nature or living environment. It also describes the characteristics of the symptoms caused by the respective pathogenic factors. They are:


a. Wind 风 fēng

b. Cold 寒 hán

c. Dampness 湿 shī

d. Dryness 燥 zào

e. Fire (Heat) 火 hûo

f. Summer-heat 暑 shû


Our living environment, seasons and climate often determines the type of pathogenic factor that we are prone to getting. The Six Exogenous Pathogens may invade individually or in combination with other factors. In seasonal countries, Wind-Heat (风热 féng rè) is predominant during Spring, Fire 火 or Summer-heat and Dampness 暑湿 during Summer, Wind-Cold (风寒 féng hán) or Dryness 风燥 during Autumn and Cold 寒邪 during Winter. In our local context, Singapore is a tropical country with hot and humid weather and hence Wind-heat (风热 féng rè), Damp-heat 湿热 and Fire 火邪 are common pathogenic factors. However, we also need to consider living environment. Most places are now air-conditioned in Singapore and hence Cold 寒邪 or Cold-dampness 寒湿 is common too. In addition, our body constitution also plays a part in determining the kind of pathogenic factors that we are prone to. For example someone who has internal heat in body or deficient in Yin are prone to Yang pathogenic factors and tend to exhibit symptoms of heat, Dryness or Fire. Let’s see how each pathogenic factor manifest itself in our body: Wind is a Yang pathogenic factor that often combines with other exogenous factors. It is light and tends to ascend or move outwards. Hence, the Wind pathogen tends to attack the upper part of the body and manifests as headaches, sore throats, blocked or runny nose. It also has the characteristic of moving restlessly and exhibit symptoms such as spasms, convulsions, dizziness or running pain spots. Cold is a Yin pathogenic factor that tends to weaken Yang in our body. It may invade our Defensive Qi (wèi qì) at body surface, resulting in aversion to cold or inability to sweat. It can also invade internal Yang Qi, causing our body to lose warming properties and result in cold limbs. Coldness tend to slow down movement and contract, resulting in blocked flow of Qi and Blood, causing aches and pain in the body. Dampness is a Yin pathogenic factor that is turbid and heavy. It tends to cause feeling of heaviness or stickiness in body, sleepiness, sticky stools or phlgem. It tends to inhibit flow of Qi and affects the Spleen organ (in charge of digestion) and often manifests as congestive symptoms or fluid build-up e.g. bloatedness, lack of appetite, swollen limbs. As dampness tends to move downward or sinks, it often affects lower part of the body or cause discharges e.g. diarrhoea or lower limbs water retention. Since Dampness has character of heaviness and tends to impair the Spleen organ that is crucial in producing vital substances that nourish our body, Dampness tends to be a stubborn problem that takes a long time to heal. Dryness is associated to Autumn season and can occur as Warm-Dryness (温燥 wen zào) during early autumn and Cool-Dryness (凉燥 liáng zào) in late autumn. It tends to invade the Lung organ which also corresponds to the Autumn season. Hence, people with weak Lung tend to suffer respiratory problems during the Autumn season. Dryness tend to exhibit as dry skin, thirst or dry throat, dry cough with scanty phlgem, nose bleed and dry stools. Fire is a Yang pathogenic factor that is also referred as Heat. Different degrees of heat are represented by Warm 温, Heat 热, Fire 火 and extreme heat known as Toxic Fire 火毒. It is a Yang pathogenic factor that tends to flare up and manifests as warm or hot feeling all over the body or particularly upper part of body, high fever, thirst, sore throat, swollen tonsils, red face, bloodshot eyes, nosebleed. Heat also tends to expend Qi and Yin or body fluids and tends to cause dehydration, thirst, dry throat or skin and yellow urine. As Heat also tends to expand and cause swelling, it often results in mouth ulcers. Summer-heat is similar to Fire (Heat) but occurs particularly during Summer. Apart from being similar to Fire (Heat), Summer-Heat can disturb the mind, causing one to feel dizzy or even faint. It is often combined with Dampness and exhibit as vomiting and loose stools. Unlike Western medicine in which the prescription can be pretty standard for cough, cold or flu, TCM prescription differs according to the syndrome as one maybe having Wind-Heat 风热 and the other Wind-Cold 风寒. Additionally, one has to consider the severity of disease (or stage of disease) and body constitution so prescriptions may not always be the same for two individuals who are down with the same flu. It is common to see people with weak constitution e.g. weak Lung Qi (肺气虚 fèi qì xū) suffer cough or flu for extended time that can occur for weeks or months or respiratory infections that recur within months. For such people, cough syrup or antibiotics may not work for them. Instead, they would need some herbs such as Astragalus root (黄芪 huáng qí) that can help to boost their Zheng Qi (body resistance to pathogens) to fight against the infection (Evil Qi 邪气 xié qì). However, we should bear in mind that not every case of extended cough or flu is the result of deficiency and so you should not be taking tonifying herbs blindly. For many times, it could also be the result of not clearing the problem completely and combination of poor diet and lifestyle factors that promote Evil Qi (邪气 xié qì). Five Endogenous Pathogens known as Wind 风、Cold 寒、Dampness 湿、Dryness 燥、Fire (Heat) 火 behave similarly to the Six Exogenous Pathogens except that it is caused by the imbalances of our internal organs. This is too much to cover in today’s topic so I will share about it next time. 2. Pestilence


Pestilence refers to highly contagious or severe epidemic diseases in which Evil Qi becomes so strong that it overpowers even people with sufficient Zheng Qi. Examples include small pox, cholera, scarlet fever and in most recent case, COVID-19. B. Internal Causes


Now let’s move on to Internal causes, which has largely to do with our diet, lifestyle, and emotions. Improper diet, lifestyle habits or unbalanced emotions can cause imbalances to our body, resulting in symptoms or illness. Let’s breakdown into each category and understand how it affects our body. 1. Improper Diet: As a modern-day TCM physician, I agree that a healthy meal consist of balanced proportions of carbohydrates, protein, fats, vitamins and minerals to support body’s daily nutritional needs. However in TCM, food are also characterised by thermal nature, flavours and functions that work on internal organs (through meridians 经). Thus, overeating a particular food may cause body imbalances especially if it is not suitable for your body constitution. Very often, the thermal nature of food affects the balance of Yin and Yang in our body, causing Heat or Cold changes that may manifests into symptoms. For example, a person who eats too much hot food such as chilli, durian or fried chicken tends to cause heatiness that often presents as dry or sore throat, thirst or dry stools. On the other hand, a person who tends to eat cold stuff such as watermelon, ice cream, cold desserts tend to get cold limbs which can impact the Yang energy of Spleen and Stomach, causing digestive problems or weight gain in the long run. Apart from thermal nature, overindulgence in particular flavour, overeating or under eating, intake of contaminated food can also result in imbalances or disease. 2. Improper lifestyle habits: This comes in many ways but I will touch on common ones. Many people tend to work long hours and sleep late. Working long hours tend to expend Qi and Blood, which are vital substances that nourish our internal organs for sustaining life. Coupled with insufficient rest and/or improper diet, lack of Qi and Blood in the long run can cause the organs to be malnourished and result in imbalances. Late night sleep also tend to cause Heart and Liver Fire that manifest as sore throat, thirst, headache and bloodshot or blurry eyes. Other improper lifestyle habits includes overindulging in sexual activities, masturbation that may cause Kidney deficient (reproductive issues). It can also come in smaller ways such as insufficient water intake that often results in Heat in Bladder (UTI) or Kidney Yin deficiency. Stagnated Qi occurs when people glance at computer screen or read for extended period of time, resulting in vision problems, aches and pain of neck, shoulder and back. On the other hand, being too inactive can also inhibit flow of Qi and Blood or even cause pathological products such as Phlgem or Dampness. 3. Emotional factors: There are seven emotions: Joy, Anger, Worry, Anxiety, Grief, Fear and Fright which are psychological responses. When the emotion is too sudden or excessive, it can impair our internal organs or cause imbalances in body. In TCM, the Heart rules all emotions and each organ is associated to an emotion. Anger to Liver, Joy to Heart, Worry or Anxiety to Spleen, Grief to Lungs and Fear to Kidney. Most people are constantly in stressful conditions and are often in worry or anxiety state that affects the Spleen and Liver. When combined with late sleep habits, this tends to affect the Liver organ that may exhibit as Liver Fire or result in “Liver overriding Spleen” (肝木克脾土) which cause imbalances to Spleen (Liver is associated to Wood element that tends to inhibit Spleen that is associated with the Earth element). Hence, it is often common to see people under stress with poor appetite, indigestion, bloated stomach, acid reflux, constipation or loose stools.


C. Other Causes: This last part is pretty straightforward. For most non-urgent cases, TCM has its own way of treating that could work pretty well e.g. sprains or strains, minor cuts, insect bites. However, TCM has its limits and when it comes to emergency cases e.g. major traumatic injury, fractures, sudden cardiac arrest, massive bleeding, it is best to be attended in acute hospitals where it is better equipped to treat the problem. As a modern-day practicing physician, it is important to keep ourselves updated and well-informed of western medical advances and technologies. While we keep to the root of Chinese medicine philosophies and practices, knowing and understanding disease from Western medicine perspective is also important so we can better manage the disease or avoid adverse interactions! I hope this article has been useful to help you understand your condition in TCM context. However, I have yet to cover much about imbalances of internal organs or syndrome diagnosis which often is the main concern of most patients. If you have a medical condition, please visit a licensed practitioner for a personal consult and accurate diagnosis for your problem!

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