Psychosomatic diseases and psychophysiological disorders
Disease Name (English)
psychosomatic diseases
Pinyin
XINSHENJIBINGHEXINLISHENGLIZHANG’AI
Alias
Western medical disease classification code
Psychosis
TCM disease classification code
Western medicine disease name definition
Most diseases are associated with emotional factors, but there are some diseases in which the emotional factors are more obvious, while the biological factors are less clear. In the last decade, only physiological disorders without pathomorphological changes are called psychophysiological disorders, including eating disorders, sleep disorders and sexual dysfunction, while those with pathomorphological changes are still called psychosomatic disorders. This article focuses on psychosomatic disorders. For details, please refer to the relevant entry.
Chinese medicine name interpretation
Western medicine etiology
Causes in Chinese medicine
Season
Region
Population
Intensity and transmission
Incidence
Morbidity mechanism
Psychosocial factors and the psychological and physical qualities of the individual are two important aspects that lead to the onset of the disease. Psychosocial factors refer to various stimuli in an individual’s life, such as death of a relative, divorce, job transfer, etc. The strongest stress reactions are caused by feelings of loss, threat, and insecurity. 903 cases of newly deceased close relatives were reported by Rees et al. in 1967 to have a 7-fold higher mortality rate than controls in their year of residence and bereavement. However, the intensity of the stress response due to life events. It is not primarily dependent on the life event itself, but rather on the individual’s evaluation of the event and the individual’s ability to cope with it. Psychosocial factors cause physiological changes through the following physiological mechanisms: ① Autonomic mechanisms: Stress information is received and integrated by the central nervous system, which sends instructions to the hypothalamus, where it is excited through the sympathetic-adrenal medullary system, releasing large amounts of catecholamines and producing an early response to stress. Sympathetic activity is hyperactive, heart rate is accelerated, blood pressure is elevated, respiration is accelerated, gastrointestinal motility is slowed, and metabolism is increased, accompanied by certain changes in parasympathetic activity. ②Neuroendocrine mechanism: The hypothalamus secretes neurohormones during the stress response, stimulating the anterior pituitary gland to produce ACTH, which in turn promotes the secretion of adrenal cortex, widely affecting the function and metabolism of various systems and appearing as a long-term response to stress. ③Immune mechanisms: Recent studies have shown that psychosocial stress has a significant effect on immune function. The loss of a spouse and catastrophic accidents can cause suppression of immune function for months or even a year, with alterations in both humoral and cellular immunity. However, the same adverse psychosocial stressful event only makes some people sick and affects different organs, the key lies in the susceptibility of the organism, i.e. its psychophysiological quality characteristics. The main theories are: ①Quality vulnerability theory: It is believed that as a result of heredity, certain systems or organs of the body are more vulnerable and therefore susceptible to disease. For example, individuals with high levels of pepsinogen are prone to ulcer disease under stressful conditions. ②Personality type theory: It is believed that psychosomatic diseases have their own specific personality type, and this theory is currently much controversial. One of the more successful studies is the prospective large sample investigation by Friedman and Roseman on type A personality susceptible to coronary heart disease. What has not been clarified, however, is whether type A personality leads to the onset of stress with an enhanced stress response or whether both type A personality and coronary heart disease are determined by qualities. (iii) Emotion and autonomic learning theory: There is fairly good evidence that emotions accompany physiological changes and can form conditioned reflexes or be reinforced by manipulation, and that autonomic responses can be altered by reinforcement to learn new ways of responding. According to Miller’s animal experiments, visceral responses may undergo operant training, thus suggesting that psychosomatic symptoms can be acquired due to broad-based learning.
Chinese medical pathology
pathology
Pathophysiology
TCM diagnostic criteria
TCM diagnosis
Western medical diagnostic criteria
Western medicine diagnosis basis
Generally speaking, the diagnosis of psychosomatic diseases should have the following two basic conditions: ① psychological factors are closely related to the occurrence or worsening of somatic symptoms. ② Somatic symptoms are clear organic pathological processes or known pathophysiological processes. The symptoms of psychosomatic diseases are similar to those of “pure” somatic diseases, both of which are manifested as somatic symptoms, and the difference between the two is mainly in the etiology. For example, renal hypertension is a systemic somatic disease due to renal dysfunction, while primary hypertension is a psychophysiological disease because no biological cause has been found and it has been confirmed that the increase in blood pressure is related to psychosocial factors. Thus, the onset of “pure” somatic diseases is mainly related to biological or physicochemical factors, while psychosomatic diseases are closely related to psychological factors. However, the distinction between the two is sometimes difficult, because almost all physical illnesses can be influenced to some degree by psychological factors. In many cases, the cause of the illness is often not single, but a combination of factors.
Onset
medical history
symptoms
signs and symptoms
The concept of psychosomatic disorders was introduced in the last century, but only became popular in the United States in the 1930s and spread to other countries. The seven “classic” psychosomatic disorders proposed at that time were: essential hypertension, bronchial asthma, ulcerative colitis, hyperthyroidism, peptic ulcer, neurodermatitis and rheumatoid arthritis. All of these are common diseases and their biological causes are not sufficiently clear so far, while the influence of psychological factors is more recognized. By the 1960s and 1970s, the range of psychosomatic diseases was greatly expanded and generally included diseases mainly influenced by the hypothalamus and related to autonomic function: ① cardiovascular system: coronary heart disease, primary hypertension, paroxysmal tachycardia, migraine, Raynaud’s disease. (ii) Respiratory system: bronchial asthma, hyperventilation syndrome, vascular allergic rhinitis, hay fever, etc. ③Digestive system: peptic ulcer, ulcerative colitis, anorexia nervosa, neurotic vomiting, esophageal and cardia or pyloric spasm, etc. ④Genitourinary system: menstrual disorders, libido suppression, impotence, neurogenic polyuria, premenstrual tension, etc. ⑤ Endocrine metabolic system: diabetes mellitus, hyperthyroidism, obesity, psychogenic polydipsia, etc. (6) Skin system: neurodermatitis, pruritus, baldness, atopic dermatitis, chronic urticaria, psoriasis, etc. (7) Musculoskeletal system: rheumatoid arthritis, spasmodic diagonal neck, tension headache, etc. (8) Nervous system: pain allergy, autonomic dysfunction, etc. ⑨ Other: malignant tumor, gestational hypertension syndrome, etc. Examples are detailed below.
Bronchial asthma
Williams et al. studied 487 cases of asthma, of which 29% were mainly allergies, 40% were infections and 30% were psychological factors. Psychological factors are likely to promote asthma in people with high IgE antibodies and bronchospastic qualities. Experimental evidence shows that psychological stimuli can cause bronchial smooth muscle contraction and shortness of breath symptoms, and that increased or decreased airway resistance can be altered by suggestion or conditioned reflexes. Some asthmatics can be conditioned to see a picture of an allergen that can cause asthma. In children with asthma, the parent-child relationship is another psychological factor associated with attacks, and children with asthma often get better after leaving home. Some children have asthma attacks only at home but not at school, even when exposed to the same allergen in both settings.
Primary hypertension
Psychosocial stress can cause arterial constriction and increased plasma renin activity, and anxiety and stress and unfamiliar situations can increase renin secretion, which in turn can cause an increase in blood pressure. It is also believed that fear, anger, and frustration caused by environmental stimuli can cause an increase in arterial blood pressure. Individuals with hypertensive qualities have a greater tendency than the general population to have elevated or sustained increases in blood pressure. Anger seems to be associated with increased systolic blood pressure, and if anger is blocked or if one feels guilty about one’s rude actions, it causes a sustained increase in sympathetic activity, which can progress to a form of primary hypertension characterized by increased plasma renin and norepinephrine levels. The cardiovascular system is sensitive to the stress response. Witnesses to catastrophic events, soldiers in combat, residents of crowded and stressful cities, and people in stressful occupational situations often develop “acute stress hypertension” that slowly subsides over weeks or months. Those with hypertensive qualities, however, will continue to be hypertensive. Thus, at least psychosocial factors play a significant role in some types of essential hypertension. A complex interaction of genetic, academic, personality, dietary and environmental factors can all contribute to a chronic pathological increase in a patient’s blood pressure.
Coronary heart disease
Roseman (1975) studied a large sample of over 3,000 people over 8-9 years and found that Type A personalities were more than twice as likely to have coronary heart disease as others. The opposite is type B. He concluded that Type A personality is the behavior pattern that predisposes to coronary heart disease. Subsequently Haynes (1980) studied a large sample of over 5000 people and came to similar conclusions. 1981 a number of American scientists reviewed the evidence from various studies of coronary heart disease and concluded that in addition to age, systolic blood pressure, cholesterol and smoking, type A personality was a causative factor of no less importance than other factors. It was also found that Type A personalities produce high levels of catecholamines and hormones in response to various stressful events, leading to lipid deposition in blood vessel walls, elevated cholesterol, and accelerated blood clotting that can harm the heart. Psychosocial stress is closely related to coronary heart disease, not only angina pectoris or myocardial infarction can be induced by emotional stress, but also, a study of a group of widowed people found that the number of deaths due to coronary heart disease within 6 months after widowhood was 6 times higher than that of the general population. In particular, a preventive study by Friedman (1982) should be mentioned, in which he used 600 cases who had had a heart attack as an observation group and group psychotherapy once a month, and 600 of the same cases treated by cardiologists only as a control group. At the end of the treatment, the type A behavior of the observation group improved and 7% of the cases had a myocardial infarction, while 14% of the control group had a myocardial infarction. This indicates that psychotherapy has a positive effect on the prevention and treatment of coronary heart disease.
Peptic ulcer
This disease is caused by excessive secretion of gastric acid and damage to the mucosa of the stomach and duodenum. Etiology includes a combination of genetic qualities, diet and emotional stress such as anxiety. Individuals with congenital pepsinogen hypersecretion are susceptible to ulcer disease under stressful conditions. Both animal experiments and clinical studies have confirmed the association between psychological stress and gastric acid secretion activity. Gastric secretion and acidity increase during anger, excitement, anxiety, and fear, and decrease in gastric acid secretion and slowing of gastrointestinal motility during depression, sadness, and disappointment. Chronic emotional anxiety can cause erosion of the congested gastric mucosa. Diet and smoking also have a relationship.
Physical examination
Electrodiagnosis
Imaging diagnosis
Laboratory diagnosis
Blood
Urine
Stool
Cerebrospinal fluid
Other Diagnosis
Immunology
Histological tests
Western Medicine Differential Diagnosis
TCM class evidence differentiation
Efficacy Assessment Criteria
Prognosis
Complications
Western medicine treatment
Because psychosomatic diseases are somatic diseases, it is important to use effective somatic treatment. However, because psychological factors play an important role in the process of onset or development, appropriate psychotherapy, including behavioral therapy and biofeedback training, is also needed to achieve the goals of lasting efficacy, preventing relapse and improving social adaptation. If necessary, anti-anxiety medications can be considered to reduce anxiety, interrupt the vicious cycle, and promote improvement.
Traditional Chinese Medicine Treatment
Chinese medicine
Acupuncture
Tui na massage
Combined Chinese and Western medicine treatment
Nursing
Rehabilitation
Prevention
Historical testimony