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ETIOLOGY AND

PATHOMECHANISM

Lecture by: M.K. Sastry


 TCM holds that there is no syndrome without cause.
 Any syndrome is a disharmonious reflection of the
body under the influence and action of some
factors.
 Etiology in TCM not only studies the nature and
pathogenic characters of pathogenic factors, but
also probes into clinical manifestations they cause.
 Thecauses are divided into four categories of
exogenous pathogens, endogenous
pathogens, pathogens from pathological
products and miscellaneous pathogens
according to the ways of attack and the
development of disease.
 The pathogens that invade the human
body to cause disease from the outside
via the surface of the body, or/and
mouth and nose.
 They include six climatic pathogens and
pestilent pathogens.
 They are a collective term used for six kinds of
exogenous pathogens of wind, cold, summer-heat,
dampness, dryness and fire.
 They are normal climatic changes in nature and do
not cause disease.
 When the climatic change is sharp or the resistance of
the body becomes weak, the six climatic factors will
become pathogens, causing the body to fall ill.
 They are also refer to as the “six evils”.
 Often connected with seasons and environmental
conditions.
 Wind-disease often occurs inspring;
 Summer-heat in summer;
 Dampness-disease in later summer;
 Dryness-disease in autumn and cold-disease in winter.
 Prolonged stay in a damp environment may contribute
to the invasion of dampness; a high-temperature
contributes to the invasion of dryness heat or fire.
 Each of the six climatic pathogens may cause
disease alone or in mixture with another.
 E.g. wind and cold can invade the body and
cause a common cold, dampness and heat can
cause diarrhea, cold and dampness can cause
“Bi” (arthralgia) syndrome。
 In the pathological process, the nature of a
syndrome caused by the six climatic pathogens
may change under certain conditions.
 E.g. cold may turn into heat after entering the
interior of the body.
 Accumulated summer-heat –dampness in the
body may change into dryness to affect the
body’s level of yin.
 The six climatic pathogens usually invade the
body through the body surface, or the mouth
and nose, or through both simultaneously.
 Clinical practice shows that the six climatic
pathogens also include pathological changes
caused by biological pathogenic factors
(bacteria, virus, etc), physics and chemical
factors that act on the body.
 Wind pathogen mostly invades the body from
the body surface to cause exogenous diseases.
 TCM holds that wind pathogen is a very
important pathogenic factor in causing
exogenous disease.
 Wind is a yang pathogen and is characterized by
dispersal, upward and outward movement.
 Dispersal means that when it invades the body, it
tends to loosen the striae of the skin and muscles,
and open the pores.
 Wind pathogen is apt to invade the upper portion of
the body (head and face) and body surface, and
thus results in headache, sweating, and aversion to
wind.
 Wind is characterized by constant movement
and rapid change.
 “Constant movement” implies that the disease
caused by wind pathogen possess the feature of
migration.
 “Rapid change” denotes that disease caused by
wind pathogen is characterized by sudden
attack and quick transformation.
 Wind is the precursor of exogenous
pathogens causing disease, and other
pathogens usually follow wind to invade the
body.
 Eg wind-cold, wind-heat, and wind-dampness
may attack the body exogenously.
 Cold is prevalent in winter.
 A case in which cold pathogen attacks the body
surface and depresses the defensive-yang is
known as a “cold-attack”;
 While a case in which cold pathogen directly
invades the interior and damages the visceral
yang-qi is called “cold-stroke”.
 Cold is a yin pathogen, and apt to damage
yang-qi of the body.
 Cold is characterized by stagnation,
condensation and obstruction. Invasion of the
body by cold pathogen may cause stagnation of
qi and blood in the meridians, thus giving rise
to various kinds of pain.
 If cold pathogen invades and stays at the blood
vessel, the flow of qi and blood will stagnate,
the vessels will contract.
 If cold pathogen invades the meridians and
joints, the meridians and tendons will tighten
and contract, there may appear spasm and pain
of the limbs and joints and impaired movement.
 Prevails in summer and is a pure exogenous
pathogen.
 It comes from transformation of fire and heat.
 Is a yang pathogen characterized by burning
heat.
 Invasion of the body by summer-heat pathogen
often results in high fever, fidgets and thirst,
flushed face, and a surging pulse.
 Summer-heat is characterized by rising and
dispersion, and apt to consume qi and body
fluid and results in heavy sweating.
 Excessive sweating consumes body fluid and a
shortage of body fluid may in turn lead to thirst,
deep yellow and scanty urine.
 When heavy sweating occurs, qi will escape with
release of body fluid, resulting in qi deficiency. This
may then lead to shortness of breath, lassitude,
collapse, or loss of consciousness.
 Summer-heat often combines with dampness
pathogen to attack the body.
 Besides fidget and thirst, there usually appear
lassitude with a heavy sensation of the limbs, chest
distress, nausea, vomiting, and sticky and loose
stools.
 Dampness is prevalent in late summer, the
period when summer is changing into autumn is
the time of a year with the most humidity.
 Exogenous dampness is a pathogenic factor
invading the body from outside because of
damp climate, being caught in rain, or living in
a damp condition.
 Endogenous dampness is a pathological state
when water-dampness accumulates internally,
which is usually caused by failure of the spleen
in transportation.
 Exogenous dampness and endogenous
dampness often influence each other in onset of
disease
 Dampness is a yin pathogen, apt to damage
yang-qi dynamic.
 When dampness pathogen invades the spleen
and makes the spleen-yang hypoactive, leading
to failure in transformation and transportation,
it will give rise to diarrhea, oliguria and edema.
 When attacking the body and staying in the
viscera and meridians, dampness pathogen is
apt to depress the qi dynamic, leading to
disharmony of qi in ascending and descending
and obstruction of the meridians; there will
appear chest distress, epigastric distention,
dysuria with scanty urine, and dyschesia with
mucosa in the stool.
 Dampness pathogen also cause a heavy
sensation in the head, general lassitude, aching
and a heavy feeling in the limbs.
 Invasion by dampness pathogen mostly leads to
sticky and greasy discharges and secretions.
 Dryness is prevalent in autumn, the atmosphere is
dry and lacking in moisture.
 Dryness invades the body mostly via the mouth and
nose to attack the lung-defense.
 Dryness is yang pathogen and most likely to
consume body fluid, resulting in various dry
symptoms and signs, such as dry mouth and nose,
thirst, dry, rough and chapped skin, dry hair, scanty
urine and constipation.
 Dryness is prone to impair the lung. The lung is
a “delicate organ” and invasion of dryness
pathogen cause the lungs fail in diffusing and
descending with such symptoms as a dry cough
with little sputum, or sticky sputum that is
difficult to be coughed out, blood-tinged
sputum, asthma and chest pain.
 Fire is a yang pathogen characterized by
burning heat.
 Invasion of the body by fire often leads to high
fever, aversion to heat, fidgets, thirst, sweating,
and a surging and rapid pulse.
 Fire pathogen often goes upward to disturb the
heart spirit, marked by fidgets with insomnia,
mania, and even coma and delirium.
 If heart-fire flares up, it will lead to a red
tongue tip, and mouth or tongue ulcers.
 If stomach-fire is flaring, it will cause toothache
with swelling gums.
 If liver-fire flares up, it will result in red eyes
with swelling and pain.
 Fire is apt to stir up wind and cause bleeding.
1. Natural climatic factors: Abnormal changes in the
climate including prolonged drought, flooding,
burning heat, bad fog, and natural disasters such
as earthquakes.
2. Environmental and dietary factors: Air, water and
food pollution.
3. Social factors: Warfare , poverty, social turbulence.

4. Prevention and isolation are not well conducted.


 The seven emotions refer to joy, anger, worry,
thinking, sorrow, fear and fright.
 Sudden, intense or prolonged emotional
stimulation beyond the regulatory range of
physiological activities of the body can cause
disturbance of qi dynamic, disorders of yin-
yang and qi-blood of the viscera, thus giving
rise to the onset of disease.
A Zang-viscus relates generally with an
emotion.
 The heart is associated with joy, the liver with
anger, the spleen with thinking, the lung with
worry, and the kidneys with fear.
 Joy, anger, thinking, worry and fear are
collectively known as the “five emotions.”
 Rage causes qi to go upward. Clinically
flushed face with red eyes, hematemesis, and
even syncope may occur.
 Over joy causes qi to relax.

 Too much joy will make qi sluggish, and the


spirit will be unable to rest, manifesting as
absent-mindedness, and mental confusion.
 Grief causes qi to be consumed.
 Great sorrow will result in depression and
consumption of lung qi, listlessness, shortness of
breath, and lassitude.
 Great fear causes qi to sink.
 Make kidney qi unconsolidated and sink downward.
Clinically there might be incontinence of urine and
feces, soreness and weakness of the bone.
 Prolonged fear also damage the kidney’s essence.
 Great fright causes qi to be disordered.
 Sudden fright may make the heart spirit lose its
house, with presentations of hesitation and panic
 Over-thinking causes qi to depress. Over-thinking
and anxiety may make spleen qi stagnated,
consumes heart-blood and result in loss of
nourishment for heart spirit, manifesting as
palpitation, amnesia, insomnia and lots of dreams.
 Improper Diet
• Immoderate Diet
• Insanitary Diet
• Particular Diet
 Maladjustment of Work and Leisure

• Over-work includes physical over


strain, mental over strain and sexual
overstrain
• Over-ease includes lack of work
and exercise
 Phlegmand Stagnant Fluid
• a result of water metabolism disorder.
• phlegm and stagnant fluid may go to every
part of the body, inward to the viscera and
outward to subcutaneous tissues, resulting
in many disorders.
 Stagnant
Blood
• Refers to stagnated blood held within
the body,.
• Stagnant blood is the pathological
outcome in the progression of a
disease.
 Fetal Transmission Factors
refers to the factors that form during the
developing process of the fetus or inherited from
the parents and cause disease after birth. It may
also be called congenital factors.

 Parasite
◦ Taking in the food contaminated by parasitic
ovum or contacting with polluted water, or
earth may allow the parasite to enter the body,
lodging in the viscera of the body to cause
various diseases.
 Traumatic Injuries:
refers to traumatic wounds, burns and scalds,
frostbite, struck by lightning, drowning, and
injuries by insect or animal.
 Patho-mechanism is the mechanism of onset,
development and change of a disease
 The onset, development and change of disease
are associated with the strength and physique
of the patient and the nature of the pathogenic
factors.
 Patho-mechanism includes three aspects:
The Onset of a Disease Concerns Vital Qi and
Pathogenic Qi.
 Vital qi refers to functional activities (including the
functions of the viscera, meridians, qi and blood)
and the resistance and recovery capacity of the
body.
 Pathogenic qi refers to various pathogens causing
disease, and it is known as the “pathogen”.
 The onset and change is a reflection of the struggle
between the vital and pathogens in a certain
condition.
A deficiency of vital qi is the inner basis of
pathogenesis.
 When vital qi is vigorous, the pathogenic qi
cannot invade the body and disease will not
occur.
 The invasion of pathogenic qi is the important
condition of disease.
 No disease occurs as the vital can defeat the
pathogen.
 Disease occurs as the pathogen defeats the
vital.
1. Relation between the constitution and the vital qi.
• the constitution of an individual depends upon
the innate endowment, dietary nutrition and
physical training.
• lack of food and or malnutrition will decrease the
formation of qi and blood and in turn lead to a
weak physique.
• eating and drinking too much will damage
the spleen and stomach
• over-ease and a lack of exercise will
harm the circulation of qi and blood,
reduce the functions of the spleen and
stomach and ultimately result in a weak
physique.
2. Relation of psychological state to vital qi:
• a relaxed mind and happy feeling contribute
to a smooth movement of qi, harmony of qi
and blood, and cooperative functions of the
viscera, thus, the vital qi will be vigorous.
• when one pays attention to mental
hygiene, keeps an easy mind, and has no
strong desires, then the genuine qi
will be harmonious.
• briefly, deficiency of vital qi is the internal
basis of the onset of a disease.
1. Immediate attack
• a disease immediately occurs after contraction
of a pathogen.

2. Slow attack
• it is closely associated to nature of the
pathogen and the constitutional factor of the
patient
• eg, the dampness pathogen is characterized
by stagnation and viscosity and most of
exogenous diseases caused by it slowly
occur, with a long course
2. Slow attack
• for some old patients whose vital-qi has
already gotten deficient, if they are affected
by exogenous pathogens, the disease often
slowly occurs
• in endogenous disease, pensiveness, great
sorrow, indulgence in sexual life, addiction to
alcohol, and preference for eating fat food with
thick flavors may cause pathological changes
that progressively develop day by day, and
result in obvious clinical symptoms and sign
after a long period.
3. Latent attack
• indicates that after a pathogen invades the
body, it hides in a part of the body, after a
period of time or under the action of a certain
inducing factors, a disease occurs.
• ancient physicians believe that due to the little
impact of the invading pathogen and the vital
qi is deficient, the disease would not
immediately appear;
• the pathogen takes advantage of the deficient
vital qi to hide in the body and to cause
disease later.
4. Secondary attack
• A new disorder occurring based on the primary
disease is called secondary attack.
• Secondary disease must take primary disease as its
prerequisite.
• E.g. a prolonged indigestion with insufficiency of
the spleen and stomach of intestinal parasitosis
in children can produce malnutrition with
accumulation.
5. Relapse
• refers to attack once more or repeatedly
of the primary disease
• is a special type of attack and a reflection
of struggle between the vital and the
pathogen under a certain conditions.
5. Relapse
5.1 The characters of relapse:
• It is the representation of the basic
pathological changes and major
pathological features of the primary
disease
• Relapse of disease mostly is of severer
conditions than the original and the
more times of relapse, the more
complicated the condition
• Relapse of disease mostly has a
certain inducing factors.
5. Relapse
5.2 The factors of relapse
• Relapse due to improperdiet
• Relapse due to overstrain
• Relapse due to abuse of medicine
• Relapse by new affection
• Relapse by other factors ie environmental or
emotional disturbance
• Spontaneous relapse due to insufficient vital qi
and
• existence of the residual pathogen.
1. Superiority or Inferiority of the Vital or the
Pathogen
• Superiority of the vital with decline of
the pathogen
• Superiority of the pathogen with deficiency
of the vital
2. Imbalance of Yin-yang
• superiority of yin or yang
• inferiority of yin or yang
• involvement of yang by yin
deficiency
• involvement of yin by yang
deficiency
• exuberant yin blocks yang
• exuberant yang blocks yin
3. Disorders of Qi and Blood
• Qi deficiency
• Disturbance of qi dynamic
• Deficiency of blood
• Disorder of blood flow
• Blood stasis
• Acceleration of blood flow
• Bleeding
• Qi stagnancy with blood stasis
• Failure of qi to control blood
• Qi deficiency with blood stasis
• Deficiency of both qi and blood
• Qi exhaustion following blood
• Failure of qi-blood to nourish meridian
4. Disorders of Metabolism of Body Fluid
• Water retention with qi stagnancy
• Qi exhaustion following fluid
• Fluid exhaustion with blood dryness
• Fluid shortage with blood stasis
5. Five Endogenous Pathogens
5.1 Production of wind from liver yang
• Is a pathological state resulting from
failure of water to nourish wood with yin
deficiency and yang hyperactivity, which is
mostly caused by emotional injuries and
mental overstrain that consume yin of the
liver and kidney, and thus lead to
undersupply of nourishment for the
tendon and vessels.
5. Five Endogenous Pathogens
5.1 Production of wind from liver yang
• Its clinical manifestations are numbness of
the limbs, tremor, vertigo with a tendency
to fall down, or wry mouth with distorted
eyes, or in a severe case, sudden coma
and unconsciousness.
5.2 Production of cold internally
• It is a pathological state deficiency-cold is
produced internally or yin-cold spreads all
over the body, which is caused by decline of
yang-qi with hypofunction of warming and qi
transforming.
• The development of endogenous clod is
mostly associated with yang qi decline of the
spleen and kidney
• Deficiency of yang qi leads to internal
production of deficiency-cold
5.3 Internal generation of turbid-dampness
• It is a pathological state of internal generation
and accumulation of water, dampness, phlegm
and stagnant fluid, which is caused by
disturbance of distribution and excretion of
body fluid.
• The key of patho-mechanism of the
endogenous dampness lies in disorder of the
spleen in transformation and transportation
5.4 Generation of dryness from fluid
consumption
• The development of endogenous dryness is
mostly due to consumption of yin-fluid in a
prolonged illness, or shortage of yin-fluid
resulting from heavy sweating, serious
vomiting, or diarrhea, or massive loss of blood
and essence, consumption of fluid by
exuberant heat in the process of some
exogenous febrile diseases.
5.5 Generation of fire-heat internally
• It is caused by exuberance of yang, or
yin deficiency with yang hyperactivity,
or transformation of fire from
emotional disturbance.
1. Prevention before a disease occurs
a. Increasing Resistance against Disease
• Taking good care of body
• Cultivating mental health
• Having a proper diet
• Medicinal prevention

b. Avoiding Invasion by Pathogens

2. Treatment before a disease develops


1. Treatment Aiming at the Root of a Disease

2. Strengthening the Vital and Dispelling the


Pathogen.
3. Attaching Importance to the General Condition.
4. Treatment Suitable for the Season, Locality and
Individual.
1.1 Emergency or chronicity of the root or the
branch.
• Treating the branch for emergency.
• Treatment of the root in chronicity.
• Treating the branch and the
root simultaneously.
1. Routine Treatment
• This means to differentiate the disease
nature of cold, heat, excess, deficiency by
analyzing clinical symptoms and signs and
then to apply respectively the different
methods of heating what is cold, cooling
what is hot, notifying what is deficient, and
reducing what is excessive in treatment.
2. Contrary treatment
• In some complicated and serious diseases
manifesting as some false appearances which
are not consistent with the essence.
• On treatment, treating hotness with the
heat, treating coldness with the cold,
treating obstruction with tonics, and
treating openness with purgatives.
• E.g. in the stage of extreme internal heat of
some exogenous diseases, because
predominant yang rejects yin, there may
appear cold sign of extreme cold limbs.
2.1 Strengthening the Vital to Dispel the Pathogen.
2.2 Dispelling the Pathogen to Strengthen the Vital.
2.3 Dispelling the Pathogen before Strengthening the
Vital.
2.3.1 Strengthening the Vital before Dispelling the
Pathogen.
2.3.2 Strengthening the Vital and Dispelling the
Pathogen Simultaneously .
a. Coordinating Yin and Yang
• Eliminating the surplus
• Supplementing the deficient

b. Regulating the Viscera


• Indirectly invigorating and purging.
• Treating sense organs based on the
conditions of Zang-viscera.
c. Regulating Qi and Blood
• Qi and blood are the material foundations
for the functional activities of the viscera
• Qi produces blood
• Qi circulates blood
• Disorder of qi dynamic may lead to
disorders of blood blow
• Qi controls blood
• Blood is the mother of qi
a. Suiting Treatment to the Season.
b. Suiting Treatment to the Locality.
c. Suiting Treatment to the Individual
• Age
• Sex
• Constitution
Thank You

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