- Including six exogenous factors, epidemic pathogenic factors, and internal injury
by seven emotions, improper diet, maladjustment of work and rest, and surgical trauma.
- Traditional Acupuncture is mainly based on the clinical manifestations of diseases,
and inquires into the pathogenic factors through analyzing the symptoms and signs
of diseases, thus providing a basis for treatment.
- This is called "determination of pathogenic factors based on the different presentation
of symptoms and signs".
- The pathogenic factors of diseases could be classified into three categories.
- 1) Pathogenic factors affect the channels and collaterals which further involve
the viscera to cause internal diseases.
- 2) The four limbs and nine orifices are affected by way of blood vessels with pathological
changes transmitted to each other resulting in blocked passage diseases so formed
are through the external skin.
- 3) Includes diseases caused by intemperance in sexual life, incised wounds and bites
and stings by animals and insects.
- Under the three categories, the causes of all diseases can be covered without exception.
- The "Triple-Etiology Doctrine" which classifies three categories of pathogenic factors,
i.e. external invasions by six exogenous factors are exopathic factors; internal
injury by the emotional upset are endopathic factors; improper diet as well as traumatic
injuries including injuries from falls, fractures, contusion and sprain, incised
wounds and injuries by insects and animals are non endopathic / exopathic factors.
- Various pathogenic factors are all exopathic factors, whereas the relative asthenia
of the vital-qi of the human body is the endoexopathic factor.
- Under general circumstances, exopathic factors become operative through endopathic
factors.
- Few common pathogenic factors are dealt with respectively as follows :
Six Exogenous Factors
- Six exogenous factors is a general term for the six climatic conditions in excess
as pathogenic factors: wind, cold, summer-heat, dampness, dryness and fire.
- Under normal conditions, they are actually six normal climatic variations of nature,
and are therefore also called "six natural factors".
- Human beings live in nature and have certain adaptability to various climatic variations,
so the six normal natural factors cannot make people contract diseases.
- But if the climatic variations are too unusual, the occurrence of the six natural
factors is too excessive or insufficient or unseasonable, and if the climatic variations
are too rapid and violent, while the vital-qi of the body is weak and cannot adapt
to the climatic variations of nature, the six natural factors will affect the human
body and cause, diseases.
- The six natural factors under such circumstances are then called "six yin” (six
exogenous factors). “Yin” here implies excess.
- Since six exogenous factors are unhealthy factors causing diseases, they are also
called "six pathogens".
- The common pathogenic characteristics of the six exogenous factors are :
1) Usually related to seasonal climate and residential environments to cause
diseases for instance, spring sees more diseases due to wind.
- Summer, more due to summer-heat.
- Autumn, more due to dryness.
- Winter, more due to cold.
- Living long in damp circumstances it is easy to be affected by dampness.
- While in high temperature circumstances it is easy to get sunstroke.
2) The six exogenous factors can either attack the body separately or simultaneously
with two or more in combination to cause diseases.
- For example, wind – cold type of common cold and wind – cold – dampness type of
arthralgia.
3) Under certain conditions the six exogenous factors can inter transform after
invading the human body.
- For instance, pathogenic cold may transform into heat after entering the body, while
in the course of time summer-heat and dampness may transform into dryness impairing
yin.
4) The six exogenous factors cause some diseases mostly by invading the body
through the skin or the mouth and nose or both, therefore diseases so caused are
called "exogenous diseases".
- From the viewpoint of modern medicine, besides climatic factors, diseases due to
six exogenous factors also include the pathological changes caused by the effect
of biological (bacteria, virus, etc.), physical, chemical and various other pathogenic
factors on the human body.
- In addition, there is also a doctrine called "Five Endo pathogens".
- Which refer to the syndromes similar to wind, cold, dampness, dryness and fire,
due to the functional derangement of the viscera.
- For the convenience of differentiation, they are referred to as endogenous wind,
endogenous cold, endogenous dampness, endogenous dryness and endogenous fire.
- They are discussed together with the six exogenous factors in the following.
1) Wind
- Wind prevails in spring but there is wind in all the four seasons.
- Though diseases due to pathogenic wind occur frequently in spring they are not limited
to spring only.
- Pathogenic wind is differentiated into exopathic wind and endogenous wind.
- Exopathic wind results mostly from the excess of pathogenic wind and is a very important
pathogenic factor in diseases produced by exopathogens.
- Endogenous wind is mostly caused by the functional derangement of the liver.
- So the Plain Questions says "All tremor and dizziness due to pathogenic wind are
caused by the disorder of the liver."
- The nature and pathogenic characteristics of pathogenic wind are as follows :
a) Pathogenic wind is apt to move and tends to rise, disperse, move upward and
outward, and is thus of yang nature.
- When pathogenic wind attacks, it tends to break the barrier of skin, causing such
symptoms as aversion to wind and perspiration.
- Pathogenic wind usually attacks the upper part of the body (head and face), skin
and muscle, causing headache, dizziness, deviation of the eye and mouth and the
like.
b) Pathogenic wind is apt to migrate and change.
- By "emigrate" it means when pathogenic wind attacks the body, the resulting symptoms
or the locations of diseases tend to be unsteady and migratory.
- For example, in wind arthralgia the pain in the joints of the limbs is wandering.
- By "change" it means diseases caused by pathogenic wind usually occur rapidly and
are capricious and variable.
- For example, a person suffering from apoplexy often faints and loses consciousness
suddenly; in urticaria skin itching occurs in no fixed places, coming here and there.
c) Domination of pathogenic wind may lead to mobility.
- • This means the symptoms and signs of diseases due to pathogenic wind are characterized
by vibration and involuntary movement, such as tremor, convulsion and vertigo.
d) Pathogenic wind is the leading pathogen causing all diseases.
- Wind is the most important pathogenic factor among the six exogenous factors.
- It is the first agent of the exogenous pathogenic factors to cause diseases.
- Other pathogenic factors mostly attach themselves to wind to invade the human body,
as in wind-cold syndrome, wind-heat syndrome and wind-dampness syndrome.
2. Cold
- Cold prevails in winter and exists also in other seasons.
- Pathogenic cold is differentiated into exopathic cold and endogenous cold.
- Exopathic cold refers to the environmental pathogenic cold.
- Endogenous cold refers to the pathological manifestation of the deficiency of yang
qi and loss of warmness.
- The two are both differentiated and related.
- A body with yang deficiency and internal cold is liable to be affected by exopathic
cold; and if exopathic cold enters the body and accumulates in the course of time
without dispersion, it will impair yang qi and result in endogenous cold.
- The nature and pathogenic characteristics of pathogenic cold are as follows:
a) Pathogenic cold is a yin pathogen and tends to impair yang qi.
- Cold is of yin nature, so when pathogenic cold incurs diseases it is most liable
to impair the yang qi of the human body.
- For example, when pathogenic cold invades the superficial portion of the body and
the defensive yang is checked, aversion to cold may appear; when pathogenic cold
attacks directly the spleen and stomach and the middle-jiao yang is thus impaired,
abdominal cold pain may come on.
b) Pathogenic cold is coagulative and obstructive in nature.
- When pathogenic cold attacks the human body, it may block or coagulate qi and blood
in the channels and impede their flow, causing various kinds of pain.
c) Cold causes constriction.
- When pathogenic cold enters the body it may cause the functional activities of qi
to constrict and cause the muscular striae, channels and collaterals and tendons
to contract and thus incur contracture and spasm.
- For instance, when pathogenic cold attacks the body surface, the sweat pores and
muscular striae will be closed and contracted, the defensive yang will be stagnated
and prevented from going outward, bringing on aversion to cold with fever and anhydrosis;
if pathogenic cold invades the channels and collaterals and joints, there will occur
muscular cramp and retarded flexion and extension of joints.
3. Summer-heat
- Summer-heat prevails in summer.
- It is transformed from fire and heat.
- Summer heat is a pure exopathogen,
- Its nature and pathogenic characteristics are as follows:
a) Summer - heat is a yang pathogen and is scorching hot in nature.
- Sumer heat is transformed from summers scorching heat so of yang nature, and is
thus a yang pathogen.
- When pathogenic summer-heat attacks the body, there tends to appear such symptoms
as high fever, upset, flushed face and full rapid pulse.
b) Summer-heat tends to rise and disperse.
- It exhausts qi and impairs the body fluid.
- Pathogenic summer-heat usually brings on diseases by opening the striae of skin
and the body fluid, resulting in thirst and desire for drinking, dryness of the
lips and tongue, and scanty dark urine.
- Together with profuse perspiration, qi is also lost with the body fluid, resulting
in deficiency of qi and causing shortness of breath, lassitude, and even sudden
fainting and loss of consciousness.
c) Summer-heat is usually accompanied with dampness.
- Summer is a hot, rainy season, so pathogenic summer-heat is usually accompanied
with dampness to cause diseases.
- Apart from such summer-heat symptoms as fever, thirst, the clinical manifestations
are often accompanied with lassitude of the limbs, chest distress, vomiting, nausea
and sticky loose stool.
4) Dampness
-
Dampness prevails in late summer.
- Late summer is a time when summer is changing into autumn, a season when dampness
is the most exuberant in the year, so in this season it is easy to contract diseases
due to dampness, which may also incur diseases in other seasons.
- Pathogenic dampness is differentiated into exopathic dampness and endogenous dampness.
- Exopathic dampness is usually due to damp climate, wading in water or being caught
in a rain, as well as damp dwelling environments.
- Endogenous dampness is usually caused by the dysfunction of the spleen in transportation
leading to the impairment of water metabolism.
- Exopathic and endogenous dampness can influence each other and are interdependent.
- The nature and pathogenic characteristics of pathogenic dampness are as follows:
a) Dampness is heavy and turbid in nature.
- Heaviness in a damp disease is usually marked by heavy sensations as lassitude,
heavy sensation of the head and body, and aching and sluggishness of the limbs.
- As turbidness is concerned, a damp, disease is usually marked by turbid excreta
and secreta such as much facial filth and eye secretions, loose stool or mucous
stool with pus and blood, turbid urine, excessive leucorrhea and turbid pyogenic
fluid.
b) Dampness is viscous and lingering in nature, which is manifested in two aspects:
- In one aspect, the symptoms of a damp disease are usually of slimy and greasy feature,
for instance, slimy and greasy fur, mucous difficult stool and difficult urination;
in the other aspect, a damp disease has a long course and is often lingering and
difficult to cure, as can be seen in damp arthralgia, eczema and damp-warm syndrome.
c) Dampness tends to go downward
- The symptoms of a damp disease are mostly found in the lower part of the body, such
as leucorrhea with turbid urine, diarrhea and dysentery.
- Dampness is a yin pathogen which tends to obstruct the functional activities of
qi and impair yang qi.
- Dampness is heavy and turbid, and is similar to water in nature, thus is defined
as a yin pathogen.
- When pathogenic dampness attacks, it is most liable to lead to the disorder of the
ascending or descending ability and digestive functions of qi.
- For example, when there is retention of dampness in the epigastrium and impediment
in the functional activities of qi, there will appear distress in the chest; when
dampness blocks the spleen and stomach and cause dysfunction of the spleen in water
circulation as well as the disturbance of the spleen-qi to ascend and the stomach-qi
to descend, there will appear anorexia, epigastric distress, nausea, vomiting and
loose stool.
- As dampness is a yin pathogen which tends to impair yang qi, when it disturbs the
spleen, the spleen yang will be insufficient, and then there will be dysfunction
of the spleen in fluid transportation and transformation and retention of dampness
within the body, resulting in diarrhea, edema, difficult urination and the like.
5) Dryness
- Dryness prevails in autumn.
- Autumn is a dry season with shortage of water.
- Dryness diseases are most likely to occur in such a season.
- Pathogenic dryness can be divided into exopathic dryness and endogenous dryness.
- Diseases caused by exopathic dryness are mostly due to affection by environmental
dry pathogens.
- Exopathic dryness is subdivided into warm dryness and cool dryness.
- Warm-dryness is mostly found in early autumn, formed by the remaining heat of late
summer and pathogenic dryness in combination.
- Cool-dryness is mostly found in late autumn, formed by the pathogenic cold of approaching
winter and pathogenic dryness in combination.
- When exopathic dryness attacks the human body it usually invades from the mouth
and nose and afflicts the defensive qi and the lung, forming exterior syndrome.
- Endogenous dryness mostly results from the exhaustion of essence and blood by lingering
diseases, the consumption of body fluid by febrile diseases, improper treatment
and loss of blood.
- The nature and pathogenic characteristics of pathogenic dryness are as follows:
1) Pathogenic dryness is dry and tends to impair the body fluid
- When pathogenic dryness attacks, various forms of symptoms and signs presenting
deficiency of body fluid and dryness are most likely to appear, such as dryness
in the mouth and nose, dryness of the throat, thirst, dryness of the skin, oliguria
and constipation.
2) Pathogenic dryness tends to impair the lung.
- The lung is a delicate organ which prefers moisture to dryness and is vulnerable
to the attack of dryness.
- The lung is related to the skin and hair of the body surface and has its specific
orifice in the nose, so pathogenic dryness usually attacks through the mouth and
nose and is most liable to impair the lung, causing such symptoms as dryness of
the nose and throat, dry cough with little phlegm, dyspnoea or asthma and chest
pain.
6) Fire
- Fire is different from warm and heat though they are of the same nature.
- Warm and heat are both referred to as pathogens, they are different only in degree
and are the same in nature.
- So they are often mentioned together.
- Fire has two meanings:
- One refers to the vital-qi in the human body and is called "junior fire" in The
Yellow Emperor’s Canon of Internal Medicine; the other refers to a pathogen called
"sthenic fire".
- Pathogenic fire is divided into exopathic fire and endogenous fire.
- Affection by exopathic fire is mostly caused direct by the invasion of external
pathogenic warm and heat; endogenous fire usually results from the excess of visceral
yang qi, as it is said: "The excess of qi is fire."
- In addition, affections by various exopathogens such as wind, cold, dampness and
dryness or mental irritation can all transform into fire under certain conditions.
- The nature and pathogenic characteristics of pathogenic fire are as follows:
1) Fire tends to burn and scorch.
- When pathogenic fire causes diseases, there often appear such symptoms as high fever,
flushed face, blood-shot eyes, and aversion to heat, desire for the cool, constipation,
dark scanty urine and red tongue with yellow fur.
2) Fire tends to flare up.
- Symptoms caused by pathogenic fire tend to appear on the upper part of the body,
for instance, on the head and face.
- For example, when heart-fire flares up, reddened tongue-tip tends to appear; when
stomach-fire exuberates and flares up, painful swollen gum may appear; when liver-fire
flares up, congested swollen eyes with pain may occur.
3) Fire tends to impair the body fluid and consume qi.
- When pathogenic fire attacks, it tends to force the body fluid to leak out and scorch
the fluid, impairing and consuming yin fluid, so it is often accompanied with symptoms
of fluid impairment.
Pathogenic characteristics of seven emotions
- The seven emotions are different from the six exogenous factors in causing diseases.
- The six exogenous factors usually invade the body through the skin, mouth and nose,
and it is exterior syndrome that mostly appears at the early stage of the onset.
- However, the seven emotions directly affect the corresponding viscus to bring on
diseases, as the Plain Questions says:
- "Anger impairs the liver".
- "Joy impairs the heart".
- "Anxiety impairs the spleen".
- "Melancholy impairs the lung".
- "Fear impairs the kidney".
- As the heart controls mental activities and is the arch-governor of the five zang
organs (or the five viscera) and six fu organs (or the six bowels), the Miraculous
Pivot says: "Excessive grief; sorrow, worry and melancholy will affect the heart,
when the heart is affected, the five zang-organs and six fu-organs will all be stirred
in accordance.
- The seven emotions mainly affect the functional activities of the visceral-qi to
impair the viscera.
- The Plain Questions says: "Rage causes adverse upward flow of the liver-qi.
- Excessive joy relaxes the heart-qi.
- Excessive sorrow leads to the consumption of qi.
-
Fear causes the sinking of the kidney-qi.
- Fright interrupts the flow of qi.
- Anxiety causes the stagnation of the spleen-qi.
- Emotional stimuli may cause the functional derangement of visceral-qi which can
lead to changes of emotional moods.
- The Miraculous Pivot says: "The deficiency of the lives-qi causes fear, whereas
the excess of the liver-qi will cause anger."
- "The deficiency of the heart-qi causes grief; whereas the excess of the heart-qi
will cause ceaseless laughing".
- The seven emotions can not only cause diseases but also aggravate them.
- In the course of many diseases, the condition of illness often deteriorates as the
result of severe fluctuation of the patient’s moods and emotions.
- So traditional Acupuncture pays great attention to the mental consolation and care
about the patients, to prompt the diseases to turn toward a favorable side.
Diet, Work and Rest
- Diet, work and rest are the fundamental conditions for human beings to live and
maintain good health.
- Improper diet and maladjustment of work and rest will affect the physiological functions
of the viscera and reduce the organism's resistance to diseases, thus becoming pathogenic
factors.
Retention of Phlegm and fluid, and Blood stasis
- Retention of phlegm and fluid is characterized by accumulation of dampness as a
pathological product resulting from disturbances of water metabolism.
- Traditional acupuncture classifies the thicker turbid dampness as phlegm and the
thinner clearer one as fluid.
- Retention of phlegm and fluid is; further differentiated into concrete and formless
ones.
- Concrete retention of phlegm and fluid refers to the visible, palpable and audible
parenchymatous phlegm and fluid, whereas formless retention of phlegm and fluid
refers to the various conditions caused by the retention, such as dizziness, chest
tightness, manic-depressive psychosis, subcutaneous nodule and scrofula, characterized
by greasy fur and slippery pulse.
- It is so called "formless phlegm" because this kind of "phlegm" only shows its symptoms
but has no concrete form and can be cured by methods of eliminating phlegm.
- Retention of phlegm and fluid is mostly due to affection by the six exogenous factors
or improper diet, or internal damage by the seven emotions.
- These etiological factors bring forth dysfunction of qi of the lung, spleen, kidney
and sanjiao with disturbance of water-fluid metabolism, resulting in accumulation
of fluid within the body.
- Once the retention is formed, it can follow qi to circulate, inward into the viscera
and outward to the skin, muscle, tendon and bone.
- It can actually reach everywhere and cause a number of diseases.
- For instance, stagnation of phlegm in the lung may cause cough with dyspnea and
expectoration; phlegm stagnation in the heart may cause palpitation and chest oppression;
mental confusion due to the invasion of phlegm to the heart may cause coma and dementia;
accumulation of phlegm in the middle jiao may cause epigastric fullness, vomiting,
nausea and dizziness; stagnation of phlegm in the channels and collaterals may lead
to numbness of the limbs„ difficult flexion and extension, and even hemiplegia;
stagnation of phlegm in the tendon.
- Pathogenic fluid has different manifestation in accordance with its stagnation in
different parts of the body.
- As Synopsis of Golden Chamber says: "A person who used to be in good health is now
very thin; if fluid flows in the intestines and makes audible noises, we call it
phlegm retention (in the narrower sense); if fluid flows in the hypochondrium and
causes hypochondriac pain with cough and spitting, we call it pleural effusion;
if fluid circulates in the four limbs, causing anhydrosis when perspiration is expected
and leading to pain of the body, we call it diffuse fluid-retention; when there
is cough with dyspnea, shortness of breath, inability to sleep and edema, we call
it excessive fluid in the chest and hypochondrium."
Blood Stasis
- Blood stasis is a pathological state resulting from the reverse or impeded flow
of blood in the body or the stagnation of blood flow in local parts as well as abnormal
blood outside of the vessels, which remains in the body and fails to disperse.
- As soon as blood stasis is formed, it can further affect the circulation of blood
and lead to new pathological changes, causing a variety of diseases and syndromes.
- So it is also one of pathogenic factors.
- Blood stasis is formed in two ways.
- In one way, it results from the impeded circulation of blood caused by deficiency
of qi, stagnation of qi, blood-cold and blood-heat, etc.
- For instance, deficiency of qi results in weak circulation of blood, stagnation
of qi results in impeded circulation of blood, blood-cold results in coagulation
of blood, and blood-heat results in the viscousness of blood. All these may impede
the circulation of blood and cause blood stasis.
- In the other way, blood stasis is caused by abnormal blood outside of the vessels
due to trauma or other reasons which fails to disperse and remains in the body.
- Blood stasis has different clinical manifestations in accordance with its stagnation
in different parts of the body and the various reasons for its formations.
- For instance, blood stasis in the heart-vessels may lead to palpitation, chest tightness
and precordial pain; stasis in the lung may lead to chest pain, cough with dyspnea
and hemoptysis; stasis in the stomach may lead to stabbing pain in the stomach and
tarry stool.
- Stasis in the liver may lead to costalgia and hepatomegaly; invasion of blood stasis
to the heart may lead to mania; stasis in the uterus may lead to pain in the lower
abdomen, dysmenorrhea, amenorrhea, purplish red black and lumpy menstruation, or
metrorrhagia and metrostaxis; stagnation of blood stasis in the terminal of the
blood vessels of the extremities may lead to gangrene of finger and toe; stagnation
of blood stasis in the local parts may cause local swelling, pain and cyanosis.
- Though diseases caused by blood stasis are many and diverse, their clinical manifestations
can be summed up as follows:
- Stabbing pain, cyanosis, tumor, bleeding (dark purplish blood with blood clots),
dark complexion, squamous and dry skin, purplish dark tongue or with petechiae,
ecchymosis, thready and uneven pulse, knotted pulse or intermittent pulse.