Etiology

 TCM holds that body keeps a dynamic balance

between the internal and external environments
owing to the relationships of opposite and unity
among them.
 Such dynamic balance maintains the physiological
activities of the body.
 If the dynamic balance is damaged and cannot be
immediately restored, it will lead to the occurrence
of disease.
 Etiology
 isdefined as various kinds of factors that
cause diseases.
As TCM sees it, etiology mainly includes
 Exogenous factors

 Endogenous factors

 Certain-case factors
 To be more specific
 six pathogenic factors invading the body from the
outside pertain to exogenous factors;
 seven emotions directly involving the internal
organs are attributed to endogenous factors;
 other pathogenic factors, such as improper diet,
overwork, traumatic injury, insect and animal bites,
etc. , are said to certain-case factors.
 The exogenous factors
 are a general term for wind, cold, summer-heat,
damp, dryness and fire.
 Under normal conditions, these are six climatic
changes indispensable to the growth of all living
things in the nature. TCM calls them the "six Qi."
 They are not harmful to human beings
 And will not cause diseases normally.
 six environmental excess
 However, when the six Qi become too
excessive or deficient,
 or when the body's resistance is too weak to
adapt itself to the abnormal changes,
 the six Qi will be changed into the
pathogenic factors to attack the human
body from outside and cause diseases.
 They are known as "six environmental
excess” or “six evil Qi”.
 Diseases due to the six exogenous pathogenic
factors are marked by certain features.
2. First of all the six exogenous pathogenic factors
are often related to seasonal changes in
weather and to the living environment.
 Diseases due to pathogenic wind often occur in
spring because it is windy in spring.
 Diseases due to pathogenic damp happen most
often during late summer and early autumn.
 Summer-heat diseases are mostly present in
summer.
 Diseases due to pathogenic dryness are
happen most often in autumn.
 Diseases due to pathogenic cold are
happen most often in winter.
 Work under high temperature usually brings
about diseases related to dry-heat or fire.
2.disease is not always the result of an attack
by a single climatic factor
 It often more than one factors may invade the
body at the same time.
 For example
 Certain common colds are the result of an attack
by both pathogenic wind and cold.
 Diarrhea can be the result of pathogenic damp
and heat dumping into the large intestine.
3. Exogenous factors attack the inside of the body
via the body surface or via the mouth and nose
mostly.
 The concept of six pathogenic factors includes the
idea of bacteria, virus, and physical and chemical
pathogenic factors.
 In fact, the six pathogenic factors are used to
generalize all the pathogenic factors from outside.
 Wind
 Is the predominant Qi in the spring,
 Although pathogenic wind and the diseases
it causes are not confined to spring.
 They can occur in any season.
 Wind
Wind is Yang in nature
 It often attack the upper part of human body
(head, face)
Rapid onset and swift changes in condition
 For example, urticaria itching now here and there,
it disappear suddenly and then start again.
Wind is the head of pathogenic factor
 It is the most important pathogenic factor that
attack human body, and other pathogenic factors
often attach themselves to pathogenic wind.
 Main manifestation
 Fever
 Aversion to cold
 Headache
 Sweat
 Cough
 Nasal discharge
 White thin tongue coat
 Superficial slow pulse
 Numbness
 Stiffness
 Convulsive spasm in the limb
 Skin itching
 Cold
 Is the predominant Qi in the winter,
 In winter, being exposed to the cold after
sweating, caught in the rain, wading in the
water
 All predisposes the individual to attack of
pathogenic wind.
 Cold
 Cold is Yin in nature
It is easily hurt Yang Qi and attack the lower part of human
body
 Cold is congealing and sluggish
 In normal state, the circulation of Qi, blood and body fluids
depend on the warming and moving function of Yang Qi.
 If the pathogenic cold impair the warming and moving
function of Yang Qi, the circulation of Qi, blood and body
fluids will become sluggish and congeal.
 Cold is a contractile factor
Because of congealing nature, it makes tendons, channels,
and vessels tightened, so it may cause contraction and
spasm in the limbs.
 Main manifestation
 Fever
 Aversion to cold
 Headache
 General pain
 Cough
 White thin tongue coat
 Superficial tense pulse; very weak pulse
 Convulsive spasm in the limb
 Cold in limbs
 Abdominal pain
 Borborygmus
 Diarrhea
 Vomit
 Summer-heat
 Isthe predominant Qi in the summer,
 Diseases caused by summer-heat are only
seen in this season.
 Summer-heat
 Summer-heat is Yang pathogenic factor, characterized by
burning hot.
It attack the human body and give rise to a series of heat
syndrome, such as high fever, dyspheria, flushed face, full
pulse.
 Is uprising and dispersing
It make the pores open and profuse sweat comes out. Hence
it may cause the depletion of Qi and body fluid.
In summer, we must supplement the water in time
 Mingles with damp factor
There are too much rain in summer, and air become hot and
moist. it is not rare case in summer that heat and damp as
dual factors mixed together to attack human body.
Heatstroke happened often
 Main manifestation
 Aversion to heat
 Sweat

 Thirst

 Fatigue

 Yellowurine
 Red tongue with white or yellow coat

 Weak rapid pulse

 Dampness
 Is the predominant Qi at the end of summer,
 Damp diseases can be caused by wet
weather, exposure to water or rain, or living
in a damp house.
 Dampness
 Is Yin in nature, it can easily to do damage to Yang Qi and
block the circulation of Qi, harass the activities of Qi,
confuse the clear and the turbid, and give rise to the
disorder of descending and ascending of Qi.
 Is heavy and turbid

When pathogenic damp invades the exterior, the patient may

complain of tightened heavy head, physical fatigue, and
heavy, cumbersome limbs.
If it accumulates in the channels and joints, the patient may
complain of numbness in the skin and muscle, and heavy
pain in the joints which often leads to inhibited bending and
stretching
It may also give rise to such signs as turbid urine, dirty
complexion, thick and slimy tongue coat, in woman,
excessive leukorrhea.
 Is slimy and sluggish
The invasion of the body by pathogenic
damp is a slow and gradual unfolding,
almost unknowing, the patient has been
affected. The secretion and excretion of
the patient are sticky and pass out
sluggishly.
 Is tending downwards

pathogenic damp often pours down and

attacks the lower part of the body,
causing turbid urine, dysentery, lower
limbs edema, and leukorrhea in woman
 Main manifestation
 Tightened and heavy head
 Physical fatigue

 Cumbersome limbs

 Aching joints with inhibited bending and

stretching
 White and sticky tongue coat

 Soft or slow pulse

 Dryness
 Isthe predominant Qi in autumn in China.
 During this season, the temperature and
humidity gradually decrease.
 Lack of moisture causes many things in
nature to dry out.
 Dryness
 Dryness consumes body fluids
It intrudes the body from outside, and usually occurs
in dry regions or in dry weather as in autumn, and
cause dryness in the nose, mouth, throat, and
skin.
 Hurts the lung

When exogenous pathogenic dryness enter the body

through the nose and mouth, it may directly attack
the lung, cause dryness in the lung, resulting in
dry cough.
 Main manifestation
 Dryness in the nose, mouth, throat and skin
 Dry cough with little or no phlegm
 Pain and itching in the throat
 Bloody sputum
 Dry stools
 Short micturition
 Dry white tongue
 Superficial rapid pulse
 Fire
 Fire and heat are caused by excessive
Yang
 Fire and heat vary in degree

 Of the two, fire is the most severe.

 Fire
 Is Yang in nature, characterized by upward flaming
It can easily attack the upper part of the body and give rise to
such signs as high fever, aversion to heat, thirst, desire for
drink, and flushed complexion.
 Can easily consume Yin fluids and cause damage to Qi

Fire consume the body fluid by burning it, and result in

depletion of Qi and body fluid.
 Stirs blood

Fire accelerate the blood circulation and lead to hemorrhage.

 Cause carbuncle

When fire brow in a local part of the body, it may corrode the
fresh, cause carbuncle.
 Main manifestation
 High fever
 Thirst
 Flushed complexion
 Dysphoria
 Delirium
 Hemoptysis
 carbuncle
 Dark red tongue
 rapid pulse
 Endogenous factors
 seven emotions refer to the human mental
activities.
 In TCM, they are classified into seven classes:
anger, joy, preoccupation, grief, fright and shock.
 They are the different responses to the
environmental stimuli in the human body in
general circumstances,
 they belong to the normal physiological activities
and will not cause diseases.
 When sudden, strong, long emotional stimuli go
beyond the body's adaptability and endurance,
 the emotional stimuli will become pathogenic
factors,
 which cause dysfunction of Qi, blood and the
Zang-Fu organs and imbalance of Yin and Yang,
hence leading to diseases.
 This is known as "internal injury caused by the
seven emotions".
 Seven emotions may directly
injure the Zang-Fu organs
 Anger injures the liver
 Joy injures the heart

 Preoccupation injures the spleen

 Grief injures the lung

 Fright injures the kidney

 Result in the malfunction of Zang-Fu organs and
disturbance in the circulation of Qi and blood

 Anger arouse ascent of Qi

 Joy induce sluggishness of Qi

 Grief dissipate Qi

 Fright cause descent of Qi

 Shock lead to confusion of Qi

 Preoccupation result in stagnation of Qi

Emotion disturbances may make
the disease more severe
 Emotion disturbances can impair Qi and
blood, and cause dysfunction of Zang-Fu
organs, especially the heart, liver and
spleen.
 Conversely, the disorders of Zang-Fu
organs can give rise to emotional troubles.
 Certain case factors
 Dietary irregularities
 Overstrain

 Lazy-cozy

 Traumas

 Excessive sexual activity

 Dietary irregularities
 There are three forms of dietary
irregularities that may bring down one’s
health and give rise to diseases.
2. Over-hunger and over-eating
3. Food preference
4. Intake of raw, cold, and unclean foods
 Diet is a substance that provides nourishment for
the body and maintains the activities of life.
 However, improper diet or imbalanced diet
frequently leads to disease.
 When taken into the body, the food depends on
the spleen and stomach to digest.
 So improper diet will affect the physiological
function of the spleen and stomach, eventually
resulting in accumulation of dampness, production
of phlegm, transformation of heat or other
pathological changes.
 Overstrain
 Denotes to a great loss or consumption of
essence, Qi and spirit as the result of
taxation fatigue, or excessive sexual
activities.
 deficiency syndrome

 Symptoms: fatigue, weakness of limbs,

anorexia, etc.
 Lazy-cozy
 It refers to too lazy and too comfortable life
 Lacking of physical exertion results in unsmooth
circulation of Qi and blood, then do damage to the
spleen and stomach.
 Is characterized by poor appetite, spiritual
lassitude, weakness in the limbs, flabby, a slight
exertion may cause palpitation, panting and
sweating, and very easy to induce other diseases.
 Excessive sexual activity
 It severely consume kidney essence
 It refers to overindulgence in sex.

 Manifestation: aching pain in lumbar region

and knees, dizziness, tinnitus, spiritual
fatigue, general lack of strength,emission,
premature ejaculation, impotence,and in
woman, menstrual disorder, leukorrhea.
 Traumas
 Itrefers to injuries caused by knives, sport
injuries, animal bites and so on.
 Main manifestation: pain, swelling, loss of
blood, skin and muscle wound, bone
fracture, joint dislocation, and sinew
damages, or even and spasm and coma if
the internal organs are involved and
damaged.
 Secondary causes for diseases
 In a certain pathologic process, pathologic
products such as stasis blood, retention of
fluid and phlegm may develop to secondary
causes and give rise to new disease.
Retention of
phlegm and
liquid, blood
stasis
Phlegm retention and liquid retention
 Belong to body fluid retardation
 Are pathologic products that may become
secondary causes of a wide variety of
diseases. It may fall into two forms:
3. Liquid retention (Edema)----thin
4. Phlegm retention (Phlegm syndrome)----
thick
 1.Edema
 Refers to dropsy of the face, eyes, four
limbs, chest abdomen or the whole body
due to accumulation and retention of fluid in
the skin and muscles.
 2.Phlegm syndrome
 Refers to the retention of stagnation and
thick fluid in the viscera, meridians, and
tissues.
 Phlegm has two meaning
 in its broad meaning, refers to the thick
fluid retention in the body,
 in its narrow sense, refers to the sputum
that can be seen.
 The broad meaning of phlegm
 The concept of phlegm in broad meaning is non –
substantial.
 How can we diagnose it?
 It will have some pathological manifestations such
as dizziness, nausea, vomiting, shortness of
breath, palpitation or semi-consciousness.
 Rolling pulse
 Blood stasis
 It refers to retention of blood in the body
 Cause:
 In the normal state, it is Qi that pushes blood to
circulate in the body, deficiency of Qi or
stagnation of Qi often lead to blood stasis
 Pathogenic heat decoct (boil down) the local
blood till it become thick clots, then make the
unsmooth of blood
 traumas make the blood flow out of vessel and
form the stasis of blood
 Pathogenic cold congeal the blood and cause
blood stasis
 Characteristic of blood stasis
1. Pain: the pain is fixed in the certain location,
aggravated by pressure
2. Bleed: blood stasis obstructs the vessels and give
rise to hemorrhage or failure of bleed to circulate
in the channel vessels, and it will have the dark
purple in the skin.
3. Ecchymosis: the blood stasis lodges in the
superficial body, ecchymosis can be seen, such
as the cyan-purple lips and tongue
4. Tumor: blood stasis will cause masses or blood
tumor in the abdomen or other places.
 Some morbidity due to blood stasis
 Palpitation, chest distress, chest pain and cyanotic
nails and lips if it is retained in the heart.
 Chest pain and coughing up bloody sputum if it is
retained in the lung.
 Vomiting black purple blood or defecating asphalt
black stools if it is retained in the intestine and
stomach.
 Hypochondriac pain and mass if it is retained in
the liver.
 Lower abdominal pain, irregular menstruation if it
is retained in the uterus.
 Local swelling, pain and cyanosis if it is retained in
the limbs and muscles.
Pathogenesis
 What is meaning of
pathogenesis?
 Pathogenesis means the mechanism of the
occurrence, development and transformation of
diseases.
 The pathogenesis of diseases are closely related
to the body's health Qi and to the nature of the
pathogenic factors.
 When the pathogens attack the human body, the
body's health Qi is bound to rise against the
pathogenic factors, forming the conflict between
health Qi and pathogenic factors.
 This conflict is bound to
destroy the relative
balance between Yin and
Yang, then to cause the
dysfunction of the Zang-Fu
organs and meridians, or
the disturbance of Qi and
blood.
 Thus bringing about a
variety of local or general
pathological changes.
 Notwithstanding various diseases and
complicated clinical manifestations, their changes
of pathogenesis, in general, are inseparable from
two aspects.
2. The struggle between the health Qi and the
pathogenic factors,
3. The imbalance between Yin and Yang.
 1.The struggle between health Qi
and pathogenic factors
Normal state,
 Health Qi can gradually prevail over the
pathogenic factors——health
Abnormal state,
 Health Qi fails to resist against the pathogenic
factors——disease

pathogenic factors
health Qi
 a. Excess syndrome
The pathogenic factors is exuberant
an acute fight
is inevitable
The health Qi is strong

Excess syndrome refers to superabundance of

pathogenic factors, indicating that both the
pathogenic factors and health Qi are strong or the
pathogenic factors are strong but the health Qi is
not weak.
 Symptom
 highfever, high voice and coarse breathing,
abdominal pain with tenderness, obstructive
urination and defecation, and full and forceful
pulse, red tongue with thick and sticky coat.
 b. Deficiency syndrome
The pathogenic factors is exuberant pathogenic
factors prevail
The health Qi is weak over health Qi
Deficiency syndrome refers to insufficiency of health Qi
indicating hypofunction of Qi, blood, body fluid,
meridians and viscera.
In this case, the health Qi is difficult to launch an
intense struggle against pathogenic factors and
eventually leads to deficiency syndrome.
 Symptom
 patients with weak constitutions or in the later
stage of a disease and in different kinds of
chronic cases, marked by lassitude, pale
complexion, palpitation, short breath,
spontaneous perspiration, night sweat feverish
sensation in the chest, palms and soles or
aversion to cold, cold extremities, feeble pulse,
etc.
2.Imbalance between Yin and Yang
Normal state,
 Balance between Yin and Yang——health

Abnormal state,
 Imbalance between Yin and Yang——
disease
Imbalance between Yin and Yang refer to
relative predomination or decline of Yin and Yang.
 The pathological changes due to the
imbalance between Yin and Yang are very
complicated, however, it can be ascribed
to the following several aspects:
2. The excess of Yin and Yang

3. The deficiency of Yin and Yang

4. Development of Yin-Yang imbalance

 1. The excess of Yin and Yang
 Relative predominance of Yin and Yang
refers to excess syndrome because the
exuberance of pathogenic factors leads to
disease.

 Excess of Yang
 Excess of Yin
 a.Excess of Yang
 Yang here refer to pathogenic Yang heat, or
hyperfunction of Zang-Fu organs.
 When pathogenic factors of Yang nature
invade the body, they lead to relative
predominance of Yang and brings on
symptom, such as high fever, flushed face,
red eyes, etc.
 b. Excess of Yin
 Yin here refer to pathogenic Yin such as
cold, damp, and liquid.
 When pathogenic factors of Yin nature
attack the body, they lead to relative
predominance of Yin and brings on
symptom, such as aversion to cold,
shivering, edema, vomit, abdominal pain,
borborygmus, diarrhea, cold limbs, white
sticky tongue coat, etc.
 2. The deficiency of Yin and Yang
 Relative decline of Yin and Yang refer to
deficiency syndrome caused by “loss of essence”

 Deficiency of Yang
 Deficiency of Yin
 a. Deficiency of Yang
 Yang here refer to Yang Qi, having the
abilities of warming the organism, mobilizing
the functional activities.
 Deficiency of Yang is associated to
malfunction of Zang-Fu organs, depletion of
Yang Qi, inherently weak constitution.
 Symptom
 As Yang is weak and insufficient and fails to
restrict Yin, Yin become preponderant.
 Manifestation: cold form, aversion to cold,
pale complexion, spontaneous sweating,
thin stools, long micturition with clear urine,
enlarged and moist tongue, slow and weak
pulse.
 b. Deficiency of Yin
 Yin refers to essence, blood, body fluid, etc. having
the function of moistening, nourishing.
 When Yin is impaired by pathogenic Yang or
internal fire, or is severely consumed during
chronic diseases, it becomes weak and insufficient,
can not restrain Yang, result in heat syndrome.
 Manifestation: low fever, steaming bones, tidal
fever, flushed cheeks, feverish sensation in the
palms, soles and chest, night sweat, dry mouth, dry
throat, red tongue with less coat, rapid and weak
pulse.
 3. Development of Yin-Yang
imbalance
 As Yin and Yang are interdependent and
counterbalance each other under normal
circumstances the two are always in a state
of dynamic balance.
 A break-down of such relative balance may
cause pathologic changes.
a. Excess of Yang results in depletion of Yin
b. Excess of Yin results in depletion of Yang
c. Deficiency of Yang leads to excess of Yin
d. Deficiency of Yin leads to excess of Yang
a. Excess of Yang results in depletion of Yin
 Excess of Yang 60
denotes to an
50
exuberance of
pathogenic heat. 40

 The excess of Yang 30 yin

yang
produces heat, and by 20
which Yin is
10
consumed.
0
 So it may lead to Yin normal
disease.
b. Excess of Yin results in depletion of Yang
 Excess of Yin denotes 60
to an exuberance of 50
pathogenic Yin.
40
 The excess of Yin cold 30 yang
may lead to yin
20
accumulation of liquid-
damp which may 10

gradually impair Yang. 0

normal
 c. Deficiency of Yang leads to excess of Yin
 Deficiency of Yang caused
by depletion of yang is
attributed chiefly to 60
weakness of renal Yang
50
which is responsible for
producing heat, warming the 40
organism and mobilizing the yang
30
functional activities. yin
 Lacking in the production of 20
heat, the organism would be 10
in hypofunction, and as the
pathologic product, liquid- 0
normal
damp will retain in the body,
and Yin cold becomes
excessive.
d. Deficiency of Yin leads to excess of Yang
 Deficiency of Yin results in 60
heat production
50
 Yin humor is weak and
insufficient and fails to 40
restrict Yang. 30 yin
yang
 If it further develops, Yang 20
become hyperactive, then
10
it will lead to hyperactivity.
0
normal
 4.Collapse of Yin and Yang
 In a critical stage of 50
disease, Yin and Yang
may be exhausted 40
simultaneously,
 Yin humor is dried up, and 30
Yin
Yang is collapsed, both of
20 Yang
them can no longer
support each other. 10
 Such dissociation of Yin
and Yang implies death. 0
normal
 Review
 Etiology is defined as various kinds of
factors that cause diseases, mainly
includes three parts.
 Secondary causes for diseases
 stasis blood
 retention of fluid and phlegm
 Pathogenesis means the mechanism of the occurrence,
development and transformation of diseases.
 The struggle between the health Qi and the pathogenic
factors
v Deficiency syndrome: pathogenic factors prevail over
health Qi
v Excess syndrome: the pathogenic factors and health Qi
are strong.
The imbalance between Yin and Yang
b. Excess of Yang results in depletion of Yin

c. Excess of Yin results in depletion of Yang

d. Deficiency of Yang leads to excess of Yin

e. Deficiency of Yin leads to excess of Yang