Traditional Chinese Medicine: Disease Causes

The Six Pathogenic Factors and the Causes of Disease

• Disease is caused by external or internal factors

Causes of Disease

• External factors are pathogens that attack the body from the outside.
• Internal factors are stress and emotions that damage organ systems, leading to lack of proper functioning
• Organ impairment can be caused by diet, toxins, medication, overwork, emotional factors, or external pathogens penetrating into the interior

Forming a Diagnosis

• Six pathogenic factors combine with Eight Principles and Zang fu assessment to create a diagnosis
• Examples of diagnosis include: Damp Heat in the Urinary Bladder, Wind Cold invading the Lung, Large Intestine Dryness.
• Assessments should include diagnosis, etiology, and progression.
• Example: SP Qi deficiency from over-consumption of cold damp foods weakens Spleen Yang, leading to Damp accumulation, and if this is untreated, it would progress into Yang deficiency, injuring the Kidney Yang

Six Pathogenic Factors

• Pathogenic factors characterize signs and symptoms and reveal disharmony patterns.
• Some signs and symptoms may be causative, while others are secondary
• In TCM, this is called root and branch.
• The six pathogenic factors are: Wind, Cold, Heat, Dampness, Dryness, Summer Heat

Wind

• Wind is characterized by rapidly arising and changing conditions like skin reactions, allergies, acute infections, headaches, and fevers.
• Wind can be interior/exterior, caused by hot/cold, or deficiency/excess
• Wind is indicated in conditions like itching, rashes, swelling, hives, and other skin reactions
• In many cases, Wind is trapped in the space between Interior and Exterior.
• Wind manifests as uncoordinated movements, tremors, tics, and fasciculation (Yang in nature)
• It affects the joints and is indicated in many cases of joint pain (Bi syndromes)
• Internal Wind begins in the Liver, responsible for coordinating smooth flow
• Internal Wind causes include Heat, Deficiency, and obstruction
• In external patterns, Wind carries acute invasions, with External Wind first invading the Lungs

Wind Cold Entering the Lungs

• Rapid onset of symptoms
• Aversion to Cold/Wind/Heat
• Chills/fever
• Sneezing
• Cough with white phlegm
• Runny nose with white mucus
• Body stiffness and aches
• Floating pulse
• Thin white coat on the tongue

Wind Heat Entering the Lungs

• Rapid onset of symptoms

• Aversion to Cold/Wind/Heat

• Chills/fever

• Sneezing

• Cough with yellow phlegm

• Runny nose with yellow mucus

• Itchy and/or sore throat

• Swollen tonsils, red back of throat

• Floating and rapid pulse

• Thin yellow coat on the tongue

• External Wind characterizes acute colds and flus

• Internal Wind is considered a more serious condition.

• Most mild Internal Wind is caused by Blood deficiency or Empty Heat.

• More serious Internal Wind is caused by damage to multiple Zang fu organs, particularly the Liver, Heart, Kidneys, and Lung

• Stroke, paralysis, and convulsive disorders are considered internal wind

Cold

• Cold contracts and congeals, often creating stasis or stagnation and injures the Yang

Cold Presentation

• Sleepiness and slowness
• Severe localized pain improved by heat
• White tongue coating and clear body discharges
• Slow pulse
• Craves warmth, aversion to cold, feels cold
• Pale complexion
• Lack of thirst
• Loose stool
• Clear and profuse urine, usually clear

Excess and Deficient Cold

• Excess Cold (Full Cold): Acute onset triggered by external factors, Deficiency Cold (Empty Cold): Chronic onset and usually internal factors

Excess Cold (Full Cold) Common Symptoms

• Pale complexion, chills, cold limbs, cold abdomen, diarrhea, copious urination
• Intense cramping or stabbing pain, improved by warmth, worse by cold, worse with pressure
• Thick white tongue, may show blueness in body
• Full, tight, slow pulse

Deficient Cold (Empty Cold) Common Symptoms

• Dull pain, improved by warmth, made worse by cold, better with pressure
• Thin white, pale tongue body that may show some blueness
• Weak, deep, slow pulse

Heat

• Yang in nature
• Blazes upwards
• Drying - damages Blood and Yin
• May cause bleeding (almost always a sign of heat)
• Potential to generate Wind when severe
• It Affects the mind (Shen)

Heat Presentation

• High fever, desires cold, aversion to heat, feels hot
• Redness - skin, face, eyes & complexion
• Thirst
• Constipation (from dryness) or foul smelling diarrhea
• Foul smelling discharges
• Scanty, dark yellow urine
• Restlessness, irritability
• Bleeding symptoms such as cough, vomit, nosebleeds, gums, urine, stool, and skin
• Rapid pulse, respiration
• Yellow tongue coating and other body discharges

Excess Heat (Full Heat)

• Constant Feeling of Heat
• Intense, constant, gulping Thirst
• Constant Dry mouth
• Intense agitation
• Red body, thick yellow coat
• Full, rapid Pulse

Deficient Heat (Empty Heat)

• Afternoon, at night Feeling of Heat
• Evening and night, sips Thirst
• Night Dry mouth
• Mild restlessness and agitation
• Red or pale body, redder at tip, papules, thin yellow coat
• Weak (empty), rapid pulse

Dampness

• Accumulation of Yin or Fluids
• Characterized by heaviness and slowness
• It Arises from:
  • Qi and Yang deficiency, lack of physical activity
  • Damp living environments
  • Ingestion of Damp substances (dairy, sugar, alcohol, soy)
• It is Sticky and difficult to move and clear
• Represents an Excess or Stagnation (Full or relative Excess)

Dampness Symptoms by Location

• Skin: Edema, feelings of swelling, oozing or weeping lesions, fungal infections
• Meridians: Joint pain, stiffness, swollen joints, heavy limbs
• Abdomen: Bloating, distension, nausea, poor appetite, loose stools
• Pelvis: Difficult or cloudy urination, feeling of heaviness in the pelvis

Types of Dampness

• Cold-Damp: Feelings of cold, heaviness in the head and body, joint stiffness and pain, swelling and edema of the abdomen and lower body
• Damp-Heat: Painful or burning urination, foul smelling discharge, red and eruptive skin lesions, thirst with no desire to drink, hypochondriac pain
• Wind-Damp: Chills and fever, joint aches
• Water-Damp: Pitting edema, ascites, difficult urination

Understanding Dampness and Phlegm

• Dampness is considered unmetabolized liquid in any part of the body.
• It is sticky and difficult to move.
• Dampness occurs when Fluid cannot be properly absorbed or transformed and can escape the vessels to infiltrate tissues and organs.
• Phlegm is a progression of Dampness occurring when elements of Fluid come out of solution and take on substance.
• Phlegm is Dampness taken form, where Dampness comes and goes, but Phlegm stays
• Examples of Phlegm in the body: Arterial plaques, lipomas, fibroids

Dryness

• Internal heat from drying or warming foods/herbs, lack of fluid intake, not enough fruit/veggies, salty processed foods
• All symptoms are DRY
• From dry and/or hot weather
• Internal dryness is a form of Yin deficiency without heat signs or symptoms of heat (yin is fluid and moisturizes)
• Cold, through congealing fluids and not allowing them to flow to where they are needed, can lead to Dryness

Summer Heat

• This is similar to heat stroke

Stagnation and Stasis

• They are not independent pathogenic factors, they are an outcome from the other pathogenic factors disturbing the vital substance
• Stagnation occurs whenever there is a lack of proper flow
• The Liver is involved whenever there is stagnation or stasis.
• Qi and Blood stasis are the terms used
• Similar to Dampness and Phlegm, Stasis is stagnation taken form.
• Stasis can be objectively confirmed by diagnostics.
• Stagnation is characterized by distending pain that comes and goes
• Stasis is characterized by fixed and sharp pain

Understanding Stagnation and Stasis

• Stagnation occurs whenever lack of smooth flow
• The Liver is involved whenever there is stagnation
• Stasis is a progression of stagnation - Stasis is Stagnation taken form
• Stagnation comes and goes, while Stasis is objectively verifiable
• Examples of Stasis in the body: Menstrual clots, endometriosis, blood clots

Eight Principles

• The Eight Principles are four pairs of opposites: Interior vs. Exterior, Hot vs. Cold, Excess vs. Deficiency, Yin vs. Yang.
• In practice, the focus is on Excess vs. Deficiency.
• Excess often dislikes pressure and may feel better with movement, while Deficiency often feels better with gentle pressure or rest.
• Hot indicates redness, a feeling of heat in the body, or agitation.
• Cold indicates pallor or a feeling of being chilled
• Interior vs. Exterior indicates whether the problem is a surface-level pathogen or chronic issue involving internal organs.
• Yin vs. Yang broadly classifies whether the overall pattern seems more Yin (lower energy, more cold) or Yang (more activity, more heat).

Pathogenic Factors - Causes of Disease or Disharmony

• TCM includes the following factors, but the causes can be internal and external.
• Wind
• Heat
• Cold
• Dampness
• Dryness, and sometimes
• Summer-Heat

TCM Diagnosis

• The diagnosis consist of: Which organ is affected and which vital substance is imbalanced?
• Some of the causes can be external or internal

Six Pathogenic Factors

• Include wind, cold, heat, damp, dryness, and Summer-Heat.
• Summer-Heat refers to sunstroke

Wind in TCM Terms

• Hardest to fully grasp, acts as the vehicle for external pathogens.
• Ancient observers noticed that colds and flus (transmitted by airborne pathogens) correlated with windy seasons
• In modern TCM, wind refers to any condition featuring sudden onset and/or abnormal movement (like tremors or spasms)
• External Wind indicates acute upper respiratory infections like a cold or flu-"Wind-Cold” or “Wind-Heat" patterns
• Internal Wind refers to tremors, tics, seizures, strokes-any involuntary movement and results from deeper organ imbalance (like Liver Blood Deficiency leading to "internal wind")..
• For external Wind, classic signs include a rapid onset of symptoms (e.g., a scratchy throat that becomes a full cold), headache, sneezing, chills, and possibly mild fever. If it's Wind-Cold, the mucus is clear and copious; if it's Wind-Heat, it's yellow or thicker.
• Internal Wind can be caused by things like extreme heat (febrile convulsions) or deficiency (like Liver Blood or Yin Deficiency causing shakiness)

Cold in TCM Terms

• Cold is described as external or internal, meaning a deficiency of Yang or Qi.
• Cold symptoms include; pallor, feeling chilled, wanting warmth, slow movements, and possibly watery or clear discharge.
• Excess Cold has more cramping and intense pain that worsens with pressure,
• Deficiency Cold is more diffuse and is improved by pressure or warmth

Heat in TCM Terms

• The cause can originate from external (infections or hot environments) or internal (caused by diet or stress), i.e greasy, spicy food-or by stress and stagnation)
• Signs of heat include redness, feeling hot, thirst, yellow or dark discharge, irritability, and restlessness
• Excess Heat is more intense, full, with acute inflammation
• Deficiency Heat is milder or occurs later in the day, Yin deficiency signs like night sweats, low-grade fever, dryness occur

Dampness Signs and Symptoms

• Heavy and has a sluggish quality that often leads to feelings of heaviness in the body, turbid discharges, edema, or a sense of brain fog
• Dampness can combine with Heat or Cold
• Damp-Heat might cause foul-smelling discharges, like diarrhea or vaginal discharge, whereas Damp-Cold might show watery edema, bloating, loose stools, and lethargy
• Raw or greasy foods often create Dampness in someone with weak digestion

Dryness Signs and Symptoms

• Dryness can be external (dry climate) or internal (Yin or fluid deficiency).
• Signs include dry skin, dry nasal passages, constipation with dry stools, and thirst
• Summer-Heat refers to sunstroke-high fever, heavy sweating, and possible delirium

Symptoms Blend Considerations

• Damp-Heat in the Bladder might mean a UTI with burning, dark urine and possibly a foul odor
• A Wind-Heat cold indicates sore throat and yellow mucus
• Identifying which of the six pathogenic factors is dominant determines the cause and path of illness
• Other considerations involves deficiency or internal organ involvement,

TCM Classifications

• Pathogenic factors are classified as wind, cold, heat, damp, dry, and Summer-Heat.
• TCM also considers internal factors based on stress as well as the function of diet

Tongue Presentations: Cold

• Localized pain, blood stagnation
• A white coating
• A Bluish-purple

Tongue Presentations: Heat

• Heat symptoms show redness
• Yellow discharges and urine also occur
• Tongue has a yellow coating
• Chronic heat can damage body fluids, leading to a very dry tongue showing that the patient also has swelling and cracks

Tongue Presentations: Wind

• Wind causes muscle stiffening, spasms, or tremors
• Tongue wind will manifest an unsteadiness
• Quivering
• Deviating of the tongue (internal wind)

Tongue Presentations: Dampness

• Wet sticky tongues
• Impaired spleen
• Swollen tongue
• Swelling often presses the tongue against the teeth edges, creating scalloped or teeth-marked sides
• Overall shiny base

Tongue Presentations: Dryness

• The opposite of damp is dryness
• Lacking moisture
• No sheen

Blood Deficiency

• Tongue Appearance is pale
• Blood stagnant with sharp pains has a bluish tongue