PATHOGENESIS

病机

What is meant by pathogenesis? By

pathogenesis is meant the mechanism of the occurrence, development and outcome of diseases. The occurrence, development and

何谓病机？病机指的是

outcome of diseases are closely related both to

疾病发生、发展和转归的机

the body's vital qi and to the nature of the

理。疾病的发生、发展和转

pathogenic factors. When the pathogens attack

归与人体的正气和病邪特性

the human body, the body's vital qi is bound to

密切相关。当病邪侵犯人体

rise against the pathogens, forming the

时，人体正气必会奋起抗邪，

conflict between vital qi and pathogens. Their

形成正邪相争。正邪相争必

conflict is bound to destroy the relative

会破坏阴阳的相对平衡、脏

balance of yin and yang to cause the dysfunction

腑经络功能失调或是气血紊

of the zang-fu organs and meridians, or the

乱，从而引起不同的局部或

disturbance of qi and blood. Thus bringing

是整体的病理改变。虽然疾

about a variety of local or general

病不同而且临床症状错综复

pathological changes. Notwithstanding various

杂，但是总的来说，它们的

diseases and complicated clinical

病理改变离不开正邪的虚

manifestations, their changes of pathogenesis,

实，阴阳失衡，或是气血失

in general, are inseparable from the excess or

常及脏腑经络的功能失调。

deficiency between the vital-qi and the pathogens, the imbalance of yin and yang, or the abnormably of qi and blood and the dysfunction of the zang-fu organs and meridians.

The conflict between the vital-qi and pathogens is not only related to the occurrence

of a disease, but also directly affects its 正邪相争不仅与疾病的development and final outcome. Meanwhile, it 发生有关，而且直接影响到has a direct influence on deficient or 疾病的发展和转归。同时，excessive changes of the syndromes in a certain 它在一定程度上也直接影响sense, the processes of many diseases are seen 了证候的虚实，许多疾病的as those of the changes of excess and deficiency 过程都是正邪相争引起虚实in the contest between the vital-qi and 改变的过程。因此，正邪的pathogens. Therefore, vicissitudes of vital qi 盛衰被认为是病机之一。 and pathogens are considered to be one of the pathogenesises.

Basic Questions says \exuberance of 《素问》云：“邪盛则pathogens results in excess syndrome, while the 实，正衰则虚。”实指的是depletion of essence-qi may bring on deficiency 邪气实，或是邪实的病理反syndrome.\应作为矛盾的主要方面。这pathogens, or a pathogenic reaction with 就是说，邪气实，正气也强。

excessive pathogens as the principal aspect of 临床上，实的病理反应通常the contradiction. That is to say, the 是正邪之间剧烈抗争的结pathogens are excessive, the vital qi is also 果，这称为实证，大多见于strong. Clinically, a sort of pathological 由六淫、痰凝、饮食不化、reactions of excess ensue with the fierce and 血瘀等引起的疾病的中早obvious struggle between vital qi and 期，在临床上可见壮热，狂pathogens, which is known as excess syndrome. 躁，声高气粗，腹痛拒按，It is mostly found in the early or middle stage 二便不通，脉实有力等。 of diseases caused either by the six exogenous pathogens or by the phlegm retention, undigested food, blood stasis, etc. ,

characterized by high fever, mania, high voice and coarse breathing, abdominal pain with tenderness, obstructive urination and defecation, and full and forceful pulse.

By deficiency syndrome is meant a syndrome caused by inadequate of vital qi, or a

pathological reaction with the deficiency of 虚证指的是由正气不足vital qi as the dominant factor of the 引起的证候，或是以正气不contradiction. That is, the vital qi become too 足的病理反应为矛盾的主要deficient to resist pathogens because of the 方面。这就是因为气、血、dysfunctions of qi, blood, body fluid, zang-fu 津液、脏腑经络的功能失调organ and meridians. Consequently, the 导致正气过虚无力抗邪。因conflict of vital qi and pathogens may not 此，正邪相争并不会造成剧produce intense pathological reaction and a 烈的病理反应，所以会导致series of insufficient manifestations arise, 一系列虚的症状，这就是所so called deficiency syndrome. This types of 谓的虚证。这一类型的证候syndrome is mostly seen in patients with weak 大多出现于体弱的病人、疾constitutions or in the later stage of a disease 病的晚期和各种慢性病中，and in different kinds of chronic cases, marked 症见神疲体倦，面容憔悴，by lassitude, pallid complexion, palpitation, 心悸气短，自汗，盗汗，五short breath, spontaneous perspiration, night 心烦热，畏寒肢冷，脉虚无sweat feverish sensation in the chest, palms 力等。 and soles or aversion to cold, cold extremities, feeble pulse, etc.

The rise and fall of vital qi and pathogens 在长期复杂的疾病中，can bring about mixed syndromes of excess and 正邪的盛衰会引起虚实混杂deficiency in protracted and complicated 的证候。这种证候主要有两diseases. Such syndromes have mainly two kinds 种病理变化：虚中夹实和实of pathological changes: deficiency syndromes 中夹虚。然而，在特殊情况mixed with excess ones and excess syndromes 下也会出现两种病理改变：mixed with deficiency ones. However, under some 真实假虚和真虚假实。前者particular circumstances, there will be two 谓之“至虚有盛候”，而后types of pathological changes: true excess 者则为“大实有赢状”。因

syndrom with pseudo-deficiency symptoms and 此，分析病机的虚实，必须true deficiency with pseudo-excess symptoms. 透过现象看本质，才能不被The former is said to be \symptoms of 假象所迷惑，而真正把握住pseudo-excess in extreme deficiency\疾病的虚实变化。 the latter is said to be \symptoms of

pseudo-deficiency in extreme excess\From the above, to identify a deficiency or excess syndrome of pathogenesis we must see through the appearance to get at the essence and so only can we not be misted by false phenomena and accurately grasp the changes of excess or deficiency syndrome .

In the course of a disease, the conflict between vital qi and pathogens not only gives 在疾病过程中，正邪相rise to their deficiency or excess, but also 争不仅会引起虚实改变，而causes the outcome of a disease. When vital qi 且会导致疾病的转归。当正prevails over pathogens, the disease tends to 气胜于邪气时，疾病就会趋improvement or even complete recovery. 于好转或痊愈。反之，当邪Otherwise, when pathogens prevail over vital 气胜过正气时，疾病就会趋qi, the disease tends to deterioration or even 于恶化或是导致死亡。 life comes to end.

In the course of occurrence, development and final outcome of a disease, disharmony of yin

在疾病的发生、发展和

and yang will occur under the action of

转归的过程中，在病邪的作

pathogens, resulting in such pathological

用下，阴阳失调就会产生，

manifestations as relative excess or

导致阴或阳的偏虚偏实和阴

deficiency of either yin or yang, mutual

阳的互损。

impairment, repellence and depletion of yin and yang.

The Disturbance of qi and blood refers to a 气血紊乱指的是气血亏morbid state caused by deficiency and 虚、功能失调和相互依赖关dysfunction of qi and blood, and the breakdown 系崩溃导致的一种病理状of their interdependent relationship. Qi and 态。人体气血是脏腑经络生blood in the body are the material basis for the 理活动的物质基础。因此，physiological activities of the zang-fu and 气血紊乱必会影响人体的功meridians. Therefore, their disturbance will 能，导致疾病。《素问》指inevitably affect the body's function to cause 出：“气血不和，百病乃变diseases. Basic Questions states: \化而生。”然而，气血是脏disharmony between qi and blood will result in 腑功能活动的产物。脏腑的various diseases\ However, qi and blood are 病理改变不仅会导致气血紊the products of the functions of the zang-fu 乱，也会影响全身的气血。organs. Pathological changes of the zang-fu 这样，气血紊乱的病理改变，organs may not only lead to qi-blood 如正邪的盛衰、阴阳的失衡，

disturbance, but also affect qi and blood of the 不仅是脏腑经络病理改变的whole body. Thus, the pathogenesis of qi-blood 根源，也是分析和研究不同disturbance, like that of the rise and decline 疾病病机的基础。 of vital qi and pathogens and the imbalance of yin and yang, is not only the root cause of pathological changes of the zang-fu organs and meridians, but also the basis for the analysis and research of the pathogenesis of various diseases.

The failure of qi activity refers to such pathological changes as qi stagnation, adverse flow of qi, qi sinking, qi blockage and qi

气机失调指的是由于气

exhaustion due to disturbance in its ascending,

的升降出入失常引起气滞、

descending, exiting and entering. Ascending,

气逆、气陷、气闭、气脱的

descending, exiting and entering are the basic

病理改变。升降出入是气的

form of qi movement, on which functional

基本运动形式。脏腑经络的

activities of the zang-fu organs and meridians

功能活动，脏腑和经络、气

as well as the relation ships between the

血、阴阳之间的关系都赖此

zang-fu organs and meridians, qi and blood, and

以维持相对平衡。由于这个

yin and yang depend to maintain their relative

原因，气机失调可以引起涉

balance. Fort his reason, the disorder of qi

及脏腑、气血、阴阳、表里、

activity may bring about various morbid

四肢、九窍的不同病理改变。

conditions involving the zang-fu organs, qi and blood, yin and yang, exterior and interior, four limbs and nine orifices.

The disorder of blood includes deficient

blood production, blood deficiency caused by 血液失常包括血的生化massive hemorrhage, over consumption of blood 不足，大量失血引起的血虚，caused by prolonged illness, or dysfunction of 长期疾病引起的过度血液损blood nourishment; it also includes the 耗或是血液的营养功能失accelerated blood circulation caused by blood 调；也包括血热迫血妄行和heat and blood stasis caused by sluggish blood 血液循环缓慢引起的血瘀。 circulation.

The metabolism of body fluid is essentially 津液的代谢是津液持续the processes of continuous production, 产生、分布和排泄的必要过distribution and excretion of body fluid. The 程。代谢紊乱指的是分布异disturbance of the metabolism means the 常和产生排泄失衡，从而产disturbance of distribution and the imbalance 生津液产生不足，形成体内between production and excretion, thus causing 水液停滞，因此，正常的津deficiency production of body fluid to form 液代谢是维持正常的分布、fluid retention in the body, So, normal 产生和排泄的基本条件。正metabolism of body fluid is the basic condition 常的津液产生、分布和排泄maintaining normal distribution, production 离不开气的升降出入和气化