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
is defined 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.
1. 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
Is the 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

Yellow urine

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
Is the 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 ones
health and give rise to diseases.
1. Over-hunger and over-eating
2. Food preference
3. 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
It refers 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:
1. Liquid retention (Edema)----thin
2. 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
1. in its broad meaning, refers to the thick fluid
retention in the body,
2. 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:
1. 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
2. Pathogenic heat decoct (boil down) the local blood till it
become thick clots, then make the unsmooth of blood
3. traumas make the blood flow out of vessel and form the
stasis of blood
4. 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.
1. The struggle between the health Qi and the
pathogenic factors,
2. 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
factorshealth
Abnormal state,
Health Qi fails to resist against the pathogenic
factorsdisease

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

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
high fever, 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 Yanghealth

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:
1. The excess of Yin and Yang

2. The deficiency of Yin and Yang

3. 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 denotes 60
to an exuberance of
50
pathogenic heat.
40
The excess of Yang
produces heat, and by 30 yin
which Yin is consumed. 20
yang

So it may lead to Yin 10

disease.
0
normal
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-
10
damp which may
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 weakness of renal 60
Yang which is responsible for
producing heat, warming the 50
organism and mobilizing the 40
functional activities.
Lacking in the production of 30 yang
heat, the organism would be in yin
20
hypofunction, and as the
pathologic product, liquid-damp 10
will retain in the body, and Yin
cold becomes excessive. 0
normal
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
disease, Yin and Yang may
be exhausted
simultaneously,
Yin humor is dried up, and
Yang is collapsed, both of
them can no longer
support each other.
Such dissociation of Yin
and Yang implies death.
 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
1. Deficiency syndrome: pathogenic factors prevail over
health Qi
2. Excess syndrome: the pathogenic factors and health Qi
are strong.
The imbalance between Yin and Yang
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