Pathogenesis

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Pathogenesis

• Lecturer QU Hongyan

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• Pathogenesis refers to the mechanism of the
  occurrence, development, and changes of
• disease.
• The theory of pathogenesis is the theory to
  study the occurrence, development and changes of
  disease, and to discuss the basic pathogenesis
  and transmission.

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• Basic pathogenesis

It probes the basic laws of the occurrence,
development, and changes of disease integratedly,
can be generalized into the following five
aspects
Five endogenous pathogenic factors
Disharmony of qi and blood
Yin yang disharmony
Metabolic disorders of body fluids
preponderance and decline of pathogenic or
healthy qi
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Preponderance and decline of pathogenic or
healthy qi
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Pathogenesis of deficiency and excess
Excess Characteristics preponderance of
pathogenic qi Manifestations a series
of excessive symptoms It usually occurs at the
early or middle stage of exogenous or endogenous
diseases with a short course
Deficiency Characteristics insufficiency of
healthy qi Manifestations a series of
deficient symptoms It is commonly
seen at the advanced stage of exogenous diseases
or various chronic diseases with a long course
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Deficiency-excess in complexity

• It refers to a pathological condition in
  which the struggle between healthy and pathogenic
  qi leads to the coexistence of exuberant
  pathogenic qi and declined healthy qi in the
  process of a disease.

Deficiency complicated by excess
Excess complicated by deficiency
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Predominance of insufficient healthy qi is
complicated by excess of pathogenic qi
Deficiency complicated by excess
Excess complicated by deficiency
Predominance of excess pathogenic qi is
complicated by insufficient healthy qi
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Conversion between deficiency and excess

• It refers to the pathological conversion
  between deficiency and excess, which is the
  result of impairment of healthy qi due to
  retention of pathogens, or accumulation of
  excessive pathogens resulting from insufficient
  healthy qi in the development of a disease.

Conversion of excess into deficiency
Excess resulted from deficiency
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• 1.Conversion of excess into deficiency

Healthy qi is injured by exuberant pathogenic qi
Excess syndrome
Excess complicated by deficiency
Delayed or improper treatment
Pathogenic qi was removed and healthy qi was
weakness
Zang-fu organs were injured
Deficient syndrome
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2.Excess resulted from deficiency
The healthy qi is originally deficient and can
not eliminate pathogenic qi
Deficiency complicated by excess
Deficient syndrome
Deficient healthy qi leads to accumulation of
excessive pathogens such as stagnant blood,
phlegm-fluid, etc.
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True or false excess and deficiency

• 1.True deficiency with false excess

Nature of disease
Deficient syndrome
Deficient syndrome
False clinical manifestation
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True or false excess and deficiency

• 2.True excess with false deficiency

Nature of disease
Excess syndrome
excess syndrome
False clinical manifestation
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Sequelae of disease and preponderance and decline
of pathogenic or healthy qi

• Domination of healthy qi with decline of
  pathogenic qi
• Withdrawal of pathogenic qi with decline of
  healthy qi
• Insufficient healthy qi with pathogenic qi
  lingering
• Domination of pathogenic qi with decline of
  healthy qi
• Healthy qi and pathogenic qi being locked in a
  stalemate

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Yin-yang disharmony

• changes of cold and heat

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Preponderance of yin or yang
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Decline of yin or yang
Mutual impairment of yin and yang
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4
Mutual rejection of yin and yang
Exhaustion of yin or yang
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Preponderance of yin or yang

• Preponderance of yin or yang, a morbid state
  marked by absolute excess of yin or yang aspect,
  refers to excess syndrome that "exuberance of
  pathogens leading to excess".
• Preponderance of yang is usually
  characterized by heat symptoms while
  preponderance of yin by cold symptoms.

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Yang pathogens
Yin qi
Preponderance of yang
Excessive heat syndrome
Yang in excess leads to weakness of yin
Yin pathogens
Yang qi
Preponderance of yin
Excessive cold syndrome
Yin in excess leads to weakness of yang
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(1)Preponderance of yang
A pathological state characterized by
exuberance of yang with functional
hyperactivities, increased metabolic action, and
enhanced bodily reactivity .
In pathogenesis, it is of excess heat
syndrome marked by excess of yang without
apparent yin deficiency
Yang waxes
Yang
Yin
Yin wanes
It is usually due to invasion of exogenous
warm pathogen of yang nature, interior
transformation of heat from exogenous cold
pathogen of yin nature, or transformation of five
emotions into fire, or transformation of heat
from qi stagnation, stagnant blood, or dyspepsia.
Equilibrium
Excessive yang causes heat
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(2) Preponderance of yin
It refers to a morbid state characterized
by exuberance of yin, suppressed or declined
bodily function, insufficient production of
heat, and accumulation of pathological
products.
In pathogenesis, it is of excess cold
syndrome marked by excess of yin without apparent
yang deficiency.
Yin waxes
yang
Yin
Yang wanes
Reasons invasion of pathogenic cold or dampness
of yin nature, excessive intake of uncooked and
cold food that lead to cold stagnation in middle
energizer and interior exuberance of yin cold
Equilibrium
Exuberant yin causes cold
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(1)Decline of yang
It refers to a morbid state characterized by
insufficient yang qi, decreased bodily function
and reaction as well as inadequate production of
heat energy.
The pathogenesis of decline of yang is
usually characteristic of deficiency-cold
syndrome in which the impaired yang qi fails to
restrict yin, leading to the relative excess of
yin.
Yin waxes
yang
Yin
Insufficient yang qi mainly involves the
spleen and kidney
Yang wanes
It usually results from congenital
deficiency, postnatal malnutrition, overstrain,
or impairment of yang qi due to prolonged
disease.
Equilibrium
Yang deficiency leads to cold
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(2)Decline of yin
It refers to a pathological state in which
yin qi is insufficient and fails to restrict
yang, resulting in relative excess of yang and
asthenic bodily hyperfunction.
decline of yin is characteristic of
deficient heat syndrome in which insufficient
body fluids and decreased function of nourishing
and quietening result in relative excess of yang
Yang waxes
yang
Yin
Yin deficiency may occur in all five viscera,
but mainly involves the lung, liver and the
kidney
Yin wanes
It usually results from exuberant heat
scorching body fluids in febrile disease,
or transformation of five emotions into fire
impairing yin, or prolonged disease consuming yin
fluid.
Equilibrium
Yin deficiency leads to heat
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Mutual impairment of yin and yang
Yin impairment involving yang a morbid
condition in which consumption of yin essence
affects yang qi and causes inadequate production
or exhaustion of yang qi Yang impairment
involving yin refers to a morbid condition in
which consumption of yang qi involves yin essence
and causes inadequate production of yin essence,
consequently bringing on deficiency syndrome of
both yin and yang with a predominance of yang
deficiency
Solitary yang cannot exist and solitary yin
cannot grow
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Repelling of yin and yang

• It refers to such a pathological
  change that either yin or yang is of extreme
  excess inside and rejects its opposite aspect
  outside.
• It results from the breakdown of the
  interdependence of yin and yang due to various
  factors, bringing on complicated pathological
  phenomena such as true cold with false heat and
  true heat with false cold.
• preponderant yin repelling yang
• preponderant yang repelling yin

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Repelling of yin and yang
1. Preponderant yin repelling yang
Yang is extremely weakness Yin cold is excessive
Yin is extremely excessive inside
nature
pale complexion, cold extremities,
listlessness, intolerance of cold and lying
with the knees crouched
Force yang to float outside
False phenomena
true cold
False heat
Flushed cheeks, dysphoria and fever, large pulse
without root
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Repelling of yin and yang
2. Preponderant yang repelling yin
Extreme yang heat stagnates inside
Extremely heat inside
nature
high fever, red complexion, hoarse breath,
dysphoria, red tongue, rapid, large and
forceful pulse
Stagnates yang qi and prevents It from
reaching the limbs
False phenomena
true heat
False cold
Cold extremities but not relieved by clothes and
quilts
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Exhaustion of yin or yang

• It is a critical state of collapse
  due to massive loss of yang qi in a short time or
  sudden and severe visceral failure.
• Reasons massive loss of yang qi due to the
  failure of healthy qi to fight against exuberant
  pathogenic qi, or induced by frequent deficiency
  of yang qi, insufficient healthy qi as well as
  overstrain or by profuse sweating, excessive
  vomiting and diarrhea, or by chronic consumptive
  disease,
• Clinical manifestations dripping with sweat,
  thin and cold sweat, cold extremities,
  listlessness, indifferent complexion, or even
  coma and faint pulse, etc..

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Exhaustion of yin or yang

• Yin
• deficiency

Yang deficiency
Yin exhaustion
Yin exhaustion
Resultsexhaustion of yin or yang
ones life in dangerous
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• Pathogenesis of yin-yang disharmony

Early stage
Development
Prognosis
Preponderance of yin or yang
Yang in excess leads to weakness of yin
Yang exhaustion
Yin in excess leads to weakness of yang
Yin exhaustion
Preponderance yin repelling yang
Preponderance yang repelling yin
Preponderant yang transform yin
Preponderant yin transform yang
Decline of yin or yang
Yin-yang in balance
Yin impairment Involving yang
Yang impairment Involving yin
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Disharmony of qi and blood
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Disorders of qi
Qi deficiency
Reversed flow of qi
Fails to ascend and descend
Qi sinking
Qi blockage
Disorders of qi movement
Fails to exit and enter the body
Qi prostration
Qi stagnation
Unsmooth flow
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Qi deficiency

• Qi deficiency refers to a morbid state in
  which qi of the whole body is inadequate in
  quantity and declined in function.
• It is caused by inadequate production of
  qi due to congenital deficiency, postnatal
  malnutrition, hypo-function of the lung, spleen
  and kidney, or by excessive consumption of qi
  due to overstrain, severe or prolonged
  illness.
• Its common clinical manifestations are
  fatigue, dispiritedness, spontaneous sweating,
  susceptibility to cold, dizziness and tinnitus,
  weak or faint and thin pulse, etc..

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Disorders of qi movement
Qi stagnation

• It refers to a morbid state characterized
  by unsmooth flow and obstruction of qi inside the
  body.
• It results from emotional depression, or
  the blockage of phlegm, dampness, indigestion and
  stagnant blood. Since the liver qi and spleen qi
  tend to ascend and the lung qi and stomach qi
  function to descend, they are of great importance
  in regulating qi movement. Therefore qi
  stagnation usually involves the lung, liver,
  spleen and stomach.
• Distension, fullness and pain in local
  regions are their common symptoms.

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Disorders of qi movement
Reversed flow of qi

• It is a morbid state in which the
  excessive upward flow of qi or failure of qi to
  descend leads to the upward adverse flow of
  visceral qi
• It usually results from emotional
  disorders, improper cold or warm diet, or
  stagnation of phlegm-turbidity.
• Such condition commonly occurs in the
  disorders of the lung, stomach, and liver.
• For example, the adverse rising of lung qi
  leads to cough with dyspnea the adverse rising
  of stomach qi causes symptoms of nausea, vomiting
  or hiccup and belching the adverse rising of
  liver qi brings about distending pain of head,
  red eyes and complexion, susceptibility to anger,
  etc..

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Disorders of qi movement
Qi sinking

• It refers to a morbid state in which the
  failure of qi to ascend or excessive descent of
  qi leads to the decline of qi in its lifting or
  holding function.
• Generally, qi sinking develops gradually from
  qi deficiency and especially has the closest
  relationship to spleen qi.
• If spleen qi fails in sending up the clear to
  nourish the head and eyes, it will lead to
  dizziness, tinnitus, lassitude, pale and
  lusterless complexion. If it fails to rise up, it
  may cause prolapse of internal viscera, such as
  gastroptosis, nephroptosis, hysteroptosis and
  proctoptosis, etc..

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Disorders of qi movement
Qi blockage

• It refers to a morbid state marked by
  interference of qi in exiting due to sudden
  blockage of qi movement, usually manifested as
  syncope.
• It usually results from emotional
  depressions, obstruction of exogenous pathogens
  and phlegm-turbidity
• The commonly seen manifestations are sudden
  syncope, unconsciousness, or accompanied by
  coldness or convulsion of the four limbs.

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Disorders of qi movement
Qi prostration

• It refers to a critical state characterized
  by extravasation of qi due to the failure of qi
  to stay internally.
• It is usually caused by the failure of
  healthy qi to ward off pathogenic qi, or by
  prolonged consumption of healthy qi due to
  chronic disease, or by exhaustion of qi resulting
  from massive bleeding, profuse sweating, frequent
  vomiting and diarrhea
• The commonly seen manifestation are pale
  complexion, endless sweating, closed eyes with
  mouth open, general flaccidity, urinary and fecal
  incontinence, faint pulse, etc.

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Disorders of blood
Blood deficiency
Blood stasis
Disorder of blood
Hemorrhage
Blood heat
Blood cold
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Blood deficiency
Disorders blood

• It refers to a morbid state characterized
  by insufficiency of blood and its declined
  nourishing function.
• Reasons inadequate production of blood
  because spleen and stomach are too weak to
  receive, transport and take enough food, or from
  heavy bleeding, or from consumption of blood due
  to prolonged illness or excessive anxiety
• Clinical manifestations pale or sallow
  complexion, light-colored tongue, lip and nails,
  listlessness and lack of strength, vertigo,
  tinnitus, dry eyes, blurred vision, numbness of
  hands and feet, thin pulse, etc.

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Qi deficiency
Yang deficiency
The former is a deficient syndrome but without
apparent cold symptoms

• difference

Yin deficiency
Blood deficiency
The former is a deficient syndrome but without
apparent heat symptoms
difference
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Blood stasis
Disorders blood

• It refers to a morbid state marked by
  slow and unsmooth blood circulation.
• Reasons qi stagnation, blood cold,
  blood heat, obstruction of phlegm-turbidity,
  traumatic injuries, etc.
• Clinical manifestations pain of fixed
  location or with the formation of swelling,
  accompanied by dark complexion, scaly skin,
  cyanotic lips and nails, purplish tongue or with
  petechiae, ecchymosis, etc.

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Hemorrhage
Disorders blood

• It denotes the excessive discharge of
  blood from blood vessels.
• Reasons failure of deficient qi to
  control blood, failure of liver to store blood,
  exuberance of pathogenic heat, traumatic
  injuries.
• Clinical manifestations a various
  symptoms of bleeding such as hemoptysis,
  hematemesis, epistaxis, hematuria and
  hematochezia, etc.

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Blood heat
Disorders blood

• It refers to a pathological change
  characterized by accelerated or abnormal blood
  flow resulting from heat in the blood phase.
• Reasons invasion of exuberant heat
  pathogen into the blood phase, five emotions in
  excess may change into fire
• Clinical manifestations red complexion
  and eyes, fever aggravated at night, dry mouth
  with no desire for drink, dysphoria, mania,
  delirium, or even coma, bleeding, hematemesis,
  hematuria, shortened menstrual cycle and
  excessive menstruation, deep red tongue and rapid
  pulse, etc.

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Blood cold
Disorders blood

• It refers to a pathological change marked
  by unsmooth blood circulation due to cold
  affecting the blood vessels
• Reasons the invasion of pathogenic
  cold into the blood phase, failure of yang qi to
  warm
• Clinical manifestations symptoms of
  yin cold, pain, cyanosis of hand, feet, nails and
  skin, purplish tongue.

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Disharmony between qi and blood
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Qi stagnation and blood stasis
Disharmony between qi and
blood
It refers to a pathological state in which
unsmooth and depressed flow of qi makes the blood
flow sluggish.
Qi can not promote the blood flow
Emotional depression
Qi stagnation
Fullness and pain in the chest and
hypochondrium, petechia, ecchymosis, abnormal mass
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Qi deficiency and blood stasis
Disharmony between qi and
blood
It refers to a pathological state in which
insufficient qi fails to promote blood flow and
results in the disturbance of blood flow.
Longstanding illness, visceral weakness in the
aged
Qi is insufficient and fails to circulate blood
Asthenic breathing, lack of Strength
palpitations, chest pain, purplish tongue
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The failure of qi to control blood
Disharmony between qi and
blood
It refers to a pathological state in which
insufficient qi fails to keep blood flow inside
the vessels, consequently resulting in various
symptoms.
Spleen fails to control blood
Prolonged illness
Impair the spleen qi
Hematochezia, hematuria, metrorrhagia,
ecchymosis, and subcutaneous bleeding
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Collapse of qi due to hemorrhage
Disharmony between qi and
blood

• It refers to a critical pathological
  condition of sudden and massive exhaustion of
  yang qi caused by heavy bleeding.
• Reasons severe traumatic bleeding,
  metrorrhagia and postpartum hemmorrhage.
• Clinical manifestations cold and
  endless sweating, cold extremities, syncope and
  hollow pulse, etc..

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Deficiency of blood and qi
Disharmony between qi and
blood
It refers to a pathological condition
characteristic of deficiency of both qi and blood
Over-consume qi and blood
Prolonged illness
Pale or sallow complexion asthenic breathing,
reluctance to speak, lassitude, lack of
strength,etc
Depletion of qi Loss of blood
Insufficient qi
Inadequate production of blood