CHAPTER SIX
PATHOLOGICAL MECHANISM
This term refers to the mechanism of the occurrence, development and changes of disease. The term pathological mechanism appeared for the first time in the book the Internal Classic. Chapter 74 in the Plain Questions states: "Grasp the functional activities of qi with caution, don't lose the pathological mechanism", "strictly follow the laws of the pathological mechanism and treat a disease according to its nature". This reveals that the ancient physicians attached great importance to the study of pathological mechanisms.TCM believes that the occurrence, development and changes of a disease is closely related to the state of physical constitution of the affected body and the nature of the evil-qi.When the evil-qi invades a human body, the genuine-qi fights against the evil-qi, resulting in a struggle between the genuine-qi and the evil-gi. This breaks the dynamic equilibrium of yin and yang within the body, damaging normal physiological functions of the viscera, tissues and all organs to the point that there is a disturbance in the ascending and descending functions of the viscera, or a derangement of qi and blood. The whole process leads to various pathological changes in both the entire body or just a local section of the body.
The pathological mechanism in traditional Chinese medicine is a theory which explains the laws of the occurrence and development of disease. It also serves in the clinical diagnosis. This theory mainly introduces the basic pathological mechanism including prosperity and decline of the genuine-qi and evil-qi, an imbalance between yin and yang, a derangement of qi and blood, and abnormality of water metabolism etc. ; the pathological mechanism of the five endogenous evil-qi, and the meridians; as well as the viscera.
Section 1 Basic Pathological Mechanism
The human body is an integrated whole that possesses a number of viscera, tissues
and organs. They are inter-connected in order to maintain harmony in their physiologica functions and inter-influenced in pathological changes. Clinically, diseases vary, the pathological mechanism of which are very complicated and changeable. A different diseast or syndrome will run their own course and have individual outcomes. Although the factors which cause diseases and the symptoms are variable, it has been discovered that many diseases and syndromes may share a certain common rules of development and out come of pathological changes. Through comprehensive and correct analysis, it has been shown that the responses of basic pathological'mechanisms of the affected body part to various pathogenic factors results from the prosperity and decline of the genuine-gi and evil-qi, the imbalance between yin and yang, the derangement of qi and blood, disturbance of the body fluids, etc. There is no doubt that this has an important practical significance in the further exploration of the essence of these pathological mechanisms. To grasp the laws that govern the development and changes of disease and to effectively guide syndrome differentiation and treatment in clinical practice has great significance in reality.
This theory of traditional Chinese medicine holds that the basic pathological response of the human body to invasion or the influence of pathogenic factors is nothing more than a prosperity and decline of the evil-qi and the genuine-qi, and an imbalance between yin an yang, a derangement of qi and blood, and an abnormality of body fluids.
I. Prosperity and Decline of the Evii-Qi and the Genuine-Qi
This phrase refers to the changes of the prosperity and decline of the genuine-qi and evil-qi in their struggle throughout the course of disease. Thus struggle is not only closely related to the changes of deficiency in the body, or the excess of pathological mechanisms and syndromes, but the struggle directly exerts an influence upon the development and outcome of disease. In the course of this struggle, the genuine-qi and evil-qi are not static. There exists between them changes of prosperity and decline in their strength, which adhere to certain laws. A general law being that a rise in the genuine-qi leads to a consumption of the evil-qi, likewise, a rise in the evil-qi leads to a consumption of the genuine-qi. As the struggle proceeds, two kinds of physiological states appear, which will manifest as a syndrome of deficiency or excess.
1. Prosperity and Decline of the Evil-Qi and the Genuine-Qi and Their Pathological Changes in Deficiency and Excess
Chapter 28 in the Plain Questions states: "Exuberance in the evil-qi may lead to a syndrome of excess, while exhaustion of the essential qi may brings about a deficiency syndrome. "
Excess means that there is a preponderance of evil-qi, which creates a pathological reaction based on the dominance of the evil-qi. In the conflict taking place in the body, the toxicity of the evil-qi and the body resistance are equally exuberant, appearing as a hyper-functioning of the viscera; or the former is hyperactive, while the latter is still strong and is able to resist the evil-qi, resulting in a severe struggle between the two sides, characteristic of the early or advanced stages of disease. This may be caused either by the six climatic evils or by improper food intake, excessive phlegm, stagnant water or blood, and give rise to pathological changes of profuse phlegm and saliva, retention food, overflowing water-dampness, internal blood stasis etc.. manifestations such ashigh fever , delirium, loud voice and coarse breathing, abdominal pain aggravated by pressure, oliguria and constipation, and a full forceful pulse, belong to the excess syndrome.
Deficiency mainly derives from the insufficiency of the genuine-qi, which is a pathological reaction dominated by impairment of the genuine-qi. In this case, qi, blood, body fluids, the viscera, and the meridians are all insufficient. Their physiological functioning is weak, body resistance low, as the genuine-qi is unable to overcome the evil-qi and the pathological reaction is less intense. This leads to a series of deficient or declined manifestations, such conditions are called syndromes of deficiency. This type of syndrome occurs most commonly in the advanced stage of a disease, or from a deficiency in one's natura composition, or in the course of various chronic diseases. In clinical observation, this type of syndrome may often be caused by serious illness, prolonged disease, consumption of the essential qi; Or by the impairment of qi, blood and body fluid as well as an impairment of yang-qi, or yin-essence due to profuse sweating, vomiting, diarrhea, and massive hemorrhage; This condition is marked by lassitude, sallow complexion, palpitation,shortness of breath spontaneous perspiration, night sweat, feverish sensation in the five centers, or an aversion to cold, cold limbs, and a thready weak pulse.
The prosperity and decline of the evil-qi and genuine-qi not only cause pure pathological changes of excess or deficiency, but also lead to the simultaneous occurrence of deficiency and excess syndromes, or the transformation of these syndromes in the course of a prolonged and complicated illness. This is because the interaction of the evil-qi and the genuine-qi during their transformation brings about the coexistence of prosperity and decline. For example, if a disease is not treated or if the therapy fails, the evil-qi will main in the body, injuring the genuine-qi. The original syndrome of excess will then transformed into the syndrome of deficiency, or into a simultaneous coexistence of both deficiency and excess.
If the genuine-qi is weak, it is unable to expel the evil-qi. Deficiency of the genuine-qi is accompanied by stagnation and blocking of pathological products, such as retention of food, accumulation of water-dampness, phlegm-retention, and blood stasis. This may result in the simultaneous occurrence of deficiency and excess syndromes, due to the preponderance of the evil-qi and the deficiency of the genuine-qi.
It is necessary to point out that, in clinical practice , certain indicators of the deficiency and excess of pathological mechanisms can be seen. But the clinical signs are only the phenomena of the disease. Under common conditions, the phenomena and the nature of a disease are consistent with each other, and thus manifest deficiency or excess of pathological mechanisms correspondingly. Under some circumstances, the phenomena do not entirely correspond with the nature of diseases, and there may appear many false phenomena which do not correctly reflect the deficiency or excess of pathological mechanisms, the leading to pathological mechanisms of " excess syndrome with pseudo-deficiency symptoms" or "deficiency syndrome with pseudo-excess symptoms. "
The pathological mechanism of the former results from the accumulation of excessive evil-qi, which obstructs the meridians and collaterals and the functional activity of qi, and does not allow the qi and blood to be dispersed and distributed to the outward body. The latter is due to the insufficiency of qi and blood, and the dysfunction of transportation and transformation, which further the dysfunction of the viscera. Those are what are called "symptoms of deficiency in extreme excess," and "symptoms of excess in extreme deficiency. " Therefore, in clinical practice, it is necessary to see the essence of a pathological mechanism through its accompanied phenomena, or in other words, to grasp the nature of a disease on the basis of changes of deficiency and excess which are reflected in the prosperity and decline of the evil-qi and the genuine-qi.
2. Prosperity and Decline of the Evil-Qi and the Genuine-Qi and the Development of Disease
In the course of the onset and development of disease, prosperity and decline of the evil-qi and the genuine-qi are not static, but are dynamic. This determines not only the changes of deficiency and excess of pathological mechanisms, but directly affects the development and outcomes of disease. In general, there are two types of development:
1) Prevalence of the Genuine-Qi with Abatement of the Evil-Qi
This refers to an outcome in which the disease turns better. It is the most common
outcome of many diseases. This is because the genuine-qi of the human body is comparatively strong, with a considerable capability to resist the evil-qi. Or, alternatively, the disease has been given prompt and proper treatment, which has been able to check the growth of the evil-qi, thus weakening or eliminating the pathogenic action against the body. The pathological lesion of the viscera and meridians may gradually get repaired, the normal functioning of the essence, qi, blood, body fluids resumes, the relative balance of yin and yang is re-established on a new basis, and finally, the disease is completely cured. For example, in exogenous heat disease caused by the six climatic evils, the evil-qi usually attacks the human body via the surface, sweat pores, or mouth and nose.
If the genuine-qi is strong enough in its resistance against the evil-qi, it can not only stop the development of disease and limit the pathological change in the body surface or in the meridians, but it also will expel the evil-qi from the body. Once the method of diaphoresis and relieving the exterior is applied, the evil-qi is eliminated and the genuine-qi has resumed, thus bringing about harmony between nutrient-qi and defense-qi and a complete cure of the disease.
2) Preponderance of the Evil-Qi with Debilitation of the Genuine-Qi
This is an outcome in which the disease turns towards deterioration or even death.Since the genuine-qi of the body declines, or the evil-qi is hyper-active, the body resistance gradually becomes weaker, and it is unable to overwhelm the evil-qi and check the development of the disease. These weaknesses ultimately lead to continuous damage of the body by the evil-qi, and the condition of disease deteriorates. If the genuine-qi exhausts but the evil-qi remains preponderant, the physiological functions of the qi, blood,viscera and meridians are declined, the divorce of yin and yang occurs, and life's activitiescome to an end. For example, in the course of exogenous heat disease, the syndromes of"collapse of yin" and "collapse of yang" are typical manifestations indicating that the genuine-qi cannot overwhelm the evil-qi, and the preponderance of the evil-qi leads to the debilitation of the genuine-qi.

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