6/26/2021 TCM External and Internal Pathogenic Causes of Disease

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TCM External and

Internal Pathogenic
Causes of Disease
Wendy Morrison • Oct 01, 2019

Are you walking the path toward health or illness? As health is dynamic,
care needs to be taken to maintain it. Health takes work but is taken
down by things like worry, overthinking, anger and stress.

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6/26/2021 TCM External and Internal Pathogenic Causes of Disease

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This article discusses how Traditional Chinese Medicine (TCM) views pathology in APPOINTMENT
the body, with a focus
on organ pathology. Chinese Medicine, as an ancient system of healing couldn't rely on modern
HOME (biomedicine)
technology used by Western medicine SERVICES- which
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analyzes PROTOCOLS change in the body
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at microscopic levels or by using internal BLOG
body scans PODCAST
- to identify and treat CONTACT
illness. 

So, the ancient Chinese Medicine doctors looked to nature and our connection to it. Ancient Chinese
Medicine grew from a universal world in which humans live - we are the microcosm affected by the
universe (the macrocosm). There is always energetic connection between us and all that is around us,
including the weather.  TCM views this connection as key to our health.

TCM is a holistic medicine which places emphasis on the human body as an integrated whole and on
the intimate relationship to our social and natural environments. One definition of health is
maintaining balance within the body (biomedicine - homeostasis in terms of our physiology) and with
the external environment. Health is dynamic and not a static event; and as such care needs to be taken
to maintain our health. 

In the picture above, the woman appears to be dressed appropriately for the weather and is walking
along a path while pressing or tapping on her head. In my TCM coloured glasses, she's pressing on DU20
(Bai Hui) which provides balance in the body and lifts up your Qi. Perhaps while wondering if she's on
the right path in her life and health, or is she overthinking, stressed, worried and thus heading towards
pathology?

What is Pathology in Chinese Medicine?

The term pathology in TCM is related to our bodies internal balance of Yin and Yang Qi and the type and
severity of the pathogenic factor(s). In order to diagnose any pathology, we ask a lot of questions to
identify a pattern of disease, what Maciocia (quote below) is calling looking for 'broad factors'.  This
includes signs and symptoms that when combined form a discernible pattern. We also look to identify
the specific etiology or etiologies (causal factors of the illness).

"Pathology explains how a disease process arises, how its manifestations change and how they are
resolved. ‘Pathology’ in Chinese medicine has a very different meaning than in Western
medicine...Chinese medicine pathology is concerned only with the broad disease processes and
changes in the light of general, broad factors, such as pathogenic factors versus the body’s Qi and the
balance of Yin and Yang. 

For example, if a patient falls ill with an upper respiratory infection which later causes a chest infection
with symptoms of fever, chest ache, profuse cough with purulent sputum...Chinese medicine...is concerned
only with the broad picture: in the case example outlined above, according to Chinese medicine
pathology, the exterior pathogenic factor has penetrated the Interior and has become stronger. Chinese
medicine would also want to look at the general picture of clinical manifestations to assess the relative
strength of pathogenic factor and body’s Qi: this is crucial to determine the treatment principle and
method and prognosis." - The Foundations of Chinese Medicine by Giovanni Maciocia

Your Zheng Qi (Immune System)

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6/26/2021 TCM External and Internal Pathogenic Causes of Disease
Where Western medicine (biomedicine), focuses on structural changes of body tissues and variations in
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blood chemistry PROTOCOLS
example, theIN PLACEfocus
primary FORofIN-CLINIC APPOINTMENTS.
TCM theory and practice is onDETAILS HERE. and
the identification

treatment of dysfunction (alteration from balance).  BOOK APPOINTMENT

A fundamental TCM theory is that

HOMEthe primary causativefactor
SERVICES in diseasePROTOCOLS
COVID-19 is weakness in your body's
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functioning. As summarized below, Zheng BLOGQi) is PODCAST
Qi (Upright CONTACT
the term representing all of the types of Qi
which defend the body against attack in order to maintain 'normal' body function. Your Wei Qi
(Defensive Qi) discussed below is first line of defence where a pathogenic factor such as those causing
the common cold looks to invade.

In practical terms, “ Zheng Qi” is a general term for all types of Qi that play a role in the defence from
pathogenic factors and therefore the immune response. It is not a specific type of Qi (as Gu Qi is, for
example), but a collective term to indicate all types of Qi that play a role in the immune response. The
terms “Zheng Qi” is often used in opposition to “Xie Qi”, i.e. pathogenic factor (literally “evil Qi”). - Giovanni
Maciocia

Once your Zheng Qi becomes weak conditions arise that manifest as dysfunction somewhere in the
body. This may be in any level of the body, but usually starts out as an energetic
dysfunction/imbalance, and gradually this can become a physical illness affecting organs and other
body tissues. So, prevention or early detection when the pathogen is at a superficial level is the best
situation. 

Pathogenic Factors as Causes of Disease

Based on significant empirical evidence (clinical work and evaluation), ancient Chinese Medicine
doctors were able to identify the pathogenic factors which create imbalances in the human body that
lead to disease. These factors are categorized into those that arise from external forces and penetrate
into the body (Exterior Pathogenic Factors - EPFs) and those occurring due to internal causes (Interior
Pathogenic Factors - IPFs). 

Chinese Medicine looks at the relative strength of the pathogenic factors (EPFs and IPFs) to our bodies
defences (biomedicine - immune system).
In TCM, we become ill either due to forces in our external environment or due to an internal imbalance
originating internally or externally. 

Your skin and the 'couli' space (between the skin & muscles - also called the 'Exterior') are part of your
immune system. Although EPFs must work against your Wei Qi to penetrate the 'Exterior', they can
penetrate deep into the body and cause internal disease if they are stronger than your Wei Qi or are not
pushed out of the body quickly enough. 

TCM uses the concept of your body as a house and the EPF as a burglar. When the burglar is at the door
you close it, but if he makes it into the atrium you push him out. However, if this is not done, he will
continue to go deeper into your house. For example, a common cold can become much more serious if
your immune system is weak or you don't take care to expel it. The best time to expel this cold is at the
first symptom, e.g. runny nose, sneeze, body aches, cough or sore throat.

When a patient with an illness comes in for TCM diagnosis and treatment, the focus is on determining
th ti l ( f di ) N t l k t li i t
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6/26/2021 TCM External and Internal Pathogenic Causes of Disease
the etiology (cause of disease). Next we look to eliminate or reduce the pathogenic factor which can be
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enhance the body’s resistance to disease. After diet, emotions are one of the mostAPPOINTMENT
common causes of
disease. Question - how many people do you know personally who are affected by stress, anxiety,
depression, and/or worry. Unfortunately,
HOME the answer is 'too many'.
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External Causes of Disease
External causes of disease relate mostly to the weather and how you work to keep in balance with
climactic conditions. For example, climate (local weather) can be a cause of disease, and TCM has
identified six EPFs, namely Wind, Dampness, Dryness, Cold, Fire and Summer-Heat. These EPFs look to
invade the body through the 'Exterior' which is guarded by your Wei Qi (part of your immune system in
TCM). If we have strong Defensive Qi (Wei Qi), then we can literally weather any storm. However, if our
Wei Qi is weak then we will more easily (and likely more frequently) come down with colds and flus, etc.

Our bodies can become ill due to an internal imbalance (i.e due to Interior Pathogenic Factors - IPFs) or
related to the external world (due to Exterior Pathogenic Factors - EPFs). For example, climate can be a
cause of disease and TCM has identified six EPFs, namely Dampness, Dryness, Wind, Cold, Fire, Summer
Heat. These EPFs also combine together, so for example on a cold and windy day, the EPF is 'Wind-
Cold'. Or if there is often Dampness in the environment (such as is usually present in Southern Ontario),
then we have to work against 'Wind-Cold-Damp'. 

If the EPF is not expelled it goes deeper into the body. So, if Wind-Cold has entered into your joints, you
may feel pain more on a rainy day which moves around. Or, if Cold-Damp is the culprit then the cold
and damp winter months in Southern Ontario you may experience stiff, achy and heavy feeling joints
(may be more painful in the back and lower parts of the body - this is called Damp-Cold Bi Syndrome;
akin to arthritis).

Chinese Medicine looks at the relative strength of the EPFs to our bodies defences. If we have strong
Wei Qi (part of our immune system), then we can literally weather the storm. However, if our Wei Qi is
weak then we will easily come down with colds and flus, etc.

You might have noticed Chinese people bundling up more in early Autumn to keep the warm and gain
protection from the wind. And, they often keep warmer clothes on longer (deeper into Spring). This is to
protect against EPFs. So, for example when I see people out in winter weather with a jacket open or one
that doesn't cover their lower abdomen, I think about how their immunity will handle this onslaught of
Cold. 

Internal Causes of Disease

In TCM, IPFs are generated mainly due to internal causes (the exception is where EPFs enter more
deeply into the body). In this article, we are discussing health issues related to the following TCM
internal Yin organs - Heart, Lung, Spleen, Kidney and Liver. Examples of IPFs are Qi Deficiency or
Stagnation, Blood Deficiency or Stasis, Dampness, Phlegm, Internal Cold, Internal Heat/Fire and
Internal Wind. They're subdivided into Excess and Deficiency conditions as this is quite important for
diagnosis and treatment. Excess includes Stagnation, Stasis, Dampness,  Phlegm and Fire; Cold, Heat
and Wind can be either Excess or Deficiency (also called Empty).

A t d b f EPF th i f t bi
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6/26/2021 TCM External and Internal Pathogenic Causes of Disease
As noted above for EPFs, pathogenic factors can combine. So, Internal Cold and Damp or Internal Heat
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causing factors. Internal Wind is typically related to imbalance in Liver function in APPOINTMENT
TCM. Internal Wind
can create serious illness; TCM considers it as a key factor in stroke, seizure and other neurological
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Internal pathogenic factors are internally generated, i.e. they form because of an internal disharmony. For
example, a deficiency of the Lungs,
Spleen and Kidneys may give rise to Phlegm, a deficiency of Yang may
lead to (Empty) Cold, a deficiency of the Spleen may lead to Dampness, etc.
 

- The Foundations of Chinese Medicine by Maciocia

Constitution
Chinese Medicine has some agreement with biomedicine that are constitution comes from our parents.
We part ways after that. Chinese Medicine views constitution in a broader sense than just our genetics
(DNA), as it includes energetic functions and the spirit of the organs. In addition, the constitution
changes somewhat depending on the overall health and age of each parent at the exact moment of
conception.

"Chinese medicine stresses the importance of the

parents’ health in general, and at the time of conception
specifically, for the health of the child. If the
parents conceive when too old, or in poor health, the
constitution of their child will be weak. This may also be the case if the mother suffered ill health or took
excessive drugs during pregnancy." - The Foundations of Chinese Medicine

We all have some weakness in our constitutions, but some people are more robust and live or have the
potential to live long, healthy lives. Others do not fair as well in this area, and so must be much more
careful with their health. Things like diet, activity, meditation, qigong and alternative therapies such as
TCM are really important when you are dealing with constitutional health issues.

Diet
There are three type of errors in regard to diet, as follows: wrong food, wrong quantity and wrong time.
Diet is really, really important to your health. Good nutritious food that you make at home (organic if
possible) is generally much better than what you can order in or get at a restaurant. There is also the
perspective of eating food in relation to the type of TCM pattern you are diagnosed with in order to
balance out your organs and hence your body. This is covered within the 'TCM Diet series'. 

One thing I will say here is that if you often feel cold (more than just your hands and feet; and even in
warm weather) and you really prefer hot drinks, it's probably not a good idea to drink cold smoothies
and eat cold salads everyday. I know that this is very 'in' right now but it may not be good for your
health if you have these symptoms (but may be okay in moderation). Too much cold or cold-natured
food depletes your Spleen Qi.

Seven Injuries (Emotions)

These are called the internal causes of disease and comprise the following: Anger, Joy, Sadness, Worry,
Fear and Shock. Emotions become disease causing (pathogenic factors) when they are extreme and/or
are held too long. We need to be more like children in relation to our emotions, in that they cycle
through emotions quickly (sometimes too fast). But the point being, that they are fluid with emotions
d t t ti ith th d lt d
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6/26/2021 TCM External and Internal Pathogenic Causes of Disease
and not stagnating with them as many adults do.
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Anger
, which also includes resentment and frustration, is related to the Liver. APPOINTMENT
Many, many North
Americans suffer from long-held anger, resentment or frustration due to our fast-paced, high stress lives
which typically have two few days of rest orSERVICES
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 ACOVID-19
really great book from Thich Nhat Hanh
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is Anger - Wisdom for Cooling the Flames. BLOG
Who is this guy? HisPODCAST CONTACT
Holiness The Dalai Lama noted that he
"shows us the connection between personal, inner peace and peace on earth." He was nominated by
Martin Luther King, Jr. for a Nobel Peace Prize.

Joy
is related to the Heart and as a pathogenic factor refers mainly to overjoy (e.g. winning the lottery
and dying of a heart attack).  Sadness
, which also includes grief, is mainly related to the Lung.  Worry
and pensiveness
  are related to the Spleen. Fear and shock are both related to the Kidney. That being
said, the Heart as the Emperor of all of the organs, feels all of the emotions in the body. 

Another point is that as the body and mind form an integrated whole, the emotion-organ relationship is
a two-way street. If we have strong emotions, this can deplete our organs or cause them to become
excessive (either way the organ is out of balance). And, if our organs are out of balance, this affects how
we feel and how we deal with things and how we relate to others in our lives.

"A very important feature of Chinese medicine is that

the state of the Internal Organs affects our emotional
state. For example, if Liver-Yin is deficient (perhaps
from dietary factors) and causes Liver-Yang to rise, this
may cause a person to become irritable all the time.
Conversely, if a person is constantly angry about a
certain situation or with a particular person, this may
cause Liver-Yang to rise...

Emotions are internal causes of disease that cause

an internal disharmony directly: this is contrasted with
external, climatic factors, which can cause an internal disharmony only after passing through the stage of
an
Exterior disharmony. For example, sadness and grief
deplete Lung-Qi directly and cause Lung-Qi
deficiency." - The Foundations of Chinese Medicine

Six Taxations (Overexertions)

1. Mental overwork - typically working at a desk or perhaps giving presentations. Thinking too long
and being overly pensive depletes your Spleen Qi and worry depletes your Lung Qi.
2. Physical overwork
- outside workers, those who travel for work, do shift work or stand too
long...mostly depletes Kidney Qi
3. Excessive physical exercise - those who over do it at the gym, serious athletes, over doing it for
your age and/or health. This generally depletes your Spleen and/or Liver Qi.
4. Excessive sexual activity - depletes your Kidney Qi (affects men more than women; women are
depleted more by pregnancy).

As a former 'overworker' in my previous field and also physically as an athlete at the varsity level, I
know too well some of the consequences of spending too much time each day on an activity. In
addition, during our time in this 'overwork lifestyle' we often don't eat well and we carry significant
mental and emotional stress (worry, anger, frustration...). Of course, I'm not alone. Many of us in the
West lead similar busy lives that can over time severely deplete their Qi (energy) down to levels where
disease begins to manifest.

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Also, we can say that 'couch potatoes' and others who do not move our bodies (and thus our Qi) enough ×
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and other athletic activities
are great, as long as you play within your body's tolerances - try not to over do it.
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Trauma ABOUT BLOG PODCAST CONTACT
Pain in Chinese Medicine is due to Qi and/or Blood Stagnation. Trauma can occur during athletic activity
or driving to work. When trauma occurs, for example an ankle sprain during a fall, skin may be
disrupted, the blood vessels such as capillaries may be damaged (creating bruising) and the immune
system kicks into action which causes local swelling. All of which creates stagnation. Stagnation equals
pain; and in this case also limited mobility, which keeps you off your foot for a while. If the skin is intact
at the site of injury and bones are not broken, then Qi and Blood moving topical ointments may be used
to help the body repair and to decrease pain. 

When I play softball and hockey, I bring ointments to relieve pain, swelling and bruising in case of
trauma such as sprains, pulled muscles and getting hit by a baseball or puck. They work fast and you
don't need to put 'ice' on the area, which has been found to reduce healing time. And in TCM, Cold can
cause longer term issues as the EPF can go deeper into the body.

"Physical traumas cause local stagnation of Qi or

Blood in the area. A slight trauma causes stagnation
of
Qi and a severe one causes stasis of Blood. In either case, it gives rise to pain, bruising and swelling.
Although trauma may seem only a transient cause of
disease, in practice the effect of trauma can linger
for
a long time, manifesting with local stagnation of Qi
and/or Blood in the area affected. 

Old accidents and falls that the person may have

completely forgotten can often be the cause of disease,
or a contributory cause. This is especially true of headaches:
as a rule of thumb, headaches that always
occur
in the same part of the head are often caused by a
previous injury to that part of the head. This
means
that local treatment aimed at removing stasis of Blood
in that area is particularly applicable".  -
The Foundations of Chinese Medicine by Giovanni Maciocia

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TCM and the TCM, Conception & The Menstrual Cycle -

Menstrual Cycle - Part The Three Treasures East meets West
II
Jing, Qi and Shen are known as This is the first part of a three
This is the second in a three- the Three Treasures because part series about women’s
part series on Traditional they are fundamental physiology, specifically as it
Chinese Medicine (TCM), substances which make us concerns the menstrual cycle,
women's physiology and the human. And, they form the main from Traditional Chinese
menstrual cycle. It's part of a energy states (densities) that Medicine (TCM) and biomedical
larger focus by Shen Space on are critical for us to live healthy views. Part II will focus on the
TCM and women's health. We lives and to bring healthy menstrual cycle and Part III will
discuss organs and channels children into the world. Jing has provide on overview of TCM
involved in the menstrual cycle the greatest density and Shen is patterns. TCM excels in
and how they direct and the most subtle. Jing, Qi and Gynecology - female physiology
support this cycle and Shen play major roles in and pathology focussed on the
conception. To live a long, women’s and men’s physiology. reproductive system - including
healthy life, reduce aging, the menstrual cycle and pain
become strong and healthy to management. TCM Gynecology
conceive, and increase the has been practiced for over two
chances of a healthy baby, it's thousand years, so we have our
important to conserve the Three own take on it. And research is
Treasures (Jing, Qi and Shen). continuing to develop in TCM
For any woman trying to and within integrated medicine.
conceive and/or get healthier In TCM terms, two common
this includes a regular routine origins of menstrual issues are
including proper nutrition & Liver Qi Stagnation (e.g. PMS)
sleep plus stress reduction. and Blood Deficiency.

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