1. Pathogenesis
Lecturer: QU Hongyan

2. 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.

3. and decline of pathogenic
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

4. Preponderance and decline of pathogenic or healthy qi

5. Pathogenesis of deficiency and 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

6. 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

7. Deficiency complicated by excess
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

8. 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

9. Delayed or improper treatment
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

10. 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.

11. True or false excess and deficiency
1．True deficiency with false excess
Nature of disease
Deficient
syndrome
Deficient
syndrome
False clinical manifestation

12. True or false excess and deficiency
2．True excess with false deficiency
Nature of disease
Excess
syndrome
excess
syndrome
False clinical manifestation

13. 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

14. ——changes of cold and heat
Yin-yang disharmony
——changes of cold and heat

15. Preponderance of yin or yang Exhaustion of yin or yang1
Preponderance of yin or yang 2
Decline of yin or yang 3
Mutual impairment of yin and yang 4
Mutual rejection of yin and yang
Exhaustion of yin or yang 5

16. 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.

17. Yin qi Preponderance of yang Excessive heat syndrome Yang qi
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

18. （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.
Excessive yang causes heat
Equilibrium

19. (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
Exuberant yin causes cold
Equilibrium

20. （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.
Yang deficiency leads to cold
Equilibrium

21. （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.
Yin deficiency leads to heat
Equilibrium

22. 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

23. 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

24. 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

25. 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

26. 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..

27. Exhaustion of yin or yang
deficiency
Yin
exhaustion
Yin
exhaustion
Yang
deficiency
Results：exhaustion of yin or yang
one’s life in dangerous

28. 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
Decline
of yin
or yang
Preponderant yin
transform yang
Yin-yang
in balance
Yin impairment
Involving yang
Yang impairment
Involving yin

29. Disharmony of qi and blood

30. Disorders of qi Qi deficiency Qi sinking Qi blockage
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
Unsmooth flow
Qi stagnation

31. 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..

32. 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.

33. 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..

34. 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..

35. 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.

36. 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.

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

38. Disorders blood
Blood deficiency
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.

39. Qi deficiency Yang deficiency Yin deficiency Blood deficiency
difference
The former is a deficient syndrome but without apparent
cold symptoms
Yin deficiency
Blood deficiency
The former is a deficient syndrome but without apparent
heat symptoms
difference

40. Disorders blood
Blood stasis
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.

41. Disorders blood
Hemorrhage
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.

42. Disorders blood
Blood heat
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.

43. Disorders blood
Blood cold
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.

44. Disharmony between qi and blood
deficiency of
both qi and
blood
Qi deficiency
and blood
stasis
failure of qi
to control
collapse of
qi due to
hemorrhage
Qi stagnation

45. Qi stagnation and blood stasis
Disharmony between qi and blood
Qi stagnation and blood stasis
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

46. Qi deficiency and blood stasis
Disharmony between qi and blood
Qi deficiency and blood stasis
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

47. The failure of qi to control blood
Disharmony between qi and blood
The failure of qi to control 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

48. Collapse of qi due to hemorrhage
Disharmony between qi and blood
Collapse of qi due to hemorrhage
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..

49. Deficiency of blood and qi
Disharmony between qi and blood
Deficiency of blood and qi
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