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Chapter Five
Etiology

Etiology refers to pathogenic causes . The etiological theories of Sinomedicine emphasize the relation of the factors , such as nature , physical constitution , psychological state ,life style and others with the diseases .

The content of etiological theories of Sinomedicine includes six evils , seven emotions ,epidemic diseases , diet and overstrain ,surgical trauma , phlegm and fluid retention diseases , blood stasis and others .

1.Six Evils

Wind ,cold ,summer-heat ,wetness ,dryness and fire are the six different climatic changes of nature ,and they are called " six kinds of natural factors " in normal condition . If disease resistibility of human body decreases , it can not adapt to the climatic changes ,or the rapid normal climatic changes surpass the adaptability in human body , the " six kinds of natural factors " will become the pathogenic conditions , and they will invade human body to cause diseases .In this condition , the " six kinds of natural factors " are called " six evils " .The evil refers to excessiveness . The six evils are the main causes of all diseases due to exogenous pathogenic factors .

In addition ,some diseases are not the diseases due to exogenous pathogenic factors , but they can show some symptoms similar to that of diseases caused by six evils . To differentiate these causes from the exogenous pathogenic six evils ,the wind , cold , wetness , dryness and fire generated inside body by dysfunction of the zang-organs and fu-organs are called endogenous wind-evil , endogenous cold-evil ,endogenous wetness-evil , endogenous dryness-evil and endogenous fire-evil .

[1].Wind

Wind is the main weather in spring .The diseases caused by wind-evil of nature mostly are found in spring ,but they can be found at all season .

Characters of Wind Evil are as following :
A.Wind is yang evil,and it has opening and expelling nature.
B.Wind is adept at migrate and change.
C.Domination of pathogenic wind may lead to mobility.

[2].Cold

Cold is the main weather in winter . Exogenous cold-evil refers to the evil of external cold air which invades human body to cause diseases .

Characters of Cold Evil are as following :
A.Cold is yin evil ,and it damages yang vital energy easily.
B.Cold has nature of spasm and stagnancy,and it takes charge of pain.

[3].Summer-heat

Summer-heat is the main weather in summer ,and it is transformed into by fire and heat energy . Seasonal febrile diseases in summer are caused by summer-heat evil ,and they are called diseases due to summer-heat evil.

Characters of Summer-heat Evil are as following :
A.Summer-heat is yang evil,and it has scorching nature.
B.Summer-heat has rising nature,and it consumes vital energy and damages body fluid.
C.Summer-heat usually holds wetness evil.

[4].Wetness

Wetness is the main weather in late summer .Wetness evil is strong in late summer , so wetness diseases is common .

Characters of Wetness Evil are as following :
A.Wetness has heavy and turbid nature.
B.Wetness has viscous nature.
C.Wetness is yin evil ,and it inhibits and damages yang vital energy and blocks functional activities of vital energy .

[5].Dryness

Dryness is the main weather in autumn .The diseases due to external dryness-evil are called exogenous dryness syndromes ,and they are also called " autumn dryness syndromes " , because they are mostly found in autumn with dry weather .

Characters of Dryness Evil are as following :
A.Dryness has dry nature , and it easily damages body fluid .
B.Dryness easily damages the lung .

[6].Fire

Fire is similar to heat ,and both are manifestation of yang and heat .However ,they are different slightly . Heat is slight while fire is serious , heat is silent while fire is active , furthermore , fire is mostly formed inside body . Fire diseases can be caused by direct attack of warm-evil and heat-evil , but they can be caused by heat and fire transformed by invaded five evils-wind , cold , summer-heat , wetness ,dryness . Endogenous fire is produced by visceral dysfunction and emotional stress .

Characters of Fire Evil are as following :

A.Fire-evil is the extreme of heat,and it has scorching and rising nature.

B.Fire-evil consumes and scorches body fluid.

C.Fire-evil compels blood to go astray.

2.Pestilent Evils

Pestilent evils belong to external pathogenic factors ,and they are pathogenic factors of acute infectious diseases with very strong infectiousness.

Occurence and epidemic of the pestilent evils relate to the factors ,such as serious abnormal natural weathers -- long drought ,excessive rains ,extremely hot weather and miasma ,as well as poor hygience condition and others.

Pestilent evils refer to pathogenic microorganisms existing in air which can cause deadly infectious diseases .Infectious diseases infect human body mostly through the respiratory tract and digestive tract . The infectious diseases caused by the same kind of pathogenic microorganism have similar symptom .Different kinds of pathogenic microorganisms cause different infectious diseases . Because of limitation of conditions,in Sinomedicine ,the pathogenic microorganisms have not been studied microscopically.However , macroscopical observation to epidemic of infectious diseases in Sinomedicine is basically correct . In Sinomedicine it is believed that the factors causing deadly infectious diseases exist in air ,and epidemic of infectious diseases relates to abnormality of weather.

3.Seven Emotions

The changes of seven emotional conditions ,overjoy ,anger , worry , overthinking , sorrow , fear , alarm are simply called seven emotions .In general condition ,seven emotions are reflections of human to objective external things ,and they belong to scope of normal mental activities . However ,if long-term mental irritation and violent mental scar exceel the scope that human physiological activities can regulate ,they may cause imbalance of yin ,yang ,vital energy and blood inside body ,as well as disturbance of functions of the zang-organs , fu-organs and meridians ,thus leading to occurence of diseases.

Seven emotions cause diseases through direct influence on the related internal organs ,therefore ,they are the main factors causing internal diseases.

Human emotional activities relate closely to the internal organs.When emotions cause diseases ,they mostly damage the related internal organs . " Plain Questions .on Matching of Yin and Yang " points out : " anger may lead to disorder of liver " , " overjoy may lead to disorder of heart " , " overthinking may lead to disorder of spleen " , " worry may lead to disorder of lung " ,"fear may lead to disorder of kidney " .

Abnormal changes of emotions damage functional activities of vital energy in the internal organs,and they cause disturbance of functions of the zang-organs and fu-organs ,thus leading to diseases . " Plain Questions.on Pain " points out :" Many diseases are caused by abnormal activities of vital energy . Anger may lead to the abnormal rising of vital energy , joy may lead to the sluggishness of vital energy , sorrow may lead to the consumption of vital energy , fear may lead to the abnormal falling of vital energy,...alarm may lead to the disorder of vital energy ,and overthinking may lead to the depression of vital energy ."

Disorder of functions of the zang-organs and fu-organs can cause certain emotional changes as well . " Miraculous Pivot.on Taking Spirit as Basis" point out: "Asthenia of liver-energy may cause fear , but sthenia of liver-energy may cause anger " ; " Asthenia of heart-energy may cause sorrow , but sthenia of heart-energy may cause continuous laugh " . Therefore , asthenia or sthenia of zang-organs energy can cause different changes of emotions.

The syndromes caused by mental factors are mostly found in heart,liver and spleen.

4.Improper Diet and Overstrain

Diet , labour and rest are essential conditions on which human being depends for existence and health-keep . However, diet must be moderate in,and labour and rest must be rationally arranged , otherwise ,they may decrease resistence of organism ,influence physiological functions of the zang-organs and fu-organs ,thus causing diseases.

[1].Improper Diet

Pathogenies of diet are improper diet ,unclean diet and partiality for a particular kind of food.

[2].Overstrain

Overtiredness consumes and damages healthy energy easily ,and constant overtiredness can cause breaking down .Over easiness and comfortableness ,lack of sport and exercise , and obstruction of circulation of vital energy and blood can cause liseases as well . Hypercoitus ,that is no abstinence of sex life ,early marriage , hyperfertility and others can consume essence of life and damage kidney.

" Labour may cause consumption of vital energy " . Overwork can cause diseases due to disorder of vital energy.

" Comfortableness may cause laziness of vital energy " . Over easiness and comfortableness , lack of labour and exercise ,decrease of consumption ,lipopexia ,obesity can cause difficulty in movement ,obstruction of circulation of vital energy and blood ,thus leading to different diseases.

Hypercoitus ,coitus after being drunk , early marriage , multifertility , and overconsumption of kidney-essence can cause asthenia of kidney.

5.Surgical Trauma

[1].Surgical Trauma

The most common surgical traumas are injuries from falls ,fractures ,contusions and strains ,and injury by metallic blade.

Injuries from falls , fractures , contusions and strains damage vital energy and blood . If vital energy is damaged ,it will be stagnated . If blood is damaged , it will be coagulated .Stagnation of vital energy can cause blood coagulation ,and blood coagulation can also stagnate circulation of vital energy.

For injury by metallic blade , in the slight sufferers , damage of skin and muscle , hemorrhage , permeation of blood through skin and muscle , beat transformed by blood stasis are found ,so they cause red ,tumescence ,heat and pain .In the serious sufferers ,damage of muscle and fracture are found ,so the sufferers feel a severe pain , and their movements are restricted.

[2].Injuries by Insects and Animals

Poisonous insect stings can cause local red ,tumescence and pain . The symptoms of general intoxication ,such as dizziness ,coma and others can be found in the serious sufferers.

For bitten injury by poisonous snake ,venins can be divided into wind toxin and fire toxin . After being bitten by poisonous snake with wind toxin ,the region of wound is no red ,no tumescence and no exudate ,but slight pain ,even numbness occur in the region . In slight sufferers , the symptoms , such as dizziness , hidrosis ,feeling of oppression in the chest , anergia of the extremities can be found ;in serious sufferers , the symptoms ,such as mydriasis ,dimness of sight ,unclearness of speech ,salivation ,lockjaw ,dysphagia ,coma ,weakening of breath ,slow and weak pulse condition or irregular pulse condition ,and final respiratory standstill can be found . After being bitten by poisonous snake with fire toxin ,the wound is severely painful ,tumescent ,blistering ,and the wound even necroses to form ulcer . Constitutional symptoms are chill and fever ,ache of the muscles in whole body ,subcutaneous hemorrhage , hematuria , hemafecia , epistaxis and homatemesis ,then ,the symptoms of jaundice and others occur , even collapse due to deficiency of heart-energy occurs.

Bitten injury by rabid dog can cause rabies.

6.Phlegm,Fluid Retention,and Blood Stasis

Phlegm ,fluid retention,and blood stasis are products of pathological changes in human body . After formation of these products ,they can become pathogenic factors , or they can cause deterioration of diseases.

[1].Phlegm , and Fluid Retention

Phlegm ,and fluid retention are pathological products of retention of water and wetness evil caused by disorder of functions of the three zang-organs ,lung ,spleen and kidney. The thick pathological product is called phlegm ,and the thin pathological product is called fluid retention.

After formation of phlegm ,and fluid retention ,they can become new pathogenic factors , causing many kinds of diseases . Because the regions in which phlegm ,and fluid retention accumulate are different , the syndromes and clinical manifestations caused by them are different as well.

For the diseases caused by phlegm ,and fluid retention ,their common characters are : cough with abundant sputum and saliva , wheezing sound in the throat due to sputum ,distension ,tumescence and edema ,vomit and vertigo ,palpitation ,greasy fur , wiry and smooth pulse and others.

[2].Blood Stasis

Obstruction of blood circulation ,stagnancy of local bloodflow , and existence of blood leaving channels in body all are blood stasis.

The symptoms of blood stasis are different because of difference of regions of obstruction and stagnancy . The diseases caused by blood stasis show manifestationsof pain ,lump ,hemorrhage and others . Blood stasis obstructs the channels ,therefore , obstruction causes pain . Pain in blood stasis syndrome is fixed in location ,showing natures of stabbing pain , refusing press ,and lasting .Hemorrhage is also common symptom of blood stasis syndrome . Colour of the hemorrhage is mostly dark purple . The hemorrhage is usually accompanied with blood clots . Constitutional symptoms of blood stasis include dimmish and blackish complexion , blue or purple skin , purplish and dimmish tongue , or tongue with petechiae , small and uneven pulse and others . If sludged blood attacks heart , mental symptoms , such as delirium ,mania and others will occur.

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