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Chinese medicine has many ways of looking for disease etiology. By looking at symptoms and syndromes the nature and courses of treatment become apparent.
The Six Exogenous Pathogenic Factors are considered causes of disease, which comes from nature. These are based on what ancient chinese could see or experience in their daily lives: heat, cold, damp, dry, damp heat (or summer heat) and wind.
All of the have both real and metaphorical properties based in their roles in nature. For example wind can be a cause and a way to categorize a disease. A cool breeze blowing on someone sleeping may cause a stiff neck. Pain that changes location is also said to be wind-pain because in nature wind is always moving. A person standing in water will be attacked by dampness. Someone who has edema, without physically being in a damp area, is also said to suffer from dampness.
Heat 热
Heat, sometimes written as fire, comes from watching the flames of early cooking fires. These fires were used for drying clothing and food. Flames had a tendency to flare upwards. If sitting close enough people began to sweat.
Infection of external based heat is usually caused by exposure heat sources or hot weather. Internal heat most often results from excess Yang qi due to disorders of Yin and Yang, Qi and Blood.
Heat has the following properties:
Fire is a Yang pathogen with a tendency to flare upwards. This is seen in high fever, aversion to heat, extreme thirst, profuse sweating, full and rapid pulse and the tendency to affect the upper body such as the head and chest.
Heat tends to consume body fluids. This is evidenced in: thirst, desire to drink, dry throat, dry cough, scanty and dark urine, and constipation.
Heat stirs up wind and disturbs the blood. This includes conditions such as: high fever, delirium, convulsions in the limbs, anoopsia (upward pointing, crossed eyes), stiff net with ulcer (hematemesis), nosebleed, bloody urine (hematuria), macule and papule, excessive menstruation (menorrhagia), abnormal bleeding from the uterus (menorrhagia) and continuous uterine hemorrhaging (menorrhagia).
Heat causes ulcers and sores. Carbuncles, sores with local redness, swelling and hot sensations.
Heat disturbs the Shen(神). In Chinese medicine the Shen is like the mind or conscious though, which lives in the heart. If it is disturbed mental illnesses, such as insomnia, mania, restless, easily upset, unconsciousness and delirium may occur.
Cold 寒
The properties for cold come from peoples' exposure to the elements in cold seasons, especially those from northern China. In the winter water freezes causing contractions and stagnations.
Exogenous cold is caused by environmental factors such as cold weather or water, and in recent times often has man-made causes like air conditioning. Endogenous cold is a morbid condition of either internal cold or excessive Yin cold due to deficient Yang qi's warming function being too weak. Both interior and exterior cold can influence and affect eachother. If external cold enters the body and stays for a long time it will reduce Yang qi causing interior cold.
Cold has the following properties:
Cold causes stagnation. Stagnation is the source of pain. Cold can cause both Qi and Blood stagnations.
Cold induces contractions. This affects the exterior of the body with chills, and an absence of sweat. Cold attacks the blood vessels causing blood stagnation. Blood can also attack joints and meridians causing retarded joint movement and spastic pain.
Dryness 燥
In nature, dry places such as deserts, have the ability to dry out living things. External dryness, caused by the local environment, always results in chills, fever, dry mouth and throat, dry mouth and dry nasal mucous. Internal dryness on the other hand, referrers to internal consumption of Yin by vomiting, diarrhea, or internal heat. This impairs Yin's normal moistening and nourishing functions. Although different they can influence each other. For example someone who has endogenous dryness will have deficient body fluids, this in turn makes it easier to be affected by the exogenous pathogen. Conversely, if the exterior dryness enters the body for a long time it will impair Yin.
Dryness has the following properties:
Dryness is dry and impairs body fluids. This is seen in symptoms of dry mouth, nose and throat; thirst; dry and chapped skin; scanty urine and dry stool.
Dryness impairs the Lungs. This causes dry cough with little or sticky phlegm, which is difficult to cough up; or phlegm with blood, difficult cough (dsypnea), asthma and chest pain.
Dampness 湿
Dampness, often occurring during rainy seasons, is a viscous and lingering sickness. Of all the internal and external pathogenic factors, dampness is the most difficult to get rid of.
In the vast majority of China there is a rainy season usually lasting about a month where it rains almost every day and the days that don't rain are overcast and very muggy. Ancient people were well familiar with dampness invading the body causing digestive problems. Most external dampness comes from living in damp environments like caves, or modern day basements; and more general environments like humid, costal or swampy areas. External dampness can also invade the body from being immersed in water for long periods of time or even wearing damp clothes.
Dampness has the properties of:
Dampness is a Yin pathogen and tends to disturb organ functions and disturb Yang qi. Symptoms often include stuffy sensation in the chest, epigastric distress, dripping and scanty urine, and sticky stool.
Dampness is characterized by heaviness and turbidity. Heavy sensation of the body, especially in the limbs; lassitude; heaviness in the head; excessive eye secretions; dirty complexion; heavy diarrhea; puss and blood in the stool; cloudy urine and heavy vaginal discharge, and eczema with oozing skin eruptions.
Dampness is viscous and lingering in nature. Stickiness, such as slimy, greasy stool and urine; longer course of illnesses and chronic reassurance.
Dampness tends to go downward attacking the Yin portion of the body. This means dampness easily attacks the lower body resulting in dripping urine(stranguria) with visible turbidity, diarrhea, dysentery, white vaginal discharge (leukorrhagia) and ulcers on the lower body.
Damp heat 暑
Damp heat, or summer heat, is probably the least understood of the six pathogenic factors. It does not have an endogenous origin, it can only attack the body from the outside. This is most likely to occur in Summer when the weather is very hot and humid. In ancient China most areas had a small rainy season during the summer. The ancients would have been well familiar with damp heat illnesses since they had no way to cool themselves like people do today with air conditioning.
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