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Part Fifteen: PATHOGENESIS

第十五部分:病机

http://www.100md.com   2006-2-7
     What is meant by pathogenesis? By pathogenesis is meant the mechanism of the occurrence, development and outcome of diseases. The occurrence, development and outcome of diseases are closely related both to the body's vital qi and to the nature of the pathogenic factors. When the pathogens attack the human body, the body's vital qi is bound to rise against the pathogens, forming the conflict between vital qi and pathogens. Their conflict is bound to destroy the relative balance of yin and yang to cause the dysfunction of the zang-fu organs and meridians, or the disturbance of qi and blood. Thus bringing about a variety of local or general pathological changes. Notwithstanding various diseases and complicated clinical manifestations, their changes of pathogenesis, in general, are inseparable from the excess or deficiency between the vital-qi and the pathogens, the imbalance of yin and yang, or the abnormably of qi and blood and the dysfunction of the zang-fu organs and meridians.

    何谓病机?病机指的是疾病发生、发展和转归的机理。疾病的发生、发展和转归与人体的正气和病邪特性密切相关。当病邪侵犯人体时,人体正气必会奋起抗邪,形成正邪相争。正邪相争必会破坏阴阳的相对平衡、脏腑经络功能失调或是气血紊乱,从而引起不同的局部或是整体的病理改变。虽然疾病不同而且临床症状错综复杂,但是总的来说,它们的病理改变离不开正邪的虚实,阴阳失衡,或是气血失常及脏腑经络的功能失调。

    The conflict between the vital-qi and pathogens is not only related to the occurrence of a disease, but also directly affects its development and final outcome. Meanwhile, it has a direct influence on deficient or excessive changes of the syndromes in a certain sense, the processes of many diseases are seen as those of the changes of excess and deficiency in the contest between the vital-qi and pathogens. Therefore, vicissitudes of vital qi and pathogens are considered to be one of the pathogenesises.

    正邪相争不仅与疾病的发生有关,而且直接影响到疾病的发展和转归。同时,它在一定程度上也直接影响了证候的虚实,许多疾病的过程都是正邪相争引起虚实改变的过程。因此,正邪的盛衰被认为是病机之一。

    Basic Questions says "the exuberance of pathogens results in excess syndrome, while the depletion of essence-qi may bring on deficiency syndrome." Excess refers to excess of pathogens, or a pathogenic reaction with excessive pathogens as the principal aspect of the contradiction.

    That is to say, the pathogens are excessive, the vital qi is also strong. Clinically, a sort of pathological reactions of excess ensue with the fierce and obvious struggle between vital qi and pathogens, which is known as excess syndrome. It is mostly found in the early or middle stage of diseases caused either by the six exogenous pathogens or by the phlegm retention, undigested food, blood stasis, etc. , characterized by high fever, mania, high voice and coarse breathing, abdominal pain with tenderness, obstructive urination and defecation, and full and forceful pulse.

    《素问》云:“邪盛则实,正衰则虚。”实指的是邪气实,或是邪实的病理反应作为矛盾的主要方面。这就是说,邪气实,正气也强。临床上,实的病理反应通常是正邪之间剧烈抗争的结果,这称为实证,大多见于由六淫、痰凝、饮食不化、血瘀等引起的疾病的中早期,在临床上可见壮热,狂躁,声高气粗,腹痛拒按,二便不通,脉实有力等。

    By deficiency syndrome is meant a syndrome caused by inadequate of vital qi, or a pathological reaction with the deficiency of vital qi as the dominant factor of the contradiction. That is, the vital qi become too deficient to resist pathogens because of the dysfunctions of qi, blood, body fluid, zang-fu organ and meridians. Consequently, the conflict of vital qi and pathogens may not produce intense pathological reaction and a series of insufficient manifestations arise, so called deficiency syndrome. This types of syndrome is mostly seen in patients with weak constitutions or in the later stage of a disease and in different kinds of chronic cases, marked by lassitude, pallid complexion, palpitation, short breath, spontaneous perspiration, night sweat feverish sensation in the chest, palms and soles or aversion to cold, cold extremities, feeble pulse, etc.

    虚证指的是由正气不足引起的证候,或是以正气不足的病理反应为矛盾的主要方面。这就是因为气、血、津液、脏腑经络的功能失调导致正气过虚无力抗邪。因此,正邪相争并不会造成剧烈的病理反应,所以会导致一系列虚的症状,这就是所谓的虚证。这一类型的证候大多出现于体弱的病人、疾病的晚期和各种慢性病中,症见神疲体倦,面容憔悴,心悸气短,自汗,盗汗,五心烦热,畏寒肢冷,脉虚无力等。

    The rise and fall of vital qi and pathogens can bring about mixed syndromes of excess and deficiency in protracted and complicated diseases. Such syndromes have mainly two kinds of pathological changes: deficiency syndromes mixed with excess ones and excess syndromes mixed with deficiency ones. However, under some particular circumstances, there will be two types of pathological changes: true excess syndrom with pseudo-deficiency symptoms and true deficiency with pseudo-excess symptoms. The former is said to be "symptoms of pseudo-excess in extreme deficiency", while the latter is said to be "symptoms of pseudo-deficiency in extreme excess". From the above, to identify a deficiency or excess syndrome of pathogenesis we must see through the appearance to get at the essence and

    so only can we not be misted by false phenomena and accurately grasp the changes of excess or deficiency syndrome .

    在长期复杂的疾病中,正邪的盛衰会引起虚实混杂的证候。这种证候主要有两种病理变化:虚中夹实和实中夹虚。然而,在特殊情况下也会出现两种病理改变:真实假虚和真虚假实。前者谓之“至虚有盛候”,而后者则为“大实有赢状”。因此,分析病机的虚实,必须透过现象看本质,才能不被假象所迷惑,而真正把握住疾病的虚实变化。

    In the course of a disease, the conflict between vital qi and pathogens not only gives rise to their deficiency or excess, but also causes the outcome of a disease. When vital qi prevails over pathogens, the disease tends to improvement or even complete recovery. Otherwise, when pathogens prevail over vital qi, the disease tends to deterioration or even life comes to end.

    在疾病过程中,正邪相争不仅会引起虚实改变,而且会导致疾病的转归。当正气胜于邪气时,疾病就会趋于好转或痊愈。反之,当邪气胜过正气时,疾病就会趋于恶化或是导致死亡。

    In the course of occurrence, development and final outcome of a disease, disharmony of yin and yang will occur under the action of pathogens, resulting in such pathological manifestations as relative excess or deficiency of either yin or yang, mutual impairment, repellence and depletion of yin and yang.

    在疾病的发生、发展和转归的过程中,在病邪的作用下,阴阳失调就会产生,导致阴或阳的偏虚偏实和阴阳的互损。

    The Disturbance of qi and blood refers to a morbid state caused by deficiency and dysfunction of qi and blood, and the breakdown of their interdependent relationship. Qi and blood in the body are the material basis for the physiological activities of the zang-fu and meridians. Therefore, their disturbance will inevitably affect the body's function to cause diseases. Basic Questions states: "The disharmony between qi and blood will result in various diseases". However, qi and blood are the products of the functions of the zang-fu organs. Pathological changes of the zang-fu organs may not only lead to qi-blood disturbance, but also affect qi and blood of the whole body. Thus, the pathogenesis of qi-blood disturbance, like that of the rise and decline of vital qi and pathogens and the imbalance of yin and yang, is not only the root cause of pathological changes of the zang-fu organs and meridians, but also the basis for the analysis and research of the pathogenesis of various diseases.

    气血紊乱指的是气血亏虚、功能失调和相互依赖关系崩溃导致的一种病理状态。人体气血是脏腑经络生理活动的物质基础。因此,气血紊乱必会影响人体的功能,导致疾病。《素问》指出:“气血不和,百病乃变化而生。”然而,气血是脏腑功能活动的产物。脏腑的病理改变不仅会导致气血紊乱,也会影响全身的气血。这样,气血紊乱的病理改变,如正邪的盛衰、阴阳的失衡,不仅是脏腑经络病理改变的根源,也是分析和研究不同疾病病机的基础。

    The failure of qi activity refers to such pathological changes as qi stagnation, adverse flow of qi, qi sinking, qi blockage and qi exhaustion due to disturbance in its ascending, descending, exiting and entering. Ascending, descending, exiting and entering are the basic form of qi movement, on which functional activities of the zang-fu organs and meridians as well as the relation ships between the zang-fu organs and meridians, qi and blood, and yin and yang depend to maintain their relative balance. Fort his reason, the disorder of qi activity may bring about various morbid conditions involving the zang-fu organs, qi and blood, yin and yang, exterior and interior, four limbs and nine orifices.

    气机失调指的是由于气的升降出入失常引起气滞、气逆、气陷、气闭、气脱的病理改变。升降出入是气的基本运动形式。脏腑经络的功能活动,脏腑和经络、气血、阴阳之间的关系都赖此以维持相对平衡。由于这个原因,气机失调可以引起涉及脏腑、气血、阴阳、表里、四肢、九窍的不同病理改变。

    The disorder of blood includes deficient blood production, blood deficiency caused by massive hemorrhage, over consumption of blood caused by prolonged illness, or dysfunction of blood nourishment; it also includes the accelerated blood circulation caused by blood heat and blood stasis caused by sluggish blood circulation.

    血液失常包括血的生化不足,大量失血引起的血虚,长期疾病引起的过度血液损耗或是血液的营养功能失调;也包括血热迫血妄行和血液循环缓慢引起的血瘀。

    The metabolism of body fluid is essentially the processes of continuous production, distribution and excretion of body fluid. The disturbance of the metabolism means the disturbance of distribution and the imbalance between production and excretion, thus causing deficiency production of body fluid to form fluid retention in the body, So, normal metabolism of body fluid is the basic condition maintaining normal distribution, production and excretion. Normal production, distribution and excretion of body fluid are inseparable from ascending, descending, exiting and entering movement of qi and its transforming function. And also. they cannot be separated from the functions of the lung, spleen, liver, kidney and the triple energizer.

    津液的代谢是津液持续产生、分布和排泄的必要过程。代谢紊乱指的是分布异常和产生排泄失衡,从而产生津液产生不足,形成体内水液停滞,因此,正常的津液代谢是维持正常的分布、产生和排泄的基本条件。正常的津液产生、分布和排泄离不开气的升降出入和气化功能,同时也离不开肺、脾、肝、肾和三焦的功能。

    The five endogenous pathogens refer to the pathological changes caused by the dysfunction of qi, blood, body fluid and the zang-fu organs, namely endogenous wind, endogenous cold, endogenous dryness , endogenous fire and endogenous dampness. They are not pathogenic factors; they are five comprehensive changes of pathogenesis.

    内生五邪指的是气血津液和脏腑功能失调引起的病理改变,即内风、内寒、内燥、内火和内湿。它们不是病理因素,而是五种综合的病理改变。

    Special phrases 特殊短语

    1.The disharmony of qi and blood may cause various diseases. 1.气血不和,百病乃变化而生

    2.Heat-transformation, fire-transformation, wind-transformation, dryness-transformation, dampness-transformation 2.化热、化火、化风、化燥、化湿

    3.Insufficiency of vital qi is the intrinsic factor of the occurrence of disease. 3.正气不足是发病的内在根据

    4.Pathogenic factors are the predominant factor of disease. 4.邪气是疾病发生的重要条件

    

 
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