中医基础理论之病因篇

第六章病因

CauseofDisease学习要点中医对病因的认识方法及分类六淫的概念及致病特点七情的概念及七情内伤痰饮、瘀血、结石的概念、形成及致病特点KEYWORDSCauseofdisease病因Etiology病因学说Sixexcesses六淫Pestilentialqi疠气Sevenemotions七情Interal-injurypathogenicfactors七情内伤Phlegm-fluidretention痰饮Stagnantblood瘀血Abdominalmass徵积Calculus结石Medicinepathogens药邪Iatrogenicfactors医过Fetalweakness胎弱Fetaltoxin胎毒Concept:Thecauseofdisease,referstothefactorsthatdamagetherelativeepuilibriumandresultindiseaseandarealsocalledpathogenicfactors.

Methods

ofCMprobingintopathogenicfactors

AskingdirectlyReferringthecausebysyndromedifferentiationIntroduction中医病因1.六淫2.七情3.疠气4.饮食5.劳逸6.痰饮7.瘀血8.结石9.外伤10.寄生虫11.药邪12.先天因素13.医过等西医病因1.生物病原：如细菌、病毒、真菌等。2.物理因素：如噪音、高温、气压、放射线等。3.化学因素：如化学药品、污染、毒物等。4.营养因素：如偏食、营养不良等。

5.精神因素：如情绪、心理等。6.遗传因素：如遗传病等。第一节六淫

SixExcessesConceptofSixExcessesThesixexcessesareacollectivetermusedforsixkindsofexogenouspathogensofwind,cold,summer-heat,dampness,drynessandfire.Undernormalconditions,theyarecalled“sixclimaticfactors”Commonpathogeniccharacteristicsofsixexcesses1.exogenousness2.seasonality3.regionality4.combination5.transformability一、风自然界中具有风之轻扬开泄、善动不居特性的外邪，称为风邪。性质致病特点主要病症轻扬开泄（浮越）病位在上病位在表头痛、鼻塞、咽痒。恶风、发热、汗出。善行数变病位游走不定行痹之四肢关节疼痛，游走不定。症状变化多端风疹块之皮疹时隐时现，此起彼伏。主动动摇不定眩晕、抽搐、拘挛、角弓反张，两目上吊。为百病之长致病先导风寒、风热、风湿、风寒湿等兼夹证。WindpathogenAllexogenouspathogenicfactorscharacteristicoflightness,rising,andopening-dispersingandmigratingarecalledwindpathogen.naturesPathogeniccharacteristicsClinicalnanifestationsLightandopening-dispersingBeingapttoattackyangportionofbodyanddischargingtheporeHeadache,stuffynasal,itchingthroat.Aversiontowind,feverandsweating.BeingmobileandchangeableCharacterizedbymigratorylocation,suddenonsetandconstantlychangingMigratoryarthralgia(migratorypaininthejountsofthefourlimbs)Rubella,characteristicofconstantlychangingBeingmobileCharacterizedbyswayVergo,convulsion,spasm,opisthotonus,upwardsquintBeingprimarypathogenTheprecursorofvariousdiseasesTendstocausediseaseinmixturewithotherpathogenicfactorssuchascold,heat,dampnessanddryness,etc二、寒自然界中具有寒冷、凝结特性的外邪，称为寒邪。性质致病特点主要病症寒为阴邪寒证，伤阳气伤寒：恶寒、无汗中寒：脘腹冷痛、呕吐腹泻伴有形寒肢冷。凝滞气血运行迟滞甚至凝结不通产生疼痛局部冷痛，遇热缓解，遇冷加重收引腠理汗孔收缩恶寒、无汗、发热筋脉牵引拘急四肢拘急，屈伸不利ColdpathogenAllexogenouspathogenicfactorscharacteristicofcold,coagulationandcontractionarecalledcoldpathogen.NaturesPathogeniccharacteristicsClinicalmanifestationAyinpathogenTendingtoattackyangqiandbeingmanifestedascoldsyndromeCold-attack：aversiontocold,absentsweatingCold-stroke：coldpaininthestomachandabdomen,vomitinganddiarrhea。CoagulationandstagnationLeadingtostagnantofqiandbloodLocalcoldpainsinthebody,alleviatedwithwarmth,aggravatedbycoldcontractionBlockageofporesAversiontocold,absentsweatingandfeverContractionoftendonsandvesselsSpasmofthelimbs性质致病特点主要病症重浊周身困重头身困重，四肢发沉，关节重着疼痛分泌物排泄物秽浊不清小便混浊、大便溏泄、下痢粘液脓血、面垢眵多。粘滞症状的粘滞性大便粘滞不爽，小便涩而不畅，苔腻。病程的缠绵性湿痹、湿温、湿疹的病程长、反复发作。为阴邪阻遏气机损伤阳气阻遏脾胃气机见脘腹胀满，食欲不振；脾阳不振见腹泻、水肿。趋下伤及人体下部，症状多见于下部淋浊、带下、泄泻、痢疾、下肢水肿、下肢溃疡。三、湿自然界中具有水湿之重浊、粘滞、趋下特性的外邪，称为湿邪。naturesPathogeniccharacteristicsClinicalmanifestationsHeavyandturbidGeneralheavinessHeavysensationintheheadandbody,achingandpainfullimbsTurbidexcretionandsecretionTurbidurination,diarrheawithpurulentandbloodydysentery,dirtycomplexion,excessiveeyesecretionsStickyandstagnantSymptomscharacteristicofstickinessandstagnancywithalingeringpathologicalcourseStickystoolswithdifficultyinemptyingbowels,difficultyinurination,greasyfurwithalongdurationandrecurrentepisodes.AyinpathogenObstructingqimovementanddamagingyangqiOppressioninchest,epigastricandabdominaldistension,poorappetite,diarrhea,scantyurine,diarrhea,edemadescendingUsuallyattackingthelowerpartofthebodyTurbidstranguria,leukorrhagia,diarrhea,dysentery,edemainthelowerlimbsandcankerouslegsDampnesspathogenAllexogenouspathogenicfactorscharacteristicofheavyturbidity,stickinessanddownwardnessarecalleddampnesspathogen.四、燥自然界中具有干燥、收敛清肃特性的外邪，称为燥邪。温燥凉燥时间初秋深秋气候有夏热之余气，燥与热结合有近冬之寒气，燥与寒结合证候燥而偏热（温燥证）燥而偏寒（凉燥证）性质致病特点主要病症干涩易伤津液，出现各种干燥症状口干唇燥，鼻咽干燥皲裂，小便短少，大便干结。易伤肺阴干咳少痰，或痰粘难咯，痰中带血。DrynesspathogenAllexogenouspathogenicfactorscharacteristicofdrynessandasringencyarecalleddrynesspathogen.Warmth-drynessCool-drynessseasonEarlyautumnLaterautumnclimateDrynessiscomplicatedbyheatofsummerDrynessiscomplicatedbycoldofwintersyndromeWarmth-drynesssyndromeCool-drynesssyndromenaturesPathogeniccharacteristicsClinicalmanifestationsBeingdryandpuckeryBeingapttoimpairfluidsDrymouth,noseandthroat,orevenclaps,scantyurineanddrystoolsBeingapttoinjurylung-yinDrycough,scantyorstickyphlegm,bloodysputum性质致病特点主要病症炎热灼燔为阳邪，实热证高热，面红，心烦，口渴，尿赤，脉洪。炎上，症状多见于上部发热，头昏，头痛，面红，目赤，咽喉红肿疼痛，口舌糜烂。易伤津耗气口渴喜饮，咽干唇焦，舌质红绛，体倦乏力少气。易生风高热，四肢抽搐，牙关紧闭，两目上视，角弓反张（热极生风）。易动血热迫血妄行，如吐血、咯血、衄血、尿血、皮肤发斑。易扰心神高热，狂躁，神昏，谵语，失眠。易致肿疡痈肿，疮疡，局部红肿热痛，化脓。五、热（火）邪自然界中具有火之炎热特性的外邪，称为火邪。（少火及壮火的概念）naturesPathogeniccharacteristicsClinicalmanifestationsFlamingUpwardAndscorchingIsayangpathogenandleadstoheatsyndromeHighfever,reddishcomplexion,dysphoria,thirsty,redurine,surgingandrapidpulseAttackingtheupperpartofthebodyDizziness,headache,reddishcomplexion,conjunctivalcongestion,swellingandpainofthroat,erosionofmucousmembraneinoralcavity.ConsumingfluidsandexhaustingqiThirstwithdesireforcooldrink,drythroatandlips,brownishtongue,tiredanddebility.CausingconvulsionandbleedingHighfeverandcoma,spasmoflimbs,lockedjaw,upwardsquint,opisthotonusHeamatemesis,non-traumatichemorrhage,bloodyurine,echymosis.Disturbingheart-mindDysphoria,coma,deliriousspeacking.InsomniaProducingsores,ulcersandabscessesAbscess,red,swollen,burning,painfulsensationinthelocalareaswiththeformationofpus.Fire(heat)pathogenAllexogenouspathogenicfactorscharacteristicoftorridityandflaminguparecalledfire(heat)pathogen.六、暑邪暑为夏季的火热之邪。大凡夏至以后，立秋以前，自然界中的火热外邪，称为暑邪。暑邪致病具有明显的季节性。性质致病特点主要病症炎热为阳邪，实热证高热，烦渴，面红，目赤，脉洪大。升散上犯头目伤暑：头昏、目眩。上扰心神中暑：突然昏倒，不省人事。腠理开泄多汗伤津耗气口渴多饮，舌红少津，气短乏力。多夹湿暑湿夹杂证身热不扬，烦渴，身重倦怠，胸闷，呕恶，苔黄腻。Summer-heatpathogenDuringthetimefromsummersolsticetoautumnbegins,theexogenouspathogenicfactorscharacteristicofscorching-hot,ascendinganddispersive,mixedwithdampnessarecalledpathogenicsummer-heat.Summer-heatpathogenischaracterixedbyanapparentseasonality.naturesPathogeniccharacteristicsClinicalmanifestationsCharacteristicbeingscorching-hotAyangpathogenandleadstoexcess-heatsyndromeHighfever,dipsesis,reddishcomplexion,conjunctivalcongestion,surgingandlargepulseCharacteristicbeingascendinganddispersiveAttackingtheheadandeyeSummer-heatattack:dizziness,dizzyvisionDisturbingheart-spiritSummer-heatstoke:suddencomaandunconsciousnessOpeninganddispersingthestriaeoftheskinsweatingImpairingfluidsandexhaustingqiThirstwithpreferencefordrink,redtongueandscantyfluids,shortbreathandlackofstrengthLikelytobemixedwithbeingdampnessSummer-heatcausingdiseaseinmixturewithdampnessHidingfever,dipsesis,lassitudeoflimbs,oppressioninchest,nauseaandvomiting,yellowishandgreasytonguefur.第二节七情

SevenEmotionsConceptofsevenemotionsThesevenemotionsrefertosevenemotionalactivitiesincludingjoy,anger,worry,anxiety,sadness,fearandfright.Normally,thesevenemotionsdon’tcausediseasesandonlywhentheemotionalstimulationsaretooabrupt,violent,andprolongedandbeyondone’sadaptabilityorwhenthereisdiminishedadaptabilityduetoimbalancedyin-yang,qiandbloodofviscera,cantheyturnintopathogenicfactors,thuscausingdiseases.情志异常的病因

外因主要是指社会因素、个人处境及自然环境对机体的影响。七情病变的内因是个体素质。个体素质主要决定于先天禀赋，后天营养、性格陶冶、文化修养、个人经历等多方面的因素。。当突发性的强烈刺激或长期持久的精神负担超过了机体对情志调节的灵敏阈时，就产生了七情病变，灵敏阈的高低标志着个体体质的差异性。Pathogeniccharacteristicsofinternalinjuryduetosevenemotions1.Sevenemotionsarisingfromtheheart2.Impairingtheviscera

以心、肝、脾三脏为多见3.Affectingthevisceralqimovementrageleadingtoqiascending,excessivejoyleadingtoqiloose,excessivesorrowleadingtoqiconsumption,fearleadingtoqisinking,frightleadingtoqiturbulence,pensivenessleadingtoqiknotting怒则气上、喜则气缓、悲则气消、恐则气下、惊则气乱、思则气结

4.Tendingtocauseemotionaldiseases5.Affectingthesequelaeofdiseases第三节疠气、劳逸、饮食、外伤、寄生虫

pestilentialqi,workandrest,diet,trauma,parasite疠气的概念pestilentialqiisanexogenouspathogenicfactorwhichisstronglyinfective.Itisvariouslycalledepidemictoxin,epidemicqi,specialpathogenicfactor,pestilentialqiorpoisonousqietc.syndromesproducedbypestilentialqiarecalledpestilences,whichincludemanyhighlycontagiousdiseasesinmodernmedicine.疠气是一类具有强烈传染性的外邪。又称“疫气”、“疫毒”、“戾气”、“乖戾之气”等。疠气引起的疾病称为“疫病”、“瘟病”、“瘟疫病”。实际上包括了现代许多传染病和烈性传染病。Pathogeniccharacteristics1.Stronginfectivityandepidemic2.Acuteonsetandseverecondition3.DiseasesvarywithpestilentialqibutsymptomsaresimilarFactorsaffectingtheformationandepidemicofpestilentialqi1.Abnormalclimates2.Environmentalandfoodpollution3.Lackofstrictpreventativemeasures4.Socialconditions劳逸失当Imbalancebetweenworkandrest过劳overstrain饮食失宜Irregularityofdiet饥饱失常improperdiet过逸Indulgenceineasylife房劳过度sexualoverstrain劳神过度mentaloverstrain劳力过度overexertion饮食偏嗜dietpredilection饮食不洁unhygienicdiet外伤traumaticinjuries枪弹、金刃伤、跌打损伤、持重努伤烧烫伤、冻伤（全身、局部）化学伤、溺水、雷击伤、虫兽伤寄生虫parasites蛔虫、钩虫、蛲虫、绦虫、疟原虫、血吸虫等。中医称寄生虫病为“虫积”。

第四节痰饮Phlegm-fluidretention痰饮的基本概念

痰饮是机体水液代谢障碍所形成的病理变化及其病理性产物。稠浊者为痰，清稀者为饮。痰饮作为一种新的致病因素作用于机体，导致新的病变，则为继发病因。Phlegm-fluidretentionisthepathologicalproductresultingfromthemetabolicdisordersofbodyfluids.Itcanbedividedintophlegmandfluidretentionwiththeformerbeingstickyandturbidandthelatterbeingthinandclear.Asanewpathogenicfactor,whenstagnatedinthebody,itcanleadtovariouspathologicalchangesanddifferentnewsyndromes.痰饮有形之痰substantialphlegm无形之痰insubstantialphlegm痰饮的形成外感六淫饮食失宜七情内伤劳逸太过肺失宣降脾不健运肾气化失司肝失疏泄三焦水道不利膀胱气化不利伤及内脏津液代谢障碍水液停滞

痰饮痰饮是由外感六淫、或饮食失常、或七情内伤、或劳逸太过等原因，导致肺、脾、肾、三焦等脏腑对水液的气化功能失常，津液代谢障碍，以致水液停滞而生成。痰饮致病的病位痰饮随气机的升降流行，内而脏腑，外达筋骨皮肉，无处不到，病位广泛。部位主要病症饮停于肺胸闷、咳喘不能平卧、其形如肿、吐清稀痰液（支饮）饮在肠胃脘腹胀痛、肠鸣漉漉有声、呕吐清水痰涎（痰饮）饮在胸胁胸胁胀满、咳嗽引胁作痛（悬饮）饮溢肌肤水肿、身重无汗、尿少（溢饮）饮停腹中腹胀大如鼓、尿少、腹壁青筋显露（腹水）痰饮的致病特点致病特点主要病症阻滞气机，阻碍气血痰阻于肺胸闷、咳嗽、喘促湿困中焦脘腹胀满，恶心呕吐痰阻经络肢体麻木，屈伸不利痰聚于局部痰核、瘰疠、阴疽流注致病广泛，变化多端百病多由痰作祟，怪病多痰病势缠绵，病程较长咳喘、眩晕、瘰疠、胸痹、癫痫、流注、中风、痰核、阴疽易扰乱神明出现神志失常的病证：精神不振，失眠易怒；喜笑不休，甚则发狂。多见滑腻舌苔Pathogeniccharacteristicsofphlegm-fluidretentionPathogeniccharacteristicsClinicalmanifestationStagnatingtheflowofqiandbloodPhlegminlungOppressioninchest,cough,dyspneawithrapidandshortbreathInmid-jiaoAbdominaldistention,nauseaandvomitingInmeridiansNumbnessoflimbs,difficultflexingandstretchingInapartareassuperficialnodule,abdominalmass,dorsalfuruncleWidelypathogenicandchangefulSingulardiseasesusuallyresultfromphlegm-fluidretention,prolongeddiseaseareusuallycausedbyphlegmLingeringpathologicalconditionandprolongeddurationCoughandasthma,dizzy,abdominalmass,thoracicobstruction,epilepsy,stroke,superficialnodule,dorsalfuruncleTendingtoblockspiritDispirited,dementiaandtantrum,constantlaughter,evenleadingtocrazyOftenmanifestedcreasyfur

第五节瘀血stagnantblood瘀血的概念

是指体内血液停滞。包括离经之血停积于体内的病理性产物，以及血液运行不畅而阻滞于脏腑经络之中的病理变化。血液停滞于体内又能导致新的病变，而成为继发病因。Stagnantbloodisapathologicalproductresultingfromdisturbanceandstagnationofbloodcirculation,includingabnormalflowofblood,orstagnatedbloodinmeridiansorvisceraduetodisturbedbloodflow.Onceitisformed,stagnantbloodwillbecomeanewpathogenicfactor.外邪情志饮食劳逸外伤外伤—络伤血溢气虚—气不摄血血热—迫血妄行损伤机体血离脉道，停积体内气血功能失调导致瘀血形成主要有以下四种：1.气虚血瘀2.气滞血瘀3.血寒致瘀4.血热成瘀气虚—血行无力气滞—血行受阻血寒—寒凝血滞血热—煎熬粘滞血行不畅阻滞脏腑经络瘀血瘀血的形成TendingtostagnateqimovementAffectingbloodcirculationAffectingthegenerationofnewbloodCausingvarioussyndromeswithfixedlocationPathogeniccharacteri