TCM Pathogenesis: External Pathogens & Internal Imbalances in Disease

Yellow Emperor inquired: “Most illnesses arise from climatic evils—wind, rain, cold, heat, dampness—and emotional excesses like unchecked joy or rage. How do these pathogens target specific bodily regions?”

Qibo replied: “Three pathogenic pathways exist:

  1. Emotional Imbalances (Yin): Excessive emotions injure yin organs (heart, liver, spleen, lungs, kidneys).
  2. Upper Body Invasion (Yang): Wind-rain pathogens exploit upper-body vulnerabilities.
  3. Lower Body Infiltration (Damp): Cold-dampness permeates lower regions through lax meridians.”

Pathogenic Progression:

  • Stage 1 – Skin Breach: Lax pores allow evils to infiltrate, causing piloerction, chills, and cutaneous pain.
  • Stage 2 – Collateral Channels: Intermittent muscle pain signals meridian transition.
  • Stage 3 – Primary Meridians: Persistent cold aversion and anxiety emerge.
  • Stage 4 – Transport Points: Blocked Taiyang meridians trigger joint stiffness and lumbar rigidity.
  • Stage 5 – Penetrating Vessels: Systemic heaviness and deep-seated pain manifest.
  • Stage 6 – Enteric Systems: Borborygmi, dyspeptic diarrhea, or thermal diarrhea develop.
  • Stage 7 – Mesenteric Networks: Blood-Phlegm congelation forms migratory abdominal masses.

Yellow Emperor pressed: “Detail the etiology of abdominal masses.”

Qibo elucidated:

  • Cold Inversion Pathway: Pedal stagnation → tibial chill → vascular congealment → gastric distension → chronic mucoid accumulations.
  • Mechanical Triggers: Dietary excesses, physical strain, or coital imprudence rupture collaterals, causing:
    • Epistaxis (upper collateral damage)
    • Hematochezia (lower collateral rupture)
    • Perienteric blood-phlegm conglomerates (mesenteric trauma + cold exposure)
  • Psychosomatic Factors: Sudden chill during emotional turmoil disrupts Six Meridian flow, coagulating blood and desiccating fluids into fixed masses.

Organ-Specific Vulnerabilities:

  • Heart: Chronic rumination → Shen disturbance
  • Lungs: Cold exposure + frigid diet → Qi stagnation
  • Liver: Unbridled wrath → Hun disharmony
  • Spleen: Postcoital wind exposure → Yi depletion
  • Kidneys: Overexertion/hydrotherapy → Jing exhaustion

Therapeutic Principles:
“Diagnose via pain topography. Apply tonification/purgation aligned with seasonal Qi. Restore Yin-Yang equilibrium through meridian modulation.”