IDENTIFICATION OF PATTERNS ACCORDING TO PATHOGENIC FACTORS

Chapter 103


imageIDENTIFICATION OF PATTERNS ACCORDING TO PATHOGENIC FACTORS




INTRODUCTION


Pathogenic factors invade the body in various forms, which are Wind, Cold, Dampness, Summer-Heat, Dryness and Fire. Each of these, with the exception of Fire, can be of exterior or interior origin. From the point of view of the Eight Principles, they always correspond to a Full pattern.


Although these pathogenic factors are also causes of disease due to weather, they have greater importance as patterns of disharmony. In other words, if a person displays all the clinical manifestations of Dampness (e.g. epigastric fullness, a feeling of heaviness, sticky taste, etc.), we can safely diagnose a pattern of Dampness, irrespective of whether that person was exposed to climatic dampness or not.


Some internally generated pathogenic factors give rise to pathological signs and symptoms similar to those caused by the exterior climatic factors. These will be discussed together with the relevant exterior pathogenic factor.


The pathogenic factors are:







WIND


Wind is Yang in nature and tends to injure Blood and Yin. It is often the vehicle through which other climatic factors invade the body. For example, Cold will often enter the body as Wind-Cold and Heat as Wind-Heat.


The clinical manifestations due to Wind mimic the action of wind itself in nature, which arises quickly and changes rapidly, moves swiftly, blows intermittently and sways the top of trees.


There is a saying that captures the clinical characteristics of Wind: ‘Sudden rigidity is due to Wind’.1 This refers to the clinical manifestations resulting from both interior and exterior Wind. In fact, interior Wind can cause paralysis (as in Wind-stroke) and exterior Wind can cause facial paralysis or simply stiffness of the neck.


The main clinical manifestations of Wind are listed in Box 103.1.



BOX 103.1   CLINICAL MANIFESTATIONS OF WIND




Tremors, convulsions and paralysis apply only to interior Wind (except for facial paralysis, which can be caused by exterior Wind). Invasion of the Lungs applies only to external Wind. All the other manifestations listed apply to both exterior and interior Wind.



Exterior Wind


The symptoms and signs of invasion of exterior Wind are:






Besides this, exterior Wind can invade the channels of the face directly and cause deviation of mouth and eyebrows (facial paralysis).


Exterior Wind can also invade any channel, particularly the Yang channels, and can settle in the joints, causing stiffness and pain there (Painful Obstruction Syndrome). The pain would typically be ‘wandering’, moving from one joint to the other on different days.


Finally, Wind can also affect some Internal Organs, principally the Liver. Wind pertains to Wood and the Liver according to the Five-Element system of correspondences. The relationship can often be observed when a person prone to migraine headaches is affected by a period of windy weather (particularly an easterly wind) causing a neck ache and headache.


Box 103.2 summarizes the patterns of exterior Wind invasion.



BOX 103.2   EXTERIOR WIND




Wind combines with other pathogenic factors and primarily Cold, Heat, Dampness and Water. Therefore, I will outline the clinical manifestation of four types of exterior Wind:







Wind-Cold


The symptoms and signs of Wind-Cold are: aversion to cold, shivering, sneezing, cough, runny nose with watery white mucus, either no fever or only a slight fever, occipital stiffness and ache, clear urine, body aches, itchy throat, lack of thirst, tongue body colour unchanged, with thin white coating, Floating-Tight pulse.


These are the general symptoms of Wind-Cold. There are, however, two separate patterns of invasion of Wind-Cold: one with a predominance of Wind (called Attack of Wind) and the other with a predominance of Cold (called Attack of Cold). The former is more likely to occur when the patient’s Upright Qi is weak (and is treated with Gui Zhi Tang Ramulus Cinnamomi Decoction); the latter occurs when the patient’s Upright Qi is relatively strong (and is treated with Ma Huang Tang Ephedra Decoction). In Attack of Wind there is slight sweating, in Attack of Cold there is no sweating.








Interior Wind


The main clinical manifestations of interior Wind are: tremors, tics, severe dizziness, vertigo and numbness. In severe cases, they are: convulsions, unconsciousness, opisthotonos, hemiplegia and deviation of the mouth.


Interior Wind is always related to a Liver disharmony. It can arise from three different conditions:



1. Extreme Heat Extreme Heat can give rise to Liver-Wind. This happens in the late stages of febrile diseases when the Heat enters the Blood portion and generates Wind. This process is like the wind generated by a large forest fire. The clinical manifestations are a high fever, delirium, coma and opisthotonos. These signs are frequently seen in meningitis and are due to Wind in the Liver and Heat in the Pericardium.


2. Liver-Yang Liver-Yang rising can produce Liver-Wind in prolonged cases. The clinical manifestations are severe dizziness, vertigo, headache and irritability.


3. Deficiency of Liver-Blood Finally, deficiency of Liver-Blood can also give rise to Empty Liver-Wind. This is due to the deficiency of Blood creating an empty space within the blood vessels, which is taken up by interior Wind. This could be compared to the draughts generated sometimes in certain underground (subway) stations. The clinical manifestations are numbness, dizziness, blurred vision, tics and slight tremors (in Chinese called ‘chicken feet Wind’ as the tremors are like the jerky movements of chickens’ feet when they are scouring the ground for food). Empty-Wind can also result from Liver-Yin deficiency.


Box 103.3 summarizes the patterns of interior Wind.



BOX 103.3   INTERIOR WIND





COLD


Cold is a Yin pathogenic factor and, as such, it tends to injure Yang. Cold can be exterior or interior.



Exterior Cold


Cold, spearheaded by Wind, can invade the Exterior of the body and give rise to symptoms of Wind-Cold, already described above.


Cold can also invade the channels directly and cause Painful Obstruction Syndrome, with pain in one or more joints, chilliness and contraction of the tendons.


Apart from invading muscles, channels and joints, Cold can also invade three of the Internal Organs directly. These are the Stomach (causing epigastric pain and vomiting), the Intestines (causing abdominal pain and diarrhoea) and the Uterus (causing acute dysmenorrhoea). In all three cases the symptoms would be accompanied by chilliness and the pain would be alleviated by the application of heat.


Box 103.4 summarizes the patterns of external Cold invasion.



BOX 103.4   EXTERNAL COLD INVASION



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Apr 15, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on IDENTIFICATION OF PATTERNS ACCORDING TO PATHOGENIC FACTORS

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