PATHOGENESIS
病機
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.	何謂病機？病機指的是疾病發(fā)生、發(fā)展和轉歸的機理。疾病的發(fā)生、發(fā)展和轉歸與人體的正氣和病邪特性密切相關。當病邪侵犯人體時，人體正氣必會奮起抗邪，形成正邪相爭。正邪相爭必會破壞陰陽的相對平衡、臟腑經絡功能失調或是氣血紊亂，從而引起不同的局部或是整體的病理改變。雖然疾病不同而且臨床癥狀錯綜復雜，但是總的來說，它們的病理改變離不開正邪的虛實，陰陽失衡，或是氣血失常及臟腑經絡的功能失調。
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.	正邪相爭不僅與疾病的發(fā)生有關，而且直接影響到疾病的發(fā)展和轉歸。同時，它在一定程度上也直接影響了證候的虛實，許多疾病的過程都是正邪相爭引起虛實改變的過程。因此，正邪的盛衰被認為是病機之一。
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.	《素問》云：“邪盛則實，正衰則虛�！睂嵵傅氖切皻鈱�，或是邪實的病理反應作為矛盾的主要方面。這就是說，邪氣實，正氣也強。臨床上，實的病理反應通常是正邪之間劇烈抗爭的結果，這稱為實證，大多見于由六淫、痰凝、飲食不化、血瘀等引起的疾病的中早期，在臨床上可見壯熱，狂躁，聲高氣粗，腹痛拒按，二便不通，脈實有力等。
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.	虛證指的是由正氣不足引起的證候，或是以正氣不足的病理反應為矛盾的主要方面。這就是因為氣、血、津液、臟腑經絡的功能失調導致正氣過虛無力抗邪。因此，正邪相爭并不會造成劇烈的病理反應，所以會導致一系列虛的癥狀，這就是所謂的虛證。這一類型的證候大多出現(xiàn)于體弱的病人、疾病的晚期和各種慢性病中，癥見神疲體倦，面容憔悴，心悸氣短，自汗，盜汗，五心煩熱，畏寒肢冷，脈虛無力等。
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 .	在長期復雜的疾病中，正邪的盛衰會引起虛實混雜的證候。這種證候主要有兩種病理變化：虛中夾實和實中夾虛。然而，在特殊情況下也會出現(xiàn)兩種病理改變：真實假虛和真虛假實。前者謂之“至虛有盛候”，而后者則為“大實有贏狀”。因此，分析病機的虛實，必須透過現(xiàn)象看本質，才能不被假象所迷惑，而真正把握住疾病的虛實變化。
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.	在疾病過程中，正邪相爭不僅會引起虛實改變，而且會導致疾病的轉歸。當正氣勝于邪氣時，疾病就會趨于好轉或痊愈。反之，當邪氣勝過正氣時，疾病就會趨于惡化或是導致死亡。
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.	在疾病的發(fā)生、發(fā)展和轉歸的過程中，在病邪的作用下，陰陽失調就會產生，導致陰或陽的偏虛偏實和陰陽的互損。
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.	氣血紊亂指的是氣血虧虛、功能失調和相互依賴關系崩潰導致的一種病理狀態(tài)。人體氣血是臟腑經絡生理活動的物質基礎。因此，氣血紊亂必會影響人體的功能，導致疾病�！端貑枴分赋觯骸皻庋�不和，百病乃變化而生�！比欢�，氣血是臟腑功能活動的產物。臟腑的病理改變不僅會導致氣血紊亂，也會影響全身的氣血。這樣，氣血紊亂的病理改變，如正邪的盛衰、陰陽的失衡，不僅是臟腑經絡病理改變的根源，也是分析和研究不同疾病病機的基礎。
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.	氣機失調指的是由于氣的升降出入失常引起氣滯、氣逆、氣陷、氣閉、氣脫的病理改變。升降出入是氣的基本運動形式。臟腑經絡的功能活動，臟腑和經絡、氣血、陰陽之間的關系都賴此以維持相對平衡。由于這個原因，氣機失調可以引起涉及臟腑、氣血、陰陽、表里、四肢、九竅的不同病理改變。
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，大量失血引起的血虛，長期疾病引起的過度血液損耗或是血液的營養(yǎng)功能失調；也包括血熱迫血妄行和血液循環(huán)緩慢引起的血瘀。
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.	津液的代謝是津液持續(xù)產生、分布和排泄的必要過程。代謝紊亂指的是分布異常和產生排泄失衡，從而產生津液產生不足，形成體內水液停滯，因此，正常的津液代謝是維持正常的分布、產生和排泄的基本條件。正常的津液產生、分布和排泄離不開氣的升降出入和氣化功能，同時也離不開肺、脾、肝、腎和三焦的功能。
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.	內生五邪指的是氣血津液和臟腑功能失調引起的病理改變，即內風、內寒、內燥、內火和內濕。它們不是病理因素，而是五種綜合的病理改變。
Special phrases	特殊短語
1.The disharmony of qi and blood may cause various diseases.	1.氣血不和，百病乃變化而生
2.Heat-transformation, fire-transformation, wind-transformation, dryness-transformation, dampness-transformation	2.化熱、化火、化風、化燥、化濕
3.Insufficiency of vital qi is the intrinsic factor of the occurrence of disease.	3.正氣不足是發(fā)病的內在根據(jù)
4.Pathogenic factors are the predominant factor of disease.	4.邪氣是疾病發(fā)生的重要條件