acupuncture - conditions, the six patogens

Deficiency and excess

Deiciency and excess are terms used to describe the relationship between the strength of a pathogen and the proportional strength of anti-pathogenic qi. An excess condition exists when a pathogenic factor is hyperactive compared to normal anti-pathogenic qi. In contrast deficiency is present when anti-pathogenic qi is being consumed. Treatment will aim at either promoting anti-pathogenic qi in the case of deiciency,or eliminating the pathogenic factor in the case of excess.

Deiciency may be of either yin,yang,blood,or qi. Deiciency of yin gives heat symptoms while deiciency of yang gives cold symptoms. Deficiency of qi is seen after a long illness especially and shows as general lassitude. There may be spontaneous sweating due to the inability of qi to control the pores. Deiciency of blood is normally due to weakness in the spleen and stomach. Because blood is unable to reach the head the patient often experiences dizziness,and lack of blood to the heart may give palpitations.

General signs of deficiency include lassitude and weight loss,weak breathing,pallor,and night sweats. Where pain is present it is alleviated by pressure (see Chapter 4). The tongue is dry with little coating. Excess shows as agitation,rapid breathing,distension and fullness in the chest. Where pain is present it is aggravated by pressure. The tongue coating is thick and sticky.

The six pathogens

The six pathogens are wind,cold,summer heat,damp,dryness and ire (representing warmth and heat). Under normal circumstances these climatic changes do not pose a threat and are seen simply as six types of qi found in the natural environment (Xinnong,1999). However,if the factors are particularly strong,or the change from one factor to another is sudden and unexpected,or if the body's ability to produce anti-pathogenic qi to combat the factors is weak,the pathogens can invade the body and cause harm. Each of the factors invades the exterior of the body (skin,mouth and nose) and may act in isolation or combination. In the case of musculoskeletal pain,the factors produce the bi syndromes (see page 54).

Wind is the main pathogen,as all the other pathogens depend on it for transport into the body. It is yang in nature and has two important characteristics in TCM. Firstly,wind is characterised by 'upward and outward dispersion' and is therefore likely to invade the upper part of the body and the external surface. Wind therefore attacks the head and face,and the lungs and skin. Secondly,wind by nature 'moves'. Conditions resulting from wind therefore show movement as part of their symptoms. Pains which change position,skin marking which appears and disappears,convulsions, spasms and tremors are all wind signs. Points such as GB-20 (wind pool), GV-16 (palace of wind),and BL-12 (wind gate) are used to treat wind-related conditions by needeling with Acupuncture needles

Cold is yin in nature,and is characterised by contraction and stagnation. Exposure to cold after sweating or when wearing thin clothing allows the cold to invade the body. Cold will consume the yang qi of the body and the warming function of the body is therefore impaired. Symptoms are cold limbs,stiffness,cold pain and contractions. There is a dislike of cold and lack of sweating. Treatment often involves moxibustion and warm needling,and reinforcing techniques.

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Diagnosis in TCM takes many factors into consideration, not least of


which are the Pathogens. These are classified as either External or Internal.


The External Pathogens are really based on climatic influences: Wind,


Cold, Damp and Heat. These are considered to be capable of entering the


body to cause disease. When present in excess, a body with deficient


defences, or Wei Qi, will be susceptible to invasion by them. Thus, External


Pathogens can become internalized, moving deeper from the meridians


into the organ systems where they can cause considerable damage to


the delicate energy balances. Each type of pathogenic invasion produces


distinctive symptoms, allowing the Pathogen to be recognized. Cold tends


to produce a deep pain, generally static in nature with loss of joint movement


- 'freezing' in effect. Damp is associated with excess fluid, oedema,


heaviness, swelling of the lower limbs and a dull pain, often a headache.


Wind is characterized by a volatile or mobile symptomatology. Joint pain


caused by Wind will not have a constant focus but is likely to move from


joint to joint. Heat is relatively straightforward, causing an increase in


internal heat, shown by a rise in body temperature or drying of body fluids


and a burning type of pain.


More than one Pathogen can invade at the same time; if a patient is suffering


from influenza, there will be a fever and also muscular aches that


wander all over the body. This is defined as an invasion of the Pathogens


Wind and Heat.We treat this using acupuncture needles.


Internal Pathogens are those arising from within the body itself and are


thought to be excess emotions. These emotions are a normal part of life,


and normal emotional activity does not lead to illness. Illness results from


emotions only when the emotional pressure is too strong, or the patient is


highly sensitive for some other health reason. Anger, fear or worry taken to


excess can lead to pathogenic damage to the energy systems within the


body. Particular emotions are said to affect specific body organs (Table 1.4);


for example, the Liver is particularly susceptible to damage by anger and


the Lungs by grief.

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