Medical Dialogue
医学会话
A Consultation on Pathogenic Factors of TCM
中医病因看询
Dr. Tony Benjamin is a doctor of Chinese medicine in the United States. He offers free consultations as a way to educate the public about the foundations of Chinese medicine. Presently, he is consulting with Mrs. Donna Martinez, 72, to help her understand the etiology of her physical complaints through a TCM perspective.
| tony: | Good afternoon. I am Dr. Tony Benjamin. Glad to meet you. |
| donna: | I am Donna Martinez. I am glad to meet you too. |
| tony: | How may I help you today, Donna? |
| donna: | I have a few questions. |
| tony: | Questions are good. I like questions. |
| donna: | I would like to understand my condition. |
| tony: | What is your condition? |
| donna: | I have arthritis* in my knees and the pain seems to move to my low back and hands. On top of that I have been diagnosed with irritable bowel syndrome*. |
| tony: | What would you like to know about those disorders? |
| donna: | I'd like to know how you make sense of* what causes those problems. |
| tony: | How I make sense of it? |
| donna: | In the view of Chinese medicine. |
| tony: | Sure. As you know, I am a doctor of Chinese medicine. The etiology* that is the cause or origin of a disease in Chinese medicine is very different from Western medicine. |
| donna: | What are the differences? |
| tony: | Generally speaking, the factors of a pathogenic influence in your body can be divided into three groups. First there are six exogenous factors. These are influences from the external environment. Second are our emotional changes. |
| donna: | The six exogenous factors? |
| tony: | Yes. They refer to wind, cold, fire, dryness, summer-heat and dampness. They become causes of disease only when the climatic changes are extreme or sudden, or when the body's resistance is low. |
| donna: | How do they affect me? |
| tony: | Let's take your joint pain, for example. Do your knees feel better with cold applied or with warmth? |
| donna: | I always have a blanket to keep my knees warm. |
| tony: | Are they worse with sudden changes in weather? |
| donna: | Oh, yes! I always know when it's going to rain or snow because the pain gets worse. |
| tony: | In TCM, we understand the joint pain you have as a impediment disease, that is a painful obstruction caused by wind, cold and damp that have invaded your joints. |
| donna: | That's exactly how it feels. Like something jamming up the gears in there. Why does the pain move around? |
| tony: | It means that wind is a predominant pathogenic factor over the cold and damp. We call this "moving impediment" in TCM terms. |
| donna: | Could this wandering nature of this painful obstruction, I mean, the wind, damp and cold have anything to do with my irritable bowel syndrome? |
| tony: | Irritable bowel syndrome is caused by internal pathogenic factors. |
| donna: | What's that? |
| tony: | Good, this brings us to the second of our three factors of pathogenic influence in the body. It is emotional changes. The internal causes of disease are those due to seven emotional strains. They are joy, anger, anxiety, worry, grieve, fear, and fright. Severe, continuous or abruptly occurring emotional stimuli often affect the functions of internal organs. |
| donna: | How do they cause irritable bowel syndrome? |
| tony: | Anger or depression, for example, often affects the functions of liver, causing the liver qi to stagnate*. |
| donna: | What are the symptoms of liver qi stagnation? |
| tony: | In TCM, the liver is responsible for the proper flow of qi through the body. Any combination of disruptions in these movements may result in pathology. In regards to liver qi stagnation, patients usually feel distending pain in the hypochondriac* area here up under the ribs and abdomen. This can also affect and stagnate the emotional state. Do you feel you are easily angered or irritable? |
| donna: | I often feel all of those symptoms. |
| tony: | If you can help the liver to course the qi through the body more efficiently, you should experience less abdominal discomfort and your emotional states should be better balanced. |
| donna: | The last doctor I visited said that I should also change my diet. |
| tony: | Yes. Good. This brings us to the third pathogenic factor: improper diet. In your case, you will need to avoid cold drinks and raw foods such as salads. |
| donna: | No way, I love cold drinks and salads. |
| tony: | This could further injure your stomach-spleen dynamic, causing diarrhea or worsen your symptoms. Prolonged stagnation of qi or emotional constraint can generate excess heat in the body. This could explain your preference for cold food and drinks. |
| donna: | Oh. |
| tony: | Of course we can't be certain of the intricacies* of your condition without a proper examination. I would be happy to work further to differentiate with you and your unique presentation and develop a treatment plan accordingly. |
| donna: | Do I make an appointment with you? |
| tony: | Our receptionist at the front desk will set everything up for you. I hope this was helpful, Mrs. Martinez. Was I able to shed a little light on things for you? |
| donna: | Yes, I enjoyed your explanations, doctor. Thank you very much. |
| tony: | You are very welcome. |