Theory of etiology and pathogenesis of traditional Chinese medicine II. Development history of etiology and pathogenesis theory of traditional Chinese medicine

The unique etiology and pathogenesis theory of traditional Chinese medicine is an important part of China medical treasure house. With the formation and development of traditional Chinese medicine, it has been gradually improved. From the development history of etiology and pathogenesis, it can be generally divided into three stages, namely, early stage, formation stage and development stage.

In the early stage, in terms of time, from ancient times to the Spring and Autumn Period. The theory of etiology and pathogenesis in this period has not yet been fully formed and is still in the stage of germination and accumulation. Therefore, it is primitive, scattered, simple and spontaneous, and lacks systematic theoretical guidance.

Our ancestor "ancient people ate fruit clams (Luoyin Naked), which made them stink, hurt the stomach and caused many diseases to the people" (Han Feizi's Five Cheaps). It is because of the fire that it is possible to "make the cannon mature and make people have no abdominal diseases" (Book of Rites). This not only makes human beings have a qualitative evolution, but also makes human beings realize the relationship between diet and gastrointestinal diseases in the process of changing diet. Moreover, the simple living conditions of human beings at that time can be imagined. Especially in the dark and humid environment, it is very easy to cause some joint diseases. This situation is described in Chang Gu Le Chun Qiu: "In Tao and early Tang Dynasty, yin and qi were stagnant, the waterways were congested, the people's spirit was stagnant [e-sound was bad], and their bones and muscles shrank, so they pretended to dance." What does this passage mean? Tao (read yo-yo here). Tang Tao, that is, in ancient times. In ancient times, people lived in a dark and humid environment, where water and dampness stagnated and qi and blood stagnated, resulting in pathological changes of "atrophy of bones and muscles". It shows that people have a certain understanding that water and humid environment can easily lead to diseases of bones and joints, so they invented dance to treat them by exercising limbs. This is actually the first method of massage guidance in later generations.

However, before writing appeared, we still knew little about ancient medicine. The above examples can only be analyzed according to legend.

The earliest script found in China at present should be Oracle Bone Inscriptions. "Armor is tortoise shell, and' bones' are the shoulder blades of cattle and other animals. This is an ancient Chinese character, which records the reasons for divination in Shang Dynasty. Up to now, more than160,000 pieces of Oracle bones have been unearthed. According to preliminary statistics, there are about 323 records about diseases, 4 15 words. It can be seen from these words that the Shang Dynasty had a high level of understanding of the causes of diseases. For example, there are curses and dental caries in Oracle Bone Inscriptions. "Shuo Wen Jie Zi Gu": "There are worms in the abdomen", and the syndrome of finger bones is caused by parasites in the abdomen. Dental caries means holes in teeth, which are caused by insects. It is particularly noteworthy that the records of "disease year", "rain disease" and "disease reduction" are the earliest understandings of epidemic diseases in the world. Of course, these records are far from all the medical knowledge of the Shang Dynasty, but they are enough to show that the understanding of the etiology and prevalence of certain diseases at that time has reached a considerable level.

By the Western Zhou Dynasty, Chinese medicine had made great progress, and medicine developed to specialization, forming a set of medical management system. In the book Zhou Li, it is clearly recorded that the court doctors at that time were divided into food doctors, disease doctors, selective doctors and veterinarians.

A food doctor, a doctor in charge of food hygiene, is similar to a modern nutrition doctor. A disease doctor, equivalent to a doctor; Choose a doctor, that is, a surgeon. "Veterinarians, doctors who treat livestock diseases. What is particularly commendable is that some scientific marriage systems were formed during this period. For example, it is clearly pointed out that "men marry at the age of 30 and women marry at the age of 20" and "Li does not marry the same surname". In the book Zuo Zhuan, there is also a saying that "men and women have the same surname, and it is not uncommon for life." This is the earliest written record of eugenics in the existing literature. It can be seen that our ancestors have long known the benefits of late marriage and the harm that consanguineous marriage brings to future generations. It can also be said that it is the initial understanding of genetic diseases.

In the Spring and Autumn Period, Chinese medicine has reached the eve of maturity, and its symbol is the formation of medical theoretical system. At that time, astronomy, calendar calculation and other science and technology had developed to a certain extent, and the theory of Yin-Yang and Five Elements had also taken shape, which created certain conditions for the development of medicine. At the same time, it also laid a foundation for the gradual formation of etiology and pathogenesis theory. It can be seen from the existing ancient books that people had a deep understanding of the causes of diseases at that time. It is initially recognized that the changes of astronomical phenomena, solar terms, climate, water, soil and other special natural conditions in some areas have an important relationship with human health and diseases. For example, there is a passage in Zhou Li that "scabies are the first in spring, itchy scabies in summer, malaria cold in autumn and cough in winter". It shows that different seasons can have different frequently-occurring diseases and common diseases. There are many head diseases in spring, and the climate in summer is humid, which is easy to get itching, scabies and other diseases; It is easy to get malaria and colds in autumn and cough and asthma in winter. The Book of Rites further points out: "If the spring season goes in autumn, the people will suffer from serious diseases" and "If the spring season goes in summer, the people will suffer from serious diseases". Epidemic refers to infectious diseases prevalent in ancient literature. This shows that in that era, it has been recognized that abnormal changes in the climate of the four seasons will cause disease epidemics. In addition, the son of Zheng Guo once solemnly pointed out that disease is "a matter of eating and drinking. Where is the god of mountains and rivers?" Yan Ying of Qi also said: Being sick is the result of "lust and self-loathing", not caused by ghosts and gods, so it is useless to pray after illness.

With people's understanding of nature, they gradually have a new understanding of the relationship between geographical conditions, environmental sanitation and disease. The book Zuo Zhuan records that "China people chase dogs", which proves that there was a clear understanding that rabies can be transmitted to people at that time, so the preventive measures of "chasing dogs" were taken. This book also records that "the soil is thick and the water is deep, so it is not ill to live in it" and "the soil is thin and the water is shallow ... and its evil is easy to die". Evil is disease. The meaning of formation. Some living conditions such as water and soil can lead to diseases, so it is necessary to improve environmental sanitation to prevent diseases. This level of understanding is not only the earliest in the history of world medicine, but also very prominent.

It is particularly worth putting forward the "six qi pathogenic theory" of medical harmony here. Yihe is a famous doctor in Qin State. When he saw a doctor after the Jin Dynasty in 5 14 BC, he made a wonderful exposition on the cause of this disease. According to Zuo Zhuan, we extracted this passage from Yihe: "There was a disease in Jinhou ... Qin Bo showed it to Yihe. Yue: I can't do anything if I'm sick, which means near the women's room. Illness is like law, neither ghosts nor food, and it is confusing to be tired of happiness. ..... The man said: Women can't be close? Right: section. " In this paragraph, the words "magic" and "chaos" refer to mental disorder. Female bedroom refers to sexual intercourse, which is called sexual labor in later generations. Jin Hou suffered from bewitching mental disorder because of overwork. You must abstain from sexual intercourse. It is further proposed in medicine that six qi can cause diseases under abnormal conditions. He said: "there are six qi in the sky, five flavors are born, five colors are born with five sounds, and six diseases are born with lewdness." Six Qi: Yin, Yang, Wind, Rain, Yin and Ming. Divided into four seasons, sequence five. In the evening, it is Zhai, cold disease, fever, wind-yin terminal disease, rain-yin abdominal disease, confusion disease and heart disease. " From this passage of Yihe, we can see the following problems:

(1) formed the concept that climate change such as five o'clock and six o'clock in four seasons is the main cause. If we analyze the diseases mentioned by Zi Chan earlier, such as "eating and drinking, mourning and being happy" and Yan Ying's "indulging in private life" and "being close to a woman's house", we can see the clues of the "three causes" theory in later generations.

② The theory of "Yang yin is hot and cold" is the predecessor of the pathogenesis theory of "Yang yin is hot and cold" in later generations, and the theory of "wind yin is the terminal disease and rain yin is the abdominal disease" has a close relationship with the theory of "limb pain caused by wind pathogen and diarrhea caused by rain and dampness" in later generations.

③ Explain the relationship between five flavors, five colors, five tones and "six qi". These concepts also laid the foundation for the formation of diagnostics and pharmacology in the future.

④ It can also be seen that the theory of Yin-Yang and Five Elements, the thought of correspondence between man and nature and its application in medicine have also taken shape.

In a word, Yihe's theory of "six qi causing disease" is a systematic summary of a large number of scattered experiences in the past and plays a fundamental role in the pathogenesis theory of later generations. It plays an important role in the development of TCM etiology and pathogenesis theory.

China entered the Warring States period and began a feudal society. During the 700 years from the Warring States to the Three Kingdoms, China's politics, economy, science and culture have been greatly developed, especially in medicine. On the basis of long-term medical practice experience, it has entered the stage of theoretical summary. The appearance of Huangdi Neijing marks the formation of medical theoretical system. The publication of Treatise on Febrile Diseases by Zhang Zhongjing established the principle of syndrome differentiation and treatment in clinical medicine. Shennong's Classic of Materia Medica is the first book that systematically summarizes pharmacology in China. The emergence of a large number of famous doctors, such as Chen, Hua Tuo and Zhang Zhongjing, marks the development of medicine to a brand-new stage. In a word, the pre-Qin and Han Dynasties were the key moments for the development of Chinese medicine, which made the scattered medical experience rise to a systematic theory, which was a historical summary of the previous generation and an important historical stage for laying a comprehensive foundation for future generations.

Under such conditions, the theory of etiology and pathogenesis has developed to the formation stage. The main performance of this stage is; First, it has systematic and complete theoretical guidance; Secondly, the inner valley is perfect, which has important practical value in clinic. We might as well look at the discussion of etiology and pathogenesis in Huangdi Neijing first.

Huangdi Neijing includes Su Wen and Ling Shu. Because it is a medical summary before coming to Korea, and it was not written by one person at a time, the content is quite rich and the amount of information is also very large. It has always been regarded as a classic by Chinese and foreign doctors. As far as the theory of etiology and pathogenesis is concerned, it can be summarized as follows.

This paper puts forward the relationship between Yin and Yang in four seasons and common diseases in four seasons, and emphasizes that "since ancient times, the origin of life lies in Yin and Yang" (Su Wen Tong Qi Tian Lun). Therefore, people must "harmonize Yin and Yang and adjust the four seasons". If yin and yang violate the four seasons, diseases will occur. For example, "anti-spring qi" means "liver qi changes internally"; "Against the summer spirit" means "the heart is in the hole"; "Anti-autumn qi" will lead to "lung qi fullness" and "anti-winter qi", which will further affect the kidney and lead to the change of "kidney qi sinking alone", and so on. There are many contents in this respect in Neijing, which cannot be listed one by one. At the same time, Neijing also has the theory of "five movements and six qi" to understand the periodic change of climate and the regularity of some diseases and explain the reasons for the periodic occurrence of some diseases. Neijing systematically tells the theory of "six evils". It is considered that the natural climate of wind, cold, heat, humidity, dryness and fire will cause disease under abnormal circumstances. This is related to and different from the pathogenic theory of "six qi". Today, we still regard "six evils" as an important content of the etiology theory.

Human consciousness and thinking are collectively called consciousness in Chinese medicine. Neijing emphasizes the relationship between mental and psychological factors and diseases. It is said that "all diseases are born of qi". It also points out the influence of seven emotions, such as joy, anger, worry, thinking, sadness, fear and shock, on the qi and blood of viscera.

Neijing also discusses in detail the relationship between geographical environment, diet fatigue, human physique and diseases. At the same time, the changing law of pathogenesis was discussed from many aspects, and 19 famous pathogenesis items were summarized. In particular, the propositions of "Qi deficiency due to the combination of pathogenic factors" and "Upholding vital energy in the interior, and the impossibility of pathogenic factors" in Neijing still reflect important significance. Starting from the overall concept, this paper expounds that the occurrence of diseases is caused by the dynamic balance in the body and the destruction of the normal ascending and descending gasification function, which is the fundamental reason and internal basis of the occurrence of diseases.

From the above brief introduction, we can easily see that the emergence of Neijing has developed the theory of etiology and pathogenesis of traditional Chinese medicine into a unique scientific theory.

Treatise on Febrile Diseases written by Zhang Ji (Zhongjing) in the Eastern Han Dynasty is also one of the most influential works in the history of medical development in China. This book was regarded as a "classic" by doctors of all ages, and Zhang Zhongjing was honored as a medical saint. Treatise on Febrile Diseases spread to the Jin Dynasty, which was divided into Treatise on Febrile Diseases and Synopsis of the Golden Chamber. It has played an important role in guiding clinic with its characteristics of syndrome differentiation and treatment. Among them, the theory of "six meridians" is not only the program of syndrome differentiation and treatment of acute fever, but also the important content of pathogenesis theory, which reveals the pathological mechanism of acute fever. At the same time, in the synopsis of the golden chamber, the theory of three causes was put forward for the first time. We can take a look at this passage: "There are only three kinds of disasters: one is that the meridians are affected by evil spirits and thus enter the viscera; Both of them, with nine orifices in the limbs, are transmitted from blood to blood, and congestion is also caused by the skin; Third, the atrioventricular, golden blade, insect and beast were injured and the disease was detailed. " This has made great contributions to the etiology theory of traditional Chinese medicine.

After the Western Jin Dynasty, Chinese medicine entered a period of all-round development. Historically, the theory of etiology and pathogenesis can also be said to be a development stage. In order to clearly see the development stage of etiology and pathogenesis theory, we introduce several representative works.

Etiology is the first masterpiece at this stage. It is the collective work of Chao and others in Sui Dynasty. The book covers 50 volumes and 67 chapters, and discusses 1739 diseases. The content is rich, and the medical experience since Wei and Jin Dynasties is summarized in detail. The etiology, symptoms, diagnosis and prognosis of various diseases are discussed in detail. The extensive and detailed record of diseases is the greatest contribution of this book.

Among them, the understanding of etiology not only inherited the valuable experience of predecessors, but also carried out new theoretical exploration on the basis of clinical experience. For example, in the book Epidemic Fever, it is believed that some infectious diseases are caused by the external harmful material factor "bad temper". These substances are also easily dyed. The knowledge of some pathogens is quite true. For example, regarding the infection of parasitic diseases, it is clearly pointed out that "not all scabies have worms", and the disease of inchworm (tapeworm) is caused by eating undercooked beef. "Lacquer sore" said: "People are naturally afraid of lacquer, but they are afraid of its poison when they see it ... Some people are also self-forbearing, cooking (painting) all day long, but it is not a big problem." It shows that the occurrence of this disease is related to people's physical endowment. This is actually a concrete analysis of allergic constitution.

Chen Yan (Wu Xuan) in Southern Song Dynasty compiled "Three Causes-Prescriptions of Disease Syndrome", which is referred to as "Three Causes" and occupies a prominent position in the development history of etiology. The main contribution is to further elaborate the theory of "three causes of disease". He divided the complicated reasons into three categories. First, internal factors, namely joy, anger, worry, thinking, sadness, fear, shock and internal injuries, originated from viscera, and external factors, namely wind, cold, summer heat, dampness, dryness, fire and external six evils, originated from meridians and originated from viscera; The internal and external causes actually refer to external causes other than six evils, including hunger, respiratory injury, tiger, wolf, insect poison, golden sore injury and other accidental factors. Although this classification method is similar to that of Zhang Zhongjing in Treatise on Febrile Diseases in the Eastern Han Dynasty, its content has been greatly developed. That is to say, the generalization of various diseases is more specific and comprehensive, so it is more in line with clinical practice. Make TCM etiology theory more systematic and theoretical. The classification principle of three factors has always been followed by the theory of etiology in later etiological works, and has been developed in various dynasties since Huangdi Neijing.

Especially in the Tang Dynasty, when Bing Wang annotated Neijing, he added "seven expositions" and 19 articles on pathogenesis, which became the main basis for future generations to discuss the pathogenesis theory of TCM. Doctors in Song and Yuan Dynasties combined with clinical experience, made specific supplements and developments to the pathogenesis theory. For example, Liu (Hejian) put forward the argument that all six qi should be cremated, and enriched 38 kinds of pathogenesis in Article 19 of Neijing into 97 kinds;

Zhu (Danxi) put forward the argument that "fire moves in madness" and "bitter is yin" from the pathogenesis study of internal heat; Gao Li (Dong Yuan) emphasized the internal injury of the spleen and stomach, and "all diseases are born". Most of these pathogenesis theories were inherited and developed by later Ming and Qing physicians. This makes the theory of etiology develop to a higher level.

During the Jin and Yuan Dynasties, a new viewpoint of treating fever began to appear. In particular, Liu Hejian clearly pointed out that pungent drugs should not be reused in the early stage of fever, advocated pungent and cool methods to relieve exterior and interior, nourish yin and clear heat, and formulated a double-dissolving prescription, which broke through the previous treatment method of pungent and warm drugs to relieve exterior and interior in the early stage of exogenous fever. In the early years of Ming Dynasty, Lv Wang put forward that "febrile diseases should not be confused with typhoid fever", and thought that febrile diseases were caused by internal heat. This has formed a trend of further distinguishing the theory of febrile diseases from typhoid fever, and provided a theoretical and practical basis for establishing an independent system of febrile diseases in the future.

During the Ming and Qing dynasties, the study of epidemic febrile diseases gradually matured and formed an independent system of epidemic febrile diseases. In this process, Wu Youxing founded the theory of "rage" in Ming Dynasty, which is a great original idea of the cause of epidemic febrile diseases.

Before Treatise on Febrile Diseases, TCM's understanding of the causes of febrile diseases was based on Treatise on Febrile Diseases. For example, Neijing said: "All febrile diseases are typhoid." Therefore, after Treatise on Febrile Diseases, such diseases are collectively called "typhoid fever".

Since the Jin Dynasty, there has been a saying that "the four seasons are unhealthy", that is, it should be cold in winter, but warm, or warm in spring, but cold, causing diseases. This has led to the emergence of diseases such as seasonal diseases, seasonal diseases and seasonal diseases. However, the boundary between such diseases and typhoid fever is still blurred. Later, there were some sayings, such as "erupting gas" and "miasma", but these all refer to some special diseases, such as malaria, rather than general febrile diseases, let alone febrile diseases. It was not until the end of Ming Dynasty that Wu Youke put forward a brand-new pathogen theory for the first time with the appearance of On Plague. This not only enriches the theory of TCM etiology, but also makes creative contributions to the formation of febrile diseases.

Wu Youke first proposed that the epidemic disease was caused by "rage". In the preface of Treatise on Epidemic Febrile Diseases, he clearly wrote in the first sentence: "Febrile disease is a disease, not wind, not cold, not summer heat, not wet, but a strange gas between heaven and earth." He also called this strange smell violent, miscellaneous or epidemic. This breaks through the views of physicians on the cause of plague before the Ming Dynasty, such as seasonal qi theory, latent qi theory, miasma theory, and the view that all diseases are caused by six qi. Wu Youke believes that hostility is material and can be subdued by corresponding drugs. The route of transmission of rage is to invade the human body through the nose and mouth. Whether it can get sick after invading the human body depends on the amount, toxicity and resistance of the human body. There are many kinds of hostility. "It is difficult to list all kinds of diseases." Different types of hostility cause different diseases and different organs, which is the understanding of the specific location of pathogens. Wu Youke also pointed out that hostility is "neutral". He said: "Should those who are partial to animals, such as rinderpest, sheep plague, chicken plague and duck plague, be regarded as human epidemics?" However, cattle sick sheep are not sick, chickens sick ducks are not sick, and people sick animals are not sick. Injury varies according to different qi. "This is actually an understanding of the susceptibility or immunity of pathogenic species. Not only that, he also realized that surgical infectious diseases such as acne rash and scabies were also caused by rage. As can be seen from the above, the content of the theory of "rage" is quite comprehensive, basically covering the causes and characteristics of infectious diseases. It should be pointed out that Wu may have such scientific thoughts in an era when bacteria and other microorganisms have not been found in the world, which is really commendable. This is a great idea.

After Wu Youke, a large number of famous febrile diseases experts emerged one after another, such as Ye Gui (Shi Tian), Wu Tang (Jutong), Bai Sheng and Wang Shixiong (Meng Ying). According to the clinical characteristics of epidemic febrile diseases, they expounded their academic opinions from different angles, thus perfecting the theory of epidemic febrile diseases.

First of all, what is epidemic febrile disease? Epidemic febrile disease is a kind of exogenous disease caused by pathogenic factors of epidemic febrile disease, which is prone to dryness and yin injury. Although these diseases have different causes, seasons and symptoms, they all have warm characteristics in the course of onset, so they are always called warm diseases.

Treatise on Febrile Diseases has developed creatively in the theory of etiology, pointing out that the etiology is the evil of external warming. In addition to the theory of primary pathogenic qi introduced by Wu Youke, he also put forward new views on pathogenic factors such as wind-heat, summer-heat, damp-heat, dry-heat and warm-toxin, and developed the traditional concept of "six evils". This makes the significance of the etiology theory of epidemic febrile diseases not only limited to explaining the etiology of epidemic febrile diseases, but more importantly, it guides clinical "syndrome differentiation and treatment to diagnose and treat diseases", which enriches the content of traditional Chinese medicine.

The incidence of epidemic febrile diseases is contagious, epidemic, seasonal and regional. The process of its occurrence and development has certain regularity. The clinical manifestations after onset can be classified into two categories, namely, new sensation and latent evil. Feel the external evil attack immediately, which is called new sensation; Feeling foreign evil does not cause disease immediately, but hides the human body. What is outdated and causes diseases is called latent evil. At the same time, Ye proposed the dialectical law of defending qi and nourishing blood for the pathogenesis of epidemic febrile diseases. Wu Jutong thinks that the pathogenesis of febrile diseases is the change of upper, middle and lower energizer, while Wang Mengying thinks that the etiology and pathogenesis of damp-heat is influenced by both dampness and summer heat, that is, damp-heat. Of course, there are also people who suffer from damp heat for a long time. The practical significance of these theories is mainly to clarify the etiology of epidemic febrile diseases, the different types of diseases at the beginning, distinguish the severity of lesions, reveal the transmission trend of pathogenesis, establish the law of consistent syndrome differentiation, and add a glorious page to the theory of etiology and pathogenesis of traditional Chinese medicine.

The above is a brief introduction from the early stage, formation stage and development stage of the theory of etiology and pathogenesis, which gives us a general understanding of the history of the development of etiology and pathogenesis and the origin of various academic debates. It is hoped that readers will take fewer detours, understand more clearly and gain more when learning the theory of etiology and pathogenesis.