Diagnosis- Methods, disharmony, build

4 diagnostic methods:
- Look
- Listen and Smell
- Ask
- Touch

Short term disharmony (pathological invasion)
- Size (swelling)
- Colour
- Temperature
- Joint deformity

Long term disharmony (ex. Kidney essence: developmental issues)
- Weight
Height
Deformity

Physique based on build:

-       Robustness

o   Strong physique

o   Solid viscera, exuberant qi and blood

o   Favorable prognosis

-       Weakness

o   Feeble physique

o   Fragile viscera, insufficient qi and blood

o   Unfavorable prognosis

-       Corpulence (overweight)

o   Corpulence and good appetite- exuberant figure

o   Corpulence with poor appetite- qi deficiency

o   Corpulent and susceptible to damp- heat and stagnation

-       Emaciation

o   Emaciation and polydipsia- fire flaming in the middle jiao

o   Emaciation and small food intake- deficiency of spleen and stomach

o   Atrophy- exhaustion of qi, body fluid, and essence

o   Emaciation with feverish sensation in the five centers and night sweating- yin and blood deficiency fire

M & A: Meridians and Collaterals

Meridians: 
- Run deeper than collaterals
- 12 regular
- 12 divergent
- 12 muscular
- 12 cutaneous
- 8 extra
- Functions of meridians include: transporting qi and blood, regulating yin and yang, resisting pathogens, transmitting needle sensations, reflection of signs and symptoms

Hand yin meridians:
- Lung meridian of hand tai yin
- Pericardium meridian of hand jue yin
- Heart meridian of hand shao yin

Hand yang meridians: 
- Large intestine meridian of hand yang ming
- San jiao meridian of hand shao yang
- Small intestine meridian of hand tai yang

Foot yang meridians: 
- Stomach meridian of foot yang ming
- Gallbladder meridian of foot shao yang
- Bladder meridian of foot tai yang

Foot yin meridians: 
- Spleen meridian of foot tai yin
- Liver meridian of foot jue yin
- Kidney meridian of foot shao yin

Anatomy- Liver/Gallbladder

Liver
- Located in upper abdominal (beneath diaphragm)
- Second largest organ in the human body (second only to skin)
- Heaviest gland of the body (3lbs)
- Has a larger right lobe, smaller left lobe
- Only place in the body that has two sources of blood (hepatic artery/hepatic portal vein)
- Filters bacteria and toxins from the body
- Manufactures bile

- Made up of approximately 10,000 lobules 

- Contain kupffer cells which destroy worn out white/red blood cells, bacteria, and other foreign matters

- Common hepatic duct joins the cystic duct from the gallbladder to form the common bile duct

Contains:
- Hepatic artery: brings fresh blood from heart (oxygenated)
- Portal vein:
- Hepatic vein: purified blood leaves through here
- Hepatic bile duct:


Gallbladder
- 7-10cm long and hangs from anterior inferior margin of the liver
- Produces 800-1000 mL of bile/day 
- Bile contains: water, bile salts, cholesterol, lecithin, bile pigments, several ions
- The bile salts helps to break down lipids.
- Bilirubin is the principal bile pigment, which is secreted into the bile and broken down in the intestine

Anatomy- Pancreas

The pancreas is located in the upper abdominal cavity, and is approximately 12-15cm long and 2.5cm thick.

Function:
- Completes the job of breaking down food
- Secretes hormones that affect sugar level (Glucagon- increases blood sugar, Insulin- stimulates cells to use glucose, Somatostatin- regulates the secretion of above)

Macrostructure
- Consists of a head, body, tail
- Contain the spinster of oddi.

Microstructure
- Exocrine: Acini (99% of clusters). Produces digestive enzymes/pancreatic juice. The juice is slightly alkaline.
- Endocrine: Islets of Langerhans (1%)
Amyylose is produced by the pancreas for sugar digestion. This can also be found in the saliva 

Pancreatic juice
- We produce 1200-1500mL per day
- It is made up of water, salts (including bicarbonate), digestive enzymes, and mucus.
- Digestive enzymes include: Pancreatic amylase (carbs), Trypsin (protein), Pancreatic lipase (fats).

Anatomy- Peripheral Nervous System

Central nervous system 
-The central nervous system contains the brain and spinal cord

Peripheral nervous system 
- The peripheral nervous system contains all nervous tissue outside of the CNS. It can be broken down into the Somatic nervous system (control skeletal muscles) and the Autonomic nervous system (regulates glands, blood vessels, and internal organs).
- It keeps the body in adjustment with the outside world.

Autonomic nervous system
- Maintains internal balance
- Regulates glands, blood vessels, and internal organs
- Maintains steady state within body automatically (ex. constant body temperature, regulates heart beat)

Sympathetic nervous system
- Prepares body for action
- Most active during stressful situations

Parasympathetic nervous system
- Helps return body to resting conditions
- Most active during periods of calm and physical rest

Cranial nerves
- There are 12 pairs, which all emerge from the brain.
- They transmit information from sensory receptors to the brain, and then transmit orders from the CNS to the muscles and glands.
- They are usually mixed nerves (a combination of afferent (sensory) and efferent (motor) nerurons).

1- Olfactory (sensory)- for smelling
2- Optic (sensory)- for vision
3- Oculomotor (motor)- eye movement
4- Trochlear (motor)- eye movement
5- Trigeminal:
     - Opthalmic (sensory)- face and scalp sensation
     - Maxillary (sensory)- mouth and nose sensation
     - Mandibular (mixed)- chewing
6- Abducens (motor)- eye movement
7- Facial (mixed)- face and scalp movement, tongue taste sensation, ear pain and temperature
8-Vestibulocochear (sensory)- hearing and equilibrium
9- Glossopharyngeal (mixed)- ear pain and temperature, tongue and throat sensations, throat movement
10- Vagus (mixed)- sensations in the throat, voice box, chest, abs. Movement in the voice box, throat, chest, abdominal viscera.
11- Accessory (motor)- neck and back movement
12- Hypoglossal (motor)- tongue movement

Spinal nerves
- These are all mixed nerves, and there are 31 pairs.
- 8 pairs of cervical spinal nerves (c1-c8)
- 12 pairs of thoracic spinal nerves (t1-t12)
- 5 pairs of lumbar (L1-L5)
- 5 pairs of sacral spinal nerves (s1-s5)
- 1 pair of cocygeal spinal nerves

Plexus 

- Cervical plexus: receives sensory information from the back of hear, neck, shoulders and upper chest
- Sends impulses to muscles of neck and shoulders
- Phrenic nerve arises from the cervical plexus and sends impulses to diagram

- Brachial Plexus: Supplies shoulder, arm, and hand.
- Ulnar and radial nerves emerge from here

- Lumbar Plexus: Supplies lower abdominal wall, buttocks, thigh, and genitals.
- Femoral nerve arises from here

-Sacral plexus: Supplies the thigh, leg, and foot
- Contains the sciatic nerve (largest nerve in the body)

Anatomy- Skin

Above is our "line of defence" in our body.

The structure of skin can be divided into 5 categories:
1- Epidermis, dermis, subcutaneous layer
2- Sweat glands
3- Oil glands (sebaceous glands)
4- Hair and nails
5- Melanin

Epidermis
- This is the outer layer of our skin (what we see), and it is made up of stratified squamous epithelial tissue.
- Our skin cells are constantly flaking off, so new epidermal cells are produced in the deepest sublayer of the epidermis, and then pushed towards the outer surface as they mature.
- The epidermis cells contain a structural matrix of Keratin. This is a protein which is essentially waterproof, and which aids in the flexibility and elasticity of the skin.
- The epidermis is NON VASCULAR. This means that there are no blood vessels.
- The epidermis contains melanin, which provides the pigment in our skin

Dermis
- This is a thick layer below the epidermis.
- Consists of connective tissue which is made up of collagen fibres. Collagen is responsible for the strength and stretching of the skin.
- The dermis is VASCULAR. This means that are are blood vessels and nervous found throughout the layer.
- The upper portion of the dermis has "dermal papillae" that project into epidermal tissue. These papillae delivery oxygen and nutrients to the cells of the epidermis and help with temperature regulation.

Subcutaneous layer 
- This layer is also known as the "superficial fascia."
- It contains loose connective tissue, as well as lots of fat (adipose) tissue.
- The function of this layer is to attach the skin to the muscles and tissues beneath.
- It also helps protect the underlying organs from mechanical shock.
- Distribution of fat in this layer is responsible for male and female body shapes.
                                                                                                                                                                        

Sweat glands
- Sweat glands are tiny coiled tubes in the dermis or subcutaneous tissue. They have a duct which extends up through the skin and opens onto the surface.
- There are over 3 million in skin
- Their functions include regulating temperature and eliminating waste.
- We sweat approximately 1 quart/day 

Sebaceous glands
- These are also known as oil glands.
- They are generally attached to hair follicles, so are mostly present on the face and the scalp.
- They secrete sebum (an oily substance) which helps lubricate the surface and prevent water loss.
- They have an anti fungal property, as well as inhibit the growth of bacteria.
- An accumulation of sebaceous glands cause blackheads.
- They are relatively inactive in childhood, but are active during and after puberty.

Hair
- Hair is found everywhere on our body except for our palms and soles.
- It has a protective function.
- The part of the hair that we see is called the shaft, the root lies below the surface.
- At the bottom of the hair follicle, a bundle of connective tissue can be found which delivers nutrients to the follicle.
- Hair is formed from Keratin.

Nails
- Nails are mainly for protection.
- They are developed from epidermal cells, and contain compressed keratin.
- Nails appear pink due to underlying capillaries

Melanin
- Melanin is responsible for pigment in our skin.
- These cells are scattered throughout the lowest layer of the epidermis.
- Albino's cannot produce melanin, and therefore are extremely pale.
- When melanin cannot absorb all of the ultraviolet rays due to sun exposure, we get a sunburn.

Random facts about skin
- Total skin on our body is approximately 20 sq feet.
- Skin helps maintain homeostasis (internal balance).
- Skin helps protect us. It is part of the first line of defence.
- In order to determine how much water we have in our body, we must multiply our body weight (kg) by 0.6.
- For example: If we weight 60kg, we will have 36 L of water in our body. Out of this 36L, intercellular fluid accounts for 24L, while extracellular fluid accounts for 12L. If we further break down the extracellular fluid, 9L will be for interstitial fluid, and 3L will be comprised of plasma.

Anatomy- Large intestine

The large intestine is separated from the small intestine by the ileocecal valve.

The function of the large intestine is to  absorb water from the remaining indigestible food matter and transmit the useless waste material from the body.

When chyme is brought towards the large intestine, the ileocecal valve opens and the chyme is allowed into the large intestine. 

Anatomy- Small intestine

The small intestine is shaped like a coiled tube, that is approximately 17 feet long when laid out. It is 4cm in diameter.

The first 9 inches of the small intestine is called the duodenum. 
The middle portion of the small intestine is called the jejunum. 
The last portion of the small intestine is called the ileum. 

After food has been digested, nutrients are absorbed by the intestinal villi. The microvilli secrets large amounts of fluid which help keep chyme in a fluid state (which helps absorb nutrients). Goblet cells in this mucus help protect the intestinal wall from acidic chyme and the action of the digestive enzymes.

The small intestine is separated from the large intestine by the ileocecal valve. 

Anatomy- stomach

When the stomach is empty, is is covered by many folds called "Rugae." When it is full, the stomach smoothes out, and has the capacity to hold more than 1 quart.

Our stomach is highly acidic and even contains hydrochloric acid (which helps to break down food and kills bacteria).

Digestion of protein is done by Pepsinogen. Pepsinogen remains inactive until is comes into contact with gastric juices from the stomach, at which point it turns into Pepsin (the active form of pepsinogen). 

Anatomy- Food passageway

Pharynx: This is the passage way for air and food. It includes 3 regions:
1- Oropharynx: posterior to pharynx
2- Nasopharynx: posterior to nose
3- Laryngopharynx: opens to larynx and esophagus

Esophagus: This allows food and drink to pass. At the lower end of the esophagus, we have the cardiac spincter (closes the stomach so that acidic stomach juices cannot go up the esophagus.

Anatomy- Mouth and tongue

The mouth contains salivary glands, which include 3 main parts:
1- Parotid glands: these are the largest
2- Submandibular gland : Located just below the jaw
3- Sublinguar gland: Located under the tongue

Tongue:

Anatomy- Digestive system

Wall of digestive tract:
- Mucosa: lines digestive tract, it is specialized for protection
- Submucosa: rich in blood vessels/nerves
- Muscles layer: pushes food along through digestive tract
- Outer coat (serosa)- connective tissue


GI tract:
Includes the following structures:
- Mouth
- Pharynx
- Esophagus
- Stomach
- Small intestine
- Large intestine
- Anus 

Anatomy- Blood and lymph

The circulatory system consists of the Cardiovascular system, as well as the lymphatic system.

- Cardiovascular: heart, blood vessels, and blood.
     - Blood: Maintains osmotic pressure, aids in transportations, buffering, immunity, and blood clotting.
*Blood is made up of cells (45%) and plasma (55%).

- Cells: Red (erythrocyte), white (leukocytes), platelets (thrombocytes)

-Plasma: Albumins (osmotic pressure), globulins (alpha- hormones, beta- proteins, gamma- antibodies), fibrinogen (clotting).

- Red blood cells: Bioconcave (allows oxygen and carbon dioxide exchange), haemoglobin is the main component (transports gases), produces in red bone marrow.

- White blood cells: 5 types:
     - Neutrophils (60%): Eat bacteria (clean up!)
     - Eosinophils (1-3%): Increase during allergic reaction/parasite infestation
     - Basophilis (1%): releases histamines and contain heparin (help prevent blood for clotting inappropriately)
     - Lymphocype (25-30%): Produces antibodies, or attacks bacteria/viruses
     - Monocyte (6%): develops into macrophage (large scavenger cells of the body)

- Lymphatic: Has 3 functions:
     1- Collects and returns interstitial fluid to blood (helps maintain fluid balance)
     2- Defends body against disease by filtering lymph
     3- Absorbs lipids from intestine and transports them to the blood

*Drains on the left side of the body, 2 lower limbs, pelvis and abs.

- Lymphnodes filter lymph and are located on the cheek, in front of and behind ear, back of head, and under chin. 

Anatomy- skeletal system

The function of the skeletal system are: support, protection, movement, mineral storage, and blood cell formation.

- There are 206 bones in the skeleton
     - Broken down into 2 groups: Axial (80). Contains the head, vertebral column, ribs, and breastbone.
                                                     Appendicular 

Anatomy- tissue

- Epithelial cells: protects the body (skin)

- Connective tissue: Joins the tissue of our body (ex. bone, cartilage, blood, marrow) 

- Nervous tissue: Receives and transmits messages (communication). Neurons transmit nerve impulses, and gila cells support and nourish the neurons.

 

Anatomy- Cells

Cells can be divided into 3 parts:

1- Plasma membrane: surrounds and protects every cell, regulates the passageway into and out of cells, and communicates with other cells.
     - Includes:
         - Lipid bilayer: basic framework of plasma membrane

2- Cytoplasm: Contains organelles ("power" for transportation)
     - Includes:
          - Smooth ER: No ribosomes (fatty acid synthesis)
          - Rough ER: Ribosomes (protein synthesis)
          - Golgi complex: Proteins processing/packaging plant (produces lysosomes)
          - Mitochondria: "fuel cells" for cellular respiration

3- Nucleus: DNA, genes, chromatin, chromosomes 

Anatomy- Body cavities

There are two body cavities: 

1- Dorsal cavity (posterior) 2 subdivisions:

     1- Cranial: formed by cranial bones and contains the brain

     2- Vertebral canal: contains the spinal cord

2- Ventral cavity (anterior) 2 subdivisions:

     1- Thoracic: heart, lungs, and associated structures

     2- Abdominopelvic: digestive, excretory, and reproductive organs 

Anatomy- Structural organization in the body

Levels of structural organization:

- Chemical level (atoms/molecules)
- Cellular level (cells)
- Tissue level (groups of cells. 4 types: muscle, connective, epithelial, nervous)
- Organ level (groups of tissue)
- System level (groups of organs. 10 types:
 skeletal (skeleton)
 muscular (movements)
nervous (collecting, transferring, and processing information)
endocrine (communication within body via hormones)
circulatory (pumping/channelling blood)
integumentary (skin, hair, nails)
respiratory (organs used for breathing)
digestive (digesting and processing food with salivary glands and the esophagus)
urinary (kidneys, bladder, and ureters. Fluid balance and excretion of urine)
reproductive (sex organs)

Anatomy- Sense organs

The sense organs include the eyes, ears, nose and tongue. All of these organs send signals to the central nervous system (CNS).

The eyes:
- Made up of 3 layers
     - Sclera & Cornea: white of eye, covers everything except anterior, covered by conjunctive
     - Choroids: absorb light rays
     - Retina: Only place where blood vessels can be observed to view pathological changes. The retina
     includes the pigmented layer (visual data) and the neural layer (contains photoreceptors, bipolar,
     ganglion)
- Lens: refracts (bends) light
- The eye has two cavities: Anterior (filled with aqueous humour) and Posterior (filled with vitreous humour). Both of these help maintain the shape of the eyes.


The ears:
Outer ear 
Pinna: What we see. This conducts sound waves to the middle ear
Ear canal: Leads to middle ear
Ear wax: Cerumen
Eardrum: Tympanic membrane (separates middle and external ear)
Middle ear- Amplifies sound waves
Contains 3 bones:
Malleus (hammer), incus (anvil), stapes (stirrup)
- All of these amplify vibrations
*air pressure equalized by eustachian tube- connects middle ear and throat*
Inner ear
- Contains mechanoreceptors (converts sound waves to nerve impulses)
- Perilymph & endolymph (carry vibrations within the ear)
- Cochlea: contains "organ of corti" which responds to sound waves by stimulating the cochlear nerves

Anatomy- Endocrine system

The main purpose of the endocrine system is to produce, store, and excrete hormones. It includes the following:

- Hypothalamus: Organizes and controls emotions, feeling, mood (including hunger and appetite). The hormones that are secreted here (oxytocin- stimulates ejaculation of milk, ADH- reabsorption of sodium ions in the kidneys), influence the pituitary gland.

-Pituitary gland: Has two lobes which secrete hormones.
       Anterior Lobe: Tropic (stimulates other endocrine glands), Prolactin (milk production), TSH      
       (thyroid stimulating hormone), ACTH (adrenocorticotropic hormone), Gonadotropic (follical
       stimulating), LH (lutinizing hormone- endorphines)
   
       Posterior: Oxytocin, ADH

-Thyroid: Has two lobes which are connected by isthmus. It secretes TH (thyroid hormone) which is essential for growth and development.

- Parathyroid: Releases PTH, which raises blood calcium if it is low.

*The thyroid and the parathyroid work together to keep blood calcium levels normal*

-Pancreas: Secretes Insulin (lowers blood sugar) as well as Glucagon (which raises blood sugar.

- Adrenal glands: Produce Gluccorticoids which lower inflammation

- Adrenal medulla: Produces Ephiephrine (Adrenaline) which is responsible for our flight or fight response

The kidneys, ovaries, testies, and heart are also part of the endocrine system.


       

Zang Fu- Spleen

The spleen is in charge of transformation and transportation, is the source of qi and blood, and also controls blood.

Spleen qi deficiency, as well as spleen yang deficiency, are often characterized by fatigue with weak digestive symptoms.

Spleen qi sinking symptoms often include bearing down sensations, diarrhea, organ prolapse as well as varicose veins.

When the spleen is unable to control the blood, fatigue with weak digestive symptoms, as well as bleeding can be seen.

When damp cold invades the spleen, gastric fullness, abdominal distention, heavy head/body, slippery tongue, and a slow and slippery pulse can often be experienced. 

Zang Fu- Liver

The main functions of the liver are to store blood, ensure smooth flow of qi, regulate tendon elasticity, and regulate emotions.

When Liver qi is stagnant, it can often lead to anger, irritability and frustration.

When liver blood is stagnant, which is often caused by stagnation of the liver qi, or heart/liver dysfunction, one can have fixed/stabbing abdominal pain, irregular periods, purple tongue, and wiry pulse. Treatment for this condition includes dispersing the liver, and regulating the blood.

Blazing liver fire can be caused by longstanding anger, repressed anger or frustration. Symptoms of this condition include headache, dizziness, an increase of blood pressure, insomnia and irritability. Treatment includes sedating the liver, as well as clearing the fire. 

Zang Fu- Heart

The function of the heart is to regulate blood and vessels. It also houses the spirit (Shen).

Heart deficiency syndromes:

- Heart qi deficiency: As one of the main functions of qi is to promote blood, when there is a deficiency, blood circulation is affected. This can lead to a yang deficiency because "movement" is affected.
The cause of heart qi deficiency can be due to an overconsumption of qi, spleen deficiency, or an endogenous cause.
In order to treat this, we generally tonify heart qi.

- Heart yang deficiency: As mentioned above, heart yang deficiency generally occurs due to a heart qi deficiency. It can also be caused by deficiency kidney yang.
In order to treat this, we generally tonify and warm heart yang.

- Heart blood deficiency: This can be caused by spleen qi deficiency, chronic worry or anxiety, as well as severe blood loss. Symptoms are very similar to those seen in iron deficient people, and treatment includes tonifying the blood and heart, as well as soothing the spirit (Shen).

- Heart yin deficiency: This is usually caused by chronic anxiety or worry, febrile disease, or disruption of kidney/spleen functions. Sign of this often include anxiety, insomnia, mental restlessness, poor memory and malar flush. Treatment calls for tonifying and nourishing heart yin, nourishing kidney yin, and calming the spirit (Shen).

Study clue:
Qi: Spleen. Loss of function.
Yang: Kidneys. Qi deficiency, cold/pain, pale.
Blood: Spleen. Mental disturbances, no heat, pale.
Yin: Kidney/spleen. Heat, fluid deficiency, red.

Pathogenesis

Pathogenesis refers to a step by step development of disease. Disease will always affect individuals differently due to our constitution/congenital essence; our inherited conditions and traits from our parents. How much a disease affects us will also depend on the strength of qi, our emotions, diet, and environment.

Inside of our bodies, there is a constant battle between evil qi (the qi that disrupts the body) and genuine qi (the qi that fights to regain balance). When genuine qi is stronger, our body is in harmony, when evil qi is stronger, our body is in disharmony.

Diseases can enter our bodies from many different orifices, but it can generally be said that yin pathogens enter through our skin and eventually penetrate organs, while yang pathogens enter through our mouth and nose and will usually attack lung and spleen first.

Excretion

In TCM, excretion of sweat and urine are accomplished by metabolism. The lung aids by dispersing fluid to the surface of the body (only for sweat). 

Body Fluid

Body fluid is defined as all normal liquid in the body. It is formed through the digestive function of the stomach and spleen, and is commonly referred to as "Jinye" in TCM.

Jinye can be broken down into two parts: Jin and Ye.

Jin is characterized by being thin, clear, easily mobile, moistening, and an ability to permeate the blood vessels. Ye is turbid, thick, slow moving, nourishing, and generally enters the joints, viscera, brain and marrow.

Jin and Ye can both transform into one another, and distribution is accomplished by the following organs:
- Spleen: transfers fluid up to the lungs
- Lung: distributes fluid throughout the body
- Kidney: distributes fluid via the function of evaporating and sending up the clear and sending down the turbid
- San Jiao: Passageway for distributing body fluids

Blood

Blood is one of the most important fluids in our body. According to TCM, blood is formed by stomach and spleen essence, lung qi, and kidney qi. It is the material basis for all mental and emotional functions. 

Blood has many functions, but mainly it seeks to nourish our body. It is made up of nutritive qi and body fluid, and is circulated by the heart, lung, and liver. 

Qi

It seems like everything has to do with qi in Chinese Medicine! Qi can be describes as the life force behind everything, and it is a yang substance. It has 5 main roles:

1- Promoting: It is the commander of blood, as well as the power behind everything

2- Warming: Maintains the constant temperature of the body, as well as the circulation of blood and body fluid.

3- Defending: Defends the bodes surface, and plays a role in preventing outside invasions.

4- Consolidating: Keeps things where they should be, thereby preventing abnormal loss of fluid.

5- Transforming: Has the ability to change.

Qi is always moving through our bodies. It can go up (yang), down (yin), in, or out. There are several different types of qi, all of them are important to our health and wellbeing:

- Primordial qi: We are born with this, as it is generated from our parents during the pregnancy stage. It is stored in the kidneys, as is depleted as we use it. It's main function is to aid in growth and development, but it also warms and promotes.

- Pectoral qi: This is also stored by the kidneys, and is derived from clear qi (air) inhaled by our lungs, as well as essential qi transformed by our stomach and spleen. The main functions of pectoral qi are to promote lung respiration, help strengthen voice and breath, move qi and blood, and regulate heart rhythm.

- Nutritive qi: This type of qi is derived from our food and drinks. Its main function is to nourish the blood, as well as to form blood. Stomach and spleen are responsible for the creation of it, and it exists within our blood vessels.

- Clean qi: This type of qi is created by the air we breathe into our lungs. Its main functions are to promote the circulation of qi, as well as dispersing wei qi (defence) to our bodies exterior.

- Wei qi: This is essentially the western version of an immune system.

- Defensive qi: Similarly to wei qi, defensive qi seeks to protect us from disease. It is created by the stomach and spleen, and generally flows outside of the blood vessels. In addition to protection, defensive qi also controls the opening and closing of interstitial space (fluid compartments) which allows for the excretion of sweat, as well as aids in the function of warming and nourishing the viscera, muscles, skin and hair.

Endogenous factors of disease

Endogenous refers to an internal cause. These include emotions, diet, and activity.

In TCM, emotions play a very important role. Each one of the Zang organs corresponds to a certain emotion:

Heart- Joy
Spleen- Pensiveness
Lung- Sadness
Kidney- Fear
Liver- Anger

When emotional qi is disrupted, the following symptoms can manifest:

Joy (Heart)- Disrupts mental functions
Pensiveness (spleen)- Disrupts functions of the heart and spleen, and can also consume body fluid and yin
Sadness (lung)- Qi stagnation, or an over consumption of qi
Fear (kidney)- Urinary and fecal incontinence
Anger (liver)- Makes qi increase, as well as blood increase

Diet also plays a very important role. Overeating or excessive hunger can damage the stomach and spleen, as well as stagnate and impair qi function. In addition, consuming unclean food can often lead to diseases related to the intestines and stomach.

Improper activity can also play a role in disease development. If one works too hard (physical over strain), this can impair nutritive qi. Similarly, mental overstrain will lead to impairment of heart, blood and spleen qi. According to Chinese Medicine, too much sex isn't good for you as it can reduce kidney function, but on the other hand, too much rest can result in weakened functions of the stomach and spleen. As in all thing, finding a balance is key!

Pestilent Evils

Pestilent evils are pathogenic factors that are very strong, contagious, and severe. An example of this is H1N1. Characteristics of pestilent evils include: sudden onset, sever symptoms, easy communication between others, and the ability to spread rapidly.

Distribution can take place by the following factors:
- Climactic
- Environmental (pollution)
- Delayed prevention and isolation
- Certain social factors

6 Exogenous Evils

In TCM there are 6 climatic factors: Wind, Summer Heat, Fire, Dampness, Cold, Dryness. Under normal conditions, these do not cause any harm to people, but under certain conditions, they become the "6 climactic evils."

It is important to note that any one of these evils can attack by itself, or in combination with another. For example: Wind can attack with cold to form "wind cold", or even "wind cold damp."

Wind (yang)
- Usually occurs in Springtime (but can occur in any season)
- Wind is the leading evil in all disease
- This is a yang evil and therefore exhibits yang characteristics: Attacks upward, is moving (can change sites of infection), is rising, and generally invades yang sites of the body (superficial and upper).
- Wind is also characterized by a quick onset and frequent changes in symptoms.
- Exogenous. This means that it develops from external factors.
- Wind usually enters via the skin and the interstitial space of the flesh

Summer Heat (yang)
- Usually attacks in summertime.
- Exogenous. This means that it develops from external factors.
- Disease caused by the heat after summer solstice: Summer heat.
- Diseased caused by heat before summer solstice: Warm disease.
- Yang evil. This means that it easily damages the yin fluid of the body.
- Often combines with dampness. 

Fire (yang)
- Endogenous. This means that it develops due to internal factors
- Develops from excess of qi.
- Yang characteristics: Mostly related to upper portion of the body, drives out body fluid, heats yin fluid.

Dampness (yin)
- Usually occurs in late summer
- Generally stays in visceras and meridians
- Lasts for a long period of time
- Sticky and stagnant
- Related to heaviness and turbidity

Cold (yin)
- Usually attacks in Winter
- Can occur due to sudden decrease in temperature
- Wind and damp commonly invade in combination with cold
- Cold attack: suppresses defensive yang
- Interior cold attack: impairs visceral yang 

Dryness
- Impairs and consumes body fluids 
- This leads to an insufficiency of yin and body fluids
- Attacks via mouth and nose
- Generally impairs the lungs
- 2 categories: warm dryness syndrome, cool dryness syndrome