Huangdi Neijing: Zhi Zhen Yao Da Lun

The Nineteen Pathogeneses: Supreme Principles of TCM Diagnosis

The Nineteen Pathogeneses: Tracing the Source

The ancients summarized complex symptoms into nineteen core mechanisms. By observing symptoms, one can deduce the imbalance of the Five Elements within the body.

☯️ Upper/Lower Jiao (Qi Mechanics)
  • All atrophy, asthma, and vomiting belong to the Upper: Often related to unsmooth Qi in the Upper Jiao.
  • All reversal cold, constipation, or diarrhea belong to the Lower: Often related to the Lower Jiao.
🌲 Wind/Wood (Liver)
  • All wind, shaking, and dizziness belong to the Liver: Tremors, swaying, and vertigo.
  • All sudden stiffness belongs to Wind: Sudden rigidity, spasms, or arching of the back.
  • Note: The Liver opens into the eyes.
🔥 Fire/Heat (Heart)
  • Heart: All pain, itching, and sores belong to the Heart.
  • Fire: Fever, chills, shivering, mania, upward Qi reversal, and painful ulceration.
  • Heat: Stiffness, cloudy fluids, vomiting/diarrhea, and abdominal distension.
  • Note: The Heart opens into the tongue; Fire/Heat causes the most widespread illnesses.
⛰️ Damp/Earth (Spleen)
  • All dampness, swelling, and fullness belong to the Spleen: Systemic or abdominal edema.
  • All spasms and neck stiffness belong to Dampness: Joint stiffness caused by damp stagnation.
  • Note: The Spleen opens into the mouth.
⚔️ Dry/Metal (Lung)
  • All Qi reversal and chest oppression belong to the Lung: Difficulty breathing and Qi blockage.
  • All dryness and withered exhaustion belong to the Lung: Depletion of bodily fluids.
  • Note: The Lung opens into the nose.
💧 Cold/Water (Kidney)
  • All cold, contraction, and pulling belong to the Kidney: Curled up limbs and inability to stretch.
  • All clear and cold bodily fluids belong to Cold: Excretions (urine, phlegm) that are clear, not sticky.
  • Note: The Kidney opens into the ears.
💡 Academic Note: The original classical text contains highly context-dependent metaphysical terminology. It is preserved only in the Chinese versions to maintain linguistic accuracy.