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The term “disease location” refers to the site of pathological changes. The transmission of disease location refers to the pathological process in which the site of disease changes and shifts during the development of the disease. The human body is an organic whole, and its tissues, such as the organs (zangfu), meridians (jingluo), sensory organs, limbs, and the vital substances like qi, blood, and body fluids can all be sites for disease occurrence. Moreover, there are interconnections between the exterior and interior, as well as among the organs through the meridians. Therefore, when a disease at one site affects and spreads to other sites, it is termed the transmission of disease location.
Common forms of disease location transmission include the transmission between the exterior and interior, as well as between the organs. Generally, externally contracted diseases begin at the exterior and often develop from the exterior to the interior. Thus, the basic form of transmission for externally contracted diseases is between the exterior and interior. Internal injuries often originate in the organs, and their development involves the affected organ impacting other organs, making the basic form of transmission for internal injuries the transmission between organs.
Understanding the rules of disease location transmission is of significant clinical importance. By adopting a dynamic perspective towards diseases, clinicians can detect subtle changes when the disease has not yet deeply progressed, allowing them to grasp the trend of disease development and seize the opportunity for treatment, thereby preventing the progression and transmission of the disease and curing it in the early stages.
Transmission Between Exterior and Interior
The transmission between exterior and interior, also known as the transmission of disease between exterior and interior, represents the depth of the pathological changes and indicates the trend of the disease. The transmission between exterior and interior can be divided into two forms: the invasion of exterior pathogens into the interior (or from exterior to interior) and the emergence of interior diseases to the exterior (or from interior to exterior).Exterior and interior have relative meanings.In a holistic sense, the skin is the exterior, while the internal organs are the interior;in terms of meridians and organs, the meridians are the exterior, and the organs are the interior;in terms of organs, the bowels are the exterior, and the viscera are the interior;in terms of meridians, the three yang meridians are the exterior, and the three yin meridians are the interior. Among the three yang, the taiyang is the exterior, the yangming is the interior, and the shaoyang is half exterior and half interior.However, in the context of syndrome differentiation, the exterior syndrome and interior syndrome generally refer to the skin and the organs.The organs and meridians of the human body are originally interconnected, and diseases are constantly changing and developing. Therefore, diseases at the exterior can enter the interior, and diseases at the interior can also emerge to the exterior.The invasion of exterior pathogens into the interior refers to the pathological process in which external pathogenic factors remain on the skin and, under certain conditions, penetrate into the interior, affecting the functions of the organs. This often occurs due to a decrease in the body’s ability to resist pathogens, excessive pathogenic factors, improper care, or misdiagnosis and mistreatment.For example, in cases of externally contracted wind-cold syndrome, symptoms such as chills, fever, and absence of sweating may indicate that the cold pathogen is present at the exterior. If treatment is inadequate or inappropriate, the exterior wind-cold pathogen may penetrate into the interior, affecting the spleen and stomach functions, leading to high fever, thirst, cough, constipation, etc., which is an example of exterior pathogens invading the interior.Certain pathological changes in bodily tissues can occur due to the connection between the five organs and the external body (the liver connects with tendons, the heart with vessels, the spleen with flesh, the lungs with skin, and the kidneys with bones). If the pathogenic factors linger without resolution, they can invade the corresponding internal organs.For instance, if bone pain persists and is re-exposed to pathogenic factors, it may invade the kidneys; if tendon pain persists, it may invade the liver; if muscle pain persists, it may invade the spleen; if skin pain persists, it may invade the lungs.Various types of pain that linger can progress from the exterior to invade the interior. This is also an example of the transmission from exterior to interior.When pathogens invade from the exterior to the interior, they generally follow the sequence of skin, meridian, and organ. Typically, external pathogens first settle in the superficial collaterals, then move to larger collaterals, and subsequently to the meridians, eventually connecting with the five organs. If both the exterior and interior meridians are affected by pathogenic factors, the five organs will inevitably suffer damage. This illustrates the order in which external pathogens invade the interior through the skin.The emergence of interior diseases to the exterior refers to the pathological process in which a disease in the interior, due to the struggle between the righteous and the evil, manifests at the skin surface. This often results from appropriate treatment and care, enhancing the body’s ability to resist pathogens.For example, in cases of warm diseases, if internal heat is excessive, symptoms such as irritability, chest tightness, and cough may appear, followed by sweating and resolution of heat or emergence of rashes, indicating the emergence of interior diseases to the exterior.The mechanism of mutual transmission between the exterior and interior primarily depends on the comparative strength of the righteous and the evil. If the righteous cannot overcome the evil, the exterior pathogens will invade the interior. Conversely, if the righteous prevail over the evil, the interior syndrome may emerge to the exterior. The emergence of interior diseases to the exterior often reflects that the evil has an outlet, indicating improvement or recovery of the disease, while the reverse indicates that the evil has penetrated the interior, the righteous qi is declining, and the disease is worsening, indicating a reversal of the disease mechanism.
“The hidden warmth emerges from the yin to the yang, which is a favorable progression in the disease mechanism. If the disease arises from the yin and collapses in the yin without reaching the yang, this is a reversal in the disease mechanism” (from “Wen Re Feng Yuan: The Confusion of Yin and Yang in Disease Evidence”).
Furthermore, in the transmission of cold damage diseases, the entry and exit of pathogenic factors must pass through a half-exterior, half-interior stage, where the external pathogens have penetrated but have not yet fully entered the interior, or the interior pathogens have emerged but have not yet reached the exterior.The shaoyang is situated between the taiyin and yangming. When the evil transmits to the shaoyang, the pathogenic factors are neither at the taiyang exterior nor have they reached the yangming interior, thus the shaoyang disease is termed a half-exterior, half-interior disease. The disease mechanism involves the evil entering the shaoyang, with the struggle between the righteous and the evil, leading to dysfunction of the shaoyang pivot, internal stagnation of gallbladder fire, which subsequently affects the stomach. Therefore, clinically, symptoms such as alternating chills and fever, fullness in the chest and hypochondria, bitter taste in the mouth, dry throat, dizziness, and aversion to food are characteristic.
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