By Eric Brand

Pathomechanisms offer a description of the dynamic process through which disease develops and transforms in the body. When assessing a patient, we generally use pattern identification as the basis for determining treatment; however, we use pathomechanisms to analyze and explain the changes that occur over time. Pattern diagnosis only provides us with a snapshot picture of the current state of illness, so our ability to predict the progression of disease depends upon our knowledge of pathomechanisms.

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A comprehensive understanding of pathomechanisms allows Chinese medicine to be practiced more holistically. It helps to better anticipate future complications and stay one step ahead of the disease that is being treated. In addition, knowledge of pathomechanisms expands our ability to prevent the development of illness and allows us to live up to the motto that a superior practitioner "treats disease before it arises."

Generally speaking, diagnosis in Chinese medicine requires that the practitioner first differentiate the disease based on traditional “disease identification” (辯病 biàn bìng). Each traditional TCM disease category is divided into patterns, so the condition is then further differentiated by "pattern identification" (辯證 biàn zhèng). This process directs the practitioner to appropriate medicinal therapy and acumoxa treatment. Although this foundation gives us a means of providing effective treatment, it provides relatively little information on the origin, development, and potential progression of the condition.

The cause of a disease (病因 bìng yīn) is closely related to the pathomechanisms (病機 bìng jī) involved. However, there is an important difference between these two related concepts. The disease cause explains the origin of the condition, while pathomechanisms describe its dynamic evolution and progression. In other words, diseases and patterns illustrate the current state of an illness, the disease cause tells us its origin, and the pathomechanisms tell us everything that happened in between and everything that we can expect to happen in the future.

The Chinese medical theories that explain normal physiology were likely preceded by theories that explained pathology. It appears that certain treatments were found to be empirically effective and medical theory was adapted and created to explain the efficacy of the treatments. Many scholars believe that the Chinese first observed patterns of dysfunction and treatment and then later created medical theories to explain why the problems arose and resolved with therapy. Theories elucidating normal physiology were likely developed in an attempt to explain why pathologies followed certain predictable trends. Since observing pathology was likely the basis for developing an understanding of physiology, the theories involved in pathomechanisms date back to the earliest sources of mature Chinese medical theory.