藏象学说 讲稿

留学生班《中医学》第三章 脏腑学说 讲稿

附三院 周颖芳

Hello, everyone!

Today we’ll talk about the theory of viscera and bowels. I am from the

third affiliated hospital of Guangzhou Medical University, my name is Zhou Yingfang. I know you have learnt Yin-yang and the five elements doctrines, which make it easier to understand what we’ll learn today.

Objectives

After the learning of this chapter, you should master the concept of

viscera and bowels, the characteristics, the main functions of the five zang-organs and the six fu-organs, and the mutual relationships among them.

At the beginning of learning TCM, not only you, but also the Chinese

students have the problem in understanding and accepting the theory of TCM, because it is really different from that of the western medicine. I hope, from now on, you can make yourselves completely into the thinking mode of traditional Chinese medicine. Just like the picture, western medicine and TCM are two different ways, but their purposes are to deal with diseases and make human beings healthy.

Let ’s see the meaning of the Chinese words of viscera, 藏象。Zang has two pronunciations, one is cang, which means hiding; another is zang, which means the internal organs. Xiang indicates the phenomena and shapes/forms. These two words together implicate the physiological

functions and pathological changes of the organs inside our body. The visceral manifestation theory is an important component of TCM. It consists of the study of the physiology and pathology of all the viscera, and the relationship between viscera. In Chinese medicine, each organ is a complex system which encompasses many aspects, such as, the material-anatomical body parts, mind-body-spirit connection, individual constitution, tissues, organs, and surrounding environment. This paradigm is the core of TCM.

We divide the internal organs of the body into three kinds:

The first one is five zang-viscera, which includes heart, liver, spleen,

lung and kidney. Their physiological function is to produce and store essential qi. Essential qi is composed of the congenital essential qi, and the qi from food and drink by transformation and transportation of the spleen and stomach.

The second one is six fu-viscera, they are gallbladder, stomach, small

intestine, large intestine, urinary bladder and san-jiao. Their physiological function is receiving, transforming, and transporting food and water. If the passage way is not smooth, been obstructed, the person will feel distension in the stomach or the abdomen area.

(The five zang-viscera store the essential qi but not discharge it, so

they are full, but cannot be filled up. The six fu-viscera transform and digest the matter but do not store it, thus, they are filled, yet are not full. )

The third type is extraordinary fu-viscera. They are brain, marrow, bone, vessel, gallbladder and uterus. They are distinct from the fu-viscera in function. We’ll go into details later.

The five zang-viscera

1．Heart

The first content is heart. As we all known that the heart is located in

the thorax and guarded externally by the pericardium.

Let ’s go into further understanding of the heart.

The heart has the function of circulating blood through the vessels to

nourish the whole body. Maybe it ’s easier to understand, because it is similar to that in western medicine. The blood circulation looks like a ring without break, but the normal circulation of blood in the vessels depends on both the heart and vessels. The vessels are the pathways of blood circulation and the heart is the motive power of blood circulation. Heart qi can promote the blood circulation, and transport the nourishment materials to the tissues and organs. The beat of the heart relies on the promoting and regulating function of the heart qi.

Shen refers to the control of whole body function in a broad sense.

Specifically the heart governs spiritual activities, which includes mental aspects, consciousness and thought. Maybe it is the most difficult part for you to understand. In modern medicine, spiritual activities are the function of the cerebrum, or the cerebrum ’s reflection, related to, and

experiences with objective things. In TCM, heart governs the physiological activities of the organs and body orifices. The material basis of spiritual activities is blood. In physiological condition, if the function of governing spiritual activities is normal, one will be full of vitality, have a clear head, and be quick in both thought and response. But, in the pathological condition, the patient will be upset, have depressive psychosis and mania caused by phlegm-fire disturbing the heart, insomnia, frequent dreaming and palpitation. Here is an example, a person named Fan Jin in a novel of Qing dynasty, lived in poor, he had experienced the exams of more than 20 times, and all failed. Until nearly 60 years old, he got the former second degree candidate in the provincial examination. He was very very happy, and became mad. If we use TCM theory to explain it, it is because the overjoy emotion hurts the heart.

In TCM, heart has close relationship with sweat. Sweat is derived from

body fluid, and is important component part of blood. There are sayings, such as blood and sweat share a common source, sweat is the fluid from the heart. In normal condition, sweat can moist the skin, while too much sweating may injury heart blood and heart qi. For example, hot environment, too much clothes, or excessive exercises may cause abnormal sweat. And the patient may feel palpitation and feeling of fear. A much more serious condition is known as depletion of yang resulting from profuse sweat, which leads to night sweating.

The heart opens to the tongue and manifests on the face. In

acupuncture, the large divergent collateral of the heart meridian goes up to the tongue and the face. These areas are rich in blood vessels. You all know a TCM practitioner often looks at the tongue and face, so as to help he/she to make diagnosis. It is said that the tongue is the sprout of the heart. The physiological functions of the heart can be detected through changes in both color and luster of the face. In physiological condition, the heart functions are well, and the heart-blood is abundant, the face will be ruddy and lustrous, and the tongue will be light red and free in motion. In the pathological condition, the manifestations depend on the concrete reason. If the heart-blood is deficient, there will be a pallor complexion and pale tongue. If the heart blood is stagnated, purplish and dark complexion, echymoses or petechiae will appear. Dysfunction of heart in governing mental activities or spirit leads to stiff tongue, difficult in speaking, or aphasis. If the heart-fire is flaring up, there will be red tongue and carbuncles。

Hair is dependent upon the nourishment of blood, so it is said hair is

the extension of blood.

Pericardium

It has the function of protecting the heart. In TCM, exogenous factors

that invading the heart often first attack the pericardium. For example, febrile disease with high fever, coma, deep red tongue is known as “heat

invading the pericardium” in TCM.

2. Lung

Governs Qi

(1) Governs air breath

“getting rid of the stale and taking in the fresh”

(2) Governs Qi of the whole body

Production of “pectoral qi”, which is composed of fresh air from

nature inhaled by the lungs and essential qi from food, water, and stored in the thorax.

Qi movement (ascent, descent, exit and entrance) of the whole body

In charge of dispersing and descending

The function of dispersing and descending involves the distribution of

qi, blood, and body-fluid to the zang-fu organs, the muscles, skin and hair.

Pathology: cough, difficulty in breathing; fullness of the chest, phlegm

Smooth the water passages

It means the ascending and descending functions of the lung qi have

the function of smoothing and regulating the distribution, circulation and discharging of the water inside body.

Discharge the metabolized water in the body in four processes: urine,

sweat, respiration, and feces.

“the lung is the upper source of water”

Governs the skin and hair

The skin and hair in this case, represent the entire surface of the body

including skin, sweat gland pores, and hair. They acts as a barrier against the invasion of exogenous pathogenic factors.

The lung spreads defensive-qi to the body surface, “warms the tissues

between the skin and muscles, replenishes the skin, nourishes the muscles, and regulates the opening and closing of the pores”.

Pathology: aversion to cold, fever, nasal obstruction, nasal discharge,

cough, or even difficult breathing.

Opens to the nose

Nose is the gate of the lung, and the passage for air enter and exit.

Proper function of the lung-qi: clear, unobstructed nasal breathing,

smelling

Pathology: stuffy nose, running nose, sneezing, itching of the throat.

3. Spleen

Governs transformation and transportation

Substances:

(1) food

Function: digesting, absorbing and transporting nutritive substances

Pathology: poor appetite, abdominal distention, diarrhea, lassitude,

and emaciation

(2) water

Function: promotes water metabolism, moisten and nourish various

tissues of the body, avoid retention of water, maintain water metabolism balance.

Pathology: edema, phlegm-dampness syndrome, diarrhea

Controls blood

Function: controlling blood and circulating it within the vessels and

prevents blood from extravasating.

Pathology: bleeding

Sends up essence

“spleen qi is in charge of ascending”

Raising up Food Essence, raising up the Internal Organs

Pathology: “sinking of the middle-jiao”

chronic diarrhea with proctoptosis

uterine prolapse

Dominates muscles and limbs

Pathology: thin muscles, forceless, flaccid and atrophied limbs

Opens to the mouth, manifests on the lips

Appetite and taste

Pathology: anorexia, tastelessness, or a sweet or sticky taste in the

mouth, pale and lusterless lips

4. Liver

Regulates the smooth flow of qi

(1) Emotions

Hypoactive: depression, sorrow, suspicion, sighing, and

hypochondriac distress.

Hyperactive: irritability, dizziness, vertigo, insomnia, and dream

disturbed sleep.

(2) Digestion and absorption

The ascent and descent of spleen and stomach qi

The normal secretion of bile

Pathology: poor appetite, indigestion, belching, acid regurgitation,

abdominal fullness, and diarrhea.

(3) The smooth flow of qi and blood

Maintaining normal circulation of qi and blood

Pathology: distending pain in the hypochondrium, breast, or lower

abdomen.

qi is the commander of blood, qi stagnation will be followed by blood

stagnation----stabbing pain in the hypochondrium, abdominal masses, irregular menstruation, dysmenorrhea, and amenorrhea.

Liver can smooth the flow of qi in the san-jiao to regulate water

passages. Otherwise, edema or ascites may appear.

The smooth flow of liver qi results in normal sexual function.

Hypoactive: impotence and premature ejaculation, or amenorrhea or

dysmenorrhea.

Hyperactive:

males----over indulgence in sexual activities,

and spermatorrhea

females----dreams of sexual fantasies, an early menstrual cycle, or metrorrhagia

Stores blood

Function: storing blood and regulating the volume of blood in

circulation.

Pathology: liver blood deficiency----blurred vision, night blindness,

contracture of muscles and tendons, and motor impairment.

women----scanty

amenorrhea

Dominates tendons and manifests on the nails

Pathology: numb and impaired movement of limbs, tremor or spasm.

heat-evil----loss of fluids---- convulsion, opisthotonos, clenched jaw

“the nails are the excretion of the tendons”

Opens to the eyes

5. Kidney

The kidneys store vital essence , and are in charge of growth,

development and reproduction

Congenital and acquired essence

Kidney qi in growth, development, reproduction and sexual

function.

Governs water metabolism

flow of menstrual blood

(1) in distributing body to nourish and moisten tissue

(2) the discharge of utilized water by the tissue

Governs the reception of Qi

“the lungs govern respiration and the kidneys govern reception of qi”

Kidneys dominate bone and manufacture marrow, which forms the

brain and manifests in the hair.

Pathology: deficiency of kidney essence---- weak or underdeveloped bone, delayed closure of the fontanel, weak bones in children

Teeth are an extension of bone.

The kidneys manufacture marrow, and the brain is the sea of marrow.

The nourishment of hair comes from blood. The kidney stores vital

essence which can be transformed into blood.

The kidneys open to the ears and have two yin parts.

The hearing function of the ear depends on nourishment from kidney

essence qi.

The two yin parts of the kidneys are the anterior and posterior yin (or

the genitals and the anus).

Six Fu -viscera

1. Gallbladder

Six fu-viscera: hollow in structure, excrete bile to help digest food.

Extraodinary fu-viscera: the bile stored in the gallbladder is

transformed from the essential qi with similar functions of the five zang-viscera.

Function: store, concentrate and excrete bile

In terms of mental state, it is in charge of judgment and decision making.

Pathology: distending pain in the hypochondriac region, poor appetite, abdominal distension, loose stool, bitter taste in the mouth, vomiting yellow-green and bitter fluid, jaundice.

2. Stomach

Location: below the diaphragm

Function:

(1) Reservoir of foodstuff

“barn”, “sea of water and cereal”, “reservoir of foodstuff”

(2) Descending function of the stomach

Along with the ascending function of the spleen

The function of the whole digestive system

Pathology: failure of descending of the stomach-qi may cause the adverse rising of the stomach-qi, marked by belching acid regurgitation, nausea, vomiting, hiccup, etc.

3. Small Intestine

Function: (1) Stores and digests food

(2) Separates the clear from the turbid

Pathology: fullness of the abdomen, pain of the abdomen, diarrhea, short of urine.

4. Large Intestine

Function:

(1) Passes and eliminates waste

(2) Governs body-fluid

Pathology: constipation or loose stool, diarrhea

5. Urinary Bladder

Function:

(1) Stores urine

(2) Discharges urine

The turbid fluid is formed after the water metabolism, and is transported downwards to the kidneys, where it turns into urine by the qi transformation of kidney.

6. San-Jiao

The concept of San-Jiao has two meanings. First, it is one of the six Fu -organs and secondly, it represents the partition of human body, i.e. the generic term of the upper energizer, middle energizer and lower energizer.

（1）San-Jiao of the six Fu -organs

Function: passing through the original qi and water.

San-Jiao is the route for the circulation of original qi and water.

Original qi is the most fundamental qi of the human body, the

motive power of human vital activities, which is derived from the kidney.

The distribution and excretion of the water inside the body are accomplished by the synergistic function of many organs, including lung, spleen and kidney, etc. But the normal circulation of water must be based on the channel function of San-Jiao .

（2）Partition Meaning of San-Jiao

As the region, San-Jiao can be divided into three parts, i.e. the upper energizer, middle energizer and lower energizer. It includes the whole body from the head to the feet. Each energizer has its own physiological characteristics.

Generally, the chest part above the diaphragm, include heart, lungs, head and face, is called upper energizer. Sometimes, the upper limbs are attributed to the upper energizer too.

Upper energizer can disperse the defense qi , distribute the food essence and fluid, nourish and moisten the whole body.

Middle energizer refers to the upper abdomen between the diaphragm and the umbilicus, which is consisted by the spleen and stomach.

Middle energizer has the function of digesting, absorbing and distributing the food essence and fluid, and producing qi and blood as well.

The part below the umbilicus is named lower energizer, which

includes small intestine, large intestine, liver, kidneys, bladder and uterus and lower limbs as well.

It has the function of discharging the residues and urine.

Extraordinary Fu -Organs

The extraordinary Fu -organs include brain, marrow, bone, vessels, gallbladder and uterus. Most of them have no internal-external relation with other organs and no attachment with the five elements, except gallbladder with liver, as one of the six Fu -organs.

1. Brain

Brain is formed by the accumulation of marrow, and then it is called the sea of marrow.

（1）Dominate Vital Activities and Spirits

Brain is an organ that can produce recognition, emotions, will and behaviors, and it is also the key position of spirit activities.

Physiology: full of spirit, clear consciousness, quick thinking, strong memory, clear language and normal emotions.

Pathology: apathetic, slow reaction, memory deterioration, manic and irritability, and even coma.

（2）Dominate Sense and Movement

It means that the eyesight, hearing, speak and movement of the human body are related to the brain.

Physiology: good eyesight, sharp hearing, keen sense of smell, normal

sensation, light and powerful movement.

Pathology: dim vision, loss of hearing, poor sense of smell, dull sensation, fatigue and even hemiplegia.

2. Uterus

（1）Controlling Menstruation

Pathology: irregular menstruation, such as amenorrhea, hypermenorrhea, hypomenorrhea, or metrorrhagia.

Since women take blood as the fundament, and the heart controls blood, liver stores blood, spleen produces qi and blood, the menstrual bleeding and cycle are closely related to the physiological functions of the heart, liver and spleen.

（2）Dominating Pregnancy

The uterus gets the ability of pregnancy at the time of the first menstrual bleeding. After the pregnancy, the uterus becomes a main organ for protecting and developing the fetus.

Mutual Relations among the Five Zang -Organs

（1）Heart and Lung

Both the heart and lungs are located above the diaphragm. The heart governs the blood and vessels, and the lungs control qi and respiration. The relationship between heart and lungs mainly manifests as the relation of qi and blood.

（2）Heart and Spleen

Heart governs blood and spleen generates blood. Heart can promote blood circulation, and spleen controls blood and prevents it from bleeding. The relation between heart and spleen are mainly manifested in two aspects, the production of blood and the circulation of blood.

（3）Heart and Liver

Heart can promote blood circulation and liver stores blood. Heart controls Shen , while liver governs free flow of qi and adjusts emotional activities. The relation between heart and liver is manifested on two aspects, blood circulation and emotional activities.

（4）Heart and Kidney

Heart belongs to fire in the five elements theory, and it is located in the upper part of human body, so it is subordinated to yang . However, kidney belongs to water in the five elements theory, which is located in the lower part of human body, and subordinated to yin . For the ascending-descending theory of water and fire, Yin -Yang as well, it’s good for those at the bottom to go upwards, and those on the top to go downwards.

（5）Lung and Spleen

Lungs govern the respiration, and spleen can generate food essence by the function of transportation and transformation. Lungs regulate water metabolism and spleen is also in charge of water metabolism. The relation between lungs and spleen mainly shows in two aspects, production of qi

and water metabolism.

（6）Lung and Liver

Lungs has descending functions and liver is characterized by dispersing. The relation between lungs and liver is mainly about the ascending and descending of qi movements.

（7）Lung and Kidney

Lungs regulate waterways, and kidneys govern water. Lungs dominate respiration and kidneys govern the reception of qi . The relation between lungs and kidneys are mainly manifested by two aspects, water metabolism and respiration.

（8）Liver and Spleen

Liver governs the free flow of qi and spleen has the function of transportation and transformation. Liver stores blood and spleen can generate and control blood. The relation between liver and spleen is mainly manifested on two aspects, digestion and absorption, blood regulation.

（9）Liver and Kidney

Liver stores blood and kidney stores essence. Liver governs the free flow of qi and kidney is in charge of storage. For the five elements theory, liver belongs to the wood and kidney is attributed to water. They have mother-son relations. The relationship between liver and kidney is mainly manifested on three aspects: essence and blood have a common source,

interdependence between storing and discharging, mutual nourishment and interaction between yin and yang .

（10）Spleen and Kidney

Spleen is the postnatal base of life, while kidney is the congenital foundation of human body. Spleen participates in the water metabolism by its function of transportation and transformation and kidney governs water. The relation between spleen and kidney is mainly manifested on two aspects, postnatal and congenital bases, and water metabolism.

Relations among the Six Fu -Organs

The six Fu-organs include gallbladder, stomach, large intestine, small intestine, bladder and San -Jiao , all of which are characterized by transporting food and distributing fluids. The relations among the six Fu -organs are mainly manifested as the aspects of the digestion and absorption of food, distribution of fluid and discharge of residues.

Relations among Zang -organs and Fu -organs

（1） Heart and Small Intestine

Their relation is mainly manifested on the pathological aspect. If the heart has excessive fire, it will affect the small intestine along the meridians and scanty, red, painful or bloody urine occurs. If the small intestine has excessive heat, it also can influence heart by the upward flow of heat along the meridian and the symptoms include restlessness, red tongue and ulcers in the mouth and on the tongue.

（2）Lung and Large Intestine

For the physiology, the descending of lung qi is helpful to the transportation of large intestine. The normal transportation of large intestine can assist the descending of lung qi . For the pathology, if the lungs cannot descend, the fluid will not go downwards and there will be constipation. If there is excessive heat in the large intestine, the qi of Fu-organs will not be smooth, which is able to affect the descending of lungs with symptoms of fullness in the chest, cough and asthma. If the lung qi is deficient and the large intestine is too weak to transport the residues, there will be constipation due to qi deficiency and difficulty in discharging feces.

（3）Spleen and Stomach

Spleen and stomach accomplish the digestion, absorption and transportation of food together to nourish the human body, so they are called the postnatal basis. The relation between spleen and stomach is mainly manifested on three aspects:

-coordination of receiving and transportation and transformation, -harmony between ascending and descending,

-adjustment of dryness and dampness.

（4）Liver and Gallbladder

The bile is derived from the liver and the storage and discharge of bile depend on the regulation of liver (free flow of qi ). And the smooth

discharging of bile is beneficial to the function of liver in governing free flow of qi .

（5）Kidney and Bladder

Kidney is the Zang -organ of water and bladder is the Fu -organ of water. The function of bladder in storing and excreting urine depends on the qi transformation and controlling of kidney.

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