Chinese Medicine : Basic Zang Fu Theory
The zang-fu theory explains the physiological function, pathological changes, and mutual relationships of every zang and fu organ. In traditional Chinese medicine the zang and fu organs are not simply anatomical substances, but more importantly represent the generalization of the physiology and pathology of certain systems of the human body.
Zang and fu consist of the five zang and six fu organs. The five zang organs are the heart (including the pericardium), lung, spleen, liver, and kidney. The six fu organs are the gall bladder, stomach, large intestine, small intestine, urinary bladder and the sanjiao (three areas of the body cavity). Zang and fu are classified by the different features of their functions. The five zang organs mainly manufacture and store essence: qi, blood, and body fluid. The six fu organs mainly receive and digest food, absorb nutrient substances, transmit and excrete wastes. As the Suwen says: The five zang organs store up essential qi and regulate its outflow. The six fu organs transform and transport substances without storing them and for this reason they may be over-filled but cannot be filled to capacity.3
There is another category of organs called the extraordinary fu organs which include the brain, marrow, bone, vessels, gall bladder, and uterus. They are named fu but their functions are similar to that of the five zang organs. Since their physiological functions and pathological changes are closely connected with the zang-fu organs they will be discussed below under the specific zang or fu organ.
The Five Zang Organs
Dominating Blood and Vessels, and Facial Complexion
Controlling the Mind
Opening into the Tongue
The lung is situated in the chest, connects with the throat and opens into the nose. Its main physiological functions and indicators are: 1) dominating qi and controlling respiration; 2) dominating the dispersion and descent of qi; 3) regulating water passage; and 4) connecting externally with skin and hair. It also has an exterior and interior relationship with the large intestine.
Dominating Qi and Controlling Respiration
Dominating the Function of Dispersion and Descent
The two functions of dispersion and descent, although opposite to each other, act in unison. If the dispersing function is not normal, the lung qi will not flow downward and vice versa. Harmonious, downward flowing of lung qi allows for an unobstructed respiratory tract, uniform breathing, and provides a normal exchange of air in the lung. In this was the lung can distribute qi, blood, and body fluid to the entire body, transport waste water down to the urinary bladder, transform it into urine and excrete it.
In pathology, the two functions of dispersion and descent affect each other. If external pathogenic factors attack the exterior of the body, then the lung qi fails to spread. This leads to pathological changes like cough and asthma due to the failure of descending lung qi. If pathogenic phlegm obstructs the lung, it will bring about an abnormal flowing of lung qi leading to pathological changes such as cough, fullness of chest, and gurgling with sputum.
Dominating the Skin and Hair and Regulating Water Passages
Pathologically there is an mutual influencing relationship between the lung, and skin and hair. For example, the invasion of exogenous pathogenic factors proceeds from the skin and hair to the lung. The manifestations are aversion to cold, fever, nasal obstruction, nasal discharge, cough, or even asthma. These are signs of the lung's failure to spread defensive qi to the body surface. If lung qi is weak and deficient, defensive qi is not dispersed and the essential nutrients to the skin and hair are not distributed. This not only causes rough skin and dry hair, but also hypoactivity of the defensive qi.
The organic body is easily attacked by external pathogenic factors. Defensive qi controls the opening and closing of the pores. When there is lung qi deficiency the body surface will be weak and manifests the symptom of spontaneous sweating. If external pathogenic cold attacks the body's exterior the lung will lose its function of dispersing and descending and the pores will close not allowing the formation of sweat.
Regulating the water passages means that the lung regulates water circulation and excretion, and keeps the water passages clear. The lung's dispersing function circulates throughout the body the nutrients which have been removed from food and water. Part of the fluid is discharged as sweat and by the descending function of the lung. Another part of the fluid is continually sent down to the kidney and then, by the qi function of the kidney, sent to the urinary bladder to be discharged. Thus the lung is also known as the "upper source of water."
Opening into the Nose
The spleen is located in the middle jiao (abdominal cavity). Its main physiological functions and indicators are: 1) governing transportation and transformation; 2)controlling blood; 3) dominating the muscles and four limbs; 4) opening into the mouth, and lip complexion. The spleen has an exterior and interior relationship with the stomach.
Governing Transportation and Transformation
If the spleen's transportation and transformation functions are sound then the functions of digestion, absorption and transportation will work normally. Otherwise, abdominal distention, diarrhea, lassitude, emaciation, malnutrition, and other symptoms may occur.
The spleen is also involved in water metabolism. When the spleen transports nutrient substances, it simultaneously distributes water to every tissue of the body carrying out its functions of nourishment and moistening. From the spleen, water is also sent down to the kidney and excreted from the urinary bladder. The whole process of distribution and metabolism of water is jointly accomplished by the lung's dispersing and descending functions and the spleen's transportation and transformation functions. If the spleen fails to transport and transform the water it will lead to various pathological changes. If water accumulates inside the body, it will turn into an inflammatory mucus (phlegm-humor); if it is retained in the skin and muscle, it becomes a swelling (edema); if the water retention is in the intestines, it will cause diarrhea; if it is in the abdominal cavity, it will result in serious fluid accumulation (ascites). In the Suwen it says, "...various kinds of diseases caused by dampness with swelling and fullness belong to the spleen."8
Since the functions of transportation and transformation of essential nutrients as well as water are interrelated, their pathological manifestations often accompany each other.
In order to control the blood, the spleen uses ying (nutrient) qi, a form of blood qi, which it produces. Qi behaves as the "commander" of the blood and, at the same time, conserves the blood. Therefore the hemorrhagic symptoms and diseases caused by the failure of spleen controlling blood are actually the results of qi failing to conserve blood.
Dominating the Muscles and Four Limbs
The normal movements and functions of the four limbs are also closely related to spleen qi. When there is sufficient spleen qi, the yang qi distributes ample nutrient substances all over the body so that the muscles are well nourished and the four limbs are strong and able to move freely, Otherwise if the spleen fails to transport and transform the yang qi and nutrient substances, there will be malnutrition of the muscles characterized by muscular atrophy, weakness of the four limbs, etc. Therefore, building up the spleen is the usual clinical treatment for wei syndromes of the four limbs.
Opening into the Mouth and Lip Complexion
Since the spleen dominates the muscles and opens into the mouth, the strength or weakness of the transporting and transforming functions are reflected in the lips. If the spleen qi is not healthy, those functions will be abnormal, a condition which is characterized by yellowish and lusterless lips.
The liver's main physiological functions and indicators are: 1) storing blood; 2) creating unrestrained conditions for qi; 3) controlling the tendons and the luster reflected in the nails; and 4) opening into the eye.
1) The liver harmonizes the emotions. Traditional Chinese medicine considers that the normal or abnormal function of an unrestrained and free flowing qi is directly related to emotional activities, and that the mental state is not only dominated by the heart but also the liver. When qi activities are normal, the body has a harmonious circulation of qi and blood, an easy mind and happy emotions. If there is a dysfunction of qi's free flow, it will directly affect the individual's emotional state. For example, liver qi stagnation will give rise to stuffiness and fullness of the chest, unhappy feelings, hypochondriasis, or even mental depression, crying, irregular menstruation, etc. If there is hyperactivity of the liver qi, there may be irritability, anger, insomnia, dream disturbed sleep, dizziness, vertigo, a ringing in the ear (tinnitus), or deafness. Any sudden change in the normal pattern of the emotions, especially great anger or mental depression, can affect and free flowing and spreading function of liver qi resulting in the pathological changes of liver qi stagnation.
2)Liver qi regulation can assist the ascending function of the spleen and the descending function of the stomach. This also involves bile secretion. Bile is necessary for the digestion of food and drink. If liver qi loses its harmonious flowing activities, it will affect the digestive function of the spleen and stomach and the excretion of bile, leading to the pathological symptoms of jaundice and bitter taste. It is very common that patients with stagnation of liver qi may not only have symptoms such as distension, pain in the chest and hypochondriac regions, anxiety, and anger, but also belching due to the failure of the stomach qi to descend and diarrhea caused by the dysfunctional ascending of spleen qi. The former is known as "liver qi affecting the stomach," and the latter as "disharmonious conditions between the liver and the spleen."
Controlling the Tendons and the Luster Reflected in the Nails
It is said that, "Nails are the remains of the tendons,"3 The dryness or moisture of the nails can reflect the sufficiency or insufficiency of liver blood. When liver blood is plentiful the tendons are supple and the nails appear hard and moist. If liver blood is insufficient and incapable of nourishing the tendons, then the nails may be thin, soft, brittle, and pale. The Suwen records, "The liver communicates with the tendons. The health of the liver is reflected in the luster of the nails."4
Opening into the Eye
The main physiological functions and indicators of the kidneys are: 1) storing essence, controlling human reproduction, growth and development; 2) controlling water metabolism; 3) receiving qi; 4) producing marrow, filling up the brain, controlling the bones, manufacturing blood and influencing hair luster; 5) opening into the ear, perineal ante-tract and perineal post-tract; 6) connects with the urinary bladder to which it is connected from the exterior and the interior.
Storing Essence, Controlling Human Reproduction Growth and Development
Essence is stored in the kidney and is known as kidney qi. It greatly influences the ability of reproduction, growth, and development. According to the Suwen:
At the age of fourteen, a woman will begin to menstruate. Her ren channel becomes unobstructed, and the qi of her chong channel is replete. This is why her menstruation becomes regular and she is able to conceive.... At the age of forty- nine, a woman's ren channel becomes deficient, the qi of the chong channel becomes weakened and scanty, sexual energy becomes exhausted, and menstruation stops with the result that her body becomes old and she is no longer able to conceive.7
In reference to men, it continues:
As to a man.... At the age of sixteen, his kidney qi becomes even more abundant, he begins to have sexual energy and is full of semen that he can ejaculate. When he has sexual intercourse with a woman, he can cause conception.... At the age of fifty-six the liver qi begins to weaken, the tendons become inactive, sexual energy begins to run out, the semen becomes inadequate, the kidney becomes debilitated with the result that all parts of the body begin to grow old. At the age of sixty-four his hair and teeth are gone.8
Thus, according to traditional Chinese medicine, kidney qi plays an essential role in the function of reproduction, growth, and development. If this function is abnormal, infertility, infantile underdevelopment, maldevelopment, weakness of bone development, etc. will manifest.
Kidney essence is classified as yin, while qi is yang. Known as kidney yin and yang, they both restrict and depend on each other in order to maintain a dynamic physiological balance. If this balance is disrupted, pathological changes of hyperactivity or hypoactivity of kidney yin and yang will occur.
Clinically, a kidney yin deficiency may be manifested soreness, aching and weakness of the lumbar region and knees, blurred vision, poor memory, etc. A yin deficiency leading to blurred vision, poor memory, etc. A yin deficiency leading to yang preponderance will produce tidal fever, night sweating, dizziness, ringing in the ear(tinnitus), spermatorrhea, and sexual dreams. Kidney yang deficiency decreases the warming function of the kidney bringing on the symptoms of lassitude, coldness and pain in the lumbar region and the knees, cold extremities and frequent urination, leading to pathological conditions such as inadequate reproductive ability, impotence, premature ejaculation and coldness of the uterus. If a certain degree of kidney yin or yang deficiency is reached then either may injure the other resulting in a loss of the body's dynamic physiological balance.
In addition, clinical manifestations such as frequent and clear urination, enuresis, incontinence of urine, spermatorrhea, premature ejaculation, etc. which show no heat or cold syndromes are considered to be a kidney qi deficiency. The clinical symptoms of dizziness, ringing in the ears, soreness and aching of the lumbar or knee region, infantile maldevelopment, etc, which demonstrate no clear cold or heat symptoms, are classified as kidney-essence deficiency.
Controlling Water Metabolism
Controlling Bone, Producing Marrow, and Influencing Hair Luster
Essence and blood generate each other. Ample essence makes sufficient blood. Hair is nourished by the blood and rooted on the basis of kidney qi. Therefore luster, moisture, dryness, roughness growth and falling out of hair is related to the sufficiency of kidney essence. As the Suwen says, "The kidney is in tune with the bones, its prosperity is reflected in the luster and moisture of the head hair."0
Opening into the Ear, Perineal Ante-tract and Perineal Post-Tract