Five Viscera

The heart governs all the viscera and bowels.
The book, Canon of Medicine says, "The heart is the monarch of all the organs".

Division of Heart
Yin (vital essence) of the heart	Refers to the material structures
Yang (vital function) of the heart	Including the blood of the heart, its function and heat, including the qi (functional activities)
The blood of the heart means the blood controlled by the heart
The qi of the heart means the function of the heart

Main physiological functions of the heart are as follows :

A) Controlling Blood Circulation

By blood circulation, it suggests both the blood and its vessels.
The heart is linked with the blood vessels to form a closed system.
The heart propels the blood to flow and circulate within the blood vessels throughout the body.
The qi of the heart is the driving force of the heart's beating.
Only when the qi of the heart is sufficient, then the heart has normal strength, rate and rhythm.
Whether the qi of the heart is sufficient or not and whether the blood of the heart is sufficient or not may both be shown from the condition of the pulse.
For instance, an empty pulse with little strength shows an insufficiency of the qi of the heart; a fine and weak pulse shows a deficiency of the blood of the heart; a rough and intermittent pulse shows stagnation of the blood of the heart, to mention but a few.

B) Mental Activities.

Higher nervous activities such as mental, conscious and thinking, results mainly from the functions of the heart.
If one's heart functions normally in controlling mental activities, one will be full of vigour, and have healthy consciousness and sound mental activities.
Such as insanity and palpitation, insomnia and dream disturbed sleep can occur.

C) Sweat as the Fluid of the Heart.

Sweat comes from body fluid. Body fluid is the most important component of the blood.
Blood circulation is controlled by the heart. So it can be said: "Blood and sweat have the same source" and "Sweat is the fluid of the heart". too much perspiration suggests easy consumption of the blood and qi of the heart, resulting in palpitation and continuous violent beating of the heart.
Furthermore, profuse sweating will damage the yang of the heart, resulting in a dangerously excessive loss of the fluid.

Quick reference table of perspiration
Deficiency of the yang of the heart	Perspire spontaneously
Insufficient yin of the heart	Sweat at night

D) Having relation with the tongue and face.

"The heart has its specific opening in the tongue proper".
"The tongue is the sprout of the heart".
“The reticular branch conduits of the heart channels ascend and connect with the tongue”.
"The heart has its outward manifestation in the face or complexion".
The face is rich in blood vessels, and its colour can show how the heart functions. Therefore, the conditions of the heart and the blood are often learned by observing the tongue and face.

Quick reference for correlations
Heart functions	Face colour
Blood is plentiful	Face will be red and bright
Blood of the heart is insufficient	Face pale and white
Stagnation of the blood	Face will be cyanosed

When the heart does not function normally in controlling mental activities, tongue rigidity, delirium or aphasia will occur.
Also the nourishment of the hair comes from the blood.
That is why it is said that hair is the surplus of the blood.
So, when the blood of the heart is insufficient, the hair will be withered.

E) Supplement: Pericardium

Pericardium is the peripheral tissue of the heart, which plays the part of protection. External pathogenic factors often invade the pericardium before they attack the heart.
For instance, high fever, coma and red tongue occurring in the course of a febrile disease are often described as "the attack of the pericardium by pathogenic heat".
In fact the signs and symptoms occurring after the pericardium have been invaded by external pathogenic factors are the same as those appearing after the heart have been attacked.

2) The Lung

Lungs have opening in the nose.

Division of Lung
Yin of the lung	The material structures of the lung
The qi of the lung	The physiological functions of the lung
The terms "the yang of the lung" and "the blood of the lung" are rarely used

The main physiological functions of the lung are as follows :

A) In charge of Qi

1) Qi of respiration.

If the lung's functions are abnormal due to being harmed by external pathogenic factors, such signs and symptoms due to the disorders of the respiratory system as cough, asthmatic breathing and difficulty in breathing will occur.

2) Qi of the whole body.

The lung operates the qi of the whole body can be seen in two aspects.
The first is that the lung takes part in the forming of “Zong qi” (pectoral energy).
Fresh air inhaled by the lung (cosmic energy) and food essence mix and accumulates in the chest to form zong qi.
Zong qi exits from the larynx, thus promoting the lung’s respiratory activities.
It spreads to all parts of the body by way of the heart channels, thus warming the viscera, bowels and tissues, and maintaining normal physiological activities.
The second is that the lung has the function of operating and regulating the qi of the whole body to ascend or descend, enter or exit.
If this function of the lung is abnormal, the formation of zong qi, and the ascending or descending and entering or exiting out of the mechanism of the qi of the whole body will be affected, manifested as shortness of breath, low voice, tiredness, lassitude and so on.

B) Activating the flow of Qi, food essence and body fluid, clearing the inspired air and keeping it flowing downward and helping maintain normal water metabolism.

By activating the flow of qi, food essence and body fluid we mean the lung has the function of disseminating defending qi, food essence and body fluid throughout the body so as to nourish the body and to warm and moisten the muscles, skin and hair.
The book Classic of Acupuncture says, "If the upper warmer functions well, it can activate the flow of qi, food essence and body fluid, nourish the skin and the whole body, moisten and brighten the hair, as the rain and dew moisten young crops."
Here, "the upper warmer's functioning well" means the lung's function of activating the flow of qi, food essence and body fluid.
Cleaning the inspired air and keeping it flowing downward mean clarifying and sending down the qi of the lung.
As the lung is within the chest, lying in the upper warmer, it is normal for its qi to descend.
If the lung's qi fails to descend, cough, asthmatic breathing, stuffy sensation in the chest and the like will appear.
In addition, this lung’s function of descending is associated with the metabolism of water.
That is, it can cause water in the upper warmer to descend into the kidney and urinary bladder, thus keeping urination smooth and the metabolism of water normal.
This is the reason for the sayings: "The lung helps maintain normal water metabolism." and "The lung has the function of dredging water passages."
If there is something wrong with this function of the lung, the dissemination and discharge of water will be disturbed, which results in dysuria, edema and phlegm retention diseases.
The lung's two functions of dispersing and descending are two components which oppose and yet complement each other.
Without normal dispersing, there will not be good descending and vice versa.
The coordination of dispersing and descending keeps breathing even and the qi. Of the lung passing in and out smoothly.
If they are not coordinated, pathological changes such as "disturbance of the qi of the lung" and "impairment of the normal function of clarifying and sending down the qi of the lung" will appear.
The clinical manifestations of these are cough, asthmatic breathing, stuffiness in the chest, hypochondriac distension and so on.

C) Association with skin and hair / special opening nose.

The skin surface, sweat glands, hair and other relevant tissues.
Being associated with the skin and hair means that the lung has the function of disseminating body fluid and activating defending energy to the skin and hair so that the skin surface can be made moist and bright.
The skin and muscles compact and the ability to fight against external pathogenic factor can be enhanced.
A deficiency of the qi of the lung brings on an unconsolidated defending energy whose manifestations are sweating spontaneously as well as being susceptible to the common cold due to a disability in fighting against external pathogenic factor.
The nose is the doorway of the lung through which the air enters and exits.
Its functions of ventilation and smelling are mainly dependent on the action of the qi of the lung.
The free movement of the qi of the lung keeps respiration unobstructed and gives a keen sense of smell.
Invasion of the lung by external pathogenic factors blocks the movement of the qi of the lung, which results in nasal obstruction, watery nasal discharge and a hyposmia.
The invasion of the lung by pathogenic heat factor often has the sign of "the wings of the nose flapping".
The nose is the passage through which pathogens invade the lung, because it is the opening of the lung.
This is why epidemic febrile pathogenic factors always attack the lung by way of the nose.

D) Association with larynx.

Being a delicate organ leading up to the Larynx.
In fact the lung is directly exposed to external air.
As a result it is open to attack from every kind of external pathogenic factor.
Therefore there is a saying: "The lung is a delicate organ, vulnerable to the attack of external influences."
The larynx is not only a part of the respiratory tract but also the phonetic organ, through which the lung channels pass.
So its ventilation and phonation directly relate to the lung.
A sufficiency of the qi of the lung produces a loud voice; while a deficiency makes the voice low.
Also, a deficiency of the yin of the lung may lead to a hoarse voice and even aphonia.
From acupuncture view point it is additionally related to water metabolism, blood circulation and the functions of the immune system.

3) The Spleen

The main functions of the spleen are as follows :

Division of Spleen
Yin of the spleen	Its material structures
Yang of the spleen	Its functions and heat
The qi of the spleen simply refers to its functions
The term "the blood of the spleen" is uncommon

A) Transporting, distributing and transforming nutrients

1) Transporting, distributing and transforming water and food.

Transporting, distributing and transforming water and food, the food taken into the stomach is digested both by the stomach and the spleen, and then, sent downwards to the small intestine to undergo the process of "differentiating pure substance from turbid substance".
The pure part (food essence) is absorbed by the spleen and transported to all parts of the body so that the five viscera, six bowels, limbs, bones, hair and tendons are nourished.
"The spleen provides the material basis for the acquired; constitution" and "The spleen is the source of producing the qi and blood."
Why? Because water and food are not only the chief source of the nutrients which man needs to keep the life activities after birth, but also the material basis for producing qi and blood, and, that is more, it is the spleen that transports, distributes and transforms nutrients.
A dysfunction of the spleen in transporting, distributing and transforming nutrients will cause poor appetite, indigestion, fullness and distension in the epigastrium, loose stools, lassitude, loss of weight and other diseases due to the deficiency of both qi and blood.

2) Promoting water metabolism.

The spleen helps in absorbing and transporting water.
The abnormality of this function will induce every kind of disease resulting from the retention of water, e.g. edema, damp phlegm, diarrhea, etc.
The spleen's function of promoting water metabolism takes place at the same time as that of transporting, distributing and transforming nutrients.
These two functions are associated with, and influence, each other.
A disorder in either one will induce an abnormality in the other

B) Keeping blood circulating within the vessels.

The spleen has the function of controlling all the blood of, the body and keeping it circulating normally within the vessels.
If it loses this function because of a deficiency of its qi, the blood will not flow normally within the vessels will extra vasate from them.
In this case, besides some signs and symptoms due to a deficiency of the qi of the spleen, certain kinds of chronic haemorrhages such as blood in the stool, purpura, uterine bleeding and others will occur.

C) Relationship with the muscle, limbs and lips.

When the spleen functions well in transportation, distribution and transformation, the food essence is distributed throughout the body so that the muscles are well developed and strong and the limbs have strength to move, because they receive plentiful nutrients.
If the spleen does not function well, the muscles will be thin; the limbs will be slack or too weak to function, because they cannot receive enough nutrients.

The spleen has its 'special body opening' in the mouth."

"It has its outward manifestations in the lips." The strong and vigorous qi of the spleen results in good appetite, normal taste, red and bright lips.
A dysfunction of the spleen in transporting, distributing and transforming nutrients leads to poor appetite, ineffective taste and pale or yellowish whithered lips.
A disturbance of the spleen by pathogenic damp factors also results in a sticky, sweet taste in the mouth,
In addition the tendency of qi of the spleen is ascending.
It has the function of sending food essence upward to the lung and fixing internal organs at their original locations.
If the qi of the spleen does not go upward but downward (which is called the sinking of the qi of the middle warmer), permanent diarrhoea, prolapse of the rectum and uterus and ptosis of other internal organs will occur.
The spleen also has the physiological characteristic of liking dryness but hating dampness.
Therefore, a dysfunction of the spleen in transportation and transformation due to a deficiency of the qi of the spleen is most liable to produce dampness, while excessive dampness will most likely disturb the spleen.
Spleen is also related to blood coagulation and body fluid metabolism.
Finally, it is needed to point out that the pancreas has not been mentioned.
Some scholars believe that the spleen includes the pancreas.

4) The Liver

Division of Liver
Yin of the liver	Its material structures, including the blood stored in it
Yang of the liver	Its functions and heat, including the qi of the liver its functions

A) Smoothing and Regulating the Flow of Vital Energy and Blood

Ancient medical men believed that a wood or a tree tended to spread out freely, so did the liver corresponding to this element.
This is why the liver is classified as "wood" in the five elements.
The liver's function in promoting unrestrained and free movement of qi is shown in the following three aspects:

1) Regulating Mind and Mood

The mental activities of human beings are controlled by the heart and have something to do with the liver's function of smoothing and regulating the flow of vital energy and blood.
When this function of the liver is normal the human body will coordinate its mental and moral activities well, which is indicated by happiness, being at ease, being able to reason and sensitivity.
But when the liver does not perform this function well, the human body will fail to coordinate its mental and moral activities.
This is indicated by dullness, anxiety, depression, belching, sighing, distension and stuffy sensation in the breast and hypochondria.
When the liver performs this function to excess, excitatory state such as restlessness of the mind, irascibility, dizziness, a sensation of distension of the head, headache; insomnia and dream-disturbed sleep may be present,

2) Promoting Digestion and Absorption

The liver's function of smoothing and regulating the flow of vital energy and blood helps the spleen in sending food essence and water up and the stomach in sending food contents down and secretion of bile, so that the function of digestion and absorption is kept normal.
If this function of the liver does not work well, the ascending and descending qi of the spleen and stomach will be affected.
The bile excretion will also be obstructed.
This results in signs and symptoms of an abnormality in the digestive function, e.g., poor appetite, indigestion, belching, vomiting of sour fluid or distension of the abdomen, and diarrhoea.
This as “in coordination between the liver and the stomach or the spleen".

3) Keeping Qi and Blood Moving Normally

The liver's function of smoothing and regulating the flow of vital energy and blood exerts a direct influence on the free movement of qi.
The liver's dysfunction in promoting the free movement of qi causes the flow of qi to be obstructed, which is indicated by pain and distension in the hypochondria, breasts and lower abdomen.
Qi is the driving force in the circulation of blood.
The flow of qi is followed by blood circulation.
Blood stasis takes place after the stagnation of qi.
The liver's dysfunction in promoting free movement of qi and blood stasis due to the stagnation of qi leads to pricking pain in the breast and hypochondria, even mass in the abdomen with fixed shape and localized pain, tumour, and possibly abnormal menstruation, dysmenorrhoea and amenorrhea in women.
Furthermore, the liver’s function of smoothing and regulating the flow of vital energy and blood also has the action of removing stagnant vital energy from the triple warmer as well as dredging the water passages.
Also when the liver does not work well in promoting the free movement of qi hydro peritoneum (ascites) and oedema may, sometimes, occur.

B) Storing and regulating blood

The liver has the function of storing blood and regulating its amount.
When the human body is in the state of rest or sleep, it needs less blood, and most blood is stored in the liver.
But when it is performing physical labour or working the amount of blood needs to be increased.
The liver will expel the blood it has stored.

C) Relationship with Tendons, Nails and Eyes

The condition of the liver determines the condition of the tendons.
The tendons depend on the nutrients from the blood of the liver to perform their functions.
Malnutrition of the tendons due to deficiency of blood from the liver may bring on numbness of the extremities, sluggishness of joint movement, spasm of the tendons and spasm of the tendons and tremors of the hands and feet.
Overabundance of pathogenic heat burns the yin of the liver, which results in spasms of the extremities, lockjaw, and opisthotonos is "liver wind stirring inside".
"Nails", in refer to the fingernails and toenails, nails and tendons have the same source of nutrients.
So it is known that "The nail is the surplus of the tendon."
The sufficiency of the blood of the liver gives ruddy, hard nails, but the deficiency of it results in withered, soft, thin or hollow and deformed nails.
"The liver has its specific body opening in the eyes."
The eye's visual sense is mainly dependent on the nutrients from the blood of the liver to function well.
The Liver Channel goes upward to the eye system. Therefore, it is reflected in the eyes whether the liver's function is normal.
For instance, the deficiency of the blood of the liver may lead to blurred vision and night blindness; the deficiency of the yin of the liver to dry eyes and hypopsia.
The flaming up of excessive heat of the liver to red, sore, swollen eyes; bilirubinemia due to the dampness and heat in the liver and gallbladder to icteric sclera.
In addition there is also a saying that "Tears are the fluid of the liver."
Because the Liver Channel goes through hypochondria, lower abdomen and external genitals, diseases occurring in these organs should be treated by an overall analysis of signs and symptoms of the liver.

5) The Kidney

Division of Kidney
Yin of the kidney	Its material structures, including its essence of life
Yang of the kidney	Its functions and heat
The kidney essence of the life is stored within them.
The qi of the kidney is produced by the kidney's essence of life

The main functions of the kidney are as follows :

A) Storing the Essence of Life

The essence of life stored in the kidney is divided into two types.

1) Congenital Essence of Life

This kind of essence of life is also known as "the essence of life from the kidney itself".
It is inherited from the parents, and is enriched and strengthened by acquired food essence.
The essence of life can be transformed in to qi.
The qi transformed from the essence of life from the kidney is known as the qi of the kidney, which is the material basis on which the human body grows, develops and reproduces.
For example, the qi of their kidney is getting richer and richer.
At the time when they reach the age of puberty, the qi of the kidney is richest and promotes the development of sperm in boys, but also the discharge of eggs and menstruation in girls.
The sexual function is perfected gradually and ability to reproduce is fully developed.
In old age, the qi of the kidney becomes weak, which causes sexual functions and reproductive abilities to become ever weaker and then disappear.
This is why often utilize the method of reinforcing the kidney to treat disorders such as slow development, premature senility and low sperm count in men, and delayed menstrual cycle or amenorrhea and primary sterility in women.

2) Acquired Essence of Life

Acquired essence of life is also known as "five viscera and six bowels' essence of life".
It is derived from food essence.
Food essence is transformed by the spleen and stomach into the acquired essence of life, which is then transported to the five viscera and six bowels, coming to be the essence of life of viscera and bowels.
When the essence of life of viscera and bowels is sufficient, part of it is provided for the needs of the physiological activities of the body, whereas the rest is stored in the kidney in preparation for future needs.
Wherever the essence of life of viscera and bowels is not sufficient, the kidney will draw and send the essence of life it has stored to the five viscera and six bowels.
Therefore, the richness or otherwise of the essence of life stored in the kidney is related to the functions of every viscus and bowel.
"When diseases of all the other viscera are too severe, they are certain to involve the kidney.
So, in the clinical treatment of prolonged diseases and severe deficiency of the heart, the liver, the spleen and the lung, what should always be considered is the inclusion of treatment of the kidney.

B) Regulating Water Metabolism

Regulating water metabolism is the function of the kidney, which regulates water circulation and helps maintain fluid balance in the body.
Water metabolism of the human body has two aspects.
One is to disseminate body fluid which has been derived from food essence and has nutritive and nourishing functions to the tissues, viscera and bowels throughout the body.
The other is to discharge from the body the turbid fluid (waste) produced by all the viscera and bowels after metabolism.
All these rely mainly on the kidney's function of regulating water metabolism.
The kidney has the function of controlling the opening and closing the gate of water.
Opening the gate makes the water excreted, while closing the gate helps retain the water needed by the organ.
If the function of regulating water metabolism is normal, opening or closing the gate of water will be properly regulated, resulting in normal urination.
If this function is abnormal it can lead to inappropriate opening or closing of the gate of water, causing a breakdown in the metabolism of water.
When closing occurs more often than opening, oliguria and oedema occur.
But when the reverse occurs, polyuria and frequent urination are apparent.

C) Controlling and Promoting Inspiration

The lung that performs the function of respiration, the kidney can aid in inhaling the air downwards.
This is known as "The kidney has the function of controlling and promoting inspiration."
When the kidney fails to do so because of the deficiency, expiration will occur more frequently than inspiration.
As well as dyspnoea severe panting on moving this is known as the kidney fails to perform the above function.

D) Determining the condition of the Bone and Marrow, manifesting in head hair.

Having its manifestations in the hair of the head
The kidney stores the essence of life, which can be transformed into bone marrow.
The bone marrow stored in the bone cavity nourishes the bone.
This is known as "the condition of the kidney determining the condition of the bone", and "the kidney promoting the formation of bone marrow".
The bone cavity is full of bone marrow if the essence of life stored in the kidney is sufficient. The bone is solid and strong if it is fully nourished by bone marrow.
Not enough bone marrow is formed if the essence of life of the kidney is insufficient.
A malnourished bone is soft and weak, or even mal developed and, in babies, late closure of the fontanel and soft, weak bones often result from a deficiency of the essence of life of the kidney.
The teeth are also nourished by the kidney's essence of life, which is known as "the teeth being the surplus of the bone".
So that disorders such as slowly growing teeth of children, loose or early loss of teeth of adults are manifestations of a deficiency of the essence of life of the kidney.
Although the nutrients for hair come from the blood, its life mechanism originates from the kidney.
This is because the kidney stores the essence of life and the essence of life can turn into blood.
The flourishing and sufficient essence of life and blood lead to strong, bright hair.
Most people who have sparse or withered hair and or loss of hair due to prolonged diseases, and those who are bald or have grey hair due to premature senility, are those who have been suffering from a lack of the kidney's essence of life and a deficiency of blood.

E) Specific opening in ears and two yin orifices (urogenital orifice and anus)

The sense of hearing of the ears is determined by nourishment from the kidney's essence of life.
Sufficient essence of life gives a keen sense of hearing. Otherwise, tinnitus and hypoacusis results.
The two yin means the front and back private includes the urethra and genitalia.
Although urine is stored and eliminated by the urinary bladder, this process cannot be fulfilled without the kidney’s function of regulating water metabolism.
This is why these disorders such as frequent urination, enuresis or oliguria and urodialysis are often related to the abnormal function of the kidney.
As to the relationship between the kidney and the reproductive function.
The large intestine controls the removal of faces. However, this also has something to do with the kidney.
For example, a deficiency of the yin of the kidney may cause the intestinal juice to dry up, leading to constipation.
A deficiency and weakness of the yang of the kidney presents a cold spleen and an accumulation of water and dampness.
This may be a cause for loose stools.
The qi of the kidney being not consolidated may result in loose stools over a long period or spontaneous defecation while eating.

F) Supplement vital gate.

The vital gate is both the root of the qi and the house of water and fire.
The yin of the five viscera has to depend on it for nutrients.
The yang of the five viscera has to depend on it for developing.
That is, the thought the functions of the vital gate are equal to those of both the yin and yang of the kidney.
However, it is proposed that the vital gate lies in the portion between the two kidneys and the fire of the vital gate is nothing but the yang of the human body.
From clinical observations it is found that diseases due to the decline of the fire from the vital gate are basically similar to those due to a deficiency of the yang of the kidney, this point to the fire of the vital gate being basically the same as the yang of the kidney.
The term "vital gate" is used to emphasize the importance of the yang of the kidney.
The kidney basically includes the functions of the urinary system, reproductive system, and part of the endocrine system and nervous system.

Contact : Dr Nilima Thakkar : 982 0676 600

info@aasp-mah.in

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