Pathogenesis of Zang-Fu Organs

Pathogenesis of Zang-Fu Organs

Each zang-fu organ has its own governing qi, its own meridians, and its own specific parts, so the diseases it is prone to and the corresponding symptoms also differ. If a single organ is diseased without affecting other organs, treating that organ alone can cure the disease; if multiple organs are diseased simultaneously, treating the other organs as well can also cure the disease. If a physician does not understand the zang-fu organs, it is impossible to identify the root cause of the disease, and prescribing medication becomes arbitrary—how could such a doctor possibly treat the disease? Therefore, I will list the general principles of the zang-fu organs below, hoping that this will provide a guide for diagnosing diseases and formulating prescriptions.

The heart is the sovereign organ, and it is the source of spiritual clarity (3). Since the heart is a fire organ that illuminates everything, it governs spiritual clarity. Spirituality exists without matter, and this is precisely the fire energy within the heart. However, this energy is not suspended in empty space; rather, it is concentrated in a small spot of blood within the heart, bright and lustrous (4), containing this energy. Thus, sometimes a radiant glow appears, which is the manifestation of spiritual clarity. The heart's function also includes producing blood (5), and several spots of blood within the heart's openings are the most refined components of the blood, serving as the source of blood production and the deep ocean of spirituality (6). When blood is deficient, the spirit becomes restless and experiences palpitations (7); if there is stagnant blood, palpitations also occur. When fire disturbs the blood, one feels frustrated and agitated (8). If the spirit is unclear, one becomes anxious and unable to sleep, with a racing heart and sudden jolts. Water drinks extinguish fire, causing the heart to race as well (9). When blood attacks the heart, one may lose consciousness and feel excruciating pain; when phlegm enters the heart, one may become insane; when fire disrupts the heart, one may become狂. The heart is closely related to the small intestine, and if heat remains in the small intestine, the urine becomes reddish and bitter. If fire does not descend to the kidneys, the spirit becomes floating (10) and dreams of nocturnal emissions. The heart's meridians run up to the throat and connect to the base of the tongue. When excessive fire builds up, it causes throat obstruction (11); when weak fire rises, the tongue becomes stiff and speech is impaired. Located on the front of the chest, when fire accumulates, it causes chest tightness (12), indigestion (13), and burning pain. If fire does not disperse, it leads to chest oppression (14). The heart's accumulation is called "Fu Liang" (15), located beneath the heart, about the size of an arm. When diseased, there is a pulsating sensation around the navel (16). This is the main principle of the heart's disease.

The pericardium is the outer defense of the heart. Since the heart is the sovereign organ, the pericardium is the minister, so the heart is called "ruler fire," while the pericardium is called "minister fire." The pericardium announces the transformation of fire (17), and all the heart's functions are carried out by the pericardium, including diagnosis and treatment methods, just like the heart itself.

The liver is a wind-wood organ, with the gallbladder residing within it. The gallbladder is minister fire, and wood generates fire. The liver stores blood, which is produced by the heart and flows down to the womb chamber, forming the "sea of blood." All the blood in the body is considered to be governed by the sea of blood (18). If the sea of blood is not disturbed, all the blood in the body will remain stable. The liver's meridian governs its specific part, so the liver is responsible for storing blood. The reason it can store blood is that the liver belongs to wood, and wood energy is harmonious and unblocked, preventing stagnation (19). If wood becomes stagnant, blood will not flow smoothly. When fire arises, it leads to anger, and blood erupts uncontrollably (20), resulting in hematemesis, irregular menstruation, and painful bleeding. If anger becomes too extreme, one may become狂; if fire becomes too intense, the cheeks may swell, the face turn blue, and the eyes become red with headaches. Wood and fire clash with earth (21), leading to dry mouth, diarrhea, inability to eat, and regurgitation—these are all signs of wood-stagnant-fire. If wood carries water evil upward, it acts as a child borrowing the mother's power (22), wreaking havoc on the spleen meridian (23), causing phlegm, diarrhea, vomiting, and headaches. Wood's nature is to facilitate drainage; when food enters the stomach, it relies entirely on the liver's wood energy to drain it, and then the food is transformed. If the liver's clear yang does not rise, it cannot drain the food, and symptoms such as bloating and distension are inevitable. The liver's clear yang is the soul energy, so it also governs the soul. If blood does not nourish the liver, and fire disturbs the soul, one may experience nocturnal emissions and insomnia. The liver also governs the muscles, and conditions such as hives and skin tightening are all liver-related illnesses. Located between the lower ribs and the lower abdomen (24), any pain in the lower ribs or lower abdomen is attributed to the liver. Its meridian is called "Jue Yin," meaning "the end of yin." When yin reaches its limit, it transforms into yang, so when the disease progresses to this stage, the fever becomes very high, and even a slight fever becomes severe. The blood is often mixed with cold and heat. The liver is closely related to the gallbladder, so liver diseases can also cause acid reflux, bitterness, deafness, and dizziness. Located on the left side, many patients suffer from left-side pain, and there is also a pulsating sensation on the left side. The liver's main diseases are roughly as described above.

The gallbladder is connected to the liver and governs minister fire. Gallbladder juice is bitter, which is essentially the taste of fire. Minister fire is announced in the San Jiao, but resides in the gallbladder. If gallbladder fire is weak, one feels faint and experiences palpitations; if gallbladder fire is too strong, one suffers from bitter taste, nausea, dizziness, and hearing loss, because the meridian surrounds the ears. When wind and fire interact on the sides of the body, one cannot turn over, and the limbs twitch. In terms of the relationship between the interior and exterior, the qi of Shaoyang flows internally through the San Jiao and externally through the skin, serving as the core of the defensive system. If this core is disrupted, one may vomit and experience chest fullness. When evil spirits invade the skin and compete with yin for heat, they produce heat; when they compete with yang for cold, they produce cold. Therefore, malaria is primarily caused by Shaoyang. Chronic wasting disease due to bone steaming (25) is also caused by Shaoyang, because the defensive system between the skin and the interior is imbalanced, and minister fire is excessively active. If minister fire carries phlegm, it can cause epilepsy. If minister fire is not restrained (26), the liver's soul will also be unsettled, leading to frequent nocturnal emissions and dreams. Moreover, if the gallbladder's minister fire is not overly strong, it is clear yang wood energy, which rises to the stomach, allowing the stomach soil to be drained

If the skin is affected, it will become flaky (37), and if it invades the lungs, it will cause pulmonary edema and water intoxication. Because the lungs are delicate organs, they fear both fire and cold. The lungs open to the nose and are responsible for breathing, serving as the overall controller of qi. Since qi originates from the kidneys, it is the yang in the primordial water, rising through the nose, and the lungs control its intake and output. The kidneys are the source of water, while the lungs are the sky; metal and water generate each other, and the cycle of heaven and earth continues. The kidneys are the origin of water, while the lungs are the masters of qi. Any wheezing or coughing is ultimately controlled by the lungs. Located in the chest, chest pain is also the responsibility of the lungs. The right side is the focus, with a condition called "Xi Ben" (38). When diseased, there is a pulsating sensation on the right side, and the lungs' role is roughly as described above.

The kidneys are water organs, containing yang within the water, which generates primordial qi. The roots of the qi lie in the dantian, and the kidneys control breathing, reaching the bladder and circulating outward as defensive qi. This qi is the yang in the water, also known as "life fire." When the kidneys have sufficient water, the fire hidden in the water is concealed and does not show itself (39), and the dragon and thunder do not rise (40). Therefore, when the qi is sufficient, the breath is light and subtle. If the water is insufficient, the fire cannot return to its origin, leading to shortness of breath, chronic fatigue, and various symptoms, such as sore throat, hoarseness, lack of communication between the heart and kidneys, loss of semen and blood, swelling, coughing, and phlegm. If yang qi is insufficient, the water becomes phlegm, flooding the heart and lungs, causing edema, abdominal pain, and panic attacks (41), along with diarrhea, cold extremities, and profuse sweating—all signs of yang qi depletion. The kidneys are also innate, responsible for storing essence. Women are responsible for Tian Gui (42), while men are responsible for essence; when the water is sufficient, there is plenty of essence and blood, but when the water is insufficient, essence and blood are depleted. The bones are also under the control of the kidneys, so bone atrophy is a kidney-related issue. When the kidneys are diseased, there is a pulsating sensation around the navel. When the kidneys communicate with the heart, water and fire are balanced; if they do not communicate, fire becomes increasingly rampant. Located in the waist, the kidneys are responsible for lower back pain. They open to the ears, so when yang qi is deficient, one may experience tinnitus and deafness. The pupils belong to the kidneys; when yang qi is deficient, the spirit's water shrinks, or cataracts develop. When yang qi rises, one may experience sore throat and flushed cheeks. If yin qi is deficient, urination becomes difficult; if yang qi is deficient, urination also becomes difficult. The pathogenesis of kidney disease is thus.

The bladder is the organ that stores urine, and the classics say, "It is the official of the state, storing fluids, and when qi is transformed, it can be released." This refers to sweat, not urine. Although urine comes from the bladder, in fact, the lungs are the primary source of water; when the upper source is clean, the lower source is also clean. The spleen is the dam that prevents water from overflowing; when the dam works well, the waterways are also smooth. The kidneys are also the masters of water; when kidney qi flows, water flows as well. The saying "when qi is transformed, it can be released" means that the bladder's qi carries fluids upward and outward, and when it is released as sweat, it creates the image of clouds moving and rain falling. Therefore, the bladder is called the "Sun Meridian," referring to the yang in the water, which extends outward as defensive qi, making it the largest yang. External factors can damage the defensive yang, causing fever and chills. The meridian runs along the back of the body, up to the head and neck, so headaches, back pain, and arching of the spine are all Sun Meridian diseases. The skin and lungs work together, and the lungs are also the source of water, so sweating requires treating the lungs, and water management also requires treating the lungs—this reflects the unity of water and air. Located in the lower part of the body, connected to the womb, blood clots are also diseases of the water, and water clots are also diseases of the blood. The bladder's diseases are roughly as described above.

The San Jiao, originally called "jiao," is the oil film that connects the upper, middle, and lower parts of the human body. During the Tang and Song dynasties, people did not understand the shape of "jiao," thinking it was famous but had no visible form. However, the "Inner Canon" clearly states, "Vertical jiao is vertical, horizontal jiao is horizontal" (43), and jiao

Bitter taste nourishes the heart, yang qi nourishes the blood, and blood nourishes the spleen.

(6) Deep ocean: Refers to the source.

(7) Palpitations: Heart racing and restlessness.

(8) Frustration: Inner restlessness and unease.

(9) Racing heart: Heart palpitations.

(10) Floating spirit: Meaning the spirit is lost and wandering. Symptoms include restlessness and anxiety.

(11) Throat obstruction: Meaning the throat is blocked and cannot breathe. This symptom is common in chronic throat diseases.

(12) Chest tightness: Cold and heat combine in the chest, resulting in hardness and pain below the heart.

(13) Indigestion: Meaning blockage and inability to pass.

(14) Chest oppression: Water or phlegm rises to the chest, with yin occupying the yang position and blocking the passage. Symptoms include wheezing, coughing, and chest and back pain.

(15) Fu Liang: One of the five accumulations, referring to the heart's accumulation. According to "Su Wen·Fu Zhong Lun": "There is a condition where the lower abdomen is swollen, with roots on all sides—up, down, left, and right. This condition is called 'Fu Liang.'" According to "Nan Jing·Wu Shi Liu Nan": "The heart's accumulation is called 'Fu Liang,' starting from above the navel, about the size of an arm, extending down to the heart. If it persists for a long time, it makes people feel troubled and uneasy."

(16) Pulsating sensation: A feeling of agitation around the navel, indicating that the organ's qi is unstable and moving.

(17) Announcing the transformation of fire: Meaning spreading yang qi.

(18) Treating chaos: Either treating or causing chaos.

(19) Stagnation: Blocking and depressing.

(20) Horizontal flow: Not following the normal flow of meridians, meaning flowing sideways.

(21) Restriction: A term specific to the Five Elements theory, meaning to restrain.

(22) Child borrowing the mother's power: Here, the child refers to the liver, and the mother refers to water evil, meaning the liver uses water to attack the spleen.

(23) Indulgence: Letting go.

(24) Lower ribs: The area near the waist, close to the lower ribs.

(25) Bone steaming: Fever due to chronic wasting.

(26) Restraint: Meaning to gather or collect.

(27) Part: Meaning section or location.

(28) Middle burner: Refers to the middle burner.

(29) Hiccups: ① Refers to hiccups. ② Refers to dry heaving.

(30) Jaundice: Refers to jaundice.

(31) Heart like a plate: According to "Jin Gui Yao Lue·Shui Qi Pian": "When qi is deficient, the heart becomes hard, about the size of a plate, with edges like a spinning cup. This is caused by water intoxication, and the prescription is Guizhi Qu Shaoyao Jia Ma Xin Fu Zi Tang."

(32) Spleen accumulation called "pi qi": According to "Nan Jing·Wu Shi Liu Nan": "The spleen's accumulation is called 'pi qi,' located in the stomach, about the size of a plate, and if it persists for a long time, it makes people's limbs unable to move, causes jaundice, and prevents food from being absorbed by the skin."

(33) Spleen controls blood: This comes from "Nan Jing·Si Shi Er Nan": "The spleen wraps blood and warms the five viscera."

In summary, the author presents many unique arguments and correct insights in this article. However, due to historical limitations, there are still shortcomings and even errors in his arguments. For example, regarding the San Jiao, the author believes that the San Jiao is equivalent to the mesentery in modern anatomy (large omentum). He bases this on the discovery of water bells in the omentum during animal dissection, claiming that the omentum has the function of transporting water to the bladder, and using this as evidence to support the "Inner Canon's" statement that "the San Jiao is the organ responsible for draining, and water flows out through it." This narrows the concept of the San Jiao, thereby diluting the overall perspective of the zang-fu theory.