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It is the master of the five internal organs and six viscera.” When the heart beats, all five internal organs tremble; as stated in the “Ling Shu · Heavenly Years” section: “What is the heart? It is the center of the mind, and through its function, it becomes…” t time “…a person.” The primary functions of the heart can be summarized into two aspects: first, it serves as the master of the five internal organs and six viscera; second, it is the source of spirit and clarity. In recent years, research in this area has been relatively limited; more often, existing experimental evidence is cited for reference and explanation. Some foreign researchers have conducted systematic studies on the mechanisms behind the effects of placebos. They discovered that placebos exhibit different actions depending on the language used to induce them. Under such circumstances, subcutaneous injections of atropine can lead to increased substance levels, while saline solutions can stimulate adrenal cortical function. Placebos may also reduce serum lipoproteins and decrease peripheral white blood cells. These experiments demonstrate that the thinking and conscious activities controlled by the cerebral cortex can alter the normal functions of various organs in the body, causing abnormal responses to conventional drug treatments. Thinking and consciousness fall under the concept of “spirit” in traditional Chinese medicine, which itself is governed by the heart. Thus, the theory that “the heart is the master of the five internal organs and six viscera” holds significant meaning. The renowned Soviet physiologist Bekov and his colleagues believed that countless intraceptive receptors exist throughout the human body, organs, and tissues—they play an indispensable role in maintaining homeostasis. For example, muscle receptors are crucial for coordinated movement, aortic arch receptors help regulate blood circulation, lung receptors aid in regulating respiration, and gastrointestinal receptors influence the activity of digestive organs... All these receptors operate through the pathways of the sympathetic and parasympathetic nerves, under the control of the central nervous system. The central nervous system itself falls within the realm of “the heart governing spirit” in traditional Chinese medicine. Numerous experimental studies have been conducted on the functions of the hypothalamus, brainstem, and autonomic nervous system. When the hypothalamus is stimulated, numerous bodily functions associated with different organs undergo noticeable changes—such as body temperature, respiration, heart rate, sleep patterns, sugar and fat metabolism, and endocrine regulation. It has been proven that the anterior and medial portions of the hypothalamus, including the superior visual area, the preoptic area, and the ventral region of the gray nucleus, control the activity of the parasympathetic nervous system. Stimulating these areas can enhance parasympathetic activity, such as slowing heart rate, dilating peripheral blood vessels, and increasing smooth muscle tension. The posterior and lateral portions of the hypothalamus, however, control sympathetic activity; stimulating these regions can enhance sympathetic activity, leading to pupil dilation, hair standing on end, increased heart rate, elevated blood pressure, and deeper, faster breathing. Modern psychology suggests [6], that emotions and feelings are forms of human response to real-life situations. When real-life conditions align with the body’s inherent needs, emotions and feelings typically manifest as joy, satisfaction, or love; when real-life conditions do not match the body’s needs, they may turn into dissatisfaction, pain, fear, hatred, or anger. The former represents positive emotions and feelings, while the latter signifies negative ones. Positive emotions and feelings can enhance the functions of various organs in the body, whereas negative emotions and feelings can suppress organ functions. Therefore, people often consider mood (emotions and feelings) to be an important factor influencing the normal functioning of the body’s various systems. Mood can be regulated through personal cultivation and moral development; thus, the directed functions of the cerebral cortex also play a role in regulating different parts of the body. These emotions, feelings (moods), along with personal cultivation and moral development, all fall under the scope of “the heart governing spirit” in traditional Chinese medicine, while their impact on various body systems is rooted in the concept of “the heart as the master of the five internal organs and six viscera.” In summary, most of the heart’s functions in traditional Chinese medicine belong to the realm of brain function in modern medicine; yet, from the perspective of “the heart governing blood vessels,” it also carries the connotations of modern heart function. Some domestic researchers used the CXZ-I type ultrasonic cardiovascular diagnostic device to conduct preliminary observations on the left ventricular systolic and diastolic functions of patients with heart qi deficiency, heart yin deficiency, and blood stasis in the heart [7]. They found that in cases of heart qi deficiency, the mean value of the mitral valve–ventricular septum distance (EPSS) increased; the mitral valve amplitude (CHE), cardiac output (SV), average systolic velocity of the left ventricular posterior wall (MPMVS), average diastolic velocity of the left ventricular posterior wall (MPWVD), wall thickness percentage (△T%), the EP slope (MVV), and the ratio of total movement amplitude in the left ventricular posterior wall during rapid filling period (R) to the total movement amplitude in the left ventricular posterior wall (R/PWE) all decreased. In cases of heart yin deficiency, in addition to the increased EPSS mean value, there was no significant change in the diastolic function index MVV. Compared to heart qi deficiency, while both conditions shared the common feature of increased EPSS mean values, other indicators showed that heart qi deficiency decreased while heart yin deficiency did not; statistically, the differences between the two were significant. In cases of blood stasis in the heart, the mean values of SV and MPWVD in the left ventricle decreased, as did the mean values of CHE and △T%. The mean values of MVV and R/PWE in the left ventricular diastolic phase also decreased, while the EPSS mean value increased. These experimental studies indicate that traditional Chinese medicine’s concepts of heart qi deficiency, heart yin deficiency, and blood stasis in the heart are closely related to cardiac systolic and diastolic function. At the same time, these studies reveal that the three conditions share both fundamental similarities and distinct characteristics in terms of cardiac systolic and diastolic function, thereby providing a material basis for understanding the traditional pathogenesis of heart qi deficiency, heart yin deficiency, and blood stasis in the heart. Domestic researchers also observed the interval between systolic and diastolic phases in coronary heart disease patients with heart qi deficiency [81]. They found that in patients with coronary heart disease due to heart qi deficiency, the electrical mechanical contraction time (QS2) was prolonged, the left ventricular ejection time (LVET) was shortened, the pre-ejection time (PEP) was extended, and the PEP/LVET ratio increased. They concluded that heart qi deficiency is closely related to left ventricular function. Using PEP/LVET as a standard—the most sensitive and reliable indicator of left ventricular function—they set the upper limit of normal at 0.37; any value greater than this indicated left ventricular dysfunction. Statistical results showed that the abnormality rate in the heart qi deficiency group was 94.7%; the heart qi deficiency and yin deficiency group had an abnormality rate of 91.7%; none of the remaining coronary heart disease patients exhibited abnormalities. Additionally, some researchers used myocardial imaging to assess left ventricular function in patients with heart qi deficiency [9], confirming that patients with heart qi deficiency experienced left ventricular dysfunction. Furthermore, researchers examined the left ventricular systolic time interval in 95 patients with different syndromes [10], concluding that cardiac dysfunction, reduced cardiac output, and insufficient blood flow to tissues throughout the body constitute the pathological foundations of heart qi deficiency. References [1] Wolf S. The pharmacology of placebos. Pharmacol Rev, 1959, 2:689 [2] Wolf S. Effects of suggestion and conditioning on the action of chemical agents in human subjects— the pharmacology of placebo. J Clin Invest, 1950, 29:100 [3] Wolf S. et al. An experimental approach to psychosomatic phenomena in rhinitis and asthma. J Allerg, 1950, 21:1 [4] Bekov. The Cerebral Cortex and the Internal Organs. People’s Health Publishing House, 1954 [5] Stron Ds. et al. Human Neuroanatomy. Shanghai Science and Technology Edition, 1963, 322 [6] Smirnov. Psychology. People’s Education Edition, 1957 [7] Li Shaozhi et al. Preliminary Study on Left Ventricular Systolic and Diastolic Function in Patients with Heart Qi Deficiency. Chinese Journal of Traditional Chinese Medicine, 1988, 29(2):130 [8] Fan Liangqing et al. Discussion on Objective Indicators for TCM Differentiation of Coronary Heart Disease. Chinese Journal of Traditional Chinese Medicine, 1981, 23(7):28 [9] Shi Zaixiang et al. Research on Left Ventricular Function in Patients with Heart Qi Deficiency. Chinese Journal of Traditional Chinese Medicine, 1982, 24(12):58 [10] Ren Shusheng et al. The Inner Connection Between Cardiac Function and Heart Qi Deficiency. Tianjin Chinese Medicine, 1985, 2:36 Five. Research on the Lung The lung serves as the canopy over the five internal organs and six viscera. The lung governs qi, controls respiration, connects with the skin and hair, and is paired with the large intestine. From these discussions, it is clear that the lung in traditional Chinese medicine possesses both the connotations of modern medical lungs and functions that modern medical lungs lack. Beyond its respiratory functions, the concepts of “the lung governs qi,” “the lung connects with the skin and hair,” and “the lung is paired with the large intestine” are core tenets of traditional Chinese medicine’s organ physiology. In recent years, researchers have conducted experimental studies to explore the essence of these concepts; although these studies are still in their early stages, they nonetheless demonstrate that the lung’s physiological functions in traditional Chinese medicine are grounded in material foundations.

(1) The Lung and the Large Intestine: A Pair of Opposite Organs

In recent years, domestic researchers have conducted several experimental studies on the relationship between the lung and the large intestine, and they consistently agree that this traditional Chinese medicine theory of organ pairing has solid material foundations. First, researchers found that severe intestinal disorders—such as paralytic ileus, mechanical intestinal obstruction, necrotizing enteritis, and others—often accompany respiratory failure. A typical case where intestinal disorders and respiratory failure coexist is adult respiratory distress syndrome (ARDS). Why do severe intestinal disorders lead to respiratory complications? Modern medicine still struggles to provide a complete answer to this question. However, from the perspective of traditional Chinese medicine, the consensus among texts like the “Internal Classics,” “Difficulties,” “Shanghan,” “Jin Gui,” and all subsequent works from the Tang and Song dynasties regarding the relationship between the lung and the large intestine seems entirely natural and logical. This view has guided clinical practice, yielding effective results in many cases. To uncover the true nature of this theory, some domestic researchers conducted systematic studies on 48 patients with ARDS [1]. They found that among the 48 patients, 25 had intestinal dysfunction before the onset of ARDS, while 23 did not exhibit intestinal dysfunction. The intestinal dysfunction referred to here was not merely general gastrointestinal disorder; among the 25 patients, 21 had paralytic ileus, 3 had mechanical intestinal obstruction, and 1 had mesenteric arterial embolism, with 16 patients subsequently developing toxic shock. All 25 patients with severe intestinal dysfunction experienced acute respiratory failure suddenly 1–3 days after the onset of intestinal symptoms, characterized by rapid breathing—often exceeding 28 breaths per minute—and a drop in arterial oxygen partial pressure, PaO₂ < 8 kPa, accompanied by an increase in A-aDO₂, with inspiratory values exceeding 4 kPa and even higher when receiving pure oxygen. These findings clearly indicated that severe intestinal dysfunction could lead to pulmonary impairment. Based on these insights, researchers employed the method of clamping the superior mesenteric artery to create an animal model [1], resulting in ischemic intestinal dysfunction in the lungs of the same animals; however, the lungs of animals without clamping showed no similar lesions. Meanwhile, researchers selected equal numbers of animals to clamp the renal artery and the lower limb artery, but neither group exhibited pulmonary changes. Furthermore, when the same number of animals were subjected to clamping the superior mesenteric artery versus not clamping any artery, the clamped groups showed positive levels of endotoxin in their blood after 90 minutes; in contrast, the non-clamped groups remained negative for endotoxin levels in their blood after 90 minutes of exposure to the superior mesenteric artery. These experiments demonstrated that intestinal dysfunction leads to pulmonary lesions, proving that the theory of the lung and large intestine being paired has material foundations. Moreover, preliminary conclusions suggested that this causal relationship might be linked to the production of endotoxin in the bloodstream. In addition to the aforementioned experiments, some researchers created permanent semi-ligatures at the lower end of the rectum [12], leading to pulmonary lesions. Others improved upon the methods of clamping and permanent semi-ligation, using external ligation to create reversible narrowing of the lower rectum, which in turn caused a series of pathological changes in the lungs [3]. These improvements proved to be largely successful, as the lungs developed a variety of lesions. Beyond confirming the theory that “the lung and the large intestine are paired,” the ability to remove the narrowing externally allowed the model to return to normal—this not only facilitated repeated use of the model but also provided better conditions for in-depth research into the true nature of this theory. Under these modified animal models, artificial formation of dry fecal matter in the large intestine led to the emergence of Yangming腑实 syndrome in the animals, which in turn resulted in specific pulmonary lesions, including pulmonary congestion, pulmonary hemorrhage, and pulmonary necrosis. Under electron microscopy, swelling and necrosis of the alveolar epithelium were observed, along with swollen and necrotic macrophages, while other organs showed no abnormalities. Experiments indicated that feeding the model animals with Dachengqi Decoction significantly improved pulmonary symptoms.

(2) The Lung Governs Qi The significance of “the lung governs qi” in traditional Chinese medicine extends beyond the lung’s respiratory functions—it also encompasses other functions of the lung itself. While experimental research in this area remains limited, according to reports from the Lung Function Research Laboratory of Zhejiang Provincial Hospital of Traditional Chinese Medicine [4], they chose lung function tests that directly reflected the lung’s respiratory role. Observations and studies on lung ventilation revealed that in chronic obstructive pulmonary disease, patients with lung qi deficiency generally exhibited abnormal lung function, while those with lung qi yang deficiency mostly showed normal lung function, with only a small number exhibiting mild abnormalities. Comparing the two groups, statistical analysis showed significant differences. Among those with abnormalities, most patients with lung qi deficiency suffered from moderate to severe ventilatory dysfunction; these impairments often took on a mixed form and were significantly more pronounced than those in patients without lung qi deficiency. Many literature reports currently suggest that vital capacity, flow–volume curves, and lung compliance are sensitive indicators for early diagnosis of small airway diseases [5][6]. In clinical practice, these diseases often present with subtle signs that are difficult to detect in the early stages; therefore, measuring these indicators is of great importance. As these indicators progress from low to high, they correspond precisely to the degree of lung qi deficiency. The results obtained from 53 patients without lung qi deficiency showed that about half of the patients already exhibited microscopic changes indicative of lung qi imbalance. Thus, it is evident that the concepts of lung qi and “the lung governs qi” in traditional Chinese medicine are grounded in material foundations. Although experimental research in this area remains limited, it has already begun to shed light on this issue. As future research progresses, the true nature of traditional Chinese medicine’s lung physiology will undoubtedly be gradually revealed.