SECTION 1 THE FIVE ZANG-ORGANS

The five zang-organs is a collective term for the heart, lung, spleen, liver and kidney. While each of
the zang-organs has its special functions, the physiological functions of the heart play a dominant
role.

The Heart

The heart is situated in the thorax, above the diaphragm and enveloped by the pericardium,
resembling an inverted lotus flower bud. It is the house of spirit, the governor of blood, and the
converging location of vessels.

Pertaining to fire in the five elements and being yang within yin, the heart plays a major role in
dominating the life activities of the human body.

That is why it is called the monarch organ in Su Wen (Plain Conversation,

). It has two main functions: controlling blood and vessels and dominating

spirit. Besides, it opens into the tongue, manifesting on the face,

associating with joy in emotions and sweat in secretion. The two major

meridians, heart meridian of hand shaoyin and small intestine of hand

shaoyang, connect and tangle each other between the heart and small

intestine. Hence the heart and small intestine are believed to be related

internally and externally.

The Main Physiological Functions of the Heart

1. Controlling blood and vessel

This function of the heart involves two aspects: control of blood and control

of blood vessel. The blood circulates in the vessel and relies on the

propelling of the heart to reach all parts of the body, so as to perform its

nourishing and moistening function. The vessel is the pathway of blood

circulation, the smoothness or obstruction of which directly influences the

normal flow of blood. Therefore, in the relatively independent system

made up of the heart, vessel and blood, the heart plays the dominant role,

and the normal pulsation of which is indispensable to the physiological

functions of this system.

The normal pulsation of the heart depends on the nourishing and moistening
function of the heart blood and heart yin as well as the propelling

b1548_Ch-05.indd 85 1548_Ch-05.indd 85 6/10/2013 3:21:15 PM /10/2013 3:21:15 PM

86 Fundamentals of Traditional Chinese Medicine

b1548 Fundamentals of Traditional Chinese Medicine b1548_Ch-05 10 Jun 2013 3:27 PM

and warming functions of the heart qi and heart yang. In this way the

normal cardiac efficiency, cardiac rate and cardiac rhythm are guaranteed,

enabling blood to circulate all over the body for nourishment. This is

manifested as rosy, lustrous complexion and slow yet forceful pulsation.

The normal circulation of blood also relies on the sufficiency of blood. If

the blood is deficient and the vessels are empty, it will also directly affect

the normal pulsation of the heart and the normal circulation of blood. In

this sense, it is considered that abundance of heart qi, sufficiency of blood

and smoothness of the vessels are prerequisite to the normal circulation of

blood. If the heart qi is insufficient, the blood is deficient and the vessels

are unsmooth, it will inevitably lead to inhibited circulation of blood and

emptiness of the vessels, marked by pale and lusterless complexion as

well as thin and weak pulse; if qi and blood are stagnated and the blood

vessels are obstructed, there will be grayish complexion, cyanotic lips and

tongue, distress or stabbing pain in the precordium region, and knotted,

intermittent, hasty or unsmooth pulses.

2. Governing spirit

Heart governing spirit, or heart storing spirit, refers to that the heart can

dominate and control the spiritual, mental and thinking activities of the

body. Spirit, in a broad sense, refers to the life activities and external

manifestations of the human body. The image of the body, the complexion,

language, response and body movements, are all classified into the

category of spirit. So there is a saying, One thrives with spirit yet perishes

without it. In everyday Chinese language, the so called shen qi

(spirit qi), shen zhi (spirit mind) and shen se (spirit complexion), are
classified into this category. While in a narrow sense, spirit refers to the

spiritual, mental and thinking activities dominated by the heart. They are

all important physiological functions of the body; besides, under certain

circumstances, they may affect the balance or coordination among different

physiological functions of the whole body. Therefore, it is said in Su

Wen (Plain Conversation, ), The heart is the monarch organ and in

Ling Shu-Xie Ke (Miraculous Pivot-Pathogenic invasion, ),

The heart, where the spirit resides, is the supreme governor of the five

zang-organs and six fu-organs.

b1548_Ch-05.indd 86 1548_Ch-05.indd 86 6/10/2013 3:21:15 PM /10/2013 3:21:15 PM

www.ebook777.com

The Theory of Visceral Manifestation 87

b1548 Fundamentals of Traditional Chinese Medicine b1548_Ch-05 10 Jun 2013 3:27 PM

The spirit, consciousness and thinking activities are physiological functions

as well as external reflections of the brain. However, in the theory of

visceral manifestation, which centers on the five zang-organs, these activities

are attributed to the five zang-organs, particularly the heart; that is

why it is said, The heart stores the spirit. Ling Shu (Miraculous Pivot,

) pointed out clearly that the heart can receive external messages and

in Lei Jing, Zhang Jingyue further put forward that the spiritual, mental

and thinking activities, though pertain to different zang-organs respectively,

are mainly controlled by the heart. Therefore, if the heart controls

spirit properly, one will be full in vitality, clear in mind, agile in thinking,

and sensitive in reaction to the external stimulation. However, malfunction

of the heart in governing the spirit may bring about such symptoms as

insomnia, dreaminess, distraction and even delirium; or slow reaction,

amnesia, dispiritedness, and even coma, etc.

The function of heart governing spirit is closely related to the function

of heart controlling blood and vessel. Blood is the material base for mental

activities; in this sense, the function of heart controlling blood and vessel

is prerequisite to that of heart governing spirit. Hence, the dysfunction of

heart controlling blood and vessel will inevitably lead to abnormal

changes of the spirit.

The Relationship of the Heart to the Emotions, Fluids,

Body Constituents and Orifices

1. The heart is associated with joy in emotions

The physiological function of the heart is closely related to joy. The theory

of visceral manifestation holds that the different emotions, namely joy,

anger, worry, contemplation and terror, are derived from the physiological

functions of the five zang-organs. Each of them is associated with a particular

zang-organ, respectively. In Su Wen (Plain Conversation, ), it

is also confirmed that joy is associated with the heart. Joy, a positive reaction

to the external environment, is beneficial to the heart. However,

excessive joy can impair heart spirit. In a word, joy is beneficial to the

heart in governing the spirit and controlling blood and vessel only when it

is not excessive.

b1548_Ch-05.indd 87 1548_Ch-05.indd 87 6/10/2013 3:21:15 PM /10/2013 3:21:15 PM

88 Fundamentals of Traditional Chinese Medicine

b1548 Fundamentals of Traditional Chinese Medicine b1548_Ch-05 10 Jun 2013 3:27 PM

2. The heart is associated with sweat in fluids

It means that sweat is the fluid of the heart, indicating the close connection

between sweat and the heart. Sweat, a fluid excreted from the sweat pore

after the activation of yang qi, is discussed in Su Wen (Plain Conversation,

) that yang acting on yin produces sweat. The secretion of sweat

relies on the control of skin striae by defensive qi. If it is open, there will

be sweat, and if not, there will be no sweat. Since sweat is transformed

from body fluid, which shares the same origin with blood, there is a saying

that blood and sweat shares the same origin. And because blood is

controlled by the heart, it is said that sweat is the fluid of the heart.

3. The heart is associated with the vessel in body constituents

It refers to the connection between the heart and all the blood vessels. Its

luster is reflected on the complexion. For this reason, the physiological or

pathological conditions of the heart can be indicated on the face. Because

the blood vessels on the head and face are very abundant, just like what is

said in Ling Shu (Miraculous Pivot, ) that the face and upper orifices

receive qi and blood from all the twelve meridians and three hundred and

sixty-five collaterals. So abundant heart qi and blood will lead to red and

lustrous complexion, whereas insufficient heart qi and blood may result in

pale complexion, and stagnated blood can cause cyanosed complexion.

4. The heart is associated with the tongue in orifices

The heart opens into the tongue, which means the tongue is the external

manifestation of the heart. The main function of the tongue is to govern

sense of taste and language expression, which rely on the function of the

heart to govern spirit, blood and vessel. If the heart functions abnormally,

there will be change of taste and inflexibility of the tongue. If the functions

of the heart are normal, the tongue will be moist and lustrous in

property, normal and sensitive in taste, and free and flexible in movement.

The disorders of the heart can also be reflected on the tongue. For example,

if yang qi in the heart is insufficient, the tongue will be light-colored,

whitish, bulgy and tender; if the blood is deficient in the heart, the tongue

will be deep-red, thin and dry; if the heart fire flames up, the tongue will

b1548_Ch-05.indd 88 1548_Ch-05.indd 88 6/10/2013 3:21:15 PM /10/2013 3:21:15 PM

www.ebook777.com

The Theory of Visceral Manifestation 89

b1548 Fundamentals of Traditional Chinese Medicine b1548_Ch-05 10 Jun 2013 3:27 PM

be reddish or even with ulcer; if the heart vessels are stagnant, the tongue

will be cyanotic or even with ecchymoses; if the physiological function of

the heart in controlling the spirit is abnormal, the tongue will become

curled up and stiff, leading to difficulty or inability to speak, etc.

Appendix: The Pericardium

The pericardium, called xinbao, or tanzhong, is the membrane enveloping

the heart to protect it. Its shape and position are recorded in many ancient

classics. In the meridian theory, it is also deemed as a zang-organ because

the heart meridian of hand jueyin is connected with the pericardium and

is closely related to the triple energizer meridian of hand shaoyin. But, in

the theory of viscera manifestation, it is regarded as the envelope of the

heart for its protection so that when there is an exogenous invasion, the

pericardium will be the first barrier. In the theory of warm diseases, such

symptoms as coma or delirium appearing in exogenous febrile diseases

are known as heat invading the pericardium or heat clouding the

pericardium.

Daily Exercises

1. What is heart governing blood and vessel?

2. What is heart governing spirit?

3. Why it is said that the heart is associated with sweat in fluids?

4. What is pericardium?

The Lung

The lung, including two lobes on the left and right, is situated in the thorax,

and is compared to a canopy because of the uppermost position

among all the viscera. The lung is tender, frail and finicky, and is susceptible

to pathogenic invasions; hence it is called the delicate organ. The

main physiological functions of the lung are to dominate qi and control

respiration, govern ascent, dispersion, purification and descent as well as

regulate water passage. It also governs management and regulation

because it is associated with various vessels. It communicates with the

b1548_Ch-05.indd 89 1548_Ch-05.indd 89 6/10/2013 3:21:15 PM /10/2013 3:21:15 PM

90 Fundamentals of Traditional Chinese Medicine

b1548 Fundamentals of Traditional Chinese Medicine b1548_Ch-05 10 Jun 2013 3:27 PM

throat, opens into the nose, and is associated with the skin and hair in the

exterior. In five emotions it is related to worry and in fluids to snivel.

Moreover, its meridian is internally and externally related to the large

intestine.

The Main Physiological Functions of the Lung

1. The lung controls qi and governs respiration

It controls the qi of the whole body, or general qi, and the air it inhales and

exhales. The reason why it controls qi of the whole body is that all kinds

of qi belong ultimately to the lung, which is mainly reflected in the process

of qi production, particularly the thoracic qi. The thoracic qi is

mainly composed of the fresh air inhaled by the lung and the cereal nutrients

transformed by the spleen and stomach. Hence the normal respiratory

function of the lung is critical for the production of thoracic qi and the

general qi. The respiration is actually a dynamic process of ascending,

descending, entering and exiting of qi, thus the lung is capable of regulating

qi activities of the whole body.

The lung governing the inhaled and exhaled qi means that the lung is the

location where the external air and the internal qi exchange. Through this

process, the external fresh air is inhaled and internal turbid qi is exhaled,

thus promoting the production of qi, regulating the ascending, descending,

entering and exiting motions of qi, and facilitating the metabolism of the

body. Both of these two functions of the lung can ultimately be traced back

to the respiratory function of the lung. The normal function of respiration

is prerequisite to the production and smooth movement of qi. Otherwise,

the production of thoracic qi and the movement of qi will be affected,

debilitating the basic function of the lung in controlling qi and may ultimately

lead to the termination of life activities. Therefore, the function of

the lung in controlling general qi relies mainly on the respiratory function

of the lung. The shortage of qi, the abnormal movement of qi, and the

abnormal distribution and circulation of blood and body fluid, however,

may also be detrimental to the respiratory function of the lung.

2. The lung manages ascent and dispersion as well as descent and purification.

Ascent and dispersion mean that the lung qi can move upward

b1548_Ch-05.indd 90 1548_Ch-05.indd 90 6/10/2013 3:21:15 PM /10/2013 3:21:15 PM

www.ebook777.com

The Theory of Visceral Manifestation 91

b1548 Fundamentals of Traditional Chinese Medicine b1548_Ch-05 10 Jun 2013 3:27 PM

and disperse outward; descent and purification means that the lung qi can

move downward and clear the foreign body away from the respiratory

tract. The lung managing ascent and dispersion is mainly reflected in three

aspects: a. Discharging the turbid qi within the body by dispersion and qi

transformation. b. Distributing the body fluid and cereal nutrients transformed

by the spleen to the whole body as well as the skin and hair in the

exterior. c. Diffusing defensive qi to warm and nourish the skin and muscles,

to regulate the opening and closing of the skin striae, and to discharge

the metabolized body fluid in the form of sweat. Hence, the

dysfunction of the lung in ascent and dispersion may lead to inhibited air

tube, nasal obstruction, sneezing, unconsistent respiration, chest distress

and cough, etc. Besides, if the lung qi is obstructed and fails to disperse

the defensive qi, there will be stagnation of defensive qi, closing of the

skin striae, absence of sweat, aversion to cold and sensation of fever, etc.

The descent and purification of the lung can also be discussed in three

aspects: a. inhaling the fresh air from nature; b. distributing downward the

inhaled fresh air as well as the body fluid and nutrients from water and
cereal transformed by the spleen; c. purifying the foreign bodies inside the

respiratory tract, and keeping it clean. Thus, if the lung fails to function

properly in this regard, there will be frequent coughing and wheezing

aggravated on exertion, or chest oppression and breathing obstruction, etc.

The ascent-dispersion and descent-purification of the lung are inseparable.

They are a unity of opposites. That is why they are mutually

affected pathologically. Without normal ascent and dispersion, there will

be no regular descent and purification, and vice versa. Only when both

function properly can the air tube be smooth, respiration be rhythmic, and

the exchange of qi between the interior and exterior be normal. Otherwise,

there will be syndromes such as the lung failing to disperse and ascend

and the lung failing to purify and descend, resulting in wheezing and

coughing, etc.

3. The lung is in charge of dredging and regulating waterways, which

are passages within the body for circulating and discharging water and

fluid. This aspect of the pulmonary function relies on the ascent-dispersion

and descent-purification of the lung to regulate the distribution, circulation

and excretion of water and fluid. The ascent and dispersion of the lung

cover three aspects: dispersing the body fluid and the essence from water

b1548_Ch-05.indd 91 1548_Ch-05.indd 91 6/10/2013 3:21:15 PM /10/2013 3:21:15 PM

92 Fundamentals of Traditional Chinese Medicine

b1548 Fundamentals of Traditional Chinese Medicine b1548_Ch-05 10 Jun 2013 3:27 PM

and cereal to all parts of the body, controlling the opening and closing the

skin striae, and regulating the secretion and excretion of sweat. In contrast,

the descent and purification of the lung enable the inhaled lucid qi to reach

the kidney and make water and fluid within the body transported downward

to the urinary bladder where they transform into urine. This process

is assisted by the qi transforming action of the kidney. Besides promoting

the smoothness of the urination, the lung can also distribute water and
fluid downwards to all parts of the body because of its supreme location

above all the other viscera (The water and fluid are taken from the external

environment and then transported to the lung via the spleen and stomach).

That is why it is called the upper source of water. If the function of the

lung in regulating waterways is abnormal, there will be retention of water,

fluid and phlegm, etc.

4. The lung opens into various vessels and is in charge of regulation and

management. Almost all vessels are convened in the lung which means that

all the blood within the body is transported to the lung through different

vessels, and after exchange of qi via respiration, the fresh blood is sent

back to the whole body. It is thus evident that the lung is closely linked to

the vessels and blood circulation. The theory of visceral manifestation

holds that the motive power of blood circulation lies in the dispersion and

regulation of lung qi as well as the propelling action of heart qi. The circulation

of visible blood relies on the propelling action of invisible qi, which

is inseparable from the lung with the functions of governing respiration

and qi of the whole body. The lung opening into myriad vessels, in this

sense, means that the lung qi can facilitate and promote blood circulation.

The lung in charge of regulation and management refers to that the lung

can regulate and manage the physiological functions of the whole body. It

is largely manifested in four aspects: a. The lung controls respiration

through which the fresh air is inhaled for physiological activities, and the

turbid qi, produced in the process of metabolism, is exhaled out of the

body; b. The respiration of the lung regulates the ascending, descending,

entering and exiting of qi; c. The lung propels and regulates blood circulation

for the reason that it can manage and regulate qi activities of the

whole body; d. With the function of descent and purification, the lung can

manage and regulate the distribution, circulation and excretion of body

fluid. That is why it is likened to a prime minister in Su Wen.

b1548_Ch-05.indd 92 1548_Ch-05.indd 92 6/10/2013 3:21:15 PM /10/2013 3:21:15 PM

www.ebook777.com