Zang-Fu Organs
In western medicine, the body’s organs are explained in terms of their anatomical structure and physiological functions. However, in Traditional Chinese Medicine (TCM), the approach is quite different. Organs are considered functional units of the body. Therefore, what is typically thought of as an organ (i.e. heart, liver, stomach etc.) has a much broader meaning and application in TCM. An organ’s anatomical structure is not as important as its yin yang properties or relationships with other organs. Chinese medicine recognizes five yin organs and six yang organs, also known as “Zang” and “Fu” organs respectively.
What are Yin Yang Organs?
The yin organs include the liver, heart, spleen, lungs and kidneys. The pericardium is sometimes considered a sixth yin organ. The function of the yin organs is to produce, transform, regulate and store fundamental substances such as qi, blood, and body fluids. In general, yin organs do not have empty cavities.
The six yang organs are made up of the gall bladder, stomach, small intestine, large intestine, bladder and triple burner. The triple burner does not have a physical structure and is considered a functional unit. The yang organs are mainly responsible for digesting food and transmitting nutrients to the body. Usually, yang organs are organs with empty cavities.
In TCM, the physiological functions of the body are based on harmonious relationships between yin and yang organs. Central to these relationships is the interior and exterior relationship theory, which states the interior belongs to yin and the exterior belongs to yang. Hence, yin organs are thought to have more internal functions and are called interior organs. They tend to play a more important role in TCM medical theory and practice. The yang organs, on the other hand, are believed to have more external functions and are considered exterior organs. (See table.)
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In western physiology, the lungs are responsible for air exchange. In addition to performing respiration in TCM, the lungs’ regulate fluid metabolism, blood circulation, the autonomic nervous system and the immune system.
“The lungs rule qi and administer respiration. “
The lungs are where qi exchange and regulation occurs. During inhalation, the lungs take in natural air qi (one type of qi referring to the atmospheric air), propelling it downward where it meets other types of qi. The different types of qi combine to produce normal qi (qi present in the body). During exhalation, the lung expels the “impure” air not useful to the body. If the lungs are healthy, qi will enter the body smoothly and respiration will be even and regular. If there is lung disharmony, respiration is weakened and normal qi production is affected, leading to qi deficiency.
“The lungs direct movement in a disseminating, descending and liquefying manner.”
The lungs disseminate substances in an ascending and outward direction. For example, impure air is expelled in this manner, and body fluids and food nutritive essence are directed towards the skin and hair. By regulating sweat secretion, the lungs disseminate protective qi (qi mainly responsible for immunity) to the skin and the pores.
The lungs also demonstrate descending and liquefying properties. They take in natural air qi during respiration and liquefy the fluids in the airway. The lungs then descend these substances downwards along with food essence transformed by the spleen. The descending function is necessary to maintain a normal respiratory tract.
The disseminating, descending and liquefying properties of the lungs are essential for good health. If disharmony occurs, individuals may suffer from coughing, wheezing, chest discomfort, abnormal sweating or congestion from phlegm.
“The lungs move and adjust the water channels”
The lungs are responsible for the transformation and movement of water in the body. They move water in the same directions as qi. The lungs’ disseminating properties enable water vapor to ascend and scatter to the skin pores. This is the process of normal sweating. The lungs also liquefy and cause water vapor to descend to the kidneys, where the liquefied waste is excreted as urine.
“The lungs collect blood vessels and rule regulation.”
As mentioned before, the lungs rule qi. By regulating qi movement, which is necessary for blood circulation to occur, the lungs intercept all blood and blood vessels. After qi exchange occurs during breathing, the qi moves the blood throughout the body. Qi movement also regulates the distribution of body fluids. Since qi is essential for all physiological functions in the body, the lungs’ ability to ‘rule and regulate qi” is an important function.
“The lungs open into the nose and their brilliance is manifested in the body hair. The lungs also connect to the throat.”
The skin and body hair share a close relationship with the lungs. Together with the sweat glands, they are often referred to as the “exterior” of the body in TCM. The lungs are the interior organs that rule this exterior. By controlling the skin, sweat glands and body hair, the lungs regulate the sweating process. In addition, they maintain healthy movement and dissemination of protective qi over the skin. Protective qi is important for guarding the body against “illness evils” (factors causing illness including wind, fire, dampness, dryness, cold and summer heat). If these particular lung functions are weakened, too much spontaneous sweating occurs, and the protective qi will become weak as well. As a result, the body will have lower resistance to illness and may easily get colds, influenza, or other respiratory problems.
The nose is considered the opening of the lungs and the exit for qi in the body. If lung dysfunction occurs, the nose is affected. For example, disordered flow of lung qi leads to a watery nasal discharge, congestion, a loss of sense of smell and sneezing. The throat and vocal cords are also connected to the lungs. Sometimes lung deficiency produces a coarse or low voice.
In TCM, the functions of the heart are different from those of the anatomical heart, as it is understood in western medicine. The heart organ represents a group of physiological functions. In addition to regulating the cardiovascular system, it is responsible for maintaining the nervous system’s functions.
“The heart rules the blood and blood vessels”
The heart is the functional unit for regulating blood flow. Blood is transported inside the blood vessels around the entire body when the heart pumps. The heart, blood and blood vessels are united by their common activities. In TCM, this functional relationship is known as the “ruling” of the heart.
Heart qi refers to the pumping actions of the heart. If heart qi is abundant and sufficient, the heart pumps at a normal pace, transporting blood smoothly inside the blood vessels, the pulse is regular and strong, and the face will look brilliant. As a result, the body is able to obtain from blood the nutrients needed to sustain life. On the other hand, if heart qi is deficient, blood cannot maintain an efficient flow in the blood vessels, and the pulse is weak. The individual looks pale, and the tongue also appears pale and white. Without healthy ruling of the heart, individuals will experience palpitations, chest discomfort and pain.
“The heart rules the spirit”
In TCM, the heart stores the “spirit”. In general, the “spirit” refers to an individual’s vitality, which is reflected in the eyes, speech, reactions and overall appearance. Specifically, the “spirit” refers to a person’s mental, cognitive and intellectual abilities. The heart takes charge of mental activities by mastering other organs and their physiological functions. If the “spirit ruling” is good, the individual will be wise and have a clear and fast mind. If there is heart disharmony, signs like forgetfulness, poor self esteem, and slow thought processes or reactions occur.
“Sweat is the fluid of the heart.”
Sweat comes from body fluids, which are an essential and integral part of blood. Blood is ruled by the heart and is the main fluid of this organ. Because sweat comes from the same origin as blood, in TCM over-sweating is considered an exploitation of qi and heart blood, leading to symptoms such as palpitations. As a result, people who sweat abnormally usually have a heart deficiency. If such sweating is spontaneous, the disharmony belongs to a deficiency of heart yang. If it takes place at night, the disharmony belongs to a deficiency of heart yin.
“The heart opens into the tongue. The heart’s brilliance is manifested in the face.”
In TCM, both the tongue and face are windows for the heart and blood. The heart “opens into the tongue” because they are connected. By observing the tongue and looking for the “heart’s brilliance to be manifested in the face,” a lot can be learned about how the heart is functioning. For example, if heart function is normal, individuals will have bright, healthy red cheeks and the tongue will appear pink. If there is blood stasis (where blood is not able to flow smoothly through the blood vessels), the face and tongue will appear purple. A healthy blood supply is also essential for providing nutrients for hair growth, because in TCM, hair is thought to be the “remains of blood.” If hair growth is affected, it may indicate a problem with the heart and blood.
In western physiology, the liver is responsible for a number of important body functions, including the production and excretion of bile, which is used to break down fat and the detoxification of blood. However, according to TCM, the liver’s functions are different. They include control of the central nervous system, the autonomic nervous system (the part of the nervous system over which a person does not have voluntary control), and the circulatory system. In addition, the liver is responsible for vision.
“The liver rules flowing and spreading.”
In TCM, the liver promotes flowing and spreading movements. By stimulating flow, the liver adjusts and ensures the smooth movement of qi, blood and body fluids, and spreads these substances to the entire body. There are three functional aspects of the liver’s “flowing and spreading” activity: regulating qi, regulating emotions and enhancing the digestive properties of the spleen.
1). Regulating qi movement
The activities of the organs and meridians are dependent on qi movement. The flow and spread of qi throughout the body are in turn dependent on the regulatory functions of the liver. If the liver is not functioning properly, qi flow is interrupted, which can lead to disharmony and imbalance. When this becomes marked,, disease and other health problems ensue.
2). Regulating emotions
The liver balances emotions. Normal emotional health depends on the harmony of qi and blood. When the liver keeps qi flowing smoothly, a relaxed internal, emotional environment is created. If liver disharmony results in stagnant liver qi, emotional disturbances like depression and anger can occur.
3). Enhancing the digestive power of spleen
The liver’s flowing and spreading functions also adjust the digestive functions of spleen. If the liver is not functioning properly, the movement of spleen qi is not smooth. Consequently, the transformation and transportation of digested food will be affected, leading to abdominal pain, nausea, belching, diarrhea and other complications.
“The liver stores the blood.”
The liver is also responsible for storing and regulating blood flow. When a person moves or exercises, the blood leaves the liver and goes to the part of body that needs it. The blood returns to the liver to be stored, when a person rests. If a person has insufficient blood available for storage in the liver, their eyes will not be adequately nourished and will become rough and dry. Dizziness can also occur.
“The liver opens into the eyes.”
The eyes have a close relationship with the liver; because, they are connected to the liver meridian. The ability to see depends on the nourishment of the eyes from blood stored in the liver, and many liver disorders are reflected in the eyes. For example, insufficient liver blood can lead to blurred vision. “Dampness and heat” of the liver and gall bladder, a condition known in western medicine as jaundice, manifests as yellow eyes.
“The liver rules the tendons and is manifested in the nails.”
The proper movement of tendons, which attach muscle to bone, is closely related to liver function. If the blood stored in the liver is insufficient and incapable of nourishing the tendons, symptoms like spasms, numbness of limbs and difficulty bending or stretching occur. Fingernail and toenail health is also dependent on the nourishment of blood from the liver. If the liver blood is sufficient, nails will appear pink and moist. If it is insufficient, the nails will become thin, brittle and pale.
In western physiology, the spleen is a large, vascular, lymphatic organ. It acts as a reservoir and filters the blood. It also plays a role in making blood early on in life. In TCM, the spleen does not perform these functions. It assists with digestion, blood coagulation and fluid metabolism in the body.
“The spleen rules transformation and transportation.”
Since the spleen is the primary organ responsible for digestion, its main function is to transform food into essence used for qi and blood transformation. Once the ingested food and liquids get into the body, the spleen extracts a pure nutritive essence from them. This pure nutritive essence is used for the production of qi, blood and body fluids, which the spleen then transports throughout the body. Liquids extracted as pure nutritive essence are sent upwards to the lung for dissemination and redistribution. However, some will descend to the kidney and bladder to be excreted as urine.
If the transformation and transportation functions of the spleen are harmonious, there will be abundant nutritive essence for qi and blood, but if the spleen is in disharmony, its digestive powers will be affected. As a result, abdominal distention, pain, diarrhea or malaise occurs.
“The spleen rules ascending pure essence.”
After transforming food into nutritive essence, the spleen sends it upwards to the heart and lungs where it is transformed into qi and blood for nourishment of the whole body. Food not transformed into nutritive essence becomes an impure substance. While the spleen ascends pure essence, the stomach, (the spleen’s corresponding exterior organ), will descend the impure substances inside the digestive tract. By ascending the pure nutritive essence and descending the impure substances, a balance in the digestive system is created.
“The spleen governs the blood.”
Not only does the spleen transform food essence, it also governs the movement of blood by keeping it flowing in its proper pathways in the blood vessels. When spleen qi is sufficient, there is adequate production of qi and blood, and blood is, therefore, kept inside the blood vessels. If the spleen’s functions are in disharmony, the blood escapes from its normal pathways, leading to symptoms such as bloody vomit, blood in the stool, blood under the skin, blood in urine, or menorrhagia (excessive menstrual bleeding).
“The spleen rules the muscles and flesh. It opens into the mouth and its brilliance is manifested in the lips.”
In TCM, the movements of the muscles and the four limbs depend on the power of the spleen. When spleen qi is sufficient, the limbs and muscles are healthy and strong because they are nourished by the blood and qi. If spleen qi is deficient, however, the muscles become weak and an individual may feel tired and have general malaise.
The lips and mouth are also affected by the spleen’s health. If spleen function is harmonious, the mouth can distinguish the five tastes (sweet, salty, sour, bitter and pungent (spicy)), and the lips appear red and moist. If the spleen is weak, the mouth cannot distinguish the different tastes and the lips will be pale.
In western physiology, the kidneys are a vital excretory organ whose main function is to create urine to help the body get rid of toxins and unwanted water. TCM practitioners view the kidneys as a very important organ that not only regulates the urinary system but also exercises control over the reproductive, endocrine and nervous systems.
“The kidneys store Jing”
In TCM, Jing is an essential substance, closely associated with life. It is the substance needed for reproduction, growth development and maturation. The kidneys are the organs responsible for human development, because they store Jing. For example, conception is made possible by the power of Jing, growth to maturity is the blossoming of Jing, and aging reflects the weakening of Jing. As time passes, Jing decreases, causing both vitality and kidney qi to decline. This decline is the normal aging process.
“The kidneys rule water.”
The kidneys rule water by regulating its distribution and excretion, traditionally described as the vaporizing power of the kidneys. The kidneys can differentiate between clean water, which is recycled and used by the body, from turbid water that is turned into urine. The separation of these two is the vaporization process.
The kidneys play an important role in water movement and balance of the whole body. Fluids and food are received by the stomach where separation begins. The unusable portions of food and fluid are sent to the intestines as waste where pure fluids (mainly water) are extracted from them. The pure fluids go to the spleen, which then sends them in a vaporized state upward to the lungs. The lungs circulate and disseminate the clear part of the fluids throughout the body. Whatever has become impure through use is liquefied by the lungs and sent downward to the kidneys. In the kidneys, the impure fluids are further separated into “clean” and “turbid” parts. The clean part is vaporized into a mist and sent upwards to the lungs, where it rejoins the cycle. The final impure portion goes to the bladder, where it is stored and finally excreted as urine.
“The kidneys rule the grasping of qi.”
Although respiratory functions mainly depend on the lungs, deep and normal breathing is controlled by the “grasping” function of the kidneys. By grasping qi, the kidneys enable the “natural air qi” of the lungs to penetrate deeply during the inhalation process. If there is kidney disharmony, respiratory problems such as shallow breathing or wheezing on exertion can occur. Some types of asthma are related to disordered grasping of qi by the kidneys. “The kidneys rule the bones and produce bone marrow.
“The kidneys manifest in the head hair.”
Stored in the kidneys, Jing is the substance responsible for producing bone marrow, which in turn, creates and supports bone growth. Therefore, bone development and repair depends on the nourishment of kidney Jing. Deficiency of Jing in children can lead to soft bones or incomplete closure of the skull bones. Teeth are made up of bone so dental problems can also indicate a kidney deficiency.
Head hair depends on blood for its nourishment. The kidneys play a role in transforming stored Jing into blood. If Jing and blood are abundant, the hair will appear bright, shiny and healthy. On the other hand, hair loss or other hair disorders can indicate a kidney deficiency or blood deficiency.
“The kidneys open into the ears and genital organs.”
Good hearing comes with abundant kidney Jing, while a deficiency causes hearing problems like deafness or ringing in the ears (tinnitus). Genital and urinary tract disorders such as urinary frequency or dripping urine (incontinence) are also signs of kidney disharmony.
Stomach Bladder
The stomach, known as “the sea of food and fluid”, is responsible for “receiving” and “ripening” ingested food and fluids. When food is ingested, it passes down into the stomach where stomach qi and fluid decompose it into materials to be further digested in the small intestine.
Food is divided into two parts in the stomach. The “pure” part is sent upwards to the spleen for transformation into nutrient materials for the body. The “impure” part is sent downwards to the small intestine. This function is called the “descending the impure” in TCM. While the spleen rules “ascending” functions, the stomach rules “descending” functions. If the stomach loses its descending properties, disharmony occurs, leading to symptoms such as nausea and vomiting. Being a yang organ, the stomach prefers a moist rather than dry environment. Excess of yang may sometimes cause “dryness fire” which leads to stomach disharmony as well. This condition presents as a dry mouth and thirst.
Bladder：
The bladder is responsible for storing and excreting urine. As previously discussed, the lungs, spleen and kidneys all have roles in fluid metabolism and regulating the water distribution in the body. The “turbid’ water collected by the kidneys that cannot be reused by the body is sent to the bladder for excretion as urine. TCM describes this function as “vaporization” of urine in the bladder. Disharmony of the bladder can lead to urinary problems such as incontinence or difficult urination. Kidney function complements bladder function so a problem with the bladder often indicates kidney problems as well.
Gallbladder：
Similar to western medicine, in TCM the Gallbladder stores and secretes bile produced by the liver. The liver’s flowing and spreading properties allow bile to be secreted into the small intestines where it aids the digestive process. Liver harmony is essential for the healthy functioning of the Gallbladder. The secretion of bile also supports the spleen in its transformation functions. If liver disharmony occurs, bile secretion is affected, which can have a negative impact on other digestive functions. Disharmony of Gallbladder function leads to jaundice where an individual develops yellow eyes and yellow skin colour as a result of a build up of bile in the body.
In TCM, the Gallbladder rules decision and is related to bravery. Mental disorders involving anxiety and fear are treated by resuming gall bladder harmony.
small intestine：
The small intestine rules “containing and transforming.” It receives what the stomach has not completely digested and this material is further digested into nutrients. The small intestine also separates the “pure” from the “impure.” Like the stomach, the small intestine sends the “pure” (useful) part to the spleen where the nutrients will be distributed, and the “impure” (waste) part is directed down into the large intestine. Any useless water produced in the digestion process will be sent to the bladder and stored as urine. Healthy small intestine functions are essential for normal urination and defecation. If disharmony is present, an individual may experience dysuria (difficulty or pain on urination) or loose stools.
large intestine：
The large intestine receives the “impure” parts of the digested food from the small intestine and continues to absorb water from these materials. At the end of the process, stools are formed and excreted through the anus. Large intestine disharmony presents with symptoms of abdominal pain, intestinal rumblings and diarrhea. Sometimes, if there is excessive “heat”, intestinal fluids will dry up, and constipation will occur.
Triple Energizer
The triple burner is a special concept in TCM, and there is no corresponding organ in western medicine. Suggestions have been made that the triple burner’s function may be related to the pancreas and metabolism in the body, but no clear conclusion has been reached as to the nature of this organ. The triple burner is actually a collective term for the upper, middle and lower burner. The Chinese word “triple burner” actually means “three parts which burn or scorch.”
The upper burner is located above the diaphragm and includes the heart and lungs. The middle burner is located in the region above the belly button and below the diaphragm and includes the spleen and stomach. The lower burner is located below the belly button, and it includes the liver, kidneys, large intestine, small intestine and bladder. (This description of location is used for the functional classification of the TCM triple burner. The above locations do not refer to the anatomical location of organs.)
The triple burner’s functions relate to the activities of qi and the movement of water. The functions of the three burners were summarized in the Huang Di Nei Jing (The Yellow Emperor’s Classic of Internal Medicine) as follows: “The upper burner acts like a mist. The middle burner acts like foam. The lower burner acts like a swamp.”
“Mist” refers to the disseminating functions of the upper burner. With this function, qi, blood and body fluids are distributed throughout the body just as mist disperses in the environment. “Foam” means the digestive churning of the middle burner. When the spleen and stomach transform and ripen food, the food decomposes in a similar way to foaming. “Swamp” relates to the excretion of impure substances. The lower burner separates the “clear” from the “turbid” substances and excretes these impurities as wastes- like a swamp breaks down certain vegetation.
The triple burner is the passage through which water, food and fluid are transported. The Huang Di Nei Jing (The Yellow Emperor’s Classic of Internal Medicine) also says, “The triple burner is the controller of the entire circulation of body fluid”. Therefore, disharmony of the triple burner can lead to edema ( fluid collection in the tissues) or difficult urination. Treatment of these conditions is aimed at resuming the harmony of the affected organs such as the lungs, spleen or kidneys.