Chapter 2     Physiology of TCM

A.  Zang Fu and Zang Xiang
1.  Five Zang (six zang): Liver, Heart, Spleen, Lung, Kidney, and Pericardium.
2.  Six Fu: GB, SI, ST, LI, BL, and Sanjiao.
3.  Extraordinary Fu: brain, marrow, bones, vessels, gallbladder, and uterus.
4.  The functions of zang-fu organs:
a. The main physiological functions of zang organs: to manufacture and store
 essential substances.  For example, essence, qi, blood, and body fluid.
b. The main physiological functions of fu organs: to receive and digest food, and
 transmit and excrete the wastes.
5.  Connection of Zang-fu organs: by the way of meridians and collaterals (jing luo).
6.  Concept of meridians and collaterals: qi and blood are circulated in them.
7.  The system of meridians and collaterals includes: 12 regular meridians, 8 extra
 meridians, 15 collaterals, 12 divergent meridians, 12 muscle regions, and 12 cutaneous regions.
8.  Concept of Zang Xiang: The theory of Zang-fu organs.  Zang—zang-fu organs;
 Xiang—functional manifestations.
9.  Content of Zang xiang: The study of the physiological functions and pathological
changes of Zang-fu organs, tissues, and their interrelationships.  The study of the physiology and pathology of vital essence, qi, blood, body fluid, and interrelationships.
10.  Zang—yin, interior; Fu—yang, exterior.
11.  Heart—spirit; Lung—animal spirit (daring); Spleen—ideas (thought); Liver—
 soul; Kidney—will.
12.  The names of Zang-fu in TCM are basically the same as those used in Western
  medicine, but all concepts are not the same.  The function of zang-fu is more emphasized than the structure.

B.  The Heart and Small Intestine
1.  Heart (xin):
a.  Dominating blood and vessels: Heart is the monarch of all the organs.  TCM divides heart into Heart qi, Heart blood, Heart yin, and Heart yang.
i.  Vessels are the mansion of blood.
ii.  Heart is the motive force for blood circulation.
iii.  The physiological function of heart in propelling the blood relies on the heart qi.  Normal blood circulation relies on three factors: Vigorous heart qi, Sufficient volume of blood, and Unobstructed vessels.
iv.  Physiological function of heart is reflected in pulse: Vigorous heart qi, sufficient blood volume—regular and strong pulse; Deficient heart qi and blood—thready and weak pulse; Stagnant heart qi and blood—choppy pulse.
b.  Housing the mind (shen):
i.  Mind—spirit, consciousness, and thinking.
ii.  Mental activities are the function of brain; in TCM, they are principally related to the heart.
iii.  Heart functions normally in housing mind: full of vigour, healthy consciousness, and normal mental activities.
iv.  Dysfunction in housing mind: insomnia, dream-disturbed sleep, or unconsciousness.
v.  Blood is main material basis for mental activities: Dysfunction in dominating blood and vessels—mental activities will be changed (disturbed sleep); Deficiency of heart blood—palpitation, insomnia.
c.  Sweat is the fluid of the heart. Blood and sweat have the same source.
i.  Profuse sweating—damages the heart yang.
ii.  Heart yang deficiency—spontaneous sweating.
iii.  Heart yin deficiency—night sweating.
d.  Opening into the tongue, manifesting on the face.
i.  Tongue is sprout (mirror) of heart.
ii.  Tongue is connected to heart meridian interiorly.
iii.  A lot of blood vessels on the tongue and face, so the color and luster of tongue and face reflect functions of heart.
iv.  Heart functions well and blood is plentiful.  Complexion and tongue will be rosy.
v.   Deficient heart blood—tongue and complexion will be pale.
vi.  Heart fire flares up—tongue tip will be red or ulceration on tongue body, face will be red.
vii.  Stagnant heart blood—dark or purplish tongue and complexion.
viii. Dysfunction in housing mind—stiff or curly tongue, or aphasia.
ix.  The heart in TCM basically suggests all the functions of the heart and the part of the nervous system in Western medicine.

2.  Small Intestine (xiao chang)
a.  Dominating receiving, digesting, and transforming: receives initial digested food from stomach and further digests and transforms into food essence.
b.  Separating the clear from the turbid.
c.  Small intestine dominates YE.
d.  Dysfunction: dysuria, loose stools, diarrhea, and abdominal pain and distention.

3.  The relationship between Heart and Small Intestine
a.  External-internal relationship.
b.  Accumulated heat in heartmoves to small intestine.
c.  Excessive heat in small intestineburns heart.
d.  Clear away heart fire and promote diuresis.

C.  Lung and Large intestine
1. Lung (Fei)
a.  Dominating qi and controlling respiration: TCM usually divides the lung into Lung yin and Lung qi; Lung is the official as Prime Minister, who performs jurisdiction and regulation: respiration, qi activities of whole body, blood circulation, and body fluid transmission.
i.  Dominating the qi of respiration
1)  The qi of heaven is communication with the lung.
2)  Lung is tender organ.
ii.  Dominating the qi of whole body
1) Taking part in the forming of pectoral qi (zong qi).
2) Operating and regulating the qi of whole body to ascend or descend, enter or exit.
 All kinds of qi belong to lung: Lung is healthy—even and regular respiration; Lung qi deficiency—weak respiration, weak voice, and short breath.
b.  Dominating dispersing and descending.
c.  Regulating (dredge, move, adjust) water passage (channels).
d.  Dominating the skin and hair (rules the exterior).
e.  Opening into the nose and leading up the throat.
Normal condition—nose moistening; Lung cold—watery running nose; 
 Lung heat—yellow and thick mucus; Lung dry—dry nose.

2.  Large intestine (Da Chang)
a.  Receiving and moving contents sent down from small intestine.
b.  Absorbing the water from the contents.
c.  Turning the remainder into feces.
d.  Pathological changes:
i.  Cold deficiency of the large intestinediarrhea, abdominal pain
ii.  Sthenic heat of the large intestineconstipation
iii.  Accumulation of damp-heat in the large intestineabdominal pain,
tenesmus (blocks the passage of flow of qi), diarrhea, stools with pus, blood.

3.  The relationship between lung and large intestine
a.  Exterior and interior relationship
b.  The transportation function of large intestine is related to the descending
function of lung.
i.  Normal descending function of lungsthe qi of large intestine will
descend normally.
ii.  Normal transportation function of large intestinebenefits the descending of lung qi.
iii.  Dysfunction of lungs in descending the qi and body fluid downwardconstipation.
iv.  Constipation and stoppage of the qi of the bowelsaffects the descending of lung qicough, distension in the chest.
v.  Lung qi deficiencyconstipation.
vi.  Constipationuse some herbs to promote lung’s descending function.
vii.  Dyspnea due to stasis of lung qiuse some herbs to relax bowels.

D.  The Spleen and Stomach
1.  Spleen
a.  Governing transportation and transformation: TCM classifies it into Spleen yin, yang, qi, and blood.
i.  Transporting and transforming water and food.
1)  Spleen is the source for manufacture of qi and blood.
2)  Vigorous spleen qi.
3)  Deficiency of spleen qi and dysfunction of spleen: indigestion, loose stools, fullness and distention, emaciation, malnutrition.
ii.  Transporting and transforming dampness (excessive water)
1)  Promoting water metabolism.
2)  Spleen is the source for production of phlegm.
               3)  All kinds of dampness, swelling, and fullness belong to spleen.
b.  Dominating ascending
i.  Ascending clarity.
ii.  Fixing internal organs at their original location.
c.  Controlling blood
i.  Spleen qi strong.
ii.  Spleen qi is weak and fails to control blood.
iii.  Invigorating the spleen qi to control bleeding.
d.  Dominating the muscles and four limbs
e.  Opening into the mouth and manifesting on the lip: Saliva is the fluid of spleen; manifesting in the lips.

2.  Stomach (wei)
a.  Receiving and decomposing food
b.  Dominating descending

 3.  The relationship between spleen and stomach
a.  Exterior and interior relationship
b.  Transportation, transformation, and reception
c.  Ascending and descending
d.  Yin and Yang
e.  Affect each other in pathology

E.  Liver and Gallbladder
1.  Liver
a.  Maintaining the free flow of qi: TCM classifies liver into Liver yin, blood, yang, and qi.
i.  Regulating emotional activities: Harmonizing the mood; Characteristic of liver is flourish and dislikes depression.
ii.  Promoting digestion and absorption.
iii.  Keeping qi and blood moving normally.
b.  Storing blood.
i.  Liver stores blood and regulates the blood volume in circulation.
ii.  Deficiency of liver bloodblurred vision, spasm of tendons, numbness of four limbs, amenorrhea.
c.  Controlling the tendons and manifesting in the nails.
i.  Tendons are nourished by liver blood: numbness of limbs, sluggishness of joint movement, spasm of tendons, tremors of extremities (deficiency of liver blood)
ii.  Nails are the surplus of the tendons: nails soft, thin, deformed, and brittle
(deficiency of liver blood)
d.  Opening into the eye.
i.  Eyes are nourished by liver blood.
ii.  Deficiency of liver blood: blurred vision, night blindness.
iii.  Liver yin deficiency: dry eyes.
iv.  Liver fire or wind heat in liver meridian: redness, swelling, and pain of eyes.
v.  Damp-heat in liver and gallbladder: icteric sclera.

2.  Gallbladder (Dan)
a.  Storing and excreting bile to aid digestion.
b.  Making decisions.
c.  Secretion and excretion of bile are obstructed: digestion and absorption of food will be disturbedloss of appetite, abdominal distention, and diarrhea.
d.  Upward perversion of gallbladder qibitter taste.
e.  Pathogenic damp-heat in liver and gallbladderbile overflowsjaundice, vomiting of bitter fluid.

3.  The relationship between Liver and GB
a.  Exterior and interior relationship: their meridians connect each other.
b.  The secretion, storage, and excretion of bile.
c.  Liver and GB often involve each other, as a result they both suffer from stagnation of qi and heat and dampness and heat.
d.  In treatment, they are treated together.

F.   The Kidney and Urinary Bladder
1.  Kidney (shen)
a.  Storing essence and dominating development and reproduction: TCM classifies kidney into Kidney yin, yang, essence, and qi.
i.  Essence and kidney essence: Kidney essence consists of congenital essence and acquired essence.
ii.  The essential qi of kidney and its functions:
1)  The essential qi of kidney includes kidney essence, kidney qi, kidney yin, and kidney yang.
2)  Dominating growth, development, and reproduction.
iii.  Kidney yin and kidney yang
1)  Kidney yin: the foundation of yin fluid of the whole body.  It nourishes and moistens zang-fu organs and tissues.
2)  Kidney yang: The function of yang qi of the whole body.  It warms and promotes the functions of zang-fu organs and tissues.
b.  Dominating water metabolism
i.  Water metabolism has two aspects: Disseminating nutrient fluid to whole body and excreting turbid fluid out.
 ii.  Kidney dominates the opening and closing of the gate of water: Kidney is water zang.
c.  Receiving qi
i.  Respiration is controlled by lung, but relies on reception of kidney.
ii.  Normal receiving function of kidneyrespiration is even.
iii.  Deficiency of kidney qifails to receive qiasthma, dyspnea, S.O.B after movement, difficult inhalation.
d.  Dominating bone, manufacturing marrow to fill up the brain, and manifesting in the hair.
i.  Kidney stores essence, essence produces marrow, marrow develops bone.
ii.  Marrow: Bone marrow, Spinal marrow.
iii.  Teeth are the surplus of bone.
iv.  Manifesting in the hair: Hair is the surplus of blood; Essence and blood promote and transform each other.
e.  Opening into the ear and dominating anterior and posterior orifices.
i.  Hearing relies on nourishment by the essential qi of kidney.
ii.  Anterior orificeurethra and genitalia (urination and reproduction).
iii.  Posterior orificeanusexcreting the feces.
f.  Supplement: Life gate (ming men); Life gate fire—Ming Men Huo—Kidney yang.

2.  Urinary bladder (Pang Guang)
a.  Storing and excreting urine
b.  Failure to control urine: enuresis, incontinence of urine
c.  Dysfunction of qi activities: dysuria, anuria, or oliguria
d.  Damp-heat in the bladder: urgent micturition
e.  Strengthen kidney qi and clear damp-heat

3.  The relationship between kidney and bladder
a.  External-internal relationship.
b.  Deficiency of kidney qibladder will lose its power to control urineincontinence of urine, enuresis.
c.  Dysfunction of qi activity of kidneyfails to effectively regulate water metabolismobstructs the bladder in excretion of urinedifficulty in urination, anuria.
d.  In treating: reinforce the kidney qi.

G.  Pericardium and Sanjiao
1.  Pericardim
a.  Concept: Xin Bao Luo or Tan Zhong; Tan Zhong is like the palace wall of the heart.
b.  Function: To protect the heart.
2.  Sanjiao
a.  Concept: Sanjiao is a particular term in TCM; a large bowel containing all the internal organs; solitary fu; Upper jiao (heart and lung); Middle jiao (spleen and stomach); Lower jiao (liver, urinary bladder, kidney, intestine, uterus).
b.  Functions
i.  Governing qiji (qi activities, movement of qi) and qihua of whole body.
Sanjiao is the pathway of flow of qi (ascending, descending, exiting, and entering of qi).
ii.  Serving as the passage for the flow of body fluid.
c.  The functions of upper, middle, and lower jiao
i.  Upper jiao: dominates respiration and distribution
ii.  Middle jiao: dominates digestion, transportation, and transformation
iii.  Lower jiao: dominates the separation of clarity from turbidity and the discharge of urine and stool

H.  The extraordinary fu organs (Qi Heng Zhi Fu)
1.  The brain is a sea of marrow.
a.  Controlling mental and thinking activities
b.  Guiding sensory and language activities
c.  Mental faculties and feelings result from zang-fu organs
2.  The uterus
a.  Presides over menstruation
b.  Nourishes the fetus (reproductive function)
c.  The function of uterus is related to three factors:
i.  The function of kidney: Tian Gui.
ii.  The functions of chong meridian and ren meridian: Chong is a sea of blood; Ren is a sea of yin meridians.
iii.  The functions of heart, liver, and spleen.

I.    Qi, Blood, and Body fluid
1.  Qi
a.  Concept:
i.  The essential substance comprising the human body and maintaining its vital activities (such as the qi of food essence, the qi of breathing).
ii.  The physiological functions of zang-fu organs, tissues, and meridians (such as heart qi, lung qi, and so on).
iii.  Characteristic of qi: strong activities, continuously changes and moves
b.  Formation of qi: Congenital qi and acquired qi (food essence and clear qi)
c.  The classification of qi:
i.  Yuan qi: primary qi, genuine qi; from congenital essence and acquired qi; Its functions are activating growth and development of the human body; promoting the functional activities of all the zang-fu, tissues, meridians, and other organs.
ii.   Zong qi: accumulated in the chest; from qing qi (nature) and food essence; its functions are promoting lung’s function of controlling respiration; filling heart channel to promote and adjust the circulation of qi and blood.
iii.  Ying qi: nutrient qi, ying blood, or ying yin; from food essence.  Its function is to transform and produce blood and circulate with it, provide nourishment to the whole body.
iv.  Wei qi: defensive qi or wei yang; from food essence; its functions are to protect the muscular surface and defend the body against exogenous pathogenic factors, control the opening and closing of the pores and the excretion of sweat to readjust body temperature, warm and nourish the zang-fu organs, muscles, skin, and hair.
d.  The function of qi
i.  Promoting function
ii.  Warming function
iii.  Defending function
iv.  Checking function
v.  Qihua function
vi.  Nourishing function
e.  Movement of qi (qi ji)
i.  Four basic movement of qi: ascending, descending, exiting, and entering
ii.  Harmonious functional activities of qi
iii.  Disharmonious functional activities of qi: Collapsed qi (qi xian); Stagnant qi (qi zhi); Rebellious qi (qi ni); Escape of qi (qi tuo); Depressed qi or close qi (over accumulation)
f.  Other types of qi: organ qi, meridian qi, zhen qi, zheng qi, xie qi, gu qi, water qi, jing qi, middle qi, etc.

2.  Blood
a.  Concept: a red liquid circulating in the vessels.
b.  Formation of blood: Ying qi and body fluid, from food essence and kidney essence.  Spleen is the main source for producing blood.
c.  Circulation of blood.
d.  Function of blood.
i.  Nourishing and moistening the whole body.
ii.  Blood is the material basis for mental activity.
e.  Insufficiency of blood: impaired vision, dryness of eyes, motor impairment of joints, numbness of four limbs, skin dryness, and itchiness.

3.  Body fluid
a.  Concept: all normal liquids of the body are called jin ye, including jin and ye.
b.  Formation, distribution, and excretion of body fluid: from water and food. Distribution involving spleen, lung, kidney, sanjiao, liver, heart.  Discharged by lung, kidney, bladder, etc.
c.  The functions of body fluid
i.  Moisturizing and nourishing.
ii.  As a component of blood.
d.  Deficiency of body fluid: thirst (stomach heat), constipation (intestinal heat), and dry cough (dryness of lung).

4.  Retention of phlegm fluid
a.  Concept: Phlegm fluid (pathological products resulting from disturbance of water metabolism); classify phlegm (thick and turbid) and retention (thin and clear) fluid; phlegm divides into concrete phlegm and formless phlegm.
b.  The formation of phlegm fluid:
i.  Pathogenic factors: six exogenous factors, improper diet, and seven emotional factors.
ii.  Pathogenic mechanism: pathogenic factors—dysfunction of lung, spleen, kidney, and sanjiao—disturbance of water-fluid metabolism—accumulation of fluid—phlegm fluid
iii.  Symptoms of phlegm fluid: different symptoms in different organs.

5.  The relationship between Qi and Blood
a.  Qi is the commander of blood
i.  qi can produce blood
ii.  qi can promote blood
iii.  qi can check blood
b.  blood is the mother of qi

6.  The relationship between Qi and Body Fluid
a.  qi can make body fluid.
b.  qi can promote body fluid and transform and excrete water.
c.  qi can guide body fluid.
d.  body fluid can carry qi.

7.  The relationship between blood and body fluid
a.  Blood and body fluid have the same source.
b.  Blood deficiency—body fluid becomes less—dry skin, even dry nails.

J.   Jing and shen
1.  Jing
a.  Concept: All kinds of essential substances (broad meaning), Essence (narrow meaning).
b.  Origins of Jing: Prenatal Jing (xian tian zhi jing), Postnatal Jing (hou tian zhi jing).
c.  Function of Jing: Dominating growth, development, and reproduction.
d.  Disharmony of Jing: improper maturation, sexual dysfunction, inability to reproduce, and premature aging.
2.  S hen
a.  Concept:
i.  Shen is vitality (mind): Shen is the general manifestation of vital activities
ii.  Material base of Shen—qi, blood, essence, body fluid
iii.  Shen is generated by the functional activities of zang-fu organs
b.  Manifestation of shen:
i.  Having strong shen (favorable prognosis)
ii.  Lack of shen (serious illness or unfavorable prognosis)
iii.  Pseudo shen (impending death)

K.   Summing up
1.  Functions of the five zang
Xin (Heart)
1)  Rules Xue and Xue Mai (blood vessel)
2)  Stores Shen (mind).
3)  Sweat is the fluid of the heart.
4)  Opens into tongue, manifests in face.

Gan (Liver)
1)  Rules free-flowing of Qi.
2)  Stores Xue (blood).
3)  Rules tendons.
4)  Opens into eyes, manifests in nails.

Pi (Spleen)
1)  Rules transportation and transformation.
2)  Rules muscles and limbs.
3)  Governs Xue (blood).
4)  Holds up organs.
5)  Opens into mouth, manifests in lips.

Fei (Lung)
1)  Rules Qi and governs respiration.
2)  Governs dispersing and descending.
3)  Regulates water channels.
4)  Rules exterior of body.
5)  Opens into nose, manifests in body hair.

Shen (Kidney)
1)  Stores Jing, rules reproduction and growth, rules bones.
2)  Foundation of Yin Yang.
3)  Rules water.
4)  Rules reception of Qi.
5)  Opens into ears, manifests in hair.

2.  Functions of the six Fu
Xiao Chang (Small intestine)
1)  Dominating receiving, digesting, and transforming.
2)  Separating the clear from the turbid.

Dan (Gallbladder)
1)  Storing and excreting bile to aid digestion.
2)  Making decisions.

Wei (Stomach)
1)  Receiving and decomposing food.
2)  Dominating descending.

Da Chang (Large intestine)
1)  Receiving and moving contents sent down from small intestine.
2)  Absorbing the water from the contents.
3)  Turning the remainder into feces.

Pang Guang (Urinary Bladder)
Storing and excreting urine.