The Internal Organs are known in Chinese medicine as the Zang-Fu. The Zang Organs are yin: their anatomical structures are mostly solid and they are responsible for producing and moving vital substances in our bodies. The anatomical structures of the Fu, or Yang Organs, are mostly hollow tubes intended to process food and eliminate waste from the body. The Organs are organized into yin and yang pairs (elemental pairs) based on the Five Element theory. The Yin Organs usually have many more functions and responsibilities than their yang counterparts.
The following discussion places the Organs into one or more of the three categories described earlier as the prerequisites of life—that is, survival, interaction, and differentiation. This order describes a progression of sophistication and complexity in the functions of the Organs.
· Lung and Large Intestine are the yin and yang pair of the Metal element and are associated with survival.
· Spleen and Stomach are the yin and yang pair of the Earth element, also associated with survival.
· Heart and Small Intestine are the yin and yang pair of the Fire element; they relate primarily to the level of interaction, but they are also involved at the level of survival.
· Kidney and Urinary Bladder are the yin and yang pair of the Water element; they relate primarily to the level of interaction, but also to survival.
· Pericardium and Triple Heater are the yin and yang pair of a quality of the Fire element called Ministerial Fire, and they are associated with the level of differentiation.
· Liver and Gall Bladder are the yin and yang pair of the Wood element, and they too relate to the level of differentiation.
There are specific responsibilities assigned to the Organs, with descriptions appropriate to the governmental roles that were necessary for maintaining the peace and safety of the Empire. The Yin Organs are generally given more emphasis because they store essential substances and have the greatest responsibility for the requirements of life. The Yang Organs, on the other hand, are more about elimination. Each Organ has at least one particular “principle” to accomplish.
While Chinese medicine acknowledges the important physiological functions of the various anatomical organs, it also gives us an understanding of other significant and subtle functions as they relate to the emotions and how we interact with the world, and to the complex interactions between the Organs. As we continually shift between the concerns of survival, interaction, and differentiation, the responsibilities and interrelationships of the Organs become relatively more complex and sophisticated, offering us the opportunity to become more aware of how we manage the world and to transform ourselves based on the realizations we gain.
The Level of Survival—Lung/Large Intestine and Stomach/Spleen
Survival requires the fundamental ability to breathe and digest food. The survival instinct is primitive, held in our DNA. Comfort is not important when our survival is threatened. We must have the functional ability to breathe and receive nourishment from food before any other aspect of life can be addressed.
Metal
Lungs—Yin Metal
As we inhale, the Lungs receive the inspiration of Da Qi/Great Qi; then, with their descending vector of Qi, the Lungs direct the breath downward in the body to be grasped by the Kidneys. The Great Qi joins with our Essence to define and manifest our destiny in life. With the completion of each inhalation, the Lungs’ dispersing quality reverses the direction of Qi to allow for expiration and the release of that which is no longer needed. The Great Qi joins with our Gu Qi (the energy resulting from our food intake) to generate Postnatal Qi.
Physiologically, the Lungs’ dispersing quality supports their responsibility for bringing fluids to the skin, which allows for perspiration, maintains moisture in the mucosal membranes of the sensory orifices, and helps the body expel excessive fluid through the expectoration of sputum or phlegm.
The Lungs are the first line of defense against external pathogenic factors. At this first exposure to exogenous influences, namely, the influences associated with Wind, the body is challenged to accommodate the volatility of change. The external factors might be the pathogens of Wind and Cold, where treatment strategies include promoting sweat and expectoration. Or the factors might be the challenges and sadness we sometimes face during our lives.
The term Lung Yin describes the mucous membrane of the entire respiratory tract, which is heavily dependent on sufficient hydration. Adequate Lung Yin is necessary to support Wei Qi, with all of its defensive functions that are somewhat analogous to the immune system.
Organ Interactions
Lung–Large Intestine: Metal elemental pair. In addition to communicating with the Kidneys, the descending vector of Lung Qi affects the functions of the Large Intestine, encouraging peristalsis to eliminate waste.
Lung–Spleen: Taiyin zonal pair
Lung–Kidney: The Lungs direct the breath downward to the Kidneys, to join with and inspire the Essence to fulfill its destiny. This interaction also supports urination.
Lung–Heart: Lung Qi supports Heart Qi to circulate the Blood.
Lung–Stomach/Spleen: Along with the Stomach and Spleen, the Lungs are responsible for the production of Postnatal Qi.
Lung–Liver: The Lungs have an important relationship with the Liver as they share the responsibilities of managing Defensive/Wei Qi. Pathologically, when the Lungs are weak and the Liver has too much energy, the ascending vector of the Liver brings its Qi to “insult” the Lungs, causing a strong, machine gun–like cough.
Role: Minister of Justice; to give us the ability to develop moral values and fairness
Principle: Respiration
Anatomical association: The Lungs are the organ with the most direct contact to the external world, giving them an association with the skin.
Emotion: The Lungs allow us to be vulnerable, and the related emotion is grief.
Virtue: The Lungs convey the ability to let go and forgive.
Large Intestine—Yang Metal
As the yang partner to the Lungs, the Large Intestine relies heavily on Defensive/Wei Qi to perform its peristaltic action and on fluids to maintain its mucous lining. Wei Qi’s involvement with the functioning of the Large Intestine demonstrates the relationship of the Large Intestine to the immune system as understood by Western medicine.
The Large Intestine’s primary responsibility is digestive in nature. It receives any remaining nutrients from the Small Intestine, absorbing anything useful before excreting the waste. Even at this relatively primitive level of functioning, the Large Intestine can make the distinction between nutrient and waste.
The Large Intestine fulfills the yang aspect of letting go and moving on.
Organ Interactions
Large Intestine–Lung: Metal elemental pair
Large Intestine–Stomach: Yangming zonal pair
Principle: Regulate Fluids; eliminate waste
Earth
Stomach—Yang Earth: The Basis of Postnatal Qi
The Stomach is responsible for the production of Postnatal Qi.
Classically, the Stomach was given a position of central importance. Our capacity to feel nurtured begins with the ability to receive and process food. Food itself serves as an important part of the bonding process. During the digestive process, the Stomach has the first opportunity to prioritize nutrients, sending what it does not want to the Small Intestine for further processing. If the rotting and ripening process of digestion is not functioning well, the Stomach cannot produce the Grain/Gu Qi that supports the generation of Lung Qi and, hence, Postnatal Qi. Overall, the Stomach’s vector of energy is descending to promote digestion.
The Stomach has the important responsibility of producing Fluids. In this capacity the ascending vector of the Stomach’s yin pair, the Spleen, brings the Thin Clear Fluids/exocrine fluids upward via the trajectory of the Stomach meridian to moisten the nose, lips, tongue, eyes, and ears. In classical literature the Stomach also has responsibility for the initial production of Blood.
The term Stomach Yin refers to the mucous lining of the entire digestive tract.
Organ Interactions
The Stomach’s central role gives it influence over all the Internal Organs.
Stomach–Spleen: Earth elemental pair
Stomach–Large Intestine: Yangming zonal pair
Stomach–Liver: On occasion, when the Liver Qi is tight it can invade the Stomach, causing symptoms such as belching, nausea, sour reflux, vomiting, or hiccups.
Principle: Digestion; “rotting and ripening”
Spleen—Yin Earth
The Spleen’s primary responsibility is to transform and transport. It transforms food that has been ingested into something useful for the body and then transports the result to the area of the body where it can be most helpful or most easily eliminated. This process is referred to as “separating the clear from the turbid.” The Spleen’s energetic vector is ascending. It supports the upward movement of fluids to moisten the mucous membranes of the Lungs and the sensory orifices. This ascending vector supports our structure as well. A prolapsed urinary bladder or uterus or poorly toned musculature is indicative of a weakness in the Spleen’s ascending vector.
The heaviness implied by the word prolapse is a clue to what happens when the Spleen is too weak to perform its job of transformation and transportation. We become Damp, or heavy, and indeed, the Spleen is the organ most damaged by Dampness.
The Spleen is also responsible for producing the “red substance” that becomes Blood, and for providing the structural integrity to “keep the Blood in its banks.” Varicose veins are a sign of a failure in this regard. This responsibility supports the Five Element concept of Earth maintaining boundaries.
As the Stomach’s yin pairing, the Spleen shares major responsibility for the production of Postnatal Qi. Our ability to engage and function in the world requires our four limbs, which give us the capacity to step out into our lives and to handle what we encounter. The Spleen has a strong influence on the four limbs.
The Spleen is associated with Earth. It offers us the ability to assimilate the requirements of our culture—to behave in a way that is harmonious with the community in which we live. The Kidneys, on the other hand, are associated with the self. Our primitive need to survive requires us to interact and cooperate with our family, our friends, authority figures, and our immediate environment. The Kidneys sacrifice their Qi and Essence to support the needs and responsibilities of the Spleen.
Organ Interactions
Spleen–Stomach: Earth elemental pair
Spleen–Lung: Taiyin zonal pair. The Spleen sends its red substance to the Lungs to be oxygenated. The Lungs take the stagnation and turbidity from the Spleen’s Dampness and try to eliminate it through expectoration or urination (via the Lung–Kidney interaction).
Spleen–Heart: The Spleen, with its ascending vector of energetic circulation, directs the red substance to the Heart. The rib cage protects the Heart. The channel called Da Bao/Great Wrap, which wraps around the chest, is associated with the Spleen.
Spleen–Kidney: Kidney Yang supplies the Heat needed for the Spleen’s process of transformation and transportation.
Spleen–Liver: When the Spleen is weak it becomes susceptible to attack. A very common pattern of energetic imbalance is called Liver invading Spleen/Stomach. Typical symptoms of this energetic imbalance include bloating, alternating constipation and diarrhea, hypochondriac and abdominal distension and pain, pebbly and dry stools or loose stools, fatigue, reduced appetite, menstrual irregularity, and flatulence.
Principle: Transform and transport; digestion
Anatomical association: The four limbs
Emotion: Worry, obsession
Virtue: Empathy
Energetic vector: The Organs of the Earth element, the Stomach and Spleen, balance each other. The Stomach has a descending vector of energy; the Spleen ascends. The Earth is the only element that has this balanced, harmonizing effect in the body.
The Level of Interaction—Heart/Small Intestine and Urinary Bladder/Kidney
If the Organs responsible for survival are functional and the necessary resources are available, we have the freedom to realize desires that go beyond just breathing and eating. We crave interaction with other beings and with the deepest levels of our own individual consciousness.
Fire
Heart—Yin Fire
The Heart holds tremendous importance in Chinese medicine as the residence of the Spirit/Shen. It is also, of course, responsible for moving the Blood, which circulates the Shen and our emotions.
From an evolutionary point of view, the Heart relates to the process we undergo when we become willing to embrace the self. The Heart gives us the opportunity to see the self as it really is, without any cognitive process. It is unconditional in its relationship to everything it experiences. There is no good or bad. There is only pure experience.
The mudra of the prayer posture, with both hands touching palm to palm at the heart, symbolically brings the duality of life into union. This process is about no longer reaching out to the world but coming inward to the chest: returning to the breath and receiving that embrace. When we are unable to do this we invite disease: heart disease, asthma, breast disease.
The Heart is the bond to the self. It delights in the Spirit, and not in what the world expects of us.
Organ Interactions
Heart–Small Intestine: Fire elemental pair
Heart–Kidney: Shaoyin zonal pair. The Heart is associated with Fire, the most yang element. The self is housed in the Kidneys, the most yin element of Water. Although the Kidneys contain our Essence, along with its imperative to survive, the Heart imbues the Essence with an enthusiasm for experience. Thus, the most yang—the Heart—gives birth to the most yin—the self.
Heart–Pericardium: The psychosocial activities of the Heart are governed by the Pericardium.
Role: The Heart is the Sovereign Ruler.
Principle: Governs the movement of Blood
Anatomical association: The Heart opens to the tongue, allowing us to speak the truth as we see it. It also controls the sweat.
Emotion: Joy or anxiety
Virtue: Gratitude and compassion
Small Intestine—Yang Fire
Anatomically, the Small Intestine serves as a bridge between the Stomach and the Large Intestine.
The Small Intestine is an organ that gives us a second chance. During the digestive process the Stomach has the first opportunity to prioritize and process the building blocks of nutrition, namely protein. The Stomach is not interested in the sugars and fats—only protein—and it sends everything else on to the Small Intestine. The Small Intestine is able to manage many different nutrients and differentiate them from toxins. It is an organ of assimilation. It further separates the clear from the turbid, which requires a certain sophistication. In the prerequisites of life model it is placed at the level of interaction, a step higher on the evolutionary scale than the survival level of the Large Intestine and Stomach.
The psychosocial function of the Small Intestine occurs at the level where our conscience is developed, where we know right from wrong and make decisions based on our judgments. A reality of contemporary society is that we have access to more information than ever before. When we are presented with too much and often conflicting information, how can we judge what is true?
The Small Intestine’s ability to further separate the clear from the turbid requires the body to generate Heat. This Heat is required for the absorption of the many minerals with which the Small Intestine reckons. With excessive Heat, however, resulting from unhealthy dietary choices or the intake of too much information, we begin to see the manifestation of the signs and symptoms of Heat conditions related to the Small Intestine.
The process of generating Heat to allow for the further separation of the clear and turbid applies not only to the foods we ingest but also to the information we receive from the world that we also need to digest. If the Small Intestine is overstimulated by food or information, a person can develop conditions such as Crohn’s disease, alternating constipation/diarrhea, or malabsorption syndrome. The Heat from this overstimulation can cause smelly stools, diarrhea with mucus, and/or lower abdominal distension. The above symptoms can also be the physical manifestation of chronic stress.
The Small Intestine works with the ability to sort out and make decisions. It specifically deals with indecisiveness due to mental confusion, where we cannot make the right choice because we cannot sort out the information. The resolution is to simplify!
There are other organs besides the Small Intestine involved with decision making. The Stomach and Spleen make the most primitive decision to separate the clear from the turbid, without the sophisticated ability to judge. The Gall Bladder’s relationship to decision making appears when there is an inability to make a decision because of a lack of courage.
Organ Interactions
Small Intestine–Heart: Fire elemental pair. As the yang pairing to the Heart, the Small Intestine has a relationship to Blood. Iron is absorbed in the Small Intestine. Iron is an essential mineral with regard to the blood, specifically the red blood cells, which contain hemoglobin. Iron transports oxygen. How the small intestine introduces iron into the bloodstream is something of a mystery even in Western science. Nevertheless, by bringing iron, and hence oxygen, into the blood, the Small Intestine contributes to the Heart’s movement of blood. When this function is operating poorly, symptoms of fatigue and anemia, or clumping of blood, as in varicosities and hemorrhoids, can occur.
Small Intestine–Urinary Bladder: Taiyang zonal pair. In the Six Divisions zonal relationships, the Small Intestine channel is paired with the Bladder channel; they function together as Taiyang, offering the strongest Yang response to resolve pathogenic factors. The Small Intestine connects the Heart to the Urinary Bladder, allowing for excessive Heat in the Heart to be eliminated from the body. Urinary tract infections are an example of the Urinary Bladder clearing Heat from the Heart via the Small Intestine.
Principle: Further separate the clear from the turbid
Water
Urinary Bladder—Yang Water
After the Small Intestine completes its process of separating the clear from the turbid, it sends the turbid fluids to the Bladder for excretion. Any difficulty in excreting these turbid fluids is termed in Chinese medical language “Lin disorder.” There are Five Lin, which describe symptoms of poor urination as cloudy, painful, stone, taxation, and blood.
Organ Interactions
Urinary Bladder–Kidneys: Water elemental pair. As the yang pairing to the Kidneys, the Urinary Bladder provides an outlet to the exterior for the body to eliminate toxicity held in the deep level of the Essence.
Urinary Bladder–Small Intestine: Taiyang zonal pair
Principle: Final transmutation of usable Fluids into Qi, to be disseminated through the Triple Heater; elimination of waste
Anatomical association: Control the Sinews (a function that also conveys the body’s ability to feel sensation)
Kidney—Yin Water
The Kidneys are rooted in the Essence/Jing. They are said to be the foundation of Jing, the most substantial, tangible aspect of our being. The Kidneys form the basis of our constitution, whether physical or temperamental. Anatomically, there are two Kidneys and they are the root of Yin and Yang in the body. The right Kidney is the root of Yang, the source of Wei Qi; the left Kidney is the root of Yin, the substance of our Essence. The moving Qi between the two Kidneys provides the energetic foundation to support the Internal Organs/Zang-Fu and is the origin of the Triple Heater mechanism.
Being rooted in Essence gives the Kidneys a strong survival instinct. They are responsible for the reproductive process. They are associated with alchemy, the transmutation that occurs when something is completely transformed. The ovum and seminal fluids coming together to create a new being are an example of this alchemical process.
Because Essence is dense, Kidney Yin tends to stagnate. It needs to be incited to action, which comes from the Heart’s impetus to experience life. The degree to which we are rooted in creativity is a statement of Kidney essence. A lack of creativity results in the stagnation of Kidney Yin. Stagnation of Kidney Yin can lead to infertility, or to an inability to otherwise express creativity.
Kidney Yang is the root of Defensive/Wei Qi, that quality of energy that engages instinctively with the world. If we live in an environment or maintain relationships that challenge our integrity, Kidney Yang is constantly called upon to support us.
Kidney Yang supports many functions in the body. If we are living “beyond our means” from an energetic point of view, we are continually taxing Kidney Yang by bringing it to the surface to maintain our Wei Qi or by bringing it to the Spleen to support digestion. If we exhaust our Kidney Yang we develop an inability to consolidate, manifesting as the “leakage of Qi”: excessive sweating or incontinence.
In our evolutionary process, as we aspire to experience our self deeply we are coming back to our “true” home, whereas the Spleen is our “comfortable” home. We realize that our sense of personal responsibility derives from the values we have absorbed from our parents and society. As we attempt to discover and express who we are, we undergo the process of Water breaking away from the confinement of Earth, flooding the banks of the river. We begin to release the definitions imposed on the self by society.
The Kidneys are associated with the highest deity of Chinese mythology, Chaos/Xuan Xuan or Shang Ren. Chaos has no morals, values, or judgments. There is no good, no bad, and anything is possible. As we move through this process of discovering our true self we begin to leave behind the limitations we have imposed upon ourselves, based on our desire to “fit in” with society. This is not to say that we have license to behave badly. We begin to live within an anarchy of our own choosing, where we are able to express our true nature.
The Kidneys are the most yin Organ. The natural urge to a quieter lifestyle during the winter is associated with the Kidneys’ inclination to contain and consolidate. As we move through this process of discovering who we are we become less and less interested in entertaining societal dramas. It is appropriate that we pull our energy inward to live a life more in line with the free expression of the self.
Organ Interactions
Kidney–Urinary Bladder: Water elemental pair
Kidney–Heart: Shaoyin zonal pair. Water and the Kidneys are associated with darkness, and Fire and the Heart with light. With its brilliance, the Heart transcends the confinement of Earth and society. The Kidneys retreat inward to discover the self and allow it to become spirited by the Heart’s desires, gradually relinquishing the social programming that limits our experience of life.
Kidney–Spleen: The Kidneys work hand in hand with the Spleen to accommodate and fulfill society’s expectations. The Kidneys represent the self and the Spleen represents society. Do we support society? Most often, yes, because we do not want to be ostracized. Leaving the tribe is fraught with danger and insecurity, a major challenge to survival. The relationship of the Kidneys and Spleen is one-sided. The Spleen, with its adherence to societal beliefs, does not support the Kidneys’ impulse toward self-identity.
Kidney–Lung: The Lungs direct Da Qi/Great Qi down to the Kidneys, fanning the flames of Mingmen Fire, to combust our Essence and fulfill our destiny.
Role: Root of Life
Principle: Store Essence and allow for reproduction
Anatomical association: The Kidneys have an association with the Bones and the Marrow. The adrenal glands are located on the top of both kidney organs and relate to Kidney Yang. The sensory organs associated with the Kidneys are the ears.
Emotion: Fear
Virtue: Faith and trust
The Level of Differentiation—Pericardium/Triple Heater and Gall Bladder/Liver
In the Five Element model, with its yin and yang pairs, one might think there are only ten Internal Organs, but with the influence of the Six Divisions, there are twelve. The extra pair, Pericardium and Triple Heater, is associated with Fire, but this Fire has a different connotation than the Fire of the Heart and Small Intestine. This Fire has a greater association with learning how to manage the influences resulting from our engagement with the world.
Ministerial Fire
Ministerial Fire refers to the roles of the Pericardium and Triple Heater as “ministers” to the Heart. The Pericardium tends to the Heart as if it were a guest, taking care of all its needs. The Triple Heater serves to actualize the Heart’s wishes; it is the emissary that directs and moves Essence into the Internal Organs to allow for our destiny to be fulfilled. The Pericardium represents the interior aspect of Fire; the Triple Heater represents the exterior aspect of Fire.
Pericardium—Yin Ministerial Fire: The Heart Protector
Anatomically, the Pericardium is the outer protective sac that surrounds the Heart. If the Heart is the Sovereign Ruler, the Pericardium is the Head Eunuch of the Court whose job is to protect the emperor from all criticism and negativity. The Pericardium’s responsibility is to protect the Heart from disruptive emotions, because the Heart is unconditional in its acceptance of experience.
The Pericardium brings its Qi to help us learn the social skills we need to function in the world: how to relate to our peers, how to handle situations we encounter, and how to get what we want. It casts our experiences in such a way as to make us feel good about ourselves. It justifies and rationalizes those experiences that are difficult and challenging, comparing them to memories of experiences that it once enjoyed. When something happens that feels unfair, the Pericardium reassures us, “That’s not right! You don’t deserve to be treated that way.” In this way, it helps to maintain our sanity.
The Pericardium is the outer expression of the Heart. The Heart experiences and the Pericardium amplifies or translates those experiences for the sole purpose of maintaining our emotional clarity.
The Pericardium brings pathology into the human psyche because it encourages us to hold on to the memories of our strong emotional experiences, whether positive or negative. The Pericardium creates a narrative, an inner dialogue to keep the experience alive. We are sometimes so engaged with the narrative that we have little awareness of what is actually happening in our lives. This holding on of past experiences and emotions takes us away from the continuum of life; it warps time.
In Chinese philosophy, time is represented by a circle. When we follow a train of thought not pertinent to our present activity, we draw a tangent off the circle (fig. 5.1) and we experience a stoppage of time. This causes our Blood to become stagnant.
It has been found that even if we are not talking out loud—when we are talking to ourselves, having conversations in our minds—our tongue muscle is moving. We are continually creating narratives about the experiences we encounter in daily life, and very often those narratives obscure the reality of this present moment. We perpetuate traumas with our memories, or maybe we keep the memory of the most joyful experience we have ever had as a standard for all other experiences. We keep reminding ourselves of what we could have had if only something had been different, all the while stagnating our Blood.
Our obsession with our memories not only stagnates our Blood but also stagnates our Qi. There is a saying that Qi follows where the mind goes. Our Qi follows the many thoughts running through our head, not attending to our present activities. The process consumes our Qi. Our thoughts can be about many things: our jobs, our relationships, fretting about the conditions of the world, what we’re preparing for dinner. We might be remembering something that happened last night or from the more distant past. We might be anticipating something we want for the future. So a part of our Qi is not engaged with the present—it is financing some other time in our lives. We might be 60 percent present, here right now, but 40 percent is elsewhere. The less energy we have invested in the present moment, the more we are investing in experiences that have already passed or in fantasies about the future. Such misplacement of our energy can lead to chronic fatigue.
Figure 5.1. In this figure, the circle represents time and the tangent represents how the distraction of narrative thinking draws us away from consciousness of the present moment.
A common result of long-term Qi deficiency and Stagnant Blood is the development of chronic degenerative disease. We need a strong Pericardium to treat chronic degenerative disease successfully. The most important thing we can do to strengthen the Pericardium is to bring back the Qi that is financing unnecessary thinking. The reason chronic degenerative disease can be so difficult to treat successfully is because it is so difficult for us to control our mental activity. The only way to let go of these thoughts and memories is to return to the Heart. The Heart is magnanimous. It is willing to embrace everything and accept the conditions that arise from our experiences in life.
Organ Interactions
Pericardium–Triple Heater: “Ministerial” Fire elemental pair. If an experience in the world is very challenging to our temperament, the Pericardium tries to harmonize it in order to avoid creating too much disturbance, or Rebellious Qi. The Triple Heater hides the disturbance to keep it latent.
Pericardium–Liver: Jueyin (Absolute Yin) zonal pair
Pericardium–Heart: As we return to the Heart we begin to release the Pericardium, with its stories and judgments and the values it has instilled into the Blood. The Heart contains the Spirit, and Spirit does not care about stories. Spirit looks upon all things equally.
The Heart is unconditional in its relationship to life; the Pericardium is conditional. In its essence, any spiritual tradition is the process of relinquishing the Pericardium and calling the Spirit back to our Heart. The Pericardium offers help. The Heart offers hope.
The Heart wants to experience life fully and unconditionally and is not so interested in survival. It wants experience for the betterment and growth of our human existence, to fulfill the evolutionary requirement to make life more “perfect.” The Kidneys are only concerned with our survival, but the Heart wants more. The Pericardium serves as the mediator, balancing the Kidneys’ urgency for survival and the Heart’s passion for experience. It blends the Kidneys’ will to live and our Heart’s spirit.
Role: Heart protector (the Eunuch in the Sovereign Ruler’s Court)
Principle: Successfully engage with the requirements of the world
Triple Heater—Yang Ministerial Fire: The Three Burners
The Three Burners refer to three anatomical regions of the body: the lower abdomen, the middle abdomen, and the chest. The “Organ” of the Triple Heater has no form; it regulates the movement of energy among these three regions.
The Moving Qi of the Kidneys is the foundation of the Triple Heater mechanism. The left Kidney contains our Essence/Jing. The right Kidney gives us Yang Qi to mix with our Essence. As described earlier, these two qualities interact as they pass through a point on the spine slightly above waist level called the Gate of Destiny/Mingmen/GV-4, where Mingmen Fire combusts the Essence, making it lighter. This is our Source/Yuan Qi, and the Triple Heater mechanism moves it up along the spine through the Bladder Shu/Transporting points to deposit it into the Internal Organs/Zang-Fu. (For more on the Bladder Shu/Transporting Points, see appendix 2.) This distribution of Source Qi is not done in equal proportions to each of the Organs, but rather according to our constitutional makeup. The Triple Heater creates our temperament, the deepest level of our emotional nature, by its dissemination of Source Qi to the Organs that support the unfolding of our destiny.
The Triple Heater controls and mediates all the Yang aspects of the body. It disseminates through the Sea of Yang/Du Mai/Governor Vessel, which in turn governs the Defensive/Wei Qi at the surface level of the body.
If we want to boil water, there must be a flame under the pot. Similarly, if our Essence is to be efficiently combusted, there must be adequate Fire at Mingmen. The nature of Heat is to rise, and Fire likes to spread. Most of us are so busy taking care of the responsibilities of our lives that we are unable to retain our Heat concentrated in the lower region, and it dissipates upward and outward.
With Fire spreading upward we accumulate Heat in the head, causing headaches or diminished sensory acuity, or Heat in the chest, causing respiratory, heart, or digestive conditions. Instead of “steaming” the Essence, the rising Fire consumes the Essence residing in the upper regions. At the same time, Dampness likes to settle downward. We develop potbellies, edema, and maybe diarrhea. If this reverse relationship of Fire and Water is occurring, where Fire is above and Water is below, Dampness does not transform. We develop accumulations. This turbidity blocks the production of Postnatal Essence. This is the scenario for most chronic degenerative disease.
Human beings have difficulty managing Wind and change. The healthy aspect of the Triple Heater relates to the knowing of who we are. The pathological aspect relates to the continual effort to bring some sense of permanence to our lives. The Triple Heater mechanism is very much involved with bringing pathology into a dormant state. If the Triple Heater can move the pathology to be hidden and held quietly, we can continue living our lives as though nothing is wrong, as though nothing is changing. This process is an attempt to keep the self in an unchanging state.
We all know at some deep level of self the changes we need to make in order to have a more productive, healthy, and happy life. If we are not honoring our own inner voice, we have some degree of stagnation in the function of the Triple Heater.
The intention to preserve the status quo, to guard against change, is the root of suffering. There is no such thing as permanence. When we are able to go with the flow of events and experiences, they will not take up residence in our body. There are many cultivation practices for regulating this Fire–Water relationship, including particular meditations, qigong, and taiji.
Differentiating the Triple Heater and the Pericardium
The Triple Heater is a reflection of the Water element and the self. This relationship to self is not the same as that which is purely reflected by the Kidneys. The Triple Heater is the Water element as it is affected by Fire, spreading out into the world. The Pericardium learns about the world so that it can direct its knowledge inward to help the Heart. The Triple Heater learns about the world to help the self evolve.
Most of us know that eating sugar is unhealthy, but most of us cannot or will not eliminate sugar from our diets. This inability to choose behaviors that support our vital existence in the world indicates that our Triple Heater mechanism is not working well. A person with a strong Triple Heater is someone who is able to acknowledge a reality about the world and has a strong will to make appropriate changes in order to have a more vibrant life.
The Pericardium helps maintain sanity by bringing emotions into latency; the Triple Heater deals with the latency of Qi.
The Pericardium, as the Heart Protector, protects us from self-inflicted damage due to our emotions; the Triple Heater protects us from damage due to Heat by maintaining latency.
Clinically, the Pericardium is used more to treat Shen/Spirit disturbances and emotional problems; the Triple Heater is used when there is an uncontrolled Heat condition with an underlying deficiency of Yin.
Organ Interactions
Triple Heater–Pericardium: “Ministerial” Fire elemental pair. The Triple Heater disseminates Source Qi according to our constitutional type. If an experience in the world is very challenging to our temperament, the Pericardium tries to harmonize it in order to avoid creating too much disturbance, or Rebellious Qi.
Triple Heater–Gall Bladder: Shaoyang zonal pair
Triple Heater–Spleen: Practitioners rarely think of the Triple Heater in relationship to the Spleen, but it is the Triple Heater that allows the Spleen to perform its function of transformation and transportation. The Triple Heater mediates the conversion of foods and fluids into Qi, in particular Postnatal Qi, and irrigates the entire body with Qi and Fluids. It converts any surplus of Qi into Postnatal Essence. This function of the Triple Heater is usually described as being under the governance of the Spleen, but it is the underlying support from the Triple Heater that enables the Spleen to transform and move turbidity and to create Postnatal Essence.
Principle: Utilizing Qi for transformation
Wood
Gall Bladder—Yang Wood
Physically, the Gall Bladder performs the same functions attributed to it by Western medicine: it stores and excretes bile. Bile, according to Chinese medicine, has a major relationship to the Thick Fluids (Ye), also referred to as the Nocturnal Fluids. These are denser Fluids than the exocrine Fluids (Jin) and have a greater role in the cultivation of Postnatal Essence. They include the cerebrospinal fluid, the marrow, and the hormones. Bile is bitter in taste; its effect is to clear Heat and support peristalsis.
The Gall Bladder has the unique role of being the only Internal Organ that is also included with a group of organs referred to as the Curious Organs. The Curious Organs (described in chapter 7) are responsible for the evolution and reproduction of our species. This inclusion recognizes that the Gall Bladder is the link between our normal postnatal life functions and our more urgent evolutionary concerns. As such, the Gall Bladder has a more sophisticated level of functioning than the organs associated with the level of survival and interaction.
The Gall Bladder is responsible for making decisions. The Gall Bladder is not instinctual. It is conscious in its decision-making role. For example, coordination and skill are required to apply the right amount of pressure needed to hold a cup. To do so indicates a certain quality of intelligence.
The Gall Bladder is capable of compromise and meticulous planning. The term Shaoyang, or Lesser Yang, describes the Gall Bladder. Unlike Greater Yang/Taiyang, which is a quality of energy that moves straightforward to accomplish a goal, Lesser Yang has the ability to fluctuate between two sides. The Gall Bladder represents the concept of choice, and it signifies intelligence. As we move toward our goal we can change directions if we need to; we can make different choices. We do not have to take things at face value.
Because the Gall Bladder’s level of functioning is critical for our survival, the changes it considers can be profound; they are changes that might mean having to let go of some part of our identity. The Gall Bladder confronts the kinds of change that can cause us terror, because at the very prospect of such a change we fear that we will lose what we believe ourselves to be. When confronted with these kinds of changes, most of us make compromises instead of letting go, even if we know that what we are holding on to is not healthy for us. It is our habituated behaviors that are threatened, however, not the Source/Yuan Qi held in our Kidneys nor the desires of our Heart. We know that our attachment only perpetuates a destructive condition in our lives; it prevents us from moving forward.
Making a compromise means we are half in the present, with the awareness that we must change, and half in the past, unwilling to do so. It is a Shaoyang condition. This inability to change gives us a bitter taste toward life, literally and figuratively. We might also have visual dizziness. We are not sensing clearly; we are disoriented by our clouded perception.
At the same time, there are symptoms of diaphragmatic constriction. Letting go of the status quo means we have to let go of our breath. With a Shaoyang condition there is the taste of bitterness; we want to vomit. We know in our hearts that we have not made the necessary changes required for our growth and evolution.
In terms of the progression of pathology, the Gall Bladder signifies that our feelings, thoughts, and actions have become sufficiently toxic that we can no longer ignore our discomfort. Alternating or intermittent signs and symptoms—perhaps pain that moves back and forth from one side of the body to the other, chills and fever, or alternating diarrhea and constipation—give the clue that pathology is held at the Shaoyang level.
The Gall Bladder is the Yang channel associated with the Wood element. The Wood element signifies new beginnings. The virtue of the Gall Bladder is having the decisiveness and courage to move forward. The word dan in Chinese not only means Gall Bladder; it also means courage. That we have the gall to make significant change means we have the courage to do it. We become comfortable with our decisions, no longer uncertain or irresolute.
We are finally able to make these changes because as we move through the process of life, we come to realize that our only recourse is to let go of our persistent, destructive actions, relationships, or thoughts and to forgive ourselves for our so-called wrong behavior.
Organ Interactions
Gall Bladder—Liver: Wood elemental pair
Gall Bladder–Triple Heater: Shaoyang zonal pair
Gall Bladder–Curious Organs: The Gall Bladder is the link to a group of Organs associated with evolutionary concerns, the Curious Organs.
Role: The Upright Official That Makes Decisions
Principle: Choice; conscious action
Anatomical association: Conscious use of the Sinews
Emotion: Courage
Virtue: Decisiveness
Liver—Yin Wood
During the process of evolution, as organisms became more sophisticated the colon and urinary bladder formed to control waste. With the ability to control the excretion of waste, these organisms also required a mechanism to manage the toxicity being held in the body. The Liver evolved to manage toxicity. If we become constipated or are otherwise unable to eliminate waste efficiently we face the possibility of autointoxication—that is, toxification that comes from within. It is the Liver’s job to manage this potentially toxic situation.
Chinese medicine assigns the Liver the responsibility of storing the Blood, but the metaphor of “storing” goes beyond Blood to include other substances as well. One of the reasons the Liver is the last of the Internal Organs to be discussed is because when there are toxins that the body has been unable to eliminate or has failed to deposit elsewhere in the body, they go to the Liver to be held dormant. This notion of storing accords with Western medicine’s recognition that the Liver stores fat for long-term energy needs and sugar, or glycogen, for short-term needs. Western science also acknowledges that the liver holds on to toxins that we have been unable to eliminate.
We store things when we do not have enough. If the body has insufficient Blood, the Liver becomes constrained. It wants to hold on to the resources that it does have. This reluctance to distribute its resources will cause a disturbance in the Shen, manifesting as spasms in the limbs with the constant need to fidget. Simultaneously there is the need to run away from the past and the inability to be in the present moment. We feel restless. These are the early signs of Liver Blood Stagnation. If the condition lingers, it becomes Liver Fire as Qi stagnates with the Blood. The Fire leads to further restlessness and irritability. Our limbs need to break through the stagnation, but they cannot.
By the time the Liver becomes involved in our illnesses there is an actual, structural stagnation of blood in the liver. At this level of progression our condition is relatively serious. We have an accumulation of toxicity and have difficulty ridding ourselves of it. We may have difficulty urinating or painful, difficult menses. We may have difficulty defecating, perhaps an irritable bowel with the discharge of mucus and blood when we defecate, which represents the loss of Essence/Jing and Blood. Our digestion is so poor that we can actually become ill because we are absorbing more toxicity from our bodies than nourishment from the food we eat. We must support the Liver in its release of toxins in order to detoxify the body.
In addition to storing the Blood, the Chinese also assign the Liver the major responsibility of harmonizing and maintaining the smooth flow of Qi. The ability to harmonize is vital to the successful management of the third requirement of life, differentiation. The Liver helps us accommodate the many changes we negotiate as we maintain our personal equilibrium in life.
The Liver is placed in the third energetic level of differentiation, the level that helps us maintain some degree of control over our lives, to maintain our sanity. If we have created a life where we believe we no longer have choices, we become guarded. We overcontrol our emotions and our physical actions; we hold ourselves tightly in order to maintain consistency in our lives, resulting in constrained Qi.
The Liver controls the Sinews, not only to enable physical activity but also to armor ourselves against the potential chaos of the world. The Su Wen states that the sinews all meet at the “Ancestral Sinew”—that is, at the region of the genitalia. Being emotionally armored results in sinew armoring. The major way we reduce or resolve emotional and physical tension is through sexual activity. A sociologist would say that a motivating factor for most people is sexuality. Sexuality can entail lust and attachment or love and bonding.
Desiring the attention of someone else is a basic need. While sexual relationships are not only for procreation, most of us want commitment from the person with whom we are involved. Unlike animals, most of which have no differentiated arousal, human beings tend to respond sexually to a particular individual with a particular appearance.
Consider the amount of time we spend watching television and reading about things related to love and sex, and how influenced we are by the attitudes and beliefs that are presented to us. How much time do we spend on our appearance, our physique, our hair, makeup, and clothing? Do we do it for ourselves? To be attractive to someone else? How much time do we spend thinking or fantasizing about sex? This is all associated with the Liver.
Another quality associated with the Liver is competition and aggression. We may feel the need to compete with someone else for the attention of the person we find attractive, and with that competition there is the potential for violence. Violence fascinates us as a society. We stop to see accidents; we eavesdrop on arguments. Violence and sexuality are often linked. Even our curse words have a sexual connotation.
At the same time, there are deeper social values that tell us that these behaviors are inappropriate, and so the more we engage with these thoughts and activities the more constrained the Liver becomes. Now we have the struggle between Wood/Liver and Earth/Spleen/Society.
Those of us who are highly engaged in the attitudes and activities associated with the Liver—that is, competition, obsession with sexuality, or a tendency to violence—will eventually experience a disintegration of yin/substance and yang/energy. We sublimate our unfulfilled need for commitment and we become self-destructive. At a deep, unconscious level, we violate ourselves, which leads to autoimmune disease.
While there are various treatment strategies to manage the types of conditions that develop at this level of pathology, ultimately the resolution for these illnesses is philosophical. Letting go of the concept of commitment is difficult in our society. This difficulty is representative of the important relationship between the Liver and the Pericardium. The Pericardium represents the need for conditional love. We try to mold ourselves to fit an image and behave in the ways we believe are necessary for us to receive love. At the same time we expect the person we love to look and behave in a particular way, in order to demonstrate that he or she loves and cares for us.
The Heart is about unconditional love. It does not matter how we, or our partner, look, dress, or behave. We love and are loved. Letting go of our expectations allows the Liver to release the tension caused by unfulfilled emotional needs. This process allows Blood to circulate differently, reducing Blood stagnation in the Liver so that it is no longer so constrained.
Organ Interactions
Liver–Gall Bladder: Wood elemental pair
Liver–Pericardium: Jueyin (Absolute Yin) zonal pair. Wood/the Liver is nourished by Water/the Kidneys and, in turn, Wood nourishes Fire. In this case, Fire relates to the Sovereign Emperor’s minister, the Pericardium. The Kidneys represent the will to live, which is fundamental to survival. We are born to live, and intrinsic to life is having experience. With its position between Water and Fire, the Liver serves as a bridge between our will and our enthusiasm for life. As Wood, it gives direction to satisfy these aspects of life.
The Liver is anatomically located in the Middle Burner and controls the balance between the Lower (Water) and Upper (Fire) Burners.
Bridge between Water and Fire: In the Five Element system the Liver is associated with Wood. Wood/the Liver is nourished from the foundation of life, Water/the Kidneys. Water is the mother of Wood. In turn, Wood is the mother of Fire and nourishes the Heart by distributing Blood to the Heart for circulation throughout the body. It also sends Blood to the Kidneys, to nourish our sense of self.
Another way to look at this bridge between Fire and Water is in the context of the Liver’s role in the Triple Heater’s function. The Liver harmonizes the back-and-forth movement of Kidney Yin and Kidney Yang as the Moving Qi of the Kidneys is combusted by Mingmen Fire. This mechanism is further supported by the Liver sending its stored Blood to nourish Kidney Yin and, especially if Kidney Yin is deficient, to anchor Kidney Yang.
Liver–Kidney: In its role of distributing resources, the Liver sends its stored Blood to the Kidneys to support Kidney Yin and anchor Kidney Yang.
The Liver has an important role in gynecology because it sends its blood to the uterus in preparation for pregnancy.
Role: The General Directing the Resources of the Army
When Kidney Yang escapes because of an inadequacy of Kidney Yin, the General has failed in his responsibility to control uprisings. The Liver has failed to control the balance between Kidney Yin and Kidney Yang; it has failed to maintain Mingmen Fire. By the time we see a health condition related to the Liver, there is a decline of Yin and Yang leading to a degeneration of Postnatal Qi. This failure does not occur at the level of the Kidneys, the root of Postnatal Qi, but arises because the Liver has failed to store Blood to support Kidney Yin and to maintain control over the upward movement of Yang from the Kidneys.
Principle: Store Blood; harmonize; govern the smooth flow of Qi
Anatomical association: The Liver opens to the eyes. It also has a relationship to the fingernails.
Emotion: Anger
Virtue: Benevolence and human kindness