TCM Organ System or Zang Fu

Zang Fu

The Zàng-Fǔ organs are functional entities stipulated by Traditional Chinese medicine (TCM). They constitute the centrepiece of TCM's general concept of how the human body works.

The term zàng (脏) refers to the organs considered to be yin in nature – Heart, Liver, Spleen, Lung, Kidney – while fǔ (腑) refers to the yang organs – Small Intestine, Large Intestine, Gall Bladder, Urinary Bladder, Stomach and Sānjiaō.

Zang Fu (Internal Organs)

Zang Organs (Yin)

Fu Organs (Yang)

Large Intestine
Small Intestine
Urinary Bladder
San Jiao
Gall Bladder

The Internal Organ Relationships

Heart and Lungs
Heart and Liver
Heart and Kidneys
Liver and Lungs
Liver and Spleen
Liver and Kidneys
Spleen and Lungs
Spleen and Kidneys
Lungs and Kidneys
Spleen and Heart

The Lungs

Functions of the Lungs

  • The Lungs are called the "Lid of the Yin Organs"
  • Rule Qi and Respiration
  • Control the Channels and Blood Vessels (with the Heart)
  • Control dispersing and descending
  • Regulate and move the Water Passages
  • Control skin, sweat glands and body hair (the "Exterior")
  • Open into the nose
  • House the Po (corporeal soul)
  • Govern the voice

Governs Qi and Respiration
The first way that the Lungs govern Qi is by taking in air or Pure Qi and exhaling used, impure, or Dirty Qi.

This constant exchange in the cycles of breathing maintain the correct function of all body's physiological processes that need Qi.

The Lungs are also responsible for the actual formation of Qi.

Food Qi (Gu Qi) is taken by the Spleen and directed to the Lungs where it combines with inhaled air (Kong Qi)(with help from Yuan Qi of Kidneys) to form Zong Qi, which is also called Qi of the Chest or Gathering Qi.

The Zong Qi regulates involuntary movement of Heart and Lungs in turn is nourished by the Qi of the Heart and Lung.

Supported by Yuan Qi (Congenital Qi), Zong Qi is then transformed into Zheng Qi (True Qi), which in its yin aspect becomes Ying Qi (Meridian Qi) and in its yang aspect becomes Wei Qi (which protects us from external pathogens).

The Lungs then spread this Qi all over the body

Simultaneously formed: "Upright" or "normal" Qi (Zhen Qi) which is divided into Ying and Wei parts.

Lungs open to the Exterior, hence are called the "Tender Organ" because they are vulnerable to attack by exogenous pathogens.

Controls Channels and Blood Vessels
Because govern Qi, which is essential to Heart to aid in Blood circulation.

The Lungs and Heart are very closely linked (via Zong Qi).

Lungs control circulation of Qi not only in Blood Vessels but in the channels.

Weak Lung Qi results in Qi being unable to push the Blood to nourish various areas. Hence, e.g. cold limbs, especially cold hands.

Controls Dispersing and Descending

Dispersing Function
Lung spreads Wei Qi (defensive Qi) and Body Fluids all over body to area between skin and muscles (The Lungs are related to skin).

This ensures that Wei Qi equally distributed under skin to warm skin and muscles and protect body from exogenous pathogens (Symptoms of a "cold" = impairment of dispersing function: exterior Wind Cold obstructs skin, blocks pores and Qi circulation: Qi cannot be dispersed.

Lung spreads Body Fluids (Jin Ye) to skin in form of "mist" to moisten skin and regulate opening and closing of pores and sweating. In health, normal pore function and normal amount of sweating.

Descending Function
Lungs are uppermost Organ ("Lid of the Yin Organs"). Therefore their Qi descends to communicate with Kidney (which "holds down" the Qi).

Lungs also direct Body Fluids downward to Kidneys/Bladder. Impairment of descending function results in Qi accumulating in the chest (cough, asthma, stuffy chest, or accumulation of fluids; upper body oedema).

Regulates Water Passages

Lungs receive refined fluids from Spleen, reduce them to fine mist and "spray" them throughout Exterior under the skin (part of dispersing function).

Fluids should be evenly spread and pores should be regulated: otherwise, fluids may accumulate causing oedema.

Lungs are "upper origin of Water". Direct fluids down to Kidney and Bladder.

Kidneys receive fluids and vaporize them, then send back up to Lung.

Controls Skin and Hair
Lung nourishes skin and hair by spreading Fluids to skin. Impaired Lung function can result in malnourished body hair and skin.

Lungs influence Wei Qi, which circulates in skin.

Opens into the Nose
Nose is the opening of the Lungs. Lungs govern sense of smell.

Houses the Po (Corporeal Soul)
Corporeal soul attached to body.

Closely linked to breathing.

Directly affected by sadness/grief which constrain its movement and affect breathing.

Lungs Govern Voice
Strength, tone and clarity of voice depend on Lung Qi (in health: like a bell). Weak Lung Qi = low voice.

The Spleen

Functions of the Spleen

The Spleen is central Organ in production of Qi.
Called the "Foundation of Postnatal existence". Extracts Food Qi (Gu Qi) from food and liquids taken into Stomach. Food Qi is basis for formation of Qi and Blood.

1. Governs transformation and transportation
2. Controls the Blood
3. Controls the muscles and the four limbs
4. Opens into the mouth and manifests in the lips
5. Controls the raising of Qi, the "raising of the pure"
6. The Spleen houses thought

Governs Transformation and Transportation

Transformation/transportation of Gu Qi (Food Qi)
Spleen is central Organ in production of Qi.

Stomach "rots and ripens" ingested food and drink, and prepares the way for the Spleen which separates and extracts the GU Qi (food Qi) and refined essence from the digested food.

Food Qi goes upward to the Lungs in the Upper Burner. Food Qi combines with air to form Zong Qi and goes to the Heart to form Blood.

Flavours are distributed to the various organs, sweet to the Spleen, salty to Kidney, bitter to Heart, sour to Liver, pungent to Lung.

Transformation/transportation of Fluids
Spleen also separates usable from unusable fluids ingested.

Pure "clear" part goes upwards to the Lungs for distribution to the skin.

"Turbid" part goes to Intestines for further separation.

In health, transforming and transporting function of Qi ensures good digestion, good appetite, normal absorption, regular bowel movements. Impaired function, poor appetite, bad digestion, abdominal distension, loose stools.

When transformation/transportation of fluids impaired, fluids can accumulate to form Dampness and then Phlegm.

"The Spleen likes Dryness and hates Dampness". Its transformation and transportation function can be impaired by Damp e.g. Damp-forming foods like salads, dairy, etc.

Spleen Yang, essential to the process, impaired by excessive consumption of cold liquids (esp. ice water, ice cream, etc.) Conversely, Deficient Qi or Yang of Spleen can cause internal Dampness.

Spleen Holds the Blood in the Blood Vessels
If Spleen Qi healthy, Blood circulates normally (see also Liver) and stays in vessels.

Deficient Spleen Qi or Deficient Spleen Yang, Blood may spill from vessels results in haemorrhages, subcutaneous bleeding, etc. (petechiae, purpura) Also, especially lower body haemorrhage, e.g. metrorrhagia can be caused by Xu Spleen Qi.

Important role in Blood formation.

(Food Qi extracted by Spleen sent to Lung and to Heart to form Blood with assistance of Yuan Qi from Kidney). To tonify Blood, always tonify Spleen.

Controls the Muscles and Four Limbs

Food Qi eventually goes to nourish all tissues in the body, transported throughout body by Spleen.

Particularly directed to the muscles.

Weak Spleen Qi results in fatigue, muscles weak or even atrophied. Tonify Spleen in fatigue.

Opens to the Mouth and Manifests in the Lips
When food enters mouth, chewing prepares food for transformation and transportation.

Therefore Spleen related to mouth.

Normal Spleen Qi; good sense of taste and moist pink lips.

Controls the Raising of Qi

Spleen has Lifting effect along midline of body that ensures that Organs in proper place.

When raising function impaired, Spleen Qi "sinks" resulting in prolapse of the uterus, Bladder, Stomach, Kidney, or haemorrhoids.

Spleen raises pure Food Qi to Lung and Heart.

Spleen Houses Thought
Is residence of I (Yi). Influences our capacity for thinking, studying, concentration, memorizing, etc.

Weak Spleen Qi results in dull thinking, poor concentration, poor memory, etc.

Excessive studying, mental work etc., weaken Spleen.

The Heart

Functions of the Heart

1. Governs the Blood
2. Controls the Blood Vessels
3. Manifests in the Complexion
4. Stores the Shen (Houses the Mind)
5. Opens to the tongue
6. Controls Sweat

Governs the Blood

Transformation of Gu Qi (Food Qi) into Blood occurs in Heart

Responsible for smooth flowing of Blood

Heart must be healthy for proper supply of Blood to all tissues.

When Heart Qi impaired, i.e., Heart Blood or Qi is deficient, circulation of Blood is affected (hands cold).

Controls the Blood Vessels
Blood Vessels (not same as in Western Medicine) depend on Heart Qi and Blood, i.e., if Heart strong and Blood plentiful, pulse will be full and regular.

If Heart Qi or Blood is weak, pulse may be irregular/weak (choppy).

Manifests in the Complexion
If Heart Blood is abundant, there will be a rosy and lustrous complexion.

Deficient Heart Blood: pale chalky complexion (plus other signs e.g. palpitations).

Deficient Heart Qi results in a bright white complexion

Stagnant Heart Blood results in a bluish purple complexion

Stores the Shen
When there is abundant Heart Blood and Yin: Shen will be nourished.

Individual will respond appropriately to the environment and Shen will retire to the Heart.

Weak Heart Qi, Deficient Blood or Heat in Heart: Shen is not nourished.

Symptoms vary, may include dull thinking, poor memory, insomnia, sleepiness, or (esp. with Heat) agitation, mania and delirium.

Flowers into the Tongue (the offshoot of the heart)

The Heart has a large influence on the colour, form, and features of the tongue, and is represented in the tip of the tongue.

The normal tongue is a pale red colour, and the sense of taste is normal.

Controls Sweating
Body Fluids and blood share a common origin and are interdependent.

Because the Heart governs Blood and there is a mutually sustaining relationship between blood and fluids, sweat is related to the heart.

The Kidneys

Functions of the Kidneys

1. Store the Jing and rule birth, growth, development, reproduction, and sexuality
2. Produce Marrow, fills up the Brain, and rule the Bones
3. Rule Water and Water Metabolism
4. Control inspiration and the grasping of Qi
5. Open into the Ears
6. Manifest in the head hair
7. Control the two lower orifices
8. Residence of the Zhi (Will Power)

Kidney Yin and Kidney Yang are the foundation of the Yin and Yang of the whole body.

Kidney Yin and Kidney Yang rely on each other for their existence. Kidney Yin provides material basis for Kidney Yang.

Kidney Yang provides necessary Heat for all Kidney functions.

Store the Jing and rule birth, development, and reproduction

Jing is the (material and immaterial) substance most intimately connected to life itself.

It is the creator of life and is the foundation for differentiation into Yin and Yang.

The Kidneys are sometimes referred to as the "Root of Life" because Jing is the basis for reproduction, growth, and development.

It flourishes as we grow and develop, and wanes as we grow old.

The Kidneys are said to govern these processes at it stores the Jing.

Jing (Essence) the precious substance has two types;

1. Prenatal Jing: Inherited from parents
2. Postnatal Jing: Partly replenished from food and fluids

Prenatal Jing
Prenatal Jing determines our basic constitution, vitality, and strength.

It is the basis of sexual life and the formation of sperm and egg.

It is the foundation for differentiation into Yin and Yang.

Insufficient Jing can cause infertility, impotence, problems relating to growth, reproduction, premature senility, etc.

Postnatal Jing

Postnatal Jing is the refined essence extracted from the food by the internal Organs, particularly the Spleen.

Kidney Jing provides material basis for both Kidney Yin and Kidney Yang.

Produces Marrow, Fill up the Brain and Spinal Chord, and Control the Bones

Jing is also the organic foundation for production of marrow.

Marrow is the common substance of bones, bone marrow, brain ("sea of marrow") and spinal cord.

Kidney Jing produces Marrow, which generates spinal cord and "fills up" brain, therefore Kidney has relationship with brain. Strong Jing nourishes brain and memory/concentration, etc. will be good.

Jing inadequate to nourish the brain: poor memory and concentration, dull thinking. Therefore Kidneys also govern bone marrow and bones (and teeth, which are said to be the outgrowth of bones).

Kidneys Governs Water and Water Passageways

Kidneys belong to Water element
They govern the transformation and transportation of body fluids in many different ways. For example, the Kidneys control flow of Body Fluids in Lower Burner. The correct balance of Kidney Yin and Kidney Yang produces normal regulation of the opening and closing of the "gate" of urination.

In disease, Kidney Yin and Yang imbalanced (not enough Yang or not enough Yin).

  • Where Yang is deficient, "gate" stays open giving rise to profuse and pale urination.
  • Where Yin is deficient, "gate" stays closed resulting in scanty and dark urination.

Control inspiration and the grasping of Qi
While the Lungs govern respiration, the Kidneys play an important role in normal breathing.

The Kidneys assist the Lungs during inhalation by "Grasping the Qi".

In this relationship, the Lungs are called the "Foundation of Qi", and the Kidneys are called the "Root of Qi".

When the Kidneys fail to Grasp the Qi, respiratory illnesses can occur, such as chronic asthma.

Opens into the Ears

Ears related to Kidneys.

Kidney Jing nourishes ears and enables proper functioning.

Weak Jing results in weak hearing or tinnitus.

Manifest in the head hair
Abundant Kidney Jing nourishes hair.

Hair then grows well and is healthy and shiny. Weak Kidney Jing results in thin brittle, dull, or falling hair, premature greying.

Please note:

Liver Blood also has to do with hair colour and shine, but Kidney Jing is instrumental in production of Liver Blood.

Controls the Two Lower Orifices

The Kidneys control the front orifice, which is the urethra (and spermatic duct in males), and the rear orifice, which is the anus.

These are functionally related to the Kidneys.

Urethra related because Kidney provides the Bladder with the Qi necessary to transform urine (weak Kidney Qi produces leaking of urinary incontinence).

Deficient Kidney Qi or Kidney Jing can cause spermatorrhoea or nocturnal emissions.

Anus anatomically related to Large Intestine but functionally related to Kidney. If Kidney Qi is weak, there may be diarrhoea or prolapsed anus.

Houses the Will Power
Will Power (Zhi), including concepts of staying power and motivation, depend on Kidneys.

The Pericardium

Functions of the Pericardium

The Heart Protector or Heart Governor

It is the outer membrane around the heart that protects it from attacks by exogenous pathogenic factors.

The pericardium is capable of being attacked by exogenous Heat, but the Heart is not (directly).

In TCM theory and herbology, this is the only way the Pericardium is usually distinguished from the Heart.

In Acupuncture however, the Pericardium has it's own meridian and is just as important as the heart Channel itself. Many points on the Pericardium Channel are used to treat the Heart, and many strongly influence the mental state.

Pericardium influences relationships with other people: Points on its channel are often used to treat emotional problems from relationship issues.

Pericardium channel particularly influences the area in the centre of the thorax.

The Liver

Functions of the Liver

1. Liver Ensures Smooth Flow of Qi
2. Stores the Blood
3. Controls The Sinews
4. Manifests in the Nails
5. Opens into the Eyes
6. Houses the Hun (Ethereal Soul)

Liver Ensures Smooth Flow of Qi

It is extremely common to find Stagnation of Liver Qi in clinic. Liver ensures smooth flow of Qi throughout all the body, in all directions.

Any activity that depends on Qi relies on the Liver's "flowing and spreading".

The Smooth Flow of Liver Qi Affects Three Main Areas

1. Emotions

The emotional state is seriously affected by the Liver's function of "Flowing and Spreading" Qi.

When it flows normally, emotions are approximate and easy.

When the spreading of Qi impaired or the circulation of Qi restrained, there will be emotional depression, frustration, repressed anger /suppressed anger, and physical symptoms.

There is a relationship between emotional state and Liver Qi. "Anger makes Qi rise and Blood stagnate in the chest."

Stagnation along channels related to Liver: hypochondriac and costal pain, "plum stone Qi", chest oppression, swollen/tender breasts and genitals, lower abdominal pain.

2. Digestion and Bile Secretion

Digestion and the Liver - Five element: Wood controls Earth.

The Liver's function of spreading Qi aids the Spleen and Stomach's digestive functions, and is important to ensure harmonious Qi movement in Middle Burner.

But Stagnant Liver Qi can "invade" or "attack" the Stomach or Spleen (Wood overacts on Earth).

Smooth flowing of Liver Qi affects bile flow.

Stagnant Liver Qi can obstruct bile flow (bitter taste, belching, or jaundice).

3. Menstruation

Stores Blood
1. Regulates volume of Blood according to physical activity
When at rest, Blood returns to Liver (Liver contributes to restoring energy). When body is active, Blood nourishes muscles to enable them to perform.

Blood regulation function influences energy level: if this function impaired, lack of Blood (= nourishment) where needed, hence easily tired.

If Liver Blood is deficient, there can be muscle cramps, tics and twitches or tremors/shaking in muscles. (Liver Wind from Blood Deficiency), dry eyes and brittle soft nails.

2. Regulates menstruation
Liver is very important in gynaecology.

If Blood storage function is abnormal, e.g. Liver Blood is deficient, menstrual problems e.g. amenorrhoea, oligomenorrhoea.

  • If Liver Fire (Excess), menorrhagia or metrorrhagia can occur.
  • If Liver Qi stagnant, Liver Blood can stagnate (dysmenorrhoea, PMS, dark clots).

Liver malfunction influences energy of Ren Mai & Chong Mai, which are closely related to uterus.

Blood& Liver function reciprocally affect each other.

Where Blood is Deficient or Hot, Liver function can be affected.

If Liver function abnormal, can affect quality of Blood.

For example:

If Liver is Hot, Blood can become Hot (causing skin eruptions, eczema, etc.: Blood becomes heated by being stored in a hot "container").

Controls Sinews

Sinews (tendons) depend on Liver Blood to moisten and nourish them so they can contract and relax as needed (smooth movement of joints and good muscle action).

Deficient Liver Blood leads to lack of nourishment in the tendons, which leads to contractions, spasms, impaired extension/flexion.

The Liver controls the Sinews (tendons), or the contractile aspect of the muslces.

The Spleen controls the muscles, or the mass or bulk.

Liver imbalances are more likely to affect movement, and Spleen weakness more likely affects flaccidity, atrophy, etc.

Manifests in the Nails
The finger and toenails are the outgrowth of sinews and are influenced by Liver Blood.

When Liver Blood is deficient, the nails will lack nourishment and become dark, indented, dry, cracked, brittle, onchomycosis, etc.

Opens to the Eyes
Liver Blood nourishes and moistens eyes and gives capacity to see.

Liver Blood deficient: blurred vision, myopia, "floaters" colour blindness, dry "sandy" eyes. If heat in Liver, eyes bloodshot, sore and burning. Blepharitis, conjunctivitis, styes, jaundice.

Houses the Hun
The Hun is also called the ethereal Soul

Hun is related to ability to be resolute, to plan and have creative drive and assertiveness.

When the Liver is out of balance in excess for instance, this becomes anger.

Influences Rising and Growth

Energy moves up and out like tree (Wood element).

The liver also relates to growth in the sense of personal growth, ability to change.

People who feel stuck in life or a situation usually have Liver Qi Stagnation.

Controls Planning
Liver gives capacity to plan.

Said to be like General of an army (Gall Bladder gives ability to make decisions, hence very closely linked).

Fu organs

The Large Intestine

Functions of the Large Intestine

The Large Intestines main function is to receive food and fluids from the Small Intestine, re-absorb some of the fluids then excrete the remainder as faeces.

Many functions attributed to the Small Intestine in Western bio-medicine are attributed to the Spleen in Chinese medicine.

The Spleen controls the transformation/transportation of food and fluids throughout the digestive system, including Small and Large Intestine.

Hence signs such as diarrhoea, abdominal distension and discomfort usually listed as Spleen imbalance (Deficient Spleen Qi or Yang).

The Stomach

Functions of the Stomach

1. Controls Rotting and Ripening of Food
· Stomach transforms the food and drink we ingest. "Rotting and ripening" is the process of fermentation which prepares the way for the Spleen to extract the refined essence from food.

· After the refined part of the food and fluids has been extracted by the Spleen, the Stomach passes the remainder to the Small Intestine for further separation and absorption.

2. Controls Transportation of Food Essences

· Together with the Spleen, the Stomach controls the transportation of the food essence to the whole body including limbs.

Strong Stomach Qi results in strong energy.

Deficient Stomach Qi, weak food essences, and
Stomach will not have Qi to transport them to the whole body, hence fatigue, and especially weak limbs.

Stomach affects tongue coating.
Tongue coating or "fur" is formed by some "turbid dampness" that is a by-product of the Stomach's rotting and ripening activity.

This dirty dampness rises up to the tongue to form the coating.

Thin white coating on tongue = Stomach is functioning properly.

No coating or peeled coating = Stomach's digesting function is impaired and Stomach Qi and perhaps Yin severely weakened.

3. Controls the Descending of Qi

Stomach sends the transformed food down to Small Intestine for further separation. Therefore, in health, Stomach Qi moves downwards.

If Stomach Qi fails to descend, food can stagnate in Stomach and cause feelings of fullness/distention, sour regurgitation, belching, hiccup, nausea and vomiting.

Causes of Stomach Qi failing to descend:

1. Overeating, which "overwhelms" Stomach
2. Liver invading Stomach (Five Element scenario)
3. Stomach is the Origin of Fluids

Stomach needs plenty of fluids in order to perform its rotting and ripening function.

Fluids themselves are actually derived from ingested food and fluids.

Stomach ensures that part of food and drink goes to form essences (which are extracted by the Spleen).

The Stomach ensures that the other part of food and fluids condenses to form body fluids. Hence, Stomach is important source of fluids.

In the Nei Jing, it states:

"The Stomach likes wetness and dislikes dryness."

If Stomach fluids are abundant, digestion will be good, sense of taste will be normal.

Deficient Stomach fluids (Deficient Stomach Yin) results in poor digestion, thirst, patchy no coat thin red and dry.

Causes of deficient Stomach fluids:

  • Eating large meals late at night
  • Deficiency of Kidney Yin, or from long-term loss of fluids.

Stomach can suffer from Yin Deficiency (Deficient Fluids) or from Yang Deficiency (producing insufficient warmth to rot and ripen) or from Retention of Food (which can relate to either).

Stomach's Relationship with the Spleen

Stomach = Yang Earth. Spleen = Yin Earth. Close relationship Stomach Qi descends, Spleen Qi ascends.

Stomach likes wetness and dislikes dryness; Spleen likes dryness and dislikes wetness.

  • If Stomach too dry, Stomach Qi cannot descend and food cannot be moved down to Small Intestine.
  • If Spleen too damp, Spleen Qi cannot ascend and fluids and food cannot be transformed.
  • Stomach easily suffers from Excess, Spleen easily suffers from Deficiency.
  • Stomach is prone to Heat, Spleen is prone to Cold (producing Dampness).
  • Stomach tends to suffer from Deficiency of Yin, Spleen tends to suffer from Deficiency of Yang.

The Small Intestine

Functions of the Small Intestine

The Small Intestine Controls Receiving and Transforming

Small Intestine receives food and fluids from the Stomach, after the Stomach has "rotted and ripened" and after the Spleen has extracted the food essences.

It communicates with the Bladder, which excretes the impure fluids, and with the Large Intestine, which excretes the impure solid waste.

It further transforms the digested food by separating the "pure" part of the food and fluids from the "impure".

The pure part goes to the Spleen to form part of the essences of food and fluids, which the Spleen then transports all over the body.

The impure or "dirty" part of the food is passed to the Large Intestine for excretion as stool.

The impure part of the fluids are passed to the Bladder for excretion as urine. (Small Intestine has close functional relationship with Bladder and influences urination). If Small Intestine function impaired, there may be excessive urination (Deficient Yang) or scanty urination (Heat).

Small Intestine's Relationship with the Heart

In pathology: Heart Fire can be transmitted to Small Intestine, which then transmits it to the Bladder. Symptoms include thirst, bitter taste in the mouth, sores and dysuria, frequency, urgency or haematuria. Jealousy is very associated!

The Urinary Bladder

Functions of the Urinary Bladder

"Bladder is like a district official; it stores the fluids so that they can be excreted by its action of Qi transformation."

Bladder has wider sphere of activity than in Western medicine.

Stores/excretes urine but also has role in transformation of fluids necessary for the production of urine.

Bladder Removes Water by Qi Transformation

"Dirty" or "impure" part of fluids is sent by Small Intestine to the bladder, which further transforms them into urine. Bladder then stores and excretes urine.

Bladder function of transforming fluids depends on the Kidney Yang.

If Kidney Yang is deficient, Bladder will lack Qi and heat to transform fluids and symptoms will include profuse, clear urine, frequent urination or even incontinence.

Bladder and Small Intestine both depend on Kidney Yang and both work together to move fluids in Lower Burner.

San jiao

The San Jiao as a Yang organ:

· “The San Jiao is the official in charge of irrigation and it controls the water passages.” (Simple Questions).

In this thought, the San Jiao has form like all the other organs.

It helps to receive food, digest it, transform and transport it, and excrete the wastes.

The San Jiao moves fluids in the upper Jiao through the defensive Qi, through the mid Jiao as nutritive Qi, and through the low Jiao as body fluids.

The ability of the Stomach, Lungs, and Kidneys and Bladder to disperse their fluids is dependant on the San Jiao.

Therefore malfunction of the San Jiao can Manifest in blockage of the upper, mid, or low Jiao.

This can cause sneezing, abdominal distension, and retention of urine.

The San Jiao is where the Yuan Qi flows:

In this theory, the San Jiao has no form, it is not an organ, it is a collection of functions.

The Classic of Difficulties says that the Yuan Qi resides between the Kidneys and spreads to the Zang Fu via the San Jiao, it then enters the twelve meridians and emerges at the Yuan-source points.

The Yuan Qi can only make possible all body functions through its spreading by the San Jiao. Therefore it greatly effects the warming for digestion, and excretion.

The San Jiao as three divisions of the body:

This theory comes from both the Spiritual Axis and The Classic of Difficulties.

1. The upper Jiao is from the diaphragm up (Heart, Lungs, Pericardium, throat and head),

2. The mid Jiao is from the diaphragm to the umbilicus (Stomach, Spleen, and Gallbladder), and

3. The area below the umbilicus is the low Jiao (Liver, Kidneys, Intestines, and Bladder).

  • Upper Jiao: distributes the fluids in a mist-like form all over the body through the use of the Lungs.
  • Mid Jiao: digests and transports the essential nourishment from food and drink to the whole body.
  • Low Jiao: separates the essences from the dirty in our foods and fluids. This functions ensures excretion of urine.

The Gallbladder

Functions of the Gall Bladder

The Gall Bladder is unusual among Yang Organs, because it does not receive, transform or transport digested food and waste products, but it stores bile.

Digested food and its products are impure substances.

Hence, since the Gall Bladder stores a pure substance, it resembles a Yin Organ. For this reason the Gall Bladder is included in the "Curious Organs".

The Gall Bladder Stores and Releases Bile

It receives bile from the Liver and stores it, releasing it when needed during digestion (same as in Western biomedicine).

Smooth flow of bile aids Stomach and Spleen digestive functions.

When Liver Qi stagnates and bile does not flow smoothly, digestive signs such as nausea and belching occur.

Gall Bladder Controls Judgment
(Liver controls planning), Gall Bladder controls ability to make decisions. These two functions are interdependent.

Gall Bladder gives a person courage and initiative, i.e., courage to make decisions, act, make changes: positive and decisive action. Deficient Gall Bladder can result in indecision, timidity and easily becoming discouraged.

Controls the Sinews (Tendons), With the Liver

Wood element (Gall Bladder and Liver) control sinews.

Liver nourishes tendons with Blood, Gall Bladder provides Qi to ensure correct movement and flexibility of tendons.

The influential point for tendons is Gall Bladder 34, i.e., on Gall Bladder channel

The Internal Organ Relationships

Heart and Lungs
Heart and Liver
Heart and Kidneys
Liver and Lungs
Liver and Spleen Liver and Kidneys
Spleen and Lungs
Spleen and Kidneys
Lungs and Kidneys
Spleen and Heart

Heart and Lungs

Heart governs Blood, Lungs govern Qi: relationship is that of Qi and Blood.

Qi and Blood are interdependent. Blood nourishes Qi but Qi pushes the Blood.

Heart moves the Blood but relies on Lung Qi to assist.

Lungs produce Ying (and Wei) Qi. Ying Qi flows with the Blood in the Vessels.

Heart and Lung connect via the Zong Qi (Chi of the Chest)

Deficient Lung Qi can lead to stagnation of Qi in the Heart and this can lead to stagnation of Blood of the Heart, with symptoms such as palpitations, chest pain, blue lips.

Excessive Heart Fire can dry up Lung fluids and cause dry cough, dry nose and thirst.

In practice, Heart and Lung Qi are often deficient at the same time because of their close relationship.

Sadness often depletes both Lung and Heart Qi.

Heart and Liver

The heart and the Liver are related via Blood.

Heart governs Blood, Liver stores Blood and regulates its volume. These two activities must be coordinated and harmonized. If Heart Blood is deficient, this may disrupt Liver's ability to regulate Blood (dizziness, excessive dreaming).

Deficient Liver Blood can cause Deficient Heart Blood (palpitations and insomnia).

Heart stores Shen and Liver rules smooth flowing of the emotions.

Shen and emotions mutually support each other. Weak Heart and Shen may lead to depression and anxiety. Or, when Liver Qi stagnates, this constrains emotions and can weaken the Shen.

Heart and Kidney

Mutual assistance of Fire and Water.

Heart belongs to Fire element and is in Upper Burner. (Fire is Yang and corresponds to movement).

Kidneys belong to Water element and are in Lower Burner. (Water is Yin and corresponds to stillness).

Heart & Kidney must be in balance as they represent two fundamental polarities of Yang and Yin (Fire & Water).

Heart Yang descends to warm Kidney Yin while Kidney Yin ascends to nourish Heart Yang. This constant interchange is referred to as "mutual support of Fire and Water".

Kidney Yang Deficient:
Kidneys cannot transform fluids; these can overflow upward to Heart.

Kidney Yin Deficient:
Yin cannot rise to nourish Heart Yin.

This can cause overactive Heart Fire (mental restlessness, insomnia, agitation, etc.)

Both these situations represent loss of communication between Heart and Kidney.

Heart and Kidneys are Common Root of Shen and Essence (Jing). The Heart houses Shen, while the Kidneys store Jing.

Shen and Jing have common root. Jing is fundamental substance from which Shen is derived, in other words, Shen is external manifestation of Jing.

Prenatal Jing is the foundation of the Shen, Postnatal Jing provides nourishment for the Shen.

Normal mental activity needs good supply of Jing.

Weak Jing results in a weak Shen and the person will lack vitality, willpower, self confidence.

When Shen is disturbed by emotional problems, Jing will not be directed by the Shen and the person will feel tired and lack motivation.

Liver and Lungs

Reflects the relationship of Qi and Blood.

Lungs govern Qi, and the Liver regulates and stores the Blood.

They rely on each other in that the Liver relies on Lung Qi to regulate Blood, and the Lungs rely on Liver Qi to smoothly move Qi.

Deficient Lung Qi can affect Liver's smooth movement of Qi (fatigue, depression, cough and hypochondriac pain).

Liver Qi can stagnate in the chest and interfere with the Lung's function of descending (cough, dyspnea, asthma).

Stagnation of Liver Qi can cause Liver Fire to rise and injure Lung Yin (Hypochondriac pain, coughing blood, pain on breathing).

Liver and Spleen
When healthy, Liver Qi aids Spleen in digestion, and ensures smooth flow of bile to aid digestion.

By ensuring smooth flow of Qi in all directions of the body, Liver ensures that Spleen Qi flows upwards in its right direction.

Stagnant Liver Qi disrupts Spleen ability to transform and transport food and fluids and to "raise the pure". (abdominal distension, hypochondriac pain, diarrhoea).

Liver and Kidneys

Based on mutual exchange between Blood and Jing.

Kidney Jing contributes to the making of Blood. (Jing produces bone marrow which is connected with manufacture of Blood in the body).

"Liver and Kidneys have a common origin".

"Essence and Blood have a common source".

Kidney Yin nourishes Liver Yin (including Liver Blood).

Deficient Kidney Jing may lead to Blood becoming Deficient (dizziness, blurred vision, tinnitus).

Kidney Yin fails to nourish Liver Yin, causing hyperactivity of Liver Yang (blurred vision, tinnitus, headaches, irritability, dizziness.

Spleen and Lungs

Mutually assist each other.

Spleen extracts Food Qi and sends it up to the Lungs where it combines with air to form Zong Qi.

Spleen relies on Lung descending function to assist in the transformation and transportation of food (diaphragm movement helps Middle burner - "pumping" action).

Lung descending function also assists Spleen in the transformation of Body Fluids. Lung Qi weak, descending function impaired, Spleen cannot transform and transport the fluids, causing edema.

Deficient Spleen Qi: Food Qi deficient and production of Qi impaired (especially of Lung Qi: tiredness, weak limbs, breathlessness, weak voice) (Earth not producing Metal).

Spleen Deficiency: fluids not transformed but accumulate to form Phlegm, which settles in Lungs and impairs Lung function. "The Spleen forms Phlegm, the Lungs store it."

Spleen and Kidneys

Relationship is one of mutual nourishment.

Spleen: Root of Post-Heaven Qi (Foundation of Postnatal Existence)

Kidneys: Root of Pre-Heaven Qi (Foundation of Prenatal Existence)

The Postnatal Essence (Postnatal Jing) is formed from the food we eat and the air we breathe. The Spleen therefore plays the most important role in the formation of Postnatal Essence.

The Postnatal Essence is stored in the Kidneys together with the Prenatal Essence. Where Spleen Qi is weak, Postnatal Essence will not be produced as effectively, and the Kidney will have less Postnatal Essence to store.

Prenatal Essence assists in the production of Qi via its active aspect (Original Qi): the Original Qi provides the necessary energy for the transformation and transportation of the substances and formation of Qi: this affects the Spleen's function.

Spleen and Kidneys support one another regarding transformation/transportation of Body Fluids.

Where Spleen Qi is weak, and Body Fluids are not able to be transformed and transported, these accumulate to form Dampness, which can interfere with the Kidney's function regarding fluid metabolism (which then makes the Dampness worse).

Where Kidney Yang is Deficient, there is not enough heat for the Spleen to transform Fluids: this can cause Dampness or oedema, chilliness and diarrhoea.

Lungs and Kidneys

Important relationship with regard to Qi and Fluids


Lungs send Qi and Fluids down to the Kidneys. Kidneys hold down the Qi and evaporate some of the Fluids, then send fluid vapor back to the Lungs to moisten them and the Lung then sends Fluids to moisten the skin.

Lungs send Qi down the Kidney and Kidneys hold down the Qi. Therefore they have an important communication regarding respiration

Communication regarding Zong Qi and Original Qi.

Zong Qi (in the chest) flows down to connect with the Original Qi from which it is nourished. Original Qi flows up to the chest to assist with the production of Qi and Blood in the Upper Burner.

The Lung function of governing Qi and respiration depends on the Kidney function of receiving Qi.

Where Kidney energy is weak: impaired reception of Qi. Kidneys fail to hold Qi down and Qi flows back up to the chest ("rebels") and obstructs the Lung's descending function. Result is asthma, cough and dyspnea (unable to inhale deeply).


Lungs control Water passages and send Fluids down to the Kidneys. Kidneys evaporate some fluids and send them back up to the Lungs to keep Lungs moist. "Kidneys govern Water and the Lungs are the upper origin of Water."

Deficient Lung Qi: Lung cannot send fluids downwards and Lung cannot communicate with Kidneys and Bladder (edema, especially of upper body).

Deficient Kidney Yang: Kidneys cannot transform and excrete Fluids in the Lower Burner. These Fluids then accumulate to form Dampness or edema (especially of lower body). Because of the close relationship of Lungs and Kidneys regarding fluid metabolism, this accumulation of Fluids can eventually affect the Lung and impair Lung's descending and dispersing function.

Deficient Kidney Yin: leads to deficiency to Fluids in the Lower Burner. Fluids fail to rise to moisten the Lungs, causing Deficiency of Lung Yin (dry throat at night, dry cough, night sweats and feeling of heat in the palms and soles of the feet).

Deficient Lung Yin (can arise from smoking, or after a long febrile disease involving the Lungs). This implies Deficient Fluids in the Lungs, inability of Lungs to send Fluids to Kidneys, which then results in Deficient Kidney Yin. (Smokers usually end up with depleted Kidney Yin as a result of this mechanism).

Spleen and Heart
Interrelated via the Blood.

Spleen provides Food Qi for the formation of Blood.

Deficient Spleen Qi can lead to Deficient Blood, which can cause Heart Blood to be Deficient (resulting in palpitations, dizziness, poor memory, insomnia).

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