1. Pathogenesis of the Heart
1. Physiological and pathological characteristics of the heart: The heart is located in the upper jiao, opens to the tongue, connects with the vessels in the body, and its manifestation is on the face, corresponding to the small intestine.
The heart houses the spirit (shen) and is the sovereign of the five organs and six bowels, governing blood and connecting with the vessels throughout the body. When the yin and yang of the heart are balanced and the qi and blood are sufficient, the spirit is vigorous, circulating throughout the body, nourishing the five organs and six bowels, and irrigating the limbs and nine orifices, thus maintaining normal life activities. The pericardium serves as the outer defense of the heart, protecting it and warding off external pathogens. The heart is an important internal organ, known as the “ruler’s organ.”
The main physiological functions of the heart are to govern the spirit and the blood vessels. Therefore, any pathological changes in the heart can lead to abnormalities in blood circulation and changes in mental and emotional states. These pathological changes are the result of imbalances in the heart’s yin, yang, qi, and blood. Thus, the imbalance of the heart’s yin, yang, qi, and blood is the intrinsic basis for cardiac diseases.
2. Basic pathological changes of the heart: Due to the different roles of yin and yang, qi and blood in the heart’s functions of governing blood vessels and spirit, the imbalances of the heart’s yin, yang, qi, and blood can manifest as various pathological changes depending on the conditions of deficiency or excess, cold or heat.
(1) Imbalance of heart qi and heart yang: The imbalance of heart qi and heart yang mainly manifests as two aspects: deficiency of yang qi and excess of yang qi.
① Deficiency of heart yang: This primarily manifests as deficiency of heart qi and deficiency of heart yang.
Heart qi deficiency: Heart qi deficiency is often caused by prolonged illness leading to physical weakness, aging, excessive sweating depleting qi, or congenital insufficiency. Since heart qi is the driving force for blood circulation, heart qi deficiency leads to a decline in the heart’s function of governing blood vessels. As blood is the material basis for the spirit, when heart qi is deficient, the driving force is weak, and blood circulation is insufficient, the spirit is not nourished, resulting in both a deficiency of the spirit and a general deficiency of qi. Clinically, this is characterized by palpitations, shortness of breath, exacerbation with exertion, fatigue, and weakness.
Heart yang deficiency: Heart yang deficiency often develops from severe heart qi deficiency; it can also be caused by cold dampness, phlegm, or other pathogens obstructing heart yang; or due to a constitutionally weak yang, emotional distress damaging heart qi; or prolonged illness leading to malnourishment. Yang deficiency leads to internal cold, and qi deficiency leads to weak blood circulation, resulting in insufficient nourishment of the spirit. Therefore, the basic pathological changes of heart yang deficiency are mainly reflected in insufficient spirit, excess yin, and blood circulation obstruction.
Firstly, insufficient spirit. The physiological function of the heart governing the spirit loses the stimulation and excitement of yang qi, leading to weakened mental, conscious, and cognitive activities, making it easy to be suppressed and difficult to be excited. Clinically, this can be seen as mental fatigue, weakened spirit, slow response, drowsiness, and low speech.
Secondly, excess yin and deficiency of yang. Yang deficiency leads to cold; with insufficient heart yang, the warming function declines, thus clinically presenting as aversion to cold and preference for warmth, cold extremities, and other signs of deficiency cold. Compared to heart qi deficiency, heart qi deficiency presents as deficiency without cold signs, while heart yang deficiency presents as deficiency with cold signs.
Thirdly, blood circulation obstruction. Blood flows when warmed and coagulates when cold. Insufficient heart yang leads to a decline in the heart’s function of governing blood vessels, resulting in blood stasis, which can even lead to obstruction of the heart vessels, forming the syndrome of heart vessel obstruction. This can be seen as cold extremities, pale or cyanotic complexion, chest tightness, stabbing pain, and a rough or intermittent pulse.
If heart yang deficiency is extreme, or if cold pathogens violently damage yang qi, or if phlegm and blood stasis obstruct the heart orifices, it can lead to a collapse of heart yang, resulting in profuse sweating, cold extremities, confusion, and a weak pulse, indicating a critical state of impending loss of yang qi.
② Excess of heart yang: This primarily manifests as excessive heart fire and phlegm-fire disturbing the heart.
Excessive heart fire: Excessive heart fire, also known as heart fire, is characterized by an excess of heart yang. Internal invasion of heat pathogens, emotional fire, excessive consumption of spicy and warming foods, or dysfunction of the organs leading to internal heat can all lead to excessive heart fire. The main pathological changes of excessive heart fire are:
Firstly, fire disturbing the spirit. Fire qi connects to the heart; when heart fire is internally blazing, it disturbs the spirit, leading to loss of control of the spirit, manifesting as irritability, insomnia, and even mania, delirium, and confusion.
Secondly, abnormal blood circulation. The heart governs blood vessels; heat forces blood to rise, and excessive heart fire leads to rapid and thin pulse, which can be seen as palpitations, flushed face, red tongue, and rapid pulse, and even excessive heat in the blood leading to various bleeding disorders.
Thirdly, heart fire rising and descending. Fire nature rises; the heart opens to the tongue, and heart fire can rise along the meridians, leading to red and painful tongue tips and sores in the mouth. The heart and small intestine are interrelated; if heart fire descends to the small intestine, it can present as yellow and red urine, or hematuria, or burning pain during urination.
Fourthly, significant heat signs. Excessive yang leads to heat; excessive heart fire often presents with signs of excess heat, such as fever, thirst for cold drinks, red urine, and constipation.
Phlegm-fire disturbing the heart: Liver qi stagnation can transform into fire, leading to liver fire stirring heart fire, resulting in a combination of heart and liver fire, which consumes body fluids into phlegm. Phlegm and fire combine, disturbing the spirit, leading to confusion as the main clinical feature.
(2) Imbalance of heart blood and heart yin: The imbalance of heart blood and heart yin mainly manifests as heart blood deficiency, heart yin deficiency, and heart blood stasis.
① Heart blood deficiency: Heart blood deficiency is often due to blood loss, insufficient blood production, emotional distress, or consumption of heart blood. The basic pathological changes of heart blood deficiency are:
Firstly, blood deficiency. Insufficient heart blood leads to empty blood vessels, and blood governs nourishment, thus presenting signs of general blood deficiency, such as pale face, lips, and tongue, and a thin and weak pulse.
Secondly, loss of control of the spirit. Blood deficiency leads to insufficient nourishment of the heart, resulting in palpitations and anxiety; the spirit cannot settle, leading to weakened consciousness and difficulty concentrating, even resulting in confusion, insomnia, vivid dreams, and anxiety.
② Heart yin deficiency: Heart yin deficiency refers to the deficiency of heart yin. It is often caused by excessive mental work, prolonged illness leading to malnourishment, or emotional distress damaging heart yin. The basic pathological changes of heart yin deficiency include:
Firstly, internal heat generation. Yin fluid deficiency cannot restrain yang; with yin deficiency and excess yang, internal heat arises. This can present as signs of internal heat, such as five hearts feeling hot, tidal fever, night sweats, thirst, dry mouth, flushed face, red tongue, and thin rapid pulse.
Secondly, inability to control the spirit. Heart yin deficiency leads to an inability to restrain heart yang, resulting in excessive heart yang, internal heat disturbing the spirit, leading to signs of restlessness, anxiety, and insomnia.
Thirdly, accelerated blood flow. Internal heat from yin deficiency forces blood to flow rapidly, leading to a thin and rapid pulse, affecting the heart’s function of governing blood vessels, thus presenting as a thin and rapid pulse.
From the perspective of pathogenesis, although heart blood deficiency and heart yin deficiency both fall under the category of insufficient yin and blood, heart blood deficiency is purely a lack of blood, leading to insufficient nourishment of the spirit, primarily manifesting as abnormal spirit and insufficient blood vessels; while the latter includes heart blood deficiency and primarily manifests as yin deficiency unable to restrain yang, leading to excessive heart yang and internal heat.
③ Heart blood stasis: Cold stagnation in the heart vessels, or phlegm turbidity can lead to blood stasis in the heart. Fatigue and cold can often provoke or exacerbate this condition.
When the qi and blood circulation in the heart vessels is obstructed, it can lead to blood stasis, presenting as palpitations, anxiety, chest tightness, stabbing pain, and even severe pain.
In summary, the heart governs blood vessels and houses the spirit, manifesting on the face and opening to the tongue, with its meridian being the hand shaoyin meridian, and is interrelated with the small intestine. The pathological changes of the heart reflect the pathological responses of this system at various levels, primarily manifested in the blood vessels and spirit.
In terms of blood vessels, cold leads to blood stagnation, causing chest pain and cold extremities; heat leads to erratic blood flow, causing a flushed complexion and bleeding; deficiency leads to weak circulation, blood flow obstruction, and a weak or rough pulse; excess leads to poor circulation, blood vessel obstruction, and blood not flowing, leading to harm from blood stasis.
In terms of the spirit, cold leads to insufficient spirit, a tranquil demeanor, and lethargy, even leading to a collapse of yang qi and confusion; heat leads to loss of control of the spirit, a restless demeanor, and insomnia, even leading to delirium; deficiency leads to fatigue and low speech, while excess leads to unpredictable emotions, excessive joy, or uncontrollable sadness, or mania. Sweat is the fluid of the heart; excessive sweating can lead to loss of heart yang, while excessive heart fire can lead to a red and painful tongue, and heart fire descending to the small intestine can lead to red, painful urination.
3. Relationship between heart disease and other organs: The relationship between heart disease and other organs mainly includes the pathological interactions between the heart and the lungs, spleen, liver, kidneys, and small intestine.
(1) Heart and lungs: The heart and lungs reside in the upper jiao, with heart qi ascending to the lungs, and the lungs governing the regulation and assisting the heart in blood circulation. Therefore, the pathological interactions between the heart and lungs mainly manifest in the dysfunction of qi and blood.
① Lung qi deficiency leads to insufficient zong qi, which cannot assist the heart in blood circulation, resulting in weak heart qi. Weak heart qi leads to insufficient nourishment of the lungs, resulting in lung qi deficiency. The mutual influence of qi deficiency between the heart and lungs ultimately leads to heart-lung qi deficiency, clinically presenting as palpitations, shortness of breath, cough, and wheezing, especially with exertion, low voice, and chest tightness, and clear phlegm.
② Lung qi deficiency or failure of lung regulation can affect the heart’s function of governing blood vessels, leading to sluggish blood circulation, presenting as chest tightness, shortness of breath, palpitations, cyanosis of the lips, and purple tongue, indicating blood stasis.
③ Insufficient heart qi or weak heart yang leads to poor blood circulation, which can also affect the lung’s descending function, resulting in chest tightness, stabbing pain, cough, shortness of breath, and wheezing.
④ Excessive heart fire can injure lung yin, leading to symptoms of heart palpitations, irritability, insomnia, and also cough and hemoptysis due to lung damage.
⑤ In the development of warm diseases, the transmission of the disease can directly enter the heart from the lung wei stage, known as “reverse transmission to the pericardium.” Clinically, this can initially present as fever, slight aversion to cold, cough, followed by high fever, confusion, and a red tongue.
(2) Heart and spleen: The heart governs blood, and the spleen generates and regulates blood, thus the pathological interactions between the heart and spleen mainly manifest in the generation and circulation of blood.
Heart yang deficiency or insufficient heart blood can affect the spleen’s function of transformation, leading to dysfunction of the spleen. Conversely, spleen deficiency and weak function can lead to insufficient qi and blood generation, resulting in the heart being deprived of nourishment, which can also lead to disease:
① Spleen disease affecting the heart: Spleen qi deficiency leads to insufficient transformation, or excessive blood loss can affect the heart, leading to insufficient heart blood. Clinically, this presents as pale complexion, fatigue, poor appetite, loose stools, and symptoms of heart palpitations, insomnia, forgetfulness, and a thin pulse.
② Heart disease affecting the spleen: The heart circulates blood to nourish the spleen; if excessive thinking damages heart blood, the blood cannot nourish the spleen, affecting its function. Clinically, this presents as symptoms of insufficient heart blood and signs of spleen qi deficiency.
Whether spleen qi deficiency leads to insufficient heart blood, or heart qi deficiency and blood loss affecting the spleen’s function, the heart and spleen mutually influence each other, ultimately leading to a syndrome of both heart and spleen deficiency. Clinically, this presents as weak spleen qi, poor appetite, abdominal distension, heart blood deficiency, palpitations, insufficient nourishment of the spirit, insomnia, vivid dreams, and general qi and blood deficiency leading to dizziness, pale complexion, and fatigue.
Additionally, the heart governs the circulation of blood, and the spleen has the function of regulating blood; under the influence of both the heart and spleen, blood circulates normally along the vessels without overflowing. When the functions of the heart and spleen are abnormal, bleeding disorders can occur.
(3) Heart and liver: The heart governs blood, and the liver stores blood; the heart governs the spirit, and the liver governs regulation. Therefore, the pathological influence between the heart and liver mainly manifests in blood and spirit:
① Blood aspect: Insufficient heart and liver yin and blood often mutually influence each other; heart blood deficiency can lead to liver blood deficiency. Conversely, liver blood deficiency can lead to heart blood weakness. Therefore, clinically, symptoms of palpitations, fatigue, pale complexion, thin pulse, and dizziness, numbness of limbs, and reduced vision, as well as menstrual irregularities in women, can often be seen.
Thus, blood deficiency syndrome often presents as both heart and spleen deficiency, as well as heart and liver blood deficiency: the syndrome of heart and liver blood deficiency presents with signs of heart blood deficiency and symptoms of liver not nourishing the tendons and eyes.
② Spirit aspect: Diseases of both the heart and liver often manifest as mental abnormalities. For example, in cases of heart and liver blood deficiency, blood does not nourish the heart, and liver loses its nourishing function, leading to a lack of control of the spirit. Therefore, patients with liver blood deficiency, in addition to symptoms of liver blood deficiency, may also present with palpitations, anxiety, insomnia, and vivid dreams. If heart yin is insufficient, internal heat can arise, leading to palpitations, irritability, insomnia, and vivid dreams, often accompanied by irritability, dizziness, flushed face, and other symptoms of liver qi rising, resulting from the lack of control of heart and liver yang. This can even lead to excessive liver fire, which can disturb the spirit and lead to mania.
In summary, in certain mental and emotional disorders, the heart and liver mutually influence each other, with liver qi stagnation and qi mechanism disorder leading to abnormal changes in the spirit. Conversely, emotional disturbances can also lead to liver qi stagnation, even causing liver qi fire to rise.
(4) Heart and kidneys: The relationship between the heart and kidneys mainly involves the balance of water and fire. The imbalance of yin and yang, water and fire, and essence and blood between the heart and kidneys can lead to heart-kidney disharmony. The main pathological manifestations are kidney water deficiency and heart fire excess, as well as heart and kidney yang deficiency leading to water retention.
① Kidney yin deficiency and excessive heart yang: Kidney water deficiency cannot nourish heart yin, leading to excessive heart yang, resulting in symptoms such as palpitations, irritability, insomnia, vivid dreams, and weakness in the lower back and knees, as well as nocturnal emissions in men and menstrual irregularities in women. This is known as “heart-kidney disharmony” or “water-fire imbalance.”
② Kidney and heart yin deficiency, with excessive internal heat: Kidney and heart yin deficiency cannot restrain heart yang, leading to excessive heart fire, presenting as five hearts feeling hot, weight loss, dry mouth, sores in the mouth, palpitations, insomnia, and forgetfulness.
③ Insufficient heart yang, with water obstructing the heart: Insufficient heart yang cannot warm the kidneys, leading to cold water obstructing the heart, presenting as palpitations, edema, and cough.
Additionally, insufficient heart blood and kidney essence deficiency are mutually causal, leading to essence deficiency and blood deficiency, presenting as dizziness, tinnitus, insomnia, vivid dreams, and weakness in the lower back and knees. This also reflects the physiological dysfunction between the heart and kidneys.
(5) Heart and small intestine: The heart and small intestine are interrelated, thus their pathological interactions can transmit heat from the heart to the small intestine, and excess heat in the small intestine can also affect the heart.
① Heat from the heart affecting the small intestine: Excessive heart fire can lead to symptoms such as irritability, sores in the mouth, and red and painful tongue tips. If heart fire descends, it can affect the small intestine’s ability to separate clear from turbid, leading to symptoms such as yellow and red urine, burning pain during urination, and even hematuria, known as “heat from the heart affecting the small intestine,” also referred to as “small intestine excess heat,” which can be treated by clearing the heart and promoting urination.
② Small intestine excess heat affecting the heart: Heat in the small intestine can also rise to the heart, leading to symptoms such as irritability, red tongue, and sores in the mouth, indicating heart fire rising. In treatment, both clearing the heart and promoting urination should be used.
2. Pathogenesis of the Lungs
1. Physiological and pathological characteristics of the lungs: The lungs reside in the chest, serving as the canopy of the five organs and six bowels, connecting to the airways and throat, opening to the nose, collectively known as the lung system. The lungs are interrelated with the large intestine. The lungs govern qi and are responsible for respiration, serving as the site for gas exchange between the body and the environment. The lungs assist the heart in blood circulation and regulate water pathways, serving as the upper source of water, and connect with the skin and hair to nourish the skin. The lungs are delicate organs, intolerant to cold and heat, preferring clarity and dryness, and their qi descends smoothly. Therefore, external pathogens often first attack the lungs. Thus, the pathological changes of the lungs mainly manifest as respiratory dysfunction, water metabolism disorders, dysfunction of the body’s surface barrier, and disturbances in qi generation, blood circulation, and certain skin diseases.
2. Basic pathological changes of the lungs: Lung diseases can be classified into deficiency and excess; deficiency is often due to qi deficiency and insufficient yin fluid, while excess is often caused by wind, cold, dryness, heat, and phlegm dampness attacking the lungs.
(1) Lung failure to disperse and descend: The lung’s dispersing and descending functions are two aspects of lung qi’s movement in and out. Although they are distinct, they mutually influence each other; both dispersing and descending are necessary for normal lung function. Lung qi failure to disperse and descend is often caused by external pathogens attacking the surface, phlegm turbidity obstructing lung channels, or excessive liver rising, with qi fire ascending to the lungs, or due to lung qi deficiency or lung yin deficiency.
① Lung qi not dispersing: Lung qi not dispersing refers to the failure of lung qi to circulate. This can lead to the following pathological changes:
Respiratory obstruction: Normal lung dispersing and descending allows for smooth breathing. When lung qi fails to disperse, qi mechanism is obstructed, leading to respiratory difficulties, presenting as nasal congestion and cough.
Stagnation of defensive qi: The lungs connect with the skin and govern qi, dispersing defensive qi to the skin. When the lungs fail to disperse, defensive qi stagnates, leading to tight pores, closed hair follicles, and symptoms such as aversion to cold, fever, and absence of sweating.
Lung qi not dispersing is generally more related to external pathogenic invasion, while lung qi not circulating is more related to internal injuries.
② Lung failure to clear and descend: Lung failure to clear and descend refers to the failure of lung qi to descend and clear the respiratory tract. Clinically, this presents as chest tightness, shortness of breath, cough, and excessive phlegm. Prolonged coughing can damage lung qi, leading to further lung qi rising. Lung qi rising and lung failure to clear and descend are similar, but cough and qi rising are more severe than lung failure to clear and descend.
Lung qi not dispersing or lung failure to clear and descend can both lead to lung qi rising, causing shortness of breath, and dysfunction of water pathways, leading to symptoms such as reduced urination and edema. Further development can also damage lung qi and lung yin, leading to lung qi deficiency or lung yin deficiency.
(2) Lung qi deficiency: Lung qi deficiency, also known as lung qi weakness, is often caused by prolonged lung failure to disperse, chronic illness leading to qi deficiency, or excessive labor damaging lung qi. In addition to the general changes associated with qi deficiency, lung qi deficiency primarily manifests as:
① Reduced respiratory function: Lung qi deficiency leads to insufficient gas exchange, presenting as cough, shortness of breath, low voice, and even wheezing and difficulty breathing.
② Accumulation of water and fluids: The lungs govern water and are the upper source of water. Lung qi deficiency cannot regulate water pathways, affecting the distribution and metabolism of water and fluids, leading to clear phlegm or even edema.
③ Weak defensive yang: Lung qi deficiency leads to insufficient defensive qi, resulting in weak external functions, leading to spontaneous sweating and aversion to cold.
(3) Lung yin deficiency: Lung yin deficiency refers to the deficiency of lung yin fluid and the pathological changes of excessive internal heat. This is often caused by dryness and heat damaging the lungs, or phlegm-fire internally damaging the lungs, or excessive emotional distress leading to internal heat damaging the lungs, or prolonged coughing damaging lung yin. Yin fluid deficiency leads to dryness in the lungs, disrupting the ascending and descending functions, or internal heat arising from yin deficiency, leading to heat damaging lung channels, resulting in bleeding. This can present as a series of symptoms of dryness and internal heat, such as dry cough without phlegm or with scanty phlegm, shortness of breath, tidal fever, night sweats, flushed cheeks, and even blood-streaked phlegm. Prolonged lung yin deficiency can also damage the kidneys, leading to lung-kidney yin deficiency.
The lungs are the gateway for the movement of qi, governing respiration and participating in regulating water metabolism. The lungs are closely connected to the external environment and are easily affected by external pathogens. Generally, the pathological changes of the lungs can be divided into excess and deficiency; excess can be due to heat obstruction, phlegm obstruction, water accumulation, or blood stasis; deficiency can be due to qi deficiency, yin deficiency, or both qi and yin deficiency. Lung deficiency syndromes often arise from the transformation of excess syndromes, and there can also be mixed excess and deficiency syndromes.
3. Relationship between lung disease and other organs: The pathological influence between the lungs and heart has been previously discussed; here we will only discuss the pathological transmission between the lungs and spleen, liver, kidneys, and large intestine.
(1) Lung and spleen: The lungs govern qi, and the spleen benefits qi; the lungs govern water, and the spleen governs the transformation of water and dampness. Therefore, the pathological relationship between the lungs and spleen mainly manifests in the abnormal functions of qi and water metabolism.
① Insufficient qi generation: Spleen qi deficiency leads to insufficient transformation, and the essence of food cannot nourish the lungs, leading to lung qi weakness, presenting as poor appetite, loose stools, abdominal distension, low energy, cough, and excessive phlegm, and even edema.
Conversely, prolonged cough and wheezing can lead to lung failure to disperse, affecting the spleen, leading to insufficient nourishment of the spleen, resulting in lung qi deficiency, presenting as cough, wheezing, fatigue, and weight loss.
Therefore, lung qi deficiency often requires tonifying the spleen to restore lung qi.
② Water metabolism disorders: Spleen dysfunction leads to water not transforming into fluids, leading to internal dampness, which accumulates as phlegm in the lungs, causing cough, wheezing, and phlegm sounds. The metabolism of water is marked by the lungs but rooted in the spleen. The movement of phlegm is governed by the spleen, while phlegm accumulates in the lungs, thus treatment should focus on strengthening the spleen, drying dampness, and clearing phlegm. Conversely, lung qi weakness leads to failure to disperse, unable to regulate water pathways, leading to poor water metabolism, water retention, and symptoms such as edema, fatigue, abdominal distension, and loose stools.
(2) Lung and liver: The lungs govern qi, and their nature is to descend; the liver governs regulation, and its nature is to rise. Therefore, the relationship between the lungs and liver affects the movement of qi in the body. Their pathological influence mainly manifests in the abnormal rise and fall of qi.
① Abnormal rise and fall of qi: Liver qi stagnation can transform into fire, leading to liver fire scorching the lungs, resulting in symptoms such as rib pain, irritability, cough, and hemoptysis. Conversely, lung failure to clear and descend can affect the liver, leading to liver dysfunction, resulting in symptoms such as cough, chest and rib pain, and fullness.
② Poor circulation of qi and blood: When the body’s qi mechanism is smooth, qi and blood circulate without obstruction. If the lung and liver qi mechanisms are dysfunctional, it can lead to stagnation of qi and blood stasis.
(3) Lung and kidneys: The lungs are the master of qi, while the kidneys are the root of qi; the lungs are the upper source of water, while the kidneys are the master of water. The lungs belong to metal, and the kidneys belong to water, thus metal and water mutually generate each other. Therefore, the pathological relationship between the lungs and kidneys mainly manifests in respiratory abnormalities, water metabolism disorders, and yin fluid deficiency.
① Respiratory abnormalities: Insufficient kidney essence can lead to poor qi reception, causing qi to float upwards, or lung qi deficiency can damage kidney qi, leading to lower qi deficiency, where the qi cannot be received, presenting as cough, shortness of breath, and difficulty breathing.
② Water metabolism disorders: Lung failure to clear and descend can affect the kidneys, leading to kidney dysfunction, resulting in water retention and symptoms such as edema, frequent urination, and difficulty urinating.
③ Yin fluid deficiency: The lungs and kidneys are mutually supportive. When lung yin is damaged, it can lead to kidney yin deficiency, and vice versa. This mutual influence can ultimately lead to lung-kidney yin deficiency, presenting as dry cough, hoarseness, tidal fever, night sweats, flushed cheeks, weakness in the lower back and knees, nocturnal emissions in men, and menstrual irregularities in women.
(4) Lung and large intestine: The lungs and large intestine are interrelated; thus, their pathological interactions manifest as lung failure to clear and the large intestine’s transmission function being impaired.
① Lung failure to clear leads to obstruction in transmission: Excessive lung heat can scorch fluids, leading to constipation, known as excess heat constipation. Lung qi deficiency can lead to weak transmission in the large intestine, resulting in constipation, known as qi deficiency constipation. If the lungs fail to clear, fluids cannot descend, leading to dry intestines and constipation. In treatment, lung-clearing, lung-tonifying, and lung-nourishing herbs can help relieve constipation.
② Transmission dysfunction leads to lung failure to clear: Dysfunction in the large intestine’s transmission can lead to lung qi failure to clear. For example, if the large intestine has excess heat, it can lead to obstruction, causing lung failure to clear, presenting as chest tightness, cough, and difficulty breathing. In treatment, ensuring smooth transmission in the large intestine can alleviate lung symptoms.
3. Pathogenesis of the Spleen
1. Physiological and pathological characteristics of the spleen: The spleen is located in the middle jiao, interrelated with the stomach, governing the muscles and limbs, opening to the mouth, and manifesting on the lips, corresponding to the abdomen. The spleen governs transformation and transportation, serving as the foundation of postnatal life and the source of qi and blood generation, and can also regulate blood circulation. The spleen governs the upward movement of clear qi and prefers dryness while disliking dampness. The pathological changes of the spleen mainly manifest as impaired transformation and transportation of food and fluids, blood generation and circulation disorders, and water metabolism disorders. Spleen qi deficiency is the basic pathological change of the spleen, but the spleen’s function of transporting dampness can lead to dampness accumulation, thus spleen deficiency with dampness accumulation is a characteristic of spleen disease.
2. Basic pathological changes of the spleen: The spleen is the taiyin damp earth; its function is primarily governed by the spleen’s yang qi. Therefore, the impairment of the spleen’s transformation function is mainly due to the deficiency of the spleen’s yang qi, leading to impaired upward movement and transformation. The spleen’s function of regulating blood is essentially a reflection of the spleen’s yang qi’s ability to consolidate.
(1) Spleen yang (qi) imbalance: The imbalance of spleen yang primarily manifests as spleen qi deficiency, spleen yang deficiency, and obstruction from dampness.
① Spleen qi deficiency: Spleen qi deficiency, also known as spleen qi weakness, is characterized by weakness of the spleen and stomach, insufficient qi, and middle qi deficiency. Any irregular diet, excessive use of digestive agents, emotional distress, excessive thinking, congenital weakness, excessive fatigue, or prolonged illness can damage spleen qi, leading to reduced transformation of food and fluids, and impaired generation of qi and blood, resulting in spleen qi deficiency.
The characteristics of spleen qi deficiency are primarily reflected in the decline of the spleen’s transformation function, leading to weakened digestive and absorption capabilities, insufficient distribution of food essence, and reduced ability to generate qi and blood, thus presenting as a comprehensive pathological manifestation of chronic digestive and absorption dysfunction. Spleen qi deficiency can lead to the following pathological changes:
Firstly, impaired digestive and absorption function. Spleen qi deficiency leads to impaired transformation, resulting in poor appetite, undigested food, abdominal distension, or mild edema, known as spleen failure to transform.
Secondly, dual deficiency of qi and blood. Spleen failure to transform leads to insufficient generation, presenting as pale complexion, thin body, low energy, and fatigue.
Thirdly, descent of middle qi. Spleen qi’s inability to rise can lead to descent of middle qi, presenting as dizziness, fatigue, organ prolapse, frequent bowel movements, and difficulty in urination.
Fourthly, spleen’s inability to regulate blood. Spleen qi deficiency cannot regulate blood, leading to symptoms such as blood in stools, irregular menstruation, sudden heavy bleeding, excessive menstruation, and various chronic bleeding disorders, known as spleen’s inability to regulate blood. Clinically, this presents as pathological changes of spleen deficiency, blood deficiency, and bleeding.
② Spleen yang deficiency: Spleen yang deficiency, also known as spleen yang weakness, is often a progression from spleen qi deficiency or due to decline of the mingmen fire, leading to insufficient warmth of the spleen. The pathological characteristics are primarily reflected in the decline of middle jiao yang qi, with prominent internal cold symptoms. Therefore, in addition to the general changes of spleen failure to transform, there are also significant symptoms of cold extremities, abdominal pain, preference for warm food, diarrhea of clear fluids, or impaired ability to transform dampness, leading to internal accumulation of dampness, phlegm, or edema.
Prolonged spleen yang deficiency can easily affect the kidneys, ultimately leading to spleen-kidney yang deficiency.
③ Spleen deficiency with dampness accumulation: Spleen disease characterized by qi deficiency is the root cause, while dampness accumulation is the manifestation. The spleen governs the transformation of dampness; when the spleen is deficient, dampness cannot be transformed and accumulates, further affecting the spleen’s function. Therefore, spleen deficiency with dampness accumulation is a pathological change caused by spleen deficiency leading to internal dampness obstruction. Its clinical characteristics include symptoms of spleen qi deficiency, abdominal distension, fatigue, reduced appetite, bland taste, or sticky mouth, nausea, loose stools, and even edema, with a white and greasy tongue coating.
When the spleen is burdened by dampness, it further obstructs the spleen’s ability to transform and transport, leading to a complex interplay of deficiency and excess, with internal dampness having a tendency to transform into cold or heat. If the spleen yang is weak, it is more likely to transform into cold, leading to cold-dampness obstructing the spleen; if the spleen yang is strong, it is more likely to transform into heat, or prolonged dampness can lead to heat, resulting in spleen-stomach damp-heat syndrome. However, dampness is a yin pathogen, and its nature is sticky; thus, when dampness is excessive, yang is weakened, leading to a primary pathological trend of dampness transforming into cold. In clinical practice, it is essential to distinguish between external dampness, internal dampness, and the spleen’s relationship to determine the severity of spleen deficiency and dampness obstruction, thus making accurate judgments on the pathogenesis.
(2) Spleen yin imbalance: Spleen yin imbalance generally refers to the imbalance of spleen yin fluid, known as spleen yin deficiency. Spleen yin deficiency is often caused by irregular diet, excessive consumption of spicy and dry foods, alcohol abuse, leading to fire damaging the middle, or emotional distress, leading to internal damage and excessive fire, thus consuming spleen yin. Spleen yin deficiency is characterized by reduced appetite, dry lips and mouth, constipation, burning sensation in the stomach, weight loss, and a red tongue with little coating.
The spleen and stomach reside in the middle jiao, connected by membranes, governing the transformation of food and fluids. The spleen governs transformation, while the stomach governs reception; their functions are closely coordinated. Therefore, spleen yin deficiency often coexists with stomach yin deficiency, and vice versa. However, there are distinctions; spleen yin deficiency is often due to emotional distress, while stomach yin deficiency is often caused by heat diseases damaging fluids. The former often presents with taste disturbances, while the latter often presents with hunger without appetite, excessive hunger, and dry retching.
In summary, spleen qi deficiency is the most basic and common pathological change of spleen dysfunction, primarily characterized by impaired digestive and absorption functions, accompanied by systemic qi deficiency. Spleen yang deficiency is often a further development of spleen qi deficiency, which can also be caused by excessive consumption of cold foods or cold medicines, directly damaging spleen yang. Spleen yang deficiency often affects kidney yang, leading to spleen-kidney yang deficiency. Spleen yang deficiency not only presents with symptoms of spleen qi deficiency but also often shows reduced warming function, leading to internal cold. Spleen qi descent or middle qi descent, or qi deficiency descent, often results from insufficient spleen qi or spleen yang, leading to middle qi deficiency, or prolonged diarrhea, excessive fatigue, and damage to spleen qi, resulting in spleen qi deficiency and functional decline, with spleen qi unable to rise, leading to descent.
3. Relationship between spleen disease and other organs: The pathological influence between the spleen and heart often presents as heart-spleen deficiency. The pathological influence between the spleen and lungs often presents as lung-spleen deficiency, as previously mentioned. Here, we will mainly discuss the pathological transmission between the spleen and liver, kidneys, and stomach.
(1) Spleen and liver: The liver stores blood and governs regulation, while the spleen generates and regulates blood and governs transformation. The relationship between the liver and spleen mainly involves regulation and transformation, with pathological manifestations primarily reflected in digestive absorption disorders and blood function disorders.
① Digestive absorption: The relationship between the liver and spleen is reflected in digestive absorption, with two different pathological manifestations: wood flourishing over earth and earth obstructing wood.
Wood flourishing over earth: This includes liver-spleen disharmony and liver-stomach disharmony. The digestive absorption of the spleen and stomach relies on the liver’s regulation. When the liver fails to regulate, it can obstruct the spleen, leading to spleen qi deficiency and impaired transformation, known as liver-spleen disharmony. Clinically, this presents as fullness in the chest and ribs, mental depression, or irritability, along with symptoms of spleen dysfunction such as poor appetite, abdominal distension, and loose stools. When the liver fails to regulate, it can also affect the stomach, leading to stomach dysfunction, resulting in symptoms such as abdominal pain and hiccups.
Earth obstructing wood: Spleen dysfunction leads to internal dampness accumulation; external dampness can also obstruct spleen yang, leading to damp-heat accumulation. Damp-heat accumulation can lead to liver and gallbladder dysfunction, resulting in jaundice, presenting as yellow skin, yellow eyes, and yellow urine. Additionally, spleen qi deficiency can lead to liver dysfunction, even leading to wind, known as spleen deficiency generating wind. For example, children with prolonged diarrhea can develop “slow spleen wind,” clinically characterized by convulsions in the limbs. This is different from the mechanism of liver wood overpowering the spleen. Therefore, in treatment, the former should focus on soothing the liver and regulating the spleen, while the latter should focus on tonifying the spleen and soothing the liver.
② Blood aspect: Spleen qi deficiency leads to insufficient transformation, resulting in insufficient generation of blood, or spleen’s inability to regulate blood, leading to excessive blood loss, which can affect the liver, leading to liver blood deficiency, presenting as poor appetite, weight loss, dizziness, blurred vision, numbness of limbs, and menstrual irregularities in women.
(2) Spleen and kidneys: The spleen is the foundation of postnatal life, while the kidneys are the foundation of prenatal life, thus they mutually influence each other in pathology. Kidney yang deficiency cannot warm spleen yang, leading to spleen yang deficiency, or prolonged spleen yang deficiency can damage kidney yang, leading to kidney yang deficiency. Both can ultimately lead to spleen-kidney yang deficiency. Clinically, this primarily manifests as digestive dysfunction and water metabolism disorders.
① Digestive dysfunction: Due to spleen-kidney yang deficiency, the spleen fails to transform, leading to water retention and stagnation, resulting in diarrhea. Kidney yang deficiency leads to insufficient warmth of the spleen, resulting in excessive cold, leading to five o’clock diarrhea. Therefore, it is said: “Kidney deficiency leads to five o’clock diarrhea.” The root cause is kidney yang deficiency, which cannot warm the spleen, leading to excessive cold, resulting in abdominal distension and diarrhea.
② Water metabolism disorders: Spleen deficiency cannot regulate water, leading to excessive dampness, which can damage its yang, thus leading to spleen deficiency affecting the kidneys, resulting in kidney yang deficiency. Kidney yang deficiency cannot warm the spleen, leading to further spleen yang deficiency. Spleen deficiency leads to the inability to regulate water, leading to water retention, presenting as edema, frequent urination, and difficulty urinating.
(3) Spleen and stomach: The spleen and stomach are interrelated; thus, their pathological interactions manifest as impaired digestion and absorption, abnormal rise and fall, and impaired moisture regulation.
① Impaired digestion and absorption: The stomach governs reception, while the spleen governs transformation; their functions are closely coordinated. If the stomach cannot receive and digest food, it can lead to poor appetite or excessive hunger. If the spleen fails to transform, it can lead to symptoms of poor digestion, fullness after eating, and loose stools. The stomach governs reception, while the spleen governs digestion. If food cannot be digested, the spleen is at fault; if food cannot be received, the stomach is at fault. However, due to the mutual influence of the spleen and stomach in pathological states, symptoms of impaired digestion and absorption often present simultaneously, thus treatment should focus on both the spleen and stomach.
② Abnormal rise and fall: The spleen governs the upward movement of clear qi; if spleen qi does not rise, or if middle qi descends, it can lead to diarrhea, prolapse of internal organs, and other symptoms. The stomach governs the downward movement of turbid qi; if stomach qi does not descend and instead rises, it can lead to nausea, vomiting, hiccups, and difficulty in bowel movements. Since the spleen rises and the stomach descends, if clear qi does not rise, turbid qi will not descend, and vice versa, leading to mutual interference. Therefore, treatment should focus on restoring the rise and fall of the spleen and stomach.
③ Impaired moisture regulation: The spleen prefers dryness and dislikes dampness, while the stomach prefers moisture and dislikes dryness. If dampness obstructs the spleen, spleen yang is obstructed, leading to water retention; if the spleen fails to transform, it can also lead to dampness accumulation. Therefore, spleen diseases often present with cold and dampness, and treatment should focus on warming and drying. Heat pathogens can easily damage fluids, scorching stomach fluids and leading to dryness; if stomach qi rises, frequent vomiting can lead to fluid loss and dryness. Therefore, stomach diseases often present with heat and dryness, and treatment should focus on cooling and moistening.
In summary, the spleen and stomach coordinate their functions, with mutual rise and fall, and moisture regulation, to maintain the digestive and absorption functions of food and fluids. If the spleen and stomach’s functions are impaired, it can lead to various pathological changes.
4. Pathogenesis of the Liver
1. Physiological and pathological characteristics of the liver: The liver is the organ of wind and wood, governing regulation and storing blood. Its qi rises and prefers smoothness while disliking stagnation. It governs the tendons, opens to the eyes, and is interrelated with the gallbladder. The liver is composed of blood and governed by qi, embodying the unity of yin and yang. Therefore, its pathological changes are complex and varied, often leading to liver qi stagnation, prolonged stagnation transforming into fire, excessive liver yang, and internal wind. Thus, the liver often has excess qi and yang, while its blood and yin are often insufficient. The liver is known as the “thief of the five organs,” thus liver diseases often affect other organs, leading to complex pathological changes.
2. Basic pathological changes of the liver: The pathological changes of liver diseases can be classified into deficiency and excess, with excess being more common.
(1) Imbalance of liver qi and liver yang: Imbalance of liver qi and liver yang is often characterized by excess liver qi, liver fire, and excessive liver yang. Excessive liver yang is often due to liver yin deficiency, leading to excess yang, thus it is discussed within the context of liver yin and liver blood imbalance.
Therefore, the pathogenesis of liver qi and liver yang imbalance mainly manifests in liver qi stagnation and liver fire rising.
① Liver qi stagnation: Liver qi stagnation, also known as liver stagnation, is the most common pathological change in liver diseases. Emotional stress, emotional stagnation, or prolonged illness can lead to liver qi stagnation, resulting in symptoms such as emotional depression, discomfort, and pain in the ribs. The pathological characteristics of liver qi stagnation are the inhibition of the liver’s regulatory function, leading to qi mechanism obstruction, which can manifest in the body or organs. Clinically, this is characterized by emotional depression, unhappiness, and rib pain, often relieved by sighing or belching.
The pathological progression of liver qi stagnation includes:
Firstly, qi stagnation leading to blood stasis. If qi is obstructed, blood will also be obstructed. Liver qi stagnation leads to qi obstruction, resulting in poor blood circulation, which can lead to blood stasis, presenting as stabbing pain in the ribs, masses, and a blue or purple tongue.
Secondly, phlegm and qi stagnation. Qi stagnation can lead to phlegm, which can obstruct the throat, leading to symptoms such as globus sensation; if it accumulates in the neck, it can lead to goiter.
Thirdly, qi stagnation transforming into fire. Excess qi can lead to fire; prolonged liver qi stagnation can transform into fire, leading to symptoms of liver fire rising.
Fourthly, affecting the spleen and stomach. Liver qi stagnation can affect the spleen and stomach’s ability to receive and transform, leading to symptoms such as vomiting, belching, abdominal distension, and diarrhea.
Although liver qi stagnation and liver qi reversal are both liver qi disorders, they have different pathological natures. Liver qi stagnation is due to insufficient liver regulation, while liver qi reversal is due to excessive regulation. Therefore, emotional disturbances can lead to liver qi stagnation, while excessive regulation can lead to liver qi reversal.
In summary, the basic pathological changes of liver qi stagnation mainly manifest in emotional depression and qi mechanism disorder.
② Liver fire rising: Liver fire rising, also known as liver fire or liver channel excess heat, is a pathological change characterized by excessive liver yang and qi fire rising. This is often due to liver qi stagnation transforming into fire, or due to anger damaging the liver, leading to excessive liver qi and fire rising, or due to emotional distress leading to excessive fire.
Liver fire rising is characterized by excessive liver yang rising, with significant heat signs in the head and face. This can present as headaches, flushed face, irritability, tinnitus, or sudden deafness. Excessive liver yang can easily damage yin blood, leading to yin deficiency and excessive fire. If liver fire injures the lung and stomach channels, it can lead to symptoms such as hemoptysis, vomiting blood, and bleeding. If qi and blood rise excessively, it can lead to fainting.
(2) Imbalance of liver yin and liver blood: The pathogenesis of liver yin and liver blood imbalance is characterized by insufficient liver yin and blood. Yin deficiency leads to yang excess, resulting in excessive liver yang and internal wind. Therefore, excessive liver yang and internal wind are often related to liver yin and blood deficiency.
① Liver yin deficiency: Liver yin deficiency, also known as liver yin deficiency, is characterized by insufficient liver yin. The liver relies on kidney water for nourishment. Kidney yin deficiency can lead to liver yin deficiency, or liver qi stagnation can lead to fire, consuming liver yin. Liver yin deficiency is characterized by dizziness, dry eyes, pain in the sides, flushed face, dry mouth and throat, and feelings of heat.
② Liver blood deficiency: Liver blood deficiency is often due to excessive blood loss, prolonged illness, or weakness of the spleen and stomach, leading to reduced blood generation. In addition to the signs of blood deficiency, the main pathological changes of liver blood deficiency are reflected in the liver’s inability to nourish the tendons and eyes, presenting as numbness of the limbs, difficulty in joint movement, and dry eyes.
Additionally, liver blood deficiency can lead to insufficient blood in the Chong and Ren vessels, leading to menstrual irregularities in women.
③ Excessive liver yang: Excessive liver yang is often due to liver yin deficiency, leading to excessive liver yang. Emotional disturbances can also lead to excessive liver yang, resulting in symptoms such as dizziness, tinnitus, flushed face, irritability, and weakness in the lower back and knees.
In summary, liver qi stagnation, liver fire rising, and excessive liver yang are interrelated in pathology. Liver qi stagnation can lead to liver fire rising, and prolonged liver fire can damage liver yin, leading to excessive liver yang. However, liver qi stagnation is primarily characterized by emotional disturbances and qi mechanism disorder, while liver fire rising is characterized by excessive heat and qi fire rising.
3. Relationship between liver disease and other organs: The liver is known as the “thief of the five organs,” thus liver diseases often affect other organs. The relationship between the liver and heart often presents as excessive heart and liver fire, while the relationship between the liver and lungs often presents as liver fire affecting the lungs. The relationship between the liver and spleen often presents as liver wood overpowering spleen earth. Here, we will mainly discuss the pathological influence between the liver and kidneys and gallbladder.
(1) Liver and kidneys: The pathological interactions between the liver and kidneys mainly reflect the imbalance of yin and yang, essence and blood, and the regulation of storage and discharge.
① Imbalance of yin and yang: The yin of the liver and kidneys are interconnected and mutually restrain each other, thus they influence each other in pathology. Kidney yin deficiency can lead to liver yin deficiency, resulting in excessive liver yang, presenting as weakness in the lower back and knees, dizziness, and tinnitus. Conversely, liver yin deficiency can lead to kidney yin deficiency, presenting as dizziness, insomnia, forgetfulness, and other symptoms of yin deficiency.
② Essence and blood imbalance: Kidney essence deficiency can lead to liver blood deficiency, while liver blood deficiency can also lead to kidney essence deficiency, ultimately resulting in both liver and kidney blood deficiency, presenting as weight loss, skin changes, and menstrual irregularities in women.
③ Dysfunction of storage and discharge: The relationship between the liver’s regulation and the kidney’s storage can lead to menstrual irregularities in women and dysfunction in male ejaculation. Women may experience excessive menstruation, early onset, or scanty menstruation, while men may experience nocturnal emissions, premature ejaculation, or difficulty in ejaculation.
(2) Liver and gallbladder: The liver and gallbladder are interrelated, thus their pathological interactions mainly manifest in abnormal bile secretion and emotional disturbances.
① Impaired bile secretion: Bile originates from the liver; if the liver’s regulatory function is impaired, it can affect the normal secretion, storage, and excretion of bile. Conversely, obstruction in the bile ducts can also affect the liver, leading to impaired regulation. Therefore, the liver and gallbladder mutually influence each other, leading to both liver and gallbladder diseases. For example, liver and gallbladder damp-heat can lead to symptoms such as jaundice, yellow skin, and yellow urine, along with symptoms of liver qi stagnation.
② Emotional disturbances: The liver governs planning, while the gallbladder governs decision-making. Dysfunction in both can lead to emotional disturbances. For example, liver disease can lead to gallbladder dysfunction, presenting as insomnia, nightmares, and anxiety.
5. Pathogenesis of the Kidneys
1. Physiological and pathological characteristics of the kidneys: The kidneys are the organs of water and fire, storing true yin and containing true yang, serving as the foundation of prenatal life and the root of life, governing essence, receiving qi, and governing water, opening to the ears and the two lower orifices, manifesting in the hair, and interrelated with the bladder. Therefore, when kidney essence is sufficient, bones are strong, teeth are firm, marrow is full, brain is clear, hearing is sharp, and vision is bright. When the mingmen fire is sufficient, the yang qi of the five organs and six bowels is vigorous and full of life. Therefore, any abnormalities related to growth, reproductive functions, water metabolism, brain, marrow, bones, and certain respiratory, auditory, and urinary disorders are often related to abnormalities in kidney physiological functions.
The kidneys are the repository of the body’s true yin and true yang, which are the foundation of human reproductive development. They should be kept secret and not leaked. If they are kept secret, normal physiological functions can be maintained; if they are depleted, it leads to fundamental weakness, resulting in various diseases. Therefore, the pathological changes of the kidneys are predominantly deficiency syndromes.
The kidneys contain both water and fire, yin and yang, with a balance of yin and yang. When the kidneys are diseased, it primarily manifests as an imbalance of water and fire, yin and yang, but there is a distinction between deficiency and excess. Diseases caused by excess pathogens are classified as excess, such as external cold and dampness, or damp-heat obstructing the kidneys, which are often excess diseases. Prolonged excess can transform into deficiency. Diseases caused by deficiency are classified as deficiency. Kidney deficiency can be divided into yin and yang deficiency, and essence and qi deficiency. However, prolonged kidney deficiency can lead to both yin and yang deficiency.
2. Basic pathological changes of the kidneys: Kidney diseases are predominantly deficiency syndromes, generally divided into yin deficiency and yang deficiency.
(1) Imbalance of kidney yang and kidney qi: Imbalance of kidney yang and kidney qi primarily manifests as kidney yang deficiency, insufficient mingmen fire, and kidney qi weakness, leading to systemic physiological dysfunction, impaired water metabolism, disordered transformation of food and fluids, reproductive dysfunction, and abnormal respiratory functions.
① Kidney qi instability: Kidney qi instability, also known as lower source instability, is a pathological change characterized by kidney qi weakness and failure to contain. This is often due to aging, congenital weakness, or prolonged illness leading to kidney qi depletion. Clinically, this presents as instability in the essence, leading to nocturnal emissions, premature ejaculation, urinary incontinence, residual urine, and frequent urination, as well as menstrual irregularities in women.
② Inability to receive qi: Inability to receive qi refers to the pathological change where kidney qi is weak and cannot receive lung qi. This is often due to excessive labor damaging kidney qi or prolonged illness leading to qi deficiency. Clinically, this presents as shortness of breath, wheezing, and difficulty breathing.
③ Kidney yang deficiency: Kidney yang deficiency, also known as kidney yang weakness, is often due to factors such as physical weakness, prolonged illness, or aging. The impact of kidney yang deficiency on kidney physiological functions primarily manifests as: 1) reproductive dysfunction, leading to male impotence, premature ejaculation, and coldness in women; 2) water metabolism disorders, leading to edema or frequent urination; 3) impaired transformation of food and fluids, leading to diarrhea or five o’clock diarrhea.
(2) Imbalance of kidney yin and kidney essence: This primarily reflects kidney essence deficiency, kidney yin deficiency, and excessive fire.
① Kidney essence deficiency: Kidney essence deficiency is often due to congenital insufficiency, prolonged illness, or excessive sexual activity, leading to depletion of kidney essence. Kidney essence is related to the body’s reproductive and developmental capabilities, as well as blood generation. Therefore, kidney essence deficiency can lead to reproductive dysfunction, such as male infertility and female menstrual irregularities; developmental disorders in children, such as delayed growth; and early aging in adults, such as hair loss, tinnitus, forgetfulness, and weakness in the lower back and knees.
② Kidney yin deficiency: Kidney yin deficiency, also known as kidney water deficiency, refers to the deficiency of kidney yin fluid, often caused by damage to essence, blood loss, or excessive consumption of warming and drying substances, leading to internal heat. Kidney yin deficiency can lead to insufficient nourishment of the organs, resulting in symptoms such as weakness, dizziness, insomnia, and menstrual irregularities in women.
③ Excessive fire: Excessive fire is a pathological change characterized by excessive internal heat leading to premature ejaculation and excessive sexual desire. This is often due to kidney water deficiency or liver-kidney yin deficiency, leading to excessive fire.
In summary, the pathological changes of the kidneys are predominantly deficiency syndromes, with cold representing yang deficiency and heat representing yin deficiency. Therefore, the harm of kidney deficiency can be divided into yin deficiency and yang deficiency. Extreme yin deficiency or yang deficiency can lead to mutual damage, ultimately resulting in both yin and yang deficiency and depletion of essence and qi.
3. Relationship between kidney disease and other organs: The kidneys are the foundation of prenatal life, and kidney yin and yang are the roots of human yin and yang. Therefore, when the five organs are diseased, prolonged illness can damage the kidneys, and kidney diseases can also easily affect other organs.
(1) Relationship between kidneys and heart, lungs, spleen, and liver: As previously mentioned, kidney yang deficiency is closely related to the heart, lungs, and spleen, presenting as heart-kidney yang deficiency, lung-kidney qi deficiency, and spleen-kidney yang deficiency. Conversely, kidney yin deficiency is closely related to the heart, lungs, and liver, presenting as heart-kidney yin deficiency, lung-kidney yin deficiency, and liver-kidney yin deficiency.
(2) Relationship between kidneys and bladder: The kidneys and bladder are connected through meridians. Kidney yang deficiency leads to impaired qi transformation, resulting in urinary difficulties; if kidney deficiency leads to insufficient containment, it can lead to urinary incontinence or nocturnal emissions. Abnormalities in urine storage and excretion are primarily due to bladder diseases, such as bladder damp-heat leading to symptoms such as painful urination, hematuria, or urinary retention. Bladder qi deficiency can lead to urinary frequency, incontinence, or nocturnal emissions. However, the storage and excretion functions of the bladder depend on kidney qi transformation; thus, abnormalities in urination are related to both the bladder and kidney qi transformation. Clinically, excess conditions are often attributed to the bladder, while deficiency conditions are often attributed to the kidneys. For example, common urinary incontinence and polyuria in the elderly are often due to kidney qi weakness.
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