1. Gallbladder
The gallbladder is the foremost of the six fu organs and belongs to the extraordinary organs. It is shaped like a pouch, resembling a hanging gourd, and is attached to the liver’s small lobe. The gallbladder is yang and belongs to wood, corresponding with the liver, which is yin wood. The gallbladder stores and excretes bile, governs decision-making, and regulates the qi of the organs.
(1) Anatomical Structure of the Gallbladder
1. Anatomical Position of the Gallbladder: The gallbladder is connected to the liver, situated between the small lobes of the liver, and has meridians that interconnect with the liver.
2. Structural Characteristics of the Gallbladder: The gallbladder is a hollow, pouch-like organ that stores bile, a pure, clear, bitter, yellow-green fluid. Therefore, it is referred to as the “zhongjing zhi fu” (中精之腑) in the “Lingshu: Ben Zang” and as the “qingjing zhi fu” (清净之腑) in the “Qianjin Yaofang”. The gallbladder’s anatomical structure is similar to that of other fu organs, thus it is one of the six fu. However, due to its physiological characteristics of storing essence, it also belongs to the extraordinary organs.
(2) Physiological Functions of the Gallbladder
It also interacts with the five zang organs in “storing essence and qi”.
1. Storage and Excretion of Bile: Bile, also known as “jing zhi” (精汁) or “qing zhi” (清汁), originates from the liver. “The residual qi of the liver leaks into the gallbladder, gathering to form essence” (from the “Mai Jing”). Bile is formed and secreted by the liver, then stored and concentrated in the gallbladder, and through the gallbladder’s excretory function, it enters the small intestine. Bile is formed by the transformation of the liver’s wood qi, and after eating, it fills the small intestine, pressing on the gallbladder to release its juice into the small intestine to aid in food digestion and waste elimination. If bile is insufficient, the essence cannot be separated, leading to pale and clean stools without yellow coloration (from the “Nanjing Zhengyi”). The liver and gallbladder both belong to the wood element, one yin and one yang, complementing each other. “The gallbladder is the fu of the liver, belonging to wood, governing the rise of clear and the descent of turbid, facilitating the middle earth” (from the “Yixue Jianeng”). Thus, the gallbladder also has the function of excretion, but its excretion relies on the liver’s qi to perform its duties.
The bile stored in the gallbladder is excreted due to the liver’s excretory function, entering the intestines to promote the digestion of food. If the functions of the liver and gallbladder are abnormal, the secretion and excretion of bile will be obstructed, affecting the digestive functions of the spleen and stomach, leading to symptoms of poor appetite, abdominal distension, diarrhea, and other digestive disorders. If damp-heat accumulates in the liver and gallbladder, causing the liver to lose its excretory function, bile overflows and saturates the skin, resulting in jaundice, characterized by yellowing of the eyes, skin, and urine. The qi of the gallbladder descends smoothly; if the gallbladder qi is obstructed, the qi mechanism may reverse, leading to symptoms such as bitter mouth and vomiting of yellow-green bitter fluid.
2. Governing Decision-Making: The gallbladder governs decision-making, referring to its role in the mental and cognitive processes of judgment and decision-making. The gallbladder’s role in decision-making is crucial for defending against and eliminating adverse effects from certain mental stimuli (such as great fright) to maintain and control the normal flow of qi and blood, ensuring the coordination between organs. Thus, it is said: “The gallbladder is the official of central justice, from which decisions are made” (from the “Suwen: Linglan Mijian Lun”). Mental and psychological activities are related to the gallbladder’s decision-making function, which can assist the liver’s excretion to regulate emotions. When the liver and gallbladder work together, emotions are stable and harmonious. A person with strong gallbladder qi is less affected by intense mental stimuli and recovers quickly. Therefore, it is said that strong qi in the gallbladder prevents evil influences. A person with weak gallbladder qi is more susceptible to adverse effects from mental stimuli, leading to conditions such as timidity, easy fright, insomnia, and vivid dreams, which can often be treated effectively by addressing the gallbladder. Thus, it is said: “The gallbladder is attached to the liver, complementing each other; even if the liver qi is strong, it cannot be without the gallbladder. When the liver and gallbladder work together, courage is achieved” (from the “Leijing: Zangxiang Lei”).
3. Regulating the Qi Mechanism of the Organs: The gallbladder is associated with the liver, assisting in the liver’s excretion to regulate the qi mechanism, thus maintaining the internal balance of the organs and the external balance of the muscles, allowing for smooth ascension and descent, and harmonious interaction. When the gallbladder functions normally, all organs are at ease, hence the saying: “All eleven organs depend on the gallbladder” (from the “Suwen: Liu Jie Zangxiang Lun”). This means that “all eleven organs rely on gallbladder qi for harmony” (from the “Zabing Yuanliu Xizhu”).
The human body is a mechanism of ascending, descending, and circulating qi. When the liver qi is smooth, the qi mechanism is regulated, allowing for orderly ascension and descent of the organ qi, maintaining the balance of yin and yang, and the harmony of qi and blood. The gallbladder is a fu, while the liver is a zang; in the relationship between zang and fu, the zang is primary, and the fu is secondary. Why is it said that “the eleven organs depend on the gallbladder” and not “the eleven organs depend on the liver”? Because the liver is yin wood, while the gallbladder is jia wood, representing the lesser yang. “Yang is the correct, and yin is the master” (from the “Suwen: Yin Yang Li He Lun”). Yin is the foundation of yang, and yang governs yin, meaning that yin and yang are interdependent, with yang leading. The gallbladder is yang wood, while the liver is yin wood, thus yang governs yin, hence the saying “the eleven organs depend on the gallbladder”.
In summary, the phrase “the eleven organs depend on the gallbladder” aims to illustrate that in cognitive activities, the liver governs deliberation, while the gallbladder governs decision-making. The liver and gallbladder mutually support each other, rather than suggesting that the gallbladder has the role of the “great master of the five zang and six fu organs”. The gallbladder’s decision-making must be guided by the heart to function normally.
(3) Physiological Characteristics of the Gallbladder
1. Gallbladder Qi Governs Ascension: The gallbladder is the lesser yang among the yang organs, inheriting the wood virtue of the east, belonging to jia wood, and governing the ascending qi of the lesser yang spring, hence it is said that gallbladder qi governs ascension. The gallbladder qi’s governing ascension is synonymous with the gallbladder’s nature of promoting smoothness, which is similar to the liver’s preference for smoothness and aversion to depression. Jiazi is the leader of the five movements and six qi, corresponding to spring, and is the lesser yang among the yang. When the spring qi ascends, all things are at peace, which is a natural law. Humans are in harmony with heaven and earth; in the human body, the gallbladder governs jiazi, and gallbladder qi ascends and promotes smoothness, just as the spring qi ascends, allowing the organ qi to flow smoothly. When the gallbladder qi ascends normally, the organ qi ascends and descends normally, thus maintaining its physiological functions. Therefore, it is said: “The gallbladder is the qi of the lesser yang spring; when the spring qi ascends, all things transform and stabilize; thus, when gallbladder qi ascends, the remaining organs follow. If gallbladder qi does not ascend, then symptoms such as nausea, diarrhea, and intestinal obstruction will arise” (from the “Piwai Lun: Pi Wei Xu Shi Zhuan Bian Lun”).
2. Preferring Tranquility: Tranquility refers to a state of clarity and calmness. The gallbladder is the residence of clarity, preferring tranquility and disliking disturbance. When tranquil and free from evil disturbances, gallbladder qi is neither rigid nor soft, inheriting the gentle qi of the lesser yang, thus fulfilling its proper role, and the bile is excreted in a timely manner, allowing for decision-making in the face of situations. If there is evil in the gallbladder, whether heat, dampness, phlegm, or depression, the gallbladder loses its clarity and tranquility, losing its gentle nature and becoming obstructed, leading to symptoms such as bitter vomiting, restlessness, palpitations, and insomnia, and in severe cases, extreme fear as if one is about to be captured. Clinically, the use of Wending Decoction to treat restlessness, insomnia, bitter vomiting, and palpitations aims to restore the gallbladder’s tranquil and gentle nature to regain its proper function.
2. Stomach
The stomach is the organ that holds food in the abdominal cavity. Its shape is curved, connecting above to the esophagus and below to the small intestine. It is responsible for receiving and digesting food and is known as the warehouse of food essence and the sea of qi and blood. The stomach is characterized by smooth descent and is in conjunction with the spleen, often referred to as the foundation of postnatal life. The stomach and spleen reside in the middle earth, but the stomach is dry earth and belongs to yang, while the spleen is damp earth and belongs to yin.
(1) Anatomical Structure of the Stomach
1. Anatomical Position of the Stomach: The stomach is located below the diaphragm, in the upper part of the abdominal cavity, connecting above to the esophagus and below to the small intestine. The stomach cavity is referred to as the “wei wan” (胃脘), divided into upper, middle, and lower parts: the upper part is the upper wan, including the cardia; the lower part is the lower wan, including the pylorus; the area between the upper and lower wans is called the middle wan. The cardia connects to the esophagus, and the pylorus connects to the small intestine, serving as the passage for food entering and exiting the stomach.
2. Structural Characteristics of the Stomach: The stomach has a curved shape, with a greater curvature and a lesser curvature. As stated in the “Lingshu: Pingren Juegu”, it curves to receive food and has both a greater and lesser curvature. The “Lingshu: Chang Wei” also states: “The stomach is curved and bent”.
(2) Physiological Functions of the Stomach
1. The Stomach Governs the Reception of Food: Reception refers to the act of accepting and containing. The stomach’s governing reception means that it accepts and contains food. When food enters the mouth, it passes through the esophagus and is temporarily stored in the stomach; this process is called reception, hence the stomach is referred to as the “taicang” (太仓) or “sea of food essence”. “What humans receive as qi is food; what is poured into the stomach is the stomach. The stomach is the sea of food essence” (from the “Lingshu: Yuban”).
“The stomach governs reception, thus it is the residence of the five grains” (from the “Leijing: Zangxiang Lei”). The physiological activities of the body and the transformation of qi, blood, and body fluids all depend on the nutrition from food, hence the stomach is also called the sea of food essence and qi and blood. The stomach’s governing reception function is the foundation of its governing digestion function and the basis of the entire digestive function. If the stomach is diseased, it will affect its reception function, leading to symptoms such as poor appetite, food aversion, and abdominal distension.
The strength of the stomach’s governing reception function depends on the strength of the stomach qi, which reflects the ability to eat or not eat. If one can eat, the stomach’s reception function is strong; if one cannot eat, the stomach’s reception function is weak.
2. The Stomach Governs the Digestion of Food: Digestion refers to the initial digestion of food in the stomach, forming chyme. The stomach’s governing digestion means that it digests food into chyme. “The middle jiao is in the stomach, neither ascending nor descending, governing the digestion of food” (from the “Nanjing: Thirty-First Difficulty”). The stomach receives food from the mouth and allows it to stay in the stomach for a short time for initial digestion, relying on the stomach’s digestion function to transform food into chyme. After initial digestion, the refined substances are transported by the spleen to nourish the entire body, while undigested chyme descends into the small intestine, continuously renewing the stomach’s digestive process. If the stomach’s digestion function is weak, symptoms such as stomach pain and belching of foul-smelling food may occur.
The functions of the stomach in governing reception and digestion must be coordinated with the spleen’s transformation function to be completed smoothly. Therefore, it is said: “The spleen is the earth (the earth is yin, while heaven is yang—author’s note). The earth assists the stomach qi in digesting food; if the spleen qi does not circulate, the food in the stomach cannot be digested” (from the “Annotations on the Treatise on Cold Damage”).
The spleen and stomach work closely together; “the stomach governs reception, while the spleen governs transformation; one receives, one transforms” (from the “Jingyue Quanshu: Diet”), allowing food to be transformed into essence, generating qi, blood, and body fluids to nourish the entire body. Therefore, the spleen and stomach are referred to as the foundation of postnatal life and the source of qi and blood generation. The nutrition from food and the digestive function of the spleen and stomach are crucial for human life and health. Thus, it is said: “Humans rely on food and water; if one is deprived of food and water, one dies” (from the “Suwen: Pingren Qixiang Lun”).
Traditional Chinese Medicine places great importance on “stomach qi”, believing that “humans rely on stomach qi for life”. When stomach qi is strong, all five zang organs thrive; when stomach qi is weak, all five zang organs decline. With stomach qi, there is life; without stomach qi, there is death. The term stomach qi encompasses three meanings: first, it refers to the physiological functions and characteristics of the stomach. The stomach is the sea of food essence, with the functions of receiving and digesting food, as well as descending and facilitating. These functions and characteristics are collectively referred to as stomach qi. Since stomach qi affects the entire digestive system’s function, it is directly related to the body’s source of nutrition. Therefore, the presence or absence of stomach qi is crucial for human life activities. In clinical practice, it is essential to protect stomach qi. Second, it refers to the reflection of spleen and stomach functions in the pulse, indicating a pulse that is calm and moderate. Because the spleen and stomach digest food and absorb the essence to nourish the entire body, and the essence is transported through the meridians, the presence or absence of stomach qi can be reflected in the pulse. Clinically, a pulse with stomach qi is characterized by a calm and moderate rhythm, neither fast nor slow. Third, it generally refers to the body’s essence qi. “Stomach qi is the qi of food, the qi of nourishment, the qi of movement, the qi of life, the clear qi, the defensive qi, and the yang qi” (from the “Piwai Lun: If the Spleen and Stomach are Weak, the Nine Orifices are Blocked”).
Stomach qi can be reflected in appetite, tongue coating, pulse, and complexion. Generally, normal appetite, normal tongue coating, a rosy complexion, and a calm and moderate pulse are considered signs of having stomach qi. Clinically, the presence or absence of stomach qi is often used as an important basis for judging prognosis; if there is stomach qi, there is life; if there is no stomach qi, there is death. The so-called protection of stomach qi actually means protecting the functions of the spleen and stomach. In clinical prescriptions, it is essential to remember “do not harm stomach qi”; otherwise, if stomach qi fails, all medicines will be ineffective.
(3) Physiological Characteristics of the Stomach
1. The Stomach Governs Smooth Descent: The stomach’s governing smooth descent is in contrast to the spleen’s governing ascent of clarity. The stomach’s governing smooth descent refers to the characteristic of the stomach’s qi mechanism being smooth and descending. “When food is digested in the stomach, the waste is transmitted from the stomach’s lower opening to the small intestine” (from the “Yixue Rumen: Zangfu”). When food enters the stomach, after undergoing digestion, it must descend into the small intestine, where the clear is separated from the turbid, with the turbid moving down to the large intestine, thus forming feces and being expelled from the body. This is accomplished through the stomach qi’s smooth descending function. Therefore, it is said: “When food enters, the stomach is full, and the intestines are empty; when food descends, the intestines are full, and the stomach is empty; the more empty and full, the more qi ascends and descends” (from the “Suwen: Wuzang Bie Lun”). Thus, the stomach’s smooth descent is crucial, and the smooth descent is the premise for receiving and digesting food. Therefore, if the stomach loses its smooth descent, symptoms such as poor appetite, abdominal distension, or pain, constipation, nausea, vomiting, and belching may occur due to the qi mechanism’s reversal. The spleen and stomach are located in the center, serving as the pivot for the body’s qi mechanism’s ascension and descent. Therefore, if the stomach qi does not descend, it not only directly leads to disharmony in the middle jiao but also affects the smooth ascent and descent of the entire body’s qi mechanism, resulting in various pathological changes.
2. Preferring Moisture and Disliking Dryness: Preferring moisture and disliking dryness refers to the stomach’s preference for being moist and its aversion to dryness. Traditional Chinese Medicine’s theory of qi states that the six qi (wind, cold, heat, fire, dampness, and dryness) are divided into three yin and three yang, with each corresponding to the five movements. “Above the Yangming, dryness is governed” (from the “Suwen: Tian Yuan Ji Da Lun”). This refers to the six qi being divided into yin and yang, indicating that dryness governs the Yangming, which refers to the theory of qi. Humans correspond with heaven and earth; in the human body, the Yangming corresponds to the six meridians, namely the foot Yangming stomach meridian and the hand Yangming large intestine meridian. Both the stomach and large intestine are influenced by dryness. “The human body inherits the dryness of heaven and earth, thus there are the stomach and large intestine, both of which are the residences for digesting and guiding food; since they inherit the dryness, they must digest and expel water” (from the “Shanghan Lun: Shallow Annotation and Correction, Volume Two”). Fire is dry, and water is moist; the Yangming dry earth must rely on the Taiyin damp earth to assist it, thus balancing water and fire, allowing the stomach to receive, digest food, and descend turbid substances.
Therefore, it is said: “The stomach and large intestine correspond to the two celestial bodies of Shen and You; Shen corresponds to the earth, which belongs to the earth, while You corresponds to the metal, which belongs to the metal. In the four seasons, this corresponds to the seventh and eighth months, which is the time for the dry metal to be in use. Heaven and earth are merely the qi of water and fire that give rise to all things; when water and fire intersect, they evaporate and become damp, and the interaction of dampness and dryness is the qi of unchanging water and fire. If fire does not evaporate water, then clouds and rain do not come; if water does not assist fire, then dew does not fall” (from the “Shanghan Lun: Shallow Annotation and Correction, Volume Two”). In summary, the stomach’s preference for moisture and aversion to dryness stems from the theory of qi, specifically the theory of the relationship between the marked and the unmarked, which states: “Above the Yangming, dryness is governed, and in the middle, the Taiyin is seen” (from the “Suwen: Tian Yuan Ji Da Lun”). The stomach’s qi must rely on moisture to be nourished; thus, the stomach prefers moisture and dislikes excessive dryness. Therefore, it is said: “The stomach prefers gentle moisture”; “the Yangming dry earth must rely on the Taiyin damp earth to be at peace” (from the “Clinical Guidelines for Medical Cases: Volume Two”). The stomach’s reception and digestion not only rely on the stomach’s yang to vaporize but also require the stomach’s fluids to moisten. Sufficient fluids in the stomach are necessary for digesting food and maintaining its smooth descent. Because the stomach is yang earth, it prefers moisture and dislikes dryness, thus its diseases are prone to the harm of dryness and heat, and the stomach yin is often damaged. Therefore, when treating stomach diseases, it is essential to protect the stomach yin; even when using bitter cold purgatives, one should stop as soon as the disease is addressed to eliminate excess heat and dryness without recklessly applying bitter cold to avoid harming the yin.
In summary, the stomach’s preference for moisture and aversion to dryness is primarily reflected in two aspects: first, “the stomach is a yang body that combines with yin essence; yin essence must descend” (from the “Four Sacred Heart Sources”). The stomach’s descending qi must rely on the nourishment of stomach yin; second, the stomach’s preference for moisture and aversion to dryness is in harmony with the spleen’s preference for dryness and aversion to dampness, thus ensuring the dynamic balance of the spleen’s ascent and the stomach’s descent.
3. Small Intestine
The small intestine is located in the abdomen, connecting above to the pylorus and communicating with the stomach, and below connecting to the large intestine, including the ileum, jejunum, and duodenum. It governs the reception and transformation of food and the separation of clear and turbid substances. It is associated with the heart, belonging to fire and yang.
(1) Anatomical Structure of the Small Intestine
1. Anatomical Position of the Small Intestine: The small intestine is located in the abdomen, with its upper end connecting to the pylorus, communicating with the stomach, and its lower end connecting to the large intestine at the ileocecal junction, serving as the organ for further digestion of food. The small intestine has meridians that connect with the heart, thus the small intestine and heart are interrelated.
2. Structural Characteristics of the Small Intestine: The small intestine is a hollow tubular organ that is coiled and looped. “The small intestine is attached behind the spine, coiling left and right, and its connection to the ileum (i.e., large intestine) is located above the navel, with sixteen loops” (from the “Lingshu: Chang Wei”).
The small intestine includes the ileum, jejunum, and duodenum.
(2) Physiological Functions of the Small Intestine
1. Governing the Reception and Transformation of Food: The small intestine’s governing reception and transformation refers to its role in receiving and transforming food. Reception means accepting and containing, while transformation refers to the processes of change, digestion, and generation. The small intestine’s governing reception and transformation function is primarily reflected in two aspects: first, the small intestine receives the food that has undergone initial digestion in the stomach, serving as a container, i.e., the reception function; second, the food that has been initially digested in the stomach must remain in the small intestine for a certain period for further digestion and absorption, transforming food into nutrients that can be utilized by the body, with the refined substances emerging from it and the waste being sent down to the large intestine, i.e., the transformation function.
In pathology, if the small intestine’s reception function is disordered, the transmission and transformation will stop, leading to qi stagnation and pain, manifesting as abdominal pain. If the transformation function is abnormal, it can lead to digestive and absorption disorders, presenting as abdominal distension, diarrhea, and loose stools.
2. Governing the Separation of Clear and Turbid: Separation refers to secretion, while clear refers to refined substances, and turbid refers to metabolic waste. The so-called separation of clear and turbid refers to the small intestine’s process of further digesting the food that has undergone initial digestion in the stomach while simultaneously separating the refined essence from the metabolic waste. The clear refers to the absorption of the essence from the food, including the fluids generated from beverages and the refined substances from food, which are absorbed and then transported by the spleen to the heart and lungs, nourishing the entire body. The turbid refers to the waste from the food, which is transmitted to the large intestine through the ileocecal junction, forming feces that are expelled from the body through the anus. “The bladder and kidneys are interrelated, both governing water; water enters the small intestine, descends into the bladder, and is excreted as urine” (from the “Zhubing Yuanhou Lun: Various Lin Conditions”). Because the small intestine participates in the body’s water metabolism during the separation of clear and turbid, it is said that “the small intestine governs fluids”. Therefore, Zhang Jingyue stated: “The small intestine is located below the stomach, receiving the food essence from the stomach and separating the clear and turbid; the fluids are thus absorbed and sent upward, while the waste is sent downward to the large intestine” (from the “Leijing: Zangxiang Lei”).
If the small intestine’s function of separating clear and turbid is normal, the fluids and waste will follow their respective paths, and normal urination and defecation will occur. If the small intestine’s function is disordered, the clear and turbid will not be separated, leading to mixed food and waste, resulting in loose stools and diarrhea. Since the small intestine governs fluids, its function of separating clear and turbid not only affects defecation but also impacts urination, manifesting as reduced urination. Therefore, in the early stages of diarrhea, the method of “promoting urination to solidify the stool” is often used for treatment.
The small intestine’s functions of governing reception and transformation and separating clear and turbid are the most critical stages in the entire digestive process. In this process, the chyme is further digested, transforming food into clear (i.e., refined substances containing fluids) and turbid (i.e., waste containing waste fluids) parts, with the former relying on the spleen’s transport to be absorbed and the latter descending into the large intestine. The small intestine’s digestive and absorption functions are often categorized within the scope of the spleen and stomach’s governing functions. The governing functions of the spleen and stomach actually encompass all aspects of modern digestive physiology and part of nutritional physiology. Therefore, it is said: “Humans receive food and water; the spleen transforms the refined essence upward, while the small intestine transforms the waste downward into the large intestine” (from the “Yiyuan”). The so-called “the spleen transforms the refined essence upward” actually refers to the small intestine’s digestive and absorption functions. Therefore, conditions of poor digestion and absorption in the small intestine fall under the category of spleen dysfunction and are often treated from the perspective of the spleen and stomach.
(3) Physiological Characteristics of the Small Intestine
The small intestine possesses the physiological characteristics of ascending clarity and descending turbid: the small intestine transforms food and separates clear and turbid, converting food into refined and waste, with the refined relying on the spleen’s ascent to nourish the entire body, while the waste relies on the small intestine’s smooth descent to be transmitted to the large intestine. The ascent and descent are interdependent, and the separation of clear and turbid is the small intestine’s role in receiving and transforming food. Otherwise, if the ascent and descent are disordered and the clear and turbid are not separated, symptoms such as vomiting, abdominal distension, and diarrhea may occur. The small intestine’s governing of ascending clarity and descending turbid is a concrete manifestation of the spleen’s ascent of clarity and the stomach’s descent of turbid functions.
4. Large Intestine
The large intestine is located in the abdomen, with its upper opening at the ileocecal junction connecting to the small intestine and its lower end connecting to the anus, including the colon and rectum. It governs the transmission of waste and the absorption of fluids. It belongs to metal and is yang.
(1) Anatomical Structure of the Large Intestine
1. Anatomical Position of the Large Intestine: The large intestine is also located in the abdominal cavity, with its upper segment referred to as the “ileum” (corresponding to the anatomical ileum and the upper segment of the colon); the lower segment is referred to as the “broad intestine” (including the sigmoid colon and rectum). Its upper opening connects to the small intestine at the ileocecal junction, and its lower end connects to the anus (also known as the “lower extreme” or “po gate”). The large intestine has meridians that connect with the lungs, thus they are interrelated.
2. Structural Characteristics of the Large Intestine: The large intestine is a tubular organ, shaped in a coiled and looped manner.
(2) Physiological Functions of the Large Intestine
1. Governing the Transmission of Waste: The large intestine’s governing transmission refers to its role in receiving the food residues that descend from the small intestine, forming feces, and expelling them through the anus. The large intestine receives the food residues from the small intestine, absorbs the remaining water and nutrients, forming feces that are expelled through the anus, representing the final stage of the entire digestive process, hence it is referred to as the “transmitting fu” or “transmitting official”. Therefore, the primary function of the large intestine is to transmit waste and excrete feces. The large intestine’s transmission function is closely related to the stomach’s smooth descent, the spleen’s transformation, the lung’s descending function, and the kidney’s storage function.
If the large intestine is diseased, the transmission will be abnormal, primarily manifesting as changes in the quality and quantity of feces and alterations in bowel movements. If the large intestine’s transmission is disordered, symptoms such as constipation or diarrhea may occur. If damp-heat accumulates in the large intestine, leading to qi stagnation, symptoms such as abdominal pain, urgency, and dysentery with pus and blood may arise.
2. Governing the Absorption of Fluids: After the large intestine receives the food residues and remaining fluids from the small intestine, it reabsorbs some of the fluids, forming feces that are expelled from the body. The large intestine’s reabsorption of fluids participates in regulating the body’s water metabolism, referred to as “the large intestine governs fluids”. This function of reabsorbing fluids in the large intestine is related to the body’s water metabolism. Therefore, large intestine diseases are often associated with fluid issues. For example, if the large intestine is deficient and cold, it will be unable to absorb fluids, leading to mixed food and resulting in symptoms such as abdominal rumbling, pain, and diarrhea. If the large intestine is in a state of excess heat, it will consume fluids, leading to dryness and constipation.
The majority of the body’s required water is absorbed in the small or large intestine, thus “the large intestine governs fluids, the small intestine governs liquids; both the large and small intestines receive the nourishing qi from the stomach, enabling them to transport fluids to the upper jiao, irrigating the skin and nourishing the pores” (from the “Piwai Lun: The Large Intestine, Small Intestine, and All Organs Belong to the Stomach; If the Stomach is Weak, All Will Be Ill”).
(3) Physiological Characteristics of the Large Intestine
In the functional activities of the organs, the large intestine is constantly receiving the food residues that descend from the small intestine, forming feces and expelling waste, demonstrating a state of accumulation and transportation coexisting, thus it is characterized by smooth descent and function. Among the six fu organs, the large intestine is particularly important for its smooth descent and function. If the large intestine’s smooth descent is abnormal, it often leads to the accumulation of waste and obstruction, hence the saying “the intestines are prone to fullness”.
5. Bladder
The bladder is also known as the clean fu, water residence, jade sea, and urine pouch. It is located in the lower abdomen, at the lowest position among the organs. It governs the storage and excretion of urine and is interrelated with the kidneys, belonging to the water element and having a yang attribute.
(1) Anatomical Structure of the Bladder
1. Anatomical Position of the Bladder: The bladder is located in the lower abdomen, beneath the kidneys and in front of the large intestine. It is positioned at the lowest part among the organs.
2. Structural Characteristics of the Bladder: The bladder is a hollow, pouch-like organ. It has ureters above that connect to the kidneys and a urethra below that opens at the front yin, referred to as the “urinary orifice”.
(2) Physiological Functions of the Bladder
1. Governing the Storage of Urine: In the process of fluid metabolism in the body, water and fluids are distributed throughout the body through the actions of the lungs, spleen, and kidneys, playing a role in moistening the body. After being utilized by the body, the “excess of fluids” returns to the kidneys. Through the kidneys’ qi transformation, the clear is returned to the body, while the turbid is sent down to the bladder, transforming into urine. Thus, it is said: “The excess of fluids enters the bladder to become urine; urine is the excess of water and fluids” (from the “Zhubing Yuanhou Lun: Bladder Disease Conditions”), indicating that urine is transformed from fluids. Urine and fluids often influence each other; if fluids are deficient, urine will be scant; conversely, if urine is excessive, it may also lead to fluid loss.
2. Governing the Excretion of Urine: When urine is stored in the bladder and reaches a certain capacity, through the kidneys’ qi transformation, the bladder opens and closes appropriately, allowing urine to be expelled from the urinary orifice in a timely manner.
(3) Physiological Characteristics of the Bladder
The bladder has the physiological characteristic of governing opening and closing. The bladder is the gathering place for the body’s fluids, thus it is referred to as the “fu of fluids” or “the official of the state”. The bladder relies on its opening and closing function to maintain the coordinated balance of urine storage and excretion.
The kidneys and bladder are interrelated, opening at the two yin; “the bladder is the official of the state, storing fluids; when qi transforms, it can be expelled. However, if the kidney qi is sufficient, it can transform; if the kidney qi is insufficient, it cannot transform. If the body’s qi does not transform, the water returns to the large intestine, resulting in diarrhea. If the expelling qi does not transform, it will block the lower jiao, leading to urinary retention. The smoothness of urination is governed by the bladder, while the solidification is governed by the kidney qi” (from the “Bihua Yijing”). The bladder’s functions of storing and excreting urine rely entirely on the kidneys’ solidification and qi transformation functions. The so-called bladder transformation actually belongs to the kidneys’ qi transformation function. If the kidneys’ solidification and qi transformation functions are abnormal, the bladder’s transformation will be disrupted, leading to urinary difficulties or retention, as well as frequent urination, urgency, incontinence, and other symptoms, hence it is said: “If the bladder is not smooth, it leads to retention; if it is not controlled, it leads to incontinence” (from the “Suwen: Xuanming Wuqing Pian”). Therefore, bladder diseases are often related to the kidneys, and in clinical treatment of abnormal urination, it is often treated from the perspective of the kidneys.
6. San Jiao (Triple Burner)
San Jiao is a unique term in the theory of organ representation. San Jiao refers to the upper, middle, and lower burners, collectively known as one of the six fu organs, and is the largest among the organs, also referred to as the external fu or solitary organ. It governs the ascending and descending of various qi and the circulation of water and fluids, belonging to fire in the five elements and having a yang attribute.
(1) Anatomical Structure of San Jiao
Historically, there has been a debate over whether San Jiao has a tangible or intangible form. Even among those who believe it has a tangible form, there is still no unified view on its essence. However, there is basic agreement on the understanding of San Jiao’s physiological functions.
As one of the six fu organs, San Jiao is generally considered to be a large fu distributed in the thoracic and abdominal cavities, being the largest and unmatched, hence the term “solitary fu”. As Zhang Jingyue stated: “San Jiao is indeed a fu, located within the body, encompassing all organs, a large fu of one cavity” (from the “Leijing: Zangxiang Lei”).
Regarding the form of San Jiao, this is an academic issue that can be further explored; however, this issue is not the main focus of the theory of organ representation itself. The concept of organs in Traditional Chinese Medicine differs from the anatomical concept of organs; TCM categorizes San Jiao as a separate fu not merely based on anatomy but more importantly based on the connections of physiological and pathological phenomena to establish a functional system.
In summary, the upper burner is above the diaphragm, including the heart and lungs; the middle burner is below the diaphragm to the navel, including the spleen and stomach; the lower burner is below the navel to the two yin, including the liver, kidneys, large and small intestines, bladder, and uterus. Among these, the liver, according to its position, should be classified in the middle burner, but due to its close relationship with the kidneys, both the liver and kidneys are classified in the lower burner. The functions of San Jiao actually encompass the overall functions of all the zang and fu organs.
(2) Physiological Functions of San Jiao
1. Governing the Circulation of Yuan Qi: Yuan qi (also known as original qi) is the most fundamental qi in the human body, originating from the kidneys, transformed from congenital essence, and nourished by postnatal essence, serving as the foundation of the yin and yang of the organs and the original driving force of life activities. Yuan qi circulates through San Jiao to nourish the five zang and six fu organs, filling the entire body, stimulating and promoting the functional activities of various organ tissues. Therefore, it is said that San Jiao is the channel for the circulation of yuan qi. The movement of qi is the basic characteristic of life. San Jiao’s ability to circulate yuan qi is related to the qi transformation of the entire body. Thus, it is said: “San Jiao is the qi of the three yuan of the human body… it governs the five zang and six fu organs, the channels of nourishment and defense, and the qi of the internal and external, upper and lower, left and right” (from the “Zhongzang Jing”).
2. Governing the Regulation of Water Pathways: “San Jiao is the official of drainage, from which the water pathways emerge” (from the “Suwen: Linglan Mijian Lun”). San Jiao can “regulate the water pathways” (from the “Yixue Sanzi Jing”), playing an important role in controlling the entire process of water metabolism in the body. The metabolism of water and fluids in the human body is a complex physiological process involving multiple organs. Among them, the upper burner, represented by the lungs, is the source of water, promoting the distribution and regulation of water; the middle burner, represented by the spleen and stomach, transforms and distributes fluids to the lungs; the lower burner, represented by the kidneys and bladder, vaporizes and transforms fluids, allowing them to ascend to the spleen and lungs, participating in internal metabolism, and then forming urine to be expelled from the body. San Jiao serves as the pathway for the generation, distribution, ascent, and descent of water and fluids. When San Jiao’s qi is regulated, the meridians are open, and the water pathways are smooth. San Jiao’s function in the water metabolism process is a summary of the functions of the lungs, spleen, kidneys, and other organs involved in water metabolism.
3. Governing the Movement of Food Essence: “San Jiao is the pathway for food essence” (from the “Nanjing: Thirty-First Difficulty”). San Jiao has the role of moving food essence, assisting in the distribution of refined substances and the excretion of waste. The upper burner “develops and distributes the flavors of the five grains, nourishing the skin and filling the muscles” (from the “Lingshu: Jueqi”), thus having the function of distributing refined substances; the middle burner “separates the waste, vaporizes the fluids, and transforms the essence, sending it upward to the lung meridians” (from the “Lingshu: Ying Wei Sheng Hui”), thus having the function of digestion and absorption; the lower burner “forms waste and sends it down to the large intestine, following the lower burner to enter the bladder” (from the “Lingshu: Ying Wei Sheng Hui”), thus having the function of excreting feces and urine. San Jiao’s function of moving food essence and assisting in digestion and absorption is a summary of the functions of the spleen and stomach, liver and kidneys, heart and lungs, and large and small intestines in completing the digestion, absorption, and excretion of food essence.
(3) Physiological Characteristics of San Jiao
1. The Upper Burner is Like Mist: The upper burner is like mist, referring to its role in promoting the distribution of defensive qi and nourishing the refined essence. The upper burner receives the refined essence from the middle burner (spleen and stomach) and distributes it through the heart and lungs, spreading it throughout the body to nourish and moisten, like the irrigation of mist. Thus, it is said that “the upper burner is like mist”. Because the upper burner receives the refined essence and distributes it, it is also referred to as “the upper burner governs reception”.
2. The Middle Burner is Like Fermentation: The middle burner is like fermentation, referring to the spleen and stomach’s role in transforming food essence and generating qi and blood. The stomach receives and digests food essence, and through the spleen’s transformation, it forms refined food essence, which generates qi and blood, and through the spleen’s upward transport, it nourishes the heart and lungs. Because the spleen and stomach have the physiological functions of digesting food and transforming refined essence, they are likened to “the middle burner is like fermentation”. Because the middle burner transforms food essence, it is referred to as “the middle burner governs transformation”.
3. The Lower Burner is Like a Drain: The lower burner is like a drain, referring to the kidneys, bladder, large and small intestines, and other organs that govern the separation of clear and turbid and the excretion of waste. The lower burner transmits the food residues to the large intestine, transforming them into feces, which are expelled from the body through the anus, and the remaining water is transformed into urine through the kidneys and bladder, which is expelled from the body. This physiological process has the tendency to open downward and excrete outward, thus it is said that “the lower burner is like a drain”. Because the lower burner opens the two excretory pathways and expels waste, it is also referred to as “the lower burner governs excretion”.
In summary, San Jiao is related to the entire process of receiving, digesting, absorbing, and excreting food essence, thus San Jiao is the channel for circulating yuan qi and moving food essence, serving as a comprehensive representation of the physiological functions of the five zang and six fu organs.
Appendix: The True Interpretation of Pulse Diagnosis for Beginners
Pulse diagnosis is based on the depth and position of the radial artery to assess the depth of the disease. The ancients relied solely on clinical experience and personal intuition, leading to various mystical discussions: “The method of combining color and pulse is highly valued by sages, and it is the key to treating diseases”; “The essence of color and pulse can connect with the divine”. Modern Western medicine only uses it to identify numbers and assess the heart. The ancient pulse theories are often disregarded. While some exaggerated claims in ancient pulse theories should indeed be abandoned, should we ignore those that are precise and relevant to treatment and diagnosis? This article aims to eliminate the confusion caused by erroneous statements and enlighten modern understanding. It seeks to ensure that the method of pulse diagnosis is not limited to the heart, allowing for refined diagnosis to shine in the future. First, we will clarify misconceptions, followed by presenting the true interpretations.
1. Misconceptions about Pulse Diagnosis
The method of pulse diagnosis in Traditional Chinese Medicine originated in the “Suwen”, was expanded by the Yue people, and was perfected by Shuhe. Since then, various famous practitioners have emerged. However, determining the yin and yang, deficiency and excess under three fingers, distinguishing between exterior and interior within a small area, while seemingly simple, is difficult to understand. The ancients relied solely on clinical experience without scientific interpretation, leading to many erroneous statements. This is a limitation of the times. Even today, if one still believes in these misconceptions, it is indeed perplexing. The confusion surrounding Traditional Chinese Medicine’s pulse theory that misleads later generations can be attributed to three main points:
First, the error in dividing pulse locations: The pulse is divided into three parts, which is why three fingers are used for pulse diagnosis. Using three fingers for pulse diagnosis facilitates distinguishing between pulse conditions. The characteristics of the pulse, such as tightness, deficiency, excess, and size, cannot be clearly understood without using the three methods of floating (shallow pressing), pressing (medium pressing), and seeking (deep pressing). This is a very simple and clear matter. Yet, the ancients even matched the three parts to the three burners and the nine conditions to heaven, earth, and humanity (as seen in the “Suwen: Three Parts and Nine Conditions”), which, although not entirely unreasonable, is still an overreaching argument. The most harmful misconception for future generations is the matching of organs to the three parts.
The division of the three parts (cun, guan, and chi) was originally for convenience in pulse diagnosis. The ancients did not seek a precise understanding of the relationship between the pulse and the influence of diseases, and instead, they arbitrarily matched organs to these three parts, leading to confusion. The “Suwen”, “Nanjing”, and various ancient texts have already matched the five zang organs, but without distinguishing between left and right. Since Wang Shuhe, there has been a clear division between left and right, matching them with the five zang and six fu organs. Here, we compare the theories of six schools:
Wang Shuhe, Li Gao, Hua Shou, Yu Jiayan, Li Shicai, Zhang Jingyue
Left Cun: Heart, Small Intestine; Left Guan: Liver, Gallbladder; Left Chi: Kidney, Bladder; Right Cun: Lung, Large Intestine; Right Guan: Spleen, Stomach; Right Chi: Kidney, Bladder, Mingmen, Sanjiao, Heart, Small Intestine.
All six schools are renowned in the medical community, and their arbitrary matching of organs raises doubts about their reliability. Upon examining the “Qianjin Fang” and “Shanghan Lun”, there is no such matching; even the “Ziyu: Four-Character Pulse Method” states: “The left governs the officials, and the right governs the fu”, without explicitly stating which part corresponds to which organ. Therefore, Wu Caolu understood this and said: “The physician names the pulse as the heart pulse, the lung pulse, the liver pulse… this is not the case. The five zang and six fu organs are all part of the twelve meridians, and both hands’ cun, guan, and chi are all part of the Taiyin pulse… they are the great meeting of the six pulses, representing the entire body”. Li Shizhen understood this and stated: “Both hands’ six parts are all lung meridians, specifically used to assess the qi of the five zang and six fu organs, not the places where the five zang and six fu organs reside”. He also stated: “I often see physicians pressing between the two hands, pressing again and again, saying that a certain organ is like this, and another organ is like that, as if the organs reside between the two hands, which is a form of self-deception”. Zhang Shiwang understood this and, when asked about the confusion of matching organs to the three parts, said: “All are true, all are false; what seems true but is false”. The saying goes: “Mountains and rivers can speak, but the buried master has no place to eat; organs can speak, but the physician’s complexion is like soil”. This is the matching of organs to the three parts.
The ancients did not believe in matching organs to the three parts, but instead adhered to the theory of the “Nanjing” as a standard. The “Nanjing” states: “The upper part corresponds to heaven, governing diseases above the chest to the head; the middle part corresponds to humanity, governing diseases below the diaphragm to the navel; the lower part corresponds to earth, governing diseases below the navel to the feet”. According to this theory, the pulse in the upper part corresponds to diseases of the chest, heart, lungs, throat, and head; the middle part corresponds to diseases below the diaphragm to the lower abdomen; the lower part corresponds to diseases of the lower abdomen, waist, kidneys, knees, shins, and feet, including the large and small intestines. The “Suwen” states: “The upper part corresponds to the upper, and the lower part corresponds to the lower”; this can be tested and recognized. Furthermore, if there is a clear local disease in the right part of the body, it must correspond to the right pulse; if there is a clear local disease in the left part of the body, it must correspond to the left pulse; this is also a well-established principle.
2. The Fallacy of Pulse Governing Disease
Pulse diagnosis is one of the diagnostic methods, and the ancients placed it at the end of the four examinations, considering pulse diagnosis as a lower-level skill. Therefore, the purpose of pulse diagnosis is to verify the body’s deficiency and excess, the depth of the disease, the progression of the disease, the prognosis, and the strength of qi and blood. Beyond this, it cannot be known through pulse diagnosis. However, some absurd individuals, having blindly believed in the matching of organs to the six parts, also mistakenly insist that the pulse governs disease, claiming that a certain pulse in a certain part indicates a certain disease, making grand statements and drawing conclusions. The most absurd of all is to determine a person’s death date, gender of a fetus, wealth, and poverty, all based on three fingers, like the likes of Peng Yongguang, which is truly a death sentence without mercy. This is why I cannot help but clarify.
The idea that the pulse governs disease originated in the “Suwen” and was greatly expanded by Wang Shuhe, who stated: “If the pulse at the cun is deep and weak, the person will surely fall”; “If the pulse at the guan is tight and slippery, it indicates a snake-like movement”; “If the pulse at the chi is deep and slippery, it indicates a white worm” (all from Wang’s pulse classics). To determine disease based solely on three fingers is laughable. The pulse is a superficial layer of the radial artery, one of the various arteries, and to assess the strength of qi and blood and the progression of diseases based on this alone is unreasonable. If the radial artery can be divided to determine diseases, then the temporal artery, foot artery, and others can also be used to determine diseases, right? Diseases are numerous, while the pulse has only about twenty types; to determine hundreds of diseases based on twenty types of pulses is unreasonable. As the condition changes, the pulse also changes. For example, in cases of diarrhea, one may often find a weak pulse at the chi. However, at the onset of diarrhea, the chi may present as deep, strong, or tight, and after diarrhea, it may present as weak, deep, slippery, or absent. Thus, a weak chi cannot be generalized to indicate diarrhea. Similarly, in cases of tuberculosis, a rapid pulse may often be seen, but at the onset of tuberculosis, one may see a floating, rapid, or strong pulse, while in severe cases, one may see a large, fine, or rapid pulse. Therefore, a rapid pulse cannot be generalized to indicate tuberculosis. Furthermore, individuals have different structures and endowments, and their responses to the pulse may also vary. Some may have a consistently deep pulse, while others may have a very rapid pulse, and some may have a palpable pulse without affecting their health. Thus, determining diseases based solely on the pulse is unreasonable. In summary, diagnosing diseases should involve various evidence combined with pulse diagnosis; it cannot rely solely on three fingers.
3. The Confusion of Pulse Classification
The confusion surrounding pulse classification by the ancients is particularly perplexing, making it difficult for people to know which to follow. The “Suwen” classifies the twelve meridians as being the same on both sides, combining them with the Yang Qiao, Yin Qiao, Du, and Ren meridians to form twenty-eight pulses, but in reality, there are only twenty-four pulses. Gao Yangsheng divided them into twenty-four pulses based on seven surfaces, eight li, and nine pathways. Zhu Hong classified them into twenty-one pulses by combining seven surfaces and eight li. Chen Wuze divided them into twenty-four pulses (with different names from Gao Yangsheng). Hua Shou divided them into twenty-six pulses. Li Shizhen divided them into twenty-four pulses. Li Zhongzi divided them into twenty-nine pulses. Zhang Huang divided them into fifteen pulses. Chen Xiuyuan divided them into eight pulses. Ke Qin divided them into ten pulses based on yin and yang. Zhang Jingyue divided them into sixteen pulses. Zhang Shiwang divided them into thirty-two pulses. The fact that the same pulse can be pressed with three fingers yet have such divergent classifications is indeed strange. The reason for this is that the ancients did not clearly understand the true nature of the pulse.
The pulse is divided into floating and sinking to indicate the height of the pulse pressure; it is divided into slow and rapid to indicate the pulse rate; it is divided into tight and soft to indicate the relaxation and tension of the pulse vessel; it is divided into slippery and rough to indicate the smoothness or blockage of blood flow; it is divided into knot and intermittent to indicate changes in the heart chamber. There are many types of pulse conditions, all of which can be categorized under these five categories. Based on these five categories, all confusing statements can be clarified.
Therefore, pulses with high pressure are classified as floating, rapid, leathery, and moving, indicating varying degrees; pulses with low pressure are classified as sinking, weak, firm, and hidden, indicating varying degrees, totaling eight pulses, all distinguished by floating and sinking. Pulses with a high rate are classified as rapid (six beats), while those with a low rate are classified as slow (three beats) or moderate (less than four beats), totaling four pulses, all categorized by slow and rapid. Pulses with tense vessels are classified as tight and string-like, while those with relaxed vessels are classified as weak and soft, totaling four pulses, all based on the analysis of the relaxation and tension of the pulse vessels. Pulses with smooth and abundant waves are classified as slippery, firm, and long, while those with blocked and insufficient waves are classified as rough, weak, and short, totaling six pulses, all categorized by smoothness and roughness to distinguish the smoothness or blockage of blood flow. If the heart chamber weakens or the valve fails to close properly, blood may intermittently flow into the radial artery, resulting in a rapid, knotty, or intermittent pulse, indicating a near cessation of heart activity. In total, there are twenty-six pulses, encompassing all pulse conditions. If summarized, only the ten pulses of floating, sinking, slow, rapid, slippery, rough, tight, weak, knotty, and intermittent are sufficient. The above interpretations, while not exhaustive, have summarized the true meaning of the pulse. Further exploration depends on diligent and thoughtful individuals.
2. The Relationship Between Pulse and Diagnosis/Treatment
Once the true meaning of the pulse is understood, we can discuss its relationship with diagnosis and treatment, which can be summarized in four points:
1. Understanding the Pathogenesis: There are countless diseases and symptoms, but if we summarize their essence, they can be categorized into the eight characters of yin, yang, deficiency, excess, exterior, interior, cold, and heat. By distinguishing these eight characters, we can discuss diseases, apply treatments, and use medications. Physicians must discern the pathogenesis by identifying these characters. Any metabolic function that is heightened is yang, while any that is diminished is yin; any nervous excitement is yang, while any weakness is yin; any robust physical condition is yang, while any deficiency is yin; any vigorous blood flow is yang, while any reduction is yin; any active pathological function is yang, while any passive function is yin. The corresponding pulse manifestations are as follows: floating, rapid, leathery, and moving pulses indicate high pressure, while sinking, weak, firm, and hidden pulses indicate low pressure; tense vessels manifest as string-like or tight pulses, while relaxed vessels manifest as weak or soft pulses; a rapid pulse indicates a high rate, while a slow pulse indicates a low rate; smooth, abundant, and long pulses indicate vigorous blood flow, while rough, weak, and short pulses indicate insufficient blood flow. Furthermore, if symptoms change, a yang condition may present with a yin pulse, indicating a turning point towards a poor prognosis, while a yin condition may present with a yang pulse, indicating a good prognosis; this cannot be discerned without pulse diagnosis. Additionally, cold and heat are not solely defined by body temperature, nor are they merely synonyms for yin and yang (where cold is yin and heat is yang). Any body temperature exceeding thirty-seven degrees Celsius is considered heat, while any temperature below normal is considered cold. If a disease is ongoing and a large amount of fluids (vomiting, diarrhea, sweating, urination, phlegm) is expelled, or if heat is severe and cannot be expelled, it is considered heat; if the disease is stagnant and fluids are reduced or cannot stop, it is considered cold. If there is overall or local congestion, it is considered heat; conversely, if there is anemia, it is considered cold. However, if symptoms appear to be heat but the pulse is yin, or if symptoms appear to be cold but the pulse is yang, this must also be discerned through pulse diagnosis. Thus, the pulse diagnosis is essential for understanding pathogenesis.
2. Determining Treatment Methods: The path to treating diseases involves eliminating pathogens and supporting the righteous qi. When pathogens are rampant, the pathological mechanisms are heightened, which the ancients referred to as excess conditions. When the righteous qi is strong, it can resist pathogens and often presents with symptoms of excess, which the ancients referred to as yang conditions. When both pathogens and righteous qi are strong, they may conflict, presenting with symptoms of high fever, severe pain, extreme cold, and intense thirst, which the ancients referred to as excess conditions. At this time, the pulse must exhibit characteristics of being rapid, string-like, slippery, and strong. If the pathogen has been eliminated, the pathological mechanism will shift to a physiological mechanism, and the pulse will become weak and slow. If the righteous qi is weak, the ability to resist disease will be insufficient, leading to symptoms of weakness and yin conditions. The corresponding pulse will be weak, slippery, and slow. If the pathogen is strong and the righteous qi is weak, or if the righteous qi is strong and the pathogen has been eliminated, the pulse may present as a yin pulse in a yang condition or a yang pulse in a yin condition, making it difficult to distinguish. The “Shanghan Lun” discusses the correspondence between pulse and symptoms in great detail. The ancients stated that a strong pulse may appear weak, while a weak pulse may appear strong; this is the essence of pulse diagnosis.
3. Determining Prognosis: The pulse and symptoms are the most clear indicators for determining prognosis. For example, in cases of stroke or convulsions, regardless of whether there is arching of the back, paralysis of the limbs, inability to speak, abdominal fullness, urinary incontinence, or constipation, a pulse that is slow, weak, and deep indicates a favorable prognosis. When the disease occurs, the vagus nerve is excited, preventing the actions of various parts, leading to a slow, weak, and deep pulse. If the vagus nerve is paralyzed and cannot control the excitement of the pulse nerve, the pulse will present as rapid, large, and strong. If the brain disease leads to medullary paralysis, the severity of the brain disease can be inferred. Therefore, a slow, weak, and deep pulse in brain diseases indicates a good prognosis, while a rapid, large, and strong pulse indicates a poor prognosis. In acute and chronic febrile diseases, if the body temperature continues to rise, it is crucial to pay attention to the health of the heart. Therefore, a rapid and strong pulse is favorable for the heart’s health. Thus, the pulse classics state: “In febrile diseases, a floating and rapid pulse is favorable; a sinking, weak, and small pulse indicates a poor prognosis”; “In cases of heat, a rapid and strong pulse is favorable, while a weak and small pulse indicates a poor prognosis”; “In cases of bone steaming and fever, a rapid and weak pulse indicates a poor prognosis”; all of these are determined by the health of the heart.
4. Identifying the Location of Disease: Knotty and intermittent pulses are signs of heart disease, which can be disregarded. However, the pulse can be used to assess the location of the disease; for example, a floating pulse indicates a disease on the skin, while a sinking pulse indicates a disease in the zang and fu organs. The pulse at the cun corresponds to diseases above the chest, while the pulse at the guan corresponds to diseases below the diaphragm; the pulse at the chi corresponds to diseases below the navel, including the large and small intestines. The “Suwen” states: “The upper part corresponds to the upper, and the lower part corresponds to the lower”; this can be tested and recognized. Furthermore, if there is a clear local disease in the right part of the body, it must correspond to the right pulse; if there is a clear local disease in the left part of the body, it must correspond to the left pulse; this is also a well-established principle.
Source: Yiping Pavilion
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