Chapter One: Foundations of Traditional Chinese Medicine
Section One: Main Characteristics of the Theoretical System of Traditional Chinese Medicine
The six fu organs include: gallbladder (dan), stomach (wei), small intestine (xiao chang), large intestine (da chang), bladder (pang guang), and san jiao (three burners). Their common physiological characteristic is to receive, transform, and transport food and fluids. In ancient times, the term “fu” was written as “府” (fu), which means a hollow place for storing items, allowing for both entry and exit. The main physiological function of the six fu organs is “transformation and transportation”, indicating that their primary role is to receive, digest, and transform food and fluids, existing in a continuous cycle of fullness and emptiness. The six fu organs do not store essence and qi.From the moment food enters the body until it is expelled, it passes through seven important gates, referred to as the “Seven Gates” in the Nanjing, namely lips (kou lin), teeth (ya chi), epiglottis (hui yan), cardia (ben men), pylorus (you men), ileocecal junction (lan men), and anus (po men). The lips serve as the “flying gate”, indicating that they can open and close freely like a door; the teeth act as the “door gate”, meaning they guard the upper end of the digestive tract and can chew food; the epiglottis is the “suction gate”, where the esophagus and trachea meet, serving as the portal for air entering and exiting the body; the cardia is where food enters the stomach; the pylorus is the connection between the stomach and small intestine; the ileocecal junction prevents the flow of refined substances from the small intestine into the large intestine; the anus, also known as the “po men”, is the final part of the digestive tract, allowing for the expulsion of feces. Therefore, any pathological changes at any of the Seven Gates will affect the reception, digestion, absorption, and excretion of food.
(1) Gallbladder
The gallbladder is attached to the liver and is a hollow sac-like organ. The main physiological function of the gallbladder is to store and excrete bile. Bile is produced in the liver and secreted by it. Once formed, bile flows into the gallbladder for storage. Bile is also known as essence fluid, hence the gallbladder is referred to as the “palace of essence”. Bile is yellow-green and extremely bitter, playing a crucial role in digestion. After eating, bile is released into the intestines through the liver’s dispersing function, assisting the spleen and stomach in maintaining normal digestion. Due to the close relationship between the liver and gallbladder, if liver function is normal, bile production and excretion will be smooth, allowing for proper digestion. If the liver is diseased, it can affect bile production and excretion, leading to digestive dysfunction. For example, if gallbladder qi ascends, bile may rise, causing a bitter taste in the mouth; if bile excretion is obstructed, it may lead to symptoms such as loss of appetite, abdominal distension, and loose stools; gallbladder and stomach diseases can also cause nausea and vomiting; if the liver and gallbladder fail to disperse properly, bile may overflow into the skin, resulting in jaundice; if bile stagnates and transforms into heat, it can further congeal into stones. Although the gallbladder is one of the six fu organs, it primarily stores essence fluid, serving as the palace of purity, and does not directly receive food waste, distinguishing it from the other fu organs, thus it is classified as a extraordinary fu organ.
(2) Stomach
The stomach is located below the diaphragm, with its upper opening known as the cardia, connecting to the esophagus, and its lower opening as the pylorus, leading to the small intestine. The stomach is also referred to as the stomach cavity, divided into upper, middle, and lower sections, with the upper part being the “upper cavity”, including the cardia; the lower part being the “lower cavity”, including the pylorus; and the section between the upper and lower cavities is called the “middle cavity”, which is the body of the stomach.
The main physiological functions of the stomach can be summarized in two aspects:
(1) It is responsible for receiving and digesting food. Food enters through the mouth, passes through the esophagus, and is received by the stomach, hence the stomach is also called the “sea of food and fluids”, as the physiological activities of the body and the transformation of qi, blood, and fluids rely on the nutrition from food, thus the stomach is also referred to as the “sea of food, qi, and blood”. Therefore, if the stomach is diseased, it can easily affect its ability to receive food, leading to symptoms such as poor appetite and aversion to food. “Digest” implies the initial processing and digestion of food. In the stomach, food is kneaded and digested, transforming it into chyme, which then moves to the small intestine for further digestion. The reception and digestion of food in the stomach are integrated with the spleen’s transportation function, referred to as “stomach qi”. “Human beings rely on stomach qi for life; with stomach qi, there is life; without stomach qi, there is death”. (2) It is responsible for descending and harmonizing. After food enters the stomach and undergoes digestion, it moves into the small intestine for further digestion and absorption, with the turbid parts descending into the large intestine to form feces for excretion. Thus, the stomach is responsible for descending and harmonizing. The descent of turbid substances is a prerequisite for the stomach to continue receiving food. If the stomach fails to harmonize and descend, food may stagnate, leading to symptoms such as distension and pain in the stomach area, and aversion to food. If stomach qi ascends, it can cause nausea, vomiting, belching, and hiccups. Additionally, if stomach qi does not descend, it can also affect the spleen’s function of ascending and clarifying.
(3) Small Intestine
The small intestine is located in the abdomen, connecting above to the pylorus and below to the ileocecal junction, where it meets the large intestine. The physiological functions of the small intestine can be summarized in two aspects: (1) It receives and transforms food. Receiving means to hold and accept, referring to the small intestine’s role in receiving the partially digested food from the stomach, thus the small intestine serves as a vessel for the contents of the stomach. Food remains in the small intestine for a longer duration to facilitate further digestion, allowing food to be transformed into essence to nourish the entire body. If the small intestine’s function of receiving food is impaired, it can lead to digestive and absorption issues, manifesting as abdominal distension, diarrhea, and loose stools. Transforming means changing, digesting, and metabolizing; the small intestine’s transformation function is to further digest and absorb the food that has been initially digested by the stomach. (2) It separates the clear from the turbid. The “clear” refers to various refined substances, while the “turbid” refers to the residual waste after digestion. The small intestine’s function of separating the clear from the turbid specifically includes three aspects: first, it separates the digested food into two parts: refined substances and waste; second, it absorbs the refined substances and transports the food waste to the large intestine; third, while absorbing the refined substances, the small intestine also absorbs a large amount of fluids, which are then excreted into the bladder as urine. Thus, the physiological function of the small intestine is crucial in the digestion of food. When the small intestine functions normally, the clear and turbid substances follow their respective pathways, refined substances nourish the body, waste is directed to the large intestine, and excess fluids are excreted into the bladder. If the small intestine is diseased, it can not only cause digestive dysfunction, leading to symptoms such as abdominal distension and pain, but also affect the excretion of urine and feces, for example, leading to reduced urination and loose stools. In such cases, methods to promote urination and solidify stools are often employed, known as “promoting urination to solidify stools”.
(4) Large Intestine
The large intestine is also located in the abdomen, connecting above to the small intestine at the ileocecal junction, and its terminal end is the anus, also known as po men. The main physiological function of the large intestine is to conduct waste. The large intestine receives the food waste separated by the small intestine, absorbs excess water from it, forming feces, which are then expelled through the anus. The smooth conduction of waste depends on the normal function of the large intestine, as well as the descending function of the stomach, the dispersing function of the lungs, and the transformation function of the kidneys. Therefore, if the large intestine is diseased, it primarily manifests as abnormalities in fecal excretion, such as diarrhea or constipation. Additionally, diseases of the large intestine can also affect the functions of the stomach, lungs, and other organs.
(5) Bladder
The bladder is located in the lower abdominal cavity, a sac-like organ situated below the kidneys and in front of the large intestine. It connects above to the kidneys via the ureters and below to the urethra, opening at the front. Among the five zang and six fu organs, the bladder is the lowest, serving as the reservoir for excess fluids after metabolism. The main physiological function of the bladder is to store and excrete urine. The water consumed by the body is transformed into fluids through the combined actions of the lungs, spleen, kidneys, and other organs, distributing nourishment throughout the body. After the metabolism of fluids, the remaining liquid is transported through the pathways of the san jiao to the kidneys and bladder, becoming urine, which is stored in the bladder. When the urine in the bladder reaches a certain volume, under the action of the kidneys’ transformation function, the bladder opens, allowing for timely and voluntary excretion. The storage and excretion of urine by the bladder rely entirely on the transformation function of the kidneys. The so-called bladder transformation actually belongs to the kidney’s vaporization and transformation. Bladder diseases primarily manifest as frequent urination, urgency, and pain during urination; or difficulty urinating, residual urine, or even urinary retention; or enuresis, and in severe cases, urinary incontinence.
(6) San Jiao (Three Burners)
San Jiao is a unique term in the theory of Traditional Chinese Medicine, referring to the upper burner, middle burner, and lower burner, and is one of the six fu organs. Its meridians are closely related to the pericardium meridian. Throughout history, there have been various interpretations regarding its form and substance, and a complete consensus has yet to be reached. However, there is agreement on its physiological functions. In terms of form, it is generally believed that the san jiao encompasses all internal organs, thus also referred to as the “lonely palace”. The physiological functions of the san jiao can be understood from both a holistic and local perspective. From a holistic perspective, the san jiao governs all qi and oversees the body’s qi transformation and the movement of fluids. (1) It governs all qi and oversees the qi mechanism and transformation. “All qi” refers to all forms of qi in the body, such as the qi of the organs, meridian qi, respiratory qi, and nutritive qi. The san jiao’s governance of all qi indicates its close relationship with the physiological activities of the organs, meridians, and tissues. The san jiao’s ability to govern all qi primarily stems from the original qi, which originates from the lower burner, derived from the kidneys and transformed from congenital essence. However, the movement of original qi can only be disseminated and reach the entire body through the pathways of the san jiao, thus stimulating and promoting the functional activities of various organs and tissues, making the san jiao play a crucial role in governing all qi. “Qi mechanism” refers to the movement of qi, manifested as the rise and fall of qi. The san jiao is the channel for the rise and fall of qi. “Transformation” refers to the complex changes of various substances, especially the reception, digestion of food and fluids, as well as the absorption of nutrients and the conduction and excretion of waste after metabolism. The transformation process is accomplished with the participation of multiple organs, and the san jiao plays a vital role in this process. The san jiao serves as the pathway for the transformation of food and the excretion of waste, being the starting and ending point for the movement of essence and qi throughout the body. Additionally, the san jiao facilitates the flow of original qi, serving as the power source for the transformation function, promoting the body’s metabolism.(2) It serves as the channel for the movement of fluids. The san jiao has the function of unblocking the waterways and facilitating the movement of fluids, serving as the pathway for the rise and fall of fluids, and is one of the organs involved in regulating fluid metabolism. As stated in the Suwen: “The san jiao is the official of drainage, from which the waterways emerge”. This indicates that the primary function of the san jiao is to complete the qi transformation process of body fluids, ensuring the smoothness of the waterways. If the san jiao is diseased, qi stagnation can occur, leading to fluid stagnation, which may manifest as edema, ascites, and other symptoms. In such cases, methods to promote the flow of the san jiao are often employed for treatment. (3) It indicates three parts of the body and their respective physiological functions. In Traditional Chinese Medicine theory, the san jiao is also a concept for dividing body parts, namely the area above the diaphragm is the upper burner, including the heart and lungs; the area below the diaphragm and above the navel is the middle burner, primarily including the spleen and stomach; the area below the navel is the lower burner, including the liver, kidneys, large and small intestines, bladder, and uterus. Although the liver is anatomically located in the middle burner, Traditional Chinese Medicine considers the liver and kidneys to be of the same origin, with a close physiological and pathological relationship, thus both are classified as part of the lower burner. Since the upper, middle, and lower burners encompass different organs, their physiological functions also differ.(1) The upper burner is like mist. “Mist” refers to a diffused and vaporous state of refined substances. The upper burner being like mist indicates that it has the function of dispersing and nourishing the body, skin, hair, and all internal organs and tissues with qi, like mist and dew. Therefore, the function of the upper burner actually reflects the qi transformation and distribution of the heart and lungs, relating to the distribution of nourishing substances such as qi, blood, and fluids. Thus, variations in the function of the upper burner primarily reflect abnormalities in heart and lung function, with treatment focusing on regulating the heart and lungs. (2) The middle burner is like fermentation. “Fermentation” here refers to the state of food undergoing digestion and fermentation. The middle burner being like fermentation indicates the transformation of refined substances by the spleen and stomach. The function of the middle burner primarily refers to the physiological functions of the spleen and stomach, such as the reception and digestion of food, absorption of nutrients, vaporization of body fluids, and transformation of refined substances into blood. In fact, the middle burner serves as the pivot for the rise and fall of qi, the source of qi and blood transformation. Therefore, variations in the function of the middle burner primarily reflect abnormalities in spleen and stomach function, with treatment focusing on regulating the spleen and stomach. (3) The lower burner is like a drainage ditch. “Drainage ditch” refers to the channels for draining water. The lower burner is responsible for separating the clear from the turbid and excreting urine and feces, a process that actually includes the functions of the kidneys, small intestine, large intestine, and bladder. Therefore, variations in the function of the lower burner primarily reflect abnormalities in kidney and bladder function, with treatment focusing on regulating the kidneys and bladder.
Traditional Chinese Medicine Knowledge: Six Fu Organs – Bladder
Traditional Chinese Medicine Knowledge: Six Fu Organs – Small Intestine
Traditional Chinese Medicine Knowledge: Six Fu Organs – Large Intestine
Traditional Chinese Medicine Knowledge: Six Fu Organs – Gallbladder
Traditional Chinese Medicine Knowledge: Six Fu Organs – Stomach
Traditional Chinese Medicine Knowledge: Six Fu Organs
Type A Questions
1. The common physiological characteristic of the six fu organs is ( ) A. Transforming essence B. Storing essence C. Full but not solid D. Storing but not excreting E. Receiving, transforming, and transporting food and fluids
2. The “lonely palace” refers to which organ ( ) A. Stomach B. Gallbladder C. Bladder D. Small Intestine E. San Jiao
3. The basis for “promoting urination to solidify stools” is ( ) A. The kidneys govern urination, thus promoting urination can solidify stools B. Insufficient central qi leads to changes in urination and defecation, thus they are related C. Dilute and drain fluids, then the spleen yang becomes strong, leading to solid stools D. Both urination and defecation originate from the small intestine’s separation of clear and turbid E. The herbs for promoting urination have a stopping diarrhea effect
4. The fu organ with the function of “receiving and transforming” is ( ) A. Gallbladder B. Stomach C. Small Intestine D. Large Intestine E. Bladder
5. The fu organ with the function of “governing fluids” is ( ) A. Gallbladder B. Stomach C. Small Intestine D. Large Intestine E. Bladder
6. The fu organ that “governs fluids” is ( ) A. Gallbladder B. Stomach C. Small Intestine D. Large Intestine E. Bladder
7. Dysfunction of the large intestine can directly lead to ( ) A. Kidney failure in transformation B. Liver failure in dispersing C. Lung failure in descending D. Spleen failure in transportation E. Spleen failure in ascending and clarifying
8. The “official of receiving” refers to ( ) A. Gallbladder B. Stomach C. Small Intestine D. Large Intestine E. Bladder
9. The “official of the capital” refers to ( ) A. Gallbladder B. Stomach C. Small Intestine D. San Jiao E. Large Intestine
10. The “official of central regulation” refers to ( ) A. Gallbladder B. Stomach C. Small Intestine D. Large Intestine E. Bladder
Type B Questions
A. Lonely Palace B. Palace of Essence C. Palace of Clarity D. Palace of Blood E. Palace of Tendons
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San Jiao is ( )
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Gallbladder is ( )
A. Gallbladder B. Stomach C. Small Intestine D. San Jiao E. Bladder
3. The “official of central regulation” refers to ( )
4. The “official of the capital” refers to ( )
A. Gallbladder B. Stomach C. Small Intestine D. San Jiao E. Large Intestine
5. The organ that “governs fluids” is ( )
6. The organ that “governs liquids” is ( )
A. Large Intestine B. Small Intestine C. San Jiao D. Bladder E. Kidney
7. The organ that governs the movement of fluids is ( )
8. The organ that governs the transformation of waste is ( )
Answers:
Type A Questions: 1.E; 2.E; 3.D; 4.C; 5.C; 6.D; 7.C; 8.C; 9.E; 10.A
Type B Questions: 1.A; 2.B; 3.A; 4.E; 5.E; 6.C; 7.C; 8.A
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