Zangxiang, Five Organs, and the Heart (Including Pericardium)

Section 1: The Five Organs

The heart, lungs, spleen, liver, and kidneys are collectively known as the five organs, with the pericardium included, referred to as the six organs. However, it is customary to associate the pericardium with the heart, thus the term “the five organs encompasses the pericardium”. The five organs share the physiological functions of generating and storing vital essence, while each has its specific role and maintains a unique connection with the body’s orifices, forming a specialized system centered around the five organs. Among them, the physiological function of the heart plays a dominant role.

1. Heart (Including: Pericardium)

The heart is located in the left side of the thoracic cavity, above the diaphragm and below the lungs, round and pointed at the bottom, resembling a lotus flower, protected by the pericardium. The heart forms a system with the small intestine, vessels, face, tongue, etc. The heart belongs to the fire element in the five elements, is the most yang organ, governs blood vessels, houses the spirit, and is the supreme ruler of the five organs and the essence of life. The heart corresponds to the summer season.

(1) Anatomical Structure of the Heart

1. Anatomical Position of the Heart: The anatomical location of the heart is clearly documented in TCM literature such as the “Neijing”, “Nanjing”, and “Yiguan”. The heart is located on the left side of the thoracic cavity, above the diaphragm and below the lungs, “the heart is situated beneath the lung vessels and above the diaphragm, attached to the fifth vertebra of the spine” (from “Liu Jing Tu Yi: Meridians”). The heart is an important organ hidden in front of the spine and behind the sternum. The apex of the heart beats beneath the left breast.

2. Structural Characteristics of the Heart: The heart is conical and round, red in color, with openings, and surrounded by the pericardium. TCM recognizes certain aspects of the heart’s weight, color, structure, and blood volume, albeit in a rough manner. “The heart is conical and round, like a lotus flower… surrounded by a red-yellow protective layer, which is the pericardium” (from “Liu Jing Tu Yi: Meridians”).

In the theory of organ representation, the heart in TCM literature is distinguished between the physical heart and the spiritual heart. The physical heart refers to the tangible heart; the spiritual heart refers to the brain’s ability to perceive and reflect external phenomena, engaging in consciousness, thought, and emotional activities. TCM attributes mental and conscious activities to the heart, hence the concept of the spiritual heart. As Li Ting stated: “The physical heart, shaped like an unopened lotus flower, resides above the liver and below the lung. The spiritual heart… governs all things, is ethereal and unclouded” (from “Introduction to Medicine: Organs and Bowels”).

(2) Physiological Functions of the Heart

1. The Heart Governs Blood Vessels: The heart governs blood vessels, indicating its role in managing blood and promoting blood circulation within the vessels, encompassing both the governance of blood and vessels. Blood refers to the bodily fluid. Vessels, also known as meridians, are the channels for blood circulation. The heart and vessels are interconnected, forming a closed system that serves as the hub of blood circulation. The heart continuously beats, propelling blood throughout the vessels, circulating endlessly, thus becoming the driving force of blood circulation. Therefore, it is said: “When the heart moves, blood flows through all meridians… thus the heart governs blood” (from “Introduction to Medicine: Organs and Bowels”). This illustrates that the physiological functions of this relatively independent system composed of the heart, vessels, and blood are all governed by the heart and depend on the normal beating of the heart.

The rhythmic beating of the heart corresponds with the rhythmic pulsation of the vessels, known as the “pulse”. TCM uses pulse palpation to understand the state of qi and blood throughout the body, serving as one of the diagnostic methods, referred to as “pulse diagnosis”. Under normal physiological conditions, if the heart functions properly, qi and blood circulate smoothly, and the body’s functions are normal, the pulse will be rhythmic, gentle, and strong. Otherwise, the pulse may exhibit abnormal changes.

For the heart to fulfill its physiological function of governing blood vessels, it must meet two conditions: first, the heart’s structure must be intact, and its yang energy must be abundant. The heart’s qi and blood, heart’s yang and yin are both oppositional and unified, constituting the heart’s internal dynamic to maintain its normal physiological function. The normal beating of the heart primarily relies on the action of heart yang energy. Only with abundant heart yang can normal heart strength, heart rate, and heart rhythm be maintained, allowing blood to circulate normally within the vessels. Second, the normal circulation of blood also depends on the fullness of the blood itself and the smoothness of the vessels. Therefore, abundant heart yang, full blood, and unobstructed vessels are the most fundamental prerequisites for blood circulation. Any abnormality in any of these factors can alter the state of blood circulation.

The physiological roles of the heart governing blood vessels are twofold: First, it circulates blood to deliver nutrients. The heart’s qi drives blood to circulate within the vessels, carrying nutrients to nourish the entire body, ensuring that the five organs, six bowels, limbs, muscles, and skin receive adequate nourishment to maintain their normal functional activities. Second, it generates blood, ensuring a continuous supply of blood. The refined essence from the digestion and absorption of food by the stomach and intestines is transported by the spleen’s function of transformation and transportation, ascending to the heart and lungs, where it is transformed into blood after the lungs expel the old and take in the new, hence the saying “the heart generates blood” (from “Suwen: Discussion on Yin and Yang Correspondences”) and “blood is generated in the heart” (from “Zhi Yi Lu”).

If the heart functions normally, its beating is regular, the pulse is gentle and strong, and the complexion is rosy and radiant. If the heart undergoes pathological changes, this will be reflected in the heart’s beating, pulse, and complexion. For instance, if heart qi is deficient, blood is insufficient, and the vessels are obstructed, blood flow will be impaired, leading to a pale complexion, weak pulse, or even stagnation of qi and blood, resulting in a dark complexion, cyanosis of lips and tongue, chest tightness, and stabbing pain, with pulse patterns such as knotted, intermittent, rapid, or choppy.

2. The Heart Governs Spirit: The heart governs spirit, also known as the heart houses the spirit.

(1) Meaning of Spirit: In TCM, the meaning of spirit primarily encompasses three aspects: First, it refers to the functions and laws of material movement and change in the natural world. The saying goes, “Yin and yang are unpredictable, referred to as spirit” (from “Suwen: Discussion on the Origin of Heaven”). Second, it refers to the totality of life activities in the human body. This is generally referred to as the broad sense of spirit. The external manifestations of life activities in the human body, such as the overall appearance, complexion, eye expression, speech, responses, and body movements, all fall within the scope of spirit. In other words, all external manifestations of the body are reflections of life activities. Third, it refers to people’s mental, conscious, and cognitive activities. This is generally referred to as the narrow sense of spirit.

(2) Generation of Spirit: Spirit is the function or capability of the human body. The physical body, composed of vital essence, is the foundation of human existence. “What is born is called essence; when two essences unite, it is called spirit” (from “Ling Shu: On Spirit”). Spirit develops and diminishes with the individual’s growth, development, and decline. Spirit is transformed from the innate vital essence; when the embryo forms, the spirit of life is also generated. After birth, during the individual’s developmental process, spirit must also rely on the nourishment of postnatal food essence. Hence, it is said: “Spirit is the essence of food and water” (from “Ling Shu: On the Absolute of Food”).

Spirit is not an immaterial entity; its generation has a material basis. Vital essence is the material foundation for the generation of spirit. The body exists, and spirit arises; the body is the form of spirit, and spirit is the function of the body. When the body exists, spirit exists; when the body ceases, spirit ceases. In summary, spirit is a product of the material natural world, a natural phenomenon in the universe.

(3) Physiological Role of the Heart Governing Spirit: The heart houses the spirit, serving as the center of life activities in the human body. Its physiological roles are twofold: First, it governs thinking, consciousness, and spirit. Under normal circumstances, the spiritual heart receives and reflects objective external phenomena, engaging in mental, conscious, and cognitive activities. This function is referred to as “receiving things”. “Receiving” means accepting, undertaking, and bearing, indicating that the heart has the role of receiving and processing external information. With this function of “receiving things”, mental and cognitive activities can occur, allowing for judgments about external phenomena. Second, it governs life activities. “The heart is the ruler of the body, the foundation of all things” (from “Yinshan Zhengyao: Preface”). The spiritual heart is the ruler of life activities in the human body. The five organs and six bowels must operate under the unified command of the heart to conduct coordinated and normal life activities. The heart is the monarch, and all organs and limbs obey the heart. The heart houses the spirit and serves the function of spirit. “The heart is the great ruler of the five organs and six bowels, where the spirit resides” (from “Ling Shu: On Evil Guests”).

(4) Relationship Between the Heart Governing Spirit and the Five Organs Housing Spirit: TCM adopts a holistic perspective, believing that all mental, conscious, and cognitive activities in the human body are reflections of the physiological functions of the organs. Thus, the spirit is divided into five aspects, each belonging to one of the five organs: “the heart houses the spirit, the lungs house the po, the liver houses the hun, the spleen houses the yi, and the kidneys house the zhi” (from “Suwen: Discussion on the Five Qi”). Although the mental, conscious, and cognitive activities of a person belong to the five organs, they primarily fall under the physiological function of the heart governing spirit. Hence, it is said: “The heart is the great ruler of the five organs and six bowels, encompassing the soul and spirit, and including will” (from “Liu Jing: Disease Categories”).

Relationship Between the Heart Governing Spirit and Governing Blood Vessels: Qi, blood, body fluids, and essence are the material basis for the functional activities of the organs. Spirit is one of the physiological functions of the heart; the heart transports blood to nourish the entire body, including providing the necessary materials for its own life activities. Therefore, in this sense, blood is the material basis for spirit activities. Thus, it is said: “Blood and qi are the spirit of a person” (from “Suwen: Discussion on the Eight Correct Spirits”) and “blood is the spirit’s qi” (from “Ling Shu: On Nutritional Health and Meeting”). Therefore, abnormalities in the heart’s function of governing blood vessels will inevitably lead to changes in spirit.

(5) Relationship Between the Heart Governing Spirit and the Brain as the Abode of the Original Spirit: The brain is the sea of marrow, and marrow is produced from essence, which originates from the qi and blood of the five organs and six bowels. Thus, the brain’s function is related to the five organs. The spiritual faculties of memory, thought, language, vision, hearing, and smell are all governed by the brain, hence it is called the abode of the original spirit, the center of life activities in the human body. The spiritual heart is essentially the brain. The heart governs blood, supplying it to the brain. Therefore, the heart and brain are interconnected, often referred to together, and treated together.

The mental, conscious, and cognitive activities of a person belong to the physiological functions of the brain, reflecting external phenomena. This has been clearly discussed in TCM literature for a long time. However, the theory of organ representation attributes mental, conscious, and cognitive activities not only to the five organs but primarily to the physiological function of the heart. Thus, the heart governing spirit essentially refers to the brain receiving and reflecting objective external phenomena through sensory organs, engaging in consciousness, thought, and emotional activities. Although the concept of organs in the theory of organ representation includes several anatomical components, it primarily serves as a symbolic system indicating various functional connections, representing the overall functional model of the human body. TCM attributes cognitive activities to the heart based on the close relationship between the fullness of heart blood and the vigor of spirit. The heart is a significant category in ancient Chinese philosophical discussions on the nature of the heart. “The heart is the organ of thought” (from “Mengzi: Gaozi I”); thus, the ancients regarded the heart as the organ of thought, which later became a synonym for the brain. The heart is the organ used for thinking. The significance of the heart lies in the actual activity of human thought. The physical heart refers to the heart’s essence, while the spiritual heart refers to the subjective consciousness arising from the heart’s essence, essentially the function of the brain. Therefore, the concept of the heart in TCM reflects the distinctive characteristics of the central philosophical thought in traditional Chinese culture. The theory of the heart and spirit in TCM has long guided clinical practice, holding significant scientific and practical value.

The importance of spirit in life activities: “Those who possess spirit thrive; those who lose spirit perish” (from “Suwen: Discussion on the Transformation of Essence and Qi”). When the physiological function of the heart governing spirit is normal, the spirit is uplifted, consciousness is clear, thinking is agile, and responses to external information are sensitive and normal. If the physiological function of the heart governing spirit is abnormal, it can lead to various mental and cognitive disturbances, such as insomnia, vivid dreams, restlessness, or even delirium, or sluggish responses, mental fatigue, and even coma or loss of consciousness. Furthermore, it can affect the functional activities of other organs, potentially endangering life. Therefore, it is said: “When the ruler is clear, the subordinates are at peace… when the ruler is unclear, the twelve organs are in danger” (from “Suwen: Discussion on the Linglan Secret Classic”) and “When the heart moves, all five organs and six bowels tremble” (from “Ling Shu: On Questions of the Mouth”). Calming the heart and spirit can dispel illness and prolong life, preventing premature aging.

(3) Physiological Characteristics of the Heart

1. The Heart is a Yang Organ and Governs Yang Qi: The heart is the sun among the yang organs, utilizing yang energy. The heart’s yang energy can promote blood circulation, sustaining human life activities, allowing for continuous vitality, hence it is likened to the “sun” of the human body. “Man is in harmony with heaven and earth; heaven has the sun, and man also has the sun, the yang of the ruler” (from “Yixue Shizai Yi”). The yang heat of the heart not only maintains the physiological functions of the heart itself but also plays a nourishing role for the entire body. “The heart is the fire organ, illuminating all things” (from “Blood Syndrome: Discussion on Organ Pathology”), thus the heart yang plays a crucial role in the digestion and transformation of the spleen and stomach, the warming and steaming of kidney yang, as well as the metabolism of body fluids and regulation of sweat throughout the body.

2. The Heart’s Qi Corresponds with Summer Qi: The heart corresponds with summer qi, meaning they mutually respond to each other. Humans and nature are a unified whole; the seasonal changes of yin and yang in the natural world are interconnected with the functional activities of the five organs in the human body. The heart is inherently linked to summer, the south, heat, fire, bitter taste, and red color. The heart, being a yang organ, governs yang energy. The correspondence between the heart and summer qi indicates that the heart’s yang is most vigorous in summer, and its functions are strongest.

[Appendix] Pericardium

(1) Anatomical Location

The pericardium, abbreviated as the pericardium, is the outer membrane of the heart, serving as the peripheral tissue of the heart, with vessels attached to it, which are the meridians through which qi and blood flow, collectively referred to as the pericardium.

(2) Physiological Functions

As the peripheral tissue of the heart, the pericardium has the function of protecting the heart and receiving pathogens on behalf of the heart. The theory of organ representation posits that the heart is the ruler’s organ, and evil cannot invade it; thus, when external pathogens attack the heart, they first invade the pericardium, hence it is said: “All evils that affect the heart are found in the pericardium” (from “Ling Shu: On Evil Guests”). The clinical manifestations primarily involve abnormalities in the function of the heart housing the spirit, such as in cases of external heat illness, where the warm pathogen penetrates inward, leading to high fever, delirium, and other disturbances of the heart spirit, referred to as “heat entering the pericardium”. Abnormalities in spirit due to phlegm turbidity manifest as confusion, consciousness disturbances, and other states of disordered heart spirit, referred to as “phlegm turbidity obscuring the pericardium”. In fact, the pathological changes resulting from the invasion of the pericardium are consistent with those of the heart, thus the differentiation and treatment are generally similar.

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