Understanding the Functions and Applications of the Six Fu Organs

The six Fu organs include: the Gallbladder (Dan), Stomach (Wei), Small Intestine (Xiao Chang), Large Intestine (Da Chang), Bladder (Pang Guang), and San Jiao (Triple Burner). Their common physiological characteristic is to receive, store, and transform food and fluids. In ancient texts, the term “Fu” was written as “府” (Fu), which means a hollow place for storing items, allowing for both entry and exit. The primary physiological function of the Fu organs is “transformation and transportation,” indicating that their role is mainly to receive, digest, and transform food, existing in a continuous cycle of fullness and emptiness. The Fu organs do not store essence and Qi.Food must pass through seven important gates, referred to as the “Seven Gates” in the “Nan Jing” (Classic of Difficulties), namely the lips, teeth, epiglottis, cardia, pylorus, ileocecal valve, and anus. The lips are likened to a “flying gate,” meaning they can open and close freely; the teeth are the “door gate,” which guards the upper digestive tract and chews food; the epiglottis is the “suction gate,” where the esophagus and trachea meet, serving as the entrance for air; the cardia is where food enters the stomach; the pylorus is the exit from the stomach to the small intestine; the ileocecal valve prevents the passage of fine substances from the small intestine into the large intestine; the anus, also known as the “po gate,” is the final part of the digestive tract, responsible for excreting feces. Therefore, any pathological changes at any of the Seven Gates can affect the reception, digestion, absorption, and excretion of food.　　(1) Gallbladder　　The Gallbladder is attached to the Liver (Gan) and is a hollow sac-like organ. Its main physiological function is to store and excrete bile.　　Bile is produced in the Liver and secreted by it. Once generated, bile flows into the Gallbladder for storage. Bile is also known as “essence fluid,” hence the Gallbladder is referred to as the “repository 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 action, assisting the Spleen and Stomach in maintaining normal digestion. Due to the close relationship between the Liver and Gallbladder, if the Liver functions normally, 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, symptoms such as loss of appetite, abdominal distension, and loose stools may occur; Gallbladder and Stomach diseases can also lead to 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 and is a repository of purity, not directly receiving food waste, which distinguishes it from the other Fu organs, thus it is classified as a “strange organ.”
　　　　(2) Stomach　　The Stomach is located below the diaphragm, with its upper opening called the cardia, connecting to the esophagus, and its lower opening called the pylorus, leading to the small intestine. The Stomach is also known as the “Stomach cavity” and is divided into three parts: upper, middle, and lower. The upper part is the “upper cavity,” which includes the cardia; the lower part is the “lower cavity,” which includes the pylorus; the area 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) Responsible for receiving and digesting food　　Food enters through the mouth, passes through the esophagus, and enters the Stomach, which receives it, 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 nutrients 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.　　“Digesting” implies initial processing and digestion. Food in the Stomach undergoes grinding and digestive actions, transforming it into chyme, which then moves down to the small intestine, laying the foundation for further digestion.　　The Stomach’s reception and digestion work in conjunction with the Spleen’s transportation function, referred to as “Stomach Qi.” “Human life is based on Stomach Qi; with Stomach Qi, there is life; without Stomach Qi, there is death.”
　　(2) Responsible for descending and harmonizing　　After food enters the Stomach and is digested, 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 Stomach distension and pain, and aversion to food. If Stomach Qi ascends, symptoms such as nausea, vomiting, belching, and hiccups may occur. Additionally, if Stomach Qi does not descend, it can also affect the Spleen’s function of ascending clear Qi.　　　　(3) Small Intestine　　The Small Intestine is located in the abdomen, connecting above to the pylorus and below to the ileocecal valve, where it meets the large intestine.　　The physiological functions of the Small Intestine can be summarized in two aspects:　　(1) Responsible for receiving and transforming substances　　Receiving means to hold substances, i.e., to accept. The Small Intestine receives the food that has been initially digested by the Stomach, thus it serves as a vessel for the contents of the Stomach. Food remains in the Small Intestine for a longer time to facilitate further digestion, allowing the nutrients 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 transforming function is to further digest and absorb the food that has been initially processed by the Stomach.　　(2) Separating the clear from the turbid　　The “clear” refers to various refined substances; 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 sends the food residues to the large intestine; third, while absorbing the refined substances, the Small Intestine also absorbs a large amount of water, which is then excreted as urine through the Bladder.　　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 paths, refined substances nourish the body, waste is sent to the large intestine, and excess water is excreted through the Bladder. If the Small Intestine is diseased, it can lead to digestive dysfunction, causing symptoms such as abdominal distension and pain, and can also affect urination and defecation, such as 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 valve, and its end is the anus, also known as the “po gate.”
　　The main physiological function of the Large Intestine is to conduct waste.　　The Large Intestine receives the food residues separated by the Small Intestine, absorbs excess water from them, and forms 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 of turbid substances from the Stomach, the dispersing action of the Lung Qi, and the transformation function of the Kidney. Therefore, if the Large Intestine is diseased, abnormalities in fecal excretion may occur, such as diarrhea or constipation. Additionally, diseases of the Large Intestine can also affect the Stomach, Lung, and other organs, leading to dysfunction.　　　　(5) Bladder　　The Bladder is located in the lower abdominal cavity, a sac-like organ situated below the Kidney 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 Lung, Spleen, and Kidney, 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 reaches a certain volume, the Bladder opens under the Kidney’s transformation action, allowing for timely and voluntary excretion.　　The storage and excretion of urine by the Bladder rely entirely on the transformation function of the Kidney. The so-called “Bladder transformation” actually belongs to the Kidney’s vaporization and transformation. Bladder diseases primarily manifest as frequent urination, urgency, and pain; or difficulty urinating, residual urine, or even urinary retention; or enuresis and, in severe cases, urinary incontinence.　　　　(6) San Jiao　　San Jiao is a unique term in TCM’s organ theory, referring to the Upper Jiao, Middle Jiao, and Lower Jiao, and is one of the six Fu organs. Its meridians are closely related to the Pericardium. Throughout history, there have been various interpretations regarding its form and substance, and a complete consensus has yet to be reached. However, there is a general agreement on its physiological functions. In terms of form, San Jiao is generally considered a large organ encompassing all internal organs, hence it is also called the “lonely repository.” The physiological functions of San Jiao can be understood from both a holistic and local perspective. Overall, San Jiao governs all Qi and is responsible for the transformation and movement of fluids.　　(1) Governing all Qi and overseeing the body’s Qi dynamics and transformation　　“All Qi” refers to all forms of Qi in the body, such as the Qi of the Zang and Fu organs, meridian Qi, respiratory Qi, and nutritive and defensive Qi. San Jiao governs all Qi, indicating that its physiological activities are closely related to those of the Zang and Fu organs, meridians, and tissues. The ability of San Jiao to govern all Qi primarily stems from the Yuan Qi, which originates from the Lower Jiao and is derived from the essence of the Kidney. However, the movement of Yuan Qi can only be disseminated and reach the entire body through the pathways of San Jiao, thus stimulating and promoting the functional activities of various Zang and Fu organs, which is why San Jiao plays a role in governing all Qi.　　“Qi dynamics” refers to the movement of Qi, manifested as the rise and fall of Qi. San Jiao serves as 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, distribution of nutrients, and the conduction and excretion of waste after metabolism. The process of transformation is completed with the participation of multiple organs, and San Jiao plays a crucial role in this process. San Jiao is the pathway for the transformation of food and the excretion of waste, serving as the starting point for the movement of essence and Qi throughout the body.　　Additionally, San Jiao facilitates the movement of Yuan Qi, serving as the power source for transformation, promoting the body’s metabolism.　　(2) Serving as the channel for the movement of fluids　　San Jiao has the function of regulating the pathways of fluids and facilitating their movement, serving as the channel for the rise and fall of fluids, and is one of the organs involved in the regulation of fluid metabolism. As stated in the “Su Wen” (Plain Questions), “San Jiao is the official of drainage, where the pathways of water emerge.” This indicates that the primary function of San Jiao is to complete the process of fluid transformation in the body, ensuring the smooth flow of water pathways. If San Jiao is diseased, Qi dynamics may become obstructed, leading to symptoms such as edema and ascites. In such cases, methods to promote the flow of San Jiao are often employed for treatment.　　(3) Indicating the three parts of the body and their respective physiological functions　　In TCM theory, San Jiao is also a concept used to divide the body into regions: the area above the diaphragm is the Upper Jiao, which includes the Heart and Lungs; the area below the diaphragm and above the navel is the Middle Jiao, primarily including the Spleen and Stomach; the area below the navel is the Lower Jiao, which includes the Liver, Kidneys, Large and Small Intestines, Bladder, and uterus. Although the Liver is anatomically located in the Middle Jiao, TCM considers the Liver and Kidneys to be closely related in physiological and pathological terms, thus both are classified as part of the Lower Jiao. Since the Upper, Middle, and Lower Jiao encompass different organs, their physiological functions also differ.　　(1) Upper Jiao is like mist　　“Mist” refers to a diffused and vaporous state of refined substances. The Upper Jiao, like mist, refers to its function of dispersing defensive Qi, nourishing the skin, hair, and all internal organs and tissues. Therefore, the function of the Upper Jiao is essentially the Qi transformation and distribution of the Heart and Lungs, relating to the distribution of nutritive substances such as Qi, blood, and fluids. Thus, variations in the function of the Upper Jiao primarily reflect abnormalities in Heart and Lung function, with treatment focusing on regulating the Heart and Lungs.　　(2) Middle Jiao is like fermentation　　“Fermentation” here refers to the image of food undergoing digestion and fermentation. The Middle Jiao, like fermentation, refers to the Spleen and Stomach’s function of transforming refined substances. The Middle Jiao’s function mainly 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 Jiao serves as the pivot for the rise and fall of Qi dynamics and the source of Qi and blood transformation. Therefore, the function of the Middle Jiao is described as “like fermentation.” Variations in the function of the Middle Jiao primarily reflect abnormalities in Spleen and Stomach function, with treatment focusing on regulating the Spleen and Stomach.　　(3) Lower Jiao is like a drainage ditch　　“Drainage ditch” refers to a channel for draining water. The Lower Jiao is responsible for separating the clear from the turbid and excreting waste, a process that includes the functions of the Kidneys, Small Intestine, Large Intestine, and Bladder. 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