Heart (Xin)

The Heart is the ‘emperor’ within the body and as such has control over everything. It is said to govern all the other organs and is pictured as a benevolent and enlightened ruler. It regulates the flow of Blood and Qi and governs the Blood in two ways. TCM sources see it as a pump which is responsible for the circulation of blood in the vessels, as understood in Western medicine. This makes it responsible for the innate health of the vessels too. The Heart propels the Blood through the tissues, communicating with every part and suffusing the body with consciousness and feeling.

The relationship between the Heart and the Blood is important and determines the strength of the constitution of an individual. Tongue diagnosis can give an indication of the relative strength of the constitution. The presence of a clear crack down the centre of the tongue would alert a TCM practitioner to the possibility of a deficiency of Heart Qi or energy. The state of the blood vessels and general circulation reflects the strength of the Heart Qi, as does the condition of the Heart pulse. Since the Heart controls the blood vessels and circulation, deficient Heart energy leads to a very noticeable bright, white complexion, often seen in Parkinson’s disease patients.

Since Blood and Body Fluids are thought to have a common origin, sweat is considered to be controlled by the Heart and to be found in the spaces just under the skin. If there is a lack of fluid within the circulation it can be replenished from this source. If there is too much heat within the body it is ‘steamed off’ and discharged through the pores. Whatever the true physiology, Heart points appear to have a clinical influence on otherwise unexplained hyperhydrosis problems.

In addition to the clear links with the mechanism of circulation, the Heart also houses the Mind or Shen. This is where the psychological influences become apparent, affecting five functions, all of which are involved in our response to any neurological illness:

The term ‘Shen’ is also sometimes used to indicate vitality. The involvement of the Heart with all of the above means that it must be considered when treating mental illness and, indeed, Heart 7, Shenmen, is a useful point to calm and relax a patient, or to treat insomnia or depression. ‘Shenmen’ translates as ‘Gateway to the Spirit’. The Heart has a strong influence over sleep patterns. If the Heart is deficient in energy the mind is said to have no residence and it will float at night, causing disturbed sleep or excessive dreaming, should sleep come at all.

The connection between the Heart and the emotions is well understood in folk legend in most countries but there is little scientific proof that this could have any foundation. However there are some interesting ideas in a paper by Rosen [2], where the internal memory of the heart cells with regard to physiological process is recognized and discussed. It is suggested that the heart does remember, ‘making use of mechanisms similar to those in other systems that manifest memory, the brain, the gastrointestinal tract and the immune system’.

The emotion of joy is most closely associated with the Heart. Joy is said to slow down the Qi and affects the Heart in this way. Since the Heart controls the Mind or Spirit and hence the emotions, it follows that an excess, i.e. over-joy or extreme anxiety, will damage the balance of Qi in this Zang Fu organ. Excess joy is said to disturb the Xin Qi so much that the Shen becomes confused and scattered. Over-joy is quite a violent emotion and in TCM a sudden laughing fit is thought to be able to trigger a heart attack. The effect of emotional lability, often found in multiple sclerosis (MS), mimics this imbalance.

The concept of a ‘broken heart’ is far from alien to TCM. When the Heart is overwhelmed by strong emotion, usually in this case shock or sorrow, the Shen will be able to break free, thinking becomes disordered and confused and the resulting anxiety will be evident in the abnormal circulation. The impaired circulation will lead to stagnation of the Blood, blood pressure decreases and the patient will show signs of heart disease, angina or chest pain. Shock and fright have an opposite effect on the Heart and are said to cause the Shen to contract.

The most extreme disharmonies of the emotions arise from imbalances within Xin (Heart) and Gan (Liver) and it is sometimes difficult to differentiate between a lack of joie de vivre caused by Xin deficiency and the sorrow and melancholy caused by depression of Gan Qi.

A further disharmony that will give rise to confusing symptoms is that between the Heart and the Kidney. This is often considered in terms of Yin and Yang or Fire and Water. The water aspect of the Kidneys must control the Fire aspect of the Heart, but if the Yin aspect of the Kidney energy is deficient then it will not control and cool the Heart Fire, which then flares up, causing symptoms like insomnia and irritability.

The Heart is said to be the most important Zang Fu organ but, although it is intimately concerned with feelings and emotions, it has little or no influence on the movements and physical activities that we understand to be controlled by the brain. The Governing Vessel, or Du meridian, in its anterior pathway passes through the Heart and is said to penetrate the brain posteriorly at GV 16 Fengfu.

Since the Du meridian is also closely associated with the Kidneys at Du 4 or Mingmen, both these points can be used to influence Heart function (Figure 1.1).

Figure 1.1 • Du meridian: Marrow and Heart linked.

A useful comparison with the TCM function of the Heart is with that of the cerebral cortex, an integrative function, giving rise to the capacity for individual thought and memory. This is further expressed through speech, the voice and facial expression. The intimate link with the Pericardium means that some of the Heart functions can be influenced by treating points on the Pericardium meridian. It is commonly held that this is a ‘gentler’ form of treatment.

Lungs (Fei)

The Lung is characterized as a diplomatic foreign minister, conducting affairs of state and determining foreign boundaries, thus effectively governing the relationship between the inside and outside of the body. The Lungs are the most external of all the organs, having direct contact with the outer air. Because the Lung is so susceptible to Pathogenic invasion it is sometimes referred to as the ‘tender organ’.

The Lungs control respiration and are responsible for the intake of clean air, which they convert into ‘Clear Qi’. Together with the Qi produced from substances that are eaten and drunk, this goes to make up the Post Heaven or renewable Qi within the body. The rhythm of the Lungs sets the rate for all other body functions, starting with the first breath taken by the newborn baby. The clean air or Qi from the Lungs condenses into fluid and passes down through the Sanjiao to the Kidneys, where it is heated, vaporizes and ascends to the Lungs again, forming a sort of energy cycle effectively controlling water circulation within the body (Figure 1.2).

Figure 1.2 • Jin Ye circulation.

(Reproduced with permission from Hopwood V. Acupuncture in Physiotherapy. Oxford: Butterworth Heinemann: 2004.)

The emptying of the Lungs, expiration, slows the movement of Qi whereas the act of filling them, inspiration, speeds it up.

Some teachers compare the activity of the lungs to that of the parasympathetic system, an inhibitory action, but it could be argued that they are just as likely to be involved in a sympathetic mode. Either way, they may be peripherally affected when central nervous system control is damaged in any neurological condition.

The Lung controls the condition of the hair and also the state of the pores. The skin is sometimes referred to as the ‘third lung’. If the skin is in poor condition the pores may remain more open than usual, allowing the invasion of exogenous pathogens. The Lung is also said to produce and control the Wei Qi, or Defensive Qi. This is the first line of defence against Pathogenic invasion of the body and circulates in the spaces just underneath the skin. The link with the Kidneys and water circulation coupled with the control of the pore size means that it also has an effect on sweating, along with the Heart.

The Lung opens into the nose, and is vulnerable to the External Pathogens Wind and Cold. The common cold is said to be an invasion of a combination of Wind and Cold. The sense of smell and the loudness of the voice are dependent on Lung health. A husky voice and a runny or blocked nose are therefore not surprising as common cold symptoms.

The Lung houses the Corporeal Soul or Hun. It is particularly sensitive to grief or sadness, and often affected by bereavement. It is associated with the pain of loss, of letting go, sorrow, loneliness, anxiety and melancholy. The effect of sorrow on the Lung can result in a lack of desire to face the world. Sadness of this kind tends to produce stagnation of Qi in the chest and this in turns inhibits the function of both the Lungs and the Heart. This could result in the subsequent stagnation of Blood throughout the body.

Treatment of LU 7 or Lieque can have a powerful release effect in constrained emotional conditions. The link between sorrow and the function of the Lung has been suggested as the reason for many recently bereaved elderly patients contracting fatal chest infections while still grieving.

Liver (Gan)

The Liver is often characterized as a General, directing his troops; this is a useful analogy because it allows us to think of this organ as concerned in the balance of energies. The Liver has a controlling action on the circulation of blood but this activity depends on whether the body is at rest or active. The Liver sends blood through the vessels when the body is in movement but gathers it back into itself and stores it when at rest.

Some authorities describe this as a rhythm, similar to that of the Lungs, but differing in that it is a voluntary rhythm depending on the circumstances [3]. Ideas of fight and flight, as understood in Western neurology, are clearly appropriate here.

The Liver is responsible for the smooth movement of Qi and body fluids throughout the body. The Liver is involved in the process of digestion, providing energy for the transportation of the Gu Qi produced by the Stomach and Spleen. The Qi from each organ has a characteristic direction of flow, actually controlled by the Liver, ensuring the TCM physiological pathways. The Liver is the source of endurance in times of mental stress or physical exertion. If the Liver Qi is weak, one is easily exhausted, finding it difficult to get out of bed in the morning. Diseases such as MS are thought to attack and weaken Liver Qi.

Liver Qi should flow freely in all directions. If it is constrained it is said to invade the Stomach, Spleen or Lung. ‘Liver invading Spleen’ is fast becoming a common modern syndrome, perhaps because of the combined effect of unsuitable diet and stress on the liver triggering a chain reaction throughout the Zang Fu [4]. The Liver functions as a gentle regulator of the Spleen and Stomach and is thus a regulator of digestion. In addition, bile, under the control of the Liver, aids in the digestive process.

Storage of Blood is seen as integral to Liver function. The Liver releases blood for the start of menstruation and continues to do this regularly, in appropriate quantity, throughout the fertile life of the female. Menstrual problems, such as amenorrhoea and dysmenorrhoea, are primarily treated by restoring Liver function. The Liver has an influence on the even movement of Blood around the body in both sexes. Stagnation is often seen as a result of poor Liver function since Blood and Qi flow together and Qi is said to clear and smooth the channels to allow the accompanying Blood flow.

The Liver controls normal muscle tone in the body. Disturbance of this function leads to muscle tremor, twitching, spasm or even convulsions. This would be said to be the result of an ‘insufficiency of the Yin and Blood in the Liver’, resulting in malnutrition of the tissues. Many of the muscle impairments present in neurological disorders, such as tremor in Parkinson’s disease and progressive paralysis in MS, are associated with Liver Qi imbalance. The Liver is also said to influence the muscle tendons. The fingernails are considered by TCM to be extensions of the tendons; thus, dry, flaky and ridged nails are indicative of an energy deficiency in the Liver.

A link with the eye means that the condition of the Liver can also be detected through examination of the ‘white of the eye’. Conversely, it also means that Liver points can be used to treat eye problems, particularly LR 2 for problems of an inflammatory nature. The fluids most closely associated with the Liver, apart from Blood, are the tears. The syndrome ‘stirring of the inner Wind of the Liver’ can cause poor vision, night blindness and abnormal movements of the eye.

Failure of the free-flowing function of the Liver may be associated with both frustration and depression and outbursts of uncontrolled anger. The Liver requires a calm internal environment, with an even disposition. It is very sensitive to being obstructed in any way. It is interesting that the English language equates being ‘liverish’ with being irritable. The Hun or ethereal soul is housed in the Liver; it is injury to the Hun which causes insomnia, so Liver Qi stagnation in neurological diseases such as MS needs to be addressed to relieve insomnia.

Blazing Gan Fire is linked with severe and violent outbursts of rage. Feelings of irritation and moderate anger are also associated with Liver imbalance and often ascribed to deficient Liver Yin or hyperactive Liver Yang, both of which cause the even tenor of life to become a little more bumpy. Stagnation of the Liver Qi, often produced by anger, can also have a profound effect on the Stomach and Spleen Qi and disturb digestion.

Spleen (Pi)

The Spleen is an interesting organ from a TCM point of view but has never excited much enthusiasm in Western medicine. It occupies the very last pages in Gray’s Anatomy and has always been regarded as generally superfluous to requirements. Splenectomy is not regarded as a life-threatening situation, although antibiotics are required to maintain health afterwards.

The spleen is said to store blood and to have some blood-manufacturing properties but the important part played in the digestive process is not recognized in the West. Interestingly, it has been observed to increase in size during digestion, although no conclusions appear to have been drawn from this.

In TCM the Spleen is regarded as the minister of agriculture, able to control and regulate the production and distribution of essential nourishment. The Spleen is said to govern transformation and transportation. It is the main digestive organ in TCM and responsible, along with the Stomach, for the breaking down or transformation of ingested food and drink and its subsequent transportation to the other sites in the body where it will be utilized. The Spleen is said to incorporate and then distribute Nutritive Essence in order to diminish or augment body mass [5]. It is responsible for forming and reconstituting the internal milieu, gathering and holding together the substance of the body.

Overeating can damage the Spleen; being continually full slows metabolism and assimilation of nutrients. Food will sit undigested in the stomach, uncomfortably inflating the abdomen with stagnant fluid and gases. Lacking sufficient energy from the food ingested, the possible gain from this new food decreases steadily. This leads to a form of weight increase that could be described as more mass than energy. Retarded digestion engenders an urge for a quick fix of sugar and starch. Hence a frequent symptom of Spleen imbalance is a craving for sweet foods or chocolate. Since this obviously applies to patients losing normal mobility, for whatever reason, nutritional advice with the TCM Spleen in mind can be helpful.

The Spleen has a direct influence on muscle bulk since the transformation and transport of food substances help to maintain this. It adjusts the quantity of pure fluid or Essence produced by the digestive process and released into circulation, a function rather like providing additional fuel when the tank is emptying. Stomach and Spleen can be compared to storehouse and granary: the food substances are refined, stored and subsequently transported for use. The whole process is vital to nutrition. Hence Spleen points are recommended where there is evidence of muscle wasting. In addition, the control exerted over the water content of the tissues affects muscle bulk. In Wei syndrome (or ‘withering’), when a decrease in muscle bulk is marked, a combination of Spleen and Stomach points is useful.

This organ is also closely involved with the control of the fluid balance throughout the body, so the Spleen channel is frequently used when there is an excess of fluid, oedema, particularly in the lower limbs. The Spleen itself is said to prefer dryness; this means that it is adversely affected by the Western habit of excessive consumption of icy, sweet drinks and forced to use too much energy in the breakdown of uncooked foods like salads.

The Spleen controls or supervises the Blood, keeping it in the blood vessels and preventing bleeding. If the Blood seeps from the vessels, causing superficial bruising with no perceived cause, then this is thought to be a weakness of Spleen Qi failing to keep it within the vessels. If the Spleen fails in this role the walls of the blood vessels may become fragile and even collapse and marked extravasation occurs, with unexplained bruising appearing on the body surface. Blood may also appear in the stools, which are characteristically loose in any Spleen syndrome. Deficient Yang Qi in the spleen will also adversely affect the formation of Blood.

The Spleen has a centralizing and uplifting effect, holding all organs in their proper places in the body. In practical terms this is said to explain why Spleen points are used to control prolapsed, particularly of the uterus or rectum. Spleen points are very useful when treating haemorrhoids.

The Spleen opens into the mouth and the lips indicate the general state of the Spleen, which should be a healthy red colour. Spleen Qi deficiencies are indicated by pale, thin lips. The associated body fluid is saliva.

The Spleen houses thought and is associated with the act of thinking. If the balance is wrong then excessive or obsessive worrying will be the sign, with general lack of energy and lassitude as the result. There is an obvious link here with the Heart. The Spleen influences our capacity for thinking, studying, concentrating, focusing and memorizing, whereas in TCM the Heart actually does it. The Spleen is damaged by long periods of intensive study or chronic anxiety and several Spleen syndromes are made worse by comfort eating, overdependence on chocolate, which of course is brought about in the first place by low-grade stress. Some scholars have also suggested that it has a connection with compassion and the emotion of caring, but this link may be perceived because, at a time when the Spleen is overwhelmed, the capacity for these emotions is lost.

Symptoms of Spleen Qi deficiency include a disinclination to talk, a low indistinct voice, sallow or pale complexion and general lassitude. Another important symptom associated with imbalance in the Spleen is loss of the sense of smell and, associated with this, the sense of taste. There may also be chronic diarrhoea due to excessive dampness. Swelling or oedema in the lower part of the body, particularly the legs and ankles, is common. Strengthening the Spleen always accompanies a similar treatment for the Stomach and is frequently used to invigorate Blood and the circulation and expel the Pathogen Damp.

Kidney (Shen)

The Kidney is characterized as a Minister of the Interior who conserves natural resources, storing them for use in times of need, growth, crisis or transition. It is of fundamental importance in TCM and said to be the root of life. The Shen Kidney stores Jing or Essence, which is derived from each of the parents and established at conception. This in turn controls the Yang aspects of sexual potency. The Yin and Yang of the Kidneys serve as the foundation for that of the rest of the body. Kidney Yin is the fundamental substance for birth, growth and reproduction while Kidney Yang is the motive force for all physiological processes. Although, according to the Five-Element theory, the Kidneys belong to Water, they are also said to be the source of Fire in the body. This is called Fire of the Gate of Vitality.

The Pre-heaven Essence determines constitutional strength and vitality. It is also associated with individual creativity, and is the basis of sexual life. Impotence and infertility can be linked with it. The Kidneys store Post-heaven Qi or Essence, the refined energy extracted from food through the transforming power of the internal organs. Kidney Essence is the original material substance that forms the basis of all other tissues. It is compared to the genetic information encoded in DNA. Essence is finite and the length of life is dependent upon the quantity and quality. After birth, through childhood and youth, through maturity and old age, all the normal development and ageing processes are associated with the Kidney Essence. When it is abundant the body has the facility to develop and grow. The changes associated with old age are all symptomatic of Kidney deficiency: loss of hair, blurring of vision, low-back pain, tinnitus and loose teeth.

Since it is the origin of both vitality and endurance the Kidney is important in many ways. It represents our own personal link in the continuous chain of existence. The Kidney energy of the fetus and newborn is manifesting the Pre-heaven Qi. The Post-heaven Qi is still potential; consider a small mulberry bush. We see the little thing beginning to grow: the berries that contain the seed haven’t formed yet, and won’t for years, but they are still there deep within the being.

It is ultimately responsible for the instinct to procreate and thus survive. If Kidney Qi is abundant, a long and vigorous sex life is expected since it supports the reproductive organs, material and activity.

When stress – the negative kind – occurs in a normal person, tension occurs, the circulation contracts, breathing is less natural or optimum, and the lack of perceived freedom or even joy creates the internal stagnations that subsequently become bad choices, low expectations and a self-fulfilling self-originating skewed world view. Growth decline and disease follows.

Since the Kidneys belong to Water and they govern the transformation and transportation of Body Fluids in many ways, they act like a gate which opens and closes to control the flow of fluids in the Lower Jiao or lower third of the body cavity. This flow is regulated by the Kidney Yang which in turn controls Kidney Yin. All forms of body fluid are derived from the synthesis of acquired and inherited body essence. This includes tears, saliva, mucus, urine, sweat, cerebrospinal fluid, synovial fluid, plasma and semen.

If too much fluid accumulates in the lower Jiao (Figure 1.2), it stagnates, giving rise to swelling at the knees and ankles, gravitational oedema, abdominal bloating and, occasionally, puffiness beneath the eyes. The build-up of fluid will have a direct effect on the lungs and eventually the heart, leading to further swelling in the upper part of the body.

Because of this involvement in the circulation of water, the Kidneys have a more direct effect on the functions of the Lung. They are said to control and promote respiration. If the Kidney energy is low, the energy necessary to ‘steam’ the pure fluids and send them back up to the Lung will be lacking. The connected descent of the heavier fluid down to the Kidney will not occur, with a build-up of fluid in the lung tissues for a different reason. This type of accumulated fluid causes wheezing and is identified as late-onset asthma.

The Kidneys are said to open into the ear, making Kidney points useful for the treatment of deafness and tinnitus. TCM associates deafness with the idea of extra-thick bone being laid down in the ear, and therefore being under the control of the Kidney. Hair growth is dependent on Essence and Blood and its loss is a result of poor supply. The whitening of the hair in the elderly is connected to the state of the Kidney Essence. There is a saying: ‘the function of the kidney reflects in the glossiness of the hair’. This is interesting because the Lung is also credited with playing a part in the condition of the hair. Perhaps it just serves to emphasize the connection between these two Zang organs.

Fear is the emotion most strongly associated with the Kidneys. It is closely linked to the desire for self-preservation and consequently encompasses true terror. The basic physiological responses, fight or flight, are involved and the other Zang Fu organs are brought into play. The type of fear that immobilizes or paralyses involves weakness of Dan (Gall Bladder) and, when linked to anger, involves Gan (Liver). If caused by worry, then the Spleen may be involved; if a result of anxiety, then the Lung also shows symptoms.

The failure of the Kidney energy to support the body-healing process is implicit in many of the neurological conditions discussed in this book. Use of points to stimulate both Kidney Yin and Kidney Yang energy is usually recommended; the best, all-round point is KI 3, Taixi.

Pericardium (Xin Bao)

The Pericardium is closely related to the Heart; traditionally it is thought to shield the Heart from the invasion of External Pathogenic factors. It is also known as the Heart Protector. The ancient manuscripts, most particularly the Spiritual Pivot [6], do not grant the Pericardium true Zang Fu status, describing the Heart as the master of the five Zang and the six Fu. The Heart is considered to be the dwelling of the Shen and no Pathogen can be allowed past the barrier of the Pericardium in case the Heart is damaged and the Shen departs and death occurs. The Pericardium displays some of the characteristics of Xin Heart but is far less important, in that it only assists with the government of Blood and housing the Mind.

However, as stated earlier, Worsley considered the Pericardium more of a function than an entity and the points on the channel are often used to treat emotional problems, having a perceived cheering effect [1]. They are also frequently used for their sedative effect. The meridian is also used in treatment of the Heart but is considered to be a less intense form of therapy than the use of Heart points.

In effect the Pericardium is considered as the active mechanism of the Heart, the physical pumping activity, whereas the Heart itself is more involved with containing the Spirit and maintaining full consciousness.

In spite of this lesser importance in Zang Fu terms, the meridian is a very useful one with many internal connections and wide-ranging physiological effects.

Small Intestine (Xiao Chang)

The Small Intestine does not differ greatly in function from what is understood in the West but the description of its connections is rather different. The Small Intestine receives food and drink from the stomach and separates the clean or reusable fraction from that which is dirty. The clean part is then transported by the Spleen to all parts of the body. The dirty or turbid part is transmitted to the Large Intestine for excretion as stools and to the Bladder to form the urine. This means that the Small Intestine has a direct functional relationship with the Bladder and influences urinary function. The Small Intestine thus plays a minor part in the Jin Ye or body water circulation.

The Small Intestine is paired with the Heart and is said to have an effect on dreams, although it is not so strong as the Heart itself. The Small Intestine is linked with the Heart through the purification of the substances that enter the Blood, thus protecting the Shen or Spirit. The traditional pairing with the Heart is rather tenuous and only really evident when heat from Fire in the Xin Heart shifts downwards into the Small Intestine and disturbs the Lower Jiao. This relationship is only relevant in the psychological sense. The Small Intestine is said to have an influence on judgement, and on making the best choices.

Large Intestine (Da Chang)

The digestive function of the Large Intestine, as described in TCM, is very similar to that understood in Western medicine. In some Chinese texts it is described as ‘passing and changing’, referring to what happens to the faecal matter. However, many of the normal functions of the Large Intestine are also ascribed to the Spleen. The most important action is the reception of food and drink from the Small Intestine, and the reabsorption of a proportion of the fluid. The remainder goes to make up the faeces and is excreted.

The Large Intestine is the final part of the digestive system and will reflect any imbalances occurring in the other organs of digestion in terms of quantity or quality.

Deficient Yang energy in the Spleen is also called Deficient Energy in the Large Intestine because both tend to result in the same symptoms. This means that the Large Intestine is part of the fluid balance mechanism of the body. The Large Intestine is linked to the Lung both interiorly and exteriorly via the meridians and can therefore have an influence on the Lung/Kidney water cycle. The Lung is said to disperse water while the Large Intestine absorbs it. Equally the Lung takes in air while the Large Intestine discharges gas. If there is Heat in the Lung the faeces will be dry and if the function of the Lung is weak the faeces tend to be loose. Simple stagnation of food in the Large Intestine or constipation can give rise to a degree of breathlessness.

If the Large Intestine is functioning poorly the mind becomes unclear and muddled. It is as though the failure to eliminate the waste leaves feelings of staleness and lifelessness. Many neurological patients suffering from constipation will describe the effect of it in just this way, as will those suffering from a drug-induced constipation. Optimum functioning of the body requires elimination of that which is no longer of use, both physically and psychologically.

Gall Bladder (Dan)

The main function of the Gall Bladder is perceived to be that of assisting the Spleen and Stomach in the process of digestion. The bile from the Gall Bladder is discharged into the Small Intestine under the control of the Liver. If this flow is impaired the digestion process is affected and there will be loss of appetite, abdominal pain and distension with diarrhoea.

This Fu organ is closely connected to the Liver. In TCM terms it is thought that Gan, the Liver, produces the bile and Dan, the Gall Bladder, stores it. The Gall Bladder is not always included in the list of Fu organs and is sometimes termed a ‘Curious Organ’ because it is hollow and secretes a pure fluid (making it more Zang than Fu). It has much in common with the pancreas, and, since the pancreas is not mentioned in the Zang Fu, is sometimes regarded as serving in that capacity too.

The Gall Bladder is said to be responsible for making decisions while the Liver is responsible for smooth planning. Both are affected by the emotional Pathogens Anger and Irritability. A deficiency in Gall Bladder energy leads to timidity, indecision or procrastination. The Gall Bladder is said to give an individual courage and increase drive and vitality. A man with a serene character and firmness of resolve could be referred to as ‘having a large Gall Bladder’ or a ‘thick Liver’ and regarded as most valuable in a military sense by Eastern philosophers.

The Liver and Gall Bladder are so closely linked that it is difficult to regard their disharmonies individually. The balance of energy within the Liver will have a bearing on the storage and release of bile and the subsequent symptoms of poor digestion may result in jaundice, hepatitis or cholecystitis.

A graphic illustration of the interconnectedness of the Zang Fu organs comes from Dey’s translation of Zhang Cong Zheng in his book on treating schizophrenia:

Stomach (Wei)

The Stomach is the most important of the Fu organs and has a vital role in digestion. Together with the Spleen it is known as the root of Post-heaven Qi. Digestion was understood by the ancient Chinese to be a rotting or fermenting process, in which the stomach was described graphically as the ‘Chamber of Maceration’. This process prepares for the action of the Spleen, which then separates and extracts the refined Essence from the food and drink. It has also been compared to a bubbling cauldron.

After the transformation process, which takes place in the Stomach, the food passes into the Small Intestine for further breakdown and absorption. The Stomach is always considered as the true origin of acquired Qi or Gu Qi and is vital for a healthy constitution. For this reason it is often necessary to tonify Stomach Qi when there is any disease process present. The most commonly used acupuncture point is Zusanli Stomach 36, often described as a boost to the system or Qi metabolism. The Stomach has a similar role to that of the Spleen in transporting the food Qi to all the tissues, most particularly the limbs. Weak muscles and general fatigue may indicate a lack of Stomach Qi.

The Stomach sends transformed food down to the Small Intestine and is described as having a descending function. If this is absent or impaired the food stagnates, leading to fullness, distension, sour regurgitation, belching, hiccups, nausea and vomiting. Vomiting is often described as ‘rebellious Stomach Qi’. Under normal conditions the Liver Qi has a hand in this smooth downward flow, so it often needs to be treated alongside the Stomach in digestive disorders.

In order to perform the ripening and rotting task assigned to it, the Stomach requires large quantities of fluid to dissolve the valuable parts of the food. It is, of course, itself a source of fluid but it works best when damp and is damaged by dryness and the Pathogen Heat. Eating large meals late at night depletes the fluids of the Stomach and sets up disharmonies right through the system.

Since it is easily damaged by Heat the Stomach is susceptible to Excess patterns, such as Fire or Phlegm Fire, and can eventually produce mental states similar to mania. Mild cases are likely to suffer from confusion and severe anxiety.

The state of the Stomach may be seen quite clearly in the tongue coating, which is formed as a byproduct of the rotting process. A thin white coating is normal. Absence of a coating implies impaired function and a yellow coating indicates Heat in the Stomach.

The Stomach and the Spleen are so closely interlinked in physiology and function that they are always treated together. While the Stomach controls the downward movement of the less pure elements in the food, the Spleen governs the upward movement of the clear fraction, linking with the Lung. Any type of illness pattern that involves the malabsorption of food and subsequent diminishing Qi production requires both Stomach and Spleen points to be stimulated. This is often apparent in any type of wasting disease where muscle bulk diminishes visibly.

The link between digestion and the mental state has often been considered in the West and common sense tells us that one affects the other. It is rare to see it considered from the Chinese perspective, however, and an article by McMillin et al. [8] throws some light on the sympathetic and parasympathetic nerve connections, which serve to reinforce the Zang Fu attributes.

Urinary Bladder (Pang Guan)

The Urinary Bladder holds few surprises. It secretes and stores urine, using energy from the Kidney, and releases it when appropriate. It is closely involved in the circulation of fluid around the body, receiving fluids separated by the Small Intestine and transforming them into urine. Energy in the Lower Jiao, particularly that of the Kidney, ensures the maintenance of clear water passages.

The Urinary Bladder tends to be susceptible to the Pathogen Heat, producing the painful symptoms of cystitis if this occurs. Incontinence of urine is directly attributable to the Bladder but is usually caused by deficient Kidney Qi. The Urinary Bladder is also said to have control of the urethral, anal and cervical sphincters, regulating the discharge of all body fluids in this area.

The Bladder is thought to be linked to negative emotions such as jealousy and the holding of long-standing grudges. Another saying associated with the Urinary Bladder is: ‘when the Bladder is deficient one dreams of voyages’.

Sanjiao

The Sanjiao or Triple Energizer is a fascinating concept peculiar to Chinese medicine, demonstrating the fundamental holistic concept of the physiological body. It is an explanation of the predominant functions in distinct areas of the trunk and the TCM theory demonstrates the interconnectedness of everything. It is a uniquely Chinese concept and is the subject of much speculation. The word Sanjiao means ‘three chambers’ or ‘three spaces’.

To understand the Sanjiao one needs to reconsider the circulation of Qi, Blood and Body Fluids. The Upper Jiao is said to contain the Lungs and Heart and is known as the ‘chamber of mist’. It is clearly defined as being the portion of the trunk above the diaphragm. The Middle Jiao is just below, between the diaphragm and the navel, and contains the Spleen and Stomach. This region is particularly concerned with the digestion and absorption of food. It is known as the Chamber of Ripening and Rotting or sometimes the Chamber of Maceration.

Since the predominant direction of Stomach Qi is downwards and that of the Spleen is upwards it is clear that the Middle Jiao acts as a kind of junction. The Lower Jiao contains all the other organs, even the Liver and Gall Bladder, although true anatomical location is somewhat inaccurate here. Of major importance physiologically, however, are the Kidneys and Bladder, giving the region the general name of ‘Drainage Ditch’ and controlling the storage and excretion of water.

The Sanjiao is really the summary of the physiology of the Zang Fu organs and points on that meridian (designated Triple Energizer, or TE, by the World Health Organization) can be utilized in coordination of function, particularly fluid circulation. Figure 1.2 shows the contents of the three Jiaos with the predominant direction of Qi flow. In fact all the Zang Fu organs are interlinked in some way, either by fluid circulation or Qi production, so any diagram can become very complex once every factor is taken into account.

The Sanjiao has a very close link with the Kidneys, both Yin and Yang aspects. Since it controls water metabolism it relies on Kidney energy to accomplish this.

The Brain (Nao)

The brain is referred to as the ‘sea of Marrow’. Zang Fu theory dictates that the pathology and physiology of the brain belong to the Heart, which is described as ‘the monarch of all the organs who is in charge of spiritual activities’, so in reality the Brain has little function in TCM terms, although the connection with the Du meridian is considered important.

In more modern texts it is designated a true Zang Fu (although one of the Curious Organs) and allotted functions that correlate closely with what we understand from our modern studies [10].

So the brain controls memory, concentration, motor activity and mental activity. It also controls the senses – sight, hearing, taste, smell and touch. Some texts also claim that Kidney Essence produces the Marrow which gathers to fill the brain and spinal cord, but this is rather a lazy way of thinking. If the brain can really be classified in the Zang Fu system then borrowing function from Western medicine is disingenuous at best. Nonetheless, one of the recent textbooks [10] has a wonderful list, owing its content to a cheerful mix of paradigms. Claiming that there are three parts to the brain, it characterizes function and offers selected acupoints, as shown in Table 1.2, giving somewhere to start in the general complexity.

Bi syndrome

Bi syndrome comprises a group of symptoms vitally connected with the general health and circulation of the body fluids. The body fluid is in a constant state of movement, whether Blood flowing in blood vessels or the interstitial fluid moving slowly between the structures and under the skin or the more precisely defined Jin Ye fluids.

When Pathogenic factors invade the body they enter the most superficial meridians, particularly the Urinary Bladder and Small Intestine, and cause a general slowing of the flow. This affects both Qi and Blood. When fluids are slowed they tend to thicken, stagnate and become sticky. This process is the beginning of the formation of what is defined in TCM as Phlegm (Figure 1.3).

Figure 1.3 • Origin of pain from Bi syndrome.

Each of the External Pathogenic factors, Wind, Cold, Damp and Heat, produces characteristic symptoms and this leads to the different classifications of Bi syndrome. It is also sometimes called painful obstruction syndrome and all of the symptoms will affect movement to some degree.

Heat Bi suggested points

• LI 11 Quchi

• LI 4 Hegu

• GV 14 Dazhui

Use meridian end points, Spring, Well and Stream points.

All the forms of Bi syndrome discussed so far represent an acute type of condition, with the potential for leading to an excess internal syndrome (Figure 1.4).

Figure 1.4 • Progression of Bi syndrome from external to internal.

(Reproduced with permission from Hopwood V. Acupuncture in Physiotherapy. Oxford: Butterworth Heinemann: 2004.)

Bi syndrome associated with Zang Fu organs

Wei Bi or atrophy syndrome

This is a definition of a neurological condition found in ancient Chinese writings. Wei is translated as ‘withered’ and implies the loss of muscle bulk or wasting as the direct cause of loss of movement. A loss of muscle condition due to the failure of the Qi to nourish the muscles and tendons is understood to lead to limp, feeble limbs and the eventual inability to walk or move independently.

This can also be described as ‘Wei Bi’ where Bi indicates an inability to walk because the foot cannot be lifted adequately.

Atrophy or Wei syndrome is characterized by a weakness of the four limbs, often uneven in nature, leading eventually to paralysis. It is often seen as a description of MS, although MS also has other definitive symptoms. It is also used to describe infantile poliomyelitis.

The theories informing a diagnosis of atrophy syndrome involve the invasion of Pathogenic Heat in the initial stages. This Heat dries up the body fluids and by doing so injures both the muscles and tendons. The original invasion also involves both the skin and the Lungs and manifests as a febrile disease (Figure 1.5).

Figure 1.5 • Origin of Wei syndrome patterns.

(After Ross J. Zang Fu, The Organ System of Traditional Chinese Medicine. Edinburgh: Churchill Livingstone, 1984.)

Atrophy syndrome usually results directly from concentration of Exterior Heat in the Lungs, causing injury to body fluid. The general treatment principle will be to tonify Yin and Jin Ye or fluid balance. Most used are the Yang Ming meridians [15]. Stomach points are used for the lower limb and Large Intestine points for the upper limb. Qi deficiency of the Spleen and Stomach, often exacerbated by irregular food intake, can produce similar symptoms, such as weakness of the limbs, with movement impaired but still present. Often there will be indigestion with bloating and faecal frequency. The patient will dislike being cold and have a pale complexion. This can often be seen after a long debilitating illness.

Feng syndromes

In TCM all involuntary muscular tremor, quivering or unintentional movement is attributed to the stirring of internal Wind. This is a more profound change than that produced by an invasion of external Wind.

These tremors may be associated with Parkinson’s disease, cerebellar disease, frontal lobe tumours, benign essential (familial) tremor, alcohol and caffeine toxicity and drug use or withdrawal. Patients who are very anxious are also seen as being more prone to disturbances of internal Wind. Older people with symptoms of Yin deficiency, Phlegm, Pathogenic Heat and Liver Yang rising are also vulnerable to Wind stroke. Often the onset of such symptoms will be apparently sudden, but tremors can also appear in more chronic situations.

Clinical manifestations of internal Wind are many and frequently associated with neurological diseases. As well as tremors and tics, numbness, severe dizziness and vertigo, in more severe cases convulsions, unconsciousness and even opisthotonus (an extreme tetanic arching of the spine) may be seen.

An attack of Wind or Cold on the YangMing or ShaoYang meridians can result in localized symptoms; in particular accumulation of Wind Phlegm in the channels can produce muscle tic or twitch, often seen in facial paralysis (Bell’s palsy).

It is interesting that all these symptoms would be considered by Western medicine as evidence of damage to either the central or autonomic nervous systems but, by identifying the early stages of Wind or Feng influences, it may be possible to treat these and prevent the later, more catastrophic effects.

The four main signs of a potential Feng syndrome are clearly shown in the tongue. Wind tends to produce stiffness, deviation, movement or quivering or a combination of all four. Fire makes the tongue red in colour and blood stasis makes the tongue a reddish purple colour. Phlegm in the system produces a swollen tongue with a sticky coating.

Some acupuncture authorities advise that any elderly person with numbness of the fingers, slightly slurred speech and a tongue showing any of the previously described colours should take immediate steps to avoid overwork, excessive stress and a poor diet. A short-term preventive measure would be direct Moxibustion on GB 39 Xuanzhong and ST 36 Zusanli [16].

Similar points to dispel wind, as in the case of wind Bi, mentioned earlier, can also be chosen. Some of the more effective are listed in Table 1.3.

Table 1.3 Points for Feng syndromes

Summary

The three groups of syndromes are all associated with neurological illness to a greater or lesser degree. It would be reasonable to combine these ideas and perhaps suggest a ‘neurological syndrome’ informed by the theories of pathogens and Zang Fu. The points recommended are frequently repeated.

When neurological diseases are analysed symptom by symptom, the problems experienced by the patient include a wide range of changes and deficits, most of which are common to all the identified conditions, although differing in severity. All of these can be directly related to the malfunction of part of the nervous system, as we currently understand it. Taken in the broadest possible sense, and in no particular order, the following are symptoms which one could expect to find in a patient with severe MS:

Very few patients are unlucky enough to suffer from all these problems but the nature of nerve damage implicit in the diagnosis of the condition means that they are all possible. Neurological conditions are often difficult to distinguish (with the possible exception of a straightforward stroke), because they have a great deal in common with one another. Table 1.4 shows the symptoms described above and how they relate to some of the diseases commonly treated by neurophysiotherapists.

The full selection is rarely found in each specified disease but the potential remains. The perceived physiological reason may also differ but the end result for the patient is the same. The double symbols indicate some of the defining diagnostic symptoms. When these symptoms are considered from the vantage point of TCM theory they fall into patterns or syndromes suggesting their treatment.

It becomes evident that the treatment of cerebrovascular accident will not be dissimilar to that of MS, apart from the obvious problem of laterality, because the basic physiological functions within the body will need to be stimulated in similar ways. This is heresy to a neurology physiotherapist and quite possibly to a traditional acupuncturist too. However the staging proposed by Blackwell and MacPherson (see Chapter 8), will apply across the range of neurological problems, with minor adjustments, because it is firmly rooted in Zang Fu theory, which in itself regards organ physiology as function [17].