藏象學說 講稿.docx

留學生班中醫(yī)學第三章 臟腑學說 講稿附三院 周穎芳Hello, everyone!Today well talk about the theory of viscera and bowels. I am from the third affiliated hospital of Guangzhou Medical University, my name is Zhou Yingfang. I know you have learnt Yin-yang and the five elements doctrines, which make it easier to understand what well learn today.Objectives After the learning of this chapter, you should master the concept of viscera and bowels, the characteristics, the main functions of the five zang-organs and the six fu-organs, and the mutual relationships among them. At the beginning of learning TCM, not only you, but also the Chinese students have the problem in understanding and accepting the theory of TCM, because it is really different from that of the western medicine. I hope, from now on, you can make yourselves completely into the thinking mode of traditional Chinese medicine. Just like the picture, western medicine and TCM are two different ways, but their purposes are to deal with diseases and make human beings healthy. Lets see the meaning of the Chinese words of viscera, 藏象。Zang has two pronunciations, one is cang, which means hiding; another is zang, which means the internal organs. Xiang indicates the phenomena and shapes/forms. These two words together implicate the physiological functions and pathological changes of the organs inside our body. The visceral manifestation theory is an important component of TCM. It consists of the study of the physiology and pathology of all the viscera, and the relationship between viscera. In Chinese medicine, each organ is a complex system which encompasses many aspects, such as, the material-anatomical body parts, mind-body-spirit connection, individual constitution, tissues, organs, and surrounding environment. This paradigm is the core of TCM. We divide the internal organs of the body into three kinds:The first one is five zang-viscera, which includes heart, liver, spleen, lung and kidney. Their physiological function is to produce and store essential qi. Essential qi is composed of the congenital essential qi, and the qi from food and drink by transformation and transportation of the spleen and stomach. The second one is six fu-viscera, they are gallbladder, stomach, small intestine, large intestine, urinary bladder and san-jiao. Their physiological function is receiving, transforming, and transporting food and water. If the passage way is not smooth, been obstructed, the person will feel distension in the stomach or the abdomen area. (The five zang-viscera store the essential qi but not discharge it, so they are full, but cannot be filled up. The six fu-viscera transform and digest the matter but do not store it, thus, they are filled, yet are not full. ) The third type is extraordinary fu-viscera. They are brain, marrow, bone, vessel, gallbladder and uterus. They are distinct from the fu-viscera in function. Well go into details later. The five zang-viscera1HeartThe first content is heart. As we all known that the heart is located in the thorax and guarded externally by the pericardium. Lets go into further understanding of the heart.The heart has the function of circulating blood through the vessels to nourish the whole body. Maybe its easier to understand, because it is similar to that in western medicine. The blood circulation looks like a ring without break, but the normal circulation of blood in the vessels depends on both the heart and vessels. The vessels are the pathways of blood circulation and the heart is the motive power of blood circulation. Heart qi can promote the blood circulation, and transport the nourishment materials to the tissues and organs. The beat of the heart relies on the promoting and regulating function of the heart qi. Shen refers to the control of whole body function in a broad sense. Specifically the heart governs spiritual activities, which includes mental aspects, consciousness and thought. Maybe it is the most difficult part for you to understand. In modern medicine, spiritual activities are the function of the cerebrum, or the cerebrums reflection, related to, and experiences with objective things. In TCM, heart governs the physiological activities of the organs and body orifices. The material basis of spiritual activities is blood. In physiological condition, if the function of governing spiritual activities is normal, one will be full of vitality, have a clear head, and be quick in both thought and response. But, in the pathological condition, the patient will be upset, have depressive psychosis and mania caused by phlegm-fire disturbing the heart, insomnia, frequent dreaming and palpitation. Here is an example, a person named Fan Jin in a novel of Qing dynasty, lived in poor, he had experienced the exams of more than 20 times, and all failed. Until nearly 60 years old, he got the former second degree candidate in the provincial examination. He was very very happy, and became mad. If we use TCM theory to explain it, it is because the overjoy emotion hurts the heart. In TCM, heart has close relationship with sweat. Sweat is derived from body fluid, and is important component part of blood. There are sayings, such as blood and sweat share a common source, sweat is the fluid from the heart. In normal condition, sweat can moist the skin, while too much sweating may injury heart blood and heart qi. For example, hot environment, too much clothes, or excessive exercises may cause abnormal sweat. And the patient may feel palpitation and feeling of fear. A much more serious condition is known as depletion of yang resulting from profuse sweat, which leads to night sweating. The heart opens to the tongue and manifests on the face. In acupuncture, the large divergent collateral of the heart meridian goes up to the tongue and the face. These areas are rich in blood vessels. You all know a TCM practitioner often looks at the tongue and face, so as to help he/she to make diagnosis. It is said that the tongue is the sprout of the heart. The physiological functions of the heart can be detected through changes in both color and luster of the face. In physiological condition, the heart functions are well, and the heart-blood is abundant, the face will be ruddy and lustrous, and the tongue will be light red and free in motion. In the pathological condition, the manifestations depend on the concrete reason. If the heart-blood is deficient, there will be a pallor complexion and pale tongue. If the heart blood is stagnated, purplish and dark complexion, echymoses or petechiae will appear. Dysfunction of heart in governing mental activities or spirit leads to stiff tongue, difficult in speaking, or aphasis. If the heart-fire is flaring up, there will be red tongue and carbuncles。Hair is dependent upon the nourishment of blood, so it is said hair is the extension of blood. PericardiumIt has the function of protecting the heart. In TCM, exogenous factors that invading the heart often first attack the pericardium. For example, febrile disease with high fever, coma, deep red tongue is known as “heat invading the pericardium” in TCM. 2. LungGoverns Qi(1) Governs air breath“getting rid of the stale and taking in the fresh”(2) Governs Qi of the whole bodyProduction of “pectoral qi”, which is composed of fresh air from nature inhaled by the lungs and essential qi from food, water, and stored in the thorax. Qi movement (ascent, descent, exit and entrance) of the whole bodyIn charge of dispersing and descendingThe function of dispersing and descending involves the distribution of qi, blood, and body-fluid to the zang-fu organs, the muscles, skin and hair.Pathology: cough, difficulty in breathing; fullness of the chest, phlegmSmooth the water passagesIt means the ascending and descending functions of the lung qi have the function of smoothing and regulating the distribution, circulation and discharging of the water inside body. Discharge the metabolized water in the body in four processes: urine, sweat, respiration, and feces. “the lung is the upper source of water”Governs the skin and hairThe skin and hair in this case, represent the entire surface of the body including skin, sweat gland pores, and hair. They acts as a barrier against the invasion of exogenous pathogenic factors. The lung spreads defensive-qi to the body surface, “warms the tissues between the skin and muscles, replenishes the skin, nourishes the muscles, and regulates the opening and closing of the pores”. Pathology: aversion to cold, fever, nasal obstruction, nasal discharge, cough, or even difficult breathing.Opens to the noseNose is the gate of the lung, and the passage for air enter and exit.Proper function of the lung-qi: clear, unobstructed nasal breathing, smellingPathology: stuffy nose, running nose, sneezing, itching of the throat. 3. SpleenGoverns transformation and transportationSubstances: (1) foodFunction: digesting, absorbing and transporting nutritive substancesPathology: poor appetite, abdominal distention, diarrhea, lassitude, and emaciation(2) waterFunction: promotes water metabolism, moisten and nourish various tissues of the body, avoid retention of water, maintain water metabolism balance.Pathology: edema, phlegm-dampness syndrome, diarrhea Controls bloodFunction: controlling blood and circulating it within the vessels and prevents blood from extravasating.Pathology: bleedingSends up essence“spleen qi is in charge of ascending”Raising up Food Essence, raising up the Internal OrgansPathology: “sinking of the middle-jiao”chronic diarrhea with proctoptosisuterine prolapseDominates muscles and limbsPathology: thin muscles, forceless, flaccid and atrophied limbsOpens to the mouth, manifests on the lipsAppetite and tastePathology: anorexia, tastelessness, or a sweet or sticky taste in the mouth, pale and lusterless lips4. LiverRegulates the smooth flow of qi(1) EmotionsHypoactive: depression, sorrow, suspicion, sighing, and hypochondriac distress.Hyperactive: irritability, dizziness, vertigo, insomnia, and dream disturbed sleep.(2) Digestion and absorptionThe ascent and descent of spleen and stomach qiThe normal secretion of bilePathology: poor appetite, indigestion, belching, acid regurgitation, abdominal fullness, and diarrhea.(3) The smooth flow of qi and bloodMaintaining normal circulation of qi and bloodPathology: distending pain in the hypochondrium, breast, or lower abdomen.qi is the commander of blood, qi stagnation will be followed by blood stagnation-stabbing pain in the hypochondrium, abdominal masses, irregular menstruation, dysmenorrhea, and amenorrhea.Liver can smooth the flow of qi in the san-jiao to regulate water passages. Otherwise, edema or ascites may appear. The smooth flow of liver qi results in normal sexual function.Hypoactive: impotence and premature ejaculation, or amenorrhea or dysmenorrhea.Hyperactive: males-over indulgence in sexual activities, and spermatorrheafemales-dreams of sexual fantasies, an early menstrual cycle, or metrorrhagiaStores bloodFunction: storing blood and regulating the volume of blood in circulation.Pathology: liver blood deficiency-blurred vision, night blindness, contracture of muscles and tendons, and motor impairment.women-scanty flow of menstrual blood amenorrheaDominates tendons and manifests on the nailsPathology: numb and impaired movement of limbs, tremor or spasm.heat-evil-loss of fluids- convulsion, opisthotonos, clenched jaw “the nails are the excretion of the tendons” Opens to the eyes5. KidneyThe kidneys store vital essence, and are in charge of growth, development and reproductionCongenital and acquired essenceKidney qi in growth, development, reproduction and sexual function.Governs water metabolism(1) in distributing body to nourish and moisten tissue(2) the discharge of utilized water by the tissueGoverns the reception of Qi“the lungs govern respiration and the kidneys govern reception of qi”Kidneys dominate bone and manufacture marrow, which forms the brain and manifests in the hair.Pathology: deficiency of kidney essence- weak or underdeveloped bone, delayed closure of the fontanel, weak bones in childrenTeeth are an extension of bone.The kidneys manufacture marrow, and the brain is the sea of marrow.The nourishment of hair comes from blood. The kidney stores vital essence which can be transformed into blood. The kidneys open to the ears and have two yin parts. The hearing function of the ear depends on nourishment from kidney essence qi.The two yin parts of the kidneys are the anterior and posterior yin (or the genitals and the anus).Six Fu-viscera 1. GallbladderSix fu-viscera: hollow in structure, excrete bile to help digest food.Extraodinary fu-viscera: the bile stored in the gallbladder is transformed from the essential qi with similar functions of the five zang-viscera.Function: store, concentrate and excrete bileIn terms of mental state, it is in charge of judgment and decision making.Pathology: distending pain in the hypochondriac region, poor appetite, abdominal distension, loose stool, bitter taste in the mouth, vomiting yellow-green and bitter fluid, jaundice.2. StomachLocation: below the diaphragmFunction: (1) Reservoir of foodstuff“barn”, “sea of water and cereal”, “reservoir of foodstuff”(2) Descending function of the stomachAlong with the ascending function of the spleenThe function of the whole digestive systemPathology: failure of descending of the stomach-qi may cause the adverse rising of the stomach-qi, marked by belching acid regurgitation, nausea, vomiting, hiccup, etc. 3. Small IntestineFunction: (1) Stores and digests food(2) Separates the clear from the turbidPathology: fullness of the abdomen, pain of the abdomen, diarrhea, short of urine. 4. Large Intestine Function: (1) Passes and eliminates waste(2) Governs body-fluidPathology: constipation or loose stool, diarrhea5. Urinary BladderFunction: (1) Stores urine(2) Discharges urine The turbid fluid is formed after the water metabolism, and is transported downwards to the kidneys, where it turns into urine by the qi transformation of kidney. 6. San-JiaoThe concept of San-Jiao has two meanings. First, it is one of the six Fu-organs and secondly, it represents the partition of human body, i.e. the generic term of the upper energizer, middle energizer and lower energizer. （1）San-Jiao of the six Fu-organsFunction: passing through the original qi and water.San-Jiao is the route for the circulation of original qi and water. Original qi is the most fundamental qi of the human body, the motive power of human vital activities, which is derived from the kidney.The distribution and excretion of the water inside the body are accomplished by the synergistic function of many organs, including lung, spleen and kidney, etc. But the normal circulation of water must be based on the channel function of San-Jiao.（2）Partition Meaning of San-JiaoAs the region, San-Jiao can be divided into three parts, i.e. the upper energizer, middle energizer and lower energizer. It includes the whole body from the head to the feet. Each energizer has its own physiological characteristics.Generally, the chest part above the diaphragm, include heart, lungs, head and face, is called upper energizer. Sometimes, the upper limbs are attributed to the upper energizer too. Upper energizer can disperse the defense qi, distribute the food essence and fluid, nourish and moisten the whole body.Middle energizer refers to the upper abdomen between the diaphragm and the umbilicus, which is consisted by the spleen and stomach. Middle energizer has the function of digesting, absorbing and distributing the food essence and fluid, and producing qi and blood as well.The part below the umbilicus is named lower energizer, which includes small intestine, large intestine, liver, kidneys, bladder and uterus and lower limbs as well. It has the function of discharging the residues and urine.Extraordinary Fu-OrgansThe extraordinary Fu-organs include brain, marrow, bone, vessels, gallbladder and uterus. Most of them have no internal-external relation with other organs and no attachment with the five elements, except gallbladder with liver, as one of the six Fu-organs.1. BrainBrain is formed by the accumulation of marrow, and then it is called the sea of marrow.（1）Dominate Vital Activities and SpiritsBrain is an organ that can produce recognition, emotions, will and behaviors, and it is also the key position of spirit activities.Physiology: full of spirit, clear consciousness, quick thinking, strong memory, clear language and normal emotions. Pathology: apathetic, slow reaction, memory deterioration, manic and irritability, and even coma.（2）Dominate Sense and MovementIt means that the eyesight, hearing, speak and movement of the human body are related to the brain.Physiology: good eyesight, sharp hearing, keen sense of smell, normal sensation, light and powerful movement. Pathology: dim vision, loss of hearing, poor sense of smell, dull sensation, fatigue and even hemiplegia.2. Uterus（1）Controlling Menstruation Pathology: irregular menstruation, such as amenorrhea, hypermenorrhea, hypomenorrhea, or metrorrhagia.Since women take blood as the fundament, and the heart controls blood, liver stores blood, spleen produces qi and blood, the menstrual bleeding and cycle are closely related to the physiological functions of the heart, liver and spleen. （2）Dominating PregnancyThe uterus gets the ability of pregnancy