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1 THE TCM VIEW OF HUMAN BODY • Different views of structure and function of the human body from Western medicine. • The visceral organs are seen as comprehensive systems of physiological function than as anatomical entities. 2 VISCERAL PICTURE • It is a theory expounding the physiological functions and pathological changes of the internal organs of the body and • The relationships among the organs through inspection of physiological and pathological signs outside. 3 VISCERAL PICTURE • Guided under the ancient philosophical thinking in China. • The viscera are not simply the organs in anatomy but also mean the physiological functions. • The names are generally the same as those of internal organs in Western medicine . 4 VISCERAL PICTURE • Through inspection of the corresponding external signs one can determine the functional status. • Eg through inspecting the complexion, tongue color, pulse picture and sensation of the chest one can know the function of the heart in governing the blood and vessels is normal. 5 THE FIVE ZANG-VISCERA五脏 Lung Liver Heart Spleen Kidney 6 FUNCTIONS AND CHARACTERISTICS OF THE FIVE ZANG-VISCERA • To produce and store essence-qi (化生和储存精气) • They can be full of essence-qi instead of containing the foodstuff. (满而不实) 7 THE FU-VISCERA六腑 Gall Bladder Bladder Small Intestine Stomach San-jiao (Triper Warmer) Large Intestine 8 FUNCTIONS AND CHARACTERISTICS OF THE SIX FU-VISCERA •To receive, digest and transmit the foodstaff (受盛 和传化水谷) •They can be full of foodstuff instead of storing essence-qi (实而不满) 9 EXTRAORDINARY FU-VISCERA奇恒之腑 • Brain Marrow Bone Vessel Gallbladder Uterus 10 MAJOR FUNCTIONS OF THE HEART (1) Governing Blood: includes two respects of circulating and producing blood: 1.1 The heart circulates blood: continuous flow of blood in the vessels depends upon the action of heart-qi. - If heart-qi is sufficient and the function of the heart in governing blood is normal, the complexion will be rosy and lustrous, comfortable thorax, even, moderate and forceful pulse. - Unsmooth blood flow, forceless or intermittent and hasty pulse, dark and gray complexion, cyanoses of the lips and tongue will be manifested if heart-qi is insufficient and the function of heart governing is disordered. 11 MAJOR FUNCTIONS OF THE HEART 1.2 The heart produces blood: Blood is mainly composed of nutritive qi and body fluid, but the movement of heart yang is essential for nutritive qi and body fluid to compose blood, - The heart produces and circulates blood to ensure adequate nourishment of blood for all tissues of the body. 12 MAJOR FUNCTIONS OF THE HEART (2) Housing spirit: - The heart has the function of dominating the body’s mental activities and life activities of the whole body. - Man’s psychological and emotional activities are closely related with the effective coordination of the five Zang-viscera and dominated by the heart. - When the heart is able to house the spirit, there will be high spirit, clear consciousness, quick thinking and swift response. - If the function is abnormal, insomnia, restlessness, delirium and madness or even coma will occur. 13 MAJOR FUNCTIONS OF THE HEART • The function of housing spirit and the function of governing blood of heart are closely related. • The function of housing spirit of the heart can regulate the heart qi in its driving blood to circulate within the vessels. • The heart’s governing blood function provides material basis for mental activities, also beneficial to the heart in its housing spirit. • Therefore the dysfunction of the heart in governing blood will inevitably lead to disorder of the heart-spirit; in the contrary, the dysfunction of the heart in housing spirit may also result in anomaly of blood flow. 14 HEART • The heart circulates and produces blood so as to guarantee sufficient nourishment of blood for all tissues of the whole body. • The heart also has the function of dominating the mental activities such as in psychology and emotions, and life activities of the whole body. (housing spirit) 15 THE HEART • The heart and small intestine form an internal-external relationship through mutual connection and affiliation of their meridians, • The heart is associated with vessel in constituent, reflects its brilliance in the face, is associated with joy in emotion, with tongue in orifice and with sweat in secretion. 16 with joy in emotion brilliance in the face heart tongue in orifice with sweat in secretio 17 THE LUNG • The major functions of it are governing respiratory qi and qi of the whole body, smoothing water passage and connecting with vessels. • The lungs and large intestine form an exterior-interior relationship through connection and affiliation of their meridians. 18 MAJOR FUNCTIONS OF THE LUNG 1. The lung governs respiratory qi: - The lung is the embodiment of diffusion and purificationdescent of the lung-qi in the process of gas exchange between the interior and exterior of the body. - Diffusion of lung-1i exhales turbid gases; and descent of lung-qi inhales clear air to ensure normality of the lung in governing respiratory qi. - If the lung-qi fails in diffusion, or descent, it will definitely influence the respiratory movement of the lung and manifested as chest distress, cough, panting etc. 19 MAJOR FUNCTIONS OF THE LUNG 2. The lung governs qi of the whole body: - The whole body’s qi is mainly composed of pectoral qi and primordial qi. - The pectoral qi is mainly produced by combination of the clear air inhaled by the lung and the essential qi of foodstuffs transformed and transported by the spleen and stomach. - The pectoral qi forms in the thorax and accumulates in the thorax. - The inhalation and exhalation by the lung plays an important role for the motion of qi of the whole body in ascending, descending, exiting and entering. 20 THE LUNGS • The lung is associated with the skin in constituent, reflects its brilliance in the fine hair, and is associated with sorrow in emotion, with nose in orifice, and with snivel in secretion. 21 lung with nose in orifice Governing qi of the whole body smoothing water passage and connecting with vessels. skin in constituent brilliance in the fine ha 22 THE SPLEEN • Its main functions are to govern transformation and transportation, send up the clear and control blood. • The spleen and stomach form an exterior-interior relationship through mutual affiliation and connection of their meridians. 23 MAJOR FUNCTIONS OF THE SPLEEN 1. The spleen governs transformation and transportation of foodstuff. - The digestion of the food takes place in the gastrointestinal tract, but it must depend on the transformation of the spleen to turn the food into essence; - The essence again depend upon the spleen to absorb and sent up to the lung and spread to the whole body. - When the spleen functions soundly, it provides sufficient nutrient for the production of essence, qi, blood and fluid to nourish the viscera, meridians, four limbs, tendons, muscles or in short, the whole body will function normally. - Diarrhea, poor appetite, lassitude and emaciation are manifestations of the spleen’s weak ability in transporting the foodstuff. 24 MAJOR FUNCTIONS OF THE SPLEEN 1.1 Transforming and transporting water: the spleen transport body fluid to regulate water metabolism. -Normal spleen qi will transport the body fluid to moisten and nourish the body. -It will also o the surplus water to the lung and kidney, where the water will be transformed into sweat and urine and discharged out of the body. -When the spleen fails in its transforming and transporting functions, it will lead to water stagnation in the body and thus the pathological products such as water-dampness and phlegm-stagnant-fluid will develop. -Hence, to ensure sufficient qi and blood and the body will be free from pathogenic invasions. 25 MAJOR FUNCTIONS OF THE SPLEEN (2) The spleen is in charge of sending up the clear: this denotes that the spleen qi goes upward and thus transport the nourishment of foodstuff essence by its transformation up to the heart, lung, head and eye. The foodstuff essence then transformed into qi-blood by the functions of the heart and lung so as to nourish the whole body. Only when the ascending of the spleen qi coordinates well with the descending of stomach qi, the body’s digestion will be in order. 26 MAJOR FUNCTIONS OF THE SPLEEN • If the spleen qi is incapable to ascend and sinks down, chronic diarrhea with proctoptosis, or ptopses of some body organs. (3) The spleen controls blood: this signifies that the spleen is able to keep the blood circulating within the vessels and preventing it from extravasation. - When qi-blood is abundant, blood will remain in the vessel. - Spleen’s weak power in controlling blood often manifested as bleeding in the lower part of the body such as hemafecia, hematuria and etc. 27 THE SPLEEN • The spleen is associated with the muscles in constituent, dominates the four limbs, reflects its brilliance in the lips, is associated with thinking in emotion, with mouth in orifice and with saliva in secretion. 28 with mouth in orifice spleen brilliance in the lips govern transformation and transportation with the muscles in constituent control blood 29 THE KIDNEY • The major functions of kidney are storing essence, governing water and governing reception of qi. • The kidney and bladder form an exterior-interior relationship through mutual connection and affiliation of their meridians. 30 MAJOR FUNCTIONS OF THE KIDNEY (1) The kidney stores essence: the essence stored in the kidney includes “ innate essence” and “essence.”, - The innate essence cines from birth and the acquired essence comes from the foodstuff, both work together to form the kidney essence, - The whole process of human life is influenced by the kidney-essence-qi. - The development of human’s reproduction organs and its reproductive power are influenced by the abundance of the kidney-essence-qi, - The reproductive power is called Tianggui (sex promoters), We age when Tiangui is exhausted. 31 MAJOR FUNCTIONS OF THE KIDNEY 1.2 the kidney essence can transform into kidney qi, and the kidney qi can present with physiological effects of two respects of kidney yin and kidney yang. The kidney yin plays moistening, calming and inhibiting roles; kidney yang plays warming, propelling and exciting roles. The kidney yin and yang are the root of yin and yang for every viscus, they restrict and depend on each other to maintain the balance of yin and yang of every viscus, 32 MAJOR FUNCTIONS OF THE KIDNEY • deficient kidney yang will manifest in listlessness, lassitude, cold limbs, clear urine of increased volume, low sexual desire and edema. • Deficient kidney yin will manifest internal heat, dizziness, tinnitus, sore and weak feeling in the waist and knees, red tongue. • The kidney yin and yang are very important to human life, so the kidney yin is called “genuine yin”and “original yin” and the kidney yang is called “genuine yang” and “original yang”. 33 MAJOR FUNCTIONS OF THE KIDNEY (2) The Kidney governs water: this function signifies that kidney is responsible for controlling and regulating the distribution and excretion of water in the body to keep water metabolism in order. -the spleen and stomach work together to transform and transport the foodstuff, diffusion and descending by the lung, steaming and qi transformation by the kidney, and taking the San-jiao as the passage ways, water is transported throughout the whole body; -the water being metabolized can be transformed into sweat and urine to be discharged out of the body, 34 MAJOR FUNCTIONS OF THE KIDNEY • The whole process involves many viscera and the kidney-essence-qi plays controlling and regulating role. (2) The kidney governs reception of qi: this function means the kidney possesses the function of receiving the fresh air inhaled by the lung so as to keep the depth of inspiration. - The respiratory function of the body is governed by the lung, but it must be through the reception and storage by the kidney qi to keep a certain depth. Hence the lung and kidney work together to perform our normal breathing activities. 35 MAJOR FUNCTIONS OF THE KIDNEY • If the essence-qi in the kidney gets deficient and with little power to receive qi, there will appear gasping by a little exertion, or dyspnea with prolonged expiration. 36 THE KIDNEY • The kidney is associated with the bone in constituent, reflects its brilliance in the hair, is associated with fear in emotions, with ear and two yin organs( urinary tract and anus) in orifice, and with spittle in secretion. 37 with ear and two yin organs in orifice storing essence bone in constituent 38 THE LIVER • Its major functions are to govern free flow of qi and store blood. • The liver and gallbladder form an exteriorinterior relationship through affiliation and connection of their meridians, • The liver is associated with tendons in constituent , reflects its brilliance in the nails, and is associated with anger in emotion, with the eye in orifice, and with tear in secretion. 39 liver to govern free flow of qi store blood with tendons in constituent brilliance in the nails 40 MAJOR FUNCTIONS OF THE LIVER (1) The liver governs free flow of qi: the liver is responsible for the dynamic of the body qi. - It plays an important role in ensuring the free flowing of the body qi so as to promote proper circulation and distribution of essence, blood and body fluid, transformation and transportation by the spleen and stomach, secretion and excretion of bile, steady emotions, ejaculation in men and menstruation in women. 41 MAJOR FUNCTIONS OF THE LIVER 1.1 free flow of qi dynamic: - When the liver fails in governing the free flow of qi, it may manifest in distending pain in the chest, pain around hypochondria, two breasts, or lateral parts of the lower abdomen; - The reverse rising of liver qi will manifest as headache and red eyes, red face, irritability, or hematemesis and hemoptysis. 42 MAJOR FUNCTION OF THE LIVER 1.2 circulation of blood and body fluid: - When the liver qi gets stagnated, qi-blood circulation will be stagnated. - The adverse rising of qi will force blood to go upward and lead to bleeding like hematemesis. - Besides, the abnormal flow of qi will also cause pathological changes of water, dampness, phlegm and fluid retention. 43 MAJOR FUNCTION OF THE LIVER 1.3 promote transformation and transportation of the spleen and stomach: - When the liver functions normally, qi flows freely and smoothly and the spleen’s ascending and stomach’s descending function will be normal. - Spleen will fail to send up the clear and manifested as dizziness and vertigo in the upper part of the body and diarrhea in the lower part; stomach qi will not descend and will manifest as hiccup and eructation in the distention and fullness in meddle, and constipation in the lower. 44 MAJOR FUNCTION OF THE LIVER 1.3 help secretion and excretion of bile: - The bile is produced by the surplus liver qi, so its secretion and excretion are controlled by the liver’s function of governing free flow of qi; - If the liver qi gets depressed, it will affect the secretion and excretion of bile, resulting in pathological changes of distension, fullness and pain in the hypochondria, bitter taste in the mouth, indigestion, and even jaundice. 45 MAJOR FUNCTION OF THE LIVER 1.4. being conducive to ejaculation in men and menstruation in women: - If the liver’s function in governing free flow of qi gets abnormal, the ejaculation in men will become unsmooth, and the menstrual cycle in women will become disturbed with obstructed menstruation, 46 MAJOR FUNCTION OF THE LIVER (2) The liver stores blood: This function signifies that the liver stores blood, regulates blood volume and prevents bleeding, The liver can store a certain amount of blood so as to check the yang qi of liver to prevent its over-rise, and thus to maintain the normal process of liver’s function of governing free flow of qi; With adequate blood being stored and assisted by the free flow of qi, the liver can effectively regulate the amount of blood demanded by every tissue according to the needs of the body. When a person is moving, blood will circulate throughout the body and as he is in rest, his blood will return to the liver. In addition, storage of blood by the liver is also conducive to keeping the blood within the vessels to prevent unduly bleeding. 47 MAJOR FUNCTION OF THE LIVER • liver is in charge of storing blood, and its body is yin, but the governing free flow of qi functions belongs to yang, so it is said “ the liver pertains to yin in substance and yang in function.” • The two functions of storing blood and governing free flow of qi are dependent upon each other. • As the liver governs free flow of qi, qi dynamic will be unimpeded, then blood can normally 48 GALL BLADDER • The gallbladder connects with the liver. • The bile stored in the gallbladder , under the control and regulation by the function of the liver in governing free flow of qi, is excreted into the intestine to help to digest and absorb the foodstuff. 49 GALL BLADDER • The gallbladder connects with the liver. • The bile stored in the gallbladder , under the control and regulation by the function of the liver in governing free flow of qi, is excreted into the intestine to help to digest and absorb the foodstuff. 50 GALL BLADDER • If the liver functions abnormally in governing free flow of qi, the excretion of bile is obstructed, thus it will affect the digestion and absorption of the foodstuff, there may appear distending pain in the hypochondrium, poor appetite and abdominal distention. • If the bile goes adversely upward, there may occur bitter taste in the mouth or vomiting with bitter liquid yellowish and green in color 51 GALL BLADDER • If the bile spreads out from the bile tract, there may appear jaundice. • The gallbladder also has the function to judge and govern decisions. 52 Gallbladder jaundice the function to judge and govern decisions bitter taste in the mouth or vomiting with bitter liquid 53 THE STOMACH • The major functions of the stomach are to receive and decompose the foodstuff. • Decomposing the foodstuff indicates the stomach has the action to primarily digest the foodstuff to make it become the chyme糜. 54 THE STOMACH • If the stomach’s functions of receiving and decomposing the foodstuff get disordered, there will be symptoms such as poor appetite, eructation with fetid odor, etc • If the stomach qi fails to descend, and further it develops into adverse rise of stomach qi, there will be symptoms such as belching, nausea, vomiting, hicup,etc 55 to receive and decompose qi fails to descend belching, nausea, vomitting 56 THE LARGE INTESTINE • The major function of the large intestine is to transform and convey the waste. • The large intestine accepts the foodstuff residue from the small intestine by its separation, and reabsorbs the redundant water in the waste so as to make the waste become stool; • then conveys the stool down and discharges via the anus out of the body. 57 THE STOMACH • The major functions of the stomach are to receive and decompose the foodstuff. • Decomposing the foodstuff indicates the stomach has the action to primarily digest the foodstuff to make it become the chyme糜. 58 THE STOMACH • If the stomach’s functions of receiving and decomposing the foodstuff get disordered, there will be symptoms such as poor appetite, eructation with fetid odor, etc • If the stomach qi fails to descend, and further it develops into adverse rise of stomach qi, there will be symptoms such as belching, nausea, vomiting, hicup,etc 59 to receive and decompose qi fails to descend belching, nausea, vomitting 60 THE LARGE INTESTINE • The major function of the large intestine is to transform and convey the waste. • The large intestine accepts the foodstuff residue from the small intestine by its separation, and reabsorbs the redundant water in the waste so as to make the waste become stool; • then conveys the stool down and discharges via the anus out of the body. 61 transform and convey the waste 62 THE SMALL INTESTINE • The major physiological functions of the small intestine are to dominate reception and digest the chyme, (accepts the chyme sent down by the stomach and holds it for a longer time so as to facilitate further digest on of it into the essence) and • to separate the clear from the turbid (separates its digested foodstuff into two parts of foodstuff essence and waste, and absorbs the essence and sends the waste down into the large intestine.) • Must coordinate with the transformation and transportation of the spleen qi so the work can be smoothly accomplished. 63 further digests food decomposed initially by the stomach turbid is sent downwards to the large intestine separation of the clear from the turbid 64 URINARY BLADDER • The major function of the urinary bladder is to store and discharge urine. • The urine is produced from the water under the qi transformation of the kidney, then poured into the bladder for storage. • When the urine in the bladder gets to a certain amount, it will be discharged out of the body. 65 URINARY BLADDER • If the kidney qi fails in control, there will appear enuresis, or even incontinence of urine. • If the qi transformation of the kidney gets disordered, there will appear dysuria(排尿困难), or even anuria(尿闭). 66 dysuria, or even anuria to store and discharge urine 67 TRI-JIAO • The tri-Jiao is a collective term for the upper, middle and lower-jiao. • The meaning of the tri-jiao is of two: - the passageways formed by the mutual communication of the spaces among the viscera and within the interior of the viscera. -a concept of simple regions, the part above diaphragm as the upper-Jiao, the part form below the diaphragm to the umbilicus as the middle-Jiao and the part below the umbilicus as the lower-Jiao. 68 TRI-JIAO • The major functions of the tri-jiao are to pas primordial qi and transmit water. • The primordial qi originates from the kidney and it flows into the five Zang and six Fu-viscera and spreads through the whole body via tri-jiao. • The water metabolism of the whole body requires the tri-jia to act as its passages to ascend, descent, exit and enter normally. • If the water passageways of the tri-Jiao get obstructed, the lung, spleen and kidney will hardly perform their physiological effects in distributing and regulating water metabolism. 69 WOMB • The major function of the womb is to control menstruation and culture the fetus. • The production of menstruation and formation and cultivation of the fetus are the outcome that the viscera, Tiangui, meridians and qi-blood act on the womb. • When the womb functions normally, the menstruation and development of the fetus will be normal. • Otherwise disturbance of menstruation, pregnancy and problem development of the fetus may appear. 70 BRAIN • The major functions of the brain are to dominate life activity, mentality and consciousness and sensible movements. • When the brain functions normally, the human body will be full of vitality with clear consciousness, acute senses and agile movements. • If the brain functions abnormally, the body will be disordered in vital activity with listlessness, unconsciousness, dull senses and slow movements. 71 TCM NOTION OF HUMAN LIFE CYCLE • Every cycle is 10 years. • Male’s cycle is 8 years, based on the body’s key organs’ prosperity and the descending and decline of qi and blood. • Female’s cycle is 7 years, based on the prosperity and decline rate of the kidney ‘s qi and tian kui , 天 癸 a unique substance responsible for maintaining the sexual functions. • Man’s key organs fully grown at the age of 10. Qi and blood flow actively and manifested in preference to move and run. • “人生十岁,五脏始定,血气已通,其气在下,故好走。” 72 TCM NOTION OF HUMAN LIFE CYCLE • At 20 years old, muscle and tendons fully grown and manifested in sheer vitality. “二十岁,血气始盛, 肌肉方长,故好趋。 • At 30 years, the human body’s physical growth reached its peak and are swift in movement. “三十 岁,五脏大定,肌肉坚固,血脉盛满,故好步。” • At 40, the human body’s growth optimized and is a watershed period. Aging soon started and hence tend to dislike moving excessively. “四十岁,五脏六腑, 十二经脉,皆大盛以平定,腠理始疏,荣华颓落,发颇斑 白,平盛不摇,故好坐。” 73 TCM NOTION OF HUMAN LIFE CYCLE • At 50, the liver energy started to decline and so the gall bladder’s secretion. Vision also began to blur. “五十岁,肝气始衰,肝叶始薄,胆汁始灭,目始不明。” • At 60, the heart energy started to turn weak and man tended to worry more. Flow of qi and blood slowed and hence preferred to rest the body by lying down. “六十岁,心气始衰,苦忧悲,血气懈惰,故 好卧。” • At 70, spleen energy became deficient and dry skin manifested. “七十岁,脾气虚,皮肤枯。” 74 TCM NOTION OF HUMAN LIFE CYCLE • At 80, lung energy weakened and unable to express eloquently. “八十岁,肺气衰,魄离,故言善 误。” • At 90, kidney’s energy burnout and visible weakening and emptiness of spleen, liver, lung and heart. “九十岁,肾气焦,四脏经脉空虚” • At 100, all organs ‘ energy became deficient and only the skeleton remained. “百岁,五脏皆虚,神气皆 去,形骸独居而终矣。” 75 76