Section three Six Fu-organS

Six fu-organs are the generalized term for the gallbladder, the stomach, the small intestine, the large intestine, the bladder and the triple energizers, whose common physiological functions is to receive and transform water and grain, i. e.to receive and hold water and grain, decompose, digest and empty them timely so as to keep them transformed continuously.In ancient times,"fu"means a place for storing articles, with entrance and exit.It is in such constant alternation of sufficiency and deficiency that six fu-organs do not store essence, with physiological manifestation of"purging without storing essence"and"full of foodstuff without essence".Meanwhile, six fu-organs also have the characteristic of regulating and descending.Only when six fu-organs keep in coordination and unobstructed can their functions be performed normally, so there is the saying"Six fu-organs takes regulating as its function and descending as its order",which emphasizes"regulating"and"descending".Excessiveness or insufficiency of regulation and descending are pathogenic states.

From entering the mouth to being discharged out of the body, food and drink have to pass through seven important junctures. Classic of Medical Issues·The Forty-fourth（Nan Jing·Si Shi Si Nan）names them as"the seven important portals",among which lips are the flying portal, teeth are the house portal, epiglottis is the absorbing portal, upper gastric outlet is the cardiac orifice, lower gastric outlet ispylorus, joint of large and small intestines is ileocecal conjunction and the anus is waste portal.Pathogenic changes of any part of the seven important portals may affect the acception, digestion, absorption and excretion of food and drink.

I The gallbladder

Gallbladder, head of six fu-organs, is also an extraordinary organ. Gallbladder stores and excretes bile, dominating determination.The gallbladder and liver are connected by meridians of foot shaoyang and foot jueyin to form an interior-exterior relation.Both the liver and gallbladder attribute to wood in five elements.

Gallbladder is a hollow saccate organ, connected with the liver. The bile stored in the gallbladder is a kind of pure and clear refined fluid, bitter in flavor and yellow in color, so the gallbladder is also called"house of refined essence".

Physiological functions

1.The gallbladder stores and excretes bile

Bile, also known as"refined fluid"or"clear fluid",is generated by surplus liver qi and has the function of promoting digestion. Through purgation of the liver, the bile stored in the gallbladder is excreted into intestinal tract to assist the spleen and stomach to maintain normal digestion.

Since the liver and gallbladder relate to each other closely, if the liver functions are in normal state, bile can be generated regularly and excreted normally, and then digestion can be in normal state. If the functions of the liver and gallbladder are abnormal, secretion and excretion of bile would be obstructed, which may affect the digestive functions of the spleen and the stomach, with dyspepsia symptoms such as anorexia, abdominal distension and diarrhea;if damp and heat accumulate in the liver and the gallbladder to make them fail in distributing and purging the bile, and the bile may go against its normal way and flow out to the skin, which is known as jaundice;if the bile stagnates and generates heat, the accumulated dampness and heat further damages the bile and thus calculus may be formed;descending gallbladder qi is favorable, but adverse ascending gallbladder qi can make bile flow upward, with symptoms of bitter tastein the mouth and vomiting of bitter fluid with yellow and green color.

2.The gallbladder dominates determination

The gallbladder dominating determination refers that the gallbladder has the function of judging things and making decisions in mental activities. Mental activities relate to the functions of gallbladder dominating determination.The gallbladder can regulate the emotions through liver dominating free flow.If the liver and the gallbladder assist each other, the emotions can be harmonized and stabilized.The one with grand spirit（exuberant gallbladder qi）will also recover soon if affected by severe mental stimulus;while the one with weak courage（deficiency of gallbladder qi）may be liable to catch diseases when affected by bad mental stimulus, with the symptoms such as timidness, palpitation due to alarm, insomnia, and nightmare.Them can be treated by treating gallbladder.

So there is the saying"Gallbladder is the judge organ, by which determination is made."（Plain Questions·Ling Lan Secret Book）. Gallbladder dominating determination plays important role in defending and eliminating bad effects of mental stimulation（such as terrible fear）to maintain and control normal circulation of qi and blood, as well as to ensure coordinating relations among zang-fu organs.

Gallbladder is similar to other fu-organs in shape, so it is one of six fu-organs. But it stores refined fluid and is a clear organ, and it does not receive grain and other wastes, which makes it different from other fu-organs.Moreover, it dominates determination.Therefore, gallbladder is also an extraordinary fu-organ.

II The stomach

Both the stomach and the spleen are situated in the middle energizer,"connected by membrane". They are connected by stomach meridian of foot yangming and spleen meridian of foot taiyin to form an interior-exterior relation.The stomach is dry earth and attributes to yang, while the spleen is damp earth and attributes to yin.They are named together as the"source of acquired constitution".As the house of essence of grain and water, sea of qi and blood, the stomach dominates receiving and decomposing grain and water, with descendingas its favorable trend.

The stomach is situated under the diaphragm and at the top of the abdominal cavity. It is also named gastric cavity and is divided into three parts:the upper part is shangwan, including cardiac orifice;the lower part is xiawan, including pylorus;in between the upper and lower parts is zhongwan.The cardiac orifice is connected with the esophagus and the pylorus is connected with the small intestine, forming the passage of food going through stomach.

1.Physiological functions

1.1　The stomach dominates receiving grain and water

The stomach dominating receiving refers that the stomach receives and contains grain and water. The swallowed diets go into the stomach and are accepted.Such process is called receiving, thus the stomach is also named"taicang","sea of grain and water".Since physiological activities of the organs and the generation of qi, blood and fluids all require being nourished by diets, the stomach is also called"sea of qi and blood".The function of stomach receiving grain and water is the foundation of digestion.If pathogenic changes occur to the stomach, the function of stomach receiving grain and water will be affected, which may result in symptoms of poor appetite, anorexia and epigastric distending oppression.

1.2　The stomach governs decomposing grain and water

Decomposing refers to the process of diets becoming chymus after preliminary digestion by the stomach. Diet in the stomach becomes chymus through grinding and digesting by the stomach, the essence of which is transformed and transmitted to nourish the whole body, and the undigested chymus will be further digested in the small intestine.This process is constantly renewed and thus forms the process of stomach digestion.If the stomach is poor in decomposing, there are the symptoms of retention of food in stomach such as distending pain in stomach and putrid belching.

Only when the functions of stomach governing receiving and decomposingare in coordination with functions of spleen's transmitting and transforming function can grain and water be transformed into essence to generate qi, blood and fluid to nourish the body. Therefore, the spleen and the stomach are collectively known as"source of acquired constitution"and"source of qi and blood".

2.Physiological characteristics

2.1　The stomach managing downward transportation of food

The stomach managing downward transportation of food refers that the characteristics of stomach qi movement should be transporting downward and unobstructed, which is opposite to spleen dominating ascending the clear. Entering the stomach, decomposed and preliminarily digested, diet must go downwards into the small intestine, where it is separated into the clear and the turbid.The turbid goes downward further into the large intestine, where it is generated into excrements and discharged out of the body.Thus alternation of deficiency and sufficiency of the stomach is ensured.The whole process is completed through stomach managing downward transportation of food, which includes the small intestine's transmitting downward food residue to the large intestine and the large intestine's transporting and transforming wastes.That is why it is important for the stomach to manage downward transportation with descending as preferable.

Descending the turbid is the premise of further receiving. If the stomach fails in harmonized descending, the food would stagnate in the stomach, resulting in symptoms of distending pain in the stomach such as poor appetite and hard stool.If stomach qi goes reversely ascending, symptoms such as nausea, vomiting, belching and hiccup would appear.Besides, stomach qi failing in descending may also affect spleen qi ascending the clear.

Theory of zang-fu manifestation generalizes the physiological functions of the digestive system with ascending and descending of the spleen and stomach. The spleen ascending makes it healthy and the stomach descending makes it harmonized.Only in this way can the spleen and stomach digest and absorb diets in coordination.

2.2　The stomach preferring moisture to dryness

The stomach likes moisture and hates dryness. Since the stomach is a fu-organ, attributing to yangming and dry earth, only when it is fully nourished by the fluids can its physiological functions of receiving and decomposing grain and water be fully exerted.That is why the stomach prefers moisture to dryness.

When stomach diseases are treated, attention must be paid to protect stomach yin. Even when bitter, cold and purging medicines must be used, they should be stopped in the middle of the treatment.It is moderate to remove excess-heat and dryness constipation.Bitter and cold medicines should not be abused to avoid resolving dryness and injuring yin.

III The small intestine

The small intestine, governing containing and transforming（digesting）and separating the clear from the turbid, is the critical passage for the organs digesting diets, absorbing the essence and transporting downward the wastes. The small intestine is situated in the abdomen.Upward it is connected with pylorus and stomach;downward it is connected with ileocecal conjunction and the large intestine.The small intestine and the heart are connected by the small intestine meridian of hand taiyang and the heart meridian of hand shaoyin to form an interior-exterior relation.

Physiological functions

1.Governing containing and transforming

The small intestine governing containing and digesting is the generalization of small intestine governing containing food and digesting food. Containing means to receive, to contain things with container, i.e.the small intestine receives diets preliminarily digested by the stomach.Transforming means to change, to digest and to generate, i.e.the small intestine digests and absorbs the chymus preliminarily digested by the stomach.The small intestine containing and transforming food is manifested in two aspects:first, the small intestine receivesand contains the chymus transmitted down from the stomach.This is the function of containing;second, the chymus preliminarily digested by the stomach stays in the small intestine for some time and is digested by the small intestine further, which transforms grain and water into two parts:the essence and the waste.The essence is absorbed and the waste is transmitted down to the large intestine.This is the function of transforming.

If the small intestine fails in containing food, transforming would stop, which is manifested as abdominal pain. If the small intestine fails in transforming, disorder of digestion and absorption would be caused, with symptoms of abdominal distention, diarrhea and loose stool.

2.Governing separating the clear from the turbid

Separating the clear from the turbid refers that the chymus is separated into the clear and the turbid during the process of digestion in the small intestine. The clear, i.e.the essence of grain and water and fluids are absorbed by the small intestine and distributed to the body through transformation of spleen qi;the turbid, food residue and some water are transmitted into the large intestine through the stomach and the small intestine.While absorbing the essence of grain and water, the small intestine also absorbs plenty of surplus water, which penetrates into the bladder, is transformed into urine and then discharged out of the body.Since the small intestine is involved in water metabolism of the body, there is the saying"the small intestine governs fluid".

If the function of the small intestine separating the clear from the turbid is normal, water fluid and the waste would flow separately. If the functions of the small intestine are in disorder, the clear could not be separated from the turbid and water fluid would be mixed with the wastes, the symptoms of loose stool and diarrhea would come up;meanwhile, urine would also be affected, which is manifested as short and deficient urine.Therefore, at early stage of diarrhea, therapy of"treating diarrhea with diuretics"is often adopted.

IV The large intestine

The large intestine governs transformation and conveyance of waste andabsorption of fluids. The large intestine and the lung are connected by the large intestine meridian of hand yangming and the lung meridian of hand taiyin to form an interior-exterior relation.

The large intestine is situated in the abdominal cavity, connected upward with the small intestine at the ileocecal conjunction and downward with the anus closely. The upper part of the large intestine is called"huichang"（equal to ileum and the upper part of colon in anatomy）;the lower part is called"guangchang"（including sigmoid colon and rectum）.

Physiological functions

1.Transforming and conveying wastes

Large intestine receives food residue transmitted down from the small intestine, absorbs its surplus water, and transforms it into excrement which is excreted out of the body. This is the last phase of digestion.So, the large intestine is also called"organ of smoothing stage".

Diseases of the large intestine are mainly manifested in abnormal excretion of excrement, such as diarrhea or constipation. If dampness and heat stagnated in the large intestine, transformation and conveyance would be abnormal, with symptoms of abdominal pain, tenesmus and diarrhea with purulent blood.

Smooth conveyance of the wastes depends on normal functions of the large intestine itself, and it is also related to the functions of stomach descending turbid, descending of lung qi and transformation of the kidney. Conversely, diseases of the large intestine can also affect the stomach, the lung and other zang-organs, making them function abnormally.

2.Large intestine dominating fuid

After receiving food residue and surplus water transmitted down from the small intestine, the large intestine will absorb again some of the water fluid and transform the wastes into excrement. Such function of the large intestine participating in water metabolism is called"large intestine dominating fluid".If the large intestine fails in dominating fluid, the surplus water in large intestinewould not be absorbed, which results in excretion of both water and wastes with symptoms of borborygmus, abdominal pain and diarrhea;excess-heat of the large intestine would consume water and make intestine fluid dry and intestinal tract lack of moistening, which may cause hard stool.

V The bladder

The bladder, also called urinary bladder, has the functions of storing and excreting urine. The bladder and the kidney are connected by the bladder meridian of foot taiyang and the kidney meridian of foot shaoyin to form an interior-exterior relation.

Physiological functions

1.Storing urine

With the functions of the lung, the spleen and the kidney, fluid is distributed throughout the body to exert its function of nourishing and moistening the organs. The metabolized water will flow down to the kidney and the bladder.in the kidney, it is transformed into urine by kidney qi and in the bladder it is stored.

2.Excreting urine

When the urine stored in the bladder comes to certain volume, the bladder would open and close moderately under the promotion of kidney qi and excrete the urine out of the body timely.

VI The triple energizer

The triple energizer is a specific term in the theory of zang-fu manifestation in traditional Chinese medicine. It was first mentioned in Canon of Medicine（Nei Jing）,but its shape and location have always been disputed and gained no recognition till now.As one of six fu-organs, it has its specific structure and physiological functions, with its own name and shape, dominating ascending and descending various qi and circulating fluid;as classifications of the upper, middle and lower parts of the body, with name but without shape, they have their physiological functions and their respective physiological characteristics.The triple energizer and the pericardium are connected by the triple energizer meridian of hand shaoyang and the pericardium meridian of hand jueyin to form an interior-exterior relation.

1.Physiological functions of the triple energizer

As one of the six fu-organs, the triple energizer is located in abdominal cavity. Same as gallbladder, stomach, small intestine, large intestine and bladder, it has its specific structure and physiological functions, as well as its meridian-triple energizer meridian of hand shaoyang.It is generally considered that triple energizer is the communicating passage of texture spaces of skin, zang-fu organs and tissues in the cavity.Its function is to circulate original qi and fluid.It is the place where qi ascends, descends, enters and exits, as well as the passage for distributing and excreting fluid.

1.1　Circulating original qi

Original qi roots in the kidney. Generated by the innate essence and nourished by the acquired essence, it is the impetus of life activities.Original qi is distributed to five zang-organs and six fu-organs through triple energizer for nourishment so as to stimulate and promote the functional activities of various zang-fu organs, so the triple energizer is the passage of the circulation of original qi.The function of the triple energizer circulating original qi affects qi movement and qi transformation.Therefore, the triple energizer governs various qi, including qi movement and qi transformation.

1.2　Dredging waterway

"Triple energizer is the organ of drainage, through which the waterway is dredged"（Plain Questions·Linglan Secret Book）. Drainage means to dredge the waterway.The triple energizer has the functions of dredging waterway and circulating fluid, being the passage of fluid generation, distribution, ascendingand descending, and one of the zang-fu organs involved in regulation of water metabolism.Though water metabolism of the whole body is co-completed by the lung, the spleen, the stomach, the kidney, the bladder and other zang-fu organs, it must go through the triple energizer as the passage to ascend, descend, enter and exit normally.If the triple energizer fails in dredging waterway, functions of the lung, the spleen and the kidney distributing and regulating water fluid could not be realized fully, with symptoms of edema, ascites, which are usually treated with method of dredging the triple energizer.The coordinating and balancing function of triple energizer in water metabolism is also known as"transformation of triple energizer".

The functions of circulating original qi and dredging waterway of the triple energizer are related to each other, for circulation of fluid depends on ascending and descending of qi movement, which in turn relies on fluid circulation. So, the passage of qi circulation must be the passage of fluid ascending and descending;and the passage of fluid ascending and descending must also be the passage of qi circulation.They are actually two aspects of one function.

2.Location of the triple energizer

As classification of the upper, middle and lower parts of the body, triple energizer originated from the statement of Spiritual Pivot·On Nutrient Qi and Defense Qi（Ling Shu·Ying Wei Sheng Hui）"The upper energizer is like fog, the middle energizer is like ferment bubble, and the lower energizer is like channel". The location of triple energizer covers the whole body from head down to foot, quite beyond the concept of the substantial six fu-organs.Since it is incomparable in scale, it is also called"solitary fu-organ".Since upper energizer, middle energizer and lower energizer contain different zang-fu organs, their physiological characteristics are also different from one another.

2.1　The upper energizer is like fog

Generally speaking, chest above the diaphragm, including the heart and the lung and the head, are called the upper energizer. Some even classify the upper limbs to the upper energizer."Fog"refers to the diffusing and transpiring stateof the essence of grain and water."The upper energizer is like fog"means that the upper energizer has the functions of dispersing defensive qi, distributing essence and fluid to nourish the skin, hair and various zang-fu organs in the state of diffusing fog.Since the upper energizer receives and distributes the essence, it is also said"the upper energizer governs receiving".The functions of the upper energizer actually manifest the functions of the heart and the lung transforming and transmitting, which relates to the distribution of nutritive qi, defensive qi, blood, fluid and other nutrients.So, abnormality of the functions of the upper energizer can reflect the abnormality of the functions of heart and lung, which should be treated by regulating mainly the heart and the lung.

2.2　The middle energizer is like ferment bubble

The middle energizer refers to the abdominal part below the diaphragm and above the navel, including the spleen, the stomach, the liver and the gallbladder."Ferment bubble"refers to the state of decomposed and fermented food."The middle energizer is like ferment bubble"means that the middle energizer has the functions of transmitting grain and water and generating qi and blood. Functions of the middle energizer mainly refer to the physiological functions of the spleen and the stomach, including receiving and digesting grain and water, absorbing nutrients, transforming body fluid and transforming essence into blood.That is why the functions of the middle energizer are described as"ferment bubble".Since the middle energizer transmits and transforms essence of grain and water, there is the saying"the middle energizer governs transforming".The middle energizer is the pivot of ascending and descending of qi movement, the source of qi and blood generation.Abnormality of functions of the middle energizer is mainly manifested as the abnormality of functions of the spleen and the stomach, which can be treated by regulating mainly the spleen and the stomach.

The liver, in location, should be classified as the middle energizer. But according to traditional Chinese medicine, the liver and the kidney share the same origin and relate to each other closely physiologically and pathologically, so the liver and the kidney are both classified as the lower energizer.

2.3　The lower energizer is like channel

Generally the parts below the naval are considered as the lower energizer, including the small intestine, the large intestine, the kidney, the bladder, the uterus, essence chamber and the lower limbs."Channel",also ditch, means the channel that can drain water."The lower energizer is like channel"means that the lower energizer has the functions of kidney, bladder, large intestine and small intestine dominating separating the clear from the turbid and excreting the wastes. The lower energizer transmits food residues and wastes down to the large intestine, where it is transformed into excrement and discharged out of the body.Meanwhile, surplus water in the body is transformed into urine by the kidney and the bladder, which is excreted out through urethra.The physiological process is downward and dredging, so it is said that"the lower energizer is like channel".Since the lower energizer dredges bowel and the bladder discharges the wastes, it is said"the lower energizer governs discharging".Abnormality of functions of the lower energizer is mainly manifested as the abnormality of functions of the kidney and the bladder, which can be treated by regulating mainly the kidney and the bladder.

3.Triple energizer syndrome differentiation

The triple energizer is the differentiation basis of epidemic febrile disease in traditional Chinese medicine. The theory of triple energizer syndrome differentiation explains three different pathological development phases of epidemic febrile disease from shallow to deep based on illustrating the pathological changes and syndromes of zang-fu organs belonging to the upper, middle and lower energizers, considering that epidemic febrile disease derives generally from the lung meridian of hand taiyin of upper energizer, is transmitted to the spleen and the stomach of middle energizer, and then ends in the liver and the kidney of lower energizer.