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Chapter 6. Fu: The Yang Organs

The Yang organs are hollow. Their main shared physiological functions are the receiving and processing (digesting) of food and other nutrients and transmitting and excreting wastes. The Yang organs are considered the more superficial and external organs, both Yang attributes, because most of them open directly to the outer environment. The Stomach opens to the mouth, the Large Intestine opens to the anus, and the Urinary Bladder opens to the urethra. The small intestine communicates with the outside world through the large intestine. The Gall Bladder is the exception, although even it connects with the small intestine through the common bile duct. The Gall Bladder is further exceptional in that it does not receive food or excrete wastes, earning it the distinction of being the only Yang organ that is also an Extraordinary Organ, a separate organ classification. The Sanjiao is an insubstantial organ and therefore not able to physically connect with the outside world. Its very insubstantiality is a Yang attribute, contrasting with the heavy denseness of Yin.

The Five Element associations of Yang organs are almost identical to those of their Yin organ counterparts. So while the Heart corresponds to Yin Fire and the Small Intestine to Yang Fire, the Fire attributes are common to both organs. Similarly, they share the same associations with body tissues, sense organs, and emotional correspondences as their Yin counterparts, although the Yang organs typically play a smaller role in those functions. Any significant divergences are included in each organ’s description.

Some of the Yang organs have a strong, obvious anatomical and physiological relationship with their paired Yin organ. Others are less obvious, but in all cases there are strong energetic relationships because their meridians are directly linked at or near their endpoints, within each paired organ, and at linking points (Luo connecting points) along the meridian pathway.

As the Yang organs do not produce or store essences and are mainly involved with nutrient absorption and waste elimination, their list of functions and attributes is smaller than those of the Yin organs. They are presented to you here in more or less the order in which they fulfill those functions.

The Stomach

The Stomach has an internal/external relationship with the Spleen, its paired Yin organ. Having a primary role in nutrient assimilation, the Stomach is considered to hold a place of special importance among the Yang organs. In fact, in the clinic it is often noted that one of the best indicators of a favorable prognosis is the return of a healthy appetite, a sign of good stomach functioning—that is, healthy Stomach Qi—while a worsening appetite usually indicates a decline in health.

Main Functions and Attributes of the Stomach

• Governs the rotting and ripening of food

• Controls the transportation of food essence

• Rules descending Qi

• Its ascendant time is 7 a.m. to 9 a.m.

Analysis

While “rotting and ripening” might be an unappealing image, it serves as a metaphor for the initial stages of digestion, where received food begins its decomposition, being mechanically broken down by the churning action of the stomach and chemically broken down by the stomach acid’s effects on proteins. After this transformative process, the pure portions are transported to the Spleen for Qi and other nutrient extraction, while the impure (still undigested) parts are sent down to the Small Intestine for further processing. This is how the Stomach controls the transportation of food essence.

The pure food essence is further transformed by the Spleen and then transported throughout the entire body. This cooperative partnership between the Stomach and Spleen’s functions of transformation and transportation is the origin of Qi for the whole body, so together they are considered to be the acquired foundation, or the root of acquired Qi.

The Stomach normally sends Qi downward. This is apparent through its function of sending the impure food down into the Small Intestine. This is balanced by the Spleen’s function of raising Qi, in its sending Qi up to the Heart for the production of Blood and in its holding all the internal organs in their proper place, preventing organ prolapse. If the Stomach’s descending function becomes impaired, it causes a syndrome called Rebellious Stomach Qi, and a variety of ailments will occur. In mild cases, the syndrome can be simple hiccups or belching. If it worsens, it can cause lack of appetite, feelings of abdominal heaviness, fullness, and distension or acid regurgitation, nausea, and vomiting.

The Small Intestine

The Small Intestine has an internal/external relationship with the Heart, its paired Yin organ. Its upper end connects to the stomach, and its lower end connects to the large intestine. It continues the stomach’s role in nutrient assimilation, primarily digesting fats and carbohydrates.

Main Functions and Attributes of the Small Intestine

• Controls receiving and transforming of food, aiding in digestion

• Separates fluids, separating the clear from the turbid

• Its ascendant time is 1 p.m. to 3 p.m. (See Appendix 2, Note 6.1.)

Analysis

The Small Intestine receives the impure (incompletely digested) portion of food sent to it by the Stomach. It continues the digestive process, transforming the food by further separating the pure from the impure parts, and absorbs essential nutrients and fluids from the food. As part of the Spleen’s job is to transport all nutrients throughout the body, the pure nutrients separated by the Small Intestine are sent to the Spleen. The Small Intestine sends the impure portion of remaining food to the Large Intestine for final processing and excretion. The pure portion of fluids, primarily water, is also sent to the Large Intestine for reabsorption, while the impure fluids are sent to the Urinary Bladder for elimination.

If the Small Intestine’s function is impaired, symptoms can range from simple intestinal rumblings and gas to poor digestion, abdominal pain, and abnormal bowel movements (either constipation or diarrhea). Since the Small Intestine’s function of separating the pure from the impure fluids is controlled by Kidney Yang Qi and the impure fluids are sent to the Urinary Bladder, other symptoms of Small Intestine dysfunction can include either excessive or scanty urination. Additional urinary symptoms may also be present.

The relationship between the Heart and Small Intestine may be illustrated most easily on the psychological/emotional level. We’ve seen that the Heart houses the mind and so governs all mental activities. The Small Intestine’s role here is in supplying clear discernment, providing the guidance necessary to assist in making the best life choices. While still under the province of the mind, this distinction is unique to the Small Intestine.

The Gall Bladder

The Gall Bladder has an internal/external relationship with the Liver, its paired Yin organ. It sits nestled against and connected to the liver, just to the right of the solar plexus. Its main physiological role is to store bile secreted by the liver and then expel relatively large quantities of it into the small intestine through the common bile duct whenever fats enter the small intestine. The bile emulsifies the fats and aids the small intestine in that aspect of digestion.

Main Functions and Attributes of the Gall Bladder

• Secretes bile

• Controls Sinews (tendons and ligaments)

• Controls judgment and decisions

• Its ascendant time is 11 p.m. to 1 a.m.

Analysis

The Gall Bladder is a unique Yang organ in that it is the only one that does not receive nutrients nor excrete wastes, and it is the only Yang organ that does not connect with the external environment.

Its function of secreting bile is identical with the Western understanding of the organ’s function, with these additions. The functional energy of the Liver, Liver Qi, is responsible for the production of bile. The Gall Bladder’s secretion of bile is dependent on the Liver’s function of regulating the smooth, free flow of Qi. Any disruption of Liver Qi will have an adverse effect on the Gall Bladder’s ability to properly secrete bile, and any Gall Bladder dysfunction will likewise adversely affect Liver function. They are dependent on each other. In this way, the physiological and energetic connection between Liver and Gall Bladder is as close as that between the Stomach and the Spleen. In fact, the Liver and Gall Bladder together are said to govern the free flow of Qi.

The Gall Bladder controls the Sinews, or tendons and ligaments, in a way similar to the Liver, which shares that function. Being a Yin organ, the Liver’s control is mediated more by the nourishing, moistening, softening effect of Blood than by Qi, providing suppleness. Being a Yang organ, the Gall Bladder’s control is mediated more by the functional energy of Qi than by Blood, providing smooth agility of movement.

The Gall Bladder normally sends Qi downward. This downward flow directs bile properly, assists in some of the digestive functions of the Stomach and Spleen, and supports normal Liver functions. If there is Gall Bladder impairment, bile, which is bitter and yellow, may rise and cause a bitter taste in the mouth or vomiting of bitter, yellow fluid. The Stomach and Spleen may be adversely affected, causing nausea, belching, abdominal distension, and diarrhea. Liver functions may become impaired, causing Liver Qi Stagnation and possibly jaundice.

Along with these functional relationships, the Gall Bladder shares in most of the Liver’s emotional characteristics. It has an additional related role controlling judgment, the ability to make decisions. This supports the Liver’s ability to plan a life trajectory. The Gall Bladder facilitates the decision-making process, providing the courage, decisiveness, and strength of will to implement the most desirable life plan. If the Gall Bladder is weak or impaired, a person may be too timid to realize their life’s path. Idiomatically, the Chinese will refer to a courageous person as having (or being) a “big gall bladder,” while a timid or weak-willed person is said to have a “little gall bladder.”

The Large Intestine

The Large Intestine has an internal/external relationship with the Lung, its paired Yin organ. It begins at the lower right quadrant of the abdomen, connects to the small intestine through the ileocecal sphincter, and ends opening to the outer environment at the anus. Once the small intestine completes the digestive process, the large intestine receives waste from the small intestine, absorbs whatever useable fluids remain, and transports and excretes the resultant feces.

Main Functions and Attributes of the Large Intestine

• Receives food/waste from the Small Intestine

• Reabsorbs fluids

• Excretes wastes

• Its ascendant time is 5 a.m. to 7 a.m.

Analysis

The physiological functions of the large intestine are the same in Chinese and Western medicine, as described above. If the large intestine is not functioning properly, there can be intestinal rumblings and gas, constipation or diarrhea. Of note, in Chinese medicine the Spleen has the ultimate control over every aspect of digestion throughout the entire digestive system. Accordingly, these same symptoms are often attributed to a Spleen dysfunction. Other diagnostic information, including pulse and tongue diagnosis, may be required to make a differential diagnosis, revealing the exact source of such symptoms.

Energetically, there are some unique connections between the Lungs and Large Intestine. We’ve seen that the Lungs have a function of descending Qi. That Lung Qi can assist the Large Intestines in the elimination of feces. When Lung Qi is weak, a person may become constipated. If constipation arises from another source and becomes chronic, that can obstruct the descent of Lung Qi and cause shortness of breath.

While not a definitive indication of an energetic connection between the Lungs and Large Intestine, it is nonetheless noteworthy that one of the most common sites of colon (large intestine) cancer metastasis is the lungs. It is much less common for it to move the other way; that is, it’s rare that a primary lung cancer metastasizes to the large intestine. This may be explained by the Large Intestine’s energetics being Yang, having the qualities of being more superficial and protective. Our environment is loaded with carcinogens, and any external carcinogenic pathogen or chemical attempting to affect the body will first be intercepted by protective Yang Qi. In the case of a carcinogen that might affect either the lungs or large intestine, the Large Intestine will be the first line of defense. If it fails, then colon cancer will occur. As the cancer moves deeper, it will then affect the deeper, more sensitive paired Yin organ, the Lungs. If the Lungs are affected first, from smoking, airborne chemical exposure, or constitution/genetics, the cancer has bypassed the defensive Yang Qi, is already a deeper problem, and is therefore much less likely to move exteriorly to its paired Yang organ.

The Urinary Bladder

The Urinary Bladder has an internal/external relationship with the Kidneys, its paired Yin organ. It is located in the central part of the lower abdomen. Physiologically, it receives urine, temporarily storing it until enough has accumulated, when the urge to urinate will then cause it to be excreted.

Main Functions and Attributes of the Urinary Bladder

• Stores and excretes urine

• Excretes fluids by Qi transformation

• Its ascendant time is 3 p.m. to 5 p.m.

Analysis

The Chinese and Western understanding of the functions of the urinary bladder are nearly identical, although Chinese medicine has a different view of how and why those functions occur and adds some information related to the role of Qi.

The Urinary Bladder receives the impure portion of fluids separated out by the Small Intestine and to a lesser extent by the Large Intestine and Lungs. Some sources state that urine is made in the Kidneys and then sent to the Urinary Bladder, which is consistent with the Western medical view. Most sources state that the Kidneys receive fluids from the Small and Large Intestines and Lungs, further separate pure from impure fluids, and send the impure fluids to the Urinary Bladder to be converted into urine.

The transformation of impure fluids into urine requires Qi, which is supplied by Kidney Yang Qi. All Yang Qi is warm or hot, so this transformation requires heat as well. It is the heat that contributes to urine’s yellow color. (See Appendix 2, Note 6.2.) This is the process of the creation of urine and what is meant by the Urinary Bladder’s function of transforming fluids with Qi. The Urinary Bladder performs that function, but it is assisted by the Kidneys. Qi is required for the functional act of urination, and that Qi is also supplied by the Kidneys. This is why the Kidneys are said to control urine and the two lower orifices. In this way, it’s easy to understand the close relationship between the Urinary Bladder and the Kidneys.

If the Urinary Bladder is not functioning properly, a variety of urinary problems can arise, including frequent or urgent urination, difficulty in or lack of urination, burning or otherwise painful urination, excessive and clear urination, incontinence, and bed-wetting.

The Sanjiao

Sanjiao is translated as “Three Burners,” “Triple Burner,” or “Triple Heater.” (San means “three,” and Jiao means “burner.”) It has an internal/external relationship with the Pericardium, its paired Yin organ, and has the distinction of being an insubstantial organ, meaning it has no physical form. In fact, in the classic Chinese medical text the Nanjing (The Classic of Difficulties), the Sanjiao is said to have “a name but no shape.” Lacking such physiology, it has no discrete Western medical counterpart with which to compare physiological functions. It is often thought of more as a collection of interrelated functions, but that does not mean it isn’t “real.” It does possess distinct qualities and can be treated through its meridian like any other organ, with the same type of expected outcomes.

Still, the exact nature of the Sanjiao is the most ambiguous of all Yang organs. Over the centuries, it has been the subject of much debate among Chinese physicians and medical scholars. Here we’ll examine only the aspects that are most agreed upon and which may most easily be put to practical use.

Main Functions and Attributes of the Sanjiao

• Governs various forms of Qi

• Provides a pathway for Yuanqi (Yuan Qi, “original Qi” or “source Qi”) and body fluids

• Delineates and divides the body into three primary regions, the Upper, Middle, and Lower Jiao

• Its ascendant time is 9 p.m. to 11 p.m.

Analysis

The Sanjiao’s functions are interdependent and best explained in a less sequential way than was used with the other organs. It assists and combines with the receiving, transforming, transporting, and excreting functions of the Zangfu organs in each body region.

Clinically, the Sanjiao is most often thought of as a water or fluid passageway. Some classical sources include the transportation of food within that function. That passageway is what links the functional activities of each of the Three Burners. Its role of governing various forms of Qi and the division of the Three Burners is largely associated with its effects on fluid metabolism. Classically, it has been referred to as an “irrigation official who builds waterways.” The Fire quality of a Burner is required to control and balance Water processes.

The Upper Burner is the body region above the respiratory diaphragm and contains the Heart, Lungs, Pericardium, and everything within the head. Here, despite being paired with the Pericardium, the Lungs and Heart are the main organs influenced by the Sanjiao. (See Appendix 2Note 6.3.) The Sanjiao meridian additionally influences the sense organs, primarily the ears, hinting at its close relationship with the Kidneys through its role in fluid metabolism.

The Upper Burner governs dispersing and distribution in conjunction with those functions of the Heart and Lungs. It assists the Heart in distributing essential Qi extracted from food and water to nourish the entire body, and it plays a stronger role in assisting the Lungs both in dispersing fluids to moisten the body and in regulating the skin and pores. These fluids are in a clear, fine state, vaporized and pervasively disseminated throughout the body, so the Upper Burner is classically described as being like a “mist” or “fog.” Assisting another Lung function, it governs the movement of Weiqi (defensive Qi), releasing it and providing unobstructed passage to the skin, where Weiqi does its primary work of protecting against external pathogenic invasion. The acupuncture point Sanjiao 5 (Waiguan, or “Outer Pass”) is used to stimulate this function.

The Middle Burner is the body region between the diaphragm and the umbilicus and contains the Stomach, Spleen, and Gall Bladder. It governs the digestive processes, promoting those functions of the Stomach and Spleen. The Middle Burner governs transformation and transportation where food Qi is extracted, and other nutrients are absorbed and transformed into useable forms of Qi, beginning the generation of healthy new Blood.

Aided by the Sanjiao’s releasing function and by the Sanjiao providing clear passage for Qi and fluids, the Spleen transports this extracted and transformed nutritive Qi throughout the body. The Sanjiao is instrumental in guiding the portion of it to the Heart that will be used to create Blood and guiding the Weiqi portion to the Lungs. This demonstrates one connection between the Upper and Middle Burners and the Sanjiao’s governance of various forms of Qi.

The Stomach is considered to be central to the Middle Burner. Accordingly, the Middle Burner is alternatively described as being like a “foam” or “froth,” referring to the state of digested food, or like a “bubbling cauldron,” describing the churning action of the stomach during digestion.

The Lower Burner is the body region below the umbilicus and contains the Liver, Large and Small Intestines, Kidneys, and Urinary Bladder. (In purely anatomical terms, the largest portion of the liver is not below the umbilicus, and in younger people, the kidneys are not either—they tend to descend somewhat with age. Functionally, they are contained within the Lower Burner.) It governs the separation of the pure from the impure, directing those functions of the Kidneys, Intestines, and Urinary Bladder, assisting in urination and defecation. Because the Lower Burner continuously directs the impure fluid and solid wastes downward for excretion, it is commonly described as “a drainage ditch.”

Regardless of whether they are located in the Upper, Middle, or Lower Burner, all of the Yin organs and most of the Yang organs have numerous functions. The Sanjiao primarily influences only those functions having to do with water metabolism, made clear by the classical imagery of mist or fog, froth or bubbling cauldron, and drainage ditch.

The last Sanjiao function is also dependent upon it being a passageway. Yuanqi, “original Qi,” is located within the Kidneys. Yuanqi needs the Sanjiao passageway in order to be distributed to all the internal organs and their related twelve meridians. Yuanqi supports, stimulates, and promotes all physiological functions throughout the body, perhaps the most important being providing the heat necessary for digestion, which is the source of all of our acquired Qi and nutrition.