Pathological Mechanisms of Six Fu-Viscera
1. Pathological Mechanisms of the Gall bladder
The gall bladder stores and excretes bile. It dominates the decision-making. Its meridian connects with the Liver Meridian, so the gall bladder has an exterior-interior rehtionship with the liver. The main physiological functions of the gallbladder are to help liver-qi conduct and disperse, to excrete bile to the small intestine, and to help decompose food stuff.
The pathological mechanisms of the gall bladder are the dysfunction of excretion bile, and the debility of decision-making due to restlessness induced by the deficiency of the gallbladder-qi.
Dysfunction of excreting bile:This is caused by the interior impairment of the emotions, or by the fire resulting from stagnated heat of the liver" and gallbladder due to blockage of evaporating pathogenic damp-heat. Dysfunction of the excretion of bile leads to weakness in the spleen and stomach's functions of transportation and transformation This may induce indigestion, or cause the bile to flow upward into the vessels and flood to the interval of skin, a condition marked by jaundice.
Debility of decision-making caused by restlessness due to deficiency of the gallbladder-qi : This is caused by congenital weak constitution or impairment of the spirit by protracted illness. Deficiency of the gallbladder-qi due to being frightened suddenly may also lead to disorder of mental activities, and weakness of decision-making, manifested timidity, doubtfulness and hesitation. Moreover, if the heat stagnates in the Gallbladder Meridian, and phlegm-heat upward disturbs the mentality, the symptoms of restlessntess and insomnia will appear.
2. Pathological Mechanisms of the Stomach
The stomach plays an important part in the viscera. It is called "the sea of water and grain," and " the acquired constitution. " The stomach and spleen are connected by the membrane, and they share an exterior-interior relationship due to the interconnection between their meridian.
The main physiological functions of the stomach are that stomach-yang and stomach qi control the receiving, decomposing, and descending downward of the food stuff.Stomach-yin moistens the stomach and helps stomach-yang digest food stuff.
The pathological mechanisms of the stomach are the disturbance of the stomach
yang-qi and stomach-yin, reflected by hyperfunction or hypofunction of the receiving and decomposing of food stuff. This is manifested as deficiency of stomach-qi, excessiveness of stomach-cold and stomach-fire, and insufficiency of stomach-yin.
1) Disturbance of the Stomach Yang-Qi
This morbid state includes deficiency of the stomach-qi, leading to the failure of de composing and descending of the food; insufficiency of stomach-yang induces excessive ness of the stomach-cold and stomach-fire, causing the hyperfunction of receiving and decomposing of food.
Deficiency of the stomach-qi is caused by an improper diet, a congenital weak constitution, or the consumption of stomach-qi due to protracted illness. The deficiency of the stomach-qi leads to the decline of the stomach functions of decomposing food, transportation of middle-jiao, and digestion, marked by anorexia or poor appetite, and fullness in the epigastrium. It may also lead to the hypofunction of transporting food downward. As a result, the stomach-qi fails to descend and the food is unable to be transported downward, which causes the stomach-qi to rise adversely. This is often is manifested as vomiting
Excessiveness of the stomach-cold is caused by over-intake of raw and cold food, or of herbs with a cold property which impair the stomach yang-qi. It also may be caused by congenital weakness of spleen and stomach yang-qi. The cold will be produced internally due to the deficiency of yang, leading to hypofunction of transportation and transformation, and abnormal digestion of food, marked by anorexia or poor appetite. When it meets cold, the blood will stagnate. Heavy stomach-cold will lead to epigastralgia due to sospasm, which may be relieved by warmth.
Hyperactivity of the stomach-fire: This is caused by the pathogenic heat attacking the stomach, or by the heat and fire which result from the stagnation of the stomach-qi due to the accumulation of food. This morbid state leads to the hyperactivity of the decomposition of food, marked by the patient's inability to satisfy his or her hunger. It also impairs the body fluids. As a result, pathogenic dryness may be produced due to insufficiency of the fluid. This is manifested as dryness-heat in the stomach, thirst, and constipation
2) Disturbance of Stomach-Yin
Stomach-yin refers to the juice of the stomach. Its disorder reflects an insufficiency of st0rnach-yin. It occurs in the later period of febrile disease. It can also be caused by the consumption of fluid due to protracted illness. Insufficiency of stomach-fluid leads to hypofunction of the moistening and descending of the stomach-qi, marked by a stuffy sensaion of deficiency-type, anorexia, repeated nausea, thirst, and a dark red tongue with litle coating.
3. Pathological Mechanism of the Small Intestine
The small intestine stores and further digests the food, and separates the clear from he turbid. Its meridian connects with the Heart Meridian, and it has an exterior-interior dationship with the heart. The physiological functions of the small intestine are to redeive and further digest the food preliminary digested in the stomach, to transport the bod-essence to the spleen to nourish the body, and to expel the residues and fluid into the large intestine or diffuse them into the urinary bladder for discharge from the body.
The pathological mechanism of the small intestine is the dysfunction of the separating of the clear from the turbid. This leads to mixture of the two, and the dysfunction of transportation. The pathological change of the small intestine is caused by duysfunction of the spleen and stomach transmitting downward, or by the heart-fire moving downward along the meridian. Pathological changes of the spleen and stomach transmitting downward are caused by Improper diet or by the cold-damp or damp-heat. When the cold-damp or damp-heat evils impair the spleen and stomach, this leads to the dysfunctions of transportation and transformation, and ascending and descending, therefore causing damp-evil to transrmit downward to the small intestine. This results in the disturbance of the small intestine's functions of separating the clear from the turdid, and further digestion. So the refined substance and wasted products mix together and transfer into the large intestine together,
a condition marked by diarrhea.
The heart-fire transmitting downward the small intestine results when an enduring emotional impairment gives rise to the heat. This leads to the hyperactivity of the heart.fire, causing the heart-heat to transmit downward to the small intestine along its meridi an, where the heat combines with the water and diffuses into the urinary bladder, a condition manifested by the symptoms of erosion and pain of the mouth and tongue, darlk colored urine, and a burning pain upon urination.
4. Pathological Mechanism of the Large Intestine
The large intestine is the organ that transfers waste products and absorbs fluid.
meridian connects with the Lung Meridian and it has an exterior-interior relationship with the lung. The physiological functions of the large intestine include receiving the food residues sent down from the small intestine, absorbing the extra water, and conveying the residues into feces (through the dryness process) which are discharged from the body.
The pathological mechanism of the large intestine is the dysfunction of transportation, which is caused by the pathological changes of the stomach or small intestine trarsmitting downward, or by that of the lung moving down along the meridian. This is man ifested as a disorder of defecation.
If the diet is improper, or the damp-heat invades the interior body, the small intestine fails to separate the the clear from the turbid and the mixture will be transported downward to the large intestine, leading to the hyperactivity of bowel movements and rapid transportation, marked by the diarrhea of heat type. If the damp-heat or cold-damp move to the large intestine to stagnate visceral-qi, this may lead to fighting between qi,blood, and damp-heat or cold damp, injuring the intestine and vessels, and bringing about symptoms such as diarrhea with purulent and bloody stool, and tenesmus.
Reduction of the large intestine movement may be caused by slow and encumbered
transportation of the large intestine, due to the impairment of intestinal juice by the stag nation of dry-heat. It also may be caused by a dysfunction of transportation and transformation of the large intestine due to the qi deficiency or due to worms obstructing the passage. As a result, transporting of the intestine may become weak or stagnant, leading to constipation. If the dampness is retained in the large intestine, it may lead to encumbered transortaion, marked by loose stool with tenesmus. If the yang-qi of the large intestine is deficient, this may lead to the dysfunction of consolidation, marked by prolonged diarrhea, and prolapse of the rectum.
If the transportation of the large intestine is inadequate, the waste products and damp evils may be retained in the intestine, and become filth of the large intestine, which obstructs the flowing of qi and blood in the meridians and vessels. This leads to the stagnation of blood, and, if the damp moves down to the anus, may cause piles. If the damp-heat stagnates in the large intestine, the nutritive qi stagnates in the muscle and the defensive qi is unable to return to the viscera, swelling and pain in local tissue, even suppuration, and acute appendicitis occur.
5. Pathological Mechanism of the Urinary Bladder
The urinary bladder is the organ that stores and discharges the urine. Its meridian connects with the Kidney Meridian, and it has an exterior-interior relationship with the kidney. The pathological mechanism of the urinary bladder is the dysfunction of micturating, manifested by paruria, frequency and urgency of urination, urodynia, dysuria, and even anuresis, enuresis, or incontinence of urine.
6. Pathological Mechanism of Triple-diao
Triple-jiao is one of the six fu-viscera, and includes the upper, middle, and lower-jiao. Their physiological functions sum up the functional activities of qi in the body, including the distributing function of the heart and lung in the upper-jiao, transportation and transformation functions of the spleen and stomach in the middle-jiao, and the normal conducting and dispersing of qi and transforming function of the liver, kidney, intestine and urinary bladder in the lower-jiao. The pathological mechanism of the triple-jiao the disturbance in its functional activities, which can be reflected in two ways: It may be manifested as a disturbance in the functional activities of qi and dysfunctions of the lung, spleen, stomach, intestines, liver, and urinary bladder; or it may be manifested as dysmetabolism of water and a dysfunction in the ascending up of the essential substance and descending down of the dross by the lung, spleen, and kidney, leading to the retention of water.
Disturbance in the functional activities of qi results when the pathogenic factors are retained in the body, or the pathogenic phlegm and food stagnate. This may lead to a disorter of the movement of the qi of the lung, liver, stomach, intestines, or urinary bladder, such as a dysfunction of dispersing and descending of the lung, normal conducting and dispersing of liver-qi, descending of the stomach-qi, transportation of the large intestine and small micturating urinary so on.
The water dysmetabolism results when there is an interior by the colddamp, or a prolonged illness which impairs the lung, spleen, and kidney. In this case yang-qi becomes deficient and results in an abnormality of qi transportation, such as the dysfunction of dispersing, descending, and regulating of water metabolism of the lung the transportation and transformation of the spleen, and the discharging of retention due to the weakness of the evaporation function. The disturbance in qi movements in trlple-jiao leads to abnormal qi movements of ascending, descending, exiting, and entering, inducing dysmetabolism of water. Water may be retained due to the stagnation of qi and vice versa, and it may flood to the interstitial space, causing edema. If this is a distubance in the transportation function of the lung and spleen, edema will occur in the upper part of the body. But if it is a disturbance of the transportation function of the spleen and kidney, edema will occur in the lower part of the body.
