Written by Jeonghwa Lee, Choonjae Lee, Published by Korea Institute of Oriental Medicine
C. Visceral Manifestation
Visceral manifestation refers to anatomic, physiologic and pathological relationships among five viscera and six bowels. In TKM, physiologic functions, pathological changes and interrelations of five viscera and six bowels can be known by outer symptoms.
Western medicine focuses on organs of the five viscera and six bowels while TKM pays attention to its system.
1. Five Viscera
1) Liver
a. The liver governs a free coursing by ensuring the free movement of qi and preventing the stagnation of qi. Its main function is to ensure smooth flow, delivery, and excretion.
- The liver influences emotions.
Good flow of the liver qi calms down emotional activities while dysfunctional liver qi triggers an angry and depressive mood. Reversely, exces-sive anger and despondency can affect liver activities. - The liver affects digestive function.
The liver’s smooth flow function should be active in order to help the spleen’s functions of transportation and transformation, and the release of bile, and excretion. Dysfunctional liver leads to digestive problems, which in turn lead to a heavy chest, belching, diarrhea and constipation. - The liver concerns pain.
Unclogged liver qi causes disturbances in the circulation of qi and blood, thus creating pain, especially in the sides, since the sides are governed by the liver. - The liver affects menstruation.
There are various reasons for menstrual disturbances, but a dysfunctional liver is responsible for menstrual disturbances caused by nervousness.
b. The liver stores blood and adjusts the quantity of blood circulation.
c. The liver governs upbearing and effusion4. The liver qi tends to move upward and effuse. Since the liver corresponds to wood among the five elements and spring among the four seasons, it has the tendency of moving upward and effusing like a sprouting and blooming plant. Overactive liver functions can lead to headaches, vertigo, irritability and anger.
d. The liver opens into the eye. The liver has a physiopathological correlation with eyes.
e. The liver is related with muscles and fingernails. Enough blood supply from the liver is necessary for proper muscle functions. Not enough blood supply from the liver causes slower movements. Serious lack of blood supply shrinks muscles and disables the limbs. In addition, too much heat in the liver causes spasms in the limbs. Given that fingernails and toenails are part of muscles, they are largely influenced by the liver. Enough blood in the liver strengthens muscles and generates strong, flexible and glossy nails whereas not enough blood in the liver makes soft, thin and discolored nails.
2) Heart
a. The heart governs bright spirit. It is related to all the human life activities including the mind, will, mood and thinking. It is related to mental and conscious activities to a certain extent. Sufficient qi and blood in the heart gives a person brilliant spirit and quick wits. If the heart becomes ill, one gets a palpitating heart, is quick to be scared, has difficulties sleeping,
talks in delirium, becomes confused or depressed, and easily looses his / her temper.
b. The heart governs the vessels in which blood circulates. Blood vessels are pathways for qi and blood. The heart controls the blood circulation in the human body.
c. The heart is related to tongue. The heart’s pathological phenomena are found in the tongue.
d. The heart governs speech.
e. The heart governs perspiration.
3) Spleen (Digestive Function)
a. The spleen governs the function of transportation and transformation. The spleen absorbs nutrients, which are delivered to each organ and tissue in the body. It also maintains balanced water metabolism by improving the circulation and excretion of body fluids.
b. The spleen governs the limbs. The spleen is in close physiopathological relationship with the arm and leg. If the spleen weakens, nutrients will not be readily delivered, which will lead to weakened limbs, emaciated or swollen arms and legs, and cold hands and feet.
c. The spleen governs flesh; Weak spleen can cause loss of weight, weak pulse, fatigue, inertia, and loss of appetite.
d. The spleen governs control of the blood. Here, control means management and restriction. The spleen ensures the proper circulation of the blood along blood vessels so that blood will not spill out of blood vessels.
e. The spleen is related to the mouth and lips; Taste of food and one’s appetite has something to do with the spleen’s transportation and transformation function. A healthy spleen generates a healthy appetite, which in turn makes red and glossy lips. In contrast, a weak spleen decreases one’s appetite, which leads to dry, yellowish and dull lips.
4) Lungs
a. The lung governs qi. The lung governs respiration by inhaling fresh air and exhaling turbid air. The lung also governs qi, the basic element of the human body.
b. The lung governs the downward movement and purifying action of lung qi in contrast to its diffusing action. The lung purifies qi and sends qi downwards.
c. The lungs regulate the pathway of water metabolism. The lung speeds up body fluid metabolism and maintains a balanced metabolism.
d. The lungs are related to the skin and hair. The lungs are closely related to the skin and hair on the skin.
e. The lungs open into the nose.
5) Kidneys
a. The kidneys store essence. Essence is composed of innate essence (essence with a reproductive function) and acquired essence (the essential substance acquired from the food after digestion and absorption, and used to maintain the vital activities and metabolism of the body). The kidneys govern all the essence.
b. The kidneys govern bones.
c. The kidneys govern water. They control body fluids.
d. The kidneys open into the ears.
2. Six Bowels
The six bowels refer to the organs that digest food, absorb nutrients, and excrete the waste such as the gall bladder, small intestine, stomach, large intestine, urinary bladder, and triple energizers.
As is already mentioned, TKM explains the human body based on the five phase / element system. The principles of yin and yang show that all matter in the universe has counterparts.
The six bowels are the corresponding organs to the five viscera. The viscera and bowels have their own functions but also cooperate with and adjust themselves to themselves. From the perspective of yin and yang, the six bowels correspond to yang.
The six bowels are the digestive organs, whose main function is controlling body fluids by taking and digesting food, absorbing nutrients, and excreting the waste. Therefore they are not always active. They become active when necessary so they go through more changes than the five viscera. This explains why the viscera are yang organs.
1) Gallbladder
a. The gallbladder assists in food digestion. The primary physiological function of the gall bladder is to speed up food digestion by releasing bile. This is the same with the western medical concept of the gall bladder.
b. The gallbladder controls judgment. It is partially responsible for one’s mental activities, so it discerns right from wrong, and makes a decision. Since the status of the gallbladder qi is related to one’s courage and cowardice, Oriental medical doctors always look at the gall bladder when treating a patient suffering from marked mental changes such as sudden palpitation, sleeplessness, and many dreams.
c. The gallbladder and the liver are like the two sides of the same thing; this means correspondence between the five viscera and the six bowels in accordance with the principle of yin and yang. The liver and the gall bladder are organs with wood energy, so the liver is in close physiopathological relationship with the gall bladder.
2) Small intestine
a. The small intestine distinguishes between the clear and the turbid. Since the small intestine is connected with the pylorus on the top and with large intestine on the bottom, the most important physiological function of the small intestine is discerning purity from impurity.
b. The small intestine is related to urine.
c. The small intestine and the heart are like the two sides of the same thing. The small intestine is in close physiopathological relationship with the heart. Excessive fire qi in the heart can affect the small intestine, resulting in less urine, red urine and dysuria.
3) Stomach
a. The stomach takes in and digests food.
b. The stomach controls the descending; the stomach qi controls all the processes of food digestion, absorption, and excretion as the food moves downward. If the stomach qi does not descend, food does not go down but stays in the stomach, causing bloating, abdominal pain, and constipation. If the stomach qi rebels upwards, belching, hiccupping, and vomiting take place.
c. The stomach likes wetness and dislikes dryness.
4) Large intestine
a. The large intestine absorbs water and excretes the leftover waste.
b. The lung and the large intestine are like the two sides of the same thing. The large intestine is in close physiopathological relationship with the lung.
5) Urinary bladder
a. The urinary bladder stores and expels urine.
b. The kidneys and urinary bladder are like the two sides of the same thing; the urinary bladder is in close physiopathological relationship with the kidneys.
6) Triple energizers
a. Constitution of the triple energizers
It has been noted that the five viscera pair up with the six bowels, but the numbers do not match. In TKM, there is another organ associated with metal activities called the pericardium in addition to the liver, heart, spleen, lung and kidneys.
This makes six viscera, not five viscera. The triple energizer is a yang organ that pairs up with the pericardium and is a unique concept only found in Oriental medicine. The triple energizer regulates interactions between yin and yang organs to a certain extent, and consists of the upper, middle, and lower energizer.
b. Triple energizers as the three divisions of the body
- Upper energizer includes the heart and the lung.
- Middle energizer includes the spleen and the stomach.
- Lower energizer includes the kidneys and the liver.
c. Functions of the triple energizers
- The upper energizer governs breathing, controls blood vessels, delivers food nutrients to all body parts, and warms the skin, muscle and bone.
- The middle energizer facilitates digestion and absorption of food, and transforms nutrients into energy and blood.
- The lower energizer discerns pure qi from impure qi, and excretes food waste and metabolized fluids outside the body.
