Lesson 4: Zangfu Theory – Heart and Small Intestine

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Heart . Small Intestine

General information

Heart and Small Intestine Channel The Heart governs blood and is dependent upon Qi to push the energy of the Heart and the Blood throughout the body. (Remember that the Liver stores Blood).  Some general information about the Heart you need to know:

  • Most Important Organ
    The Heart is the most important organ and is called the Ruler, Emperor and Monarch of all internal organs. One cannot live without the Heart. In Chinese culture, rank is very important. To say that the Heart is the Monarch is to give it the highest status. For this reason some schools of Chinese Medicine say that one must not needle points on the Heart channel as this will deplete the Heart energy.
  • Location of the Heart
    The Heart is located in the Upper Jiao on the left side of the chest above the diaphragm. It looks like a reverse lotus, the holy flower in Buddhism. The Pericardium is a membrane covering the surface of the Heart. TCM regards the Pericardium as a yin organ separate from but closely tied to the heart – like a Prime Minister. Needling on the Pericardium channel will transfer the benefits directly to the Heart. For this reason, Pericardium 6, 7 and 8 are used often for heart problems.
  • Heart Qi
    All functions of the Heart are based upon Heart Qi, the pushing energy of the Heart.
Physiological Functions of the Heart
The Heart governs the Blood

The Heart governs the Blood in two ways:

  • Heart qi transforms blood
    Food and drink go from the Stomach, which ripens and rots what is ingested, then passes the goodies to the Small Intestine which has the function of separating out the good from the not so good (called turbid in TCM speak). Once the good stuff is extracted, that energy then goes to the Spleen. The Spleen absorbs the essence from the food and sends this ying or nutritive qi up to the Heart. This ying qi is converted by the Heart into “red body fluids,” or blood.A dysfunctional Spleen or Heart does not have enough energy to generate the blood. To nourish blood, tonify the qi, especially the Heart qi.
  • Heart qi, the pushing energy of the Heart, transports the blood
    This is related to both Heart qi and Heart yang. Yang is actually closely associated with Qi and is the active principle of energy. Heart Yang/Qi pushes the Heart, and therefore the blood, circulating it throughout the body to nourish the internal organs, extremities and the five sensory organs.If the Heart qi is dysfunctional or deficient it will manifest in a person as a pale face or pallor, pale tongue, fatigue, and cold extremities. Secondary symptoms can include a purple face and lips indicating a stagnation in the flow of blood. Secondary symptoms can also include chest pain with stuffiness in the chest.
The Heart controls the blood vessels

This is true in the Western medical model as well. The state of the Heart energy is reflected in the state of the blood vessels. The vessels depend upon the Heart’s Qi and Blood to:  1) nourish the vessels, and 2) fill the vessels. Because the Heart qi pushes the circulation of Blood, if the Qi is strong, the vessels will be too. If the Heart Qi is weak, the pulse is weak and irregular.

Good Blood circulation requires:

  • Open blood vessels with no obstructions
  • Enough blood in the vessels to move, which is why deficient blood shows as a thin, weak pulse.
  • Strong enough Heart qi for normal flow
The Heart manifests in the complexion

Though it distributes blood all over the body, it is in the facial complexion that the Heart truly manifests. A normal complexion, reflecting good Heart function is rosy and lustrous. A few examples of pathologies of the heart showing in the complexion are as follows.

  • A patient deficient in Heart Blood or Heart Qi will have a pale or bright white complexion.
  • Blood stagnation manifests as with a purplish or bluish facial complexion.
  • Heart heat displays on the face as a red complexion.
The Heart houses the Shen (the Mind)

ShenThe mind is referred to as the Shen in TCM and in Chinese culture. Shen is also sometimes translated as the spirit of a body. While Blood is yin in nature, Shen is yang in nature.

The Heart needs adequate blood in order to nourish and hold the Shen. Physiologically, if the Heart has sufficient quality and quantity of qi and blood, a person can think, concentrate and remember well. When the Shen and/or Qi are deficient memory and concentration is poor, thinking is impaired, and often sleep will be hard to come by.

It is for this reason that as a general rule when you want to increase memory (especially short term memory) and concentration, focus on tonifying Heart Blood. A strong and balanced Heart equals a strong mind that works well.

There are 2 meanings for Shen to be aware of:

  • Narrow meaning
    This refers to mental activities of all kinds: emotions, consciousness, memory, thinking, sleep, dreaming, etc.
  • Broad meaning
    Shen can also mean the comprehensive expression of a live human body. Examples include facial complexion, eye movement, conversation with others (or whether one converses with imaginary others), answers to questions, speech, and mannerisms. All of this reflects the energy and expression of a body whether that expression is inactive and withdrawn or hyperactive with lots of talking.

Because Shen is also closely linked with emotions, strong Heart Qi and Blood will also yield a happier person, while poor Heart function leads to poor spirit, sadness and depression, especially when the Heart Qi and Blood are blocked.

Each of the 5 Yin organs is in charge of a certain mental activities or aspects of the emotional self:

Mind or Shen: Heart
Ethereal Soul or Hun: Liver
Corporeal Soul or Po: Lungs
Will Power or Zhi: Kidney
Thought or Yi: Spleen

Pathological expressions of poor or deficient Heart qi are poor memory, bad concentration, poor sleeping, pale face. Pathological expressions of excess conditions of the Heart or Blood are Shen disturbances such as mania. Most often Heart fire will cause manic behavior while Heart Blood deficiency will cause insomnia and/or light sleeping with easy waking and dream disturbed sleep.

“Dream disturbed sleep” is a term common in TCM clinics. This refers to dreaming which interrupts sleep. The most obvious example is waking from nightmares, but the expression might also be vivid dreams, anxious dreaming, disturbing dreams, etc. The Shen is said to be “rooted in the Blood.” Without healthy Heart Blood the Shen doesn’t have a firm root and will “wander” during sleep.

If you wish to nourish the Shen, tonify the Heart and the Heart Blood.

The Heart is related to and controls joy

Joy in balance makes the mind peaceful and relaxed, benefiting the nutritive (ying) and defensive (wei) qi, encouraging these 2 forms of qi to relax and flow well. Joy in excess however, can injure the hear. Joy in an excess state refers to mania or schizophrenia. All emotions are considered physiologically normal until out of balance. When out of balance they become pathological and cause disease.

The Heart opens to the tongue

Red tongue tipThe tongue is an offshoot of the Heart. The color, form and appearance of it are all controlled by the Heart. Here are some examples:

  • If the tip of the tongue is very red it indicates heat in the Heart
  • If the tongue itself is very pale it indicates a deficiency of Blood in the Heart
  • Stagnation is indicated by a stiff tongue.
Organ conditions other than those of the Heart are also reflected in the status of the tongue. The Spleen channel, for example, goes to the root or undersurface of the tongue. The sides of the tongue show problems in the Liver and Gallbladder. The back of the top surface of the tongue can show problems in the Lower Jiao, etc.

Heart qi also communicates through the tongue. There are 5 tastes: sweet, salty, sour, pungent, and bitter (some also throw in bland here, but that taste becomes more important in herbs than it does in acupuncture). If you can taste all 5, your heart and spleen are functioning well.

Because the Heart governs blood and houses Shen this is reflected in the movement of the tongue. If a person stutters, the problems are of the Heart and Kidney. Stiffness of the tongue can occur after a stroke causing aphasia. Flaccidity of the tongue can reflect Heart deficiency.

The Heart controls sweating

Other organs also help control sweating (especially the Lung and it’s associated Wei qi), but in different ways. The Heart’s role in controlling sweating has to do with its function of governing blood. Blood is a combination of body fluid and ying or nutritive qi. Sweat, as a part of the Body Fluids, comes from the spaces between the skin and muscles.The Heart can affect sweat by controlling blood and body fluids. If the Heart Qi or Yang is insufficient, a person may sweat profusely.

By way of example, patients with congestive heart failure often have profuse sweating which seems to have no triggering event as a symptom. Western medicine acknowledges that to loose too much fluid through dehydration or profuse sweating will affect the Heart and Blood (as well as the Yin, as discussed previously).

For this reason it is very important not to induce sweating in your treatments if you detect a Heart Blood deficiency. Heart Qi and Blood deficiencies will render the heart incapable of holding the fluids together with the blood and it will leak out in the form of sweat.

The Heart controls dreaming

DDSAll dreams relate to the Heart, are a manifestation of Shen, and reflect the status of the Shen. If your Heart is balanced, you will sleep well. If not, you may experience insomnia, superficial sleep, and/or dream disturbed sleep.

Vivid dreams and dream disturbed sleep are abnormal phenomenon rather than basic garden variety dreaming in which you likely won’t remember the dreams even if you remember that you did dream. When dreams disturb your sleep, they will wake you up, scare you, or be anxious and tense. You can often remember them in detail. This can have more to do with the Heart than with the Liver. Traditional herbal and acupuncture point formulas to treat sleep will often treat the Heart as well. Insomnia and/or dream disturbances are often the first symptom of Heart dysfunction that a patient notices and will sometimes be their chief complaint when they come into your clinic.

The Heart loathes heat

Though the Heart is a yin organ, it is very “yangish” in nature. The Heart is represented by and is representative of the element of Fire. It is also related to summer.

Both the Heart and Liver (which also has a fire type association – more later on that) can have Yang disorders such as deficiency of Heart Yang, or Liver Yang rising. An excess affecting the Heart is Heart fire. More heat is always a Heart excess and if the client is has it, they will have an aversion to heat and probably a thirst for cold drinks.

Heart loathes heatBecause the Heart is firey in nature any extra heat added to its native fire will affect it pretty quickly. And because the Heart is the most important organ, the body will try to move the fire away from the Heart as much as possible. It hands this extra fire off to the coupled organ, the Small Intestine. The Small Intestine doesn’t want it, so it hands it off to the Bladder to get rid of the extra heat. That can cause what looks like a UTI but may actually test negative for bacteria.

External pathogens attack the Pericardium first, rather than attacking the Heart directly. A biomedical example of this is pericarditis, an infection and/or inflammation condition of the body that attacks the pericardial sac.

The Heart controls speech

The heart opens to the tongue and therefore has a strong connection to speech. Refer back to the connection of the Heart with Shen and with the tongue. A patient that is extremely talkative might have an excessive Heart syndrome/condition. Aphasia can indicate heart blood stagnation. Stuttering is also a heart disorder. Speech related to psychological disorders such as incoherent or wild crazy speech can also be Heart and Shen related.

The Heart Channel

Heart ChannelThe Heart channel originates from the Heart organ. After it emerges from the Heart it goes through the diaphragm, connects to the Small Intestine, then branches to the throat and the eye. Another branch of the Heart Channel enters the Lungs, emerging at the axilla (armpit) and joins the superficial channel running along the medial aspect of the arm, ending at the tip of the little finger.

Small Intestine: General Information

The Small Intestine is related to and paired with the Heart. The Small Intestines channel connects to the Heart channel as shown in the graphic to the right. Both the Heart and Small Intestine are Fire organs in Five Element Theory.

Functions of the Small Intestine

There are two basic functions for the Small Intestine in TCM:

Control receiving and transportation of digested food.
The origin of the reception of food and drink is the Stomach and Spleen. The Stomach grinds up the food/drink (ripens and rots, per the Neijing) then passes it on to the Small Intestine which separates the pure stuff from the turbid (or not so pure) stuff. Solids and liquids are separated as are wastes. The solids go to the Large Intestine while the Kidney and Bladder receive the liquids.

The Small Intestine separates fluids, separating the pure from the turbid or impure as described in the first item above. Bonus information: you can also take this to a non-physical level. You intake more than just food and liquids. You intake information, other people’s emotions, etc. If the Small Intestine is strong you can separate the good from the bad, useful from non-useful, truth from non-truth. Pretty handy, eh?

Small Intestine’s relationship to the Heart

The Small Intestine manages the movement and transportation of fluids in that purer, cleaner parts of food and drink are allowed to absorb into the body while the turbid and not so clean stuff is excreted to the colon.

A dysfunction of the Small Intestine results in a mixture of dirty or turbid in with the clean. This can express (pardon the pun) as diarrhea with undigested food in it. (Traditionally in TCM one promotes urination in order to stop diarrhea….)

Clinically, the Small Intestine has more to do with heat than with anything else. Pathologically, heat in the heart can cause diarrhea as well as the aforementioned UTI like symptoms. Heat in the heart can be generated from over-thinking, anxiety and worry. It might show clinically as a very red tip of the tongue, as ulcers or blisters on the tongue, and/or as jitteriness or anxiousness.

Heat can also be transmitted from the Heart to the Small Intestine. Because the Small Intestine sends fluids to the Urinary Bladder where it becomes urine, this heat is also passed along to the Bladder and manifests as urgent need to urinate, painful urination and dark urine. The urine may be scanty when this happens and it may burn when the bladder is voided. These all look like UTI symptoms. Patients who go to the doctor with UTI symptoms but who test negative for bacterial infection are probably experiencing Heart heat transmitted to the Small Intestine and Bladder.

Bonus information:
Why would heat from the Heart be transmitted to the Small Intestine? Because the Small Intestine is Yang and because it is the coupled organ with the Heart. It can handle it better than the heart.

So why would heat in the Small Intestine end up in the Bladder? What’s that about? The Heart and Small Intestine are a Zangfu pair, which is also called a Husband and Wife pair. The relationship between the Small Intestine and the Bladder is a channel relationship. Both of them are part of the Taiyang channel: Small Intestine is the Hand Taiyang channel while Bladder is the Foot Taiyang channel.

I think of the Small Intestine and Bladder as more of a work related association while the Zangfu relationship is more of a close familial association.

Works Cited

  • Source: Wu, Qianzhi. “Foundations of Chinese Medicine.” AOMA Graduate School of Integrative Medicine, Austin Texas. Fall 2007. Lecture Series.
  • Maciocia, Giovanni. Foundations of Chinese Medicine. London: Elsevier Ltd, 2006. Print
  • Ni, Maoshing. The Yellow Emperor’s Classic of Medicine. Boston MA: Shambhala Publications, 1995. Print.
  • Larre, Claude. Rooted in Spirit: The Heart of Chinese Medicine. Barrytown, NY: Station Hill Press, 1995. Print.
  • Larre, Claude. The Seven Emotions: Psychology and Health in Ancient China. Taos NM: Redwing Books, 1996. Print