Medical Dialogue
医学会话
Review on the Visceral Manifestation Theory
复习脏腑理论
Maria and Mark are two students at an American TCM college in the United States. They have met by chance and are reviewing the visceral manifestation theory in the hallway before a test.
| maria: | Hi, Mark, would you like to review before we go in the classroom? |
| mark: | Hi, Maria. Sure. Okay, what can you tell me about visceral manifestation theory? |
| maria: | It is the core of TCM physiology. It involves five viscera and six bowels. It is about their physiological functions, their interrelationships and how they manifest their pathologic changes externally. It is how we describe the body as an integrated whole. And if we hope to properly differentiate a patient's visceral disease, we must use this theory. |
| mark: | And how do we do this? |
| maria: | By the four examinations of TCM. And by knowing the correspondences of internal organs, we know what we are looking for and listening for. |
| mark: | And what are these correspondences? |
| maria: | Well, each organ influences and is correlated to an emotion, a sense organ, a color, a taste, and a sound. Just as we can influence change inside the body through needles and massage, the condition of the internal organs can manifest to the surface of the body. This is more dramatically observed when there is a pathological change present. |
| mark: | Right, and what do we call this? |
| maria: | Visceral manifestation. |
| mark: | How does a pathological change inside the body present externally? |
| maria: | There are five viscera: the spleen, the heart, the liver, the kidney and the lung. There are six bowels. These are hollow, yang organs. They are the large and small intestines, the stomach, the gall bladder and the urinary bladder. |
| mark: | Don't forget the triple burners! |
| maria: | I always forget the triple burners. |
| mark: | Right, because like the pericardium, which would make six viscera and not five, the triple burner is not a physical organ. |
| maria: | So the viscera store and generate essence and qi. The bowels receive, transport and discharge things. |
| mark: | Yes. |
| maria: | And the viscera and bowels have organic connections with the surface of the body and with the sense organs and their orifices. |
| mark: | For example? |
| maria: | These are complex functional relationships. |
| mark: | For example. |
| maria: | There are too many to name with the time we have left. |
| mark: | Just a few, then. |
| maria: | Well, the pathological change of any viscera can be observed through the corresponding body tissue, sense organ and emotion. |
| mark: | For example. |
| maria: | The heart controls blood vessels and its condition is reflected in the complexion. Liver controls the sinews and manifests in the nails. Spleen controls the muscle and manifests in the lips. Lungs govern the skin and their condition is reflected through the body hairs, and the kidneys control the bone with its essence expressing through the hair on the head. Changes of these tissues can reflect the pathologic changes from the associated organs. |
| mark: | Remember the case study last week? |
| maria: | The 37 year old male with neck pain and headaches and occasional bloating in the lower right abdomen? |
| mark: | He was restless through the interview but appeared tired. His pulse was slippery and wiry. His tongue was pale-red with a greasy white coating. |
| maria: | We knew there was liver involvement and that dampness was accumulating. The liver ensures the free coursing of qi through each of the viscera and bowels and its associated tissues. The neck pain was likely due to a stagnation of qi, but were the headaches due to the same stagnant qi or was this due to a deficiency of blood? Remember his eyes? |
| mark: | He had minimal signs of blood deficiency. His nail beds were pink and well nourished. He did express feelings of tightness at the tendons of his hips and knees after an hour of hiking. So, possibly the sinews were not being nourished properly by the liver blood. And what about his eyes? |
| maria: | The liver opens to the eyes. He had dry eyes, remember. The tears are formed by the liver. Deficient blood means deficient tears. And he wore glasses and had poor night vision and he reported floaters in his eyes. |
| mark: | Yes, there were signs of both blood deficiency and qi stagnation. But the headaches were from the qi stagnation. Anger is the emotion of the liver, right? Think how he described himself emotionally. He said he was moody and that he repressed his anger. |
| maria: | Yes, liver qi stagnation with no heat signs. This was not effulgent fire flaring up due to liver yin deficiency that caused his headaches. |
| mark: | No, it was not that deep yet. He's young, still. But if he continues as he has been, he'll likely suffer from greater blood deficiency as he gets older, with heat signs and more pronounced digestive disorders. Neck pain would be the least of his complaints. |
| maria: | It's time to get to class and take this test. Thanks for the review. Good luck! |
| mark: | Yes, good luck. |