The Characteristics of Visceral Manifestation Theory

The foundations upon which visceral manifestation theory was formed also determined its characteristics: first, a holistic view centered on the five zang organs; and second, a structural-functional model infused with the concepts of time and space.

1. The Holistic View Centered on the Five Zang Organs

The holistic view centered on the five zang organs is the embodiment of the concept of holism within visceral manifestation theory. It holds that the human body is an extremely complex organic whole. The various constituent parts of the human body are structurally and morphologically inseparable, physiologically and functionally mutually coordinated, interconnected in their material metabolism, and mutually influential in their pathological changes. This intrinsic wholeness of the human body is primarily manifested in three aspects. First, the five zang, six fu, bodily form, and sensory orifices are linked through the connections of the meridians, the thoroughfare of qi and blood, and the subordinate relationships of functional cooperation, forming five major functional systems. Second, among these five major functional systems, the dynamics of engendering and restraining within the five elements enable them to mutually promote and restrict one another, thereby maintaining the life activities of the whole. Within the five major functional systems, the five zang store and conserve essence qi and preside over qi transformation, occupying a core position. The functions of the six fu are subordinate to the five zang, and the essence qi stored by the extraordinary fu organs also originates from the five zang. Only when the functions of the five zang are vigorous and robust can the activities of the other organs of the body function normally and the body be strong and healthy. Hence, the Suwen · Mai Yao Jing Wei Lun (Basic Questions: Treatise on the Essentials of Pulse Diagnosis) states: "The five zang are the guardians within. When they maintain their guardianship, there is life; when they lose their guardianship, there is death." Among the five zang, the heart in turn serves as the great sovereign of the entire body. Under the direction of the heart, the functional activities of all the zang-fu organs throughout the body can achieve coordinated unity. Thus, the Lingshu · Kou Wen (Spiritual Pivot: Oral Inquiry) states: "The heart is the master of the five zang and six fu." Third, the physiological activities of the five zang are intimately linked to human mental and psychological activities. Visceral manifestation theory holds that mental activities are governed by the heart and are distributed under the jurisdiction of the five zang. The Suwen · Xuanming Wu Qi (Basic Questions: Elucidating the Five Qi) states: "The heart stores the spirit (shen), the lung stores the corporeal soul (po), the liver stores the ethereal soul (hun), the spleen stores the mind (yi), and the kidney stores the will (zhi)." Emotional changes correspond to the five zang: the heart's associated emotion is joy, the liver's is anger, the spleen's is pensiveness, the lung's is grief, and the kidney's is fear. Together, the five zang maintain the normal conduct of mental and psychological activities.

In addition, the five major functional systems centered on the five zang also communicate and correspond with the external environment. Primarily through the functional activities of the five zang, the coordinated balance between the body's internal and external environments is regulated. In summary, visceral manifestation theory takes the five zang as the center, attributing the body's internal organs, bodily form, various orifices, and mental and psychological activities all to the five zang, and uses the functional activities of the five zang and their interrelationships to explain the coordinated unity of the body's internal environment and its harmony with the external environment.

2. A Structural-Functional Model Infused with the Concepts of Time and Space

The process of constructing visceral manifestation theory was one of evolution from an emphasis on physical substance toward a paradigm of functional states. Although the formation of visceral manifestation theory was based on a certain foundation of anatomical knowledge, it was primarily accomplished under the influence of ancient philosophical thought, through the observation and analysis of physiological and pathological appearances and clinical therapeutic outcomes, with physiology, pathology, diagnosis, and treatment mutually confirming and deriving one another. Therefore, the visceral manifestation theory of Chinese medicine places great emphasis on studying the functional activities and structural relationships of the zang-fu organs, while its understanding of their morphological structure is quite rough. In some cases, it is even difficult to determine their precise location and form, and it does not investigate the material composition of the zang-fu organs. For example, for the liver, Chinese medicine recognizes its functions of governing free flow (shu xie) and storing blood, and has detailed descriptions of these. In terms of structural relationships, it recognizes that the liver and gallbladder are internally-externally paired, that it opens into the eyes, that its corresponding body tissue is the sinews, and that its bloom is manifest in the nails. Yet it very rarely discusses the morphological location of the liver. In fact, from the perspective of liver function and its relationship with the spleen and kidney, the location of the liver is inferred retroactively, giving rise to a debate over whether the liver resides in the middle burner or the lower burner. Furthermore, proceeding from the holistic perspective that "humanity corresponds with heaven and earth, and responds to the sun and moon," visceral manifestation theory emphasizes time and directional orientation. The zang-fu organs it describes inherently carry within them the concepts of time and orientation. In terms of time, the liver corresponds with spring, the heart with summer, the spleen with late summer, the lung with autumn, and the kidney with winter. If the day and night of a single day are seen as analogous to the four seasons of a year, then the liver corresponds with dawn, the heart with midday, the lung with sunset, and the kidney with midnight. The qi of each of the five zang is relatively exuberant at its corresponding time, thereby manifesting a temporal rhythmicity in life activities. In terms of directional orientation, the liver corresponds with the east, its qi being gentle and warm, bearing the image of the initial birth of all things. The heart corresponds with the south, its qi being hot and scorching, bearing the image of the luxuriant growth of all things. The spleen corresponds with the center, its qi being moist and damp, bearing the image of the transformation of all things. The lung corresponds with the west, its qi being cool and solemn, bearing the image of contraction and gathering. The kidney corresponds with the north, its qi being cold and freezing, bearing the image of closure and storage. When this correspondence is extrapolated to the human body, if one positions oneself facing south, then as the Suwen · Ci Jin Lun (Basic Questions: Treatise on the Prohibitions of Needling) states: "The liver generates on the left, the lung stores on the right, the heart distributes on the exterior, the kidney governs in the interior, and the spleen serves as their emissary." Precisely because visceral manifestation theory is a structural-functional model possessing a spatiotemporal perspective, the function of a single zang organ in this theory may encompass the functions of multiple organs or systems in terms of anatomical structure, while the functions of a single organ in modern medicine may be distributed among several different TCM zang-fu organs. The essence of visceral manifestation is thus a multi-entity physical structure in which systemic function serves as the principal subject.

Owing to the constraints of historical conditions and the holistic observation and analogical reasoning characteristic of Chinese medicine's modes of thought, visceral manifestation theory is marked by an emphasis on macroscopic reasoning over microscopic investigation, and on zang-fu function over morphological structure. Its understanding of the zang-fu organs is detailed in its observation and analysis of physiological and pathological phenomena and their relationships and connections with zang-fu tissues, while it is abbreviated in the nuanced dissection of specific morphological structures. Therefore, in studying visceral manifestation theory, one should pay attention to scientifically understanding and grasping its connotations, and continuously develop it in conjunction with clinical practice.