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The Theory of Visceral Manifestation1. The phrase of visceral manifestation or zang xiang in Chinese first appeared in the Chapter of Six Sections of Discussion on Visceral Manifestation in Su Wen . “藏像”一词，首见于内经之素问六节藏象论。 According to the explanation in some Chinese medical classics , “zang” refers to interior organs which are stored inside the body , and “xiang” refers to exterior manifestations of physiological functions and pathological changes of internal organs . 许多中医经典著作认为：藏指藏于体内的脏腑组织器官；象指内部器官表现于外的生理功能和病理变化。 In Lei Jing ( Canon of Classification ) compiled by Zhang Jingyue, for example , it was recorded that “ xiang means image ” . The viscera are stored inside the body and the image is manifested outwardly . For this reason , it is called “ visceral manifestation . That is why zang xiang is sometimes translated as “ viscera and their manifestations ” 故张景岳在类经藏象类中说：“象，形象也，藏居于内，形现于外，故曰藏象，那也是为什么藏像有时候被译为“脏和形”。 .2. The theory of visceral manifestation studies the physiological functions and pathological changes of viscera and their relations. 藏象，是研究内脏及其所属关系的生理功能和病理变化的学说。 It plays an important role in building the theoretical system of TCM and is significant for expounding the physiology of the human body and for guiding clinical practice. 它在建立中医理论体系中上演着重要的角色。同时，它对阐述人体生理病理以及指导临床实践有着重要意义。3. Viscera, basis for the theory of visceral manifestation, is a collective term of internal organs which, according to their physiological functions , can be classified into three major categories the five zang-organs , including the heart , liver , spleen , lung and kidney ; the six fu-organs , including the gallbladder , stomach , small intestine , large intestine , bladder and triple energizer ; and the extraordinary fu-organs , including the brain , marrow , bone , vessel , gallbladder and uterus . 藏象学说以脏腑为基础。脏腑是人体内脏的总称，通过它们的生理功能，可以将它们分为五脏、六腑、奇恒之腑。五脏即心、肝、脾、肺、肾；六腑即胆、胃、小肠、大肠、膀胱、三焦；奇恒之腑，即脑、髓、骨、脉、胆、女子胞。4. The common physiological function of the five zang-organs is to transform and store essence ; while that of the six fu-organs is to receive , transport and transform water and food . 五脏的共同生理功能是化生贮藏精气；而六腑的共同生理功能是受盛传化水谷。 The extraordinary fu-organs , as a kind of fu-organs , differing form the six fu-organs in shape and physiological function , are relatively hermetic organs and do not contact with water and food directly . 奇恒之腑，近似腑脏，但在形态和生理功能上与腑脏不同，它们是相对封闭的脏器，与水谷没有什么直接联系。 So in the Chapter of Special Discussion on Five Zang-organs in Su Wen , it was described that “the so called five zang-organs refer to the organs that only store essence but not excrete it ; that is the reason why they can be full but not solid . 所以素问五脏别论说：“所谓五藏者，藏精气而不泻也，故满而不能实。 The six fu-organs are in charge of transporting and transforming food , so they can be solid but not full . 六腑者，传化物而不藏，故实而不能满也。 The reason is that the stomach becomes full and the intestines remain empty when food is taken into the stomach through the mouth ; the intestines become solid and the stomach gets empty when food is transported downward . That is what to be full but not to be solid and to be solid but not to be full means .” 所以然者，水谷入口，则胃实而肠虚；食下，则肠实而胃虚。故曰，实而不满，满而不实也。”5. The above mentioned fullness and solidity actually refer to the characteristics of essence and food . 以上提到的实和满实际指精气和水谷的特性。 Wang Bing said , “Essence is characterized by fullness and food by solidness . Since the five zang-organs only store essence , they can just be full , but not solid ; the function of the six fu-organs is to receive food but not to store essence , so they only can be solid but not full .” 王冰说：“精气为满，水谷为实。五脏但藏精气，故满而不实；六腑则不藏精气，但受水谷，故实而不能满也。”6. The significance for differentiating between the zang-organs and the fu-organs is not only for explaining their physiological functions , but also for guiding clinical practice . 区分脏与腑的重大意义不仅在阐述它们的生理功能，而且在于指导临床实践。 For instance , the disorders of zang-organs are of deficiency type mostly ; while the disorders of fu-organs are of excess type mainly . 例如：五脏的病变多属虚，而六腑的病变多属实。 The related fu-organ can be purged for the treatment of the excess type of zang-organ disorders , and the related zang-organ can be nourished for the treatment of the excess type of fu-organ disorders . 五脏之实证可借泻其腑以驱邪，六腑之实证自当补其脏以驱邪。 These therapeutic principles are still of great significance for guiding clinical practice until now . 这些治疗原则至今都对临床实践有着重要意义。7. The theory of visceral manifestation advanced on the development of the following three aspects . 藏象学说的发展基于以下三个方面的发展。8. ( 1 ) The knowledge of anatomy accumulated in ancient times . 早期解剖知识的积累 In Ling Shu , for instance , it says , “The eight-chi human body may be measured on the surface . After death , the body may be dissected and the texture of the zang-organs , the size of fu-organs , the capacity of the intestines , the length of the arteries , the condition of the blood can also be observed ” 比如灵枢中说：“若夫八尺之士，皮肉在此，外可度量切循而得之；其死，可解剖而视之。其藏之坚脆，腑之大小，谷之多少，脉之长短，血之清浊，皆有大数” From anatomys point of view , such a proper understanding of the human body laid concrete foundation for the theory of visceral manifestation in morphology . 从解剖的观点来看，这种对人体恰当的理解奠定了藏象概念的形态学基础。9. ( 2 ) The long-term observation of the human physiological functions and pathological changes . 长期对人体生理病理现象的观察和总结。 For example , since catching a cold produce such symptoms as stuffy nose , running nose and cough , the ancient people gradually came to realize that there was a close relationship between the skin and hair as well as the nose and lung . 例如感冒，症见鼻塞、流涕、咳嗽。因此，古人逐渐意识到了，皮毛、鼻、肺之间有着密切关系。10. ( 3 ) The repeated medical practice in which certain physiological were disproved and analyzed in the light of pathological phenomena and curative effect . 反复医疗实践，分析这些病理现象与治疗效应的对应关系，即可反证某些脏腑的生理关系。 For example , because eye disorders were mostly cured by treating the liver , the ancient people eventually reached the conclusion that “ the liver opens into the eyes ”. 例如，通过治疗肝脏，大可治愈眼疾，因此古人总结了一句话：肝开窍于目。11. The theory of visceral manifestation is mainly characterized by the concept of organic holism藏像学说的主要特征是具有独特的脏腑理论体系。. According to this theory , the zang-organs pertain to yin and the fu-organs to yang . 在这一学说里，脏属阴，腑属阳。One zang-organ is internally and externally related to a certain fu-organ , for example , the heart is internally and externally related to the small intestine , the lung to the large intestine , the spleen to the stomach , the liver to the gallbladder , the kidney to the bladder and the pericardium to the triple energizer . 脏与腑相为表里，比如心与小肠、肺与大肠、脾与胃、肝与胆、肾与膀胱、以及心包与三焦，构成表里关系。 These internal and external relations are deduced on the basis of the interconnection between meridians . 这些表里关系的推论是基于经络的内在联系。12. The physiological functions are closely related to mental and emotional activities . 脏腑的生理功能与人的精神情志密切相关。 Spirit, consciousness and thinking reflect the functions of the brain , which was already mentioned in Nei Jing . 脑的生理功能体现在人的精神、意识、思维上，在内经中早有提及。 However, the theory of visceral manifestation holds that spirit , consciousness and thinking are also closely related to the physiological functions of the five zang-organs . 但是藏像学说却认为人的精神意识思维与五脏的生理功能有密切联系。 Since the physiological functions of the five zang-organs control that of the whole body , the brain also depends on the five zang-organs to perform its physiological functions. 因为五脏主宰了整个机体，而脑则是在五脏的基础上来行使其生理功能的。 So the balance of the five zang-organs physiological functions is the key to the maintenance of relative constant of the internal environment of the human body. 因此，五脏生理功能的平衡是维持人体内环境稳定的关键。13. The above analysis shows that the theory of visceral manifestation , though based on ancient anatomy , was established mainly by means of observation according to the idea that “ viscera inside the body must manifest themselves externally .” 以上分析说明了，尽管藏像学说的形成以古代解剖知识为基础，但其发展主要是运用了“有诸内，必行诸外”的观察研究方法。Therefore , the result of the observation and analysis was inevitably beyond the viscera in human anatomy . That is why TCM has developed such a unique system for physiology and pathology . 因此，其观察和分析的结果必然会超越人体脏器解剖范围。那也是为什么中医已经形成了一个独特的生理病理体系的原因。14. As a result , the heart , lung , spleen , liver and kidney in the theory of visceral manifestation differ greatly in physiology and pathology from the corresponding organs in the modern human anatomy . 所以，在生理病理现象方面，藏像学说中的心肝脾肺肾的与现代解剖学对应的器官有很大区别。 In fact , the physiological function of one internal organ in the theory of visceral manifestation may include that of several internal organs in the modern human anatomy . Similarly , the physiological function of one organ in the modern human anatomy may be involved in that of several organs in the theory of visceral manifestation . 实际上，藏像学说里所指的一个内脏，在生理功能上包含了现代解剖学里的多个脏器。同样的，现代解剖学里的一个脏器也涉及到了藏像学说里的多个脏器。 This is due to the fact that the viscera in the theory of visceral manifestation is not only a simple anatomical concept , but also a concept that generalizes the physiology and pathology of a certain system . 这就是因为，脏在藏象学说里不仅是一个解剖概念，而且也是概括某一系统生理病理的概念。
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