Five viscera-liver

The liver is located in the abdomen, under the diaphragm, under the right hypochondrium and on the left side. Together with gallbladder, eyes, tendons and claws, it forms the liver system. Dominate venting, hide happiness and hate depression, body yin and yang. The five elements belong to wood, which is the yang in yin. The liver corresponds to the spring of four seasons:

Anatomical morphology of liver

1. Anatomical location of the liver: The liver is located in the abdomen, under the diaphragm, under the right hypochondrium and slightly to the left. "The liver lives under the diaphragm, under the ninth vertebra of the spine" ("The Positive Diagram of Internal Organs" is necessary for doctors), "The liver ... its organs are in front of the right kidney, and the stomach penetrates the ninth vertebra of the spine" (The Fourteen Classics Play). It shows that Chinese medicine has correctly recognized that the liver is located in front of the right kidney under the right hypochondrium, but it should be pointed out that Chinese medicine also has the saying that "the liver is left and the lungs are right". It first appeared in Neijing, "The liver is born in the left and the lung is hidden in the right" (Su Wen Ci Ban)

Open "). Why the left liver and right lung? Because the left and right are the way of yin and yang, the qi of life, yang rises from the left and yin falls from the right. The liver belongs to wood, and it should be in the spring and live in the East, which is the beginning of Yang Sheng's life. The lung belongs to gold, so it should be in autumn and in the west. It is the beginning of hiding in the dark, killing and falling. The left is yang rising, and the right is yin falling. Therefore, the liver resides in the right, while its qi rises in the left; The lung lives above the diaphragm, and its qi descends from the right. The liver is dominated by yang, while the lung is dominated by yin. Therefore, from the physiological function characteristics of liver and lung, it is "left liver and right lung". It can be seen that "left liver and right lung" refers not to the anatomical site, but to its functional characteristics. Therefore, Zhang Jingyue said, "The liver is flourishing in the east, and its main source is in the middle, so its qi is born in the left. Lung gold thrives in the west, mainly converging, so its gas reservoir is on the right "(Jing Lei Acupuncture Class). In short, the liver is born on the left, that is, the liver qi dominates the rise, and its treatment is on the left. According to the theory that the left rises and the right falls, the qi of the liver is on the left. 2. Morphological structure of the liver: The liver is a lobulated organ with leaves on the left and right, and the color is purplish red. Although there are records about the division of liver in TCM literature, there are many inaccuracies. For example, there is a difference between "only two leaves" and "three leaves on the left, four leaves on the right and seven leaves on the * * *" in Difficult Classics. Yang Shangshan believes: "The liver, according to the big leaf, is also a two-leaf. If it is said by Xiao Ye, it will flourish "(Notes on Difficult Classics). According to Yang's description, the surface of the liver is divided into two lobes, and the inner lobe is a five-lobe anatomical entity.

Physiological function of liver

1. The liver governs the discharge: the liver governs the discharge, which means that the liver has the functions of discharging and Shu Da, so as to keep the whole body qi flowing smoothly, dispersing without stagnation, and dispersing without depression. The liver governing the discharge is an important condition to ensure the normal operation of various physiological functions of the body. Dredging means dredging, dredging and venting means rising and venting. Drainage, ventilation, dredging. The word "Shu" first appeared in Su Wen's On Zheng Wuchang: "The soil is sparse, and the air is pale", which is synonymous with the soil and the wood. Zhu Yuan Danxi clearly put forward "the liver is also sparse" for the first time (Yang Sheng Yin Deficiency Theory).

In human physiological activities, the main functions of the liver governing the discharge are:

(1) Regulating Qi: The physiological function of the liver governing the flow of qi is generally related to regulating the qi of the human body. The movement of qi is the up-and-down movement of qi. Rising and falling are the basic forms of gasification. The human body is a constantly vaporizing organism. The ascending and descending process of gasification is realized through the functional activities of viscera. The meridians, qi and blood, body fluid, ying and Wei, yin and yang of human viscera are all interrelated, maintaining their normal physiological function: the purgative function of the liver, which plays an important role in dredging and regulating the ascending and descending balance of qi in various organs and tissues of the whole body. "the twelve meridians's qi in the zang-fu organs must be inspired by the qi in the liver and gallbladder, so that it can be unobstructed and not ill" (Volume 4 of Essays on Reading Doctors). Therefore, if the excretory function of the liver is normal, the qi will be regulated smoothly, the qi and blood will be harmonized, the meridians will be unblocked, and the activities of the viscera and tissues will be coordinated normally.

(2) Regulating mental mood: Emotion, that is, emotion, refers to a psychological process that mainly reflects emotional changes in people's mental activities. Emotion in TCM belongs to the category of God in a narrow sense, including joy, anger, worry, thinking, sadness and fear, also known as seven emotions. The liver can regulate people's mental and emotional activities through its function of relieving qi. People's spiritual and emotional activities are not only dominated by the mind, but also closely related to the liver's catharsis function. Therefore, there is a saying that "the liver governs the mind" ("Su Wen's Secret Collection"). Thinking is thinking, thinking deeply. The function of the liver is to assist thinking to participate in the regulation of neuropsychiatric activities such as thinking and emotion. Under normal physiological conditions, if the function of the liver is normal, the liver qi rises, and it is neither excited nor depressed, and it is comfortable, then people can better coordinate their mental and emotional activities, which are manifested as being cheerful, comfortable, clear-headed, quick-thinking, calm and calm. If the liver is not excreted smoothly, it is easy to cause abnormal mental and emotional activities. If you don't let go, you will be depressed and sentimental. Excessive venting is manifested as irritability, head swelling and headache, and blushing.

Liver governing the discharge and emotional disorder are often mutually causal. Emotional abnormality caused by liver failure is called depression. Liver failure caused by abnormal mood is called depression due to illness.

(3) Promote digestion and absorption: the spleen and stomach are the main digestive organs of the human body. Stomach governs reception and spleen governs transport and transformation. The liver governing the discharge is an important condition to maintain the normal digestion and absorption of the spleen and stomach. The liver can promote the digestion and absorption of the spleen and stomach by coordinating the qi movement of the spleen and stomach, secreting and excreting bile.

Coordinate the rise and fall of qi in the spleen and stomach: stomach qi dominates the decline, and Shui Gu decomposes and transports it to the spleen; Temper is dominant, while Shui Gu subtly irrigates the surrounding areas. Spleen ascending stomach descending constitutes the digestive movement of spleen and stomach. The normal function of the liver is an important condition to maintain the coordination of the spleen and stomach lifting hub. Liver belongs to wood, spleen and stomach belong to soil, and soil gets wood. "The nature of wood depends on drainage. Eating gas to one's stomach is completely relieved by the gas of liver and wood, then Shui Gu will be transformed. If the liver stands upright, it can't drain the valley, and it will be full of seepage "(On Blood Syndrome and Pathogenesis of Zang-fu Organs). It can be seen that the digestion and absorption of diet are closely related to the antidiarrheal function of the liver. Therefore, the antidiarrheal function of the liver can not only help the spleen to transport and transform, so that the qi of clearing yang rises, and the subtle Shui Gu can be attributed to the lung, but also help the stomach to absorb and decompose, promote the decline of the qi of turbid yin, and release chyme into the small intestine. If the liver loses the function of transforming qi and the spleen interferes with the stomach, the spleen and stomach will rise and fall abnormally. Clinically, besides the symptoms of stagnation of liver qi, there may also be symptoms of disharmony between liver and stomach, such as warm nausea, abdominal distension and loose stool, such as stagnation of spleen qi.

Bile secretion and excretion: Bile adheres to the liver and contains bile, which can promote digestion. Bile is formed by accumulation of qi outside the liver. As Dai Qizong said: "The essence of gallbladder overflows people's gallbladder, because the liver qi is too strong, so (gallbladder) hides in short leaves and lives side by side, with three kinds of essence juice in it, and its juice is clean" (Pulse Tactics Wrong Volume). It can be seen that bile comes from the liver and is stored in the gallbladder, and bile is excreted into the intestinal cavity to help digestion and absorption of food.

(4) Maintaining the circulation of qi and blood: the release of the liver can directly affect the smooth flow of qi. Only by regulating Qi-flowing can we give full play to the functions of heart governing blood, lung assisting heart and activating blood, and spleen governing blood, thus ensuring the normal operation of qi and blood. Therefore, when the liver qi is comfortable, the blood can run with it, and the storage and discharge are moderate. "Blood follows the pneumatic, and the peripheral flow will not stop" (Four Syndrome Treatments of Wind-induced Fatigue and Diaphragm). The source of blood is qi, which leads to blood circulation, and qi stagnation leads to blood stasis. If the liver loses the function of the pump, it will inevitably affect the operation of qi and blood. If qi is blocked, qi stagnation leads to blood stasis, tingling in chest and hypochondrium, and even stagnation, lump, dysmenorrhea, amenorrhea, etc. If qi is in disorder, it will also cause blood to flow out from the normal way. As the saying goes, "blood is the combination of qi, heat of qi is the cold of qi, rising of qi is the decline of qi, and coagulation of qi is the depression of qi" (due to the theory of water mirror or purple or black).

(5) Regulation of water-liquid metabolism: The regulation of water-liquid metabolism is mainly completed by lung, spleen, kidney and other viscera, but it is also closely related to liver. Because the liver governs the drainage, it can smooth the qi of triple energizer, and promote the function of regulating water-liquid metabolism of upper, middle and lower triple energizer, lung, spleen and kidney, that is, regulating water-liquid metabolism by promoting the transport of water and dampness of spleen, transport of water and fluid of lung and evaporation of kidney. Triple energizer is the channel of water-liquid metabolism. "If the focus is not healed, water will make it high; If the coke in the middle is not solidified, water will stay in the middle; If the coke is not solidified, the water will be chaotic. When the triple energizer is treated with qi, the veins are smooth and the waterways are favorable (Jing Dirty Image). In fact, the function of triple energizer is a combination of the functions of lung, spleen and kidney in regulating water and fluid. When the liver is excreted normally and the qi is regulated smoothly, then the triple energizer can be treated with qi, the waterway can be unblocked and the body fluid can be unblocked. It can be seen that the liver regulates the water-liquid metabolic activity in the body through its functions of relieving qi and regulating triple energizer, which is the theoretical basis of regulating qi and controlling water. However, it should be pointed out that the method of regulating qi is not the main method to treat edema, but an important part of assisting water circulation.

(6) Adjustment and replication

① Conditioning Chong and Ren: Women's special physiological activities, such as menstruation, belt, fetus, childbirth, etc., are all related to the functions of many viscera and organs, among which the liver plays an important role, and there is a saying that "women are born in the liver". Women focus on blood all their lives. Because the consumption of menstrual blood, pregnancy, pregnancy and childbirth bleeding all involve blood, women are full of qi and lack of blood. Chong is a sea of blood, and the main fetus is a secondary pulse, which is closely related to the physiological function of women. The liver is a sea of blood, and the two meridians of Chong and Ren are connected with the liver meridian of Foot Jueyin, belonging to the liver. The liver governing the discharge can regulate the physiological activities of chong and ren. The liver's excretory function is normal, the qi in the meridian of Foot Jueyin is smooth, and the ren meridian is promoted by it, so that the ren meridian is smooth, the pulse is too strong, the menstruation is normal, the leucorrhea is normal, and the pregnancy and delivery are smooth. If the liver loses its function, it will lead to imbalance of chong and ren, disharmony of qi and blood, which will lead to menstruation, leucorrhea, fetal disease, sexual dysfunction and infertility.

② Regulating the sperm room: The sperm room is where men hide their sperm. When a man's kidney is full of qi, the essence will overflow and he will have reproductive ability. The opening and closing of male testis and the storage and discharge of semen are related to liver and kidney function. "The kidney is also the main source of zang-fu organs, and the liver is also the source of qi-flowing" (Theory of Excess of Yang and Deficiency of Yin). If the release of the liver and the closure of the kidney are coordinated and balanced, the opening and closing of seminal vesicles will be moderate, the excretion of semen will be inhibited, and the sexual and reproductive functions of men will be normal. If the liver is abnormal, it will lead to disharmony between opening and closing. It is better to see low sexual desire, impotence, oligospermia, infertility, etc. If it is too much, sexual desire will be high, sun be the spirit will be strong, and wet dream will appear.

(1) Liver controls blood storage: Liver storing blood means that the liver has the functions of storing blood, preventing bleeding and regulating blood volume. Therefore, the liver governs the blood sea.

① Blood storage: Blood comes from Shui Gu subtle, biochemical in spleen and stored in liver. Storing a certain amount of blood in the liver can not only nourish itself, but also restrict the yang of the liver, so as to maintain the balance of yin and yang, harmonize qi and blood, and prevent bleeding. Therefore, if the liver does not store blood, it will not only lead to liver blood deficiency, but also lead to bleeding.

② Regulating blood volume: Under normal physiological conditions, the blood volume of all parts of the human body is relatively constant. However, the blood volume of different parts of the human body often changes with different physiological conditions. When the body is active or emotional, the blood demand of all parts of the body will increase accordingly, so the blood stored in the liver will be distributed to the periphery of the body for the needs of physical activities. When people have a quiet rest and are in a stable mood, due to the reduction of activities in various parts of the body, the demand for peripheral blood of the body is correspondingly reduced, and part of the blood is stored in the liver. The so-called "human movement leads to blood flowing in the meridians, while human quietness leads to blood returning to the liver". Because the liver has the function of storing blood and regulating blood volume, it is called "blood sea".

When the blood storage function of the liver is damaged, there are two situations: one is blood deficiency. In liver blood deficiency's disease, the blood distributed all over the body can't meet the needs of physiological activities, and there may be pathological changes of blood deficiency and malnutrition. Blood loss leads to dry eyes and dim vision, or night blindness; If the tendons are not nourished, the tendons will be tense, the limbs will be numb, the flexion and extension will be unfavorable, the menstrual flow of women will be less, and even amenorrhea will occur. The second is blood rash. Pathological changes of bleeding tendency, such as hematemesis, epistaxis, menorrhagia, metrorrhagia and so on, may occur if the liver does not store blood.

(2) The liver governs blood production: the liver governs blood production, that is, the liver participates in blood production. The liver not only stores blood, but also produces blood. "The liver ... is filled in the tendons to invigorate the blood" (Su Wen's Six Sections on Zangxiang), "Qi is not needed, but it is better than the kidney. If the essence does not leak, it will return to the liver and clear the blood "(Zhang Yitong Xue Zhuren). It can be seen that the liver is involved in the production of blood.

The liver governs the drainage and the liver governs the production of blood: the liver takes blood as the body and qi as the use. "The liver governs blood, and the liver is autotrophic with blood. Sufficient blood is soft, but insufficient blood is strong "(volume 6 of Treatise on Febrile Diseases). The liver produces blood and the liver itself is full of blood. Rigid mass is soft. If it is smooth, there will be no danger of upward movement. Eliminating qi and generating blood, liver qi and liver blood are mutually used, and dynamic and static are mutually generated. Liver blood deficiency, on the other hand, has excessive liver qi, excessive body fluid, liver qi, liver fire and liver wind.

Physiological characteristics of liver

1. Ganxi turn up: turn up, stretch, smooth and accessible. Depression, stop block. The liver is the dirty of wind and wood, and the liver qi rises, which makes you happy and disgusting. Liver qi should be kept soft and comfortable, and normal physiological functions can be maintained, just like the growth of trees in spring. Liver governing ascending hair means that the liver has the characteristics of long ascending hair period and endless vitality, and has the function of inspiring the growth and education of various organs. Liver belongs to wood, and its qi passes through spring. In Haruki, it is pregnant and gives birth to a lifting machine. Because of the lifting property of Haruki, it is similar to the liver. Therefore, it is called liver governing ascending hair, and it is also called liver governing ascending qi. Reaching out is the nature of wood. In nature, all wood belongs to this genus, its growth trend likes stretching, smoothness and openness, and it extends its natural nature without suppression or deterrence. Liver belongs to wood, and the nature of wood reaches the limit, so the nature of limit is also the nature of liver. Liver-soothing refers to liver-soothing, that is, liver-qi-soothing. Under normal physiological conditions, the liver qi rises, which is soft and comfortable, not depressed and not excited, and rushes smoothly. Therefore, Tang Rongchuan said: "The liver belongs to wood, and the wood is flourishing and developed. If you are not depressed, your blood vessels will be smooth "(Theory of Blood Syndrome and Pathogenesis of Zang-fu Organs). If the liver qi does not rise and stagnate, symptoms such as chest tightness, hypochondriac pain, depression and unhappiness will appear. If the liver qi rises too much, there will be symptoms such as impatience, dizziness, headache and abdominal distension. This characteristic of the liver is closely related to the physiological function of the liver in regulating the flow of qi.

When the liver qi rises without depression, the liver's drainage function is normal. The physiological function of the liver governing the discharge is determined by the nature that the liver is fond of ascending and winding up. 2. The liver is just dirty: the liver is the dirty of wind and wood, and it likes everything but hates depression. Its qi is easy to be reversed and strong, so it is called. It's just, it's just that rape is urgent. Strong liver, irritability and easy resistance, so it is called "the official of the general." It is taboo for the liver to use yin and yang, which is the dirty of wind and wood, and its qi dominates the initiative, and it is also taboo to be bored with achieving goals. The rigidity of the liver is caused by the nature that the liver uses yin and yang. The liver is yin, and if it is combined with yang, yin and yang, rigidity and softness, the function of the liver is normal. Therefore, the Japanese said: "The liver is the dirty of wind and wood, because there is fire inside, and the body is yin and yang. Its nature is rigid, positive and upward, all because the water of God is used to contain it, the blood is used to moisten it, and the descending order of lung gold is leveled. If you cultivate the simple atmosphere of Zhonggong Dunfu, you will be both rigid and flexible, so you will be smooth and energetic. What's the disease?

The significance of the "body yin" of the liver: First, the liver belongs to the category of yin organs, located under the diaphragm, so it belongs to yin; Second, the liver stores yin and blood: blood belongs to yin. The liver must rely on the nourishment of yin blood to play its normal physiological role. The liver is just dirty, not soft, not discordant.

The significance of liver "using Yang" is as follows: firstly, according to the physiological function of liver, the liver controls catharsis, has sexual pleasure and internal fire, and rises voluntarily, belonging to Yang according to the yin-yang attribute; Second, from the pathological changes of the liver, it is easy to hyperactive yang and move wind. Liver diseases are often manifested as hyperactivity of liver yang and internal movement of liver wind, which causes dizziness, numbness of limbs, convulsions, tremors, inversion of angular arch and other symptoms. Qi is yang, blood is yin, yang is dynamic, and yin dominates quietness, so the liver is called "body yin and yang".

In fact, the relationship between the physical structure and physiological function of the liver is summarized, and the main characteristics of the physiological and pathological changes of the liver are also revealed.

Because the liver has the characteristics of body yin and yang, in the clinical treatment of liver diseases, "drugs should not be rigid and soft, and should not be cut and balanced" (volume 3 of Syndrome Differentiation and Treatment). Nourishing yin, nourishing blood and benefiting the liver, or cooling the liver and purging the liver are commonly used to inhibit the hyperactivity of liver qi and liver yang.