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Middle Burner runs from the entrance to the stomach down to its exit at the pyloric valve and controls digestion by harmonizing the functions of stomach, spleen, and pancreas.
Located at the abdomen/hypochondriac
Considered as maceration chamber
( ‘bubbling cauldron’)
The core of digestion – spleen and stomach
Described as ‘ rating and ripening’
Governs transformation
Disorder – accumulation/stagnation of food in stomach
San Jiao
The closest western medicine system that resembles the sanjiao is the lymphatic system.
Western Medicine Aspect
The function of lymphatic system can be summarized as follows
The lympthatic system is in charge of taking up the interstitial fluid, and carrying it back to the circulatory system.
Lymphatic system has very important role in the body’s defensive mechanism. It contributes to production and circulation of lymphocytes.
Lawenda BD, Mondry TE, Johnstone PA. Lymphedema: a primer on the identification and
management of a chronic condition in oncologic treatment. CA Cancer J Clin 2009; 59:8.
Human Physiology: From Cells to Systems, by Lauralee Sherwood
The Blockage of this Lymphatic system will result in swelling of limbs – which may be regional or generalized, depending on the cause
Where is it?
Located just around the heart, it envelops the whole heart excluding the vessels leading to the heart.
Function
It is a fibroelastic sac that envelops the heart, preventing heart to overfill with blood.
Reduces friction with other organs such as the lungs
It is filled with “pericardial fluid”. (1)
Its Western Medicine aspect
Massimo Imazio, MD, FESC; Clinical presentation and diagnostic evaluation of acute pericarditis; UptoDate.com (sited 8/4/2014)
Cardiac tamponade
accumulation of pericardial fluid under pressure.
Constrictive pericarditis
Constrictive pericarditis is the result of scarring and consequent loss of the normal elasticity of the pericardial sac.
Pericarditis
Infection of the pericardium by virus / bacteria.
May lead to scarring and fibrotic change
Lawenda BD, Mondry TE, Johnstone PA. Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment. CA Cancer J Clin 2009; 59:8.
Human Physiology: From Cells to Systems, by Lauralee Sherwood
Massimo Imazio, MD, FESC; Clinical presentation and diagnostic evaluation of acute pericarditis; UptoDate.com (sited 8/4/2014)
Imazio M. Contemporary management of pericardial diseases. Curr Opin Cardiol 2012; 27:308.
Imazio M. Contemporary management of pericardial diseases. Curr Opin Cardiol 2012; 27:308.
Sweat
三焦
flows between skin and mucous
Introducting San Jiao
The reference “San Jiao” (三焦) can be found in Yellow Emperor’s Huang Di Nei Jing.
Wu Ju Tong (Qing Dynasty) was the first to identify a disease according to the San Jiao a.k.a Triple Burner or Triple Heater.
It is also called as the “Minister of Dykes and Dredges” (决渎之官) of the body.
Chapter 30 of Ling Shu stated that “ the upper burner is like mist”. “若雾露之溉”
Has a diffusing and dispersing function.
Upper jiao diffuse and disperse defensive qi.
Upper burner distributes fluids by the lungs to all over the body in space between skin and muscles in the form of fine vapour.
One of the Six Fu Viscera.
It is a fire-energy Yang organ.
The triple burner is very
controversial.
Does it have any form?
Is it an actual organ with functions?
Stomach Juice
what is original Qi?
Original Qi activates all physiological functions and provides heat
Original qi is the transformation of innate essence(先天之精) with the input of acquired essence (后天之精).
Yuan qi resides in between kidney.
Yuan qi is closely related to the “Fire Gate Of Life” (命门).
Share the role of “Fire Gate of Life” to provide heat necessary to all body’s function activities.
Triple burner controls the ascending-descending and entering-exiting of qi in the Qi mechanism.
Triple burner controls the movement of “penetration” (通) of qi in general
Qi Transformation By Triple Burner the function of triple burner in ensuring the qi passes through the qi mechanism, in all the cavities and organs.
Triple burner controls all types of qi
Qi transformation results in the production of
Triple burner controls the three qi
<<难经.六十六>>说: “ 三焦者,原气之别使也”
Chapter 66 of “Classic of Difficulties” : “ The triple burner makes the original qi seperates”
Upper Burner Gathering qi
Middle Burner Nutritive qi
Lower Burner Defensive qi
Defensive qi exerts its influence primarily on upper burner and superficial layers of body. However it originates from lower burner.
Triple burner is responsible for the free passage of qi in all channels and structures of body.
Moisten body & integrate Blood
Controls water passages and excretion of fluids
Triple burner is the official in charge of “irrigation” and controls transportation and excretion of fluids from body.
Triple burner is responsible for transformation, transportation and excretion of fluids.
The chinese word which has connection to the influence of triple burner on body fluids is 疏 (free flow) and 通 (free passage).
Like a system of canals and waterways to channel irrigation water out.
2. Its transportation and excretion of body fluids is closely dependent on its transformation and penetration of qi.
Triple burner influence the qi mechanism.
3. Process of transformation, transportation and excretion of fluids leads to formation of various body fluids in each of the three burners
From the ‘ Spiritual Axis’ in Chapter 18 :
Middle Jiao is situated in the stomach…….it receives Qi, expels the wastes, steams the body fluids, transformed the refined essences of food and connects upwards with the lungs.”
Considered as the ‘Drainage Ditch’
Main physiological process
Separate essences of food – clean and turbid
Excrete waste
Separate the clean from the turbid of the fluids
Facilitates the excretion of urine
Governs excretion
Urine
From the ‘ Spiritual Axis’ in Chapter 18 :
“Food and drink first enter the stomach, the waste products go to the large intestine in the Lower Jiao which occurs downwards, secretes the fluids and transmits them to the
bladder.”
the WESTERN Aspect of San-Jiao and Pericardium
Small amount of fluid in stool
Pericardium energy is related to the loving feelings associated with sex.
It is a fire-energy organ.
Provides heart with physical protection.
The energy also protects the heart from damage and disruption by excessive emotional energies generated by the other organ.
Liver Anger
Kidney Fear
Lungs Grief
Helps regulate circulation in the major blood vessels that run in and out of the heart
Pericardium (心包) also known as “pericardium meridian”
Is called the “heart protector”.
Is a Yin organ paired with yang organ San Jiao.
“huang di nei jing”(黄帝内经)also called the “King’s Bodyguard”(心主之官城)
It moderates the raw sexual energy of the kidneys with the all embracing love generated by the heart.
Thus, linking the physical and emotional aspect of sexual activities.
Heart is the main organ of the five zang and six fu, is the place where the spirit live
After the invasion by pathogenic factors, heart hurt
The spirit will leave the body and death
《灵枢。邪客》:“心者,五脏六腑之大主也,精神之所舍也。其脏坚固,邪弗能容也。容之则心伤,心伤则神去,神去则死矣。”
viscera picture theory(藏象学说):
helpful against heart protection.
The heart can be called the monarch of human body, can not suffer by pathogenic factor
if pathogenic factor invades into the heart, the pericardium will first bear it
心包有“代心受邪”之用。心为人身之君主,不得受邪,所以若外邪扰心,则心包络当先受病
Paired organ : Triple burner
Colour : Purple red
Peak hours : 7pm – 9pm
Mental qualities : Love and sex
Physical branches : blood, tongue, throat,
sweat, facial complexion
Pathogenic heat entering the heart orifice
热入心包
http://www.tcmbasics.com/zangfu_5zang_heart.htm
http://baike.baidu.com/view/1383900.htm
If pathogenic heat attacks the heart, the symptoms are :
unconsciousness神昏
Delirium缠语
If pathogenic phlegm(痰阻心窍) causes :
mental confusion意识模糊
mental disorder昏迷不醒
pathogenic phlegm obstructing the heart orifice
痰蒙心包
Presenters - Dylan Oo
Clinical Application of San-Jiao
Daphne Kho
Pericardium
The San jiao Syndrome
(“温病条辨” by吴鞠通)
吴鞠通, a specialist in Warm Disease in the Chin
Dynasty – wrote 温病条辨 -“analysis of Warm
Diseases”
In his system, the syndromes of externally
contracted warm diseases are classified into…
Upper jiao
Middle Jiao
Lower Jiao
Also suggested that there are stages in the
progress of warm diseases.
Warm Heat attack
Lung Channel of Hand-Taiyin
Pericardium Channel of Hand- Jueyin
A) Warm heat enters by mouth and nose,
hence defense system of lungs are affected.
Fever, red tongue edge, floating rapid pulse, aversion to cold, cough, sweating, thirst.
B) Heat pathogen enters the interior and the
Lung, lung qi cannot descend – reversed flow
of qi.
Cough, panting, thirst
C) Pathogen travel to pericardium
Mind disturbed, high fever, rigid tongue, cold limbs, Crimson tongue
Tatsuki Abe
Xue Yun
Heat pathogen travel from the upper jiao to
Middle jiao.
May transform into the Dry-heat (Yang-ming) pattern or damp heat (Tai-Yin) pattern,
Depending on the main organ affected out of Spleen / Stomach
Late stage of illness – pathogen invade the
Lower Jiao, injures Liver Yin and Kidney Yin.
Heat pathogen stays long and injures the
2 organs causing…
Dry-heat – stomach prefers moistness, so stomach
Heat and injury to body fluid causes…
Accumulation of dry stool, fever, flushed cheek, harsh braething, abdominal fullness, constipation, thirst, preferring cold drink, dry mouth, cracked lips, concentrated urine, deep, excess, and forceful pulse or deep and rough pulse
Diagnostics of Traditional Chinese Medicine – 2nd edition.
Clinical Foundation of Traditinoal Chinese Medicine – National Planned University Textbook for International Traditional Chinese Medicine Education - 2008
Damp-heat – Spleen prefers dryness, damaged spleen will
caused blockage of Qi which causes…
Mild fever, distended feeling of head, heavy sensation of body,
suffocating feeling in the gastric region, nausea, difficulty defacating,
loose stools, difficult urination, red tongue, soggy and rapid pulse
心包