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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

Sanjiao

Sanjiao in Western medicine

The closest western medicine system that resembles the sanjiao is the lymphatic system.

San-Jiao

Western Medicine Aspect

The function of lymphatic system can be summarized as follows

  • It is responsible for the removal of interstitial fluid from tissues
  • It absorbs and transports fattyacids and fats as chyle from the digestive system
  • It transports white blood cells to and from the lymph nodes into the bones
  • The lymph transports antigen-presenting cells (APCs), such as dendritic cells, to the lymph nodes where an immune response is stimulated.

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

Pericardium

Sanjiao in Western medicine

The Blockage of this Lymphatic system will result in swelling of limbs – which may be regional or generalized, depending on the cause

Pericardium

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)

Problems associated with Pericardium in western medicine

References

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

Three Major function of triple burner

what is original Qi?

  • Mobilizes the 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.

  • Controls transportation and penetration of qi

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

Nutritive qi (营气)

Controls the transportation and penetration of qi

Defensive qi (卫气)

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.

Blood

Body Fluids

  • Controls the water passages and the excretion of fluids

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.

Controls water passages and excretion of fluids

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

INTRODUCING PERICARDIUM

PERICARDIUM (emotional)

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.

Pericardium

pericardium

Heart and pericardium

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

reference

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

Upper Jiao Syndrome

吴鞠通

Pathology of Sanjiao

三焦辨证

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

Middle Jiao Syndrome

Lower Jiao Syndrome

Xue Yun

References

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…

  • Deficient essence
  • Lassitude, deafness
  • Decreased ying, overwhelming yang
  • Deficiency heat, fever, flushed cheeks, feverish feeling on hands and feet, dry mouth, deficient and large pulse
  • Water fails to nourish wood
  • Malnutrition of tendons and squirm of limbs.

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

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