On the 5 Major Physiological Regulatory Systems of the Brain as Spirit Storehouse in TCM

Xu Guangwen, Switzerland

(Continuing from the previous period)

3. The “5 spirit storehouses”: the connotations of the brain’s 5 major physiological regulatory systems

Chapter 23 of Suwen, entitled “Treatise Explaining the 5 Qi”, clearly states “what the 5 viscera store: the heart stores the spirit, the lung stores the corporeal soul, the liver stores the ethereal soul, the spleen stores reflection, and the kidneys store the mind”[2]. In chapter 9 of Suwen, entitled “Treatise on the 6 Periods and Visceral Manifestations”, Wang Bing comments that “the 5 spirit storehouses [are] first, the liver; second, the heart; third, the spleen; fourth, the lung; and fifth, the kidneys […] the liver stores the ethereal soul, the heart stores the spirit, the lung stores the corporeal soul, the spleen stores reflection, and the kidneys store the mind”[4]. Chapter 8 of Huangting Neijing Jing [Canon of the Inner Vista of the Yellow Court], entitled “The Heart Spirit”, says: “Namely, the heart spirit, lung spirit, liver spirit, kidney spirit, and spleen spirit are collectively referred to as the 5 storehouse spirits.” Integrating discussions from throughout history, “5 spirit storehouses” does not mean that the 5 viscera each store their own spirits, but rather the spirits stored by the 5 viscera all gather in the brain. The spirits are stored in the brain, integrating them into the 5 major physiological regulatory systems of the 5 spirit storehouses.

Physiologically, the heart spirit system maintains the order of life by regulating the viscera, bowels, qi, and blood: “The heart acts as the great governor of the 5 viscera and 6 bowels, commands and controls the ethereal and corporeal souls, and also completes the reflection and mind”(Leijing, volume 15, “Diseases”). “Namely, when anxiety stirs in the heart, the lung responds; when thought stirs in the heart, the spleen responds; when anger stirs in the heart, the liver responds; when fear stirs in the heart, the kidneys respond.” [5] This shows how the brain coordinates throughout the body. Pathologically, disturbance of the heart spirit presents with muddled consciousness (such as senile dementia) and affect-mind abnormalities (such as anxiety or depression), most of which are related to insufficiency of brain marrow and the heart spirit being deprived of nourishment. 

3.1 The heart spirit system: the “office of monarch” governing mental awareness

Chapter 8 of Suwen, entitled “Treatise of the Arcane Book of the Orchid Chamber in the Spirit Tower”, says that “the heart is the office of monarch, from which spirit light emanates”[2]. Here, the “spirit” that is “stored in the heart” is a general term for mental activity (including consciousness, thought, and perception), with the brain as the functional carrier. Volume 3 of Leijing, entitled “Visceral Manifestations”, comments that “the yang spirit is called the ethereal soul, the yin spirit is called the corporeal soul, and reflection, mind, thought, preoccupation, and the like are all spirit”[4]. This shows that the “heart spirit” is the core of the brain spirit, controlling the other 4 spirits. 

3.2 The lung corporeal soul system: the “office of assistant” controlling instinctive reaction and perception

Volume 3 of Leijing, entitled “Visceral Manifestations”, defines the “functions of the corporeal soul [as] being able to move and act; pain and itching are felt through it”[4]. The “corporeal soul” is the instinctive activity and basic perception that does not require conscious control (such as the heartbeat, respiratory rhythm, pain sensation, hearing, and the crying of a newborn baby). “The corporeal soul moves in and out with the breath; when the breathing is stable, the corporeal soul is quiet and calm” (Xuezheng Lun [On Blood Patterns])[5]. The core mechanism of the lung storing the corporeal soul is “the connection between lung qi and the brain”: chapter 17 of Lingshu, entitled “Vessel Measurement Standards”, says that “the lung qi connects to the nose; when the lung is harmonious, the nose can distinguish between malodor and fragrance”[2]. Yilin Gaicuo adds that “the nose connects to the brain; the malodor or fragrance that [one] smells returns to the brain”[5], showing that the lung enters the brain through the orifice of the nose, and the lung of the brain spirit (the corporeal soul) regulates the sense of smell and respiration. At the same time, “the lung governs qi and is in charge of breathing”; the lung qi drives the ancestral qi to pour upward into the brain, providing an impetus for the activities of the corporeal soul. Pathologically, disturbance of the lung corporeal soul presents with shallow and hasty breathing, a poor sense of smell, and blunted pain perception; for instance, feeble breathing and tendency to fatigue are often seen in those with lung qi vacuity [11]. 

3.3 The liver ethereal soul system: the “office of general” regulating emotions and the subconscious

Volume 3 of Leijing, entitled “Visceral Manifestations”, explains that “speaking of the ethereal soul, [things] like abstractions and dreams, and the realms of transmutation, illusion, and wandering, all [pertain to] it”[4]. The “ethereal soul” is the subconscious and emotional reactions that are produced along with the activities of the heart spirit (such as dreams, emotional fluctuations, and continuity of thought). The key to the liver storing the ethereal soul is that “liver blood fills the brain”. Chapter 80 of Lingshu, entitled “On Great Confusion”, says that “the liver stores the blood, the blood nourishes the ethereal soul, and the ethereal soul nourishes the eyes”[2]. If the liver blood is sufficient, the brain marrow will be nourished and the ethereal soul will be able to rely on it; emotions will be stable and dreams will be peaceful. If the liver blood is insufficient, the ethereal soul will be deprived of nourishment, leading to insomnia, profuse dreaming, irascibility, and blurred vision. Chapter 39 of Suwen, entitled “Treatise on Pain”, states that “[when there is] anger, the qi moves upward; blood counterflows along with the qi, causing the person to have a headache”[2]; in other words, disharmony of the liver ethereal soul (anger) causes qi and blood counterflow to the brain, proving the physiological connection between the brain and the liver’s ethereal soul [9][11]. 

3.4 The spleen reflection system: managing memory and cognition 

Volume 3 of Leijing, entitled “Visceral Manifestations”, says, “speaking of [when] a thought is engendered, [when] the heart has a direction but is undecided, [this] is called reflection”[4]. “Reflection” is the processing, selection, and memory of external information (including cognition, making plans, and storing experience). The core of the spleen storing reflection is that “the spleen’s movement and transformation engenders essence, which fills the brain”. Chapter 8 of Suwen, entitled “Treatise of the Arcane Book of the Orchid Chamber in the Spirit Tower”, says that “the spleen and stomach hold the office of the granaries, from which the 5 flavors emanate”[2]. The spleen converts the essence of water and grain into qi and blood, which pours into the brain through the channels and network vessels, providing a material basis for the activities of “reflection”. Chapter 17 of Lingshu, entitled “Vessel Measurement Standards”, notes that “the heart qi connects to the tongue; when the heart is harmonious, the tongue can recognize the 5 flavors”[2]. The fact that “the heart opens at the tongue” relies on the regulation of the spleen reflection: when the spleen reflection is normal, one will have a keen sense of taste, clear speech, and a solid memory. Disharmony of the spleen reflection presents with memory loss (such as forgetfulness), cognitive disorders (such as delayed intellectual development in children), and blunted sense of taste; that is, “when the spleen fails to move and transform, qi and blood are insufficient, the brain marrow is deprived of nourishment, and reflection is not preserved” (Yijing Jingyi [Essential Meaning of Medical Classics])[5][9]. 

3.5 The kidney mind system: the “office of labor” that governs willpower and endurance

Volume 3 of Leijing, entitled “Visceral Manifestations”, gives the following definition: “[when] reflection has made a decision and stands tall and firm, [this is] called mind” [4]. “Mind” consists of objectives that have already been determined and the ability to persevere (including willpower, endurance, and focus). The root of the kidneys storing the mind is the fact that “kidney essence engenders marrow to fill the brain”: Nanjing [The Classic of Difficult Issues] proposes that “the kidneys store essence, essence is transformed into marrow, and marrow fills the brain” [4]. Yijing Jingyi adds that “the kidneys govern the brain marrow […] when essence is sufficient, marrow can work. When marrow can work, the bones are strong. When essence is sufficient and the spirit is strong, naturally there is much ingenuity” [5]. This explains how the kidney essence is the origin of brain marrow. When kidney essence is sufficient, the brain marrow is full, the will is strong, and there is substantial resilience. When kidney essence is depleted, the brain marrow is insufficient, so there will be weakness of the will (such as giving up easily), decreased resilience (such as fatigue after the slightest taxation), and lapses in memory (such as senescent forgetfulness). Pathologically, disharmony of the kidney mind is often seen in premature senility and menopausal syndrome; most cases are related to wearing on kidney essence and brain marrow being deprived of nourishment [9]. 

4. The relationship between the brain, the 5 sense organs, and the channels and network vessels: concrete manifestations of the spirit storehouse’s regulatory functions 

As the center of the “5 spirit storehouses”, the brain must achieve regulation of the whole body through the 5 sense organs (eyes, ears, nose, tongue, and mouth) as well as the channels and network vessels. The 5 sense organs are the “windows” through which the brain spirit perceives the outside world, while the channels and network vessels are the “passageways” by which the brain spirit transmits signals. Together, they both constitute the connecting threads between the brain and the external world as well as the internal viscera and bowels. 

4.1 The physiological connections between the spirit storehouse (brain) and the sense organs 

4.1.1 The link between the brain and the eyes: the liver and heart govern vision

Chapter 17 of Suwen, entitled “Treatise on the Essential Subtleties of the Pulse”, says that “bright essence is that which is used to see the myriad things, differentiate white from black, and assess short and long” [2]. Zhang Xi-chun comments that “bright essence is the same as spirit light; the brain is the spirit of bright essence” [5], showing that the core of vision is in the brain. In terms of links to the viscera and bowels: ① The liver governs the eyes: chapter 17 of Lingshu, entitled “Vessel Measurement Standards”, states that “the liver qi connects to the eyes; when the liver is harmonious, the eyes can distinguish among the 5 colors”[2], and the liver blood “enters through the eye tie to connect with the brain” (Lingshu, chapter 62, “Transports”)[2], nourishing the brain spirit’s liver (the ethereal soul) in order to regulate vision. ② The heart governs the eyes: chapter 81 of Suwen, entitled “Treatise Explaining Subtle Essence”, says that “the heart, among the 5 viscera, concentrates essence, and the eyes are its orifice”[2]; the heart spirit “connects to the brain through the eye tie” (Yilin Gaicuo)[5] to guide visual judgment. Pathologically, when the brain marrow is insufficient, “the eyes see nothing” (Lingshu, chapter 33, “On Seas”)[2]; for example, blurred vision in cases of liver blood depletion and clouded flowery vision in cases of heart blood insufficiency are both related to the brain spirit being deprived of nourishment. 

4.1.2 The link between the brain and the ears: the kidneys govern hearing 

Chapter 5 of Suwen, entitled “Great Treatise on the Correspondences and Manifestations of Yin and Yang”, states that “the kidneys govern the ears […] among the orifices, they are the ears” [2]. Chapter 17 of Lingshu, entitled “Vessel Measurement Standards”, says that “the kidney qi connects to the ears; when the kidneys are harmonious, the ears can hear the 5 notes”[2]. The mechanism for this is the fact that “the kidneys govern brain marrow and the ears connect to the brain [via] an extremely direct and quick route” (Yijing Jingyi)[5]: kidney essence engenders marrow to fill the brain and the brain spirit’s kidneys (mind) “connect to the brain through a small tube in the earhole” (Yilin Gaicuo)[5] to regulate hearing. Pathologically, cases of kidney essence depletion often present with tinnitus and deafness; in other words, “when the sea of marrow is insufficient, the brain spins and the ears ring” (Lingshu, chapter 33, “On Seas”)[2]. 

4.1.3 The link between the brain and the nose: the lung governs the sense of smell 

Chapter 5 of Suwen, entitled “Great Treatise on the Correspondences and Manifestations of Yin and Yang”, states that “the lung governs the nose […] among the orifices, it is the nose”[2]. Chapter 17 of Lingshu, entitled “Vessel Measurement Standards”, says that “the lung qi connects to the nose; when the lung is harmonious, the nose can distinguish between malodor and fragrance”[2]. The key to this is the fact that “the nasal orifice connects to the brain; the brain percolates out as nasal mucus” (Suwen, chapter 81, “Treatise Explaining Subtle Essence”, annotation by Wang Bing)[4]. The lung qi drives the ancestral qi to pour upward into the brain and the brain spirit’s lung (the corporeal soul) perceives scents through the nasal orifice. Pathologically, cases of lung qi vacuity present with a diminished sense of smell; in other words, “ when the lung is harmonious, the nose can distinguish between malodor and fragrance; when the lung is in disharmony, the nose cannot smell malodor or fragrance” (Leijing, volume 8, “Channels and Network Vessels”)[4]. 

4.1.4 The link between the brain and the tongue: the heart governs speech and the sense of taste

Chapter 5 of Suwen, entitled “Great Treatise on the Correspondences and Manifestations of Yin and Yang”, says that “the heart governs the tongue; among the orifices, it is the tongue” [2]. Chapter 17 of Lingshu, entitled “Vessel Measurement Standards”, states that “the heart qi connects to the tongue; when the heart is harmonious, the tongue can recognize the 5 flavors”[2]. The pathway for this is the fact that “at the center of the tongue there are 2 tubes that internally connect to the brain qi, enabling the tongue to move and create speech” (Yilin Gaicuo)[5]. The brain spirit’s heart (spirit) achieves speech expression and taste perception through the orifice of the tongue. Pathologically, cases of heart spirit disharmony often present with stiffness of the tongue preventing speech (as in wind strike or stroke) and a blunted sense of taste; in other words, “when the heart is in disharmony, the tongue cannot recognize the 5 flavors and the speech is not clear” (Lingshu Xuanjie [Interpretation of the Magic Pivot]). 

4.2 The channels and network vessels enter the brain; they are the passageways by which the spirit storehouse (brain spirit) regulates the whole body

Chapter 4 of Lingshu, entitled “Forms of Disease from Evil Qi in the Bowels and Viscera”, records that “[regarding] the 12 channels and network vessels, and the 365 network vessels, their blood and qi all go up to the face and move through the empty orifice; their essence and yang qi move up to the eyes in order to see; their divergent qi moves to the ears in order to hear; their ancestral qi emerges up at the nose in order to smell; their turbid qi emerges in the stomach and moves to the lips and tongue in order to taste”[2]. This clearly points out that the channels and network vessels all move through the empty orifice, which is the brain orifice. The channels and network vessels enter the brain, so they are the passageways connecting the brain spirit (spirit storehouse) with the viscera, bowels, and 5 sense organs. Thus, the spirit storehouse (brain spirit) regulates the senses of vision, hearing, smell, and taste, and controls the physiological functions of the whole body [5]. 

The channels and network vessels primarily enter the brain through the following pathways: 

•The governing vessel enters the brain: Chapter 60 of Suwen, entitled “Treatise on Bone Hollows”, says that “the governing vessel […] passes through the spine and belongs to the kidneys; together with the greater yang [channel], it rises at the inner corner of the eye, goes up the forehead, intersects with the vertex, and enters to connect with the brain”. As the “sea of yang vessels”, the governing vessel transmits the yang qi of the whole body up into the brain to maintain the yang qi of the brain spirit. 

•The foot greater yang channel enters the brain: Chapter 21 of Lingshu, entitled “Cold and Heat Diseases”, states that “the foot greater yang [channel] has [a part that] connects to the nape and enters the brain, which belongs to the root of the eyes, and its name is called the eye tie […] it enters the brain.” This channel connects to the brain and eyes through the “eye tie”, transmitting liver and heart blood to the brain; it nourishes the brain to regulate vision[2]. 

•The hand and foot lesser yang channels enter the brain: Chapter 10 of Lingshu [The Magic Pivot], entitled “Channel Vessels”, says that “the gallbladder foot lesser yang vessel rises at the sharp corners of the eyes [i.e., the outer canthus], goes up to hit the corners of the head, and goes down behind the ears”. The hand lesser yang channel “ties behind the ears, and goes straight up to emerge from the upper corner of the ear”[2]. These 2 channels connect the brain to the ears and eyes, respectively, transmitting the qi of the gallbladder and triple burner to the brain to regulate hearing and vision[5]. 

The physiological significance of the channels and network vessels entering the brain is: all of the channels gather at the head and enter the network vessels of the brain, and the spirit storehouse (brain spirit) transmits regulatory signals through the channels and network vessels to the viscera and bowels (e.g., the kidneys of the brain spirit regulate the kidneys’ storage of essence through the kidney channel). The viscera and bowels also pour essence, qi, and blood up into the brain through the channels and network vessels (e.g., the spleen moves the essence of water and grain as well as qi and blood to the brain through the spleen channel), forming a bidirectional regulatory loop consisting of “the spirit storehouse (brain), channels and network vessels, and viscera and bowels”[5][11]. 

5. Discussion and future prospects 

5.1 Theoretical innovation: restoring the original theory of TCM brain storehouse manifestations 

Through a review of classic literature, this article corrects 2 key cognitive biases: (It breaks free from the limited notion that “the 5 viscera are anatomical organs”, clarifying the fact that the 5 storehouses in TCM are “unified bodies consisting of the physical forms of the viscera and the spirit storehouses”, and the spirit storehouses are centered in the brain, not dispersed in the organs of the 5 viscera. ) It corrects the misunderstanding that “the brain functions belong separately to the 5 viscera”. The core of the “5 spirit storehouses” in Huangdi Neijing is that “the 5 viscera store spirits and the spirit storehouses gather in the brain”. Medical experts throughout the ages have never proposed this “separate” view, which originates from misinterpretations of modern textbooks[5].  

The essence of the “brain as 5 spirit storehouses” theory is an expression of the TCM holistic view of “unified form and spirit” “centered on the 5 storehouses”: the physical forms of the viscera (the flesh-and-blood viscera) provide a material basis for the brain and the spirits of the 5 storehouses (the 5 major functional systems of the brain) govern vital activities. Both of these “can be divided, but not separated”; together, they form a living whole. This theory fits the 5-phase attribute pattern in Neijing, i.e. “heaven has 5 phases and humans have 5 storehouses”, and also provides a unique theoretical framework for TCM brain science research.

5.2 Clinical significance: providing new ideas for prevention and treatment of brain-related diseases

Based on the theory of the “5 major physiological regulatory systems of the brain as spirit storehouse”, TCM prevention and treatment of brain-related diseases (such as insomnia, dementia, wind strike or stroke, and anxiety) can be approached from the following directions [7][8][9]: 

•Nourish essence to fill the brain: For kidney essence depletion leading to insufficiency of brain marrow (such as senile dementia or premature senility), use methods that supplement the kidneys and replenish essence (such as cooked rehmannia root, lycium berry, cuscuta seed, and Left-Restoring [Kidney Yin] Pill variant formulas). Acupuncture and moxibustion: KI-03 (Great Ravine), KI-23 (Spirit Seal), and KI-25 (Spirit Storehouse) on the kidney channel; HT-07 (Spirit Gate) on the heart channel; as well as BL-23 (Kidney Transport) and SP-06 (3 Yin Intersection), to improve the brain spirit function through “kidney essence engendering marrow to fill the brain”. 

•Regulate qi to boost the brain: For lung qi insufficiency leading to disharmony of the lung corporeal soul (such as insomnia or shallow, hasty breathing), use methods that supplement the lung and boost qi (such as astragalus root, codonopsis root, white atractylodes root, and Spleen-Returning Pill variant formulas). Acupuncture and moxibustion: LU-01 (Central Treasury) and LU-09 (Great Abyss) on the lung channel, HT-07 (Spirit Gate) on the heart channel, and GB-13 (Root Spirit) on the gallbladder channel on the forehead, to stabilize instinctive reactions by using “lung qi to supplement the brain”. 

•Nourish blood to quiet the brain: For liver blood insufficiency leading to disharmony of the liver’s ethereal soul (such as insomnia with profuse dreaming and irascibility), use methods that nourish the liver and supplement blood (such as Chinese angelica, white peony root, spiny jujube kernel, and Liver-Supplementing Decoction variant formulas). Acupuncture and moxibustion: LV-03 (Supreme Surge) and LV-08 (Spring at the Bend) on the liver channel, HT-07 (Spirit Gate) on the heart channel, SP-10 (Sea of Blood) and SP-06 (3 Yin Intersection) on the spleen channel,  and GB-13 (Root Spirit) on the gallbladder channel on the forehead to supplement “liver blood to nourish the brain”, thereby regulating the emotions. 

•Fortify the spleen to nourish the brain: For cases of the spleen failing to move and transform leading to disharmony of the spleen reflection (such as forgetfulness and cognitive disorders), use methods that fortify the spleen and supplement qi (such as ginseng root, poria, dioscorea, and Ginseng, Poria, and White Atractylodes Pill variant formulas). Acupuncture and moxibustion: SP-03 (Supreme White), SP-06 (3 Yin Intersection), and SP-10 (Sea of Blood) on the spleen channel; ST-36 (Leg 3 Li) on the stomach channel; HT-07 (Spirit Gate) on the heart channel; and GV-20 (Hundred Convergences) on the governing vessel, in order to improve memory by “fortifying the spleen to engender essence and fill the brain”.  

•Quiet the spirit to stabilize the brain: For disharmony of the heart spirit leading to muddled consciousness and affect-mind abnormalities (such as anxiety and depression), use methods that nourish the heart and quiet the spirit (such as polygala root, poria, longan flesh, and Spleen-Restoring Decoction variant formulas). Acupuncture and moxibustion: SP-03 (Supreme White), SP-06 (3 Yin Intersection), and SP-10 (Sea of Blood) on the spleen channel; ST-36 (Leg 3 Li) on the stomach channel; HT-07 (Spirit Gate) on the heart channel; and GV-20 (Hundred Convergences) and GV-24 (Spirit Court) on the governing vessel, in order to quiet and settle the heart spirit by “supplementing heart blood to nourish the brain”. 

5.3 Research limitations and future directions

This article is based solely on a review of classic literature on the theoretical system of “the brain as 5 spirit storehouses”; it lacks the support of modern experimental research and clinical data. In the future, it will be necessary to undertake further clinical research to enhance this theory.

Conclusion

The theories of “form and spirit together” and the “5 spirit storehouses” in Huangdi Neijing establish a foundation for “the brain as spirit storehouse”, and  generations of medical experts continued to enrich its connotations through clinical practice. The 5 storehouses of spirits in TCM are unified bodies of “physical forms of viscera (flesh-and-blood viscera)” and “spirit storehouses (the brain governing spirit light)”. The brain is the center where the spirit storehouses converge, forming 5 major physiological regulatory systems, the “heart spirit, lung corporeal soul, liver ethereal soul, spleen reflection, and kidney mind”. Through the 5 sense organs, channels, and network vessels, they govern mental awareness, regulate the qi and blood of the viscera and bowels, control vital activities, and regulate the physiological functions of the human body. 

The theory of “the brain as the 5 spirit storehouses” not only restores the original theory of TCM brain storehouse manifestations, but also breaks free of cognitive limitations of the idea that “ the brain functions belong separately to the 5 viscera”. It provides a basis for innovation and development in TCM brain physiopathology; at the same time, it offers new ideas that “start from the brain to determine treatment while taking care of the 5 viscera” for the prevention and treatment of brain-related diseases . In the future, it will be necessary to integrate modern science and technology to further verify the scientific nature and clinical value of this theory, and promote the modernization of TCM brain science.

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作者简介：

徐廣文，1955 年出生。畢業於上海中醫藥大學，博士，主任醫師。

英國和瑞士注冊中醫師，針灸師。 郵箱：[email protected]