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According to Maciocia, "Interrelationship is the essence of Chinese medicine since the body is regarded as an integrated whole." (Maciocia, 2005, p. 171) Therefore, even though the five Zang organs, which are known in TCM theory as the Heart, Lungs, Spleen, Liver and Kidneys, have their own vital functions, they are also interrelated and coordinated in order to maintain a balance among the Internal Organs.
Hence, in order to understand them properly, it is important that these vital functions are not considered in isolation but are seen as an inseparable part of all the functions since the human body is seen as an organic whole that depends on maintaining balance and harmony in order to achieve optimal health (Liu, 2009).
The Heart and Lungs are interrelated through Qi and Blood; the Heart governs Blood and the Lungs govern Qi. "Qi and Blood mutually assist and nourish each other." (Maciocia, 2005, p. 28) Although the Heart controls the circulation of Blood, it relies on the Lungs to provide the Qi to make Blood circulate. Conversely, the Lungs rely on Blood from the Heart as Blood nourishes Qi, therefore if Qi circulates well so does Blood. Consequently, Lung-Qi deficiency can lead to Heart-Qi stagnation, which in turn can lead to Heart-Blood stagnation which manifests with palpitations, chest pain and blue lips (Maciocia, 2005). Alternatively, if the Heart is diseased then this will impair the dispersion of Lung-Qi resulting in tightness in the chest, shortness of breath, coughing and laboured breathing (Liu, 2009).
The Heart and Liver are interrelated through Blood. The Heart governs Blood whereas the Liver stores Blood and regulates Blood volume. Therefore, a Liver-Blood deficiency can often lead to a Heart-Blood deficiency, resulting in palpitations and insomnia (Maciocia, 2005). Alternatively, if Heart-Blood is deficient, it can affect the Liver's job of regulating Blood volume causing dizziness and excessive dreaming (Maciocia, 2005). The Heart and Liver also mutually support each other on a mental level. "Blood is the material basis for mental and emotional activities." (Liu, 2009, p. 93) The Heart houses the Mind which controls mental activity, while the Liver ensures the emotions flow smoothly. A deficiency of both Heart-Blood and Liver-Blood causes malnourishment of the Mind resulting in symptoms such as palpitations, insomnia and possibly dream-disturbed sleep (Liu, 2009).
The main element of the relationship between the Heart and Kidneys is one of harmony between Fire and Water. The Heart resides in the Upper Burner and belongs to Fire which is Yang in nature. The Kidneys reside in the Lower Burner and belong to Water which is Yin in nature. In order to maintain harmony, Heart-Yang descends to warm Kidney-Yin and Kidney-Yin ascends to moisten Heart-Yang. (Liu, 2009) This constant interaction is referred to as "the mutual support of Water and Fire". (Liu, 2009, p. 93) If Kidney-Yin is deficient, it can't ascend to nourish Heart-Yin causing Empty-Heat of Heart-Fire resulting in palpitations, mental restlessness, insomnia, red flushed cheeks and night sweats (Maciocia, 2005). A deficiency in Heart-Yang can result in Heart-Fire not able to descend to assist Kidney-Yang resulting in palpitations, edema and dyspnea (Liu, 2009).
The relationship between the Liver and Lungs is one of Blood and Qi; the Liver stores Blood and ensures the smooth flow of Qi and the Lungs govern Qi. Therefore, the Liver relies on Qi from the Lungs to regulate Blood and similarly, Lung-Qi requires moisture and nourishment from Liver-Blood in order to flow smoothly. Another aspect of this relationship is the direction of flow of their individual Qi; the ascending of Liver-Qi is reliant on the descending of Lung-Qi and vice versa. "Both organs must function normally for Qi to be regulated properly." (Liu, 2009, p. 95) Consequently, stagnation of Liver-Qi in the chest and Liver-Qi failing to ascend to the Lungs can impede the flow of Lung-Qi causing cough, breathlessness and hypochondrial distension. Conversely, a deficiency in Lung-Qi will prevent Liver-Qi from rising resulting in Liver-Qi stagnation causing listlessness, depression, cough and hypochondrial pain. (Maciocia, 2005)
There is a close relationship between the Liver and Spleen, in which the Liver stores Blood and the Spleen makes Blood (Maciocia, 2005). Proper digestion and the normal circulation of Blood also rely on the close cooperation between the Liver and Spleen. (Liu, 2009) The smooth flow of Liver-Qi aids the Spleen's function of transformation and transportation helping digestion. Therefore, stagnation of Liver-Qi will prevent the Spleen-Qi ascending resulting in abdominal distension, hypochondriac pain and diarrhoea. "If the Liver loses its pliable nature, it can "invade" and cause disruption of the Spleen." (Kaptchuk, 2000, p. 82) Conversely, if Spleen-Qi is deficient this can result in undigested food which can affect Liver-Qi, resulting in abdominal distension, hypochondriac pain and irritability (Maciocia, 2005). Additionally, if the functions of the Spleen are impaired, Blood volume is reduced leading to a Liver-Blood deficiency. (Liu, 2009)
The Liver and Kidneys mutually support each other through Blood and Essence; the Liver stores Blood and the Kidneys store Essence. Liver-Blood continually nourishes and replenishes Kidney-Essence which in turn contributes to making Blood (Maciocia, 2005). "Essence and blood are interchangeable, when one is deficient, it can be supplemented by the other." (Wu, 2010) A deficiency in Kidney-Essence can lead to a Blood deficiency causing dizziness, tinnitus and blurred vision. Similarly, a Liver-Blood deficiency can lead to a Kidney-Essence deficiency because of the lack of nourishment from Liver-Blood resulting in deafness, tinnitus and nocturnal emissions. Insufficient Kidney-Yin will fail to nourish Liver-Yin leading to a Liver-Yin deficiency. This will result in hyperactivity of Liver-Yang causing blurred vision, tinnitus, dizziness, irritability, and headaches (Maciocia, 2005).
The relationship between the Spleen and Lungs is one of mutual assistance in the formation of Qi. The Spleen produces Qi and the Lungs govern Qi. Therefore, Spleen-Qi benefits Lung-Qi by continually providing Food-Qi upward to the Lungs where it combines with air to form Gathering Qi. Similarly, Lung-Qi influences Spleen-Qi whereby the Spleen relies on Lung-Qi descending to assist the Spleen in performing the transformation and transportation of food and Body Fluids. Hence "the Spleen is the origin of Qi and the Lungs are the axis of Qi." (Maciocia, 2005, p. 172) Therefore, a Spleen-Qi deficiency can result in insufficient Lung-Qi causing tiredness, weak limbs, breathlessness and a weak voice. Spleen-Qi deficiency can also result in the accumulation of fluids, which form Phlegm and impair the Lungs. Alternatively, Lung-Qi deficiency will impact the Spleen causing oedema (Maciocia, 2005).
The Spleen and Kidneys are related through mutual nourishment. The Spleen is the root of Post-Heaven Qi, whereas the Kidneys are the root of Pre-Heaven Qi. Hence, the Spleen relies on being warmed by Kidney-Yang in order to transform and transport food essence. Alternatively, the abundance of Kidney-Essence relies on a continual supply of Food-Qi transported by the Spleen (Liu, 2009). Therefore, if Spleen-Qi is deficient it will be unable to replenish Kidney-Essence, causing symptoms such as tiredness, tinnitus, dizziness and lower back ache. If Kidney-Yang is deficient, it will be unable to warm the Spleen resulting in diarrhoea and coldness (Maciocia, 2005). They also provide mutual assistance in relation to the transformation and transportation of Body Fluids. A deficiency in Spleen-Qi can result in the accumulation of fluids forming Dampness, which can impair the Kidneys' function of governing water and aggravate Dampness more. Conversely, a Kidney-Yang is deficiency can result in Dampness or oedema, chilliness and diarrhoea (Maciocia, 2005).
The Lungs and Kidneys are interrelated mainly through Qi and fluids. In relation to Qi, the Lungs govern Qi and respiration and the Kidneys stores Qi. Lung-Qi descends to communicate with the Kidneys, which respond by holding Qi down. If Kidney-Qi is weak, it will fail to hold the descending Lung-Qi resulting in asthma, breathlessness and cough (Maciocia, 2005). In relation to fluids, the Lungs regulate Water passages and send fluids down to the Kidneys, which respond by vaporising some of the fluids and sending them back up to moisten the Lungs. "Kidneys govern Water and the Lungs are the Upper Source of Water." (Maciocia, 2005, p. 180) If Lung-Qi is deficient, it loses its ability to send fluids down to the Kidneys resulting in retention of urine or incontinence. A deficiency in Kidney-Yin results in a lack of fluids causing Lung-Yin deficiency, producing symptoms such as dry cough, dry throat at night and night sweats (Maciocia, 2005).
The Spleen and Heart are interrelated through the formation and circulation of Blood. The Spleen makes Blood and the Heart governs Blood and controls Blood vessels. The Spleen "is the origin of Blood as it produces Food-Qi, which is the basis for the formation of Blood." (Maciocia, 2005, p. 62) When Spleen-Qi is in abundance, the source of Blood is also in abundance and the Heart is well nourished. A deficiency in Spleen-Qi, whereby it is unable to produce enough Blood, can often lead to a Heart-Blood deficiency resulting in palpitations, insomnia, dizziness and poor memory. Conversely, as Heart-Yang pushes Blood in the vessels and the Spleen is nourished by Heart-Blood, a deficiency in Heart-Yang can diminish the Spleen's nourishment (Maciocia, 2005).