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Gallbladder
胆 〔膽〕dǎn
Abbreviation: GB. The gallbladder is located between the lobes of the liver and stands in exterior-interior relationship with the liver. Like the liver, it belongs to wood among the five phases. Its associated channel is the foot lesser yáng (shào yáng) gallbladder channel. The gallbladder stores and discharges bile and governs decision. The functions of the gallbladder are closely related to the liver’s free coursing action.
Gallbladder Functions
The Gallbladder Stores and Discharges Bile
According to traditional theory, bile is produced from a surplus of liver qì. Ancient physicians understood bile to be an internal product of the body rather than a waste product. They regarded it as clean and pure. Hence they described the gallbladder as the bowel of center essence
(中精之腑 zhōng jīng zhī fǔ), the
(清净之腑 qīng jìng zhī fǔ), and bowel of center clearness
(中清之腑 zhōng qīng zhī fǔ). In this lies a unique feature of the gallbladder. While the five other bowels deal with external products and waste products, the gallbladder stores and discharges a clear substance, and hence has an affinity with the viscera, which store essential qì.
For this reason, it is classed not only as one of the six bowels but also as one of the extraordinary organs.
Revised Conception of Bile
The fact that Chinese medicine traditionally failed to associate jaundice with bile anomalies has apparently troubled modern scholars so much that they have modernized traditional theories. Previously the yellow coloring of the skin in jaundice was naturally explained as a spleen problem, on account of yellow being the color associated with spleen-earth. This has now been adjusted to include the notion of bile, without discarding the traditional explanations altogether.
According to biomedicine, bile is an alkaline fluid secreted by liver cells, stored in the gallbladder between meals, and released into the duodenum upon eating. Bile contains substances that aid digestion of fats, as well as waste products, including bilirubin destined for excretion. Bilirubin is produced from red blood cells reaching the end of their lifespan. When more red blood cells than normal are reaching the end of their lifespan, when the liver is overloaded or damaged, or when processed bilirubin fails to move from the liver through the biliary tract to the duodenum, bilirubin builds up in the body and gives the skin and sclerae an abnormal yellow coloring, a condition known as jaundice.
Chinese medicine’s revised conception of bile, as influenced by biomedicine, is as follows:
- In accordance with traditional theory, bile is said to be produced in the liver from surplus liver qì and passes into the gallbladder, where it is temporarily stored. In the modernized explanation, by the liver’s action of free coursing, it is released into the small intestine, where it performs its function of promoting digestion.
- A disturbance of liver and gallbladder function can affect the production and release of bile, which can in turn affect the intake and rotting and ripening function of the stomach and the movement and transformation function of the spleen. These disturbances manifest in signs of poor digestion such as aversion to food, abdominal distension, and diarrhea.
- When damp-heat or cold-damp arising in the spleen binds in the gallbladder and impairs free coursing, bile can spill outward into the flesh, causing jaundice, which manifests in yellow eyes, yellow body, and yellow urine. Damp-heat jaundice is characterized by a brighter yellow coloration than cold-damp. In this conception, the traditional notion of a yellow complexion being associated with spleen-earth is upheld since the spleen is involved. However, the biomedical fact that the coloring is attributed to bilirubin is included by rephrasing it as
bile spilling outward into the flesh.
The Gallbladder Governs Decision (胆主决断 dǎn zhǔ jué duàn)
The gallbladder is accorded the function of judgment and decision-making. It resists negative mental stimuli that affect physiological activity, thereby promoting the flow of qì and blood and coordinating the functions of the viscera.
The Nèi Jīng states, the
(胆者, 中正之官, 决断出焉 dǎn zhě, zhōng zhèng zhī guān, jué duàn chū yān). This phrase emphasizes that sound judgment, equanimity, and ability to make decisions are related to the gallbladder. The liver governs the making of strategies, but it is the gallbladder that is responsible for decision. When gallbladder qì is strong, a person can make decisions easily. When gallbladder qì is weak and timid, a person may become indecisive. Note that justice
in the Nèi Jīng phrase is expressed as 中正 zhōng zhèng, literally center straight,
implying unbiasedness. It shares a possibly not fortuitous phonological similarity with 中精 zhōng jīng, center essence,
referring to bile.
The gallbladder is also associated with courage, a quality that is closely related to the ability to make decisions. When gallbladder qì is weak, there may be shyness, timidity (often referred to as gallbladder timidity
), susceptibility to fright, in addition to scheming without ability to make a decision, frequent sighing, insomnia, and profuse dreaming or nightmares.
The Gallbladder Channel (胆经 dǎn jīng)
The channel associated with the gallbladder is the
Gallbladder Disease Signs and Patterns
The gallbladder may be affected by damp-heat that also affects the liver, giving rise to jaundice, digestive problems, or conditions of the external genitalia, through which the gallbladder channel passes. It may also be affected by phlegm, which manifests in gallbladder timidity
(indecision and lack of courage) as well as heart signs such as insomnia and profuse dreaming.
Liver-gallbladder damp-heat (肝胆湿热 gān dǎn shī rè): Distension and pain in the rib-side, scorching pain in the rib-side, bitter taste in the mouth, thirst, aversion to food, torpid intake, alternating aversion to cold and heat effusion, yellowing of the eyes (bright yellow), yellowing of the body (bright yellow), upwelling and nausea, stool irregularities, eczema of the scrotum with unbearable itching, hot painful swollen testicles, fetid yellow vaginal discharge, and pudendal itch. The tongue is red with a slimy yellow fur. The pulse is slippery and rapid.
Depressed gallbladder and harassing phlegm (胆郁痰扰 dǎn yù tán rǎo): Gallbladder timidity and susceptibility to fright; insomnia and profuse dreaming; bitter taste in the mouth; oppression in the chest and rib-side.
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