The term triple-Jiao is a peculiar phrase in the visceral manifestation theory of TCM. It collectively refers to the upper-jiao, middle-jiao, and lower-jiao, and is one of the six fu-viscera. Its meridian connects with the pericardium, with which it is externally-internally related. Physicians of successive dynasties have brought forward different opinions regarding its shape and nature, but presently, no unanimous conclusions may be drawn. However, there is agreement as to its physiological functions. Morphologically,it is generally recognized that the triple-jiao is a large fu-viscus and contains all internal organs, therefore it is called a "unique fu-viscus. " For example, Zhang Jingyue, a medical doctor in the Ming Dynasty, said.. "The triple-jiao is, in fact, a fu-viscus, which is outside all other viscera, but within the human body, and contains all internal organs, being the largest fu-viscus within the body cavity. " The physiological function of the triple-jiao can be understood through its whole or local part. Its function is to dominate every kind of qi, if looked at in whole. It controls the transformative function of qi in the body, and circulates water-fluid as well. 1. In Charge of All Types of Qi "All types of qi" refers to all the qi in the entire body, these being the qi of the viscera, the qi of the meridians, the qi of respiration, nutrient-qi, and defense-qi, etc. The triple-jiao is in charge of all qi and so represents its close relation to the physiological functions of the viscera, meridians, tissues, and organs. The ability to take charge of all kinds of qi is attributed to the primordial qi, which is rooted in the lower-jiao, originates from the kidney, and derives from the congenital essence. The triple-jiao functions thus, for the primordial qi circulates through the whole body aided by the triple-jiao pathway, so as to arouse and promote the physiological activities of the viscera, tissues, and organs. The Thirty-sixth Problem in the book Classic on Medical Problems states: "The triple-jiao is considered as the ambassador of primordial qi; it circulates the three kinds of qi and distributes them to the five zang-viscera and six fu-viscera. " 2. Controlling Transformative Function of Qi Here, "Transformative function of the qi" refers to the complicated changes of all types of materials, the reception and digestion of the diet, the absorption and distribution of the nutrient substances, the conveyance and excretion of the waste, etc. The process involved in the transformative function of qi is performed most importantly by the triplejiao, and also includes the joint efforts of various internal organs. The triple-jiao is the passage through which drink and food are transported, and the waste is excreted, therefore distributing essential qi to the entire body from beginning to end. In addition, the triple-jiao circulates primordial qi, which supplies the motive power for the transformative process of qi, thus promoting metabolism of the human body. 3. The Passage for Water-fluid The triple-jiao functions in the dredging of water passages, and the circulating of the water-fluid. It is a passage in which water-fluid ascends, descends, exits, enters, and participates in regulating water metabolism. Thus Chapter 8 in the Plain Questions states.. "The triple-jiao is a water passage dredging official who is responsible for waterways. " This suggests that its main function is to perform transforming processes of the body fluids, and ensure free flow through the water-ways, If the triple-jiao is diseased,the functional activity of qi is obstructed, resulting in edema, ascites, etc. In treating such conditions, the method of dredging and regulating the triple-jiao is usually used. 4. Representing Three Sections of the Human Body In TCM the term triple-jiao is also used to explain each body area. The upper-jiao is the body cavity located above the diaphragm, which houses the heart and lung; the middle-jiao is between the diaphragm and umbilicus and houses the spleen and stomach; and the lower-jiao is the section below the umbilicus, which houses the liver, bladder,large and small intestines, urinary bladder and uterus, etc. The liver is clearly an organ within the middle-jiao, however TCM believes that the liver and kidney share the same source and are closely related in pathology and physiology, and for this reason both are considered to be in the lower-jiao. Since the different sections of the triple-jiao house different organs, with different functions, each section is considered distinctly separate in physiological function. 1) The Upper-Jiao as a Fog-generator "Fog" in this sense, describes the all pervading vapor-like state of the clear and light essential substances of drink and food. The upper-jiao dominates its dispersion and distribution. In other words, the heart cooperates with the lung in disseminating the essential substances through the body, allowing for the nourishing of skin, muscles, tendons, bones, etc. Thus, Chapter 13 in the Spirit Pivot states. "The upper-jiao is open and permits effusion; it causes the five flavors of the diet to diffuse, it warms the skin, nourishes the body, and keeps the hair moist, like the sprinkling of the fog and dew. Such is the action of the qi. " This corroborates with the saying. "The upper-jiao resembles a foggenerator," which in clinical practice refers to the dispersion of the defence-qi and distribution of the essential substances by the heart and lung. 2) The Middle-Jiao as a Fermentor "Fermentor" describes the decomposed and fermented state of ones' diet. Thi phrase denotes the transportation and transformation of the essential substances of f00 and drink through the spleen and stomach. The function of the middle-jiao is mainly referred to as the physiological functions of the spleen and stomach. These functions include reception and digestion of diet, absorption of the essential substances, evaporation of diet, absorption of the essential substances, evapouation of the body fluids, transformation of the essential substances into the blood, etc. As a matter of fact, the middle-jiao is the ascending and descending pivot of qi movement, the resource of qi and blood formation.Therefore its function is described as "the fermentor. " 3) The Lower-diao as a Drainer "Drain" refers to the sluice, "drainer" refers to a tool used to dredge the ditch. The lower-jiao dominates the separation of the clear and the turbid, and excretion of the urint and stools. This process involves the functions of the kidney, small intestine, large intestine and urinary bladder. 5. A Concept in Differentiation of Syndrome The triple-jiao syndrome differentiation represents a method of diagnosing exogenous heat diseases. Diseases of the upper-jiao include exogenous evils that attack the lung, and the heat-evil which penetrate to the pericardirm, etc. These diseases mostly correspond to the first stage of exogenous heat-disease. Diseases of the middle-jiao include heat-accumulation of the stomach and intestine, damp-heat of the spleen and stomach, which correspond to mid-stage exogenous heat disease. Diseases of the lower-jiao include such con ditions as heat-evil consuming yin-fluid of the liver and kidney, exhaustion of the kidneyyin, insufficiency of the liver-blood, etc. These correspond to the advanced stage of exogenous heat disease. The concept of the triple-jiao and the method of triple-jiao syndrome differentiation are used in diagnosing endogenous damage and miscellaneous disorders as well. However,these methods appear to be less detailed and systematized that when it is used in diagnosing exogenous heat-disease.
