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Human beings are generated by inheriting the Qi of Yin, Yang, and the Five Elements (Wu Xing), yet the transformations of Yin and Yang are endless. Now, discussing the division of Zang-Fu organs into Yin and Yang: the Zang organs belong to Yin and primarily govern the interior; the Fu organs belong to Yang and primarily govern the exterior. The five Zang organs possess the characteristics of the Five Elements, and each of the Five Elements further contains both Yin and Yang. Therefore, the Qi of each Zang organ is Yang, while its Blood is Yin.

If we pair the Fu organs with the Zang organs: the Liver is Yi Wood, belonging to Yin; the Gallbladder is Jia Wood, belonging to Yang; Wood generates Fire. The Heart is Ding Fire, belonging to Yin; the Small Intestine is Bing Fire, belonging to Yang; Fire generates Earth. The Spleen is Ji Earth, belonging to Yin; the Stomach is Wu Earth, belonging to Yang; Earth generates Metal. The Lung is Xin Metal, belonging to Yin; the Large Intestine is Geng Metal, belonging to Yang; Metal generates Water. The Kidney is Gui Water, belonging to Yin; the Bladder is Ren Water, belonging to Yang; and Water generates Wood again. Thus, the generation and transformation of the Qi of Yin, Yang, and the Five Elements ceaselessly continue.

The mutual generation among the Five Elements refers to mutual growth. If the generating Qi is excessive, it becomes hyperactive; therefore, within generation lies restriction (Ke). "Restriction" means control or restraint, such as Wood controlling Earth, Earth controlling Water, Water controlling Fire, Fire controlling Metal, and Metal controlling Wood, which act as mutual checks. Consequently, when a certain element is deficient, it is assisted by the element that generates it, such as tonifying the Liver to aid the Heart (note: text implies using generative relationships for regulation); when an element is excessive, it is restrained by the element that controls it, such as nourishing Water to restrain Fire. Treatment continues until balance is restored.

The term "Zang" (Viscera) implies storing; they store Essence-Qi without draining. The term "Fu" (Cavities) implies vessels; they transmit and transform substances without storing. The abilities to store and transform are all achieved through the operation of the Qi of Yin, Yang, and the Five Elements. Each Zang-Fu organ has its specific dominance, functions, and responsibilities. If these duties fail, the Qi transformation will become disordered, leading to various diseases.

For example: The Liver stores Hun (Ethereal Soul) and Blood, and governs the sinews/tendons. The Heart stores Shen (Spirit), and governs the blood vessels. The Lung stores Po (Corporeal Soul) and Qi, and governs the skin and body hair. The Spleen stores Yi (Intellect), and governs the muscles. The Kidney stores Jing (Essence) and Zhi (Willpower), and governs the bones. The Lung also weighs and regulates the Qi of the whole body, and the Spleen commands the Blood of the whole body. The Heart acts as the Monarch, directing the Qi and Blood of the entire body, because all Zang organs have meridians connecting to the Heart. Therefore, if the Heart is stable, the Spirit is clear, and the five Zang organs are at peace; if the Heart is overworked and moves recklessly, all five Zang organs will become diseased.

For instance: Worry suppresses Heart Qi; Anger causes Liver Qi to rebel upwards; Overthinking causes Spleen Qi to knot; Grief consumes Lung Qi; Fear injures Kidney Essence. Thus, all Seven Emotions originate from the Heart and first injure the respective Zang organs.

Regarding their functional responsibilities: The Liver governs free flow and drainage, opening into the eyes. The Kidney governs closure and storage, opening into the two lower orifices (urethra and anus). The Spleen governs transportation and transformation, opening into the mouth. The Lung governs respiration, opening into the nose. The Heart governs discernment and inspection, opening into the tongue. The ears connect the Qi of the Heart and Kidney and serve as the external orifices for both.

The pairing of Zang and Fu organs is based on their connected anatomical locations forming Exterior-Interior relationships, where they mutually support each other. The Fu organs rely on Zang Qi to disseminate and transform; thus, if the Zang is deficient, the Fu cannot transport effectively. The Zang organs rely on Fu Qi to relax and harmonize; thus, if the Fu is full of pathogenic factors, the Zang Qi may rebel. For example, the Lung and Large Intestine are exterior-interior pairs. If Lung Qi is deficient, the Large Intestine loses its function, resulting in diarrhea or constipation. If turbid stagnation in the Large Intestine fails to move, Lung Qi rebels causing fullness and inability to descend. The rest can be inferred similarly, demonstrating their mutual utility.

Furthermore, the Stomach governs the reception of food, relying on the Spleen's robust transportation to digest dietary essences, sending them upward to the Lung to distribute throughout the body, thereby nourishing all Zang-Fu organs. Thus, the Stomach is called the "Sea of Water and Grain" and the great source of the six Fu organs. The dregs pass down to the Small Intestine, which separates the clear from the turbid. Clear fluids seep into the Bladder, while turbid residues go to the Large Intestine. This process relies on the smooth Qi transformation of the Sanjiao (Triple Burner) to balance Water and Fire, ensuring the unobstructed passage of urine and feces. Hence it is said: "Qi transformation allows for excretion." However, Sanjiao Qi transformation originates from the Yin and Yang of the Kidney Yuan (Original Qi). If Kidney Yuan declines, the Sanjiao loses authority, causing disorder in Spleen-Stomach ascending and descending, mixing clear and turbid, leading to myriad diseases. This explains why Zang-Fu organs have different functions.

Only the Gallbladder attaches to the Liver as an exterior-interior pair. Its essence juice (bile) enters but does not exit normally. If affected by Heat Pathogens, bile leaks out causing bitter taste in the mouth, resulting in disease. There is also the Pericardium (Xin Bao Luo), located in the Danzhong region, serving as the outer protection for the Heart, acting on behalf of the Heart. Whenever pathogens invade the Heart, the Pericardium receives them. If the Heart itself is invaded, the Spirit departs, and departure of the Spirit means death. The Pericardium meridian connects with the Sanjiao meridian, forming an exterior-interior relationship. Thus, the five Zang, six Fu, and the Pericardium together constitute the twelve Hand-Foot Yin-Yang meridians. Detailed explanations are found in the chapter on Ying-Wei (Nutritive and Defensive) and Meridians.

One must thoroughly understand the principles of Zang-Fu generation/transformation and the pathways of meridian circulation before being able to differentiate the exterior-interior and deficiency-excess nature of diseases for treatment. Therefore, students must prioritize this study and cannot neglect it.