Upper Respiratory System

General Function
The upper respiratory system primarily refers those parts of the respiratory system lying
outside of the thorax. Although, there is dispute about the interchange between upper- and the
respiratory system. Some physiology books refer to the interchange as the vocal cords (larynx),
while others refer to the cricoid’s cartilage. The upper respiratory system includes, in general,
the following structures: nose cavity, pharynx and larynx. The main function of the upper
respiratory system is threefold: moistening, warming and protecting.

The nose includes the nasal cavities, paranasal sinuses and the lining of the nasal cavity, the
mucous membrane. The pharynx includes different anatomical locations, in sequence: the
nasopharynx, oropharynx and laryngopharynx. The larynx, commonly named the vocal box,
includes the cricoids cartilage, laryngeal incisure (Adam’s apple) and the vocal cords.

Sù Wèn chapter 5-110:

The fèi takes charge of the nose.

Líng Shû chapter 37-3 :

The nose is the official of fèi.

Nán Jîng question 37 :

Fèi qì is in harmony and communication with the nose.

Respiration takes place through the nose, while foods enters the body through the mouth. This
indicates that fèi-lung is in charge of respiration.

Sù Wèn chapter 5-170:

Heavenly qì is in communication with feì-lung.

Heavenly qì is referred to as air, that enters the body from outside and seen as heavenly qì.
Earthly qì will be referred to later in this book, is seen as food, entering the oesophagus (Sù
Wèn chapter 5-171). Air is also called dà qì, 大氣, literally translated as great qì. Fèi-lung is in

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communication with heavenly qì, which indicates that fèi is, in general, in charge of respiration.
Respiration, inhaling and exhaling is movement of air, movement of wind. This is the wood aspect
of fèi, as the seasonal qì of fèi is wood.

Líng Shû chapter 56-2 :

There is something called great qì (dà qì, 大氣), which gathers together and
stays put in the chest, called sea of qì.
Dà qì travels outwards from the lung to move along the throat,
and causes inspiration and expiration.

Moistening
The inhaled air needs to be saturated with moist or water. The inhaled air usually contains 0.5
kPa (kilo Pascal, a measurement used for saturation or pressure), while the exhaled air is
increased to 6.3 kPa of H2O. This amount of water or moist, is dispensed into the air to increase
gas exchanges in the alveoli. An adult person exhales during one day, in normal physical
conditions, approximately 1 litre of water.

Warming
The temperature of the inhaled air is usually not equal to the body temperature. The inhaled air
needs to be warmed, besides moistening. The main location of warming the air is the nasal cavity,
with its different sinuses. The mucous membranes, that are lining the nasal cavity and the
different sinuses, warm the air, as it is strongly vascularised.

Protecting
The air that reaches the alveoli needs to be completely sterile. Airborne particles are removed
from the air, through the respiratory passage. The main place to trap airborne particles, like
dust, viruses and bacteria, is the nasal cavity and the sinuses. The dust is connected to the
sticky surface of the mucous membrane, located in nasal cavity, pharynx, larynx and bronchi. The
dust is removed from the air passage tissue through ciliated surface cells. A cilia is a hair-like
structure on the surface of cells, wavibg like a tail. In the mucous membrane is the motile ciliae
found. Motile cilia are usually present on a cell's surface in large numbers and beat in
coordinated waves. The tails of the ciliated cells remove the particles into the direction of the
nose, to be expelled from the body.
The trapped pathogens, which could cause diseases, are caught in the mucous membrane tissue.
The so-called first line of defence system of the body removes and inactivates them. The first
line of defence extinguish viruses and bacteria with macrophages, antibodies and immunoglobulin,
present either in the mucous membrane or in the superficial blood vessel system. Upper
respiratory tract infections are amongst the most common infections in the world.

Sù Wèn chapter 23-36: Líng Shû chapter 78-29 :

Fèi transform nasal discharge. Fèi is in control of nasal discharge.

The moistening of the inhaled air through the nose is controlled by two zàng. In the first place
fèi-lung, which is responsible for moistening of the nose. This aspect of health is more visible in
cats and dogs, if they have a wet nose, they are healthy. The second, and more important zàng is
the gân-liver. The gân is responsible for the condition of all mucous membrane in the body,
especially in the upper respiratory tract. The earth aspect of gân (seasonal qì) is responsible for
the moistening of tissue, while the qì of wood controls the coordinated waves. Furthermore, the
gân places a major role in the defence of the body.

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 Sù Wèn chapter 23-10:
Fèi qì causes cough

Sù Wèn chapter 23-13:

Shèn-kidney qì causes sneeing

Airborne particles are present in inhaled air. The air needs to reach the alveoli completely
sterile. If there are particles present in the air, they are trapped by the mucous membrane. But
if there is a collection of particles, causing production of phlegm, and located on a deeper level,
like bronchi, they have to be removed by coughing or sneezing.

Sù Wèn chapter 18-19:

True organ qì of fèi reaches the level of the lung, and travels through the
yíng qì (nutritive qì), wèi qì (defensive qì) and yîn and yáng regions.

The immune system of the body has different layers. This concept of defence, wèi qì, will be
extensively elaborated on in this book. The first layer of wèi qì is the level of fèi. Fèi protects
the body against real climatic influences, from which coldness is the most harmful and the main
cause of upper respiratory diseases. Wèi qì is a combination of metal, as protector and giving
border and limitation, and wood, with its centrifugal direction of qì. Fèi has both qualities of qì.

Sù Wèn chapter 23-29 | Líng Shû chapter 78-28 :

Fèi dislikes coldness.

The second layer of defence is the level of gân-liver. Gân wèi qì is comparable with the western
first line of defence. Gân is responsible for the creation of immunoglobulin and the function of
monocytes and macrophages. The wood aspect of gân (wŭ xíng) and the metal (heavenly stem) are
the qualities of qì that perform this task of defence. The Nèi Jîng elaborates on the wèi qì
extensively, although mainly about the function of fèi as the organ of wèi qì. In clinical practise,
merged with western knowledge, the discovery of three more yîn organs as part of the wèi qì
was discovered. This makes a total of five qualities of wèi qì. Theie role and function will be
explained in this book.

Tissues | Function
The next paragraph will go over all the different tissues of the upper respiratory system,
explain their function and relationship with the zàng fŭ. The order of presentation will be from
most external towards internally, from nose towards vocal cords and all what is in between.
Where possible, confirmation from the Nèi Jîng and Nán Jîng will be added with quotes and
chapter numbers.

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 Nose
The first part of the nasal cavity is build of conchae. Conchae are long and narrow curved bones,
covered with mucous membrane, shaped laike an elongated sea-shell. This is to enlarge the
surface of the mucous membrane, to have a steady airflow and largest contact possible, to
control temperature and moistening. The nose has several functions, being the porch of
respiration, these functions are: moistening, warming and cleaning of the inhaled air, and to
transport odours to the upper nasal cavity to be smelled. All these functions are explained in the
previous paragraph, except smell. The sense of smell is mediated by specialized sensory cells,
located at the roof of the nasal cavity. These sensory cells are nerve ending (neurons) of the N.
Olfactorius, cranial nerve number I. The receptor neurons in the nose are interesting because
they are the only direct recipient of stimuli in all of the senses which are nerves. Human beings
have about 10 cm2 olfactory epithelium, while some dogs have 170 cm2, with 100 times more
receptors per square centimetre. Airborne molecules of odours passing through the nasal cavity
reach the sensory tissue and dissolve mucous membrane lining. A receptor protein, located at the
terminal part of the neuron, recognizes only one specific odour. The nose can distinguish among
hundreds of substances, even in minute quantities. As of yet, there is no theory that explains
olfactory perception completely.

Nán Jîng question 37 :

Fèi qì is in harmony and communication with the nose,
and when the nose is in harmony, it is able to smell.

The fèi qì is responsible for the sense smell, while supported by dãn-gallbladder. Dãn is number I
of the earthly branches, and as there are twelve earthly branches, there are twelve cranial
nerves. Each cranial nerve is controlled by one of the earthly branches, in their sequence of
development (the ontogenesis goes from cranial nerve I towards XII), they follow the concept
of time, from branch number I towards XII.

The nose is controlled by fèi, as mentioned many times before. But fèi is supported by dà cháng.
The pathway of dà cháng, shŏu yáng míng, has its terminal point (Co-20) directly located next to
the nose and nourishes the area. The shŏu yáng míng and shŏu tài yîn are forming a couple, and
cooperate in nourishing and protecting the area of the nose.

Líng Shû chapter 9-12 :

The shŏu yáng míng and shŏu tài yîn are in control of diseases
that occur in the region above the waist.

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 Líng Shû chapter 47-12 :
The fèi is in tune with dà cháng.

Body Diagnosis
The nose is also important for body diagnosis. The tip of the nose is controlled by pí-spleen-
pancreas, while the left nostril is controled by fèi and the right one by pí-spleen-pancres. This
last aspect is important in symptoms like blocked nose, discharge from one nostril or epistaxis
(nosebleeding).

Sinuses
Sinus comes from Latin and means bay, pocket, curve or bosom. A sinus is a cave shaped space or
cavity with several functions, and they are part of the upper respiratory tract. The first role
they have is deminishing of the weight of the head. Most important role is the climate control of
the inhaled air and to prevent infection of pathogens. Especially the paranasal sinus (maxillaris)
and sinus frontalis plays a major role in moistening and regulating the temperature of the inhaled
air through the nose. The sinus frontalis gives also space for the sensory organ smell, with on
the roof the neurons of n. olphactorius. There are four sinuses around the nasal cavity,
bilaterally located. The largest one is sinus maxillaris (behind the cheeck bones or os maxillaris),
sinus frontalis (in the forehead), sinus ethmoidalis (between the eyes), and sinus sphenoidalis
(behind the eyes). Only the sinus maxillaris and ethmoidalis are present at birth. The other two
develop during the first 7 or 8 years. Approximately 5 % of people have absent sinus frontalis.

Sinuses
All sinuses are covered with mucous membrane, as part of the wè qì (defensive qì). The mucous
membrane is controlled by gân-liver.

Sinus Frontalis
Sinus frontalis is located in the area of nourishment, and therefore controlled by zú tài yáng
(páng guâng) and dû mài. These two channels have strong connections on various places (e.g. the
shû points on the back).

Sinus Ethmoidalis
While the sinus frontalis is more connected and nourihed by zú tài yáng (páng guâng), the sinus
ethmoidalis is nourished more by dû mài, although also connected to zú tài yáng (páng guâng).

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Sinus Sphenoidalis
Sinus sphenoidalis is located in os spenoidalis, located in the centre at the base of the skull, just
below the pituitary. Sinus sphenoidalis develops during postnatal period. This sinus is a meeting
point of three major channels dû mài, rèn mài and chông mài, and nourihed by them.

Sinus Maxillaris
Sinus maxillaris is bilateral located in the os maxillaris and controlled by dà cháng-colon and wèi-
stomach. Due to its location, this sinus is nourished and controlled by zú yáng míng and shŏu yáng
míng. Actually, it is the yáng míng layer which is responsible for nourishment. This indicates that
this sinus is especially vulnerable for dryness or dry cold air.

Nasopharynx
The nasopharynx is the nasal part of the pharynx and the uppermost part of the pharynx. This
part of the pharynx stays always open, and spreads from the base of the skull towards the
beginning of the soft palate. On the lateral side of the nasopharyngeal cavity, the pharyngo-
tympanic tube is located bilateral. At the posterior wall is found special tissue, lymphoid tissue,
these are the adenoids or pharyngeal tonsils.

The nasopharynx is covered with mucous membrane, controlled by gân-liver qì. This part of the
pharynx is a main part of protection against invasion of pathogens (viruses and bacteria).
Therefore the condition of the wèi qì of the gân is crucial. There will be support from the qì
from fèi (shŏu tài yîn) and dà cháng (yáng míng).

Adenoids
The adenoids, or (naso)pharyngeal tonsils, are very interesting for different reasons. In the
first place they are located in the curve between the nasal cavity and the pharynx. This
indicates that all inhaled air makes contact with the adenoids, and airborne particles will stick
here. Secondly, they are build from other tissue than mucous membrane. The adenoids are
lymphoid tissue, which is part of the immune system, and defends against infections. In normal
conditions they shrink, a few years after birth. Other lymphoid tissues are the tonsils, thymus,
spleen, appendix and the lymph nodes.

The adenoids are very important for the body as a working place, exercising location, a
laboratorium (torium comes from territorium, meaning place or location. Labore is to work). The
adenoids are created from lymphoid tissue, which is part of the immune system, the wèi qì. The
fèi qì protects the body against actual climates, from which cold is the worst enemy. Gân wèi qì

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is located in all mucous membrane and the dermis. This type of wèi qì is partly derived through
mother milk, and partly created by the blood (monocyte – macrophage). This is known in western
physiology as the first line of defence, and fights viruses and bacteria. Western physiology
mentions another tool as part of immune system. This is the so called antigen – antibody system.
The body needs to exercise, to learn how to recognise a pathogen or an invader (the antigen –
the antibody generator). Secondly, the immune system needs to create a specific, tailor made
tool to fight and kill the invader (antibodies created by white cells). The newborn needs to have
a working place to exercise this way of self protection (antigen – antibody system). The adenoids
are the place to exercise. The adenoids are cooperating with the lymph nodes and the spleen.
Information between the battle place at the front (adenoids), the different small working
camps, divided all over the body, (lymph nodes) and base-camp (spleen), is transported through
lymph vessels. This complete structure, all over the body, is nourished and controlled by pí-
spleen(pancreas).

Wèi qì, defensive qì, is formed and nourished by all the zàng. The order from most superficial to
most deep, starts with fèi and follows all the zàng in the order of kè. Chapter 76- of Líng Shû
elaborates on this:

When wèi qì starts to travel throughout the yîn region,

it enters shèn through zú shão yîn.
And then it enters into xîn from the shèn,
then it enters the fèi from the xîn,
then it enters the gân from fèi,
then it enters the pí from gân,
then it returns to shèn from pí,
to complete a full circulation.

This paragraph is not expressing the order from most superficial towards most deep, but
explains that the source of the wèi qì is shèn-kidney qì, nourished through zú shão yîn. The
development of wèi qì, or the order from most simple towards most sophisticated wèi qì, starts
with fèi and follows the kè order. From fèi to gân, pí, shèn and xîn.

Pharyngo-Tympanic Tube
Next to the adenoids, on both sides, laterally located, are the pharyngo-tympanic tubes located.
Other names for this tube are: Eustachian (Eustachius was a 16th century anatomist) tube or
auditory tube. This tubes links the pharynx with the middle ear. The pharyngo-tympanic tubes
develop during the first years of life. Normally the tubes are closed, but it could opens up to let
air in or out. The tubes equalise the atmospheric pressure between the middle ear and the
environment. If the pressure between the middle ear and the environment is not equalised, this
will give pressure on the eardrum (tympanic membrane). The second role of the tubes is to
ventilate the middle ear, and drains mucous from the middle ear. In children the tube is more
horizontal, shorter and has a smaller floppier opening, making the drainage of fluid more
difficult.

The lining of the pharyngo-tympanic tube is made of mucous membrane, and therefore controlled
by gân qì. The condition and the function of the tubes depends also on the chông mài. There is a
pathway of the chông mài, from Cv-23, towards the middle ear.

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 Uvula
The uvula is a floppy conic shaped tissue, located in the middle and at the posterior edge of the
soft palate. It is build of soft connective tissue and contains a few muscle fibres. The function
of the uvula is mainly in connection with speech and articulation. The uvula creates specific
sounds (guttural) in cooperation with the soft palate, the oropharynx and air from the lungs. A
second role is to coordinate the passage of air and food and drinks.

The uvula, in combination with the soft palate, is controlled and nourished by shèn-kidney qì.
From Kid-27 an internal branch reaches the throat, root of the tongue (tonsils) and continues
into the soft palate and uvula. The jîng bié channel of zú shão yîn has a straight upwards channel
meeting the root of the tongue, the oral cavity and continues to the back of the neck. (Líng Shû
chapter 10-22 and 11-2).

Oropharynx
From the complete pharynx, the nasopharynx, oropharynx and laryngopharynx, the nasopharynx
is the most important. The oropharynx is just a passage region of air and food.

The oropharynx is controlled and nourished by shèn-kidney qì. From Kid-27 an internal branch
reaches the throat, root of the tongue (tonsils) and continues into the soft palate and uvula. The
jîng bié channel of zú shão yîn has a straight upwards channel meeting the root of the tongue,
the oral cavity and continues to the back of the neck. (Líng Shû chapter 10-22 and 11-2).
The lining of the oropharynx is made of mucous membrane, and therefore controlled by gân qì.

Tonsils
The tonsils, or sometimes named as palatine tonsils or faucial tonsils, are bilateral located
between the base of the tongue and lateral sides of the back of the throat. The tonsils are part
of the immune system of the body. The tonsils are lymphoid tissue, as the adenoids. The B cells
of the tonsils can mature to produce all the five major Ig classes. When the cells of tonsils are
in contact with antigens, they are able to produce specific antibodies against many bacterial and
viral infections (like: diphtheria, polio, streptococci, staphylococci and influenza). The response
of T-lymphocytes created in the tonsils against infections, is much stronger in comparison to the
supply through blood.
Tonsil cells are able to create different types of cytokines. Cytokines play a major role in the
immune system of the human beings. The cytokines are proteins, peptides or glycoproteins and
are able to control or modulate different types of target cells.

The tonsils are controlled and nourished by shèn-kidney qì. From Kid-27 an internal branch
reaches the root of the tongue (tonsils). The jîng bié channel of zú shão yîn has a straight
upwards channel meeting the root of the tongue. (Líng Shû chapter 10-22 and 11-2).

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In their function as being part of the immune system, the tonsils strongly cooperate with the
thymus. The thymus is controlled by shèn qì, as there is nourishment from bilateral Kid-22
towards Cv-17, to continue in Kid-23. The only function of the thymus is to produce and educate
the T-lymphocytes, supported by the tonsils. This is the fourth system of wèi qì – defensive qì.
As seen above, the most superficial and simple protection is covered by fèi, followed by first line
of defence, gân, antigen – antibody system, nourished by pí, and followed in the kè order in the
wŭ xíng, by shèn wèi qì.
Shèn wèi qì is also active as anti-inflammatory, or wèi qì, in the nourishment of the production of
different glucocorticoids, from which cortisol is the most important one. Cortisol is produced in
the adrenal cortex, and has a suppressing action on inflammatory processes in the body.
Western medicine uses this system frequently by supplying of synthetic corticosteroids.

Epiglottis
The epiglottis is located at the entrance of the larynx, which is named the glottis. From the root
of the tongue and connected to os hyoideus, a piece of elastic cartilage tissue is pointing dorsal.
The function of the epiglottis is to cover the entrance of the larynx, by folding downwards,
while swallowing. The epiglottis is part of the coordination of air and food, like the uvula. A
second function, in some parts of the world (Arabic speaking places), is the production of
specific sounds in articulation.

The epiglottis is controlled and nourished by shèn-kidney qì. From Kid-27 an internal branch
reaches the root of the tongue (epiglottis). The jîng bié channel of zú shão yîn has a straight
upwards channel meeting the root of the tongue. (Líng Shû chapter 10-22 and 11-2).

Laryngopharynx
From the complete pharynx, the nasopharynx, oropharynx and laryngopharynx, the nasopharynx
is the most important. The laryngopharynx is just a passage region of air.

The laryngopharynx is controlled and nourished by shèn-kidney qì. From Kid-27 an internal
branch reaches the throat. The jîng bié channel of zú shão yîn has a straight upwards channel
meeting the throat. (Líng Shû chapter 10-22 and 11-2).
The lining of the laryngopharynx is made of mucous membrane, and therefore controlled by gân
qì.

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 Vocal Cords
The vocal cords, or vocal folds, are bilateral horizontal located, across the larynx from anterior
to posterior. The vocal cords are two cords of strong mucous membrane at the top of the
trachea, and stretched or relaxed by different muscles. The vocal cords are white in colour and
differ in size in men and woman (men: 17.5 – 25 mm and woman: 12.5 – 17.5 mm). The vocal cords
vibrate, due to contraction of local muscles, to create sound, speech and singing.

The vocal cords are controlled and nourished by shèn qì. As seen above, the jîng mài and jîng bié
are passing by in their pathways. More important is clinical experience, in which patients with
vocal cord polyps or vocal cord cancer are diagnosed. In pulse diagnosis the shèn qì shows signs
of abnormality, which in the case of recovery of the vocal cord polyps, disappear.

Sù Wèn chapter 9-35:

Fèi-lung makes the voice loud and clear.

Larynx
The larynx or voice box, is located behind the cricoids cartilage (laryngeal incisure – Adam’s
apple) and houses the vocal cords. From the epiglottis towards the lower border of the cricoids
cartilage is the area of the larynx. On top of the larynx is the interchange, laryngopharynx, with
the pharynx, while underneath starts the trachea or windpipe. The larynx is level with C-3 to C-
6.

The larynx is controlled and nourished by shèn-kidney qì. From Kid-27 an internal branch reaches
the throat. The jîng bié channel of zú shão yîn has a straight upwards channel meeting the
throat. (Líng Shû chapter 10-22 and 11-2).
The lining of the larynx is made of mucous membrane, and therefore controlled by gân qì.

Sù Wèn chapter 9-35:

Fèi-lung makes the voice loud and clear.

Trachea
The trachea connects the larynx, via the bronchi, with the actual lung tissue, to conduct air
passage. The lining is covered with mucous membrane tissue, containing many ciliated cells. These
cells are responsible to trap airborne particles, to prevent them from entering lung tissue. The
production of mucous, together with the rhythmic waves of the cilia, expels pathogens from the
windpipe, as phlegm. The trachea is surrounded by C shaped cartilaginous rings (15 up to 20), to
prevent closure of the windpipe. The length of the trachea is 10-016 cm, while the diameter is 21
to 27 mm.

The lining of the trachea is made of ciliated mucous membrane, and therefore nourished and
controlled by gân qì.

Peter C. van Kervel

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