The Pancreas: Where Does the Fifth House End and the Sixth House Begin?

First published 4 September 2008 · revised and expanded 3 November 2026. The 2008 note stands as it was written, apart from the diacritics and its links: the bare URLs it carried in parentheses are now live links where the pages survive, and dropped where they do not. Everything after the first rule is new, and the figures are drawn on the page.

In most books we learn that the fifth house is from the navel to the lungs, namely the stomach and heart. The sixth house, we are told, is from the navel to just above the reproductive organs. That is to say, it consists of the organs required for all important digestion.

However, in my recent papers on the astrology of Diabetes and Cystic Fibrosis, where the pancreas is involved in both, I use different houses to describe the pancreas.

In Diabetes, which is well known to originate in the pancreatic Islets of Langerhans, I looked to the fifth house for insight. In studying the clogged pancreatic ducts of Cystic Fibrosis, I primarily focused on the natural and actual sixth houses.

Why the split?

I think it has everything to do with the pancreas being the only place that is both an endocrine and an exocrine gland.

The Islets of Langerhans are composed of endocrine cells.

According to the volume The Body, by Alan E. Nourse, “the islets are “busily manufacturing their hormone and generally disregarding the pancreatic cells all around them, as though they were located in some completely different part of the body.” (Wikipedia, Pancreas)

Since the pancreas is still above the navel and still tucked under the stomach, and since the islets’ hormone is used firstly within the pancreas itself, I think the pancreatic endocrine functions count as fifth house in the astrology chart.

Compare that with the terrible complications of Cystic Fibrosis on the pancreas, where the acinar cells of the pancreatic ducts, and hence its exocrine function, are affected.

In contrast to the endocrine pancreas, which secretes hormones into the blood, the exocrine pancreas produces digestive enzymes and an alkaline fluid, and secretes them into the small intestine through a system of exocrine ducts. Digestive enzymes include trypsin, chymotrypsin, pancreatic lipase, and pancreatic amylase, and are produced and secreted by acinar cells of the exocrine pancreas. Specific cells that line the pancreatic ducts, called centroacinar cells, secrete a bicarbonate- and salt-rich solution into the small intestine.

This has everything to do with the digestive system and hence the sixth house.

Make sense?

So, the fifth house for endocrine and the sixth house for exocrine.

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Eighteen years on

The note above gives an answer in eleven words and a question mark: the fifth house for endocrine and the sixth house for exocrine, make sense? I still think it is the right answer. But it is the kind of answer that deserves its working shown, and in 2008 I showed almost none: no verse for the limbs of the Kālapuruṣa, no anatomy for where the gland actually sits against the navel, nothing from the Āyurvedic texts, and one sentence about the islets’ hormone being used “firstly within the pancreas itself” that I asserted and did not source. So here are the sources, four drawings, and two things the note does not have: that Caraka put his seat of fire above the navel too, and that the fence between the two glands has a gate that the diseases walk through in both directions.

The limbs of the Kālapuruṣa

The “most books” of the note are following Varāhamihira, whether they say so or not. The fourth verse of the Bṛhat Jātaka hands out the body of Time, kāla-puruṣa, to the twelve signs in order:

Twelve limbs for twelve signs. The fifth, Leo’s, is kroḍa — lexically the lap or the hollow of the trunk, which the commentators and translators take as the belly; the sixth, Virgo’s, is vāsobhṛt, literally “what bears the garment” — the waist, where the cloth is tied, which the translators give as the hips or the loins (kaṭi). The seventh is basti, the lower belly or bladder. The texts give these limbs to the signs, and the houses inherit them through the natural zodiac, the Kālapuruṣa’s own horoscope with Aries rising; that is how the handbooks arrive at a fifth house of the stomach and heart and a sixth of the intestines, and why they end the fifth at the navel. Varāhamihira’s word is better than the handbooks’ line, I think. He does not say “navel”; he says the fence between the fifth limb and the sixth is the waistband. On a body in a dhotī the waistband falls at the navel or just under it, and the picture is the same. But the word tells you what kind of boundary it is: not a line drawn on the skin, but the place where one thing is held in and another begins.

Where the gland lies

The note says the pancreas is “still above the navel and still tucked under the stomach”, and both halves are true, more exactly than I wrote them. The gland lies behind the peritoneum, all but its tail, against the back wall of the abdomen, with the stomach and the lesser sac in front of it. Its head sits in the C-shaped loop of the duodenum, to the right of the spine at about the second lumbar vertebra; its neck crosses the midline on the transpyloric plane, the horizontal plane through the first lumbar vertebra that also passes through the pylorus of the stomach; and its body and tail run up and to the left to the hilum of the spleen. The navel, in a person who is not heavy, marks the disc between the third and fourth lumbar vertebrae. So the neck of the gland lies two vertebrae above the handbooks’ line, and even its head, which reaches down to the second lumbar vertebra and sometimes the third, stays above it. By position it is fifth house entirely, and that is the house I used for “the pancreatic region” in Troubling Benefic, the paper on Jupiter in type 1 diabetes published the following year.

What the note was reaching for, then, was not position but delivery. The gland’s juice does not stay where the gland is. It runs down the main duct, through the ampulla where the bile duct joins it, into the second part of the duodenum, and from there with the food into the jejunum and ileum, which fill the belly from the navel down — the vāsobhṛt and basti of the verse, the sixth and seventh limbs. The hormones go the other way: out of the islets into the capillaries, into the splenic and portal veins, to the liver, and from there to the whole body. One product goes down and out, the other in and everywhere. The 2008 split is a split by where the product is used, and that is the only split that could put one organ in two houses.

Āyurveda’s seat of fire

The Āyurvedic texts have no pancreas. The organ that modern Āyurvedic writers most often give the name to is kloma, one of the fifteen viscera of the trunk in Caraka’s list, which the texts put to the right of the heart and connect with thirst and the channels of water; the identifications on offer in the literature run from the right lung to the gall bladder to the pancreas, and one careful appraisal concludes it is the mediastinum. In Troubling Benefic I wrote that Jupiter is associated with the kloma, or pancreas, citing my class notes from Dr. Lad; I would now say that is the modern reading of an uncertain organ. But modern India has settled the vocabulary without waiting for the scholars. In Telugu the pancreas is klomagranthi, the kloma gland. In Hindi it is agnyāśaya, the seat of fire.

That coinage is exact, and it is older than it looks. Caraka’s chapter on the disorders of the grahaṇī defines its organ with the same idea, in another word for seat:

And the half-verse I have elided, 56cd, locates it: nābher upari, above the navel, propped and strengthened by the strength of agni. Suśruta has the same organ as a membrane, the sixth of his kalās, the pittadharā, “standing between the pakvāśaya and the āmāśaya” — between the receptacle of the ripe and the receptacle of the raw — “it is called the grahaṇī.” Hoernle, editing the Bower manuscript, identified it with the duodenum, and most readers since have put it in the duodenum and the upper small intestine, which is exactly where the pancreas delivers its juice. So the seat of fire in Caraka is above the navel and does the digesting: the same crossing of position and function that made the pancreas awkward in 2008, the better part of two thousand years earlier and about the organ that lies in the pancreas’s own curve. Caraka’s grahaṇī is fifth house by its address and sixth house by its work, and nobody in the tradition seems to have minded.

The texts keep the two diseases apart as well, and along the same seam. The failures of the grahaṇī — food released unripe, the fire weakened and vitiated by what it could not cook — are a chapter of their own in Caraka, and paired with diarrhoea in Vāgbhaṭa. The sweet urine is somewhere else entirely. Caraka’s prameha has no organ of its own: twenty kinds of it, ten from kapha, six from pitta, four from vāta, and a pathology that runs through tissues rather than places — kapha, grown abundant and loose, mixes with fat (medas), the fat with the body’s moisture (kleda) and with flesh, and the mixture, heavy, finds its way into the channels of the urine. The last of the twenty is the one the West would later call mellitus, honeyed:

A disease of the fire’s seat, located; a disease of sweetness, not located, carried in the tissues and read in the urine. The tradition drew its line between the two by what the patient does and passes, not by what the cells are, and still drew it in the same place the microscope would: the gut’s digestion on one side, the sugar in the blood on the other. That is a comfort to the note. The 2008 split is not an import from histology into Jyotiṣa; it is a seam the Āyurvedic nosology already had.

The two glands

Here is the organ as the microscope has it. By bulk the pancreas is an exocrine gland: acini, berry-shaped clusters of enzyme-making cells, drained by a tree of ducts that gathers into the main duct and empties through the ampulla into the duodenum, about a litre of juice a day, enzymes from the acinar cells and a bicarbonate-rich fluid from the cells that line the ducts. Scattered through that tissue are about a million islets, one to two per cent of the gland’s volume, which take ten to fifteen per cent of its blood. In a human islet roughly half the cells are β-cells making insulin, a third or more are α-cells making glucagon, and the rest are δ, PP and ε cells making somatostatin, pancreatic polypeptide and ghrelin. The islets’ whole output is measured in milligrams. One gland, two products, two routes, six orders of magnitude.

Both Endocrine · fifth Exocrine · sixth

The fence inside the organ was found slowly. Paul Langerhans described the cell clusters in his Berlin dissertation of 1869 without knowing what they were for; Édouard Laguesse named them islets after him in 1893 and guessed that they made an internal secretion; in between, in 1889, Oskar Minkowski and Joseph von Mering had taken the pancreas out of dogs and watched them become diabetic, which was the first proof that a gland pouring juice into the gut was also, somehow, governing the blood; Eugene Opie found the islets damaged in diabetics in 1901; and Banting, Best, Collip and Macleod had insulin in a patient in Toronto in January 1922. Fifty-three years to establish that one organ is two. The note’s “only place that is both” is a little strong — the liver, the testis and the ovary are both as well, and the stomach and gut make hormones — but the pancreas is the one where the two glands are interleaved cell by cell through the whole organ, and it is the one on which the distinction was learned.

“Used firstly within the pancreas itself”

This was the sentence I asserted without a source, and it is the one that most needed checking, because it carries the fifth-house argument. The fifth house is the belly, but it is also what the body keeps for itself — its own intelligence, its own children, its own store of merit — and the note was claiming that the islets’ product is first of all the gland’s own. It turns out to be well documented, and under a name of its own. The arteriole that enters an islet breaks up inside it into a glomerulus of capillaries; the capillaries that leave do not go straight to a vein but run on into the acini around the islet, so that those acinar cells are bathed in blood carrying insulin at concentrations the rest of the body never sees. Fujita named this the insulo-acinar portal system in 1973; Henderson had asked, in 1969, why the islets should be scattered through the exocrine gland at all if not to do something to it; and the answer has been drawn in histology ever since as the peri-insular halo, a ring of acinar cells, larger and fuller of zymogen granules than their neighbours, around each islet. Insulin is trophic to the acinar cell. The hormone is used first within the pancreas itself.

Nourse’s islets, “disregarding the pancreatic cells all around them, as though they were located in some completely different part of the body”, are right as a picture of the islet’s business and wrong about the neighbours. The islet does not disregard the acini. It feeds them first.

Crossing the fence

The two diseases the note used as its examples do not stay on their own sides of the fence, and the note does not consider that. Cystic fibrosis is the clearer case. Dorothy Andersen named it in 1938 from what she found at autopsy in infants and children who had been thought to have coeliac disease: a pancreas full of cysts and fibrosis, its ducts blocked — “cystic fibrosis of the pancreas”, the disease named for the gland before the sweat defect was known, and while the lung infections that killed her patients were still taken for a complication. In 1989 the gene was found, on chromosome 7, and its product CFTR turned out to be a chloride channel in the cells that line the ducts, the cells the note calls “acinar cells of the pancreatic ducts” and should have called ductal: without it the juice is thick and poorly watered, the ducts plug, and the acini behind them die back. That is the sixth house, and in most people with the disease the exocrine gland fails in infancy. But the scarring does not stop at the islets. By adolescence about one in five people with cystic fibrosis has diabetes of its own kind, and by adulthood two in five or more — not type 1, not type 2, but cystic-fibrosis-related diabetes, the islets destroyed by the fibrosis around them. A sixth-house disease that becomes, in time, a fifth-house one.

It goes the other way too. In type 1 diabetes the immune system destroys the β-cells, and the exocrine gland is supposed to be a bystander. It is not: in organ donors, the whole pancreas of a person with type 1 diabetes weighs about half what a healthy one does, and in people who merely carry the autoantibodies, and have not yet become diabetic, it already weighs about three-quarters. The acini around each dead islet have lost their insulin bath — the halo in reverse. And there is a third crossing with a name of its own: diabetes that follows disease of the exocrine gland, mostly chronic pancreatitis, is now classed as type 3c, and in Western populations it is five to ten per cent of all diabetes, about half of it misfiled as type 2.

I do not think any of this undoes the note. It makes it a better piece of Jyotiṣa than it was, because this is how adjacent houses behave. Counted from the sixth, the fifth is its twelfth — the house of what it loses, where it ends; counted from the fifth, the sixth is its second, what sustains it and what it accumulates. A disease of the ducts that ends in the islets, and a disease of the islets that starves the ducts, are the fifth and sixth houses doing to each other what bhāvāt bhāvam says they do. The fence is real. It has a gate.

So, the fence

Where does the fifth house end and the sixth begin? On the Kālapuruṣa, at the waistband. In the body, for most organs, at the navel or near it, the fifth above, the sixth below. For the pancreas the line runs through the lobule instead: around every islet, between the cells that send their product inward and the cells that send it down. Varāhamihira’s word was better than the handbooks’ line. The islet is what the belly holds in; the acinus is what it hands on. The fifth house for endocrine and the sixth house for exocrine — I keep the eleven words, and I would now add a twelfth: mostly. The diseases cross, and the chart should be read expecting them to.

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Related: Troubling Benefic: Jupiter in Diabetes Type One (the 2009 paper, eight charts) · What We Can Learn from Epidemiological Birth Data of Type One Diabetes · Turmeric Seems to Succeed Against Cystic Fibrosis · the research bibliography (the 2008 cystic fibrosis case study and the diabetes papers) · The Returned Gaze (on the houses and their aspects) · Ask Vāgbhaṭa (the Aṣṭāṅgahṛdaya, searchable).

References

1. Varāhamihira, Bṛhat Jātaka 1.4: the limbs of the Kālapuruṣa, Aries onward. Sanskrit and English after M. D. Neely’s rendering (2007); the older translations (B. Suryanarain Rao, V. Subrahmanya Sastri) give vāsobhṛt as the hips or waist and uras as the chest, where the modern handbooks say arms.
2. Caraka Saṃhitā, Cikitsāsthāna 15.56–57 (the grahaṇī defined as the seat of agni, above the navel, nābher upari; it holds the food unripe and releases it ripe from the side), as given in the Charak Samhita New Edition online (carakasamhitaonline.com, Grahani Chikitsa). Suśruta Saṃhitā, Śārīrasthāna 4.18 names the sixth kalā, the pittadharā, and the grahaṇī; the two-line form quoted here, ṣaṣṭhī pittadharā nāma yā kalā parikīrtitā | pakvāmāśayamadhyasthā grahaṇī sā prakīrtitā ||, is the one the Āyurvedic literature carries, usually referred to the Uttaratantra (chapter 40). Hoernle’s identification of the grahaṇī with the duodenum is in his edition of the Bower Manuscript (p. 268), as reported in the Aṣṭāṅgahṛdaya glossary at wisdomlib.org, s.v. grahaṇī.
3. Caraka Saṃhitā, Nidānasthāna 4 (Prameha Nidāna): the twenty pramehas (4.3), the pathogenesis through kapha, medas, kleda and māṃsa into the urinary channels (4.8), the ten kaphaja, six pittaja and four vātaja kinds, and the madhumeha verse (4.44), from the same online edition. Vāgbhaṭa, Aṣṭāṅgahṛdaya, Nidānasthāna 8 (atīsāra and grahaṇī-doṣa) and 10 (prameha).
4. Kloma: Caraka Śārīrasthāna 7.10 lists it among the fifteen koṣṭhāṅgas; Suśruta Śārīrasthāna 4 places it below and to the right of the heart; it is a root of the water channels (Caraka Vimānasthāna 5). The survey of identifications — gall bladder, pancreas (agnyāśaya), liver, right lung — and the case for the mediastinum is V. M. Nanal, “The organ kloma: a fresh appraisal,” Ancient Science of Life 9:2 (1989), 61–65. Jupiter and the kloma: my own “Troubling Benefic: Jupiter in Diabetes Type One,” CVA Journal, Spring/Summer 2009, p. 27, citing Dr. Lad’s classes of 2000 and the fifth house as the abdominal area of the Kālapuruṣa from Hart de Fouw’s and Dr. Lad’s classes of 2001. Telugu klomagranthi and Hindi agnyāśaya for the pancreas: Amarkosh (amarkosh.tech) and Bharat Discovery (bharatdiscovery.org), s.vv.
5. Position of the gland: the pancreas lies retroperitoneally across L1–L2, its head to the right of the spine at about L2, its neck in the transpyloric plane in the midline, with the stomach and lesser sac on its anterior surface (The Common Vein, pancreas anatomy pages, 2007). The transpyloric plane is at the level of L1 and passes through the pylorus; the umbilicus marks the approximate level of the L3/L4 intervertebral disc in non-obese individuals (University of Arkansas for Medical Sciences, Topographical Anatomy of the Abdomen).
6. Islets: about one million in the adult pancreas (Sleisenger & Fordtran, 10th ed., 2015, p. 928; Ganong says one to two million), 1–2 % of its volume, receiving 10–15 % of its blood flow (Ganong’s Review of Medical Physiology, 23rd ed., 2009, p. 316). Human islet cell proportions — β about 50 %, α 35–40 %, δ 10–15 % — from O. Cabrera et al., “The unique cytoarchitecture of human pancreatic islets has implications for islet cell function,” PNAS 103 (2006), 2334–2339, as summarised in P. Rorsman and M. Braun, Annual Review of Physiology 75 (2013), 155–179. Daily pancreatic juice of the order of a litre: the standard physiology texts (Guyton & Hall). The islets’ output in milligrams: one unit of insulin is 34.7 μg of the hormone, and a healthy adult secretes some tens of units a day.
7. The insulo-acinar portal system: T. Fujita, “Insulo-acinar portal system in the horse pancreas,” Archivum Histologicum Japonicum 35 (1973), 161–171; T. Fujita and T. Murakami, “Microcirculation of monkey pancreas with special reference to the insulo-acinar portal system,” ibid., 255–263; J. R. Henderson, “Why are the islets of Langerhans?” Lancet 2 (1969), 469–470; J. A. Williams and I. D. Goldfine, “The insulin-pancreatic acinar axis,” Diabetes 34 (1985), 980–986. The current summary, with the peri-insular halo and the share of blood flow, is M. D. Sans, R. Bruce and J. A. Williams, “Regulation of pancreatic exocrine function by islet hormones,” Pancreapedia (review).
8. History: P. Langerhans, Beiträge zur mikroskopischen Anatomie der Bauchspeicheldrüse (Berlin, 1869); J. von Mering and O. Minkowski, Archiv für experimentelle Pathologie und Pharmakologie 26 (1890), 371–387, the experiments of 1889; G.-É. Laguesse, Comptes rendus de la Société de Biologie 45 (1893), 819–820; E. L. Opie, Journal of Experimental Medicine 5 (1901), 527–540; F. G. Banting, C. H. Best, J. B. Collip, W. R. Campbell and A. A. Fletcher, Canadian Medical Association Journal 12 (1922), 141–146. M. Bliss, The Discovery of Insulin (1982), is the narrative.
9. D. H. Andersen, “Cystic fibrosis of the pancreas and its relation to celiac disease: a clinical and pathologic study,” American Journal of Diseases of Children 56 (1938), 344–399. J. R. Riordan et al., “Identification of the cystic fibrosis gene: cloning and characterization of complementary DNA,” Science 245 (1989), 1066–1073. A. Moran et al., “Epidemiology, pathophysiology, and prognostic implications of cystic fibrosis–related diabetes: a technical review,” Diabetes Care 33 (2010), 2677–2683: “CFRD is present in about 20 % of adolescents and 40–50 % of adults with CF”; the islet loss is attributed to the scarring and destruction of the exocrine gland.
10. M. Campbell-Thompson, C. Wasserfall, E. L. Montgomery, M. A. Atkinson and J. S. Kaddis, “Pancreas organ weight in individuals with disease-associated autoantibodies at risk for type 1 diabetes,” JAMA 308 (2012), 2337–2339: 164 organ donors; the pancreas in type 1 diabetes about half the weight of controls, in autoantibody-positive donors about three-quarters. N. Ewald and P. D. Hardt, “Diagnosis and treatment of diabetes mellitus in chronic pancreatitis,” World Journal of Gastroenterology 19 (2013), 7276–7281: type 3c diabetes 5–10 % of all diabetes in Western populations, chronic pancreatitis the cause in nearly 80 % of cases, and only about half of cases correctly classified.
11. Alan E. Nourse, The Body (Life Science Library, Time Inc., 1964), as quoted in the 2008 note by way of the Wikipedia article on the pancreas of that year; the book itself is not quoted here.

Figures 1–4 are drawn on the page. Figure 2’s buttons need no scripting; without CSS support for them it shows both glands.