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Abbreviation: SP. The organ that lies against the lower face of the stomach; one of the five viscera. The spleen belongs to earth and has the functions of movement and transformation and of controlling the blood. It governs the flesh, opens at the mouth, and has drool as its humor. It stores ideation, and its mind is thought. It stands in internal-external relationship with the stomach. It holds the office of the Granaries.

For additional details about the functions, attributes, and associations of the spleen further to the description below, analogy in Chinese medicine: spleen, earth, Office of the Granaries.

Spleen Functions

The spleen governs movement and transformation of the essence of grain and water (solid and liquid foods), which means that it helps the stomach to digest food, absorbs the essence of grain and water, and dispatches it around the body. In this way, it begins the work of producing qì and blood, to which the heart and lung also contribute.

A second function of the spleen is to control the blood, which means preventing it from escaping from the blood vessels.

The Spleen Governs Movement and Transformation (脾主运化 pí zhǔ yùn huà)

The spleen’s movement and transformation (运化 yùn huà) action comprises several different aspects:

Overview of the Spleen

Functions Governs movement and transformation Moves the fluids of the stomach Extracts the essence of grain and water Upbears the clear and disperses essence Source of qì and blood formation Moves and transforms water-damp Controls the blood Associations Phase: Earth Bowel: Stomach Channel: Foot greater yīn (tài yīn) spleen channel Orifice: Mouth Body constituent: Flesh Bloom: Lips Humor: Drool Spiritual entity: Ideation Mind: Thought Aversion: dampness Office: Granaries

Thespleen governs movement and transformation of the essence of grain and water (脾主运化水谷之精微 pí zhǔ yùn huà shuǐ gǔ zhī jīng wéi): This statement has manifold significance.

Moves the fluid of the stomach: The stomach governs intake of food, i.e., it controls the appetite. It rots and ripens grain and water, or in other words, it performs the preliminary digestion of food. This function is traditionally understood to be reliant on the action of spleen qì; hence it is said that the spleen moves the fluids of the stomach (脾主为胃行其津液 pí zhǔ wèi wèi xíng qí jīn yè). In pathology, when splenic movement and transformation are impaired, the stomach’s governance of intake can also be affected, causing reduced eating (poor appetite).

Upbears the clear and disperses essence: The spleen extracts the essence of grain and water and dispatches it upward to the lung and heart, which then distribute it to all parts of the body. For this reason, it is said that the spleen governs upbearing of the clear (脾主升清 pí zhǔ shēng qīng) and the spleen disperses essence (脾散精 pí sàn jīng). Note that essence in this context refers to nutrients that the spleen extracts from food that are made into qì, blood, and fluids by the action of the spleen, heart, and lung.

The spleen’s upbearing of the clear is contrasted with the downward movement of stomach qì that carries matter down the alimentary canal, which is called downbearing the turbid. When spleen qì’s upbearing movement is impaired, the downbearing action of stomach qì is also easily affected. This qì dynamic disorder is reflected in distension and fullness in the stomach duct and abdomen.

The upbearing action of spleen qì is also responsible for keeping organs in place and preventing prolapse. When this function is impaired, the resulting pattern is spleen vacuity qì fall, which is characterized by persistent diarrhea, in severe cases with prolapse of the rectum. In women, it can manifest as prolapse of the uterus.

The upbearing of spleen qì is also responsible for ensuring that blood is retained with in the vessels (see spleen controls the blood further ahead).

Source of qì and blood formation: Because the spleen plays a first and primary role in the production of qì and blood, it is said that the spleen is the source of qì and blood formation (脾为气血生化之源 pí wéi qì xuè shēng huà zhī yuán). When the spleen’s function of extracting the essence of grain and water is affected, qì and blood formation are impaired, giving rise to qì and/or blood vacuity characterized by pale-white or withered-yellow facial complexion, fatigue and lack of strength, and emaciation (or obesity).

Note that the spleen is said to be the source of qì and blood formation, rather than the producer of qì and blood, because, while providing the main raw materials, it is not the only element involved in qì and blood formation. Qì is produced when the essence of grain and water extracted by the spleen combines with the clear qì inhaled by the lung to create ancestral qì, provisioning qì, and defense qì. Blood is produced when provisioning qì and fluids enter the vessels, are warmed by heart yáng and undergo further transformation in the lung. Traditionally, provisioning qì is said to be stored by the spleen.

Root of later heaven: The spleen is the root of later heaven (脾为后天之本 hòu tiān zhī běn). The central importance of the spleen and stomach in producing nutrients for the body is reflected in the Nèi Jīng epithet of the root of later heaven, that is, the basis of a person’s acquired constitution. The root of later heaven stands in complementary opposition to the root of earlier heaven, the basis of the congenital constitution, which is the kidney.

The spleen governs movement and transformation of water-damp (脾主运化水湿 pí zhǔ yùn huà shuǐ shī): The spleen eliminates water-damp (水湿 shuǐ shī), which is a term loosely referring to dampness or unwanted surplus fluids in the body. The spleen absorbs water into the body to create the liquid and humor of the body. In this process, it sends excess water-damp downward to be eliminated through the kidney and bladder. Whenever the yáng qì of the spleen weakens for any reasons, it easily fails to cope with water-damp, giving rise to dampness that obstructs the center burner. For this reason, it is said that the spleen likes dryness and is averse to dampness.

When the spleen fails to move and transform water-damp, there are signs such as torpid intake (a tendency to eat less because eating causes fullness), heavy cumbersome limbs, heavy-headedness, abdominal fullness, sloppy stool, and a glossy or slimy tongue fur. Depending on other factors, dampness can develop into cold-damp or damp-heat.

Water-damp can also concentrate to form phlegm and rheum under the influence of heat or qì stagnation. Therefore, it is said that the spleen is the source of phlegm formation (脾为生痰之源 pí wéi shēng tán zhī yuán).

The Spleen Controls the Blood (脾统血 pí tǒng xuè)

The spleen has the function of keeping blood flowing in the vessels and preventing it from spilling out, and hence it is said to control the blood. This is an extension of the spleen being the source of qì and blood formation. When movement and transformation are impaired and qì and blood become depleted, this can affect the retentive power of qì. Retaining the blood and fluids is one of the numerous functions attributed to qì. So, the spleen failing to control the blood essentially means that the retentive power of qì is impaired. Spleen failing to control the blood may manifest as nosebleed, spontaneous bleeding of the flesh, bloody stool, bloody urine, and flooding and spotting (heavy and light bleeding via the vagina).

The Spleen’s Associations and Epithets

The Spleen and Stomach Stand in Exterior-interior Relationship (脾与胃相为表里 pí yǔ wèi xiāng wéi biǎo lǐ)

The spleen and stomach have opposite characteristics and perform complementary functions in the digestive process.

• The stomach governs intake of food; its qì bears downward, carrying food down to the intestines. The spleen governs movement and transformation; its qì bears upward, that is, it extracts the essence of grain and water and sends it upward, to be dispatched to all parts of the body.
• The stomach likes moistness and is averse to dryness, while the spleen likes dryness and is averse to dampness. Fire-heat evil or excessive consumption of hot acrid and drying foods can easily damage the liquid of the stomach and cause stomach heat, while the spleen is susceptible to external dampness and when its yáng qì is weak, it fails to cope with fluids, allowing water-damp to arise internally.

Spleen and Stomach
The stomach has greater importance to the spleen than other bowels have to their corresponding viscera, and hence the two are often referred to together as spleen and stomach or spleen-stomach. They are also often referred to together as the center. The term center alludes to the center burner in which the spleen and stomach are located and to the central position of earth in the five phases.

The Spleen Channel (脾经 pí jīng)

The spleen is associated with the foot greater yīn (tài yīn) spleen channel (SP).

The Spleen Opens at the Mouth (脾开窍于口 pí kāi qiào yú kǒu)

This means that appetite and taste in the mouth reflect the condition of the spleen. When splenic movement and transformation are strong, the appetite is healthy, and the taste in the mouth is normal. Impaired movement and transformation are reflected in poor appetite and abnormal tastes in the mouth such as bland or sweet tastes or a slimy sensation. When impaired movement and transformation gives rise to accumulation of water-damp (water-damp obstructing the center), there is a bland taste in the mouth. Damp-heat can cause a sweet taste in the mouth, fetid mouth odor, and even mouth sores.

The Spleen Governs the Flesh and the Four Limbs (脾主肌肉、四肢 pí zhǔ ròu、sì zhī)

The Nèi Jīng says that the spleen has its fullness (充 chōng) in the flesh. The flesh corresponds to muscle and subcutaneous fat in anatomy. The flesh of the body and limbs is dependent on qì and blood derived from the essence extracted from grain and water by the spleen. When the spleen is healthy and ensures adequate supplies of qì and blood to meet the body’s needs, the flesh of the body is full and firm, and the limbs are powerful. Failure of the spleen to move and transform can lead to emaciation and to limpness and fatigue of the limbs. Dampness affecting the spleen is reflected in heavy cumbersome limbs. For this reason, the spleen is said to govern the limbs.

The Spleen Has its Bloom in the Lips and Four Whites (脾, 其华在唇四白 pí, qí huá zài chún sì bái)

This means that healthy, lustrous, red lips reflect general health, and especially the health of the spleen, which is the source of qì and blood formation. When splenic movement and transformation are weakened and qì and blood production are affected as a result, the lips become pale and lusterless. Four whites is usually explained as the pale flesh surrounding the lips, but some scholars explain it as sections in the eyes surrounding the pupils.

Drool is the Humor of the Spleen (脾, 在液为涎 pí, zài yè wéi xián)

Chinese medicine distinguishes two kinds of saliva, a thin kind called drool, associated with the spleen, and a thicker, foamy kind called spittle, associated with the kidney. Drool has the function of keeping the mouth moist, protecting it, and helping to digest food. When splenic movement and transformation are normal, fluids rise to enter the mouth and become drool, helping the digestive function of the spleen and stomach. When the spleen and stomach are in disharmony, drool may be produced in larger quantities and can flow spontaneously out of the mouth. This is often called drooling from the corners of the mouth.

The Spleen Stores Ideation (脾藏意 pí cáng yì)

The ability to form ideas, including thoughts, opinions, intentions, and plans is called ideation. The Chinese character is 意 yì, which is composed of 音 yīn, sound, and 心 xīn, heart, suggesting the sound of the heart. The character has many senses including intention, interest, opinion, or meaning, and thought. In Chinese medicine, it denotes the faculty for creative mental activity, which is in keeping with the notion of earth as the mother of the myriad living things. This notably includes思 sī, thought, as the mind of the spleen.

Thought is the Mind of the Spleen (脾, 在志为思 pí, zài yì wéi sī)

Of the five minds (anger, joy, thought, worry, fear), thought is the one associated with the spleen. Thought is a creative process that accords with the notion of earth as the mother of the myriad living things. Excessive thought damages the spleen, just as overcultivation damage the earth. In clinical practice, it is found to damage the spleen and the heart (dual vacuity of the heart and spleen).

The Spleen Belongs to Earth (脾属土 pí shǔ tǔ)

Earth is the sowing and reaping. It is the mother of the myriad living things (万物之母 wàn wù zhī mǔ). It is associated with late summer; dampness; the center; sweetness; and yellow.

Why the spleen is ascribed to earth: The spleen is associated with earth on the following counts.

Mother of the myriad living things: The spleen extracts essence from grain and water, which are used to produce qì, blood and fluids essential to the maintenance of the body, just as earth produces plants that support the life of humans and animals. Furthermore, the spleen is averse to dampness; it cannot perform its functions when dampness prevails in the body. Hence, it is like earth, which when water-logged fails to produce any crops.

The spiritual entity associated with the spleen is ideation and its mind is thought. These are the faculties of mental productiveness, which corresponds to the production of crops and the production of qì, blood, and fluids.

Late summer: Spleen qì resonates with the qì of late summer, the time when the spleen’s yáng qì is must effulgent. Late summer in most parts of China is a damp season, dampness being the environmental condition to which the spleen is averse.

Sweetness: Sweetness enters the spleen. Sweet medicinals such as dǎng shēn (Codonopsis Radix), huáng qí (Astragali Radix), bái zhú (Atractylodis Macrocephalae Rhizoma), biǎn dòu (Lablab Semen Album), dà zǎo (Jujubae Fructus), and yí táng (Maltosum) are used to treat poor appetite with fatigue and lack of strength owing to spleen qì vacuity.

Center: Earth is associated with the central position (the other phases are associated with the cardinal directions: wood with east, fire with south, metal with west, and water with north). The spleen and stomach are located in the center burner. The term center (中 zhōng) is used to denote the spleen, spleen and stomach, or the center burner, e.g., water-damp obstructing the center.

Yellow: Yellow is the color of earth. The Chinese 黃 huáng includes many hues that English speakers might normally call brown. So, it is important to note that in Chinese medicine yellow covers a wider range of colors than it normally does in common speech. A yellow complexion is often a sign of spleen disease. A withered-yellow complexion is a sign of blood or qì-blood vacuity arising when the impairment of splenic movement and transformation affects blood and qì production. Jaundice (yellowing of the skin of the whole body and sclera) was traditionally explained in terms of dampness affecting the spleen.

Cyclical relationships: In its cyclical relationships, spleen-earth is engendered by heart-fire and engenders lung-metal. It is restrained by liver-wood and restrains kidney-water.

The Spleen and Stomach Hold the Office of the Granaries (脾胃者, 仓廪之官 pí wèi zhě, cāng lǐn zhī guān)

Sù Wèn (Chapter 8) states, The spleen and stomach hold the office of the Granaries; the five flavors arise from them (脾胃者, 仓廪之官, 五味出焉 pí wèi zhě, cāng lǐn zhī guān, wǔ wèi chū yān). The spleen and stomach are like an official responsible for the national grain stores; they provide nourishment for the whole body, just as earth produces crops and feeds the myriad living things. Note that since traditionally the effect of not only medicinals but also foodstuffs was understood in terms of qì and flavor, the expression five flavors denotes the various nutritive properties of food.

The Spleen Likes Dryness and Is Averse to Dampness (脾喜燥恶湿 pí xǐ zào wù shī)

The spleen belongs to earth among the five phases. As explained above, just as when earth becomes waterlogged, it cannot produce crops, so the spleen cannot work effectively when there is too much water-damp. Whenever the spleen’s movement and transformation function is weak, water-damp can easily accumulate. Hence, it is said that the spleen is averse to dampness. Water-damp can take the form of internal dampness, with fullness and distension in the stomach duct and abdomen. It can also take the form of puffy swelling.

Spleen Disease Signs

Signs of spleen disease fall into five categories.

• Appetite: Reduced eating or torpid intake (spleen affecting the stomach’s function of governing intake).
• Reduced qì and blood production: Fatigue and lack of strength.
• Poor digestion: Fullness, distension, and sloppy stool or diarrhea.
• Dampness: Fullness, distension, and heaviness.
• Controlling the blood: When the spleen function of controlling the blood is impaired, chronic bleeding of various kinds arises.

Reduced eating (食少 shí shǎo); torpid intake (纳呆 nà dāi): Reduced eating simply means eating less than normal as a result of poor appetite. It is most commonly a sign of spleen qì vacuity affecting the stomach’s function of intake. Torpid intake is an impairment of the stomach’s function of governing intake that implies reduced eating due to a feeling of satiety before meals and fullness experienced on intake of food. Torpid intake in spleen disease is usually a sign of dampness, whose clogging effect affects the stomach’s intake function.

Fatigue and lack of strength (倦怠乏力 juàn dài fá lì): A sign of spleen qi vacuity in which qì and blood production are affected.

Sloppy stool (便溏 biàn táng); diarrhea (泄泻 xiè xiè): Sloppy stool is semiliquid stool, without increased frequency. In older texts, it is sometimes referred to as duck slop (鸭溏 yā táng or鹜溏 wù táng) on account of its similarity to duck droppings. It is a sign of insufficiency of the spleen’s yáng qì failing to cope with water-damp, giving rise to a pattern of dampness encumbering the spleen. Diarrhea is a more severe condition marked by increased frequency of defecation. It is associated with spleen vacuity fall, food damage (stomach upset due to eating bad food or too much food), or large intestine problems.

Distension and fullness in the stomach duct and abdomen (脘腹胀满 wǎn fù zhàng mǎn); glomus and oppression in the stomach duct and abdomen (脘腹痞闷 wǎn fù pǐ mèn): Stomach duct (胃脘 wèi wǎn) is the part of the abdomen above the umbilicus in which the stomach is located. Fullness (满 mǎn) is a subjective feeling of bloating. It occurs in any spleen pattern. Distension (胀 zhàng) is severe fullness associated with palpable or even visible expansion of the affected area. Oppression (闷 mèn) is a sensation of pressure or tightness. Glomus (痞 pǐ) is a feeling of localized distension or a sensation of blockage. It is associated particularly with dampness and phlegm-rheum.

Abdominal pain (腹痛 fù tòng): Pain in the stomach duct (i.e., region of the stomach) or the abdomen may be associated with any spleen problem.

Heavy cumbersome limbs (四肢困重 sì zhī kùn zhòng): A subjective sensation that the limbs are heavy and difficult to lift; a sign of dampness encumbering the spleen.

Obesity (形体肥胖 xíng tǐ féi pàng); emaciation (形体消瘦 xíng tǐ xiāo shòu): Both emaciation and obesity are attributable to spleen qì vacuity. Emaciation arises when the spleen fails to ensure copious supplies of qì and blood to the flesh. Obesity arises out of a yīn-yáng imbalance. When splenic movement and transformation are weak, excess water-damp is not eliminated and when the yáng qì of the body in general is weak as a result, it fails to keep the yīn qì of the body in check. Weight loss treatment in medicinal therapy invariably makes use of medicinals that fortify the spleen and disinhibit dampness. A further aspect of this imbalance is seen in the observation that obese people have copious phlegm (肥人多痰 féi rén duō tán). The physical substance of the body, dampness, and phlegm are all yīn qìand are only kept in check when yáng qì is exuberant.

Chronic bleeding (慢性出血 màn xìng chū xuè): Chronic bleeding that manifests in bloody stool, bloody urine, vomiting of blood, nosebleed, bleeding gums, flooding and spotting, or profuse menstruation occurs when the spleen fails to control the blood.

Spleen Patterns

For fuller information than is given below, follow the pattern links. See spleen pattern identification.

Spleen disease patterns fall into two categories:

• Insufficiency: Spleen qì vacuity, spleen yáng vacuity, spleen vacuity qì fall, and spleen failing to control the blood, which stem from insufficiency of the spleen’s yáng qì.
• Dampness: Dampness patterns are caused by external dampness or by insufficiency of spleen yáng qì failing to eliminate water-damp. External or internal dampness can develop into cold-damp or damp-heat.

Insufficiency

Spleen qì vacuity (脾气虚 pí qì xū): Spleen qì vacuity is impairment of the spleen’s function of movement and transformation. It manifests in several ways.

• When spleen qì vacuity prevents food from being moved and transformed, there is distension and fullness in the stomach duct and abdomen, especially after eating, and sloppy stool or diarrhea.
• When it affects the stomach’s function of intake, there is reduced eating.
• When it affects the rotting and ripening of grain and water, there may be fullness and distension.
• When it affects the production of qì, there may be obesity, fatigued limbs and lack of strength, laziness to speak, and shortness of breath.
• When it affects the production of qì and blood, there may be fatigue and lack of strength, emaciation, and a withered-yellow complexion.
• When water-damp is not moved and transformed, internal dampness, obesity, phlegm-rheum, or water swelling may arise.
• The facial complexion is withered yellow. The tongue is pale with a white fur. The pulse is moderate and weak.

Spleen yáng vacuity (脾阳虚 pí yáng xū): Spleen yáng vacuity is essentially the same as spleen qì vacuity, but with the addition of cold signs such as continual abdominal pain that likes warmth and pressure, and lack of warmth in the limbs. The tongue is pale and enlarged with dental impressions and a glossy white fur. The pulse is sunken, slow and forceless. In women, there may be clear thin vaginal discharge.

Spleen vacuity qì fall (脾虚气陷 pí xū qì xiàn): This is a specific kind of spleen qì vacuity that culminates in severe diarrhea and prolapse of the rectum or in prolapse of the uterus. In mild cases, there may only be sagging sensations in the stomach duct and abdomen exacerbated by eating and in some cases frequent urge to defecate. There may also be a heavy sagging sensation in the anus. In severe cases, there may be chronic diarrhea and prolapse of the anus, or, in women, prolapse of the uterus. In some cases, spleen qì fall may take the form of murky urine like rice water. General signs of qì vacuity are observed: fatigue and lack of strength, dizzy head and vision, lusterless white complexion, reduced eating, and sloppy stool. The tongue is pale with a white fur. The pulse is moderate or weak.

Spleen failing to control the blood (脾不统血 pí bù tǒng xuè): This is a specific form of qì vacuity that manifests in conditions such as profuse menstruation, flooding and spotting, in bloody stool, bloody urine, or nosebleed. Spleen qì vacuity signs include reduced eating, lassitude of spirit and lack of strength, shortness of breath and laziness to speak, a withered-yellow facial complexion, and a pale tongue. The pulse is fine and forceless.

Dampness

Cold-damp encumbering the spleen (寒湿困脾 hán shī kùn pí) manifests in distension, oppression, and pain in the stomach duct and abdomen, torpid intake, nausea and vomiting, bland taste in the mouth without thirst, heavy cumbersome head and body, sloppy stool, and a withered-yellow facial complexion. The tongue fur is white and glossy or slimy. The pulse is soggy and moderate or sunken and fine. Jaundice with a dull yellow coloration is a specific manifestation of cold-damp encumbering the spleen and affecting the gallbladder.

Damp-heat brewing in the spleen (湿热蕴脾 shī rè yùn pí) may be caused by externally contracted damp-heat as in a humid environment or by damp-heat arising internally as a result of excessive consumption of fatty or sweet foods or alcohol. The main signs are glomus and oppression in the stomach duct and abdomen, torpid intake, aversion to food, retching and vomiting, heavy cumbersome limbs, sloppy stool, heat effusion, a red tongue with slimy yellow tongue fur. The heat effusion associated with damp-heat typically fluctuates or fails to surface (不外扬 bù wài yáng), that is, only felt at the body’s surface on prolonged palpation.

Jaundice with bright colored skin is a specific manifestation of damp-heat brewing in the spleen. Itchy skin conditions are also attributed to damp-heat brewing in the spleen. The tongue is red with a slimy yellow tongue fur. The pulse is soggy and rapid or slippery and rapid.

The Spleen’s Relationships

Spleen and Heart

The spleen is the source of qì and blood formation; it is the main viscus responsible for producing blood. The spleen also controls the blood, that is, prevents extravasation. The heart governs the blood; it moves the blood around the body.

The relationship between the heart and spleen concerns (a) the production of blood; (b) the movement of blood; and (c) the connections between blood, spirit, and movement and transformation.

Production of blood: The spleen governs movement and transformation of grain and water and is the source of qì and blood formation. When spleen qì is exuberant, blood production is normal, the heart has blood to govern. Conversely, the health of the spleen is in some measure reliant on the health of the yáng qì of the heart for its warming action.

In pathology, the heart and spleen can influence each other in several ways. Excessive thought and preoccupation can wear the heart blood. When the yáng qì of the heart is insufficient, this can deprive the spleen of warmth and nourishment, thereby affecting blood production. In any event, the result is dual vacuity of the heart and spleen, which manifests in heart palpitation, insomnia, reduced eating, and fatigue.

Movement of blood: The heart governs the blood, while the spleen controls the blood. When the heart and spleen are healthy and coordinated, blood production and flow are normal.

When heart qì is insufficient and fails to move the blood adequately, blood stasis and stagnation can develop. When insufficiency of heart yáng deprives the spleen of warmth and nourishment, this can impair the spleen’s ability to control the blood, causing bloody stool, bloody urine, or flooding and spotting.

Blood, spirit, and movement and transformation: The heart governs the blood; blood provides the spleen with nourishment. At the same time, the heart governs the spirit; a normal heart spirit helps to ensure normal splenic movement and transformation. Splenic movement and transformation are necessary to produce heart blood and to nourish the spirit. Hence, a close relationship exists between heart blood, heart spirit, and splenic movement and transformation.

When spleen qì is weak and movement and transformation fails, or when the spleen fails to control the blood, this can cause insufficiency of heart blood or disquieted heart spirit. The dual condition, called dual vacuity of the heart and spleen, manifests in reduced eating, sloppy stool, chronic bleeding, together with lusterless facial complexion, heart palpitation, insomnia, and profuse dreaming.

Spleen and Lung

The relationship between the lung and spleen is chiefly seen in the production of qì and distribution of fluids.

Production of qì: The qì of the body is dependent upon the respiratory function of the lung and the movement and transformation function of the spleen. The clear qì inhaled by the lung and the essential qì of grain and water that is moved and transformed by the spleen provide the material basis for the production of ancestral qì, provisioning qì, and defense qì. Hence, the health of qì is dependent on the health of the lung and spleen.

When spleen qì is weak, it can cause insufficiency of lung qì, which is often referred to as earth failing to engender metal and is treated by the method of banking up earth to engender metal.

Enduring lung disease can affect the spleen, causing splenic movement and transformation failure, which manifests in reduced eating, abdominal distension, sloppy stool, and even water swelling. This is often called disease of the upper body affecting the center. In medicinal therapy, this is also treated by banking up earth to engender metal. There is no special method for treating spleen qì vacuity stemming from lung qì vacuity, because qì vacuity in any bowel or viscus is primarily treated by fortifying the spleen.

Distribution of fluids: The lung and spleen perform mutually complementary functions in the realm of fluid distribution.

• The lung’s diffusion, depurative downbearing, and regulation of the waterways help the spleen to move and transform water and prevent internal dampness from arising.
• The spleen’s function of moving and transforming water-damp and spreading essence to the lung is not only necessary for normal regulation of the waterways, but also provides the lung with nourishment.

When splenic movement and transformation are impaired, fluid often collects and stagnates, leading to phlegm and rheum, which affect the diffusion and depurative downbearing functions of the lung and cause cough with copious phlegm. For this reason, it is said that the spleen is the source of phlegm formation and the lung is the receptacle that holds phlegm.

Spleen and Liver

The spleen governs movement and transformation, is the source of qì and blood production, and controls the blood (prevents extravasation). The relationship between the spleen and liver is primarily seen in the mutual influence between splenic movement and transformation and the liver’s free coursing. Less importantly, the liver and spleen are related in the realm of production, storage, and movement of blood, and its retention in the vessels.

Digestion: Digestion is performed by the combined action of spleen and stomach qì, which is in turn dependent upon the liver’s free coursing. When free coursing is normal, the spleen performs its movement and transformation function adequately.

If liver’s free coursing action is deficient, it cannot assist the spleen’s upbearing action. This is called wood failing to course earth or more commonly liver-spleen disharmony. This is marked by depressed anger, mental depression, distension and fullness in the chest and rib-side, abdominal distension and pain, and sloppy stool or diarrhea.

Dampness arising internally owing to impaired splenic movement and transformation can, under the influence of heat or cold, develop into spleen-stomach damp-heat or cold-damp, which then invades the liver and gallbladder, giving rise to jaundice. Damp-heat steaming the liver causes the bile to discharge excessively and gives rise to yáng yellowing, characterized by a bright yellow complexion. Cold-damp obstructing the gallbladder hampers the flow of the bile, making it move in abnormal directions. The result of this is yīn yellowing, marked by a dark-yellow complexion.

Blood: When the spleen is healthy, it produces adequate supplies of blood and keeps it within the vessels, the liver has blood to store. If the spleen fails to produce blood and fails to control it and allows excessive bleeding, this can cause insufficiency of liver blood.

The liver’s function of storing blood and the spleen’s function of controlling the blood coordinate to prevent bleeding. When these two functions are disturbed, bleeding can develop in numerous forms, such as bloody stool, bloody urine, spontaneous bleeding of the flesh, nosebleed, bleeding gums, profuse menstruation, or flooding and spotting.

Spleen and Kidney

The spleen is the root of later heaven, while the kidney is the root of earlier heaven. Herein lies the most important aspect of the relationship between the spleen and kidney. The complementarity of the spleen’s movement and transformation function and the kidney’s governing of water constitutes a secondary aspect of the relationship.

Earlier and later heaven: The spleen moves and transforms the essence of grain and water and is the source of qì and blood formation; it is the root of later heaven (acquired constitution). The kidney stores essence and houses the true fire of the life gate; it is the root of earlier heaven (congenital constitution).

Splenic movement and transformation rely on the warming and steaming action of kidney yáng. Hence, it is said, spleen yáng is rooted in kidney yáng (脾阳根于肾阳 pí yáng gēn yú shèn yáng). The essential qì in the kidney is reliant on the spleen for constant replenishment from the essence of grain and water. Hence, the root of earlier heaven and the root of later heaven are entirely interdependent.

In pathology, earlier and later heaven often affect each other:

• Vacuity of spleen qì with impaired movement and transformation can cause insufficiency of kidney essence. The resulting dual condition manifests in spleen signs such as abdominal distension, sloppy stool, and emaciation, together with kidney signs such as aching lumbus and tinnitus.
• Insufficiency of kidney yáng depriving the spleen of warmth or enduring spleen yáng vacuity affecting kidney yáng gives rise to spleen-kidney yáng vacuity, which is marked by cold pain in the abdomen, clear-grain diarrhea (diarrhea with undigested food in the stool) or fifth-watch diarrhea (diarrhea just before dawn, heralded by pain and rumbling intestines), and water swelling.

Water metabolism: The spleen is responsible for moving and transforming ingested fluids. The kidney governs water: by its steaming action, it returns clear fluids into the system and drains off the waste in the form of urine; it also controls the opening and closing of the bladder. Normal water metabolism thus requires the coordinated action of the spleen and kidney. Furthermore, the spleen can only perform its functions when it benefits from the warming of kidney yáng. Less importantly, the warming action of kidney yáng can only be maintained if spleen yáng is exuberant.

In pathology, the spleen and kidney influence each other greatly in the realm of water metabolism in the following ways:

• Kidney yang vacuity with impaired qì transformation can also cause water-damp to brew internally and affect splenic movement and transformation, ultimately causing dual vacuity of the spleen and kidney with water-damp collecting internally. This is called kidney vacuity water flood, which is characterized by scant urine and puffy swelling, abdominal distension and sloppy stool, with fear of cold, cold limbs, and limp aching lumbus and knees.
• Spleen vacuity with impaired movement and transformation causes water-damp to arise internally. When this condition endures and kidney yáng becomes insufficient, the condition may turn into one of kidney vacuity water flood.

Etymology

Chin 脾 pí is composed of the flesh signifier 月, an abbreviated form of 肉 ròu combined with 卑 bēi, which gives the character its sound, and by its meaning of low or below, may contribute to meaning by indicating that the spleen is the organ located below the stomach.

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