Lesley Tierra L.Ac.
Western medicine and Traditional Chinese Medicine (TCM) have long been
viewed as two distinct and divergent medicines. Their approaches to
physiology and healing appear quite different in perspective. While Western
medicine separates the various systems and organs of the body and delves
deeper and deeper into the particles that comprise matter, Chinese medicine
views the body and further, the whole person, as a unified organic whole.
Spiritual, mental, emotional and physical aspects are all seen as
interrelated and interdependent.
Western medicine treats illness by isolating the diseased area and giving
drug medications to alter and counteract the individual problem. Chinese
medicine treats illness by identifying which parts of the whole are out of
balance and the resulting energy patterns they form. These are then treated
with energetic therapies and herbal medications to correct the imbalance
and bring the whole to stasis. While Western medicine derived its theory
and treatments from dissection, microscopic analysis and chemical
derivations, Chinese medicine developed mainly through thousands of years
of observation, not only of the human body, but its relationship to nature
and the universe.
Despite the fact that both medicines had a unique historical development
and approach healing from a distinctly different perspective, it is
fascination to discover actual correspondences between the two, which can
allow their differences to assume more complementary roles. Ironically, it
is Western medicine, which is helping to bridge this gap, as its well
developed technology is now able to corroborate what 5000 years of TCM has
known all along. From this we may create a common understanding of the two
medicines and learn not only alternative natural therapies to Western
drugs, but also how the Chinese treat Western "incurable" diseases and
energy imbalances which respond poorly to Western medications.
The TCM spleen as the source of energy derived from food and fluid is one
of the most important organ systems and makes a good study to appreciate
the similarities and differences between the two systems. At first glance
it appears there are no correspondences at all, but upon deeper examination
we learn that it is only terminology and perspective which mask their
underlying similarities. To compare them, however, it is necessary to look
beyond the spleen itself in Western medicine to other physiological
processes in the body. Because in Chinese medicine the body is seen as an
interrelated whole, functions of an organ actually occur on a cellular
level throughout the entire body. To compare this with the Western
definition of an organ it is thus necessary to look at several processes
and cellular constituents as well as the spleen itself.
To inspect these similarities we will first review the Western
understanding of the spleen and then a comparison with the Chinese view.
Next we will compare them and give the TCM treatment strategies for spleen
imbalances. Perhaps through more inspection of these seeming differences
between contemporary Western and traditional Chinese medicines, we can
ultimately come to a more integrated approach to health and healing based
upon traditional and contemporary principles.
I. THE SPLEEN ITSELF
In Western medicine the spleen is considered to be part of the lymphatic
system in the body. This system is comprised of lymph and lymph vessels,
nodes and organs - the tonsils, thymus gland and spleen. The primary
function of the lymphatic system is to drain from the tissue spaces
protein-containing fluid which escapes from blood capillaries, transport
fats from the digestive tract to the blood to produce lymphocytes and
develop immunities, and for the lymph organs to filter lymph and add white
blood cells and antibodies.
The spleen has several functions in Western medicine:
- a. defense
- phagocytosis of bacteria and worn-out red blood cells and platelets,
salvaging iron and globulin content and returning them to the blood
- production of lymphocytes, monocytes and plasma cells, which in turn
- store blood and release it through contraction of the spleen or in case
- production of red blood cells in the fetus but not adults.
II. THE DIGESTIVE PROCESS
Because the TCM definition of the spleen functions includes the digestive
processes and functions, which occur on a cellular level throughout the
body, we need to look at both these aspects in Western medicine also. In
terms of the western view of digestion, food is digested in the stomach and
passed on to the small intestines where the nutrients in the food are
absorbed and distributed to all tissues and cells of the body through the
blood circulation. Energy is then produced through biological oxidation of
foods primarily in the mitochondria of the cells.
III. CELLULAR FUNCTIONS
We now look within the cells themselves in Western medicine to obtain an
overall body view. Scattered throughout the plasma in cells are organelles
called mitochondria. These are called "the powerhouses of the cells"
because they produce most of the form of chemical energy used by the cells.
The mitochondria are important in the Krebs cycle in the body, a series of
energy-yielding steps in the catabolism of carbohydrates. The enzymes for
this pathway are in the mitochondria matrix, and they catalyze oxidation
reactions that form ATP, an energy carrying molecule, in the Krebs Cycle.
This cycle occurs as follows: the catabolism of carbohydrates, fats and
proteins transfers energy to the ATP bio-molecule through enzymes and an
oxidation process. It does this in two places, in the cytoplasm and in the
mitochondria. The latter is the most important place as it accounts for 95%
of ATP molecules from glucose breakdown and 100% from fatty acid breakdown.
Thus, food is catabolized and energy from it is captured and put into the
ATP bio-molecule. The rest of the energy is released as heat that keeps our
bodies warm. Then when ATP breaks down, it releases energy for cellular
work. Overall, the Krebs cycle provides energy and heat for the body's many
processes, and the mitochondria are key to this process.
III. SPLEEN DISEASES IN WESTERN MEDICINE:
There are several diseases recognized by Western medicine that involve the
Spleen. These include mononucleosis, leukemia, splenomegaly, Hodgkin's
disease, AIDS and all the various types of anemias. In general these
include an elevation of white bloods cells and/or insufficient production
of red blood cells, lymph disorders and depressed or impaired immunity.
The spleen is seen as a paired complex in Traditional Chinese Medicine
(TCM) of the Earth element, the spleen being the yin component and the
stomach being the yang. They work together and imply the other's functions.
Because the spleen is the deeper yin organ where the energy of food and
fluid is transformed, it is the more vital of the pair and so the one most
often referred to. In TCM the spleen has the following functions:
- Rules the transformation and transportation of food and fluids in the body. The spleen transforms food to extract the energy from it and then
transports the resulting food "energy" to various organs and parts of the
body where the body's energy and blood are produced. Thus, the spleen is
seen as the basis for the production of energy and blood in the entire
body. The spleen also controls transformation, separation and movement of
fluids. It separates the usable and the unusable from the fluids ingested
and these are then transported to their appropriate places. Thus it plays a
central role in nourishing the body and promoting development.
- Governs the blood. The spleen keeps he blood circulating in the
vessels. It also provides the extracted energy from food and sends it to
the heart to be mixed with Kidney energy to form blood.
- Rules the muscles, flesh and the four limbs. It does this by
transporting the body's energy and blood to the muscles, flesh, arms and
legs. Consequently, overall muscle tone, strength and appearance,
especially that of the arms and legs, reflects the health of the spleen.
- Opens into the mouth and it's brilliance is manifested in the lips.
Chewing prepares food for its digestion. If the spleen is healthy there is
a good sense of taste and all five tastes can be distinguished. Further,
the lips are moist and rosy.
- Raises the qi. The spleen qi produces a lifting effect along the
midline of the body and keeps the internal organs in place so they do not
sag or prolapse.
- Rules thought. The spleen influences our capacity for thinking,
studying, focusing, concentration and memorizing.
SIGNS OF SPLEEN DYSFUNCTION IN TCM
General signs of spleen dysfunction include:
- Abdominal distention, aching or pain relieved by local warmth and pressure
- Lack of appetite and flat taste in the mouth
- Abdominal flatulence after meals, aggravated by stress
- Abnormal stool such as water, first well-shaped then loose,
loose, well-shaped and loose alternatively, or diarrhea.
- Chronic hemorrhage or blood in the stool, vomit, mucus or under the skin, not caused by blood heat evils and trauma
- Sallow complexion or pale lips
- Pale and swollen tongue, or with teeth marks on its margin
- Emaciation, or puffy appearance
- Weakness in the arms and legs or muscles.
Specifically these signs of dysfunction can be grouped into energy
patterns. Each of these is comprised of specific signs and symptoms and
each is then treated accordingly.
Signs of deficient spleen qi:
No appetite, abdominal distention after eating, spiritlessness, tiredness,
lethargy, lassitude not caused by stagnation of dampness or physical
stress, sallow complexion, weakness of the arms and legs, visceroptosis or
rectal prolapse or hemorrhoids,debilitated defecation, defecating without
stool or defecating immediately after meals, loose stools, sleepiness after
eating, hallow pulse, slow and weak pulse or feeble and hollow pulse,
tongue swollen with scallops of the side in the middle section.
Signs of deficient spleen yang:
Lack of appetite, abdominal distention and/or pain, especially after
eating, tiredness, sallow or bright white complexion, weakness of the four
limbs, loose stools or watery stools with undigested food in them, edema,
chilliness, cold limbs, pale, swollen and moist tongue and weak, slow and
Spleen energy sinking:
Signs of spleen qi deficiency plus a bearing down sensation in the abdomen,
prolapse of the stomach, uterus, anus, or vagina, frequency and urgency of
urination, extreme chronic diarrhea, a pale tongue and empty or weak pulse.
Spleen not controlling the blood:
Signs of spleen qi deficiency plus bleeding in general, purpura, blood
spots under the skin, blood in urine or stools, hemorrhage, menorrhagia,
sallow complexion and shortness of breath, pale tongue and fine pulse.
Cold-damp invading the spleen:
No appetite, feeling of cold in the epigastrium which improves with warmth,
feeling of heaviness or stuffiness in the head, chest and/or epigastrium,
sweet taste in the mouth or absence of taste, no thirst, loose-thin stools,
white vaginal discharge, lassitude, rumbling intestines, abdominal pain,
sticky thick white coating on the tongue and a slippery, slow pulse.
Damp-heat invading the spleen
Stuffiness in the epigastrium and lower abdomen, no appetite, feeling of
heaviness, thirst without desire to drink or with a desire to drink small
sips, nausea, vomiting, abdominal pain, loose stools with offensive odor,
burning sensation of the anus, scanty and dark yellow urination, low grade
fever, headache, sticky yellow tongue coating and slippery and rapid pulse.
There are many comparisons of the spleen between Western medicine and TCM,
and they are best shown by following the various functions of the spleen in
The Spleen rules transformation and transportation of food and fluids in
A combined Western medicine/TCM study done in China yielded surprising
results in the connection between the spleen in both medicines. In the
study samples of the gastric mucosa were taken from a variety of people who
were identified with the various TCM patterns of spleen dysfunction. These
were then compared with gastric mucosa samples of people with no TCM
symptoms of spleen dysfunction. Those with spleen symptoms all showed
The conclusion found that the spleen in TCM is closely related to the
mitochondria. To see this graphically, the digestive process between
Western medicine and TCM is as follows:
TCM View of the Spleen
Food --- stomach (decomposing) --- small intestine (digesting and
distinguishing the refined substance from the dross) --- upward transport
of the essence --- spleen (transporting and transforming) --- vital energy
Modern Medicine View of the Spleen
Food --- stomach (mechanical digestion mainly) --- small intestine
(chemical digestion mainly and absorption of nutrients) --- blood
(transportation) --- mitochondria (biological oxidation) --- energy
Examples of how TCM equals Modern Medicine:
Spleen (transporting and transforming) = mitochondria (biological oxidation)
From this it is clear the function of the TCM spleen is quite similar to
that of the mitochondria. In the study, deficient spleen qi patients
experiencing abdominal flatulence, abnormal stools and undigested food in
the stool after the intake of a high protein diet had obvious quantitative
and qualitative changes of mitochondria and displayed a decreased number of
the enzyme secreting cells (zymogen granules) necessary for normal
digestion. A deficiency of spleen qi was thus found to correspond to an
insufficiency of digestive enzymes and a reduction of enzyme activity,
interfering with digestion of proteins. This digestion on the cellular
level corresponds to the digestive process ruled by the spleen, that of
transforming (essentially absorbing) and transporting (taking the nutrients
to where they are needed).
A decrease in the number and quality of mitochondria also leads to less
heat being created as a product of the ATP formation process. In turn this
provides less "metabolic fires", resulting in poor absorption and
transportation of nutrients to the cells. This heat released by ATP
corresponds to the yang function in the body. In the TCM spleen this heat
gives appetite, energy, digestive capacity, warmth, proper circulation of
fluids and stool formation.
When there is deficient spleen qi the fluid metabolism is interfered with
and edema and swelling result. A function of the Western Spleen is to drain
from tissue spaces protein-containing fluid which escapes from blood
capillaries. In the cases of deficient spleen qi patients, the mitochondria
of the stomach parietal cells were swollen. This may be a result of
insufficient energy (poor mitochondria functioning) leading to an
impediment of the sodium-potassium pump and resulting in an accumulation of
fluid in the cells.
The spleen governs the blood
In TCM the spleen is a source of vital energy and blood and a controller
of blood circulation. When spleen qi is weak it's blood controlling
function is disturbed and bleeding results. Further, the production of
blood and qi are decreased. In the blood routine examinations of patients
with diarrhea attributive to the deficiency of spleen energy, there was
revealed a decreased hemoglobin level. Other patients who had pale lips,
sallow complexion and bleeding had fewer mitochondria in the parietal cells
of the stomach and these had obviously damaged cristal membranes.
The spleen rules the muscles, flesh and four limbs (extremities)
When spleen energy is sufficient, blood and qi are well provided and
muscles are brawny. Otherwise, they may be weak, thin, puffy or even
emaciated. In the case study, deficient spleen qi patients had
listlessness, tiredness, thin musculature and fewer mitochondria that had
more evidence of damaged ridges. In those with muscular atrophy, the
mitochondria were found to have broken ridges, defected membranes and faint
stromas. Further, there was an impediment of energy metabolism in muscles
with anti-mitochondria antibodies discovered in some cases.
The spleen opens into the mouth and it's brilliance is manifested in the
The spleen produces a lifting effect along the midline of the body and
keeps the internal organs in place so they do not sag or prolapse.
Mitochondria are found in almost all tissues and cells of body. In
deficient spleen qi patients with sallow complexions, pale lips, a flat
taste in mouth, abdominal flatulence, shortness of breath, debilitated
defecation and visceroptosis, the mitochondria are found to be decreased in
number and many are damaged and swollen.
The spleen rules thought.
The spleen influences our capacity for
thinking, studying, focusing, concentration and memorizing. Poor digestion
and assimilation results in a lack of nutrients nourishing the brain and
can effect the blood sugar. Both can cause mental unrest, irritability,
worry, dwelling on things or obsession, and a lack of focus and clarity.
The importance of this comparison of the spleen helps herbalists better
understand the value and effect of herbs on the body.( ) The spleen is
probably the most important strategy for healing in TCM because it affects
the body's immunity and capacity to maintain and heal itself. If we can
understand the diagnostic indications for spleen patterns and herbs used
for them, then its possible to better understand the properties of the
For example, qi tonics such as ginseng probably help in mitochondria
formation, both in quantity as well as quality. Also, dampness-eliminating
herbs probably help re-form swollen mitochondria and perhaps aid in lymph
circulation. Thus, qi tonifying herbs in TCM are important, not just as
tonics or adaptogens, but because they aid mitochondria repair and
replication, and increase resistance to disease by stimulating the spleen
to produce lymphocytes and leukocytes.
There are several functions of qi tonics. One is as adaptogens, herbs that
have anti-irradiation, anti-stress and anti-fatigue effects. In terms of
Western medicine this means they probably increase leukocytes and promote
antibody formation. Examples include ginseng, astragalus and schizandra.
Another function of qi tonics is as immune promoters and strengtheners.
Examples are astragalus, codonopsis, ginseng and atractylodes.
Qi tonics are usually classified as having a sweet flavor. This
demonstrates their life supporting effects that build up body tissue and
produce energy. Since the Chinese believe food is the best tonic, qi tonics
are often combined with food such as rice, ginger, red dates, meat soup, or
in Ayurveda, with milk. Qi tonics are also frequently used with herbs that
eliminate dampness or tonify the yang. Because the overuse of tonics can
cause stagnation of qi leading to gastrointestinal fullness, chest pains
and tightness, spasms or headaches, it is important to use tonics in
moderate doses and give them with qi regulating herbs (carminatives).
SPLEEN QI TONICS
Ginseng, American ginseng, codonopsis, astragalus, jujube dates,
atractylodes, licorice, dioscorea, honey, barley malt or rice syrup,
spikenard, elecampane root, suma (Pfaffia paniculata)
SPLEEN DAMPNESS ELIMINATION AND CARMINATIVES
cardamom, magnolia bark, orange peel, saussurea root, poria cocos (hoelen)
I. Spleen Qi Deficiency
Four Gentleman Decoction (si jun zi tang)
- Rx Ginseng 3-9 gm
- Rhz Atractylodis macrocephalae 6-9 gm
- Sclerotium Poria cocos 6-9 gm
- Rx Glycyrrhizae uralensis, honey-fried 3-6 gm
This is a very harmonious and moderate formula that is not too warm or
drying. It may be used in treating any disorders for which deficient spleen
qi is considered the root. It treats pallid complexion, low and soft voice,
reduced appetite, loose stools, weakness in the limbs, pale tongue body and
thin and/or frail pulse.
Extraordinary Merit Powder (yi gong san)
- Four Gentleman Decoction plus:
- Pericarpium citri reticulatae (chen pi) 6-9 gm
In addition to the effects of the Four Gentleman Decoction, this formula
also harmonizes the stomach, treating a stifling sensation in the chest and
epigastrium, nausea and vomiting.
Six Gentleman Decoction (jiao zhu fu ren liang fang)
- Rx Ginseng 3 gm
- Rhz Atractylodes macrocephalae 4.5 gm
- Sclerotium Poria cocos 3 gm
- Rx Glycyrrhizae uralensis, honey-fried 3 gm
- Pericarpium Citri reticulatae 3 gm
- Rhz Pinelliae ternatae 4.5 gm
This formula tonifies spleen qi, transforms phlegm and stops vomiting. It
is good for loss of appetite, nausea, vomiting, abdominal distention, a
stifling sensation in the chest and epigastrium, possible coughing and
copious thin and white sputum.
Six Gentleman Decoction with Cardamom and Saussurea
(Ziang sha liu jun zi tang)
- Six Gentleman Decoction with:
- Eletarria cardamomum 2.4 gm
- Saussurea 2.1 gm
This formula additionally strengthens the spleen, harmonizes the stomach,
and regulates qi and stops pain. It treats spleen and stomach qi deficiency
with cold-damp stagnation, decreased appetite with feelings of fullness
after eating only a little, belching, abdominal distention or pain and
periodic vomiting and diarrhea.
Nourish the Stomach Decoction with Cardamom and Saussurea
(xiang sha yang wei tang)
- Rx Ginseng (ren shen) 1.5 gm
- Rhz Atractylodes macrocephalae (bai zhu) 3 gm
- Sclerotium Poria cocos (fu ling) 2.4 gm
- Rhz Atractylodes (cang zhu) 2.4 gm
- Cortex Magnoliae officinalis, ginger juice-fried 2.4 gm
- Pericarpium Citri Reticulate 2.4 gm
- Rhz Cyperi rotundi, dry-fried 2.4 gm
- Fructis Amomi cardamomi 2.1 gm
- Saussurea 1.4 gm
- Eletarria cardamom 3 gm
- Rx Glycyrrhizae uralensis, honey-fried 1.5-3 gm
- Rhz Zingiberis officinale recens 3 gm
- Fr Zizyphi jujube 1.5-3 gm
This formula strengthens and harmonizes the spleen and stomach and
resolves dampness. It treats decreased appetite, loss of taste, inability
to eat more than a little at a time, bloating after eating, distention and
II. Spleen Yang Deficiency
Stabilize the True Decoction (gu qhen tang)
- Rx Ginseng 7.5 gm
- Rx Aconite napellus 7.5 gm
- Sclerotium Poria cocos 7.5 gm
- Rhz Atractylodes macrocephalae 7.5 gm
- Tuber Dioscoreae oppositae (shan yao) 6 gm
- Rx Astragalus membranacii, honey-fried 6 gm
- Cortex Cinnamom cassiae 6 gm
- Rx Glycyrrhizae uralensis 6 gm
This treats lethargy, pasty-white complexion, profuse sweating, rhythmic
spasms of the hands and feet, clear liquid diarrhea, pale tongue with white
thin coat, submerged faint pulse and possible prolonged bout of vomiting
Preserve the Basal Decoction (bao yuan tang)
- Rx Astragalus membranicus 6-9 gm
decocted with a handful of glutinous rice
- Rx Ginseng 6-9 gm
- Glycyrrhizae uralensis, honey-fried 3 gm
- Cortex Cinnamom cassiae 1.5-2.1 gm
This formula is for deficiency and consumption, fatigue, lethargy,
shortness of breath, aversion to cold with possible pain, vomiting and
III. Spleen Qi Deficiency with Dampness
Ginseng, Poria and Atractylodes Powder
(Shen ling bai zhu san)
- Four Gentlemen Decoction plus Dioscorea 1 part
- Semen Dolichoris 3/4 part
- Lotus Seeds 1/2 part
- Coix 1/2 part
- Cardamom 1/2 part
- Platycodon 1/2 part
This formula harmonizes the stomach, leaches out dampness, protects the
lungs and tonifies spleen qi. Citri reticulatae can be added to strengthen
the formula's ability to benefit the spleen and expel dampness. It treats
loose stools or diarrhea, lowered appetite, weakness of the extremities,
weight loss, distention and a stifling sensation in the chest and
epigastrium, pallid and wan complexion, pale tongue with white coat, thin,
moderate or deficient pulse, possible vomiting and cough with sputum.
Tonify Middle and Augment the Qi Decoction
(bu zhong yi qi tang)
- Rx Astragalus membranicus 12-24 gm
- Rx Ginseng 9-12 gm
- Rhz Atractylodes macrocephalae 9-12 gm
- Rx Glycyrrhizae uralensis, honey-fried 3-6 gm
- Rx Angelica sinensis (Dong quai) 6-12 gm
- Pericarpium Citri reticulatae 6-9 gm
- Cimicifuga 3-6 gm
- Bupleurum falcatum 3-9 gm
This formula treats intermittent fever, spontaneous sweating, aversion to
cold, thirst for warm beverages, shortness of breath, laconic speech,
tendency to curl up, weak limbs, shiny pale complexion, loose and watery
stools, pale tongue with thin white coat, and a flooding deficient pulse.
It raises prolapse and tonifies qi.
The understanding of the organs in TCM is often overlooked as being
unscientific and invalid. Interestingly, not only are its organ functions
based on scientific physiology, they often go beyond it in understanding,
meaning and usefulness. While Western medicine confines the dysfunctions of
the spleen to specific diseases, TCM views the spleen as much more
encompassing in its effects in the body. On the other hand, the
technological advantages of Western medicine are well suited to providing
Westerners with a deeper understanding and appreciation of Traditional
We can apply this same approach to the current view of Western herbalism
and more quickly see the limitations of solely placing medicinal value on
herbs' chemical reactions and biochemical constituents. The broader
holistic view of TCM allows herbalists to see the potential of what herbs
are able to do and how herbs relate to individual physiological conditions
rather than general disease or biochemical categories. Much more work can
be done in the area of comparing the body's physiology between Western
medicine and TCM that would further the understanding of both medicines and
perhaps, overall, come to a more integrated approach to health and healing.
Lesley Tierra is a California State licensed acupuncturist who practices
with her husband, Michael Tierra in Santa Cruz, California. She is the
author of The Herbs of Life and dean of the East West Herbal Correspondence
The East West Course is a 36 lesson correspondence course in Chinese,
Western and Ayurvedic herbology written by Dr. Michael Tierra. Those who
are interested can visit the
EastWest School of Herbology website:
Santa Cruz, Ca. 95060