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.
WESTERN VIEW OF THE SPLEEN ()
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:
b. phagocytosis of bacteria and worn-out red blood cells and platelets, salvaging iron and globulin content and returning them to the blood
c. production of lymphocytes, monocytes and plasma cells, which in turn produce antibodies
d. store blood and release it through contraction of the spleen or in case of hemorrhage
e. 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.
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 anemia's. 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.
CHINESE VIEW OF THE SPLEEN
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:
a. 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.
b. 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.
c. 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.
d. 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.
e. 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.
f. 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:
1. Abdominal distention, aching or pain relieved by local warmth and pressure
2. Lack of appetite and flat taste in the mouth
3. Abdominal flatulence after meals, aggravated by stress
4. Abnormal stool such as water, first well-shaped then loose,
loose, well-shaped and loose alternatively, or diarrhea.
5. Chronic hemorrhage or blood in the stool, vomit, mucus or under the skin, not caused by blood heat evils and trauma
6. Sallow complexion or pale lips
7. Pale and swollen tongue, or with teeth marks on its margin
8. Emaciation, or puffy appearance
9. 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, spirit-lessness, 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 deep pulse.
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.
COMPARISON OF WESTERN AND TCM UNDERSTANDING OF THE SPLEEN
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 TCM.
a) The Spleen rules transformation and transportation of food and fluids in the body.
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 similar results.
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 (qi)
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
TCM = 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.
b. 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.
c. 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.
d. The spleen opens into the mouth and it's brilliance is manifested in the lips.
e. 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.
f. 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 herbs themselves.
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 general weakness.
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 and diarrhea.
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 diarrhea.
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 Chinese Medicine.
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 Course.