The Spleen and Stomach According to Traditional Chinese Medicine (TCM)

This article is part of a series explaining the body’s organ systems from the perspective of Traditional Chinese Medicine (TCM) and Five Elements Theory.

TCM, the Five Elements and Late Summer

The Five Elements (Water, Fire, Wood, Metal, Earth) are qualities of nature that are foundational to the theory of TCM. The theory of the Five Elements is systematically applied to symptomatology, diagnosis, and treatment.  Some may argue that, together with the theory of Yin-Yang, it constitutes the foundation of TCM theory.

Each season is associated with an element, organ system, taste, etc. Each of these correspondences are then utilized in identifying patterns (TCM diagnosis), and treatment options. For example: Herbs that are recommended for phlegm in the sinuses are generally pungent (acrid).

A partial list of the Five-Elements correspondences for Late Summer includes:

  • Season — Late Summer; some references list as none
  • Element — Earth
  • Yin Organ system — Spleen
  • Yang Organ system — Stomach
  • Developments — Transformation
  • Color — Yellow
  • Sounds — Singing
  • Emotions — Pensiveness/ Worry/ Cyclical Thinking
  • Taste — Sweet
  • Tissue — Muscle
  • Sense organ — Mouth and Lips
  • Climate — Dampness

The Spleen has nine principal functions

  • Governs transformation and transportation
  • Controls the ascending of Qi
  • Controls the Blood
  • Controls the muscles and the four limbs
  • Opens into the mouth and manifests in the lips
  • Controls saliva
  • Controls the “raising of Qi”
  • Houses the Intellect (Yi)
  • Affected by pensiveness/ worry

Spleen governs transformation and transportation

One of the most important functions of the Spleen is to transform (break down) and transport (move) food in the form of “essence,” Qi, and fluids.  The Spleen and Stomach make up the “digestive” system. The Spleen breaks down the ingested food into usable components (Food Qi) and to dispatch those nutrients to the rest of the body. Food Qi is the basis for the production of Qi and Blood. If the function of transformation and transportation is normal, the digestive system is considered to be strong. If it is impaired, common symptoms may include poor appetite, gas (flatulence or belching), abdominal bloating, and loose stool.

“Food enters the Stomach, the refined part goes to the Liver, the excess goes to the sinews. Food enters the Stomach, the unrefined part goes to the Heart, the excess goes to the blood vessels. Fluids enter the Stomach. The upper part goes to the Spleen, the Spleen transports the refined essence upwards to the Lungs.” (Macioia, 2005, p 144)                                                            

This function is important because it allows for the body to function on Food energy instead of drawing on Kidney energy.  It is the energetic equivalent of writing “checks” from your “checking account” that you regularly add income to, and not from your “savings account,” which, once it is spent, is gone for good.

The Spleen plays an important role in separating the usable from unusable parts of food and directing Food Qi upwards to the Lungs to combine with air to form Gathering Qi and to the Heart to form Blood. 

The Spleen also controls the transformation, separation and movement of fluids. As mentioned above it separates the usable from the unusable parts of the fluids ingested. The “clear,” usable part goes upwards to the Lungs and is then distributed to the skin and the space between the skin and muscles. The unusable part goes downward to the Intestines where it is further separated. This is TCM’s early understanding of why staying hydrated is so important. Today Western medicine recognizes the symptoms of dehydration and its impact on the skin and muscles. It is the Spleen’s responsibility to make sure that the usable aspects get to where they need to go.

If the Spleen’s function of transforming and transporting fluids is affected, Dampness or Phlegm may accumulate causing symptoms such as edema. It is said that Dampness hinders the Spleen. Dampness can accumulate because of foods consumed, high stress or lifestyle damaging the Spleen’s function of transforming fluids. Whenever Dampness is present the Spleen must be supported. 

The Spleen loathes dampness and likes dryness.

Spleen controls the ascending qi

The Spleen and Stomach are located in the Middle Burner.

The Triple Burner or San Jiao is a special concept unique to Traditional Chinese Medicine with no correlation to Western medicine. The body is divided up into three “Burners” as described below:

Note: The organ name is capitalized below to distinguish that we are referring to the TCM Organ System of that name (i.e. the energetic pathways associated with the organ), not the anatomical organ by itself.

  • Upper Burner – Located above the diaphragm and consisting of the Heart, Pericardium, and Lungs.
  • Middle Burner – Located in the region above the belly button and below the diaphragm and consisting of Spleen and Stomach.
  • Lower Burner – Located below the belly button and consisting of Liver, Kidneys, Large Intestine, Small Intestine, and Bladder.

The location of Spleen and Stomach at the center of the Middle Burner, together with its function of controlling the movement and direction of Qi in all the Burners, allows for it to act like a vital energetic highway. It connects all that is essential for proper movement, direction and transformation of Qi in all Three Burners.

The ascending of the Spleen Qi in relation to Qi, food essence, and fluids

The term “ascending Spleen Qi” (or Spleen Qi rising) includes all movements of Spleen qi in the process of digestion and not just the upward movement towards the Lungs. The ascension of Spleen Qi is essential for proper transformation and transportation of food essence, Qi and fluids by the Spleen.

The ascending movement of the Spleen is coordinated with the descending action of the Stomach.

Spleen Qi ascending is responsible for “lifting” or “holding” other internal organs, keeping them in their place. When this function fails one might see prolapse of the bladder, uterus, or rectum.

Spleen controls Blood

Whereas the Heart governs the blood, the Spleen controls it. This means that the Spleen is responsible for “holding” the blood in the vessels, and plays an important role in making the blood. In general it is the Qi’s responsibility to hold the blood in the vessels, and it is specifically the Spleen Qi that does it. It is said that the Heart “governs” the blood, the Liver “stores” the blood and the Spleen “makes” the blood. All of these organ systems work together in harmony to create the symphony of blood movement throughout our body. When one organ system is having dysfunction it is only a matter of time before all systems are “offline.”

The action of holding the blood in the vessels is closely linked to Spleen Qi ascending. For example, when Spleen Qi ascending is compromised a woman may have symptoms of menorrhagia, such as heavy menstrual bleeding or hemorrhaging of blood. If there is dysfunction of the Spleen Qi controlling the blood it implies an impairment of Spleen Qi ascending.

Note: Menstrual blood (Tian Gui) is not made by the Spleen, but rather is derived from Kidney Essence. Blood in the body is derived from the Spleen and Kidney. It is the function of the Spleen to keep the blood in the vessels and to lift the organs. Hence when the Spleen Qi ascending is impaired it can cause menorrhagia. The Heart and Liver also play a role in menstruation. The Liver blood primarily controls menstruation, and is stored in the uterus. However, it is the Heart that controls the blood discharge (downward movement of Qi and Blood) that occurs during menstruation.

In TCM, “blood vessels” constitute one of five energetic layers, each controlled by a given organ system. These are:

  • Skin (Lungs)
  • Muscles (Spleen)
  • Sinews (Liver)
  • Blood vessels (Heart)
  • Bones (Kidney)

(Maciocia, 2005, p. 108)

Spleen controls the muscles and the four limbs

The Spleen is responsible for extracting the Food Qi (nutrients) and nourishing all of the tissues in the body. If Spleen Qi is strong it is directed to the muscles and limbs. If it is weak, the Qi can not be transported to the muscles. Common symptoms are: feeling fatigued, weak muscles, heavy limbs, and in severe cases atrophy.

Spleen opens into the mouth and manifests on the lips, controls saliva

Chewing is the first process of digestion. Saliva is a part of the mastication process. Together chewing and saliva prepares the food for the Spleen to be able to transform and transport it. It is because of this that the Spleen opens into the mouth by way of the channel pathway. 

When Spleen Qi is deficient, there may be a lack of taste, difficulty chewing, and lack of appetite. 

The lips are a reflection of the Spleen, specifically Spleen blood. When the Spleen Qi and Blood are healthy lips are rosy and moist. When Spleen blood is deficient lips are pale; if Spleen yin is deficient lips are dry. Red, dry and sweet taste could indicate Heat in the Spleen.

Spiritual aspects of internal organs

  • Liver – Ethereal Soul (Hun) – responsible for sleep, plans, projects, life aims, ‘coming and going of Shen’
  • Lung – Corporeal Soul (Po) – responsible for physiological activities, sensations, sight, hearing, smell, taste, ‘entering and exiting of Jing’
  • Spleen – Intellect (Yi) – responsible for thinking, memory, concentration
  • Kidney – Will-power (Zhi) – responsible for will-power, drive, determination
  • Heart – Mind (Shen) – responsible for consciousness, thinking, affections, memory, sleep

Spleen houses the intellect (Yi)

Spleen is responsible for applied thinking, studying, memorizing, focusing, concentrating and general ideas.

The Postnatal Qi and blood are the physiological basis for intellect.

If the Spleen Qi is deficient the following symptoms may occur: slow thinking, poor memory, poor capacity for studying, poor concentration and focusing.

Note: Excessive studying, mental work and concentration for sustained periods of time can weaken the Spleen. It is not uncommon for Spleen Qi deficiency to be a symptom of students. Especially students in post-graduate programs.

Spleen is affected by pensiveness

According to the Merriam-Webster Dictionary, pensiveness means “dreamily thoughtful, suggestive of sad thoughtfulness.” This  translation doesn’t fully convey what TCM is referring to, which encompasses brooding, or constantly thinking about certain events or people (even though not worrying), or nostalgic yearning after the past. 

Some TCM texts use the term “worry” instead of “pensive.” Each has a slightly different meaning, but all point to rumination or cyclical thinking. 

Pointing back to the student analogy one can see how the Spleen can suffer dysfunction from chronic rumination or overthinking.

When there is chronic rumination or pensiveness, it can lead to poor digestion and abdominal distention.

The Spleen and Stomach Organ Systems and Channels

Note: “cun” is a TCM form of measurement. One cun is equivalent with the width of the interphalangeal joint (the top part of your thumb). A cun is based on your client’s body measurement.

The Spleen Channel of Foot TaiYin

Image with the kind permission of www.amanualofacupuncture.com (Deadman et al., 2005)

The Primary Channel of the Spleen

  • Begins at the medial side (closest to the midline of the body) of the tip of the big toe at SP 1
  • Runs along the medial aspect of the foot, following the border where the skin changes color
  • Ascends in front of the medial malleolus at SP 5
  • Follows the posterior border of the tibia up the medial aspect of the leg to a point 8 cun superior to the medial malleolus where it crosses (and then travels anterior to) the Liver channel
  • Ascends along the medial aspect of the knee and the antero-medial aspect of the thigh to the lower abdomen where it intersects the Conception Vessel (Ren) at REN 4 and REN 10 before entering the Spleen and connecting with the Stomach
  • Emerges in the region of the Stomach and ascends first at 4 cun lateral to the midline then at 6 cun lateral to the midline, passing through GB 24, LIV 14, and LU 1, and descends to terminate in the seventh intercostal space on the mid-axillary line at SP 21

Branch 1 of the Spleen

  • Ascends through the diaphragm, runs alongside the esophagus and spreads over the lower surface of the tongue

Branch 2 of the Spleen

  • Ascends from the Stomach, passes through the diaphragm and flows to link with the Heart

(Deadman et al., 2005, pp 177-178)

The Stomach Channel of Foot YangMing

The Primary Channel of the Stomach

  • Begins at the lateral side of the nose at LI 20 (Large Intestine 20)
  • Ascends to the medial canthus (next to the nose where the upper and lower lid meet) where it meets BL 1 (Bladder 1)
  • Descends laterally along the infra-orbital (infra = below, orbital =eye) ridge to ST 1 (Stomach 1). 
  • Descends to enter the upper gum and curves to meed DU 28 (Governing vessel 28) and DU 26 (Governing vessel 26)
  • Circles around the lips and meets REN 24 (Conception Vessel 24) in the mento-labial groove of the chin
  • Runs laterally across the cheeks to ST 6 (Stomach 6) at the angle of the mandible
  • Ascends anterior to the ear passing via ST 7, GB3
  • Ascends within the hairline of the temporal region to ST 8, passing via GB 6, GB 5, GB 4
  • Follows the hairline to meed Governing Channel at DU 24
Image with the kind permission of www.amanualofacupuncture.com (Deadman et al., 2005)

Branch 1 of the Stomach

  • Separates at ST 5 and descends along the anterior border of the sternocleidomastoid muscle (SCM) in the throat region to enter the supraclavicular fossa at ST 12
  • Travels posteriorly to the upper back where it meets the Governing Channel at DU 14
  • Descends through the diaphragm, linking with REN 13, and RES 12 to enter the Stomach and connect with the Spleen

Branch 2 of the Stomach

  • Originates from ST 12 along the mamillary line, 4 cun lateral to the midline as far as ST 18, then passes 2 cun lateral to the midline and descends along the umbilicus to ST 30 in the inguinal region
  • From the inguinal region at  ST 30 the channel travels laterally to ST 31 on the antero-lateral aspect of the thigh
  • Descends along the lateral margin of the femur to the patella alongside the lateral margin of the tibia to the dorsum of the foot, terminating at the lateral side of the tip of  the second toe at ST 45

Branch 3 of the Stomach

  • Separates from the channel at ST 36, 3 cun below the knee, and terminates at the lateral aspect of the middle toe.

Branch 4 of the Stomach

  • Separates on the dorsum of the foot at ST 42 and terminates at the medial side of the tip of the big toe at SP 1, where it links with the Spleen channel

(Deadman et al., 2005, pp 125-126)

Additional information

References

  • Deadman, P., Al-Khafaji, M., & Baker. K. (2005). A Manual of Acupuncture. East Sussex: Journal of Chinese Medicine Publications.
  • Hyunbae,K. (2007). Handbook of Oriental Medicine (3rd ed.). Harmony & Balance Press.
  • Kastner, J. (2004). Chinese Nutritional Therapy. Jeorg Thieme Verlag.
  • Maciocia, G., & Xin Ming, S. (2005). The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. London: Churchill Livingstone.
  • Pitchford, P. (2002). Healing with Whole Foods (3rd ed.). Berkeley, CA: North Atlantic Books.
  • Wiseman, N. (ed., trans.), & Ellis, A. (trans.) (1996). Fundamentals of Chinese Medicine. (Rev. ed.) Brookline, MA: Paradigm Publications.
Teri Calandra

Teri began her studies in energy medicine as part of her own personal development journey, and continues to to learn and integrate that knowledge into her practice. Teri is the founding practitioner of Calandra Center for Health & Wellness in Schaumburg, Illinois. She is licensed by the State of Illinois in acupuncture (L.Ac.), and board certified through the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).