Spleen - A Vital Organ

Over the course of 20 years of practice I have struggled talking to patients about some of the "unique" thought processes inherent in Chinese medicine.  One concept that plaqued me for years - and still does to some degree - is the Spleen.  Much of our understanding of the Spleen differs dramatically from modern understanding and physiology.  That being said there are some very important overlaps and, given the date these ideas were conceived, some impressive insights to how the body works.  In this article I am going to talk about the spleen in many aspects - modern physiology and pathology, traditional concepts and understanding, the similarities and differences.  

Understanding the Spleen in Chinese Medicine

Digestion

This is arguably the spleens most important role in Chinese Medicine and the area in which it differs the most from modern medicine.  The Spleen's influence on digestion is twofold:  1. It is responsible for processing nutrients and qi and moving them to the correct locations. 2. It is also responsible for transforming the waste and fluids for disposal.  A dysfunctional Spleen will almost always have digestive symptoms associated with it.  

Transformation and Transportation

The Spleen transforms food and drink into nutrient Qi, which is then used to form Blood and Wei Qi (defensive Qi). It transports energy upward and the turbid downward to be excreted. If this function is impaired, symptoms like bloating, poor appetite, loose stools, and fatigue may result.

Governing Blood

The Spleen keeps Blood within the vessels. When Spleen Qi is weak, one might see easy bruising, uterine bleeding, or heavy menstrual flow.

Controlling the Muscles

The Spleen nourishes the flesh and limbs. Weakness, fatigue, and lack of tone—especially in the arms and legs—are often attributed to Spleen deficiency.

Mental-Emotional Aspect: The Yi

The Spleen houses the Yi, or intellect. This includes concentration, memory, and the capacity for applied thinking. Worry and overthinking damage the Spleen; conversely, a strong Spleen supports clear, grounded mental activity.

Season and Flavor

The Spleen is associated with late summer—a time of harvest, ripening, and digestive nourishment. It is also connected to the Earth element, symbolizing centrality and balance. In moderation, the sweet flavor tonifies the Spleen. This includes naturally sweet foods like squash, carrots, and rice. Too much of a good thing, excessive sweets  can damage Spleen function.

Modern Physiology

The spleen is a fist-sized organ located in the upper left quadrant of the abdomen, nestled just beneath the rib cage. It plays several important—but often underappreciated—roles in hematological and immunological function. As part of the lymphatic system, the spleen filters the blood, removing old or damaged red blood cells and recycling iron. It also acts as a reservoir for white blood cells for the immune system and platelets to clot blood. In times of infection or hemorrhage, the spleen can contract to release stored platelets and red blood cells into circulation—a survival adaptation rooted in its evolutionary role.

While not considered essential to life, the loss of a spleen results in increased susceptibility to infections, compromising regulation of immune responses and blood cell turnover, illustrating the spleen’s importance as a multitasking organ in systemic homeostasis.

A Functional Overlap

Though the anatomical spleen of Western medicine differs from the functional concept of the “Spleen” in Chinese medicine, there are striking overlaps in their respective roles in maintaining vitality and systemic regulation.

In Chinese medicine, the Spleen is not just a discrete physical structure but part of a functional system that includes aspects of digestion, fluid metabolism, blood generation, immune defense, and even emotional regulation.

The most obvious example is immunity. As we discussed above, the spleen is a reservoir for white blood cells that are essential for robust immune system function. The Spleen (capital “S” in Chinese medicine) governs the immune system by producing the energy to protect against infection. This is called Wei Qi. Herbal formulas that address immune function always include herbs to strengthen the Spleen.

The second example of overlap between modern and traditional medicine here is the spleen’s role in clotting. As we stated, the spleen stores platelets and releases them when needed. Platelets help our blood clot when bleeding. In Chinese Medicine we say the Spleen “controls” the blood. Diagnostically this most often manifests as people who bruise easily, purpura, or menorrhagia. The Spleen’s relationship to Blood generation in TCM also bears similarity to the Western spleen’s role in hematopoiesis.

Like the lymphatic and circulatory support provided by the biomedical spleen, the Chinese Spleen ensures that nourishment reaches the tissues and that waste is appropriately removed. Moreover, the Chinese concept of the Spleen’s role in managing Dampness mirrors the Western understanding of lymphatic fluid regulation.

Pathology

When the Spleen fails to transform and transport properly, Damp accumulates—manifesting as edema, heaviness, loose stools, and a sticky tongue coat. Spleen Qi can also “sink,” leading to organ prolapse, chronic diarrhea, and hemorrhoids.

Common Patterns of Spleen Disharmony

• Spleen Qi Deficiency: fatigue, poor appetite, bloating, loose stools, pale complexion
• Spleen Yang Deficiency: as above, plus cold limbs, preference for warmth, and water retention
• Spleen Not Controlling Blood: purpura, menorrhagia, spotting
• Spleen Qi Sinking: prolapse, dragging sensation, chronic diarrhea
• Dampness Encumbering the Spleen: fullness, nausea, thick tongue coat, sluggishness, weight gain

Spleen Formulas We Offer: A Comparative Guide

Vim Vita – Bu Zhong Yi Qi Tang

Focus: Spleen Qi deficiency with sinking

This formula lifts and tonifies. Ideal for prolapse, chronic fatigue, postpartum recovery, and those with loose stools and poor digestion. It’s a classic choice when Spleen Qi is weak and unable to raise the clear yang. Key herbs include Huang Qi, Ren Shen, and Chai Hu.

Best for: exhaustion, weak digestion, uterine or rectal prolapse, postpartum fatigue.

No. Four

Focus: Gentle daily tonification of Qi and Blood

This balanced tonic strengthens Spleen Qi while supporting overall vitality. It’s less focused on prolapse or sinking and more on day-to-day constitutional support for those recovering from long illness or managing low-grade fatigue.

Best for: weak constitution, low energy, slow recovery, everyday wellness support.

ShenLien

Focus: Digestive recovery and fluid metabolism

ShenLien is our go-to for patients with weak digestion, loose stools, post-antibiotic gut repair, Damp accumulation and especially heart palpitations associated with anxiety and spleen deficiency. It’s slightly warming and drying, with herbs like Bai Zhu and Chen Pi that fortify the Spleen and mobilize stagnant fluids.

Best for: bloating, sluggish digestion, Dampness, poor appetite, loose stools.

Restore

Focus: Spleen deficiency with emotional component

Restore bridges the gap between Spleen and Heart, particularly where digestive symptoms coincide with overthinking, worry, insomnia, or obsessive tendencies. The inclusion of herbs like Fu Shen and Bai Zhu reflects the Spleen-Heart-Shen relationship.

Best for: digestion + anxiety, overthinking, poor sleep, pensiveness with fatigue.

Other Supporting Formulas

• GastroRest: Used acutely for food stagnation but often overlaps with Spleen deficiency where overeating or greasy food taxes the system. Helpful adjunct during holiday or travel eating.
• Free and Easy: While not a primary Spleen formula, its focus on Liver helps soften the burden on the Spleen so it can do its job properly.
• Harmonia: Best used when Spleen weakness results in chronic digestive distress with nausea, fullness, and loose stools due to Damp accumulation.

Conclusion: Supporting the Spleen in Everyday Life

Whether viewed through a biomedical or Chinese lens, the Spleen plays a central role in nourishing and sustaining life. Its capacity to transform, transport, and generate Qi and Blood is foundational to all healing. By understanding the Spleen’s functions and patterns of disharmony, practitioners can more accurately assess, diagnose, and treat patients who present with complex, often overlapping symptoms. Our line of formulas offers a spectrum of support—from constitutional tonics to focused clinical interventions. When used correctly, they restore not just digestion, but the grounded vitality that the Spleen represents.

References

• Jiao, S. D. (2003). Ten lectures on the use of formulas from the personal experience of Jiao Shu-De (G. Trans. & H. Trans., Trans.). Paradigm Publications.
• Lange Medical Book. (2024). Current medical diagnosis & treatment (63rd ed.). McGraw Hill.
• Lyttleton, J., & Maclean, W. (1998). Clinical handbook of internal medicine: The treatment of disease with traditional Chinese medicine (Vol. 1). University of Western Sydney.
• Maciocia, G. (2005). The foundations of Chinese medicine: A comprehensive text for acupuncturists and herbalists (2nd ed.). Elsevier Churchill Livingstone.
• Bensky, D., Clavey, S., & Stöger, E. (2004). Chinese herbal medicine: Materia medica (3rd ed.). Eastland Press.