Zang Fu Patterns: SP/ST Flashcards
What are the two major functions of the spleen in TCM?
1) Transformation and transportation of food (Gu Qi) and fluids
2) Controlling blood - holding blood in blood vessels
Talk about T & T of the pure part of food/water by the Spleen.
Food from the ST/SP in the middle jiao is sent up to the LU/HT in the upper jiao where it combines with Qing Qi (air) to form Zong Qi (chest qi). Zong Qi is catalyzed by Yuan Qi to form Zhen Qi (true qi). From Zhen Qi comes both Wei (defensive) and Ying (nutritive) Qi.
Gu Qi is also passed from the Lung to the Heart and transforms into blood with the help of Yuan Qi (original qi). Ying Qi plus Ye portion of Body Fluid forms Xue (blood).
Fluids from the ST/SP are sent to the upper jiao where they becomes Jin Ye. Part of it goes to the lungs for distribution to the skin.
Talk about transformation and transportation of the impure fraction of food/water by the Spleen.
Impure or “turbid” fluids and solids are sent to the lower jiao, first to Xiao Chang (SI) then the Da Chang (LI) where solids are excreted as faeces. Finally the impure fluids are sent to Pang Guang (BL) to be excreted as urine.
What happens if transformation and transportation by the Spleen (Pi) is impaired?
If the Pi function is deficient, there may be deficient Qi and Xue. There may also be an accumulation and stagnation of Jin Ye as Damp and Phlegm. SP/Pi is the main digestive organ so there may be a variety of GI problems such as poor appetite, bad digestion, loose stools, abdominal distention etc.
After Shen the ________ energies of the body, Pi is considered since it is the foundation of ________ life.
Prenatal; postnatal
The Spleen likes ________ and hates _______.
What can be impaired by excessive consumption of cold liquids?
Dryness; dampness
Spleen Yang
What are the aspects of SP controlling Xue (blood)?
1) It holds blood in blood vessels. This is different from governing blood by the heart that is associated with circulation.
If SP Qi or especially SP Yang is deficient then Xue is not held in Xue Mai and it may leak out and lead to bleeding signs and hemorrhages such as melaena (dark, black, tarry faeces associated with upper GI bleeding), petechia, menorrhagia etc.
2) The SP also plays an important role in blood formation as mentioned in the T & T section. Gu Qi is sent to LU and then HT to form blood with the help of Yuan Qi. To tonify blood always tonify SP!
What are the three main causes of bleeding in TCM?
1) Heat burning BV
2) SP failing to hold blood in BV
3) Blood Stasis
How do you distinguish between heat burning BV and SP failing to hold blood in BV?
With heat the colour of the blood is bright and fresh red. It is more acute. Heat goes up therefore more bleeding in the upper body and a large amount.
With SP failure it is chronic, not acute, so the colour is more pale and thin, often there is poor nutrition. The amount may be large or small and seen mostly in the lower body. EG. Excessive menstruation, varicose veins, hemorrhoids etc.
What vital substances are involved in the SP?
Qi and Yang
What are the 3 most important Sn/Sx for SP disharmony?
- Poor appetite
- Abdominal distention/pain
- Loose stools
What are other common Sn/Sx of SP disharmony?
Muscular weakness or atrophy, low energy (lassitude), overweight, too much phlegm, edema, damp retention, different types of bleeding (hemorrhage esp.), sometimes excessive appetitie if SP and LV are not harmonized
What are the functions of the spleen in Western medicine?
The spleen acts primarily as a blood filter. It removes old and damaged red blood cells and recycles iron. It also holds about a cup of blood as reserve. As part of the mononuclear phagocyte system it metabolizes hemoglobin. The globin portion is broken down to constituent amino acids while the heme is transformed into bilirubin and removed by the liver.
The spleen synthesizes antibodies in its white pulp and removes antibody coated bacteria/blood cells by way of blood and lymph node circulation. The red pulp contains a reservoir of over half of the body’s monocytes.
Just as in TCM the spleen plays a role in blood formation. This is primarily true during the first 5 months of gestation where it can create red blood cells. After this and throughout the life cycle it retains the ability to produce lymphocytes and therefore remains a hematopoietic organ.
The pancreas is also considered to be a part of the Pi or SP functional system in TCM. What is it’s role in Western medicine?
The pancreas is part of the digestive and endocrine system. As an endocrine gland it produces insulin, glucagon, somatostatin and pancreatic polypeptide. As a digestive organ it acts as an exocrine gland and secretes pancreatic juice containing bicarbonate as well as digestive enzymes. The enzymes assist the SI in digestion and absorption of nutrients.
What are the other primary functions of the SP in TCM?
- Rules the…
- Holds up the …
- Opens into…
- Manifests in the…
- Houses…
- Rules the Muscles and Limbs
- Holds up the Organs (controls raising of Qi)
- Opens into the Mouth
- Manifests in the Lips
- Houses Thought, residence of Yi
How does the SP rule the muscles and limbs?
Food Qi eventually goes to nourish all tissues in the body, transported throughout body by Spleen. Particularly directed to the muscles. Weak Spleen Qi: fatigue, muscles weak or even atrophied. Tonify Spleen in fatigue.
Fair amount of overlap between Muscles ruled by Pi and Tendons ruled by Gan.
How does the SP hold up the Organs (control the raising of Qi)?
What are th main organs/tissues affected by sinking SP Qi?
The SP has a lifting effect along the midline of the body which ensures that organs stay in their proper place. When this raising or holding function is impaired and SP Qi sinks, prolapse can occur.
The prolapse occurs primarily in the lower body so uterus, anus, bladder, kidneys but also stomach.
SP also raises pure Food Qi to LU/HT.
Talk about how the SP opens into the mouth and manifests in the lips.
If Pi Qi is abundant the mouth can differentiate the five flavours and the lips are red and moist. If Pi Qi is deficient there may be a loss of taste and the lips may be pale and dry. If there is heat in Pi and Wei the lips may be cracked and dry.
SP houses thought (Yi)
Spleen is the residence of Yi or thought. It influences our capacity for thinking, studying, concentration, memorizing etc. Weak SP Qi results in poor concenctration and memory, dull thinking etc. Excessive mental work or worry can damage the SP.
What are the three primary etiological factors for Spleen disharmonies?
- Mental factors: Excessive thinking, studying, brooding, obsessing etc. weakens SP
- Diet: This one is very important. Spleen likes foods that are warm (in temp and energy) eg. meat, ginger, pepper, orange peel and dry foods. Excessive consumption of cold foods will impair the spleen’s function of transformation/transportation and cause interior dampness and digestive problems. Also eating in a hurry, when stressed out, skipping meals or eating unhealthy foods.
- Exogenous pathogens: Exogenous Dampness can invade when people damp places, remain in wet clothing, wade in water or work in watery areas. Women are prone to the invasion of Exogenous Dampness during menses and after childbirth. Exterior dampness can combine with heat or cold.
Spleen Qi Deficiency Etiology
- Improper diet: Excessive cold and raw foods, irregular eating, too much or too little and not enough protein
- Mental strain: Excessive thinking over a long time. Discussing work or studies over lunch.
- Climate: prolonged exposure to damp weather or damp house
- Chronic disease: tends to weaken spleen (Root of Postnatal Jing and hence overworked trying to restore health)
This pattern forms the basis for all other SP disharmonies. Very common in our culture.
Spleen Qi Deficiency Western Dx
Chronic gastritis
Chronic enteritis
Chronic hepatitis
Cirrhosis of liver
GI dysfunciton
Peptic ulcer
Spleen Qi Deficiency Sn/Sx
NO Appetite Spleen Qi weak
Abdominal distention after eating Impairment of Spleen’s transformation & transportation function
FATIGUE, lassitude, weakness of limbs Spleen transports food essences to the four limbs
Sallow complexion, disinclination to speak General Qi Deficiency
LOOSE STOOLS Impaired transformation/transportation function
If Deficient Spleen Qi leads to Internal Dampness:
Nausea Dampness obstructs epigastrium & prevents Stomach Qi from descending
Stuffiness of chest & epigastrium Dampness obstructs chest area
Feeling of heaviness in head and limbs (head in bag) Dampness interferes with the clear Yang in the head, obstructs muscles
Tongue: Pale or normal
Chronic: swollen sides in the MIDDLE SECTION only of the Tongue. Very severe cases have swollen sides with transverse cracks) Spleen area of Tongue
Coating: thin, white sticky, greasy (Deficient Spleen Qi
Dampness)
Pulse: Empty, weak (Deficiency)
Spleen Qi Deficiency POT and Herb Px
POT:
Tonify Spleen Qi
Herbs:
Sheng Lin Bai Zhu San (Ginseng, Poria, Atractylodis Macrocephelae Powder)
SP Qi Xu Point Px
REN-12 (Zhong wan Middle Cavity) - Front Mu of ST, Meeting Pt of Fu; Tonifies Spleen Qi
ST-36 (Zu san li Three Leg Mile) - He Sea/Earth Pt, Heavenly Star, Sea of Water and Grain, Command Pt of Abdomen; Fortifies Spleen Qi and resolves Dampness
SP-3 (Tai bai Supreme White) - Shu Stream/Earth Pt, Yuan Source point; Tonifies Spleen Qi
SP-6 (San Yin jiao Three Yin Intersection); Tonifies Spleen Qi
BL-20 (Pi shu), BL-21 (Wei shu) - Tonifies Spleen Qi (esp. important combo Tonifies Spleen and Stomach Qi) where the Spleen and Stomach are both chronically Deficient.
Method:Tonification. Moxa is applicable.
Sinking of Zhong (Spleen) Qi Etiology
- Improper diet: Excessive cold and raw foods, irregular eating, too much or too little and not enough protein
- Mental strain: Excessive thinking over a long time. Discussing work or studies over lunch.
- Climate: prolonged exposure to damp weather or damp house
- Chronic disease: tends to weaken spleen (Root of Postnatal Jing and hence overworked trying to restore health); especially prolonged diarrhea or dysentery
- Overstrain: more likely in people who stand for long periods
Sinking of Zhong (SP) Qi Western Dx
Chronic enteritis (inflammation of SI)
Chronic dysentery
Functional disorder of intestine
Prolapse of viscera (ST, KD)
Sinking of SP Qi Sn/Sx
SP Qi Xu Sn/Sx plus at least ONE sign of PROLAPSE: uterus, anus, stomach (gastroptosis), kidney (nephroptosis), vagina, heavy sensation in abdomen, e.g. of bearing down, frequent/urgent urination, hemorrhoids, varicose veins
Shortness of breath, unwillingness to speak, low voice, vertigo and blurred vision
Tongue: Pale
Pulse: Empty/weak; rootless at middle position (Guan) on right side
What things will make SP Qi Sinking sx (prolapse) worse? Better?
Epigastric sag and distention which becomes worse after eating (food has weight therefore more heaviness).
Worse after heavy work (consuming qi eg. shortness of breath)
Prolapses usually better with laying down (may complain of backache from ST or KI prolapse)
Sinking of Zhong (Spleen) Qi POT and Herb Px
POT:
Tonify SP Qi
Raise SP Qi
Herb:
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction - Ginseng and Astragalus)
Sinking of SP Qi Point Px
Du 20 (Bai hui Hundred Meetings) - Point of Sea of Marrow; Raises Qi (apply cones of moxa). Esp. good for prolapse of uterus
Ren 6 (Qi Hai - Sea of Qi) - Tonifies Qi, raises Qi: use for any prolapse
ST 21 (Liang men - Beam Gate) - Tonifies Stomach: use for prolapse of Stomach
Du 1 (Cheng Qiang - Long Strong) - Luo Connecting Pt of GV; Use for prolapse of anus
Method:Tonification. Moxa applicable
Spleen Yang Deficiency Etiology
- Improper diet: Excessive cold and raw foods, irregular eating, too much or too little and not enough protein
- Mental strain: Excessive thinking over a long time. Discussing work or studies over lunch.
- Climate: prolonged exposure to damp weather or damp house
- Chronic disease: tends to weaken spleen (Root of Postnatal Jing and hence overworked trying to restore health)
- 1-4 all lead to SP Qi Xu —> SP Yang Xu
- Kidney Yang Xu —> fail to promote earth —> SP Yang Xu
Spleen Yang Deficiency Western Diseases
Chronic gastritis
Gastric and duodenal ulcer
Functional disorder of ST/intestines
Chronic enteritis
Chronic hepatitis
Cirrhosis of Liver
Chronic nephritis
SP Yang Deficiency Sn/Sx
Lack of Appetite SP Qi weak
Abdominal distention after eating, General edema Impaired Spleen function of transporting/transforming
Bright white or sallow complexion Qi Deficiency
FATIQUE, Weakness of the four limbs Deficient Spleen not sending food essences to limbs
LOOSE STOOLS (often with undigested food) Deficient Spleen Yang fails to transform digestate
CHILLINESS - Cold LIMBS, abdominal pain relieved by warmth or pressing Signs of Cold
Difficult urination, Profuse dilute leucorrhea Yang Deficiency
Tongue: Pale, swollen, wet Deficient Yang causes accumulation of untransformed fluids on Tongue.
Pulse: Weak, slow, deep Deficient Yang
Spleen Yang Deficiency POT and Herb Px
POT:
Tonify and warm SP Yang
Herbs:
Li Zhong Tang (Decoction to Regulate the Middle)
Spleen Yang Deficiency Point Px
NOTE: If edema or Dampness is present, the following Points are SEDATED:
SP-9 (Yin ling quan - Yin Mound Spring) He Sea/Water Pt; Regulate SP and resolve dampness
REN-9 (Shui fen - Water Separation) Resolve Dampness in lower burner
ST-28 (Shui dao Water Passage) Regulate the lower jiao
BL-22 (San jiao shu) Regulates SP/ST, Enable Spleen to transform/transport fluids
Method: Tonification and Moxa
Spleen Unable to Control Blood Etiology
- Improper diet: Excessive cold and raw foods, irregular eating, too much or too little and not enough protein
- Mental strain/Physical Strain: Excessive thinking over a long time. Discussing work or studies over lunch.
- Climate: prolonged exposure to damp weather or damp house
- Chronic disease: tends to weaken spleen (Root of Postnatal Jing and hence overworked trying to restore health)
- Spleen Qi Deficiency (caused by 1-4) —> Spleen unable to control blood
Spleen Unable to Control Blood Western Disease
Thrombocytopenic purpura
Allergic purpura
Aplastic anemia
Dysfunctional uterine bleeding
Spleen Unable to Control Blood Sn/Sx
Signs of Spleen Qi Deficiency (eg. sallow complexion, SOB, plus Signs of Bleeding and maybe signs of blood deficiency
Examples: Petechiae, ecchymoses (bleeding into the skin), blood in stool or urine, menorrhagia (excessive menstrual bleeding), metrorrhagia (abdnormal menstrual bleeding), metrostaxis (small but continuous hemorrhage from uterine lining), hematuria, hematohidrosis
Tongue: Pale (xu), white coating
Pulse: Thready, weak, fine - Deficient Blood
SP Unable to Control blood POT and Herb Px
POT: Supplement qi to stop bleeding
Herbs: Gui Pi Tang
Spleen Unable to Control Blood Pathology… Is this an excess or deficiency?
Spleen function of keeping Blood in the vessels is impaired: therefore bleeding occurs. Bleeding is of Deficiency kind rather than the Excess type of bleeding that occurs when there is Heat in the Blood.
SP Unable to Control Blood Pt Px
Same as for Spleen Qi Deficiency:
REN-12 (Zhong wan Middle Cavity) - Front Mu of ST, Meeting Pt of Fu; Tonifies Spleen Qi
ST-36 (Zu san li Three Leg Mile) - He Sea/Earth Pt, Heavenly Star, Sea of Water and Grain, Command Pt of Abdomen; Fortifies Spleen Qi and resolves Dampness
SP-3 (Tai bai Supreme White) - Shu Stream/Earth Pt, Yuan Source point; Tonifies Spleen Qi
SP-6 (San Yin jiao Three Yin Intersection); Tonifies Spleen Qi
BL-20 (Pi shu), BL-21 (Wei shu) - Tonifies Spleen Qi (esp. important combo Tonifies Spleen and Stomach Qi) where the Spleen and Stomach are both chronically Deficient.
plus:
SP-10 (Xue hai / Sea of Blood) - Strengthens Spleen function of controlling Blood & returns Blood to Vessels
BL-17 (Ge shu / Diaphragm Shu) Meeting Point (Influential Pt) of Blood; Tonifies Blood & stops bleeding, when needled (not with moxa)
SP-1 (Yin bai / Hidden White) Jing Well/Wood Pt, Ghost Pt, Entry Pt from ST42; with moxa cones to strengthen Spleen function of controlling Blood; stops uterine bleeding. Use moxa on this point to stop bleeding only of a Deficient nature (esp. uterine)
DU4 (Ming Men / Life Gate) Strengthen Yang Qi
KI7 (Fu Liu / Returning Current) Jing River/Metal Pt/Mother; Strengthen yang qi
Method: Tonification. Moxa is applicable
Damp-Cold Invading Spleen Etiology
Exposure to external Dampness (Cold/raw food/drink or climate, etc.) or from Deficient Spleen Qi or Deficient Spleen Yang —> Obstruction of Qi —> Disorder of SP/ST
- Improper diet: Excessive cold and raw foods, irregular eating, too much or too little and not enough protei
- Mental Strain/Physical Strain: Excessive thinking over a long time. Discussing work or studies over lunch.
- Climate: prolonged exposure to damp weather or damp house
- Chronic disease: tends to weaken spleen (Root of Postnatal Jing and hence overworked trying to restore health)
- Spleen Qi Xu from 1-4
- Spleen Yang Xu from 5 or from Kidney Yang Xu
Damp-Cold Invading Spleen Western Disease
Chronic gastritis
Chronic enteritis
Chronic hepatitis
Cirrhosis of liver
Chronic nephritis
Damp-Cold Invading Spleen Pathology
Pathology: Cold or Damp will predominate
If Cold predominates, this pattern is commonly associated with the pattern of retention of fluid in Stomach due to Cold and with Deficient Spleen Yang.
If Dampness predominates, it can be Internal or External.
External Dampness is usually acute and of more sudden onset. It can be caused by too much Cold or raw food & drink as well as by damp climatological factors.
Internal Dampness gradually accumulates from Deficiency of Spleen Qi and Spleen Yang being unable to transform/transport Fluids. (This is a Deficiency pattern turning into Excess).
