Monday, September 17, 2012

Nourishing Earth: Chinese Herbalism & the Spleen/Stomach

The Spleen & the Stomach are the organs associated with Late Summer and the Earth Element. In Chinese medicine physiology, the Spleen & Stomach are responsible for digestion of food, assimilation of nutrients and production of energy we use to think and function on a day-to-day basis.

Many herbs in the Chinese medicine pharmacopoeia are used to help the Spleen and Stomach function optimally.

A truly skilled practitioner of Chinese herbalism can assess a patient's physiological imbalances with an astonishing degree of subtlety. Indeed, the Chinese pharmacopoeia includes multiple herbs that perform very specific functions, depending on just what is needed to help a patient feel better.

To underline the subtlety of this system, I can't resist posting a list of "treatment strategies" employed by traditional Chinese herbalists to improve Spleen & Stomach function. Each of these "treatment strategies" has a specific Chinese name, along with a list of herbs to choose from which help perform that function:

  • Tonify the Spleen
  • Build the Center & Uplifting Qi
  • Warm the Spleen:   the Spleen is damaged by cold
  • Move the Spleen
  • Harmonize the Center & Qi in the Central Burner
  • Emolliate acute Mid-Abdominal Distress
  • Raise Central Yang and Lift Collapse: where the Spleen fails to hold things in place or raise clear Qi to the head
  • Aromatically Dry Damp:  Dampness is an outcome of Spleen weakness, and hinders Spleen function
  • Transform Phlegm
  • Percolate Damp
  • Disinhibit Damp
  • Drive Out Water Rheum
  • Nourish Stomach Yin:  in cases of excess dryness, heat or inflammation in the Stomach
  • Clear Stomach Heat:  the Stomach is harmed by heat & dryness
  • Purge Stomach Fire
  • Dissolve Food Accumulation
  • Harmonize the Stomach & Descend Rebellious Qi
  • Control Acid

How the Spleen & Stomach (i.e. Digestive Health) Came to Occupy a Central Role in Traditional Chinese Medicine:

So why is all this meticulous attention paid to the function of the digestive system?

Chinese medicine is thousands of years old. As with any tradition of this  magnitude, there are numerous different schools of thought & sub-traditions within traditional Chinese medicine.

A major school of thought emerged in the 1200s and 1300s which viewed the Spleen & Stomach (digestion) as having central importance to health and healing. The leader of this school was a physician known as Li Dong Yuan, who lived from 1180 to 1252 C.E.

Dr. Li was responding to the overuse of cold medicinals in the herbal medicine practiced at his time. The Chinese herbal pharmacopoeia has lots of herbs that are strongly anti-bacterial, anti-fungal, and anti-viral. In fact, at Dr. Li's time, many Chinese herbalists were having success saving patients from life-threatening infections. --- Yes, it's true: the Chinese had herbal "antibiotics" a thousand years ago, obviously well before the invention of antibiotic drugs in the west. The trouble with these herbs is that they were very cold in nature. Cold herbs damage the function of the Spleen and Stomach. Because the Earth organs (Spleen & Stomach) are the root of a person's day-to-day energy, Dr. Li observed that patients who had taken too many of these cold medicinals became weak over time.

Based on his observations, Dr. Li put forward a theory that most diseases are due to injury to the Spleen and Stomach, which occurred as a result of taking cold medicinal herbs, overeating, overworking, or emotional strain. He expounded on this theory in a book, Pi Wei Lun, or Treatise on the Spleen and Stomach.

Very basically, Dr. Li proposed that all patterns of chronic illness and weakness could be cured by improving the way a person digested and assimilated nutrients--- that is, by supporting the function of the Spleen and Stomach.

Dr. Li is famous for developing an herbal formula called bu zhong yi qi tang, or Tonify the Middle and Augment the Qi Decoction. This formula which combines eight common Chinese herbs, including the roots of ginseng, astragalus and angelica is still widely used today.

What Is the Relevance of Dr. Li's Work and the Pi Wei Lun Today?

The "Spleen & Stomach" (Pi-Wei) school of thought expounded by Dr. Li has occupied a significant place in Chinese medicine practice right up to today.

Many acupuncturists, including myself, name Dr. Li as one of their heroes.

Our modern-day medical scenario has something in common with what Dr. Li observed in his day. Biomedicine has given us critically life-saving antibiotics and other powerful drugs. Antibiotics are extremely cold in nature (as are vaccinations). Western medicine is exceptional in its ability to fight infectious disease; but few would argue that antibiotics and many other drugs take a toll on our long-term health. Antibiotics injure our digestive systems and can have a cascade affect on other body systems.

Traditional Chinese Medicine includes strategies to fight infection and heal serious injury and illness. But the real advantage of Chinese medicine over biomedicine is its ability to strengthen people constitutionally—making them less vulnerable to illness in the first place. Chinese medicine is also exceptional in remedying chronic illnesses and chronic pain in many instances where biomedicine has little offer.

Supporting digestive health by supporting the Spleen & Stomach through acupuncture & herbal medicine is central to helping people recover from chronic illness, moderating the damaging affects of biomedical drug regimens, and strengthening people constitutionally. A healthy Spleen brings nutrients to all cells, ensuring their integrity, and to the muscles, ensuring their strength. Of course, supporting the Spleen is not the only thing we need to do. We often have to remove pathogenic factors that build up when the body is not functioning optimally. We need to support and regulate different organ systems. For example, when the relationship between the Spleen and Liver has become imbalanced, or when the prolonged Spleen dysfunction has weakened the Kidney, these organ systems need to be rebalanced.

In the end, constitutional strengthening is almost always a part of the recovery process, and the Spleen is almost always central to this.

The Chinese pharmacopoeia has an enormous array of medicinal substances that improve the function of the Spleen and Stomach. Most of these medicinals are in fact quite gentle, but can have profound effect in regulating energy, moderating any illness process.

I'll close this article with a list of treatment strategies & herbs, reprinted from the Institute for Trasitional Medicine's very comprehensive website:

SPLEEN QI DEFICIENCY (pi qi xu): primary symptoms include decreased appetite; sallow complexion; fatigue; shallow breathing or shortness of breath; little desire to talk; epigastric and/or abdominal bloating (especially after eating); loose or unformed bowel movements. Secondary symptoms may include weak or emaciated extremities; edematous extremities; inhibited urination; decreased amount of (pale colored) menstrual flow. The tongue typically manifests with a pale body, toothmarks, and a thin white coating; the pulse tends to be weak and slow.

Representative Herbs: codonopsis (dangshen), astragalus (huangqi), atractylodes (baizhu), hoelen (fuling), dioscorea (shanyao), lotus seed (lianzi), coix (yiyiren), dolichos (biandou), jujube (dazao); citrus (chenpi), shen-chu (shenqu).

Representative Formulas: Four Major Herbs Combination (Si Junzi Tang); Six Major Herbs Combination (Liu Junzi Tang).

DOWNWARD COLLAPSE OF SPLEEN QI (pi qi xia xian): primary symptoms include weak voice; shortness of breath; fatigue; bloating sensation right after eating; prolapsing sensation in stomach and abdomen (wan fu zhong duo); (bianyi pinshuo); or possibly prolapse of anus due to chronic diarrhea; or prolapse of stomach or uterus. Secondary symptoms may include dizziness; unclear sensory perception (especially blurry vision); poor appetite; spontaneous sweating; mental and physical fatigue; diarrhea. The tongue typically presents with a pale body and a thin white coating; the pulse tends to be weak and empty.

Representative Herbs: astragalus (huangqi), codonopsis (dangshen), atractylodes (baizhu), dioscorea (shanyao), dolichos (biandou), cimicifuga (shengma), pueraria (gegen); bupleurum (chaihu), citrus (chenpi).

Representative Formula: Ginseng and Astragalus Combination (Buzhong Yiqi Tang).

STOMACH YIN DEFICIENCY (wei yin xu): primary symptoms include dry lips; frequent thirst sensation; dry throat; sticky sensation in the mouth; poor appetite; sensation of emptiness, stuckness, or pain in epigastric region. Secondary symptoms may include hunger sensation without desire for food; constipation; restlessness; sensations of surging heat. The tongue typically presents with a red body and a mirror surface without coating, or with a red body and little coating, or with a dry tongue and little moisture; the pulse tends to be fine and rapid.

Representative Herbs: glehnia (bei shashen), ophiopogon (maimendong), yu-chu (yuzhu), dendrobium (shihu), raw rehmannia (sheng dihuang), trichosanthes root (tianhuafen), Asian pear juice (li zhi), sugar cane juice (ganzhe zhi); bamboo skin (zhuru).

Representative Formulas: Glehnia and Ophiopogon Formula (Shashen Maidong Yin), Boost the Stomach Decoction (Yiwei Tang).

SPLEEN YANG DEFICIENCY (pi yang xu): primary symptoms are spleen qi deficiency symptoms with an emphasis on cold signs, such as abdominal pain that improves with the application of heat and pressure; cold extremities; poor appetite; abdominal bloating; loose or unformed stools. Secondary symptoms include decreased taste sensation; little desire to drink; edematous extremities; inhibited urination; increased amounts of clear vaginal discharge. The tongue typically presents with a pale and tender body and a white and slippery coating; the pulse tends to be deep and fine, or deep and slow.

Representative Herbs: dry ginger (ganjiang), aconite (fuzi), evodia (wuzhuyu), zanthoxylum (chuanjiao), clove (dingxiang), atractylodes (baizhu), codonopsis (dangshen).

Representative Formulas: Ginseng and Ginger Combination (Lizhong Tang), Fill the Spleen Formula; Magnolia and Atractylodes Combination (Shipi Yin).

COLD DAMP OBSTRUCTING THE SPLEEN (han shi kun pi): primary symptoms are a general sense of heaviness in the body and/or the head; discomfort or bloating in the abdomen or epigastric region; reduced taste sensation; little or no thirst; abdominal pain; unformed stools or diarrhea. Secondary symptoms include no appetite; nausea and vomiting; sticky sensation in mouth; puffy face; edematous extremities; bags under the eyes; increased vaginal discharge. The tongue is typically fat and has a greasy white coating; the pulse tends to be soft and moderate.

Representative Herbs: red atractylodes (cangzhu), atractylodes (baizhu), hoelen (fuling), magnolia bark (houpo), citrus (chenpi), pinellia (banxia), tsao-kuo (caoguo), agastache (huoxiang), (peilan), perilla stalk ( zi sugeng).

Representative Formulas: Magnolia and Citrus Combination (Pingwei San); Magnolia and Hoelen Combination (Wei Ling Tang).

DAMP HEAT IMPLICATING THE SPLEEN (shi re yun pi): primary symptoms are stuffy sensation in the subcostal and epigastric regions; abdominal bloating; poor appetite; dry and sticky sensation in mouth; aversion to greasy foods; nausea and vomiting; general sensation of heaviness; jaundiced eyes and face. Secondary symptoms may be body itch; fever; dark and scanty urination; obstructed bowel movements. The tongue typically presents with a greasy and yellow coating; the pulse tends to be soft and rapid.

Representative Herbs: capillaris (yinchen), bamboo skin (zhuru), red atractylodes (cangzhu), atractylodes (baizhu), hoelen (fuling), polyporus (zhuling), alisma (zexie), chih-shih (zhishi).

Representative Formulas: Capillaris and Hoelen Five Formula (Yinchen Wuling San); Capillaris and Hoelen Four Formula (Yinchen Siling San).

THE SPLEEN CANNOT CONTAIN THE BLOOD WITHIN THE VESSELS (pi bu tong xue): primary symptoms are general signs of spleen qi deficiency, such as pale face and tendency towards diarrhea, accompanied by signs of bleeding, such as blood in the stool, nose bleed, gum bleeding, subcutaneous bleeding (purpura), increased amounts of menstrual bleeding or continuous spotting. Secondary symptoms may include other spleen deficiency symptoms, such as decreased appetite; fatigue, bloating after eating; shallow breathing or shortness of breath; cold extremities; skinny constitution. The tongue typically presents with a pale body and a white coating; the pulse tends to be soft, fine, and weak.

Representative Herbs: codonopsis (dangshen), astragalus (huangqi), atractylodes (baizhu), tang-kuei (danggui), dioscorea (shanyao), lotus seed (lianzi), roasted ginger (paojiang), longan (longyanrou), baked licorice (zhi gancao).

Representative Formula: Ginseng and Longan Combination (Guipi Tang).