The Middle: Transformation, Assimilation and the Role of the Spleen in Chinese Medicine

A rendering of the young Yellow Emperor.

Classical texts hint at the inherent nature of the study and practice of Chinese medicine in referring to it as 方术 fangshu, literally the “art of direction”. This leads to the natural question of what the treatment of pathology of the human body has to do with an understanding of spatial positioning or geographic location, one that to the Western logician seems irrelevant at best, or even hokey, borderline superstition. However, in the synchronistic view of the universe firmly established within the mainstream of Chinese thought as far back as several thousand years before the beginning of the Common Era, direction is a crucial metaphor through which the subtleties of the human body can be better understood.

Throughout written history, China has referred to itself and its empire as 中国 Zhongguo, the Middle Kingdom. The inhabitants of the Middle Kingdom are the descendants of a great mythological figure known as 黄帝 Huangdi, the Yellow Emperor. Coming to the throne at a very young age, legend has it that the boy emperor was endowed with a miraculous power to converse with the immortals through dream. While still a teenager, he sunk deep into a vision that lasted several months. Returning from this seemingly comatose state, he began to instruct the nomadic tribesmen of his day in the practices of agriculture, thus creating a more stable societal structure and ushering in a golden age of peace and prosperity that would last beyond the one hundred plus years of his reign. His other achievements  include the creation of the oracle bone script (the foundation for present day hanzi), mastery of the production of silk and cloth, as well as the systematic establishment of Chinese medicine, as recorded in a series of discussions between him and his advisors, entitled 黄帝内经 Huangdi Neijing, The Yellow Emperor’s Classic of Internal Medicine.

Chinese civilization is in a fundamental sense, strongly characterized to this day by these agrarian roots. The Han people, as the descendants of the Yellow Emperor, are a people who cultivate the earth and reap the rewards bestowed upon them by the fertile lands composing the Middle Kingdom, giving thanks through observance to the Heavens above for that which has been brought to fruition below. They saw in processes such as the turning of the seasons and the falling of the rains, the balanced expression of the Will of Heaven, a natural order within the seeming chaotic changes of Nature.

At the heart of this historical narrative lies the correlation between Earth and the Middle position. The four cardinal directions fall into place in relation to this central point, representing the intersection of the axes of three-dimensional space. This balance is still observable in the traditional layout of the ancient capital of Beijing. The Emperor (dressed in the traditional color of yellow) sits upon his throne in the Forbidden City at the Middle, facing South over the Temple of Heaven (Yang); to the North, is the Temple of Earth (Yin); the East the Temple of the Sun (Yang); and to the West, the Temple of the Moon (Yin). Five Elements theory (五行 wuxing, more appropriately translated as the five movements as it is based upon the movements of the five observable planets in the night sky) correlates the Earth element with the planet of Saturn, whose position is the most stable of the group and through which the cycles of all four other planets pass at regular intervals. The Earth element is, like the Emperor himself, characterized by acceptance, that which absorbs all things and transforms it into the fruits of nourishment of the people. Politically, a rich harvest and thriving population reflected the Emperor’s accordance with Will of Heaven, guaranteeing the dynasty’s continuation for future years.

This concept of the Middle forms a fitting metaphorical understanding of the Earth element within the human body, namely the cooperative relationship between the Spleen and Stomach. Each of the major organ systems in Chinese medicine is composed of an organ, yin in nature, and its paired viscera, that which is yang in nature. In keeping with their yang nature, the viscera correspond more directly with the outside world, while the organs reside more interiorly, carrying out vital physiological functions and safeguarding our vital energy, 元气 yuanqi. In the case of the Middle, the Stomach represents the viscera, an organ sac that is filled and emptied of its contents at regular intervals; the Spleen, its corresponding organ, remains full of nourishing energy that is depleted gently through the natural aging process or more strongly through various pathological processes. Digestion in the Chinese medical model is a two-stage process: the mechanical rottening and ripening that is carried out in the Stomach and the subsequent extraction of nutritive elements and their conversion into nourishing energy by the Spleen. Whereas the Stomach fits well with the general Western medical conceptualization of digestion, the Spleen adds a second crucial and often neglected element to the process: assimilation. Our body’s nutritional intake is dependent not only upon the content of our food, but also our body’s own internal ability to assimilate it. This statement holds true for the psychological as well as the physical. Our mental adaptability to new energy and information is also based upon the strength of the Spleen.

As the central hub of the entire energetic system, the Spleen represents the root of all post-natal energy production. If we conceive of the baseline energetic inheritance of Kidney Essence to a savings account, the Spleen corresponds to the paired checking account. It must be replenished each day with proper dietary intake, exercise and adequate rest, both physical and mental. When the Middle is functioning properly, the transformation of the other elements of the energetic system will occur naturally and the entire system will turn smoothly, without distortion in any given direction.

In the physical body, the Spleen corresponds to the musculature and the four limbs. This means that when the Middle is healthy and one is assimilating energy well, the body will naturally build muscle. The four limbs will feel full of vitality and ready for movement or work. Conversely, regular exercise or physical work will drive the energetic processes of the Spleen, resulting in healthy digestion and increased assimilation. Sweat is also one way that we ensure the proper circulation of fluids in the body, a process we will soon see is closely tied to the Spleen as well. Expelling adequate amounts of moisture through the skin is key to preventing the accumulation of internal dampness and the pathological byproduct of phlegm.

In communication with the natural environment, the Spleen corresponds to energy in the form of dampness. As one of the six naturally occurring environmental factors, dampness plays an important role in softening and tempering the elements of both wind and dryness within the body. However, in excess, it represents a pathological element that will lead to long-term accumulation and stagnation. Dampness may arise in one of two ways: first, living in an extremely damp and humid climate or home environment will lead to the excessive accumulation of damp energy within the channels, resulting in symptoms such as heaviness and lethargy of the four limbs, joint and muscle pain worse upon waking and improved with activity, and headaches or sensations of heaviness or fogginess in the head. Alternatively, dampness may be internally generated through improper lifestyle habits and chronic psychological imbalance. Overtaxing the Spleen through dense energetic foods that are difficult to fully assimilate (meats, dairy, beer, rich baked goods, processed foods, iced foods and beverages, etc.) will result in an accumulation of energy within the Middle and will manifest as dampness. This type of diet combined with lack of regular exercise (the typical sedentary modern lifestyle) will exacerbate the accumulation of dampness to a large degree. Psychological factors and states leading to the production of dampness will be discussed in greater detail below.

As dampness builds over time, it takes hold within the digestive system and gives rise to a congealed form of energy know as phlegm. In keeping with five movement theory, Earth generates Metal, meaning that the energetic characteristic of the Spleen is transferred to its child, the Lungs. The Middle is often referred to as the “source of phlegm” as it originates in excessive energy within the digestive system that cannot be actively assimilated by the Spleen. Symptoms, however, will manifest in the Lungs (Large Intestine, musculature or blood) and its associated external orifice, the nose. Chronic sinus congestion, seasonal allergies, chronic productive cough, etc. are all manifestations of accumulation in the Spleen infecting the Lungs and need to be addressed through changes in diet, proper exercise and appropriate clinical measures to address imbalance within the Middle.

Psychologically, the Spleen corresponds to both a contemplative and empathetic state of mind. It is the avenue through which introspection and understanding are made possible. The process of introspection is one by which we develop greater clarity of mind and efficiency in the transition of inner desire to outward action. In the modern mind, laden with endless information and connectivity, this proactive process often gives way to ongoing inner dialogue, rumination, and worry. Shiftless thoughts and emotions divorced from any tangible outcome pull us away from our mental center of the present moment and are the root of most stress and anxiety. As such, they tax the energy of both the Spleen and its child, the Lungs, represented in the above image as the clear, descending energy of Autumn and the westerly direction. This cycle feeds in upon itself, as the gathering function of the energetic body becomes impaired, aimless thoughts grow in frequency and intensity, affecting concentration, sleep and general sense of well-being.

Owing to the plugged-in nature of our lifestyle today, the assimilative function of the Spleen is under greater stress than ever before. We are constantly exposed to a high-volume stream of information and stimuli that we must choose to either internalize and assimilate, or reject as having no value or relationship to us. The difficulty lies in our lack of clarity and indecision. We are not always ready to take definitive action in the moment based upon whatever stimulus reaches our attention and so we file away these potential decisions or responsibilities into our mental shopping cart to be dealt with later. This is a pattern that creates a psychological form of dampness. The result, as we all know, is that when faced with difficult decisions and “stress”, the body feels heavy, without energy, we desire rest, feel dizzy or are prone to headaches, indigestion, lack of appetite and so on. The Chinese use the expression 困脾 kunpi, literally making the Spleen feel besieged and surrounded. It is important to limit our exposure to various stimuli and unnecessary forms of information as much as possible. Be away from the computer and the internet whenever possible; limit the amount of television and news that you consume.

The bottom line on maintaining a healthy Spleen is actually quite simple. In addition to a healthy diet and low intake of taxing foods, we can add exercise and meditation into our daily routine. Exercise allows us to engage the musculature and move the limbs in order to awaken the Middle, stimulating digestion and assimilation on physical as well as mental levels. The next time you feel overwhelmed with indecision and mental strain, try going for an invigorating workout and observe the changes in your mood and mental state afterward. Meditation is a tool for developing mental clarity: to recognize definitively what we need and what we don’t. The mind trained in the art of concentration will not allow unnecessary things to hang around for any longer than is necessary, thus preventing the internal generation of dampness. A great rule of thumb for diagnosing your own proclivity in this regard is to take a quick look at your living and work space. Is it well organized with plenty of emptiness in which to spread out and move around in, or is it cluttered and full of things that you don’t need? Simplify and alleviate accumulation and its taxing effect on your state of mind. Create clean lines of space around you and air out your living and work space on a regular basis. Much like on a hot, humid summer day, a gentle breeze, both physical and psychological is one strategy for alleviating dampness. This concept extends to inter-personal relationships as well. Surround yourself as best you can with people who leave you feeling refreshed with their clarity and simplicity in opinions and attitudes. Avoid situations that add confusion or seem to have no clear conclusion or outcome.