《孫真人備急千金要方》Vol. 46

The Spleen governs a person’s thoughts. The Spleen is where thoughts reside; thought is the faculty of mind that remembers and retains things. It is also like a remonstrating minister, receiving information from the Heart and the other four organs. What the Heart remembers is called “intent”; what thought retains is called “will”; changes that follow the will are called “reflection”; when reflection projects into the distance, it is called “deliberation”; and when deliberation is used to deal with things, it is called “wisdom.”

Intent is the mental activity stored by the Spleen. The lips are the Spleen’s outward expression, and Spleen Qi communicates with the mouth. When the mouth functions in harmony, it can distinguish the flavors of the Five Grains. Thus, the mouth belongs to Wu, while the tongue and lips belong to Ji. Spleen Qi circulates through the body’s center, rises to the jaw and cheeks, and then appears beneath the lips. It also returns to the Spleen, where it enriches nutritive Qi. The Spleen expresses itself externally through the tongue and governs the muscles; internally, it is associated with distinguishing flavors.

The Spleen weighs two jin and three liang. It is flat and broad, three cun across and five cun long. It also has half a jin of dispersed fatty tissue, which encloses the blood and warms and nourishes the five organs. The Spleen’s spirit is called “Bi.” It governs nutritive Qi in the organs and viscera (some editions read “intent”) and is also called the “organ of intent.” Nutritive Qi moves in accordance with the seasons, so it is said that the Spleen stores nutritive Qi, which resides in intent. When Spleen Qi manifests in the voice, it produces belching; when it manifests in fluids, it produces saliva.

When Spleen Qi is weak, the limbs become powerless and the five organs are unsettled. When Spleen Qi is excessive, the abdomen becomes distended and urination and bowel movements are obstructed. When Spleen Qi is weak, one dreams of having too little food. When Spleen Qi is in season, one dreams of building walls and houses. When Spleen Qi is flourishing, one dreams of singing, dancing, and playing music, while the body feels heavy and the hands and feet cannot move. When counterflowing Qi invades the Spleen, one dreams of hills, marshes, collapsing houses, and wind and rain.

In the system of visceral correspondences, the Spleen belongs to Earth and pairs with the Stomach, which is the Spleen’s bowel. The Spleen channel is the Foot Taiyin Spleen Channel, paired internally and externally with the Foot Yangming Stomach Channel. The Spleen pulse is moderate. It corresponds to summer and is strongest in late summer, the long-summer season.

The Spleen belongs to Earth. Earth is substantial and nourishes all things, so “substantial” conveys the sense of being thick and solid. The colors of all things differ, yet Earth nourishes them all. Trees take root, grow stems, and put forth leaves; flying and crawling creatures, along with all kinds of living beings, also receive Earth’s bounty. Earth’s nature is gentle, though it also has a sluggish aspect. Thus, the pulse of the Foot Taiyin Spleen Channel is moderate and somewhat slow, and the pulses at the inch and cubit positions also differ. The flavors—sour, salty, bitter, and pungent—each have their own effects. They combine with one another and follow their separate courses through the seasons rather than blending into a single mass; these foods are all suitable for ordinary consumption. When Earth is cold, it should be warmed and supplemented; when Earth is hot, it should be cooled. Earth gives birth to a child called Metal. Earth embraces Metal…

Gold, held close to the body, cannot be separated from it. Afraid of fire and worried that hot vapors will scorch it, Gold leaves its mother and flees into Water. Water is Gold’s child, so it hides the Fire spirit and shuts its doors, cutting off communication between inside and outside. This describes how, in winter, Earth loses its child and its Qi grows weak. Water then overflows, soaking the land and striking the skin and face. This causes swelling that spreads to the limbs.

A doctor who does not understand medicine sees the edema and treats it at once with purgation. The result is that the Spleen becomes weak and the Stomach empty, while the pathogenic Water instead remains lodged in the body. Lung Qi rises, causing labored breathing; Lung Qi then suppresses Liver Qi, forcing it downward. Afraid of Lung Qi, Liver Qi is like someone who sees thorns below and fears being hurt, so it withdraws to one side. When Heart Qi weakens, it lies hidden; when Liver Qi grows faint, it sinks. The pulse, too, therefore becomes hidden and deep.

A skilled doctor first observes the illness from a distance, then opens and clears the body’s passages so that urination flows freely and the waterways are unobstructed. The body’s normal fluids can then descend, and the movement of Yin-Yang is restored. As the breathing gradually eases, a slight sweat appears. Liver Qi can stretch out and its root becomes secure; Heart Qi then rallies, Yang Qi reaches the limbs, and Lung Qi settles. The breathing becomes calm. Kidney Qi steadies, and the voice returns to normal. The Kidneys govern the salty flavor and depend on Spleen Earth for nourishment. When Spleen Earth is damaged, a foul, fishy odor appears. When Earth obtains its child, it can gather into a mountain; when Metal obtains its mother, it is called a mound.

The order in which the four seasons unfold, and the different conditions brought about by changes that follow or go against that order, are all like this. What, then, does the Spleen pulse govern? The Spleen belongs to Earth and is an organ at the center, responsible for conveying Qi and blood to the four directions. When the Spleen pulse is even, it is not easy to detect on its own; when it is abnormal, it is easy to recognize. What kind of pulse is abnormal? If it comes like flowing water, this is excess, and the illness is at the body’s surface. If it comes like a bird’s beak, this is deficiency, and the illness is within. Excess makes the limbs heavy and difficult to lift; deficiency blocks the body’s nine orifices—the openings of the eyes, ears, nose, and mouth, among others. This condition is called “heavy stiffness.”

The Spleen pulse, when it comes gently and smoothly, with an open, regular rhythm between beats, is like a chicken walking on the ground; this is a normal pulse. In late summer, when Earth’s Qi is in season, the pulse takes Stomach Qi as its root. If the Spleen pulse comes full and forceful, yet hurried, like a chicken lifting its feet, the Spleen is ill. If the Spleen pulse is hard and sharp, like a bird’s beak or claw, or like water leaking from a roof and flowing without pause, it is a death pulse showing that the Spleen is about to fail.

A true death pulse of the Spleen is weak, sometimes sparse and sometimes scattered. The complexion is yellow tinged with green and lacks luster, and the hair has lost its shine. These are signs that death is near.

In late summer, a slightly soft and yielding pulse is normal. A weak pulse with plenty of Stomach Qi indicates Spleen illness. A pulse with pauses and no Stomach Qi is a death pulse. If a soft, yielding pulse contains a hard “Stone” pulse, illness is expected in winter; if the Stone pulse is especially pronounced, it indicates illness in the present.

The spleen stores Yi (intention and thought). When sorrow cannot be dispelled for a long time, it damages Yi. When Yi is harmed, a person feels inwardly distressed, thoughts become confused, the limbs grow weak, the hair becomes dry and brittle, and the complexion grows dull. According to the generating and overcoming relationships of the Five Phases, if this illness flares up in spring, it may be life-threatening.

When the Qi of the Foot Taiyin Spleen Channel is cut off, the pulse Qi can no longer nourish the lips. The lips are the root of the muscles; when the pulse Qi fails to nourish them, the muscles become slack and weak. As they slacken, the philtrum beneath the nose swells; when the philtrum swells, the lips turn outward. Outward-turning lips indicate that the muscles will be the first to deteriorate. If the nails darken and the illness is severe, the patient may die on an Yi day, when Wood is in command, according to the overcoming relationships of the Five Phases, because Wood overcomes Earth.

When the spleen is near death, the pulse feels large and moderate under light pressure (another account says firm), but under deep pressure it feels as though a cup has been placed upside down over it. Its beats are fine and irregular, as if trembling. This pulse indicates death. The sixth month, the last month of summer, corresponds to the Wei month; between Kun and Wei lies the position of Earth, and this is also when the spleen is at its height. A normal spleen pulse should be broad and moderate. If instead it is floating, large, and surging, the Heart pulse is affecting the Spleen pulse. Since the Heart is the Spleen’s mother, this is called “the mother returning to the child” and is a vacuity pathogen. Though illness is present, it is easy to treat. If the pulse is faint, rough, and short, the Lung pulse is affecting the Spleen pulse. Since the Lung is the Spleen’s child, this is called “the child overacting on the mother” and is an excess pathogen. Though illness is present, it may resolve on its own. If the pulse is taut and long, the Liver pulse is affecting the Spleen pulse. Since Wood overcomes Earth, this is a thief pathogen; the illness runs strongly against the proper order and is beyond saving in eight or nine cases out of ten. If the pulse is deep, soft, and slippery, the Kidney pulse is affecting the Spleen pulse. Since Water overwhelms Earth, this is a slight pathogen; though illness is present, the patient will soon improve.

If the Yin pulse at the right-hand Guan position—the part of the Cun Kou pulse corresponding to the Spleen and Stomach—is cut off, this indicates the absence of a Spleen pulse. The patient will have shortness of breath, diarrhea, abdominal distension, and a heavy feeling in the body; the limbs will be reluctant to move, and vomiting may occur readily. The Foot Yangming Channel may be needled to treat the Yang.

If the Yin pulse at the right-hand Guan position is firm and forceful, this indicates Spleen excess. If there is a hard, lump-like sensation in the intestines and difficulty passing stool, the Foot Taiyin Channel may be needled to treat the Yin.

The Spleen pulse is normally long and weak, arriving at wide intervals and leaving at close intervals (another account says it leaves quickly). Three beats per breath is called “deviating from the channel.” In severe illness, four beats per breath is called “loss of essence.” Five beats indicate death; six mean life is nearly at an end. These are the descriptions of the Foot Taiyin Spleen Channel pulse.

If the Spleen pulse is excessively rapid, it indicates spasms of the sinews and vessels; if somewhat rapid, it indicates fullness and distension in the chest and diaphragm, with food vomited back up after entering the mouth, along with saliva. If the pulse is excessively slow, it indicates withered, weak, and cold limbs; if somewhat slow, it indicates muscle weakness caused by Wind, with the limbs unable to move. If the pulse is excessively surging, it indicates sudden collapse; if somewhat large, it indicates a Spleen hernia (an abdominal disorder associated with the Spleen and Stomach), or a large mass of pus and blood contained within the abdomen, with the lesion outside the intestines and Stomach. If the pulse is excessively fine and small, it indicates alternating chills and fever; if somewhat small, it indicates wasting-thirst disease. If the pulse is excessively slippery, it indicates tuí lóng (a disorder involving scrotal swelling or urinary obstruction); if somewhat slippery, it indicates parasites, roundworms, or intestinal rumbling. If the pulse is excessively rough, it indicates an epilepsy-like disorder of the intestines; if somewhat rough, it indicates internal ulceration, with frequent discharge of pus and blood.

When the spleen pulse is firm and long, the complexion turns yellow and the person usually has shortness of breath. When the pulse is soft and scattered, the complexion loses its luster, and the lower legs often swell as if filled with water.

When a yellow pulse appears, it is large and weak. This indicates accumulated qi in the abdomen, along with qi that has risen and become disordered. The condition is called “Jueshan” (a class of abdominal disorders caused by disordered qi). Women can experience a similar condition. If it progresses to sweating in the limbs, and the person is exposed to wind while sweating, illness will follow.

Bian Que said: When the spleen is diseased, the complexion becomes withered and yellow. When the spleen is excessive, the root of the tongue becomes stiff; when it is deficient, accumulations are likely to form, and symptoms such as difficulty swallowing and diarrhea often occur. A person with an excessive spleen and abundant Yang qi may dream of food and drink.

The spleen corresponds to singing in the voice, sighing as an abnormal expression, and thoughtfulness among the emotions. Excessive thoughtfulness injures the spleen. When Jing and qi gather in the spleen, a person feels hungry. The spleen’s sound corresponds to late summer; if illness manifests as an abnormal voice, the channels should be treated. Fear that persists without relief damages Jing and qi. When Jing and qi are damaged, the bones become sore and weak and the limbs grow cold; seminal fluid may sometimes discharge spontaneously, giving rise to a Jing disorder. The function of the five organs is to store Jing and qi, so they must not be harmed. If they are damaged, Jing and qi fail to remain contained and Yin becomes deficient. When Yin is deficient, there is no qi; without qi, death follows.

When illness first arises in the spleen, the flow of qi becomes blocked, and the body aches and feels heavy. On the first day, the illness passes to the stomach, causing abdominal distension; on the second day, it passes to the kidneys, causing pain in the lower abdomen, lower back, and back, as well as soreness in the lower legs; on the third day, it passes to the bladder, causing pain in the back and sinews and difficulty urinating. If the person is still not better after ten days, death will follow. In winter this occurs around the time people settle down for the night; in summer, after the evening meal. (The original text has variant readings in phrases such as “at midday, remain below and be still,” whose meaning is difficult to determine.)

Spleen disease is milder around the time the sun declines in the west, at about three in the afternoon; it worsens at dawn, stabilizes at midday, and is quiet in the evening. If the spleen disease is related to the East, to eating pheasant or rabbit, or to the fruits of various trees, then, if none of these is the cause, it should flare up in spring. The day of onset will be a Jia or Yi day.

Spleen disease typically manifests as heaviness in the body, frequent hunger, weakness and lack of strength in the feet, a tendency to cramp while walking, and pain in the soles. When the spleen is deficient, the abdomen distends, the intestines rumble, and undigested food passes in the stool as diarrhea. Treatment may involve points on the Foot Taiyin Spleen Channel, the Foot Yangming Stomach Channel, and the Foot Shaoyin Kidney Channel, together with bloodletting.

On deep palpation, the spleen pulse is soft and yielding; on superficial palpation, it is weak. The patient may have abdominal distension and oppressive discomfort in the chest and abdomen, heat in the stomach, loss of appetite, difficulty digesting food, difficulty passing stool, and numbness or discomfort in the limbs. The illness may be related to sexual activity and may also be accompanied by absent menstruation or unusually frequent menstruation.

When the spleen is diseased, the complexion turns yellow, food cannot be digested, the abdomen is distended and full, the body feels heavy, and the joints ache.

When the bowels are obstructed, treatment is still possible if the pulse is weak, moderate, and somewhat long. Suitable medicines include Pingwei Pills, Xiepi Pills, Zhuyu Pills, or Fuzi Decoction. In spring, needle Yinbai; in winter, needle Yinlingquan, using the reducing method in both cases. In summer, needle Dadu; in late summer, needle Gongsun; and in autumn, needle Shangqiu, using the reinforcing method for these points. Moxa should also be applied for fifty cones at Zhangmen and one hundred cones at the first vertebra on the back.

When pathogenic Qi invades the Spleen and Stomach, the muscles become painful. If Yang Qi is excessive and Yin Qi deficient, there will be internal heat and increased hunger. If Yang Qi is deficient and Yin Qi excessive, there will be internal cold, rumbling in the intestines, and abdominal pain. If both Yin and Yang are excessive, or both are deficient, cold and heat will appear together. In all these cases, regulate the Zusanli point.

A blow or fall, sexual intercourse after drinking or eating one’s fill, or exposure to cold wind while sweating can injure the Spleen. When the Spleen is injured, the Middle Qi becomes disordered and Yin and Yang separate; Yang Qi can no longer remain joined to Yin Qi. The condition must therefore be assessed from three aspects to determine whether the patient will live or die.

A person with Wind affecting the Spleen has a slight fever and looks as if drunk. The abdomen feels troubled and heavy, the flesh and skin twitch, and breathing is short. Symptoms of Cold affecting the Spleen are described below.

In Spleen Water, the abdomen is distended and the limbs feel heavy and uncomfortable. Fluids are not produced; the person feels only shortness of breath and has difficulty urinating. In Spleen Distension, the person often hiccups, the limbs are cramped (some versions read “stiff”), and the body feels heavy. It is difficult to put on clothing (some versions read “difficult to draw the body together”).

When the Fuyang pulse is floating and rough, the floating quality indicates relatively strong Stomach Qi, while the rough quality indicates frequent urination. When floating and rough occur together, the stool becomes dry and hard. This is called “Spleen Bind.” A person with Spleen Bind has dry, hard stools and free urination, yet is not thirsty.

A person with weak Spleen Qi has diarrhea and passes white intestinal residue. Alternatively, the stool may be dry and impossible to pass while sweating continues without stopping. This is called “weak Spleen Qi.” Sometimes fluids of five colors also flow downward: green, yellow, red, white, and black.

When the Cunkou pulse is wiry and slippery, the wiry quality indicates pain, while the slippery quality indicates an excess condition. Pain makes a person feel constricted; an excess condition brings intense pain. Together, they cause a constricting pain in the chest and flanks.

When the Fuyang pulse is floating and rough, the floating quality indicates weak Stomach Qi, while the rough quality indicates declining Spleen Qi. When both Stomach Qi and Spleen Qi are weak and declining, breathing becomes impaired. This is a disorder of the Spleen’s function.

When the Cunkou pulses in both hands are tight, this indicates that pathogenic Qi has entered the interior and Qi cannot move outward. The exterior condition has passed, and the illness is in the interior; there will be fullness and hardness below the heart.

When the Fuyang pulse is faint and rough, the faint quality indicates insufficient Stomach Qi, while the rough quality indicates injury to the Spleen. Cold has lodged in the diaphragm, yet purging is used instead. The accumulated Cold cannot then disperse; Stomach Qi is weakened, the Spleen is injured, and Grain Qi therefore cannot…

Frequent belching after eating indicates that cold Qi has lodged in the upper chest and diaphragm. The upper part of the body is deficient while the lower part is replete, so the Qi of food cannot circulate freely. This is an obstructive disorder.

The cun pulse at the wrist is relaxed and slow. A relaxed pulse indicates Yang, with a long, even breath; a slow pulse indicates Yin. The movement of nutritive Qi is hurried—or, according to another interpretation, deficient—but nutritive and defensive Qi are in harmony. Firmness and suppleness work together, and the three burners—the upper, middle, and lower—support one another. The Qi can then grow strong.

The Fuyang pulse on the top of the foot, used to assess Stomach Qi, is slippery and tight. A slippery pulse indicates that Stomach Qi is replete; a tight pulse indicates that Spleen Qi is injured. If food cannot be digested after eating, the Spleen’s transforming and transporting function is impaired. Being able to eat without abdominal distention indicates that Stomach Qi is abundant. Abdominal distention with inability to eat, accompanied by a feeling of hunger in the pit of the stomach, indicates that Stomach Qi is not circulating freely and Heart Qi is deficient. Feeling distended after eating indicates impaired Spleen function.

A flat area beneath the patient’s nose indicates a Stomach disorder. A faintly red color may indicate an abscess or swelling; a faintly black color indicates heat; a bluish color indicates cold; and a white color indicates a difficult-to-treat condition. Blackened lips indicate that the Stomach was affected first. Slightly dry lips with thirst can still be treated; without thirst, the condition is difficult to treat. A navel that protrudes outward indicates that Spleen Qi has declined—or, according to another interpretation, is about to be exhausted.

Some people’s pulse returns to normal, yet by evening they feel slightly troubled again. This is because others, seeing the patient improve, urge them to eat. At that point, Spleen and Stomach Qi are still weak and cannot digest the food, so the feeling of unease returns. Reducing the amount of food brings improvement.

When a Spleen accumulation is diagnosed, the pulse is floating, large, and long. The symptoms ease when the person is hungry, but after eating their abdomen swells. The food seems to contend with Spleen Qi, and the condition waxes and wanes. Beneath the pit of the stomach, one can feel separate hard lumps like peaches or plums, which are also visible from the outside. Other symptoms include abdominal distention, vomiting or diarrhea, intestinal rumbling, heaviness in the limbs, and swelling of the ankles and lower legs. The hands and feet may even become cold, making it impossible to lie comfortably. This kind of illness damages the flesh and turns the complexion yellow.

A Spleen accumulation is called “Pi Qi.” The hard lump lies in the region of the Stomach, and its shape spreads over the area like a large plate. If the illness persists, symptoms may include impaired movement of the limbs, jaundice, and an inability to turn food into flesh. When this illness arises on a Ren or Gui day in winter, it is because a Liver disorder has passed to the Spleen. According to the Five Phases theory of generation and conquest, a Spleen disorder should then pass to the Kidneys. But the Kidneys are in their season of strength and can resist the pathogenic influence. Spleen Qi then tries to pass the disorder back to the Liver, but the Liver does not accept it. The pathogenic influence therefore remains and congeals, forming an accumulation. This is why Pi Qi is said to arise in winter.

In a Spleen disorder, the complexion should be yellow, yet the body turns bluish; there may be incontinence of urine, a fixed stare, lips turned back, bluish-purple nails, vomiting after eating, heaviness of the body, painful joints, and an inability to move the limbs. The pulse should be floating, large, and relaxed, yet instead it is taut and rapid; the complexion should be yellow, yet instead it is blue-green. This means that Wood Qi is overcoming Earth Qi. It is a severe counterflow pattern, and in eight or nine cases out of ten it cannot be cured.

People associated with the “Gong tone” primarily correspond to the Spleen. The sound produced by the Spleen resembles singing. The Spleen’s sound is “song,” and its emotional expression is sorrow.

When the channel Qi of the Foot Taiyin Spleen channel becomes disordered and the Qi of the Yangming channel is also out of balance, the movement of nutritive Qi and defensive Qi is obstructed, and Yin and Yang lose their balance. Yang Qi surges inward, while Yin Qi is damaged on the outside. This damage brings on a fear of cold, which leads to weakness. As weakness sets in, the whole body gradually wastes away, and the voice becomes low and labored, like the sound of a broken drum. The tongue stiffens and can no longer move freely, and the person often swallows saliva. The mouth cannot be opened, the lips turn black, and the limbs cannot move. The body feels as heavy as if a mountain were pressing down on it, and diarrhea continues without stopping. When the illness is severe, it is difficult to treat. Treatment should address the cause; the principal prescription is Ma Huang Tang (Ephedra Decoction; see another volume for the formula).

In another condition, the voice conveys sorrow and fear, and the root of the tongue curls back. This results from Wood restraining Earth (in Five Phases theory, Wood overcomes Earth), with Yang Qi surging against Yin Qi, Yin Qi lying dormant, and Yang Qi rising. As Yang Qi rises, it becomes excessive; excess brings fever, and fever leads to agitation and confusion. The person’s body feels heavy, they cannot turn over, their speech is drawn out, their breathing is deep but obstructed, and they feel an urgent pressure in the heart. These are signs that pathogenic heat has injured the Spleen; in severe cases, the illness is difficult to treat. If the lips are dry and yellow but the voice can still move freely, the person can still be saved.

When Spleen disease manifests as malaria, the person feels cold and has pain in the abdomen. During fever, the intestines rumble; after the rumbling, sweating continues without stopping. Hengshan Wan (Hengshan Pill; see another volume for the formula) may be used. If someone who rarely gets angry suddenly behaves abnormally, becoming easily angered or joyful and unable to control their emotions, laughing through the nose while speaking seriously, and failing to respond to others, these are signs of Spleen disease in the voice and emotions. Disaster will follow within a month. To diagnose and treat diseases involving Yin and Yang, one should trace the illness back to its source in the channels, identify the cause and the corresponding method of treatment, and only then proceed, so that nothing is overlooked.

Yellow corresponds to the Spleen, and the Spleen corresponds to the muscles. A yellow complexion and an abdomen like the belly of an eel are auspicious signs. The Spleen governs the lips, which are its outward expression. This person’s body type belongs to the Earth type and corresponds to the upper Gong tone: the complexion is somewhat yellow; the head is large and round; the features are well-proportioned; the shoulders and back are broad and sturdy; the abdomen is large; the thighs and lower legs are slender; the hands and feet are fleshy; and the body is proportionate above and below. Their gait is steady, and when they lift a foot, the sole remains level. They enjoy helping others, dislike power and status, and like to be close to people. They tolerate autumn and winter well but not spring and summer. In spring and summer, they are easily affected by pathogenic influences and tend to fall ill, mainly in connection with the Foot Taiyin Spleen channel.

The Spleen’s disposition is steady and substantial. The Spleen corresponds to the moon: just as the moon waxes and wanes, the Spleen varies in size from person to person. The size of the lips is related to the Spleen. A thick upper lip and thin lower lip, missing gums, or lips that are damaged or split all indicate that Spleen Qi is out of order. Lips that turn upward indicate that the Spleen is positioned too high. When the Spleen is high, it tends toward excess; excess produces heat, and heat brings pain and fullness in the lateral costal region, along the sides of the body near the lower ribs. Lips that droop, are broad, and lack firmness indicate that the Spleen is positioned too low. When the Spleen is low, it tends toward deficiency; deficiency brings danger, and danger leads to fear of cold. With this fear of cold, the body feels heavy and the person cannot walk. Firm lips…

When the spleen is firm, its Qi is stable. When the spleen’s Qi is stable, the internal organs are at ease, and a person is less prone to illness. If the upper and lower lips are balanced and well formed, this indicates that the spleen is correctly positioned. When it is properly positioned, the spleen and stomach are in harmony and function freely, and the person is less likely to fall ill. If one side of the lips is slanted or raised, this indicates that the spleen is displaced; symptoms such as pain and abdominal distension may follow. Depressions or raised areas in different regions of the face often correspond to disorders within the body.

The stomach belongs to the Yangming channel, whose corresponding region on the face is associated with the spleen. The Qi of the internal organs connects the inner body with the outside, so the regions of the face likewise reflect the condition of the organs. According to this account, turbid Qi that sinks belongs to the interior, while clear Qi that rises belongs to the exterior. If an illness is on the exterior and invades the corresponding region from outside, that area will bulge. Treatment first drains Yang and then supplements Yin. If an illness is in the interior and manifests in the corresponding region from within, that area will become depressed. Treatment first regulates Yin and then Yang. Excessive Yang produces repletion-heat, while deficient Yin produces deficiency-cold. Cold governs the exterior; heat governs the interior.

Life, death, fortune, and misfortune can be assessed from changes in the spirit and Qi of the internal organs, as well as from the colors and forms visible on the outside. When spleen disease is about to arise, the lips become dry and parched, losing their luster. When the spleen’s Qi is about to expire, the lips become dry and bluish-white, gradually drawing inward as the jaws clench shut. If the regions of the forehead, such as “Heaven’s Center,” also show corresponding signs of decline, ancient diagnostic methods regard the illness as critical and difficult to treat. The depth of the color must also be observed to judge how quickly the illness will progress: if the color is pale, the illness is slower and may come to a head within four hundred days; if the color is deep and pronounced, the illness is urgent and may come to a head within ten days to a month.

How can one recognize a patient who seems to be recovering from spleen disease but then dies suddenly? The answer: if a bluish-black spot about the size of a thumb appears on the cheek, sudden death is considered likely. According to this account, once the spleen’s Qi is severed, death will follow within twelve days. How can this be recognized? If the mouth is cold, the feet are swollen, the abdomen is hot and distended, and the patient has diarrhea without knowing it, death may come soon. A note beside the scripture says death may occur within one or five days. A bluish complexion and yellow eyes may indicate death within five days.

A bedridden patient with heart pain and shortness of breath shows signs that the spleen’s Qi is failing and the internal organs are damaged. Even if the patient seems to recover after a hundred days, they may still stagger and lose their balance when trying to get up, sink down to the floor, or be unable even to lean against the bedside. The scripture says that anyone able to treat this illness may be called a skilled physician. Another account says that a yellow face and red eyes do not necessarily mean death; but if the face is as yellow as the fruit of the trifoliate orange, it foretells death.

The colors of the regions of the face can be used to assess fortune and misfortune. If a faint blackish-yellow color appears and extends to the lips, it is said that illness will certainly arise that year and will be difficult to cure. A commentary on the scripture says this region lies above the bridge of the nose, between the eyes. If the region called “Year Above” shows no corresponding signs, the misfortune may come to pass within three years.

The spleen pulse in late summer, when Earth is at its peak, is associated with the color yellow and with the Foot Taiyin Spleen channel. The channel’s origin lies four inches above the point Zhongfeng, and corresponds to the back’s transport points and the root of the tongue. Zhongfeng is located one inch in front of the inner ankle, in the hollow on the inner side of the large tendon. The channel’s root is at the point Yinbai, located on the inner side of the tip of the big toe.

This passage mainly describes the course of the Spleen channel’s sinews and vessels, its collateral branches and the Gongsun point, as well as the symptoms that arise when the Spleen channel is affected.

The Spleen channel’s sinews begin at the inner side of the tip of the big toe and ascend to gather at the inner ankle. One branch runs straight upward and gathers at the bone on the inner side of the knee. It travels up the inner thigh, gathers at the hip (the root of the thigh), and converges at the genitals. It then ascends to the abdomen, gathers at the navel, travels upward within the abdomen, gathers at the ribs, and spreads through the chest. Another branch attaches to the spine.

The Spleen channel’s vessels also begin at the tip of the big toe. They follow the inner side of the toe along the border of the white flesh, pass behind the bony prominence at the base of the big toe, and ascend past the front of the inner ankle. They travel up the inner lower leg behind the shinbone, meet the Jueyin channel, then pass in front of it. Continuing along the front edge of the knee and inner thigh, they enter the abdomen, connect with the Spleen, and link to the Stomach. They ascend through the diaphragm, flank the throat, connect to the root of the tongue, and spread beneath it. One collateral branch separates from the Stomach, passes through the diaphragm, and flows into the Heart. The Foot Taiyin Spleen channel and the Foot Yangming Stomach channel are interiorly and exteriorly related. The Stomach channel begins at Lidui (the tip of the second toe), then ascends to the space between the big toe and second toe on the top of the foot, about three cun from the toes. The Spleen channel also meets the Hand Taiyin channel.

The collateral vessel of the Foot Taiyin Spleen channel is called Gongsun (the Spleen channel’s connecting point). It lies one cun behind the joint at the base of the big toe. From there, it branches toward the Foot Yangming Stomach channel. Another branch of the Gongsun collateral enters the body and connects with the intestines and Stomach.

When the Spleen channel has an excess condition, there is heat in the Stomach. If the heat becomes severe, it causes intense abdominal pain. The classical text describes the pulse in this condition as the Yang pulse at the cun position (the pulse-taking point at the wrist) being three times stronger than normal. Other possible symptoms include a stiff tongue, contracted sinews, retraction of the testicles, pulling pain along the inner thigh, pain in the hip, abdominal distension, heaviness of the body, inability to eat, irritability, and tightness below the heart.

When the Spleen channel is deficient, there is cold in the Stomach. Severe cold may cause abdominal fullness and distension. The classical text describes the pulse as the Yin pulse at the cun position being half as strong as normal. Other possible symptoms include watery diarrhea, restlessness and inability to sleep, difficulty standing upright, and pain in the thigh and inner side of the knee. If the sinews feel as though they are broken or twisted, the pulse beats intermittently, and the attacks are severe, the classical text regards the condition as critical and difficult to treat.

The last eighteen days of each of the four seasons are called the seasons’ “remaining days,” and are governed by the Spleen and Stomach. Disorders involving the Spleen and Stomach can also affect the muscles. The original text has another variant reading. The underlying cause of this kind of illness is described as disharmony between the Foot Taiyin Spleen channel and the Foot Yangming Stomach channel, imbalance during seasonal transitions, and improper regulation of cold and dampness in the Triple Burner (the organ system that regulates the movement of Qi and fluids). These disrupt the harmony of the Qi of the four seasons and consequently damage the organs. Yang Qi dissipates outward while Yin Qi remains trapped within, and symptoms vary accordingly. If the Qi of the organs and bowels is weak, Yin evils may take advantage of the deficiency, causing a heavy head, a stiff neck, and stiffness or numbness of the skin and flesh. If the Qi of the organs is congested and excessive, Yang evils may invade; the evil Qi then accumulates into a lump that begins in the throat or at the side of the neck and spreads toxic heat through the skin and muscles.

Heat enters below the hairline and passes through the temples. A persistent, dull warmth continues without interruption, which is why this is called “yellow flesh following the illness.”

Bian Que said: Moxibustion at the transport points of the liver and spleen can treat erysipelas. For illnesses associated with the four seasons, determine the cause and distinguish deficiency from excess before deciding whether to tonify or drain. If the skin and flesh become ill along with the heat, use a sickle-shaped needle to lance the affected area, then apply the prescribed medicine and recite an incantation to hasten its effect. In this way, the illness will have nowhere to escape.

Essential Prescriptions Worth a Thousand in Gold for Emergencies, by Sun Simiao, juan 46.