SPLEEN-YIN DEFICIENCY

When we study the pathology of the Internal Organs, for the Spleen, we generally emphasize Spleen-Qi and Spleen-Yang deficiency. This is understandable as these two patterns are indeed extremely common. By contrast, when it comes to the Stomach, we do mention Stomach-Yin deficiency. In fact, some people say that this is a well-known contradiction: the Stomach is a Yang organ but it suffers from Yin deficiency while the Spleen is a Yin organ but it suffers from Yang deficiency.

All this is true, but in this article, I want to discuss the aetiology, pathology, diagnosis and treatment of Spleen-Yin deficiency. 

Historical development
Although we nowadays emphasize Spleen-Yang deficiency, some of the old classics did often mention Spleen-Yin deficiency. For example, the Su Wen in chapter 3 says that the excessive use of bitter foods or herbs causes Spleen-Qi not to be “immersed”. Modern doctors interpret “Spleen-Qi not immersed” as Spleen-Yin deficiency. 

Doctor Wang Lun Ti (Ming dynasty) said that Stomach-Fire may injure Spleen-Yin.  Qin Huang Shi (1706) says in Zheng Yin Mai Zhi: “The Spleen may be deficient in Yang or Yin: in Spleen-Yin deficiency, there is deficiency of Spleen-Blood and Empty Heat arises.” 

Tang Zong Hai, author of “Xue Zheng Lun” bemoaned the fact that, since Li Dong Yuan (author of “Pi Wei Lun”), doctors paid attention to Spleen-Yang but not Spleen-Yin. 

Aetiology
The aetiology of Spleen-Yin deficiency is clearly dietary.  It is caused by irregular eating, i.e. eating in a hurry, eating standing up, eating while working at one’s computer, eating late at night, eating while discussing business, eating while in a state of worry, etc. 

However, besides the dietary causes, Spleen-Yin deficiency may also be caused by emotional stress related to worry and pensiveness and by excessive physical work that depletes the Spleen.

Clinical manifestations
The main clinical manifestations of Spleen deficiency are:

Poor appetite, distension after eating, dry stools, dry mouth and throat, dry lips, thin body, dull complexion without lustre, night-sweating, 5-palm heat (only if there is Empty Heat), bleeding (in small quantity), tongue without coating (red if there is Empty Heat), Fine pulse.1 

Please note that Empty Heat does derive from Yin deficiency but someone may have Yin deficiency for years before Empty Heat develops.  The tongue is in fact the best clinical sign to distinguish when Yin deficiency has given rise to Empty Heat: if the tongue lacks a coating but it is not red, there is Yin deficiency without Empty Heat.  If the tongue lacks a coating and it is red, then there is Yin deficiency and Empty Heat (Plates 1 and 2 and Fig. 1).

Plate 1 (no coating, normal colour)

Plate 2 (no coating, red colour)

Fig. 1. Progression of Yin deficiency and development of Empty Heat 

The Spleen controls yun hua, i.e. transportation and transformation of food essences.  Yun Hua is impaired not only when Spleen-Yang si deficient but also when Spleen-Yin is deficient, hence the lack of appetite. The Yin deficiency causes the loss of weight and therefore thin body. 

Spleen-Yin includes Blood and Ying and for this reason Spleen-Yin deficiency may cause bleeding such as in the stools, vomit or under the skin. 

Please note the sign of dry lips as this is quite a key sign of Spleen-Yin deficiency.

Chinese journals often include symptoms and signs of Empty Heat with Spleen-Yin deficiency and they say that this pattern cause the flaring up of the pathological Minister Fire. I tend to disagree with this view.  In chronic, long-standing cases, Spleen-Yin deficiency can indeed give rise to Empty Heat but, in very many cases, there is just Yin deficiency without Empty Heat (see Fig. 1 and Plates 1 and 2 above).

Pathology
Dr Hong Guang Huai makes an important differentiation between Stomach-Yin and Spleen-Yin deficiency. He says that in Stomach-Yin deficiency there is a deficiency of fluids while in Spleen-Yin deficiency there is a deficiency of Ying and Blood. They are both Yin deficiency as fluids, Ying and Blood are all part of Yin.2  

Diagnosis
Dr Mao Jiong divides the clinical manifestations of Spleen-Yin deficiency into three groups and this may help the diagnostic process.  The three groups are:

- Digestive symptoms: abdominal distension, poor appetite, dry stools.
- Yin deficiency symptoms (dryness): dry mouth and throat, dry lips.
- Lack of nourishment signs: dull complexion, thin body, dry skin. 

As mentioned above, dry lips is quite a key, distinctive sign of Spleen-Yin deficiency.  Another very distinctive sign are small transversal cracks on the sides of the tongue (Plates 3-4-5). 

Plate 3. Spleen-Yin deficiency cracks

Plate 4. Spleen-Yin deficiency cracks

Plate 5. Spleen-Yin deficiency cracks

Herbal Treatment
One must nourish Yin, strengthen the Spleen, nourish Ying and “lift” fluids. Doctor Wang Guang Jun summarizes the treatment in four words: sweet, sour, moisten, lift.

By “sweet” he means using herbs (and foods) with a sweet taste and the main herbs he advocates   are Huang Jing Rhizoma Polygonati, Tai Zi Shen Radix Pseudostellariae, Shan Yao Radix Dioscoreae oppositae and Bai Bian Dou Semen Dolichoris lablab. 

By “sour” he means herbs (or foods) with a sour taste because the sour taste keeps fluids in and it therefore nourishes Yin. Bai Shao Radix Paeoniae alba, Wu Mei Prunus Mume, Wu Wei Zi Fructus Schisandrae chinensis, Shan Zha Fructus Crataegi. 

By “moisten”, he means the use of herbs that are rich in fluids such as Lian Rou (lotus fruit).  By “lifting” he means the use of herbs that lift Qi such as Ge Gen Radix Puerariae and Sheng Ma Rhizoma Cimicifugae. 

Bearing these four principles in mind, Dr Wang recommends the following prescription to nourish Spleen-Yin. 

Huang Jing Rhizoma Polygonati
Tai Zi Shen Radix Pseudostellariae
Shan Yao Radix Dioscoreae oppositae 
Bai Bian Dou Semen Dolichoris lablab
Bai Shao Radix Paeoniae alba
Shan Zha Fructus Crataegi
Wu Mei Prunus Mume
Ge Gen Radix Puerariae 
Lian Zi Semen Nelumbinis nuciferae 
Da Zao Fructus Jujubae
Gan Cao Radix Glycyrrhizae

Dr Hong Guang Huai also recommends nourishing Yin and strengthening the Spleen and he says that two important herbs are Ren Shen Radix Ginseng and Tian Hua Fen Radix Trichosanthis. He recommends the following herbs for Stomach-Yin and Spleen-Yin:

Stomach-Yin: Mai Men Dong Tuber Ophiopogonis, Bei Sha Shen Radix Glehniae, Yu Zhu Rhizoma Polygonati odorati, Shi Hu Herba Dendrobii.

Spleen-Yin: Ren Shen Radix Ginseng, Tian Hua Fen Radix Trichosanthis, E Jiao Colla Corii Asini, Sheng Di Huang Radix Rehmanniae.

He also recommends herbs with a sweet and bland taste for Spleen-Yin such as Shan Yao Radix Dioscoreae oppositae, Lian Rou (lotus fruit), Geng Mi (rice), Mai Ya Fructus Hordei vulgaris germinatus, Tai Zi Shen Radix Pseudostellariae, Xi Yang Shen Radix Panacis quinquefolii, Bei Sha Shen Radix Glehniae littoralis, Ge Gen Radix Puerariae, He Ye Folium Nelumbinis. 

He recommends the following formulae for Spleen-Yin deficiency:
- Ren Shen Gu Ben Tang Ginseng Consolidating the Root Decoction.
- Zhi Gan Cao Tang Glycyrrhiza Decoction (without Gui Zhi Ramulus Cinnamomi and with the addition of Bai Shao Radix Paeoniae alba).
- Yu Quan Wan Jade Spring Pill. 

Acupuncture Treatment
The acupuncture treatment of Spleen-Yin deficiency is based on the following points: Ren-12 Zhongwan, Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, LIV-13 Zhangmen. 

As Spleen-Yin deficiency very often occurs in conjunction with Stomach-Yin deficiency, I outline below the clinical manifestations and treatment of Stomach-Yin deficiency.

Stomach-Yin deficiency
No appetite or slight hunger but no desire to eat, constipation (dry stools), dull or slightly burning epigastric pain, dry mouth and throat especially in the afternoon with desire to drink in small sips, slight feeling of fullness after eating.
Tongue: without coating in the centre, or with rootless coating, normal body colour.
Pulse: Floating-Empty on the Right-Middle position (Plates 6-7-8-9). 

Plate 6. Stomach cracks.

Plate 7. Two patches without coating

Plate 8. Central Stomach crack

Plate 9. No coating in the centre. 

If there is Empty Heat, there will be some additional symptoms such as feeling of hunger, night-sweating, 5-palm heat, bleeding gums, feeling of heat in the evening, red tongue without coating in the centre, Floating-Empty pulse on the Right-Middle position and slightly Rapid. 

Points: Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao.

Herbal formulae (for Stomach-Yin)
Sha Shen Mai Dong Tang Glehnia-Ophiopogon Decoction.
Shen Ling Bai Zhu San Ginseng-Poria-Atractylodes Powder.
Yi Wei Tang Benefiting the Stomach Decoction.


Plates 10 and 11 illustrate the difference between Shen Ling Bai Zhu San and Sha Shen Mai Dong Tang.

Plate 10. Partially without coating. Shen Ling Bai Zhu San

Plate 11. Completely without coating. Sha Shen Mai Dong Tang

END NOTES
1. The Symptoms and Treatment of Spleen-Yin deficiency by Wang Guang Jun in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 31, no. 2, 1990, p. 18.

2. Concerning the Differentiation between Stomach-Yin and Spleen-Yin Deficiency by Hong Guang Gui Huai in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 31, no. 7, 1990, p. 4.

3. Introduction to Research on Spleen-Yin Deficiency by Mao Jiong in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 32, no. 5, 1991, p. 50.

PRESCRIPTIONS
ZHI GAN CAO TANG
Glycyrrhiza Decoction
Zhi Gan Cao Radix Glycyrrhizae uralensis preparata 
Ren Shen Radix Ginseng 
Da Zao Fructus Jujubae 
Sheng Di Huang Radix Rehmanniae 
Mai Men Dong Radix Ophiopogonis 
E Jiao Colla Corii Asini 
Hu Ma Ren Semen Sesami indici
Sheng Jiang Rhizoma Zingiberis recens 
Gui Zhi Ramulus Cinnamomi cassiae 
Qing Jiu Rice wine 10 ml (added at the end)

REN SHEN GU BEN TANG
Ginseng Consolidating the Root Decoction 
Ren Shen Radix Ginseng
Shan Yao Radix Dioscoreae oppositae
Sheng Di Huang Radix Rehmanniae
Shu Di Huang Radix Rehmanniae preparata
Tian Men Dong Tuber Asparagis cohinchinensis
Mai Men Dong Tuber Ophiopogonis
Fu Ling Poria
Shan Zhu Yu Fructus Corni officinalis
Mu Dan Pi Cortex Moutan
Ze Xie Rhizoma Alismatis orientalis

YU QUAN TANG
Jade Spring Decoction
Huang Lian Radix Coptidis
Ge Gen Radix Puerariae
Tian Hua Fen Radix Trichosanthis
Zhi Mu Radix Anemarrhenae asphodeloidis
Mai Men Dong Tuber Ophiopogonis
Ren Shen Radix Ginseng
Wu Wei Zi Fructus Schisandrae
Sheng Di Huang Radix Rehmanniae
Lian Rou Lotus fruit
Wu Mei Prunus Mume
Dang Gui Radix Angelicae sinensis
Gan Cao Radix Glycyrrhizae uralensis
(plus human milk, cow’s milk, lotus juice, pear juice)

ITCHING

Itching is a symptom that accompanies many diseases and patterns.  The main pathogenic factors that cause itching are:
Heat
External Wind
Wind in the skin
Dampness
Blood deficiency

For each pathogenic factor I will give the general acupuncture points for treatment.  Please note that these are only general points and other points depend on the disease and the part of the body affected. Please note that Baichongwo is an extra point located 1 cun above SP-10 Xuehai. Its name means "100 insects nest", a clear reference to its action on itching that feels as if insects were crawling under the skin. 

In the lists of points, I mention HE-7 Shenmen because, besides calming the Shen, it stops itching.

Heat
The itching caused by Heat manifests with red skin eruptions of the papular type.  It is seen in various diseases such as herpes.  In order to diagnose Heat as the cause of itching the tongue is important: it must be red with a yellow coating and possibly red points.

Acupuncture: LI-11 Quchi, SP-10 Xuehai, P-9 Zhongchong, LIV-2 Xingjian, HE-7 Shenmen.

Red papules

                                                                     

Red body with red points

External Wind
External Wind may cause itching such as itchy throat or itchy nose. 

Acupuncture: BL-12 Fengmen, TB-5 Waiguan, LU-7 Lieque, LI-4 Hegu. 

Wind the skin
By “Wind in the skin” I refer to a type of Wind that is neither internal nor external, but closer to the latter. Wind is a major pathogenic factor in skin diseases and it escapes a classification into internal or external.  

Wind in the skin is a major cause of itching in skin diseases.  It is characterized by being all over the body or moving from place to place. For example, in urticaria, the intense itching is caused by Wind in the skin.  Wind in the skin is also the cause of itching is certain types of eczema. We can diagnose Wind in the skin only when the itching involves the whole body or when it moves from place to place: if the itching is confined to one specific area, it is not Wind. 

Another characteristic of itching from Wind is that often there is nothing to be seen on the skin (although of course in urticaria there are bullae and in eczema papules).  Wind in the skin is the cause of itching in herpes zoster (but remember that this is also caused by Dampness).

Acupuncture: GB-31 Fengshi, TB-6 Zhigou, Baichongwo extra point, LIV-3 Taichong, HE-7 Shenmen.

Urticaria

Dampness
Dampness is a frequent cause of itching. Its main characteristic is that the itching is usually confined to one place.  For example, the itching from vaginitis or herpes is confined to the genitals.  The itching from Dampness manifests with vesicles or papules.  

When Dampness is combined with Heat, the itching is more intense as it is caused by the combined effect of both Dampness and Heat.  Damp-Heat is a major pathogenic factor in eczema: it is very important to treat the itching in eczema because scratching aggravates this disease significantly.  Indeed some of the pathology of eczema is caused by the scratching rather than the disease itself. Scratching causes skin erosion and it may facilitate the entry of bacteria that cause skin infections. 

Acupuncture: Ren-9 Shuifen, Ren-5 Shimen, BL-22 Sanjiaoshu, SP-9 Yinlingquan, Baichongwo, HE-7 Shenmen.

Herpes Zoster  (Damp-Heat)

Herpes simplex (Damp-Heat)

Genital herpes (Damp-Heat)

Blood deficiency
In Blood deficiency the itching is generalized, i.e not confined to a specific area. An important characteristic of itching from Blood deficiency is that is may occur without any skin lesions.  Itching from Blood deficiency is seen in chronic eczema (in which case of course there are skin lesions) and in psoriasis. 

The itching from Blood deficiency may also be accompanied by other changes in the skin such as dryness and desquamation: this is seen a lot in psoriasis. 

Acupuncture: LIV-8 Ququan, Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, HE-7 Shenmen.

Desquamation

Erosion

Itching may also be classified according to Chinese categories of pathogenic factors as follows:
Du (Toxin)
Feng (Wind)
Jiu (Alcohol)
Re (Heat)

Du (Toxin)
The itching from Toxin manifests with erosion, papules or bullae and it appears suddenly.  Contact dermatitis is a good example of it.   

Acupuncture: BL-40 Weizhong, SP-10 Xuehai.

Bullae

Feng (Wind)
The itching from Wind is generalized.  It may be from external Wind or Wind in the skin as defined above.  It may also be from Internal Wind in which case it would manifest with desquamation. 

Acupuncture: GB-31 Fengshi, BL-12 Fengmen, GB-20 Fengchi, Du-16 Fengfu, TB-17 Yifeng.

Jiu (Alcohol)
This is the itching that affects people after drinking alcohol. This occurs in people who are not usual drinkers.  

Acupuncture: LIV-3 Taichong, SP-10 Xuehai, HE-7 Shenmen. 

Re (Heat)
As we have sen above, Heat is a common cause of itching and it may manifest with red bullae or papules. 

Acupuncture: LI-11 Quchi, SP-10 Xuehai, P-9 Zhongchong, LIV-2 Xingjian, HE-7 Shenmen.

THE PO AND ITCHING
The Po is the physical soul that resides in the Lungs. It is always contrasted with the Hun that resides in the Liver.  The Hun is Yang and survives after death; the Po is Yin and dies with the body.  

Zhang Jie Bin says: “The Po can move and do things and [when it is active] pain and itching can be felt”.  The Po is responsible for sensations and itching and is therefore closely related to the skin through which such sensations are experienced. For this reason, in itching, I also treat the Lungs with LU-7 Lieque. 

HERBS THAT EXPEL WIND IN SKIN DISEASES
Fang Feng Radix Saposhnikoviae
Jing Jie Herba Schizonepetae
Chan Tui Periostracum Cicadae
Cang Er Zi Fructus Xanthii
Bo He Herba Menthae haplocalycis
Niu Bang Zi Fructus Arctii

HERBS THAT RELIEVE ITCHING
Chan Tui Periostracum Cicadae
Ku Shen Radix Sophorae flavescentis
She Chuang Zi Fructus Cnidii
Xu Chang Qing Radix Cynanchi paniculati

DIAGNOSTIC DIFFERENTIATION OF DIGESTIVE SYMPTOMS

In this blog post, I will discuss the diagnostic differentiation between various digestive symptoms and specifically, a feeling of distension, fullness, oppression and stuffiness.

A feeling of  DISTENSION (zhang 胀) indicates stagnation of Qi.  This type of sensation will be seldom referred to as "distension" by Western patients: more often than not, patients will call it a feeling of “bloating”, "bursting", "being blown-up", etc.

A feeling of distension is both subjective and objective.  Subjectively, the patient feels bloated, and objectively, it can be seen and palpated.  On palpation it feels like an over-inflated balloon, it resists on palpation and “rebounds”.

A feeling of distension indicates Qi stagnation: it is the cardinal symptom of Qi stagnation which usually affects the Liver.  Remember, however, that it affects also other organs: in the context of digestive disorders, it affects the Stomach, Intestines and Spleen.

Note that Qi stagnation does not always derive from anger (whether repressed or not) but it frequently derives from worry or guilt.

The pulse reflects where the stagnation is centered. We can distinguish Liver-Qi stagnation, Stomach-Qi stagnation, Spleen-Qi stagnation and Qi stagnation in the Intestines.

- Liver-Qi stagnation: abdominal and/or epigastric bloating, related to emotional state. Pulse all Wiry or Wiry on left.

- Stomach-Qi stagnation: epigastric bloating, not much related to emotional state.  Alleviated by burping. Pulse Wiry on right Guan.

- Spleen-Qi stagnation: lower abdominal bloating, loose stools. Alleviated by passing gas and by rest. Pulse slightly Wiry on left and Weak on right.

- Intestines Qi stagnation: abdominal distension and pain,  borborygmi, constipation.  Alleviated by passing gas. Pulse Wiry on both Chi position.

Distension of epigastrium: Ren-10 Xiawan, Ren-12 Zhongwan, ST-21 Liangmen, ST-34 Liangqiu, ST-40 Fenglong, GB-34 Yanglingquan.

Distension of lower abdomen: ST-25 Tianshu, SP-15 Daheng, GB-34 Yanglingquan, Ren-6 Qihai.

A feeling of FULLNESS (man 满 ) indicates retention of food or Dampness. A feeling of fullness is different than a feeling of distension.  One  literally feels full and slightly nauseous.   It may affect the epigastriun or abdomen.

The feeling of fullness is subjective and objective.  Subjectively, the patient feels full and slightly nauseous.  It is felt objectively on palpation but not seen on observation. On palpation, the abdomen feels hard but not elastic as in the feeling of distension.

Epigastric fullness: ST-19 Burong, ST-21 Liangmen, Ren-10 Xiawan, SP-4 Gongsun/P-6 Neiguan (Chong Mai), ST-34 Liangqiu.

Abdominal fullness: ST-25 Tianshu, ST-27 Daju, SP-4 Gongsun/P-6 Neiguan (Chong Mai),  ST-37 Shangjuxu, ST-39 Xiajuxu.

A feeling of OPPRESSION (men 闷 ) denotes Phlegm or severe Qi stagnation.

A feeling of oppression is purely subjective and it is experienced mostly in the chest.  Some patients would describe it as a “weight” on the chest.  A feeling of oppression indicates Phlegm or also more severe stagnation of Qi.  The translation of this term cannot adequately convey the image evoked by its Chinese character: this depicts a heart constrained by a door and, besides the physical sensation, it also implies a certain mental anguish associated with this feeling.

In Western patients too, a feeling of oppression of the chest reflects emotional stress especially to do with sadness, grief, worry, shame and guilt.

Feeling of oppression of the chest: Ren-17 Shanzhong, P-6 Neiguan, LU-7 Lieque, ST-40 Fenglong.

A feeling of STUFFINESS (pi  痞) indicates Stomach-Qi deficiency or Stomach-Heat.  Contrary to the previous two sensations which can be felt objectively on palpation (e.g. a distended or full abdomen feels so on touch), the sensation of stuffiness is only subjective and the abdomen feels soft on touch.

The feeling of stuffiness is usually in the epigastrium.

	DISTENSION	FULLNESS	OPPRESSION	STUFFINESS
Chinese	Zhang 張	Man 滿	Men  悶	Pi  痞
Subjective/objective	Both	Both	Subjective	Both
Objective on what	Palpation and observation	Palpation		Palpation
Symptom	Bloating	Feeling full, nausea	Feeling of weight	Mildly full
Pattern	Qi stagnation	Dampness	Phlegm	Deficiency and Stomach-Heat

COSMOLOGICAL SEQUENCE OF THE 5 ELEMENTS - PART 3

In the first Clinical Tip we discussed the possible origin of the theory of the 5 Elements and the connection between the ancient Four Directions and the Cosmological arrangement of the 5 Elements (with Earth in the Centre).  In the second Clinical Tip we discussed the clinical application of the Cosmological Sequence of the 5 Elements.

In this third and last Clinical Tip I would like to address the relationship between the 5 Elements and the 4 Seasons. Numerology pervades Chinese medicine very often with contradictions.

There is the number 1 which is the Dao, bearing in mind that the Dao is part not only of Daoist philosophy but also of the philosophies of Confucianism and of the Yin-Yang School.

There is the number 2 which is of course Yin and Yang.  Number 3 is Heaven-Earth-Person (Tian-Di-Ren). I deliberately use the word “person” rather than “man” as ren in Chinese does indeed mean “person”: nan ren is a male person and nu ren a female one.

Incidentally, the “Earth” of “Heaven, Earth and Person” is not the same as the “Earth” of the 5 Elements. The “Earth” of “Heaven, Earth and Person” is the counterpole of Heaven: Heaven refers to a state of dispersal of Qi and Earth to a state of condensation of Qi. The “Earth” of the 5 Elements is a “neutral” centre of the other four Elements.

Number 4 corresponds corresponds to the Four Seasons.  Number 5 is of course the 5 Elements.

Thus, these are the correspondences:
1 = Dao
2 = Yin-Yang
3 = Heaven, Earth, Person
4 = Four Seasons
5 = 5 Elements

I mentioned contradictions earlier because the correspondence between these numbers and the phenomena they represent is not always smooth and the 4 Seasons and 5 Elements are a good example of this. How do we fit 5 into 4?  Another very good example is the conundrum of 12 channels but “5 Zang and 6 Fu”.

So, how are four seasons reconciled with 5 Elements?  They are reconciled because Earth does not correspond to any season, as it is the centre, the neutral term of reference around which the seasons and the other Elements spin.

The “Classic of Categories” (Lei Jing, 1624) by Zhang Jie Bin has a very interesting statement: “The Spleen belongs to Earth which pertains to the Centre, its influence manifests for 18 days at the end of each of the four seasons and it does not pertain to any season on its own”.

This confirms that the Spleen does not correspond to any season and that its influence manifests for 18 days at the end of each season.  Again, it is better to refer to the Cosmological arrangements of the 5 Elements rather than the Generating (Sheng) sequence. In the Cosmological arrangement, the Spleen is in the centre and does not correspond to any season.

In the Generating sequence, the Earth has moved out between Fire and Metal and, as it comes after Fire (Summer), it “must” correspond to “Late Summer”.  The association between Earth and Late Summer has never convinced me.  What the Lei Jing says about the energy of the Spleen influencing the end of every season is more convincing.  The Earth provides nourishment, and it make sense that the Spleen should influence the end of every season.

The same idea is also in the “Discussion of Prescriptions from the Golden Chest” (Jin Gui Yao Lue, c. AD 220) by Zhang Zhong Jing: “During the last period of each season, the Spleen is strong enough to resist pathogenic factors”.

Thus, in the cycle of seasons, the Earth actually corresponds to the late stage of each season. Although the Earth element is often associated with “Late Summer” or “Indian Summer”, it also corresponds to “Late Winter”, “Late Spring” and “Late Autumn”.

Clinically, the position of the Earth in the centre makes sense as the Earth is the origin of nourishment and the Stomach and Spleen are the source of Post-Natal Qi. Nourishing the Earth and tonifying the Stomach and Spleen will tonify all other organs.

The association of the Spleen with the end phase of each season also has some clinical relevance as Qi and Blood tend to decline at the end of each season (especially autumn and winter) and it therefore makes sense to tonify Stomach and Spleen then.

To tonify Stomach and Spleen, I use ST-36 Zusanli and SP-6 Sanyinjiao, often with moxa on the needle.  If they are particularly deficient, I add direct moxa cones on BL-20 Pishu and BL-21 Weishu.  

1.  1982 Classic of Categories (Lei Jing), People’s Health Publishing House, Beijing, p 46 (first published 1624).
2.  1981 Discussion of Prescriptions of the Golden Chest (Jin Gui Yao Lue Fang Lun), Zhejiang Scientific Publishing House, p 1 (first published c. AD 220).