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הטחול, איבר העיכול העיקרי ברפואה המסורתית - מאת יאנה וייס Ph.D, L.Ac

 למאמרים נוספים מאת המחברת הקישו כאן

The Spleen is a central digestive organ in traditions around the world, often associated with cold and dampness. Examples from Chinese, Tibetan, Ayurvedic (India), Mexican and Arabic medicine follow.
 
Chinese Medicine
 
Centrality of the spleen
 
The Spleen and Liver are both situated in the Middle Burner, between the diaphragm and the umbilicus, hence are both related to digestion. (The Upper Burner is the chest cavity which contains the Heart, and Lungs; the Lower Burner below the umbilicus houses the Kidneys.) In Chinese medicine, the digestive tract is associated primarily with the Spleen (O’Connor and Bensky 1981: 13). Li Dong-yuan (Li Gao, Li Kao) established the centrality of the Spleen in Chinese medicine in his 1249 Chinese classic “Treatise on the Spleen and Stomach (Pi Wei Lun)” (Unschuld 1985:177-179). Li considered the Spleen to be the source of all postnatal Qi (energy) and Blood, hence of foremost importance in both disease causation and treatment (Li 1993). Li wrote, “When the digestive system and stomach in the body sustain damage, all kinds of illnesses can occur!” (Unschuld 1985:178). According to Li, factors that damage the Spleen and Stomach are irregular food and drink, overwork , and excessive emotions (Unschuld 1985:178).
 
Understanding the organs
 
Chinese medicine classifies symptoms and signs under 5 primary, yin or solid (zang) organs. These primary Chinese organs can be considered as analogous to the modern concept of a system (e.g., reproductive, hormonal, immune, etc.) in the sense that each organ incorporates a wide range of symptoms that are spatially scattered throughout the body, and that relate to the traditional physiological function of each organ (cf. Kaptchuk 1983:53, O’Connor and Bensky 1981:10-12).). In English Chinese medical texts, it is customary to capitalize Chinese organ names, in order to distinguish this much broader “systemic” Chinese organ concept from the narrower Western medical definition of an organ. Often, the word ‘Organ’ is also capitalized, to emphasize this distinction (e.g., Kaptchuk 1983, O’Connor and Bensky 1981).
 
Five minor, yang or hollow (fu) organs are paired with each of the 5 primary organs. Four of the 5 minor or hollow (fu, yang) Chinese organs are affiliated with digestion: Stomach (paired with the Spleen), Gallbladder (paired with the Liver), Large Intestine (paired with Lungs) and Small Intestine (paired with Heart). (The fifth is the Bladder, paired with the Kidneys). Of these minor organs, the Stomach is the most important, and tends to suffer when there is a dysfunction of the Liver. Symptoms of stomach disharmony may include excessive hunger, bleeding gums, halitosis, frontal headaches, constipation, hemorrhoids, and acid reflux. Symptoms related to Spleen dysfunction are discussed in depth below.
 
Spleen traditional function and dysfunction
 
The Spleen’s primary traditional medical functions and associated body parts include: 1. “transformation and transportation,” i.e., responsible for the digestion and absorption of metabolites, their transportation to the various organs, and from them to the whole body, thereby producing Blood and Qi (energy), 2. “governing or controlling the blood,” keeping the blood properly flowing within the vessels, 3. the muscles, including their function of holding the organs in their respective places, 4. the mouth. Each organ is also associated with a color, element, flavor, and emotion. For the Spleen these are: yellow, earth, sweet and overthinking, or worry (Kaptchuk 1983:57-59, 221-223, O’Connor and Bensky: 13-14). (For an extensive discussion of the Chinese Spleen, refer to Freuhauf’s on-line article.)
 
The transformation and transportation function is a major function of the Spleen, which, if compromised, may deleteriously affect all the other organs. Hence the Spleen has a central position in relation to the other organs. In one variation of the depiction of the 5 elements, the Spleen is situated in the center, surrounded by the remaining 4 yin (zang, solid) organs. If a deficiency in the “transformation and transportation” function of the Spleen arises, digestive symptoms such as abdominal distention, diarrhea, chronic loose and frequent stool, and anorexia may arise.
 
When a dysfunction of the “governing the blood” function arises, symptoms such as vomiting blood, blood in the stool, “black and blue” spots, excessive uterine bleeding (menorrhagia) or abnormal uterine bleeding (metrorrhagia) may occur. Hormonal function in Chinese medicine is distributed among the Spleen, Liver and Kidneys. Scanty periods or lack of menstruation (amenorrhea) or pale menstrual blood are most often due to insufficient production of Blood because of the inability to carry out its transformation and transportation function. Craving sweets, the flavor of the spleen, may be considered a hormonal imbalance due to the Spleen (Lee 1992:83-84).
 
Organ prolapse, such as uterine, rectal or stomach prolapse, is associated with a loss of muscle tone and a loss of the organ-holding function of the Spleen.
 
Abnormal or excessive weight loss or gain, loss of appetite, shortness of breath (dyspnea), fatigue and pale or yellow skin color are all primarily associated with the Spleen. The Spleen prefers warmth and dislikes cold; in order to preserve the metabolic digestive “fire” of the spleen, that “cooks” the food after ingestion, the Chinese prefer cooked foods and foods that are warming in nature. Ginger (Zingiber officinale, Zingiberaceae, sheng jiang) is a major culinary ingredient that warms and strengthens Spleen function on a regular basis.
 
A Spleen injured by cold produces mucus that is stored in the Lungs, hence respiratory symptoms are often associated with the Spleen as well as the Lungs. Asthma, bronchitis, recurrent acute upper respiratory tract infections, such as sore throats and ear infections in children, are therefore also associated with the Spleen. Treatment is directed to relieve the “branch” or secondary symptoms of the Lungs, and to the “root” of the problem in the Spleen. Many Chinese herbal tonics support the Lungs and Spleen simultaneously. Examples are Atractylodes macrocephala (Compositae, bai zhu), ginger (Zingiber officinale, Zingiberaceae, sheng jiang), Astragalus membranaceus (Leguminosae, huang qi), ginseng (Panax ginseng, Araliaceae, ren shen) and licorice (Glycchyrrhiza glabra, Leguminosae, gan cao) (Bensky and Gamble 1993: 300-301, 314-325).
 
The Spleen is also easily injured by dampness, with symptoms such as vaginal discharge. If the discharge is due to heat dampness , the discharge is yellow, and if due to cold dampness, then it is white. Chronic fatigue syndrome and candida most often fit a picture of deficient Spleen function. Edema, an abnormal accumulation of fluid, is a symptom classically associated with the Spleen’s propensity for Dampness. Other Spleen symptoms usually associated with dampness include a feeling of heaviness, a slippery pulse (hua mai, like pearls rolling on a tray, also translated as a rolling pulse), borborygmus (stomach gurgling), thick moist sticky tongue fur, and a tongue with distinct tooth marks along the edges (Kaptchuk 1983:223). (For a discussion of Spleen Damp Heat, see Kaptchuk 1983:224.)
 
The pancreas and thyroid functions, though not specifically mentioned in Chinese medicine, are often associated with the Spleen and Stomach. For instance, the “3 ‘Much-es’ or Excesses” of diabetes (pancreas-related), include symptoms for each of the Three Burners and their associated organs: excessive thirst associated with the Upper Burner and Lungs, excessive hunger associated with the Middle Burner and Stomach (Stomach Heat), and excessive urination, associated with Lower Burner and Kidneys (Kaptchuk 1983:332). The sluggish metabolism of hypothyroidism could correspond to a Chinese symptom pattern of Spleen deficiency. (Kaptchuk (1983:235) offers Kidney Yang Deficiency in association with hypothyroidism. Miriam Lee (1992:83-84) considers diabetes and hypothyrodism to be Spleen/Stomach disorders.)
 
The liver
 
The Liver’s main functions are to 1. store Blood and 2. be responsible for the free flow of Qi in the body. Liver symptoms related to digestion are due to Depressed, Stagnant or Constrained Liver Qi (gan qi yu jie) (Kaptchuk 1983:60, 226; Shen 2005:40), when the Qi is obstructed and does not flow freely. The Liver’s digestive symptoms include nausea, subcostal distention or pain, hiccups, belching, intercostal distention or pain. As mentioned above, the Liver is related to hormonal function. Premenstrual symptoms, irregular menstruation, breast tenderness, sensation of a lump in the throat, are all Liver symptoms associated with the Liver’s inability to regulate the free flow of Qi. The Liver tends towards Heat disorders. Prolonged Constrained Liver Qi may transform into Heat and Wind. Symptoms may include red eyes, headaches, bitter taste in the mouth (Kaptchuk 1983:60, distinguished from a bitter tasting plant that is related to the flavor of the Heart), dizziness, tinnitus, cramping. The Liver is associated with green-blue, wood, sour, and anger. Depression, from suppressed anger, is most often associated with the Liver.
 
Tibetan Medicine
 
Due to Tibet’s geographical situation between India and China, Tibetan medicine bears similarities to both Ayurvedic and Chinese medicine. Tibetan medicine closely resembles Ayurvedic medicine in that both are based on three main bodily humors (Ayurvedic doshas, dosas) among which imbalance may develop: wind, bile, and phlegm (Donden 1986: 34). Bile corresponds to fire and heat; phlegm corresponds to earth, water, cold and dampness (Baker 1997:44-46). The Spleen and Stomach, of the earth element, are associated with phlegm (Donden 1986: 31, 40, 84). (Lungs, Kidneys, and Urinary Bladder are also phlegm related.) Digestive symptoms predominate with phlegm disorders and include: loss of appetite, indigestion, frequent vomiting, loss of sense of taste, distention of stomach, frequent belching with the smell of food eaten, heaviness of mind and body, laziness, coldness of body, discomfort after eating (Clifford 1984:102).
 
The “three poisons,” the three basic afflictive emotions that give rise to all suffering, are fundamental Buddhist concepts that form the foundation of Tibetan medicine. According to Tibetan medicine and Buddhist philosophy, we are all sick, in that we are all still within cyclic existence. Ultimately, our true healing entails our liberation from cyclic existence and attainment of enlightenment. The three poisons, attachment, hatred and ignorance (delusion, obscuration) are the three causes of rebirth. Wind disorders arise from attachment, namely our desires, passions, likes, attractions, wants, cravings, and the consideration of some as close and dear to us. Bile or heat disorders arise from hatred and anger (one word in Tibetan, also called aversion), our dislikes, disgusts, rejections, and the holding of some as distant from us, our “enemies.”
 
Ignorance, the root of the three poisons and the main obstacle to enlightenment, gives rise to phlegm disorders. In order to be released from perpetual attachment and hatred, ignorance must be dispelled. Ignorance is our mistaken view of self, our mistaken belief in an inherently existing “I.” Realization of the true nature of the self as non-inherently existing, in other words, the realization of emptiness or selflessness, coupled with a compassionate altruistic intention towards all living beings, liberates from cyclic existence and leads to full enlightenment (Baker 1997:58-62, Clifford 1984:5, Donden 1986:26).
 
According to Yeshi Donden, personal physician to His Holiness the Dalai Lama for over twenty years, “the most important point concerns ignorance, for the entities and causes of all illness derive from ignorance. From ignorance there is obscuration, due to which we do not recognize unsalutory states of mind as faulty and instead generate desire that leads to many ill-deeds and the accumulation of bad karma… From obscuration, which is heavy, dull, and cloudy, phlegm disorders increase, phlegm being heavy and viscous… The root is beginningless ignorance. Due to its force we are caught in cyclic existence, in the round of repeated birth, aging, sickness, and death. Ignorance is with us like our own shadow; thus, even if we think that there is no reason to be ill, even if we think that we are in very good health, actually we have had the basic cause of illness since beginningless time.” (Donden 1986: 26).
 
Ayurveda
 
In Ayurvedic medicine, the phlegm humor is called kapha. Kapha mucus is best relieved by emetic therapy, the induction of vomiting. Herbs that are warm, dry, light and stimulating in nature, pungent, bitter, astringent, and strengthen the digestive fire are prescribed for Kapha disorders. While diuretic, diaphoretic and expectorant herbs may assist in expelling moisture, including edema and fat, carminative herbs that promote digestion are the primary means of dispelling Kapha. Many carminative digestives that relieve Kapha are also diaphoretic and expectorant, such as ginger, cinnamon (Cinnamomum zeylanicum, Lauraceae) and cloves (Syzygium aromaticum, Myrtaceae) (Frawley and Lad 1986:38-40). Examples of pungent hot exotic restorative tonic herbs (rasayana karma) for Kapha are pippali (Indian long pepper, Piper longum, Piperaceae) and guggul (Indian bedellium, Commiphora mukul, Burseraceae), a resin of the same genus as myrrh (Frawley and Lad 1986:72-73). Cold foods, such as ice cream, sour cream and yogurt increase Kapha. Additional examples of Kapha relieving herbs are cumin (Cuminum cyminum, Apiaceae) coriander (Coriandrum sativum, Apiaceae) and cardamom (Elettaria cardamomum, Zingiberaceae) (Lad 1984:154).
 
Mexican Traditional Medicine
 
Mexico, with 54 indigenous groups, is rich in both cultural and biodiversity. The indigenous groups and the majority mestizo culture vary with regard to medical beliefs and herb use. Nevertheless, some medical practices are widely shared. For example, in Mexico, and throughout Latin America, warming herbs that protect the digestive function such as non-native chamomile (Matricaria recutita,Compositae, manzanilla ) and peppermint (Mentha x piperita, Labiatae, hierbabuena) are often given to young children (e.g., Linares et al. 1990: 56, 68; Weiss 1998: 122, 124, 127). My discussion focuses on the Chatino of Oaxaca, among whom I conducted two years of fieldwork.
 
Hot and cold, used in the classification of illnesses and medicinal plants, are concepts native to Mexico and the New World (Ortiz de Montellano 1990:193-235, Weiss 1998:334-338). The Badianus Codex, an Aztec (Nahuatl) herbal written by de la Cruz in 1552 (Ortiz de Montellano 1990:20) shortly after the Spanish conquest, mentions various body parts in relation to hot and cold disorders; only the abdomen is mentioned in relation to cold. The Badianus Codex also mentions a particular kind of diarrhea caused by drinking cold water after eating raw vegetables. Cold, phlegm and wind disorders were associated with Tlaloc, the rain god (Ortiz de Montellano 1990:155-156).
 
For the Chatino, a cold disorder is often precipitated by attack by the river god, jo’o kieku, first experienced as a sudden fright in water. Cold symptoms are related to the Spleen. Reminiscent of the Chinese Spleen, the afflicted Chatino Spleen prefers warmth, and is also associated with diarrhea, palor, and swelling (Weiss 1998:107-108). For cold disorders, warming herbs are heated and applied externally to the left side of the body, over the Spleen. Internally, in addition to chamomile, Chatino herbs specifically mentioned for cold type diarrhea are: feverfew (Tanacetum parthenium, Compositae, santa maría), cinnamon (canela), anise (Pimpinella anisum, Apiaceae, anís), Hyptis sauveolens (Labiatae, tintallo) (Weiss 1998:108-109, 127).
 
Latido, a pulsing abdominal pain, is a chief complaint among the Chatino and a major cause of concern. Latido can be differentiated into hot and cold types; heat is associated with the Chatino Liver. Cold latido may be due to exposure to cold or to skipped meals (malpasa de hambre). Hot plants for cold type latido include the standard chamomile and peppermint, as well as croton (Croton ciliatoglandulifer, Euphorbiaceae, garañona, kuityi karaño, also used in external baths for edema and swelling), avocado leaves (Persea sp., Lauraceae, aguacate, also used by the Chatino internally for bruises and contusions, a Chinese Spleen indication), feverfew (Tanacetum parthenium, Compositae, santa maría), Lippia sp. (Verbenaceae, hierba dulce), black pepper (Piper nigrum, Piperaceae, pimiento),canelillo (Montanoa xanthiifolia, Compositae), and orégano (possibly Origanum sp., Labiatae, or Lippia sp., Verbenaceae) (Weiss 1998:140-141). (In a comparative study of Highland Mayan and Western medicine, Berlin and Jara (1993) found that me’ winik, “a jumping pain, is often equivalent to a Western medical diagnosis of gall bladder disease (cholecystitis)” (Weiss 1998:283).
 
Concluding Remarks
 
Differential diagnosis
 
Traditional concepts such as heat, cold and wind are found in diverse cultures around the world. These concepts are not abstract and obtuse, but are empirically associated with specific clearly defined symptoms and signs. These concepts concisely summarize complex clinical pictures, and are therefore clinically useful. The Spleen in traditional medicine is most often related to cold, phlegm and damp disorders, which have been the focus of my presentation. However, digestive disorders need to be differentially diagnosed as hot or cold before herbs can be selected. For example, the Chatino distinguish between hot and cold diarrhea; hot diarrhea is red (dysentery), while cold diarrhea is accompanied by green or white mucus. As mentioned above, the Chinese Liver and Stomach, also associated with digestion, are most often afflicted by heat. Tibetan wind and bile/heat are also affiliated with digestion. The same can be said for Ayurvedic pitta (bile).
 
Hot and cold controversy

 
The hot-ness, cold-ness, and other traditional designations, of some medicinal plants that have been widely used for digestive disorders are controversial. For example, some Western herbalists consider peppermint, and mints in general, to be cooling, based on the Chinese classification of Mentha arvensis (also M. haplocalyx, Labiatae, bo he) as a cooling diaphoretic herb for febrile conditions and Constrained Liver Qi (Bensky and Gamble 1993:40-41. As we have seen, this designation of peppermint is not supported by the medical anthropological literature. Nevertheless, peppermint does have a history of European use for liver disorders, and chamomile is well known to be anti-inflammatory (Weiss 1988:29). (Liver disorders and inflammation are most often associated with heat.) Holmes (1989:462-465) considers peppermint “warm with secondary cooling effects,” primarily a diaphoretic for febrile (Wind Heat) and Liver conditions, and chamomile “warming with cooling potential,” primarily for Constrained Liver Qi. Tierra (1988:358-359) describes peppermint as slightly cool, and chamomile as neutral. For practical purposes, we might consider these two herbs to be neutral, useful and important plants for digestive problems, both hot and cold. In my own formulas, I accentuate my intention to warm or cool by using a combination of herbs.
 
Arabic herbs for chinese spleen
 
Among Israeli Arabs, maramiya (Salvia fruticosa, Labiatae, marva) is used primarily for digestive disorders: diarrhea, stomachache, gas and indigestion (kilkul kayva) (Palevitch and Yaniv 1991:217). One Christian Arab woman from Nazareth told me that maramiya was hot and gave her constipation. Others have also asserted that it is hot. Salvia officinalis dries breast milk and is contraindicated during nursing. S. officinalis also has estrogenic activity (Newall et al. 1996:232, Weil et al. 2000) and is therefore considered by some Western herbalists to be a Yin tonic that moistens dryness (Herbal Hall, pers. comm.). Holmes (1989:246-247) considers S. officinalis cool and dry, a Lung and Spleen Qi tonic with estrogenic uterine effects. Tierra (1988:150-151) considers sage to be warm. Perhaps sage regulates fluids and is both a Spleen Qi and Kidney Yin tonic. In Shefar’am, all parts of the mature fennel plant (Foeniculum vulgare, Apiaceae, shomar, shumar) are boiled as a tea to treat asthma. Fennel seeds are carminative and tonic for digestion and “help bring up phlegm from the lungs” (Tierra 1988:243). I consider fennel a Lung and Spleen tonic, much as those mentioned above for Chinese medicine. Holmes and Tierra share their personal views and clinical experience regarding traditional classification of Western herbs. I recommend using their works as general guidelines, not as definitive scripture (torah mi’sinai). I have been applying traditional diagnosis and concepts to Western herbs in my own practice for the past 25 years; I encourage you to do the same, and to keep an open mind.

 


 

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