脾脏象中坤。安和对胃门。
五营运大论云。中央生湿。湿生土。土生甘。甘生脾。又云。其性静。其政为
谧。皆安和之谓也。脉经脾部第三云。脾象土与胃合为府。其经足太阴。
与足阳明为表里。故曰安和对胃门也。
按阴阳应象大论云。中央生湿。湿生土。土生甘。甘生脾。脾生肉。肉生肺。
脾主口。在天为湿。在地为土。在体为肉。在脏为脾。在色为黄。在音为宫。
在声为歌。在变动为哕。在窍为口。在味为甘。在志为思。思伤脾。怒胜思。
湿伤肉。风胜湿。甘伤肉。酸胜甘。金匮真言论云。中央色黄。入通于脾。开
窍于口。藏精于脾。故病在舌本。其味甘。其类土。其畜牛。其谷稷。其应四
时。上为镇星。是以知病之在肉也。其音宫。其数五其臭香。
旺时随四季。自与土为根。
肝旺春。心旺夏。肺旺秋。肾旺冬。每脏各旺七十二日。惟脾则于辰戌丑
未之月。土王用事之时。寄王十八日。亦共成七十二日。以终一岁。故太
阴阳明论。帝曰。脾不主时。何也。岐伯曰。脾者。土也治中央。常以四时长。
四藏各十八日寄治。不得独主于时也。脾脏者。常着胃土之精也。土者
生万物而法天地。故上下至头足。不得至时也。
磨谷能消食。荣身本在温。
夫脾胃旺。则谷易消。而津液行。足以荣养一身。而温暖肌肉。故东垣饮
食伤脾论云。夫脾行胃津液。磨胃之谷。主五味也。又云。脾受胃禀。乃能
熏蒸。腐熟五谷者也。故曰磨谷能消食也。经云。饮食入胃。游溢精气。上
输于脾。脾气散精。上归于肺。通调水道。下输膀胱。水精四布。五经并行。
合于四时五脏。阴阳揆度以为常也。东垣脾胃论云。胃者十二经之源。
水谷之海也。平则万化安。病则万化危。五脏之气。上通九窍。五脏禀受
气于六腑。六腑受气于胃。六腑者。在天为风寒暑湿燥火。此无形之气
也。胃气和平。荣气上行。始生温热。温热者。春夏也。故曰荣身本在温也。
应唇通口气。连肉润肌臀。
五脏生成篇云。其华在唇。四曰其充在肌。阴阳应象大论云。土生甘。甘
生脾。脾生肉。肉生肺。脾主口。其在天为湿。在地为土。在体为肉。在脏为
脾。在色为黄。在音为宫。在声为歌。在变动为哕。在窍为口。故曰。应唇通
口气。连肉润肌臀也。
形扁方三五。膏凝散半斤。
四十二难曰。脾重二斤三两。扁广三寸。长五寸。有散膏半斤。
顺时脉缓慢。
脾属土。王于四季辰戌丑未之月。每于立春立夏立秋立冬前十八日。
是其候也。尤于六月长夏为之正旺。其脉当如春风中之杨柳。阿阿缓
大。乃为顺时也。
按人镜云。脾脉大而缓。脾合肌肉。故脾脉循肌肉而行。持脉指法如九
菽之重。按至肌肉而得者。如微风轻 柳梢之状为缓。又稍加力。脉道
敦实为大也。
失则气连吞。
熊宗立云。夏以胃气为本。反得脉弦而急。如相连吞咽而来是。肝木克
脾土。故为反脉。张世贤曰。气谓脉气也。脉气如相连吞咽而来。即雀啄
漏水之脉。脾衰乃见。故曰失矣。据二氏之说。俱以气字为脉气。然熊氏
之说。本于李 范。 范曰。连吞者。所以形容紧数之状。恐未必然。何也。
若以脾脉之反时言。则弦而急矣。连吞是何脉。而足以尽弦急之状也。
以愚观之。气字当作口气。
按内经宣明五气篇云。五气所病。脾为吞。又针经云。刺中脾十日死。其
动为吞。是以知吞为口气言。非为脉状言也。予尝见一人脾病。其口常
如连连吞咽之状。至死方休。此之谓也。
按玉机真藏论云。真脾脉至弱。而乍数乍疏。色黄青不泽。毛折乃死。
实梦歌欢乐。虚争饮食分。
淫邪发梦篇云。脾气胜则梦歌乐。身体重不举。厥气客于脾。则梦见丘
陵大泽。坏屋风雨。又方盛衰论云。脾气虚。故梦饮食不足。
按中藏经云。脾实则梦筑墙盖屋。盛则梦歌乐。虚则梦饮食。不足。厥邪
客于脾。则梦大泽丘陵。风雨坏室。
湿多成五泄。肠响若雷奔。
夫脾主湿。湿多则成泄矣。五十七难曰。泄凡有几。皆有名否。然。泄凡有
五。其名不同。有胃泄。有脾泄。有大肠泄。有小肠泄。有大瘕泄。名曰后重。
胃泄者。饮食不化色。黄脾泄者。腹胀满泄注。食即呕吐逆。大肠泄者。食
已窘迫。大便色白。肠鸣切痛。小肠泄者。溲而便脓血。小腹痛。大瘕泄者。
里急后重。数至圊而不能便。茎中痛。此五泄之法也。脉经云。脾病者。虚
则腹胀。肠鸣溏泄食不化。取其足太阴阳明少阴血也。
痞气冬为积。皮黄四体昏。
五十六难曰。脾之积。名曰痞气。在胃脘。覆大如盘。久不愈。令人四肢不
收。发黄瘅。饮食不为肌肤。以冬壬癸日得之。何以言之。肝病传脾。脾病
传肾。肾以冬适旺。旺者不受邪。脾复欲还肝。肝不肯受。故留结为积。故
知痞气以冬壬癸日得之。
二斤十四两。三斗五升存。
四十二难曰。人肠胃长短。受水谷多少。各几何。然。胃大一尺五寸。径长
二尺六寸。横屈受水谷三斗五升。其中常留谷二斗。水一斗五升。又曰。
胃重二斤十四两。纡曲屈伸。长二尺六寸。大一尺五寸。径五寸。容谷二
斗。水一斗五升。张世贤曰。此歌言脾。今并及胃者。脾胃相连故耳。
The Spleen corresponds to the Kun trigram in the five phases. Its Qi is peaceful and harmonious, facing the gate of the Stomach.
The *Suwen: Wuyunxing Dalun* states: The Central direction generates Dampness; Dampness generates Earth; Earth generates Sweet taste; Sweet taste nourishes the Spleen. It also states: Its nature is quiet; its administration is tranquil. All these refer to "peaceful and harmonious." The *Maijing*, Chapter 3 on the Spleen section records: The Spleen's image belongs to Earth, combining with the Stomach to form a Fu organ. Its meridian is the Foot-Taiyin Splein Meridian, which is interior-exteriorly related to the Foot-Yangming Stomach Meridian. Hence it is said that the Spleen's Qi is peaceful and harmonious, corresponding to the Stomach's gate.
According to the *Suwen: Yin-Yingxiang Dalun*: The Central direction generates Dampness; Dampness generates Earth; Earth generates Sweet taste; Sweet taste nourishes the Spleen. The Spleen generates flesh/muscle; muscle Qi connects to the Lung. The Spleen opens into the mouth. In heaven it is Dampness, on earth it is Earth, in the body it governs flesh/muscle, in the zang organs it is the Spleen, in color it is Yellow, in the five tones it is Gong (Palace), in the five sounds it is Song (Song/Garble), in pathological change it is Hiccup (Yue), in orifices it is the mouth, in tastes it is Sweet, in emotions it is Pensiveness (Si). Excessive pensiveness damages the Spleen; Anger can overcome Pensiveness. Dampness damages flesh/muscle; Wind can overcome Dampness. Excessive Sweet taste damages flesh/muscle; Sour taste can overcome Sweet taste. The *Jingui Zhenyan Lun* states: The Central color is Yellow, internally connecting to the Spleen. It opens into the mouth, storing essence in the Spleen. Therefore, diseases often manifest at the root of the tongue. Its taste is Sweet, its category is Earth, its animal is the Ox, its grain is Ji (Millet). It corresponds to the late summer season among the four seasons, and in the sky corresponds to the Planet Zhenxing (Saturn). Thus, one knows the disease is located in the flesh/muscle. Its tone is Gong, its number is Five, its odor is Fragrant.
The Spleen prospers at the end of each season, rooting itself in Earth.
The Liver prospers in Spring, the Heart in Summer, the Lung in Autumn, and the Kidney in Winter. Each zang organ prospers for seventy-two days. Only the Spleen, during the months of Chen, Xu, Chou, and Wei—when Earth rules—prospers for an additional eighteen days, totaling seventy-two days to complete the year. Thus, in the *Suwen: Taiyang Yangming Lun*, the Yellow Emperor asked: Why does the Spleen not rule a specific season? Qibo answered: The Spleen belongs to Earth, governing the Center, and constantly nourishes all things throughout the four seasons. The four zang organs each borrow governance for eighteen days; the Spleen cannot solely rule a single season. The Spleen constantly attaches to the essence of the Stomach's Earth. Earth generates all things following the pattern of Heaven and Earth; therefore, Spleen Qi moves from the head above to the feet below, unable to be confined to a single season.
Grinding grains enables digestion; nourishing the body fundamentally relies on warmth.
When the Spleen and Stomach are vigorous, grains digest easily, and body fluids circulate, sufficiently nourishing the whole body and warming the muscles. Therefore, Li Dongyuan stated in his *Lun on Dietary Injury to the Spleen*: The Spleen transports the fluids of the Stomach, grinds the grains in the Stomach, and governs the absorption of the five tastes. He further stated: The Spleen receives the endowment from the Stomach, enabling it to steam and rot-ripen the five grains. Hence it is said that grinding grains enables digestion. The classics state: When food enters the Stomach, its essence floats and overflows, transporting upward to the Spleen. The Spleen scatters the refined essences, sending them upward to return to the Lung, regulating water passages, and transporting downward to the Bladder. Water essences distribute in all directions, and the five meridians run together, conforming to the changes of the four seasons and five zang organs, measured by yin and yang as the norm. Li Dongyuan's *Piwei Lun* states: The Stomach is the source of the twelve meridians and the sea of water and grain. When peaceful, all transformations are secure; when diseased, all transformations are endangered. The Qi of the five zang organs connects upward to the nine orifices. The five zang organs receive Qi from the six fu organs, and the six fu organs receive Qi from the Stomach. The six fu organs correspond in heaven to Wind, Cold, Summer-heat, Dampness, Dryness, and Fire—this is formless Qi. When Stomach Qi is peaceful, Ying (Nutritive) Qi ascends, generating warmth and heat. Warmth and heat correspond to Spring and Summer. Hence it is said that nourishing the body fundamentally relies on warmth.
Manifesting on the lips, communicating through oral breath, connecting to muscle, moistening skin and buttocks.
The *Suwen: Wuzang Shengcheng Pian* states: Its brilliance manifests on the lips; its substance fills the muscles. The *Suwen: Yin-Yingxiang Dalun* states: Earth generates Dampness, Dampness generates Sweet taste, Sweet taste generates the Spleen, the Spleen generates flesh/muscle, flesh/muscle generates the Lung. The Spleen governs the mouth. In heaven it is Dampness, on earth it is Earth, in the body it is flesh/muscle, in the zang organs it is the Spleen, in color it is Yellow, in tone it is Gong, in sound it is Song, in change it is Hiccup, in orifice it is the mouth. Hence it is said: Manifesting on the lips, communicating through oral breath, connecting to muscle, moistening skin and buttocks.
Shape is flat and square, weighing three jin and five liang, containing half a jin of loose pancreas (San Gao).
The *Nanjing: Chapter 42* states: The Spleen weighs two jin and three liang, is flat and wide three cun, long five cun, and contains half a jin of San Gao (loose pancreas/fatty tissue).
The pulse conforming to the season is slow and moderate.
The Spleen belongs to Earth and prospers in the months of Chen, Xu, Chou, and Wei at the end of the four seasons. Specifically, eighteen days before Lichun, Lixia, Liqiu, and Lidong marks its seasonal indicator. Especially in the sixth month, Late Summer, it is in peak prosperity. Its pulse should resemble willow branches in the spring breeze—gentle, large, and slow—which indicates conformity to the season.
According to the *Renjing*, the Spleen pulse is large and slow. The Spleen combines with muscles; thus, the Spleen pulse travels along the muscles. The finger pressure for palpation should be equivalent to the weight of nine beans. Pressing until the muscle layer yields the pulse; if it feels like a gentle breeze brushing willow tips, it is a Slow (Huan) pulse. Applying slightly more force, the pulse channel becomes solid and large.
Loss of normality results in continuous swallowing sensations.
Xiong Zongli stated: In Summer, Stomach Qi is fundamental. If a string-taut and rapid pulse appears instead, resembling continuous swallowing, this is Liver Wood overcoming Spleen Earth, hence an inverse pulse. Zhang Shixian stated: "Qi" refers to pulse Qi. If pulse Qi resembles continuous swallowing, it is the Sparrow Pecking or Leaking Water pulse, seen in Spleen decline, hence termed "loss." Based on these two scholars' views, both interpret "Qi" as pulse Qi. However, Xiong's view originates from Luo Tianyi (referenced as Li Fan in text, likely a textual variant/error for Luo or Li Dongyuan's lineage), who stated that "continuous swallowing" describes a tight and rapid state, which may not be entirely correct. Why? From the perspective of the Spleen pulse being contrary to the season, it should be string-taut and rapid. What pulse is "continuous swallowing," sufficient to encompass the state of string-tautness and rapidity? In my opinion, "Qi" should be interpreted as "oral breath/spit."
According to the *Neijing: Xuanming Wuqi Pian*: Diseases caused by the five qi, the Spleen manifests as Swallowing (Yi/Qi reflux). Also, the *Zhenjing* states: Piercing the Spleen leads to death in ten days; its movement manifests as Swallowing. Thus, we know "Swallowing" refers to oral symptoms, not pulse characteristics. I once observed a patient with Spleen disease whose mouth constantly exhibited a continuous swallowing motion until death. This is what is meant.
According to the *Suwen: Yuji Zhenzang Lun*: The True Spleen pulse arrives weak, alternating between rapid and slow; the complexion is yellowish-green without luster; hair breaks and falls, indicating death.
Excess conditions dream of joy and song; deficiency conditions dream of fighting for food.
The *Suwen: Yinxie Famen* states: When Spleen Qi is excessive, one dreams of singing and joy, with a heavy body unable to move. When Jue Qi invades the Spleen, one dreams of hills, large marshes, ruined houses, wind, and rain. Also, the *Suwen: Fang Shengshuai Lun* states: Due to Spleen Qi deficiency, one dreams of insufficient food.
According to the *Zhongzang Jing*: When the Spleen is excess, one dreams of building walls and houses; when flourishing, one dreams of singing and joy; when deficient, one dreams of insufficient food. When Jue evil invades the Spleen, one dreams of large marshes, hills, wind, rain, and ruined rooms.
Excess dampness leads to the five types of diarrhea; intestinal rumbling sounds like rushing thunder.
The Spleen governs Dampness; excessive dampness leads to diarrhea. The *Nanjing: Chapter 57* asks: How many types of diarrhea are there? Do they have names? The answer is: There are five types of diarrhea, with different names. There is Stomach Diarrhea, Spleen Diarrhea, Large Intestine Diarrhea, Small Intestine Diarrhea, and Da Xia Diarrhea (also called Houzhong/Tenesmus).
Stomach Diarrhea symptoms: Undigested food, yellow stool.
Spleen Diarrhea symptoms: Abdominal fullness and distension, profuse diarrhea, vomiting and regurgitation immediately after eating.
Large Intestine Diarrhea symptoms: Urgency after eating, white stool, severe intestinal pain and rumbling.
Small Intestine Diarrhea symptoms: Painful urination accompanied by pus and blood in stool, lower abdominal pain.
Da Xia Diarrhea symptoms: Tenesmus (urgent need to defecate but difficulty passing), frequent trips to the toilet without success, pain in the urethra. These are the methods/classifications of the five diarrheas. The *Maijing* states: Patients with Spleen disease, when deficient, experience abdominal distension, intestinal rumbling, loose stools, and undigested food. Treatment involves selecting blood points of the Foot-Taiyin, Foot-Yangming, and Foot-Shaoyin meridians.
Pi Qi develops into an accumulation in winter; skin turns yellow, limbs feel heavy and dizzy.
The *Nanjing: Chapter 56* states: The accumulation of the Spleen is named Pi Qi. Located in the epigastrium, covering a large area like a plate. If not cured for a long time, it causes the limbs to become useless, jaundice, and prevents food from transforming into flesh/muscle. It occurs on Ren and Gui days in Winter. Why? Because Liver disease transmits to the Spleen, and Spleen disease transmits to the Kidney. The Kidney is prosperous in Winter; prosperous organs do not accept pathogenic factors. The Spleen attempts to return the pathogen to the Liver, but the Liver refuses to accept it. Thus, it remains and forms an accumulation. Therefore, we know Pi Qi is acquired on Ren and Gui days in Winter.
Weighing two jin and fourteen liang, capacity of three dou and five sheng.
The *Nanjing: Chapter 42* states: Regarding the length of human intestines and stomach and their capacity for water and grain: The Stomach is one chi five cun wide, two chi six cun long, curved to hold three dou and five sheng of water and grain. It usually retains two dou of grain and one dou five sheng of water. It also states: The Stomach weighs two jin and fourteen liang, winding and curving, two chi six cun long, one chi five cun wide, five cun in diameter, holding two dou of grain and one dou five sheng of water. Zhang Shixian notes: This verse discusses the Spleen but includes the Stomach because the Spleen and Stomach are connected.