3.2 Zang Organ Patterns II: Spleen, Liver, and Kidney

3.2 Zang Organ Patterns II: Spleen, Liver, and Kidney

Quick Answer: The Spleen transforms and transports food and fluids, raises clear Qi, and holds Blood in the vessels; its key patterns are Qi deficiency, Yang deficiency, Qi sinking, failure to control Blood, and Cold-Damp or Damp-Heat invasion. The Liver stores Blood and ensures the smooth flow of Qi; its key patterns are Qi stagnation, Blood and Yin deficiency, Liver Fire, Liver Yang rising, and the four types of internal Liver Wind. The Kidney stores Jing, governs water, and grasps Qi; its key patterns are Yang deficiency (with or without water overflowing), Yin deficiency, Jing deficiency, Kidney Qi not firm, and Kidney failing to grasp Qi.

This section continues the Zang organ review from Section 3.1 (Heart and Lung). For each organ, learn the functions first, because every pattern is a failure of a specific function. A Spleen that cannot raise Qi produces prolapse; a Kidney that cannot grasp Qi produces breathlessness on inhalation. On the FOM exam, the deciding clue is usually one function-specific sign combined with the tongue and pulse.

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3. Spleen (Pi) - The Granary Official

The Spleen is designated the Granary Official (Cang Lin Zhi Guan) in the Su Wen, serving as the foundation of Post-Heaven Essence (Hou Tian Zhi Ben) and the primary manufacturing factory for Qi and Blood.

Primary Physiological Functions

• Governs Transportation and Transformation (Yun Hua): Operates as the central digestive engine. It transforms ingested food into Grain Qi (Gu Qi) and separates usable fluids from turbid waste. The Spleen dislikes dampness and likes dryness (Xi Zao E Shi).
• Controls Blood (Pi Tong Xue): Spleen Qi keeps Blood circulating securely within the vascular pathways, preventing extravasation. When Spleen Qi is deficient, it fails to hold Blood, leading to chronic hemorrhages.
• Dominates the Muscles and the Four Limbs (Zhu Ji Rou Si Zhi): Spleen distributes Gu Qi and fluids to muscular tissues. Abundant Spleen Qi creates firm muscle mass, physical vitality, and motor stamina. Spleen deficiency results in muscular atrophy, heavy limbs, and chronic fatigue.
• Raises Qi (Pi Zhu Sheng Qing): The natural directional movement of Spleen Qi is upward (Sheng). It ascends clear nutrients to the Heart, Lung, and head, and holds internal organs in their proper anatomical positions. When Spleen Qi sinks (Pi Qi Xia Xian), organ prolapse occurs.
• Opens into the Mouth (Kai Qiao Yu Kou) and Manifests in the Lips (Rong Zai Chun): Normal Spleen Qi enables sharp taste perception and moist, plump, red, lustrous lips. Spleen deficiency produces a flat or sweet sticky taste in the mouth and pale, dry, cracked lips.
• Controls Saliva (Xian): The fluid of the Spleen is thin, clear saliva (Xian), which moistens the oral cavity and assists digestion.

Spleen Pattern Differentiations

A. Spleen Qi Deficiency

• Core Manifestations: Poor appetite (Na Dai), dull abdominal distension after eating, fatigue and lassitude (Shen Pi Fa Li), loose stools (Da Bian Tang Xie), weak limbs, and a pale, sallow complexion.
• Tongue: Pale or normal body, tooth-marked edges (Chi Hen), thin white coating.
• Pulse: Weak (Ruo) or Empty (Xu), particularly at the right Guan position.
• Treatment Principle: Tonify Spleen Qi and strengthen transformation and transportation.

B. Spleen Yang Deficiency

• Core Manifestations: Spleen Qi deficiency symptoms plus internal cold signs: pronounced physical coldness, cold extremities, dull abdominal pain that improves with warmth and manual pressure, watery diarrhea with undigested food particles (Wan Gu Bu Hua), and pitting edema of the lower extremities.
• Tongue: Pale, swollen, wet body with teethmarks and a moist white coating.
• Pulse: Deep (Chen), slow (Chi), and weak (Ruo).
• Treatment Principle: Warm Spleen Yang, dispel interior Cold, and tonify Qi.

C. Spleen Qi Sinking (Zhong Qi Xia Xian)

• Etiology: Long-standing Spleen Qi deficiency exacerbated by heavy physical lifting, chronic standing, or multiple child deliveries.
• Core Manifestations: Spleen Qi deficiency symptoms combined with a prominent bearing-down sensation in the lower abdomen, prolapse of the stomach (gastroptosis), uterus, rectum, or urinary bladder, frequent urgency to urinate, and chronic watery diarrhea.
• Tongue: Pale, swollen body with teethmarks.
• Pulse: Weak (Ruo), sunken, and soft.
• Treatment Principle: Tonify Spleen Qi and raise sunken Yang (Bu Zhong Yi Qi).

D. Spleen Failing to Control Blood (Pi Bu Tong Xue)

• Etiology: Severe, chronic Spleen Qi deficiency failing to hold blood within the vascular bed.
• Core Manifestations: Chronic, recurrent, pale, watery hemorrhages: petechiae, purpura, blood in the stool (melena), hematuria, epistaxis, menorrhagia, or continuous metrorrhagia (Beng Lou). Accompanied by sallow pale face, fatigue, and loose stools.
• Tongue: Pale body, thin white coating.
• Pulse: Thready (Xi) and weak (Ruo), or hollow (Kou).
• Treatment Principle: Tonify Spleen Qi and restrain hemorrhage.

E. Cold-Damp vs. Damp-Heat Invading Spleen

• Cold-Damp Invading Spleen: Heavy fullness in the epigastrium and abdomen, poor appetite, cold feeling in stomach, feeling of heaviness in the limbs and head as if tightly wrapped in a wet towel (Tou Zhong Ru Guo), nausea, loose stools with mucus, absence of thirst. Tongue is pale, swollen, with a thick greasy white sticky coat; pulse is slippery and slow (Hua Chi) or soggy (Ru).
• Damp-Heat Invading Spleen: Epigastric and abdominal distension, nausea, vomiting, loose burning diarrhea with foul odor, jaundice (bright orange-yellow like a ripe tangerine), low-grade persistent fever not relieved by sweating, bitter sticky taste, dark scanty urine. Tongue is red with a thick greasy yellow coating; pulse is slippery and rapid (Hua Shu) or soggy-rapid (Ru Shu).

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4. Liver (Gan) - The General

The Liver is designated the General of an Army (Jiang Jun Zhi Guan) in the Su Wen, responsible for tactical planning, strategic movement, and maintaining uninhibited physiological flow.

Primary Physiological Functions

• Stores Blood (Cang Xue): Regulates circulating blood volume based on rest and physical exertion. During rest and sleep, blood retreats to the Liver; during physical exertion, it surges into the peripheral muscles and channels. It also supplies blood to the eyes, sinews, and uterus for normal menses.
• Ensures the Smooth Flow of Qi (Shu Xie): The most dynamic function of the Liver. It regulates four major physiological domains:
  1. Emotional Balance: Smooth Qi flow produces a relaxed, uninhibited emotional state. Stagnation produces depression, frustration, and sighing; hyperactive rebellion produces anger and rage.
  2. Digestive Harmony: Facilitates the Spleen ascending clear Qi and Stomach descending turbid Qi.
  3. Bile Secretion: Controls the secretion and excretion of bile from the Gallbladder into the intestines.
  4. Menstrual Regulation: Coordinates the timing, volume, and pain-free discharge of the menstrual cycle.
• Controls the Sinews (Zhu Jin) and Manifests in the Nails (Rong Zai Zhao): The Liver moistens and nourishes tendons, ligaments, and connective tissue. Abundant Liver Blood provides flexibility and prevents cramping. Nails are considered the surplus of the sinews (Jin Zhi Yu); healthy nails are smooth, pink, and strong, whereas deficient Blood produces brittle, pale, ridged nails.
• Opens into the Eyes (Kai Qiao Yu Mu): Visual acuity, color perception, and ocular moisture rely on Liver Blood and Yin. Deficiency causes dry eyes, blurred vision, floaters, and night blindness; Liver Fire causes red, painful, bloodshot eyes.
• Controls Tears (Lei): Tears are the fluid of the Liver, providing physiological lubrication to the eyes.

Liver Pattern Differentiations

A. Liver Qi Stagnation (Gan Qi Yu Jie)

• Core Manifestations: Distension and fluctuating pain in the hypochondrium, chest, epigastrium, or lower abdomen; frequent sighing (Tai Xi); emotional irritability, mood swings, or melancholy; sensation of a foreign body in the throat that cannot be swallowed or coughed up (Plum-Pit Qi / Mei He Qi); premenstrual breast distension; irregular menses; and dysmenorrhea.
• Tongue: Normal body color or slightly red on the lateral margins, thin white coating.
• Pulse: Wiry (Xian), particularly at the left Guan position.
• Treatment Principle: Soothe the Liver, regulate Qi, and relieve stagnation.

B. Liver Blood Deficiency vs. Liver Yin Deficiency

• Liver Blood Deficiency: Dizziness, blurred vision, vitreous floaters, night blindness, numbness or tingling in the limbs, muscle spasms and tendon cramps, pale brittle ridged nails, scanty menses or amenorrhea, and a pale sallow complexion. Tongue is pale, especially on the lateral sides, with a thin dry coat; pulse is thready (Xi) or choppy (Se).
• Liver Yin Deficiency: Includes Liver Blood deficiency signs plus internal Empty Heat: dry burning eyes, photophobia, burning hypochondriac pain, five-palm heat, malar flush, night sweats, and dry mouth. Tongue is red, peeled, without coating; pulse is wiry, thready, and rapid (Xian Xi Shu).

C. Liver Fire Blazing vs. Liver Yang Rising

• Liver Fire Blazing (Full Fire / Excess Heat): Severe throbbing temporal headache, red face, bloodshot injected eyes, extreme irritability, violent outbursts of rage, roaring tinnitus like ocean waves or sudden deafness, bitter taste in mouth, hematemesis, epistaxis, dark urine, and dry constipation. Tongue is red with dark red margins and a dry yellow coating; pulse is wiry, rapid, and forceful (Xian Shu Shi).
• Liver Yang Rising (Deficiency Below, Excess Above): Rooted in Liver and Kidney Yin deficiency failing to anchor Yang. Throbbing headache at the temples or vertex, dizziness, high-pitched tinnitus, irritability, propensity to outbursts, blurred vision, insomnia, and a distinct sensation of heaviness in the head with weakness in the legs ("top-heavy, bottom-light"). Tongue is red, particularly on the edges; pulse is wiry and forceful at the left Guan, but thready and weak at the Chi position.

D. Liver Wind Moving Internally (Four Etiologies)

Internal Liver Wind (Gan Feng Nei Dong) is characterized by sudden, involuntary, shifting neurological manifestations: tremors, convulsions, tics, spasms, deviations, and paralysis.

1. Extreme Heat Generating Wind (Re Ji Sheng Feng): High fever, neck rigidity (stiff neck), lockjaw, opisthotonos, upward-staring eyes, violent convulsions, delirium, coma. Tongue: Deep red, stiff, dry yellow coat. Pulse: Wiry, rapid, and forceful.
2. Liver Yang Transforming into Wind (Gan Yang Hua Feng): Sudden collapse, loss of consciousness, facial deviation, hemiplegia, slurred speech or aphasia, severe dizziness, numbness. This is the classic presentation of Wind-Stroke (Zhong Feng). Tongue: Stiff, deviated, red body with a thick coat. Pulse: Wiry, long, rapid.
3. Liver Blood Deficiency Generating Wind (Xue Xu Sheng Feng): Numbness of the extremities, muscle twitching, fasciculations, mild tremors of the hands and feet, facial tics, blurred vision. Tongue: Pale, thin body. Pulse: Thready (Xi) and slightly wiry.
4. Liver/Kidney Yin Deficiency Generating Wind (Yin Xu Sheng Feng): Chronic, continuous fine tremors of the limbs, head nodding, low-grade afternoon fever, night sweats, severe dizziness. Tongue: Red, peeled, cracked body. Pulse: Thready, rapid, floating-empty.

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5. Kidney (Shen) - The Imperial Ancestor

The Kidney is designated the Minister of Health and Vigorous Effort (Zuo Qiang Zhi Guan) in the Su Wen, housing the Pre-Heaven Essence (Xian Tian Zhi Ben) and providing the physiological foundation of all Yin and Yang in the body.

Primary Physiological Functions

• Stores Jing (Essence) and Governs Growth, Development, and Reproduction: Kidney Jing controls biological milestones from conception to puberty (Tian Gui), sexual maturation, fertility, conception, gestation, and aging. Depletion leads to developmental delays, premature senility, and infertility.
• Governs Water Metabolism (Zhu Shui): Termed the Gate of the Stomach and Lower Source of Water. Kidney Yang warms and vaporizes fluids, powering the Urinary Bladder's transformation (Qi Hua) into urine while sending clear vapor upward to moisten the Lung.
• Controls the Reception of Qi (Zhu Na Qi): The Kidney anchors clear Qi inhaled by the Lung. Respiration requires both Lung descending and Kidney grasping. When Kidney fails to grasp Qi, dyspnea and shallow breathing occur, particularly with difficulty inhaling.
• Governs the Bones and Generates Marrow (Zhu Gu Sheng Sui): Kidney Jing produces Marrow, which fills bone cavities, nourishes the spinal cord, and converges in the cranium to form the Sea of Marrow (Sui Hai—the Brain). Teeth are considered the surplus of the bones (Chi Wei Gu Zhi Yu).
• Controls the Two Lower Orifices (Si Er Yin): Governs the anterior orifice (urethra and genitalia—urination and ejaculation/menses) and the posterior orifice (anus—defecation).
• Opens into the Ears (Kai Qiao Yu Er) and Manifests in the Head Hair (Rong Zai Fa): Acute hearing depends on Kidney Jing; deficiency causes high-pitched cicada-like tinnitus or gradual deafness. Head hair vitality depends on Kidney Jing and Blood; deficiency causes premature graying, thinning, and alopecia.
• Houses the Willpower (Zhi): Governs mental stamina, determination, focus, and drive.

Kidney Pattern Differentiations

A. Kidney Yang Deficiency vs. Water Overflowing

• Kidney Yang Deficiency: Severe soreness, weakness, and coldness in the lumbar spine and knees (Yao Xi Suan Ruan); cold limbs; aversion to cold; pale dull complexion; impotence, premature ejaculation, low libido, or female infertility; clear, abundant, frequent urination or nocturia; and loose stools at dawn.
  • Tongue: Pale, swollen, wet body with a white coating.
  • Pulse: Deep (Chen), weak (Ruo), and slow (Chi), especially at the right Chi position.
• Kidney Yang Deficient Water Overflowing: Severe systemic edema starting in the ankles and lower legs, pitting edema, abdominal distension (ascites), breathlessness when lying down, palpitations, oliguria, cold extremities. Tongue is pale, extremely swollen, wet with teethmarks; pulse is deep, slow, and thready.

B. Kidney Yin Deficiency

• Core Manifestations: Soreness and weakness of the lower back and knees, dizziness, high-pitched tinnitus like cicadas, insomnia with excessive dreaming, five-palm heat, afternoon tidal fever, night sweats, dry mouth and throat at night, malar flush, nocturnal emissions with erotic dreams, premature ejaculation, oliguria with dark yellow urine, and dry hard constipation.
• Tongue: Red body, peeled coating (or completely stripped mirror tongue), fine cracks.
• Pulse: Thready (Xi) and rapid (Shu), or floating-empty (Fu Xu).
• Treatment Principle: Nourish Kidney Yin and clear Empty Heat.

C. Kidney Jing Deficiency

• Pediatric Signs: Failure to thrive, delayed motor/speech development, delayed fontanelle closure, softened skull/bones, intellectual disability.
• Adult Signs: Premature graying or loss of hair, loose teeth, severe brittle bones, dementia, cognitive decline, memory impairment, profound deafness, sterility, severe oligospermia, or amenorrhea.
• Tongue: Pale, peeled, or small flaccid red body.
• Pulse: Weak, hollow, or thready.

D. Kidney Qi Not Firm vs. Kidney Failing to Grasp Qi

• Kidney Qi Not Firm (Shen Qi Bu Gu): Failure of the lower gate to seal. Enuresis, frequent dribbling urination, urinary incontinence, nocturia, spermatorrhea without dreams, premature ejaculation, clear copious vaginal discharge, and recurrent habitual miscarriage. Tongue is pale; pulse is deep and weak (Chen Ruo).
• Kidney Failing to Grasp Qi (Shen Bu Na Qi): Failure to root inhaled air. Severe shortness of breath aggravated by slight exertion, difficulty inhaling more than exhaling, rapid shallow breathing, spontaneous cold sweating on exertion, cold extremities after effort, and lumbar soreness. Tongue is pale; pulse is deep, weak, and thready (Chen Ruo Xi).