1. The Spleen Governs Transformation and Transportation

1. The Spleen Governs Transformation and Transportation

The TCM concept of the spleen governing transformation and transportation is broadly related to modern medical concepts such as digestion, absorption, gastrointestinal motility, and metabolic systems.

(1) The Spleen and Digestion

When the spleen fails to properly transform and transport, digestion becomes poor and appetite decreases. Some researchers have used salivary amylase activity as an indicator, finding that in patients with spleen deficiency, salivary amylase activity significantly decreases under effective load (acid stimulation), whereas in healthy individuals it increases^⑨^. Others have found that patients with stomach pain and spleen deficiency have significantly lower basal acid output (BAO) and peak acid output (PAO) compared to healthy people^⑩^. Some have measured gastric proteinase activity in 24-hour urine of chronic gastritis patients with spleen deficiency symptoms, finding it unchanged from normal^⑪^. The Beijing Municipal Institute of Traditional Chinese Medicine measured salivary amylase activity in patients with spleen deficiency and found it significantly lower than normal, preliminarily indicating that pancreatic amylase secretion in patients with spleen deficiency is impaired^⑫^. Some have conducted pancreatic function tests on patients with spleen deficiency, finding that trypsin secretion is also impaired^⑬^.

From the above experimental studies, it can be seen that whenever spleen qi is deficient and transformation and transportation are impaired, salivary amylase secretion, basal and peak gastric acid secretion, salivary amylase activity, pancreatic amylase secretion, and trypsin function all decrease below normal levels. This shows that the TCM concept of "spleen transformation and transportation impairment" essentially involves a reduction in various digestive secretory functions.

(2) The Spleen and Absorption

In addition to the reduction in various digestive enzyme secretions, the TCM concept of "spleen transformation and transportation impairment" also includes changes in gastrointestinal absorption. Some domestic institutions have used xylose excretion rate as an indicator to study the small intestinal absorption status of patients with spleen deficiency. The Beijing Municipal Institute of Traditional Chinese Medicine found that children with rickets and children prone to respiratory diseases who exhibit spleen deficiency symptoms have lower xylose excretion rates than normal. After spleen-strengthening treatment, as the spleen deficiency symptoms improve, xylose excretion rates also return to normal^⑫^. Some have repeated the above experiment on adults with spleen deficiency symptoms, with the same results^⑭^. Some have conducted pathological observations on gastric tissue removed from patients with spleen deficiency, finding that the regeneration of gastric mucosal epithelial cells is enhanced, while the process of differentiation into mature cells is hindered^⑮^. Some have conducted pathological observations on duodenal biopsy tissues of patients with chronic gastritis and peptic ulcers who exhibit spleen deficiency symptoms, finding that the mucosal villi are flattened, many are damaged, and tiny villi are sparse and easily shed^⑯^.

(3) The Spleen and Gastrointestinal Motility

The concept of "spleen transformation and transportation impairment" also involves changes in gastrointestinal motility. Patients with spleen deficiency typically experience belching, acid reflux, bloating, and loose stools. TCM considers these symptoms as evidence of impaired ascending and descending movement of the spleen and stomach—what is referred to as "impaired ascending and descending movement" is essentially "impaired spleen transformation and transportation." Some have used barium meal X-ray fluoroscopy to find that most patients with spleen deficiency have reduced gastrointestinal peristalsis and prolonged gastric emptying time^⑰^. Others have used surface gastric electrical wave indicators to find that patients with spleen deficiency have lower amplitude of surface gastric electrical waves, a phenomenon that is very obvious whether fasting or after eating. After spleen-strengthening and qi-replenishing treatment, this situation quickly improves^⑱^. Some have used ^131^I isotope tracing to observe gastrointestinal emptying function, finding that patients with tumor-related spleen deficiency have significantly faster gastrointestinal emptying speeds than patients without tumor-related spleen deficiency and normal individuals, and that taking spleen-strengthening and qi-replenishing medicines can improve this situation^⑲^.

(4) The Spleen and Metabolism

The concept of "spleen transformation and transportation impairment" also includes disruptions in the metabolic processes of nutrients. Some have found that patients with atrophic gastritis and superficial gastritis who exhibit spleen deficiency symptoms have lower serum isocitrate dehydrogenase activity than normal (P<0.01). After treatment with Xiang Sha Liu Jun Zi Tang, activity increased, though there was a significant difference before and after treatment, it still did not reach normal levels^⑳^. These patients' serum

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The activity of lactate dehydrogenase is also lower than normal; after treatment with Xiangsha Liujunzi Decoction, the enzyme activity significantly increased. Some researchers have observed that in patients with epigastric pain due to spleen deficiency, the average number of subcellular mitochondria per unit area of gastric mucosa is markedly reduced. At the same time, subcellular mitochondria in these patients exhibit swelling, membrane defects, and cristae rupture^㉑^. Mitochondria are organelles responsible for the biological oxidation of nutrients within cells; they contain enzymes necessary for oxidative processes. Therefore, studying the morphology and function of cellular mitochondria in patients with spleen deficiency is highly meaningful for exploring the essence of spleen deficiency.