TREATISE on the SPLEEN and STOMACH:
A book review by Z’ev Rosenberg, L. Ac.
The greatest influences on my practice of Chinese medicine have been, in acupuncture, the Nan Jing, and in internal medicine, the Pi wei lun/Treatise on the Spleen and Stomach. I first discovered this text some twelve years ago, when the first edition was published by Blue Poppy Press as part of it’s “Great Masters Series”. This was soon followed by two texts by another great Jin-Yuan Dynasty physician, Zhu Dan-xi, “ Dan xi xin fa/The Heart and Essence of Dan-xi’s Methods of Treatment”, and Ge zhi yu lun/Extra Treatises Based On Investigation and Inquiry”. Descendents of this school practice what is now called “Li-Zhu Medicine”. I humbly consider myself a practitioner of this school of thought.
So, how did I come to this approach to Chinese medicine, and why is it so important to me? Let me share a little about my own evolution in Chinese medicine, which I’ve now been involved with in one form or another for over thirty years.
My background in Chinese medicine began in my teens when I discovered the Yi Jing, macrobiotics, shiatsu massage, and tao yin (do-in, self-massage techniques). Macrobiotics was based on yin-yang and five phase theory (although an idiosyncratic version of these theories), and taught that eating a balanced diet based on grains and vegetables was the foundation of good health. Macrobiotics also taught that digestion was the root of health and disease. The macrobiotic teachings were passed to Michio Kushi and Herman Aihara by their teacher, Georges Ohsawa, who also was one of the first teachers of acupuncture in the West (he taught with Georges Soulie de Morant in Paris in the 1950’s). George Ohsawa listed Sagen Ishizuka and an 18th century physician, Ekiken Kaibara, as his own inspirations in the development of macrobiotics.
In one of my many visits to Boston in the 1960’s and 70’s, I went to Tao (later Redwing) Bookstore, which was perhaps the first ‘alternative medicine’ bookstore in America. I found a copy of Yojokun, by Ekiken Kaibara, for $1.95 there, and devoured it. From reading this work, I was able to envision the type of practice I wanted to do for a living, based on dietary and lifestyle counseling, herbal medicine, and acupuncture, which was Kaibara’s trade. He was also a Neo-Confucianist scholar, clearly influenced by the teachings of Li Dong-yuan and Zhu Dan-xi.
Later on, when the first English version of the Treatise on the Spleen and Stomach was released, I recognized the connection between the bu tu pai/Supplement Earth School” and macrobiotics, and was overjoyed. This text provided the unifying principle to bring together everything I had learned and wanted to practice in a unified way. In addition, through articles by Bob Flaws and Chip Chace, and the later text, Golden Needle Wang Le-ting (published by Blue Poppy Press), I was able to learn an approach to acupuncture/moxabustion that was also based on the teachings of Li Dong-yuan (who was also an accomplished acupuncturist, not very common among the great historical Chinese physicians).
The first edition of the Treatise was adequately translated for the era (the early 90’s), but quite obscure in parts. I noted to Bob Flaws and Honora Wolfe my opinion that the text needed commentaries to illuminate some of the more difficult material so that more people could appreciate the often obscure contents of the text. As my Chinese skills slowly improved, I started collecting Chinese language copies of Li Dong-yuan’s writings, including a gift of his complete works from Miki Shima.
Happily, Blue Poppy Press have released a new translation of the Treatise on the Spleen and Stomach, this time by Bob Flaws, along with his own commentary/annotations. This includes voluminous case histories translated from modern Chinese medical journals that apply Li Dong-yuan’s prescriptions to the treatment of modern complex illnesses.
So, why a new translation? As our profession matures, we have learned a few lessons about English language Chinese medical texts. The first is the need for a standard terminology, based on Nigel Wiseman and Feng Ye’s Clinical Dictionary of Chinese Medicine. The first Blue Poppy translation of the Treatise on the Spleen and Stomach was done primarily by Yang Shou-zhong, a Chinese scholar of medicine. He did a fine job, but there were problems with occasional obscure use of English. In translation work, it is important to involve native speakers of the target language. In fact, a native speaker of English with the ability to read medical Chinese is usually the best choice, alternately a translation team of Western and Chinese authors together. This is because the nuances of the English language need to be understood in order to make sense. It goes without saying that translating an advanced Chinese medical text is not an easy undertaking.
Bob Flaws takes this version of the Treatise on the Spleen and Stomach even further, by writing perhaps the first comprehensive commentary by a Western author on a seminal Chinese medical text. In order to do this, he had to consult existing commentaries in Chinese, find Chinese language research articles, and work with yin fire theory for the past fifteen years and have both intellectual and clinical familiarity with it.
So what is so special about yin fire or spleen-stomach theory?
First of all, Li Dong-yuan was the first prominent Chinese physician to focus on internal causes of disease, especially the effects of poor diet, irregular eating, and imbalanced emotions on health. Previously, the main influence on Chinese internal medicine literature was the Shang Han Lun, which focused on external causes of disease. Many internal or ‘miscellaneous disorders’ are chronic and complex, and require different strategies in order to heal them than disease of external origin.
Secondly, Li Dong-yuan developed strategies for the treatment of multi-pattern diseases. By multi-pattern, I mean complex disorders with several concurrent zang-fu patterns that interact with each other to produce enduring disease. If one tries to treat only one pattern or aspect of the disease, it tends to recur or not be resolved.
Thirdly, by recognizing debilitation of the spleen and stomach as the root of many disorders, and the need to address this factor, he was able to develop core strategies for many herbal prescriptions, dietary recommendations and acupuncture/moxabustion treatments that could rectify both root and branch of disorders.
Finally, the theory of yin fire. Yin fire is a type of damp heat that develops in the interior from the spleen’s inability to separate and raise the clear yang and descend the turbid yin. When the spleen and stomach are debilitated, the defensive qi cannot protect the body from exterior evils. Bob Flaws says in his commentary (pg. 86), “because the spleen is the latter heaven root of the engenderment and transformation of the qi and the source of both the defensive and constructive, the defense qi becomes vacuous and insufficient and fails to secure the exterior. Thus, external evils are easily contracted and, once contracted, are difficult to thrust out from the body again. This helps explain why patients suffering from yin fire often have lowered immunity.”
Yin fire theory can provide comprehensive treatment strategies for a wide range of autoimmune disorders, including allergies, metabolic disorders, obesity, rheumatoid arthritis, multiple sclerosis, lupus, skin diseases and other functional disorders. Li Dong-yuan’s teachings were adapted by the author of a major classic work in gynecology, Fu qing zhu nu ke/Fu Qing-zhu’s Gynecology (also translated and published by Blue Poppy Press), and Sun Bing-yin’s recent work in treating cancer.
My only criticism of this translation and commentary is a small one. While I agree with Bob that much of the material on stems and branches calculation is obscure, and possibly inaccurate, I think that we should not ignore the potential of chrono-biological treatment, i.e. medical treatment based on time of day, month, season, or circadian rhythms. Chinese authors from the time of Wang Bing’s version of the Su Wen wrote about this in depth. In my opinion, this is one of the great strengths of Chinese medicine, especially in designing acupuncture/moxabustion treatments.
In conclusion, I feel this version of the Treatise on the Spleen and Stomach is one of the most important and superior translations of a Chinese medical text to appear in English so far. I hope it will inspire others in their study and practice as it has in mine.
1 Treatise on the Transmutation of Vacuity & Repletion of the Spleen
2 Diagram of Upbearing & Downbearing, Upfloating & Sinking,
Supple-mentation & Drainage of the Visceral Qi in Different Seasons
3 Treatise on the Waxing & Waning of the Spleen & Stomach
4 Treatise on the Lungs In Relation to Spleen & Stomach Vacuity
5 The Rule Concerning the Sovereign, Minister, Assistant, & Envoy
6 Composing Formulas in Light of the Channels and In Accordance
7 Treatise on Medicinal Indications & Prohibitions
8 The Spleen & Stomach According to Zhongjing's Quotations from
the Nei Jing
1 Diagrams & Explanations on the Waxing & Waning of the Movement
2 Treatise on the Initiation of Heat in the Center Due to Damage by
Food & Drink and Taxation Fatigue
3 Diseases in Different Seasons Due to Spleen & Stomach Vacuity
Weakness and Formula Composing According to Different Diseases
4 Treatise on the Use of Qing Shu Yi Qi Tang in Case of the Stomach
Troubled Particularly Profoundly by Damp Heat in Long Summer
5 Rules for Modifying Medicinals in Different Seasons
6 Treatise on Intestinal Pi with Blood in Stools
7 Treatise on the Prohibition of Unwarranted Use of Ejecting Medicinals
in Spleen & Stomach Vacuity
8 Treatise on Quieting & Nurturing the Heart Spirit and Regulating & Treating the Spleen & Stomach
9 The Necessity of Enquiring About Inclinations Before Treating
10 Treatise on the Downsliding of Stomach Qi and Consequent Simulta-neous Arising of Various Diseases
11 Yin Disease Treated through Yang, Yang through Yin
12 Debilitation & Effulgence of the Original Qi of the Triple Burner
1 Treatise on Ascription of the Large Intestine, Small Intestine, & Five Viscera All to the Stomach and Stomach Vacuity Leading to Disease of Them All
2 Treatise on Spleen & Stomach Vacuity Being Responsible for Blockage of the Nine Portals
3 Treatise on the Viscera & Bowels, Channels & Connecting Vessels Having Nowhere from Which to Receive Qi (thus) Contracting Disease When the Stomach is Vacuous
4 Treatise on the Generation of Various Diseases Due to Stomach Vacuity & Insufficient Original Qi
5 Treatise on Weight Gained at One Time & Lost at Another
6 Treatise on the Laws of Engendering & Killing of Yin & Yang in Heaven
7 Treatise on Yin and Yang, Longevity & Premature Death
8 Treatise on the Intricate Changes of the Qi of the Five Viscera
9 Treatise on the Ascension & Descension of Yin & Yang
10 Experiences in Regulating & Rectifying the Spleen & Stomach
Treatise on Inadvertent Detriment Due to Mistakes Out of Ignorance
in the Use of Upbearing & Downbearing, Upfloating & sinking Treatment Methods in Medication
11 Treatise on the Yang Ming Disease of Overwhelming Dampness & Spontaneous Sweating
12 Treatise on Damp Heat Developing into Atony and Lung Metal Being Subjected to Evils
13 Treatise on Dietary Damage of the Spleen
14 Treatise on Damage Due to Excessive Drinking of Wine
15 Detriment to the Spleen & Stomach Warrants A Balanced Diet and Moderation in Cold & Hot (Foods)
16 Methods for Nurturing & Rectifying the Spleen & Stomach
Keeping Desires at a Distance
Admonition on Economy of Speech