Macrobiotics and Chinese Medicine II: Liver/Spleen Disharmonies


In the last issue, we pointed out how an oversimplified macrobiotic use of the yin/yang dialectic often leads to problems, such as the inability to discriminate between conditions of yin deficiency and excess yang. This discussion will focus on Liver/Spleen disharmonies, which are very frequently seen disorders that macrobiotic people also more often than not misdiagnose as "too yang" and treat inappropriately. More specifically, we will be discussing a condition known as "Liver Depression, Spleen Deficiency." Sometimes this pattern is also simply referred to as "Liver stagnation."


Liver/Spleen disharmonies are commonplace both inside and outside of the macrobiotic community, and for the most part, they go untreated for years. To the best of my knowledge, there are no comprehensive or effective treatments for this pattern outside of Traditional Chinese Medicine. Typical signs and symptoms of Liver/Spleen disharmonies are: digestive disturbances such as belching, acid reflux, bloating, gas, irregular bowel movements, pain under the ribs, menstrual irregularities, breast distention, breast lumps, fatigue, loose stool, dizziness, vertigo, headaches, alternating feelings of hot and cold, cold hands and feet, depression, anxiety, dry mouth and throat, bitter taste in the mouth, insomnia, impatience, irritability and quickness to anger, frequent dreams, and dark circles under the eyes. The pulse is usually wiry, tight, thin, or weak, and the tongue tends to be either dark red or dark and pale. A person would rarely possess all or even most of these symptoms. Even if one or two are present, that is usually sufficient to confirm a diagnosis if the tongue and pulse indications also fit the pattern.

From a biomedical point of view, this pattern can give rise to such Western named diseases as hepatitis, chronic gastritis, peptic ulcer, hypoglycemia, functional uterine bleeding, menopausal syndrome, pelvic inflammatory disease, fibrocystic breasts, neurasthenia, PMS, hysteria, and neurosis. Looking at the above list, we can see that Liver/Spleen disorders manifest mainly in the nervous system, digestive system, and female reproductive system.

A brief explanation of some Chinese Medicine theory will help us to understand this condition. According to ancient Taoist science, our bodies are a microcosm of the universe. If we can accurately understand ourselves, we can understand everything. Like everything else in the universe, the human body is composed of and governed by the dynamic interaction of yin and yang. That part of us which is yin is dense and heavy, and is best represented by the concepts of substance, water, or flesh. That part of us which is yang is light and moving, and is best represented by the concepts of qi, fire, or spirit. In Chinese Medicine theory, that function in the human body which is responsible for opening the dense yin so that qi can suffuse through it, animate it, and then drain waste materials out -- is called the Liver function, and its operations are known as "coursing and draining." Without this coursing and draining, our bodies would get more and more dense until we became inert, or dead.

Liver depression, or Liver stagnation, exists when this function is either disrupted or inhibited. The coursing and draining become either sluggish and ineffective, or hyperactive and chaotic. Nutrients are neither delivered on time nor to their proper destinations. Waste materials and fluids build up in the cells and are not discharged and eliminated.


In Chinese Medicine, the Liver is not the same as the Western anatomical liver organ. Likewise, the Chinese Spleen is not the same as the spleen organ. Because we are limited by space, a complete explanation and description of these TCM technical terms is not possible; so for our purposes here, we will just say that the Chinese Liver is mainly associated with the nervous system, the circulation, and the emotions, whereas the Chinese Spleen is associated with all of the organs, glands, and bodily functions which are directly responsible for digestion (with the exception of the Stomach.)

Liver/Spleen disharmonies exist when the correct relationship between these two organ systems is damaged by either internal pathologies or invading external forces. This relationship is so important that when it breaks down, literally hundreds of diseases and symptoms can result, from ulcers to menstrual problems to cancer.


For the most part, the standard macrobiotic diet, augmented by small amounts of animal food, is a good, healthy diet for strengthening the Spleen and keeping the Liver in a natural balance. However, if people eat too many raw fruits and vegetables, gummy flour products and greasy foods, or if they drink too much fruit juice or too many iced drinks, they can easily damage the Spleen. Too much thinking and worrying, not eating regular meals, continually overworking and not getting enough rest can also damage the Spleen. When the Spleen is damaged, a Pandora's box of evil is let loose in the body. Fluids from food and drink are not transformed properly, and so they tend to build up internally as pathological substances known in Chinese Medicine as "dampness" or "mucous." These two unhealthy fluids inhibit the free flow of qi and Blood, which then further weaken an already injured Spleen.

The Spleen is the source of generation and transformation. (Pi wei sheng hua zhi yuan.)( 1) Think of the implications of this statement. What we are talking about here is the biological transmutation of elements, an idea which has been a popular topic of discussion for many years in macrobiotic circles. But in the absence of a comprehensive literature -such as exists in Chinese Medicine -which explains how and why this takes place, the discussion always remains on an abstract level, with little or no practical application.


The Spleen should be able to transform anything we eat, within reason, into healthy human qi and Blood. Dietary rules and special foods become necessary only after some damage has occurred to this organ. And once the Spleen has been injured, every other organ and bowel in the body will be quickly affected.

The Liver needs Blood and it needs qi. Because of preexisting damage and weakness, many, if not most, macrobiotic people have trouble producing enough qi and Blood from their mostly vegetarian foods. Some would say, why not just eat more meat and solve the problem that way? This might work in a small percentage of cases, but not for the majority. Except for a few individuals who avoid eating meat exclusively for religious reasons or out of compassion for animals, most people who avoid it do so because they are already having some problem digesting it properly. Maybe they have noticed that it gives them bad breath, armpit or foot odor, or that it makes them slightly nauseous. These are indications that a weak Spleen function is not properly transforming and elevating the meat's heavy, greasy qualities, and so they are remaining in the body as pathological substances, causing all kinds of mischief. In my experience, even when there is weakness and obvious deficiency, it is usually better not to eat meat except in very small quantities until the digestive capabilities have been adequately strengthened.

Blood belongs to yin and qi belongs to yang. When the Liver is deficient in Blood, it has a relative excess of qi, or yang, and a deficiency of yin. This will cause the Liver function to become hyperactive and move in an unpredictable and frenetic manner. Depending upon the exact conditions of excess and deficiency, the metabolism can become either hyperactive or sluggish, or some combination of the two. Careful discrimination needs to be made to determine how to approach treatment. In any case, problems in the Liver will weaken the Spleen even further, causing or aggravating digestive complaints such as bloating, gas, and irregular bowel movements, or menstrual problems, headaches, etc.

As the Spleen gets weaker and weaker, the Liver problems also get worse, and a vicious cycle is generated. The reason that someone with Liver depression/Spleen deficiency is often misdiagnosed as being "too yang" is that, in addition to the symptoms mentioned above, there is often a difficult to describe but very intense "tight" feeling that manifests both physically and mentally. This feeling is produced by the depressed and constrained Liver qi. It feels very much like a strong contraction; hence, right away people erroneously jump to the conclusion that they are "too yang." This is an illusion. The Liver Blood is deficient, while the liver qi is either stuck or moving frenetically. How could eating sugar or drinking fruit juices, both of which dampen and damage the Spleen, or drinking coffee, which further consumes the Liver Blood, possibly solve this problem? These solutions are not really solutions at all; in fact, they only make things worse.


Furthermore, although often produced by deficiencies of qi and Blood, Liver/ Spleen disorders frequently have nothing to do with food. As I stated previously, the Liver is closely associated with our concept of the nervous system, so it can easily be affected by stress. In America, everyone has stress. Permeating our lives, it seems to be in the air that we breathe and the water that we drink. The very things that support our happiness, such as our careers and our families, are also major sources of stress. In addition, once people have fallen into serious states of deficiency, many normally benign environmental factors such as cool breezes or hot sunshine become sources of stress. So we have to deal with it, realizing that up to a point, it makes us stronger, while beyond that point it weakens us.

Among the many macrobiotic people who come to me for Chinese Herbal therapy, I see a great deal of stress related Liver/Spleen disharmonies. They are, in fact, of epidemic proportions, and it is rare to find anyone who isn't suffering to some degree. Consider menstrual problems in macrobiotic women, for example. Most women just put up with them as though they are normal, such is their prevalence in our society. But emotional liability, cramps, headaches, clotting, breast distention, and all the similar symptoms which women stoically endure are not at all normal, and can usually be quickly and effectively alleviated by addressing these disharmonies with Chinese herbal formulas.

In men, Liver/Spleen problems are both caused and aggravated by the habitual use of the three scourges of our civilization: coffee, tobacco, and alcohol. These powerful substances override important, self-regulating bodily functions, resulting in major physical, mental, and spiritual problems. In small amounts, for certain people, alcohol can have positive uses, as it can invigorate the blood. But macrobiotic people rarely have need of this quality, since their blood is usually not thick and sludgy from the over-consumption of animal fats. On the other hand, repeated and excessive ingestion of alcohol causes a toxic condition known as "damp heat" in both the Spleen and the Liver/Gall-bladder, which can be very difficult to treat.

Tobacco is warm, acrid, bitter, and drying. It can transform mucous and temporarily alleviate symptoms of dampness and qi stagnation, but used habitually it will exhaust the Lung yin and the yin in general. People who smoke and have a hard time quitting invariably have Spleen and Liver problems.


Coffee has even less to recommend it. Once again, for people whose Spleen and Liver functions are already disordered, it can promote diuresis by stimulating the Liver's coursing and draining ability. But there are much better and safer ways to accomplish this. Coffee is very seductive: it promises a lot, delivers nothing, and then steals what we have. It is so yin that it appears yang. Coffee does not give us energy; rather, it releases energy by consuming the deepest and finest "essence" which is stored in the kidneys. This precious substance is very difficult, if not impossible, to replace, and should never be squandered recklessly. Usually, people who are attracted to coffee already have various deficiencies -- that's why they are looking for a boost in the first place. In cases such as these, a different approach is needed. Instead of becoming "coffee achievers," these people should cut back on their mental and physical activities for awhile and concentrate on restoring and rejuvenating their qi, Blood, and essence.

Because of the careless and selfish ways that modem Americans relate to each other, anger and deep seated resentment are often big problems for both men and women in the macrobiotic community. Anger is a negative type of energy which can be used as a substitute motivator for those whose righteous, or correct energies are deficient or disordered. It is a sure sign of Liver problems, and it also will make those problems worse if it is indulged and allowed to endure. In Chinese Medicine theory, emotional problems caused by stress and repressed anger are seen as the main causes of cancer, with bad diet playing a secondary role, and environmental pollutants a distant third.


Macrobiotic counselors who treat cancer patients could improve their success rate dramatically if they did not rely exclusively upon diet to cure conditions that are not exclusively caused by diet. If not treated correctly, Liver Depression/Spleen Deficiency will become an impenetrable barrier which will define the upper level of one's health.

When a macrobiotic person's Spleen is deficient, he will be naturally attracted to strengthening foods and activities, and when these instincts are followed, his energy will increase. But this increase of energy coming into his system will energize the depressed Liver qi as well, thus aggravating the symptoms generated by Liver stagnation. If at this point he cannot see through the illusions surrounding this set of circumstances, he will invariably conclude that he is "too yang," and reduce or avoid the very strengthening foods that he badly needs to regain his health.

This sets into motion a degenerative spiral whereby, in order to avoid unpleasant mental or physical symptoms, a person with Liver stagnation will unconsciously opt for a life of gradually decreasing vitality.


Chinese herbs, however, can be of real help in these cases, not only by providing symptomatic relief, but also by addressing the root causes of the problem. For internally or emotionally generated Liver/Spleen disharmonies, the famous Chinese Medicine formula Xiao Yao Wan and its many variations are usually the prescriptions of first choice by TCM practitioners.

Typically, these formulas will do at least three things: dredge, free up and smooth the stuck and stagnant Liver qi, strengthen the Spleen and transform dampness, and tonify and harmonize the Blood. If there is extra heat, qi deficiency, or Blood stagnation, specific herbs are added to the formula to make it effective for these problems as well.

For Liver/Spleen disorders caused by externally invading pathogens, the two thousand year old Xiao Chai Hu Tang or one of its derivatives is heavily relied upon. Known as "harmonizing formulas" in Chinese Medicine, these wonderfully effective prescriptions perform complicated tasks that cannot be achieved with diet, no matter how much we try to micromanage what we eat.

1. Flaws, Bob, Statements of Fact in Traditional Chinese Medicine, Blue Poppy Press, Boulder, Co. 80304, p.38.

A thirty year macrobiotic, Randall Effner lives and practices Chinese Herbology in rural Jamestown, Missouri. He is certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). He is also author of The Road To True Health a book which discusses the great healing power contained in the teachings of Jesus and Lao Tzu.


By Randall Effner

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