Inter-relationship & the Spleen, Gallbladder and Small Intestine

Hello All!

Hope you are enjoying this vibrant spring blooming!

We are super excited to be presenting a synthesis of our manual therapy approach to the abdomen--specifically focusing on chronic digestive patterns in the small intestine (such as SIBO)--coming up next weekend. 

As many of you who treat these conditions know, they can be complex and often defy available diagnostic categories and treatment protocols (e.g. patients often relapse, symptoms can be beguiling and mysterious, and lab results can run contrary to the patient experience).   In our course, together we will explore a holistic understanding -- combining a felt-sense approach to the abdomen with insights from both osteopathic and classical Chinese medicine.  We hope it will serve towards the further understanding and treatment of these difficult cases.

We have been putting the finishing touches on our workshop course manual in advance of next weekend.  There is so much more to explore than what we have distilled so far, but I would love to share with you an introduction to my approach to this work: a brief discussion of the inter-relationships that I have observed clinically in these cases.

Interrelating the Spleen, Gallbladder and Small Intestine for Clinical Understanding and Treatment

I came to this understanding from applying the osteopathic principles that are at the root of our work. Namely, listening to the body. I began noticing that many patients who had a SIBO diagnosis or complaints related to lower digestive system symptoms (bloating, cramping, etc…), had a positive listening for treating the gallbladder. Treating the gallbladder helped with their symptoms and in some patients’ was part of successfully resolving their issues.

The Gallbladder, an extraordinary organ:

In Chinese medicine, the Gallbladder is termed the extraordinary fu. There is something unique about it among all the organs. It is a yang organ and yang (fu) organs are said to be hollow so that substance can pass through and yin (zang) organs are solid. Well, the Gallbladder is hollow but contains a yin substance – the bile. In this way, it is an atypical yang organ, regularly secreting this yin substance into the digestive system (specifically, into the small intestine via the sphincter of oddi).

Let’s take a step back in time and place and turn to the body. Literal translations of classical Chinese are difficult to peg down – the language was/is contextual (more than maybe our contemporary western minds can grasp easily). If we look at the anatomy, the biliary tree descends and joins with the pancreatic duct. The pancreas sits nestled in a semi-circle formed by the duodenum and rests against the sphincter of oddi. So, in function and anatomical proximity there is strong relationship between gallbladder and pancreas. It’s certainly conceivable that in classical Chinese thought, this was understood and woven into the physiological understanding of the Gallbladder.

It is possible that this concept of extraordinary fu is more than bile. Possibly, the extraordinariness of the gallbladder is in its coordinated functionality with the exocrine portion of the pancreas and that this is truly extraordinary ☺

Classical Chinese thought was concerned with the relationships between things and with processes, particularly those observed in nature. There was nothing in the classical Chinese worldview that was understood to be fixed, except change. Along with this deep appreciation for the constancy of change and inter-relationship, there was a fundamental orientation towards process. The material world was, at least in part, understood based on the processes that brought the ten thousand things into being.

How might this perspective infuse our current understanding of the body? Inter-related processes unfolding within an environment that is ever-changing. It is within the range of possibilities that classical Chinese medicine understood that the delicate and very yin pancreas is part of the functionality, the process of the Gallbladder.

Spleen from a Chinese medicine perspective:

The Spleen organ is considered primarily a digestive organ in Chinese physiology. Perhaps, this is also due in part to its’ relationship with the pancreas. In Chinese medicine the Spleen is described much as western medicine describes the small intestine. The spleen “raises the clear qi” and is partially responsible for our clarity of thought. Brain fog is considered a Spleen organ system pathology. Additionally, it is said that the Spleen is responsible for transforming and transporting – both digestive activities.

If we stretch out a little, loosen our minds, and are willing to see both contemporary western medicine and classical Chinese medicine as offering useful understandings of the body, then we can explore these contradictions and maybe gain some insight.

What we see when we see the Small Intestine…

The small intestine is experiencing an upsurge of pathologizing these days. Small intestine pathologies are real, bacterial overgrowth in the small intestine is real, dysfunction of the small intestine is a contributing factor in lots of patients’ symptom patterns. These small intestine pathologies have proven to be difficult to treat clinically.

The sphincter of oddi distributes the pancreatic juices and bile into the small intestine. In this regard, the sphincter of oddi is a significant contributor to the terrain, the environment of the small intestine. These yin fluids that the small intestine relies upon to do its good work are coming from the biliary tree and the pancreas.

Whenever there may be some functional disharmony or insufficiency within any of the above-discussed organs, it is worth exploring how that is contributing to the problems arising within the Small Intestine. So, instead of seeing the Small Intestine singularly, let’s pull back our focus and see it within these constellated relationships and functional dynamics and explore pathology from that perspective. From a Chinese medicine standpoint, the Small Intestine is responsible for separating the clear from the turbid.  This involves the processes of discernment and sorting. So, if the Spleen’s function is weakened, then transport and transformation will become dysregulated, water and food will not be transformed and the Small Intestine will not be able to properly separate the clear and the turbid.

Bringing these understandings to a hands-on approach

So, through the hands-on techniques we will be exploring next Saturday, we will be bringing this inter-related understanding to meet the real lived experience of the belly and its soft-tissue milieu.   If these cases are a part of your practice or you're interested in gaining more fluency with abdominal work, we would love to have to you join us.  Visit our registration page online if you would like to sign up. Hope to see you soon!

best,

michael