1. Governing Transportation and Transformation
This function includes the transportation and transformation of water, and of essential nutrients. If the spleen's transportation and transformation functions are sound then the functions of digestion, absorption and transportation will work normally. Otherwise, abdominal distention, diarrhea, lassitude, emaciation, malnutrition, and other symptoms may occur.

The spleen is also involved in water metabolism. When the spleen transports nutrient substances, it simultaneously distributes water to every tissue of the body carrying out its functions of nourishment and moistening. From the spleen, water is also sent down to the kidney and excreted from the urinary bladder. The whole process of distribution and metabolism of water is jointly accomplished by the lung's dispersing and descending functions and the spleen's transportation and transformation functions. If the spleen fails to transport and transform the water it will lead to various pathological changes. If water accumulates inside the body, it will turn into an inflammatory mucus (phlegm-humor); if it is retained in the skin and muscle, it becomes a swelling (edema); if the water retention is in the intestines, it will cause diarrhea; if it is in the abdominal cavity, it will result in serious fluid accumulation (ascites). In the Suwen it says, "...various kinds of diseases caused by dampness with swelling and fullness belong to the spleen."

2. Controlling Blood
The spleen regulates blood circulation inside the blood vessels. If there is a qi deficiency in the spleen, then its function of controlling the blood is lost and the blood flows outside of the vessels. This is evidenced by various hemorrhagic symptoms and diseases, such as chronic uterine bleeding. In order to control the blood, the spleen uses ying (nutrient) qi, a form of blood qi, which it produces. Qi behaves as the "commander" of the blood and, at the same time, conserves the blood. Therefore the hemorrhagic symptoms and diseases caused by the failure of spleen controlling blood are actually the results of qi failing to conserve blood.

3. Dominating the Muscles and Four Limbs
The spleen transports and transforms nutrient substances to nourish the muscles. If this function is normal, there will be sufficient nutrition. Any abnormality of transportation and transformation will certainly affect muscle tissue quality. The Suwen records, "The spleen is in charge of the muscles."

The normal movements and functions of the four limbs are also closely related to spleen qi. When there is sufficient spleen qi, the yang qi distributes ample nutrient substances all over the body so that the muscles are well nourished and the four limbs are strong and able to move freely, Otherwise if the spleen fails to transport and transform the yang qi and nutrient substances, there will be malnutrition of the muscles characterized by muscular atrophy, weakness of the four limbs, etc. Therefore, building up the spleen is the usual clinical treatment for wei syndromes of the four limbs.

4. Opening into the Mouth and Lip Complexion
The appetite and sense of taste are closely related to the transportation and transformation functions of the spleen. If these functions are healthy, then there will be good appetite and normal sense of taste. If those functions are abnormal, there will be a lack of appetite. A greasy and sweet taste in the mouth is caused by damp obstruction in the spleen. In the Suwen it says, "Spleen qi is in communication with the mouth, and when the spleen functions harmoniously, the mouth will be able to taste the flavors of the five cereals."

Since the spleen dominates the muscles and opens into the mouth, the strength or weakness of the transporting and transforming functions are reflected in the lips. If the spleen qi is not healthy, those functions will be abnormal, a condition which is characterized by yellowish and lusterless lips.