Traditional Chinese medicine and Western medicine share the term " spleen, " yet there are fundamental differences in its functions, location, and structure. In traditional Chinese medicine, the " spleen" is a functional concept that encompasses multiple systems, including digestion, metabolism, and immunity. However, in Western medicine, the " spleen" is an anatomical concept referring to the largest solid organ in the immune system. This article systematically explores the similarities and differences between the two from five distinct dimensions: conceptual essence, physiological functions, pathological mechanisms, clinical diagnosis, and clinical intersections. We conclude that the integration and cross-fertilization between the traditional Chinese medicine " spleen" and the Western medicine " spleen" have significant theoretical and clinical value for standardizing the diagnostic and therapeutic approach to integrated Chinese and Western medicine and optimizing clinical treatment plans.