As one of the core theories of spleen governing transportation and transformation in the traditional Chinese medicine visceral manifestation theory, the modern biological basis of "spleen qi disperses essence" has not been fully elucidated. Lipids are one of the three major nutrients in the body, which are derived from exogenous absorption or endogenous transformation, and belong to the category of "grease" and "essence" substances in traditional Chinese medicine. Because of their hydrophobic nature, lipids require apolipoproteins to be transported in the bloodstream and used by the body; similarly, essence also needs spleen qi transformation to be distributed throughout the body and exert their nourishing effects, revealing a certain degree of inherent unity between the two. When the spleen qi functions properly, essence dispersal is orderly and lipid metabolism remains in homeostatic balance; if spleen deficient leads to impaired transportation, the essence will not be distributed, and the lipid turbidity will accumulate, causing disease. Classic strengthening spleen prescriptions such as Zexie Decoction, can reshape lipid homeostasis by regulating apolipoproteins. Based on apolipoprotein-mediated lipid metabolism, this paper explores the modern molecular biology basis of the theory of "spleen qi disperses essence," which provides novel insights for enriching the modern research of traditional Chinese medicine visceral manifestation theory, and lays the foundation for clinical practice and theoretical innovation in the treatment of metabolic diseases from the spleen.