[Concept]

spleen qi deficiency is also called spleen qi deficiency or middle qi deficiency. spleen qi deficiency syndrome/pattern refers to the symptoms and signs caused by poor spleen movement and insufficient original qi. essential qi If taken away, it will be empty. Qi transformation comes from essence, which is born from water and grain, and the transportation, absorption, and distribution of water and grain all depend on the rise and fall of spleen qi. If spleen qi is insufficient, there will be dysfunction of spleen in transportation, and the water and grains will not be melted; if the grains are not melted, there will be scanty sperm; if there is scanty sperm, the qi will be weak. Piwei Lun． "The Injury of Diet Overstrain Begins with Heat" says: "The spleen and stomach qi are weak, and the original qi is insufficient." The reasons are mostly due to improper diet, excessive overstrain, prolonged worry, injury to the spleen, or insufficient endowment, physical weakness, old age, infirmity, early recovery from a serious illness, or careless recuperation, etc.

The main clinical symptoms of spleen qi deficiency syndrome/pattern are: loss of appetite, feeling full after eating or feeling full after eating, no taste in the mouth, or even not thinking about eating at all, large loose stools, thin stools, and lack of energy. , shortage of qi: laziness, inability to withdraw limbs, fatigue and sleepiness, complexion, shallow yellow, lack of beauty, weight loss, tongue texture, light or light fat with tooth marks, tongue coating, thin white, weak pulse.

spleen qi deficiency syndrome/pattern is clinically common in "diarrhoea", "epigastric pain", "abdominal pain", "edema", "phlegm-fluid retention", "asthma", "atrophy-flaccidity disease", "consumptive" disease", "infantile malnutrition with accumulation in children" and other diseases.

spleen qi deficiency syndrome/pattern is often confused with "spleen yang deficiency syndrome/pattern", "syndrome/pattern of spleen deficiency with dampness encumbrance", "syndrome/pattern of deficiency of both heart and spleen", clinical application Pay attention to identification.

[Identification Processing]

The spleen and stomach are the foundation of tomorrow, Piwei Lun. "Spleen Stomach Deficiency Transmission and Change Treatise" says: "Since the Qi of the spleen and stomach is damaged, original qi cannot be replenished, which is the cause of all diseases." spleen qi is a deficiency, and various disease causes arise, but it is not the same as in diseases. The clinical manifestations, mechanism of disease, and treatment methods of spleen qi deficiency are also different and should be analyzed.

1. The characteristics of spleen qi deficiency syndrome/pattern in diarrhea disease are: it is more common in chronic diarrhea, so it is also called diarrhea due to spleen deficiency. The main clinical manifestations are chronic diarrhea that does not heal, grains that do not dissolve, loose stools that are sometimes light and sometimes heavy, abdominal distension and fullness, intestinal borborygmus, and increased diarrhea frequency when eating too much or greasy food. The reason is that spleen qi deficiency is weak, has no power to transport and transform, water and dampness cannot be transformed, and food cannot be eliminated, and clear and turbidity cannot be distinguished, so loose stool diarrhea occurs frequently, and chronic diarrhea does not heal. "Shen's Book of Honoring Students". "The Origin of Diarrhea" says: "Soggy diarrhea is a disease, also known as through-flux diarrhea. It is caused by excessive dampness, that is, spleen deficiency. The disease is caused by soil deficiency that cannot control dampness and water, the intestines and stomach are not solid, and dampness prevails." Zhang Jing-yue in Jingyue Quanshu. Zabing Mo's Treatise on Diarrhea said: "If the cause is spleen deficiency, the only treatments are Four Gentlemen Decoction, Shenshu Decoction, Ginseng, Poria and White Atractylodes Powder is suitable."
2. If syndrome/pattern of spleen deficiency occurs in epigastric pain or abdominal pain, the pain site is in the epigastrium or on the umbilicus. The cause of the pain is multifactorial spleen-stomach weakness, or the spleen and stomach are injured after a long-term or serious illness. , or excessive overstrain, causing spleen qi to be unable to perform well. The pain is characterized by: first, continuous pain; second, the symptoms are mild and then severe, and the course of the disease is long; third, it is like to press, and the pain will be relieved when it is warmed. Clinically, it is difficult to distinguish clearly between the epigastric pain and abdominal pain of spleen qi deficiency syndrome/pattern and the cold-deficiency stomach and abdominal pain of spleen yang deficiency. Because Qi also belongs to Yang, yang deficiency pain is the further development of qi deficiency pain, and treatment When toning the spleen and replenishing qi warming the middle, use Minor Center-Fortifying Decoction, Astragalus Center-Fortifying Decoction ( Jingui Yaolue ).
3. If disease with edema is seen in spleen qi deficiency syndrome/pattern, it is characterized by swelling starting under the eye socket, which is more obvious on the head and face in the morning. After exertion, the lower limbs will be swollen, and even the whole body will be swollen, and the urine will be normal or less. Lingshu． Shuizhang said: "When the water begins to rise, the puffiness of the eyelid is like a new lying down. The head is pulsing, coughing, coldness between the vagina and thighs, swollen feet and shins, and a large abdomen. The water has become "" This kind of edema that first starts under the eyes, then the shins, and finally reaches the abdominal heels and spreads throughout the whole body is mostly caused by insufficient spleen qi, "Shen Shi Zunsheng Book." "The Source of Swelling" says: "Those who are sick with water must have a deficient spleen, so it is necessary to strengthen the spleen." FANG L>Spleen-Invigorating Pill ("Shen Shi Zunsheng Book"), or use Six Gentlemen Decoction ( Furen Liangfang ) together with Five Ingredients with Poria Powder ("Disease caused by cold") addition and subtraction.
4. If phlegm-fluid retention is seen as spleen qi deficiency, the phlegm will be clear and thin, or it may be foamy, and it is easy to cough up the large amount. Due to insufficient middle energizer spleen qi, the duty of health and fortune is not fulfilled, water and dampness are not transformed into body fluids but stop internally, and dampness accumulates into phlegm. Therefore, there is a saying that "spleen being the source of phlegm, treating phlegm and ignoring the spleen is not the cure". Yizong Bidu． phlegm-fluid retention" says: "The spleen soil is deficient and wet, and the clear ones are difficult to ascend, and the turbid ones are difficult to descend, leaving the intestines stagnant and stagnant to form phlegm. Therefore, to treat phlegm, first nourish the spleen, and the spleen will be restored to normal movement, and the phlegm will naturally change" . Fang uses Two Old Ingredients Decoction ( Hejiju Fang ), White Atractylodes Rhizome Pills (《Jiegujiazhen》), Six Gentlemen Decoction ( Furen Liangfang ) addition and subtraction.
5. If spleen qi deficiency is seen due to asthma, it is more common in children who have insufficient endowment, weak spleen and earth elements, and water and grains are not transformed into essence, resulting in phlegm and turbidity. Asthma symptoms may suddenly occur due to improper diet or exposure to external pathogens, such as loud breathing and endless slurping. When it attacks, distinguish the difference between hot and cold, and use downbearing counterflow and relieving panting; when it is relieved, strengthen the spleen to consolidate its root. FANG Yong Three-Seed Filial Devotion Decoction ( Hanshi Yitong ), Two Old Ingredients Decoction, Six Gentlemen DecoctionAddition and subtraction.
6. atrophy-flaccidity disease See spleen qi deficiency, four wilting impediment weakness, symptoms gradually worsen, Yangming spleen soil controls the muscles of the limbs, moisturizes all tendons, binds muscles and bones, promotes joints, spleen soil deficiency means less qi and blood, all Tendons lose moisture, muscles and bones become slack, and the four wilting impediments are useless, so there is a saying of "treating flaccidity only taking yang brightness". Yixue Zhengzhuan． "Atrophy-Flaccidity Disease" says: "If the spleen is injured, the limbs cannot be used and all kinds of impotence will occur... Yangming actually means that all tendons are moist, can bind the bones and sharpen the joints. The method of treating impotence does not come from this." Use Four Gentlemen Decoction and Ginseng, Poria and White Atractylodes Powder ( Hejiju Fang ) to add and subtract.
7. If consumptive disease internal damage fever (see spleen qi deficiency syndrome/pattern), the body must have symptoms of spleen deficiency. The fever may be high or low, aggravated by exertion, and lingering for a long time. Li Dong-yuan Piwei Lun said: "The injury caused by diet overstrain is first caused by heat", that is, spleen qi deficiency and fever, the treatment should be tonifying middle and replenishing qi, relieving fever with sweet and warm. Middle-Tonifying Qi-Replenishing Decoction ( Piwei Lun ) addition and subtraction. consumptive disease spleen qi deficiency syndrome/pattern is seen when the disease occurs, most of which are mild symptoms of consumptive disease. Its clinical manifestations and characteristics are as follows: Li Dong-yuan Piwei Lun. "Stomach deficiency zang-fu organs, meridians and meridians are unable to receive qi and all diseases are related" says: "If you eat it, you will feel sleepy, if you have unconsciousness and want to sleep, it is because the spleen is weak." To treat the spleen and replenishing qi, use Middle-Tonifying Qi-Replenishing Decoction plus Villous Amomum Fruit ("Four Major Symptoms and Treatments of Fenglao Xiangge"), or Xiangsha Yangwei Pills ( "The Empress Dowager Cixi's Selection of Medical Prescriptions").

The spleen and stomach are the foundation of acquired life. It is located in the middle energizer and can be poured into the four sides. Drinking into the stomach, the spleen qi can disperse the essence, and the five zang-organs and six fu-organs can be nourished. Jingyue Quanshu． Miscellaneous evidence. It is said in Spleen and Stomach: "There are spleen qi in all five zang-organs, and there are five zang-organs' qi in the spleen and stomach,... Therefore, those who are good at treating the spleen can regulate the five zang-organs, that is, they can treat the spleen and stomach; they can cure it." The spleen and stomach make the stomach strong when food is taken in, that is, it is the five zang-organs." Spleen and stomach qi deficiency are the causes of all diseases; and spleen qi deficiency syndrome/pattern also occurs in various disease processes. Although various manifestations are different, they also have their own characteristics, which are reliable basis for identification.

spleen qi deficiency syndrome/pattern is more common in infants and young children with congenital deficiencies and improper feeding and care, or in the elderly and infirm, or in patients who have not recovered from original qi after a long illness or serious illness. Spleen qi deficiency syndrome/pattern in infants and young children usually manifests as indigestion, vomiting, thinness, abdominal distension and fullness, and complexion. Spleen qi deficiency syndrome/pattern often appears in the elderly and infirm, and often manifests as heaviness and weight loss. Weakness of limbs, fatigue and sleepiness; spleen qi deficiency syndrome/pattern is seen when recovering from long-term illness or serious illness. Weight loss, lack of strength, faint low voice, complexion shallow yellow, and shortness of breath when moving are common.

The spleen and stomach cohabit, middle energizer, Zhubing Yuanhou Lun. The theory of spleen and stomach states: "The spleen is the viscera, and the stomach is the internal organs. The two qi of the spleen and stomach are the exterior and interior of each other. The stomach receives grains and the spleen grinds them. If the two qi are in balance, the grains will turn into food." Spleen qi is deficient, and stomach qi is rarely deficient, so it is often called "spleen and stomach qi deficiency" in clinical practice, and the two cannot be completely separated. However, if you look carefully, you will find that the two are not the same. If spleen qi deficiency is the main factor, the grinding function will be poor, resulting in anorexia and loose stool. If stomach qi deficiency is the main factor, the receptive function will be poor and belching will occur. , disgusting vomiting. For patients with spleen and stomach qi deficiency, clinical treatment should be to supplement spleen qi, supplemented by digestive products, and use zhaoji Six Gentlemen Decoction ("Yi Qi").

[Type Evidence Identification]

1. spleen yang deficiency syndrome/pattern and spleen qi deficiency syndrome/pattern: Qi also belongs to Yang, qi deficiency is often the initial stage [first stage] of yang deficiency, and yang deficiency is often the further step of qi deficiency develop. The mechanism of disease of spleen qi deficiency syndrome/pattern is mainly characterized by a decrease in the spleen's health function. Zhubing Yuanhou Lun． Diseases of the spleen and stomach say: "If you grind spleen qi and eliminate it, you can eat." "If you can't eat, the spleen won't grind." The main clinical manifestation of spleen qi deficiency syndrome/pattern is a decrease in diet, which is caused by "inability to eat." Abdominal distension and fullness means fullness, and diarrhea means that the grains will not dissolve; spleen qi deficiency means that the source of qi and blood transformation is insufficient, and the muscles of the limbs lack shortage of qi blood nourishment, which manifests as limb fatigue, lack of strength, and complexion, shallow yellow, weight loss, and pale tongue. Symptoms of weak pulse. As for spleen yang deficiency syndrome/pattern, in addition to the above symptoms of spleen qi deficiency syndrome/pattern, there must be "yang deficiency leading to cold" fear of cold cold syndrome/pattern manifestations of cold limbs, or abdominal pain and preference for warmth. Symptoms of yang deficiency include pressing, bowel sounds, diarrhea and undigested food in stool, difficulty in urination, swollen limbs, vomiting and clear saliva, or slow and weak pulse. The key to distinguishing the two is whether there are signs of cold syndrome/pattern: yang deficiency leading to cold, qi deficiency does not show cold symptoms; spleen yang deficiency syndrome/pattern mostly develops from spleen qi deficiency, and spleen yang appears in severe illness If it is insufficient, it is mostly caused by excessive pudendal coldness or direct attack of cold evil from Taiyin spleen soil.
2. syndrome/pattern of spleen deficiency with dampness encumbrance and spleen qi deficiency syndrome/pattern: dampness is the yin pathogen, which causes the accumulation of dampness in the body. In mild cases, due to insufficient spleen qi, health and fortune are lost, and the dampness cannot be resolved. ; In severe cases, spleen yang is weak and water dampness stops gathering. The former mainly manifests as drowsiness in the head, body and limbs, and white and greasy tongue coating; the latter mainly manifests as cold limbs, phlegm-fluid retention, edema, etc. Generally speaking, the so-called syndrome/pattern of spleen deficiency with dampness encumbrance refers to spleen qi deficiency and being trapped by dampness. The disease cause is mostly overeating raw and cold food, or internal dampness, overeating raw and cold food, sitting and lying in wet places, resulting in Dampness traps spleen soil. syndrome/pattern of spleen deficiency with dampness encumbrance If it is first caused by spleen deficiency and dampness encumbrance, it is mostly syndrome/pattern of excess syndrome/pattern, or syndrome/pattern of deficiency and excess complex. The disease will be delayed over time. More difficult to treat. If the water-dampness evil enters from the outside due to overeating raw or cold food or sitting or lying in wet places, it will usually be excess syndrome/pattern, and the course of the disease will be short. Easy to cure. The key points in identifying the syndrome/pattern of spleen deficiency with dampness encumbrance and spleen qi deficiency syndrome/pattern are: the former is a tangible dampness evil, which is a suitable syndrome; the latter is an invisible qi deficiency, which is a deficiency syndrome/pattern.
3. syndrome/pattern of deficiency of both heart and spleen and spleen qi deficiency syndrome/pattern: deficiency of both heart and spleen refers to the clinical manifestation of spleen qi being both deficient and insufficiency of heart blood. Due to insufficient spleen qi deficiency and middle energizer, the essence of water and grain cannot be transformed into blood, so the blood is less and the heart loses its nourishment, resulting in insufficiency of heart blood, palpitation, severe palpitation, amnesia, insomnia, dreamfulness and other symptoms. Often due to overthinking and overworking the spleen, the spleen qi is insufficient, the spleen is not healthy, the qi is less, blood deficiency, and the mind is not nourished. Jisheng Fang． "Treatment of Amnesia" says: "The spleen governs thinking, and the heart also governs thinking. Excessive thinking, and inability to concentrate on mind, make people suffer from amnesia." Syndrome/pattern of deficiency of both heart and spleen, from the analysis of disease cause mechanism of disease, spleen qi deficiency comes first and heart blood deficiency comes later, so nourishing the spleen can nourish the heart. Or worry about qi stagnation, or improper diet, or long-term illness and disorder, causing spleen qi deficiency to be unable to metabolize heart blood; or spleen qi deficiency to be unable to absorb blood, resulting in various bleeding symptoms, resulting in less blood and loss of heart support. It is the cause of the insufficiency of heart blood. Judging from the manifestations of clinical symptoms, syndrome/pattern of deficiency of both heart and spleen, in addition to insufficient spleen qi, there are symptoms of insufficiency of heart blood such as amnesia and palpitation. Its treatment should also focus on nourishing the spleen, supplemented by nourishing heart and tranquilizing mind. syndrome/pattern of deficiency of both heart and spleen and spleen qi deficiency syndrome/pattern Although both have the symptoms of spleen qi deficiency, the former must have symptoms of palpitation, amnesia and other symptoms of blood not nourishing the heart, which is different from simple spleen qi deficiency syndrome/pattern , can be identified.

[Documentation]

1. Weisheng Baojian． "Overstrain means there is cold in the deficiency caused by overstrain": "The spleen and stomach belong to earth, located in the middle solution, in the five zang-organs, called the solitary organ, and in the triple energizer, called the middle energizer. The middle energizer alone treats the middle... If the spleen is deficient, use Gan To replenish it, it must be sweetened to nourish the spleen. "
2. Yishu. Spleen and stomach: "In spleen qi injuries, the pulse is large and weak, and...the pulse is large, full and stuffy, as if food is stagnant. This is an illusion caused by spleen deficiency."
3. "Bihua Medical Mirror." Spleen": "In patients with spleen deficiency, the right Guan pulse will be thin and soft. The symptoms are vomiting, diarrhea, chronic dysentery, abdominal pain, soft limbs, yellow face, swelling, muscle thinness, and tympanites. It is aversion to cold, it is spontaneous sweating, it is retention of food, it is not digestion of food, it is prolapse of rectum, it is intestinal blood."