bubble_chart Concept

Spleen qi deficiency, also known as insufficient spleen qi or insufficient middle qi. Spleen qi deficiency syndrome/pattern refers to the symptoms and signs formed by the spleen's inability to function properly and the deficiency of original qi. The loss of essential qi leads to deficiency. Qi transformation occurs in essence, and essence is generated from water and grains, but the transportation, absorption, and distribution of water and grains all depend on the strength of spleen qi. If spleen qi is insufficient, leading to dysfunction of the spleen in transportation, then water and grains cannot be transformed; if grains are not transformed, there will be scanty sperm; and scanty sperm leads to qi deficiency. Piwei Lun．In the "Discussion on the Initial Heat Damage from Dietary Overstrain," it is said: "The decline of spleen and stomach qi leads to the insufficiency of original qi." The reasons are mostly due to irregular diet, excessive overstrain, prolonged worry, injury to the spleen earth, or congenital deficiency, inherent weakness, or aging and physical decline, or just recovering from a serious illness, and improper recuperation.

The main clinical symptoms of spleen qi deficiency syndrome/pattern are: poor appetite, feeling full immediately after eating or abdominal distension and fullness after eating, loss of taste, in severe cases, complete loss of appetite, loose stools, lack of energy, shortage of qi and reluctance to speak, inability to control the limbs, fatigue and desire to lie down, shallow yellow complexion without luster, emaciation, pale or pale and swollen tongue with tooth marks, thin white tongue coating, and weak pulse.

Spleen qi deficiency syndrome/pattern is commonly seen in clinical conditions such as "diarrhea," "epigastric pain," "abdominal pain," "edema," "phlegm-fluid retention," "asthma," "atrophy-flaccidity disease," "deficiency fatigue," and "infantile malnutrition with accumulation."

Spleen qi deficiency syndrome/pattern is often confused with "spleen yang deficiency syndrome/pattern," "syndrome/pattern of spleen deficiency with dampness encumbrance," and "syndrome/pattern of deficiency of both heart and spleen," and clinical differentiation should be noted.

bubble_chart Differentiation and Treatment

The spleen and stomach are the foundation of the acquired constitution, Piwei Lun. The "Treatise on Spleen and Stomach Deficiency and Transmission and Change" states: "When the qi of the spleen and stomach is injured, the original qi cannot be replenished, and thus various diseases arise." When spleen qi is deficient, various diseases can arise, but the clinical manifestations, mechanisms of disease, and treatment methods of spleen qi deficiency differ in different diseases and should be analyzed and differentiated.

1. The characteristics of spleen qi deficiency syndrome/pattern in diarrhea disease are: it is more common in chronic diarrhea, hence it is also called diarrhea due to spleen deficiency. The main clinical manifestations are chronic diarrhea that does not heal, undigested food, loose stools that alternate between diarrhea and normal, sometimes mild and sometimes severe, abdominal distension and fullness, borborygmus, and increased frequency of diarrhea after eating more or consuming greasy food. This is due to the weakness of spleen qi, which impairs its function of transformation and transportation, leading to the inability to digest water and dampness, resulting in undigested food and the mixing of clear and turbid, hence loose stools and chronic diarrhea that does not heal. "Shen's Book of Life Preservation. The Origin and Development of Diarrhea" states: "The symptom of soggy diarrhea, also known as profuse diarrhea, is due to excessive dampness, which is spleen deficiency diarrhea. It is caused by the deficiency of earth (spleen) being unable to control dampness and water, leading to the instability of the intestines and stomach, and the predominance of dampness causing illness." Zhang Jing-yue in Jingyue Quanshu. Zabing discusses the treatment of various diarrheas and says: "If it is solely due to spleen deficiency, then Four Gentlemen Decoction, Ginseng and Atractylodes Decoction, Ginseng, Poria and White Atractylodes Powder are appropriate."
2. If epigastric pain or abdominal pain presents with the syndrome/pattern of spleen deficiency, the pain is located in the stomach or above the navel. The cause of the pain is often due to inherent spleen-stomach weakness, or damage to the spleen and stomach after a long illness or major illness, or excessive overstrain, leading to the inability of spleen qi to function properly. The characteristics of the pain are: it is continuous and mild, the symptoms fluctuate in severity, the course is long, and the pain is relieved by pressure and warmth. Clinically, it is difficult to distinguish between spleen qi deficiency syndrome/pattern of epigastric pain and abdominal pain and the cold deficiency stomachache and abdominal pain of spleen-stomach yang deficiency, as qi also belongs to yang, and yang deficiency pain is a further development of qi deficiency pain. The treatment should focus on tonifying the spleen and replenishing qi, warming the middle, using Minor Center-Fortifying Decoction, Astragalus Center-Fortifying Decoction (Jingui Yaolue).
3. If disease with edema presents with spleen qi deficiency syndrome/pattern, the characteristic is that the swelling starts below the eye socket, is more pronounced in the face in the morning, and worsens in the lower limbs after exertion, sometimes leading to generalized edema, with normal or reduced urine output. Lingshu. On water swelling, it says: "When water swelling begins, there is puffiness of the eyelid, like after waking up, the head pulses, there is occasional coughing, coldness in the groin, swelling of the lower legs, and the abdomen becomes large, indicating that the water swelling has formed." This type of swelling, starting from below the eyes, then the lower legs, and finally the abdomen and spreading throughout the body, is mostly caused by insufficient spleen qi. "Shen's Book of Life Preservation. The Origin and Development of Swelling" states: "Those who suffer from water disease must have spleen deficiency, so it is essential to strengthen the spleen as the main treatment," "regulate qi and nourish the spleen to treat the root, so that spleen qi becomes abundant and functions properly, and water will naturally disperse." The formula used is Ginseng and Atractylodes Spleen-Invigorating Pill ("Shen's Book of Life Preservation"), or Six Gentlemen Decoction (Furen Liangfang) combined with Five Ingredients with Poria Powder ("Treatise on Cold Damage Diseases") with modifications.
4. If phlegm-fluid retention presents with spleen qi deficiency, the phlegm is clear and thin, or frothy, abundant, and easy to expectorate. Due to the deficiency of spleen qi in the middle energizer, the function of transformation and transportation is impaired, water and dampness are not transformed into body fluids and stagnate internally, and dampness accumulates to form phlegm. Hence, there is the saying, "The spleen is the source of phlegm, treating phlegm without regulating the spleen is not a proper treatment." Yizong Bidu. On phlegm-fluid retention, it says: "When spleen earth is deficient and damp, the clear is difficult to rise, the turbid is difficult to descend, stagnating in the middle and intestines, congealing to form phlegm. Therefore, treat phlegm by first tonifying the spleen, when the spleen resumes its normal function of transformation and transportation, phlegm will naturally transform." The formula used is Two Old Ingredients Decoction (Hejiju Fang), White Atractylodes Rhizome Pill ("Jiegu's Family Treasures"), Six Gentlemen Decoction (Furen Liangfang) with modifications.
5. If asthma is accompanied by spleen qi deficiency, it is often seen in children with insufficient innate endowment and inherently weak spleen-earth, where food and drink are not transformed into essence but instead form internal phlegm turbidity. Each time due to improper diet or exposure to external pathogens, asthma symptoms suddenly occur, with audible breathing and continuous wheezing. During the attack, differentiate between cold and heat to downbear counterflow and relieve panting; during remission, strengthen the spleen to secure the root. Prescriptions used include Three-Seed Filial Devotion Decoction(Hanshi Yitong), Two Old Ingredients Decoction, and Six Gentlemen Decoction with modifications.
6. Atrophy-flaccidity disease, when associated with spleen qi deficiency, manifests as four wilting impediments with weakness, and symptoms gradually worsen. The Yangming spleen-earth governs the muscles of the limbs, nourishes all tendons, and supports the bones and joints. When spleen-earth is deficient, qi and blood are insufficient, all tendons lose their nourishment, and the bones and muscles become lax, leading to the four wilting impediments becoming useless. Hence, there is the saying, "treating flaccidity only by addressing Yang brightness." Yixue Zhengzhuan states: "When the spleen is damaged, the limbs cannot function, and various wilting conditions arise... When Yangming is strong, all tendons are nourished, able to support bones and benefit joints. The method of treating wilting lies herein." The formula used is Four Gentlemen Decoction, Ginseng, Poria, and White Atractylodes Powder (Hejiju Fang) with modifications.
7. If deficiency fatigue with internal damage and fever presents with spleen qi deficiency syndrome/pattern, there must be pre-existing spleen deficiency symptoms, with fever fluctuating in intensity, worsening after exertion, and lingering for a long time without recovery. Li Dong-yuan Piwei Lun states: "Overstrain from diet initially leads to heat within," meaning spleen qi deficiency causes fever. Treatment should focus on tonifying the middle and replenishing qi, relieving fever with sweet and warm herbs. The formula used is Middle-Tonifying Qi-Replenishing Decoction (Piwei Lun) with modifications. Deficiency fatigue disease presenting with spleen qi deficiency syndrome/pattern mostly belongs to mild cases of deficiency fatigue. Its clinical manifestations are as described in Li Dong-yuan Piwei Lun, "Stomach Deficiency Zang-Fu Organs, Meridians, and Collaterals All Lack Qi and Become Diseased": "After eating, one feels drowsy, with a dull mind and a desire to sleep, indicating spleen deficiency." Treatment should focus on tonifying the spleen and replenishing qi, using Middle-Tonifying Qi-Replenishing Decoction with Villous Amomum Fruit ("Feng Lao Gu Ge Si Da Zheng Zhi") or Xiangsha Yangwei Pill ("Cixi Taihou Yifang Xuanyi").

The spleen and stomach are the foundation of the postnatal constitution, located in the middle energizer to nourish the four directions. When food enters the stomach, spleen qi disperses essence, nourishing the five zang and six fu organs. Jingyue Quanshu states in "Miscellaneous Syndromes: Spleen and Stomach": "The five zang organs all contain spleen qi, and the spleen and stomach also contain the qi of the five zang organs... Therefore, those skilled in treating the spleen can regulate the five zang organs, thereby treating the spleen and stomach; treating the spleen and stomach to improve appetite and strengthen the stomach is how to stabilize the five zang organs." Spleen and stomach qi deficiency leads to various diseases; moreover, spleen qi deficiency syndrome/pattern often appears during the course of many diseases. Although the manifestations vary, they each have distinct characteristics, providing reliable bases for differentiation.

Spleen qi deficiency syndrome/pattern is commonly seen in infants and children with congenital deficiencies or improper postnatal care, the elderly or physically weak, or patients recovering from prolonged or severe illnesses with unrecovered original qi. In infants and children, spleen qi deficiency syndrome/pattern often manifests as indigestion, vomiting, emaciation with abdominal distension, and a pale, dull complexion. In the elderly or physically weak, it often presents as heaviness in the body, weakness in the limbs, fatigue, and a tendency to sleep. In patients recovering from prolonged or severe illnesses, it often manifests as weight loss, lack of strength, faint and low voice, shallow yellow complexion, and shortness of breath upon exertion.

The spleen and stomach reside together in the middle energizer. Zhubing Yuanhou Lun states in "Spleen and Stomach Disorders": "The spleen is a zang organ, the stomach is a fu organ; the qi of the spleen and stomach are mutually related. The stomach receives food, and the spleen grinds it; when the two qi are balanced, food is digested, and one can eat." When spleen qi is deficient, stomach qi is rarely unaffected, hence clinically it is often referred to as "spleen and stomach qi deficiency," and the two cannot be completely separated. However, upon careful differentiation, they are not entirely the same. When spleen qi deficiency is predominant, the grinding and transforming functions are impaired, leading to reduced appetite, anorexia, and loose stools. When stomach qi deficiency is predominant, the receiving function is impaired, leading to belching and nausea. For spleen and stomach qi deficiency, clinical treatment should focus on tonifying spleen qi, supplemented with digestive aids, using Six Gentlemen Decoction ("Yi Bian").

bubble_chart Differentiation of Similar Syndromes

1. Spleen yang deficiency syndrome/pattern and spleen qi deficiency syndrome/pattern: Qi is also a part of yang, and qi deficiency is often the initial stage of yang deficiency, while yang deficiency is usually a further development of qi deficiency. The mechanism of disease in spleen qi deficiency syndrome/pattern is mainly characterized by a decline in the spleen's function of transportation and transformation. Zhubing Yuanhou Lun states: "When spleen qi grinds and digests, one can eat," and "If food is not digested, the spleen is not grinding." The main clinical manifestations of spleen qi deficiency syndrome/pattern include reduced appetite, abdominal distension and fullness due to "undigested food," and diarrhea with undigested grains. Spleen qi deficiency leads to insufficient production of qi and blood, resulting in a lack of nourishment for the muscles of the limbs, manifesting as fatigue, lack of strength, pale complexion, emaciation, pale tongue, and weak pulse. In contrast, spleen yang deficiency syndrome/pattern includes all the symptoms of spleen qi deficiency syndrome/pattern, along with signs of "yang deficiency leading to cold," such as fear of cold, cold limbs, abdominal pain that prefers warmth and pressure, borborygmus with diarrhea and undigested food in stool, difficulty urinating, edema, clear saliva, and a deep, slow, thin, and weak pulse. The key to differentiating the two is the presence or absence of cold syndrome/pattern: yang deficiency leads to cold, while qi deficiency does not manifest cold symptoms. Spleen yang deficiency syndrome/pattern often develops from spleen qi deficiency, but if it occurs suddenly, it is usually due to excessive internal cold or direct attack of cold pathogens on the spleen.
2. Syndrome/pattern of spleen deficiency with dampness encumbrance and spleen qi deficiency syndrome/pattern: Dampness is a yin pathogen, and the cause of internal dampness can be mild, due to insufficient spleen qi and impaired transportation and transformation, or severe, due to weakened spleen yang leading to water and dampness stagnation. The former mainly manifests as heaviness in the head, body, and limbs, and a white, greasy tongue coating; the latter mainly manifests as cold limbs, fear of cold, phlegm-fluid retention, or edema. Generally, the syndrome/pattern of spleen deficiency with dampness encumbrance refers to spleen qi deficiency being encumbered by dampness, often caused by excessive consumption of raw and cold foods, or a constitution with inherent internal dampness, exacerbated by sitting or lying in damp environments. If spleen deficiency leads to water and dampness stagnation, it is often a root deficiency with superficial excess syndrome/pattern, or a complex syndrome/pattern of deficiency and excess, with a prolonged and difficult-to-treat course. If dampness invades from external factors like excessive consumption of raw and cold foods or damp environments, it is usually an excess syndrome/pattern with a shorter course and easier treatment. The key to differentiating spleen deficiency with dampness encumbrance and spleen qi deficiency syndrome/pattern is that the former involves tangible dampness pathogens and is an excess syndrome/pattern, while the latter involves intangible qi deficiency and 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 clinical manifestations of both spleen qi deficiency and insufficiency of heart blood. Due to spleen qi deficiency and insufficient transformation in the middle energizer, the essence of food cannot be transformed into blood, leading to blood deficiency and the heart losing its nourishment, resulting in symptoms such as palpitations, severe palpitations, forgetfulness, insomnia, and dreamfulness. This often occurs due to excessive worry, overworking the heart and spleen, leading to spleen qi deficiency, impaired spleen function, qi and blood deficiency, and loss of nourishment for the heart spirit. Jisheng Fang states: "The spleen governs intention and thought, and the heart also governs thought. Excessive thinking leads to unclear intention and forgetfulness." From the perspective of disease cause and mechanism, spleen qi deficiency precedes heart blood deficiency, so strengthening the spleen can nourish the heart. Excessive worry, improper diet, or prolonged illness can lead to spleen qi deficiency, which fails to produce heart blood or control blood, resulting in various bleeding symptoms and blood deficiency, causing the heart to lose its nourishment. Clinically, deficiency of both heart and spleen syndrome/pattern includes not only spleen qi deficiency but also symptoms of heart blood insufficiency such as forgetfulness and palpitations. Treatment should focus on strengthening the spleen, supplemented by nourishing the heart and calming the mind. Although both deficiency of both heart and spleen syndrome/pattern and spleen qi deficiency syndrome/pattern involve spleen qi deficiency, the former must include symptoms of blood failing to nourish the heart, such as palpitations and forgetfulness, distinguishing it from simple spleen qi deficiency syndrome/pattern.

bubble_chart Documentation

1. Weisheng Baojian．Overstrain Damage with Cold in Deficiency: "The spleen and stomach belong to earth, located in the middle, among the five zang-organs, it is called the solitary organ, in the triple energizer, it is called the middle energizer. The middle energizer governs alone in the middle, ... For those with spleen deficiency, it should be supplemented with sweetness, to aid the spleen, sweet agents are necessary."
2. Yishu．Spleen and Stomach: "For those with injured spleen qi, the pulse is floating, large, and weak, ... Moreover, there is a large pulse and fullness, resembling food stagnation, this is spleen deficiency showing false signs."
3. 《Bihua Medical Mirror．Spleen Section》: "For those with spleen deficiency, the pulse at the right guan must be thin and soft, the symptoms include vomiting, diarrhea, chronic dysentery, abdominal pain, limb weakness, yellow complexion, swelling, emaciation, tympanites, aversion to cold, spontaneous sweating, food retention, indigestion, prolapse of the rectum, and intestinal bleeding."