This pattern is also known as spleen being encumbered by dampness, cold-dampness encumbering spleen, or dampness encumbering spleen yang. This pattern may arise from spleen qi deficiency leading to the inability to transport water and dampness, resulting in dampness encumbering the spleen; or from spleen yang deficiency causing cold-dampness to accumulate in the middle energizer, leading to dampness encumbering spleen yang. Both scenarios are due to spleen deficiency occurring first, followed by the generation of dampness. It can also result from external dampness invading internally, soaking the spleen earth, and injuring spleen qi or impairing spleen yang. The pattern of spleen deficiency with dampness encumbrance includes two aspects: one is spleen deficiency (spleen qi deficiency, spleen yang deficiency), and the other is the accumulation of water and dampness.

The main clinical manifestations of the pattern of spleen deficiency with dampness encumbrance are: epigastric stuffiness and discomfort, dull pain in the epigastrium and abdomen, reduced appetite or lack of desire to eat, sticky and greasy sensation in the mouth, nausea and vomiting, loose stools, heavy and fatigued limbs, heaviness of the head as if wrapped, dull and sallow complexion, and in severe cases, swelling of the limbs, increased leukorrhea in women, pale or swollen tongue, white and slippery or white and greasy tongue coating, and a soggy and slow pulse.

The pattern of spleen deficiency with dampness encumbrance is commonly seen in conditions such as "phlegm-fluid retention," "vomiting," "diarrhea," "cholera," "jaundice," and "edema."

The pattern of spleen deficiency with dampness encumbrance should be differentiated from "spleen qi deficiency pattern," "spleen yang deficiency pattern," "spleen-kidney yang deficiency pattern," and "pattern of kidney deficiency and water diffusion."

Cold-dampness pathogenic qi causes illness, either due to external invasion of dampness or internal generation of cold-dampness. There are deficiency pattern as well as excess pattern. The location of the disease is often in the lungs, spleen, and kidneys, with the key being the spleen. Therefore, Suwen-Zhizhenyao Da Lun states: "All dampness patterns with swelling and fullness are ascribed to the spleen." Jingyue Quanshu-Dampness Pattern says: "Those with pudendal coldness and insufficient yang qi often exhibit these symptoms." The pattern of spleen deficiency being troubled by cold-dampness manifests differently in various diseases, each with its own characteristics.

1. If phlegm-fluid retention is seen in the pattern of spleen deficiency with dampness encumbrance, it is due to spleen qi deficiency failing to transport and transform water-dampness into body fluids, leading to dampness accumulation and fluid retention, which then affects the lungs, resulting in copious sputum that is white and thin, accompanied by poor appetite, epigastric distension, loose stools, lack of strength, a white and greasy tongue coating, and a slippery or soggy pulse. Treatment should focus on invigorating the spleen and drying dampness, using Two Old Ingredients Decoction(Hejiju Fang);
2. or if spleen yang deficiency leads to cold-dampness encumbering the spleen, it will inevitably cause chronic cough disease with wheezing, internal exuberance of cold-fluid, and copious phlegm-fluid retention with foam, accompanied by fear of cold, cold limbs, or facial edema. Treatment should warm the spleen and lungs to resolve fluid retention, using Potia, Licorice, Schisandra, Ginger, and Asarum Decoction(Jingui Yaolue);
3. or if spleen yang is weak and water-fluid fails to transform, accumulating in the stomach, there will be splashing sounds in the stomach, fullness in the chest and hypochondrium, cold back the size of a palm, nausea, vomiting of clear water and phlegm, palpitations, shortness of breath, blurred vision, a white and slippery tongue coating, and a wiry and slippery pulse. Treatment should warm the spleen and resolve retained fluid, using Poria, Cinnamon Twig, Bighead Atractylodes, and Licorice Decoction(Jingui Yaolue).

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1. If vomiting is seen in the pattern of spleen deficiency with dampness encumbrance, the vomit is mostly clear water and phlegm, with usual symptoms of clear water in the mouth, epigastric stuffiness, anorexia, dizziness, palpitations, a white tongue coating, and a slippery pulse. This is due to weak spleen yang, cold-dampness obstructing the middle, clear yang failing to rise, and turbid yin counterflowing upward. Treatment should warm the middle and resolve dampness, downbear counterflow to stop vomiting, using Minor Pinellia combined with Poria, Cinnamon Twig, Bighead Atractylodes, and Licorice Decoction(Jingui Yaolue) with modifications.
2. If diarrhea is seen in the pattern of spleen deficiency with dampness encumbrance, or if spleen yang is insufficient, water failing to transform into qi leads to internal generation of cold-dampness, or overeating cold and raw foods, or external invasion of dampness, causing dysfunction of the spleen in transportation, imbalance of ascending and descending, separation of clear and turbid, and failure to transform food, resulting in clear and thin stools or even watery stools, abdominal pain, borborygmi, a white and greasy tongue coating, and a soggy and slow pulse. If water-dampness is internally generated and dampness encumbers spleen yang, mild cases should warm the spleen, dry dampness, and promote urination, using Stomach-Calming Powder(Hejiju Fang), Stomach Poria Decoction(Danxi Xinfa); severe cases should warm and activate spleen yang, as yang's dominance leads to dryness, and yin-dampness naturally recedes, using Zuoguan Decoction(Jingyue Quanshu).
3. If external dampness invades internally, encumbering the spleen and causing diarrhea, it should be accompanied by aversion to cold with fever, headache, body aches, and a sticky mouth. Treatment should use aromatic herbs to resolve dampness, strengthen the spleen, and relax the middle. Use Patchouli Qi-Righting Powder(Hejiju Fang).
4. If cholera disease is seen in the pattern of dampness encumbering spleen yang, the onset is sudden, with vomiting and diarrhea occurring dozens of times a day or even more, diarrhea with undigested food or like rice water, not very foul-smelling, chest stuffiness, abdominal pain, and cold limbs. This is due to cold-dampness stagnating in the middle energizer, obstructing spleen yang, leading to the separation of clear and turbid, and vomiting and diarrhea. Treatment should use aromatic herbs to dry dampness, warm the middle, and strengthen the spleen, using Patchouli Qi-Righting Powder, Priceless Qi-Righting Powder(Hejiju Fang).
5. If jaundice disease is seen in the pattern of cold-dampness disturbing the spleen, manifesting as yin jaundice, with a dull and lusterless yellow color, poor appetite, epigastric stuffiness, fear of cold, mental fatigue, loose stools, a white and greasy tongue coating, and a thin and slow pulse, it is due to weak middle yang, cold-dampness obstructing the middle, and gallbladder bile overflowing, leading to yellowing of the body and eyes. Treatment should warm the middle, invigorate the spleen, and resolve dampness, using Virgate Wormwood Cold-Extremities Decoction(Zhangshi Yitong).
6. If a disease with edema presents with the pattern of dampness encumbering spleen yang, then the edema is particularly severe below the waist, depressible upon pressure, accompanied by cold limbs, loose stool, difficulty in urination, a white and slippery tongue coating, and a deep and slow pulse. This indicates a pattern of spleen yang deficiency leading to internal flooding of water-dampness. The treatment should focus on warming and activating spleen yang, promoting urination, and draining dampness. The recommended formula is Spleen-Strengthening Decoction (Jisheng Fang).

The pattern of spleen deficiency with dampness encumbrance is commonly seen in individuals with obesity and weak constitution, as the saying goes, "the obese tend to have more dampness." It often manifests as a plump body with flabby muscles, fatigue and heaviness in the limbs, soreness and lack of strength, shortness of breath, spontaneous sweating, accumulation of phlegm and fluid retention, or swelling in the lower limbs, or in women, clear and thin leukorrhea, a swollen and tender tongue often with tooth marks, and a soggy and slow pulse. Among the Six Climatic Factors, dampness is the dominant qi during the summer and autumn. Therefore, during these seasons, exposure to rain and dew, wading through rivers, or indulging in cold drinks can lead to dampness invading from the outside or arising internally, resulting in spleen disorders due to dampness encumbrance.

bubble_chart Differentiation of Similar Patterns

1. Spleen qi deficiency pattern and pattern of spleen deficiency with dampness encumbrance: The spleen governs the digestion and transformation of water and grains, and dominates the circulation of elemental qi to transform dampness and distribute essential substances. Spleen qi deficiency leads to the spleen's inability to digest grains, manifesting as reduced appetite, epigastric distension, diarrhea, lack of strength, shallow yellow complexion, fatigue, emaciation, pale tongue, and weak pulse. In the pattern of spleen qi insufficiency, symptoms of dampness not being transformed may be seen, which is due to the spleen's failure in transportation and transformation caused by spleen qi deficiency. Therefore, the key to spleen qi deficiency lies in the spleen's inability to transport and transform, and treatment should focus on strengthening the spleen, possibly supplemented with drying dampness agents. If spleen deficiency persists, dampness is not transformed, or external dampness invades internally, leading to the accumulation of tangible dampness in the middle energizer or obstruction of spleen qi, the manifestations, in addition to spleen qi deficiency, include limb heaviness, body heaviness, head feeling wrapped, sticky mouth, nausea, vomiting, and other symptoms of excessive dampness, forming the pattern of spleen deficiency with dampness encumbrance. Treatment, besides strengthening the spleen, must include aromatic herbs to resolve dampness, as removing dampness strengthens the spleen and eliminating pathogens restores health. If internal dampness overwhelms and obstructs spleen yang, in addition to symptoms of dampness obstructing spleen qi, there may also be fear of cold, cold limbs, or lower limb edema, and in women, clear and thin leukorrhea. This is also the pattern of spleen deficiency with dampness encumbrance, and treatment should warm spleen yang to transform cold-dampness. In summary, spleen qi deficiency is purely a deficiency pattern, while spleen deficiency with dampness retention is a syndrome of deficiency-type pathogen excess.
2. Spleen yang deficiency pattern and pattern of spleen deficiency with dampness encumbrance: Due to spleen yang deficiency, dampness is not transformed and overflows the muscles, similar to the edema caused by cold-dampness overwhelming spleen yang in the pattern of spleen deficiency with dampness encumbrance. The disease mechanisms are essentially the same, with clinical manifestations including edema, especially significant below the waist. The difference lies in that spleen yang deficiency pattern primarily manifests as yang deficiency, such as fear of cold, cold limbs, cold and painful lower back, and treatment should focus on warming yang. In contrast, the pattern of spleen deficiency with dampness encumbrance, while also showing symptoms of spleen yang deficiency like fear of cold and cold limbs, is relatively milder, with more pronounced symptoms of dampness excess pathogen accumulation, including heavy body, limb heaviness, fatigue, somnolence, epigastric stuffiness, and sticky mouth, in addition to edema below the waist. Treatment should warm yang while also drying dampness, resolving dampness, and draining dampness for differentiation.
3. Spleen-kidney yang deficiency pattern and pattern of spleen deficiency with dampness encumbrance: Spleen-kidney yang deficiency pattern is caused by insufficient spleen yang failing to transform dampness and insufficient kidney yang disturbing qi transformation, leading to internal dampness retention, with symptoms mainly of cold nature, and edema more pronounced below the waist. The edema caused by cold-dampness encumbering the spleen and spleen deficiency leading to water overflow in the pattern of spleen deficiency with dampness encumbrance is milder and lacks kidney yang deficiency symptoms, manifesting as lumbago, diarrhea before dawn, and even impotence, while symptoms of dampness obstructing the spleen, such as chest stuffiness, nausea, limb heaviness, and head heaviness as if wrapped, are more pronounced than in spleen-kidney yang deficiency pattern. Therefore, the two syndromes are not difficult to distinguish. Pattern of kidney deficiency and water diffusion and pattern of spleen deficiency with dampness encumbrance: The former is due to insufficient kidney yang, qi failing to promote water transformation, yin not following yang, thus edema is the main symptom, along with cold limbs, fear of cold, lumbago, limb weakness, clear and long urination, impotence, and deep pulse, all symptoms of kidney yang deficiency. Although the pattern of spleen deficiency with dampness encumbrance may also involve insufficient spleen yang and spleen failing to resolve dampness leading to water overflowing the skin, its manifestations should primarily be spleen yang deficiency and internal dampness excess, such as chest stuffiness, desire to vomit, body heaviness, and head heaviness, distinguishing it from the pattern of kidney deficiency and water diffusion.