The syndrome of turbid yin failing to descend refers to a general term for a series of symptoms caused by insufficient spleen and stomach yang, dysfunction in ascending lucidity and descending turbidity, resulting in the inability to properly digest, absorb, and excrete nutrients and waste. It is often caused by improper diet, overstrain, emotional imbalance, and injury to the spleen and stomach.

The main clinical manifestations include: epigastric stuffiness, abdominal distension and fullness, reduced appetite, loose stool, or constipation, difficulty or inability to urinate, body heaviness, fatigue and lack of strength, and in severe cases, swelling of the lower limbs, turbid and greasy tongue coating, and a soggy and slippery pulse.

The syndrome of turbid yin failing to descend is commonly seen in diseases such as "dampness obstruction," "edema," "ischuria," and "leukorrhea."

bubble_chart Differentiation and Treatment

The syndrome of turbid yin failing to descend can occur in various diseases.

1. For example, if the syndrome of turbid yin failing to descend appears in dampness injury, it often manifests as limb fatigue and lack of strength, or a heavy head as if wrapped, chest tightness, abdominal distension and fullness, poor appetite, sticky and bland or sweet taste in the mouth, white and greasy tongue coating, and a soft and slippery pulse, which are characteristics of "dampness encumbering the spleen and stomach." Treatment should focus on aromatic herbs resolving dampness, and the formula used is Patchouli Qi-Righting Powder(Taiping Huimin Heji Jufang) or Stomach-Calming Powder(Taiping Huimin Heji Jufang).
2. If the syndrome of turbid yin failing to descend appears in a disease with edema, the clinical manifestations often include generalized edema, epigastric fullness, abdominal distension and fullness, and even ascites. Reduced appetite, loose stools, pale complexion, scanty urine, a pale and swollen tongue with tooth marks on the edges, and other symptoms characterize "yin edema syndrome." Treatment should focus on fortifying the spleen and disinhibiting water, and the formula used is Spleen-Strengthening Decoction(Jisheng Fang).
3. If the syndrome of turbid yin failing to descend is seen in ischuria, it may manifest as lower abdominal distension and fullness, frequent desire to urinate but inability to do so, or scanty and difficult urination, mental fatigue and lack of strength, poor appetite, anorexia, shortness of breath, and a weak voice. Treatment should focus on ascending lucidity and descending turbidity, tonifying qi, and promoting water movement. The formula used is Middle-Tonifying Qi-Replenishing Decoction(Piwei Lun) with modifications.

The syndrome of turbid yin failing to descend often occurs in individuals with obesity and weak constitution, as "obese individuals tend to have dampness." Common symptoms include listlessness, dull complexion, shortness of breath upon exertion, and heavy limbs. In women, the syndrome of turbid yin failing to descend mainly manifests as continuous and clear leukorrhea, delayed menstruation, and other symptoms. This varies from person to person, and treatment should be tailored according to individuality.

When a disease progresses to the stage of turbid yin failing to descend, it is often due to spleen qi deficiency (i.e., spleen-stomach weakness), leading to dysfunction in the ascending and descending of qi, which can cause the retention of water-dampness, phlegm-turbidity, and other yin pathogens. Prolonged illness affecting the kidneys and kidney yang deficiency can lead to impaired qi transformation, resulting in further retention of water-dampness and phlegm-turbidity, which may then ascend and cause symptoms such as a dull complexion, listlessness, mental confusion, vertigo, nausea, vomiting, scanty or absent urine, generalized edema, and a dull and bluish tongue texture, which are signs of turbid yin ascending. If dampness-turbidity accumulates over time and transforms into heat, it can lead to dampness-heat disorders.

bubble_chart Differentiation of Similar Patterns

1. Pattern of spleen and stomach deficiency and the syndrome of turbid yin failing to descend: Both syndromes are pathological conditions arising from the insufficiency of spleen and stomach qi. The pattern of spleen and stomach deficiency is caused by dysfunction in reception and transportation; the syndrome of turbid yin failing to descend is due to the dysfunction of the spleen and stomach's ascending and descending mechanisms, specifically the stomach's failure to descend turbidity. The syndrome of turbid yin failing to descend is often caused by dietary irregularities, overstrain, injury to the spleen and stomach, or stagnation of the seven emotions, with liver qi transversely invading the stomach. Due to the dysfunction of the spleen in transportation, the stomach fails to descend turbidity, leading to the stagnation of dampness turbidity, preventing the clear yang from rising, and causing dampness obstruction in the middle energizer. This results in symptoms such as epigastric stuffiness, abdominal distension and fullness, reduced appetite, and loose stools. If the clear qi aspect does not ascend, the turbid yin will have difficulty descending, leading to difficulty in urination. Insufficiency of middle yang leads to yang failing to transform qi, resulting in qi failing to promote water transformation, causing internal accumulation of water dampness that overflows to the skin, leading to edema, especially below the waist. Deficiency of spleen and stomach qi leads to dysfunction in conduction, which can also cause constipation. Internal obstruction by dampness prevents yang qi from extending, leading to symptoms such as heavy limbs, fatigue, lack of strength, greasy tongue coating, and a soggy, slippery pulse. On the other hand, the pattern of spleen and stomach deficiency is due to the insufficiency of spleen and stomach qi, leading to dysfunction in reception and transportation, insufficient generation of qi and blood, resulting in symptoms such as reduced appetite, anorexia, epigastric distension and fullness after eating, loose stools, shortness of qi, reluctance to speak, fatigue in the limbs, emaciation, shallow yellow complexion, pale tongue with white coating, and a weak, slow pulse. The two syndromes are clearly different.

bubble_chart Documentation

1. Suwen-Yinyang Yingxiang Da Lun: "When the clearing qi aspect is below, it leads to reproductive discharge; when the turbid qi is above, it causes distension. This is the reversal of yin-yang, the inversion and compliance of disease."
2. Zhengzhi Huibu‧Spleen and Stomach: "Damp phlegm stagnates in the middle, causing the clear yang to fail to rise and the turbid yin to fail to descend, leading to stuffiness and blockage, even to the point of urinary obstruction. In such cases, use Atractylodes to dry spleen dampness, and Two-Cured Decoction to resolve phlegm qi. Use Bupleurum and Cimicifuga to guide the clearing qi aspect upward. Once the clearing qi aspect rises, the turbid qi will naturally descend, the stagnation will be relieved, body fluids will distribute, dampness will flow, dryness will moisten, and urination will improve."
3. Zhengzhi Huibu‧Abdominal Mass: "In cases of spleen deficiency, occasional qi stagnation and misuse of harsh treatments can lead to the scattering and disarray of middle qi, causing water qi to overflow and produce distension. This is due to spleen deficiency failing to control and regulate. The method should be to tonify the earth and regulate the middle, allowing the turbid yin to transform naturally."
4. Zhengzhi Huibu‧Stuffiness and Fullness: "For cases of middle deficiency causing non-movement, with symptoms like hunger and stabbing pain, tonify qi and warm the middle. For internal damage from overwork, with the clearing qi aspect sinking and turbid qi invading upward, tonify the middle and replenish qi."
5. Luo's Compendium of Medical Mirrors‧Miscellaneous Syndromes: "There are also cases where spleen deficiency fails to generate metal, causing the clearing qi aspect to fail to rise. How then can the turbid qi descend? The classics state that spleen-stomach deficiency leads to the obstruction of the nine orifices. Use Middle-Tonifying Qi-Replenishing Decoction, with ginseng and astragalus to warm the spleen, and Bupleurum and Cimicifuga to lift qi, nourishing the postnatal source of transformation. This is the subtle use of tonifying the mother in cases of deficiency."