The pattern of clear yang failing to ascend is a type of the pattern of spleen qi insufficiency. It refers to a series of clinical manifestations that occur when the clear yang qi fails to ascend, resulting in the inability to warm and nourish the head, body surface, and limbs. It is often caused by improper diet, overstrain, and damage to the spleen and stomach.

The main clinical manifestations include: dizziness, blurred vision, tinnitus, deafness, fear of cold, cold limbs, fatigue, lack of strength, loss of appetite, anorexia, loose stools, a pale and tender tongue with a white coating, and a weak or deficient pulse.

The pattern of clear yang failing to ascend is commonly seen in diseases such as "vertigo," "tinnitus," "deafness," "atrophy-flaccidity," "diarrhea," "prolapse of rectum," "prolapse of uterus," and "menorrhagia and metrostaxis."

This syndrome should typically be differentiated from the "spleen qi deficiency pattern."

bubble_chart Differentiation and Treatment

The pattern of clear yang failing to ascend can appear in various diseases.

1. For example, if it appears in vertigo, it is often accompanied by tinnitus, a heavy head as if wrapped, chest tightness, nausea, fatigue, lack of strength, fear of cold, cold limbs, poor appetite, loose stools, excessive sleepiness, a white and greasy tongue coating, and a weak or deep and slippery pulse, which are characteristics of "yang being trapped by dampness." This is caused by overindulgence in rich and sweet foods, overstrain, and excessive damage to the spleen and stomach, leading to impaired transportation and transformation, internal accumulation of water and dampness, and obstruction of phlegm and turbidity, resulting in the failure of clear yang to ascend. Treatment should focus on strengthening the spleen and raising yang, drying dampness, and resolving phlegm. The formula used is Pineilia, White Atractylodes and Gastrodia Decoction(Yixue Xinwu) combined with Middle-Tonifying Qi-Replenishing Decoction(Piwei Lun) with modifications.
2. If the pattern of clear yang failing to ascend is seen in deafness, the clinical manifestations often include blurred vision, a dull complexion, poor appetite, low voice, shortness of breath, lack of strength, loose stools, a tender tongue with a thick coating, and a weak and thin pulse, which are symptoms of "insufficient middle qi." This is caused by irregular diet, excessive overstrain, damage to the spleen and stomach, insufficient middle qi, and the failure of clear yang to ascend. Treatment should focus on tonifying the spleen and replenishing qi, raising yang, and benefiting the stomach. The formula used is Tonifying Qi Congming Decoction(《Dongyuan Shixiao Li》).
3. If the pattern of clear yang failing to ascend is seen in atrophy-flaccidity, the clinical manifestations include flaccid and weak limbs, muscle wasting, gradual worsening, poor appetite, loose stools, a puffy and dull face, mental fatigue, lack of strength, a thin white tongue coating, and a deep and thin pulse, which are symptoms of "qi deficiency flaccidity." This is caused by hunger and overstrain, damage to the spleen and stomach, failure of spleen qi to ascend, and lung qi failing to distribute, leading to the loss of nourishment to the muscles and sinews. Zhengzhi Huibu points out: "Qi deficiency flaccidity is caused by hunger and overstrain, leading to the deficiency of stomach qi, the exhaustion of lung qi, and the loss of nourishment to the skeleton and valleys... In general, weakness of the hands and feet after illness is due to qi deficiency, as the spleen is diseased and cannot transport body fluids for the stomach, and the limbs cannot receive the qi of water and grains, leading to their dysfunction." Treatment should focus on tonifying the middle and replenishing qi. The formula used is Middle-Tonifying Qi-Replenishing Decoction(Piwei Lun).
4. If the pattern of clear yang failing to ascend is seen in diarrhea disease, it manifests as chronic diarrhea that does not stop, or even prolapse of the rectum, a pale yellow complexion, fatigue, lack of strength, abdominal distension, a pale tongue with a white coating, and a weak and thin pulse, which are characteristics of "sinking of spleen qi." This is caused by spleen-stomach weakness, impaired transportation and transformation, failure to digest food, and the separation of clear and turbid, where "the ascending essence qi descends and becomes diarrhea." Treatment should focus on tonifying the spleen and replenishing qi to stop diarrhea. The formula used is Ginseng, Poria and White Atractylodes Powder(Taiping Huimin Heji Jufang).
5. If the pattern of clear yang failing to ascend is seen in prolapse of rectum, the clinical manifestations often include prolonged and unhealed prolapse of the rectum, shortness of breath, lack of strength, sweating, cold limbs, fear of cold, reluctance to speak, and loss of taste, which are characteristics of "middle heat sinking." This is caused by dietary overstrain damaging the spleen, or prolonged illness damaging the spleen, leading to chronic diarrhea and sinking of middle qi, resulting in the failure of lifting and raising. Treatment should focus on tonifying the middle and replenishing qi, raising yang, and elevating the drooping. The formula used is Middle-Tonifying Qi-Replenishing Decoction(Piwei Lun).

The pattern of clear yang failing to ascend often occurs in people with a naturally weak constitution, as prolonged illness and physical weakness lead to deficiency of middle qi, commonly seen with symptoms such as listlessness, a dull complexion, shortness of breath, a low voice, fatigue, lack of strength, cold limbs, and fear of cold. In women, the pattern of clear yang failing to ascend mainly manifests as sinking of middle qi leading to prolapse of the uterus and failure of qi to control blood, resulting in menorrhagia and metrostaxis, or the failure of clear yang to ascend and the downward flow of dampness, leading to continuous and clear leukorrhea.

Ascending, descending, exiting, and entering are the fundamental forms of the body's qi transformation function. The spleen governs the rise of the clear, while the stomach governs the descent of the turbid. The spleen and stomach, one ascending and one descending, jointly maintain the body's nutritional metabolism. In the progression of the mechanism of disease, if the spleen's clear yang fails to ascend, it can lead to the kidney's turbid yin failing to descend, resulting in symptoms such as chest tightness, abdominal distension and fullness, loose stools, scanty urine, heaviness of the head, fatigue, poor appetite, anorexia, and in severe cases, urinary retention, edema, a greasy tongue coating, and a wiry-slippery pulse. In the context of the entire body, the ascending and descending functions of the spleen and stomach are crucial to the overall qi movement's ascending, descending, exiting, and entering. The spleen and stomach are the foundation of the acquired constitution, located in the middle energizer, connecting the upper and lower parts of the body, and serving as the pivot of ascending and descending movements. The liver's generation, the lung's purification and descent, the heart fire's descent, the kidney water's ascent, the lung's control of exhalation and heat, and the kidney's control of qi reception all require the cooperation of the spleen and stomach to complete their ascending and descending movements. If the spleen and stomach's ascending and descending functions are abnormal, the clear yang qi cannot be distributed, the acquired essence cannot be stored, the clearing qi aspect of food cannot enter, and waste turbid substances cannot be expelled, leading to the development of various diseases. Wuyi Huijiang said: "...The method of treating the spleen and stomach is most refined in ascending and descending... If ascending and descending are not properly regulated, the spleen and stomach will be damaged. If the spleen and stomach are damaged, the mechanism of intake and output will lose its normal rhythm, and the acquired vitality will cease, leading to the premature death of the people."

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1. Spleen qi deficiency pattern and pattern of clear yang failing to ascend: Spleen qi deficiency is also known as insufficient spleen qi or spleen-stomach weakness (from the "Chinese Medicine Dictionary"). The pattern of clear yang failing to ascend originally falls within the category of spleen qi deficiency pattern. The disease cause and mechanism of disease, as well as clinical manifestations, are very similar between the two, but there are also certain differences. The concept of spleen qi deficiency is broader than that of clear yang failing to ascend. Spleen qi deficiency pattern can include the pattern of clear yang failing to ascend, whereas the pattern of clear yang failing to ascend is only a part of the spleen qi deficiency pattern. In terms of disease cause, the pattern of clear yang failing to ascend is often caused by irregular diet, excessive overstrain, injury to the spleen and stomach, or chronic illness damaging the spleen. Due to spleen-stomach weakness and insufficient middle qi, clear yang fails to ascend and cannot nourish the brain and the seven orifices, leading to symptoms such as dizziness, blurred vision, mental confusion, tinnitus, and deafness. Spleen qi deficiency pattern is also caused by irregular diet, internal damage from overstrain, and injury to the spleen and stomach. However, spleen qi deficiency pattern is a general term for the symptoms and signs of weakened spleen and stomach function in the middle energizer. It includes dysfunction of the spleen in transportation (such as abdominal distension and fullness, diarrhea with loose stool, and reduced appetite or anorexia), insufficient middle qi (such as a sallow and dull complexion, pale or dark lips, shortness of breath, low voice, reduced appetite, and fatigue), clear yang failing to ascend (such as vertigo, tinnitus, deafness, and mental confusion), sinking of middle qi (such as rectal prolapse, chronic diarrhea, and uterine prolapse), and spleen failing to control blood (such as menorrhagia and metrostaxis, bloody stool), among other syndromes. The pattern of clear yang failing to ascend, however, only refers to the symptoms caused by insufficient middle qi and the spleen's failure to lift and clear, which can be used for differentiation.

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bubble_chart Documentation

1. Suwen-Yinyang Yingxiang Da Lun: "Clear yang exits from the upper orifices, turbid yin exits from the lower orifices; clear yang spreads to the striae and interstice, turbid yin travels to the five zang-organs; clear yang strengthens the limbs, turbid yin returns to the six fu organs."
2. Zhengzhi Huibu‧Upper Orifices Section: "The spleen is the central region, it ascends the yang of the heart and lungs, and guards against the yin of the kidneys and liver. If overworked, excessive sweating leads to yang exhaustion, original qi sinks, clear yang fails to ascend, this vertigo arises from insufficient middle qi."
3. Zhengzhi Huibu‧Upper Orifices Section: "Gradual deafness develops over time, and there must be accompanying symptoms to discern." "Laziness in the limbs, vertigo, and poor appetite indicate spleen deficiency." "Middle-Tonifying Qi-Replenishing Decoction treats yang deficiency qi sinking deafness."
4. Zhengzhi Huibu‧Waist and Knees Section: "Qi deficiency atrophy is caused by hunger, stomach qi deficiency leads to lung qi deficiency first, the skeleton and valleys all lose nourishment, hence the tendons relax and the joints become empty. Weakness in the hands and feet after illness in general is due to qi deficiency. It is said that when the spleen is diseased, it cannot transport body fluids for the stomach, the limbs do not receive the essence of water and grain, and thus become useless, it is appropriate to tonify the middle and replenish qi."
5. Zhengzhi Huibu‧Lower Orifices Section: "When stomach qi is harmonious, food enters the stomach, essential qi is transported to the spleen, returns to the lungs, circulates through the hundred vessels to form nutrient-defense. If internal and external pathogens from diet and lifestyle injure the spleen and stomach, transmission and transformation are disordered, clear and turbid are not separated, the ascending essence qi descends instead, leading to diarrhea."
6. Shenzhai Yishu‧Dizziness: "The head is the leader of all yang, dizziness in patients is due to clear yang not ascending, heaviness of the head unable to lift is due to yang deficiency unable to support."
7. Duyi Suibi‧Discussion on Ascending, Descending, Exiting, and Entering: "Heart and lung yang follow stomach qi to descend to the right, descending transforms into yin; liver and kidney yin follow spleen qi to ascend to the left, ascending transforms into yang."