Yang deficiency pattern, also known as pattern of deficiency cold, refers to a general term for a series of clinical manifestations caused by insufficient yang qi and functional decline, leading to a failure in warming. This syndrome is often caused by congenital deficiencies, prolonged illness, physical weakness, or damage to yang by cold pathogens. The yang deficiency pattern discussed here refers to the overall insufficiency of yang qi in the body, which is interconnected with the yang deficiency pattern of the heart, spleen, kidney, and other zang-fu organs. The yang deficiency pattern with prominent symptoms of specific zang-fu organs is described separately in the respective yang deficiency pattern of those organs.

The main clinical manifestations of yang deficiency pattern include: fear of cold, cold limbs, pale complexion, fatigue and lack of strength, shortness of breath and reluctance to speak, spontaneous sweating, bland taste in the mouth without thirst, clear and abundant urine, loose stools, pale tongue texture, and a weak, slow, or deep and feeble pulse.

Yang deficiency pattern is commonly seen in diseases such as "edema," "diarrhea," "palpitation," and "deficiency fatigue."

In clinical practice, this syndrome should be differentiated from "qi deficiency pattern," "internal pattern of pathogenic cold coagulation," and "pattern of true heat with false cold."

bubble_chart Differentiation and Treatment

Yang deficiency pattern can be seen in various diseases.

1. In diarrhea disease, the appearance of yang deficiency pattern is often due to chronic diarrhea damaging the spleen and stomach yang, leading to impaired transportation and transformation, or due to insufficient kidney yang and decline of life gate fire. The main manifestations include abdominal fear of cold, borborygmus abdominal pain, loose and thin stools, and a deep, thin, and weak pulse. Treatment should focus on warming yang to stop diarrhea. For spleen and stomach yang deficiency, Middle-Regulating Decoction(Shanghan Lun) is selected, while for kidney yang deficiency, Four Miracle Pill(Zhengzhi Zhunsheng) is used.
2. If yang deficiency pattern appears in disease with edema, it is often due to spleen yang failing to transport, leading to water-dampness not being transformed, or due to insufficient kidney yang and dysfunction of qi transformation. The main manifestations include severe swelling below the waist, which is difficult to rebound when pressed, cold limbs, mental fatigue, scanty urine, a pale and fat tongue with a white and slippery coating, and a deep, thin pulse. Treatment should focus on warming yang and excreting water. For spleen yang deficiency, Spleen-Strengthening Decoction(Jisheng Fang) is selected, while for kidney yang deficiency, True Warrior Decoction(Shanghan Lun) is used.
3. If yang deficiency pattern appears in palpitation disease, it is often due to insufficient heart yang. The main manifestations include palpitation, dizziness, cold body and limbs, mental fatigue, lack of strength, a white tongue coating, and a thin, weak, and rapid pulse. Treatment should focus on invigorating heart yang, and Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction(Shanghan Lun) is selected. If yang deficiency pattern appears in deficiency fatigue disease, it is often due to insufficient spleen yang leading to impaired transportation and transformation, or due to insufficient kidney yang and decline of life gate fire. The main manifestations include fear of cold, cold limbs, fatigue, shortage of qi, loose stools, a pale tongue with a white coating, and a weak pulse. Treatment should focus on warming yang and supporting the right. For spleen yang deficiency, Yang-Saving and Overstrain-Curing Decoction(Yizong Bidu) is selected, while for kidney yang deficiency, Right-Restoring Pill(Jingyue Quanshu) is used.

In the evolution of yang deficiency pattern, two situations often arise:

• 1. Yin and yang mutually generate each other. Prolonged yang deficiency can damage yin, leading to pattern of both yin and yang deficiency, which manifests as fear of cold, cold limbs, fatigue, and lack of strength due to yang deficiency, as well as tidal fever, night sweats, and vexing heat in the chest, palms, and soles due to yin deficiency.
• 2. Insufficient yang qi leads to impaired transportation and transformation, resulting in turbid yin abdominal mass, water-dampness obstruction, phlegm-fluid retention, and static blood.

bubble_chart Differentiation of Similar Patterns

1. Qi deficiency pattern and Yang deficiency pattern: Qi deficiency pattern originally falls within the scope of Yang deficiency pattern. The further development of Qi deficiency pattern leads to Yang deficiency pattern. Qi deficiency pattern is caused by congenital insufficiency, postnatal malnutrition, prolonged illness damaging Qi, and other reasons. Due to Qi deficiency, the functions of the Zang-Fu organs are not robust, and the clinical manifestations mainly include fatigue, lack of strength, shortness of Qi, reluctance to speak, dizziness, blurred vision, spontaneous sweating, pale tongue, weak and feeble pulse, and other symptoms. Yang deficiency pattern, in addition to having the same disease causes as Qi deficiency pattern, can also be caused by exposure to cold pathogens, excessive consumption of raw and cold foods, injury to Yang Qi, and other reasons, and can also develop from Qi deficiency pattern. Due to insufficient Yang Qi, the whole body lacks warmth, and clinically, in addition to the manifestations of Qi deficiency pattern, there are also symptoms of fear of cold, cold limbs, slow pulse, and other manifestations of insufficient Yang Qi and failure to warm. The key points for differentiation from Qi deficiency pattern are the presence of fear of cold, cold limbs, slow pulse, and other cold signs.
2. Internal pattern of pathogenic cold coagulation and Yang deficiency pattern: Internal pattern of pathogenic cold coagulation is generally referred to as pattern of pathogenic cold coagulation, and Yang deficiency pattern is also known as pattern of deficiency cold. Both syndromes have cold signs such as aversion to cold, cold limbs, bland taste in the mouth, absence of thirst, and pale complexion. Pattern of pathogenic cold coagulation is caused by excessive cold pathogens invading the body and obstructing Yang Qi, manifesting as aversion to cold, cold limbs, bland taste in the mouth, absence of thirst, pale complexion, abdominal pain with tenderness, constipation, thick white tongue coating, and a tight and forceful pulse. The difference between pattern of pathogenic cold coagulation and Yang deficiency pattern is that the former does not have symptoms of fatigue, lack of strength, shortness of Qi, reluctance to speak, spontaneous sweating, and other signs of Yang Qi deficiency, but instead presents with abdominal pain with tenderness, constipation, thick white tongue coating, and a tight and forceful pulse, which are manifestations of excess pattern.
3. Pattern of true heat with false cold and Yang deficiency pattern: Both syndromes have external cold manifestations such as cold limbs and fear of cold. In pattern of true heat with false cold, the cold limbs and fear of cold are caused by excessive internal heat, with Yang Qi blocked internally and unable to reach the limbs and surface of the body. Although the body fears cold, it does not desire to be near clothing or blankets, and there are also manifestations of thirst with a preference for cold drinks, scanty and dark urine, dry stool, red tongue with yellow coating, and a slippery and rapid pulse, which are signs of internal heat pattern. In contrast, Yang deficiency pattern presents with a series of cold symptoms, and the pulse is deep and slow, which are key points for differentiation.

bubble_chart Documentation

1. Jingyue Quanshu‧sweating syndrome: "…spontaneous sweating night sweat, each also has yin-yang syndromes, it cannot be said that spontaneous sweating must belong to yang deficiency, night sweat must belong to yin deficiency. However, yin-yang are different, how to distinguish them? It is said: only observe whether there is fire or not, then whether it is yin or yang, it can be seen naturally. For those who sweat due to excessive fire, it is known as yin deficiency due to fire scorching yin. For those who sweat without fire, it is known as yang deficiency due to insecurity of exterior qi. Knowing these two, the essence of sweating is fully understood, and the methods of treatment can also be grasped."
2. Yixue Zhengzhuan‧Medical Questions: "It is said that yang deficiency is the deficiency of the original yang of the heart meridian, its disease is mostly aversion to cold, blaming the lack of fire, the treatment method is to add Wu, Fu and other medicines in qi tonic, in severe cases, Sanjian Tang, Zhengyang San and the like."