bubble_chart Concept

Spleen-stomach yang deficiency pattern, also known as middle energizer yang deficiency pattern or spleen-stomach yang deficiency pattern, refers to a clinical manifestation characterized by middle energizer yang deficiency, impaired digestion and transportation, leading to undigested food, internal retention of dampness, and yang qi failing to warm the zang-fu organs and extremities. It is often caused by excessive consumption of cold or raw foods, overuse of cold medications, prolonged illness with poor nourishment, or insufficient kidney yang, resulting in the spleen losing its warmth.

The main clinical manifestations of this syndrome include: epigastric and abdominal cold pain, vomiting of clear fluid or phlegm, reduced appetite, borborygmus, abdominal pain, diarrhea with undigested food, cold limbs, fatigue, pale or sallow complexion, dizziness, pale lips, a swollen and tender tongue with a white or slippery coating, and a weak or deep-thin pulse.

Spleen-stomach yang deficiency pattern is commonly seen in conditions such as "deficiency fatigue," "epigastric pain," "abdominal pain," "vomiting," "hiccup," "regurgitation," "diarrhea," "dysentery," "bloody stool," "edema," and "fluid retention pattern."

This syndrome should typically be differentiated from "spleen qi deficiency pattern," "spleen-kidney yang deficiency pattern," and "spleen yang obstruction pattern."

bubble_chart Differentiation and Treatment

Spleen-stomach yang deficiency pattern, due to yang deficiency leading to cold, is also referred to as "spleen-stomach yang deficiency pattern." Examples include cold-type stomachache and cold-type abdominal pain. Although the clinical manifestations of this syndrome share common features, each also has its own characteristic symptoms, and the treatment methods, while similar, have differences that require careful differentiation.

1. For instance, in cases of deficiency fatigue with spleen-stomach yang deficiency pattern, the symptoms include a pale yellow complexion, reduced appetite, cold body, mental fatigue, lack of strength, shortness of breath, reluctance to speak, cold pain in the abdomen, borborygmus, diarrhea, a pale tongue with white coating, and a faint, thin pulse. Hua Tuo Zhongcang Jing states: "The spleen corresponds to earth, and its illness manifests as a pale yellow complexion." This is caused by spleen-stomach yang deficiency, leading to poor digestion and distribution of nutrients, resulting in a lack of source for generation and transformation, zang - fu organs Jingmai losing nourishment. Treatment involves warming the middle and strengthening the spleen, using Aconite Middle-Regulating Decoction (Hejiju Fang ) with modifications.
2. In cases of abdominal pain or epigastric pain with spleen-stomach yang deficiency pattern, the pain is persistent, relieved by warmth and pressure, worsens with hunger or fatigue, and improves with eating or rest. Abdominal pain is characterized by lower abdominal pain and loose stools, while epigastric pain is marked by poor appetite, vomiting of clear fluid, and cold hands and feet. These are all due to spleen-stomach yang deficiency and internal cold. Deficiency leads to a preference for pressure, while cold leads to a preference for warmth. Treatment should focus on sweet warming and tonifying deficiency, relieving pain, using Astragalus Center-Fortifying Decoction (Jingui Yaolue ) with modifications.
3. In hiccup disease with spleen-stomach yang deficiency pattern, the hiccups are low and weak, with shortness of breath, pale complexion, and cold extremities, caused by spleen-stomach yang qi deficiency, lack of source for generation and transformation, abnormal ascending and descending, and stomach qi ascending counterflow. Treatment involves warming and tonifying the spleen and stomach, harmonizing the middle and stopping hiccups, using Middle-Regulating Decoction (from "Cold-Damage Disease Treatise") with added Clove and Evodia.
4. In vomiting with spleen-stomach yang deficiency pattern, vomiting is easily triggered by irregular eating or overexertion, accompanied by dizziness and vomiting, due to spleen-stomach deficiency and middle yang weakness. Treatment should focus on tonifying the middle and stopping vomiting, using Six Gentlemen Decoction (Furen Liangfang ) with added Submature Bitter Orange and Bamboo Shavings.
5. In regurgitation with spleen-stomach yang deficiency pattern, symptoms include vomiting food eaten in the morning in the evening and vice versa, with undigested food, due to spleen-stomach yang deficiency and lack of stomach fire. Treatment involves warming the middle and strengthening the spleen, descending counterflow and harmonizing the stomach, using Middle-Regulating Decoction (from "Cold-Damage Disease Treatise") with modifications.
6. In diarrhea disease with spleen-stomach yang deficiency pattern, symptoms include borborygmus, abdominal pain, increased bowel movements, undigested food in stool, and even cold pain in the abdomen and diarrhea with undigested food, caused by spleen-stomach yang deficiency, internal cold, and poor digestion. As stated in Zhizhenyao Da Lun : "All thin, clear, and watery discharge is ascribed to cold." Treatment involves warming the middle and dissipating cold, strengthening the spleen and stopping diarrhea, using Middle-Regulating Decoction (from "Cold-Damage Disease Treatise") with added Aconite Lateral Root and Cassia Bark. The "Hejian Six Books. Diarrhea Chapter" notes: "Spleen diarrhea is characterized by abdominal distension and fullness... treat with Jianzhong and Middle-Regulating Decoction."
7. In dysentery with spleen-stomach yang deficiency pattern, symptoms include chronic dysentery, tenesmus, thin stools with white mucus, dull abdominal pain, and cold limbs, caused by spleen-stomach yang deficiency and cold-dampness stagnation in the intestines. Treatment involves warming the middle and strengthening the spleen, using Middle-Regulating Decoction (from "Cold-Damage Disease Treatise") with added Cassia Bark, Aconite Lateral Root, Atractylodes Rhizome, and Cardamom.
8. In disease with edema and spleen-stomach yang deficiency pattern, symptoms include edema in the limbs, mental fatigue, lack of strength, and reduced urine output, caused by middle yang deficiency, spleen dysfunction in transportation, and failure of qi to promote water transformation, leading to water-dampness overflow. Zhang Jing-yue states: "All water-related conditions involve the lungs, spleen, and kidneys... water fears earth, and its control lies in the spleen... spleen deficiency leads to earth's inability to control water and instead being overcome by it." Treatment involves warming and promoting spleen yang, moving qi and promoting water discharge, using Spleen-Strengthening Decoction (Jisheng Fang ) with modifications.
9. In the pattern of fluid retention, spleen-stomach yang deficiency pattern is observed, manifested as fullness in the chest and hypochondrium, a preference for warmth and pressure in the epigastric region, splashing sounds in the stomach, coldness in the back the size of a palm, aversion to drinking water, vomiting of clear saliva, dizziness, palpitations, a white and slippery tongue coating, and a wiry, thin, and slippery pulse. These symptoms are all due to spleen yang deficiency, leading to the accumulation of water in the body that cannot be transformed. Since fluids are yin pathogens, they tend to accumulate when encountering cold and disperse when warmed. The treatment should primarily focus on warming the spleen and resolving retained fluid. Jingui Yaolue states: "For those suffering from phlegm-fluid retention, it should be treated with warm herbs to harmonize." The Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction (from the "Treatise on Cold Damage Diseases") can be used with modifications.
10. In the case of bloody stool with spleen-stomach yang deficiency pattern, the main symptoms include dark purple or black bloody stool, dull abdominal pain, pale complexion, mental fatigue, and cold limbs. This is often caused by deficiency-cold of the spleen and stomach, insufficient middle yang, the spleen's failure to control blood, the failure of qi to control blood, resulting in blood passing with the stool. Chengfang Biandu said: "Once the spleen-earth becomes deficient, it loses its governing power. Thus, when exposed to heat, blood flows recklessly; when exposed to cold, it coagulates and stagnates. Both can cause blood to leave its normal pathways and descend, making the blood restless." Treatment should focus on warming the middle to support yang, nourishing yin, and stopping bleeding. Oven Yellow Earth Decoction (from Jingui Yaolue) can be modified for this purpose.

From the perspective of the zang-fu organs concept of holism, the spleen and stomach are closely related to other zang-fu organs. For example, fluid retention pattern and edema are disorders caused by the dysfunction of the lungs, spleen, and kidneys, each with distinct diagnostic characteristics. Insufficient spleen yang is particularly closely related to the decline of stomach yang. The spleen yang's transformative function relies on the warming assistance of the fire of the life gate, which is referred to as "fire generating earth." If the fire of the life gate declines, cold water from the lower energizer may rise, a condition known as "water counteracting earth." Therefore, spleen-stomach yang deficiency pattern, if prolonged, can also lead to spleen-kidney yang deficiency.

bubble_chart Differentiation of Similar Patterns

1. Spleen qi deficiency pattern and spleen-stomach yang deficiency pattern: Spleen qi deficiency and spleen yang deficiency are very similar in terms of the mechanism of disease and symptoms. Spleen yang deficiency is more severe than spleen qi deficiency, and spleen yang deficiency can be seen as a further development of spleen qi deficiency. Because yang deficiency leads to cold, the cold manifestations in spleen-stomach yang deficiency pattern are more prominent. Spleen qi deficiency syndrome is the most common manifestation of dysfunction of the spleen in transportation, with symptoms such as lack of appetite, fatigue, shortness of breath, lack of strength in the limbs, abdominal distension and fullness, pale tongue, thin white coating, and slow or soggy pulse. Spleen-stomach yang deficiency pattern, in addition to being more severe than spleen qi deficiency pattern, also includes manifestations of yang deficiency generating internal cold, such as cold limbs, loose stools, and clear saliva regurgitation, which are the differences between the two.
2. Spleen-kidney yang deficiency pattern and spleen-stomach yang deficiency pattern: The kidney is the innate foundation, and the spleen is the acquired foundation. The spleen's transportation function relies on the warming assistance of the life gate fire, while the essence stored in the kidney requires the spleen to transport essential qi for nourishment. This is the intrinsic relationship of mutual dependence between the innate and acquired. Prolonged spleen yang deficiency can affect the kidney, and insufficient kidney yang, decline of the life gate fire, and fire failing to generate earth will inevitably lead to spleen yang deficiency. Therefore, spleen-kidney yang deficiency pattern is mostly caused by kidney yang deficiency and the spleen losing its warmth and nourishment. Conversely, prolonged spleen yang deficiency can lead to the inability to transport water and grains, resulting in kidney yang deficiency as well. Spleen-stomach yang deficiency pattern is mainly characterized by dysfunction of the spleen in transportation, stomach failing to receive and transform food, poor appetite, vomiting, diarrhea, abdominal distension and fullness, etc. Spleen-kidney yang deficiency pattern includes symptoms of both kidney yang deficiency and spleen yang deficiency, such as pale complexion, fear of cold, cold limbs, weak breath, undigested food in stool, early morning diarrhea, cold and sore lower back and knees, impotence, edema, swollen tongue, white and slippery coating, and deep, thin, and weak pulse. Spleen-stomach yang deficiency pattern does not include the manifestations of kidney-yang deficiency pattern.
3. Spleen yang obstruction syndrome and spleen-stomach yang deficiency pattern: The spleen has a very close relationship with dampness, such as cold-dampness encumbering the spleen, internal retention of water-dampness, and the spleen failing to transport dampness. Because cold and dampness are both yin pathogens, they easily damage yang, especially obstructing spleen yang. Spleen yang obstruction syndrome is often caused by internal dampness, excessive consumption of raw and cold foods, exposure to rain, or sudden external dampness, all of which can obstruct and damage middle yang. When the spleen is obstructed by dampness, its transportation function is impaired, leading to symptoms such as loss of taste, abdominal fullness, sticky mouth, heavy head and body, aversion to cold, loose stools, white and greasy tongue coating, and soggy pulse. Spleen yang obstruction syndrome is an excess pattern of cold-dampness encumbering the spleen, where spleen yang cannot stretch; while spleen-stomach yang deficiency pattern is a deficiency pattern. Since both syndromes are located in the spleen, and there are differences in deficiency and excess manifestations, the treatment methods should also differ. Spleen-stomach yang deficiency pattern is due to spleen yang not functioning, and should be treated mainly by warming yang, strengthening the spleen, tonifying qi, and harmonizing the stomach, focusing on supporting the healthy qi. Spleen yang obstruction syndrome should be treated mainly by dispersing cold and transforming dampness. Once cold-dampness is removed, spleen yang can stretch, and the symptoms can be resolved, focusing on eliminating pathogens. The differentiation between the two can also be made based on the tongue and pulse. In spleen-stomach yang deficiency pattern, the tongue texture is swollen and pale, and the pulse is weak and thin; in spleen yang obstruction syndrome, the tongue coating is thick and greasy, and the pulse is soggy or slippery. The "Guide to Tongue Differentiation" states: "Differentiating tongue texture can reveal the deficiency and excess of the five zang-organs." This indicates that changes in tongue coating reflect the severity of pathogens and the deficiency and excess of healthy qi. Since there is a difference between deficiency and excess, they can be distinguished.

bubble_chart Documentation

1. Zhubing Yuanhou Lun．five zang and six fu-organs: "Insufficient spleen qi leads to weakness of the limbs, diarrhea, indigestion, vomiting, abdominal distension and fullness, borborygmus, which are signs of spleen qi deficiency."
2. Suwen．Zhizhenyao Da Lun: "All dampness syndromes with swelling and fullness are ascribed to the spleen."
3. 《Bihua Yijing．Spleen Section》: "The spleen belongs to earth, central yellow color, the foundation of postnatal life. It receives the fire of the life gate below to transform and steam food, and transports the fluid of food above to irrigate the zang-fu organs. Therefore, the origin of human survival relies greatly on the function of the spleen earth."