bubble_chart Concept

Stomach qi deficiency pattern is a summary of the clinical symptoms caused by insufficient stomach qi, weakened functions of receiving and decomposing water and grains, leading to the failure of stomach qi to descend. It is often caused by dietary irregularities, overstrain and deficiency damage, or excessive vomiting and diarrhea that injure stomach qi.

The main clinical manifestations include: dull pain in the epigastric region, which is alleviated by pressure, lack of appetite, or difficulty in digesting food after eating, or vomiting after eating, often accompanied by symptoms such as shortness of qi, reluctance to speak, faint low voice, and shallow yellow complexion. The tongue texture is pale with a white coating, and the pulse is weak.

Stomach qi deficiency pattern is commonly seen in diseases such as "epigastric pain," "epigastric upset," "hiccup," "belching," "vomiting," "deficiency fatigue," and "morning sickness."

Stomach qi deficiency pattern should usually be differentiated from "spleen qi deficiency pattern," "stomach yang deficiency pattern," "pattern of middle qi insufficiency," and "pattern of liver qi invading the stomach."

bubble_chart Differentiation and Treatment

Stomach qi deficiency pattern can occur in various diseases, and due to the differences in diseases, its clinical characteristics also vary.

1. For example, in the initial stage of epigastric pain, it is mostly an excess pattern (such as liver qi invading the stomach, external pathogens, or phlegm-fluid retention stagnating in the stomach, etc.). Over time, it damages the healthy qi, and the stomach qi is impaired, often leading to stomach qi deficiency pattern. Its characteristics include prolonged epigastric pain, dull pain that worsens on an empty stomach, alleviated slightly after eating, relieved by pressure, pale tongue, and weak pulse, which are caused by the weakness of stomach qi and the lack of warmth and nourishment in the Jingmai. The treatment should focus on tonifying stomach qi, and the formula used is Astragalus Center-Fortifying Decoction (Jingui Yaolue).
2. In the condition of epigastric upset, stomach qi deficiency pattern manifests as a sensation of hunger without actual hunger, a sensation of pain without actual pain, a feeling of restlessness in the stomach that is hard to describe, bland taste in the mouth, nausea, vomiting, and other symptoms. This is caused by the weakness of stomach qi, impaired digestion, failure of turbid yin to descend, and stagnation of phlegm-fluid retention. As stated in "Bihua Yijing, Volume 2": "Epigastric upset is characterized by restlessness, temporary relief after eating, shortness of breath, and reduced appetite, which is due to middle deficiency accompanied by phlegm." The treatment should focus on invigorating the spleen and harmonizing the stomach, and the formula used is Extraordinary Efficacy Powder (Xiao'er Yaozheng Zhijue).
3. Stomach qi deficiency pattern can also appear in hiccup disease, manifesting as low and weak hiccups, shortness of breath, faint and low voice, and lack of appetite. This is caused by insufficient stomach qi, failure of qi to descend harmoniously, and rebellion of qi upwards. Zhubing Yuanhou Lun states in the section on vomiting diseases: "When the spleen and stomach are both deficient and affected by wind pathogens, newly ingested food cannot be transformed and transported in the stomach. The qi of the food interacts with the newly ingested food, causing stomach qi to rebel, and stomach rebellion leads to spleen distension and qi counterflow. When exposed to cold, hiccups occur." The treatment should focus on tonifying the stomach and harmonizing the middle to stop hiccups, and the formula used is Six Gentlemen Decoction (Furen Liangfang) with modifications.
4. If stomach qi deficiency pattern appears in belching disease, it manifests as persistent belching without food odor, epigastric stuffiness, and a preference for rubbing and pressure. This is caused by damage to the middle qi due to sweating, vomiting, or purging, leading to weak stomach qi, food stagnation, and stomach qi ascending counterflow. Leizheng Zhicai states in the section on vomiting: "When stomach deficiency causes guest qi to rebel upwards, leading to belching and a desire to vomit, use salty substances to soften stuffiness and heavy substances to descend counterflow." The treatment should focus on tonifying deficiency and descending counterflow, and the formula used is Inula and Hematite Decoction ("Cold-Damage Disease Treatise").
5. If stomach qi deficiency pattern appears in vomiting disease, it manifests as vomiting clear fluid, or vomiting easily when food is slightly inappropriate, anorexia, or loose stools. This is caused by spleen-stomach weakness and abnormal ascending and descending functions. Yixue Zhengzhuan states in the section on vomiting: "When pestilent qi is deficient for a long time and stomach qi is severely weakened, the smell of food causes vomiting and hiccups." This explains the characteristics of this syndrome. The treatment should focus on invigorating the spleen and harmonizing the stomach, and the formula used is Middle-Regulating Decoction ("Cold-Damage Disease Treatise") with modifications.
6. In deficiency fatigue disease, stomach qi deficiency pattern manifests as emaciation, shallow yellow complexion, anorexia, fatigue, lack of strength, faint and low voice, and shortness of breath with reluctance to speak. This is caused by spleen-stomach weakness and insufficient production of qi and blood. Zhubing Yuanhou Lun states in the section on deficiency fatigue diseases: "The spleen governs the muscles of the body, and the stomach is the sea of water and grain. Deficiency fatigue leads to disharmony of the zang-fu organs, and weak spleen and stomach qi, resulting in inability to eat." The treatment should focus on tonifying the spleen and stomach, and the formula used is Four Gentlemen Decoction (Hejiju Fang) with modifications.
7. Additionally, stomach qi deficiency pattern can also be seen in gynecological morning sickness, characterized by nausea and vomiting in the early stages of pregnancy, or vomiting immediately after eating, aversion to the smell of food, lack of appetite, pale tongue, and slippery and slow pulse. This is caused by inherent stomach qi deficiency, which worsens after pregnancy as qi and blood gather to nourish the fetus, leading to further deficiency of stomach qi, failure of harmonious descending, and rebellion of qi along the Chong vessel. Zhubing Yuanhou Lun states: "Morning sickness is often seen in those with weak stomach qi accompanied by stagnation." The treatment should focus on strengthening the spleen and harmonizing the middle, descending counterflow to stop vomiting, and the formula used is Cyperus, Amomum and Six Gentlemen Decoction (Zhangshi Yitong).

Stomach qi deficiency pattern can occur in any season and affect people of all ages and genders, but it is more common in those with irregular diets or inherent weakness. In children, stomach qi deficiency pattern mainly manifests as reduced appetite, picky eating, or lack of appetite, and emaciation.

The stomach is known as the "sea of water and grain," primarily responsible for receiving and decomposing food and water. Its qi flows downward, working in tandem with the spleen, collectively referred to as the "root of postnatal life" and the "source of qi and blood generation and transformation." In the progression of its disease mechanism, insufficient stomach qi and weakened digestive functions often lead to spleen qi deficiency, resulting in a state of spleen-stomach weakness. Due to this weakness, the source of qi and blood generation and transformation becomes insufficient, easily leading to symptoms of qi and blood deficiency. Clinically, this manifests as a pale or sallow complexion, fatigue, shortness of breath, reluctance to speak, tired limbs, dizziness, a pale tongue, and a weak pulse. Additionally, weak stomach qi can cause turbid yin to fail to descend and qi stagnation, easily leading to the retention of food, phlegm-fluid, and static blood in the middle jiao. This results in symptoms such as distension and pain in the stomach, stabbing pain that resists pressure, stuffiness and discomfort, and vomiting of phlegm and saliva. Furthermore, weak stomach qi prevents the proper descent of qi, leading to continuous vomiting, which not only depletes yin but also damages yang, resulting in a syndrome of both yin and yang deficiency in the stomach. Clinically, this presents as a burning sensation in the stomach, reduced appetite, belching, acid reflux, fatigue, weakness, feverish palms and soles, cold fingers, a red tongue with little or no coating, and a weak pulse, indicating a more severe condition.

bubble_chart Differentiation of Similar Patterns

1. Spleen qi deficiency pattern and stomach qi deficiency pattern: The spleen and stomach belong to the earth element and reside in the middle energizer. The spleen governs transportation and transformation, while the stomach governs reception and decomposition, working together to complete the digestion, absorption, and distribution of food. If the stomach cannot properly receive and decompose food, it will inevitably affect the spleen's transportation function; dysfunction of the spleen in transportation will also affect the stomach's reception and decomposition. Therefore, spleen qi deficiency and stomach qi deficiency often coexist, presenting symptoms of qi deficiency such as a shallow yellow complexion, shortness of breath, reluctance to speak, pale tongue, and weak pulse. However, their mechanisms of disease and clinical features differ. Spleen qi deficiency, with weak transportation function, is characterized by abdominal distension and fullness after eating, loose stools, and edema. Stomach qi deficiency, with weakened reception and decomposition functions, is characterized by dull stomach pain, poor appetite, and difficulty digesting food. Spleen qi should ascend; if spleen qi is deficient and clear yang does not rise, vertigo may occur. Stomach qi governs descending; if stomach qi is deficient, turbid yin does not descend, leading to stomach qi ascending counterflow, resulting in hiccups, belching, nausea, and vomiting. Additionally, the spleen controls blood; if spleen qi is deficient and cannot govern blood, symptoms such as subcutaneous bleeding, menorrhagia, and metrostaxis may occur, distinguishing it from stomach qi deficiency pattern.
2. Stomach yang deficiency pattern and stomach qi deficiency pattern: Qi belongs to yang, and prolonged stomach qi deficiency can develop into stomach yang deficiency. Stomach yang deficiency pattern is often caused by excessive consumption of cold foods or overuse of cold medications, injuring stomach yang, which differs from the causes of stomach qi deficiency pattern. Insufficient stomach yang leads to internal cold, resulting in cold stomach pain, preference for warmth and pressure, fear of cold, and cold limbs; yang deficiency prevents the transformation of fluids, leading to turbid yin rising and causing vomiting of clear fluids. Stomach qi deficiency pattern is mainly characterized by dull stomach pain, poor appetite, or difficulty digesting food, often accompanied by a shallow yellow complexion, shortness of breath, reluctance to speak, and a pale tongue. Stomach yang deficiency pattern typically presents with a deep, slow, and weak pulse, with clear signs of cold; stomach qi deficiency pattern typically presents with a weak pulse without signs of cold, serving as the main distinguishing point.
3. Pattern of middle qi insufficiency and stomach qi deficiency pattern: The spleen is a yin earth organ, preferring dryness and disliking dampness; the stomach is a yang earth organ, preferring moisture and disliking dryness. Spleen qi should ascend, while stomach qi should descend. Middle qi insufficiency is often caused by irregular diet, overwork, excessive thinking, or chronic diarrhea, damaging spleen qi and affecting the stomach. It can also result from stomach qi deficiency, leading to turbid yin not descending and clear yang not rising, damaging spleen qi. Middle qi insufficiency leads to spleen qi deficiency, causing abdominal distension and fullness after eating, loose stools, undigested food in stools, and edema. It also leads to stomach qi deficiency, causing poor appetite, nausea, and vomiting, often accompanied by shortness of breath, reluctance to speak, limb fatigue, mental fatigue, a shallow yellow complexion, and vertigo. Stomach qi deficiency pattern mainly features weakened reception and decomposition functions, without spleen qi deficiency, distinguishing it from middle qi insufficiency. Pattern of middle qi insufficiency may present with a swollen, tender tongue with tooth marks and a slow pulse; stomach qi deficiency pattern typically presents with a pale tongue with white coating and a weak pulse, aiding differentiation.
4. Pattern of liver qi invading the stomach and stomach qi deficiency pattern: The liver governs the free flow of qi, promoting the stomach's decomposition and digestion. Pattern of liver qi invading the stomach is often caused by emotional distress, liver qi stagnation, and impaired free flow of qi, leading to liver qi attacking the stomach. Stomach qi deficiency pattern is often caused by dietary irregularities, overexertion, or excessive vomiting and diarrhea, damaging stomach qi. Liver qi invading the stomach disrupts qi movement, causing stabbing or distending stomach pain radiating to the hypochondriac region; the stomach's failure to descend leads to turbid yin rising, causing poor appetite, belching, acid regurgitation, nausea, and vomiting, often accompanied by depression, irritability, and chest tightness. Stomach qi deficiency with weak qi rising may also cause belching, poor appetite, nausea, and vomiting, but with milder symptoms and characterized by dull stomach pain. Pattern of liver qi invading the stomach typically presents with a normal or red tongue with thin yellow coating and a wiry or rapid pulse, indicating excess; stomach qi deficiency pattern typically presents with a pale tongue with white coating and a weak pulse, indicating deficiency, serving as a distinguishing point.

bubble_chart Documentation

1. Suwen-Yinyang Yingxiang Da Lun: "When the clearing qi aspect is below, it causes diarrhea; when the turbid qi is above, it causes distension and bloating."
2. Zhubing Yuanhou Lun‧five zang and six fu-organs diseases: "The stomach corresponds to earth and dominates in late summer. The Foot Yangming is its meridian, and it is the fu-organ of the spleen. It is the sea of water and grains, and all zang-fu organs receive the qi of water and grains from the stomach. When the qi is excessive, it causes abdominal distension and fullness, which is a sign of stomach qi excess and should be purged. When the stomach qi is insufficient, it causes hunger but inability to accept water and grains, lienteric diarrhea, and vomiting, which is a sign of stomach qi deficiency and should be tonified. When the stomach pulse is excessive, it causes distension; when deficient, it causes diarrhea."
3. Shengji Zonglu‧Volume 47: "It is said that the Foot Yangming stomach meridian and the Foot Taiyin spleen meridian are exterior-interiorly related. Their qi prefers warmth and dislikes cold, and warmth enables the transformation of water and grains. If the qi is insufficient and cold qi takes advantage, it causes the meridian to be cold and unable to rest, aversion to wind, shivering, urgent eyes, constant pain in the abdomen, distension in the flanks, frequent rumbling, alternating cold and heat, dry lips, facial and eye swelling, and inability to eat, all due to stomach deficiency and cold."
4. Piwei Lun‧Discussion on the Prosperity and Decline of the Spleen and Stomach: "Improper diet leads to stomach disease, which causes shortness of breath, reduced spirit, and great heat, sometimes manifesting as fire rising to scorch the face. The Huangdi's Classic of Acupuncture states: "Facial heat is a disease of the Foot Yangming." When the stomach is diseased, the spleen has nothing to receive, and as the spleen is dead yin and does not dominate any season, it also becomes diseased."
5. Bihua Medical Mirror‧Volume 2: "When the stomach is deficient, the lips are pale, and the pulse at the right guan is weak. The symptoms include vomiting, dysphagia, inability to eat, and epigastric pain."
6. Qianzhai Medical Lecture Notes‧zang-fu organs diseases and principles of medication: "Stomach: 1. The sea of water and grains, causing loss of appetite and distension. 2. It should harmonize and descend, causing nausea, vomiting, hiccups, belching, and epigastric pain. 3. As yang earth, it causes epigastric upset, thirst with desire to drink, swift digestion with rapid hunger, and fetid mouth odor. 4. Along the stomach meridian, common symptoms include swollen and painful gums. 5. Exterior-interiorly related to the spleen, spleen weakness causes indigestion."