The spleen resides in the middle energizer, and spleen qi is also known as middle qi. The pattern of spleen deficiency and sinking of qi is also referred to as qi sinking pattern or pattern of middle qi sinking. Spleen qi governs ascending; if spleen qi deficiency leads to an inability to rise and disperse, or even to sinking without lifting, it can cause the sinking of visceral qi, resulting in symptoms such as chronic diarrhea, menorrhagia and metrostaxis, and prolapse of internal organs, which is known as the pattern of spleen deficiency and sinking of qi. This condition is often caused by excessive fatigue, multiple pregnancies and childbirths in women, or inadequate postpartum care, which injures spleen qi.

Clinically, it mainly manifests as emaciation, pale complexion, shortness of breath, low and timid voice, fatigue and lack of strength, dizziness and blurred vision, or spontaneous sweating. Other symptoms include reduced appetite, abdominal distension and fullness, loose stools, chronic diarrhea, prolonged dysentery, prolapse of the rectum, menorrhagia and metrostaxis, prolapse of the uterus, and a sensation of heaviness below the navel. The tongue may appear pale or with tooth marks, and the pulse is thin and weak.

The pattern of spleen deficiency and sinking of qi is commonly seen in diseases such as "chronic diarrhea," "prolonged dysentery," "menorrhagia and metrostaxis," "prolapse of the rectum," and "prolapse of the uterus."

The pattern of spleen deficiency and sinking of qi should be differentiated from "spleen qi deficiency pattern," "pattern of spleen failing to control blood," or "spleen-kidney yang deficiency pattern."

The pattern of spleen deficiency and sinking of qi, regardless of the disease it appears in, whether diarrhea, dysentery, menorrhagia and metrostaxis, prolapse of the rectum, or prolapse of the uterus, can clinically manifest in two groups of symptoms: one is the manifestations of insufficient spleen qi, where the spleen qi is insufficient, leading to impaired transportation and transformation, insufficient source of transformation in the middle energizer, and further decline in qi and blood, resulting in symptoms such as poor appetite, emaciation, shortness of breath, fatigue, low voice, pale complexion, and dizziness; the other is the manifestations of sinking middle qi, presenting with symptoms such as abdominal distension and sagging, chronic diarrhea, prolonged dysentery, menorrhagia and metrostaxis, prolapse of the rectum, prolapse of the uterus, and visceral prolapse. The treatment should focus on tonifying the spleen and replenishing qi, raising yang and elevating the drooping, using formulas such as Middle-Tonifying Qi-Replenishing Decoction (from Piwei Lun), Raising the Sinking Decoction (from Yixue Zhongzhong Canxilu), and Original-Qi Lifting Decoction (from Jingyue Quanshu).

bubble_chart Differentiation of Similar Patterns

1. Spleen qi deficiency pattern and spleen deficiency sinking syndrome: Spleen qi deficiency leads to weakened transportation and distribution functions, resulting in symptoms such as reduced appetite, epigastric distension, loose stools, fatigue, pale complexion, and emaciation; whereas the pattern of middle qi sinking, in addition to the symptoms of insufficient spleen qi, also includes symptoms of middle qi sinking and failing to rise. Spleen qi deficiency is merely "deficiency with clear yang failing to rise," but spleen deficiency sinking syndrome is "clear yang sinking" and failing to rise ("Ancient and Modern Mingyi Fanglun"). The former is mild while the latter is more severe. Therefore, the severity of the conditions differs, and the mechanism of disease also differs.
2. Spleen-kidney yang deficiency pattern and spleen deficiency sinking syndrome: The key to spleen deficiency sinking syndrome lies in the clear yang of the middle energizer sinking and failing to rise, manifesting as chronic diarrhea, prolonged dysentery, menorrhagia and metrostaxis, and various symptoms of visceral prolapse; although spleen-kidney yang deficiency pattern also includes diarrhea or diarrhea with undigested food, diarrhea before dawn, and even chronic diarrhea, this is due to yang deficiency in the middle and lower energizers, with the key being the decline of the life gate fire in the lower energizer. Therefore, there must be symptoms of yang deficiency, such as fear of cold, cold limbs, cold pain in the lower back, knees, or lower abdomen, difficulty urinating, and even edema, a pale and swollen tongue with tooth marks, and a deep pulse. These can be used for differentiation.
3. Pattern of spleen failing to control blood and spleen deficiency sinking syndrome: Menorrhagia and metrostaxis, bloody stools caused by sinking of middle qi and failure of qi to control blood are the pattern of spleen failing to control blood. In addition, there are bleeding symptoms such as subcutaneous bleeding and gum bleeding caused by failure of qi to control blood. Clinically, it is also called the pattern of spleen failing to control blood. Furthermore, bloody stools formed by insufficient spleen yang, middle energizer deficiency cold, and spleen failing to control blood, with dark purple or black stool, must be accompanied by symptoms of insufficient spleen yang such as fear of cold, cold limbs, pale complexion, mental fatigue, shortness of breath, pale lips and tongue, and a thin and weak pulse, and the course of the disease is usually longer.

bubble_chart Documentation

1. "Shen Zhai's Posthumous Writings: Internal Damage": "Middle Qi is deficient. Middle Qi refers to the empty space at the center of the navel, between the two kidneys. Spleen Qi resides within Middle Qi and relies on it for support, but it is not the same as Middle Qi. Middle Qi is valued for its emptiness, and its ability to remain empty is due to the spleen's ability to transport, allowing Yang Qi to rise and thus maintaining the emptiness in the center. If Spleen Qi sinks, filling and blocking this space, then the root of the zang-fu organs is injured, the pathways for the flow of Qi and blood are obstructed, and illness arises from this."