Spleen yang deficiency is also known as spleen yang insufficiency, spleen yang debilitation, and middle yang debilitation. Due to yang deficiency causing cold, it is also referred to as spleen yang deficiency pattern or spleen-stomach yang deficiency pattern. This syndrome is often caused by prolonged illness leading to internal damage to spleen yang, or by sudden depletion of spleen yang.

The main clinical symptoms of spleen yang deficiency pattern are: fear of cold, cold limbs, reduced appetite, cold pain in the epigastric and abdominal regions that prefers warmth and pressure, clear and loose stools, or watery diarrhea, undigested food in stool, or chronic diarrhea and prolonged dysentery, pale complexion, mental fatigue, bland taste in the mouth, preference for hot drinks, or clear saliva regurgitation, or edema, difficulty in urination, or in women, excessive and clear leucorrhea, pale and swollen tongue with possible tooth marks, white and slippery tongue coating, and deep, thin, slow, and weak pulse.

Spleen yang deficiency pattern is commonly seen in diseases such as "diarrhea," "dysentery," "epigastric and abdominal pain," "phlegm-fluid retention," "edema," and "tympanites."

Spleen yang deficiency pattern should be differentiated from "spleen qi deficiency pattern," "pattern of spleen deficiency with dampness encumbrance," "spleen-kidney yang deficiency pattern," and "lung spleen-kidney yang deficiency pattern."

bubble_chart Differentiation and Treatment

Spleen yang deficiency pattern appears in many diseases. Although all exhibit symptoms of internal cold due to the decline of middle energizer yang qi, the specific manifestations vary across different diseases, and so do the treatment methods.

1. If diarrhea presents with spleen yang deficiency pattern, it may result from sudden watery diarrhea, which rapidly depletes spleen yang; more commonly, it is seen in chronic diarrhea, where prolonged illness, undigested food, and persistent symptoms that fluctuate in severity are accompanied by dull abdominal pain that improves with warmth. This aligns with the statement in Suwen·Discussion on the Correspondence of Visceral Qi to the Seasons: "In spleen diseases, deficiency manifests as abdominal distension and fullness, borborygmus, lienteric diarrhea, and indigestion." This is often caused by inherent spleen-stomach weakness and internal pudendal coldness. Jingyue Quanshu·Diarrhea states: "A weak spleen is prone to diarrhea due to deficiency, and diarrhea further exacerbates the deficiency. If the 'gate' is not secure, qi is lost with diarrhea, leading to yang decline, and cold arises from this decline." Treatment should focus on regulating original qi, warming the middle to strengthen the spleen. When original qi is sufficient and spleen yang is restored, the diarrhea ceases. Formulas such as Yangwei Jian and Wen Stomach Fluid Retention (Jingyue Quanshu) with modifications are used.
2. If excessive consumption of cold foods leads to severe internal pudendal coldness, chilling and freezing spleen yang, resulting in failure of clearing qi to ascend and turbid qi to descend, symptoms include clear and thin diarrhea, abdominal distension and fullness with pain, deep and tight pulse, or persistent vomiting. Treatment should focus on warming the middle and dispelling cold, strengthening the spleen, and tonifying qi. The formula Middle-Regulating Decoction(Shanghan Lun) with modifications is used.
3. If dysentery presents with spleen yang deficiency, it is often due to prolonged dysentery with cold accumulation in the intestines, manifesting as cold abdomen with dull pain, thin stools with mucus, and flare-ups in cold conditions. Treatment should focus on warming the middle and dissipating cold, resolving stagnation. Qianjin Fang·Cold Dysentery states: "For chronic cold dysentery, first use Spleen-Warming Decoction to purge, followed by Spleen-Invigorating Pill to tonify, which is always effective."
4. If epigastric and abdominal pain presents with spleen yang deficiency pattern, it is due to declining middle yang and internal cold accumulation, causing sudden severe pain that improves with warmth and worsens with cold, possibly accompanied by vomiting and inability to eat. Treatment should focus on warming the middle and dissipating cold, allowing the middle energizer to warm and pudendal coldness to dissipate, relieving pain. The formula Aconite and Rice Decoction is used, or in severe cases, Major Center-Fortifying Decoction(Jingui Yaolue).
5. If phlegm-fluid retention presents with spleen yang deficiency pattern, it is due to insufficient spleen yang and failure in qi transformation, leading to fluid retention below the heart, splashing sounds in the stomach, preference for warmth and pressure in the epigastric region, fullness in the chest and hypochondrium, cold back, palpitations, and shortness of breath. Treatment should focus on warming the spleen and resolving retained fluid. Jingui Yaolue·Phlegm-Fluid Retention Cough Disease states: "For shortness of breath with mild fluid retention, it should be eliminated through urination, and Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction is the main treatment."
6. If disease with edema presents with spleen yang deficiency pattern, edema is most severe below the waist, with pitting edema, and difficulty urinating. This is due to insufficient spleen yang and failure of qi to promote water transformation, leading to lower energizer water overflow. Treatment should focus on warming and activating spleen yang to promote water transformation. Jisheng Fang·Edema states: "The treatment method is to first strengthen the spleen; when the spleen is strong, it can control water, and when the earth is in order, swelling will naturally subside." The formula Spleen-Strengthening Decoction(Jisheng Fang) is used.
7. If tympanites presents with spleen yang deficiency pattern, Danxi Xinfa·Tympanites states: "This is due to severe spleen deficiency," with symptoms including significant abdominal distension and fullness, visible veins, difficulty urinating, or lower limb edema. The spleen and stomach are the foundation of postnatal life and the pivot of ascent and descent. When spleen yang is deficient, spleen transportation is impaired, leading to failure of clearing qi to ascend and turbid qi to descend, resulting in tympanites. Treatment should focus on warming and activating spleen yang, warming yang qi to promote diuresis. Linzheng Zhinan Yi'an states: "For cold and deficient distension diseases, warming and tonifying methods are used. Ancient prescriptions emphasize the importance of unblocking methods, as unblocking yang prevents turbid yin from accumulating, while excessive tonification may dull the middle energizer." The formula Tiaozhong Spleen-Invigorating Pill (from "Shen's Zunsheng Shu") is used.

Although spleen yang deficiency pattern is clinically seen in various diseases, its disease cause and mechanism of disease are generally limited to the following situations: First, the spleen and stomach are too weak, initially presenting symptoms of spleen qi deficiency such as anorexia, epigastric distension, loose stools, and mental fatigue. Due to lack of proper care or incorrect treatment, it further develops into spleen yang deficiency. This is commonly seen in the elderly with weak constitutions and children with insufficient innate endowment. In women with spleen yang deficiency pattern, it often manifests as clear and copious leukorrhea. Second, middle energizer spleen-stomach weakness, a preference for cold and cool foods during summer, or improper diet after prolonged illness or major recovery, further damages spleen yang. Sudden injury to spleen yang often also harms stomach yang, commonly presenting with severe epigastric pain and vomiting. Third, cold-damage disease from external contraction, where cold pathogens directly attack the taiyin, presenting symptoms of abdominal distension and fullness, vomiting, and diarrhea. Fourth, initial deficiency of kidney yang, decline of life gate fire, which fails to warm and support the spleen earth, leading to spleen yang deficiency, often accompanied by symptoms of kidney yang deficiency. Fifth, careless treatment, misuse of bitter-cold emetic or purgative drugs, leading to severe vomiting and diarrhea, thereby injuring spleen yang. Each of these situations should be carefully differentiated.

bubble_chart Differentiation of Similar Patterns

1. Spleen qi deficiency pattern and spleen yang deficiency pattern: Although spleen qi deficiency and spleen yang deficiency are of the same nature, they differ in severity, with qi deficiency being mild and yang deficiency being severe. Yang deficiency often develops gradually from qi deficiency. Those with qi deficiency may exhibit cold symptoms but not necessarily yang deficiency, while those with yang deficiency experience cold arising internally and must also have insufficient qi, hence it is called yang qi deficiency. Spleen qi deficiency pattern is solely due to impaired spleen function, leading to weakened digestion and absorption, insufficient distribution of nutrients, and inadequate generation and transformation of qi and blood. Clinically, it manifests mainly as reduced appetite, abdominal distension, loose stools, fatigue, lack of strength, and mental fatigue. Spleen yang deficiency pattern includes the main symptoms of spleen qi deficiency pattern, with varying degrees of aggravation, and must also exhibit yang deficiency symptoms such as cold limbs and fear of cold. Other symptoms like watery diarrhea, undigested food in stool, failure of yang to transform water, and water-dampness stagnation are also common in spleen yang deficiency pattern. Spleen qi deficiency pattern is often caused by improper diet and internal damage from overstrain, while spleen yang deficiency pattern can result from the progressive development of spleen qi deficiency pattern, or from insufficient kidney yang and decline of life gate fire. In summary, qi deficiency pattern does not exhibit cold symptoms, while yang deficiency pattern shows both qi deficiency and cold symptoms, making them distinguishable.
2. Pattern of spleen deficiency with dampness encumbrance and spleen yang deficiency pattern: Spleen deficiency can be either qi deficiency or yang deficiency. When spleen yang deficiency leads to water-dampness stagnation, it is often called pattern of spleen deficiency with dampness encumbrance. Conditions such as phlegm-fluid retention due to internal phlegm-dampness, diarrhea from water-dampness stagnation, and edema from water-dampness accumulation are common. The characteristics of pattern of spleen deficiency with dampness encumbrance are insufficient spleen yang and internal excess of water-dampness. Insufficient yang leads to internal pudendal coldness, and water cannot be transformed into nutrients, instead accumulating as tangible excess pathogens, manifesting as watery diarrhea, phlegm-fluid retention, or edema. This can be due to inherent middle energizer deficiency leading to water-dampness stagnation, or from excessive consumption of cold drinks suddenly damaging spleen yang. In summary, spleen yang deficiency pattern primarily exhibits cold symptoms due to yang deficiency leading to cold, and while it may sometimes include water-dampness stagnation, this is not the main feature. In contrast, pattern of spleen deficiency with dampness encumbrance, in addition to the cold pattern of spleen yang deficiency, primarily features internal excess of water-dampness, which is the main distinguishing feature between the two.
3. Spleen-kidney yang deficiency pattern and spleen yang deficiency pattern: Spleen-kidney yang deficiency pattern is a complex symptom and sign that includes both spleen yang deficiency and kidney yang deficiency. It may occur because spleen yang deficiency fails to nourish kidney yang, affecting the kidneys through the spleen, or due to congenital weakness and insufficient endowment, where kidney yang deficiency fails to warm and nourish spleen yang, affecting the spleen through the kidneys, ultimately damaging both spleen and kidney yang qi. Clinically, spleen-kidney yang deficiency pattern mainly manifests as cold limbs, anorexia, abdominal distension and fullness, chronic diarrhea, diarrhea with undigested food, or diarrhea before dawn, difficulty urinating, generalized edema, cold and sore lower back and knees, impotence, seminal emission, or in women, uterine cold and infertility, pale and swollen tongue with tooth marks, white and slippery tongue coating, and deep, slow, thin, and weak pulse. Its main characteristics are: first, impaired digestion and absorption; second, water-dampness stagnation, as mentioned in Zhubing Yuanhou Lun．"Kidney deficiency cannot properly circulate water qi, and spleen deficiency cannot control water, leading to water qi overflow"; and third, reduced sexual function. In contrast, pure spleen yang deficiency pattern does not include cold and sore lower back and knees or reduced sexual function, making it easy to distinguish.
4. Lung spleen-kidney yang deficiency pattern and spleen yang deficiency pattern: Lung spleen-kidney yang deficiency pattern is caused by lung qi deficiency, spleen yang deficiency, and insufficient kidney qi or kidney yang. It is commonly seen in chronic cough disease with phlegm-fluid retention. Due to chronic cough disease, phlegm and wheezing deplete lung qi, leading to lung qi deficiency, shortness of breath, weak cough and wheezing, weak lung defense, spontaneous sweating, and fear of cold; insufficient spleen yang results in the inability to transform water into body fluids, leading to phlegm-fluid retention, damp phlegm obstructing the lungs, wheezing, stuffiness, and dysfunction of the spleen in transportation, accompanied by symptoms such as poor appetite, abdominal distension, loose stool, fatigue, and lack of strength; insufficient kidney qi or kidney yang leads to prolonged exhalation and short inhalation, shortness of breath, especially upon exertion, along with cold and sore lower back and knees, cold limbs, clear and long urination or enuresis, pale and swollen tongue with tooth marks, and deep, slow, thin, and weak pulse. In summary, prolonged cough and wheezing with severe phlegm-fluid retention are the main manifestations of lung spleen-kidney yang deficiency pattern. Jingyue Quanshu ．"Phlegm-fluid retention" states: "The spleen governs dampness, and when dampness moves, it becomes phlegm. The kidney governs water, and when water overflows, it also becomes phlegm. Therefore, the transformation of phlegm is always related to the spleen, and the root of phlegm is always related to the kidney." Although spleen yang deficiency pattern also has symptoms of internal damp phlegm due to the spleen's inability to resolve dampness, such as clear and abundant phlegm, lung qi and kidney qi may not necessarily be deficient, and there is no manifestation of kidney's failure to receive qi, nor symptoms of kidney qi deficiency such as sore lower back and enuresis. This is the main difference between lung spleen-kidney yang deficiency and spleen yang deficiency pattern.

bubble_chart Documentation

1. Qianjin Fang．Spleen: "Spleen deficiency cold, the pulse on the right hand's guan position shows yin deficiency, which pertains to the Foot Taiyin Meridian. Symptoms such as diarrhea, abdominal distension and fullness, qi counterflow, cholera vomiting, jaundice, restlessness and inability to sleep, borborygmus, are collectively referred to as spleen deficiency cold."
2. Jisheng Fang．On the Treatment of Spleen and Stomach Deficiency and Excess: "The spleen, ... when it is deficient, deficiency gives rise to cold, cold leads to the inability to move the limbs, indigestion, frequent belching and acid regurgitation, or vomiting immediately after eating, or sudden inability to swallow food, abdominal pain and borborygmus, occasional sloppy diarrhea, heavy limbs, constant overthinking, aversion to hearing human voices, dreaming of insufficient food and drink, and a pulse that is deep, thin, and weak, all these are signs of deficiency cold."
3. 《Bihua Medical Mirror．Spleen Section》: "Symptoms of spleen cold, the right guan pulse must be deep and slow, the lips and tongue must be pale, the symptoms include vomiting, diarrhea, white dysentery, abdominal pain, body pain, jaundice, damp swelling, cold limbs, and reversal cold of limbs."