1. Syndrome of Spleen-Qi deficiency
Manifestations
Main symptoms
Poor appetite, fullness in the stomach and distension of the abdomen after eating, soft stool, tiredness and weakness of the limbs. These symptoms start and get worse under conditions of changing diet or after taking heavy food.
Secondary symptoms
Heaviness of the limbs, sallow complexion, prolapse of the internal organs (e.g. uterus, stomach and rectum), large amount of leukorrhea, edema, heavy menstruation, poor concentration or inability to study and memorize things.
Tongue
Pale tongue (may be flabby with teeth marks in a chronic severe case) with a thin white coating.
Pulse
Weak or soft in general.
Associated disorders in western medicine
Chronic diseases and disorders of digestion, metabolism and immune function, such as chronic gastric ulcer, duodenal ulcer, food allergy and intolerance, hypotension, hypoglycemia, hypothyroidism, diabetes, chronic fatigue syndrome and prolapse of organs.
Analysis of the syndrome
Weakness of Spleen-Qi is often seen in people who have a poor constitution or suffer from chronic diseases, have the wrong diet or have been taking medication for too long. It is often seen in elderly people.
• When Spleen-Qi is impaired, the function of transportation and transformation of the Spleen is disturbed. Patients may have poor appetite (even nausea and vomiting) when the Stomach-Qi is unable to descend.
• Soft stool (even diarrhea) may appear when the Spleen-Qi sinks instead of rising.
• Since the wrong diet or heavy food places an extra burden on the Spleen and Stomach, these symptoms may start or get worse in these conditions.
• Since the Spleen controls the muscles, Spleen-Qi deficiency may weaken the strength of the muscles and cause tiredness, heaviness of the limbs and prolapse of the internal organs.
• When the Qi is too weak to push the water to circulate in the body, there may be edema, diarrhea or a feeling of heaviness in the body.
• When Spleen-Qi is not able to control circulation of blood in the blood vessels, a large bleed that is light in color may occur.
• When Spleen-Qi is not able to control transportation of the food essence, leakage may present, manifested as a large amount of leukorrhea, unstable plasma glucose and glucose, and protein or blood in the urine.
• A pale tongue with tooth marks indicates Qi deficiency in the Middle-Jiao, and the tongue coating shows the degree of accumulation, damp-phlegm, damp-heat or phlegm-heat. A soft or weak pulse obviously indicates deficiency of the Spleen-Qi. If there is accumulation in the Middle-Jiao, a full or forceful pulse may show in the second position on the right side.
Treatment principle: Tonify the Spleen-Qi and regulate the Middle-Jiao
Herb selection principles and formula composition strategies
• First, herbs that enter the Spleen and Lung meridians and have the function of tonifying the Spleen-Qi are selected.
• Second, herbs that regulate the Qi movement and water metabolism in the Middle-Jiao, and therefore strengthen the function and reduce the cloying nature of the tonifying herbs, are selected.
• Third, herbs that ascend the Spleen-Qi and herbs that treat the accompanying symptoms are selected.
Structure of the formula and selection of herbs
Chief: Tonify the Spleen-Qi directly
Ren Shen ( Ginseng radix)
Ren Shen is sweet and slightly bitter, and enters the Spleen and Lung meridians. It can strongly tonify the Spleen-Qi and the Source-Qi. It is used as chief in the formula to treat severe conditions of Qi deficiency or critical conditions of Qi collapse. Except for Xi Yang Shen ( Panacis quinquefolii radix), all of the Ren Shen products are warm in nature. It is so strong in tonifying Qi that it can produce warmth in the body, and therefore should be used with caution in patients who suffer from Yin and blood deficiency accompanied by Qi deficiency. In most cases of Spleen-Qi deficiency, especially in chronic conditions, a large dosage of Dang Shen ( Codonopsis radix) is often used as an effective substitute for Ren Shen.
Dang Shen ( Codonopsis radix)
Dang Shen is sweet and neutral, and enters the Spleen and Lung meridians. It is effective for tonifying the Spleen-Qi and the Lung-Qi. Its function is much gentler than that of Ren Shen. The strong point of this herb is that, as it is not heavy and sticky, and does not generate heat and dryness in the body, it is more suitable to be selected in a formula to treat chronic, mild cases of Spleen-Qi and Lung-Qi deficiency. As it can also generate the Yin and body fluids, it is also used for both Qi and Yin deficiency.
Huang Qi ( Astragali radix)
Huang Qi is sweet and warm, and enters the Spleen and Lung meridians. It can strengthen the Middle-Jiao, tonify the Spleen-Qi and thus treat Spleen-Qi deficiency. Compared with Dang Shen ( Codonopsis radix), Huang Qi is sweeter and warmer, and its function of tonifying the Spleen-Qi is stronger. Its specific action is to tonify the Qi, raise the Yang-Qi of the Spleen and strengthen the muscles. It is selected as chief in the formula to treat sinking of Spleen-Qi, which manifests as chronic diarrhea, prolapsed internal organs, weakness and heaviness of the limbs and tiredness. It is also used as chief in formulas that promote wound healing after surgical operations or trauma.
Since Huang Qi can control circulation in the blood vessels, it can be applied as chief in the formula to stop chronic bleeding caused by Spleen-Qi deficiency, such as uterine bleeding, blood in the stool and purpura. As it is also able to tonify the Spleen-Qi and transport the dampness promptly, it can therefore treat edema.
Gan Cao ( Glycyrrhizae radix) and Yi Tang ( Maltose)
Gan Cao is sweet and neutral, and enters all meridians. Yi Tang is sweet and slightly warm, and enters the Spleen meridian. Although they are mild ingredients, they are used in specific conditions as chief in the formula to treat Spleen-Qi deficiency. The moderate tonifying action is the most important characteristic of these two substances. They can be used for mild deficiency of Spleen-Qi, or for chronic conditions of Spleen-Qi deficiency when the body is too weak to bear strong tonification. As sweetness may moderate tension and ease muscles, these substances can be used in a reasonably large dosage to treat acute abdominal cramp and muscular pain due to weakness of the Spleen and attack by the Liver.
Deputy: Tonify the Spleen-Qi; promote Qi movement and water metabolism in the Middle-Jiao
Bai Zhu ( Atractylodis macrocephalae rhizoma)
Bai Zhu is sweet and warm, and enters the Spleen meridian. It can tonify the Spleen-Qi directly and its bitter and warm property can dry dampness. It is often selected as deputy in the formula to enhance the ability of the chief as well as to dry dampness in the Middle-Jiao. It can effectively treat poor appetite, fullness in the stomach, distension in the abdomen, diarrhea and heaviness of the limbs.
Shan Yao ( Dioscoreae rhizoma)
Shan Yao is neutral and sweet, and enters the Spleen meridian. It can either tonify the Spleen-Qi or stabilize the Yin. It is especially selected in the formula as deputy to enhance the ability of the chief to tonify the Qi and treat both Qi and Yin deficiency in the Middle-Jiao. Shan Yao also possesses a slightly astringent property, which is helpful in stopping diarrhea. Furthermore, this herb also enters the Lung and Kidney meridians, and is often applied to tonify and stabilize the Qi and Yin of these organs. The common symptoms are lack of appetite, fatigue, loose stool, shortness of breath, thirst and sweating.
Assistant: Regulate the Middle-Jiao, treat the accompanying symptoms and reduce the side effects of the chief and deputy herbs
Fu Ling ( Poria)
Fu Ling is neutral and bland, and can gently tonify the Spleen-Qi or eliminate dampness in the Middle-Jiao. As the function of Fu Ling is gentle, it can be used for a long period of time in chronic and mild syndromes of Qi deficiency of the Spleen. Moreover, Fu Ling can promote urination and leach out dampness from the Lower-Jiao, and therefore treat leukorrhea or reduce the cloying side effect of the sweet tonifying herbs.
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