1. Spleen and Stomach Syndrome Differentiation

1. Spleen and Stomach Syndrome Differentiation

(1) Spleen and Stomach Qi Deficiency

Pale complexion, poor appetite, fatigue, and lack of energy are the basic symptom clusters of this syndrome. If accompanied by edema, abdominal distension, or loose stools, it is referred to as spleen dysfunction; if accompanied by bleeding symptoms such as hemoptysis, hematemesis, hematochezia, or epistaxis, it is called spleen non-transportation of blood; if accompanied by drooping eyelids, uterine prolapse, gastric ptosis, wandering spleen, or other visceral prolapses, it is termed sinking of middle qi. The therapeutic approach for spleen and stomach qi deficiency is to strengthen the spleen and tonify qi, with Si Jun Zi Tang (from "Jufang") as the foundational formula. For spleen dysfunction, it is advisable to strengthen the spleen and tonify qi, regulate qi, and eliminate dampness using Xiang Sha Liu Jun Zi Tang (also from "Jufang"); for spleen non-transportation of blood, strengthen the spleen and tonify qi, guide blood back to the spleen using Gui Pi Tang (from "Jisheng Fang"); for sinking of middle qi, strengthen the spleen and tonify qi, elevate yang, and lift up the sagging qi using Bu Zhong Yi Qi Tang (by Li Dongyuan). Xiang Sha Liu Jun Zi Tang, Gui Pi Tang, and Bu Zhong Yi Qi Tang are all derived from Si Jun Zi Tang, as spleen dysfunction, spleen non-transportation of blood, and sinking of middle qi all stem from spleen and stomach qi deficiency.

(2) Spleen and Stomach Yang Deficiency

This syndrome develops from spleen and stomach qi deficiency, so it still presents with the four basic symptoms of pale complexion, poor appetite, fatigue, and lack of energy. However, when yang is deficient, additional symptoms appear—cold limbs and spontaneous sweating. Since the spleen is the organ responsible for transportation and transformation, its dysfunction leads to abdominal distension, edema, and loose stools. These three symptom clusters combined constitute the syndrome of spleen and stomach yang deficiency. The therapeutic approach for spleen and stomach yang deficiency is to strengthen the spleen and warm the middle jiao, with Lizhong Tang (from "Shanghan Lun") as the foundational formula. This formula is also similar to those derived from Si Jun Zi Tang, as spleen and stomach yang deficiency is likewise a derivative of spleen and stomach qi deficiency.

(3) Cold-Damp Accumulation in the Spleen and Stomach

Headache and fever, abdominal distension, nausea and vomiting, intestinal rumbling and diarrhea, slippery and moist pulse—treatment involves releasing exterior cold, dispelling interior dampness, and aromatizing to transform turbidity, commonly using Huo Xiang Zheng Qi San (from "Jufang"). When the spleen and stomach are inherently weak, once they encounter wind-cold and internal dampness combined with external cold, this syndrome arises. Therefore, the symptom cluster consists of two parts: first, headache and fever, slippery and moist pulse (external cold); second, abdominal distension, nausea and vomiting, intestinal rumbling and abdominal pain (internal dampness).

(4) Spleen and Stomach Damp-Heat

When dampness and heat combine and stagnate in the spleen and stomach, this syndrome emerges. If heat predominates over dampness, there will be high fever, thirst, burning sensation during defecation, yellow and greasy tongue coating, and slippery, rapid pulse—treatment involves clearing heat and drying dampness, using Ge Gen Qin Lian Tang (from "Shanghan Lun"). If dampness predominates over heat, the initial presentation is like being wrapped in something, with body heat not rising, abdominal distension, intestinal rumbling and diarrhea, nausea and vomiting—here, it is advisable to clear heat and remove dampness, aromatize to transform turbidity, using San Ren Tang (from "Wenbing Tiaobian") or Huo Pu Xia Ling Tang (from "Yiyuan"). When heat dominates over dampness, the condition progresses rapidly (sudden onset and downward pressure, all belonging to heat); when dampness dominates over heat, the progression is slower (dampness is sticky and difficult to eliminate quickly). Thus, the former is characterized by rapid heat accompanied by dampness, while the latter is marked by slow dampness accompanied by heat.

(5) Exuberant Stomach Fire

Dry mouth, bad breath, oral erosion, toothache and swollen gums, gingival bleeding, burning sensation in the epigastric region, red tongue with yellow coating, rapid pulse—treatment involves clearing stomach fire and draining excess heat, using Qing Wei San (by Li Dongyuan). The hallmark of this syndrome lies in the oral cavity, as the mouth is the orifice of the spleen and stomach, located at the upper part of the body. When fire rises upward, it directly affects the oral cavity, leading to this syndrome.

(6) Stomach Yin Deficiency

Epigastric burning, dry mouth without drinking, red tongue with little coating, fine and rapid pulse, accompanied by bone-steaming tidal fever, five-heart vexation, night sweats—treatment involves nourishing yin and benefiting the stomach, using Yi Wei Tang (by Ye Tianshi) or Sha Shen Mai Men Dong Tang (by Zhang Zhongjing). This syndrome comprises two parts:

1. Yin-deficiency symptom cluster: bone-steaming tidal fever, five-heart vexation, night sweats, dry mouth without drinking, red tongue with little coating, fine and rapid pulse. The first three symptoms are the basic manifestations of yin deficiency, while the last three are general manifestations of yin deficiency.
2. Stomach-heat symptom cluster: epigastric burning. Although there is stomach heat, it differs from exuberant stomach fire; the former results from heat damaging yin, while the latter arises from heat intensifying fire, with fiery ascent leading to various oral symptoms.

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