1. Spleen-Stomach Differentiation

1. Spleen-Stomach Differentiation

(1) Spleen-Stomach Qi Deficiency

Pale complexion, poor appetite, fatigue, and lack of energy are the basic symptoms of this condition. If accompanied by edema, abdominal distension, or loose stools, it is referred to as “spleen failing to transport”; if accompanied by hemoptysis, hematemesis, hematochezia, or epistaxis, it is called “spleen failing to control blood”; and if accompanied by drooping eyelids, uterine prolapse, gastric prolapse, or wandering spleen, it is termed “middle qi descending.” For spleen-stomach qi deficiency, it is advisable to tonify the spleen and replenish qi, using Si Jun Zi Tang (from the “Bureau Formulas”) as the foundational prescription; for spleen failing to transport, tonify the spleen and replenish qi while promoting qi circulation and eliminating dampness, using Xiang Sha Liu Jun Zi Tang (from the “Bureau Formulas”); for spleen failing to control blood, tonify the spleen and replenish qi while guiding blood back to the spleen, using Gui Pi Tang (by Yan Yonghe); and for middle qi descending, tonify the spleen and replenish qi while lifting yang and raising the sinking qi, using Bu Zhong Yi Qi Tang (by Li Dongyuan).

(2) Spleen-Stomach Yang Deficiency

Pale complexion, poor appetite, fatigue, abdominal distension, edema, loose stools, feeling cold, and spontaneous sweating are the basic symptoms of this condition. This syndrome consists of three parts:

① Spleen-stomach yang deficiency develops on the basis of spleen-stomach qi deficiency, so this condition shares the symptoms of pale complexion, poor appetite, and fatigue.

② The spleen is responsible for transportation; when yang is deficient, transportation is impaired, resulting in abdominal distension, edema, and loose stools.

③ Spleen yang deficiency necessarily entails yang-deficiency symptoms, hence the feeling of cold and spontaneous sweating. For spleen-stomach yang deficiency, it is advisable to tonify the spleen and warm the middle jiao, using Li Zhong Tang (by Zhang Zhongjing) or Fu Zi Li Zhong Tang (by Zhang Zhongjing).

(3) Cold-Dampness Trapping the Spleen

Headache with chills and fever, fullness and distension in the epigastric region, nausea and vomiting, intestinal rumbling and diarrhea, and a floating, soft pulse—all call for exterior-releasing, cold-dispelling, and aromatic-decocting therapies, using Huo Xiang Zheng Qi San (from the “Bureau Formulas”). For those with inherently weak spleen-stomach yang, exposure to wind-cold causes internal dampness to combine with external cold, thus forming this syndrome. Therefore, the symptoms of this condition consist of:

• External cold: headache with chills and fever, floating, soft pulse
• Internal dampness: fullness and distension in the epigastric region, nausea and vomiting, intestinal rumbling and diarrhea

(4) Spleen-Stomach Damp-Heat

Damp-heat combines and stagnates in the spleen-stomach, giving rise to this syndrome. If heat predominates over dampness, high fever, thirst, burning diarrhea, yellow greasy tongue coating, and slippery, rapid pulse will appear; in such cases, it is advisable to clear heat and dry dampness, using Ge Gen Qin Lian Tang (by Zhang Zhongjing).

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If dampness predominates over heat, the initial symptoms include feeling wrapped up, body heat not rising, fullness and distension in the epigastric region, nausea and vomiting, and intestinal rumbling and diarrhea; in such cases, aromatic-decocting therapies are recommended, using San Ren Tang (by Zhang Zhongjing) or Huo Pu Xia Ling Tang (from the “Medical Origins”). When heat dominates over dampness, the condition progresses rapidly (sudden onset and downward pressure, all indicative of heat); when dampness dominates over heat, the progression is slower (dampness is sticky and hard to eliminate quickly). Therefore, the former is characterized by heat and rapidity combined with dampness; the latter by dampness and slowness combined with heat.

(5) Excessive Stomach Fire

Dry mouth, bad breath, oral ulcers, toothache and gum swelling, bleeding from gums, burning pain in the epigastric region, red tongue with yellow coating, and rapid pulse—all call for clearing stomach fire and draining excess heat, using Qing Wei San (by Li Dongyuan). The hallmark of this condition lies in the oral cavity, as the mouth is the gateway to the spleen-stomach; moreover, the upper part of the body is where fire tends to ascend, directly reaching the oral cavity and causing dryness, odor, ulcers, swelling, and bleeding—all signs of fiery heat.

(6) Stomach Yin Deficiency

Epigastric burning pain, dry mouth with no desire to drink, red tongue with little coating, and thin, rapid pulse, accompanied by bone-steaming hot flashes, five-heart discomfort, and night sweats—these are the symptoms of stomach Yin deficiency. It is advisable to nourish stomach Yin, using Yang Wei Tang (by Ye Tianshi) or Sha Shen Mai Men Dong Tang (by Zhang Zhongjing). This condition comprises two parts:

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(3) Excessive Heart Fire

Chest discomfort and restlessness, insomnia, red tip of the tongue, and thin, rapid pulse are the basic symptoms of excessive heart fire. If accompanied by oral ulcers and reddish, stinging urine, it indicates that heart fire has spread to the small intestine (organ heat transferring to viscera). Heart fire originates in the chest; when it becomes excessive, the tendency to ascend intensifies, and the basic symptoms are all rooted in this phenomenon. The heart and small intestine are interrelated and connected by meridians; although fire ascends, it can also descend along the meridians to the small intestine. The small intestine is “the official in charge of receiving and transforming substances,” playing a role in separating pure and impure elements. When the small intestine is hot, the urine becomes reddish and stinging. Oral ulcers are caused by the small intestine’s dampness rising upward with the fiery nature of the fire. For excessive heart fire, it is advisable to drain fire and calm the mind, using Huang Lian A Jiao Tang (by Zhang Zhongjing); for heart fire spreading to the small intestine, it is advisable to guide the heat downward, using Dao Chi San (by Qian Yi).

(4) Phlegm Obscuring the Heart Orifice

Confusion of consciousness (restlessness, mania, laughter, speech), slippery pulse, and greasy tongue are the basic symptoms of this condition. It is advisable to dispel phlegm, open the heart orifice, and calm the mind, using Sheng Tie Luo Yin (by Cheng Zhongling). The heart governs the spirit; when the heart orifice is blocked, consciousness becomes confused. The slippery pulse and greasy tongue are manifestations of phlegm, indicating that the blockage of the heart orifice is caused by phlegm.

(5) Blood Stasis in the Heart

Pain in the precordial region, radiating pain to the arms, palpitations and shortness of breath, purple-dark tongue, and a choppy, intermittent pulse are the basic symptoms of this condition. It is advisable to activate blood circulation, resolve stasis, and unblock the flow of yang, using Guan Xin II (by the Beijing Regional Collaborative Group) or Gua Luo Xie Bai Ban Xia Tang (by Zhang Zhongjing). A choppy pulse and a purple-dark tongue indicate blood stasis; precordial pain and palpitations suggest that the site of blood stasis is in the heart.