1. Spleen-Stomach Pattern Differentiation

1. Spleen-Stomach Pattern Differentiation

(1) Spleen-Qi Deficiency

Pale complexion, poor appetite, fatigue, and shortness of breath are the basic symptom cluster of this syndrome. If accompanied by edema, abdominal distension, or loose stools, it is called spleen dysfunction; if accompanied by hemoptysis, hematemesis, hematochezia, or epistaxis, it is called spleen non-regulation of blood; if accompanied by drooping eyelids, uterine prolapse, gastric prolapse, or wandering spleen, it is called sinking of middle qi. The treatment for spleen qi deficiency is to strengthen the spleen and tonify qi, with the basic formula being Si Jun Zi Tang (from "Jufang"). For spleen dysfunction, it is recommended to strengthen the spleen and tonify qi, regulate qi and dispel dampness, using Xiang Sha Liu Jun Zi Tang (from "Jufang"); for spleen non-regulation of blood, it is recommended to strengthen the spleen and tonify qi, guiding blood back to the spleen, using Gui Pi Tang (from "Jisheng Fang"); for sinking of middle qi, it is recommended to strengthen the spleen and tonify qi, raise yang and lift sinking, 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, because spleen dysfunction, spleen non-regulation of blood, and sinking of middle qi all stem from spleen qi deficiency.

(2) Spleen-Yang Deficiency

This syndrome develops from spleen qi deficiency, so it still presents with the four symptoms of pale complexion, poor appetite, fatigue, and shortness of breath; however, yang deficiency adds another set of symptoms—cold limbs, spontaneous sweating. Since the spleen is the organ responsible for digestion, when its function is impaired, it leads to abdominal distension, edema, and loose stools. These three aspects combined form the spleen-yang deficiency symptom cluster. The treatment for spleen-yang deficiency is to strengthen the spleen and warm the center, with the basic formula being Li Zhong Tang (from "Shanghan Lun"), which is also similar to the derivation from Si Jun Zi Tang, because spleen-yang deficiency is also a derivative of spleen qi deficiency.

(3) Cold-Damp Stagnation in the Spleen

Headache with chills and fever, fullness and distension in the upper abdomen, nausea and vomiting, intestinal rumbling and diarrhea, slippery and moist pulse—treatment involves releasing the exterior and dispersing cold, as well as aromatic transformation of turbidity, commonly using Huo Xiang Zheng Qi San (from "Jufang"). The spleen is inherently weak; once exposed to wind-cold, internal dampness combines with external cold, resulting in this syndrome. Therefore, the symptom cluster consists of two parts: 1. Headache with chills and fever, slippery and moist pulse (external cold); 2. Fullness and distension in the upper abdomen, nausea and vomiting, intestinal rumbling and abdominal pain (internal dampness).

(4) Spleen-Damp-Heat

Damp-heat combines and stagnates in the spleen, leading to this syndrome. When heat predominates over dampness, high fever, thirst, burning rectum during diarrhea, yellow and greasy tongue coating, and slippery, rapid pulse occur—treatment involves clearing heat and drying dampness, using Ge Gen Qin Lian Tang (from "Jingui Yaolüe"). When dampness predominates over heat, the initial sensation is like being wrapped up, with body heat not rising, abdominal distension, intestinal rumbling and diarrhea, nausea and vomiting—treatment involves clearing heat and removing dampness, as well as aromatic transformation of turbidity, using San Ren Tang (from "Wenbing Tiaobian") and Huo Bu Xia Ling Tang (from "Yiyuan"). When heat predominates over dampness, the situation is urgent (sudden onset and pressing downward are both heat-related); when dampness predominates over heat, the situation is slower (dampness is sticky and hard to eliminate quickly), so the former is characterized by rapid heat mixed with dampness, while the latter is characterized by slow dampness mixed with momentum.

(5) Intense Stomach Fire

Dry mouth, bad breath, oral erosion, toothache and gum swelling, bleeding gums, burning pain in the stomach, red tongue with yellow coating, and rapid pulse—treatment involves clearing stomach fire, using Qing Wei San (by Li Dongyuan). The characteristic of this syndrome lies in the mouth, because the mouth is the orifice of the spleen-stomach and located at the top; when fire rises upward, it directly attacks the mouth, thus forming this syndrome.

(6) Stomach Yin Deficiency

Burning pain in the stomach, dry mouth without drinking, red tongue with little coating, and a fine, rapid pulse. At the same time, there are symptoms of bone-steaming heat, five-heart heat, night sweats—treatment involves nourishing yin and nourishing the stomach, using Yang Wei Tang (by Ye Tianshi) and Sha Shen Mai Men Dong Tang (by Zhang Zhongjing). This syndrome consists of two parts: D. Yin-deficiency symptoms: bone-steaming heat, five-heart heat, night sweats, dry mouth without drinking, red tongue with little coating, and a fine, rapid pulse. The first three symptoms are basic yin-deficiency symptoms, while the last three are general yin-deficiency symptoms. 2. Stomach-heat symptoms: burning pain in the stomach. Although there is stomach heat, it is different from intense stomach fire; the former damages yin due to heat, while the latter intensifies fire due to heat, with fire rising upward causing various oral symptoms.