1. Spleen and Stomach Differentiation

1. Spleen and Stomach Differentiation

(1) Spleen and Stomach Qi Deficiency

Pale complexion, poor appetite, fatigue, and lack of energy are the basic symptoms of this syndrome. If accompanied by edema, abdominal distention, or loose stools, it is called spleen dysfunction; if accompanied by hemoptysis, hematemesis, hematochezia, or epistaxis, it is called spleen non-coordination of blood; if accompanied by drooping eyelids, uterine prolapse, gastric prolapse, or wandering spleen, it is called sinking of middle qi. For spleen and stomach qi deficiency, it is advisable to strengthen the spleen and invigorate qi, using Sijunzi Tang (from "Jufang") as the base formula; for spleen dysfunction, it is advisable to strengthen the spleen and invigorate qi while promoting qi circulation and eliminating dampness, using Xiangsha Liu Junzi Tang (from "Jufang"); for spleen non-coordination of blood, it is advisable to strengthen the spleen and invigorate qi while guiding blood back to the spleen, using Guipi Tang (by Yan Yonghe); for sinking of middle qi, it is advisable to strengthen the spleen and invigorate qi while lifting yang and raising qi, using Buzhong Yiqi Tang (by Li Dongyuan).

(2) Spleen and Stomach Yang Deficiency

Pale complexion, poor appetite, fatigue, abdominal distention, edema, loose stools, sensitivity to cold, and spontaneous sweating are the basic symptoms of this syndrome. This syndrome consists of three parts: ① Spleen and stomach yang deficiency develops on the basis of spleen and stomach qi deficiency, so this syndrome also exhibits pale complexion, poor appetite, and fatigue. ② The spleen is responsible for digestion, and when yang is deficient, digestion is impaired, resulting in abdominal distention, edema, and loose stools. ③ Spleen yang deficiency inevitably involves symptoms of yang deficiency, such as sensitivity to cold and spontaneous sweating. For spleen and stomach yang deficiency, it is advisable to strengthen the spleen and warm the middle jiao, using Lizhong Tang (by Zhang Zhongjing) or Fuzi Lizhong Tang (by Zhang Zhongjing).

(3) Cold-Dampness Trapping in the Spleen and Stomach

Headache and chills, abdominal distention and fullness, nausea and vomiting, intestinal rumbling and diarrhea, and a floating, moist pulse—these are the symptoms of this syndrome. It is advisable to dispel cold and scatter dampness, using Huoxiang Zhengqi San (from "Jufang"). Those with inherently weak spleen and stomach tend to catch wind-cold, and the combination of internal dampness and external cold leads to this syndrome. Therefore, this syndrome consists of two parts: ① Headache and chills, along with a floating, moist pulse (external cold). ② Abdominal distention, nausea and vomiting, intestinal rumbling and diarrhea (internal dampness).

(4) Spleen and Stomach Damp-Heat

Damp-heat combines and stagnates in the spleen and stomach, leading to this syndrome. If heat predominates over dampness, there will be high fever, thirst, burning rectum during diarrhea, yellow and greasy tongue coating, and slippery, rapid pulse—then it is advisable to clear heat and dry dampness, using Gegen Qinlian Tang (by Zhang Zhongjing). If dampness predominates over heat, the initial symptoms will be heaviness, lack of warmth, abdominal distention, nausea and vomiting, and intestinal rumbling and diarrhea—then it is advisable to disperse dampness and clear heat, using Sanren Tang (by Zhang Zhongjing) or Huopu Xialing Tang (from "Yiyuan"). When heat dominates, the condition progresses rapidly (violent attacks, all belonging to heat); when dampness dominates, the condition progresses slowly (dampness is sticky and hard to get rid of). Therefore, the former is characterized by heat and rapid progression, while the latter is characterized by dampness and slow progression.

(5) Exuberant Stomach Fire

Dry mouth, bad breath, oral erosion, toothache and gum swelling, gingival bleeding, burning sensation in the abdomen, red tongue with yellow coating, and rapid pulse—these are the symptoms of this syndrome. It is advisable to clear stomach fire and drain excess heat, using Qingwei San (by Li Dongyuan). The characteristic of this syndrome lies in the mouth, because the mouth is the orifice of the spleen and stomach; moreover, since the fire tends to rise upward, it directly attacks the mouth, causing dryness, bad breath, erosion, swelling, and bleeding—all signs of excessive fire.

(6) Stomach Yin Deficiency

Burning sensation in the stomach, dry mouth without drinking, red tongue with little coating, fine and rapid pulse, accompanied by bone-steaming hot flashes, five-heart heat, and night sweats—these are the symptoms of this syndrome. It is advisable to nourish stomach yin, using Yangwei Tang (by Ye Tianshi) or Shashen Maimendong Tang (by Zhang Zhongjing). This syndrome consists of two parts: ① Yin deficiency symptoms: bone-steaming hot flashes, five-heart heat, night sweats, dry mouth without drinking, red tongue with little coating, and fine and rapid pulse. ② Stomach heat symptoms: burning sensation in the stomach. Although it is stomach heat, it is different from exuberant stomach fire. This syndrome damages yin due to heat, so it does not have the fiery upward surge that causes oral symptoms.