JOURNAL OF CHINESE MEDICINE NUMBER 4 7 JANUARY 1995

            Differentiation and Treatment
                                                  by Steven Clavey

          ne of the most interesting things about tradi-          still left gaps which became increasingly obvious to the
          tional Chinese medicine is its intensely practical      practising physician. As medical theory progressed in
          approach to clinical practice. Very little of the       response to this need, one of the most important develop-
basic theory is not applied in the day-to-day interface           ments was the successive delineation of the yin and yang
with patients, and those Chinese working in the field,            functioning of each zang.
from ancient times down to the present, have on the                                    e                  e
                                                                     For example, in th Nei Jing and th Shang Han Lun, only
whole resisted the tendency to theorise to a level of             ‘Kidney qi’ was mentioned1. The terms ‘Kidney Fire’ and
abstraction beyond that which is useful.                                                                           e
                                                                  ‘Kidney Water’ appear only much later. After th Nan Jing
  Even th Yi Jing (Classic of Changes) or the ‘Heavenly
          e                                                       Chapters 36 and 39 described the right Kidney as ming-
Stems and Earthly Branches’ which to us in the West seem          men, this concept of “one (left) Kidney and ming-men on
to border on the mystical or fanciful are seen as simply          the right” continued right up until the Ming dynasty,
more subtle descriptions of our relationship with nature,         when ming-men was amalgamated into (or between) the
and therefor hav their medica applications Zhang
             e      e               l                .            overall functioning of two Kidneys, as fire within water.
Jing-Yue, in hi Jing Yue Quan Shu (Complete Works of
               s                                                                    ,         r            t
                                                                  Zhang Jing-Yue a majo proponen of the ming-men
Jing Yue, 1624), says that “Those who study th Yi Jing
                                                  e               School, said: “Kidneys are two: the outer broken yin lines
without knowing medicine are mystified and think it               of the trigram Kan; ming-men is one, the unbroken yang
unfathomable - but that is only because they do not know          line in the centre” 2.
medicine”. The Heavenly Stems and Earthly Branches, as               Spleen theory too had undergone a similar successive
the basis of the theory of the ‘Five Circuit Phases and Six       development in response to clinical necessity. Prior to the
Energetic Configurations’ (as Porkert calls the Wu Yun            Jin and Yuan dynasties, Spleen yang received most atten-
Liu Qi), are again simply an almanac-like description of          tion; there was little in the literature about ‘Spleen yin’ - at
the type of weather conditions to be expected at different        least in these terms - until after this period. However,
times, and the effects that these - or their alterations - will   recognition of the clinical reality of Spleen yin xu can be
have on the body. As Porkert comments, the usefulness of          traced back to a very early stage.
this system lessens as we move away from its origins in              In the Ling Shu Chapter 20 it says: “A pathogen in the
geography and time, but it is still seen as applicable in the     Spleen and Stomach will lead to pain in the muscles and
context of the treatment of shi bing/seasonal illnesses - at      flesh; if the yang qi is excessive and the yin qi insufficient,
least within China.                                               there will be epigastric heat and excessive hunger”. This
  The foregoing remarks are apropos because o the  f              refers to excessive Stomach yang and deficient Spleen yin.
remarkably consistent reaction from TCM practitioners                                  y
                                                                     In the Han dynast Shang Han Lun, Zhang Zhong-Jing
when the topic of this article was brought up: “What!             describes the Pi yue/bound Spleen syndrome (Wiseman’s
Spleen yin xu!? What’s the point of that”? Well, it is true       “splenic jam”) with its symptoms of dry constipation,
that in many cases there may be little point in differenti-       profuse urination and deep rapid or choppy pulse. In this
ating Spleen yin xu from Stomach yin xu. They are very            condition, excessive Stomach heat not only damages the
similar in location, aetiology and manifestation, and with        jin fluids of the Stomach and Intestines, but the strong
certain treatment modalities the management of each is            Stomach heat yue/binds the weak Spleen and prevents it
almost identical. When using herbs, however, and espe-            from fulfilling its function of transporting Stomach’s jin-
cially in those cases where the middle jiao is the major          ye fluids. The essence of food and fluids is both exhausted
focus of pathology, such a differentiation may turn a             by the heat, and also forced out of the body before it can
clumsy ‘shotgun’ approach into a much more elegant and            be transported by the Spleen to the other organs and
effective treatment.                                              tissues, leading to the profuse urination and deep rapid
                                                                  pulse. Not only are the other organs deprived of moisture,
  Historical factors influencing the concept                      the Spleen itself loses nourishment, becoming ever more
                 of Spleen yin                                    yin deficient. As Cheng Jiao-Qian, a Qing dynasty com-
The early historical stages of the description of zang/                           e
                                                                  mentator on th Shang Han Lun, remarks:
organ physiological functioning, while relatively detailed,          In the bound Spleen condition, Spleen’s yin is leached


  out, there is no ye-fluid to moisten. The Spleen itself is     Physiology of yin fluids in the Spleen and
  the first to dry and wither, how can it provide extra yin                      Stomach
  shade for the Intestines and Stomach? Thus the Stomach        Spleen
  fire is excessive and the Intestines parched, the stool       The Spleen is yin earth, storing jing qi without letting it
  becomes hard and pellet-like.                                 leak away, and its qi rises. Spleen yin is the pasty viscous
 So the treatment uses:                                         ying ye/nutritious liquid derived by transformation from
  Ma Zi Ren Wan (Hemp Seed Pill) to broaden the Intes-          food and fluids. The function of this liquid is to pour into
  tines and moisten dryness in order to soften the hard-        and irrigate the zangfu, moistening and nourishing the
  ness, the aim simply being to make Spleen yin pass on         flesh and muscles; it is also the material substrate from
  internally [rather than pass out externally] 3.                     h         n                   d
                                                                whic Splee yang is supporte and transformed It            .
Zhou Yan (1832-1905) agrees saying Ma Zi Ren Wan                supports and assists digestive and distributive activities,
"primarily enhances Spleen yin to transform parched qi”;        and houses yi/thought ( ) .e   Th Ling Shu Chapter 8 says:
and Huo Ma Ren (Semen Cannabis Sativae) can “enter the          “Spleen stores ying, ying houses yi”.
Spleen to moisten its yin jin-fluids 4.                            The Spleen as the taiyin damp earth can only move
  Thus, as these commentators show, the understanding           when activated by yang. Its transportation and transfor-
of Spleen yin has deepened since the Ming and Qing              mation function is most harmonious when yin and yang
dynasties. The fact that it is not yet a major part of TCM                    ,                           :
                                                                act together and thus the statement “The Splee by        n
theory however can probably be attributed to the empha-         nature prefers firm dryness, and its ti/form ( ) is yin
sis placed on the tonification of Spleen yang by Li Dong-       while its yong/function ( ) is yang”. Tang Rong-Chuan
Yuan in hi Pi Wei Lun (Treatise on Spleen and Stomach)          in the Xue Zheng Lun (Discussion of Bleeding Disorders,
and the tremendous influence this had on later genera-          1884) discusses the tonification of Spleen yin extensively,
tions of Chinese doctors, who tended to use the “sweet          noting in one location:
warm” tonifying approach in dealing with Spleen prob-              The regulating treatment of Spleen and Stomach re-
lems, whether this was indicated or not, a situation which         quires differentiating yin and yang. Since the time of Li
led Wang Lun (Ming dynasty author of th Ben Cao Ji Yao,            Dong-Yuan, those emphasising the Spleen and Stom-
1496) to sigh with frustration:                                    ach only know they should tonify Spleen yang, and do
  Nowadays those who discuss the treatment of Spleen               not know the moistening nourishment of Spleen yin.
  and Stomach never distinguish yin, yang, qi and blood,           When Spleen yang is deficient, food and fluids of course
  instead all just “regulate the Stomach”! The herbs they          do not transform; when Spleen yin is insufficient, food
  use, furthermore, are all pungent warm, parching and                      s
                                                                   and fluid still do not transform. It is just like cooking
  hot, the prescriptions helping fire to desiccate yin, caus-      rice on a stove: without fire underneath, it will never
  ing Stomach fire to become ever more overbearing and             cook - but if there is no water in the pot it will not cook
  Spleen yin ever more damaged. The clear pure harmo-              either!7
  nious qi of the centre changes to a parching heat, the        Stomach
  epigastric area dries and withers, the Large Intestine        The Stomach is yang earth, changing and moving mate-
  parches and knots, and the Spleen zang edges toward           rial without holding on to it, and its qi descends. Stomach
  extinction5.                                                  yin refers to the watery jin-fluid and jing/essence which
  A further obfuscation of the importance of Spleen yin         moisten the Stomach fu. It permeates and moistens the
resulted from the rise of the Warm Disease school and Ye        food taken in and held in the Stomach for ‘ripening’, and
Tian-Shi’s forceful advocacy of the Stomach yin xu theory,      these yin fluids are the material substrate from which
which in fact was overly broad in terms of symptoms and         Stomach yang is supported and transformed. Together
aetiology. Analysis of his case histories shows that many       with the Stomach yang these fluids ensure that the func-
Spleen yin xu cases were diagnosed as Stomach yin xu,           tions of intake, holding, warming and ripening occur
although the treatments do show an unspoken differen-           harmoniously.
tiation between Stomach yin xu and Spleen yin xu6.                        h               g
                                                                   Stomac is yangmin dry earth and its downward
  Nonetheless the tidal force of the Warm Disease school’s      moving qi settles peacefully when balanced by yin; thus
innovative redirection of the theoretical trend in TCM has      it is said “The Stomach by nature enjoys soft moistness,
lasted several centuries, so that even today “Spleen yin        and its form is yang while its function is yin”.
xu” as an individual condition separate from the concept
of Stomach yin xu is a topic that can barely get a hearing.            Integrated functions of the Spleen
                                                                                  and Stomach
         The present state of the Spleen                        The Spleen and Stomach are both located in the ‘Central
                 yin xu concept                                 Prefecture’ - the middle jiao - and are connected by a
The following sections will examine the physiology, pa-         membrane (Pi yu Wei lian mo                     ).
thology, differentiation and treatment of both Spleen yin         The Spleen extracts and lifts the clear subtle essence
xu and Stomach yin xu, concentrating however on the             derived from the food and fluids held in the Stomach, and
former, since the latter has already had more than enough       distributes the jin-ye fluids for the Stomach. Stomach qi
press.                                                               s              ,
                                                                move downwards carrying the turbid qi and other
                                                                       l           g                s         n
                                                                materia remainin after Spleen’ extractio has been

                                               JOURNAL OF CHINESE MEDICINE NUMBER 4 7 JANUARY 1995

Thus the middle jiao forms the axis for the rise and fall of      • red tongue (especially in the centre) with sparse coating
         n            ,        d
qi withi the body powere by the lifting actio of           n      • rapid thready pulse.
Kidney yang and Liver wood on the one hand, and the
descending nature of Lung metal on the other. Th Si   e
                                                                                      Spleen yin xu
Sheng Xin Yuan (‘Secret Sources of the Four Masters’,             The yin in this case refers to blood, yin essence, and the
1753) says:                                                       nourishing ying yin in the Spleen channel, together known
  Middle qi is the axis of ascent and descent for yin and         as ‘the yin-natured ye-fluids which are stored without
  yang, and so is called earth. The movement of the axis          being passed out’. The Spleen is called the damp earth,
  is from the spiralling ascent of clear qi on the left - which   symbolising the nourishment provided by the blood and
  transform into Fire - and the spirallin descen of
             s                                  g          t      essence to ‘the ten thousand things’. Spleen yin xu will
  turbid qi on the right - which transforms into water. Yin       have the following symptoms most in evidence:
  originates above. The Stomach from [the position of]            • trouble digesting the food that is eaten
  pure yang enfolds [incipient] yin qi; having this yin it        • easily full after eating a small amount
  then descends. The descent of turbid qi thus creates a          • bloating and feelings of uncomfortable fullness after
  lack of clear qi above and produces an appetite for food.         eating
  Yang originates below. The Spleen from [the position            • loss of taste discrimination
  of] pure yin enfolds [incipient] yang qi; having yang it        • dry lips and possibly ulceration of the mouth
  ascends. The ascent of yang qi thus warms and facili-           • loss of lustrous complexion
  tates digestion8.                                               • difficulty putting on weight, wasting of the flesh and
This ascending-descendin relationshi is also exten-
                           g                p                       emaciation
sively discussed in Li Dong-Yuan’ Pi Wei Lun (Treatise
                                   s                              • bowel movements varying between slow and loose
on the Spleen and Stomach).                                       • lack of strength in the limbs
                                                                  • restless heat in the hands and feet
    Pathology: the source of the deficiency                       • tender red tongue body, with at least the middle of the
Under normal circumstances, the different physiological             tongue coating peeled or scanty
functions discussed above assist and complement each              • thready rapid and weak pulse
other, regulating each other in an active - rather than a
static - balance. Both Spleen and Stomach yin deficiencies
                                                                        Spleen yin xu involving other zang
have in common symptoms of lack of fluids and weak-               Spleen yin xu can be brought on by weakness of yin in
ness of yin.                                                      other zang which drain its moistening nourishment, espe-
  Spleen yin xu however usually results from long term            cially if the Spleen is itself weak and unable to keep up
internal depletion, and its main manifestations will be           with the demand. If the other zang are strong, however,
those of poor transformation and poor distribution of the         Spleen weakness can still gradually fail to provide the yin
subtle essence from food and fluids, involving lack of            nourishment they need and so the yin fluids of the other
moistening nourishment for the Spleen itself and its re-          zang also suffer.
lated body areas, channels, collaterals and sense organs;           For example, palpitations and irregular pulse can result
and reduced efficiency of the Spleen’s functions of trans-        from lack of blood and ying/nutritive energy failing to fill
portation and transformation, containing blood within             and nourish the vessels of the pulse.
the vessels, and the lifting of jing wei/subtle essence             Weak Spleen yin allowing yang fire to ascend may in-
upwards.                                                          volve the Heart, leading to Spleen and Heart yin xu with
  Stomach yin xu, on the other hand, more often results                      s                  ,        a
                                                                  symptom of palpitations insomni and disturbing
from recent exogenous febrile disease, and manifests as           dreams.
reduced intake and acceptance of food, with impaired                It may also dry the Lungs leading to symptoms of dry
moistening and descent, and even failure to descend at all,       cough with little phlegm or some phlegm with streaks of
with the resultant upward rebellion of Stomach qi caus-           blood and a dry parched throat.
ing nausea and constipation. This will affect the Intes-            If the Spleen yin weakness has affected the Liver, there
tines, the related channels and collaterals, and the body         may be symptoms of vertigo, dryness of the eyes, blurry
areas related to the Stomach.                                     vision and dull pain in the flanks, and the activity of the
                                                                  tendons may be limited.
        Symptoms of Spleen yin xu and                               Similarly the ‘true yin’ of the Kidneys will gradually be
              Stomach yin xu                                      depleted through interruption of the supplementation by
Symptoms in common:                                               Spleen yin, resulting in weakness of the lower back and
• disordered digestion                                            knees, darkish scanty urine, and symptoms of xu fire.
• dry mouth
• easily quenched thirst                                                             Stomach yin xu
• low grade fever                                                 This is an exhaustion of the Stomach yin fluids, the jin-
• sensations of burning in the epigastric and abdominal           fluids which are ‘passed along without storage’, causing
  areas                                                           an inability of the Stomach to hold food and fluids in order
• disordered bowel movements                                      to ‘mature’, ‘ripen’ and ‘ferment’ them. Clinically, consti-
• possible ulceration of the mouth and tongue                     tutional wood and fire types of people, and those who


have had febrile diseases or parching fire conditions, are      Failure of the intake and acceptance of food
most likely to suffer depletion of Stomach yin.                 If the patient has sensations of hunger - sometimes quite
  Stomach yin xu will have the following symptoms most          marked hunger - but cannot accept food, this is a Stomach
in evidence:                                                    problem: despite the hunger they do not feel like eating or
• thirst but not insatiable thirst                              may even have an aversion to food. There may also be
• hunger but inability to eat much                              epigastric burning and cao za/indefinable epigastric dis-
• burning of the epigastric area                                comfort (Wiseman’s “clamoring stomach”), and a red
• cao za/indefinable epigastric discomfort                      tongue with little coating. The deficient fire causes the
• dry heaves                                                    frequent hunger, but the xu prevents the patient from
• hiccoughs                                                     ‘accepting and holding’ the food due to lack of yin fluids.
• nausea                                                        Disruption of ascent and descent
• possibly sour regurgitation                                   Descent but lack of ascent indicates a Spleen disorder,
• constipation with dry stool                                   manifesting as dry mouth and tongue, often found to-
• swelling and pain of the gums                                 gether with loose stool.
             e                     ,       y
• red tongu with little coating possibl gloss and  y               If there is ascent but poor descent, this is a Stomach
  mirror-like                                                   disorder, manifesting as nausea, dry heaves or vomiting,
• thready rapid pulse                                           and constipation.
                                                                   Other aspects of functioning can also help to determine
         Differentiation of Spleen and                          the location to be the Spleen, such as slack muscle weak-
                Stomach yin xu                                  ness or withering of the limbs or the flesh, lack of saliva,
It is not always a simple matter to differentiate Spleen yin    dry lips and skin, or bleeding difficulties such as bruising
xu from Stomach yin xu, and in many cases they are found        easily (which in my experience responds well to tonifying
inter-linked. The situation is complicated by several fac-      any pattern of Spleen deficiency)
                             ,           f
tors: i. as noted previously most o the ancien texts t          b) Differentiation according to the aetiological or the
discuss weakness of the Spleen and Stomach together,                              pathological mechanism
without differentiating the strengths and weaknesses of                          l                   l         s
                                                                The aetiologica and pathologica factor involve in        d
each; ii. pathogenic heat, cold, damp and phlegm can give       Spleen yin xu are more complex than those of the Stomach
rise to symptoms which are similar to those of deficiency,      and are usually seen in the context of i. chronic diseases,
and these need to be eliminated as causative agents in          ii. constitutional yin deficiencies, or iii. emotional distur-
one’s differential diagnosis. To make matters worse, such       bances which either prevent Liver qi from assisting Spleen
pathogens will usually co-exist with some degree of defi-       transport or have turned to fire and insidiously exhausted
ciency. All of this complicates the clinical situation, and     the essential yin. Any or all of these can adversely influ-
the tendency to simply put the whole thing down to              ence the transportation and transformation of the Spleen,
‘Spleen and Stomach weakness’ becomes a highly attrac-          manifesting with such symptoms as reduced ability to
tive proposition in a busy practice. However focusing           taste or enjoy food, and becoming easily full after eating
even a small amount of attention on differentiating the         a small amount.
relative deficiencies of Spleen and Stomach will quite             Stomach yin xu, on the other hand, is frequently the
quickly yield both enhanced understanding of the physi-         result of an acute febrile disease damaging body fluids, or
ology and pathology of the middle jiao, and vastly im-                      e                 ,               n
                                                                intemperat eating habits or medicatio such as hot
proved results in treatment. That is, the more one tries, the   parching pungent herbs. Also, because Stomach is yang
better one becomes, and the situation turns from frustrat-      earth, it easily becomes overbearing, hot and parching to
ing to challenging, and then to satisfyingly enjoyable.         the jin/fluids, causing symptoms such as thirst and con-
The differentiation can be approached from three aspects:       stipation with dry stool.
                    n           g           n
   a) Differentiatio accordin to Splee and Stomach                    c) Differentiation according to the length and
physiology.                                                                        severity of the disease
   b) Differentiation according to the aetiological or the      Relatively speaking, Stomach yin xu is usually of shorter
pathological mechanism.                                         duration and less severe, and if treated early enough the
   c) Differentiation according to the length and severity of   fluids of the Stomach can be restored quite quickly.
the disease.                                                             n                 e     n          n
                                                                   Splee yin xu is mor ofte seen i generalise xu        d
    a) Differentiation according to the physiological           syndromes of longer duration, and is more serious, taking
         functioning of the Spleen and Stomach                  longer to completely restore to normal.
The location of the problem can be determined by identi-           The rule of thumb is therefore: short term = Stomach;
fying which functions of digestion and distribution are         long term = Spleen.
failing to operate efficiently, as detailed below:                 Both are yin xu conditions, but the yin exhaustion is
Acceptance of food but failure to transform                     more evident when the Spleen is involved. The treatment
If the patient has a normal appetite but the food does not      of Spleen yin xu is likewise more lengthy and complicated
digest well, then this indicates a Spleen problem: the          than that of Stomach yin xu, because Spleen yin xu in-
patient becomes bloated after eating even a small amount,       volves not only Spleen’s jin/fluids, but also the yin blood.
with epigastric discomfort, and eventually there will be a         If one remembers to apply the above three aspects of
reduction in appetite and loss of taste.                        differentiation in clinical practice, the task of differentiat-

                                               JOURNAL OF CHINESE MEDICINE NUMBER 4 7 JANUARY 1995

ing between Spleen yin xu and Stomach yin xu becomes              Huo Ma Ren (Semen Cannabis Sativae)
much easier.                                                      He Ye (Folium Nelumbinis Nuciferae)
                                                                  Ge Gen (Radix Puerariae)
 Treatment of Spleen and Stomach Yin Xu                           E Jiao (Gelatinum Asini)
In general, the treatment of Spleen yin xu emphasises             Xuan Shen (Radix Scrophulariae Ningpoensis)
restoration of yin while harmonising ying/nutritive qi,           Honey
strengthening the Spleen and nourishing ye/fluids. The           These herbs also tonify Spleen qi as well as yin:
treatment of Stomach yin xu emphasises replenishment              Shan Yao (Radix Dioscoreae Oppositae)
of the jin/fluids, cooling heat and harmonising the Stom-         Bai Bian Dou (Semen Dolichoris Lablab)
ach.                                                              Ren Shen (Radix Ginseng)
                                                                  Xi Yang Shen (Radix Panacis Quinquefolii)
           Treatment of Spleen yin xu                             Tai Zi Shen (Radix Pseudostellariae Heterophyllae)
The overall direction for Spleen yin tonification can be          Huang Jing (Rhizoma Polygonati)
found as early as th Su Wen (Chapter Ten): “The Spleen            Dang Shen (Radix Codonopsis Pilosulae)
       s              .           s
desire sweetness” The herb used shoul therefore d                 Yi Yi Ren (Semen Coicis Lachryma-jobi)
mainly be sweet, as “sweet herbs guard the centre”. Sweet         Hong Zao (Fructus Zizyphi Jujubae)
herbs, though, have different categories: there are sweet
warm, sweet cool, sweet cold and sweet bland types. In             Analysis of a typical Spleen yin formula
the Pi Wei Lun Li Dong-Yuan focused on Spleen yang xu            One of the best formulas for Spleen yin tonification that I
and lack of middle qi ascent, saying: “Use sweet warm to         have yet seen comes from Dr. Yu Chang-Hui9. He calls it
tonify the centre and lift its yang”. In the Wen Re Lun, Ye      Yi Pi Tang (Benefit the Spleen Decoction) and its constitu-
Tian-Shi said: “Quickly use sweet cool moistening things”        ents are as follows:
which is aimed at recent Stomach yin damage from a                 Yi Pi Tang (Benefit the Spleen Decoction)
febrile pathogen.                                                  Tai Zi Shen (Radix Pseudostellariae Heterophyllae) 12g
   In Spleen yin xu, however, the best is sweet and bland.         Fu Ling (Sclerotium Poriae Cocos) 9g
This is because if Spleen yin is weak, sweet can restore and       Bai Zhu (Rhizoma Atractylodis Macrocephalae) 9g
tonify, but the Spleen also abhors turbid damp, which              Jie Geng (Radix Platycodi Grandiflori) 3g
bland can leach out. Thus sweet and bland in combination           Shan Yao (Radix Dioscoreae Oppositae) 9g
can restore that which is deficient and eliminate a possible       Lian Zi Rou (Semen Nelumbinis Nuciferae) 9g
build-up of damp due to the previous weakness of the               Yi Yi Ren (Semen Coicis Lachryma-jobi) 9g
Spleen. Herbs of this type are almost all gentle and neutral       Qian Shi (Semen Euryales Ferox) 6g
in nature, not cold or greasy which would encourage                Bai Bian Dou (Semen Dolichoris Lablab) 9g
damp, nor warm and parching which might damage yin.                Shi Hu (Herba Dendrobii) 12g
The Su Wen notes: “If one desires to strengthen the Spleen,        Gu Ya (Fructus Oryzae Sativae Germinantus) 9g
do not block the qi, do not sit for long when full, do not eat     Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 3g
      y             ,
overl sour foods do not eat any raw food - sweet  s                                                   f
                                                                 This formula is actually an alteration o Shen Ling Bai Zhu
benefits, as does bland.”                                        San (Ginseng, Poria and Atractylodes Macrocephala Pow-
   Thus herbs used in the treatment of Spleen yin xu             der). Tai Zi Shen is exchanged for Ren Shen (Radix Gin-
should be moistening, sweet neutral, sweet bland, and            seng) and the overly warm and parching Sha Ren (Fructus
gentle. In any formula, Tai Zi Shen (Radix Pseudostellariae                  n         )          n
                                                                 seu Seme Amomi and Che Pi (Pericarpiu Citri       m
Heterophyllae) can be substituted for Ren Shen (Radix                         )               .           t
                                                                 Reticulatae are eliminated The swee bland Spleen
Ginseng) or Dang Shen (Radix Codonopsis Pilosulae),              nourishers Shi Hu and Qian Shi are added instead, along
and Shan Yao (Radix Dioscoreae Oppositae) should be              with Gu Ya to assist Spleen transport.
used in its unprepared form. Herbs which also assist the         Explanation of formula
lifting of Spleen jing/essence are useful additions, such as     • Tai Zi Shen, Shan Yao and Bai Bian Dou moisten and
Ge Gen (Radix Puerariae) and He Ye (Folium Nelumbinis            nourish Spleen yin.
Nuciferae). At the same time, when designing a prescrip-         • Lian Zi and Qian Shi encourage the tonifying consolida-
tion for an individual patient, pay attention to the yang        tion of Spleen yin.
within the yin, and if necessary use both gentle and also        • Yi Yi Ren and Fu Ling are sweet and bland to strengthen
some “hard” herbs like Bai Zhu (Rhizoma Atractylodis             the Spleen while gently leaching damp.
Macrocephalae), tonifying the qi to transform fluids. This       • Jie Geng and Gu Ya lift clear essence and assist Spleen
is also an important method in the restoration of Spleen         transport.
yin.                                                             • Bai Zhu and Zhi Gan Cao are sweet and warm, encour-
   Individual herbs (listed in order of most common us-          aging yang to produce yin.
age) are:                                                        • Shi Hu considers Stomach yin, which will also suffer if
   Shan Yao (Radix Dioscoreae Oppositae)                         Spleen yin is weak.
   Qian Shi (Semen Euryales Ferox)                                 Yi Pi Tang (Benefit the Spleen Decoction), therefore, is
   Lian Zi Rou (Semen Nelumbinis Nuciferae)                      an elegantly designed formula, using gentle sweet neu-
   raw Mai Ya (Fructus Hordei Vulgaris Germinantus)              tral tonics to restore damaged Spleen yin, while combin-
   raw Gu Ya (Fructus Oryzae Sativae Germinantus)                          t             p        s
                                                                 ing swee bland dam leacher and also som sweet     e


warm Spleen tonics to restore normal Spleen functioning.        Spleen yin are both deficient, warm tonification of Spleen
Both the moistening and the contracting aspects of yin are      yang could damage Spleen yin. So Spleen yin should
taken into account. The emphasis is on Spleen yin, since        always be considered and appropriate herbs utilised where
this is the major problem, but significantly the other          necessary. As Yu Chang (zi-name Jia-Yan, 1585 - c.1664,
aspects of Spleen functioning are not ignored - even            author of the Yi Men Fa Lu ‘Precepts for Physicians’) says:
Stomach yin is considered.                                        Although ‘The Spleen likes dryness’, excessive dryness
                                                                  of earth means the grass and woods parch and wither.
          Treatment of Stomach yin xu                             Thus prescriptions to nourish the Spleen must have
Treatment for Stomach yin xu should include sweet cold,           moistening and drying both, each according to need.
sweet cool, and moist yin nourishing herbs. Sour and            Deficiency of both Spleen qi and yin is a similar case
sweet herbs can be combined to form yin, such as Bai Shao       where both need attention. A formula such as Shen Ling
(Radix Paeoniae Lactiflorae) and Gan Cao (Radix                 Bai Zhu San (Ginseng, Poria and Atractylodes Macro-
Glycyrrhizae Uralensis). Wu Mei (Fructus Pruni Mume)            cephala Powder) works well.
produces fluids and preserves yin, and can be assisted by       d) Weak Spleen yin with excessive Stomach yang
Mu Hu Die (Semen Oroxyli Indici) to regulate qi and             In situations such as ‘Middle Wasting Disorder’ (zhong
move blood, so that tonification has no chance of causing       xiao zheng), the pathological mechanism is that of weak
unwanted obstruction.Individual herbs (listed in order of       Spleen yin with excessive Stomach yang. Here the treat-
most common usage)                                              ment must support Spleen yin while suppressing Stom-
  Zhi Mu (Radix Anemarrhenae Asphodeloidis)                     ach yang, with herbs such as Ren Shen (Radix Ginseng),
  Tian Hua Fen (Radix Trichosanthis)                            Sheng Di Huang (Radix Rehmanniae Glutinosae),Shan
  Shi Hu (Herba Dendrobii)                                      Yao (Radix Dioscoreae Oppositae), Sheng Mu Li (raw
  Mai Men Dong (Tuber Ophiopogonis Japonici)                    Concha Ostreae), Mai Men Dong (Tuber Ophiopogonis
  Yu Zhu (Rhizoma Polygonati Odorati)                           Japonici), Tian Hua Fen (Radix Trichosanthis), Zhi Mu
  Lu Gen (Rhizoma Phragmitis Communis)                          (Radix Anemarrhenae Asphodeloidis), Huang Lian
  Sheng Di Huang (Radix Rehmanniae Glutinosae)                  (Rhizoma Coptidis) and Ku Shen (Radix Sophorae
  Bei Sha Shen (Radix Glehniae Littoralis)                      Flavescentis). If qi is deficient as well, Huang Qi (Radix
  Nan Sha Shen (Radix Adenophorae)                              Astragali) can be added.
  Wu Mei (Fructus Pruni Mume)                                   e) Atrophic gastritis
  Bai He (Bulbus Lilii)                                         In disorders such as the bio-medically defined atrophic
  Xi Gua Cui Pi (Pericarpium Citrullus Vulgaris)                gastritis, where there are Stomach yin xu symptoms like
  Juices such as those from pears, sugar cane and lotus         anorexia, epigastric burning pain and discomfort, thirst,
Formulas to nourish Stomach yin are well-documented,            dry mouth and constipation, Yi Wei Tang (Benefit the
and so will not be considered here in detail, but include Yi    Stomach Decoction) plus Shao Yao Gan Cao Tang (Peony
Wei Tang (Benefit the Stomach Decoction), Mai Men Dong          and Licorice Decoction) can be combined, adding sour
Tang (Ophiopogonis Decoction), and Sha Shen Mai Men             herbs such as Wu Mei (Fructus Pruni Mume) and Mu Gua
Dong Tang (Glehnia and Ophiopogonis Decoction).                 (Fructus Chaenomelis Lagenariae) to form yin. This will
                                                                achieve good results in stopping pain and improving the
     Other matters in the treatment of Spleen                   appetite. If nausea is a problem, Zhu Ru (Caulis Bambusae
              and Stomach yin xu                                in Taeniis), Fo Shou Pian (Fructus Citri Sarcodactylis), Bai
Although Spleen and Stomach yin xu may frequently be            Shao (Radix Paeoniae Lactiflorae) and Pi Pa Ye (Folium
treated together instead of separately, there are certain       Eriobotryae Japonicae) can be used.
other related conditions which must be handled with
special consideration:                                                                  Sources
a) Spleen and Stomach yin both deficient, with Spleen           1. The major sources for this article are: “Wei yin xu yu Pi
yang also damaged.                                              yin xu de qubie yu lianxi” (Discrimination and relation
In this case, if cold or cool sweet herbs are used to restore   between deficiency of Stomach-yin and deficiency of
yin, yang may be further damaged. Sweet moisteners can          Spleen-yin), Beijing, Journal of Traditional Chinese Medi-
be used, but they should be of neutral temper.                  cine, 1990, Vol. 31, No. 7, pp.4-10; and “Pi bing yin yang,
b) Stomach yin in late stage damp warm disease                  bu ke pian fei” (Do not ignore yin and yang in Spleen
In the latter stages of a shi wen/damp warm disease,            disease), an article in the book Zhong Yi Li Lun Bian
where the Stomach yin has been depleted by the heat of          (Debates on Theories of Chinese Medicine), edited by Qu
the pathogen, but the warm damp pathogen itself has not         Yue-Yun, Hunan Science and Technology Press, 1990,
been completely eradicated, sweet cold Stomach tonifying        pp.199-207.
herbs will tend to increase the pathogenic damp. Sweet
bland herbs which nourish Spleen and Stomach but also                                 References
leach away damp should be used instead.                           1. Li Zhao-Hua Shen Yu Shen Bing De Zheng Zhi (Syn-
c) Even in Spleen yang xu cases, still consider yin             dromes and Treatment of Kidneys and Kidney Disease),
Often ‘Spleen xu’ is simply treated with ‘Spleen tonics’        Hebei People’s Publishing, 1979, pp. 2-3). Cf. also Zhong
such as Bai Zhu (Rhizoma Atractylodis Macrocephalae)            Yi Li Lun Bian (Debates on Theories of Chinese Medicine),
and other warm parching herbs. But if Spleen yang and           p.200.

                                                JOURNAL OF CHINESE MEDICINE NUMBER 4 7 JANUARY 1995

   2. ibid.
   3. Zhong Yi Li Lun Bian (Debates on Theories of Chinese
Medicine), p.200.
   4. Ben Cao Si Bian Lu (Records of Distinguished Thoughts
in the Materia Medica) by Zhou Yan, 1904; Peoples
Publishing, Beijing, 1982, p.77.
   5 . Quoted inZ hong Yi Li Lun Bian, p. 201. For more about
Wang Lun and hi Collection of the Important Elements in
Pharmaceutics, see Unschuld Medicine in China: A History
of Pharmaceutics, p.119.
   6. For a clear example see Case 66 i Ye Shi Yi An Cun
Zhen Shu Zhu (Annotated True Cases of Ye Tian-Shi), by
Peng Xian-Zhang, 1937; Sichuan Science and Technology
Press, 1984, p.95.
   7. Xue Zheng Lun (Discussion of Bleeding Disorders),
Tang Rong-Chuan, 1884; Shanghai Science and Technol-
ogy Press, 1977, p.25.
   8. Si Sheng Xin Yuan (‘Secret Sources of the Four Mas-
ters’, Huang Yuan-Yu, 1753), quoted in e Pi Wei Lun
Zuan Yao (A Compilation of the Essential Discussions on
the Spleen and Stomach), Shaanxi TCM College, Shaanxi
Science and Technology Press, 1986, p.6).
   In the second paragraph, there occurs the interesting
phrase “Wei yi chun yang er han yin qi ... Pi yi chun yin er
han yang qi” (                                                 ).
My rather insipid translation is “Stomach from pure yang
enfolds yin qi” and so on fails to convey its multi-level
associations, expanded upon briefly below:
   In terms of the middl Jiao, the Stomac hold the h      s
        n              e                    h
positio of suprem yang from whic yin descen is              t
engendered, while Spleen holds the position of supreme
yin from which yang ascent springs. It is here, in the
central prefecture, that all of the ascent and descent of qi
within the body has its axis. It is difficult in English to find
an exact equivalent of the word “han” ( ) in this expres-
sion. It is usually translated “contain”, but here its picto-
rial representation of “holding in the mouth” carries rich
implications of the holding of the seed of yin within the
round fullness of extreme yang, and yang within extreme
yin: hidden for the moment - but pregnant with inevitable
   In order to understand the ‘left’, ‘right’, ‘above’ and
‘below’ discussed in the first paragraph, the reader should
refer to the Five Phases diagram with Earth in the middle.
For an extensive discussion of this, see my forthcoming
Fluid Physiology and Pathology in Chinese Medicine, Chapter
One, to be published by Churchill-Livingstone early 1995.
   9. Formula with slightly different analysis found in
Zhong Yi Li Lun Bian (Debates on Theories of Chinese
Medicine), edited by Qu Yue-Yun, Hunan Science and
Technology Press, 1990, p.205.

Steven Clavey qualified as a physician of Chinese gynaecology
at the Zhejiang College of TCM after spending 5 years in
Taiwan and 2 years in Mainland China. He has been practising
      e        l
Chines herba gynaecology in Melbourne Australia since
1986. He is the author of the forthcomin Fluid Physiology and
Pathology in Chinese Medicine to be published by Churchill
Livingstone in early 1995.


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