Spleen Pattern Differentiation in Chinese Medicine

• Spleen Qi Deficiency
• Spleen Yang Deficiency
• Spleen Qi Sinking
• Spleen Unable Control Blood
• Damp Cold Invading the Spleen
• Damp-Heat Invading the Spleen

Etiology of Spleen Patterns

1. Mental factors

   Excessive thinking, studying, concentrating, brooding, obsessing, etc. weakens Spleen.

2. Diet

   Very important. Spleen likes foods that are warm (in energy & temperature) e.g. meat, pepper, ginger, orange peel, kumquat, and dry foods.

   Excessive consumption of Cold foods (in temperature & energy) will impair Spleen function of transformation/transportation and cause interior Dampness & digestive problems.

   In addition, eating in a hurry, when stressed or upset, skipping meals and eating poor quality food all significantly weaken Spleen Qi.

   NOTE: further reading on the energy of foods according to TCM:
   The Tao of Healthy Eating - Bob Flaws

3. Exogenous Pathogens

   Spleen hates Dampness: can be invaded by Exogenous Dampness. Dampness can invade when people live in damp places, remain in wet clothes after running or swimming, wade in water or work in watery areas.

   Women are very prone to invasion of exogenous Dampness during menstruation and after childbirth.

   Exterior Dampness can combine with Heat or Cold.

Spleen Qi Deficiency

Signs:

NO Appetite	Spleen Qi weak
Abdominal distention after eating	Impairment of Spleen's transformation & transportation function
FATIGUE, lassitude, weakness of limbs	Spleen transports food essences to the four limbs
Sallow complexion
LOOSE STOOLS	Impaired transformation/transportation function
If Deficient Spleen Qi leads to Internal Dampness:
Nausea	Dampness obstructs epigastrium & prevents Stomach Qi from descending
Stuffiness of chest & epigastrium	Dampness obstructs chest area
Feeling of heaviness in head and limbs (head in a bag)	Dampness interferes with the clear Yang in the head, obstructs muscles
Tongue: Pale or normal Chronic: swollen sides in the MIDDLE SECTION only of the Tongue. Very severe cases have swollen sides with transverse cracks)	Spleen area of Tongue
Coating: thin, white sticky, greasy	Deficient Spleen Qi Dampness
Pulse: Empty	Deficiency

Etiology/Pathology:

1. Diet
   Excessive Cold and raw foods deplete the Spleen Qi.
   Irregular/excessive eating
   Eating too little in general or not enough protein.
2. Mental Strain
   Excessive thinking over long time (common in students & business people).
   Especially bad if discuss work over lunch or hurry lunch and rush back to work.
3. Climate
   Prolonged exposure to damp weather or damp house weakens Spleen
4. Chronic Disease
   Tends to weaken Spleen (which is the root of Postnatal Jing and is hence overworked trying to restore health).

This pattern forms the basis for all other Spleen disharmonies. It is a very common pattern in our culture because of excessive thinking and irregular eating habits.

Treatment Principle:

• Tonify Spleen Qi

Points:

REN-12 (Zhong wan)	Tonifies Spleen Qi
ST-36 (Zu san li)	Tonifies Spleen Qi
SP-3 (Tai bai)	Source point: tonifies Spleen Qi
SP-6 (San Yin jiao)	Tonifies Spleen Qi
BL-20 (Pi shu), BL-21 (Wei shu)	Tonifies Spleen Qi (esp. important combo Tonifies Spleen and Stomach Qi) where the Spleen and Stomach are both chronically Deficient.
Method:	Tonification. Moxa is applicable.

Spleen Yang Deficiency

Signs:

Lack of Appetite
Abdominal distention after eating
FATIGUE
Bright white or sallow complexion	Deficiency
Weakness of the four limbs	Deficient Spleen not sending food essences to limbs
LOOSE STOOLS (often with undigested food)	Deficient Spleen Yang fails to transform digestate
CHILLINESS - Cold LIMBS	Signs of Cold
Edema	Impaired Spleen function of transforming/transporting fluids
Tongue: Pale, swollen, wet	Deficient Yang causes accumulation of untransformed fluids on Tongue.
Pulse: Weak, slow, deep	Deficient Yang

Etiology/Pathology:

As for Spleen Qi Deficiency, or from overeating of Cold and raw foods, or exposure to Cold and Damp environment.

Pathology:

Similar pattern to Spleen Qi Deficiency but has symptoms of Cold because Spleen Yang fails to warm the body.

Treatment Principle:

• Tonify and warm Spleen Yang

Points:

NOTE: If edema or Dampness is present, the following Points are SEDATED:

SP-9 (Yin ling quan), REN-9 (Shui fen)	Resolve Dampness in lower burner
ST-28 (Shui dao), BL-22 (San jiao shu)	Enable Spleen to transform/transport fluids
Method:	Tonification and Moxa

Spleen Qi Sinking

Signs:

Signs of Spleen Qi Deficiency, plus:

PROLAPSE: of uterus, anus, stomach, vagina, heavy sensation in abdomen, e.g. of bearing down,
Frequent/urgent urination
Hemorrhoids, varicose veins

Tongue: Pale

Pulse: Empty/weak

Etiology/Pathology:

As for Spleen Qi Deficiency but even more likely in those who have Spleen Qi Deficiency and who also stand for a long time every day (i.e. - at work).

Treatment Principle:

• Tonify Spleen Qi and Raise Qi

Points:

As for Spleen Qi Deficiency plus

Du 20 (Bai hui)	Raises Qi (apply cones of moxa). Esp. good for prolapse of uterus
Ren 6 (Qi hai)	Tonifies Qi, raises Qi: use for any prolapse
ST 21 (Liang men)	Tonifies Stomach: use for prolapse of Stomach
Du 1 (Cheng Qiang)	Use for prolapse of anus
Method:	Tonification. Moxa applicable

Spleen Unable Control Blood

Signs:

Signs of Spleen Qi Deficiency plus Signs of Bleeding

Examples: Petechiae, ecchymoses (bleeding into the skin), Blood in stool or urine, menorrhagia, Spleen fails to govern Blood, Metorrhagia, sallow complexion, shortness of breath

Tongue: PALE	Deficiency
Pulse: FINE	Deficient Blood

Pathology:

Spleen function of keeping Blood in the vessels is impaired: therefore bleeding occurs. Bleeding is of Deficiency kind rather than the Excess type of bleeding that occurs when there is Heat in the Blood.

Etiology/Pathology:

Same as for Spleen Qi Deficiency

Treatment Principle:

• Tonify Spleen Qi

Points:

Same as for Spleen Qi Deficiency plus:

SP-10 (Xue hai)	strengthens Spleen function of controlling Blood & returns Blood to Vessels
BL-17 (Ge shu)	tonifies Blood & stops bleeding, when needled (not with moxa)
SP-1 (Yin bai)	with moxa cones to strengthen Spleen function of controlling Blood; stops uterine bleeding. Use moxa on this point to stop bleeding only of a Deficient nature (esp. uterine)
Method:	Tonification. Moxa is applicable

Damp Cold Invading the Spleen

Signs:

No Appetite,
STUFFY CHEST & EPIGASTRIUM,	Dampness obstructs chest and epigastrium, preventing normal movement of Qi
Cold feeling in epigastrium improved by warmth
HEAVY FEELING in head,	Damp prevents the clear Yang ascending to head
Heavy limbs, lethargy, No taste or sweetish taste in mouth, No thirst	Patient already excessively Damp
Thin stools Turbid secretions/excretions: white vaginal discharge, diarrhea	Dampness tends to sink diarrhea downwards to the lower burner
stickiness of eyes and fluid filled skin eruptions. May be retention or dribbling urine & edema	Dampness impairs fluid of metabolism
Tongue: Pale with THICK STICKY WHITE COATING	Dampness
Pulse: SLIPPERY, slow	Dampness and Cold

Pathology: Cold or Damp will predominate

1. If Cold predominates, this pattern is commonly associated with the pattern of retention of fluid in Stomach due to Cold and with Deficient Spleen Yang.
2. If Dampness predominates, it can be Internal or External.
   External Dampness is usually acute and of more sudden onset. It can be caused by too much Cold or raw food & drink as well as by damp climatological factors. Internal Dampness gradually accumulates from Deficiency of Spleen Qi and Spleen Yang being unable to transform/transport Fluids.
   (This is a Deficiency pattern turning into Excess).

Etiology/Pathology:

Exposure to external Dampness (Cold/raw food/drink or climate, etc.) or from Deficient Spleen Qi or Deficient Spleen Yang.

Treatment Principle:

• Resolve Dampness

Points:

SP-9	Yin ling quan	Resolves Dampness from Lower Burner
SP-6	San Yin jiao	Resolves Dampness
REN-12	Zhong wan	Tonifies Spleen to resolve Dampness
SP-3	Tai bai	Resolves Dampness
ST-8	Tou wei	Resolves Dampness from head; particularly good for HA or heavy head from Dampness
Method:		Sedation or neutral (even) method

Damp-Heat Invading the Spleen

Overlaps with the pattern Damp-Heat in Large Intestine or if bile flow is Obstructed, as Damp-Heat in Liver and Gallbladder.

Signs:

• No Appetite
• Feeling of heaviness
• Stuffiness/distention of epigastrium & lower abdomen
• Thirst without desire to drink or desire to drink small sips
• Nausea, vomiting
• Abdominal pain
• Loose stool with offensive odor
• Burning sensation of anus
• Scanty, dark yellow urine
• Low grade fever
• Headache

Tongue: STICKY YELLOW COATING, maybe slightly red body

Pulse: SLIPPERY, RAPID

Etiology/Pathology:

1. Subdivided into predominance of Damp or of Heat
   1. Damp predominating: no thirst or thirst without desire to drink not particularly rapid Pulse, not very red Tongue body.
   2. Heat predominating: thirst, rapid Pulse, red Tongue body.
2. Subdivided into External Damp-Heat or Internal Damp-Heat
   1. External Damp-Heat; usually acute & of sudden onset: arises from exposure to hot, humid climate or from contaminated food.
   2. Internal Damp-Heat usual chronic, gradual onset; arises from excess consumption of greasy foods & alcohol etc. over long time.
3. Subdivided into whether bile flow Obstructed or not
   1. Bile flow Obstructed: Signs are similar to Damp-Heat in Liv & GB i.e. jaundice, bitter taste in mouth. Tx as for the latter. (Common disease patterns would include hepatitis, cholecystitis & cirrhosis)

in general, Signs are of Dampness accumulating and obstructing the flow of Qi, e.g. Signs of heaviness, distention & scanty urination. Damp depresses Spleen function producing lack of Appetite & lethargy.
Heat Signs include low fever, thirst, (but without desire to drink much, because of presence of Dampness).

Treatment Principle:

• Resolve Dampness, clear Heat

Points:

SP-9 SP-6	Yinlingquan SanYinjiao	Resolve Dampness and Damp-Heat from lower burner
DU-9	ZhiYangq	Resolves Damp-Heat
LI-11	Quchi	Clears Heat, resolves Dampness
BL-20	Pishu	Resolves Dampness
GB-34	Yanglingquan	Resolves Damp-Heat
Method:		sedation, no moxa