Spleen qi deficiency: signs, diet, herbs, and formulas
Spleen qi deficiency, pi qi xu, is the pattern in which the Spleen's power of transformation and transportation (yun hua) is weak, so that food is not fully turned into qi and Blood and the fluids the Spleen should move begin to pool as dampness. Its signature is tiredness that is worse after eating, a poor appetite, bloating after meals, loose stools, a sallow face, a pale swollen tongue with teeth marks along its edges, and a weak pulse. The Spleen is the root of post-heaven qi, the qi made after birth, so this pattern lies beneath many others: Blood deficiency, dampness and phlegm, Lung qi deficiency, the sinking of qi with prolapse, and the Spleen's failure to hold the Blood in its vessels.
Recognising the pattern
The digestion tells most of it: appetite low or satisfied too soon, a stomach that swells after eating, stools loose or unformed and sometimes carrying undigested food, wind, and a heaviness after meals that makes the person want to lie down. The energy follows the digestion: tiredness in the limbs, which the Spleen governs, weak muscles, a slump in the late morning when the Spleen's hours end, and a mind that cannot hold a thought, since the Spleen houses thought (yi). The face is sallow or pale-yellow, the lips pale. When the deficiency has gone further, there is bruising without cause, heavy periods, or bleeding gums, because the Spleen no longer holds the Blood; or a dragging sensation, haemorrhoids, and prolapse, because the Spleen no longer raises the clear.
The tongue is pale, swollen, and scalloped by the teeth, with a thin white coat that turns greasy as damp gathers. The pulse is weak (ruo) or empty (xu), soft under the finger, most clearly at the right middle position, which belongs to the Spleen and Stomach.
Spleen yang deficiency adds cold: cold limbs, abdominal cold pain eased by warmth and pressure, watery stools, a pale wet tongue, and calls for Li Zhong Wan. Kidney yang deficiency shows diarrhoea at daybreak and a cold lower back, and calls for Si Shen Wan. Dampness obstructing the Spleen shows heaviness and a thick greasy coat with fullness rather than emptiness.
Causes
Diet first: cold and raw food, iced drinks, overeating, irregular meals, sweets and dairy in quantity, all of which put out the fire the Spleen needs to transform. Worry and overthinking, which the Suwen assigns to the Spleen, knot its qi. Long illness, overwork, and long sitting, which injures the flesh, wear it down; some are born with a weak Spleen. Li Dongyuan's Pi Wei Lun makes the Spleen and Stomach the pivot of every internal disorder, and the modern textbook follows him.
Treatment principle and formulas
The principle is to fortify the Spleen and boost the qi (jian pi yi qi), drying dampness where it has gathered and raising the clear where it has sunk. Si Jun Zi Tang, the Four Gentlemen Decoction of the Taiping Huimin Heji Ju Fang, is the base:
| Herb | Pharmaceutical name | Role | Dose in decoction |
|---|---|---|---|
| Ren Shen or Dang Shen | Ginseng Radix, or Codonopsis Radix | Chief: tonifies the qi of the middle | 9 grams; Dang Shen 9 to 15 grams |
| Bai Zhu | Atractylodis macrocephalae Rhizoma | Deputy: fortifies the Spleen, dries damp | 9 grams |
| Fu Ling | Poria | Assistant: leaches damp, aids the Spleen | 9 grams |
| Zhi Gan Cao | Glycyrrhizae Radix praeparata | Envoy: tonifies the middle, harmonises | 6 grams |
Liu Jun Zi Tang adds Chen Pi 6 grams and Ban Xia 9 grams for the phlegm-damp that a weak Spleen makes, with nausea and a greasy coat. Xiang Sha Liu Jun Zi Tang adds Mu Xiang 6 grams and Sha Ren 3 to 6 grams for distension and pain. Shen Ling Bai Zhu San, also from the Ju Fang, is the choice for chronic loose stools with damp. Bu Zhong Yi Qi Tang, Li Dongyuan's formula, with Huang Qi 15 to 30 grams as chief, is for the sunken qi of prolapse and chronic diarrhoea; Gui Pi Tang for the Heart and Spleen deficiency of insomnia with bleeding.
Tonics are held back during an acute exterior invasion. Ren Shen is incompatible with Li Lu, Veratrum, and antagonistic to Wu Ling Zhi under the classical lists. Gan Cao with long use raises blood pressure and lowers potassium and adds to the effect of warfarin.
Diet
The Spleen loves warmth and dryness and hates cold and damp, so its diet is cooked, warm, chewed well, and eaten at regular hours in moderate amounts. Rice, millet, and oats as congee; sweet potato, pumpkin, squash, carrot; Shan Yao, Chinese yam; chestnut, Da Zao, jujube, lotus seed, hyacinth bean; well-cooked legumes in modest amounts; a little ginger, cinnamon, and cardamom; chicken and beef in long-cooked soups; fruit stewed rather than raw. Iced drinks, salads in quantity, dairy, refined sugar, greasy food, eating late, and eating while working undo the formula faster than the formula can work.
The points are ST36 Zusanli, SP3 Taibai, SP6 Sanyinjiao, CV12 Zhongwan, CV6 Qihai, and the back-shu points BL20 Pishu and BL21 Weishu, and moxibustion on ST36 and CV12 suits this pattern better than any other.
Not medical advice.