The Three Treasures Newsletters
AUTUMN 2004
SPLEEN-QI TONICS
Spleen-Qi deficiency is the most common pattern encountered in clinical
practice. Our hectic modern life style and erratic diet almost inevitably
conduce to a Spleen-Qi deficiency. I shall review the main Deficiency
patterns of the Spleen which are all variations of Spleen-Qi deficiency.
The patterns are:
It is a special characteristic of the Spleen deficiency patterns
that these are all variations of Spleen-Qi deficiency: each pattern
highlights a particular aspect of the pathology of Spleen-Qi deficiency.
SPLEEN-QI DEFICIENCY
Clinical manifestations: Poor appetite,
slight abdominal distension after eating, tiredness, lassitude,
pale complexion, weakness of the limbs, loose stools, slight depression,
tendency to obesity, Pale tongue, Empty pulse.
Acupuncture: Ren-12 Zhongwan, ST-36 Zusanli,
SP-3 Taibai, SP-6 Sanyinjiao, BL-20 Pishu, BL-21 Weishu.
Prescription: Si Jun Zi Tang Four
Gentlemen Decoction or Liu Jun Zi Tang Six
Gentlemen Decoction.
Three Treasures formula: Prosperous
Earth, Soothe the Centre
Comment
Prosperous Earth is the main formula to tonify the Spleen:
it is a variation of Liu Jun Zi Tang (Six
Gentlemen Decoction). It can be used in all cases of Spleen-Qi
or Spleen-Yang deficiency. As this pattern often coexists with others,
this remedy is frequently combined with others. For example, if,
in addition to Spleen-Qi deficiency there is also Dampness, Prosperous
Earth can be combined with Drain
Fields.
Soothe the Centre can also be used to
tonify Spleen-Qi but only when this is accompanied by Dampness and
Qi stagnation in the Middle Burner. Therefore the pulse and tongue
corresponding to Soothe the Centre
are different than those corresponding to Prosperous
Earth: the tongue would be Pale but with a relatively thick-sticky
coating while the pulse would be Weak but also Slippery, or Soggy.
SPLEEN- YANG DEFICIENCY
Clinical manifestations: Poor appetite,
slight abdominal distension after eating, tiredness, lassitude,
pale complexion, weakness of the limbs, loose stools, slight depression,
tendency to obesity, feeling cold, cold limbs, oedema, Pale and
wet tongue, Deep-Weak pulse.
Acupuncture: Ren-12 Zhongwan, ST-36 Zusanli,
SP-3 Taibai, SP-6 Sanyinjiao, BL-20 Pishu, BL-21 Weishu, SP-9 Yinlingquan,
Ren-9 Shuifen, BL-22 Sanjiaoshu, ST-28 Shuidao, Ren-11 Jianli, ST-22
Guanmen. Moxa is applicable.
Prescription: Li Zhong Tang Regulating
the Centre Decoction.
Three Treasures remedy: Prosperous
Earth can be used to tonify Spleen-Yang as well as Spleen-Qi.
SPLEEN-BLOOD
DEFICIENCY
Clinical manifestations: Poor appetite,
slight abdominal distension after eating, tiredness, lassitude,
dull-pale complexion, weakness of the limbs, loose stools, depression,
thin body, scanty periods or amenorrhoea, insomnia, joint ache,
Pale and Thin tongue, Choppy or Fine pulse.
Acupuncture: Ren-12 Zhongwan, ST-36 Zusanli,
SP-3 Taibai, SP-6 Sanyinjiao, BL-20 Pishu, BL-21 Weishu, Ren-4 Guanyuan,
BL-17 Geshu (with direct moxa).
Prescription: Gui Pi Tang Tonifying
the Spleen Decoction.
Three Treasures formula: Calm
the Shen
Comments
This pattern describes the pathology of deficient Spleen-Qi not
making enough Blood (as Gu Qi of the Spleen is the precursor of
Blood) and leading to Blood deficiency.
Calm the Shen tonifies Spleen-Qi and Blood:
therefore is used whenever Spleen-Qi deficiency leads to Blood deficiency,
a situation that is extremely common in women. It also nourishes
Heart-Blood and calms the Mind.
SPLEEN-QI SINKING
Clinical manifestations: Poor appetite,
slight abdominal distension after eating, tiredness, lassitude,
pale complexion, weakness of the limbs, loose stools, depression,
tendency to obesity, a bearing-down sensation in the abdomen, prolapse
of stomach, uterus, anus or bladder, frequency and urgency of urination,
Pale tongue, Weak pulse.
Acupuncture: Ren-12 Zhongwan, ST-36 Zusanli,
SP-3 Taibai, SP-6 Sanyinjiao, BL-20 Pishu, BL-21 Weishu, Du-20 Baihui,
Ren-6 Qihai, ST-21 Liangmen, Du-1 Chengqiang. Moxa is applicable.
Prescription: Bu Zhong Yi Qi Tang Tonifying
the Centre and Benefiting Qi Decoction.
Three Treasures formula: Tonify
Qi and Ease the Muscles, Breaking
Clouds
Comments
This pattern describes the pathology of sinking of Spleen-Qi: this
cannot occur without Spleen-Qi deficiency and it is a variation
of it. When Spleen-Qi sinks there may a prolapse of an organ or
chronic frequent urination.
Tonify Qi and Ease the Muscles is a variation
of Bu Zhong Yi Qi Tang which lifts Qi in cases of sinking of Qi:
it also tonifies Spleen-Qi. This remedy can therefore be used to
tonify Spleen-Qi and lift Qi in cases of sinking of Qi. This remedy
is particularly suitable if, in addition to Spleen-Qi deficiency,
there is also Dampness.
Breaking Clouds is also a variation of
Bu Zhong Yi Qi Tang and can be used to tonify Spleen-Qi and lift
Qi in cases of sinking of Qi. It is particularly suitable if there
is mental depression.
SPLEEN NOT CONTROLLING
BLOOD
Clinical manifestations: Poor appetite,
slight abdominal distension after eating, tiredness, lassitude,
pale complexion, weakness of the limbs, loose stools, depression,
tendency to obesity, blood spots under the skin, blood in the urine
or stools, excessive uterine bleeding, sallow complexion, Pale tongue,
Weak or Fine pulse.
Acupuncture: Ren-12 Zhongwan, ST-36 Zusanli,
SP-3 Taibai, SP-6 Sanyinjiao, BL-20 Pishu, BL-21 Weishu, Du-20 Baihui,
Ren-6 Qihai, BL-17 Geshu, SP-10 Xuehai, SP-1 Yinbai.
Prescription: Gui Pi Tang Tonifying
the Spleen Decoction.
Three Treasures formula: Calm
the Shen
Comments
This pattern describes the pathology of deficient Spleen-Qi being
unable to hold blood in the blood vessels and leading to bleeding.
This can be bleeding from any part of the body such as coughing
of blood, nosebleed, vomiting of blood, blood in the stools, blood
in the urine, excessive menstrual bleeding and bleeding under the
skin.
Although Calm the Shen is aimed at treating
insomnia and anxiety deriving from Blood deficiency, it can be used
to tonify the Spleen's function of holding blood in order to stop
bleeding because it is a variation of Gui Pi Tang. As this formula
tonifies Spleen-Qi and enters the Blood portion, it can stop bleeding
from Qi deficiency.
SPLEEN-YIN DEFICIENCY
Clinical manifestations: Poor appetite,
poor digestion, retching, gnawing hunger, loss of taste, slight
epigastric pain, dry mouth, dry lips, dry stools, thin body, night-
sweating, sallow complexion with possibly red tip of the nose, tongue
without coating, transversal cracks on the sides, Weak or Floating
Empty pulse.
Acupuncture: ST-36 Zusanli, Ren-12 Zhongwan,
SP-6 Sanyinjiao.
Prescription: Ma Zi Ren Wan Cannabis
Pill, Wu Ren Wan Five-Seed
Pill, Shen Ling Bai Zhu San Ginseng-Poria-Atractylodes
Powder
Three Treasures formula: Central
Mansion, Harmonize the Centre,
Jade Spring
Comments
Spleen-Yin deficiency is not often mentioned but it does exist.
First of all, it should be understood that the pattern of Spleen-Yin
deficiency cannot exist without concurrent Spleen-Qi and Stomach-Yin
deficiency. It is therefore a more advanced stage of Spleen-Qi deficiency
and it is nearly always associated with Stomach-Yin deficiency.
If we analyze the clinical manifestations, we can classify them
as follows:
| • |
Poor appetite, poor digestion, sallow complexion, Weak pulse:
Spleen-Qi deficiency |
| • |
Retching, gnawing hunger, loss of taste, slight
epigastric pain, tongue without coating: Stomach-Yin deficiency |
| • |
Dry lips, dry stools, red tip of nose, transversal cracks
on the sides: Spleen-Yin deficiency |
| • |
Dry mouth: Stomach- and/or Spleen-Yin deficiency |
| • |
Thin body, night- sweating, Floating
Empty pulse: general manifestations of Yin deficiency. |
The most distinctive signs of Spleen-Yin deficiency are dry lips
and small, transversal cracks on the sides of the tongue.
THE TONGUE IN STOMACH- AND SPLEEN-QI DEFICIENCY
The tongue coating is produced as a by-product of the Stomach's
digestion. In the process of digesting the food, some "dirty
Dampness" flows upwards to the tongue and forms the tongue
coating. Therefore the presence of a tongue coating is normal and
shows that the Stomach is functioning properly and Stomach-Qi is
intact. A normal coating should be white and thin (thin enough to
see the tongue-body colour through it). It is important to note
that even if a coating is pathological (e.g. yellow and thick),
the very presence of a coating shows that Stomach-Qi is intact.
In the above example, the fact that the coating is thick and yellow
would indicate that there is Stomach-Heat: however, the very presence
of the coating shows that Stomach-Qi is intact and that, therefore,
the pattern is a Full one.
 |
| Fig.
1. Coating with root (like grass) |
The normal coating has a "root": the best way to describe
this is with the analogy of grass (Fig. 1). The tongue coating is
formed by filiform papillae (the ancient Chinese called them "fine
hairs") which are very much like blades of grass rooted in
soil. A coating with root indicates a good state of Stomach-Qi (even,
I repeat, if it is pathological in terms of colour and thickness).
To imagine a coating without root, we can think of a bare patch
of soil onto which we spread grass cuttings: in such a case the
blades of grass will lie on top of the soil and will not be rooted
in it. The coating without root looks like it has been added or
spread onto the tongue and not like it grows out of it (Fig. 2).
 |
Fig.
2. Coating without root
(like grass clippings spread on bare soil) |
The coating without root can take many different appearances and
it may be variously described as looking like salt, snow or bean
curd. A coating without root indicates a weakened Stomach-Qi and
it is usually the first stage of a process that leads to Stomach-Yin
deficiency when the tongue has no coating. In other words, before
losing the coating (indicating Stomach-Yin deficiency), the tongue
usually goes through a stage of losing the root of the coating (indicating
Stomach-Qi deficiency).
Please do not assume that a coating without root is necessarily
thin as it may be thin or thick: if it is thin, it simply indicates
Stomach-Qi deficiency (therefore an Empty condition), but if it
is thick, it indicates that, in addition to Stomach-Qi deficiency,
there is also a pathogenic factor (therefore a Full/Empty condition).
We can therefore plot different stages in the pathological process
that leads to full-blown Stomach-Yin deficiency with Empty Heat
and the tongue is a very reliable and objective marker to identify
these stages. Before describing these stages, it is important to
clarify that, although Empty Heat eventually develops from Yin deficiency,
there will be a long stage during which there is Yin deficiency
without Empty Heat. On the tongue, the Yin deficiency is manifested
by the lack of coating and the Empty Heat by the redness of the
tongue body (associated with lack of coating). The stages leading
to full-blown Stomach-Yin deficiency with Empty Heat are as follows:
| • |
Stomach-Qi good: tongue has coating with root |
| • |
Stomach-Qi weakened: coating without root
(thin) |
| • |
Stomach-Yin deficiency: no coating (normal
colour) |
| • |
Stomach-Yin deficiency with Empty
Heat: no coating, red tongue body. |
We have stated above that the tongue coating is a by-product of
the Stomach's digestion: however, the Spleen also plays a role in
forming the coating and therefore, often a lack of coating indicates
both Stomach- and Spleen-Yin deficiency.
 |
| Fig.
3. Stomach crack |
Cracks are also indicative of Yin deficiency. Stomach-Yin deficiency
many manifest either with a central, wide crack in the middle of
the tongue (Fig. 3), or with scattered cracks all over (Figs. 4-5).
 |
 |
| Fig.
4. Stomach cracks |
Fig.
5. Stomach cracks |
 |
| Fig.
. 6. Spleen cracks |
Spleen-Yin deficiency may manifest with small, transversal cracks
on the sides: these are a very reliable sign of Spleen-Yin deficiency
(Fig. 6).
We can now relate tongue images to the relevant remedies. I shall
list the remedies in order of progression from Stomach- and Spleen-Qi
deficiency to Stomach- and Spleen-Yin deficiency.
Prosperous Earth
Patterns: Stomach- and Spleen-Qi deficiency
Tongue: Pale, coating with root.
Central Mansion
Patterns: Stomach and Spleen-Qi deficiency,
Stomach- and Spleen-Yin deficiency (borderline between the two).
Tongue: coating without root or partially
peeled, body colour not Red, possibly central Stomach crack (Fig.
3) or scattered Stomach cracks (Figs. 4-5).
Harmonize the Centre
Patterns: Stomach- and Spleen-Qi deficiency,
Stomach- and Spleen-Yin deficiency (the latter more pronounced than
in previous remedy), some Empty Heat, Phlegm.
Tongue: coating without root, partially
peeled, body colour may tend to Red, possibly central Stomach crack
(Fig. 3) or scattered Stomach cracks (Fig. 4-5) and/or Spleen cracks
(Fig. 6).
Jade Spring
Patterns: Stomach- and Spleen-Yin deficiency,
Lung-Yin deficiency.
Tongue: without coating, Stomach cracks
(Figs. 4-5), Spleen cracks (Fig. 6).
Besides these remedies for Empty conditions, we should mention also
Soothe the Centre which is for Full/Empty conditions.
Soothe the Centre
Patterns: Spleen-Qi deficiency, Dampness
and Qi stagnation in the Middle Burner.
Tongue: slightly Swollen, sticky coating.
FOCUS ON A REMEDY: PROSPEROUS EARTH
Prosperous Earth is a variation of Liu
Jun Zi Tang Six Gentlemen Decoction
from the "Revised Fine Formulae for Women" (Jiao
Zhu Fu Ren Liang Fang). In turn, this formula is a variation
of the famous Si Jun Zi Tang Four
Gentlemen Decoction from the "Imperial Grace Formulary
of the Tai Ping Era" (Tai
Ping Hui Min He Ji Ju Fang) of 1078.
The ingredients of Prosperous Earth are:
Ren Shen Radix
Ginseng
Bai Zhu Rhizoma
Atractylodis macrocephalae
Fu Ling Poria
Chen Pi Pericarpium
Citri reticulatae
Ban Xia Rhizoma
Pinelliae
Zhi Gan Cao Radix Glycyrrhizae
praeparata
Huang Qi Radix
Astragali
Shan Yao Rhizoma
Dioscoreae
The first six ingredients form the original formula Liu Jun Zi Tang.
Ren Shen and Bai Zhu tonify Stomach- and Spleen-Qi; Fu Ling and
Chen Pi resolve Dampness from the Middle Burner; Ban Xia resolves
Phlegm; Zhi Gan Cao tonifies the Middle Burner and harmonizes.
I have added Huang Qi and Shan Yao to strengthen the tonic effect
and also to strengthen Lung-Qi.
Patterns: Stomach- and Spleen-Qi deficiency,
some Dampness in the Middle Burner.
Indications: Poor appetite, slight abdominal
distension after eating, tiredness, lassitude, pale complexion,
weakness of the limbs, loose stools, slight depression, tendency
to obesity, uncomfortable feeling in the epigastrium, lack of taste
sensation, weak limbs, Pale tongue, Empty pulse.
Comments
Prosperous Earth is the main remedy to
tonify Spleen-Qi: although it resolves Dampness, the main emphasis
is on tonification. However, it contains herbs that resolve Dampness
because the simultaneous occurrence of Spleen-Qi deficiency and
some Dampness is extremely common. If Dampness predominates, the
tongue has a thick-sticky coating and the pulse is Full and Slippery,
then Drain Fields should be used instead.
It is not advisable to use tonic herbs in the presence of a Full
condition of Dampness.
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