How to Tonify the Spleen in Cases of Deficiency
Introduction
The spleen and stomach reside in the middle of the body, playing a vital role in processing food and water, serving as the source of Qi and blood production. All five organs rely on the essence of food and water for their Qi. Therefore, the spleen and stomach are often referred to as the "foundation of acquired constitution."
The spleen and stomach's ability to transform grains and transport essence, as well as raise the clear and lower the turbid, depends on the robustness of middle burner Yang Qi. Thus, the spleen primarily relies on Yang Qi, and its deficiency manifests as Qi deficiency and Yang deficiency.
1. Tonifying Spleen Qi
After birth, the human body requires nourishment through food and water, allowing the spleen and stomach to function properly. When diet is appropriate, the body thrives, and Qi is abundant. However, insufficient intake of food and water leads to weakness and diminished Qi. As the ancient text "Ling Shu - Five Flavors" states, "If grains do not enter for half a day, Qi weakens; if for a whole day, Qi diminishes significantly."
This demonstrates that the energy of the spleen and stomach originates from the essence of food and water. Strong digestion relies on the abundance of this essence. Eastern medicine recognizes this, hence the term "grain Qi" to describe middle burner Qi.
When dietary habits are unbalanced and grain Qi diminishes, symptoms such as shortness of breath, reduced appetite, fullness in the abdomen, fatigue, and weight loss become apparent. These are signs of weakened spleen and stomach functions, which are responsible for receiving and transforming nutrients and transporting essence.
As the spleen and stomach weaken, their ability to process food and water diminishes, leading to a lack of essential nutrients. Thus, supplementing spleen Qi is vital. Dangshen and Huangqi, sweet and warm herbs, are recommended as primary tonics. They help boost Qi, strengthen the spleen, and enhance its ability to process and transport nutrients, allowing grain Qi to gradually replenish itself.
Considering the spleen's inclination towards "liking dryness and disliking dampness," the condition requires a gentle supplementing approach. Baizhu, sweet and slightly bitter, is suitable as an auxiliary herb. It helps boost middle burner Qi, dry dampness, and support the spleen's functions. Fuling helps remove dampness, allowing the spleen's clear Qi to rise, facilitating proper digestion.
In cases involving middle burner issues, Gancao's sweet and soothing nature is used to preserve the middle burner's balance. The supplementing approach should be gradual to allow middle burner Qi to naturally recover. In summary, sweet and warm tonics, along with dampness-drying, represent the correct method. Representative formulas include Si Junzi Tang. For conditions associated with dampness and diarrhea, Shenling Baizhu San is suitable, while Bu Zhong Yi Qi Tang is recommended when middle Qi sinks.
2. Tonifying Spleen Yang
Qi is associated with Yang, and the body's organs and Qi are interconnected. As stated in the "Su Wen - On the Absolute Qi," "Yang Qi governs the exterior during the day. In the morning, Yang Qi is born, and at noon, it reaches its peak." This illustrates the gradual transition from Qi to Yang and vice versa. Middle Qi relies on Yang, and when grain Qi is abundant and Qi is vigorous, Spleen Yang is invigorated. Conversely, if grain intake is insufficient, Qi weakens, leading to a decline in middle Yang.
Spleen Yang deficiency, often referred to as middle Yang insufficiency or Spleen Cold, typically develops from the further decline of middle Qi. It can result from chronic illness, consumption of cold foods, or the consumption of cold herbal medicines that weaken middle Qi. As middle Qi is depleted, the body loses its ability to warm and transform, allowing internal cold to accumulate. This is the principle of "Yang deficiency leading to internal cold."
Symptoms of Spleen Yang deficiency are based on the combination of Spleen Qi deficiency and interior cold. Yang deficiency is the root cause, and internal cold is the secondary manifestation. Supplementing Spleen Yang involves establishing a foundation of middle Qi. With strong Qi, Yang can naturally flourish.
Ginseng, Astragalus, and sweet syrups are primary tonics that fortify middle Qi, strengthening the spleen and promoting the transformation of food. Secondary herbs like dried ginger and cinnamon, which are pungent and hot, help warm and stimulate Yang Qi while dispelling cold evil. Additionally, Atractylodes and Licorice assist in nourishing the spleen and preserving the middle burner.
The key to herbal combinations is a foundation of sweet and warm Qi-tonifying herbs with pungent and hot Yang-tonifying herbs. This aligns with the principle from the ancient text: "When cold evil intrudes, treat with sweet and hot tonics." Representative formulas include Lizhong Tang. If abdominal pain and urgency are present, Xiaojianzhong Tang is recommended.
Additionally, considering the physiological connection between Spleen Yang and the Heart (the sovereign fire) and Kidneys (the minister fire), it's essential to ensure the robustness of Heart and Kidney Yang. This is necessary for the spleen's functions, including grain transformation, essence production, and the distribution of bodily fluids.
If middle Yang deficiency persists or the "life gate" fire (Ming Men) is weak, formulas like Baoyuan Tang can be used to replenish Kidney Yang and support middle Yang. For cases where both Heart and Spleen Yang are weakened, Xiaojianzhong Tang with modifications can be effective, as it warms the middle, supports Heart Yang, and alleviates palpitations.
Spleen Yang deficiency is characterized by heavy Qi deficiency and mild internal cold. Treating this condition involves warming and tonifying Yang Qi. If cold evil or dampness accumulates in the middle burner and obstructs Yang, it primarily requires warming and dispelling cold or warming and dispelling cold-dampness methods. Examples include Ganjiang Fuzi Tang and Houpo Wen Zhong Tang, both of which are warming methods, not tonifying methods.
3. Tonifying Spleen Yin
The functions of the spleen, including grain transformation, raising the clear, lowering the turbid, and distributing bodily fluids, essentially encompass the entire digestive system, involving the stomach, small intestine, and large intestine.
Therefore, the concept of "Spleen Yin" broadly refers to various bodily fluids produced during the digestive process (saliva, gastric juices, intestinal secretions) and the essence generated from grain transformation. Spleen Yin is continually consumed and regenerated during digestion, maintaining the balance of Yin and Yang.
Bodily fluids and essence are derived from food and water, relying on middle burner Yang Qi for their creation and distribution. Spleen Yin deficiency is primarily the result of weak Yang Qi's inability to generate Yin fluids. When clear fluids fail to ascend, turbid fluids fail to descend, and essential Qi isn't properly distributed, symptoms like dry lips, parched mouth, constipation, dry skin, and weight loss become apparent.
Supplementing Spleen Yin involves tonifying middle Qi with herbs like Ginseng, Astragalus, and Dioscorea. These herbs help strengthen the spleen's transformation functions, allowing Spleen Yin to be generated continuously.
However, when Yin fluids are already deficient, and dryness-related symptoms arise, herbs like Mai Dong, Schisandra, and pollen are introduced to augment Yin fluids and alleviate dryness. Combining these approaches results in a formula that addresses both the root and the branches. Zhang Xichun's creation, Yu Ye Tang (Jade Liquid Decoction), is a noteworthy example.
Dongyuan excelled in using sweet and warm methods to boost Qi, invigorate Yang, and promote the flow of bodily fluids. His prescriptions, such as Qingzao Tang and Baizhu San, all fall into this category. Clinical cases of Spleen Yin deficiency and intestinal dryness are usually caused by the consumption of evil heat, which damages bodily fluids. Treatments, such as Maziren Wan by Zhang Zhongjing, fall into this category. Their focus is on nourishing Yin, clearing heat, and moistening dryness rather than tonification. These methods are not elaborated upon here.
