Spleen Yang Deficiency

Understanding Spleen Yang Deficiency

Spleen Yang is the warming half of the Spleen. It cooks food and dries fluids; when it declines, the middle turns cold and what is eaten passes through rather than being transformed.

The abdominal pain is dull and improves with warmth and gentle pressure. Stools are watery, sometimes with recognisable food. Hands and feet are cold and the person feels the cold easily.

The tongue is pale, puffy and tender with teeth marks and a white slippery coat. The pulse is deep, slow and weak, particularly at the right guan position.

It usually develops from long-standing Spleen Qi deficiency, or from a diet of cold and raw food on top of a cold constitution.

Treatment warms the middle and strengthens the Spleen. Moxibustion over the abdomen and warm food are central, and cold food undoes the treatment.

Signs and symptoms

Key signs

• Dull abdominal pain that improves with warmth and pressure
• Feeling cold easily, with cold hands and feet
• Loose watery stools or undigested food in the stool
• Poor appetite with abdominal bloating

Also seen

• A cold feeling in the abdomen
• No thirst, or a wish only for warm drinks
• Tiredness and a weak voice
• Puffiness in the face
• Frequent pale urine
• A dislike of cold weather

Variations

• Morning diarrhoea
• Borborygmus
• Cold limbs in summer

Timing

• Pain and diarrhoea are worse in the morning and in cold weather.
• They improve quickly with local warmth.

Practitioner notes

• The tongue is pale, puffy and tender with teeth marks and a white slippery coat.
• The pulse is deep, slow and weak, particularly at the right guan.
• The distinction from Spleen Qi deficiency is the coldness: pain relieved by warmth and cold limbs.
• The distinction from Cold-Damp invading the Spleen is that this is a deficiency picture rather than an active obstruction, though the two overlap.

Causes

Common causes

• Progression from Spleen Qi deficiency
• Cold and raw food
• Exposure to Cold and Damp environments
• Overwork, mental exhaustion and excessive worry

How it develops

• It develops slowly from Spleen Qi deficiency.
• If it deepens, it can involve the Kidney Yang, giving early-morning diarrhoea.

Diagnosis

Diagnosis rests on Spleen deficiency together with clear coldness and relief from warmth.

Tongue

• Body: Pale, puffy and tender with teeth marks.
• Coating: White and slippery.
• Note: A yellow coat would indicate Heat.

Pulse

Deep, Slow, Weak

Weak at the right guan, corresponding to the Spleen.

Observation

• Pale, puffy face
• Cold hands
• A hunched, guarded posture

Listening

• A weak voice
• Abdominal gurgling

Palpation

• Abdomen: Cool and soft, with dull tenderness that improves with gentle pressure and warmth.
• Channels: BL-20 and REN-6 may feel cold and empty.

Questions that separate it from look-alikes

• Does warmth help the abdominal pain?
• Are the stools watery, and is there undigested food?
• How cold do the hands and feet feel?
• How much cold food and drink?

Treatment

Principles

• Warm the Spleen Yang
• Strengthen the Spleen and stop diarrhoea
• Relieve the cold abdominal pain
• Use moxibustion and warm food as core measures

Herbs

Formulas

• Li Zhong Wan - The reference formula for cold deficiency in the middle, warming and strengthening.
• Wu Zi Yan Zong Wan - For Spleen and Kidney Yang deficiency with early-morning diarrhoea.
• Xiao Jian Zhong Tang - For cold abdominal pain with deficiency, warming and easing the cramp.
• Ling Gui Zhu Gan Tang - For fluid retention from Spleen Yang weakness with dizziness.
• Shi Pi Yin - For Spleen Yang deficiency with swelling and fatigue.
• Bu Zhong Yi Qi Tang - For the Qi deficiency with sinking that may accompany it.

Acupoints

• ST-36 (Zusanli) - Strengthens the Stomach and Spleen; moxibustion is often used.
• REN-6 (Qihai) - Warms the lower abdomen and strengthens Qi.
• BL-21 (Weishu) - The Stomach back-shu point, warmed with moxibustion.
• LR-13 (Zhangmen) - The Spleen front-mu point, used for abdominal fullness and cold pain.
• SP-6 (Sanyinjiao) - Supports the Spleen and regulates the lower body.

Personalising the plan

• If coldness dominates, warming herbs and moxibustion are increased.
• If diarrhoea dominates, astringing herbs are added.
• If there is a bearing-down feeling, lifting herbs are added.
• If the Kidney is involved, Kidney Yang support is added.

Self-care

Diet

• Warm cooked food; congee, stews, ginger and small amounts of cinnamon
• Avoid all cold and raw food and iced drinks
• Reduce dairy and greasy food
• Small frequent meals

Lifestyle

• Apply warmth to the abdomen; moxibustion is traditionally used
• Keep the lower body warm
• Gentle walking after meals
• Rest and avoid overwork

Qigong and movement

• Gentle warming practice with an emphasis on the abdomen.

How it differs from look-alikes

Patterns that can be mistaken for spleen yang deficiency, and the contrast that separates them.

Where it appears

Skin conditions in which this pattern is commonly seen.

Safety and when to get help

For anything severe, sudden or spreading quickly, read when a skin problem needs urgent care.

This page describes a TCM pattern, not a diagnosis, and a pattern can accompany more than one skin condition. Get urgent medical help for a rash with fever, confusion or feeling very unwell; skin that is blistering, peeling or spreading quickly; swelling of the face, lips or throat, or difficulty breathing; or a lesion with increasing pain, warmth, red streaks or pus. For anything persistent, severe or changing, have it assessed by a clinician before treating it yourself.

Read the skin condition pages for the red flags that belong to a specific presentation.

Urgent-sign guidance is based on standard sources: NHS anaphylaxis, NHS cellulitis, NHS Stevens-Johnson syndrome, NHS melanoma.

Evidence note

No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.

Related patterns