Sunday, June 8, 2014


When we study the pathology of the Internal Organs, for the Spleen, we generally emphasize Spleen-Qi and Spleen-Yang deficiency. This is understandable as these two patterns are indeed extremely common. By contrast, when it comes to the Stomach, we do mention Stomach-Yin deficiency. In fact, some people say that this is a well-known contradiction: the Stomach is a Yang organ but it suffers from Yin deficiency while the Spleen is a Yin organ but it suffers from Yang deficiency.

All this is true, but in this article, I want to discuss the aetiology, pathology, diagnosis and treatment of Spleen-Yin deficiency. 

Historical development
Although we nowadays emphasize Spleen-Yang deficiency, some of the old classics did often mention Spleen-Yin deficiency. For example, the Su Wen in chapter 3 says that the excessive use of bitter foods or herbs causes Spleen-Qi not to be “immersed”. Modern doctors interpret “Spleen-Qi not immersed” as Spleen-Yin deficiency. 

Doctor Wang Lun Ti (Ming dynasty) said that Stomach-Fire may injure Spleen-Yin.  Qin Huang Shi (1706) says in Zheng Yin Mai Zhi: “The Spleen may be deficient in Yang or Yin: in Spleen-Yin deficiency, there is deficiency of Spleen-Blood and Empty Heat arises.” 

Tang Zong Hai, author of “Xue Zheng Lun” bemoaned the fact that, since Li Dong Yuan (author of “Pi Wei Lun”), doctors paid attention to Spleen-Yang but not Spleen-Yin. 

The aetiology of Spleen-Yin deficiency is clearly dietary.  It is caused by irregular eating, i.e. eating in a hurry, eating standing up, eating while working at one’s computer, eating late at night, eating while discussing business, eating while in a state of worry, etc. 

However, besides the dietary causes, Spleen-Yin deficiency may also be caused by emotional stress related to worry and pensiveness and by excessive physical work that depletes the Spleen.

Clinical manifestations
The main clinical manifestations of Spleen deficiency are:

Poor appetite, distension after eating, dry stools, dry mouth and throat, dry lips, thin body, dull complexion without lustre, night-sweating, 5-palm heat (only if there is Empty Heat), bleeding (in small quantity), tongue without coating (red if there is Empty Heat), Fine pulse.1 

Please note that Empty Heat does derive from Yin deficiency but someone may have Yin deficiency for years before Empty Heat develops.  The tongue is in fact the best clinical sign to distinguish when Yin deficiency has given rise to Empty Heat: if the tongue lacks a coating but it is not red, there is Yin deficiency without Empty Heat.  If the tongue lacks a coating and it is red, then there is Yin deficiency and Empty Heat (Plates 1 and 2 and Fig. 1).

Plate 1 (no coating, normal colour)

Plate 2 (no coating, red colour)

Fig. 1. Progression of Yin deficiency and development of Empty Heat 

The Spleen controls yun hua, i.e. transportation and transformation of food essences.  Yun Hua is impaired not only when Spleen-Yang si deficient but also when Spleen-Yin is deficient, hence the lack of appetite. The Yin deficiency causes the loss of weight and therefore thin body. 

Spleen-Yin includes Blood and Ying and for this reason Spleen-Yin deficiency may cause bleeding such as in the stools, vomit or under the skin. 

Please note the sign of dry lips as this is quite a key sign of Spleen-Yin deficiency.

Chinese journals often include symptoms and signs of Empty Heat with Spleen-Yin deficiency and they say that this pattern cause the flaring up of the pathological Minister Fire. I tend to disagree with this view.  In chronic, long-standing cases, Spleen-Yin deficiency can indeed give rise to Empty Heat but, in very many cases, there is just Yin deficiency without Empty Heat (see Fig. 1 and Plates 1 and 2 above).

Dr Hong Guang Huai makes an important differentiation between Stomach-Yin and Spleen-Yin deficiency. He says that in Stomach-Yin deficiency there is a deficiency of fluids while in Spleen-Yin deficiency there is a deficiency of Ying and Blood. They are both Yin deficiency as fluids, Ying and Blood are all part of Yin.2  

Dr Mao Jiong divides the clinical manifestations of Spleen-Yin deficiency into three groups and this may help the diagnostic process.  The three groups are:

- Digestive symptoms: abdominal distension, poor appetite, dry stools.
- Yin deficiency symptoms (dryness): dry mouth and throat, dry lips.
- Lack of nourishment signs: dull complexion, thin body, dry skin. 

As mentioned above, dry lips is quite a key, distinctive sign of Spleen-Yin deficiency.  Another very distinctive sign are small transversal cracks on the sides of the tongue (Plates 3-4-5). 

Plate 3. Spleen-Yin deficiency cracks

Plate 4. Spleen-Yin deficiency cracks

Plate 5. Spleen-Yin deficiency cracks

Herbal Treatment
One must nourish Yin, strengthen the Spleen, nourish Ying and “lift” fluids. Doctor Wang Guang Jun summarizes the treatment in four words: sweet, sour, moisten, lift.

By “sweet” he means using herbs (and foods) with a sweet taste and the main herbs he advocates   are Huang Jing Rhizoma Polygonati, Tai Zi Shen Radix Pseudostellariae, Shan Yao Radix Dioscoreae oppositae and Bai Bian Dou Semen Dolichoris lablab

By “sour” he means herbs (or foods) with a sour taste because the sour taste keeps fluids in and it therefore nourishes Yin. Bai Shao Radix Paeoniae alba, Wu Mei Prunus Mume, Wu Wei Zi Fructus Schisandrae chinensis, Shan Zha Fructus Crataegi

By “moisten”, he means the use of herbs that are rich in fluids such as Lian Rou (lotus fruit).  By “lifting” he means the use of herbs that lift Qi such as Ge Gen Radix Puerariae and Sheng Ma Rhizoma Cimicifugae

Bearing these four principles in mind, Dr Wang recommends the following prescription to nourish Spleen-Yin. 

Huang Jing Rhizoma Polygonati
Tai Zi Shen Radix Pseudostellariae
Shan Yao Radix Dioscoreae oppositae 
Bai Bian Dou Semen Dolichoris lablab
Bai Shao Radix Paeoniae alba
Shan Zha Fructus Crataegi
Wu Mei Prunus Mume
Ge Gen Radix Puerariae 
Lian Zi Semen Nelumbinis nuciferae 
Da Zao Fructus Jujubae
Gan Cao Radix Glycyrrhizae

Dr Hong Guang Huai also recommends nourishing Yin and strengthening the Spleen and he says that two important herbs are Ren Shen Radix Ginseng and Tian Hua Fen Radix Trichosanthis. He recommends the following herbs for Stomach-Yin and Spleen-Yin:

Stomach-Yin: Mai Men Dong Tuber Ophiopogonis, Bei Sha Shen Radix Glehniae, Yu Zhu Rhizoma Polygonati odorati, Shi Hu Herba Dendrobii.

Spleen-Yin: Ren Shen Radix Ginseng, Tian Hua Fen Radix Trichosanthis, E Jiao Colla Corii Asini, Sheng Di Huang Radix Rehmanniae.

He also recommends herbs with a sweet and bland taste for Spleen-Yin such as Shan Yao Radix Dioscoreae oppositae, Lian Rou (lotus fruit), Geng Mi (rice), Mai Ya Fructus Hordei vulgaris germinatus, Tai Zi Shen Radix Pseudostellariae, Xi Yang Shen Radix Panacis quinquefolii, Bei Sha Shen Radix Glehniae littoralis, Ge Gen Radix Puerariae, He Ye Folium Nelumbinis

He recommends the following formulae for Spleen-Yin deficiency:
- Ren Shen Gu Ben Tang Ginseng Consolidating the Root Decoction.
- Zhi Gan Cao Tang Glycyrrhiza Decoction (without Gui Zhi Ramulus Cinnamomi and with the addition of Bai Shao Radix Paeoniae alba).
- Yu Quan Wan Jade Spring Pill

Acupuncture Treatment
The acupuncture treatment of Spleen-Yin deficiency is based on the following points: Ren-12 Zhongwan, Ren-4 Guanyuan, ST-36 Zusanli, SP-6 Sanyinjiao, LIV-13 Zhangmen. 

As Spleen-Yin deficiency very often occurs in conjunction with Stomach-Yin deficiency, I outline below the clinical manifestations and treatment of Stomach-Yin deficiency.

Stomach-Yin deficiency
No appetite or slight hunger but no desire to eat, constipation (dry stools), dull or slightly burning epigastric pain, dry mouth and throat especially in the afternoon with desire to drink in small sips, slight feeling of fullness after eating.
Tongue: without coating in the centre, or with rootless coating, normal body colour.
Pulse: Floating-Empty on the Right-Middle position (Plates 6-7-8-9). 
Plate 6. Stomach cracks.

Plate 7. Two patches without coating

Plate 8. Central Stomach crack

Plate 9. No coating in the centre. 

If there is Empty Heat, there will be some additional symptoms such as feeling of hunger, night-sweating, 5-palm heat, bleeding gums, feeling of heat in the evening, red tongue without coating in the centre, Floating-Empty pulse on the Right-Middle position and slightly Rapid. 

Points: Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao.

Herbal formulae (for Stomach-Yin)
Sha Shen Mai Dong Tang Glehnia-Ophiopogon Decoction.
Shen Ling Bai Zhu San Ginseng-Poria-Atractylodes Powder.
Yi Wei Tang Benefiting the Stomach Decoction.

Plates 10 and 11 illustrate the difference between Shen Ling Bai Zhu San and Sha Shen Mai Dong Tang.
Plate 10. Partially without coating. Shen Ling Bai Zhu San

Plate 11. Completely without coating. Sha Shen Mai Dong Tang

1. The Symptoms and Treatment of Spleen-Yin deficiency by Wang Guang Jun in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 31, no. 2, 1990, p. 18.

2. Concerning the Differentiation between Stomach-Yin and Spleen-Yin Deficiency by Hong Guang Gui Huai in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 31, no. 7, 1990, p. 4.

3. Introduction to Research on Spleen-Yin Deficiency by Mao Jiong in Journal of Traditional Chinese Medicine (Zhong Yi Za Zhi), Vol. 32, no. 5, 1991, p. 50.

Glycyrrhiza Decoction
Zhi Gan Cao Radix Glycyrrhizae uralensis preparata 
Ren Shen Radix Ginseng 
Da Zao Fructus Jujubae 
Sheng Di Huang Radix Rehmanniae 
Mai Men Dong Radix Ophiopogonis 
E Jiao Colla Corii Asini 
Hu Ma Ren Semen Sesami indici
Sheng Jiang Rhizoma Zingiberis recens 
Gui Zhi Ramulus Cinnamomi cassiae 
Qing Jiu Rice wine 10 ml (added at the end)

Ginseng Consolidating the Root Decoction 
Ren Shen Radix Ginseng
Shan Yao Radix Dioscoreae oppositae
Sheng Di Huang Radix Rehmanniae
Shu Di Huang Radix Rehmanniae preparata
Tian Men Dong Tuber Asparagis cohinchinensis
Mai Men Dong Tuber Ophiopogonis
Fu Ling Poria
Shan Zhu Yu Fructus Corni officinalis
Mu Dan Pi Cortex Moutan
Ze Xie Rhizoma Alismatis orientalis

Jade Spring Decoction
Huang Lian Radix Coptidis
Ge Gen Radix Puerariae
Tian Hua Fen Radix Trichosanthis
Zhi Mu Radix Anemarrhenae asphodeloidis
Mai Men Dong Tuber Ophiopogonis
Ren Shen Radix Ginseng
Wu Wei Zi Fructus Schisandrae
Sheng Di Huang Radix Rehmanniae
Lian Rou Lotus fruit
Wu Mei Prunus Mume
Dang Gui Radix Angelicae sinensis
Gan Cao Radix Glycyrrhizae uralensis
(plus human milk, cow’s milk, lotus juice, pear juice)