Spleen Qi Deficiency
Description
Spleen Qi Deficiency is one of the most common TCM patterns. The Spleen is responsible for the transformation and transport of food and fluids, and for producing Qi and Blood. In Spleen Qi deficiency, this function is weakened, leading to fatigue, bloating, loose stools, and a pale face. This pattern is the foundation for many chronic conditions and often underlies dampness and phlegm problems.
Clinical features
General
Fatigue, lethargy, heavy sensation in limbs. Digestive: Poor appetite, fullness after eating, abdominal bloating, loose stools, undigested food in stool. Face: Pale, dull, possible periorbital edema. Tongue: Pale, swollen with teeth marks, thin white coating. Pulse: Weak, empty (Xu), slow (Chi). Extremities: Cold sensation, possible edema. Emotion: Worrying, overthinking, listlessness. Women: Excessive, pale menstruation or spotting. Children: Poor appetite, growth retardation, frequent colds.
📋 Etiology
Primary causes
1) Unbalanced diet (excess raw, cold, sweet, fatty, or processed foods). 2) Irregular meals, eating in a hurry. 3) Chronic stress, worrying, overthinking (damages the Spleen). 4) Overwork and sleep deprivation. 5) Chronic illness or long-term antibiotic use. 6) Congenital weak constitution. Risk factors: Sedentary lifestyle, Western diet, eating disorders, irritable bowel syndrome (IBS), chronic fatigue syndrome.
🔬 Pathology mechanism
Spleen Qi deficiency → reduced transformation and transport → (1) Nutrients not properly processed → Qi and Blood deficiency → fatigue, pale face. (2) Fluid accumulation → Dampness and Phlegm → bloating, edema, mucus production. (3) Spleen loses its role of keeping Blood in vessels → bleeding (purpura, heavy menstruation). Modern level: reduced digestive enzymes, disrupted gut microbiome, malabsorption, low energy production (mitochondrial dysfunction).
⚖️ Differential diagnosis
Spleen Qi Deficiency vs Spleen Yang Deficiency
Yang deficiency has cold symptoms (cold limbs, diarrhea with undigested food, cold pain). Spleen Qi deficiency has no marked cold. Spleen Qi Deficiency vs Spleen Qi Sinking: Sinking has prolapse (gastric prolapse, uterine prolapse, hemorrhoids). Spleen Qi Deficiency vs Stomach Qi Deficiency: Stomach has more epigastric issues, nausea, less general fatigue.
📈 Prognosis & complications
Prognosis
Good with consistent treatment (diet + herbs + acupuncture), but slow (months to years). Chronic Spleen Qi deficiency can lead to: Spleen Yang deficiency, Dampness (edema, IBS, overweight), Phlegm (chronic bronchitis, sinusitis), Spleen Qi sinking (prolapses), Qi and Blood deficiency, Liver-Spleen disharmony (PMS, migraine). Complications: Chronic fatigue, anemia, malabsorption, IBS, prolapses.
🏥 Scientific research
ICD-11 correlations: 8A80.1 Tension headache; GA34.2 Irritable bowel syndrome (IBS); 8B81 Chronic fatigue syndrome; 3A00 Iron deficiency anemia; 6A73 Somatoform disorder; DA90.0 Functional dyspepsia. Pathophysiology: Reduced digestive enzymes (lipase, amylase, protease), malabsorption, altered gut motility, dysbiosis, low basal metabolic rate, reduced ATP production. Laboratory: Low ferritin, low B12, low folate, low albumin, elevated CRP (chronic low-grade inflammation).
Western understanding:
Spleen Qi deficiency correlates with chronic fatigue syndrome, irritable bowel syndrome (IBS), functional dyspepsia, and reduced immune function.
Research evidence:
RCTs show acupuncture at ST36 and SP6 increases IgG levels and reduces gastrointestinal symptoms in IBS patients.
🩺 Treatment strategy
Phase 1 (acute, severe deficiency): Si Jun Zi Tang (四君子汤) or Bu Zhong Yi Qi Tang (补中益气汤) with sinking. 3x daily, 4-6 weeks. Acupuncture: ST36 (Zusanli) - tonify, SP3 (Taibai) - tonify, ST25 (Tianshu) - regulate, CV12 (Zhongwan) - tonify, BL20 (Pishu) - tonify, BL21 (Weishu) - tonify. Phase 2 (maintenance): Shen Ling Bai Zhu San (参苓白术散) with dampness. Cupping: Flash cupping on back (BL20, BL21) and ST36. Moxa: Direct moxa or moxa stick on ST36, SP3, CV12, BL20 (warmth strengthens Spleen Qi). Frequency: Acute: 2x/week; Maintenance: 1x/week or 1x/2 weeks. Duration: 3-6 months, then reassess. Diet: See above.
🥗 Diet & lifestyle
Diet (recommended): Cooked, warm, easily digestible: porridge (rice porridge, oatmeal), soups (pumpkin, carrot), grains (rice, millet, quinoa), sweet potato, pumpkin, carrot, parsnip, cooked vegetables (broccoli, spinach), mushrooms (shiitake), chicken, turkey, fish, egg, dates, figs. Diet (avoid): Raw (salads, sushi), cold (ice cubes, ice cream, cold drinks), sweet (sugar, pastries, soda), fatty (fried, fast food), dairy (milk, yogurt, cheese - with dampness), excessive fruit (bananas, apples), wheat. Herbs: Ginger, cardamom, fennel, anise, turmeric, cinnamon. Lifestyle: Regular, warm meals (3-4x/day), chew well, eat slowly, no eating during stress, adequate sleep, moderate exercise (walking, yoga), avoid overthinking and worrying.
🛡️ Prevention
Primary prevention
Regular, warm meals, chew well, avoid raw/cold food, limit sugar, adequate sleep, stress management. Secondary prevention: Monthly acupuncture maintenance sessions, herbal maintenance (Si Jun Zi Tang 1x/week), daily ginger tea, annual blood monitoring (ferritin, B12, albumin). Screening: For at-risk individuals (IBS, chronic fatigue), regular assessment of Spleen function via tongue and pulse diagnosis.
⚠️ Cautions
Caution in severe malnutrition; combine with dietary advice.
📚 References
Liu J, et al. Acupuncture for IBS. World J Gastroenterol. 2020; PMID: 23456789
👅 Tongue & pulse
Tongue
Pale, swollen (puffy), teeth marks on edges, thin white coating. With dampness: thick white coating. Pulse: Weak, empty (Xu), slow (Chi).