Spleen pattern identification

The process of diagnosing a morbid condition as a disease pattern of the spleen.

Physiology Recap

The spleen governs movement and transformation and controls the blood. Both are functions of its yáng qì.

Movement and transformation constitute a multi-faceted function:

• Helping the stomach to digest food (moving the fluids of the stomach).
• Extracting the essence of grain and water (nutrients from food).
• Sending nutrients upward for circulation around the body (upbearing the clear and dispersing essence) to produce qì and blood.
• Warming and transforming water-damp to prevent it from accumulating.
• Holding the internal organs in place.

Controlling the blood is the retentive action of spleen qì that keeps blood flowing in the vessels and prevents it from extravasating.

Pathomechanical Features

Spleen pathologies are disturbances of spleen qì’s movement and transformation action and blood-controlling function.

Spleen pathologies include vacuity and repletion patterns. Vacuity patterns are spleen qì vacuity, spleen yáng vacuity, spleen vacuity qì fall, and spleen failing to control the blood. Repletion patterns are associated with water-damp, which can arise either from externally contracted dampness or from the spleen’s yáng qì failing to warm and transform excess fluid in spleen qì vacuity or spleen yáng vacuity. Hence, the distinction between vacuity and repletion is not clear-cut.

Insufficiency of Yáng Qì

Insufficiency of the yáng qì of the spleen causes impairment of the spleen’s movement and transformation function and accounts for all spleen vacuity patterns. Since it easily causes accumulation of water-damp, it is also a major factor in repletion patterns (cold-damp and damp-heat).

Impaired Movement and Transformation

When the yáng qì of the spleen is insufficient, movement and transformation functions are impaired.

Appetite, abdomen, stool: Digestive signs include the following:

• reduced eating or torpid intake arising when the spleen vacuity affects the stomach’s intake function;
• distension and pain in the stomach duct and abdomen arising when spleen vacuity affects spleen upbearing and stomach downbearing;
• sloppy stool arising when movement and transformation of grain and water is impaired.

Insufficiency of qì and blood arises when impaired movement and transformation persists and affects the spleen’s ability to produce essence from grain and water is reduced. This manifests in:

• lassitude of spirit and fatigue;
• lack of strength in the limbs;
• emaciation attributable to reduced production of qì and blood or
• obesity attributable to inability to warm and transform water-damp;
• lusterless pale-white lips.

Cold signs associated with spleen yáng vacuity:

• continual abdominal pain that likes warmth and pressure;
• cold limbs;
• absence of thirst.

Spleen vacuity qì fall: When the spleen’s upbearing action is affected, there is diminished uplift manifesting in:

• chronic diarrhea;
• sagging sensation in the abdomen;
• prolapse of the rectum or uterus;
• murky urine, seminal emission, or vaginal discharge; or
• failure to retain a fetus resulting in miscarriage.

Spleen failing to control the blood: When the spleen’s function of controlling the blood is impaired, chronic bleeding occurs. This commonly affects the lower burner, taking the form of bloody stool, bloody urine, profuse menstruation, or flooding and spotting. Less commonly, it takes the form of nosebleed, bleeding gums, vomiting of blood, or spontaneous bleeding of the flesh.

General vacuity signs: Spleen qì vacuity patterns are marked by appetite, abdomen, and stool signs, as well as signs of insufficiency of qì and blood. In spleen yáng vacuity, these signs are more pronounced, and cold signs are also observed. Spleen vacuity qì fall and spleen failing to control the blood are specific forms of spleen qì vacuity in which the signs of general spleen vacuity also appear.

Water-Damp

By its warming and transforming action, the spleen normally prevents accumulation of water-damp, that is, unwanted fluids and dampness. When external dampness invades, this places an extra burden on the spleen; and when spleen qì is vacuous, it cannot cope even with normal amounts of fluids, causing internal dampness. In either case, the dampness hampers the movement of qì, giving rise to a condition variously called water-damp obstructing the center (水湿中阻 shuǐ shī zhōng zǔ) or center burner damp obstruction (湿阻中焦 shī zǔ zhōng jiāo), or simply damp obstruction (湿阻 shī zǔ). This can take the form of cold-damp or damp-heat patterns. Furthermore, when dampness lies stagnant, it can accumulate to form phlegm-rheum or puffy swelling. Cold-damp and damp-heat can further affect other bowels and viscera.

Factors contributing to the water-damp are:

• insufficiency of the spleen’s yáng qì;
• contraction of external dampness;
• excessive consumption of raw or cold foods;
• excessive consumption of rich, sweet, and fatty foods.

Insufficiency of the spleen’s yáng qì makes the spleen more susceptible to externally contracted dampness, while externally contracted dampness exacerbates insufficiency of the spleen’s yáng qì.

Developments of water-damp: Water-damp can develop into cold-damp or damp-heat. It can concentrate to form phlegm or rheum. It can also give rise to water swelling.

Dampness: Dampness is heavy, sticky, and stagnant; it easily obstructs yáng qì, resulting in

• abdominal fullness;
• poor appetite;
• heavy cumbersome limbs;
• sloppy stool;
• a glossy or slimy tongue fur.

Dampness has the tendency to develop either with cold or heat.

Dampness forming with cold (湿从寒化 shī cóng hán huà): In patients habitually suffering from spleen yáng vacuity, the formation of dampness will damage spleen yáng further, causing cold to arise internally. This pathomechanism is called dampness forming with cold giving rise to a pattern of cold-damp encumbering the spleen characterized by:

• a withered-yellow complexion with vacuity puffiness;
• cold limbs and fear of cold with a liking for warmth; and
• a glossy or slimy white tongue fur.

Dampness forming with heat (湿从热化 shī cóng rè huà): In patients with exuberant yáng qì, dampness evil that has lain depressed for a long time easily transforms into fire, causing a damp-heat pattern. This is the pathomechanism of dampness forming with heat giving rise to a pattern of damp-heat brewing in the spleen characterized by:

• fluctuating generalized heat effusion failing to surface that is not resolved by sweating;
• a bitter taste in the mouth;
• urgent defecation with diarrhea and sticky foul-smelling brown stool;
• turbid reddish urine;
• a slimy yellow tongue fur.

Dampness affecting the liver and gallbladder: Both cold-damp and damp-heat developing in the spleen can affect the liver’s free-coursing action on the bile, causing spillage of bile into the skin and eyes, which results in jaundice.

• Cold-damp causes a dull yellow coloration of the skin.
• Damp-heat causes a bright coloration classically described as being the color of tangerines.

According to modern textbooks, damp-heat jaundice is attributed to liver-gallbladder damp-heat, which is discussed under Gallbladder Patterns below. It should be noted, however, that before the introduction of Western medicine into China, jaundice was mostly attributed to the spleen, yellow being the color associated with spleen-earth. Dampness originating in the spleen and affecting the liver and gallbladder represents a compromise between traditional and biomedical theories. This is one example of how Chinese medicine has been influenced by biomedicine.

Dampness pouring downward: Dampness is heavy and stagnant in nature. Hence it can easily pour downward to lower parts of the body. Because dampness and cold are both yīn evils, it is not surprising that cold-damp should pour downward. What is surprising though is that even when dampness develops with heat, it can overcome the upward tendency of heat and carry the heat downward to the lower body. This pathomechanism is described as damp-heat pouring downward.

• Cold-damp pouring down to the lower burner can cause thin white vaginal discharge.
• Damp-heat pouring down to the large intestine causes diarrhea with foul-smelling stool or to dysentery with tenesmus and blood and pus in the stool.
• Damp-heat pouring down to the bladder causes strangury (painful, dribbling urination) with stones in the urine.
• Damp-heat pouring down into the genitals can cause itchy exudative conditions, yellow vaginal discharge that is sticky and foul-smelling, or red and white vaginal discharge.
• Damp-heat pouring down into the lower limbs can cause skin conditions that are often itchy or exudative and fail to heal easily, such as foot qì sores (athlete’s foot) or lower-limb fire flow, which is a form of cinnabar toxin.

Phlegm-rheum: Excess water-damp can collect to form phlegm or rheum. These do not give rise to spleen patterns, but rather they affect other bowels and viscera (stomach, heart, lung).

Water swelling: Insufficiency of the spleen’s yáng qì is often a contributory factor in the development of water swelling. Insufficiency of the yáng qì of the kidney and the lung usually play a more significant role; hence, there is no spleen pattern in which water swelling is a major sign.

Relationship to Other Bowels and Viscera

Heart and Spleen

The heart governs the blood and vessels, while the spleen is the source of qì and blood formation. Simultaneous insufficiency of heart blood and impaired spleen movement and transformation causes a pattern of dual vacuity of the heart and spleen. This arises in several ways:

• excessive thought and preoccupation affecting splenic movement and transformation and damaging heart blood;
• impaired movement and transformation resulting in reduced blood formation, which compromises the supply of heart blood; or
• blood loss resulting from the spleen failing to control the blood, which affects the supply of heart blood.

However dual vacuity of the heart and spleen arises, the signs are heart palpitation, insomnia, profuse dreaming, lusterless facial complexion, lassitude of spirit and fatigue, reduced eating, abdominal distension, and sloppy stool. If the spleen’s function of controlling the blood is affected, bleeding may occur too.

Lung and Spleen

The lung and spleen are both involved in the production of qì and in water metabolism. Disease of the lung can cause disease of the spleen and vice versa, manifesting in insufficiency of qì production and in water metabolism disorders.

Qì production: The lung is the governor of qì, drawing clear qì in from outside the body to contribute to qì production. The spleen is the source of qì and blood formation: it extracts the essence of grain and water, which then combines with the clear qì inhaled by the lung to produce ancestral qì, defense qì, and provisioning qì.

Impairment of the qì-producing functions of either viscus can hamper the ability of the other to perform its functions adequately.

• Insufficiency of lung qì stemming from enduring illness or persistent cough can affect the spleen, impairing its movement and transformation action. This is often called disease of the upper body affecting the center (上病及中 shàng bìng jí zhōng).
• Impaired movement and transformation reducing qì production can affect the lung, causing insufficiency of lung qì. This is called earth failing to engender metal (土不生金 tǔ bù shēng jīn).

In both cases, the result is lung-spleen qì vacuity, which manifests in scantness of breath or shortness of breath with laziness to speak, fatigue and lack of strength, reduced eating or torpid intake, abdominal distension, and sloppy stool. It is treated by banking up earth to engender metal (培土生金 péi tǔ shēng jīn).

Water metabolism: The lung normally ensures regulated flow through the waterways by the diffusion and downbearing action of its qì. The spleen normally prevents the accumulation of water-damp by its movement and transformation function.

Impairment of the functions of either viscus can hamper the ability of the other to perform its functions adequately.

• Impaired diffusion and downbearing of the lung can place an added burden on the spleen’s function of warming and transforming water-damp.
• Impaired movement and transformation of fluids can cause water-damp to collect internally and seep up into the lung and obstruct the waterways.

In either case, phlegm-rheum or water swelling may arise.

The importance of the relationship between the lung and spleen regarding phlegm is highlighted by the phrases the spleen is the source of phlegm production and the lung is the receptacle that holds phlegm.

Spleen and Bladder/Large Intestine

Damp-heat brewing in the spleen can pour down into the bladder or large intestine, to cause bladder damp-heat or large intestine damp-heat. The resulting patterns are discussed further ahead.

Spleen Signs

Spleen signs are mostly appetite and digestion disorders but also include head, body, limb, and lower body signs.

Appetite

Reduced eating (食少 shí shǎo): Poor appetite; eating less than normal or less than required for health. Reduced eating is chiefly associated with spleen qì vacuity, spleen yáng vacuity, stomach qì vacuity, stomach cold, and stomach yīn vacuity. Compare next item.

Torpid intake (纳呆 nà dāi): Absence of hunger or desire for food because of a feeling of satiety at mealtimes and fullness in the stomach duct and abdomen after one starts eating. Torpid intake usually indicates dampness, stomach cold, or food stagnating in the stomach duct.

Aversion to food (厌食 yàn shí): A feeling of revulsion at the sight or thought of food. It is a sign of food accumulation, damp-heat, or pregnancy. Aversion to greasy food (厌油 yàn yóu) may be a sign of gallstones.

Bitter taste in the mouth (口苦 kǒu kǔ): A bitter taste in the mouth unassociated with any food. It is caused by heat in the liver and/or gallbladder; it also occurs in damp-heat brewing in the spleen and in lesser yáng (shào yáng) disease patterns.

Digestion

Distension and fullness in the stomach duct and abdomen (脘腹胀满 wǎn fù zhàng mǎn): Distension means palpable or even visible expansion; fullness means a subjective feeling of expansion. Stomach duct (脘 wǎn, 胃脘 wèi wǎn) means the stomach itself or the part of the greater (upper) abdomen occupied by the stomach. Distension and fullness in the stomach duct and abdomen can be the result of spleen-stomach yáng qì vacuity, the presence of evils (such as food or dampness evil), or qì stagnation. It occurs in spleen qì vacuity, spleen yáng vacuity, food stagnating in the stomach duct, cold-rheum collecting in the stomach, liver depression invading the spleen or liver depression invading the stomach. A feeling of sagging associated with distension, such as sagging distension in the stomach duct and abdomen (脘腹坠胀 wǎn fù zhuì zhàng) or sagging distension in the small abdomen (小腹坠胀 xiǎo fù zhuì zhàng), is a sign of spleen vacuity qì fall.

Glomus (痞 pǐ); glomus and oppression (痞闷 pǐ mèn); glomus and distension (痞胀 pǐ zhàng): A sensation of blockage and fullness in the stomach duct or the region below the heart. It is attributed to stagnation of the qì dynamic in the center burner, usually resulting from dampness but sometimes from stomach qì vacuity. Note that some modern Chinese-language textbooks avoid the term 痞 pǐ altogether and replace it with distension.

Pain in the stomach duct and abdomen (脘腹疼痛 wǎn fù téng tòng); abdominal pain (腹痛 fù tòng): Pain in the stomach duct and in the abdomen in general, usually with fullness. This arises when the spleen’s yáng qì is insufficient or when evils are present. Its significance is as follows:

• Pain that likes pressure indicates vacuity (insufficiency of yáng qì).
• Pain that refuses pressure indicates repletion.
• Pain that likes warmth indicates cold.
• Pain that likes cold indicates heat.

Pain that is limited to the stomach duct tends to indicate stomach disease; pain that is also felt in the abdomen more commonly indicates a spleen problem. See pain in the stomach duct under Stomach Signs.

Nausea (恶心 ě xīn); retching and vomiting (呕吐 ǒu tù): Nausea and vomiting or dry retching are signs of stomach qì ascending counterflow and hence mostly indicate stomach disease. However, they often occur in damp-heat brewing in the spleen when dampness affects the downbearing of stomach qì.

Sloppy stool (便溏 biàn táng): Semiliquid stool that is traditionally described as being like duck’s droppings. This results when the yáng qì of the spleen fails to remove excess water from the digestive tract. In some cases of spleen qì vacuity, the stool is first dry and then sloppy. Sloppy stool with ungratifying defecation (a feeling after the passing of stool that defecation is not complete) is usually a sign of damp-heat.

Diarrhea (泄泻 xiè xiè): Increased frequency of defecation with semiliquid or liquid stool. In spleen disease, it is associated with spleen qì fall, spleen yáng vacuity, and damp-heat or cold-damp patterns. However, severe diarrhea is more commonly associated with the large intestine.

Clear-grain diarrhea (下利清谷 xià lì qīng gǔ): Diarrhea with grain failing to transform (完谷不化 wán gǔ bù huà), that is, the presence of only partially digested food in the stool. It is usually attributed to spleen yáng vacuity. Being a sign of vacuity, it is usually persistent.

Head, Body, and Limbs

Fatigue and lack of strength (倦怠乏力 juàn dài fá lì); fatigued limbs (肢体倦怠 zhī tǐ juàn dài); lassitude of spirit and lack of strength (神疲乏力 shén pí fá lì): The spleen governs the flesh and limbs. It is the later-heaven source of qì and blood. Fatigue and lack of strength in the limbs or whole body and lassitude of spirit arises when the spleen fails to produce sufficient qì and blood.

Heavy cumbersome limbs (四肢困重 sì zhī kùn zhòng), generalized heaviness (身重 shēn zhòng): A subjective sensation that the limbs or whole body are heavy and difficult to lift; a sign of dampness encumbering the spleen.

Heavy-headedness (头重 tóu zhòng): A subjective sensation of heaviness and clouding of the head. Like heavy cumbersome limbs and generalized heaviness, it is a sign of dampness encumbering the spleen.

Emaciation (形体消瘦 xíng tǐ xiāo shòu): Pathological thinness of the body. The spleen governs the flesh and limbs. Emaciation arises when insufficiency of the spleen’s yáng qì affecting production of qì and blood deprives the flesh of nourishment. Since spleen’s yáng qì is dependent on kidney and because the blood is closely related to the liver, emaciated patients often present with spleen-kidney yáng vacuity or liver-kidney yīn vacuity signs.

Obesity (形体肥胖 xíng tǐ féi pàng): A condition of excessive bodily weight. It is attributed to insufficiency of the spleen’s yáng qì or phlegm-damp. Fat flabby people, that is, people with copious soft flesh, are usually found to have yáng vacuity constitutions. The spleen governs the flesh and limbs. When its yáng qì is insufficient, it fails to move the fluids adequately, hence it invariably entails some degree of water-damp accumulating in the flesh that is also reflected in the enlarged tongue of yáng vacuity. Very often, the dampness gathers and concentrates to form phlegm-rheum; hence obese people may also present other signs of phlegm-rheum, such as a slimy tongue fur and slippery pulse. This explains the traditional maxim Obese people tend to have copious phlegm (肥人多痰 féi rén duō tán).

Generalized heat failing to surface (身热不扬 shēn rè bù yáng): Heat in the body that is only felt on prolonged palpation. It is characteristic of damp-heat and arises because the dampness traps the heat in the body so that it is not easily felt at the body’s surface. Heat effusion resulting from damp-heat heat may also be fluctuating. Note that this is like steaming bone tidal heat associated with yīn vacuity in that it is only felt on prolonged palpation, although the attending signs are quite different.

Itchy skin (皮肤瘙痒 pí fū sào yǎng): Itchy skin conditions, especially when exudative, are often attributable to damp-heat. Foot qì sores (脚气疮 jiǎo qì chuāng), referred to colloquially as athlete’s foot (tinea pedis ), and genital itch often fall in this category, as well as some forms of eczema. Other causes of itching include blood heat, blood vacuity, wind-damp, and wind evil.

Lower Body

Bleeding (出血 chū xuè): Loss of blood. Bleeding stems from numerous causes and occurs in different locations. Bleeding that results from the spleen failing to control the blood is (a) chronic and (b) usually takes the form of bloody stool, flooding and spotting, or profuse menstruation.

Prolapse of the rectum (脱肛 tuō gāng): Protrusion of the rectum through the anus. It is usually attributable to spleen vacuity qì fall. It usually in conditions of chronic diarrhea.

Prolapse of the uterus (子宫下垂 zǐ gōng xià chuí): Traditionally regarded as a disease and called yīn (vaginal) protrusion (阴挺 yīn tǐng) or eggplant disease (茄子病 qié zi bìng). Protrusion of the vagina through the vulva. It is usually attributable to spleen vacuity qì fall.

Vaginal discharge (带下 dài xià): Discharge of mucus via the vagina. Vaginal discharge can be attributable to many causes that are identified by the color and consistency of the discharge and by accompanying symptoms.

• White vaginal discharge (白带 bái dài) can reflect insufficiency of the spleen’s yáng qì (spleen qì vacuity, spleen yáng vacuity, spleen vacuity qì fall, or cold-damp pouring downward). It may also be attributable to kidney vacuity, in which case the discharge may be thinner and more copious and is accompanied by kidney signs.
• Yellow vaginal discharge (黄带 huáng dài), usually copious and foul-smelling, is associated with damp-heat. Note however that mild damp-heat may manifest in white vaginal discharge and severe damp-heat in red vaginal discharge. Yellow-green vaginal discharge indicates damp toxin.
• Red vaginal discharge (赤带 chì dài), which is actually mixed red and white vaginal discharge, with a slight malodor is usually attributable to depressed heat in the liver channel.

Spleen-Related Diseases

Diarrhea, constipation, and abdominal pain, traditionally regarded as diseases as well as symptoms, are described under Spleen Signs above. Other spleen-related diseases include the following:

Gān accumulation (疳积 gān jī): Often translated as malnutrition. A disease of infancy or childhood marked by emaciation, dry hair, heat effusion, abdominal distension with visible superficial veins, yellow facial complexion, and loss of essence-spirit vitality. It arises when dietary factors, evils, or worms damage the spleen and stomach.

Stomach reflux (反胃 fǎn wèi): A disease marked by vomiting in the evening of food ingested the previous morning or by vomiting in the morning of food ingested the previous evening. It is mostly attributable to spleen-stomach vacuity cold (spleen or stomach yáng vacuity) or spleen-kidney yáng vacuity.

Yellow swelling (黄胖 huáng pàng): Also called yellow obesity. Swelling of the face and ankles with a withered-yellow facial complexion, together with fatigued spirit and lack of strength. It is sometimes associated with nausea and vomiting of yellow water, and a desire to eat uncooked rice, tea leaves, and coal. This is now known to be caused by hookworm infestation, anemia, or malnutrition.

Flooding and spotting 崩漏 bēng lòu): Flooding is heavy bleeding via the vagina (flooding and spotting ); spotting is light bleeding via the vagina (metrostaxis ). These conditions are caused by frenetic movement of hot blood or the spleen failing to control the blood.

White turbidity (白浊 bǎi zhuó): A condition in which the urine is white and murky like water in which rice has a been washed. The term white turbidity usually refers to white murky urine unassociated with inhibited urination or pain on urination and is attributable to kidney vacuity or spleen vacuity qì fall. By contrast, unctuous strangury usually refers to conditions caused by damp-heat and associated with painful inhibited urination. However, in practice, the use of the terms is not so clear-cut.

Summer infixation (疰夏 zhù xià): The regular summer recurrence of loss of appetite, fatigue and lack of strength, and low fever with gradual recovery in the autumn (the driest season), occurring with sloppy stool or diarrhea. This is one form of damp obstruction (dampness encumbering the spleen and stomach). A higher body temperature with more pronounced heat signs indicates summer heat-damp. Summer infixation is little discussed in modern literature, but it is a condition that is popularly recognized in China.

Spleen Patterns

Below is a brief description of the major spleen disease patterns, with links to entries that provide more detail. See also spleen pattern identification.

Simple Patterns

Spleen qì vacuity (脾气虚 pí qì xū): Reduced eating; sloppy stool; distension and fullness in the stomach duct and abdomen more pronounced after eating; qì vacuity signs. It develops from dietary irregularities; taxation fatigue (overwork); excessive thought and preoccupation; enduring vomiting or diarrhea; major or enduring illness; constitutional weakness; decline in visceral qì in advancing years.

Spleen yáng vacuity (脾阳虚 pí yáng xū): Continual cold pain in the stomach duct and abdomen that likes warmth and pressure; signs of vacuity cold. It develops from enduring spleen qì vacuity; excessive consumption of raw and cold foods or excessive use of cold and cool medicinals; kidney yáng vacuity depriving the spleen of warmth.

Spleen vacuity qì fall (脾虚气陷 pí xū qì xiàn): Sagging distension in the stomach duct and abdomen; enduring diarrhea or dysentery; prolapse of internal organs; signs of spleen qì vacuity. It develops from spleen qì vacuity; constitutional vacuity; enduring diarrhea; taxation fatigue; excessive childbirth; or poor postpartum care.

Spleen failing to control blood (脾不统血 pí bù tǒng xuè): Chronic bleeding, typically in the form of bloody stool, bloody urine, or flooding and spotting; spleen qì vacuity signs. It develops from enduring spleen qì vacuity or less commonly from taxation fatigue damaging the spleen.

Cold-damp encumbering the spleen (寒湿困脾 hán shī kùn pí): Distension and pain in the stomach duct and abdomen; nausea and vomiting; sloppy stool; signs of cold-damp collecting internally. It develops from insufficiency of spleen yáng vacuity; contraction of external dampness; consumption of raw and cold foods. It can give rise to jaundice.

Damp-heat brewing in the spleen (湿热蕴脾 shī rè yùn pí): Glomus and distension in the stomach duct and abdomen; nausea and vomiting; bitter taste in the mouth; sloppy stool with ungratifying defecation; aversion to food; signs of damp-heat brewing internally. It develops from externally contracted damp-heat or from excessive consumption of fatty or sweet food or alcohol. It can give rise to jaundice.

Combined Patterns

Dual vacuity of the spleen and lung (脾肺气虚 pí fèi qì xū): Reduced eating; abdominal distension; sloppy stool; cough; panting; shortness of breath; qì vacuity signs. It develops when enduring cough causes damage to lung qì, which affects the spleen (disease of the child affecting the mother) or when dietary irregularities cause damage to the spleen that affects the lung (spleen failing to engender earth).

Spleen-kidney yáng vacuity (脾肾阳虚 pí shèn yáng xū): Cold pain in the lumbus and abdomen; clear-grain diarrhea; fifth-watch diarrhea; puffy swelling; vacuity cold signs. It arises when, in enduring diarrhea or dysentery, disease of the spleen affects the kidney or when, in kidney vacuity water flood, disease of the kidney affects the spleen.

Liver-spleen disharmony (肝脾不調 gān pí bù tiáo): Also called liver depression and spleen vacuity (肝郁脾虚 gān yù pí xū). Distension and fullness and scurrying pain in the chest and rib-side; frequent sighing; torpid intake; abdominal distension; sloppy stool with ungratifying defecation; abdominal pain heralding diarrhea with relief from pain on defecation; rumbling intestines; passing of flatus. It can arise when affect-mind depression resulting from dissatisfaction or other negative emotions damage the liver causes depressed liver qì that moves cross-counterflow and overwhelms spleen-earth. It can also arise when dietary irregularities or taxation fatigue damage spleen qì and, as a result, the spleen rebels against wood and impairs the liver’s free coursing action.