In clinical practice, patients with Spleen and Kidney Yang Deficiency are quite common, presenting with both Spleen Yang deficiency leading to impaired transformation and Kidney Yang deficiency causing excessive water and dampness. The main clinical manifestations include three aspects: ① Yang deficiency with excessive cold, leading to stagnation of Qi, resulting in a pale complexion, aversion to cold, cold limbs, weakness in the lower back and knees, and abdominal cold pain; ② Impaired transportation of food and fluids leading to abdominal distension, chronic diarrhea, or even early morning diarrhea with clear stools; ③ Excessive water and dampness leading to difficulty urinating, facial swelling, and limb edema, or frequent urination with residual dribbling, or nocturia. The tongue is pale and swollen with tooth marks, the coating is white and slippery, and the pulse is deep, slow, thin, and weak, indicating a deficiency of Yang Qi. Traditional Chinese Medicine (TCM) holds that “the Kidney is the root of congenital essence, and the Spleen is the root of acquired essence”. Kidney water requires nourishment from the Spleen earth to thrive. If the body constitution is Yang deficient, or if one is elderly and frail, or if Spleen Yang deficiency has persisted for a long time, it can lead to insufficient Yang Qi in both the Spleen and Kidney. Therefore, clinical treatment must pay attention to ① whether the Spleen is primarily affected or the Kidney, and ② whether Spleen Yang deficiency is more severe or Kidney Yang deficiency is more severe, before selecting the appropriate formulas and medications. The main treatment principle should be to warm and tonify the Spleen and Kidney.
In clinical practice, the symptoms of Spleen and Kidney Yang deficiency can be diverse. Therefore, if treatment does not address the current symptoms, it cannot be targeted effectively. Even if the diagnosis of Spleen and Kidney Yang deficiency is made, the medication may seem appropriate but may not yield satisfactory results. In clinical practice, it is essential to maintain a holistic view; the human body is a whole, and the conditions may be intertwined and complex. Therefore, when selecting formulas and medications, it is crucial to consider all symptoms and carefully summarize the relationships between various syndromes to clarify the pathogenesis, avoiding a scattergun approach to prescribing.
Commonly used formulas for treating Spleen and Kidney Yang deficiency include Zhen Wu Tang (True Warrior Decoction), Ling Gui Zhu Gan Tang (Poria, Cinnamon, Atractylodes, and Licorice Decoction), Fu Zi Li Ling Tang (Aconite and Poria Decoction), Ji Sheng Shen Qi Wan (Kidney Qi Pill for Life Preservation), Fu Zi Li Zhong Wan (Aconite and Middle Pill), Si Shen Wan (Four Spirit Pill), Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill), You Gui Wan (Right Return Pill), Wang Qing Ren’s Emergency Yang Reviving Decoction, and Shu Fu Tang (Atractylodes and Aconite Decoction). Classical formulas are the foundation of clinical diagnosis and treatment and can yield the best therapeutic effects. However, they must be selected based on the specific symptoms, and adjustments should be made according to the syndrome differentiation. In summary, the treatment for Spleen and Kidney Yang deficiency typically consists of Spleen tonifying herbs + Kidney tonifying herbs + Yang warming herbs. Spleen tonifying herbs often include Bai Zhu (White Atractylodes), Cang Zhu (Atractylodes), Chen Pi (Aged Tangerine Peel), Chai Hu (Bupleurum), Hou Po (Magnolia Bark), Dou Kou (Cardamom), Ren Shen (Ginseng), Fu Ling (Poria), Shan Yao (Chinese Yam), Tai Zi Shen (Pseudostellaria), Chun Sha Ren (Spring Sand Seed), Lian Zi (Lotus Seed), Guang Mu Xiang (Aromatic Wood), Chao Xiang Fu (Fried Cyperus), Bai Bian Dou (White Hyacinth Bean), Yi Yi Ren (Job’s Tears), Huang Qi (Astragalus), Yu Zhu (Polygonatum), Dou Kou (Cardamom), Cao Dou Kou (Grass Cardamom), Cao Guo (Tsaoko), Ji Nei Jin (Chicken Inner Gold), and Jiao San Xian (Fried Three Immortals); Kidney Yang tonifying herbs commonly used include Hei Fu Zi (Black Aconite), Rou Gui (Cinnamon), Lu Jiao Pian (Deer Antler), Yin Yang Huo (Epimedium), Xian Mao (Curculigo), Ba Jiao Tian (Morinda), Bu Guo Zhi (Psoralea), Wu Zhu Yu (Evodia), Suo Yang (Cynomorium), Tu Si Zi (Cuscuta), Rou Cong Rong (Cistanche), Jiu Cai Zi (Chive Seed), Yang Qi Shi (Yang Stone), Zi Shi Ying (Purple Quartz), Ge Jie (Gecko), Hai Long (Sea Dragon), Hai Ma (Sea Horse), Xu Duan (Dipsacus), Zi He Che (Human Placenta), Yi Zhi Ren (Alpinia), Sha Yuan Zi (Astragalus), He Tao Ren (Walnut), Fu Pen Zi (Raspberry), Hu Lu Ba (Fenugreek), and Du Zhong (Eucommia); Yang warming herbs commonly used include Gan Jiang (Dried Ginger), Gui Zhi (Cinnamon Twig), Fu Zi (Aconite), Rou Gui (Cinnamon), Wu Zhu Yu (Evodia), Gao Liang Jiang (Galanga), Chuan Hua Jiao (Sichuan Pepper), Bi Ba (Cubeb), Ding Xiang (Clove), Bi Cheng Qie (Bitter Orange), Xiao Hui Xiang (Fennel), Hu Jiao (Black Pepper), Ai Ye (Mugwort), and Wu Tou (Aconite).
In clinical practice, when warming and tonifying the Yang of the Spleen and Kidney, it is crucial not to use excessively hot and spicy warming herbs indiscriminately. Many practitioners, upon seeing a patient who is averse to cold, will prescribe large doses of ginger and aconite, but after taking the medicine, patients often find their tongue coating becomes even thicker and whiter, and their aversion to cold and wind is not alleviated, and may even worsen. I have encountered practitioners who used dozens or even hundreds of grams of aconite and dried ginger to treat Spleen and Kidney Yang deficiency, and the patients did not recover until they experienced toxicity. Many practitioners lament that despite having a large fire, they cannot dispel even a bit of cold and dampness! Some practitioners even doubt whether the properties of aconite are “cold” rather than “spicy and hot,” without reflecting on the need to differentiate treatment based on individual constitution and condition, especially since some practitioners rely solely on pharmacological combinations without considering the compatibility of herbs, leading to poor clinical outcomes. In clinical practice, we can refer to the Su Wen: Yin Yang Ying Xiang Da Lun which states, “When the strong fire Qi is weak, the weak fire Qi is strong; strong fire consumes Qi, and Qi consumes weak fire; strong fire disperses Qi, and weak fire generates Qi.” Ma Shi believes: “If the flavor is too thick, it is strong fire; using strong fire products will cause our Qi to be unable to withstand it, leading to a decline (for example, using Wu Fu and similar products, our Qi cannot overcome it, hence causing heat). If the flavor is warm, it is weak fire; using weak fire products will gradually strengthen our Qi.” Zhang Jingyue believes: “The fire of Yang and harmony generates life, while excessive fire harms life; thus, if fire is too strong, Qi declines, and if fire is harmonious, Qi strengthens.”
I often see patients with Spleen and Kidney Yang deficiency who have taken ginger and aconite without improvement. I frequently use herbal medicine combined with acupuncture treatment, often employing Su Yang Tang (Reviving Yang Decoction) (a family recipe from Zhang Xueli) for regulation, which includes: Chao Er Zhu (Fried Atractylodes), Neng Gui Zhi (Tender Cinnamon), Bei Chai Hu (Northern Bupleurum), Lu Jiao Shuang (Deer Antler Frost), Xian Ling Pi (Spleen Herb), Xian He Cao (Herb of the Crane), Xian Mao Shen (Ginseng), Hong Shen Pian (Red Ginseng Slices), Tu Si Zi (Cuscuta), Zi Dan Shen (Purple Salvia), Ji Xue Teng (Chicken Blood Vine), Da Ze Lan (Big Ze Lan), Yun Fu Ling (Cloud Poria), Guang Chen Pi (Aged Tangerine Peel), Huai Shan Yao (Chinese Yam), Tu Si Zi (Cuscuta), Dan Gan Jiang (Dried Ginger), and Zhi Gan Cao (Honey-fried Licorice), decocted in water, one dose per day, taken warm in the morning and evening. If Spleen Yang deficiency is severe, add Sha Ren (Cardamom), Rou Dou Kou (Nutmeg), Cao Guo Ren (Tsaoko), Bi Ba (Cubeb), Bi Cheng Qie (Bitter Orange), and Gu Yue; if Kidney Yang deficiency is severe, add Hei Fu Zi (Black Aconite), Rou Gui (Cinnamon), Ba Jiao Tian (Morinda), Rou Cong Rong (Cistanche), and Zi He Che (Human Placenta); if Qi deficiency is severe, add Huang Qi (Astragalus) and Ci Wu Jia (Siberian Ginseng), and substitute Korean Ginseng for Red Ginseng; if there is accompanying Yin and blood deficiency, add Wu Wei Zi (Schisandra), Mai Dong (Ophiopogon), Jiu Dang Gui (Wine-processed Angelica), Shu Di Huang (Rehmannia), Shan Zhu Yu (Cornus), and Yu Zhu (Polygonatum); if Spleen deficiency leads to poor transportation, add Bu Zha Ye (Burdock Leaf), Jiao San Xian (Fried Three Immortals), Ji Nei Jin (Chicken Inner Gold), and Bai Dou Kou (White Cardamom); if Kidney deficiency leads to significant edema, add Ze Xie (Alisma), Zhu Ling (Polyporus), Fang Ji (Stephania), Mu Tong (Akebia), Che Qian Zi (Plantago Seed), and Dong Gua Ren (Winter Melon Seed); if there is loose stools or early morning diarrhea, add Chi Shi Zhi (Red Stone), Bu Guo Zhi (Psoralea), He Zi (Myrobalan), Rou Dou Kou (Nutmeg), and Ying Su Ke (Poppy Seed); if there is constipation, add Rou Cong Rong (Cistanche), He Zi (Myrobalan), Bai Zi Ren (Biota Seed), Xing Ren (Apricot Seed), Tao Ren (Peach Seed), Gua Lou Ren (Trichosanthes Seed), and Zhi Ma Ren (Sesame Seed); for infertility, add Zi He Che (Human Placenta), Xu Duan (Dipsacus), Sang Ji Sheng (Mulberry Parasitic Plant), and Fu Pen Zi (Raspberry); for impotence, add Wu Gong (Centipede), She Chuang Zi (Cynanchum), Jiu Dang Gui (Wine-processed Angelica), Ge Jie (Gecko), and Yang Qi Shi (Yang Stone), and take She Gan San (She Gan and Ganoderma) (1.5-3 grams each, ground into fine powder) with wine; for lower back pain and weakness, add Bie Jia San (Vinegar Bie Jia ground into fine powder, 20 grams daily, taken with wine morning and evening), Jin Gou Ji (Golden Dog Spine), Chao Du Zhong (Fried Eucommia), Niu Da Li (Cow Strength), Chuan Xu Duan (Dipsacus), and Chuan Du Huo (Angelica); for aversion to cold and wind, add Zi He Che (Human Placenta), Hei Fu Zi (Black Aconite), and Rou Gui (Cinnamon powder), and apply moxibustion (on Ren and Du meridians).
Moxibustion therapy is one of the most commonly used methods to tonify Yang in clinical practice. Moxa is one of the plants abundant in Yang Qi in nature. By stimulating acupuncture points with the heat of moxa, it can quickly restore Yang Qi in the body. The Book of Bian Que states: “The first method for preserving life is moxibustion, the second is elixirs, and the third is aconite.” Moxibustion is particularly selected for Spleen and Kidney Yang deficiency at: Zhong Wan, Shen Que (Navel), Tian Shu, Qi Hai, Guan Yuan, Da Zhui, He Gu, Tai Xi, Zu San Li, San Yin Jiao, Zhao Hai, Yin Ling Quan, Feng Long, and back Shu points (Heart Shu, Spleen Shu, Liver Shu, Kidney Shu, Lung Shu), and Ming Men.
Elixirs are believed by Daoists to warm and nourish the internal organs and meridians through the practice of internal alchemy. Few modern practitioners study internal alchemy, which may be related to the impact of Western scientific discourse, as the ethereal methods cannot be explained by Western “science.” However, with persistent practice, Qi can be gathered in the lower dantian, and over time, a warm sensation like a “small sun” will appear in the lower dantian. Many modern internal martial arts and Qigong schools have researched internal alchemy, thus preserving this ancient Chinese tradition, which is quite difficult.
Zhang Yulong, from a family of traditional Chinese medicine practitioners, graduated from Anhui University of Traditional Chinese Medicine with a bachelor’s degree. He studied under renowned national TCM experts such as Yang Jun, Yang Renmin, Ma Jun, Zhou Meisheng, Pan Jialong, Dong Hongqiang, and Ma Shan, specializing in pulse diagnosis, facial diagnosis, and tongue diagnosis. He is skilled in comprehensive treatments including herbal medicine (internal and external), acupuncture, tuina (Chinese therapeutic massage), moxibustion, guasha (scraping therapy), cupping, and bloodletting.
Specializes in treating:
Internal Medicine: Colds, coughs, asthma, bronchitis, hypertension, diabetes, stroke, cardiovascular diseases, gastrointestinal diseases (abdominal pain, diarrhea, acute and chronic gastritis, acute and chronic enteritis, atrophic gastritis, intestinal polyps), liver and gallbladder diseases (acute and chronic hepatitis, cholecystitis, biliary polyps, jaundice), kidney diseases (acute and chronic nephritis, nephrotic syndrome, pyelonephritis, etc.), stubborn insomnia, headaches (migraine, tension headache, post-traumatic headache), and treatment of various systemic tumors.
Gynecology: Irregular menstruation, amenorrhea, dysmenorrhea, pregnancy-related diseases (morning sickness, pregnancy-related infections, pregnancy-induced hypertension, high blood sugar, pregnancy-related constipation, urinary retention, etc.), metrorrhagia, gynecological inflammation, postpartum diseases, breast diseases, uterine fibroids, ovarian cysts, polycystic ovary syndrome, adenomyosis, and infertility.
Pediatrics: Colds (recurrent upper respiratory infections), coughs (acute and chronic bronchitis).