Formulas for Winter Spleen Health

During the winter holidays, patients often experience months of higher consumption of fatty meals, high-sugar desserts and poor food combinations. These dietary challenges are also often combined with higher levels of stress due to family concerns or seasonal malaise. This combination of gastrointestinal / emotional challenges is one of the most common clinical presentations I encounter in my clinic.

But there's hope for these patients, in the form of herbal medicine. Let's discuss some important classical formulas that can be used to effectively balance and harmonize clinical presentations which may arise during and after the often busy and stressful holiday season.

Spleen and Liver Disharmony

The concept of spleen health in traditional Chinese medicine is an essential foundational topic for patient education during the winter months. However, the average patient's lifestyle during the holiday months is not conducive to promoting healthy spleen qi and low stress levels, which often aggravates the flow of liver qi. This results in the common clinical pattern presentation of liver / spleen disharmony.

Formulas which boost spleen qi and harmonize the liver / spleen, while important, are often used after acute clinical complaints are reported by the patient. Formulas such as Yu Ping Feng San (Jade Windscreen Powder), Huang Qi Jian Zhong Tang (Astragalus Decoction to Construct the Middle), Bu Zhong Yi Qi Tang (Tonify the Middle to Augment the Qi Decoction), and Xiao Yao San (Free and Easy Wanderer Powder) variations are important for seasonal health, but often need to be taken for months before improvements are seen.

In my clinical practice, I most commonly see patients presenting with gastrointestinal complaints combined with chronic stress issues such as anxiety, depression, and insomnia during the stressful holiday months, when preventative care is most often disregarded or ignored. At this point, tonic formulas are most likely not effective. In such situations, I often refer to two classical formulas which are highly effective for acute issues revolving around unique gastrointestinal / psychological-emotional complaints: Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) from Essential Prescriptions of the Golden Cabinet (Golden Chamber) and Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) from A Discussion of Cold Damage (Shang Han Lun).

Ban Xia Hou Po Tang

This classical formula is commonly used when the following symptom constellations appear: feeling of something being caught in the throat or chest, often combined with emotional issues, coughing or chest stuffiness, nausea, vomiting, low appetite and abdominal upset (often combined with emotional issues), and a tongue coating which is usually thick and greasy, white and greasy and/or the mouth having a thick, sticky sensation.

These unique symptoms are extremely common to encounter when patients eat a diet rich in fatty foods and sugary desserts in an environment of stress. I find this classical formula particularly effective in patients who have already taken common naturopathic remedies such as probiotics and digestive enzymes with little to no improvement in symptoms; and in patients who consume larger amounts of alcohol during the winter months.

It is quite easy to find this classical formula in patent form and can be taken in a higher dosage until acute symptoms resolve. Once acute complaints have calmed, I often continue patients on this formula at a lower maintenance dose until the thick, greasy tongue coating / throat sensation / emotional issues have substantially decreased. This formula is particularly effective in patients with underlying dampness and chronic weak spleen qi. In patients with the pattern symptomatic gastrointestinal symptoms, and also chronic emotional frustrations, I often combine Ban Xia Hou Po Tang with Jia Wei Xiao Yao Wan.

Ban Xia Xie Xin Tang

This classical formula is extremely effective when patients present with gastrointestinal / psychological-emotional complaints with the following characteristics: a sensation of pain or pressure in the upper abdomen which feels better with pressure; nausea, vomiting, diarrhea, irritability and restlessness, often combined with insomnia and feelings of internal body heat; and thin greasy or yellow greasy tongue coating. I find this formula extremely effective in patients who eat heavier protein diets and in patients who have histories of symptoms of GERD and /or chronic use of over-the-counter or prescription protein-pump inhibitors.

One of the most important aspects of this formula is the balanced use of cooling and warming medicinals. This balanced and nuanced approach is a fundamental benefit of using TCM formulas over basic digestive enzymes, basic probiotics, or basic gastric reflux medications. The dose can be prescribed in higher amounts during acute symptoms and phased into a lower maintenance dose to be taken until symptoms completely resolve and tongue body / coating is closer to a normal, healthy presentation.

In patients with chronic underlying mental-emotional problems and the above symptoms, I often combine this patent formula with Xiao Yao Wan in cases of chronic depression and with Tian Wang Bu Xin Dan in patients who suffer from the above gastric symptoms with history of chronic insomnia – an extremely common clinical presentation which can be exacerbated during the busy and stressful holiday months.

Clinical Takeaway

I hope this short discussion of these two classical TCM formulas inspires clinicians to move beyond using basic digestive enzymes and allopathic herbal approaches in unique presentations of combined gastrointestinal / mental-emotional dysfunction. When patients present with unique symptom constellations, this is the time when TCM can truly shine and provide exceptional results for patients who might otherwise be given poor-quality health care.

I chose to discuss two simple classical TCM formulas to highlight how TCM can treat unique symptom constellations, but this is just the tip of the iceberg, so to speak, as there are literally hundreds of TCM classical formulas which can be discussed and explored. I particularly encourage practitioners to study the informative texts, Ten Key Formula Families in Chinese Medicine and Huang Huang's Guide to Clinical Application of Classical Formulas by Huang Huang for more in-depth discussions on how to expand the use of classical TCM formulas in the clinical setting.