Yin and Yang Deficiency, Part V

By Barbra Esher , AOBTA CI. Dipl. ABT & Ac. (NCCAOM), LAc

Yin and Yang Deficiency, Part V

By Barbra Esher , AOBTA CI. Dipl. ABT & Ac. (NCCAOM), LAc

If you've been following this series of articles, you're now familiar with the differences between yin and yang deficiency. At this point, you know yin deficiency in depth and have been introduced to yang deficiency. This article explains how to differentiate the different types of yang deficiency, so you can fine-tune your assessment and treatment. (Editor's note: Barbra's entire series of articles can be accessed online by clicking here.)

When evaluating yin and yang, always consider the big picture. Yin aspects are related to nourishment and substance; yang aspects are more energetic and functional. We need yin and yang; women and men contain both, or they cease to exist. In the first article in this series, I discussed the aging process as it relates to yin and yang. People naturally start to decline in yin, yang or both as they age. If yin wanes, people may have less of a desire to nurture or care for others, or they may become more outgoing or outspoken. Substance also declines - for example, bone density decreases. If yang declines, they may become more relaxed and accommodating to others, but they also may have sexual dysfunction and trouble holding urine throughout the night. (This is discussed a little more extensively in part I of the yin/yang series: www.massagetoday.com/archives/2002/09/07.html.)

Yang deficiency always has some cold symptoms in the pattern, but overall, it does not appear as an excess condition. Most people with yang deficiency present with at least a few of these symptoms:

Refer to part IV of this series to see how these symptoms relate to yang deficiency.

When you determine there is a yang deficiency, the next step is to decide what organ is primarily involved. It could be Spleen, Kidney or Heart, (capitalized to distinguish the Chinese view of these organs as an orb of influence, rather than what we commonly think of in the West). Actually, yang deficiency could be a progression from qi deficiency, such that organ patterns look the same, but with the addition of cold symptoms. (Editor's note: See the General Full Cold Symptoms chart below).

Spleen Yang Deficiency includes any of the broad symptoms listed in the first chart (above), keeping in mind that there must also be cold symptoms because of the relative lack of yang. Various digestive problems also manifest, such as lack of appetite; a puffy, tired feeling after eating; or loose stools. This is an indication that the Spleen's transportation and transformation function is impaired. For the same reason, if the Spleen can't convert the qi in food to a usable form, a person feels tired, listless or has trouble waking up in the morning. Fluids also will build up, because they aren't being transported and distributed properly (another function of the Spleen).

Poor diet is the primary cause of Spleen yang deficiency. Eating excessive cold, frozen, raw or sweet foods will damage the Spleen. Irregular eating habits; under- or overeating; eating too quickly; or eating while working or driving all can damage the Spleen. Is it no wonder that this is such a common syndrome is our society! Taking too many Chinese herbs with a cold nature also can cause Spleen yang deficiency, so if the patient is taking herbs, make he or she is seeing a qualified herbalist.

To evaluate Kidney Yang Deficiency, check for at least a few of the symptoms in the chart above. There may also be problems with the lower back and/or knee pain, both of which can be relieved by warmth. The Kidneys are closely related to Ming Men Fire, which emanates from the area of the lower back. When it fails to warm the body, the lower back feels cold. Whenever there is cold, there is pain, as the cold contracts and obstructs the free flow of qi. In addition, Kidney yang gives strength and support to the bones of the back and knees, so a deficiency will cause weakness in those areas.

The warmth of Kidney yang is needed for sexual function and fertility so a deficiency causes problems such as impotence, infertility, premature ejaculation or decreased sexual desire. Kidney yang also enervates the zhi, which is the spirit housed in the Kidneys. A deficiency will cause lassitude and a lack of motivation or willpower. Patients with Kidney yang deficiency feel they don't have the energy to do anything, or that they have used up all of their reserves -- which indeed they have!

Kidney yang deficiency often develops from Spleen yang deficiency, so you see symptoms such as edema in the legs, caused by lack of fluid transformation. For the same reason, fluids build up in the tongue, causing it to become swollen.

Kidney qi actually holds the urine in place, but since a deficiency of Kidney qi is often a precursor of Kidney Yang deficiency, you will see symptoms of nocturia (getting up at night to go to the bathroom), dribbling after urination or incontinence (in severe cases).

The causes of Kidney yang deficiency include chronic, longstanding illness; excessive sexual activity; a constitutional deficiency; or a decline of the Kidneys with advancing age. Some medications, such as those used for high blood pressure, will also deplete Kidney yang.

When someone seems to have symptoms of a yang deficiency (especially if his or her hands get cold), suspect a Heart Yang Deficiency. The Heart meridian goes down the arms; if there is insufficient Heart yang, qi can't be transported to the extremities. The person may also have a stuffiness or uncomfortable feeling in the region of the Heart. A cardinal sign for any Heart pattern is Heart palpitations, often described as an awareness of the heartbeat, or a fluttering feeling. These symptoms are caused by insufficiency of the Heart yang in moving the qi in the chest.

Heart yang deficiency can develop from a Heart qi deficiency, so you will see symptoms such as shortness of breath, sweating with no exertion and listlessness. The causes are the same as for Kidney yang deficiency. Heart Yang deficiency can also be caused by a sudden or prolonged loss of blood, which causes a deficiency of Blood, qi and (eventually) Heart yang.

I am including a chart on the symptoms of some excess/full cold patterns (below), but I am not going to explain them in detail, because it's not within the scope of this series. Included are four fairly common syndromes you will see in your practice.

By this point, you should be an expert at differentiating a cold from a hot condition, or an excess from a deficiency. You should also be able to pinpoint the exact organ involved. To complete the picture, next month's article will detail treatment protocols for yang deficiency, addressing each of the zang-fu disharmonies. I'll also include dietary, lifestyle and environmental counseling. Until then, keep your yang-deficient clients warm!


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  • Maciocia, Giovanni, Foundations of Chinese Medicine, Churchill Livingston, © 1989, Edinburgh, UK.
  • Xinnong, Chen, Chinese Acupuncture and Moxibustion, Foreign Language Press, ©1987, Beijing, China.