Spleen Deficiency, Dampness, and Phlegm: A Case Study of IBS with Heavy Limbs and Shortness of Breath

In Traditional Chinese Medicine, digestive disorders are rarely confined to the intestines alone. When the Spleen’s function of transformation and transportation is impaired, the effects can ripple outward into the limbs, the chest, and even the breath itself.

This case study of one of Dr. Wu’s recent patients illustrates how long-standing Spleen deficiency with dampness accumulation can manifest as irritable bowel symptoms alongside profound fatigue, heaviness, and reduced stamina.

Chief Complaints

A female patient presented with alternating constipation and loose stools for over one year, accompanied by abdominal distension, borborygmus (intestinal rumbling), and dull abdominal discomfort. In recent months, symptoms had worsened and expanded beyond the digestive tract, including:

• A sensation of heaviness in both legs, described as “filled with lead”

• Shortness of breath on mild exertion, such as hiking

• Markedly reduced physical stamina

These symptoms fluctuated and were clearly aggravated by emotional stress and dietary indiscretions, a hallmark of Spleen-centered disorders with qi mechanism disruption.

Western Diagnosis

Irritable Bowel Syndrome (Mixed Type)

TCM Diagnosis

Diarrhea / Intestinal Depression

Pattern: Spleen deficiency with dampness exuberance, phlegm-turbidity obstruction, and qi mechanism disharmony

Understanding The Pattern

In TCM, the Spleen governs digestion, fluid metabolism, and the nourishment of the limbs. When Spleen qi is deficient, food and fluids are not properly transformed or transported. Over time, this leads to the internal accumulation of dampness.

Dampness is heavy, turbid, and lingering by nature. In this patient, it manifested in several characteristic ways:

• Irregular stools and abdominal distension
  Dampness obstructing the intestines and impairing the bowel’s conveyance function

• Heavy, fatigued legs
  Dampness obstructing the channels and collaterals, preventing the limbs from being properly nourished

• Shortness of breath on exertion
  Dampness congealing into phlegm, which rose upward and interfered with the Lung’s ability to diffuse and descend qi

Additionally, emotional stress further disrupted the ascending and descending movement of qi, worsening stool irregularity and abdominal discomfort.

The tongue and pulse strongly supported this diagnosis.
Tongue: pale, swollen with tooth marks and a thick, white, greasy coating
Pulse: soggy (Ru) and thin (Xi)

Initial Treatment Response: A Key Diagnostic Confirmation

After beginning herbal treatment, the patient reported a distinct sequence of changes, which is diagnostically meaningful in TCM:

1. Increased bowel movements and urination
   Dampness and turbidity being expelled outward

2. Expectoration of phlegm
   Phlegm-dampness loosening and Lung qi beginning to regulate

3. Subjective lightness, stronger legs, and improved breathing
   Qi mechanism becoming smoother and Spleen transportation beginning to recover

Importantly, during a recent hike, the patient noted improved leg strength and less shortness of breath, confirming that the treatment was addressing the root rather than merely suppressing symptoms.

Treatment Principle

The core strategy was to:

• Strengthen the Spleen

• Drain dampness and turbidity

• Transform phlegm

• Regulate qi and restore proper ascending and descending movement

Rather than aggressively stopping diarrhea or forcing bowel regularity, treatment focused on restoring physiological order, allowing the intestines to normalize naturally.

Herbal Prescription (RP)

Bai Zhu (30g) Strengthens the Spleen and dries dampness

Fu Ling (10g) Promotes urination, leaches dampness, and supports the Spleen

Shan Hai Luo (20g) Tonifies qi and supports digestion

Zhi Gan Cao (6g) Harmonizes the formula and supports Spleen qi

Chen Pi (10g) Regulates qi, dries dampness, and relieves distension

Fa Xia (6g) Transforms phlegm and harmonizes the Stomach

Bai Dou Kou (6g, added near end) Aromatically transforms dampness and awakens the Spleen

Dosage: One dose daily, decocted twice and taken warm morning and evening, for an initial course of five doses.

Lifestyle and Dietary Guidance

Herbal medicine works best when paired with appropriate lifestyle adjustments:

• Maintain emotional ease and avoid prolonged anxiety or tension

• Eat a light, warm, and easily digestible diet

• Avoid raw, cold, greasy, spicy foods, and gas-producing foods such as dairy and legumes

• Keep the abdomen and lower limbs warm

• Engage in gentle movement, such as walking, without overexertion

Follow-up after five doses was advised to reassess progress and refine the prescription.

Results

Following treatment, the patient reported positive feedback of "very good effect," manifesting as initial "increased bowel and urinary excretion" (expelling dampness and draining turbidity) to "expectorating phlegm" (transforming phlegm and diffusing lung qi), and ultimately "feeling lighter," "legs having strength," and "shortness of breath reduced." This validates the effectiveness of the TCM treatment principle moving from "unblocking the fu organs and promoting diuresis to drain dampness" to "transforming phlegm and regulating qi" for the pattern of spleen deficiency with dampness exuberance and phlegm obstruction causing qi stagnation.

Clinical Takeaway

This case highlights an essential principle of Chinese medicine: Digestive disorders are systemic disorders.

IBS symptoms may originate in the intestines, but when rooted in Spleen deficiency with dampness and phlegm, they can manifest as fatigue, limb heaviness, and even respiratory symptoms. By treating the underlying pattern rather than chasing isolated complaints, true and lasting improvement becomes possible.

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