For Spleen Deficiency “Puffy Fat,” See Shaanxi Master TCM Practitioner Xu Tao’s “Qingshen Xiaozhi Tang” (Light-Body Lipid-Dissolving Decoction)
6. For Spleen Deficiency “Puffy Fat,” See Shaanxi Master TCM Practitioner Xu Tao’s “Qingshen Xiaozhi Tang” (Light-Body Lipid-Dissolving Decoction)
spleen dampness middle-burner obstruction, phlegm-stasis mutual binding type, organized and published in Hubei Journal of TCM in 2004 by his student Han Jianna." class="reference-link">Xu Tao, renowned Shaanxi TCM master; Qingshen Xiaozhi Tang is his proven formula for treating simple obesity of the spleen dampness middle-burner obstruction, phlegm-stasis mutual binding type, organized and published in Hubei Journal of TCM in 2004 by his student Han Jianna.
Pathomechanism
Simple obesity can be divided into excess and deficiency types. Excess obesity often presents with large appetite, abdominal fullness, and constipation — belonging to stomach heat and intestinal excess or damp-heat stagnation; deficiency obesity doesn’t necessarily have large appetite, yet presents with obese body, soft muscles, shortness of breath on exertion, and loose stools. The pathomechanism chain of the latter is clear: irregular diet damages the spleen and stomach; spleen deficiency failing to transport causes internal water-dampness stagnation; dampness accumulating over time is refined into phlegm; phlegm obstructing qi stagnation impairs blood flow forming stasis; phlegm and stasis mutually bind, lipid turbidity accumulates without being transformed — this completes the entire process from “eaten in” to “piled on the body.” Spleen deficiency is the starting point, phlegm-stasis is the endpoint, and the intermediate damp turbidity is the catalyst.
III. Formula Composition
Composition: Fleeceflower Root 15g, Raw Hawthorn 15g, Atractylodes 10g, Alisma 10g, Dried Lotus Leaf 10g, Stir-fried Cassia 10g, Winter Melon Skin 30g, Bupleurum 6g, Red Ginseng 6g, Notoginseng Powder 6g (taken in liquid), Raw Rhubarb 5g, Leech 3g
Efficacy: Strengthens the spleen and removes dampness, transforms phlegm and resolves stasis
Primary Application: Simple obesity (spleen dampness middle-burner obstruction, phlegm-stasis mutual binding pattern)
In this formula, Atractylodes serves as sovereign: sweet and warm, entering the spleen and stomach, strengthening the spleen and tonifying qi, drying dampness and promoting urination, blocking the source of dampness generation. Fleeceflower Root tonifies the liver and kidneys, nourishes blood and removes wind; Alisma is sweet and cold, promoting urination, leaching dampness, and excreting turbidity. These two herbs assist Atractylodes to tonify without stagnation, promote without damage, together serving as ministers. The assistants divide into two pathways: one pathway regulates qi mechanism — Red Ginseng tonifies spleen and benefits lung, assisting Atractylodes’ spleen-strengthening power; Raw Rhubarb unblocks the intestines and excretes turbidity, providing an outlet for phlegm-dampness; Bupleurum disperses the liver and regulates qi, when qi moves water moves. The other pathway attacks hard masses and scatters nodules — Winter Melon Skin promotes urination and reduces edema, Stir-fried Cassia clears the liver and unblocks the bowels, these two herbs open up the excretory passages for damp turbidity; Raw Hawthorn digests food and strengthens the spleen, moves qi and scatters stasis, Leech breaks blood, expels stasis, and unblocks the menses, Notoginseng Powder invigorates blood, scatters stasis, and stops bleeding — the three blood-invigorating herbs enter the blood aspect directly, dismantling the core pathology of phlegm-stasis mutual binding. Dried Lotus Leaf leaches dampness and raises the clear; Dai Yuanli said “taking lotus leaf makes one thin and lean”; it guides the other herbs to circulate throughout the body, serving as the guide. The whole formula simultaneously applies five methods: strengthening spleen, leaching dampness, transforming phlegm, expelling stasis, and dispersing the liver; each of the twelve herbs has its specific role.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Sovereign | Atractylodes 10g | Strengthens spleen and tonifies qi, dries dampness and promotes urination, cuts off the source of dampness generation |
| Minister | Fleeceflower Root 15g, Alisma 10g | Tonifies liver and benefits kidneys, nourishes blood and removes wind, promotes urination, leaches dampness, excretes turbidity |
| Assistant₁ | Red Ginseng 6g, Raw Rhubarb 5g, Bupleurum 6g | Tonifies spleen and benefits lung to assist spleen-strengthening, unblocks intestines and excretes turbidity to open an outlet, disperses liver and regulates qi to unblock qi mechanism |
| Assistant₂ | Winter Melon Skin 30g, Stir-fried Cassia 10g, Raw Hawthorn 15g, Leech 3g, Notoginseng Powder 6g | Promotes urination and reduces edema, clears liver and unblocks bowels, digests food and scatters stasis, expels stasis and unblocks menses, resolves phlegm-stasis mutual binding |
| Guide | Dried Lotus Leaf 10g | Leaches dampness and raises the clear, guides drugs to circulate, assists lipid turbidity dissolution |
Hawthorn must use the raw form; stir-fried Hawthorn tends toward digesting food and stopping diarrhea, while raw Hawthorn has blood-invigorating stasis-scattering power; this formula takes its stasis-scattering rather than food-digesting property. Cassia must be stir-fried to reduce its cold nature, preventing spleen-stomach damage with prolonged use. Notoginseng is powdered and taken in liquid for excellent stasis-scattering and bleeding-stopping effects. Leech dosage should be light, starting at 3g, expelling stasis without damaging vitality.
IV. Modifications by Pattern
| Combined Pattern | Modification Herbs | Therapeutic Intent |
|---|---|---|
| Poor appetite, abdominal fullness | Add Magnolia Bark 10g, Chicken Gizzard 10g | Move qi and open the middle, digest food and resolve accumulation, assist spleen-stomach intake and transport |
| Facial and limb edema | Add Plantain Seed 15g (bag decoction), Areca Peel 10g | Promote urination and leach dampness, move qi and reduce edema, guide water-dampness downward |
| Excess phlegm and chest fullness | Add Pinellia 10g, Red Tangerine Peel 10g | Dry dampness and transform phlegm, regulate qi and open the chest, resolve phlegm-dampness obstructing the lungs |
Leech, under Notoginseng Powder’s pairing, attacks stasis without damaging blood; however, for those with marked qi-blood deficiency, Leech dosage should be halved or removed, and Notoginseng Powder also reduced to 2g, to avoid consuming qi and disturbing blood. Raw Rhubarb in this formula is not a harsh purgative; 5g in decoction takes its “gentle laxation” rather than “rapid purgation,” intending to unblock the intestines rather than forcefully purge; those with formed stools can reduce accordingly.
Summary
Qingshen Xiaozhi Tang uses Atractylodes for spleen-strengthening as the base, Leech, Hawthorn, and Notoginseng for stasis expulsion as the core, Alisma, Winter Melon Skin, and Lotus Leaf for water promotion as the branch, Red Ginseng and Fleeceflower Root for qi-tonifying blood-nourishing to simultaneously support vitality, Rhubarb and Cassia for intestinal unblocking and turbidity excretion to provide an outlet for the pathogen, and Bupleurum for liver-dispersing qi-regulation running throughout. Twelve herbs simultaneously apply five methods; attack does not damage vitality, tonification does not harbor the pathogen. Suitable for spleen-deficient phlegm-stasis type “puffy fat” caused by irregular diet and prolonged sitting with little movement — that constitution type of “not eating much but unable to lose weight, panting with any exertion, loose stools.”
References:
[1] Han Jianna. Xu Tao’s Experience in Using Qingshen Xiaozhi Tang for Simple Obesity. Hubei Journal of TCM, 2004, 26(5): 18
[2] Xu Tao. Shaanxi College of TCM Affiliated Hospital. Renowned TCM Masters’ Obesity Department Specialist Formulas
[3] Xie Linli. Professor Xu Pengling’s Experience in Treating Primary Hyperlipidemia. Guiding Journal of TCM and Pharmacy, 2016, 04: 116-118
[4] Dai Yuanli. Sisheng Bencao. “Taking lotus leaf makes one thin and lean”