bubble_chart Concept

The pattern of qi and yin deficiency refers to a simultaneous insufficiency of the body's original qi and true yin. It manifests as symptoms of original qi deficiency in the lungs, spleen, and kidneys, as well as signs of yin deficiency with excessive heat due to the internal consumption of body fluids and insufficient nutritive yin in the five zang-organs. This syndrome is commonly seen in the middle to late stages [third stage] of external-contraction warm diseases and internal damage Zabing, resulting from prolonged illness or excessive sweating, vomiting, diarrhea, or urination, which deplete qi and yin.

The clinical manifestations of this syndrome mainly include: mental fatigue and lack of strength, sweating and shortness of breath, dry cough with little phlegm, anorexia, dry mouth and sore throat, dizziness and blurred vision, afternoon tidal fever, palpitations, feverish sensation in the palms and soles, sore lower back and tinnitus, scanty urine and constipation, a red and crimson tongue with little coating, and a thin, rapid, and weak pulse.

This syndrome is scattered across various conditions such as "spring warmth," "summerheat warmth," "dampness warm disease," and "autumn dryness" in external contraction warm febrile diseases, as well as "epigastric pain," "pulmonary tuberculosis," "palpitations," and "overstrain stranguria" in internal damage Zabing.

The pattern of qi and yin deficiency should be differentiated from the "pattern of both qi and blood deficiency" and the "pattern of both yin and yang deficiency."

bubble_chart Differentiation and Treatment

Due to the differences in the disease cause, pathogenic factors, and the nature of pathological changes, as well as the location of the disease, clinical differentiation should be carefully analyzed. In external contraction warm febrile disease,

1. this syndrome can be seen in "spring warmth," often caused by exposure to warm pathogenic factors in spring, with pathogenic heat lodging in the qi aspect, heat accumulation in Yangming, depleting qi and fluids, leading to gastrointestinal conduction dysfunction, manifesting as body heat, mental fatigue and lack of strength, dry mouth and sore throat, slight abdominal distension and fullness, constipation, scorched yellow tongue coating, and deep weak pulse. Treatment should focus on replenishing qi and nourishing yin, increasing fluids and promoting bowel movement, using the formula Newly Supplemented Yellow Dragon Decoction(Wenbing Tiaobian) with modifications. It can also be seen in "summerheat warmth," often caused by the heat of summer, pathogenic heat forcing sweating, easily depleting qi and yin. As stated in "Selected Medical Cases of Famous Qing Dynasty Physicians: Jin Zijiu's Medical Cases," "Profuse sweating leads to external depletion of qi, and intense heat leads to internal depletion of yin." If summerheat damages qi and yin, symptoms include profuse sweating with body heat, limb fatigue and mental fatigue, thirst and irritability, and a weak pulse. Treatment should focus on clearing summerheat and tonifying qi and yin, using Wang's Summerheat-Clearing Qi-Replenishing Decoction(Wenre Jingwei) with modifications. If summerheat recedes but qi and yin are severely depleted, be cautious of fluid depletion and qi collapse, with symptoms including fever subsided, continuous sweating, thirst and irritability, shortness of breath and panting, and a scattered and weak pulse. This indicates qi failing to consolidate and yin failing to hold internally. Urgently tonify qi and astringe yin, generate fluids and secure collapse, using Pulse-Reinforcing Powder(Neiwaishang Bianhuo Lun) with modifications.
2. In "dampness warm disease," this syndrome often results from repeated sweating, as dampness is sticky and stagnant, sweating fails to resolve dampness-heat, dampness stagnates and qi and yin are severely depleted, presenting with fever and unresolved sweating, mental fatigue and timidity, dry white miliaria on the chest and abdomen like dry bones, pale tongue, slippery and greasy coating, and thin rapid pulse, indicating deficiency of both qi and yin in "dried miliaria." Treatment should focus on tonifying qi and nourishing yin, generating fluids and astringing fluids, using Pulse-Reinforcing Powder or Adenophora and Ophiopogon Decoction(Wenbing Tiaobian) with modifications.
3. This syndrome can also be seen in "autumn dryness," where autumn dryness invades the lung, dryness easily transforms into heat and damages qi and yin, presenting with body heat, dry cough without phlegm, panting and thirst, irritability, chest and hypochondriac distension and oppression, dry mouth and nose, scant tongue coating, red tongue edges and tip, and thin rapid pulse. Treatment should focus on relieving dryness and moistening the lung, using Dryness-Clearing Lung-Rescuing Decoction(Yimen Falu) with modifications.
4. If dryness transforms into heat, scorching the lung and stomach, depleting body fluids internally, it will result in damage to both lung and stomach qi and yin, presenting with hidden fever, continuous dry cough, dull pain in the chest and abdomen, burning sensation in the stomach, dry throat and thirst, dry and peeled tongue coating, and thin rapid pulse. Treatment should focus on clearing and nourishing the lung and stomach, using Adenophora and Ophiopogon Decoction with modifications.
5. If warm pathogenic heat toxins penetrate deeply into the lower energizer, depleting true yin, or if sweating methods are mistakenly used, it will result in palpitations, restlessness, and continuous spontaneous sweating, indicating deficiency of both heart and kidney qi and yin. Treatment should focus on tonifying qi and calming, supporting the upright and cultivating the origin, using the Rescue Decoction (Wenbing Tiaobian) with modifications. The formula notes: "If the pulse is weak and large and about to scatter, add two qian of Ginseng."

In the differentiation of internal damage Zabing, this syndrome often involves two or more zang-fu organs.

1. For example, in "epigastric pain," this syndrome is often caused by dietary irregularities, inherent spleen and stomach deficiency, compounded by internal damage from seven emotions, liver qi stagnation, qi depression transforming into fire, transversely invading the stomach, scorching stomach yin, manifesting as deficiency of both qi and yin in the spleen, stomach, and liver, with symptoms including dull pain and distension in the stomach, distension more severe than pain, epigastric upset and dry mouth, mental fatigue and lack of strength, occasional belching, loose stools, burning sensation in the stomach, red tongue with scant coating, and thin wiry weak pulse. Treatment should focus on regulating the liver and harmonizing the stomach, tonifying qi and nourishing yin, using Stomach-Nourishing Decoction (Zhengzhi Zhunsheng) combined with Peony and Licorice Decoction(from "Treatise on Cold Damage Diseases") with modifications.
2. Another example is "pulmonary tuberculosis" presenting with this syndrome, often due to innate weakness, careless daily habits, overstrain and excessive thinking, which dissipate original qi, leading to insufficient healthy qi, allowing the tuberculosis pathogen to invade, injuring lung yin, resulting in deficiency of both qi and yin in the spleen, stomach, and lungs. Symptoms include cough, hemoptysis, afternoon tidal fever, flushed cheeks, shortness of breath, mental fatigue, faint low voice, spontaneous sweating, night sweats, reduced appetite, red tongue with little coating, and a thin, weak pulse. Treatment should focus on tonifying qi and nourishing yin, banking up earth to generate metal, and the formula chosen is Moonlight Pill (Yixue Xinwu) with modifications.
3. This syndrome can also be seen in "palpitation" disease, often due to constitutional weakness, spleen and stomach deficiency, excessive contemplation, consumption of heart blood, blood deficiency leading to yin deficiency, resulting in deficiency of both qi and yin in the spleen, stomach, and heart. Symptoms include restless palpitation, dizziness, blurred vision, pale complexion, dry mouth and sore throat, feverish feeling in palms and soles, mental fatigue and lack of strength, pale red tongue with little coating, and thin and rapid or irregular pulse. Treatment should focus on tonifying qi and nourishing the heart, enriching yin to calm the spirit. The formula of choice is Celestial Emperor Heart-Tonifying Pill(Shiyi Dexiao Fang), or Prepared Liquorice Decoction(from "Treatise on Cold Damage Diseases") with modifications.
4. This syndrome can also be seen in "stranguria," often due to prolonged urinary tract infection, deficiency of spleen and stomach original qi, combined with overwork, excessive sexual activity, or excessive diuresis damaging body fluids, resulting in deficiency of both qi and yin in the spleen, stomach, and kidneys. Since it is triggered by overexertion, it is called "overstrain stranguria." Symptoms include dribbling urination, recurrent episodes, mental exhaustion, slight abdominal distension and fullness, dry mouth and sore throat, vexing heat in the chest, palms, and soles, red tongue with little coating, and thin and rapid pulse. Treatment should focus on tonifying the spleen and replenishing qi, enriching yin to tonify the kidneys. The formula of choice is Seven-Ingredient Qi-Astringing Pill(from "Yi Zong Ji Ren Bian") with modifications.

The above focuses on the syndrome caused by spleen and stomach qi deficiency affecting other zang-fu organs. Of course, it can also be seen in cases where lung qi deficiency or kidney qi deficiency affects other zang-fu organs, such as

1. lung atrophy due to deficiency of both lung and spleen qi and yin;
2. severe palpitation due to deficiency of both lung and heart qi and yin;
3. hemoptysis due to deficiency of both lung and liver qi and yin;
4. wheezing syndrome due to deficiency of both lung and kidney qi and yin;
5. insomnia due to deficiency of both heart and kidney qi and yin;
6. apoplexy due to deficiency of both liver and kidney qi and yin

, and so on. In summary, clinically, one should start from the holistic view and the theory of zang-fu organ relationships, grasp the location of qi and yin injury and the main zang-fu organs involved, in order to clearly distinguish and systematically manage the complex symptoms.

It must be pointed out that whether caused by external contraction or internal damage, this syndrome is often seen in individuals with constitutional qi deficiency or yin deficiency. It is more common in summer and autumn, as the heat of summer easily consumes qi and damages yin, and autumn dryness attacks, easily transforming into heat and scorching qi and yin, leading to this syndrome. In addition to the above disease causes, iatrogenic factors should also be emphasized, as mistaken purging, vomiting, excessive sweating, or excessive diuresis can deplete the body's original qi and lose yin fluids, leading to the emergence of this syndrome, which must be carefully considered.

In summary, during the evolution of this syndrome, it is often accompanied by depression, phlegm, and blood stasis. Deficiency of both qi and yin accompanied by qi depression is often due to emotional depression, liver depression transforming into fire, exacerbating the consumption of qi and yin, such as dry cough and wheezing; deficiency of both qi and yin accompanied by phlegm-heat is often due to spleen qi deficiency leading to internal retention of phlegm-dampness, transforming into dryness-heat and further damaging qi and yin, such as vertigo; deficiency of both qi and yin accompanied by static blood is often due to static blood obstruction transforming into heat and damaging yin, such as dysphagia and abdominal mass disease. For those with accompanying pathogenic factors, treatment should focus on reinforcing healthy qi and eliminating pathogenic factors, and drastic formulas should not be used indiscriminately. If the attack is excessive, it violates the principle of not depleting the already deficient. There is a saying that "warming yang is easy but restoring yin is difficult," indicating that the recovery of qi and yin is a process that should be approached gradually, not hastily, and one should not recklessly use overly greasy tonics, which may hinder the generation of stomach qi. If the pattern of qi and yin deficiency cannot gradually recover, qi deficiency may progress to yang deficiency, leading to the pattern of both yin and yang deficiency. This is the inevitable progression of qi, blood, yin, and yang deficiency pattern to the late stage [third stage], which will inevitably affect the root of kidney yin and kidney yang. Finally, due to the exhaustion of original yin and original yang, yin and yang separate, and life ceases.

bubble_chart Differentiation of Similar Patterns

1. pattern of both qi and blood deficiency and pattern of qi and yin deficiency: Both can clinically present with symptoms of "qi deficiency" such as mental fatigue, lack of strength, shortness of breath, and poor appetite. However, the pattern of both qi and blood deficiency involves deficiencies in both "qi" and "blood," leading to insufficient production in the body, zang-fu organ dysfunction, and symptoms such as mental fatigue, lack of strength, shortness of breath, dizziness, blurred vision, palpitations, insomnia, pale complexion, numbness in the hands and feet, pale nails, a pale and tender tongue, and a weak, thin pulse. The key points for differentiation from the pattern of qi and yin deficiency are:
   • 1. The pattern of both qi and blood deficiency involves both qi and blood, while the pattern of qi and yin deficiency involves both qi and yin.
   • 2. The former has obvious symptoms of "blood deficiency," such as dizziness, blurred vision, palpitations, insomnia, pale complexion, and pale lips and nails; while the pattern of qi and yin deficiency has obvious symptoms of "yin deficiency leading to internal heat," such as dry cough with little phlegm, dry mouth, sore throat, afternoon tidal fever, and feverish sensation in the palms and soles.
   • 3. In the progression of the disease, the pattern of both qi and blood deficiency may lead to yin deficiency due to blood deficiency, resulting in deficiency of both qi and yin, and the two are interrelated in the mechanism of disease.
   • 4. The treatment for the pattern of both qi and blood deficiency should focus on tonifying and replenishing qi and blood, while the treatment for the pattern of qi and yin deficiency should focus on tonifying qi, enriching yin, and producing fluids.
2. pattern of both yin and yang deficiency and pattern of qi and yin deficiency: Both belong to deficiency pattern and have manifestations of yin deficiency pattern. However, the pattern of both yin and yang deficiency mainly refers to the deficiency of both primordial yin and yang of the kidney. Regardless of the yin-yang deficiency in the heart, lungs, liver, or spleen, when it progresses to the late stage [third stage], it will inevitably affect the true yin and yang of the kidney, as kidney yin and kidney yang are the foundation of the body's yang qi and yin fluids. Therefore, clinically, deficiency of both yin and yang refers to the kidney. On the other hand, the pattern of qi and yin deficiency does not necessarily involve the kidney and can occur in any of the five zang-organs. The pattern of qi and yin deficiency has obvious symptoms of qi deficiency such as mental fatigue, lack of strength, faint low voice, and shortness of breath; while the pattern of both yin and yang deficiency not only has manifestations of insufficient yin fluids but also shows yang qi deficiency and yang deficiency leading to external cold. For example, the pattern of both yin and yang deficiency caused by "pulmonary tuberculosis" may present with symptoms such as coughing, hemoptysis, abnormal rising of qi, panting, aggravated by movement, steaming bone fever, night sweats, seminal emission, cold and sore lower back and knees, cold limbs, spontaneous sweating, impotence, a pale and swollen tongue, and a deep, thin pulse. Therefore, clinically, as long as the characteristic of yang deficiency leading to cold is grasped, it is not difficult to differentiate between the two syndromes.

bubble_chart Documentation

1. "External Contraction Warm Heat Chapter": "There is another type of miliaria alba, small grains like crystal color, this is due to dampness-heat injuring the lungs, although the evil has exited but the qi and fluids are depleted, it must be supplemented with sweet medicine; or if it has not yet prolonged to injure the qi and fluids, it is due to dampness stagnating in the defense aspect, the inability to sweat, the evil of the qi aspect should be regulated; or if it is white like dry bones, it is mostly ominous, as the qi and fluids are exhausted."
2. Wenbing Tiaobian ‧ Lower Energizer Chapter: "Heat entering the uterus, the doctor clears the qi aspect and blood, half of the evil is removed, the pulse is rapid, the remaining evil is unresolved, the Hu Yang He Yin Decoction is prescribed." "Summer heat long fever, unable to sleep peacefully, unable to eat well, unclear consciousness, both yin fluids and original qi are injured, the Sancai Decoction is prescribed." "Long dysentery injures yin, qi sinking, anal prolapse and sacral soreness, the Rehmannia Yuliang Decoction is prescribed." "Long dysentery damages yin, thirst and dry tongue, mild fever and slight cough, the Ginseng Smoked Plum Decoction is prescribed."
3. "Essence of Medical Cases from Famous Doctors of the Qing Dynasty ‧ Ma Peizhi's Medical Cases" "Pulse manifestation is thin and fine, the left guan is relatively stringy, the spleen and stomach have been deficient for a long time, hyperactivity of liver yang, coupled with excessive exertion, heart qi is also deficient. Since the beginning of summer, it has also been affected by the evil of cold and heat, resulting in abdominal pain and diarrhea, which has now been cured. At dawn, borborygmus and abdominal pain, clear saliva in the mouth, soreness of the limbs and joints, thirst and heart vexation, unable to sleep peacefully at night. Eating meat results in thin stools, the tongue coating is peeled in the middle, both qi and yin are injured, middle qi cannot be established, it is difficult to prescribe either cold or hot medicine. It is planned to regulate and nourish the heart and spleen, and establish middle qi. Tangshen, Huai yao, Zao ren, Smoked Plum, Peony Root, roasted licorice, Yu zhu, Chinese Angelica, Poria with Pine, Liao dou, roasted Qi, Yizhi, Chinese date."
4. "Essence of Medical Cases from Famous Doctors of the Qing Dynasty ‧ Jin Zijiu's Medical Cases" "Also, over seventy years old, the illness has lasted for more than two decades, not only is the true yin damaged, but the vital qi is also consumed, using gelatin and Rehmannia to enter yin and preserve fluids, ginseng and Ophiopogon to enter qi and preserve fluids. In the past two days, it seems to have turned around, the fierce situation has gradually retreated, body fluids have also been restored. The pulse manifestation of rigidity and irritability has also decreased, the tongue texture of rigidity and dryness has not moistened, the stool has not been passed for six days, the fu qi's descending function is lost, the remaining heat and phlegm linger. The treatment method is still based on the original intention with additions and subtractions. American ginseng, fresh Unprocessed Rehmannia Root, Donkey-hide Gelatin, Rhinoceros Horn, Prepared Gypsum, licorice products, Trichosanthis Fruit kernel, Danpi, Lonicera, Platycodon Root, Bamboo Juice, Mulberry Leaf."