bubble_chart Concept

The syndrome/pattern of yin deficiency and internal heat refers to the deficiency of yin fluid and the internal generation of deficient heat, commonly presenting with symptoms such as low-grade fever, dry mouth, night sweats, flushed cheeks, and dry stools. It is often caused by prolonged unresolved external contraction of pathogenic heat, emotional depression, excessive sexual activity, or inadequate recuperation after severe or chronic illnesses.

The main clinical manifestations include: low-grade fever, night sweats, flushed cheeks, vexing heat in the chest, palms, and soles, dry mouth with desire to drink, scanty dark urine, dry stools, ankyloglossia, red tongue with little moisture, and a thin, rapid pulse.

The blood heat syndrome/pattern is commonly seen in diseases such as "pulmonary tuberculosis," "consumptive thirst," "lumbago," "seminal emission," and "internal damage fever."

This condition should typically be differentiated from the "yin deficiency syndrome/pattern," "fluid deficiency syndrome/pattern," and "syndrome/pattern of yin deficiency and yang hyperactivity."

bubble_chart Differentiation and Treatment

In clinical practice, the manifestations of the syndrome/pattern of yin deficiency and internal heat vary depending on the cause and location of the disease. For example, this syndrome can be seen in pulmonary tuberculosis, often due to congenital insufficiency, excessive indulgence in alcohol and sexual activities, or prolonged illness without proper treatment, leading to damage to yin, blood, and body fluids, and a decline in disease resistance, resulting in infection with tuberculosis. Mingyi Zazhu‧pulmonary tuberculosis states: "In men around the age of twenty, excessive sexual desire leads to injury of essence and blood, inevitably causing diseases of yin deficiency and fire agitation, with symptoms such as night sweats during sleep, afternoon fever, dry cough, fatigue and weakness, poor appetite, and in severe cases, phlegm with blood, coughing up blood, or hemoptysis, hematemesis, epistaxis, fever, deep and rapid pulse, emaciation, which is called pulmonary tuberculosis. It is the most severe and difficult to treat. Mild cases require dozens of doses of medicine, while severe cases may take years. However, the patient must cherish their life, maintain a firm and determined will, abstain from sexual activities, cease delusional thoughts, avoid anger, and moderate their diet to nurture their root. Otherwise, even the best medicine will be useless. This disease is easier to treat in its early stages, but if it progresses to muscle wasting, severe bedridden conditions, and a deep, thin, and rapid pulse, it becomes difficult to treat." This passage elaborates on the etiology, pathogenesis, clinical manifestations, disease management, prevention, duration of medication, and the importance of early treatment for pulmonary tuberculosis. The treatment should focus on nourishing yin and moistening the lungs, using the Moonlight Pill (Yixue Xinwu).

In cases of lumbago, the lower back is the residence of the kidneys and the area nourished by the essential qi of the kidneys. The kidneys and bladder are internally and externally related, and the area is traversed by the foot great yang meridian, as well as the Ren, Du, Chong, and Dai meridians. Therefore, internal damage is often related to kidney disease. It is often caused by prolonged illness, aging, or excessive indulgence, leading to kidney essence deficiency and inability to nourish the tendons, resulting in lumbago. Jingyue Quanshu‧lumbago states: "Lumbago that is persistent and recurrent is due to kidney deficiency." Zhengzhi Huibu‧lumbago proposes: "Treatment should prioritize tonifying the kidneys, followed by addressing the pathogenic factors." Symptoms include soreness and weakness in the lower back, preference for pressure and massage, weakness in the loins, worsening with fatigue, recurrent episodes, low-grade fever, night sweats, restlessness, insomnia, dry mouth and throat, flushed cheeks, feverish sensation in the palms and soles, red tongue with little coating, and a wiry, thin, and rapid pulse. Treatment should focus on nourishing kidney yin, using the Major Yin-Tonifying Pill (Danxi Xinfa) combined with the Young Maid Pill (Hejiju Fang).

In cases of consumptive thirst, this syndrome often arises from constitutional yin deficiency and excessive sexual activity, leading to yin deficiency with internal heat. Consumptive thirst is divided into upper, middle, and lower types based on the location of the disease. Jingyue Quanshu‧Three Consumptions and Thirst states: "If it is due to true water deficiency, it is entirely related to yin deficiency. Regardless of whether it is upper, middle, or lower, urgent treatment should focus on the kidneys. Only when yin qi gradually replenishes and essence and blood gradually recover will the disease naturally heal. If one only knows to clear fire, yin will not be generated, and the condition will worsen day by day, leading to further distress."

In cases of seminal emission, this syndrome often arises from excessive indulgence, leading to depletion of kidney yin and inability of yin to control yang. Overexertion of the mind leads to non-interaction between the heart and kidneys, with the spirit agitated above and essence leaking below, resulting in seminal emission. Symptoms include dream-induced seminal emission, restless sleep, easy arousal of male sexuality, heat and restlessness in the heart, dizziness, tinnitus, dry mouth, thirst, red tongue with little coating, and a wiry, thin, and rapid pulse. Treatment should focus on nourishing yin and reducing fire, using the Anemarrhena, Phelloendron, and Rehmannia Pill (Yifangkao).

If this syndrome is seen in internal damage fever, it is mostly due to constitutional yin deficiency, or Rebing over a long period, damage to yin and depletion of fluids, or improper treatment, leading to deficiency of yin essence, yin decline and yang excess, water failing to control fire, and internal generation of deficiency heat causing fever. As stated in Zhubing Yuanhou Lun·Deficiency Fatigue Heat Syndrome: "Deficiency fatigue with heat is due to insufficient yin qi; yang qi is excessive, hence heat is generated internally and externally, not from external pathogenic qi." Symptoms include afternoon or evening fever, steaming bone fever, tidal fever, feverish hands and feet, night sweats, flushed cheeks, dry mouth and lips, restlessness and insomnia, scanty dark yellow urine, constipation, dry red tongue with or without cracks, little or no coating, and a thin rapid pulse. Treatment should focus on enriching yin and clearing heat, using Bone-Clearing Powder (Zhengzhi Zhunsheng).

The syndrome/pattern of yin deficiency and internal heat manifests differently in various diseases, each with its own clinical characteristics.

The syndrome/pattern of yin deficiency and internal heat is commonly seen in individuals with constitutional yin deficiency, or those with prolonged Rebing, which injures yin fluids, or excessive indulgence, emotional imbalance, or improper treatment, leading to the depletion of yin fluids, resulting in yin deficiency and yang exuberance, where water cannot control fire, and fever is observed. As stated in Jingyue Quanshu‧Fire Syndromes/Patterns: "Those with yin deficiency can develop fever, as true yin is depleted, and water cannot control fire."

However, the syndrome/pattern of yin deficiency and internal heat varies in clinical manifestations depending on the affected zang-fu organs, the degree of deficiency, and the age and gender of the individual. For example, in cases of kidney yin deficiency with internal heat, the elderly often experience hair loss, tooth loss, tinnitus, deafness, vertigo, forgetfulness, constipation, and difficulty urinating; middle-aged men often experience irritability, insomnia, seminal emission, and premature ejaculation; women often experience menstrual irregularities, infertility, or a tendency for early abortion.

In the progression of the syndrome/pattern of yin deficiency and internal heat, according to the theory of yin-yang interdependence and mutual transformation, the evolution often involves yin deficiency generating heat, heat scorching and transforming into dryness, where the more yin is deficient, the more severe the dryness-heat becomes, and the more severe the dryness-heat, the more yin is depleted, creating a vicious cycle that exacerbates the condition; moreover, those with yin deficiency are often prone to being affected by dryness-heat pathogens. On the other hand, yin and yang can transform into each other; over time, yin impairment can affect yang, leading to dual injury of qi and yin or deficiency of both yin and yang, which should be noted.

bubble_chart Differentiation of Similar Syndromes

Yin deficiency syndrome/pattern and syndrome/pattern of yin deficiency and internal heat: Both syndromes can be caused by congenital insufficiency, excessive sexual activity, Rebing damage to yin, etc., leading to a deficiency of yin fluids. Clinical manifestations often include emaciation, dry mouth and throat, flushed cheeks, night sweats, vexation, insomnia, a red tongue with little coating, and a thin, rapid pulse. However, yin deficiency syndrome/pattern is mainly characterized by insufficient yin fluids, leading to a lack of nourishment in the limbs, tendons, and seven orifices, with mild heat transformation. In contrast, syndrome/pattern of yin deficiency and internal heat may present with persistent fever that worsens in the afternoon and evening, vexing heat in the chest, palms, and soles, with a more severe heat condition. Yin deficiency syndrome/pattern can develop into syndrome/pattern of yin deficiency and internal heat when the deficiency is severe, while the root of syndrome/pattern of yin deficiency and internal heat always lies in yin deficiency. Clinically, it is essential to identify the root cause and understand the transformation to differentiate between the two.

Fluid deficiency syndrome/pattern and syndrome/pattern of yin deficiency and internal heat: Both syndromes can result from external contraction or internal damage due to dryness-heat injuring body fluids, excessive sweating, vomiting, diarrhea, or improper treatment. However, fluid deficiency syndrome/pattern refers to the insufficiency of various body fluids essential for survival, such as sweat, saliva, urine, and intestinal fluids. Clinical manifestations include dry mouth and throat, dry cough, loss of voice, dry and cracked nose and lips, dry eyes with little tears, dry skin, scanty urine, dry stools, a red tongue with little moisture, little or peeling coating, and a thin, rough pulse. The main feature is dryness, and if fever is present, thirst and excessive drinking are prominent. Syndrome/pattern of yin deficiency and internal heat refers to the deficiency of yin fluids leading to internal heat, with symptoms such as tidal fever, night sweats, flushed cheeks, worsening in the afternoon and evening, vexation, insomnia, feverish sensation in the palms and soles, tinnitus, dizziness, soreness and weakness in the lower back and knees, a red tongue with little coating, and a thin, rapid pulse. The characteristic feature is persistent low-grade fever that worsens in the afternoon and evening. In treatment, fluid deficiency syndrome/pattern should be addressed by nourishing yin fluids, while syndrome/pattern of yin deficiency and internal heat, which involves deficiency leading to heat, requires "strengthening the water to control the sunlight." Only by enriching yin and clearing heat can the fever be reduced. In the course of disease progression, fluid deficiency syndrome/pattern can develop into syndrome/pattern of yin deficiency and internal heat, often starting with fluid deficiency syndrome/pattern. If left untreated for a long time, it can damage the zang-fu organs' yin fluids, leading to yin deficiency. When yin declines and yang prevails, and water fails to control fire, syndrome/pattern of yin deficiency and internal heat is formed.

Syndrome/pattern of yin deficiency and yang hyperactivity and syndrome/pattern of yin deficiency and internal heat: For details, see the "Differential Diagnosis" section under the entry for syndrome/pattern of yin deficiency and yang hyperactivity.

bubble_chart Documentation

• Zhubing Yuanhou Lun‧deficiency fatigue heat syndrome: "Deficiency fatigue with heat is due to insufficient yin qi and excess yang qi, thus generating heat internally and externally, not from pathogenic qi invading from the outside."
• Mingyi Zazhu‧pulmonary tuberculosis: "Men around the age of twenty, due to excessive indulgence in sexual desires, will inevitably suffer from diseases caused by yin deficiency and fire agitation, such as night sweats during sleep, afternoon fever, dry cough, fatigue and weakness, reduced appetite, and in severe cases, phlegm mixed with blood, coughing up blood, or hemoptysis, hematemesis, nosebleeds, body heat, deep and rapid pulse, emaciation, this is called pulmonary tuberculosis. It is the most difficult to treat, with mild cases requiring dozens of doses of medicine, and severe cases taking years. However, the patient must cherish their life, have a firm will, abstain from sexual activity, cease delusional thoughts, avoid anger, and moderate their diet to nurture their root. Otherwise, even the best medicine will be useless. This disease is easier to treat early on; if it reaches the stage of muscle wasting, deep and fixed bedridden state, deep and thin rapid pulse, it becomes difficult to treat."
• 《Zhenglun Huibu, lumbago》: "Treatment should prioritize tonifying the kidney, and then address the symptoms according to the presence of pathogenic factors."
• Jingyue Quanshu‧fire syndromes/patterns: "If yin deficiency can cause fever, it is due to true yin deficiency, where water cannot control fire."
• Jingyue Quanshu‧lumbago: "Lumbago syndrome, if it is lingering and recurrent, is due to kidney deficiency."
• Jingyue Quanshu‧triple consumptive thirst: "The disease of triple consumptive thirst is a disorder of the triple energizer. Upper consumptive thirst is a thirst syndrome, where one drinks and immediately feels thirsty again, due to the drying up of body fluids in the upper energizer. Ancient texts say the disease is in the lung, but they do not realize that the fire of the heart, spleen, and yang ming can also scorch and cause this, hence it is also called upper consumptive thirst. Middle consumptive thirst is a disease of the middle energizer, characterized by excessive eating and hunger, but without gaining muscle, and daily increasing emaciation. The disease is in the spleen and stomach, hence it is also called middle consumptive thirst. Lower consumptive thirst is a disease of the lower energizer, with dark urine, strangury, turbidity, greasy or fatty urine, blackened face and ears, and daily increasing emaciation. The disease is in the kidney, hence it is also called lower consumptive thirst." "If it is due to true water deficiency, then it is entirely yin deficiency, regardless of upper, middle, or lower. The urgent treatment should focus on the kidney, ensuring that yin qi gradually fills and essence and blood gradually recover, then the disease will naturally heal. If one only knows to clear fire, then yin will have nothing to generate, and daily decline will worsen, leading to further distress."
• Linzheng Zhinan Yi'an‧triple consumptive thirst: "If the disease is in the upper and middle, the diaphragm area becomes a blazing field, then use Jingyue's Jade Lady Decoction, Liuwei with Erdong, Tortoise Carapace, and Hanlian, to clear yang ming heat and nourish shaoyin; to rescue the yin of the heart and lung and protect true fluids. If there is no yang transformation but consumption, then use Hejian's Sweet Dew Decoction, to generate fluids, clear heat, moisten dryness, nourish yin, and gently harmonize yang. As for strengthening water to control yang light, use Liuwei to supplement the three yin, and add Plantain Seed and Achyranthes Root to guide the liver and kidney. Adjust and adapt flexibly, this is indeed excellent."