bubble_chart Concept

The syndrome/pattern of yin deficiency and yang hyperactivity refers to the deficiency of yin fluid and the excessive yang due to the lack of restraint, characterized by symptoms and signs such as dizziness, blurred vision, tidal fever, night sweats, headache, tinnitus, dysphoria, and insomnia; a red tongue with little moisture, and a thin and rapid pulse. It is often caused by aging and physical decline, prolonged external contraction of pathogenic heat, or chronic illness, emotional imbalance, and excessive sexual activity.

The main clinical manifestations include: irritability, insomnia, flushed cheeks, dry mouth and throat, dizziness, blurred vision, tinnitus, deafness, tidal fever, night sweats, a red tongue with little moisture, and a thin and rapid pulse.

The syndrome/pattern of yin deficiency and yang hyperactivity is commonly seen in diseases such as "insomnia," "vertigo," "headache," "apoplexy," and "tinnitus and deafness."

This syndrome should typically be differentiated from the "syndrome/pattern of yin deficiency and internal heat," "liver yin deficiency syndrome/pattern," and "syndrome/pattern of yin deficiency and wind stirring."

bubble_chart Differentiation and Treatment

The syndrome/pattern of yin deficiency and yang hyperactivity manifests with distinct clinical features in different diseases, and the treatment methods vary accordingly, necessitating careful differentiation.

• For instance, this syndrome can be seen in insomnia. On one hand, it may result from constitutional weakness, indulgence in sexual desires, or prolonged illness, leading to the depletion of kidney yin, which fails to nourish the heart, resulting in the hyperactivity of heart yang. As stated in Jingyue Quanshu‧Insomnia: "Insufficiency of true yin and blood leads to the failure of yin and yang to interact, causing the spirit to be unsettled." On the other hand, emotional disturbances can cause liver qi stagnation, which transforms into fire, consuming essence and blood, leading to yin deficiency with yang hyperactivity, which disturbs the heart-mind and results in insomnia. The pathological changes are generally characterized by yin deficiency with yang hyperactivity and the failure of yin and yang to interact. Symptoms include irritability, insomnia, palpitations, dizziness, tinnitus, vexing heat in the chest, palms, and soles, night sweats, flushed cheeks, dry mouth with a desire to drink, soreness in the lower back, forgetfulness, a red tongue, and a thin, rapid pulse. The treatment should focus on nourishing yin and reducing fire, as well as nourishing the heart and tranquilizing the mind. The formulas used are Coptis and Ass Hide Glue Decoction (Waitai Miyao) combined with Cinnabar Spirit-Tranquilizing Pill (Neiwaishang Bianhuo Lun).
• In cases of vertigo, yin deficiency with yang hyperactivity can arise from two causes: one is congenital kidney yin deficiency, leading to the failure of water to nourish wood, resulting in liver yin deficiency and ascendant hyperactivity of liver yang, causing vertigo; the other is prolonged emotional stagnation, which transforms into fire, depleting liver yin and causing the upward disturbance of wind-yang, affecting the seven orifices and resulting in vertigo. Symptoms include vertigo, tinnitus, headache with a distending sensation, aggravated by fatigue or anger, irritability, tidal fever, irritability, bitter taste in the mouth, dry throat, insomnia with dream-disturbed sleep, a red tongue with yellow coating, and a wiry pulse. The treatment should focus on nourishing yin and subduing yang, as well as nourishing the liver and kidney. The formula used is Major Yin-Tonifying Pill (Danxi Xinfa).
• In cases of headache, the syndrome/pattern of yin deficiency and yang hyperactivity often results from congenital insufficiency, prolonged deficiency of kidney essence, indulgence in sexual desires, aging, or post-illness depletion of essence and blood, leading to the failure of yin to control yang. Symptoms include distending headache, dizziness, irritability, feverish sensation in the palms and soles, soreness and weakness in the lower back and knees, dry and astringent eyes, seminal emission, a red tongue, and a thin, weak pulse. The treatment should focus on nourishing the kidney and reducing fire. The formula used is Anemarrhena, Phellodendron, and Rehmannia Pill (Yifangkao).
• In cases of apoplexy, this syndrome often arises from constitutional yin deficiency, leading to the failure of water to nourish wood, compounded by emotional disturbances, causing sudden hyperactivity of liver yang, yin deficiency below, and yang hyperactivity above, resulting in wind stirring due to yang transformation, qi counterflow with bleeding, phlegm, and fire, which disrupt the meridians and obstruct the seven orifices, leading to a critical condition of upper excess and lower deficiency, with yin and yang failing to support each other. Symptoms include pre-existing dizziness, tinnitus, insomnia with dream-disturbed sleep, sudden worsening of headache and dizziness, facial distortion, stiff tongue with slurred speech, or heavy and sluggish limbs, even hemiplegia, a red tongue with greasy coating, and a thin, rapid pulse. The treatment should focus on nourishing yin and subduing yang, extinguishing wind, and unblocking the collaterals. The formula used is Liver-Settling Wind-Extinguishing Decoction (Yixue Zhongzhong Canxilu).
• In cases of tinnitus and deafness, the syndrome/pattern of yin deficiency and yang hyperactivity often results from aging, post-illness depletion of essence and blood, or indulgence in sexual desires, leading to the depletion of liver and kidney essence and blood. As stated in Yixue Xinwu, "The ears are the external manifestation of the kidney. Zhongcang Jing says: The kidney is the residence of the spirit and the root of life, externally connected to the ears, and the gallbladder meridian of foot shaoyang also connects to the ears." It also states: "If deafness persists for a long time, it is due to kidney deficiency and insufficient essential qi, which fails to ascend to the ears. It is appropriate to use Six-Ingredient Rehmannia Pill with additions such as Barbary Wolfberry Fruit, Ginseng, Acorus, and Milkwort Root." This indicates that abundant kidney essence leads to sharp hearing, while depletion of kidney essence and emptiness of the sea of marrow fail to nourish the seven orifices, causing rootless fire to float upward, resulting in tinnitus and deafness. Symptoms include tinnitus or deafness, dizziness, flushed cheeks, dry mouth, feverish sensation in the palms and soles, soreness and weakness in the lower back and knees, seminal emission or spermatorrhea, a red tongue, and a thin, weak pulse or a weak and large pulse at the chi position. The treatment should focus on nourishing the kidney and reducing fire, as well as consolidating essential qi. The formula used is Zuoci's Deafness Pill (Xiao'er Yaozheng Zhijue), which is based on Six-Ingredient Rehmannia Decoction, aiming to "strengthen the water to control the sunlight."

The syndrome/pattern of yin deficiency and yang hyperactivity, while sharing common clinical features, also exhibits distinct clinical characteristics in different diseases.

This syndrome is commonly seen in individuals with constitutional yin deficiency, or those who are elderly and physically weak, indulge in excessive alcohol and sexual activities, women around menopause, or those who have long-term depression and anger. The depletion of yin essence leads to an inability of yin to control yang, resulting in the onset of symptoms. Elderly individuals with diminished yin fluids often experience tinnitus, deafness, soreness in the waist and legs, apoplexy with hemiplegia, and heel pain. In younger individuals with essence deficiency, there is frenetic stirring of ministerial fire, manifesting as seminal emission upon seeing sexual stimuli, easy arousal, premature ejaculation, restlessness, and irritability. In women nearing the end of their menstrual cycle, kidney qi gradually declines, the Blood Sea dries up, and the Chong and Ren meridians become deficient, leading to symptoms such as irregular menstruation, delayed periods, scanty menstruation or amenorrhea, irritability, dizziness, spontaneous sweating, night sweats, tinnitus, deafness, dry mouth, dry eyes, flushed face, and vexing heat in the chest, palms, and soles.

Yin deficiency with yang hyperactivity, if not cured for a long time, is prone to cause yang rising and wind stirring, leading to the upward reversal of qi and blood, often accompanied by wind, fire, phlegm, and heat evils, which cloud the seven orifices and develop into the syndrome/pattern of obstruction, as stated in Suwen-Tiaojing Lun: "When blood and qi rush upward together, it results in major syncope." The manifestations include sudden collapse, unconsciousness, body heat and red face, clenched jaw, coarse breathing with fetid mouth odor, constipation, yellow greasy tongue coating, and wiry pulse. The treatment should focus on nourishing yin and subduing yang, using Antelope Horn Decoction (Yichun Shengyi) combined with Peaceful Palace Bovine Bezoar Pill (Wenbing Tiaobian). If yin fluids are depleted over a long period, or if there is improper treatment, yang may float upward while yin is exhausted below, leading to a tendency of yin-yang separation and signs of yang qi sudden collapse, developing into the syndrome/pattern of collapse. Symptoms include sudden collapse, unconsciousness, open mouth and closed eyes, snoring, withered tongue, hands releasing and incontinence, profuse sweating, cold limbs, and a faint pulse on the verge of extinction. The treatment should aim at tonifying qi and restoring yang, rescuing yin and securing collapse, using Ginseng and Aconite Decoction (Furen Liangfang) combined with Pulse-Reinforcing Powder (Neiwaishang Bianhuo Lun).

bubble_chart Differentiation of Similar Syndromes

The syndrome/pattern of yin deficiency and internal heat and the syndrome/pattern of yin deficiency and yang hyperactivity: Both involve the deficiency of yin fluid and the failure of yin to control yang, but the former is mainly characterized by the internal generation of deficient fire, while the latter is mainly characterized by the hyperactivity of yang above. In terms of disease cause, yin deficiency with internal heat is often due to congenital insufficiency, excessive indulgence in alcohol and rich foods, or improper treatment of major or prolonged illnesses leading to damage to yin fluid, resulting in water failing to control fire and manifesting as fever. The disease cause of the syndrome/pattern of yin deficiency and yang hyperactivity, in addition to the damage to yin described in the syndrome/pattern of yin deficiency and internal heat, is often due to emotional disturbances such as sudden anger, overthinking, and depression, which lead to the hidden consumption of yin fluid and the failure of yin to control yang, resulting in yin deficiency with yang hyperactivity. Clinically, the syndrome/pattern of yin deficiency and internal heat often presents with persistent low-grade fever, dry mouth, flushed cheeks, vexing heat in the chest, palms, and soles, scanty and dark urine, and dry stools, characterized by internal exuberance of deficient fire, low-grade fever, and worsening in the afternoon and at night. The syndrome/pattern of yin deficiency and yang hyperactivity presents with dizziness, blurred vision, tinnitus, deafness, irritability, and insomnia, mainly characterized by the hyperactivity of yang above. In terms of treatment, the former should be treated by enriching yin and clearing heat, while the latter should be treated by nourishing yin and subduing yang. Although the two syndromes share many similarities in disease cause, mechanism of disease, clinical manifestations, and treatment principles, they each have unique characteristics and can be easily distinguished clinically.

Liver yin deficiency syndrome/pattern and syndrome/pattern of yin deficiency and yang hyperactivity: Both syndromes involve yin deficiency, and their clinical manifestations are quite similar, including vertigo, headache, tinnitus, dry mouth and throat, flushed cheeks, red eyes, vexing heat in the chest, palms, and soles, tidal fever, night sweats, insomnia, dreamfulness, irritability, a red tongue with scant coating, and a thin, rapid pulse. In terms of disease cause, the syndrome/pattern of yin deficiency and yang hyperactivity is often due to weak constitution, excessive indulgence in desires, loss of blood damaging yin, or emotional disturbances leading to hidden consumption of essence and blood, resulting in yin failing to control yang. Liver yin deficiency syndrome/pattern often develops from liver blood deficiency syndrome/pattern or is caused by stagnation transforming into fire, leading to hidden consumption of liver yin. The liver governs the tendons, opens into the eyes, manifests in the nails, and its channel runs through the hypochondriac region. Insufficient liver yin fails to nourish the tendons, nails, and eye orifices, as stated in Jingui Yi·Discussion on Hypochondriac Pain: "Liver deficiency refers to liver yin deficiency. Yin deficiency leads to tense and urgent pulses. The liver channel runs through the diaphragm and spreads to the hypochondriac region. Yin deficiency and blood dryness cause the Jingmai to lose nourishment and result in pain." Therefore, symptoms such as dull nails, photophobia, dry and astringent eyes, blurred vision, night blindness, and hypochondriac pain are seen, with the disease located in the liver, which differs from yin deficiency with yang hyperactivity. The liver and kidney share the same source, and prolonged liver yin deficiency can lead to liver-kidney yin deficiency, with the pathological changes often influencing each other. This syndrome can also result from liver and kidney yin deficiency, with water failing to nourish wood, leading to excessive ascendant hyperactivity of liver yang, or uncontrolled rising of liver yang, exhaustion of essence and blood, and failure to nourish the tendons, resulting in internal stirring of liver wind.

Syndrome/pattern of yin deficiency and wind stirring and syndrome/pattern of yin deficiency and yang hyperactivity: Although both syndromes involve yin deficiency, their disease causes and clinical manifestations differ. The syndrome/pattern of yin deficiency and wind stirring refers to the symptoms and signs of pathogenic heat damaging yin in warm diseases, leading to the failure to nourish the tendons and the internal stirring of deficient wind. In addition to yin deficiency symptoms, it also presents with dry and wrinkled skin, parched lips, withered tongue, wriggling of limbs, or even convulsions, severe palpitations, mental fatigue, sunken eyes, deafness, a constant desire to collapse, a deep red tongue with scant coating, and a weak or thin, rapid pulse. Wenbing Tiaobian·Lower Energizer Chapter states: "Prolonged retention of pathogenic heat scorches true yin, or due to mistaken exterior treatment or reckless purging, leading to mental fatigue, convulsions, weak vessel qi, a deep red tongue with scant coating, and a constant desire to collapse, Major Wind-Stabilizing Pearl is indicated." The syndrome/pattern of yin deficiency and wind stirring is often a severe condition of extreme yin fluid damage, which can develop from the syndrome/pattern of yin deficiency and yang hyperactivity, and the two can be easily distinguished.

bubble_chart Documentation

• Jingui Yaolue‧Blood Impediment Deficiency Fatigue: "Deficiency fatigue, vexation and inability to sleep, Sour Jujube Decoction is the main treatment."
• Jingyue Quanshu‧Insomnia: "True yin and essence blood insufficiency, yin-yang not interacting, and the spirit not being at peace."
• Jingyue Quanshu‧Dizziness: "In cases of dizziness, deficiency accounts for eight or nine out of ten, while those involving fire or phlegm are only one or two out of ten."
• Jingyue Quanshu‧Non-Wind: "Most of those who suffer from this disease are usually not cautious, or are injured by the seven emotions, or indulge excessively in alcohol and sex, first damaging the true yin of the five zang-organs, ... yin-essence impairment as a prodrome, yang damage later, yin-fluid exhaustion in the lower and yang qi insufficiency in the upper, leading to the loss of yin-yang interaction, essential qi not communicating, hence sudden confusion and collapse."
• Linzheng Zhinan Yi'an‧Vertigo: "The classics say all wind with vertigo and shaking is ascribed to the liver. The head is the leader of all yang, and the ears, eyes, mouth, and nose are all connected to the clear orifices. Those who suffer from vertigo are not affected by external evils, but by the wind and yang of the liver and gallbladder, and in severe cases, there is a risk of falling."Linzheng Zhinan Yi'an‧Apoplexy: "Now Ye Shi has elucidated that internal wind is a change in the body's yang qi. The liver is the organ of wind, and due to the depletion of essence and blood, water failing to nourish wood, the wood lacks nourishment, hence liver yang is excessively active, internal wind arises from time to time, treated by nourishing fluids to extinguish wind, moistening and nourishing the network vessels, tonifying yin to subdue yang."
• Medical Cong Lun‧Vertigo: "After all, the kidney is the mother of the liver, the kidney governs the storage of essence, and essence deficiency leads to emptiness of the brain sea and heaviness of the head, hence Neijing discusses kidney deficiency and insufficiency of the marrow sea. Speaking of deficiency refers to the root of the disease, speaking of the disease's manifestations, the principle is consistent."
• Yixue Xinwu‧Ear: "The ear is the external manifestation of the kidney, Zhongcang Jing says: The kidney is the residence of the spirit and the root of life, externally connected to the ear, the gallbladder meridian of foot shaoyang, all connect to the ear," "If suffering from deafness for a long time, it belongs to kidney deficiency, essential qi insufficiency, unable to ascend to the ear, suitable to use Six-Ingredient Rehmannia Pill with Barbary Wolfberry Fruit, Ginseng, Acorus, Milkwort Root, and the like."