bubble_chart Concept

In classical medical texts, "thirst" is referred to as "dry mouth," "mouth dryness," "dryness of the mouth and tongue," "desire for water," "wish to drink water," "severe thirst," "intense thirst," and "great thirst with a strong desire to drink." However, strictly speaking, "dry mouth" and "mouth dryness" are not entirely the same as "thirst." "Dry mouth" and "mouth dryness" often refer to a lack of body fluids in the mouth, which does not necessarily imply a desire to drink water, whereas "thirst" typically indicates a desire to drink. The two are not completely equivalent.

bubble_chart Pattern Analysis

1. Exuberant Heat in Yangming︰Thirst and preference for cold drinks, high fever with sweating, flushed face, red eyes, dysphoria, or abdominal distension and pain, severe constipation, dark urine, yellow and dry tongue coating, or even scorched black with prickles, rapid or deep and forceful pulse. Mostly caused by pathogenic heat entering the interior, with intense heat in the Yangming qi aspect. Its characteristics include extreme thirst with a desire to drink large amounts, accompanied by high fever, profuse sweating, and a surging large pulse; the Yangming fu-organ pattern must also include constipation, epigastric distension and fullness, and pain. Treatment should focus on clearing heat and purging fire to preserve fluids, using White Tiger Decoction Plus Ginseng. For Yangming fu-organ excess, treat with Major or Minor Purgative Decoction.
2. Heat Entering the Nutrient-Blood Level︰Thirst, drinking little or no desire to drink, fever worsening in the afternoon, dysphoria with delirious speech, or faint macula and papule, tongue texture crimson or tip red with prickles, pulse manifestation thin and rapid. When heat enters the nutrient-blood, although thirst may still be present, its severity is significantly reduced. Initially entering the nutrient aspect, as pathogenic heat scorches the body fluids in the blood and causes upward steaming, despite dryness in the mouth and tongue, one may not feel particularly thirsty. Even if there is thirst, the intake of fluids is minimal, accompanied by symptoms such as vexing heat at night, restlessness, faint macula and papule, and a crimson tongue texture, indicating heat in the nutrient-blood. For such cases of interior heat thirst, once the heat is addressed, the thirst will naturally cease, and there is no need to focus solely on promoting fluid production to quench thirst. The approach should be clearing the nutrient aspect and cooling the blood, selecting Nutrient-Clearing Decoction, Rhinoceros Horn and Rehmannia Decoction, and similar formulas.
3. Dampness-heat︰Thirst, but without desire to drink, or drinking only a little, chest and gastric stuffiness, anorexia, retching, feverish body and vexed heart, fatigued limbs, severe constipation or loose stool without relief, dark yellow urine, or jaundice, yellow and slimy tongue coating, soggy and rapid pulse. It often appears in dampness-warm disease or summerheat-dampness, but is also not uncommon in miscellaneous diseases. Generally, in dampness-warm disease patterns, because dampness is a yin pathogen and fluid damage is not severe, thirst is often absent. However, in cases where dampness-heat is equally severe or heat outweighs dampness, symptoms like thirst and feverish body may occur. Its clinical characteristics are: thirst without desire to drink, or drinking only a little, or preference for warm drinks, accompanied by signs of dampness obstruction, such as hidden fever or afternoon fever, chest and gastric stuffiness, heavy body and head fog, loose stool without relief, yellow and slimy tongue coating, etc. Treatment should combine clearing heat and resolving dampness, with specific approaches based on the severity of dampness-heat. For cases where heat outweighs dampness, Three-Stone Decoction or Coptis and Magnolia Bark Decoction may be used; for cases where dampness-heat are equally severe, Skullcap and Talc Decoction or Sweet Dew Detoxicating Pill with modifications can be applied. Dampness-heat thirst, due to its characteristic of thirst without desire to drink or drinking only a little, should also be distinguished from heat entering the nutrient-blood level. Heat entering the nutrient-blood level must involve nutrient-aspect heat patterns (such as unconsciousness with delirious speech, macules and papules, crimson tongue), which differ markedly from the manifestations of dampness-heat patterns.
4. Internal Retention of Water and Fluid︰Dry mouth without desire to drink, discomfort after drinking, or vomiting upon water intake, dizziness and blurred vision, fullness or palpitations in the epigastrium, abdominal distension and fullness with a heavy body, or limb edema, difficulty in urination, pale and swollen tongue with teeth marks, slippery or greasy coating, deep wiry and slippery pulse. This is caused by internal obstruction of phlegm-fluid retention, failure of yang qi to distribute, disturbance of qi transformation, and body fluids failing to ascend, resulting in thirst. Its characteristics include dry mouth but no desire to drink, discomfort after drinking, or vomiting upon water intake, accompanied by symptoms of internal fluid retention such as abdominal distension and fullness with a heavy body, edema, palpitations in the epigastrium or throbbing below the navel, difficulty in urination, and a slippery tongue coating. The treatment principle is warming yang and resolving retained fluid. For fluid retention in the epigastrium, Poria, Cinnamon Twig, Bighead Atractylodes and Licorice Decoction is prescribed; for fluid retention in the lower energizer, Five Ingredients with Poria Powder can be used.
5. Lung Dryness and Fluid Depletion︰Thirst, dry throat, dry nose, dry cough without phlegm, irritability, hypochondriac pain, dry skin, dry stools, red tongue with thin and dry coating, wiry and rough or rapid and small pulse. This is caused by external contraction of dryness pathogen scorching lung fluids, or chronic cough damaging lung yin. The lungs govern the qi pathway, distribute body fluids, control the skin and hair, and connect with the large intestine. Therefore, the symptoms manifest as thirst, dry nose and throat, dry cough without phlegm, dry skin, dry stools, etc.
6. Yin Deficiency︰Dry mouth and throat, especially at night, restlessness and insomnia, dizziness and blurred vision, feverish sensation in the palms and soles, or tidal fever and steaming bone fever, red and thin tongue with scant coating, deep and thin rapid pulse. This may be due to Rebing in the late stage [third stage], where yin fluids are scorched, or due to chronic sexually transmitted diseases leading to prolonged illness and depletion of yin-blood, resulting in yin deficiency generating internal heat. Thus, not only are there symptoms of dry mouth and throat, worse at night, but also insomnia, dizziness and blurred vision, steaming bone fever and tidal fever, vexing heat in the chest, palms and soles, red tongue with scant and dry coating, and other signs of yin deficiency with effulgent fire. For cases of lung dryness and fluid damage, it is appropriate to relieve dryness and moisten the lungs to promote fluid production, with formulas such as Dryness-Clearing Decoction or Dryness-Clearing Lung-Rescuing Decoction. For yin deficiency with effulgent fire, it is suitable to enrich yin and generate fluids, using formulas like Six-Ingredient Rehmannia Decoction combined with Fluid-Increasing Decoction.

There are many diseases characterized by thirst, and the most common symptoms and signs have been discussed above. During clinical diagnosis, it is important to pay attention to whether the patient desires to drink, the amount of fluid intake, preference for warm or cold drinks, and to consider the pulse and tongue coating for a thorough analysis. It is essential to differentiate whether the condition is related to qi, blood, yin deficiency, yang exuberance, whether it is a deficiency or excess syndrome, and which organs are involved. Treatment should be tailored accordingly, and it should not be uniformly attributed to interior heat.

bubble_chart Documentation

1. Piwei Lun．Discussion on the Prosperity and Decline of the Spleen and Stomach: "Improper diet and injuries from overwork lead to spleen-stomach weakness, which is the root of blood-related illnesses. It primarily causes the stagnation of body fluids in the mouth, hence leading to dry mouth and throat. The patient feels thirsty,... The treatment should focus on nourishing the root of the spleen and stomach through the heart and small intestine, using sweet and warm herbs as the main treatment, bitter and cold herbs as assistants, and sour herbs as supplementary treatments.... To treat the root cause, one must purge the excessive heart fire from the spleen and stomach."
2. Cishi NanzhiVolume 2: "When all six pulse conditions are tense, and the pulse feels weak upon palpation, it indicates spleen-stomach weakness and pain, reduced food intake with unquenchable thirst, epigastric stuffiness, abdominal pain, or a feeling of tightness in the abdomen like a rope, difficulty in urination, irregular bowel movements, and diminished spirit. This medicine specifically treats unquenchable thirst, tightness in the abdomen, reduced food intake, and is highly effective. Ingredients include White Poria, Dried Tangerine Peel, Ginseng, Fresh Ginger Rhizome, and Liquorice Root."
3. Jingyue Quanshu．Volume 26: "Thirst and dry mouth are quite different, yet many cannot distinguish between them. Thirst is due to excessive fire and dryness, while dry mouth is due to insufficient body fluids. Excess fire should be treated as a real Heat Syndrome, and insufficient body fluids should be treated as yin deficiency.... Therefore, after severe diarrhea, profuse sweating, overwork, major illness, postpartum blood loss, large ulcers from carbuncle and gangrene, or excessive consumption of salty foods, one may feel thirsty. All these conditions arise from yin exhaustion and fluid loss, leading to dryness and dehydration, and are not heat syndromes, so they should not be mistaken for fire.... For water deficiency below, it is appropriate to tonify the spleen and kidneys. If yang deficiency prevents the generation of yin, and qi deficiency prevents the transformation of essence, then without the mutual nourishment of water and fire, there will be no benefit."
4. 《Yizong Jiren Pian．Thirst》: "There is a type of middle qi deficiency and cold, where cold water rises, pushing the floating fire to the throat and mouth, causing a desire to drink. However, drinking more than a sip or two becomes unpleasant, and soon after, thirst returns, but drinking is again limited. This is because the upper energizer seeks water for relief, but the middle energizer, upon encountering water, finds it repulsive. For those with a red face and dysphoria, Middle-Regulating Decoction with Eight Flavor Pill, or Aconite Lateral Root with Licorice, Ginger, and Ophiopogon Tuber can also be effective. Another type desires to drink water, but shortly after drinking, vomits, and soon after vomiting, seeks to drink again, unable to keep down any medicine or food. This is a symptom of exuberant yin repelling yang, a cold-damage disease of the kidney. Zhang Zhongjing used White Unblocking Decoction with human urine and gall fel, a method of using hot medicine coldly, which cures in one dose. Women often suffer from this condition. These two conditions are both yin syndromes, but one belongs to the Taiyin and the other to the Shaoyin, and should not be confused."