bubble_chart Concept

Fluid deficiency pattern refers to a general term for a series of symptoms characterized by dryness and lack of body fluids, caused by the insufficiency of various fluids (also known as "body fluids") that the human body relies on to maintain normal life activities, such as sweat, saliva, gastric juice, intestinal juice, urine, etc. In diseases of external contraction or internal damage, this syndrome can be caused by dryness-heat damage to fluid, excessive sweating, vomiting and diarrhea, and mistreatment.

The clinical manifestations of this syndrome mainly include: dry mouth and throat, dry and cracked nose and lips, dry cough and loss of voice, dry skin, dry eyes with little tears, scanty urine, dry intestines and difficult bowel movements, red tongue with little or peeled coating, little fluid on the tongue, and thin and choppy pulse.

This syndrome is commonly seen in "yangming disease", "wind-warmth", and "autumn dryness" in external-contraction febrile diseases, and in "lung atrophy", "constipation", "fulminant diarrhea", "consumptive thirst", and "dysphagia" in internal damage Zabing.

Fluid deficiency pattern should be differentiated from "yin deficiency pattern" and "blood deficiency pattern".

bubble_chart Differentiation and Treatment

This syndrome can be elucidated from two aspects: external contraction and internal damage. In the differentiation of external-contraction febrile diseases, predecessors have stated that "cold-damage disease damages yang, while warm disease damages yin," believing that cold-damage disease is caused by the invasion of cold pathogens, leading to the suppression and damage of yang qi, and thus should be treated by warming and dispersing cold pathogens. In fact, cold-damage disease can also deplete body fluids, as the lingering of cold pathogens can transform into heat and damage fluids, and excessive sweating from warming and dispersing can also deplete body fluids.

1. As stated in Article 181 of the "Treatise on Cold-Damage Diseases": "Question: How does one contract Yangming disease? Answer: Taiyang disease, if treated with sweating, purging, or promoting urination, leads to fluid exhaustion, dryness in the stomach, and thus transforms into Yangming. If there is no bowel movement, internal solidity, and difficulty in defecation, this is called Yangming disease." This explains that if cold-damage disease undergoes heat transformation and is mistreated, it can cause the pathogenic factors to enter the interior, leading to the depletion of fluids and the emergence of related syndromes. It first proposes the Yangming Meridian Pattern, characterized by high fever, profuse sweating, extreme thirst, and a surging pulse, which should be treated by clearing the interior and draining heat, promoting fluid production to quench thirst, using White Tiger Decoction or White Tiger Decoction Plus Ginseng (from the "Treatise on Cold-Damage Diseases");
2. if there is Yangming heat accumulation and depletion of large intestine fluids, presenting with tidal fever, delirious speech, unclear vision, unsmooth eye movement, excessive sweating, abdominal distension and fullness, hard stools, a deep and forceful pulse, and scorched yellow tongue coating, this is the Fu Excess Pattern, which should be treated by purging fu heat and emergent purgation to preserve yin, using Major Purgative Decoction (from the "Treatise on Cold-Damage Diseases"); if there is Yangming heat accumulation and depletion of body fluids, with hard stools but not suitable for drastic purgation, it should be treated by moistening and promoting bowel movement, using Fried-Honey Anal Plug Guiding Formula (from the "Treatise on Cold-Damage Diseases");
3. if the pathogenic factors of cold-damage disease are expelled but the original qi is damaged and body fluids are insufficient, with residual heat causing thirst and desire to vomit, it should be treated by tonifying qi and fluids, clearing residual heat, using Bamboo Leaf and Gypsum Decoction (from the "Treatise on Cold-Damage Diseases").

Zhang Zhongjing also warned against inducing sweating in cases of "dry throat," "frequent urination," "sores," "nosebleeds," "blood loss," and "excessive sweating," fearing further depletion of fluids leading to this syndrome. Warm disease practitioners prioritize protecting yin fluids, and their methods of pattern identification and treatment have developed from Zhang Zhongjing's teachings.

Of course, warm pathogens invading the body easily deplete fluids, so at every stage of warm disease development, body fluids must be carefully preserved, as the saying goes, "preserving one part of body fluids means preserving one part of vitality." Taking Wu Ju-tong's Wenbing Tiaobian triple-energizer pattern identification as an example, when the disease is in the upper energizer, symptoms include fever, headache, aversion to wind, thirst, cough, and a floating rapid pulse.

1. If the patient has a constitutionally yin deficiency and extreme thirst, body fluids should be protected while releasing the exterior with pungent-cool herbs, supplemented by sweet-cold fluid-rescuing methods, using Snow Pear Juice or Five-Juice Decoction (Wenbing Tiaobian), or Modified Polyghace Seche Decoction (Chongding Tongsu Shanghan Lun);
2. if warm pathogens invade the lungs, pathogenic heat scorches fluids, or autumn dryness damages the hand taiyin qi, presenting with fever, dry nose and throat, cough, and thirst, it should be treated by releasing the exterior with pungent-cool herbs, moistening the lungs, and relieving cough, using Mulberry Leaf and Apricot Kernel Decoction (Wenbing Tiaobian) with modifications;
3. if dryness pathogens are severe and lung fluids are damaged, presenting with fever, dry cough without phlegm, qi counterflow cough and wheezing, dry mouth and nose, and dry throat thirst, it should be treated by relieving dryness and moistening the lungs, using Dryness-Clearing Lung-Rescuing Decoction (Yimen Falu) with modifications;
4. if dryness-heat lingers in the lungs, damaging lung and stomach fluids, presenting with fever, thirst, dry throat, dry cough with little phlegm, and a red tongue with little coating, it should be treated by clearing and moistening the lungs and stomach, using Coastal Glehnia Root and Ophiopogon Decoction (Wenbing Tiaobian) with modifications.
5. When the disease is in the middle energizer, symptoms include severe fever, or fever without chills, sweating, thirst, red face and eyes, dark urine, constipation, or heat retention with watery discharge, yellow or scorched yellow tongue coating, and a surging rapid or deep forceful pulse. It should be treated by softening hardness, purging, and draining heat, using Stomach-Regulating Purgative Decoction (from the "Treatise on Cold-Damage Diseases"). However, when warm-heat pathogens reside in Yangming, depleting stomach fluids and drying intestinal fluids, the pattern identification and treatment are similar to cold-damage disease Yangming disease.
6. In the application of the purgative method, it is proposed that if a person's body fluids are inherently insufficient and they take Chengqi but do not have a bowel movement, this indicates that the body fluids in the stomach and intestines are depleted, like a boat without water to sail. Therefore, the method of "nourishing water to sail the boat" was created, using the Fluid-Increasing Decoction (Wenbing Tiaobian). Wu Shi stated in the discussion on the Fluid-Increasing Formula: "This theory establishes three methods for Yangming excess patterns: for cases of heat accumulation with dry fluids and major excess pattern, use Da Chengqi; for cases leaning towards heat accumulation but not dryness, such as diarrhea, use Tiaowei Chengqi; for cases leaning towards dryness of fluids with less heat accumulation, use Zengye, aiming to protect the deficiency and preserve body fluids, which is the core principle."
7. Diseases located in the lower energizer manifest with symptoms such as fever, unconsciousness, delirious speech, bleeding from the mouth and nose, a dry and stiff tongue, dry throat, deafness, macules and papules, a crimson red tongue, and peeled tongue coating. This is due to prolonged retention of warm pathogens, heat forcing nutrient-blood, and internal consumption of body fluids. Treatment should focus on clearing the nutrient aspect and cooling the blood while protecting body fluids. The recommended formula is Nutrient-Clearing Decoction ( Wenbing Tiaobian ), or Rhinoceros Horn and Rehmannia Decoction ( Beiji Qianjin Yaofang ) with modifications.
8. If pathogenic heat disturbs the Shaoyin and body fluids are severely depleted, symptoms include dry mouth and tongue, deafness, blackened teeth, palpitations, and a desire to sleep, with a red tongue and a large, weak pulse. Treatment should focus on nourishing fluids, moistening dryness, clearing heat, and promoting fluid production. The recommended formula is Modified Pulse-Restoring Decoction ( Wenbing Tiaobian ). Wu also proposed that after the fever of warm disease subsides, if symptoms such as loss of appetite, dry skin, and mild dry cough appear, the method of recuperation should still focus on protecting body fluids. The recommended formula is Five-Juice Decoction combined with Stomach-Tonifying Decoction ( Wenbing Tiaobian ) with modifications.

In internal damage Zabing , due to the different pathogenic factors and pathological changes affecting the zang - fu organs, the clinical manifestations vary.

1. For example, body fluid deficiency can be seen in "lung atrophy," often resulting from chronic cough disease that does not heal, pathogenic heat accumulating in the lungs, and severe damage to lung fluids. Symptoms include coughing up turbid sputum, shortness of breath, dry mouth and throat, dry skin and hair, a red and dry tongue, and a weak, rapid pulse. Treatment should focus on clearing heat, moistening dryness, nourishing the lungs, and promoting fluid production. The recommended formula is Ophiopogon Decoction ( Jingui Yaolue ) or long-term use of Fine Jade Paste ("Hong's Collection of Proven Formulas").
2. Another example is seen in "constipation," often caused by constitutional yin deficiency, heat accumulation in the stomach and intestines, and dryness of intestinal fluids. Symptoms include dry stools, dry mouth with little saliva, abdominal distension and fullness, a yellow and dry tongue coating, and a thin, rapid pulse. Treatment should focus on clearing heat and moistening the intestines. The recommended formula is Hemp Seed Pill ("Treatise on Cold Damage") with modifications.
3. Another example is seen in "fulminant diarrhea," often caused by improper diet, summer heat and epidemic toxins damaging the spleen and stomach, and the mixing of clear and turbid in the middle energizer, leading to sudden vomiting and diarrhea and severe loss of body fluids. Symptoms include rice-water-like diarrhea, foul odor, vomiting, thirst, fever, abdominal pain, sunken eyes, listlessness, spasms, a yellow and greasy tongue coating, and a weak, rapid pulse. Treatment should focus on clearing heat, resolving dampness, and expelling turbidity. The recommended formula is Burning Bright Decoction ( Huoluan Lun ) or Silkworm Excrement Decoction ( Huoluan Lun ) with modifications.
4. Another example is seen in "consumptive thirst," often caused by constitutional yin deficiency, improper diet, excessive sexual activity, and dryness-heat damaging fluids. If dryness-heat affects the lungs, it manifests as upper consumptive thirst, with symptoms mainly including excessive drinking, dry mouth and tongue, accompanied by increased appetite and frequent urination. Treatment should focus on clearing heat, moistening the lungs, and promoting fluid production to quench thirst. The recommended formula is Consumptive Thirst Formula ( Danxi Xinfa ) with modifications.
5. If dryness-heat damages the stomach, it manifests as middle consumptive thirst, with symptoms mainly including excessive eating, emaciation, and frequent hunger, accompanied by excessive drinking and frequent urination. Treatment should focus on clearing stomach fire and nourishing body fluids. The recommended formula is Jade Lady Decoction ( Jingyue Quanshu ) with modifications.
6. If dryness-heat damages the kidneys, it manifests as lower consumptive thirst, with symptoms mainly including excessive urination, turbid urine like paste, accompanied by thirst and increased appetite. Treatment should focus on nourishing kidney water. The recommended formula is Six-Ingredient Rehmannia Decoction ( Xiao'er Yaozheng Zhijue ) with modifications.
7. Another example is seen in "dysphagia," often caused by damage to the spleen and stomach, phlegm and food stagnation, emotional depression, qi stagnation and blood stasis, pathogenic factors blocking and accumulating, transforming into heat and damaging fluids, and the esophagus losing its moistening function. Symptoms include difficulty swallowing with pain, difficulty eating and vomiting, fear of eating despite hunger, dry mouth, emaciation, irritability, a red tongue with peeled coating and cracks, and a wiry, thin, and weak pulse. Treatment should focus on nourishing fluids, moistening dryness, and resolving middle consumptive thirst. The recommended formula is Five-Juice Anzhong Drink ("Chinese Internal Medicine") with modifications.

The fluid deficiency pattern is commonly seen in individuals with internal accumulation of dryness-heat and insufficient yin fluids, as dryness pathogens are prone to heat transformation, leading to damage to fluid, and pathogenic heat scorches fluids, resulting in dryness and thirst. This syndrome can manifest differently depending on the season, time, age, gender, and habits. For example, in the dry climate of autumn, symptoms such as dry and cracked lips, dry nose and mouth, and dull skin are common; in the hot summer, pathogenic heat forces sweat out, often leading to excessive sweating and thirst with a desire to drink. In the dry and cold regions of the northwest, due to the lack of water and dryness, and the consumption of rich, roasted, and spicy foods to combat the cold, overeating such foods can easily lead to heat accumulation and damage to fluid. Those with a constitution of yin deficiency tend to generate internal heat due to yin deficiency, which consumes body fluids, resulting in symptoms such as dry mouth, sore throat, dizziness, blurred vision, afternoon tidal fever, and vexing heat in the chest, palms, and soles. In children, this syndrome is often caused by insufficient congenital essence and blood from parents and kidney deficiency, commonly presenting with symptoms such as sweating, difficulty in defecation, excessive urination, and unquenchable thirst, resembling "diabetes insipidus." In women, it is often due to excessive blood loss during menstruation or postpartum, leading to damage to fluid, with symptoms such as dizziness, blurred vision, thirst, excessive sweating, difficulty in defecation, and convulsive syncope. It is also not uncommon for body fluids to be depleted due to excessive sweating, vomiting, diarrhea, or excessive urination, and physicians must be cautious.

The generation, distribution, and excretion of body fluids are closely related to the zang-fu organs such as the lungs, spleen, kidneys, and triple energizer. Therefore, the decline in the function of these zang-fu organs can lead to a deficiency of body fluids. For example, if the lungs fail to disperse and descend, it can result in the failure of qi to transform fluids, leading to symptoms such as dry cough, panting, dry skin, and scanty urine. Dysfunction of the spleen in transportation can prevent the generation, transformation, and distribution of body fluids, causing symptoms like abdominal distension and fullness, thirst, dry tongue, wilting and impediment of the limbs, and difficulty in defecation. Insufficiency of kidney essence can fail to warm and nourish the lungs and spleen, leading to disturbance in qi transformation and symptoms such as vertigo, dry throat, soreness and weakness of the lower back and knees, palpitations, and scanty urine. If the triple energizer fails to regulate the waterways, it can obstruct the pathways of body fluids, qi, and blood, leading to symptoms like dry mouth, sweating, and scanty urine. In summary, "failure of qi to transform fluids" and "failure of qi to distribute fluids" are important factors contributing to this syndrome. On the other hand, since blood is transformed from body fluids, the Lingshu·Carbuncle Chapter states: "When body fluids are harmonized and regulated, they transform into red blood." Fluids transform into blood, which circulates in the vessels to nourish the body, hence the saying "fluids and blood share the same source." Deficiency of body fluids can lead to blood deficiency and dryness, causing symptoms such as dizziness, blurred vision, tinnitus, palpitations, and others. Conversely, blood deficiency or blood loss can also lead to insufficient body fluids, resulting in symptoms like dry mouth, dry tongue, dry skin, dry eyes, and constipation. Therefore, the two have a mutually causal relationship. In the clinical progression of this syndrome, it is often due to the lingering of pathogenic factors such as phlegm, stagnation, food, and stasis, which transform into heat and fire, consuming and damaging body fluids. For example, phlegm-fire injuring the lungs and scorching fluids can manifest as dry cough with scanty and thick phlegm; liver qi stagnation transforming into fire can cause dry mouth and bitterness; food accumulation in the stomach and intestines transforming into heat and damaging fluids can lead to dry intestines, thirst, and constipation; and stasis-heat obstructing internally and consuming fluids can result in dry mouth and a desire to rinse the mouth. Therefore, "it is important to pay attention to the characteristics of the accompanying pathogenic factors in differentiation." Further progression of this syndrome can lead to pathological changes such as "yin deficiency with effulgent fire," "deficiency of fluids and blood," "blood deficiency producing wind," and "collapse due to fluid exhaustion."

bubble_chart Differentiation of Similar Patterns

1. Yin deficiency pattern and fluid deficiency pattern: Yin deficiency pattern refers to a pathological reflection caused by damage to the essence and substance of the zang-fu organs, primarily manifested as yin deficiency with effulgent fire, with symptoms such as low-grade fever, afternoon fever, flushed cheeks, tinnitus, vertigo, sore throat, vexing heat in the chest, palms, and soles, night sweats, dry mouth, red tongue with little or peeled coating, and a thin, rapid pulse. Fluid deficiency pattern, on the other hand, refers to the depletion of body fluids due to dryness-heat, clinically characterized by dryness and reduced fluids. Both syndromes may present with fever and dry mouth, but the former is due to yin deficiency leading to internal heat, where the "heat" is deficient heat, hence the characteristics of low-grade fever, afternoon fever, dry mouth, and vexing heat in the chest, palms, and soles. In contrast, the "heat" in fluid deficiency pattern is pathogenic heat, resulting in more pronounced fever and thirst with a strong desire to drink. The deficient heat in yin deficiency pattern cannot be cleared by direct repulsion with bitter cold; instead, it requires nourishing water to control the sunlight. The pathogenic heat in fluid deficiency pattern can be addressed through clearing and draining methods to remove the heat and restore fluids. Therefore, fluid deficiency pattern is often seen in the early stages of disease, while yin deficiency pattern is more common in the middle and late stages. However, if fluid deficiency pattern persists and leads to severe depletion of fluids, damaging the yin fluids of the zang-fu organs, it can develop into yin deficiency pattern.
2. Blood deficiency pattern and fluid deficiency pattern: Both are syndromes of fluid depletion. Blood deficiency pattern mainly refers to the insufficiency of blood's nourishing function for the zang-fu organs, filling the blood vessels, and moistening the tendons and marrow, leading to weakened regulation and control of blood by the heart, liver, and spleen, resulting in symptoms such as dizziness, blurred vision, pale complexion, pale lips, palpitations, severe palpitations, pale nails, tinnitus, shortness of breath, light and scanty menstruation, or bleeding, pale tongue, and thin pulse. In severe cases, blood deficiency can lead to wind stirring, causing symptoms like spasms, convulsions, and convulsive syncope. Fluid deficiency pattern, on the other hand, broadly refers to insufficient body fluids, with clinical characteristics of dryness and reduced fluids, which can be easily distinguished from the aforementioned symptoms of blood deficiency pattern. Furthermore, blood deficiency pattern is primarily related to the heart's inability to govern blood, the liver's inability to store blood, and the spleen's failure to control blood, while fluid deficiency pattern is associated with dysfunction in the body fluids and qi-blood functions of the lung, spleen, kidney, and triple energizer. Therefore, differentiation should be based on these aspects.

bubble_chart Documentation

1. Lingshu-Jueqi Chapter: "The striae and interstice vent, and sweat pours out profusely, this is called fluid. When grains enter and qi is full, the rich moisture flows into the bones, the joints bend and stretch, the moisture drains and nourishes the brain marrow, the skin becomes moist and smooth, this is called liquid."
2. Lingshu-Wulong Jinye Biepian: "When water and grains enter the mouth and are transported to the intestines and stomach, their liquids are divided into five: in cold weather with thin clothing, it becomes urine and qi; in hot weather with thick clothing, it becomes sweat; when sorrow and qi combine, it becomes tears; when there is internal heat and stomach prolapse, it becomes saliva; when pathogenic qi reverses internally, it causes the qi to be blocked and not flow, and if it does not flow, it becomes water swelling."
3. Zhubing Yuanhou Lun·On Consumptive Thirst: "The five zang and six fu-organs all have body fluids."
4. "On Cold-Damage Disease": "In yangming disease, there is originally spontaneous sweating, and if the doctor further induces sweating, the illness may improve, but if there is still slight restlessness and incomplete recovery, this must be due to hard stool. Because of fluid exhaustion, the stomach becomes dry, thus causing hard stool. One should ask how many times the patient urinates in a day. If originally the patient urinates three to four times a day, and today only twice, it is known that stool will soon be passed. Now, because the frequency of urination has decreased, the body fluids should return to the stomach, so it is known that stool will soon be passed."
5. Zhubing Yuanhou Lun·On Postpartum Conditions in Women: "There is also the case where the small intestine is originally affected by heat, and due to childbirth, both water and blood are lost, body fluids are exhausted and dry, heat accumulates in the uterus, thus causing urinary blockage. However, if the uterus turns, there will be slight abdominal distension and fullness, with urgent qi and colicky pain. If there is deficiency heat and body fluids are exhausted and dry, the distension and urgency will not be severe, but there will still be blockage. When body fluids are generated and qi is harmonized, urination will occur."
6. Danxi Xinfa·On Consumptive Thirst: "Unrestrained consumption of alcohol and fried foods... thus the flaming fire rises upward, the zang-fu organs generate heat, dryness-heat becomes intense, body fluids dry up and burn, and one thirsts and drinks water uncontrollably." Jingyue Quanshu·On Three Types of Consumptive Thirst: "Upper consumptive thirst is a thirst condition, with great thirst and frequent drinking, drinking and thirsting in turn, because the body fluids of the upper energizer are dried up. Ancient texts say the disease is in the lung, but do not realize that the fire of the heart and spleen yang can also scorch and cause this, hence it is also called upper consumptive thirst. Middle consumptive thirst is a disease of the middle energizer, with excessive eating and hunger, not forming muscles, and daily increasing emaciation. The disease is in the spleen and stomach, hence it is called middle consumptive thirst. Lower consumptive thirst is a disease of the lower energizer, with dark urine, becoming strangury or turbidity, like grease or fat, with blackened face and scorched ears, daily increasing emaciation. The disease is in the kidney, hence it is also called lower consumptive thirst."
7. Yimen Falu·On Lung Atrophy: "Lung atrophy does not develop in a single day, and its cold and heat are not limited to one cause. It is generally due to the body fluids of the stomach not being transported to the lung, the lung losing its nourishment, becoming increasingly dry and withered, and then forming the condition."

(Hu Guoqing)