The pattern of blood deficiency and fluid depletion is caused by constitutional blood deficiency, excessive sweating, vomiting, diarrhea, or the consumption of body fluids by warm febrile diseases, or due to loss of blood, excessive postpartum metrorrhagia, leading to the depletion of yin blood and body fluids, resulting in the failure of the zang-fu organs to be nourished, manifesting as symptoms and signs.

The main clinical manifestations include: emaciation, dizziness, tinnitus, palpitations, forgetfulness, insomnia, dreamfulness, dry mouth and throat, cracked nose and lips, dry cough, loss of voice, dry skin, dry eyes with little tears, scanty urine, constipation, pale tongue with little moisture, thin or peeled coating, and a thin and small pulse.

The pattern of blood deficiency and fluid depletion is commonly seen in diseases such as "constipation," "dry impediment," "consumptive thirst," "deficiency fatigue," and "atrophy-flaccidity disease."

This syndrome should be differentiated from the "yin deficiency pattern" and the "fluid deficiency pattern."

bubble_chart Differentiation and Treatment

The pattern of blood deficiency and fluid depletion is due to a constitutional blood deficiency, where pathogenic heat from warm diseases internally binds and scorches, damaging fluids or excessive loss of blood leading to a depletion of both yin blood and body fluids, which cannot nourish the zang-fu organs. Its clinical manifestations are mainly in two aspects. Firstly, it presents as blood deficiency, such as dizziness, palpitations, a dull complexion, scanty menstruation or amenorrhea, a pale tongue, and a thin pulse. Secondly, it shows signs of fluid depletion, such as dry mouth and throat, cracked lips and nose, dry eyes, itchy skin, and constipation. The characteristics of this syndrome vary in different diseases.

1. For example, in constipation, the clinical manifestations include dry and hard stools, a pale and dull complexion, palpitations and forgetfulness, dizziness and blurred vision, dry mouth, a pale red and dry tongue, and a thin pulse. This syndrome is common in the elderly, the weak, or those who have lost blood postpartum. Danxi Xinfa‧dryness accumulation states that constipation is due to a lack of blood, as it says, "Dryness accumulation with little blood cannot moisten, so it is appropriate to nourish yin." The revised Yanshi Jisheng Fang‧secretions treatment states, "Women who have recently given birth and lost blood, depleting body fluids, often suffer from constipation." Wanbing Huichun‧constipation disease states, "In chronic illness with deficiency, constipation is due to deficiency; constipation due to excessive sweating is due to the exhaustion of fluids; ... constipation in the elderly is due to the drying up of blood and qi; constipation in the weak, postpartum women, and those who have lost blood is due to blood deficiency." It is believed that a constitutional blood deficiency and a lack of fluids; or postpartum disease leading to yin and blood deficiency; or loss of blood and sweat, damaging fluids and depleting blood, can all lead to blood deficiency and fluid depletion. Blood deficiency leads to the large intestine not being nourished, and fluid depletion leads to dry intestines, causing dry stools and difficulty in defecation. Treatment should focus on nourishing blood and producing fluids, moistening the intestines to relieve constipation. The formula used is Intestine-Moistening Pill (from "Shen's Zunsheng Book") with modifications.
2. In dry impediment, this syndrome manifests as vague pain in the limbs and joints, without redness or swelling, difficulty in extension and flexion; even numbness, dry mouth and tongue, dry skin, and thirst. "Luzhi Zheng's Medical Collection" repeatedly emphasizes: "Dry impediment is mainly due to yin and blood deficiency, dry and depleted fluids, and the loss of nourishment to the tendons and joints." Treatment should focus on nourishing yin and blood, activating blood circulation, and moistening dryness. The formula used is Four Ingredients Decoction (Hejiju Fang) combined with Pulse-Generating Drink (Yixue Qiyuan) with modifications.
3. In consumptive thirst, the pattern of blood deficiency and fluid depletion mostly occurs in the late stage of consumptive thirst [third stage], due to constitutional yin and blood deficiency, improper diet, excessive sexual activity, and dryness-heat damaging fluids. Fluids and blood come from the same source, so without fluids to transform into blood, blood becomes more deficient. Clinical manifestations include: polyuria, polydipsia, polyphagia, emaciation, dizziness and tinnitus, dry skin, generalized itching, a pale red tongue with little coating, and a thin and rapid pulse. "Key to Diagnosis and Treatment‧Consumptive Thirst" states: "The three consumptions are due to the excess of qi and the deficiency of blood. If not treated for a long time, qi becomes completely deficient and powerless." It also states: "In the long term of the three consumptions, essence and blood are depleted, leading to blindness or paralysis of limbs like wind disease, but it is not wind disease." The pathology of consumptive thirst mainly lies in the deficiency of yin, blood, and fluids, with dryness-heat predominating. Treatment should focus on nourishing yin and blood, clearing heat, and moistening dryness. The formula used is Six-Ingredient Rehmannia Decoction (Xiao'er Yaozheng Zhijue) combined with Lily Bulb Metal-Securing Decoction (from "Shenzhai's Posthumous Writings") with modifications.
4. In atrophy-flaccidity disease, this syndrome manifests as: flaccidity and weakness of the limbs and tendons, even muscle atrophy and paralysis. It is mostly due to constitutional spleen and stomach deficiency. The spleen and stomach are the foundation of the postnatal, and spleen-stomach weakness leads to insufficient generation and transformation of qi, blood, and body fluids, unable to nourish the five zang-organs and circulate blood and qi; coupled with kidney deficiency, depletion of yin essence, and deficiency of water and excess of fire in the kidney, leading to the loss of nourishment to the bones and tendons, joint stiffness, muscle wasting, and flaccid limbs. Yizong Bidu‧flaccidity states: "The stomach, belonging to yangming, is responsible for receiving water and grains, transforming essence, and nourishing the exterior and interior, thus it is the sea of the five zang and six fu-organs, and moistens all tendons below... It governs the bones and facilitates the joints," "Deficiency of yangming leads to insufficient blood and qi, unable to moisten and nourish all tendons, thus causing flaccidity; flaccidity of all tendons leads to the belt vessel being unable to contract, thus causing foot flaccidity." Suwen-Wei Lun: "Treating flaccidity only by addressing yangming." Since the body fluids of the lungs come from the spleen and stomach, and the essence and blood of the liver and kidney depend on the generation and transformation of the spleen and stomach, treatment should focus on tonifying the spleen and stomach. Treatment should focus on strengthening the spleen and nourishing blood, moistening the tendons. The formula used is Ginseng, Poria, and White Atractylodes Powder (Hejiju Fang) combined with Hidden Tiger Pill (Danxi Xinfa).
5. In deficiency fatigue, it is often due to innate insufficiency, postnatal disharmony, or improper treatment of various diseases, prolonged illness leading to lack of nourishment, or accumulated fatigue causing internal damage, excessive consumption of body and spirit, gradually leading to the depletion of original qi, deficiency of essence and blood, zang-fu organ function decline, and insufficient generation and transformation of qi and blood. Pattern of blood deficiency and fluid depletion: In this disease, it mainly manifests as physical weakness, dizziness, blurred vision, tinnitus, deafness, palpitation, forgetfulness, muscle soreness, dry mouth and throat, dry skin, constipation, pale tongue with little coating, and thin rapid pulse. Treatment should focus on strengthening the spleen and nourishing blood, enriching yin and producing fluid. The formula used is Returning to Spleen Decoction (Jisheng Fang) with modifications.

The pattern of blood deficiency and fluid depletion is commonly seen in patients with depletion of yin blood and body fluids due to various causes. During the progression of the disease mechanism, it is prone to generate wind and transform into dryness, leading to symptoms such as muscle twitching, hand and foot tremors, limb numbness, and other wind-related symptoms, as well as manifestations of dryness-heat such as dry mouth and throat, dry skin, and thirst with a desire to drink. Since essence and blood share the same source, significant blood loss or inherent blood deficiency, combined with excessive sweating, vomiting, or diarrhea, can result in substantial depletion of blood and body fluids. As the condition progresses further, the blood vessels become empty, presenting with severe symptoms and signs such as pale complexion, vertigo, palpitations, a pale tongue with scant coating, and a faint pulse on the verge of disappearing. This critical condition is referred to as "blood collapse." This is an important aspect to consider in the clinical diagnosis and treatment of the pattern of blood deficiency and fluid depletion. Since blood is the mother of qi and qi is the commander of blood, the two are interdependent and mutually supportive. Therefore, blood collapse is often accompanied by qi collapse and yang exhaustion.

bubble_chart Differentiation of Similar Patterns

1. Yin deficiency pattern and pattern of blood deficiency and fluid depletion: Both are deficiency pattern. Blood, essence, body fluids, and liquids all belong to yin, and "essence and blood from the same source," "fluid and blood from the same source," they are closely related, but there are differences between them. Generally speaking, yin deficiency pattern is broader in scope than blood deficiency pattern. From the perspective of disease cause and mechanism of disease, pattern of blood deficiency and fluid depletion is caused by inherent spleen-stomach weakness, insufficient transformation source, sweating, vomiting, diarrhea, or damage to fluids by warm-heat pathogens, or due to significant loss of blood or fluids. Blood deficiency cannot nourish the head and eyes, leading to dizziness and blurred vision, pale or shallow yellow complexion, and pale lips. Insufficient nutrient-blood leads to poor nourishment of the heart spirit, resulting in palpitations, insomnia, and forgetfulness. Fluid depletion manifests as signs of dryness-heat, such as dry mouth and throat, dry skin, and constipation. Yin deficiency pattern is mostly caused by damage to yin fluids after Rebing or prolonged Zabing, or due to overacting of five minds, excessive sexual activity, or overconsumption of warm-dry substances, leading to hidden depletion of yin fluids, inability to control yang, and reduced moistening and nourishing functions, manifesting as pattern of deficiency heat. Clinically, it presents with emaciation, dry mouth and throat, tidal fever, flushed cheeks, vexing heat in the chest, palms, and soles, night sweats, scanty urine, dry stools, red tongue with little moisture and coating, and thin rapid pulse. Both belong to deficiency pattern and exhibit blood deficiency and fluid depletion, but yin deficiency pattern leans more towards "heat," such as feverish feeling in palms and soles, tidal fever, night sweats, etc., which can be used for differentiation.
2. Fluid deficiency pattern and pattern of blood deficiency and fluid depletion: Both are deficiency pattern and can exhibit signs of body fluids depletion, such as dry mouth and throat, dry skin, thirst, scanty and yellow urine, and dry, hard stools. Pattern of blood deficiency and fluid depletion, in addition to symptoms of body fluids depletion, also includes clinical manifestations of blood deficiency, such as dizziness, tinnitus, palpitations, and insomnia. Clinically, they are not difficult to differentiate.

bubble_chart Documentation

1. Zhubing Yuanhou Lun‧Postpartum Disorders in Women: "There are cases where the small intestine inherently harbors heat, and due to childbirth, both water and blood are lost, leading to exhaustion and dryness of body fluids, accumulation of heat in the womb, resulting in urinary blockage. However, if the womb is displaced, it causes slight abdominal distension and fullness, with urgent colicky pain. If it is due to deficiency heat and exhaustion of body fluids, the distension and urgency are not severe, but there is still blockage. When body fluids are replenished and qi is harmonized, urination will resume."
2. Jingyue Quanshu‧Blood Pattern: "The agility of the mouth, the functionality of the limbs, the flexibility of the tendons and bones, the fullness of the muscles, as well as the nourishment of the zang-fu organs, the calming of the spirit, the moistening of the complexion, the replenishment of nutrient-defense, and the smooth passage of body fluids, all depend on the function of blood. Therefore, wherever there is a deficiency of blood, it will manifest as various disorders in the corresponding areas."