Blood dryness, also known as internal dryness, is a general term for the clinical manifestations of the body losing its moisture due to the depletion of essence and blood. It is often caused by excessive loss of blood or the late stage [third stage] of warm disease, prolonged illness leading to internal depletion of essence and blood, aging resulting in the decline of essence and blood, or vomiting, diarrhea, profuse sweating, damage to fluids and blood, or internal obstruction of static blood preventing the generation of new blood.

The main clinical manifestations include: dry mouth and throat, dry and rough (scaly) skin, dry and dull hair, emaciated muscles, severe constipation, scanty urine, or itchy skin with scales, red tongue with dry coating, and a wiry, thin, and rapid pulse.

The pattern of blood dryness is commonly seen in diseases such as "dysphagia," "abdominal mass," "deficiency fatigue," "constipation," "amenorrhea," "eczema," and "psoriasis."

This syndrome should typically be differentiated from "yin deficiency pattern," "blood deficiency pattern," and "blood heat pattern."

bubble_chart Differentiation and Treatment

The pattern of blood dryness can occur in various diseases, especially commonly seen in the late stage (third stage) of sexually transmitted diseases. Its clinical manifestations vary, and the treatment methods are also different.

1. For example, when the pattern of blood dryness appears in deficiency fatigue disease, it often manifests as extreme emaciation, abdominal distension and fullness, inability to eat, scaly skin, blurred vision, and other characteristics of "dry blood internal knot." This is due to long-term deficiency fatigue, compounded by depression and qi stagnation, leading to internal blood stasis, failure to generate new blood, and the body losing its nourishment. The primary treatment should focus on dispelling stasis to promote regeneration, using the Rhubarb and Ground Beetle Pill (from "Jin Gui Yao Lue"). After the static blood is removed, it is appropriate to nourish blood and tonify qi, using the Eight Precious Ingredients Decoction (from Zhengti Leiyao).
2. If the pattern of blood dryness appears in dysphagia, its clinical manifestations include chest and diaphragm pain, dry and obstructed throat, difficulty swallowing, or vomiting after eating, even difficulty drinking water, dry and hard stool like sheep feces, emaciation, dry skin, red tongue with little fluid or purple-dark, and thin and choppy pulse, characteristic of static blood dryness syndrome. This is caused by internal static blood knotting, obstructing the esophagus, leading to exhaustion of fluid and blood, and loss of nourishment. Zhu Zhen-heng said, "Accumulation over time leads to exhaustion of blood and fluid, drying up the stomach" (from "Ju Li Fa Hui"). The treatment should focus on nourishing yin and blood, breaking knots, and promoting blood circulation, using the Decoction for Opening Pylorus (from Lanshi Micang).
3. If the pattern of blood dryness is seen in abdominal mass, the clinical manifestations often include hard masses, severe pain, shallow yellow or dark complexion, dry and rough skin, emaciation, reduced appetite, pale purple tongue or with stasis spots, gray and rough tongue coating, and wiry, thin, and rapid pulse, characteristic of deficiency and stasis syndrome. This is often caused by long-term accumulation, blood stasis, failure to generate new blood, and severe damage to yin fluid. The treatment should focus on nourishing yin and blood, removing blood stasis, and resolving accumulation, using the Four Ingredients Decoction (from Taiping Huimin Heji Jufang) combined with the resolving accumulation pill (from Zabing Yuanliu Xizhu) with modifications.
4. If the pattern of blood dryness is seen in constipation disease, the clinical manifestations often include severe constipation, dry lips, reduced urine, weak body and spirit, and emaciation. This is caused by long-term illness depleting essence and blood, old age and weak body depleting essence and blood, or excessive sweating, vomiting, and diarrhea leading to loss of fluid and blood, resulting in insufficient fluid and blood, and loss of nourishment in the intestines and stomach. The treatment should focus on nourishing blood and enriching yin, moistening intestines to relieve constipation, using the Four Ingredients Decoction (from Taiping Huimin Heji Jufang) combined with the Five-Kernel Pill (from Shiyi Dexiao Fang).
5. If the pattern of blood dryness appears in chronic skin diseases such as eczema and psoriasis, the clinical manifestations often include dry skin, scaling, roughness, thickening, itching, and may be accompanied by dizziness, pale complexion, thin white tongue coating, wiry pulse, or worsening of skin lesions and itching during emotional fluctuations, accompanied by irritability, bitter taste in the mouth, dry throat, and wiry and rapid pulse. This is often caused by spleen deficiency and insufficient blood, leading to loss of nourishment in the skin and generating wind and dryness. The treatment should focus on nourishing blood to moisten dryness, using the Four-Ingredient Wind-Dispelling Decoction (from Yizong Jinjian) with modifications for eczema, and the Blood-Generating and Skin-Moistening Decoction (from Yixue Zhengzhuan) for psoriasis.

The pattern of blood dryness often occurs in the elderly and weak, related to the decline of essence and blood with age. Clinically, it often manifests as listlessness, dull complexion, dizziness, tinnitus, deafness, dry and dull skin, and severe constipation. In women, the pattern of blood dryness mainly manifests as blood depletion amenorrhea, emaciation, scaly skin, dark complexion, and constipation.

In the disease mechanism evolution of the pattern of blood dryness, it is often accompanied by the pattern of blood dryness producing wind. Due to blood failing to nourish the liver, internal stirring of liver wind occurs, leading to vertigo, tremor, or convulsion, and even fainting. The treatment should focus on nourishing yin and subduing yang, nourishing blood and extinguishing wind.

bubble_chart Differentiation of Similar Patterns

1. Blood deficiency pattern and pattern of blood dryness: Both syndromes are pathological conditions caused by the depletion of blood, hence they share similarities in disease cause, mechanism of disease, and clinical manifestations, but there are also certain differences. Pattern of blood dryness is due to scanty sperm and blood withering, leading to insufficient nourishment of the mouth, lips, skin, and muscles by body fluids and blood, resulting in dry lips and tongue, thirst, dry and rough skin, emaciated muscles, dry and lusterless hair, scanty urine, and constipation. On the other hand, blood deficiency pattern is often caused by significant loss of blood, weakness of the spleen and stomach, insufficient generation and transformation, as well as emotional stress transforming into fire and damaging yin. Clinically, it is characterized by a pale or shallow yellow complexion, pale lips, dizziness, blurred vision, palpitations, insomnia, numbness in the hands and feet, a pale tongue texture, and a thin, weak pulse. Blood dryness not only involves insufficient blood but also the drying and depletion of body fluids due to blood deficiency. Its clinical manifestations include symptoms of blood deficiency pattern along with symptoms of dryness, which clearly differentiate it from blood deficiency pattern.
2. Yin deficiency pattern and pattern of blood dryness: Both syndromes are pathological conditions caused by the deficiency of yin fluids in the body. Yin deficiency pattern is often due to prolonged illness leading to insufficient yin, or Rebing consuming and damaging body fluids, or excessive sweating, vomiting, and diarrhea leading to the loss of yin and fluids. Clinically, apart from symptoms of yin fluid deficiency such as emaciation, dry mouth and throat, vertigo, insomnia, a thin pulse, and a tongue without coating, it is often accompanied by symptoms and signs of yin failing to control yang and the generation of internal heat, such as vexing heat in the chest, palms, and soles, tidal fever, night sweats, a deep red tongue, and a rapid pulse. Pattern of blood dryness often develops on the basis of yin deficiency and blood deficiency, further transforming into dryness. Therefore, its clinical manifestations include not only symptoms of yin deficiency but also signs of dryness such as scaly skin, dry and lusterless hair, and constipation, making it easy to differentiate.
3. Blood heat pattern and pattern of blood dryness: For details, see the section on "Differential Diagnosis" under the entry for blood heat pattern.

bubble_chart Documentation

1. "Shen Zhai Yi Shu - Heat, Summer, Dryness": "The disease of dryness-heat resembles the heat pattern, where the stomach qi does not circulate, and there is a lack of body fluids internally leading to dryness. Patients seek soup and drink to save themselves, not because of thirst, but due to dry mouth. Although the tongue is dry, the root of the tongue is mostly moist; they desire to drink but consume little soup. The pulse is broad and weak. In severe cases of dryness, there may be unconscious murmuring without delirious speech, which is a sign of blood depletion."
2. "Zhang Shi Yi Tong" Volume 2: "Either due to excessive depletion from a major illness, or internal loss of body fluids from vomiting and diarrhea; or mistakenly taking metal and stone substances for health, or sexual overexertion leading to deficiency, the use of tonifying yang dry formulas, too much pungent heat, can all excessively support wild fire and damage true yin. The fire hidden in yin gradually burns, depleting blood and fluids, making dryness-heat more severe and causing various diseases. Externally, the skin becomes wrinkled and cracked; above, the throat and nose become dry; internally, there is a decrease in water fluids leading to irritability and thirst; below, the intestines and stomach dry up, with no moisture leading to difficulty in bowel movements; in the limbs, there is weakness and lack of strength; in the pulse, it becomes thin, rough, and faint. All these are due to yin blood being injured by fire heat, and the method of treatment should be with nourishing and moistening sweet-cold formulas."
3. "Zheng Zhi Hui Bu" - Dryness Pattern: "Wind-dryness is due to liver blood not nourishing the tendons, hence tendon pain and nail splitting. Fire dryness is due to spleen's hidden fire, hence lip cracking and constipation. Blood dryness is due to heart blood scattering, hence much white dandruff and hair loss. Deficiency dryness is due to kidney yin deficiency drying up, hence frequent urination, dry throat, and swollen throat. These are the initial causes of dryness, and moistening will naturally cure them. If not properly nourished, leading to true water depletion, it can result in consumptive thirst dysphagia, wilting impediment amenorrhea, dry cough with hoarse voice, stiff tendons, lockjaw and clenched fists, slack tendons, and a myriad of diseases arising, then the wildfire cannot be stopped."