bubble_chart Concept

Yawning, known as "呵欠" in Chinese, is generally a normal physiological phenomenon that occurs when one is tired and sleepy or just waking up. However, if yawning occurs frequently regardless of the time and not during times of fatigue, it is considered a pathological manifestation.

In ancient medical texts, yawning was referred to as "欠". The "Lingshu" states that "the kidneys govern yawning". The "Jingui Yaolue" in the chapter on abdominal distension and fullness, cold abdominal colic, retained food, and abnormal pulse syndromes and treatments mentions: "Those with cold in the middle often like to yawn". Later generations also referred to it as "呼欠" or "欠[去欠]" (pronounced as "qu").

bubble_chart Pattern Analysis

1. Liver Qi Depression︰Frequent yawning, depression with little joy, low spirits, indifferent expression, chest tightness, hypochondriac pain, belching, abdominal distension and fullness, or a sensation of obstruction in the throat as if something were stuck, or mental confusion, prone to sadness and crying, wiry and thin pulse. Mostly caused by emotional depression, unresolved overthinking, restlessness due to worry, liver failing to regulate qi, and disorder of qi movement, leading to frequent yawning. Treatment should focus on soothing the liver and regulating qi, soothing the liver to dissipate binding. The recommended formula is Bupleurum Liver-Soothing Powder with Chinaberry Fruit and Curcuma Root. If prolonged depression damages the spirit, causing mental confusion, sadness and frequent crying, or restless sleep, Licorice, Wheat and Jujube Decoction with silktree albizia bark, jujube seed, Poria with Pine, and dragon's teeth may be used.
2. Qi Stagnation and Blood Stasis︰Frequent yawning, chest tightness, or stabbing pain in the precordial region, palpitation, shortness of breath, dizziness, tinnitus, memory decline, irritability, red or dark purple tongue texture, mostly deep and choppy pulse, or intermittent pulse. Mostly caused by prolonged illness affecting the blood, stasis in the collaterals, obstruction of yang qi, and failure to disperse. Symptoms include sudden yawning accompanied by chest tightness, or dull pain, palpitation, shortness of breath, and faint cyanosis of the lips, which differ from those of liver depression qi stagnation. Treatment should focus on invigorating blood and resolving stasis, regulating qi and breaking stagnation. The recommended formula is Blood House Stasis-Expelling Decoction with modifications.
3. Spleen-kidney Yang Deficiency︰Mental fatigue, frequent yawning, accompanied by aversion to cold and cold limbs, pale complexion, poor appetite, abdominal distension and fullness, loose stools, increased nocturia, or clear and profuse urine, pale tongue with bluish lips, and deep-thin pulse. It is mostly caused by congenital insufficiency, chronic illness leading to physical weakness, spleen and kidney yang decline, middle energizer deficiency-cold, deficiency of yang with exuberance of yin, and mutual attraction of yin and yang. Symptoms include mental fatigue and frequent yawning, aversion to cold and fear of cold, deep-thin and weak pulse. Treatment should focus on strengthening the spleen and warming yang, tonifying the kidney and boosting fire. The recommended formula is Right-Restoring Pill with modifications.

Qi is the commander of blood, and blood is the mother of qi. Qi stagnation leads to blood stasis. Prolonged qi stagnation often results in blood stasis, and blood stasis can also exacerbate qi stagnation. Qi stagnation is mostly of an excess nature, while blood stasis often involves a combination of deficiency and excess. Spleen-kidney yang deficiency, however, is purely a deficiency pattern.

bubble_chart Documentation

1. Lingshu．Koujian Chapter: "Huangdi said: What causes people to yawn? Qibo replied: The defense qi travels through the yang during the day and through the yin at midnight. Yin governs the night, and the night is for resting. Yang governs the upper, and yin governs the lower... Yin and yang attract each other, hence frequent yawning."
2. Zhangshi Yitong．On Yawning and Sneezing: "The classics say: 'The kidney is responsible for yawning and sneezing. When qi is depressed in the stomach, yawning occurs. The stomach meridian of foot yangming, when disturbed, causes symptoms such as chills, frequent stretching, and yawning. When the two yang and one yin are affected, it leads to fright, skeletal issues, back pain, frequent belching, and yawning.' The stomach represents the two yang, and the kidney represents the one yin. When stomach deficiency causes qi depression in the middle, it results in belching; when kidney deficiency causes meridian stagnation below, it results in yawning."Neijing. Neijing attributes yawning to the stomach, but it must be due to the shaoyin meridian qi stagnating below and unable to ascend to yangming, causing stomach qi to be uncomfortable and leading to frequent yawning to release the qi and relax the meridian. If the shaoyin qi does not descend, even if the stomach qi is deficient, the depression will ascend and result in only belching without yawning."