bubble_chart Concept

Chinese medicine believes that this syndrome should be classified under the category of "dryness syndrome" in Chinese medicine. The disease cause and mechanism of disease are: constitutional yin deficiency with dryness-heat, compounded by the invasion of warm dryness pathogens. The causes of dryness pattern are none other than fire-heat dryness qi damaging body fluids, or internal depletion of body fluids, or excessive sexual activity leading to true yin deficiency, or yin deficiency with effulgent fire, or mistaken ingestion of mineral substances, or excessive use of yang-tonifying and drying formulas, injuring body fluids. Dryness pattern can affect various parts of the body, but the focus is on the skin and mucous membranes, causing dry skin, brittle nails, dry eyes and nose, dry mouth and throat, constipation, dry and red tongue texture, scant coating, and a thin, choppy pulse. As Zhangshi Yitong said: "All astringent, withered, and parched conditions, with dry and cracked manifestations, belong to dryness."

bubble_chart Modern Research

Sjogren's syndrome is an autoimmune connective tissue disease that affects the exocrine glands throughout the body, primarily targeting the lacrimal and salivary glands, manifesting as dryness of the eyes and mouth. The incidence of this disease is recorded in foreign literature as 0.2% to 0.5%, making it the second most common connective tissue disease after rheumatoid arthritis. It can occur at any age but is more common in middle-aged women; it is usually divided into primary and secondary types. The primary type mainly affects the salivary and lacrimal glands, known as sicca syndrome, while the secondary type refers to Sjogren's syndrome associated with other connective tissue diseases. The onset is mostly insidious and chronic, with a few cases presenting acutely and progressing rapidly.

The pathogenesis of this disease is now mostly considered to be an autoimmune disease. In the early stages of the disease, tissue injury is caused by antigen recognition and/or B cells and plasma cells migrating to the lesion area. The mechanism of tissue injury may be antibody-dependent cell-mediated lymphocytotoxicity or the production of cytotoxic antibodies. The abdominal mass of T cells in the lesion area may be caused by the production of lymphocyte chemotactic factors or other non-antigen-specific inflammatory factors.

[Diagnosis]

1. Unexplained dry keratitis and conjunctivitis (Bengal rose test ++ or above, and Shirmer test less than 10 square millimeters or positive fluorescence staining test).
2. Characteristic histopathological findings of the lacrimal or parotid gland tissue (more than 50 round cell infiltrations around the intralobular ducts, with at least one or more visible in the same lobule).
3. Specific findings on parotid ductography (diffuse, varying sizes of punctate or patchy shadows with a diameter of more than 1 mm visible in the parotid gland).

The presence of one of the above three items can confirm the diagnosis.

bubble_chart Pattern Analysis

1. Yin Deficiency︰Dry mouth and throat, dry eyes, dry skin, thin physique, low-grade fever or vexing heat in the chest, palms, and soles, flushed cheeks, night sweats; dizziness, insomnia, tinnitus, deafness, sore cheeks, soreness and weakness in the lower back and knees, joint soreness, dry stools. Or seminal emission in men, menstrual irregularities in women. Red tongue with scant coating or a peeled, coatingless tongue, thin and rapid or wiry and rapid pulse. Nourish yin and clear heat to moisten dryness. Modified Six-Ingredient Rehmannia Decoction: Prepared Rehmannia Root, Unprocessed Rehmannia Root, Chinese Yam, Ophiopogon Tuber, Barbary Wolfberry Fruit, Glossy Privet Fruit, Polygala Root, each 15g; Mongolian Snakegourd Root, Alisma, Indian Bread Tuckahoe, Forsythia, each 10g; Chinaberry Fruit 6g; Coastal Glehnia Root 20g. For predominant dryness-heat with thirst and irritability, add Coptis Rhizome 3g and Anemarrhena 10g; for severe yin deficiency without obvious dryness-heat, remove Unprocessed Rehmannia Root and Forsythia, and add Cornus Fruit and Donkey-hide Gelatin, each 15g; for deficiency fire flaming upward with severe flushed cheeks and night sweats, add Chinese Wolfberry Root-bark 10g, Tortoise Carapace, and Turtle Carapace, each 30g; for dry, blurry eyes and hypochondriac pain as main symptoms, consider modified Lycium and Chrysanthemum Rehmannia Decoction; for significant joint pain, add Gentian, Pubescent Angelica, and Notopterygium, each 10g; for severe constipation, add Trichosanthes Seed, Scrophularia Root, and Hemp Seed, each 10g; for dry cough, breathlessness, or even panting, with reticular fibrosis shadows on chest X-ray, consider Yin-Nourishing Lung-Clearing Decoction or modified Lily Bulb Metal-Securing Decoction; for dry mouth and tongue, retching hiccups, hunger without appetite, and dull stomach pain, consider modified Stomach-Tonifying Decoction.
2. Deficiency of Both Qi and Yin︰Physical fatigue, mental fatigue, shortness of qi, reluctance to speak, dry mouth and throat with little saliva, hoarse voice, thirst but no desire to drink or drinking does not quench thirst, dry and itchy eyes, blurred vision, dry and uncomfortable nose, feverish feeling in palms and soles or reversal cold of hands and feet, distending pain in the stomach, dry stools or loose diarrhea. The tongue is pale red with scant and dry coating, and the pulse is thin and rapid or thin and weak. Tonifying qi, nourishing yin, and moistening dryness. Fluid-Increasing Decoction with comprehensive analysis of pulse and complexion, White Atractylodes Powder with modifications. Scrophularia Root, Unprocessed Rehmannia Root, Ophiopogon Tuber, Tangshen, Chinese Yam, Areca Peel, 15g each; Poria, White Atractylodes Rhizome, Platycodon Root, Hyacinth Bean, Medicated Leaven, 10g each; Villous Amomum Fruit, Dried Tangerine Peel, 6g each; Coix Seed, 30g; Chinese Date, 5 pieces. For persistent low-grade fever, add Starwort Root, turtle carapace, Sweet Wormwood, 10g each; for palpitations and restlessness, add Sour Jujube, Barbary Wolfberry Fruit, Chinese Angelica, 10g each; for reversal cold of hands and feet, add prepared Aconite Lateral Root, Dried Ginger, 10g each; for loose stools, remove Scrophularia Root and Unprocessed Rehmannia Root.
3. Warm-dryness Invading the Lung︰Swelling of the cheeks, dry mouth and eyes, fever with aversion to wind, cough with scanty yellow sputum, dry nose without discharge, dry throat and hoarseness. The tongue is reddish and dry with a yellow coating, and the pulse is floating and rapid. Disperse wind and resolve heat, ventilate the lung and moisten dryness. Modified Mulberry Leaf and Apricot Kernel Decoction: Mulberry Leaf, Bitter Apricot Seed, Schizonepeta, Saposhnikovia Root, and Platycodon Root, 10g each; Coastal Glehnia Root, Dendrobium, and Ophiopogon Tuber, 15g each; Stiff Silkworm and Liquorice Root, 6g each. For significant joint pain, add Mulberry Twig and Notopterygium, 10g each. For dizziness and headache, add Mentha and Chrysanthemum Flower, 10g each.
4. Dampness-heat︰The mouth feels sticky and dry, with slight dryness in both eyes and increased eye discharge. There is swelling and soreness in the cheeks, gum swelling and pain, restlessness in the chest and epigastrium, anorexia with reduced food intake, fetid mouth odor, thirst without excessive drinking, scanty dark urine, and either hard or loose stools. The joints of the limbs are red, swollen, and distendingly painful, particularly in the larger joints. The tongue is red with a yellow, greasy coating, and the pulse is slippery and rapid. The treatment principle is clearing heat and draining dampness. Modified Sweet Dew Detoxicating Pill is used, including 10g each of Amomum Fruit, Patchouli, Fortune Eupatorium, Akebia Stem, Prepared Atractylodes Rhizome, Phellodendron Bark, Acorus, Fritillaria Bulb, and Belamcanda Rhizome, 20g of Virgate Wormwood, and 30g of Coix Seed, with 15g of Talc. For constipation, add Trichosanthes Fruit. For migratory arthralgia, add 10g each of Chinese Taxillus Herb, Cibot Rhizome, Gentian, Saposhnikovia Root, Chinese Clematis Root, and Flowering Quince Fruit.
5. Blood Deficiencyblood Stasis︰Dry mouth and throat, foreign body sensation in the eyes, dull complexion, purplish-red papules on the skin that do not fade when pressed; pain and numbness in the limbs and joints, or Raynaud's phenomenon, swelling of the cheeks, stabbing pain, abdominal pain with tenderness, palpable masses of accumulation. Pale red tongue with ecchymosis, thin and choppy pulse. Nourish blood and activate blood circulation, nourish yin and moisten dryness. Modified Shengxue Runfu Yin: Barbary Wolfberry Fruit, Unprocessed Rehmannia Root, Black Sesame 15g each, Moutan Bark, Red Peony Root, Peach Kernel, Donkey-hide Gelatin (melted), Chinese Angelica 10g each, Salvia 30g. For loose stools, remove Peach Kernel and Black Sesame, add White Atractylodes Rhizome 10g; for predominant dry eyes, add Chrysanthemum Flower, Flatstem Milkvetch Seed, Scouring Rush Herb, Buerger Pipewort Flower 10g each.
6. Phlegm-Dampness Obstructing the Interior︰Mild dryness and discomfort in the mouth and eyes, swelling of the cheeks that gradually increases, enlarged lymph nodes in the neck and submandibular area, or an abdominal mass that is palpable, fixed, immobile, painful, and tender to touch, accompanied by chest tightness, cough with excessive phlegm. The tongue is pale with a white, greasy coating, and the pulse is wiry and slippery. The treatment principle is to resolve phlegm, soften hardness, regulate qi, and moisten dryness. Modified Sargassum Jade Flask Decoction is used: seaweed, kelp, Scrophularia Root, and Poria, 15g each; Fritillaria Bulb, Dried Tangerine Peel, Green Tangerine Peel, Sichuan Lovage Rhizome, Chinese Angelica, Pro Formula Pinellia, and Forsythia, 10g each; Liquorice Root, 6g. For severe constipation, add 30g of whole Trichosanthis Fruit and 15g of Hemp Seed. For hard and swollen lymph nodes, add 10g of Air Potato, 10g of Zedoary Rhizome, and 15g of oyster shell. For abdominal masses, add 10g of Appendiculate Cremastra Pseudobulb, 30g of Hedyotis, 30g of Barbated Skullcup Herb, and 15g of Salvia. For chest tightness and discomfort, add 10g each of Curcuma Root, Acorus, and Trichosanthis Fruit.
7. Deficiency of Both Yin and Yang︰The illness has persisted for a long time, with yin impairment affecting yang, manifesting as dryness of the mouth, eyes, and nose, a pale and lusterless complexion, joint pain, deafness, tinnitus, soreness and weakness of the lower back and knees, and impotence. The tongue may be pale or red, with a white or scanty coating, and the pulse is deep and weak. The treatment principle is to nourish yin, benefit yang, and moisten dryness. Modified Left-Restoring Decoction is used, consisting of Chinese Yam and Suberect Spatholobus Stem (30g each), Cornus Officinalis, Poria, Achyranthes Root, Eucommia Bark, and Pale Butterflybush Flower (10g each), Cassia Bark (5g), Donkey-hide Gelatin (melted), Prepared Rehmannia Root, Barbary Wolfberry Fruit, Cervi Deer-Horn Glue (melted), and Dodder Seed (15g each). For cold limbs, add 6g of Prepared Aconite Lateral Root. For dry stools, add 10g each of Scrophularia Root and Desertliving Cistanche.