Astringing agents

Also securing-astringing agents. Astringing medicinals promote contraction to check sweating, diarrhea, urination, seminal emission, incessant flooding (major loss of blood via the vagina), and vaginal discharge. They are mainly used for severe loss of fluid that is described as efflux desertion (滑脱 huá tuō) observed in vacuity patterns without evil repletion. In addition to containing fluids, some also constrain lung qì and suppress cough in the treatment of lung vacuity cough. Others close sores.

Subcategories

Astringing medicinals are categorized as follows:

• Sweat-checking agents, which treat vacuity sweating.
• Intestine-astringing diarrhea-checking agents, which treat efflux diarrhea. Many of these also constrain the dispersal of lung qì.
• Essence-securing, urine-reducing, and discharge-checking agents, which treat seminal emission or seminal efflux, enuresis, or vaginal discharge.

In addition, there are several medicinals which stanch bleeding by their constraining action and are used in the treatment of flooding and spotting, though they are not all contained in one section.

Astringing medicinals generally have no supplementing action to replace lost fluid. They treat the tip of the condition rather than the root. Thus they are usually combined with supplementing medicinals so that both tip and root are addressed. In the particular case of yáng collapse with dripping sweat, urinary incontinence, or incessant flooding, astringents are ineffective on their own and have to be combined with medicinals that return yáng and stem desertion such as rén shēn (Ginseng Radix), fù zǐ (Aconiti Radix Lateralis Praeparata), and gān jiāng (Zingiberis Rhizoma).

Astringing medicinals are used for patterns of vacuity of right qì in the absence of evils. Whenever they are used before external evils have disappeared, they pose the danger of shutting the gates keeping the intruder inside. They are not appropriate for any condition of evil repletion, such as exterior patterns that have not resolved; sweating in febrile disease; cough due to phlegm-rheum invading the lung; seminal emission or seminal efflux due to evil heat (or fire) stirring the essence chamber; diarrhea due to accumulation and stagnation of food; dysentery due to evil heat distressing the intestines, short rough voidings of urine due to damp-heat pouring downward; and flooding and spotting due to exuberant heat causing frenetic movement of hot blood.

Astringing medicinals are mostly warm or balanced in nature and sour/astringent in flavor. Many of them enter the lung, kidney, and large intestine channels.

Note that the word astringent denotes both a sensory quality and a therapeutic action. As a sensory quality, astringency refers to the property that causes the tissues of the mouth and tongue to pucker. In Chinese, this is called 涩 sè. Astringency is not strictly considered a flavor, yet many medicinals are denoted as having an astringent flavor.

As a therapeutic action, astringency means the ability of a medicinal to cause contraction of tissues to prevent loss of substances from the body. Medicinals possessing an astringent action are also called securing-astringing medicinals or astringing medicinals. Many, but not all of these, are marked as being astringent together with their flavor. Because the concept of astringency as a flavor came about later than the original five flavors, it is less common to see medicinals explicitly described as astringent under the typical nature and flavor section of Chinese textbooks.

Properties

Nature: Mostly warm or balanced.

Flavor: Mostly sour or astringent; some are sweet.

Channel entry: Nearly half the astringing medicinals enter the lung, large intestine, and kidney channels. Some enter the liver and spleen channels.

Toxicity: Yīng sù ké (qiào) (Papaveris Pericarpium) is toxic.

Actions

Astringing medicinals can be classified according to their main action: a) checking sweating, b) checking diarrhea, or c) securing essence (i.e., semen), reducing urine, and checking vaginal discharge. They are usually either astringent (i.e., they pucker the tissues of the mouth) or sour in flavor. Those that check sweating enter the lung channel since the lung governs the skin and body hair; those that check diarrhea enter the large intestine channel; those that secure essence and reduce urine enter the kidney channel. Medicinals that check vaginal discharge tend to enter the kidney or spleen channels. Note that some astringing medicinals also stanch bleeding or suppress cough.

Indications

Astringing medicinals treat uncontrollable loss of fluids, called efflux desertion. They are also used for milder disorders of sweating, diarrhea, urination, and seminal emission or abnormal vaginal discharge in the absence of evil repletion.

Qì Vacuity spontaneous sweating

Pathomechanism: Qì vacuity spontaneous sweating is due to vacuity of the lung, spleen, and/or heart. When the qì of any of these viscera becomes vacuous, its retentive function is diminished, the skin and body hair are insecure, and the interstices loosen. This allows fluid to discharge outward in the form of sweat.

Signs: Frequent sweating with other signs of qì vacuity such as fatigue and lack of strength, bright white facial complexion, shortness of breath, faint voice, dizziness, and a weak fine soft pulse.

Treatment method: Boost qì and check sweating. In this application, astringing medicinals are combined with qì-supplementing medicinals.

Yīn Vacuity night sweating

Pathomechanism: Yīn vacuity night sweating is due to lung, kidney, and/or heart yīn vacuity. Yīn vacuity engenders internal heat, which forces the sweat to flow out.

Signs: Night sweating with slight heat effusion, postmeridian tidal heat effusion (fever after midday), dry mouth and throat, and emaciation.

Treatment method: Constrain sweat and boost yīn. For this purpose, combine astringents with yīn-supplementing medicinals. Sometimes it is also necessary to supplement the blood and nourish the heart.

Enduring diarrhea with Efflux Desertion

Pathomechanism: When diarrhea or dysentery persists, it can damage the spleen and kidney. The spleen’s movement and transformation relies on the warming action of kidney yáng. When the spleen is deprived of that warming action, severe spleen-kidney yáng vacuity develops. When in spleen yáng vacuity spleen qì falls downward, there is incessant diarrhea, with prolapse of the rectum (efflux desertion) in severe cases. This is exacerbated by the failure of the kidney to perform its function of governing storage.

Signs: Uncontrollable diarrhea occurring day and night, accompanied by fatigue, reduced intake of food, reversal cold of the limbs sometimes with swelling, pain in the region of the umbilicus that likes warmth and pressure, shortness of breath, emaciation, a pale tongue with white fur, and a pulse that is slow and fine.

Treatment method: Astringe the intestines and check diarrhea. Combine astringents with medicinals that warm and supplement the spleen and kidney.

Lung Vacuity due to Enduring cough

Pathomechanism: When a cough due to any cause persists for a long period without abatement, it damages lung qì and lung yīn.

Signs: Cough, in severe cases with panting, together with spontaneous sweating and a vacuous pulse.

Treatment method: Constrain the lung and suppress cough; boost qì and nourish yīn. The treatment uses lung-constraining cough-ssuppressing medicinals such as wǔ wèi zǐ (Schisandrae Fructus), wū méi (Mume Fructus), and yīng sù ké (qiào) (Papaveris Pericarpium), which stem the dispersal of lung qì. These are combined with medicinals that boost qì and nourish yīn, such as rén shēn (Ginseng Radix) and ē jiāo (Asini Corii Colla).

Warnings: Lung-constraining cough-ssuppressing medicinals should not be used when evils are present, because they can shut the gates and keep the intruder inside, i.e., detain evils.

Seminal emission or seminal efflux

Pathomechanism: The kidney governs opening and closing and stores essence. When insufficiency of kidney qì or kidney yáng develops, kidney qì fails to perform its functions adequately; hence there is seminal emission or seminal efflux.

Signs: Seminal emission unassociated with dreaming, or seminal efflux, accompanied by limp aching lumbus and knees, listlessness of the essence-spirit, clouded head and tinnitus, panting on physicial exertion, bright white facial complexion, frequent urination during the day or profuse urination at night, a pale tongue with a white fur, and a sunken and weak pulse.

Treatment method: Supplement the kidney and secure essence. In this application, combine astringents with kidney-supplementing medicinals.

Warning: Astringing medicinals are not suitable for the treatment of seminal emission or seminal efflux when these are caused by frenetic movement of the ministerial fire (associated with dream emission) or by damp-heat.

Enuresis or Frequent Urination

Pathomechanism: When insufficiency of kidney qì or kidney yáng develops, kidney qì fails to perform its functions adequately. This can affect the retentive power of the bladder, the result of which is enuresis or frequent urination.

Signs: Same as for seminal emission or seminal efflus (above), but with an emphasis on urination.

Treatment method: Supplement the kidney and reduce urination. Combine astringents with kidney-supplementing medicinals.

Warning: Urine-reducing medicinals are ineffective in the treatment of children who wet the bed for lack of training. They are not used to treat damp-heat strangury (lín).

Vaginal discharge

Pathomechanism: When the spleen is vacuous and fails to move and transform, fluids collect to form dampness. This dampness can pour downward to the lower burner and damage the controlling (rèn) vessel and the girdling (dài) vessel, which leads to increased vaginal discharge. Similarly, when for various reasons the lower origin is depleted, the girdling (dài) vessel loses its retentive power and the controlling (rèn) vessel becomes insecure, which again results in vaginal discharge.

Signs: White vaginal discharge either with signs of spleen dampness such as reduced eating, fullness and oppression in the stomach duct, sloppy stool or diarrhea, cumbersome fatigued limbs that may be swollen, and a thick slimy tongue fur, or with signs of kidney yáng vacuity such as bright white facial complexion, torpor of the essence-spirit, fear of cold, lack of warmth in the extremities, dizziness, tinnitus, limp aching lumbus and knees, and an enlarged pale tongue.

Treatment method: Eliminate dampness and check vaginal discharge; supplement the kidney and check vaginal discharge. Combine astringents with water-disinhibiting medicinals and/or kidney-supplementing medicines.

Warnings: A small amount of clear or white vaginal discharge is normal and does not require any treatment. Medicinals that check vaginal discharge should not be used when the discharge is due to damp toxin. Damp toxin vaginal discharge is characterized by copious foul-smelling discharge like the water that rice has been washed in or yellow-green discharge resembling pus, or multicolored discharge, and accompanied by pain and genital itch, abdominal pain, short voidings of reddish urine, and in some cases heat effusion.

Spleen Vacuity Flooding / profuse menstruation)

Pathomechanism: Spleen qì vacuity with the spleen failing to control the blood and insecurity of the thoroughfare (chōng) vessel.

Signs: Flooding or profuse menstruation with thin, pale blood, accompanied by heart palpitation, shortness of breath, pale tongue, and a pulse that is fine and weak.

Treatment method: Secure the thoroughfare (chōng) and contain blood; boost qì and fortify the spleen.

Combinations

Efflux desertion fundamentally is attributable to right qì vacuity. Many astringing medicinals have no supplementing effect, and therefore only treat the tip (branches) of the problem. Therefore, we often combine them with vacuity-supplementing medicinals to ensure that tip and root are both cared for.

Qì vacuity spontaneous sweating, combine astringing medicinals with qì-supplementing medicinals.

Yīn vacuity night sweating, combine astringing medicinals with yīn-supplementing medicinals.

Spleen-kidney yáng vacuity diarrhea or enduring dysentery, combine astringing medicinals with medicinals that warm and supplement the spleen and kidney.

Seminal emission or seminal efflux, and enuresis or frequent urination, combine astringing medicinals with kidney-supplementing medicinals for vacuity patterns.

Vaginal discharge due to spleen qì depletion or to insufficiency of kidney yáng, combine astringing medicinals with medicinals that supplement qì and fortify the spleen or ones that supplement kidney yáng.

Warnings

Avoid detaining evil. Astringing medicinals can detain evil (or constrain evil), meaning that they can prevent evils from being eliminated. In cases where exterior evils is not yet resolved, damp-heat is exuberant, or depressed heat has not been cleared, the early use of astringents will have the effect of shutting the gate and keeping the intruder inside. It is important to dispel the evil before giving astringing medicinals.