Fluid depletion

Also:

• Insufficiency of fluids (津液不足 jīn yè bù zú)
• Insufficiency of yīn liquid (阴津不足 yīn jīn bù zú)
• Damage to fluids (阴津损伤 yīn jīn sǔn shāng)
• Damage to liquid (伤津 shāng jīn) refers to mild forms.
• Damage to yīn (伤阴 shāng yīn) refers to severe forms.
• Humor desertion (脱液 tuō yè) refers to very severe forms.

A disease pattern chiefly characterized by dry mouth, nose, lips, tongue, skin, and stool; thirst; scant urine; in severe cases, sunken eyes and emaciation.

Description: Depending on the severity, a distinction is made between damage to liquid and humor desertion.

Damage to liquid (伤津 shāng jīn): Dry lips; dry pharynx, dry skin (cracked in some cases); thirst with a liking for drinks, short voidings of scant urine; and dry bound stool. When cough is present, it is a dry cough with no phlegm or with scant sticky phlegm that is difficult to expectorate.

Humor desertion (脱液 tuō yè, 液脱 yè tuō): This is the same as yīn collapse. The signs are sunken eyes; emaciation; loose skin that has lost its natural elasticity; dry eyes; scant or no urine, listlessness of essence-spirit or vexation and agitation; dry lusterless facial complexion; sometimes, cramps in the lower legs or tremor and wriggling of the extremities; a red tongue with dry yellow fur or in more severe cases, a crimson and shrunken tongue with little or no fur (often called a mirror tongue); and a pulse that that is fine and rapid (in more severe cases racing), and forceless.

The main signs of humor desertion that differ from damage to liquid include bare red tongue with little or no fur (often called a mirror tongue), dry lips and mouth with no taking of fluid, sunken eyes, severe emaciation often described as loss of bulk and shedding of flesh, (破䐃脱肉 pò jùn/jiǒng tuō ròu), and dry skin and hair. Its severest manifestation is cramping of the legs. When yīn vacuity stirs wind, there is tremor or wriggling of the extremities.

Pathogenesis: Insufficiency of fluids depriving the body of moisture and nourishment owing to any of several factors:

• vomiting, diarrhea, or loss of blood;
• heat effusion and copious sweating (as from heat evil or excesses of the five minds transforming into fire), dryness evil, or burns;
• insufficient fluid intake in hot weather;
• insufficiency of visceral qì preventing the production of fluids;
• excessive use of acrid dry medicinals;
• spleen-stomach vacuity causing reduced production of fluids;
• reduction in food and drink intake, as resulting from dysphagia-occlusion or stomach reflux.

Analysis of signs

• Damage to liquid: Dry lips, dry pharynx, dry skin (cracked in some cases), dry body hair, thirst with a liking for drinks, short voidings of scant urine, dry bound stool; dry cough with no phlegm or with scant sticky phlegm that is difficult to expectorate. Cramps in the lower leg, such as occur in cholera, are attributed to severe sudden loss of liquid.
• Humor desertion: Sunken eyes; emaciation; loose skin that has lost its natural elasticity; dry eyes; scant or no urine; dry lusterless facial complexion; bare red tongue with little or no fur.
• Insufficiency of visceral qì: Lassitude of spirit and lack of strength.
• Spirit signs due to vacuity heat: Vexation and agitation.
• Yīn vacuity stirring wind due to severe humor desertion: Tremor and wriggling of the extremities.
• Tongue: Red with dry yellow fur; in severe cases, crimson and shrunken with little or no fur (often called a mirror tongue).
• Pulse: Fine, rapid (in severe cases urgent), and forceless.

Further developments: Liquid is a component of blood; hence it is said that liquid and blood are of the same source.

• Depletion of fluid can cause depletion of yīn blood, giving rise to blood dryness and vacuity heat.
• Blood dryness, in turn, can cause blood dryness engendering wind characterized by itchy and scaly skin. This is a variant of blood vacuity engendering wind, which is otherwise marked by tremor of the extremities, twitching of the flesh, hypertonicity of the joints, dizziness, and numbness. See blood vacuity engendering wind and liver wind stirring internally.
• When fluids are damaged and the amount of blood is reduced, the flow of blood can become stagnant and inhibited. This is called liquid depletion and blood stasis.

Treatment

Medicinal therapy: Clear heat and moisten dryness; engender liquid and increase humor using agents shā shēn (沙参 Glehniae Radix), mài mén dōng ( 麦门冬 Ophiopogonis Radix), yù zhú (玉竹xuán shēn (玄 Scrophulariae Radix), shēng dì huáng 生地黄 (Rehmanniae Radix Exsiccata seu Recens), and tiān huā fēn 天花粉 (Trichosanthis Radix). Zhú yè shí gāo tāng (竹叶石膏汤 Lophatherum and Gypsum Decoction) or zēng yè tāng (增液汤 Humor-Increasing Decoction) are representative formulas.

Acumoxatherapy: TB‑2 (yù mén), KI‑3 (tài xī), and KI‑7 (fù liú), which address fluid insufficiency, can be combined with LU‑10 (yú jì), LI‑11 (qū chí), and PC‑7 (dà líng), which address vacuity heat.