Chapter Seventeen. Syndrome of dryness and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that moisten dryness by increasing body fluids or promoting the spreading of body fluids. They are used to treat the syndrome of dryness.
Syndrome of dryness
Dryness has a contracting and holding nature. It is associated with the Lung and predominates in the autumn. Pathogenic dryness can be divided into external dryness and internal dryness.
External dryness is one of the six exogenous pathogenic factors; it appears in the autumn and directly injures the Lung. In the early autumn, dryness is often combined with heat and it consumes the body fluid and Yin of the Lung – this syndrome is referred to as warm-dryness. In the late autumn, dryness is mainly combined with cold and causes obstruction of spreading of the body fluid of the Lung – this syndrome is referred to as cold-dryness.
Internal dryness is caused directly by the consumption of body fluids. Some diseases, medicines, herbs or food products can injure the body fluids and cause dryness. Long-term stress and emotional disturbance can also cause consumption of the body fluids. As the Lung, Stomach and Large Intestine are mainly involved, the syndrome of dryness can be respectively divided into dryness in the Upper-, Middle- and Lower-Jiao.
In clinical practice, external dryness and internal dryness can coexist.
1. Syndrome of external dryness
Syndrome of warm-dryness
Manifestations
Main symptoms
Dry nasal cavity, dry mouth and throat, thirst, dry cough without phlegm or with a small amount of scanty and thick phlegm.
Secondary symptoms
Headache and fever.
Tongue
Red with a thin, dry, white coating.
Pulse
Superficial, rapid.
Syndrome of cold-dryness
Manifestations
Main symptoms
Slight headache with chills, blocked nose, aversion to wind and cold, cough with thin sputum.
Secondary symptoms
Dry nasal cavity, dry skin.
Tongue
White and slightly dry coating.
Pulse
Superficial, wiry.
2. Syndrome of internal dryness
Manifestations
Main symptoms
Dry nasal cavity, dry throat, cough with scanty sputum, shortness of breath, dry mouth, thirst, acid regurgitation, constipation and hemorrhoids.
Secondary symptoms
Cough with blood-streaked sputum, a dry and sore throat, sadness, depression, tiredness, anxiety, mood swings, hot palms and soles, night sweats.
Tongue
Red with a dry, yellow, thin coating.
Pulse
Thready and rapid.
Associated disorders in western medicine
Common cold, influenza, recovery period of influenza, bronchitis, pneumonia, chronic rhinitis, tuberculosis and other infectious diseases caused by bacteria and viruses, diabetes, peptic ulcer, irritable bowel syndrome, constipation and hemorrhoids, skin diseases that are characterized by dryness of the skin lesions, such as disorders of keratinization and senile pruritus.
Analysis of the syndrome
The Lung is an organ that is directly exposed to the environment. It is a very fragile organ, which cannot bear warmth, cold and dryness. It needs fluid to nourish its light body and Qi to support its function. If these conditions are not fulfilled, symptoms of dysfunction immediately appear.
Warm-dryness
• Exogenous pathogenic warm-dryness can injure the Lung-Qi and fluid, block the Qi dispersing and descending, and directly cause cough with thin, scanty sputum.
• The nose is the passage and the throat is the gateway of the Lung. When the Lung-Qi is disturbed, nasal obstruction, dry nasal cavity and dry throat may occur.
• The Lung relates to the skin and controls the opening and closing of the pores. When dryness obstructs the superficial region of the body, slight headache, chills and aversion to wind and cold may exist.
• The warm-dryness consumes the fluids directly and causes thirst, a red and dry tongue and a superficial and rapid pulse.
Cold-dryness
• When exogenous pathogenic cold-dryness invades the superficial region of the body, closes the pores, obstructs the Qi movements there and further obstructs the Lung, it may cause dysfunction of dispersing and descending of Lung-Qi. The patient may have a slight headache with chills, aversion to wind and cold, a blocked nose and cough with thin and scanty sputum.
• When the distribution of fluid is blocked, and the fluid condenses and turns into phlegm, the patient may suffer from dry nasal cavities and dry skin, as well as cough with scanty, thin sputum. A white and slightly dry tongue coating and a superficial and wiry pulse are often seen in this syndrome.
Internal dryness
• In the syndrome of internal dryness due to Qi and Yin deficiency of the Lung, symptoms such as dry nasal cavity, dry cough, scanty sputum and thirst may exist.
• When Yin deficiency is accompanied by empty-fire, the fire may push the blood into leaving its pathway, and blood may appear in the sputum.
• As soon as the fluid fails to moisten the Lung, the Lung-Qi weakens and patients may feel sad, tired and depressed. If there is heat in the Lung at the same time, patients may have mood swings and feel anxious.
• When the Kidney-Yin is consumed severely, night sweats, dry and sore throat and hot palms and soles appear. In this syndrome, the tongue body is red, the coating is thin and the pulse is thready and rapid.
• The dryness arising in the Stomach and Large Intestine can be very severe and because they are Yang Ming organs, they are filled up with heat, the Yin and fluid are easily injured and acid regurgitation and constipation may occur.
• Hemorrhoids are often caused by dryness in the intestines, heat in the blood and stagnation of blood.
In this syndrome, the tongue is red, the coating is very dry and yellow, and the pulse is thready and rapid. They indicate dryness and heat in the body.
Treatment principles
• For treating warm-dryness syndrome: Slightly disperse the dryness, gently clear and moisten the Lung.
• For treating cold-dryness syndrome: Disperse cold-dryness, regulate the Lung-Qi and transform the phlegm.
• For treating internal dryness syndrome: Nourish the Yin and fluids of the Lung, Kidney, Stomach and Large Intestine.
CAUTIONS
1. Caution for using sweet herbs in an external syndrome:
Sweet and cold herbs with a sticky and cloying nature should not be used in the syndrome of external dryness as they may hold onto the pathogenic factors.
2. Consider the condition of the Spleen:
Patients with Spleen-Qi and Spleen-Yang deficiency should not use herbs that are cold and sweet as they may place an extra burden on the Stomach.
4. Avoid foods that may generate dryness:
Patients who suffer from the syndrome of dryness should avoid spicy food and food that induces heat, such as hot pepper, onion, cinnamon and deep-fried food. Very sour food, such as citrus fruits and vinegar, should not be consumed in excess as they may make the fluid distribution slow or even stop.
5. Avoid overstimulating the Qi:
In composing formulas, the use of herbs that are very pungent and aromatic, and have a drying nature to promote the Qi movement should be avoided as they may consume the Yin.
Although dryness should influence many organs, in the following sections, two syndromes are particularly discussed: the syndrome of dryness in the Lung, which links with climate, and the syndrome of dryness in the Stomach and Large Intestine, which links with physiological and pathological features of the Yang Ming organs and dietary habit. The dryness of internal organs can be also consulted in the sections on syndromes of Yin deficiency and syndromes of blood deficiency in Chapter 5.
Syndrome of dryness in the Lung
Herb selection principles and formula composition strategies
• To treat a syndrome of warm-dryness, sweet and cold herbs that enter the Lung meridian are selected to moisten the Lung.
• To treat a syndrome of cold-dryness, herbs that are slightly warm, pungent, bitter and moistening, and enter the Lung meridian are selected to disperse the Lung-Qi and expel cold.
• To treat a syndrome of internal dryness of the Lung, sweet, bitter and cold herbs are selected to nourish the Lung-Yin, generate the body fluids and clear Lung-heat.
• Along with these, herbs that regulate the Lung-Qi, stop cough and moisten the Lung are often used.
• Herbs that tonify the Lung-Qi in order to stimulate the generation and spreading of the Yin and fluids should be selected in the condition of Qi deficiency.
• Herbs that nourish the Kidney-Yin can be added in a chronic condition of Lung-Yin deficiency.
Structure of the formula and selection of herbs
Chief: Directly treat the main pathological change
Sang Ye ( Mori folium), Bo He ( Menthae herba) and Lian Qiao ( Forsythiae fructus)
These herbs are aromatic, light and cold, and enter the Upper-Jiao. Sang Ye and Bo He enter the Lung meridian and Lian Qiao enters the Heart meridian. Their aromatic smell can disperse the constrained Qi and heat in the Lung and their cold nature can reduce the heat and protect the Yin. They are often selected as chief in the formulas to treat the syndrome of warm-dryness.
Zi Su Ye ( Perillae folium) and Dan Dou Chi ( Sojae semen praeparatum)
These two herbs are pungent and warm, and enter the Lung meridian. They can gently and effectively disperse the cold-dryness from the superficial region and stimulate the Lung-Qi, thus accelerating the distribution of the Qi and fluid in the body. They are often used as chief in the formula to treat cold-dryness syndrome.
Bei Sha Shen ( Glehniae radix), Mai Men Dong ( Ophiopogonis radix), Tian Men Dong ( Asparagi radix) and Bai He ( Lilii bulbus)
These herbs are sweet and cold, and enter the Lung meridian. They can nourish the Yin of the Lung and moisten the dryness. They are often used as chief in the formula to treat dryness caused by internal heat.
Bei Sha Shen, Mai Men Dong and Bai He not only nourish the Yin, but also gently tonify the Qi. They are suitable for use in syndromes where the Qi and Yin are both weak. In addition, as Mai Men Dong and Bai He also enter the Heart meridian, they can be used when dry-heat injures the Yin of the Lung and Heart, causing anxiousness, restlessness and insomnia in the latter.
Tian Meng Dong is the coldest herb in this group and can effectively reduce heat. Since it also enters the Kidney meridian, it is often used in conditions when the Lung-Yin and the Kidney-Yin are both injured, particularly in chronic and severe syndromes of Lung-Yin deficiency.
Deputy: Regulate Lung-Qi, stop cough, eliminate phlegm and moisten the Lung
Xing Ren ( Armeniacae semen), Chuan Bei Mu ( Fritillariae cirrhosae bulbus) and Pi Pa Ye ( Eriobotryae folium)
Xing Ren, Chuan Bei Mu and Pi Pa Ye enter the Lung meridian. They are all able to remove phlegm and stop cough. Since they are moistening in nature, they eliminate phlegm without the likelihood of injuring the fluid of the Lung. They are the appropriate choice in the formula to treat dryness in the Lung in both internal and external syndromes.
Sang Ye ( Mori folium) and Xing Ren ( Armeniacae semen)
Sang Ye is sweet, bitter and cold, can gently disperse the Lung-Qi, disperse and clear the heat, and moisten the dryness of the Lung. Xing Ren is pungent, bitter and warm but moist in nature. It can disperse and descend the Lung-Qi and eliminate phlegm without the likelihood of injuring the fluid. These two herbs can be selected to gently disperse the Lung-Qi and expel the cold-dryness without leading to a drying side effect.
Xing Ren ( Armeniacae semen) and Qian Hu ( Peucedani radix)
Xing Ren and Qian Hu are pungent and bitter, and enter the Lung meridian. Xing Ren is warm and can disperse the Lung-Qi; Qian Hu is cold and can descend the Lung-Qi. They can eliminate phlegm and stop cough without the side effect of drying. They can be selected as deputies in a formula to regulate the Lung-Qi and relieve cough in an acute syndrome of external dryness.
Hei Zhi Ma ( Sesami semen nigricum), Li ( Pyri fructus), Li Pi ( Pyri pericarpium) and milk
Hei Zhi Ma
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