THIRST AND DRINK

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[level-membership-for-complementary-medicine-category]Chapter 32

imageTHIRST AND DRINK

WHY WE ASK

The symptom of thirst (or its absence) reflects the state of the Body Fluids. There are two types of fluid, one called Jin, the other called Ye. The Jin fluids are clear, light and watery and they circulate with the Defensive Qi in the space between skin and muscles; sweat comes from these fluids. The Ye fluids are more dense and heavy and they moisten and lubricate the joint spaces and the sense organs. Saliva is an expression of these Ye fluids; dryness of the mouth or thirst (these are not the same thing) are therefore symptoms of deficiency of such fluids, either because they are burned by Heat or Empty-Heat, or because there is not enough Yin.

The organ involved most closely with thirst and dry mouth is the Stomach but the Kidneys also exert an influence on saliva. However, Heat or Empty-Heat of any organ may cause thirst or a dry mouth.

WHEN WE ASK

During the time I have been practising, I have never had a patient seek treatment for a problem related to thirst (although in China patients recognize problems related to thirst as being indicative of an imbalance that needs to be treated). However, I will ask almost every patient I see whether they feel particularly thirst, have a dry mouth, etc. I usually do this after I have asked about food and appetite, or when I am trying to establish the Hot or Cold nature of a condition.

I specifically ask about thirst in conditions where a patient has apparent symptoms of Heat but I suspect does not actually have Heat. For example, in cases of rebellious Qi in the Penetrating Vessel, a woman may have a feeling of heat of the face and a red face, but no thirst because there is no actual Heat.

HOW WE ASK

For cultural reasons, thirst and dry mouth are two symptoms Chinese patients are very aware of; whereas Western patients are somewhat less aware of these symptoms and seldom report them spontaneously. An added difficulty in the West is that more and more people force themselves to drink very frequently in the mistaken belief that this is a beneficial habit that ‘flushes the kidneys’. As a result of this habit, such people will seldom feel thirsty even if they suffer from Heat. An added difficulty in England is that tea consumption is very high and this would also stop people from feeling thirsty. The same applies to countries where coffee consumption is high. In the USA, people tend also to drink a lot in general (including water and soda). As a result of these factors, fewer patients will report feeling thirsty than is the case in China even though they do suffer from Heat.

Generally speaking, the preference for hot or cold drinks reflects a condition of Cold or Heat of the Stomach respectively. However, this diagnostic symptom may be rendered invalid by cultural habits in Western countries and especially in the USA, where the consumption of iced drinks is very widespread.

THIRST

Symptoms and Signs, Chapter 70

Generally speaking, thirst indicates Heat, which may be either Full- or Empty-Heat. Thirst is not the same as dry mouth, as the former usually reflects Heat whereas the latter reflects Yin deficiency.

Full-Heat causes intense thirst with desire to drink cold fluids. Full Heat of any organ can cause this symptom, but especially Stomach-Heat, Lung-Heat, Liver-Fire and Heart-Fire.

Empty-Heat causes thirst with desire to drink in small sips, especially in the evening or during the night. This symptom is caused particularly by Empty- Heat of the Stomach, Lungs, Kidneys and Heart.

A particular symptom in Chinese diagnosis is that of ‘thirst without desire to drink’. This particular symptom may seem strange but it does occur and Western patients do occasionally report it even spontaneously. Damp-Heat causes thirst but without the desire to drink; this is because Heat causes the thirst but Dampness, obstructing the Middle Burner, makes the patient reluctant to drink.

Thirst with a desire to drink but immediately followed by the vomiting of fluids indicates Phlegm-Heat.

In rare cases, a mild thirst with a desire to sip fluids may be due to severe, chronic Qi deficiency; this is due to the deficient Qi not transporting the fluids to the mouth and causing thirst.

Intense thirst with profuse urination may indicate diabetes (Case history 32.1).

Case history 32.1

A 50-year-old woman had been suffering from type-II, late-onset diabetes which had been diagnosed only 7 weeks before. The first manifestations of it were thirst, frequent urination, vaginal itching and irritation and extreme tiredness. The onset of the diabetes coincided with the stopping of her periods, during which time she suffered from hot flushes, night sweating, urination at night, disturbed sleep, dry eyes and throat at night with desire to sip water and what she described as ‘a feeling of adrenaline rushing up and around the chest’. She was overweight, her voice was quite loud and she was generally lively. Her complexion was quite flushed.

Diagnosis: The red complexion and the symptoms she developed after the stoppage of her periods clearly indicate Heat or Empty-Heat. However, this case is an example of a striking contradiction between the symptoms and the tongue: in fact, her tongue was Pale and Swollen. In order to confirm or exclude the presence of Cold or Yang deficiency as manifested by the tongue, I asked about cold feeling and she did confirm that, although she felt hot at night, she also experienced very cold feet and needed to wear socks in bed. This contradiction is very common especially in women of menopausal age and it simply indicates that there is a deficiency of both Kidney-Yin and Kidney-Yang. The deficiency of the Kidneys was also confirmed by the fact that she suffered from chronic lower backache; the symptom of frequent urination experienced with the onset of her diabetes also confirms the Kidney deficiency and it is not by chance that the diabetes developed when her periods stopped and the Kidney energy declined.

Her pulse was Deep, slightly Slippery, Weak on both Rear positions and relatively Overflowing on the Heart position. The Deep and Weak pulse on both Rear positions confirms the Kidney deficiency, while the Slippery quality indicates the presence of Phlegm which is confirmed by her being overweight. The relatively Overflowing quality of the Heart pulse is common in menopausal women and, rather than indicating an actual Heart pattern, it reflects a rising of Qi towards the top of the body due to the deficiency of the Kidneys below. It is this rising of Qi that causes the hot flushes and in her case, also the peculiar symptom of ‘a feeling of adrenaline rushing up and around the chest’.

The treatment principle in this case is to tonify the Kidneys, strengthen the Penetrating and Directing Vessels, tonify the Spleen and resolve Phlegm.

ABSENCE OF THIRST

Symptoms and Signs, Chapter 70

Although ‘absence of thirst’ is not a symptom as such, it is considered in Chinese medicine because it has a particular diagnostic significance. Absence of thirst, that is, if the patient feels seldom thirsty and never has the desire to drink, indicates a Cold pattern. Obviously, this symptom is elicited on interrogation as a patient will not normally report it spontaneously.

Box 32.1 summarizes the patterns underlying thirst.

BOX 32.1   THIRST

[/level-membership-for-complementary-medicine-category][not-level-membership-for-complementary-medicine-category]Chapter 32

imageTHIRST AND DRINK

WHY WE ASK

The symptom of thirst (or its absence) reflects the state of the Body Fluids. There are two types of fluid, one called Jin, the other called Ye. The Jin fluids are clear, light and watery and they circulate with the Defensive Qi in the space between skin and muscles; sweat comes from these fluids. The Ye fluids are more dense and heavy and they moisten and lubricate the joint spaces and the sense organs. Saliva is an expression of these Ye fluids; dryness of the mouth or thirst (these are not the same thing) are therefore symptoms of deficiency of such fluids, either because they are burned by Heat or Empty-Heat, or because there is not enough Yin.

The organ involved most closely with thirst and dry mouth is the Stomach but the Kidneys also exert an influence on saliva. However, Heat or Empty-Heat of any organ may cause thirst or a dry mouth.

WHEN WE ASK

During the time I have been practising, I have never had a patient seek treatment for a problem related to thirst (although in China patients recognize problems related to thirst as being indicative of an imbalance that needs to be treated). However, I will ask almost every patient I see whether they feel particularly thirst, have a dry mouth, etc. I usually do this after I have asked about food and appetite, or when I am trying to establish the Hot or Cold nature of a condition.

I specifically ask about thirst in conditions where a patient has apparent symptoms of Heat but I suspect does not actually have Heat. For example, in cases of rebellious Qi in the Penetrating Vessel, a woman may have a feeling of heat of the face and a red face, but no thirst because there is no actual Heat.

HOW WE ASK

For cultural reasons, thirst and dry mouth are two symptoms Chinese patients are very aware of; whereas Western patients are somewhat less aware of these symptoms and seldom report them spontaneously. An added difficulty in the West is that more and more people force themselves to drink very frequently in the mistaken belief that this is a beneficial habit that ‘flushes the kidneys’. As a result of this habit, such people will seldom feel thirsty even if they suffer from Heat. An added difficulty in England is that tea consumption is very high and this would also stop people from feeling thirsty. The same applies to countries where coffee consumption is high. In the USA, people tend also to drink a lot in general (including water and soda). As a result of these factors, fewer patients will report feeling thirsty than is the case in China even though they do suffer from Heat.

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