EMPTY HEAT
"Empty Heat" derives from Yin deficiency. There are two aspects I would like to clarify straight away. The term "Empty" Heat may give the impression that Empty Heat is not "real" Heat. Although deriving from Yin deficiency, Empty Heat is "real" Heat and it heats up as much as Full Heat.
The second important clarification is that, although Empty Heat derives from Yin deficiency, this may occur by itself for years before giving rise to Empty Heat. Thus, although Empty Heat derives from Yin deficiency, it takes time for it to develop. Therefore one may have Yin deficiency for years without Empty Heat.
The tongue shows this very clearly. Yin deficiency manifests on the tongue with lack of coating; if there is only Yin deficiency without Empty Heat, the tongue will lack a coating but will have a normal colour. I have several dozens pictures of tongues that lack a coating but have a normal colour. The tongue below is an example of this.
Therefore, a tongue without coating with normal tongue-body colour indicates Yin deficiency, while a tongue without coating and a red body colour indicates Yin deficiency with Empty Heat.
The tongue below is red without coating.
- a feeling of heat in the afternoon/evening
- a dry mouth with desire to drink in small sips
- malar flush (red cheekbones)
- a dry throat at night
- a feeling of heat in the chest and palms and soles (also called A5-palm heat@)
- dry stools
- scanty-dark urine
- a Floating-Empty and Rapid pulse
- a red tongue without coating.
Thus for every organ, there is a pattern of Yin deficiency (without Empty Heat) and one of Empty Heat. This distinction is very apparent also from the categories of herbs and formulae in Chinese herbal medicine. The category of herbs and formulae that nourish Yin is quite distinct from that of herbs and formulae that clear Empty Heat. Herbs that nourish Yin are sweet and cold and while those that clear Empty Heat are bitter and cold.
For example, herbs that nourish Yin are Mai Men Dong and Bei Sha Shen and these do not necessarily clear Empty Heat. An example of a formula that nourishes Yin is Sha Shen Mai Dong Tang Adenophora-Ophiopogon Decoction.
Examples of herbs that clear Empty Heat are Qing Hao Herba Artemisiae annuae and Di Gu Pi Cortex Lycii. Examples of formulae that clear Empty Heat are Qing Hao Bie Jia San Artemisia annua-Carapax Trionycis Powder or Qing Gu San Clearing the Bones Powder. Of course, one can simultaneously nourish Yin and clear Empty Heat in which case one would start from a Yin-nourishing formula and add some herbs that clear Empty Heat.
With acupuncture too, there is a difference between nourishing Yin and clearing Empty Heat. To nourish Yin, one would use points such as SP-6 Sanyinjiao, Ren-12 Zhongwan or KI-3 Taixi. Generally, one can use the Yuan points of the Yin organs to nourish Yin (KI-3 Taixi, LIV-3 Taichong, SP-3 Taibai, LU-9 Taiyuan, HE-7 Shenmen).
To clear Empty Heat, one would use Fire points such as P-8 Laogong, HE-8 Shaofu, LIV-2 Xingjian, etc. Acupuncture is less Aprecise@ than herbal medicine as the Fire points can also be used to clear Full Heat.
Aetiology of Empty Heat
As Empty Heat derives from Yin deficiency, there is no specific aetiology of Empty Heat, only of Yin deficiency. In my experience, the main cause of Yin deficiency is overwork in the sense of working long hours without adequate rest, leaving home in the early morning and returning in the late evening, year after year. Overwork intended in this sense is particularly detrimental because it always involves two other causes of disease, i.e. emotional stress and irregular diet which are associated with overwork.
However, there is in my opinion a cause of disease that would favour the rise of Empty Heat and that is emotional stress. In particular, emotions that cause a rising of Qi. In fact, Empty Heat is particularly associated with a rising of Qi towards the chest, throat and head. Empty Heat causes a rising of Qi because it derives from Yin deficiency. Yin is the root that should Aanchor@ Qi: when the root is weakened, Qi rises.
Emotions that cause a rising of Qi and therefore favour Empty Heat are anger, frustration, resentment, guilt, shame, worry and fear. Yes I know, the Nei Jing says that fear Amakes Qi descend@ but I think that is more fright than fear. A chronic state of fear, such as that seen in chronic anxiety, makes Qi rise and it causes a disconnection between the Lower and the Upper part and between the Kidneys and Heart. The rising Qi combines with the Empty Heat (which has a tendency to rise anyway) causing a feeling of heat of the face and malar flush (red cheekbones).
I will now describe the Empty Heat patterns for each of the Yin organs plus the Stomach. For each organ, I will give the pattern of Yin deficiency (without Empty Heat) and that of Yin deficiency with Empty Heat.
HEART-YIN DEFICIENCY
Clinical manifestations
Palpitations, insomnia, dream-disturbed sleep, poor memory, anxiety, propensity to be startled, mental restlessness, uneasiness, dry mouth and throat in the afternoon or evening.
Tongue: normal-coloured without coating or with rootless coating.
Pulse: Floating-Empty, especially in the left-Front position.
Acupuncture
HE-7 Shenmen, Ren-14 Juque, Ren-15 Jiuwei, Ren-4 Guanyuan, SP-6 Sanyinjiao.
Prescription
Sha Shen Mai Dong Tang Adenophora-Ophiopogon Decoction.
HEART-YIN DEFICIENCY WITH EMPTY HEAT
Clinical manifestations
Palpitations, insomnia, dream-disturbed sleep, poor memory, anxiety, propensity to be startled, mental restlessness, uneasiness, "feeling hot and bothered", dry mouth and throat in the evening, thirst with desire to drink in small sips, a feeling of heat in the evening, malar flush, night-sweating, 5-palm heat.
Tongue: Red, redder on the tip, without coating.
Pulse: Floating-Empty, especially on the left-Front position and Rapid.
Acupuncture
HE-7 Shenmen, Ren-14 Juque, Ren-15 Jiuwei, Ren-4 Guanyuan, HE-6 Yinxi, SP-6 Sanyinjiao, KI-6 Zhaohai, P-7 Daling, L.I.-11 Quchi, HE-9 Shaochong, HE-8 Shaofu.
Prescription
Tian Wang Bu Xin Dan Heavenly Emperor Tonifying the Heart Pill.
LIVER-YIN DEFICIENCY
Clinical manifestations
Dizziness, numbness or tingling of limbs, insomnia, blurred vision, Afloaters@ in eyes, dry eyes, diminished night-vision, scanty menstruation or amenorrhoea, dull-pale complexion without lustre but with red cheek-bones, muscular weakness, cramps, withered and brittle nails, very dry hair and skin, depression, a feeling of aimlessness.
Tongue: normal-coloured without coating or with rootless coating.
Pulse: Floating-Empty
Acupuncture
LIV-8 Ququan, SP-6 Sanyinjiao, ST-36 Zusanli, Ren-4 Guanyuan, KI-3 Taixi.
Prescription
Yi Guan Jian One Linking Decoction.
LIVER-YIN DEFICIENCY WITH EMPTY-HEAT
Clinical manifestations
Dizziness, numbness or tingling of limbs, insomnia, blurred vision, Afloaters@ in eyes, dry eyes, diminished night-vision, scanty menstruation or heavy menstrual bleeding (if Empty Heat is severe), red cheek-bones, muscular weakness, cramps, withered and brittle nails, very dry hair and skin, depression, a feeling of aimlessness, anxiety, a feeling of heat in the evening, night-sweating, 5-palm heat, thirst with desire to drink in small sips.
Tongue: Red without coating.
Pulse: Floating-Empty and slightly Rapid.
Acupuncture
LIV-8 Ququan, SP-6 Sanyinjiao, ST-36 Zusanli, Ren-4 Guanyuan, KI-3 Taixi, LIV-2 Xingjian, L.I.-11 Quchi.
Prescription
Yi Guan Jian One Linking Decoction plus Zhi Mu Radix Anemarrhenae asphodeloidis and Mu Dan Pi Cortex Moutan radicis.
Qing Hao Bie Jia Tang Artemisia Annua-Carapax Trionycis Decoction.
Qing Gu San Clearing the Bones Powder.
LUNG-YIN DEFICIENCY
Clinical manifestations
Cough which is dry or with scanty-sticky sputum, weak and/hoarse voice, dry mouth and throat, tickly throat, tiredness, dislike to speak, thin body or thin chest, night-sweating.
Tongue: normal-coloured, dry without coating (or with rootless coating) in the front part.
Pulse: Floating-Empty.
Acupuncture
LU-9 Taiyuan, Ren-17 Shanzhong, BL-43 Gaohuangshu, Ren-12 Zhongwan, SP-6 Sanyinjiao.
Prescription
Bai He Gu Jin Tang Lilium Consolidating Metal Decoction.
Sha Shen Mai Dong Tang Adenophora-Ophiopogon Decoction.
LUNG-YIN DEFICIENCY WITH EMPTY HEAT
Clinical manifestations
Dry cough or with scanty sticky sputum which could be blood-tinged, dry mouth and throat at night, weak and/or hoarse voice, tickly throat, night-sweating, tiredness, malar flush, dislike to speak, a feeling of heat or a low-grade fever in the evening, 5-palm heat, thirst with desire to drink in small sips, insomnia, anxiety, thin body, thin chest.
Tongue: Red without coating.
Pulse: Floating-Empty and Rapid.
Acupuncture
LU-9 Taiyuan, Ren-17 Shanzhong, BL-43 Gaohuangshu, Ren-12 Zhongwan, SP-6 Sanyinjiao, LU-10 Yuji, L.I.-11 Quchi.
Prescription
Yang Yin Qing Fei Tang Nourishing Yin and Clearing the Lungs Decoction.
KIDNEY-YIN DEFICIENCY
Clinical manifestations
Dizziness, tinnitus, vertigo, poor memory, hardness of hearing, night-sweating, dry mouth and throat at night, lower backache, ache in bones, nocturnal emissions, constipation, dark-scanty urine, infertility, premature ejaculation, tiredness, lassitude, depression, slight anxiety.
Tongue: normal-coloured without coating.
Pulse: Floating-Empty.
Acupuncture
Ren-4 Guanyuan, KI-3 Taixi, KI-6 Zhaohai, SP-6 Sanyinjiao, Ren-7 Yinjiao, LU-7 Lieque and KI-6 Zhaohai in combination (opening points of the Ren Mai).
Prescription
Zuo Gui Wan Restoring the Left [Kidney] Pill.
Liu Wei Di Huang Wan Six-Ingredient Rehmannia Pill.
KIDNEY-YIN DEFICIENCY WITH EMPTY HEAT
Clinical manifestations
Dizziness, tinnitus, vertigo, poor memory, hardness of hearing, night-sweating, dry mouth at night, 5-palm heat, a feeling of heat in the evening, malar flush, thirst with desire to drink in small sips, lower backache, ache in bones, nocturnal emissions with dreams, constipation, dark-scanty urine, infertility, premature ejaculation, tiredness, depression, anxiety, insomnia, excessive menstrual bleeding.
Tongue: Red without coating; in severe cases also cracked.
Pulse: Floating-Empty and slightly Rapid.
Acupuncture
Ren-4 Guanyuan, KI-3 Taixi, KI-6 Zhaohai, KI-10 Yingu, SP-6 Sanyinjiao, Ren-7 Yinjiao, LU-7 Lieque and KI-6 Zhaohai in combination (opening points of the Ren Mai), KI-2 Rangu.
Prescription
Zhi Bo Di Huang Wan Anemarrhena-Phellodendron-Rehmannia Pill.
Da Bu Yin Wan Great Tonifying Yin Pill.
Er Zhi Wan Two Solstices Pill.
STOMACH-YIN DEFICIENCY
Clinical manifestations
No appetite or slight hunger but no desire to eat, constipation (dry stools), dull or slightly burning epigastric pain, dry mouth and throat especially in the afternoon, slight feeling of fullness after eating.
Tongue: without coating in the centre, or with rootless coating, normal body colour.
Pulse: Floating-Empty on the Right-Middle position.
Acupuncture
Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao, SP-3 Taibai.
Prescription
Sha Shen Mai Dong Tang Glehnia-Ophiopogon Decoction.
Shen Ling Bai Zhu San Ginseng-Poria-Atractylodis Powder.
Yi Wei Tang Benefiting the Stomach Decoction.
STOMACH-YIN DEFICIENCY WITH EMPTY HEAT
Clinical manifestations
Dull or burning epigastric pain, feeling of heat in the afternoon, constipation (dry stools), dry mouth and throat especially in the afternoon, thirst with desire to drink in small sips, feeling of hunger but no desire to eat, slight feeling of fullness after eating, night-sweating, 5-palm heat, bleeding gums, feeling of heat in the evening.
Tongue: Red and without coating in the centre.
Pulse: Floating-Empty on the Right-Middle position and slightly Rapid.
Acupuncture
Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao, SP-3 Taibai, ST-44 Neiting, ST-21 Liangmen, L.I.-11 Quchi.
Prescription
Sha Shen Mai Dong Tang plus Zhi Mu Radix Anemarrhenae asphodeloidis and Shi Hu Herba Dendrobii.
Qing Wei San Clearing the Stomach Powder.
