Phlegm and retained fluid:introduction of pathological reasons,syndrome differentiation and common syndromes.

Syndromes of Traditional Chinese Medicine. ✵Traditional Chinese medicine has been used for thousands of years. Through thousands of years of practice, it has been proved that Chinese medicine is effective and feasible in treating diseases, preventing diseases and maintaining health. The treatment of diseases with traditional Chinese medicine has saved countless lives. The treatment of diseases in traditional Chinese medicine is macro and comprehensive.

 The theoretical system of traditional Chinese medicine is derived from and guided by long-term clinical practice. Through the analysis of the phenomenon, the internal mechanism is explored. Therefore, this unique theoretical system of traditional Chinese medicine has two basic characteristics, one is the overall-concept, the other is the dialectical treatment.

Phlegm and Retained Fluid.
Phlegm and Retained Fluid. 
 ✵Phlegm and retained fluid:Phlegm retention refers to the body fluid could not be transformed, stay or permeability inside a part of the body, which is generalized phlegm retention, among them there are differences between phlegm and drink: first of all, they are the pathological results formed by the metabolic disorders of the so-called "condensed water form drink, drink coagulate into phlegm", they may become the new pathogenic factors. Generally speaking, the thick and turbid is called phlegm, and the clear and dilute is called drink. Phlegm is not only referring to sputum from cough spit and the visible sputum but also includes scrofula, sputum core and other phlegm liquid stagnation in the viscera and other tissues, manifestations can be determined by the syndromes, this sputum is called "invisible sputum". Drink, namely water fluid stays in the human body, because its location and symptom are different and have different names.

 ✵In the condition water pathogen below in the heart, palpitation, shortness of breath and fearsome, dizziness and mad, cold first due to deficiency, heat first due to excess. Thus water pathogen in the heart, hard below the heart, short of breath, sick of water and do not want to drink water; water pathogen in the lung, spit saliva and foam, wand to drink water; water pathogen in the spleen, lack in Qi, heavy body; water pathogen in the liver, full below the costal region, sneeze and pain; water pathogen in the kidney, palpitation(epigastric throb).

 ✵Etiology and pathogenesis: Sputum is produced by six exogenous affectins, diet injury and endogenous seven emotions injury, causing Qi functional disorders of the lung, spleen, kidney viscera. In the condition the lung lost is function of Xuan Su(diffusing and disseminating, cleansing and down-bringing), body fluid could not be transformed, could condense into phlegm; Spleen main for transport and transformation, spleen and stomach hurt, could not perform transport and transformation function, water and dampness stagnant internally, could condense into phlegm; Kidney governs water, regulates excretion and retention of water, kidney Yang insufficiency, disorder in its function of regulates excretion and retention of water, water and dampness flows upward, gathers and become phlegm. Because the phlegm generation reason is different, so there are different types of cold phlegm, hot phlegm, wet phlegm, wind phlegm, depressed phlegm. Phlegm and heat binding together, is hot phlegm; Cold and phlegm coagulation, turn to cold phlegm; Phlegm and dampness binding, is dampness-phlegm; Phlegm and dryness binding, turns to dryness phlegm.

 The formation of fluid-retention, mainly or mostly due to the spleen and kidney Yang Qi deficiency, with exogenous cold and dampness, food and consumption hurt, resulting in dysfunction of the Zang-viscera and Fu-viscera, water could not be transported and transformed in the body, stagnant or accumulated in a certain location. The fluid-retention stagnant in stomach and intestines is phlegm retained fluid, the fluid-retention flow below the costal region is the pleural effusion(Xuan Yin, suspending fluid), the water flow into body and limbs is the anasarca(Yi Yin), the water pathogen affect chest and lung is the diaphragm retention of fluid(Zhi Yin). The pathogenesis of the fluid-retention is Yang deficiency and Yin excess. The anasarca(Yi Yin) is associated with edema, and the diaphragm retention of fluid(Zhi Yin) is associated with asthma.

 The phlegm and retained fluid are visible Yin pathogens, so after the formation of phlegm and retained fluid, show the characteristics of dampness wet and sticky, which can not only block Qi circulation, affect the circulation of meridians collaterals, Qi and blood circulation, also means the syndrome is trouble and difficult to be eliminated.

 ✵Symptoms of Phlegm: the phlegm pathogen remains in the body, rise and descending with the Qi, everywhere, or block in the lung, or stagnant in the stomach, or affect the heart, or depression in the liver, or move in the kidney, or flow through the meridians and collaterals, resulting in the attack of a number of syndromes, symptoms vary.

 Phlegm stagnant and obstruction in the lung, lung Qi disorder in function of Xuan Jiang(diffusing and disseminating function, cleansing and down-browing function), symptoms choking sensation in chest(sense of suppression in the chest), cough, asthma(gasp, short of breath), much sputum;

 Phlegm obstructed in the heart, the blood circulation not free, common symptoms choking sensation in chest(sense of suppression in the chest), palpitations; phlegm blocks the heart, then faint, dementia, or suddenly faint, unconsciousness, phlegm sounding in the throat, two eyes look up, hand and foot convulsion; phlegm heat disturb the heart, insomnia and upset, mania and take rash actions, language disorder, or beat others and destroy things;

 Phlegm stagnant in the stomach, the stomach disorder in harmonization and descending, epigastric fullness, disgusting nausea and vomit phlegm saliva;

 Phlegm stagnant in gallbladder, symptoms panic and could not sleep, restlessness and not calm, bitterness in mouth and vomiting, distension in chest and hypochondria, dizziness and tinnitus;

 Phlegm turbidity affect upward to the head, symptoms dizzy, dazzled, and heaviness in the head;

 Phlegm pathogen condenses in the pharynx and larynx, symptoms pharynx obstruction, could not swallow, could not vomit out, is the condition of globus hysteriocus(Mei He Qi);

 Phlegm pathogen stagnant in the meridians collaterals and bones, can cause scrofula sputum core, numbness in limbs, or hemiplegia(paralysis of half of one's body, Yin Ju), or turn to dorsal furuncle and gravitational abscess(deep multiple abscesses, multiple abscesses deep to the muscle, or Liu Zhu).

 ✵Symptoms of retained fluid:

 Retained-fluid in the intestine, borborygmus(bowel sounds);

 Retained-fluid in the chest and hypochondria, fullness in chest and hypochondrium, cough and spit lead to pain;

 Retained-fluid in the chest diaphragm, short of breath and could not lie down or sleep, appearance as swelling;

 Retained-fluid flow into the skin, skin edema, no sweat(not perspire), body pain.

 Retained-fluid stagnant in the abdomen, abdominal distension and big as a drum, veined on the abdominal wall(veins bulging), emaciated, short of urine(urine volume is little).

 The case suffering from phlegm or retained-fluid normally tongue coating slippery and greasy, pulse slippery(smooth), string-like or sinking and late.

Common syndromes of Phlegm and Retained-fluid.
Common syndromes of Phlegm and Retained-fluid. 
 ✦There are two principles of the differentiation and treatment of phlegm syndrome: the 1st principle is, to know well the deficiency and excess nature of the viscera, to treat the phlegm first, to eliminate the phlegm and dispel the phlegm first, and second to seek the treatment of the root cause of the phlegm, to treat the lung, spleen and kidney. the 2nd principle is, according to the different natures of the phlegm, use different principles and methods.

 ✦The retained-fluid is Yin pathogen, coagulate due to cold, flows when getting warm, therefore in the Jin Kui Yao Lue Fang Lun(the Synopsis of the Golden Chamber), herbalist Zhāng Zhòngjǐng said: "condition of phlegm and retained-fluid, should be harmonized with warm herbs", not only the case of Yang deficiency and retained-fluid not serious should be warmed, but also the prescriptions for eliminating retained-fluid, induce perspiration, prompt diuresis should add warm herbs too; The second is to distinguish the root cause and symptoms, degree of urgency, the difference between the deficiency and excess, exterior and interior, "the condition of anasarca(Yi Yin), should induce perspiration"; the condition of pleural effusion(Xuan Yin, suspending fluid), should attack and reduce the water and retained fluid, in the condition of diaphragm retention of fluid(Zhi Yin), is mainly cold retained fluid in the lung, should warm the lung and eliminate the retained fluild; in the condition of spleen and kidney Yang deficiency, should replenish the spleen and kidney warmly, to eliminate the retained fluid. Common syndromes of phlegm and retained-fluid are introduced as:

 ✧(1). Phlegm stagnant in the lungs: often due to wind-cold dampness heat pathogens, or cough and asthma for a long time, cough and asthma(panting, gasp for breath), or sputum with sound, phlegm white color, easy to cough out, or accompanied by cold and heat exterior syndrome, tongue coating thin white greasy, pulse floating or slippery.

 ✧(2). Phlegm blocking the heart: often caused by seven emotions hurt, such as depression, rage, or affected by dampness and turbid pathogens, symptoms coma(unconsciousness) and madness, choking sensation in chest(sense of suppression in the chest) and not pain, or fainting and fall on the ground, unconsciousness, phlegm sounding in throat, tongue coating white greasy, pulse slippery.

 ✧(3). Phlegm accumulated in spleen and stomach: mainly due to improper diet and drink(eating and drinking without temperance), thinking and consumption fatigue. Symptoms anorexia(poor appetite), nausea and vomiting, distention and fullness not comfortable, fatigue and lassitude(lack in strength), heavy body and lethargy(drowsiness, somnolence), tongue coating white greasy, fat tongue body, pulse soft and slow.

 ✧(4). Liver meridian phlegm stagnation: mostly caused by Liver Qi depression and stasis. Symptoms uneasy in pharynx(uncomfortable in the throat), seem to have thing infarction(something obstacles in the throat), insidious pain in chest and hypochondria region, belching, irritability and depressed, tongue coating is thin white and greasy, pulse string-like and slippery.

 ✧(5). Phlegm stagnant in the kidney: mostly due to prolonged illness and affect the kidney, deficiency of Yang and excessive water, or deficient fire burning body fluid and turned into phlegm. Symptoms panting(asthma, gasp for breath) and short of breath, or aversion to cold and edema, cold and painful in lumbar and knees(cold pain in low back and knees), morning ejaculation and frequent urination, pale tongue, pulse sinking and fine, or dizziness and tinnitus(ringing in ears), pain and soft in low back and knees, tongue color red with little tongue coating, pulse string-like fine and rapid.

 ✧(6). Phlegm stagnant in joints and meridians: phlegm and turbidinous flow in the joint and meridians, due to various pathogenic reasons, symptoms joint pain and swelling, numbness in limbs(numbness in arms and legs), or hemiplegia, or facial paralysis(mouth and eye aslant), or scrofula, gall, nodules, masses, tongue coating white greasy, pulse string-like and slippery.

 ✧(7). Phlegm and retained-fluid(narrow sense): spleen Yang weakness and deficiency, water and retained-fluid stay in the stomach and intestines, symptoms epigastric hard and fullness and pain, water sound in stomach, vomiting sputum clear and diluted, mouth not thirsty or thirsty but not want to drink, vertigo and dizziness, or water sound dripping in intestine, tongue coating white greasy or yellow greasy, pulse string-like and slippery.

 ✧(8). Pleural effusion(Xuan Yin,suspending fluid): water and retained-fluid flowing in the flanks, blocked collaterals, Qi movement disturbance(inhibited Qi movement), symptoms swelling pain in chest and hypochondria, cough and spit sputum, turn around, pain increased in breathing(breathing lead to increased pain), shortness of breath, tongue coating white, pulse sinking and string-like.

 ✧(9). Anasarca(Yi Yin): mainly due to malpractice of lung and spleen transportation, water flowing to the muscles of the limbs, symptoms limb pain and heavy, or limb swelling edema, inhibited urination, or fever and aversion to cold without sweat, cough and asthma sputum foam, white tongue coating, pulse string-like and tight.

 ✧(10). Diaphragm retention of fluid(Zhi Yin): water and retained-fluid attack the chest and lung, rising of lung Qi, symptoms cough asthma(panting, heavily breath) and fullness in the chest, even can not lie on the back, sputum as white foam and much, chronic cough and edema of face, tongue coating white and greasy, pulse string-like and tight.

 The pathogenesis of phlegm syndrome is a systemic pathological change involving multiple systems of the body, and the changes of the syndrome are various. Only by distinguishing the local and the whole, locating the viscera, and determining the importance and urgency of deficiency and excess, can we have a definite target and accurate treatment.

Other Syndromes of Phlegm and Retained-fluid.
Other Syndromes of Phlegm and Retained-fluid. 
 ✦Other syndromes of phlegm and retained-fluid are introduced as:

 ✧Deficiency and cold in heart and abdomen, phlegm flow and rising of Qi, fullness in chest and hypochondria, no appetite(do not take food), vomit, coldness in chest;

 ✧Phlegm retained-fluid below the heart, fullness in chest and hypochondria, blurred vision;

 ✧Pleural effusion(Xuan Yin,suspending fluid);

 ✧Anasarca(Yi Yin);

 ✧Diaphragm retention of fluid(Zhi Yin) in diaphragm, panting and fullness, distention and hard below the heart, dark complexion, pulse sinking and tight, affected over tens of days, not relieved by induce-vomiting;

 ✧Case addicted to alcohol,cough, surely will vomit blood, for sitting too long and over drink, pulse deficient surely will perspire on head, diaphragm in chest, fullness in the chest;

 ✧Diaphragm retention of fluid(Zhi Yin), could not breath;

 ✧Case vomit and not thirst, should thirst but not thirst on the contrary, for the reason diaphragm retention of fluid(Zhi Yin) below the heart; or case thirst first and vomit, this is due to water retained-fluid stagnant below the heart;

 ✧Sudden vomit, epigastric oppression, water retained-fluid between the diaphragm, dizziness, palpitation;

 ✧Thin, palpitation below the belly, spit saliva and foam and vertigo blackout, is the condition of retained-fluid;

 ✧Abdomen full, dryness in mouth, retained-fluid in intestine;

 ✧Pulse deep-sited, uninhibited urination, although urination free, hard and fullness below the heart, this is due to retained-fluid will be eliminated;

 ✧Phlegm stagnant in chest, retained-fluid stagnant, fullness below the bellybutton, nausea vomit and no appetite(could not take food);

 ✧Phlegm fullness in chest and between the diaphragm;

 ✧Cold phlegm and retained fluid, uneasy in chest and between the diaphragm;

 ✧Phlegm and retained-fluid, swallow sour saliva;

 ✧Swelling and fullness in chest, retained-fluid;

 ✧Prolonged fluid retention, undigested food, accumulation in abdomen;

 ✧Phlegm and retained-fluid, indigestion, dysemesia(retched);

 ✧Phlegm and retained-fluid in chest, bowel sounding, indigestion(food could not be digested), vomit liquid;

 ✧Cold pathogen accumulated in chest, vexed in heart, vexation and fullness, no appetite(could not take food), pain in heart and chest and radiating to the back;

 ✧Phlegm retained-fluid and cold pathogen in chest diaphragm heart and abdomen, water dampness in the heart and vexation, or bowel sounding and much sputum, clear liquid spit out from mouth, acute distension pain in hypochondrium and ribs, no appetite(no desire for food), this is mainly due to cold affect stomach, pulse sinking string-like fine and slow;

 ✧Phlegm retained fluid due to cold or heat, no appetite(could not take food, or no desire for food), deficiency and fullness below the heart, as retained-fluid;

 ✧Phlegm retained in chest due to chronic cold, choking in chest and pain, inhibited Qi, irregular of cold and heat in triple energizer, reduced appetite and no taste, or heat cold heavy body, sleep and no desire to get up;

 ✧Phlegm stagnant in chest and diaphragm, sputum as gum(very sticky), no appetite(could not take food);

 ✧Phlegm stagnant and accumulated in chest, retained-fluid, reduced appetite(poor food intake), stomach Qi deficiency, cough and vomit;

 ✧Phlegm cold and retained-fluid, fullness in chest and short of breath, vomit foam and headache(cephalea), indigestion(food could not be digested);

 ✧Phlegm stagnant above heart and retained-fluid excess, cold and oppression in heart;

 ✧Phlegm in chest, accumulated heat;

 ✧Sudden headache(cephalea), as breaking, not affected by cold, nor affected by wind, the pain mainly due to phlegm Jue Qi rising up from the chest and diaphragm, this is the condition of Jue Headache;

 ✧Phlegm stagnant in diaphragm due to cold and heat, headache and vexation in attack, desire to vomit but could not vomit out;

 ✧Five types of retained-fluid:Liu Yin(retained-fluid below the heart), Pi Yin(retained-fluid stagnant in hypochondria), Dan Yin(retained-fluid stagnant in stomach), Yi Yin(retained-fluid flow in lung and heart above the diaphragm), Liu Yin(retained-fluid flow in intestines, sounding), mainly due to drink alcohol and cold affection, drink too much cold water;

 ✧Ting Yin and Pi Yin(retained-fluid stagnant in hypochondria), stagant in hypochondria, distension and swelling in abdomen, thin and emaciation, no appetite(could not take food and drink), food indigestion(food could not be digested),spit and dysemesia(dry retching), inhibited or unhibited urination and defecation, shaking in abdomen and water sounding, heat in abdomen, dry mouth, prefer to drink water, dizziness and faint to fall down when stand up suddenly, pain in hypochondria;

 ✧Pi Yin(retained-fluid stagnant in hypochondria), stagnant and accumulated, vexation oppression and dark eyes;

 ✧Accumulation in heart and abdomen, distension and swelling in hypochondria, Liu Yin(retained-fluid below the heart) and phlegm stagnant, inhibited urination and defecation, cutting pain in abdomen, blocking above diaphragm;

 ✧Pi Yin(retained-fluid stagnant in hypochondria), stagnant in hypochondria, distension and fullness in abdomen, emaciation, no appetite(could not take food and drink), indigestion(food could not be digested), spit and dysemesia(dry retching), unhibited or inhibited urination and defecation;

References:
  • 1.Phlegm and retained fluid:introduction of pathological reasons,syndrome differentiation and common syndromes.
  • 2.Su Wen:the Plain Questions of Huangdi's Internal Classic.By 黄帝(the Yellow Emperor).
  • 3.Jin Kui Yao Lue Fang Lun:the Synopsis of Prescriptions of the Golden Chamber.By 张仲景(Zhāng Zhòngjǐng),王叔和(Wáng Shūhé),林亿(Lín Yì),高宝衡(Gāo Bǎohéng).
  • 4.Zhu Bing Yuan Hou Lun:the General Treatise on the Cause and Symptoms of Diseases.By 巢元方(Cháo Yuánfāng).

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