Retention of Phlegm and Fluid and Stagnant Blood
1. Retention of Phlegm and Fluid
Both phlegm and fluid retention are pathological products formed when the water
metabolism is disturbed. Generally, phlegm is thick and turbid and static fluid is thin and clear. Phlegm, here, refers not only to the jelly-like substance from the throat, but also to the evils causing scrofula and subcutaneous nodule, and the phlegm-natured evils stagnated in the viscera, meridians, and collaterals, which are called the "formless phlegm," and can be diagnosed according to the clinical symptoms produced by them.
The fluid retention refers to the water accumulation in certain parts of the human body. It is given different names according to the sites in which it is found and the symptoms it produces. For example, it is termed " phlegm-fluid retention," "suspended fluid retention," "overflowing fluid retention," and "propped-up fluid retention" in Synopsis of the Golden Chamber.
The Formation of Phlegm and Fluid Retention:Retention of phlegm and fluid are formed when the lung, spleen, kidney, and triple-jiao are affected by the six climatic evils, food and drink pathogenic factors, and the seven emotions pathogenic factors,resuiting in the dysfunction of visceral qi and disturbed water metabolism, which, in turn, causes the detention of water and body fluid.
In the human body, the lung dominates the physiological function of ascending and descending, is in charge of dredging the water ditch, and disperses the body fluid; the kidney dominates the water transformation; and triple-jiao serves as the ditch in which water and the body fluid may flow; and all the above-mentioned zang-viscera and triple jiao have close relations with the water metabolism. Their dysfunction can lead to the accumulation of dampness which produces phlegm. After phlegm and fluid retention take form, they go to different parts of the body. The fluid retention mostly stays in the intestines, stomach, sternocostal region, muscles and skin, while phlegm-fluid retention goes, following the ascent and descent of qi, to the viscera internally, and to the tendons, bones, muscles and skin externally. Both cause many different types of disease.
The Pathogenic Features of Phlegm and Fluid Retention: The diseases caused by
phlegm and fluid retention have different clinical manifestations depending upon their lodging sites after formation. When they are in meridians and collaterals, they affect the circulation of qi and blood and visceral physiological functions. When they are in the viscera, they affect visceral functions and physiological ascent and descent of qi.
The Pathogenic Features of Phlegm: When in the lung, phlegm causes asthma with
sputum. When in the heart, phlegm causes the syndrome of disturbed circulation of qi and blood, with symptoms of chest distress and palpitation. When in the orifice of the heart, phlegm causes vague mind and dementia, and when it is harassing the heart in combination with fire, phlegm causes mental disarrangement. When in the stomach, it causes the syndrome of the failure of stomach-qi to descend, with symptoms of vomiting and abdominal distention. When it is in the meridians, collaterals, tendons and bones, it causes scrofula, subcutaneous nodule, numb limbs, or hemiparalysis and gangrenous symptoms. When invading the head, phlegm causes dizziness and mental confusion; and when stagnating in the throat, it causes a feeling as if the throat is being obstructed by a foreign body which can neither be swallowed nor be thrown up.
The Pathogenic Features of Fluid Retention: When in the intestines, the fluid retention causes intestinal gurgling sounds. When in the sternocostal region, it causes sternocostal distention and contracted pain due to coughing. When the fluid is in the chest and diaphragm, it causes chest distress, cough, asthma, refusal to lie in a horizontal position, and a swollen appearance of the body. When in the muscles and skin,it causes edema related to muscles and skin, anhidrosis, and pain of the body with a feeling of heaviness.
In differentiating the syndromes caused by phlegm and fluid retontion, a comprehensive analysis is needed, often taking the presence of a slippery and greasy tongue coating and slippery or wiry pulse into consideration, together with the pathogenic features of phlegm and fluid retention.
2. Stagnant Blood
The stagnant blood includes both stagnant blood outside meridians, and the stagnant blood inside meridians and the viscera due to disturbed blood circulation. On the one hand, stagnant blood is a kind of pathological product, and on the other hand, it also is atype of pathogenic factor.
There are two aspects of the formation of stagnant blood. First, blood circulation is disturbed due to the deficiency of qi, the stagnancy of qi, the cold in the blood or the heat in the blood. This disturbance also may be due to the heat in the nutrient and blood phases, and the concretion of the blood owing to the heat in the blood. Second, blood escapes from meridians and vessels due to failure to control the blood because of deficiency of qi,and the heat in the blood.
The Pathogenic Features of Stagnant Blood: When the blood becomes stagnant, it
not only loses its nourishing function, but also affects the general or local blood circulation, causing pain, bleeding, meridian and vessel obstruction, visceral lumps, and many other unfavorable consequences. Stagnant blood can cause various kinds of clinical problems according to different sites where it lodges and the different causes of its formation.
When in the heart, stagnant blood causes palpitation, chest distress, headache,
cyanotic lips and nails. When in the lung, it causes painful chest, and coughing with blood. When in the stomach and intestines, stagnant blood causes the vomiting of blood, and black stools. When in the liver, it causes hypochondriac pain and lumps. When in the heart, stagnant blood causes mental disarrangement. When stagnant blood is in the uterus, it causes pain in the lower abdomen, irregular menstruation, dysmenorrhea, amenorrhea, dark-purplish menses with masses, or metrorrhagia and metrostaxis. When in the distal parts of the four limbs, stagnant blood causes finger gangrene or toe gangrene. And, when in the local area of muscles and skin, stagnant blood causes swelling,pain, and blue-purplish color of the affected area.
Although the syndromes produced by stagnant blood have different characteristics,they have common clinical manifestations. The pain often is found to be a stabbing pain which has fixed sites,worsens on palpation, and becomes serious at night. In the case dlocal traumatic wounds of muscles and skin, the swelling lumps can be found to be bluepurplish in color; if these lumps exist in the body for a long time, they can accumulate and form hard masses with fixed sites. In cases of bleeding, stagnant blood can be found to be lumpy with a dark purplish color; long-standing stagnation of the blood can cause blackish complexion, rough skin, cyanotic lips, nails and tongue, or spots of stagnant blood on the tongue, and sublingual varices. The pulse often will be found to be thready and uneven, deep and wiry, or irregular.
