Retention of phlegm and fluid and stagnant blood "are the pathological products formed during the course of disease when the human body suffers from an invasion by certain pathogenic factors. When these pathological products are formed, they will directly or indirectly affect certain zang-viscera and fu-viscera and cause various kinds of syndromes; so they also are considered to be one category of pathogenic factors.
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 an 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, resulting 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 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.
