Phlegm and fluid retention
AliasPhlegm and fluid retention syndrome
Traditional Chinese Medicine Definition
Pblegm-Retained Fluid, classified under the category of qi, blood, and body fluid disorders in Traditional Chinese Medicine (TCM), is a condition resulting from dysfunction of the lung, spleen, and kidney zang-organs, impaired water metabolism, and accumulation of phlegm-dampness. Its basic pathogenesis involves abnormal water metabolism, endogenous generation of phlegm-dampness, and obstruction of qi movement. The classic TCM text *Internal Medicine of Traditional Chinese Medicine* records: "Pblegm-retained fluid is a disease of water-dampness, arising from loss of regulation in qi transformation by the lung, spleen, and kidney, leading to failure of water-fluid distribution and accumulation into phlegm."
The clinical pattern differentiation approach for phlegm-retained fluid primarily revolves around its core pathogenesis. In TCM clinical practice, it is believed that the formation of phlegm-retained fluid is closely related to dysfunction of the lung, spleen, and kidney zang-organs, with common triggers including improper diet, emotional disturbances, and imbalance between activity and rest. During pattern differentiation, attention should be paid to distinguishing different patterns of phlegm-retained fluid, such as phlegm-retained fluid stagnating in the stomach pattern, suspended fluid pattern, supportive fluid pattern, and spillage fluid pattern, with the key point being differentiation of cold, heat, deficiency, and excess.
The phlegm-retained fluid stagnating in the stomach pattern manifests as splashing sounds in the epigastrium, vomiting of clear fluid and phlegm saliva, palpitations, and dizziness, with the treatment principle being warming the spleen to resolve fluid and harmonizing the stomach to descend rebellious qi. The suspended fluid pattern is characterized by fullness in the chest and hypochondrium, cough-induced pulling pain, shortness of breath, and aggravation upon turning, with the treatment principle being attacking and expelling water-fluid, and stopping cough and calming panting. The supportive fluid pattern presents with cough and dyspnea with inability to lie flat, copious white phlegm, and facial edema, with the treatment principle being warming the lung to resolve fluid, and stopping cough and calming panting. The spillage fluid pattern primarily involves body pain, heavy limbs, edema, and absence of sweating, with the treatment principle being inducing sweating to release the exterior, and warming to resolve water-fluid.
Overall treatment direction: The treatment of phlegm-retained fluid should focus on regulating the functions of the lung, spleen, and kidney zang-organs to restore water metabolism balance and eliminate phlegm-dampness. In TCM clinical practice, corresponding therapeutic methods are adopted according to different patterns, such as warming yang to resolve fluid, strengthening the spleen to drain dampness, and clearing heat to transform phlegm, aiming to harmonize qi and blood, unblock the channels and collaterals, and restore bodily balance.
Common Syndrome Types and Key Points of Differentiation
Pattern of phlegm-rheum retention in the stomach
Main Manifestations: Splashing sound in the epigastrium, vomiting of clear watery fluid and phlegm, palpitations, dizziness, white and slippery tongue coating
Management Approach: Warm the spleen to transform fluid-retention, and harmonize the stomach to descend rebellious qi.
Floating fluid syndrome
Main Manifestations: Fullness in the chest and hypochondrium, cough with pulling pain, shortness of breath, aggravated by turning to the side.
Management Approach: Expelling retained fluid to relieve cough and calm wheezing.
Supporting fluid syndrome
Main Manifestations: Coughing and shortness of breath, unable to lie down, profuse sputum with a white color, facial edema
Management Approach: Warm the lungs and resolve retained fluid, stop cough and relieve wheezing.
Overflowing Fluid Syndrome
Main Manifestations: Body pain, heavy limbs, and in severe cases edema, without sweating.
Management Approach: Promote sweating to release the exterior, and warm and transform fluid retention.
The above syndrome information is based on traditional Chinese medicine textbooks and clinical standards. Specific differentiation should be completed by a practicing traditional Chinese medicine physician in person.
Physician's Clinical Insights
In patients with phlegm-retained fluid disease, the phlegm is often frothy. I frequently use the texture and color of the phlegm as clues for pattern differentiation and treatment.
— Wang Zhengxiang Traditional Chinese Medicine Practitioner
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This page is for the popular science of traditional Chinese medicine knowledge and does not constitute medical advice. Specific diagnosis should be completed by a licensed traditional Chinese medicine practitioner in person.
This article has been reviewed by licensed TCM physicians at Hangzhou Kezhentang TCM Clinic. It is for TCM popular science reference only and does not involve specific treatment plan recommendations.
References: Internal Medicine of TCM (13th Five-Year Plan Textbook), Diagnostic and Therapeutic Effectiveness Standards for TCM Diseases and Syndromes (ZY/T001.1-94), Classification and Codes of TCM Diseases and Syndromes (GB/T 15657-2021)