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Syndrome differentiation of fluid disorder

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Updated: Tuesday, Sep 01,2009, 12:54:01 PM
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The disorders of body fluid mainly include deficiency of body fluid as well as retention of phlegm and fluid and edema. The former is caused by insufficiency of the production of body fluid or excessive loss of body fluid, the latter is caused by dysfunction of the viscera and disturbance of the distribution and excaretion of body fluid which leads to the retention and accumulation of fluid.

Insufficiency of body fluid

Insufficiency of body fluid refers to syndrome due to deficiency of body fluid which fails to nourish and moisten viscera, tissues and organs. This syndrome is mainly caused by excessive consumption of body fluid due to high fever, profuse sweating, excessive vomiting, excessive diarrhea and profuse urine or consumption of fluid by dryness and heat; or by insufficiency of body fluid due to scanty drinking of water and decline of visceral qi.

Clinical manifestations: Dry mouth and throat, dry or fissured lips, sunken orbit, dry skin, thirst with desire for water, scanty urine, retention of dry feces, dry tongue with scanty saliva and thin and astringent pulse.
 
Analysis of symptoms: Dry mouth, lips, tongue, throat and skin as well as sunken orbit and thirst with desire for water are due to failure of deficient body fluid to nourish and moisten the viscera and body; scanty urine is due to deficiency of body fluid to transform urine; retention of dry feces is due to scanty body fluid to lubricate the large intestine; scanty saliva is due to deficiency of body fluid to moisten the tongue; thin and fast pulse is due to insufficiency of qi and blood.

Key points for syndrome differentiation: Dry mouth, lips, tongue, throat and skin as well as scanty urine and dry stool.

Phlegm syndrome

Phlegm syndrome refers to syndrome due to local retention of phlegm or migration of phlegm. Phlegm is produced by such factors like six exogenous pathogenic factors, emotional impairment, improper food, overstrain and lack of necessary physical activities which affect the transforming functions of the lung, spleen and kidney, leading to stoppage of fluid distribution and production of phlegm. The retention of phlegm in viscera, meridians and tissues results in phlegm syndrome.

Clinical manifestations: Cough with sticky sputum, chest oppression, or dizziness, or epigastric mass, anorexia, nausea, vomiting, or coma with sputum rale, or mental derangement with mania, dementia and epilepsy, or numbness of limbs, hemiplegia, or scrofula, goiter, breast nodules, phlegm nodules, greasy fur and slippery pulse.

Analysis of symptoms: Phlegm is marked by variability in causing disease. So there is a saying that "all diseases are caused by phlegm". Chest oppression and cough with sticky sputum are due to retention of phlegm in the lung which affects the lung to disperse and descend; dizziness is due to phlegm invading the head and preventing lucid yang from rising; epigastric mass, anorexia, vomiting and nausea are due to retention of phlegm in the middle energizer that prevents the spleen from transforming and the stomach from descending; coma with sputum rale or mental derangement with mania, dementia and epilepsy are due to phlegm confusing the mind; numbness of limbs, or hemiplegia is due to retention of phlegm in the meridians and inhibited flow of qi and blood; scrofula, goiter, breast nodules and phlegm nodules are due to retention of phlegm in the skin and muscles; greasy fur and slippery pulse are signs of internal exuberance of phlegmatic dampness.

Key points for syndrome differentiation: This syndrome is marked by vomiting of sputum or dizziness, vomiting, or coma with sputum rale, or numbness of limbs, or phlegm nodules, greasy fur and slippery pulse. Phlegm syndrome may be divided into cold phlegm, heat syndrome, damp phlegm, dry phlegm and stagnant phlegm according to the nature of phlegm and the complication which should be carefully differentiated.

Fluid-retention syndrome

Fluid-retention syndrome refers to syndrome caused  by retention of fluid in the viscera and tissues, usually caused by stoppage of fluid and retention of fluid resulting from six exogenous pathogenic factors, or overstrain and weakness.
 
Clinical manifestations: Epigastric and abdominal fullness and distension, borborygmus, vomiting of clear fluid; or cough and asthma, profuse thin sputum, chest oppression and palpitation, even inability to lie flat on bed; or thoracic and hypochondriac fullness, distending pain, aggravation of pain after cough, spitting or rotating the body; or dizziness, dysuria, dropsy and aching  heaviness of the limbs; whitish slippery fur and taut pulse.
 
Analysis of symptoms: The symptoms are various due to different location of fluid-retention. In his Synopsis of Golden Chamber, Zhang Zhongjing divided fluid-retention syndrome into phlegmatic fluid-retention (in a narrow sense), suspended fluid-retention, sustained fluid-retention and extravasating fluid-retention. Phlegmatic fluid-retention is marked by epigastric and abdominal distension, borborygmus and vomiting of clear fluid due to retention of fluid in the stomach and intestines, inactivation of gastrosplenic yang and dysfunction of transportation and transformation; suspended fluid-retention is marked by chest and hypochondrium fullness, distending pain, aggravation of pain after cough, spitting or rotating the body due to retention of fluid in the chest and hypochondrium; sustained fluid-retention is marked by cough and asthma, profuse thin sputum, chest oppression and palpitation, even inability to lie flat on bed due to retention of fluid in the lung and fluid-retention invading the heart; extravasating fluid-retention is marked by dizziness, dysuria, dropsy and aching heaviness of the limbs due to retention of fluid in the muscles of the four limbs; whitish slippery tongue and taut pulse are signs of fluid-retention.

Key points for syndrome differentiation: Phlegmatic fluid-retention is marked by epigastric and abdominal fullness and distension as well as borborygmus; suspended fluid-retention is marked by thoracic and hypochondriac fullness, distending pain, aggravation of pain due to spitting, cough or rotation of the body; sustained fluid-retention is marked by cough and asthma, profuse and thin sputum, chest oppression and palpitation; extravasating fluid-retention is marked by dropsy of limbs and dysuria.

 

 Edema

Edema refers to dropsy of eyelid, face, four limbs, chest and abdomen or even the whole body due to accumulation of fluid in the muscles resulting from disturbance of the lung, spleen and kidney in distributing and excreting fluid. Clinically, edema is divided into yang edema and yin edema.
 
Yang edema

Yang edema, of sthenia in nature, is marked by swelling above the waist and short duration due to exogenous pathogenic wind or spreading of fluid and dampness.

Clinical manifestations: Dropsy of face and eyelids, eventually involving the whole body with rapid development, smooth and bright skin, scanty urine, accompanied by fever, aversion to wind and cold, aching pain of limbs, sore-throat, thin fur and floating pulse; or dropsy of the whole body with slow development, depression under pressure, heaviness of the limbs, epigastric and abdominal  fullness and oppression, poor appetite, nausea and regurgitation, whitish greasy tongue fur as well as soft and slow pulse.

Analysis of symptoms: Dysuria and sudden dropsy are due to disorder of fluid distribution and spreading of fluid in the muscles resulting from dysfunction of the lung to disperse and regulate caused by wind attacks dropsy of head and eyelids with the involvement of the whole body due to the fact that wind tends to float upwards and change and that wind comes into combination with fluid; fever, aversion to wind and cold, aching pain of limbs, sore-throat, thin fur and floating pulse are due to pathogenic wind invading the lung and failure of the lung to disperse; general edema and heaviness of limbs are due to encumbrance of the spleen by fluid and dampness which leads to failure of yangqi to rise, dysfunction of transformation and extravasation of fluids dysuria or scanty urine is due to internal accumulation of fluid and dampness, dysfunction of the triple energizer to  control fluid and  disturbance of the bladder to transform qi; epigastric and abdominal fullness and oppression, poor appetite, regurgitation and nausea are due to encumbrance of the spleen and stomach by dampness which affects ascent and descent.
 
Key points for syndrome differentiation: This syndrome is marked by rapid onset and development of edema primarily involving the eyelids, face and head as well as severe edema of the upper part of the body.

Yin edema

Yin edema is marked by asthenia of spleen and kidney qi, severe edema of the part below the waist and long duration, usually caused by asthenia of the healthy qi due to prolonged illness, internal impairment due to overstrain and consumption of spleen and kidney yang.

Clinical manifestations: Repeated relapse of edema, severity below the waist, depression under pressure, epigastric and abdominal distension and oppression, poor appetite and loose stool, dispiritedness, fatigue of limbs, cold body and limbs, preference for warmth, or aching cold sensation of loins and knees, scanty urine, dull or pale complexion, pale and bulgy tongue with white and slippery fur as well as sunken, slow and weak pulse.

Analysis of symptoms: Edema and scanty urine are due to spreading of fluid and dampness resulting from failure of the asthenic spleen yang to warm and transport and failure of asthenic kidney yang to transform qi; repeated relapse of edema, severity below the waist and depression under pressure are due to asthenia of spleen and kidney yang, accumulation of fluid and dampness, downward migration of dampness as well as heavy and sticky nature of dampness; cold body and limbs, aching cold sensation of loins and knees, dull or pale complexion, dispiritedness and fatigue of limbs are due to asthenia of spleen and kidney yang and decline of mingmen fire to warm and nourish the  body;  epigastric and abdominal distension and oppression, poor appetite and loose stool are due to asthenia of spleen yang and inability to transport and transform; pale and bulgy tongue, white and slippery fur as well as sunken, slow and weak pulse are signs of yang asthenia and internal exuberance of dampness.

Key points for syndrome differentiation: Repeated relapse of edema, long duration, severity below the waist, accompanied by asthenia of spleen and kidney yang.


Tags: disorder Fluid

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