Search in dictionary
Fluids pattern identification
津液辨证 〔津液辨證〕 jīn yè biàn zhèng
The process of diagnosing a morbid condition as a disease pattern of the fluids.
Pathology
Pathologies of the fluids relate to the production, distribution, and excretion of fluids, and hence to the lung, spleen, stomach, and kidney. They can take the form of insufficiency of fluids or gathering of water-damp.
Fluid Depletion
Internally, the fluids moisten and nourish the bowels and viscera; externally, they moisten and nourish the orifices and the skin and body hair. Fluid depletion therefore has broad-ranging consequences.
Liquid is clear, thin, and runny. In the inner body, it provides the fluid of the blood and moistens the bowels and viscera. In the outer body, it moistens the skin and body hair and the orifices. Liquid is easily damaged and replenished, and hence damage to liquid
is a mild, easily treatable condition.
Humor is the thicker, more viscous kind of fluid that moistens and nourishes the viscera, the marrow, and the brain, and lubricates the joints. It is less easily lost than liquid but also less easily replenished. Humor desertion,
also called damage to yīn,
is therefore more serious than damage to liquid.
Fluid depletion is most commonly due to damage to liquid and humor by the exuberant heat, profuse sweating, vomiting, or diarrhea. It may also be due to decreased production of fluids.
Fluid Accumulation
Fluid accumulation occurs when either the distribution or excretion of fluid is impaired and unwanted fluids, referred to as water-damp,
gather internally as a result of spleen, lung, or kidney vacuity or depressed liver qì. It can gather in different places, taking the form either of water swelling or phlegm-rheum. Accumulation of fluids mostly takes the form of repletion patterns but also includes vacuity patterns (notably yīn water).
Gathering of water-damp: Water-damp is unwanted fluid in the body. It gathers when either the distribution or the excretion of fluids is impaired. The spleen, lung, and kidney are the main viscera responsible for the distribution and excretion of fluids. The liver’s free coursing action also plays a role in fluid distribution.
Water-damp can develop in external contractions or miscellaneous internal damage diseases. It can gather in different places, developing into either water swelling or phlegm-rheum.
Impaired distribution: The distribution of fluids is jointly handled by the diffusion and depurative downbearing of the lung, the movement and transformation of the spleen (the spleen disperses essence), and the free coursing of the liver. When these actions fail, water-damp collects and forms into phlegm-rheum.
Impaired excretion: Fluids leave the body in the form of sweat, urine, and stool. If sweating and urination decrease, water collects in the form of water swelling. Sweating and urination are closely related to lung qì’s diffusing action and the kidney’s qì transformation action respectively.
- Lung qì’s diffusion action carries defense qì to the exterior, where it controls the opening and closing of the interstices, regulating the amount of sweat that leaves the body. Although sweat is said to be the humor of the heart, pathological sweating is often more closely related to the lung.
- By its qì transformation action, the kidney steams the fluids, returns the clear part into circulation, and drains the turbid part off to the bladder to be discharged from the body.
The action of heat on the fluids: Heat boils
the fluids and water-damp, turning them into phlegm.
Fluid-Related Diseases
Phlegm-Rheum
Epilepsy (癫痫 diān xián): A disease marked by brief episodes (seizures) in which there are spasms and temporary loss of spirit.
- Mild cases: Temporary loss of spirit, white complexion, and fixity of the eyes.
- Severe cases: Sudden clouding collapse, foaming at the mouth, upward-staring eyes, clenched jaw, convulsion of the limbs, and even squealing like a goat or pig.
The convulsions are explained by internal wind, while the loss of consciousness is explained by the wind carrying phlegm upward to cloud the heart spirit. The term fright epilepsy, which is commonly seen in traditional literature, refers to epileptic fits triggered by fright or emotional shock.
Phlegm node (痰核 tán hé): A lump below the skin that feels soft and slippery under the finger is associated with no redness, pain, or swellingand does not suppurate. It is caused by damp phlegm binding under the skin.
Yīn flat-abscess (阴疽 yīn jū): A deep malign suppuration of the flesh, sinew, and even the bone, attributed to toxic evil obstructing qì and the blood and causing putrefaction. It largely corresponds to
Water Swelling
Water swelling (水肿 shuǐ zhǒng): Water swelling, often loosely referred to in English texts as edema,
is the disease name for conditions manifesting in puffy swelling.
It includes various forms, which will be discussed below.
Drum distension (鼓胀, 臌胀 gǔ zhàng): Severe abdominal distension, often associated with a somber-yellow coloration of the skin, and prominent green-blue veins (The Origin and Indicators of Disease
), now understood as blood fluke infestation). Drum distension can manifest in dampness, damp-heat, qì stagnation, spleen vacuity, or kidney vacuity. Severe forms forming repletion patterns are often treated with drastic water-expelling medicinals.
Fluids Patterns
Simple Patterns
Damage to liquid (伤津 shāng jīn): Dry lips, pharynx, and skin, thirst with a liking for drinks, short voidings of scant urine. It results from dryness and heat evil; fire forming as a result of excesses among the seven affects; heat effusion, burns, copious sweating, vomiting, diarrhea, or loss of blood; excessive use of acrid dry medicinals.
Humor desertion (液脱 yè tuō): Similar to damage to liquid but more severe. The signs are sunken eyes, emaciation, loose inelastic skin, dry eyes, scant or no urine, listlessness of essence-spirit or vexation and agitation, dry lusterless facial complexion. It results from the same factors as damage to liquid.
Phlegm patterns (痰证 tán zhèng): A slimy tongue fur and a slippery pulse, and in the case of tangible phlegm, expectoration of phlegm. Phlegm results from (a) the spleen’s failure to cope with water-damp, allowing it to accumulate and concentrate into phlegm; (b) disturbance of the lung’s governing of the waterways; (c) heat boiling
the fluids so that they bind into phlegm; (d) depressed liver qì hampering fluid metabolism.
Water swelling (水肿 shuǐ zhǒng): Diffuse swelling of the face and eyes, limbs, or the whole body, resulting from insufficiency of kidney, spleen, and lung functions or from externally contracted evils obstructing lung qì. Yīn water is swelling of lower limbs and face and eyes first. Yáng water is swelling of upper limbs and face and eyes first.
Combined Patterns
Liquid collecting and obstructing qì (津停气阻 jīn tíng qì zǔ): Accumulation of liquid causing obstruction of qì or obstruction of qì preventing water-rheum from being removed. When phlegm-rheum obstructs the lung, the signs are fullness in the chest, copious phlegm, and rapid panting that prevents the patient from lying down. When water-damp collects in the center burner, affecting the upbearing and downbearing of spleen and stomach qì, there may be distension and fullness in the abdomen and stomach duct, belching, and reduced eating. When water-rheum spills out to the four limbs, the signs are cumbersome heavy swollen limbs.
Blood stasis causing liquid to collect (血瘀津停 xuè yū shuǐ tíng): Also called blood stasis causing water to collect
(血瘀水停 xuè yū shuǐ tíng). Blood stasis causing obstruction of qì dynamic, which in turn hampers the movement of fluids, or water-rheum causing obstruction of qì dynamic, which in turn hampers the movement of blood. The resulting condition manifests in blood stasis signs on the one hand and phlegm-rheum or water swelling on the other.
Qì deserting with liquid (气随津脱 qì suí jīn tuō): Sudden or gradual loss of liquid giving rise to qì desertion. This often occurs as a result of profuse sweating in febrile conditions or from severe vomiting or diarrhea. The signs are sweating, vomiting, or diarrhea followed by the sudden appearance of somber-white complexion, great dripping sweating, reversal cold of the limbs, faint breathing, unresponsive spirit-affect, and a faint pulse on the verge of expiration.
Liquid depletion and blood dryness (津亏血燥 jī kuī xuè zào): Also called dual damage to liquid and blood
(津血两伤 jīn xuè liǎng shāng). Severe insufficiency of liquid affecting the blood and causing blood dryness and vacuity heat. It often occurs after high fever, vomiting, diarrhea, and great sweating. The signs are dry throat and mouth; thirst with desire to drink; parched and possibly cracked lips; short voidings of scant urine; dry stool; heart vexation; vexing heat in the five hearts; emaciation; dry skin with itching in severe cases; a red tongue with little liquid; and a pulse that is fine and rapid.