Differentiation of Body Fluid Disorders
Body fluids (津液, jīnyè) refer to the normal fluids in the human body, which nourish the organs, lubricate the joints, and moisten the skin. Their generation and distribution are closely related to the functions of the spleen (脾, pí), lungs (肺, fèi), and kidneys (肾, shèn). Disorders of body fluids can generally be categorized into two main types: insufficient body fluids and accumulation of fluids.
1. Insufficient Body Fluids Syndrome
Insufficient body fluids, also known as fluid deficiency (津亏, jīnkūi) or fluid damage (津伤, jīnshāng), refers to a condition where there is a deficiency of body fluids, leading to dryness in the body or certain organs. This condition is classified as an internal dryness syndrome (内燥证, nèizàozhèng). The causes of insufficient body fluids can be attributed to both insufficient production and excessive loss; for instance, weakness of the spleen and stomach (脾胃虚弱, píwèixuǔruò) can lead to reduced generation of body fluids, or excessive dietary restrictions and certain diseases (such as esophageal obstruction or vomiting) can lead to long-term food intake reduction, resulting in a lack of resources for fluid generation. Additionally, excessive heat can damage fluids, leading to significant loss through sweating, vomiting, diarrhea, or excessive bowel movements, all of which can cause insufficient body fluids.
[Clinical Manifestations] Dry mouth and throat, chapped lips, dry and lifeless skin, scanty urination, dry and hard stools, red tongue with little moisture, and thin rapid pulse.
[Syndrome Analysis] The diagnosis of insufficient body fluids syndrome is based on the dryness of the skin, lips, tongue, and throat, as well as scanty urination and dry stools. The body’s internal organs and external skin rely on body fluids for nourishment. When body fluids are depleted, they cannot moisten the mouth and throat, leading to dryness; if they cannot nourish the skin, it becomes dry and lifeless; if they cannot generate urine or moisten the large intestine, urination becomes scanty and stools become dry. The deficiency of body fluids also leads to a reduction in blood generation, causing internal heat due to the deficiency of both body fluids and blood, hence the red tongue with little moisture and thin rapid pulse.
There are many pathogenic factors for this syndrome, and clinical differentiation and treatment should be based on the analysis of the primary disease to ensure targeted therapy.
2. Accumulation of Fluids
Any external pathogenic factors (六淫, liùyín) or internal emotional disturbances (七情, qīqíng) that affect the lung, spleen, or kidney’s ability to distribute and excrete body fluids can lead to fluid accumulation. This section focuses on edema (水肿, shuǐzhǒng) and phlegm-fluid (痰饮, tán yǐn).
(1) Edema: The accumulation of body fluids within the body, leading to swelling of the face, limbs, abdomen, or even the entire body, is referred to as edema. Clinical differentiation begins with distinguishing between Yang edema (阳水, yángshuǐ) and Yin edema (阴水, yīnshuǐ) to clarify the nature of the condition.
① Yang Edema: Edema characterized by a solid nature is called Yang edema. It is often caused by external wind pathogens or excessive dampness.
[Clinical Manifestations] Swelling of the face, typically starting from the eyelids and then spreading to the entire body, scanty urination, rapid onset, and the skin appears thin and shiny. Often accompanied by aversion to wind and cold, fever, heavy limbs, thin white tongue coating, and floating tight or rapid pulse. Alternatively, generalized edema may develop slowly, with a feeling of heaviness and fatigue in the limbs, scanty urination, abdominal fullness, and nausea. The tongue coating may be greasy, and the pulse may be deep.
[Syndrome Analysis] Yang edema is characterized by rapid onset and severity, with initial swelling of the eyelids and face being key diagnostic points. The lungs govern the distribution and excretion of fluids, and when they are affected by wind pathogens, the normal function is disrupted, leading to fluid accumulation and edema. The upper jiao (上焦, shàngjiāo) is primarily affected, causing swelling to first appear in the face, and if the distribution of fluids is obstructed, it can quickly spread throughout the body. The three jiaos (三焦, sān jiāo) may all be involved, leading to a rapid and widespread edema. Due to the wind pathogen, symptoms such as aversion to wind, cold, fever, and pain in the throat may also be present. If the edema is due to dampness, it may also fall under the category of Yang edema, gradually spreading throughout the body.
② Yin Edema: Edema characterized by a deficiency nature is called Yin edema, often caused by prolonged illness, deficiency of the body’s vital energy, or irregular sexual activity.
[Clinical Manifestations] Edema is more pronounced below the waist, with a pitting nature, scanty urination, abdominal fullness, poor appetite, pale complexion, fatigue, and a pale tongue with a white slippery coating, and a deep pulse. In severe cases, the edema may worsen, with difficulty urinating, coldness in the lower back and knees, cold limbs, aversion to cold, fatigue, pale complexion, and a pale, swollen tongue with a white slippery coating, and a deep, slow, weak pulse.
[Syndrome Analysis] Yin edema has a slow onset, with swelling beginning in the feet and being most pronounced below the waist. The spleen’s inability to transform and transport fluids, along with the kidney’s inability to separate clear from turbid, can lead to metabolic disorders of body fluids, resulting in Yin edema. The swelling starts from the feet and is particularly severe below the waist, with a pitting nature. The spleen’s deficiency leads to poor transformation of fluids, resulting in scanty urination. If the spleen and stomach are affected, there may be abdominal fullness and poor appetite. The spleen governs the muscles, and its deficiency leads to a pale complexion and fatigue. Yin edema is characterized by deficiency of vital energy, leading to a pale tongue and a deep pulse, indicating internal accumulation of cold fluids.
Prolonged spleen deficiency edema can damage kidney Yang, or kidney Yang deficiency can lead to poor fluid excretion, resulting in Yin edema. Edema due to kidney Yang deficiency is often more severe than that due to spleen deficiency, leading to worsening swelling. The kidney and bladder are interrelated; if kidney Yang is insufficient, bladder function is impaired, leading to difficulty urinating. Kidney Yang deficiency also fails to warm the lower back and knees, resulting in pain and coldness; it also fails to warm the limbs, leading to cold extremities and fatigue. A pale complexion indicates water retention due to Yang deficiency, while a grayish complexion indicates water overflow due to kidney deficiency. A pale, swollen tongue with a white slippery coating and a deep, slow, weak pulse are signs of kidney Yang deficiency and internal cold fluid accumulation.
(2) Phlegm-Fluid: Phlegm and fluids are often manifestations of disorders caused by dysfunction of the internal organs and metabolic disturbances of body fluids.
① Phlegm Syndrome: Phlegm syndrome refers to the condensation of body fluids, which become thick and accumulate in the organs, meridians, and tissues, leading to various disorders. This can be caused by external pathogenic factors or internal emotional disturbances that disrupt organ function.
[Clinical Manifestations] Coughing, wheezing, phlegm production, chest tightness; abdominal fullness, poor appetite, nausea, vomiting of phlegm, dizziness; confusion, delirium, phlegm rattling in the throat; numbness of limbs, hemiplegia, goiter, phlegm nodules, and a sensation of a foreign body in the throat. The tongue coating may be white greasy or yellow greasy, and the pulse may be slippery.
[Syndrome Analysis] Phlegm syndrome presents with a variety of clinical manifestations, leading to the saying that “all strange diseases belong to phlegm.” In differentiation, aside from recognizing the unique symptoms associated with different affected areas, the following manifestations can generally be used as diagnostic criteria: expectoration of phlegm or vomiting of phlegm, or phlegm rattling in the throat during confusion, or numbness of limbs, or the presence of phlegm nodules, with a greasy tongue coating and slippery pulse. Phlegm obstructs the lungs, leading to coughing, wheezing, and phlegm production; if phlegm obstructs the stomach, it leads to abdominal fullness and poor appetite; if stomach qi is reversed, it can cause nausea and vomiting. Due to phlegm obstructing the clear yang, dizziness may occur. Phlegm can also cloud the heart, leading to confusion and delirium, with phlegm turbidity being more common in delirium and phlegm heat being more common in mania. Phlegm obstructing the meridians can lead to numbness of limbs and hemiplegia; phlegm can also accumulate in the skin and muscles, forming lumps, commonly seen as goiter in the neck, phlegm nodules in the limbs, and breast lumps, as well as a sensation of a foreign body in the throat. The tongue coating is often greasy, with white greasy indicating phlegm dampness and yellow greasy indicating phlegm heat, while a slippery pulse indicates the presence of phlegm.
② Fluid Syndrome: Fluid syndrome refers to the presence of clear, thin fluids that stagnate between the organs and tissues. This is often caused by decline or obstruction of organ function.
[Clinical Manifestations] Coughing, wheezing, chest tightness, with clear, thin phlegm that is white and abundant, phlegm rattling in the throat, difficulty lying flat, and in severe cases, palpitations, lower limb edema, or abdominal fullness with a sloshing sound, vomiting clear fluids, and reduced appetite. There may also be chest and flank distension and pain, with cough and wheezing causing pain. The tongue coating may be white slippery, and the pulse may be wiry.
[Syndrome Analysis] This fluid syndrome primarily involves fluid stagnation in the lungs, stomach, and intestines. Other fluid syndromes can refer to the sections on “edema” and “organ differentiation.” Fluid stagnation in the lungs leads to coughing and wheezing; as fluids are considered a yin pathogen, they are thin and clear, leading to abundant white phlegm; if fluids obstruct the airways, lung qi cannot descend, leading to phlegm rattling in the throat and difficulty breathing. This syndrome often recurs and, if prolonged, can damage heart yang, leading to palpitations due to water and fluids overwhelming the heart; if spleen and stomach yang are deficient, lower limb edema may occur, and fluid stagnation in the stomach and intestines can lead to abdominal fullness. When water is in the stomach, a sloshing sound may be heard; when water is in the intestines, a gurgling sound may be heard. Due to internal fluid stagnation, the digestive function is impaired, leading to upward reversal of stomach qi, resulting in vomiting of clear fluids and reduced appetite. Fluid stagnation in the chest and flanks can lead to distension and pain. As fluids are a yin pathogen, the tongue coating is often white and slippery, while a wiry pulse is commonly seen in fluid-related conditions.
Yang Wenjie, Physician (Compiled) Email: [email protected]