Firstly, there is the syndrome of insufficient body fluids, also known as jin kui (jin deficiency) or jin shang (jin injury). It is characterized by symptoms of “dryness.” Symptoms include dry mouth and throat, cracked lips, dry and lifeless skin, hard stools, scanty urination, a red tongue with little moisture, and a thin, rapid pulse. The diagnostic basis includes dryness of the skin, lips, and throat, as well as scanty urination and hard stools. Insufficient body fluids cannot nourish, leading to dry mouth and throat, and cracked lips. If the exterior cannot be moistened, the skin becomes dry and withered; if the lower body cannot transform and moisten the large intestine, it results in scanty urination and hard stools. A red tongue with little moisture and a thin, rapid pulse are signs of insufficient body fluids.
Secondly, there is the syndrome of fluid accumulation, which can be divided into two main categories:
1. Edema: yang shui (yang edema) presents as swelling of the head and face, starting from the eyelids and then spreading throughout the body, with scanty urination, a rapid onset, and thin, shiny skin. If caused by an external pathogen, it is often accompanied by aversion to wind, cold, fever, and heavy aching joints, with a thin white coating on the tongue and a floating, tight pulse; if caused by dampness, the onset is slower, with generalized edema, pitting on pressure, heavy limbs, scanty urination, a feeling of fullness in the abdomen, poor appetite, nausea, a white greasy tongue coating, and a submerged pulse.
For yin shui (yin edema), the swelling is more pronounced below the waist, with pitting on pressure and scanty urination, poor appetite, loose stools, a pale complexion, fatigue, a pale tongue with a white, slippery coating, and a submerged pulse; or the edema may worsen daily, with difficulty urinating, soreness and coldness in the lower back and knees, cold limbs, aversion to cold, fatigue, a pale or grayish complexion, a pale tongue with a swollen body and a white, slippery coating, and a submerged, slow, weak pulse.
Yang edema is characterized by a rapid onset, with the head and face swelling first, particularly the eyelids, which is a key diagnostic point. When an external pathogen is involved, the lung’s defensive qi is affected, leading to abnormal dissemination and downward movement, resulting in fluid accumulation that overflows into the skin, creating a condition of wind-water. The lung is located in the upper jiao, and when its function is obstructed, fluid stagnates, causing edema to first appear in the head and face. The triple burner is not functioning properly, and the bladder’s qi transformation is impaired, leading to scanty urination. Therefore, the rapid onset and shiny skin are observed. If caused by wind, symptoms include aversion to wind, cold, fever, and heavy aching joints, as well as sore throat. The presence of wind-water indicates a real condition, with a thin white coating and a floating, tight pulse indicating cold wind-water, while a red tongue and a floating, rapid pulse indicate heat. If the yang edema is due to dampness, it indicates that the spleen is constrained, leading to impaired transformation and transportation, resulting in generalized edema with a slower onset. Dampness obstructs the spleen, causing heaviness and fatigue in the limbs; if the bladder’s qi transformation is impaired, it leads to scanty urination; if the spleen and stomach are affected, it results in fullness and poor appetite; if stomach qi rebels, it leads to nausea and vomiting. A white greasy tongue coating and a submerged pulse indicate internal excess of water and dampness.
2. Phlegm-fluid: This can be divided into phlegm syndrome and fluid syndrome.
The phlegm syndrome manifests as cough, wheezing, expectoration of phlegm, chest tightness, abdominal discomfort, poor appetite, nausea, vomiting of phlegm and saliva, dizziness, and vertigo; there may be a rattling sound in the throat, and in severe cases, confusion or delirium; numbness of the limbs, hemiplegia, scrofula, and phlegm nodules in the breast, as well as 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.
The fluid syndrome presents with cough, wheezing, chest tightness, clear, thin, white phlegm in large amounts, a rattling sound in the throat, and difficulty lying flat. In severe cases, there may be palpitations, lower limb edema, abdominal fullness, a sloshing sound in the stomach, and poor appetite; or there may be chest and hypochondriac distension and pain, with cough and wheezing causing pain, a white slippery tongue coating, and a wiry pulse.
Phlegm-fluid manifests in various forms, as “all strange diseases belong to phlegm.” Clinically, there are distinctions between wind-phlegm, heat-phlegm, cold-phlegm, damp-phlegm, and dry-phlegm. When phlegm obstructs the lungs, normal dissemination is impaired, leading to cough and wheezing; if qi is obstructed by phlegm, it results in chest tightness and discomfort. If phlegm stagnates in the stomach, it leads to abdominal fullness and poor appetite; if stomach qi rebels, it causes nausea and vomiting of phlegm and saliva; if phlegm obstructs the clear yang, it results in dizziness and vertigo. If phlegm confuses the heart orifices, it leads to confusion or delirium; if phlegm follows qi reversal, it causes a rattling sound in the throat. Phlegm obstructs the meridians, leading to limb numbness and even hemiplegia; phlegm can form lumps under the skin and muscles; it can be seen as scrofula in the neck, phlegm nodules in the limbs, and breast lumps; it can also cause a sensation of a plum pit in the throat. A greasy tongue coating often indicates phlegm, with white greasy indicating damp phlegm, yellow greasy indicating heat phlegm, and a slippery pulse indicating phlegm.
The fluid syndrome often accumulates in the lungs, gastrointestinal tract, and chest and hypochondriac regions, with distinctions between phlegm-fluid, suspended fluid, overflowing fluid, and supporting fluid. When fluid accumulates in the lungs, it causes cough and wheezing; as fluid is a yin pathogen, it is thin and light, leading to clear, thin, white phlegm in large amounts; fluid obstructs qi and does not descend, causing a rattling sound in the throat and difficulty breathing while lying flat. This condition often recurs, and prolonged illness can damage the heart yang, leading to palpitations due to fluid encroaching on the heart; if yin deficiency leads to water and dampness descending, it results in lower limb edema; if fluid accumulates in the gastrointestinal tract, it causes abdominal fullness and a sloshing sound in the stomach; if fluid is in the intestines, it leads to a sloshing sound between the intestines. If water and fluid stagnate internally, stomach qi rebels, leading to vomiting of clear water; if fluid accumulates in the chest and hypochondriac regions, it obstructs qi, causing chest and hypochondriac distension and discomfort; if fluid obstructs the lungs, it leads to cough and wheezing, often accompanied by a pulling pain. As fluid is a yin pathogen, the tongue coating is white and slippery; a wiry pulse is commonly seen in fluid conditions.