Author: Ji Linghui
In the world of diseases, they can be categorized as either cold or hot; either deficiency or excess. In this issue, we will continue discussing “excess”. Excess refers to the presence of pathogenic factors, meaning that evil qi is retained. The syndromes caused by pathogenic excess are called excess syndromes. In Traditional Chinese Medicine (TCM), there are four types of excess syndromes: Qi stagnation, blood stasis, phlegm-damp, and accumulation. Below, I will discuss each one in detail.1 Qi Stagnation Qi is the most fundamental substance that constitutes and maintains human life activities. Qi is dynamic (energy) and constantly in motion, and can be divided into clear qi and turbid qi, with clear qi rising and turbid qi descending, following the natural order.
Qi stagnation refers to the retention of qi. The syndrome caused by the obstruction of qi flow is called qi stagnation syndrome.
Common manifestations of qi stagnation syndrome include distension and pain in the chest, flanks, epigastrium, and abdomen, with symptoms varying in intensity and location. The distension often fluctuates with emotional changes and may alleviate with belching or flatulence, with a pulse that is often wiry.
Qi stagnation syndrome is generally divided into three situations.
The first situation: Since qi exists in a dynamic form, when turbid qi accumulates in one place, it is similar to debris accumulating on the surface of a river, leading to variable locations of qi stagnation; when dispersed, it is lighter, and when gathered, it is heavier. The accumulation of turbid qi can lead to distension; when there is no flow, there is pain, as the retention of turbid qi can cause discomfort. Emotional changes can affect the speed of qi movement, so qi stagnation can fluctuate with emotions.
If turbid qi is retained in the upper part of the body and does not descend, this is referred to in TCM as qi counterflow, and the syndrome caused by qi counterflow is called qi counterflow syndrome.
The direct treatment for qi stagnation is to regulate qi;
The direct treatment for qi counterflow is to descend qi.
The total amount of qi in the human body is relatively constant; when there is more clear qi, there is less turbid qi, and vice versa. As mentioned above, the qi that can be retained in the body is all turbid qi, so qi stagnation is always accompanied by qi deficiency (i.e., insufficient clear qi).
When a patient exhibits symptoms primarily of qi stagnation, it is qi stagnation syndrome;
When a patient exhibits symptoms primarily of qi deficiency, it is qi deficiency syndrome.
This is why TCM practitioners must differentiate between deficiency and excess when they observe symptoms of “distension” in clinical practice.
If the patient resists palpation, it indicates excess, and the treatment should focus on regulating qi, typically using formulas like Xiao Yao Wan (Free and Easy Wanderer) or Mu Xiang Shun Qi Wan (Aucklandia and Amomum Pill);
If the patient prefers palpation, it indicates deficiency, and the treatment should focus on tonifying qi, typically using Bu Zhong Yi Qi Wan (Tonify the Middle and Augment the Qi).
The second situation: “Qi is the commander of blood, and blood is the mother of qi,” indicating that qi not only promotes and holds blood and body fluids but also must rely on blood and body fluids. When blood is insufficient, qi cannot flow smoothly, leading to a syndrome also called qi stagnation syndrome.
When qi stagnates, weak blood circulation can lead to blood stasis; abnormal distribution of body fluids can lead to the retention of phlegm-damp and water retention. When blood stasis and phlegm-damp water retention are severe, the treatment should focus on symptomatic relief, primarily activating blood and resolving stasis, and eliminating phlegm-damp and water retention; when blood stasis and phlegm-damp water retention are not very severe, the treatment should focus on addressing the root cause, primarily eliminating qi stagnation.
The third situation: When there is a blockage of pathogenic excess in the body, it can obstruct the flow of qi, leading to qi stagnation.
When qi stagnation is severe, the treatment should focus on symptomatic relief, primarily regulating qi;
When qi stagnation is not very severe, the treatment should focus on addressing the root cause, primarily eliminating pathogenic excess. 2 Blood Stasis Blood stasis refers to the obstruction of blood flow. The syndrome caused by the obstruction of blood flow is called blood stasis syndrome.
However, it is important to note that blood flow obstruction in blood vessels is blood stasis, and “extravasated blood” (blood that has left the vessels) also belongs to “blood flow obstruction” because blood can only flow smoothly within blood vessels; once it leaves the vessels, it becomes “stuck”.
Clinically, symptoms caused by blood stasis are diverse, but they mainly manifest as pain, lumps, bleeding, and stasis pulse signs. The characteristics of the pain include sharp, stabbing pain, tenderness in the painful area, fixed and immovable pain, and severe pain at night.
If lumps are present on the surface of the body, they may appear bluish-purple, while those inside the body may feel hard upon palpation and remain immovable;
The characteristics of bleeding include recurrent episodes, dark purple color, or mixed with blood clots;
The signs of stasis pulse mainly include a dark complexion, bluish-purple lips and nails, subcutaneous purpura or visible veins, a dark purple tongue, purple spots, or varicose veins under the tongue, with a pulse that is choppy or knotted.
Three points should be noted in the treatment of blood stasis.
1. What caused the blood stasis: if caused by cold, it needs to be warmed and dispelled; if caused by heat, it needs to clear heat and drain fire; if caused by qi deficiency or qi stagnation, it needs to tonify qi and regulate qi, etc.
2. What other syndromes are caused by blood stasis: if blood stasis leads to blood deficiency, it needs to tonify blood; if blood stasis leads to qi stagnation, it needs to regulate qi; if blood stasis leads to heat, it needs to disperse heat, etc.
3. What other concurrent syndromes are present: if there is deficiency, tonify; if there is excess, drain; if there is heat, clear; if there is cold, warm.
3 Phlegm-Damp and Water Retention
Abnormal body fluids in the human body can lead to phlegm-damp and water retention: thick phlegm is called phlegm, thin phlegm is called water retention, and the intermediate state is dampness. All three are pathological products formed due to metabolic disorders of body fluids.
The syndrome caused by phlegm-damp and water retention is called phlegm-damp and water retention syndrome.
Phlegm
There are two types of phlegm in the human body: one is the narrow definition of phlegm, which refers to the phlegm that we can see and feel being expelled from the throat; the other is the broad definition of phlegm, which refers to phlegm that exists in the body but is generally not visible.
The narrow definition of phlegm: if one feels phlegm in the throat or can cough it up, it indicates the presence of narrow definition phlegm.
The cold and heat characteristics of narrow definition phlegm: white and thin phlegm is cold; yellow and thick phlegm is heat. White phlegm with a thick consistency is caused by cold transforming into heat; yellow and thin phlegm is caused by old heat combined with new cold.
Treatment for narrow definition phlegm: under the principle of warming the cold and cooling the heat, it is also necessary to strengthen the spleen to resolve phlegm and promote lung function to expel phlegm. This is because the spleen is the source of phlegm production, and the lung is the organ that stores phlegm; thus, phlegm generation is due to spleen deficiency, and the inability to expel phlegm is due to lung deficiency.
Although diagnosing broad definition phlegm is more challenging, two points can be noted:
One is to use the method of exclusion. If deficiency syndromes, blood stasis, qi stagnation, accumulation, water retention, and dampness are ruled out, and narrow definition phlegm is also excluded, then the appearance of the syndrome is likely due to broad definition phlegm;
The second is to observe the tongue coating. A thick tongue coating, slippery pulse, and the absence of narrow definition phlegm or water and dampness indicate broad definition phlegm.
The cold and heat characteristics of broad definition phlegm are determined based on its manifestations (symptoms, tongue, pulse, and other signs). If the manifestations indicate heat, then broad definition phlegm is heat; if the manifestations indicate cold, then broad definition phlegm is cold.
The treatment for broad definition phlegm is similar to that for narrow definition phlegm, with the only difference being that there is no need to “tonify the lung and expel turbid” since narrow definition phlegm needs to be expelled externally, while broad definition phlegm needs to be “dissolved internally”.
Dampness
The sources of dampness in the human body are twofold: one is external, such as exposure to cold dampness or damp heat; the other is internal, which occurs when spleen deficiency leads to abnormal distribution of body fluids, resulting in stagnation and dampness.
Due to the characteristics of dampness being “heavy and turbid” and “sticky”, sometimes clinical treatment may alleviate the condition temporarily, but it cannot be cured for a long time. In such cases, one must consider the presence of dampness in the body, as dampness is sticky and difficult to eliminate.
In treatment, it is often necessary to utilize the downward tendency of dampness and use methods to promote urination and defecation to eliminate dampness. Of course, depending on the location and severity of dampness, other methods such as resolving dampness, drying dampness, and promoting dampness may be employed. If there is concurrent spleen deficiency, it is essential to strengthen the spleen and resolve dampness.
A yellow and greasy tongue coating is often associated with damp heat, requiring heat-clearing and dampness-draining; a white and greasy tongue coating is often associated with cold dampness, requiring warming and dispersing cold dampness. Water Retention
Water retention includes both edema and fluid retention.
Edema can be divided into two types: one is visible swelling and puffiness on the surface of the body, and the other is invisible but perceptible abdominal swelling, such as ascites caused by liver cirrhosis.
Fluid retention is classified into four types based on the location of retention: fluid retention in the gastrointestinal tract is called “phlegm fluid”; “phlegm fluid” can be heard as a sloshing sound in the abdomen, but the abdomen does not swell, which distinguishes it from edema; fluid retention under the ribs is called “suspended fluid”; fluid retention in the chest and lungs is called “pleural effusion”; fluid retention in the limbs is called “overflowing fluid”.
The treatment for water retention, under the principle of “cooling heat and warming cold”, must provide an outlet for the water retention evil, either by dispersing it through the skin or expelling it through urination. 4 Accumulation Accumulation refers to the piling up; stagnation refers to retention.
Accumulation, commonly seen in clinical practice, includes four types: food accumulation, parasitic accumulation, stones, and intestinal stagnation.
The syndrome caused by accumulation is called accumulation syndrome.
Nowadays, it is relatively easy to check for parasites and stones in the body, and there are many treatment methods available. For those that can be treated with medication, medication should be used; for those that cannot be treated with medication, surgery is also an option.
Diagnosing food accumulation and intestinal stagnation is also relatively straightforward, such as feeling a blockage in the stomach area, which worsens after eating, indicating food accumulation, commonly referred to as “indigestion”; discomfort in the abdomen with no bowel movement for several days indicates intestinal stagnation, commonly referred to as “constipation”. Treatment methods
For food accumulation, the primary treatment is to digest food and guide stagnation; for intestinal stagnation, the primary treatment is to unblock the intestines and relieve stagnation.
When treating food accumulation, it is beneficial to promote bowel movements in addition to digesting food, as this allows for better resolution of food accumulation due to the principle of “old cannot go, new cannot come” (the expulsion of material from the intestines makes room for new material from the stomach);
When treating intestinal stagnation, it is beneficial to add nourishing herbs to the treatment, as this allows for better expulsion of intestinal stagnation due to the principle of “water can carry a boat” (the stool in the intestines is like a “boat”, and the nourishing effect of the herbs is like “water”).
The above are the four common excess syndromes.
The author of this article is the author of “Learn TCM in Three Months”; this article is an original work specially commissioned for this publication.
Source: “Traditional Chinese Medicine Health and Wellness” magazine, March 2016 issue
New Media Editor: Xiao Xiong
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This content is an original work of “Traditional Chinese Medicine Health and Wellness” magazine. If reprinted, authorization must be obtained and the source must be indicated.
