Phlegm and Fluid Retention

Phlegm and Fluid Retention

The condition of phlegm and fluid retention has already been discussed in detail under the sections on hemoptysis, hematemesis, and cough. Given that all patients with blood loss invariably have concurrent phlegm and fluid retention, we will elaborate further on this topic without hesitation.

Phlegm and fluid retention refer to the accumulation of water within the body. Water consumed through diet enters the body via the mouth and is excreted through the bladder, while lung qi disperses it, spleen qi facilitates its absorption, and kidney qi transforms and vaporizes it, ensuring that it is drained away rather than retained. If this water is not retained, there is no pathogenic factor of fluid retention. Body fluids originate in the kidneys, reside in the cell compartments, ascend with qi, and spread throughout the lung meridians, forming what is known as body fluids. When body fluids disperse, they do not condense but instead form phlegm.

When the upper jiao suffers from blood deficiency and excessive fire, the body fluids are refined and condensed into phlegm. This causes the lungs to become dry, leading to coughing, fever, and thick, sticky phlegm that obstructs the airways. This occurs because blood deficiency prevents the heart from being nourished, resulting in excessive heart fire that suppresses the lung metal element, preventing the dispersion of body fluids and causing them to condense into phlegm. In such cases, Huotan Pills are used for treatment, and Erchen Decoction with Huanglian, Huangqin, Chaihu, and Gualou Shuang can also be effective. Additionally, Yuniujian with Fuling, Baiqian, Xuanfuhua, or Baohe Wan can be employed to nourish the lungs. The stomach is a dry earth, and when dryness becomes severe, body fluids condense into phlegm, which is primarily treated with Zhi Mi Fuling Wan; for stubborn phlegm that obstructs the airways, Gun Tan Wan is used.

When phlegm adheres to the throat and causes a sensation of obstruction, it is referred to as "plum pit syndrome." Zhang Zhongjing used Qiqi Tang to regulate qi and eliminate phlegm. Patients with blood disorders often experience this condition alongside stagnant fire, so Zhi Mi Fuling Wan combined with Gancao, Jiegeng, Zisu, Xiangfu, Xuanfuhua, Bohe, Shegan, Gualou Shuang, and Niubang is recommended. According to the theory of the Shaoyin meridian, the throat is surrounded by the Shaoyin meridian, and when heart fire is excessively strong, phlegm tends to accumulate and manifest as plum pit syndrome. Therefore, Ganjutang with Shegan, Shan Zhi Zi, Fushen, Lianqiao, and Bohe is advised, along with half a piece of Banxia cut into slices, boiled three times in vinegar, then mixed with a small amount of musk before taking the decoction. Furthermore, the Chong meridian also runs through the throat; if chong qi rises abnormally and accumulates in the throat, causing plum pit syndrome, symptoms such as flushed cheeks and shortness of breath may appear. If it is determined that water and fluid are rising, Guiling Gancao Wuwei Tang is used for treatment; if it is determined that phlegm and fire are rising, Zhu Ling Tang combined with Meifen, Gualou Shuang, and Xuanfuhua is recommended.

Phlegm is formed when body fluids condense, and the original source of body fluids is the kidneys. When the lower jiao suffers from blood deficiency and excessive heat, body fluids fail to rise, and fire boils into phlegm. In such cases, Zhu Ling Tang and Dihuang Tang combined with Chuanbei, Wuwei Zi, Maidong, Xuanfuhua, Kuandonghua, Haigefen, Niuxi, Baiqian, Longgu, Muli, Huangbo, and Zhimu are prescribed.

Fluid retention is caused by the stagnation of water, and the bladder bears responsibility for this. If the water in the bladder rises due to cold, causing rumbling sounds in the chest and abdomen, as well as gurgling in the throat and coughing or wheezing, this indicates that the earth is unable to manage the water, leading to exhaustion of the lungs. In such cases, Erchen Decoction is used for treatment, along with Liu Junzi Tang, Zhenwu Tang, and Xiao Qinglong Tang.

For patients with blood loss, due to yin deficiency and yang excess, few develop cold-type fluid retention, even if they cough or spit out saliva. If the pulse is slippery and rapid, and the person feels restless and hot, it indicates that fire is dominant and water is overflowing, with fire reversing the flow of water. Therefore, the treatment focuses on clearing fire and draining water simultaneously, using Tingli Dazao Xiefei Tang, Xiaohua Wan, and Erchen Decoction with Qin, Lian, Chaihu, and Baiqian roots. Refer to the sections on cough for more details.

[Commentary] Most cases of blood-related phlegm and fluid retention are caused by excessive fire and phlegm accumulation, leading to symptoms such as coughing, fever, and thick, sticky phlegm. Treatment options include Huotan Pills, Erchen Decoction with Qin and Lian, as well as Yuniujian, Zhi Mi Fuling Wan, and Gun Tan Wan with adjustments. When phlegm adheres to the throat and causes obstruction, it is called "plum pit syndrome," and the author advocates using Zhi Mi Fuling Wan with Gancao, Jiegeng, Zisu, Xiangfu, and Xuanfuhua, or alternatively, Ganjutang with Shegan, Shan Zhi Zi, Fushen, Lianqiao, and Bohe for treatment. A large slice of Banxia, boiled three times in vinegar, then mixed with a small amount of musk before taking the decoction, proves particularly effective. Additionally, for cases of excessive fire and insufficient water, as well as lower jiao blood deficiency, Dihuang Tang combined with Chuanbei, Wuwei Zi, Maidong, and other herbs is recommended. Traditionally, plum pit syndrome is treated with Banxia Houpu Tang or Siqi Tang, but this article offers a slightly different approach to treating this condition, demonstrating a degree of creativity and providing valuable insights for reference.