Phlegm-retention syndrome is a disease resulting from general or local retention of body fluid, which is attributable to the dysfunctioning of the lungs, spleen and kidneys. It is conventionally classified into two main categories, i.e., "yin-syndrome" (fluid retention) and "tan-syndrome" (phlegm retention). "Yin" is the thin and clear fluid which is accumulated when its distribution, transportation and elimination are deranged. "Tan" is the thick and turbid fluid which is concentrated from the body fluids by heat evil.

YIN-SYNDROME (FLUID-RETENTION)

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

According to the location of fluid retention, it is classified into: (1) phlegm-retention in which the fluid is accumulated in the stomach and intestines; (2) fluid-retention appearing in the hypochondrium; (3) anasarca, referring to a generalized subcutaneous accumulation of fluid; and (4) fluid-retention occurring in the thorax and lungs.

B. Therapeutic principles "Yin" is a kind of yin evil which can be eliminated by yang-qi, so drugs of a warm nature are commonly applied. But "yin" is also a morphotic evil, and the therapeutic principles of diaphoresis and dispelling excessive fluid with potent purgatives should be employed.

Classification and Treatment

A. Phlegm-retention

(a) Deficiency of spleen-yang and kidney-yang

Manifestations: Distention of the chest, splashing sound over the abdomen, vomiting of thin fluid, thirst without desire for drinking, coldness of the back, dizziness, palpitations, shortness of breath, pale tongue with smooth or greasy coating and wiry and smooth pulse.

Therapeutic principles: Warm yang and promote diuresis.

Prescription: Decoction of Poria, Ramulus Cinnamomi, Atractylodis Macrocephalae and Glycyrrhizae

Poria 30 g
Ramulus Cinnamomi 10 g
Rhizoma Atractylodis Macrocephalae 12 g
Radix Glycyrrhizae 5 g

Remarks: Add Rhizoma Zingiberis Recens and Rhizoma Pinelliae for cases with severe, frequent vomiting. Add Polyporus Umbellatus and Rhizoma Alismatis for those with oliguria. Add Rhizoma Gastrodiae and Radix Angelicae Dahuricae for those with marked dizziness. Add the Bolus of Six Mild Drugs Adding Radix Aucklandiae and Amomi for those with abdominal distention and anorexia.

(b) Exhaustion of kidney-yang

Manifestations: Lower abdominal stiffness, dysuria or dyspnea aggravated by exercise, pale tongue with white smooth coating and deep and weak pulse.

Therapeutic principles: Nourish and support kidney-yang, promote diuresis and improve inspiration.

Prescription: The Modification of Zhenwu (god of controlling water) Decoction

Poria 30 g
Rhizoma Atractylodis Macrocephalae 15 g
Radix Paeoniae Alba 15 g
Rhizoma Zingiberis Recens 10 g
Fructus Psoraleae 10 g
Herba Epimedii 10 g

B. Fluid-retention in the hypochondrium

Manifestations: Pain over the chest and hypochondrium aggravated by coughing, fullness of the intercostal space, shortness of breath, thin greasy tongue coating and deep and wiry pulse.

Therapeutic principles: Expel excessive fluid.

Prescription: Decoction of Lepidii seu Descurainiae and Jujubae for Expelling Phlegm with Decoction of Fructus Trichosanthis and Zanthoxyli

Semen Lepidii seu Desurainiae 20 g
Fructus Trichosanthis 30 g
Ramulus Cinnamomi 10 g
Fructus Jujubae 6 pcs
Poria 20 g
Pericarpium Zanthoxyli 10 g

Remarks: Add Radix Bupleuri, Herba Menthae, Radix Peucedani and Radix Platycodi for cases in the early stage with superficies-syndrome, such as fever and chilliness. C. Anasarca Manifestations: General pain, heaviness and edema, dyspnea, cough with frothy sputum, pale tongue with white greasy coating and wiry and tense pulse.

Therapeutic principles: Eliminate fluids and expel superficial evils.

Prescription: The Modification of Small Blue Dragon Decoction

Herba Ephedrae 10 g
Ramulus Cinnamomi 10 g
Radix Paeoniae Alba 10 g
Herba Asari 3 g
Fructus Schisandrae 5 g
Rhizoma Zingiberis Recens 10 g
Rhizoma Zingiberis (dried) 6 g
Poria 20 g
Rhizoma Pinelliae 10 g

Remarks: Add Gypsum Fibrosum for cases with fever and restlessness. Add Fructus Perillae, Semen Armeniacae Anarum and Lumbricus for those with dyspnea. Increase the dosages of Ephedrae and Cinnamomi for cases with superficies-syndrome such as fever and chilliness. Add Radix Aconiti Lateralis Praeparata for those with palpitations and muscular twitching. Add Semen Persicae, Flor Carthami and Radix Angelicae Sinensis for those with blood-stasis syndrome.

TAN-SYNDROME (PHLEGM-RETENTION)

Phlegm-retention syndrome is developed on the basis of fluid-retention syndrome, in which the phlegm is formed by the action of heat or fire on the accumulated fluid, or the retention of dampness due to the dysfunction of the spleen.

A. Dampness-phlegm

Manifestations: Profuse expectoration of thin white and frothy sputum, pale tongue with white and moist or greasy coating and wiry and smooth pulse.

Therapeutic principles: Dry dampness and eliminate sputum.

Prescription: The Modification of Erchen Decoction

Rhizoma Pinelliae 10 g
Poria 20 g
Rhizoma Atractylodis 10 g
Pericarpium Citri Reticulatae 10 g
Radix Glycyrrhizae 5 g

Remarks: Add Radix Codonopsis Pilosulae and Rhizoma Atractylodis Macrocephalae for cases with fatigue, sallow complexion and feeble pulse. Add Fructus Perillae, Semen Armeniacae Amarum and Cortex Magnoliae Officinalis for those with cough and dyspnea.

B. Dryness-Phlegm

Manifestations: Difficult expectoration of small amount of thick sputum, dryness of mouth and lips, red dry tongue and wiry, thready and rapid pulse.

Therapeutic principles: Moisten dryness and eliminate sputum.

Prescription: The Decoction for Drying Phlegm

Radix Asparagi 10 g
Bulbus Fritillariae Cirrhosae 10 g
Fructus Trichosanthis 5 g
Radix Scutellariae 10 g
Exocarpium Citri Grandis 6 g
Folium Eriobotryae 15 g
Flos Inulae 10 g
Pumex 15 g

C. Wind-phlegm

Manifestations: Sudden onset of headache, dizziness and coma, lockjaw, laryngeal rales, rapid respiration, convulsions, thick, greasy tongue coating and smooth and wiry pulse.

Therapeutic principles: Expel wind and eliminate sputum.

Prescription: The Modified Decoction of Pinelliae, Atractylodis Macrocephalae and Gastrodiae

Rhizoma Pinelliae 10 g
Rhizoma Gastrodiae 10 g
Exocarpium Citri Grandis 10 g
Ramulus Uncariae cum Uncis 15 g
Bombyx Batryticatus 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Poria 15 g
Rhizoma Arisaema cum Bile 6 g
Scorpio 6 g

Remarks: Add Radix Salviae Miltiorrhizae, Radix Paeoniae Rubra and Flor Carthami for cases with cyanotic face and lips due to blood stasis. Add Rhizoma Coptidis, Radix et Rhizoma Rhei and Fructus Trichosanthis for those with constipation, vomiting and halitosis.

B. Cold-phlegm

Manifestations: Expectoration of thin white sputum, aversion to cold, coldness of extremities, loss of appetite, loose stool, pale tongue with white smooth coating and deep, slow and weak pulse.

Therapeutic principles: Warm middle jiao and eliminate sputum.

Prescription: Bolus for Regulating the Middle Jiao and Dissolving Phlegm

Radix Codonopsis Pilosulae 12 g
Rhizoma Atractylodis Macrocephalae 15 g
Rhizoma Zingiberis (dried) 10 g
Poria 15 g
Ramulus Cinnamomi 10 g
Rhizoma Pinelliae 10 g
Radix Glycyrrhizae 5 g

E. Heat-phlegm

Manifestations: Cough with thick yellow sputum, dyspnea, feverish sensation with restlessness or palpitations, insomnia, delirium, yellow, greasy tongue coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat, eliminate sputum and tranquilize the mind.

Prescription: Bolus for Clearing Qi and Eliminating Sputum

Radix Scutellariae 10 g
Rhizoma Arisaema cum Bile 10 g
Pericarpium Citri Reticulatae 10 g
Fructus Aurantii Immaturus 10 g
Fructus Trichosanthis 15 g
Rhizoma Pinelliae 10 g
Poria 15 g
Radix Polygalae 10 g
Semen Armeniacae Amarum 10 g

Remarks: Add Fructus Gardeniae and Caulis Bambusae in Taeniam for cases with restlessness, nausea and vomiting. Add Semen Ziziphi Spinosae and Cortex Albizziae for those with palpitations and insomnia. Add Pill of Lapis Micae Aurens Usta for Expelling Phlegm for those with delirium due to upward disturbance of phlegm-fire.

Copyright 1995 Hopkins Technology