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Like qi and blood, the pathological changes of fluid-humor can be generalized into two major types: deficiency and excess. The excess patterns include phlegm, fluid retention and water retention, because fluid metabolism disorder can result in the formation of phlegm, fluid retention and water retention.

Deficiency Patterns
虚证类

Deficiency patterns of fluid-humor disorder mainly include fluid-humor deficiency pattern and humor collapse pattern.

Fluid-humor deficiency pattern arises when body fluids are in deficiency and fail to nourish and moisten the body. This condition is marked by dry mouth and throat, parched or cracked lips, thirst with desire for drink, oliguria, constipation, reddened tongue lacking moisture, and rapid fine weak pulse.

Humor collapse pattern is a severe case of fluid deficiency pattern. It is marked by parched or cracked lips, withered skin, sunken eyes, tinnitus, oliguria and dry fecal binding, and reddened tongue with no moisture and fine weak pulse.

Excess Patterns
实证类

Excess patterns of fluid-humor disorder include phlegm pattern*, fluid retention pattern* and water retention pattern*.

Phlegm pattern is a general term for a group of patterns marked by cough, dyspnea with profuse expectoration, or by nausea, vomiting and dizziness, or by formation of lumps or nodes, slippery and slimy tongue fur and slippery pulse, or by mental disorder, such as epilepsy, depressive psychosis and manic psychosis.

Phlegm refers to both pathologic secretions of the diseased respiratory tract, which is mostly known as sputum, and the viscous turbid pathological product, which can accumulate in every part of the body, causing a variety of diseases.*

Fluid retention pattern may occur when fluid and humor metabolism is in disorder, marked by dizziness, thoracic and epigastric stuffiness, vomiting of clear fluid, splashing sound* in the abdomen, slippery tongue coating and string-like pulse. The patient may also have a cough with wheezing; or chest fullness with stretching pain during coughing; or heavy pain in the body and body edema; or oppression in the chest, short breath, and palpitation.

Based on the location of the retained fluid, fluid retention pattern is clinically further divided into phlegm-fluid retention*, thoracic fluid retention*, subcutaneous fluid retention* and pleural fluid retention* as shown in Fig. 10-4.

Fig. 10-4 Types of fluid retention

Phlegm-fluid retention here refers to the narrow sense of phlegm-fluid retention and is a particular designation for retention of fluid in the gastrointestinal tract, e.g. gastric retention in pyloric stenosis*, usually marked by abdominal distention, vomiting clear water and splashing sound in the abdomen.

Pleural fluid retention is a disease characterized by excess fluid retained in the side of the thorax with stretching pain* during coughing, because cough causes retained fluid to damage the surrounding tissues. In addition to the stretching pain, the patient usually also has the sensation of oppression in the chest because of fluid retained there.

Subcutaneous fluid retention is caused by excessive fluid of the body spilling outward to the body surface, manifested by heavy pain in the body, edema of the limbs, inhibited urination, aversion to cold, and absence of sweating.

Thoracic fluid retention occurs when retention of excessive fluid is in the lung and chest, or in the pericardial cavity, obstructing the heart and lung qi. This condition is marked by cough, palpitation, oppression in the chest, and shortness of breath.

Water retention pattern arises when water remains in the body or a part of the body, marked by edema, oliguria, or accompanied by ascites, pale plump* tongue with white slippery coating and soggy relaxed pulse.

The pathomechanism is the same as fluid retention, phlegm and dampness formation.

Clinically, edema is subdivided into yang edema and yin edema.

Yang edema refers to edema due to attack of wind or immersion of water-dampness involving the lung and the spleen respectively, usually with acute onset and a short course, accompanied by exterior heat and excess symptoms. It is of excess in nature. The eyelids and face start to have edema first and then it moves to the whole body; edema of the upper body above the waist is relatively more severe. This symptom is usually seen in the pattern of mutual contention of wind and water*.

Yin edema is due to yang deficiency of the spleen and the kidney with inhibited qi movement, usually with a gradual onset and a long course. It occurs mainly below the waist, accompanied by interior cold and deficiency symptoms.