1 TAN YIN PHLEGM-RETENTION SYNDROMES Huijun Shen Shenzhou Open TCM University Amsterdam The Netherlands November 2015
2 TAN YIN -PHLEGM- RETENTION SYNDROMES 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.
3 Classification of Phlegm Retention Syndrome in Golden Chamber of Synpnosis Tan Yin 痰饮 Retention in Lung and Stomach Xuan Yi 悬饮 Retention in Hypochondriac region Yi Yin 溢饮 Retention in General edema (limbs and muscles) Zhi Yin 支饮 Retention in Chest and diaphragm
4 Western medicine chronic bronchitis, gastritis, pleurisy (pleural effusion), ascites, heart or kidney disorders causing edema, emphysema, stomach and intestine disorders TCM external pathogenic invasion, irregular diet, chronic illness, overwork, etc.
5 YIN-SYNDROME (FLUID- RETENTION) Syndrome Differentiation and Therapeutic Principles A. Syndrome differentiation according to the location: (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.
6 B. Therapeutic principles Yin" is a kind of yin evil which can be eliminated by yang-qi, so herbss 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.
7 Classification and Treatment A. Phlegm-retention (a) Yang Deficiency of spleen and kidney 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.
8 (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 respiration.
9 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.
10 C. Anasarca edema of whole body 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.
11 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.
12 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.
13 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.
14 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.
15 D. 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.
16 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.
17 Acupuncture treatment: Tan Yin hypochondriac and chest fullness, palpitations, shortness of breath, water sounds in abdomen, vomiting clear fluids, thirst with no desire to drink, dizziness, blurred vision, soft stools, lumbago, cold limbs, low abdominal spasms, cold limbs, irregular urination (scanty difficult or frequent copious), T-pale with white slippery greasy coat, P-wiry slippery or deep wiry P/T warm Yang Qi, induce diuresis Acupuncture Rx foot taiyang, taiyin, Ren, Moxa, tonify, BL-23 (Shen Shu), BL-20 (Pi Shu), BL-22 (San Jiao Shu), SP-6 (San Yin Jiao), Ren-4 (Guan Yuan), Ren-6 (Qi Hai) (invigorate Yang Qi to help water transformation) -soft stools ST-36 (Zu San Li), Ren-12 (Zhong Wan) -palpitation, shortness of breath PC-6 (Nei Guan), HT-7 (Shen Men)
18 Xuan Xin -cough with frothy fluids, chest and hypochondriac distended pain, chest fullness, bland taste, T-pale, P-deep wiry P/T regulate and harmonize Shaoyang Qi Acupuncture Rx neutral stimulation, BL-13 (Fei Shu) & LU-1 (Zhong Fu)(cough), BL22 (San Jiao Shu), GB-37 (Guang Ming = Liver Luo) & GB-40 (Qiu Xu = yuan) regulate shaoyang Qi -to move water more LU-7 (Lie Que), LR-14 (Qi Men), Ren-17 (Tan Zhong)
19 Yi Yin Wind edema, water spreads to muscles/limbs, heavy body, aching limbs, edema, aversion to cold, cough white frothy phlegm, shortness of breath, dry heaves, no thirst, T-white coat, P-wiry tense P/T induce sweat to eliminate water Acupuncture Rx foot taiyin, yangming, taiyang, stimulate until patient breaks sweat, purge and sedate, SP-6 (San Yin Jiao), SP-9 (Yin Ling Quan), & BL- 20 (Pi Shu) (help Spleen transform Damp), BL-12 (Feng Men), BL-13 (Fei Shu) & LU-7 (Lie Que)(induce sweat), LI-4 (He Gu), LI-11 (Qu Chi)(invigorate Qi, expel pathogens)
20 Zhi Yin Pleurisy, cough, dyspnea, chest fullness, can t lay flat, cough large amounts of frothy white phlegm, if condition becomes chronic patient may get facial edema, T-pale, with white greasy coat, P-wiry tense P/T warm Lung to transform fluids Acupuncture Rx foot taiyin, taiyang, Ren, Moxa, Ren-17 (Tan Zhong) & BL-13 (Fei Shu)& LU-7 (Lie Que)(Lung Qi regulation), Ding chuan & GB-21 (Jian Jing)(deficient Lung Qi), BL-20 (Pi Shu) & SP-9 (Yin Ling Quan) (Spleen transform Damp)
21 Discussion on Phlegm, Damp and Water Retentions Journal of the Association of Traditional Chinese Medicine (UK) Volume 17 Issue 1 March Hui Jun Shen 沈惠军 Senior Lecturer of Acupuncture Programme University of Lincoln, UK
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