Phlegm and Rheum - Tan Yin

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Contents

Denfiniton

Water and fluid accumulate in certain parts of the body due to transport and distribution abnormalities.

The concepts of Tan Yin

  • General concept: defined here as “Water and fluid accumulate in certain parts of the body due to transport and distribution abnormalities.” These include Tan Yin, Xuan Yin, Yi Yin and Zhi Yin.
  • Narrow concept: one of the Yins – Tan Yin. This is water accumulates in the Stomach and intestines.
  • Orthodox medicine equivalents: some stages of chronic bronchitis, bronchial asthma, exudative pleurisy, tuberculous pleurisy, gastrointestinal dysfunction, incomplete pylorochesis and congestive heart failure.

Causes and Pathological Mechanisms

Patterns

Tan Yin (Phlegm-rheum)

Spleen Yang Deficiency

  • Symptoms: Distension in epigastrium, chest and hypochondria, vibrating noise of water in stomach, preference of warmth and aversion to cold in stomach and abdomen, slight aversion to cold at back, vomit of clear water or sputum, thirst by do not want to drink and vomit after drinking water, palpitation and short of breath, poor appetite, loose feces and gradual weight loss.
  • Tongue: Pale tongue with white and slippery coating
  • Pulse: Wiry, Thready and Slippery
  • Treatment strategy: Warm and invigorate spleen yang, resolve rheum and reduce adverse qi
  • Formula: Ling Gui Zhu Gan Tang or Xia Ban Xia Jia Fu Ling Tang
  • Acupoints:

Retention in the Stomach and intestine

  • Symptoms: Hard distension and pain in stomach and abdomen with diarrhoea, symptoms relieved by diarrhoea but deteriorates again later, vibrating noise of water moving in intestines, sometime constipation and bloated abdomen with a dry mouth but no desire for water.
  • Tongue: Yellow or white and greasy tongue coating
  • Pulse: Deep and Wiry
  • Treatment strategy: Purgation to eliminate water and rheum
  • Formula: Ji Jiao Li Huang Wan or Gan Sui Ban Xia Tang
  • Acupoints:

Xuan Yin (Suspended rheum)

Rheum invasion in the chest and Lung

  • Symptoms: Stabbing pain in chest and hypochondria aggravated by movement and breathing, hard and distending epigastrium, fever with no aversion to cold, or alternate fever and chill, little sweat or sweat without relief of fever, cough and breathing difficulties with little phlegm, retch, dry throat with a bitter taste in the mouth.
  • Tongue: Thin white or yellow tongue coating
  • Pulse: Wiry and Rapid
  • Treatment strategy: Disperse lung qi and mediate shaoyang
  • Formula: Chai Zhi Ban Xia Tang
  • Acupoints:

Rheum retention in chest and hypochondria

  • Symptoms: Stabbing pain in chest and hypochondria aggravated cough and spitting, breathing difficulties and dyspnoea, unable to lie in supine position or only able to lie in lateral position on the rheum side and a bulge in the chest.
  • Tongue: Thin white and greasy tongue
  • Pulse: Deep and Wiry or Slippery
  • Treatment strategy: Eliminate retained rheum
  • Formula: Shi Zao Tang
  • Acupoints:

Disharmony of collateral Qi

  • Symptoms: Chest and hypochondriac distension with twinge and burning sensation, rough respiration, oppressed cough. Can be protracted and aggravated with dull, damp and wet weather.
  • Tongue: Dull tongue with thin coating
  • Pulse: Wiry
  • Treatment strategy: Regulate Qi flow and harmonise collateral
  • Formula: Xiang Fu Xuan Fu Hua Tang
  • Acupoints:

Yin Deficiency with interior Heat

  • Symptoms: Paroxysmal cough with little sticky phlegm, dry mouth and throat, afternoon tidal fever, flushed cheeks and night sweat, dysphoria and insomnia, chest and hypochondriac distending pain and weight loss.
  • Tongue: Red tongue with little coating
  • Pulse: Thready and Rapid
  • Treatment strategy: Nourish Yin and clear heat, dredge collaterals and remove rheum
  • Formula: Sha Shen Mai Dong Tang and Xie Bai San
  • Acupoints:

Yi Yin (Flooding rheum)

  • Symptoms: Heavy and achy body, limbs and body oedema, aversion to cold, no sweat, cough and dyspnoea, large amount of white and frothy phlegm, chest distension, retch and no thirst.
  • Tongue: White tongue coating
  • Pulse: Wiry and Tight
  • Treatment strategy: Relieve the exterior and resolve rheum
  • Formula: Xiao Qing Long Tang
  • Acupoints:

Zhi Yin (Sustained rheum)

Cold rheum accumulation in the Lung

  • Symptoms: Cough and dyspnoea, unable to lie in supine position, large amount of white frothy phlegm, protracted course and attack aggravated or triggered by cold weather, face and feet oedema, back pain, trembling, fever and aversion to cold.
  • Tongue: White slippery and greasy tongue coating
  • Pulse: Wiry and Tight
  • Treatment strategy: Warm the lung and resolve rheum
  • Formula: Xiao Qing Long Tang
  • Acupoints:

Spleen Yang Deficiency and Kidney Yang Deficiency

  • Symptoms: Dyspnoea and short of breath aggravated by exertion, cough with little qi, much phlegm, poor appetite, chest distension, weariness, aversion to cold. Cold limbs, lower abdominal contraction, trembling below umbilicus, feet oedema, urination difficulties, frothy saliva, dizziness and blurred vision.
  • Tongue: Large and bulgy tongue with white and moist or dull grey and greasy coating
  • Pulse: Deep and Thready
  • Treatment strategy: Warm to invigorate spleen and kidney, resolve water and rheum
  • Formula: Jing Gui Shen Qi Wan and Ling Gui Zhu Gan Tang
  • Acupoints:

References

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