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The production of phlegm is often caused by external factors such as the six excesses, dietary indiscretions, or emotional disturbances, leading to dysfunction in the qi transformation of the lungs, spleen, and kidneys. The spleen governs transformation and transportation; when the spleen and stomach are injured, their ability to transform is impaired, resulting in the accumulation of dampness that can condense into phlegm. Phlegm is a tangible yin pathogen, and once formed, it possesses characteristics of dampness, turbidity, and stickiness, which can obstruct the flow of qi and affect the circulation of qi and blood in the meridians, leading to persistent and difficult-to-treat conditions.
When phlegm is retained in the body, it rises and falls with the qi, affecting various organs: it may obstruct the lungs, stagnate in the stomach, cloud the heart or liver, or move through the meridians, leading to various symptoms that can differ widely.
If phlegm is stagnant in the spleen and stomach, the stomach loses its ability to harmonize and descend, resulting in symptoms such as fullness and distension in the epigastric region, nausea, vomiting of phlegm and saliva, loss of appetite, discomfort and fullness, fatigue, heaviness, drowsiness, swelling and itching of the eyelids, a sandy sensation in the eyes, or difficulty opening the eyelids.
Locally, mild cases may present with slightly red eyelid skin, while severe cases may show redness and swelling; the inner eyelids may appear red or purplish, and in severe cases, there may be ulceration with a white greasy coating, a swollen tongue, and a slippery, weak pulse.
What should be done if phlegm accumulates in the spleen and stomach?
There are two principles for the differentiation and treatment of phlegm syndromes:
First, understand the deficiency or excess of the affected organs and the urgency of the condition; if urgent, treat the phlegm first, focusing on phlegm transformation and elimination; if not urgent, address the root cause, treating the lungs, spleen, and kidneys. Second, based on the different properties of phlegm, apply different treatment methods.
Therefore, for spleen deficiency with dampness accumulating into phlegm, it is advisable to strengthen the spleen, dry dampness, and transform phlegm.
1. Xiangsha Liujunzi Decoction (香砂六君子汤) with modifications
This formula is derived from the “Ancient and Modern Famous Physician’s Formulas” Volume 1, citing Ke Yunbo’s formula.
This formula consists of Liujunzi Decoction (六君子汤) with the addition of Sha Ren (Cardamom) and Mu Xiang (Aucklandia). The ingredients Ren Shen (Ginseng), Bai Zhu (White Atractylodes), Fu Ling (Poria), and Gan Cao (Licorice) tonify qi and strengthen the spleen; Ban Xia (Pinellia), Chen Pi (Tangerine Peel), Sha Ren, and Mu Xiang regulate qi and transform phlegm. It has the effect of dispersing and tonifying while transforming phlegm.
This formula is used for symptoms caused by spleen and stomach qi deficiency with phlegm obstructing qi stagnation, characterized by abdominal distension and pain, vomiting, fullness, and loss of appetite, with a pale tongue and white greasy coating.
It is mainly used for gastric ulcers, duodenal ulcers, chronic gastritis, gastric prolapse, gastrointestinal dysfunction, bronchiectasis, chronic atrophic gastritis, diabetes, autonomic dysfunction-related intestinal diseases, renal anemia (with modifications for this condition), etc., all of which are associated with spleen and stomach qi deficiency and phlegm obstructing qi stagnation.
2. Xiaoxianxiong Decoction (小陷胸汤) with modifications
This formula includes Huang Lian (Coptis) to clear heat from the stomach and eliminate fullness. Ban Xia (Pinellia) descends the qi mechanism, dries dampness, and transforms phlegm. Gua Lou Shi (Trichosanthes Fruit) clears heat and nourishes yin, guiding heat downward, transforming phlegm, and clearing fluids without harming yin.
It has the effect of clearing heat, transforming phlegm, and dispersing chest obstruction.
This formula is indicated for phlegm-heat obstructing the chest syndrome, characterized by chest and epigastric fullness, pain upon pressure, or chest pain with cough of yellow, thick phlegm, a red tongue with a yellow greasy coating, and a slippery, rapid pulse.
Rational use of Xiaoxianxiong Decoction can guide TCM differentiation and Western medicine diagnosis; whether treating digestive diseases or respiratory diseases, it must align with the pathological changes and diagnostic criteria of Xiaoxianxiong Decoction to achieve improvement.
In clinical practice, Xiaoxianxiong Decoction with modifications can also be used for: acute and chronic gastritis, acute bronchitis, pneumoconiosis with lung infection, coronary heart disease, intercostal neuralgia, pleuritis, pleural adhesions, and lymph node tuberculosis, etc.
However, if you have cold phlegm in the spleen and stomach, use this formula with caution.
Due to space limitations, the content on phlegm accumulation in the spleen and stomach cannot be fully covered; for example, its pathogenesis, symptoms, and improvement methods cannot be summarized in just a few sentences. Other methods for improving phlegm accumulation in the spleen and stomach include Erchen Decoction (二陈平胃汤) with modifications, Qingwei Decoction (清胃汤) with modifications, etc. If there is an opportunity, I will discuss this issue again.
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