The formation of phlegm-dampness follows a process: first, there is dampness, which accumulates into fluid, and then condenses into phlegm. This process occurs step by step. Phlegm can be categorized into visible and invisible forms. Visible phlegm includes the phlegm we can see, such as white, yellow, or green phlegm. White phlegm indicates cold, while yellow and green phlegm indicate heat. Some individuals may feel phlegm in their throat, unable to cough it out or swallow it, which is also a manifestation of phlegm. Others may experience phlegm sounds in the chest, often feeling nauseous, which is another sign of phlegm. Invisible phlegm, on the other hand, pervades the body, being unseen and untouchable, yet it can lead to various diseases, such as dizziness and mania. So, how does phlegm-dampness actually form? This relates to the body’s fluid metabolism, which involves multiple organs, including the lungs, spleen, kidneys, liver, and the San Jiao (Triple Burner). The spleen is the source of phlegm production; it transforms and transports fluids. When the spleen functions normally, it distributes fluids properly. However, if the spleen is deficient, it may only metabolize eight parts of the fluids instead of the usual ten, leading to the accumulation of dampness.
What causes spleen deficiency? There are various reasons, such as consuming cold, raw, or excessively rich foods, overworking which depletes spleen blood, excessive thinking which also harms spleen blood, and factors related to chronic illness or age. Some people adhere to the health advice of drinking eight glasses of water daily; if the spleen’s function is normal, this may not be an issue, but if the intake exceeds the spleen’s capacity to process, it can lead to dampness. The lungs serve as the storage for phlegm; they are a place where phlegm easily accumulates. If the lung’s functions of dispersing and descending are impaired, fluids can stagnate, and when confronted with cold, heat, or fire pathogens, they can obstruct the lungs, leading to symptoms such as chest tightness, cough, and excessive phlegm. Therefore, when observing a cough with phlegm, it is not necessarily a lung issue; the root cause is often related to the spleen. The kidneys are the foundation of phlegm production; they act like the water management system. Kidney yang warms the spleen, and the kidneys also have a role in the transformation of fluids into urine. If kidney qi is insufficient, fluid metabolism can be disrupted. Some individuals may frequently expel foamy white phlegm that dissolves in water, without necessarily coughing or showing cold symptoms, but they may have persistent white phlegm. In such cases, it is essential to strengthen the spleen and resolve phlegm, as well as tonify the kidneys, for example, with the Li Ping Tang (Phlegm Resolving Decoction). The liver governs the smooth flow of qi; in this process, it acts like a facilitator. If liver qi is stagnant, fluid metabolism can be obstructed, leading to fluid accumulation. The San Jiao functions like the pathways for fluid movement; if these pathways are blocked, fluids will also stagnate. Additionally, the formation of phlegm-dampness can result from prolonged exposure to damp environments, external damp pathogens, consumption of rich and greasy foods leading to internal dampness, emotional disturbances causing qi stagnation and fluid retention, and conditions of qi deficiency and blood stasis that hinder fluid movement. Once phlegm-dampness forms, it travels throughout the body with the flow of qi, affecting the meridians, skin, muscles, bones, and organs, manifesting various symptoms.
What are the impacts of phlegm-dampness? It affects the circulation of qi and blood; phlegm-dampness is a tangible pathogenic factor that is sticky and can cause numbness in the limbs and hinder movement when it stagnates in the meridians. If it stagnates in the lungs, it can lead to chest tightness, shortness of breath, and excessive coughing with phlegm. If it stagnates in the stomach, it can cause nausea and vomiting. Phlegm-dampness results from abnormal fluid metabolism, but conversely, it also affects fluid metabolism; phlegm-dampness obstructs the spleen, leading to its dysfunction; phlegm turbidity obstructs the lungs, causing dysfunction in dispersing and descending; phlegm fluid stagnation in the San Jiao leads to impaired kidney transformation. Phlegm-dampness can easily cloud the mind; for instance, phlegm turbidity rising with qi can cause dizziness and mental fatigue; in severe cases, phlegm turbidity combined with wind or fire pathogens can lead to confusion, incoherence, and mania. Stroke is also related to phlegm turbidity, as it can obstruct the clear orifices, leading to facial drooping. However, it is essential to differentiate between cold phlegm and heat phlegm; for example, the An Gong Niu Huang Wan is considered an excellent emergency remedy for stroke but is only suitable for heat phlegm. Many diseases are caused by phlegm, and phlegm-dampness can lead to various unusual conditions, such as snoring, chest tightness, nausea, white phlegm, plum pit qi, eczema, obesity, and lipomas. There are many herbs for regulating phlegm-dampness, such as Er Chen Wan, Liu Jun Zi Wan, Xiang Sha Liu Jun Wan, Ping Wei Wan, Xiang Sha Ping Wei Wan, Xiang Sha Yang Wei Wan, Shen Ling Bai Zhu San, Jin Gui Shen Qi Wan, Li Ping Tang, Wen Dan Tang, and San Zi Yang Qin Tang, which need to be selected based on differential diagnosis and symptoms.
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