When it comes to phlegm-dampness, many people often recall the well-known saying: the spleen (pi) is the source of phlegm, while the lung (fei) is the container for phlegm.
The generation of phlegm-dampness is closely related to the spleen and lung. The spleen transforms phlegm-dampness, which then travels upwards to the lungs, affecting lung qi, preventing it from dispersing and descending. Thus, the lungs become a container, a reservoir for phlegm.
However, the issue of phlegm-dampness is not only related to the spleen and lungs but also involves the kidneys (shen).
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Strangely, what is the relationship between phlegm-dampness and the kidneys? Let’s start with a medical case.
During the Republic of China period, there was a woman with severe phlegm-dampness, to the point where she could not eat and would become breathless with slight activity. After three years of herbal decoctions without improvement, she finally sought help from the well-known Zhang Xichun.
After diagnosing her pulse and observing her severe shortness of breath, Zhang Xichun concluded that this was clearly a case of kidney deficiency, where the kidneys could not hold qi. He then added several kidney-tonifying herbs to the phlegm-transforming formula, and the woman recovered after just a few doses.
The kidneys govern storage; they can hold some of the body’s most precious essences. However, the kidneys can also falter, sometimes holding well and sometimes leaking.
We can imagine the kidneys as a wooden barrel. If the barrel becomes damaged, the water inside will leak out. Therefore, kidney deficiency does not only mean that the essence within the kidneys is consumed too quickly; it can also leak out. Where does it leak to? It leaks into the bladder. Soon, the bladder becomes filled, transitioning from a state of emptiness to fullness.
At this point, the fluids in the spleen and stomach cannot be expelled downwards. Originally, these fluids could exit through the bladder, but now they accumulate in the spleen and stomach, gradually forming phlegm-dampness.Thus, there is a saying in TCM: the kidneys are the root of phlegm generation.
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Returning to the case, what formula did Zhang Xichun prescribe? The Li Phlegm Decoction (Li Tan Tang).
As the name suggests, it helps to regulate phlegm-dampness from the lungs to the spleen and then to the kidneys, clearing it from top to bottom. This concept is quite profound.
Li Phlegm Decoction: Qian Shi (Euryale Seed) 30g, Bai Fu Ling (Pinellia Tuber) 12g, Hei Zhi Ma (Black Sesame, roasted and crushed) 9g, Bai Zi Ren (Platycladus Seed, roasted and crushed) 6g, Bai Shao (White Peony) 6g, Chen Pi (Dried Tangerine Peel) 6g, Fu Ling (Poria) 6g, decoct in water for oral administration.
Bai Fu Ling, Chen Pi, and Fu Ling, along with a dose of Gan Cao (Licorice), form the classic Er Chen Tang (Two Aged Decoction). This formula primarily transforms phlegm from the spleen and lungs. The Li Phlegm Decoction can be seen as a modified version of Er Chen Tang. In Zhang Xichun’s own words, the Li Phlegm Decoction compensates for the shortcomings of Er Chen Tang. This does not mean that Er Chen Tang is ineffective; it is the foundational formula for phlegm transformation. As the saying goes, a tall building rises from a solid foundation; Er Chen Tang is that solid base. If the foundation is not well laid, the building cannot stand firm.
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Zhang Xichun’s Li Phlegm Decoction has two main characteristics:
First, he places Qian Shi at the forefront, using a significantly larger amount than Bai Fu Ling.
What is the function of Qian Shi?
It can tonify, not only replenishing kidney essence but also sealing leaks. This way, the original essence will not leak out, and the replenished essence can also be retained. From another perspective, sufficient kidney qi can timely transform some phlegm-dampness and fluids.
Additionally, Qian Shi not only enters the kidneys but also the spleen. The Shen Nong’s Herbal Classic states it is a “spleen and kidney herb,” while the Compendium of Materia Medica mentions it can “tonify the spleen and secure essence.”
Historically, a notable figure who cherished Qian Shi was Su Shi. Not only was he a great writer, but he also paid great attention to health. It is said that he chewed Qian Shi daily, persistently for years, and even in old age, he remained sharp-minded and creatively prolific.
For those with diarrhea or frequent urination, consuming more Qian Shi is beneficial. It can be cooked into porridge or ground into powder for consumption over time, nurturing both innate and acquired essences.
Second, he added Hei Zhi Ma and Bai Zi Ren to nourish yin and moisten dryness.
While Bai Fu Ling is an excellent phlegm-transforming herb, it is slightly warm and drying, which can easily lead to heat.
Hei Zhi Ma is the black seed of the sesame plant, and Bai Zi Ren is the seed of the Platycladus tree. These seeds contain many oils, which have a sweet and moistening nature, helping to counteract the warming and drying properties of Bai Fu Ling. They can also moisten the intestines, allowing phlegm-dampness to be expelled through bowel movements. Both Hei Zhi Ma and Bai Zi Ren also have kidney-tonifying effects, assisting Qian Shi in nourishing kidney essence.
Bai Shao and Fu Ling can promote urination, guiding phlegm-dampness into the bladder for excretion through urination.
Chen Pi’s main role here is to regulate qi. Phlegm-dampness is merely a mass of turbid stagnation in the body, akin to a stagnant pool in nature. How does it move? It relies on the qi within the body. Chen Pi can help push the phlegm-dampness downwards.
The thought process behind Li Phlegm Decoction is as follows: first, use Bai Fu Ling to dissolve phlegm-dampness, then, with the descending action of Bai Fu Ling and Chen Pi, guide the phlegm-dampness downwards. Next, use Hei Zhi Ma and Bai Zi Ren to moisten the intestines, while Bai Shao and Fu Ling promote urination, allowing the expelled phlegm-dampness to exit through two routes: one through bowel movements and the other through urination. Qian Shi can tonify the kidneys, attacking from one side while supplementing from the other, effectively cutting off the source of phlegm-dampness.
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Who is suitable for this formula?
Those who frequently experience oily skin on the face, a feeling of phlegm in the throat that cannot be cleared, along with symptoms of kidney qi deficiency, such as weakness in the lower back and knees, sensitivity to cold, fatigue, and dry mouth but reluctance to drink water, can use this Li Phlegm Decoction decocted in water for oral administration.
Finally, I wish everyone good health and freedom from the troubles of phlegm-dampness.
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