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Many unusual diseases are caused by phlegm-dampness; this article clarifies “phlegm-dampness”

The function of the spleen in transforming and transporting water and dampness declines, or there are obstacles in the circulation and excretion of fluids in the body, leading to abnormal accumulation of fluids that cannot nourish the body properly, resulting in a pathological substance known in TCM as “phlegm-dampness”.

The turbid, viscous, and thick part is called “phlegm”, while the clear, thin, and transparent part is referred to as “dampness”.

Therefore, in TCM, “phlegm” does not merely refer to the mucus produced in the lungs that can be expelled through coughing and is visible to us; TCM’s concept of “phlegm” also includes pathological products that arise from metabolic disorders of fluids, characterized by turbid, viscous, and thick properties.

For example, obesity is referred to as “phlegm” in TCM. Since this type of “phlegm” is not as easily recognized as the phlegm from the lungs, it is termed “invisible phlegm”, while the phlegm produced in the lungs that can be expelled through coughing and is visible is called “visible phlegm”. Together, these two concepts form the TCM understanding of “phlegm”.

“Visible phlegm” primarily exists in the lungs and may arise from either internal metabolic disorders of fluids or external pathogenic factors invading the lungs. This type of phlegm can be expelled through coughing and is observable, making it easier to understand.

We are quite familiar with “visible phlegm”, as we often encounter it during colds and coughs, but have we noticed a detail: even though the phlegm coughed up from the lungs is the same, there are various differences in its characteristics?

For instance, some phlegm is white and viscous, some is white and thin, some is white and foamy, some is yellow and thick, some is gray-black, and some is yellow-green… Why does phlegm, which is essentially the same, exhibit so many variations?

Upon careful analysis, the various characteristics of phlegm can be summarized into two aspects: one is the texture, which can be thick, thin, or foamy; the other is the color, which can be white, gray-black, yellow, or yellow-green.

1. Different Textures and Colors of Phlegm

Let’s consider a common phenomenon: dissolving sugar in water. We obtain a colorless and transparent liquid. If we heat this colorless and transparent sugar water, what happens? We can see that the sugar water gradually becomes thick, and its color changes from transparent to light yellow, then to deep yellow.

From this phenomenon, we can deduce that the thickness and color of phlegm in the body are closely related to the body’s “heat”. If there is heat in the body, the phlegm will be yellow and thick; if there is no heat, the phlegm will be thin and white. The higher the degree of yellow thickness, the higher the degree of heat in the body.

According to this principle, TCM categorizes phlegm that is white and thin, or foamy, or gelatinous as “cold phlegm”, while phlegm that is yellow and thick, or even yellow-green, is categorized as “heat phlegm”.

Since the essence of cold phlegm and heat phlegm is completely opposite, their treatments are also entirely different. Treating cold phlegm requires warming and transforming it, commonly used herbs include Gan Jiang (Dried Ginger), Xi Xin (Asarum), Ban Xia (Pinellia), Chen Pi (Aged Tangerine Peel), Bai Jie Zi (White Mustard Seed), and Lai Fu Zi (Radish Seed); while treating heat phlegm requires clearing heat and transforming phlegm, commonly used herbs include Zhe Bei Mu (Fritillaria), Chuan Bei Mu (Fritillaria), Tian Zhu Huang (Bamboo Shavings), Dan Nan Xing (Arisaema), Gua Lou (Trichosanthes), and Tian Hua Fen (Trichosanthes Root).

However, whether it is cold phlegm or heat phlegm, TCM emphasizes a focus on the concept of “transformation” in treatment. What does “transformation” mean? In the past, before the advent of tap water, if the water quality was murky, we often added a small amount of alum to the water tank, and after a while, the water would become clear. Alum plays a role in breaking down and settling the turbid substances in the murky water, which is the essence of “transformation”.

The phlegm-transforming herbs used in TCM for various phlegm conditions are akin to the role of “alum”, capable of breaking down and settling the phlegm turbidity, thereby eliminating diseases caused by phlegm turbidity.

Western medicine also recognizes phlegm in two categories: one is infectious phlegm, such as that caused by bacterial, fungal, mycoplasma, or chlamydia infections; the other is exudative phlegm, often resulting from excessive secretion of mucus by respiratory mucosal cells.

Among these, antibiotics have some efficacy against phlegm caused by bacterial infections, while there are limited options in Western medicine for phlegm caused by fungal, mycoplasma, or chlamydia infections, as well as exudative phlegm. How does TCM view and treat these “phlegm” diseases?

TCM believes that microorganisms such as fungi, mycoplasma, and chlamydia naturally exist in the air and do not harm or affect the human body under normal circumstances. Only when there is excessive accumulation of water and dampness in the body, creating an overly humid internal environment, do these microorganisms proliferate and reproduce in large numbers, thereby harming human health and causing various diseases.

Therefore, for these types of diseases, the internal environment’s “dampness” is the true root cause. Just like in the rainy season, the humid environment allows fungi to proliferate, making things prone to mold. If you can recognize that the humid environment in nature is the main reason for the proliferation of fungi, why would the human body be any different?

So, how should we treat phlegm caused by internal dampness? In daily life, dampness is often associated with overcast and rainy weather; if the sky is clear and the sun is shining, there will naturally be no damp environment.

There is a saying, “When the sun is blazing, the haze dissipates,” which illustrates this principle. The blazing sun can drive away dampness, primarily relying on its heat. Therefore, when treating this type of phlegm, we should use warming herbs to create a “blazing sun” effect in the body, allowing the damp “haze” to dissipate. This eliminates the root cause of water and dampness accumulation in the body, preventing the environment for the survival and reproduction of fungi and other microorganisms, thus providing rapid efficacy against phlegm caused by infections from fungi, mycoplasma, chlamydia, and exudative phlegm.

The Han Dynasty medical sage Zhang Zhongjing proposed in the “Essentials of the Golden Chamber” that the principle for treating this condition is “For phlegm-dampness, one should use warming herbs to harmonize it”. This perspective remains remarkably insightful even today, and we cannot help but admire the ancient methods and thoughts in exploring the mysteries of life and disease.

2. Invisible Phlegm

Having discussed visible phlegm, what is “invisible phlegm”? How can we determine the existence of “invisible phlegm”? TCM has four criteria for judging the presence of “invisible phlegm” in the body.

01

Obesity

In TCM, it is said that “obese individuals have more phlegm-dampness”, indicating that obese individuals often have “invisible phlegm” present in their bodies, as fat possesses the characteristics of “phlegm”—turbid, viscous, and thick. It is formed from the accumulation of turbid substances in the water and dampness within the body.

02

Thick and Greasy Tongue Coating

A thick and greasy tongue coating is the most direct manifestation of excessive water and dampness in the body.

03

Masses

Any masses that are not red in color, protruding from the skin surface, and are nodular in shape, soft or firm to the touch, contain water, mucus, or gelatinous substances, are referred to in TCM as “phlegm masses”.

04

Slippery Pulse

In TCM, the pulse is classified into more than twenty types based on different sensations felt under the fingers, and the slippery pulse is one of them. The description of a slippery pulse in TCM is “smooth and flowing, like beads rolling on a plate”, indicating that the presence of a slippery pulse is a characteristic manifestation of phlegm turbidity in the body and is one of the main diagnostic criteria for “phlegm” in TCM.

Based on TCM’s understanding of phlegm, combined with Western medicine’s microscopic examinations, the concept of “invisible phlegm” can be made more concrete and intuitive. For example, conditions such as hyperlipidemia, cysts, lymph node tuberculosis, and bone tuberculosis all exhibit characteristics of turbidity, viscosity, and thickness, and can thus be considered phlegm-related diseases. In this way, Western medical examinations extend the TCM diagnostic methods of observation, listening, inquiry, and pulse-taking.

Through TCM’s understanding of the mechanisms of phlegm formation, we can relate the occurrence of these diseases to the overall balance state of the body, finding fundamental treatment methods for these diseases. For instance, hyperlipidemia, cysts, and lymph node tuberculosis all align with the characteristics of TCM phlegm, and their fundamental causes are related to the spleen’s dysfunction in transforming and transporting water and dampness, leading to excessive accumulation of phlegm turbidity in the body. Therefore, treatment can be approached through strengthening the spleen’s function and transforming phlegm to soften hard masses. Moreover, since this method addresses the root cause of phlegm formation, the treatment effects are long-lasting.

Here, I will provide two examples. One patient with hyperlipidemia had taken Shujian Zhi and Liping Zhi without significant effect. He felt dizzy and fatigued, had poor appetite, excessive daytime sleepiness, frequent dreams at night, palpitations, and his stool was often unformed. His complexion was dull, tongue coating was pale white, and his pulse was weak and thin.

I diagnosed him with spleen deficiency leading to an inability to transform and transport water and dampness, resulting in the accumulation of phlegm turbidity in the blood vessels, affecting the circulation of qi and blood, and causing illness. I prescribed a formula to strengthen the spleen and transform phlegm: 30g of Chao Bai Zhu (Fried Atractylodes), 15g of Dang Shen (Codonopsis), 10g of Chen Pi (Aged Tangerine Peel), 10g of Ban Xia (Pinellia), 6g of Gan Cao (Licorice), 15g of Fu Ling (Poria), 6g of Ju Luo (Tangerine Peel), 10g of Dan Nan Xing (Arisaema), 15g of Jiao Shan Zha (Hawthorn), and 5 slices of Sheng Jiang (Fresh Ginger).

After taking the 7 doses of medicine, the patient felt a significant improvement in energy and appetite, dizziness decreased by more than half, and his stool had become mostly formed. I then advised him to continue taking the same formula for another 7 doses. When he returned for a follow-up, his various symptoms had largely resolved, and his blood lipid levels had returned to normal.

Another patient with a popliteal cyst came to consult me out of fear of surgery.

In TCM, the formation of cysts is considered a result of the accumulation of phlegm turbidity in a specific area, and the production of phlegm turbidity is directly related to the spleen’s function in transforming and transporting water and dampness. Therefore, by improving and enhancing the spleen’s ability to transform and transport water and dampness, we can eliminate the accumulation of phlegm turbidity in the body, thus removing the cyst.

Based on this approach, I prescribed a formula to strengthen the spleen, transform phlegm, and reduce swelling: 45g of Chao Bai Zhu (Fried Atractylodes), 15g of Ze Xie (Alisma), 15g of Hua Shi (Talc), 10g of Zhu Ling (Polyporus), 15g of Fu Ling (Poria), 10g of Gui Zhi (Cinnamon Twig), 20g of Ban Xia (Pinellia), 10g of Zhi Nan Xing (Arisaema), 30g of Yi Yi Ren (Job’s Tears), and 10g of Qing Pi (Green Tangerine Peel).

The patient took this formula for about a month, and the popliteal cyst completely disappeared. During this time, the formula was slightly adjusted based on symptom changes, but the main herbs remained as described. These two examples clearly demonstrate that the TCM theory of “phlegm” withstands practical testing.

The spleen’s insufficient function in transforming and transporting water and dampness leads to the accumulation of water and dampness in the body. The turbid substances in the water and dampness can condense into phlegm masses in specific areas, such as the cysts, lymph node tuberculosis, and bone tuberculosis mentioned earlier. They can also enter the meridians and blood vessels, traveling throughout the body with the circulation of qi and blood, as seen in the case of hyperlipidemia.

These turbid substances have viscous properties, often leading to obstruction of qi and blood flow in the meridians and blood vessels, causing pathological changes due to ischemia and hypoxia in the organs, resulting in various diseases. For example, if phlegm accumulates in the head, it can affect blood supply to the brain, leading to symptoms such as dizziness, forgetfulness, drowsiness, and even coma, hemiplegia, or speech difficulties, which Western medicine refers to as cerebral infarction, and many cases in TCM are attributed to phlegm.

If phlegm accumulates in the limbs, it can lead to blood supply disorders in the limbs, resulting in symptoms such as numbness, cold extremities, etc.; if phlegm accumulates in the blood vessels, it can lead to insufficient blood supply to the heart, causing palpitations, irregular heartbeat, and chest tightness, which in Western medicine is often related to coronary heart disease, and in many cases, it is closely associated with phlegm.

Moreover, phlegm can also affect a person’s mental state. If the turbid qi of phlegm-dampness obstructs normal mental activities, it can lead to symptoms such as excessive talking, depression, and unexplained sadness, which are classified as depressive disorders in TCM. Since TCM believes that the “heart” governs the mind, this type of mental disorder caused by excessive “phlegm turbidity” is referred to as “phlegm obstructing the heart orifices”.

3. The Mobility of Phlegm

Regarding the mobility of phlegm, the great physician Zhu Danxi from the Yuan Dynasty stated: “Phlegm, as a substance, rises and falls with qi, reaching everywhere.” It is precisely because of the characteristic that phlegm “reaches everywhere” that many unusual diseases or diseases with poor treatment outcomes in TCM are attributed to “phlegm”.

Thus, there is a saying in TCM that “many strange diseases arise from phlegm”. Zhu Danxi also proposed the theory that “many diseases are accompanied by phlegm”, which adds a new perspective to disease diagnosis and treatment. Some diseases may be diagnosed correctly, and the medication may be appropriate, but the clinical outcomes are not ideal; in such cases, we can consider adding phlegm-transforming methods, which often yield unexpectedly good results.

I once treated a patient with vertigo who had experienced dizziness for over a year. If he stood up suddenly after squatting or sitting for a long time, he would feel black in front of his eyes and even faint.

He felt heavy-headed all day, mentally fatigued, spoke softly, and had a pale complexion. His appetite was average, and his bowel movements were normal. His tongue was pale red with a thin white coating, and his pulse was weak and thin. In the past month, his dizziness seemed to worsen. Western medicine diagnosed him with insufficient blood supply to the brain.

At that time, I thought this was a typical case of qi deficiency, where qi deficiency leads to the inability of qi and blood to rise and nourish the head, which should be easy to treat. So I prescribed 5 doses of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). After prescribing the formula, I confidently told the patient that he would definitely see significant improvement after taking the 5 doses.

However, five days later, the patient returned for a follow-up and poured cold water on my head, telling me that there was no improvement in his dizziness! He also comforted me, saying that perhaps it was because he had this problem for a long time, and improvement wouldn’t come so quickly. I carefully inquired about the patient’s condition and concluded that it was indeed qi deficiency. Since there was no diagnostic error, why was there no effect?

At this point, I recalled Zhu Danxi’s saying that “many diseases are accompanied by phlegm”, and I suddenly understood. The confusion in my mind was resolved; since there was qi deficiency, it would inevitably lead to abnormal transformation and transportation of water and dampness, resulting in the internal generation of phlegm turbidity, which obstructed the brain and caused dizziness.

The previous treatment was ineffective because I only considered qi deficiency and did not take into account the phlegm turbidity present in the meridians and blood vessels. Therefore, I prescribed a new formula to tonify qi and transform phlegm: 15g of Huang Qi (Astragalus), 15g of Dang Shen (Codonopsis), 12g of Chao Bai Zhu (Fried Atractylodes), 10g of Ban Xia (Pinellia), 10g of Fu Ling (Poria), 6g of Chen Pi (Aged Tangerine Peel), 10g of Chuan Xiong (Szechuan Lovage), 3g of Sheng Ma (Cimicifuga), 3g of Chai Hu (Bupleurum), 6g of Jie Geng (Platycodon), 6g of Ju Luo (Tangerine Peel), and 6g of Zhi Nan Xing (Arisaema). I still prescribed 5 doses.

Five days later, the patient joyfully reported that this time the medicine was effective; after just five days, his dizziness had significantly decreased. Later, I had him take Xiang Sha Liu Jun Wan (Fragrant Sand Six Gentlemen Decoction) for consolidation, and after about a month of treatment, I followed up with the patient a year later, and he had not experienced any recurrence of dizziness.

4. Meniere’s Disease, a Strange Disease Caused by Phlegm-Dampness

Here, I would like to mention Meniere’s disease (formerly known as Ménière’s disease).

The clinical features of this disease include: paroxysmal vertigo that occurs frequently, during which the patient feels that surrounding objects are spinning, as if sitting on a vehicle that is swaying, accompanied by nausea, vomiting, and head pain, with activity exacerbating the severity of dizziness and vomiting.

Therefore, during an episode, patients often lie still with their eyes closed, afraid to move, and some may feel a sense of blockage and pressure in the ear, or experience nystagmus.Western medicine believes this disease is caused by increased lymphatic fluid in the inner ear, leading to ear-related vertigo.

Based on Zhang Zhongjing’s records in the “Essentials of the Golden Chamber” regarding the “Mao Xuan” syndrome (“Mao” refers to nausea and vomiting, and “Mao Xuan” indicates a disease characterized by dizziness and nausea/vomiting occurring together. Zhang Zhongjing believed it was caused by “fluid retention in the heart”, which closely resembles Meniere’s disease), I believe this condition is caused by water and dampness stagnating in the inner ear, and I used the “Ze Xie Decoction” from the “Essentials of the Golden Chamber” for treatment, achieving excellent clinical results.

The composition of Ze Xie Decoction consists of just two herbs—Ze Xie (Alisma) and Bai Zhu (Atractylodes). Ze Xie is recorded in the “Shen Nong’s Herbal Classic” as having the effect of “treating wind, cold, dampness, and dispelling water”; Bai Zhu, in the “Record of Famous Physicians” by the Jin Dynasty physician Tao Hongjing, is said to “eliminate phlegm and water, expel wind-water accumulation”, and is also noted for its ability to “warm the stomach and eliminate food stagnation”.

These two herbs work together: Ze Xie primarily promotes urination to eliminate internal water and dampness, while Bai Zhu supports the spleen to eliminate phlegm and water. This combination effectively addresses both the symptoms of water and dampness accumulation and the root cause of phlegm-dampness due to spleen deficiency, resulting in rapid efficacy despite the small number of herbs.

I once treated a 43-year-old female patient with Meniere’s disease who had suffered for over three years. This time, her condition was triggered by fatigue, and she felt dizzy, nauseous, and unable to eat, with water being vomited immediately. She lay still in bed with her eyes closed, feeling slightly better, but any movement exacerbated her symptoms.

She felt heavy-headed, spoke softly, and during the consultation, she vomited twice at the door, with the vomit being clear water. She reported that she hadn’t eaten anything for a day and still felt nauseous. Her tongue was pale with a greasy white coating, and her pulse was wiry.

Based on the idea of “fluid stagnation in the inner ear”, I prescribed Ze Xie Decoction: 30g of Ze Xie (Alisma) and 45g of Chao Bai Zhu (Fried Atractylodes). I instructed her to use one and a half bowls of water, decocting it down to half a bowl, and to take it warm.

I also advised the patient not to drink it all at once; instead, she should take a sip, wait about five minutes, and if there were no adverse reactions, take another sip, and so on, until she finished the half bowl of medicine.

Surprisingly, the patient did not vomit after taking the medicine, gradually fell asleep, and did not wake up until the next morning. Upon waking, she felt as if her illness had disappeared. After two days of adjusting her treatment with spleen-strengthening and dampness-transforming herbs, she was completely well and has not experienced a recurrence since.

5. Self-Assessment for Phlegm-Dampness Constitution

1. Dizziness, Headache, Heaviness in the Head

In TCM, the head is considered the residence of the clear and the spirit, requiring nourishment from qi, blood, and essence, and should not be disturbed by turbid evils. If phlegm-dampness ascends and obstructs the clear, it can lead to dizziness, headache, and a feeling of heaviness in the head.

Headaches and dizziness that are substantial are often seen in cases of hypertension.

Western medicine believes that hypertension is caused by spasms of cerebral blood vessels or loss of elasticity due to vascular hardening, leading to obstructed blood flow and increased pressure.

From a TCM perspective, the turbid evil of phlegm-dampness, being heavy and tangible, combined with the characteristic of “phlegm being a problem that rises and falls with qi, reaching everywhere”, can lead to phlegm-dampness ascending and obstructing the clear yang, filling and blocking the blood vessels, which can also result in elevated blood pressure.

Therefore, for hypertensive patients who exhibit symptoms of phlegm-dampness obstructing the head’s clear yang, treating them with methods to clear and transform phlegm-dampness can yield significant results.

Symptoms of dizziness, headache, and heaviness in the head caused by phlegm-dampness may persist or fluctuate, but they are fundamentally different from those caused by qi and blood deficiency. Using tonifying agents is not only ineffective but may worsen the condition, as it obstructs the substantial nature of the problem.

If stubborn phlegm and stagnant blood do not disperse, they can condense into tumors, residing in the brain or other parts of the body. Without transforming and dispersing the stubborn phlegm and stagnant blood, the tumor cannot be eliminated.

2. Nausea or Vomiting of Phlegm and Saliva, or Gurgling Sounds in the Stomach and Intestines, or Sticky, Greasy, Dry Mouth with No Desire to Drink Water

The turbid evil of phlegm-dampness lingers in the stomach and intestines, causing the stomach to lose its harmony and descent, leading to obstruction of the qi in the bowels, resulting in frequent nausea or vomiting of phlegm and saliva, or gurgling sounds in the stomach and intestines.

Phlegm and fluids rising can lead to a sticky sensation in the mouth. Phlegm turbidity is originally transformed from body fluids, but it can also obstruct the movement of body fluids, leading to occasional dry mouth, as excessive drinking only increases the phlegm evil, causing water to enter and lead to nausea and vomiting.

The above symptoms are often clinically diagnosed as gastrointestinal neurosis, and medication is often ineffective. However, treating with methods to warm and transform phlegm can yield rapid results, or additionally focusing on soothing the liver and regulating the spleen.

3. A Sensation of a Lump in the Throat, Difficulty Swallowing, Occasional Appearance and Disappearance

The occurrence of this symptom generally begins with liver qi stagnation and emotional disharmony, leading to liver depression and spleen deficiency. When the liver and spleen are not in harmony, the spleen’s qi is also suppressed, leading to the accumulation of fluids as phlegm, which rises and obstructs the throat, causing a sensation of a lump and difficulty swallowing.

The characteristic of phlegm is that it can gather and disperse, and since this symptom begins with liver qi stagnation, followed by spleen dysfunction leading to phlegm accumulation, this symptom of a lump in the throat can also appear and disappear with emotional fluctuations.

This type of symptom is often seen in female patients. If the condition persists for a long time, it can lead to deficiency, resulting in yin deficiency with phlegm. If only phlegm-transforming methods are used, it may further deplete yin fluids, exacerbating the sensation of blockage and dryness in the throat. It is essential to also include sufficient nourishing yin fluids to nourish while transforming, so that phlegm and qi obstruction can be resolved.

4. Palpitations, Insomnia, or Fainting, Convulsions, or Mental Disorders, but Neurological Examinations Show No Abnormalities, and There Are No Symptoms of Yin Deficiency or Yang Excess

“Phlegm qi obstructing the heart” and “phlegm obstructing the heart orifices” refer to this type of condition. In TCM, the “heart” also refers to brain function, as in “the heart governs the spirit” and “the brain is the residence of the original spirit”.

Thus, when phlegm qi obstructs the heart orifices, it often manifests as dysfunction of the cerebral cortex. Treating these conditions with methods to clear phlegm and open the orifices can often yield satisfactory results.

5. Stools Coated with Phlegm and Saliva, or Constipation with Difficulty Passing Stools

When phlegm turbidity lingers in the stomach and intestines, it can lead to stools being coated with phlegm and saliva. Treating with methods to strengthen the spleen and transform phlegm should yield results. If phlegm turbidity lingers in the intestines, obstructing the qi in the bowels, it can lead to constipation (but the stools are not dry). In this case, the more one tries to moisten the bowels, the more constipated they become. If one uses methods to move qi and transform phlegm, the stools will pass quickly.

6. Low-grade Fever and Heaviness in the Body, or a Sensation of Heat Without Obvious Fever

Phlegm is a yin evil, characterized by its viscous nature, making it prone to internal stagnation. When phlegm turbidity stagnates, it obstructs yang qi, preventing it from spreading, leading to a situation where yin does not match yang, causing yin to obstruct yang and generate heat. The heat caused by phlegm turbidity obstructing yang is different from the heat caused by external pathogens or the symptoms of blood deficiency, yin deficiency, or qi deficiency. Its characteristic is heaviness in the body without significant elevation in temperature. Many cases of unexplained low-grade fever, where there are no signs of yin deficiency or qi deficiency, belong to this category.

If one carelessly uses nourishing yin and qi tonics, it may further promote phlegm and evil, leading to persistent low-grade fever and heaviness. If one can carefully examine the tongue and pulse, and accurately assess the true symptoms, focusing on transforming and dispersing phlegm-dampness will yield satisfactory results.

7. Localized Heat or Cold in the Limbs (or Cold Sensation in the Back, or Numbness Without Pain or Itching, or Differences in Size and Sensation in Certain Areas of the Body, but Neurological, Orthopedic, and Dermatological Examinations Show No Abnormalities)

“Phlegm travels with qi and reaches everywhere”, and “the sensations (and) diseases vary widely”; when phlegm turbidity lingers and obstructs, the local circulation of qi and blood is affected, leading to the aforementioned symptoms. If phlegm turbidity accumulates and does not disperse, the affected area may also exhibit swelling or nodules.

8. Ulcers, Erosions, or Exudation of Thick Phlegm-Like Fluid, Long-Term Non-Healing, or Localized Skin Thickening with Scaling but No Exudation

Phlegm-dampness lingers, or heat phlegm condenses, affecting local qi and blood circulation, leading to the exudation of tangible phlegm turbidity. This can result in persistent exudation and even ulceration. If this condition persists for a long time, the righteous qi may weaken, and the affected area may become susceptible to external wind, cold, or heat, making it difficult for the qi and blood to return to normal, resulting in prolonged non-healing. This condition begins with phlegm turbidity accumulation, which subsequently leads to qi and yin deficiency, accompanied by stubborn phlegm that does not transform.

If the affected area exhibits thickened skin with scaling, it indicates qi and yin deficiency, along with the presence of stubborn phlegm accumulation.

9. Chest Tightness and Shortness of Breath, Sensation of Distension in the Back, Preference for Sighing or Pounding on the Chest. These Symptoms Are Particularly Obvious in Overcast or Rainy Weather or During Temperature Changes

Phlegm-dampness stagnates in the chest, obstructing the yang qi in the chest (leading to lung qi failing to descend), resulting in a sensation of chest tightness and shortness of breath. If phlegm turbidity stagnates in the back, it can lead to a sensation of distension or coldness in the back.

Sighing and pounding on the chest can temporarily relieve the qi obstruction, which is why patients often sigh loudly or pound their chests for relief. If phlegm turbidity obstructs excessively, causing complete blockage of the chest’s yang qi, it can lead to temporary stagnation of qi and blood flow, resulting in pain in the chest area, which can lead to severe acute myocardial infarction.

10. Masses or Nodules, Either Beneath the Skin or Accumulated in the Abdomen, Can Also Occur in Other Tissues or Organs, with No Changes on the Skin Surface, or a Slight Cold Sensation, or Dull Skin Color