In Traditional Chinese Medicine (TCM), phlegm-dampness is a pathological substance formed due to the impaired function of the spleen in transforming and transporting water and dampness. When the circulation and excretion of fluids in the body are obstructed, these fluids fail to nourish the body properly and instead accumulate abnormally, leading to the formation of a pathological substance known as “tan yin” (痰饮).

Among these fluids, the turbid, viscous, and thick parts are referred to as “tan” (痰), while the clear, thin, and transparent parts are called “yin” (饮).

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

For instance, obesity is referred to as “tan” in TCM. This type of “tan” is not as easily recognized as the phlegm from the lungs, so it is termed “invisible phlegm” (无形之痰), while the phlegm produced in the lungs that can be expelled and seen is called “visible phlegm” (有形之痰). Together, these two concepts form the TCM understanding of “tan”.

“Visible phlegm” primarily exists in the lungs and may arise from either internal metabolic disorders of fluids or external pathogenic factors invading the lungs. Once produced, this 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. However, have we noticed the various differences in the characteristics of phlegm that is coughed up from the lungs? For example, some phlegm may be white and viscous, while others may be thin and white, foamy, thick and yellow, gray-black, or yellow-green. Why does phlegm exhibit such a variety of changes?

Upon careful analysis, the differences in the 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. What do the different textures and colors of phlegm signify?

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

This phenomenon can be extrapolated to the phlegm in the body. The thickness and color of phlegm are closely related to the presence of “heat” in the body. 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 greater the thickness of the yellow phlegm, the higher the level of heat in the body.

Based on this principle, TCM categorizes thin, white, or foamy phlegm as “cold phlegm” (寒痰), while thick, yellow, or even yellow-green phlegm is classified as “hot phlegm” (热痰).

Since cold phlegm and hot phlegm reflect completely opposite natures, their treatments are also entirely different. To treat cold phlegm, warming and transforming methods are used, with common herbs including Gan Jiang (干姜), Xi Xin (细辛), Ban Xia (半夏), Chen Pi (陈皮), Bai Jie Zi (白芥子), and Lai Fu Zi (莱菔子). In contrast, to treat hot phlegm, clearing heat and transforming phlegm methods are employed, with common herbs such as Zhe Bei Mu (浙贝), Chuan Bei Mu (川贝), Tian Zhu Huang (天竺黄), Dan Nan Xing (胆南星), Gua Lou (瓜蒌), and Tian Hua Fen (天花粉).

Regardless of whether it is cold or hot phlegm, TCM emphasizes the concept of “transformation” in treatment. What does “transformation” mean? In the past, before the advent of running 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. The alum acted to decompose and settle the impurities in the murky water, which is the essence of “transformation”.

The phlegm-transforming herbs used in TCM for various phlegm conditions serve a similar role to that of alum, helping to decompose and settle the phlegm-dampness, thereby alleviating diseases caused by phlegm-dampness.

Western medicine also recognizes two types of phlegm: one is infectious phlegm, caused by bacteria, fungi, mycoplasma, or chlamydia infections; the other is exudative phlegm, often resulting from excessive secretion of mucus by respiratory mucosal cells.

In this case, antibiotics can be effective against phlegm caused by bacterial infections, but there are limited options for phlegm caused by fungi, mycoplasma, or chlamydia infections, as well as for exudative phlegm. How does TCM view and treat these “phlegm” diseases?

TCM believes that microorganisms such as fungi, mycoplasma, and chlamydia are normally present in the air and do not harm the 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 the body and causing various diseases.

Therefore, for these types of diseases, the true root cause lies in the “humidity” of the internal environment. Just as in the rainy season, the humid environment allows for the proliferation of fungi, making things prone to mold. If you can recognize that humidity is the main cause of fungal proliferation in natural phenomena, why would the human body be any different?

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

There is a saying: “When the sun is high in the sky, the haze dissipates.” This means that the intense sunlight can drive away humidity, primarily relying on its heat. Therefore, when treating this type of phlegm, we should use warming herbs to create a “high sun” effect in the body, allowing the humid “haze” to dissipate. This eliminates the root cause of water and dampness accumulation in the body, preventing the survival and reproduction of microorganisms such as fungi.

In the Han Dynasty, the medical sage Zhang Zhongjing proposed in the “Jin Gui Yao Lue” that the principle for treating this condition is “for those with 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 then is “invisible phlegm,” and how can we determine its presence? TCM identifies four criteria for determining the existence of “invisible phlegm” in the body.

① Obesity. TCM states that “obese individuals often have phlegm-dampness,” referring to the presence of “invisible phlegm” in the bodies of overweight individuals, as fat possesses the characteristics of “tan” (phlegm) in terms of its turbid, viscous, and thick nature, accumulating from the dirty parts of water and dampness in the body.

② Thick and greasy tongue coating. A thick and greasy tongue coating is the most direct manifestation of excessive water and dampness in the body.

③ Masses. Any mass that is not red in color, protruding from the skin surface, and is nodular in shape, soft or firm upon palpation, is referred to as a “phlegm mass” (痰块) in TCM, containing water, mucus, or gelatinous substances.

④ Slippery pulse. TCM classifies pulse sensations felt under the fingers into more than twenty types, with slippery pulse being one of them. The description of slippery pulse in TCM is “flowing smoothly, like beads rolling on a plate,” indicating that the pulse sensation we feel is as smooth and swift as beads rolling on a smooth plate. The presence of slippery pulse is one of the characteristic manifestations of phlegm-dampness in the body and is a major basis for TCM diagnosis of “phlegm”.

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 palpation.

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 instance, hyperlipidemia, cysts, and lymph node tuberculosis all conform to 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-dampness in the body. Therefore, treatment can be approached through strengthening the spleen, assisting its function, and transforming phlegm to soften hard masses. Moreover, by eliminating the generation of phlegm from the root, the treatment effects are long-lasting.

Here, I can provide two examples. One patient with hyperlipidemia had taken medications such as Shujian and Lipingzhi without significant effects. He felt dizzy and fatigued, had poor appetite, excessive daytime sleepiness, frequent dreams at night, palpitations, and irregular bowel movements, with a pale complexion and a thin, weak pulse.

I diagnosed him with spleen deficiency leading to the inability to transform water and dampness, resulting in the accumulation of phlegm-dampness in the blood vessels, affecting the circulation of qi and blood, thus causing the disease. I prescribed a TCM formula to strengthen the spleen and transform phlegm: 30g of Chao Bai Zhu (炒白术), 15g of Dang Shen (党参), 10g of Chen Pi (陈皮), 10g of Ban Xia (半夏), 6g of Gan Cao (甘草), 15g of Fu Ling (茯苓), 6g of Ju Luo (橘络), 10g of Dan Nan Xing (胆南星), 15g of Jiao Shan Zha (焦山楂), and 5 slices of Sheng Jiang (生姜).

After completing the 7 doses of medicine, the patient reported significant improvements in energy and appetite, with dizziness reduced by more than half, and bowel movements became more regular. 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 a recheck of his blood lipids showed they had returned to normal levels.

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

In TCM, the formation of cysts is seen as a result of phlegm-dampness accumulating in a specific area, and the production of phlegm-dampness 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 water and dampness, we can eliminate the accumulation of phlegm-dampness in the body, thus resolving the cyst.

Based on this understanding, I prescribed a formula to strengthen the spleen, transform phlegm, and promote diuresis: 45g of Chao Bai Zhu (炒白术), 15g of Ze Xie (泽泻), 15g of Hua Shi (滑石), 10g of Zhu Ling (猪苓), 15g of Fu Ling (茯苓), 10g of Gui Zhi (桂枝), 20g of Ban Xia (半夏), 10g of Zhi Nan Xing (制南星), 30g of Yi Yi Ren (薏苡仁), and 10g of Qing Pi (青皮).

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 ingredients remained as stated. These two examples clearly demonstrate that the theory of phlegm in TCM withstands practical testing.

The spleen’s insufficient ability to transform water and dampness leads to the accumulation of turbid substances in the body, which can condense into phlegm masses, such as the cysts, lymph node tuberculosis, and bone tuberculosis mentioned earlier. It 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 possess viscous characteristics, often obstructing the flow of qi and blood in the meridians and blood vessels, causing pathological changes due to ischemia and hypoxia in the organs, leading to various diseases. For example, if phlegm accumulates in the head, it can affect blood supply to the brain, resulting in symptoms such as dizziness, forgetfulness, excessive sleepiness, and even coma, hemiplegia, or speech difficulties, which Western medicine refers to as cerebral infarction, but many cases in TCM are attributed to phlegm.

If phlegm accumulates in the limbs, it can lead to blood supply disorders in the extremities, resulting in symptoms such as numbness in the limbs and cold extremities. 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 incessant 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-dampness” is referred to as “phlegm obstructing the heart orifices” (痰迷心窍).

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 TCM attributes many strange diseases or conditions with poor treatment outcomes to “phlegm”.

Thus, there is a saying in TCM: “Strange diseases often 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. Sometimes, even when the syndrome differentiation is correct and the medication is appropriate, the clinical outcomes may not be 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. After squatting or sitting for a long time, if he suddenly stood up, he would feel black in front of his eyes and even faint.

He felt heavy-headed all day, with low energy, a soft voice, pale complexion, average appetite, and normal bowel and urinary functions. His tongue was pale with a thin white coating, and his pulse was thin and weak. In the past month, his dizziness seemed to have worsened. Western medicine diagnosed him with insufficient blood supply to the brain.

At that time, I thought this was a typical case of qi sinking. 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 (补中益气汤). After prescribing the medicine, I confidently told the patient that he would definitely see significant improvement after finishing the 5 doses.

However, five days later, the patient returned for a follow-up and told me that there had been no improvement in his dizziness! He also reassured me that it might take time to improve since he had this problem for a long time. I carefully inquired about his condition and concluded that it was still qi sinking. Since there was no error in syndrome differentiation, 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. Since there was qi deficiency, it must have led to abnormal transformation of water and dampness, resulting in internal phlegm obstructing the brain and causing dizziness.

The previous treatment was ineffective because I only considered qi deficiency without considering the presence of phlegm-dampness in the meridians and blood vessels. Therefore, I prescribed a new formula to tonify qi and transform phlegm: 15g of Huang Qi (黄芪), 15g of Dang Shen (党参), 12g of Chao Bai Zhu (炒白术), 10g of Gan Jiang (干姜), 10g of Fu Ling (茯苓), 6g of Chen Pi (陈皮), 10g of Chuan Xiong (川芎), 3g of Sheng Ma (升麻), 3g of Chai Hu (柴胡), 6g of Jie Geng (桔梗), 6g of Ju Luo (橘络), and 6g of Zhi Nan Xing (制南星). I prescribed 5 doses again.

Five days later, the patient joyfully reported that this time the medicine was effective; after just five days, his dizziness had significantly reduced. I then advised him to take Xiang Sha Liu Jun Wan (香砂六君丸) for consolidation. After about a month of taking it, I followed up with the patient a year later, and he had not experienced any recurrence of dizziness.

4. Meniere’s Disease as a Phlegm-Dampness Induced Condition

Here, I would like to mention Meniere’s disease (formerly known as Ménière’s disease). The clinical features of this condition include paroxysmal vertigo that frequently occurs, during which the patient feels that surrounding objects are spinning, similar to the sensation of being on a moving vehicle, accompanied by nausea, vomiting, and head heaviness, with activities exacerbating the severity of vertigo and vomiting.

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 condition is caused by increased lymphatic fluid in the inner ear, leading to ear-related vertigo.

Based on Zhang Zhongjing’s records in the “Jin Gui Yao Lue” regarding the “Mao Zhuang” syndrome (where “Mao” refers to nausea and vomiting, indicating a disease characterized by vertigo, nausea, and vomiting during episodes), he believed it was caused by “fluid retention in the heart,” which closely resembles Meniere’s disease. I treated it using the “Ze Xie Tang” (泽泻汤) from the “Jin Gui Yao Lue,” achieving excellent clinical results.

The composition of Ze Xie Tang consists of just two herbs—Ze Xie (泽泻) and Bai Zhu (白术). Ze Xie, as recorded in the “Shen Nong Ben Cao Jing,” has the effect of “relieving wind, cold, and dampness, and eliminating water.” Bai Zhu, as mentioned in the “Ming Yi Bie Lu” by the Jin Dynasty physician Tao Hongjing, is said to “eliminate phlegm and water, and expel wind-water accumulation,” and is also noted for its ability to “warm the stomach and eliminate food stagnation.”

When these two herbs are combined, Ze Xie primarily promotes urination to eliminate water retention, while Bai Zhu assists in strengthening the spleen and eliminating phlegm. This combination effectively addresses both the symptoms of water retention and the root cause of phlegm-dampness due to spleen deficiency, resulting in rapid therapeutic effects despite the small number of ingredients.

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 experienced severe vertigo, nausea, and vomiting, making it impossible for her to eat, with any intake resulting in vomiting. She lay in bed with her eyes closed, feeling slightly better, but any movement exacerbated her symptoms.

She felt heavy-headed and spoke softly. During the consultation, she ran to the door to vomit twice, with the vomit being clear fluid. She reported that she had not eaten anything for a day and still felt nauseous. Her tongue was pale with a white greasy coating, and her pulse was wiry.

Based on the understanding of “fluid retention in the inner ear,” I prescribed Ze Xie Tang: 30g of Ze Xie and 45g of Chao Bai Zhu, boiled in one and a half bowls of water until reduced to half a bowl, to be taken warm.

I instructed the patient not to drink it all at once but to take a sip, wait about five minutes, and if there were no adverse reactions, to take another sip, gradually finishing 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 diet with spleen-strengthening and dampness-eliminating herbs, she was completely well and has not experienced any recurrence since.

Phlegm-Dampness Constitution Self-Assessment

1. Dizziness, headache, and heaviness in the head.

In TCM, the head is the residence of the clear yang 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 yang, it results in dizziness, headache, and heaviness in the head.

Headaches, dizziness, and heaviness in the head are often associated with hypertension.

Western medicine considers hypertension to be caused by spasms of cerebral blood vessels or loss of elasticity in the blood vessels, leading to obstructed blood flow and increased pressure.

From a TCM perspective, the phlegm-dampness evil is heavy and turbid, and combined with the characteristic of “phlegm being a problem that rises and falls with qi, reaching everywhere,” phlegm-dampness can ascend and obstruct the clear yang, filling and blocking the blood vessels, which can also lead to vascular spasms and loss of elasticity, resulting in elevated blood pressure.

Therefore, for hypertensive patients who exhibit symptoms of phlegm-dampness obstructing the clear yang in the head, 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 also worsen the condition, as it aggravates the obstruction of turbid evils.

If stubborn phlegm and stagnant blood accumulate and solidify, they can form tumors, residing in the brain or other parts of the body. Without transforming and dispersing stubborn phlegm and stagnant blood, the issue of tumors cannot be resolved.

2. Nausea or vomiting phlegm and saliva, or a gurgling sound in the stomach, or a sticky, greasy mouth with a lack of thirst.

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

Phlegm and fluids rising can lead to a sticky mouth. Phlegm turbidity is originally transformed from body fluids, but it can also obstruct the movement of body fluids, leading to occasional dryness in the mouth. If excessive water intake occurs, it can exacerbate the phlegm evil, resulting in nausea and vomiting.

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

3. A sensation of obstruction in the throat, difficulty swallowing, with symptoms appearing intermittently.

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

The characteristic of phlegm is that it can accumulate and disperse, and since this symptom begins with liver qi stagnation, followed by spleen dysfunction leading to phlegm accumulation, it manifests as a sensation of obstruction in the throat, which can appear intermittently based on emotional states.

This type of symptom is often seen in female patients. If the condition persists for a long time, it can lead to deficiency of yin, accompanied by phlegm. If only phlegm-transforming methods are used, it may further deplete yin fluids, worsening the sensation of obstruction and dryness in the throat. It is essential to also include sufficient nourishing yin fluids to support the treatment, combining nourishment with phlegm transformation, to resolve the obstruction of phlegm and qi.

4. Palpitations, insomnia, or fainting, convulsions, or mental disorders, but neurological examinations show no abnormalities, nor are there signs of yin deficiency or yang hyperactivity.

“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 and turbidity linger in the stomach and intestines, they can lead to stools coated with phlegm and saliva. Treating with methods to strengthen the spleen and transform phlegm should yield results. If phlegm and turbidity linger in the intestines, obstructing the qi of the bowels, it can lead to constipation (though the stools are not dry). This condition can worsen with excessive moistening, leading to more constipation. If treated with methods to move qi and transform phlegm, bowel movements can quickly become smooth.

6. Low-grade fever and body heaviness, or a sensation of heat without a significant increase in body temperature.

Phlegm is a yin evil, characterized by its viscosity and tendency to remain hidden. When phlegm and turbidity remain hidden, they obstruct yang qi, preventing it from expanding, leading to a situation where yin does not match with yang, causing stagnation of yin and resulting in fever. Phlegm and turbidity obstructing yang and causing fever is different from the fever caused by external pathogens or the symptoms of blood deficiency, yin deficiency, or qi deficiency. The characteristic here is a heavy body without significant fever. Many cases of unexplained low-grade fever, where there are no signs of yin deficiency or qi deficiency, belong to this category.

If nourishing yin and tonifying qi herbs are recklessly administered, it can further promote phlegm and evil, leading to persistent low-grade fever and body heaviness. If one can carefully examine the tongue and pulse, and accurately assess the symptoms, focusing on transforming and dispersing phlegm-dampness will yield satisfactory results.

7. Localized heat or cold in the limbs (or a sensation of coolness in the back, or numbness without pain or itchiness in certain areas, or differences in size and sensation in certain parts of the body, but no abnormalities found in neurological, orthopedic, or dermatological examinations).

“Phlegm follows qi and reaches everywhere,” and “the sensations experienced vary, leading to numerous pathological changes.” When phlegm and turbidity linger and obstruct, the local circulation of qi and blood is hindered, resulting in the aforementioned symptoms. If phlegm and turbidity accumulate and do not disperse, the affected area may also exhibit swelling or nodules.

8. Ulcers, erosions, or exudation of thick phlegm, which do not heal for a long time, or localized skin thickening with scaling but no exudation.

Phlegm and dampness linger, or hot phlegm condenses, affecting local qi and blood circulation, leading to the exudation of phlegm and turbidity. This can result in persistent ulcers and exudation. If this condition does not heal for a long time, the righteous qi becomes deficient, and the affected area’s pores may open, making it susceptible to external wind, cold, or heat evils, preventing the restoration of normal qi and blood circulation, thus prolonging the healing process. This begins with the accumulation of phlegm and turbidity, leading to qi and yin deficiency, along with the presence of stubborn phlegm.

For example, if the affected area’s skin thickens and scales, it indicates a deficiency of qi and yin, along with the presence of accumulated stubborn phlegm.

9. Chest tightness and shortness of breath, with a feeling of fullness in the back, preferring to sigh or pound the chest. These symptoms are particularly pronounced during overcast or rainy weather or during temperature fluctuations.

Phlegm and fluids stagnate in the chest, obstructing the yang qi in the chest (causing lung qi to lose its ability to descend), leading to a feeling of chest tightness and shortness of breath. If phlegm and turbidity stagnate in the back, the yang qi in the back is obstructed, resulting in a feeling of fullness or coolness in the back. Sighing and pounding the chest can temporarily relieve the qi obstruction, which is why patients often sigh loudly or pound their chests to feel better. If phlegm and turbidity obstruct the yang qi excessively, it can lead to temporary stagnation of qi and blood circulation, resulting in pain due to obstruction, manifesting as a squeezing sensation in the chest, which can lead to severe acute myocardial infarction in some cases.

10. Masses or nodules, either beneath the skin or within the abdomen, which may also occur in other tissues or organs, with no changes on the skin surface, or a slight coolness or dull color.

The spleen has the function of containing blood, and abnormalities in this function can lead to various bleeding issues. Here, I will introduce the structure that executes the spleen’s function of containing blood (coagulation and anticoagulation).

The Definition of the Spleen’s Function of Containing Blood (Coagulation and Anticoagulation)

This refers to the function of the coagulation system, which produces coagulation factors to prevent bleeding, and the anticoagulation system, which produces anticoagulation factors to prevent thrombosis. The coagulation system consists of the liver, gastrointestinal tract, endothelial cells, platelets, and coagulation factors; the anticoagulation system consists of the anticoagulation system and the fibrinolytic system.

Literature Evidence for the Spleen’s Function of Containing Blood

“Nan Jing, Chapter 42: The spleen… governs the containment of blood.”

“Jing Yue Quan Shu, Miscellaneous Diseases: The spleen contains blood; if the spleen qi is deficient, it cannot contain blood.”

“Ming Yi Bie Lu: The spleen governs the blood of all meridians.”

“Yi Yan, Blood: The spleen governs blood, which flows according to the spleen qi.”

“Jin Gui Yao Lue Zhu: The blood of the five organs and six bowels relies entirely on the spleen qi for containment.”

“Jin Gui Yi, Volume 2: The spleen governs blood; if the spleen is deficient, it cannot contain blood; if the spleen cannot transform blood, it cannot transport it, leading to blood being uncontrolled and leaking.”

“Xue Zheng Lun, Zang Fu Pathogenesis: The spleen governs blood; the circulation of blood up and down relies entirely on the spleen. If the spleen yang is deficient, it cannot govern blood.”

“Xue Zheng Lun, Salivary Blood: If the spleen can govern blood, then blood will circulate through the meridians and not move erratically.”

“Zheng Zhi Hui Bu, Blood Disorders: Therefore, for blood disorders with spleen deficiency, one should tonify the spleen to govern the blood.”

“Shi Yi De Xiao Fang, Treating Yin: If there is damage from labor, or injury to the meridians, if the spleen is deficient and the stomach is weak, it cannot contain blood, leading to sudden and violent bleeding, hence it is called ‘bleeding in the middle’.”

“Ben Cao Jing Jie, Deer Antler: The liver stores blood, the spleen governs blood; if the liver blood does not store, then the spleen blood cannot govern, leading to leakage of bad blood.”

“Nu Ke Cuo Yao, Irregular Menstruation: Blood is produced in the spleen soil, hence the spleen governs blood.”

The above literature indicates that traditional Chinese medicine has recognized the spleen’s function of containing blood and preventing bleeding.

The Execution Structure of the Spleen’s Function of Containing Blood – Coagulation System

Coagulation refers to the process of blood clotting, where blood changes from a flowing liquid state to a non-flowing gel state to prevent bleeding. The coagulation system refers to the bodily structures that have coagulation functions.

1. The liver synthesizes coagulation factors I, II, VII, VIII, IX, X, XI, XII, XIII, high molecular weight kininogen, and pre-kallikrein.

2. The gastrointestinal tract: ① The intestinal flora produces vitamin K, which is absorbed in the small intestine and metabolized with chylomicrons. Dietary vitamin K is fat-soluble and requires bile for absorption. Vitamin K is involved in the synthesis of coagulation factors II, VII, IX, and X; ② The small intestine absorbs calcium ions (Ca2+), which is coagulation factor IV.

3. Endothelial cells (EC): Endothelial cells can prevent blood from leaking out, reduce the formation of blood clots, and synthesize coagulation factors III and V.

The Execution Structure of the Spleen’s Function of Containing Blood – Anticoagulation System

Anticoagulation refers to preventing embolism or thrombosis within blood vessels. The anticoagulation system refers to the bodily structures that have anticoagulation functions.

1. The liver synthesizes antithrombin (mainly), heparin cofactor II, and protein C. Additionally, liver cells can uptake and inactivate activated coagulation factors.

2. Endothelial cells synthesize antithrombin (secondarily), tissue factor pathway inhibitor (TFPI), nitric oxide (NO), prostacyclin (PGI2), adenosine diphosphate (ADP)ase, thrombospondin, membrane-associated heparin-like molecules, tissue-type plasminogen activator (t-PA), and smooth muscle relaxant factors.

It is precisely because coagulation factors, anticoagulation systems, and fibrinolytic systems are primarily synthesized by the liver, and the liver plays an important role in food digestion and nutrient absorption (the spleen’s function of transformation), that the function of containing blood is attributed to the spleen.