In the theory of organ systems in Traditional Chinese Medicine (TCM), the spleen is not equivalent to the anatomical spleen but is a functional concept. For instance, the spleen is responsible for ascending clear qi, while the stomach is responsible for descending turbid qi. The spleen also governs the transformation and transportation of water and dampness. If there are obstacles in the circulation and excretion of body fluids, these fluids cannot nourish the body properly and may instead accumulate abnormally, forming a pathological substance. This abnormal accumulation of fluids is collectively referred to as “phlegm-damp”.Among these, the turbid, viscous, and thick parts are called “phlegm” (痰), while the clear, thin, and transparent parts are referred to as “damp” (饮).
Therefore, “phlegm-damp” does not solely refer to the phlegm produced in the lungs that is expelled through coughing and can be seen. In TCM, “phlegm” also includes pathological products that arise due to metabolic disorders of body fluids, characterized by turbid, viscous, and thick properties.
Since this type of “phlegm” is not as readily observable as the phlegm in the lungs, TCM refers to it as “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 understanding of “phlegm” in TCM.
“Visible phlegm” primarily exists in the lungs and may arise from either internal metabolic disorders of body 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 likely familiar with “visible phlegm” as we often encounter it during colds and coughs. However, have we noticed the detail that even though it is all phlegm coughed up from the lungs, there are various differences in its characteristics?
For example, 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 the same phlegm 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
Visible Phlegm
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 thick, and its color changes from transparent to light yellow and 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 greater the degree of yellow thickness, the higher the level of heat in the body.
According to this principle, TCM classifies 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 classified as “heat phlegm”.
Since cold phlegm and heat phlegm reflect completely opposite natures, their treatments are also entirely different. To treat cold phlegm, warming methods are used, with commonly used herbs including 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 for heat phlegm, clearing heat and transforming phlegm is the approach, with commonly used herbs including Zhe Bei Mu (Zhejiang Fritillaria), Chuan Bei Mu (Sichuan 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 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 played a role in breaking down and settling the impurities 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 phlegm turbidity, thereby eliminating diseases caused by phlegm turbidity.
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 formed due to excessive secretion of mucus by respiratory tract 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 naturally exist in the air and do not harm the body under normal circumstances. Only when there is excessive accumulation of dampness in the body, creating an overly humid internal environment, do these microorganisms proliferate and reproduce in large numbers, thereby harming health and causing various diseases.
Therefore, for these types of diseases, the true root cause lies in the “dampness” of the internal environment. Just as 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 weather. If the sky is clear and sunny, there will be no damp environment.
There is a saying, “When the sun is high, the haze dissipates”, which illustrates this point. The intense 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 “high sun” effect in the body, allowing the damp “haze” to dissipate. This eliminates the root cause of 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 phlegm-damp, 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” and how can we determine its existence? TCM identifies four criteria for determining the presence of “invisible phlegm” in the body.
①Obesity. The TCM saying “obese individuals have more phlegm-damp” refers to the presence of “invisible phlegm” in obese individuals, as fat possesses the characteristics of phlegm: turbid, viscous, and thick. It is formed from the accumulation of turbid substances in the body.
②Thick and greasy tongue coating. A thick and greasy tongue coating is the most direct manifestation of excessive water and dampness in the body.
③Swelling masses. Any swelling that is not red, protrudes from the skin surface, and is nodular in shape, soft or resilient to touch, is referred to as a “phlegm mass” in TCM.
④Slippery pulse. TCM classifies pulse sensations into more than twenty types, 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 pulse feels like beads rolling smoothly on a surface. 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 instance, conditions such as hyperlipidemia, cysts, lymph node tuberculosis, and bone tuberculosis in Western medicine all exhibit characteristics of turbidity, viscosity, and thickness, and can thus be considered phlegm-related diseases. In this way, Western medical examinations become an extension of TCM’s 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 of the body, finding fundamental treatment methods. For example, 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 transformation and transportation, leading to excessive accumulation of damp phlegm in the body. Therefore, treatment can be approached by strengthening the spleen, assisting its function, and transforming phlegm to soften hard masses. Moreover, by addressing the root cause of phlegm formation, the treatment effect is long-lasting.
The spleen’s insufficient transformation of water and dampness leads to the accumulation of dampness in the body, and the turbid substances in the dampness can condense in certain areas, forming phlegm masses, such as the cysts, lymph node tuberculosis, and bone tuberculosis mentioned above. They can also enter the meridians and blood vessels, traveling throughout the body with the circulation of qi and blood, as previously discussed regarding blood lipids.
These turbid substances possess viscous properties, 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 and tissues, leading to various diseases. For instance, if phlegm accumulates in the head, it can affect blood supply to the brain, resulting in symptoms such as dizziness, forgetfulness, drowsiness, and even coma, hemiplegia, or speech difficulties, which Western medicine refers to as cerebral infarction. 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 symptoms such as palpitations, anxiety, irregular heartbeat, and chest tightness, which Western medicine refers to as coronary heart disease, and in many cases, it is closely related to phlegm.
Moreover, phlegm can also affect a person’s mental state. If the turbid qi of phlegm-damp obstructs normal mental and cognitive 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
Characteristics of Phlegm
Regarding the characteristics of phlegm, the great physician of the Yuan Dynasty, Zhu Danxi, 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 that “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 the diagnosis and treatment of diseases. Sometimes, even if the syndrome differentiation is correct and the medication is appropriate, the clinical outcomes may not be ideal. In such cases, we can consider incorporating phlegm-transforming methods, which often yield unexpectedly good results.
4
Meniere’s Syndrome as Phlegm-Damp
Meniere’s syndrome, previously known as Ménière’s disease, is characterized clinically by: paroxysmal vertigo that occurs frequently, 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 pain, with activity exacerbating the severity of vertigo and vomiting.
Therefore, during an episode, patients often lie still with their eyes closed, afraid to move, and some may feel a sensation of blockage and pressure in the ear, or experience nystagmus.
Western medicine believes this condition is caused by increased lymphatic fluid and pressure in the inner ear, leading to ear-related vertigo.
According to the description of “Mao Xuan” syndrome in the “Jin Gui Yao Lue”, “Mao” refers to nausea and vomiting, and “Mao Xuan” indicates a disease characterized by simultaneous vertigo and nausea/vomiting.
Zhang Zhongjing believed it was caused by “water retention in the heart”, which is very similar to Meniere’s syndrome, suggesting that this disease is due to water retention in the inner ear. The use of the “Ze Xie Decoction” from the “Jin Gui Yao Lue” can achieve excellent clinical results.
The composition of Ze Xie Decoction consists of two herbs—Ze Xie (Alisma) and Bai Zhu (White Atractylodes). Ze Xie, as recorded in the “Shen Nong’s Herbal Classic”, is said to “treat wind, cold, dampness, and eliminate water”; Bai Zhu, as mentioned in the “Record of Famous Physicians” by the Jin Dynasty physician Tao Hongjing, is said to “eliminate phlegm and water, expel wind-water swelling”, 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 internal water retention, while Bai Zhu assists in strengthening the spleen and eliminating phlegm-water. This combination effectively addresses both the symptoms of water retention and the root cause of phlegm production due to spleen deficiency, resulting in rapid therapeutic effects despite the small number of ingredients.
Self-Assessment for Phlegm-Damp Constitution
1. Dizziness, headache, and heaviness in the head.
In TCM, the head is considered the residence of clear yang and the place where the original spirit resides. It requires nourishment from qi, blood, and essence, and should not be disturbed by turbid evils. If phlegm-damp rises and obstructs the clear yang, it results in dizziness, headache, and a feeling of heaviness.
Headaches, dizziness, and heaviness in the head are often associated with hypertension.
Western medicine considers hypertension to be caused by vascular spasms or loss of elasticity in blood vessels, leading to obstructed blood flow and increased pressure.
From a TCM perspective, the turbid evil of phlegm-damp is heavy and tangible, and combined with the characteristic of phlegm being able to rise and fall with qi, it can obstruct the clear yang, filling and blocking the blood vessels, which may also lead to vascular spasms and loss of elasticity, resulting in elevated blood pressure.
Therefore, for hypertensive patients who exhibit symptoms of phlegm-damp obstructing the clear yang in the head, treatment based on clearing and transforming phlegm-damp can yield significant results.
Symptoms of dizziness, headache, and heaviness in the head caused by phlegm-damp may persist or fluctuate, but they are fundamentally different from those caused by qi and blood deficiency. Using tonics may not only be ineffective but may also worsen the condition, as it can aggravate the obstruction of turbid evils.
If stubborn phlegm and stagnant blood accumulate, they can condense into 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 of phlegm and saliva, or a gurgling sound in the stomach and intestines, or a sticky, greasy mouth, or dry mouth with no desire to drink.
The turbid evil of phlegm-damp lingers in the stomach and intestines, causing the stomach to lose its harmony and descent, leading to obstructed qi in the bowels, resulting in frequent nausea or vomiting of phlegm and saliva, or a gurgling sound 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 dry mouth, as if drinking too much water only adds to the phlegm evil, causing water to enter and then lead to nausea and vomiting.
These symptoms are often clinically diagnosed as gastrointestinal neurosis, and medication is often ineffective. However, if treated with warming and transforming phlegm, or by promoting liver and spleen function, the results can be rapid.
3. A sensation of obstruction in the throat, difficulty swallowing, with symptoms appearing intermittently.
The occurrence of this condition generally begins with liver qi stagnation due to emotional distress, 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 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 condition 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 or disappear depending 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 with 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 substances to nourish while transforming, so that phlegm and qi obstruction can be resolved without recurrence.
4. Palpitations, insomnia, or fainting, convulsions, or mental disorders, but neurological examinations show no abnormalities, nor are there signs of yin deficiency or yang excess.
“Phlegm-qi obstructing the heart” and “phlegm obstructing the heart orifices” refer to these types of symptoms. 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, phlegm-qi obstructing the heart and phlegm obstructing the heart orifices often manifest as dysfunction of the cerebral cortex. For these types of symptoms, treatment with phlegm-clearing and orifice-opening methods can often yield satisfactory results.
5. Stools coated with phlegm and saliva, or constipation with difficulty passing stools.
Phlegm turbidity lingers in the stomach and intestines, leading to stools coated with phlegm and saliva. Treatment with spleen-strengthening and phlegm-transforming methods should yield results. If phlegm turbidity lingers in the intestines, obstructing bowel qi, it can lead to constipation (though the stools are not dry). In this case, the more one tries to moisten the bowels, the more constipated they become. If treated with qi-moving and phlegm-transforming methods, the stools can be quickly passed.
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 viscous nature and tendency to remain hidden. When phlegm turbidity remains hidden, it obstructs yang qi, preventing it from expanding, resulting in a condition where yin does not match yang, leading to stagnation and heat. Phlegm turbidity obstructing yang can cause low-grade fever, which 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 heat. Many cases of unexplained low-grade fever, where signs of yin deficiency or qi deficiency are absent, belong to this category.
If one carelessly administers yin-nourishing and qi-tonifying formulas, it may further promote phlegm and evil, resulting in persistent low-grade fever and heaviness. If one can carefully examine the tongue and pulse, and accurately assess the symptoms, focusing on transforming and dispersing phlegm-damp, satisfactory results can be achieved.
7. Localized heat or cold in the limbs (or a cool sensation in the back, or numbness without pain or itchiness, or differences in size and sensation in certain areas of the body, but neurological, orthopedic, and dermatological examinations show no abnormalities).
“Phlegm follows qi and reaches everywhere”, and “the sensations experienced can vary, with numerous pathological changes”. When phlegm turbidity lingers and obstructs, the flow of qi and blood in the local area is hindered, 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 viscous phlegm, which do not heal for a long time, and may also present with thickened skin that does not exude fluids.
Phlegm-damp lingers or heat phlegm condenses, affecting local qi and blood flow, leading to the exudation of phlegm turbidity. This can result in persistent ulcers and erosions. If the condition does not heal for a long time, the righteous qi may be weakened, and the affected area may be exposed to external wind, cold, or heat, making it difficult for qi and blood to return to normal, resulting in prolonged non-healing. This condition begins with phlegm turbidity condensing, leading to qi and yin deficiency, along with stubborn phlegm that does not transform.
If the affected area exhibits thickened skin, it indicates qi and yin deficiency, along with the presence of stubborn phlegm.
9. Chest tightness and shortness of breath, with a feeling of fullness in the back, a tendency to sigh or pound the chest. These symptoms are particularly pronounced during overcast or changing weather.
Phlegm-damp stagnates 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 turbidity stagnates in the back, it can lead to a feeling of fullness or coldness in the back. Sighing and pounding the chest can temporarily relieve the qi obstruction, which is why patients often sigh loudly or pound their chest for relief. If phlegm turbidity obstructs the yang qi completely, it can lead to temporary stagnation of qi and blood flow, resulting in chest pain that feels constricting, and can even lead to severe acute myocardial infarction.
10. Swellings, nodules, or lumps, either beneath the skin or within the abdomen, which may also occur in other tissues or organs, with no changes in the skin surface, or a cool sensation, or a dull complexion.
⊙Copyright Notice: The article is sourced from the internet, and the copyright belongs to the original author. If there is any infringement, please contact the 【Ai Jiang】 public account for deletion. Thank you.
