Flowing phlegm

A chronic destructive condition of the joints characterized by the formation of pus that can flow, or spread, to other parts, and that after rupture discharges like thin phlegm. Flowing phlegm is nowadays considered to be a form of headless flat-abscess. It is most commonly observed in children and adolescents often found to have a history of consumption (pulmonary tuberculosis), and affects most commonly the hip bone or spine and less commonly the knee, ankle, shoulder, elbow, or wrist.

Flowing phlegm is named differently according to location. Flowing phlegm of the spine is called tortoise’s-back phlegm, whereas that of the hip is called Jumping Round phlegm after GB-30 (Jumping Round, 环跳 huán tiào).

Flowing phlegm arises in patients suffering from insufficiency of the congenital constitution or from kidney yīn depletion in enduring illness, when external evils exploit a vacuity and enter the body and cause phlegm turbidity to gather and congeal. It may be brought on by disharmony of qì and blood stemming from knocks and falls. The condition begins with slight local swelling associated with distension but without redness, heat, or marked pain. The swelling gradually spreads, becomes painful, and suppurates, and the surrounding flesh becomes atrophied. In an advanced stage, effulgent yīn depletion fire may cause postmeridian heat effusion, night sweating, encumbered body and lack of strength, and reduced food intake. Following rupture, clear thin pus is discharged, the flesh is purple, the mouth of the sore is depressed, does not close easily, and the cavity is like a tunnel.

Treatment: In the initial stage, it is treated by supplementing the liver and kidney, warming the channels and transforming phlegm using formulas like Harmonious Yáng Decoction (阳和汤 yáng hé tāng). In the middle stage, treatment aims to support right and expel toxin. In the advanced stage after suppuration and rupture, emphasis is placed on supporting right to help the sore to close. Patients with signs of dual depletion of qì and blood can be given Ginseng Provisioning-Nourishing Decoction (人参养荣汤 rén shēn yǎng róng tāng), whereas those with signs of effulgent yīn depletion can be given Major Yīn Supplementation Pill (大补阴丸 dà bǔ yīn wán). If there is tunneling, Thousand Gold Pieces Powder (千金散 qiān jīn sǎn) can be applied topically.

Biomedical correspondence: tuberculosis of the bone or joints.

See headless flat-abscess; flat-abscess; sore³.