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Medicinals used in phlegm-dispelling formulas to treatcough and panting and other conditions caused by phlegm.

Phlegm-transforming cough-relieving panting-calming agents can be divided into two groups: phlegm-transforming medicinals and cough-relieving panting-calming agents. However, the distinction is blurred because phlegm is a major cause of cough and panting, because most phlegm-transforming medicinals can suppress cough and calm panting, and because most agents that suppress cough and calm panting also treat phlegm patterns.

In Chinese medicine, phlegm is understood as a pathological product that can cause disease. It is therefore regarded an evil. It is a substance that not only collects in the lungs, but that can appear in other parts of the body. It can collect in the flesh, giving rise to scrofula, phlegm nodes, or goiter. Phlegm confounding the orifices of the heart can give rise to epilepsy, mania and withdrawal, feeble-mindedness, or wind stroke. Patients suffering from these latter diseases may not suffer from any pronounced condition of phlegm in the chest; hence their phlegm is sometimes described as insubstantial or formless. Nevertheless, it is reflected in the same tongue fur and pulse, namely a slimy tongue fur and a slippery or slippery stringlike pulse.

Phlegm-transforming cough-relieving panting-calming medicinals are either warm or cool. Many are acrid and dispersing; some are bitter and discharging. A few are salty and soften the hardness of goiter, scrofula, and phlegm nodes.

Subcategories

1. Phlegm-transforming agents
2. Cough-relieving panting-calming agents

Properties

Nature: Most are either (slightly) warm or (slightly) cold; few are balanced.

Flavor: Many are bitter (and mostly, when also cold, clear heat); many are acrid (and diffuse the lung, effuse the exterior, or disinhibit qì dynamic). Some are sweet (and often moisten the lung or the intestines); a few animal products are salty and a few other medicinals are balanced.

Channel entry: Almost all phlegm-transforming and most cough-relieving panting-calming medicinals enter the lung (the receptacle of phlegm). Some phlegm-transforming medicinals enter the spleen (the source of phlegm formation); some enter the liver, and some enter the large intestine, heart, or other channels.

Bearing: Varying. Some phlegm-transforming medicinals are upfloating. Many of the cough-relieving panting-calming medicinals treat counterflow ascent of lung qì and are downsinking.

Toxicity: A small number have some degree of toxicity.

Actions andIndications

1. Phlegm-Transforming Agents

Origin of phlegm: Phlegm arises a) when water-damp that gathers as a result of splenic movement and transformation failure concentrates into a thicker form (hence the spleen is said to be the source of phlegm formation), or b) when heat boils and concentrates the fluids of the body.

Places where phlegm collects: Phlegm most easily gathers in the lung (the lung is the receptacle of phlegm). However, in Chinese medical theory, phlegm is not merely a substance that is coughed up as sputum. It can gather in various parts of the body. Phlegm is said to follow qì upward and downward; there is nowhere that is does not reach.

• Collecting in the lung, phlegm gives rise to cough and panting with phlegm rale.
• Obstructing the chest, it causes chest impediment (xiōng bì).
• Collecting in the stomach duct and abdomen, it causes glomus and fullness.
• Clouding the orifices of the heart, it can cause dizziness, epilepsy, and mania and withdrawal.
• When carried by liver wind, it can give rise to wind stroke and fright wind.
• Obstructing the channels and network vessels, it can give rise to tingling and numbness of the limbs, hemiplegia, deviated eyes and mouth, scrofula, goiter, phlegm nodes, and yīn flat-abscesses (yīn jū).

Kinds of phlegm: Four basic kinds of phlegm are differentiated.

• Damp phlegm is characterized by cough and/or panting with expectoration of copious clear thin white phlegm, accompanied by general signs of dampness. Dizziness, glomus and fullness, chest impediment, yīn flat-abscesses, as well as tingling and numbness of the limbs can also be caused by damp phlegm. Damp phlegm is treated by drying dampness and transforming phlegm.
• Cold phlegm gives rise to the same range of conditions as damp phlegm. However, instead of dampness signs, there are general signs of cold. Cold phlegm is treated by warming and transforming cold phlegm.
• Heat phlegm is characterized by cough and panting, with expectoration of thick sticky yellow phlegm and accompanied by general signs of heat. phlegm nodes, scrofula, goiter, epilepsy patterns, and fright wind are sometimes attributable to phlegm fire, which also lies within the scope of heat phlegm. Heat phlegm is treated by clearing heat and transforming phlegm.
• Dryness phlegm is characterized by scant thick sticky phlegm that is not easily expectorated, and dry cough accompanied by signs of dryness.

2. Cough-Relieving Panting-Calming Agents

• These treat cough and panting. Cough and panting can be caused by contraction of external evils or by disease of the bowels and viscera. They can take the form of cold, heat, vacuity, and repletion patterns.
• External evils assailing the lung cause cough and panting accompanied by aversion to cold, heat effusion, nasal congestion, and itchy throat. The most common evils are wind-cold and wind-heat, which each give rise to different patterns.
• Phlegm-turbidity obstruction gives rise to cough and panting accompanied by different signs depending on the nature of the phlegm. A basic distinction is made between damp phlegm, cold phlegm, heat phlegm, and dryness phlegm (see previous subsection).
• Lung yīn vacuity, which often develops after enduring illness, gives rise to cough and panting characterized by dry cough and associated with hoarse voice, emaciation, tidal heat effusion, and night sweating.
• Lung-kidney qì vacuity (with kidney failing to absorb qì) gives rise to vacuity panting, usually associated with faint low voice, greater exhalation than inhalation, panting exacerbated by physical exertion, lassitude of spirit, and spontaneous sweating.

Some cough-relieving panting-calming agents have other actions. For example, some also clear lung heat, so they are suitable for lung-heat cough or panting. These medicinals are described as clearing the lung and relieving cough or clearing the lung and calming panting. Some also transform phlegm, and so are suitable for cough and panting due to phlegm turbidity. These are described as transforming phlegm and relieving cough or transforming phlegm and calming panting. Others possess a lung-moistening action so that they treat cough due to yīn vacuity or lung dryness. These are described as moistening the lung and relieving cough.

Combinations with Other Categories

1. Phlegm-Transforming Agents

It is important to determine the nature of the phlegm and any concurrent evil, and select phlegm-transforming medicinals accordingly (dampness-drying phlegm-transforming medicinals for damp phlegm; heat-clearing phlegm-transforming medicinals for heat phlegm, etc).

• Spleen vacuity with movement and transformation failure is the main cause of water-damp that gives rise to phlegm. Hence, phlegm-transforming medicinals are commonly combined with agents that fortify the spleen and dry dampness, to treat the root of the condition.
• Phlegm turbidity often hampers the qì dynamic giving rise to qì stagnation; at the same time, qì stagnation easily gives rise to phlegm (when qì stagnates, phlegm congeals). For this reason, phlegm-transforming medicinals are often combined with qì-moving medicinals.
• Phlegm turbidity often obstructs the orifices of the lung, giving rise to cough and panting. Therefore, phlegm-transforming medicinals are often combined with agents that suppress cough and calm panting.
• Heat phlegm is formed when fire-heat binds with phlegm. Agents that clear heat and drain fire can be added.
• Cold phlegm and damp phlegm are addressed by adding interior-warming cold-dispersing agents and dampness-transforming dampness-disinhibiting agents.
• For dryness damaging the lung, agents that nourish yīn and moisten the lung can be added.
• For mania and withdrawal, epilepsy, and fright wind due to liver wind with phlegm and characterized by clenched jaw, arched-back rigidity, or convulsions with clouded spirit, add wind-extinguishing tetany-checking and orifice-opening agents.
• For scrofula or goiter with signs of static blood, add blood-quickening stasis-transforming medicinals.

1. Cough-Relieving Panting-Calming Agents

Cough and panting invariably involve phlegm, hence Liú Hé-Jiān said, When treating cough and panting, the priority is to treat phlegm. Phlegm-transforming medicinals are often used in the treatment of cough and panting.

Cough and panting are often caused or triggered by externally contracted evils. For wind-cold cough or panting, agents that effuse and disperse wind-cold and agents that diffuse the lung and calm panting are often used. For wind-heat giving rise to cough with itchy throat, commonly used agents course and disperse wind-heat and disinhibit the throat.

• For dry cough due to yīn vacuity, cough-relieving panting-calming medicinals are often combined with agents that nourish lung yīn.
• For cough with expectoration of blood, blood-stanching medicinals are used.
• For rapid panting and shortness of breath due to lung-kidney qì vacuity, use medicinals that supplement lung and kidney qì.
• For panting and cough with fullness in the chest and rapid breathing, add qì-moving medicinals that disinhibit the qì dynamic in the chest.
• For lung-heat cough and panting, cough-relieving panting-calming medicinals are often combined with agents that clear the lung and drain fire.

Method of Use and Warnings

1. Phlegm-Transforming Agents

Some phlegm-transforming medicinals are irritants and should not be used when expectorated phlegm is streaked with blood or when there is coughing of blood, because they can increase the bleeding.

Warm drying medicinals should not be used where there are signs of yīn vacuity or blood heat.

Some phlegm-transforming medicinals are toxic. Their dose should be controlled; they must be processed properly, and they should be used with care or are contraindicated in pregnancy.

When using minerals or shells in pill or powder form for patients suffering from spleen vacuity, it is important to use spleen-fortifying agents and food-dispersing agents.

2. Cough-Relieving Panting-Calming Agents

Cough-relieving panting-calming medicinals treat the tips (i.e., the tip versus the root of the disorder). For cough and panting when evil qì is present, it is not appropriate to use medicinals of this subcategory alone, since this may close the gates, shutting the intruder inside, and prevent the evil from being dispelled.

A small number of cough-relieving panting-calming medicinals are toxic. Their dosage should be controlled. Attention should be paid to their method of use. Their use should be discontinued once the disease has been dealt with.

Some items are seeds that are oily and lubricate the intestines; these should be used with care in patients suffering from spleen vacuity with sloppy stool.

Some cough-relieving medicinals gain a yīn-nourishing lung-moistening action after being mix-fried with honey. This allows them to be used for yīn vacuity and lung dryness.

Phlegm-Transforming Cough-Relieving Panting-Calming Agents

Phlegm-Transforming Agents

• Bàn xià (半夏 Pinelliae Rhizoma, pinellia [rhizome])
• Tiān nán xīng (天南星 Arisaematis Rhizoma, arisaema [root])
• Dǎn xīng (胆南星 Arisaema cum Bile , bile [-processed] arisaema [root])
• Bái fù zǐ (白附子 Typhonii Rhizoma, typhonium [rhizome])
• Guān bái fù (关白附 Aconiti Coreani Radix, Korean aconite [root])
• Bái jiè zǐ (白芥子 Sinapis Albae Semen, white mustard [seed])
• Zào jiá (皂荚 Gleditsiae Fructus, gleditsia [fruit])
• Zào jiǎo cì (皂角刺 Gleditsiae Spina, gleditsia thorn)
• Xuán fù huā (旋覆花 Inulae Flos, inula flower)
• Jīn fèi cǎo (金沸草 Inulae Herba, inula)
• Bái qián (白前 Cynanchi Stauntonii Rhizoma, willowleaf swallowwort [rhizome])
• Qián hú (前胡 Peucedani Radix, peucedanum [root])
• Jié gěng (桔梗 Platycodonis Radix, platycodon [root])
• Chuān bèi mǔ (川贝母 Fritillariae Cirrhosae Bulbus, Sìchuān fritillaria [bulb])
• Guī wěi (归尾 Angelicae Sinensis Radicis Extremitas, Chinese angelica [root] tail)
• Zhè bèi mǔ (浙贝母 Fritillariae Thunbergii Bulbus, Zhèjiāng fritillaria [bulb])
• Guā lóu (瓜蒌 Trichosanthis Fructus, trichosanthes [fruit])
• Guā lóu pí (瓜蒌皮 Trichosanthis Pericarpium, trichosanthes rind)
• Guā lóu zǐ (瓜蒌子 Trichosanthis Semen, trichosanthes seed)
• Tiān zhú huáng (天竺黄 Bambusae Concretio Silicea%#%, bamboo sugar)
• Zhú lì (竹沥 Bambusae Succus, bamboo sap)
• Zhú rú (竹茹 Bambusae Caulis in Taenia, bamboo shavings)
• Hǎi zǎo (海藻 Sargassum , sargassum)
• Kūn bù (昆布 Laminariae/Eckloniae Thallus, kelp)
• Méng shí (礞石 Chloriti seu Micae Lapis, chlorite/mica [schist])
• Pàng dà hǎi (胖大海 Sterculiae Lychnophorae Semen, sterculia)
• Hǎi fú shí (海浮石 Costaziae Os/Pumex, costazia bone/pumice)
• Wǎ léng zǐ (瓦楞子 Arcae Concha, ark shell)
• Gé ké (qiào) (蛤壳 Meretricis seu Cyclinae Concha, clamshell)
• Bí qí (荸荠 Heleocharitis Cormus, water chestnut¹)
• Zhū dǎn zhī (猪胆汁 Suis Bilis, pig's bile)
• Huáng yào zǐ (黄药子 Dioscoreae Bulbiferae Rhizoma, air potato)

Cough-Relieving Panting-Calming Agents

• Xìng rén (杏仁 Armeniacae Semen, apricot kernel)
• Tián xìng rén (甜杏仁 Armeniacae Semen Dulce, sweet apricot kernel)
• Zǐ sū zǐ (紫苏子 Perillae Fructus, perilla fruit)
• Bǎi bù (百部 Stemonae Radix, stemona [root])
• Zǐ wǎn (紫菀 Asteris Radix, aster [root])
• Kuǎn dōng huā (款冬花 Farfarae Flos, coltsfoot)
• Mǎ dōu líng (马兜铃 Aristolochiae Fructus, aristolochia fruit)
• Pí pá yè (枇杷叶 Eriobotryae Folium, loquat leaf)
• Sāng bái pí (桑白皮 Mori Cortex, mulberry bark)
• Bái guǒ (白果 Ginkgo Semen, ginkgo [nut])
• Tíng lì zǐ (葶苈子 Lepidii/Descurainiae Semen, lepidium/descurainia)
• Yáng jīn huā (洋金花 Daturae Flos, datura flower)
• Zhōng rǔ shí (钟乳石 Stalactitum , stalactite)
• Luó hàn guǒ (罗汉果 Siraitiae Fructus, monkfruit)
• Míng dǎng shēn (明党参 Changii Radix, changium root)
• Hú tuí zǐ yè (胡颓子叶 Elaeagni Pungentis Folium, pungent oleaster leaf)
• Mǎn shān hóng (满山红 Rhododendri Daurici Folium, Daurian rhododendron [leaf])
• Hān cài (蔊菜 Rorippae Herba seu Flos, rorippa)

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