Phlegm

1. A viscid substance traditionally understood to be a product and a cause of disease. Phlegm may gather in the lung, from where it can be expelled by coughing. However, phlegm as referred to in Chinese medicine is wider in meaning than sputum spoken of in Western medicine, and denotes a viscus fluid that can accumulate anywhere in the body causing a variety of diseases such as stroke, epilepsy, scrofula etc., but which in the absence of expectoration are usually characterized by a slimy tongue fur and a slippery or slippery stringlike pulse. Phlegm is a thick turbid substance that is distinguished from a thinner clearer form of accumulated fluid, rheum (饮 yǐn), although the term phlegm is sometimes used to cover both.

Formation of phlegm

Phlegm and rheum may result from the impaired movement and transformation of fluids that is associated with morbidity of the lung, spleen, and kidney. Phlegm—but not rheum—may also result from the boiling of the fluids by depressed fire. Invasion of the six excesses, affect damage, and damage by food and drink may all affect the dynamic of bowels and visceral qì causing water humor to gather and form phlegm.

The two most important of the five viscera in the formation of phlegm are the spleen and lung. Phlegm is the product of a transformation of fluids; most commonly it is the product of congealing water-damp. The spleen normally moves and transforms water-damp, but when its qì is weak or dampness evil is exuberant, the normal movement and transformation of water-damp is impaired, and dampness gathers to form phlegm. For this reason, it is said that the spleen is the source of phlegm formation. It is said that obese people tend to suffer from phlegm. This saying can be explained by the observation that excessive consumption of sweet or fatty rich foods causes spleen dampness to gather (more at obesity). The lung is the upper source of water; it governs depurative downbearing and regulation of the waterways. When dampness and phlegm accumulate, these functions can be overloaded so that phlegm collects in the lung; hence it is said that the lung is the receptacle that holds phlegm. Phlegm may also form in the lung when heat scorches lung liquid.

Phlegm, however, appears not only in the lung; it can follow the upbearing and downbearing of qì and arrive at all places. Thus, in addition to expectoration of phlegm, it can, depending on the organ or channel affected, cause vomiting of phlegm-drool, clouded spirit, mania and withdrawal, phlegm rale in the throat, numbness of the limbs, hemiplegia, scrofula, goiter, mammary aggregation, phlegm nodes, plum-pit qì, or dizziness. Phlegm that can be coughed up or vomited up is often referred to as tangible phlegm (有形之痰 yǒu xíng zhī tán), while phlegm that is understood to be present in the tissues is often referred to as intangible phlegm (无形之痰 wú xíng zhī tán).

Locus

Lung: Phlegm in the lung causes cough, panting, and oppression in the chest. Clear thin phlegm indicates cold, whereas yellow or thick white phlegm indicates heat. Scant phlegm expectorated with difficulty signifies either heat or dryness. Copious phlegm that is easily expectorated indicates dampness. Coughing of fishy-smelling pus and phlegm generally indicates pulmonary welling-abscess in a pattern of toxic heat brewing in the lung. Expectoration of phlegm containing blood (or pure blood without phlegm) is attributed either to dryness-heat, vacuity fire, or lung heat damaging the network vessels; if the blood is purplish black, it indicates a blood stasis complication. Although many lung diseases lead to local collection of phlegm, it is only when the coughing up of phlegm is more pronounced than other signs that the condition is strictly described as a phlegm pattern. See cold phlegm; heat phlegm; dryness phlegm; phlegm-damp. See also phlegm-rheum.

Spleen-stomach: Phlegm in the spleen and stomach (also called damp-phlegm) causes easily expectorated phlegm often accompanied by abdominal distension, sloppy stool, yellow face, lassitude of spirit, heavy limbs, white slimy tongue fur, and moderate pulse. phlegm-rheum. Phlegm in the heart is said to cloud the orifices of the heart (consciousness) and is observed in externally contracted febrile disease and other diseases such as wind stroke. See phlegm confounding the orifices of the heart.

Liver channel: Phlegm in the liver channel is phlegm being carried up by wind yáng ascending counterflow (ascendant liver yáng transforming into wind), causing sudden collapse, phlegm rale in the throat, and convulsions or hemiplegia, as observed in wind stroke or epilepsy. In depressed liver qì, liver qì that ascends counterflow can contend with phlegm so it binds in the throat causing a sensation of blockage by some foreign body known as plum pit qi or qì phlegm.

Phlegm ascending to invade the head: Phlegm-drool ascending counterflow to the head can cause dizziness, hemilateral headache, deviated eyes and mouth, and hair loss. Depressed gallbladder-stomach heat engendering phlegm that ascends counterflow along the channels to harass clear yáng causes dizziness, bitter taste in the mouth, tinnitus, vacuity vexation and insomnia, fright palpitation and profuse dreaming. Wind-phlegm surging up into the head can cause hemilateral headache or pain on one side of the face, or twitching of the eyes and mouth. Cold phlegm attacking the upper body gives rise to cold pain in the brain with a desire for warmth and an aversion to cold.

Kidney channel: Phlegm in the kidney channel is characterized by black complexion, lassitude of spirit, and phlegm with black flecks and a salty taste.

Exterior channels and network vessels: Phlegm in the channels and network vessels of the exterior can cause numbness, or phlegm node (lumps of varying sizes under the skin without change of skin color) or breast lumps called mammary aggregation. Phlegm in the neck can cause scrofula or goiter.

Phlegm deep-lying in the sinews and bone: After contraction of cold-damp evil, the interstices, channels, and network vessels become blocked, and fluid gathers and binds to form phlegm. This phlegm may penetrate the sinew and bone, causing damp phlegm and cold phlegm patterns such as bone flat-abscess, crane’s-knee phlegm, and flowing phlegm.

See entries beginning with phlegm and wind-phlegm; cold phlegm; damp phlegm; heat phlegm; old phlegm; dryness phlegm; qì phlegm.

NB: The compound terms of phlegm with heat and damp take the form of both heat phlegm, cold phlegm, and damp phlegm on the one hand and phlegm-heat, phlegm-damp on the other. In most cases, the unhyphenated forms in which phlegm follows the name of the other evil (i.e., heat phlegm, cold phlegm, and damp phlegm) refer to conditions of the lung characterized by expectoration of copious phlegm, such as cold phlegm obstructing the lung, while the hyphenated forms in which phlegm precedes the name of the other evil refer to combined causes of conditions that do not necessarily involve the lung or copious expectoration, e.g., phlegm-damp headache. This distinction may not always hold, since damp phlegm leg qì does not refer to a lung condition.

2. An abbreviation for flowing phlegm, as in ankle-boring phlegm.