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Phlegm-dispelling formulas

祛痰剂 〔祛痰劑〕 qū tán jì

Medicinal formulas that treat various phlegm-rheum patterns, using phlegm-transforming agents (see phlegm-transforming cough-relieving panting-calming agents) combined with medicinals from other categories.

When we speak of phlegm-dispelling formulas, the term phlegm includes rheum, which is a thinner form of phlegm. Both are pathological products of the body and that arise when dampness collects and in the initial stages invariably present with cough. However, phlegm and rheum are not only pathological products; they are also causes of disease, since it can flow into the chest and diaphragm, stomach, and intestines, into the channels and limbs, into the head and the joints, giving rise to numerous different conditions. The Yī Fāng Jí Jiě (醫方集解 Medical formulas Gathered and Explained) by Wāng Áng sums describes this neatly, saying, When in the lung,[phlegm-rheum] causes cough; in the stomach, vomiting, in the head, dizziness; in the heart, palpitation, in the back, cold; in the rib-side, distension, with countless variations. In clinical practice, signs include cough, rapid panting, headache, dizziness, chest impediment, retching and vomiting, wind stroke and phlegm reversal, mania and withdrawal, and fright epilepsy, as well as phlegm nodes and scrofula.

The causes of phlegm-rheum are many and complex and are treated by different methods. Here are some examples:

Phlegm-dispelling methods are classed according to the accompanying evils, as discussed under Subcategories below.

Dampness is engendered by water-damp which develops when the spleen fails to perform its movement and transformation function adequately. Hence phlegm-dispelling formulas often include agents that fortify the spleen and dispel dampness. Phlegm-damp is also closely associated with the kidney, which governs water. When this function weakens, excess fluid remains in the body (called kidney vacuity water flood), which can also give rise to phlegm-rheum. For this reason, agents that boost the kidney are also used.

Phlegm moves up and down with qì. When qì becomes congested, phlegm stagnates; when qì moves, phlegm disappears. Hence, phlegm-dispelling formulas often include qì-rectifying medicinals.

For phlegm flowing into the channels and network vessels and interstices to form scrofula and phlegm nodes, formulas often include agents that soften hardness and disperse binds, with adjustments being made for vacuity and repletion on the one hand and cold and heat on the other.

Cautions

When using phlegm-dispelling formulas, it is important to determine the nature of the phlegm disease, particularly with regard to presence of cold, heat, dryness, and dampness. Attention should also be paid to the root and tip of the condition and the order in which they are treated.

When there is cough, harsh drying agents should not be used since these can cause expectoration of blood. When there is copious phlegm before exterior evils have been resolved, moist agents should be used with care, since these can cause the exterior evils to stagnate and congest, making the condition more difficult to cure.

Subcategories

  1. Dampness-drying phlegm-transforming formulas
  2. Heat-clearing phlegm-transforming formulas
  3. Dryness-moistening phlegm-transforming formulas
  4. Cold-warming phlegm-transforming formulas
  5. Wind-eliminating phlegm-transforming formulas

1. Dampness-Drying Phlegm-Transforming Formulas

Dampness-drying phlegm-transforming formulas treat damp phlegm patterns presenting with copious phlegm that is easily expectorated, glomus and oppression in the chest, retching and nausea, dizziness, and fatigued limbs as well as a slimy white or glossy white tongue and a pulse that is moderate or slippery.

Main agents

Frequently combined with these are agents that fortify the spleen and recfy qì such as bái zhú (白朮 Atractylodis Macrocephalae Rhizoma, white atractylodes) and bái zhú (白朮 Atractylodis Macrocephalae Rhizoma, white atractylodes).

Representative formulas

2. Heat-Clearing Phlegm-Transforming Formulas

These treat heat phlegm patterns, which are marked by cough with thick, sticky, yellow phlegm that is not easily expectorated, as well as heat phlegm chest pain, dizziness, or fright epilepsy.

Main agents

Representative formulas

When phlegm-heat clouds the clear orifices, causing clouded spirit and convulsions, heat-clearing phlegm-transforming agents are combined with heat-clearing orifice-opening formulas such as ān gōng niú huáng wán (安宫牛黄丸 Peaceful Palace Bovine Bezoar Pill) or zǐ xuě dān (紫雪丹 Purple Snow Elixir).

3. Dryness-Moistening Phlegm-Transforming Formulas

Dryness-moistening phlegm-transforming formulas treat dryness phlegm thick, sticky phlegm with ungratifying expectoration, dry throat, hacking cough, hoarse voice.

Main agents

Representative formula: Bèi mǔ guā lóu sǎn (贝母栝蒌散 Fritillaria and Trichosanthes Powder).

4. Cold-Warming Phlegm-Transforming Formulas

Cold-warming phlegm-transforming formulas treat cold phlegm, which manifests in coughing up of clear thin white phlegm, with a glossy white tongue fur. Medicinals used include cold-warming phlegm-transforming agents such as gān jiāng (干姜 Zingiberis Rhizoma, dried ginger), xì xīn (细辛 Asari Rhizoma et Radix, asarum), bái jiè zǐ (白芥子 Sinapis Albae Semen, white mustard [seed]), and bàn xià (半夏 Pinelliae Rhizoma, pinellia).

Representative formula: Líng gān wǔ wèi jiāng xīn tāng (苓甘五味姜辛汤 Poria, Licorice, Schisandra, Ginger, and Asarum Decoction).

5. Wind-eliminating Phlegm-Transforming Formulas

Wind-eliminating phlegm-transforming formulas treat wind-phlegm patterns. The wind of wind-phlegm may be of external or internal origin.

External wind with phlegm mostly arises when externally contracted wind affects diffusion and downbearing of lung qì, causing fluids to congeal and find into phlegm turbidity. This is marked by cough with copious phlegm together with aversion to wind and heat effusion. It is treated by coursing wind and transforming phlegm, using both agents the course wind evil and agents that relieve cough.

Representative formula: Zhǐ sòu sǎn (止嗽散 Cough-Stopping Powder).

Internal wind with phlegm arises in patients with phlegm turbidity when liver wind arises and carries the phlegm to harass the upper body. It is marked by cough with copious phlegm, together wind dizziness, headache, and even clouding reversal leaving the patient unable to speak. It may also present in the form epilepsy. This is treating by extinguishing wind and transforming phlegm using agents that calm the liver and extinguish wind with phlegm-transforming medicine as the main agents, with which spleen-fortifying, orifice-opening, and spirit-quieting medicinals may also be combined

Representative formulas

See dispelling phlegm.

Phlegm-Dispelling Formulas

Dampness-Drying Phlegm-Transforming Formulas

Heat-Clearing Phlegm-Transforming Formulas

Dryness-Moistening Phlegm-Transforming Formulas

Cold Phlegm Warming and Transforming Formulas

Wind-eliminating Phlegm-Transforming Formulas

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