Phlegm-dispelling formulas

Medicinal formulas that treat various phlegm-rheum patterns.

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:

• Splenic movement and transformation failure giving rise to dampness that develops into phlegm is treated by drying dampness, fortifying the spleen, and transforming phlegm.
• Fire-heat exuberant in the inner body, scorching the fluids and condensing them into phlegm is treated by clearing heat and transforming phlegm.
• Lung dryness with liquid depletion with vacuity fire condensing the fluids into phlegm is treated by moistening dryness and transforming phlegm.
• Spleen-kidney yang vacuity with cold rheum collecting internally or lung cold and lodged rheum is treated by warming transformation of cold phlegm.
• Phlegm turbidity arising in the body that is carried upward by liver wind stirring internally is treated by transforming phlegm and extinguishing wind.

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.

Subcategories

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

• Dampness-drying phlegm-transforming formulas
• Heat-clearing phlegm-transforming formulas
• Dryness-moistening phlegm-transforming formulas
• Cold-warming phlegm-transforming formulas
• Wind-relieving phlegm-transforming formulas

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

• Pinellia (Pinelliae Rhizoma, 半夏 bàn xià)
• Arisaema (Arisaematis Rhizoma, 天南星 tiān nán xīng)

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

Representative formulas

• Two Matured Ingredients Decoction (二陈汤 èr chén tāng)
• Gallbladder-Warming Decoction (温胆汤 wēn dǎn tāng)

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

• Trichosanthes seed (Trichosanthis Semen, 栝楼子 guā lóu zǐ)
• Bile arisaema (Arisaema cum Bile, 胆星 dǎn xīng)

Representative formulas

• Qì-Clearing Phlegm-Transforming Pill (清气化痰丸 qīng qì huà tán wán)
• Minor Chest Bind Decoction (小陷胸汤 xiǎo xiàn xiōng tāng)

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 Peaceful Palace Bovine Bezoar Pill (安宫牛黄丸 ān gōng niú huáng wán) or Purple Snow Elixir (紫雪丹 zǐ xuě dān).

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

• Fritillaria (Fritillariae Bulbus, 贝母 bèi mǔ)
Trichosanthes seed (Trichosanthis Semen, 栝楼子 guā lóu zǐ)

Representative formula: Fritillaria and Trichosanthes Powder (贝母瓜蒌散 bèi mǔ guā lóu sǎn).

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 Fritillaria and Trichosanthes Powder (贝母瓜蒌散 bèi mǔ guā lóu sǎn) and med>asarum (Asari Rhizoma et Radix, 细辛 xì xīn).

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

Wind-Relieving Phlegm-Transforming Formulas

Wind-relieving 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: Cough-Stopping Powder (止嗽散 zhǐ sòu sǎn)

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

• Pinellia, White Atractylodes, and Gastrodia Decoction (半夏白朮天麻汤 bàn xià bái zhú tiān má tāng)
• Fit-Settling Pill (定痫丸 dìng xián wán)
• Phlegm-Flushing Decoction (涤痰汤 dí tán tāng)

See dispelling phlegm.