Types of Phlegm

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The TCM concept of Phlegm is different from the Western definition of

phlegm. The Western concept of phlegm is that it's the snot that results

from a cold or the stuff you cough up out of your lungs or that

slimy-looking stuff that some people have in their bowel movements. TCM

recognizes these things as Phlegm but goes further. Phlegm can manifest as

tingling, numbness, some cases of paralysis, tumors, swellings, severe

psychological problems, etc. Complex cases that are hard to diagnose and

treat often involve Phlegm.

 

Basicly, Phlegm is Dampness that has hung around too long and congeled into

Phlegm.

 

Phlegm can be classified more than one way. It can be " substantial " (the

stuff in the lungs) or it can be " insubstantial " (under the skin in the form

of lumps, swellings, fibroids, lipomas; in the channels causing things like

numbness, Misting the Heart causing severe psychological problems like

mania/ psychotic depression; gall bladder and kidney stones; and in the

joints causing bone deformity). (Information in this paragraph from

Maciocia, Foundations of Chinese Medicne, p. 196)

 

Phlegm also can be classifed as Thick Phlegm (Tan) or Thin Phlegm (Yin).

Thick Phlegm can circulate with Qi to any part of the body. Thin Phlegm

usually is found in the cavities of the chest, abdomen, and

gastro-intestinal tract.

 

What I mainly want to look at in this post is Phlegm classified according to

how it develops, its etiology. These 10 types are Excess, Deficiency, Cold,

Heat, Wet, Wind, Dry, Fire, Emotional Congestion, and Food. These are what

C.S. Cheung, MD, L.Ac. in Comprehensive Management Phlegm Fluid (Tan Yin)

calls " qualitative differential diagnosis of Phlegm. " (p. 19)

 

All Phlegm is by definition Excess. Any Phlegm is too much and will create

problems. When Cheung refers to Excess Phlegm as a " qualitative

differential diagnosis " , he's talking about what caused the Phlegm to

develop. In this case, an Excess caused Phlegm to develop. For example,

let's say a person is living in a very dry area like a desert. Or working in

an overly-dry office. The Exterior Pernicious Evil (Dryness) can cause

normal fluid in the lungs to congeal into Phlegm. Qi Stagnation (Qi not

moving like it should - classified as an Excess problem) can cause Phlegm to

form. Blood Stasis - another Excess problem, the Blood not moving properly

- can cause Phlegm to form. Etc.

 

On the other hand, Deficiency Phlegm is Phlegm that forms because the body

lacks enough of something. What we're talking about here are Qi, Yang,

and/or Yin Deficiency. One of the roles of the Spleen is to transport and

tranform fluids within the body. If the Spleen is Qi or Yang Deficiency, it

can't do this job. Dampness lingers and eventually congeals into Phlegm.

In the case of Yang Deficiency, this Phlegm also will be classified as Cold

Phlegm because there's not enough Yang to warm the body properly and Phlegm

congeals. In the case of Yin Deficiency, the Deficiency Heat is cooking the

Fluids into Phlegm.

 

Zhang Jie Bing stated that Deficiency Phlegm is worse than Excess Phlegm.

Excess Phlegm develops quickly but also terminates quickly. On the other

hand, Deficinecy Phlegm is slow to form but also slow to depart, and thus,

difficult to treat. He said it's useless to use drastic measures to attack

Deficiency Phlegm. If you attack it directly, this damages the Original Qi.

(p. 5)

 

The general treatment principle for Excess Phlegm is to Expel the Phlegm and

eliminate the Excess which is causing the Phlegm to form. The general

principle for Deficiency Fatigue is to tonify the Deficiency and dissolve

the Phlegm, warm Yang and dissolve Phlegm, and/or moisten Yin and resolve

Phlegm.

 

Phlegm can have more than one cause. For example, the Phlegm that arises

because of Yang Deficiency (not enough Yang to move Fluids and warm the

body) is Deficiency Cold Phlegm. But Phlegm that forms because the

temperature in the environment is too cold is Excess Cold Phlegm. The

proper treatment of Phlegm is going to vary according to what caused it to

develop in the first place. For example, if Phlegm developed because of

Spleen Deficiency, the Phlegm is just going to keep forming as fast as you

can get rid of it with Phlegm attacking herbs until the underlying imbalance

of Spleen Deficiency is corrected. Furthermore, just attacking this Phlegm

is going to make the underlying problem of Qi Deficiency worse. You need to

build up the Spleen if you want to get rid of this Phlegm.

 

What gets rid of one type of Phlegm can make another type worse, so you do

want to identify which type of Phlegm it is.

 

The number one system for producing Phlegm is the Spleen, but Kidney and

Lung imbalance also can play a big role in Phlegm production because these

systems also play roles in the tranporation and transformation of Fluids in

the body. The Liver (in large part because of its tendency to Qi Stagnation

problems and the fact that it's responsible for the smooth and proper flow

of Qi throughout the body), the Heart (because it's susceptible to Yang and

Yin Deficiency), and the Triple Heater also rank high in participation of

the development of Phlegm.

 

The number one recepticle for Phlegm is the Lungs. Phlegm can show up

anywhere in the body, but it has a special affinity for the Lungs.

 

Victoria

 

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