Key Learning Points
Phlegm can cause many diseases in Chinese medicine, some of them serious.
Unfortunately, it is easy to get and hard to clear.
Here’s what you need to know, and the first thing to realise is that the ‘catarrh’, ‘mucus’, ‘gunk’, ‘goo’, – thick stuff – you have to cough or hawk up is indeed nearly always ‘Phlegm’ with a capital P.
But not always!
For example, thick, white stuff could be due just to Heat.
Click to read about Phlegm Colour.
By the way, many internet sites suggest ways to clear it. They have good ideas, but no explanation as to why one method works and not another.
So you end up trying this, then that and not necessarily knowing why this works, and that doesn’t!
A Small ‘Plug’ for my Book on Phlegm – much more detail than here!
I’ve written a book on this, with suggestions for the FIVE MAIN different kinds of gunk.
It explains how your body gets it and what to do about it.
It goes into much more detail than this page, covering herbs for each kind and then, taking the suggestions you find elsewhere on the web, explaining which work for your kind of the stuff!
As far as I’ve seen, no other website explains how different kinds of phlegm need different solutions!
Available for Kindle and in softback from Amazon. (… end of Sales pitch …) |
Phlegm is also lots of other things in Chinese medicine, including nodules, lumps and bumps under the skin, swellings and soft masses in the abdomen, dry powdery stuff you see in the cracks in people’s tongues and at the corners of their mouths.
And even when you can’t see any phlegm as such, it could still be there, technically, obstructing the free movement of Qi and Blood.
That’s when it becomes the cause of disease. So it can contribute to the formation of both Qi Stagnation and Blood Stagnation.
Worse, it can obstruct free movement of Qi in the Heart, leading to all sorts of serious Western medically-defined diseases.
When it blocks up what are called the ‘orifices’ of the Heart, you can get very disturbed mental behaviour, (because the Heart ‘governs’ your Mind – for example, see Heart Phlegm-Fire).
Of course, it’s also the result of other processes malfunctioning and of other syndromes.
Technically to be Phlegm (capital P), there should be:
One last thing before I get on to the reasons you have it, and this is for the geeks. Phlegm is a form of yin excess. The more you get to know about yin and yang, the more this will make sense and the faster you’ll understand what you’re doing ‘wrong’ and how to do something about it.
So! Onto the causes …
Nearly everyone agrees that the Spleen is most to ‘blame’ for Phlegm formation. Almost equally important, at least to my mind, are the Lungs and the Kidneys.
In fact, a Lung or Kidney syndrome can be the prime cause. The poor old Spleen tags along, unable to clear the mess the other has left.
Having pointed blame at the Spleen, do be aware that it is mainly YOUR fault if your Spleen isn’t functioning well!
You’ve been eating all wrong, so read on.
Your Spleen energy is a bit like Cinderella, never quite able to keep up with the demands of her older sisters, but vital for keeping the house tidy.
When Cinderella fails to clear up their mess, you get decaying piles of old food, mildew and dust in the corners, smelly unwashed garments, untidy beds and an air of subdued complaint and desperation. (Go right out and buy yourself a good recording of Rossini’s interpretation of the Cinderella story. It’s funny, witty and full of good tunes.)
In Chinese medicine, the Spleen is supposed to ‘transform and transport’.
‘Transforming’ means turn something into something else (like the Fairy Godmother in many tales of Cinderella).
In this context it means both
By the way … Who wants fat? Everyone! It’s probably our best form of insulation, energy and energy reserves, and our forefathers burned it up through physical effort and manual labour. We make it by eating too much food that turns into sugar in our blood which we don’t burn up because we take little exercise. Of course our genes play a part in this too, but I doubt if they can be blamed for more than a small proportion of overweight humanity.
Anyway, you guessed it, excess fat is a form of Phlegm!
By ‘Transporting’, is meant clearing stuff away from where it has lost its usefulness, which means keeping the highways and byways of your body clear.
When Phlegm builds up, things don’t move so smoothly, and everything becomes an effort, like wading through glue.
So far, so good!
Now it gets tricky, because there are lots of sub-categories of Phlegm and each has different causes and different treatments. Here are some of them. It’s possible to have more than one of the following at the same time.
As you read on down, you may get a bit mesmerised by all the reasoning, and other syndromes to which there are links (click on the words in colour and underlined).
If this concentrated mass of information is a bit much for you, my book Yuck! Phlegm! should make it easier. I think, as it is, this page reaches about the limit of information that most people can take in a sitting. I’ve just re-read it and even my mind began to wander! (Nothing new there, of course.)
‘Stomach phlegm’ causes are usually either from poor diet or bad eating habits. Maybe too much cold food, or too much greasy food? But also see below under diet.
Phlegm in the Lungs disturbs and blocks the proper flow of Lung Qi which should be downwards: the result is coughing as Lung Qi ‘escapes’ upwards.
It also stops Lung Qi dispersing effectively and the result can be dyspnoea (meaning an awareness of breathing difficulty when you wouldn’t expect it) and/or mucus expectoration.
It’s good to be able to expectorate mucus from the Lungs, but some people find it hard to raise, including children, so its absence doesn’t mean there is no Phlegm, if other symptoms suggest it.
NB If you have thick white mucus, this may or may not be Phlegm! It could be due to Heat, which has ‘cooked’ the natural colourless mucus. In this case, treatment to clear Phlegm wouldn’t work: you would also have to clear the Heat.
Phlegm here causes:
Phlegm here may not be in a visible form, but is still ‘assumed’ to be present, blocking the free flow of Heart Qi. The technical name for it is ‘blocking the orifices of the Heart’.
A bit like someone with vital life or death decisions to make for his family, who can’t see or hear what’s going on, let alone communicate properly, and who gets very upset and disturbed.
With blocked Heart’s orifices you get:
Over time, heat dries fluids and creates first phlegm then stones. Kidney and Gallbladder stones are intensely painful end-products.
Phlegm here causes:
The What?
Jingluo is the name given to all the interconnecting paths and passageways that Qi takes just under the surface of the body.
Here we get into the area of ‘theoretical’ Phlegm. When you get areas of numbness for which there is no other obvious cause, the default suspect is Phlegm. Elderly people are prone to this.
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(This was the kind of phlegm I had that led me to acupuncture, though it was complicated by Qi Stagnation. After I sorted out the Qi Stagnation situation, the problem didn’t return. In the meantime, acupuncture really helped keep the ‘Damp-Phlegm’ at bay, though I had to make some dietary changes too.)
Mainly caused by Spleen deficiency and appears as Lung syndromes:
Commonly appears in syndromes of Stomach or Lungs:
Example of Phlegm ColdI just went out on my bicycle (not a pretty picture so you’re not getting one) to deliver a homoeopathic remedy to someone who lives about two miles away, mostly uphill.
It’s not a steep hill, but it wasn’t a warm day and I had to pedal hard.
Normally I try to exercise without breathing through my mouth – just through my nose – but I was on my lunch break. (… Yes, though I work on the website from home, I try to keep office hours. Should you ever find me asleep on the sofa after lunch, I’ll assure you it’s not sleep but deep thought …)
So I was in a hurry and did breathe quite a lot through my mouth. This cooled my lungs.
I think the exercise did me good, overall, but when I got back my chest felt full of liquid, and my nose felt blocked and I did a certain amount of hawking and snorting to clear it from my throat and lungs.
This was really a form of Lung Phlegm Cold, from cold air and slight over-exertion, which weakened the Lung function of descending qi. For more, read Lung Phlegm Cold.
This – Lung Phlegm Cold – is common in skiers, especially as they age and find their Kidney Yang energy reducing. If you are like this you should definitely avoid cold foods. |
Mainly occurs in syndromes of the Lungs, Stomach or Heart:
Mostly affects the Lungs:
This ‘phlegm in throat’ sort, is where you get a sensation that phlegm is stuck in your throat constantly, or at the back of your throat.
It feels like a phlegm lump in your throat.
It’s too deep to see, and neither swallowing nor hawking will clear it.
What’s more, your doctor won’t be able to see it either. And in reality, there may be NO actual phlegm in your throat! But you can certainly FEEL it!
This syndrome is mainly associated with Liver Qi stagnation.
If this ‘phlegm stuck in throat’, or ‘lump in throat’ sensation is worse when you are under pressure, especially ’emotional’ pressure, then it’s almost certainly this Qi-phlegm type.
For instance, if you get it when
Well! … in all these examples your phlegm-throat feeling is because of Qi stagnation, caused by stress. Often you don’t actually have any phlegm in your throat, but your Qi is constrained – stagnating – and constricts your feelings there.
This makes it hard to speak confidently and assertively. You often feel as if your Adam’s Apple is pushing up in the front of your neeck and you have to keep swallowing to ‘push’ it down.
Usually this feeling subsides when you do something to clear your Qi Stagnation. (Read the linked page for more on this and more on what you can do about it.)
For example, if you aren’t in the stressful situation, usually the phlegm-in-throat, or lump-in-throat feeling goes away. Often pleasant exercise shifts it, until your stress returns or you start worrying about it!
By the way, acupuncture is brilliant at sorting out this Qi Phlegm, Phlegm in Throat syndrome.
Of course, you can have real phlegm in throat. But unless it’s from stress too, you can usually swallow it or hawk it up and spit it out. (Though hawking up Phelgm-Heat and Phlegm-Dryness can be difficult.)
Real, observable, hawkable phlegm in throat can come from many of the syndromes listed on this page, including Damp-Phlegm, Phlegm-Cold, Phlegm-Heat, Stomach-phlegm, Wind-phlegm and Lung-phlegm.
Various kinds of Phlegm-Fluids occur, in the hypochondrium, stomach, the limbs and the diaphragm, each with different symptoms, but nearly all have
This syndrome occurs with a serious and acute condition called, in Chinese medicine, Wind-Stroke, which has a close relationship to ‘stroke’ and ‘epileptiform’ conditions.
What can you do to improve the chance of successful treatment – see below?
This is the obvious solution, but not so easy for all of us!
Foods known to weaken or block the Spleen include
These cause Damp fluids which easily turn to Phlegm. Don’t ignore this dietary advice! It really can make a difference!
Poor eating habits include:
Given that Phlegm comes into existence when fluids either
and you’ll realise that there’s not much point just trying to wave it away unless you also deal with the underlying cause (Qi Stagnation, Cold or Heat).
If the cause is Qi Stagnation, you must do something about it! Unless you do, the problem will return. (Mine did! I know what I’m talking about!)
Later, that probably means your acupuncturist will need to treat your Liver at some point, but other Zangfu may be involved depending on underlying emotional factors. (… not that emotional factors are the only causes of Qi stagnation, see my book, ‘Yuck! Phlegm!’)
He (or she) will choose – from knowledge of either TCM Theory or 5 Element acupuncture theory, for example – the acupuncture channels to adjust by means of acupuncture points on them.
Then, because the Spleen has been unable to free up the passage of fluids, meaning that Phlegm has accumulated, he must treat the Spleen.
He or she might not do acupuncture – he might start with cupping, as in the picture above.
If the Lungs, which tend to store the Phlegm, are involved, then treatment must assist them.
Finally, he must ‘support’ your Kidney Qi, because it supports all the other zangfu, helps Spleen Yang to transform Phlegm and is particularly relevant for the warmth of your body.
Lots! For example if an external pathogenic factor – a bug/bacteria/virus – is Hot and is blocking your Lung Qi from disseminating fluids, you get a thick, sticky or green ‘gloop’ that is often smelly.
If the invading pathogen has produced a Cold reaction, then your phlegm is clear, more runny and odourless.
In both cases, your body may clear the invader but be unable to clear the Phlegm. Sometimes the invader appears to remain. During treatment, symptoms of the original invasion may then recur before your body can eliminate both invader and Phlegm.
Sometimes the patient gets repeated attacks of what seems to be Wind-Cold when actually it is not a deficient immune system, but Phlegm blocking the passageways and preventing ‘Wei Qi’ – your immune force – being circulated to the exterior. In this case, trying to strengthen Wei Qi wouldn’t work until Phlegm had been cleared.
And that’s not all! Once Phlegm gets into the system, especially that of an older, weaker person with a system that can’t clear it, the phlegm becomes self-perpetuating and slows everything down, causing more fluids to stagnate leading to even more Phlegm.
This is common where someone eats a poor diet, not recognising which foods to avoid. Dairy foods are often better avoided if you have Phlegm – but there are other causes too, see above.
However, Western medically trained doctors, not trained in energetic-type medicine, typically use medications that prevent the body making the repairs needed. For instance
As you see, although not deeply complicated, there are many ways in which Phlegm can compromise the body. Making the right diagnosis and then treatment is not always easy.
For example, if the cause has been, say Heat invasion, but there is also an underlying Yin deficiency, Kidney Yang exhaustion (as can happen with the elderly) and a history of bad diet, picking one’s way through the treatment process can take time.
Here the weak Kidney Yang cannot transform fluids, which then overflow upwards and stagnate. Guess what happens? Those fluids transform back into Phlegm!
So … I hope you’ll agree that Chinese medicine has given Phlegm a considerable amount of thought over the millennia. It’s a sometimes deep and often complicated subject.
You CAN do a lot to help yourself, however, and in my book I’ve summarised many successful strategies, treatments and herbs you can use once you understand your kind of phlegm, and its cause.
Of course, both acupuncture and herbs have been used to clear Phlegm for millennia. If you are receiving treatment, be patient!
Go right to the bottom of this page and you’ll find comments and questions from readers, with some replies.
These may deepen your understanding of phlegm.
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Aggressive Energy (AE) is a diagnosis and treatment used in Five Element acupuncture. It can obstruct success of otherwise good treatments.
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10 Responses
Very interesting, thank you!
Diseases come on horseback, and return on foot. ~ French proverb
Hi Jonathan, glad you like the page on phlegm. And what a great proverb! Jonathan CW
I really needed this information and I’m so grateful I found you! I have been struggling with this embarrassing phlegm issue for several years, at first I thought it was something that would go away on its own but it hasn’t. It is creating issues in my personal life and I need to get rid of it somehow. Just like another reader commented on a different page, it seems to be provoked when stomach goes towards empty at night so in the middle of the night I feel it at the back of my throat and I have to get up and go to the bathroom to spit it out, very disturbing! I also noticed it more often after drinking water even if it’s not cold water. I often drink ACV diluted in water, I really enjoy the tangy taste but that too lifts up phlegm. Besides acupuncture what else do you think would help in my case? I don’t eat dairy anymore but it doesn’t make a difference. Thank you for all your work!
I’m sorry you have so much phlegm, and it can be hard to shift. I would say your next strategy is to use herbs. In my book (Yuck! Phlegm!) I list and explain quite a few herbs that may help and give the names of basic Chinese formulae for each kind of phlegm.
When using the Chinese formulae, please do not buy them off the shelf as already ‘made-up’ formulae. While this makes them cheaper, it doesn’t necessarily make them better for you! Any practitioner of Chinese medicine, if he or she thought that the basic formula I list were the correct one, would then adapt it to your particular needs.
A slightly crass analogy would be when your left foot hurts and your doctor suggests new shoes. So you ring up a shoe shop and order a pair of their most popular shoes, but forget to mention your size. Your size is rather important! Similarly with a herbal formulae: your herbalist must adapt it to your particular circumstances.
Not getting it right might theoretically make it worse and if merely ineffective would reduce your confidence in what is otherwise a great and honourable medical tradition, body of experience and intellectual acuityy: also a cultural asset.
Wow. I have just started seeing a Chinese medicine doctor for shortness of breath on exertion and problems with gas exchange at alveolar level though I have good lung capacity volume and have been doing my own rehab with breathing exercises till now. I was diagnosed with ovarian cancer in Nov 2019 and had successful radical surgery and 4 rounds of aggressive chemotherapy (which I believe damaged my lungs). I had 11 months in remission but now they say the cancer is back in my lymph nodes. I did not want any more chemo or radiation which is all that was on offer in NHS and as I had had successful acupuncture/chinese herbal treatment for breathing problems many years ago I decided to give it a go again. My Chinese Dr who has been practising 30 years says I have blocked Lung chi/phlegm. I felt immediate improvement after first session and know I have a long way to go to rebalance my body with Chinese medicine as well as rebooting my body via juice detox schedule (for 10 days initially). Thank you for this detailed information and evidently I have to and want to learn/understand more this regime I am embarking on to regain health. I know Chinese medicine can’t cure my cancer but I am hoping it can make my final months more comfortable and bearable and who knows if the enlarged lymph nodes are not cancer but merely a lot of inflammation in my body I. might have a better outcome than expected. I’m 72 and a retired nurse and have some understanding of how the body works physically, mentally and emotionally (according to Western medicine) but I have always been interested in ‘old’ medicine and so I am ‘all in’/totally committed to these radical changes in looking after my body. I am very overweight and am sure eventually acupuncture will help me to shift the fat too. I know I made my body sick with eating wrong foods (processed) although I am vegan and eat more fruit and veg than most, so I owe it to my body to try to make it better, more balanced. Thanks again for all your words of wisdom and I’m sure I will be back to buy some of your books in the coming weeks as my journey progresses and I observe changes and want to understand more of how to support my body as it goes through treatment and change. I came looking for explanation of what my Dr told me that I have lung phlegm blockage and didn’t realise I had so much to learn but I am a good and fast learner. From your words I understand this translates into too much Yin/cold and I need to heat up my body with food, medicine, acupuncture and more physical ability as able. I am totally committed so again thanks for leading me to the path of balancing chi.
Dear Robyn
Thank you for your long contribution. Phlegm takes many forms and certainly can lead to other problems such as Blood stasis and cancer. It is a form of yin excess.
As a general rule, with Chinese medicine you try to clear blockages such as excesses of yin first, to allow clear Qi and Blood to circulate smoothly.
It’s true, Yin factors are more often cold than hot but they can have some hot characteristics, as with Damp-Heat.
Excess ‘fat’ is also regarded as a form of phlegm!
Because phlegm takes many forms, the solutions are different. In my book on phlegm I describe five main kinds, with what to do in each case. More than likely one, or possibly several of them, will apply to you.
What we eat makes a huge difference and vegetables are usually good.
Good luck with your treatment!
Jonathan
Hi, Thank you for this in-depth summary. I am recovering from mold exposure, and while I have mostly eliminated it from my home, I am only about 90% better and still struggling to fully clear the phlegm from my body. I am hypersensitive to it now and have an allergic reaction when exposed with many symptoms (actually phlegm (white), anaphylaxis, as well as nausea, heartburn, sneezing, stomach pain, my doctor said my liver was slightly stressed…). I am curious if mold has a hot or cold effect. Do you know anything about it? I am trying to work on my diet but find it difficult to cut out alcohol, popped corn, and potato chips. I will eat more ginger. Otherwise, I eat very healthy (lots of bone broth, warm foods and tea, nuts and fruits and seeds, and generally few carbs and sugars. The proverb above is exactly how I feel.
Hi Anna, It’s your body that ‘decides’ if mould, or indeed anything, has a hot or cold effect.
Also, you can have a reaction that is ‘hot’ or yang in one part of your body and ‘cold’ or yin in another. From what you say, you have a mix of yang and yin imbalances (or possibly more complicated than even that, with elements of yin deficiency and yang deficiency too).
Guessing, I would agree with your doctor but go one step further and suggest that the action in terms of Chinese medicine of your Gallbladder may be imbalanced. This Wood energy regulates your Earth energy, including your Stomach (nausea, heartburn, pain, craving for sweet foods such as alcohol, popcorn and chips) and bile cuts through fat in the intestines so can be likened to cutting through the effect of mould.
But without examining you, including tongue and pulse, I can’t be sure.
Hope this helps. Jonathan
Hi Jonathan
I had a bad flu towards the end of November last year. My throat was on fire for a few days coughing. I had lots of mucus in my head and sinuses. Also, had an unbearable thirst whilst sick for nearly 3 weeks. I was taking paracetamol and ibuprofen during that time. I drank a lot of chicken broth as had no appetite.
But now I have phlegm in my throat since, with that is a cough. Sometimes I find my throat sticky, eating a piece of apple or a grape. I can’t swallow it all. It sticks in my throat, takes 2 or 3 attempts to get it down.
Also within the last 2 weeks I’ve noticed heartburn only suffered from whilst pregnant. I feel an emptiness feeling below my sternum. Not sure if this is indigestion. I’m drinking kefir milk which has helped heartburn but dairy not good for phlegm. But I think now the phlegm & cough are related to the stomach?
I feel cold & energy not good since flu in November.
I eat pretty well, glass a wine maybe once a week and sometimes not. Fresh fruit & vegetables. Do eat meat but not much. Cook from scratch, no processed foods & organic where possible.
I’ve made GP appointment as bothering me now and mind working overtime. But reading your information as led me to writing this.
What do you think?
Thanks Joyce
Hi Joyce
From what you say I think you may have a mixture of Damp Phlegm, Stomach Yin deficiency, and Kidney yang deficiency, all associated with Spleen qi deficiency.
That’s a difficult mix because to warm yourself you need warming foods but if they’re too heating they’ll worsen your Stomach yin deficiency.
First read our page on Stomach Yin deficiency and when it comes to the suggestion about warming or heating foods, be sure to eat warm foods, but to avoid very spicy foods as listed on our page on Heating Foods. Red wine is usually good but white wine and beer are less beneficial.
Acupuncture would help. Antibiotics are usually cooling so avoid them. Obviously you’re aware of the main foods that worsen phlegm. Good luck with your doctor.