Phlegm in Chinese Medicine an important tale teller

Phlegm can be the cause of many diseases in Chinese medicine. It is a surprising tale teller that needs more attention than most people think.
Ginger tea mug
Photo by Dominik Martin on Unsplash

Key Learning Points

  • Why Phlegm in Chinese medicine is behind so many problems
  • Who gets Chinese medicine Phlegm
  • What kinds of Phlegm there are
  • How to get rid of it

Phlegm can be the cause of 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 for clear it. They have good ideas, but they haven’t sorted them into how to deal with the different kinds of mucus.

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:

  • Tongue: tongue coating is greasy or slimy or viscid and the tongue body is usually swollen
  • Pulse: slippery and sometimes wiry (technical terms used by acupuncturists to describe what they feel when taking your pulse)
  • There is, very often, heaviness in the chest, with heaviness in the body as a whole, a confused ‘thick’ head, and sometimes dizziness too. Also, nausea is common.

 

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 …

 

Phlegm’s Underlying Cause – the Spleen

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

  • turning food into good blood and energy but also 
  • clearing Damp and accumulated detritus, which could be blood cells past their use-by date, or muscular tissue being broken down through exercise, or fat hanging around, unwanted.

 

Lean Woman on the beach. Few signs of Phlegm.
Photo by Christopher Campbell on Unsplash

A Plug for FAT!

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!

Sub-categories of Phlegm

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 and Phlegm

  • Nausea
  • Vomiting of a clear sticky sort of mucus
  • Pulse: the slippery pulse might be more noticeable in the middle position on the right wrist.
  • Tongue: signs of a greasy coating more noticeable in the centre of the tongue

 

Lungs and Phlegm

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.

  • Pulse: slippery in the Lung position, but also probably in the Spleen position, being the middle and distal positions respectively  on the right wrist.
  • Tongue: slimy coating towards the front of the tongue

 

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.

Head and Upper Body

Phlegm here causes:

  • Dizziness (often crippling, very severe, as for example in diseases such as Meniere’s)
  • This dizziness may recur in bouts
  • This dizziness often occurs as a result of other syndromes such as Liver Fire or Internal Wind, with their related symptoms such as headaches, neurological disorders and even epilepsy.
  • Pulse: slippery in the distal and possibly middle positions but there would be other qualities depending on the syndromes involved
  • Tongue: greasy towards the front of the tongue, but with other qualities depending on the syndromes involved

 

Heart and Phlegm

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:

 

man holding his temples and looking down
Photo by Siavash Ghanbari
  • palpitations
  • lack of clarity in self-expression
  • disturbed expression
  • … which can become signs of mental derangement including Western medically-recognised conditions such as schizophrenia and bi-polar disorder
  • Pulse: slippery in the distal positions at the wrist but probably other pulse qualities too
  • Tongue: viscid or slimy coating towards the tip of the tongue but often also a deep central line to the tip, which may have what looks like powder in it.

 

Kidney and Gall-Bladder

Over time, heat dries fluids and creates first phlegm then stones. Kidney and Gallbladder stones are intensely painful end-products. 

  • During pain, the pulse will be wiry.

 

Chest and Sides of Body

Phlegm here causes:

  • Sensation of distension in the chest and/or
  • Pain in the chest
  • Sore cough
  • Pulse: slippery in the middle and distal positions
  • Tongue: slimy coating towards the front of the tongue
  • Note: a sensation of distension in the chest could be caused by Qi Stagnation too. In that case the Qi Stagnation has to be dealt with before expecting the phlegm to disappear. I’ve written a whole book about Qi Stagnation: see below.

 

The Jingluo

The What?

Jingluo is the name given to all the interconnecting paths and passageways that Qi takes just under the surface of the body.

  • Nodules, lumps and swellings that feel rubbery and don’t move around much. Usually they don’t hurt and Western medicine regards them as being removable with surgery. These are Phlegm in yet another form. Sometimes the channel on which they lie is clearly discernible, and treatment along that channel may slow down their growth. Once a nodule forms, however, it takes time to clear, even with good treatment.
  • Lymph nodes that swell display Phlegm, as do swollen thyroid glands and lipomas.
  • Where bones and joints get deformed and swollen, an underlying syndrome is Phlegm. Fluid build-up over a long period of time eventually coagulates to Phlegm. That Phlegm can then transform into bony growths. (This may not be how it is seen in modern rheumatology, but from the point of view of Energetic medicine, it is a way to understand and diagnose a condition, then treat it.)

 

black net like jingluo deformed by phlegm
Photo by Andrés Canchón

Skin of the limbs

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.

  • Numb areas on the skin, without obvious other cause
  • Pulse: slippery
  • Tongue: you would expect a greasy tongue coating
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Other kinds of Phlegm

Damp-Phlegm

Mainly caused by Spleen deficiency and appears as Lung syndromes:

  • poor appetite
  • nausea, especially on waking in the morning
  • huge amounts of clear or white mucous sometimes with the feeling that the chest contains lumps of the stuff
  • lack of thirst
  • chest feels oppressed
  • sense of fatigue
  • sticky taste in the mouth
  • Tongue: often swollen, with a sticky coating
  • Pulse: slippery

 

Phlegm-Cold (or ‘Cold-Phlegm’)

Commonly appears in syndromes of Stomach or Lungs:

  • cough is wet
  • mucous is clear and may be stringy
  • sense of coldness, eg cold arms and legs, easily chilled, likes warmth
  • nausea
  • chest feels heavy, full

 

Ice and Snow can be a cause of cold-phlegm
Photo by Pascale Amez on Unsplash

 

  • lack of thirst
  • Tongue: pale, swollen and coating is white and wet
  • Pulse: slow, slippery, may be deep

 

Example: I 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.

 

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.

 

Phlegm-Heat

Mainly occurs in syndromes of the Lungs, Stomach or Heart:

  • mucus expectorated is thick, sticky and either green or yellow: it may also be full of globules or big lumps of phlegm
  • Mucus can be hard to expectorate
  • chest feels full and heavy, difficult to breathe easily
  • Signs of Heat, such as fever, dryness, thirst (although not always with desire to drink, as the phlegm fills the stomach)
  • nausea
  • face is red
  • mouth is dry
  • generally restless
  • Tongue: red, swollen, with yellow, sticky coating
  • Pulse: fast and slippery

 

Phlegm-Dryness

Mostly affects the Lungs:

  • often cannot expectorate phlegm
  • any phlegm is very tenacious and thick, almost rubbery
  • difficulty breathing
  • chest feels very congested, causing distress
Smoking - a cause of Lung Phlegm with Lung and Spleen deficiency
Smoking – Photo by Riccardo Fissore on Unsplash
  • can occur after inhaling poisons: tobacco smokers get this
  • Tongue: may be red and dry
  • Pulse: slippery but also tight or even wiry

 

Qi-Phlegm

This syndrome is mainly associated with Liver Qi stagnation.

  • throat feels as if there’s a lump in it, swelling it, although no swelling or lump can be found
  • hard to swallow
  • chest and upper abdomen feel stuffy and oppressed
  • emotional, especially angry or irritable, and moody
  • depression
  • patient feels better when doing something, especially something physical
  • Tongue: may be unaffected, or sometimes with teethmarks on the sides
  • Pulse: wiry

 

Phlegm-Fluids

Various kinds of Phlegm-Fluids occur, in the hypochondrium, stomach, the limbs and the diaphragm, each with different symptoms, but nearly all have

  • expectoration of thin watery mucus, 
  • difficulty breathing, 
  • dizziness and 
  • swollen tongue. 
  • Pulse is usually wiry. Worse cold.

 

Wind-Phlegm

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.

  • mucus expectorated is watery or white, may be bubbly
  • phlegm is easily coughed up
  • chest feels heavy
  • throat sounds rattly, as of phlegm there
  • aphasia
  • dizziness
  • vomiting and nausea
  • limbs may feel numb or tingly or lose power (usually one-sided)
  • Tongue: swollen, often deviated or seems to ‘strain’ to one side, with a sticky coating
  • Pulse: wiry

 

What can You do about your Phlegm?

Self-Help

What can you do to improve the chance of successful treatment – see below?

Certain foods are best avoided with most kinds of Phlegm:

 

DIY : avoid foods that increase phlegm!
DIY Disaster – Photo by Andre Maritz -Dreamstime

 

  • Foods known to weaken or block the Spleen include dairy foods (milk, cheese, cream, yogurt), greasy/fatty food, sweet food, sugars and sweets, raw food (especially when you have Cold Phlegm) and cold/iced food – and drinks. These cause Damp fluids which easily turn to Phlegm. Don’t ignore this dietary advice! It really can make a difference!
  • Food that has been refined, or treated with preservatives, or contains food additives such as artificial colours or flavours or flavour enhancers. Although these obviously modern substances were not available to the Chinese who worked out how phlegm was caused, I think they would be included in the list of discouraged substances now. 
  • Foods that are not organic include antibiotics, pesticides, herbicides and fungicides, admittedly in minute quantities. On any one day these are unlikely to cause harm, but taking such foods regularly over time may build up undesirable amounts in the body fluids, hampering Spleen, Kidney and Liver actions.
  • Alcohol: at the time this can feel like a very good idea to help drown the misery, but you may notice that your Phlegm quickly worsens. 

 

Bad Habits

Poor eating habits include:

  • eating in a rush or when working or otherwise occupied
  • irregular meals
Frequent snacks lead to phlegm
Cheetos Baked chip bag lot
  • not chewing food properly before swallowing
  • eating when tense or tired
  • eating too much at a time
  • snacking
  • eating too fast, or – as mentioned – a big cause! …
  • … not chewing properly.

 

What if you are ill?

  • If you are ill, take longer to eat, eat with small mouthfuls, and chew everything well. The same goes if you are elderly and your digestion lacks its earlier ‘fire’.
  • Drinking lots of cold or iced liquids douses your Stomach Fire, so you won’t digest food so well. Warm liquids are better. In fact, if you suspect that your digestion is below-par, always start and finish meals with something warm, even if it’s just a cup of warm tea: this helps to ‘warm’ the tubes!
  • Your Spleen nearly always benefits from Ginger. Get the root variety, not the dried powder. Cut up a slither of root and add it to whatever you’re eating. Or make it into a tea by pouring hot water over it in a mug.
  • Read more under Nutrition and Supplements.

 

Movements to move Phlegm

 

Movement helps to clear phlegm.
Photo by Ahmad Odeh
  • There are various stretching movements that keep the spine flexible and in so doing force you to expand and contract your lungs. Tai Qi is one way that has helped many; the simple exercise in appendix 10 of my book Qi Stagnation takes about 2 minutes to do and can be repeated regularly through the day. Walking in fresh air is usually beneficial, but make progress – don’t amble! (However, for Phlegm-Cold affecting the lungs, you may be better in a warm environment, if the air is well-circulated and clean.)
  • However, the above advice is mostly appropriate to the Cold and Damp forms of Phlegm. If you have Phlegm Heat, there are other considerations and you will want to drink more cool (not iced) fluids to dilute the Phlegm and wash it away. But you’ll also probably need treatment to clear the Heat.

Treatment for Phlegm

Given that Phlegm comes into existence when fluids either

  • stagnate because of Qi Stagnation, or 
  • arise from either Cold congealing fluids or
  • thicken or condense fluids to become Phlegm because of Heat

 

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.

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, below.)

What will your acupuncturist do? 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, you must treat the Spleen.

If the Lungs, which tend to store the Phlegm, are involved, then treatment must assist them.

Finally, Kidney Qi, which supports all the other zangfu, helps Spleen Yang to transform Phlegm and is particularly relevant for the warmth of the body, must be supported.

Complicating factors?

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 there’s another problem. Once Phlegm gets into the system, especially if it’s that of an older, weaker person with a system that can’t clear it, it becomes self-perpetuating and slows everything down, causing more fluids to stagnate leading to 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.

 

Pills and sugars often increase phlegm
Photo by freestocks.org on Unsplash

Western Medicine and Phlegm

However, Western medically trained doctors, not trained in energetic-type medicine, typically use medications that prevent the body making the repairs needed. For instance

  • In the case of hot or dry Phlegm, broncho-dilators (which Chinese medicine regards as having a hot-dry energy) may make symptoms temporarily better but then worse.
  • Where there is blockage or what seems like an inflammation (which could be not from a bug but from Yin deficiency), it is tempting to use steroid-type sprays, but these often have a weakening effect, not to say anti-inflammatory effect, that is in effect cooling.
  • where bacterial infection is suspected, antibiotics may be prescribed. These mostly have a cold-damp effect. They usually kill the bug (assuming the antibiotic is well-chosen and the bacteria hasn’t learned to resist it, now becoming a huge problem) but, being cold and damp, can weaken the Spleen. That means that the Phlegm remains and may increase. IF your type of phlegm is by nature cold and damp, antibiotics will make it, and you, worse. Instead, make yourself warm soups and stews with plenty of warming ginger. Take clogstoun congee for moisture (add ginger to that too) and energy. You’ll probably find the improvement matches anything antibiotics can do, with the advantage that you don’t go down with the same thing again right after stopping them!

 

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.

That’s why I wrote the book about it “Yuck! Phlegm!”

For example, if the cause has been, say Heat invasion, but there is also an underlying Yin deficiencyKidney 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!

How to Proceed!

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!

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