Phlegm is one of the pathological products of Chinese medicine. When it comes to phlegm, most people immediately think of coughing and spitting symptoms of patients with lung diseases, because at this time the phlegm has shape, color, texture and taste, and can be seen by the human eye, so it is easy to diagnose and understand. At the same time, there is a classic phrase in Chinese medicine called “all diseases are caused by phlegm”, which extends the connotation of phlegm abruptly and gradually forms the phlegm pathology of Chinese medicine. In phlegm pathology, phlegm is often categorized into tangible and intangible phlegm, broad and narrow phlegm, etc. Tangible phlegm refers to phlegm in the form of phlegm. Tangible phlegm refers to the visible phlegm of the lung system; invisible phlegm refers to those phlegm diseases that only see signs, but not its form, such as epilepsy, vertigo, and so on. Referring to the literature, we did not find any systematic discussion of invisible phlegm in pulmonary diseases. So whether there is invisible phlegm in pulmonary diseases, how to recognize invisible phlegm, how to diagnose and treat, the author will talk about his own views on these issues. I. The existence of invisible phlegm in pulmonary diseases The reason why we believe that invisible phlegm exists in pulmonary diseases is inspired by the three forms of matter and the relationship between blood stasis and stasis in Chinese medicine. Here, the three forms of matter and the relationship between blood stasis and blood stasis are used to illustrate the conception of the existence of invisible phlegm in pulmonary diseases. First of all, let’s briefly talk about the three forms of matter, solid, liquid and gas, which exist in different conditions and situations and can be transformed between them. For example, such as water, usually liquid (visible state), heat is transformed into gas (invisible state), the gas state by the cold will be turned into liquid. Then look at the fluid in Chinese medicine, there are also liquid and gaseous state two, just fluid in the body’s metabolic process is much more complex than the process of conversion of water in nature. Fluid liquidity, by the kidney Yang steam gasification after the gas, gas will be able to rise, in the process of rising to play the role of moistening the internal organs, the metabolism of the internal organs and the formation of liquid, summed up in the bladder to form urine, urine that is discharged from the human body. This is a physiological process. If the metabolism of fluid abnormalities, not return to the right chemistry, then born phlegm dampness. If the generated phlegm-dampness is visible to the naked eye, it is tangible phlegm; if it is not visible to the naked eye, but can be reflected through the patient’s signs that there is phlegm in the body, it is intangible phlegm. This is a description of phlegm-dampness of the whole body, and if the scope is narrowed to the lungs, it is lung phlegm. Phlegm-dampness is categorized as tangible and intangible, and lung phlegm can also be categorized as tangible and intangible. Next, the existence of invisible phlegm in lung system diseases is envisioned from the perspective of blood stasis and stasis. Blood stasis is a state of stagnation of the blood, while stasis of blood is a tangible pathological product formed after stagnation of the blood, so the concepts of the two are not the same. Blood stasis is generally considered to be the poor fluidity of the blood, but not yet the formation of stasis; while stasis is a tangible product formed after the blood does not flow. The reason why the concepts of Blood stasis and Blood stasis are cited here is also to better illustrate the categorization of Phlegm Dampness as tangible and intangible. It has been suggested that invisible phlegm is closely related to the stagnant state and poor mobility of the blood, and even further that hyperviscosity is a manifestation of phlegm-dampness in Chinese medicine rather than stasis of blood. If this view is valid, then this kind of phlegm-dampness, which is neither visible to the naked eye nor visible in form, should belong to the invisible phlegm. The formation of phlegm-dampness is related to the five organs, if it is closely related to the lung system or occurs in the lung system, then it will become lung phlegm, phlegm-dampness has invisible phlegm, then lung phlegm has invisible phlegm. According to different sources, the production of invisible phlegm in lung diseases can be divided into three aspects: phlegm produced by the lungs, phlegm produced by other organs and phlegm produced by the lungs and blood stasis. (According to different causes, phlegm produced by the lungs can be categorized into phlegm produced by external infection and phlegm produced by internal injury. Exogenous phlegm is the pathological result of the poor functioning of the fluid formed when the lungs are attacked by wind-cold, wind-heat or dryness, and the function of the water channels is less affected by the loss of propagation and purification. At this time, if the fluid does not run well, the formation of stagnant phlegm, can be discharged out of the phlegm is tangible phlegm, if only to stay in the running state, the formation of phlegm is intangible phlegm. Internal injury generates phlegm, which is the pathological result of repeated episodes of various chronic lung diseases, leading to self-injury of the lung, loss of XuanSuDi, decline in ventilation, decline in the metabolism of water and liquid, and formation of poor functioning of fluids. If not smooth lead to fluid stagnation, cluck out for tangible phlegm, if only not smooth for intangible phlegm. We often say that croup is caused by ambient phlegm, this ambient phlegm actually belongs to the invisible phlegm. Croup is not an attack of invisible phlegm hidden in the lungs, an attack of invisible phlegm in the sense of attraction and stagnation, so phlegm rises with the gas, gas due to phlegm obstruction, phlegm and gas struggle, congestion, airway, narrowing of the lungs, resulting in phlegm, such as roar, breath shortness of breath. Therefore, the meaning of the invisible phlegm in lung diseases, from the author’s personal point of view, is more inclined to refer to the pathological state or dysfunctional state of the fluid that is formed by the poor functioning of the fluid. (2) The generation of phlegm by other organs and the lungs The generation of phlegm by other organs refers to the production of phlegm-dampness as a result of the dysfunction of the spleen, kidney, liver and triple jiao, which arrives with the qi and stays in the lungs, thus causing disease. Spleen main transportation of water and grain, the spleen and stomach dysfunction of the water and grain is not returned to the positive chemical formation of phlegm and dampness; kidney main water, the kidney gas vaporization of the metabolism of the body of the water has a fundamental role in the kidney, kidney yin or renal yang function abnormalities of the gasification of water and liquids will be reduced the ability to stop the accumulation of phlegm; the liver is the main excretory, including excretory fluids, emotional and psychological pathology can affect the liver’s function of the excretory fluids and thus become phlegm; the triple jiao is a watercourse, the qi is unfavorable or produces Watery drinks, or breeding phlegm-dampness. These organs produced by the phlegm and dampness, with the gas up and down, up to the lungs, retained in the lungs can also produce lung disease. (C) Blood stasis and phlegm Blood stasis and phlegm come from the same source of fluid and blood. Diseases of the fluid can lead to diseases of the blood, such as the formation of blood stasis, while diseases of the blood can also lead to diseases of the fluid, one of the manifestations of which is the production of invisible phlegm. One of the manifestations of this is the production of invisible phlegm in lung system diseases because of blood stasis in the lungs. Blood stasis leads to poor flow of fluid in the veins, resulting in the production of invisible phlegm. This is what Zhang Jingyue said in “Jingyue Quanshu Miscellaneous Certificates Mol”: “Phlegm and saliva are all blood and gas, if the chemistry is not correct, then the internal organs are sick, the fluid is lost, and the blood and gas become phlegm and saliva.” Moreover, this invisible phlegm is often associated with blood stasis, one of the manifestations is phlegm and blood stasis blocking the collaterals, so clinically, there are blood stasis and phlegm collaterals treatment. Many people know that blood stasis obstructs the collaterals, in fact, phlegm obstructs the collaterals is also very common, and its mechanism is due to blood stasis and phlegm, phlegm stasis and inter-conjugation, and the collaterals are not smooth. Diagnostic reference of invisible phlegm in pulmonary diseases With the help of patients’ clinical manifestations and modern examination, preliminary diagnosis of invisible phlegm in pulmonary diseases can be made. Although invisible phlegm is invisible, it is after all a pathological product, which will also show clinical symptoms, and its existence can also be confirmed from the perspective of modern examination. (A) clinical diagnosis based on the lung disease invisible phlegm clinical manifestations of cough, shortness of breath, chest tightness, dizziness, dizziness, mental instability, and even drowsiness, lethargy, and so on. Characterized by the absence of phlegm visible, phlegm disease signs appearing on the basis of the original lung disease. For example, some patients with wheezing symptoms do not have obvious coughing phlegm, but in the clinical treatment is still used to resolve phlegm to calm the asthma, the lung to stop coughing method as evidence. Moreover, more and more experts and scholars have begun to recognize and treat asthma from the perspective of invisible phlegm. (ii) Modern laboratory support Modern research has found that many patients with pulmonary diseases do not have obvious symptoms of cough and phlegm, but blood tests can show many abnormalities. For example, elevated leukocytes in blood routine, elevated C-reactive protein and calcitoninogen, and elevated lipids in biochemistry. In terms of blood rheology, patients with phlegm symptoms have increased blood consistency, viscosity, aggregation and coagulation. It has also been found that some patients with invisible phlegm have manifestations of whole blood viscosity, erythrocyte pressure volume, blood sedimentation, platelet aggregation function, increased fibrinogen and slowed erythrocyte electrophoresis. Therefore, we can draw on these modern laboratory results to help the microscopic diagnosis of invisible lung phlegm. The connection between invisible phlegm and tangible phlegm in pulmonary diseases Like the transformation of material forms, invisible phlegm and tangible phlegm in pulmonary diseases can be transformed, and the transformation conditions of the two can be transformed according to the changes of the disease and the treatment. Typical representative of the disease with the change of condition is the aforementioned croup, which is invisible ambient phlegm when it does not attack, and tangible phlegm visible to the naked eye when it attacks; the representative of the transformation with the treatment is the phlegm therapy, which is often referred to as phlegm, phlegm is firstly transformed from tangible phlegm to invisible phlegm, and then to achieve the effect of transforming and eliminating the invisible phlegm during the treatment, and at this time, the patient will experience a gradual reduction in the amount of phlegm, and eventually the disease will be cured. The patient will then experience a gradual decrease in the amount of phlegm and eventually be cured. However, it is important to note that the presence or absence of phlegm does not necessarily mean the severity of the disease. Invisible does not necessarily mean that the symptoms are light, but only that they are not visible, and visible does not necessarily mean that the symptoms are heavy, but only that they can be eliminated through the trachea. Therefore, tangible and intangible does not represent the severity of the disease, the difference between the two lies only in the ability to discharge only. V. Treatment Principles of Invisible Phlegm in Lung Diseases Since invisible phlegm is also phlegm, the treatment should follow the conventional thinking of phlegm treatment, first of all, we should distinguish between evil and positive and determine whether the condition is caused by external or internal injuries. If the disease is caused by external infection, it is necessary to relieve the surface and promote the lungs, and according to the nature of the disease, it is divided into wind-cold, wind-heat and wind-dry theory of treatment, and it can be appropriately accompanied by the treatment of phlegm. If the disease is caused by internal injuries, the nature of the disease is mostly evil solid and positive deficiency. If the standard solid is the main one, the treatment is to get rid of the evil and treat the standard, and if the deficiency is the main one, it is necessary to combine the different organs of the lungs, spleen, kidneys, liver, triple jiao and so on, and treat them separately. Detailed methods are as follows. (I) Treatment of phlegm: there is a difference between hot and cold phlegm, which should be combined with the nature and duration of the lung disease, using methods such as warming the lung to dissolve phlegm, clearing the lung to dissolve phlegm, and guiding phlegm to exclude phlegm. (ii) Treatment of qi Treatment of qi, i.e., methods of regulating qi. “Those who are good at treating phlegm should first treat the qi instead of the phlegm”. When the evidence is clear, it is important to distinguish between the real and the imaginary. The real is diarrhea, the use of unimpeded qi, the method of relieving the depression of qi; deficiency is complementary, the use of qi methods, tonifying the lungs and kidneys, the spleen and stomach of the qi. (C) treatment of blood stasis Guan Youbo, an old Chinese medicine practitioner, believes that: “the treatment of phlegm must activate the blood, blood activation is phlegm; the treatment of blood (stasis) must be treated with phlegm, phlegm blood easy to move. In clinical practice, Chinese medicines that activate blood circulation and eliminate blood stasis can be used to promote the elimination of pulmonary phlegm. (Many chronic cough and asthma patients are accompanied by symptoms of blood stasis, such as cyanosis of the lips and nails, sallow color, dark red tongue, purple or petechiae, astringent pulse, mostly due to blood stasis and phlegm and turbidity are interspersed with the disease. When treating stasis, the treatment should be accompanied by products that promote the lungs and clear the lung channels, such as Angelica sinensis, Rhizoma Ligustici Chuanxiong, Rhizoma Dillonii, Silk Gourd, Tangerine Luo, etc., in order to invigorate blood stasis, dissolve phlegm and dampness, and clear the lung channels. (E) expectorate the wind Part of the asthma patients with sudden onset of disease, onset and off, recurrent episodes, and the wind evil “good for several changes” in line with the nature of the disease is identified as wind phlegm for the disease. Treatment can be combined with wind, phlegm medicine, such as Xu Changqing, wind, Cang Er Zi, soap horn, silkworms, cicadas, Dilong, Lu Bifang and so on. Especially the insect medicine, go into the channels, searching and picking the evil, can dispel the lung meridian ambient evil, enhance the function of asthma and reduce reversal, and is good at dispelling wind and spasm, phlegm through the channels.