A Preliminary Study on the Diagnosis and Treatment of Phlegm in Traditional Chinese Medicine
I. The understanding of phlegm in Chinese medicine
(A) Definition and concept of phlegm
Sputum is a pathological product produced by the airway under the action of various pathogenic factors, stimulated by the airway, and expelled from the airway with coughing, which is also a pathological product of the internal organs. Sputum is a pathological phenomenon, which contains mucus, foreign matter, pathogenic microorganisms, various inflammatory cells and necrotic shed mucosal epithelial cells and other components. It can irritate the mucous membrane of the respiratory tract causing coughing and can aggravate the infection. However, it should be emphasized that it is the secretion discharged from the airway due to coughing, not the nasal and pharyngeal areas, which are not accompanied by the secretion produced by coughing. This secretion is not phlegm in the true sense of the word.
(II) Causes of phlegm
Ancestral medicine believes that the spleen is the source of phlegm production and the lung is the reservoir of phlegm. The production of phlegm is mainly closely related to the lungs and spleen. The lungs are responsible for breathing and regulating the flow of Qi (vital energy) in and out and up and down. When the external evil attacks the body, the lungs lose suction and lowering, the watercourse is obstructed, the essence will be impregnated with lung into drink, gathered into phlegm, there will be cough, wheezing can not lie down, etc.; spleen is the main transport and transformation of water and dampness, if dampness invades the body, or excessive thinking, fatigue and internal injury and diet, etc., will also damage the spleen and stomach, so that it loses its normal transport function, causing water and dampness to stop and condense into phlegm.
(3) Scope and classification of phlegm
In fact, the scope of “phlegm” in Chinese medicine is very broad and narrow, including “tangible phlegm” and “invisible phlegm”. Tangible phlegm refers to the phlegm secreted by the respiratory tract, coughing and spitting. In addition, some diseases such as vertigo, hyperlipidemia, nausea and vomiting, palpitations and shortness of breath, fainting or epilepsy may also be caused by phlegm. However, this invisible phlegm is called invisible phlegm. The following on the tangible phlegm (also referred to in the narrow sense of the specific phlegm), the author combined with their clinical experience and understanding, to discuss. Broadly speaking, “tangible phlegm” can be divided into cold phlegm, hot phlegm, wind phlegm, wet phlegm and dry phlegm.
II. Diagnosis and treatment of phlegm
(A) Traditional diagnosis and treatment of cold phlegm
Coughing phlegm with white and thin color, light mouth and salivation, accompanied by fear of cold, or cold back and limbs, thirst for hot drinks, light tongue with thin white coating and moist, tight pulse. Pathogenesis: Cold offends the lung, and the lung loses its cathartic function. Treatment: Dispersing cold in the lung, resolving phlegm and relieving cough. Gui Zhi 6 grams, Han Xia 9 grams, dry ginger 6 grams, Hosin 3 grams, almond 10 grams, thorny mustard 9 grams, Bai Qian 9 grams. With shortness of breath add 12 grams of roasted ephedra. Care: active treatment of wind-cold cold at the same time, drink more plain water, or choose some Chinese medicine such as Chen Pi, Mandarin and other phlegm infusion to drink. Hot phlegm: yellow and sticky phlegm, fear of heat and cold drinks, yellow bowel movements, red tongue with yellow coating or yellow greasy coating, slippery pulse. Pathogenesis: Heat attacking the lung or suffering from wind-cold first, not healed for a long time, turning heat into heat, burning fluid and becoming yellow sticky phlegm. Treatment: To promote the lung and clear heat, resolve phlegm and stop cough. Adjustment: It is advisable to have a light diet, do not eat fried, dry fried and other foods that can easily get on fire, you can drink some gardenia, fresh bamboo water or pear juice. Wind phlegm: sputum white thin, or foam sputum at the beginning, later can turn yellow sticky sputum; patient afraid of wind, easy to catch a cold, tongue coating white at the beginning, later turn thin yellow, pulse floating. Mechanism: wind attacking the lung, lung loss of suction treatment: dredge wind and clear heat, stop coughing and resolve phlegm formula: Almond 10g, Su Ye 9g, Thornbush 9g, Qian Hu 9g, Mandarin 9g, Bai Qian 10g. If the phlegm turns yellow, add 6 grams of bile star, 15 grams of forsythia and 15 grams of silver flower. Damp phlegm is seen: white thin watery phlegm, white face with heavy limbs, or easy fatigue or thin stools, etc., thin white tongue coating or white greasy. The pathogenesis: dampness is trapped in the spleen, the spleen is not transported and transformed treatment: strengthen the spleen and dry dampness, reduce phlegm and stop coughing formula: Er Chen Tang or San Zi Nourishing Parent Soup plus reduction: 9 grams of Han Xia, 12 grams of orange red, l5 grams of Fu Ling, 6 grams of roasted licorice, 9 grams of almonds, 18 grams of Coix Seed, 12 grams of each of Atractylodes. Care: eat foods such as barley, yam, etc. to strengthen the spleen and dispel dampness. Pay attention to strengthen physical exercise, reduce weight, etc. Dry phlegm: phlegm is sticky and not easy to cough up or phlegm with blood, the patient feels dry in the mouth, nose and throat, dry skin, red tongue with little coating or thin yellow coating, thin pulse. Mechanism: dryness attacks the lung, the lung is not clear and moistened. Treatment: remove wind and clear the lung, moisten and stop coughing. Care: Drink plenty of plain water, and use medicines that nourish yin such as salvia and maitake as tea substitutes, and drink plenty of plain water to keep the respiratory tract moist, or use a humidifier.
(2) Special diagnosis and treatment of phlegm
Yellow sticky phlegm – is wind-heat, mostly Gram-positive cocci such as Staphylococcus aureus infection. It can be treated with addition and subtraction of Mao Xing Shi Gan Tang, regardless of whether it is a new infection or a new attack of an old disease. Can be treated with Qing Jin Hua Phlegm Tang or Sang Pi Tang plus or minus. Chinese medicine can be used to choose gold buckwheat tablets, scape shell capsule or lung power cough combination.
White mucous sputum – main spleen deficiency, mostly seen in chronic bronchitis, if the sputum volume increases suggests Gram-negative bacterial infection. If the sputum is thick and intertwined and not easy to cough out, use Er Chen Tang or San Zi Yang Yin Tang with Gua Gua Ren and Hai Fu Shi to treat.
Dilute white sputum is cold and damp, mostly seen in wind-cold colds and cold croup of croup. It can be treated with addition and subtraction of Sugan Ma Huang Tang or Xiao Qing Long Tang.
Foamy sputum-mostly seen in chronic bronchitis and emphysema, treatable with Xiao Qing Long Tang with addition and subtraction.
Phlegm with sticky gelatinous filaments or lumps or old phlegm that does not dissolve – Pay attention to exclude cancerous lesions of the lung, and treat with dialectical evidence and at the same time, treat with Polishing Phlegm Tang with addition and subtraction of Hai Fushi, Yuan Zhi and Sea Clam Shell.
Salty phlegm-mainly due to kidney deficiency, mostly due to non-intake of kidney water and upward flooding of fluids. It can be treated with Jinshui Liujun Decoction Plus Decrease, which tonifies the kidney and strengthens the spleen, and reuse 30 grams of Shu Di.
Fishy and thick sputum-mostly seen in lung abscesses (canker sores). Generally speaking, when anaerobic bacteria are infected, pus sputum has a foul odor. In the early stage, it can be treated with Yin Qiao San, and in the middle stage, it can be treated with Qian Jin Wei Zhi Tang with reduction.
Sputum with a sweet taste – the main reason is spleen deficiency, which is caused by the retention of phlegm and dampness in the spleen. Sweet and white sputum is cold and damp sputum. Sputum that is sweet and thick and yellow is damp-heat sputum. According to Mr. Cheng Menxue’s experience, regardless of cold-damp or damp-heat phlegm, all phlegm that is sweet should be appropriately added with aromatic and damp-transforming products such as Chen Pi and Sha Ren, which can improve the efficacy.
Brick-red sputum-Acute lung inflammation caused by Klebsiella pneumoniae with reddish-brown jelly-like sputum or brick-red sputum, mostly seen in elderly, malnourished, chronic alcoholism, patients with existing chronic bronchio-pulmonary disease and systemic failure. Rust-colored sputum – rust-colored sputum is usually considered lobar pneumonia, which is caused by Streptococcus pneumoniae infection. In the early stage, it can be treated with mulberry chrysanthemum drink or mahong shi gan soup with addition and subtraction while fighting against infection, which can significantly relieve symptoms and shorten the course of treatment. Black or gray sputum – mostly due to long-term smoking and smoke inhalation, also seen in pneumoconiosis (coal pneumonia is common). It can be treated with siliciclovir. Yellow-green sputum-mostly due to Pseudomonas aeruginosa infection, which can be seen in bronchial dilatation and other diseases. It can be treated with addition and subtraction of Sangbai Pi Tang or Qingjin Huapu Tang. Pink sputum – In acute pulmonary edema, coughing up pink thin foamy sputum is common. It can be treated with Astragalus membranaceus capsule and other treatments along with comprehensive treatment. Jam-like sputum – When pulmonary schistosomiasis is infected, it is often manifested as brown-red jam-like sputum. It can be treated with thiodichlorophenol, praziquantel (high efficacy, low toxicity, short course). Coffee-like sputum – pulmonary amebiasis often coughs up coffee-like sputum or chocolate colored sputum. Mostly treated with metronidazole and other drugs.
The use of cough and phlegm-suppressing Chinese medicines
Wind-heat cough – This type of cough is characterized by frequent coughing, coarse breath, sore throat, thick yellow or sticky phlegm, often accompanied by fear of wind, body heat, yellow runny nose, thirst, headache and other symptoms. The main Chinese patent medicines available are Acute Branch Syrup, Luohan Guo Cough Relief, Snake Gall Bladder and Chuanbei Lozenges, Chuanbei Loquat Lozenges, Zhen Coughing Ning Syrup, Niuhuang Snake Gall Bladder and Chuanbei Lozenges, Jin Buckwheat Tablets, Scape and Shell Capsules, Lung Power Cough Capsules, Xian Sheng Cough and Wheezing, Fresh Bamboo Li Oral Liquid, Expectorant Spirit (compound Fresh Bamboo Li) Oral Liquid, and injections such as Phlegm Heat Clear, Heat Poisoning, and Asthma Cure.
Wind-cold cough – This type of cough is characterized by a heavy cough, thin and white sputum, often accompanied by nasal congestion, clear runny nose, headache, fever and chills, no sweating, and aching limbs. The main Chinese medicines available are almond cough syrup, snake gall bladder and chenpi oral liquid, Guilong cough and wheezing, Xiaoqinglong granules, Tongxuan lung oral liquid, etc.
Phlegm-damp cough – This type of cough is characterized by a heavy cough, thick phlegm, sticky or thick lumps of phlegm, white or grayish color, which can be aggravated by eating sweet and oily food, with symptoms such as chest tightness, low food intake, body fatigue and loose stools. The main Chinese herbal medicines available are: Han Xia Dew, Orange Red Phlegm and Cough Punch (oral liquid and cream), Er Chen Wan, Orange Red Phlegm and Cough Oral Liquid, and Ding Qi and Cough Capsules.
Dry heat cough – This type of cough is characterized by dry cough without sputum, or sputum that is small and sticky and not easy to cough up, or sputum with blood in it, dry throat, dry nose and lips, etc. The main Chinese medicines available for this type of cough are: Antelope Qing Lung Pill, Xing Su Er Chen Pill, Cough and Phlegm Relief Granules, Ten Flavors Gentian Flower Granules, Pudi Lan Anti-inflammatory Oral Liquid, etc.
Yin deficiency cough – This type of cough is characterized by a prolonged dry cough, a short cough, or blood in the sputum, often accompanied by red flushes in the afternoon, night sweats, and fatigue. The main Chinese medicines available are: Honey Refined Chuanbei Loquat Paste, Baihe Gujin Pill, Autumn Pear Paste, Nourishing Yin and Clearing Lung Pill, Ermu Ning Pill, Chuanbei Snow Pear Paste, etc.
Lung Qi deficiency cough – This type of cough is characterized by a weak cough, thin sputum, spontaneous sweating and fear of wind, and susceptibility to colds, often caused by a prolonged cough. The main Chinese medicines that can be chosen are: Yu Ping Feng San, Huai Qi Huang Granules, Gu Ben Cough and Asthma Tablets, etc.
4. Select Chinese medicines according to the nature of phlegm
For cold phlegm and damp phlegm, Chinese herbal medicines include Radix Panax notoginseng, Tennant’s star, White mustard seed, Yu Baiyun, Radix Platycodon, Radix et Rhizoma, Baisian, Qianhu, Chen Pi, Radix et al.
Chinese herbal medicines used for the evidence of heat phlegm include Qian Hu, Fritillaria, Bai Qian, Radix Platycodon, Chuan Bei Mu, Zhe Bei Mu, Gua Gua Pi, Dong Gua Zi, Zhu Ru, Zhu Li, Tian Zhu Huang, Hai Clam Shell, Hai Fu Shi, Fatshai, etc.; Chinese herbal medicines used for the evidence of dry phlegm include Chuan Bei Mu, Zhe Bei Mu, etc.
Chinese herbal medicines used for the evidence of wind phlegm include Tian Nan Xing, Bile Nan Xing, Yu Bai Shen, Bamboo Leach, etc.
Chinese herbs used for the evidence of stubborn phlegm or old phlegm include sea clam shell, sea pumice, saponaria, pores, etc.
V. Dietary contraindications and phlegm
①Cough patients, no matter how new or long they are, should be earnestly advised on the dietary contraindications. ② Diet should be light, eat fried, crispy, fatty and sweet such as cane sugar and other most likely to produce hot phlegm. ③ too much fruit intake, easy to trap the spleen and help damp phlegm, such as eating citrus phlegm. ④ Avoid eating pickled and salty products such as soy sauce mixed vegetables, pickled vegetables, tofu milk, cured meat products, its cold is particularly strong, eating it must be. ⑤ Avoid seafood and other pungent and spicy products, which are also an important part of curing cough and should not be ignored.