Phlegm can be easily observed when it accumulates in the Lung as it can be expectorated:

Invisible phlegm can result in different symptoms:

(See Figure 9.1 on page 247 and Figure 9.2 on page 248.)

Ban Xia, Ju Hong and Chen Pi are the most commonly used herbs to treat damp-phlegm no matter where it is located.

Ban Xia is warm, pungent and poisonous, and enters the Spleen and Stomach meridians. This herb is able to dry dampness and transform phlegm in the Middle-Jiao. When dampness is removed, the transportation function of the Spleen is recovered and phlegm is no longer generated. In the formulas that treat phlegm, Ban Xia is often selected as chief to dry and eliminate phlegm, as it particularly treats cough with a large amount of white sputum and tightness in the chest. Ban Xia can also effectively soothe the Stomach-Qi and transform damp-phlegm in the Stomach. It can relieve nausea, vomiting and fullness in the epigastria, and improve appetite. Since raw Ban Xia is poisonous, this herb is often used after processing.

Ju Hong is fresh tangerine peel that has been dried and stored for up to 1 year. It is warm and pungent, and enters the Lung and Stomach meridians. Like Ban Xia, it can dry dampness and remove damp-phlegm. It is particularly used when there is a large amount of phlegm that can be easily expectorated. Since Ban Xia and Ju Hong work via the same approach, they are often used together to enhance each other’s ability.

Chen Pi is tangerine peel that has been dried and stored for more than a year. Its pungent and warm nature decreases with time, but it is excellent to move the Qi. It enters the Stomach and Spleen meridians. In the formula for removing phlegm, it is often selected to enhance the ability of Ban Xia to dry and eliminate phlegm. Its aromatic smell can soothe the Stomach-Qi and stimulate the Spleen to transform dampness.

These herbs are the most commonly used herbs to treat phlegm-heat. They are selected as chief in formulas to treat phlegm-heat syndrome.

Bei Mu is divided into Chuan Bei Mu and Zhe Bei Mu. Both are bitter and cold, and enter the Lung and Heart meridians. They can transform phlegm-heat, dissipate nodules and treat cough with thick green sputum that is difficult to expectorate, as well as dryness in the mouth and nasal cavities.

Chuan Bei Mu is also sweet but less cold than Zhe Bei Mu; thus it can moisten the Lung, transform phlegm and relieve cough. It is effective for treating phlegm-heat syndrome with signs of Lung-Yin or fluid deficiency. The symptoms are of a small amount of very sticky and thick sputum that is difficult to expectorate. It is often used with herbs that nourish the body fluid to dilute the phlegm. Furthermore, this herb can dissipate thick phlegm and disperse the constrained Qi in the chest. If combined with herbs that spread the Liver-Qi, it can treat depression, plum-pit syndrome and nodules, which are caused by the obstruction of Qi and phlegm.

Zhe Bei Mu is more bitter and colder than Chuan Bei Mu. It has no function in moistening the Lung, but is stronger in clearing heat and reducing fire, and is more suitable for treating severe phlegm-heat in the Lung. This herb is also stronger in breaking up congealed phlegm and dissipating nodules than Chuan Bei Mu. It can be selected to treat red, swollen and painful scrofula or abscesses. If combined with other herbs, it is used to treat tumors.

Gua Lou and Gua Lou Ren are also frequently selected to treat phlegm-heat. They are sweet, bitter and cold, and enter the Lung, Stomach and Large Intestine meridians. Both can clear heat from the Lung, transform phlegm-heat and unbind the Qi in the chest. They are selected as chief to treat cough with a large amount of green sputum, distension, constriction and pain in the chest, and irritability. They can also be used for treating abscesses. The strong point of these herbs is that they can promote bowel movement and treat constipation, as well as accelerate the descending of Lung-Qi and remove phlegm-heat in the Lung. Comparing the functions of the two herbs, Gua Lou is stronger in clearing heat and transforming phlegm; Gua Lou Ren is stronger in moistening the intestines and promoting bowel movement. If combined with herbs that clear heat, Gua Lou Ren is effective for removing phlegm-heat from the intestines and for treating colitis and dysentery.

When the powder of Tian Nan Xing ( Arisaematis rhizoma) is processed with bovine bile, it is called Dan Nan Xing. Dan Nan Xing is bitter and cold. It is characterized by its ability to clear heat, eliminate phlegm, extinguish wind and calm spasm. It can effectively treat cough without phlegm or with scanty green sputum that is difficult to expectorate. Moreover, since it is particularly able to eliminate the invisible phlegm that covers the Heart and blocks the orifices, it can treat epilepsy and wind-stroke.

Zhu Ru is slightly cold and enters the Lung, Stomach and Gall Bladder meridians. As well as clearing heat and transforming phlegm from the Lung, it can effectively disperse the constrained Qi, eliminate irritability and calm the mind. It is often selected in formulas that treat depression, anxiety and other mental disorders due to phlegm-heat disturbing the Heart, Gall Bladder and Stomach. It is also effective for soothing the Stomach-Qi, clearing heat and treating nausea and vomiting, such as morning sickness of early pregnancy, heatstroke, migraine and Ménière’s disease.

These herbs are able to remove damp-phlegm and phlegm-heat from the Heart meridian.

Damp-phlegm may disturb or cover the Heart and cause mental disorders, which manifest as poor concentration, forgetfulness and difficulty with making decisions, a white and sticky tongue coating and a slippery pulse.

Shi Chang Pu is pungent, bitter and warm, and enters the Heart and Stomach meridians. As its aromatic smell and pungent property can transform phlegm and open up the Heart orifice, it treats all these symptoms.

Yuan Zhi is pungent, bitter and warm, and enters the Heart, Spleen and Lung meridians. It can stimulate the Heart-Yang and Qi, connect the Heart-Qi with the Kidney-Qi and remove the phlegm from these meridians, thus improving concentration and memory. Shi Chang Pu and Yuan Zhi are often used together to enhance the ability to remove phlegm and open up the orifices.

These herbs are able to remove phlegm-heat from the Heart meridian. They are sweet and cold, and enter the Heart meridian. They have the functions of clearing heat and transforming phlegm. They are selected either as deputy or chief in formulas that remove phlegm-heat from the Heart.

Zhu Li is colder than Tian Zhu Huang. It enters the Heart, Lung and Stomach meridians. It has a lubricating nature and its function is characterized by strongly eliminating phlegm-heat from the Heart and reviving the Heart-shen. It treats a syndrome where patients lose consciousness and have gurgling sounds in the throat, such as in epilepsy, cerebrovascular accident and myocardial infarction. Zhu Li is also often used to treat conditions such as schizophrenia and anxiety when phlegm-heat disturbs the mind.

Tian Zhu Huang enters the Heart and Liver meridians. It is effective in dislodging phlegm, clearing heat, cooling the Heart and controlling convulsions. It is often used to reduce high fever, irritability and convulsions caused by disturbance of the Heart and Liver by phlegm-heat.

In order to increase the strength of their action, they are often used in formulas with other herbs that transform phlegm or regulate the Qi, such as Tian Ma ( Gastrodiae rhizoma)**, Yu Jin ( Curcumae radix), Zhu Ru ( Bambusae caulis in taeniam), Zhi Ke ( Aurantii fructus), Zhi Shi ( Aurantii fructus immaturus) and Meng Shi ( Lapis micae seu chloriti)*. They are also used with herbs that promote blood circulation and calm the mind, such as Dan Shen ( Salviae miltiorrhizae radix), Hong Hua ( Carthami flos), Hu Po ( Succinum), Ci Shi ( Magnetitum) and Zhen Zhu Mu ( Concha margaritifera usta).

These herbs can be selected as deputy to remove phlegm from the Stomach. As they soothe the Stomach-Qi, they can relieve nausea, vomiting, fullness in the epigastria, reduced appetite and distension in the abdomen. In most cases, patients have a sticky tongue coating and a rapid, wiry or slippery pulse.

Xuan Fu Hua, Zi Su Zi and Zi Su Ye are warm in nature; they are particularly used for damp-phlegm syndrome. Zhu Ru, Pi Pa Ye and Huang Qin are cold in nature; they are used for phlegm-heat syndrome.

These herbs are used particularly to transform phlegm and open the nose orifice. They are warm and aromatic. As they can effectively transform dampness and phlegm, and open the nose orifice, they are used for runny nose, blocked nose and loss of the sense of smell, such as in sinusitis.

These substances are able to moisten the Lung and loosen sputum, and are particularly suitable for treating scanty sputum caused by heat consuming the fluid in the Lung. They are selected in formulas when the main complaint is scanty sputum that is difficult to expectorate, or cough without phlegm. In this syndrome, the tongue is red with a thin, dry, yellow coating and the pulse is rapid and thready.

In order to increase the therapeutic result, these herbs are often used with herbs that moisten the Lung and nourish the Lung-Yin, such as Sang Ye ( Mori folium), Tian Hua Fen ( Trichosanthis radix), Lu Gen ( Phragmitis rhizoma), Bei Sha Shen ( Glehniae radix) and Mai Men Dong ( Ophiopogonis radix).

These three herbs are used to treat chronic cough with phlegm. All are slightly warm in nature and enter the Lung meridian. They can moisten the Lung, descend the Lung-Qi, transform phlegm and relieve cough. Although they are warm, pungent and bitter, they have no drying property. They can be used for treating different types of cough caused by either exterior or interior pathogenic factors, at the acute or chronic stage, in excess or deficiency conditions, or in a heat or cold syndrome.

Comparing the functions of the three herbs, Zi Wan is the strongest to transform phlegm, Kuan Dong Hua is the most effective to relieve cough and Bai Bu is the one most commonly used to treat chronic cough.

These herbs are able to transform wind-phlegm and open up the meridians and collaterals.

Zhi Nan Xing, the processed product of Tian Nan Xing, is pungent, bitter and warm, and enters the Lung, Spleen and Liver meridians. It has a very strong dispersing ability and can intensively dry dampness and dissolve damp-phlegm. It is also able to eliminate phlegm from the meridians and collaterals and is used for syndromes of wind-phlegm obstruction in the meridians, which manifests as numbness, heaviness and tingling of the limbs, such as in arthritis, facial paralysis and facial spasm.

Bai Fu Zi is another important herb to eliminate wind-phlegm. It is pungent, sweet, very hot and very poisonous. It has a strong ascending ability and can expel wind, remove phlegm and dry dampness. It is used for headache, migraine, deviation of the tongue, facial paralysis or cramp due to the obstruction of phlegm in the meridians and collaterals.

Bai Jie Zi is warm in nature and enters the Lung meridian. It is pungent and dispersing, spreads the Qi, expels cold-phlegm and reduces swelling of the joints, muscles and subcutaneous region. It treats numbness, stiffness, cramping and pain of the muscles and joints.

Tian Zhu Huang enters the Heart and Liver meridians, and is effective in dislodging phlegm, clearing heat, cooling the Heart and controlling convulsions. It is often used for childhood disorders when there is high fever, irritability, convulsions and night crying caused by disturbance of the Heart and Liver by phlegm-heat.

Zhu Li enters the Heart, Lung and Stomach meridians. It can strongly eliminate phlegm-heat, especially when the phlegm blocks the Heart meridians and collaterals. It is used to treat numbness, tingling or cramp of the limbs in epilepsy, hemiplegia and facial paralysis.

Tian Ma can expel wind. It is sweet and neutral, and can extinguish internal wind as well as expel external wind. Since it has a moderate and moist nature, it is widely used in different types of wind-phlegm syndrome. It can be selected to treat dizziness with nausea and vomiting caused by disturbance of wind-phlegm. It is effective for calming spasms and convulsions from high fever. Together with herbs that promote the Qi movement and blood circulation, it can be used to treat stiff, painful, numb and tingling limbs, such as in Bi syndrome, or the sequelae of cerebrovascular accident, dementia and Parkinson’s disease.

Except for Zhu Li and Tain Zhu Huang, all the other herbs are warm and pungent in nature. As Tian Nan Xin and Bai Fu Zi are very warm, pungent and poisonous, dosages and processing procedures should be carefully monitored. In formulas to treat phlegm obstruction of the meridians and collaterals, they are often used with herbs that regulate the Qi and blood, expel wind-dampness and extinguish internal wind.

These herbs are used for transforming phlegm, softening hardness and dissipating nodules. They are salty and cold, and enter the Liver, Lung and Kidney meridians. As both can clear heat, transform phlegm, soften hardness and dissipate nodules, they are often used together in formulas to treat nodules, such as goiter and scrofula.

Comparing the functions of these two herbs, Hai Zao is stronger in transforming phlegm and dissipating nodules, and is suitable to treat soft masses, such as goiter and scrofula. Kun Bu is stronger in softening hardness and reducing congealed blood, and is more suitable to treat hard masses, such as hepatosplenomegaly, cirrhosis of the liver and tumors.

To enhance their therapeutic effect, they are used with other herbs that also have the function of softening hardness to dissipate nodules, such as Mu Li ( Ostrea concha), Huang Yao Zi ( Dioscoreae bulbiferae rhizoma), Zhe Bei Mu ( Fritillariae thunbergii bulbus), Xia Ku Cao ( Prunellae spica) and Xuan Shen ( Scrophulariae radix).

Jie Geng and Xing Ren both enter the Lung meridian. They are often selected as assistants to regulate the Lung-Qi so as to eliminate phlegm. In addition, they can effectively relieve cough, a direct symptom of phlegm obstruction in the Lung.

Jie Geng is pungent, bitter and neutral. It is able to transform phlegm and stop cough. As it is light in weight and in nature, its function is characterized by ascending the Lung-Qi gently but sufficiently.

Xing Ren is bitter, warm and slightly poisonous. As it can descend the Lung-Qi, disperse the accumulation of phlegm and the stagnation of Qi, it can stop cough. It contains oil, which gives this herb a moist nature.

Comparing Jie Geng and Xing Ren, one moves upwards and the other moves downwards; one disperses the Lung-Qi and the other descends the Lung-Qi. They match each other perfectly to regulate the Lung-Qi, eliminate phlegm and relieve cough, hence they are often used together in formulas to treat damp-phlegm.

Ting Li Zi and Sang Bai Pi are cold and enter the Lung meridian. They are able to direct the Lung-Qi downwards, eliminate phlegm and accumulated water, and therefore reduce obstruction of the Lung-Qi and arrest wheezing. They are used together to treat conditions where there is coughing, wheezing, fullness in the chest, edema and difficult urination.

Ting Li Zi is very pungent, bitter and cold, and is much stronger than Sang Bai Pi in directing the Lung-Qi downwards and draining water. It is more suitable for treating the excess syndromes of phlegm and water accumulation in the Lung. It also enters the Large Intestine meridian and can drain heat, water and phlegm via bowel movement. However, since Ting Li Zi is a harsh, cold herb and easily injures the Qi, it is only used in excess syndromes for a short time.

Sang Bai Pi is sweet, bland and cold. It can clear heat and leach out dampness without the side effect of Yin consumption. As Sang Bai Pi is gentler than Ting Li Zi in directing the Qi downwards and eliminating the accumulation of water and phlegm, it has fewer side effects and can be used for a longer period of time.

Bai Qian and Qian Hu are pungent in nature and enter the Lung meridian. They are effective for relieving cough and have the ability to disperse and descend the Lung-Qi. They are often selected as assistants to treat fullness in the chest, cough and wheezing due to obstruction of the Lung-Qi.

Bai Qian is a warm herb and its action of descending the Lung-Qi is stronger than that of Qian Hu. It is suitable to treat damp-phlegm syndrome. Qian Hu is cold in nature and is more suitable to clear heat in the Lung and treat phlegm-heat syndrome.

These herbs can regulate the Qi of the Lung, Stomach, Spleen and San Jiao and therefore can be selected in formulas as assistants to enhance the ability of herbs that remove phlegm.

Hou Po is bitter, pungent and warm, and enters the Spleen, Stomach, Lung and Large Intestine meridians. It can descend the Qi, dissipate the obstruction of phlegm and dry dampness. It can be selected in formulas to remove phlegm as it can effectively reduce the distension in the Upper-, Middle- and Lower-Jiao, and enhance the ability of the chief to remove damp-phlegm.

Chen Pi, Mu Xiang and Sha Ren are all aromatic herbs and warm in nature. They can promote digestion and Qi movement and reduce distension. Chen Pi is particularly selected for treating Qi obstruction in the Stomach; Mu Xiang is for stagnation in the intestines and Liver; and Sha Ren is for Qi obstruction in the Large Intestine.

Zhi Shi is cold and has a bitter taste. It moves downwards. It has an intensive action of opening the obstruction of the Qi, breaking up the accumulations of Qi, blood, food or phlegm, and can also promote bowel movement. In formulas that eliminate phlegm, this herb is often used when the Qi is obstructed and bowel movement is difficult. It is also used to treat constipation.

Zhi Ke is cold in nature and its function of regulating the Qi is gentle and slow. It moves horizontally in the Upper- and Middle-Jiao. It is very often used as assistant in formulas that eliminate phlegm to open up the Qi obstruction in the chest, stomach and hypochondria.

Xiang Fu is a very commonly used herb to regulate the Liver-Qi. It is pungent, sweet, slightly bitter and warm, and enters the Liver and San Jiao meridians. Xiang Fu is an effective and gentle herb to regulate Qi. It is warm and pungent without a harsh or drying nature. It promotes Liver-Qi movement without the likelihood of injuring the Yin and blood. As it is somewhat bitter, it can reduce the slight Liver-heat that is generated by Liver-Qi stagnation. The sweetness can soften the Liver and moderate the speed of the Qi movement. Because it enters the San Jiao meridian that is the passage of the Qi and water, it can effectively spread the Qi in the entire body.

Shi Gao and Huang Qin can reduce heat from the Lung and relieve fire-toxin so as to clear excess heat from the Lung. In phlegm-heat syndrome, when the heat is strong and the herbs that remove phlegm-heat are not sufficient to clear the heat, Shi Gao and Huang Qin should be used.

Shi Gao is pungent, sweet and very cold, and enters the Stomach and Lung meridians. It can clear heat and disperse the constrained Qi and fire. It has another strong point in that it can protect the body fluids from excess heat in the Stomach and Lung as the sweet and cold nature can generate Yin.

Huang Qin is bitter and cold, and enters the Lung and Large Intestine meridians. It can dry dampness and clear heat. It is especially suitable to be selected when there is damp-heat in the Lung and Large Intestine.

These herbs are all warm in nature and may be used in formulas to treat cold-phlegm, which manifests as thin sputum, a cool sensation in the throat when the phlegm is expectorated, cold limbs and a fear of cold.

Xi Xin is very hot and primarily enters the Kidney meridian. It can warm the interior, disperse the accumulated fluid and treat cold-phlegm due to Yang deficiency of the Kidney and Lung. Gan Jiang can warm the Spleen and treat damp-phlegm due to Spleen-Yang deficiency and Sheng Jiang can warm the Stomach and disperse the water accumulation there.

Cang Zhu and Bai Zhu are pungent and warm, and can effectively dry the dampness. Cang Zhu is warmer and more pungent than Bai Zhu, and is better selected for a severe damp-phlegm syndrome. Bai Zhu is characterized by tonifying the Spleen-Qi and drying the dampness, and is a perfect choice for a chronic damp-phlegm syndrome.

The other three herbs are able to leach out dampness and promote urination. They can be selected in the formula to assist the chief and deputy herbs to remove damp-phlegm. Among these herbs, Fu Ling is neutral and can gently tonify the Spleen-Qi; Ze Xie and Yi Yi Ren are cold and are more suitable for treating phlegm-heat syndrome.

Since all these herbs eliminate dampness, they should be used with caution in patients who suffer from constipation or other disorders caused by heat or dryness.

These herbs can be selected to aid digestion. Poor digestion is often a cause of phlegm generation. Removing food accumulation is a strategy to remove phlegm accumulation in the Middle-Jiao. In addition, if phlegm has accumulated in the Middle-Jiao, food digestion is often disturbed too, especially among children whose digestive function has not yet fully developed. Herbs that promote digestion can therefore be chosen as assistant in the formulas.

Deep-fried Mai Ya, Shen Qu and Shan Zha can aid digestion of starchy food, alcohol, protein and fat respectively, and they are often used together.

Zhi Shi can regulate the Qi and remove phlegm, as well as promote bowel movement. Da Huang can purge the accumulation intensively from the intestines. A small dosage of Da Huang can promote digestion. Both Zhi Shi and Da Huang can enhance herbs that remove phlegm from the Spleen and intestines.

These herbs are applied to directly tonify the Spleen. To treat a chronic condition of phlegm syndrome, herbs that tonify the Spleen-Qi are often used to strengthen the functions of transportation and transformation of the Spleen.

Dang Shen is sweet and neutral, and enters the Spleen and Lung meridians. It is an effective and gentle herb for treating Spleen-Qi deficiency in chronic conditions.

Bai Zhu is warmer than Dang Shen but is bitter. The strong point of this herb is that it can either tonify the Qi or dry dampness. It can also treat the cause and manifestations of phlegm. It is often selected to treat damp-phlegm syndrome.

Huang Qi can strongly tonify and ascend the Spleen-Qi and strengthen the muscles. It is therefore effective in treating tiredness and heaviness of the body. The only side effect of this herb is that it can keep dampness inside the body due to its tonifying, stabilizing and ascending actions. It should be used in the formula with other herbs that remove phlegm.

This group of herbs is particularly used to nourish the fluid and dilute scanty phlegm, which is caused by fluid deficiency in the Lung. They are cold in nature and enter the Lung meridian. They can clear heat, nourish the fluid and moisten the dryness of the Lung, thus diluting the phlegm.

Lu Gen can transform pus; Bai Mao Gen is able to cool the blood and stop bleeding; Tian Hua Fen is able to nourish the fluid of the Stomach. All are used at the late stage or during the recovery period of febrile diseases, such as acute bronchitis or influenza. Moreover, as these herbs do not have a cloying nature, they do not have the same side effects as the Yin tonifying herbs.

These herbs can stabilize the Lung-Qi. They have a sour taste and are only used in conditions where the Qi of the Lung disperses excessively, such as in severe wheezing, cough and asthma. Since the sour taste may retain phlegm and make the syndrome more difficult to treat, these herbs should be used in a small dosage and in a well-organized formula.

Jie Geng is light in weight and nature, and can disperse and ascend the Lung-Qi. It is often used as envoy to guide other herbs in the formula entering the Lung and removing phlegm there.