by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Phlegm is a product of the body's activities acting upon qi and moisture taken in with food and beverages; it is "congealed moisture." Unlike qi, phlegm is always viewed by Chinese physicians as substantive and stagnating rather than light and flowing, though there are two kinds of phlegm: the visible, which has greater accumulation of matter, and the invisible, which is finely divided, though not as fine as qi. Phlegm is, in some ways, comparable to another body humor, blood, which is also produced by the body's activities acting upon qi, and is a sticky substance that shares some of the same potential pathologies with phlegm: deficiency, inadequate circulation, firm coagulation, and complexing with heat or cold factors.

Phlegm is a normal and required substance in terms of the mucous membrane lining and other lubricating functions, but it becomes a pathological substance when:

  1. it is derived from stagnated food in the stomach;
  2. when normal phlegm (mucoid substance) is produced in excess; or
  3. when it is complexed with internal or external pathological factors, such as cold, heat, wind, or toxin.

Phlegm accumulates when the lungs are irritated, when the moisture of the body is overheated by pathological qi (causing it to dry and transform into thick phlegm), when the qi is stagnant and the normal phlegm is not circulated (or when pathological phlegm is not eliminated quickly due to poor circulation of the fluid), and when the kidneys are too cold and the moisture condenses and transforms into phlegm. Phlegm may become insufficient when there is an inadequate source of the necessary nutrients in the diet; when the spleen is weak and cannot raise the qi derived from food upward to moisturize the upper body; when the lungs suffer from deficient qi and cannot transform moisture to phlegm; or when the environmental conditions or the consumption of drying foods (such as spices) disperse too much of the existing phlegm

Phlegm is thought to have a similarity to grease or fat, and therefore, fatty foods are deemed one potential source of phlegm. In general, any food that is not completely digested is said to give rise only to a pathological type of phlegm: normal phlegm is produced when pure substances are obtained from digested foods and then processed into a useful body lubricant. Obese persons are said to be displaying an excess of phlegm in their extra body weight (see: Obesity and hyperlipidemia: Bojenmi tea and other Chinese herb formulas): the equivalence of phlegm, fatty foods, and body fat is most clearly demonstrated by this connection. According to Chinese thinking, the spleen and lungs have the primary responsibility for generating and circulating the mucoid substances necessary for normal body functions, and dysfunctions of these organs are often responsible for the accumulation of fats.

While most Westerners think of phlegm as referring only to the excess mucus produced in the lungs and sinuses, from the Oriental view, phlegm can exist in many places in the body; it may form lumps, it may block the meridians, obstruct the heart orifices, or simply accumulate throughout the tissues, preventing the normal in and out flow of qi.

Soft or fluid-filled swellings in the body are generally regarded as phlegm masses. This would include lymphatic swellings, ovarian cysts, thyroid nodules, lipomas, and breast lumps that are not hardened; some of these are malignant masses. The thickened fluid obstructing the bursa of the joints in patients with bursitis is considered a phlegm disorder. Symptoms of phlegm accumulation associated with the digestive system include nausea, vomiting, and greasy stool.

Here is a description of the problem of phlegm fluid accumulation (retention) described in the Advanced Textbook of Traditional Chinese Medicine and Pharmacology:

Phlegm and retained fluids are pathological products of impaired local or general water metabolism. The concept of phlegm (tan) and phlegm-fluid retention (tanyin) in Chinese medicine embraces a wide range of manifestations....Phlegm and phlegm fluids are either substantial or non-substantial. Substantial phlegm and retained fluids are visible....Non-substantial phlegm and retained fluids refer to pathological manifestations such as dizziness, nausea, vomiting, shortness of breath, palpitations, or mania and semi-consciousness, all of which are linked to invisible phlegm or fluid discharge from the body. Nonetheless, these conditions respond well when treated as substantial phlegm and retained fluids....Phlegm and retained fluids are caused by the influence of the six exogenous pathogenic factors, irregular diet, or abnormal emotional activities; all impair the water metabolism of the lung, spleen, kidney, and triple burner qi. The lung dominates the dispersion and descent of qi and the distribution of body fluids. The water retention resulting from a failure of these functions produces phlegm and retained fluids. The spleen controls the transportation and transformation of water, the failure of which causes an accumulation of water which then turns into phlegm and other retained fluids. The kidney is responsible for the gassification of water [steaming the water; converting water to qi]. When kidney yang is insufficient, water cannot be transformed into qi. It accumulates and, again, turns into phlegm and other retained fluids. Retained fluids and phlegm may also appear when the triple burner passages are blocked, for the normal transportation, distribution, and excretion of body fluids are interfered with. Furthermore, since the triple burner houses all the zangfu organs, failure of the qi activity of the triple burner may result in the formation of pathogenic phlegm and retained fluids and make them accumulate in the zangfu organs and, more superficially, in the tendons, bones, skin, and muscles, causing various pathological changes.

The diagnosis of phlegm or fluid retention syndrome often revolves around three factors: a moist, and, especially, a thick tongue coating; a smooth, and, especially, a full, slippery pulse; and obvious signs of phlegm accumulation, such as discharge of excess sputum (lung/sinus problems), obesity, palpable soft accumulations (lumps and swellings), and adverse reactions to intake of greasy foods. However, because phlegm retention can occur in persons with a wide range of accompanying conditions, and because phlegm retention can be of the "non-substantial" type, one may need to look further. Some examples of manifestation of phlegm disorder are mentioned in the Advanced Textbook... , as follows:

Phlegm that blocks the lungs results in coughing, asthmatic breathing, and expectoration of sputum. Phlegm in the heart causes suffocating feeling in the chest and palpitations. If the Heart Meridian [heart orifices] is obstructed by phlegm, dementia and loss of consciousness may occur. If the heart is disturbed by phlegm-fire, mania may occur. Phlegm stagnating in the stomach causes nausea, vomiting, and fullness in the stomach. An accumulation of phlegm in the meridians, tendons, and bones may cause scrofula, subcutaneous nodules, a numbness of the limbs, hemiplegia, or fistulous infection of the tissues. Phlegm attacking the head produces dizziness. Phlegm and qi in the throat may produce the sensation of a foreign body in the throat. Retention of fluids also has different syndromes. Morbid fluid in the intestine produces a gurgling sound. In the costal region, it produces a full sensation in the chest and pain on coughing. If it accumulates in the diaphragm, it causes stuffiness in the chest, coughing, dyspnea, difficulty in lying flat, and puffiness. Morbid fluid in the tissues and skin causes edema, absence of sweat, and heavy feeling of the body.


Herbs that help resolve phlegm problems are divided, in the Materia Medica, into those which resolve cold phlegm (which is moist, thin, and clear), and those which resolve hot phlegm (which is drier, thick, and sometimes discolored). In most cases, herbs from both categories are combined together in varying proportions to get the best influences of the important phlegm-resolving herbs; several herbs from other Materia Medica categories have phlegm-resolving properties, and may be included in developing an optimal prescription. In the following presentation, the two main groups (herbs for resolving hot phlegm and herbs for resolving cold-phlegm) are listed in accordance with Oriental Materia Medica (Hsu) with some adjustments from Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine (Huang and Wang).

Along with the description of each herb, an example of a formula in which it is utilized is offered to help illustrate the principles of combining that have been relied upon in China. It will be noted that many of the formulas contain citrus materials: citrus (chenpi), aurantium (jupi), chih-shih (zhishi), or blue citrus (qingpi). These herbs are found in the qi-regulating section of the Materia Medica, but they are important herbs for resolving phlegm accumulations, both because of inherent phlegm-resolving activity of the herbs and because of the principle: "if the qi circulates well, phlegm also circulates." Ginger (fresh ginger, shengjiang) also appears in many of the formulas because it helps to resolve phlegm and to promote the stomach function so that food stagnation does not arise. In addition, several of the formulas contain herbs for clearing heat (e.g., scute, gardenia, anemarrhena); their use is indicated in cases where heat pathogens combine with or cause phlegm accumulation and it also is important when prolonged phlegm accumulation turns to heat. Several of the formulas contain herbs for dispelling wind (notably siler, angelica, chiang-huo, asarum, and schizonepeta) to help treat acute ailments or the surface manifestation of a chronic ailment, and some formulas contain tonic herbs (e.g., ginseng, jujube, licorice, atractylodes, and hoelen) to aid the spleen in transforming and transporting functions so that phlegm does not continue to accumulate. When the phlegm is in the lungs, herbs that reduce coughing may also be included (e.g., apricot seed, perilla seed). For phlegm masses, oyster shell may be added; for wind-phlegm-fire disorder (which tends to cause spasms or paralysis), silkworm is often added; for thickened phlegm associated with yin deficiency, ophiopogon is often added; when food accumulation leads to phlegm production, shen-chu, malt, and crataegus may be included; schizandra is included in some formulas to astringe excess fluid production, but is in other formulas to help generate fluid when there is yin deficiency yielding insufficient mucus production.


The herbs that resolve hot phlegm generally have a cold property; those with a salty or bitter taste are often used for resolving swellings, including tumors, while those with a sweet taste moisten dryness.

Aurantium and Bamboo Combination
Jupi Zhuru Tang
Aurantium jupi; or use chenpi 12 g
Bamboo zhuru 12 g
Ginger shengjiang 9 g
Jujube dazao 5 pieces
Licorice zhi gancao 6 g

Zhu Po Baoying Dan
patent remedy from Guangzhou
Snake gallbladder sanshedan 12.9%
Scorpion quanxie 9.7%
Gastrodia tianma 8.0%
Silkworm jiangcan 8.0%
Siler fangfeng 8.0%
Uncaria gouteng 8.0%
Succinum hupo 7.2%
Bamboo sap tianzhuhuang 5.7%
Calomel qingfen 5.7%
[note: contains mercury]
Borneol bingpian 5.7%
Cicada chantui 5.7%
Pearl zhenzhu 5.4%
Musk shexiang 4.3%

Atractylodes and Hai-ko Formula
Kaiyu Zhengyuan San
Atractylodes baizhu 3 g
Citrus chenpi 3 g
Blue citrus qingpi 2 g
Cyperus xiangfuzi 3 g
Crataegus shanzha 3 g
Hai-ko haige 3 g
Platycodon jiegeng 3 g
Hoelen fuling 3 g
Cardamon sharen 1.5 g
Corydalis yansuhuo 3 g
Malt guya 3 g
Licorice gancao 1.5 g
Shen-chu shenqu 3 g
Ginger shengjiang 2 slices

Jia Kang Wan
(main ingredients of pill used in clinical trial for hyperthyroid disease)
Prunella xiakucao 16%
Oyster shell muli 12%
Sargassum haizao 12%
Laminaria kunbu 12%
Pinellia banxia 12%
Fritillaria zhebaimu 12%
Hoelen fuling 12%
Aurantium juhong 8%
Bulbifera huangyaozi 4%

Platycodon and Schizonepeta Formula
Zhi Sou San
Cynanchum baiqian 17%
Platycodon jiegeng 17%
Schizonepeta jingjie 17%
Aster ziyuan 17%
Stemona baibu 17%
Citrus chenpi 9%
Licorice gancao 6%

Platycodon and Fritillaria Combination
Qingfei Tang
Platycodon jiegeng 6 g
Fritillaria beimu 6 g
Scute huangqin 6 g
Apricot seed xingren 6 g
Bamboo zhuru 6 g
Ophiopogon maimendong 9 g
Gardenia zhizi 6 g
Citrus chenpi 6 g
Hoelen fuling 9 g
Morus sangbaipi 6 g
Asparagus tianmendong 6 g
Tang-kuei danggui 9 g
Jujube dazao 6 pieces
Fresh ginger shengjiang 1 slice
Licorice gancao 3 g
Schizandra wuweizi 1.5 g

Lapis and Scute Formula
Mengshi Guntan Wan
Lapis mengshi 35%
Rhubarb dahuang 26%
Scute huangqin 26%
Aquilaria chenxiang 13%

Perilla Fruit Combination
Suzi Jiangqi Tang
Perilla seed suzi 9 g
Pinellia banxia 9 g
Tang-kuei danggui 9 g
Peucedanum qianhu 6 g
Magnolia bark houpo 6 g
Cinnamon bark rougui 6 g
Licorice zhi gancao 6 g
Ginger shengjiang 3 slices

Laminaria 4
Hai Lin Pian
Laminaria kunbu 40%
Sargassum haizao 39%
Oyster shell muli 10%
Pumice haifushi 10%
Sinapis baijiezi 1%

Yanhou Tang
(used in clinical research, proportions not available)
Lonicera jinyinhua
Ophiopogon maimendong
Chyrsanthemum juhua
Platycodon jiegeng
Sterculia pangdahai
Oroxylum muhudie
Licorice gancao

Ophiopogon and Trichosanthes Combination
Maimendong Yin Zi
Ophiopogon maimendong 21 g
Hoelen fuling 18 g
Rehmannia shengdi 12 g
Anemarrhena zhimu 9 g
Pueraria gegen 9 g
Trichosanthes root gualougen 6 g
Ginseng renshen 6 g
Bamboo zhuru 3 g
Schizandra wuweizi 3 g
Licorice gancao 3 g

Anemarrhena and Fritillaria Formula
Ermu Ningsou Wan
Anemarrhena zhimu 10%
Fritillaria chuanbeimu 8%
Trichosanthes seed gualouren 10%
Morus bark sangbaipi 10%
Citrus chenpi 10%
Hoelen fuling 10%
Gardenia zhizi 10%
Scute huangqin 10%
Chih-shih zhishi 8%
Schizandra wuweizi 8%
Licorice gancao 6%

Trichosanthes, Bakeri, and Pinellia Combination
Gualou Xiebai Banxia Tang
Trichosanthes fruit gualou 3 g
Bakeri Xiebai 4.5 g
Pinellia Banxia 6 g

Pinellia and Usnea Formula
Ying Jie San
Fried wheat zhi xiaomai 12 g
Usnea songluo 9 g
Pinellia banxia 9 g
Fritillaria zhebeimu 9 g
Sargassum haizao 9 g
Laminaria kunbu 9 g
Gentiana longdancao 9 g
Arca shells walengzi 9 g
Tetrapanax tongcao 9 g
Alum mingfan 9 g

Sargassum and Tu-huo Combination
Haizao Yuhu Tang
Sargassum haizao 3 g
Laminaria kunbu 3 g
Pinellia banxia 3 g
Citrus chenpi 3 g
Blue citrus qingpi 3 g
Forsythia lianqiao 3 g
Fritillaria zhebeimu 3 g
Tang-kuei danggui 3 g
Cnidium chuanxiong 3 g
Tu-huo duhuo 3 g
Licorice gancao 3 g
Kelp haidai 1.5 g

Chuan Ke Ling
(patent cough syrup)
Platycodon jiegeng 35%
Licorice gancao 30%
Apricot seed xingren 25%
Chu-dan zhudan 10%


Pinellia and Arisaema Combination
Qingshi Huatan Tang
Pinellia banxia 12 g
Hoelen fuling 12 g
Atractylodes baizhu 12 g
Arisaema tiannanxing 9 g
Scute huangqin 9 g
Fresh ginger shengjiang 3 slices
Citrus chenpi 7.5 g
Sinapis baijiezi 4.5 g
Bamboo sap tianjuhuang 4.5 g
Chiang-huo qianghuo 4.5 g
Angelica baizhi 4.5 g
Licorice gancao 4.5 g

Xanthium 12
Kang Xieqi Pian
Xanthium cangerzi 13%
Sophora kushen 12%
Bupleurum chaihu 9%
Centipeda ebushicao 9%
Scute huangqin 9%
Cynanchum baiqian 9%
Siler fangfeng 8%
Mume wumei 8%
Ginseng renshen 6%
Licorice gancao 6%
Asarum xixin 6%
Schizandra wuweizi 5%

Angelica and Mastic Combination
Xianfang Huoming Yin
Lonicera jinyinhua 9 g
Citrus chenpi 9 g
Anteater scales chuanshanjia 3 g
Angelica baizhi 3 g
Gleditsia spine zaoci 3 g
Trichosanthes root gualuogen 3 g
Peony baishao 3 g
Myrrh moyao 3 g
Frankincense ruxiang 3 g
Fritillaria zhebeimu 3 g
Tang-kuei danggui 3 g
Siler fangfeng 3 g
Licorice gancao 3 g

Schizonepeta and Pinellia Formula
Qingfei Cao San
Schizonepeta jingjie 17.5 g
Peucedanum qianhu 13.5 g
Inula xuanfuhua 9 g
Asarum xixin 9 g
Hoelen fuling 5.4 g
Pinellia banxia 4.5 g
Licorice gancao 3 g
Ginger shengjiang 2 slices
Jujube dazao 3 pieces

Pinellia Combination
Banxia Xiexin Tang
Pinellia banxia 18 g
Ginseng renshen 9 g
Jujube dazao 6 pieces
Fresh ginger shengjiang 3 slices
Coptis huanglian 3 g
Scute huangqin 9 g
Licorice zhi gancao 9 g

Fritillaria and Platycodon Formula
Ning Sou Wan
Platycodon jiegeng 10%
Perilla fruit zisuzi 10%
Dendrobium shihu 10%
Fritillaria beimu 10%
Hoelen fuling 10%
Pinellia banxia 10%
Mentha bohe 8%
Morus sangbaipi 8%
Apricot seed xingren 8%
Red citrus juhong 6%
Wheat sprout xiaomai 6%
Licorice gancao 4%

Lige Huotan Tang
Pinellia banxia 9 g
Red citrus juhong 9 g
Chih-shih zhishi 9 g
Areca seed binglang 9 g
Aquilaria chenxiang 9 g
Platycodon jiegeng 9 g
Trichosanthes root gualougen 9 g
Coptis haunglian 9 g
Gardenia zhizi 9 g
Cyperus xiangfuzi 9 g
Sinapis baijiezi 6 g
Gypsum shigao 12 g
Tea xicha 3 g

True Jade Powder
Yu Zhen San
Typhonium baifuzi 3 g
Arisaema tiannanxing 3 g
Siler fangfeng 3 g
Angelica baizhi 3 g
Gastrodia tianma 3 g
Chiang-huo qianghuo 3 g

June 1998