Damp and Phlegm Revisited

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When I was a student of acupuncture in the early 90’s I remember the concepts of damp and phlegm being briefly explained to me. If you want to understand the nature of damp you can go out in England and experience it simply enough. It is heavy, it is misty, it’s usually cold and it tends to slow things down and block them up. When the Sun shines dampness evaporates so it is more of a problem in the winter.
I understood that damp forming within the body is almost always a consequence of deficiency of the Spleen and therefore very common. Then it was explained to me that it could give rise to phlegm, which could block the orifices of the Heart and “mist the mind”. But I had some vague notion that it was in fact a lot more complicated than that. Were there not different types of phlegm doing different things in different places? You can see phlegm when you have a cold but was this the same phlegm that could “Block the orifices?” And what about damp heat, phlegm heat and phlegm fire? It was in some ways a relief to move on to study at a different college where phlegm and damp were not even mentioned. In fact, any mention of such things was discouraged since it was (at that time) considered unnecessary or in some way not true to the colleges tradition. So I happily forgot all about phlegm for a while.

When I started working at the London College of Traditional Acupuncture I did the Chinese Medicine theory course to refresh my memory. Phlegm was back and I was shown a book some two inches thick on “Phlegm diseases” I learned that “Phlegm goes up and damp goes down” and that there are indeed two types of phlegm “substantial” and “non-substantial”. Just as I was beginning to get mildly depressed about it someone said “Its ok all that stuff is really just for herbalists”. It seemed to me that there was only one main point prescribed for damp and phlegm anyway, St40 (Feng Long). Then perhaps Sp9 (Yin Ling Quan) for damp heat and Gb34 (Yang Ling Quan) and one or two others. I felt that one seemed to do a lot of theorising just to pick the same couple of points each time! So maybe I knew enough already and should leave the complexities of phlegm to the herbalists? Someone else said that in China a doctor had said “If in doubt treat phlegm” So I started using St40 rather a lot after that.

I have not been to China but I have met quite a few Chinese practitioners here. My difficulty has usually been communication, Ive often felt that they held a great deal of knowledge but my lack of any Chinese language and their poor English really limited my learning. But In about 2001 I did get the opportunity to speak to Dr Huide Jin. There is something special about hearing the Chinese speak about Chinese medicine because they can the whole thing sound easy and natural. At such times one can remember that the origin of Chinese Medicine is not a textbook but humanity as an integral part of the natural environment. The theory seems to be almost engrained within the Chinese subconscious, it’s really in their bones or “Jing”. It’s like hearing an English person complain about the weather because it flows so naturally. Diagnosis tends to be clear-cut, like “Yin deficiency” or “Blood stagnation”. One of Jin’s favourite prescriptions is simple too: “Cupping” which he seems to use for all kinds of conditions, but that’s another story.

I am always mindful of the phrase “To be a master you must master the basics” and this was an attempt to establish exactly what the basics of phlegm and damp are.

Q. Dr Jin Could you define what damp and phlegm are?
Dr J. Damp and phlegm are two different things but from the same origin. Firstly you can have internal and external damp. External comes from outside, from the weather and it can invade the body causing Bi (Painful obstruction) syndromes.

Q. And this could come into the channels or directly into the organs?
Dr J. Yes like the Stomach, damp can invade the Stomach and Spleen directly and that can impair their functions. When I say that phlegm and damp are of the same origin I am speaking of internal damp. Internal damp and phlegm are the results of poor circulation of the body fluids. Three main organs are involved here, Lung, Spleen and Kidney.

Q. Would you only ever get phlegm if you had damp first, the damp developing into phlegm?
Dr J. Well theoretically yes because phlegm is the thick form of damp. In damp weather the dampness cannot necessarily be seen but it can cause the symptoms inside. Now with phlegm there are two types, substantial is visible as sputum, its thicker so you can actually see it. It’s the result of accumulation of dampness, but practically speaking phlegm can occur directly without passing through the dampness stage.

Q. So you may get someone without signs and symptoms of damp but they do have say….. Phlegm misting the mind?
Dr J. Yes that is non-substantial phlegm.

Q. Is phlegm typical of certain organs in the way damp is, you said damp is mainly the concern of Spleen, Kidney and Lung?
Dr J. When we talk about the Lungs we don’t use the word dampness, you will never have heard of retention of dampness in the Lungs.

Q. No, I’ve heard of retention of fluid in the Lungs what is the difference?
Dr J. We have 4 forms of accumulated body fluids. Dampness, Water, Retained fluid and Phlegm. Water is thicker than dampness, like its there on the floor whereas damp is in the air, while retained fluid is even thicker and phlegm thickest of all. (Despite the fact that you can’t see it phlegm is the thickest)

Q. So if you’ve got phlegm its serious?
Dr J. Well it also depends upon areas, In the Lungs its always substantial phlegm. We have all had a cold sometime and it was not that serious. Non-substantial phlegm is more difficult.
Phlegm and damp are very common pathological factors and they cause many diseases. For example acupuncture is widely used in cases of invasion of external damp or for Bi syndrome for painful joints when it combines with wind, cold or heat. So we are using all kinds of points for damp and phlegm: local areas, channel points, distal areas and if damps invading the Spleen causing diarrhoea then acupuncture is very good for that. In the treatment of diarrhoea we treat the dampness primarily because diarrhoea itself is accumulation of the dampness. Of course it can be from outside (invasion) or it can be based on deficiency of the Spleen. In some cases acupuncture can be as effective as herbal medicine in these cases.

Q. And how do we treat phlegm?
Dr J. It also depends on where it is if its misting the mind we have to resolve it but first we have to establish which organs are most effected. These patients will normally have Heart involved, Spleen involved and Liver involvement. Kidney can also be involved sometimes and treatment depends on the balance of organ involvement. Phlegm misting the heart can give rise to palpation’s and mental disorders; the main cause of conditions of mania, depression and epilepsy is phlegm.

Q. And would one necessarily be treating the Spleen, Sp6 (San Yin Jiao), St40 for that?
Dr J. We have to analyse but generally I think the points on the head should be used like Du 20 (Bai Hui), Gb 20 (Feng Chi), St 8 (Tou Wei). In China we use Electro acupuncture on the head for mental depression those points on the head help to clear phlegm. You would also use points like P 4/5/6 (Xi Men, Jian Shi, Nei Guan) and Heart points depending on the condition.

Q. Ok so it really depends where the damp and phlegm is, it’s not a blanket term?
Dr J. For dampness we use different terms to describe the different ways of treating. If there is damp in the middle jiao we use the term resolve damp, points like Ren12 (Zhong Guan), St 36 (Zu San Li), Sp6 together. In the lower jiao we use the term “promote dieresis” to get rid of the damp e.g. Ren 3 (Zhong Ji) or in a chronic case Ren 4 (Guan Yuan) and Sp 9 and 6.

Q. And you don’t get damp in the upper jiao?
Dr J. We don’t use the word dampness, for the Lung and Heart we often use the word phlegm e.g. retention in Lung or misting the Heart.

Q. Do you get phlegm in the middle and lower jiao’s?
Dr J. Of course it goes everywhere?

Q. Can you give an example?
Dr J. Phlegm in the middle jiao, namely the Stomach and Spleen can cause nausea, vomiting, poor appetite, fullness etc…..

Q. I’ve never heard anyone say phlegm in the Stomach and Spleen?
Dr J. Oh yes you get phlegm as well as dampness in Stomach and Spleen but when there is damp the nausea and vomiting are not that pronounced. It is those factors which indicate the presence of phlegm but we don’t usually use the term phlegm in this context. Your acupuncture points won’t vary that much but if one is using herbal medicine then the herbs to resolve phlegm are different from those to resolve damp.

Q. But St 40 is not our only answer, it’s a point commonly used but it would depend?
Dr J. Well take for example a case of wind cold, you have phlegm but St40 is not an obvious choice of point in that case. St40 is an excellent point to resolve phlegm however, its probably the main leg point.

Q. Now how about phlegm in the lower jiao?
Dr J. You can get phlegm in the Kidney too it’s mostly what leads to the pain symptoms related to Kidney. Like back pain and knee pain, it is still phlegm we just don’t tend to call it that.

Q. And if you were to give phlegm to an element it’s the earth element, right?
Dr J. Yes, The origin of damp and phlegm is the Stomach and Spleen but the Lungs are the place of storage of phlegm.

Q. Are we all storing some?
Dr J. Theoretically not, phlegm and damp are pathogenic factors so only present in disease states.

Q. And finally, the phlegm and damp pulse?
Dr J. There are two main pulses for phlegm and damp conditions the Huo or slippery pulse and the Fu or floating pulse but you cant say that’s phlegm and that’s damp it depends upon the accompanying signs and symptoms etc.

Thankyou.

So Dr Jin did help clarify some key points for me:

Substantial (visible) phlegm only occurs in the Lungs.
Non-substantial phlegm occurs all over the body and accumulation of phlegm is often a way of explaining the cause of pain.
There are different common terms used to explain damp and phlegm and their treatment depending upon which organ is most effected.
Since damp and phlegm are often caused by deficiency of the Stomach, Spleen and Lungs certain points like St36, Sp6, St40, Co4 (He Gu) seem to be prescribed a lot to treat them. But actually phlegm and damp could be treated by almost any point if it were appropriate.

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