Phlegm-constipation

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A simplified definition of Phlegm is that it is Dampness that has

hung around too long and congealed into Phlegm.

 

A weak Spleen is the number one cause of Phlegm. One of the chief

functions of Spleen Qi is to transform and transport Fluids in the

body. If the Spleen Qi is too weak to transform and transport

Fluids, they hang around and congeal into Phlegm.

 

The Lungs and Kidneys also can play roles in Phlegm production. (More

about this in future posts.) If the Triple Heater (San Jiao) becomes

blocked, Fluid can congeal into Phlegm. Liver Qi Stagnation and also

Liver Invading Spleen and Liver Invading Stomach can lead to Phlegm.

If Fluids are not moving, they can congeal into Phlegm. Also, if Qi

is flowing the wrong way, for example Stomach Qi Rebelling (flowing

upward when it should be descending), this too can produce Phlegm.

 

Phlegm can accumulate anywhere in the body where Qi flows. (Or

rather, does not flow but should.)

 

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There are different types of constipation, and each type requires a

different treatment. Usually what is meant by constipation is hard,

dry stools brought about by Heat and/or Drying. The treatment

principle is to moisten. This type of constipation frequently

accompanies Yin Deficiency (Deficiency Heat - not enough Yin to

properly moisten and cool). Or, it can be due to Excess Heat (too

much Heat and/or Dry caused by diet or improper herbs).

 

But, there are other types of constipation which require different

treatments. For example, Cold, either Deficiency Cold (Yang

Deficiency - not enough Yang to properly activate and warm the body)

or Excess Cold (too many foods and herbs with Cold thermal energy,

direct invasion of Exterior Cold into the Intestines) can trigger a

different type of constipation which more properly could be described

as " colonic inertia " . These are not hard, dry stools of Heat

constipation, but moist, maybe even loose stools. The person simply

does not have to go to the bathroom a lot. One characteristic of

Cold is it slows things down. Needless to say, giving a person who

suffers from colonic inertia due to Cold an herb like psyllium which

moistens and cools is going to aggravate this type of constipation.

The psyllium is just going to lie there in the intestine because the

problem is not due to Heat or Dryness but due to a lack of

peristalsis (the wave-like motions that move feces through the

intestines).

 

Qi Deficiency as well as Qi blockage and Qi Stagnation can result in

colonic inertia. Qi moves things. If the Qi is Deficient or not

getting to an area or sluggish, the bowels are not going to move

properly. (Neither is anything else.) Cold is only one of the things

that can cause Qi to Stagnate, so there is a separate category for Qi

constipation. (Dampness also can trigger Qi Stagnation as can other

things.)

 

If there is a disorder in Fluid metabolism in the body (usually due

to weak Spleen but accompanied by other factors like Qi Stagnation),

eventually all that Dampness is going to hang around too long and

congeal into Phlegm. When this happens, the person really has

problems. Phlegm can give rise to a host of problems, and Phlegm can

take a long time to treat.

 

Steven Clavey in Fluid Physiology and Pathology in Traditional

(p. 176) goes into a little detail about Phlegm-

constipation:

 

" Sluggish incomplete bowel movements, but not dry stool. The stool

may contain mucus. "

 

What he's talking about here is that even though the person can feel

a need to go to the bathroom, the bowels do not move or they move

incompletely. The person may go days between bowel movements. Each

day that goes by without a bowel movement, the person becomes more

and more uncomfortable.

 

Now Cold all by itself or Qi Deficiency and Stagnation can cause

colonic inertia and going a few days between bowel movements and even

an occasional incomplete bowel movement. So what distinguishes

Phlegm-constipation from the milder Cold and/or Qi Root? The

severity of the symptoms and the lack of satisfactory response to

treatment for just Cold and/or Qi imbalance. In fact, one of the

major tip-offs that one is dealing with Phlegm in any health problem

is that the condition does not respond as expected or in the time

expected. Also, there is the mucus in the bowel movements. The

mucus may not always be visible, but it will be present somewhere in

the Intestines.

 

" If the sluggishness is minor, it may only be accompanied by

abdominal distention, or epigastric " (upper, middle abdomen, area

where the stomach is) " fullness and discomfort. If the constipation

is more serious, there may be symptoms such as restless feelings of

agitation in the chest, fullness and distention in the head and

disorientation, disturbing normal thinking, eating and sleeping.

Symptoms like these are not life-threatening but are very annoying. "

(The symptoms themselves may only be annoying, but the Roots which

give rise to the symptoms and to the Phlegm can progress to more

serious manifestations and be life-threatening in time.) " A tell-

tale indication of the root cause of the whole syndrome is that on

those occasions when the bowels move well, the patient suddenly feels

light and clear, 'on top of the world'.23 "

 

Actually, any Excess condition will be relieved by a bowel movement.

Deficiency conditions will be characterized by the person feeling

worse after a bowel movement. Phlegm is an Excess condition.

(Excess problems are caused by there being too much of something, and

any Phlegm is too much. Qi Stagnation is also an Excess problem. So

is Dampness.)

 

Because Phlegm is an Excess but usually due to Deficiency (Spleen Qi

Deficiency in particular or Kidney Deficiency often), what usually

happens is the person will report both feeling better and feeling

worse at various times following bowel movements. If the Phlegm-

constipation is particularly severe, the person will report that

bowel movements makes him/her feel better. If the Phlegm-

constipation has been brought under some correction and is not as

troublesome as it can be, and the bowel movements are more normal,

the person may report feeling worse after a bowel movement. Suspect

Phlegm-constipation when the person reports sometimes feeling better,

sometimes feeling worse following bowel movements. The feeling worse

following a bowel movement usually means Qi Deficiency. (I'll post

one of Clavey's case histories illustrating " alternating dispersal

and collection of phlegm and damp " .)

 

" The underlying mechanism in this type of constipation is deep

internal phlegm obstructing the descent of fu-organ " (the Yang

Organs - Stomach, Large Intestine, Small Intestine) " qi. A common

associated factor is Liver qi stasis, which by overcoming the Spleen "

(he's talking Liver Invading Spleen here) " can cause damp and

eventually phlegm. It can also directly influence the descent of qi

through the Stomach and Intestines. " (When Liver Invades Stomach, one

of the effects can be that Stomach Qi Rebels, ascends instead of

descends like it's supposed to. This too can be a factor in the

accumulation of Damp in the Lower Jiao (Lower Burner, lower abdomen)

and eventually Phlegm.

 

" It should be noted that this is not parched phlegm (zao tan) or

phlegm-fire causing the constipation by drying out the stool but

rather turbid phlegm: the stool is not dry, and may even contain

mucus. 'Phlegm-constipation', however, is a diagnosis often

overlooked by even experienced Chinese doctors amongst the myriad of

other causes: fire, heat, parching dryness, cold, qi obstruction, qi

deficiency, yin deficiency, and so on. But it has to be considered

if only to understand why certain treatments fail.24 "

 

" Why certain treatments fail " sums up one of the chief clues that one

is dealing with Phlegm in any medical problem. Phlegm disorders can

be intractable - not easily or quickly treated or cured.

 

Some Phlegm problems are easier and quicker to cure than others.

When the Phlegm involves the proper ascent and descent of Qi through

the Middle Burner (Middle Jiao - Stomach and Spleen), these can be

particularly intractable. The Qi is going to have to flow properly

and freely in order to for the Phlegm to resolve. But, one is not

only dealing with the originate reason for the Qi Rebelling (like the

Liver Invading the Stomach), one also is dealing with the Phlegm

itself further blocking the proper flow of Qi. Think of a mighty

fortress of Phlegm blocking the paths of Qi, making it difficult to

get the Qi, warmth, Yang, etc. to the area that needs it. Think of

needing to tear down that fortress from the inside, only the Phlegm

itself is blocking access to the inside.

 

Complicating dealing with Phlegm is that individuals usually will

need to follow proper diets and eating habits in order to strengthen

the Spleen so Dampness will not accumulate. This can be next to

impossible in some societies, but it will need to be done if the

Phlegm is to be resolved.

 

Also complicating the treatment of Phlegm is the fact that some types

of Phlegm do not respond well to being attacked. Treatment will need

to be directed at what enabled the Phlegm to develop in the first

place. Cold Phlegm is a good example of this. Just using Phlegm-

busting herbs on Cold Phlegm does not work and can even aggravate

some symptoms (even if the Phlegm-relieving herb is one with Warm

thermal energy). In dealing with Cold Phlegm it is best to deal with

the reason for the Cold.

 

There are many different types of Phlegm depending on what co-factors

enabled the Phlegm to form. For example Cold Phlegm, Dry Phlegm

(you'll want to moisten in this case even though that is

contraindicated in most cases of Phlegm), Hot Phlegm, etc.

 

The things to remember about Phlegm is that the number one cause is a

weak Spleen. Qi Stagnation also can be an important factor in its

development. Phlegm can show up anywhere in the body where Qi flows

(or should be flowing). This includes the meridians as well as the

skin, thyroid gland, joints, muscles, Organs, etc. Phlegm can give

rise to a multitude of symptoms, including some unusual ones.

Suspect Phlegm if there is a lot of unusual symptoms. Also suspect

Phlegm if treatments which should be working well are not. Phlegm

can be intractable.

 

The longer any problem has gone on, the longer it will take to

correct it.

 

Victoria