Wind-phlegm pattern has two types: one is liver wind accompanied by phlegm, which disturbs the seven orifices or wind phlegm wandering through the collaterals, Jingmai leading to a series of manifestations caused by phlegm excess and wind movement. It belongs to the category of internal damage, often due to spleen deficiency generating phlegm, liver yang transforming into wind, and phlegm moving with the wind. The second type is wind phlegm entering the collaterals, causing facial deviation, which is caused by external contraction of wind evil and the mutual binding of wind and phlegm. Clinically, there are also cases where exterior pattern with cough, dyspnea, and phlegm panting is referred to as wind phlegm, but this is not within the scope of this discussion.

The main clinical manifestations are: phlegm sounds in the throat, nausea and vomiting, expelling clear and frothy phlegm, fullness and oppression in the chest and hypochondrium, dizziness and blurred vision, numbness of the limbs, even sudden falls, unconsciousness, stiff tongue and inability to speak, convulsions and convulsive syncope, or facial deviation, hemiplegia, thick and greasy tongue coating, and wiry and slippery pulse.

This syndrome is commonly seen in diseases such as "vertigo," "apoplexy," and "epilepsy."

This syndrome should be differentiated from "heat-phlegm pattern" and "blood stasis pattern" in clinical practice.

bubble_chart Differentiation and Treatment

The differentiation of this syndrome indicates that all wind-phlegm pattern exhibit the manifestation of abundant phlegm stirring wind, but they have different characteristics when appearing in different diseases.

1. The wind-phlegm pattern of vertigo is characterized by dizziness as if spinning, dizzy vision, tinnitus, and vomiting of phlegm and saliva, mostly caused by wind-phlegm disturbing upwards, liver wood overacting on the stomach, and stomach qi ascending counterflow. The preferred treatment is Pinellia, White Atractylodes and Gastrodia Decoction (Yixue Xinwu) with modifications. The wind-phlegm pattern of apoplexy further differentiates between wind-phlegm blocking collaterals and wind-phlegm blocking the orifices: the pattern of wind and phlegm blocking collaterals is mostly caused by external wind stirring internal wind, wind-phlegm wandering through the meridians, and qi-blood stagnation, mainly manifesting as facial deviation, limb numbness, and even hemiplegia. The treatment should focus on dispelling wind and resolving phlegm, dredging the meridians, with the formula selection of Pull Aright Powder (from "Yang's Family Prescriptions") or Major Gentian Decoction (from "Medical Inventions") with modifications;
2. the pattern of wind and phlegm blocking the mind is mostly caused by yang hyperactivity transforming into wind, wind-phlegm surging upwards, and obscuring the seven orifices, mainly manifesting as sudden collapse, unconsciousness, stiff tongue and inability to speak, phlegm sounds in the throat, and drooling from the mouth corners. The treatment should focus on resolving phlegm for resuscitation, with the formula selection of Phlegm-Cleansing Decoction (Qixiao Liangfang) with modifications.
3. The pattern of wind and phlegm blocking collaterals refers to apoplexy involving meridians, without mental disorders; the condition is generally milder; the pattern of wind and phlegm blocking the mind refers to what is generally called apoplexy involving zang-organs, with unconsciousness and sluggish speech, and the condition is generally more severe. The wind-phlegm pattern of epilepsy is caused by wind-phlegm disturbing upwards and the mind being obscured, and is a paroxysmal disease. During an attack, it mainly manifests as sudden collapse, unconsciousness, frothing at the mouth, upward gaze of the eyes, limb convulsions, and making pig or sheep-like sounds, waking up after a while, and frequently recurring without sequelae. The treatment should focus on removing phlegm and stopping wind, resuscitation to stabilize epilepsy, with the formula selection of Epilepsy-Stabilizing Pill (Yixue Xinwu) with modifications.

The wind-phlegm pattern is commonly seen in individuals with liver and kidney yin deficiency, ascendant hyperactivity of liver yang, and obesity with abundant phlegm. Liver yang transforming into wind, with phlegm moving with the wind, most easily causes this syndrome. Those with a violent temperament are prone to liver qi depression, qi depression transforming into fire, and sudden expansion of liver yang, with yang hyperactivity stirring wind, thus phlegm moves with the wind, resulting in a wind-phlegm pattern. In the disease mechanism evolution of this syndrome, it often includes spleen deficiency dampness-phlegm pattern and liver-kidney yin deficiency pattern. "The spleen being the source of phlegm," dietary irregularities, overstrain and internal damage, impairing the spleen and stomach, insufficient spleen qi, failure to transform water and grain, accumulating dampness and generating phlegm, thus forming spleen deficiency dampness-phlegm pattern. Spleen deficiency dampness-phlegm pattern is often the source of phlegm in wind-phlegm pattern, hence wind-phlegm pattern often includes spleen deficiency dampness-phlegm pattern. Its main manifestations include anorexia, nausea, vomiting of turbid phlegm, abdominal distension and fullness after eating, loose stools, fatigue and lack of strength, and a shallow yellow and lusterless complexion. Damage from the seven emotions or sexual overexertion, depleting essence and blood, liver-kidney yin deficiency, yin failing to restrain yang, yang hyperactivity transforming into wind, and phlegm moving with the wind, thus liver and kidney yin deficiency and yang hyperactivity transforming into wind are the basis for phlegm pattern stirring wind. Additionally, liver yang hyperactivity, yang heat consuming body fluids, also becomes a source of phlegm in wind-phlegm syndrome, hence wind-phlegm pattern often includes liver-kidney yin deficiency pattern. The main manifestations of liver-kidney yin deficiency pattern include soreness and weakness of the waist and knees, dizziness and tinnitus, tidal fever and night sweats, vexing heat in the chest, palms, and soles, afternoon malar flush, and dry mouth and throat.

bubble_chart Differentiation of Similar Patterns

1. Heat-phlegm pattern and wind-phlegm pattern: Both heat-phlegm pattern and wind-phlegm pattern can present with abnormal mental states and excessive phlegm-saliva. Heat-phlegm pattern arises when pathogenic heat scorches body fluids to produce phlegm, or when phlegm stagnation generates heat, leading to the combination of heat and phlegm forming heat-phlegm. When heat-phlegm invades the heart-mind and disturbs the seven orifices, symptoms such as irritability, insomnia, frequent laughter, or manic behavior may occur. Wind-phlegm pattern results from excessive liver yang attacking the spleen-earth, leading to impaired spleen transportation and the internal production of turbid phlegm, or from overstrain and internal damage causing spleen dysfunction, dampness accumulation, and phlegm production. Liver wind carrying phlegm disrupts the meridians and obstructs the seven orifices, resulting in sudden collapse, unconsciousness, and a stiff tongue with speech difficulties. The key distinguishing features between heat-phlegm pattern and wind-phlegm pattern in terms of mental state are: heat-phlegm pattern manifests as manic mental states, while wind-phlegm pattern presents as unconsciousness with wind symptoms. In terms of phlegm characteristics: heat-phlegm pattern is associated with yellow, thick phlegm or white, clumpy phlegm, while wind-phlegm pattern involves clear, thin, and frothy phlegm. Regarding tongue and pulse: both syndromes show greasy tongue coating and slippery pulse, but heat-phlegm pattern also exhibits heat signs, such as a red tongue with yellow, greasy coating and a rapid, slippery pulse, whereas wind-phlegm pattern shows signs of liver wind, with a wiry and slippery pulse.
2. Blood stasis pattern and wind-phlegm pattern: Blood stasis pattern is caused by static blood obstructing the meridians, leading to malnourishment of the vessels, and may present with limb numbness and hemiplegia. Wind-phlegm pattern is caused by wind-phlegm obstructing the meridians, also leading to malnourishment of the vessels, and may present with limb numbness and hemiplegia. Therefore, the clinical manifestations of the two are similar. The main distinction lies in the accompanying symptoms: blood stasis pattern presents with cyanotic lips and nails, a dark purple tongue with ecchymosis, and a thin, choppy pulse, while wind-phlegm pattern presents with excessive phlegm-saliva, a greasy tongue coating, and a slippery pulse, making the two easily distinguishable.

bubble_chart Documentation

1. Yizong Bidu‧Phlegm-Fluid Retention: "In the liver meridian, it is called wind phlegm, with a wiry pulse and a greenish complexion, fullness and discomfort in the limbs, difficulty in urination and defecation, occasional irritability and anger, the phlegm is green and frothy, treated with Boiled Golden Flower Pill, Saposhnikovia Root Pill, and Sichuan Lovage Rhizome Pill."
2. Yixue Rumen‧Phlegm Category: "Wind phlegm from external contraction of thief pathogen, or kidney dryness and wood movement, or internal wind and stagnant heat, with a green and shiny appearance, treated with Wind-Deficiency Three Raw Ingredients Decoction, Ancient Dragon and Tiger Pill, Wind-Heat Minor Provincial Wind Decoction, Wind-Searching Phlegm-Resolving Pill, Spirit-Returning Elixir, and Bamboo Juice Paste."