The pattern of phlegm and stasis obstructing the internal is a general term for a series of clinical manifestations caused by the mutual binding of phlegm stagnation and static blood, obstructing the movement of qi. This syndrome is due to the dysfunction of the zang-fu organs, leading to the accumulation of dampness and phlegm from blood stasis, or the obstruction of blood by phlegm stagnation, resulting in the binding of phlegm stagnation and static blood.

The clinical manifestations of this syndrome vary depending on the location of the stasis obstruction, mainly including: numbness and heaviness, stabbing pain that does not move, long-lasting and unhealed, worse with cold and relieved by warmth; internal masses, fixed and immovable; unclear consciousness or restlessness and irritability: dark purple tongue texture, thick and greasy tongue coating, etc.

The pattern of phlegm and stasis obstructing the internal is commonly seen in diseases such as "chest impediment", Bi disease, lung abscess, manic syndrome, sequelae of wind stroke, and abdominal mass.

This syndrome should be clinically differentiated from "wind-phlegm pattern" and "blood stasis pattern".

bubble_chart Differentiation and Treatment

The pattern of phlegm and stasis obstructing the internal is often seen in prolonged and difficult-to-cure diseases, manifesting differently in various conditions.

1. In chest impediment, the pattern of phlegm and stasis obstructing the internal presents as stabbing chest pain radiating to the back, fixed and unrelenting, worsening at night or with cold exposure, accompanied by coughing and spitting of phlegm, a dark purple tongue texture, and a thick, greasy tongue coating. This is caused by the binding of cold phlegm and static blood in the chest, leading to obstruction of the collaterals and stagnation of qi movement. Treatment should focus on resolving phlegm, dispelling stasis, diffusing impediment, and activating yang. The formula used is Trichosanthes, Chinese Chive and Pinellia Decoction(Jingui Yaolue) combined with Blood House Stasis-Expelling Decoction(Yilin Gaicuo) with modifications.
2. In Bi disease, the pattern of phlegm and stasis obstructing the internal is characterized by localized stabbing pain, fixed and unrelenting, worsening with cold and at night, accompanied by numbness, heaviness, dark purple skin, and joint deformities. This is due to the obstruction of phlegm and stasis, leading to blocked collaterals. Treatment should focus on resolving phlegm, dispelling stasis, dredging collaterals, and relieving pain. The formula used is Collaterals-Activating Pill(Taiping Huimin Heji Jufang) with modifications.
3. In lung abscess, the pattern of phlegm and stasis obstructing the internal is characterized by coughing up purulent phlegm with a foul smell, or hemoptysis, chest distension and stabbing pain. The disease mechanism is the accumulation of pathogenic heat, phlegm turbidity, and static blood in the lungs, leading to abscess formation. Treatment should focus on clearing phlegm, transforming stasis, clearing heat, and resolving bind. The formula used is Phragmites Stem Decoction(Beiji Qianjin Yaofang) combined with Minor Chest Bind Decoction(from the "Treatise on Cold Damage Diseases") with modifications.
4. In mania, the pattern of phlegm and stasis obstructing the internal presents with symptoms of mental disturbance such as agitation, restlessness, or dementia and sluggishness, along with a dull complexion, dark purple tongue texture, and deep, choppy pulse, indicating internal static blood obstruction. This is caused by phlegm and stasis affecting the heart and disturbing mental activity. Treatment should focus on calming the heart, clearing phlegm, invigorating blood, and resolving stasis. The formula used is Depression and Mania Awakening Decoction(Yilin Gaicuo) with modifications.
5. In the sequelae of wind stroke, the pattern of phlegm and stasis obstructing the internal presents with hemiplegia, limb numbness, facial deviation, and speech difficulties, along with a dull complexion and a dark purple tongue with stasis spots. This is due to the binding of phlegm and stasis, leading to blocked collaterals, impaired qi movement, and insufficient blood nourishment to the limbs. Treatment should focus on tonifying qi, invigorating blood, expelling wind, and resolving phlegm. The formula used is Yang-Tonifying Five-Returning Decoction(Yilin Gaicuo) with additions such as Acorus, Milkwort Root, Arisaema, and Giant Typhonium Rhizome.
6. In abdominal mass, the pattern of phlegm and stasis obstructing the internal presents as a fixed abdominal mass with distending or stabbing pain, a dark tongue with a greasy coating. This is due to the binding of phlegm and stasis, forming a mass. Treatment should focus on invigorating blood, resolving phlegm, and dispersing masses. The formula used is Turtle Carapace Decocted Pill(Jingui Yaolue) or Resolving Accumulation Pill(Zabing Yuanliu Xizhu).

The pattern of phlegm and stasis obstructing the internal is often seen in individuals with yang qi deficiency. Yang qi deficiency leads to weak qi movement, causing water-dampness stagnation and phlegm formation, as well as blood stasis due to obstructed blood flow. Moreover, phlegm stagnation can further lead to blood stasis, and blood stasis can cause phlegm coagulation. Once phlegm and stasis form, the impaired circulation of qi and blood further depletes the already deficient yang. Patients with this pattern, in addition to the primary symptoms of phlegm and stasis binding, may also exhibit yang deficiency symptoms such as mental fatigue, lack of strength, shortness of breath, reluctance to speak, fear of cold, cold limbs, bland taste in the mouth, lack of thirst, clear urine, and loose stools. Phlegm and stasis are yin pathogens, and symptoms worsen at night or in cold environments due to the reinforcement of yin. The main manifestations of yang deficiency syndrome include mental fatigue, lack of strength, shortness of breath, reluctance to speak, fear of cold, cold limbs, bland taste in the mouth, lack of thirst, clear urine, and loose stools. In such cases, treatment for the pattern of phlegm and stasis obstructing the internal often includes resolving phlegm and invigorating blood, combined with medicinals that warm yang and replenish qi. The pattern of phlegm and stasis obstructing the internal generally has a prolonged course and is difficult to cure. In young adults, it often manifests as Bi disease, lung abscess, or mania; in the elderly, it often manifests as chest impediment or sequelae of wind stroke. Therefore, the clinical manifestations of the pattern of phlegm and stasis obstructing the internal vary among individuals, and treatment should be tailored accordingly.

1. Wind-phlegm pattern and pattern of phlegm and stasis obstructing the internal: Both wind-phlegm pattern and pattern of phlegm and stasis obstructing the internal can present with common symptoms of sequelae of wind stroke such as hemiplegia, limb numbness, facial deviation, and speech difficulties, thus they should be differentiated. Pattern of phlegm and stasis obstructing the internal is caused by the dysfunction of zang-fu organs, obstruction of qi, blood, and body fluids, or the accumulation of dampness leading to phlegm, stagnation of phlegm causing blood stasis, or blood obstruction leading to static blood, which in turn obstructs the flow of fluids and generates phlegm, resulting in the mutual binding of phlegm and stasis, hindering qi movement. The sequelae of wind stroke characterized by the mutual binding of phlegm and stasis are marked by a dull complexion, purple tongue with ecchymosis, and other manifestations of static blood. Wind-phlegm pattern is caused by overstrain internal damage, dysfunction of the spleen in transportation, internal generation of phlegm turbidity, and liver wind carrying phlegm, transversely invading the meridians. Its sequelae of wind stroke are accompanied by phlegm rales in the throat, dizziness, blurred vision, thick and greasy tongue coating, and wiry-slippery pulse, indicating the upward disturbance of wind-phlegm. In terms of disease course, the wind-phlegm pattern of sequelae of wind stroke appears earlier with a shorter course, while the pattern of phlegm and stasis obstructing the internal appears later with a longer course. The wind-phlegm pattern, if prolonged, often develops into the pattern of phlegm and stasis obstructing the internal.
2. Blood stasis pattern and pattern of phlegm and stasis obstructing the internal: Both syndromes can present with common manifestations such as fixed stabbing pain, masses in the body, or restlessness. Blood stasis pattern is caused by qi deficiency, qi stagnation, blood cold, etc., leading to poor blood circulation and stagnation. The clinical characteristics of blood stasis pattern include scaly skin, cyanotic lips and nails, purple-dark tongue texture, or ecchymosis, and choppy pulse, while the pattern of phlegm and stasis obstructing the internal generally includes local numbness and heaviness, thick and greasy tongue coating, etc. For some patients presenting with stasis pattern, if invigorating blood and resolving stasis treatments are ineffective over a long period, even without obvious phlegm stagnation, the relationship between phlegm and stasis should be considered, and treatment according to the pattern of phlegm and stasis obstructing the internal often yields results.

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bubble_chart Documentation

1. Zhengyin Maizhi‧Bi Disease: "The symptom of chest impediment, which is stomach impediment. There is fullness and stuffiness in the chest, stagnation and inability to move, vomiting immediately after eating, inability to swallow, or occasional nausea. This is the symptom of chest impediment. The cause of chest impediment is irregular diet, injury from hunger and satiety, phlegm coagulation and blood stagnation, turbidity in the middle energizer, leading to the occurrence of symptoms such as food obstruction and stuffy pain."
2. Zabing Yuanliu Xizhu‧Source of Phlegm-Fluid Retention: "Seven days of food phlegm. Food is not digested, or mixed with static blood, forming a nest, leading to stuffiness and fullness. It is advisable to use Trichosanthis Fruit pills."
3. Leizheng Zhicai‧Stuffiness and Fullness: "Phlegm mixed with static blood forms a nest, causing stuffiness, with a deep and choppy pulse, and it does not heal for a long time. Only those who are sorrowful and depressed have it, and it should be treated from blood depression. Peach kernel, Carthamus, Moutan bark, Cyperus, Rosewood, Sappan Wood, leek juice, and child's urine."
4. 《Essence of Medical Cases of Famous Doctors in the Qing Dynasty‧Ye Tian-shi's Medical Cases》: "After several years of chronic illness, the disease must be in the collaterals. The pain is not a deficiency pattern, because the constitution has been weakened over time, encountering unsuitable food or emotional depression, phlegm due to qi stagnation, qi obstructing blood stasis, all meridians are in disorder, vomiting filth, and constipation. Doctors see cold limbs and consider it as collapse, using Aconite Lateral Root to warm the interior and protect yang. However, yang qi is all intangible, and the disease has a cause, definitely not yang deficiency and collapse. Recalling the onset of the disease, it was like liver disease. All methods of dredging qi and blood were effective, but the disease was not completely cured, mostly due to temperament and food. In summer, specifically use the Taiyin-Yangming obstruction-removing formula, now the pain is in the epigastrium, and over time, the turbid stasis gathers again, it is advisable to use light and bland flavors for clear nourishment. Initially, Bamboo Juice pills were used, and still used; in the morning, another method of dredging stasis was established. Sappan Wood, Ginseng, Curcuma Root, Peach Kernel, Tail of Chinese Angelica, Platycladi Seed, amber, Leonurus, and Chinese date meat pills."