bubble_chart Concept

Heat-phlegm pattern, also known as fire-phlegm pattern, refers to a series of symptoms caused by the accumulation of phlegm and heat, phlegm-heat congesting the lungs, or phlegm-fire disturbing the heart. This syndrome arises when pathogenic heat scorches body fluids to produce phlegm, or when phlegm stagnation generates heat, leading to the binding of heat and phlegm.

The main clinical manifestations of heat-phlegm pattern include: thick, yellow phlegm, or white, sticky phlegm that is difficult to expectorate, cough and panting, vexing heat and chest pain, dry mouth and throat, or palpitations due to fright and insomnia, or frequent laughter, or mania and delirium, scanty and dark urine, dry and bound stools, a red face and lips, a red tongue with a yellow, greasy coating, and a slippery, rapid pulse.

Heat-phlegm pattern is commonly seen in diseases such as "cough," "wheezing," "panting," "insomnia," "mania," and "thoracic accumulation."

In clinical practice, heat-phlegm pattern should be differentiated from "dry-phlegm pattern," "heart fire hyperactivity pattern," and "warm disease blood aspect pattern."

bubble_chart Differentiation and Treatment

The heat-phlegm pattern appears in diseases such as cough, wheezing, panting, insomnia, mania, and thoracic accumulation. Although a series of common manifestations of phlegm and heat accumulation can be observed, each disease has its own characteristics.

1. The heat-phlegm pattern, where phlegm-heat obstructs the lungs, can lead to three diseases: cough, wheezing, and panting. They share the same disease cause and location, hence many common symptoms such as thick yellow phlegm, chest stuffiness, irritability, and dry mouth. The differences are: cough is characterized by cough qi counterflow; wheezing is a paroxysmal phlegm-panting disorder, often with a history of attacks, characterized by rapid breathing and wheezing in the throat; panting caused by heat-phlegm is often due to external contraction, with symptoms like aversion to cold with fever, and is characterized by rapid breathing, even open-mouth shoulder lifting, and flaring nostrils. For heat-phlegm cough, treatment should focus on clearing heat and resolving phlegm, ventilating the lung and relieving cough, with the formula Qianjin Phragmites Stem Decoction (Phragmites Stem Decoction) from (Beiji Qianjin Yaofang) with modifications; for wheezing due to heat-phlegm, treatment should focus on clearing heat and resolving phlegm, diffusing the lung to downbear counterflow, with the formula Panting-Arresting Decoction (Panting-Arresting Decoction) from (Shesheng Zhongmiao Fang) with modifications; for panting due to heat-phlegm, treatment should focus on clearing heat and resolving phlegm, ventilating the lung and relieving panting, with the formula Ma Xing Shi Gan Tang (from the Treatise on Cold Damage Diseases) or Mulberry Root Bark Decoction (Jingyue Quanshu) with modifications.
2. The heat-phlegm pattern can be seen in insomnia, mainly characterized by insomnia palpitation due to fright, irritability, chest stuffiness, nausea, belching, abdominal distension, yellow greasy tongue coating, and slippery rapid pulse. The formula Gallbladder-Warming Decoction (Gallbladder-Warming Decoction) from (Qianjin Yaofang) with modifications is selected.
3. The heat-phlegm pattern can be seen in mania, mostly due to emotional frustration, liver qi depression, transforming into fire, which boils body fluids into phlegm, and phlegm-heat disturbs mental activity. The main characteristics are mental derangement, clinical manifestations include irritability, headache insomnia, manic behavior, angry staring, erratic shouting, excessive strength, harming others and destroying objects, climbing high walls, red and deep tongue texture, yellow greasy tongue coating, and wiry large slippery rapid pulse. Treatment should focus on clearing the heart and resolving phlegm, calming the heart and draining the liver, with the formula Pig Iron Flakes Decoction (Pig Iron Flakes Decoction) from (Yixue Xinwu) with modifications.
4. The heat-phlegm pattern can also be seen in thoracic accumulation, where pathogenic heat enters the interior and combines with phlegm in the chest and stomach, forming the heat-phlegm thoracic accumulation syndrome. The main clinical manifestations are body heat, red face, thirst for cold drinks, vomiting upon drinking water, chest and stomach stuffiness, pain upon pressure, constipation, yellow greasy tongue coating, and wiry rapid pulse. Treatment should focus on clearing heat and resolving phlegm to open the knot, with the formula Xiao Xian Xiong Jia Zhi Shi Tang (Wenbing Tiaobian) with modifications.

People with yang exuberance are prone to the heat-phlegm pattern, as yang exuberance causes heat, and excessive heat boils body fluids into phlegm. The combination of phlegm and heat obstructs the lungs and disturbs the heart, leading to various manifestations of the heat-phlegm pattern.

The heat-phlegm pattern often coexists with lung yin deficiency pattern during its evolution. Pathogenic heat scorches fluids to produce phlegm, damages yin and consumes fluids, which can coexist with lung yin deficiency pattern. In cases of lung yin deficiency, yin deficiency generates heat, which can also boil body fluids into heat-phlegm. Therefore, the heat-phlegm pattern often coexists with lung yin deficiency pattern. The manifestations of lung yin deficiency pattern include dry cough, shortness of breath, scanty and thick phlegm, or phlegm with yellowish leukorrhea and blood, dry mouth and throat, hoarse voice, emaciation, tidal fever, night sweats, vexing heat in the chest, palms, and soles, afternoon cheek flushing, red tongue with little moisture, and thin rapid pulse.

bubble_chart Differentiation of Similar Patterns

1. Dry-phlegm pattern and heat-phlegm pattern: Both dry-phlegm pattern and heat-phlegm pattern can present symptoms such as thick and sticky phlegm that is difficult to expectorate, dry mouth and throat, cough, and qi counterflow. Dry-phlegm pattern is often caused by exposure to dryness pathogens, or the late stage of Rebing [third stage], or vomiting and diarrhea, profuse sweating, excessive bleeding, injury to yin fluids, and dryness and stagnation of body fluids. Its characteristics include dry cough with little phlegm, a red tongue with little or no coating or a thin and dry coating, and a wiry, thin, and rapid pulse. Heat-phlegm pattern is caused by external pathogens transforming into heat internally, or excessive consumption of spicy and fried foods, heavy bedding, internal heat generation, heat scorching body fluids, which are then condensed into phlegm, leading to phlegm-heat binding and obstruction of the lungs and heart. Its characteristics include yellow and thick phlegm, flushed face and red lips, vexing heat and chest pain, a red tongue with a yellow and greasy coating, and a slippery and rapid pulse.
2. Heart fire hyperactivity pattern and heat-phlegm pattern: Both heart fire hyperactivity pattern and heat-phlegm pattern can present symptoms such as dry mouth and throat, flushed face and red lips, vexation and insomnia, scanty and dark urine, dry stool, a red tongue with a yellow coating, and a rapid pulse, or frequent laughter, or mania and delirium. Heart fire hyperactivity pattern is caused by emotional distress, five minds transforming into fire, or the Six Climatic Factors stagnating and transforming into fire, or excessive consumption of pungent and warming tonics, leading to internal blazing of heart fire and disturbance of mental activity. In addition to the symptoms shared with heat-phlegm pattern, it may also present with a red and painful tip of the tongue, and if heart heat moves downward to the small intestine, symptoms such as scanty and painful urination, and hematuria may occur. Heat-phlegm pattern, on the other hand, is characterized by thick and yellow phlegm, or phlegm that is sticky and difficult to expectorate, a yellow and greasy tongue coating, and a slippery and rapid pulse.
3. Warm disease blood aspect pattern and heat-phlegm pattern: Both heat-phlegm pattern and blood aspect pattern can present with symptoms of dysphoria and restlessness, even mania and delirium, so they should be differentiated clinically. Warm disease blood aspect pattern is caused by external pathogens entering from the exterior to the interior and transmitting to the blood aspect. In addition to high fever, it often presents with macules or bleeding, a deep crimson tongue, and a thin and rapid pulse. In contrast, the mania and delirium caused by heat-phlegm are characterized by a red tongue with a yellow and greasy coating, a slippery and rapid pulse, and no bleeding symptoms, but with yellow and thick phlegm.

bubble_chart Documentation

1. Zhubing Yuanhou Lun‧Phlegm Fluid Retention Disease: "Heat phlegm is caused by the accumulation of stagnant water and fluids. It is said that the stagnation of yin and yang in the upper energizer generates heat. The heat interacts with phlegm and water, gathering and not dispersing, thus causing the body to feel weak and hot, impairing digestion, and leading to a hot sensation in the head and face. Therefore, it is called heat phlegm."
2. Yizong Bidu‧Phlegm-Fluid Retention: "In the heart meridian, it is called heat phlegm, characterized by a strong pulse, red face, feverish heart pain, dry mouth and lips, frequent laughter, and phlegm that is hard and clumped. It is treated with Small Yellow Pill and Rhubarb Rhizoma Decoction."
3. 《Qisong Yan Ji‧Phlegm-Fluid Retention》: "Fire phlegm occurs when metal is controlled by fire, causing body fluids to congeal into phlegm, leading to severe constipation, thirst, and dry throat. It is treated with cooling and moistening formulas."