bubble_chart Concept

The sound of phlegm in the throat, commonly referred to as phlegm rale, wheezing, or gurgling phlegm, occurs when excessive phlegm accumulates in the throat, obstructing the airway and causing a rattling sound during breathing.

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1. Phlegm Congestion and Qi Blockage︰Chest and diaphragm fullness and oppression, rapid and coarse breathing, gurgling with phlegm, severe inability to lie down, lack of appetite, white and greasy tongue coating, and slippery pulse. This is mostly due to excessive lung heat, which scorches fluids into phlegm, with fiery qi flaring upward. The phlegm ascends with the fire and accumulates in the chest and diaphragm, pressing upward to the throat, resulting in panting and phlegm rattling. The key clinical distinguishing features are: the phlegm is yellow in color and thick in texture, difficult to expectorate, accompanied by fever, dysphoria, thirst with desire to drink, yellow and greasy tongue coating, red tongue body, rapid pulse, and other signs of heat. Treatment should focus on clearing heat and resolving phlegm, suppressing cough and relieving asthma. The recommended formulas are Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) and Panting-Arresting Decoction with modifications.
2. Phlegm-heat Obstructing the Lung︰Fever, chest tightness, panting, flaring of the nostrils, wheezing in the throat with a sound like sawing, yellow and thick phlegm, red tongue texture, yellow and greasy tongue coating, rapid pulse. Mostly caused by excessive lung heat scorching fluids into phlegm, fiery qi flaring upward, phlegm ascending with fire and accumulating in the chest and diaphragm, pressing upward to the throat and causing wheezing and phlegm noise. The key clinical distinguishing features are: the phlegm is yellow and thick, difficult to expectorate, accompanied by fever, dysphoria, thirst with desire to drink, yellow and greasy tongue coating, red tongue texture, rapid pulse, and other heat signs. Treatment should focus on clearing heat and resolving phlegm, suppressing cough and relieving asthma. Prescriptions such as Ma Xing Shi Gan Tang and Panting-Arresting Decoction with modifications can be used.
3. Phlegm-fire Transforming into Wind︰Sudden vertigo, even fainting, unconsciousness, deviation of the mouth and eyes, inability to lift the limbs, or hemilateral numbness, stiffness of the tongue root, phlegm sounds in the throat, red tongue texture, yellow and greasy coating, flooding-rapid and slippery pulse. Mostly caused by phlegm stagnation transforming into fire, fire-heat generating wind, phlegm-fire carrying wind to disturb upward, obstructing the seven orifices, hence sudden fainting, inability to lift the limbs, deviation of the mouth and eyes, stiff tongue and inability to speak, belonging to the apoplectoid stroke syndrome. "The Essential Techniques of Diagnosis and Treatment" states, "The syndrome of apoplexy... or copious phlegm-drool, throat making sounds." Usually, there is frequent dizziness, headache, tinnitus, dizzy vision, or irritability and easy anger, heart vexation, dreamfulness. Occasionally, due to anger or alcohol consumption stirring phlegm-fire to transform into wind, sudden onset of fainting occurs, and after regaining consciousness, there are often sequelae such as hemiplegia, deviation of the mouth and eyes, stiff tongue and slurred speech. Treatment should focus on reviving the spirit, orifice-opening, resolving phlegm, clearing fire, pacifying the liver and extinguishing wind. The formula used is Supreme Treasured Pill combined with Phlegm-Cleansing Decoction, Antelope Horn Powder with modifications.
4. Phlegm Obscuring the Clear Orifices︰Vertigo headache, chest tightness and discomfort, followed by sudden fainting, phlegm sounds in the throat, frothing at the mouth, limb convulsions, dull tongue texture, thick greasy coating, slippery or wiry pulse. This is often caused by phlegm-turbidity disturbing upward, blocking the orifices, and clouding the mind, leading to sudden fainting, unconsciousness, frothing at the mouth, limb convulsions, etc., which are characteristic of epilepsy. The key clinical distinguishing features are: mostly due to liver qi disharmony, yang rising and wind stirring, triggering accumulated phlegm that clouds the seven orifices. Wind-phlegm gathers and disperses irregularly, resulting in recurrent episodes without a fixed pattern or trigger. Before an episode, dizziness, chest tightness, irritability, and lack of strength may occur, followed by sudden fainting, upward gaze, clenched teeth, phlegm sounds in the throat, frothing at the mouth, and limb convulsions. Recovery occurs when qi reverses, and daily activities return to normal. Treatment should focus on resolving phlegm to stabilize epilepsy, using formulas such as Epilepsy-Stabilizing Pill or modified Biotite Schist Phlegm-Resolving Pill.
5. Spleen-kidney Qi Deficiency︰Shortage of qi leads to reluctance to speak, more exhalation than inhalation, thin and clear phlegm, and phlegm sounds in the throat. Fear of cold and cold limbs, reduced appetite, loose stools, pale tongue texture, white coating, and weak pulse. Phlegm originates from the kidneys and is activated by the spleen, often due to spleen deficiency and weak qi, impaired transportation, insufficient kidney qi, and inability of qi transformation, causing water pathogens to rise and accumulate as dampness into phlegm. Therefore, the phlegm obstructing the lungs in this syndrome, leading to panting and phlegm sounds, must be accompanied by a bland taste in the mouth, reduced appetite, loose stools, fatigue, lack of strength, and other signs of insufficient spleen qi, as well as panting upon exertion, soreness and weakness in the lower back and knees, fear of cold, cold limbs, weak pulse, and faint chi pulse, indicating insufficient kidney qi. The treatment should focus on tonifying and replenishing the spleen and kidney, regulating the lungs to resolve phlegm, using modified Jian Six Gentlemen Metal and Water Decoction.

The symptom of gurgling phlegm in the throat can be seen in various diseases, with distinctions between deficiency and excess, cold and heat. It is necessary to determine the cause based on the symptoms and to treat accordingly. It is also often one of the manifestations of critical illness. Jingyue Quanshu．Miscellaneous Syndromes states, "If the condition of miscellaneous syndromes has become severe, and the sound of phlegm in the throat is gurgling, gradually worsening, this is a sign of impending danger."

bubble_chart Documentation

1. 《Medical Congregation Records: True Apoplexy Syndrome》"For those with a yin constitution, who often suffer from internal cold, when wind pathogens invade, wind and edema combine,... the sound of phlegm gurgles like boiling water."