Cold-phlegm pattern, also known as cold phlegm pattern, refers to a series of symptoms caused by the combination of cold and phlegm, where cold phlegm obstructs the lungs. Cold-phlegm pattern is due to pre-existing phlegm turbidity combined with external cold, or yang deficiency generating cold, leading to the stagnation of water-dampness, resulting in the combination of cold and phlegm.

The main clinical manifestations of cold-phlegm pattern are: white and clear thin phlegm, chest tightness, cough, and wheezing, cold body and limbs, clear urine, loose stool, pale tongue texture, white and slippery tongue coating, and deep slippery pulse.

Cold-phlegm pattern is commonly seen in diseases such as "asthma," "cough," and "vomiting."

In clinical practice, cold-phlegm pattern should be differentiated from "dampness-phlegm pattern" and "pattern of wind-cold invading the lung."

bubble_chart Differentiation and Treatment

cold-phlegm pattern appears in diseases such as wheezing, cough, and vomiting, all of which share the common manifestations of phlegm and cold congealing, but each has its own characteristics, and their treatments also differ.

1. Wheezing and cough caused by cold-phlegm pattern, due to the same disease cause and location of disease, both exhibit a series of manifestations of the aforementioned cold-phlegm pattern. However, wheezing is a recurrent panting disease caused by cold-phlegm lodging in the lungs, where the patient appears normal when not having an attack, but during an attack, it is characterized by rapid breathing and wheezing in the throat. The treatment should focus on warming and resolving cold-phlegm, regulating qi, and calming panting, with the formula selection being Minor Green-Blue Dragon Decoction (from the "Treatise on Cold Damage Diseases").
2. Cough presenting with cold-phlegm pattern is caused by cold-phlegm obstructing the lungs and the lungs losing their descending function. It is characterized by a prolonged cough that varies in severity and a cold sensation in the back. The treatment should focus on warming the lungs and dissipating cold, resolving phlegm, and relieving cough, with the formula selection being Potia, Licorice, Schisandra, Ginger, and Asarum Decoction (from Jingui Yaolue) combined with Two Old Ingredients Decoction (from Taiping Huimin Heji Jufang) with modifications.
3. Vomiting presenting with cold-phlegm pattern is caused by cold-phlegm stagnating internally and the stomach losing its harmonious descending function. It is characterized by epigastric distension and discomfort, a preference for warmth and aversion to cold, and vomiting of phlegm and saliva. The treatment should focus on warming and resolving cold-phlegm, harmonizing the stomach, and descending adverse qi, with the formula selection being Minor Pinellia Decoction (from Jingui Yaolue) combined with Poria, Cinnamon Twig, White Atractylodes, and Licorice Decoction (from the "Treatise on Cold Damage Diseases") with modifications.

Cold-phlegm pattern is often seen in individuals with yang deficiency, where yang deficiency leads to excessive cold, water-dampness obstruction, and congealing into phlegm. Elderly individuals with insufficient yang qi are more prone to cold-phlegm pattern. In certain seasons, pudendal coldness is prevalent, and combined internal and external pathogens make cold-phlegm pattern more likely to occur or worsen in winter. During the day, yin qi is strong at night, so the manifestations of cold-phlegm pattern often worsen at night. In northern China, where temperatures are lower and pudendal coldness is more prevalent, cold-phlegm pattern is more common than in the south.

In the evolution of the mechanism of disease, cold-phlegm pattern is prone to accompanying symptoms and signs such as spleen yang deficiency and kidney yang deficiency. The spleen governs transportation and transformation of water-dampness, and ancient texts refer to the "spleen as the source of phlegm." Spleen yang deficiency leads to impaired transportation and transformation, causing water-dampness to congeal and form phlegm. Moreover, phlegm-dampness obstruction further damages spleen yang, so cold-phlegm pattern often accompanies spleen yang deficiency pattern. Spleen yang deficiency pattern is mainly manifested as poor appetite, epigastric and abdominal pain that is relieved by pressure and warmth, cold limbs, loose stools, a pale and tender tongue texture, white and slippery tongue coating, and a deep, thin, and weak pulse. Kidney yang is the foundation of the body's yang qi and has the function of transforming water. Kidney yang deficiency leads to impaired warming and transformation, causing water-dampness to stagnate internally and rise as phlegm. Cold-phlegm obstruction also damages kidney yang, so cold-phlegm pattern often accompanies kidney-yang deficiency pattern. Kidney-yang deficiency pattern is mainly manifested as soreness and weakness in the lower back and knees, cold body and limbs, dizziness, tinnitus, a pale tongue with a white coating, and a deep, thin, and weak pulse.

1. Dampness-phlegm pattern and cold-phlegm pattern: Dampness-phlegm pattern is caused by spleen qi deficiency, leading to the inability to transport water and dampness, which accumulates and transforms into phlegm. Cold-phlegm pattern is due to pre-existing phlegm turbidity in the body, combined with external cold invasion, or spleen-kidney yang deficiency, where yang deficiency generates cold, causing water and dampness to fail to transform and condense into phlegm. Both dampness-phlegm pattern and cold-phlegm pattern can present with symptoms such as white, thin phlegm, chest fullness, cough with rapid breathing, pale tongue with slippery coating. The differentiation lies in that dampness-phlegm pattern is characterized by copious sputum production, anorexia, nausea, chest tightness, and heavy body, reflecting dampness encumbering the spleen and stomach. In contrast, cold-phlegm pattern is characterized by clear, thin phlegm, cold body and limbs, clear urine, and loose stools, reflecting cold signs.
2. Pattern of wind-cold invading the lung and cold-phlegm pattern: Pattern of wind-cold invading the lung is caused by external contraction of wind-cold, which enters the lung, leading to the failure of lung defense to disperse. Due to the lung's failure to descend and distribute body fluids, they condense into phlegm, hence pattern of wind-cold invading the lung also presents with cough, white, clear, thin phlegm, similar to cold-phlegm pattern. However, pattern of wind-cold invading the lung can also be accompanied by aversion to cold with fever, body aches, nasal congestion, and clear nasal discharge, which are signs of exterior cold pattern, thus allowing differentiation from cold-phlegm pattern.

bubble_chart Documentation

1. Zhubing Yuanhou Lun‧phlegm fluid retention disease: "Cold phlegm refers to stomach qi deficiency and weakness, which prevents the proper circulation of water and grains, leading to the accumulation of phlegm and water in the chest and diaphragm. This often causes acid swallowing, qi counterflow, bluish limbs, and inability to eat or drink."
2. Shengji Zonglu‧phlegm-fluid retention section: "Cold phlegm: It is said that qi is yang; when yang is insufficient, it cannot dissolve water and drinks. When spleen qi is deficient and weak, the qi pathway becomes blocked, leading to the accumulation of fluids and the formation of phlegm. This phlegm soaks the intestines and stomach, causing vomiting and acid swallowing above, and profuse diarrhea and cold in the middle below. If this persists for a long time, it can lead to emaciation, shortness of breath, and difficulty in eating and drinking. In the past, people often treated phlegm-fluid retention with warm medicines, precisely for this reason."
3. Yizong Bidu‧phlegm-fluid retention: "In the kidney meridian, it manifests as cold phlegm, with deep pulse, dark face, urgent and painful urination, cold feet and inversion, and frequent feelings of terror. The phlegm has black spots and is thin. Treatments include Ginger and Cinnamon Pill, Eight-Ingredient Pill, and Pepper Fruit Middle-Regulating Pill."
4. 《Qisong Yanji‧phlegm-fluid retention》: "Cold phlegm is due to the initial deficiency of yang qi, which fails to protect the exterior and interior. When exposed to external cold, it causes phlegm and panting. Internal deficiency leads to poor transportation and transformation, resulting in phlegm-fluid retention and stuffiness and fullness with a tendency to cough. Treatment involves warming the middle and tonifying qi, dispersing cold from the exterior and interior."