bubble_chart Concept

The dry-phlegm pattern refers to a series of symptoms caused by dryness pathogen scorching body fluids and phlegm obstructing the lung collaterals. This syndrome is mostly due to external contraction of autumn dryness pathogen, combined with internal obstruction of phlegm turbidity, or lung-kidney yin deficiency, with deficient fire scorching body fluids.

The main clinical manifestations of dry-phlegm pattern are: scanty white phlegm, sticky and difficult to expectorate, dry and itchy throat with scanty fluids, cough and panting, dry nose and lips, red tongue texture with scanty fluids, wiry, thin and rapid pulse, or thin and choppy pulse. The dry-phlegm pattern is mainly seen in "cough" and less commonly appears in other diseases.

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

bubble_chart Differentiation and Treatment

The identification of dry-phlegm pattern is mainly seen in cough, and the treatment should focus on moistening dryness and resolving phlegm. The prescription chosen is Fritillaria and Trichosanthes Fruit Powder(Yixue Xinwu) with modifications.

Dry-phlegm pattern is often seen in individuals with yin deficiency and the elderly. In individuals with yin deficiency, they are prone to dryness pathogens, which scorch and deplete body fluids, leading to dry-phlegm pattern. Due to insufficient yin fluids, symptoms such as tidal fever, night sweats, and vexing heat in the chest, palms, and soles may be observed. In the elderly, insufficient qi and yin, along with yin deficiency and reduced fluids, lead to the inability of qi to transform fluids, easily resulting in dry phlegm. This is often accompanied by symptoms of qi deficiency such as cough, shortness of breath, fatigue, and lack of strength. Dry-phlegm pattern often occurs during the autumn dryness-heat season, as dryness-heat pathogens easily deplete and damage fluids, transforming them into phlegm. During the autumn dryness season, dryness pathogens invade the lungs, leading to dry-phlegm pattern, often accompanied by symptoms of dryness pathogens affecting the exterior, such as fever, slight aversion to wind and cold, headache, and reduced sweating.

Dry-phlegm pattern is prone to evolve into lung yin deficiency pattern during the disease mechanism process. Insufficient lung yin leads to the lungs losing nourishment and generating dryness-heat, with deficient fire scorching metal and transforming fluids into phlegm. This results in symptoms of dry phlegm obstructing the lungs, such as scant white sticky phlegm that is difficult to expectorate, dry and itchy throat, and cough and wheezing. The main manifestations of lung yin deficiency pattern include blood-streaked phlegm, tidal fever, night sweats, vexing heat in the chest, palms, and soles, flushed cheeks in the afternoon, red tongue with scant coating, and a thin and rapid pulse.

bubble_chart Differentiation of Similar Patterns

1. Heat-phlegm pattern and dry-phlegm pattern: Both syndromes share common manifestations such as cough with sticky phlegm that is difficult to expectorate, dry mouth, and dry throat, thus they should be differentiated. Dry-phlegm pattern is caused by external contraction of dryness-heat pathogens, which scorch lung fluids, or due to lung yin deficiency, where deficient fire scorches the metal (lung), transforming fluids into dry phlegm. Its characteristics include dry cough with scanty phlegm, dryness of the mouth and nose, and even dry and withered skin, which are manifestations of severe dryness damaging fluids. It can also damage the lung collaterals, leading to blood in the phlegm or epistaxis. On the other hand, heat-phlegm pattern arises from pathogenic heat scorching body fluids to produce phlegm, or from phlegm stagnation generating heat, resulting in the binding of phlegm and heat. Hence, the phlegm is yellow and thick, with scanty dark urine, dry stool accumulation, flushed face, and red lips, which are signs of excessive heat. In terms of tongue and pulse, both syndromes present with a red tongue texture, but dry-phlegm pattern shows a red tongue with little moisture, while heat-phlegm pattern presents with a red tongue and yellow greasy coating. Dry-phlegm pattern often manifests with a wiry, thin, and rapid pulse, or a thin and rough pulse, whereas heat-phlegm pattern typically shows a slippery and rapid pulse.

bubble_chart Documentation

1. Zhengyin Maizhi‧phlegm pattern Discussion: "The symptoms of dry phlegm include fever, parched lips, thirst with a desire to drink, wheezing and coughing with short breaths, occurring intermittently, difficulty in expectorating, this is the symptom of externally contracted dry phlegm. The cause of dry phlegm, either due to excessive yang activity, encountering a fiery season, the qi of dryness-heat, affecting the lung system, causing wheezing and coughing; injuring the intestines and stomach, leading to phlegm and cough, this is the onset of externally contracted dry phlegm. The pulse of dry phlegm, the pulse is necessarily rapid and large, floating and rapid indicating injury to the exterior, deep and rapid indicating injury to the interior, the left pulse rapid and large, dryness injuring the liver and gallbladder, the right pulse slippery and rapid, dryness injuring the lung and stomach. The treatment of dry phlegm, should clear heat and moisten dryness, lower fire and resolve phlegm, Bamboo Leaf and Gypsum Decoction, Two Mothers Gypsum Decoction, Two Mothers Two Old Ingredients Decoction." "The symptoms of dry phlegm, coughing and wheezing with counterflow, phlegm-fire rising, coughing intermittently, inability to expectorate phlegm, continuous coughing, red face and rising qi, this is the symptom of internally damaged dry phlegm. The cause of dry phlegm, the fire of five emotions, stirring within, or excessive sexual desire, exhaustion of water, or accumulation of heat from rich food, tormenting the intestines and stomach, steaming the lungs, refining into phlegm, then the symptoms of dry phlegm occur. The pulse of dry phlegm, the right inch pulse is rapid and large, heat in the lung system, the right guan pulse is deep and rapid, heat in the intestines and stomach, the left guan pulse is rapid, the evil of wood-fire, both chi pulses are deep and rapid, dryness and exhaustion of kidney water. The treatment of dry phlegm, nourish yin and strengthen water, moisten the lung and produce fluid, then the fire is extinguished and dryness is removed and phlegm does not arise, if using drying flavors to disperse phlegm, disaster follows immediately, true water dries up, Two Duo Two Mothers Decoction, accumulation of heat from rich food, Jie Zhai Resolving Phlegm Pill."