Dampness-phlegm pattern, also known as dampness-phlegm pattern, refers to a phlegm pattern caused by the prolonged internal stagnation of dampness turbidity. It is often due to spleen deficiency leading to impaired transportation and internal retention of water-dampness.

The main clinical manifestations of dampness-phlegm pattern are: cough with copious phlegm, white and thin in color, or spitting frothy saliva, chest stuffiness and tightness, or wheezing with phlegm, or nausea and anorexia, heavy and fatigued limbs, shallow yellow or puffy complexion, pale and swollen tongue, slippery and greasy tongue coating, and slippery or slow pulse.

This syndrome is commonly seen in "cough," "panting," and "vomiting," and can also be observed in diseases involving "unconsciousness."

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

bubble_chart Differentiation and Treatment

The differentiation of dampness-phlegm pattern can appear in various diseases.

1. Cough and wheezing seen in dampness-phlegm pattern are mostly caused by damp-phlegm obstructing the lungs, leading to the failure of lung purification and descent. The cough is characterized by profuse sputum, easy expectoration, and white, thin sputum. Treatment should focus on invigorating the spleen and drying dampness, resolving phlegm, and relieving cough. The formula of choice is Two Old Ingredients Decoction(Taiping Huimin Heji Jufang) with modifications;
2. wheezing syndrome is characterized by rapid breathing, phlegm rales, chest tightness, and even open-mouth breathing and flaring of the nostrils. Treatment should focus on drying dampness, dispelling phlegm, descending qi, and relieving dyspnea. The formula of choice is Three-Seed Filial Devotion Decoction(Hanshi Yitong) combined with Two Old Ingredients Decoction with modifications;
3. vomiting seen in dampness-phlegm pattern is mainly characterized by recurrent vomiting of phlegm and saliva, caused by damp-phlegm obstructing the middle energizer and the failure of stomach qi to descend. Treatment should focus on harmonizing the stomach and descending adverse qi, drying dampness, and resolving phlegm. The formula of choice is Minor Pinellia Decoction(Jingui Yaolue), or Two Old Ingredients Decoction with modifications.
4. Unconsciousness seen in dampness-phlegm pattern is characterized by phlegm rales in the throat, gurgling sounds, vomiting of phlegm and saliva, mental confusion, unclear speech, and unconsciousness. This is caused by damp-phlegm clouding the seven orifices. Treatment should focus on drying dampness and resolving phlegm, and resuscitation to awaken the spirit. The formula of choice is Phlegm-Cleansing Decoction(Qixiao Liangfang) taken with Styrax Pill(Taiping Huimin Heji Jufang).

Dampness-phlegm pattern often appears in obese individuals, and symptoms tend to worsen during the late summer when dampness is prevalent. Damp-phlegm is a yin pathogen, and with the assistance of yin qi at night, the amount of phlegm increases during the night.

In the evolution of the disease mechanism, dampness-phlegm pattern is prone to developing into pattern of spleen deficiency with dampness encumbrance and pattern of ascending counterflow of stomach qi. Spleen qi deficiency leads to water-dampness stagnation, which easily generates damp-phlegm. Damp-phlegm obstructing the middle energizer further injures spleen qi, hence dampness-phlegm pattern is often complicated by pattern of spleen deficiency with dampness encumbrance. The main manifestations of pattern of spleen deficiency with dampness encumbrance include poor appetite, abdominal distension and fullness after eating, chest and epigastric distension, anorexia, nausea, scanty urine, loose stools, heaviness of the head as if wrapped, and heavy limbs. Damp-phlegm obstructing the middle energizer, combined with ascending counterflow of stomach qi, also manifests as epigastric distension and pain, nausea, and vomiting.

bubble_chart Differentiation of Similar Patterns

1. Wind-phlegm pattern and dampness-phlegm pattern: Both wind phlegm and dampness phlegm can be seen in patients with unconsciousness. Their common manifestations include excessive phlegm, gurgling sounds in the throat, and vomiting of phlegm and saliva. The difference between the two syndromes is that wind-phlegm pattern involves the combination of wind and phlegm. Patients usually have hyperactive liver yang, and the phlegm moves with the wind, leading to sudden onset, dizziness, blurred vision, convulsions, numbness in the limbs, hemiplegia, facial distortion, and even fainting, frothing at the mouth, flushed face, dysphoria, and a wiry, slippery, and rapid pulse. On the other hand, dampness-phlegm pattern involves dampness and phlegm obstructing the seven orifices, with symptoms such as excessive phlegm, frothing at the mouth, somnolence, heavy or immobile limbs, dull complexion, and a soft, slow pulse. The former has wind pattern manifestations, while the latter is characterized by excessive dampness and phlegm, making them easy to distinguish.
2. Cold-phlegm pattern and dampness-phlegm pattern: Cold-phlegm pattern is caused by pre-existing phlegm turbidity combined with external cold, or yang deficiency leading to cold, resulting in the stagnation of water and dampness, and the combination of cold and phlegm. Both dampness-phlegm pattern and cold-phlegm pattern have symptoms such as white and thin phlegm, chest tightness, and coughing. However, dampness-phlegm pattern is characterized by a large amount of phlegm that is white, thin, and sticky, and is easily coughed up. It may also include symptoms of dampness affecting the spleen and stomach, such as abdominal distension, loose stools, and heavy limbs. In contrast, cold-phlegm pattern is characterized by white, thin, and clear phlegm, along with cold pattern manifestations such as cold limbs, clear urine, and loose stools, which can be used to distinguish between the two.

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bubble_chart Documentation

1. Zhengyin Maizhi‧Phlegm Pattern Discussion: "The symptoms of damp-phlegm syndrome include body heat or no heat, heavy body and sore feet, vomiting without thirst, fullness in the chest and diaphragm, occasional spitting of phlegm, and general body weakness and fatigue. This is the internal damage dampness-phlegm syndrome. The cause of damp-phlegm is the insufficiency of middle qi, the inability of stomach yang to digest, and the inability of spleen yang to distribute, leading to the retention of water and grains turning into phlegm and fluid, thus forming the damp-phlegm syndrome. The pulse of damp-phlegm is mostly deep and slippery; slippery and solid indicates stubborn phlegm, slippery and soft indicates deficiency stagnation, slippery but not rapid indicates spleen dampness turning into phlegm, slippery and rapid indicates dampness-heat. The treatment for damp-phlegm is to dry dampness to transform white phlegm, regulate the spleen to move phlegm, use Erchen Stomach-Calming Powder, or Erchen Qiangfang Decoction. For dampness turning into heat, use Zhilian Two Old Ingredients Decoction. For deficient individuals, use Six Gentlemen Decoction, add Zhilian for heat, and add ginger and aconite for cold."
2. 《Seven Pine Rock Collection‧Phlegm-Fluid Retention》: "Those with damp-phlegm are externally obese, with profuse sweating and fatigue; internally, they experience fullness and borborygmus with diarrhea. The main treatment is to dry dampness and promote diuresis."
3. 《Essence of Medical Cases from Famous Doctors of the Qing Dynasty‧Jin Zijiu's Medical Cases》: "If the phlegm is thick first and then thin in the morning, it must be spleen and stomach damp-phlegm."