A STUDY GUIDE TO PHLEGM-RESOLVING HERBS

A STUDY GUIDE TO PHLEGM-RESOLVING HERBS

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Phlegm is a product of the body's activities acting upon qi and moisture taken in with food and beverages; it is "congealed moisture." Unlike qi, phlegm is always viewed by Chinese physicians as substantive and stagnating rather than light and flowing, though there are two kinds of phlegm: the visible, which has greater accumulation of matter, and the invisible, which is finely divided, though not as fine as qi. Phlegm is, in some ways, comparable to another body humor, blood, which is also produced by the body's activities acting upon qi, and is a sticky substance that shares some of the same potential pathologies with phlegm: deficiency, inadequate circulation, firm coagulation, and complexing with heat or cold factors.

Phlegm is a normal and required substance in terms of the mucous membrane lining and other lubricating functions, but it becomes a pathological substance when:

1. it is derived from stagnated food in the stomach;
2. when normal phlegm (mucoid substance) is produced in excess; or
3. when it is complexed with internal or external pathological factors, such as cold, heat, wind, or toxin.

Phlegm accumulates when the lungs are irritated, when the moisture of the body is overheated by pathological qi (causing it to dry and transform into thick phlegm), when the qi is stagnant and the normal phlegm is not circulated (or when pathological phlegm is not eliminated quickly due to poor circulation of the fluid), and when the kidneys are too cold and the moisture condenses and transforms into phlegm. Phlegm may become insufficient when there is an inadequate source of the necessary nutrients in the diet; when the spleen is weak and cannot raise the qi derived from food upward to moisturize the upper body; when the lungs suffer from deficient qi and cannot transform moisture to phlegm; or when the environmental conditions or the consumption of drying foods (such as spices) disperse too much of the existing phlegm

Phlegm is thought to have a similarity to grease or fat, and therefore, fatty foods are deemed one potential source of phlegm. In general, any food that is not completely digested is said to give rise only to a pathological type of phlegm: normal phlegm is produced when pure substances are obtained from digested foods and then processed into a useful body lubricant. Obese persons are said to be displaying an excess of phlegm in their extra body weight (see: Obesity and hyperlipidemia: Bojenmi tea and other Chinese herb formulas): the equivalence of phlegm, fatty foods, and body fat is most clearly demonstrated by this connection. According to Chinese thinking, the spleen and lungs have the primary responsibility for generating and circulating the mucoid substances necessary for normal body functions, and dysfunctions of these organs are often responsible for the accumulation of fats.

While most Westerners think of phlegm as referring only to the excess mucus produced in the lungs and sinuses, from the Oriental view, phlegm can exist in many places in the body; it may form lumps, it may block the meridians, obstruct the heart orifices, or simply accumulate throughout the tissues, preventing the normal in and out flow of qi.

Soft or fluid-filled swellings in the body are generally regarded as phlegm masses. This would include lymphatic swellings, ovarian cysts, thyroid nodules, lipomas, and breast lumps that are not hardened; some of these are malignant masses. The thickened fluid obstructing the bursa of the joints in patients with bursitis is considered a phlegm disorder. Symptoms of phlegm accumulation associated with the digestive system include nausea, vomiting, and greasy stool.

Here is a description of the problem of phlegm fluid accumulation (retention) described in the Advanced Textbook of Traditional Chinese Medicine and Pharmacology:

Phlegm and retained fluids are pathological products of impaired local or general water metabolism. The concept of phlegm (tan) and phlegm-fluid retention (tanyin) in Chinese medicine embraces a wide range of manifestations....Phlegm and phlegm fluids are either substantial or non-substantial. Substantial phlegm and retained fluids are visible....Non-substantial phlegm and retained fluids refer to pathological manifestations such as dizziness, nausea, vomiting, shortness of breath, palpitations, or mania and semi-consciousness, all of which are linked to invisible phlegm or fluid discharge from the body. Nonetheless, these conditions respond well when treated as substantial phlegm and retained fluids....Phlegm and retained fluids are caused by the influence of the six exogenous pathogenic factors, irregular diet, or abnormal emotional activities; all impair the water metabolism of the lung, spleen, kidney, and triple burner qi. The lung dominates the dispersion and descent of qi and the distribution of body fluids. The water retention resulting from a failure of these functions produces phlegm and retained fluids. The spleen controls the transportation and transformation of water, the failure of which causes an accumulation of water which then turns into phlegm and other retained fluids. The kidney is responsible for the gassification of water [steaming the water; converting water to qi]. When kidney yang is insufficient, water cannot be transformed into qi. It accumulates and, again, turns into phlegm and other retained fluids. Retained fluids and phlegm may also appear when the triple burner passages are blocked, for the normal transportation, distribution, and excretion of body fluids are interfered with. Furthermore, since the triple burner houses all the zangfu organs, failure of the qi activity of the triple burner may result in the formation of pathogenic phlegm and retained fluids and make them accumulate in the zangfu organs and, more superficially, in the tendons, bones, skin, and muscles, causing various pathological changes.

The diagnosis of phlegm or fluid retention syndrome often revolves around three factors: a moist, and, especially, a thick tongue coating; a smooth, and, especially, a full, slippery pulse; and obvious signs of phlegm accumulation, such as discharge of excess sputum (lung/sinus problems), obesity, palpable soft accumulations (lumps and swellings), and adverse reactions to intake of greasy foods. However, because phlegm retention can occur in persons with a wide range of accompanying conditions, and because phlegm retention can be of the "non-substantial" type, one may need to look further. Some examples of manifestation of phlegm disorder are mentioned in the Advanced Textbook... , as follows:

Phlegm that blocks the lungs results in coughing, asthmatic breathing, and expectoration of sputum. Phlegm in the heart causes suffocating feeling in the chest and palpitations. If the Heart Meridian [heart orifices] is obstructed by phlegm, dementia and loss of consciousness may occur. If the heart is disturbed by phlegm-fire, mania may occur. Phlegm stagnating in the stomach causes nausea, vomiting, and fullness in the stomach. An accumulation of phlegm in the meridians, tendons, and bones may cause scrofula, subcutaneous nodules, a numbness of the limbs, hemiplegia, or fistulous infection of the tissues. Phlegm attacking the head produces dizziness. Phlegm and qi in the throat may produce the sensation of a foreign body in the throat. Retention of fluids also has different syndromes. Morbid fluid in the intestine produces a gurgling sound. In the costal region, it produces a full sensation in the chest and pain on coughing. If it accumulates in the diaphragm, it causes stuffiness in the chest, coughing, dyspnea, difficulty in lying flat, and puffiness. Morbid fluid in the tissues and skin causes edema, absence of sweat, and heavy feeling of the body.
PHLEGM-RESOLVING HERBS

Herbs that help resolve phlegm problems are divided, in the Materia Medica, into those which resolve cold phlegm (which is moist, thin, and clear), and those which resolve hot phlegm (which is drier, thick, and sometimes discolored). In most cases, herbs from both categories are combined together in varying proportions to get the best influences of the important phlegm-resolving herbs; several herbs from other Materia Medica categories have phlegm-resolving properties, and may be included in developing an optimal prescription. In the following presentation, the two main groups (herbs for resolving hot phlegm and herbs for resolving cold-phlegm) are listed in accordance with Oriental Materia Medica (Hsu) with some adjustments from Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine (Huang and Wang).

Along with the description of each herb, an example of a formula in which it is utilized is offered to help illustrate the principles of combining that have been relied upon in China. It will be noted that many of the formulas contain citrus materials: citrus (chenpi), aurantium (jupi), chih-shih (zhishi), or blue citrus (qingpi). These herbs are found in the qi-regulating section of the Materia Medica, but they are important herbs for resolving phlegm accumulations, both because of inherent phlegm-resolving activity of the herbs and because of the principle: "if the qi circulates well, phlegm also circulates." Ginger (fresh ginger, shengjiang) also appears in many of the formulas because it helps to resolve phlegm and to promote the stomach function so that food stagnation does not arise. In addition, several of the formulas contain herbs for clearing heat (e.g., scute, gardenia, anemarrhena); their use is indicated in cases where heat pathogens combine with or cause phlegm accumulation and it also is important when prolonged phlegm accumulation turns to heat. Several of the formulas contain herbs for dispelling wind (notably siler, angelica, chiang-huo, asarum, and schizonepeta) to help treat acute ailments or the surface manifestation of a chronic ailment, and some formulas contain tonic herbs (e.g., ginseng, jujube, licorice, atractylodes, and hoelen) to aid the spleen in transforming and transporting functions so that phlegm does not continue to accumulate. When the phlegm is in the lungs, herbs that reduce coughing may also be included (e.g., apricot seed, perilla seed). For phlegm masses, oyster shell may be added; for wind-phlegm-fire disorder (which tends to cause spasms or paralysis), silkworm is often added; for thickened phlegm associated with yin deficiency, ophiopogon is often added; when food accumulation leads to phlegm production, shen-chu, malt, and crataegus may be included; schizandra is included in some formulas to astringe excess fluid production, but is in other formulas to help generate fluid when there is yin deficiency yielding insufficient mucus production.
RESOLVING HOT PHLEGM.

The herbs that resolve hot phlegm generally have a cold property; those with a salty or bitter taste are often used for resolving swellings, including tumors, while those with a sweet taste moisten dryness.

* Bamboo refers to the shavings of the stem of several species of bamboos, most commonly Phyllostachys nigra. The Chinese name, zhuru, means the edible part of the well-known plant called zhu. It has a sweet taste and a mild cold nature, entering the lung and stomach meridians to resolve thick phlegm and to control vomiting due to heat and accumulation in the stomach. It is an important ingredient of Aurantium and Bamboo Combination (Jupi Zhuru Tang) used for nausea, hiccoughing, and vomiting. The active components, including triterpenes, resolve thickened phlegm and reduce inflammation of the stomach.


Aurantium and Bamboo Combination
Jupi Zhuru Tang
Aurantium jupi; or use chenpi 12 g
Bamboo zhuru 12 g
Ginger shengjiang 9 g
Jujube dazao 5 pieces
Licorice zhi gancao 6 g

* Bamboo sap, in liquid form is called zhuli, and dried bamboo sap is often called tianzhuhuang (heavenly bamboo yellow); these materials have similar applications to bamboo shavings (zhuru), but are more cooling in nature (perhaps due to the higher content of minerals). These sap materials enter the heart meridian and treat phlegm mist obstructing the heart orifices, to relieve convulsions, paralysis, and high fever. Bamboo sap is included in patent medicines for phlegm-fire disorder, such as Baoying Dan, used for fever and difficult respiration due to acute ailment in infants.


Zhu Po Baoying Dan
patent remedy from Guangzhou
Snake gallbladder sanshedan 12.9%
Scorpion quanxie 9.7%
Gastrodia tianma 8.0%
Silkworm jiangcan 8.0%
Siler fangfeng 8.0%
Uncaria gouteng 8.0%
Succinum hupo 7.2%
Bamboo sap tianzhuhuang 5.7%
Calomel qingfen 5.7%
[note: contains mercury]
Borneol bingpian 5.7%
Cicada chantui 5.7%
Pearl zhenzhu 5.4%
Musk shexiang 4.3%

* Clam shells are obtained from many species of bivalves, but especially Cyclina sinensis. The Chinese name, haigeke, simply refers to the ocean, hai, the clam, ge, and its shell, ke. Like other sea shells, it has a salty taste, a cold nature, and it influences the liver and lungs. It resolves phlegm masses, which include tenacious sputum in the lungs, and swellings. Clam shell is a major component of Isatis and Hai-ko Formula (Dai Ge San), comprised of those two herbs alone, for stubborn phlegm in the lungs that is discolored (due to toxic heat; an infection); it is also a major component of Atractylodes and Hai-ko Formula (Kaiyu Zhengyuan San) that is used for abdominal masses, such as uterine fibroids (this formula is a modification of Kaiyu Erchen Tang), which develop secondary to qi stagnation and food stagnation with phlegm accumulation. The active components of the clam shell are calcium salts and proteins.


Atractylodes and Hai-ko Formula
Kaiyu Zhengyuan San
Atractylodes baizhu 3 g
Citrus chenpi 3 g
Blue citrus qingpi 2 g
Cyperus xiangfuzi 3 g
Crataegus shanzha 3 g
Hai-ko haige 3 g
Platycodon jiegeng 3 g
Hoelen fuling 3 g
Cardamon sharen 1.5 g
Corydalis yansuhuo 3 g
Malt guya 3 g
Licorice gancao 1.5 g
Shen-chu shenqu 3 g
Ginger shengjiang 2 slices

* Bulbifera refers to the rhizome of Dioscorea bulbifera, one of several Dioscorea species used in Chinese medicine. The Chinese name huangyaozi refers to its yellow color and to the bulbous underground stem, with zi indicating offspring, as it does for aconite branch roots, fuzi. Its influence is cooling, affecting the liver and heart to reduce swellings associated with interior heat, such as carbuncles, lung abscess, breast lumps, goiter, and tumors. Bulbifera is a component of Jia Kang Wan for treating hyperthyroidism: it is one of several phlegm-resolving herbs used to remove the thyroid mass, which is interpreted as a phlegm mass. Researchers caution, however, that high dosage or prolonged use of bulbifera can cause liver damage. This herb is usually not used in by Western practitioners due to the safety concerns, though the amount in this formula is small and, thus, it is considered by Chinese physicians to be a safe level for use in China. Li Shizhen had written that bulbifera is "bitter in taste, mild in nature, and nonpoisonous, reducing heat by cooling the blood and curing goiter through removing toxins."


Jia Kang Wan
(main ingredients of pill used in clinical trial for hyperthyroid disease)
Prunella xiakucao 16%
Oyster shell muli 12%
Sargassum haizao 12%
Laminaria kunbu 12%
Pinellia banxia 12%
Fritillaria zhebaimu 12%
Hoelen fuling 12%
Aurantium juhong 8%
Bulbifera huangyaozi 4%

* Cynanchum refers to the rhizome of Cynanchum stauntoni and related species. The Chinese name, baiqian, means white front, referring to the appearance of the leaves. The taste is acrid and sweet, and the influence is mildly cold. It enters the lung meridian to help moisten the lungs, aid the descent of qi, and expel profuse sputum. Cynanchum is a major ingredient of the Platycodon and Schizonepeta Formula (Zhi Sou San) used for the treatment of cough with excessive sputum. The active components are saponins that thin the sputum and relieve inflammation.


Platycodon and Schizonepeta Formula
Zhi Sou San
Cynanchum baiqian 17%
Platycodon jiegeng 17%
Schizonepeta jingjie 17%
Aster ziyuan 17%
Stemona baibu 17%
Citrus chenpi 9%
Licorice gancao 6%

* Fritillaria refers to two major species of fritillaria, F. cirrosa and F. thunbergii, members of the Lily family. Both varieties are bitter, mildly cold, and affect the lung and heart. The two species have similar actions and uses, but the cirrhosa species is deemed more suitable for moistening the lungs when there is a heat syndrome, and thunbergii is more suited for removing phlegm masses, including tumors. The Chinese name, beimu, makes reference to the appearance of the white bulbs like cowry shells (the cirrosa species is known as chuanbeimu because it comes from Sichuan Province; the thunbergii species is known as zhebeimu, produced in Zhejiang Province). In most formulas, the variety of fritillaria is not specified and, because it is more readily available and less expensive, zhebeimu is usually selected. Fritillaria is an important ingredient of Platycodon and Fritillaria Combination (Qingfei Tang), a traditional prescription for bronchitis that is mostly used in Japan. The formula nourishes yin and clears heat, two properties common to the lily bulbs, and the complex formulation is aimed at treating sputum that is sticky but profuse. The active components of fritillaria are steroidal alkaloids which have sedative, anti-inflammatory, and phlegm resolving actions.


Platycodon and Fritillaria Combination
Qingfei Tang
Platycodon jiegeng 6 g
Fritillaria beimu 6 g
Scute huangqin 6 g
Apricot seed xingren 6 g
Bamboo zhuru 6 g
Ophiopogon maimendong 9 g
Gardenia zhizi 6 g
Citrus chenpi 6 g
Hoelen fuling 9 g
Morus sangbaipi 6 g
Asparagus tianmendong 6 g
Tang-kuei danggui 9 g
Jujube dazao 6 pieces
Fresh ginger shengjiang 1 slice
Licorice gancao 3 g
Schizandra wuweizi 1.5 g

* Lapis is a mineral which is well-known as a semi-precious stone laced with mica schist; in fact, today, Chinese doctors use the less expensive mica (which has a golden color) alone. The Chinese name, jinmengshi, refers to the inconsistent color meng, of the stone, shi, for which the golden variety, jin, has been selected. The taste is acrid and salty, and it has a cold nature. Lapis affects the lung and liver, resolving phlegm and calming agitation. Lapis is an ingredient in the Lapis and Scute Formula (Mengshi Guntan Wan) used for phlegm fire syndrome, as applied in the treatment of mental disorders, convulsions and tenacious sputum associated with an inflammatory disease, such as gastritis, bronchitis, pharyngitis, and tuberculosis.


Lapis and Scute Formula
Mengshi Guntan Wan
Lapis mengshi 35%
Rhubarb dahuang 26%
Scute huangqin 26%
Aquilaria chenxiang 13%

* Peucedanum refers to the roots of Peucedanum praeruptorum, a close relative of the more commonly used herb bupleurum. Its Chinese name, qianhu, reflects its comparison to bupleurum, called chaihu. The taste is bitter and acrid, it has a mild, cold nature and affects the lungs to resolve phlegm and to relieve coughing. It is especially used in cases of acute bronchitis, and because of its mild nature, it is used for both hot and cold syndromes. It is an important ingredient in the Perilla Fruit Combination (Suzi Jiangqi Tang), used for treatment of asthma, bronchitis, emphysema, and other lung disorders, given when there is copious sputum. The active components include flavonoids, such as peupraerin, which dilate the blood vessels and aid expectoration.


Perilla Fruit Combination
Suzi Jiangqi Tang
Perilla seed suzi 9 g
Pinellia banxia 9 g
Tang-kuei danggui 9 g
Peucedanum qianhu 6 g
Magnolia bark houpo 6 g
Cinnamon bark rougui 6 g
Licorice zhi gancao 6 g
Ginger shengjiang 3 slices

* Pumice refers to volcanic lava that has entered the ocean, becoming light due to the influence of steaming water, making it porous as it cools. The pores become filled with tiny marine life. The resulting material is salty, mildly cold, and influences the lungs to remove phlegm masses; its mild nature makes it suitable for treatment of children's coughs. It is also used for resolving swellings, such as goiter, tumors, and scrofula. Pumice is not included as an ingredient among traditional formulas. It is included in the modern formula Laminaria 4 (Hai Lin Pian), used for phlegm masses and tenacious sputum in the lungs. The active components of pumice are silicon dioxide, a component also found in bamboo sap, plus the minerals common to sea materials such as clam shells, mainly calcium salts.


Laminaria 4
Hai Lin Pian
Laminaria kunbu 40%
Sargassum haizao 39%
Oyster shell muli 10%
Pumice haifushi 10%
Sinapis baijiezi 1%

* Sterculia refers to the seed of Sterculia scahigera. Its Chinese name pangdahai, refers to the fact that the herb swells up when dipped in water and floats like a sponge. Although listed in the phlegm-resolving section of most Chinese herb texts, it has minimal direct action on phlegm, mainly having an "opening" action that aids the normal flow of mucus. It has a sweet taste and cold property, affecting the lungs and large intestine-moistening dryness, opening the lungs and throat, and promoting bowel movements. The herb is rarely included in traditional formulas, but it is sometimes used in modern clinical practice. For example is an ingredient of Yanhou Tang, used for the treatment of chronic pharyngitis. The active components of this herb have not yet been ascertained.


Yanhou Tang
(used in clinical research, proportions not available)
Lonicera jinyinhua
Ophiopogon maimendong
Chyrsanthemum juhua
Platycodon jiegeng
Sterculia pangdahai
Oroxylum muhudie
Licorice gancao

* Trichosanthes refers to a starchy root obtained from the Chinese gourd plant Trichosanthes kirilowii. The Chinese name, gualougen, simply refers to the root, gen, of the gourd; it is also called tianhuafen, indicating the white powder obtained from the root. The taste is sweet and sour and it has a cold property. It influences the lung and stomach, moistening dryness and clearing heat and swelling. It is most commonly used for diseases with thirst as a symptom, including diabetes. It is an important ingredient of Ophiopogon and Trichosanthes Combination (Maimendong Yin Zi), a formula used for diabetes and chronic bronchitis with dry cough. The active components of trichosanthes include sterols and saponins. The root is also the source of a protein drug, trichosanthin, commonly called Compound Q, which has been used as an abortifacient, a treatment for cancer, and a trial drug in the treatment of AIDS.


Ophiopogon and Trichosanthes Combination
Maimendong Yin Zi
Ophiopogon maimendong 21 g
Hoelen fuling 18 g
Rehmannia shengdi 12 g
Anemarrhena zhimu 9 g
Pueraria gegen 9 g
Trichosanthes root gualougen 6 g
Ginseng renshen 6 g
Bamboo zhuru 3 g
Schizandra wuweizi 3 g
Licorice gancao 3 g

* Trichosanthes seed is derived from the same plant as the root. The Chinese name, gualouren simply indicates that it is the seed of the gourd. The taste is bitter and it affects the lung and stomach as well as the large intestine to resolve phlegm and treat dryness. Trichosanthes seed is an ingredient of Anemarrhena and Fritillaria Formula (Ermu Ningsou Wan), a pill used for severe coughing with dryness. The active components include fatty acids and saponins. The whole trichosanthes gourd or just the outer portion are also used in Chinese medicine, with similar applications, especially used for treating persistent discharge of colored phlegm; the seed is selected in cases of congestion accompanied by constipation, while the outer portion is selected when there is sticky phlegm in the chest.


Anemarrhena and Fritillaria Formula
Ermu Ningsou Wan
Anemarrhena zhimu 10%
Fritillaria chuanbeimu 8%
Trichosanthes seed gualouren 10%
Morus bark sangbaipi 10%
Citrus chenpi 10%
Hoelen fuling 10%
Gardenia zhizi 10%
Scute huangqin 10%
Chih-shih zhishi 8%
Schizandra wuweizi 8%
Licorice gancao 6%

* Trichosanthes fruit is derived from the same plant as the root. The Chinese name, gualou simply indicates that it is this particular gourd. Sometimes, only the peel of the fruit is used; it is known as gualoupi. The taste is sweet and it affects the lung and stomach as well as the large intestine to resolve thick phlegm and treat dryness. Trichosanthes fruit is a major component of Trichosanthes, Bakeri, and Pinellia Combination (Gualou Xiebai Banxia Tang) which is used for phlegm accumulation in the chest area, affecting the heart and lungs, as occurs with some heart disease.


Trichosanthes, Bakeri, and Pinellia Combination
Gualou Xiebai Banxia Tang
Trichosanthes fruit gualou 3 g
Bakeri Xiebai 4.5 g
Pinellia Banxia 6 g

* Usnea refers to the parasitic plant Usnea longissima and related species, found growing from the branches of pine trees. The Chinese name, songluo, refers to its beard-like appearance on the pine tree. It has a bitter and sweet taste, cleanses the lungs, controls bleeding, and reduces inflammation and infection. It is an ingredient of Pinellia and Usnea Formula (Ying Jie San), used in the treatment of tumors that are comprised of a phlegm mass, such as melanomas and lymphatic tumors. The active components of usnea include usnic acid.


Pinellia and Usnea Formula
Ying Jie San
Fried wheat zhi xiaomai 12 g
Usnea songluo 9 g
Pinellia banxia 9 g
Fritillaria zhebeimu 9 g
Sargassum haizao 9 g
Laminaria kunbu 9 g
Gentiana longdancao 9 g
Arca shells walengzi 9 g
Tetrapanax tongcao 9 g
Alum mingfan 9 g

* Laminaria refers to at least two seaweeds, Laminaria japonica or Ecklonia kurome, the latter being the most common source in modern times. The Chinese name kunbu refers to the appearance of its many broad leaves. The seaweed, like others, is salty in taste and has a cold property. It influences the liver, kidney, and stomach, reducing swellings and eliminating excess moisture. Since laminaria is almost always combined with another seaweed, sargassum, a representative formula using laminaria is presented with the sargassum entry. The salts in seaweed may be responsible for both diuretic and phlegm-resolving activities. There are also polysaccharides that reduce lung irritation. Laminaria is mainly used in formulas that "soften" masses, being used for ovarian cysts, thyroid swellings, and tumors.
* Sargassum is a seaweed obtained from Sargassum fusiforme and some related species. The Chinese name, haizao simply means sea hair. Its taste is salty and bitter, and it has a cold nature. It influences the liver, kidney, and stomach to treat swelling, edema, and phlegm accumulation. Its properties are like those of laminaria, with which it is usually combined. Sargassum and laminaria are ingredients of the Sargassum and Laminaria Combination, sometimes called the Seaweed Combination (Haizao Yuhu Tang). It is used in the treatment of thyroid swellings and tumors.


Sargassum and Tu-huo Combination
Haizao Yuhu Tang
Sargassum haizao 3 g
Laminaria kunbu 3 g
Pinellia banxia 3 g
Citrus chenpi 3 g
Blue citrus qingpi 3 g
Forsythia lianqiao 3 g
Fritillaria zhebeimu 3 g
Tang-kuei danggui 3 g
Cnidium chuanxiong 3 g
Tu-huo duhuo 3 g
Licorice gancao 3 g
Kelp haidai 1.5 g

* Chu-dan is the bile obtained from pigs; the Chinese name zhudan simply refers to the pig's (zhu) gallbladder or bile (dan). It has a bitter taste and affects the lung, liver, and gallbladder. Chu-dan is used to treat cough with profuse phlegm or difficult expectoration due to a lung heat syndrome; it is also utilized for a wide range of heat syndromes, including swollen and painful eyes, sore throat, dysentery, boils, inflammation of the liver, and congestion of the bile duct or gallbladder. It is an ingredient of cough syrups, such as Chuan Ke Ling, and is often used as an inexpensive substitute for snake bile (shedan). The active constituents are bile acids.


Chuan Ke Ling
(patent cough syrup)
Platycodon jiegeng 35%
Licorice gancao 30%
Apricot seed xingren 25%
Chu-dan zhudan 10%

HERBS FOR COLD PHLEGM

* Arisaema refers to the processed tuber of Arisaema consanguineum. The Chinese name tiannanxing means heaven's southern star. It is acrid and bitter, and somewhat toxic before processing, usually with pig's bile (it is then often called dannanxing; dan means gallbladder or bile). Its influence is mainly on the lung, liver, and spleen, resolving phlegm, calming wind, and drying dampness; it is also used to resolve resulting heart phlegm congestion, for stroke, paralysis, and convulsion. Arisaema is a major ingredient of the Pinellia and Arisaema Combination (Qingshi Huatan Tang), used for pain and numbness due to phlegm obstruction of the nerves, muscles, and joints. The main active components are saponins that thin the phlegm and reduce inflammation.


Pinellia and Arisaema Combination
Qingshi Huatan Tang
Pinellia banxia 12 g
Hoelen fuling 12 g
Atractylodes baizhu 12 g
Arisaema tiannanxing 9 g
Scute huangqin 9 g
Fresh ginger shengjiang 3 slices
Citrus chenpi 7.5 g
Sinapis baijiezi 4.5 g
Bamboo sap tianjuhuang 4.5 g
Chiang-huo qianghuo 4.5 g
Angelica baizhi 4.5 g
Licorice gancao 4.5 g

* Centipeda refers to the whole plant of Centipeda minima, a member of the Dandelion Family; it should not be confused with the insect centipede, which is also used in Chinese medicine. One of the Chinese names, shihusui, makes reference to similarities in its appearance to husui, coriander; it is more commonly know as ebushicao ("herb that even a goose won't eat;" because of its strong taste). It has an acrid taste and is said to enter the lung meridian because of its strong effects on the lungs and sinuses, alleviating stuffiness. In addition, it clarifies obstructed vision and can be used in treating infections of the respiratory system or intestines. It is not commonly included in traditional Chinese formulas, but is used in some modern clinical applications. It is an ingredient of the formula Xanthium 12, devised in the U.S. to treat allergy reactions, especially sinus allergies. The active components of centipeda include taraxesterols found also in dandelion, and flavonoids that reduce allergy reaction.


Xanthium 12
Kang Xieqi Pian
Xanthium cangerzi 13%
Sophora kushen 12%
Bupleurum chaihu 9%
Centipeda ebushicao 9%
Scute huangqin 9%
Cynanchum baiqian 9%
Siler fangfeng 8%
Mume wumei 8%
Ginseng renshen 6%
Licorice gancao 6%
Asarum xixin 6%
Schizandra wuweizi 5%

* Gleditsia refers to the sharp spines of Gleditsia officinalis and related species of the member of the Legume family. The Chinese name, zaoci, simply refers to the spike, ci, of the plant commonly called zao, meaning black, because black soap was made from the saponins of the fruits. It has an acrid taste and a mild warm quality. It enters the lung meridian and aids in dispersing phlegm masses. Gleditsia is an ingredient in many antitumor formulas, such as Angelica and Mastic Combination (Xianfang Huoming Yin), used for carbuncles, abscess, swelling ulcers, and tumors. The main active components are saponins. Gleditsia fruits (zaojia) have similar properties, but are mainly used for cases of phlegm obstruction of the orifices, thus treating stroke, convulsion, and paralysis.


Angelica and Mastic Combination
Xianfang Huoming Yin
Lonicera jinyinhua 9 g
Citrus chenpi 9 g
Anteater scales chuanshanjia 3 g
Angelica baizhi 3 g
Gleditsia spine zaoci 3 g
Trichosanthes root gualuogen 3 g
Peony baishao 3 g
Myrrh moyao 3 g
Frankincense ruxiang 3 g
Fritillaria zhebeimu 3 g
Tang-kuei danggui 3 g
Siler fangfeng 3 g
Licorice gancao 3 g

* Inula refers to the flowers of Inula britannica, an internationally used herb of the Dandelion family. Its name xuanfuhua, refers to the dense curled shape of the flower head. The taste is acrid and bitter, and its property is mildly warm. It affects the lung and large intestine, and the spleen and stomach, resolving phlegm, causing qi to descend, and softening hardness. Inula is an ingredient of the Schizonepeta and Pinellia Formula (Qingfei Cao San) used for the treatment of bronchitis with productive cough and sinus congestion. The active components are mainly taraxasterol and related compounds that reduce inflammation and disperse phlegm.


Schizonepeta and Pinellia Formula
Qingfei Cao San
Schizonepeta jingjie 17.5 g
Peucedanum qianhu 13.5 g
Inula xuanfuhua 9 g
Asarum xixin 9 g
Hoelen fuling 5.4 g
Pinellia banxia 4.5 g
Licorice gancao 3 g
Ginger shengjiang 2 slices
Jujube dazao 3 pieces

* Pinellia refers to the processed tuber of Pinellia ternata, the most frequently used of all the phlegm-resolving herbs. The Chinese name, banxia, means half summer, and refers to the fact that it is collected in mid-summer. It has an acrid taste and is toxic until processed, usually cooked with ginger juice. It enters the spleen and stomach meridians, harmonizing the stomach and reducing the production of phlegm due to undigested food and excessive upward movement of qi and moisture. It is the key herb of Pinellia Combination (Banxia Xiexin Tang), a formula that is widely used and often modified slightly for specific applications; it is mostly used for indigestion, nausea, vomiting, gastritis, and ulcer. The active components are many, including alkaloids, phenols, and sterols, producing a sedative, antiemetic, and phlegm-resolving action.


Pinellia Combination
Banxia Xiexin Tang
Pinellia banxia 18 g
Ginseng renshen 9 g
Jujube dazao 6 pieces
Fresh ginger shengjiang 3 slices
Coptis huanglian 3 g
Scute huangqin 9 g
Licorice zhi gancao 9 g

* Platycodon refers to the roots of Platycodon graniflorum; it is a relative of the tonic herbs codonopsis and adenophora. The Chinese name, jiegeng, makes reference to the quality of the plant's stalk. Its taste is acrid and bitter, and its property is neutral. It enters the lung meridian to ventilate the lungs, resolve phlegm and disperse cold; because of its neutral quality, however, it is frequently used in treatment of lung heat and sore throat. It is an ingredient of the Fritillaria and Platycodon Formula (Ning Sou Wan), a pill that is used for acute and chronic bronchitis with persisting cough and excessive sputum. The active components of platycodon are saponins, sterols, and triterpenoids, that reduce inflammation and thin the sputum.


Fritillaria and Platycodon Formula
Ning Sou Wan
Platycodon jiegeng 10%
Perilla fruit zisuzi 10%
Dendrobium shihu 10%
Fritillaria beimu 10%
Hoelen fuling 10%
Pinellia banxia 10%
Mentha bohe 8%
Morus sangbaipi 8%
Apricot seed xingren 8%
Red citrus juhong 6%
Wheat sprout xiaomai 6%
Licorice gancao 4%

* Sinapis, sometimes called brassica, refers to the seed of Brassica alba, also called Sinapis alba, and related species of mustard. The Chinese name, baijiezi, refers to the white seed that confers strength. It has an acrid taste and enters the lung meridian to promote the flow of qi in the chest, expel phlegm, and disperse swellings. Sinapis is an ingredient in Lige Huotan Tang, used for the treatment of phlegm accumulation that leads to hiccups, choking sensation, and difficulty consuming food. Even though sinapis is warming, it is included in this formula for phlegm stagnation that has turned hot, because of its powerful dispersing qualities, counterbalanced by inclusion of coptis, gardenia, and gypsum. The active components of sinapis include the glycoside sinalbin, which has expectorant properties.


Lige Huotan Tang
Pinellia banxia 9 g
Red citrus juhong 9 g
Chih-shih zhishi 9 g
Areca seed binglang 9 g
Aquilaria chenxiang 9 g
Platycodon jiegeng 9 g
Trichosanthes root gualougen 9 g
Coptis haunglian 9 g
Gardenia zhizi 9 g
Cyperus xiangfuzi 9 g
Sinapis baijiezi 6 g
Gypsum shigao 12 g
Tea xicha 3 g

* Typhonium, often called "white aconite," is obtained either from the tuber of Typhonium giganteum or Aconitum koreanum. The Chinese name, baifuzi, means white aconite. The taste is acrid and sweet, and it affects mainly the stomach, to get rid of phlegm that rises due to adverse movement of qi. The herb is used for phlegm obstruction causing paralysis, pain, or convulsion. Typhonium is an important ingredient of the formula True Jade Powder (Yu Zhen San) used for tonic muscular paralysis. The active components of the Typhonium species are sterols while the Aconitum species yield alkaloids, the latter having a stronger pain-relieving action.


True Jade Powder
Yu Zhen San
Typhonium baifuzi 3 g
Arisaema tiannanxing 3 g
Siler fangfeng 3 g
Angelica baizhi 3 g
Gastrodia tianma 3 g
Chiang-huo qianghuo 3 g


June 1998