Phlegm-Heat in the Lungs

Understanding Phlegm-Heat in the Lungs

Phlegm obstructs the airways and Heat thickens it further. Together they congest the Lungs, which is why breathing becomes short and the chest feels tight rather than merely irritated.

The sputum is copious, yellow and sticky, and may be hard to clear. Breathing is short or rapid, and lying flat makes it worse. The chest feels tight and full.

Fever or a sensation of heat accompanies it, and the person may be restless. The tongue is red with a yellow greasy coat and possible red prickles on the front third, and the pulse is slippery and rapid.

It comes from Wind-Heat invading the Lungs, Wind-Cold that has transformed, pre-existing Phlegm that has combined with Heat, or epidemic illness.

Treatment clears Heat and transforms Phlegm while opening the Lungs and settling the breathing. Breathlessness is a medical warning sign and is assessed, not just treated.

Signs and symptoms

Key signs

• Cough with copious yellow sticky sputum
• Shortness of breath or rapid breathing
• Chest tightness and fullness
• Fever or sensation of heat

Also seen

• Wheeze
• A rattling chest
• Restlessness
• Thirst
• Difficulty lying flat
• A flushed face

Variations

• Sputum that is difficult to expectorate
• Cough that is worse at night
• Dry mouth

Timing

• It is worse at night and when lying flat.
• It follows a cold that has worsened rather than settled.

Practitioner notes

• The tongue is red, possibly swollen at the front, with a yellow greasy coat and red prickles on the front third.
• The pulse is slippery and rapid, sometimes wiry.
• The distinction from Lung Heat is the abundance of Phlegm and the breathlessness; here the airways are obstructed.
• The distinction from Damp-Phlegm in the Lungs is colour and heat: there the phlegm is white and the tongue pale.

Causes

Common causes

• External Wind-Heat invading the Lungs
• Wind-Cold transforming into Heat
• Pre-existing Phlegm combining with Heat
• Epidemic illness

How it develops

• It develops from a surface Heat pattern or from heated Phlegm.
• If severe, it can obstruct breathing, which is a medical emergency.

Diagnosis

Diagnosis rests on copious yellow sputum with breathlessness and a yellow greasy coat.

Tongue

• Body: Red, possibly swollen at the front, with red prickles.
• Coating: Yellow and greasy.
• Note: A white greasy coat would indicate Damp-Phlegm.

Pulse

Slippery, Rapid

Slippery shows Phlegm; rapid shows Heat.

Observation

• Flushed face
• Rapid breathing
• Audible congestion

Listening

• A rattling cough with thick sputum
• Wheeze

Palpation

• Abdomen: Possible fullness in the upper abdomen.
• Channels: The chest feels warm; LU-1 and BL-13 may be tender.

Questions that separate it from look-alikes

• How much sputum, and what colour?
• Is breathing short, and is lying flat worse?
• Any fever?
• How long has it lasted?

Treatment

Principles

• Clear Lung Heat
• Transform and clear the congesting Phlegm
• Open the Lungs and settle breathing
• Redirect Qi downward

Herbs

Formulas

• Qing Qi Hua Tan Wan - The reference formula for Phlegm-Heat with thick yellow sputum.
• Ma Xing Shi Gan Tang - For Lung Heat with cough and breathlessness, clearing and descending.
• Ding Chuan Tang - For breathlessness with Phlegm-Heat, opening and settling the Lungs.
• Xiao Xian Xiong Tang - For chest oppression with difficult expectoration.
• Wei Jing Tang - For abundant Phlegm in the Lungs, transforming it while clearing Heat.

Acupoints

• Zhongfu LU-1 - The Lung front-mu point, used for cough and breathlessness.
• Fenglong ST-40 - The principal point for transforming Phlegm.
• Feishu BL-13 - The Lung back-shu point, used for congestion and cough.
• Tiantu REN-22 - Regulates Lung Qi and relieves breathlessness and cough.
• Quchi LI-11 - Clears Heat from the body.
• Dingchuan EX-B-1 - An extra point used for wheeze and breathlessness.

Personalising the plan

• If breathlessness dominates, opening and descending herbs are increased.
• If Phlegm dominates, transforming herbs are increased.
• If fever dominates, cooling herbs are increased.
• If the sputum is very sticky, moistening and loosening herbs are added.

Self-care

Diet

• Light cooling food; reduce dairy, sugar and fried food
• Stop smoking and avoid smoke
• Adequate water to loosen sputum

Lifestyle

• Sit upright rather than lying flat when breathless
• Rest in a cool ventilated room
• Seek urgent care for breathlessness at rest or blue lips

Qigong and movement

• Gentle breathing practice between flares, with medical clearance.

How it differs from look-alikes

Patterns that can be mistaken for phlegm-heat in the lungs, and the contrast that separates them.

Where it appears

Skin conditions in which this pattern is commonly seen.

Safety and when to get help

For anything severe, sudden or spreading quickly, read when a skin problem needs urgent care.

This page describes a TCM pattern, not a diagnosis, and a pattern can accompany more than one skin condition. Get urgent medical help for a rash with fever, confusion or feeling very unwell; skin that is blistering, peeling or spreading quickly; swelling of the face, lips or throat, or difficulty breathing; or a lesion with increasing pain, warmth, red streaks or pus. For anything persistent, severe or changing, have it assessed by a clinician before treating it yourself.

Read the skin condition pages for the red flags that belong to a specific presentation.

Urgent-sign guidance is based on standard sources: NHS anaphylaxis, NHS cellulitis, NHS Stevens-Johnson syndrome, NHS melanoma.

Evidence note

No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.

Related patterns