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Ordinary people refer to abnormal secretions in the throat as phlegm, which is the narrow sense of phlegm. In Traditional Chinese Medicine (TCM), there is also a broad sense of phlegm, which refers to all pathological, thick liquids in the body. By the way, pathological, thinner and clearer liquids are called "fluid retention," and they are usually collectively referred to as "phlegm-fluid retention," which encompasses various pathological liquids in the body.

From the formation of the character for "phlegm," one can see the high wisdom of ancient medical practitioners. The character "痰" (phlegm) is composed of "疒" (illness) and "炎" (inflammation). The double "火" (fire) in "炎" suggests excessive internal heat, which is the pathological product caused by excessive internal heat (heatiness). "Fire" refers to the oxidative energy production of cells. The proper functioning of the human body requires appropriate internal fire. If the internal fire is too strong, it burns too quickly, producing excessive metabolic waste that cannot be expelled efficiently, leading to accumulation in the circulatory system, forming the broad sense of "phlegm."

When does excessive internal heat occur?

1. Overexertion of the body: just like a machine that is overworked and overheated, the body produces excessive metabolic waste. Without rest, the waste cannot be metabolized efficiently, and over time, it accumulates and turns into phlegm.
2. External pathogenic qi infection: the body will vigorously operate and mobilize a large amount of resources to fight against the pathogenic qi, also generating a large amount of metabolic waste. Infected and inflamed tissues also produce pathological secretions, all of which are "phlegm." The phlegm from a common cold or throat inflammation is one such example.

If the "fire" in the body is too weak, leading to insufficient oxidative energy production, which is qi deficiency or yang deficiency, the body lacks sufficient energy to move fluids and carry out various metabolic processes. Fluids that should normally flow through the circulatory system tend to stagnate, forming the thinner and clearer "fluid retention." Substances that should be utilized by cells also accumulate in the circulatory system due to low metabolism, forming the thicker "phlegm." Both "phlegm" and "fluid retention" can affect the circulation of blood and body fluids, hindering cellular function and being detrimental to the body.

Disorders in any of the five zang-organs can lead to phlegm-fluid retention. For example:

• Weak heart function (heart qi deficiency) results in poor venous blood return, causing fluids to accumulate in the extremities. What is visible to the naked eye is limb edema, while what is not visible is the "fluid retention" in the interstitial spaces of the body's tissues.
• Weak spleen system function (spleen qi deficiency) leads to poor digestion and absorption, resulting in insufficient nutrition and plasma protein production. The osmotic pressure in blood vessels is insufficient, causing more fluid to seep from blood vessels into interstitial spaces, leading to visible edema in the limbs and stagnant "fluid retention" in the body's tissues. Additionally, insufficient insulin secretion, which is part of the spleen system, prevents glucose from entering cells for energy or storage, leading to its accumulation in the circulatory system, forming "phlegm."
• Weak liver function results in insufficient production of plasma proteins, leading to the same outcome as spleen qi deficiency. The liver is also responsible for the production and metabolism of cholesterol. If liver function declines, cholesterol accumulates in the circulatory system throughout the body, which is also a form of "phlegm."
• Poor kidney function and reduced urine output can also lead to the accumulation of fluids in the body, manifesting as edema in the limbs and stagnant "fluids" in the internal tissues.

The lungs, connected directly to the outside through the trachea, are easily invaded by various external pathogenic qi, leading to inflammation and the production of many secretions, resulting in the expectoration of visible phlegm. Therefore, TCM has the saying "the lung being the container of phlegm." The spleen system, with its opening directly receiving food and drink, is also prone to invasion by external pathogenic qi, leading to illness. The spleen system is closely related to the body's dampness, and once illness occurs, it is more likely to lead to phlegm-fluid retention and dampness-related diseases. Hence, TCM has the saying "the spleen being the source of phlegm."

Both phlegm and fluid retention stay within the circulatory channels, affecting the flow of blood and body fluids. However, compared to the thin and clear "fluid retention," the thick and sticky "phlegm" has a stronger obstructive force, increases the viscosity of blood and body fluids, is more difficult to break down and eliminate within the body, and is more likely to become a disease-causing factor. Wherever "phlegm" blocks, illness arises. For example, blockage between brain nerves can cause mental confusion, even leading to epilepsy or mania, known as "phlegm confusing the heart orifice"; phlegm blocking cerebral blood vessels can cause brain cells to stop functioning and die, resulting in half-body paralysis; phlegm-dampness obstructing the digestive system can affect gastrointestinal motility, causing nausea and vomiting; phlegm blocking the chest and trachea can lead to chest tightness, wheezing, and coughing; lipomas are called "phlegm nodules" in TCM, which are also a type of "phlegm" abdominal mass. Many difficult and strange diseases are often related to phlegm obstruction.

Phlegm can also be classified and named differently based on its source and outcome. Some phlegm arises due to illness, such as wind phlegm, heat phlegm, cold phlegm, dry phlegm, and damp phlegm; some illnesses are caused by phlegm, such as phlegm fire, sublingual cyst, phlegm nodule, phlegm malaria, stubborn phlegm, chronic phlegm, and latent phlegm.

Comparison of various disease-causing factors that hinder the circulation of qi and blood in the body

• Qi stagnation: Refers to the dysfunction of the regulation and opening-closing mechanisms of the circulatory channels, affecting the flow of blood and body fluids.
• Phlegm obstruction: The circulatory water channels or blood vessels are obstructed by thicker pathological products (phlegm), such as excessively high concentrations of blood sugar, triglycerides, cholesterol, uric acid, or other metabolic products and waste.
• Blood stasis: There is a substantial obstruction in the blood circulation channels, which may be caused by static blood or thick phlegm coagulating within the blood vessels.
• Fluid retention: Pathological fluid accumulation in the interstitial spaces, i.e., edema.