Stroke, Too Much Phlegm, a Yellow Greasy Tongue — What Should I Do? Doctor Luo Dalun on the Phlegm-Heat Constitution: How to Clear Phlegm-Heat

When the weather turns cold, heart and brain patients start falling ill

Every year, as autumn arrives and the weather turns cool, have you noticed? Patients with heart and brain (cardiovascular and cerebrovascular) conditions begin falling ill in clusters — you constantly see emergency patients being rushed to hospital, many of them elderly people with twisted mouths and crooked eyes (kou yan wai xie), seriously ill.

💬 Note from Doctor Luo: What is really going on here? Today let’s talk about phlegm-heat (tan re). A very large share of these elderly patients have phlegm-heat brewing inside their bodies — phlegm-heat clouds the pericardium, the mind goes unclear, and they collapse suddenly. A twisted mouth and crooked eyes is what we call wind-stroke (zhong feng); they may also develop hemiplegia (half the body paralyzed), slurred speech, unclear diction, and drool running from the corner of the mouth.

If at that moment you pry the person’s mouth open and look, the tongue is usually covered with a very thick coating — yellow, greasy, sticky. Chinese medicine calls this state: phlegm-heat clouding the pericardium (tan re meng bi xin qiao).

First, what exactly is “phlegm” in Chinese medicine?

To understand phlegm-heat, you first need to understand what Chinese medicine means by phlegm (tan).

💬 Note from Doctor Luo: Chinese medicine divides phlegm into two kinds: visible phlegm (you xing zhi tan) and invisible phlegm (wu xing zhi tan). When phlegm is in the lungs you can cough it out — yellow or white — that is visible phlegm. What is invisible phlegm? It is the thick, sticky fluids inside the body. These fluids are often the body’s normal fluids being stewed by heat pathogen — the heat evaporates the water, and what is left turns into thick, sticky liquid. This sticky liquid blocks the movement of qi and blood through the channels, and acts as a disease pathogen, an obstacle in the body — you cannot see it, but we call it phlegm.

Visible phlegm and invisible phlegm are really the same thing — both are those sticky kinds of fluid. Phlegm is closely related to water: phlegm generally arises when water fluids are steamed by heat, and when the body has too much dampness, over time it gradually condenses into phlegm as well. That is why people always say “phlegm-dampness (tan shi)” — phlegm and dampness are usually spoken of together: people with heavy phlegm have heavy dampness, and people with heavy dampness end up with a lot of phlegm in their bodies too.

💬 Note from Doctor Luo: Phlegm is both a pathological product and a disease-causing product. It blocks the movement of qi and blood. If there is heavy phlegm-dampness in your body, rest assured, the body is certainly not healthy. So where does phlegm come from? I keep telling everyone: there is no such thing as a pathogen without a reason (mei you wu yuan wu gu de xie qi). A pathogen is always based on something having gone wrong in your own body — so everyone must remember: the foundation on which phlegm appears is that your own upright qi (zheng qi) has developed a problem.

The kidney is the root of phlegm, the spleen its source, and the lung its storehouse

Chinese medicine has a famous saying: the spleen is the source of phlegm, the lung is the storehouse of phlegm qi, and the kidney is the root of phlegm. How should we understand this?

Start with the kidney — if your body has developed heavy phlegm-dampness, you must understand that it is connected to kidney qi deficiency. When the organs are depleted, the root lies in insufficient kidney qi: you lack the strength to transform and transport the water-dampness in the body, the dampness gradually condenses, and finally solidifies into phlegm.

💬 Note from Doctor Luo: So we often meet such people — kidney deficient, and when they cough there is no strength at all. Why? Kidney qi is insufficient. People with insufficient kidney qi will cough and will have phlegm; whether visible or invisible, the phlegm they cough out is usually thin and clear, leaning toward white. How did the ancients treat this kind of phlegm? They used Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) — as you keep taking it, the kidney qi is gradually replenished, and the phlegm slowly decreases. Take the famous Ming-dynasty physician Doctor Xue Lizhai, who was director of the Imperial Academy of Medicine — he was especially skilled with formulas like Jin Gui Shen Qi Wan, Bu Zhong Yi Qi Wan (Tonify the Middle and Augment Qi Pill), and Xiao Yao Wan (Free and Easy Powder). In many of his case records, the patient clearly had phlegm, and no matter how you tried to transform the phlegm it would not work — so he treated it from the root: he tonified the kidney, and as the kidney-tonifying medicine took effect, the phlegm disappeared and the body became healthy.

Next, the spleen — the spleen is the source of phlegm, it is the origin. The spleen belongs to Earth, and Earth governs water; the spleen is responsible for transporting and transforming the body’s nutrients and water fluids — a very heavy duty.

💬 Note from Doctor Luo: Once the spleen-Earth is injured, water-dampness easily overflows through the body. Spleen-deficient people tend to develop edema — the shinbones, leg bones, and hands swell, the eyelids swell too. Why? The spleen is deficient, with no strength to control the water. In the past, treating edema mostly meant regulating the spleen and stomach — adjust the spleen and stomach well, and the body can slowly recover. I have seen elderly women who, while walking, simply urinate on themselves — enuresis (yi niao). Why? The spleen is deficient and cannot control the water. Give them a bit of Gui Pi Wan (Spleen-Restoring Pill), support the upright qi, replenish the spleen qi, and it gets better. When the spleen has problems, the body’s water-dampness is heavy; when dampness is heavy for a long time, it also condenses into phlegm — so strengthening the spleen to transform phlegm (jian pi hua tan) is an extremely important idea in Chinese medicine.

The most typical example of spleen deficiency generating phlegm is the big fat people all around you.

💬 Note from Doctor Luo: Big fat people start wheezing the moment they walk, and feel weak. They are spleen deficient, with no strength to transform water fluids; and the refined nutrients of food — the nourishment they eat — also cannot be transformed: what should be absorbed is not absorbed, what should be excreted is not excreted, and it all stays stored inside. So whether water fluids or nutrients, an enormous amount stays in the body, and this increases the generation of phlegm — not only does water slowly condense, but the fat meat you eat, all the sticky rich, fatty, sweet food (fei gan hou wei), turns into garbage piled up inside. So nowadays many big fat people are weak when they walk, have phlegm, cough phlegm constantly, and have a lot of phlegm inside their bodies, with blocked channels. To truly regulate them, strengthening the spleen is an important direction — you must make the spleen and stomach strong, let them use what should be used and excrete what should be excreted.

Finally the lung — the lung is the storehouse of phlegm qi; it is really just a “container,” quite innocent.

💬 Note from Doctor Luo: Your spleen and kidney are both deficient, there is a great deal of garbage in the body, and the garbage looks for a place to be expelled — some cannot be expelled and is stored in the lungs. Once an external pathogen invades, the lung cannot travel light and cannot fight the pathogen, so it enters a state of illness. At that point the phlegm in the body wants to be expelled upward; when the external pathogen comes and fights the upright qi, more phlegm is generated — that is why when some people meet an external pathogen nothing happens, while others meet an external pathogen and phlegm comes gushing out. In fact this phlegm is the waste produced by the body’s attempt to expel the external pathogen and fight it — getting it out is a good thing. But producing too much is also a pathological product that often worsens the illness; when phlegm cannot be expelled and piles up more and more, breathing problems result.

So you see, the ancients made it very clear: phlegm is generated only when the organs are deficient and depleted. Therefore, to transform phlegm and expel it, you must make supporting the upright (fu zheng) the foundation — do not stare only at the phlegm; you must think of supporting the upright. This is very important.

Phlegm comes in cold and hot: how is hot phlegm “refined”?

Phlegm is also divided into cold and hot. Cold phlegm (han tan) is phlegm generated when the body’s yang qi is insufficient — it is generally white, some as clear as egg white, some like foam. Let’s leave cold phlegm for another day; today we focus on phlegm-heat (tan re).

💬 Note from Doctor Luo: Hot phlegm works like this: when your body has a tendency toward heat, the phlegm you generate more easily turns hot. Sometimes, when phlegm accumulates for a long time, it slowly turns hot by itself — the ancients used an analogy: firewood piled up for a long time slowly generates heat inside, energy accumulates. Our bodies are the same: dampness and phlegm-dampness accumulated for a long time slowly generate heat, forming hot phlegm.

What other situations produce hot phlegm? Doctor Luo sums up three kinds of people:

💬 Note from Doctor Luo: The first kind, people with a constitution leaning toward heat. They eat rich, fatty, sweet food all the time — braised pork belly every day, stewed pork hock, all of it energy. Once eaten, the body becomes hotter and hotter; you cannot metabolize it, so the body runs hot, and these things gradually turn into phlegm-dampness — all of it hot phlegm. The second kind, people with blazing liver fire (gan huo da). That thin, lean type usually does not have a big temper — think of the monks in temples, they do not have big tempers. Who has a big temper? People who are busy all day outside, tormented by all kinds of affairs. When liver fire blazes, and on top of that the person eats rich fatty food and is also spleen deficient and kidney deficient, a great deal of phlegm comes out — the liver fire is like a little stove, constantly burning the container; the water in the container dries up and condenses into sticky material. This is called shuo ye cheng tan — “fire boiling fluids into phlegm”; the more the fire burns, the heavier it gets. The third kind, people with a yin-deficient constitution. In yin deficiency, the useful water you can actually use is reduced — but the pathogenic fluids you cannot use may well be abundant — so some yin-deficient people do have phlegm. Yin-deficient people have deficiency fire, a constitution leaning toward heat, so their phlegm also turns into phlegm-heat.

Look at the tongue: red tongue body, yellow greasy coating — the hallmark of phlegm-heat

Doctor Luo specializes in tongue diagnosis, and he teaches everyone how to read the tongue of a phlegm-heat constitution:

💬 Note from Doctor Luo: First, the tongue body is red (she zhi hong). The tongue body showing at the edges must be red, not the pale color of yang qi deficiency. Some tongues have cracks, and inside the cracks is red; when the illness has lasted long, it can even become a very red, dark red-sauce color. A red tongue body means there is heat. Second, the coating is thick and greasy (she tai hou ni). Since it is phlegm, the coating is often thick, greasy, sticky — somewhat moist and sticky; and because it is phlegm-heat, it carries a yellow tint. If you really go to a hospital and look at stroke patients’ tongues, they are often truly very yellow — a red tongue with a yellow greasy coating, that is the hallmark of phlegm-heat.

Besides the tongue, phlegm-heat sends out a whole array of signals across the body:

💬 Note from Doctor Luo: The visible phlegm coughed up is yellow and extremely sticky — the heat inside evaporates the fluid, so the phlegm is very thick. The face is red; some people even in a stroke coma have faces red as if scorched by fire. The throat is filled with the gurgling, rumbling sound of phlegm. The body is usually hot, always feeling irritable, quick to anger, big temper; thirsty, always wanting to drink something cool. The urine is yellow; the stool tends to be dry and bound — in hospitals you often see stroke patients with hemiplegia: many have dry stool, some have not had a bowel movement for many days, and when the family is asked during resuscitation, they say he has been constipated for years. Why? There is heat in the body, the fluids have been evaporated, and the stool cannot pass smoothly.

If the hot phlegm is heavier in the lungs, there will also be constant coughing, coughing yellow phlegm, rapid breathing, and a rumbling sound of phlegm in the windpipe; if phlegm blocks the chest, you feel chest oppression and distension, vexation, thirst with a desire for cold water — but when you drink it, you do not want to swallow it down, and sometimes water even spills back up; when phlegm-heat blocks the chest and stomach region, pressing there finds painful spots.

The most dangerous step: phlegm-heat clouding the pericardium

Of everything discussed, the most important is phlegm-heat clouding the pericardium (tan re meng bi xin qiao).

💬 Note from Doctor Luo: Outside our heart there is the pericardium (xin bao luo), and what do we fear most? That turbid phlegm becomes very heavy and clouds the pericardium. When does this happen? One way is through warm-heat pathogen — you catch an external pathogen and develop a warm disease (wen bing); the heat pathogen attacks the pericardium channel and clouds the pericardium. The other way has nothing to do with external infection — I am very fat, my body is heavy with phlegm-dampness, I lose my temper constantly and my fire is big, and as a result phlegm-heat clouds the pericardium and directly interferes with the operation of the spirit-mind (xin shen).

What are the symptoms of phlegm-heat clouding the pericardium? Vexation, inability to sleep, unbearably hot, deranged spirit, talking nonsense, not sleeping at night and smashing things. Doctor Luo once told a real case:

💬 Note from Doctor Luo: I once saw a young man, extremely strong, normally bad-tempered. At that time he had deteriorated: he did not sleep at night and smashed things. His family came to me: Doctor Luo, please take a look at him. When the young man came in, I looked — his eyes were fixed and straight, his lips bright red, and at the corner of his mouth there were traces of blood — he had been bleeding from the mouth. At night he did not sleep, just raged and smashed things. His parents thought, my goodness, we cannot control him — with that build of his, his parents simply could not restrain him. Do you see? What is phlegm-heat? When it rises to disturb the spirit-mind, it produces agitation and these kinds of problems.

But this kind of mania is not especially common nowadays — what is far more common is the elderly:

💬 Note from Doctor Luo: Old people have insufficient qi and blood, and still generate phlegm; the phlegm gradually turns hot, and suddenly clouds the pericardium — the clear orifices of the brain and the brain nerves are disturbed; suddenly the head spins, they faint, suffer a stroke, cannot speak; mouth twisted, eyes crooked, limbs numb, hemiplegia, speech gone, consciousness clouded — and then you hear the gurgling, rumbling sound in the throat. This is an especially critical condition in which phlegm-heat disturbs the spirit-mind.

Daily prevention: soak the feet in Wen Dan Tang, dissolve phlegm while it is still a bud

So how exactly do you regulate phlegm-heat? Doctor Luo’s thinking is clear: do not wait until it develops into a stroke — clear it the moment the bud appears.

💬 Note from Doctor Luo: If you really see that situation — a person who is very fat, with a very red tongue and a very thick, very yellow coating — you should pay attention: keep the diet light, support the upright qi, and tonify the spleen and stomach. At the same time soak the feet in Wen Dan Tang (Warm Gallbladder Decoction), adding more Gua Lou (Trichosanthes fruit) and some Dan Nan Xing (Arisaema with bile) in it, and slowly dissolve the phlegm — as long as you dissolve it slowly from the start, none of the serious consequences later will happen. Old people also need attention: the elderly must always support the upright; if you see an elderly person stick out a tongue with a very thick coating, you must add a little phlegm-transforming medicine on the foundation of supporting the upright, and let them slowly clear the garbage out of the body.

If it truly reaches that point — suddenly fainting, stroke, unconsciousness, high body heat or even fever, twisted mouth and crooked eyes, hemiplegia — Chinese medicine has a whole set of first-aid medication strategies.

First aid: cow bezoar, antelope horn, water buffalo horn

First, cow bezoar (niu huang) — transforms phlegm, calms the spirit, and settles liver wind.

💬 Note from Doctor Luo: Where does cow bezoar come from? It is the gallstone inside an ox’s gallbladder. We rarely see it nowadays. In the past, my maternal grandfather — my grandpa was an old village doctor — when an ox was slaughtered and someone really obtained cow bezoar, they would bring it to my grandpa. Why? Because this thing can cure illness. Natural cow bezoar used to exist, and its power to settle the liver, extinguish wind, and clear phlegm-heat is extremely strong — truly miraculous in effect, genuinely effective. But today natural cow bezoar is far too scarce, so we use artificial cow bezoar — refined from ox bile, pig bile, and so on. Its effect is also quite good, and it likewise settles the liver, extinguishes wind, and clears phlegm-heat.

There is also antelope horn (ling yang jiao) and water buffalo horn (shui niu jiao):

💬 Note from Doctor Luo: Antelope horn clears liver heat; water buffalo horn clears the heat of the heart and liver. Their power to settle the liver, extinguish wind, and clear heat pathogen is extremely strong. Water buffalo horn nowadays comes as powder, and also as very thin slices that must be boiled first — water buffalo horn’s heat-clearing effect is very strong, and we generally use it as a substitute for rhinoceros horn (xi jiao). Antelope horn is also excellent for clearing the heat of the liver and gallbladder.

Niu Huang Qing Xin Wan: expel the pathogen without forgetting to support the upright — the soul of a classic formula

These medicines are basically all gathered in traditional old formulas — for example Tong Ren Tang’s Niu Huang Qing Xin Wan (Cow Bezoar Heart-Clearing Pill), a very fine old formula.

💬 Note from Doctor Luo: In this formula there are artificial cow bezoar, antelope horn, water buffalo horn, and so on. Why do we call it classic? I think its most wonderful feature is this: on top of calming the spirit and washing away phlegm-heat, it pairs in many upright-supporting medicines — what are the Ren Shen (ginseng) and Bai Zhu (atractylodes) doing? Strengthening the spleen. There is also a little Gan Jiang (dried ginger). What are Dang Gui (angelica), Bai Shao (white peony), and E Jiao (ass-hide gelatin) doing? Nourishing the blood. You see, classic formulas are classic because the main design is wonderfully conceived and grounded in medical reasoning — that is why the effects are good, which is why they have been passed down for a thousand years and can be seen in every time-honored pharmacy.

When should you use Niu Huang Qing Xin Wan? When phlegm-heat is especially heavy and has already affected the spirit-mind:

💬 Note from Doctor Luo: When there is vexation and sleeplessness, when the person cannot bear it, when the body is raging violently inside, or even starting to develop a twisted mouth and crooked eyes, inability to speak, gurgling phlegm, or even coma — then formulas like this can be used. The artificial cow bezoar, water buffalo horn, and antelope horn in it are especially effective at transforming and clearing phlegm-heat, and have a calming, spirit-settling effect — these are for rescue, for expelling the excess pathogen: the pathogen is phlegm-heat, I help you clear the heat and remove the phlegm, and drive the pathogen out.

But there is one particularly important idea here:

💬 Note from Doctor Luo: If you see only the pathogen — my goodness, there is phlegm, let me transform it — if you think only of this phlegm-heat, then you have treated only half the illness. What is the other half? Supporting the upright qi (fu zheng qi). The reason this person’s phlegm-heat is so rampant is that the upright qi is insufficient, so qi and blood cannot circulate freely — the phlegm-heat occupies the body’s main roads, blocks the pericardium, and clouds the clear orifices. At such a time, while clearing heat, you must also support the upright qi, rouse the spirit-mind, and let qi and blood flow smoothly again. That is why what is especially precious in this formula is precisely those upright-supporting medicines.

The story of gold leaf: gold settles the spirit, and Premier Zhou personally approved the gold

After formulas like Niu Huang Qing Xin Wan are made, they are wrapped on the outside with gold leaf (gold powder) (jin bo) — why?

💬 Note from Doctor Luo: Because gold has the effect of calming the spirit and heavily settling the spirit-mind (zhong zhen xin shen). Sometimes this mania, this mental agitation, really cannot be controlled without gold. So the ancients would wrap the pill in extremely thin gold leaf or gold powder, and when you took it, the gold coat had to be swallowed together with the medicine.

This is no legend; after the founding of the People’s Republic there is a true story:

💬 Note from Doctor Luo: After liberation, our country’s gold reserves were extremely small and gold was extremely expensive. The time-honored pharmacies like Tong Ren Tang needed gold leaf to make the medicines that settle the spirit and treat critical illness, so using gold required submitting an application. The central authorities studied it: can this work? Our gold is so scarce, and you want to use it for medicine — is that acceptable? In the end the matter was brought to Premier Zhou Enlai. Premier Zhou summoned the old doctors and asked them personally: is this gold truly so important in treating this disease? The old doctors answered: in treating this disease, it is truly very important. So Zhou Enlai personally approved gold from the national treasury, specially for the time-honored pharmacies to make this kind of life-saving, gold-wrapped medicine. What does this show? It shows that our government is a people’s government that values the people’s health — this is from materials I have read.

Closing: health is the most precious thing — be the guardian of your own and your family’s health

Things like phlegm-heat can sometimes endanger our health.

💬 Note from Doctor Luo: I always say, if you do not take care of your own body in normal times, when a problem finally appears it is often critical — sometimes it can snatch your life away in an instant, and sometimes it leaves paralysis and all kinds of sequelae, lowering your quality of life. So everyone should try not to let themselves enter that state. If you notice any sign of it, taking medicine should relieve it immediately, and then you should actively seek treatment right away. In daily life you should also regulate your body — do not let the bud of illness grow bigger and bigger until it finally endangers your life.

💬 Note from Doctor Luo: What is the most valuable thing? Your own health is the most valuable thing. What is the most precious thing? The time you can spend peacefully with your family and friends is the most precious. Everyone should hold this idea: take good care of yourself; if a problem arises, learn to use a ready-made patent medicine temporarily to rescue yourself and buy time until a Chinese medicine or Western medicine doctor can treat you. So learning a bit of Chinese medicine knowledge and using it in a crisis never does any harm.

Finally, Doctor Luo adds a special word on seasonal health:

💬 Note from Doctor Luo: Now the weather is turning cold, and many people’s channels become less free-flowing. At such a time, if there is phlegm-heat — although it looks like heat, when the outside turns cold and the channels are blocked, it is even easier for it to stir up trouble inside. That is why in autumn and winter there are so many stroke patients. Everyone must take precautions and keep an eye on their family members. Learn more health knowledge and be the guardian of your own and your family’s health.

What to take away

1. Recognize phlegm-heat (tan re) by three signs. A red tongue body with a thick yellow greasy coating, phlegm that is yellow and extremely sticky, and a face that is red with a body that runs hot and irritable — plus thirst for cold drinks, yellow urine, and dry bound stool. When you see these in an elderly person or a heavy person, take it seriously.
2. Understand the mechanism. Phlegm is born when the organs are deficient — the kidney is its root, the spleen its source, the lung its storehouse. It turns hot when heat is added on top: rich fatty food, blazing liver fire, or a yin-deficient constitution “boil fluids into phlegm” (shuo ye cheng tan). So transforming phlegm must always be built on supporting the upright (fu zheng) — tonify the kidney, strengthen the spleen, and the phlegm gradually disappears by itself.
3. The most dangerous step is phlegm-heat clouding the pericardium (tan re meng bi xin qiao). It blocks the mind, causes fainting and stroke — twisted mouth, crooked eyes, hemiplegia, slurred speech, coma, and the gurgling sound of phlegm in the throat. This is why heart and brain patients cluster in autumn and winter, when cold weather blocks the channels and the heat is trapped inside.
4. Prevent it while it is still a bud. For a fat person with a red tongue and thick yellow coating: keep the diet light, support the upright, tonify the spleen and stomach, and soak the feet in Wen Dan Tang (Warm Gallbladder Decoction) with extra Gua Lou (Trichosanthes fruit) and Dan Nan Xing (Arisema with bile) to dissolve the phlegm slowly. Elderly people should add a little phlegm-transforming medicine on top of supporting the upright.
5. First aid when it strikes. Niu Huang Qing Xin Wan (Cow Bezoar Heart-Clearing Pill) — with artificial cow bezoar, antelope horn, and water buffalo horn — clears phlegm-heat and settles the spirit; what makes the formula classic is that it pairs the expelling medicines with upright-supporting ones (ren shen, bai zhu, gan jiang, dang gui, bai shao, e jiao), because the person is only this sick when the upright qi is insufficient. Clear the pathogen and support the upright at the same time.

Compiled from Doctor Luo Dalun’s special lecture series on Chinese medicine knowledge, explaining how to identify and regulate the phlegm-heat constitution.