Research On Conception And Application Rule Of Expelling Phlegm Therapy

1Subject"Phlegm" in traditional Chinese medicine, also known as "phlegm turbidity", is a kind of metabolites generated and accumulated by the gasification disorder of internal organs which caused by various factors. The treatment of removing phlegm from the human body is referred as "expelling phlegm method" in Chinese medicine. Combined with the study approach of historical literature review, this study is organized by the theoretical thinking, which attempts to provide systemic conclusions and analyses about theories and practices of the "expelling phlegm method" from the related literature. Our study mainly focuses on the academic origin, the concept and the theoretical framework of the "expelling phlegm method".2Content(1) Academic origin of the "expelling phlegm methodVertically combed the treatment, the therapeutic principle of phlegm syndrome in All previous dynasties book, Summarizes the knowledge and experience of the "expelling phlegm method" At different times, Comprehensive combing " expelling phlegm method " and its related concepts, To clarify the academic origin of expectorant method.(2) The concept of the "expelling phlegm method"Through the collecting extraction of relative term in ancient and modern literature,the Clinical practice,the comparative analysis of the corresponding formulas, To interpret the connotation of the concept of "expelling phlegm method" and to define its denotation.(3) The application framework of "expelling phlegm method"Comprehensive analysis of ancient and modern physicians of phlegm syndrome, treatment and clinical therapeutic principle, the basis of related in this paper, On the basis of the theory of TCM etiology and pathogenesis and foster the excess or insufficiency of, biao, real therapeutic principles, etc, Sputum concrete analysis of the actual situation, the new long, viscera, nature, position,to refine the application framework of "expelling phlegm method".3Method(1) Methods of Documentary Information ScienceUsing Chinese medicine standard to collect Ancient and modern literature connecting to phlegm-heat.Using Traditional Chinese Medicine Dictionary, Differential diagnosis of TCM symptomatology, etc.to collect the modern literature.Using cnki and wanfang to collect magazines(2) Medicine historiography methodUsing this method to explain the connotation and denotation of The method of clearing away heat and eliminating sputum.(3) Theoretical analysis, inductive methodUsing this method to sum up the characteristics and application framework of The method of clearing away heat and eliminating sputum.(4) The method of HermeneuticsUsing this method to explain the connotation and denotation of The method of clearing away heat and eliminating sputum.4Results(1) The academic origin of the "expelling phlegm method"The theories and methods of the "expelling phlegm method" in Chinese medicine are originated from the pre-Qin period and Han dynasty. Firstly, Sheng Nong Ben Cao Jing (《神农本草经》)has clearly documented that the croton has the effect on treating phlegm. Secondly, although these two books——Huangdi Nei Jing (《黄帝内经》) and Shanghan Zabing Lun(《伤�'杂病论》)do not discussed the treatment of phlegm, of which the therapeutic principle theory are put forward to become the theoretical foundation for latter treatment of phlegm. Especially in Shanghan Zabing Lun, the recorded prescription of removing phlegm involves spitting treatment, swallowing treatment, warming yang treatment, replenishing qi treatment, regulating qi treatment, and clearing heat phlegm treatment. The prescription of removing phlegm in Shanghan Zabing Lun embodies the principle of balancing between evil and good, and guiding it along its course of development to treat phlegm syndrome.Some discussions on the treatment of phlegm syndrome appear in the Wei&Jin Dynasties and Sui&Tang Dynasties. Based on the knowledge of diseases caused by phlegm in chest and diaphragm, most physicians in that period claim to spit out phlegm directly from chest and diaphragm. Besides, many physicians create other treatment of removing phlegm, such as using food or regulating qi or doing acupuncture. In that period, physicians pay more attention to the reason that the deficiency of internal organs generates the phlegm, thus the treatment should balance strength and deficiency, reinforcement and elimination in combination. For example, replenish nourishment after removing phlegm; removing phlegm comes first in combination with replenishing nourishment; add something helpful for removing phlegm based on replenishing deficiency. According to the characteristics of pathogenesis and symptoms, physicians in that period classify phlegm syndrome into cold phlegm, heat phlegm, wind phlegm, and hardened phlegm stagnation, etc. The previous studies open the door for latter diagnosis and treatment of phlegm syndrome.Physicians are creative in the aspect of treating phlegm syndrome in Song and Yuan Dynasties. Compared with previous physicians, physicians in Song and Yuan Dynasties make breakthroughs in the respect of creating the "expelling phlegm method" and prescription. On the respect of diagnosis, Yang Shiying classifies phlegm into five kinds:cold phlegm, heat phlegm, damp phlegm, dryness phlegm and wind phlegm. He also puts forward the corresponding treatment:warming, clearing, drying, moistening and dispersing. Zhu Danxi contends many things should be taken into consideration to treat phlegm, such as the etiology and pathogenesis, the nature of disease, the trend of disease, the position of disease and the main symptoms of disease. Physicians in Song and Yuan Dynasties explore the relationship between removing phlegm and regulating qi, and the relationship between healthily operating spleen&stomach and removing phlegm. In terms of the relationship between removing phlegm and regulating qi, many physicians not only hold the view that regulating qi generally comes first, but also think that it should firstly remove phlegm when there is much sputum which becomes more and more serious, or the syndrome of intermingled phlegm and qi. In terms of the relationship between healthily operating spleen&stomach and removing phlegm, many physicians contend that phlegm is caused by the deficiency of spleen, thus they suggest that we should apply the yuntan (运痰) into treatment. That is to say, they insist that the treatment should not be hasty in removing phlegm, avoiding injuring the spleen and stomach. Physicians in that period consider that when the "expelling phlegm method" of swallowing is applied, it should be adjusted according to the emergency and the seriousness of disease. Therefore, the method and prescription of the treatment of removing phlegm are created, such as "liaotan method" created by Zhang Zihe, the method of treating the long-term phlegm in chest and diaphragm, i.e. spit out phlegm by stimulating throat; the prescription of removing dirty phlegm by taking guntan pills made by Wang Gui.Physicians in Ming and Qing Dynasties generalize and interpret the method of removing phlegm. Liu Chun generalizes seven types of the expelling phlegm method, that is, draining, guiding, diffusing, eliminating, regulating qi, nourishing, swallowing, and adjusting Yin and Yang, etc. Wang Lun advocates nourishing spleen, adjusting dry and wet, smoothing qi, guiding qi, and purging fire, etc. You Zaijing concludes that there are seven methods of removing phlegm, i.e. expelling, guiding, neutralizing, nourishing, soothing, clearing and moistening. And he interprets definitions of these seven methods above. Huang Gongxiu classifies the method of removing phlegm into three kinds, i.e. scattering phlegm, spitting phlegm and reducing phlegm. Specifically, light phlegm should be scattered; diaphragmatic phlegm should be spitted, serious phlegm should be reduced. Physicians in Ming and Qing Dynasties diagnose the phlegm syndrome from the internal organs, combining the nature of phlegm, the actual condition, the duration and position of phlegm. They emphasize that the treatment should be carried out based on its essential reason, especially stressing on the recuperation of the spleen and kidney. In addition, they suggest that the treatment should be adjusted according to the emergency of disease and be flexible to handle the relationships among expelling phlegm methods with regulating qi, removing rheumatism and nourishing blood. During that period, physicians make emphasis on the compatibility and incompatibility of the swallowing phlegm method. They not only pay attention to the integration of the swallowing phlegm method and other methods, but also make some creative changes about the swallowing phlegm method.(2) The concept of the "expelling phlegm method"The connotation of its concept. Through the analysis of previous literature review and referring to related definitions on modern reference books and monographs, this dissertation defines the connotation of the "expelling phlegm method" from the perspective of the means and methods of removing phlegm. That is, through the method of the internal digestion and external guidance, the treatment aims at removing phlegm generated in our body such as internal organs, energy channels, limbs, skin, and fascia and so on.The denotation of its concept. This study concludes the terminology of the "expelling phlegm method" from physicians both ancient and contemporary, such as huatan (化痰), xiaotan (消痰), daotan (导痰), yuntan (运痰), tutan (吐痰), yongtan (涌痰), liaotan (�'�痰), kaitan (开痰), ditan (涤痰), santan (散痰),jiangtan (降痰), zhuitan (坠痰), xiatan (下痰), potan (破痰), zhutan (逐痰). Those terms are interpreted in this dissertation. Generally speaking, the concept of the "expelling phlegm method" could be named in the following ways:the first way is to name it according to the different applied approaches, such as tutan (spitting phlegm,吐痰) treatment, xiatan (swallowing phlegm,下痰) treatment, huatan (resolving phlegm,化痰) treatment and xiaotan (dissolving phlegm,消痰) treatment; the second way is to name it according to the different methods, such as liaotan (�'�痰) treatment, kaitan (开痰) treatment, santan (散痰) treatment, jiangtan (降痰) treatment and daotan (导痰) treatment; the third way is to name it according to the intensity of phlegm expelling, such as yongtan (涌痰) treatment, zhuitan (坠痰[) treatment, zhutan (逐痰) treatment,poton (破痰) treatment and ditan (涤痰) treatment. Since the physicians of previous generations tend to name the "expelling phlegm method" from different perspectives, there might be overlapping situations among the concepts of "expelling phlegm methods".(3) The application framework of "expelling phlegm method"(3) The application framework of "expelling phlegm method"Determine the therapy after distinguishing repletion or vacuity phlegm. Distinguishing whether it is repletion or vacuity phlegm is an important principle when determining the therapy of treating phlegm syndromes. Repletion phlegm occurs in the situation when the vital qi is not vacant and phlegm is excessive. At this time, the phlegm shall be expelled in time in order to eliminate the symptoms caused by phlegm. Vacuity phlegm is formed because of the vacuity of vital qi. Thusly, qi and blood shall be invigorated and the deficiency of yin and yang shall be supplemented, so that the corresponding viscera functions can recover and the phlegm turbidity will eliminate by itself. But clinically, the phlegm syndromes are commonly composed of the mixture of both repletion and vacuity phlegm. There might be the possibility that the repletion phlegm generates because of the vacuity at first, or the phlegm has ceased at a certain location for some time and the viscera becomes vacant. At this time, it is better to conduct purgation and tonification in combination, and handle the intensity of tonification and phlegm expelling according to the condition of the pathogenic factors.Determine the therapy after distinguishing new or old phlegm. Whether the phlegm is new or old is an important factor that affects the degree of phlegm binds. The phlegm can be divided into new phlegm and old phlegm according to its lasting time. New phlegm means the newly formed phlegm with a respectively low gathering and binding degree of phlegm turbidity. We could mainly provide targeted treatments to eliminate the sources of phlegm generations. By performing this step, the functions of viscera could be regulated correspondingly. Phlegm turbidity usually resolves with it, and vanishes at last. Old phlegm refers to the situation when the phlegm ceases for a long time and assembles to make it hard to resolve or expel. So during the therapy, we mainly focus on eliminating the phlegm binds, and apply kaitan (开痰) treatment, daotan (导痰) treatment, attacking and expelling treatment and so on according to the qualities of the phlegm binds and the locations they stay.Determine the therapy after distinguishing the viscera that phlegm relates to. Phlegm generates because of the malfunction of viscera, so we should aim at the viscera involved during the therapy in order to regulate the viscera, resume the gasifying function, and cut off the sources of phlegm. Clinically, if we merely attack the phlegm but not eliminate its foundation, new phlegm will generate although old phlegm has gone. Thusly, it is not an effective way to expel phlegm and the vital qi will be harmed as well. Since spleen and kidney are the most important viscera for phlegm generation, we should pay more attention on tonifying the spleen and kidney when regulating viscera.Determine the therapy after distinguishing the qualities of phlegm. According to the qualities of phlegm, phlegm syndromes are commonly divided into wind phlegm, heat phlegm, cold phlegm, damp phlegm, dryness phlegm and qi phlegm clinically. The corresponding therapies possess different features. Generally speaking, wind phlegm caused by external infection should be treated by santan (散痰) treatment, while wind phlegm caused by internal damage should be treated by ditan (涤痰M) treatment. Heat phlegm had better be cleared. Cold phlegm should get warmed and dispersed. Damp phlegm should be warmed and dried. Dryness phlegm ought to be moistened and wind phlegm should be channeled.Determine the therapy after distinguishing the pathogenic factors that phlegm carries. When phlegm turbidity stays inside of the body, it often combines with some tangible pathogenic factors like blood stasis or dyspepsia, and forms phlegm-stasis syndrome and food-phlegm syndrome accordingly. So when treating such diseases, we should combine blood quickening, food dispersing and phlegm eliminating at the same time. If phlegm stagnation and phlegm food accumulate and gather, the treatment of attacking and expelling should be applied.In conclusion, based on the systemic reorganization and analyses of ancient and modern physicians’theories and practical experience about phlegm treating, this dissertation systemically summarizes the thoughts and experience about phlegm syndrome treating which are brought up by the physicians in different historical periods, and clarifies the academic origin of "expelling phlegm method". From the spatial dimension, this dissertation explains the basic concepts of "expelling phlegm method" and analyzes its theoretical foundation as well. What is more, this dissertation constructs an application framework for "expelling phlegm method" with the core of therapies, combined with the etiology and pathogenesis as well as the prescription medication from the perspectives of distinguishing the repletion or vacuity, new or old, viscera, qualities, pathogenic factors and location of phlegm.5ConclusionThis article bases on the perspective of expectorant ways and methods, defined the connotation of the concept of "expelling phlegm method" as "by using the method of digestion in solution and guiding phlegm out,remove viscera, meridian, segments, stay in the skin, fascia and other body phlegm turbidity".The basic concept of expectorant method can be divided into three categories:first, emetic method,such as tutan (吐痰), yongtan (涌痰), liaotan (�'�痰)etc;second, internal diabetes,suah as yuntan(运痰), santan (散痰), kaitan (开痰), potan (破痰)etc; third, zhuxialei,such aszhuitan(坠痰), zhutan (逐痰)etc.According to the etiology and pathogenesis of TCM theory and Therapeutic principles, concretly analyze the actual situation, the new long, viscera, nature, position of the phlegm To clarify the expectorant method using the law of combined with related concepts and to build theoretical framework of expectorant method.