In Singapore's hot and humid weather, do you often feel physically heavy and exhausted? Oily face, bloated belly with a large abdomen, and excessive phlegm in the throat? Beware, this might be "dampness" at work! Heavy dampness belongs to the phlegm-damp constitution type in Traditional Chinese Medicine (TCM). How can TCM regulate to expel dampness?
What causes a phlegm-damp constitution?
Dr. Que Poh Yuen Albert, a TCM expert at Gong Fang Tang TCM Clinic in Singapore, explains that in TCM, phlegm-dampness is a pathological product formed when the body's water metabolism is abnormal, leading to the stagnation and accumulation of body fluids. Singapore is located in the tropics with year-round high temperatures and humidity. Coupled with a lifestyle of indulging in raw, cold, sweet, and greasy foods, excessive reliance on air conditioning, and prolonged sitting with little movement, the spleen function (the spleen governs the transportation and transformation of water-dampness) is easily damaged. This leads to internal stagnation of dampness, which accumulates to form phlegm, resulting in a phlegm-damp constitution.
What foods are major taboos for a phlegm-damp constitution?
Physician Dr. Que Poh Yuen Albert emphasizes that for regulating a phlegm-damp constitution, "controlling the mouth" is more important than taking medicine! The following foods are major taboos for this constitution:
Raw, Cold, and Chilled Foods:
Iced drinks/ice products: Ice water, iced beer, ice cream, slushies, etc. Cold directly damages spleen yang, further impairing its ability to transform dampness.
Raw sashimi: Raw fish, raw oysters, etc. Their cold and damp nature increases the burden on the spleen and stomach.
Excessive cold-natured fruits: Watermelon, honeydew melon, pear, dragon fruit, banana, etc. Small amounts are acceptable; excess promotes dampness.
Sweet, Greasy, and Sticky Foods:
High-sugar desserts/drinks: Cake, chocolate, bubble tea, sugary sodas, various sweet soups (e.g., bubur cha cha). Sweetness generates dampness and promotes phlegm.
High-sugar tropical fruits: Durian, mango, lychee, longan, etc. Delicious but cloying, easily promoting dampness and generating heat.
Glutinous rice products: Lo mai gai (glutinous rice chicken), nian gao (rice cake), tang yuan (glutinous rice balls), zongzi (sticky rice dumplings). Sticky and hard to digest, obstructing the spleen and stomach.
Rich, Fatty, Greasy, and Fried Foods:
Fried foods: Fried chicken, french fries, fried snacks, etc. Greasiness obstructs the spleen, generating dampness and transforming into heat.
Fatty meat, animal offal: E.g., roast pork, braised pork belly, offal dishes. Cloying and hard to digest, promoting dampness and generating phlegm.
Thick sauces/coconut milk dishes: E.g., curry (especially coconut milk base), laksa (coconut milk version), satay sauce, etc. High in calories and cloying.
Excessive Dairy Products:
Milk, cheese, cream, etc. TCM considers them relatively cold, cloying, and damp in nature, easily generating phlegm-dampness (especially when chilled).
Excessive Alcohol:
Especially beer (cold-damp) and sweet wines. Alcohol is a damp-heat substance, easily promoting dampness, generating heat, and trapping the spleen and stomach.
What are the typical symptoms of a phlegm-damp constitution?
Body Shape/Sensation: Overweight (especially soft, flabby abdominal fat), feeling of heaviness in the body, fatigue and tiredness, easily drowsy, head feels heavy as if wrapped (like a damp towel).
Face/Skin: Face and hair easily become oily, complexion is sallow and dull, eyelid puffiness (prominent eye bags), prone to eczema, acne (pustular type).
Mouth/Throat/Digestion: Sticky or sweet taste in the mouth, thick and greasy tongue coating (white-greasy or yellow-greasy), swollen tongue body with teeth marks. Poor appetite, or easily hungry but bloated after eating, loose and sticky stools (sticks to toilet bowl, hard to flush clean).
Secretions/Respiration: Constant phlegm in the throat (white or sticky phlegm), women may have excessive thick vaginal discharge. Chest tightness, prone to snoring.
Other: Sensitive to dampness, rainy weather, or air-conditioned environments, feeling of joint soreness and heaviness. Pulse is often soggy-slippery or wiry-slippery.
How does TCM effectively regulate a phlegm-damp constitution?
Targeting the core pathogenesis of a phlegm-damp constitution—spleen deficiency failing in transportation leading to dampness accumulation forming phlegm—Physician Que Poh Yuen particularly advocates for and is skilled in using the classic formula originating from the Song Dynasty text "Taiping惠民和剂局方" (Formulas from the Imperial Pharmacy)—Two-Chen Decoction (Er Chen Tang) to resolve it.
Two-Chen Decoction is composed of Pinellia (Ban Xia), Aged Tangerine Peel (Chen Pi), Poria (Fu Ling), Fresh Ginger (Sheng Jiang), Dark Plum (Wu Mei), and Licorice (Gan Cao).
In the formula: Pinellia (Ban Xia), acrid, warm, and drying in nature, excels at drying dampness and transforming phlegm, and also harmonizes the stomach and directs rebellious Qi downward. It serves as the Monarch (Jun) herb. Aged Tangerine Peel (Chen Pi) is the Minister (Chen) herb. It can both regulate Qi and move stagnation, and also dry dampness and transform phlegm. The pairing of Monarch and Minister has two meanings: First, using them in equal amounts not only synergistically enhances their dampness-drying and phlegm-transforming power but also embodies the principle of "treating phlegm by first regulating Qi; when Qi flows smoothly, phlegm dissipates." Second, Pinellia and Tangerine Peel are best when aged (Chen), avoiding excessive drying. Hence the formula name "Two-Chen" (Two Aged Herbs). This forms the basic structure for drying dampness and transforming phlegm. Poria (Fu Ling) is added as the Assistant (Zuo) herb to fortify the spleen and percolate dampness—percolating dampness assists phlegm transformation, fortifying the spleen cuts off the source of phlegm production. Considering Tangerine Peel and Poria address Qi stagnation causing phlegm and the source of phlegm, they are a common combination in phlegm-expelling formulas for regulating Qi, transforming phlegm, fortifying the spleen, and percolating dampness. Adding fresh ginger while decocting serves two purposes: it counteracts Pinellia's toxicity and assists it in transforming phlegm, directing rebellious Qi downward, and harmonizing the stomach to stop vomiting. Reusing a small amount of Dark Plum (Wu Mei) astringes lung Qi. Paired with Pinellia and Tangerine Peel, it adds astringency to dispersion, guarding against excessive drying and dispersion injuring the righteous Qi. Both are Assistant herbs. Licorice (Gan Cao) serves as the Guiding (Shi) herb to fortify the spleen, harmonize the middle, and moderate the other herbs.
Modifications and Ingenious Applications:
Obvious Spleen Deficiency (fatigue, loose stools): Add Codonopsis (Dang Shen), Atractylodes (Bai Zhu) (i.e., Six Gentlemen Decoction approach) to enhance spleen-fortifying power.
Predominant Damp-Heat (yellow-greasy tongue coating, bitter mouth, acne): Add Virgate Wormwood (Yin Chen Hao), Scutellaria (Huang Qin), Coix Seed (Yi Yi Ren) to enhance heat-clearing and dampness-draining effects.
Prominent Abdominal Distension and Fullness: Add Magnolia Bark (Hou Po), Bitter Orange (Zhi Ke) (combining with Ping Wei San approach) to strengthen Qi-moving and distension-relieving effects.
Severe Profuse Phlegm and Chest Tightness: Add Trichosanthes Fruit (Gua Lou), Allium Macrostemon (Xie Bai) to widen the chest and transform phlegm.
Obesity, High Blood Lipids: Add Hawthorn (Shan Zha), Lotus Leaf (He Ye), Alisma (Ze Xie) to reduce lipids and drain turbidity.
Medical Case
Patient: Mr. Chen, 42 years old.
Chief Complaint: Weight continuously increased over the past 3 years (BMI 28), obvious abdominal obesity. Often feels physically heavy and fatigued, easily drowsy, head feels heavy and dull. Severe oiliness on face and hair, requiring washing multiple times daily. Always has sticky white phlegm in throat upon waking, difficult to clear completely. Appetite is fair but experiences post-meal abdominal distension. Stools are loose, sticky, and greasy (sticks to toilet bowl). Usual habits include indulgence in iced drinks, coffee, and enjoys foods like laksa, nasi lemak, etc.
First Visit: Tongue pale and swollen, teeth marks on edges, thick white-greasy coating. Pulse soggy-slippery.
TCM Pattern Differentiation: Internal accumulation of phlegm-dampness, spleen deficiency failing in transportation.
Treatment Principle: Dry dampness, transform phlegm, fortify spleen, regulate Qi.
Prescription: Modified Two-Chen Decoction.
Formula Herbs: Pinellia (Fa Ban Xia) 10g, Aged Tangerine Peel (Chen Pi) 10g, Poria (Fu Ling) 20g, Honey-fried Licorice (Zhi Gan Cao) 6g, Stir-fried Atractylodes (Chao Bai Zhu) 15g (fortify spleen, dry dampness), Codonopsis (Dang Shen) 15g (tonify Qi, fortify spleen), Virgate Wormwood (Mian Yin Chen) 12g (clear and drain damp-heat, targeting local climate), Coix Seed (Yi Yi Ren) 30g (fortify spleen, percolate dampness), Magnolia Bark (Hou Po) 10g (move Qi, relieve fullness), Stir-fried Hawthorn (Chao Shan Zha) 15g (promote digestion, resolve stagnation, reduce lipids), Fresh Ginger (Sheng Jiang) 3 slices (provided by patient, decoct together).
Medical Advice: Strictly avoid raw, cold, iced drinks; sweet, greasy, fried foods; high-sugar fruits (especially durian, mango); thick coconut milk. Reduce coffee. Eat light meals, 70% full for dinner. Walk briskly for 30 minutes daily until slight sweating occurs. 7 doses. Decoct 1 dose daily in water for oral consumption.
Second Visit (1 week later): Feeling of bodily heaviness and head dullness reduced. Throat phlegm volume decreased. Stool consistency improved (still slightly sticky). Facial oiliness slightly reduced. Adjusted prescription: Original formula plus Alisma (Ze Xie) 10g (enhance dampness draining).
Third Visit: Fatigue significantly improved, better spirits, abdominal distension reduced, stools formed and no longer stick to toilet bowl. Formula effective, so continued without change. Take 5 more doses.
Result: Weight reduced by approximately 3kg (mainly waist/abdominal fat). Body feels lighter. Significant improvement in facial oiliness. Throat has less phlegm, easier to expectorate. Good energy and physical strength.
