Working with the Waters of Life

     The Phlegmatic humor is divided into two portions: phlegm and serous fluids.  Phlegm is accumulated mucus, the secretions of the body's mucous membranes.  The serous fluids are the deeper clear fluids of the body - plasma, lymph, interstitial fluids, synovial fluid and crebrospinal, pericardial and pleural fluids.  All these fluids and mucous secretions are manifestations of the Water element in the human body, and readily respond to and influence each other.  If one of them is aggravated or out of balance, it will affect the others as well.
     What unites all the various Phlegmatic fluids of the body is their common temperament: Cold and Wet.  So, the general rule is that heating and/or drying substances tend to reduce the Phlegmatic humor, whereas cooling and/or moistening substances tend to increase it.
     However, there are also many other factors that can complicate the clinical picture.  Once phlegm is generated and accumulates in excess, it can easily stagnate and be unduly retained in the body, due to its passive, sluggish nature.  And during the course of its retention, it can be influenced by all kinds of pathogenic factors that can alter its qualities and consistency, requiring other therapeutic qualities and approaches to remove it.
     Lymph and serous fluids, especially when chronically excessive or aggravated, can be complicated by other pathogenic factors as well.  The organs that regulate their metabolism and excretion, such as the spleen, lungs or kidneys, can also become weak or devitalized. 


Working with Phlegm

     The first line of treatment in any phlegm reducing regimen must be dietary.  Foods that generate excess phlegm, and foods and drinks that cool or weaken the Digestive Fire and Metabolic Heat of the Natural Faculty, must be avoided.  These include cooling, moistening foods like cucumbers and melons; cold drinks and juices; milk and dairy products; sugar and sweets; and refined white sugars and starches.
     Herbs that stimulate the Digestive Fire and Metabolic Heat of the Natural Faculty with their heating, drying qualities are called stimulants.  By having a heating, drying, stimulating effect on humor generation in the liver, stimulants adjust the metabolism so that less phlegm is generated.  By their antipathy of temperament to phlegm, these heating stimulants burn off and evaporate excess moisture and phlegm from the body.  Some commonly used stimulants for this purpose are Cayenne, Black Pepper, Long Pepper (Pippali), Ginger and Galangal.
     Special stimulants that warm and stimulate humor metabolism in the liver to generate less phlegm are Fenugreek seed, Juniper berries and Milk Thistle seed.
     Rather than focusing on one part of the body, the action of most stimulants is systemic, to concoct, dissolve and eliminate excess phlegm throughout the organism by stimulating circulation, digestion and metabolism.  Galen was a great believer in the power of heating stimulants to concoct and dispel excess phlegm, and included many of them in his herbal formulas. 
     Expectorants are herbs that help the body eliminate excess phlegm, usually by expectorating or coughing it up from the lungs and respiratory tract.  Due to the cold, wet nature of phlegm, most of these herbs are warming and drying in temperament.  However, expectorants that facilitate the expulsion of excess phlegm by liquefying or attenuating phlegm that has become thickened or toughened by pathogenic heat and/or dryness can be moistening, and either temperate or slightly cooling in temperature.
     Expectorant herbs that are strongly heating tend to specialize in removing watery, insipid phlegm, which is the coldest in temperament of all the types of phlegm.  Examples are Long Pepper, Thyme, Greek Oregano and Asarum, or Wild Ginger.
Thick, slimy white or clear phlegm usually originates from a cold, weak, atonic stomach and digestion, and then gets transferred or spreads to the lungs via the gastropulmonary reflex.  The expectorants in this category are moderately warming and drying in temperament, and have a dual action - not only facilitating the expectoration of excess phlegm from the lungs and respiratory tract, but also improving digestion by concocting and dissolving excess phlegm from the stomach and GI tract.  Examples of these dual action expectorants are Elecampane, Hyssop, Basil, Greek Oregano, Citrus peel and Fenugreek seed.
     Quince seeds
are a remarkable expectorant that is widely used in cold remedies in the Middle East.  Like Fenugreek seeds, they contain a mucilaginous principle that dissolves and liquefies tough, congealed phlegm, but they also have a sticky, binding quality that grabs the phlegm and draws it out.
     Sometimes, aggravations of coldness and phlegm clog the delicate respiratory passages, obstructing the free flow of pectoral pneuma or vital energy, provoking breathing difficulties or spasmodic coughing.  For these conditions, expectorants with a loosening action that opens the airways, deepens breathing, and reduces spasmodic coughing are called for.  Examples are Coltsfoot, Fir buds, Poplar buds, Pine buds, Wild Thyme / Mother of Thyme (Thymus serpyllum) and Mullein.
     Liquefying expectorants are used to facilitate the expectoration of tough, thickened phlegm that has been so altered by pathogenic heat and dryness.  Examples include Plantain, Flax seeds, Hibiscus flowers, Jujubes and Licorice root.
Although excess and congestion is the more common problem in dealing with phlegm, one can also suffer from a deficiency of these mucous secretions as well.  In the respiratory tract, this would produce conditions like hoarseness, sore throat and a dry, hacking cough.  In these cases, the above herbs can also be used as soothing, moistening demulcents, due to their moistening nature.
     In addition to the respiratory tract, which generally occupies most of our attention when it comes to phlegm problems, moistening demulcents can also have a beneficial soothing and healing effect on the mucosa of other bodily tracts and systems:
     Stomach:  Chickweed, Hibiscus, Solomon's Seal
     Bowels (in chronic constipation due to dryness):  Flax seeds
     Genitourinary tract: Plantain, Licorice, Marshmallow root


Emesis for Excess Phlegm

     One of the most powerful ways to eliminate excess phlegm from the body is by emesis, or therapeutic vomiting.  Emesis eliminates excess phlegm from the stomach, lungs, chest, respiratory tract and head by powerfully activating the gastropulmonary reflex, to purge upwards.  Emesis has been found to be effective in cases of chronic bronchitis, lung congestion and asthma.
     Many of the herbs used to provoke emesis are very heating and drying, and therefore fit the general profile of an anti-phlegm herb.  Common emetic herbs include Calamus root and Lobelia.  Emetic herbs are quite potent, and are best used under medical supervision.
     There are two other reasons why emesis is best performed under medical supervision:  First of all, the trained clinical eye of a physician is best fit to discern who would be a good candidate for emesis, and who wouldn't.  Secondly, those who suffer from psychosomatic eating disorders like bulemia are prone to abuse emesis.
     For more information on emesis and therapeutic vomiting, please refer to the Hygienic Purification Therapies page in the Therapies section.


Working with Serous Fluids

     With phlegm, the most common problems that the physician must deal with are generally those of excess.  With serous fluids, which form the bulk of the moist, flourishing Phlegmatic humor, deficiency is just as much of a common problem as excess. 
     Deficiency conditions of the serous fluids are essentially various forms of dehydration, either acute or chronic.  Excess conditions of the serous fluids are essentially various forms of water retention, edema, and lymphatism, or lymphatic congestion and obstruction.  In addition to these deficiency and excess conditions, you can also have various toxic conditions of the lymph and serous fluids, in which the Waters of Life have become polluted. 
     Here again, to keep the serous fluids, or the deeper Waters of Life healthy, the first line of treatment should be dietary.  Over two-thirds of our body consists of Water, or various types of fluids, so keeping them balanced, pure and healthy is a top health priority.  And the foods that work most directly on preserving the health, balance and integrity of the serous fluids and other bodily fluids are fruits and vegetables, preferably fresh or minimally cooked and processed. 
     Fresh fruits and vegetables also alkalize the blood and serous fluids, which need to be slightly alkaline to be balanced in pH.  But because so many people consume so few fresh fruits and vegetables, many people suffer from acidosis, or a chronically acidic condition of the blood and serous fluids. 
     Fresh vegetables alkalize the blood and serous fluids directly, since they themselves are alkaline.  Most fresh fruits, especially the tart or sour ones, are themselves acidic, but alkalize the blood and serous fluids indirectly thorugh their diuretic effect, which increases the elimination of acidic toxins. 
     Here again, the general rule for working with the serous fluids, whether with foods or with herbs, is that cooling and/or moistening foods and herbs tend to increase or nourish the serous fluids, whereas heating and/or drying foods and herbs tend to reduce serous fluids, or keep them balanced and in check by improving their circulation and metabolism.

Nourishing the Serous Fluids

     Foods that have a nourishing, increasing effect on the serous fluids are mainly cooling and moistening fruits and vegetables like cucumbers, melons or lettuce.  Sometimes, the seeds of cooling vegetables and herbs like Lettuce or Purslane were used in traditional herbal medicine.
     Herbs that nourish or increase the serous fluids in conditions of deficiency or dehydration are called serous tonics, and generally have a moderately cooling and/or moistening temperament.  Since many of these herbs can also soothe and moisten the mucous membranes, there's a high degree of overlap between them and the demulcents and emollients.  Examples are Solomon's Seal, White Pond Lily, Marshmallow root and Flax seed.
     In the Middle East there is a remarkable moistening serous tonic herb with antiinflammatory, antiulcerous and emollient effects called Salep, which is the root or tuber of a species of orchid.  It is highly esteemed as a nutritive tonic in cases of chronic aesthenia and debility.  Salep has been used to treat lung conditions like chronic bronchitis and tuberculosis; digestive problems like gastritis, ulcers, chronic diarrhea and colitis; and sexual disorders like prostatitits and impotence.  In Turkey, a hot milk decoction of Salep is taken as a fortifying tonic, especially in the winter.
     In Chinese Medicine, many nutritive tonics are used to moisten and nourish the serous fluids of various organs, principally the lungs, stomach and kidneys.  In addition to their own indigenous varieties of Polygonatum, or Solomon's Seal, they use Lily bulbs, Glehnnia root, Ophiopogonis root, Asparagus root, Raw Rehmannia root, Prince Ginseng, or Pseudostellaria root, and many others.  In Chinese medical terms, these herbs nourish the Yin, which is essentially serous fluids, or the Water element in the body.
     Western herbal medicine uses a seaweed that is very rich in protein and nourishing mucilage, Irish Moss, as a nutitive tonic to the serous fluids.  It is very helpful in the convalescence from serious or debilitating illness.  Another nutritive tonic, Slippery Elm, can also be used as a nourishing, therapeutic food when the digestion is too weak to handle anything else.  The Japanese use a wide variety of seaweeds, or sea vegetables, as sources of minerals, trace minerals, protein and nourishing mucilage; all these diverse nutritional factors are great bodybuilders.
     Nutritive tonics, or serous tonics, occupy an esteemed and valuable place in herbal medicine, especially in facilitating recovery from the ravages of serious or prolonged febrile or wasting diseases.  Fenugreek seeds, although basically warming and drying in temperament, also have nutritive mucilaginous constituents in them; Hippocrates used Fenugreek seed to facilitate convalescence from serious or prolonged respiratory tract infections.


Reducing Serous Fluids

     When it comes to reducing or eliminating excess serous fluids from the body, the main vehicle for their release is through the urine; and so, most herbs that reduce or eliminate excess serous fluids have a diuretic effect.  Secondarily, sweating through diaphoretics can also eliminate excess serous fluids.
     Nutritionally, the most important vitamins when it comes to regulating fluid balance and metabolism are the B vitamins.  Vitamin B6 has a marked diuretic effect.
     All diuretics are drying in temperament and action, since they reduce the overall fluid level in the body through diuresis.  Cooling diuretics, in addition to eliminating fluids, also cool and detoxify, eliminating excess heat and choler from the blood and serous fluids.  Warming diuretics, as well as those that are moderate or temperate in temperature, generally eliminate excess fluids by improving their circulation and metabolism; it's these warming and drying diuretics that are most directly remedial for excesses of serous fluids and the Phlegmatic humor.
     Venous blood, like the Phlegmatic humor, is also Cold and Wet, or cool and moist, in temperament.  In addition, since the lymphatic system drains back into the venous system, poor venous circulation and return often accompanies water retention, edema and lymphatic obstruction.  So, many diuretics that improve the circulation and metabolism of serous fluids also work to improve venous circulation and return.  For example, Butcher's Broom and Horse Chestnut relieve edema in the legs by improving venous circulation and return.
The main organs that regulate the circulation, metabolism and excretion of water and serous fluids are the lungs, liver, spleen and kidneys.  Each of these organs has certain characteristic fluid retention signs and symptoms associated with it.
     The lungs, which are closely associated with the heart, are associated with swelling and fluid retention in the chest, lungs, arms, hands, face and upper body.  When associated with severe conditions of congestive heart failure, this is called cardiac edema.  Herbs used to treat this kind of edema include Perilla leaves, Pleurisy root, Wild Cherry bark, Lily of the Valley root and Foxglove.  The last two are used to treat cardiac edema. 
     The liver is often associated with swelling and bloating in the abdominal region which is worse after eating.  This kind of edema is also associated with portal hypertension, or poor venous return to the liver from the intestines through the veins of the hepatic portal system.  Herbs that are beneficial for this kind of hepatic edema include Artichoke, Barberry, Burdock root and seeds, Blessed Thistle, Corn Silk, Dandelion root and leaves, and Yarrow. 
     The spleen purifies and metabolizes the lymph, which is one of the most important serous fluids.  Splenic edema is associated with lymphatic toxicity, congestion and obstruction, and generally pervades the whole body, right below the skin.  Congestion and poor metabolism of the spleen and lymph is also associated with chronic damp, oozing skin conditions like weeping eczema.  Many of the herbs for edema of the spleen and lymph are also called splenicals and lymphatics; these include Echinacea, Burdock root, Lotus leaf, Carline Thistle root, Cleavers herb, Figwort, Fumitory, Poke root, Prickly Ash bark and Sarsaparilla.
     If the kidneys are weak and devitalized, the water retention will be mainly below the waist, especially in the knees, ankles and feet.  Chronic edema in the low back, hips and loins is also associated with rheumatic and arthritic conditions, and so many of these herbs are also antirheumatic in their effects.  Perhaps the two greatest diuretics of Greek Medicine are Restharrow (Ononis spinosum) and Couchgrass (Agropyron repens).  The former also treats chronic skin diseases, whereas the latter treats rheumatic and arthritic conditions.  These two wonderful diuretics are very gentle yet reliable, with no adverse effects.  Other valuable diuretics that are also tonics to the kidneys are Agrimony, Burdock root, Knotgrass and Pipsissewa.
     Some diuretics eliminate excesses of phlegm and serous fluids through their strong warming, stimulating effect on digestion and metabolism.  Examples are Sassafras, Buchu, Myrtle leaves and Juniper berries.  Of these, Sassafras can be excessively stimulating and aggravate heat and choler in the liver if not mellowed out with a relaxing nervine like Valerian and/or soothing demulcents like Fennel or Licorice root.
     When it comes to using diuretics, it's generally best to stick to the milder and gentler ones, especially until you get more prficiency in herbal medicine.  With a few exceptions, like Poke root and the herbs for cardiac edema, most of the diuretics mentioned here are gentle, yet reliable and effective.


Unani Herbs to Adjust the Phlegmatic Humor

     In Greek and Unani Medicine, blood is the easiest humor to adjust and regenerate, since it is the first humor to arise.  But phlegm, or the Phlegmatic humor, takes a full nine days to ripen and be adjusted for any lasting therapeutic effect.
     In The Traditional Healer's Handbook, Hakim G. M. Chishti gives instructions and recipes for adjusting and regulating phlegm with herbs.  The following herbs and spices, he says, are very useful for the general regulation and adjustment of the Phlegmatic humor:  Anise, Cinnamon, Valerian root, Black Raisins, Cardamom, Garlic and Ginger.
     Let's take a look at each of these herbs individually and see what effects they have on phlegm and the Phlegmatic humor:
     Anise:  More heating, drying and stimulating than Fennel, Anise is anti-Phlegmatic by temperament, and also has a demulcent action that liquefies phlegm for easier expulsion.  It is particularly useful for cold, watery, insipid phlegm obstructing the stomach, lungs and chest.
     Cinnamon:  By gently warming and stimulating the metabolic heat and the digestive fire, Cinnamon prevents the generation of excess phlegm at its source - humor generation in the liver.  By gently warming and drying off excess phlegm and adjusting the metabolism, Cinnamon has a beneficial effect in type 2 diabetes, a disease in which excess phlegm often bogs down the digestion and metabolism of sweets and carbohydrates.
     Valerian root:  Valerian root has a drying effect that dries up excess phlegm, as well as aromatic carminative properties that increase the circulation, metabolism and expulsion of phlegm from the body.  It also combines very well with Cinnamon.
     Black Raisins:  Having a sweet, demulcent quality that liquefies phlegm as well as a subtle astringency that cuts through thick, toughened phlegm, Black Raisins are a useful auxiliary or adjuvant to anti-phlegm formulas.
     Cardamom:  Cardamom strengthens the stomach and digestion, and cleans up turbid phlegm and dampness in the GI tract with its fragrant odor.  Cardamoms also gently stimulate the functioning of the kidneys to remove excess fluid retention from the body.
     Garlic:  With its stimulating, fiery heat, Garlic is one of the most powerful herbs to concoct and eliminate excess phlegm from the body.  Garlic also stimulates the digestion and metabolism, so that they can be more efficient and generate less phlegm.
     Ginger:  Dried Ginger is a balanced yet effective stimulant that warms the digestion and metabolism to concoct and eliminate excess cold phlegm.  Fresh Ginger is a great purifier of the lymphatic system.  Both forms serve to adjust and regulate the Phlegmatic humor.
     According to Hakim Chishti, excess phlegm is first concocted or ripened, and then eliminated or purged.  There are different formulas for doing each of these things.
     One formula he gives in The Traditional Healer's Handbook for ripening phlegm is the following:
     1/4 teaspoon Sebestan (Capers)
     1/4 teaspoon Cowslip root
     1/2 teaspoon Anise seed
     1    teaspoon Mint
     Boil these in two cups water for ten minutes, then strain.  The dose is one half cup as a tea, three times per day, for nine days.
     After the phlegm has been concocted and ripened by this formula, it should then be purged.  Hakim Chishti offers the following recipe to accomplish this purpose:
     1/4 teaspoon each of Hyssop, Violet flowers and ground Fennel seed.  Place in three cups water and add 1/4 cup Black Raisins, 2 chopped dried Figs, and 1 teaspoon of Licorice root. 
     Boil down to one cup.  Add 1/2 teaspoon each of fresh Cucumber Pulp, Rose petals and Gur, or Raw Sugar.  Boil ten more minutes and strain.  Add one teaspoon Sweet Almond Oil.
     The dose is three teaspoons in the morning, to be taken once.
     The purgative, if successful, will cause a bowel movement within one to six hours.  After the purging, a cold drink of Basil, Honey and Rosewater may be given.  If the bowel movements continue and turn into diarrhea, then yogurt and cooked rice are to be eaten.

The Traditional Healer's Handbook: A Classic Guide to the Medicine of Avicenna
by Hakim G. M. Chishti, N. D., pg. 172
@1988, 1991 by Hakim G. M. Chishti
Published by Healing arts Press, Rochester, VT USA