The Phlegmatic humor has two broad divisions: the mucous portion and the serous portion.  Phlegm is basically excess mucus, and is secreted by the various mucosa of the body.  The serous portion is concocted by the liver and circulated via the blood and lymph vessels throughout the body; it consists of plasma, lymph, interstitial and various serous and synovial fluids. 
     Fluids of the serous portion are also open to excess, aggravation and various forms of morbidity or corruption, just like phlegm.  The two portions or halves of the Phlegmatic humor are interconnected, and feed and influence each other. 
     Although its home is in the mucosal tracts of the body, phlegm, especially in its finer, subtler forms, can invade any part of the organism.  Cold, wet conditions prevailing in the body, as well as certain dietary abuses, will aggravate or increase both the mucous and serous portions of the Phlegmatic humor. 
     Excessive or morbid phlegm is generally produced by cold, wet, sluggish or atonic conditions of the digestion and metabolism.  Subsequent aggravations of phlegm will depress digestion and metabolism even further, initiating a vicious cycle of hypo-pepsis and phlegm generation.  Of all the Four Humors, excesses and morbidities of phlegm are responsible for the most stagnation, congestion, obstruction and hypofunction. 
     Pathologies of phlegm can either be quantitative or qualitative in nature - or both.  The quantitative disorders are basically those of excess versus deficiency.  Qualitative disorders consist of various types of dystempers, dyscrasias and putrefaction of the Phlegmatic humor itself.

Phlegmatic Excess, or Plethora

     In Greek Medicine, conditions of excess, or plethora, of the Phlegmatic humor are commonly called diseases of phlegm, which are very common.  These include respiratory conditions like asthma, bronchitis, rhinitis, sinusitis, hay fever, respiratory allergies, and even some food allergies; colds and flu; coughing and lung congestion: swelling, bloating, edema; lymphatic toxicity, congestion and obstruction; water retention and oliguria; leucorrhea and white vaginal discharges in women.
     Causes:  The causes of Phlegmatic plethora are many and varied.  Environmental causes include extremely cold and/or damp weather or climate; and dust, molds, yeasts and fungi.  Extreme cold and dampness will immediately aggravate phlegm, and the digestive and respiratory mucosa start to secrete excess phlegm to protect themselves from harmful irritants and allergens. 
     Dietary causes center mainly on the consumption of ice cold foods and drinks and phlegm forming foods like sweets, dairy products and refined starches and sugars.  Digestive and metabolic causes consist of a cold, damp, hypofunctioning digestion and Natural Faculty, which is prone to generate excess phlegm; these metabolic and dietary causes may aggravate each other in a vicious circle. 
     Accumulation sites:  Because of its sluggish, passive nature, phlegm may accumulate in the organism quite subtly and asymptomatically for a long time before provoking any acute crisis.  As the Natural Faculty is the site of its generation, the first accumulation site for excess phlegm is the stomach and upper digestive tract. 
     From here, excess phlegm quickly finds its way, via the gastropulmonary reflex, into the lungs, chest, throat and upper respiratory tract, including the nose and sinuses.   Then, the head and brain become stuffy, sluggish and congested.  Phlegm congestion in the lungs and chest will cause congestion and stagnation in the lymph and lymphatic system, which can also be aggravated by poor veinous return.   Finally, the serous and synovial fluids become excessive and aggravated, affecting the pleura, pericardium, brain and spinal cord, and the bones and joints.  Excess phlegm can invade any part of the body.
     Signs and Symptoms:  The cardinal signs and symptoms of Phlegmatic plethora are as follows:
     Head / Mind:  Heaviness, lethargy, sleepiness, mental dullness.  Heavy head with possible vertigo or headache.  Swollen, puffy eyelids; moist, teary eyes.
     Respiratory:  Runny or stuffy nose, nasal discharges, post nasal drip, sinus congestion.  Cough with copious phlegm, usually clear or white.  Wheezing, dyspnea, lung congestion.  Susceptibility to colds and flu.
     Oral:  Drooling, excess salivation.  Reduced thirst.  Enlarged tongue, moist and glossy, or with thick white coat.  Swollen, pale palate, throat, uvula.  Pale lips.
     Digestive:  Indigestion with watery regurgitations.  Slow, weak, atonic digestion.  Poor appetite.  Gurgling intestines.  Sluggishness and drowsiness after meals.
     Skin, complexion:   Pallor; smooth, milky white complexion.  Cold, moist, clammy skin.  Weeping, oozing skin conditions.  Flabbiness, poor muscle tone.   Hypersensitivity to cold, winter weather.
     Fluids, lymphatic:  Puffiness, swelling, edema.  Swollen or tender glands; lymphatic congestion or obstruction.  Cellulite.
     Genitourinary:  Urine retention, oliguria.  Swollen, distended bladder.  Pale, thick urine.  Swollen testicles, flaccid penis.  Slow, watery menses in women; possible leucorrhea. 
     Pulse:  Soft, slow, deep. 
     Dreams:  Of water, ocean, floods, waves, snow, etc...
     Few, if any will experience all these signs and symptoms simultaneously.  The signs and symptoms will vary, depending where the excess phlegm has accumulated.  The more of these signs and symptoms you experience, and the more severe they are, the more severe the plethora.  

   Phlegmatic Deficiency, or Wasting

     When it comes to deficiencies of the Phlegmatic humor, the chief concern is a depletion of the serous portion - the vital fluids and inherent moisture of the organism.  In modern medical terms, this would involve a depletion of fluids, electrolytes and plasma proteins. 
     The serous portion of the Phlegmatic humor moistens, lubricates and nourishes the organism on a deep and fundamental level.  These vital fluids - plasma, lymph, interstitial, synovial and serous fluids - are rooted in the Radical Moisture, from whence they derive their ability to nourish.  The core serous portion of the Phlegmatic humor nourishes the production of mucus, phlegm and saliva, and even underlies the nourishing fecundity of the blood. 
     The fluids of this serous portion of the Phlegmatic humor also cool down the organism and keep it from overheating.  In this sense, they are like the coolant or radiator fluid in your car.
     Phlegmatic or serous deficiency can vary greatly in severity, and is associated with many conditions of wasting, marasmus and consumption.  A consumptive condition centered in the lungs and respiratory tract, for example, is tuberculosis. 
     The basic clinical picture of Phlegmatic or serous deficiency centers on a consumptive deficiency fever, often complicated by extreme exhaustion, or marasmus:  a low-grade fever or feverishness that's worse in the afternoons and evenings, or with exertion: a rosy glow on the temples, earlobes, cheeks, center of the chest, palms and soles; sunken eyes and hollow cheeks; a possible thin, furtive sweat; nervous exhaustion, or neuraesthenia; a thin, thready, rapid pulse; and a thin, dark red, emaciated tongue. 
     Depending on where this serous deficiency is centered, and which organs and tissues aren't receiving adequate nourishment and hydration from the Phlegmatic humor, the auxiliary, specific signs and symptoms may vary:
     Lungs:  great thirst, a dry, scratchy sore throat; a dry, weak or hacking consumptive cough; hoarseness of voice, dry nose and nosebleeds; hemoptysis, or coughing up blood, which is a cardinal sign of pulmonary tuberculosis.
     Heart:  insomnia, night sweats, palpitations; anxiety and restless spirits.
     Liver:  dizziness, vertigo; dry eyes, photophobia (sensitivity to light), visual floaters; short periods or irregular, scanty menstruation in women; anger and irritability.
     Stomach:  a peeling tongue coat; excessive thirst; giddiness, nausea or anorexia.
     Kidneys:  a burning soreness or pain in the lower back, worse with exertion or exhaustion; tinnitus, or ringing in the ears; hot, itchy heels or soles of the feet; thick, dark, concentrated urine that may be hot or burning; chronic urinary irritation, inflammation or infection.
     Reproductive:  sexual erythrism, erotomania; sexual exhaustion and debility; premature ejaculation, nocturnal emissions.
     Bones, Joints, Tendons:  tight, stiff bones, joints, tendons and ligaments, especially in the legs; cracking, popping joints.
     Generally speaking, aside from certain infectious diseases like tuberculosis, we get, or gradually build up, a deficiency of the Phlegmatic humor, or a serous deficiency, by chronic overindulgence in things or activities that are too drying on the one hand, and an undersupply of things and activities that are moistening and nourishing on the other.  The list of causes includes: insufficient hydration and fluid consumption; failure to eat an adequately varied, generous, moistening, nourishing diet; chronic stress, overwork and burnout; excessive exercise or exertion; and insufficient rest and sleep.


Qualitative Changes:  A Field Guide to Phlegm

     Phlegm is expectorated, or excreted from the body, in a wide variety of forms that vary in quantity, texture, consistency, taste, color and many other properties.  This shows that phlegm, once generated, can go through many different qualitative changes of varying degrees of morbidity.  In addition to the forms of phlegm that are apparent and visible, there are other kinds of morbid phlegm that are usually found deep within the body.
     Normal phlegm, when first produced, is relatively thin and clear, and mildly sweet in taste.  But the longer it stagnates and accumulates, the more likely it is to undergo morbid changes that can greatly alter its form, taste, texture, viscosity, color and opacity.  As with any other humor, these changes include dystempers, dyscrasias, fermentations and putrefactions of the phlegm humor itself. 
     The taste of one's saliva is an important indicator of the overall state of one's phlegm and Phlegmatic humor.  Saliva consists of both serous and mucous fluids.  The taste of normal saliva is mildly sweet or bland, but if one's saliva tastes unduly sweet, sour, acrid or bitter, it may indicate morbid qualitative changes in the Phlegmatic humor. 
     Every discharge of phlegm has its own particular story to tell.  The astute physician pays close attention to these Phlegmatic discharges and learns much about the patient's condition by reading their various signs.
     Insipid phlegm is thin and watery, and is usually produced by extreme cold.  Insipid phlegm is the coldest and wettest of all types of phlegm, and is tasteless and odorless.  Common causes are ice cold drinks and foods, chills, and acute exposure to extreme cold.  Watery, tearing eyes, a runny nose, a moist, glossy, pale tongue, a tight constricted chest with congestion and spasmodic coughing, postnasal drip, and a scratchy, constricted sore throat are common symptoms.  In the stomach, insipid phlegm will accumulate and splash around, and in the intestines, it will gurgle. 
     Light, watery phlegm that's salty is called bilious phlegm, which is the hottest, driest and lightest of all types of phlegm.  It's salty because it's amalgamated with residues of yellow bile.  Being thin, light and penetrating, bilious phlegm can go anywhere.
     Being hot, dry and sharp, bilious phlegm compromises the deep, fundamental nourishment and soothing protection that the Phlegmatic humor should provide; it also favors chronic inflammatory conditions.  Bilious phlegm corrupting fluids that require considerable viscosity, such as synovial fluid, unduly thins them, compromising their supporting protective function and increasing friction and irritability.
     Atrabilious phlegm is corrupted with morbid black bile, and is bitter in taste, sometimes acrid or sour.  Its temperament is  Cold and Dry, and it's thicker and stickier than bilious phlegm.  The morbid black bile compromises the nutritive properties of the phlegm, and can be a chronic irritant to the organism.  Atrabilious phlegm can also penetrate deep into the body. 
     Phlegm that's very sweet can either be due to excessive heat and moisture in the digestion and metabolism, or to amalgamation with the Sanguine humor.  Sanguineous phlegm is thicker and stickier than ordinary phlegm, and can be seen in metabolic disorders like diabetes.
     Mucilaginous phlegm is thick and slimy, and may either be clear, milky and translucent, or white and opaque.  It originates in the stomach and digestive tract due to a cold, weak, sluggish digestion and metabolism.  Many phlegm-forming foods also generate mucilaginous phlegm.
     From the digestive tract, mucilaginous phlegm most commonly spreads to the respiratory tract and the throat, head, nose and sinuses.  Mucilaginous phlegm obstructing the head can cause a heavy head, dizziness, vertigo, nasal congestion and allergies, sinusitis and post nasal drip.  Mucilaginous phlegm may even invade the urinary tract and bladder, producing mucous cystitis. 
     Mucilaginous phlegm can stagnate and accumulate, depressing the digestion and metabolism even further, and creating even more phlegm in a vicious downward spiral.  Mucilaginous phlegm then becomes the basic raw material for many other types of morbid phlegm, which can subsequently be altered by extremes of heat, cold, or dryness.
     Extreme heat can cook or bake the phlegm, thickening, drying and hardening it.  As the phlegm is distilled or concocted, the thinner, waterier portions are separated out, leaving behind a thick residue.  Extreme cold can separate out distillations of insipid phlegm, leaving behind a thick, concentrated residue; cold can also congeal phlegm.  Dryness will directly evaporate and thicken phlegm. 
     Heat and choler will transform mucilaginous phlegm into hot phlegm, which is not only thick and opaque, but yellowish, greenish or brownish in color.  If hot phlegm is mixed with pus, it will also have a foul odor; such phlegm is commonly seen in pulmonary abscesses.
     Hot phlegm in the lungs is usually expectorated profusely with a barking cough.  Wheezing, asthma, shortness of breath, and a feeling of burning or constriction in the chest are also common.  Generally, the tongue is red with a thick yellow coat, and the pulse is rapid, full and slippery. 
     Hot phlegm in the stomach will produce stuffiness and fullness of the epigastrium, sore throat, mucoid stools, mental agitation and confusion, indigestion and insomnia.  The tongue and pulse will be similar. 
     Hot phlegm in the heart agitates and disturbs the vital spirits, producing mental and emotional disturbances, usually of a manic or delusional character.  There may be startled hyper-reactivity, impulsive or rash behavior, incoherent speech and muttering to oneself, agitated violent behavior, mental confusion, palpitations, stuffiness in the chest, restlessness, disturbed sleep and insomnia.      Dry phlegm is mucilaginous phlegm that's been dried to a thick, tenacious consistency.  Inhabiting the lungs, chest, throat and respiratory tract, the chief feature of dry phlegm is it's extremely sticky, tenacious and difficult to expectorate.  Dry phlegm can also cause a dry, hacking cough; in smokers, it's called a smoker's cough.
     Wind can combine with phlegm to produce wind phlegm, which has a bubbly, frothy appearance on the tongue.  Wind phlegm, in its subtle distillations, can obscure or block the sensory orifices, producing delusions, hallucinations, or partial or total blockage of the senses.  In extreme cases, wind phlegm is seen in epilepsy and other convulsive disorders, with gurgling and frothing of phlegm in the mouth and raspy, wheezing breathing. 
     If we dive deeper into the organism, we find morbid types of phlegm that typically inhabit the innermost recesses of the body.  These are vitreous phlegm, which is so-called because it's glassy and gelatinous, and calcareous phlegm, which is white and chalky.  Calcareous phlegm is usually found in the joints of elderly people suffering from arthritic and rheumatic disorders in deposits called tophi.


Putrefaction of Phlegm

     Phlegm itself can ferment and putrefy, becoming putrefied phlegm.  Its taste is slightly acrid or sour, much like grape juice that has started to ferment into wine.  The microbes involved could be bacteria, or they could be yeasts, like candida albicans.  With yeasts, there may be froth in the phlegm, which can fizzle in the digestive tract if the fermentation is severe enough.  Chronic candidiasis, when entrenched and systemic, can wreak havoc on immunity. 
     Putrefied phlegm in the digestive tract can produce dizziness, wooziness, a sour stomach, chronic indigestion, gas, bloating and distension.  The stools will be loose, chunky and foul smelling. 
     When too much phlegm accumulates in the respiratory tract, it can putrefy and produce a respiratory tract infection.  Colds and respiratory infections can be seen as healing crises that allow the organism to cleanse itself of accumulated phlegm.
     To burn off a lot of phlegm very quickly, the organism may manifest or utilize a fever.  This is usually a quotidian fever, which is basically a "24 hour bug", lasting only a day.  If the phlegm is in the GI tract, it will be a 24 hour stomach flu.  Because phlegm is the coldest in temperament of all the humors, Phlegmatic fevers are usually not very high.  A Phlegmatic fever typically peaks in the mid-afternoon, which is the hottest time of day, and starts to subside by nightfall.

Pathologies of Lymph and Serous Fluids

     The serous fluids moisten and lubricate, cool and nourish the organism on a deep, fundamental level.  The lymph also cleanses, filtering and purifying the plasma and interstitial fluids before returning them to the bloodstream.  If this cleansing function is compromised, so will be the overall health and immunity of the organism. 
     A good, healthy flow of serous fluids is necessary to maintain their quality and purity, as stagnation leads to morbidity.  Toxic residues and morbid humors in the serous fluids also impede their circulation, leading to stagnation and obstruction.  The basic signs of lymphatic toxicity, stagnation or obstruction, also called lymphatic congestion or lymphatism, are: swollen or tender lymph nodes; and puffiness, swelling or edema. 
     Since the mucous and serous fluids are interconnected, morbid phlegm of any type can infiltrate the deeper organs and tissues and affect the serous fluids.  According to the nature and temperament of the corrupting toxins or morbid humors, the lymphatic and serous fluids can undergo pathological changes of function and composition of many different kinds.
     If the toxins and morbid humors are cold and wet in nature, there will be marked pallor, puffiness or edema.  Weeping or oozing skin lesions can also be present, as well as leucorrhea with white, odorless discharges in women.  The lymph nodes may be swollen or enlarged.  The pulse will be slow, deep and soft, and the urine may be turbid and cloudy, as well as scanty.  There may also be heaviness, sluggishness, and dull, aching pains in the bones and joints.
     If hot, Choleric residues accumulate in the lymph and serous fluids, inflammatory conditions will be favored.  There may also be easy bruising or swelling, even from minor impact.  The lymph nodes may be tender or enlarged.  Heat rashes, hives and urticaria may also appear; boils and abscesses will also be favored.  Although traditional Greek Medicine sees pus formation as primarily due to a putrefaction of the blood, pus accumulates and forms cysts where the lymphatic drainage is poor.
     Putrefactive conditions of excess heat and moisture in the lymph and serous fluids will produce damp heat and itching in the groin and other sensitive areas of the body.  Skin conditions with yellowish, brownish or smelly exudations may develop, as can vaginal discharges with a yellowish color and foul odor.  The lymph nodes may be swollen, tender or enlarged. 
     Residues or corruptions of morbid black bile in the serous fluids will change their wetness into dryness, compromising their nutritive function.  This can cause dry skin, dehydration and thirst, and generalized emaciation and wasting.  There will often be an acrid or bitter taste in the mouth. 
     In addition to being enlarged, the lymph nodes may also be hard.  Chronic or severe atrabilious corruption of the lymph is one of the major causative factors associated with hard swellings, tumors and cancer in Greek Medicine. 
     The synovial fluid surrounding and lubricating the joints and articular structures can be similarly corrupted by residues of various morbid humors.  These can lead to degenerative rheumatic or arthritic changes in the joints and articular structures, according to the nature and temperament of the offending toxins and morbid humors.

Maturation and Ripening

     The basic time period for the Phlegmatic humor to be concocted, ripened and purified is nine days.  In general, phlegm is ripened or concocted with expectorants, lymphatic cleansers, stimulants and diuretics.  Most of these ripening agents have heating and drying properties, which are contrary to those of the Phlegmatic humor.  If Phlegm has been corrupted by heat and choler, cooling expectorants that dissolve or liquefy tough, dry phlegm may be called for.