Obesity & Depression

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TCM & the Phlegm Connection

In Chinese Medicine, Phlegm (Tanyin) is a lot more than the stuff that builds up in your nose when you have a cold. In fact, Phlegm is found all over the body and has serious implications for a person’s physical, mental, emotional and even spiritual health. This article will discuss the formation of phlegm and focus on the relationship between Phlegm, digestion and excess body weight. It will also examine how these affect mood and mental health.


Phlegm is formed in the body when Dampness (Shi) combines with Heat and/or Stagnation. Interior Dampness forms in the digestive system and then can migrate all over the body. It arises from a deficiency of Spleen as well as Kidney energy.  If the Spleen’s function of transformation and transportation of body fluids is weak, fluids are not adequately utilized and accumulate to form Dampness. Dampness may be caused by poor diet, poor eating habits and/or stress.

There are also external causes of Dampness, such as damp weather, damp clothing, wading in water or sitting on damp ground; however, as External Dampness does not form into Phlegm, we shall look more closely at Internal Dampness.

As mentioned, the development of Internal Dampness is mainly associated with the Spleen. In Chinese Medicine, the Spleen is an important organ of the digestive system. It is a Yin organ associated with the element of Earth. It is said in the Chinese Medicine classics that the Spleen likes dry and warm foods — both in temperature and food quality. Excessive intake of cold and raw foods, excessive consumption of sugar, and overeating in general all weaken the Spleen. Excessive consumption of greasy and fried foods also gives rise to the formation of Dampness and Phlegm.

In addition to what one eats, the way in which one eats has an impact on how food is digested. Eating in a rush, when under stress, or late at night can inhibit digestion. Excessive worry and pensiveness, the emotional imbalance associated with the element of Earth, likewise interferes with digestion.

Symptoms of excess Dampness include “a feeling of heaviness of body or head, poor appetite, a feeling of fullness of chest or epigastrium, a sticky taste, urinary difficulty, a white sticky vaginal discharge, a sticky tongue coating, and a Slippery or Soggy pulse.” (1)


Like Dampness, Phlegm originates from a dysfunction of the Spleen in transforming and transporting fluids, but its formation also involves the Liver, Lungs and Kidneys. Phlegm is thicker and denser than Dampness. It develops from Dampness condensed by Fire or Stagnation. Phlegm primarily involves the upper part of the body. It can also be retained in the Channels (Luo) and under the skin, causing swelling and lumps. From a Chinese Medicine perspective, cholesterol and excess body fat are also considered expressions of Phlegm in the body.

From a Western Medicine perspective, new understandings of excess body fat suggest that obesity is connected to depression. A study recently completed at Vanderbilt University indicates a bi-directional association between adiposity (obesity) and depression, with inflammation possibly playing an intermediary role. (2)

These findings suggest a number of reasons why overweight people are prone to depression. Some are aware of being judged by others, and are negatively impacted by the reality that size-ism is alive and well in our communities. Many internalize this rejection, and suffer from self-loathing and a sense of powerlessness. In addition to these subjective experiences, the cytokines in every fat cell increase inflammation in the body, which is linked to higher risk of depression.


Phlegm is also associated with depression in Chinese Medicine. Excess body fat represents a challenge to the body’s ability to transform and transport nutrients. Adipose tissue concretizes the action of the body holding on to past experience – not only the experience of ingesting food, but also life experiences that are held in the tissues of the body. While holding on to the past, the body carries excess weight. This weight can cause a heaviness of body, mind and spirit, affecting mood, sleep, clarity of thought and energy level.

According to the classic Chinese medical text, the Ling Shu Jing (often translated as ‘Spiritual Axis’), “phlegm mists and obstructs the Mind.” The Mind (Shen) resides in the Heart and is responsible for thinking, cognition, consciousness, self-identity, insight, emotions and memory. “Phlegm obstructs the Mind (the Heart’s orifices) and may cause dullness of thought, a fuzzy head, a confused mind and dizziness. In the mental-emotional field, Phlegm obstructing the Mind causes a certain loss of insight which, in extreme degrees, gives rise to serious mental illnesses such as psychosis, schizophrenia or bipolar disorder.” (3)

From a Chinese Medicine perspective, Phlegm is therefore implicated in mental and emotional imbalances, including, but not limited to, bipolar disorder, depression and attention deficit disorder. I also propose that food addiction can be understood as another manifestation of Phlegm misting the Mind.

The relationship between sugar, compulsive eating and addiction has been widely studied. In some people, sugar intake elicits the symptoms associated with addiction, including: tolerance (whereby increasing amounts are needed to reach and maintain intoxication or satiety); withdrawal symptoms (such as distress and dysphoria upon discontinuation of consumption); and a high incidence of relapse. Chinese Medicine also affirms a connection between sugar and Phlegm production. Sugar is Phlegm-producing in the body, according to Chinese Medicine, and the sweet flavour is associated with the Spleen/Stomach (digestive system). Excess intake of food leads to weight gain and adipose tissue, also a form of Phlegm. Phlegm has negative effects on clarity of mind and mental-emotional balance.

Dr. David Kessler, former commissioner of the U.S. FDA, has cited salt, concentrated sugar and excess dietary fat as substances that “focus attention on food” such that the “reward center” of the brain overpowers the body’s “homeostatic system.” Kes-sler finds that sugar, fat and salt tend to be mutually reinforcing. These food elements have been called the “three points of the compass” that make food compelling. (4)

Numerous related scientific studies have measured variables including genetic predispositions, social factors, effects on the brain (particularly pleasure and pain centres) and brain receptors (including, but not limited to, dopamine and serotonin). (5) Research suggests that food can affect brain changes in similar ways to alcohol and narcotics. Furthermore, “neuroimaging studies have supported the hypothesis that loss of control over eating and obesity produced changes in the brain which are similar to those produced by drugs of abuse.” (6)

This is similar to the ancient Chinese understanding that “Phlegm mists the Mind.” A recent food addiction study suggests obesity and compulsive eating cause the following changes in brain function: (7)

– The hypothalamus senses that eating has occurred with a delay in time that increases with the mass of the body
– The brain’s somatosensory cortex changes with overeating and obesity so that the mouth and tongue increase their geographical area on the homunculus

These studies illustrate changes that Chinese Medicine has pointed to for thousands of years.


In addition to understanding the formation of Phlegm, Chinese Medicine has elaborated treatment solutions. A balanced lifestyle, acupuncture, herbal remedies, and addressing underlying mental-emotional issues can bring healing. Just as the initial coagulation of Phlegm is rooted in an inability of the ‘bodymind’ to transform and transport nutrition, the resolution of Phlegm invites a process of positive transformation.

According to Paul Pitchford (Healing with Whole Foods, North Atlantic Books, 1993) foods that dry dampness include rye, amaranth, corn, aduki beans, celery, lettuce, pumpkin, scallion, alfalfa, turnip, and white pepper.
Some bitter herbs that can be helpful include dandelion, burdock leaf, yarrow and chamomile. Chinese herbal remedies can also be very effective and are best prescribed by a herbalist who works with you in person and can address your individual situation.

Treatment – combined with earnest effort in making positive lifestyle changes and letting go of unhelpful attachments and habits – offers new hope to sufferers.


(1) Giovanni Maciocia, “The Foundations of Chinese Medicine.” China, Churchill Livingston Press,  2005, p. 693.
(2) Dr. Richard C. Shelton and Dr. Andrew H. Miller, “Eating ourselves to death (and despair): The contribution of adiposity and inflammation to depression.” Nashville, Tenn., Vanderbilt University, 2010.
(3) Giovanni Maciocia, “The Psyche and Chinese Medicine.” China, Churchill Livingston Press, 2010
(4) Werdell et al., “Physical Craving and Food Addiction.” The Food Addiction Institute, 2009.
(5) Ibid, p. 10-15.
(6) Mark S. Gold, MD, “Eating Disorders, Overeating, and Pathological Attachment to Food: Independent of Addictive Disorders?” The Haworth Press, 2004
(7) Werdell et al., “Physical Craving and Food Addiction.” The Food Addiction Institute, 2009, p. 11.

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