Hypothyroidism - Phlegm-Dampness Internal Obstruction Pattern

Dr. Li Wei, DACM

Hypothyroidism · Phlegm-Dampness Internal Obstruction Pattern

Updated: June 23, 2026

Reviewed by: Dr. Li Wei, DACM

Reading Time: 7 min

Body Area: Whole Body

Pattern Overview

Phlegm-Dampness Internal Obstruction is a common pattern in hypothyroidism, characterized by glycosaminoglycan deposition, myxedema, heavy sensation, sticky mouth, and fluid retention. The core pathogenesis is accumulation of Phlegm-Dampness in the body due to impaired Spleen transformation, leading to interstitial fluid retention and myxedema.

Key Symptoms and Differentiation Points

| Differentiation Dimension | Manifestations |

| :— | :— |

| Primary Symptoms | Myxedema (swelling), heavy sensation, sticky mouth, weight gain |

| Associated Symptoms | Fatigue, poor appetite, chest tightness, loose stools |

| Tongue and Pulse | Pale and swollen tongue with white greasy coating, slippery pulse |

| Pathogenesis | Phlegm-Dampness accumulating in the body |

| Etiology | Poor diet, cold food intake, Spleen deficiency, hypothyroidism |

Acupuncture Point Prescription

| Point | Location | Function |

| :— | :— | :— |

| Fenglong (ST40) | 8 cun above the lateral malleolus, 2 cun lateral to the tibial crest | Transforms Phlegm and Dampness |

| Pishu (BL20) | Lower back, 1.5 cun lateral to T11 | Back-Shu point of Spleen meridian; strengthens Spleen Qi |

| Zhongwan (RN12) | 4 cun above the umbilicus | Front-Mu point of Stomach; harmonizes the Stomach |

| Yinlingquan (SP9) | Below the medial condyle of the tibia | Transforms Dampness and promotes diuresis |

| Zusanli (ST36) | 3 cun below the patella, 1 finger-width lateral to the tibial crest | Strengthens Spleen and Stomach; tonifies Qi |

Clinical Recommendation: Filament needle, even method; moxibustion may be applied to Pishu and Zhongwan to strengthen Spleen and transform Dampness.

Herbal Formula

Base Formula: Er Chen Tang (二陈汤) + Wu Ling San (五苓散)

Composition:

Pinellia (Ban Xia), Tangerine Peel (Chen Pi), Poria (Fu Ling), Atractylodes (Bai Zhu), Alisma (Ze Xie), Polyporus (Zhu Ling), Cinnamon Twig (Gui Zhi), Licorice (Gan Cao)

Action: Transforms Phlegm, drains Dampness, and promotes diuresis.

Modifications

| Associated Symptoms | Additions/Subtractions |

| :— | :— |

| Severe myxedema | Add Fu Ling, Zhu Ling to promote diuresis |

| Heavy sensation | Add Huo Xiang, Pei Lan to transform Dampness |

| Sticky mouth | Add Cang Zhu, Hou Po to dry Dampness |

| Chest tightness | Add Zhi Ke, Jie Geng to regulate Qi and relieve distension |

Western Mechanism Reference

Glycosaminoglycan deposition causing interstitial fluid retention, myxedema, and serous cavity effusions. Phlegm-Dampness Internal Obstruction corresponds to hypothyroidism with myxedema and fluid retention, where glycosaminoglycan accumulation and reduced metabolism contribute to interstitial fluid retention.

References

  1. Internal Medicine of TCM - Phlegm-Fluid with Phlegm-Dampness.

  2. DB-XJB: Er Chen Tang.

  3. WHO. (2023). Thyroid disorders. World Health Organization.

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