By Thea Elijah, LAc
Citrus and Pinellia is the primary formula for cold damp phlegm. It’s usually combined with other formulas, or has single herbs added to it, to direct it to various parts of the body. I will sometimes give this formula to break up mental phlegm—for example, if somebody is living in a cognitive goo-land and you want to open up some of those block-chunk ideas. These are the clients who are so deep in their life story that they would not notice data to the contrary if it smacked them right in the face. They’ve got their life story like a cognitive phlegm barricade around them wherever they go. These chunky thoughts form a blockade against any incoming data that doesn’t fit the story.
For the client, what’s seductive about this state of being is that with lots of cognitive phlegm, they’re always at home. They’ve created a home out of phlegm. They’ve created a security, a comfort, and this is the reason for the phlegm’s existence. Phlegm gives us a feeling just like integrity, only it’s not. It’s a pathological mockery of the important Earth qualities of loyalty and stability. It’s very solid; it keeps things simple. Phlegm answers our need for something to be stable, something to be comfortable, something to be familiar and unquestioned in our lives.
The Desire for Simplicity and Its Drawbacks
I think it’s very important to be aware of this longing in all of us, especially in order to undermine any capacity for judgment of others on this score. Isn’t there a part of us that really wants things to be simple? Please, couldn’t something be simple? Wouldn’t it be great to have some things in life that are just simple—like block letters. Remember all the things that were so clear back in kindergarten? There are nice people and bad people. When they told you that, it just seemed so clear. Well, we’ll just stay away from the bad ones, right? Everything was spelled out so clearly in these very simple chunks. We didn’t have to question it. Our parents told us, and our teachers told us, and life was simple. It was nice. It was comfortable. It was ok to not question. Who doesn’t have some nostalgia for that childhood simplicity?
This can lead straight to phlegm—to places in ourselves where we choose not to question, choose to be a child, choose to make it all simpler than it actually is. We can get stuck in that, and start to move through life in this simplicity; then it blocks perception, it blocks cognition, it blocks nourishment.
Citrus and Pinellia in Cognitive Digestion
The transformation of virtue of this formula is frequently demonstrated by the wonderful Chinese medicine teacher Stephen Cowan, a 5 Element pediatrician who does terrific presentation on diagnosing the 5 Element constitutions of infants and little children. His book Fire Child, Water Child is so fabulous for both practitioners and lay people, helping parents understand their kids earlier, what their kids’ needs are, and how the needs of a little Wood child might be different than the needs of its Metal mother. Stephen Cowan takes material that, if I taught it, would’ve been presented with so much subtlety of nuance and detail that only five people in the room would have been able to follow it. Stephen Cowan’s brilliance is in breaking it down so that it’s very, very simple, but without phlegm.
Balancing Simplicity and Complexity in Thought
This ability to mentally digest to the point of simplicity is an incredible cognitive skill (represented herbally by Ban Xia, Chen Pi, Fu Ling, Gan Cao. It takes a particular kind of intelligence to make things so simple. Teaching the beginner level of any subject is, in some ways, a more skilled practice than teaching to more advanced students. It’s an important Earth element practice: how do I render very, very simple, something huge and rich and complex, bring it down to a level that a beginner would understand while maintaining complete fidelity, so that we don’t have to later say, “Well, it’s not really like that.”
I face this all the time with my son. Five-year-olds ask these extraordinary questions like “Why are people mean?” Right? We need to answer in simple ways. I might say something like, “Because they’re not loved.” He thinks about that for a while then asks: “Well, what if I love them and they’re still mean?”
How do we answer these questions? A large measure of the answer lies in gauging and judging just how finely to chunk it down, so as to give idea-chunks sized to suit the cognitive digestion of the person to whom we’re speaking. This happens with adults as well as children, or with clients in the treatment room. “What’s that point for?” What do you say? You say whatever is going to satisfy the mind of the person you’re talking to at that moment. “Oh, it’s for helping you achieve more balance.” For some people that’s good enough. That’s what they wanted to know. It’s true; it embodies the Earth virtue of fidelity, integrity, sincerity. What can I say to this person that is sincere, dependable, truthful, has integrity with the whole, but is also the right-sized cognitive chunk?
Citrus and pinellia is a formula for those who long for the comfort of simplicity and familiarity and unquestioningness, and are paying the price because they’re choosing simplicity at the expense of integrity. They need to be helped beyond childhood mind, to being able to cut up their own French toast and chew it fully.
Herbal Components and Their Cognitive Impacts
The Ban Xia/pinellia is of course the primary herb here, the one that helps you chew your food-for-thought (or ‘real’ food). I’m going to break down this blocky chunk of stuff. It’s not so simple. I can’t keep it simple, because if I do, I’m not really going to get it. Chunk it down, digest it.
Chen Pi/tangerine peel is a back up to the Ban Xia/pinellia because in situations where there is damp phlegm, i.e. where dampness has stagnated to the point of chunkification— or where food and life experiences have not been fully enough processed—there’s usually a digestive background of qi stagnation as well as dampness. Chen Pi is good for clearing up the dampness that has accumulated specifically in the system of somebody whose cognitive and digestive qi are going round and round in a circle without getting anywhere, in their mind or in their gut. There’s a good likelihood of phlegm forming in somebody who’s doing the gerbil wheel routine with their Earth element.
Fu Ling/poria is a backup to the chen pi/tangerine peel and the ban xia/pinellia. If we clear the stagnant moisture that’s around, it’s a heck of a lot less likely to congeal into phlegm. Thus we have Fu Ling/poria opening drainage, while Chen Pi/tangerine peel is opening the circle-of-mind out of worry and into thoughtfulness, and Ban Xia/pinellia helps us question and break down the old stories, the old loyalties, the old comforts, for real nourishment.
Then there’s Zhi Gan Cao/licorice. Why? So that there’s a little something in the formula that’s sweet and comfortable; you’re not asking this Earth person to give up everything. Gan Cao brings a little taste of true sweetness, because, hey, you’re asking me to grow up? I can’t stand it. I want it to be that simple. I want to be a child, and I want to be able to trust in a child-like way. I want to choose my friends, my food, my furniture, my whole life with the blind loyalty to familiarity and comfort of Ban Xia. If it’s not comfortable and familiar, I can’t digest it—I’m going to puke. That also keeps it simple. That’s Ban Xia, too.
Instead, with the help of this formula, I’m going to have to do something that’s harder digestive work than just blind loyalty or puking. I need to discern; I need to look at life in terms of a greater level of subtlety
There’s a loss of childhood here, a loss of those comforts and simplicities. I definitely think that’s an opportunity for a little Gan Cao, a little acknowledgement that there are still some things in life that could be sweet and simple…
Of course on a physical level, what it does is protect somebody from getting dried out. Chinese formulas are so good at keeping that balance. Here we are taking away somebody’s pathological security and simplicity, and now with Gan Cao (or in some versions of the formula, the three sweets), we’re adding healthy security/simplicity, and the childlike ability to drink in comfort and nourishment. As we’re getting rid of all this excess moisture, dampness, and phlegm in somebody’s system, we protect their flesh, their true home, and make sure their flesh can keep the proper fluid, proper comfort, and proper sweetness.
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