汪（五八） 宿哮久矣不发。心悸震动。似乎懊 之象。此属痰火。治以宣通郁遏。勿徒呆补。（痰火）
半夏 川连 石菖蒲 蛤粉 枳实 茯苓 川郁金 橘红
竹沥姜汁法丸。
刘 痰火郁遏。气滞。吸烟上热助壅。是酒肉皆不相宜。古称痰因气滞热郁。治当清热理气为先。
川连 白术 枳实 浓朴 茯苓 半夏
淡姜汤泛丸。
沈（三四） 痰火久嗽。海蛤丸。
张（妪） 痰火风眩晕。防仆跌。
明天麻 炒半夏 茯苓 橘红 羚羊角 钩藤 竹沥
陈（妪） 老年痰火咳逆。痰有秽气。
芦根 苡仁 桃仁 丝瓜子 葶苈 大枣
又 下虚不纳。浊泛呕逆。痰秽气。
熟地炭 紫衣胡桃肉 炒杞子 炒牛膝 川斛 茯神
某 痰火上逆蒙窍。耳鸣头晕。二陈加天麻钩藤甘菊羚羊蒌皮。
某 夏至节。两关脉弦长。五火燔燎。而肝阳胃阳尤甚。动怒抽掣为肝病。食辛香浓味即病至。
胃病使然。痰火根深。非顷刻可扫除。惟静养勿恚忿。薄味以清里。此病发之势必缓。由渐加
功议药。乃近理治法。
羚羊角 犀角 川连 郁金 山栀 北秦皮 牛黄 胆星 橘红 生石膏 寒水石 金箔
方诸水法丸。竹叶灯心汤送。
何（妪） 诊脉右关弦滑。痰多。舌干微强。语言似謇。盖因痰火上蒙。津液不得上承。高年颇虑风痱。
宜清上宣通。勿进刚燥及腻滞之药。
半夏 金石斛 橘红 黑山栀 茯苓 郁金 生甘草 石菖蒲 竹沥 姜汁
张 昏昏如寐。神愦如迷。痰热内闭。势非轻渺。（痰热内闭神昏）
半夏 石菖蒲 桔梗 枳实 郁金 橘红 竹沥 姜汁
某 郁痰。（郁痰）
半夏曲 郁金 石菖蒲 明天麻 白蒺藜 橘红 茯苓 钩藤
陶 脉左弦坚搏。痰多。食不易运。此郁虑已甚。肝侮脾胃。有年最宜开怀。不致延及噎膈。
半夏 姜汁 茯苓 杏仁 郁金 橘红
又 脉如前。痰气未降。前方去杏仁加白芥子。
金（四六） 湿热内蒸。痰火日伙。根本渐怯。阳泄为汗。阴泄遗浊。酒客喜于爽口食物。医药中滋腻补
方。决不适用也。（湿热蒸痰）猪肚丸方。
叶 久寓南土。水谷之湿。蒸热聚痰。脉沉弦。目黄。肢末易有疮疾。皆湿热盛。致气隧不得流畅。
法当苦辛寒清里通肌。仿前辈痰因热起。清热为要。
生茅术 黄柏 栝蒌实 山栀 莱菔子 川连 半夏 浓朴 橘红 竹沥姜汁丸。
某 病后。浓味蒸痰。
风化硝 栝蒌仁霜 枳实 郁金 生茯苓 姜汁炒山栀
竹沥法丸。
汪 脉胀。湿阻热痰。
半夏 茯苓 黑山栀 橘红 制蒺藜 远志 降香
徐 阳动内风。用滋养肝肾阴药。壮水和阳。亦属近理。夏季脾胃主司。肝胆火风。易于贯膈犯
中。中土受木火之侮。阳明脉衰。痰多。经脉不利矣。议清少阳郁热。使中宫自安。若畏虚滋腻。
上中愈实。下焦愈虚。二陈去甘草加金斛桑叶丹皮。（木火犯中胃虚生痰）
又 脉左浮弦数。痰多。脘中不爽。烦则火升眩晕。静坐神识安舒。议少阳阳明同治。
羚羊角 连翘 广皮 炒半夏曲 黑山栀皮 香豉
又 脉两手已和。惟烦动恍惚欲晕。议用静药。益阴和阳。
人参 熟地 天冬 金箔
汪 痰火上盛。肾气少摄。朝用通摄下焦。暮服清肃上焦方法。（肝肾虚上有痰火）
羚羊角 半夏 茯苓 橘红 黑栀皮 郁金 苦丁茶煎汤法丸暮服
熟地 淡苁蓉 杞子 五味 牛膝 茯苓 远志 线胶 蜜丸。早服。
曹（五一） 色鲜明。属上有痰饮。盖上实则下虚。半百年岁。未得种玉。诊得脉左小不静。右部弦滑。法
当清肺胃之热痰。益肾肝之精血。仿曼倩卫生方法。
燕窝胶 甜梨膏 人参 黄 麦冬 山药 茯苓 于术 黄节 黑节 鹿尾胶 羊内肾
淡苁蓉 故纸（胡桃蒸） 青盐
芮 向来痰多食少。而参术服饵未合。此 质为阳。不受温热刚燥之剂。上年冬季温暖。入春
痰愈多。体中微倦。由乎藏聚未固。春气自地升举之征。法当摄肾固真。乃治痰之本。方为有益。（肾虚痰多）
熟地 茯苓 补骨脂 胡桃肉 杞子 五味 牛膝 远志 车前 蜜丸。
痰症之情状。变幻不一。古人不究标本。每着消痰之方。立消痰之论者甚多。后人遵其法
而用之。治之不验。遂有称痰为怪病者矣。不知痰乃病之标。非病之本也。善治者。治其所
以生痰之源。则不消痰而痰自无矣。余详考之。夫痰乃饮食所化。有因外感六气之邪。则
脾肺胃升降之机失度。致饮食输化不清而生者。有因多食甘腻肥腥茶酒而生者。有因
本质脾胃阳虚。湿浊凝滞而生者。有因郁则气火不舒。而蒸变者。又有肾虚水泛为痰者。
此亦因土衰不能制水。则肾中阴浊上逆耳。非肾中真有痰水上泛也。更有阴虚劳症。龙
相之火。上炎烁肺。以致痰嗽者。此痰乃津液所化。必不浓浓。若欲消之。不惟无益。而徒伤
津液。其余一切诸痰。初起皆由湿而生。虽有风火燥痰之名。亦皆因气而化。非风火燥自
能生痰也。其主治之法。惟痰与气一时壅闭咽喉者。不得不暂用豁痰降气之剂以开之。
余皆当治其本。故古人有见痰休治痰之论。此诚千古之明训。盖痰本饮食湿浊所化。人
岂能禁绝饮食。若专欲消之。由于外邪者。邪散则痰或可清。如寒痰温之。热痰清之。湿痰
燥之。燥痰润之。风痰散之是也。若涉本原者。必旋消旋生。有至死而痰仍未清者矣。此乃
不知治本之故耳。今观案中治法。有因郁因火者。必用开郁清火为君。以消痰佐之。有因
湿因热者。则用燥湿清热。略佐化痰之品。若因肝肾虚而生痰者。则纯乎镇摄固补。此真
知治痰之本者矣。若因寒因湿者。更当于痰饮门兼参而治之。（华岫云）
徐评 所列方案。皆治肺胃浮痰之药。若透经入络。盘踞脏腑。及三焦隐处之老痰。尚有峻厉
制炼之方。此等方不能奏效也。
Wang (58 years old) Has suffered from recurrent asthma for a long time, which had not flared up. Now experiencing palpitations and tremors, seemingly presenting symptoms of vexation and restlessness. This condition belongs to Phlegm-Fire. Treatment should focus on dispersing and unblocking the stagnation and obstruction; do not merely use cloying tonification. (Phlegm-Fire)
Pinelliae Rhizoma Preparatum (Banxia), Coptidis Rhizoma (Chuanlian), Acori Tatarinowii Rhizoma (Shichangpu), Concha Meretrix (Gafen), Ziziphi Spinosae Semen (Zhishi), Poria (Fuling), Curcumae Radix (Chuanyujin), Citri Reticulatae Pericarpium (Juhong).
Pills made with Bamboo Juice (Zhuli) and Ginger Juice (Jiangzhi).
Liu Phlegm-Fire is stagnant and obstructed, Qi is滞涩 (stagnant). Smoking aggravates upper Jiao heat and aids congestion; therefore, alcohol and meat are all unsuitable. The ancients stated that Phlegm arises from Qi stagnation and Heat depression; treatment should prioritize clearing heat and regulating Qi.
Coptidis Rhizoma (Chuanlian), Atractylodis Macrocephalae Rhizoma (Baizhu), Ziziphi Spinosae Semen (Zhishi), Magnoliae Officinalis Cortex (Houpo), Poria (Fuling), Pinelliae Rhizoma Preparatum (Banxia).
Pills made with mild Ginger Decoction (Danjiang Tang).
Shen (34 years old) Chronic cough due to Phlegm-Fire, administered Hai Ge Wan (Clam Shell Pill).
Zhang (Elderly woman) Dizziness and vertigo caused by Phlegm-Fire stirring Liver Wind; precautions against falling and injury are necessary.
Gastrodiae Rhizoma (Tianma), Prepared Pinelliae Rhizoma (Banxia), Poria (Fuling), Citri Reticulatae Pericarpium (Juhong), Cornu Saigae Tataricae (Lingyangjiao), Uncariae Ramulus cum Uncis (Gouteng), Bamboo Juice (Zhuli).
Chen (Elderly woman) Elderly patient with Phlegm-Fire causing cough and rebellious Qi; sputum has a foul odor.
Asparagi Radix (Lugen), Coicis Semen (Yiren), Persicami Semen (Taoren), Trichosanthis Cucumerinae Semen (Siguazi), Lepidii Fructus (Tingli), Jujubae Fructus (Dazao).
Re-evaluation: Deficiency in the Lower Jiao fails to grasp Qi; turbid Yin rebels upward causing vomiting and counterflow; sputum is foul.
Prepared Rehmanniae Radix (Shuditan), Walnut Kernel with Purple Skin (Ziyi Hutao Rou), Prepared Lycii Fructus (Chao Qizi), Prepared Achyranthis Bidentatae Radix (Chao Niuxi), Dendrobii Nobile Caulis (Chuanhu), Poria Cum Pino (Fushen).
Certain case Phlegm-Fire rebels upward and clouds the orifices, resulting in tinnitus and dizziness. Er Chen Tang modified with Gastrodiae Rhizoma (Tianma), Uncariae Ramulus cum Uncis (Gouteng), Chrysanthemi Flos (Ganju), Cornu Saigae Tataricae (Lingyangjiao), Trichosanthis Pericarpium (Loupi).
Certain case At the Summer Solstice, the Guan pulse on both hands is wiry and long. The fire of the five viscera is blazing, with Liver Yang and Stomach Yang being particularly severe. Anger leading to twitching and pulling indicates Liver disease. Consuming pungent, aromatic, and rich flavors triggers the illness. This is due to Stomach pathology. The root of Phlegm-Fire is deep-seated and cannot be cleared instantly. Only through quiet rest, avoiding anger, and consuming bland flavors to clear the interior can the tendency for flare-ups be slowed. Gradual medication adjustment is the rational approach.
Cornu Saigae Tataricae (Lingyangjiao), Cornu Bubali (Xijiao), Coptidis Rhizoma (Chuanlian), Curcumae Radix (Yujin), Gardeniae Fructus (Shanzhi), Fraxini Chinensis Cortex (Qinpi), Calculus Bovis (Niuhuang), Arisaematis Cum Bile (Danning), Citri Reticulatae Pericarpium (Juhong), Gypsum Fibrosum (Sheng Shigao), Halloysit Rubra (Hanshui Shi), Lamina Aurum (Jinpiao).
Pills made with Fangzhu Water, taken with Decoction of Bambusa Leaves (Zhuye) and Juncus Lampapus (Dengxincao).
He (Elderly woman) Pulse diagnosis: Right Guan is wiry and slippery. Excessive phlegm, dry tongue slightly stiff, speech appears slurred. This is due to Phlegm-Fire clouding upwards, preventing fluids from ascending. In an elderly person, there is concern for Feng Fei (stroke with aphasia or paralysis).
Treatment should clear the Upper Jiao and unblock orifices; avoid harsh-drying and cloying-stagnating medicines.
Pinelliae Rhizoma Preparatum (Banxia), Dendrobii Officinalis Caulis (Jinshihu), Citri Reticulatae Pericarpium (Juhong), Gardeniae Fructus (Heishanzhi), Poria (Fuling), Curcumae Radix (Yujin), Glycyrrhizae Radix et Rhizoma (Sheng Gancao), Acori Tatarinowii Rhizoma (Shichangpu), Bamboo Juice (Zhuli), Ginger Juice (Jiangzhi).
Zhang Drowsy as if sleeping, spirit confused as if lost, Phlegm-Heat internally closed; the condition is not trivial. (Phlegm-Heat Internal Closure with Coma)
Pinelliae Rhizoma Preparatum (Banxia), Acori Tatarinowii Rhizoma (Shichangpu), Platycodonis Radix (Jiegeng), Ziziphi Spinosae Semen (Zhishi), Curcumae Radix (Yujin), Citri Reticulatae Pericarpium (Juhong), Bamboo Juice (Zhuli), Ginger Juice (Jiangzhi).
Certain case Depressive Phlegm. (Depressive Phlegm)
Prepared Pinelliae Rhizoma Qu (Banxiaqu), Curcumae Radix (Yujin), Acori Tatarinowii Rhizoma (Shichangpu), Gastrodiae Rhizoma (Tianma), Tribuli Fructus (Bajili), Citri Reticulatae Pericarpium (Juhong), Poria (Fuling), Uncariae Ramulus cum Uncis (Gouteng).
Tao Left pulse is wiry, firm, and forceful. Excessive phlegm, food digestion is difficult. This is due to excessive worry and depression, where Liver Wood insults Spleen and Stomach. For the elderly, it is best to keep the mind open to avoid progression to Ye Ge (dysphagia/chorea).
Pinelliae Rhizoma (Banxia), Ginger Juice (Jiangzhi), Poria (Fuling), Armeniacae Semen (Xingren), Curcumae Radix (Yujin), Citri Reticulatae Pericarpium (Juhong).
Re-evaluation: Pulse remains the same, Phlegm-Qi has not descended. Remove Armeniacae Semen (Xingren) from the previous formula, add Brassicae Semenis Albi (Baijiezi).
Jin (46 years old) Damp-Heat steaming internally, Phlegm-Fire increasing daily, the root gradually weakening. Yang leakage manifests as sweating, Yin leakage manifests as seminal emission. Alcoholics prefer refreshing foods; cloying and tonifying medicinal formulas are absolutely contraindicated. (Damp-Heat Steaming Phlegm) Zhu Du Wan (Pig Stomach Pill) formula.
Ye Long-term residence in southern humid lands, dampness from water and grain steams into heat and gathers into Phlegm. Pulse is deep and wiry, yellow eyes, limbs prone to sores. All indicate excess Damp-Heat, causing Qi tunnels to be unsmooth.
Treatment should use bitter, acrid, cold herbs to clear the interior and unblock the muscles. Following predecessors' theory that "Phlegm arises from Heat," clearing heat is essential.
Atractylodis Rhizoma (Sheng Maozhu), Phellodendri Cortex (Huangbai), Trichosanthis Fructus (Gualou Shi), Gardeniae Fructus (Shanzhi), Raphani Fructus (Laifuzi), Coptidis Rhizoma (Chuanlian), Pinelliae Rhizoma Preparatum (Banxia), Magnoliae Officinalis Cortex (Houpo), Citri Reticulatae Pericarpium (Juhong), Bamboo Juice and Ginger Juice Pills.
Certain case Post-illness, rich flavors steam and generate Phlegm.
Natrii Sulfas (Fenghua Xiao), Trichosanthis Semen Frost (Gualou Ren Shuang), Ziziphi Spinosae Semen (Zhishi), Curcumae Radix (Yujin), Raw Poria (Sheng Fuling), Gardeniae Fructus stir-fried with Ginger Juice (Jiangzhi Chao Shanzhi).
Pills made with Bamboo Juice method.
Wang Pulse distension, Dampness obstructing Hot Phlegm.
Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Gardeniae Fructus (Heishanzhi), Citri Reticulatae Pericarpium (Juhong), Processed Tribuli Fructus (Zhi Bajili), Polygalae Radix (Yuanzhi), Costi Fructus (Xiangxiang).
Xu Yang moves internally generating Wind; using herbs to nourish Liver and Kidney Yin to strengthen Water and control Yang is also a reasonable approach. In summer, Spleen and Stomach govern; Liver-Gallbladder Fire and Wind easily penetrate the diaphragm and invade the Middle. Middle Earth is insulted by Wood and Fire, Yangming pulse declines, excessive Phlegm, meridians are unsmooth. Proposal: Clear Shaoyang depressive heat so the Middle Palace becomes peaceful. If one fears deficiency and uses cloying tonics, the Upper and Middle become more full, while the Lower Jiao becomes more deficient. Er Chen Tang minus Glycyrrhizae Radix et Rhizoma, plus Dendrobii Nobile Caulis (Jinhu), Mori Folium (Sangye), Moutan Cortex (Danpi). (Wood-Fire invading Middle, Stomach Deficiency generating Phlegm)
Re-evaluation: Left pulse is floating, wiry, and rapid. Excessive Phlegm, discomfort in the epigastrium,烦躁 (vexation) causes Fire rising and dizziness; quiet sitting brings mental peace. Proposal: Treat Shaoyang and Yangming simultaneously.
Cornu Saigae Tataricae (Lingyangjiao), Forsythiae Fructus (Lianqiao), Citri Reticulatae Pericarpium (Guangpi), Prepared Pinelliae Rhizoma Qu (Chao Banxiaqu), Gardeniae Fructus Peel (Heishanzhi Pi), Fermented Soybean (Xiangchi).
Re-evaluation: Pulses on both hands have harmonized, only vexation,恍惚 (fluctuation/confusion), and desire for dizziness remain. Proposal: Use calming herbs to nourish Yin and harmonize Yang.
Ginseng Radix et Rhizoma (Renshen), Prepared Rehmanniae Radix (Shudi), Asparagi Radix (Tiantong), Lamina Aurum (Jinpiao).
Wang Phlegm-Fire is abundant in the Upper, Kidney Qi lacks grasping power. Morning: Unblocking and grasping Lower Jiao methods. Evening: Clearing and purifying Upper Jiao methods. (Liver-Kidney Deficiency with Phlegm-Fire above)
Cornu Saigae Tataricae (Lingyangjiao), Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Citri Reticulatae Pericarpium (Juhong), Gardeniae Fructus Peel (Heizhipi), Curcumae Radix (Yujin), Decoction of Ilex Kudingcha Tea (Kudingcha) for evening pills.
Prepared Rehmanniae Radix (Shudi), Cynomorii Fenestrati Rhizoma (Dancongrong), Lycii Fructus (Qizi), Schisandrae Fructus (Wuweizi), Achyranthis Bidentatae Radix (Niuxi), Poria (Fuling), Polygalae Radix (Yuanzhi), Gelatinum Corii Asini (Xianjiao), Honey Pills for morning consumption.
Cao (51 years old) Bright complexion indicates Phlegm-Fluid above, because Excess above leads to Deficiency below. Over fifty years old, unable to conceive. Pulse: Left small and restless, Right wiry and slippery. Treatment should clear Lung-Stomach Hot Phlegm and nourish Liver-Kidney Essence-Blood. Following Manqian's health preservation method.
Swallow Nest Gelatin (Yanwo Jiao), Sweet Pear Paste (Tianli Gao), Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Ophiopogonis Radix (Maidong), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Atractylodis Macrocephalae Rhizoma (Yuzhu), Huangjie, Heijie, Cervi Cornu Gelatinum (Luwei Jiao), Sheep Kidney (Yang Neishen), Cynomorii Fenestrati Rhizoma (Dancongrong), Psoraleae Fructus (Guzhi - steamed with Walnut), Green Salt (Qingyan).
Rui Always has excessive Phlegm and poor appetite, but Shen and Atractylodes did not suit him. This constitution is Yang-type, intolerant of warm-hot and harsh-drying agents. Last winter was warm; entering spring, Phlegm increased further, body felt slightly fatigued, due to unstable storage of Zang-Fu essence. Spring Qi rises from the earth. Treatment should grasp Kidney and secure True Qi; this is the root of treating Phlegm, making the prescription beneficial. (Kidney Deficiency with Excessive Phlegm)
Prepared Rehmanniae Radix (Shudi), Poria (Fuling), Psoraleae Fructus (Buguzhi), Walnut Kernel (Hutao Rou), Lycii Fructus (Qizi), Schisandrae Fructus (Wuweizi), Achyranthis Bidentatae Radix (Niuxi), Polygalae Radix (Yuanzhi), Plantaginis Seed (Cheqian), Honey Pills.
The manifestations of Phlegm diseases vary unpredictably. Ancients did not investigate root and branch, often focusing on Phlegm-resolving prescriptions and theories. Later generations followed these methods without success, leading some to call Phlegm a strange disease. They did not realize that Phlegm is the branch (symptom), not the root (cause). Skilled practitioners treat the source that generates Phlegm, so Phlegm disappears without direct resolution. I have carefully examined: Phlegm is transformed from food and drink. It can arise from external invasion of Six Qi pathogens, disrupting the ascending-descending mechanism of Spleen, Lung, and Stomach, leading to unclear transformation of food. It can arise from excessive consumption of sweet, greasy, fatty, fishy, tea, and alcohol. It can arise from inherent Spleen-Stomach Yang deficiency, causing damp-turbidity to coagulate. It can arise from depression causing Qi and Fire to stagnate and transform. There is also Phlegm generated by Kidney Deficiency causing water to overflow. This is due to Earth failing to control Water, causing Yin turbidity from Kidney to rebel upward, not actual water flooding from the Kidney itself. Furthermore, in Yin Deficiency consumptive diseases, Dragon and Minister Fire flaming upward scorches the Lung, causing Phlegm-cough. This Phlegm is transformed from body fluids and is not thick. Attempting to resolve it is not only useless but damages fluids. All other Phlegms initially arise from Dampness. Although named Wind, Fire, Dryness Phlegm, they all transform via Qi; Wind, Fire, and Dryness do not generate Phlegm independently. The primary treatment method: only when Phlegm and Qi suddenly block the throat should one temporarily use expectorant and Qi-descending agents to open it. Otherwise, one must treat the root. Thus, the ancient saying "Do not treat Phlegm when seeing Phlegm" is a timeless maxim. Phlegm is transformed from food dampness and turbidity; how can one forbid diet? If one solely tries to resolve it, for cases due to external pathogens, resolving the pathogen may clear the Phlegm, e.g., warming Cold Phlegm, clearing Heat Phlegm, drying Damp Phlegm, moistening Dry Phlegm, dispersing Wind Phlegm. For cases involving the root, Phlegm will continuously regenerate until death. This is due to not knowing how to treat the root. Observing the cases here: for those due to depression and fire, opening depression and clearing fire is the sovereign herb, assisting with Phlegm resolution; for those due to dampness and heat, drying dampness and clearing heat with slight assistance of Phlegm-resolving herbs; for those due to Liver-Kidney deficiency, purely sedating and securing tonification. These truly understand the root of treating Phlegm. For Cold and Damp, refer to the Phlegm-Fluid section for combined treatment. (Commentary by Hua Xiuyun)
Xu's Commentary: The listed prescriptions are all for floating Phlegm in Lung and Stomach. For old Phlegm penetrating meridians and collaterals, occupying viscera, or hiding in the Triple Burner, there are still harsh and refined formulas; these types of formulas cannot achieve efficacy.