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Phlegm formation arises from dampness, heat, cold, wind, advanced age (deficiency), and food stagnation. When the pulse is floating, emesis should be used; phlegm above the diaphragm must be expelled by emesis; phlegm in the meridians cannot be removed without emesis, which inherently contains the meaning of dispersing. For example, epilepsy may result from fright; fright causes the Shen (Spirit) to leave its residence (the Heart), leaving it empty so that pathogenic phlegm enters; once phlegm occupies the residence, it obstructs the Shen, preventing its return. Phlegm in the intestines and stomach can be cured with purgation. Damp-phlegm is treated with herbs like Cangzhu (Atractylodis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma); Heat-phlegm with Qingdai (Indigo Naturalis), Huangqin (Scutellariae Radix), and Lianqiao (Forsythiae Fructus) [Note: Original text says Qin, Lian, usually Huangqin, Huanglian]; Cold-phlegm with Erchen Tang (Two-Cured Decoction); Wind-phlegm with Tian Nanxing (Arisaematis Rhizoma) and Baifuzi (Girardiniae Semen); Old-phlegm with Haishi (Pumice) and Gualou (Trichosanthis Fructus); Food-stagnation phlegm with Shenqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus). If Qi is excess and phlegm-heat are knotted, making emesis difficult, or if it forms clumps that cannot be expectorated, indicating Qi stagnation, it is difficult to treat. Phlegm located superiorly that is sticky, solid, and turbid must be expelled by emesis. Emetic methods often use sprouted tea, pickled vegetable juice, ginger juice, a little vinegar, and a small amount of Gudi San (Melon Stalk Powder), plus Jiegeng (Platycodonis Radix) and Fangfeng (Saposhnikoviae Radix), all working by raising Qi to induce vomiting. Another method uses Fuzi Jian (Tip of Prepared Aconite Root Lateral Child Root), Jiegeng, Lurenshen (Asparagus Fern Root), Gudi, and Lilü. Arsenic (Pi) is rarely used, only in critical emergencies. Mugwort leaves and powdered tea can also induce spontaneous vomiting without manual stimulation; both powder and decoction can be used. Before inducing vomiting, bind the waist tightly with a cloth belt and perform this method in a draft-free area. Use half a sheng of radish seeds, grind them, mix with one bowl of fermented grain water, filter out the dregs, add a little oil and honey, simmer until lukewarm, drink, and stimulate vomiting with a goose feather. The goose feather should first be soaked in tung oil, then washed with soap pod water to remove the oil, and dried before use. Shrimp juice is also an effective emetic. If vomiting persists, antidotes are needed: Shexiang (Moschus) counteracts Lilü and Gudi; Congbai (Allii Fistulosi Bulbus) counteracts Gudi; water and Gancao (Glycyrrhizae Radix et Rhizoma) generally counteract toxins. Any nodules in the body that are not red, not painful, and do not suppurate are caused by phlegm accumulation. If a patient responds poorly to various medicines but the Guan pulse is deep and large, it indicates phlegm. Darkening of the eyelids and under-eye area resembling smoke stains also indicates phlegm. Any lumps in the upper, middle, or lower parts of the body are phlegm; inquire about dietary preferences, and after emesis or purgation, use specific medications to resolve them. Strengthening the Spleen Earth and drying Spleen Dampness is the fundamental method for treating phlegm. Scholar Xu stated: Using Cangzhu to treat phlegm-fluid forming "cocoons" is extremely effective; phlegm mixed with blood and fluid forms cocoons. Chronic phlegm diseases presenting with a choppy pulse are hard to open suddenly and require prolonged regulation. Erchen Tang added with Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) moistens the bowels and promotes urination, widening the chest and diaphragm. Internal injury with phlegm requires Renshen (Ginseng Radix et Rhizoma), [missing character, likely Huangqi], and Baizhu, often taken with ginger juice, or added with Banxia (Pinelliae Rhizoma); for severe deficiency, add Zhuli (Bambusae Caulis in Taenia). Heat-phlegm often accompanies wind, manifesting as exterior symptoms; if it forms clumps that cannot be expectorated and involves depression, it is difficult to treat. Damp-phlegm is soft, causing fatigue and heaviness. Wind-phlegm presents with unusual symptoms. Food-stagnation phlegm requires simultaneous attack and tonification; for Qi deficiency, send it down with Qi-tonifying herbs. If fire is excessive and rebellious, treat the fire first with Baizhu, Huangqin, and Shigao (Gypsum Fibrosum); if Middle Qi is insufficient, add Baizhu and Renshen, then treat the phlegm. Phlegm moves up and down with Qi, reaching everywhere; many diseases involve it, yet most people do not recognize it. For Spleen deficiency, clear the Middle Qi to transport and descend phlegm using Erchen Tang plus Baizhu, along with Shengma to raise Qi. In deficient patients with phlegm, Stomach Qi relies on nourishment, so do not completely attack; over-attacking increases deficiency. Vertigo and epigastric discomfort stem from fire agitating phlegm; treat with Erchen Tang plus Zhizi (Gardeniae Fructus), Huangqin, and Huanglian. Phlegm nodules in the throat that are dry and unable to exit require phlegm-resolving herbs with salty flavors to soften hardness, such as Gualou, Xingren (Armeniacae Semen), Haishi, Jiegeng, and Lianqiao, with a little Fengxiao (Natrii Sulfas Exsiccatus) and ginger, made into honey pills to be held in the mouth. Phlegm in the subcutaneous tissue and meridians requires Jiangzhi (Ginger Juice), Zhuli, and Jingli (Schizonepetae Herba Juice). Phlegm in the four limbs requires Zhuli. A sensation of a foreign body in the throat that cannot be coughed up or swallowed is phlegm. Severe cases require emesis; mild cases use Gualou; excess Qi cases require Jingli. For blood stasis with fluid retention in the Middle Jiao, drink three to four cups of chive juice chilled; temporary chest irritability is normal, and recovery follows. Haifen (Sea Powder) descends heat-phlegm, dries damp-phlegm, softens knotted-phlegm, and eliminates stubborn-phlegm; suitable for pills, not decoctions. Huangqin treats heat-phlegm by descending fire. Zhishi (Immature Bitter Orange Fruit) drains phlegm powerfully. Tianhuafen (Trichosanthis Radix) treats upper diaphragm heat-phlegm. Wubeizi (Chinese Gall) combined with other herbs treats stubborn-phlegm. Gualou and Huashi (Talcum) treat food-stagnation phlegm by cleansing the organs. Oil-fried Banxia treats damp-phlegm and wheezing/cough/heart pain; take thirty pill doses with congee and ginger decoction. Xiaowei Dan damages Stomach Qi; food-stagnation phlegm patients should not take it frequently. Formula for damp-phlegm: Huangqin, Banxia, Xiangfu (Cyperi Rhizoma), Beimu (Fritillariae Cirrhosae Bulbus); adding Gualou and Qingdai treats heat-phlegm as pills. Clear phlegm uses Erchen Tang. Treating wind-phlegm requires Baifuzi, Tianma (Gastrodiae Rhizoma), Xionghuang (Realgar), Niuhuang (Calculus Bovis), Jiangcan (Bombyx Batryticatus), and Zhuya Zaojiao (Ziziphus Spinosae Spina/Pulse). Zhonghe Wan treats damp-phlegm with Qi-heat: equal parts Cangzhu, Huangqin, Banxia, Xiangfu, powdered and formed into congee pills. Formula for drying damp-phlegm: Nanxing (1 liang), Banxia (2 liang), Ge Fen (Concha Meretricis et Cyclinae), powdered, steamed dough pills coated with Qingdai. Formula for Yin deficiency with internal food-stagnation phlegm: Zhen Chuanxiong (7 qian), Huanglian, Gualou Ren, Baizhu, Shenqu, Maiya (1 liang each), Qingdai (5 qian), Renzhongbai (3 qian), powdered, ginger juice steamed dough pills. Zhuli treats inter-diaphragmatic phlegm, mania, amnesia, or wind-phlegm, and nourishes blood; used with Jingli. Xiaowei Dan treats damp-heat phlegm accumulation and leukorrhea: Gansui coated in wet flour, boiled in running water until permeable, washed, dried; Daye boiled in running water for one hour, washed, dried; Yuanhua mixed with good vinegar, left overnight, stir-fried in a clay pot until black without burning; Dahuang wrapped in paper, moistened, baked in ash fire until dry, unwrapped, cut, dried, then fried with wine until hot; Huangbai stir-fried double the amount of Dahuang; all ground, mixed, formed into congee pills size of hemp seeds, 12 pills per dose. Alternative: Reduce Gansui and Daye by one-third, coat with Cinnabar, named Chen Sha Hua Tan Wan. Phlegm formula: Nanxing, Banxia (1 liang each), Ge Fen (2 liang), specifically for damp-phlegm. Add Qingdai for heat, Cangzhu for damp, Shenqu, Maiya, Shanzha for food stagnation. Alternative: Huangqin, Xiangfu, Banxia, Gualou, Beimu, Qingdai, powdered, congee pills. Treat food-stagnation phlegm-fire and purge Stomach fire: Ruanguoshi (Soft Gypsum) fine powder, vinegar pills, mung bean size, 10 pills per dose. Qingmengshi Wan resolves food stagnation and removes damp-phlegm; adjust for cold/heat/excess/deficiency. Qingmengshi (0.5 liang, processed), Banxia (7 qian), Nanxing, Fuling, Pianqin (0.5 liang each), Fazhi Xiao (3 qian): Boil Xiao with radish, remove radish, filter through silk, let crystallize, powder, form with wheat paste. Add Cangzhu and Huashi. Alternative: Banxia (2 liang), Baizhu (1 liang), Fuling, Chenpi (0.75 liang each), Huangqin, Mengshi (0.5 liang each), Fenghua Xiao (2 qian). Phlegm-wheezing formula: Zaogui Hui (0.5 liang), Haifen, Luobozi (steamed), Nanxing (soaked in Bai Fan, dried, 1 liang each), Gualou Ren (1 liang), powdered, ginger-honey pills to be held in mouth. Alternative: Nanxing, Banxia, Xingren, Gualou, Luobozi, Qingdai, Xiangfu, malt paste pills. Qingjin Wan clears Lung fire and descends upper diaphragm heat-phlegm; use with Qinghua Wan. Huangqin powdered, water pills. Qinghua Wan formula: Bitterness dries damp-heat, lightness treats upper jiao, specifically for heat-cough and sore throat. Powdered, mixed with vinegar to apply to throat. Denglong Cao leaf powdered, steamed dough pills. Fuling Wan treats phlegm: Banxia (4 liang), Fuling (2 liang), Zhike (1 liang), Fenghua Xiao (5 qian). Treat depressed phlegm: Bai Jiangcan, Xingren, Gualou Ren, Hezi, Beimu, Wubeizi. Dao Yin Wan: Wu Zhu Yu (processed 3 qian), Fuling (1 liang), Huanglian (5 qian), Huashi (0.75 liang), Cangzhu (1.5 liang soaked in sweet water), powdered, malt paste pills, 100 pills per dose with ginger decoction. Baiyu Wan: Jiangzi (30), Nanxing, Banxia, Huashi, Qingfen (3 qian each), powdered, soap pod juice pills, sesame seed size, 5-7 pills per dose. Gualou Wan: Treats food stagnation, phlegm obstruction wheezing. Gualou Ren, Banxia, Shanzha Rou, Shenqu (equal parts), powdered, Gualou water pills, take 20 with ginger juice and Zhuli. Alternative: Banxia (1 liang), Cangzhu (2 liang), Xiangfu (2.5 liang), Huangqin, Huanglian, Gualou (1 liang each), powdered, malt paste pills. Qing Ge Hua Tan Fang: Huanglian (1 liang), Huangqin (1 liang), Huangbai (5 qian), Shanzhi (5 qian), Xiangfu (2.5 liang), Cangzhu (2 liang), powdered, malt paste pills. Sou Feng Hua Tan Wan: Renshen, Jiangcan, Huaiguozhi, Bai Fan, Tianma, Chenpi (deveined), Jingjie (1 liang), Banxia (4 liang soaked in ginger juice), Chen Sha (0.5 liang), powdered, ginger juice steamed dough pills, dried in shade, coated with Chen Sha, 40 pills with ginger decoction. Zhui Tan Wan: Effective for phlegm-fluid. Zhishi, Zhike (stir-fried, deveined, 0.5 liang), Hei Qianniu (half jin, head powder), Zhuya Zaojiao (2 qian wine-fried), Mingfan (3 qian, refined half), Pu Xiao (3 qian, exsiccated), powdered, radish juice pills, 40 pills at dawn; initially stools, then phlegm. Treat damp-phlegm: Cangzhu (1 qian), Baizhu (6 qian), Xiangfu (1 qian), Jiu Baishaoyao (2 qian), powdered, steamed dough pills. Treat obese person's damp-phlegm: Kushen, Banxia (1.5 qian each), Baizhu (2.5 qian), Chenpi (1 qian), one dose, 3 slices ginger, Zhuli and water, boil to one bowl, take far from meals, swallow Sanbu Wan 15 pills. Treat upper jiao wind-phlegm: Gualou Ren, Huanglian, Banxia, Zhuya Zaojiao (equal parts), powdered, ginger juice steamed dough pills. Treat phlegm-Qi: Pian Huangqin, Chenpi, Banxia (5 qian each), Baizhu, Baishaoyao (1 liang each), Fuling (3 qian), powdered, ginger juice steamed dough pills. Dispel wind-phlegm, move turbid Qi: Fangfeng, Chuanxiong, Ya Zao, Bai Fan, Yujin (1 liang each), Chi Bai Wugong (one each), powdered, steamed dough pills, sesame seed size, 25 pills before meals with tea soup; in spring, use Bajiao soup to probe for emesis. Li Ge Hua Tan Wan: Excellent for chest-diaphragm phlegm-Qi. Beimu, Banxia (0.5 liang each), Tian Nanxing, Ge Fen (1 liang each), Gualou Ren, Xiangfu (0.5 liang each), soaked in child's urine, powdered. Use 14 pods of Zhuya Zaojiao, crushed, boiled in 1.5 bowls water, add Xingren (de-skinned, de-pitted, 1 liang), boil until water nearly dry, remove pods, grind Xingren to paste, mix with previous powders, add ginger juice, form into green bean-sized pills, coat with Qingdai, dry, 50-60 pills per dose. Qing Tan Wan specifically treats chest phlegm accumulation (or Middle Jiao phlegm accumulation): Wumei (5 qian), Ku Mingfan (5 qian), Nanxing, Banxia (1 liang each), Huangqin (5 qian), Cangzhu (5 qian), Shenqu (1 liang), Tangli (1 liang), Qingpi, Chenpi (5 qian each), Xiangfu (1 liang), Huashi (stir-fried 5 qian), Gan Jiangsheng (1 liang), Zhishi (1 liang), powdered, steamed dough pills.

Case 1: A 79-year-old man had heavy, dizzy head and weak limbs, continuous expectoration of phlegm. Left pulse was scattered, large, and slow; right pulse was slow and large but weaker than left, powerless upon deep pressure. Slight decrease in appetite, slight thirst, bowel movement every 3-4 days. Using wind-dispersing herbs would lead to death by late spring; this is a severe deficiency syndrome. Treat with large doses of tonics: Huangqi, Renshen, Danggui Shen, Shaoyao, Baizhu, Chenpi, decocted strongly, taken with 30 Wanbi Pills. After 1.5 years, energy returned to youth levels. Wanbi Pill adds dried ginger in winter as a guiding herb; other seasons follow the base method. Huanglian and Huangbai are stir-fried with ginger juice to powder, formed into pills with ginger paste.

Case 2: A man near 30, fond of rich food and prone to anger, developed pain around the hip joint extending to the knee in autumn, worse at night, cold sensation at pain site, occasional thirst. Treated with wind-dispersing and blood-nourishing herbs, leading to swollen, painful knees by next spring, weight loss, knee swelling like a bowl, inability to bend/extend. Pulse string-like, large, somewhat excess, rapid, short. Frequent, short urination. Diagnosed as food-stagnation phlegm accumulation in Taiyin and Yangming. Banxia (5 qian), Huangbai (1 liang wine-fried), Sheng Gancao Shao (3 qian), Cangzhu (3 qian salt-fried), Chuanxiong (3 qian), Sheng Xijiao Xie (3 qian), Chenpi, Niuxi, Mutong, Shaoyao (5 qian each). Add Tiaohuangqin (2 qian) in heat/noise. Powdered, 3 qian per dose, ground with ginger juice, boiled with water, taken hot before meals, 4 times/day/night. After half month, rapid pulse decreased, pain eased, remove Xijiao, add Niuxei and Baiguiban (0.5 liang), Danggui Shenwei (0.5 liang). Continue. After another half month, swelling reduced, appetite improved, no longer cold-sensitive, only knee weakness. Remove Cangzhu, Huangqin. Summer: add Chao Huangbai to 1.5 liang. Add Niuxi. Spring/Summer use stem, Autumn/Winter use root; leaf juice is best. Avoid alcohol, meat, damp noodles, pepper. Middle-aged: add Shengdi (0.5 liang). Winter: add Yuzhu, Guizhi.

Case 3: A person had slight facial wind sensation like knife scraping, back not sensitive to cold, good appetite, string-like pulse, normal daily life. First use Chuanxiong, Jiegeng, Shengjiang, Shanzhi, Xiacha to induce phlegm emesis, then take Huanglian Daotan Tang.

Case 4: Brother-in-law, after drunken binge, spoke nonsense, saw hallucinations, accurately described deceased brother's past. Uncle scolded him: "Excessive fish and alcohol caused this phlegm." Gave large bowl of salt water, vomited one sheng of phlegm, profuse sweating, slept soundly, recovered.

Case 5: Jin family woman, young adult, returned from summer banquet, scolded by mother-in-law for seating error, felt ashamed, became ill with disordered speech and self-blame. Pulses string-like and rapid. I said: Not ghost evil, but disease. Prescribed Spleen-tonifying, phlegm-draining, heat-clearing. Should recover in days. Family disbelieved, consulted shamans who splashed water to frighten her; died after ten days.

Case 6: Woman over 50, angry at night, ate roasted pork, next morning face swollen, anorexic, fatigued. Six pulses deep, choppy, and hollow-large. Body deficiency, phlegm-obstruction failing to descend. Tonify deficiency, promote phlegm drainage. Morning: Large dose of Erchen Tang plus Renshen and Baizhu, followed by probing emesis to expel medicine. After Chen hour: Sanhe Tang tripled with extra Baizhu, two doses. Before sleep: Shen Wan seven pills to drain phlegm, remove Qianniu. Recovered after one month.

Case 7: Fu Xian's clerk, thirsty from labor in summer, drank plum water excessively, suffered 3-4 major frights, hallucinations, seemed possessed. Pulses deficient, string-like, deep, rapid. I said: Rapid indicates heat, deficient string-like indicates major fright, sour liquid retained in Middle Jiao. Tonify deficiency, clear heat, guide out phlegm stagnation. Prescribed Renshen, Baizhu, Chenpi, Huangqin, Huanglian, Fuling, strong decoction with Zhuli and Jiangzhi. No effect after ten days, others doubted prescription. I knew deficiency hadn't recovered, phlegm not guided out. Added Jingli to previous formula. Recovered after another ten days.

Case 8: Person with Yin deficiency and phlegm. Shenqu, Maiya, Huanglian, Baizhu (1 liang each), Chuanxiong (7 qian), Gualou Ren, Qingdai, Renzhongbai (0.5 liang each), powdered, ground with ginger juice, steamed dough pills.

Case 9: Person with damp-heat and fatigue, post-marriage chest discomfort, sensation of cold drink, choppy-large pulse. Previously took too many acrid-warm dispersing herbs, damaging Qi and Blood. Cangzhu, Banxia, Baizhu, Chenpi (5 qian each), Baishaoyao (6 qian), Guiban (7.5 qian), Chao Huangbai (1.5 qian), Huangqin (3 qian), Sharen, Gancao (1 qian each), powdered, steamed dough pills, 40-50 pills before meals with ginger decoction. Cold phlegm in diaphragm remained, so Xiaoxianxiong Tang added with small amount of Zhuyu as guide, formed into pills.

Case 10: Person with excess Qi and robust build, chronic chest-diaphragm Qi discomfort. Treated with Sanyi Chengqi Tang and phlegm-guiding herbs.

Case 11: Person with food stagnation, phlegm-Qi, weak Spleen. Beimu, Lianqiao, Maiya, Chenpi (0.5 liang each), Nanxing, Huangqin, Baizhu (1 liang each), Laifuzi (2.5 qian), powdered, steamed dough pills.

Case 12: Elderly person, vomiting phlegm, chest fullness, alternating chills and fever due to food injury. Used Erchen Dao Yin, Baizhu to tonify Spleen, Chaihu/Huangqin to reduce chills/fever, Cangzhu to release exterior cold, Sharen to stop vomiting and direct Qi downward.

Case 13: Woman with thick coating on tongue and pain, hardness below heart, Yangming phlegm-heat. Huangbai, Zhimu (honey-fried), Beimu (2 liang each), Gualou, Zhishi, Maiya, Jianghuang, Niuxi (0.5 liang each), powdered, kept on tongue. Then Baizhu (2 liang), Bidengqie, Laifuzi, Lianqiao, Shigao (0.5 liang each), Qingzi, Fengxiao, Shengma (3 qian each), powdered, steamed dough pills.

Erchen Tang is a key herb for phlegm, often ignored by the world. Pingwei San is commonly taken; why not Erchen Tang? With appropriate modifications, it is always effective. People value hearsay over sight, not just in this case.