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Pathogenesis of Phlegm-Fire involves aversion to wind, fever, and a wiry-rapid pulse, which is indistinguishable from Cold Damage (Shanghan). However, by listening to the patient's cough and rapid breathing, one can identify it as caused by Phlegm-Fire. The onset of Phlegm-Fire stems from insufficient blood in the Spleen Meridian and excessive Stomach Fire, which boils down body fluids into phlegm. This phlegm ascends to the Lungs, causing cough and rapid breathing. Once Stomach Fire activates, Ministerial Fire (Xiang Huo) flares up in response, resulting in chills and fever. It is appropriate to use Shuzhong Shaoyao Decoction for three to four doses; thereafter, the pulse should become harmonious and slow. If the pulse remains wiry and rapid, or becomes large and forceful while rapid, this indicates "Solitary Yang without Yin," a critical condition often fatal. If the pulse slightly diminishes or becomes fine and rapid, treatment should depend on observing the sputum color: if yellow sputum is expectorated with chest discomfort due to food stagnation generating phlegm, Gualou Zhishi Decoction is suitable; if the sputum is blue-white, thin and not viscous, indicating Kidney deficiency where water boils to form phlegm, Jiawei Dihuang Decoction is suitable to nourish Water to control Fire, without being confined to merely treating phlegm. In the early stage, if there are no external symptoms like chills or fever, nor internal symptoms like irritability, heat, or rapid breathing, but only mental confusion, restlessness, limb weakness, low voice, poor appetite, and a deep, fine, and forceless pulse, Xiangsha Liujunzi Decoction is suitable; in severe cases, Bawei Dihuang Wan may also be used.

Shuzhong Shaoyao Decoction: Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma), Baifu (Poria), Gancao (Glycyrrhizae Radix et Rhizoma), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Zhiqiao (Aurantii Fructus Immaturus), Jiegeng (Platycodonis Radix), Baishao (Paeoniae Radix Alba), Mutong (Akebiae Caulis), Beimu (Fritillariae Bulbus), Gualou Shuang (Trichosanthis Semen), Tiandong (Asparagi Radix). Add Nongpo (Magnoliae Officinalis Cortex) if there is food stagnation.

Gualou Zhishi Decoction: Chenpi, Baifu, Gancao, Zhishi (Aurantii Fructus Immaturus), Gualou Shuang, Beimu, Danggui (Angelicae Sinensis Radix), Jiegeng, Shanzhi (Gardeniae Fructus), Huangqin.

Jiawei Dihuang Decoction: Shudi (Rehmanniae Radix Preparata), Shanyao (Dioscoreae Rhizoma), Baifu, Danpi (Moutan Cortex), Shanyurou (Corni Fructus), Zexie (Alismatis Rhizoma), Tiandong, Maidong (Ophiopogonis Radix), Jiegeng, Gancao, Niuxi (Achyranthis Bidentatae Radix) (use double dose).

Xiangsha Liujunzi Decoction: Chenpi, Banxia, Baifu, Gancao, Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Sharen (Amomi Fructus), Xiangfu (Cyperi Rhizoma), Huoxiang (Agastaches Herba).

Coughing with sound but no phlegm is called "Ke" (cough), indicating Lung Qi injury and lack of clarity. Coughing with phlegm but no sound is called "Sou" (sputtering), indicating Spleen dampness stirring phlegm. Coughing with both sound and phlegm is called "Kesu" (cough and sputtering), indicating phlegm generated by the Spleen transmitted to the Lungs. Wind-Cold and consumptive cough have their own sections; seasonal coughs must be distinguished. Danyu stated: Spring is ascending Qi; Summer is fire blazing upward most severely; Autumn is damp-heat injuring the Lungs; Winter is Wind-Cold constraining externally. The so-called ascending Qi refers to Spring when Wood is prosperous, Liver Fire is excessive, attacking Lung Metal, causing cough. Qinggan Ningsou Decoction is suitable, and the pulse must be wiry and rapid as evidence. If cough persists for a long time, Guishao Dihuang Decoction is suitable. Since Kidney Water is the mother of Liver Wood, weak Kidney Water lacks the root for growth and nourishment, leading to internal heat and cough. Guishao Dihuang Decoction treats the root. The so-called fire blazing upward refers to Summer when Heart Fire dominates, attacking Lung Metal, like Metal being overcome by Fire, a mutual destruction in Five Elements, with extremely severe symptoms. If not treated urgently, it may persist until Autumn. Long-term cough often becomes consumption (Lao Qie); Guishao Dihuang Decoction or Tianwang Buxin Dan may be used. The so-called damp-heat injuring the Lungs refers to after the Autumn Equinox when Dry Metal dominates; the wind arising is entirely dry air, unlike before the equinox where heat contains dampness. Hence grass turns yellow, trees shed leaves. The human body responds with dry Lungs and Stomach, withered fluids, causing cough. Danyu's statement that damp-heat injures the Lungs might be a printing error and should not be taken as definitive theory. In such cases, Guishao Dihuang Decoction is also used. The so-called Wind-Cold constraining externally refers to Winter when cold weather easily harms people. Those affected by Wind have a fine-slow pulse; those affected by Cold have a floating-rapid pulse, which can be distinguished. Generally, although seasonal coughs differ, in Southeast regions, heat and phlegm are common. First use agents to clear Metal and transform phlegm, then treat the root individually. Do not abruptly use cloying medicines like Rehmannia. (Profound insights) are crucial. For cough with rapid breathing and chest tightness, treatment must distinguish excess and deficiency. Excess presents with a deep-slippery pulse; Erchen Tang with food-resolving herbs can be used. If the pulse is wiry-fine-rapid, with slight chills/fever, and stool is difficult to pass, it is extremely dangerous. Neither purging nor tonifying is applicable; only nourishing Blood, transforming phlegm, strengthening Spleen, and resolving food stagnation remain, leaving fate to heaven. This section is absent in other books and should not be overlooked lightly. (Superb discussion, clear understanding, differentiating medications by season, elucidating unpublished ancient texts. Note: The source of cough indicated in Neijing is 'accumulated in Stomach, related to Lungs'; careful study leads to personal comprehension.)

Qingan Ningsou Decoction: Chaihu, Huangqin, Huafen (Trichosanthis Radix), Gancao, Chenpi, Baifu, Danggui, Baishao, Maidong, Danpi, Jiegeng, Beimu.

Guishao Dihuang Decoction: Danggui, Baishao, Maidong, Jiegeng, Shudi, Danpi, Shanyao, Baifu, Zexie, Shanyu (Corni Fructus).

Ningsou Jianpi Decoction: Danggui, Baishao, Maidong, Chenpi, Shanzha (Crataegi Fructus), Shenqu (Medicated Leaven), Xingren (Armeniacae Semen Amarum), Beimu, Zexie, Yiren (Coicis Semen). Add Nongpo if chest is not wide.