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XVII. Question: Since the right kidney is already one of the five zang organs, why is its tangible form not counted to complete the number in the twelve meridians, but instead replaced by the pericardium (Hand-Jueyin Pericardium Meridian)? What is the reason for this?

Shengshengzi said: Your inquiry is detailed. Although the *Nan Jing* (Classic of Difficult Issues) states that the right kidney and Mingmen (Gate of Life) constitute one zang organ, it has no meridians and vessels externally belonging to it. Furthermore, it says "its qi communicates with the kidney," implying that they are essentially just the kidney. This may refer to the concept of "Xi Kan" (repeated danger/deep water, symbolizing the deep storage of water virtue). The *Huang Ting Jing* (Yellow Court Classic) states: "The color of the North is black, internally connecting to the Kidney, opening at the two yin orifices. The left kidney belongs to Ren, the right kidney belongs to Gui (both Ren and Gui belong to Water)." The *Su Wen* (Basic Questions), Chapter 6 "Zang-Xiang Theory," states: "The Kidney governs hibernation, is the root of sealing and storing, and is the residence of essence." It receives and stores the essence of the zang and fu organs (essence also belongs to Water). Because these all belong to Water, they are collectively governed and attributed to the Foot-Shaoyin Kidney Meridian. This represents a unity of two and a duality within one. As for the Hand-Jueyin Pericardium, it has external meridians and vessels, belongs to Ministerial Fire, and is affiliated with the hand meridians. Considering the pattern of yin-yang pairing between hand and foot meridians, hand does not pair with foot, fire does not pair with water, and yin does not pair with yin. Therefore, it cannot be included in the number of the twelve meridians. Moreover, fire rises and stays high, while water descends and stays low; water and fire do not intrude upon each other.

XXIX. Discussion on Phlegm being generated from body fluids and spleen dampness, as well as arising from fire, deficiency, qi stagnation, and food retention. However, strong and purgative formulas like Er Chen Tang should not be used indiscriminately.

Shengshengzi said: Phlegm is generated from body fluids. The Classics state: "When food and drink enter the stomach, their essence floats and overflows, transmitting upwards to the Spleen. The Spleen scatters the essence, sending it upwards to return to the Lung. [The Lung] regulates the water passages, transmitting downwards to the Bladder. Water essence distributes throughout the four directions, running through the five meridians in accordance with the four seasons and the yin-yang of the five zang organs, serving as the standard measure." If spleen deficiency leads to dampness stagnation, the normal function of vigorous transportation is lost. It fails to deliver essence to the Lung, thus forming phlegm. This is phlegm generated by spleen dampness. In cases of insufficient yin blood, ministerial fire rebels upward, insulting the Lung so that it cannot descend clearly and purely. Consequently, body fluids become turbid and coagulate, generating phlegm instead of blood. This is phlegm formed due to yin deficiency and fire agitation. From this, we know that phlegm, as a substance, is clearly composed of spleen dampness and body fluids. When treating phlegm, one must investigate its source. Secular practice commonly uses Er Chen Tang to treat all types of phlegm without distinguishing cold from heat. For phlegm caused by dampness, this is indeed appropriate. Ban Xia (Pinelliae Rhizoma) dries spleen dampness; Chen Pi (Citri Reticulatae Pericarpium) benefits lung qi; Fu Ling (Poria) enters the Taiyin Lung meridian to promote downward flow of water; Gan Cao (Glycyrrhizae Radix et Rhizoma) harmonizes the properties of the herbs and acts as an envoy to the Spleen. These three ingredients are drying and damp-resolving agents with rigid and fierce properties. They cause water to move and qi to descend, removing dampness and drying the earth, thereby eliminating phlegm and strengthening the spleen. However, if the spleen lacks cold-dampness, how can it withstand such treatment? Thus, Er Chen Tang treats phlegm not generally, but specifically phlegm caused by dampness. Regarding phlegm where fire injures Lung Metal, preventing descent, using Er Chen Tang is negligent. If caused by fire, treat the fire; once fire subsides, Lung Metal clears, the autumnal energy (descending) functions, water flows without obstruction, and from where would phlegm arise? Zhu Danxi said: "Huang Qin (Scutellariae Radix) treats hot phlegm by borrowing its fire-descending power," which refers precisely to this. If Er Chen Tang is used uniformly, I fear the spleen will become drier and fire more agitated. Not only will the disease persist, but symptoms such as sore throat, hoarseness, coughing, night sweats, irritability, and thirst will increase. There is also phlegm due to food retention. Overeating damages the Spleen; spleen damage leads to qi deficiency; qi deficiency causes dampness stagnation; dampness stagnation generates phlegm. One should use formulas like Bao He Wan (Preserve Harmony Pill). There is also phlegm generated by qi stagnation. Yan Yonghe stated: "The qi pathway in humans values smoothness. Smoothness allows body fluids to circulate freely, preventing phlegm-fluid disorders." Therefore, treating phlegm requires first benefiting qi. The origin of phlegm lies in emotional depression, unclear qi pathways, and qi accumulation producing saliva/phlegm. By regulating qi, opening depressions, and smoothing the qi pathway, where would phlegm-fluid remain? Formulas like Qi Qi Tang (Seven Qi Decoction) or Yue Ju Wan (Relieve Depression Pill) are appropriate. There is also wind-phlegm, caused by exterior deficiency and loose interstices allowing wind pathogens to invade. Lung qi becomes obstructed, pathogenic factors stagnate and transform into heat, resulting in thick, sticky turbid nasal discharge. Treatment should scatter wind and benefit qi, using herbs such as Xing Ren (Armeniacae Semen Amarum), Zhi Ke (Aurantii Fructus), Zi Su (Perillae Folium), and Qian Hu (Peucedani Radix). There is fright-phlegm. Fright causes the spirit to lose its dwelling, qi becomes chaotic in the chest, clear and turbid interfere with each other, pulse channels become obstructed, and phlegm is generated. Fright-phlegm often causes heart pain and epilepsy. Treatments include Niu Huang Zhen Xin Wan (Calming Heart Pill with Calculus Bovis). There is cold-phlegm, caused by spleen and stomach weakness failing to transport and transform fine essences. Qi deficiency leads to slow movement, causing body fluid stagnation. Treatment should warm the spleen and stomach. Once the spleen is robust, body fluids circulate. Herbs such as Gan Jiang (Zingiberis Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) are suitable. There is also phlegm due to kidney deficiency failing to control fire. Body fluids generate phlegm and fail to produce blood. The Lung governs exhalation, and the Kidney governs inhalation. Now, kidney deficiency fails to grasp qi and return it to its origin. Exhalation without inhalation leads to accumulation; accumulation without dispersion generates phlegm. Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) is used. It contains Fu Ling (Poria) and Ze Xie (Alismatis Rhizoma) to promote downward water flow, eliminating dampness and cutting off phlegm; Di Huang (Rehmanniae Radix) and Shan Yu (Corni Fructus) tonify and fill kidney water. As water rises, fire naturally descends, fulfilling the function of storage. Regarding insufficiency of middle qi leading to phlegm accumulation, the stomach also relies on nourishment. Strong draining medicines should not be used harshly, lest stomach injury lead to unpredictable ominous changes. Warm tonification is preferred to enrich the spleen and stomach, allowing phlegm to flow naturally, such as Liu Jun Zi Tang (Six Gentlemen Decoction). This is why Danxi earnestly warned against the misuse of strong draining medicines. For Li Yin, Zhi Yin, Fu Yin, Xuan Yin, and Yi Yin (types of fluid retention) that have persisted for years and are stubbornly difficult to treat, one must assess the patient's constitution. Depending on suitability, employ sweating, vomiting, purging, or melting/dissolving methods to forcibly remove them. After phlegm removal, tonification and nourishment are necessary to ensure the middle qi is substantial, avoiding the errors of harsh purgation. Scholars should understand this.

Someone asked: Danxi said, "Solidifying spleen earth and drying spleen dampness is the root of treating phlegm." He also said, "Er Chen Tang manages phlegm throughout the body and is the essential medicine for treating phlegm. To direct it upward, add guiding herbs; to direct it downward, add descending herbs." Do you consider these words not to be Danxi's? I replied: These likely refer to phlegm generated from spleen-stomach dampness transformation. The spleen and stomach are the sea of water and grain, receiving qi from the five zang and six fu organs. Human emotions and living habits cannot always adhere to moderation. Slight depression causes qi and blood stagnation, body fluids fail to circulate, and phlegm is generated. Hence, Danxi often emphasizes solidifying spleen earth and drying spleen dampness. For example: "Phlegm in the hypochondrium cannot reach without Bai Jie Zi (Brassicae Semenis); phlegm in the four limbs cannot pass without Zhu Li (Bambusae Succus); phlegm inside the skin and outside the membranes cannot be removed without Jiang Zhi (Zingiberis Juice) and Zhu Li; phlegm in qi-deficient persons cannot be opened without Zhu Li." He also said: "Phlegm nodules in the throat, dry and unable to expectorate, should be treated with phlegm-resolving herbs added with salty substances that soften hardness, such as Gua Lou Ren (Trichosanthis Semen), Xing Ren (Armeniacae Semen), Hai Shi (Calcium Carbonatum), Jie Geng (Platycodonis Radix), Lian Qiao (Forsythiae Fructus), with a little Po Xiao (Natrii Sulfas), made into pills with ginger juice and honey to be held in the mouth." He further stated: "Tian Hua Fen (Trichosanthis Radix) greatly descends upper jiao hot phlegm. Hai Fen (Sea Powder/Calculus Bovis or similar) descends hot phlegm, dries damp phlegm, softens knotted phlegm, and eliminates stubborn phlegm. Zhi Shi (Aurantii Fructus Immaturus) treats phlegm, capable of breaking through walls. Ren Zhong Huang (Human Middle Yellow/Nitrum) descends yin fire and clears food-retention phlegm." He also said: "When phlegm rebels upward due to excessive fire, treating fire is primary, using Bai Zhu (Atractylodis Macrocephalae Rhizoma), Huang Qin (Scutellariae Radix), Shi Gao (Gypsum Fibrosum). In chronic illness with rising yin fire, where body fluids generate phlegm instead of blood, one should tonify blood and control ministerial fire; the phlegm will resolve itself." Danxi never relied solely on Er Chen Tang. The aforementioned phlegm-treating herbs are numerous. Did Danxi ever adhere rigidly to this? No, he established methods based on clinical reasoning. Physicians must achieve thorough understanding and adaptability; otherwise, what distinguishes them from carving a mark on a boat to find a sword?