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(Yin - Fluid Retention)
Phlegm (Tan, pathological accumulation of dampness and fluids) is originally the body's Jin-Ye (body fluids), circulating with Qi. If Qi is harmonious, Jin-Ye flows and spreads, nourishing all bones and joints; how could it become Phlegm and cause disease? If Qi loses its clear and descending nature and becomes overly hot, Jin-Ye is boiled by Fire and turns thick and turbid; or if Qi loses its warmth and becomes overly cold, Jin-Ye stagnates due to Cold and gradually condenses, thus forming Phlegm. Therefore, although Phlegm is one entity, the causes differ between Cold and Heat; can they be treated uniformly? The method of differentiation: ancients considered yellow and thick Phlegm as Heat, and thin and white Phlegm as Cold. This merely describes the general situation and should not be applied rigidly. Let us speak from the perspective of external contraction. I have verified this myself. In wind-cold injury with cough, Phlegm comes out with coughing, frequently and in large amounts. The color is always thin and white. Mistakenly treating it as Cold leads to worsening condition. Later, understanding the principle, I realized it was caused by extreme Heat. Because Fire was excessive and obstructive, frequent coughing expelled Phlegm quickly, leaving little time for it to turn yellow and thick. When Fire subsided and Qi calmed, coughing ceased, but the expelled Phlegm became yellow and thick, appearing only once every half day. This was because Fire no longer surged upward, allowing Phlegm to remain longer and undergo further boiling/concentration, leading to recovery. Thus, yellow and thick Phlegm indicates that Fire is relatively slow and mild; thin and white Phlegm indicates that Fire is actually urgent and excessive. These cases require acrid-cool dispersing methods and are unsuitable for warm-hot medicines. Speaking of internal injury: Kidney Fire deficiency causes Water to overflow into Phlegm; this Phlegm is clear and thin, requiring warm-hot treatment, which is certain. Even if Kidney Fire is excessive, causing Water to boil into Phlegm, this Phlegm is also clear and thin. Because Dragon-Lei Fire moves violently, rainwater follows, surging up suddenly; although slightly turbid, it cannot compare to yellow-thick Phlegm. It also requires sweet-cool tonification of Water and is unsuitable for warm-hot medicines. Who says thin-white Phlegm must belong to Cold? Generally, thin-white Phlegm that feels cold upon exiting the throat belongs to Cold. (I once had Phlegm that felt cold in the throat; although coughing was frequent, there were more non-coughing periods, and the pulse was not rapid. I recovered using stomach-warming and lung-astringent herbs. However, there are cases where Phlegm feels very cold in the throat, yet the syndrome is still Heat. This is because Phlegm is essentially Water; when accumulated for a long time and in large quantities, Fire cannot warm it. Hence, Zhang Zihe said: New Phlegm is Heat, old Phlegm is Cold.) Frequent vomiting due to wind-cold with constrained Heat, and internal injury with Dragon-Lei Fire movement, definitely belong to Heat. Due to Spleen Qi deficiency and Cold failing to control saliva, with frequent spitting everywhere, definitely belongs to Cold. (Such persons are quiet without other symptoms, neither wind-cold cough nor Dragon-Lei Fire movement, so it can be differentiated.) Such cases require careful differentiation and reference to the pulse. There are Jin-Ye generated by Qi transformation, and Jin-Ye derived from food and drink. The Stomach is the sea of Jin-Ye, so Phlegm gathers here. Accumulated over time and in large quantities, spreading with Spleen-Stomach Qi to all directions, it flows溢出 outside the intestines and stomach, within the body shell. Meridians become obstructed, skin and flesh become numb, even forming "nest-like sacs" (Ke-Nang) that are unbreakable, causing various harms. The treatment lies in balancing Qi: for Heat, restore the normal clear-descending state, like cool wind drying damp earth; for Cold, restore Yang harmony, like sunrise melting ice. Once Qi is balanced, the source of Phlegm is cut off, then the Phlegm retained inside the intestines/stomach and in the muscles/skin can be slowly addressed. Otherwise, the root remains, and Phlegm regenerates immediately after removal, never showing effect. Furthermore, Phlegm moves with Qi; having moved outside the intestines/stomach with Qi, it also enters back inside with Qi, like the tide's ebb and flow. Human Qi moves outward during the day and returns inward at night. Thus, upon waking in the morning and rinsing the mouth, Phlegm secretion is particularly heavy. Is this not because Phlegm returns to the Stomach with the night Qi? Therefore, what has gone out must be made to return, what is outside must be brought inside, to provide an exit. Otherwise, it lingers in the meridians, difficult to resolve. Yu Jiayan elucidated this theory, stating people should not eat at night, lest Stomach-Spleen Qi moves outward due to food digestion and fails to收 (receive/retain), making it hard for Phlegm to return to the Stomach. This is indeed a sound argument. However, labor and disturbance at night are strictly forbidden. By analogy, Yu's theory should be extended.

Wind-Phlegm belongs to the Liver: pulse is wiry, face is green, limbs ache and feel stifled/numb, urination and defecation are blocked and涩 (astringent/difficult). (See details in Two Excretions and Stroke sections.) Heart often has depression and anger, potentially leading to paralysis, convulsions, and dizziness. Use Shuizhu Jinhua Wan, Chuanxiong Wan, Fangfeng Wan, Qufeng Wan, Daotan Wan. Xing (Arisaema Cum Bile), Banxia (Pinellia), Tianma (Gastrodia), Yazao (Gleditsia Sinensis), Jiangcan (Bombyx Batryticatus), Qinjiao (Gentiana Macrophylla) all treat Wind-Phlegm and can use emetic methods. If suffocated unconscious by Phlegm, use Wuyao (Lindera), Zhike (Aurantii Fructus), Xing (Arisaema), Jiangzhi (Ginger Juice); instilling wakes them immediately.

Heat-Phlegm belongs to the Heart: pulse is surging, face is red, vexation, heat, dryness, thirst, excessive laughing, dizziness, epigastric discomfort, headache with eye ulcers, or a spot of cold on the back of the heart area, Phlegm is abundant, thick, and turbid. Use Xiaohuang Wan, Huangqin Lige Wan (see Pi), Guntan Wan. For purgation, use Kongxian Dan mixed equally with Pening (Basaltic mineral salt?), 30 pills per dose. Gualou Ren (Trichosanthis Semen), Huangqin (Scutellaria), Lian (Coptis), Qingdai (Indigo Naturalis), Shanzhi (Gardeniae Fructus), Er Dong (Tian Dong & Mai Dong), Zhuli (Bamboo Sap), Tongbian (Infant Urine) can be used. Caused by Summerheat: Xiaoshu Wan (see Shangshu).

Damp-Phlegm belongs to the Spleen: pulse is slow, face is yellow, limbs feel heavy, fatigue, weakness, desire to lie down, abdominal distension, indigestion, diarrhea, joint stiffness, or formation of masses, numbness and insensitivity. Use Baizhu Wan. Er Zhu (Zhu Ru & Bai Zhu), Xing, Banxia, Fuling (Poria), Zexie (Alisma) can be used. For masses, add Ruxiang (Frankincense), Moyao (Myrrh); for arm pain, add Bohe (Mint), Guizhi (Cinnamon Twig), Jianghuang (Curcuma); for rib distension, add Chaihu (Bupleurum), Baijiezi (White Mustard Seed), Qingpi (Aurantii Pericarpium Rubrum); Guntan Wan is most beneficial; for excessive fluid retention, Xiaowei Dan. Damp-Phlegm is abundant and easy to expectorate. Phlegm's movement is governed by Dampness, primarily controlled by the Spleen. It arises either from Spleen Qi stagnation or Spleen Qi deficiency and Cold failing to transport.

Qi-Phlegm belongs to the Lung: pulse is choppy, face is pale, Qi rises causing panting, chills and fever, sadness and unhappiness, wandering stabbing pain, distending pain in both ribs. Use Yufen Wan, Ju Fang Jiegeng Tang. Erchen Tang remove Gancao, add Xiangfu (Cyperi Rhizoma), Muxiang (Aucklandiae Radix), Sharen (Amomi Fructus), Zhike, Wuyao, Suzi (Perillae Fructus), Qingpi, Zhuli, Jiangzhi. For Qi depression, Qi Qi Tang (see Qi), Yueju Wan (see Yu). Phlegm is scanty, sticky, and hard to expel; this is Qi dryness. Moisten it with Donggen (Ophiopogonis Radix), Dihuang (Rehmanniae Radix), Gouqi (Lycii Fructus), etc., to make Lung Qi clear and descend.

Cold-Phlegm belongs to the Kidney: pulse is deep, face is black, feet are cold, heart often feels fearful, fullness obstruction, bone bi, limbs unable to move. Use Jianggui Wan, Ju Fang Hujiao Lizhong Wan. Ganjiang (Zingiberis Rhizoma) is absolutely essential; severe cases add Guizhi, Mahuang (Ephedrae Herba), Xixin (Asari Radix et Rhizoma). The root of Phlegm is Water, originating from the Kidney. Kidney Fire deficiency causes Water overflow into Phlegm; this Phlegm is clear. Use Bawei Wan. Fire excess causes Water boiling into Phlegm; this has turbid foam. Use Liuwei Wan. (Water boiling into Phlegm is acute obstruction. If Fire is not surging but merely hot and drying, Phlegm becomes thick and sticky. Both these types belong to Heat, not Cold.)

Also, fright causes Heart Spirit to leave its residence; empty residence allows Phlegm to enter, often forming Heart Pain and Epilepsy. Women suffering fright during childbirth often have this syndrome. Abdomen feels like a pregnancy mass, moving and jumping, unbearable pain. Use Gansui (Kansui Radix), Daji (Euphorbiae Pekinensis Radix), Baijiezi, add Zhusha (Cinnabar). For severe pain, add Quanxie (Scorpio); for masses, add Shanjiya (Manis Squama), Chao Biejia (Testudinis Carapax et Plastrum Cheloniae), Yuanhu (Corydalis Rhizoma), Ezhu (Curcumae Rhizoma).

Food stagnation generates Phlegm, often forming malaria-dysentery, pi masses, belching with food odor. Use Shanzha (Crataegi Fructus), Shenqu (Massa Medicata Fermentata), Maiya (Hordei Fructus Germinatus), Zhike, Muxiang, Huanglian (Coptidis Rhizoma). Guntan Wan is also excellent, or Baohe Wan (see Shang Yinshi). Alcohol generates Phlegm, often causing vomiting, nausea, poor appetite. Use Miaoying Wan plus Xionghuang (Realgar) and Quanxie, 2 qian each, 10 pills per dose.

Old Phlegm is Depressed Phlegm, forming sticky clumps, impossible to spit out. Treated with Nanxing (Arisaema Cum Rhizoma), Banxia, Fuling, Cangzhu (Atractylodis Rhizoma). Qingdai is the main herb, plus Wuweizi (Schisandrae Fructus), Haishi (Pteritum), Kugeng (Platycodonis Radix), Xuanfuhua (Inulae Flos), Gualou Ren, Mangxiao (Natrii Sulfas). Tanhe (Phlegm Nodule): Phlegm knots in the throat like a plum pit. Use half-green half-yellow plums, soak each in 1 liang of salt, sun-dry several times until water is gone. Place two plums between three large copper coins, tie tightly with hemp thread, store in a clay jar, bury underground for 100 days. Hold in mouth; juice swallowing dissolves it. Another method: Haishi, Wumei (Mume Fructus), Gualou, Jiegeng, Mangxiao, Shegan (Belamcandae Rhizoma), Zaocys (Haliploris), Jiangzhi, honey-made pills, hold in mouth. (See Yanhou.)

Under the head, face, neck, and body, subcutaneous nodules that are not red, painful, hard, or suppurating are all Tanhe. Spleen-Lung Qi rebellion, Phlegm stagnating internally resolves with regulating Qi and resolving Phlegm. Also, depression and anger damaging Liver-Spleen, blood pathology forming nodules: nourish Blood and clear Liver Fire. Externally apply Baiguo Rou (Ginkgo seed pulp) and Nanxing paste.

Phlegm in the body feels like lying on thorns or insects crawling; or migratory pain; or dry itching, scratching produces urticaria. Phlegm in skin/hair causes baking heat, color like brocade spots. Phlegm in the head causes hemi-cephalic wind, Lei Tou Feng (Thunder Head Wind), dizziness. Phlegm in the forehead causes frontal stuffiness/pain, brow ridge itching/pain. Phlegm in the eyes causes visual vertigo, eye twitching, sticky itching like ginger sting, sparks in eyes, seeing white mist, double moons, golden rays, darkness, or gray-black under eyelids. Phlegm in ears causes ear rim itching/pain, cicada buzzing/water sounds. Phlegm in nose causes congestion or smelling burnt odor. Phlegm in mouth causes tooth/gum itching/pain, swollen gums, mouth ulcers/tongue rot, dry mouth/thick saliva, vomiting cold saliva/green water/black juice, delirium, mutism. Phlegm in the face causes emaciation/scorched hair, swollen/hard jaw/cheeks, pseudo-pain. Phlegm in neck causes spontaneous swelling, circumferential nodules, throat obstruction, Phlegm like broken cotton/peach gum/clam meat, impossible to spit/swallow, choking/stuffiness, sensation of fire/smoke rising, facial heat, or fishy smell in throat. Phlegm in limbs causes shoulder/back soreness/swelling/hardness, pseudo-pain, wandering bone/muscle pain, hand numbness/arm pain resembling wind-damp, sudden collapse/cold limbs, numbness/heaviness/traction/inability to move. Requires Zhuli/Jiangzhi to open; use Erchen Tang + Zhike, Nanxing, Muxiang, Jianghuang. Phlegm in chest/heart causes belching/acid regurgitation/discomfort, pain/foulness (dry heaving), feeling of ice/iron in epigastrium, palpitations/fear of being chased, mental confusion like dementia, fullness/amnesia/nausea. Phlegm in spine causes a line or spot of coldness on the back, pain, or sensation of hot water pouring on back.

Phlegm in both ribs causes distending pain like boiling water; only Baijiezi can reach it. Phlegm in waist/kidneys causes sudden joint pain in waist, difficulty breathing. Phlegm in two excretions causes urinary retention/constipation, enuresis like rice water, post-defecation fish-jelly stool, amenorrhea in women. Phlegm in feet causes ankle soreness/weakness, walking like stepping on ash. Phlegm in dreams causes sleep paralysis, dreaming of torture/weapons, entering houses surrounded by walls with no exit, burning ground/smoke/bones/foul smell/no escape, waking from anger/sorrow without trigger, bizarre dreams indescribable. Li Zhongzi treats all with Guntan Wan.

Pang Anchang said: The human body has no upward-flowing Phlegm; the world has no backward-flowing water. Thus, good Phlegm-treaters treat Qi, not Phlegm. When Qi is smooth, body fluids follow smoothly. Combine Su Zi Jiang Qi Tang (see Qi) and Daotan Tang halves; or Xiao Banxia Fuling Tang + Zhishi, Muxiang 0.5 qian, swallow Wutao Wan; or decoct Wutao Wan ingredients as a drink. Good results.

Note: Phlegm is the branch (Biao); the cause of Phlegm is the root (Ben). Treating disease seeks the root, but must consider urgency. Slow: treat root. Fast/excessive Phlegm difficult to disperse, requiring attack: deficient patients can treat branch and root simultaneously (attack and tonify). Extremely urgent: even deficient patients must attack first, then tonify, e.g., San Sheng Yin (see Zhuzhong), Kongxian Dan for stroke. When throat is blocked, not expelling Phlegm leads to immediate death by suffocation. Ignorant practitioners fear deficiency and dare not use these, ignoring the danger of death. Deficiency is worst in stroke, yet we attack first; why fear it in ordinary deficiency? *Zhunsheng* states: Treating Phlegm should tonify Spleen to restore transportation, letting Phlegm transform naturally. But long-standing accumulation is like clogged ditches with filth; without dredging, trying to clarify stagnant water is impossible. Also: for diseases involving Phlegm-Fluid transforming into various syndromes, do not be distracted by symptoms; treat Fluid first. E.g., headache/brow pain unresponsive to wind herbs for months resolved with Phlegm herbs; red painful eyes unresponsive to cooling herbs resolved with Phlegm formula. True maxims. (Both cases involve Phlegm-Heat obstructing upwards.)

Yu Jiayan said: Spleen Damp-Heat and Stomach Strong Fire interact, forming turbid Phlegm, overflowing into upper orifices, lingering, penetrating lung membranes, forming Ke-Nang (nest sacs). Ke-Nang Phlegm is like bees in cells or lotus seeds in pods; easy to grow, hard to remove. Narrow outside, wide inside, resisting expulsion, harming other organs. Fundamentally, not just Ke-Nang Phlegm is hard to remove; stubborn Phlegm adhering for years outside lungs and in membrane origins, like vines on trees, dust in houses, moss on stones, is hard to cut quickly. Treatment must calm Qi to prevent Three Yin Fire from rising. Strictly control Spleen to prevent Taiyin Dampness from steaming upward. Then take large doses of medicine to harmonize Five Zang, nourish Lung Qi. Once Lung Metal Qi clears, whole-body Qi descends together, cutting off the source of ascending turbid evil. He also said: Body Qi flows from Jing to Luo when Jing is full, and from Luo to Jing when Luo is full. Ke-Nang formation starts with Phlegm gathering at the Stomach gate. Vomiting agitates Stomach Qi; half exits via throat, half enters Luo vessels. Stomach Luo pierces the diaphragm; urgent Qi rushes through diaphragm, allowing Phlegm to settle, increasing daily, hence hard to treat. Must first remove Stomach Phlegm without triggering vomiting, letting Stomach Qi not rush to Luo, making Stomach empty to allow Luo Qi to return to Stomach. Gradually guide and wash out the sac with medicine, and it heals. He also said: Li Zijiang suffered chronic cough/Phlegm, chest tightness. Last summer/autumn bedridden, nearly died twice, arranged affairs, accepted death, felt slightly better—a sign that "mind dead, body healthy." Soon resumed family duties, illness returned. Examination showed dozens of small nodules on cheeks. Told him: Your strong pulse/tendons indicate lust and overexertion. Disease should manifest as abscess. Avoided due to plain diet and Fire venting through essence pores. But disease has deepened. Your chest/back/shoulders resemble rocks/sprouts/beehives/thorns. Whenever Fire moves/Qi rises/Phlegm obstructs, you suffer immensely, wanting life but not living, wanting death but not dying, worse than prisoners in stocks. Lust/exertion causes Qi to fail returning to origin, rising to Liver/Lungs, filling gaps/membranes. Over time, paths form. Once Kidney Qi moves, thousands of troops rush in, entering but not exiting, like tide returning. If rear tide doesn't stop, front tide doesn't recede. Many die of this. You are sturdy, so currently safe. Go home, rest mind/spirit, act as if dead, so Fire doesn't move, Phlegm-Qi doesn't worsen, chest/back fortifications have gaps. I will prepare medicine to destroy the nest, and you will recover. He thought he wouldn't die immediately, went to collect rent, exertion triggered acute onset, Phlegm gushed like spring, sound like sawing, swollen face/tongue, stiff throat/protruding eyes, died in two days.

Yin refers to retained water. Thin Phlegm is called Yin, hence Phlegm-Yin mentioned together. *Jin Gui* says Yin has four types: Person formerly fat now thin (Jin-Ye transformed into Phlegm-Yin, no longer filling body), water sloshing in intestines with sound, called Tan Yin (Phlegm-Fluid). Water flowing under hypochondrium, pain on coughing/vomiting, called Xuan Yin (Hanging Fluid). Water flowing to limbs, no sweat despite needing it, heavy body pain, called Yi Yin (Overflowing Fluid). Coughing/reversal of Qi, shortness of breath, inability to lie down, swollen appearance, called Zhi Yin (Supporting Fluid). These four are named by location. Also: Leftover Yin in Heart area causes back coldness palm-sized (blocking Heart Yang), hypochondriac pain radiating to Quepen (blocking Liver Qi), worsening cough (Qi reversal). Leftover Yin in Chest causes shortness of breath (Lung Qi forced) and thirst (Water blocking Qi spread, no fluids generated). Limb joint pain (blockage of meridians). Extending this: Spleen leftover causes abdominal swelling/heaviness; Kidney leftover causes scrotal/shin swelling. This covers Leftover Yin and Fu Yin (Hidden Yin), the summary of the above four. Also: Phlegm disease above Diaphragm (Yin stays above Diaphragm, hidden, boils into Phlegm) causes fullness, panting, cough, vomiting. Attacks cause chills/fever, back/waist coldness (attacks triggered by autumn cold or spring wind). Eyes weep spontaneously (severe cough lifts lung lobes), body tremors (severe panting causes shaking). This implies Fu Yin (Hidden Yin, harder to attack than Leftover). Also: Water stopped below Heart causes palpitations (Heart Qi forced by Water).