王节斋云。痰之本水也。原于肾。痰之动湿也。主于脾。古人用二陈汤。为治痰通用。然以治湿痰寒痰
则是矣。若夫阴火炎上。熏于上焦。肺气被郁。故其津液之随气而升者。凝结而成痰。腥秽稠浊。甚则有带血
而出者。此非中焦脾胃湿痰寒痰之所比。亦非半夏枳壳南星之所治。惟用清气化痰。须有效耳。噫。节斋论痰
而首揭痰之本于肾。可为发前人所未发。惜乎启其端而未竟其说。其所制之方。皆治标之药。而其中寒凉之品
甚多。多致损胃。惟仲景先生云。气虚有痰。用肾气丸补而逐之。吴茭山诸证辨疑又云。八味丸治痰之本也。
此二公者。真开后学之蒙聩。济无穷之夭枉。盖痰者病名也。原非人身之所有。非水泛为痰。则水沸为痰。但
当分有火无火之异耳。肾虚不能制水。则水不归源。如水逆行。洪水泛滥而为痰。是无火者也。故
用八味丸。以补肾火。阴虚火动。则水沸腾动于肾者。犹龙火之出于海。龙兴而水附。动于肝者。犹雷火之出
于地。疾风豪雨。水随波涌而为痰。是有火者也。故用六味丸以配火。此不治痰之标。而治痰之本者也。然有
火无火之痰。何以辨之。曰无火者纯是清水。有火者中有重浊白沫为别耳。善用者。若能于肾虚
者。先以六味八味。壮水之主益火之原。复以四君子或六君子。补脾以制水。于脾虚者。既补中理中。
又能以六味八味制水以
益母。子母互相生克。而于治痰之道。其庶几矣。
庞安常有言。有阴水不足。阴火上升。肺受火侮。不得清肃下行。徭是津液凝浊。生痰不生血者。此当
以润剂。如门冬地黄枸杞之属滋其阴。使上逆之火。得返其宅而息焉。则痰自清矣。投以二陈。立见其殆。有
肾虚不能纳气归原。原出而不纳则积。积而不散则痰生焉。八味丸主之。庞公之见甚确。录之以为案。
蒙筌谓地黄泥膈生痰。为痰门禁药。以姜汁炒之。嗟乎。若以姜汁炒之。则变为辛燥。地黄无用矣。盖
地黄正取其濡润之品。能入肾经。若杂于脾胃药中。土恶湿。安得不泥膈生痰。八味六味丸中诸品。皆少阴经
的药。群队相引。直入下焦。名曰水泛为痰之圣药。空腹服之。压以美膳。不留胃中。此仲景制方立法之
妙。何必固疑。
Wang Jiezhai stated: The root of phlegm is water, originating from the Kidney; the movement of phlegm arises from dampness, governed by the Spleen. The ancients used Er Chen Tang (Two-Aged Decoction) as a general formula for treating phlegm syndromes. However, using it to treat Damp-Phlegm and Cold-Phlegm is correct. In cases where Deficient Fire flares upward, scorching the Upper Jiao and causing stagnation of Lung Qi, the body fluids that rise with the Qi will condense into phlegm. This type of phlegm has a fishy odor, is thick and turbid, and in severe cases may contain blood when expectorated. This is not comparable to the Damp-Phlegm or Cold-Phlegm of the Middle Jiao Spleen and Stomach, nor can it be treated with Ban Xia (Pinelliae Rhizoma), Zhi Ke (Aurantii Fructus), or Tian Nan Xing (Arisaematis Rhizoma). Only by employing methods to clear heat and transform phlegm will there be an effect. Alas, Wang Jiezhai’s discussion on phlegm first revealed that its root lies in the Kidney, which can be said to have uncovered insights previously unexpressed by predecessors. Unfortunately, he only initiated the topic without fully elaborating on it. The formulas he prescribed were all remedies targeting the branch symptoms, and among them, many were cold-natured herbs, often leading to damage of the Stomach Qi. Only Master Zhang Zhongjing stated: "In cases of Qi deficiency with phlegm, use Shen Qi Wan (Kidney Qi Pill) to tonify and expel." Wu Jiaoshan, in his work *Zhu Zheng Bian Yi* (Differentiation of Doubts Regarding Various Syndromes), further stated: "Ba Wei Wan (Eight-Ingredient Pill) treats the root of phlegm." These two masters truly enlightened later learners and saved countless lives from premature death.
Generally speaking, Phlegm is a disease name and is not originally a substance possessed by the human body. It is either water flooding to become phlegm, or water boiling to become phlegm; one should merely distinguish between cases with Fire and those without. When Kidney deficiency fails to control water, water does not return to its source, flowing backward like a flood overflowing its banks, thus forming phlegm; this is a case of no Fire. Therefore, Ba Wei Wan (Jin Gui Shen Qi Wan) is used to tonify the Fire of the Kidney Yang. In cases of Yin deficiency with hyperactive Fire, water boils and surges within the Kidney, resembling Dragon Fire rising from the sea—when the dragon rises, water follows; or like Thunder Fire erupting from the earth, where fierce winds and heavy rains cause water to surge with the waves, forming phlegm; this is a case with Fire. Therefore, Liu Wei Wan (Liu Wei Di Huang Wan) is used to harmonize and subdue Fire. This approach treats the root of phlegm rather than its branch manifestations.
However, how can one distinguish between phlegm with Fire and phlegm without Fire? The answer is: Phlegm without Fire is purely clear water, whereas phlegm with Fire is distinguished by the presence of heavy, turbid white foam. A skilled practitioner, if dealing with Kidney deficiency, should first use Liu Wei Wan or Ba Wei Wan to strengthen the master of Water and benefit the source of Fire, followed by Si Jun Zi Tang (Four Gentlemen Decoction) or Liu Jun Zi Tang (Six Gentlemen Decoction) to tonify Spleen Qi to control Water. For Spleen deficiency, one should use Bu Zhong Yi Qi Tang or Li Zhong Wan to regulate the Middle Jiao, while simultaneously using Liu Wei Wan or Ba Wei Wan to control Water and nourish the Mother organ (Kidney). Through the mutual generation and restriction between the Child and Mother organs, the method for treating phlegm would be nearly perfect.
Pang Anchang once said: There are cases of insufficient Yin Water with rising Yin Fire, where the Lung suffers from the oppression of Fire and cannot descend clearly and purifyingly. Consequently, body fluids become turbid and condensed, generating phlegm instead of Blood. In such cases, moistening agents such as Mai Dong (Ophiopogonis Radix), Di Huang (Rehmanniae Radix), and Gou Qi Zi (Lycii Fructus) should be used to nourish Yin, allowing the rebellious Fire to return to its residence and subside, thereby clearing the phlegm naturally. Administering Er Chen Tang would immediately lead to danger. Additionally, when Kidney deficiency fails to grasp Qi and return it to its origin, Qi emerges but is not retained, leading to accumulation; accumulation that does not dissipate generates phlegm. In these cases, Ba Wei Wan is the primary treatment. Master Pang’s view is very accurate; I record it as a case reference.
Miao Xuan argued that Di Huang is cloying and obstructs the diaphragm, generating phlegm, making it a contraindicated herb in phlegm syndromes, unless stir-fried with Ginger Juice. Oh! If stir-fried with Ginger Juice, it becomes acrid and drying, rendering Di Huang useless. Di Huang is valued precisely for its moistening properties that enter the Kidney Meridian. If mixed with Spleen and Stomach herbs, since Earth dislikes dampness, how could it not become cloying, obstruct the diaphragm, and generate phlegm? The various ingredients in Ba Wei Wan and Liu Wei Wan are all herbs of the Shaoyin Meridian. They guide each other in groups, entering directly into the Lower Jiao, and are named the sacred medicines for treating "Water Flooding to Become Phlegm." Taken on an empty stomach and pressed down with fine food, so that the medicine does not remain in the Stomach, this is the subtlety of Zhang Zhongjing’s formulation principles. Why persist in doubt?