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Zhu Danxi treated an unmarried young woman. She was usually robust. In the sixth month, she developed mental restlessness and oppression, fatigue, loss of appetite, and a frequent desire to enter a well (to seek coolness). Her pulse was deep, fine, rapid, and weak; her mouth gradually became thirsty. Physicians treated it as Summerheat disease (Shu Bing) without effect. The condition worsened with vomiting and emaciation, heat in the palms, a preference for dark places, a pulse that gradually became hidden (Fu Mai), and delirious speech. Zhu Danxi prepared Miaoxiang Wan from the Bureau Formulas, sized like a Chinese chestnut (Qianshi). He instructed the patient to swallow one pill with well water. Half a day later, stool was passed, and the medicine had been excreted. However, the illness did not subside. Therefore, he washed the pills with musk-infused water, pierced three holes in them with a needle, and had the patient swallow them with cool water. Half a day later, several sheng (a traditional unit of volume) of thick phlegm were expectorated. She then fell asleep and gradually recovered. This recalls the statement in *Jingui Yaolue*: "Those who were formerly fat but are now thin have Phlegm."

Yu Zhen's commentary: This case requires Miaoxiang Wan; formulas such as Wendan Tang (Warm the Gallbladder Decoction) or Daotan Tang (Guide Out Phlegm Decoction) would be ineffective. Yet, swallowing a pill the size of a Chinese chestnut whole is a peculiarity. Furthermore, washing the excreted pill with water, piercing it with a needle, and swallowing it again is even more peculiar.

Xue Lizhai treated a scholar. A swelling appeared on his back; it was soft upon pressure, with normal skin color and normal diet. Upon exertion, he expectorated phlegm and felt fatigued. This indicated Spleen deficiency with Phlegm stagnation. He prescribed Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria) and Banxia (Pinellia Rhizome), with a small amount of Qianghuo (Notopterygium Rhizome). Externally, Yinyang San (Yin-Yang Powder) was applied with ginger juice, leading to the resolution of the swelling. Later, due to overexertion, he experienced dizziness and vomiting. The previous prescription was used minus Qianghuo, plus Manjingzi (Vittatis Fructus), resulting in recovery.

Yu Zhen's commentary: This is what common people call Wet-Phlegm flowing into the collaterals (Shi Tan Liu Zhu). Expectoration of phlegm and fatigue upon exertion clearly indicates Spleen deficiency.

Grand Secretary Liang Nongzhai suffered from shortness of breath and phlegm, red and scanty urine, and pain in the heels. His Chi (Cun-Guan-Chi) pulse at the radial artery was floating and large, but rough (Se Mai) upon heavy pressure. This indicated Kidney deficiency with Phlegm-fluid retention. Siwu Tang (Four Substances Decoction) was used to deliver Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). Within a month, he recovered. Zhang Zhongjing stated: "For Qi deficiency with fluid retention, use Shenqi Wan (Kidney Qi Pill) to tonify and expel." This indeed enlightens later learners and saves countless premature deaths. Shenqi Wan is essentially Liuwei Dihuang Wan.

Yu Zhen's commentary: Siwu Tang delivering Liuwei Dihuang Wan specifically tonifies Kidney Yin. If referring to Zhang Zhongjing's Shenqi Wan, it must include Rougui (Cinnamon Bark) and Fuzi (Aconite Root) added to Liuwei Dihuang Wan. Moreover, given shortness of breath, heel pain, and a rough Chi pulse, using only Liuwei Dihuang Wan might be ineffective. This case follows the same method as the case treating Censor Meng. Liang had red, scanty urine, whereas Meng had enuresis; Liang had a floating-large Chi pulse that was rough upon pressure, whereas Meng had a floating-large Chi pulse that felt empty upon pressure; Meng also had dizziness, making differentiation easier.

Li Shicai said: Hanlin Li Jixu engaged in excessive labor and sexual activity after drinking, resulting in profuse sweating and much phlegm. After taking medicines to widen the diaphragm and resolve phlegm, he felt more obstructed and oppressed. His pulse was deep and rough, especially in both Chi positions. I told his son-in-law: "Phlegm presenting with a rough pulse is difficult to cure in the short term. Moreover, severe roughness in the Chi position indicates damage to Essence (Jing). According to medical principles, this is untreatable. I will tentatively prescribe Buzhong Yiqi Tang added with Banxia and Fuling." After two doses, there was slight improvement, and everyone was pleased. I said: "The roughness remains unchanged, and the pulse lacks root; death is near." Indeed, he died ten days later.

Yu Zhen's commentary: This case and Liang Nongzhai's case both involve a rough pulse, yet the outcomes differed in life and death. In Liang's case, only the Chi pulse was floating-large and rough upon pressure; here, all six positions were deep and rough, especially the Chi positions, indicating a difference in severity. Furthermore, the phrase "pulse lacks root" suggests a deep, fine, and rough pulse that nearly disappears upon pressure. Otherwise, in the Asthma and Cough section, the case of Gu Minghua also presented with a rough pulse, yet why did he recover after initial tonification followed by emesis and purgation?

Li Shicai treated Qin Jingming. He had chronic Phlegm-fluid retention, exacerbating four or five times a year, accompanied by vomiting and inability to eat during attacks. This disease had formed nests (Ke Nang) over time; without strong emesis, it could not be cured. First, Buzhong Yiqi Tang was administered. Ten days later, Gudi San (Melon Stalk Powder) was frequently given. Several sheng of material resembling red bean paste were vomited up. Subsequently, about one sheng of crystal-clear phlegm was expelled. This cycle of seven tonifications and seven emeses continued until, after one hundred days, the nests were completely cleared. Thereafter, he exclusively took Liujunzi Tang (Six Gentlemen Decoction) and Bawei Wan (Eight-Ingredient Pill) continuously for a year.

Yu Zhen's commentary: Those skilled in treating Phlegm include Zhang Dairen in the past and Wang Yinjun in recent times. However, these methods are suitable only for patients with strong constitution and excess syndromes, not for deficiency cases. This case, with seven tonifications and seven emeses, serves to correct the biases of both schools. Fundamentally, there is no such thing as Phlegm in the human body; Phlegm arises due to pathology. Treating the cause of Phlegm generation naturally eliminates the Phlegm. Although formularies list various types such as Wind-Phlegm, Cold-Phlegm, Fire-Phlegm, Damp-Phlegm, Dry-Phlegm, Clear-Phlegm, Old-Phlegm, Dietary-Phlegm, Wine-Phlegm, Stagnant-Phlegm, Stubborn-Phlegm, Shock-Phlegm, and Deficiency-Phlegm, manifesting in myriad symptoms resembling various miscellaneous diseases, one cannot simply treat them as miscellaneous diseases. If one treats the Phlegm directly, the disease resolves. Whether addressing the branch first then the root, or the root first then the branch, depends entirely on the physician's flexibility.