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It is said that boats cannot navigate without water, yet if waves boil and overflow, the disaster of capsizing arises. Humans cannot survive without Qi (vital energy), yet if phlegm and saliva accumulate, the disaster of life-threatening collapse occurs. Waves do not arise spontaneously; their cause is the uneven terrain. Phlegm and saliva do not accumulate spontaneously; their cause is the stagnation of unsmooth Qi. Therefore, those skilled in navigating boats do not fear the waves but fear the imperfection of the boat; those skilled in preserving health do not fear phlegm and saliva but fear the unsmoothness of Qi. Thus, among the diseases of people in the world, none are more urgent in damaging life than phlegm and saliva. Yet, physicians of the world see them but fail to recognize them, or recognize them but fail to treat them. The number of unfortunate people who suffer premature death or sudden death from this is countless. Why? People throughout the world know only that Wind pathogen can produce phlegm and saliva, but do not know that Cold in the Zang-Fu organs also produces phlegm and saliva, nor does Heat in the Zang-Fu organs fail to produce it. Once phlegm and saliva arise, they transform in thousands of ways, and the origins of disease are not limited to a single aspect. I now briefly list several aspects to clarify this, so that future students of medicine, by analogy and deduction during diagnosis and treatment, may perhaps prevent people from suffering unnecessary premature or sudden deaths.

Although the name "phlegm and saliva" is one, it encompasses several types: 1. Wind Phlegm and Saliva (Feng Xian), 2. Heat Phlegm and Saliva (Re Xian), 3. Cold Phlegm and Saliva (Leng Xian), 4. Disease Phlegm and Saliva (Bing Xian), 5. Deficiency Phlegm and Saliva (Xu Xian), 6. Toxic Phlegm and Saliva (Du Xian).

Regarding Wind Phlegm and Saliva (Feng Xian): It is generally caused by an excess of Wind in the body rising to steam the fluids, preventing them from descending into the Stomach. When Wind steams, phlegm and saliva rise together, filling the chest and causing fainting and loss of consciousness. If the Wind remains unsmooth for a long time, the danger to life is as swift as turning a palm; if the Wind has not reached its peak, it may smooth out within moments, allowing the saliva to descend with the Qi, restoring normalcy. This often occurs when muscle layers are thick and interstices (Cou Li) are dense, preventing Wind from venting externally. Internal attack by Wind-Heat on the Large Intestine causes constipation and heat, while toxic vapors attack upward, resulting in this condition named Wind Phlegm and Saliva. However, although the name is the same, variations occur due to differences in the deficiency or excess of the Zang-Fu organs. For instance, in current cases where the Large Intestine has Excess Heat, phlegm fills the mouth, resembling clear glue. Breathing in the chest may remain normal, but no food or drink can be swallowed. Food reaches the throat but cannot go down; forcing it down causes blockage, panting, fainting, and recovery only after a long time, with only small amounts of thick porridge acceptable. This is also a symptom of Wind Phlegm and Saliva. Given these varying symptoms, how should it be treated?

The response is: One who excels at clearing thorns first cuts the roots; one who excels at treating Wind-Phlegm first smooths the Qi. There is no phlegm that flows upward against gravity in the human body, nor water that flows upstream in the world. When Wind-Phlegm rises and blocks the chest, endangering life, it is because Wind moves upward. Currently, many treating Wind-Phlegm use herbs like Tian Nan Xing (Arisaema Rhizome) and Ban Xia (Pinellia Tuber), which ignores the source and flow of the disease, akin to removing thorns without pulling the roots. If one uses medicine first to smooth the Wind Qi and simultaneously open the Cou Li (interstices/skin pores), allowing Wind to vent externally and move smoothly internally, the phlegm in the chest will naturally descend with the Qi. The phlegm will become smooth even before taking specific phlegm-resolving medicines. However, treatment must be urgent or slow depending on severity. If Wind is blazing and sticky phlegm rises, making Qi difficult to smooth suddenly, urgent treatment via emesis (vomiting) is necessary. If Wind is not extreme and phlegm has not fully gathered, posing less harm, slow treatment is appropriate: first smooth the Qi, then treat the phlegm. This is the general principle of treating phlegm.

However, Wind Phlegm varies in Cold and Heat. Some are struck by Cold Wind, causing Cold Phlegm accumulation. Such individuals likely had reduced appetite and heavy bodies, weak sinews and vessels, and nausea upon seeing meat, half a year or months prior. Occasionally, cold saliva droplets appear without awareness. When Cold Phlegm gathers, sudden fainting occurs, followed by numbness, limb twitching, aphasia, etc. Cold Phlegm usually accumulates in the Middle Jiao, overflowing the chest, enveloping the Pericardium, causing delirium, unstable spirit, and involuntary arm movements. This is Cold Phlegm invasion.

Treatment involves first using warm medicines to disperse Cold-Toxic Qi, urgently applying hot medicines to open the Cou Li, and then using phlegm-draining medicines to evacuate the phlegm. Although temporarily relieved, those struck by Cold Wind do not survive long. Why? Warm Wind resembles Spring/Summer winds, containing Life-Qi to nourish all things; illness from such wind rarely leads to death, as ancients said, "Wind can nourish." Cold Wind resembles Autumn/Winter winds, containing Killing-Qi to wither all things; illness from such wind leads to death quickly, as ancients said, "Wind can harm."

Second is Heat Phlegm and Saliva (Re Xian). This affects men of strong temper who consume rich, greasy, salty, and sour foods, indulge in lust, and recklessly take tonics. Sudden exhaustion from drunkenness and sexual activity damages Essence. Although the Dantian and Marrow Sea are empty, internal deficiency-Heat intensifies. Phlegm accumulates in the Middle Jiao; due to Kidney Cold, Evil Qi interacts with Heat Phlegm, causing pain. Severe cases lead to death within hours. Physicians mistakenly attribute this to Liver/Kidney Qi issues, ignoring that Heat Phlegm is the root. Herbs like San Leng (Sparganium Rhizome) and E Zhu (Curcuma Rhizome) do not treat Qi directly; their ineffectiveness stems from misunderstanding the disease's origin. Skilled physicians adapt to circumstances, assessing severity. For abundant phlegm, use emesis; for scant phlegm, use purgation. Medicines should target Liver Wind-Toxicity.

Third is Cold Phlegm and Saliva (Leng Xian). This occurs when Liver Qi is Excess and Spleen Qi is Deficient. Sudden anger and chronic resentment damage Heart and Liver Righteous Qi, causing Cold Phlegm accumulation. Spleen Deficiency allows Liver Qi to overact, stagnating fluids and grains. Chronic resentment causes Qi stagnation. Since the Liver generates Wind and governs Anger (which causes Qi rebellion), Cold Phlegm rises with rebellious Qi, causing severe disease. Symptoms include precordial discomfort, a sensation of an object rising to the throat, fainting, cold extremities, followed by recovery. Treatment requires emetic medicines. The expelled phlegm is clear as water and cold as snow. After evacuation, harmonize the Zang-Fu Qi according to the pathology.

Fourth is Disease Phlegm and Saliva (Bing Xian). Caused by consuming hard-to-digest foods damaging Spleen Qi, combined with anger damaging Heart/Liver Qi, or residual toxins from severe illnesses lodging in Zang-Fu. Qi becomes stagnant and turbid, unable to circulate freely, leading to phlegm accumulation. Interaction between phlegm and stagnant Qi causes pain. Precordial pain persists for years if mild, or causes rapid death if severe. Severity depends on phlegm quantity. Treatment uses laxatives/emetics based on severity. Mild cases yield oily phlegm; severe cases yield white-glue-like phlegm. Post-evacuation, clear Zang-Fu Qi and tonify Righteous Qi to restore balance.

Fifth is Deficiency Phlegm and Saliva (Xu Xian). Caused by constitutional Qi deficiency, exacerbated by Cold/Raw foods after severe illness or excessive lust during convalescence. Zang-Fu Qi becomes empty and weak, with deficiency-Heat steaming upward from bones. Upper Qi appears Excess, Lower Qi Deficient. Yin and Yang fail to interact. Unsmooth Qi blocks the Middle Jiao, accumulating Deficiency Phlegm. Wind-Heat attack causes phlegm to rush upward. Initial symptoms include mouthfuls of clear saliva, sensation of rising object, throat tightness, fainting, chaotic hand movements, scalp itching, and umbilical pain. Recovery follows when Qi descends. Treatment uses mild laxatives (half dose) at onset due to weak Stomach Qi; full emetics are contraindicated. If unsuccessful, use modified Wind-Phlegm remedies. Apply moxibustion to Qi Hai (CV-8) to guide phlegm down to the Stomach. Then harmonize Zang-Fu, tonifying deficiency and draining excess to balance Upper and Lower Qi. If pulse is fine and Large Intestine is Cold, reduce Liver Qi and tonify Stomach Qi. In children, this is purely Stomach Qi deficiency; moxibustion on Qi Hai warms the Spleen/Stomach to cure the phlegm. Avoid harsh Wind-Phlegm drugs.

Sixth is Toxic Phlegm and Saliva (Du Xian). Seen in Yang-Toxic Shang Han (Cold Damage) where Liver, Heart, Spleen, and Lung are affected by epidemic toxicity. Toxic phlegm accumulates centrally. Symptoms include constipation with heat, yellow/scanty urination, dark-red complexion, whole-body fever, drowsiness resembling intoxication, delirium, and unconsciousness. All these stem from phlegm. Pulse is deep and hidden, felt only with heavy pressure near the bone. This is Epidemic Toxic Phlegm filling the chest, hiding the pulse characteristics. Treatment urgently employs dispersing and transforming medicines to extract toxic vapors and purge phlegm. Medicines must address Heart, Liver, Spleen, and Lung, prioritizing the Liver.

Although phlegm diseases transform in thousands of ways, the above examples cover the basics. Future students should deduce further with clear insight to ensure accurate diagnosis and treatment, eliminating the threat of phlegm as a major affliction.