权。理脾则如烈日当空。片云纤翳。能掩之乎。其理脾之法。须药饵与饮食相参。不但滑腻杂食
当禁。即饭食粥饮亦须少减。则脾气不用以消谷。转用之消痰。较药力万万耳。膏粱过浓之人。
每多味痰。尤宜清理脾胃为主。夫五味入口而藏于胃。胃为水谷之海。五脏六腑之总司。人之食
饮太过而结为痰涎者。每随脾气之健运而渗灌于经隧。其间往返之机。如海潮然。脾气行则潮去。
脾气止则潮回。所以治沉锢之法。但取辛热微动寒凝。以后止而不用。恐痰得热而妄行。为害不
浅也。不但痰得热而妄行。即脾得热亦过动不息。如潮之有去无回。其痰病之决裂。可胜道哉。
从来服峻利之药者。深夜亦欲饮食。人皆不知其故。反以能食为庆。曾不思爱惜脾气。令其昼运
夜息。乃可有常。况人身之痰。既由胃以流于经隧。则经隧之痰。亦必返之于胃。然后可从口而
上越。从肠而下达。此惟脾气静息之时。其痰可返。故凡有痰证者。早食午食而外。但宜休养脾
气不动。使经隧之痰。得以返之于胃。而从胃气之上下。不从脾气之四迄。乃为善也。试观痰病
轻者。夜间
安卧。次早即能呕出泄出。痰病重者。昏迷复醒。反能呕出泄出者。岂非未尝得食。脾气静息。
而与痰以出路耶。世之喜用热药峻攻者。能知此乎。噫。天下之服辛热而转能夜食者多矣。能因
此而三复否。
李士材云。先哲论脾为生痰之源。肺为贮痰之器。又曰。治痰不理脾胃。非其治也。以脾土
虚。则清者难升。浊者难降。留中滞膈。淤而成痰。故治痰先补脾。脾复健运之常。而痰自化矣。
析而言之。痰有五。饮亦有五。治法因之而变。在脾经者。名曰湿痰。脉缓面黄。肢体沉重。嗜
卧不收。腹胀食滞。其痰滑而易出。二陈加枳、术。挟虚者。六君子汤。酒伤者。加白豆蔻、干
葛。在肺经者。名曰燥痰。又名气痰。脉涩面白。气上喘促。洒淅寒热。悲愁不乐。其痰涩而难
出。利金汤去枳壳加葳蕤、姜用蜜煎。在肝经者。名曰风痰。脉弦面青。肢胁满闷。便溺秘涩。
时有躁怒。其痰清而多泡。十味导痰汤。用浆水煎服。甚则千缗汤加川芎、大黄。在心经者。名
曰热痰。脉洪面赤。烦热心痛。口干唇燥。时多喜笑。其痰坚而成块。凉膈散加苓、半下之。在
肾经者。名曰寒痰。脉沉面黑。小便急痛。足寒而逆。心多恐怖。其痰有黑点而多稀。桂苓丸加
泽泻、车前。肾虚水泛为痰。八味丸。其人素盛今瘦。水走肠间。漉漉有声。名曰痰饮。心下冷
极。苓桂术甘汤和之。饮后水流在胁下。咳唾引痛。名曰悬饮。十枣汤下之。饮水流于四肢。当
汗不汗。身体疼重。名曰溢饮。内经所谓溢饮者。渴。暴多饮。而溢入肌皮肠胃之外也。小青龙
汤汗之。咳逆倚息。短气不得卧。其形如肿。名曰支饮。五苓散、泽泻汤利之。膈满呕吐。喘咳
寒热。腰背痛。目泪出。其人振振恶寒。身 惕者。名曰伏饮。倍术丸加茯苓、半夏。更有一种
非痰非饮。时吐白沫不甚稠粘者。此脾虚不能约束津液。故涎沫自出。宜用六君子汤加炮姜、益
智仁以摄之。嗟乎。五痰五饮。证各不同。治法迥别。至于脾肺二家之痰。尤不可混。脾为湿土。
喜温燥而恶寒润。故白术、半夏、茯苓为要药。肺为燥
金。喜凉润而恶温燥。故门冬、贝母、桔梗为要药。二者误治。鲜不危困。每见世俗畏半夏之燥。
喜贝母之润。一见有痰。便以贝母投之。若是脾痰。则土气益伤。饮食渐减矣。即使肺痰。毋过
于凉润以伤中州。稍用脾药以生肺金。方为善治。故曰。治痰不理脾胃。非其治也。信夫。
凡人身中有块。不痒不痛。或作麻木。名败痰失道。宜随处用药消之。如忽患手足胸背头项
腰膝疼痛不可忍。及连筋骨牵引吊痛。坐卧不安。走易不定。头疼困倦。手足重坠痹冷。脉伏。
此乃涎饮顽痰。伏在心胸上下。发为此疾。非风非毒。导痰汤加羌、防、白芷、姜汁、竹沥。痰
火相煽于膈上。胸中时觉痞满眩晕。或目齿疼。饮食后稍觉快爽。少间复加迷闷。大便或结或泻。
小便或赤或清。此皆痰饮或开或聚之故。治宜健脾以运痰。清肺以润燥。六君子加苏子、栝蒌、
姜汁、竹沥之类。老痰积于胸膈作痞。或流滞于经络四肢者。青礞石丸。壮物理浓之人。可用姜
汁、竹沥下滚痰丸。然后用理脾行气药调理。湿痰积于胁下。隐隐作痛。天阴疼软更甚。轻则二
陈汤加白芥子。重则控涎丹缓攻之。痰挟死血。随气攻注。流走刺痛。有时得热则止。有时得热
转剧。此本寒痰阻塞。故得热则止。若痛久火邪伤血。则得热转剧。控涎丹加胡椒、蝎尾、木香、
鲮鲤甲。痛定时。局方七气汤与六君子。并加竹沥。相间服之。痰在胁下。非白芥子不能达。痰
在四肢及在皮里膜外。非竹沥、姜汁不行。二味治阴虚有痰。大有奇验。但食少脾胃不实者。不
可轻用。以其寒滑能走大便也。枳实治痰。能冲墙倒壁。黄芩、花粉。大降膈上热痰。然能郁遏
火邪。伤损中气。脾胃虚寒及有外感者切忌。痰在膈间。使人颠狂健忘。四肢偏枯。及类中风痰。
俱用竹沥。痰在肠胃。可下而愈。枳实、大黄、芒硝之类。膈上痰热痞闷。小陷胸汤加枳实、茯
苓、姜汁、竹沥。中脘留伏痰饮。臂痛难举。手足不能转移。
背上凛凛畏寒者。指迷茯苓丸。痰饮流入四肢。令人肩背酸痛。两手软痹。若误以为风。则非其
治。导痰汤加姜黄、木香。不应。加桂枝以和营气。眼黑而行步呻吟。举动艰难者。痰入骨也。
非用萆 、苦参不除。其病遍体骨节疼痛。审气血加化痰药。湿痰痞塞。胸中不快。气不宣通。
及痰火吐痰不见血者。沉香化痰丸。肥盛多湿热人。痰湿胶固于中外。动则喘满眩晕者。运痰丸。
老痰不化。喉中常觉哽塞。咯之不出者。消痰饼子。喉中有物。咯不出。咽不下。或作刺痛。此
是郁痰。四七汤。脉涩者。卒难得开。必费调理。多思虑人。胃中虚寒。饮聚食减者。局方七气
汤、深师消饮丸选用。心胸中有寒痰宿水。自吐出水后。心胸间虚。气满不能食。外台茯苓饮。
寒涎沃胆。时吐痰水。不得眠。或时眩晕。温胆汤。多惊。加蝎尾。痰火盛于上焦。气盛喘促。
有时能食。有时不能食。或周身走痛。饱闷痞胀者。用滚痰丸。西北人倒仓法最妙。病患久虚。
内有宿积痰饮。用参、术补之。久乃吐出臭痰。或绿色痰者难治。盖积之既久。而脾胃虚热不运。
且有积热。故郁臭耳。急用二陈加枳、术、黄连、竹沥。庶可十全一二。若肺痈吐臭痰脓血。不
在此例。脾肺气虚。不能运化而有痰者。六君子加木香。肺胃气虚。不能清化而有痰者。六君子
加桔梗。脾气虚。不能运化而生痰者。理中丸加半夏、茯苓。脾中气滞。而痰中有血者。加味归
脾汤去木香、远志。加牡丹皮、砂仁。肝经血热。而痰中有血者。加味逍遥散去柴胡、煨姜。加
童便、藕汁。肝肾阴虚。而痰中有血者。六味丸加乌 骨、茜根。若过服寒凉。唾痰有血者。异
功散加炮姜。痰饮结聚腹胁之间。有类积聚。但按之不甚坚。而时时口吐涎沫者。六君子合五苓
加枳实。平居无事。但有痰数口。或清或坚。宜小半夏茯苓汤。不应。加人参以健胃气。则痰自
不生矣。阴血不足。相火上炎。肺受火乘。不得下行化令。由是津液凝滞。生痰不生血。当用润
剂。如二冬膏、六味丸之类
滋其阴。使上逆之火得返其宅而息。则疾自消。投以二陈等汤。立见其殆。瘦人多此。肾虚不能
纳气归源。出而不纳。则为积滞。积滞不散。则痰生。八味丸。肥人多此。老人肾虚水泛为痰上
涌者。八味丸以摄之。不应。用真武汤。凡尺脉浮大。按之则涩。气短有痰。小便赤涩。足跟作
痛。皆肾虚不能行浊气。凝聚而为痰也。肾气丸。脉来细滑或缓。痰涎清薄。身体倦怠。手足酸
软。此脾虚挟湿。六君子加炮姜。或补中益气加半夏、茯苓。然痰病须辨有火无火。无火者纯是
清水。有火者中有重浊白沫耳。内伤中气。虚而有痰。必用参、术。佐以姜汁传送。甚者加竹沥。
脾气虚。宜清中气以运痰。使之下行。六君加枳、术。兼用升、柴以提清气。脉濡缓。身体倦怠。
体浓人属湿痰。二陈加生术、羌活。气虚。佐参、术。脉沉滞。或滑。证兼恶心。心下饱闷。属
郁痰。宜开郁行气。脉滑见于右关。时常恶心吐清水。痞塞。就吐中以鹅翎探之。盖热痰在膈上。
泻亦不去。必用吐。胶固稠浊。非吐不开。浮滑宜吐。脉涩年高虚人不可吐。痰在经络中。非吐
不可。吐中犹有发散之意。须先升提其气乃吐。如瓜蒂、防风、川芎、桔梗、芽茶、齑汁之类。
晴明时于不通风处以布紧勒其肚。乃吐。肾虚水泛为痰。有用肾气丸屡未得效。因思痰本阴类。
复用地黄助阴。良非所宜。当于方中减熟地黄、山茱萸。加菖蒲、沉香开通其气。自效。大抵阴
虚痰燥。切忌二陈、六君辈香燥益气药。阳虚饮泛。切戒四物、六味滋阴腻膈药。此歧路攸分。
不可不辨。大凡痰饮变生诸证。不当为诸证牵掣作名。且以治饮为先。饮消诸证自愈。如头风眉
棱骨痛。累用风药不效。投以痰剂收功。如患眼赤羞明而痛。与凉药弗瘳。畀以痰剂获效。凡此
之类。不一而足。散在各门。不复繁引。
〔诊〕脉沉者有留饮。双弦者寒也。偏弦者饮也。肺饮不弦。但苦喘满短气。支饮亦喘不得卧。
短气。其脉平也。病患
一臂不遂。时复移在一臂。其脉沉细。非风也。必有饮在上焦。痰得涩脉难愈。陈无择云。饮脉
皆弦细沉滑。左右关脉浮大而实者。膈上有稠痰也。宜吐之。病患百药不效。关上脉伏而滑者。
痰也。眼胞上下如煤黑者。亦痰也。
唾 唾者。坐处不时多唾。此胃中寒也。以胃气虚寒不运。故病后多有是证。理中汤或六君
子汤加益智仁摄之。
虞恒德治一妇。因多食青梅得痰病。日间胸膈痛如刀锥。至晚胸中痛止。而膝KT 大痛。此
痰饮随气升降故也。服丁、沉、姜、桂、乌、附诸药皆不效。乃以莱菔子研汁与半碗。吐痰半升。
至夜痛尤甚而厥。此引动其猖狂之势耳。次日。用参芦一两逆流水煎服。不吐。又次日。苦参煎
汤服。亦不吐。又与附子尖、桔梗芦。皆不吐。后一日清晨。用藜芦末一钱。麝香少许。酸浆水
调服。始得大吐稠痰升许。其痛如失。调理脾胃而安。
钱仲立治一人。素患痰火。外貌虽 。禀气则实。医者误认虚火而用补中益气。气喘上升几
殆。遂用二陈探吐。出痰碗许。始得安寝。仍用二陈去半夏。加硝、黄。下结粪无数。其热始退。
调理脾胃而安。
王中阳治江东富商。自奉颇浓。忽患心惊。如畏人捕。闻脂粉气。即便遗泄。坐卧欲人拥护。
逼身红晕紫斑。两腿连足淫湿损烂。脓下不绝。饮食倍常。酬应不倦。屡以惊悸虚脱风疮治皆不
效。王诊得六脉俱长。三部有力。此系太过之脉。心肾不交。而上悸下脱。皆痰饮留积所致。风
疮亦是痰饮流入经隧。内湿招风之故。先以滚痰丸逐去痰毒。三日一次。然后用豁痰药。加减调
理而安。
薛立斋治一人。背肿一块。按之则软。肉色如故。饮食如常。劳则吐痰。此脾虚而痰滞。用
补中益气加茯苓、半夏、羌活。外以香附末、姜汁调饼。灸之而散。后因劳役头眩作呕。仍以前
药减羌活。加蔓荆子而愈。
李士材治秦景明。素有痰饮。每岁必四五发。发即呕吐不能食。此病久结成窠囊。非大涌之
弗愈也。须先进补中益气。十日后以瓜蒂散频投。涌如赤豆沙者数升。已而复得水晶色者升许。
如是者七补之。七涌之。百日而窠囊始尽。专服六君子、八味丸。经年不辍。
又治朱文哉。遍体如虫螫。口舌糜烂。寅卯必见异物。其脉两关弦滑且大。定为痰饮之 。
投滚痰丸一服。微有所下。更以控涎丹下痰及积。身痛减半。更以参、术煎汤送控涎丹。复下数
行而愈。
石顽治周又韬张使。本燕人。体肥痰盛。善肉善饭。而患痰鸣喘嗽数年。食伤恒发。则六脉
迟滑。时见歇止。声如拽锯。遍地皆痰。每岁或一二发。或三五发。深秋初冬尤甚。遂用倒仓法。
自言肢体皆轻。前证遂不复作。二年后。因不禁牛肉。复发。然其势较前不过十一。是亦不慎口
腹所致耳。
Quan. Regulating the Spleen is like the scorching sun in the sky; how can a wisp of cloud obscure it? The method of regulating the Spleen requires the combination of herbal medicine and diet. Not only should greasy miscellaneous foods be prohibited, but even rice meals and porridge drinks must be reduced appropriately. In this way, the Spleen Qi does not need to digest grains, but instead transforms into eliminating phlegm, which is ten thousand times more effective than medicinal power alone. People who consume rich and fatty foods often generate excessive phlegm-dampness and should primarily focus on clearing and regulating the Spleen and Stomach. The five flavors enter the mouth and are stored in the Stomach. The Stomach is the sea of water and grain, and the general manager of the Zang-Fu organs. When dietary intake is excessive and condenses into phlegm-fluids, it often permeates into the collaterals and meridians along with the healthy movement of Spleen Qi. The mechanism of their back-and-forth movement is like the ocean tide. When Spleen Qi moves, the tide recedes; when Spleen Qi stops, the tide returns. Therefore, the method for treating entrenched and stubborn phlegm involves using acrid-hot herbs slightly to move and resolve cold coagulation, and then stopping their use. Otherwise, fear that the phlegm will act recklessly upon receiving heat, causing significant harm. Not only will phlegm act recklessly with heat, but the Spleen itself will also become overly active and ceaseless, like a tide that goes but never returns. How can the devastation of such phlegm diseases be fully described?
It has been observed that those taking harsh purgative or draining medicines often desire food late at night. People do not understand the reason behind this and instead rejoice in their ability to eat. They fail to consider preserving Spleen Qi, allowing it to transform during the day and rest at night, so as to maintain normalcy. Moreover, since phlegm in the body flows from the Stomach into the collaterals and meridians, phlegm within the collaterals and meridians must necessarily return to the Stomach before it can be vomited up through the mouth or discharged downward through the intestines. This return is only possible when Spleen Qi is at rest. Therefore, for patients with phlegm syndromes, apart from breakfast and lunch, one should only rest and preserve Spleen Qi, keeping it inactive, so that phlegm in the collaterals and meridians can return to the Stomach. It should then be expelled following the ascending and descending movements of Stomach Qi, rather than being dispersed by the four-directional movement of Spleen Qi. This constitutes good treatment. Observe that in mild phlegm cases, patients sleep peacefully at night and can expectorate or discharge phlegm early the next morning. In severe cases, after regaining consciousness from coma, they can still expectorate or discharge phlegm. Is this not because no food was consumed, allowing Spleen Qi to rest and thus providing an exit for the phlegm? Those in the world who favor using hot herbs for aggressive attack—can they understand this principle? Alas, many people in the world take acrid-hot medicines yet find themselves able to eat at night. Can they reflect on this repeatedly?
Li Shicai stated: Ancient sages discussed that the Spleen is the source of phlegm production, and the Lung is the vessel storing phlegm. It is also said: Treating phlegm without regulating the Spleen and Stomach is not correct treatment. Because when Spleen Earth is deficient, clear Yang fails to ascend, and turbid Yin fails to descend, remaining stagnant in the middle Jiao and diaphragm, accumulating to form phlegm. Thus, treating phlegm begins with tonifying the Spleen; once the Spleen restores its normal transformative function, phlegm dissolves naturally.
Analyzing in detail, there are five types of phlegm and five types of fluid retention (Yin), and treatment methods vary accordingly. Phlegm located in the Spleen Meridian is called Damp-Phlegm (Shi Tan). Symptoms include a slow pulse, yellow complexion, heavy limbs, lethargy, abdominal distension, and food stagnation. The phlegm is slippery and easy to expectorate. Use Er Chen Tang (Two-Cured Decoction) plus Zhi Shi (Immature Bitter Orange) and Bai Zhu (Atractylodes Macrocephala Rhizome). For deficiency patterns, use Liu Jun Zi Tang (Six-Gentlemen Decoction). For alcohol injury, add Bai Dou Kou (Cardamom) and Gan Ge (Pueraria Root). Phlegm located in the Lung Meridian is called Dry-Phlegm (Zao Tan), also known as Qi-Phlegm. Symptoms include a choppy pulse, pale complexion, upward rushing Qi with panting, chills and fever, sadness, and unhappiness. The phlegm is sticky and difficult to expectorate. Use Li Jin Tang (Benefit Metal Decoction), removing Zhi Ke (Bitter Orange Peel) and adding Wei Rui (Polygonatum Odoratum Rhizome), decocted with Ginger using Honey. Phlegm located in the Liver Meridian is called Wind-Phlegm (Feng Tan). Symptoms include a wiry pulse, greenish complexion, fullness and oppression in the limbs and hypochondrium, constipation and dysuria, and occasional irritability. The phlegm is clear and foamy. Use Shi Wei Dao Tan Tang (Ten-Flavor Guiding Phlegm Decoction), decocted with Fermented Rice Water. For severe cases, use Qian Mian Tang (Thousand-Silk Decoction) plus Chuan Xiong (Ligusticum Chuanxiong Rhizome) and Da Huang (Rhubarb Root and Rhizome). Phlegm located in the Heart Meridian is called Heat-Phlegm (Re Tan). Symptoms include a flooding pulse, red complexion, vexation, heart pain, dry mouth, dry lips, and frequent laughter. The phlegm is hard and forms clumps. Use Liang Ge San (Cool the Diaphragm Powder) plus Fu Ling (Poria) and Ban Xia (Pinellia Tuber) to purge downward. Phlegm located in the Kidney Meridian is called Cold-Phlegm (Han Tan). Symptoms include a deep pulse, black complexion, urgent painful urination, cold and inverted feet, and frequent fear. The phlegm contains black spots and is thin. Use Gui Ling Wan (Cinnamon and Poria Pill) plus Ze Xie (Alisma Rhizome) and Che Qian Zi (Plantago Seed). For Kidney Deficiency causing water overflow into phlegm, use Ba Wei Wan (Eight-Ingredient Pill). If a person was previously obese but now emaciated, with water flowing between the intestines making gurgling sounds, it is called Phlegm-Fluid Retention (Tan Yin). With extreme cold below the heart, use Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) to harmonize it. If drinking water flows into the hypochondrium, causing coughing and spitting with pulling pain, it is called Suspended Fluid Retention (Xuan Yin); purge it with Shi Zao Tang (Ten Jujube Decoction). If drinking water flows into the limbs, where sweating should occur but does not, causing body ache and heaviness, it is called Overflowing Fluid Retention (Yi Yin). As stated in the Nei Jing, Yi Yin occurs when thirsty, sudden excessive drinking causes water to overflow into the muscles, skin, and outside the stomach and intestines. Treat with Xiao Qing Long Tang (Minor Green Dragon Decoction) to induce sweating. If coughing and wheezing require leaning to breathe, shortness of breath prevents lying down, and the body appears swollen, it is called Supporting Fluid Retention (Zhi Yin). Treat with Wu Ling San (Five-Ingredient Powder with Poria) and Ze Xie Tang (Alisma Decoction) to promote urination. If there is diaphragmatic fullness, vomiting, panting, coughing, chills and fever, lower back pain, tearing eyes, aversion to cold with shivering, and muscle twitching, it is called Hidden Fluid Retention (Fu Yin). Use Bei Shu Wan (Double Atractylodes Pill) plus Fu Ling and Ban Xia. There is another type, neither phlegm nor fluid, characterized by frequent spitting of white foam that is not very thick or sticky. This is due to Spleen Deficiency failing to constrain body fluids, causing saliva and foam to flow out spontaneously. Use Liu Jun Zi Tang plus Pao Jiang (Charred Ginger) and Yi Zhi Ren (Alpinia Oxyphylla Fruit) to secure it.
Alas, the five phlegms and five fluid retentions have different manifestations and vastly different treatments. The phlegm of the Spleen and Lung must not be confused. The Spleen is Wet Earth, preferring warm-dryness and disliking cold-moisture; thus, Bai Zhu, Ban Xia, and Fu Ling are essential herbs. The Lung is Dry Metal, preferring cool-moisture and disliking warm-dryness; thus, Mai Dong (Ophiopogon Tuber), Bei Mu (Fritillaria Bulb), and Jie Geng (Platycodon Root) are essential herbs. Misdiagnosis and mistreatment of either rarely avoid danger. Commonly, laypeople fear the dryness of Ban Xia and prefer the moistening nature of Bei Mu. Upon seeing phlegm, they immediately administer Bei Mu. If this is Spleen Phlegm, Earth Qi is further injured, and appetite gradually decreases. Even if it is Lung Phlegm, one should not use excessively cool-moistening herbs to damage the Middle Jiao. Instead, slightly use Spleen herbs to generate Lung Metal; this is proper treatment. Hence, it is said: Treating phlegm without regulating the Spleen and Stomach is not correct treatment. Truly so.
Whenever there are lumps in the body that are not itchy or painful, or feel numb, it is called "Defeated Phlegm Losing Its Path." Medication should be applied locally to dissipate it. If suddenly suffering from unbearable pain in the hands, feet, chest, back, head, neck, waist, and knees, extending to bones and sinews with pulling pain, restlessness, wandering pain, headache, fatigue, heavy and cold paralyzed limbs, and a hidden pulse, this is caused by stubborn phlegm and fluid retention hiding above and below the heart and chest. It is not Wind or Toxin. Use Dao Tan Tang (Guiding Phlegm Decoction) plus Qiang Huo (Notopterygium Rhizome), Fang Feng (Saposhnikovia Root), Bai Zhi (Angelica Dahurica Root), Jiang Zhi (Ginger Juice), and Zhu Li (Bamboo Sap). If Phlegm-Fire stirs mutually above the diaphragm, causing chest stuffiness, dizziness, or tooth and eye pain, feeling relieved after eating but worsening shortly after, with irregular bowel movements and urine color changes, this is due to phlegm-fluid retention opening or gathering. Treatment should strengthen the Spleen to transport phlegm and clear the Lung to moisten dryness. Use Liu Jun Zi Tang plus Su Zi (Perilla Seed), Gua Lou (Trichosanthes Fruit), Jiang Zhi, and Zhu Li. For old phlegm accumulated in the chest and diaphragm causing stuffiness, or flowing stagnantly into collaterals and limbs, use Qing Meng Shi Wan (Green Ore Pill). For robust individuals with dense constitution, use Jiang Zhi and Zhu Li to deliver Gun Tan Wan (Rolling Phlegm Pill), followed by regulation with Spleen-regulating and Qi-moving herbs. For damp-phlegm accumulating in the hypochondrium causing dull pain, worse in cloudy weather, use Er Chen Tang plus Bai Jie Zi (White Mustard Seed) for mild cases, or Kong Yan Dan (Controlling Saliva Pellet) for severe cases. When phlegm carries dead blood, attacking and flowing with Qi, causing stabbing pain that stops with heat but worsens with prolonged pain due to fire injuring blood, use Kong Yan Dan plus Hu Jiao (Pepper), Xie Wei (Scorpion Tail), Mu Xiang (Aucklandia Root), and Ling Li Jia (Manis Squama). When pain is fixed, alternate Ju Fang Qi Qi Tang (Seven-Air Decoction from the Bureau Formulary) and Liu Jun Zi Tang with Zhu Li. Phlegm in the hypochondrium cannot reach without Bai Jie Zi; phlegm in the limbs or under the skin cannot move without Zhu Li and Jiang Zhi. These two are highly effective for Yin-deficiency with phlegm, but should not be used lightly in those with poor appetite and weak Spleen-Stomach, as their cold and slippery nature promotes bowel movements. Zhi Shi treats phlegm, capable of breaking walls; Huang Qin (Scutellaria Root) and Hua Fen (Trichosanthes Root) greatly reduce upper diaphragm heat-phlegm, but may suppress fire evil and damage Middle Qi; contraindicated in Spleen-Stomach deficiency-cold and exterior conditions. Phlegm in the diaphragm causes mania, amnesia, hemiplegia, and stroke-like symptoms; treat all with Zhu Li. Phlegm in the intestines and stomach can be purged away using Zhi Shi, Da Huang, and Mang Xiao (Mirabilite). For upper diaphragm heat-phlegm causing stuffiness, use Xiao Xian Xiong Tang (Minor Chest-Harmonizing Decoction) plus Zhi Shi, Fu Ling, Jiang Zhi, and Zhu Li. For mid-Jiao retained phlegm-fluid causing arm pain preventing lifting, inability to move hands and feet, and aversion to cold on the back, use Zhi Mi Fu Ling Wan (Point-Mystery Poria Pill). Phlegm-fluid flowing into limbs causes shoulder and back soreness, soft paralysis of hands; misdiagnosing as Wind is incorrect. Use Dao Tan Tang plus Jiang Huang (Curcuma Longa Rhizome) and Mu Xiang; if ineffective, add Gui Zhi (Cinnamon Twig) to harmonize Ying-Qi. Blackened vision, groaning while walking, and difficulty moving indicate phlegm entering bones; remove with Bi Xie (Dioscorea Hypoglauca Rhizome) and Ku Shen (Sophora Root). For generalized joint pain, assess Qi-Blood and add phlegm-resolving herbs. For damp-phlegm obstruction causing chest discomfort and Qi stagnation, or phlegm-fire coughing without blood, use Chen Xiang Hua Tan Wan (Agarwood Phlegm-Resolving Pill). For obese individuals with damp-heat, where phlegm-dampness is stuck internally and externally, causing panting, fullness, and dizziness upon movement, use Yun Tan Wan (Transporting Phlegm Pill). For untransformed old phlegm causing throat blockage and inability to expectorate, use Xiao Tan Bing Zi (Phlegm-Resolving Cake). For foreign body sensation in the throat, unable to spit out or swallow, or causing stabbing pain, this is Depressed Phlegm; use Si Qi Tang (Four-Air Decoction). For choppy pulses, opening is difficult and requires prolonged regulation. For overthinkers with Stomach deficiency-cold, fluid accumulation, and reduced appetite, select Ju Fang Qi Qi Tang or Shen Shi Xiao Yin Wan (Deep Master Fluid-Resolving Pill). For cold-phlegm and old water in the chest and heart, after spontaneous vomiting clears the chest, leaving emptiness, Qi-fullness, and inability to eat, use Waitai Fu Ling Yin (External Platform Poria Drink). For cold saliva flooding the Gallbladder, causing frequent spitting of phlegm-water, insomnia, or dizziness, use Wen Dan Tang (Warm the Gallbladder Decoction); add Xie Wei for palpitations. For Phlegm-Fire flourishing in the Upper Jiao, causing Qi excess, panting, variable appetite, wandering pain, and bloating, use Gun Tan Wan. The Dao Cang Fa (Stomach Purging Method) is excellent for people from Northwest China. For chronically deficient patients with old accumulations of phlegm-fluid, tonify with Ren Shen (Ginseng Root) and Bai Zhu first; eventually, foul-smelling or green phlegm may be vomited, indicating difficulty. Long-standing accumulation leads to Spleen-Stomach deficiency-heat and non-transport, causing郁 (depression) and odor. Urgently use Er Chen Tang plus Zhi Shi, Bai Zhu, Huang Lian (Coptis Rhizome), and Zhu Li; only then might one achieve partial success. Pulmonary Abscess vomiting foul pus and blood is excluded here. For Spleen-Lung Qi deficiency failing to transform and produce phlegm, use Liu Jun Zi Tang plus Mu Xiang. For Lung-Stomach Qi deficiency failing to clear and transform, use Liu Jun Zi Tang plus Jie Geng. For Spleen Qi deficiency failing to transform and generate phlegm, use Li Zhong Wan (Regulate the Middle Pill) plus Ban Xia and Fu Ling. For Spleen Qi stagnation with blood in phlegm, use Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction), removing Mu Xiang and Yuan Zhi (Polygala Root), adding Mu Dan Pi (Moutan Cortex) and Sha Ren (Amomum Fruit). For Liver Meridian Blood-Heat with blood in phlegm, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder), removing Chai Hu (Bupleurum Root) and Wei Jiang (Roasted Ginger), adding Tong Bian (Child's Urine) and Ou Jian (Lotus Root Juice). For Liver-Kidney Yin Deficiency with blood in phlegm, use Liu Wei Wan (Six-Ingredient Pill) plus Wu Gu Ji (Black-bone Hen) and Qian Gen (Rubia Cordifolia Root). For excessive cooling leading to blood in sputum, use Yi Gong San (Medicine of Merit Powder) plus Pao Jiang. For phlegm-fluid accumulation in the abdomen and hypochondrium resembling accumulations, but soft upon pressure with frequent spitting of saliva, use Liu Jun Zi Tang combined with Wu Ling San plus Zhi Shi. For asymptomatic periods with only a few mouthfuls of phlegm, clear or hard, use Xiao Ban Xia Fu Ling Tang (Minor Pinellia and Poria Decoction); if ineffective, add Ren Shen to strengthen Stomach Qi, and phlegm will cease. For Yin-blood deficiency with Minister Fire flaming upward, attacking the Lung and preventing downward transformation, causing fluid stagnation, generating phlegm instead of blood, use moistening agents like Er Dong Gao (Two Winter Pastes) or Liu Wei Wan to nourish Yin, allowing rebellious Fire to return to its home and extinguish, curing the disease. Administering Er Chen Decoction etc. will lead to immediate peril. This pattern is common in thin individuals. Kidney Deficiency failing to grasp Qi results in exhalation without inhalation, causing stagnation; unresolved stagnation generates phlegm. Use Ba Wei Wan. This is also common in obese individuals. For elderly with Kidney Deficiency causing water overflow and phlegm surging upward, use Ba Wei Wan to secure it; if ineffective, use Zhen Wu Tang (True Warrior Decoction). Whenever Chi (Kidney) pulse is floating and large, becoming choppy upon pressure, accompanied by shortness of breath, phlegm, reddish-choppy urination, and heel pain, it indicates Kidney Deficiency failing to transport turbid Qi, condensing into phlegm. Use Shen Qi Wan (Kidney Qi Pill). For fine-slippery or slow pulses with thin phlegm-saliva, body fatigue, and sore weak limbs, this is Spleen Deficiency with Dampness. Use Liu Jun Zi Tang plus Pao Jiang, or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction) plus Ban Xia and Fu Ling.
However, phlegm diseases must be differentiated by the presence or absence of Fire. Without Fire, it is purely clear water; with Fire, it contains heavy, turbid white foam. For internal injury to Middle Qi, deficiency with phlegm, Ren Shen and Bai Zhu are essential, assisted by Jiang Zhi for transmission; severe cases add Zhu Li. For Spleen Qi deficiency, clear Middle Qi to transport phlegm downward. Use Liu Jun Zi Tang plus Zhi Shi and Bai Zhu, combined with Sheng Ma (Cimicifuga Rhizome) and Chai Hu to lift clear Qi. For soggy-slow pulses and body fatigue in obese individuals, it belongs to Damp-Phlegm. Use Er Chen Tang plus raw Bai Zhu and Qiang Huo; assist with Ren Shen and Bai Zhu for Qi deficiency. For deep-stagnant or slippery pulses with nausea and epigastric fullness, it belongs to Depressed Phlegm; open depression and move Qi. For slippery pulses at Right Guan, with frequent nausea, vomiting clear water, and stuffiness, induce vomiting using a goose feather probe. Heat-phlegm in the diaphragm cannot be cleared by purging; vomiting is necessary. Sticky and turbid phlegm cannot open without vomiting; floating-slippery pulses suit vomiting. Choppy pulses in the elderly and deficient preclude vomiting. Phlegm in collaterals requires vomiting, which also has a dispersing effect. First lift Qi before vomiting, using Gua Di (Melon Tip), Fang Feng, Chuan Xiong, Jie Geng, Ya Cha (Sprouted Tea), or Xi Zhi (Pickled Vegetable Juice). On clear days, in a draft-free room, bind the abdomen tightly with cloth, then induce vomiting. For Kidney Deficiency water overflow causing phlegm, if Shen Qi Wan fails repeatedly, consider that phlegm is Yin-type, and using Di Huang (Rehmannia Root) to aid Yin is inappropriate. Reduce Shu Di Huang (Prepared Rehmannia Root) and Shan Zhu Yu (Cornus Fruit) in the formula, add Shi Pu (Acorus Rhizome) and Chen Xiang (Aquilaria Wood) to open Qi, and efficacy will follow. Generally, for Yin-deficiency with dry phlegm, strictly avoid aromatic-dry Qi-tonifying herbs like Er Chen and Liu Jun Zi. For Yang-deficiency with fluid overflow, strictly avoid cloying Yin-nourishing herbs like Si Wu and Liu Wei. This distinction is crucial. Generally, when phlegm-fluid generates various syndromes, do not name them after the secondary syndromes; prioritize treating the fluid retention first. Once fluid resolves, other syndromes heal spontaneously. For example, head wind and brow bone pain unresponsive to Wind-dispelling herbs respond to phlegm-resolving formulas. Red, light-sensitive, painful eyes unresponsive to cooling herbs respond to phlegm-resolving formulas. Such examples are numerous and scattered across chapters, not repeated here.
[Diagnosis] Deep pulses indicate retained fluid. Bilateral wiry pulses indicate Cold. Unilateral wiry pulses indicate Fluid Retention. Lung Fluid Retention is not wiry, but suffers from panting, fullness, and shortness of breath. Supporting Fluid Retention also causes panting preventing lying down and shortness of breath, with a normal pulse. If a patient has one arm paralysis that shifts to the other arm, with deep-thin pulses, it is not Wind, but likely Fluid Retention in the Upper Jiao. Phlegm presenting with choppy pulses is difficult to cure. Chen Wuzhe stated: Fluid retention pulses are wiry, thin, deep, and slippery. Floating-large and solid pulses at Left/Right Guan indicate thick phlegm in the diaphragm; induce vomiting. If hundred medicines fail, and pulses at Guan are hidden and slippery, it is phlegm. Dark circles under the eyelids also indicate phlegm.
Spitting: Frequent spitting while sitting indicates Stomach Cold. Due to Stomach Qi deficiency-cold and failure to transport, this syndrome often follows illness. Use Li Zhong Tang (Regulate the Middle Decoction) or Liu Jun Zi Tang plus Yi Zhi Ren to secure.
Yu Hengde treated a woman who developed phlegm disease from eating too many green plums. During the day, chest and diaphragm pain felt like knife thrusts; at night, chest pain ceased, but knee and thigh pain became severe. This is phlegm-fluid moving with Qi ascent and descent. Herbs including Ding (Clove), Chen (Tangerine Peel), Jiang (Ginger), Gui (Cinnamon), Wu (Aconite Child), and Fu (Aconite Mother) were ineffective. Radish juice (Lai Fu Zi) was ground and half a bowl given, resulting in vomiting half a sheng of phlegm. Pain worsened at night with cold extremities, drawing out the rampant pathogen. Next day, Shen Lu (Ginseng Stem) one liang decocted in reverse-flowing water did not induce vomiting. Next day, Ku Shen (Sophora Root) decoction did not induce vomiting. Fu Zi Jian (Aconite Tip) and Jie Geng Lu (Platycodon Stem) also failed. Early next morning, Li Lu (Veratrum Powder) one qian and She Xiang (Musk)少许 mixed with sour water induced massive vomiting of thick phlegm, resolving pain. Regulate Spleen-Stomach to recover.
Qian Zhongli treated a man with chronic Phlegm-Fire. Though outwardly emaciated, his constitution was solid. Physicians mistakenly diagnosed deficiency-fire and used Bu Zhong Yi Qi, causing rising Qi panting nearly fatal. Er Chen Decoction was used to induce vomiting, expelling a bowl of phlegm, allowing sleep. Er Chen Decoction minus Ban Xia, plus Xiao (Niter) and Huang (Rhubarb), purged countless hardened feces, heat subsided. Regulate Spleen-Stomach to recover.
Wang Zhongyang treated a wealthy merchant from Jiangdong, accustomed to rich diet. Suddenly suffered heart palpitations, fearing capture. Smelling cosmetics caused seminal emission. Desired support when sitting/lying. Red-purple rashes on body, wet rotting sores on legs and feet with continuous pus. Appetite doubled, socializing tireless. Treatments for palpitations, deficiency collapse, and wind-sores failed. Wang diagnosed long pulses in six positions, strong in three layers. This excessive pulse indicates Heart-Kidney non-interaction, upper palpitations, lower leakage, all caused by phlegm-fluid accumulation. Wind-sores also result from phlegm-fluid entering collaterals, internal damp attracting wind. First use Gun Tan Wan to purge phlegm-toxin every three days, then use phlegm-resolving herbs, adjusting to recover.
Xue Lizhai treated a man with a back lump, soft on pressure, normal skin color, normal appetite, vomiting phlegm upon exertion. This is Spleen Deficiency with phlegm stagnation. Use Bu Zhong Yi Qi Tang plus Fu Ling, Ban Xia, Qiang Huo. Externally, apply Xiang Fu (Cyperus Rhizome) powder mixed with ginger juice as a cake, moxa to dissipate. Later, labor-induced dizziness and vomiting cured by previous formula minus Qiang Huo, plus Man Jing Zi (Vernonia Seed).
Li Shicai treated Qin Jingming, chronic phlegm-fluid, recurring 4-5 times yearly with vomiting and inability to eat. Long-standing disease formed nests/sacs, requiring strong vomiting to cure. First tonify with Bu Zhong Yi Qi for ten days, then frequently administer Gua Di San (Melon Tip Powder). Vomiting yielded red bean paste-like substance several sheng, then crystal-colored liquid one sheng. Repeat seven cycles of tonification and vomiting. After 100 days, nests cleared. Continuously take Liu Jun Zi Tang and Ba Wei Wan for a year.
Also treated Zhu Wenzai, body itching like insect bites, mouth/tongue ulceration, hallucinations at Yin/Mao hours. Pulses at both Guan wiry-slippery-large, determined as phlegm-fluid pestilence. One dose of Gun Tan Wan caused slight purging. Then Kong Yan Dan purged phlegm and accumulation, halving body pain. Finally, Ren Shen and Bai Zhu decoction delivered Kong Yan Dan, purging several times to cure.
Shi Wan treated Envoy Zhou You Tao, native of Yan, obese with heavy phlegm, good appetite, but chronic rattling phlegm and asthma. Food injury triggers attacks, pulses slow-slippery with intermittent stops, sound like sawing wood, phlegm everywhere. Recurs 1-3 times yearly, worse in late autumn/winter. Used Dao Cang Fa (Stomach Purging). Reported light limbs, symptoms ceased. Two years later, relapsed due to beef consumption, but severity less than 1/10th, due to dietary indiscretion.