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Phlegm is a disease name. In the human body, if Qi and Blood are clear and smooth, then Body Fluids flow freely, so how can there be phlegm? Only when Qi and Blood become turbid and rebellious do Body Fluids lose their clarity, get steamed and accumulated, and transform into phlegm. The root of phlegm lies in Water, originating from the Kidney; the movement of phlegm depends on Dampness, governed by the Spleen. Ancient practitioners used Er Chen Tang (Two-Aged Decoction) as a general formula for treating phlegm, aiming to strengthen the Spleen and dry Dampness to treat the branch manifestation. However, while it is appropriate for treating Damp-phlegm, Cold-phlegm, Phlegm-fluid retention, and Phlegm-saliva, if phlegm arises due to Fire pathogen causing unclear Lung Qi, with frequent coughing, or if old phlegm and constrained phlegm form sticky masses that stagnate in the throat, making them difficult to expectorate, such phlegm results from the Fire pathogen flaring upward, steaming the Upper Jiao, and constraining Lung Qi. Consequently, Body Fluids rising with Qi are steamed by Fire, becoming turbid, condensed, and knotted. Over years, they become deeply rooted and solid, hence named "old" and "constrained," with the fundamental cause being the Fire pathogen. The pathology is located in the Upper Jiao (Heart and Lung regions) and the throat, distinct from the Damp-cold phlegm, fluid retention, and saliva of the Middle Jiao (Spleen and Stomach). Therefore, decoctions are difficult to cure, and herbs such as Banxia (Pinelliae Rhizoma), Fuling (Poria), Cangzhu (Atractylodis Rhizoma), Zhike (Aurantii Fructus), and Nanting (Arisaematis Rhizoma Preparatum) cannot treat it. The key lies in resolving constraints, descending Fire, clearing and moistening Lung Metal (the Lung organ), thereby dissolving condensed phlegm, treating slowly, hoping for efficacy! Now, a formula is formulated below:

Tianmendong (Asparagi Radix, heart removed), Huangqin (Scutellariae Radix, wine-fried), Haifen (Natrii Boras), Juhong (Citri Reticulatae Pericarpium Rubrum) (each 1 liang); Jiegeng (Platycodonis Radix), Lianqiao (Forsythiae Fructus), Xiangfu (Cyperi Rhizoma, pounded, soaked in light salt water, fried) (each 5 qian); Qingdai (Indigo Naturalis, ground separately), Mangxiao (Natrii Sulfas, ground separately) (each 3 qian); Gualouren (Trichosanthis Semen, flesh taken and ground separately) (1 liang).

Grind all ingredients into fine powder. Add refined honey and a little Ginger Juice, pound thoroughly until uniform. Form pills the size of dragon eyes. Hold one pill in the mouth to dissolve. Alternatively, chew thoroughly and swallow slowly with clear water. Or form pills the size of millet grains, take 50-60 pills with light ginger soup.

My commentary: The preceding formula consists of sweet, bitter, salty, and cold-natured herbs. Although it can soften hardness, resolve constraints, transform phlegm, and descend Fire, does it not risk damaging Stomach Qi? If Spleen Earth is excessive, generating phlegm due to Qi stagnation and constrained heat, this formula is suitable. However, if Spleen Earth is deficient, generating phlegm due to Qi blockage and deficiency heat, using this formula will inevitably lead to abdominal fullness, acid regurgitation, abdominal swelling, dysuria, and even death. Practitioners must exercise caution!

A man who was generally poor at self-care suffered from excessive spitting of phlegm, dry mouth, and poor appetite. After taking formulas for transforming phlegm and moving Qi, he experienced chest fullness and abdominal distension, with increased phlegm-saliva; after taking formulas for guiding out phlegm and regulating the Spleen, his abdomen swelled, and urination and defecation became obstructed; after taking formulas for separating Qi and promoting diuresis, his abdomen enlarged with hypochondriac pain, unable to sleep lying down; after taking formulas for breaking blood and promoting digestion, both legs swelled, and the Guan pulse on both wrists was floating and large, failing to reach the Cun position. I diagnosed this as phlegm generated due to Spleen Earth deficiency. In the morning, I administered Jin Gui Jia Jian Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet), and in the evening, I administered Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to wash down the previous pills. After more than a month, symptoms gradually receded, and diet improved. Subsequently, using Ba Wei Wan (Eight-Ingredient Pill) and Bu Zhong Yi Qi Tang, after another month, he could turn over, and after two more months, he could walk. Later, taking Shi Quan Da Bu Tang (Great Tonifying Decoction for Ten Powers) and Huan Shao Dan (Return to Youth Elixir), he recovered after half a year. When he later neglected care, his abdomen bloated again, but immediately recovered upon taking the previous medicines.

A military officer, with a robust physique, usually did not use heating pads and disliked hot food, panting when walking. He believed he had excess Qi and old phlegm, and took Bei Ji Wan (Stele Record Pill) for purgation. His pulse was flooding and rapid, but completely empty upon heavy pressure. I diagnosed Mingmen Fire decline and Spleen-Lung deficiency-cold. One dose of Ba Wei Wan stopped the phlegm and panting slightly; after several doses, it stopped completely, allowing him to tolerate fire sources and prefer hot food. Bei Ji Wan originates from the Western Regions and was formulated by Buddhist monks. The Classics state that the water and soil of the Western Regions are tough and strong; the people wear coarse cloth and sit on straw mats, have ruddy complexions and fatty bodies, so external pathogens cannot harm their physical forms, their diseases arise internally, and treatment should suit toxic drugs. From this perspective, it is feared that this cannot be used indiscriminately.

Lu Zhongshe of Taicang suffered from abdominal distension and enlargement due to Kidney deficiency failing to control water. He died in Beijing after taking this pill only a few times. Specialists in treating Gu distension today use this very formula. It is also called Hei Wan (Black Pill); its use invariably leads to rapid death.

Cai Yi from the Silk Workshop neglected daily routines. His symptoms were similar to the above, accompanied by cold extremities, aversion to cold, and anorexia. I used Bu Zhong Yi Qi Tang plus 1 qian of Fuzi (Aconiti Lateralis Radix Preparata) to first restore Yang. After several doses, symptoms gradually improved. Due to my absence, others used harsh purgatives, causing severe hematochezia, leading to his demise.

Such old phlegm is common among drinkers. Wine Qi rises and transforms into Fire, affecting the Lungs and Stomach, leading to constraint and knotting. This formula uses Tianmendong (Asparagi Radix) and Maidong (Ophiopogonis Radix), Huangqin (Scutellariae Radix) to drain Lung Fire; Haifen (Natrii Boras) and Mangxiao (Natrii Sulfas) to soften hardness with salty flavor; Gualouren (Trichosanthis Semen) to moisten the Lungs and clear phlegm; Xiangfu (Cyperi Rhizoma) to open constraints and descend Qi; Lianqiao (Forsythiae Fructus) to resolve knots and descend Fire; Qingdai (Indigo Naturalis) to descend constrained Fire. Thus, aromatic-drying herbs are avoided.

My commentary: For the aforementioned conditions, if there is poor appetite or chest-diaphragm discomfort, this indicates Middle Qi deficiency; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be the primary treatment. Once Middle Qi is strong, phlegm will naturally transform. If Kidney Qi is damaged, Body Fluids fail to descend, becoming turbid phlegm, this is a True Zang disease; Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) should be the primary treatment. Once Kidney Qi is robust, Body Fluids will clear and transform, leaving no room for phlegm. There are also cases where Spleen-Stomach damage and Middle Jiao Qi deficiency prevent transformation into phlegm, or where excessive harsh medication further weakens Spleen Qi, preventing transformation and causing Body Fluids to stagnate into phlegm. All such cases should prioritize strengthening the Spleen and Stomach.