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The *Qijiao Bian Da Lun* (Great Treatise on the Changes of Qi and Earth) states: When the annual earth qi is excessive, it leads to the onset of fluid retention (Yin), epigastric fullness, and reduced appetite.

The *Wuchang Zheng Da Lun* (Great Treatise on the Normal Policies of the Five Constants) states: When Taiyang governs the year, dampness alters the nature of things, causing water and fluids to accumulate internally, resulting in epigastric fullness and an inability to eat.

The *Liuyuan Zhengji Da Lun* (Great Treatise on the Correct Records of the Six Origins) states: When Shaoyin governs the year, during the fourth Qi phase, the people suffer from diseases of fluid retention. When Taiyin arrives, it manifests as accumulated fluid retention (Ji Yin) and stagnation with obstruction. When earth depression erupts, it manifests as fluid retention and watery diarrhea.

The *Zhihen Yao Da Lun* (Great Treatise on the Most Essential Truths) states: When Sui Taiyin is in the lower position, the people suffer from diseases of fluid accumulation. When Sui Yangming is in the lower position, the people suffer from frequent vomiting and bitter vomit. When Taiyin prevails, fluid retention occurs in the middle jiao. When Taiyin rebounds, fluid retention occurs in the middle jiao, with spitting and vomiting of clear fluids. When Taiyang rebounds, clear water is spat out, accompanied by hiccups and belching. All pathological fluids that are clear, pure, and cold belong to Cold syndrome.

Regarding the syndrome of Tan (Phlegm) and Yin (Fluid Retention), in the *Neijing* (Inner Canon), there is only the concept of "accumulated fluid retention" (Ji Yin), and originally no name for "Tan syndrome." From this, it can be generally known that the *Neijing* did not emphasize Tan syndrome. Examining the origin of the term "Tan," although it started with Zhang Zhongjing, later generations have passed down the notion that whether it is phlegm or not, one immediately speaks of "phlegm-fire." Some say strange diseases are caused by phlegm; some say phlegm is the mother of a hundred diseases. It seems the relationship of phlegm is indeed heavy. So why does the *Neijing* ignore it? One must understand that for phlegm to exist as a disease, there must be a cause. If phlegm arises due to Wind or Fire, one should only treat the Wind and Fire; once Wind and Fire subside, the phlegm will naturally clear. If phlegm arises due to Deficiency or Excess, one should only treat the Deficiency and Excess; once Deficiency and Excess are resolved, the phlegm will naturally settle. It has never been heard that treating only the phlegm allows Wind and Fire to dissipate spontaneously or Deficiency and Excess to regulate themselves. This is precisely because phlegm arises from disease, rather than disease arising from phlegm. Therefore, the reason the *Neijing* does not mention phlegm is exactly because phlegm is not the root of the disease, but merely the branch manifestation. Today, doctors throughout the world only know how to attack phlegm with every method, thinking this constitutes treating the disease. They completely fail to understand what phlegm is and why it arises. Is this not equivalent to pointing at a finger to make the arm move, or watering leaves to save the roots? Misidentifying root and branch, losing one's main judgment, seeking to cure diseases is difficult! Very difficult!

First, although Phlegm (Tan) and Fluid Retention (Yin) are said to be of the same category, they are actually different. Generally, Yin belongs to the category of water fluids. Symptoms such as vomiting clear water, abdominal distension, acid regurgitation, belching with rotting food sensations, and gurgling sounds in the abdomen all indicate that leftovers from food and drink have stopped and accumulated without moving; this is what is called Yin. The difference between Tan and Yin is that Yin is clear while Tan is thick and turbid. Yin only stays and accumulates in the intestines and stomach, whereas Tan can reach everywhere. When food and drink fail to digest and stop as Yin, the disease is entirely due to the Spleen and Stomach; when substances go nowhere and transform into Tan, injury to any of the five Zang organs can cause it. Therefore, those who treat this condition must know how to distinguish them and must not fail to examine their root.

Second, Tan is essentially the body's Jin Ye (Body Fluids), which are nothing but transformations of food and grain. This Tan is also something that has been transformed, not something untransformed. However, if transformation proceeds correctly, the physique becomes strong, Ying and Wei (Defensive and Nutritive Qi) become abundant, and originally, phlegm and saliva are part of Blood and Qi. If transformation loses its correctness, then Zang organs become diseased, Jin Ye deteriorate, and Blood and Qi turn into phlegm and saliva. This is like bandits in chaotic times; were they not all good citizens in peaceful times? But the rise of bandits must stem from the sickness of the nation's fortune. Similarly, the production of phlegm and saliva must stem from the sickness of Yuan Qi (Original Qi). I once heard Mr. Lizhai say, "If Blood and Qi are both abundant, where would phlegm come from?" In my early years, I greatly doubted this statement, asking, "Are there really no cases of Excess Phlegm?" Now, with more settled insight, I believe it to be true. How do we see this? The transformation of phlegm and saliva originates from food and grain. If the Spleen is strong and the Stomach healthy, as in young and vigorous people, food is digested immediately upon ingestion and all transforms into Blood and Qi; how could it remain to become phlegm? Only because they cannot fully transform, leaving one or two parts out of ten, that one or two parts become phlegm. Leaving three or four parts out of ten makes three or four parts phlegm. Even leaving seven or eight parts means we only see Blood and Qi daily diminishing while phlegm and saliva daily increase. The reason for this is precisely that Yuan Qi cannot transport and transform; the more deficient it is, the more abundant the phlegm becomes. Then, isn't Mr. Lizhai's words a view beyond common sense? Nowadays, seeing those who treat phlegm always say, "Phlegm is a harm; how can it be removed without attacking?" They do not know that if Zheng Qi (Upright Qi) does not move, and Deficient Phlegm aggregates, then even if one attacks with all effort, not only will the phlegm not be removed, but deficiency will further increase. Thus, some may die from being purged away by attack. Or some may temporarily recover but become worse than before; these are all errors of attacking. Who knows that few types of phlegm can be attacked, while many cannot? Therefore, anyone preparing to treat phlegm must first examine Deficiency and Excess.

Third, Phlegm has Deficiency and Excess aspects, which must be distinguished. Although it is phlegm, it appears as if it is all Excess (Repletion); so where is the difference between Deficiency and Excess? The terms Deficiency and Excess are entirely spoken of in relation to Yuan Qi. Whatever can be attacked is Excess Phlegm; whatever cannot be attacked is Deficient Phlegm. What is meant by "can be attacked"? It refers to cases where age and strength are still robust, Blood and Qi are not yet injured, or due to excess of rich and sweet foods, or prevalence of Damp-Heat, or external closure of skin and hair by Wind-Cold, or internal connection of rebellious Qi to Liver and Diaphragm, all of which can suddenly lead to Phlegm and Fluid Retention. As long as one observes that the physical constitution and pathological Qi both belong to Excess, it is Excess Phlegm. What is Excess Phlegm? It means the Yuan Qi is still solid. In such cases, methods of moving, dissolving, and reducing should be used; removing the phlegm is acceptable. What is meant by "cannot be attacked"? It refers to cases where the physique is emaciated and Qi is weak, reaching middle age decline; this is Deficient Phlegm. Or due to multiple illnesses, fatigue, or worry, thought, alcohol, and lust leading to Consumption, Non-Wind (stroke-like conditions), or sudden syncope; these are also Deficient Phlegm. Or if the pulse is fine and rapid, with no Yang pathogenic factors in the Zang organs, accompanied by symptoms such as occasional nausea, vomiting, diarrhea, shortness of breath, and hoarseness; as long as one observes that the physical constitution and pathological Qi originally lack Excess characteristics, these are all Deficient Phlegm. What is Deficient Phlegm? It means the Yuan Qi is already deficient. In such cases, only regulation and tonification are suitable; if attacked, danger is inevitable. Moreover, Excess Phlegm is originally not numerous; it comes suddenly and departs quickly, and the disease is easy to treat. Why? Because the disease root is not deep. Deficient Phlegm, conversely, is often severe; it comes gradually and departs slowly. The disease is also difficult to treat. Why? Because the disease did not arise in a single day. Therefore, Excess Phlegm is not worth worrying about, while the most fearful is Deficient Phlegm. In summary, the method for treating phlegm is nothing else: if one can make Yuan Qi strengthen day by day, then phlegm will surely decrease day by day. Even if there is slight phlegm, it will not cause harm and will even assist Stomach Qi. If Yuan Qi declines day by day, then food and drink Jin Ye will all become phlegm; it generates as fast as it is removed. Can anyone attack it until it is gone and preserve Yuan Qi intact? I do not believe it. Therefore, those skilled in treating phlegm are only those who can prevent it from generating; this is the hand that mends the sky. Thus, those treating this condition must distinguish Deficiency and Excess. To attempt to attack everything uniformly, as Wang Yinjun discussed, claiming that internal and external hundred diseases all arise from phlegm and using drugs like Gun Tan Wan indiscriminately, is merely knowing the present benefit while ignoring future harm.

Fourth, although diseases of the five Zang organs can all generate phlegm, none do so without involving the Spleen and Kidney. The Spleen governs Dampness; when Dampness moves, it becomes phlegm. The Kidney governs Water; when Water overflows, it also becomes phlegm. Therefore, the transformation of phlegm lies entirely with the Spleen, while the root of phlegm lies entirely with the Kidney. Hence, for any phlegm syndrome, it involves either one or the other, definitely relating to these two Zang organs. However, phlegm in the Spleen system has both Deficiency and Excess. For example, excessive dampness stagnation is Spleen Excess; soil weakness failing to control water is Spleen Deficiency. As for phlegm in the Kidney system, it is purely Deficiency. Fire failing to generate Earth is also Fire failing to control Water; Yang failing to overcome Yin means Water counter-invades the Spleen; these are all deficiencies of Fire within Yin. If Fire is excessive and scorches Metal, Essence fails to guard its residence, Jin Ye dries up, and Metal and Water harm each other; these are all deficiencies of Water within Yin. These differences in Spleen and Kidney Deficiency and Excess must be distinguished. Furthermore, regarding ancient classifications such as Damp Phlegm, Depressed Phlegm, Cold Phlegm, and Heat Phlegm, although they vary by location (upper/lower) and nature (cold/heat), their source of generation cannot escape these two Zang organs. For instance, Cold and Damp Phlegms are originally diseases of the Spleen; does the generation of Cold and Damp truly have no connection to the Kidney? Wood depression generating Wind, originally Liver phlegm; does Wood strictly controlling Earth not involve the Spleen? Fire excess overcoming Metal, with phlegm in the Lung; does the flaming upward of Fire pathogen not originate from the Lower and Middle Jiao? Therefore, anyone wishing to treat phlegm but not knowing its source is merely guessing and groping.

Fifth, the three essays on Phlegm in the Chapter on Non-Wind should be read cross-referentially.