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Pang Anchang stated: There are cases of insufficient Yin fluid, leading to the ascent of deficient fire (Yin fire), where the Lung is affected by fire pathogenic factors and cannot descend clearly and turbidly. Consequently, body fluids coagulate and become turbid, generating phlegm instead of blood. In such cases, moistening agents such as Ophiopogonis Radix (Maidong, 麦冬), Rehmanniae Radix (Dihuang, 地黄), and Lycii Fructus (Gouqi, 枸杞) should be used to nourish Yin, allowing the ascending deficient fire to return to its residence (the Kidney), after which the phlegm will clear naturally. Administering Er Chen Tang (Two-Cured Decoction) would immediately lead to danger. Additionally, when Kidney deficiency fails to grasp Qi and return it to its origin, Qi exits but is not grasped, leading to accumulation; if this accumulation does not dissipate, phlegm is generated. This condition is primarily treated with Ba Wei Wan (Eight-Ingredient Pill).

Wu Jiaoshan, in *Zhu Zheng Bian Yi* (Differentiation of Doubts Regarding Various Syndromes), stated that Ba Wei Wan treats the root cause of phlegm.

Xu Xueshi used Rhizoma Atractylodis Macrocephalae (Cangzhu, 苍术) to treat phlegm forming "cocoons" (phlegm nodules), achieving excellent results. Phlegm combined with blood stasis forms these cocoons.

Zhu Danxi said: For those with Spleen deficiency, it is appropriate to clear and regulate Middle Jiao Qi to transport and descend phlegm. Er Chen Tang can be modified with Atractylodis Rhizoma (Baizhu, 白术), combined with Cimicifugae Rhizoma (Shengma, 升麻) to lift Qi. Er Chen Tang governs the treatment of phlegm throughout the body. To guide phlegm downward, add guiding herbs for descent; for phlegm located superiorly, add guiding herbs for ascent. Generally, masses found anywhere in the body are mostly due to phlegm. One should inquire about dietary preferences, first apply emetic or purgative methods, and then administer medication.

Wang Jiezhai said: Phlegm originates from the Spleen and Stomach; thus, strengthening the Spleen and drying dampness is suitable. Since phlegm ascends with Qi, regulating Qi should come first, followed by differentiation and drainage. Ascending Qi belongs to Fire; therefore, regulating Qi involves descending Fire. Heat-phlegm requires clearing heat; damp-phlegm requires drying dampness; wind-phlegm requires dispersing; stagnant-phlegm requires opening stagnation; stubborn-phlegm requires softening; food-stagnation-phlegm requires digestion; phlegm located superiorly is treated with emesis; phlegm located centrally is treated with purgation. Furthermore, for those with deficient Middle Qi, securing Middle Qi to transport phlegm is appropriate. If attack methods are too harsh, Stomach Qi becomes deficient, and phlegm worsens.

Xue Lizhai said: In any phlegm syndrome characterized by poor appetite or chest/diaphragm discomfort, this indicates deficiency of Middle Qi. Treatment should focus on Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction); once Middle Qi is robust, phlegm will naturally transform. If Kidney Qi is deficient, causing body fluids to fail to descend and turning into turbid waste-phlegm, this is a disease of the True Zang organs, primarily treated with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). Once Kidney Qi is strong and body fluids are clear and transformed, how could there be phlegm? There are also cases where Spleen and Stomach damage leads to Middle Jiao Qi deficiency, failing to transform fluids into phlegm; or cases where excessive use of harsh drugs further damages Spleen Qi, preventing fluid transformation and causing stagnation-phlegm. All such cases require strengthening the Spleen and Stomach as the primary approach.

He further stated: Phlegm is essentially the body fluids of the Spleen and Stomach. It may be injured by diet or disturbed by the Seven Emotions and Six Exogenous Pathogens, leading to Qi obstruction and phlegm aggregation. The Spleen is the meridian governing blood and moving Qi; if Qi and Blood are abundant, where would phlegm come from? It arises from excessive thinking and dietary injury damaging meridians. When Spleen Blood is deficient, Stomach Qi becomes relatively hyperactive, causing dampness to transform abnormally, resulting in much phlegm. Phlegm travels throughout the body without exception. When phlegm-Qi is excessive, the pathogen overcomes the healthy Qi. If it attacks the large collaterals of the Spleen, sudden collapse occurs, known as Phlegm Syncope (Tan Jue). If it ascends to the Lung, it causes wheezing and cough. If it confuses the Heart, it causes palpitations and mental confusion. If it moves to the Liver, it causes dizziness, numbness, and hypochondriac distension/pain. If it affects the Kidney, one expects no cough but excessive sputum. If it remains in the Stomach, it causes vomiting, diarrhea, and alternating chills/fever. If it enters the Chest, it causes sore throat and pain in the supraorbital ridge. If it enters the Intestines, it produces gurgling sounds; dispersed it makes noise, aggregated it causes obstruction. If Spleen Qi is weak and cannot resolve dampness, use Bu Zhong Yi Qi Tang plus Poria (Fuling, 茯苓) and Pinelliae Tuber (Banxia, 半夏). If caused by Spleen Qi weakness with damp-heat, use Dongyuan Qing Zao Tang (Clear Dryness Decoction). If Stomach Qi is weak with cold-phlegm stagnation, use Renshen Lizhong Tang (Ginseng Regulate the Middle Decoction). If Spleen-Stomach deficiency-cold with phlegm stagnation, use Lizhong Huatan Wan (Regulate the Middle Phlegm-Resolving Pill). If Spleen deficiency fails to transport, leading to phlegm stagnation and Qi rebellion, use Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Aucklandiae Radix (Muxiang, 木香). If Spleen-Stomach weakness allows Liver Wood to invade, use Liu Jun Zi Tang plus Bupleuri Radix (Chaihu, 柴胡). If Lung Qi is weak and cannot clear/transform, causing phlegm, use Liu Jun Zi Tang plus Platycodonis Radix (Jiegeng, 桔梗). For headache, use Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction). If headache is due to Spleen-Kidney weakness and cold pathogen invasion, use Fuzi Xixin Tang (Aconite and Asarum Decoction).

He further stated: When treating wind-phlegm, if caused by Wind-Heat in the Lung Meridian, use Jin Fei Cao San (Boilweed Powder). If Wind-Fire clash with blazing Wind-Heat in the Liver Meridian, use Niuhuang Baolong Wan (Calculus Bovis Protecting Dragon Pill) or Niuhuang Qingxin Wan (Calculus Bovis Clearing Heart Pill). If caused by Liver Blood dryness, use Liu Wei Di Huang Wan. If Excess Heat restricts Metal (Lung), failing to control Wood (Liver), use Chaihu Zhizi San (Bupleurum and Gardenia Powder). If Middle Qi is weak and fails to transform, use Liu Jun Zi Tang modified with Chaihu and Uncariae Ramulus cum Uncis (Gouteng, 钩藤). If Kidney deficiency causes deficient fire to flare upward, use Liu Wei Di Huang Wan.

He further stated: Regarding phlegm nodules, causes include Spleen Meridian stagnation injuring Yin/Blood, Kidney Water deficiency causing deficient fire to flare, or Spleen-Lung Fire stagnation generating phlegm. Treatment methods: If caused by emotional stagnation with phlegm saliva stuck in the throat, first use Si Qi Tang (Four-Seven Decoction) from *Ju Fang* to harmonize stagnant Qi, then use Guipi Tang (Restore the Spleen Decoction) to tonify Spleen Blood. If Spleen Fire injures blood, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). For Kidney Water deficiency, use Liu Wei Di Huang Wan. For Lung Meridian stagnant fire, use Zhimu Fuling Tang (Anemarrhena and Poria Decoction). If women suffer this with leukorrhea, it is due to stagnation injuring Liver-Spleen; assist with Si Qi Tang administered with Qingzhou Bai Wanzi (Qingzhou White Pills). These syndromes have Spleen-Stomach Qi deficiency as the root and Qi stagnation/phlegm nodulation as the branch. Ancient formulas like Shizao Tang (Ten Jujube Decoction), Kongxian Dan (Drain Fluid Pellet), Shenyou Wan (Divine Protection Pill), Guntan Wan (Rolling Phlegm Pill), along with herbs like Aucklandiae Radix and Immature Bitter Orange, aim to clear diaphragm and wash out phlegm, break fluid retention, descend Qi, and resolve phlegm, similar to Suhexiang Wan (Styrax Pill). These are medicines for patients with substantial constitution. People in the Northwest may find them effective. However, for those who are deficient, they will inevitably die from abdominal distension.

He further stated: As a disease, phlegm manifests differently: Heat-phlegm often causes irritability and heat; Wind-phlegm often leads to paralysis and strange syndromes; Cold-phlegm often leads to bone bi (painful obstruction); Damp-phlegm often causes lethargy and weakness; Shock-phlegm often causes heart pain and epilepsy; Drink-phlegm often causes hypochondriac and arm pain; Food-stagnation-phlegm often creates masses and fullness. The manifestations are numerous and hard to name. I believe that if the aforementioned syndromes are due to Kidney Water deficiency and Yin insufficiency failing to descend, causing evil water to overflow, resulting in excessive sputum, one should nourish the source of transformation, and the phlegm will vanish. If due to Liver Wood insulting Spleen Earth with wind-phlegm congestion, first use Arisaematis Rhizoma (Nanxing, 南星) and Pinelliae Tuber to clear phlegm, then use Liu Jun Zi Tang to regulate Stomach Qi, and phlegm will not recur. If one indiscriminately uses Wind-dispersing herbs, depleting Yang Qi and cutting off the source of Yin Blood, it merely creates more wind and aggravates the disease.

He further stated: If Spleen Qi is damaged, with phlegm residing in the Middle Jiao, blocking the clear pathways, causing diseases in the limbs and bones, the proper approach is to strengthen Spleen Qi primarily, assisting with phlegm-resolving methods, so that robust Middle Qi transforms phlegm naturally. If phlegm increases after Dao Cang therapy (a drastic vomiting/purging method), it indicates further Spleen Qi deficiency where fluids turn to phlegm; the correct approach is Bu Zhong Yi Qi Tang. Only Ginseng, Atractylodes, and Er Chen Tang can treat this; one must strictly avoid Qi-regulating/phlegm-resolving herbs and Dao Cang methods.

Xu Donggao said: Yan Shi stated: When human Qi is smooth, body fluids flow freely, and there is absolutely no phlegm. Ancient prescriptions for phlegm often used sweating, purging, warming, and draining methods. It is better to prioritize regulating Qi, followed by differentiation and drainage. When Qi is smooth, body fluids circulate, and phlegm-drink transforms and descends, exiting via urine. Yan Shi had insight to say this. *Yuji Wei Yi* states: Regulating Qi is only one method; one must observe the depth of phlegm. If phlegm accumulation is sticky and fixed, obstructing Qi flow, one should first expel the accumulated phlegm before Qi can become smooth. How can one solely advocate Qi regulation? I hold that when regulating Qi leads to spontaneous phlegm resolution, it treats mild cases. When expelling phlegm leads to smooth Qi, it treats severe cases. Both are essential treatments for phlegm and cannot be neglected. One must judge whether phlegm or Qi is heavier or lighter, applying urgent or slow treatments accordingly. Thus, expelling phlegm and regulating Qi have a specific sequence.