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Zhang Zhongjing stated in the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet): "There are four types of Yin pathogen, what are they?" The master replied: "There is Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Branch Fluid). When a patient who was previously robust becomes emaciated, with water accumulating in the intestines making a gurgling sound, it is called Tan Yin. When fluid accumulates under the hypochondrium after drinking, causing pain upon coughing or spitting, it is called Xuan Yin. When water flows into the limbs, sweating should occur but does not, accompanied by body pain, it is called Yi Yin. When there is coughing and wheezing requiring leaning for support, shortness of breath preventing lying flat, and swelling appearance, it is called Zhi Yin. Water in the Heart causes hardness and palpitations below the heart, shortness of breath, aversion to water, and lack of desire to drink. Water in the Lungs causes expectoration of saliva and foam, and desire to drink. Water in the Spleen causes Qi deficiency and heavy body. Water in the Liver causes distension and fullness under the hypochondrium, with pain upon sneezing. Water in the Kidneys causes palpitations below the heart. If there is Liu Yin (Retained Fluid) in the Heart, the patient experiences coldness on the back over an area the size of a palm. In Liu Yin disease, pain under the hypochondrium radiates to the Quepen (LI 12) acupoint, worsening with coughing. If there is retained fluid in the chest, the patient suffers from shortness of breath and thirst, and pain in all joints of the four limbs. A deep pulse indicates retained fluid. Phlegm disease above the diaphragm presents with fullness, wheezing, coughing, and expectoration; upon onset, there are alternating chills and fever, back and waist pain, spontaneous tearing, and severe trembling of the body, indicating Fu Yin (Hidden Fluid). Patients who drink excessive water will suffer from sudden wheezing and fullness. Generally, eating little and drinking much leads to water stagnation below the heart; severe cases cause palpitations, mild cases cause shortness of breath. A double-wiry pulse indicates Cold. These often follow excessive purgation leading to deficiency; a single wiry pulse indicates Fluid retention. Lung fluid retention does not present with a wiry pulse, but rather distress from wheezing and shortness of breath. Zhi Yin also involves wheezing and inability to lie down, plus shortness of breath, with a normal pulse. For treating Tan Yin disease, warm herbs should be used to harmonize."

Chen Wuyue said: "When patients do not respond to various medicines, a伏 (deep/hidden) and large pulse at the Guan position indicates Phlegm. Ash-gray or black discoloration under the eyelids indicates Phlegm."

The *Heren Shu* (Book of Living People) states: "Phlegm in the Zhongwan (CV 12) acupoint can cause aversion to cold and fever, aversion to wind, and spontaneous sweating, with chest and diaphragm stuffiness and fullness, resembling Shanghan (Cold Damage) syndrome, but distinguished by the absence of headache and neck stiffness."

The *Yuan Bing Shi* (Treatise on Original Causes of Disease) says: "Accumulated and retained fluids are those that accumulate without dissipating. Water dissipates when dry but fails to digest when damp, forming accumulated fluid, due to the pathology of Earth-dampness. Broadly, one must distinguish between Damp-Heat and Cold-Damp causes."

Zhang Zihe said: "There are five types of Phlegm diseases in humans: first, Feng Tan (Wind-Phlegm); second, Re Tan (Heat-Phlegm); third, Shi Tan (Damp-Phlegm); fourth, Jiu Tan (Wine-Phlegm); fifth, Shi Tan (Food-Phlegm). For example, acute Wind-Phlegm arises from exposure to cold and consumption of cold drinks; Heat-Phlegm arises from excessive Fire suppressing Metal (Lung); Damp-Phlegm arises from stagnant fluids failing to dissipate; Wine-Phlegm and Food-Phlegm arise from dietary excess."

Wang Jiezhai said: "Jin Ye (Body Fluids) are the surplus of Blood, circulating outside the vessels throughout the body, like clear dew from heaven. If Blood and Qi become turbid, they condense into Tan (Phlegm). Tan is a transformation of Jin Ye, like dew. Thus, it is said that Tan pervades the entire body, reaching everywhere. It is essentially the Jin Ye circulating in the body. Jin Ye is generated by the Spleen and Stomach from food and water; when turbid, it becomes Tan. Therefore, Tan originates from Spleen-Earth."

Xue Lizhai said: "Regarding Tan Huo (Phlegm-Fire) syndromes, some arise from Spleen Qi deficiency, some from Spleen Qi stagnation, some from depletion of Spleen and Lung Qi, and some from Kidney Yin deficiency failing to control water, leading to flooding and formation of Phlegm. Some arise from Spleen Qi deficiency failing to contain saliva, which overflows upwards resembling Phlegm. Some arise from Heat generating Phlegm; some from Phlegm generating Heat. Others result from Wind-Cold, Summer-Heat, or Dampness; from Fright; from Qi stagnation; from Wine; from Food stagnation; from Spleen deficiency failing to transform and transport; or from Phlegm stagnation in the chest resembling spirit possession. Each must be treated according to its root source."

Xu Donggao said: "The Spleen and Stomach are the granaries responsible for receiving grain. Due to Spleen weakness failing to circulate and transport, Blood and Qi lose nourishment and fail to flow freely. Qi pathways become obstructed, and the Middle Jiao fails to rot and ripen grain, leading to stagnation as Phlegm and Fluid. Its transformations include Cold or Heat, Wheezing or Cough, Vomiting or Reverse Regurgitation, Swelling and Fullness, Vertigo, Wind-Seizures, Belching, Acid Regurgitation and Dyspepsia, Dysphagia, Palpitations, Pain, and other conditions too numerous to describe. All these are variations of Phlegm diseases, originating from Spleen-Dampness failing to flow and the stagnation of Grain-Jin Ye."