痰古作淡，淡、澹通，澹水动也，故水走肠间，名为淡饮。今之痰者，古之云涕云唾云涎云沫是也。或称
为饮，如膈间支饮是也。痰字训为胸上液者，实非仲景之旨，然遂为千古之定名，顾鲜能知其义之异者，吾故
表而出之。
源候总说 人之有痰饮病者，由荣卫不清，气血败浊，凝结而成也。内则七情 乱，藏气不行，郁而
生涎，涎结为饮，为内所因。外有六淫侵冒，玄府不通，当汗不泄，蓄而为饮，为外所因。或饮食过伤，嗜欲
无度，叫呼疲极，运动失宜，津液不行，聚为痰饮，属不内外因。三因所成，证状非一，或为喘，或为咳为呕
为泄，晕眩嘈烦，松悸 KT ，寒热疼痛，肿满挛僻，癃闭痞膈，如疯如癫，未有不由痰饮之所致也。（《三
因》）
外所因证候难明，风燥寒凝，暑烁湿滞，皆能闭诸络，郁而生涎，不待饮水流入四肢，而致支溢疼痛也。
当以理推，无胶轨辙。（同上）
其或喜怒哀乐不中节，起居食饮失其常，皆令荣卫痞阻，气血败浊，为痰为涎为饮，诸证生焉。结伏于焦
膈，则眩晕懵忪，仲悸 KT ，癃闭痞膈，喘嗽气急。停滞于关节，则筋脉挛急，肢节疼痛，手足 曳，寒热
往来。三者同源而异治。痰则伏于包络，随气上浮，客于肺经，因嗽而发。涎则伏于
脾元，随气上溢，口角流出。唯饮则生于胃腑，为呕为吐，宜详甄别也。（《简易》）
惟气与血，能生诸病，痰亦如之。夫痰者，津液之异名，人之所恃以润养肢体者也。血气和平，关络条畅，
则痰散而无。气脉闭塞，脘窍凝滞，则痰聚而有。痰之所以发动者，岂无自而然哉。风搏寒凝，暑烦湿滞，以
至诸热蒸郁，啖食生冷煎爆，腥 咸鹾，动风发气等辈，皆能致痰也。是痰作恙，为喘为嗽，为壅为呕，为眩
晕，为风痫，为狂迷，为忪悸，或吞酸，或短气，或痞膈，或肿胀，或寒热，或疼痛，痰实主之。（《直指》）
人身之痰，如长流水，贵乎顺行，又赖土为之堤防，偶为风所逆，或为物所壅滞，则使有声，可以过颡。
故痰之为病，或由脾土虚弱，不能摄养金肺，或为四气七情所干，气壅痰聚，发而为喘为咳。（《大成》）
若因六阴伤胃，以致玄府不通，当汗不汗，蓄而成痰，乃外因也。使津液不得舒布，凝聚而成痰者，乃内
因也。（《原理》）
痰因气滞生 （寒热二因）人之一身，无非血气周流，痰亦随之。夫痰者，津液之异名。流行于上者，
为痰饮；散周于下者，为精液。其所以使之流行于上下者，亦气使之然耳。大抵气滞则痰滞，气行则痰行，故
三生饮佐之以木香，无有不效。人之气道贵乎顺，顺则津液流通，决无痰饮之患。一失其宜，则气道闭塞，停
饮聚于膈上，结而成痰。（《朱氏》）
庞安常云∶人身无倒上之痰，天下无逆流之水（按∶今庞书中无所考，史载之有此语，见于后）。诚哉斯
言，以此思之，人之气道贵乎顺，顺则津液流通，决无痰饮之患。调
摄失宜，气道闭塞，水饮停于胸腑，结而成痰。（《济生》）
古人有云∶身无倒上之痰，世无逆流之水。斯固然也，愚见以为末然。水无逆流，言其势也；痰无倒上，
尚有推详。且人呼吸出入者，阴阳也。血气循环，随经上下，则津液流通，决无痰饮之患。故使将理失宜，七
情气乱，阴阳失理，郁于经络，气升而不降，痰涎壅滞，随气而升，结于胸膈，上逼咽喉，为呕为哕为吐，岂
非倒上也。甚则风痰壅上，喉声如曳锯，精神昏愦，至此药则罔功，此又非寻常痰之比也。（《治病活法秘方》）
痰本吾身之津液，随气营运。气若和平，津液流布，百骸受其润泽，何致成痰为病。苟气失其清肃而过于
热，则津液受火煎熬，转为稠浊，或气失其温和而过于寒，则津液因寒积滞，渐致凝结，斯痰成矣。故痰一也
，而因寒因热，其源不同，可概治欤。（《医碥》）
痰因热成 痰者，水也，标也；火者，热也，本也。自世人不明标本之理而曰痰火，却以痰能生火，
而不知火能生痰也。譬诸釜中之水，无火之时，清清冷冷，湛然无滓；火一举之，则湛然者皆为白沫矣。人身
无病，则津液澄清；若一病焉，则血气不和，不和则经络壅塞而生热，热则津液之澄清者，亦随热混浊而成痰
矣，岂非火热生痰之谓乎。若曰热痰则可，谓之痰火则非矣。（《儒医精要》）
《玉机微义》云∶痰之为病诚多也。何则？人之血气流行，无一息之间断，才有壅滞，津液凝积，郁而成
热，痰遂生焉（按∶今《微义》文止此）。因证而观，痰则火之变出也，未有痰病而不因火而成者也。间有寒
痰为病者，亦千百中之一二也。甫谓寒痰之说非也，饮则有寒有热不同，痰则一因于热而已，加之寒字不得。
所以痰脉多滑大，明知停冷
成痰，亦遂郁而为热，药惟以橘皮、半夏、神曲之辛，以散之行之，亦不敢用热药也。陈无择云饮脉多沉弦微
细，始可以言寒，治以理中、二陈之属是也。性理所谓有温泉而无寒火，不其然欤。（《医统》）
其由有三 夫痰之生也，其由非一，其为治也，药亦不同。由于阴虚火炎，上迫乎肺，肺气热则煎熬
津液，凝结为痰，是谓阴虚痰火，痰在乎肺而本乎肾，治宜降气清热、益阴滋水法。忌辛温燥热补气等药。
由于脾胃寒湿生痰，或兼饮啖过度，好食油面猪脂，以致脾气不和，壅滞为痰，浓浓胶固，甚至流于经络及皮
里膜外，或结为大块，或不思食，或彻夜不眠，或卒尔眩仆，不知人事，或发癫痫，或昔肥今瘦，或叫呼异常，
或身重腹胀，不便行走，或泄泻不止，及成瘫痪，种种怪证，皆痰所为。故昔人云∶怪病多属痰，暴病多属火。
有以夫。此病在脾胃，无关肺肾，治宜燥脾行气、散结软坚法，忌滞泥苦寒湿润等药及诸浓味。由于风寒
郁闭，热气在肺，而成痰嗽 喘，病亦在肺，治宜豁痰除肺热药中，加辛热、辛温如麻黄、生干姜之属，以散
外寒，则药无格拒之患，法忌温补酸收等药。病因不齐，药亦宜异，利润利燥及利发散，各有攸当，非可混施
也。（《本草经疏》）
涎有六种 论曰∶舟非水不行，然波涛沸溢，则覆舟之患生；人非气不活，然痰涎并积，则倾人之患
至。波涛非自生也，其所以生者，不平之势作之也；痰涎非自积也，其所以积者，不顺之气留之也。故善行舟
者，不惧波涛，而惧舟之不完；善摄生者，不惧痰涎，而惧气之不顺。故世人之疾病，其所以残伤性命之急者，
无甚于痰涎；而世之医者，乃有见之而不能识，或有识之而不能治。此不幸之人，其残伤夭横者，不可胜数。
何则？举天下之人，独知风气之有涎，不
知脏腑冷亦生涎，热亦生涎，痰涎一生，千变万化，而病之所起，非特一端，愚今略举数端明之。后之学人，
于诊疗之际，类而推之，亦庶几其疾病之徒无夭横者矣。夫涎之为名一也，而具数种∶一曰风涎，二曰热涎，
三曰冷涎，四曰病涎，五曰虚涎，六曰毒涎。其一曰风涎，盖因人之风气之盛，上运于涎，不能下入于胃，风
气一蒸，痰涎并起而上，填塞胸中，即使人闷倒无知。其风气久而不顺，性命之倾危，速如反掌。若其风气未
盛，逡巡之间，仍复自顺，其涎亦随气而下，即平复如故。此盖人之肌肉浓，腠理深，风不得泄于外，风热内
攻，大府秘热，毒瓦斯上攻，遂生斯疾，此名之曰风涎。然风涎之为名一也，而入脏腑虚实之不同，则涎之为病
也，变化不一，愚得以即其变而言之。若今人之病大府实热，痰涎满口，吐如清胶，胸中喘息如常，但汤水饮
食俱不可进，凡所饮食，只到喉中，即不能下，用力咽下，即喉中隔绝，喘急闷倒，良久方愈，惟进得些小稠
粥，此亦风涎之候也。然风涎之候变不同，则当如何而治之？曰∶善除荆棘者，先断其根；善治风疾者，先顺
其气。人身无倒上之涎，天下无逆流之水。今风疾一上，而填塞胸中，倾人性命者，风气运而上也。今之治风
涎者，多使天南星、半夏之类，是不知病之源流，去荆棘而不除其根也。苟能以药先顺其风气，兼发其腠理，
使其风气得以发泄于外，顺行于内，则其胸中之痰涎，自随气而下，未吃涎药而痰涎自顺矣。然病势之有轻重
，则取之有缓急。若风气炎盛，胶涎并起，其气卒难以顺之者，当制之以急，非吐之不可；风气未极，痰涎未
并，为害未深者，当制之以缓，先顺其气而后治其涎也，此亦治涎之大约也。然风涎之候，又有冷热不同。或
有寒风所中，冷涎所聚，其人必先于半年或数月前，吃食减
少，身体沉重，筋脉痿弱，才见肉味，便觉恶心，非时口中一两点冷涎出，身不自觉，冷涎所并，忽闷倒不知
人事，良久复苏，即生麻痹，或生 曳，或失音不语，冷涎所积，少有上并，多聚中焦，盈溢胸中，包裹心络，
能使人狂言妄语，神识不定，非特不觉，手臂忽自举动，如此为冷涎之所中也。治之法，先以温暖之药，散其
冷毒之气，急以热药，发其腠理，然后以治涎之药，取下其涎，虽且暂安，而寒风所中于人，亦甚不久。何则？
热风中人，如天地春夏之风，长含生气，以养万物，其人虽病难死，此古人所谓风所以能养人也；寒风所中于
人，如天地秋冬之风，长含杀气，以肃杀万物，其人所中非久必死，此古人所谓风所以能害人也。其二曰热涎，
若今有恣性之丈夫，多食荤腻，好食咸酸，以色为心，恣贪补药，忽因酗酒房室，劳伤其精，丹元髓海，因以
空虚，而脏腑骨槽，虚热转盛，其涎所积，隔在中焦，因其肾脏之虚寒，邪气与热涎相交，发为疼痛，重则不
移时而倾人性命。医者治之，不过曰此肝肾之气，是不知热涎乃病之根本。然京三棱、蓬莪术非不能治气，而
世人用而不验者，不识其病之源流也。善为医者，临事制宜，随机应变，审当轻重，涎多者吐之，涎少者下之，
所用之药，偏取肝家之风毒，又何患乎人之不安哉。三曰冷涎者，若今人之肝脏有余，脾气不足，忽因使性，
长怀郁怒，伤损肝心正气，此冷涎之所以积也。脾气不足，复因肝气所乘，伏而不动，停水滞谷，久而不化，
肝心长怀郁怒，则其气滞涩而不行，此冷涎之所以积也。然肝主风性之不定，忽时而作。肝主怒，怒则气逆，
此冷涎所以随气而上，而生人之大病也。证其候而言之。则其病必先觉心前溃乱不快，相次闻有一物，随气
而上触，至咽喉即闷倒不知人事，手足肌肉渐次寒冷，逡巡复
平愈。治之之法，当以吐药取之，得其所取之涎，其清如水，其冷如雪。取涎之后，更审其藏气，随其所病而
调和之，亦无患乎药之不验也。四曰病涎，其人必好食坚硬之物，伤损脾气，忽因郁怒，伤损心肝正气，忽因
寒邪热毒之伤，忽因大病之后，余毒客在脏腑，其气结涩凝滞，不能宣畅，是以痰涎因而聚积，涎与滞气相交，
往往发为疼痛，此名之为病涎者也。明其病证，在心前痛，轻则连年累月，痛无暂停，重则倾人性命，速如反
掌，重轻之殊，涎之多少也。治之之法，当在量其病势轻重，以利药取之，轻则其涎如油，重则其凝如白胶。
取涎之后，然后使药，清其藏气，益其正气，使之平复如故也。五曰虚涎，其人必因受气之虚，忽因大病之后，
生冷所伤，忽因疾病之间，淫欲不节，致令脏腑之气空虚羸乏，而骨槽之间虚热上蒸，上气镇长有余，下气但
常不足，阴阳之气不相交际，不顺之气隔在中焦，是以虚涎因而积裹，风热一攻，即其涎并上。初发作时，先
觉清涎满口，渐闻心前有一物，上触咽喉，即喉中急促，闷倒不觉，两手相乱把拽，风气极上，即头上痒，忽
皮脐间痛，逡巡风气顺下，乃遂平复。治之之法，当以临发时，使五分利药取之，以其胃气不足，不可十分利
吐也。若利吐不出，非时以坏风涎药搅之，候分数稍减，即于气海上安之一灸，引其涎下入于胃，然后使药调
其藏气，酌量其脏腑之虚实，有余者泻，不足者补，令上下之气相等，可庶几其全安也。若脉气微细，大府虚
冷，减其肝气，益其胃气斯可矣。若小儿得病者，全是胃气之虚，气海上安灸，补暖脾胃，以愈斯痰，仍不辄
吃取风涎药也。六曰毒涎，若今人之患阳毒伤寒，肝心脾肺受其疫毒之气，因其毒涎相积聚在中，候其证，即
使人大府秘热，小便赤涩，面色黯赤，浑身发热，昏昏如醉，狂言妄
语，不知人事，如此之候悉皆是涎。诊其脉气又却沉伏，重手取之骨间乃得，此乃疫毒之涎，盈溢心胸，伏其
脉气，非脉气之与病相反者也，此所谓毒涎者矣。治之之法，急以疏转之药，取其毒瓦斯，荡下其涎，所下之药
须心肝脾肺四脏俱治，然当以肝脏为主，偏下肝脏之药为要也。虽然，涎之为病，千变万化，其状不一，是今
之所举数端，止其大略而已。后之学人，类而推之，加以识见之明，而诊疗无瘥，亦无患乎涎为人之大患者矣。
（《史载之方》）
Phlegm (Tan, Phlegm) was anciently written as "Dan" (Dan, Pale/Light). "Dan" and "Dan" (Dan, Ripples/Water movement) are interchangeable; "Dan" means water moving. Therefore, when water flows between the intestines, it is called "Dan Yin" (Dan Drink). The phlegm of today corresponds to what was anciently called nasal mucus (Ti), saliva (Tuo), thin saliva (Xian), or foam (Mo). It is sometimes also referred to as "Yin" (Drink), such as the supporting drink in the diaphragm (Ge Jian Zhi Yin). Defining phlegm as fluid above the chest is not actually the intent of Zhang Zhongjing, yet it has become a fixed name for millennia. Few people know the difference in its meaning, so I hereby clarify it.
General Discussion from *Zhu Bing Yuan Hou Lun*: People suffering from phlegm-drink diseases do so because Ying and Wei (Nutritive and Defensive Qi) are impure, and Qi and Blood have become turbid and coagulated. Internally, the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) cause disorder, and Zang-Fu Qi fails to circulate. Stagnation generates Xian (thin saliva), which condenses into Yin (drink); this is an internal cause. Externally, the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) invade, the pores (Xuan Fu) become blocked, sweat should be released but isn't, leading to accumulation as Yin; this is an external cause. Alternatively, excessive diet, unbridled desires, shouting until exhausted, or improper exercise cause Jin Ye (Body Fluids) to fail to circulate, gathering into phlegm-drink; this belongs to neither internal nor external causes. Caused by these three factors, symptoms vary: some present with panting, some with coughing, vomiting, or diarrhea; dizziness, heartburn, palpitations, aversion to cold and fever, pain, swelling, abdominal fullness, muscle spasms or paralysis, urinary retention, epigastric fullness and obstruction, or even madness resembling mania. None of these occur without being caused by phlegm-drink. (*San Yin Ji Yi Bing Zheng Fang Lun*)
Symptoms caused by external factors are difficult to clarify. Wind-dryness, cold-coagulation, summer-heat scorching, and dampness-stagnation can all close the collaterals, causing stagnation and generation of Xian. This leads to supportive overflow pain without waiting for drinking water to flow into the limbs. One must reason through medical principles rather than sticking rigidly to fixed patterns. (Ibid.)
If joy, anger, sorrow, etc., are not regulated properly, or if daily routine and diet lose their regularity, it causes blockage of Ying and Wei, and turbidity of Qi and Blood, forming phlegm, Xian, and Yin, giving rise to various symptoms. If phlegm lodges in the Jiao Ge (triple burner/diaphragm area), it causes dizziness, mental confusion, palpitations, urinary retention, epigastric fullness, panting, coughing, and shortness of breath. If it stagnates in the joints, it causes muscle spasms, limb pain, dragging of hands and feet, and alternating chills and fever. Although these three originate from the same source, their treatments differ. Phlegm lodges in the Pericardium Collateral, floats upward with Qi, resides in the Lung Meridian, and manifests due to coughing. Xian lodges in the Spleen origin, overflows upward with Qi, and flows from the corners of the mouth. Only Yin arises in the Stomach, manifesting as vomiting and spitting; careful differentiation is required. (*Ji Sheng Fang* / *Jian Yi*)
Only Qi and Blood can generate various diseases, and phlegm is no exception. Phlegm is merely another name for Body Fluids, used by humans to moisten and nourish the limbs. When Qi and Blood are harmonious and collaterals are smooth, phlegm disperses and does not exist. When Qi pulses are blocked and orifices are stagnant, phlegm gathers and exists. Does phlegm arise spontaneously? No. Wind collision, cold coagulation, summer-heat annoyance, dampness stagnation, and various heat steaming, along with consuming raw/cold or fried foods, fishy/salty preserved items, or things that stir wind and move Qi, can all cause phlegm. Thus, phlegm as a disease manifests as panting, coughing, congestion, vomiting, dizziness, wind epilepsy, mania, palpitations, acid regurgitation, shortness of breath, epigastric fullness, swelling, chills/fever, or pain. These are truly governed by phlegm. (*Zhi Zhi Fang*)
Phlegm in the human body is like flowing water; it values smooth movement and relies on Earth (Spleen) as a dam. Occasionally reversed by wind or obstructed by objects, it makes noise and can even pass over the throat. Therefore, phlegm disease may arise from weak Spleen Earth failing to nourish Metal (Lungs), or from interference by the Four Qi and Seven Emotions, causing Qi congestion and phlegm accumulation, resulting in panting and coughing. (*Yi Xue Da Cheng*)
If six Yin injuries damage the Stomach, causing pore blockage and failure to sweat, leading to accumulation as phlegm, this is an external cause. If Body Fluids cannot spread and condense into phlegm, this is an internal cause. (*Yuan Li*)
Phlegm arises from Qi stagnation (Involving Cold and Heat factors): The entire body relies on the circulation of Qi and Blood, and phlegm follows. Phlegm is another name for Body Fluids. Those circulating upward are called Phlegm-Drink; those spreading downward are called Essence Fluids. What makes them circulate up and down is Qi. Generally, Qi stagnation leads to phlegm stagnation; Qi movement leads to phlegm movement. Hence, adding Mugwort (Mu Xiang) to San Sheng Yin is always effective. The airways value smoothness; smoothness ensures fluid circulation and prevents phlegm-drink disorders. Once impropriety occurs, airways close, stagnant drink gathers above the diaphragm, and condenses into phlegm. (*Zhu Shi*)
Pang Anchang said: "There is no phlegm flowing upward in the body, just as there is no water flowing backward in the world." (Note: This cannot be verified in Pang's current books, but historical records contain this quote, appearing later). Indeed, this statement is true. Reflecting on this, the airways value smoothness; smoothness ensures fluid circulation and prevents phlegm-drink disorders. Improper care closes the airways, causing water-drink to stop in the chest and viscera, condensing into phlegm. (*Ji Sheng Fang*)
The ancients said: "There is no phlegm flowing upward in the body, and no water flowing backward in the world." This is indeed correct, but I believe it is not entirely so. Water does not flow backward, referring to its natural tendency; phlegm not flowing upward warrants further scrutiny. Breathing in and out involves Yin and Yang. If Qi and Blood circulate following the meridians up and down, fluids flow smoothly, preventing phlegm-drink. However, if management is improper, Seven Emotions disrupt Qi, Yin and Yang lose order, stagnating in collaterals, Qi rises but does not descend, phlegm-Xian becomes congested, rises with Qi, knots in the chest and diaphragm, presses against the throat, causing vomiting, hiccups, or spitting. Is this not flowing upward? Severe cases involve wind-phlegm congesting above, with throat sounds like sawing, mental confusion, where medicine is useless; this differs from ordinary phlegm. (*Zhi Bing Huo Fa Mi Fang*)
Phlegm is originally our body's Body Fluids, circulating with Qi. If Qi is peaceful, fluids distribute, nourishing the bones and tissues, how could they form phlegm? If Qi loses its clear/pure nature and becomes too hot, fluids are boiled by fire, turning thick and turbid. If Qi loses its warmth and becomes too cold, fluids accumulate due to cold, gradually coagulating, thus forming phlegm. So, although phlegm is one entity, its origins differ by cold or heat; can it be treated uniformly? (*Yi Que*)
Phlegm forms due to Heat: Phlegm is water, the branch; Fire is heat, the root. People who don't understand root and branch call it "Phlegm-Fire," mistakenly thinking phlegm generates fire, not knowing fire generates phlegm. Like water in a pot: without fire, it is clear and pure; with fire, it turns into white foam. Without disease, Body Fluids are clear; once diseased, Qi and Blood are disharmonious, collaterals become congested, generating heat. Heat causes clear fluids to mix turbidly and form phlegm. Isn't this fire-heat generating phlegm? Calling it "Heat-Phlegm" is acceptable; calling it "Phlegm-Fire" is incorrect. (*Ru Yi Jing Yao*)
*Yu Ji Wei Yi* states: Phlegm causes many diseases. Why? Qi and Blood flow without interruption; any congestion causes fluid accumulation, stagnation generates heat, and phlegm arises. Observing symptoms, phlegm is a variation of fire; no phlegm disease occurs without fire. Rarely, cold-phlegm occurs, perhaps 1 in 1000. To say cold-phlegm is wrong, while Drink varies by cold/heat, Phlegm is solely due to heat; adding "cold" is inappropriate. Thus, phlegm pulses are often slippery and large. Even if known to be cold-stagnation phlegm, it郁 (stagnates) into heat. Medicines use only the acridity of Tangerine Peel (Ju Pi), Pinellia (Ban Xia), and Medicated Leaven (Shen Qu) to disperse and move it; hot medicines are avoided. Chen Wuyue says Drink pulses are often deep, wiry, fine, and small, indicating cold, treated with Li Zhong Tang or Er Chen Tang. As Neo-Confucianism says, there are hot springs but no cold fires, is this not so? (*Yi Tong*)
There are three origins: Phlegm production has multiple causes and treatments. Due to Yin deficiency and fire flaring, pressing on the Lungs, Lung heat boils fluids into phlegm, called Yin-deficiency Phlegm-Fire. Phlegm is in the Lungs but rooted in the Kidneys. Treatment should lower Qi, clear heat, benefit Yin, and nourish water. Avoid acrid-warm, drying-hot, and tonifying Qi medicines. Due to Spleen-Stomach cold-damp generating phlegm, or excessive eating of greasy/noodle/pork-fat foods, Spleen Qi becomes disharmonious, congesting into phlegm, becoming thick and sticky, flowing into collaterals or outside membranes, forming lumps, loss of appetite, insomnia, sudden fainting, epilepsy, weight loss, abnormal shouting, heaviness, diarrhea, or paralysis. Strange diseases often belong to phlegm; acute diseases often belong to fire. This disease is in the Spleen/Stomach, unrelated to Lungs/Kidneys. Treatment should dry Spleen, move Qi, dissipate nodules, and soften hardness. Avoid cloying, bitter-cold, moistening medicines and rich flavors. Due to wind-cold closure and heat in the Lungs, causing phlegm-cough-panting, disease is in the Lungs. Treatment should add acrid-hot/warm herbs like Ephedra (Ma Huang) or Raw Dried Ginger (Sheng Gan Jiang) to resolve external cold, avoiding warm-tonifying and sour-astringent methods. Causes vary, so medicines differ; draining dampness, drying, and dispersing each have their proper place and cannot be mixed. (*Ben Cao Jing Shu*)
Xian has six types: It is said: Boats need water, but waves capsize them; humans need Qi, but accumulated phlegm-Xian kills them. Waves aren't self-generated; uneven pressure creates them. Xian isn't self-accumulated; irregular Qi causes it. Good boatmen fear broken boats, not waves; good health preservers fear irregular Qi, not Xian. Among diseases, none endanger life faster than phlegm-Xian. Yet doctors often see but don't recognize, or recognize but can't treat. Unfortunate victims die prematurely. Everyone knows wind produces Xian, but doesn't know cold or heat in Zang-Fu also produce Xian. Once formed, Xian changes infinitely. I list a few points. Later learners should classify and deduce to prevent premature death. Though named Xian, there are several types: 1. Wind-Xian, 2. Heat-Xian, 3. Cold-Xian, 4. Disease-Xian, 5. Deficiency-Xian, 6. Toxic-Xian.
1. Wind-Xian: Due to strong wind Qi rising to Xian, unable to enter the Stomach. Wind steams, Xian rises, blocking the chest, causing fainting. If wind persists, life is endangered quickly. If wind subsides, Xian descends, and recovery occurs. This happens when flesh is dense, pores deep, wind trapped inside, wind-heat attacks internally, large intestine is constipated/hot, toxic vapors attack upward. If large intestine heat is excess, Xian fills the mouth, spit like clear glue, chest breathes normally, but food/water stops at the throat, causing choking and panting. Only thick porridge can be taken. This is Wind-Xian. To treat: Cut the root. Smooth the Qi first. There is no upward-flowing Xian. Treating with Arisaema (Tian Nan Xing) or Pinellia (Ban Xia) ignores the root. First smooth Qi, open pores, let wind vent externally and move internally, then Xian descends naturally. If wind is extreme and Xian thick, urgent vomiting is needed. If mild, smooth Qi first, then treat Xian. Wind-Xian varies by cold/heat. Cold wind attacking causes Cold-Xian: reduced appetite, heaviness, weakness, nausea at meat smell, spontaneous cold Xian, sudden fainting, numbness, dragging limbs, aphasia. Cold Xian accumulates in Middle Jiao, surrounds Heart Pericardium, causing madness. Treat with warm medicines to disperse cold-toxic, hot medicines to open pores, then extract Xian. Hot wind is like spring/summer (nourishing); cold wind is like autumn/winter (killing).
2. Heat-Xian: From indulgent men eating greasy/spicy/sour foods, lustful, taking tonics, damaging essence via alcohol/sex. Dan Yuan and Marrow Sea become empty, Zang-Fu bone cavities have deficient heat. Xian accumulates in Middle Jiao, interacting with Kidney cold-deficiency and evil heat, causing pain, potentially fatal. Doctors mistake this for Liver/Kidney Qi issues, not knowing Heat-Xian is the root. San Leng and E Zhu treat Qi but fail here due to ignorance of roots. Good doctors adjust to situation: vomit if much Xian, purge if little. Use medicines targeting Liver wind-toxin.
3. Cold-Xian: Liver excess, Spleen deficiency. Anger/stress damages Liver/Heart righteous Qi. Spleen deficiency allows Liver Qi to invade, stagnating water/grain. Liver anger causes Qi stagnation, leading to Cold-Xian. Liver governs unpredictable wind and anger (Qi rebellion). Symptoms: precordial chaos, sensation of object rising to throat, fainting, cold limbs, recovery. Treat with emetics. Extracted Xian is clear as water, cold as snow. Afterward, regulate Zang Qi.
4. Disease-Xian: From eating hard foods damaging Spleen, anger damaging Heart/Liver, cold/heat toxins, or residual toxins after severe illness. Qi stagnates, Xian accumulates, interacting with stagnant Qi, causing pain. Precordial pain, chronic or acute/fatal. Depends on amount of Xian. Treat by measuring severity, using purgatives/emetics. Light: Xian like oil; Heavy: Xian like white glue. After extraction, clear Zang Qi, boost righteous Qi.
5. Deficiency-Xian: From Qi deficiency, post-illness cold/raw food injury, or sexual indiscretion during illness. Zang-Fu Qi empty, bone cavity deficient heat steams upward. Upper Qi excess, Lower Qi deficiency, Yin/Yang fail to interact, irregular Qi blocks Middle Jiao, Deficiency-Xian accumulates. Wind-heat attack causes Xian to rise. Initial symptoms: mouth full of clear Xian, object rising to throat, choking, fainting, hand grasping, head itching, umbilical pain, then recovery. Treat at onset with mild purgatives (1/5 strength) due to weak Stomach Qi. If vomiting fails, use bad wind-Xian medicine to stir, moxa Qihai (CV-6) to draw Xian down to Stomach, then regulate Zang Qi based on deficiency/excess. For children, purely Stomach Qi deficiency; moxa Qihai to warm Spleen/Stomach. Do not use wind-Xian drugs lightly.
6. Toxic-Xian: Yang-Du Shang Han (Yang-Toxic Cold Damage). Liver/Heart/Spleen/Lung infected by epidemic toxin. Toxic Xian accumulates in Middle. Symptoms: constipation/hot, red/scanty urine, dark-red face, whole-body fever, drunken confusion, madness, unconsciousness. All are Xian. Pulse is deep-hidden, felt only deeply near bone. Epidemic-toxic Xian fills chest/heart, hiding pulse. Not contrary to disease, but defines Toxic-Xian. Treat urgently with dispersing/moving medicines to take toxic vapor and purge Xian. Medicine must treat Heart/Liver/Spleen/Lung, focusing primarily on Liver.
Although Xian changes infinitely, these are general outlines. Learners should classify and deduce with wisdom to ensure accurate diagnosis and treatment, preventing Xian from being a major disaster. (*Shi Zai Zhi Fang*)