五痰 子和云∶凡人病痰者有五∶一曰风痰，二曰热痰，三曰湿痰，四曰酒痰，五曰食痰。盖风痰者，
形寒饮冷；热痰者，火盛制金；湿痰者，停饮不散；酒痰、食痰者、饮食过伤所致。（《微义》）（按∶此说
原出《治法杂论》等，凡三见，互有少异，食痰或作沫痰，今从《微义》节文录出。）
或问∶方书皆曰五痰，何谓也？答曰∶所谓风痰、寒痰、热痰、气痰、味痰又名酒痰。味痰者，因饮食酒
醪浓味而唾痰也。气痰者，因事逆意而然也。热痰者，因饮食辛辣烧炙煎 ，重 浓褥，及天时郁勃而然也。
寒痰者，因冲冒风凉不节之气而然也。风痰者，因感风而发，或因风热怫郁而然也。此皆素抱痰疾者，因风寒
气热味而喘咯咳唾，非别有此五种之痰。（《养生主论》）
虚实 痰有虚实，不可不辨。夫痰则痰矣，皆若有余，又何有虚实之异？盖虚实二字，全以元气为言
。凡可攻者，便是实痰；不可攻者，便是虚痰。何为可攻？以其年力犹盛，血气未伤，或以肥甘过度，或以湿
热盛行，或风寒外闭皮毛，或逆气内连肝膈，皆能骤至痰饮，但察其形气病气俱属有余者，即实痰也。实痰者
何？谓其元气犹实也，此则宜行消
伐，但去其痰，无不可也。何为不可攻？则或以形羸气弱，年及中衰者，即虚痰也。或以多病，或以劳倦。或
以忧思酒色，致成劳损、非风、卒厥者，亦虚痰也。或脉见细数，脏无阳邪，时为呕恶泄泻、气短声喑等证，
但察其形气病气本无有余者，皆虚痰也。虚痰者何？谓其元气已虚也，此则但宜调补，若或攻之，无不危矣。
且凡实痰本不多，其来也骤，其去亦速，其病亦易治。何也？以病本不深也。虚痰反甚多，其来则渐，其去则
迟，其病亦难治。何也？以病非一日也。是以实痰无足虑，而最可畏者，惟虚痰耳。总之，治痰之法无他，但
能使元气日强，则痰必日少。即有微痰，亦自不能为害，而且亦充助胃气。若元气日衰，则水谷津液无非
痰耳，随去随生。有能攻之使尽，而且保元气无恙者，吾不信也。故善治痰者，惟能使之不生，方是补天之手。
然则治此者，可不辨其虚实，而欲一概攻之，如王隐君所论，内外百病皆生于痰，悉用滚痰丸之类，其亦但知
目前而不知日后之害哉。（《景岳》）
脉法 其脉皆弦微沉滑。（《大成》）
沉弦细滑，大小不匀，皆痰气为病。（《医鉴》）
病患百药不效，关上脉伏而大者，痰也。（《微义》）
痰实上壅，脉伏而实者，宜吐，不可下。既吐而复壅者，不可再吐。（《续易简方脉论》）
脉浮当吐。久得脉涩，卒难开也（《纂要》曰∶痰饮胶固，脉道阻涩也），必费调理。（《丹溪》）左右
关脉大者，膈中有痰也，可吐之。怕吐者，消息下之。（《纲目》）
痰凝气滞，关格不通，则其脉固有不动者，有三两路乱动，时有时无者，或尺寸一有一无者，有关脉绝骨
（《名医汇粹》引骨作滑）不见者，或时动而大小不常者，有平居之人，忽
然而然，有素禀痰病，不时而然者，有僵仆暴中而然者，皆非死脉也。（《养生主论》）（《汇粹》此下有实
因乎痰而然句。）
证状总说 王隐君论云∶痰证古今未详，方书虽有五痰诸饮之异，而莫知其为病之源。或头风眩，目
运耳鸣，或口眼蠕动，眉棱耳叶俱痒或痛，或四肢游风肿硬而似疼非疼，或为齿颊痒痛，牙齿浮而痛痒不一，
或噫气吞酸，心下嘈杂，或痛或哕，或咽嗌不利，咯之不出，咽之不下，其痰似墨，有如破絮、桃胶、蚬肉之
状，或心下如停冰铁，心气冷痛，或梦寐奇怪之状，或足腕酸软，腰肾骨节卒痛，或四肢筋骨疼痛难名，并无
常所，乃至手麻臂疼，状若风湿，或脊上每日一条如线之寒起者（按∶此证原书所无，《纲目》引丹溪有之）
，或浑身习习如卧芒刺者，或眼粘湿痒口糜舌烂喉痹等证，或绕项结核状若瘰 ，或胸腹间如有二气交纽，噎
塞烦闷，有如烟火上冲，头面烘热，或为失志颠狂，或中风瘫痪，或劳废荏苒之疾，或风毒香港脚，或心下怔忡
，如畏人捕（《明医指掌》曰∶颠走痴呆不识人），或喘嗽呕吐，或呕冷涎、绿水、黑汁，甚为肺痈、肠毒、
便脓、挛跛。盖内外为病百般，皆痰所致，其状不同，难以尽述。盖津液既凝为痰，不复周润三焦，故口燥咽
干，大便秘，面如枯骨，毛发焦槁，妇人则因此月水不通，若能逐去败痰，自然服饵有效。余尝用一药，即滚
痰丸，以愈诸疾，不可胜数矣，今特相传于世云。（《微义》）（按∶《养生主论》原文颇繁糅，故《微义》
稍加删订，今亦从之。《微义》更附《脉经》一臂不遂条、《活人书》痰饮类伤寒条，曰∶余特叙《脉经》、
《活人》二条，以证隐君之说有所本也。但所制滚痰丸一方，难以通治诸痰。）
夫痰之源不一，有因痰而生热者，有因热而生痰者，有因
气而生者，有因风而生者，有因惊而生者，有积饮而生者，有多食而成者，有因暑而生者（《微义》曰∶有因
风寒暑湿而得者），有伤冷物而成者，有脾虚而成者，有饮酒而成者。其为病也，惊痰则成心包痛，颠疾；热
痰则成烦躁，头风烂眼，燥结怔忡，懊 惊眩；风痰成瘫痪，大风眩乱，暗风闷乱；饮痰成胁痛，四肢不举，
每日呕吐；食痰成疟痢，口出臭气（《微义》曰∶食积痰多成癖块痞满）；暑痰中晕眩冒，黄胆头疼；冷痰骨
痹，四肢不举，气刺痛；酒痰饮酒不消，但得酒，次日又吐；脾虚生痰，食不美，反胃呕吐；气痰攻注走
刺不定。妇人于惊痰最多，盖因产后交接，月事方行，其惊因虚而入，结成块者，为惊痰，必有一块在腹，发
则如身孕，转动跳跃，痛不可忍。（《纲目》引丹）
痰涎之为物，随气升降，无处不到。入于心，则迷窍而成癫痫，妄言妄见。入于肺，则塞窍而成咳唾稠粘
，喘急背冷。入于肝，则留伏蓄聚，而成胁痛干呕，寒热往来。入于经络，则麻痹疼痛。入于筋骨，则头项胸
背腰痛，手足牵引隐痛。（《本草纲目》）
但痰症初起，头痛发热，类外感表症；久则潮咳夜重，类内伤阴火；又痰饮流注，肢节疼痛，类风症；但
痰症，胸满食减，肌肉如故，脉滑不匀不定为异耳。（《入门》）
臂不能动是痰（按∶全取《指迷》茯苓丸主证），嘈杂是痰。凡人胸膈一时如火烘炙，似痛非痛，忽然饥
甚，北人呼为心刺，此火动其痰也。
眩晕是痰，头目眩晕，眼前黑暗，如坐舟车，HT HT 欲吐者，痰也。烦躁是痰，凡人似热非热，似寒非寒，
似病无病，坐卧不宁，心中焦躁，欲哭欲叫者，痰病也。审其人之虚实，从痰治之立愈。颠狂是痰，凡人忽然
发狂，语言错
乱，弃衣登高，此痰病也。痰在膈上，使人颠狂或健忘。颠仆是痰，凡人卒然跌倒，不省人事，痰病也，虽气
虚治痰为先，中风不语是痰，虽曰中风，亦以治痰为先。（《医统》）
百病中多有兼痰者，世所不知也。（《丹溪》）
凡奇怪之症，人所不识者，皆当作痰症而治之也。（《济世全书》）（按∶《格致余论》有《虚病痰病有
似邪祟论》，此龚氏所本。又《锦囊秘 》辨怪症多属痰之谬，其说颇确，当参。）
外候 凡有痰者，眼皮及眼下必有烟灰黑色（按∶此亦出《微义》），举目便知，不待切脉。眼黑而
颊赤者，热痰也；面大黄色，亦热痰也。外症必烦满膈热，口干思冷，大便秘结，小便赤热，久必生风，或眩
晕耳鸣眼花多虚症。治之而用热药，服久必脉大实，发大热而中风，可急下之。眼黑而行步呻吟，举动艰难者，
入骨痰也，其症遍体骨节疼痛，眼黑而面带土色。四肢痿痹，屈伸不便者，风湿痰也。眼黑而气短促者，惊风
痰也。（《纲目》）
痰色 （宜吐证。臭痰）王隐君云∶论痰清白者为寒，黄而浊者为热。殊不知始则清白，久则黄浊。清
白稀薄浮于上，黄浊稠粘凝于下。嗽而易出者，清而白也；咳而不能出，则黄浊结滞者也。若咯唾日久，湿热
所郁，上下凝结，皆无清白者也。甚至带血，血败则黑。痰为关格异病，人所不识。又清白者气味淡，日久者
渐成恶味，酸辣腥臊焦枯不一。（《微义》）（按∶此系节文。《微义》又曰∶此以痰之新久厘清浊，可谓得
病机之情矣。）
宜吐之症，必须看其痰，吐在壁上有光亮者，放心吐之，余则皆忌。光亮者，如蜗牛之涎一样光亮也。但
看见光亮者，无论其痰在上中下，此光亮之色，必须俟其痰迹干而分
辨之，不可据其湿痰时，而即以为光亮也。（《石宝秘 》）
病患久虚，内有宿积痰饮，用参、术补之，久乃吐出臭痰或绿色痰者，难治。盖积之既久，而脾胃虚热不
运，且有积热，故郁臭耳。急用二陈加枳、术、黄连、竹沥，庶可十全一二。若肺痈吐臭痰脓血，不在此例。
（《医通》）
中痰 （更有痰厥，宜参后涌吐方及《厥》门。） 若手足 曳，口眼 斜，或一边身体不随，或手
足身中有一点钓痛，肠鸣多睡，口中多流唾涎，此是中痰也。宜以参苏饮，及控涎丹，或星香饮子，皆效。
（《管见良方》）（星香饮子，出《中风》三生饮下。）
头痛体痛 人知痛生于气血，孰知痰涎流注，亦能缠滞而为痛乎。如头风证，眉棱耳角俱痛，投以风
药不效，投以痰药收功。如患眼证，赤肿羞明而痛，与之凉剂弗瘳。与之痰剂获愈。（按∶《医碥》举此文曰∶
二证皆痰壅热上。）如酒家手臂痛重，时或麻痹，二陈汤加片子姜黄，下白丸子、消饮丸、倍术丸辈，每每就
安。如斗家胸骨扑伤，刺痛无已，散血之剂罔功，续以自已溲便饮之，须臾吐痰，其痛立止。此皆痰涎作痛之
明证也。（《直指》）
痰饮流入四肢，令人肩背酸疼，两手软痹，医误以为风，则非其治，宜导痰汤，加木香、姜黄各半钱。
（《要诀》）
凡人手臂或动不得，或骨节遍身痛，坐卧不宁，此痰入骨也。如忽患手足胸背头项腰膝疼痛不可忍，及连
筋骨牵引吊痛，坐卧不安，走易不定，头疼困倦，手足重坠，痹冷脉伏，此乃涎饮顽痰，伏在心胸上下，发为
此疾，非风非毒，导痰汤加羌、防、白芷、姜汁、竹沥。（《医通》）
结核 凡人身上中下有块者，多是痰。问其平日好食何物，吐下后，方用药。（《丹溪》）
凡人身中有结核，不痛不红，不作脓者，皆痰注也（按∶此丹溪说）。或耳后项门有痰核，以僵蚕、酒大
黄、青黛、牛胆南星各等分，炼蜜为丸含化。颈项下结生痰核，以二陈汤加酒大黄、连翘、桔梗、柴胡、栝蒌
仁主之。臂生痰核作痛，以二陈汤加连翘、防风、川芎、皂角刺、苍术主之。（《原病集》）
凡人身中有块，不痒不痛，或作麻木，名败痰失道，宜随处用药消之。（《医通》）
难治证 痰成块，咯吐不出，气郁滞者，难治。（《丹溪纂要》）
类证 更有一种，非痰非饮，时吐白沫，不甚稠粘，此脾虚不能约束津液，故涎沫自出，宜用六君子
汤，加益智仁以摄之。（《必读》）
治法要领 疗痰之法，理气为上，和胃次之。若风若寒，若湿若热，如前数者，亦当推寻所受之因。
和胃谓何？涎者脾之液也，脾胃一和，痰涎自散，故治痰多用半夏，盖半夏能利痰故也。（《直指》）
子和谓饮无补法，必当去水，故用吐汗下之三法，治人常愈。又论热药治痰之误，固为精切。亦有挟寒挟
虚之证，不可不论。夫久痰凝结，胶固不通，状若寒凝，不用温药引导，必有拒格之患。况有风寒外束，痰气
内郁者，不用温散，亦何以开郁行滞也。又有血气亏乏之人，痰客中焦，闭塞清道，以致四肢百骸，发为诸病
，理宜导去痰滞，必当补泻兼行，又难拘于子和之三法也。夫凡病久淹延，卒不便死者，多因食积痰饮所致。
何以然？盖胃气亦赖痰积所养，饮食虽少，胃气卒不便虚故也。亦有治痰用峻利过多，则脾气愈虚，津液不运
，痰反易生而愈盛（按∶丹溪曰∶凡治痰，用利药过
多，致脾气虚，则痰反易生而多），法当补脾胃，清中气，则痰自然运下（按∶《医统》又曰∶治痰用寒凉
攻击药过多，而痰不去，此必脾气虚而不营运也，亦须佐以温补），此乃治本之法，世谓医中之王道者，正此
类也。（《微义》）
愚谓有理气而痰自顺者，治其微也，有逐痰而气方畅者，治其甚也。二者皆治痰之要也，不可偏废者也。
但看痰与气，孰轻而孰重，故施治有可急而可缓，故曰逐痰理气，有所先后。（《医统》）
痰之 涌上焦，结聚胸中，皆由于气。故治痰莫先于治气，治气又莫先于降火，破气清火则痰自消，此则
言乎六淫七情怫郁暴积之痰耳。若日积月累，老痰凝结，又当积渐以消释之，更当相其人之阳虚阴虚，助以调
补。苟如前法，将见痰未降而气已消，为患不可胜言矣。（《医津一筏》）
治痰之法，须要审察气体虚实冷热用药，若以耗气之剂太多，脾肺气虚，痰愈盛矣。世俗不明脉理，类风
Five Types of Phlegm: Zhang Zihe said, "In general, when people suffer from phlegm disorders, there are five types: first, Wind-Phlegm; second, Heat-Phlegm; third, Dampness-Phlegm; fourth, Wine-Phlegm; fifth, Food-Phlegm. As for Wind-Phlegm, it is caused by exposure to cold and drinking cold water; as for Heat-Phlegm, it is caused by excessive fire restraining the Metal element (Lung belongs to Metal); as for Dampness-Phlegm, it is caused by the stagnation and failure to dissipate fluid retention; as for Wine-Phlegm and Food-Phlegm, they are caused by excessive damage from diet." (From *Yixue Wei Yi*) [Note: This theory originally appeared in texts such as *Zhi Fa Za Lun*, appearing three times with slight variations; 'Food-Phlegm' is sometimes written as 'Foam-Phlegm'. Here, it is recorded based on the excerpt from *Yixue Wei Yi*.]
A question arises: "Medical books all speak of five types of phlegm. What does this mean?" The answer is: "The so-called five types refer to Wind-Phlegm, Cold-Phlegm, Heat-Phlegm, Qi-Phlegm, and Flavor-Phlegm; Flavor-Phlegm is also known as Wine-Phlegm. Flavor-Phlegm results from spitting up phlegm after consuming alcohol and strongly flavored foods. Qi-Phlegm arises from events that go against one's will, leading to emotional stagnation. Heat-Phlegm is caused by consuming spicy, roasted, fried, or grilled foods, sleeping under heavy quilts, and muggy weather conditions. Cold-Phlegm is caused by exposure to wind, cold, and cool air without proper regulation. Wind-Phlegm occurs due to contracting wind pathogens or due to the stagnation of wind-heat. These conditions affect individuals who already have a predisposition to phlegm diseases, triggering symptoms like wheezing, expectoration, coughing, and spitting upon exposure to wind, cold, qi disturbances, heat, or flavors; they do not represent five distinct, independent types of phlegm." (From *Yangsheng Zhu Lun*)
Differentiation of Deficiency and Excess: Phlegm disorders can be classified into deficiency (Xu) and excess (Shi) patterns, which must not be overlooked. Although phlegm appears as an excess pathogen, how can there be a distinction between deficiency and excess? The terms 'deficiency' and 'excess' are defined entirely by the state of Yuan Qi (Primal Qi). If a condition can be treated with purgative or attacking methods, it is Excess Phlegm; if it cannot, it is Deficiency Phlegm. What constitutes 'can be attacked'? If the patient is young and vigorous, with unimpaired blood and qi, or if the cause is excessive consumption of rich and sweet foods, prevalent damp-heat, external closure of the skin and hair by wind-cold, or rebellious qi connecting internally to the liver and diaphragm, sudden production of phlegm-fluids can occur. If observation shows that both the physical constitution and the disease manifestation indicate excess, it is Excess Phlegm. What is Excess Phlegm? It means the Yuan Qi is still substantial. In such cases, methods of moving qi, resolving accumulation, and attacking pathogens are suitable; removing the phlegm will lead to cure. What constitutes 'cannot be attacked'? If the body is emaciated and qi weak, or if the person has reached middle age and decline, it is Deficiency Phlegm. It may also result from chronic illness, overwork, or excessive worry, thought, alcohol, and sexual indulgence leading to consumptive diseases, non-stroke collapse, or sudden syncope. Or, if the pulse is fine and rapid, with no yang pathogens in the zang organs, accompanied by symptoms like vomiting, nausea, diarrhea, shortness of breath, and hoarseness, and observation shows no signs of excess in constitution or disease, these are all Deficiency Phlegm. What is Deficiency Phlegm? It means the Yuan Qi is already deficient. In such cases, only tonification and regulation are appropriate; attacking it would inevitably lead to danger. Moreover, Excess Phlegm is relatively rare; it comes suddenly, leaves quickly, and is easy to treat because the root is not deep. Deficiency Phlegm is more common; it develops gradually, lingers long, and is difficult to treat because it is not a one-day affliction. Therefore, Excess Phlegm is not to be feared, while Deficiency Phlegm is most dreaded. In summary, the method for treating phlegm lies in nothing else but strengthening the Yuan Qi day by day; then phlegm will decrease daily. Even slight phlegm will not cause harm and may even assist stomach qi. If Yuan Qi declines daily, then all fluids from food and drink turn into phlegm, regenerating as soon as removed. I do not believe anyone can purge all phlegm while preserving Yuan Qi intact. Thus, a skilled phlegm practitioner is one who prevents phlegm from forming, possessing the power to restore heaven. However, practitioners who fail to differentiate deficiency and excess and indiscriminately use attacking methods, as Wang Yinjun argued—that all internal and external diseases arise from phlegm and should be treated with pills like Guntan Wan—only see the immediate benefit without considering future harm. (From *Jingyue Quanshu*)
Pulse Methods: The pulses associated with phlegm are generally wiry (Xian), faint (Wei), deep (Chen), and slippery (Hua). (From *Yixue Dacheng*)
Deep, wiry, fine, and slippery pulses, irregular in size, all indicate disease caused by phlegm and qi. (From *Yijian*)
If a patient responds poorly to various medicines, and the Guan position pulse is hidden and large, it indicates phlegm. (From *Yixue Wei Yi*)
When phlegm-excess obstructs the upper jiao, and the pulse is hidden and solid, emesis (vomiting induced therapy) is indicated, not purgation. If obstruction recurs after emesis, do not induce vomiting again. (From *Xu Yijian Fang Mai Lun*)
If the pulse is floating, emesis is indicated. A chronic slippery pulse is difficult to resolve (as *Zuanyao* states: phlegm-fluids are sticky and solid, blocking the pulse channels), requiring prolonged regulation. (From *Danxi Xinfa*) If the left and right Guan pulses are large, phlegm exists in the diaphragm, and emesis is indicated. For those afraid of emesis, consider gentle purgation. (From *Bencao Gangmu*)
When phlegm coagulates and qi stagnates, causing blockage (Geguan), the pulse may show immobility, erratic movement in certain areas, intermittent presence, absence at Cun or Chi positions, or absence of Guan/Gu pulses (some texts read 'slippery'). Intermittent pulsations of varying sizes, sudden onset in healthy individuals, or irregular occurrences in those prone to phlegm, or following sudden collapse, are not necessarily death omens. (From *Yangsheng Zhu Lun*) [Note: *Huicui* adds: 'This reality stems from phlegm.']
General Description of Symptoms: Wang Yinjun stated: "Descriptions of phlegm syndromes have never been detailed in ancient or modern times. Although medical books distinguish five types of phlegm and various fluids, few understand their root source. Symptoms may include headache vertigo, eye movement issues, tinnitus; twitching of mouth and eyes, itching or pain in eyebrows, orbits, and ears; wandering wind-like swelling and hardness in limbs, painful yet not quite painful; itching and pain in teeth and cheeks, loose teeth with varied pain/itch sensations; belching and acid reflux, epigastric discomfort, pain or hiccups; throat obstruction, inability to cough up or swallow phlegm; phlegm resembling ink, broken cotton wadding, peach gum, or clam meat; sensation of ice or iron in the epigastrium, cold heart pain; strange dreams; soreness and weakness in ankles, sudden pain in lower back, kidneys, and joints; unnamed pain in limb bones and tendons without fixed location; hand numbness and arm pain resembling wind-dampness; a line of cold rising daily along the spine (note: absent in original text, cited from Danxi in *Gangmu*); generalized prickling sensation like lying on thorns; sticky wet eyes, mouth ulcers, tongue rot, throat bi; neck masses resembling scrofula; sensation of two energies knotting in chest/abdomen, choking, stifling distension, feeling of smoke/fire rushing upward, facial flushing; mental derangement, mania, stroke paralysis, chronic debilitating diseases, wind-toxus podagra, palpitations fearing pursuit (as *Mingyi Zhizhang* describes: running mad, dementia, unrecognized persons); wheezing, cough, vomiting; vomiting cold saliva, green water, black juice, potentially developing lung abscess, intestinal toxin, pus in stool, spasms, and lameness. Essentially, hundreds of internal and external diseases are caused by phlegm, with diverse manifestations hard to fully describe. Once body fluids congeal into phlegm, they no longer circulate and moisten the San Jiao, leading to dry mouth and throat, constipation, sallow face like dried bone, and brittle hair. Women may experience amenorrhea. If foul phlegm is expelled, medication will naturally be effective. I once used a single remedy, Guntan Wan, to cure countless diseases, which I now pass down." (From *Yixue Wei Yi*) [Note: *Yangsheng Zhu Lun* was complex, so *Yixue Wei Yi* edited it. *Yixue Wei Yi* also cites *Maijing* and *Huo Ren Shu* to validate Wang Yinjun’s views but notes Guntan Wan cannot treat all phlegm.]
Sources of phlegm vary: some generate heat from phlegm, others generate phlegm from heat; some arise from qi, wind, fright, accumulated fluids, overeating, summerheat (or wind-cold-dampness), cold injuries, spleen deficiency, or alcohol. Manifestations include: Fright-phlegm causes pericardium pain and epilepsy; Heat-phlegm causes irritability, head wind, rotten eyes, dryness, palpitations, and dizziness; Wind-phlegm causes paralysis, severe vertigo, and silent confusion; Fluid-phlegm causes hypochondriac pain, immobility of limbs, and daily vomiting; Food-phlegm causes malaria/dysentery and foul breath (food stagnation leads to masses/fullness); Summerheat-phlegm causes heatstroke vertigo, jaundice, and headache; Cold-phlegm causes bone bi, limb immobility, and stabbing qi pain; Wine-phlegm causes indigestion of alcohol, vomiting the next day after drinking; Spleen-deficiency phlegm causes poor appetite, reverse vomiting; Qi-phlegm causes wandering stabbing pain. Women often suffer Fright-phlegm, especially postpartum or during menstruation, where fright enters via deficiency, forming abdominal masses that feel like pregnancy, causing unbearable pain upon movement. (Cited from *Bencao Gangmu* referencing Danxi)
Phlegm-saliva moves with qi, reaching everywhere. Entering the Heart, it confuses orifices causing epilepsy, delirium, and hallucinations. Entering the Lung, it blocks orifices causing thick sticky cough, wheezing, and cold back. Entering the Liver, it accumulates causing hypochondriac pain, dry retching, and alternating chills/fever. Entering meridians, it causes numbness and pain. Entering sinews/bones, it causes pain in head, neck, chest, back, waist, and pulling pain in limbs. (From *Bencao Gangmu*)
Early phlegm symptoms mimic exterior colds (headache, fever); later, night-worsening cough mimics interior yin-fire; phlegm-fluid flowing to joints mimics wind-disease. However, phlegm is distinguished by chest fullness, reduced appetite, normal muscle mass, and irregular slippery pulses. (From *Rumen*)
Immobility of arms indicates phlegm (citing *Zhimi* Fuling Wan main indications); epigastric discomfort indicates phlegm. Sudden burning sensation in chest, akin to pain but not quite, followed by intense hunger (called 'heart stab' in the North), is fire stirring phlegm.
Vertigo indicates phlegm (dizziness, darkness before eyes, seasickness sensation, desire to vomit). Irritability indicates phlegm (feeling neither hot nor cold, sick yet well, restlessness, urge to cry/shout). Assess deficiency/excess and treat phlegm for immediate cure. Mania indicates phlegm (sudden madness, confused speech, discarding clothes, climbing high). Phlegm above the diaphragm causes mania or forgetfulness. Sudden collapse indicates phlegm (fainting, unconsciousness); even with qi deficiency, treat phlegm first. Stroke with aphasia indicates phlegm; despite being called stroke, treat phlegm first. (From *Yitong*)
Many diseases involve concurrent phlegm, unknown to the world. (From *Danxi Xinfa*)
Strange symptoms unrecognized by people should be treated as phlegm disorders. (From *Jishi Quan Shu*) [Note: Based on *Gezhi Yulun*'s discussion on deficiency/phlegm mimicking evil spirits. *Jinnang Mi Lu* correctly argues against attributing all strange symptoms to phlegm; consult both.]
External Signs: Those with phlegm always have ash-gray/black color under eyelids and below eyes, visible without pulse diagnosis. Black eyes with red cheeks indicate Heat-Phlegm; yellowish face indicates Heat-Phlegm. External signs include vexation, chest heat, dry mouth craving cold, constipation, dark hot urine. Long-term use of hot herbs may cause large solid pulse, high fever, and stroke, requiring urgent purgation. Black eyes with groaning gait and difficulty moving indicate Bone-Penetrating Phlegm (body joint pain, earth-colored face). Limb flaccidity and stiffness indicate Wind-Damp Phlegm. Black eyes with shortness of breath indicate Fright-Wind Phlegm. (From *Bencao Gangmu*)
Phlegm Color (Indications for Emesis. Foul Phlegm): Wang Yinjun said: "Clear/white phlegm is Cold; yellow/turbid is Heat. But initially clear/white, it turns yellow/turbid over time. Clear/white floats thin on top; yellow/turbid condenses thick at bottom. Easy to cough up is clear/white; hard to cough up is yellow/turbid stagnation. Long-term damp-heat stagnation eliminates clarity. Blood may appear, turning black if decayed. People do not recognize phlegm as a cause of Geguan. Clear/white smells mild; old phlegm becomes foul, varying in sour/spicy/fishy/burnt odors." (From *Yixue Wei Yi*) [Note: *Yixue Wei Yi* praises this differentiation of new/old phlegm.]
For emesis, check phlegm: if it shines on walls (like snail slime), emesis is safe. Wait for phlegm to dry to judge shininess, do not assume wet phlegm is shiny. (From *Shibao Mi Lu*)
In chronic deficiency with old phlegm-fluid retention, if tonifying with Ginseng/Atractylodes leads to expulsion of foul/green phlegm, prognosis is poor due to long-standing accumulation and spleen/stomach heat stagnation. Use Erchen Tang plus Zhi Shi, Bai Zhu, Huang Lian, Zhu Li for best chance. Lung abscess with foul pus/blood is different. (From *Yitong*)
Middle Phlegm (See Phlegm-Jue and emetic formulas later): Dragging limbs, facial deviation, hemiplegia, localized hook-like pain, borborygmus, somnolence, drooling indicate Middle Phlegm. Use Shen Su Yin, Kongyan Dan, or Xingxiang Yinzi. (From *Guanjian Liangfang*) [Xingxiang Yinzi from *Zhongfeng* San Sheng Yin.]
Headache and Body Pain: Pain usually arises from qi/blood, but phlegm-fluid stagnation also causes pain. Head wind pain unresponsive to wind-dispelling herbs may respond to phlegm-resolving herbs. Eye inflammation painful/light-sensitive unresponsive to cooling herbs may respond to phlegm herbs (*Yiqi* notes: both are phlegm-heat ascending). Alcoholics with arm pain/numbness improve with Erchen Tang + Jiang Huang, Baixi Wan, Xiaoyin Wan, Beizhu Wan. Traumatic chest injury unresponsive to blood-invigorators stops pain after urination induces phlegm expulsion. These prove phlegm-induced pain. (From *Zhizhi Fang*)
Phlegm-fluid entering limbs causes shoulder/back ache and soft limb bi. Misdiagnosed as wind, treat with Daotan Tang + Mu Xiang, Jiang Huang. (From *Yaojue*)
Arm immobility or widespread joint pain, restlessness indicates Bone-Infiltrating Phlegm. Sudden unbearable pain in limbs/chest/back/head/waist/knees, pulling pain, restlessness, wandering pain, headache, heaviness, cold bi, hidden pulse indicates stubborn phlegm hiding in chest/upper-lower jiao. Not wind/toxin. Treat with Daotan Tang + Qiang Huo, Fang Feng, Bai Zhi, Ginger Juice, Zhu Li. (From *Yitong*)
Nodules: Masses anywhere on body are mostly phlegm. Ask dietary habits, use emesis/purgation first, then medication. (From *Danxi Xinfa*)
Non-painful, non-red, non-suppurating nodules are Phlegm-Nodules (Danxi). Post-auricular/neck nodules: Cang Er, Jiuhuanglian, Qingdai, Niuxing equal parts, honey pills. Neck nodules: Erchen Tang + Jiuhuanglian, Lianqiao, Jiegeng, Chaihu, Gualou Ren. Arm nodules painful: Erchen Tang + Lianqiao, Fangfeng, Chuanxiong, Zaocis Spina, Cangzhu. (From *Yuanbing Ji*)
Masses, non-itchy/non-painful, or numb, called 'Defeated Phlegm Lost Path', treat locally to resolve. (From *Yitong*)
Difficult Cases: Phlegm clumped, unable to expectorate, with qi stagnation is difficult. (From *Danxi Zuanyao*)
Similar Syndromes: Non-phlegm/non-fluid, frequent white foam, not sticky, due to spleen deficiency failing to control fluids. Use Liujunzi Tang + Yizhiren. (From *Bidu*)
Treatment Principles: Treating phlegm prioritizes regulating qi, then harmonizing stomach. Address causes: wind, cold, damp, heat. Harmonizing stomach: Saliva is spleen fluid; harmonizing spleen/stomach disperses phlegm. Banxia is常用 because it resolves phlegm. (From *Zhizhi Fang*)
Zihehe said fluids require no tonification, only removal via emesis, sweating, purgation. Critiqued hot herbs for phlegm. However, cold/deficiency patterns exist. Old, sticky phlegm resembles cold stagnation; needs warm guiding herbs to avoid rejection. External wind-cold with internal phlegm-q stagnation needs warm dispersal. Qi/blood deficient patients with phlegm blocking clear pathways need simultaneous tonification and purgation, not just Zihehe’s three methods. Chronic illness often stems from food stagnation/phlegm, as stomach qi relies on phlegm accumulation for sustenance. Overuse of harsh draining herbs damages spleen qi, reducing fluid transport and increasing phlegm (Danxi: excessive draining harms spleen, increasing phlegm). Method: Tonify spleen/stomach, clear middle qi, phlegm will drain naturally (Yitong: add warm tonics if cold/attacking herbs fail). This is treating the root, the 'Kingly Way' of medicine. (From *Yixue Wei Yi*)
Regulating qi smooths mild phlegm; expelling phlegm unblocks severe qi stagnation. Both are essential. Prioritize based on severity of phlegm vs. qi. (From *Yitong*)
Phlegm surging to upper jiao/chest stems from qi. Treat qi first, then descend fire. Breaking qi/clearing fire resolves phlegm from acute six-evils/seven-emotions. Chronic old phlegm requires gradual resolution and constitutional tonification (yang/yin deficiency). Acute methods may deplete qi before resolving phlegm. (From *Yijin Yifa*)
Treat phlegm by assessing qi deficiency/excess and cold/heat. Too many qi-consuming herbs worsen phlegm via spleen/lung qi deficiency. Laypeople misunderstand pulses...