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On the Treatment of Sinking Qi and Stagnant Blood

The Heavenly Master said: The method of "raising" (Yang Zhi) refers to conditions where Qi sinks and fails to ascend, and Blood stagnates and fails to circulate. When Qi is raised, it becomes relaxed and舒展 (unfolds); when Blood is raised, it becomes active and flows. If Qi remains sunk and suppressed without being raised, symptoms such as hiccups or limb paralysis will inevitably occur. Medication must be used to raise it, so that Qi becomes舒展 and Blood becomes active. The prescription consists of Dang Gui (Angelica Sinensis Root) 3 qian, Bai Shao (White Peony Root) 3 qian, Huang Qi (Astragalus Membranaceus Root) 3 qian, Bai Zhu (Atractylodes Macrocephala Rhizome) 3 qian, Chai Hu (Bupleurum Root) 5 fen, Shu Di Huang (Prepared Rehmannia Root) 5 qian, Sheng Ma (Cimicifuga Rhizome) 5 fen, Ren Shen (Ginseng Root) 1 qian, Fu Ling (Poria) 1 qian, and Chuan Xiong (Ligusticum Chuanxiong Rhizome) 1 qian, decocted in water and taken orally. This is Ba Zhen Tang (Eight Treasures Decoction). Its brilliance lies in the balanced tonification of Qi and Blood; if Gan Cao (Licorice Root) were used instead of Huang Qi, it would no longer be Ba Zhen Tang. By tonifying Qi and Blood in balance, avoiding bias, and subsequently using Sheng Ma and Chai Hu to raise them, the flow of Qi and Blood is promoted. Consequently, there will be no condition where Qi merges with Blood causing paralysis, nor where Blood merges with Qi causing hiccups. Since this raising method cannot be discarded, a separate category has been established. If one only tonifies Yang without tonifying Yin, Yang will flourish while Yin diminishes further. If one only tonifies Yin without tonifying Yang, Yin will flourish while Yang extinguishes further. Therefore, both must be tonified simultaneously for the raising method to be beneficial; it should not be conflated with the category of dispersing methods.

Lord Zhang said: The exposition is subtle and meticulous, leaving nothing to be criticized.

On Treating Newly Onset Phlegm, Established Phlegm, and Chronic Phlegm; On Old Phlegm and Stubborn Phlegm

The Heavenly Master said: The method of treating phlegm addresses phlegm obstructing the throat. Although it may seem like a minor illness, major diseases often arise from it, which is why ancient masters established a separate category for its treatment. However, prescriptions established by predecessors primarily treat the branch (biao/symptoms) of phlegm and are insufficient to treat the root (ben/origin). Thus, Er Chen Tang (Two Aged Ingredients Decoction) was created to treat new, temporary, and chronic phlegm across the Upper, Middle, and Lower Jiao, but it lacks practical efficacy when used universally. I now establish three new prescriptions: one for newly onset phlegm, one for established phlegm, and one for chronic phlegm. Although phlegm diseases are numerous, they do not exceed the scope of my methods. Newly onset phlegm manifests as wind-cold affecting the lungs with coughing and expectoration. It is treated with Ban Xia (Pinellia Tuber) 1 qian, Chen Pi (Aged Tangerine Peel) 1 qian, Tian Hua Fen (Trichosanthes Root) 1 qian, Fu Ling (Poria) 1 qian, Gan Cao (Licorice Root) 1 qian, and Su Zi (Perilla Fruit) 1 qian, decocted in water and taken orally. Two doses can eliminate the phlegm. This prescription removes phlegm from the Upper Jiao. Phlegm in the Upper Jiao originally resides in the Stomach, not the Lung. Removing phlegm from the Stomach allows Lung Metal Qi to descend and肃 (purify), preventing Fire from rising. Established phlegm resides in the Middle Jiao. One must distinguish it by observing whether the color is white or yellow, which is crucial. Yellow indicates that Fire is about to recede; white indicates that Fire is blazing. For blazing Fire, cold and cool herbs are suitable; for receding Fire, herbs that expel phlegm are added. I have established a single prescription for both cases: Bai Zhu (Atractylodes Macrocephala Rhizome) 3 qian, Fu Ling (Poria) 5 qian, Chen Pi (Aged Tangerine Peel) 1 qian, Gan Cao (Licorice Root) 1 qian, Bai Jie Zi (White Mustard Seed) 3 qian, Zhi Zi (Gardenia Fruit) 1 qian, and if it is Fire-Phlegm, add Zhi Ke (Aurantium Fruit) 5 fen, decocted in water and taken orally. This prescription belongs to the category of strengthening the Spleen, not merely expelling phlegm. However, excessive phlegm often results from Dampness due to Spleen Qi deficiency. By strengthening Spleen Qi, Water-Dampness descends. Since Water-Dampness does not remain in the Spleen, how can it emerge upwards? Moreover, with the addition of the supreme herb for resolving phlegm, how could the phlegm not quickly subside and disappear? As for chronic phlegm, it must not be diagnosed simply as Spleen-Dampness generating phlegm. Prolonged illness invariably leads to Kidney Water deficiency. It is either Kidney Water flooding upward as phlegm or Kidney Fire boiling upward as phlegm. This type of chronic phlegm requires tonifying the Kidney to expel it. The prescription uses Shu Di Huang (Prepared Rehmannia Root) 5 qian, Fu Ling (Poria) 3 qian, Shan Yao (Dioscorea Rhizome) 3 qian, Yi Yi Ren (Coix Seed) 5 qian, Qian Shi (Euryale Seed) 5 qian, Shan Zhu Yu (Cornus Fruit) 3 qian, Bei Wu Wei Zi (Schisandra Berry) 1 qian, Mai Dong (Ophiopogon Tuber) 3 qian, Che Qian Zi (Plantago Seed) 1 qian, and Yi Zhi Ren (Alpinia Oxyphylla Fruit) 3 fen, decocted in water and taken orally. This is the supreme medicine for treating phlegm caused by water flooding. If it is phlegm caused by boiling Fire, add Rou Gui (Cinnamon Bark) 1 qian internally. The brilliance of this prescription lies purely in its Kidney-tonifying ingredients, combined with dampness-resolving and phlegm-resolving agents. When Water enters the Kidney Palace, it naturally transforms into True Essence; thus, how could it rise and transform into phlegm? This is the method for treating phlegm in the Lower Jiao. With these three prescriptions, one can adjust based on specific symptoms, leaving no aspect of phlegm treatment unaddressed.

Lord Zhang said: These three prescriptions are extremely ingenious and can serve as supreme formulas for treating phlegm. However, I have additional prescriptions. For newly onset phlegm, the Heavenly Master's prescription is sufficient. For established phlegm, my prescription is also excellent and is attached below. Use Bai Zhu (Atractylodes Macrocephala Rhizome) 3 qian, Fu Ling (Poria) 3 qian, Chen Pi (Aged Tangerine Peel) 1 qian, Tian Hua Fen (Trichosanthes Root) 2 qian, Yi Zhi Ren (Alpinia Oxyphylla Fruit) 3 fen, Ren Shen (Ginseng Root) 3 fen, and Yi Yi Ren (Coix Seed) 3 fen. If there is Fire, add Huang Qin (Scutellaria Root) 1 qian; if there is no Fire, add Gan Jiang (Dried Ginger) 1 qian, decocted in water and taken orally. This prescription also strengthens the Spleen and eliminates Dampness, without consuming Qi or aggravating boiling Fire. After two doses, phlegm symptoms will naturally subside. For chronic phlegm, using my Liu Wei Wan Tang (Six Ingredient Pill Decoction) modified with Mai Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Berry) yields miraculous results and can be transmitted alongside the Heavenly Master's prescriptions for eternity. If there is no Fire, add Fu Zi (Aconite Lateral Root) and Rou Gui (Cinnamon Bark).

Lord Hua said: I have two more prescriptions for treating phlegm that has become old phlegm due to duration. The prescription uses Bai Shao (White Peony Root) 3 qian, Chai Hu (Bupleurum Root) 1 qian, Bai Jie Zi (White Mustard Seed) 5 qian, Fu Ling (Poria) 3 qian, Chen Pi (Aged Tangerine Peel) 3 fen, Gan Cao (Licorice Root) 1 qian, Dan Pi (Moutan Cortex) 2 qian, Tian Hua Fen (Trichosanthes Root) 8 fen, and Yi Yi Ren (Coix Seed) 5 qian, decocted in water and taken orally. The brilliance of this prescription lies in using Bai Jie Zi (White Mustard Seed) as the sovereign herb, Yi Yi Ren (Coix Seed) and Bai Shao (White Peony Root) as minister herbs, and Chai Hu (Bupleurum Root) and Tian Hua Fen (Trichosanthes Root) as assistant herbs, leaving no place for old phlegm to hide, allowing it to gradually digest. Eight doses of this prescription will eliminate all old phlegm. The formula name is Xiao Ke San (Thirst-Quenching Powder). Another prescription treats stubborn phlegm forming lumps obstructing the throat as "stubborn phlegm," and phlegm remaining in the chest and diaphragm without dissolving as "old phlegm." The prescription uses Bei Mu (Fritillaria Bulb) 3 qian, Gan Cao (Licorice Root) 1 qian, Jie Geng (Platycodon Root) 3 qian, Zi Wan (Aster Root) 2 qian, Ban Xia (Pinellia Tuber) 3 qian, Fu Ling (Poria) 3 qian, Bai Zhu (Atractylodes Macrocephala Rhizome) 3 qian, Shen Qu (Medicated Leaven) 3 qian, and Bai Fan (Alumen) 1 qian, decocted in water and taken orally. The brilliance of this prescription lies in the combination of Bei Mu (Fritillaria Bulb) and Ban Xia (Pinellia Tuber); one is drying and one is moistening, leaving no refuge for phlegm. Additionally, Bai Fan (Alumen) eliminates lumps, Jie Geng (Platycodon Root) and Zi Wan (Aster Root) remove pathogens, and Gan Cao (Licorice Root) harmonizes the center. How could it fail to produce immediate efficacy? These two prescriptions should not be discarded.

(Note: Adding Rou Gui (Cinnamon Bark) for phlegm caused by boiling Fire is because the Fire is insufficient to overcome the Water, requiring a counter-agent strategy. Recorded by Li Zi Yong.)