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Phlegm and fluid retention (Yin) are both transformations of body fluids. Phlegm is turbid while fluid retention is clear; phlegm arises from fire, whereas fluid retention arises from dampness. Phlegm originates in the Spleen; when dampness prevails, the essence and grains fail to be transported, leading to condensation. It may obstruct the Lung orifices or flow through the meridians and collaterals. Fluid retention gathers in the Stomach; if cold lingers, water fluids fail to circulate, leading to overflow. It may accumulate below the diaphragm (epigastrium) or soak into the intestines. This results from the yin coagulation of water and dampness in the Spleen and Stomach. Yang qi must be robust and transporting so that turbid yin descends, just as smoke and clouds dissipate under the scorching sun. Therefore, treatment should focus on regulating the Spleen and expelling dampness.

If Kidney yang deficiency fails to control water, causing water to overflow into phlegm, the fluid qi rebels upward. In this case, the phlegm is clear and transparent; treatment should involve unblocking yang and draining dampness, avoiding cloying substances that aid yin, such as Siwu Decoction (Four Substance Decoction) or Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). If Kidney yin is deficient, deficient fire will scorch Metal (Lung), and heat condenses into phlegm, manifesting as rising phlegm-fire; thus, the phlegm is thick and turbid. Treatment should nourish yin and clear moistness, avoiding warm substances that aid dryness, such as Erchen Decoction (Two-Cured Decoction) or Liujunzi Decoction (Six-Gentleman Decoction). These distinctions are essential in treatment principles.

Clear substances are fluid retention; thick and turbid substances are phlegm. Fluid retention only stagnates in the intestines and stomach, whereas phlegm moves with the ascending and descending of qi, reaching all parts of the body. Pang Anchang said: "There is no backward-flowing water in the world, for it is driven by wind." There is no upward-rebelling phlegm in the human body, for it is driven by qi. When in the Lung, it causes cough; in the Stomach, vomiting; in the Heart, palpitations; in the head, dizziness; in the back, coldness; in the chest, stuffiness; in the hypochondrium, distension; in the intestines, diarrhea; in the meridians, swelling; in the limbs, bi-syndrome (impediment syndrome). Changes are myriad, as the ancients said: "Strange diseases often belong to phlegm, and acute diseases often belong to fire." However, it is also said, "When seeing phlegm, do not merely treat the phlegm," because treating the root is necessary; fearing that solely focusing on eliminating phlegm will severely damage Stomach qi, thereby exacerbating abdominal distension. Danxi stated: "Stomach qi also relies on phlegm for nourishment; attacking and purging leads to Stomach deficiency and worsens the phlegm."

There are also methods specifically targeting phlegm: For Wind-phlegm, use dispersal, such as Fangfeng Wan (Windscreen Pill) adding Tianxing (Arisaema Cum Bile) and Shengjiang (Fresh Ginger); for Wind combined with Cold, use Qingzhou Baiwanzi (Qingzhou White Pills); for Cold-phlegm, use warming, such like Lizhong Huatan Wan (Regulate the Middle Phlegm-Resolving Pill); for Summerheat-phlegm, use resolution/clearing, such as Xiaoshu Wan (Summerheat-Relieving Pill); for Damp-phlegm, use drying, such as Eryi Erchen Tang (Erchen Decoction with Atractylodes and Cyperus) or Baizhu Wan (Atractylodes Macrocephala Pill); for Dry-phlegm, use moistening, such like Runfei Yin (Moisten the Lung Drink) adding Xingren (Apricot Seed) and Baimi (White Honey); for Fire-phlegm, use clearing, such as Qingqi Huatan Wan (Clear Qi Phlegm-Resolving Pill); for Food-phlegm, use digestion/resolution, such like Baohe Wan (Preserve Harmony Pill) or Gualou Wan (Trichosanthes Pill); for Alcohol-phlegm, use transformation, such as Ruizhutang Huatan Wan (Ruizhu Hall Phlegm-Resolving Pill); for Stagnation-phlegm, use unblocking, such as San Yin Qi Qi Tang (Three Causes Seven-Qi Decoction) adding Yujin (Curcuma Longa Rhizome), Shichangpu (Acorus Tatarinowii Rhizome), and Xiangfu (Cyperus Rotundus Rhizome); for Qi-phlegm, use promoting movement, characterized by inability to expectorate or swallow, feeling like rotten cotton or a plum pit, using Qi Qi Tang (Seven-Qi Decoction) or Sanxian Wan (Three Immortals Pill); for Shock-phlegm, use purgation/drainage, such like Kongxian Dan (Controlling Fluids Powder) adding Chen Sha (Cinnabar) and Xiwei (Scorpion Tail); for Old-phlegm, use softening hardness, using Haishi (Floating Limestone), Haifen (Sea Powder), Mangxiao (Mirabilite), or Lewangzi (Arca Shell), or Qingmengshi Wan (Green Meng Stone Pill); for Stubborn-phlegm, use emesis, such like Sansheng San (Three Saints Powder) or Qinglv Wan (Green-Yellow Pill), and for deficiency cases, Shenlu San (Ginseng Rhizome Powder) adding Zhuli (Bamboo Juice).

For phlegm in the upper jiao, induce vomiting using Jiegeng Lu San (Platycodon Rhizome and Rhizome Powder) or Xixian San (Thin Saliva Powder); for phlegm in the lower jiao, guide downward using Daotan Tang (Guide Phlegm Decoction), or Guntan Wan (Rolling Phlegm Pill) for severe cases; for phlegm in the Spleen, which is yellow, slippery, and easy to expectorate, use Erchen Decoction adding Zhishi (Immature Bitter Orange) and Baizhu (Atractylodes Macrocephala); for phlegm in the Lung, which is white like rice grains, astringent, and difficult to expectorate, use Lijin Tang (Benefit Metal Decoction) removing Shengjiang and Zhishi, adding Yuzhu (Polygonatum Odoratum Rhizome), taken with honey water; for phlegm in the Liver, which is green and foamy, use Chuanxiong Wan (Chuanxiong Pill) adding Tianxing and Zhishi, or Qianmin Tang (Thousand Thread Decoction) for severe cases; for phlegm in the Heart, which is red and sticky like glue, use Banhuang Wan (Half-Yellow Pill); for phlegm in the Kidney, which is black and salty, use Guiling Wan (Cinnamon and Polyporus Pill) adding Zexie (Alisma Rhizome) and Cheqian (Plantago Seed).

Phlegm lingering in the hypochondrium causes dull pain on cloudy days; treat with Erchen Decoction adding Baijiezi (White Mustard Seed). Phlegm stagnating in the meridians causes pulling pain in sinews and bones; treat with Jingli (Perilla Leaf Juice), Zhuli, and Jiangzhi (Ginger Juice), or Xuanfuhua Tang (Inula Flower Decoction) adding Guizhi (Cinnamon Twig). Phlegm entering the limbs causes weakness in hands and feet; treat with Daotan Decoction adding Guizhi, Jianghuang (Turmeric Rhizome), and Zhuli. Phlegm hidden in the subcutaneous tissue causes swelling and numbness; treat with Erchen Decoction adding Baijiezi, Jiangzhi, and Zhuli. If it forms movable nodules, treat with Daotan Decoction adding Jiangzhi and Zhuli. If it forms knots in the neck, use Tanhe Wan (Phlegm Nodule Pill) or Tanhe Jiu (Phlegm Nodule Wine).

Phlegm stopping above the diaphragm causing stuffiness is treated with Xiaoxianxiong Tang (Minor Chest-Harmonizing Decoction) adding Fuling (Poria), Zhishi, Jiangzhi, and Zhuli. Hidden phlegm in the epigastrium causing arm pain is treated with Zhimi Fuling Wan (Point-Mystery Poria Pill). Phlegm stagnation with rebellious qi causing frequent cough is treated with Liu'an Jian (Six-Safe Decoction). Cold saliva flooding the Gallbladder causing insomnia is treated with Wendan Tang (Warm the Gallbladder Decoction), adding Xiwei for excessive fright. Phlegm mixed with dead blood attacking is treated with Kongxian Dan adding Jiuzhi (Leek Juice), Taoren (Peach Seed), Muxiang (Aucklandia Root), Hujiao (Pepper), and Linglijia (Pangolin Scale). Phlegm knotting in sacs causing vomiting is treated with a drink of Jiangzhi, Zhuli, and Jiuzhi. Stroke with phlegm confusing the heart orifices: if cold, administer Nitang Tang (Cleanse Phlegm Decoction) with Niuhuang Wan (Calculus Bovis Pill); if hot, administer Erdan Wan (Two Cinnabars Pill). Epilepsy with phlegm oppression and convulsions is treated with Niuhuang Wan. These are all treatments addressing the branch (symptoms).

To treat the root: For Spleen deficiency with Damp-phlegm, strengthen the Spleen to transport, using Sijunzi Tang (Four Gentlemen Decoction) or Shenzhu Jianpi Wan (Ginseng and Atractylodes Spleen-Strengthening Pill). For Lung heat with Fire-phlegm, clear the Lung and moisten, using Qingfei Yin (Clear the Lung Drink) or Siyin Jian (Four Yin Decoction). For Spleen-Lung qi deficiency failing to transform and generate phlegm, use Liujunzi Decoction adding Muxiang. For Lung-Stomach qi deficiency failing to transform and generate phlegm, use Liujunzi Decoction adding Jiegeng. For Spleen qi stagnation, use Yigong San (Extraordinary Aid Powder) adding Sharen (Amomum Fruit). For Middle qi weakness, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).

For Spleen-Stomach deficiency with dampness, presenting with soggy-slow pulse and thin phlegm, use Liujunzi Decoction adding Paojiang (Prepared Ginger), or Buzhong Yiqi Decoction adding Fuling and Banxia (Pinellia Tuber). For Liver-Kidney deficiency with blood in phlegm, use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) adding Wuyu Gu (Cuttlefish Bone) and Sanqi (Notoginseng Root). For Kidney yin deficiency with fire stirring phlegm ascent, use Wuwei Tiandong Wan (Five-Flavor Asparagus and Ophiopogon Pill) or Baihua Gao (Hundred Flowers Paste). For Ministerial fire scorching phlegm fluids causing dryness, use Ziyin Qinghua Wan (Nourish Yin Clear Transform Pill). For Kidney yang decline with water overflowing as phlegm, use Xue Shi Bawei Wan (Xue's Eight-Ingredient Pill), or Zhenwu Tang (True Warrior Decoction) if ineffective. For consumptive disease with cough producing white phlegm like egg white, commonly called "white blood," use Bufei Tang (Tonify the Lung Decoction). This constitutes treating the root of phlegm. Since phlegm and fluid retention are named together but treated differently, how can they be confused?

Turning from phlegm to discuss fluid retention: The *Neijing* mentions fluid retention but not phlegm; its discussion of fluid retention diseases attributes them all to dampness overacting and Earth qi stagnating. In the *Jingui Yaolue*, names such as Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), Zhi Yin (Supporting Fluid), Liu Yin (Retained Fluid), and Fu Yin (Hidden Fluid) were established, all referring to pathological water accumulation. If a person was formerly fat but is now thin, with water moving in the intestines making a gurgling sound, it is called Tan Yin, accompanied by dizziness and shortness of breath. Fluid in the Yang aspect causes short exhalation, treated with Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction). Fluid in the Yin aspect causes short inhalation, treated with Shenqi Wan (Kidney Qi Pill). The *Jingui* states: "Shortness of breath with slight fluid retention should be promoted via urination," primarily using Linggui Zhugan Tang or Shenqi Wan.

Water flowing into the hypochondrium after drinking, causing pain upon coughing and spitting, is called Xuan Yin, with a deep-wiry pulse, treated with Shizao Tang (Ten Jujube Decoction). Water flowing into the limbs, where sweating should occur but does not, causing heavy body pain, is called Yi Yin, treated with Xiaoqinglong Tang (Minor Blue Dragon Decoction). Coughing with reversed qi, leaning to breathe, shortness of breath preventing lying down, and swelling-like appearance is called Zhi Yin, treated with Tingli Xiefei Tang (Descurainia Draining Lung Decoction) or Wuling San (Five-Ingredient Powder with Poria). Water stopping below the heart, with coldness on the back the size of a palm, shortness of breath, joint pain, hypochondriac pain radiating to the supraclavicular fossa, and deep pulse, is called Liu Yin, treated with Daotan Decoction. Diaphragmatic fullness, wheezing, cough, vomiting, alternating chills and fever, lower back pain, and body tremors constitute Fu Yin, treated with Beishu Wan (Double Atractylodes Pill) adding Fuling and Banxia. Phlegm-fluid without thirst is treated with Xiaobanxia Tang (Minor Pinellia Decoction). Zhi Yin with dizziness is treated with Zexie Tang (Alisma Decoction). Epigastric stuffiness, water between the diaphragm, palpitations, and dizziness are treated with Xiaobanxia Jia Fuling Tang (Minor Pinellia Decoction plus Poria). Habitual consumption of tea or alcohol forming masses is treated with Jianggui Wan (Ginger and Cinnamon Pill). Fluid mass with sour belching and gastric discomfort is treated with Sanxian Wan or Cangzhu Wan (Atractylodis Lanceae Pill).

Distinct from phlegm and fluid retention, vomiting clear saliva and foam indicates Spleen deficiency failing to secure, treated with Liujunzi Decoction adding Yizhi (Alpinia Oxyphylla Fruit) and Shengjiang. Thirst with desire to drink, but vomiting immediately after swallowing, is named Shui Ni (Water Rebellion), treated with Wuling San. The general principle holds: external fluid retention resides in the Spleen, internal fluid retention in the Kidney. Treating the Spleen uses Linggui Zhugan Tang; treating the Kidney uses Shenqi Wan. For qi congestion, open it with Xiaoqinglong Decoction removing Mahuang (Ephedra) and Xixin (Asarum). For choking cough, calm it with fresh Pipaye (Loquat Leaf), Xingren, Fuling, Qianhu (Peucedani Radix), Suzi (Perilla Fruit), and Sangpi (Mulberry Bark). For turbid rebellion, warm with Zhenwu Decoction. For mild yang, harmonize with Waitai Fuling Yin (Waitai Poria Drink). For damp stagnation, secrete with Wuling San. For retained fluid, purge with Guiling Tang (Cinnamon and Polyporus Decoction). For supporting fluid knotting into collaterals, unblock with Fuling Guizhi Tang (Poria and Cinnamon Twig Decoction) adding Renshen (Ginseng), Gancao (Licorice), Chuanjiao (Sichuan Pepper), Banxia, Shengjiang, and Shuqi (Polygala Root). General treatment for fluid symptoms uses Wuyin Tang (Five Fluids Decoction). Zhang Zhongjing said: "Treat phlegm-fluid with warm herbs to harmonize," which summarizes the essence.

Zhongjing stated: "When fluid retention accompanies cough, treat only the fluid retention, not the cough."

Miao Zhongchun said: "The sources of phlegm generation are diverse, and treatments differ. When caused by yin deficiency with fire flaming upward, forcing the Lung, condensing into phlegm, this is termed Yin-deficiency Phlegm-Fire. The phlegm is in the Lung but rooted in the Kidney; treatment should descend qi and clear heat, benefiting yin and nourishing water. Avoid acrid-warm, drying, hot, and tonifying qi herbs. When caused by Spleen-Stomach cold-damp generating phlegm, or excessive eating/drinking causing Spleen qi stagnation, this disease lies in the Spleen and Stomach, unrelated to Lung and Kidney; treatment should dry the Spleen and promote qi movement. Avoid cloying, bitter-cold, and moistening herbs. When caused by Wind-Cold constraining heat generating phlegm, the disease is also in the Lung; treatment should resolve phlegm, with clearing and draining aided by acrid-warm herbs like Mahuang and Shengjiang to disperse external cold. Avoid warm-tonifying and astringent herbs to prevent drug rejection. Phlegm substance is thick and sticky; fluid retention is only clear water, or green-yellow, bitter, or sour, often due to excessive tea/alcohol consumption or emotional depression causing middle-jiao cold-damp obstruction. Treatment should dry dampness and promote urination, warming and unblocking yang qi to move it, such as Erchen Tang, Wuling San, or Zhenwu Tang."

Zhang Luyu said: "Phlegm-fluid generates various symptoms; one must prioritize treating the fluid retention first, and the other symptoms will heal themselves. For example, in headache with brow bone pain, repeated use of wind-dispelling herbs fails, but phlegm-resolving agents succeed. For red, light-sensitive, painful eyes, cooling herbs do not cure, but phlegm-resolving agents achieve efficacy. Such cases are numerous, relying on flexible diagnosis and treatment. For instance, Taiyin Phlegm-Jue headache does not exclusively treat wind, following this same logic."