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The pulse is rebellious, with pain drawing between the back and chest, termed *Fei Ji* (Lung Accumulation). The pulse is deep and hollow (*Kou*), with no fixed location for the pain above or below, accompanied by chest fullness, palpitations, and heat in the abdomen, termed *Xin Ji* (Heart Accumulation). The pulse is wiry and thin, with pain under both hypochondria, pathogenic factors moving to the epigastrium, swelling and cold heaviness in the feet, termed *Gan Ji* (Liver Accumulation). The pulse is deep and rapid, suffering from drawing pain between the kidney and waist, appearing when hungry and diminishing when full, termed *Shen Ji* (Kidney Accumulation). The pulse is floating, large, and long, diminishing when hungry and appearing when full, with abdominal fullness, diarrhea, vomiting, and swelling of the shins, termed *Pi Ji* (Spleen Accumulation). At the Cun Kou position, the pulse is deep and transverse; there is transverse accumulation pain under the hypochondria and in the abdomen. A transverse pulse on the left indicates the syndrome is on the left; a transverse pulse on the right indicates the syndrome is on the right. A larger pulse head indicates the lesion is upper; a smaller pulse head indicates the lesion is lower. A wiry pulse with urgent pain in the abdomen indicates *Jia* (mobile mass). A fine and minute pulse indicates *Zheng* (fixed mass). A heavy pulse with a scattered center indicates a *Zheng* mass formed by cold and food stagnation. A pulse turning left and heavy indicates Qi stagnation in the stomach; a pulse turning right and failing to reach the Cun Kou position indicates a flesh *Zheng* mass inside. A fine, deep pulse that is sometimes straight indicates an abscess in the body; if there is *Fu Liang* (hidden beam) in the abdomen. A deep, small, and solid pulse indicates accumulation in the stomach, inability to eat, and vomiting immediately after eating. A deep and tight pulse indicates cold at the epigastrium with intermittent pain and accumulation. A large Guan pulse with fine Chi and Cun pulses indicates cold accumulation in the heart and abdomen. A slow and slippery pulse indicates interior cold with phlegm binding. A wiry and hidden pulse indicates an immobile *Zheng* mass in the abdomen, which is fatal and untreatable. Weakness leads to death; firmness and urgency lead to survival.

Phlegm arises from Spleen dampness, being rarely cold but often hot. Dampness in the Liver channel is called Wind Phlegm. Dampness in the Heart channel is called Heat Phlegm. Dampness in the Spleen channel is called Damp Phlegm. Dampness in the Lung channel is called Qi Phlegm. Dampness in the Kidney channel is called Cold Phlegm. For Wind Phlegm, the pulse is wiry and the complexion green, limbs are full and stuffy, urination and defecation are obstructed, and the mind is prone to irritability and anger; treat with *Shuizhu Jinhua Wan* (Boiled Golden Flower Pill) or *Chuanxiong Fangfeng Wan*. For Heat Phlegm, the pulse is surging and the complexion red, with vexation, heart pain, dry lips and mouth, and excessive laughter; treat with *Xiao Huang Wan* or *Xiao Chai Hu Tang* (Minor Bupleurum Decoction) plus Banxia. For Damp Phlegm, the pulse is moderate and the complexion yellow, limbs are heavy, there is lethargy, abdominal distension, and indigestion; treat with *Baizhu Wan* or *Fangji Wan* from *Ju Fang*. For Qi Phlegm, the pulse is choppy and the complexion pale, with upward rushing Qi causing panting, alternating chills and fever, sorrow, and unhappiness; treat with *Yufen Wan* or *Jiegeng Tang* from *Ju Fang*. For Cold Phlegm, the pulse is deep and the complexion dark black, with urgent painful urination, cold and rebellious feet, and frequent fear; treat with *Jiangui Wan*, *Hujiao Lizhong Wan* from *Ju Fang*, or *Wuzhuyu Tang* from *Jinkui Yaolue*. If there is epigastric stuffiness, add Zhishi (5 qian). If body heat is severe, add Huanglian (5 qian). If weight is heavy, add Fuling and Baizhu (1 liang each). If Qi rebels upward, add Ku Tingli (5 qian). If Qi is short, add Renshen and Jiegeng (5 qian each). If edema occurs, add Yuliren and Xingren (5 qian each). If constipation occurs, add Dahuang (5 qian). (These items originally appeared in the Cough section; refer to it for coughs.)

Phlegm is divided into five colors: White corresponds to the original color of the West; Yellow corresponds to reversing towards Kun (Earth); Red corresponds to extreme internal heat, where Metal is imprisoned by Fire, making it difficult to treat; Green corresponds to entanglement by Wind; Black like soot spots corresponds to smoothing towards the North (Water), healing without treatment.

The Classics state: Water enters the Stomach, its essence floats and overflows, moves up to the Spleen, the Spleen scatters the essence, sends it up to return to the Lungs, regulates the water passages, and transports it down to the Bladder. Water essence distributes in four directions, running through the five meridians. Where does such a thing as "phlegm" come from? Phlegm is generated because Spleen Qi is insufficient, unable to deliver essence to the Lungs, resulting in stagnation and formation. Therefore, treating phlegm begins with tonifying the Spleen; once the Spleen restores its normal transportation function, phlegm transforms naturally. However, if stagnation persists for a long time, like a blocked canal flooding, it flows backward and upward, becoming turbid, foul, and diverse. If one does not dredge the canal but tries to clarify the already blocked water, it is impossible. *Jinkui Yaolue* states: A person who was formerly fat but is now thin, with water moving in the intestines making a gurgling sound, is termed *Tan Yin* (Phlegm-Fluid). It should be treated with warm herbs to harmonize it. It also states: For Tan Yin at the epigastrium, *Guiling Gan Zhu Tang* (Cinnamon Twig, Poria, Licorice, and Atractylodes Macrocephala Decoction) is the primary formula. When drinking water flows into the hypochondria, causing pain upon coughing and spitting, it is termed *Xuan Yin* (Hanging Fluid), treated with *Shi Zao Tang* (Ten Jujube Decoction). (This medicine is too harsh; substitute with *Xiao Wei Dan* for a milder effect, but it must not be used in deficient persons.) When drinking water flows into the limbs, sweating should occur but does not, causing body pain and heaviness, it is termed *Yi Yin* (Overflowing Fluid), requiring diaphoresis. Treat with *Da Qing Long Tang* (Major Green Dragon Decoction) or *Xiao Qing Long Tang* (Minor Green Dragon Decoction). For coughing, rebellion, leaning to breathe, shortness of breath, inability to lie down, and swelling-like appearance, it is termed *Zhi Yin* (Supporting Fluid). It also states: Vomiting patients usually feel thirsty; if they do not feel thirsty now, it is due to Zhi Yin at the epigastrium, treated with *Xiao Banxia Tang* (Minor Pinellia Decoction). It also states: For Zhi Yin at the epigastrium causing dizziness and vertigo, *Zexie Tang* (Alisma Decoction) is the primary formula. Commonly use *Haizang Wu Yin Tang* or *Beizhu Wan* from *Ju Fang*. Zhu Danxi said: The sources of phlegm are varied. There is phlegm generating heat, heat generating phlegm, phlegm arising from Qi, from Wind, from Shock, from accumulated fluids, from excessive eating, from Summerheat, from cold-damaging foods, from Spleen deficiency, and from alcohol indulgence. Its diseases include: Shock Phlegm causes Pericardium pain and epilepsy. Heat Phlegm causes vexation, headache, rotting eyes, dry constipation, palpitations, and distress. Wind Phlegm causes paralysis, severe wind stroke, vertigo, silent wind, and confusion. Fluid Phlegm causes hypochondriac pain, inability to move limbs, and daily vomiting. Food Phlegm causes malaria and dysentery, bad breath. Summerheat Phlegm causes fainting, dizziness, jaundice, and headache. Cold Phlegm causes bone bi, inability to move limbs, and stabbing Qi pain. Alcohol Phlegm causes indigestion of alcohol, vomiting the next day after drinking. Spleen Deficiency Phlegm causes poor appetite, regurgitation, and vomiting. Qi Phlegm causes wandering stabbing pain. Women suffer most from Shock Phlegm, likely due to intercourse postpartum while menstruation is just starting; shock enters due to deficiency, forming lumps. There must be a lump in the abdomen; during attacks, it moves and jumps like pregnancy, unbearable pain. For Heat Phlegm, use *Huanglian Lige Wan*; for downward purging, use *Miaoying Wan* plus Penxiao in equal parts, 3 liang per dose; *Tun Tan Wan* is also usable. For Shock Phlegm, use *Miaoying Wan* plus Zhusha (2 qian) and Quanxie (3 qian), 8-9 pills per dose, taken 3-5 times to eliminate completely. For Shock Qi forming lumps, use *Miaoying Wan* plus fried Shanzhijia and calcined Biejia (3 qian each), Yanhusuo and Pengze (4 qian each), 50-70 pills per dose, stopping when loose stools occur. For Cold Phlegm, use *Miaoying Wan* plus Hujiao, Dingxiang, Quanxie, and Rougui in equal parts, 25 pills per dose. For Wind Phlegm, use *Qufeng Wan* or *Daotan Wan*. For Alcohol Phlegm, use *Miaoying Wan* plus Xionghuang and Quanxie (2 qian each), 10 pills per dose. For Fluid Phlegm, use *Xiao Wei Dan*. For Food Phlegm, use *Baohe Wan*. For Summerheat Phlegm, use *Xiaoshu Dan*. Pang Anchang said: In the human body, phlegm never rises inversely; in the world, water never flows upstream. Thus, skilled phlegm doctors treat Qi, not phlegm; when Qi is smooth, body fluids follow Qi smoothly. Use *Suzi Jiangqi Tang* and *Daotan Tang* half doses mixed and decocted. Or *Xiao Banxia Fuling Tang* plus Zhishi and Muxiang (half qian each), swallowing *Wutao Wan*. Or decoct *Wutao Wan* ingredients as a drink. If otherwise healthy but with a few mouthfuls of phlegm, clear or hard, use *Erchen Tang* or *Xiao Banxia Fuling Tang*. For abundant phlegm, intermittently take *Qingzhou Baiwanzi* and *Laifu Dan*, named *Laibai Wan*; if mixed with *Bashen Laifu Dan*, it is named *Qingshen Wan*. This treats not only phlegm-fluid but especially wheezing, cough, vomiting, and regurgitation. When phlegm-fluid flows into limbs, causing shoulder/back soreness and soft numbness in hands, misdiagnosed as Wind, it is incorrect treatment; use *Daotan Tang* plus Muxiang and Jianghuang (half qian each). Generally, when phlegm-fluid generates various syndromes, do not be dragged by them or invent new names; prioritize treating the fluid. Once fluid resolves, other syndromes heal themselves. For example, headache and angular eye pain unresponsive to wind herbs respond to phlegm herbs. Red, light-sensitive, painful eyes unresponsive to cooling herbs heal with phlegm formulas. Such cases are numerous and scattered in various sections, not repeated here. For insufficient Yin blood with ministerial fire rebelling upwards, insulting the Lungs, preventing clear descending, leading to turbid fluids forming phlegm instead of blood, use moistening agents like Maidong, Dihuang, and Gouqizi to nourish Yin, allowing rebelling fire to return home and rest, clearing phlegm. Using *Erchen Tang* here leads to danger. Kidney deficiency failing to grasp Qi leads to accumulation; if accumulation does not disperse, phlegm forms; treat with *Bawei Wan*. Fine, slippery, or moderate pulse with thin phlegm-saliva, fatigue, and weak limbs indicates Spleen deficiency with dampness; use *Liujunzi Tang* or *Buzhong Yiqi Tang* plus Banxia and Fuling. Knotted, choppy pulse with chest oppression or stabbing pain indicates Qi depression; use *Qi Qi Tang* or *Yueju Wan*. Some people sitting spit phlegm-saliva everywhere, not sticky but frothy, indicating Qi deficiency failing to control saliva; do not use draining medicines, use *Liujunzi Tang* plus Yizhiren (1 qian) to control it. Gong Lu'an from Danyang, over seventy years old, had uncomfortable phlegm in the diaphragm, poor appetite, initially harmless. He sought medical care in Jingkou, taking *Yueju Wan* and *Qingqi Huatan Wan*, feeling slightly relieved, took them daily without stopping. After more than a year, he was exhausted, rented a boat to seek my help. His muscles were wasted, pulses like wandering threads, Taixi pulse absent. Seeing my difficulty, he said, "I expect to die, but diaphragmatic bloating is unbearable, constipation is severe. Please relieve me briefly before I die." Insisting I prescribe, out of kinship duty, I taught using large doses of Renshen and Baizhu decocted in water. Shortly after, he went to toilet, passed several liters of accumulated phlegm, chest felt relieved, but died a few days later.