大意
痰属湿。津液所化。（杂着）行则为液。聚则为痰。流则为津。止则为涎。（绳墨）百病中多有兼痰者。（丹溪）
内因
人之气道。贵乎清顺。则津液流通。何痰之有。若外为风暑燥湿之侵。内为惊怒忧思之扰。饮食劳倦。酒色
无节。荣卫不清。气血浊败。熏蒸津液。痰乃生焉。（汇补）
外候
痰之为物。随气升降。无处不到。为喘为嗽。为呕为泻。为眩晕心嘈。为怔忡惊悸。为寒热肿痛。为痞满膈塞。
或胸胁辘辘如雷鸣。或浑身习习如虫行。或身中结核。不红不肿。或颈项成块。似 非 。或塞于咽喉。状
若梅核。或出于咯吐。形若桃胶。或胸臆间如有二气交纽。或背心中常作一点冰冷。或皮间赤肿如火。或
心下寒痛如冰。或一肢肿硬麻木。或胁梢癖积成形。或骨节刺痛无常。或腰腿酸刺无形。或吐冷涎绿水
黑汁。或梦烟火剑戟丛生。或大小便脓。或关格不通。或走马喉痹。或齿痛耳鸣。以至劳瘵癫痫。失音瘫痪。
妇人经闭带下。小儿惊风搐搦。甚或无端见鬼。似祟非祟。悉属痰候。（王隐君）
痰分五脏
生于脾。多腹痛膨胀。或二便不通。名曰清痰。或四肢倦怠。或久泻积垢。或淋浊带淫。名曰湿痰。若挟食积
痰血。内成窠囊癖块。外为痞满坚硬。又名食痰。留于胃脘。多吞酸嘈杂。呕吐少食。噎膈嗳气。名曰郁痰。或
上冲头面烘热。或眉棱鼻 作痛。名曰火痰。若因饮酒。干呕嗳气。腹痛作泻。名曰酒痰。升于肺。则塞窍鼾
睡。喘息有声。名曰中痰。若略有感冒。便发哮嗽。呀呷有声。名曰伏痰。若咽干鼻燥。咳嗽喉痛。名曰燥痰。久
之凝结胸臆。稠粘难咯。名曰老痰。七情过多。痰滞咽喉。咯之不出。咽之不下。胸胁痞满。名曰气痰。迷于心
为心痛惊悸。怔忡恍惚。梦寐奇怪。妄言见祟。癫狂痫喑。名曰惊痰。动于肝。多眩晕头风。眼目 动。耳叶搔
痒。左瘫右痪。麻木蜷跛。名曰风痰。停于膈上。一臂不遂。时复转移一臂。蓄于胁下。胁痛干呕。寒热往来。名
曰痰饮。聚于肾。多胫膝酸软。腰背强痛。骨节冷痹。牵连隐痛。名曰寒痰。又名虚痰。（入门）
痰病分辨
痰症初起。停留中焦。头痛寒热。类外感表症。久则停于脾肺。潮咳夜重。类内伤阴火。又痰饮流注。肢节疼
痛。类风家痹症。但痰病胸满食减。肌色如故。脉滑或细为异。（入门）
痰症察色
昔肥今瘦者。痰也。眼胞目下。如烟熏黑者。痰也。目睛微定。临时转动者。亦痰也。眼黑而行步呻吟。举动艰
难。遍身疼痛者。痰入骨也。眼黑而面带土色。四肢痿痹。屈伸不便者。风湿痰也。（汇补）
痰分形色
新而轻者。形色清白稀薄。咯之易出。气味亦淡。久而重者。黄浊稠粘。咯之难出。渐成恶味。（入门）但伤风者。
痰必清薄而上有浮沫小泡。伤热者。痰必浓浓而难化。内虚者。痰亦清薄而易于化水。又味甜者属脾热。
味腥者属肺热。味咸者属肾虚。味苦者属胆热。色青者属肝风。色黑者属肾水。大抵黑色为肾虚水泛。气
不归元。色红为火盛凌金。血不及变。所以红痰必劳损病症居多。最宜慎重。（汇补）
痰症脉法
左右关上滑大者。膈上有痰。又关脉洪者。痰随火动。关脉伏者。痰因气滞。若痰症得涩脉者。卒难得开。必
费调理。有病患一臂不遂。时复转移一臂。其脉沉细者。非风也。必有痰饮在上焦。
痰似杂症
痰饮变生诸症。形似种种杂病。不当为诸杂病牵掣作名。且以治痰为先。痰饮消则诸症愈。如头风眉棱
角痛。累用风剂不效。投痰药收功。如赤眼羞明涩痛。与以凉药弗瘳。畀痰剂获效。凡此之类。不一而足。散
在各症。不能繁引。智者悟之。（三锡）
痰症总治
热痰则清之。湿痰则燥之。风痰则散之。郁痰则开之。顽痰则软之。食痰则消之。在胸臆者吐之。在肠胃者
下之。（节斋）此为实人立法也。若肺虚有痰者。宜保肺以滋其津液。脾虚有痰者。宜培脾以化其痰涎。肾虚
有痰者。宜补肾以引其归藏。（汇补）
痰兼火治
有因热而生痰者。有因痰而生热者。故痰即有形之火。火即无形之痰。（绳山）然究而论之。痰之未病。即身
中真阴也。火之未病。即身中真阳也。苟不能平调。六欲七情。交相为害。偏胜浮越。痰得火而沸腾。火得痰
而煽炽。或升于心肺。或留于脾胃。或渗于经络。或散于四肢。或滞于皮肤。或溢于咽喉。种种不同。治者欲
清痰之标。必先顾其本。欲辨火微甚。须明气盛衰。盖元气盛者火必实。元气虚者火必虚。能调元气之盛
衰。而痰火相安于无事矣。（汇补）
痰兼气治
痰之在内者。为涎为饮。为癖为积。攻冲胀痛。皆属气滞。（时珍）然有二种之分。痰随气升者。导痰先须顺气。
（严氏）积痰阻气者。顺气须先逐痰。（玉机）可见逐痰理气。各审先后。有理气而痰自顺者。治其微也。有逐痰
而气方畅者。治其甚也。（徐春甫）
痰分燥湿
痰之外出者。为咳为咯。皆属于肺。为嗽为吐。皆属于脾。亦有二者之分。从嗽吐来者为湿痰。因脾为湿土。
喜温燥而恶寒湿。故二陈、二术为要药。从咳咯来者为燥痰。因肺为燥金。喜清润而恶温燥。故二母、二冬、
桔梗为要药。二者易治。鲜不危殆。（汇补）
痰兼脾肺
脾肺二家。往往病则俱病者。因脾为生痰之源。肺为贮痰之器。脏气恒相通也。故外症既现咳嗽稠痰。喉
干鼻燥之肺病。又现心嘈倒饱。食少泻多之脾虚。此时若以燥药补脾。则碍肺。以润药利肺。则碍脾。当斟
酌于二者之中。拣去苦寒香燥。务以平调为主。泽及脾胃。而肺痰自平。不必专用清肺化痰诸药。盖脾有
生肺之功。肺无扶脾之力也。（汇补）宜异功散。加苡仁、麦冬、石斛、桔梗、山药、扁豆、莲心之属。
虚痰补脾
痰之动。出于脾。（丹溪）凡衰弱之人。脾虚不运。清浊停留。津液凝滞。变为痰饮者。其痰清晨愈多。其色稀白。
其味亦淡。宜实脾养胃。使脾胃调和。饮食运化。而痰自不生。故治痰不知理脾。失其治也。（汇补）
虚痰补肾
痰之源。出于肾。故劳损之人。肾中火衰。不能收摄邪水。冷痰上泛者。宜益火之原。或肾热阴虚。不能配制
阳火。咸痰上溢者。宜壮水之主。（汇补）
虚痰忌吐
痰之在身。如木之津。如鱼之涎。遍身上下。无处不到。（节斋）故虚痰上溢者。宜补气行痰。若过用吐药。则无
以滋养经络。变为肾枯骨痿。（仲景）
虚痰忌下
虚弱之人。中焦有痰而生病者。胃气亦赖所养。卒不可攻。攻尽则愈虚。（丹溪）所以治痰用利药过多。中气
受伤。而痰反易生。（汇补）
痰症用药
主以二陈汤。取半夏燥脾湿。橘红利滞气。茯苓渗湿和中。甘草益胃缓中。盖湿渗则脾健。气利则中清。而
痰自化也。后人不知古人精微。谬谓药燥。而以贝母代之。殊失立法之义。夫贝母乃心肺二经药。性能疗
郁。亡血家肺中有郁火。及产乳余症消渴。阴虚咳嗽之人。忌用燥剂。姑以贝母代之。非半夏所长。若风痰。
肝脉弦。面青。四肢满闷。便溺秘涩。心多燥怒。水煮金花丸、川芎防风丸。热痰。心脉洪。面赤燥热。心痛。唇口
干燥。多喜笑。小黄丸、小柴胡汤。加半夏。湿痰。脾脉缓。面黄。体倦沉重。嗜卧。腹胀食不消。白术丸、局方防己
丸。气痰。肺脉涩。面白。气上喘促。洒淅寒热。悲愁不乐。人参逍遥散、观音应梦散。食积痰。加山楂、神曲、麦芽、
枳实。甚者必攻之。久病虚者。加参、术。兼补以运之。酒痰。用栝蒌、青黛。蜜丸噙化之。如酒积痰。白龙丸。脉滑
数。或弦急。症兼口干面赤。心烦嘈杂等火症者。二陈加芩、连、山栀。便秘者。加玄明粉。不已者。滚痰丸。盖痰
火盛于上焦。非滚痰丸不可。脉濡缓。身体倦怠觉重者。属湿痰。宜二陈、二术、羌活、防风。气虚。加参、术。若多
郁悒人胃中湿痰。或周身走痛。饱闷恶心者。坠痰丸、小胃丹。脉沉滞。或滑。或结涩。兼恶心饱闷。或刺痛。属
郁气挟痰。宜开郁行气。七气汤、越鞠丸。脉浮滑。见于右关。或两手关前浮大而实。时常恶心。吐清水。痞塞
者。就欲吐时。以探吐之。后以小胃丹徐服。痰在膈上咽下。泻亦不去。必用吐法。胶固稠浊。非吐不可也。又
痰在经络中。亦有吐法。吐中有发散之意。须先升提其气。后乃吐之。如防风、川芎、桔梗、芽茶、韭汁之类。其
吐药亦有数种。瓜蒂吐热痰。蒜白吐寒痰。乌尖吐湿痰。莱菔子吐气痰。藜芦吐风痰。常山吐疟痰。参芦吐
虚痰。必俟清明时。于不通风处。以布勒紧其肚。乃可吐之。若脉涩年高虚人。不可用吐法也。有人坐处。率
吐痰满地。其痰不甚稠粘。此气虚不摄而吐沫也。不可用利药。宜六君子加益智以摄之。若面有红赤光
者。乃阴火上炎。又当用滋阴药。地黄汤加麦冬、五味。凡人身中有块。不痒不痛。或作麻木。乃败痰失道。宜
随处用药消之。外以生姜时擦之。亦不必治。若有痛处。按之无血色。坚硬如石。破之无脓。或出清水。或如
乳汁。此属虚症。急于益气养荣汤中。加星、半以和气血。则已成者。使化脓速破为良。其轻而未成者。必自
内消。切忌刀针之类。脾家湿热生痰上逆者。治火为先。白术、枳实、黄芩、石膏之类。痰挟瘀血。结成窠囊。膈
间胀闷。诸药不效者。由浓味积热。肠胃枯涸。又加怫郁。胃脘之血。为痰浊所滞。日积月累。渐成噎膈反胃。
若用燥剂。其结愈甚。惟竹沥、姜汁、韭汁。可以治之。日进三五杯。后用养血健脾药。一法。用神术丸。大效。痰
在肠胃。可下者。枳实、大黄、芒硝之属。痰在胁下。非白芥子不能达。痰在四肢。非竹沥、姜汁不能行。在皮里
膜外。亦必用之二味。在阴虚有痰。大获奇效。痰在膈上。颠狂健忘。噎膈反胃。阴虚劳嗽。半身不遂。必加竹
沥。盖竹沥能养血清金润燥也。又痰阴流入四肢。令人肩背酸痛。两手软痹。医误以为风。则非矣。宜导痰
汤加姜黄、木香。痰入经络成结核者。用夏枯草。人实者。用海藻、昆布。阴血不足。相火上炎。肺受火凌。津液
凝滞。生痰不生血者。当润剂中。加麦冬、地黄之属滋其阴。使上逆之火得返其家。而痰自息。投以二陈。立
见危殆。瘦人多此症。有热在肺经而不在脾胃。致使咽喉干燥。稠痰凝结。咯不出。咽不下。当用节斋化痰
丸。涤痰润燥。开结降火为上。但五液皆本于肾。肾虚无以制火。则火炎上。又当滋阴补肾以治本。尝治老
年男妇。一切燥痰噎膈不舒。大便干燥。或痰结喉中咯不出。悉用清化膏以培肾壮水。兼噙化痰丸以治
标。其效甚速。气虚有痰饮。肾气丸补而逐之。凡尺脉浮大。按之则涩。气短有痰。小便赤涩。足跟作痛。皆肾
虚不能行。浊气泛上而为痰也。肾气丸屡验。若脉沉濡。清气不升。致浊液不降成痰者。二陈汤加枳、术、升
麻。若脉细滑兼缓。痰清薄。身倦怠。肢酸软。此脾气虚而不能运化有痰也。六君子加姜汁、木香。若脉浮濡。
易于伤风痰嗽。此肺气虚不能清化而有痰也。六君子加桔梗。若脾经气滞而痰中有血者。异功散加麦
冬、白芍药。肝经血热而痰中有血者。加味逍遥散。肝肾阴虚而痰中有血者。六味丸。若过服寒凉之剂唾
血者。四君子汤。
痰症选方
二陈汤（和剂） 统治痰饮之症。谓其健脾燥湿。化气和中也。
陈皮 半夏（各五两） 白茯苓（三两） 甘草（一两半）
为剂。每服四钱。水一盏。姜五片。煎六分服。加南星、枳壳。名导痰汤。加南星、黄芩、黄连。名润下丸。以
盐水拌煮诸药。故名润下。治痰热症。
新制润下丸 降痰极效。
陈皮（四两以盐水拌煮透晒干为末） 炙甘草（一两）
水酒糊丸绿豆大。清茶下。
半夏丸 治肺热咳嗽生痰。
栝蒌仁 熟半夏（等分）
各为末。和匀。淡姜汤丸。
神术丸 治膏粱郁结。胃槁肠燥。凝痰不顺。将成噎膈者。
茅山苍术（五钱） 生芝麻（五钱水研） 大枣（十五枚水煮）
以术为末。捣二味为丸。加真广皮五钱。更效。
四制化痰丸 治肥人因醇酒浓味。肺胃上口有痰生火者。
半夏一斤。分作四分。一分用生姜、黄连煮。一分用知母、贝母煮。一分用人参、杏仁煮。一分用桔梗、桑皮煮。
各拣去余药。单用半夏为末。水糊丸。
汝言化痰丸 治肺家老痰在于喉中。咯之不出。咽之不下者。
栝蒌 杏仁 海粉 桔梗 连翘 五倍子 香附 蛤粉 瓦楞子 风化硝
以姜汁少许。和竹沥捣入药。加蜜丸。噙化。或作小丸。清茶下。
抑痰丸 治痰结胸喉。用此顺降。功与化痰丸相似。而药味简要。可摘入煎剂中用之。
栝蒌仁（一两） 贝母（六钱） 半夏（三两）
以蒸饼丸如麻子大。每服百丸。淡姜汤下。
黄栝蒌丸 治食积痰饮。胸膈胀闷。吐痰如胶。或五更发咳之症。
栝蒌 半夏 山楂 神曲
[General Principle]
Phlegm belongs to Dampness. It is transformed from Body Fluids (Jin Ye). (From *Za Zhu*) When flowing, it is called Liquid; when accumulating, it is called Phlegm; when circulating, it is called Jin (clear fluids); when stagnant, it is called Xian (saliva). (From *Sheng Mo*) Among the hundred diseases, many are complicated by Phlegm. (From Zhu Danxi)
[Internal Causes]
The Qi pathway in the human body must be clear and smooth so that Body Fluids can circulate freely; otherwise, how could Phlegm arise? If invaded externally by Wind, Summer-heat, Dryness, or Dampness, or disturbed internally by Fright, Anger, Worry, or Overthinking, combined with irregular diet, overexertion, and unrestrained alcohol and sexual activity, causing Ying and Wei Qi to become impure and Blood and Qi to become turbid and degenerated, steaming and evaporating the Body Fluids, Phlegm is generated. (From *Zheng Zhi Hui Bu*)
[External Manifestations]
Phlegm, as a pathogenic factor, rises and falls with Qi, reaching everywhere. It manifests as wheezing, coughing, vomiting, diarrhea, dizziness, heart palpitations, fright, and anxiety, chills and fever, swelling and pain, chest fullness, and diaphragmatic obstruction. Or there may be rumbling sounds in the chest and hypochondrium like thunder, or a sensation of insects crawling all over the body, or subcutaneous nodules that are neither red nor swollen, or lumps on the neck resembling goiter but not quite, or obstruction in the throat feeling like a plum pit (Plum-pit Qi), or expectorated sputum resembling peach gum, or a sensation of two Qi streams knotting in the chest, or a cold spot in the back, or skin redness and swelling like fire, or cold pain under the heart like ice, or swelling, hardness, numbness, and paralysis of one limb, or masses forming at the edge of the hypochondrium, or unpredictable stabbing pain in joints, or formless acid-stabbing pain in waist and legs, or expectoration of cold saliva, green water, or black juice, or dreams of fire, smoke, swords, and halberds, or pus in stool or urine, or Guan Ge syndrome (obstruction of upper and lower orifices), or rapid-onset throat bi (acute sore throat with difficulty breathing), or toothache and tinnitus, extending to Lao Zhai (chronic wasting-thirst disease/tuberculosis), epilepsy, aphonia, and hemiplegia, amenorrhea and leukorrhea in women, and convulsions in children, or even seeing ghosts without cause, resembling spirit possession but not actually so. All these belong to Phlegm manifestations. (From Wang Yinjun)
[Phlegm Divided by Five Zang Organs]
Phlegm generated in the Spleen often causes abdominal pain and distension, or blockage of urination and defecation, named Clear Phlegm; or four-limb fatigue, chronic diarrhea with accumulated filth, or strangury and leukorrhea, named Damp Phlegm. If mixed with food stagnation and blood stasis, forming cavities and masses internally, and presenting as chest fullness and hardness externally, it is also named Food Phlegm. Retaining in the stomach, it causes acid regurgitation and heartburn, vomiting with little appetite, dysphagia, and belching, named Stagnant Phlegm. Rushing up to the head and face causing heat, or pain in the supraorbital ridge and nose, named Fire Phlegm. Caused by drinking alcohol, leading to dry heaving, belching, abdominal pain, and diarrhea, named Alcohol Phlegm. Rising to the Lungs, blocking orifices, snoring during sleep, and wheezing with sound, named Middle Phlegm. Triggered by slight colds, causing asthma and cough with harsh sounds, named Latent Phlegm. With dry throat and nose, cough, and sore throat, named Dry Phlegm. Condensing in the chest over time, becoming thick and sticky and difficult to expectorate, named Old Phlegm. Excessive emotions causing Phlegm to stagnate in the throat, unable to be coughed out or swallowed, with chest and hypochondriac fullness, named Qi Phlegm. Confusing the Heart, causing heart pain, fright, palpitations, confusion, strange dreams, delirium, seeing spirits, mania, epilepsy, and aphonia, named Fright Phlegm. Moving in the Liver, causing dizziness, wind-head, eye twitching, ear itching, left-side paralysis, numbness, curling, and limping, named Wind Phlegm. Stopping above the diaphragm, causing unilateral arm paralysis that shifts sides, accumulating in the hypochondrium with pain, dry heaving, and alternating chills and fever, named Phlegm-Fluid. Gathering in the Kidney, causing soreness and weakness in shins and knees, stiffness and pain in waist and back, cold bi in joints, and lingering dull pain, named Cold Phlegm, also named Deficiency Phlegm. (From *Ru Men*)
[Differentiation of Phlegm Diseases]
In the early stage of Phlegm disease, staying in the Middle Jiao, it presents with headache and chills/fever, resembling exterior syndromes of external contraction. Later, staying in the Spleen and Lungs, it presents with tidal cough worsening at night, resembling internal injury Yin-fire. Also, Phlegm-Fluid flowing into collaterals causes joint pain, resembling Bi-syndrome of Wind pathogens. However, Phlegm disease is distinguished by chest fullness, reduced appetite, normal muscle color, and slippery or fine pulse. (From *Ru Men*)
[Observing Color in Phlegm Syndromes]
Those who were formerly fat but are now thin have Phlegm. Those with eyelids and under-eye areas darkened like smoke stains have Phlegm. Those with slightly fixed pupils that move temporarily also have Phlegm. Those with dark eye sockets, groaning while walking, difficulty moving, and whole-body pain have Phlegm entering the bones. Those with dark eye sockets and earth-colored faces, flaccid paralysis of four limbs, and difficulty bending and stretching have Wind-Damp Phlegm. (From *Zheng Zhi Hui Bu*)
[Color and Form of Phlegm]
New and mild Phlegm is clear, white, thin, and easy to expectorate, with a faint odor. Long-standing and severe Phlegm is yellow, turbid, thick, sticky, difficult to expectorate, and gradually develops a foul odor. (From *Ru Men*) However, Phlegm from Wind-Cold is clear, thin, and has floating foam/bubbles; Phlegm from Heat is thick and difficult to resolve; Phlegm from Internal Deficiency is also clear, thin, and easily transforms into water. Sweet taste indicates Spleen Heat; fishy smell indicates Lung Heat; salty taste indicates Kidney Deficiency; bitter taste indicates Gallbladder Heat; green color indicates Liver Wind; black color indicates Kidney Water. Generally, black color indicates Kidney Deficiency with Water overflowing and Qi failing to return to its source; red color indicates excessive Fire insulting Metal (Lung) and blood failing to transform properly. Thus, red Phlegm is mostly seen in consumption diseases and requires great caution. (From *Zheng Zhi Hui Bu*)
[Pulse Diagnosis for Phlegm Syndromes]
Slippery and large pulses at the Guan position on both hands indicate Phlegm above the diaphragm. A洪 (Surging) Guan pulse indicates Phlegm moving with Fire. A hidden Guan pulse indicates Phlegm due to Qi stagnation. If a Phlegm syndrome presents with a choppy pulse, it is suddenly difficult to open and will require extensive regulation. A patient with unilateral arm paralysis shifting to the other side, with a deep and fine pulse, does not have Stroke but likely has Phlegm-Fluid in the Upper Jiao.
[Phlegm Mimicking Miscellaneous Diseases]
Phlegm-Fluid generates various symptoms that resemble miscellaneous diseases. One should not let these miscellaneous diseases dictate the name; instead, treat Phlegm first. Once Phlegm-Fluid is eliminated, the other symptoms resolve. For example, headache and supraorbital pain unresponsive to Wind-dispelling agents responds to Phlegm-resolving medicines. Red eyes with photophobia and gritty pain unresponsive to Cooling medicines respond to Phlegm-resolving formulas. Such cases are numerous and scattered across various syndromes; the wise will understand this. (From San Xi)
[General Treatment of Phlegm Syndromes]
Heat Phlegm is cleared; Damp Phlegm is dried; Wind Phlegm is dispersed; Stagnant Phlegm is opened; Stubborn Phlegm is softened; Food Phlegm is digested. Phlegm in the chest/throat is expelled via emesis; Phlegm in the intestines/stomach is purged via catharsis. (From Jie Zhai) This establishes principles for Excess patterns. For Lung Deficiency with Phlegm, preserve the Lung to nourish Body Fluids. For Spleen Deficiency with Phlegm, fortify the Spleen to transform Phlegm-Saliva. For Kidney Deficiency with Phlegm, tonify the Kidney to guide storage. (From *Zheng Zhi Hui Bu*)
[Treating Phlegm Accompanied by Fire]
Some Phlegm arises from Heat; some Heat arises from Phlegm. Thus, Phlegm is visible Fire, and Fire is invisible Phlegm. (From Sheng Shan) However, fundamentally, before Phlegm becomes pathological, it is True Yin in the body; before Fire becomes pathological, it is True Yang. If not balanced, the Six Desires and Seven Emotions harm each other, leading to excess and floating. Phlegm boils with Fire; Fire fans Phlegm. They may rise to Heart/Lungs, stay in Spleen/Stomach, seep into collaterals, scatter in limbs, stagnate in skin, or overflow in the throat. To clear the branch (Phlegm/Fire), one must protect the root. To distinguish mild vs. severe Fire, one must know Qi's strength. Strong Yuan Qi implies Excess Fire; weak Yuan Qi implies Deficient Fire. Regulating Yuan Qi balances Phlegm and Fire. (From *Zheng Zhi Hui Bu*)
[Treating Phlegm Accompanied by Qi]
Internal Phlegm, manifesting as saliva, fluid, masses, or accumulations, causing attacking pain and distension, belongs to Qi stagnation. (From Li Shizhen) There are two types: If Phlegm rises with Qi, regulate Qi first to guide Phlegm. (From Yan Shi) If accumulated Phlegm blocks Qi, eliminate Phlegm first to smooth Qi. (From *Yu Ji*) Thus, eliminating Phlegm and regulating Qi requires judging the sequence. Regulating Qi makes Phlegm smooth (treating mild cases); eliminating Phlegm makes Qi flow (treating severe cases). (From Xu Chunfu)
[Distinguishing Dry and Damp Phlegm]
Externally exiting Phlegm, coughing and spitting, belongs to the Lungs; retching and vomiting, belongs to the Spleen. Wet Phlegm comes from retching/vomiting because the Spleen is Earth of Dampness, preferring warm/dry and disliking cold/damp; thus Er Chen Tang and Er Zhu (Atractylodes macrocephala and Atractylodes lancea) are key herbs. Dry Phlegm comes from coughing/spitting because the Lung is Metal of Dryness, preferring moist/clear and disliking warm/dry; thus Anemarrhena, Fritillaria, Asparagus, and Ophiopogon, plus Platycodon, are key herbs. These two are easy to treat and rarely critical. (From *Zheng Zhi Hui Bu*)
[Phlegm Involving Spleen and Lung]
Spleen and Lung diseases often occur together because the Spleen is the source of Phlegm generation, and the Lung is the container of Phlegm storage; their organ Qi is constantly connected. External symptoms show Lung issues (cough with thick phlegm, dry throat/nose) and Spleen Deficiency (heartburn, fullness after eating, poor appetite, frequent diarrhea). Using drying herbs to tonify the Spleen hinders the Lung; using moistening herbs to benefit the Lung hinders the Spleen. One must balance both, avoiding bitter-cold and aromatic-drying herbs, focusing on harmonization. Nourishing the Spleen and Stomach calms Lung Phlegm naturally, without solely using Lung-clearing Phlegm-resolving drugs. The Spleen generates the Lung; the Lung does not support the Spleen. (From *Zheng Zhi Hui Bu*) Yi Gong San is suitable, added with Coix Seed, Ophiopogon, Dendrobium, Platycodon, Yam, Hyacinth Bean, and Lotus Plumule.
[Deficiency Phlegm Tonifying Spleen]
Phlegm movement originates from the Spleen. (From Zhu Danxi) In frail people, Spleen Deficiency fails to transport, causing clear and turbid to stagnate and Body Fluids to condense into Phlegm-Fluid. This Phlegm is most abundant in the morning, pale white, and bland-tasting. Fortify the Spleen and nourish the Stomach to harmonize digestion, preventing Phlegm generation. Treating Phlegm without regulating the Spleen misses the essence of treatment. (From *Zheng Zhi Hui Bu*)
[Deficiency Phlegm Tonifying Kidney]
The source of Phlegm lies in the Kidney. In consumptive patients, if Kidney Fire declines and cannot control evil water, leading to cold Phlegm flooding upward, benefit the origin of Fire (warm Kidney Yang). If Kidney Heat and Yin Deficiency fail to control Yang Fire, leading to salty Phlegm overflowing upward, strengthen the master of Water (nourish Kidney Yin). (From *Zheng Zhi Hui Bu*)
[Contraindication of Emesis for Deficiency Phlegm]
Phlegm in the body is like sap in trees or mucus in fish, reaching everywhere. (From Jie Zhai) For Deficiency Phlegm flooding upward, tonify Qi and move Phlegm. Overusing emetics depletes nourishment to collaterals, leading to Kidney exhaustion and bone atrophy. (From Zhang Zhongjing)
[Contraindication of Purging for Deficiency Phlegm]
In weak individuals with middle Jiao Phlegm, Stomach Qi relies on nourishment; sudden purging worsens deficiency. (From Zhu Danxi) Overusing draining herbs damages Middle Qi, making Phlegm easier to generate. (From *Zheng Zhi Hui Bu*)
[Medications for Phlegm Syndromes]
The main formula is Er Chen Tang (Two-Aged Decoction), using Pinellia Rhizome (Banxia) to dry Spleen Dampness, Tangerine Peel (Chenpi) to move stagnant Qi, Poria (Fuling) to leach out Dampness and harmonize the Middle, and Licorice Root (Gancao) to benefit the Stomach and moderate the Middle. Leaching Dampness strengthens the Spleen; moving Qi clears the Middle, transforming Phlegm. Later generations misunderstood the subtlety, claiming the medicine is too drying, and replaced Banxia with Fritillaria Bulb (Beimu), losing the legislative intent. Beimu enters the Heart and Lung meridians, treating stagnation; it is contraindicated in blood-loss patients with Lung郁 Fire, postpartum conditions, Xiao Ke (wasting-thirst), and Yin-deficiency cough. Replacing Banxia with Beimu is inappropriate.
For Wind Phlegm (Liver pulse wiry, blue face, limb fullness, constipation, irritability): Shuizi Jinhua Wan or Chuanxiong Fangfeng Wan.
For Heat Phlegm (Heart pulse surging, red face, heat, heart pain, dry lips/mouth, laughter): Xiao Huang Wan or Xiao Chai Hu Tang plus Banxia.
For Damp Phlegm (Spleen pulse slow, yellow face, heaviness, lethargy, abdominal fullness, indigestion): Baizhu Wan or Ju Fang Fangji Wan.
For Qi Phlegm (Lung pulse choppy, pale face, wheezing, chills/fevers, sadness): Renshen Xiaoyao San or Guanyin Yingmeng San.
For Food Stagnation Phlegm: Add Hawthorn, Medicated Leaven, Malt, Immature Bitter Orange. Severe cases require purging; chronic deficiency cases add Ginseng and Atractylodes to tonify and move.
For Alcohol Phlegm: Trichosanthes Fruit and Indigo Naturalis, honey pills to hold in mouth. For Alcohol Accumulation Phlegm: Bailong Wan.
If pulse is slippery-rapid or wiry-tight, with dry mouth, red face, irritability (Fire signs): Er Chen Tang plus Scutellaria, Coptis, Gardenia. Constipation: add Mirabilite. Unresolved: Guntan Wan (Rolling Phlegm Pill), essential for Upper Jiao Phlegm-Fire.
If pulse is soggy-slow, heavy fatigue: Damp Phlegm. Use Er Chen Tang, Er Zhu, Notopterygium, Saposhnikovia. Qi Deficiency: add Ginseng, Atractylodes.
For depressed individuals with Stomach Damp Phlegm, wandering pain, fullness, nausea: Zhuitan Wan or Xiaowei Dan.
If pulse is deep-stagnant, slippery, or knotted-choppy, with nausea, fullness, stabbing pain: Qi Stagnation with Phlegm. Use Qiqi Tang or Yueju Wan to open stagnation and move Qi.
If pulse is floating-slippery at Right Guan or both Guan positions (floating-large-solid), with nausea, clear water vomiting, obstruction: induce emesis when urge arises, then slowly administer Xiaowei Dan.
Phlegm stuck in diaphragm/throat, unrelieved by purgation, requires emesis. Thick, turbid, stubborn Phlegm must be vomited.
Phlegm in collaterals can also be treated with emesis, which has a dispersing effect. First lift Qi, then vomit, using Saposhnikovia, Ligusticum, Platycodon, young tea, leek juice.
Emetic herbs vary: Melon Rind (Gua Di) for Heat Phlegm; Garlic White for Cold Phlegm; Aconite Tip for Damp Phlegm; Radish Seed for Qi Phlegm; Veratrum for Wind Phlegm; Dichroa for Malaria Phlegm; Ginseng Rhizome for Deficiency Phlegm. Perform emesis only in clear weather, in a draft-free room, with tight abdominal binding. Contraindicated in elderly with choppy pulses or extreme deficiency.
Spitting copious non-sticky phlegm indicates Qi Deficiency failing to grasp; do not use draining herbs. Use Liu Jun Zi Tang plus Alpinia Oxyphylla to grasp.
Red flush on face indicates Yin Fire flaming upward; use Yin-nourishing herbs, Dihuang Tang plus Ophiopogon, Schisandra.
Subcutaneous lumps, non-itchy/painful or numb, are failed Phlegm off course; dissolve locally, rub with fresh ginger. No specific treatment needed unless painful. Hard, stone-like lumps without blood color, bursting with clear water/milk, are Deficiency syndromes. Urgently use Yiqi Yangrong Tang plus Arisaema and Pinellia to harmonize Qi/Blood. Mature abscesses should burst quickly; immature ones resolve internally. Avoid knives/needles.
Spleen Damp-Heat generating ascending Phlegm: Treat Fire first with Atractylodes, Immature Bitter Orange, Scutellaria, Gypsum.
Phlegm with Blood Stasis forming cavities, chest oppression, unresponsive to drugs: Caused by rich foods, intestinal dryness, and depression. Stomach blood stagnated by turbid Phlegm leads to dysphagia/regurgitation over time. Drying herbs worsen clumping. Only Bamboo Sap, Ginger Juice, and Leek Juice work. Drink 3-5 cups daily, then tonify Blood/Spleen. Alternatively, Shenzhu Wan is highly effective.
Phlegm in intestines/stomach amenable to purgation: Immature Bitter Orange, Rhubarb, Mirabilite.
Phlegm in hypochondrium: Must use White Mustard Seed (Baijiezi).
Phlegm in limbs: Must use Bamboo Sap and Ginger Juice.
Phlegm in subcutaneous/fascial layers: Also requires these two. Effective for Yin Deficiency with Phlegm.
Phlegm in diaphragm causing mania, forgetfulness, dysphagia, Yin-deficiency cough, hemiplegia: Must add Bamboo Sap, which nourishes Blood, clears Metal, and moistens Dryness.
Yin Phlegm flowing into limbs causes shoulder/back pain, soft paralyzed hands; misdiagnosed as Wind. Use Daotan Tang plus Turmeric and Costus Root.
Phlegm nodules in collaterals: Use Prunella Vulgaris. Excess patterns: use Kelp and Ecklonia.
Yin-Blood Deficiency with Minister Fire flaming, insulting Lung, condensing fluids into Phlegm instead of Blood: Add Ophiopogon and Rehmannia to moistening formulas to nourish Yin, returning Fire home and stopping Phlegm. Using Er Chen Tang here causes danger. Common in thin people. Heat in Lung meridian (not Spleen/Stomach) causes dry throat, thick Phlegm stuck in throat. Use Jie Zai Huatan Wan to cleanse Phlegm, moisten Dryness, open knots, and descend Fire. Since all five fluids originate from Kidney, Kidney Deficiency fails to control Fire, causing upward flaming. Nourish Kidney Yin to treat the root. Treated elderly men/women with Dry Phlegm, dysphagia, constipation, or stuck throat Phlegm using Qinghua Gao (to nourish Kidney/Water) and Qintan Wan (for symptom relief) with rapid results.
Qi Deficiency with Phlegm-Fluid: Shenqi Wan tonifies and expels. Floating-large Chi pulse, choppy upon pressure, shortness of breath, Phlegm, red/scanty urine, heel pain: Kidney Deficiency failing to move, turbid Qi flooding up. Shenqi Wan is verified.
Deep-soggy pulse, failing to raise Clear Qi, causing turbid fluids to sink into Phlegm: Er Chen Tang plus Immature Bitter Orange, Atractylodes, Cimicifuga.
Fine-slippery-slow pulse, thin Phlegm, fatigue, limb soreness: Spleen Qi Deficiency failing to transport. Liu Jun Zi Tang plus Ginger Juice and Costus Root.
Floating-soggy pulse, prone to Wind-Phlegm cough: Lung Qi Deficiency failing to clear. Liu Jun Zi Tang plus Platycodon.
Spleen Qi Stagnation with Blood in Phlegm: Yi Gong San plus Ophiopogon and White Peony.
Liver Blood Heat with Blood in Phlegm: Jiawei Xiaoyao San.
Liver-Kidney Yin Deficiency with Blood in Phlegm: Liuwei Dihuang Wan.
Hemoptysis from overuse of Cold/Cooling herbs: Sijun Zi Tang.
[Selected Formulas for Phlegm Syndromes]
Er Chen Tang (from *Heji*) governs Phlegm-Fluid syndromes, strengthening Spleen, drying Dampness, transforming Qi, and harmonizing the Middle.
Tangerine Peel, Pinellia Rhizome (each 5 liang), Poria (3 liang), Licorice Root (1.5 liang).
Powder, 4 qian per dose, with 1 cup water, 5 slices ginger, decoct to 0.6 cup. Add Arisaema and Immature Bitter Orange -> Daotan Tang. Add Arisaema, Scutellaria, Coptis -> Runxia Wan (soaked in salt water), treating Heat-Phlegm.
Xin Zhi Runxia Wan: Highly effective for descending Phlegm.
Tangerine Peel (4 liang, boiled in salt water, dried, powdered), Roasted Licorice (1 liang).
Pill with water/wine paste, size of mung bean, taken with clear tea.
Banxia Wan: Treats Lung Heat cough with Phlegm.
Trichosanthes Seed, Cooked Pinellia (equal parts).
Powder, pill with light ginger soup.
Shenzhu Wan: Treats rich-food stagnation, dry stomach/intestines, stubborn Phlegm impending dysphagia.
Maoshan Atractylodes (5 qian), Raw Sesame (5 qian, ground with water), Jujube (15 pieces, boiled).
Powder Atractylodes, mash sesame/jujube, form pills. Add 5 qian true Guangpi for better effect.
Si Zhi Huatan Wan: Treats obese people with Phlegm-Fire from rich food/alcohol in Lung/Stomach upper orifice.
Pinellia (1 jin), divided into 4 parts: boiled with Ginger/Coptis; Anemarrhena/Beimu; Ginseng/Almond; Platycodon/Mulberry Bark. Remove other herbs, use only Pinellia powder, pill with water paste.
Ru Yan Huatan Wan: Treats Old Phlegm in Lung throat, stuck/unswallowable.
Trichosanthes, Almond, Sea Powder, Platycodon, Forsythia, Chinese Gall, Cyperus, Clam Shell, Ark Shell, Weathered Nitre.
Mix with small amount of Ginger Juice and Bamboo Sap, add honey, pill, hold in mouth or take with clear tea.
Yitan Wan: Treats Phlegm knotting in chest/throat, descending smoothly. Similar to Huatan Wan but simpler. Can be added to decoctions.
Trichosanthes Seed (1 liang), Fritillaria (6 qian), Pinellia (3 liang).
Pill with steamed dough, size of hemp seed, 100 pills per dose, light ginger soup.
Huang Gualou Wan: Treats Food Stagnation/Phlegm-Fluid, chest oppression, jelly-like sputum, or 5 AM cough.
Trichosanthes, Pinellia, Hawthorn, Medicated Leaven