（一名风寒夹痰）
【因】外感风寒。每涉于痰。多由素有痰积。或夹痰饮。或夹痰火。复感风寒。及形寒饮冷所致。
多属肺病。或风从皮毛而入肺。或寒从背俞而入肺。痰证多端。姑就于风寒有关者。推求其源。
【证】风伤肺而夹痰火者。头痛发热。恶风自汗。咳嗽气逆。甚则头眩胸痞。痰多黄浊稠粘。或
凝结成块。成条。咳逆难出。渐成恶味。剧则带血。舌苔白滑而浓。或黄白相兼而糙。寒伤肺而夹痰饮者。
头痛发热。恶寒无汗。鼻鸣气喘。咳嗽多痰。清白稀薄。气味亦淡。甚或咯吐不爽。呕逆眩晕。舌苔
白滑而薄。或灰白相兼而滑。
【脉】右寸浮滑。左手弦缓者。伤风而夹痰火也。右脉弦滑。左手紧盛者。伤寒而夹痰饮也。
【治】风夹痰火。轻则葱豉桔梗汤加杏仁、橘红。重则越脾加半夏汤。寒夹痰饮。轻则新加三拗汤增姜夏、
橘红。重则小青龙汤。惟夹痰火较痰饮为难治。往往有痰迷清窍。口吐粘涎。发狂如祟。妄言妄见。
神识昏迷。俗称
痰蒙。当用玳瑁郁金汤开透之。更有痰伏膈上。心下烦满。气上冲胸。饥不能食。甚则手足厥冷。
脉乍紧乍结者。此痰与邪结在胸中。当用瓜蒂散加生萝卜汁涌吐之。（甜瓜蒂二十粒、杜赤豆三十粒、
淡香豉三钱、用开水一碗煎成大半碗、冲入生萝卜汁两瓢顿服之、得快吐为度。）不吐者。改用三
物白散急吐之。（川贝母三钱、苦桔梗二钱、巴豆霜一钱、轻用一分、重则二分、开水和服、痰在
膈上必吐、在膈下者必利、不利进热稀粥一杯、利过不止、进冷粥一杯、即愈。）至若痰症类伤寒
者亦甚多。其证胸满气冲。憎寒壮热。恶风自汗。胸中郁痛。饥不能食。使人揉按之。反多涎唾。甚
或下利日十余行。右脉微滑。左脉反迟。此有寒痰在胸中。仲景所谓病如桂枝证。头不痛。项不强。寸
脉微浮。胸中痞硬。气上冲咽喉不得息者是也。法当吐之。切忌发汗。当用瓜蒂二陈汤（甜瓜蒂二十
粒、姜半夏、广橘红各钱半、以水煎成、冲生莱菔汁二瓢。）惟诸亡血虚家。亦不可与此汤。宜求其
痰病之源。细心酌治。
【秀按】感症夹痰。外内合邪。邪正交攻。最多经络脏腑纠结之症。初治莫妙于《活人》豁痰汤。
（紫苏、薄荷各一钱、羌活、川朴各八分、枳壳、前胡、制南星、姜半夏各钱半、酒芩一钱、炙草
四分。）然痰症头绪甚繁。断非见病治病者可以胜任。俞君厘清伤风伤寒痰火痰饮。使阅者较有头绪。
惟风热风燥二症。常多夹痰。均当用辛润法。解其邪以豁其痰。如加减葳蕤汤、清燥救肺汤之类。
并加竹沥莱菔汁等。临症时屡奏殊功。若误与辛热发汗。温燥劫痰。则变证百出矣。慎之。
【廉勘】伤寒为外感六气之通称。凡夹痰症。必先分辨六淫以施治。如冒风邪而生痰。痰因
肺津郁结而化。仍当从肺管咳出。肺位最高。风为阳邪。当用辛凉轻剂。吴氏桑菊饮加减。（冬桑叶
二钱、滁菊花钱半、苏薄荷、苦桔梗、广皮红各八分、栝蒌皮、光杏仁各二钱、生萝卜一两、饴糖一
钱。）重则张氏银翘麻黄汤。（银
花一钱、连翘钱半、带节麻黄三分、苏薄荷六分、炒牛蒡一钱、广橘红八分、苦桔梗六分、生甘草五分。）
若风已化热。热蒸胃液以成痰。宜佐以清胃之品。知母、花粉（各三钱。）萝卜汁、竹沥等是也。
如感寒邪而生痰。势必毛窍外闭。肺气逆满。邪气无从发泄。形寒伤肺。肺气抑郁。当用辛温宣剂。轻则
三子导痰汤加荆、防。（荆芥、防风、姜半夏、莱菔子、苏子、枳壳、茯苓各钱半、广皮红一钱、白芥
子六分、炙甘草五分。）重则麻黄二陈汤。（麻黄五分、光杏仁三钱、姜半夏二钱、广橘红一钱、前胡、
白前各钱半、茯苓三钱、炙草五分。）若郁而化火。热盛痰壅。当用加味麻杏石甘汤。（蜜炙麻黄四分、
光杏仁二钱、生石膏四钱、生甘草四分、栝蒌仁四钱、竹沥半夏钱半、广皮红、小枳实各一钱。）如暑邪
由口鼻吸受。伤肺犯胃。津液郁结而化痰。痰因火动。当用辛凉重剂。竹叶石膏汤加枳实、竹沥。（鲜
竹叶二钱、生石膏八钱、仙半夏二钱、毛西参一钱、生甘草五分、陈仓米一百粒、荷叶包煎、枳实汁两小
匙、竹沥两大瓢、和匀同冲。）如湿郁于中。脾胃气滞。壅结为痰。治必运脾清胃。藿朴二陈汤加减。
（杜藿梗三钱、真川朴一钱、半夏曲、新会皮、苏佩兰各钱半、浙茯苓三钱、淡竹茹二钱、小枳实钱半、
滑石四钱。）若湿郁成热。热重湿轻者。当用清热渗湿。俞氏增减黄连泻心汤。如感秋燥而伤肺。烁津
液而化粘痰。当用辛凉润剂。陆氏桑杏蒌贝汤加减。或用五汁饮。（竹沥、梨汁、莱菔汁各两瓢、鲜石菖
蒲汁一小匙、薄荷油三滴、重汤炖温服。）六淫中惟火最生痰。石顽老人名曰痰火。其证痰涎壅盛。咳嗽
喘满。甚则屡咳而痰不得出。咳剧则呕。创立玉竹饮子。（生玉竹、川贝各三钱、紫菀、浙苓各二钱、蜜
炙广皮红一钱、苦桔梗、生甘草各六分、梨汁两瓢、生姜汁两滴、和匀同冲、气塞、加沉香汁两小匙冲。）
若肥人气虚多痰。用六君子汤加竹沥、姜汁。瘦人阴虚多火。六味地黄汤去泽泻、合生脉散。然生脉散不
及参贝六贤散。（制半夏四两、元参、甘草各三两、姜制南星二两、青盐十两、陈皮一斤去白煎去辣味、
六味以好泉水同煮、候干晒燥、为细末、以西洋参、川贝母去心各二两、海蛤壳 飞六两、
共研细和匀、每用五六分、或一钱、药汤调下。）涤痰止嗽。清火降气。虽然。火有君相之别。皆能消烁
肺胃之津液。 酿为痰。痰火冲心。心主君火而藏神。轻则神烦不寐。重则痰厥昏迷。法当豁痰清心。轻则
吴氏清宫汤加减。（犀角一钱磨汁冲、竹叶卷心二钱、元参心钱半、连翘心一钱、莲子心五分、竹沥、梨
汁各一瓢、鲜石菖蒲汁一匙、和匀同冲。）重则俞氏犀羚三汁饮。急则先用吐痰法。紫雪（五分。）品三
物白散（一分。）次用金箔镇心丹。（老竺黄、真琥珀、飞辰砂各三钱、金箔、九制胆星、珍珠粉各一钱、
西牛黄五分、麝香一厘、蜜丸、金箔为衣、约重一分、每服三粒至五粒。）薄荷三分。灯心三帚。泡汤送下
以宁其神。又次用正诚露珠丹。（透明辰砂一两、以瓷器盛露四十九夜、猪心中血、丝绵绞去滓、用净血三
两、每次一个、拌砂晒干、再拌再晒、三个用讫、再研极细、加西牛黄一钱、共研匀细、用糯米糊和捣万杵
为丸、每重七分、阴干得五分、瓷瓶密收、夜卧时噙化一丸、治殚虑劳神、火升痰壅、心悸不寐、遇事善忘
等证、最效。）善其后以防复发。痰火烁肝。肝藏相火而主筋。轻则头晕耳鸣。嘈杂不寐。手足躁扰。甚
发螈 。法当清火镇肝。羚角钩藤汤加减。（冬桑叶、滁菊花各二钱、双钩藤、京川贝、茯神木、青蛤散各
四钱、绢包、天竺黄钱半、竹沥、童便各二瓢冲、先用羚角片钱半、石决明一两、煎汤代水。）重则昏狂
痉厥。癫痫痴呆。直上巅顶。冲激神经。法当先通脑气。藜香散。（白藜芦九分、真麝香一分、共研匀细。）
搐鼻取嚏。次用导痰开关散。（杜牛膝根汁晒取净末、生皂角各一两、炒僵蚕、枯白矾各五钱、共研细匀、
轻用八分、重则一钱、开水一茶钟调服。）涌吐痰涎。痰涎虽吐。而神识时清时昏者。当用四汁饮。（竹沥、
梨汁、萝卜汁各二瓢、鲜石菖蒲汁二匙、重汤炖温服。）调下局方妙香丸。整肃痰火以醒神。俟神识清醒。
再用柔肝熄风煎。（方载发狂勘语中、如嫌明矾难吃、原方中去郁矾两味、代以白金丸钱半或二钱、亦可。）
善其后以防微。终用坎气潜龙汤。滋阴潜阳以除根。痰火蕴结胃肠。多由痰涎上壅气管。咯吐不及。咽入
食管而落胃。或杂食油腻浓味。胃气不清。
液郁为痰。久则嵌入于胃肠膜络之间。酿成老痰顽痰。胶粘坚固。或由瘀热凝结。成为结痰。或由伏饮化浊。
成为痰浊。发现恶心呕吐。胸膈壅塞。嘈杂脘满。便溏腹泄。或胸中肠中辘辘有声。法当清化下泄。廓清肠
胃。轻则节斋化痰丸。（栝蒌霜、苦杏仁、 瓦楞子、青海粉各一两、制香附、海蛤粉、风化硝、青连翘各
五钱、苦桔梗、广皮红各三钱、姜汁一匙、和竹沥捣药为丸、轻用三钱、重则四钱、清茶送下。）或豁痰丸。
（栝蒌霜五钱、花粉、射干、苦杏仁、茯苓、白前、当归各三钱、知母、川贝、枳壳、桔梗各二钱、生甘草
一钱、姜汁少许、和竹沥捣丸、每服三四钱。）轻清润降以搜涤之。重则礞石滚痰丸。或竹沥达痰丸。（大
黄、黄芩、仙半夏、橘红各二两、青礞石、炙甘草各一两、上沉香五钱、竹沥姜汁泛丸、每服二三钱）苦辛咸
降以荡涤之。此皆治六淫夹痰之大要也。总之痰涎为物。随气升降。无处不到。变证最多。试为约举十端。以
扼其要。如抬头屋转。眼常黑花。见物飞动。猝然晕倒者。此风痰上冲头脑也。名曰痰晕。治必先辨其因。因
于外风者。麻菊二陈汤为主。（明天麻一钱、滁菊花钱半、钩藤钩、茯神木各四钱、荆芥钱半、川芎八分、姜
半夏三钱、广皮红一钱、清炙草四分。）因于内风者。香茸六味丸加减。（鹿茸血片一钱、生地熟地各一两、
山萸肉四钱、淮山药、茯神各八钱、桑叶、丹皮各四钱、定风草三钱、真麝香五厘、共细末、豆淋酒捣糊为
丸、每服三钱、细芽茶五分、杭茶菊五朵、泡汤送下。）如痰涎壅盛。语言蹇涩。甚则暴喑。四肢厥冷者。此
风痰挟火阻塞喉中也。名曰痰厥。治必先吐其痰。导痰开关散为主。继则豁痰降气。三子导痰汤加减。若在夏
月。由冒暑挟痰而眩晕。甚则昏厥者。又不得概作风痰治。法当先开清窍。紫金片（五分至八分、）鲜石菖
蒲汤烊化灌服。继则辛凉芳透。清络饮。（鲜荷叶边、鲜银花、鲜竹叶、鲜丝瓜皮各二钱、扁豆花一钱、西
瓜翠衣五钱。）加竹沥、莱菔汁、（各两瓢冲）然因痰而晕厥者。多兼气厥。轻则用苏合香丸。（姜汁两滴、
和童便两瓢、磨服。）重则用《局方》妙香丸。（鲜石菖蒲汁两小匙、和竹沥两瓢送服。）如手足牵引。四肢麻
木。骨节串疼。或肿而痛者。此湿痰挟瘀流注经络也。名曰痰注。法当搜涤络痰。轻则《三因》控涎丹。重则蠲痛
活络丹。（川乌、草乌、地龙各五钱、杜胆星六钱、明乳香、净没药各三钱、炒黑丑四十九粒、全蝎七只、麝
香五分、酒糊丸、每重四分、轻用一丸、重用二丸、姜汁竹沥送服。）久则用《圣济》大活络丹。白花蛇、乌稍
蛇、威灵仙、两头尖、（俱酒炒）制草乌、煨天麻、全蝎、炙龟版、首乌、黑豆、水浸麻黄、贯仲、炙草、羌
活、官桂、杜藿香、小川连、乌药、熟地、酒蒸大黄、广木香、沉香、以上各二两、北细辛、净没药、赤芍、
僵蚕、明乳香、公丁香、姜制南星、小青皮、骨碎补、白豆蔻、安息香、酒蒸制附子、黄芩、酒蒸茯苓、制香
附、生白术、元参、以上各一两、犀角、麝香（另研）松脂、炙地龙各五钱、当归、葛根、虎胫骨、炙稣各两
半、牛黄、龙脑各钱半、防风、二两五钱、人参三两、血竭另研七钱、以上五十味研细末、蜜丸如桂圆大、
金箔为衣、每服一丸。并用芥子竹沥汤送服。（淡竹沥三瓢、黄荆沥两瓢、生姜汁四滴、陈绍酒两小匙、先
用白芥子八分、煎取清汤、重炖三汁、陈绍酒和服、日二夜一。）如中满腹胀。上气喘逆。二便不利。甚或面
肢俱肿者。此湿痰挟气阻滞胸腹也。名曰痰胀。先当去郁陈 。经验理中消胀丸为主。（大戟二钱五分、制牙
皂三钱、广木香二钱、炒黑丑钱半、煨甘遂一钱、用红枣肉捣丸、每用三钱、匀三次进服、第一次葱白陈酒
送、二次莱菔子、砂仁汤送、三次牛膝、木瓜汤送、体虚者勿服。）继则视其喘肿胀之进退。酌量施治。若腹
胀轻减。喘肿未除者。法当降气达膜。五子五皮饮加减。（紫苏子、莱菔子各钱半、白芥子六分、葶苈子八
分、车前子三钱、生桑皮、浙苓皮各四钱、大腹皮三钱、新会皮钱半、生姜皮一钱、先用杜赤豆一两、鲜茅根
二两、煎汤代水。）终则培元利水。七味枳术汤。（枳实一钱、拌炒生晒术三钱、六神曲、炒麦芽各三钱、先用
浙茯苓二两、杜赤豆、车前草各一两、煎汤代水。）调服天一丸。（灯草心一斤、以米粉浆染晒干、研末入水澄
之、浮者为灯草心、取出又晒干、入药用二两五钱、而沉者为米粉浆不用矣、赤白茯苓去皮兼用。茯神去木各
五两、滑石水飞过五两、猪苓去皮二两、泽泻去芦三两、五味各为细末、以潞党参熬膏和丸、龙眼大、辰砂为
衣、飞金为裹、每服一丸。）善其后以杜复发。如咳逆无痰。喉间如含炙脔。咯之不出。咽之不下者。此燥痰
粘结喉头也。名曰痰结（即梅核气）法当散结活痰。加味甘桔汤为主。（生甘草五分、苦桔梗、嫩苏梗、紫菀、
白前、橘红、制香附、旋复花各钱半。）口含清化丸。（川贝一两、甜杏仁五钱、上青黛一钱、共研细、生姜
(Also known as Wind-Cold with Phlegm Syndrome)
**Etiology:** Exogenous contraction of Wind-Cold pathogens, often accompanied by phlegm. This is mostly due to pre-existing phlegm accumulation, or concurrent Phlegm-Fluid (Tan Yin) or Phlegm-Fire (Tan Huo), compounded by re-contracting Wind-Cold, as well as exposure to cold and consumption of cold drinks/foods.
Such conditions mostly belong to Lung diseases. It may be that Wind enters from the skin/hair pores and attacks the Lung, or Cold enters from the Back-Shu points and attacks the Lung. There are many types of Phlegm syndromes; here we only explore the source regarding those related to Wind-Cold.
**Symptoms:** When Wind injures the Lung and is complicated by Phlegm-Fire, symptoms include headache and fever, aversion to wind with spontaneous sweating, cough with rebellious Qi, and in severe cases, dizziness and chest oppression. The phlegm is abundant, yellow, turbid, thick, and sticky, or coagulates into blocks or strips, making it difficult to expectorate. It gradually develops a foul odor, and in extreme cases, contains blood. The tongue coating is white, slippery, and thick, or yellow-white mixed and rough. When Cold injures the Lung and is complicated by Phlegm-Fluid, symptoms include headache and fever, aversion to cold without sweating, nasal congestion with wheezing, cough with abundant phlegm that is clear, white, thin, and watery, with a faint odor. Expectoration may be unsatisfactory, accompanied by vomiting and dizziness. The tongue coating is white, slippery, and thin, or grey-white mixed and slippery.
**Pulse:** A floating and slippery pulse at the Right Cun position, with a wiry and moderate pulse on the Left hand indicates Wind injury with Phlegm-Fire. A wiry and slippery pulse on the Right hand, with a tight and vigorous pulse on the Left hand indicates Cold injury with Phlegm-Fluid.
**Treatment:** For Wind complicated by Phlegm-Fire, mild cases use Congchi Jiegeng Tang (Scallion and Fermented Soybean Decoction with Platycodon) added with Xingren (Almond) and Juhong (Tangerine Peel). Severe cases use Yuespi Jia Banxia Tang (Yue Bi Decoction plus Pinellia). For Cold complicated by Phlegm-Fluid, mild cases use Xinjia San'ao Tang (Modified San'ao Decoction) added with Shengjiang (Fresh Ginger), Banxia (Pinellia), and Juhong. Severe cases use Xiao Qinglong Tang (Minor Green Dragon Decoction). Among these, Phlegm-Fire is more difficult to treat than Phlegm-Fluid. Often, Phlegm may confuse the Clear Orifices, causing the mouth to spit out sticky saliva, mania resembling possession, delirium, visual hallucinations, and coma, commonly called "Phlegm Obscuration." In such cases, Daimei Yujin Tang (Aeschynomite and Curcuma Decoction) should be used to open and penetrate the orifices. Furthermore, if Phlegm lodges above the Diaphragm, causing irritability and fullness below the heart, Qi rushing up to the chest, hunger but inability to eat, and in severe cases, cold extremities with a pulse that is suddenly tight or knotted, this indicates Phlegm and pathogenic factors knotting in the Chest. Guati San (Melon Tip Powder) added with fresh Radish Juice should be used to induce vomiting. (Twenty melon tips, thirty red adzuki beans, three qian of light fermented soybeans, decocted in one bowl of boiling water until half remains, then mixed with two large ladles of fresh radish juice and taken at once. Stop when profuse vomiting occurs.) If vomiting does not occur, switch to Sanwu Baisan (Three Substance White Powder) for urgent vomiting. (Three qian of Chuanbeimu, two qian of bitter Jiegeng, one qian of Badou Frost. Use one fen for mild cases, two fen for severe cases, taken with boiled water. Phlegm above the diaphragm will cause vomiting; phlegm below will cause purging. If no purging occurs, drink a cup of hot rice gruel. If purging continues excessively, drink a cup of cold rice gruel to stop it.) There are also many Phlegm syndromes resembling Taiyang disease. Symptoms include chest fullness and Qi rushing, aversion to cold with high fever, aversion to wind with spontaneous sweating, chest depression and pain, hunger but inability to eat, and excessive salivation upon palpation. In severe cases, diarrhea occurs more than ten times a day. The Right pulse is slightly slippery, and the Left pulse is slow. This indicates Cold Phlegm in the Chest, which Zhang Zhongjing described as resembling Guizhi Tang syndrome but without headache or stiff neck, with a slightly floating Cun pulse, chest oppression and hardness, and Qi rushing up to the throat preventing respiration. The treatment method should be vomiting; sweating is strictly contraindicated. Use Guati Erchen Tang (Melon Tip and Two-Chen Decoction): twenty melon tips, one and a half qian each of Jiang Banxia and Guang Juhong, decocted in water, mixed with two large ladles of fresh Radish juice. Patients who have lost blood or are deficient must not take this decoction. One must seek the root of the Phlegm disease and treat carefully.
**Commentary by Xiu:** Contracting pathogens with Phlegm involves internal and external evil combining, with pathogenic and righteous factors attacking each other, resulting in complex entanglement of meridians and organs. The best initial treatment is Huotan Tang (Phlegm-Expelling Decoction) from *Liuren Shu* (Zisu, Bohe each one qian; Qianghuo, Chuanpu each eight fen; Zhiqiao, Qianhu, Zhiningxing, Jiangbanxia each one and a half qian; Jiuhuang one qian; Zhigancao four fen). However, Phlegm syndromes are intricate and cannot be handled merely by treating the visible disease. Mr. Yu clarified the distinction between Wind-Cold and Phlegm-Fire/Phlegm-Fluid, giving readers a clearer framework. Wind-Warmth and Wind-Dryness syndromes often accompany Phlegm and should be treated with Acrid-Moistening methods to resolve the pathogen and expel the Phlegm, such as Jiawei Weirui Tang or Qingzao Jiufei Tang, added with Zhuli (Bamboo Sap) and Laifuzhi (Radish Juice), which have proven effective clinically. Mistakenly using Acrid-Warm sweating methods or Warm-Dry methods to rob Phlegm will lead to myriad complications. Be cautious.
**Commentary by Lian:** Taiyang disease is a general term for exogenous Six Qi pathogens. For any Phlegm-complicated syndrome, one must first distinguish the Six Excesses to apply treatment. If Wind-Evil generates Phlegm, where Phlegm transforms due to stagnation of Lung fluids, it should still be coughed out via the Lung tubes. Since the Lung is located highest and Wind is a Yang pathogen, use an Acrid-Cool mild formula, such as Wu's Sangju Yin modified. (Dongsangye two qian, Chujuhua one and a half qian, Subohet, Ku Jiegeng, Guangpihong each eight fen, Gualoupi, Guangxiren each two qian, fresh Luobuo one liang, Yitang one qian.) Severe cases use Zhang's Yinqiao Mahuang Tang. (Jinyinhua one qian, Lianqiao one and a half qian, Daijie Mahuang three fen, Subohet six fen, Chao Niubangzi one qian, Guangjuhong eight fen, Ku Jiegeng six fen, Shenggancao five fen.) If Wind has transformed into Heat, steaming Stomach fluids into Phlegm, add Stomach-clearing agents like Zhimu and Huafen (each three qian), along with Luobozhi and Zhuli. If Cold-Evil generates Phlegm, pore closure occurs, Lung Qi becomes rebellious and full, and the pathogen has no outlet. Cold injuring the Lung causes Lung Qi depression; use an Acrid-Warm dispersing agent. Mild cases: Sanzi Daotan Tang added with Jingjie and Fangfeng. (Jingjie, Fangfeng, Jiangbanxia, Laifuzi, Suzi, Zhiqiao, Fuling each one and a half qian, Guangpihong one qian, Baijaizi six fen, Zhigancao five fen.) Severe cases: Mahuang Erchen Tang. (Mahuang five fen, Guangxiren three qian, Jiangbanxia two qian, Guangjuhong one qian, Qianhu, Baiqian each one and a half qian, Fuling three qian, Zhigancao five fen.) If depression transforms into Fire, with excess Heat and Phlegm obstruction, use Jiawei Maxing Shigan Tang. (Honey-fried Mahuang four fen, Guangxiren two qian, Shengshigao four qian, Shenggancao four fen, Gualouren four qian, Zhuli Banxia one and a half qian, Guangpihong, Xiao Zhishi each one qian.) If Summerheat-Evil is inhaled through the mouth/nose, injuring Lung and Stomach, causing fluid stagnation and Phlegm formation driven by Fire, use a heavy Acrid-Cool formula: Zhuye Shigao Tang added with Zhishi and Zhuli. (Xianzhuye two qian, Shengshigao eight qian, Xianbanxia two qian, Mao xishen one qian, Shenggancao five fen, Chen cangmi one hundred grains wrapped in Lotus leaf for decoction, Zhishi juice two small spoons, Zhuli two large ladles, mixed and taken together.) If Dampness stagnates in the Middle, causing Spleen/Stomach Qi stagnation and knotting into Phlegm, treatment must move Spleen and clear Stomach: Huopo Erchen Tang modified. (Du huogeng three qian, Zhen chuanpu one qian, Banxiaqu, Xinhui pi, Su peilan each one and a half qian, Zhe fuling three qian, Dan zhuru two qian, Xiao zhishi one and a half qian, Huashi four qian.) If Dampness transforms into Heat with Heat predominating over Dampness, use Heat-clearing and Damp-draining methods: Yu's Zengjian Huanglian Xiexin Tang. If Autumn Dryness injures the Lung, scorching fluids into sticky Phlegm, use an Acrid-Cool moistening formula: Lu's Sangxing Loubei Tang modified, or Wuzhi Yin. (Zhuli, Lizhi, Laifuzhi each two large ladles, Xian shichangpu juice one small spoon, Bohe oil three drops, warmed in double boiler.) Among the Six Excesses, Fire generates Phlegm most readily; Shiwan Laoren named this Phlegm-Fire. Symptoms include abundant saliva/phlegm, cough with wheezing/fullness, difficulty expectorating despite frequent coughing, and vomiting when coughing is severe. He created Yuzhu Yinzi. (Sheng yuzhu, Chuanbei each three qian, Ziwan, Zhefu ling each two qian, Honey-fried Guangpihong one qian, Ku Jiegeng, Shenggancao each six fen, Lizhi two large ladles, Shengjiangji two drops, mixed and taken together; for Qi blockage, add Chenxiang juice two small spoons.) For obese individuals with Qi deficiency and excess Phlegm, use Liujunzi Tang added with Zhuli and Shengjiangji. For thin individuals with Yin deficiency and excess Fire, use Liuwei Dihuang Tang minus Zexie, combined with Shengmai San. However, Shengmai San is inferior to Shenbei Liuxian San. (Zhi banxia four liang, Yuan Shen, Gancao each three liang, Jiang zhi nanting two liang, Qingyan ten liang, Chenpi one jin peeled and decocted to remove pungency; boil these six ingredients in good spring water until dry, sun-dry, and grind to fine powder. Add Yangshen and Chuanbei (de-cored) each two liang, Haigek shell (calcined) six liang; grind all finely and mix. Take 5-6 fen or one qian with medicinal liquid.) This clears Phlegm, stops cough, clears Fire, and descends Qi. Although Fire has Ministerial and Sovereign distinctions, both consume Lung/Stomach fluids to create Phlegm. Phlegm-Fire rushing to the Heart (which houses the Sovereign Fire and Spirit) causes mild irritability and insomnia, or severe Phlegm-Jue coma. Treatment requires expelling Phlegm and clearing the Heart. Mild cases: Wu's Qinggong Tang modified. (Xijiao one qian ground and mixed with juice, Zhuyejuanxin two qian, Yuanshenxin one and a half qian, Lianqiaoxin one qian, Lianzixin five fen, Zhuli, Lizhi each one large ladle, Xian shichangpu juice one spoon, mixed and taken together.) Severe cases: Yu's Xiling Sanzhi Yin. For emergencies, first induce vomiting of Phlegm using Zixue (five fen) or Sanwu Baisan (one fen). Next, use Jinbo Zhenxin Dan. (Lao zhuhuang, Zhen hupo, Fei chensha each three qian, Jinbo, Jiu zhi danxing, Zhenzhu fen each one qian, Xi niuhuang five fen, Shexiang one li; honey pills coated with gold foil, weighing about one fen per pill. Take 3-5 pills, washed down with tea made from Bohe three fen and Dengxin three bundles, to calm the Spirit.) Then use Zhengcheng Luzhu Dan. (Transparent chensha one liang, exposed to dew in porcelain for 49 nights; pig heart blood filtered through silk to obtain three liang of pure blood. Mix one pill-sized amount with sand, sun-dry, repeat mixing and drying three times. Grind extremely fine, add Xi niuhuang one qian, mix well. Form pills with glutinous rice paste, pounding 10,000 times. Each pill weighs seven fen, dried to five fen. Store in sealed porcelain bottle. Dissolve one pill in mouth at night to treat mental exhaustion, rising Fire and obstructing Phlegm, palpitations, insomnia, and forgetfulness; highly effective.) Treat the aftermath to prevent recurrence. Phlegm-Fire scorches the Liver (which houses Ministerial Fire and governs sinews), causing mild dizziness, tinnitus, epigastric discomfort, insomnia, restlessness, or severe spasms. Treatment requires clearing Fire and calming the Liver: Lingjiao Gouteng Tang modified. (Dongsangye, Chujuhua each two qian, Shuang gouteng, Jing Chuanbei, Fushenmu, Qingheshan each four qian wrapped in silk, Tianzhuhuang one and a half qian, Zhuli, Tongbian each two large ladles mixed; first decoct Lingjiao pian one and a half qian and Shijueming one liang in water to substitute for water.) Severe cases involve coma, mania, convulsions, epilepsy, dementia, ascending to the vertex, and stimulating nerves. Treatment must first unblock Brain Qi using Lixiang San. (Baililu nine fen, Zhen shexiang one fen; grind finely.) Snuff into nose to induce sneezing. Next, use Daotan Kaiguan San. (Du niuxigen juice sun-dried to powder, Sheng zaojiao each one liang, Chao jiangcan, Ku baijian each five qian; grind finely. Take eight fen for mild cases, one qian for severe, mixed with one teacup of boiling water.) Induce vomiting of Phlegm-saliva. If consciousness fluctuates after vomiting, use Sizhi Yin. (Zhuli, Lizhi, Luobozhi each two large ladles, Xian shichangpu juice two spoons, warmed in double boiler.) Take with Ju Fang Miaoxiang Wan to rectify Phlegm-Fire and awaken the Spirit. Once conscious, use Rougan Xifeng Jian (see commentary on Mania for formula; if Mingfan is too hard to swallow, remove Yufan and replace with Baijin Wan 1.5-2 qian). Treat the aftermath to prevent subtle progression. Finally, use Kankai Qianlong Tang to nourish Yin and submerge Yang to eradicate the root. Phlegm-Fire knotting in Intestines/Stomach often results from Phlegm-saliva obstructing airways, failing to be expectorated, swallowed into esophagus/stomach, or mixed with greasy/rich food causing unclear Stomach Qi, leading to fluid stagnation and Phlegm. Over time, it embeds in intestinal/membrane networks, forming old/stubborn Phlegm, sticky and firm. It may arise from Blood-Heat coagulation (Knot Phlegm) or latent Fluid transforming into turbidity (Turbid Phlegm). Symptoms include nausea, vomiting, chest/diaphragm oppression, epigastric fullness, loose stools/diarrhea, or rumbling sounds in chest/intestines. Treatment requires clearing, transforming, and draining downward to cleanse intestines/stomach. Mild cases: Jiezai Huatan Wan. (Gualoushuang, Ku xingren, Walengzi, Qinghaifen each one liang; Zhixiangfu, Haigefen, Fenghuaxiao, Qing lianqiao each five qian; Ku Jiegeng, Guangpihong each three qian; Jiangzhi one spoon, mixed with Zhuli to form pills. Take three qian for mild, four qian for severe, washed down with green tea.) Or Huotan Wan. (Gualoushuang five qian, Huafen, Shegan, Ku xingren, Fuling, Baiqian, Danggui each three qian; Zhimu, Chuanbei, Zhiqiao, Jiegeng each two qian; Shenggancao one qian; little Jiangzhi, mixed with Zhuli to form pills. Take 3-4 qian per dose.) Use light/clear/moistening/descending methods to search and purge. Severe cases: Mengshi Gun Tan Wan or Zhuli Datang Wan. (Dahuang, Huangqin, Xianbanxia, Juhong each two liang; Qing mengshi, Zhigancao each one liang; Shang chenxiang five qian; pills formed with Zhuli and Jiangzhi. Take 2-3 qian per dose.) Use Acrid/Bitter/Salty descending methods to scour and purge. These are the main principles for treating Six Excesses with Phlegm. In summary, Phlegm-saliva moves with Qi, reaching everywhere, causing many complications. Here are ten key examples:
1. **Phlegm-Dizziness (Tan Yun):** Looking up causes room spinning, black spots in vision, moving objects, sudden fainting. Caused by Wind-Phlegm rushing to head. Differentiate origin: External Wind uses Maju Erchen Tang as main formula. (Tiantianma one qian, Chujuhua one and a half qian, Goutenggou, Fushenmu each four qian, Jingjie one and a half qian, Chuanxiong eight fen, Jiangbanxia three qian, Guangpihong one qian, Qing zhigancao four fen.) Internal Wind uses Xiangrong Liuwei Wan modified. (Lurong xuepian one qian, Shengdi, Shudi each one liang, Shanyurou four qian, Huaishanyao, Fushen each eight qian, Sangye, Danpi each four qian, Dingfengcao three qian, Zhen shexiang five li; fine powder, Doulin wine paste pills. Take three qian, washed down with five fen fine bud tea and five Hangzhou chrysanthemum flowers in tea.)
2. **Phlegm-Jue (Tan Jue):** Abundant Phlegm-saliva, slurred speech, sudden aphonia, cold extremities. Caused by Wind-Phlegm with Fire blocking throat. First induce vomiting with Daotan Kaiguan San, then expel Phlegm and descend Qi with Sanzi Daotan Tang modified. In summer, if caused by Summerheat with Phlegm leading to dizziness/coma, do not treat solely as Wind-Phlegm. First open orifices with Zijian Pian (5-8 fen) dissolved in Xian shichangpu soup. Then use Acrid-Cool aromatic penetration: Qingluo Yin. (Xian heye bian, Xian yinhua, Xian zhuye, Xian siguapi each two qian, Biandouhua one qian, Xigua cuyi five qian.) Add Zhuli, Laifuzhi (each two large ladles mixed). Phlegm-induced fainting often accompanies Qi-Jue. Mild: Suhexiang Wan (two drops Jiangzhi mixed with two large ladles Tongbian, ground and taken). Severe: Ju Fang Miaoxiang Wan (two small spoons Xian shichangpu juice, two large ladles Zhuli, taken together).
3. **Phlegm-Injection (Tan Zhu):** Limb pulling, numbness, joint pain/swelling. Caused by Damp-Phlegm with Blood stasis flowing into meridians. Search and purge collateral Phlegm. Mild: San Yin Kongyan Dan. Severe: Juan Tong Huoluo Dan. (Chuanwu, Caowu, Dilong each five qian, Du danxing six qian, Ming ruxiang, Jing moyao each three qian, Chao hei chou forty-nine seeds, Quanxie seven, Shexiang five fen; wine paste pills, four fen each. Take one pill mild, two severe, washed down with Jiangzhi/Zhuli.) Long-term: Shengji Daluo Dan. (Baihuashe, Wushaoshe, Weilingxian, Liangtoujian [wine fried], Zhicaowu, Wei tianma, Quanxie, Zhiguiban, Shouwu, Heidou, Shuijin mahuang, Guanzhong, Zhicao, Qianghuo, Guangui, Du huoxiang, Xiao chuanlian, Wuyao, Shudi, Jiudahuang, Guangmuxiang, Chenxiang [each two liang]; Beixixin, Jing moyao, Chishao, Jiangcan, Ming ruxiang, Gong dingxiang, Jiang zhi nanting, Xiao qingpi, Gusuibu, Baidoukou, Anshixiang, Jiuzhi fuzi, Huangqin, Jiufu ling, Zhixiangfu, Shengbaizhu, Yuanshen [each one liang]; Xijiao, Shexiang [separately ground], Songzhi, Zhidilong [each five qian]; Danggui, Gegen, Hu jingggu, Zhisu [each two and a half liang]; Niuhuang, Naozhang [each one and a half qian]; Fangfeng [two and a half liang]; Renshen [three liang]; Xuexie [separately ground seven qian]. Fifty ingredients ground fine, honey pills size of longan, gold foil coated. Take one pill, washed down with Jiezi Zhuli Tang. (Dan zhuli three large ladles, Huangjingli two large ladles, Shengjiangji four drops, Chen shaojiu two small spoons. First decoct Baijaizi eight fen for clear soup, re-boil three juices, mix with wine, take twice day/once night).
4. **Phlegm-Bloating (Tan Zhang):** Abdominal fullness, upper body Qi rebellion, urinary/fecal retention, facial/limb edema. Caused by Damp-Phlegm with Qi blocking chest/abdomen. First remove stagnation with Jingyan Lizhong Xiaozhang Wan. (Daji two qian five fen, Zhizayao three qian, Guangmuxiang two qian, Chao hei chou one and a half qian, Weigansui one qian; red date flesh pills. Take three qian divided into three doses. 1st dose: Congbai Chenjiu; 2nd dose: Laifuzi, Sharen soup; 3rd dose: Niuxi, Mugua soup. Avoid in deficiency.) Then adjust based on improvement. If bloating reduces but swelling persists, descend Qi to membranes: Wuzi Wupi Yin modified. (Zisuzi, Laifuzi each one and a half qian, Baijaizi six fen, Tinglizi eight fen, Cheqianzi three qian, Sheng sangpi, Zhe lipi each four qian, Dafupi three qian, Xinhui pi one and a half qian, Shengjiangpi one qian. First decoct Du chidou one liang, Xian maogen two liang to substitute water.) Finally, tonify origin and drain water: Qiwei Zhizhu Tang. (Zhishi one qian, mixed-fried Shengshai zhu three qian, Liushenqu, Chao maiya each three qian. First decoct Zhe fuling two liang, Du chidou, Cheqiancao each one liang to substitute water.) Take Tianyi Wan. (Dengcaoxin one jin, dyed with rice flour paste, sun-dried, ground, water-washed; floating part is Dengcaoxin [two and a half liang used], sinking part discarded. Chi baifu ling peeled, Fushen de-woody each five liang, Huashi water-washed five liang, Zhuling peeled two liang, Zexie de-radicle three liang. All fine powders, mixed with Ludangshen paste into pills size of longan, chensha coated, gold foil wrapped. Take one pill.) Treat aftermath to prevent recurrence.
5. **Phlegm-Knot (Tan Jie / Plum Pit Qi):** Cough without phlegm, sensation of roasted meat in throat, unable to expectorate or swallow. Caused by Dry-Phlegm knotting throat. Disperse knots and activate phlegm: Jiawei Ganjie Tang as main formula. (Shenggancao five fen, Ku Jiegeng, Nen sugeng, Ziwan, Baiqian, Juhong, Zhixiangfu, Xuanfuhua each one and a half qian.) Hold Qinghua Wan in mouth. (Chuanbei one liang, Tien xingren five qian, Shang qingdai one qian; grind fine...)