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Although Phlegm-Fluid (Tan-Yin) is regarded as a single syndrome, its etiology falls into two categories. The thick and turbid substance is Phlegm (Tan), caused by Fire (Huo), characterized by heat without cold; treatment requires distinguishing whether the pathology resides in the Lung (Fei) or the Spleen (Pi). The thin and clear substance is Fluid (Yin), caused by Dampness (Shi), which may present with either heat or cold, and primarily belongs to the Spleen. However, Damp-Earth (Shi-Tu) flourishes throughout the four seasons; three seasons are dominated by heat and one by cold. Therefore, among Fluid syndromes, those formed by Cold-Damp are few, while those formed by Damp-Heat are numerous.

According to Zhongchun: The generation of Phlegm has various causes and thus requires different treatments. If it arises from Yin Deficiency causing Empty Fire to flare upward, scorching the Lung, and boiling body fluids until they congeal into Phlegm, this is called Yin-Deficiency Phlegm-Fire. Although the Phlegm is in the Lung, its root lies in the Kidney. Treatment should focus on nourishing Water to clear Metal (Zhuang Shui Qing Jin), descending Qi, and resolving Phlegm. If it arises from Spleen Dampness failing to transform and transport, leading to stagnation and Phlegm formation, or if it results from excessive alcohol consumption and rich, greasy foods, the Phlegm becomes thick, sticky, and solidified. It may flow into the collaterals, or between the skin and membranes, forming large masses; or cause loss of appetite, insomnia all night, heavy body and abdominal distension preventing walking; or sudden dizziness and collapse with loss of consciousness; or manifest as epilepsy; or abnormal shouting; or change from obesity to emaciation; or persistent diarrhea, even paralysis. All these strange symptoms are caused by Phlegm. Hence, the ancients said: "Strange diseases often belong to Phlegm, acute diseases often belong to Fire," which is indeed true. This type of syndrome resides in the Spleen and Stomach, unrelated to the Lung and Kidney. Treatment should focus on drying the Spleen, moving Qi, dissipating nodules, and softening hardness. If Wind-Cold closes the exterior, trapping Heat in the Lung, resulting in Phlegm-cough and wheezing, this also belongs to the Lung. Treatment should focus on clearing Phlegm and descending Qi, adding acrid-warm agents to lung-clearing herbs to disperse Wind-Cold. Thus, moistening, drying, and dispersing each have their appropriate indications and must not be mixed indiscriminately. In modern times, Phlegm and Fluid are often confused without distinguishing sticky Phlegm from clear Fluid, leading to inappropriate treatment that fails to address the actual condition. One must know that Fluid varies in color and consistency: it may be green, yellow, blue-green, black, sour, or bitter. It may lie hidden in the intestines and stomach, or attack the chest and hypochondrium, causing Heart pain, Epigastric pain, or stabbing pain in the ribs. It may flow into the collaterals and limbs, causing joint stiffness. It may present with aversion to cold, fever, spontaneous sweating, chest oppression, wheezing, anorexia, or insomnia. These are all its manifestations. This syndrome is often caused by drinking tea or soup excessively after alcohol, condensing with Damp-Heat in the intestines and stomach. Or it may result from emotional depression, or Spleen-Stomach weakness where dietary Dampness fails to dissipate, also forming Fluid. In summary, it must stem from Dampness in the Spleen-Stomach. Treatment should focus on strengthening the Spleen, drying Dampness, eliminating Fluid, promoting water metabolism, descending Qi, and dissipating stagnation.

Examining medical texts regarding Phlegm syndromes: when in the Lung Meridian, it is called Dry Phlegm (Zao Tan), which is sticky and difficult to expectorate. When in the Spleen Meridian, it is called Damp Phlegm (Shi Tan), which is slippery and easy to expectorate. When in the Heart Meridian, it is called Heat Phlegm (Re Tan), which is hard and forms clumps. When in the Liver Meridian, it is called Wind Phlegm (Feng Tan), which is green and foamy. When in the Kidney Meridian, it is called Cold Phlegm (Han Tan), which contains black specks and is thin. *Jin Gui Yao Lue* discusses four types of Fluid syndromes: Water flowing between the intestines with gurgling sounds is called Tan-Yin (Phlegm-Fluid); water accumulating under the hypochondrium causing pain upon coughing and spitting is called Xuan-Yin (Hanging Fluid); water flowing into the limbs with no sweat and heaviness is called Yi-Yin (Overflowing Fluid); coughing and wheezing requiring leaning to breathe, shortness of breath, inability to lie flat, and swelling-like appearance is called Zhi-Yin (Piercing Fluid). These are also differentiated by location in the Lung, Spleen, Heart, Liver, and Kidney. This truly demonstrates the infinite variations of Phlegm-Fluid pathologies, which deserve detailed study by those committed to deep investigation.

Shu Xie Li Jin Tang [See Shang Feng]
Original formula can be added with Stir-fried Ephedrae Herba (Mahuang) [Disperses Wind-Cold, 3-5 fen], Gypsum Fibrosum (Shigao) [Clears Lung Heat, dosage adjusted].
This formula is used for cases where Wind-Cold closes the exterior and Heat is trapped in the Lung, causing Phlegm-cough and wheezing.

Qing Jin San, Qing Ning Gao, Qin Hua Wan [All see Xu Lao], Jie Ming Wan [See Zhong Feng]
These four formulas are selected for Yin-Deficiency Phlegm-Fire syndromes. Since the Lung is Dry Metal, it prefers cool-moistening and dislikes warm-drying. If the Phlegm is stubbornly stuck, add Xia Tian Gao.

Shun Qi Kai Tan Yin [See Zhong Feng]
Treats Qi rebellion and Fire rising, with Phlegm obstructing the throat, feeling like a lump.
Original formula [Shun Qi Kai Tan] adds Ophiopogonis Tuber ( Maidong), Anemarrhenae Rhizoma (Zhimu), Phellodendri Cortex (Huangbai) [Clears Fire], White Peony Root (Baishao), Schisandrae Fructus (Wuweizi) [Astringes Fire and guides it downward].
This is a formula for smoothing Qi, opening Phlegm, and descending Fire.

Hu Po Wan
Treats Phlegm syndromes with miraculous effect.
Real Amber (Hupo), Cinnabar (Zhusha) [Calms the Heart and anchors Spirit], Ginseng Radix et Rhizoma (Renshen) [Tonifies Qi and calms Spirit], Poria (Fushen), Lotus Seed (Lianrou) [Each 3 qian], Chinese Yam (Shanyao) [1 liang], Licorice Root (Gancao) [Tonifies Heart and benefits Spleen], Bamboo Dalium (Tian Zhu Huang) [Enters Heart, clears Heat Phlegm], Arisarum Rhizoma processed with bile (Chen Danxing) [Enters Liver, dispels Wind Phlegm]. Can add Calculus Bovis (Niuhuang) [Clears Heart, cools Lung, clears Heat and resolves Phlegm, 1 qian is better]. [Honey pills, each weighing 3 qian, coated with Cinnabar; children's pills weigh 1 qian each].
This is a formula for calming the Heart, anchoring Spirit, clearing Heat, and resolving Phlegm. It is a sacred medicine for pediatrics. For slow convulsions, it is effective upon administration, and also treats all deficiency syndromes in children.

Gua Lou Ju Hong Wan
Treats Phlegm in the Stomach causing urge to vomit.
Trichosanthis Fructus Semen (Gualou Ren), Exocarpium Citri Reticulatae Viride (Juhong) [Each 4 liang]. [Made into pills with Bamboo Sap (Zhuli) and Ginger Juice (Jiangzhi), taken after meals].
This is a formula for smoothing Qi, opening Phlegm, and stopping vomiting.

Jia Wei Gua Lou Ban Xia Tang
For Phlegm-cough, Qi rebellion, frequent vomiting, sensation of cold object blocking the chest and diaphragm, relieved slightly by hot drinks. Only use this formula in such cases.
Trichosanthis Fructus processed with Arsenolite powder (Gualou Shuang) [Stir-fried, 3 qian], Pinelliae Rhizoma (Banxia) [Processed with Ginger Juice, 1.5 qian]. One moistens, one dries. The original formula had only these two ingredients; the additional drugs were added by Zhongchun. Perilla Fructus (Suzi) [Stir-fried and crushed], Exocarpium Citri Reticulatae Viride (Juhong), Poria (Fuling) [All resolve Phlegm and descend rebellious Qi, each 3 qian], Cardamomi Fructus (Baidoukou) [5 fen], Evodiae Fructus (Wuzhuyu) [Has ability to warm Middle and descend Qi, 3-7 fen, soaked in decoction]. Add Bamboo Sap (Zhuli) [Small cup], Ginger Juice (Jiangzhi) [Opens Phlegm and stops vomiting, 5 spoons].
This is a formula for resolving Phlegm, descending rebellious Qi, warming the Middle, and guiding Qi downward. It is strictly contraindicated for Heat syndromes.

Er Chen Tang [See Zhong Feng]
The essential medicine for treating Damp Phlegm and all Fluid syndromes.
This is a formula for drying Dampness, regulating Qi, and resolving Phlegm. For deficiency cases, add Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) to tonify Qi and strengthen the Spleen to transform Phlegm; this is named Liu Jun Zi Tang. Ancients said: "The Spleen is the source of Phlegm generation." Also: "Treating Phlegm without managing the Spleen and Stomach is not correct treatment." If there is salivation that is not very thick/sticky, this is due to Spleen deficiency failing to control body fluids. Treat with Liu Jun Zi Tang plus Alpinia Oxyphylla Fructus (Yizhiren). Yizhiren is acrid and hot, capable of controlling saliva; do not use unless it is a Deficiency-Cold pattern. Often seeing cases of dysphagia etc., with much white saliva, this is caused by extreme Heat. Upon clinical presentation, careful examination is most important to avoid treatment errors.

Zhongchun Tan Yin Wan [Can also be decocted]
Treats all Fluid syndromes with miraculous effect.
Liu Jun Zi Tang minus Glycyrrhizae Radix et Rhizoma (Qu Gancao) [Strengthens Spleen and dries Dampness; removing Licorice avoids its moderating nature, each 4 liang], added with Inulae Flos (Xuanjinhua) [Resolves Phlegm, 3 liang], Polyporus (Ling/Lie Ling - text says Lie Ling, likely typo for Zhu Ling or Fu Ling, kept as per text entity extraction context but interpreted as diuretic), Alismatis Rhizoma (Zexie) [Promotes water metabolism, each 3 liang], Immature Bitter Orange (Zhishi) [1 liang], Magnoliae Officinalis Cortex (Noupu), Aucklandiae Radix (Muxiang) [Descends Qi and dissipates stagnation, each 5 qian]. For Alcohol-Damp, add Scutellariae Radix (Huanglian) [1 liang]; for Cold-Damp, add Atractylodis Rhizoma (Maoshu) [2 liang], Cardamomi Fructus (Baidoukou) [5 qian]; for Depression, add Perillae Folium (Zisu) [4 liang]. [Made into pills with Ginger Juice and thin rice paste, size of mung beans, taken with light Ginger Decoction. Dosage 3-5 qian per time, 3 times daily].
This is a formula for strengthening the Spleen, drying Dampness, eliminating Fluid, promoting water metabolism, descending Qi, and dissipating stagnation. Effective for all Fluid syndromes. Zhang Zhongjing used Guizhi Tang combined with Fuling, Baizhu, and Gancao; these four ingredients unblock Yang, transform Qi, seep out water, strengthen the Spleen, overcome Dampness, and eliminate Fluid. He used Ba Wei Shen Qi Wan to tonify True Yang, ensuring Kidney Qi is not deficient so Water does not rise to form Phlegm. He used Tingli Dazao Tang to drain Lung Qi obstruction, allowing Qi to move so Fluid naturally does not accumulate. Recorded in *Jin Gui Yao Lue*, Tan Yin chapter. There are many such formulas, worthy of reference and study.

Shen Zhu Wan
Treats Damp Phlegm [Common in obese people] and all Fluid syndromes with miraculous effect.
Atractylodis Rhizoma (Maoshu) [1 jin, Black Sesame Seed 1 jin. Grind together with water into paste, steam nine times and sun-dry nine times]. [Made into pills with Jujube Flesh. In autumn dry weather, take with Tian Dong decoction].
This is a divine agent for treating Dampness and eliminating Fluid, also extremely effective for Damp Bi and Spleen-Damp swelling.

Fu Ling Wan
Treats Phlegm stagnating in the Zhongwan area, Spleen Qi congestion, unable to descend, attacking both arms, causing pulling pain and inability to lift hands. [Since the Spleen governs the four limbs]. Immediate effect upon taking.
Pinelliae Rhizoma (Banxia) [2 liang], Poria (Fuling) [1 liang], Aurantii Fructus (Zhike) [5 qian], Natrii Sulfas (Fenghua Xiao) [Guides phlegm-resolving and Qi-regulating agents, combines with lubricating downward action to enter Large Intestine, 2.5 qian]. [Boiled with Ginger Juice, made into pills with wheat starch paste, size of paulownia seeds. Dosage 30-50 pills, taken with light Ginger Decoction].
This is a mild agent for guiding Phlegm and lubricating the bowels.

Meng Shi Gun Tan Wan
Treats all accumulations and Phlegm knots, hundreds of strange syndromes. [When disease manifests in hundreds of variations, symptoms are unreliable, pulse is untrustworthy, and origin is unpredictable, it largely belongs to Phlegm].
Calcitum (Qing Mengshi) [Essential herb for resolving accumulation and dropping Phlegm. Calcined with equal parts Saltpeter to golden color. Tang's method uses 1 qian for children; how can the sovereign herb be less? Original dosage suspected error]. Prepared Rheum Palmatum (Zhi Dahuang) [Divine agent for driving out all accumulations and stagnant Fluid], Scutellariae Radix (Huangqin) [Scutellaria treats Phlegm by borrowing its ability to descend Fire, each 8 liang], Real Aquilaria Wood (Zhen Chenxiang) [Aquilaria treats Phlegm by borrowing its ability to descend Qi, 1 liang. Xanthoceras Radix/Muxiang also acceptable]. [Made into pills with water, taken with plain water, 1-3 qian].
This is a sacred agent for expelling Phlegm, clearing Heat, and draining knots. If caused by Spleen Dampness failing to transform, leading to stagnation and Phlegm, or due to alcohol and rich foods causing thick, sticky Phlegm difficult to expectorate, this drug takes only the Phlegm accumulation, bringing it down gradually without severe purging; response will be immediate like drum and stick. Contraindicated for Yin-Deficiency Phlegm-Fire, and also forbidden for deficient persons.

If the pulse is choppy (Se) with Phlegm, it is difficult to treat.