Wang (58 years old) Has suffered from recurrent asthma for a long time, which had not flared up. Now experiencing palpitations and tremors, seemingly presenting symptoms of vexation and restlessness. This condition belongs to Phlegm-Fire. Treatment should focus on dispersing and unblocking the stagnation and obstruction; do not merely use cloying tonification. (Phlegm-Fire)
Pinelliae Rhizoma Preparatum (Banxia), Coptidis Rhizoma (Chuanlian), Acori Tatarinowii Rhizoma (Shichangpu), Concha Meretrix (Gafen), Ziziphi Spinosae Semen (Zhishi), Poria (Fuling), Curcumae Radix (Chuanyujin), Citri Reticulatae Pericarpium (Juhong).
Pills made with Bamboo Juice (Zhuli) and Ginger Juice (Jiangzhi).

Liu Phlegm-Fire is stagnant and obstructed, Qi is滞涩 (stagnant). Smoking aggravates upper Jiao heat and aids congestion; therefore, alcohol and meat are all unsuitable. The ancients stated that Phlegm arises from Qi stagnation and Heat depression; treatment should prioritize clearing heat and regulating Qi.
Coptidis Rhizoma (Chuanlian), Atractylodis Macrocephalae Rhizoma (Baizhu), Ziziphi Spinosae Semen (Zhishi), Magnoliae Officinalis Cortex (Houpo), Poria (Fuling), Pinelliae Rhizoma Preparatum (Banxia).
Pills made with mild Ginger Decoction (Danjiang Tang).

Shen (34 years old) Chronic cough due to Phlegm-Fire, administered Hai Ge Wan (Clam Shell Pill).

Zhang (Elderly woman) Dizziness and vertigo caused by Phlegm-Fire stirring Liver Wind; precautions against falling and injury are necessary.
Gastrodiae Rhizoma (Tianma), Prepared Pinelliae Rhizoma (Banxia), Poria (Fuling), Citri Reticulatae Pericarpium (Juhong), Cornu Saigae Tataricae (Lingyangjiao), Uncariae Ramulus cum Uncis (Gouteng), Bamboo Juice (Zhuli).

Chen (Elderly woman) Elderly patient with Phlegm-Fire causing cough and rebellious Qi; sputum has a foul odor.
Asparagi Radix (Lugen), Coicis Semen (Yiren), Persicami Semen (Taoren), Trichosanthis Cucumerinae Semen (Siguazi), Lepidii Fructus (Tingli), Jujubae Fructus (Dazao).
Re-evaluation: Deficiency in the Lower Jiao fails to grasp Qi; turbid Yin rebels upward causing vomiting and counterflow; sputum is foul.
Prepared Rehmanniae Radix (Shuditan), Walnut Kernel with Purple Skin (Ziyi Hutao Rou), Prepared Lycii Fructus (Chao Qizi), Prepared Achyranthis Bidentatae Radix (Chao Niuxi), Dendrobii Nobile Caulis (Chuanhu), Poria Cum Pino (Fushen).

Certain case Phlegm-Fire rebels upward and clouds the orifices, resulting in tinnitus and dizziness. Er Chen Tang modified with Gastrodiae Rhizoma (Tianma), Uncariae Ramulus cum Uncis (Gouteng), Chrysanthemi Flos (Ganju), Cornu Saigae Tataricae (Lingyangjiao), Trichosanthis Pericarpium (Loupi).

Certain case At the Summer Solstice, the Guan pulse on both hands is wiry and long. The fire of the five viscera is blazing, with Liver Yang and Stomach Yang being particularly severe. Anger leading to twitching and pulling indicates Liver disease. Consuming pungent, aromatic, and rich flavors triggers the illness. This is due to Stomach pathology. The root of Phlegm-Fire is deep-seated and cannot be cleared instantly. Only through quiet rest, avoiding anger, and consuming bland flavors to clear the interior can the tendency for flare-ups be slowed. Gradual medication adjustment is the rational approach.
Cornu Saigae Tataricae (Lingyangjiao), Cornu Bubali (Xijiao), Coptidis Rhizoma (Chuanlian), Curcumae Radix (Yujin), Gardeniae Fructus (Shanzhi), Fraxini Chinensis Cortex (Qinpi), Calculus Bovis (Niuhuang), Arisaematis Cum Bile (Danning), Citri Reticulatae Pericarpium (Juhong), Gypsum Fibrosum (Sheng Shigao), Halloysit Rubra (Hanshui Shi), Lamina Aurum (Jinpiao).
Pills made with Fangzhu Water, taken with Decoction of Bambusa Leaves (Zhuye) and Juncus Lampapus (Dengxincao).

He (Elderly woman) Pulse diagnosis: Right Guan is wiry and slippery. Excessive phlegm, dry tongue slightly stiff, speech appears slurred. This is due to Phlegm-Fire clouding upwards, preventing fluids from ascending. In an elderly person, there is concern for Feng Fei (stroke with aphasia or paralysis).
Treatment should clear the Upper Jiao and unblock orifices; avoid harsh-drying and cloying-stagnating medicines.
Pinelliae Rhizoma Preparatum (Banxia), Dendrobii Officinalis Caulis (Jinshihu), Citri Reticulatae Pericarpium (Juhong), Gardeniae Fructus (Heishanzhi), Poria (Fuling), Curcumae Radix (Yujin), Glycyrrhizae Radix et Rhizoma (Sheng Gancao), Acori Tatarinowii Rhizoma (Shichangpu), Bamboo Juice (Zhuli), Ginger Juice (Jiangzhi).

Zhang Drowsy as if sleeping, spirit confused as if lost, Phlegm-Heat internally closed; the condition is not trivial. (Phlegm-Heat Internal Closure with Coma)
Pinelliae Rhizoma Preparatum (Banxia), Acori Tatarinowii Rhizoma (Shichangpu), Platycodonis Radix (Jiegeng), Ziziphi Spinosae Semen (Zhishi), Curcumae Radix (Yujin), Citri Reticulatae Pericarpium (Juhong), Bamboo Juice (Zhuli), Ginger Juice (Jiangzhi).

Certain case Depressive Phlegm. (Depressive Phlegm)
Prepared Pinelliae Rhizoma Qu (Banxiaqu), Curcumae Radix (Yujin), Acori Tatarinowii Rhizoma (Shichangpu), Gastrodiae Rhizoma (Tianma), Tribuli Fructus (Bajili), Citri Reticulatae Pericarpium (Juhong), Poria (Fuling), Uncariae Ramulus cum Uncis (Gouteng).

Tao Left pulse is wiry, firm, and forceful. Excessive phlegm, food digestion is difficult. This is due to excessive worry and depression, where Liver Wood insults Spleen and Stomach. For the elderly, it is best to keep the mind open to avoid progression to Ye Ge (dysphagia/chorea).
Pinelliae Rhizoma (Banxia), Ginger Juice (Jiangzhi), Poria (Fuling), Armeniacae Semen (Xingren), Curcumae Radix (Yujin), Citri Reticulatae Pericarpium (Juhong).
Re-evaluation: Pulse remains the same, Phlegm-Qi has not descended. Remove Armeniacae Semen (Xingren) from the previous formula, add Brassicae Semenis Albi (Baijiezi).

Jin (46 years old) Damp-Heat steaming internally, Phlegm-Fire increasing daily, the root gradually weakening. Yang leakage manifests as sweating, Yin leakage manifests as seminal emission. Alcoholics prefer refreshing foods; cloying and tonifying medicinal formulas are absolutely contraindicated. (Damp-Heat Steaming Phlegm) Zhu Du Wan (Pig Stomach Pill) formula.

Ye Long-term residence in southern humid lands, dampness from water and grain steams into heat and gathers into Phlegm. Pulse is deep and wiry, yellow eyes, limbs prone to sores. All indicate excess Damp-Heat, causing Qi tunnels to be unsmooth.
Treatment should use bitter, acrid, cold herbs to clear the interior and unblock the muscles. Following predecessors' theory that "Phlegm arises from Heat," clearing heat is essential.
Atractylodis Rhizoma (Sheng Maozhu), Phellodendri Cortex (Huangbai), Trichosanthis Fructus (Gualou Shi), Gardeniae Fructus (Shanzhi), Raphani Fructus (Laifuzi), Coptidis Rhizoma (Chuanlian), Pinelliae Rhizoma Preparatum (Banxia), Magnoliae Officinalis Cortex (Houpo), Citri Reticulatae Pericarpium (Juhong), Bamboo Juice and Ginger Juice Pills.

Certain case Post-illness, rich flavors steam and generate Phlegm.
Natrii Sulfas (Fenghua Xiao), Trichosanthis Semen Frost (Gualou Ren Shuang), Ziziphi Spinosae Semen (Zhishi), Curcumae Radix (Yujin), Raw Poria (Sheng Fuling), Gardeniae Fructus stir-fried with Ginger Juice (Jiangzhi Chao Shanzhi).
Pills made with Bamboo Juice method.

Wang Pulse distension, Dampness obstructing Hot Phlegm.
Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Gardeniae Fructus (Heishanzhi), Citri Reticulatae Pericarpium (Juhong), Processed Tribuli Fructus (Zhi Bajili), Polygalae Radix (Yuanzhi), Costi Fructus (Xiangxiang).

Xu Yang moves internally generating Wind; using herbs to nourish Liver and Kidney Yin to strengthen Water and control Yang is also a reasonable approach. In summer, Spleen and Stomach govern; Liver-Gallbladder Fire and Wind easily penetrate the diaphragm and invade the Middle. Middle Earth is insulted by Wood and Fire, Yangming pulse declines, excessive Phlegm, meridians are unsmooth. Proposal: Clear Shaoyang depressive heat so the Middle Palace becomes peaceful. If one fears deficiency and uses cloying tonics, the Upper and Middle become more full, while the Lower Jiao becomes more deficient. Er Chen Tang minus Glycyrrhizae Radix et Rhizoma, plus Dendrobii Nobile Caulis (Jinhu), Mori Folium (Sangye), Moutan Cortex (Danpi). (Wood-Fire invading Middle, Stomach Deficiency generating Phlegm)
Re-evaluation: Left pulse is floating, wiry, and rapid. Excessive Phlegm, discomfort in the epigastrium,烦躁 (vexation) causes Fire rising and dizziness; quiet sitting brings mental peace. Proposal: Treat Shaoyang and Yangming simultaneously.
Cornu Saigae Tataricae (Lingyangjiao), Forsythiae Fructus (Lianqiao), Citri Reticulatae Pericarpium (Guangpi), Prepared Pinelliae Rhizoma Qu (Chao Banxiaqu), Gardeniae Fructus Peel (Heishanzhi Pi), Fermented Soybean (Xiangchi).
Re-evaluation: Pulses on both hands have harmonized, only vexation,恍惚 (fluctuation/confusion), and desire for dizziness remain. Proposal: Use calming herbs to nourish Yin and harmonize Yang.
Ginseng Radix et Rhizoma (Renshen), Prepared Rehmanniae Radix (Shudi), Asparagi Radix (Tiantong), Lamina Aurum (Jinpiao).

Wang Phlegm-Fire is abundant in the Upper, Kidney Qi lacks grasping power. Morning: Unblocking and grasping Lower Jiao methods. Evening: Clearing and purifying Upper Jiao methods. (Liver-Kidney Deficiency with Phlegm-Fire above)
Cornu Saigae Tataricae (Lingyangjiao), Pinelliae Rhizoma Preparatum (Banxia), Poria (Fuling), Citri Reticulatae Pericarpium (Juhong), Gardeniae Fructus Peel (Heizhipi), Curcumae Radix (Yujin), Decoction of Ilex Kudingcha Tea (Kudingcha) for evening pills.
Prepared Rehmanniae Radix (Shudi), Cynomorii Fenestrati Rhizoma (Dancongrong), Lycii Fructus (Qizi), Schisandrae Fructus (Wuweizi), Achyranthis Bidentatae Radix (Niuxi), Poria (Fuling), Polygalae Radix (Yuanzhi), Gelatinum Corii Asini (Xianjiao), Honey Pills for morning consumption.

Cao (51 years old) Bright complexion indicates Phlegm-Fluid above, because Excess above leads to Deficiency below. Over fifty years old, unable to conceive. Pulse: Left small and restless, Right wiry and slippery. Treatment should clear Lung-Stomach Hot Phlegm and nourish Liver-Kidney Essence-Blood. Following Manqian's health preservation method.
Swallow Nest Gelatin (Yanwo Jiao), Sweet Pear Paste (Tianli Gao), Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi), Ophiopogonis Radix (Maidong), Dioscoreae Rhizoma (Shanyao), Poria (Fuling), Atractylodis Macrocephalae Rhizoma (Yuzhu), Huangjie, Heijie, Cervi Cornu Gelatinum (Luwei Jiao), Sheep Kidney (Yang Neishen), Cynomorii Fenestrati Rhizoma (Dancongrong), Psoraleae Fructus (Guzhi - steamed with Walnut), Green Salt (Qingyan).

Rui Always has excessive Phlegm and poor appetite, but Shen and Atractylodes did not suit him. This constitution is Yang-type, intolerant of warm-hot and harsh-drying agents. Last winter was warm; entering spring, Phlegm increased further, body felt slightly fatigued, due to unstable storage of Zang-Fu essence. Spring Qi rises from the earth. Treatment should grasp Kidney and secure True Qi; this is the root of treating Phlegm, making the prescription beneficial. (Kidney Deficiency with Excessive Phlegm)
Prepared Rehmanniae Radix (Shudi), Poria (Fuling), Psoraleae Fructus (Buguzhi), Walnut Kernel (Hutao Rou), Lycii Fructus (Qizi), Schisandrae Fructus (Wuweizi), Achyranthis Bidentatae Radix (Niuxi), Polygalae Radix (Yuanzhi), Plantaginis Seed (Cheqian), Honey Pills.

The manifestations of Phlegm diseases vary unpredictably. Ancients did not investigate root and branch, often focusing on Phlegm-resolving prescriptions and theories. Later generations followed these methods without success, leading some to call Phlegm a strange disease. They did not realize that Phlegm is the branch (symptom), not the root (cause). Skilled practitioners treat the source that generates Phlegm, so Phlegm disappears without direct resolution. I have carefully examined: Phlegm is transformed from food and drink. It can arise from external invasion of Six Qi pathogens, disrupting the ascending-descending mechanism of Spleen, Lung, and Stomach, leading to unclear transformation of food. It can arise from excessive consumption of sweet, greasy, fatty, fishy, tea, and alcohol. It can arise from inherent Spleen-Stomach Yang deficiency, causing damp-turbidity to coagulate. It can arise from depression causing Qi and Fire to stagnate and transform. There is also Phlegm generated by Kidney Deficiency causing water to overflow. This is due to Earth failing to control Water, causing Yin turbidity from Kidney to rebel upward, not actual water flooding from the Kidney itself. Furthermore, in Yin Deficiency consumptive diseases, Dragon and Minister Fire flaming upward scorches the Lung, causing Phlegm-cough. This Phlegm is transformed from body fluids and is not thick. Attempting to resolve it is not only useless but damages fluids. All other Phlegms initially arise from Dampness. Although named Wind, Fire, Dryness Phlegm, they all transform via Qi; Wind, Fire, and Dryness do not generate Phlegm independently. The primary treatment method: only when Phlegm and Qi suddenly block the throat should one temporarily use expectorant and Qi-descending agents to open it. Otherwise, one must treat the root. Thus, the ancient saying "Do not treat Phlegm when seeing Phlegm" is a timeless maxim. Phlegm is transformed from food dampness and turbidity; how can one forbid diet? If one solely tries to resolve it, for cases due to external pathogens, resolving the pathogen may clear the Phlegm, e.g., warming Cold Phlegm, clearing Heat Phlegm, drying Damp Phlegm, moistening Dry Phlegm, dispersing Wind Phlegm. For cases involving the root, Phlegm will continuously regenerate until death. This is due to not knowing how to treat the root. Observing the cases here: for those due to depression and fire, opening depression and clearing fire is the sovereign herb, assisting with Phlegm resolution; for those due to dampness and heat, drying dampness and clearing heat with slight assistance of Phlegm-resolving herbs; for those due to Liver-Kidney deficiency, purely sedating and securing tonification. These truly understand the root of treating Phlegm. For Cold and Damp, refer to the Phlegm-Fluid section for combined treatment. (Commentary by Hua Xiuyun)

Xu's Commentary: The listed prescriptions are all for floating Phlegm in Lung and Stomach. For old Phlegm penetrating meridians and collaterals, occupying viscera, or hiding in the Triple Burner, there are still harsh and refined formulas; these types of formulas cannot achieve efficacy.