(饮)
痰本吾身之津液，随气营运。气若和平，津流液布，百骸受其润泽，何致成痰
为病？苟气失其清肃而过于热，则津液受火煎熬转为稠浊；或气失温和而过于寒，
则津液因寒积滞，渐致凝结，斯痰成矣。故痰一也，而因寒因热其源不同，可概治
欤？辨别之法，古以黄稠者为热，稀白者为寒，此特言其大概而不可泥也。试以外
感言之，余尝自验。伤风咳嗽，痰随嗽出，频数而多。色皆稀白。误作寒治，遂致
困顿，后悟其理，方知为热极所致。盖火盛壅逼，频咳频出，停留不久，故未至于
黄稠耳。迨火衰气平，咳嗽渐息，痰之出者，半日一口，反黄而稠，则火不上壅，
痰得久留，受其煎炼所致，而病亦遂愈。方知黄稠之痰，火气尚缓而微；稀白之痰，
火势反急而盛也。此皆当用辛凉解散，而不宜于温热者也。又以内伤言之，肾火虚，
水泛为痰，其痰清稀，当用温热，固也。即肾火盛，水沸为痰，其痰亦清稀。盖龙
雷动而雨水随之，卒然上涌，虽略带浊沫，终非黄稠可比，亦宜用甘寒壮水，而不
宜于温热者也。孰谓稀白之痰，必属于寒哉？大抵稀白而吐 者，必属寒。（予尝吐痰，
出喉冰冷，虽咳嗽频并，而不咳之时多，仍是 非数，用温胃敛肺之药而愈。然又有
痰出喉甚冷，而证仍属热者，盖痰本水属，积久而多，则火不能温也。故张子和谓∶新痰热，旧痰寒。）
吐数而因伤风郁热者，及内伤雷龙火动者，必属热。因于脾气虚寒不能摄涎，频吐遍地者，必属寒。（其人安
静无他，既非伤风咳嗽，又非雷龙火动，可辨。）此等须细为辨别，更当参之以脉，
可见也。有气化之津液，有饮食之津液，胃者津液之海也，故痰聚焉。积久聚多，随脾胃之气以
四讫，则流溢于肠胃之外，躯壳之中。经络为之壅塞，皮肉为之麻木，甚至结
成窠囊牢不可破，其患固不一矣。法在平调其气，热者使复清肃之常，凉风生而湿
土燥；寒者使回阳和之令，旭日出而坚冰消。气得其平，痰源以绝，而后其停蓄于
肠胃之内、肌肤之中者，乃可徐图。否则根株不拔，旋去旋生，无奏效之日矣。更
有一妙义，痰随气行，既随气以出于肠胃之外，亦随气以入于肠胃之内，若潮之往
返。然人身之气，日则行于外，夜则返于内者也，故遇夜安卧。晨兴盥嗽则吐痰独
多，岂非痰随夜气内返于胃之故乎？然则往者必令复返，外者必令复内，乃有出路。
否则迷留经络之中，难于消导矣。喻嘉言发明此理，谓人不宜夜食，恐脾胃之气因
食运动，外达而不内收，痰难返胃，诚为笃论。然遇夜而劳扰不息，更属大戒。举一
返三，喻氏之说，所当推展也。
风痰属肝，脉弦面青，肢体痛闷、麻痹，便溺秘涩，（详二便及中风门。）心多郁怒，
或成瘫痪，搐搦眩晕，水煮金花丸、川芎丸、防风丸、祛风丸、导痰丸。星、半、
天麻、牙皂、僵蚕、秦艽，皆治风痰，可用吐法。或因痰闷绝，乌药、枳壳、明星、
姜汁，灌之即醒。
热痰属心，脉洪面赤，烦热燥渴，多笑，眩晕嘈杂，头风烂眼，或背心一点冰
冷，痰多稠浊，小黄丸、黄芩利膈丸（见痞）、滚痰丸。当下者，控涎丹加盆硝等分，每
服三两丸。栝蒌仁、芩、连、青黛、山栀、二冬、竹沥、童便可用。因暑得者，消
暑丸。（见伤暑。）
湿痰属脾，脉缓面黄，肢体重，倦弱嗜卧，腹胀食不消，泄泻，关节不利，或
作肿块，麻木不仁，白术丸。二术、星、半、茯苓、泽泻可用。肿块加乳、没；臂
痛加薄、桂、姜黄；肋胀加柴胡、白芥、青皮，滚痰丸最利；饮盛者小胃丹。湿痰，
多而易出。痰之动湿也，主于脾，或由脾气壅滞不行，或由脾气虚寒不运而生。
气痰属肺，脉涩面白，气上喘促，洒淅寒热，悲愁不乐，攻注走刺不定，两肋
胀痛，玉粉丸，局方桔梗汤。二陈汤去甘草，加香附、木香、砂仁、枳壳、乌药、
苏子、青皮、竹沥、姜汁。气郁，七气汤（见气）、越鞠丸（见郁）。痰少而粘连不易出，气燥
也。宜润之，门冬、地黄、枸杞之属，使肺气得清肃下行。
寒痰属肾，脉沉面黑，足寒，心多恐怖，痞塞、骨痹，四肢不举，姜桂丸、局
方胡椒理中丸。干姜决不可少，甚则加桂、麻黄、细辛。痰之本，水也，原于肾。
肾火虚则水泛为痰，其痰清，八味丸。火盛则水沸为痰，有浊沫，六味丸。（水沸为痰，
暴壅也。若火非涌盛，而但热涸者，痰则稠粘。此二者皆属于热，不作寒论。）
又有因惊而心神出舍，舍空痰入，多成心痛癫疾，妇人因产受惊，多有此证。
腹有如孕一块，转动跃跳，痛不可忍，甘遂、大戟、白芥子，加朱砂。痛加全蝎，
成块加山甲、炒鳖甲、玄胡、莪术。
食积生痰，多成疟痢，痞块，口嗳食臭，山楂、神曲、麦芽、枳壳、木香、黄
连。滚痰丸亦妙，或保和丸。（见伤饮食。）饮酒生痰，常多呕恶，食不美，妙应丸加雄
黄、全蝎各二钱，每服十丸。
老痰即郁痰，结成粘块，吐咯不出，非南星、半夏、茯苓、苍术可治。青黛为
主，五倍、海石、苦梗、旋复花、栝蒌仁、芒硝。痰核，痰结喉咙，如梅核状，用
梅子半青半黄、每一个用盐一两浸晒数次，以水尽为度，用大钱三个夹梅两个，麻
线扎定，贮瓦罐，埋地下百日。含口中，汁下即消。又一法，用海石、乌梅、栝蒌、
桔梗、芒硝、射干、海藻、姜汁，蜜为丸，噙。（又见咽喉。）
头面颈项身之中，下有结核，不红不痛，不硬不作脓，皆痰核。脾肺气逆，痰
滞于内，顺气消痰自愈。亦有郁怒伤损肝脾，血病结核者，宜养血清肝火。外用白
果肉、南星捣贴。
痰在身，习习如卧芒刺，如虫行；或走注疼痛；或燥痒，搔之则瘾疹随生。痰
在皮毛，烘热，色如锦斑。痰在头，偏头风，雷头风，头眩。痰在额，额闷痛，眉
棱痒痛。痰在目，目晕，眼蠕动，如姜蜇胶粘痒涩，目中时出火星，眼前如见白气，
或见两月交辉，或见金光数道，或眼前黑暗，或眼皮下烟灰黑色。痰在耳，轮痒痛，
蝉鸣水响。痰在鼻，鼻塞，或闻焦臭。痰在口，齿颊痒痛，牙床浮，口糜舌烂，口
燥唾稠，呕冷涎、绿水、黑汁，胡言，不语。痰在面，形枯发焦，颔腮肿硬，似疼
非疼。痰在颈项，无故肿，绕项结核，喉痹，痰如破絮、桃胶、蚬肉，咯不
出，咽不下，或噎塞烦闷，如烟火上冲，头面烘热，或喉间豆腥。痰在四肢，
肩背酸疼肿硬，似疼非疼，或筋骨疼无常处，难名状，或手麻臂疼，状如风湿，或
倏然仆地，四肢厥冷，或麻木不仁，或重滞，或牵引，或不举，非竹沥、姜汁不开，
二陈加枳壳、南星、木香、姜黄。痰在心胸，噫气吞酸嘈杂，或痛或秽，（干呕也。）或
心下如停冰铁，或惊悸怔忡如畏人捕，或胸膈迷闷如癫呆状，或痞满、健忘、恶心。
痰在脊背，脊上冰冷一条如线，或冰冷一点，疼痛，或如热汤沃背。
痰在两肋，肋胀痛如汤沸，非白芥子不能达。痰在腰肾，腰间骨节卒痛，呼吸
难任。痰在二便，癃闭秘结，遗同米泔，粪后鱼冻，妇人月水不通。痰在足，足腕
酸软，步履如踏灰上。痰在梦，寐睡时魇，梦刑戳刀兵，梦入人家，四壁
围绕，一实得出，不知何所，梦在烧人地上，烟火枯骨，焦气扑鼻，无路可出，或
不因触发，忿怒悲啼而寤，怪诞百般，不可殚述。隐君悉以滚痰丸治之。
庞安常有言，人身无倒上之痰，天下无逆流之水。故善治痰者，不治痰而治气，
气顺则一身之津液亦随气而顺矣。并宜苏子降气汤（见气）、导痰汤各半帖合煎；或小半
夏茯苓汤加枳实、木香各半钱，吞五套丸；或以五套丸料，根据分两作饮子煎服，亦好。
按痰，标也；所以致痰者，本也。治病固当求本，然须看痰势缓急，缓则治本
固也。若痰势盛急，度难行散，非攻无由去者，虚人可标本并治，攻补兼施。若势
甚紧急，则虽虚人亦当先攻后补，如中风之用三生饮（见诸中）、控涎丹是也。当此咽喉
闭塞之时，不吐去其痰，立即堵塞而死矣。昧者乃畏其虚而不敢用，独不畏其死耶。
夫人之虚，莫虚于中风者矣，犹必先攻后补，乃于寻常虚人，反畏之耶。《准绳》谓∶
治痰固宜补脾以复健运之常，使痰自化。然停积既久，如沟渠壅遏，瘀浊臭秽，无
所不有，若不疏通，而欲澄治已壅之水而使之清，决无是理。又谓∶凡病痰饮而变
生诸证，不当为诸证牵掣，且以治饮为先。如头风眉棱骨疼，累月风药不效，投痰
药收功；眼赤羞明而痛，与凉药弗瘳，授痰剂获愈云云，真格言也。（按二证皆痰壅热上。）
喻嘉言曰∶脾之湿热，胃之壮火，交煽互蒸，结为浊痰，溢入上窍，久久不散，透
开肺膜，结为窠囊。窠囊之痰，如蜂子之穴于房中，如莲实之嵌于蓬内，生长则易，
剥落则难。繇其外窄中宽，任行驱导，徒伤他脏，此实闭拒而不纳耳。究
而言之，岂但窠囊之中痰不易除，即肺叶之外、膜原之间，顽痰胶结多年，如树之
有萝，如屋之有游，如石之有苔，附托相安，仓卒有难于刻伐者，治法必静以
驭气，使三阴之火不上逆。又必严以驭脾，使太阴之湿不上蒸，乃广服大药，以安
和五脏，培养肺气。肺金之气一清，则周身之气翕然从之下降，前此上升浊邪，允
绝其源矣。又曰∶人身之气，经盛则注于络，络盛则注于经。窠囊之成，始于痰聚
胃口，呕时数动胃气，胃气动则半从上出于喉，半从内入于络。胃之络贯膈者也，
其气奔入之急则冲透膈膜，而痰得以居之，日增一日，故治之甚难。必先去胃中之
痰，而不呕不触，俾胃经之气不急奔于络，转虚其胃以听络中之气返还于胃，逐渐
以药开导其囊而涤去其痰，则自愈矣。又曰∶李继江常苦咳嗽生痰，胸膈不宽。今
夏秋间卧床不起，濒亡者再，将家事分拨，安心服死，忽觉稍安，亦心死则身
康之一征也。未几仍与家事，其病复作。就诊，见其颐旁有小小垒块数十高出，谓
之曰∶观尔脉盛筋强，必当好色而喜任奔走，本病宜发痈疽。所以得免者，以未享
膏粱之奉，且火才一动，便从精孔泄出耳。然虽不病痈，而病之所造，今更深矣。
尔胸背肩 间， 岩如乱石插天，栉比如新笋出土，嵌空如蜂莲之房，芒
锐如棘栗之刺，每当火动气升，痰壅紧逼之时，百苦交煎，求生不生，求死不死，
比桁杨之罪人，十倍过之。由好色作劳，气不归元，腾空而上，入于肝肺，散
叶空隙之间、膜原之内者，日续一日，久久渐成熟路，只俟肾气一动，千军万马乘
机一时奔辏，有入无出，如潮不返，海潮兼天涌至，倘后潮不熄则前潮不退，古今
死于此病者，不知其几。但尔体坚堪耐，是以病至太甚，尚自无患耳。尔宜归家休
心息神，如同死去，俾火不妄动，则痰气不为助虐，胸背之坚垒始有隙可入，吾急
备药，为尔覆巢捣穴，可得痊也。渠以为病未即死，且往乡征租，因劳陡发，暴不
可言，痰出如泉，声响如锯，面大舌胀，喉硬目突，二日而卒。
饮者，停水之名。又痰之清稀者曰饮，故痰饮并称。《金匮》谓饮有四∶其人
昔肥今瘦，（由津液尽化痰饮，不复外充形体也。）水走肠间，沥沥有声，曰痰饮。饮后水流胁
下，咳吐引痛，曰悬饮。（悬结于胁中，不上不下也。）饮水流行，归于四肢，当汗出而汗不
出，身体疼重，谓之溢饮。（饮水乃有形之水，非水精四布之水，止宜下行从小便出。今不下行而旁达，
应从汗泄而不得化汗以出，故身体疼重，即风水水肿之病也。曰溢者，言泛溢于四旁也。）咳逆倚息，气短（倚，
坐而倚物也，以不得卧故。息，呼吸也，气短、喘急也。）不得卧，（气逆使然。）其形如肿，
（面多肿。）曰支饮。（水停于胸，在心肺之侧，如木之旁枝也。按此四饮，乃随其部位分言耳。）又谓∶
心下有留饮，（久而不去名留。）背寒冷，如掌大，（阻遏心阳故背寒冷。）胁下痛引缺盆，（留于胁则碍肝气，故胁痛。
缺盆为十二经道路，故引及之。）咳嗽则转甚。（气逆也。）胸中有留饮，其人短气（肺气被迫也）而渴，（水阻气
不布，不能化生津液，故胸虽停水，而咽喉则干也。）四肢历节痛，（留于身体则塞经络，故肢痛。由此推之，
留于脾分则腹肿身重，留于肾部则囊、足胫肿，理必然矣。此言留饮，及下文言伏饮，乃上四饮之总纲也。）又谓∶
膈上病痰，（饮留膈上，伏而不出，煎炼成痰也。）满喘咳吐，（留伏日多，故胸满。肺气被迫，而喘咳且吐痰
也。）发则寒热，背痛腰冷，（发，谓伏而发也。今之值秋寒，或感春风而发。发则喘满，咳吐痰多，寒热，
背痛腰疼，俗名吼喘病者此也。）目泣自出，（咳甚则肺叶举，而目泣自出也。）振振身 ，（喘咳甚则身动，即
抬肩摇身也。）必有伏饮。（伏而难攻也，比留为更甚矣。）又谓∶水停心下，甚者则悸，（心气为水所逼，
（饮）
痰原本是我们身体的津液，随着气的运行而流动。如果气机平和，津液就能正常流布，全身骨骼关节都能得到滋润，怎么会形成痰成为疾病呢？假如气失去了清肃的特性而过热，津液就会受到火的煎熬变成稠厚浑浊；或者气失去了温和的特性而过寒，津液就会因为寒冷而积滞，逐渐凝结，这样痰就形成了。所以痰虽然是一种东西，但因为寒或热导致的原因不同，可以一概而论地治疗吗？辨别的方法，古人认为黄色稠厚的是热证，稀白的是寒证，这仅仅是说大概情况，不能拘泥于此。试着从外感病来说，我曾经自己验证过。伤风咳嗽时，痰随着咳嗽出来，次数频繁而且量多。颜色都是稀白的。如果错误地当作寒证治疗，就会导致病情困顿加重，后来领悟了其中的道理，才知道这是热极所致。因为火势旺盛壅塞逼迫，频繁咳嗽频繁排痰，痰停留的时间不久，所以还没有变黄变稠。等到火气衰退、气机平复，咳嗽逐渐停止，排出的痰变成半天才一口，反而变黄变稠，这是因为火气不再上壅，痰得以长时间停留，受其煎炼所致，而病也就痊愈了。这才知道黄色的稠痰，火气尚且缓慢轻微；稀白的痰，火势反而急迫旺盛。这些都应该用辛凉解散的方法，而不适宜用温热药。再从内伤病来说，肾火虚弱，水泛溢为痰，这种痰清稀，应当用温热药，这是肯定的。即使是肾火旺盛，水沸腾为痰，这种痰也是清稀的。因为龙雷之火妄动，雨水随之而来，突然向上涌出，虽然略带浊沫，终究不能和黄稠的痰相比，也适宜用甘寒壮水的方法，而不适宜用温热药。谁说稀白的痰一定属于寒证呢？大抵稀白并且吐出来感觉冰冷的，一定属于寒证。（我曾经吐痰，痰出喉咙感觉冰冷，虽然咳嗽频繁，但不咳嗽的时候多，脉象仍然不是数脉，用温胃敛肺的药治好了。然而又有痰出喉咙很冷，但证候仍然属于热的，因为痰本质属水，积聚久了且多，火就不能温暖它。所以张子和说：新痰属热，旧痰属寒。）频繁呕吐且因伤风郁热导致的，以及内伤导致雷龙之火妄动的，一定属于热证。因为脾气虚寒不能摄纳涎液，频繁吐痰遍地都是的，一定属于寒证。（这种人安静没有其他症状，既不是伤风咳嗽，也不是雷龙火动，可以辨别。）这种情况必须仔细辨别，更应当参考脉象，就可以看出来了。有气化生成的津液，有饮食转化的津液，胃是津液的海洋，所以痰聚集在这里。积聚久了聚积多了，随着脾胃之气向四周扩散，就会流溢到肠胃之外，躯壳之中。经络因此被壅塞，皮肉因此麻木，甚至结成窠囊牢不可破，其危害确实不止一端。治疗方法在于平调气机，热证的使气恢复清肃的正常状态，像凉风吹来湿土变干；寒证的使阳气回复和顺的命令，像旭日东升坚冰消融。气得到平衡，痰的来源断绝，然后那些停蓄在肠胃之内、肌肤之中的痰，才可以慢慢图谋消除。否则根株不拔除，刚去掉又生出来，就没有见效的日子了。更有一个精妙的道理，痰随着气运行，既然随着气到了肠胃之外，也会随着气进入肠胃之内，像潮水的往返一样。然而人体的气，白天行于体表，夜晚返回体内，所以遇到晚上安睡，早晨起床洗漱漱口时吐痰特别多，难道不是痰随着夜气内返于胃的缘故吗？那么过去的（在外面的）一定要让它返回，在外的（在体表的）一定要让它回到内里，才有出路。否则迷留在经络之中，难以消导。喻嘉言阐发这个理论，说人不宜晚上吃东西，恐怕脾胃之气因为食物运动，向外发散而不能内收，痰难以返回胃中，这确实是确切的议论。然而遇到晚上劳累扰动不停息，更是大忌。举一反三，喻氏的说法，应当推广运用。
风痰属于肝，脉弦面色青，肢体疼痛闷胀、麻痹，大小便闭塞涩滞，（详见二便及中风门）。心中多郁怒，或形成瘫痪，抽搐强直眩晕，可用水煮金花丸、川芎丸、防风丸、祛风丸、导痰丸。天南星、半夏、天麻、牙皂、僵蚕、秦艽，都是治疗风痰的药物，可以使用吐法。如果因痰闷绝昏迷，用乌药、枳壳、天南星、姜汁，灌下去就能醒过来。
热痰属于心，脉洪大面色红赤，烦躁发热干燥口渴，爱笑，眩晕嘈杂，头风烂眼，或者背心有一点冰冷，痰多稠浊，可用小黄丸、黄芩利膈丸（见痞）、滚痰丸。应当攻下的，用控涎丹加盆硝各等分，每次服用三两丸的量（注：此处原文“三两丸”疑为剂量单位误植或特指丸剂数量，依原文翻译）。瓜蒌仁、黄芩、黄连、青黛、山栀、天冬麦冬、竹沥、童便可以使用。因暑邪引起的，用消暑丸。（见伤暑。）
湿痰属于脾，脉缓面色黄，肢体沉重，疲倦乏力嗜睡，腹胀食物不消化，泄泻，关节不利，或者形成肿块，麻木不仁，可用白术丸。苍术白术、天南星、半夏、茯苓、泽泻可以使用。肿块加乳香没药；臂痛加薄荷、桂枝、姜黄；肋胀加柴胡、白芥子、青皮，滚痰丸最有利；水饮盛者用小胃丹。湿痰，多而且容易吐出。痰的变动由湿引起，主宰于脾，或者是因为脾气壅滞不行，或者是因为脾气虚寒不运化而生。
气痰属于肺，脉涩面色白，气逆喘促，洒淅恶寒发热，悲伤忧愁不快乐，气攻走刺痛不定，两肋胀痛，可用玉粉丸，局方桔梗汤。二陈汤去掉甘草，加香附、木香、砂仁、枳壳、乌药、苏子、青皮、竹沥、姜汁。气郁，用七气汤（见气）、越鞠丸（见郁）。痰少且粘连不易吐出，是气燥。应当润之，用麦冬、地黄、枸杞之类，使肺气清肃下行。
寒痰属于肾，脉沉面色黑，脚冷，心中多恐惧，痞塞、骨痹，四肢不能举动，可用姜桂丸、局方胡椒理中丸。干姜绝对不可少，严重时加桂枝、麻黄、细辛。痰的根本是水，源于肾。肾火虚则水泛溢为痰，这种痰清稀，用八味丸。火盛则水沸腾为痰，有浊沫，用六味丸。（水沸腾为痰，是暴发性壅塞。如果火不是涌盛，只是热而干枯，痰则稠粘。这两种都属于热，不按寒证论治。）
又有因为惊吓导致心神离舍，舍空痰入，多形成心痛癫疾，妇人因为生产受惊，多有此证。腹部像怀孕有一块东西，转动跳跃，疼痛不可忍受，用甘遂、大戟、白芥子，加朱砂。痛甚加全蝎，成块加穿山甲、炒鳖甲、玄胡索、莪术。
食积生痰，多形成疟痢，痞块，口中有嗳气食臭味，用山楂、神曲、麦芽、枳壳、木香、黄连。滚痰丸也很好，或者保和丸。（见伤饮食。）饮酒生痰，常多呕吐恶心，食欲不佳，用妙应丸加雄黄、全蝎各二钱，每次服用十丸。
老痰即郁痰，结成粘块，吐咯不出来，非天南星、半夏、茯苓、苍术可治。以青黛为主，配五倍子、海浮石、苦桔梗、旋覆花、瓜蒌仁、芒硝。痰核，痰结在喉咙，像梅核形状，用半青半黄的梅子半个，每一个用盐一两浸泡晒数次，以水尽为度，用大铜钱三个夹住两个梅子，用麻线扎紧，贮存在瓦罐里，埋在地下百日。含在口中，汁液咽下即消。又一方法，用海浮石、乌梅、瓜蒌、桔梗、芒硝、射干、海藻、姜汁，蜜做成丸，噙化。（又见咽喉。）
头面颈项身之中，下有结核，不红不痛，不硬不作脓，都是痰核。脾肺气逆，痰滞于内，顺气消痰自愈。也有因郁怒损伤肝脾，血病形成结核的，宜养血清肝火。外用白果肉、南星捣碎贴敷。
痰在身上，感觉像躺着芒刺，像虫子爬；或者游走性疼痛；或者干燥瘙痒，搔抓则瘾疹随之产生。痰在皮毛，烘热，颜色像锦缎斑纹。痰在头，偏头风，雷头风，头晕目眩。痰在额，额头闷痛，眉棱骨痒痛。痰在目，眼晕，眼球蠕动，像姜蜇胶粘痒涩，眼中时常冒出火星，眼前像看见白气，或者看见两轮月亮交辉，或者看见几道金光，或者眼前黑暗，或者眼皮下有烟灰黑色。痰在耳，耳轮痒痛，蝉鸣水响。痰在鼻，鼻塞，或者闻到焦臭味。痰在口，齿颊痒痛，牙床浮肿，口糜舌烂，口燥唾稠，呕吐冷涎、绿水、黑汁，胡言乱语，不语。痰在面，形体枯槁头发焦黄，下巴腮帮肿硬，似疼非疼。痰在颈项，无故肿胀，绕项结核，喉痹，痰像破絮、桃胶、蚬肉，咯不出来，咽不下去，或者噎塞烦闷，像烟火上冲，头面烘热，或者喉间有豆腥味。痰在四肢，肩背酸痛肿硬，似疼非疼，或者筋骨疼痛没有固定位置，难以名状，或者手麻臂疼，状如风湿，或者突然仆倒在地，四肢厥冷，或者麻木不仁，或者重滞，或者牵引，或者不能举动，非竹沥、姜汁不能开通，用二陈汤加枳壳、南星、木香、姜黄。痰在心胸，打嗝吞酸嘈杂，或者痛或者秽臭，（干呕），或者心下像停放着冰铁，或者惊悸怔忡像怕人抓捕，或者胸膈迷闷像痴呆状，或者痞满、健忘、恶心。痰在脊背，脊背上冰冷一条像线，或者冰冷一点，疼痛，或者像热汤浇背。
痰在两肋，肋胀痛像开水沸腾，非白芥子不能到达。痰在腰肾，腰间骨节突然疼痛，呼吸难以承受。痰在二便，小便癃闭秘结，遗尿像米泔水，大便后像鱼冻，妇女月经不通。痰在足，足踝酸软，走路像踩在灰上。痰在梦，睡觉时魇镇，梦见刑罚刀兵，梦见进入别人家，四壁围绕，无法出去，不知道去哪里，梦见在烧人的地上，烟火枯骨，焦气扑鼻，无路可出，或者不因触发，愤怒悲啼而醒来，怪诞百般，不可尽述。李中梓全部用滚痰丸治疗。
庞安常曾说，人身没有倒上的痰，天下没有逆流的水。所以善于治痰的人，不治痰而治气，气顺则一身之津液也随着气而顺了。并宜用苏子降气汤（见气）、导痰汤各半帖合煎；或者小半夏茯苓汤加枳实、木香各半钱，吞服五套丸；或者用五套丸的药料，按照分量作饮子煎服，也好。
按：痰，是标；所以导致痰的，是本。治病固然应当求本，但是必须看痰势的缓急，缓则治本是肯定的。如果痰势盛急，估计难以行散，非攻逐无法去除的，虚人可以标本并治，攻补兼施。如果形势非常紧急，那么即使是虚人也应当先攻后补，如中风用的三生饮（见诸中）、控涎丹就是这样。当此时咽喉闭塞的时候，不吐去其痰，立即堵塞而死。愚昧的人害怕病人虚不敢用，难道不怕他死吗？人的虚，没有比中风更虚的了，还要先攻后补，对于寻常虚人，反而害怕吗？《准绳》说：治痰固然应该补脾以恢复健运的正常状态，使痰自化。然而停积已久，像沟渠壅塞，瘀浊臭秽，无所不有，如果不疏通，而想澄清已经壅塞的水使之清澈，决无此理。又说：凡是病痰饮而变生各种证候，不应当被各种证候牵掣，且以治饮为先。如头风眉棱骨疼，累月用风药无效，投用痰药收功；眼赤羞明而痛，用凉药不愈，给予痰剂获愈等等，真是格言啊。（按：这两个证候都是痰壅热上。）
喻嘉言说：脾的湿热，胃的壮火，交煽互蒸，结为浊痰，溢入上窍，久久不散，透开肺膜，结为窠囊。窠囊的痰，像蜂子在房中筑穴，像莲子嵌在莲蓬内，生长则容易，剥落则难。因为它外窄中宽，任凭驱导，徒然伤害其他脏腑，这实际上是闭拒而不接纳。究其根本而言，岂但窠囊中的痰不易清除，就是肺叶之外、膜原之间，顽痰胶结多年，像树上有萝，像屋里有游尘，像石头上有苔，依附相安，仓促间难于砍伐，治法必须静以驭气，使三阴之火不上逆。又必须严以驭脾，使太阴之湿不上蒸，乃广服大药，以安和五脏，培养肺气。肺金之气一清，则周身之气翕然随之下降，此前上升的浊邪，确实断绝了源头。又说：人身之气，经盛则注入络，络盛则注入经。窠囊的形成，始于痰聚胃口，呕吐时多次触动胃气，胃气动则一半从上出于喉，一半从内入于络。胃的络脉贯穿膈肌，其气奔入急促则冲透膈膜，而痰得以占据，日增一日，所以治疗很难。必须先去除胃中的痰，而不呕吐不触动，使胃经之气不急奔于络，转虚其胃以听任络中之气返还于胃，逐渐以药开导其囊而涤去其痰，则自愈了。又说：李继江常苦于咳嗽生痰，胸膈不宽。今年夏秋间卧床不起，濒临死亡两次，将家事分拨安排，安心服死，忽然觉得稍安，这也是心死则身康的一个征兆。不久又参与家事，病又发作。就诊，见他颐旁有小小垒块数十高出，对他说：观你脉盛筋强，必定好色而喜欢奔走，本病应当发痈疽。之所以得以免除，是因为未享受膏粱之奉，且火才一动，便从精孔泄出罢了。然而虽不病痈，而病所造成，如今更深了。你胸背肩之间，岩层如乱石插天，栉比如新笋出土，嵌空如蜂莲之房，芒锐如棘栗之刺，每当火动气升，痰壅紧逼之时，百苦交煎，求生不生，求死不死，比受桁杨之罪的犯人，十倍过分。由于好色作劳，气不归元，腾空而上，入于肝肺，散叶空隙之间、膜原之内者，日续一日，久久渐成熟路，只待肾气一动，千军万马乘机一时奔凑，有入无出，如潮不返，海潮兼天涌至，倘若后潮不熄则前潮不退，古今死于此病者，不知其几。但你身体坚固能耐受，所以病至太甚，尚且无患。你应当回家休心息神，如同死去，使火不妄动，则痰气不为助虐，胸背的坚垒始有隙可入，我急忙备药，为你覆巢捣穴，可得痊愈。他认为病未即刻死，且去乡里征收租税，因劳陡发，暴病不可言，痰出如泉，声响如锯，面大舌胀，喉硬目突，二日而卒。
饮，是停水的名目。又是痰中清稀的叫饮，所以痰饮并称。《金匮》说饮有四：那人过去肥现在瘦，（因为津液都化为痰饮，不再外充形体也），水走肠间，沥沥有声，叫痰饮。饮水后水流胁下，咳吐引痛，叫悬饮。（悬结于胁中，不上不下也。）饮水流行，归于四肢，应当出汗而汗不出，身体疼重，叫做溢饮。（饮水乃有形之水，非水精四布之水，只宜下行从小便出。今不下行而旁达，应从汗泄而不得化汗以出，故身体疼重，即风水水肿的病。曰溢者，言泛溢于四旁也。）咳逆倚息，气短（倚，坐而倚物也，因为不能卧故。息，呼吸也，气短、喘急也。）不能卧，（气逆使然。）其形如肿，（面多肿。）叫支饮。（水停于胸，在心肺之侧，像树的旁枝也。按：这四饮，乃是随其部位分说罢了。）又说：心下有留饮，（久而不去叫留。）背寒冷，如掌大，（阻遏心阳故背寒冷。）胁下痛引缺盆，（留于胁则碍肝气，故胁痛。缺盆为十二经道路，故引及之。）咳嗽则转甚。（气逆也。）胸中有留饮，其人短气（肺气被迫也）而渴，（水阻气不布，不能化生津液，故胸虽停水，而咽喉则干也。）四肢历节痛，（留于身体则塞经络，故肢痛。由此推之，留于脾分则腹肿身重，留于肾部则囊、足胫肿，理必然矣。此言留饮，及下文言伏饮，乃上四饮之总纲也。）又说：膈上病痰，（饮留膈上，伏而不出，煎炼成痰也。）满喘咳吐，（留伏日多，故胸满。肺气被迫，而喘咳且吐痰也。）发则寒热，背痛腰冷，（发，谓伏而发也。今之值秋寒，或感春风而发。发则喘满，咳吐痰多，寒热，背痛腰疼，俗名吼喘病者此也。）目泣自出，（咳甚则肺叶举，而目泣自出也。）振振身 ，（喘咳甚则身动，即抬肩摇身也。）必有伏饮。（伏而难攻也，比留为更甚矣。）又说：水停心下，甚者则悸，（心气为水所逼，
(Yin - Fluid Retention)
Phlegm (Tan, pathological accumulation of dampness and fluids) is originally the body's Jin-Ye (body fluids), circulating with Qi. If Qi is harmonious, Jin-Ye flows and spreads, nourishing all bones and joints; how could it become Phlegm and cause disease? If Qi loses its clear and descending nature and becomes overly hot, Jin-Ye is boiled by Fire and turns thick and turbid; or if Qi loses its warmth and becomes overly cold, Jin-Ye stagnates due to Cold and gradually condenses, thus forming Phlegm. Therefore, although Phlegm is one entity, the causes differ between Cold and Heat; can they be treated uniformly? The method of differentiation: ancients considered yellow and thick Phlegm as Heat, and thin and white Phlegm as Cold. This merely describes the general situation and should not be applied rigidly. Let us speak from the perspective of external contraction. I have verified this myself. In wind-cold injury with cough, Phlegm comes out with coughing, frequently and in large amounts. The color is always thin and white. Mistakenly treating it as Cold leads to worsening condition. Later, understanding the principle, I realized it was caused by extreme Heat. Because Fire was excessive and obstructive, frequent coughing expelled Phlegm quickly, leaving little time for it to turn yellow and thick. When Fire subsided and Qi calmed, coughing ceased, but the expelled Phlegm became yellow and thick, appearing only once every half day. This was because Fire no longer surged upward, allowing Phlegm to remain longer and undergo further boiling/concentration, leading to recovery. Thus, yellow and thick Phlegm indicates that Fire is relatively slow and mild; thin and white Phlegm indicates that Fire is actually urgent and excessive. These cases require acrid-cool dispersing methods and are unsuitable for warm-hot medicines. Speaking of internal injury: Kidney Fire deficiency causes Water to overflow into Phlegm; this Phlegm is clear and thin, requiring warm-hot treatment, which is certain. Even if Kidney Fire is excessive, causing Water to boil into Phlegm, this Phlegm is also clear and thin. Because Dragon-Lei Fire moves violently, rainwater follows, surging up suddenly; although slightly turbid, it cannot compare to yellow-thick Phlegm. It also requires sweet-cool tonification of Water and is unsuitable for warm-hot medicines. Who says thin-white Phlegm must belong to Cold? Generally, thin-white Phlegm that feels cold upon exiting the throat belongs to Cold. (I once had Phlegm that felt cold in the throat; although coughing was frequent, there were more non-coughing periods, and the pulse was not rapid. I recovered using stomach-warming and lung-astringent herbs. However, there are cases where Phlegm feels very cold in the throat, yet the syndrome is still Heat. This is because Phlegm is essentially Water; when accumulated for a long time and in large quantities, Fire cannot warm it. Hence, Zhang Zihe said: New Phlegm is Heat, old Phlegm is Cold.) Frequent vomiting due to wind-cold with constrained Heat, and internal injury with Dragon-Lei Fire movement, definitely belong to Heat. Due to Spleen Qi deficiency and Cold failing to control saliva, with frequent spitting everywhere, definitely belongs to Cold. (Such persons are quiet without other symptoms, neither wind-cold cough nor Dragon-Lei Fire movement, so it can be differentiated.) Such cases require careful differentiation and reference to the pulse. There are Jin-Ye generated by Qi transformation, and Jin-Ye derived from food and drink. The Stomach is the sea of Jin-Ye, so Phlegm gathers here. Accumulated over time and in large quantities, spreading with Spleen-Stomach Qi to all directions, it flows溢出 outside the intestines and stomach, within the body shell. Meridians become obstructed, skin and flesh become numb, even forming "nest-like sacs" (Ke-Nang) that are unbreakable, causing various harms. The treatment lies in balancing Qi: for Heat, restore the normal clear-descending state, like cool wind drying damp earth; for Cold, restore Yang harmony, like sunrise melting ice. Once Qi is balanced, the source of Phlegm is cut off, then the Phlegm retained inside the intestines/stomach and in the muscles/skin can be slowly addressed. Otherwise, the root remains, and Phlegm regenerates immediately after removal, never showing effect. Furthermore, Phlegm moves with Qi; having moved outside the intestines/stomach with Qi, it also enters back inside with Qi, like the tide's ebb and flow. Human Qi moves outward during the day and returns inward at night. Thus, upon waking in the morning and rinsing the mouth, Phlegm secretion is particularly heavy. Is this not because Phlegm returns to the Stomach with the night Qi? Therefore, what has gone out must be made to return, what is outside must be brought inside, to provide an exit. Otherwise, it lingers in the meridians, difficult to resolve. Yu Jiayan elucidated this theory, stating people should not eat at night, lest Stomach-Spleen Qi moves outward due to food digestion and fails to收 (receive/retain), making it hard for Phlegm to return to the Stomach. This is indeed a sound argument. However, labor and disturbance at night are strictly forbidden. By analogy, Yu's theory should be extended.
Wind-Phlegm belongs to the Liver: pulse is wiry, face is green, limbs ache and feel stifled/numb, urination and defecation are blocked and涩 (astringent/difficult). (See details in Two Excretions and Stroke sections.) Heart often has depression and anger, potentially leading to paralysis, convulsions, and dizziness. Use Shuizhu Jinhua Wan, Chuanxiong Wan, Fangfeng Wan, Qufeng Wan, Daotan Wan. Xing (Arisaema Cum Bile), Banxia (Pinellia), Tianma (Gastrodia), Yazao (Gleditsia Sinensis), Jiangcan (Bombyx Batryticatus), Qinjiao (Gentiana Macrophylla) all treat Wind-Phlegm and can use emetic methods. If suffocated unconscious by Phlegm, use Wuyao (Lindera), Zhike (Aurantii Fructus), Xing (Arisaema), Jiangzhi (Ginger Juice); instilling wakes them immediately.
Heat-Phlegm belongs to the Heart: pulse is surging, face is red, vexation, heat, dryness, thirst, excessive laughing, dizziness, epigastric discomfort, headache with eye ulcers, or a spot of cold on the back of the heart area, Phlegm is abundant, thick, and turbid. Use Xiaohuang Wan, Huangqin Lige Wan (see Pi), Guntan Wan. For purgation, use Kongxian Dan mixed equally with Pening (Basaltic mineral salt?), 30 pills per dose. Gualou Ren (Trichosanthis Semen), Huangqin (Scutellaria), Lian (Coptis), Qingdai (Indigo Naturalis), Shanzhi (Gardeniae Fructus), Er Dong (Tian Dong & Mai Dong), Zhuli (Bamboo Sap), Tongbian (Infant Urine) can be used. Caused by Summerheat: Xiaoshu Wan (see Shangshu).
Damp-Phlegm belongs to the Spleen: pulse is slow, face is yellow, limbs feel heavy, fatigue, weakness, desire to lie down, abdominal distension, indigestion, diarrhea, joint stiffness, or formation of masses, numbness and insensitivity. Use Baizhu Wan. Er Zhu (Zhu Ru & Bai Zhu), Xing, Banxia, Fuling (Poria), Zexie (Alisma) can be used. For masses, add Ruxiang (Frankincense), Moyao (Myrrh); for arm pain, add Bohe (Mint), Guizhi (Cinnamon Twig), Jianghuang (Curcuma); for rib distension, add Chaihu (Bupleurum), Baijiezi (White Mustard Seed), Qingpi (Aurantii Pericarpium Rubrum); Guntan Wan is most beneficial; for excessive fluid retention, Xiaowei Dan. Damp-Phlegm is abundant and easy to expectorate. Phlegm's movement is governed by Dampness, primarily controlled by the Spleen. It arises either from Spleen Qi stagnation or Spleen Qi deficiency and Cold failing to transport.
Qi-Phlegm belongs to the Lung: pulse is choppy, face is pale, Qi rises causing panting, chills and fever, sadness and unhappiness, wandering stabbing pain, distending pain in both ribs. Use Yufen Wan, Ju Fang Jiegeng Tang. Erchen Tang remove Gancao, add Xiangfu (Cyperi Rhizoma), Muxiang (Aucklandiae Radix), Sharen (Amomi Fructus), Zhike, Wuyao, Suzi (Perillae Fructus), Qingpi, Zhuli, Jiangzhi. For Qi depression, Qi Qi Tang (see Qi), Yueju Wan (see Yu). Phlegm is scanty, sticky, and hard to expel; this is Qi dryness. Moisten it with Donggen (Ophiopogonis Radix), Dihuang (Rehmanniae Radix), Gouqi (Lycii Fructus), etc., to make Lung Qi clear and descend.
Cold-Phlegm belongs to the Kidney: pulse is deep, face is black, feet are cold, heart often feels fearful, fullness obstruction, bone bi, limbs unable to move. Use Jianggui Wan, Ju Fang Hujiao Lizhong Wan. Ganjiang (Zingiberis Rhizoma) is absolutely essential; severe cases add Guizhi, Mahuang (Ephedrae Herba), Xixin (Asari Radix et Rhizoma). The root of Phlegm is Water, originating from the Kidney. Kidney Fire deficiency causes Water overflow into Phlegm; this Phlegm is clear. Use Bawei Wan. Fire excess causes Water boiling into Phlegm; this has turbid foam. Use Liuwei Wan. (Water boiling into Phlegm is acute obstruction. If Fire is not surging but merely hot and drying, Phlegm becomes thick and sticky. Both these types belong to Heat, not Cold.)
Also, fright causes Heart Spirit to leave its residence; empty residence allows Phlegm to enter, often forming Heart Pain and Epilepsy. Women suffering fright during childbirth often have this syndrome. Abdomen feels like a pregnancy mass, moving and jumping, unbearable pain. Use Gansui (Kansui Radix), Daji (Euphorbiae Pekinensis Radix), Baijiezi, add Zhusha (Cinnabar). For severe pain, add Quanxie (Scorpio); for masses, add Shanjiya (Manis Squama), Chao Biejia (Testudinis Carapax et Plastrum Cheloniae), Yuanhu (Corydalis Rhizoma), Ezhu (Curcumae Rhizoma).
Food stagnation generates Phlegm, often forming malaria-dysentery, pi masses, belching with food odor. Use Shanzha (Crataegi Fructus), Shenqu (Massa Medicata Fermentata), Maiya (Hordei Fructus Germinatus), Zhike, Muxiang, Huanglian (Coptidis Rhizoma). Guntan Wan is also excellent, or Baohe Wan (see Shang Yinshi). Alcohol generates Phlegm, often causing vomiting, nausea, poor appetite. Use Miaoying Wan plus Xionghuang (Realgar) and Quanxie, 2 qian each, 10 pills per dose.
Old Phlegm is Depressed Phlegm, forming sticky clumps, impossible to spit out. Treated with Nanxing (Arisaema Cum Rhizoma), Banxia, Fuling, Cangzhu (Atractylodis Rhizoma). Qingdai is the main herb, plus Wuweizi (Schisandrae Fructus), Haishi (Pteritum), Kugeng (Platycodonis Radix), Xuanfuhua (Inulae Flos), Gualou Ren, Mangxiao (Natrii Sulfas). Tanhe (Phlegm Nodule): Phlegm knots in the throat like a plum pit. Use half-green half-yellow plums, soak each in 1 liang of salt, sun-dry several times until water is gone. Place two plums between three large copper coins, tie tightly with hemp thread, store in a clay jar, bury underground for 100 days. Hold in mouth; juice swallowing dissolves it. Another method: Haishi, Wumei (Mume Fructus), Gualou, Jiegeng, Mangxiao, Shegan (Belamcandae Rhizoma), Zaocys (Haliploris), Jiangzhi, honey-made pills, hold in mouth. (See Yanhou.)
Under the head, face, neck, and body, subcutaneous nodules that are not red, painful, hard, or suppurating are all Tanhe. Spleen-Lung Qi rebellion, Phlegm stagnating internally resolves with regulating Qi and resolving Phlegm. Also, depression and anger damaging Liver-Spleen, blood pathology forming nodules: nourish Blood and clear Liver Fire. Externally apply Baiguo Rou (Ginkgo seed pulp) and Nanxing paste.
Phlegm in the body feels like lying on thorns or insects crawling; or migratory pain; or dry itching, scratching produces urticaria. Phlegm in skin/hair causes baking heat, color like brocade spots. Phlegm in the head causes hemi-cephalic wind, Lei Tou Feng (Thunder Head Wind), dizziness. Phlegm in the forehead causes frontal stuffiness/pain, brow ridge itching/pain. Phlegm in the eyes causes visual vertigo, eye twitching, sticky itching like ginger sting, sparks in eyes, seeing white mist, double moons, golden rays, darkness, or gray-black under eyelids. Phlegm in ears causes ear rim itching/pain, cicada buzzing/water sounds. Phlegm in nose causes congestion or smelling burnt odor. Phlegm in mouth causes tooth/gum itching/pain, swollen gums, mouth ulcers/tongue rot, dry mouth/thick saliva, vomiting cold saliva/green water/black juice, delirium, mutism. Phlegm in the face causes emaciation/scorched hair, swollen/hard jaw/cheeks, pseudo-pain. Phlegm in neck causes spontaneous swelling, circumferential nodules, throat obstruction, Phlegm like broken cotton/peach gum/clam meat, impossible to spit/swallow, choking/stuffiness, sensation of fire/smoke rising, facial heat, or fishy smell in throat. Phlegm in limbs causes shoulder/back soreness/swelling/hardness, pseudo-pain, wandering bone/muscle pain, hand numbness/arm pain resembling wind-damp, sudden collapse/cold limbs, numbness/heaviness/traction/inability to move. Requires Zhuli/Jiangzhi to open; use Erchen Tang + Zhike, Nanxing, Muxiang, Jianghuang. Phlegm in chest/heart causes belching/acid regurgitation/discomfort, pain/foulness (dry heaving), feeling of ice/iron in epigastrium, palpitations/fear of being chased, mental confusion like dementia, fullness/amnesia/nausea. Phlegm in spine causes a line or spot of coldness on the back, pain, or sensation of hot water pouring on back.
Phlegm in both ribs causes distending pain like boiling water; only Baijiezi can reach it. Phlegm in waist/kidneys causes sudden joint pain in waist, difficulty breathing. Phlegm in two excretions causes urinary retention/constipation, enuresis like rice water, post-defecation fish-jelly stool, amenorrhea in women. Phlegm in feet causes ankle soreness/weakness, walking like stepping on ash. Phlegm in dreams causes sleep paralysis, dreaming of torture/weapons, entering houses surrounded by walls with no exit, burning ground/smoke/bones/foul smell/no escape, waking from anger/sorrow without trigger, bizarre dreams indescribable. Li Zhongzi treats all with Guntan Wan.
Pang Anchang said: The human body has no upward-flowing Phlegm; the world has no backward-flowing water. Thus, good Phlegm-treaters treat Qi, not Phlegm. When Qi is smooth, body fluids follow smoothly. Combine Su Zi Jiang Qi Tang (see Qi) and Daotan Tang halves; or Xiao Banxia Fuling Tang + Zhishi, Muxiang 0.5 qian, swallow Wutao Wan; or decoct Wutao Wan ingredients as a drink. Good results.
Note: Phlegm is the branch (Biao); the cause of Phlegm is the root (Ben). Treating disease seeks the root, but must consider urgency. Slow: treat root. Fast/excessive Phlegm difficult to disperse, requiring attack: deficient patients can treat branch and root simultaneously (attack and tonify). Extremely urgent: even deficient patients must attack first, then tonify, e.g., San Sheng Yin (see Zhuzhong), Kongxian Dan for stroke. When throat is blocked, not expelling Phlegm leads to immediate death by suffocation. Ignorant practitioners fear deficiency and dare not use these, ignoring the danger of death. Deficiency is worst in stroke, yet we attack first; why fear it in ordinary deficiency? *Zhunsheng* states: Treating Phlegm should tonify Spleen to restore transportation, letting Phlegm transform naturally. But long-standing accumulation is like clogged ditches with filth; without dredging, trying to clarify stagnant water is impossible. Also: for diseases involving Phlegm-Fluid transforming into various syndromes, do not be distracted by symptoms; treat Fluid first. E.g., headache/brow pain unresponsive to wind herbs for months resolved with Phlegm herbs; red painful eyes unresponsive to cooling herbs resolved with Phlegm formula. True maxims. (Both cases involve Phlegm-Heat obstructing upwards.)
Yu Jiayan said: Spleen Damp-Heat and Stomach Strong Fire interact, forming turbid Phlegm, overflowing into upper orifices, lingering, penetrating lung membranes, forming Ke-Nang (nest sacs). Ke-Nang Phlegm is like bees in cells or lotus seeds in pods; easy to grow, hard to remove. Narrow outside, wide inside, resisting expulsion, harming other organs. Fundamentally, not just Ke-Nang Phlegm is hard to remove; stubborn Phlegm adhering for years outside lungs and in membrane origins, like vines on trees, dust in houses, moss on stones, is hard to cut quickly. Treatment must calm Qi to prevent Three Yin Fire from rising. Strictly control Spleen to prevent Taiyin Dampness from steaming upward. Then take large doses of medicine to harmonize Five Zang, nourish Lung Qi. Once Lung Metal Qi clears, whole-body Qi descends together, cutting off the source of ascending turbid evil. He also said: Body Qi flows from Jing to Luo when Jing is full, and from Luo to Jing when Luo is full. Ke-Nang formation starts with Phlegm gathering at the Stomach gate. Vomiting agitates Stomach Qi; half exits via throat, half enters Luo vessels. Stomach Luo pierces the diaphragm; urgent Qi rushes through diaphragm, allowing Phlegm to settle, increasing daily, hence hard to treat. Must first remove Stomach Phlegm without triggering vomiting, letting Stomach Qi not rush to Luo, making Stomach empty to allow Luo Qi to return to Stomach. Gradually guide and wash out the sac with medicine, and it heals. He also said: Li Zijiang suffered chronic cough/Phlegm, chest tightness. Last summer/autumn bedridden, nearly died twice, arranged affairs, accepted death, felt slightly better—a sign that "mind dead, body healthy." Soon resumed family duties, illness returned. Examination showed dozens of small nodules on cheeks. Told him: Your strong pulse/tendons indicate lust and overexertion. Disease should manifest as abscess. Avoided due to plain diet and Fire venting through essence pores. But disease has deepened. Your chest/back/shoulders resemble rocks/sprouts/beehives/thorns. Whenever Fire moves/Qi rises/Phlegm obstructs, you suffer immensely, wanting life but not living, wanting death but not dying, worse than prisoners in stocks. Lust/exertion causes Qi to fail returning to origin, rising to Liver/Lungs, filling gaps/membranes. Over time, paths form. Once Kidney Qi moves, thousands of troops rush in, entering but not exiting, like tide returning. If rear tide doesn't stop, front tide doesn't recede. Many die of this. You are sturdy, so currently safe. Go home, rest mind/spirit, act as if dead, so Fire doesn't move, Phlegm-Qi doesn't worsen, chest/back fortifications have gaps. I will prepare medicine to destroy the nest, and you will recover. He thought he wouldn't die immediately, went to collect rent, exertion triggered acute onset, Phlegm gushed like spring, sound like sawing, swollen face/tongue, stiff throat/protruding eyes, died in two days.
Yin refers to retained water. Thin Phlegm is called Yin, hence Phlegm-Yin mentioned together. *Jin Gui* says Yin has four types: Person formerly fat now thin (Jin-Ye transformed into Phlegm-Yin, no longer filling body), water sloshing in intestines with sound, called Tan Yin (Phlegm-Fluid). Water flowing under hypochondrium, pain on coughing/vomiting, called Xuan Yin (Hanging Fluid). Water flowing to limbs, no sweat despite needing it, heavy body pain, called Yi Yin (Overflowing Fluid). Coughing/reversal of Qi, shortness of breath, inability to lie down, swollen appearance, called Zhi Yin (Supporting Fluid). These four are named by location. Also: Leftover Yin in Heart area causes back coldness palm-sized (blocking Heart Yang), hypochondriac pain radiating to Quepen (blocking Liver Qi), worsening cough (Qi reversal). Leftover Yin in Chest causes shortness of breath (Lung Qi forced) and thirst (Water blocking Qi spread, no fluids generated). Limb joint pain (blockage of meridians). Extending this: Spleen leftover causes abdominal swelling/heaviness; Kidney leftover causes scrotal/shin swelling. This covers Leftover Yin and Fu Yin (Hidden Yin), the summary of the above four. Also: Phlegm disease above Diaphragm (Yin stays above Diaphragm, hidden, boils into Phlegm) causes fullness, panting, cough, vomiting. Attacks cause chills/fever, back/waist coldness (attacks triggered by autumn cold or spring wind). Eyes weep spontaneously (severe cough lifts lung lobes), body tremors (severe panting causes shaking). This implies Fu Yin (Hidden Yin, harder to attack than Leftover). Also: Water stopped below Heart causes palpitations (Heart Qi forced by Water).