哲言
痰病有十∶有风痰、湿痰、热痰、寒痰、郁痰、气痰、食痰、酒痰、惊痰、虚痰，其源不一。（朱丹溪）
痰本津液所化，行则为液，聚则为痰；流则为津，止则为涎。（《绳墨》）
稠浊为痰，津液凝聚；清稀为饮，水饮留积。绵缠为涎，风热津所结；清沫为沫，气虚液不行。（《医阶辨证》）
痰之热者，如釜上浮沤；痰之寒者，如沟中水 。（《医参》）
人自初生，以至临死，皆有痰。生于脾，聚于胃，以人身非痰不能滋润也。而其为物，则流动不测，故其
为害，上至巅顶，下至涌泉，随气升降，周身内外皆到，五脏六腑俱有。正如云雾之在天壤，无根柢，无归宿，
来去无端，聚散靡定。火动则生，气滞则甚，风鼓则涌，变怪百端，故痰为诸病之源，怪病皆由痰而成也。然
天之云雾，阳光一出，即消散无迹；人身之痰，若元阳壮旺，则阴湿不凝，而消灭无迹，其理固相同也。
热痰者，痰因火盛也。痰即有形之火，火即无形之痰；痰随火而升降，火引痰而横行，变生诸证，不可
纪极；火借气于五脏，痰借液于五味；气有余则为火，液有余则为痰。（汪 庵）
痰，即人之津液，无非水谷之所化。此痰亦既化之物，而非不化之属也。但化得其正，则形体强、营卫
充，而痰涎本皆血气。若化失其正，则脏腑病、津液败，而血气即成痰涎。此亦犹乱世之盗贼，何孰非治世之
良民。盖痰涎之化，本由水谷，使果
脾强胃健，则随食随化，皆成血气，焉得留而为痰。惟其不能尽化，而十留一、二，则一、二为痰矣；十留三、
四，则三、四为痰矣；甚至留其七、八，则但见血气日削，而痰涎日多矣。此其故，正以元气不能运化，愈虚
则痰愈盛也。（张景岳）
人之气道，贵乎调顺，则津液流通，何痰之有？若外为风暑燥湿之侵，内为惊恐忧思之扰，饮食劳倦，酒
色无节，营卫不调，气血败浊，熏蒸津液，痰乃生焉。○昔肥今瘦者，痰也；眼胞目下如烟熏黑者，痰也；眼
目花黑，行动艰难，遍身疼痛者，痰入骨也；面色如土，四肢痿痹，屈伸不利者，风湿挟痰也。（《证治汇补》）
寒痰清，湿痰白，火痰黑，热痰黄，老痰胶。○痰证初起，停留中焦，头痛寒热，类外感证；久则停于
脾肺，朝咳夜重，类内伤证；流注肢节疼痛，类风痹证。但痰病胸满食减，肌色如故，脉滑不匀为异。（《医学入门》）
热痰多成烦热；风痰多成瘫痪；冷痰多成骨痹；湿痰多成倦怠软弱；惊痰多成心痛癫疾；饮痰多成胁疼
臂痛；食积痰多成痞块痞满。（《赤水玄珠》）
痰着不出，是无力也。黑痰出于肾，中气虚寒，肾水泛上也。（周慎斋）
人身无痰，痰者，津液所聚也。五谷入于胃，其糟粕、津液、宗气，分为三隧。故宗气积于胸中，出于喉
咙，以贯心、肺而行呼吸焉。营气者，泌其津液，注之于脉，化而为血，以荣四末，内注五脏六腑，以应刻数
焉。卫气者，出其悍气之 疾，而先行于四末、分肉、皮肤之间而不休者也。昼行于阳，夜行于阴，常从足少
阴之分间，行于五脏六腑。实则行，虚则聚，聚则为痰，散则还为津液血气，初非经络脏腑之中，别有邪气秽
物，号称曰痰，以为身害，必先去之而后已者也。余幼而喜唾痰，愈唾愈多，已而戒之，每觉喉间梗梗不可耐，
辄呷白汤数口 咯退场门中，用
舌搅研令碎，因而漱之百余，津液满口，即随鼻中吸气咽下，以意送至丹田，默合少顷，咽间清泰矣。如未清，
再漱再咽，以化尽为度。方咯出时，其味甚咸，漱久则甘，世人乃谓淤浊之物，无澄而复清之理，何其谬哉！
吾尝渡河矣，见舟人掬浊流而贮之瓮，糁入矾末，实时澄清，此可以悟治痰之法也。故上焦宗气不足，则痰聚
胸膈，喉间梗梗，鼻息喘促；中焦营气不足，则血液为痰，或壅塞脉道，变幻不常；下焦卫气不足，则势不悍
疾，液随而滞，四末分肉之间，麻木壅肿。治其本则补之宜先；治其标则化之有法。（《证治准绳》）
液所以养筋，血涩不行，则痰聚于膈上而手足弱。（梅膺祚）
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
满隔塞。或胸胁漉漉如雷鸣；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；
或腰腿酸刺无力；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）
人身之病，四百有四，外不过风、寒、暑、湿、燥、火六气之淫，内不过喜、怒、忧、思、惊、恐、悲
七情之伤，变见于脏腑、经络、皮毛之间而为病，安有所谓怪也？庸工不晓病机，一遇不识之证，辄云怪病多
属痰。况痰非人身之所素有，及津液既病而成痰，则亦随所在经络而见证，岂可借此一语藉为口实耶？○按脏腑
津液，受病为痰，随气升降，理之常也。若在皮里膜外及四肢关节曲折之地，而脏腑之痰何能流注其所？此即
本处津液，遇冷遇热，即凝结成痰而为病，断非别部之津液，受病成痰，
舍其本位而移于他部者。况气本无形，故能无微不达，而液随气运，亦可藉气周流。至若津液受病成痰，则变为
有形而凝滞，焉能随气周流于至微至密之所耶？（《冯氏锦囊》）
脾为生痰之原，肺为贮痰之器，此无稽之谈也。夫脾为胃行其津液，以灌四旁，而水精又上输于肺，焉得
凝结而为痰？惟肾为胃关，关门不利，故水聚而泛为痰也，则当曰肾为生痰之原。《经》云∶受谷者浊，受气
者清，清阳走五脏，浊阴归六腑。肺为手太阴，独受诸气之清，而不受有形之浊，则何可贮痰？惟胃为水谷之
海，万物所归，稍失转输之职，则湿热凝结为痰，根据附胃中而不降，当曰胃为贮痰之器。（柯韵伯）
补编
治痰当知求本，则痰无不清，若但知治痰，其谬甚矣。凡痰因火动者，宜治火为先；痰因寒生者，宜温
中为主。风痰宜散之，非辛温不可；湿痰宜燥之，非渗利不除。郁痰有虚实，郁兼怒者宜抑肝邪，郁兼忧者宜
培肝肺。饮食之痰，亦自不同，有因寒者，有因热者，有因肥甘过度者，有因酒湿伤脾者，凡此皆能生痰，而
其中各有虚实之辨。又如脾虚不能制湿，肾虚不能纳水，皆能生痰，此即寒痰之属也；或以脾阴干燥而液化为
胶，或以金水偏枯而痰本乎血，此即热痰之属也。二者，痰证中十居八、九，是皆虚痰之不可攻者也。（张景岳）
痰证变幻不一，古人不究标本，每着消痰方论，后人遵其法，用之不验，遂称痰为怪病。不知痰乃病之
标，非病之本也，善治者治其生痰之源，则不消痰而痰自无矣。余详考之，夫痰之生，有因外感六气之邪，则
脾、肺、胃升降之机失度，致饮食输化不逮而生者；有因多食肥甘茶酒而生者；有因脾胃阳虚，湿浊凝滞而生
者；有因郁则气火不舒而蒸变者；又有肾虚水泛为痰者；更有阴虚劳证，龙相之火，上炎铄肺，以致痰嗽者。
其余诸痰，皆由湿而生，虽有风、火、燥痰之名，亦皆因气而化，非风、火、燥
自能生痰也。治法∶惟痰气一时壅闭咽喉，不得不暂用豁痰降气之剂以开之，余皆当治其本，见痰休治痰之论，
诚千古之明训。盖痰本饮食湿浊所化，人岂能禁绝饮食。若专欲消之，由于外邪者，邪散则痰或可清，如寒痰
温之、热痰清之、湿痰燥之、燥痰润之、风痰散之是也。若涉本原者，必旋消旋生，有至死而痰仍未清者矣。（《临证指南》）
王节斋云∶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，痰在胸膈者
吐之，痰在肠胃者下之。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。○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。故外证既见咳嗽稠痰、喉干鼻燥之肺病，又见心 倒饱、食少泻多之脾病。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，不必专用清肺化痰诸药。盖脾
有生肺之功，肺无扶脾之力也。宜异功散，加苡仁、麦冬、石斛、桔梗、山药、扁豆、莲肉之属。○痰在人身，
如木之津，如鱼之涎，遍身上下，无处不到。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。（《证治汇补》）
予平生治病，以补中气为本，故每得效。常治痰多之人，治痰不效，专补中气，久之，其痰自消。（吴篁池）
脾土上应乎天，本属湿化，水谷津液不行，即停聚而为痰也。夫人之病痰者，十有八、九，老人不可速降
其火，虚人不宜尽去其痰，攻之太急，则病转剧而致危殆，须固元气为本。（崆峒子）
凡胸胁胀痛、呕逆恶心、时作时止者，皆属于痰。缘宿痰凝滞胸膈，已成窠臼，渐渐积满，作胀作呕，呕
去痰涎，次日胸膈宽舒，稍待半月，疾又复作，缠延岁月，不能断根。若此者将何以治之？常闻治顽民，必先
之以德化，而济之以刑罚。治病亦然，
前证必须先补脾、肾，兼之顺气行痰，使气血流行，痰不凝滞，用药之久，方可收功。如脾胃已旺，而痰仍不
流利，谓之顽痰。盖其积之既久，卒不可除，须用倒仓法，所谓空其窠穴也。吐后再用补剂，仍兼化痰，使其
不复停留，此治法先后之序。若因循姑息，终不能治，然不补脾胃而专于攻吐者，卒亦不免于死也。○凡用痰
药，须加行气药于其中，如木香、香附、砂仁之类，胃气得香味而能行，痰涎因气行而不滞。若无行气药，多
不见效。寒痰用气药固然，至于热痰，虽用芩、连，亦必以气药助之，所谓从治法也。不然，痰已胶固，又用
凉药，必不营运。常见人以凉药治热痰而不效者，以其中无气药为之响导故耳。盖人身以气为本，气滞则痰滞，
气行则痰行，昔人谓治痰莫先顺气，此知其要也。（余傅山）
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。（庞安常）
王节斋云∶痰之本，水也，原于肾；痰之动，痰也，主于脾。古人用二陈汤为治痰通剂，然以之治湿痰、
寒痰则是矣，若夫阴火炎上，熏于上焦，肺气被郁，津液随气而升，凝结成痰，腥秽稠浊，甚则带血而出，此
非中焦寒痰、湿痰之比，亦非半夏、南星之所能治，惟用清气化痰有效。噫！节斋论痰，而首揭痰之本原于肾，
可谓发前人之未发。惜乎虽启其端而未竟其说，其所制方，皆治标之药。寒凉之品，多损脾胃。惟仲景云∶气
虚有痰，用肾气丸补而逐之。吴茭山云∶八味丸治痰之本。此二公真开后学之 ，济无穷之夭枉。盖痰，病
名也，原非人之所有，非水泛为痰，则水沸为痰，但当分有火、无火之异耳。肾虚不能制水，则水不归原，如
水逆行，泛滥而为痰，是无火也，故用八味丸以补肾火。阴虚火动，则水沸腾，动于肾者，犹龙火之出于海，龙
兴而水附，动于肝者，犹雷火之出于地，疾风豪雨，水随波涌而为痰；是有火也，故用六味丸以配火，此不治
痰之标而治痰之本
也。然有火、无火，何以辨之？曰∶无火者纯是清水，有火者中有重浊白沫为别耳。能于肾虚者先用六味、八
味壮水益火，复以四君、六君补土制水；于脾虚者既用补中、理中，又以六味、八味制水益母，治痰之道庶几
矣。庞安常云∶有阴水不足，阴火上升，肺受火侮，不得清肃下行，由是津液凝浊，生痰不生血者，此当以润
剂治之。如门冬、地黄、枸杞之属，以滋其阴，使上逆之火，得反其宅，则痰自清矣。投以二陈，立见其殆。
更有肾虚不能纳气归原，气出而不能纳则积，积而不散，则痰生焉，又宜八味丸主之。（赵氏《医贯》）
立斋治痰，每言肾虚水泛为痰，法当补肾。壬申秋，予病咳嗽多痰，自知多欲肾虚，恪服六味丸，月余竟
愈。时师治痰，最忌熟地，以为腻膈，乌知个中妙理。（《折肱漫录》）
肾虚水泛为痰，有用肾气丸，屡未得效。因思痰本阴类，复用地黄助阴，良非所宜，当于方中减去地黄、
山萸，加入菖蒲、沉香，开通其气，自效。（《张氏医通》）
治痰之法∶曰驱、曰导、曰涤、曰化、曰涌、曰理脾、曰降火、曰行气，前人之法，不为不详。至于窠囊
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，由其外窄中宽，任行驱、导、涤、涌之
药，徒伤他脏，此实闭拒而不纳耳。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
哲言
痰病有十种：有风痰、湿痰、热痰、寒痰、郁痰、气痰、食痰、酒痰、惊痰、虚痰，其成因各不相同。（朱丹溪）
痰原本是由津液所化生，流动时称为液，积聚时则成为痰；流淌时是津液，停止时则变为涎。（《绳墨》）
质地稠厚浑浊的是痰，由津液凝聚而成；质地清稀的是饮，由水饮停留积聚而成。黏腻缠绕的是涎，由风热与津液结合而成；清稀泡沫状的是沫，由气虚导致津液运行不畅所致。（《医阶辨证》）
热痰的样子，就像锅面上浮起的泡沫；寒痰的样子，就像沟渠中的积水。（《医参》）
人从出生到死亡，体内都有痰。痰生于脾，聚集于胃，因为人体如果没有痰（津液），就无法得到滋润。但这种物质，流动变化不可预测，所以它造成的危害，上至头顶，下至足底涌泉穴，随着气的升降，遍布全身内外，五脏六腑中都有。正如天空大地间的云雾，没有根基，没有归宿，来去无常，聚散不定。火动则痰生，气滞则痰加重，风鼓则痰涌起，变化怪异多端，所以痰是各种疾病的根源，怪病大多由痰引起。然而天上的云雾，阳光一出就消散无影；人体的痰，如果元阳壮旺，那么阴湿就不会凝结，从而消灭得无影无踪，这个道理原本是相同的。
热痰，是因为火盛导致的痰。痰就是形质的火，火就是无形的痰；痰随着火而升降，火引导痰而横行，变生出各种证候，数不胜数；火借助五脏之气产生，痰借助五味之液生成；气有余就会变成火，液有余就会变成痰。（汪昂）
痰，就是人的津液，无非是由水谷精微所化。这种痰也是已经化生的物质，而不是不能消化的东西。但如果化生得当，那么形体强健、营卫充盈，而原本的痰涎其实都是血气的一部分。如果化生失当，那么脏腑生病、津液败坏，而血气就变成了痰涎。这也就像乱世中的盗贼，哪一个是治世时的良民呢？大概痰涎的化生，本源于水谷，如果确实脾胃强健，那么食物随吃随化，都变成血气，怎么会留下成为痰呢？只因为不能完全消化，十分中留下一二，这一二就成为痰了；十分中留下三四，这三四就成为痰了；甚至留下七八，那么就只见血气日渐削弱，而痰涎日渐增多了。这其中的原因，正是元气不能运化，越虚弱痰就越旺盛。（张景岳）
人的气道，贵在调顺，这样津液才能流通，哪里有痰呢？如果外受风、暑、燥、湿的侵袭，内受惊恐、忧思的干扰，加上饮食劳倦、酒色无节制，导致营卫不调，气血败坏浑浊，熏蒸津液，痰就产生了。○以前肥胖现在消瘦的，是痰；眼睑眼下像烟熏黑一样的，是痰；眼睛花黑，行动艰难，全身疼痛的，是痰入骨；面色如土，四肢痿软麻痹，屈伸不利的，是风湿挟痰。（《证治汇补》）
寒痰清稀，湿痰白色，火痰黑色，热痰黄色，老痰胶结。○痰证初起，停留在中焦，出现头痛、恶寒发热，类似外感证；久了则停在脾肺，早晨咳嗽晚上加重，类似内伤证；流注到肢节引起疼痛，类似风痹证。但是痰病的特点是胸满食欲减退，肌肉肤色如常，脉象滑而不匀，这是与其他病不同的地方。（《医学入门》）
热痰多形成烦热；风痰多形成瘫痪；冷痰多形成骨痹；湿痰多形成倦怠软弱；惊痰多形成心痛癫疾；饮痰多形成胁痛臂痛；食积痰多形成痞块痞满。（《赤水玄珠》）
痰咳不出来，是因为无力。黑痰出于肾，是中气虚寒，肾水泛溢上来。（周慎斋）
人体如果没有痰，所谓的痰，就是津液聚集而成的。五谷进入胃，其中的糟粕、津液、宗气，分为三条通道。所以宗气积聚在胸中，出于喉咙，贯通心、肺而行呼吸。营气，分泌它的津液，注入脉中，化生为血，以营养四肢末端，向内灌注五脏六腑，以应合时刻的变化。卫气，发出它剽悍疾速的气，先行于四肢末端、分肉、皮肤之间而不停息。白天行于阳分，夜晚行于阴分，常从足少阴经的分间，行于五脏六腑。实的时候运行，虚的时候聚集，聚集了就成为痰，散开就变回津液血气，起初并不是经络脏腑之中，另有邪气秽物，号称叫痰，用来伤害身体，一定要先去除它才罢休。我小时候喜欢吐痰，越吐越多，后来戒掉了，每次觉得喉间梗塞难受，就喝几口白开水，吐在门口，用舌头搅拌研磨弄碎，然后漱口一百多次，直到口中津液充满，就随着鼻子吸气咽下，用心意送到丹田，默合片刻，咽喉间就清爽安宁了。如果不清爽，再漱再咽，直到完全化尽为止。刚吐出来时，味道很咸，漱久了则变甜，世人却说这是淤浊之物，没有澄清后再变清的道理，多么荒谬啊！我曾经渡河，看见船夫捧起浑浊的水存入瓮中，撒入明矾末，立刻澄清，这可以领悟治疗痰的方法。所以上焦宗气不足，痰就聚集在胸膈，喉间梗塞，鼻息喘促；中焦营气不足，血液变成痰，或者壅塞脉道，变幻无常；下焦卫气不足，气势就不剽悍疾速，津液随之停滞，在四肢末端、分肉之间，出现麻木壅肿。治疗根本则应该先补益；治疗标症则有化解的方法。（《证治准绳》）
津液用来滋养筋脉，如果血液涩滞不行，痰就会聚集在膈上而导致手足软弱。（梅膺祚）
痰这种东西，随着气升降，无处不到，表现为喘、嗽、呕、泻，表现为眩晕、心嘈，表现为怔忡、惊悸，表现为寒热肿痛，表现为痞满隔塞。有时胸胁间沥沥作响如雷鸣；有时浑身感觉像虫子爬一样；有时身上有结核，不红不肿；有时颈项成块，似瘰疬非瘰疬；有时堵塞于咽喉，形状像梅核；有时通过咯吐出来，形状像桃胶；有时胸臆间好像有两股气交纽；有时背心常有一点冰冷；有时皮肤间赤肿如火；有时心下寒痛如冰；有时一个肢体肿硬麻木；有时胁梢癖积成形；有时骨节刺痛无常；有时腰腿酸刺无力；有时吐出冷涎、绿水、黑汁；有时梦见烟火剑戟丛生；有时大小便脓；有时关格不通；有时走马喉痹；有时齿痛耳鸣；以至于劳瘵癫痫；失音瘫痪，妇人经闭带下；小儿惊风搐搦；甚至无缘无故见鬼，似祟非祟，都属于痰的证候。（王隐君）
人身上的病，四百零四种，外不过风、寒、暑、湿、燥、火六气的淫邪，内不过喜、怒、忧、思、惊、恐、悲七情的损伤，变化表现在脏腑、经络、皮毛之间而成为病，哪里有什么所谓怪的呢？庸医不懂病机，一遇到不认识的证候，就说怪病多属于痰。况且痰不是人体素有的，等到津液既已生病成为痰，也就随着所在的经络而显现证候，怎么能借此一句话作为借口呢？○按脏腑津液，受病成为痰，随着气升降，是常理。如果在皮里膜外及四肢关节曲折的地方，脏腑的痰怎么能流注到那里？这就是本处的津液，遇冷遇热，就凝结成痰而致病，绝对不是别处的津液，受病成痰，舍弃本位而移动到别部的。况且气本来无形，所以能无孔不入，而津液随着气运行，也可以借气周流。至于津液受病成为痰，就变成有形而凝滞，怎么能随着气周流到最细微最紧密的地方呢？（《冯氏锦囊》）
“脾为生痰之源，肺为贮痰之器”，这是没有根据的说法。脾为胃输送津液，以灌溉四周，而水精又向上输注于肺，怎么会凝结成为痰呢？只有肾是胃的关口，关口不利，所以水聚集而泛滥成为痰，应该说肾是生痰之源。《内经》说：受纳谷物者浊，受纳气者清，清阳走向五脏，浊阴归于六腑。肺是手太阴经，独受诸气的清轻，而不受形质的浊重，那怎么能贮存痰呢？只有胃是水谷之海，万物所归，稍微失去转输的职责，湿热就凝结成为痰，依附在胃中而不降，应该说胃是贮痰之器。（柯韵伯）
补编
治疗痰应当知道寻求根本，那么痰就没有不清除的，如果只知道治疗痰，那就大错特错了。凡是痰因火动的，宜先治火；痰因寒生的，宜以温中为主。风痰宜疏散，不用辛温药不行；湿痰宜燥湿，不用渗利药不能去除。郁痰有虚实之分，郁兼怒的宜抑制肝邪，郁兼忧的宜培补肝肺。饮食产生的痰，也各不相同，有因寒的，有因热的，有因肥甘过度的，有因酒湿伤脾的，凡此都能生痰，而其中各有虚实的辨别。又如脾虚不能制约湿气，肾虚不能收纳水液，都能生痰，这属于寒痰一类；或者因脾阴干燥而液化为胶，或者因金水偏枯而痰本乎血，这属于热痰一类。这两类，在痰证中占十之八九，都是虚痰，不可攻伐。（张景岳）
痰证变幻不一，古人不究标本，每着消痰方论，后人遵循其法，使用不灵验，于是称痰为怪病。不知道痰是病的标，不是病的本，善于治疗的人治疗生痰的源头，那么不消痰而痰自然就没有了。我详细考证，痰的产生，有因外感六气邪气，导致脾、肺、胃升降之机失度，致使饮食输化不及而产生的；有因多吃肥甘茶酒而产生的；有因脾胃阳虚，湿浊凝滞而产生的；有因郁结导致气火不舒而蒸变产生的；又有肾虚水泛为痰的；更有阴虚劳证，龙相之火，上炎灼肺，以致痰嗽的。其余各种痰，都是由湿而生，虽然有风、火、燥痰的名称，也都是因气而化，不是风、火、燥自己能生痰。治法：只有痰气一时壅闭咽喉，不得不暂时用豁痰降气的药剂来开通，其余都应当治本，见到痰不要只治痰的言论，确实是千古的明训。大概痰本是饮食湿浊所化，人怎么能禁绝饮食。如果专门想消除它，由于外邪引起的，邪气散去痰或许可以清除，如寒痰温之、热痰清之、湿痰燥之、燥痰润之、风痰散之是这样。如果涉及本原的，必定是边消边生，有到死痰仍未清除的了。（《临证指南》）
王节斋说：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，痰在胸膈的用吐法，痰在肠胃的用下法。这是为实证患者立的法则。如果肺虚有痰的，宜保肺以滋其津液；脾虚有痰的，宜培脾以化其痰涎；肾虚有痰的，宜补肾以引其归藏。○脾、肺两家，往往病了都一起病，因为脾是生痰之源，肺是贮痰之器，脏气恒常相通。所以外证既见咳嗽稠痰、喉干鼻燥的肺病，又见心下痞满倒饱、食少泻多的脾病。此时如果用燥药补脾则会碍肺，用润药利肺则会碍脾，应当在二者中斟酌，拣去苦寒香燥，务必以平调为主，不必专用清肺化痰诸药。因为脾有生肺之功，肺无扶脾之力。宜用异功散，加薏苡仁、麦冬、石斛、桔梗、山药、扁豆、莲肉之类。○痰在人身，像树的汁液，像鱼的涎液，遍身上下，无处不到。所以虚痰上溢的，宜补气行痰，如果过用吐药，就无法滋养经络，变为肾枯骨痿。（《证治汇补》）
我平生治病，以补中气为本，所以每每见效。常治疗痰多的人，治痰不效，专门补中气，久而久之，其痰自消。（吴篁池）
脾土上应乎天，本属湿化，水谷津液不行，就停聚而为痰。人生痰病的，十之八九，老人不可速降其火，虚人不宜尽去其痰，攻之太急，则病转剧而致危殆，须固护元气为本。（崆峒子）
凡是胸胁胀痛、呕逆恶心、时作时止的，都属于痰。因为宿痰凝滞胸膈，已成窠臼，渐渐积满，作胀作呕，呕去痰涎，次日胸膈宽舒，稍待半月，疾病又发作，缠绵岁月，不能断根。像这种情况将怎么治疗？常听说治理顽民，必先以德化，而济之以刑罚。治病也是这样，前证必须先补脾、肾，兼之顺气行痰，使气血流行，痰不凝滞，用药之久，方可收功。如果脾胃已旺，而痰仍不流利，叫做顽痰。大概其积聚已久，突然不可除去，须用倒仓法，所谓空其窠穴。吐后再用补剂，仍兼化痰，使其不再停留，这是治法先后之序。如果因循姑息，终不能治，然而不补脾胃而专于攻吐的，最终也不免于一死。○凡是用痰药，须加行气药在其中，如木香、香附、砂仁之类，胃气得香味而能行，痰涎因气行而不滞。如果没有行气药，多不见效。寒痰用气药固然，至于热痰，虽然用黄芩、黄连，也必以气药助之，所谓从治法。不然，痰已胶固，又用凉药，必然不运转。常见人以凉药治热痰而不效的，是因为其中无气药为之向导的缘故。大概人身以气为本，气滞则痰滞，气行则痰行，昔人说治痰莫先顺气，这是抓住了关键。（余傅山）
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，则一身之津液也随气而顺了。（庞安常）
王节斋说：痰之本，是水，源于肾；痰之动，是痰，主于脾。古人用二陈汤作为治痰的通剂，然而用它治湿痰、寒痰是可以的，如果是阴火炎上，熏于上焦，肺气被郁，津液随气而升，凝结成痰，腥秽稠浊，甚至带血而出，这就不是中焦寒痰、湿痰可比，也不是半夏、南星所能治疗的，只有用清气化痰有效。唉！节斋论痰，而首先揭示痰之本原于肾，可以说是发前人所未发。可惜虽然开了头而没有说完，他所制的方，都是治标的药。寒凉之品，多损脾胃。只有仲景说：气虚有痰，用肾气丸补而逐之。吴茭山说：八味丸治痰之本。这两位先生真是开启后学的门径，救济无穷的夭折枉死。大概痰，是病名，本来不是人所具有的，不是水泛为痰，就是水沸为痰，只应当分有火、无火的差异罢了。肾虚不能制水，则水不归原，如水逆行，泛滥而为痰，这是无火，所以用八味丸以补肾火。阴虚火动，则水沸腾，动于肾的，犹如龙火出于海，龙兴而水附，动于肝的，犹如雷火出于地，疾风豪雨，水随波涌而为痰；这是有火，所以用六味丸以配火，这是不治痰之标而治痰之本。然而有火、无火，怎么辨别？说：无火的是纯清水，有火的是中有重浊白沫作为区别罢了。能在肾虚者先用六味、八味壮水益火，再用四君、六君补土制水；于脾虚者既用补中、理中，又以六味、八味制水益母，治痰之道差不多了。庞安常说：有阴水不足，阴火上升，肺受火侮，不得清肃下行，由此津液凝浊，生痰不生血的，这应当以润剂治之。如门冬、地黄、枸杞之类，以滋其阴，使上逆之火，得反其宅，则痰自清了。投以二陈，立见其危险。更有肾虚不能纳气归原，气出而不能纳则积，积而不散，则痰生焉，又宜八味丸主之。（赵氏《医贯》）
立斋治痰，每言肾虚水泛为痰，法当补肾。壬申年秋，我患咳嗽多痰，自知多欲肾虚，恪服六味丸，月余竟愈。当时医生治痰，最忌熟地，认为腻膈，哪里知道其中的妙理。（《折肱漫录》）
肾虚水泛为痰，有用肾气丸，屡未得效。因而想到痰本属阴类，复用地黄助阴，实在不合适，应当在方中减去地黄、山萸，加入菖蒲、沉香，开通其气，自然有效。（《张氏医通》）
治痰之法：曰驱、曰导、曰涤、曰化、曰涌、曰理脾、曰降火、曰行气，前人的方法，不为不详。至于窠囊之痰，像蜂子在房中筑巢，像莲子嵌在蓬内，生长容易，剥落难，由其外窄中宽，任凭使用驱、导、涤、涌的药，徒然损伤其他脏腑，这是实闭拒而不纳耳。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，像树...
Zhe Yan (Philosophical Remarks)
There are ten types of phlegm diseases: wind-phlegm, dampness-phlegm, heat-phlegm, cold-phlegm, constraint-phlegm, qi-phlegm, food-phlegm, wine-phlegm, fright-phlegm, and deficiency-phlegm; their origins are not uniform. (Zhu Danxi)
Phlegm is originally transformed from body fluids (Jinye); when flowing, it is called fluid, and when accumulating, it becomes phlegm; when circulating, it is Jin (thin fluid), and when stagnant, it becomes Xian (thick saliva). (*Shengmo*)
Thick and turbid substance is Phlegm, formed by the condensation of body fluids; clear and thin substance is Yin (fluid retention), formed by the accumulation of water and fluids. Sticky and entangled substance is Xian, formed by the combination of wind-heat and body fluids; clear and foamy substance is Mo, caused by Qi deficiency leading to poor circulation of fluids. (*Yijie Bianzheng*)
Heat-phlegm resembles the foam floating on top of a boiling pot; cold-phlegm resembles water in a ditch. (*Yican*)
From birth until death, every person has phlegm. It originates in the Spleen and gathers in the Stomach, because the human body requires phlegm (referring to normal fluids) for nourishment. However, this substance flows unpredictably, so its harmful effects reach from the vertex of the head to the Yongquan acupoint at the sole of the foot, rising and descending with Qi, reaching all parts inside and outside the body, existing in the Five Zang and Six Fu organs. Just like clouds and mist in the sky and earth, it has no root and no destination, coming and going without warning, gathering and scattering without stability. When Fire moves, phlegm arises; when Qi stagnates, phlegm worsens; when Wind drums, phlegm surges, creating hundreds of bizarre changes. Therefore, phlegm is the source of various diseases, and strange diseases are mostly caused by phlegm. Yet, just as clouds and mist dissipate without a trace when the sun shines, if the Primordial Yang (Yuanyang) of the human body is strong, Yin-dampness will not coagulate, and phlegm will disappear without a trace; the principle is indeed the same.
Heat-phlegm is caused by excessive Fire. Phlegm is tangible Fire, and Fire is intangible Phlegm; Phlegm rises and falls with Fire, and Fire guides Phlegm to move horizontally, generating various syndromes that are countless; Fire relies on Qi from the Five Zang organs, and Phlegm relies on fluids from the Five Flavors. Excess Qi becomes Fire, and excess fluids become Phlegm. (Wang Ang)
Phlegm is simply human body fluids, nothing but the transformation of grain and food. This phlegm is also a product of transformation, not something untransformed. If transformation occurs correctly, the physique becomes strong, Ying (Nutritive) and Wei (Defensive) Qi become abundant, and the original phlegm and saliva are essentially part of Blood and Qi. If transformation goes awry, the Zang-Fu organs become diseased, body fluids deteriorate, and Blood and Qi turn into phlegm and saliva. This is like bandits in chaotic times; who among them was not a good citizen in peaceful times? Generally, the transformation of phlegm and saliva originates from grain and food. If the Spleen is strong and the Stomach healthy, food is transformed immediately upon ingestion, becoming Blood and Qi, how could it remain as phlegm? Only because it cannot be fully transformed, leaving one or two parts out of ten, these become phlegm; leaving three or four parts, they become phlegm; even leaving seven or eight parts, one only sees Blood and Qi daily diminishing while phlegm and saliva daily increase. The reason for this is precisely that Yuan Qi (Primordial Qi) cannot transport and transform, and the more deficient it is, the more abundant the phlegm becomes. (Zhang Jingyue)
The airways of humans must be smooth and regulated for body fluids to circulate freely; otherwise, where would phlegm come from? If externally invaded by Wind, Summerheat, Dryness, and Dampness, or internally disturbed by Fright, Fear, Worry, and Thought, combined with dietary irregularities, overwork, and unrestrained sexual activity, leading to disharmony of Ying and Wei Qi and deterioration of Blood and Qi, which steam and vaporize body fluids, phlegm is generated. ○ Those who were formerly fat but are now thin have phlegm; those with eye bags and under-eye areas darkened like smoke stains have phlegm; those with blurred vision, difficulty moving, and whole-body pain have phlegm entering the bones; those with sallow complexion, flaccid paralysis of limbs, and inability to flex or extend have Rheumatism complicated by phlegm. (*Zhengzhi Huibu*)
Cold-phlegm is clear, dampness-phlegm is white, fire-phlegm is black, heat-phlegm is yellow, and old-phlegm is sticky. ○ At the onset of phlegm syndromes, it stays in the Middle Jiao, causing headache, aversion to cold, and fever, resembling exterior syndromes; later, it stops in the Spleen and Lungs, causing morning cough and evening worsening, resembling interior injury syndromes; flowing into joints causing pain, resembling Wind-Bi syndrome. However, phlegm diseases are distinguished by chest fullness, reduced appetite, normal muscle color, and slippery yet irregular pulse. (*Yixue Rumen*)
Heat-phlegm often forms irritability and heat; wind-phlegm often forms paralysis; cold-phlegm often forms bone Bi; dampness-phlegm often forms fatigue and weakness; fright-phlegm often forms heart pain and epilepsy; drink-phlegm often forms hypochondriac and arm pain; food-stagnation phlegm often forms epigastric masses and fullness. (*Chishui Xuanzhu*)
Inability to expectorate phlegm indicates lack of strength. Black phlegm comes from the Kidney, indicating deficiency-cold of Middle Qi and flooding upward of Kidney Water. (Zhou Shenzhai)
If the human body had no phlegm, what is called phlegm is merely gathered body fluids. When five grains enter the Stomach, their dregs, body fluids, and Zong Qi (Gathering Qi) are divided into three pathways. Thus, Zong Qi accumulates in the chest, emerges from the throat, penetrates the Heart and Lungs, and governs respiration. Ying Qi secretes its fluids, injects them into the vessels, transforms them into Blood, nourishes the four extremities, and internally irrigates the Five Zang and Six Fu organs, corresponding to the passage of time. Wei Qi emits its fierce and rapid energy, proceeding first through the four extremities, interstices of muscles, and skin without rest. It travels through Yang during the day and Yin at night, often passing through the branches of Foot-Shaoyin, circulating through the Five Zang and Six Fu organs. When full, it moves; when deficient, it gathers. Gathering becomes phlegm; dispersing returns to body fluids, Blood, and Qi. Initially, there is no other pathogenic evil or filth within the meridians and Zang-Fu organs called "phlegm" to harm the body, which must be removed before cessation. In my youth, I liked to spit phlegm; the more I spat, the more there was. Later, I stopped. Whenever I felt unbearable obstruction in the throat, I would sip a few mouthfuls of plain hot water, spit it out, grind it with my tongue, rinse my mouth over a hundred times until filled with saliva, then inhale through the nose and swallow, directing the intention to the Dantian. After a moment of silence, the throat became clear and peaceful. If not clear, rinse and swallow again until completely dissolved. When first expectorated, it tastes very salty; after rinsing, it becomes sweet. People say it is turbid matter with no possibility of clarification, how absurd! I once crossed a river and saw boatmen scoop muddy water into jars, sprinkle alum powder, and it clarified instantly. This can enlighten us to the method of treating phlegm. Therefore, if Zong Qi in the Upper Jiao is insufficient, phlegm gathers in the chest and diaphragm, causing throat obstruction and panting breath; if Ying Qi in the Middle Jiao is insufficient, blood turns into phlegm, blocking vessel pathways and changing unpredictably; if Wei Qi in the Lower Jiao is insufficient, its vigor declines, fluids stagnate, causing numbness and swelling in the extremities and muscle interstices. To treat the root, tonification should come first; to treat the branch, there are methods for resolution. (*Zhengzhi Zhunsheng*)
Fluids nourish the sinews. If Blood is stagnant and does not flow, phlegm gathers above the diaphragm, causing weak hands and feet. (Mei Yingzuo)
Phlegm, as a substance, rises and falls with Qi, reaching everywhere. It manifests as wheezing, coughing, vomiting, diarrhea, dizziness, palpitations, anxiety, chills, fever, swelling, pain, epigastric fullness, and obstruction. Sometimes the chest and hypochondrium gurgle like thunder; sometimes the whole body feels like insects crawling; sometimes nodules appear in the body, neither red nor swollen; sometimes lumps form on the neck, resembling scrofula but not quite; sometimes obstructing the throat, feeling like a plum pit; sometimes expectorated, shaped like peach gum; sometimes two energies seem to knot in the chest; sometimes a spot on the back feels constantly cold; sometimes skin becomes red and swollen like fire; sometimes epigastric area feels cold and painful like ice; sometimes one limb becomes swollen, hard, and numb; sometimes hypochondriac masses form; sometimes bone joints suffer stabbing pain intermittently; sometimes lower back and legs feel sore, stabbing, and weak; sometimes cold saliva, green water, or black juice is vomited; sometimes dreaming of fire, smoke, swords, and halberds growing densely; sometimes pus in urine or stool; sometimes Guan-Ge (obstruction) preventing passage; sometimes rapid throat bi; sometimes toothache and tinnitus; extending to consumptive tuberculosis and epilepsy; loss of voice and paralysis; amenorrhea and leukorrhea in women; convulsions and tremors in children; even seeing ghosts without cause, resembling possession but not quite—all belong to phlegm syndromes. (Wang Yinjun)
Diseases of the human body number 404. Externally, they do not exceed the six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire) invading; internally, they do not exceed the Seven Emotions (Joy, Anger, Worry, Thought, Fright, Fear, Sorrow) injuring. Changes manifest in the Zang-Fu, meridians, and skin/hair as disease. How can there be so-called "strange" diseases? Quack doctors do not understand the disease mechanism. Upon encountering unfamiliar syndromes, they immediately claim that strange diseases mostly belong to phlegm. Moreover, phlegm is not inherently present in the body. Once body fluids become diseased and turn into phlegm, they manifest according to the meridians involved. How can one use this phrase as an excuse? ○ According to the theory, Zang-Fu body fluids becoming diseased and turning into phlegm, rising and falling with Qi, is a normal principle. But in the spaces between skin and fascia, and in the bends of limbs and joints, how can phlegm from the Zang-Fu organs flow there? This is simply the local body fluids, encountering cold or heat, coagulating into phlegm and causing disease. It is absolutely not body fluids from other parts becoming diseased, turning into phlegm, abandoning their original location, and moving to another part. Furthermore, Qi is inherently formless, thus penetrating everywhere, and fluids follow Qi's movement, circulating via Qi. However, once body fluids become diseased and turn into phlegm, they become tangible and stagnant. How can they circulate with Qi to the most minute and dense places? (*Fengshi Jinnang*)
"The Spleen is the source of phlegm production, the Lung is the vessel of phlegm storage" is baseless talk. The Spleen transports fluids for the Stomach to irrigate the surroundings, and water essence ascends to the Lung. How can it coagulate into phlegm? Only the Kidney is the gate of the Stomach. If the gate is not functional, water gathers and floods, becoming phlegm. Thus, we should say the Kidney is the source of phlegm production. The *Classic* says: What receives grain becomes turbid, what receives Qi becomes clear. Clear Yang goes to the Five Zang, turbid Yin returns to the Six Fu. The Lung is Hand-Taiyin, receiving only the clarity of Qi, not the tangibility of turbidity. How can it store phlegm? Only the Stomach is the sea of water and grain, the destination of all things. If it slightly loses its transport function, damp-heat coagulates into phlegm, adhering to the Stomach and failing to descend. Thus, we should say the Stomach is the vessel of phlegm storage. (Ke Yunbo)
Supplementary Compilation
Treating phlegm requires seeking the root; then phlegm will never fail to clear. If one only knows how to treat phlegm, the error is great. For phlegm caused by Fire, treating Fire should be prioritized; for phlegm caused by Cold, warming the Middle should be primary. Wind-phlegm should be dispersed, requiring acrid-warm herbs; dampness-phlegm should be dried, requiring leaching and draining herbs. Constraint-phlegm has deficiency and excess patterns. Constraint accompanied by anger requires suppressing Liver Evil; constraint accompanied by sorrow requires cultivating Liver and Lung. Phlegm from diet varies: some due to Cold, some due to Heat, some due to excessive rich/sweet foods, some due to alcohol-damp injuring the Spleen. All these can generate phlegm, each having deficiency/excess distinctions. For example, Spleen deficiency failing to control dampness, and Kidney deficiency failing to grasp water, both generate phlegm, belonging to cold-phlegm; or Spleen Yin drying up causing fluid to become glue, or Metal-Water deficiency making phlegm originate from Blood, these belong to heat-phlegm. These two categories account for 80-90% of phlegm syndromes and are deficiency-phlegm that must not be purged. (Zhang Jingyue)
Phlegm syndromes vary unpredictably. Ancients did not investigate root and branch, often prescribing phlegm-resolving formulas. Descendants followed these methods, found them ineffective, and thus called phlegm a "strange disease." They did not know phlegm is the branch of disease, not the root. A skilled practitioner treats the source of phlegm generation; then, without resolving phlegm directly, it disappears naturally. I have studied carefully: Phlegm arises from external invasion of the Six Qi, causing dysfunction of Spleen, Lung, and Stomach transportation and transformation, leading to inadequate digestion of food; or from excessive consumption of rich foods, tea, and wine; or from Spleen-Stomach Yang deficiency causing stagnation of damp-turbidity; or from constraint causing Qi-Fire discomfort and steaming transformation; or from Kidney deficiency causing water flooding; or from Yin deficiency consumptive syndromes where Dragon-Minister Fire flares up, scorches the Lung, causing phlegm-cough. Other phlegms all arise from dampness. Although named wind, fire, or dryness phlegm, they are all transformed by Qi; wind, fire, or dryness do not generate phlegm independently. Treatment methods: Only when phlegm-Qi temporarily blocks the throat is it necessary to temporarily use phlegm-expelling and Qi-descending agents to open it. Otherwise, one must treat the root. The saying "See phlegm, do not treat phlegm" is indeed a timeless maxim. Phlegm is transformed from food-damp and turbidity. Can one forbid eating? If one specifically tries to eliminate it, for cases due to external pathogens, eliminating the pathogen may clear the phlegm, such as warming cold-phlegm, clearing heat-phlegm, drying damp-phlegm, moistening dry-phlegm, and dispersing wind-phlegm. For cases involving the root, phlegm will be eliminated and regenerated simultaneously, potentially persisting until death. (*Linzheng Zhinan*)
Wang Jiezhai said: Heat-phlegm is cleared, dampness-phlegm is dried, wind-phlegm is dispersed, constraint-phlegm is opened, stubborn-phlegm is softened, food-phlegm is digested, phlegm in the chest/diaphragm is induced to vomit, phlegm in the intestines/stomach is purged. This establishes laws for excess patients. For Lung deficiency with phlegm, preserve the Lung to nourish fluids; for Spleen deficiency with phlegm, cultivate the Spleen to transform phlegm-saliva; for Kidney deficiency with phlegm, tonify the Kidney to guide storage. ○ The Spleen and Lung often suffer together because the Spleen is the source of phlegm and the Lung is the vessel of storage, and their organ energies are constantly connected. Thus, exterior symptoms show Lung disease (cough with thick phlegm, dry throat/nose) and Spleen disease (epigastric fullness, poor appetite, frequent diarrhea). At this time, using drying herbs to tonify the Spleen hinders the Lung, and using moistening herbs to benefit the Lung hinders the Spleen. One must balance both, avoiding bitter-cold and aromatic-drying herbs, focusing on harmonization, without exclusively using Lung-clearing and phlegm-resolving drugs. Because the Spleen generates the Lung, but the Lung does not support the Spleen. Use Yigong San, adding Coix Seed, Ophiopogon, Dendrobium, Platycodon, Yam, Hyacinth Bean, Lotus Seed, etc. ○ Phlegm in the body is like sap in wood or saliva in fish, reaching everywhere. For deficiency-phlegm overflowing upward, tonify Qi to move phlegm. Overusing emetics fails to nourish meridians, leading to Kidney exhaustion and bone萎 (atrophy/weakness). (*Zhengzhi Huibu*)
In my lifelong medical practice, I take tonifying Middle Qi as the foundation, hence achieving efficacy. Often treating patients with excessive phlegm, direct phlegm treatment fails. Specifically tonifying Middle Qi, over time, the phlegm disappears naturally. (Wuang Huangchi)
Spleen Earth corresponds to Heaven, originating in Dampness transformation. If grain-food fluids do not circulate, they stagnate and become phlegm. Eight or nine out of ten people suffering from phlegm diseases: the elderly should not rapidly reduce Fire, and deficient persons should not completely eliminate phlegm. Attacking too urgently worsens the disease and leads to danger. One must secure Yuan Qi as the root. (Kongtongzi)
Chest and hypochondriac distending pain, nausea, vomiting, occurring intermittently, all belong to phlegm. Because old phlegm stagnates in the chest/diaphragm, forming a nest, gradually filling up, causing distension and vomiting. After vomiting phlegm-saliva, the chest feels comfortable the next day. Wait half a month, and the illness recurs, lingering for years without cure. How to treat this? We often hear that governing unruly people requires virtue first, assisted by punishment. Treating disease is the same. The aforementioned symptoms require first tonifying Spleen and Kidney, combined with regulating Qi and moving phlegm, allowing Blood and Qi to circulate, preventing phlegm stagnation. Only after prolonged medication can success be achieved. If Spleen-Stomach is strong but phlegm remains non-fluid, it is called stubborn-phlegm. Having accumulated for a long time, it cannot be suddenly removed. One must use the Dao Cang Fa (Stomach Emptying Method), emptying the nest. After vomiting, use tonics combined with phlegm-resolving herbs to prevent recurrence. This is the sequence of treatment. Indulgence and leniency will never cure it. However, not tonifying Spleen-Stomach and solely attacking/vomiting inevitably leads to death. ○ When using phlegm medicines, add Qi-moving herbs like Aucklandia, Cyperus, or Amomum. Stomach Qi moves with fragrant flavors, and phlegm-saliva does not stagnate with Qi movement. Without Qi-moving herbs, efficacy is rare. For cold-phlegm, Qi herbs are natural. For heat-phlegm, although using Scutellaria and Coptis, Qi herbs must assist, known as the "following treatment" method. Otherwise, if phlegm is already sticky and cold herbs are used, circulation will fail. Commonly, people fail to treat heat-phlegm with cold herbs because they lack Qi herbs as guides. The human body takes Qi as the root. Qi stagnation causes phlegm stagnation; Qi movement causes phlegm movement. Ancients said treating phlegm begins with regulating Qi; this grasps the essence. (Yu Fushan)
There is no upward-flowing phlegm in the human body, just as there is no backward-flowing water in the world. Therefore, skilled practitioners do not treat phlegm but treat Qi. When Qi is smooth, body fluids throughout the body follow Qi and become smooth. (Pang Anchang)
Wang Jiezhai said: The root of phlegm is Water, originating in the Kidney; the movement of phlegm is governed by the Spleen. Ancients used Er Chen Tang as a general phlegm remedy. While effective for dampness-phlegm and cold-phlegm, if Yin-Fire flares upward, steaming the Upper Jiao, depressing Lung Qi, causing fluids to ascend with Qi, coagulating into foul, thick, turbid phlegm, even bloody, this is not comparable to Middle Jiao cold/damp phlegm, nor can Banxia (Pinellia) or Nanxing (Arisaema) treat it. Only Qingqi Huatan Tang clears it effectively. Alas! Jiezhai discusses phlegm, revealing its origin in the Kidney, uncovering what predecessors missed. Unfortunately, he started but did not finish the argument; his formulas were all branch-treating. Cold-cooling herbs damage Spleen-Stomach. Only Zhang Zhongjing said: For Qi deficiency with phlegm, use Shenqi Wan to tonify and expel. Wu Jiaoshan said: Bawei Wan treats the root of phlegm. These two gentlemen truly opened paths for later learners, saving countless lives. Phlegm is a disease name, not inherent to humans. It is either water flooding as phlegm or water boiling as phlegm. One must distinguish Fire presence. Kidney deficiency failing to control Water means Water does not return to its source, flowing backward like reverse water, flooding as phlegm—this is No-Fire, so use Bawei Wan to tonify Kidney Fire. Yin deficiency with Fire movement causes water boiling. Movement in Kidney is like Dragon Fire emerging from the sea; Dragon rises, water follows. Movement in Liver is like Thunder Fire emerging from earth; storm and rain, water surges as phlegm—this is With-Fire, so use Liuwei Wan to balance Fire. This treats the root, not the branch. How to distinguish Fire/No-Fire? No-Fire is pure clear water; With-Fire contains heavy turbid white foam. For Kidney deficiency, first use Liuwei/Bawei to strengthen Water/Fire, then Sijunzi/Liu Junzi to tonify Earth controlling Water. For Spleen deficiency, use Buzhong Yiqi Lizhong, then Liuwei/Bawei to control Water and benefit Mother. The way to treat phlegm is nearly complete. Pang Anchang said: Yin Water deficiency, Yin Fire ascending, Lung受 (affected) by Fire, unable to descend clearly, causing fluid turbidity, generating phlegm instead of Blood. Treat with moistening agents like Ophiopogon, Rehmannia, Cornus to nourish Yin, returning ascending Fire to its home, clearing phlegm naturally. Using Er Chen Tang brings immediate peril. More cases: Kidney deficiency failing to grasp Qi, Qi exits but cannot be grasped, accumulating, stagnating, generating phlegm. Use Bawei Wan primarily. (*Yiguan*)
Lizhai treated phlegm, often stating Kidney deficiency water flooding causes phlegm, requiring Kidney tonification. In autumn of Ren-Shen year, I suffered cough with much phlegm, knowing it was due to excessive desire and Kidney deficiency. I strictly took Liuwei Wan, cured in a month. Contemporary doctors treating phlegm most avoid Shudi (Prepared Rehmannia), thinking it cloying. Who knows the subtlety? (*Zegong Manlu*)
Kidney deficiency water flooding causing phlegm, using Shenqi Wan yielded no effect repeatedly. Thinking phlegm is Yin-type, using Shudi to assist Yin is inappropriate. Remove Shudi and Shan Zhu Yu from the formula, add Shichangpu (Acorus) and Chenxiang (Aquilaria) to open Qi, naturally effective. (*Zhangshi Yitong*)
Methods of treating phlegm: Expel, Guide, Wash, Transform, Emetic, Regulate Spleen, Descend Fire, Move Qi. Predecessors' methods were detailed. As for phlegm in nests/cysts, like bees in honeycombs or lotus seeds in pods, easy to grow, hard to remove, narrow outside, wide inside. Regardless of expelling, guiding, washing, or emetic drugs, they only injure other organs, as the cavity rejects entry. Not only in nests is phlegm hard to remove, but outside lung lobes, between membrane origins, stubborn phlegm stuck for years, like trees...