痰饮皆津液所化，痰浊饮清，痰因于火，饮因于湿也。痰生于脾，湿胜则精微不运，从而凝结，或壅肺
窍，或流经隧∶饮聚于胃，寒留则水液不行，从而泛滥，或停心下，或渍肠间。此由脾胃水湿阴凝，必阳气健
运，则浊阴下降，如烈日当空，则烟云消散，宜以理脾逐湿为治者也。若夫肾阳虚火不制水，水泛为痰，则饮
逆上攻，故清而澈，治宜通阳泄湿，忌用腻品助阴；如四物六味等汤。肾阴虚，火必烁金，火结为痰，为痰火上
升，故稠而浊，治宜滋阴清润，忌用温品助燥，如二陈六君子等汤。治法所必辨也。夫清澈为饮，稠浊为痰，
饮惟停蓄肠胃，而痰则随气升降，遍身皆到。庞氏云∶天下无逆流之水，因乎风也。人身无倒上之痰，因乎
气也。在肺则咳，在胃则呕，在心则悸，在头则眩，在背则冷，在胸则痞，在胁则胀，在肠则泻，在经络则肿，
在四
肢则痹，变幻百端，昔人所谓怪症多属痰，暴病多属火也。然又谓见痰休治痰者，以治必探本，恐专事消涤，
重虚其胃气，反滋膨胀耳。丹溪云∶胃气亦赖痰以养，攻涤则胃虚而痰愈剧。亦有但治其痰者，如风痰散之，
防风丸加南星、生姜。风兼寒者，青州白丸子。寒痰温之，理中化痰丸。暑痰豁之，消暑丸。湿痰燥之，二术
二陈汤、白术丸。燥痰润之，润肺饮加杏仁、白蜜。火痰清之，清气化痰丸。食痰消之，保和丸、栝蒌丸。
酒痰化之，瑞竹堂化痰丸。郁痰解之，三因七气汤加郁金、菖蒲、香附。气痰利之，咯不出，咽不下，如败
絮，如梅核。七气汤、三仙丸。惊痰泄之，控涎丹加辰砂、蝎尾。老痰软之，如海石、海粉、芒硝、瓦楞子之
类，或青礞石丸。顽痰吐之，三圣散、青绿丸，虚者参芦散加竹沥。在上者涌之，桔梗芦散，或稀涎散。在下
者导之，导痰汤，甚者滚痰丸。在脾者黄，滑而易出，二陈汤加枳、术。在肺者白如米粒，涩而难出，利金
汤去姜、枳，加玉竹，蜜水冲。在肝者青而多泡，川芎丸加星、枳，甚者千缗汤。在心者赤，结如胶粘，半
黄丸。在肾者黑而多咸。桂苓丸加泽泻、车前。留胁下者，天阴隐痛。二陈汤加白芥子。滞经络者，筋骨牵
痛。荆沥、竹沥、姜汁行之，或旋复花汤加桂枝。入四肢者，手足疲软。导痰汤加桂枝、姜黄、竹沥。隐皮里
膜外者，肿而麻木。二陈汤加白芥子、姜汁、竹沥。或成块流走不定，导痰汤加姜汁、竹沥。或成核结聚项
间。痰核丸、痰核酒。膈上停痰痞闷，小陷胸汤加茯苓、枳实、姜汁、竹沥。脘中伏痰臂痛，指、迷茯苓丸。
痰滞气逆嗽多，六安煎。寒涎沃胆不眠，温胆汤，多惊者，加蝎尾。痰挟死血攻注，控涎丹加韭汁、桃仁、
木香、胡椒、鲮鲤甲。痰结窠囊呕吐，姜汁、竹沥、韭汁饮。中风痰迷心窍，属寒者，涤痰汤下牛黄丸；属
热者，下二丹丸。癫痫痰闷抽掣，牛黄丸。此皆治其标也。如求其本，脾虚湿痰，宜健脾以运之。四君子汤、
参术健脾丸。肺热火痰，宜清肺以润之。清肺饮、四阴煎。脾肺气虚不运生痰者，六君子汤加木香。肺胃气虚
不化生痰者，六君子汤加桔梗。脾气滞者，异功散加砂仁。中气弱者，补中益气汤。
脾胃虚挟湿者，脉濡缓，痰清稀，六君子汤加炮姜，补中益气汤加茯苓、半夏。肝肾虚，痰中见血者，六味
汤加乌 鱼骨、参三七。肾阴亏，火动痰升者，五味天冬丸、百花膏。相火烁痰津涸者，滋阴清化丸。肾阳衰，
水泛为痰者，薛氏八味丸，如不应，真武汤。劳损咳白痰如鸡蛋清，俗名白血者，补肺汤。此乃治痰之本矣，
且痰饮同称而殊治，岂可混乎。试由痰论饮，《内经》有饮无痰，其论饮病，皆由湿淫土郁。至《金匮》乃
立痰饮、悬饮、溢饮、支饮、留饮、伏饮等名，皆停水为患。如其人昔肥今瘦，水走肠间，漉漉有声，为痰饮，
必目眩短气。饮在阳，则呼气短，苓桂术甘汤。饮在阴则吸气短，肾气丸。《金匮》云∶短气有微饮，当从小
便利之，苓桂术甘汤、肾气丸主之。饮后水流胁下，咳唾引痛为悬饮，脉必沉弦。十枣汤。饮水流于四肢，
当汗不汗，身体疼重为溢饮。小青龙汤。咳逆倚息，短气不得卧，形如肿，为支饮。葶苈泻肺汤，或五苓散。
水停心下，背寒冷如掌大，短气，肢节痛，胁痛引缺盆，脉沉，为留饮。导痰汤。膈满喘咳呕吐，寒热，腰背
痛，身振 ，为伏饮。倍术丸加茯苓、半夏。痰饮不渴，小半夏汤。支饮眩冒，泽泻汤。心下痞，膈间有水，
悸眩。小半夏加茯苓汤。茶饮过多成癖，及饮酒成癖，姜桂丸。饮癖呕酸嘈杂，心悬如饥。三圣丸、苍术丸。
别有非痰非饮，吐清涎沫者，脾虚不能收摄也。六君子汤加益智、姜。渴欲饮水，水入即吐者，名水逆。五苓
散，大法，外饮在脾，内饮在肾。治脾，苓桂术甘汤；治肾，肾气丸。气壅者开之，小青龙汤去麻、辛。呛咳
者平之，鲜枇杷叶、杏仁、茯苓、前胡、苏子、桑皮。浊逆者温之，真武汤。阳微者和之，外台茯苓饮。湿滞
者渗之，五苓散。留饮者逐之，桂苓汤。支结入络者通之，茯苓桂枝汤加参、草、川椒、半夏、姜、蜀漆。
饮症通治，五饮汤。仲景云∶治痰饮当以温药和之，此可谓一言提要者矣。
仲景曰∶饮而兼咳者，但治饮，不必治咳。
缪仲淳曰∶生痰之源不一，治各不同。由阴虚火炎，上迫乎肺，凝结为痰，是谓阴虚痰火。痰在肺而本
于肾，治宜降气清热，益阴滋水。忌辛温燥热补气药。由脾胃寒湿生痰，或饮啖过度，
致脾气壅滞为痰，此病在脾胃，无关肺肾，治宜燥脾利气。忌滞腻寒苦湿润药。由风寒郁热生痰，病亦在肺，
治宜豁痰，清利中佐以辛温，麻黄生姜之类，以散外寒，忌温补酸收药。则药无格拒之患。夫痰质稠粘，饮惟
清水，或青绿苦酸，多因过饮茶酒，或情抱抑郁，中寒湿阻，治宜燥湿利水，温通阳气以行之。二陈五苓真武
之属。
张路玉曰∶痰饮变生诸症，必以治饮为先，诸症自愈。如头风眉棱骨痛，屡用风药不效，投以痰剂收功。患
眼赤羞明而痛，与凉药弗瘳，畀以痰剂获效。凡此之类，不一而足，在审症圆机耳。如太阴痰厥头痛，不专
治风，亦此意也。
痰和饮都是由津液转化而成的，其中痰质地浑浊而饮质地清稀，痰的产生多与火邪有关，饮的产生多与湿邪有关。痰生成于脾，当湿气过盛时，水谷精微无法正常运化，从而凝结成痰；它或壅塞肺窍，或流注经络隧道。饮积聚于胃，若寒气停留，则水液运行不畅，从而泛滥成患；它或停聚在心下（胃脘部），或浸渍于肠间。这是由于脾胃的水湿阴凝所致，必须依靠阳气的健运，才能使浊阴下降，就像烈日当空时烟云自然消散一样，因此治疗应以调理脾胃、驱逐湿气为主。
如果肾阳虚衰，无法制约水液，导致水泛为痰，那么饮气就会逆向上攻，此时痰质清彻，治疗宜通阳泄湿，忌用滋腻助阴的药物，如四物汤、六味地黄汤等。若肾阴虚，虚火必会灼伤肺金，火热结聚而成痰，表现为痰火上冲，此时痰质稠厚浑浊，治疗宜滋阴清润，忌用温燥助火的药物，如二陈汤、六君子汤等。这是治法中必须辨别的要点。
清澈的为饮，稠浊的为痰。饮只停蓄在肠胃之中，而痰则随着气机的升降流动，遍布全身。庞安常说：“天下没有逆流的水，是因为风的作用。”人体也没有倒上的痰，是因为气的作用。痰在肺则咳嗽，在胃则呕吐，在心则心悸，在头则眩晕，在背则发冷，在胸则痞闷，在胁肋则胀满，在肠则腹泻，在经络则肿胀，在四肢则痹痛，变化多端，正如古人所说“怪病多属痰，暴病多属火”。然而又说“见痰休治痰”，因为治病必须探求根本，恐怕专门从事消痰涤痰，会严重损伤胃气，反而加重腹胀。丹溪说：“胃气也依赖痰来滋养，攻伐涤除会导致胃虚而痰更剧。”
也有专门针对痰进行治疗的方法：如风痰用散法，可用防风丸加南星、生姜；风兼寒者，用青州白丸子；寒痰用温法，用理中化痰丸；暑痰用豁法，用消暑丸；湿痰用燥法，用二术二陈汤、白术丸；燥痰用润法，用润肺饮加杏仁、白蜜；火痰用清法，用清气化痰丸；食痰用消法，用保和丸、栝蒌丸；酒痰用化法，用瑞竹堂化痰丸；郁痰用解法，用三因七气汤加郁金、石菖蒲、香附；气痰用利法，症状为咯不出、咽不下，感觉像败絮、像梅核，用七气汤、三仙丸；惊痰用泄法，用控涎丹加辰砂、蝎尾；老痰用软坚法，用海浮石、海粉、芒硝、瓦楞子之类，或青礞石丸；顽痰用吐法，用三圣散、青绿丸，体虚者用参芦散加竹沥。
痰在上焦的涌吐之，用桔梗芦散，或稀涎散；在下焦的导之下，用导痰汤，严重的用滚痰丸；在脾的痰色黄，滑利易出，用二陈汤加枳实、白术；在肺的痰色白如米粒，涩滞难出，用利金汤去生姜、枳实，加玉竹，用蜜水冲服；在肝的痰色青且多泡沫，用川芎丸加南星、枳实，严重的用千缗汤；在心的痰色赤，凝结如胶粘，用半黄丸；在肾的痰色黑且味咸，用桂苓丸加泽泻、车前子。
痰停留在胁下的，遇阴天隐痛，用二陈汤加白芥子；停滞在经络的，筋骨牵拉疼痛，用荆沥、竹沥、姜汁行气，或旋复花汤加桂枝；进入四肢的，手足疲软无力，用导痰汤加桂枝、姜黄、竹沥；潜伏在皮里膜外的，肿胀而麻木，用二陈汤加白芥子、姜汁、竹沥；或结成块状流走不定，用导痰汤加姜汁、竹沥；或结成核聚集在颈项间，用痰核丸、痰核酒。
膈上停痰导致痞闷，用小陷胸汤加茯苓、枳实、姜汁、竹沥；胃脘中伏痰导致臂痛，用指迷茯苓丸；痰滞气逆导致咳嗽多，用六安煎；寒涎沃胆导致失眠，用温胆汤，多惊者加蝎尾；痰挟死血攻注，用控涎丹加韭汁、桃仁、木香、胡椒、鲮鲤甲；痰结窠囊导致呕吐，用姜汁、竹沥、韭汁饮用。
中风痰迷心窍，属寒的，用涤痰汤送服牛黄丸；属热的，送服二丹丸。癫痫痰闷抽搐，用牛黄丸。这些都属于治标的方法。如果要治本：脾虚湿痰，宜健脾以运化，用四君子汤、参术健脾丸；肺热火痰，宜清肺以滋润，用清肺饮、四阴煎；脾肺气虚不运而生痰者，用六君子汤加木香；肺胃气虚不化而生痰者，用六君子汤加桔梗；脾气滞者，用异功散加砂仁；中气弱者，用补中益气汤。
脾胃虚挟湿者，脉象濡缓，痰清稀，用六君子汤加炮姜，或补中益气汤加茯苓、半夏。肝肾虚，痰中带血者，用六味地黄汤加乌贼骨、三七。肾阴亏，虚火动痰升者，用五味天冬丸、百花膏。相火旺灼伤痰津干涸者，用滋阴清化丸。肾阳衰，水泛为痰者，用薛氏八味丸，如无效，用真武汤。劳损咳嗽吐出白痰如鸡蛋清，俗名白血者，用补肺汤。这才是治痰的根本，而且痰饮虽然同称但治疗方法不同，岂可混淆？
试着从痰论及饮，《内经》中有饮无痰的说法，其论述饮病，皆由湿邪淫溢、土气郁结所致。到了《金匮要略》，才设立痰饮、悬饮、溢饮、支饮、留饮、伏饮等名称，都是停水为患。如果那人以前肥胖现在消瘦，水走肠间，漉漉有声，称为痰饮，必然伴有目眩、短气。饮在阳分，则呼气短，用苓桂术甘汤；饮在阴分，则吸气短，用肾气丸。《金匮》说：“短气有微饮，应当从小便利之”，用苓桂术甘汤、肾气丸主治。
饮水流于胁下，咳唾牵引疼痛，称为悬饮，脉象必沉弦，用十枣汤。饮水流于四肢，当汗出不汗，身体疼重，称为溢饮，用小青龙汤。咳逆倚息，短气不得卧，形体如肿，称为支饮，用葶苈泻肺汤，或五苓散。水停心下，背部寒冷如掌大，短气，肢节痛，胁痛牵引缺盆，脉沉，称为留饮，用导痰汤。膈满喘咳呕吐，寒热，腰背痛，身体振颤，称为伏饮，用倍术丸加茯苓、半夏。痰饮不渴，用小半夏汤。支饮眩冒，用泽泻汤。心下痞，膈间有水，心悸眩晕，用小半夏加茯苓汤。茶饮过多成癖，及饮酒成癖，用姜桂丸。饮癖呕酸嘈杂，心中悬空如饥，用三圣丸、苍术丸。
另有非痰非饮，吐出清涎沫的，是脾虚不能收摄，用六君子汤加益智仁、生姜。渴欲饮水，水入即吐的，名叫水逆，用五苓散。大法认为：外饮在脾，内饮在肾。治脾用苓桂术甘汤；治肾用肾气丸。气壅者开之，用小青龙汤去麻黄、细辛。呛咳者平之，用鲜枇杷叶、杏仁、茯苓、前胡、苏子、桑白皮。浊逆者温之，用真武汤。阳微者和之，用外台茯苓饮。湿滞者渗之，用五苓散。留饮者逐之，用桂苓汤。支结入络者通之，用茯苓桂枝汤加人参、甘草、川椒、半夏、生姜、蜀漆。饮症通治，用五饮汤。仲景说：“治痰饮当以温药和之”，这可谓是一言中的。
缪仲淳说：“生痰之源不一，治法各不相同。由阴虚火炎，上迫于肺，凝结为痰，这叫阴虚痰火。痰在肺而本于肾，治疗宜降气清热，益阴滋水。忌用辛温燥热补气药。由脾胃寒湿生痰，或饮食过度，致脾气壅滞为痰，此病在脾胃，无关肺肾，治疗宜燥脾利气。忌用滞腻寒苦湿润药。由风寒郁热生痰，病亦在肺，治疗宜豁痰，清利中佐以辛温，如麻黄、生姜之类，以散外寒，忌用温补酸收药，这样就没有药格拒的隐患。痰质稠粘，饮只有清水，或青绿苦酸，多因过饮茶酒，或情志抑郁，中焦寒湿阻滞，治疗宜燥湿利水，温通阳气以行之，如二陈汤、五苓散、真武汤之类。”
张路玉说：“痰饮变生诸症，必以治饮为先，诸症自愈。如头风眉棱骨痛，屡用风药不效，投以痰剂收功。患眼赤羞明而痛，与凉药弗瘳，畀以痰剂获效。凡此之类，不一而足，在审症圆机耳。如太阴痰厥头痛，不专治风，亦此意也。”
Phlegm and fluid retention (Yin) are both transformations of body fluids. Phlegm is turbid while fluid retention is clear; phlegm arises from fire, whereas fluid retention arises from dampness. Phlegm originates in the Spleen; when dampness prevails, the essence and grains fail to be transported, leading to condensation. It may obstruct the Lung orifices or flow through the meridians and collaterals. Fluid retention gathers in the Stomach; if cold lingers, water fluids fail to circulate, leading to overflow. It may accumulate below the diaphragm (epigastrium) or soak into the intestines. This results from the yin coagulation of water and dampness in the Spleen and Stomach. Yang qi must be robust and transporting so that turbid yin descends, just as smoke and clouds dissipate under the scorching sun. Therefore, treatment should focus on regulating the Spleen and expelling dampness.
If Kidney yang deficiency fails to control water, causing water to overflow into phlegm, the fluid qi rebels upward. In this case, the phlegm is clear and transparent; treatment should involve unblocking yang and draining dampness, avoiding cloying substances that aid yin, such as Siwu Decoction (Four Substance Decoction) or Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). If Kidney yin is deficient, deficient fire will scorch Metal (Lung), and heat condenses into phlegm, manifesting as rising phlegm-fire; thus, the phlegm is thick and turbid. Treatment should nourish yin and clear moistness, avoiding warm substances that aid dryness, such as Erchen Decoction (Two-Cured Decoction) or Liujunzi Decoction (Six-Gentleman Decoction). These distinctions are essential in treatment principles.
Clear substances are fluid retention; thick and turbid substances are phlegm. Fluid retention only stagnates in the intestines and stomach, whereas phlegm moves with the ascending and descending of qi, reaching all parts of the body. Pang Anchang said: "There is no backward-flowing water in the world, for it is driven by wind." There is no upward-rebelling phlegm in the human body, for it is driven by qi. When in the Lung, it causes cough; in the Stomach, vomiting; in the Heart, palpitations; in the head, dizziness; in the back, coldness; in the chest, stuffiness; in the hypochondrium, distension; in the intestines, diarrhea; in the meridians, swelling; in the limbs, bi-syndrome (impediment syndrome). Changes are myriad, as the ancients said: "Strange diseases often belong to phlegm, and acute diseases often belong to fire." However, it is also said, "When seeing phlegm, do not merely treat the phlegm," because treating the root is necessary; fearing that solely focusing on eliminating phlegm will severely damage Stomach qi, thereby exacerbating abdominal distension. Danxi stated: "Stomach qi also relies on phlegm for nourishment; attacking and purging leads to Stomach deficiency and worsens the phlegm."
There are also methods specifically targeting phlegm: For Wind-phlegm, use dispersal, such as Fangfeng Wan (Windscreen Pill) adding Tianxing (Arisaema Cum Bile) and Shengjiang (Fresh Ginger); for Wind combined with Cold, use Qingzhou Baiwanzi (Qingzhou White Pills); for Cold-phlegm, use warming, such like Lizhong Huatan Wan (Regulate the Middle Phlegm-Resolving Pill); for Summerheat-phlegm, use resolution/clearing, such as Xiaoshu Wan (Summerheat-Relieving Pill); for Damp-phlegm, use drying, such as Eryi Erchen Tang (Erchen Decoction with Atractylodes and Cyperus) or Baizhu Wan (Atractylodes Macrocephala Pill); for Dry-phlegm, use moistening, such like Runfei Yin (Moisten the Lung Drink) adding Xingren (Apricot Seed) and Baimi (White Honey); for Fire-phlegm, use clearing, such as Qingqi Huatan Wan (Clear Qi Phlegm-Resolving Pill); for Food-phlegm, use digestion/resolution, such like Baohe Wan (Preserve Harmony Pill) or Gualou Wan (Trichosanthes Pill); for Alcohol-phlegm, use transformation, such as Ruizhutang Huatan Wan (Ruizhu Hall Phlegm-Resolving Pill); for Stagnation-phlegm, use unblocking, such as San Yin Qi Qi Tang (Three Causes Seven-Qi Decoction) adding Yujin (Curcuma Longa Rhizome), Shichangpu (Acorus Tatarinowii Rhizome), and Xiangfu (Cyperus Rotundus Rhizome); for Qi-phlegm, use promoting movement, characterized by inability to expectorate or swallow, feeling like rotten cotton or a plum pit, using Qi Qi Tang (Seven-Qi Decoction) or Sanxian Wan (Three Immortals Pill); for Shock-phlegm, use purgation/drainage, such like Kongxian Dan (Controlling Fluids Powder) adding Chen Sha (Cinnabar) and Xiwei (Scorpion Tail); for Old-phlegm, use softening hardness, using Haishi (Floating Limestone), Haifen (Sea Powder), Mangxiao (Mirabilite), or Lewangzi (Arca Shell), or Qingmengshi Wan (Green Meng Stone Pill); for Stubborn-phlegm, use emesis, such like Sansheng San (Three Saints Powder) or Qinglv Wan (Green-Yellow Pill), and for deficiency cases, Shenlu San (Ginseng Rhizome Powder) adding Zhuli (Bamboo Juice).
For phlegm in the upper jiao, induce vomiting using Jiegeng Lu San (Platycodon Rhizome and Rhizome Powder) or Xixian San (Thin Saliva Powder); for phlegm in the lower jiao, guide downward using Daotan Tang (Guide Phlegm Decoction), or Guntan Wan (Rolling Phlegm Pill) for severe cases; for phlegm in the Spleen, which is yellow, slippery, and easy to expectorate, use Erchen Decoction adding Zhishi (Immature Bitter Orange) and Baizhu (Atractylodes Macrocephala); for phlegm in the Lung, which is white like rice grains, astringent, and difficult to expectorate, use Lijin Tang (Benefit Metal Decoction) removing Shengjiang and Zhishi, adding Yuzhu (Polygonatum Odoratum Rhizome), taken with honey water; for phlegm in the Liver, which is green and foamy, use Chuanxiong Wan (Chuanxiong Pill) adding Tianxing and Zhishi, or Qianmin Tang (Thousand Thread Decoction) for severe cases; for phlegm in the Heart, which is red and sticky like glue, use Banhuang Wan (Half-Yellow Pill); for phlegm in the Kidney, which is black and salty, use Guiling Wan (Cinnamon and Polyporus Pill) adding Zexie (Alisma Rhizome) and Cheqian (Plantago Seed).
Phlegm lingering in the hypochondrium causes dull pain on cloudy days; treat with Erchen Decoction adding Baijiezi (White Mustard Seed). Phlegm stagnating in the meridians causes pulling pain in sinews and bones; treat with Jingli (Perilla Leaf Juice), Zhuli, and Jiangzhi (Ginger Juice), or Xuanfuhua Tang (Inula Flower Decoction) adding Guizhi (Cinnamon Twig). Phlegm entering the limbs causes weakness in hands and feet; treat with Daotan Decoction adding Guizhi, Jianghuang (Turmeric Rhizome), and Zhuli. Phlegm hidden in the subcutaneous tissue causes swelling and numbness; treat with Erchen Decoction adding Baijiezi, Jiangzhi, and Zhuli. If it forms movable nodules, treat with Daotan Decoction adding Jiangzhi and Zhuli. If it forms knots in the neck, use Tanhe Wan (Phlegm Nodule Pill) or Tanhe Jiu (Phlegm Nodule Wine).
Phlegm stopping above the diaphragm causing stuffiness is treated with Xiaoxianxiong Tang (Minor Chest-Harmonizing Decoction) adding Fuling (Poria), Zhishi, Jiangzhi, and Zhuli. Hidden phlegm in the epigastrium causing arm pain is treated with Zhimi Fuling Wan (Point-Mystery Poria Pill). Phlegm stagnation with rebellious qi causing frequent cough is treated with Liu'an Jian (Six-Safe Decoction). Cold saliva flooding the Gallbladder causing insomnia is treated with Wendan Tang (Warm the Gallbladder Decoction), adding Xiwei for excessive fright. Phlegm mixed with dead blood attacking is treated with Kongxian Dan adding Jiuzhi (Leek Juice), Taoren (Peach Seed), Muxiang (Aucklandia Root), Hujiao (Pepper), and Linglijia (Pangolin Scale). Phlegm knotting in sacs causing vomiting is treated with a drink of Jiangzhi, Zhuli, and Jiuzhi. Stroke with phlegm confusing the heart orifices: if cold, administer Nitang Tang (Cleanse Phlegm Decoction) with Niuhuang Wan (Calculus Bovis Pill); if hot, administer Erdan Wan (Two Cinnabars Pill). Epilepsy with phlegm oppression and convulsions is treated with Niuhuang Wan. These are all treatments addressing the branch (symptoms).
To treat the root: For Spleen deficiency with Damp-phlegm, strengthen the Spleen to transport, using Sijunzi Tang (Four Gentlemen Decoction) or Shenzhu Jianpi Wan (Ginseng and Atractylodes Spleen-Strengthening Pill). For Lung heat with Fire-phlegm, clear the Lung and moisten, using Qingfei Yin (Clear the Lung Drink) or Siyin Jian (Four Yin Decoction). For Spleen-Lung qi deficiency failing to transform and generate phlegm, use Liujunzi Decoction adding Muxiang. For Lung-Stomach qi deficiency failing to transform and generate phlegm, use Liujunzi Decoction adding Jiegeng. For Spleen qi stagnation, use Yigong San (Extraordinary Aid Powder) adding Sharen (Amomum Fruit). For Middle qi weakness, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
For Spleen-Stomach deficiency with dampness, presenting with soggy-slow pulse and thin phlegm, use Liujunzi Decoction adding Paojiang (Prepared Ginger), or Buzhong Yiqi Decoction adding Fuling and Banxia (Pinellia Tuber). For Liver-Kidney deficiency with blood in phlegm, use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) adding Wuyu Gu (Cuttlefish Bone) and Sanqi (Notoginseng Root). For Kidney yin deficiency with fire stirring phlegm ascent, use Wuwei Tiandong Wan (Five-Flavor Asparagus and Ophiopogon Pill) or Baihua Gao (Hundred Flowers Paste). For Ministerial fire scorching phlegm fluids causing dryness, use Ziyin Qinghua Wan (Nourish Yin Clear Transform Pill). For Kidney yang decline with water overflowing as phlegm, use Xue Shi Bawei Wan (Xue's Eight-Ingredient Pill), or Zhenwu Tang (True Warrior Decoction) if ineffective. For consumptive disease with cough producing white phlegm like egg white, commonly called "white blood," use Bufei Tang (Tonify the Lung Decoction). This constitutes treating the root of phlegm. Since phlegm and fluid retention are named together but treated differently, how can they be confused?
Turning from phlegm to discuss fluid retention: The *Neijing* mentions fluid retention but not phlegm; its discussion of fluid retention diseases attributes them all to dampness overacting and Earth qi stagnating. In the *Jingui Yaolue*, names such as Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), Zhi Yin (Supporting Fluid), Liu Yin (Retained Fluid), and Fu Yin (Hidden Fluid) were established, all referring to pathological water accumulation. If a person was formerly fat but is now thin, with water moving in the intestines making a gurgling sound, it is called Tan Yin, accompanied by dizziness and shortness of breath. Fluid in the Yang aspect causes short exhalation, treated with Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction). Fluid in the Yin aspect causes short inhalation, treated with Shenqi Wan (Kidney Qi Pill). The *Jingui* states: "Shortness of breath with slight fluid retention should be promoted via urination," primarily using Linggui Zhugan Tang or Shenqi Wan.
Water flowing into the hypochondrium after drinking, causing pain upon coughing and spitting, is called Xuan Yin, with a deep-wiry pulse, treated with Shizao Tang (Ten Jujube Decoction). Water flowing into the limbs, where sweating should occur but does not, causing heavy body pain, is called Yi Yin, treated with Xiaoqinglong Tang (Minor Blue Dragon Decoction). Coughing with reversed qi, leaning to breathe, shortness of breath preventing lying down, and swelling-like appearance is called Zhi Yin, treated with Tingli Xiefei Tang (Descurainia Draining Lung Decoction) or Wuling San (Five-Ingredient Powder with Poria). Water stopping below the heart, with coldness on the back the size of a palm, shortness of breath, joint pain, hypochondriac pain radiating to the supraclavicular fossa, and deep pulse, is called Liu Yin, treated with Daotan Decoction. Diaphragmatic fullness, wheezing, cough, vomiting, alternating chills and fever, lower back pain, and body tremors constitute Fu Yin, treated with Beishu Wan (Double Atractylodes Pill) adding Fuling and Banxia. Phlegm-fluid without thirst is treated with Xiaobanxia Tang (Minor Pinellia Decoction). Zhi Yin with dizziness is treated with Zexie Tang (Alisma Decoction). Epigastric stuffiness, water between the diaphragm, palpitations, and dizziness are treated with Xiaobanxia Jia Fuling Tang (Minor Pinellia Decoction plus Poria). Habitual consumption of tea or alcohol forming masses is treated with Jianggui Wan (Ginger and Cinnamon Pill). Fluid mass with sour belching and gastric discomfort is treated with Sanxian Wan or Cangzhu Wan (Atractylodis Lanceae Pill).
Distinct from phlegm and fluid retention, vomiting clear saliva and foam indicates Spleen deficiency failing to secure, treated with Liujunzi Decoction adding Yizhi (Alpinia Oxyphylla Fruit) and Shengjiang. Thirst with desire to drink, but vomiting immediately after swallowing, is named Shui Ni (Water Rebellion), treated with Wuling San. The general principle holds: external fluid retention resides in the Spleen, internal fluid retention in the Kidney. Treating the Spleen uses Linggui Zhugan Tang; treating the Kidney uses Shenqi Wan. For qi congestion, open it with Xiaoqinglong Decoction removing Mahuang (Ephedra) and Xixin (Asarum). For choking cough, calm it with fresh Pipaye (Loquat Leaf), Xingren, Fuling, Qianhu (Peucedani Radix), Suzi (Perilla Fruit), and Sangpi (Mulberry Bark). For turbid rebellion, warm with Zhenwu Decoction. For mild yang, harmonize with Waitai Fuling Yin (Waitai Poria Drink). For damp stagnation, secrete with Wuling San. For retained fluid, purge with Guiling Tang (Cinnamon and Polyporus Decoction). For supporting fluid knotting into collaterals, unblock with Fuling Guizhi Tang (Poria and Cinnamon Twig Decoction) adding Renshen (Ginseng), Gancao (Licorice), Chuanjiao (Sichuan Pepper), Banxia, Shengjiang, and Shuqi (Polygala Root). General treatment for fluid symptoms uses Wuyin Tang (Five Fluids Decoction). Zhang Zhongjing said: "Treat phlegm-fluid with warm herbs to harmonize," which summarizes the essence.
Zhongjing stated: "When fluid retention accompanies cough, treat only the fluid retention, not the cough."
Miao Zhongchun said: "The sources of phlegm generation are diverse, and treatments differ. When caused by yin deficiency with fire flaming upward, forcing the Lung, condensing into phlegm, this is termed Yin-deficiency Phlegm-Fire. The phlegm is in the Lung but rooted in the Kidney; treatment should descend qi and clear heat, benefiting yin and nourishing water. Avoid acrid-warm, drying, hot, and tonifying qi herbs. When caused by Spleen-Stomach cold-damp generating phlegm, or excessive eating/drinking causing Spleen qi stagnation, this disease lies in the Spleen and Stomach, unrelated to Lung and Kidney; treatment should dry the Spleen and promote qi movement. Avoid cloying, bitter-cold, and moistening herbs. When caused by Wind-Cold constraining heat generating phlegm, the disease is also in the Lung; treatment should resolve phlegm, with clearing and draining aided by acrid-warm herbs like Mahuang and Shengjiang to disperse external cold. Avoid warm-tonifying and astringent herbs to prevent drug rejection. Phlegm substance is thick and sticky; fluid retention is only clear water, or green-yellow, bitter, or sour, often due to excessive tea/alcohol consumption or emotional depression causing middle-jiao cold-damp obstruction. Treatment should dry dampness and promote urination, warming and unblocking yang qi to move it, such as Erchen Tang, Wuling San, or Zhenwu Tang."
Zhang Luyu said: "Phlegm-fluid generates various symptoms; one must prioritize treating the fluid retention first, and the other symptoms will heal themselves. For example, in headache with brow bone pain, repeated use of wind-dispelling herbs fails, but phlegm-resolving agents succeed. For red, light-sensitive, painful eyes, cooling herbs do not cure, but phlegm-resolving agents achieve efficacy. Such cases are numerous, relying on flexible diagnosis and treatment. For instance, Taiyin Phlegm-Jue headache does not exclusively treat wind, following this same logic."