治肺痈 逆上气，时时唾浊，但坐不眠。
皂荚（刮去皮、弦，炙） 为末，蜜丸，以枣膏和汤，服三丸。
喻嘉言曰∶火热之毒结聚于肺，表之、里之、温之，清之，曾不少应坚而不可攻
者，令服此丸，庶几无坚不入，竟成洗荡之功，不可以药之微贱而少之也。本方加蛤粉
等分，为末，名皂蛤丸，治妇人风邪客于乳房而成奶痈，每服二钱，酒下。此药能导其
汁，散其风邪，汗出而病自愈矣。
治痿症咳嗽有痰，午后热并声飒。
人参 阿胶珠 甘草（各一钱） 柴胡（四钱） 桑白皮（二钱） 茯苓 五味子 贝母 杏仁
（炒） 桔梗（炒） 枳实（各一钱五分） 每服八钱，姜枣水煎，食后温服。
用芥菜卤，煎一沸，入坛中封口，藏于地内，隔三年取起，患者饮一杯，神效。
治咳嗽，唾中有脓血虚劳症，肺痿肺痈。
人参 桔梗 茯苓（各一钱） 阿胶（炒） 甘草 紫菀（各五分） 知母
贝母（各一钱五分） 五味子（十五粒） 水煎服。
治咽痛肺痈吐脓。
桔梗（炒，一两） 甘草（五钱） 水煎空心服，吐尽脓为效。
一方
治肺痈久不敛口者，用合欢树皮，即槿树皮，一名夜合，同白敛二味煎服，最佳。
人禀二气以生，有清有浊，阳之清者，为元气，阳之浊者，即为火，阴之清者，为
津液，阴之浊者，即为痰，故痰者，乃血气津液不清，熏蒸结聚而成。一有此生，便有
此气血津浓，有此气血津液，便有此痰火，乃清浊邪正之气，变化必然之理，但不可使
清浊混淆，邪害正气耳。《经》曰∶太阴在泉，湿淫所胜，民病饮积∶又曰∶岁土太
过，雨湿流行，甚则饮发。《内经》论痰皆因湿土为害。《内经》有饮字而无痰字，
至仲景始立五饮之名，而痰饮居其一。然脾为生痰之源。夫饮入于胃，游溢精气，上输
于脾，脾气散精上归于肺，通调水道，下输膀胱，水精四布，五经并行，何痰之有？惟
脾虚不能致精于肺，下输水道，则清者难升，浊者难降，留中滞鬲淤而成痰。故治痰
先补脾，脾复健运之常而痰自化矣。虽然人但知痰之标在于脾，而不知痰之本更在肾。
盖痰者，水也。有肾虚不能制水，水泛为痰，是无火之痰，痰清而稀；阴虚火动，火
结为痰，是有火之痰，痰稠而浊。稠者为痰，稀者为饮，水湿其本也，得火则结为
痰，随气升降，在肺则咳，在胃则呕，在头则眩，在心则悸，在背则冷，在胁则胀，其
变不可胜穷。析而言之，痰有五，饮亦有五，而治法因之以变，在脾经者名曰湿痰，
脉缓面黄、肢体沉重，嗜卧不收，腹胀食滞，其痰滑而易出。在肺经者名曰燥痰，脉
涩面白，气上喘促，洒淅寒热，悲愁不乐，其痰涩而难出。在肝经者，名曰风痰，脉弦
面青，四肢满闷，便溺秘涩，时有燥怒，其痰青而多泡。在心经者，名曰热痰，脉洪面
赤，烦热心痛，口干唇燥，时多喜笑，其痰坚而成块。在肾经者，名曰寒痰，脉沉面
黑，小便急痛，足寒而逆，心多恐怖，其痰有黑点而多稀。若其人索盛今瘦，水走肠间
辘辘有声，心下冷极，名曰痰饮，饮后水流在胁下，咳唾引痛，名曰悬饮，饮水流于四
肢，当汗不汗，身体疼重，名曰溢饮。 逆倚息，短气不得卧，其形如肿，名曰支
饮，膈满呕吐，喘 寒热，腰背痛，目泪出。其人振振恶寒，身 惕者，名曰伏饮
更有一种，非痰非饮，时吐白沫，不甚稠枯，此气虚不能约束津液，故涎沫自出，不
可用利药，宜六君子汤加益智仁以摄之。嗟乎！五痰五饮，证各不同，稍或不详，妄投
药剂，非徒无益，而反害之。至如脾肺二家之痰，尤不可混，脾为湿土，喜温燥而恶寒
润，故二术星夏为要药，肺为燥金，喜凉润而恶温燥，故二母、二冬、地黄、桔梗为要
药，二者易治，鲜不危困，每见世俗恶半夏之燥，一见有痰，便以贝母代之。若是脾痰
则胃气易伤，饮食愈减矣。即使肺痰，亦毋过于凉润，以伤中州，稍用脾药，以生肺
金，方为善治，盖即肺中之浊痰，亦以脾中之湿为母，故治痰不理脾胃，非其治也。然
天下无逆流之水，由乎风也。人身无倒上之痰，由乎气也。故善痰治者，不治痰而治
气，气顺则一身之津液亦随气而顺，更不治痰而补脾，脾得健运，而痰自化矣。
痰在人身，非血非气，生于脾土，谓之津液，周流运用，血气由之，如道路然，而
不可无者，但湿盛过多，加以外感，固滞于中，或煽以相火上攻心臆，斯为患耳。凡有
怪症、莫不由兹，故丹溪有十病九痰之论，但治其痰之所因，使津液各归其经，而非痰
矣。故曰痰者，津液之病名也。苟气血清顺，则津液流通，何痰之有？惟气血浊则津
液不清，熏蒸成聚，而变为痰，痰之本水也。原于肾，痰之动湿也。主于脾，古人用
二陈汤为治痰通用者，所以实脾燥湿，治其标也。然以之而治湿痰、寒痰、痰饮、痰涎
则是矣。若夫痰因火上，肺气不清，咳嗽时作，及老痰，郁痰结成粘块，凝滞喉间，吐
咯难出，此等之痰，皆因火邪炎上，熏于上
焦，肺气被郁，故其津液之随气而升者，为火熏蒸，凝浊郁结而成，岁月积久根深蒂
固，故名老名郁，而其原则火邪也，病在上焦心肺之分，咽喉之间，非中焦脾胃湿痰，
冷痰、痰饮、痰涎之比也，故汤药难治，亦非半夏、茯苓、苍术、枳壳、南星等药所能
治也。惟在开其郁，降其火，清润肺金而消化之，缓以图治，庶可取效，故曰热痰者，
痰困火盛也。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
症，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，气能发
火，火能役痰，故治痰者，必降其火，治火者，必顺其气也。
痰之为物，随气升降无处不到，或在脏腑，或在经络，所以为病之多也。若夫寒
痰、湿痰、热痰则易治。至于风痰、燥痰、老痰则难治也。胶结多年，如树之有萝，屋
之有尘，石之有苔，托附相安，驱导涌涤，徒伤他脏，此则闭拒不纳耳。分而治焉，寒
则温之，湿则燥之，热则清之，风则散之，燥则润之，老则软之，总而治焉，用人参、
甘草以补脾；半夏、白术以燥湿；陈皮、青皮以降气；茯苓、泽泻以渗水，是举其纲
也。如寒痰加以附子、姜桂；湿痰加以苍术、浓朴；食积痰加以曲 、山楂；热痰加
以芩、连、栀子；风痰加以南星、皂角；燥痰加以栝蒌、杏仁；郁痰加以枳壳、香附；
老痰加以海石、芒硝，是张其目也。虽然，痰症又有挟虚者，不可不加以补药而运之，
则愈虚，而津液愈凝，即药力而无正气以助之。则独力难行矣。故挟气虚者，加以四
君，血虚加以四物，脾虚治以六君，肾虚治以八味、六味，分其表里上下，审其寒热虚
实，未有不中病情者。若徒以燥湿消痰为事，血液潜耗，胃脘干枯，药助病邪，展转
深涸，以无伤性命之轻症，受成隔噎不可救之沉 矣。
津液受病化为痰饮，或吐咯上出，或凝滞胸膈，或留聚肠胃，或流注经络四肢，遍
身上下，无处不到，其为病也，为喘咳，恶心呕吐，痞膈壅塞，关格异病，泄泻眩晕，
嘈杂怔忡，惊悸颠狂，寒热痈肿，或胸间辘辘有声，或背心一点洋冷，或四肢麻痹不
仁，百病中多有兼痰者，然更有新久轻重之殊，新而轻者，形色清白稀薄，气味亦淡，
久而重者，黄浊稠粘，咳之难出渐成恶味，酸辣腥臊咸苦，甚至带血而出。然痰生于脾
胃，故治宜实脾燥湿，但随气而升，故尤宜顺气，气升属火，故顺气在于降火，热痰清
之，湿痰焕之，风痰散之，郁痰开之，硬痰软之，食积痰消之，在上者吐之，在中者下
之，中气虚者，更宜固中气以运之。若徒加攻削则胃气愈虚，而痰愈多。况人之病痰火
者，十之八九。老人不宜速降其火，虚人不宜尽去其痰，攻之太甚则病转剧而致危殆。
丹溪曰∶凡人身上中下有块者多是痰。然痰在皮里膜外，则遍体游行，肿而色白，
滞而不痛，宜导达疏利。痰因火走则体多小块，色红痛甚，流走无定，宜解毒清火为
主。痰胶固稠浊，及脉浮者，俱用吐法。眼胞及眼下如烟煤者痰也。气虚不能摄涎，其
痰不甚稠粘者，不可用利药，宜六君子汤，加益智仁以摄之。中焦有痰则饮食虽少，胃
气亦赖所养，卒不便虚，故病有痰者，必淹延久而不思食，胃亦不虚，若攻之尽则虚
矣。内伤中气虚者，必用参术，佐以姜汁以传送阵下，痰在膈上，必用吐法，泻亦不能
去。风痰多见奇症，温痰多见倦怠软弱，热痰挟风外症为多，痰在肠胃间可下而愈，在
经络中非吐不可，吐中便有发散之义，黄芩治热痰，假其下火也。竹沥滑痰，菲姜汁不
能行经络，五倍子能治老痰。凡用吐药，宜升提其气便吐也。如防风、山栀、川芎、桔
梗、牙茶、生姜、齑汁之类，或用瓜蒂散，苍术治痰成窠囊，一边行者极妙，痰挟瘀血
则遂成窠囊。眩运嘈杂乃火动其痰，用二陈汤加山栀子、苓连之类。噫气吞酸，此食郁
有热，火气上动，以黄芩为君，南星、半夏为臣，橘红为使，热多加青黛。痰在胁下，
非白芥子不能达。痰在皮里膜外，非姜汁、竹沥不能通。白芥子亦能散皮里膜外之痰
气，惟善用者，能收奇功也。痰在四肢，非竹沥不开，痰结核在咽喉中，不能出入，用
化痰药，加咸润软坚之味，如栝蒌、杏仁、海石、桔梗、连翘，少佐朴硝姜汁蜜和丸噙
服之。海粉即海石，热痰能降，湿痰能燥，结痰能软，顽痰能消，可入丸散，不可入煎
药。小胃丹治膈上痰热，能损胃气。凡治痰用利药过多，致脾气虚，则痰易生而多。天
花粉大能降膈上热痰，痰在膈间，使人颠狂，或健忘，或风痰，皆用竹沥，亦能养
血，与荆、沥用，功治稍重，能食者，用此二味效速稳当。韭汁治血滞不行，中焦有
饮，自然汁饮二三盏，必胸中烦燥不宁而后愈。
节斋论痰，而首揭痰之本于肾，可为发前人所未发，惜乎启其端而未竟其说，其所
制之方，皆治标之药，而其中寒凉之品甚多，多致损胃，惟仲景先生云∶虚气有痰，
用肾气丸补而逐之。吴茭出又云∶八味丸治痰之本也。此二公者，真开后学之蒙 ，济
无穷之夭在，盖痰者，病名也。原非人身之所有，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，则水不归源，逆流泛滥而为痰，是无火者也。故用八
味丸以补肾火。（张）常用加牛膝、五味子更效。阴虚火动则水沸腾动于肾者，犹尤火
之于海，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
火者也。故用六味丸以补水配火，（张）常用加牛膝、麦冬、五味子更妙，此不治痰之
标，而治痰之本也。故善于治肾虚者，先以六味八味壮水之主，益火之原，复以四君
子，或六君子，补脾以制水。于脾虚者，既投以补中，理中实脾，复以六味八味，制水
以益母，使子母互相济养，而治痰之道尽矣。
庞安常有言，有阴水不足，阴火上升，肺受火侮不得清肃下行，由是津液凝浊而生
痰，不生血者，此当以润剂，如门冬、地黄之属滋其阴、使上逆之火得返其宅而息焉，
则痰自清矣。投以二陈立见危殆，有肾虚不能纳气归原，原出而不纳则积，积而不散则
痰生焉，八味丸主之。然蒙筌谓地黄泥膈生痰，为痰门禁药，以姜汁炒之。嗟乎！若以
姜汁炒之，则变为辛燥，地黄无用矣。盖地黄正取其濡润，能入肾经。若杂于脾胃药
中，则土恶湿，安得不泥膈生痰？八味六味丸中诸品，皆少阴经的药，群队相引，直入
下焦，名曰水泛为痰之圣药，空腹服之，压以美膳，不留胃中，此仲景制方立法之妙。
（张）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，亦可籍气周流。若至津液受病成痰，则变为有形而凝滞，焉能随气流通于至
微至密之所耶？
六味地黄汤、八味地黄汤
并见痨瘵门。
治疗肺痈，气逆上冲，时常吐出浑浊痰液，只能端坐不能平卧。
皂荚（刮去外皮和筋膜，炙烤）研成细末，用蜂蜜制成丸剂，配合枣膏汤送服，每次服用三丸。
喻嘉言说：火热毒邪结聚在肺部，采用解表、攻里、温法、清法治疗，都没有丝毫效果，病情坚硬无法攻破。让患者服用这个丸剂，大概能无坚不摧，最终达到涤荡清除的功效，不要因为药物廉价而轻视它。本方加入蛤粉等量，研成细末，名为皂蛤丸，治疗妇人风邪客居乳房形成的乳痈，每次服用二钱，用酒送下。此药能引导排出汁液，疏散风邪，出汗后病自然痊愈。
治疗痿症伴有咳嗽有痰，午后发热且声音嘶哑。
人参、阿胶珠、甘草（各一钱）、柴胡（四钱）、桑白皮（二钱）、茯苓、五味子、贝母、杏仁（炒）、桔梗（炒）、枳实（各一钱五分）。每次服用八钱，加生姜、大枣用水煎煮，饭后温服。
用芥菜卤水，煮沸一次，装入坛中封口，埋藏在地底下，经过三年取出，患者饮用一杯，疗效神奇。
治疗咳嗽，唾液中带有脓血的虚劳症，以及肺痿、肺痈。
人参、桔梗、茯苓（各一钱）、阿胶（炒）、甘草、紫菀（各五分）、知母、贝母（各一钱五分）、五味子（十五粒）。用水煎煮后服用。
治疗咽痛、肺痈吐脓。
桔梗（炒，一两）、甘草（五钱）。用水煎煮，空腹服用，直到将脓液吐尽为见效。
另一方法
治疗肺痈久治不愈伤口不闭合的，使用合欢树皮（即槿树皮，又名夜合），与白敛两味药一起煎煮服用，效果最佳。
人禀受天地二气而生，气有清浊之分。阳气之清者，称为元气；阳气之浊者，即为火；阴气之清者，称为津液；阴气之浊者，即为痰。所以痰，是由于血气津液不清，熏蒸结聚而成的。一旦有了这种生成，就有了这些气血津液的浓浊状态，有了这些气血津液，便有了这些痰火，这是清浊、邪正之气变化必然的道理，只是不能让清浊混淆，导致邪气伤害正气罢了。《内经》说：“太阴湿土在泉，湿气过胜，百姓容易患饮积病”；又说：“岁运土气太过，雨湿流行，严重时会引发饮病”。《内经》论述痰都是因为湿土为害。《内经》中有“饮”字而没有“痰”字，到了张仲景才确立五饮的名称，而痰饮是其中之一。然而脾是生痰之源。饮水进入胃中，游溢精气，向上输送到脾，脾气散精向上归于肺，通调水道，向下输送到膀胱，水精四布，五脏经脉并行运行，哪里会有痰呢？只有脾虚不能将精微物质输送给肺，向下输注水道，那么清者难以上升，浊者难以下降，滞留于中焦膈间淤积而成痰。所以治疗痰首先要补脾，脾恢复健运的正常功能，痰自然化解了。虽然人们只知道痰的标在于脾，却不知道痰的本更在于肾。因为痰就是水。如果肾虚不能制约水，水泛滥成为痰，这是无火之痰，痰液清稀；如果阴虚火动，火结聚成为痰，这是有火之痰，痰液稠厚浑浊。稠厚的称为痰，稀薄的称为饮，水湿是其根本，遇到火则结聚成为痰，随着气机升降，在肺则咳嗽，在胃则呕吐，在头则眩晕，在心则心悸，在背则发冷，在胁肋则胀满，其变化不可胜数。分析来说，痰有五类，饮也有五类，治疗方法因此而变化。在脾经的叫做湿痰，脉缓面色黄、肢体沉重，嗜睡懒动，腹胀食滞，其痰滑利易出。在肺经的叫做燥痰，脉涩面色白，气逆喘促，洒淅寒热，悲愁不乐，其痰涩滞难出。在肝经的叫做风痰，脉弦面色青，四肢满闷，大小便秘涩，时有烦躁易怒，其痰青色多泡沫。在心经的叫做热痰，脉洪大面色红，心烦心痛，口干唇燥，时常喜笑，其痰坚硬成块。在肾经的叫做寒痰，脉沉面色黑，小便急痛，脚冷逆冷，心中多恐惧，其痰有黑点多且稀。如果其人原本壮盛现在消瘦，水走肠间辘辘有声，心下极冷，叫做痰饮；饮水后水流在胁下，咳唾牵引疼痛，叫做悬饮；饮水流于四肢，应当出汗却不出汗，身体疼重，叫做溢饮；气逆倚息，短气不能平卧，身形如肿，叫做支饮；膈满呕吐，喘促寒热，腰背痛，流泪，身体振振恶寒，身惕不安的，叫做伏饮。
又有一种情况，非痰非饮，时常吐出白沫，不是很稠枯，这是气虚不能约束津液，所以涎沫自出，不能用利水药，宜用六君子汤加益智仁来收摄。唉！五痰五饮，证候各不相同，稍微不详察，妄投药剂，不仅无益，反而有害。至于脾肺两家之痰，尤其不可混淆。脾属湿土，喜欢温燥而厌恶寒润，所以苍术、白术、半夏、天南星是主要药物；肺属燥金，喜欢凉润而厌恶温燥，所以知母、贝母、麦冬、天冬、地黄、桔梗是主要药物。这两者容易治疗，很少出现危困情况。常见世俗之人厌恶半夏的燥性，一见有痰，就用贝母代替。如果是脾痰，则胃气容易受伤，饮食更加减少。即使是肺痰，也不要过于凉润，以免损伤中州脾胃，稍用健脾药，以滋生肺金，这才是善治。因为即使肺中的浊痰，也是以脾中的湿作为母体，所以治疗痰如果不调理脾胃，就不是正确的治疗方法。然而天下没有逆流的水，是因为有风。人身没有倒上的痰，是因为有气。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，更不治痰而补脾，脾得健运，痰自然化解了。
痰在人身，既不是血也不是气，生于脾土，称之为津液，周流运用，血气依靠它，如同道路一样，是不可缺少的。但湿气过盛过多，加上外感，固滞于中焦，或者煽动相火上攻心包，这才成为祸患。凡是怪症，没有不由此引起的，所以朱丹溪有十病九痰的说法。只要治疗痰产生的原因，使津液各归其经，就不再是痰了。所以说痰，是津液的病名。如果气血清顺，则津液流通，哪里有痰呢？只有气血浊则津液不清，熏蒸聚结，而变为痰。痰的根本是水，源于肾；痰的动因是湿，主于脾。古人用二陈汤作为治疗痰的通用方，是为了实脾燥湿，治疗其标。然而用它来治疗湿痰、寒痰、痰饮、痰涎是可以的。至于痰因火起，肺气不清，咳嗽时作，以及老痰、郁痰结成粘块，凝滞喉间，吐咯难出，这种痰，都是因为火邪炎上，熏于上焦，肺气被郁，所以其津液随气升者，被火熏蒸，凝浊郁结而成，岁月积久根深蒂固，所以名叫老痰、郁痰，而其根源是火邪。病位在上焦心肺之分，咽喉之间，不同于中焦脾胃的湿痰、冷痰、痰饮、痰涎。所以汤药难治，也不是半夏、茯苓、苍术、枳壳、南星等药所能治疗的。只有在开其郁结，降其火势，清润肺金而消化它，缓慢图谋治疗，才可以取效，所以说热痰，是痰困火盛。痰即是有形的火，火即是无形的痰，痰随火而升降，火引痰而横行，变生各种症状，不可胜数。火借气于五脏，痰借液于五味，气有余则为火，液有余则为痰，气能发火，火能役使痰，所以治痰者，必须降其火；治火者，必须顺其气。
痰这种东西，随气升降无处不到，或在脏腑，或在经络，所以致病很多。至于寒痰、湿痰、热痰则容易治疗。至于风痰、燥痰、老痰则难治。胶结多年，像树上有萝藦，屋上有灰尘，石上有苔藓，依附相安，强行驱导涌涤，只会伤害其他脏腑，这是因为闭拒不纳。分别治疗，寒则温之，湿则燥之，热则清之，风则散之，燥则润之，老则软之。总括治疗，用人参、甘草以补脾；半夏、白术以燥湿；陈皮、青皮以降气；茯苓、泽泻以渗水，这是举其纲领。如寒痰加附子、姜桂；湿痰加苍术、厚朴；食积痰加神曲、山楂；热痰加黄芩、黄连、栀子；风痰加南星、皂角；燥痰加瓜蒌、杏仁；郁痰加枳壳、香附；老痰加海浮石、芒硝，这是展开其条目。虽然如此，痰症又有挟虚的，不可不加补药而运化它，否则愈虚，津液愈凝滞，即使有药力而无正气以助之，则独力难行。所以挟气虚者，加四君子汤；血虚加四物汤；脾虚治以六君子汤；肾虚治以八味丸、六味丸。分辨其表里上下，审察其寒热虚实，没有不切中病情的。如果只以燥湿消痰为事，血液暗中消耗，胃脘干枯，药助病邪，辗转深涸，以轻症受成隔噎不可救的沉疴。
津液受病化为痰饮，或吐咯上出，或凝滞胸膈，或留聚肠胃，或流注经络四肢，遍身上下，无处不到。其为病，表现为喘咳，恶心呕吐，痞膈壅塞，关格异病，泄泻眩晕，嘈杂怔忡，惊悸颠狂，寒热痈肿，或胸间辘辘有声，或背心一点冰冷，或四肢麻痹不仁。百病中多有兼痰者，然而更有新久轻重之别。新而轻者，形色清白稀薄，气味亦淡；久而重者，黄浊稠粘，咳之难出渐成恶味，酸辣腥臊咸苦，甚至带血而出。然而痰生于脾胃，所以治疗宜实脾燥湿，但随气而升，所以尤宜顺气，气升属火，所以顺气在于降火。热痰清之，湿痰燥之，风痰散之，郁痰开之，硬痰软之，食积痰消之。在上者吐之，在中者下之，中气虚者，更宜固中气以运之。如果只加攻削，则胃气愈虚，而痰愈多。况且人之病痰火者，十之八九。老人不宜速降其火，虚人不宜尽去其痰，攻之太甚则病转剧而致危殆。
朱丹溪说：“凡人身上中下有块者多是痰。”然而痰在皮里膜外，则遍体游行，肿而色白，滞而不痛，宜导达疏利。痰因火走则体多小块，色红痛甚，流走无定，宜解毒清火为主。痰胶固稠浊，及脉浮者，俱用吐法。眼胞及眼下如烟煤者是痰。气虚不能摄涎，其痰不甚稠粘者，不可用利药，宜六君子汤加益智仁以摄之。中焦有痰则饮食虽少，胃气亦赖所养，卒不便虚，所以病有痰者，必淹延久而不思食，胃亦不虚，若攻之尽则虚矣。内伤中气虚者，必用参术，佐以姜汁以传送阵下。痰在膈上，必用吐法，泻亦不能去。风痰多见奇症，温痰多见倦怠软弱，热痰挟风外症为多，痰在肠胃间可下而愈，在经络中非吐不可，吐中便有发散之义。黄芩治热痰，假其下火也。竹沥滑痰，非姜汁不能行经络，五倍子能治老痰。凡用吐药，宜升提其气便吐也。如防风、山栀、川芎、桔梗、芽茶、生姜、齑汁之类，或用瓜蒂散。苍术治痰成窠囊，一边行者极妙，痰挟瘀血则遂成窠囊。眩运嘈杂乃火动其痰，用二陈汤加山栀子、苓连之类。噫气吞酸，此食郁有热，火气上动，以黄芩为君，南星、半夏为臣，橘红为使，热多加青黛。痰在胁下，非白芥子不能达。痰在皮里膜外，非姜汁、竹沥不能通。白芥子亦能散皮里膜外之痰气，惟善用者，能收奇功也。痰在四肢，非竹沥不开，痰结核在咽喉中，不能出入，用化痰药，加咸润软坚之味，如瓜蒌、杏仁、海浮石、桔梗、连翘，少佐朴硝姜汁蜜和丸噙服之。海粉即海浮石，热痰能降，湿痰能燥，结痰能软，顽痰能消，可入丸散，不可入煎药。小胃丹治膈上痰热，能损胃气。凡治痰用利药过多，致脾气虚，则痰易生而多。天花粉大能降膈上热痰，痰在膈间，使人颠狂，或健忘，或风痰，皆用竹沥，亦能养血，与荆沥用，功治稍重，能食者，用此二味效速稳当。韭汁治血滞不行，中焦有饮，自然汁饮二三盏，必胸中烦燥不宁而后愈。
节斋论痰，而首揭痰之本于肾，可为发前人所未发，可惜他启其端而未竟其说。他所制的方，都是治标的药，而其中寒凉之品甚多，多致损胃。只有张仲景先生说：“虚气有痰，用肾气丸补而逐之。”吴茭出又说：“八味丸治痰之本也。”这两位先生，真是开启后学之蒙昧，救济无穷之夭折啊。盖痰者，病名也。原非人身之所有，非水泛为痰，则水沸为痰，但当分有火无火之异罢了。肾虚不能制水，则水不归源，逆流泛滥而为痰，是无火者也。故用八味丸以补肾火。（张）常用加牛膝、五味子更效。阴虚火动则水沸腾动于肾者，犹如火之于海，龙兴而水附；动于肝者，犹如雷火之出于地，疾风豪雨，水随波涌而为痰，是有火者也。故用六味丸以补水配火，（张）常用加牛膝、麦冬、五味子更妙，此不治痰之标，而治痰之本也。故善于治肾虚者，先以六味八味壮水之主，益火之原，复以四君子，或六君子，补脾以制水。于脾虚者，既投以补中、理中实脾，复以六味八味，制水以益母，使子母互相济养，而治痰之道尽矣。
庞安常有言，有阴水不足，阴火上升，肺受火侮不得清肃下行，由是津液凝浊而生痰，不生血者，此当以润剂，如门冬、地黄之属滋其阴，使上逆之火得返其宅而息焉，则痰自清矣。投以二陈立见危殆。有肾虚不能纳气归原，原出而不纳则积，积而不散则痰生焉，八味丸主之。然而蒙筌认为地黄泥膈生痰，为痰门禁药，以姜汁炒之。唉！若以姜汁炒之，则变为辛燥，地黄无用矣。盖地黄正取其濡润，能入肾经。若杂于脾胃药中，则土恶湿，安得不泥膈生痰？八味六味丸中诸品，皆少阴经的药，群队相引，直入下焦，名曰水泛为痰之圣药，空腹服之，压以美膳，不留胃中，此仲景制方立法之妙。
（张）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，亦可籍气周流。若至津液受病成痰，则变为有形而凝滞，焉能随气流通于至微至密之所耶？
六味地黄汤、八味地黄汤
并见于痨瘵门。
Treatment for Lung Abscess (Fei Yong) with rebellious Qi, frequent expectoration of turbid phlegm, where the patient can only sit and cannot lie down.
*Gleditsiae Fructus* (Zao Ying) (scraped of skin and membrane, roasted), ground into powder, formed into pills with honey, taken with Jujube Paste Decoction (Zao Gao Tang), three pills per dose.
Yu Jiayan said: "When toxic heat gathers in the lungs, treatments such as releasing the exterior, purging the interior, warming, and clearing have yielded no effect; the condition is hard and unassailable. Having the patient take this pill may achieve the effect of penetrating hardness and thoroughly cleansing. Do not despise it because the medicine is cheap." Adding *Sinapis Semen* (Ge Fen) in equal amounts to this formula, ground into powder, named *Zao Ge Wan*, treats breast abscess (Nai Yong) caused by wind pathogen lodging in the breasts of women. Take two qian per dose, washed down with wine. This medicine can guide out the fluid and disperse the wind pathogen; the disease will heal spontaneously after sweating.
Treatment for Wei Syndrome (Wei Zheng) with cough and phlegm, afternoon fever, and hoarse voice.
*Renshen* (Ginseng Radix), *Ejiao* (Donkey-hide Gelatin) processed into beads, *Gancao* (Licorice Root) (each 1 qian); *Chaihu* (Bupleuri Radix) (4 qian); *Sangbaipi* (Mori Cortex) (2 qian); *Fuling* (Poria), *Wuweizi* (Schisandrae Fructus), *Beimu* (Fritillariae Bulbus), *Xingren* (Armeniacae Semen Amarum) (roasted), *Jiegeng* (Platycodonis Radix) (roasted), *Zhishi* (Aurantii Fructus Immaturus) (each 1.5 qian). Take 8 qian per dose, decoct with Ginger and Jujube in water, take warm after meals.
Use brine from mustard greens, boil once, put into a jar, seal it, and bury it underground. After three years, retrieve it. The patient drinks one cup; the effect is miraculous.
Treatment for cough with pus and blood in sputum due to Consumption (Xu Lao), as well as Lung Flaccidity (Fei Wei) and Lung Abscess (Fei Yong).
*Renshen* (Ginseng Radix), *Jiegeng* (Platycodonis Radix), *Fuling* (Poria) (each 1 qian); *Ejiao* (Donkey-hide Gelatin) (roasted), *Gancao* (Licorice Root), *Ziwan* (Asternatis Radix) (each 0.5 qian); *Zhimu* (Anemarrhenae Rhizoma), *Beimu* (Fritillariae Bulbus) (each 1.5 qian); *Wuweizi* (Schisandrae Fructus) (15 grains). Decoct in water and take.
Treatment for sore throat and Lung Abscess (Fei Yong) with expectoration of pus.
*Jiegeng* (Platycodonis Radix) (roasted, 1 liang), *Gancao* (Licorice Root) (5 qian). Decoct in water and take on an empty stomach. Effect is achieved when all pus is vomited up.
Another prescription
For Lung Abscess (Fei Yong) that has persisted for a long time without healing the wound, use *Hehuanpi* (Albiziae Cortex) (also known as *Jinshupi* or *Yehé*), decocted together with *Baibianlian* (Dichroae Radix? Note: Text says Bai Lian, likely *Trollii Radix* or similar, but keeping name as Bai Lian) in equal measure. This is best.
Humans are born receiving the two Qi of Heaven and Earth; Qi has clarity and turbidity. The clear aspect of Yang Qi is called Yuan Qi (Primordial Qi); the turbid aspect of Yang Qi is Fire. The clear aspect of Yin Qi is Jin Ye (Body Fluids); the turbid aspect of Yin Qi is Tan (Phlegm). Therefore, Phlegm is formed by the steaming and gathering of unclear Blood, Qi, and Body Fluids. Once this generation occurs, there is this thickening of Blood, Qi, and Body Fluids; once there is this Blood, Qi, and Body Fluids, there is this Phlegm-Fire. This is the inevitable principle of change among clear/turbid and evil/righteous Qi. However, one must not allow clear and turbid to mix, so that evil harms righteous Qi. The *Classic* says: "When Taiyin is in the泉 (subterranean position), excessive dampness causes the people to suffer from fluid accumulation." It also says: "When the year's Earth Qi is excessive, rain and dampness circulate widely, leading to severe fluid disorders." The *Neijing* discusses Phlegm as always caused by Damp-Earth harm. The *Neijing* has the character for "Yin" (Fluid) but not for "Tan" (Phlegm); it was Zhang Zhongjing who first established the names of Five Yins, with Phlegm-Fluid being one of them. However, the Spleen is the source of Phlegm production. When water enters the Stomach, its essence floats and overflows, transporting upward to the Spleen. The Spleen scatters the essence upward to the Lungs, regulates the water passages, and transports downward to the Bladder. Water essence distributes everywhere, and the five meridians run together. How can there be Phlegm? Only when the Spleen is deficient and cannot transport essence to the Lungs or downward through water passages, then the clear fails to rise, the turbid fails to descend, stagnating in the middle and diaphragm to form Phlegm. Therefore, treating Phlegm begins with tonifying the Spleen; once the Spleen restores its normal transportation function, Phlegm transforms itself. Although people know the branch of Phlegm lies in the Spleen, they do not know the root lies even more in the Kidney. Because Phlegm is Water. If Kidney deficiency fails to control Water, Water floods and becomes Phlegm; this is Phlegm without Fire, which is clear and thin. If Yin deficiency leads to Fire agitation, Fire condenses to form Phlegm; this is Phlegm with Fire, which is thick and turbid. Thick is called Phlegm, thin is called Yin (Fluid). Water-Dampness is the root; encountering Fire, it condenses into Phlegm, rising and falling with Qi. In the Lungs, it causes cough; in the Stomach, vomiting; in the head, dizziness; in the Heart, palpitations; in the back, coldness; in the hypochondrium, distension. Its changes are countless. Analyzing further, there are five types of Phlegm and five types of Yin, and treatment methods vary accordingly. Those in the Spleen Meridian are called Damp-Phlegm: pulse is slow, face yellow, limbs heavy,嗜睡 (lethargic), abdominal distension with food stagnation; the phlegm is slippery and easy to expectorate. Those in the Lungs Meridian are called Dry-Phlegm: pulse is choppy, face pale, Qi rebels with panting, aversion to cold and fever, sadness and unhappiness; the phlegm is astringent and difficult to expectorate. Those in the Liver Meridian are called Wind-Phlegm: pulse is wiry, face green, limbs full and stifling, urination and defecation obstructed, occasional irritability; the phlegm is blue-green and foamy. Those in the Heart Meridian are called Heat-Phlegm: pulse is surging, face red, vexation and heart pain, dry mouth and lips, frequent laughter; the phlegm is hard and forms lumps. Those in the Kidney Meridian are called Cold-Phlegm: pulse is deep, face black, urgent painful urination, cold feet; the mind is fearful; the phlegm has black spots and is thin. If a person was formerly robust but now emaciated, water moves in the intestines making a gurgling sound, extreme cold in the epigastrium, this is called Phlegm-Fluid (Tan Yin). If drinking water flows under the hypochondrium, causing pain upon coughing and spitting, this is called Hanging Fluid (Xuan Yin). If drinking water flows into the limbs, sweat should occur but does not, body aches and heaviness, this is called Overflowing Fluid (Yi Yin). Rebellious Qi supporting breathing, shortness of breath unable to lie down, shape like edema, this is called Supporting Fluid (Zhi Yin). Diaphragmatic fullness and vomiting, panting, cold and fever, lower back pain, tearing eyes, trembling aversion to cold, bodily restlessness, this is called Hidden Fluid (Fu Yin).
There is another type, neither Phlegm nor Fluid, frequently spitting white foam, not very thick or dry. This is Qi deficiency failing to constrain Body Fluids, so saliva and foam flow out spontaneously. Do not use draining medicines; instead, use *Liu Jun Zi Tang* (Six Gentlemen Decoction) plus *Yizhiren* (Profit Seed) to restrain it. Alas! The five Phlegms and five Fluids have different syndromes; slight negligence in diagnosis and reckless administration of drugs will not only be useless but harmful. Especially regarding Phlegm of the Spleen and Lungs, they must not be confused. The Spleen is Wet Earth, preferring warm-dryness and hating cold-moisture; thus *Cangzhu* (Atractylodis Rhizoma), *Baizhu* (Atractylodis Macrocephalae Rhizoma), *Banxia* (Pinelliae Rhizoma), and *Nanxing* (Arisaematis Rhizoma Preparatum) are essential medicines. The Lung is Dry Metal, preferring cool-moisture and hating warm-dryness; thus *Zhimu* (Anemarrhenae Rhizoma), *Beimu* (Fritillariae Bulbus), *Maidong* (Ophiopogonis Radix), *Tian Dong* (Asparagi Radix), *Dihuang* (Rehmanniae Radix), and *Jiegeng* (Platycodonis Radix) are essential. These two are easy to treat, rarely leading to danger. Commonly, worldly doctors dislike the dryness of *Banxia*; seeing phlegm, they replace it with *Beimu*. If this is Spleen Phlegm, Stomach Qi is easily injured, and food intake decreases further. Even if it is Lung Phlegm, do not use too much cool-moisture to damage the Middle Jiao. Use some Spleen-tonifying medicines to generate Lung Metal; this is good treatment. For even turbid phlegm in the Lungs takes the dampness of the Spleen as its mother. Therefore, treating Phlegm without regulating the Spleen and Stomach is not correct treatment. However, there is no reverse-flowing water in the world without wind. There is no upward-reversing Phlegm in the human body without Qi. Thus, those skilled in treating Phlegm do not treat Phlegm directly but treat Qi. When Qi is smooth, the Body Fluids of the whole body follow Qi smoothly. Furthermore, do not treat Phlegm directly but tonify the Spleen. When the Spleen obtains healthy transportation, Phlegm transforms itself.
Phlegm in the human body is neither Blood nor Qi; it is generated from Spleen Earth, called Body Fluids. It circulates and operates, Blood and Qi rely on it, like roads. It is indispensable. But if Dampness is excessively abundant, combined with external contraction, solidifying in the middle, or fanning Ministerial Fire attacking the Heart and Chest, this becomes a disaster. All strange symptoms arise from this. Hence Danxi said nine out of ten diseases involve Phlegm. Treat the cause of Phlegm, make Body Fluids return to their channels, and it is no longer Phlegm. Thus, Phlegm is the disease name of Body Fluids. If Blood and Qi are clear and smooth, Body Fluids flow freely; how can there be Phlegm? Only when Blood and Qi are turbid, Body Fluids are unclear, steaming and gathering to become Phlegm. The root of Phlegm is Water, originating in the Kidney; the movement of Phlegm is Dampness, governed by the Spleen. Ancients used *Er Chen Tang* (Two Aged Ingredients Decoction) as a general remedy for Phlegm to solidify the Spleen and dry Dampness, treating the branch. However, using it for Damp-Phlegm, Cold-Phlegm, Phlegm-Fluid, and Saliva is appropriate. As for Phlegm caused by Fire, Lung Qi unclear, intermittent coughing, and old Phlegm, stagnant Phlegm forming sticky lumps, stagnating in the throat, difficult to spit out, these Phlegms are all due to Fire Pathogen flaming upward, steaming the Upper Jiao, Lung Qi being depressed. Thus, Body Fluids rising with Qi are steamed by Fire, condensing into turbid, stagnant Phlegm. Accumulated over years, deeply rooted, hence named Old and Stagnant Phlegm, with Fire Pathogen as the root. The disease is in the Upper Jiao, division of Heart and Lungs, between the throat and pharynx, not comparable to Middle Jiao Spleen-Stomach Damp-Phlegm, Cold-Phlegm, Phlegm-Fluid, and Saliva. Therefore, decoctions are difficult to treat, and medicines like *Banxia*, *Fuling*, *Cangzhu*, *Zhike*, *Nanxing* cannot treat it. One must open the stagnation, descend the Fire, clear and moisten Lung Metal to digest it, treating slowly to achieve effect. Thus, Heat-Phlegm is Phlegm trapped by excessive Fire. Phlegm is tangible Fire; Fire is intangible Phlegm. Phlegm rises and falls with Fire; Fire guides Phlegm to move horizontally, generating various symptoms, incalculable. Fire borrows Qi from the Five Zang; Phlegm borrows Fluids from the Five Flavors. Excess Qi becomes Fire; excess Fluids become Phlegm. Qi can generate Fire; Fire can command Phlegm. Therefore, treating Phlegm requires descending Fire; treating Fire requires smoothing Qi.
Phlegm, as a substance, rises and falls with Qi, reaching everywhere, whether in Zang-Fu or meridians, hence causing many diseases. Cold-Phlegm, Damp-Phlegm, and Heat-Phlegm are easy to treat. Wind-Phlegm, Dry-Phlegm, and Old-Phlegm are difficult. Glued for years, like vines on trees, dust in houses, moss on stones, attached peacefully, forcing drainage and washing only injures other organs; this is closure and rejection. Treat separately: Cold, warm it; Damp, dry it; Heat, clear it; Wind, scatter it; Dry, moisten it; Old, soften it. Treat generally: Use *Renshen* (Ginseng Radix) and *Gancao* (Licorice Root) to tonify Spleen; *Banxia* (Pinelliae Rhizoma) and *Baizhu* (Atractylodis Macrocephalae Rhizoma) to dry Dampness; *Chenpi* (Citri Reticulatae Pericarpium) and *Qingpi* (Citri Reticulatae Pericarpium Viride) to descend Qi; *Fuling* (Poria) and *Zexie* (Alismatis Rhizoma) to渗水 (percolate water). This outlines the principles. Add *Fuzi* (Aconiti Lateralis Radix Praeparata) and Ginger-Cinnamon for Cold-Phlegm; *Cangzhu* (Atractylodis Rhizoma) and *Houpo* (Magnoliae Officinalis Cortex) for Damp-Phlegm; *Shenqu* (Massae Fermentatae Medicinosae) and *Shanzha* (Crataegi Fructus) for Food-Stagnation Phlegm; *Huangqin* (Scutellariae Radix), *Huanglian* (Coptidis Rhizoma), *Zhizi* (Gardeniae Fructus) for Heat-Phlegm; *Nanxing* (Arisaematis Rhizoma Preparatum) and *Zaojiao* (Gleditsiae Fructus Spina) for Wind-Phlegm; *Gualou* (Trichosanthis Fructus) and *Xingren* (Armeniacae Semen Amarum) for Dry-Phlegm; *Zhike* (Aurantii Fructus Immaturus) and *Xiangfu* (Cyperi Rhizoma) for Stagnant Phlegm; *Haishi* (Calcitrum) and *Mangxiao* (Natri Sulfas) for Old-Phlegm. This expands the details. Although, Phlegm syndromes often accompany deficiency; one must add tonifying medicines to move them, otherwise deficiency increases, Body Fluids coagulate further. Even with drug power, without Righteous Qi to assist, it is hard to act alone. Therefore, with Qi deficiency, add *Si Jun Zi Tang* (Four Gentlemen Decoction); with Blood deficiency, add *Si Wu Tang* (Four Substances Decoction); with Spleen deficiency, treat with *Liu Jun Zi Tang* (Six Gentlemen Decoction); with Kidney deficiency, treat with *Ba Wei Wan* (Eight-Ingredient Pill) or *Liu Wei Wan* (Six-Ingredient Pill). Differentiate exterior-interior, upper-lower, examine Cold-Heat, Deficiency-Excess; none will miss the pathology. If merely focusing on drying Dampness and eliminating Phlegm, Blood is secretly consumed, Stomach cavity dries up, drugs aid the pathogen, turning progressively deeper and drier. Light illnesses suffer from incurable severe obstruction.
When Body Fluids are diseased and transform into Phlegm-Fluid, either expectorated upwards, or stagnating in chest-diaphragm, or accumulating in intestines-stomach, or flowing into meridians-limbs, reaching everywhere in the body. Diseases caused include panting-cough, nausea-vomiting,痞膈 (epigastric fullness-obstruction), Guan-Ge (obstruction syndromes), diarrhea-dizziness, burning sensation-palpitations, fright-insanity, cold-fever-abscess, gurgling sound in chest, cold spot on back, numbness-paralysis of limbs. Many diseases involve Phlegm, yet there are differences in new/old and mild/severe. New and mild: color-shape clear-white, thin-thin, odor light. Old and severe: yellow-turbid, thick-sticky, difficult to cough out, gradually becoming foul-smelling, sour-spicy-fishy-salty-bitter, even bloody. Since Phlegm is generated in Spleen-Stomach, treatment should solidify Spleen and dry Dampness. But since it rises with Qi, smoothing Qi is especially important. Qi rising belongs to Fire, so smoothing Qi lies in descending Fire. Clear Heat-Phlegm, dry Damp-Phlegm, scatter Wind-Phlegm, open Stagnant Phlegm, soften Hard Phlegm, eliminate Food-Stagnation Phlegm. In the Upper, induce vomiting; in the Middle, purge downwards. If Middle Qi is deficient, further solidify Middle Qi to transport it. If merely adding attacking/scraping methods, Stomach Qi becomes more deficient, and Phlegm increases. Moreover, eight or nine out of ten people suffering from Phlegm-Fire. Elderly should not rapidly descend Fire; deficient persons should not completely remove Phlegm. Over-attacking makes the disease worse and dangerous.
Danxi said: "Lumps in the upper, middle, or lower body of ordinary people are mostly Phlegm." However, Phlegm in the subcutaneous tissue and fascia travels throughout the body, swelling with white color, stagnating without pain; guide and diffuse it. Phlegm moving with Fire forms many small lumps, red color, severe pain, wandering不定; detoxify and clear Fire primarily. Phlegm glued and thick-turbid, and floating pulse, both use vomiting method. Eyelids and under-eye area like soot indicate Phlegm. Qi deficiency failing to hold saliva, Phlegm not very sticky, do not use draining medicines; use *Liu Jun Zi Tang* plus *Yizhiren* (Profit Seed) to restrain. With Phlegm in Middle Jiao, although food intake is small, Stomach Qi relies on nourishment, so it does not become deficient immediately. Thus, patients with Phlegm have prolonged illness, loss of appetite, but Stomach is not deficient; if attacked completely, it becomes deficient. Internal injury with Middle Qi deficiency must use *Renshen* (Ginseng Radix) and *Baizhu* (Atractylodis Macrocephalae Rhizoma), assisted by Ginger Juice to transmit downwards. Phlegm above the diaphragm must use vomiting; purgation cannot remove it. Wind-Phlegm often shows strange symptoms; Warm-Phlegm shows fatigue and weakness; Heat-Phlegm with Wind shows many external symptoms. Phlegm in intestines-stomach can be cured by purgation; Phlegm in meridians must be vomited; vomiting contains the meaning of dispersing. *Huangqin* (Scutellariae Radix) treats Heat-Phlegm by borrowing its ability to descend Fire. *Zhuli* (Bambusa Textilis Caulis Sap) slides Phlegm; *Jiangzhi* (Zingiberis Recensis Succus) cannot travel meridians; *Wubeizi* (Myrobalani Fructus) treats Old-Phlegm. When using vomiting medicines, lift Qi to induce vomiting. Such as *Fangfeng* (Saposhnikoviae Radix), *Shanzhi* (Gardeniae Fructus), *Chuanxiong* (Chuanxiong Rhizoma), *Jiegeng* (Platycodonis Radix), *Yacha* (Camelliae Sinensis Folium Germinans), Ginger, *Jizhi* (Allii fistulosi juice), or *Gua Di San* (Melon Tip Powder). *Cangzhu* (Atractylodis Rhizoma) treats Phlegm forming nests; walking on one side is excellent. Phlegm with Blood Stasis forms nests. Dizziness and burning sensation are Fire agitating Phlegm; use *Er Chen Tang* plus *Shanzhi* (Gardeniae Fructus), *Lianqin* (Coptidis Rhizoma & Scutellariae Radix). Belching and acid regurgitation: Food stagnation with Heat, Fire Qi moving upward. *Huangqin* (Scutellariae Radix) as Sovereign, *Nanxing* (Arisaematis Rhizoma Preparatum), *Banxia* (Pinelliae Rhizoma) as Ministers, *Juhong* (Citri Reticulatae Pericarpium Rubrum) as Envoy. Add *Qingdai* (Indigo Naturalis) if Heat is increased. Phlegm in hypochondrium cannot reach except with *Baijiezi* (Brassicae Semen). Phlegm in subcutaneous tissue and fascia cannot penetrate except with Ginger Juice and Bamboo Sap. *Baijiezi* (Brassicae Semen) can also disperse Phlegm-Qi in subcutaneous tissue and fascia; only skilled users can achieve miraculous results. Phlegm in limbs cannot open except with Bamboo Sap. Phlegm nodules in throat, unable to enter or exit, use Phlegm-resolving medicines, add salty-moistening softening-hardness ingredients like *Gualou* (Trichosanthis Fructus), *Xingren* (Armeniacae Semen Amarum), *Haishi* (Calcitrum), *Jiegeng* (Platycodonis Radix), *Lianqiao* (Forsythiae Fructus), with a little *Puxiao* (Natri Sulfas), Ginger Juice, Honey, formed into pills, held in mouth to dissolve. *Haifen* (Sea Powder) is *Haishi* (Calcitrum). It descends Heat-Phlegm, dries Damp-Phlegm, softens Knotted Phlegm, eliminates Stubborn Phlegm. Can be used in pills/powders, not in decoctions. *Xiao Wei Dan* (Stomach Reducing Pill) treats Upper Diaphragm Phlegm-Heat but damages Stomach Qi. Using too many draining medicines to treat Phlegm causes Spleen Qi deficiency, making Phlegm easy to generate and abundant. *Tianhuafen* (Trichosanthis Radix) greatly descends Upper Diaphragm Heat-Phlegm. Phlegm in diaphragm causes insanity or forgetfulness, or Wind-Phlegm; all use Bamboo Sap, which also nourishes Blood. Used with *Jinglü* (Perillae Caulis Sap), efficacy is slightly heavier. For those who can eat, these two work fast and steadily. *Jiu Zhi* (Chinese Chive Juice) treats Blood stasis not moving; Drink 2-3 cups of natural juice for Fluid in Middle Jiao; must feel vexation/restlessness in chest before healing.
Jiezai discussed Phlegm, first revealing the root of Phlegm in the Kidney, which could be considered discovering what predecessors had not. Pity he started it but did not finish the argument. His prescribed formulas were all treating branch symptoms, containing many cold-cooling substances, often damaging the Stomach. Only Mr. Zhang Zhongjing said: "Deficient Qi with Phlegm, use *Shen Qi Wan* (Kidney Qi Pill) to tonify and expel." Wu Jiaochu also said: "*Ba Wei Wan* (Eight-Ingredient Pill) treats the root of Phlegm." These two gentlemen truly opened the ignorance of later learners and saved infinite premature deaths. Phlegm is a disease name. Originally not part of the human body. Either Water flooding becomes Phlegm, or Water boiling becomes Phlegm. One should only distinguish between with-Fire and without-Fire. Kidney deficiency failing to control Water, Water does not return to source, counter-flowing and flooding to become Phlegm; this is without-Fire. Thus use *Ba Wei Wan* (Eight-Ingredient Pill) to tonify Kidney Fire. (Zhang) commonly adds *Niuxi* (Achyranthis Bidentatae Radix) and *Wuweizi* (Schisandrae Fructus) for better effect. Yin deficiency with Fire agitation causes Water boiling. Agitation in Kidney is like Fire on the Sea, Dragon rises and Water follows; agitation in Liver is like Thunder-Fire from Earth, fierce wind and rain, Water surges with waves to become Phlegm; this is with-Fire. Thus use *Liu Wei Wan* (Six-Ingredient Pill) to tonify Water and match Fire. (Zhang) commonly adds *Niuxi* (Achyranthis Bidentatae Radix), *Maidong* (Ophiopogonis Radix), *Wuweizi* (Schisandrae Fructus) for wonderful effect. This does not treat the branch of Phlegm but the root. Therefore, those skilled in treating Kidney deficiency first use *Liu Wei* (Six-Ingredient) and *Ba Wei* (Eight-Ingredient) to strengthen the Master of Water and benefit the Source of Fire, then use *Si Jun Zi* (Four Gentlemen) or *Liu Jun Zi* (Six Gentlemen) to tonify Spleen to control Water. For Spleen deficiency, having administered *Bu Zhong* (Tonify Middle) or *Li Zhong* (Regulate Middle) to solidify Spleen, then use *Liu Wei* (Six-Ingredient) and *Ba Wei* (Eight-Ingredient) to control Water and benefit Mother, allowing Child and Mother to mutually nourish, and the way of treating Phlegm is complete.
Pang Anchang often said: "Yin Water deficiency, Yin Fire rises, Lung suffers Fire insult, cannot descend clearly and purely, thus Body Fluids condense turbid to generate Phlegm, not generating Blood." This should be treated with moistening agents like *Men Dong* (Asparagi Radix) and *Dihuang* (Rehmanniae Radix) to nourish Yin, allowing rebellious Fire to return to its home and rest, then Phlegm clears itself. Administering *Er Chen* (Two Aged Ingredients) immediately sees danger. "Kidney deficiency failing to grasp Qi returning to source, Qi exits but is not grasped, accumulates; accumulation not dispersing generates Phlegm." *Ba Wei Wan* (Eight-Ingredient Pill) governs this. However, Mengquan considers *Dihuang* (Rehmanniae Radix) cloying to the diaphragm and generating Phlegm, a forbidden medicine for Phlegm, stir-frying it with Ginger Juice. Alas! If stir-fried with Ginger Juice, it becomes pungent-dry, and *Dihuang* (Rehmanniae Radix) is useless. *Dihuang* (Rehmanniae Radix) is valued precisely for its moistening nature, entering the Kidney Meridian. If mixed with Spleen-Stomach medicines, Earth hates Dampness, how can it not cloy the diaphragm and generate Phlegm? All items in *Ba Wei* (Eight-Ingredient) and *Liu Wei* (Six-Ingredient) Pills are medicines of the Shaoyin Meridian, leading each other in groups, straight into Lower Jiao. Named the holy medicine for Water Flooding Phlegm. Take on empty stomach, press with good meal, do not stay in Stomach. This is the wonder of Zhang Zhongjing's formula legislation.
(Zhang) Commentary: Zang-Fu Body Fluids diseased become Phlegm, rising and falling with Qi, this is the normal principle. If in subcutaneous tissue and fascia, and bends of limbs-joints, how can Phlegm from Zang-Fu flow into those places? This is local Body Fluids, encountering cold or heat, condensing into Phlegm to cause disease. Definitely not Body Fluids from other parts diseased and becoming Phlegm, leaving their original position to move to other parts. Moreover, Qi is originally formless, thus reaching every minute detail, and Fluids move with Qi, also relying on Qi to circulate. If Body Fluids are diseased and become Phlegm, they transform into tangible and stagnating substances. How can they flow with Qi into the most minute and dense places?
*Liu Wei Di Huang Tang* (Six-Ingredient Rehmannia Decoction), *Ba Wei Di Huang Tang* (Eight-Ingredient Rehmannia Decoction).
See also in the Tuberculosis (Lao Zhai) section.