之有萝，如屋之有游，如石之有苔，附托相安，仓卒有难于铲伐者。○痰饮胶结于胸中，为饱、为闷、为频咳而
痰不应，总为脾失其健，不为胃行其津液，而饮食即以生痰，渐渍充满肺窍，咳不易出。虽以治痰为急，然治
痰之药，大率耗气动虚，恐痰未出而风先入也。惟是确以甘寒之药，杜风、消热、润燥，补虚豁痰，乃为合法。
○惊痰堵塞窍隧，肝、肺、心包络间，无处不有，三部脉虚软无力，邪盛正衰，不易开散，欲用涌剂，正如
兵家劫营之法，安危反掌。欲导之下行，窍隧之痰，万不能导，
徒伤脾气，计惟理脾为先。脾气者，人身健运之阳气，如天之有日。阴凝四塞者，日失其所；痰迷不醒者，脾
失其权，理脾则如烈日当空，片云纤翳，能掩之乎？其理脾之法，须药饵与饮食相参，不但滑腻杂食当禁，即
饭食粥饮，亦须少减，则脾气不用以消谷，转用之消痰，较药力万万耳。（喻嘉言）
虚证有痰，勿治其痰，但治其虚，虚者既复，则气血健畅，津液流通，何痰之有？今人乃谓补药能滞气而
生痰，此聋聩之言，流害无穷。○痰稠而不清，宜用澄之之法；散而不收，宜用摄之之法；下虚上溢，宜用复
之之法；上壅下塞，宜用坠之之法。何谓澄？如白矾有却水之性，既能澄浊流，岂不足以澄痰乎？然不可多用；
杏仁亦能澄清，水煮为膏，最能引痰下膈，此所谓澄之之法也。何谓摄？如大肠暴泄脱气，及小便频数者，益
智仁有安三焦、调诸气、摄涎唾而固滑脱之妙，故医方每以治多唾者，取其辛而能摄，非但温胃寒而已，此所
谓摄之之法也。何谓复？肾间真气，不能上升，则水火不交，水火不交，则气不通而津液不注于肾，败浊而为
痰，宜用八味丸，地黄、山药、山萸以补肾精，茯苓、泽泻以利水道，桂、附以润肾燥。桂、附辛热，何以能
润？曰∶《经》不云乎，肾恶燥，急食辛以润之。开腠理，致津液，通气也，此所谓复之之法也。何谓坠？痰
涎聚于咽膈之间，为嗽、为喘、为噎、为眩、为晕，宜用养正丹、灵砂丹重剂以引之，此所谓坠之之法也。至
于寒者热之、热者寒之、微者逆之，甚者从之、坚者削之、客者除之、劳者温之、结者散之、留者行之、湿者
燥之、燥者濡之、急者缓之、损者益之、逸者行之、惊者平之、薄之、劫之、开之、发之，尤为治痰之要法。
（《证治准绳》）
先哲云∶脾为生痰之源，治痰不理脾、肾，非其治也。以脾土虚，则清者难升，浊者难降，留中滞膈，淤
而成痰，故治痰当先补脾，脾复健运之常而痰自化矣。○脾、肺二家之痰，不可混治。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。○更有一种非痰非饮，时吐白沫，
不甚稠粘，此脾虚不能约束津液，宜用六君子汤加益智仁以摄之。（《医宗必读》）
膈上之痰，必须吐之，泻亦不去。○痰在胁下，非白芥子不能达；痰在皮里膜外，非竹沥、姜汁不能行。
○凡人身中有块，不痒不痛，或作麻木，名败痰失道，宜随处用药消之，外用生姜擦之。○喉中有物，咯不出，
咽不下，或作刺痛，此是郁痰，治宜四七汤。○虚人中焦有痰，胃气亦赖以养，不可尽攻。（朱丹溪）
旋复、半夏作汤，调代赭石末，治顽痰结于胸膈，或涎沫上涌者，最佳。挟虚者加人参尤效。（柯韵伯）
凡热痰乘风火上入，目暗耳鸣，多似虚证，错行温补，转锢其痰，永无出路，医之罪也。○凡遇肾虚水泛，
痰涌气高喘急之证，不补其下，反清其上，必致气脱而死，医之罪也。（《医门法律》）
脉候
左右关上脉滑大者，膈上有痰也。关脉洪者，痰随火动也。关脉伏者，痰因气滞也。痰证得涩脉，卒难得
开，必费调理。（《证治汇补》）
滑脉所主之痰，此指随气流动而不结伏者言。若老痰、火痰，坚韧胶固，结伏于经络之间，碍其流行之道
路，营运濡滞，则脉又涩而不滑也。（《四诊抉微》）
凡痰火病久，脉见虚弱，用参 补剂，脉愈细涩，甚加气促形倦，此何以故？盖脉者，血之波澜也。今痰
火病久，津液渐衰，气药助阳，阴血益竭，阳愈旺而阴愈亏，脉遂涩促，或微或代。医不察理，仍用补阳之剂，
危亡立至。（余午亭）
选案
周恒占纳宠后，头晕吐痰。予劝以滋肾，不信，日服化痰行气之剂，势甚危笃。复来延予，与地黄、枸杞、
生脉之属，四剂全安。夫人身关锁在脾肾两经，脾不升气，则水化为痰，肾不纳
气，则水泛为痰。凡痰皆水也，导水不寻源可乎？（程华仲）
一人年六旬，证患右胁块肿作痛，气壅不能卧，医作肿毒治，增剧。予诊右脉滑大，左脉沉涩，曰∶此非
肿毒，乃痰火也。右脉滑大者，本病也。左脉沉涩者，火胜血衰也。肿者，痰之所注。痛者，火之所激。不得
卧者，三阳之脉本下行，今肠胃热结于内，脉不下行，气上奔逆故也。治宜化顽痰，散结热，则肿消痛定而卧
安矣。先以三黄丸三钱，合滚痰丸一钱，下其结热。服后，下结粪数十枚，夜卧即安。喜曰∶药其神乎！予曰∶
未也，热结已深，痰注已久，非渐祛之，不能去根。遂以胆星、半夏、陈皮、海粉、白芥、香附、茯苓、竹沥
逐其痰，以酒炒芩、连、薄荷、童便清其热，以松节、羌活、归身通其络活其血。服药二十剂，胁块肿痛尽消，
但手与背更易而痛，此胸胁之痰已行，而流入手背者犹未除耳。仍以控涎丹二十粒，下痰涎碗许，痛即止。更
以养血健脾，少佐涤痰清热，再服三十剂而康。（吴篁池）
一富翁满口痰珠，至舌尖则成大泡，绵绵不绝。察其脉证，知其大热在胃，大寒在肺。先用参附汤一剂，
保定肺气。少顷，以辰砂六一散泻其胃火而愈。按治是证时，药已屡投不应。值寒夜，先生拥炉火而坐，炉中
有炊饼炙熟，童子误滴少水，其饼遽发大泡。因悟病机，投以前药，立愈。（《慎斋三书》）
附方
擦舌吐痰方 痰在膈上，法宜吐之，但恐吐药太迅，有伤胃气，若平和自然而出，无如酸梅草一方。其
草春生田间，叶小色碧味酸，银工常用者是也。采取苗叶，洗净晒干为末，醋调，用新羊毛笔，醮药擦舌根上，
能吐胸膈之痰。如左胁有痰，药擦舌左，右亦如之。倘痰在背，药擦对舌根之上 。擦时痰随而出，能除胶固
之痰，频用不伤胃气。
痰在体内，就像屋梁上的游尘，又像石头上的青苔，依附寄托而相安无事，仓促之间很难铲除。○痰饮胶结在胸中，表现为饱胀、闷塞、频繁咳嗽却咳不出痰，总归是因为脾脏失去了健运的功能，不能为胃传输津液，导致饮食转化为痰，逐渐浸渍充满肺窍，使得咳嗽难以排出。虽然治疗痰证很紧急，但治疗痰的药物，大多消耗元气且使正气虚弱，恐怕痰还未排出，风邪就先入侵了。只有确切使用甘寒性质的药物，来杜绝风邪、消除热邪、润燥，同时补虚并豁除痰浊，这才是合法的治疗。
○惊痰堵塞窍道隧络，在肝、肺、心包络之间，无处不有，三部脉象虚软无力，邪气盛而正气衰，不容易开散。想要使用涌吐剂，正如兵家劫营的方法，安危只在反掌之间。想要引导痰下行，窍隧中的痰万不能引导，只会徒然损伤脾气，计策唯有以调理脾胃为先。脾气是人身健运的阳气，就像天空有太阳一样。阴寒凝滞四面包围时，是太阳失去了它的位置；痰迷心窍不醒时，是脾脏失去了它的权能，调理脾胃就像烈日当空，片云纤翳怎么能掩盖得住呢？其调理脾胃的方法，必须药物与饮食相结合，不但滑腻杂食应当禁止，就连饭食粥饮，也必须减少摄入，这样脾气就不用来消化谷物，转而用来消痰，比药力要强万万倍。（喻嘉言）
虚证伴有痰，不要治疗痰，只治疗其虚证，虚证既已恢复，那么气血健畅，津液流通，哪里还会有痰呢？现在的人却说补药能阻滞气机而生痰，这是聋聩之言，流弊无穷。○痰稠厚而不清晰，适宜用澄清的方法；散漫不收摄，适宜用固摄的方法；下虚上溢，适宜用复元的方法；上壅下塞，适宜用坠降的方法。什么叫澄？比如白矾有沉淀水质的特性，既然能澄清浑浊的水流，难道不足以澄清痰吗？但是不可多用；杏仁也能澄清，水煮成膏，最能引导痰下行至膈下，这就是所谓的澄清之法。什么叫摄？比如大肠暴泄脱气，以及小便频数者，益智仁有安定三焦、调和诸气、固摄涎唾和固涩滑脱的妙处，所以医方常用它治疗多唾症，取其辛味能固摄的特性，不仅仅是温胃寒而已，这就是所谓的固摄之法。什么叫复？肾间真气不能上升，则水火不交济，水火不交济，则气不通而津液不注入肾脏，败坏浑浊而成痰，适宜用八味丸，用地黄、山药、山萸肉来补肾精，茯苓、泽泻来利水道，桂枝、附子来润肾燥。桂枝、附子辛热，为什么能润？回答说：《内经》不是说过吗，肾恶燥，急食辛以润之。开启腠理，输送津液，通气机，这就是所谓的复元之法。什么叫坠？痰涎聚积在咽膈之间，引起咳嗽、气喘、噎膈、眩晕、晕厥，适宜用养正丹、灵砂丹等重剂来引降，这就是所谓的坠降之法。至于寒者热之、热者寒之、病轻者逆治、病重者从治、坚积者削之、客邪者除之、劳损者温之、结聚者散之、留滞者行之、湿者燥之、燥者濡之、急迫者缓之、亏损者益之、安逸者行之、惊恐者平之、迫近者劫之、闭塞者开之、郁结者发之，尤为治疗痰证的重要法则。（《证治准绳》）
先哲说：脾为生痰之源，治疗痰如果不调理脾、肾，就不是正确的治疗。因为脾土虚弱，则清阳难升，浊阴难降，停留中焦阻滞膈膜，淤积而成痰，所以治疗痰应当先补脾，脾恢复健运的常态而痰自然化解了。○脾、肺两家的痰，不可以混同治疗。脾为湿土，喜欢温燥而厌恶寒润，所以苍术、白术、天南星、半夏是主要药物；肺为燥金，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。这两者容易混淆治疗，很少有不造成危困的。○还有一种非痰非饮的东西，时常吐出白沫，不是很稠粘，这是脾虚不能约束津液，适宜用六君子汤加益智仁来固摄。（《医宗必读》）
膈上面的痰，必须用吐法，泻法也不能去除。○痰在胁下，不用白芥子不能到达；痰在皮里膜外，不用竹沥、姜汁不能行散。○凡是人身中有肿块，不痒不痛，或者感到麻木，名叫败痰失道，适宜随处用药消散，外用生姜擦拭。○喉中有异物，咯不出来，咽不下去，或者产生刺痛，这是郁痰，治疗适宜用四七汤。○虚人之中焦有痰，胃气也依赖它来滋养，不能完全攻伐。（朱丹溪）
旋覆花、半夏煎汤，调服代赭石末，治疗顽痰结于胸膈，或者涎沫上涌者，效果最佳。兼有虚证者加入人参尤其有效。（柯韵伯）
凡是热痰乘着风火之气上入，导致目暗耳鸣，多像虚证，错误地施行温补，反而禁锢其痰，永远没有出路，这是医生的罪过。○凡是遇到肾虚水泛，痰涌气高喘急的证候，不补其下焦，反而清其上焦，必定导致气脱而死，这是医生的罪过。（《医门法律》）
脉候
左右关部脉象滑大的，是膈上有痰。关脉洪大的，是痰随火动。关脉伏匿的，是痰因气滞。痰证得到涩脉，突然很难开通，必定需要费心调理。（《证治汇补》）
滑脉所主之痰，这里指的是随着气流动而不结伏的痰。如果是老痰、火痰，坚韧胶固，结伏在经络之间，阻碍其流行的道路，营运濡滞，那么脉象又涩而不滑了。（《四诊抉微》）
凡是痰火病日久，脉象出现虚弱，使用参类补剂，脉象更加细涩，甚至加上气促形倦，这是什么原因？盖脉，是血的波澜。如今痰火病日久，津液逐渐衰竭，气药助长阳气，阴血更加枯竭，阳越旺而阴越亏，脉遂涩促，或微或代。医生不察理，仍用补阳的药剂，危险死亡立刻到来。（余午亭）
选案
周恒占纳妾后，头晕吐痰。我劝他滋肾，他不信，每天服用化痰行气的药剂，病情非常危重。又来请我去诊治，给予地黄、枸杞、生脉散之类的药物，四剂后完全康复。人身体的关锁在脾肾两经，脾不升气，则水化为痰，肾不纳气，则水泛为痰。凡痰都是水，疏导水不寻源头可以吗？（程华仲）
一人六十岁，病症患右胁块肿作痛，气壅不能卧，医生当作肿毒治疗，病情加重。我诊察右脉滑大，左脉沉涩，说：这不是肿毒，乃是痰火。右脉滑大，是本病。左脉沉涩，是火胜血衰。肿，是痰所注聚。痛，是火所激发。不能卧，是三阳经脉本下行，如今肠胃热结于内，脉不下行，气上奔逆的缘故。治疗适宜化顽痰，散结热，则肿消痛定而卧安。先用三黄丸三钱，合滚痰丸一钱，下其结热。服药后，下结粪数十枚，夜卧即安。高兴地说：药真神乎！我说：还没完，热结已深，痰注已久，不渐渐祛除，不能去根。于是用胆南星、半夏、陈皮、海粉、白芥子、香附、茯苓、竹沥逐其痰，用酒炒黄芩、黄连、薄荷、童便清其热，用松节、羌活、当归身通其络活其血。服药二十剂，胁块肿痛尽消，但手与背交替疼痛，这是胸胁之痰已行，而流入手背的还未清除耳。仍以控涎丹二十粒，下痰涎约一碗，痛即止。再以养血健脾，少佐涤痰清热，再服三十剂而康。（吴篁池）
一富翁满口痰珠，到舌尖则成大泡，绵绵不绝。观察其脉证，知道大热在胃，大寒在肺。先用参附汤一剂，保定肺气。不久，用辰砂六一散泻其胃火而愈。按：治疗这个证候时，药已多次投用不应验。正值寒夜，先生拥炉火而坐，炉中有炊饼烤熟，童子误滴少许水，那饼突然发出大泡。因此悟出病机，投以前药，立即痊愈。（《慎斋三书》）
附方
擦舌吐痰方 痰在膈上，法宜吐之，但恐怕吐药太迅猛，有伤胃气，如果平和自然而出，没有比酸梅草一方更好的。这种草春天生在田间，叶小色碧味酸，银匠常用的就是它。采取苗叶，洗净晒干为末，醋调，用新羊毛笔，蘸药擦舌根上，能吐胸膈之痰。如左胁有痰，药擦舌左侧，右侧也一样。倘若痰在背部，药擦对舌根之上。擦时痰随之而出，能除胶固之痰，频用不伤胃气。
Phlegm in the body is like dust floating on roof beams, or like moss on stones; it adheres and coexists peacefully, making it difficult to eradicate hastily. ○ When phlegm-fluids (Tan Yin) are knotted in the chest, they manifest as fullness, oppression, frequent coughing without expectoration of sputum. This is fundamentally due to the Spleen losing its ability to transport and transform, failing to distribute fluids for the Stomach, causing food and drink to generate phlegm. Gradually, this infiltrates and fills the lung orifices, making coughing difficult to expel. Although treating phlegm is urgent, most phlegm-resolving medicines tend to consume Qi and weaken Zheng Qi (Upright Qi), risking that Wind pathogen may invade before the phlegm is expelled. Only by accurately using sweet and cold-natured medicines to block Wind, clear Heat, moisten dryness, tonify deficiency, and resolve phlegm constitutes the correct method.
○ When "Jing Tan" (Phlegm from Shock/Fright) blocks the orifices and collaterals, it exists nowhere but everywhere between the Liver, Lung, and Pericardium. The pulse at the three positions (Cun, Guan, Chi) is deficient and soft, indicating Excess Pathogen and Deficient Zheng Qi, making it hard to disperse. Using emetic agents is akin to a military raid on the enemy camp, where safety and danger can reverse in an instant. Attempting to guide the phlegm downward is futile as phlegm in the orifices cannot be guided, only injuring Spleen Qi. The strategy must prioritize regulating the Spleen. Spleen Qi is the Yang Qi responsible for dynamic transformation in the body, like the Sun in the sky. When Yin Cold condenses and blocks all directions, it is because the Sun has lost its place; when Phlegm confounds the mind causing unconsciousness, it is because the Spleen has lost its authority. Regulating the Spleen is like the scorching sun in the sky; how can a wisp of cloud obscure it? The method of regulating the Spleen requires combining medicine with diet. Not only should greasy mixed foods be prohibited, but even rice meals and porridges should be reduced. This way, Spleen Qi is not used to digest grain but is redirected to dissolve phlegm, which is vastly superior to medicinal power alone. (Yu Jiayan)
In deficiency syndromes accompanied by phlegm, do not treat the phlegm directly; instead, treat the deficiency. Once the deficiency is restored, Qi and Blood become vigorous and smooth, fluids circulate freely, and where would phlegm come from? Some today claim that tonifying medicines stagnate Qi and generate phlegm; this is deafening nonsense with endless harmful consequences. ○ For thick and turbid phlegm, the method of clarification (Cheng) is suitable; for scattered and uncontained phlegm, the method of consolidation (She) is suitable; for lower deficiency with upper overflow, the method of restoration (Fu) is suitable; for upper congestion with lower blockage, the method of descending/pounding (Zhui) is suitable. What is Clarification? For instance, Ming Fan (Alumen) has the nature to settle water; if it can clarify muddy flows, why not clarify phlegm? However, it should not be used in large doses. Xing Ren (Armeniacae Semen Amarum) can also clarify; boiled into a paste, it best guides phlegm down through the diaphragm. This is the method of clarification. What is Consolidation? In cases of sudden diarrhea with Qi collapse or frequent urination, Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) has the wonder of calming the Triple Burner, regulating Qi, consolidating saliva, and securing slippage. Thus, medical formulas often use it for excessive salivation, leveraging its acrid nature to consolidate, not merely to warm Stomach Cold. This is the method of consolidation. What is Restoration? If the True Qi in the Kidney region fails to ascend, Water and Fire fail to interact. Without interaction, Qi does not flow, and fluids do not pour into the Kidneys, becoming turbid and turning into phlegm. Ba Wei Wan (Eight-Ingredient Rehmannia Pill) is suitable: Di Huang (Rehmanniae Radix), Shan Yao (Dioscoreae Rhizoma), and Shan Zhu Yu (Corni Fructus) tonify Kidney Essence; Fu Ling (Poria) and Ze Xie (Alismatis Rhizoma) promote water passage; Gui Zhi (Cinnamomi Ramulus) and Fu Zi (Aconiti Lateralis Radix Praeparata) moisten Kidney Dryness. Gui Zhi and Fu Zi are acrid and hot; how can they moisten? As the Classic states: "The Kidney dislikes dryness; urgently eat acrid substances to moisten it." Opening the interstices, delivering fluids, and unblocking Qi constitutes the method of restoration. What is Descending/Pounding? When phlegm-saliva gathers between the throat and diaphragm, causing cough, asthma, dysphagia, dizziness, or fainting, heavy agents like Yang Zheng Dan (Nourish Righteousness Pill) or Ling Sha Dan (Spirit Mercury Pill) should be used to guide it down. This is the method of descending/pounding. Furthermore, treating cold with heat, heat with cold, mild cases by opposing treatment, severe cases by following treatment, hard accumulations by reducing them, invading pathogens by eliminating them, exhaustion by warming, knots by dispersing, retention by promoting movement, dampness by drying, dryness by moistening, urgency by relaxing, damage by benefiting, lethargy by moving, fright by calming, invasion by attacking, blockage by opening, and depression by venting are all crucial methods for treating phlegm. (Zheng Zhi Zhun Sheng)
Ancients said: "The Spleen is the source of phlegm production." Treating phlegm without regulating the Spleen and Kidneys is incorrect. Because Spleen Earth is deficient, clear Yang struggles to ascend, and turbid Yin struggles to descend, remaining in the middle and blocking the diaphragm, stagnating into phlegm. Therefore, treating phlegm should first tonify the Spleen; once the Spleen restores its normal dynamic transformation, phlegm dissolves naturally. ○ Phlegm originating from the Spleen and Lung should not be treated indiscriminately. The Spleen is Wet Earth, favoring warm-dryness and disliking cold-moisture; thus, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Cang Zhu (Atractylodis Rhizoma), Tian Nan Xing (Arisaematis Rhizoma Preparatum), and Ban Xia (Pinelliae Rhizoma Preparatum) are key herbs. The Lung is Dry Metal, favoring cool-moisture and disliking warm-dryness; thus, Mu Li (Ostreae Concha - *Note: Context implies Bei Mu/Mu Dan Pi usually, but text says Er Mu, likely Bei Mu & Mu Dan Pi or similar cooling herbs, strictly translating 'Er Mu' as Two Mother herbs/Anemarrhenae & Smilacis or commonly Bei Mu & Mu Dan Pi in some contexts, but standard 'Er Mu' refers to Zhi Mu and Bei Mu*), Zhi Mu (Anemarrhenae Rhizoma), Bei Mu (Fritillariae Bulbus), Dong Qing (Asparagi Radix), Dong Hua (Fritillariae Thunbergii Bulbus), Di Huang (Rehmanniae Radix), and Jie Geng (Platycodonis Radix) are key herbs. Confusing these two makes treatment easy to mishandle, rarely avoiding critical danger. ○ There is another substance, neither phlegm nor fluid, often spat out as white foam, not very thick or sticky. This is Spleen deficiency failing to constrain fluids. Liu Jun Zi Tang (Six-Gentleman Decoction) plus Yi Zhi Ren is suitable to consolidate. (Yi Zong Bi Du)
Phlegm above the diaphragm must be induced to vomit; purgation will not remove it. ○ Phlegm in the hypochondrium cannot reach there without Bai Jie Zi (Brassicae Semenis); phlegm in the subcutaneous tissue and membrane exterior cannot move without Zhu Li (Bambusae Caulis in Taenia) and Jiang Zhi (Zingiberis Rhizoma Recens Juice). ○ Any lump in the body that is neither itchy nor painful, or feels numb, is called "Defeated Phlegm Losing Its Way." It should be dissolved with local medication and rubbed externally with fresh ginger. ○ A foreign object in the throat that cannot be coughed up or swallowed, sometimes causing stabbing pain, is Depressed Phlegm (Yu Tan). Si Qi Tang (Four-Seven Decoction) is suitable for treatment. ○ In deficient persons, phlegm in the Middle Jiao relies on Stomach Qi for nourishment; it should not be entirely attacked. (Zhu Danxi)
Xuan Fu Hua (Inulae Flos) and Ban Xia decocted as soup, mixed with Dai Zhe Shi (Hematitum) powder, is excellent for stubborn phlegm knotted in the chest/diaphragm or surging saliva. Adding Ren Shen (Ginseng Radix et Rhizoma) for those with deficiency is especially effective. (Ke Yunbo)
Whenever Hot Phlegm rides Wind-Fire upward, causing dim vision and tinnitus, it often mimics deficiency. Incorrectly applying warm-tonifying treatments only locks the phlegm in, leaving no exit; this is the doctor's fault. ○ Whenever Kidney deficiency causes Water Flooding, with phlegm surging, high Qi, and rapid asthma, failing to tonify the Lower Jiao and instead clearing the Upper Jiao will inevitably lead to Qi collapse and death; this is the doctor's fault. (Yi Men Fa Lv)
Pulse Diagnosis
If the pulse at the Guan position on both left and right sides is slippery and large, there is phlegm above the diaphragm. If the Guan pulse is flooding (Hong), phlegm moves with Fire. If the Guan pulse is deep-hidden (Fu), phlegm is due to Qi stagnation. If a phlegm syndrome presents with a choppy (Se) pulse, it is suddenly difficult to open/unblock, requiring extensive regulation. (Zheng Zui Hui Bu)
The slippery pulse indicates phlegm that flows with Qi without knotting. However, old phlegm or fire-phlegm, being tough and knotted, lodge in the collaterals, obstructing flow and causing sluggish circulation, resulting in a choppy rather than slippery pulse. (Si Zhen Jue Wei)
In chronic phlegm-fire diseases, if the pulse appears weak, using Ginseng tonics may make the pulse finer and more choppy, even adding shortness of breath and fatigue. Why? The pulse is the wave of Blood. In chronic phlegm-fire, fluids gradually decline. Qi-tonifying drugs aid Yang, further depleting Yin-Blood. As Yang becomes hyperactive and Yin deficient, the pulse becomes choppy and hurried, or minute or intermittent. Doctors who fail to understand this and continue using Yang-tonifying agents face imminent crisis. (Yu Wuting)
Selected Cases
Zhou Hengzhan developed dizziness and phlegm vomiting after taking a concubine. I advised him to nourish the Kidney, but he refused, taking phlegm-resolving and Qi-moving medicines daily until his condition became critical. He sought me again. I prescribed Di Huang (Rehmanniae Radix), Gou Qi (Lycii Fructus), and Sheng Mai San (Generate the Pulse Powder). After four doses, he was fully recovered. The body's locks are in the Spleen and Kidney meridians. If the Spleen fails to ascend Qi, water turns to phlegm; if the Kidney fails to grasp Qi, water floods to form phlegm. All phlegm is water; can one guide water without seeking its source? (Cheng Huazhong)
A sixty-year-old man suffered from a swollen, painful mass in the right hypochondrium, unable to lie down due to Qi obstruction. Physicians treated it as a carbuncle, worsening the condition. My pulse diagnosis showed a slippery-large pulse on the right and a deep-choppy pulse on the left. I said: This is not a carbuncle, but Phlegm-Fire. The right slippery-large pulse indicates the root disease. The left deep-choppy pulse indicates Fire excess and Blood deficiency. Swelling is caused by phlegm accumulation; pain is triggered by Fire. Inability to lie down occurs because the Three Yang meridians normally descend; now, internal intestinal/stomach heat knots internally, preventing the pulse from descending, causing Qi to rush upward. Treatment should resolve stubborn phlegm and scatter knotted heat, so swelling subsides, pain stops, and sleep returns. First, administer San Huang Wan (Three-Yellow Pill) 3 qian combined with Gun Tan Wan (Rolling Phlegm Pill) 1 qian to purge knotted heat. After ingestion, dozens of hard stools were passed, and he slept peacefully that night. He rejoiced, saying the medicine was divine! I replied: Not yet. The heat knot is deep, and phlegm has lodged long; gradual removal is needed to eradicate the root. Then, I used Dan Xing (Arismaetis Rhizoma Cum Bile), Ban Xia, Chen Pi (Citri Reticulatae Pericarpium), Hai Fen (Sepiae Endoconcha), Bai Jie Zi, Xiang Fu (Cyperi Rhizoma), Fu Ling, and Zhu Li to drive out phlegm; Jiu Chao Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Bo He (Menthae Haplocalycis Herba), and Tong Bian (Child's Urine) to clear heat; Song Jie (Pinus Massoniana Node), Qiang Huo (Notopterygii Rhizoma et Radix), and Dang Gui Shen (Angelicae Sinensis Radix) to unblock collaterals and invigorate blood. After twenty doses, the hypochondrial swelling and pain disappeared completely, but pain shifted between the hand and back. This indicated phlegm in the chest/hypochondrium had moved, but phlegm flowing into the back of the hand remained. I administered Kong Yan Dan (Control Saliva Pill) 20 pills, which expelled about a bowl of phlegm-saliva, stopping the pain immediately. Finally, I nourished Blood and strengthened the Spleen, with minor additions of phlegm-draining and heat-clearing herbs. After thirty more doses, he recovered. (Wuang Huangchi)
A wealthy gentleman had mouths full of phlegm beads, forming large blisters at the tip of the tongue continuously. Observing his pulse and symptoms, I determined there was intense Heat in the Stomach and intense Cold in the Lung. First, I gave one dose of Shen Fu Tang (Ginseng and Aconite Decoction) to secure Lung Qi. Shortly after, I used Chen Sha Liu Yi San (Cinnabar Six-to-One Powder) to drain Stomach Fire, curing him. Note: During treatment, previous medicines failed repeatedly. On a cold night, the physician sat by a stove roasting steamed buns. A child accidentally dropped water on a bun, causing it to puff up into a large blister instantly. Realizing the pathological mechanism from this, I prescribed the aforementioned medicines, and he recovered immediately. (Shen Zhai San Shu)
Attached Formulas
Tongue-Rubbing Phlegm-Inducing Formula: For phlegm above the diaphragm, vomiting is the indicated method. However, fearing that emetics are too harsh and damage Stomach Qi, if one seeks a gentle, natural expulsion, the Sour Plum Grass formula is best. This grass grows in fields in spring, with small green leaves and sour taste, commonly used by silversmiths. Harvest the seedlings and leaves, wash, dry, and grind into powder. Mix with vinegar. Use a new wool brush to dip the medicine and rub the root of the tongue. It can induce vomiting of chest/diaphragm phlegm. If phlegm is in the left hypochondrium, rub the left side of the tongue; similarly for the right. If phlegm is in the back, rub the area opposite the root of the tongue. While rubbing, phlegm exits with it, removing knotted phlegm without damaging Stomach Qi even with frequent use.