王节斋曰∶痰者病也。人之一身，气血清顺则津液流通，何痰之有？惟夫气血浊逆，则津液不清，熏
蒸成聚，而变为痰焉。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，则固是矣。若夫痰因火上，肺金不清，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，皆因火邪上炎，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，故名老痰、郁痰。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、枳实、南星等
药所能治也。惟开郁降火，清润肺金，而消化凝结之痰，缓以治之，庶可取效；天冬、黄芩、海粉、栝蒌仁、
桔梗、香附、连翘。青黛、芒硝、橘红。大率饮酒之人，酒气上升为火，肺与胃脘皆受火邪，故郁滞而成，
此天冬、黄芩泻肺火也，海粉、芒硝咸以软坚也，栝蒌润肺除痰，香附开郁降气，连翘开结降火，青黛解郁
火，故皆不用辛燥之药。
痰属湿热，乃津液所化，因风寒湿热之感，或七情饮食所伤，以致气逆液浊，变为痰饮。或吐咯不出，
或凝滞胸膈，或留聚肠胃，或流注经络、四肢，随气升降，遍身上下，无处不到。其为病也，为喘，为咳，
为恶心、呕吐，为痞膈壅塞、关格异病，为泄，为眩运，为嘈杂、怔忡、惊悸，为颠狂，为寒热，为肿痛。
或胸间辘辘有声，或背心一点常如冰冷，或四肢麻痒不仁，皆痰所致。百病中多有兼痰者，世所不知也。痰有
新久轻重之殊，新而轻者，形气清白稀薄，气味亦淡；久而重者，黄浊稠粘凝结，咳之难出，渐成恶味，
酸辣咸苦，甚至带血而出。治法∶痰生于脾胃，实脾燥湿。又随气而升，宜顺气为先，分导次之，又气升属
火，顺气在于降火，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，食积痰则消之，在
上者吐之，在中者下之。又中气虚者，宜固中气以运痰。若攻之太重，则胃气虚而痰愈盛矣。主方用二陈汤，
总治一身之痰。如要下行加引下药，上行加引上药。湿痰多饮，如身体倦怠之类，加苍术，白术。寒痰痞塞
胸中，加半夏，甚者加麻黄、细辛、乌头之类。痰厥头痛，亦加半夏。风厥加南星、枳壳、白附子、天麻、
僵蚕、猪牙皂角之类。气虚者则更加竹沥，气实加荆沥，俱用姜汁。热痰加黄芩、黄连，痰因火盛逆上，降
火为先，加白术、黄芩、石膏、黄连之类。眩运嘈杂，火动其痰也，亦加山栀、黄
连、黄芩。血虚有痰者，加天冬、知母、栝蒌，香附、竹沥、姜汁。带血者，更加黄芩、白芍、桑皮。血
滞不行，中焦有饮者，取竹沥，加姜、韭自然汁。气虚有痰者，加人参、白术。脾虚者，宜补中益气以
运痰。下陷加白术、白芍、神曲，兼用升麻提起。内伤挟痰，加参、 、白术之类，姜汁传送，或加竹
沥尤妙。食积痰，加神曲、山楂、麦芽、炒黄连、枳实以消之。甚者必用攻之，宜丸药。兼血虚者，用补血
药送下。中焦有痰者，食积也。胃气亦赖所养，若攻之，尽则虚矣。老痰用海石、半夏、栝蒌仁、香附、连翘
之类。五倍子佐他药，大治顽痰，宜丸药。喉中有物，咯不出，咽不下者，此痰结也。用药化之，加咸味软
坚之类，宜栝蒌、海石、桔梗、连翘、香附，少佐朴硝、姜汁，蜜化噙服。脉涩者，卒难开，痰在膈上，必
用吐法。胶固稠粘者，脉浮者，痰在经络间者，必用吐，吐中有发散之义。凡用吐，升提其气便吐，如防风、
川芎、桔梗、芽茶、生姜、韭汁之类，或瓜蒂散。凡吐，用布紧勒肚，于不通风处。痰在肠胃可下，枳实、
甘遂、巴豆、大黄、芒硝之类，凡痰用利药过多，肠胃易虚，则痰易生而多。痰在胁下，非白芥子不能除。
痰在皮里膜外，非姜汁、竹沥不可及。在四肢，非竹沥不开。在经络中，亦用竹沥，必佐以姜汁、韭汁。膈
间有痰，或颠狂，或健忘，或风痰，俱用竹沥，与荆汁同功。气虚少食，用竹沥。气实能食，用荆沥。凡人身
上中下有块，是痰也，问其平日好食何物，吐下后方用药。凡人头面颈颊身中有痰核，不痛不红，不作脓者，
皆痰疰也，宜随处用药消之。滚痰丸功泻肠胃痰积，及小儿食积痰，急惊痰盛者，最为要药，常令合备，但
量人虚实用之。
薛立斋曰，痰者脾胃之津液，或为饮食所伤，或因七精
六淫所扰，故气壅而痰聚。谚云肥人多痰，而在瘦人亦有之者，何也？盖脾统血，行气之经，气血俱盛，
何痰之有？皆由过思与饮食所伤，损其经络，脾血既虚，胃气独盛，是以湿因气化，故多痰也。游行周身，
无所不至，痰气既盛，客必胜主，或夺于脾之大络之气，则倏然仆地者，此痰厥也。升于肺者则喘急咳嗽，
迷于心则怔忡恍惚，走于肝则眩运不仁、胁肋胀满，关于肾不咯而多痰唾，留于胃脘则呕泄而作寒热，注于
胸则咽嗝不利、眉棱骨痛，入于肠则辘辘有声，散则有声，聚则不利。窃谓若脾气虚不能消湿，宜用补中益
气汤加茯苓、半夏。若脾气虚弱，湿热所致，宜用东垣清燥汤。若因胃气虚弱，寒痰凝结，宜用人参理中汤。
若因脾胃虚寒，而痰凝滞者，宜理中化痰丸。若因脾虚而痰滞气逆者，宜用六君子加木香。若因脾胃虚弱而
肝木乘侮，宜六君子加柴胡，头痛宜用白术半夏天麻汤。若因脾胃虚弱，寒邪所乘以致头痛，宜用附子细
辛汤。《脉诀》云热则生风，故云风自火出。若风邪气滞，痰蕴于胸中者，宜用南星、枳壳、白附子、天麻、
僵蚕、牙皂之类。若因肺经风热而生痰者，宜用金沸草散。若因风火相搏，肝经风热炽盛而生痰者，宜用牛
黄抱龙丸，或牛黄清心丸。若因肝经血燥而生痰者，宜用柴胡栀子散。若因中气虚弱，不能运化而生痰者，
宜用六君、柴胡、钩藤。
李士材曰∶五痰五饮症各不同，至于脾、肺二家之痰，尤不可混。脾为湿土，喜温而恶寒润，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，喜贝母之润，若是脾痰，则土气益伤，饮食忽减矣。即使肺痰，毋过于凉润以伤中州，
稍用脾药以生肺金，方为善治。故曰∶不理脾胃，非其治也。
王中 曰∶古今医方，痰论已尝喻及。顾外淫之病，当祖仲景专科。若七情之方，虽有多门，原其
本标，半因痰病，盖亦有因病而生痰者也。故痰之为病，不出六经。医书以脾为中州，合胃为表里，胃为
水谷之海，其气熏蒸，上朝肺为华盖，主司皮毛，周流内外，充润百骸，氤氲为荣卫之气，合会为津液不源。
随经变化，在肝名津，在肺名液，在心名血，在肾为精，在胃为涎。元和纯粹，谷气相资，升降无穷。髓、
脑、涕、唾、精、津、气、血、液，同出一源，而随机应感，故凝之则为败痰。夫痰者，湿类也，属足太阴
湿土所司，故肿满至极则必浮，在方则有理气消肿之药。故不言痰也。肺为贮痰之器，痰实郁勃而湿热化，化
属乎少阴君火所司，在方则有除热清剂，故不言痰也。火盛金衰，木无以制，属足厥阴风木所司，风性飘荡，
动静不常，干犯诸经，在方则有一百二十种风，故不言痰也。痰乃败精结实之形，窒碍朝会隧道，气不流畅，
在方则有七十二般气，故不言痰也。津既为痰，不复合气，氤氲停留肺胃之间，自为恶物，其冷如冰。积之日
久，或咳不咳，或喘不喘，或呕哕涎沫，或不吐痰，或面青唇黑，四肢厥逆，或恶风，或恶寒，或头疼身痛，
或多汗如雨，或即无汗。本因肺气，状若伤寒，属足太阳寒水所司，在方则合分治法，故不言痰也。或因志不
遂，忧思郁结，或因惊伏痰，或因伏痰怔忡，如畏人捕，拂勃至甚，火气上炎；性好夸大；语言错谬，狂乱
悲笑，逾垣上屋，邪阳独盛，膂力过人，属少阳相火所司，在方则有宁志镇心之剂，故不言痰也。中风者，
涎痰浮凝，津不润下，大便燥涩。有伏痰者，肺气不治，开合失常，衣食辛热，或天气抑蒸，内外交烁而壅，
或冲冒风寒，则毛窍骤开，肺壅痰塞，甚至皮毛枯竭皱燥，并属阳明燥金所司，在方则各方证类，故不言痰也。
盖因痰而致病者，先治其痰，后调余病；因病而致痰者，先调其病，后逐其痰。其有败痰既下，诸症悉除。
经又云∶有治本而得者，有治标而得者。此之谓也。
戴元礼曰∶凡人忽患胸、背、手、足、头，项、腰、胯痛不可忍，连筋骨，牵引吊痛，坐卧不安，走易
不定，俗医不晓，谓之走 ，用风药及针灸，非也。以药贴，亦非也。或头痛不可举，或神思昏倦多睡，或
饮食无味，痰唾稠粘，夜间喉中如锯声，多流涎唾，手足重坠痹冷，脉不通，误认为瘫痪，亦非也。乃是痰
饮顽涎伏在心膈上下，变为此疾。
张子和曰∶留饮之证，不过蓄水而已。然其得之，由来有五∶肝愤郁而不得伸则乘脾，脾气不化，故为
留饮。肝主虑，久虑而不决，则饮食不行。脾主思，久思而不已则脾结，故亦为留饮。因劳役远行，乘困饮
水，脾胃力衰，因而嗜卧，不能布散于脉，亦为留饮。饮酒过多，肠胃已满，又复增之，脬经不及渗泄，久
久如斯，亦为留饮。隆暑津液焦涸，喜饮寒水，本欲止渴，乘快过多，逸而不勤，亦为留饮。人病饮者，不能
出此五者之外。然水者阴物也，积水则生湿，停酒则发燥，久则成痰。在左胁者同肥气，在右胁者同息贲，上
入肺则多嗽，下入大肠则为泄，入肾则为涌水，濯濯如囊浆，上下无所不之，故在太阳则为支饮，皆由气逆而
得之。故湿在上者，目黄面浮。在下者，股膝肿厥；在中者，支满痞膈。痰逆在阳不去者，久则化气。在阴
不去者，久则成形。今代刘河间，根据仲景十枣汤，制三花神佑丸，而加大黄、牵牛。新得之痰，下三五十丸，
气流饮去。在上可以瓜蒂散通之，下以禹功丸去之，然后以痰剂流其余蕴。复未尽者，可以苦葶苈、杏仁、桑
皮、椒目等逐水之药，伏水皆去矣。夫黄连、黄柏可以清上燥湿，黄 、茯苓可以补下渗湿，二者可以收后，
不可以先驱。治病有先后，邪未去时，慎不可补耳。
戴院使曰∶有饮癖积成块，在腹胁之间，类积聚，用破块药多不效，此当行其饮，宜导痰汤。
何以知其为饮？其人先曾病瘥，口吐涎沫、清水，或素来多痰者是也。又多饮人结成酒癖，腹胁积块，
胀急疼痛，或全身肿满，肌黄少食，宜十味大七气汤，红花酒煎服。
王中 曰∶一切无痰不嗽不哕者，世人莫知为痰。又见之于脉，有虾游、雀啄、代止之形，亦时
有痰气关格者。若非谙练扬历，未免根据经断病，而贻笑大方。盖痰凝气滞，关格不通，其脉固有不可动者。
有两三路乱动，时有时无者，或尺寸一有一无者，有关脉绝滑不见者，或时动而大小不常者，有平居之人忽
然而然者，有素禀痰病不时而然者，有僵仆暴中而然者，非皆死脉也，实因乎痰而然。
然痰之为症，方书散入杂症，是以大小七气汤、治中、二陈、半夏茯苓汤，细辛、白术、薄荷、石膏、
白矾、皂角、南星、贝母、常山，以至青州白丸子、寿星散，利种消酒化气、去风宽膈、止恶诸方，皆显
仁藏，用于其间。古人治痰，莫不在斯。
而余因制滚痰丸一方，获效万无一失。惟脱形不食，及水泄并孕妇不服外，自数岁以上至八旬者，
皆可量度饵之。或常人大便频去，或稍腹痛，或微觉后重，但看其色焦黄稠粘者，并是痰泻，正宜服之。
逐去顽痰，脏腑清利，自然不泄也。
喻嘉言曰∶痰饮之证，留伏二义，最为难明。《金匮》论留饮者三，伏饮者一。曰∶心下有留饮，其人
背寒如掌大。曰∶留饮者，胁下痛引缺盆。曰∶胸中有留饮，其人短气而渴，四肢历节痛。言胸中留饮，阻
抑上焦心肺之阳而为阴噎，则有
深入于背者有冷无热，并阻督脉上升之阳，而背寒如掌大，无非阳火内郁之象也。胁下为手足厥阴上
下之脉，而足少阳之脉，则由缺盆过季胁，故胁下引缺盆而痛，为留饮偏阻，是木火不升之象。饮留胸中，
短气而渴，四肢历节痛，为肺不行气，脾不散精之象也。合三条而观之，心、肺、肝、脾，痰饮皆可留而累
之矣。至伏饮，曰∶膈上病痰，饮喘嗽吐，发则寒热，背痛腰疼，目泣自出，其人振振身 ，剧则必有伏
饮。言胸中乃阳气所治，留饮阻抑其阳，则不能发动。然重阴终难蔽 ，有时阳伸，忽而吐发。然伸而复屈
，太阳不伸，作寒热、腰背痛、目泣；少阳不伸，风火之化，郁而并于阳
明土中，阳明主肌肉，遂振振身 而剧也。留饮之伏而不去，其为累更大若此。治法无大于用温药和之，
而急以通其阳，若仲景苓桂术甘汤等，虽治支满目眩，可于此仿其意矣。
王节斋说：痰是一种病证。人体一身之中，气血清澈顺畅则津液流通，哪里会有痰呢？只有当气血浑浊逆乱，津液就不清彻，被熏蒸积聚，从而变成痰。痰的根本在于水，源头在肾；痰的动因在于湿，主宰在脾。古人用二陈汤作为治疗痰证的通用方剂，是为了健脾燥湿，这是治其标的方法。然而用它来治疗湿痰、寒痰、痰饮、痰涎，确实是合适的。如果是由于火邪导致痰生，肺金不清澈，咳嗽时常发作，以及老痰、郁痰，结成粘稠块状，凝滞于喉间，吐咯困难，这些痰都是因为火邪上炎，熏灼上焦，肺气被郁遏，所以随气上升的津液，被火邪熏蒸，凝结浊质而成。岁月积累久了，根深蒂固，所以称为老痰、郁痰。其根本原因是火邪，病变部位在上焦心肺之间及咽喉处，不同于中焦脾胃的湿痰、冷痰、痰饮、痰涎。因此汤药难以治愈，也不是半夏、茯苓、苍术、枳实、南星等药物所能治疗的。只有开郁降火，清润肺金，然后消化凝结之痰，缓慢调理，才可能见效；可用天冬、黄芩、海粉、栝蒌仁、桔梗、香附、连翘、青黛、芒硝、橘红。大致而言，饮酒之人，酒气上升化为火邪，肺与胃脘都受火邪侵害，因而郁滞成痰，这里的天冬、黄芩是泻肺火的，海粉、芒硝是用咸味软坚散结的，栝蒌润肺除痰，香附开郁降气，连翘开结降火，青黛解郁火，所以都不使用辛温燥烈的药物。
痰属于湿热，是由津液转化而来，因为感受风寒湿热，或七情、饮食所伤，导致气逆液浊，变为痰饮。有的吐咯不出，有的凝滞胸膈，有的留聚肠胃，有的流注经络、四肢，随气升降，遍布全身，无处不到。它引起的病症有：气喘、咳嗽、恶心、呕吐、痞满膈塞、关格等不同疾病，腹泻、眩晕、嘈杂、怔忡、惊悸，癫狂，寒热往来，肿痛。有的胸间辘辘有声，有的背心一点常像冰冷一样，有的四肢麻木瘙痒不知痛痒，这都是痰所致。百种疾病中多有兼夹痰证的，世人并不知晓。痰有新久轻重的区别，新发而轻的，形态气息清白稀薄，气味也淡；久而重的，黄浊稠粘凝结，咳出困难，逐渐产生恶臭，味道酸辣咸苦，甚至带血而出。治疗方法：痰生于脾胃，应健脾燥湿。又因痰随气上升，宜以顺气为先，分消导滞次之。气升属火，顺气在于降火。热痰则清热，湿痰则燥湿，风痰则疏散，郁痰则开郁，顽痰则软坚，食积痰则消导。病位在上者用吐法，在中者用下法。中气虚者，宜固护中气以运化痰。如果攻伐太重，则胃气虚弱而痰反而更盛。主方用二陈汤，总治一身之痰。如果要下行加引下药，上行加引上药。湿痰多饮，如身体倦怠之类，加苍术、白术。寒痰痞塞胸中，加半夏，严重的加麻黄、细辛、乌头之类。痰厥头痛，也加半夏。风厥加南星、枳壳、白附子、天麻、僵蚕、猪牙皂角之类。气虚者再加竹沥，气实加荆沥，都用姜汁送服。热痰加黄芩、黄连，痰因火盛逆上，以降火为先，加白术、黄芩、石膏、黄连之类。眩晕嘈杂，是火动其痰，也加山栀、黄连、黄芩。血虚有痰者，加天冬、知母、栝蒌、香附、竹沥、姜汁。带血者，再加黄芩、白芍、桑白皮。血滞不行，中焦有饮者，取竹沥，加姜、韭自然汁。气虚有痰者，加人参、白术。脾虚者，宜补中益气以运化痰。下陷加白术、白芍、神曲，兼用升麻提起。内伤挟痰，加人参、（此处原文缺字，推测为黄芪或类似补气药）、白术之类，用姜汁传送，或加竹沥尤妙。食积痰，加神曲、山楂、麦芽、炒黄连、枳实以消导。严重的必须用攻伐法，宜用丸药。兼血虚者，用补血药送下。中焦有痰者，多是食积。胃气也依赖食物滋养，如果攻伐过度，胃气就虚了。老痰用海浮石、半夏、栝蒌仁、香附、连翘之类。五倍子辅助其他药，大治顽痰，宜用丸药。喉中有物，咯不出，咽不下，这是痰结。用药化解，加咸味软坚之类，宜用栝蒌、海浮石、桔梗、连翘、香附，少佐朴硝、姜汁，蜂蜜融化含服。脉涩者，突然难开，痰在膈上，必用吐法。胶固稠粘者，脉浮者，痰在经络间者，必用吐法，吐法中有发散的意义。凡是用吐法，提升其气就会吐，如防风、川芎、桔梗、芽茶、生姜、韭汁之类，或用瓜蒂散。凡是吐法，用布紧紧勒住肚子，在不通风的地方进行。痰在肠胃可下，用枳实、甘遂、巴豆、大黄、芒硝之类。凡是用利药过多，肠胃容易虚，则痰易生且多。痰在胁下，非白芥子不能除。痰在皮里膜外，非姜汁、竹沥不能到达。在四肢，非竹沥不能开通。在经络中，也用竹沥，必须佐以姜汁、韭汁。膈间有痰，或癫狂，或健忘，或风痰，都用竹沥，与荆沥功效相同。气虚少食，用竹沥。气实能食，用荆沥。凡人身上下中有肿块，是痰，问其平日喜好吃什么，吐下后再用药。凡人头面颈颊身中有痰核，不痛不红，不作脓的，都是痰疰，宜随处用药消除。滚痰丸功泻肠胃痰积，及小儿食积痰，急惊痰盛者，是最为重要的药，常令制备备用，但要根据人的虚实用量服用。
薛立斋说：痰是脾胃的津液，或因饮食所伤，或因七情六淫所扰，所以气壅而痰聚。谚语说肥人多痰，而在瘦人也有这种情况，为什么呢？盖脾统血，是行气的经脉，气血俱盛，哪里有痰呢？都是由过思虑和饮食所伤，损伤其经络，脾血既虚，胃气独盛，所以湿气因气化异常，故多痰。游行周身，无所不至，痰气既盛，客邪必胜主气，或夺于脾之大络之气，则突然仆倒在地，这是痰厥。升于肺则喘急咳嗽，迷于心则怔忡恍惚，走于肝则眩晕不仁、胁肋胀满，关于肾则不咯而多痰唾，留于胃脘则呕泄而作寒热，注于胸则咽嗝不利、眉棱骨痛，入于肠则辘辘有声，散则有声，聚则不利。我认为若脾气虚不能消湿，宜用补中益气汤加茯苓、半夏。若脾气虚弱，湿热所致，宜用东垣清燥汤。若因胃气虚弱，寒痰凝结，宜用人参理中汤。若因脾胃虚寒，而痰凝滞者，宜用理中化痰丸。若因脾虚而痰滞气逆者，宜用六君子汤加木香。若因脾胃虚弱而肝木乘侮，宜用六君子汤加柴胡，头痛宜用白术半夏天麻汤。若因脾胃虚弱，寒邪所乘以致头痛，宜用附子细辛汤。《脉诀》说热则生风，所以说风自火出。若风邪气滞，痰蕴于胸中者，宜用南星、枳壳、白附子、天麻、僵蚕、牙皂之类。若因肺经风热而生痰者，宜用金沸草散。若因风火相搏，肝经风热炽盛而生痰者，宜用牛黄抱龙丸，或牛黄清心丸。若因肝经血燥而生痰者，宜用柴胡栀子散。若因中气虚弱，不能运化而生痰者，宜用六君子汤、柴胡、钩藤。
李士材说：五痰五饮症状各不相同，至于脾、肺二家的痰，尤其不可混淆。脾为湿土，喜温而恶寒润，所以苍术、白术、南星、半夏是主要药物；肺为燥金，喜凉润而恶温燥，所以知母、贝母、天冬、麦冬、地黄、桔梗是主要药物。这两者容易治疗，很少出现危困情况。常见世俗人厌恶半夏的燥性，喜欢贝母的润性，如果是脾痰，则土气更加受伤，饮食忽然减少。即使是肺痰，也不要过于凉润以损伤中州脾胃，稍用脾药以生肺金，这才是善治。所以说：不理脾胃，不是正确的治疗方法。
王中林说：古今医方，关于痰的论述已经曾经提及。但是外感淫邪的病，应当遵循张仲景的专科理论。如果是七情致病的方法，虽然有多门，追溯其本标，一半是因为痰病，大概也有因病而生痰的情况。所以痰之为病，不出六经范围。医书认为脾为中州，合胃为表里，胃是水谷之海，其气熏蒸，上朝于肺（肺为华盖），主管皮毛，周流内外，充润百骸，氤氲化为营卫之气，合会成为津液的源头。随经络变化，在肝名为津，在肺名为液，在心名为血，在肾为精，在胃为涎。元气元和纯粹，谷气相互资助，升降无穷。髓、脑、涕、唾、精、津、气、血、液，同出一源，而随机感应，所以凝结就成为败痰。夫痰，属于湿类，由足太阴湿土所司管，所以肿满至极则必然浮肿，在方剂中有理气消肿的药物，所以不言痰。肺是贮痰之器，痰实郁勃而湿热化，化属于少阴君火所司管，在方剂中有除热清剂的药，所以不言痰。火盛金衰，木无以制，属于足厥阴风木所司管，风性飘荡，动静不常，干犯诸经，在方剂中有一百二十种风的说法，所以不言痰。痰乃败精结实之形，窒碍朝会隧道，气不流畅，在方剂中有七十二般气的说法，所以不言痰。津既然成为痰，不再复合气，氤氲停留于肺胃之间，自为恶物，其冷如冰。积累日久，或咳或不咳，或喘或不喘，或呕哕涎沫，或不吐痰，或面青唇黑，四肢厥逆，或恶风，或恶寒，或头疼身痛，或多汗如雨，或即无汗。本因肺气，状若伤寒，属于足太阳寒水所司管，在方剂中合分治法，所以不言痰。或者因为志向不顺，忧思郁结，或者因为惊伏痰，或者因为伏痰怔忡，如畏人捕，拂勃至甚，火气上炎；性好夸大；语言错谬，狂乱悲笑，逾垣上屋，邪阳独盛，膂力过人，属于少阳相火所司管，在方剂中有宁志镇心的药剂，所以不言痰。中风者，涎痰浮凝，津不润下，大便燥涩。有伏痰者，肺气不治，开合失常，衣食辛热，或天气抑蒸，内外交烁而壅，或者冲冒风寒，则毛窍骤开，肺壅痰塞，甚至皮毛枯竭皱燥，并属于阳明燥金所司管，在方剂中各方证类，所以不言痰。大概因为痰而致病的，先治其痰，后调余病；因病而致痰的，先调其病，后逐其痰。如果有败痰既下，诸症悉除。经书又说：有治本而得愈的，有治标而得愈的。说的就是这个道理。
戴元礼说：凡人忽然患胸、背、手、足、头、项、腰、胯痛不可忍，连筋骨，牵引吊痛，坐卧不安，走易不定，俗医不懂，称之为走注，用风药及针灸，是不对的。用膏药贴敷，也是不对的。有的头痛不可举，有的神思昏倦多睡，有的饮食无味，痰唾稠粘，夜间喉中如锯声，多流涎唾，手足重坠痹冷，脉不通，误认为瘫痪，也不对。乃是痰饮顽涎伏在心膈上下，变为此疾。
张子和说：留饮的证候，不过是蓄水而已。然而它的成因，由来有五：肝愤郁而不得伸则乘脾，脾气不化，所以为留饮。肝主虑，久虑而不决，则饮食不行。脾主思，久思而不已则脾结，所以也为留饮。因劳役远行，乘困饮水，脾胃力衰，因而嗜卧，不能布散于脉，也为留饮。饮酒过多，肠胃已满，又复增之，膀胱经不及渗泄，久久如此，也为留饮。隆暑津液焦涸，喜饮寒水，本欲止渴，乘快过多，逸而不勤，也为留饮。人病饮者，不能出此五者之外。然而水是阴物，积水则生湿，停酒则发燥，久则成痰。在左胁者同肥气，在右胁者同息贲，上入肺则多嗽，下入大肠则为泄，入肾则为涌水，濯濯如囊浆，上下无所不之，所以在太阳则为支饮，皆由气逆而得之。所以湿在上者，目黄面浮。在下者，股膝肿厥；在中者，支满痞膈。痰逆在阳不去者，久则化气。在阴不去者，久则成形。今代刘河间，根据张仲景十枣汤，制作三花神佑丸，而加大黄、牵牛。新得的痰，下三五十丸，气流饮去。在上可以用瓜蒂散通之，下用禹功丸去之，然后用痰剂流其余蕴。复未尽者，可以用苦葶苈、杏仁、桑皮、椒目等逐水之药，伏水皆去矣。夫黄连、黄柏可以清上燥湿，黄芪、茯苓可以补下渗湿，二者可以作为收后之法，不可以先驱。治病有先后，邪未去时，慎不可补耳。
戴院使说：有饮癖积成块，在腹胁之间，类似积聚，用破块药多不效，这应当行其饮，宜用导痰汤。怎么知道它是饮？其人先前曾病愈，口吐涎沫、清水，或者素来多痰的是。又多饮人结成酒癖，腹胁积块，胀急疼痛，或全身肿满，肌黄少食，宜用十味大七气汤，红花酒煎服。
王中林说：一切无痰不嗽不哕的，世人不知道是痰。又见于脉象，有虾游、雀啄、代止的形状，也时有痰气关格的情况。如果不是谙练扬历，未免根据经文断病，而被大方之家嘲笑。盖痰凝气滞，关格不通，其脉固有不可动的。有两三路乱动，时有时无的，或者尺寸一有一无的，有关脉绝滑不见的，或者时动而大小不常的，有平居之人忽然这样的，有素禀痰病不时这样的，有僵仆暴中而这样的，并非都是死脉，实在是因为痰而导致的。
然而痰之为症，方书散入杂症，是以大小七气汤、治中、二陈、半夏茯苓汤，细辛、白术、薄荷、石膏、白矾、皂角、南星、贝母、常山，以至青州白丸子、寿星散，利种消酒化气、去风宽膈、止恶诸方，皆显仁藏，用于其间。古人治痰，莫不在斯。
而我因此制作滚痰丸一方，获效万无一失。除了脱形不食，以及水泄并孕妇不服外，自数岁以上至八旬者，都可以量度服用。或者常人大便频去，或者稍腹痛，或者微觉后重，只要看其色焦黄稠粘的，都是痰泻，正宜服用。逐去顽痰，脏腑清利，自然不泄也。
喻嘉言说：痰饮之证，留伏两义，最为难明。《金匮要略》论留饮者有三条，伏饮者有一条。说：心下有留饮，其人背寒如掌大。说：留饮者，胁下痛引缺盆。说：胸中有留饮，其人短气而渴，四肢历节痛。言胸中留饮，阻抑上焦心肺之阳而为阴噎，则有深入于背者，有冷无热，并阻督脉上升之阳，而背寒如掌大，无非阳火内郁之象也。胁下为手足厥阴上下之脉，而足少阳之脉，则由缺盆过季胁，故胁下引缺盆而痛，为留饮偏阻，是木火不升之象。饮留胸中，短气而渴，四肢历节痛，为肺不行气，脾不散精之象也。合三条而观之，心、肺、肝、脾，痰饮皆可留而累之矣。至伏饮，说：膈上病痰，饮喘嗽吐，发则寒热，背痛腰疼，目泣自出，其人振振身 动，剧则必有伏饮。言胸中乃阳气所治，留饮阻抑其阳，则不能发动。然重阴终难蔽阳，有时阳伸，忽而吐发。然伸而复屈，太阳不伸，作寒热、腰背痛、目泣；少阳不伸，风火之化，郁而并于阳明土中，阳明主肌肉，遂振振身动而剧也。留饮之伏而不去，其为累更大若此。治法无大于用温药和之，而急以通其阳，若张仲景苓桂术甘汤等，虽治支满目眩，可于此仿其意矣。
Wang Jiezhai stated: Phlegm is a pathological condition. In the human body, when Qi and Blood are clear and smooth, Body Fluids circulate freely, so how can there be phlegm? Only when Qi and Blood become turbid and rebellious do Body Fluids lose their clarity, get steamed and accumulated, and transform into phlegm. The root of phlegm lies in Water, originating from the Kidney; the movement of phlegm is due to Dampness, governed by the Spleen. Ancients used Er Chen Tang (Two-Cured Decoction) as a general formula for treating phlegm, aiming to strengthen the Spleen and dry Dampness, which treats the branch manifestation. However, using it to treat Damp-Phlegm, Cold-Phlegm, Fluid Retention, and Saliva is indeed appropriate. If phlegm arises due to Fire, causing the Lung Metal to be unclear, with frequent coughing, or if it is Old Phlegm or Stagnant Phlegm, forming sticky clumps that stagnate in the throat, difficult to expectorate, these types of phlegm are all caused by Fire Pathogens flaming upward, steaming the Upper Jiao, depressing Lung Qi. Thus, Body Fluids rising with Qi are steamed by Fire, condensing into turbid, stagnant knots. Accumulated over years, they become deeply rooted, hence named Old Phlegm and Stagnant Phlegm. Their root cause is Fire Pathogen, the disease location is in the Upper Jiao between Heart and Lung and the throat, distinct from Middle Jiao Spleen-Stomach Damp-Phlegm, Cold-Phlegm, Fluid Retention, and Saliva. Therefore, decoctions are difficult to cure, and herbs such as Banxia (Pinellia Rhizome), Fuling (Poria), Cangzhu (Atractylodis Rhizoma), Zhishi (Aurantii Fructus), and Nanting (Arisaematis Rhizoma Preparatum) cannot treat them. One must open stagnation and descend Fire, clear and moisten Lung Metal, then digest the condensed phlegm, treating slowly to achieve efficacy. Ingredients include Tiandong (Asparagi Radix), Huangqin (Scutellariae Radix), Haifen (Calcariae Concha), Gualouren (Trichosanthis Semen), Jiegeng (Platycodonis Radix), Xiangfu (Cyperi Rhizoma), Lianqiao (Forsythiae Fructus), Qingdai (Indici Folium), Mangxiao (Natrii Sulfas), and Juhong (Citri Reticulatae Pericarpium). Generally speaking, in those who drink alcohol, Wine Qi rises transforming into Fire, affecting both Lung and Stomach, leading to stagnation and phlegm formation. Here, Tiandong and Huangqin purge Lung Fire; Haifen and Mangxiao use salty flavor to soften hardness; Gualou moistens Lung and eliminates phlegm; Xiangfu opens stagnation and descends Qi; Lianqiao resolves knots and descends Fire; Qingdai resolves Stagnant Fire. Hence, acrid-warm drying herbs are not used.
Phlegm belongs to Damp-Heat, transformed from Body Fluids. Due to contraction of Wind-Cold-Damp-Heat or injury from Seven Emotions and Diet, Qi becomes rebellious and fluids turbid, transforming into Phlegm and Fluid Retention. It may be unable to expectorate, stagnate in chest and diaphragm, accumulate in intestines and stomach, flow into meridians and limbs, rising and falling with Qi, reaching everywhere in the body. Its diseases include: wheezing, cough, nausea, vomiting, fullness and obstruction, Guan-Ge syndrome, diarrhea, dizziness, heartburn, palpitations, fright, mania, alternating chills and fever, swelling and pain. There may be rumbling sounds in the chest, a cold spot on the back like ice, numbness and itching in limbs without sensation—all caused by phlegm. Many of the hundred diseases involve phlegm, though people are unaware. Phlegm varies in newness, duration, severity, and lightness. New and mild phlegm is clear, white, thin, and odorless. Long-standing and severe phlegm is yellow, turbid, thick, sticky, and clotted, difficult to cough out, gradually developing a foul smell, tasting sour, spicy, salty, or bitter, even bloody. Treatment methods: Since phlegm originates in Spleen and Stomach, one should strengthen Spleen and dry Dampness. As phlegm rises with Qi, regulating Qi is primary, followed by differentiation and drainage. Rising Qi belongs to Fire, so regulating Qi involves descending Fire. Heat-Phlegm requires clearing heat; Damp-Phlegm requires drying dampness; Wind-Phlegm requires dispersing; Stagnant-Phlegm requires opening; Stubborn-Phlegm requires softening; Food-Stagnation Phlegm requires digestion. For phlegm in the upper part, induce vomiting; for middle part, purge downwards. For deficiency of Middle Qi, consolidate Middle Qi to transport phlegm. If purging is too heavy, Stomach Qi becomes deficient and phlegm increases. The main formula is Er Chen Tang (Two-Cured Decoction), treating whole-body phlegm. To direct downward, add guiding drugs; upward, add upward-guiding drugs. For Damp-Phlegm with excessive drinking, such as physical fatigue, add Cangzhu (Atractylodis Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma). For Cold-Phlegm obstructing chest, add Banxia (Pinellia Rhizome); if severe, add Mahuang (Ephedrae Herba), Xixin (Asari Radix et Rhizoma), or Wutou (Aconiti Radix). For Phlegm-Jue headache, also add Banxia. For Wind-Jue, add Nanting (Arisaematis Rhizoma Preparatum), Zhike (Aurantii Fructus), Baifuzi (Typhonii Rhizoma), Tianma (Gastrodiae Rhizoma), Jiangcan (Bombyx Batryticatus), and Zhuya Zaojiao (Gleditsiae Sinensis Spina). For Qi deficiency, add Zhuli (Bambusae Caulis in Taenia Succus); for Qi excess, add Jingli (Schizonepetae Herba Succus), both with Jiangzhi (Zingiberis Rhizoma Succus). For Heat-Phlegm, add Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma); if phlegm rebels upward due to excessive Fire, descending Fire is priority, adding Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma). For dizziness and heartburn caused by Fire stirring phlegm, also add Zhizi (Gardeniae Fructus), Huanglian (Coptidis Rhizoma), Huangqin (Scutellariae Radix). For Blood deficiency with phlegm, add Tiandong (Asparagi Radix), Zhimu (Anemarrhenae Rhizoma), Gualou (Trichosanthis Fructus), Xiangfu (Cyperi Rhizoma), Zhuli (Bambusae Caulis in Taenia Succus), Jiangzhi (Zingiberis Rhizoma Succus). If bloody, add Huangqin (Scutellariae Radix), Baishao (Paeoniae Radix Alba), Sangpi (Mori Cortex). For Blood stasis with Fluid retention in Middle Jiao, take Zhuli (Bambusae Caulis in Taenia Succus), add Ginger and Jiuzhirui (Allii Tuberosi Succus). For Qi deficiency with phlegm, add Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodis Macrocephalae Rhizoma). For Spleen deficiency, tonify Middle and boost Qi to transport phlegm. For sinking, add Baizhu (Atractylodis Macrocephalae Rhizoma), Baishao (Paeoniae Radix Alba), Shenqu (Massa Medicata Fermentata), combined with Shengma (Cimicifugae Rhizoma) to lift. For internal injury with phlegm, add Renshen (Ginseng Radix et Rhizoma), [missing character, likely Huangqi], Baizhu (Atractylodis Macrocephalae Rhizoma), transmitted with Jiangzhi (Zingiberis Rhizoma Succus), or adding Zhuli (Bambusae Caulis in Taenia Succus) is excellent. For Food-Stagnation Phlegm, add Shenqu (Massa Medicata Fermentata), Shanzha (Crataegi Fructus), Maiya (Hordei Fructus Germinatus), Chao Huanglian (Coptidis Rhizoma Stir-fried), Zhishi (Aurantii Fructus) to digest. If severe, purging is necessary, preferably pills. If accompanied by Blood deficiency, administer with Blood-tonifying pills. Phlegm in Middle Jiao is often food stagnation. Stomach Qi relies on nourishment; if purged excessively, it becomes deficient. For Old Phlegm, use Haishi (Calcariae Concha), Banxia (Pinellia Rhizome), Gualouren (Trichosanthis Semen), Xiangfu (Cyperi Rhizoma), Lianqiao (Forsythiae Fructus). Wubeizi (Galla Chinensis) assists other herbs to treat stubborn phlegm, preferably as pills. For foreign body sensation in throat, unable to spit out or swallow, this is Phlegm Knot. Use medication to resolve, adding salty substances to soften hardness, such as Gualou (Trichosanthis Fructus), Haishi (Calcariae Concha), Jiegeng (Platycodonis Radix), Lianqiao (Forsythiae Fructus), Xiangfu (Cyperi Rhizoma), with small amounts of Puxiao (Natrii Sulfas) and Jiangzhi (Zingiberis Rhizoma Succus), dissolved in honey and held in mouth. If pulse is choppy, sudden opening is difficult; if phlegm is above diaphragm, vomiting method is mandatory. If phlegm is gelatinous and thick, or pulse is floating, or phlegm is in meridians, vomiting is mandatory, as vomiting contains dispersing meaning. When inducing vomiting, lift Qi to trigger vomiting, using Fangfeng (Saposhnikoviae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Jiegeng (Platycodonis Radix), Yacha (Tea Sprouts), Shengjiang (Zingiberis Rhizoma Fresh), Jiuzhi (Allii Tuberosi Succus), or Gouti San (Melon Dispersant Powder). Tighten abdomen with cloth, perform in non-ventilated area. For phlegm in intestines/stomach, purge using Zhishi (Aurantii Fructus), Gansui (Kansui Radix), Badou (Crotonis Fructus), Dahuang (Rhei Radix et Rhizoma), Mangxiao (Natrii Sulfas). Excessive use of purgatives damages intestinal Qi, making phlegm generation easier and more frequent. For phlegm in hypochondrium, only Baijiezi (Sinapis Semen) can remove it. For phlegm inside skin and fascia, only Jiangzhi (Zingiberis Rhizoma Succus) and Zhuli (Bambusae Caulis in Taenia Succus) can reach it. For phlegm in limbs, only Zhuli (Bambusae Caulis in Taenia Succus) can open it. For phlegm in meridians, also use Zhuli (Bambusae Caulis in Taenia Succus), assisted by Jiangzhi (Zingiberis Rhizoma Succus) and Jiuzhi (Allii Tuberosi Succus). For phlegm between diaphragm, or mania, amnesia, or Wind-Phlegm, use Zhuli (Bambusae Caulis in Taenia Succus), same effect as Jingli (Schizonepetae Herba Succus). For Qi deficiency with little appetite, use Zhuli (Bambusae Caulis in Taenia Succus). For Qi excess with good appetite, use Jingli (Schizonepetae Herba Succus). Any lump anywhere in the body is phlegm; ask about dietary preferences, apply vomiting/purging first, then medicate. Any phlegm nodules on head, face, neck, cheeks, body that are painless, non-red, and non-suppurative are Phlegm-Zhu, treat locally to eliminate. Gun Tan Wan (Rolling Phlegm Pill) purges gastrointestinal phlegm accumulation, pediatric food-stagnation phlegm, and acute convulsive phlegm abundance; it is a crucial medicine, always prepared, but dose according to deficiency/excess.
Xue Lizhai said: Phlegm is Spleen-Stomach Body Fluid, injured by diet or disturbed by Seven Emotions and Six Evils, causing Qi congestion and phlegm accumulation. Proverb says fat people have much phlegm, but thin people also have it. Why? Spleen governs Blood and is the channel of Qi circulation; if Qi and Blood are abundant, where is phlegm? It results from excessive thinking and diet injuring meridians, depleting Spleen Blood, leaving Stomach Qi excessive, causing Dampness due to abnormal Qi transformation, thus producing much phlegm. Traveling through the body, nowhere is it absent. When Phlegm-Qi is abundant, pathogen defeats host; if it attacks Spleen's great collateral Qi, sudden collapse occurs, called Phlegm-Jue. Rising to Lung causes wheezing and cough; confusing Heart causes palpitations and confusion; moving to Liver causes dizziness, insensitivity, and hypochondriac distension; involving Kidney causes inability to expectorate but much saliva/phlegm; staying in Stomach causes vomiting, diarrhea, and alternating chills/fever; entering Chest causes throat obstruction and supraorbital pain; entering Intestines causes rumbling sounds; scattered it makes sound, gathered it causes obstruction. I believe if Spleen Qi is deficient and cannot transform Dampness, use Buzhong Yiqi Tang (Tonify Middle and Boost Qi Decoction) plus Fuling (Poria) and Banxia (Pinellia Rhizome). If Spleen Qi is weak with Damp-Heat, use Dongyuan Qingzao Tang (Clear Dryness Decoction). If Stomach Qi is weak with Cold-Phlegm coagulation, use Renshen Lizhong Tang (Ginseng Regulate Middle Decoction). If Spleen-Stomach deficiency-cold with phlegm stagnation, use Lizhong Huatan Wan (Regulate Middle Phlegm-Resolving Pill). If Spleen deficiency with phlegm stagnation and Qi rebellion, use Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Muxiang (Aucklandiae Radix). If Spleen-Stomach weakness with Liver Wood overacting, use Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Chaihu (Bupleuri Radix); for headache, use Baizhu Banxia Tianma Tang (Atractylodes-Banxia-Gastrodia Decoction). If Spleen-Stomach weakness with Cold Evil causing headache, use Fuzi Xixin Tang (Aconite-Asari Decoction). "Mai Jue" states Heat generates Wind, so Wind comes from Fire. If Wind Evil causes Qi stagnation and phlegm in chest, use Nanting (Arisaematis Rhizoma Preparatum), Zhike (Aurantii Fructus), Baifuzi (Typhonii Rhizoma), Tianma (Gastrodiae Rhizoma), Jiangcan (Bombyx Batryticatus), Ya Zao (Gleditsiae Sinensis Spina). If Lung Meridian Wind-Heat generates phlegm, use Jin Fei Cao San (Boil Grass Powder). If Wind-Fire clash with Liver Meridian Wind-Heat generating phlegm, use Niuhuang Baolong Wan (Calculus Bovis Protect Dragon Pill) or Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill). If Liver Meridian Blood Dryness generates phlegm, use Chaihu Zhizi San (Bupleurum-Gardenia Powder). If Middle Qi deficiency fails to transport generating phlegm, use Liu Jun Zi Tang (Six-Gentlemen Decoction), Chaihu (Bupleuri Radix), Gouteng (Uncariae Ramulus cum Uncis).
Li Shicai said: Five Phlegms and Five Fluid Retentions have different symptoms; especially Spleen and Lung phlegm must not be confused. Spleen is Wet Earth, likes warmth, dislikes cold-moisture; thus Er Zhu (Cangzhu, Baizhu), Xing (Nanting), Xia (Banxia) are key herbs. Lung is Dry Metal, likes cool-moisture, dislikes warm-dry; thus Er Mu (Zhimu, Beimu), Er Dong (Tiandong, Maidong), Dihuang (Rehmanniae Radix), Jiegeng (Platycodonis Radix) are key herbs. These two are easy to treat, rarely critical. Commonly, people dislike Banxia's dryness and prefer Beimu's moisture. If this is Spleen Phlegm, Earth Qi is further injured, appetite suddenly decreases. Even for Lung Phlegm, do not overuse cool-moist to injure Middle Jiao; slightly use Spleen herbs to generate Lung Metal, which is good treatment. Thus: Not managing Spleen-Stomach is not correct treatment.
Wang Zhonglin said: Ancient and modern medical formulas discuss phlegm. For external pathogens, follow Zhang Zhongjing's specialized approach. For Seven Emotions, although diverse, tracing root and branch, half are due to phlegm diseases, or diseases generating phlegm. Thus phlegm diseases do not exceed Six Channels. Medical books say Spleen is Middle Jiao, paired with Stomach as interior-exterior; Stomach is Sea of Grain and Water, its Qi steams upward to Lung (Canopy), governing skin/hair, circulating internally/externally, nourishing bones/body, transforming into Ying-Wei Qi, converging into source of Body Fluids. Changing along meridians: in Liver named Jin, in Lung named Ye, in Heart named Blood, in Kidney named Jing, in Stomach named Xian. Yuan Qi is pure, aided by Grain Qi, ascending/descending endlessly. Marrow, Brain, Nasal Mucus, Saliva, Essence, Jin, Qi, Blood, Ye share one source, responding to stimuli, condensing into败痰 (Defective Phlegm). Phlegm belongs to Wet category, managed by Foot Taiyin Damp Earth; thus extreme swelling floats, formulas have Qi-regulating swelling-reducing drugs, so phlegm is not mentioned. Lung is vessel storing phlegm; phlegm stagnates transforming into Damp-Heat, managed by Shaoyin Minister Fire; formulas have heat-clearing agents, so phlegm is not mentioned. Fire excess, Metal decline, Wood uncontrolled, managed by Foot Jueyin Wind Wood; Wind drifts, moves unpredictably, invading channels; formulas have 120 types of Wind, so phlegm is not mentioned. Phlegm is shape of congealed defective essence, blocking tunnels, Qi not flowing smoothly; formulas have 72 types of Qi, so phlegm is not mentioned. Once Jin becomes phlegm, it no longer combines with Qi, lingering in Lung/Stomach as evil matter, cold as ice. Accumulating long, may cough or not, wheeze or not, vomit saliva, or not expectorate, blue face/black lips, cold limbs, aversion to wind/cold, headache/body ache, profuse sweat or no sweat. Originating from Lung Qi, resembling Cold Damage, managed by Foot Taiyin Cold Water; formulas have separate treatments, so phlegm is not mentioned. Or due to thwarted will, sorrow/thought knotting, or startled phlegm, or latent phlegm palpitations fearing capture, extreme agitation, Fire flaming up; personality exaggerated; speech erroneous, manic laughter/crying, climbing walls, Yang Evil excessive, strength surpassing others, managed by Shaoyang Minister Fire; formulas have calming spirit/settling heart agents, so phlegm is not mentioned. Stroke involves floating congealed saliva-phlegm, Jin not moistening down, dry stool. Latent phlegm means Lung Qi not regulated, opening/closing abnormal, spicy/hot food or weather suppression steaming, internal/external burning congestion, or Wind-Cold invasion causing pore opening, Lung congestion/phlegm blockage, even skin枯燥 (withered/dry), managed by Yangming Dry Metal; formulas have various syndrome categories, so phlegm is not mentioned. Generally, if disease caused by phlegm, treat phlegm first, then rest; if phlegm caused by disease, treat disease first, then expel phlegm. If defective phlegm is expelled and symptoms removed. Classics say: some cured by treating root, some by treating branch. This is what it means.
Dai Yuanli said: People suddenly suffer unbearable pain in chest, back, hands, feet, head, neck, waist, hips, radiating to bones/tendons, pulling pain, restless sitting/sleeping, moving unpredictably. Vulgar doctors don't understand, call it "Zou Zhu" (Wandering Pain), use Wind herbs/acupuncture, incorrect. Plasters also incorrect. Some have unbearable headache, mental confusion/drowsiness, loss of taste, thick sticky saliva/phlegm, saw-like sound at night, drooling, heavy/cold paralyzed limbs, blocked pulse, misdiagnosed as paralysis, also incorrect. It is stubborn phlegm-fluid/saliva latent above/below diaphragm, causing this disease.
Zhang Hezi said: Retained Fluid syndrome is merely water accumulation. Causes are five: Liver anger/depression attacking Spleen, Spleen Qi not transforming, causing retained fluid. Liver governs worry; long worry without decision stops food intake. Spleen governs thought; long thought without end knots Spleen, causing retained fluid. Labor/far travel drinking while tired, Spleen-Stomach strength declines, lethargy, unable to distribute in vessels, causing retained fluid. Excessive drinking fills gut, adding more, Bladder meridian cannot excrete, long-term, causing retained fluid. Summer heat drying fluids, liking cold water to quench thirst, drinking too much while comfortable, laziness, causing retained fluid. Drink diseases cannot exceed these five. Water is Yin; accumulation generates Dampness; stagnation generates Dryness; long-term becomes phlegm. Left hypochondrium similar to Fei Qi; right hypochondrium similar to Xi Ben; entering Lung causes cough; entering Large Intestine causes diarrhea; entering Kidney causes Yong Shui (Surging Water), sloshing like bag of fluid, going everywhere; in Taiyang called Zhi Yin (Supporting Fluid), all due to Qi rebellion. Thus Dampness above: yellow eyes, floating face. Below: thigh/knee swelling/cold. Middle: fullness/obstruction. Phlegm rebelling in Yang not departing, long-term transforms to Qi. In Yin not departing, long-term forms shape. Liu Hejian based on Zhang Zhongjing's Shi Zao Tang (Ten Date Decoction), made San Hua Shen You Wan (Three Flowers Divine Protection Pill), adding Dahuang (Rhei Radix et Rhizoma) and Qianniu (Pharbitidis Semen). New phlegm: take 30-50 pills, Qi flows, fluid goes. Above use Gouti San (Melon Dispersant); below use Yu Gong Wan (Meritorious Work Pill), then phlegm agents drain remaining. Unfinished parts use Tingli (Descurainiae Semen), Xingren (Armeniacae Semen Amarum), Sangpi (Mori Cortex), Jaomu (Zanthoxyli Pericarpium) to drain water, hidden water removed. Huanglian (Coptidis Rhizoma) and Huangbai (Phellodendri Cortex) clear upper dry Dampness; Huangqi (Astragali Radix) and Fuling (Poria) tonify lower渗 Dampness. These two are for aftercare, not initial attack. Treatments have sequence; when pathogen not gone, beware tonification.
Dai Yuan Shi said: Drink癖 (Drink癖) accumulates into mass in abdomen/hypochondrium, resembling Ji Ju (Accumulation/Mass); breaking mass herbs ineffective. Should move drink, use Dao Tan Tang (Guide Phlegm Decoction). How to know it's drink? Patient previously recovered, spitting saliva/clear water, or naturally has much phlegm. Heavy drinkers form Jiu Pi (Wine癖), abdominal/hypochondriac masses, distension/pain, or whole body swelling, yellow skin/little food, use Shi Wei Da Qi Qi Tang (Ten-Flavor Great Qi Qi Decoction), decoct with Honghua (Carthami Flos) wine.
Wang Zhonglin said: All coughing/vomiting without phlegm is unknown to people. Pulse shows Xi You (Shrimp Swimming), Que Zhuo (Sparrow Pecking), Dai Zhi (Intermittent) shapes; sometimes Phlegm-Qi Guan Ge (Obstruction). Without experience, relying on classics leads to mockery. Phlegm condenses Qi stagnation, Guan Ge blocks, pulse immobile. Three paths chaotic, intermittent, or Cun/Guan Chi one present/absent, Guan pulse slippery invisible, or varying size, sudden in healthy people, or inherent phlegm constitution, or sudden collapse stroke—not all death pulses, truly due to phlegm.
Phlegm syndromes scattered in miscellaneous diseases in formulas: Da/Xiao Qi Qi Tang, Zhi Zhong, Er Chen, Banxia Fuling Tang, Xixin, Baizhu, Bohe, Shigao, Baifan, Zaojiao, Nanting, Beimu, Changshan, Qingzhou Bai Wan Zi, Shou Xing San, Li Zhong, Xiao Jiu, Hua Qi, Qu Feng, Kuan Ge, Zhi E formulas all used. Ancients treated phlegm here.
I made Gun Tan Wan (Rolling Phlegm Pill), effective almost always. Except emaciation/no eating, watery diarrhea, pregnant women. Ages 8 to 80 can dose appropriately. Frequent bowel movements, slight abdominal pain, tenesmus, if stool is dark yellow/thick/sticky, it is Phlegm Diarrhea, suitable to take. Expel stubborn phlegm, organs clear, natural cessation of diarrhea.
Yu Jiayan said: Phlegm-Fluid syndrome, Retained/Latent meanings hardest to understand. "Jin Gui" discusses three Retained Fluids, one Latent Fluid. Says: Retained fluid under Heart, back cold palm-sized. Retained fluid, hypochondriac pain radiating to Qimen. Fluid in chest, shortness of breath/thirst, limb joint pain. Chest fluid obstructs Upper Jiao Heart-Lung Yang causing Yin Obstruction, deep into back, cold no heat, blocking Du Mai ascending Yang, back cold palm-sized, image of internal depressed Yang Fire. Hypochondrium is Foot-Shao-Yin/Yang channels; Foot-Shaoyang passes Qimen to lateral costal margin; hypochondriac pain to Qimen is Retained Fluid partial blockage, image of Wood-Fire not ascending. Fluid in chest, shortness of breath/thirst, limb joint pain, image of Lung not moving Qi, Spleen not distributing essence. Observing three lines, Heart/Lung/Liver/Spleen, phlegm-fluid can retain and affect them. Latent Fluid: Phlegm disease above diaphragm, fluid/wheeze/cough/vomit, onset chills/fever, back/waist pain, weeping eyes, body tremors, severe implies latent fluid. Chest is Yang Qi domain; retained fluid depresses Yang, cannot activate. Heavy Yin hard to cover Yang; sometimes Yang extends, suddenly vomits. Extends then contracts, Taiyang not extending causes chills/fever/back pain/weeping; Shaoyang not extending, Wind-Fire transformation, depression merging into Yangming Earth; Yangming governs muscle, thus body tremors severe. Retained fluid latent not departing, burden greater thus. Treatment no better than warming herbs harmonizing, urgently opening Yang. Zhang Zhongjing Ling Gui Zhu Gan Tang (Poria-Cinnamon-Atractylodes-Honey Decoction) treats Zhi Yin/dizziness, imitate intent here.