痰者，病名也。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，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，
而消凝结之痰，缓以治之，冀可效耳！今制一方于后。
天门冬（去心） 黄芩（酒炒） 海粉 橘红（各一两） 桔梗 连翘 香附（杵碎淡盐水浸炒，各五钱）
青黛（另研） 芒硝（另研，各三钱） 栝蒌仁（取肉另研，一两）
上为细末，炼蜜入姜汁少许，和药杵极匀，丸小龙眼大，噙化一丸。或嚼烂，清汤细咽之。或丸如
黍米大，淡姜汤送下五、六十丸。
愚按前方味属甘苦咸寒之剂，虽能软坚、开郁、化痰、降火，而不无损胃之祸乎！若脾土太过，气滞郁
热而生痰者，用之得宜；若脾土不及，气痞虚热而生痰者，用之必致中满吞酸、肚腹肿胀、小便不利而殁。
治者审之！
一男子素不善调摄，唾痰，口干，饮食不美。服化痰行气之剂，胸满腹膨，痰涎愈盛；服导痰理脾之
剂，肚腹膨胀，二便不利；服分气利水之剂，腹大胁痛，睡卧不得；服破血消导之剂，两足皆肿，两关脉
浮大，不及于寸口。余以脾土虚而生痰，朝用金匮加减肾气丸，夕用补中益气汤煎送前丸，月余诸症渐
退，饮食渐进；再用八味丸、补中益气汤，月余乃能转侧，又两月而能步履；却服十全大补汤、还少丹，
又半载而康。后稍失调理，其腹仍胀，随服前药即愈。
一武职，形体魁梧，素不围炉，不喜热食，行则喘促。自谓气实老痰，服碑记丸攻伐之。诊其脉洪数，
重按全无。余谓命门火衰，脾肺虚寒，与八味丸一服，痰喘稍止，数服全止，遂能亲火，喜热饮食。盖
碑记丸出自西域，况方外人所制者。经云西域水土刚强，其民不衣而褐荐，其民华色而脂肥，故邪不能伤
其形体，其病生于内，其治宜毒药。由此观之，恐不可概用也。
太仓陆中舍，以肾虚不能摄水，肚腹胀大，用此丸未数服而殁于京。今之专门治蛊者，即此方也。又
名黑丸子，用之无不速亡。
机房蔡一，素不慎起居，患症同前，更加手足逆冷，恶寒饮食。余用补中益气汤加附子一钱，先回其
阳，至数剂诸症渐愈。余因他往，或用峻厉之剂，下鲜血甚多，亦致不起。
若此等老痰，饮酒之人多有之。酒气上升为火，肺与胃脘皆受火邪，故郁结而成。此方用天麦冬、黄
芩泄肺火也，海粉、芒硝咸以软坚也，栝蒌仁润肺清痰，香附米开郁降气，连翘开结降火，青黛降郁火，
故皆不用香燥之剂。
愚按前症若饮食少思，或胸膈不利者，此中气虚弱也，宜用补中益气汤为主，中气既健，其痰
自运化；若肾气亏损，津液难降，败浊为痰者，乃真脏之症，宜用六味地黄丸为主，肾气既壮，津液清
化，而何痰之有哉！亦有因脾胃亏损，中焦气虚，不能运化而为痰者，亦有因峻厉过度，脾气愈虚，不
能运化，津液凝滞而为痰者。凡此皆当健脾胃为主。
痰，是一种病名。人体一身之中，若气血清利顺畅，则津液流通无阻，哪里会有痰呢？只有当气血浑浊逆乱时，津液才会不清澈，被熏蒸积聚而变成痰。痰的根本在于水，源头在肾；痰的动因在于湿，主宰在脾。古人使用二陈汤作为治疗痰证的通用方剂，是为了通过健脾燥湿来治其标。然而，用二陈汤治疗湿痰、寒痰、痰饮、痰涎固然合适，但如果是因为火邪导致肺气不清，咳嗽不时发作，以及老痰、郁痰结成粘块，凝滞于咽喉之间，吐咯难以排出，这类痰证，都是因为火邪炎上，熏灼上焦，肺气被郁遏，导致随气上升的津液被火邪熏蒸，凝结浊滞而成。岁月积累，根深蒂固，所以称为“老”、“郁”，而其根本原因在于火邪。病变部位在上焦心肺之分及咽喉之间，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、枳壳、南星等药物所能治疗的。关键在于开解郁结，降泄火邪，清润肺金（肺脏），从而消除凝结之痰，缓缓调理，才有望见效！现制定一方如下：
天门冬（去心） 黄芩（酒炒） 海粉 橘红（各一两） 桔梗 连翘 香附（捣碎，用淡盐水浸泡后炒制，各五钱）
青黛（单独研磨） 芒硝（单独研磨，各三钱） 栝蒌仁（取肉单独研磨，一两）
将上述药物研为细末，加入炼蜜和少许姜汁，与药粉捣匀，制成如龙眼核大小的丸剂，含化一丸。或者嚼烂，用清汤细细咽下。也可以制成如黍米大小的丸剂，用淡姜汤送服五六十丸。
我按语：前方药物属性属于甘苦咸寒之剂，虽然能软坚散结、开郁化痰、降火，但难道不会损伤胃气吗？如果脾土太过，气滞郁热而生痰者，使用此方得当；如果脾土不足，气痞虚热而生痰者，使用此方必然导致中满吞酸、肚腹肿胀、小便不利甚至死亡。施治者务必审慎！
有一男子平时不善于调养摄生，唾痰多，口干，饮食无味。服用化痰行气的药剂后，胸满腹胀，痰涎更加旺盛；服用导痰理脾的药剂后，肚腹膨胀，大小便不通利；服用分气利水的药剂后，腹部肿大胁痛，睡眠躺卧不得；服用破血消导的药剂后，两脚皆肿，两手关脉浮大，不及于寸口。我认为这是脾土虚弱而生痰，早晨服用金匮加减肾气丸，晚上服用补中益气汤煎汤送服前面的丸药，月余诸症逐渐消退，饮食逐渐增加；再用八味丸、补中益气汤，月余才能翻身转动，又两个月才能行走；后来服用十全大补汤、还少丹，又过了半年才康复。后来稍有不慎失于调理，腹部再次胀满，随即服用之前的药物即痊愈。
有一位武官，形体魁梧，平时不围炉取暖，不喜欢热食，行走时气喘急促。自认为是气实老痰，服用碑记丸进行攻伐。诊察其脉象洪数，重按完全无力。我认为是命门火衰，脾肺虚寒，给予八味丸一服，痰喘稍微停止，服用几剂后完全停止，于是能够靠近火源，喜欢热饮食。因为碑记丸出自西域，况且是出家人所制的方子。经书说西域水土刚强，那里的百姓不穿丝绸而穿粗布草席，百姓面色红润且脂肪丰厚，所以外邪不能伤害他们的形体，他们的病生于内部，治疗适宜用毒药。由此看来，恐怕不能一概使用。
太仓陆中舍，因为肾虚不能摄纳水液，肚腹胀大，服用此丸未几就死在北京。现在专门治疗蛊胀病的医生，用的就是此方。又名黑丸子，使用它没有不迅速死亡的。
机房蔡一，平时不注意起居作息，患病症状同前，更加手足逆冷，恶寒厌食。我用补中益气汤加附子一钱，先回阳救逆，至数剂后诸症逐渐好转。我因其他事情外出，别人用了峻烈猛厉的药剂，导致下鲜血很多，也致使病情恶化无法挽回。
像这种老痰，饮酒的人多有此症。酒气上升化为火，肺与胃脘都受到火邪侵害，所以郁结而成。此方用天冬、麦冬、黄芩泻肺火，海粉、芒硝以咸味软坚散结，栝蒌仁润肺清痰，香附米开郁降气，连翘开结降火，青黛降郁火，所以都不用香燥的药物。
我按语：前述病症如果饮食减少思虑，或胸膈不利者，这是中气虚弱，宜用补中益气汤为主，中气既健旺，痰自然运化；如果肾气亏损，津液难降，败浊成为痰者，这是真脏受损的病症，宜用六味地黄丸为主，肾气既强壮，津液清化，哪里还会有痰呢！也有因为脾胃亏损，中焦气虚，不能运化而为痰者，也有因为峻厉药物过度使用，脾气更虚，不能运化，津液凝滞而为痰者。凡此种种，都应当以健运脾胃为主。
Phlegm is a disease name. In the human body, if Qi and Blood are clear and smooth, then Body Fluids flow 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 depends on Dampness, governed by the Spleen. Ancient practitioners used Er Chen Tang (Two-Aged Decoction) as a general formula for treating phlegm, aiming to strengthen the Spleen and dry Dampness to treat the branch manifestation. However, while it is appropriate for treating Damp-phlegm, Cold-phlegm, Phlegm-fluid retention, and Phlegm-saliva, if phlegm arises due to Fire pathogen causing unclear Lung Qi, with frequent coughing, or if old phlegm and constrained phlegm form sticky masses that stagnate in the throat, making them difficult to expectorate, such phlegm results from the Fire pathogen flaring upward, steaming the Upper Jiao, and constraining Lung Qi. Consequently, Body Fluids rising with Qi are steamed by Fire, becoming turbid, condensed, and knotted. Over years, they become deeply rooted and solid, hence named "old" and "constrained," with the fundamental cause being the Fire pathogen. The pathology is located in the Upper Jiao (Heart and Lung regions) and the throat, distinct from the Damp-cold phlegm, fluid retention, and saliva of the Middle Jiao (Spleen and Stomach). Therefore, decoctions are difficult to cure, and herbs such as Banxia (Pinelliae Rhizoma), Fuling (Poria), Cangzhu (Atractylodis Rhizoma), Zhike (Aurantii Fructus), and Nanting (Arisaematis Rhizoma Preparatum) cannot treat it. The key lies in resolving constraints, descending Fire, clearing and moistening Lung Metal (the Lung organ), thereby dissolving condensed phlegm, treating slowly, hoping for efficacy! Now, a formula is formulated below:
Tianmendong (Asparagi Radix, heart removed), Huangqin (Scutellariae Radix, wine-fried), Haifen (Natrii Boras), Juhong (Citri Reticulatae Pericarpium Rubrum) (each 1 liang); Jiegeng (Platycodonis Radix), Lianqiao (Forsythiae Fructus), Xiangfu (Cyperi Rhizoma, pounded, soaked in light salt water, fried) (each 5 qian); Qingdai (Indigo Naturalis, ground separately), Mangxiao (Natrii Sulfas, ground separately) (each 3 qian); Gualouren (Trichosanthis Semen, flesh taken and ground separately) (1 liang).
Grind all ingredients into fine powder. Add refined honey and a little Ginger Juice, pound thoroughly until uniform. Form pills the size of dragon eyes. Hold one pill in the mouth to dissolve. Alternatively, chew thoroughly and swallow slowly with clear water. Or form pills the size of millet grains, take 50-60 pills with light ginger soup.
My commentary: The preceding formula consists of sweet, bitter, salty, and cold-natured herbs. Although it can soften hardness, resolve constraints, transform phlegm, and descend Fire, does it not risk damaging Stomach Qi? If Spleen Earth is excessive, generating phlegm due to Qi stagnation and constrained heat, this formula is suitable. However, if Spleen Earth is deficient, generating phlegm due to Qi blockage and deficiency heat, using this formula will inevitably lead to abdominal fullness, acid regurgitation, abdominal swelling, dysuria, and even death. Practitioners must exercise caution!
A man who was generally poor at self-care suffered from excessive spitting of phlegm, dry mouth, and poor appetite. After taking formulas for transforming phlegm and moving Qi, he experienced chest fullness and abdominal distension, with increased phlegm-saliva; after taking formulas for guiding out phlegm and regulating the Spleen, his abdomen swelled, and urination and defecation became obstructed; after taking formulas for separating Qi and promoting diuresis, his abdomen enlarged with hypochondriac pain, unable to sleep lying down; after taking formulas for breaking blood and promoting digestion, both legs swelled, and the Guan pulse on both wrists was floating and large, failing to reach the Cun position. I diagnosed this as phlegm generated due to Spleen Earth deficiency. In the morning, I administered Jin Gui Jia Jian Shen Qi Wan (Modified Kidney Qi Pill from the Golden Cabinet), and in the evening, I administered Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to wash down the previous pills. After more than a month, symptoms gradually receded, and diet improved. Subsequently, using Ba Wei Wan (Eight-Ingredient Pill) and Bu Zhong Yi Qi Tang, after another month, he could turn over, and after two more months, he could walk. Later, taking Shi Quan Da Bu Tang (Great Tonifying Decoction for Ten Powers) and Huan Shao Dan (Return to Youth Elixir), he recovered after half a year. When he later neglected care, his abdomen bloated again, but immediately recovered upon taking the previous medicines.
A military officer, with a robust physique, usually did not use heating pads and disliked hot food, panting when walking. He believed he had excess Qi and old phlegm, and took Bei Ji Wan (Stele Record Pill) for purgation. His pulse was flooding and rapid, but completely empty upon heavy pressure. I diagnosed Mingmen Fire decline and Spleen-Lung deficiency-cold. One dose of Ba Wei Wan stopped the phlegm and panting slightly; after several doses, it stopped completely, allowing him to tolerate fire sources and prefer hot food. Bei Ji Wan originates from the Western Regions and was formulated by Buddhist monks. The Classics state that the water and soil of the Western Regions are tough and strong; the people wear coarse cloth and sit on straw mats, have ruddy complexions and fatty bodies, so external pathogens cannot harm their physical forms, their diseases arise internally, and treatment should suit toxic drugs. From this perspective, it is feared that this cannot be used indiscriminately.
Lu Zhongshe of Taicang suffered from abdominal distension and enlargement due to Kidney deficiency failing to control water. He died in Beijing after taking this pill only a few times. Specialists in treating Gu distension today use this very formula. It is also called Hei Wan (Black Pill); its use invariably leads to rapid death.
Cai Yi from the Silk Workshop neglected daily routines. His symptoms were similar to the above, accompanied by cold extremities, aversion to cold, and anorexia. I used Bu Zhong Yi Qi Tang plus 1 qian of Fuzi (Aconiti Lateralis Radix Preparata) to first restore Yang. After several doses, symptoms gradually improved. Due to my absence, others used harsh purgatives, causing severe hematochezia, leading to his demise.
Such old phlegm is common among drinkers. Wine Qi rises and transforms into Fire, affecting the Lungs and Stomach, leading to constraint and knotting. This formula uses Tianmendong (Asparagi Radix) and Maidong (Ophiopogonis Radix), Huangqin (Scutellariae Radix) to drain Lung Fire; Haifen (Natrii Boras) and Mangxiao (Natrii Sulfas) to soften hardness with salty flavor; Gualouren (Trichosanthis Semen) to moisten the Lungs and clear phlegm; Xiangfu (Cyperi Rhizoma) to open constraints and descend Qi; Lianqiao (Forsythiae Fructus) to resolve knots and descend Fire; Qingdai (Indigo Naturalis) to descend constrained Fire. Thus, aromatic-drying herbs are avoided.
My commentary: For the aforementioned conditions, if there is poor appetite or chest-diaphragm discomfort, this indicates Middle Qi deficiency; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be the primary treatment. Once Middle Qi is strong, phlegm will naturally transform. If Kidney Qi is damaged, Body Fluids fail to descend, becoming turbid phlegm, this is a True Zang disease; Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) should be the primary treatment. Once Kidney Qi is robust, Body Fluids will clear and transform, leaving no room for phlegm. There are also cases where Spleen-Stomach damage and Middle Jiao Qi deficiency prevent transformation into phlegm, or where excessive harsh medication further weakens Spleen Qi, preventing transformation and causing Body Fluids to stagnate into phlegm. All such cases should prioritize strengthening the Spleen and Stomach.