庞安常云∶有阴水不足，阴火上升，肺受火邪，不得清肃下行，由是津液凝浊，生痰不
生血者。此当以润剂，如麦门冬、地黄、枸杞之属滋其阴，使上逆之火，得返其宅，则痰自
清矣。投以二陈，立见其殆。有肾虚不能纳气归原，原出而不纳则积，积不散则痰生焉，八
味丸主之。
吴茭山《诸证辨疑》云∶八味丸，治痰之本也。
许学士用苍术治痰成窠囊一边行，极妙。痰挟瘀血，遂成窠囊。
朱丹溪曰∶脾虚者，宜清中气以运痰降下，二陈汤加白术之类，兼用升麻提起。二陈汤
，一身之痰都治管。如要下行，加引下药，在上加引上药。凡人身上中下有块者多是痰，问
其平日好食何物，吐下后方用药。
王节斋曰∶痰生于脾胃，宜实脾燥湿。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
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
胃气虚而痰愈甚矣。
薛立斋曰∶凡痰证饮食少思，或胸膈不利者，此中气虚弱也，宜用补中益气为主，中气
既健，其痰自运化。若肾气亏损，津液难降，败浊为痰者，乃真脏之病，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。
又曰∶痰者，脾胃之津液，或为饮食所伤，或为七情六淫所扰，故气壅痰聚。盖脾为统
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，则喘急咳嗽。迷于心，则怔忡恍惚。走于肝，则
眩晕不仁，胁肋胀痛。关于肾，不哈而多痰唾。留于胃脘，则呕泻而作寒热。注于胸，则咽
痛不利，眉棱骨痛。入于肠，则漉漉有声，散则有声，聚则不利。若脾气虚弱，不能消湿，
宜用补中益气汤加茯苓、半夏。若因脾气虚弱，湿热所致，宜用东垣清燥汤。若胃气虚弱，
寒痰凝滞者，宜用人参理中汤。若脾胃虚寒而痰凝滞者，宜用理中化痰丸。若脾虚不能运化
，而痰滞气逆，宜用六君子加木香。若脾胃虚弱而肝木乘侮，宜用六君子加柴胡。若肺气虚
弱，不能清化而有痰者，宜六君子加桔梗。头痛，宜用半夏白术天麻汤。若脾肾虚弱，寒邪
所乘，以致头痛，宜用附子细辛汤。
又曰∶凡治风痰，若肺经风热而生痰者，宜用金沸草散。若风火相搏，肝经风热炽盛而
生痰者，宜用牛黄抱龙丸，或牛黄清心丸。若肝经血燥而生痰者，宜六味地黄丸。若热盛制
金，不能平木而生痰者，宜柴胡栀子散。若中气虚弱，不能运化而生痰者，宜六君柴胡、钩
藤。若肾虚阴火炎上，宜六味丸。
又曰∶凡治痰结，有因脾经郁结而伤阴血者，有因肾水亏损而阴火上炎者，有因脾肺火
郁而生痰者。治法∶若因七情郁结，痰涎滞于喉间者，先用《局方》四七汤调和滞气，后用
归脾汤调补脾血。脾火伤血，用加味归脾汤。肾水亏损，用六味地黄丸。肺经郁火，用知母
茯苓汤。若妇人患此而兼带下，皆由郁结伤损肝脾，当佐以四七汤，送青州白丸子。此等证
候，属脾胃气虚为本，而气滞痰结为末也。古方用十枣汤、控涎丹、神佑丸、滚痰丸、木香
、枳实利膈涤痰，透罗破饮、降气化痰等汤，苏合丸之类，皆形气充实之药也。西北人用之
，或有效验。其属虚弱者，必致肚腹胀满而殁。
又曰∶痰之为病，若热病则多烦热。风痰多成瘫痪奇证，冷痰多成骨痹，湿痰多怠惰软
弱，惊痰多成心痛癫疾，饮痰多胁痛臂痛，食积痰多成癖块痞满，其为病种种难名。窃谓前
证若因肾水虚弱，阴亏难降，使邪水上溢，故多痰唾。宜滋其化源，其痰自消。若因肝木侮
脾土，而风痰壅滞者，先用南星、半夏清其痰，后用六君子之类调胃气，痰自不至。若概用
风药，耗其阳气，而绝阴血之源，适足以成其风，益其病也。
又曰∶若因脾气亏损，痰客中焦，闭塞清道，以致四肢百骸发为诸病者，理宜壮脾气为
主，兼佐以治痰，则中气健而痰涎自化。若倒仓之后而痰反甚，此脾气愈虚，则津液反为痰
者，理宜补中益气。非参术二陈之类不能治，最忌行气化痰及倒仓之法。
徐东皋曰∶严氏云∶人之气顺则津液通流，决无痰患。古方治痰，多用汗下温利之法，
不若以顺气为先，分导次之。气顺则津液流通，痰饮运下，自小便中出矣。此则严氏亦有所
见而云然也。《玉机微义》云∶顺气特一法耳，要观痰之深浅，有痰积胶固，气道因之而不
得顺，宜先逐去积痰。然后气可得顺。岂可专主理气一法？愚谓有理气而痰自顺者，治其微
也。有逐痰而气方畅者，治其甚也。二者皆治痰之要也，不可偏废者也。但看痰与气孰轻而
孰重，施治有可急而可缓，故曰逐痰理气，有所先后。
庞安常说：有阴液不足，导致阴火上升，肺受到火邪侵害，无法清肃下行，因此津液凝结浑浊，生成痰而不是生成血。这种情况应当使用润剂，如麦门冬、地黄、枸杞这类药物来滋养阴液，使上逆的虚火得以回归本位（肾），那么痰自然就会清除。如果误用二陈汤（燥湿化痰方剂），立刻就会见到危险。还有肾虚不能纳气归元，气只出而不纳则积聚，积聚不散则生成痰，这种情况用八味丸主治。
许学士用苍术治疗痰形成窠囊（痰结聚成巢穴状），效果极好。痰挟带瘀血，于是形成了窠囊。
朱丹溪说：脾虚的人，适宜清利中焦之气以运化痰浊并使其降下，可用二陈汤加白术之类，同时配合升麻提升清气。二陈汤能治理全身之痰。如果要让痰下行，加入引药引导其下行；如果在上部，加入引药引导其上行。凡是人身上下中有肿块的多是痰，询问其平日喜好吃什么食物，先用吐法或下法处理后，再用药调理。
王节斋说：痰生于脾胃，适宜健脾燥湿。又随气机上升，适宜先顺气，其次分消导滞。气机上升属于火，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，食痰则消食，在上部的用吐法，在中部的用下法。另外中气虚的人，适宜固护中气以运化痰。如果攻伐太重，则胃气虚弱而痰更加严重。
薛立斋说：凡是痰证出现饮食减少、胸膈不适的，这是中气虚弱，适宜以补中益气为主，中气既已强健，痰自然运化。如果是肾气亏损，津液难以下降，败浊之物化为痰，这是真脏病，适宜以六味地黄丸为主。肾气既已强壮，津液清化，哪里还会有痰呢？也有因为脾胃亏损，中焦气虚，不能运化而生成痰的；也有因为峻烈药物过度使用，脾气更虚，不能运化津液，凝滞而成痰的，凡此情况都应当以健脾胃为主。
又说：痰，是脾胃的津液，或者被饮食所伤，或者被七情六淫所扰，所以气壅痰聚。脾是统血行气的经络，气血俱盛，哪里有痰？都是因为思虑过度与饮食所伤，损伤了经络，脾血既已虚弱，胃气独盛，因此湿气因气化异常，所以多痰。痰游行周身，无所不到，痰气既盛，客邪必胜主气，如果夺取脾之大络的气，则突然仆倒在地，这叫痰厥。痰升于肺，则喘急咳嗽。痰迷于心，则心悸恍惚。痰走于肝，则眩晕麻木，胁肋胀痛。涉及肾，不咳而多痰唾。留在胃脘，则呕吐腹泻且寒热交替。注入胸中，则咽痛不利，眉棱骨痛。进入肠中，则漉漉有声，散则有声，聚则不通畅。如果脾气虚弱，不能消除湿气，适宜用补中益气汤加茯苓、半夏。如果因为脾气虚弱，湿热所致，适宜用东垣清燥汤。如果胃气虚弱，寒痰凝滞者，适宜用人参理中汤。如果脾胃虚寒而痰凝滞者，适宜用理中化痰丸。如果脾虚不能运化，而痰滞气逆，适宜用六君子汤加木香。如果脾胃虚弱而肝木乘侮（克制），适宜用六君子汤加柴胡。如果肺气虚弱，不能清化而有痰者，适宜用六君子汤加桔梗。头痛，适宜用半夏白术天麻汤。如果脾肾虚弱，寒邪侵袭，以致头痛，适宜用附子细辛汤。
又说：凡是治疗风痰，如果肺经风热而生痰者，适宜用金沸草散。如果风火相搏，肝经风热炽盛而生痰者，适宜用牛黄抱龙丸，或牛黄清心丸。如果肝经血燥而生痰者，适宜用六味地黄丸。如果热盛制约肺金，不能平抑肝木而生痰者，适宜用柴胡栀子散。如果中气虚弱，不能运化而生痰者，适宜用六君子汤加柴胡、钩藤。如果肾虚阴火炎上，适宜用六味地黄丸。
又说：凡是治疗痰结，有因脾经郁结而伤阴血的，有因肾水亏损而阴火上炎的，有因脾肺火郁而生痰的。治疗方法：如果因七情郁结，痰涎滞于喉间者，先用《局方》四七汤调和滞气，后用归脾汤调补脾血。脾火伤血，用加味归脾汤。肾水亏损，用六味地黄丸。肺经郁火，用知母茯苓汤。如果妇人患此症且兼带下，皆由郁结伤损肝脾，当佐以四七汤，送服青州白丸子。这些证候，属脾胃气虚为本，而气滞痰结为标。古方用十枣汤、控涎丹、神佑丸、滚痰丸、木香、枳实利膈涤痰，透罗破饮、降气化痰等汤剂，苏合丸之类，都是针对形体元气充实者的药物。西北人使用，或许有效验。那些属于虚弱体质的人，必定会导致肚腹胀满而死。
又说：痰作为疾病，如果是热病则多烦热。风痰多形成瘫痪奇证，冷痰多形成骨痹，湿痰多怠惰软弱，惊痰多形成心痛癫疾，饮痰多胁痛臂痛，食积痰多形成癖块痞满，其病症种种难以名状。我认为前述证候如果因肾水虚弱，阴亏难降，使邪水上溢，所以多痰唾。适宜滋生化之源，痰自然消除。如果因肝木侮脾土，而风痰壅滞者，先用南星、半夏清其痰，后用六君子汤之类调胃气，痰自然不再产生。如果一概用风药，耗损阳气，断绝阴血之源，恰好足以造成风证，加重病情。
又说：如果因脾气亏损，痰客居中焦，闭塞清道，以致四肢百骸发为各种疾病，理应壮脾气为主，兼佐以治痰，则中气健旺而痰涎自然化解。如果在倒仓法（一种催吐泻下的疗法）之后痰反而增多，这是脾气更虚，津液反化为痰，理应补中益气。非人参、白术、二陈汤之类不能治疗，最忌行气化痰及倒仓之法。
徐东皋说：严氏说：人的气顺则津液通流，决无痰患。古方治痰，多用汗、下、温、利的方法，不如以顺气为先，分消导滞次之。气顺则津液流通，痰饮运化下行，自然从小便排出。这则是严氏也有见解才这样说。《玉机微义》说：顺气只是一种方法，要看痰的深浅，如果有痰积胶固，气道因此不得顺畅，适宜先驱逐去除积痰。然后气才可顺畅。岂可专门主张理气这一种方法？我认为有理气而痰自顺的，是治疗轻微的；有逐痰而气才通畅的，是治疗严重的。两者都是治痰的要法，不可偏废。只看痰与气哪个轻哪个重，施治有可急可缓，所以说逐痰理气，有所先后。
Pang Anchang stated: There are cases of insufficient Yin fluid, leading to the ascent of deficient fire (Yin fire), where the Lung is affected by fire pathogenic factors and cannot descend clearly and turbidly. Consequently, body fluids coagulate and become turbid, generating phlegm instead of blood. In such cases, moistening agents such as Ophiopogonis Radix (Maidong, 麦冬), Rehmanniae Radix (Dihuang, 地黄), and Lycii Fructus (Gouqi, 枸杞) should be used to nourish Yin, allowing the ascending deficient fire to return to its residence (the Kidney), after which the phlegm will clear naturally. Administering Er Chen Tang (Two-Cured Decoction) would immediately lead to danger. Additionally, when Kidney deficiency fails to grasp Qi and return it to its origin, Qi exits but is not grasped, leading to accumulation; if this accumulation does not dissipate, phlegm is generated. This condition is primarily treated with Ba Wei Wan (Eight-Ingredient Pill).
Wu Jiaoshan, in *Zhu Zheng Bian Yi* (Differentiation of Doubts Regarding Various Syndromes), stated that Ba Wei Wan treats the root cause of phlegm.
Xu Xueshi used Rhizoma Atractylodis Macrocephalae (Cangzhu, 苍术) to treat phlegm forming "cocoons" (phlegm nodules), achieving excellent results. Phlegm combined with blood stasis forms these cocoons.
Zhu Danxi said: For those with Spleen deficiency, it is appropriate to clear and regulate Middle Jiao Qi to transport and descend phlegm. Er Chen Tang can be modified with Atractylodis Rhizoma (Baizhu, 白术), combined with Cimicifugae Rhizoma (Shengma, 升麻) to lift Qi. Er Chen Tang governs the treatment of phlegm throughout the body. To guide phlegm downward, add guiding herbs for descent; for phlegm located superiorly, add guiding herbs for ascent. Generally, masses found anywhere in the body are mostly due to phlegm. One should inquire about dietary preferences, first apply emetic or purgative methods, and then administer medication.
Wang Jiezhai said: Phlegm originates from the Spleen and Stomach; thus, strengthening the Spleen and drying dampness is suitable. Since phlegm ascends with Qi, regulating Qi should come first, followed by differentiation and drainage. Ascending Qi belongs to Fire; therefore, regulating Qi involves descending Fire. Heat-phlegm requires clearing heat; damp-phlegm requires drying dampness; wind-phlegm requires dispersing; stagnant-phlegm requires opening stagnation; stubborn-phlegm requires softening; food-stagnation-phlegm requires digestion; phlegm located superiorly is treated with emesis; phlegm located centrally is treated with purgation. Furthermore, for those with deficient Middle Qi, securing Middle Qi to transport phlegm is appropriate. If attack methods are too harsh, Stomach Qi becomes deficient, and phlegm worsens.
Xue Lizhai said: In any phlegm syndrome characterized by poor appetite or chest/diaphragm discomfort, this indicates deficiency of Middle Qi. Treatment should focus on Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction); once Middle Qi is robust, phlegm will naturally transform. If Kidney Qi is deficient, causing body fluids to fail to descend and turning into turbid waste-phlegm, this is a disease of the True Zang organs, primarily treated with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). Once Kidney Qi is strong and body fluids are clear and transformed, how could there be phlegm? There are also cases where Spleen and Stomach damage leads to Middle Jiao Qi deficiency, failing to transform fluids into phlegm; or cases where excessive use of harsh drugs further damages Spleen Qi, preventing fluid transformation and causing stagnation-phlegm. All such cases require strengthening the Spleen and Stomach as the primary approach.
He further stated: Phlegm is essentially the body fluids of the Spleen and Stomach. It may be injured by diet or disturbed by the Seven Emotions and Six Exogenous Pathogens, leading to Qi obstruction and phlegm aggregation. The Spleen is the meridian governing blood and moving Qi; if Qi and Blood are abundant, where would phlegm come from? It arises from excessive thinking and dietary injury damaging meridians. When Spleen Blood is deficient, Stomach Qi becomes relatively hyperactive, causing dampness to transform abnormally, resulting in much phlegm. Phlegm travels throughout the body without exception. When phlegm-Qi is excessive, the pathogen overcomes the healthy Qi. If it attacks the large collaterals of the Spleen, sudden collapse occurs, known as Phlegm Syncope (Tan Jue). If it ascends to the Lung, it causes wheezing and cough. If it confuses the Heart, it causes palpitations and mental confusion. If it moves to the Liver, it causes dizziness, numbness, and hypochondriac distension/pain. If it affects the Kidney, one expects no cough but excessive sputum. If it remains in the Stomach, it causes vomiting, diarrhea, and alternating chills/fever. If it enters the Chest, it causes sore throat and pain in the supraorbital ridge. If it enters the Intestines, it produces gurgling sounds; dispersed it makes noise, aggregated it causes obstruction. If Spleen Qi is weak and cannot resolve dampness, use Bu Zhong Yi Qi Tang plus Poria (Fuling, 茯苓) and Pinelliae Tuber (Banxia, 半夏). If caused by Spleen Qi weakness with damp-heat, use Dongyuan Qing Zao Tang (Clear Dryness Decoction). If Stomach Qi is weak with cold-phlegm stagnation, use Renshen Lizhong Tang (Ginseng Regulate the Middle Decoction). If Spleen-Stomach deficiency-cold with phlegm stagnation, use Lizhong Huatan Wan (Regulate the Middle Phlegm-Resolving Pill). If Spleen deficiency fails to transport, leading to phlegm stagnation and Qi rebellion, use Liu Jun Zi Tang (Six-Gentlemen Decoction) plus Aucklandiae Radix (Muxiang, 木香). If Spleen-Stomach weakness allows Liver Wood to invade, use Liu Jun Zi Tang plus Bupleuri Radix (Chaihu, 柴胡). If Lung Qi is weak and cannot clear/transform, causing phlegm, use Liu Jun Zi Tang plus Platycodonis Radix (Jiegeng, 桔梗). For headache, use Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction). If headache is due to Spleen-Kidney weakness and cold pathogen invasion, use Fuzi Xixin Tang (Aconite and Asarum Decoction).
He further stated: When treating wind-phlegm, if caused by Wind-Heat in the Lung Meridian, use Jin Fei Cao San (Boilweed Powder). If Wind-Fire clash with blazing Wind-Heat in the Liver Meridian, use Niuhuang Baolong Wan (Calculus Bovis Protecting Dragon Pill) or Niuhuang Qingxin Wan (Calculus Bovis Clearing Heart Pill). If caused by Liver Blood dryness, use Liu Wei Di Huang Wan. If Excess Heat restricts Metal (Lung), failing to control Wood (Liver), use Chaihu Zhizi San (Bupleurum and Gardenia Powder). If Middle Qi is weak and fails to transform, use Liu Jun Zi Tang modified with Chaihu and Uncariae Ramulus cum Uncis (Gouteng, 钩藤). If Kidney deficiency causes deficient fire to flare upward, use Liu Wei Di Huang Wan.
He further stated: Regarding phlegm nodules, causes include Spleen Meridian stagnation injuring Yin/Blood, Kidney Water deficiency causing deficient fire to flare, or Spleen-Lung Fire stagnation generating phlegm. Treatment methods: If caused by emotional stagnation with phlegm saliva stuck in the throat, first use Si Qi Tang (Four-Seven Decoction) from *Ju Fang* to harmonize stagnant Qi, then use Guipi Tang (Restore the Spleen Decoction) to tonify Spleen Blood. If Spleen Fire injures blood, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction). For Kidney Water deficiency, use Liu Wei Di Huang Wan. For Lung Meridian stagnant fire, use Zhimu Fuling Tang (Anemarrhena and Poria Decoction). If women suffer this with leukorrhea, it is due to stagnation injuring Liver-Spleen; assist with Si Qi Tang administered with Qingzhou Bai Wanzi (Qingzhou White Pills). These syndromes have Spleen-Stomach Qi deficiency as the root and Qi stagnation/phlegm nodulation as the branch. Ancient formulas like Shizao Tang (Ten Jujube Decoction), Kongxian Dan (Drain Fluid Pellet), Shenyou Wan (Divine Protection Pill), Guntan Wan (Rolling Phlegm Pill), along with herbs like Aucklandiae Radix and Immature Bitter Orange, aim to clear diaphragm and wash out phlegm, break fluid retention, descend Qi, and resolve phlegm, similar to Suhexiang Wan (Styrax Pill). These are medicines for patients with substantial constitution. People in the Northwest may find them effective. However, for those who are deficient, they will inevitably die from abdominal distension.
He further stated: As a disease, phlegm manifests differently: Heat-phlegm often causes irritability and heat; Wind-phlegm often leads to paralysis and strange syndromes; Cold-phlegm often leads to bone bi (painful obstruction); Damp-phlegm often causes lethargy and weakness; Shock-phlegm often causes heart pain and epilepsy; Drink-phlegm often causes hypochondriac and arm pain; Food-stagnation-phlegm often creates masses and fullness. The manifestations are numerous and hard to name. I believe that if the aforementioned syndromes are due to Kidney Water deficiency and Yin insufficiency failing to descend, causing evil water to overflow, resulting in excessive sputum, one should nourish the source of transformation, and the phlegm will vanish. If due to Liver Wood insulting Spleen Earth with wind-phlegm congestion, first use Arisaematis Rhizoma (Nanxing, 南星) and Pinelliae Tuber to clear phlegm, then use Liu Jun Zi Tang to regulate Stomach Qi, and phlegm will not recur. If one indiscriminately uses Wind-dispersing herbs, depleting Yang Qi and cutting off the source of Yin Blood, it merely creates more wind and aggravates the disease.
He further stated: If Spleen Qi is damaged, with phlegm residing in the Middle Jiao, blocking the clear pathways, causing diseases in the limbs and bones, the proper approach is to strengthen Spleen Qi primarily, assisting with phlegm-resolving methods, so that robust Middle Qi transforms phlegm naturally. If phlegm increases after Dao Cang therapy (a drastic vomiting/purging method), it indicates further Spleen Qi deficiency where fluids turn to phlegm; the correct approach is Bu Zhong Yi Qi Tang. Only Ginseng, Atractylodes, and Er Chen Tang can treat this; one must strictly avoid Qi-regulating/phlegm-resolving herbs and Dao Cang methods.
Xu Donggao said: Yan Shi stated: When human Qi is smooth, body fluids flow freely, and there is absolutely no phlegm. Ancient prescriptions for phlegm often used sweating, purging, warming, and draining methods. It is better to prioritize regulating Qi, followed by differentiation and drainage. When Qi is smooth, body fluids circulate, and phlegm-drink transforms and descends, exiting via urine. Yan Shi had insight to say this. *Yuji Wei Yi* states: Regulating Qi is only one method; one must observe the depth of phlegm. If phlegm accumulation is sticky and fixed, obstructing Qi flow, one should first expel the accumulated phlegm before Qi can become smooth. How can one solely advocate Qi regulation? I hold that when regulating Qi leads to spontaneous phlegm resolution, it treats mild cases. When expelling phlegm leads to smooth Qi, it treats severe cases. Both are essential treatments for phlegm and cannot be neglected. One must judge whether phlegm or Qi is heavier or lighter, applying urgent or slow treatments accordingly. Thus, expelling phlegm and regulating Qi have a specific sequence.