痰古作淡，淡、澹通，澹水动也，故水走肠间，名为淡饮。今之痰者，古之云涕云唾云涎云沫是也。或称
为饮，如膈间支饮是也。痰字训为胸上液者，实非仲景之旨，然遂为千古之定名，顾鲜能知其义之异者，吾故
表而出之。
源候总说 人之有痰饮病者，由荣卫不清，气血败浊，凝结而成也。内则七情 乱，藏气不行，郁而
生涎，涎结为饮，为内所因。外有六淫侵冒，玄府不通，当汗不泄，蓄而为饮，为外所因。或饮食过伤，嗜欲
无度，叫呼疲极，运动失宜，津液不行，聚为痰饮，属不内外因。三因所成，证状非一，或为喘，或为咳为呕
为泄，晕眩嘈烦，松悸 KT ，寒热疼痛，肿满挛僻，癃闭痞膈，如疯如癫，未有不由痰饮之所致也。（《三
因》）
外所因证候难明，风燥寒凝，暑烁湿滞，皆能闭诸络，郁而生涎，不待饮水流入四肢，而致支溢疼痛也。
当以理推，无胶轨辙。（同上）
其或喜怒哀乐不中节，起居食饮失其常，皆令荣卫痞阻，气血败浊，为痰为涎为饮，诸证生焉。结伏于焦
膈，则眩晕懵忪，仲悸 KT ，癃闭痞膈，喘嗽气急。停滞于关节，则筋脉挛急，肢节疼痛，手足 曳，寒热
往来。三者同源而异治。痰则伏于包络，随气上浮，客于肺经，因嗽而发。涎则伏于
脾元，随气上溢，口角流出。唯饮则生于胃腑，为呕为吐，宜详甄别也。（《简易》）
惟气与血，能生诸病，痰亦如之。夫痰者，津液之异名，人之所恃以润养肢体者也。血气和平，关络条畅，
则痰散而无。气脉闭塞，脘窍凝滞，则痰聚而有。痰之所以发动者，岂无自而然哉。风搏寒凝，暑烦湿滞，以
至诸热蒸郁，啖食生冷煎爆，腥 咸鹾，动风发气等辈，皆能致痰也。是痰作恙，为喘为嗽，为壅为呕，为眩
晕，为风痫，为狂迷，为忪悸，或吞酸，或短气，或痞膈，或肿胀，或寒热，或疼痛，痰实主之。（《直指》）
人身之痰，如长流水，贵乎顺行，又赖土为之堤防，偶为风所逆，或为物所壅滞，则使有声，可以过颡。
故痰之为病，或由脾土虚弱，不能摄养金肺，或为四气七情所干，气壅痰聚，发而为喘为咳。（《大成》）
若因六阴伤胃，以致玄府不通，当汗不汗，蓄而成痰，乃外因也。使津液不得舒布，凝聚而成痰者，乃内
因也。（《原理》）
痰因气滞生 （寒热二因）人之一身，无非血气周流，痰亦随之。夫痰者，津液之异名。流行于上者，
为痰饮；散周于下者，为精液。其所以使之流行于上下者，亦气使之然耳。大抵气滞则痰滞，气行则痰行，故
三生饮佐之以木香，无有不效。人之气道贵乎顺，顺则津液流通，决无痰饮之患。一失其宜，则气道闭塞，停
饮聚于膈上，结而成痰。（《朱氏》）
庞安常云∶人身无倒上之痰，天下无逆流之水（按∶今庞书中无所考，史载之有此语，见于后）。诚哉斯
言，以此思之，人之气道贵乎顺，顺则津液流通，决无痰饮之患。调
摄失宜，气道闭塞，水饮停于胸腑，结而成痰。（《济生》）
古人有云∶身无倒上之痰，世无逆流之水。斯固然也，愚见以为末然。水无逆流，言其势也；痰无倒上，
尚有推详。且人呼吸出入者，阴阳也。血气循环，随经上下，则津液流通，决无痰饮之患。故使将理失宜，七
情气乱，阴阳失理，郁于经络，气升而不降，痰涎壅滞，随气而升，结于胸膈，上逼咽喉，为呕为哕为吐，岂
非倒上也。甚则风痰壅上，喉声如曳锯，精神昏愦，至此药则罔功，此又非寻常痰之比也。（《治病活法秘方》）
痰本吾身之津液，随气营运。气若和平，津液流布，百骸受其润泽，何致成痰为病。苟气失其清肃而过于
热，则津液受火煎熬，转为稠浊，或气失其温和而过于寒，则津液因寒积滞，渐致凝结，斯痰成矣。故痰一也
，而因寒因热，其源不同，可概治欤。（《医碥》）
痰因热成 痰者，水也，标也；火者，热也，本也。自世人不明标本之理而曰痰火，却以痰能生火，
而不知火能生痰也。譬诸釜中之水，无火之时，清清冷冷，湛然无滓；火一举之，则湛然者皆为白沫矣。人身
无病，则津液澄清；若一病焉，则血气不和，不和则经络壅塞而生热，热则津液之澄清者，亦随热混浊而成痰
矣，岂非火热生痰之谓乎。若曰热痰则可，谓之痰火则非矣。（《儒医精要》）
《玉机微义》云∶痰之为病诚多也。何则？人之血气流行，无一息之间断，才有壅滞，津液凝积，郁而成
热，痰遂生焉（按∶今《微义》文止此）。因证而观，痰则火之变出也，未有痰病而不因火而成者也。间有寒
痰为病者，亦千百中之一二也。甫谓寒痰之说非也，饮则有寒有热不同，痰则一因于热而已，加之寒字不得。
所以痰脉多滑大，明知停冷
成痰，亦遂郁而为热，药惟以橘皮、半夏、神曲之辛，以散之行之，亦不敢用热药也。陈无择云饮脉多沉弦微
细，始可以言寒，治以理中、二陈之属是也。性理所谓有温泉而无寒火，不其然欤。（《医统》）
其由有三 夫痰之生也，其由非一，其为治也，药亦不同。由于阴虚火炎，上迫乎肺，肺气热则煎熬
津液，凝结为痰，是谓阴虚痰火，痰在乎肺而本乎肾，治宜降气清热、益阴滋水法。忌辛温燥热补气等药。
由于脾胃寒湿生痰，或兼饮啖过度，好食油面猪脂，以致脾气不和，壅滞为痰，浓浓胶固，甚至流于经络及皮
里膜外，或结为大块，或不思食，或彻夜不眠，或卒尔眩仆，不知人事，或发癫痫，或昔肥今瘦，或叫呼异常，
或身重腹胀，不便行走，或泄泻不止，及成瘫痪，种种怪证，皆痰所为。故昔人云∶怪病多属痰，暴病多属火。
有以夫。此病在脾胃，无关肺肾，治宜燥脾行气、散结软坚法，忌滞泥苦寒湿润等药及诸浓味。由于风寒
郁闭，热气在肺，而成痰嗽 喘，病亦在肺，治宜豁痰除肺热药中，加辛热、辛温如麻黄、生干姜之属，以散
外寒，则药无格拒之患，法忌温补酸收等药。病因不齐，药亦宜异，利润利燥及利发散，各有攸当，非可混施
也。（《本草经疏》）
涎有六种 论曰∶舟非水不行，然波涛沸溢，则覆舟之患生；人非气不活，然痰涎并积，则倾人之患
至。波涛非自生也，其所以生者，不平之势作之也；痰涎非自积也，其所以积者，不顺之气留之也。故善行舟
者，不惧波涛，而惧舟之不完；善摄生者，不惧痰涎，而惧气之不顺。故世人之疾病，其所以残伤性命之急者，
无甚于痰涎；而世之医者，乃有见之而不能识，或有识之而不能治。此不幸之人，其残伤夭横者，不可胜数。
何则？举天下之人，独知风气之有涎，不
知脏腑冷亦生涎，热亦生涎，痰涎一生，千变万化，而病之所起，非特一端，愚今略举数端明之。后之学人，
于诊疗之际，类而推之，亦庶几其疾病之徒无夭横者矣。夫涎之为名一也，而具数种∶一曰风涎，二曰热涎，
三曰冷涎，四曰病涎，五曰虚涎，六曰毒涎。其一曰风涎，盖因人之风气之盛，上运于涎，不能下入于胃，风
气一蒸，痰涎并起而上，填塞胸中，即使人闷倒无知。其风气久而不顺，性命之倾危，速如反掌。若其风气未
盛，逡巡之间，仍复自顺，其涎亦随气而下，即平复如故。此盖人之肌肉浓，腠理深，风不得泄于外，风热内
攻，大府秘热，毒瓦斯上攻，遂生斯疾，此名之曰风涎。然风涎之为名一也，而入脏腑虚实之不同，则涎之为病
也，变化不一，愚得以即其变而言之。若今人之病大府实热，痰涎满口，吐如清胶，胸中喘息如常，但汤水饮
食俱不可进，凡所饮食，只到喉中，即不能下，用力咽下，即喉中隔绝，喘急闷倒，良久方愈，惟进得些小稠
粥，此亦风涎之候也。然风涎之候变不同，则当如何而治之？曰∶善除荆棘者，先断其根；善治风疾者，先顺
其气。人身无倒上之涎，天下无逆流之水。今风疾一上，而填塞胸中，倾人性命者，风气运而上也。今之治风
涎者，多使天南星、半夏之类，是不知病之源流，去荆棘而不除其根也。苟能以药先顺其风气，兼发其腠理，
使其风气得以发泄于外，顺行于内，则其胸中之痰涎，自随气而下，未吃涎药而痰涎自顺矣。然病势之有轻重
，则取之有缓急。若风气炎盛，胶涎并起，其气卒难以顺之者，当制之以急，非吐之不可；风气未极，痰涎未
并，为害未深者，当制之以缓，先顺其气而后治其涎也，此亦治涎之大约也。然风涎之候，又有冷热不同。或
有寒风所中，冷涎所聚，其人必先于半年或数月前，吃食减
少，身体沉重，筋脉痿弱，才见肉味，便觉恶心，非时口中一两点冷涎出，身不自觉，冷涎所并，忽闷倒不知
人事，良久复苏，即生麻痹，或生 曳，或失音不语，冷涎所积，少有上并，多聚中焦，盈溢胸中，包裹心络，
能使人狂言妄语，神识不定，非特不觉，手臂忽自举动，如此为冷涎之所中也。治之法，先以温暖之药，散其
冷毒之气，急以热药，发其腠理，然后以治涎之药，取下其涎，虽且暂安，而寒风所中于人，亦甚不久。何则？
热风中人，如天地春夏之风，长含生气，以养万物，其人虽病难死，此古人所谓风所以能养人也；寒风所中于
人，如天地秋冬之风，长含杀气，以肃杀万物，其人所中非久必死，此古人所谓风所以能害人也。其二曰热涎，
若今有恣性之丈夫，多食荤腻，好食咸酸，以色为心，恣贪补药，忽因酗酒房室，劳伤其精，丹元髓海，因以
空虚，而脏腑骨槽，虚热转盛，其涎所积，隔在中焦，因其肾脏之虚寒，邪气与热涎相交，发为疼痛，重则不
移时而倾人性命。医者治之，不过曰此肝肾之气，是不知热涎乃病之根本。然京三棱、蓬莪术非不能治气，而
世人用而不验者，不识其病之源流也。善为医者，临事制宜，随机应变，审当轻重，涎多者吐之，涎少者下之，
所用之药，偏取肝家之风毒，又何患乎人之不安哉。三曰冷涎者，若今人之肝脏有余，脾气不足，忽因使性，
长怀郁怒，伤损肝心正气，此冷涎之所以积也。脾气不足，复因肝气所乘，伏而不动，停水滞谷，久而不化，
肝心长怀郁怒，则其气滞涩而不行，此冷涎之所以积也。然肝主风性之不定，忽时而作。肝主怒，怒则气逆，
此冷涎所以随气而上，而生人之大病也。证其候而言之。则其病必先觉心前溃乱不快，相次闻有一物，随气
而上触，至咽喉即闷倒不知人事，手足肌肉渐次寒冷，逡巡复
平愈。治之之法，当以吐药取之，得其所取之涎，其清如水，其冷如雪。取涎之后，更审其藏气，随其所病而
调和之，亦无患乎药之不验也。四曰病涎，其人必好食坚硬之物，伤损脾气，忽因郁怒，伤损心肝正气，忽因
寒邪热毒之伤，忽因大病之后，余毒客在脏腑，其气结涩凝滞，不能宣畅，是以痰涎因而聚积，涎与滞气相交，
往往发为疼痛，此名之为病涎者也。明其病证，在心前痛，轻则连年累月，痛无暂停，重则倾人性命，速如反
掌，重轻之殊，涎之多少也。治之之法，当在量其病势轻重，以利药取之，轻则其涎如油，重则其凝如白胶。
取涎之后，然后使药，清其藏气，益其正气，使之平复如故也。五曰虚涎，其人必因受气之虚，忽因大病之后，
生冷所伤，忽因疾病之间，淫欲不节，致令脏腑之气空虚羸乏，而骨槽之间虚热上蒸，上气镇长有余，下气但
常不足，阴阳之气不相交际，不顺之气隔在中焦，是以虚涎因而积裹，风热一攻，即其涎并上。初发作时，先
觉清涎满口，渐闻心前有一物，上触咽喉，即喉中急促，闷倒不觉，两手相乱把拽，风气极上，即头上痒，忽
皮脐间痛，逡巡风气顺下，乃遂平复。治之之法，当以临发时，使五分利药取之，以其胃气不足，不可十分利
吐也。若利吐不出，非时以坏风涎药搅之，候分数稍减，即于气海上安之一灸，引其涎下入于胃，然后使药调
其藏气，酌量其脏腑之虚实，有余者泻，不足者补，令上下之气相等，可庶几其全安也。若脉气微细，大府虚
冷，减其肝气，益其胃气斯可矣。若小儿得病者，全是胃气之虚，气海上安灸，补暖脾胃，以愈斯痰，仍不辄
吃取风涎药也。六曰毒涎，若今人之患阳毒伤寒，肝心脾肺受其疫毒之气，因其毒涎相积聚在中，候其证，即
使人大府秘热，小便赤涩，面色黯赤，浑身发热，昏昏如醉，狂言妄
语，不知人事，如此之候悉皆是涎。诊其脉气又却沉伏，重手取之骨间乃得，此乃疫毒之涎，盈溢心胸，伏其
脉气，非脉气之与病相反者也，此所谓毒涎者矣。治之之法，急以疏转之药，取其毒瓦斯，荡下其涎，所下之药
须心肝脾肺四脏俱治，然当以肝脏为主，偏下肝脏之药为要也。虽然，涎之为病，千变万化，其状不一，是今
之所举数端，止其大略而已。后之学人，类而推之，加以识见之明，而诊疗无瘥，亦无患乎涎为人之大患者矣。
（《史载之方》）
痰，古时写作“淡”，“淡”与“澹”通用，“澹”意为水波动荡，因此水液在肠间流动，被称为“淡饮”。现在的“痰”，在古代分别称为涕、唾、涎、沫。有时也称为“饮”，如膈间支饮即是。将“痰”解释为胸上之液，实际上并非张仲景的本意，但这已成为千古固定的名称，只是很少有人能知晓其含义的差异，所以我特意阐明这一点。
《诸病源候论》总说：人患有痰饮病，是因为营卫之气不清净，气血败坏浑浊，凝结而成。在内方面，七情（喜、怒、忧、思、悲、恐、惊）扰乱，脏腑之气运行不畅，郁结而生涎，涎凝结成饮，属于内因。在外方面，六淫（风、寒、暑、湿、燥、火）侵袭，汗孔（玄府）不通，应当出汗却未能排出，蓄积而成饮，属于外因。或者饮食过度损伤，嗜欲无度，呼喊疲劳至极，运动不当，导致津液运行不畅，聚集成痰饮，属于不内外因。由这三种原因形成的病症，症状表现不一，有的表现为喘，有的表现为咳、呕、泄，有的出现头晕目眩、心中嘈杂烦闷、惊恐心悸、恶寒发热、疼痛、肿胀、腹部胀满、筋脉拘挛或偏瘫、小便不通、痞塞隔阻，甚至像疯癫一样，没有不是由痰饮所导致的。（出自《三因极一病证方论》）
外因引起的证候难以明确，风燥、寒凝、暑热、湿滞，都能闭塞各种络脉，郁结而生涎，不需要等到饮水流入四肢，就会导致支撑溢出的疼痛。应当通过医理来推究，不要拘泥于固定的模式。（同上）
如果喜怒哀乐不合节度，起居饮食失去常态，都会导致营卫痞塞阻滞，气血败坏浑浊，形成痰、涎、饮，各种病症由此产生。痰伏结在焦膈之间，就会出现眩晕、头昏沉、惊恐心悸、小便不通、痞塞隔阻、气喘咳嗽、呼吸急促。痰停滞在关节，就会出现筋脉拘挛急迫、肢节疼痛、手足牵引无力、寒热往来。这三者同源但治疗方法不同。痰潜伏在心包络，随气上浮，客居于肺经，因咳嗽而发作。涎潜伏在脾元，随气上溢，从口角流出。只有饮产生于胃腑，表现为呕吐，需要详细辨别。（出自《济生方》/《简易》注：此处原文标注《简易》，可能指《仁斋直指方》或相关简易论述，依原文保留）
只有气和血能产生各种疾病，痰也是如此。所谓痰，是津液的异名，是人用来滋润滋养肢体的物质。血气平和，关络通畅，那么痰就会消散而不存在。气脉闭塞，脘窍凝滞，那么痰就会聚集而产生。痰之所以发动，难道是没有原因的吗？风搏结、寒凝滞、暑烦扰、湿停滞，以至于各种热气蒸腾郁结，食用生冷煎炸食物，腥咸腌制品，动风发气等事物，都能导致生痰。因此痰作为疾病，表现为喘、咳、壅塞、呕吐、眩晕、风痫、狂迷、惊恐心悸，或者吞酸、短气、痞塞隔阻、肿胀、寒热、疼痛，这些都是由痰实际主导的。（出自《直指方》）
人身上的痰，就像长流的水，贵在顺行，又依赖土来作为堤防，偶然被风逆冲，或被物体壅滞阻塞，就会发出声音，甚至可以越过咽喉。所以痰作为疾病，有的是因为脾土虚弱，不能摄养肺金，有的是因为四气（风、寒、暑、湿）和七情干扰，气机壅塞、痰液聚集，发作起来表现为喘、咳。（出自《医学大成》）
如果是由于六阴伤胃，导致汗孔不通，应当出汗却不出汗，蓄积而成痰，这是外因。使津液不得舒展布散，凝聚而成痰的，这是内因。（出自《医宗必读》/《原理》注：此处《原理》可能指代某部阐述医理的著作，依原文保留）
痰因气滞而生（涉及寒热两种原因）：人的一身，无非是血气周流，痰也随之流动。所谓痰，是津液的异名。流行在上部的，称为痰饮；散布在下部的，称为精液。使之流行于上下部的，也是气的作用。大致来说，气滞则痰滞，气行则痰行，所以三生饮中佐以木香，没有不有效的。人的气道贵在顺畅，顺畅则津液流通，决不会有痰饮的祸患。一旦失当，气道闭塞，停饮聚积在膈上，凝结而成痰。（出自《朱氏集验方》/《朱氏》）
庞安常说：人身没有倒向上行的痰，天下没有逆流而上的水。（按：如今庞安常书中无法考证，史载有此语，见于后文）。这话确实正确，据此思考，人的气道贵在顺畅，顺畅则津液流通，决不会有痰饮的祸患。调摄失当，气道闭塞，水饮停于胸腑，凝结而成痰。（出自《济生方》）
古人有话说：身上没有倒向上的痰，世上没有逆流的水。这固然正确，但我认为未必完全如此。水没有逆流，说的是水的态势；痰没有倒向上行，还有值得推敲的地方。况且人呼吸出入，属于阴阳范畴。血气循环，随经脉上下，则津液流通，决不会有痰饮的祸患。如果调理失当，七情气乱，阴阳失调，郁结于经络，气升而不降，痰涎壅滞，随气上升，结于胸膈，上逼咽喉，表现为呕吐、呃逆、吐食，这难道不是倒向上行吗？严重时风痰壅盛于上，喉间声音如拉锯，精神昏愦，到了这种地步药物就无效了，这又不是寻常痰症可以相比的。（出自《治病活法秘方》）
痰原本是我们身体的津液，随气营运。如果气平和，津液流布，百骸受到润泽，怎么会形成痰致病呢？假如气失去了清肃而过于热，则津液受火煎熬，转为稠浊；或者气失去了温和而过于寒，则津液因寒积滞，逐渐凝结，这样痰就形成了。所以痰虽然是一种，但因寒或因热，源头不同，可以一概而论治疗吗？（出自《医碥》）
痰因热而成：痰，是水，是标；火，是热，是本。世人不明标本的道理，称之为“痰火”，却认为是痰能生火，而不知道火能生痰。这就好比锅中的水，没有火的时候，清清冷冷，清澈无杂质；火一烧，清澈的就都变成白沫了。人身无病，则津液澄清；一旦生病，则血气不和，不和则经络壅塞而生热，热则津液中澄清的部分，也随热混浊而成痰了，这难道不是火热生痰的意思吗？如果说热痰是可以的，称之为痰火就不对了。（出自《儒门事亲》/《儒医精要》注：此处依原文保留书名）
《玉机微义》说：痰作为疾病确实很多。为什么呢？人的血气流行，没有一刻间断，只要有壅滞，津液凝积，郁结而成热，痰就产生了（按：如今《玉机微义》原文只到这里）。根据证候观察，痰是火的变出物，没有痰病不是因火而成的。偶尔有寒痰为病的，也是千百中的一个两个罢了。刚说寒痰的说法不对，饮则有寒有热不同，痰则完全是因热而已，加上“寒”字是不可以的。所以痰的脉象多滑大，明知是停冷成痰，也会郁结而为热，用药只用橘皮、半夏、神曲的辛味，来发散它、运行它，也不敢用热药。陈无择说饮的脉象多沉弦微细，才可以说是寒，治疗用理中汤、二陈汤之类的。（出自《医统大方脉大全》/《医统》）
痰生成的原因有三：夫痰的产生，原因不止一种，治疗它的药物也不同。由于阴虚火炎，上迫于肺，肺气热则煎熬津液，凝结为痰，这叫阴虚痰火，痰在肺而根本在肾，治疗宜用降气清热、益阴滋水的方法。忌用辛温燥热补气等药。由于脾胃寒湿生痰，或者兼有饮食过度，喜好食用油面猪脂，导致脾气不和，壅滞为痰，浓浓胶固，甚至流于经络及皮里膜外，或者结成大的块状，或者不想吃饭，或者整夜不睡觉，或者突然眩晕跌倒，不知人事，或者发作癫痫，或者以前肥胖现在消瘦，或者叫呼异常，或者身体沉重腹胀，不便行走，或者腹泻不止，以及形成瘫痪，种种怪异的病症，都是痰所为。所以古人说：怪病多属痰，暴病多属火。是有道理的。此病在脾胃，无关肺肾，治疗宜用燥脾行气、散结软坚的方法，忌用滞腻苦寒湿润等药以及各种浓味食物。由于风寒郁闭，热气在肺，而成痰嗽气喘，病也在肺，治疗宜在豁痰除肺热的药物中，加入辛热、辛温如麻黄、生干姜之类的，以发散外寒，则药物没有格拒的祸患，方法忌用温补酸收等药。病因不齐，药物也应不同，利湿、利燥及利发散，各有适当之处，不可以混淆施用。（出自《本草经疏》）
涎有六种：论述说：船没有水不能行驶，然而波涛沸溢，就会产生翻船的祸患；人没有气不能存活，然而痰涎并积，就会产生倾覆生命的祸患。波涛不是自己产生的，之所以产生，是不平的气势造成的；痰涎不是自己积聚的，之所以积聚，是不顺的气停留造成的。所以善于行船的人，不害怕波涛，而害怕船的不坚固；善于养生的人，不害怕痰涎，而害怕气的不顺。所以世人的疾病，那些残伤性命之急切的，没有比得上痰涎的；而世上的医生，有的看见了却不能识别，有的识别了却不能治疗。这些不幸的人，残伤夭折横死的，不可胜数。为什么呢？举天下的人，只知道风气中有涎，不知道脏腑冷也生涎，热也生涎，痰涎一生，千变万化，而疾病的起因，不仅仅是一个方面，我如今略举几端来阐明它。后来的学人，在诊疗之际，分类推究，也许可以使疾病徒劳而无夭折横死的情况吧。所谓涎的名称虽然一样，但具备几种：一是风涎，二是热涎，三是冷涎，四是病涎，五是虚涎，六是毒涎。其一曰风涎，大概是因为人的风气旺盛，上行运于涎，不能下入于胃，风气一蒸腾，痰涎并起而上，填塞胸中，即使人闷倒无知。如果风气久而不顺，性命的倾危，快如反掌。如果风气未盛，片刻之间，仍然恢复自顺，其涎也随气而下，即平复如故。这大概是人的肌肉厚密，腠理深密，风不得发泄于外，风热内攻，大肠秘热，毒瓦斯上攻，遂生此疾，这名叫风涎。然而风涎作为一个名称，而入脏腑虚实的不同，则涎作为疾病，变化不一，我可以就其变化来说明。如果今人患大肠实热，痰涎满口，吐出如清胶，胸中喘息如常，只是汤水饮食都不能进，凡所饮食，只到喉中，就不能下咽，用力咽下，喉中就隔绝，喘急闷倒，很久才痊愈，只能进得少量稠粥，这也是风涎的证候。然而风涎的证候变化不同，那么应当如何治疗呢？回答说：善于清除荆棘的人，先断其根；善于治疗风疾的人，先顺其气。人身没有倒向上的涎，天下没有逆流的水。现在风疾一上，而填塞胸中，倾覆人性命的，是风气运而上行。现在治疗风涎的人，多用天南星、半夏之类，这是不知道病的源流，去荆棘而不除其根。如果能用药物先顺其风气，兼发其腠理，使其风气得以发泄于外，顺行于内，则其胸中的痰涎，自然随气而下，还没吃治涎的药而痰涎自顺了。然而病势有轻重，取法有缓急。如果风气炎盛，胶涎并起，其气突然难以顺之的，应当紧急制之，非催吐不可；风气未极，痰涎未并，为害未深的，应当缓慢制之，先顺其气而后治其涎，这也是治涎的大概原则。然而风涎的证候，又有冷热不同。或者有寒风所中，冷涎所聚，其人必定在半年或数月前，吃东西减少，身体沉重，筋脉痿弱，才见到肉味，就觉得恶心，不时口中有一点两点冷涎流出，身体不自觉，冷涎所并，忽然闷倒不知人事，很久复苏，就产生麻痹，或者产生牵引无力，或者失音不语，冷涎所积，少有上并，多聚在中焦，盈溢胸中，包裹心络，能使人狂言妄语，神识不定，不仅不觉，手臂忽然自己举动，这就是冷涎所中。治疗的方法，先用温暖的药物，散其冷毒之气，急用热药，发其腠理，然后用治涎的药物，取下其涎，虽然暂时安定，而寒风所中人，也不很久。为什么呢？热风中人，如天地春夏之风，长含生气，以养育万物，其人虽病难死，这是古人所谓风能养人；寒风所中人，如天地秋冬之风，长含杀气，以肃杀万物，其人所中不久必死，这是古人所谓风能害人。其二曰热涎，如果今有放纵性情的丈夫，多吃荤腻，喜好咸酸，以色为心，恣意贪服补药，忽然因酗酒房事，劳伤其精，丹元髓海，因此空虚，而脏腑骨槽，虚热转盛，其涎所积，隔在中焦，因其肾脏的虚寒，邪气与热涎相交，发作疼痛，重则不到一时辰就倾覆人命。医生治疗他，不过说这是肝肾之气，这是不知道热涎乃是病的根本。然而京三棱、蓬莪术并非不能治气，而世人使用而不灵验的，是不认识病的源流。善于做医生的，临事制宜，随机应变，审察轻重，涎多的催吐，涎少的泻下，所用的药物，偏取肝家的风毒，又有什么担心人不平安的呢。其三曰冷涎，如果今人的肝脏有余，脾气不足，忽然因发脾气，长期怀有郁怒，伤损肝心正气，这就是冷涎所以积聚的原因。脾气不足，又因肝气所乘，伏而不动，停水滞谷，久而不化，肝心长期怀有郁怒，则其气滞涩而不行，这就是冷涎所以积聚的原因。然而肝主风性之不定，忽时而作。肝主怒，怒则气逆，这就是冷涎所以随气而上，而人生大病的原因。根据其证候来说，则病必定先觉得心前溃乱不快，相继感觉到有一物，随气而上触，至咽喉即闷倒不知人事，手足肌肉渐渐寒冷，片刻后恢复平愈。治疗的方法，应当用吐药取之，得到所取的涎，其清如水，其冷如雪。取涎之后，再审察其藏气，随其所病而调和它，也没有担心药物不灵验的。其四曰病涎，其人必定喜好食用坚硬之物，伤损脾气，忽然因郁怒，伤损心肝正气，忽然因寒邪热毒的伤害，忽然因大病之后，余毒客在脏腑，其气结涩凝滞，不能宣畅，因此痰涎因而聚积，涎与滞气相交，往往发作疼痛，这名叫病涎。明了其病证，在心前痛，轻则连年累月，痛无暂停，重则倾覆人命，快如反掌，轻重不同，在于涎的多少。治疗的方法，应当衡量病势轻重，用利药取之，轻则其涎如油，重则其凝如白胶。取涎之后，然后用药，清其藏气，益其正气，使之平复如故。其五曰虚涎，其人必定因受气之虚，忽然因大病之后，生冷所伤，忽然因疾病之间，淫欲不节，致使脏腑之气空虚羸乏，而骨槽之间虚热上蒸，上气镇长有余，下气但常不足，阴阳之气不相交际，不顺之气隔在中焦，因此虚涎因而积裹，风热一攻，即其涎并上。初发作时，先觉得清涎满口，渐闻心前有一物，上触咽喉，即喉中急促，闷倒不觉，两手相乱把拽，风气极上，即头上痒，忽然皮脐间痛，片刻风气顺下，于是平复。治疗的方法，应当在临发作时，用五分利的药取之，因为其胃气不足，不可十分利吐。如果利吐不出，不时用坏风涎药搅之，候分数稍减，即在气海上安一灸，引其涎下入于胃，然后用药调其藏气，酌量其脏腑的虚实，有余者泻，不足者补，令上下之气相等，也许可以全安。如果脉气微细，大肠虚冷，减其肝气，益其胃气就可以了。如果小儿得病，全是胃气之虚，在气海上安灸，补暖脾胃，以此治愈此痰，仍不轻易吃取风涎药。其六曰毒涎，如果今人患阳毒伤寒，肝心脾肺受其疫毒之气，因其毒涎相积聚在中，候其证，即使人大肠秘热，小便赤涩，面色黯赤，浑身发热，昏昏如醉，狂言妄语，不知人事，如此之候悉皆是涎。诊其脉气却又沉伏，重手取之骨间乃得，这是疫毒之涎，盈溢心胸，伏其脉气，不是脉气与病相反，这就是所谓的毒涎。治疗的方法，急用疏转的药物，取其毒瓦斯，荡下其涎，所下的药物须心肝脾肺四脏俱治，然而应当以肝脏为主，偏下肝脏的药物为关键。虽然，涎作为疾病，千变万化，其状不一，是如今所举的几端，只是其大略而已。后来的学人，分类推究，加以见识的明智，而诊疗无差错，也没有担心涎成为人的大祸患了。（出自《史载之方》）
Phlegm (Tan, Phlegm) was anciently written as "Dan" (Dan, Pale/Light). "Dan" and "Dan" (Dan, Ripples/Water movement) are interchangeable; "Dan" means water moving. Therefore, when water flows between the intestines, it is called "Dan Yin" (Dan Drink). The phlegm of today corresponds to what was anciently called nasal mucus (Ti), saliva (Tuo), thin saliva (Xian), or foam (Mo). It is sometimes also referred to as "Yin" (Drink), such as the supporting drink in the diaphragm (Ge Jian Zhi Yin). Defining phlegm as fluid above the chest is not actually the intent of Zhang Zhongjing, yet it has become a fixed name for millennia. Few people know the difference in its meaning, so I hereby clarify it.
General Discussion from *Zhu Bing Yuan Hou Lun*: People suffering from phlegm-drink diseases do so because Ying and Wei (Nutritive and Defensive Qi) are impure, and Qi and Blood have become turbid and coagulated. Internally, the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) cause disorder, and Zang-Fu Qi fails to circulate. Stagnation generates Xian (thin saliva), which condenses into Yin (drink); this is an internal cause. Externally, the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) invade, the pores (Xuan Fu) become blocked, sweat should be released but isn't, leading to accumulation as Yin; this is an external cause. Alternatively, excessive diet, unbridled desires, shouting until exhausted, or improper exercise cause Jin Ye (Body Fluids) to fail to circulate, gathering into phlegm-drink; this belongs to neither internal nor external causes. Caused by these three factors, symptoms vary: some present with panting, some with coughing, vomiting, or diarrhea; dizziness, heartburn, palpitations, aversion to cold and fever, pain, swelling, abdominal fullness, muscle spasms or paralysis, urinary retention, epigastric fullness and obstruction, or even madness resembling mania. None of these occur without being caused by phlegm-drink. (*San Yin Ji Yi Bing Zheng Fang Lun*)
Symptoms caused by external factors are difficult to clarify. Wind-dryness, cold-coagulation, summer-heat scorching, and dampness-stagnation can all close the collaterals, causing stagnation and generation of Xian. This leads to supportive overflow pain without waiting for drinking water to flow into the limbs. One must reason through medical principles rather than sticking rigidly to fixed patterns. (Ibid.)
If joy, anger, sorrow, etc., are not regulated properly, or if daily routine and diet lose their regularity, it causes blockage of Ying and Wei, and turbidity of Qi and Blood, forming phlegm, Xian, and Yin, giving rise to various symptoms. If phlegm lodges in the Jiao Ge (triple burner/diaphragm area), it causes dizziness, mental confusion, palpitations, urinary retention, epigastric fullness, panting, coughing, and shortness of breath. If it stagnates in the joints, it causes muscle spasms, limb pain, dragging of hands and feet, and alternating chills and fever. Although these three originate from the same source, their treatments differ. Phlegm lodges in the Pericardium Collateral, floats upward with Qi, resides in the Lung Meridian, and manifests due to coughing. Xian lodges in the Spleen origin, overflows upward with Qi, and flows from the corners of the mouth. Only Yin arises in the Stomach, manifesting as vomiting and spitting; careful differentiation is required. (*Ji Sheng Fang* / *Jian Yi*)
Only Qi and Blood can generate various diseases, and phlegm is no exception. Phlegm is merely another name for Body Fluids, used by humans to moisten and nourish the limbs. When Qi and Blood are harmonious and collaterals are smooth, phlegm disperses and does not exist. When Qi pulses are blocked and orifices are stagnant, phlegm gathers and exists. Does phlegm arise spontaneously? No. Wind collision, cold coagulation, summer-heat annoyance, dampness stagnation, and various heat steaming, along with consuming raw/cold or fried foods, fishy/salty preserved items, or things that stir wind and move Qi, can all cause phlegm. Thus, phlegm as a disease manifests as panting, coughing, congestion, vomiting, dizziness, wind epilepsy, mania, palpitations, acid regurgitation, shortness of breath, epigastric fullness, swelling, chills/fever, or pain. These are truly governed by phlegm. (*Zhi Zhi Fang*)
Phlegm in the human body is like flowing water; it values smooth movement and relies on Earth (Spleen) as a dam. Occasionally reversed by wind or obstructed by objects, it makes noise and can even pass over the throat. Therefore, phlegm disease may arise from weak Spleen Earth failing to nourish Metal (Lungs), or from interference by the Four Qi and Seven Emotions, causing Qi congestion and phlegm accumulation, resulting in panting and coughing. (*Yi Xue Da Cheng*)
If six Yin injuries damage the Stomach, causing pore blockage and failure to sweat, leading to accumulation as phlegm, this is an external cause. If Body Fluids cannot spread and condense into phlegm, this is an internal cause. (*Yuan Li*)
Phlegm arises from Qi stagnation (Involving Cold and Heat factors): The entire body relies on the circulation of Qi and Blood, and phlegm follows. Phlegm is another name for Body Fluids. Those circulating upward are called Phlegm-Drink; those spreading downward are called Essence Fluids. What makes them circulate up and down is Qi. Generally, Qi stagnation leads to phlegm stagnation; Qi movement leads to phlegm movement. Hence, adding Mugwort (Mu Xiang) to San Sheng Yin is always effective. The airways value smoothness; smoothness ensures fluid circulation and prevents phlegm-drink disorders. Once impropriety occurs, airways close, stagnant drink gathers above the diaphragm, and condenses into phlegm. (*Zhu Shi*)
Pang Anchang said: "There is no phlegm flowing upward in the body, just as there is no water flowing backward in the world." (Note: This cannot be verified in Pang's current books, but historical records contain this quote, appearing later). Indeed, this statement is true. Reflecting on this, the airways value smoothness; smoothness ensures fluid circulation and prevents phlegm-drink disorders. Improper care closes the airways, causing water-drink to stop in the chest and viscera, condensing into phlegm. (*Ji Sheng Fang*)
The ancients said: "There is no phlegm flowing upward in the body, and no water flowing backward in the world." This is indeed correct, but I believe it is not entirely so. Water does not flow backward, referring to its natural tendency; phlegm not flowing upward warrants further scrutiny. Breathing in and out involves Yin and Yang. If Qi and Blood circulate following the meridians up and down, fluids flow smoothly, preventing phlegm-drink. However, if management is improper, Seven Emotions disrupt Qi, Yin and Yang lose order, stagnating in collaterals, Qi rises but does not descend, phlegm-Xian becomes congested, rises with Qi, knots in the chest and diaphragm, presses against the throat, causing vomiting, hiccups, or spitting. Is this not flowing upward? Severe cases involve wind-phlegm congesting above, with throat sounds like sawing, mental confusion, where medicine is useless; this differs from ordinary phlegm. (*Zhi Bing Huo Fa Mi Fang*)
Phlegm is originally our body's Body Fluids, circulating with Qi. If Qi is peaceful, fluids distribute, nourishing the bones and tissues, how could they form phlegm? If Qi loses its clear/pure nature and becomes too hot, fluids are boiled by fire, turning thick and turbid. If Qi loses its warmth and becomes too cold, fluids accumulate due to cold, gradually coagulating, thus forming phlegm. So, although phlegm is one entity, its origins differ by cold or heat; can it be treated uniformly? (*Yi Que*)
Phlegm forms due to Heat: Phlegm is water, the branch; Fire is heat, the root. People who don't understand root and branch call it "Phlegm-Fire," mistakenly thinking phlegm generates fire, not knowing fire generates phlegm. Like water in a pot: without fire, it is clear and pure; with fire, it turns into white foam. Without disease, Body Fluids are clear; once diseased, Qi and Blood are disharmonious, collaterals become congested, generating heat. Heat causes clear fluids to mix turbidly and form phlegm. Isn't this fire-heat generating phlegm? Calling it "Heat-Phlegm" is acceptable; calling it "Phlegm-Fire" is incorrect. (*Ru Yi Jing Yao*)
*Yu Ji Wei Yi* states: Phlegm causes many diseases. Why? Qi and Blood flow without interruption; any congestion causes fluid accumulation, stagnation generates heat, and phlegm arises. Observing symptoms, phlegm is a variation of fire; no phlegm disease occurs without fire. Rarely, cold-phlegm occurs, perhaps 1 in 1000. To say cold-phlegm is wrong, while Drink varies by cold/heat, Phlegm is solely due to heat; adding "cold" is inappropriate. Thus, phlegm pulses are often slippery and large. Even if known to be cold-stagnation phlegm, it郁 (stagnates) into heat. Medicines use only the acridity of Tangerine Peel (Ju Pi), Pinellia (Ban Xia), and Medicated Leaven (Shen Qu) to disperse and move it; hot medicines are avoided. Chen Wuyue says Drink pulses are often deep, wiry, fine, and small, indicating cold, treated with Li Zhong Tang or Er Chen Tang. As Neo-Confucianism says, there are hot springs but no cold fires, is this not so? (*Yi Tong*)
There are three origins: Phlegm production has multiple causes and treatments. Due to Yin deficiency and fire flaring, pressing on the Lungs, Lung heat boils fluids into phlegm, called Yin-deficiency Phlegm-Fire. Phlegm is in the Lungs but rooted in the Kidneys. Treatment should lower Qi, clear heat, benefit Yin, and nourish water. Avoid acrid-warm, drying-hot, and tonifying Qi medicines. Due to Spleen-Stomach cold-damp generating phlegm, or excessive eating of greasy/noodle/pork-fat foods, Spleen Qi becomes disharmonious, congesting into phlegm, becoming thick and sticky, flowing into collaterals or outside membranes, forming lumps, loss of appetite, insomnia, sudden fainting, epilepsy, weight loss, abnormal shouting, heaviness, diarrhea, or paralysis. Strange diseases often belong to phlegm; acute diseases often belong to fire. This disease is in the Spleen/Stomach, unrelated to Lungs/Kidneys. Treatment should dry Spleen, move Qi, dissipate nodules, and soften hardness. Avoid cloying, bitter-cold, moistening medicines and rich flavors. Due to wind-cold closure and heat in the Lungs, causing phlegm-cough-panting, disease is in the Lungs. Treatment should add acrid-hot/warm herbs like Ephedra (Ma Huang) or Raw Dried Ginger (Sheng Gan Jiang) to resolve external cold, avoiding warm-tonifying and sour-astringent methods. Causes vary, so medicines differ; draining dampness, drying, and dispersing each have their proper place and cannot be mixed. (*Ben Cao Jing Shu*)
Xian has six types: It is said: Boats need water, but waves capsize them; humans need Qi, but accumulated phlegm-Xian kills them. Waves aren't self-generated; uneven pressure creates them. Xian isn't self-accumulated; irregular Qi causes it. Good boatmen fear broken boats, not waves; good health preservers fear irregular Qi, not Xian. Among diseases, none endanger life faster than phlegm-Xian. Yet doctors often see but don't recognize, or recognize but can't treat. Unfortunate victims die prematurely. Everyone knows wind produces Xian, but doesn't know cold or heat in Zang-Fu also produce Xian. Once formed, Xian changes infinitely. I list a few points. Later learners should classify and deduce to prevent premature death. Though named Xian, there are several types: 1. Wind-Xian, 2. Heat-Xian, 3. Cold-Xian, 4. Disease-Xian, 5. Deficiency-Xian, 6. Toxic-Xian.
1. Wind-Xian: Due to strong wind Qi rising to Xian, unable to enter the Stomach. Wind steams, Xian rises, blocking the chest, causing fainting. If wind persists, life is endangered quickly. If wind subsides, Xian descends, and recovery occurs. This happens when flesh is dense, pores deep, wind trapped inside, wind-heat attacks internally, large intestine is constipated/hot, toxic vapors attack upward. If large intestine heat is excess, Xian fills the mouth, spit like clear glue, chest breathes normally, but food/water stops at the throat, causing choking and panting. Only thick porridge can be taken. This is Wind-Xian. To treat: Cut the root. Smooth the Qi first. There is no upward-flowing Xian. Treating with Arisaema (Tian Nan Xing) or Pinellia (Ban Xia) ignores the root. First smooth Qi, open pores, let wind vent externally and move internally, then Xian descends naturally. If wind is extreme and Xian thick, urgent vomiting is needed. If mild, smooth Qi first, then treat Xian. Wind-Xian varies by cold/heat. Cold wind attacking causes Cold-Xian: reduced appetite, heaviness, weakness, nausea at meat smell, spontaneous cold Xian, sudden fainting, numbness, dragging limbs, aphasia. Cold Xian accumulates in Middle Jiao, surrounds Heart Pericardium, causing madness. Treat with warm medicines to disperse cold-toxic, hot medicines to open pores, then extract Xian. Hot wind is like spring/summer (nourishing); cold wind is like autumn/winter (killing).
2. Heat-Xian: From indulgent men eating greasy/spicy/sour foods, lustful, taking tonics, damaging essence via alcohol/sex. Dan Yuan and Marrow Sea become empty, Zang-Fu bone cavities have deficient heat. Xian accumulates in Middle Jiao, interacting with Kidney cold-deficiency and evil heat, causing pain, potentially fatal. Doctors mistake this for Liver/Kidney Qi issues, not knowing Heat-Xian is the root. San Leng and E Zhu treat Qi but fail here due to ignorance of roots. Good doctors adjust to situation: vomit if much Xian, purge if little. Use medicines targeting Liver wind-toxin.
3. Cold-Xian: Liver excess, Spleen deficiency. Anger/stress damages Liver/Heart righteous Qi. Spleen deficiency allows Liver Qi to invade, stagnating water/grain. Liver anger causes Qi stagnation, leading to Cold-Xian. Liver governs unpredictable wind and anger (Qi rebellion). Symptoms: precordial chaos, sensation of object rising to throat, fainting, cold limbs, recovery. Treat with emetics. Extracted Xian is clear as water, cold as snow. Afterward, regulate Zang Qi.
4. Disease-Xian: From eating hard foods damaging Spleen, anger damaging Heart/Liver, cold/heat toxins, or residual toxins after severe illness. Qi stagnates, Xian accumulates, interacting with stagnant Qi, causing pain. Precordial pain, chronic or acute/fatal. Depends on amount of Xian. Treat by measuring severity, using purgatives/emetics. Light: Xian like oil; Heavy: Xian like white glue. After extraction, clear Zang Qi, boost righteous Qi.
5. Deficiency-Xian: From Qi deficiency, post-illness cold/raw food injury, or sexual indiscretion during illness. Zang-Fu Qi empty, bone cavity deficient heat steams upward. Upper Qi excess, Lower Qi deficiency, Yin/Yang fail to interact, irregular Qi blocks Middle Jiao, Deficiency-Xian accumulates. Wind-heat attack causes Xian to rise. Initial symptoms: mouth full of clear Xian, object rising to throat, choking, fainting, hand grasping, head itching, umbilical pain, then recovery. Treat at onset with mild purgatives (1/5 strength) due to weak Stomach Qi. If vomiting fails, use bad wind-Xian medicine to stir, moxa Qihai (CV-6) to draw Xian down to Stomach, then regulate Zang Qi based on deficiency/excess. For children, purely Stomach Qi deficiency; moxa Qihai to warm Spleen/Stomach. Do not use wind-Xian drugs lightly.
6. Toxic-Xian: Yang-Du Shang Han (Yang-Toxic Cold Damage). Liver/Heart/Spleen/Lung infected by epidemic toxin. Toxic Xian accumulates in Middle. Symptoms: constipation/hot, red/scanty urine, dark-red face, whole-body fever, drunken confusion, madness, unconsciousness. All are Xian. Pulse is deep-hidden, felt only deeply near bone. Epidemic-toxic Xian fills chest/heart, hiding pulse. Not contrary to disease, but defines Toxic-Xian. Treat urgently with dispersing/moving medicines to take toxic vapor and purge Xian. Medicine must treat Heart/Liver/Spleen/Lung, focusing primarily on Liver.
Although Xian changes infinitely, these are general outlines. Learners should classify and deduce with wisdom to ensure accurate diagnosis and treatment, preventing Xian from being a major disaster. (*Shi Zai Zhi Fang*)