【食积痰之症】饱满不食，恶心呕吐，或攻四肢，肩背作痛，下遗大肠，时泻时止，或
时吐痰，口中觉甘，此食积痰之症也。
【食积痰之因】胃强能纳，脾弱不运，前食未消，后食随进，停积成痰，故曰食积痰也
【食积痰之脉】脉多滑大，滑大不数，寒凝痰结；滑大而数，积痰而热。
【食积痰之治】宜消食化痰，佐以利气宣导，导痰汤、枳朴二陈汤、三子养亲汤；甚者
导痰汤
南星 橘红 白茯苓 半夏 甘草 枳壳
枳朴二陈汤 治胃家有痰。
枳实 浓朴 半夏 白茯苓 广皮 甘草
三子养亲汤 治食积痰。
山楂子 莱菔子 白芥子
滚痰丸 见前悬饮。
湿痰用二陈汤；虚者，六君子汤。
风痰头痛、发热，脉浮大，祛风丸、导痰丸。
寒痰身不热，口不渴，脉沉迟。
热痰面赤多汗，口渴眼烂，烦躁，燥结，脉数，用栀连二陈汤，或加石膏、黄芩、竹
血虚痰，五心烦热，形体滑瘦，六脉细数，加减四物汤，加贝母、杏仁、青黛。
气虚痰，面黄肌瘦，六脉濡缓，六君子汤。
精虚痰，骨蒸潮热，虚火时升，脉多细数，地黄丸、加减二冬汤、固本丸，加玄武胶，
食积痰，痰味甘甜。五更咳嗽，或成疟痢，六脉沉滑，或见数大沉实，枳术丸、保和丸
老痰，即结痰，顽痰，坚结胶固，吐咯难出，脉见沉牢，海石青黛丸加半夏、栝蒌、
痰在咽喉，咯不出，咽不下，即老痰结痰也，宜节斋化痰丸。
痰在膈上，六脉弦迟，白芥子可以引达。
痰在肠胃间，肠鸣而濯濯有声，脉见沉滑，导痰汤。
痰在皮里膜外，或结核，或麻痹，非竹沥不能通，非姜汁不能散。
滚痰丸，攻泻肠胃痰积，最为要药，然须看虚实。
肾气丸，治肾阳不足，不能纳火归源，水泛为痰者最效；肾水阴虚火旺，金水皆枯者，
十枣、控涎三花、神佑诸汤 治胁痛，虚人不可妄施。
痰饮在胃，每多攻注，四肢肩背，或为麻木，软痹肿痛，指迷丸主之。
指迷丸 消胃家上结之痰，化大肠下凝之垢。
半夏（四两） 白茯苓（三两） 广皮（三两） 枳壳（一两） 元明粉（一两） 甘草（五钱）
上为细末，竹沥为丸，钩藤汤送下。肝胆有火，加胆星；痰积不消，加海石。
按∶节斋化痰丸，化肺中燥痰，兼化胃痰者，今指迷丸，消胃中湿痰，兼消肠中痰者也
饮因水湿，痰因火动，然就火而论，有湿火、燥火之分。肺火成痰为燥痰，胃火成痰为
；治燥用润，治湿用燥，人人知之。用润而已结之痰，凝滞不化；用燥助火，则痰愈生。思
得《金匮》以门冬、半夏同用，又以石膏、半夏同用；节斋化痰丸，以香附、天冬同用，凡
此皆是用润以制燥，用燥以制润。方书以二陈汤，加栀连，治湿火之痰；家秘以二陈汤，
加知母、石膏，兼治燥火之痰，良以用半夏，则已结之痰，从半夏而化，同石膏，则燥热之
火，从石膏而清，半夏同石膏，亦能散热，石膏同半夏，亦能化痰，立此法门，用燥不犯辛
燥，用润不犯凝滞。家秘治夹食伤寒，用平胃保和散恐太燥，多冲竹沥、萝卜汁，广而推悟者也。
【食积痰的症状】腹部饱胀不想进食，恶心呕吐，或者疼痛攻窜至四肢，肩背部疼痛，病邪下注大肠，时而腹泻时而停止，或者时常吐出痰液，口中感觉甘甜，这就是食积痰的症状。
【食积痰的成因】胃气强盛能受纳食物，但脾气虚弱不能运化，前面的食物尚未消化，后面的食物又随之进入，停滞积聚而成痰，所以称为食积痰。
【食积痰的脉象】脉象多表现为滑大，若滑大而不数，是寒凝导致痰结；若滑大而数，则是积痰化热。
【食积痰的治疗】应当采用消食化痰的方法，辅以利气宣导之法。可用导痰汤、枳朴二陈汤、三子养亲汤；病情严重的用导痰汤。
导痰汤组成：南星、橘红、白茯苓、半夏、甘草、枳壳。
枳朴二陈汤：治疗胃中有痰。
组成：枳实、浓朴、半夏、白茯苓、广皮（陈皮）、甘草。
三子养亲汤：治疗食积痰。
组成：山楂子、莱菔子、白芥子。
滚痰丸：见前文悬饮篇。
湿痰使用二陈汤；虚证患者，使用六君子汤。
风痰表现为头痛、发热，脉象浮大，使用祛风丸、导痰丸。
寒痰表现为身体不发热，口不渴，脉象沉迟。
热痰表现为面赤多汗，口渴眼烂，烦躁，大便燥结，脉象数，使用栀连二陈汤，或者加石膏、黄芩。
血虚痰表现为五心烦热，形体消瘦，六脉细数，使用加减四物汤，加贝母、杏仁、青黛。
气虚痰表现为面色黄、肌肉瘦削，六脉濡缓，使用六君子汤。
精虚痰表现为骨蒸潮热，虚火时升，脉象多细数，使用地黄丸、加减二冬汤、固本丸，加玄武胶。
食积痰表现为痰味甘甜，五更时分咳嗽，或者形成疟疾痢疾，六脉沉滑，或者见数大沉实，使用枳术丸、保和丸。
老痰，即结痰、顽痰，坚硬胶固，吐咯难以排出，脉象见沉牢，使用海石青黛丸加半夏、栝蒌。
痰在咽喉部位，咯不出来，咽不下去，就是老痰结痰，适宜使用节斋化痰丸。
痰在膈上，六脉弦迟，白芥子可以引药达病所。
痰在肠胃之间，肠鸣且发出濯濯的声音，脉象见沉滑，使用导痰汤。
痰在皮里膜外，或者形成结核，或者导致麻痹，非竹沥不能疏通，非姜汁不能消散。
滚痰丸，攻泻肠胃中的痰积，是最为重要的药物，然而必须辨别虚实。
肾气丸，治疗肾阳不足，不能纳火归源，水泛为痰的情况最为有效；若是肾水阴虚火旺，金水皆枯者……（原文此处中断）
十枣汤、控涎丹、三花神佑诸汤，治疗胁痛，体虚之人不可妄用。
痰饮在胃中，常常多攻注于四肢肩背，或者导致麻木，软痹肿痛，以指迷丸为主治。
指迷丸：消除胃中上结之痰，化解大肠下凝之垢。
组成：半夏（四两）、白茯苓（三两）、广皮（三两）、枳壳（一两）、元明粉（一两）、甘草（五钱）。
制成细末，用竹沥为丸，钩藤汤送服。肝胆有火，加胆南星；痰积不消，加海浮石。
按语：节斋化痰丸，化解肺中燥痰，兼化胃痰；现在的指迷丸，消除胃中湿痰，兼消肠中痰。
饮因水湿而生，痰因火动而成，然而就火而言，有湿火、燥火之分。肺火成痰为燥痰，胃火成痰为湿痰……（原文此处似有缺字或排版问题，依语境补全逻辑）；治疗燥痰用润法，治疗湿痰用燥法，人人都知道。但如果对已经凝结的痰使用润法，会导致凝滞不化；使用燥法助火，则痰会更多产生。思考得到《金匮要略》中以麦门冬、半夏同用，又以石膏、半夏同用；节斋化痰丸，以香附、天冬同用，凡此都是利用润法来制约燥性，利用燥法来制约润性。方书记载以二陈汤加栀子、黄连，治疗湿火之痰；家传秘方以二陈汤加知母、石膏，兼治燥火之痰，确实是因为使用半夏，则已结之痰，随半夏而化解，配合石膏，则燥热之火，随石膏而清除，半夏配合石膏，也能散热，石膏配合半夏，也能化痰，确立这样的法门，用燥不犯辛燥，用润不犯凝滞。家传秘方治疗夹食伤寒，用平胃保和散恐怕太燥，所以多冲入竹沥、萝卜汁，这是由此推广领悟的道理。
[Symptoms of Phlegm due to Food Stagnation] Abdominal fullness with loss of appetite, nausea and vomiting, or pain attacking the four limbs and causing pain in the shoulders and back; pathogenic factors descending to the large intestine causing intermittent diarrhea that stops and starts; or frequent expectoration of phlegm with a sweet sensation in the mouth. These are the symptoms of Phlegm due to Food Stagnation (Shi Ji Tan).
[Etiology of Phlegm due to Food Stagnation] The Stomach Qi is strong and capable of receiving food, but the Spleen Qi is weak and incapable of transforming and transporting. Previous food remains undigested while new food enters subsequently, leading to stagnation and accumulation that transforms into Phlegm. Hence, it is called Phlegm due to Food Stagnation.
[Pulse of Phlegm due to Food Stagnation] The pulse is mostly Slippery (Hua) and Large (Da). If Slippery and Large without Rapid (Shu) quality, it indicates Cold coagulation and Phlegm binding; if Slippery, Large and Rapid, it indicates accumulated Phlegm with Heat.
[Treatment of Phlegm due to Food Stagnation] One should employ methods to resolve food stagnation and transform Phlegm, assisted by promoting Qi circulation and guiding out stagnation. Formulas include Dao Tan Tang (Phlegm-Guiding Decoction), Zhi Po Er Chen Tang (Aurantium and Magnolia Bark Er Chen Decoction), and San Zi Yang Qin Tang (Three Seeds Decoction for Nourishing the Elderly); for severe cases, use Dao Tan Tang.
Dao Tan Tang composition: Tuber Pinelliae Preparatum (Nan Xing), Exocarpium Citri Reticulatae (Ju Hong), Poria (Bai Fu Ling), Rhizoma Pinelliae Preparatum (Ban Xia), Radix Glycyrrhizae (Gan Cao), Fructus Aurantii (Zhi Ke).
Zhi Po Er Chen Tang: Treats Phlegm in the Stomach.
Composition: Fructus Aurantii (Zhi Shi), Cortex Magnoliae Officinalis (Nong Pu), Rhizoma Pinelliae Preparatum (Ban Xia), Poria (Bai Fu Ling), Exocarpium Citri Reticulatae (Guang Pi), Radix Glycyrrhizae (Gan Cao).
San Zi Yang Qin Tang: Treats Phlegm due to Food Stagnation.
Composition: Fructus Crataegi (Shan Zha Zi), Semen Raphani (Lai Fu Zi), Semen Sinapis Albae (Bai Jie Zi).
Gun Tan Wan (Rolling Phlegm Pill): See previous section on Suspended Fluid (Xuan Yin).
For Damp-Phlegm, use Er Chen Tang; for deficiency patterns, use Liu Jun Zi Tang (Six Gentlemen Decoction).
For Wind-Phlegm presenting with headache and fever, with a Floating and Large pulse, use Qu Feng Wan (Wind-Expelling Pill) or Dao Tan Wan (Phlegm-Guiding Pill).
For Cold-Phlegm, the body is not hot, there is no thirst, and the pulse is Deep (Chen) and Slow (Chi).
For Heat-Phlegm, there is facial redness, excessive sweating, thirst, rotting eyes, irritability, dry constipation, and a Rapid pulse. Use Zhi Lian Er Chen Tang (Gardenia and Coptis Er Chen Decoction), or add Gypsum Fibrosum (Shi Gao) and Radix Scutellariae (Huang Qin).
For Blood Deficiency Phlegm, there is five-palm heat, emaciation, and a Fine and Rapid pulse in all six positions. Use Jia Jian Si Wu Tang (Modified Four Substances Decoction), adding Radix Bupleuri? No, Fritillariae Bulbus (Bei Mu), Semen Pruni (Xing Ren), and Indicum (Qing Dai).
For Qi Deficiency Phlegm, there is sallow complexion and muscle emaciation, with a Soft (Ru) and Slow (Huan) pulse in all six positions. Use Liu Jun Zi Tang.
For Essence Deficiency Phlegm, there is bone-steaming tidal fever, rising deficient fire, and a mostly Fine and Rapid pulse. Use Di Huang Wan (Rehmannia Pill), Jia Jian Er Dong Tang (Modified Two Asparagus Decoction), Gu Ben Wan (Root-Firming Pill), adding Glue from Black Tortoise (Xuan Wu Jiao).
For Phlegm due to Food Stagnation, the phlegm tastes sweet. There is coughing at dawn (Wu Geng), or formation of malaria/dysentery. The pulse is Deep and Slippery, or Rapid, Large, Deep, and Solid. Use Zhi Shu Wan (Aurantium and Atractylodes Pill) or Bao He Wan (Preserve Harmony Pill).
Old Phlegm (Lao Tan), also known as Knotted Phlegm (Jie Tan) or Stubborn Phlegm (Wan Tan), is hard, sticky, and difficult to expectorate. The pulse appears Deep and Firm (Lao). Use Hai Shi Qing Dai Wan (Halloysite and Indicum Pill) added with Rhizoma Pinelliae Preparatum (Ban Xia) and Fructus Trichosanthis (Gua Lou).
When Phlegm is in the throat, unable to be expectorated or swallowed, it is Old Phlegm/Knotted Phlegm. Jie Zai Hua Tan Wan (Jie Zai Phlegm-Transforming Pill) is appropriate.
When Phlegm is above the diaphragm, the six pulses are Wiry (Xian) and Slow (Chi). Semen Sinapis Albae (Bai Jie Zi) can guide the medicine to the site.
When Phlegm is between the intestines and stomach, there is borborygmus with gurgling sounds, and the pulse is Deep and Slippery. Use Dao Tan Tang.
When Phlegm is in the subcutaneous tissue and membrane exterior, forming nodules or causing numbness/paralysis, only Bamboo Sap (Zhu Li) can unblock it, and only Ginger Juice (Jiang Zhi) can disperse it.
Gun Tan Wan attacks and purges Phlegm accumulation in the intestines and stomach; it is a crucial drug, but one must assess deficiency and excess.
Shen Qi Wan (Kidney Qi Pill) is most effective for treating Kidney Yang deficiency where Fire cannot return to its source, causing Water flooding to form Phlegm; for Kidney Water deficiency with Hyperactive Fire, where Metal and Water are both withered... [Text cuts off].
Shi Zao Tang (Ten Jujube Pill), Kong Xian Dan (Saliva-Controlled Pill), San Hua Shen You Tang (Three Flowers Divine Protection Decoction) treat hypochondriac pain; they must not be used recklessly in deficient persons.
When Phlegm-Fluid is in the Stomach, it often attacks and pours into the four limbs, shoulders, and back, causing numbness, soft bi-syndrome, swelling, and pain. Zhi Mi Wan (Finger-Mystifying Pill) is the primary treatment.
Zhi Mi Wan: Resolves Phlegm knotted above in the Stomach, transforms filth condensed below in the Large Intestine.
Composition: Rhizoma Pinelliae Preparatum (Ban Xia, 4 liang), Poria (Bai Fu Ling, 3 liang), Exocarpium Citri Reticulatae (Guang Pi, 3 liang), Fructus Aurantii (Zhi Ke, 1 liang), Natrii Sulfas (Yuan Ming Fen, 1 liang), Radix Glycyrrhizae (Gan Cao, 5 qian).
Pulverize into fine powder, make pills with Bamboo Sap (Zhu Li), and take with Uncariae Ramulus cum Uncis (Gou Teng Tang). If Liver/Gallbladder has Fire, add Rhizoma Pinelliae Preparatum with胆汁 (Dan Xing); if Phlegm accumulation does not resolve, add Halloysite (Hai Shi).
Note: Jie Zai Hua Tan Wan resolves Dry-Phlegm in the Lung and simultaneously resolves Stomach Phlegm; the current Zhi Mi Wan eliminates Damp-Phlegm in the Stomach and simultaneously eliminates Intestinal Phlegm.
Fluid arises from Water-Dampness, Phlegm arises from Fire agitation. However, discussing Fire, there is a distinction between Damp-Fire and Dry-Fire. Lung Fire forming Phlegm is Dry-Phlegm; Stomach Fire forming Phlegm is [Damp]-Phlegm; treating Dryness uses Moistening, treating Dampness uses Drying—everyone knows this. But using Moistening on already knotted Phlegm causes stagnation and non-resolution; using Drying aids Fire, thus generating more Phlegm. Reflecting on *Jin Gui Yao Lue*, Ophiopogonis Radix (Mai Dong) and Rhizoma Pinelliae are used together, as are Gypsum Fibrosum and Rhizoma Pinelliae; Jie Zai Hua Tan Wan uses Cyperi Rhizoma (Xiang Fu) and Asparagi Radix (Tian Dong) together. All these utilize Moistening to restrain Dryness, and Drying to restrain Moistening. Formula books state that Er Chen Tang added with Gardeniae Fructus (Zhi Chi) and Coptidis Rhizoma (Huang Lian) treats Damp-Fire Phlegm; family secret formula uses Er Chen Tang added with Anemarrhenae Rhizoma (Zhi Mu) and Gypsum Fibrosum to simultaneously treat Dry-Fire Phlegm. This is indeed because using Rhizoma Pinelliae allows already knotted Phlegm to transform via Pinellia, while combining with Gypsum clears Dry-Heat Fire via Gypsum. Pinellia combined with Gypsum can also dissipate heat; Gypsum combined with Pinellia can also transform Phlegm. Establishing this method, using Drying does not offend with Acrid-Dryness, and using Moistening does not offend with Stagnation. The family secret formula treats Cold Damage with Food Stagnation using Ping Wei Bao He San, fearing it might be too drying, so Bamboo Sap and Radish Juice are frequently added. This is an extension and comprehension derived from such principles.