第五章．治痰饮方

Chapter 5. Formulas for phlegm

1. 理饮汤

1. Liyin Tang (Li means clearing here in Chinese, Yin means phlegm, which is almost as water)

治因心肺阳虚，致脾湿不升，胃郁不降，饮食不能运化精微，变为饮邪。停于胃口为满闷，溢于膈上为短气，渍满肺窍为喘促，滞腻咽喉为咳吐粘涎。甚或阴霾布满上焦，心肺之阳不能畅舒，转郁而作热。或阴气逼阳外出为身热，迫阳气上浮为耳聋。然必诊其脉，确乎弦迟细弱者，方能投以此汤。
This formula is used to treat the condition, in which the Heart-Lung Yang Qi is weak, which cause the Spleen Humidity (Wetness) not go up and the Stomach Qi not move down. The nutrition from the food cannot be turned into the use by the body, so it becomes the Yin Xie. (Xie means it so becomes disease-causing stuff. The Yin here does not mean the Yin in the Yin-Yang concept). If the Yin Xie stops on the stomach, person feels fullness. If it is in the chest, the person feels short of breath, asthma, cough with phlegm. If it accumulates too much in the Upper Jiao, it would block the Heart-Lung Yang Qi. When the stagnated Heart-Lung Yang Qi cannot disperse, it will turn into Fire. Or, the Yin Qi presses the Yang Qi out to cause body hot, press the Yang Qi float to cause deafness. However the person’s pulse must be checked. Only if the pulse is string, late, thin and weak, can this formula be used.

于术（四钱） 干姜（五钱） 桂枝尖（二钱） 炙甘草（二钱） 茯苓片（二钱） 生杭芍（二钱）桔红（钱半） 川浓朴（钱半）
Baizhu 12 gram, Ganjiang 15 gram, Guizhi tip 6 gram, Zhi Gancao 6 gram, Fulin 6 gram, Baishao 6 gram, Jiehong 4.5 gram, and Houpo 4.5 gram.

服数剂后，饮虽开通，而气分若不足者，酌加生黄芪数钱。
After taking of this formula for several days and with the opening and disperse of the Yin Xie, but the person still has weakness in the Qi, add herb Huangqi several gram.

方中用桂枝、干姜，以助心肺之阳，而宣通之。白术、茯苓、甘草，以理脾胃之湿，而淡渗之（茯苓甘草同用最泻湿满）。用浓朴者，叶天士谓：“浓朴多用则破气，少用则通阳”，欲借温通之性，使胃中阳通气降，运水谷速于下行也。用桔红者，助白术、茯苓、甘草以利痰饮也。至白芍，若取其苦平之性，可防热药之上僭（平者主降），若取其酸敛之性，可制虚火之浮游（《神农本草经》谓芍药苦平，后世谓芍药酸敛，其味实苦而微酸）。且药之热者，宜于脾胃，恐不宜于肝胆，又取其凉润之性，善滋肝胆之阴，即预防肝胆之热也。况其善利小便，小便利而痰饮自减乎。
The herbs, Guizhi and Ganjiang in the formula, work to support the Heart-Lung Yang, so to disperse them. The Baizhu, Fuling and Gancao work to clear the humidity in the Spleen-Stomach (the co-use of the Fuling and Gancao works well to clear the humidity). For the herb Houpo, Mr. Ye Tianshi said: “Houpo can break the Qi in large amount, and can promote the Yang Qi moving in small amount.). Its use is to promote the moving down of the Stomach Yang Qi, to promote the water and food move down. The Jiehong helps the Baizhu, Fuling and Gancao to clear the phlegm. The Baishao, for its bitter-calm nature, can prevent the rushing up of the hot herbs (calming herb has down-moving property). For its sour-restraining property, it can suppress the floating Fire. The hot herbs are usually suit to nourish the Spleen-Stomach, but not good for the Liver-Gall Bladder. So, for its cooling property, it works to nourish the Yin of the Liver-Gall Bladder. For its ability to promote urine, when the urine is smooth, the phlegm is easy to clear.

一妇人，年四十许。胸中常觉满闷发热，或旬日，或浃辰之间，必大喘一两日。医者用清火理气之药，初服稍效，久服转增剧。后愚诊视，脉沉细几不可见。病家问：系何病因？愚曰：此乃心肺阳虚，不能宣通脾胃，以致多生痰饮也。人之脾胃属土，若地舆然。心肺居临其上正当太阳部位（膈上属太阳，观《伤寒论》太阳篇自知），其阳气宣通，若日丽中天暖光下照。而胃中所纳水谷，实借其阳气宣通之力，以运化精微而生气血，传送渣滓而为二便。清升浊降，痰饮何由而生？惟心肺阳虚，不能如离照当空，脾胃即不能借其宣通之力，以运化传送，于是饮食停滞胃口，若大雨之后，阴雾连旬，遍地污淖，不能干渗，则痰饮生矣。痰饮既生，日积月累，郁满上焦则作闷，渍满肺窍则作喘，阻遏心肺阳气，不能四布则作热。医者不识病源，犹用凉药清之，勿怪其久而增剧也。遂为制此汤，服之一剂，心中热去，数剂后转觉凉甚。遂去白芍，连服二十余剂，胸次豁然，喘不再发。
A lady, about 40 years of old, felt fullness and hot in the chest. For every several days, or for every months, there would be an outbreak of asthma for several days. It was little improvement when using Fire-clearing and Qi-dispersing herbs. The herbs worked in only a short time. The condition became worse when the herbs taken for a longer time. When I saw her, her pulse was thin and deep, almost could not be touched. The family member asked: what is this disease? I said: it belongs to the Yang deficiency in the Heart and Lung, which fail to promote the function of the Spleen-Stomach, so cause the accumulation of the phlegm. … With accumulated phlegm stocked in the chest to cause fullness and asthma. It blocks the disperse of the Yang Qi, to cause hot feeling in the chest. Doctors do not the reason for the disease, so used the cooling herbs. It is not strange that long time take of such cold herbal tea would make things worse. For her, I prescribed this formula. Several doses later, she felt cold. So, the herb Baoshao was moved. After about twenty doses, she felt much clear in the chest and the asthma never had outbreak. 

一妇人，年三十许。身形素丰。胸中痰涎郁结，若碍饮食，上焦时觉烦热。偶服礞石滚痰丸有效，遂日日服之。初则饮食加多，继则饮食渐减，后则一日不服，即不能进饮食。又久服之。竟分毫无效，日仅一餐，进食少许，犹不能消化。且时觉热气上腾，耳鸣欲聋，始疑药不对证。求愚延医，其脉象浮大，按之甚软。愚曰：此证心肺阳虚，脾胃气弱，为服苦寒攻泻之药太过，故病证脉象如斯也。拟治以理饮汤。病家谓，从前医者，少用桂附，即不能容受，恐难再用热药。愚曰：桂附原非正治心肺脾胃之药，况又些些用之，病重药轻，宜其不受。若拙拟理饮汤，与此证针芥相投，服之必无他变。若畏此药，不敢轻服，单用干姜五钱，试服亦可。病家根据愚言，煎服干姜后，耳鸣即止，须臾觉胸次开通。继投以理饮汤，服数剂，心中亦觉凉甚。将干姜改用一两，又服二十余剂，病遂除根。
A lady, about 30 years of old, with pretty over-weight body, felt phlegm accumulation in the chest and poor eating. She felt annoying hot in the Upper Jiao. Her condition is occasionally improved by taking herb Menshi Gongtan Wan, so she take it day by day. From beginning, the eating was improved, but later reduced again. Later, she could not eat anything without taking the herbs. Such condition lasted for a long time, but the disease appeared no more improvement at all. She can only eat for only meal. It was hard to digest such little amount of food.  From time to time, she felt hot vapor rush up, strong ringing in the ears to deaf, so that she doubt that the herbs were not the proper ones. When I was asked to see her, her pulse was floating and big, but very soft when pressing. I said, this condition is due to weakness of the Heart-Lung Yang Qi and to the weakness in the Spleen-Stomach Qi, due to over intake of cold herbs. The herbal formula of Liyin Tang was then prescribed to her. The family member told me that, she could not endure herbs, such as Guizhi and Fuzi prescribed by previous doctors. It might be difficult to take the hot herbs. I said: the herb Guizhi and Fuzi are originally not the exact herbs for the Heart, Lung, Spleen and Stomach. If they were use only little amount, the herbs are less than the severity of the disease, the body may not accept it. With my formula, the Liyin Tang, the formula matches the disease exactly, there should have no side effects. If the herbs were really feared, she could try only the Ganjiang 15 gram to try. The family followed my suggestion, and let her drink the Ganjiang tea. After drinking, the ear ringing stopped, later the fullness in the chest released. The Liyin Tang was followed after that. Several doses later, her heart felt cold too. So, the Ganjiang was increased to 30 gram. After twenty doses, the disease was completely improved. 

一妇人，年四十许。上焦满闷烦躁，思食凉物，而偶食之，则满闷益甚。且又黎明泄泻，日久不愈，满闷益甚，将成臌胀。屡次延医服药，多投以半补半破之剂，或佐以清凉，或佐以收涩，皆分毫无效。后愚诊视，脉象弦细而迟。知系寒饮结胸，阻塞气化。欲投以理饮汤，病家闻而迟疑，似不敢服。亦俾先煎干姜数钱服之，胸中烦躁顿除。为其黎明泄泻，遂将理饮汤去浓朴、白芍，加生鸡内金钱半，补骨脂三钱，连服十余剂，诸病皆愈。
A lady, about 40 years old, had fullness and annoying in the chest. She liked to eat cold food but if take it occasionally, she would feel more fullness. For a long time, she had diarrhea in the early morning. She later felt also fullness in the abdomen. She visited doctors for help, most of them used half-nourishing and half-breaking herbs, or with little addition of cooling herbs, or with little restraining herbs, none worked. When I saw her, her pulse was string, thin and late. It was suspected to be the Cold-Phlegm accumulation in the chest, which blocked the Qi movement in the chest. The family felt heisted and dared not to use it, the movement I would use the Liyin Tang. I also recommended them to try Ganjiang several grams. After drinking, the lady felt disappear of the annoying. To solve her morning diarrhea, the herb Houpo, Baishao were removed, but herb Jineijing 4.5 gram, and Buguzhi 9 gram were added. After continueous tens of doses, every condition were improved completely.

一妇人，年近五旬，常觉短气，饮食减少。屡次延医服药，或投以宣通，或投以升散，或投以健补脾胃，兼理气之品，皆分毫无效。浸至饮食日减，羸弱不起，奄奄一息，病家亦以为不治之证矣。后闻愚在其邻村，屡救危险之证，复延愚诊视。其脉弦细欲无，频吐稀涎。询其心中，言觉有物杜塞胃口，气不上达，知其为寒饮凝结也。遂投以理饮汤，方中干姜改用七钱，连服三剂，胃口开通。又觉呼吸无力，遂于方中加生黄芪三钱，连服十余剂，病全愈。

A lady, about 50 years of old, felt short of breath and poor eating. She also visited many doctors, taking dispersing herbs, or raising-dispersing herbs, or –Spleen-nourishing, or Qi-dispersing herbs, none worked. Later, the disease was delayed, so that she felt less and less eating, very weak to get up. The family thought she got hard-to-cure disease. Later, they heard that I was in another village close by and that I have saved many dangerous cases, so come to ask my help. Her pulse was string, thin and weak to disappear. She spit clear, water-like saliva very frequently. She told that she felt something blocked in her chest, which block the upper stomach, felt the air not moving up. I suspected her condition as Cold Phlegm-Yin block in the chest. She was given the Liyin Tang to drink, in which the herb Ganjiang was increased to 21 gram. After three doses, her appetite was recovered. For her hard to breath, added Hungqi 9 gram in the formula. After tens of doses, the condition was cured.

方书谓，饮为水之所结，痰为火之所凝，是谓饮凉而痰热也。究之饮证亦自分凉热，其热者，多由于忧思过度，甚则或至癫狂，虽有饮而恒不外吐。其凉者，则由于心肺阳虚，如方名下所言种种诸情状。且其证，时吐稀涎，常觉短气，饮食廉少，是其明征也（后世谓痰之稀者为饮，稠者为痰，与《金匮》所载四饮名义不同）。
In medical books, it is said that, the Yin is developed from the Water, while the phlegm from Fire. However, the Yin can also be separated into the Cold and Hot. The Hot Yin is mostly due to over missing-thinking. The person can even have madness. He will not spit even if there is Yin condition in the body. The Cold Yin is due to the Yang deficiency of the Heart-Lung. The clinic manifestations as listed under the Liyin Tang here. The person can spit water-like saliva from time to time, felt short of breath, reduced eating. (Later doctors named the not-thick phlegm as the Yin, the thick phlegm as the phlegm. This is different from the concept in the book《Jin Kui》for the four Yin conditions. )

邑，韩××医学传家，年四十有四，偶得奇疾。卧则常常发搐，旋发旋止，如发寒战之状，一呼吸之间即愈。即不发搐时，人偶以手抚之，又辄应手而发。自治不效，广求他医治疗皆不效。留连半载，病势浸增。后愚诊视，脉甚弦细。询其饮食甚少，知系心肺脾胃阳分虚惫，不能运化精微，以生气血。血虚不能荣筋，气虚不能充体，故发搐也。必发于卧时者，卧则气不顺也。人抚之而辄发者，气虚则畏人按也。授以理饮汤方，数剂，饮食加多，搐亦见愈。二十剂后，病不再发。

Mr. Han, 44 years of old, was a doctor with family doctor history. Occasionally, he suffered from a strange disease. He would have spasm when he had sleep. It comes and goes quickly, as having a chilly. On the outbreak, he might appear as his breath stopped. When there was no outbreak, touch him by hand may trigue the outbreak. Neither he himself, or other doctors, could help him. After delay for some years, the disease became worse. When I saw him, his pulse was string and thin. When asked, he said he ate very little. It was so suspected to have Spleen-Stomach Yang deficiency, which cannot conduct the food metabolism to produce more Qi and Blood. The insufficient blood cannot nourish the tendons. The Qi deficiency cannot fill up the body, so the spasm happens. The Qi is not smooth during the lying down, so the spasm occurred mostly in lying position. When the Qi is insufficient, the person dislikes touch by others. Therefore the spasm occurred when touched by others. He was given this Liyin Tang. After several doses, his eating was increased and the spasm was also reduced in level. Twenty doses alter, the disease stopped.   

2．理痰汤

2. Litan Tang. (Li means clearing, tan means phlegm in Chinese)

治痰涎郁塞胸膈，满闷短气。或渍于肺中为喘促咳逆。停于心下为惊悸不寐。滞于胃口为胀满哕呃。溢于经络为肢体麻木或偏枯。留于关节，着于筋骨，为俯仰不利，牵引作疼。随逆气肝火上升，为眩晕不能坐立。
This formula works for a phlegm accumulation condition. If it accumulates in chest, the person feels fullness in chest, cough and/or asthma. If it is in the upper abdomen, he feels scaring and has poor sleep. If it is in the stomach, the person has stomach bloating, hiccup, burping. If it sticks in the meridian, the person feels numb or has paralysis in the extremes. If it stocks in the joints, or in the bone or tendons, the body cannot bend or stretch smoothly and feels pain. If the phlegm rushes up with the Liver Fire, the person feels dizziness and hard to stand or sit up.

生芡实（一两） 清半夏（四钱） 黑芝麻（三钱，炒捣） 柏子仁（二钱，炒捣） 生杭芍（二钱）陈皮（二钱） 茯苓片（二钱）
Qianshi 30 gram, Banxia 12 gram, Heizima 9 gram (fried, grind), Boziren 6 gram (fried and grind), Baishao 6 gram, Chenpi 6 gram, Fuling 6 gram  

世医治痰，习用宋《局方》二陈汤，谓为治痰之总剂。不知二陈汤能治痰之标，不能治痰之本。何者？痰之标在胃，痰之本原在于肾。肾主闭藏，以膀胱为腑者也。其闭藏之力，有时不固，必注其气于膀胱。膀胱膨胀，不能空虚若谷，即不能吸引胃中水饮，速于下行而为小便，此痰之所由来也。又肾之上为血海，奇经之冲脉也。其脉上隶阳明，下连少阴。为其下连少阴也，故肾中气化不摄，则冲气易于上干。为其上隶阳明也，冲气上干，胃气亦多上逆，不能息息下行以运化水饮，此又痰之所由来也。此方以半夏为君，以降冲胃之逆。即重用芡实，以收敛冲气，更以收敛肾气，而浓其闭藏之力。肾之气化治，膀胱与冲之气化，自无不治，痰之本原清矣。用芝麻、柏实者，润半夏之燥，兼能助芡实补肾也。用芍药、茯苓者，一滋阴以利小便，一淡渗以利小便也。用陈皮者，非借其化痰之力，实借其行气之力，佐半夏以降逆气，并以行芡实、芝麻、柏实之滞腻也。
When treat the Phlegm condition, doctors commonly used the Erchen Tang that introduced in the book 《Ju Fang》. It is said that this is the root formula for the Phlegm condition. They do not know that this formula can treat the result (symptom) of the Phlegm, but not the reason (source) of the Phlegm. Why? The symptom of the Phlegm is in the Stomach, while the source and the reason for the Phlegm is in the Kidney. The Kidney dominates the holding function, since Urine Bladder is its container. Sometimes, its holding capacity is in disorder, it has to share its Qi to the Urine Bladder. The Urine Bladder becomes full, cannot keep in a empty status, e.g. cannot attract the Water Yin from the Stomach into the Urine Bladder as urine. So the Stomach Yin turns into the Phlegm. … Again, the Kidney Qi is easy to rush up, to push the Stomach Qi up too. The Stomach Qi cannot flow down to transport the Water down. This is another reason for the source of the Phlegm. In this formula, herb Banxia is the king, the leader, the dominating herb, to suppress the reversed Stomach Qi. Using large amount of herb Qianshi is to suppress the up-rushing Qi. More importantly, it works to restrain the Kidney Qi, to enhance its holding capacity, so to solve the reason for the Phlegm. The use of Heizhima and Boziren, for their lubrating capacity, is to solve the dryness side effect of Banxia.  They can also help the Qianshi to nourish the Kidney. Herb Shaoyao can nourish the Yin to help urine; and Fuling can also promote urine. To use Chenpi is not to take its advantage of dissolving Phlegm, but of promoting Qi movement, to help Banxia to suppress the reversed Qi, as well as to reduce the sticky nature of the Qianshi, Zhima and Boziren.

友人毛××，曾治一妇人，年四十余。上盛下虚，痰涎壅滞，饮食减少，动则作喘。他医用二陈汤加减治之，三年，病转增剧。后延毛××诊视，投以此汤，数剂病愈强半。又将芡实减去四钱，加生山药五钱，连服二十余剂，痰尽消，诸病皆愈。至今数年，未尝反复。
My friend Mr. Mao has treated a lady who was 40 years of old. Her condition was Upper-Extreme-Lower-Weakness. She had lots of phlegm in the chest, had reduced eating, and asthma upon slight physical activity. Previous doctors used Erchen Tang (with some modifications) for the treatment. After three years, the condition was worse. When Mr. Mao saw her, he gave this Litan Tang. After several doses, her condition was improved more than half. He then reduced the amount of Qianshi, added Shangyao 15 gram. After intake of twenty doses, the phlegm disappeared completely. It has been several years pass, no any recur.

毛××又尝治一少妇，患痫风。初两三月一发，浸至两三日一发。脉滑、体丰，知系痰涎为恙。亦治以此汤，加赭石三钱，数剂竟能拔除病根。后与愚觌面述之。愚喜曰：向拟此汤时，原不知能治痫风，经兄加赭石一味，即建此奇功，大为此方生色矣。
Mr. Mao also treated another lady, who suffered from Dianfeng (epilepsy and seizures). The disorder had outbreak once every two to three months, gradually once every two to three days. Her pulse was slippery. She was overweight. It is so believed to be a Phlegm condition. She was given this Litan Tang, with addition of Daizheshi 9 gram. Several doses even cured the condition. Later, when we met, he told me this case. I was very happy and said: in the beginning when I set up this formula, I did not know that it can treat seizures. With addition of Daizheshi by you, it works so marvelous. You bright this formula!

按：此方若治痫风，或加朱砂，或加生铁落，或用磨刀水煎药，皆可。

Comment: if this formula is used for the seizures, Zhusha (cinnabar), Shenqieluo can be added. Or, the formula can be cooked with Modao water[1], instead of pure water.

3．龙牡理痰汤

3. Longmu Litan Tang

治因思虑生痰，因痰生热，神志不宁。
Longmu Litan Tang treats the Phlegm-Fire condition, in which the Phlegm is due to over worry and the Fire is due to the Phlegm, so the heart-spirit is not calm.

清半夏（四钱） 生龙骨（六钱，捣细） 生牡蛎（六钱，捣细） 生赭石（三钱，轧细） 朴硝（二钱）黑芝麻（三钱，炒捣） 柏子仁（三钱，炒捣） 生杭芍（三钱） 陈皮（二钱） 茯苓（二钱）
Banxia 12 gram, Longgu 18 gram (grind), Muli 18 gram (grind), Daizheshi 9 gram, Puxiao 6 gram, Black Zhima 9 gram (fried and grind), Boziren 9 gram (fried and grind), Baishao 9 gram, Chenpi 6 gram, Fuling 6 gram.

此方，即理痰汤，以龙骨、牡蛎代芡实，又加赭石、朴硝也。其所以如此加减者，因此方所主之痰，乃虚而兼实之痰。实痰宜开，礞石滚痰丸之用硝黄者是也；虚痰宜补，肾虚泛作痰，当用肾气丸以逐之者是也。至虚而兼实之痰，则必一药之中，能开痰亦能补虚，其药乃为对证，若此方之龙骨、牡蛎是也。

This formula is modified from above Litan Tang, in which, the herb Qianshi is replaced by Longgu and Muli, and herb Daizheshi and Puxiao are added. The reason for such modification is that, this formula is set to solve the Phlegm, which is weak but also condensed Phlegm. Condensed Phlegm should be breaken, using Puxiao and Daihuang as in the formula Mengshi Gongtan Wan; the weak Phlegm condition should be nourished, or be supplied.  If the Phlegm is due to Kidney deficiency, the Shenqi Wan should be used to expel the Phlegm. For such condition with both weak and condensed Phlegm, there should be herbs both to break and to nourish, so that the herbs match the disease, such as the use of Longgu and Muli.

盖人之心肾，原相助为理。肾虚则水精不能上输以镇心，而心易生热，是由肾而病及心也；心因思虑过度生热，必暗吸肾之真阴以自救，则肾易亏耗，是由心而病及肾也。于是心肾交病，思虑愈多，热炽液凝，痰涎壅滞矣。惟龙骨、牡蛎能宁心固肾，安神清热，而二药并用，陈修园又称为治痰之神品，诚为见道之言。故方中用之以代芡实，而犹恐痰涎过盛，消之不能尽消，故又加赭石、朴硝以引之下行也。
The Heart and the Kidney in the body, in normal condition, works and helps each other. In Kidney deficiency, the Kidney Water cannot be transported up to nourish the Heart, so the Heart tends to develop Fire. This is the condition, the Kidney disease develops into the Heart. If the Heart worries very much to develop Fire, it would attract the Water in the Kidney to save itself. The Kidney would be exhausted to deficiency. This is the condition, in which the Heart disease develops to the Kidney. When both the Heart and the Kidney get sick, the worry is more, the Fire is more. The Fire would burn Water in the body to produce Phlegm. Only the Longgu and Muli can cool down the Heart Fire and too enhance the Kidney. The two herbs were stated by Dr. Xhen Xiuyuan, as the marvelous herbs for the treatment of Phlegm. This is true. Therefore, they are used to replace the Qianshi. For the consideration that the over accumulated Phlegm cannot be cleared completely, the Daizheshi and Puxiao are used to conduct the Phlegm down to expel.

一人，年三十余。常觉胆怯，有时心口或少腹 动后，须臾觉有气起自下焦，上冲胸臆，郁而不伸，连作呃逆，脖项发热，即癫狂唱呼。其夹咽两旁内，突起若瘰 ，而不若瘰 之硬。且精气不固，不寐而遗，上焦觉热，下焦觉凉。其脉左部平和，微嫌无力，右部直上直下（李士材脉诀云直上直下冲脉昭昭），仿佛有力，而按之非真有力。从前屡次医治皆无效。此肾虚，致冲气挟痰上冲，乱其心之神明也。投以此汤，减浓朴之半，加山萸肉（去净核）五钱，数剂诸病皆愈，惟觉短气。知系胸中大气下陷（理详升陷汤下），投以拙拟升陷汤，去升麻、柴胡，加桂枝尖二钱，两剂而愈。盖此证，从前原有逆气上干，升麻、柴胡能升大气，恐兼升逆气。桂枝则升大气，兼降逆气，故以之代升、柴也。
A man, about 30 years of old, felt fear quite often. Sometimes, he felt a tingling in the upper or lower abdomen, then there was a feeling of Qi rushing up to the chest and blocking there, so that he felt hiccups, hot in the neck and then cry and behave mad. There was mass along the side of throat. The mass is not as hard as a tumor. He had also leak of semen even no in sleep. He felt hot in the upper body, but cold in the lower body. His left pulse was calm with little weak, but the right pulse was straight, appearing to be hard, but not hard when touched hard. None of the previous treatments worked. This condition belongs to Kidney deficiency that causes the up-rushing Qi bring the Phlegm up to disturb the Heart. He was given this Longmu Litang Tang, with reduction of Puxiao to half of amount, and addition of Shangyurou (removal of kernel) 15 gram. After several doses, the condition was much improved, with only short of breath. It was considered the Qi-skink condition (see the chapter for the Qi-sink), so he was given the Shengxian Tang, with removal of Shengma and Chaihu, but add Guizhi Tip 6 gram. Two doses solved the condition. For this case, there was previously the reversed Qi rushing up, the use of Shengma and Chaiju may promote the reverse Qi again. Guizhi can raise the Big Qi, and also suppress the reversed Qi, so it is used to replace the Shengma and Chaihu.

一媪，年六十二，资禀素羸弱。偶当外感之余，忽然妄言妄见，惊惧异常，手足扰动，饥渴不敢饮食，少腹塌陷，胸膈突起。脉大于平时一倍，重按无力。知系肝肾大虚，冲气上逆，痰火上并，心神扰乱也。投以此汤，去朴硝，倍赭石，加生山药、山萸肉（去净核）、生地黄各六钱。又磨取铁锈水煎药（理详一味铁养汤下），一剂即愈。又服一剂，以善其后。

An old lay, 62 years of old, was slim and weak for her whole life. One day after a common cold, she suddenly had delebious speak and watch, appearing as she was very fear or scared, mad movement of arms and legs. She felt thirsty and hungry but dared not to drink or eat. Her lower abdomen shrink down, but the chest bloated up. The pulse was big, double amount as usual, but weak when touch heavier. Her condition is considered to be: the Liver-Kidney was weak; the Chong Qi rushed up; the Phlegm and Fire rushed up to bother the Heart. She was given this Longmu Litang Tang, with removal of Puxiao, double the Daizheshi, addition of Shanyao 18 gram, Shanyurou (remove kernel) 18 gram, and Shengdi 18 gram. The herbs were cooked in Modao water, not in pure water. One dose solved all disorders. Additional dose was used for a maintenance.

4．健脾化痰丸

4. Jianpi Huatan Wan

治脾胃虚弱，不能运化饮食，以至生痰。
This formula is used to solve Spleen-Stomach weak, so they could not digest food, and cause Phlegm.

生白术（二两） 生鸡内金（二两，去净瓦石糟粕）
Baizhu 60 gram, Jineijin 60 gram.

上药二味，各自轧细过罗，各自用慢火焙熟（不可焙过），炼蜜为丸梧桐子大。每服三钱，开水送下。白术为健补脾胃之主药，然土性壅滞，故白术多服久服，亦有壅滞之弊；有鸡内金之善消瘀积者以佐之，则补益与宣通并用。俾中焦气化，壮旺流通，精液四布，清升浊降，痰之根柢蠲除矣。又此方不但治痰甚效，凡廉于饮食者，服之莫不饮食增多。且久服之，并可消融腹中一切积聚。初拟此方时，原和水为丸。而久服者间有咽干及大便燥结之时。后改用蜜丸，遂无斯弊。

The two herbs were grinded to thin powder, separately. Then bake with mild fire (do not bake over). Mix them and make into pills with honey as 1 cm diameter. Take 9 gram each time. Swallow with help of warm water. Herb Baizhu is the main herb to nourish the Spleen. However, if it is taken for a long time, the person may feel fullness in the stomach. The Jineijin (the inside membrane of stomach) is good to melt and to dissolve accumulated mass, so to solve this side effect. The combination of them works both for nourishing and dispersing. When the middle Qi works, the nutrition distributes to the body; the clear Qi rising and the heavy Qi flowing down; the source for Phlegm is removed. This formula can not only be used in the treatment of Phlegm, but also of any poor-eating conditions. Long term of take helps to increase eating, to dissolve any mass in the stomach too. In the beginning to set up this formula, it is prepared into pills with water. A long time intake of such pills may cause dry throat and/or constipation. After change to use honey, the side effect no longer is a problem.

5．期颐饼

5. Qiyi Bing. (Qi means hope; Yi means long life span, and Bing means cake.)

治老人气虚，不能行痰，致痰气郁结，胸次满闷，胁下作疼。凡气虚痰盛之人，服之皆效，兼治疝气。
This formula is for old man. He/she has Qi insufficiency, hard to cleansing the Phlegm, which is so accumulated and causes fullness in the chest and pain on the side of abdomen. It works for any people with overwhelming Phlegm in the body. It also works for hernia.

生芡实（六两） 生鸡内金（三两） 白面（半斤） 白沙糖（不拘多少）
Qianshi 180 gram, Jineijin 90 gram, white wheat flour 180 gram, white sugar some amount.

先将芡实用水淘去浮皮，晒干，轧细，过罗。再将鸡内金（中有瓦石糟粕去净分量还足）轧细，过罗，置盆内浸以滚水，半日许。再入芡实、白糖、白面，用所浸原水，和作极薄小饼，烙成焦黄色，随意食之。
Wash the Qianshi with water. Remove floating peel, dry naturally under sunshine, grind into powder. Gring Jineijin into powder (remove any debrits), rinse it in boiling water for half day. Add the Qianshi powder, wheat flour and sugar in. Prepare the mixture into cake. Bake it and eat it.

鸡内金，以补助脾胃，大能运化饮食，消磨瘀积。食化积消，痰涎自除。再者，老人痰涎壅盛，多是下焦虚惫，气化不摄，痰涎随冲气上泛。芡实大能敛冲固气，统摄下焦气化。且与麦面同用，一补心，一补肾，使心肾相济，水火调和，而痰气自平矣。
Jineijin works to help the Spleen-Stomach to function, can help digestion and wear down any accumulated mass in the stomach. When the food is well digested and accumulated mass disappears, there is no way to have Phlegm in the body. In old person with lots of phlegm, the most common reason is the weakness in the Lower Jiao, in which the Qi movement is reduced and the phlegm rushes up. Qianshi can restrain the Qi and to govern the Qi movement in the Lower Jiao. Together with the wheat flour, one helps the Heart and one helps the Kidney, making the Heart and Kidney work and help in a harmony manner, e.g. the Fire and Water in a harmony status, the phlegm of course would disappear.

或问：老人之痰，既由于气虚不行，何不加以补助气分之品？答曰：凡补气之药，久服转有他弊。此方所用药品，二谷食，一肉食，复以沙糖调之，可作寻常服食之物，与他药饵不同。且食之，能令人饮食增多，则气虚者自实也。
It might be asked: the phlegm in old people, if it is due to Qi deficiency, why not add some Qi-nourishing herbs? Answer: the Qi-nourishing herbs, after a long time intake, could cause side effect. The ingredients used in this formula, one is wheat (wheat flour), one is meat (Jineijin), mixed with sugar, so can be eaten as regular food. It can increase the eating, so the Qi deficiency is solved.

此方去芡实，治小儿疳积痞胀，大人 瘕积聚。

After removal of Qianshi from this formula, it can be used to treat accumulated mass in the children, and mass in adult.

6．治痰点天突穴法

6. Solve the phlegm – Massage on the Tiantu point

（附：捏结喉法、明矾汤、麝香香油灌法）
点天突穴以治痰厥，善针灸者，大抵知之。而愚临证体验，尤曲尽点法之妙。穴在结喉（颈间高骨）下宛宛中。点时屈手大指（指甲长须剪之）以指甲贴喉，指端着穴，直向下用力（勿斜向里），其气即通。指端，当一起一点，令痰活动，兼频频挠动其指端，令喉痒作嗽，其痰即出。
To massage on the Tiantu point to solve coma due to block by phlegm is well known by acupuncturist. In my clinic experience, there are some subtle tricks to do it. The Tiantu point is in the hollow under the Adam’s apple….

一妇人，年二十许。数日之前，觉胸中不舒，一日忽然昏昏似睡，半日不醒。适愚自他处归，过其村。病家见愚喜甚，急求延医。其脉沉迟，兼有闭塞之象。唇 动。凡唇动者，为有痰之征。脉象，当系寒痰壅滞上焦过甚。遂令人扶之坐，以大指点其天突穴，俾其喉痒作嗽。约点半点钟，咳嗽十余次，吐出凉痰一碗，始能言语。又用干姜六钱，煎汤饮下而愈。
A lady, 20 years of old, felt fullness and discomfort in the chest several days ago. One day, she suddenly fall into drowsy and sleep for half day without wake. By chance, I was pass this village. The family was happy and invited me to have a look. Her pulse was deep and late with somehow close/block feeling. Her mouth lips were moving. The moving mouth lips is the indication of phlegm. The pulse should suggest that the Cold Phlegm accumulated too much in the Upper Jiao. So, I asked the help her sit up; used my thumb to massage her Tiantu point to making her feel tingling to couch. After about 30 min, she coughed ten times and spitted out one bowl of cold phlegm, and started to speak. Then I prescribed Ganjiang 18 gram to cook and to drink. The problem was solved. 

岁在甲寅，客居大名之金滩镇。时当孟春，天寒，雨且雪，一兵士衣装尽湿，因冻甚，不能行步，其伙舁之至镇，昏不知人。呼之不应，用火烘之，且置于温暖之处，经宿未醒。闻愚在镇，曾用点天突穴法，治愈一人，求为延医。见其僵卧不动，呼吸全无。按其脉，仿佛若动。以手掩其口鼻，每至呼吸之顷，微觉有热，知犹可救。遂令人扶起俾坐，冶以点天突穴之法，兼捏其结喉。约两点钟，咳嗽二十余次，共吐凉痰碗半，始能呻吟。亦饮以干姜而愈。

One early spring, the weather was very cold. It was raining and snowing. A soldier had his dressing all wet. For cold, he could not walk. Upon walked to the village where I was, he lost consciousness, without any response upon calling. He was arranged close to a fire to warm him. He was not waked up for the whole night. The people heard that I had been in that village solved a person with the Tiantu point massage, so came for help. When I came to see the sick soldier, he lied there without any movement and without any breath. His pulse seems with pulsing. When touched his mouth with my hand, I felt some warm, so I thought there was chance to save him. I asked help to let him sit up, use the Tiantu Massage, in addition with the use of throat-holding technique. After about two hours, he coughed twenty times, spitted out one and half bowl of cold phlegm, and started to have breath. He was also given the Ganjiang water to drink for a final cure.

【捏结喉法】得之沧州友人张××，其令人喉痒作嗽之力尤速。欲习其法者，可先自捏其结喉，如何捏法即可作嗽，则得其法矣。然当气塞不通时。以手点其天突穴，其气即通。捏结喉，必痒嗽吐痰后，其气乃通。故二法宜相辅并用也。

The throat-holding technique was learned from my friend in Canzhou city, Mr. Zhang. It works much better to let people feel itch to cough. To practice it, you can hold your own Adam’s apple, see in which way you would feel itch to cough. That is the way. However, when the Qi is not conducting, the Tiantu point massage can make the Qi moves. The throat-holding technique stimulates cough, the Qi then conducts. Therefore, the two techniques are usually used together.

按：西人谓，冻死者若近火，则寒气内迫，难救。宜置寒冷室中，或树阴无风处，将衣服脱除，用雪团或冷水，周身摩擦；或将身置冷水中，周身摩擦。及四肢渐次柔软，行人工呼吸法，此时摩擦，更不宜间断。迨患者自能呼吸，先被以薄衾，继用稍浓之被，渐移入暖室。
If put a heavy-freezing person close to fire, the cold would come into the body, and the save of his life would be difficult. The frozen person should be put in cold room, or put in a place without wind. Take off his clothes, massage his body with snow or cold water; or put his body in cold water to massage. When the extremes become soft, practice artificial breath to him. At this time, continue the massage without stop. When the person can have breath by himself, cover him with thin covering, then gradually with heavier covering and move him into warm room.

按：此法必周身血肉，冻至冰凝，呼吸全无者，方宜用之。若冻犹不至若是之剧，用其法者又宜斟酌变通。究之其法虽善，若果有寒痰杜塞，必兼用点天突穴，捏结喉法，方能挽救。

Comment: this procedure is used when the person is frozen to ice and has no any breath. If it is not frozen to such level, the saving technique is somehow different. This technique works, but if there is cold phlegm block, the Tiantu point massage and the throat-holding technique should be used to save the life.

人工呼吸法，即患者呼吸全无，以法复其呼吸之谓也。其法，先将患者仰卧，俾其头及胸稍高。启其口，将舌周遭缠以细布条，紧结之，防舌退缩，及口之收闭。救护者跪于头之旁，以两手握患者之两肘，上提过头，俾空气流入肺中，以助其吸后，须臾，将两肘放下，紧压于胸胁之际，以助其呼（助其呼时更有人以两手心按其胸及心窝更佳）。如此往复，行至患者自能呼吸而止。此为救急之良方，凡呼吸暴停者，皆可用此方救之。
(this paragraph tells how to practice artificial breath saving technique).

【明矾汤】生白矾，长于治顽痰热痰，急证用之，诚有捷效。惟凉痰凝滞者，断不可用。一妇人，年二十余。因悲泣过度，痰涎杜塞胃口，其胃气蓄极上逆，连连干呕。形状又似呃逆，气至咽喉不能上达。剧时，浑身抖战，自掇其发，有危在顷刻之状。医者，用生姜自然汁灌之，益似不能容受。愚诊视之，其脉左手沉濡，右三部皆无。然就其不受生姜观之，仍当是热痰杜塞，其脉象如此者，痰多能瘀脉也。且其面有红光，亦系热证。遂用生白矾二钱，化水俾饮之，即愈。此方愚用之屡次，审知其非寒痰杜塞，皆可随手奏效。即痰厥至垂危者，亦能救愈。
【Ming Fan Tang】: Baifan (alum) is good at solving sticky and hot phlegm. It works in many emergency conditions. It should not be used in cold phlegm at all. A lady, 20 years of old, due to cry too much, had phlegm block in the stomach. The Stomach Qi accumulated more and it reversely rushed up to cause dry nausea, which appeared also as hiccups. She felt the air could only reach to the throat, not further. When the condition is severe, her body was shacking as to die. Doctor had tried to let her drink Ganjiang tea, but she could not endure. When I saw her, her left pulse was deep and ru, right pulse could not be touched at all. Since she could no endure the Ganjiang tea, it was considered to belong to Hot Phlegm, not Cold Phlegm. Her pulse as such could be due to the block of the pulse by the phlegm. Her face was red in color, suggesting the Hot Phlegm too. So, she was asked to drink the Baifan (alum) 6 gram in water. The condition was solved right away. This formula has been used by my self several times, knowing it works in the Hot Phlegm condition, even if the condition is so severe to threaten the life.

【麝香香油灌法】严用和云：“中风不醒者，麝香清油灌之。”曾治一人，年二十余。因夫妻反目，身躯忽然后挺，牙关紧闭，口出涎沫。及愚诊视，已阅三点钟矣。其脉闭塞不全，先用痧药吹鼻，得嚏气通，忽言甚渴。及询之，仍昏昏如故，惟牙关微开，可以进药。因忆严用和麝香清油灌法，虽治中风不醒，若治痰厥不醒，亦当有效。况此证形状，未必非内风掀动。遂用香油二两炖热，调麝香一分，灌之即醒。
【Shexiang Xiangyou Pouring】: Dr. Yan Yunhe said: “In the condition of stroke with loss of consciousness, use the Shexiang Xiangyou to pour.” There was a case. The person was 20 years of old. Due to quarrel with his wife, he suddenly had his body straight and fall backwards. His teeth bite tightly, and his mouth spit white bubble. When I saw him, three hours has past. His pulse was blocked. He was first given herbs into nose to make him sneeze. He then said he felt very thirsty. When asked again, he fall into loss of consciousness again, with only mouth slightly open. Since remembered the Dr. Yang method, it is used for loss of consciousness in stroke, it should also work for the loss of consciousness in Phlegm block condition. In addition, his condition now might also be with inner Wind attack. So, take Xiangyou (sesame oil) 60 ml warm up, mix it with Shexiang (musk) 0.3 gram. Pour the mixture into his mouth and he waked up.

又：硼砂四钱化水，治痰厥可代白矾，较白矾尤稳妥。若治寒痰杜塞，用胡椒三钱捣碎，煎汤灌之，可代生姜自然汁，与干姜汤。
Addition comment: Pengsha (Borax) 12 gram, dissolved in water, can be used to replace alum in the treatment of Phlegm-stroke condition. It is much  safe. To treat Cold Phlegm, use hot pepper powder. Mix the pepper with water, pouring into his anus, to replace the use fresh ginger juice, or Ganjiang (dried ginger) juice.

附录：
Appendix:

沧县董××来函：
Letter from Mr. Dong, from Can city:

朱姓妇，产后旬余，甚平顺。适伊芳弟来视，午后食煮包一大碗，伊芳弟去后，竟猝然昏倒，四肢抽搐，不省人事。延为诊视，六脉皆伏。当系产后五内空虚，骤而饱食填息，胸中大气不能宣通，诸气亦因之闭塞，故现此证。取药不及，急用点天突穴及捏结喉法，又用针刺十宣及少商穴，须臾咳吐稠痰若干，气顺腹响，微汗而愈。

A lady, Mrs. Zhu, had childbirth for some months. Everything was ok. One day, after eating one bowl of food, she suddenly fall down, lost consciousness, with spasm and shacking in arms and legs. When I saw her, there were no any pulses. This is a condition, in which the body was empty in side body after childbirth. The empty inside was suddenly filled with large amount of food, which blocked the Big Qi in chest, so that every Qi movement was stopped to function. There was no time to buy herbs, so I used Tiantu massage technique and throat-holding technique, together with acupuncture on Shixuan point and Shaoshang point. Soon, she spitted out some stick phlegm, with sound in the stomach and slight sweat on the skin. The condition was solved.