Written By Jun Heo(許浚, 1539~1615), Translated by Namil Kim, Wung Seok Cha et al., Published by Ministry of Health & Welfare (Korea)
18 Emetic Methods for Phlegm and Fluid Retention 痰飮吐法 담음의 토법
① When phlegm is in the diaphragm, the emetic method must be used. The draining method will not be effective.
② When the person’s pulse is floating, the emetic method should be used.
③ When phlegm is attached firmly with stickiness and turbidity, the emetic method must be used.
④ Phlegm along the meridians must be treated with the emetic method. The emetic method has the meaning of dispersion not only in inducing vomiting phlegm.
⑤ When using the emetic method, qi should be brought upward for the person to vomit soon. Herbs like Saposhnikoviae Radix (防風), Gardeniae Fructus (梔子), Cnidii Rhizoma (川芎), Platycodonis Radix (桔梗), Camelliae Sinensis Folium (芽茶) ,Zingiberis Rhizoma Crudus (生薑), and Kimchi liquid are used. Also, prescribe a Syzygii Flos Relieve Stomach Decoction and massage the throat to induce vomiting, or prescribe Trichosanthes Guiding Powder.
19 Treatment Methods for Phlegm and Fluid Retention 痰飮治法 담음 치료법
① Strengthening the spleen Earth and drying spleen dampness are the key points of treatment.
② When a weak person has phlegm in the middle energizer, the phlegm should not be suddenly removed because stomach qi receives nutrients from phlegm. When all the phlegm is purged, the person will become more deficient.
③ Using too much qi-circulating herbs in treating phlegm renders the spleen qi to move downward. This causes easy formation of phlegm, which in turn results in more phlegm in the body. When treating phlegm, the spleen should be tonified and middle qi should be cleared to make phlegm move downward by itself. This is a method of treating the root.
④ When treating phlegm, first harmonize qi and distribute it. Ascending qi belongs to Fire. The movement of phlegm due to
qi is called phlegm qi. Use a Smooth Qi and Guide Out Phlegm Decoction. The movement of phlegm due to Fire is called phlegm Fire. Use a Clear Heat and Guide Out Phlegm Decoction. The movement of phlegm due to dampness is called dampness phlegm. Use a Guide Out Phlegm Decoction. A Syzygii Flos Relieve Stomach Decoction is widely used.
⑤ A yang deficiency causes the kidneys to become cold. This causes the overflow of cool phlegm, dizziness, dyspnea at night, and soaring qi. It should be pressed and brought down by an Eight Ingredients Pill. (The formula is written in the chapter on Deficiency Vexation). Or Black Metal Elixir, (The formula is written in the chapter on Deficiency Vexation).
⑥ When transportation and transformation do not work properly due to a spleen deficiency, use a Six Gentlemen Decoction with the leaf of Bambusae Caulis in Liquamen (竹瀝) and the juice of Zingiberis Rhizoma Crudus (生薑汁) or use a Tonify the Center to Augment the qi Decoction with Pinelliae Tuber (半夏), Bambusae Caulis in Liquamen (竹瀝) and the juice of Zingiberis Rhizoma Crudus (生薑汁)
⑦ Zhang Zihe says, “Do not use the tonifying method for fluid retention diseases. The treatment should aim at removing water qi. The diseases will be cured well by promoting perspiration, the emetic method, and purgation.” However, the diseases may accompany coldness, deficiencies, or deficient blood and qi. Therefore, the treatment should simultaneously
remove a blockage by phlegm and tonify the deficiency. Therefore, the doctors should not be tied to the three methods of Zhang Zihe (張子和).
⑧ Phlegm is formed in the spleen. In treatment, the spleen should be tonified and dampness dried. Also, when it moves upward along with qi, which belongs to Fire, qi should be harmonized first. Harmonizing the qi means bringing the Fire down.
⑨ The Classic of Difficult Issues (難經) says, “The kidneys govern the five fluids”. The five fluids transform to the five dampnesses, and dampness engenders phlegm. Phlegm is the movement of dampness in the spleen due to coughing. Pinelliae Tuber (半夏) can remove phlegm that is manifested in the exterior, but cannot remove its origin. To remove the origin of phlegm is to clear the water passage to the kidneys. A Ten Jujubes Decoction and Triple Transformation Spiritual Blessing Pill (the formula is written in the later chapter) have this effect.
⑩ Heat phlegm should be cooled by Gypsum Fibrosum (石膏), Polygoni Tinctori Fructus (靑黛), Gardeniae Fructus (梔子), Scutellariae Radix (黃芩), and Coptidis Rhizoma (黃連). Cold phlegm should be warmed by Pinelliae Tuber (半夏), Zingiberis Rhizoma Crudus (乾薑), Aconiti Lateralis Radix Preparata (附子), and Cinnamomi Cortex (肉桂). Dry phlegm should be moistened. Use Trichosanthis Semen (瓜蔞仁), Armeniacae Semen (杏仁), Schisandrae Fructus (五味子), and Trichosanthis Radix (天花粉). Dampness phlegm should be dried with Atractylodis Rhizoma (蒼朮), Atractylodis Rhizoma Alba (白朮), Magnoliae Cortex (厚朴), and Poria Sclerotium (茯苓). Wind phlegm should be dispersed with Arisaematis Rhizoma (南星),
Gleditsiae Fructus (皂角), Aconiti Koreani Tuber (白附子), and Bambusae Caulis in Liquamen (竹瀝). Old phlegm should be softened with Anodontae Caro (海石), Natrii Sulfas (芒硝), Trichosanthis Semen (瓜蔞仁), Aruantii Fructus Immaturus (枳
殼), and Cyperi Rhizoma (香附子) (便香附子). Phlegm due to indigestion should be resolved by Crataegi Fructus (山楂), Massa Medicata Fermentata (神麯), and Hordei Vulgaris Fructus (麥芽). The core points of treating phlegm is tonifying the spleen with Ginseng Radix (人參) and Glycyrrhizae Radix (甘草), drying dampness with Atractylodis Rhizoma Alba (白朮) and Pinelliae Tuber (半夏), circulating qi with Citrus Unshius Pericarpium (陳皮) and Citri Unshius Pericarpium Immaturus (靑皮), and draining water with Poria Sclerotium (茯苓) and Alismatis Rhizoma (澤瀉).
• Smooth Qi and Guide Out Phlegm Decoction 順氣導痰湯 순기도담탕: 1 don of Pinelliae Tuber (半夏), Arisaematis Rhizoma (南星), Poria Sclerotium (茯苓), Ponciri Fructus Immaturus (枳實), Citrus Unshius Pericarpium (陳皮), Cyperi Rhizoma (香附子), and Linderae Radix (烏藥), and 5 pun of Aucklandiae Radix (木香), Aquillariae Lignum (沈香), and Glycyrrhizae Radix (甘草). Cut these herbs to make 1 package. Boil with 5 pieces of ginger.
• Six Gentlemen Decoction 六君子湯 육군자탕: ① It treats excessive phlegm due to a qi deficiency. 1.5 don of Pinelliae Tuber (半夏) and Atractylodis Rhizoma Alba (白朮), 1 don of Citrus Unshius Pericarpium (陳皮), Poria Sclerotium (白茯苓) and Ginseng Radix (人參), and 5 pun of Glycyrrhizae Radix (甘草) (roasted). Cut these herbs to make 1 package. Boil these with 3 pieces of ginger and 2 dates. ② Other formula uses 1 don of each herb.
20 Common Medicinals for the Phlegmretention Syndrome 痰飮通治藥 담음을 두루 치료하는 약
A Syzygii Flos Relieve Stomach Decoction (二陳湯), Poria and Pinellia Decoction, Chuanxiong and Pinellia Decoction (芎夏湯), Relief Drink and Aaurantii Immaturus Fructus Pill, Worth a Thousand Pieces of Gold Pathfinder Pill, Phlegm Resistance Pill and Minor Kidneys Elixir are commonly prescribed for the phlegm-retention syndrome. A Five Drinks Decoction and Break Up and Eliminate Phlegm Drink Formula are used for cool phlegm. A Flush Away Roiling Phlegm Pill and Aucklandia Harmonize and Moderate Pill should be prescribed for dampness-heat phlegm and fluid retention. Use a Clear Qi and Dissolve Phlegm Pill for phlegm and fluid retention caused by food accumulation. Use a Bamboo Sap and Atractylodes Pill and Rosy Glow in Sky Paste (the formula is written in a previous chapter) for treating phlegm and fluid retention in a weak or old person.
• Syzygii Flos Relieve Stomach Decoction 二陳湯 이진탕
① It widely treats diseases caused by a phlegm and fluid retention syndrome. It treats vomiting, nausea, dizziness, palpitations, cold and fever, and pain that move around the body. 2 don of Pinelliae Tube Preparata (法製半夏), 1 don of Citrus Unshius Pericarpium (橘皮) and Poria Sclerotium (赤茯苓), and 5 pun of Glycyrrhizae Radix (甘草) (roasted). Cut these herbs and make 1 package. Boil with 3 pieces of ginger, and take the drugs.
② Mr. Bang said, “Pinelliae Tuber (半夏) circulates phlegm and dries dampness. Citrus Unshius Pericarpium (橘紅) resolves phlegm and circulates qi. Poria Sclerotium (茯苓) brings qi down and leads dampness out. Glycyrrhizae Radix (甘草) tonifies
the spleen and harmonizes middle qi.” If the spleen is tonified, dampness will not be formed, and when dampness is dried and excreted through urine, dampness will not be formed. If qi is circulated well, phlegm will disappear. Therefore, this drug works on the exterior as well as the interior with essence-function. Add or subtract herbs depending on the patient’s symptoms.
• Poria and Pinellia Decoction 茯苓半夏湯 복령반하탕
① It treats various diseases caused by the rentention of contained fluids and persistently excessive fluid. 3 don of Pinelliae Tube Preparata (法製半夏), 2 don of Poria Sclerotium (赤茯苓). Cut these drugs to make 1 package. Boil these drugs with 7 pieces of ginger, and take this mixture.
② This is the same formula as Renzhai’s Straight-forward Directions on Formulas (直指)’s Pinellia and Poria Decoction.
• Great Pinellia Decoction 大半夏湯 대반하탕
It treats the same symptoms as in the previous formula. 2.5 don of Pinelliae Tube Preparata (法製半夏), Citrus Unshius Pericarpium (陳皮) and Poria Sclerotium (赤茯苓). Cut these drugs to make 1 package. Boil these with 5 pieces of ginger and drink.
• Chuanxiong and Pinellia Decoction 芎夏湯 궁하탕
This prescription is widely used to expel water and bring phlegm and fluid retention syndrome down. 1 don of Cnidii Rhizoma (川芎), Pinelliae Tube Preparata (法製半夏), and Poria Sclerotium (赤茯苓), 5 pun of Citrus Unshius Pericarpium (陳皮), Citri Unshius Pericarpium Immaturus (靑皮), and Aruantii Fructus Immaturus (枳殼), and 2.5 pun of Atractylodis Rhizoma Alba (白朮) and Glycyrrhizae Radix (甘草) (roasted). Cut these herbs to make 1 package. Boil with 5 pieces of ginger and drink.
• Relief Drink and Aaurantii Immaturus Fructus Pill 蠲飮枳實丸 견음지실환
It expels fluid retention, resolves phlegm, circulates qi, and clears the diaphragm. 3 nyang of Pharbitidis Semen (黑丑) (sieved after grinding), and 1 nyang of Ponciri Fructus Immaturus (枳實) (stir-fried with bran), Pinelliae Tube Preparata (法製半夏) and Citrus Unshius Pericarpium (橘紅). Grind these and mix with flour paste. Make the pills to the size of the seed of the royal foxglove tree. Take 50 pills with water boiled with ginger.
• Worth a Thousand Pieces of Gold Pathfinder Pill 千金指迷丸 천금지미환
① It treats various diseases caused by phlegm and fluid retention syndrome. 2 nyang of Pinelliae Tube Fermentata (半夏麴), 1 nyang of Poria Sclerotium (白茯苓) (Mix with Hominis Lac (人乳汁) and steam for the deficient person and soak with Amomi Fructus (砂仁) in alcohol and remove the Amomi Fructus (砂仁) and soak in the juice of Rehmanniae Radix Crudus (生地黃) and steam for the thin person), and Aruantii Fructus Immaturus (枳殼) (soaked with bran in vinegar and stir-fried), and 2.5 don of Mirabilitum (風化硝). Grind these herbs and mix with the paste made with the juice of Zingiberis Rhizoma Crudus (生
薑汁). Make pills to the size of the seed of the royal foxglove tree. Take 30 – 50 pills with water boiled with ginger. After 10 days, feces will become watery. This is an indication of the disappearance of phlegm accumulation.
② For phlegm in the spleen and stomach, make pills with paste made with Massa Medicata Fermentata (神麯).
③ For phlegm in blood, make pill with paste made with alcohol.
④ For phlegm in qi aspect and the upper energizer, make pills with paste made with rice cake.
⑤ For phlegm in the joints and the four limbs, make pills with paste made with alcohol, salt and the juice of Zingiberis Rhizoma Crudus (生薑汁)
⑥ For phlegm in the leg, knead with Achyranthis Radix plaster to pills.
⑦ When the phlegm disease is in serious condition, make pills with beef tallow. If the person takes too much of this, the person may sweat, vomit, or have loose stools as if the emetic method has been used.
• Phlegm Resistance Pill 敵痰丸 적담환
It is widely used for treating phlegm and fluid retention syndrome. 3 nyang of Pharbitidis Semen (黑丑) (grinded and sieved), 2 nyang of Gleditsiae Fructus (皂角) (covered with condensed milk and roasted), 1 nyang of Alumen (白礬) roasted), Pinelliae Tube Fermentata (半夏麴) and Citrus Unshius Pericarpium (陳皮) (removed of the inner peel). Grind these herbs and then mix with water. Make pills to the size of the seed of the royal foxglove tree. Take 40~50 pills with water boiled with ginger.
• Immortal Hanging Phlegm Formula 神仙墜痰元 신선추담원
It is commonly prescribed for various diseases caused by phlegm and fluid retention syndrome. 3 nyang of Pharbitidis Semen (黑丑) (grinded and sieved), 1.6 nyang of Gleditsiae Fructus (皂角) (covered with condensed milk and roasted), and 1 nyang of Alumen (白礬) (in raw state). Grind these drugs and mix these with water. Make pills to the size of the seed of the royal
foxglove tree. Take 30~50 pills with alcohol.
• Minor Kidneys Elixir 小胃丹 소위단
① It treats damp phlegm and heat accumulation in the diaphragm. It acts on the upper part of the body to remove phlegm in the diaphragm, and on the lower part of the body to bring phlegm in the stomach and intestines down. It should not be prescribed to persons who eat little due to a deficient stomach. It also treats wind phlegm, heat phlegm, damp phlegm,
and phlegm due to indigestion. 5 don of Genkwa Flos (芫花) (soaked in vinegar for a night and then stir-fried to black), Euphorbiae Kansui Radix (甘遂) (Covered with flour and roasted under an ash Fire, and then soaked in water for a day before dried under the sun), Euphorbiae Pekinensis Radix (大戟) (decocted in Aqua ex Longo Curso (長流水) and dried under the sun), 1 nyang of Rhei Radix et Rhizoma (大黃) (Covered with damp paper and roasted under an ash Fire and then soaked in alcohol before stir-frying for a long time.), and 2 nyang of Phellodendri Cortex (黃柏) (stir-fried). Powder these drugs and mix these to a soup. Make pills to the size of a hemp seed. Take 10 pills before going to bed.
② Another method is mixing with Atractylodis Rhizoma Alba plaster and making pills to the size of a Raphani Radix (蘿蔔子). Take 20~30 pills before going to bed and drink boiled water.
• Five Drinks Decoction 五飮湯 오음탕
It treats the five kinds of fluid retention: persistently excessive fluid, wall fluid, phlegm-retention, overflowing fluid, and streaming fluid. 7 pun of Inulae Flos (旋覆花), Ginseng Radix (人參), Citrus Unshius Pericarpium (陳皮), Ponciri Fructus Immaturus (枳實), Atractylodis Rhizoma Alba (白朮), orun Sclerotium (茯苓), magnoluns Cortex (厚朴), Pinelliae Tuber (半夏), Alismatis Rhizoma (澤瀉), Polyporus (猪苓), Angelicae Decursivae Radix (前胡), Cinnamomi Cortex (桂心), Paeoniae Radix (白芍藥), and Glycyrrhizae Radix (甘草). Cut these drugs to make 1 package. Boil with 10 pieces of ginger for best results.
• Break Up and Eliminate Phlegm Drink Formula 破痰消飮元 파담소음원
It treats all kinds of phlegm and fluid retention syndromes. 1 nyang of Citri Unshius Pericarpium Immaturus (靑皮), Citrus Unshius Pericarpium (陳皮), Sparganii Rhizoma (三稜) (covered with damp paper and roasted), Curcumae Rhizoma (蓬朮) (covered with damp paper and roasted), Alpiniae Officinari Phizoma (良薑) (roasted under ash Fire), Zingiberis Rhizoma Crudus (乾薑) (covered with damp paper and roasted), and Amomi Tsao-ko Fructus (草果) (covered with damp paper and roasted). Grind these drugs and then mix with paste made with water. Make pills to the size of the seed of the royal foxglove tree. Dry this in the shade and take 50 pills of with water boiled with ginger.
• Flush Away Roiling Phlegm Pill 滾痰丸 곤담환
① It treats all diseases caused by the accumulation of phlegm due to damp heat. 8 nyang of Rhei Radix et Rhizoma (大黃) (steamed with alcohol), Scutellariae Radix (黃芩) (removed of rotten parts), 1 nyang of Chalcocitum (靑礞石) (Sealed with 1 nyang of Mirabilitum (焰硝) in the jar and covered with salty mud, dried under the sun and heated until the Chalcocitum (靑礞石) gains a golden color) and Aquillariae Lignum (沈香). Grind these herbs and mix while water drops are added. Make pills to the size of the seed of the royal foxglove tree. Take 40~50 pills with warm or cold water. It should be taken before going to bed. After taking the prescription, the person should lie still to allow the herbs to move slowly down along the throat and diaphragm. When waste materials are moved down to the stomach and intestines gradually, the person will experience the great effects of this prescription.
② Prescribe 100 pills when the person is out of his or her mind or suffers from mania-withdrawal.
③ Take 30~50 pills for hemiplegia from cerebrovascular diseases or constipation from excessive phlegm.
④ Take 70~80 pills when all the muscles and bones of the body are painful with uncertain symptoms.
⑤ Take 70~80 pills when the person belches, suffers from acid regurgitation, and vomits phlegm and saliva due to qi obstruction in the chest.
⑥ Take 70~80 pills for palpitation, or when it becomes an obstruction and rejection and then shows strange symptoms.
⑦ Take 70~80 pills when the person’s throat is blocked with blood-shot eyes.
⑧ Take 50~60 pills when the cheeks and jaw swell, nodules forms around the neck, or sores form in the mouth and on the tongue.
⑨ When poisonous phlegm attacks from the inside, the following symptoms are observed: painful and ice-coldness of the pit of the stomach, squeezing pain in the abdomen, swelling and pain of the head and face, and swelling and itching of the whole body. It can decrease in some parts of the body while being increased in other parts of the body. Sometimes, it becomes an intestinal abscess or internal carbuncle. Take 70~80 pills at a time.
⑩ Take 80~90 pills at a time when a blood mass or dirty waste comes in dysentery or white dysentery.
⑪ It must be effective when all the other prescriptions do not work for old diseases with various symptoms in the interior or exterior, or when the doctor cannot identify the pattern thoroughly.
⑫ In this prescription, Rhei Radix et Rhizoma (大黃) and Scutellariae Radix (黃芩) greatly purge damp heat within the bright yang stomach. Chalcocitum (靑礞石) brings accumulated phlegm down and Aquillariae Lignum (沈香) leads all qi up to
top of the head and down to the sole.
⑬ 2 nyang of Cinnabaris (朱砂) may be coated before use.
• Aucklandia Harmonize and Moderate Pill 木香和中丸 목향화중환
① It resolves phlegm, removes damp heat, frees the diaphragm, and harmonizes the spleen and stomach. 2.3 nyang of Pharbitidis Semen (黑丑) (grinded and filtered), 2 nyang of Talcum (滑石), 1.2 nyang of Rhei Radix et Rhizoma (大黃), 5 don of Aucklandiae Radix (木香), Scutellariae Radix (黃芩), Chalcocitum (靑礞石), Aruantii Fructus Immaturus (枳殼), Arecae Semen (檳榔), Citri Unshius Pericarpium Immaturus (靑皮) and Citrus Unshius Pericarpium (陳皮), and 2 don of Aquillariae Lignum (沈香). Powder these drugs and mix with water. Make pills to the size of the seed of the royal foxglove tree. Take 50 pills with water boiled with ginger or tea water.
② This is also called an Aquilaria Pill to Harmonise the Center. It treats chest discomfort due to excessive phlegm from damp heat.
• Clear Qi and Dissolve Phlegm Pill 淸氣化痰丸 청기화담환
It treats excessive phlegm due to all kinds of phlegm and fluid-retention, phlegm due to indigestion, and the rentention of food due to immoderate drinking. 2 nyang of Arisaematis Rhizoma (南星) and Pinelliae Tuber (半夏) (Soaked in water with 2 nyang of Alumen (白礬), Gleditsiae Fructus (皂角), Zingiberis Rhizoma Crudus (生薑) for one day, cut, boiled until the white spots on Arisaematis Rhizoma (南星) are removed and dried under the sun.), 1.5 nyang of Massa Medicata Fermentata (神麯) (stir-fried) and Hordei Vulgaris Fructus (麥芽) (stir-fried), 1 nyang of Fraxini Cortex, Ponciri Fructus Immaturus (枳實), Atractylodis Rhizoma Alba (白朮), Poria Sclerotium (白茯苓), Perillae Semen (蘇子), Raphani Semen (蘿蔔子) (stir-fried), Trichosanthis Semen (瓜蔞仁), Cyperi Rhizoma (香附子), Crataegi Fructus (山楂肉), and Amomi Fructus Rotundus (白豆蔲),
5 don of Citri Unshius Pericarpium Immaturus (靑皮), Puerariae Radix (葛根) and Coptidis Rhizoma (黃連), 8 don of Scutellariae Radix (黃芩), and 7 don of Notarchi Leachii Ovum (海粉). Grind these medicinal and with rice cake soaked in Bambusae Caulis in Liquamen (竹瀝), and the juice of Zingiberis Rhizoma Crudus (生薑汁), knead into pills to size of the seed of the royal foxglove tree. Take 50~70 pills at a time with ginger-decocted water or tea.
• Bamboo Sap and Atractylodes Pill 竹瀝枳朮丸 죽력지출환
It treats loss of appetite due to excessive phlegm in the old or deficient person. It tonifies the spleen and promotes digestion. It also resolves phlegm and brings Fire down to remove dizziness. 1 nyang of Pinelliae Tuber (半夏) and Arisaematis Rhizoma (南星) (Boiled with Alumen (白礬), Gleditsiae Fructus (皂角) and Zingiberis Rhizoma Crudus (生薑) for one day, the Gleditsiae Fructus (皂角) and Zingiberis Rhizoma Crudus (生薑) removed and then dried under a fire), Ponciri Fructus Immaturus (枳實), Scutellariae Radix (黃芩) (thin and fruitful), Citrus Unshius Pericarpium (陳皮), Atractylodis Rhizoma (蒼朮) (soaked in rice water and in salt water and then stir-fried), Crataegi Fructus (山楂肉), Brassicae Junceae Folium (白芥子) (stir-fried) and Poria Sclerotium (白茯苓), and 5 don of Coptidis Rhizoma (黃連) (soaked in the juice of Zingiberis Rhizoma Crudus (生薑 汁) and stir-fried) and Angelica Gigantis Radix (當歸) (washed with alcohol). Powder these drugs and mix with paste of 6 nyang of Massa Medicata Fermentata (神麯), and 1 cup of the juice of Zingiberis Rhizoma Crudus (生薑汁) and Bambusae Caulis in Liquamen (竹瀝). Make pills to the size of the seed of the royal foxglove tree. Take 100 pills with boiled water or clear water boiled with ginger.
