The most important thing in our clinical treatment is syndrome differentiation. Pay attention to "due to time, place and people". Therefore, there is a saying that "the same disease is treated differently" and "different diseases are treated together". Among them, "adapting to the time" not only refers to the change of gas in four seasons in a year, but also includes the change of treatment methods. We should also refer to the macro changes of the times, so that the types and nature of diseases will change and the treatment will change accordingly. Historically, with the changes of the times and the spectrum of diseases, many medical schools have been formed. For example, medical schools in the Jin and Yuan Dynasties and febrile diseases in the Ming and Qing Dynasties were all products of the times.

Nowadays, science and technology have made great progress, the degree of social civilization has improved significantly, and material wealth is quite rich. However, the social competition is becoming increasingly fierce, interpersonal relationships are complicated, work is tense and tiring, and mental stress is increasing. In addition, there are many ways of entertainment and rich material enjoyment. Many people are tired of socializing in order to survive, work and career. Fat and sweet all day, addicted to alcohol and tobacco, staying up at five o'clock, waking up after noon, upside down day and night, used to it. Another example is illegal cohabitation, which is very common. Pregnancy before marriage is not uncommon. Marriage is a child's play, and sexual intercourse is a common occurrence. As well as air pollution, environmental degradation and increased radiation. These characteristics of today's era will inevitably lead to changes in the spectrum of diseases, such as AIDS, air-conditioning disease, atypical pneumonia and various sexually transmitted diseases-all unheard of diseases in the past. It is also the role of many social factors that lead to the obvious increase of phlegm syndrome and phlegm disease, and the method of treating phlegm is more valued and widely used by doctors.

1. What is phlegm?

Phlegm is the waste produced by human metabolism and the pathological product of body fluids. Not just the sticky substance between the trachea and the larynx. It can widely stagnate among various organs and tissues of the human body, leading to various strange diseases. Phlegm is not only the cause of many diseases, but also the product of many pathogenic factors in human body. Etiology lists it as one of the internal and external causes, and some people call it the second cause. Physicians in past dynasties also had many clear understandings and incisive expositions on phlegm. Such as: Yuan? The king said, "Phlegm is a thing, rising and falling with qi, and it is everywhere." Ming? Wang Lun also said: "Phlegm is also the name of the disease. A person's body is full of qi and blood, so why is there phlegm in the circulation of body fluid? When the husband's qi and blood are turbid, the body fluid is unclear, and it becomes phlegm after fumigation. " Because the diseases caused by phlegm have few laws to be found, and their symptoms are peculiar, there is a saying that "strange diseases are full of phlegm" and "all kinds of strange syndromes belong to phlegm".

Phlegm is different from drinking: although both of them are caused by water-liquid metabolic disorder, phlegm is sticky and drinking is thin; Phlegm stagnates and moves less, and drinking is uncertain; There is no phlegm in the viscera and tissues of the whole body, and the range of disease caused by drinking is relatively limited; Phlegm syndrome is often irregular, while drinking is simple; There is no exact method to treat phlegm, but drinking can't be separated from warming yang. Phlegm drinking is also very common in clinic.

Phlegm is different from blood stasis: phlegm is condensed by body fluid, while blood stasis is formed by blood stasis; Phlegm can spread all over the viscera, while blood stasis only exists inside and outside the pulse; The diseases caused by phlegm are extensive and changeable, and the diseases caused by blood stasis have many regular characteristics. Phlegm is characterized by swelling more than pain, and blood stasis is characterized by pain more than swelling, and there is a fixed place. There is no definite method to treat phlegm. Treating blood stasis is nothing more than promoting blood circulation and dredging collaterals. Mutual obstruction of phlegm and blood stasis is also very common in clinic.

Second, the formation of phlegm.

1, causes of phlegm:

Excessive six qi and five aspirations can be turned into fire, and fire can burn body fluid and turn into phlegm. In modern society, the climate is getting warmer and the heat is higher. In addition, work stress and fatigue, accelerated pace of life, increased mental stress, or eating spicy food (the current restaurant is almost the world of Sichuan and Hunan cuisine), fat and sweet, excessive alcohol and tobacco; Or nightlife increases, sexual life is excessive, and unrestrained consumption of essence hurts yin; Or abuse warm tonic, the body is slightly unwell, regardless of cold and heat, often eat ginseng, velvet antler, cordyceps. The above factors are generally the inducement of phlegm disease. Zhang Congzheng's "Confucianism is close to people" said: "Anyone who sticks to the beam, lives in leisure, supports himself excessively, and drinks and drinks, so that he leaves a cup of drink." (refers to drinking, including phlegm) "Su Wen? The ancient naive theory put it better, "Today's people take wine as their pulp, do whatever they want, get drunk and enter the palace, try their best to exhaust their essence, dissipate their true feelings, are not satisfied, always wake up, be quick with their hearts, disobey their orders and be unrestrained." "These words are actually a portrayal of the lives of many modern people (especially urban white-collar workers) and a common cause of phlegm disease in today's society.

2. Pathogenesis of phlegm:

The predecessor of phlegm is body fluid. Phlegm turbidity caused by body fluid is due to the burning of fire evil. The so-called "burning liquid into phlegm". Therefore, the body fluid can only burn into phlegm when the evil fire is flourishing. Under what circumstances does fire evil flourish? These are the situations mentioned above: a fire can be made when six gases pass through the pole or five gases pass through the pole, which is the so-called "six gasification fire" and "five gasification fire". The fire that tortures body fluid can be real fire or virtual fire. It's easy to understand. If you really burn the liquid into phlegm, it goes without saying. How does deficiency fire burn body fluid into phlegm? Anyone with excessive fire must first have weak vaginal fluid, yin deficiency leads to hyperactivity of yang, and insufficient body fluid leads to excessive fire. Excessive fire, insufficient yin, body fluid can be burned, and it is easier to condense into phlegm. Therefore, the most fundamental reasons for the formation of this phlegm syndrome are yin deficiency and insufficient body fluid. The treatment can't be simply purging fire, but mainly nourishing yin and promoting fluid production. In addition, the burned body fluid can only stop when it stops. The operation of body fluid needs the promotion of qi. If qi deficiency or qi stagnation cannot promote the movement of body fluid, body fluid will stop accumulating and become turbid. Therefore, treating phlegm should treat qi. Help qi or promote qi to eliminate phlegm. Qi deficiency and qi stagnation can not promote the circulation of body fluid and blood at the same time, so when phlegm syndrome is formed, blood often stagnates and condenses into blood stasis, which is the mutual resistance of phlegm and blood stasis. Therefore, treating phlegm is often combined with removing blood stasis, and vice versa. Phlegm dampness is the same as drinking. At the same time of phlegm turbidity formation, it often has the performance of drying dampness and quenching thirst. Therefore, while eliminating phlegm, we should also eliminate dampness and promote diuresis. Furthermore, the metabolism of body fluid is inseparable from the five internal organs, especially the lung, spleen and kidney. The formation of phlegm turbidity is closely related to the dysfunction of lung, spleen and kidney. This mechanism will be discussed in the later treatment, so I won't go into details here.

The formation mechanism of phlegm syndrome can be summarized as follows:

The Six Factors of Nature ―― Wind

The five senses (seven emotions) cause excessive fire and boiling body fluid into phlegm, which is the second cause of phlegm syndrome.

Diet fatigue, qi deficiency, qi stagnation, asthenia of rising yang

Metabolic dysfunction of five zang-organs

Clinical experience:

"Treatment must seek its root", and treatment of phlegm also requires its root. In clinical practice, the symptoms of phlegm disease and phlegm syndrome are found by four diagnostic methods: looking, smelling, asking and touching. Then, using dialectical kung fu from the exterior to the interior, removing the false and retaining the true, examining the cause of the syndrome and tracing back to the source, we can find out the initial causes of phlegm syndrome, as well as the nature (mainly deficiency and excess, cold and heat) and the existing parts of phlegm. According to the etiology, location and nature of the disease. Is the fundamental treatment.

Physicians in past dynasties paid equal attention to treating phlegm and seeking roots. In particular, the therapeutic principle of "stopping phlegm and treating phlegm" was put forward. For example, Ye said, "If the source of phlegm is not removed, it will be removed." . He Mengyao also said: "Phlegm is also marked, so those who cause phlegm are also." Treatment should focus on the root cause, but it depends on the priority of sputum. "

There are many specific methods to treat phlegm, and different doctors use different methods. Based on the principle of seeking the root of the disease, this paper summarizes many years' experience in treating phlegm, and summarizes eight commonly used methods for treating phlegm in clinic, which are briefly introduced as follows:

First, Yiqi Huatan:

Body fluid runs, and qi is the driving force. "Pneumatic means water moves, and gas stagnation means water stops". Qi deficiency or stagnation of qi leads to qi weakness, and stagnation of body fluid leads to phlegm turbidity. Therefore, all phlegm syndromes, such as qi deficiency or qi stagnation, should be treated to replenish qi and resolve phlegm. Pang An often said: "Those who are good at phlegm must treat qi first, but not phlegm". Feng also said: "those who treat phlegm treat qi but not phlegm." If the qi is smooth, the body fluid will follow. " The ancient and modern medical guide also said: "those whose phlegm rises with qi should be qi-compliant first, and then qi-compliant." Therefore, doctors of all ages have realized that treating phlegm must treat qi. In addition, "excessive qi leads to insufficient fire, and fire can burn body fluid into phlegm", so at the same time of eliminating phlegm, it is sometimes necessary to clear qi and purge fire.

Astragalus membranaceus is a commonly used drug in clinic. Astragalus membranaceus is beneficial to water and dampness while invigorating qi. Clinically, it is often used with Cang, Atractylodis Rhizoma, Coicis Semen and Poria.

Pericarpium Citri Reticulatae and Rhizoma Cyperi are commonly used qi-promoting drugs. Chenpi eliminates dampness and phlegm, regulates qi and stomach, and Cyperus rotundus regulates qi and relieves depression, and relieves the twelve meridians and six depression.

Trichosanthes kirilowii, bamboo shavings, clams, seaweed, kelp and selfheal are commonly used to regulate qi and resolve phlegm. These drugs can not only clear away heat and resolve phlegm, but also have the effects of softening and resolving hard mass. They are most suitable for patients with hot phlegm.

Second, nourishing yin and resolving phlegm:

It is the unanimous understanding of doctors in past dynasties that phlegm and turbidity are transformed into body fluid. For example, Zhang Jingyue said that "phlegm is the body fluid, which is nothing more than the transformation of Shui Gu". "Cover (phlegm) is the transformation of body fluid and blood. If ying and Wei are in harmony, body fluid and blood are self-sufficient. Why is there sputum? " Body fluid burning, phlegm turbidity; When phlegm is produced, body fluid will be insufficient. Therefore, the treatment of phlegm must take care of body fluids. In treating phlegm, pungent, warm, fragrant and impetuous products should not be used, so as not to hurt body fluids more. If vaginal fluid is insufficient, drugs for nourishing yin and moistening dryness must be added, among which Scrophularia and Carapax Trionycis are the most suitable. Scrophularia can clear away heat and nourish yin, and has the effect of resolving stagnation and resolving phlegm. In addition to nourishing yin and reducing fever, Carapax Trionycis can soften hard mass and disperse hard mass. Both drugs have the effect of clearing heat and cooling blood. One medicine is used three times, which is most suitable for patients with phlegm-yin deficiency.

Third, purging fire and resolving phlegm:

The relationship between phlegm and fire has been discussed before. There are also many expositions by doctors in past dynasties, especially in Qing dynasty, which are more detailed. For example, Feng discussed it in detail in Feng's Secrets. "-phlegm is tangible fire, and fire is intangible phlegm. Phlegm and turbidity rise and fall with fire, and fire leads to phlegm and turbidity, which produces various syndromes and is extremely unruly. Fire borrows qi from five internal organs, and phlegm borrows liquid from five flavors. Excess of qi leads to excess of fire, while excess of liquid leads to excess of phlegm. Qi can get angry, and fire can cure phlegm. Therefore, those who treat phlegm will reduce the fire; Those who cure fire will go with the flow. " Regarding the choice of drugs for purging fire and resolving phlegm, most doctors advocate the use of drugs such as Scutellaria baicalensis Georgi, Coptidis Rhizoma and Indigo Naturalis. For example, "Danxi Heart Method" says: "Indigo Naturalis, Coptis chinensis and Scutellaria baicalensis Georgi are used for heat phlegm". "Scutellaria baicalensis Georgi cures phlegm, and fire is virtual." In addition, bezoar, rhubarb, forsythia, houttuynia cordata and so on. It is also often used, but qi, blood and body fluid are cold and coagulated, so it should be used with caution. To avoid further coagulation of body fluids.

Fourth, removing blood stasis and resolving phlegm:

Body fluid condenses into phlegm, and blood condenses into blood stasis. Body fluid and blood are both things flowing in the body, and they were both born in Shui Gu. The so-called essence, fluid and pulse in Neijing can be divided into six in one breath. Furthermore, the etiology and pathogenesis of phlegm and blood stasis are similar, and the treatment methods are similar. Therefore, there has always been a saying that phlegm and blood stasis are homologous and the same disease is treated together. For example, Zhu Danxi thought that "phlegm with blood stasis turns into a nest". Ye pointed out in the treatment of gastropathy that the chronic and repetitive gastropathy must be caused by "phlegm and blood stasis", which is a tangible obstacle. Use leek juice, peach kernel and Pinellia ternata to dissipate blood stasis and phlegm. Tang Rongchuan even thought that "it is necessary to know that phlegm stagnation is caused by blood stasis, but if the blood stasis is removed, the phlegm will disappear." Similar arguments are too numerous to mention.

The treatment of phlegm and blood stasis syndrome is often mainly expectorant drugs, such as salvia miltiorrhiza, Ligusticum chuanxiong, peach kernel, safflower, Eupatorium adenophorum and pangolin scales. Among them, salvia miltiorrhiza has the effect of removing blood stasis and promoting tissue regeneration, and can be used for various abdominal pains. It is often used to treat coronary heart disease, arrhythmia, digestive tract ulcer, chronic gastritis, liver cirrhosis, hepatosplenomegaly, breast abscess, hyperplasia of mammary glands, irregular menstruation, hysteromyoma, psoriasis, neurasthenia, insomnia and other diseases. For example, Radix Astragali, Radix Polygalae, Rhizoma Acori Graminei, Ramulus Cinnamomi, Poria and Dragon's Tooth are used to treat coronary heart disease and arrhythmia; Mixing with Carapax Trionycis, Herba Lycopi, Herba Polygoni Avicularis, Radix Paeoniae Rubra, Rhizoma Cyperi, Radix Curcumae, etc. Treating liver cirrhosis; Mix with flos Lonicerae, fructus forsythiae, flos Sophorae Immaturus, radix Arnebiae, periostracum Cicadae, periostracum Serpentis and cortex Dictamni Radicis to treat psoriasis; Combined with Lignum Dalbergiae Odoriferae and Radix Notoginseng to treat peptic ulcer and angina pectoris.

Five, drink phlegm:

Drinking is similar to phlegm, so it is often called phlegm drinking. But the similarities are also different. It is said that it is the same because of homology, and it is all transformed by Shui Gu's body fluids; To say that it is different means that its symptoms and treatment are different. Zhang Jingyue made it very clear: "Although phlegm is similar to drinking, it is actually different ... and the drink is clear and thick, with phlegm. Drinking only stops the accumulation of stomach and intestines, but phlegm is everywhere; Shui Gu gave up drinking, and all his illnesses were caused by the spleen and stomach. Anyone who turns into phlegm can be caused by injuries to the five internal organs. " As for treatment, the treatment of drinking alcohol focuses on warming yang and benefiting water. Commonly used methods of sweating and diuresis, such as Ling Ze, Plantago asiatica, Coicis Semen, etc. But there is no definite method to treat phlegm. If phlegm and alcohol coexist, they should be treated together.

Six, clearing lung and resolving phlegm:

Although phlegm is related to five internal organs, it is most closely related to lung, spleen and kidney. Clear. Wu Cheng said in "Brief Discussion on Phlegm Syndrome": "Covering the lung governs qi, and lung injury leads to qi stagnation and phlegm, so phlegm comes from the lung; The transformation of phlegm also lies in the spleen; If the origin of phlegm is in the kidney. Therefore, the three main methods are unified. " The lung governs qi, and its qi is clear and descending, and it transports body fluid to the whole body. If the purgation is not normal and there is no treatment for the joints, the body fluid will stagnate and gather into phlegm; Lung likes dampness, lung yin is insufficient, and deficiency fire can burn body fluid or become phlegm; Or excessive six evils, burning body fluid with fire, can also become phlegm; Or the spleen is not healthy, the kidney loses temperature, "water is full of phlegm", and it can also be stained on the lungs, so it is also said that "the lungs are the hiding place of phlegm". Treatment is often clear, cool and moist. There are many drugs for clearing away lung heat and resolving phlegm, such as Fritillaria, Trichosanthes kirilowii, Cortex Mori, Scutellariae Radix, gypsum, etc.

Seven, spleen and phlegm:

The spleen governs the movement of Shui Gu, and its qi moves from the spleen to the stomach, which is the hub of the whole body qi movement. If the spleen loses its health, or the qi moves abnormally, and the subtle Shui Gu cannot move normally, it will condense into phlegm. Feng said: "Spleen deficiency cannot disperse essence in the lungs, and it is difficult for the clear to ascend, the turbid to descend, and the blood stasis becomes phlegm." Its treatment should be to strengthen the spleen and stomach and regulate qi. Spleen likes dryness and hates dampness, so spleen cannot be separated from dryness and dampness. Atractylodes macrocephala, Atractylodes macrocephala, Poria and Coicis Semen are the first choice drugs. The stomach is wet and dry, and fried radish seeds, hawthorn, grain malt and honey are often used. The application of Atractylodes lancea and Crataegus pinnatifida is especially discussed here.

Atractylodes lancea: Dryness and spleen strengthening can be used for all clinical manifestations of phlegm-dampness regardless of exterior and interior. Even if yin and blood are insufficient, but phlegm and dampness are syndrome, Yin-nourishing drugs can also be combined. Such as Atractylodes lancea, Polygonum Multiflori Radix, Radix Rehmanniae Preparata, Radix Angelicae Sinensis, Ramulus Mori, Achyranthis Radix, Periostracum Cicadae, etc. Is used for treating Liriodendron; Mixing with Cortex Phellodendri, Radix Sophorae Flavescentis, Cortex Dictamni Radicis, Periostracum Cicadae and Cortex Pseudolaricis for treating eczema and neurodermatitis; Mixing with Cortex Phellodendri, Radix Sophorae Flavescentis, Cortex Toona, Herba Schizonepetae, Semen Plantaginis, etc. Treating damp-heat leukorrhagia; Use dried tangerine peel, magnolia bark, agastache rugosa, Eupatorium etc. Treat chronic gastroenteritis in summer.

Hawthorn, promoting digestion, promoting blood circulation and removing blood stasis, is an important drug to eliminate meat stagnation and has the effect of resolving phlegm and removing blood stasis. "Compendium of Materia Medica" mentions "reducing diet, eliminating accumulated meat, abdominal pain, acid swallowing, blood stasis and flatulence". Clinically, it is often combined with other drugs to treat children's dyspepsia, coronary heart disease, hyperlipidemia, hypertension, postpartum lochia, postpartum abdominal pain, obesity and other diseases.

Eight, warming kidney and resolving phlegm:

Kidney governs water, and when water is opened, it is closed. Kidney is congenital, and it was sent by Yuan Yang and Yuan Yin. Therefore, kidney yang deficiency, or poor opening and closing, water does not work, known as phlegm. Wang Kentang said: "Phlegm dampness leads to spleen and stomach qi deficiency, and longevity declines. Water without fire is cloudy, and there is no fire at the bottom of the pot. Both can be wet, and phlegm and dampness must be born. " . Liu Shilian also said in the "Combination of Medicine and Nursing". : "Although phlegm is born in the spleen and stomach, it is actually kidney-yang deficiency, which can't fumigate the spleen and stomach, so that the spleen can't swallow saliva and become phlegm." Therefore, Chen Nianzu concluded: "Wang said:' The turbid Shui Yuan also comes from the kidney; Phlegm moves towards dampness, which is mainly in the spleen, and the rest is: phlegm turns into qi and is stored in the lungs. These six words can be regarded as the program of phlegm disease. "To treat phlegm and turbidity caused by deficiency of kidney yang and stagnation of water and dampness, besides resolving phlegm, products that warm yang and tonify kidney are often used, such as aconite, cornu Cervi, Rhizoma Curculiginis, Herba Epimedii and Cordyceps sinensis. Among them, Cordyceps sinensis, which warms kidney and moistens lung, eliminates phlegm and dampness, is the best choice, but it is expensive and convenient to use.

Phlegm disease, the treatment of phlegm disease, although there is "Su Wen" in Neijing. On strange diseases, orchid and spiritual pivot. Evil guest Pinellia decoction. But after all, the system is not complete. Go to Zhang Zhongjing's synopsis of the golden chamber to teach "phlegm drinking" and clearly point out that the treatment principle of phlegm drinking disease should be "warming the medicine" However, Zhongjing's method of "harmonizing warm medicines" is actually aimed at water and drinking. It was not until the source of disease of Sui Fang that phlegm and drink were discussed separately. Later, many physicians treated phlegm and drink separately. The eight methods of treating phlegm mentioned above are the summary of personal clinical experience for many years on the basis of previous people's treatment of phlegm. In addition, the treatment of phlegm disease, phlegm disease, avoid the use of cold and hot drugs. Qi, blood, body fluid, heat will do, cold will coagulate. Therefore, even if the heat phlegm stagnates, it is unnecessary to use or use as little as possible bitter and cold drugs to avoid more coagulation of qi, blood and body fluids. When it is cool and humid, it is suitable. On the other hand, heat energy damages and consumes body fluid, and the formation of phlegm is originally caused by heat consuming body fluid and burning body fluid. Therefore, even if the cold phlegm condenses, it is best not to use or use the products with great pungent heat as much as possible, so as to avoid the body fluid from burning again, and warming is always desirable. This should be regarded as a taboo in clinical treatment of phlegm.