Formulas · Text · Donguibogam 東醫寶鑑

Phlegm-Rheum

Damum

한글 담음 · Pinyin Tan Yin

The hundred strange diseases that issue from one cause, and the eight rheums and ten phlegms they divide into

痰飮

The longest and most ambitious chapter in the second volume of the Inner Landscape, and the one with the boldest claim. Heo Jun opens by separating three things English collapses into one — phlegm, drool and rheum — then sets out Zhongjing's eight rheums, sorted by where the water has stopped, and Danxi's ten phlegms, sorted by what set it moving. At the centre stands Wang Yinjun's treatise, which argues that a hundred disorders no physician has been able to account for are all one disease, and that a single prescription will answer them. Heo Jun records the claim in full, then records Liu Zonghou's objection to it in the next breath, and leaves both standing. What follows is the chapter's real work: the outward signs, the pulses, the colours of the phlegm, the presentations that mimic possession, and a treatment method that puts normalizing the qi before attacking the phlegm and fortifying the spleen before either.

6.1 Phlegm, Drool and Rheum Are Three Different Things 痰涎飮三者不同

6.1.1

Source원문

痰者, 津液之異名, 人之所恃, 以潤養肢體者也. 曰痰, 曰涎, 曰飮, 又有理一分殊之別. 伏於包絡, 隨氣上浮, 客肺壅嗽而發動者, 痰也. 聚於脾元, 隨氣上溢, 口角流出而不禁者, 涎也. 惟飮生於胃府, 爲嘔爲吐, 此則胃家之病, 不可不知. 《直指》

Translation영역

Phlegm is another name for the fluids and humours, the thing a person relies on to moisten and nourish the limbs and the body. Yet phlegm, drool and rheum, though one in principle, are distinguished in their divisions. What lies hidden in the pericardiac network, floats upward with the qi, settles as a guest in the lung and congests it so that coughing is set off — that is phlegm. What gathers at the root of the spleen, spills upward with the qi, and runs from the corners of the mouth beyond restraint — that is drool. Rheum alone arises in the stomach bowel, and becomes retching and vomiting; this is a disease of the stomach household, and it must not go unrecognized.

Clinical note임상 주석

The chapter opens by refusing a single word. Phlegm, drool and rheum are one substance in principle — all of them the fluids gone wrong — but each has its own seat, its own route and its own sign: phlegm hides in the pericardiac network and surfaces as cough, drool gathers at the spleen and runs from the mouth, rheum forms in the stomach and comes up as vomit. The phrase 理一分殊, one principle with distinct divisions, is borrowed from Neo-Confucian metaphysics and is doing real clinical work here — it licenses treating the three as one disorder while insisting the practitioner know which of the three is in front of them. English has no equivalent triad, so the translation keeps all three terms distinct throughout the chapter rather than resolving them into "phlegm."

Jikji 直指

6.2 Phlegm and Rheum Divided as Turbid and Clear 痰飮分淸濁

6.2.1

Source원문

痰者, 津液因熱而成, 熱則津液熏蒸而稠濁, 故名爲痰也. 《丹心》

Translation영역

Phlegm is fluid formed under heat: heat steams and scorches the fluids until they thicken and turn turbid, and so it is named phlegm.

Clinical note임상 주석

The mechanism in one line. Heat is the cooking agent and thickening is the result, which is why the whole chapter treats consistency as diagnostic — thick and sticky points to heat, thin and clear does not.

Dansim 丹心

6.2.2

Source원문

水之與飮, 同出而異名也. 人惟脾土有虧, 故所飮水漿, 不能傳化, 或停於心下, 或聚於脇間, 或注於經絡, 或溢於膀胱, 往往因此而致病矣. 《直指》

Translation영역

Water and rheum issue from the same source under different names. It is only because the spleen earth is deficient that the water and thin gruel a person drinks cannot be conveyed and transformed; it stands below the heart, or gathers between the ribs, or pours into the channels and network vessels, or spills over into the bladder — and again and again disease arises from this.

Clinical note임상 주석

The etiology that governs the eight rheums in the next section. The spleen fails to convey and transform, so what was drunk stops where it stops, and the name of the rheum follows the site. Below the heart, between the ribs, in the channels, in the bladder — four locations, and the sections that follow are essentially an expansion of this list.

Jikji 直指

6.2.3

Source원문

飮者, 因飮水不散而爲病, 痰者, 因火炎熏灼而成疾. 故痰形稠濁, 飮色淸. 痰古方謂之飮, 今人謂之痰, 其實一也.

Translation영역

Rheum becomes disease because water that has been drunk does not disperse; phlegm becomes disease because fire flames up and scorches. Hence phlegm is thick and turbid in form, while rheum is clear in colour. What the old formularies called rheum, people today call phlegm — in truth they are one.

Clinical note임상 주석

The section's title is answered here: turbid is phlegm, clear is rheum, and the difference is whether fire has been at work. The closing remark is a piece of editorial honesty worth noting — Heo Jun records that the two words have drifted into one another over time and declines to police the usage, having just spent two passages distinguishing them. The chapter title itself, 痰飮, carries both.

Donguibogam · Damum

6.3 Wang Yinjun's Treatise on Phlegm 王隱君痰論

6.3.1

Source원문

痰證古今未詳. 方書雖有懸飮ㆍ留飮ㆍ支飮ㆍ痰飮ㆍ諸飮之異, 而莫知其爲病之源. 或頭風眩暈, 目昏耳鳴. 或口眼蠕動, 眉稜耳輪瘙痒. 或四肢遊風腫硬, 似痛非痛. 或爲齒頰痒痛, 牙床浮腫而痛痒不一. 或噫氣呑酸, 嘈雜嘔噦. 或咽嗌不利, 咯之不出, 嚥之不下, 色如煤炱, 形如敗絮, 桃膠, 蜆肉之類. 或心下如停氷雪, 心頭冷痛時作. 或夢寐奇怪鬼魅之狀. 或足腕痠軟, 腰背卒痛. 或四肢骨節煩疼, 幷無常所, 乃至手麻臂痛, 狀若挫閃. 或脊中每有一掌, 如氷凍之寒痛者. 或渾身習習如蟲行者. 或眼眶澁痒, 口糜舌爛, 甚爲喉閉等證. 又或遶項結核, 似癧非癧. 或胸腹間如有二氣交紐, 噎塞煩悶, 有如烟氣上衝, 頭面烘熱. 或爲失志癲狂. 或爲中風癱瘓. 或爲勞瘵荏苒之疾. 或爲風痺, 及脚氣之候. 或心下怔忡驚悸, 如畏人將捕. 或喘嗽嘔吐. 或嘔冷涎綠水黑汁, 甚爲肺癰, 腸毒, 便膿, 攣跛. 其爲內外疾病, 非止百端, 皆痰之所致也. 盖津液旣凝, 爲痰爲飮, 而洶涌上焦, 故口燥咽乾, 流而之下, 則大小便閉塞, 面如枯骨, 毛髮焦乾. 婦人則經閉不通, 小兒則驚癎搐搦. 治法宜先逐去敗痰, 然後看虛實調理. 故製沈香滾痰丸方見下, 爲通治三焦痰飮之劑也.

Translation영역

Phlegm patterns have never been set out clearly, past or present. The formularies distinguish suspended rheum, retained rheum, propping rheum, phlegm-rheum and the rest, yet none has known the source from which the disease arises. There may be head wind with dizziness, clouded vision and ringing in the ears. Or wriggling of the mouth and eyes, itching at the brow ridge and the rim of the ear. Or roving wind in the four limbs with swelling and hardness, something like pain and not quite pain. Or itching and pain in the teeth and cheeks, the gums puffy and swollen with pain and itch in no fixed measure. Or belching and swallowing of acid, gnawing discomfort, retching and vomiting. Or the throat not free, so that what will not be coughed up will not be swallowed down either — the colour of soot, the form of rotted silk floss, of peach gum, of clam flesh. Or a feeling below the heart as though ice and snow were standing there, with cold pain at the heart coming and going. Or dreams of strange and uncanny shapes, of goblins and spectres. Or aching weakness of the foot and ankle, sudden pain in the lumbus and back. Or vexing pain in the bones and joints of the four limbs with no fixed place, reaching to numbness of the hand and pain in the arm as though it had been wrenched. Or a patch in the spine the size of a palm, cold and painful as if frozen. Or a creeping over the whole body as though insects were walking on it. Or the eye sockets rough and itching, the mouth sore and the tongue ulcerated, in severe cases going on to closure of the throat. Or nodules ringing the neck, resembling scrofula and not scrofula. Or a sensation in the chest and abdomen as though two currents of qi were knotted together, with choking obstruction and vexing oppression, something like smoke surging upward and the head and face flushing hot. Or loss of the will, with mania and withdrawal. Or wind stroke with hemiplegia. Or the lingering disease of taxation consumption. Or the signs of wind impediment and leg qi. Or throbbing and fright palpitation below the heart, as though in fear of being seized. Or panting, coughing, retching and vomiting. Or the vomiting of cold drool, green water and black fluid, in severe cases going on to lung abscess, intestinal toxin, pus in the stool, and contracture and lameness. The diseases it makes, inner and outer, do not stop at a hundred, and all of them are brought about by phlegm. For once the fluids have congealed and become phlegm and rheum, they surge up into the upper burner, and so the mouth is parched and the throat dry; and flowing downward, they block the stool and urine, the face turns like withered bone, and the hair scorches dry. In women the menses close and will not pass; in children there is fright epilepsy with tugging and slackening. In treatment one should first drive out the spoiled phlegm, and only then look to vacuity or repletion and regulate accordingly. Hence Aquilaria Roll the Phlegm Pill formula below was composed, as a medicine to treat phlegm-rheum of the three burners generally.

Clinical note임상 주석

The chapter's centrepiece and its most consequential claim. Wang Yinjun's argument is that the formularies have catalogued the rheums by location without ever identifying the cause, and that the cause — for a list of complaints running from tinnitus to mania to lameness — is one thing. The catalogue is worth reading slowly rather than skimming: it is not padding but the evidence for the claim, and several of its images recur as diagnostic markers later in the chapter, particularly the phlegm the colour of soot and the shape of rotted silk floss, and the two currents of qi knotted in the chest. Two things deserve attention. First, the treatment sequence — drive out the spoiled phlegm first, assess vacuity and repletion second — is the reverse of the order the chapter itself will recommend at 6.19, where normalizing the qi comes first and fortifying the spleen is called treating the root. Heo Jun does not reconcile the two. Second, the whole treatise terminates in a single prescription, which is an unusual move for a text that ordinarily differentiates before it prescribes, and it is precisely this that draws the objection recorded in the next passage. A modern reader should hold the claim as a historical position rather than a clinical one. A list this broad — hemiplegia, epilepsy, lung abscess, amenorrhoea, mania — spans conditions that require quite different investigation today, and the passage is preserved here for what it shows about how a unifying aetiology was argued for, not as a diagnostic guide.

Donguibogam · Damum

6.3.2

Source원문

劉宗厚曰, 痰之爲病, 仲景論四飮六證, 無擇叙三因內外, 俱爲切當. 惟王隱君, 論人之諸疾, 悉出於痰, 此發前人所未發, 可謂深識痰之情狀, 而得其奧者矣. 製滾痰丸一方, 總治斯疾, 固爲簡便, 較之仲景三因有表裏內外, 而分汗下溫利之法, 則疏闊矣. 況又有虛實寒熱之不同者哉.

Translation영역

Liu Zonghou said: on phlegm as a disease, Zhongjing's discussion of the four rheums and six patterns, and Wuze's account of the three causes inner and outer, are both exactly to the point. It is Wang Yinjun alone who argues that all a person's various diseases issue from phlegm — bringing out what no earlier writer had brought out. He may be said to have understood the true condition of phlegm deeply and to have reached what is hidden in it. But composing the single formula of Roll the Phlegm Pill to treat the whole of this disease, convenient though it certainly is, is loose and slack set beside Zhongjing's three causes with their exterior and interior, inner and outer, and his separate methods of sweating, purging, warming and freeing. How much more so, when there are further differences of vacuity and repletion, cold and heat.

Clinical note임상 주석

Heo Jun records the praise and the objection in the same section, and does not adjudicate. Liu Zonghou grants Wang Yinjun the insight — no earlier writer had reached it — and then says the therapeutic conclusion drawn from it is slack: one pill cannot answer exterior and interior, cold and heat, vacuity and repletion. This is the editorial method of the Bogam at its most characteristic, and it is worth naming because it recurs throughout the book. A strong claim is preserved intact, the strongest objection to it is set immediately beside it, and the reader is left to do the differentiating. The twenty-two sections that follow are, in effect, Heo Jun siding with Liu Zonghou in practice while keeping Wang Yinjun's treatise as the chapter's opening argument.

Donguibogam · Damum

6.4 The Eight Rheum Diseases 飮病有八

6.4.1

Source원문

有留飮ㆍ癖飮ㆍ痰飮ㆍ溢飮ㆍ流飮ㆍ懸飮ㆍ支飮ㆍ伏飮等證, 皆因飮酒冒寒, 或飮水過多所致. 《仲景》

Translation영역

There are the patterns of retained rheum, aggregated rheum, phlegm-rheum, spilling rheum, flowing rheum, suspended rheum, propping rheum and lurking rheum. All of them come about from drinking wine and braving cold, or from drinking too much water.

Clinical note임상 주석

Eight names and two causes. The eight are sorted by where the fluid has come to rest and what it does there, not by what set it moving — that is the other axis, and it belongs to the ten phlegms in the next section. Flowing rheum has no section of its own below; the text folds it into suspended rheum, which is identified with it explicitly.

Junggyeong 仲景

6.4.1 Retained Rheum 留飮

6.4.1.1

Source원문

胸中有留飮, 其人短氣而渴, 四肢歷節痛, 脉沈細. 《仲景》

Translation영역

When there is retained rheum in the chest, the person is short of breath and thirsty, there is pain running through the joints of the four limbs, and the pulse is sunken and fine.

Junggyeong 仲景

6.4.1.2

Source원문

留飮者, 水停心下, 背冷如手掌大, 或短氣而渴, 四肢歷節疼痛, 脇痛引缺盆, 咳嗽轉甚. 《入門》

Translation영역

In retained rheum, water stands below the heart; there is a cold patch on the back the size of a palm, or shortness of breath with thirst, aching pain running through the joints of the four limbs, and pain in the ribside drawing into the empty basin, with the cough growing worse.

Clinical note임상 주석

The cold patch on the back the size of a palm is the sign that makes retained rheum recognizable, and it is precise enough to be worth carrying over intact — a circumscribed area of cold the patient can point to, rather than general chill. Paired with breathlessness, ribside pain drawing toward the clavicle, and a worsening cough, the picture overlaps with pleural effusion.

Immun 入門

6.4.1.3

Source원문

留飮之證, 四肢歷節痛, 氣短脉沈, 久則令人骨節蹉跌, 恐爲癲癎. 宜導痰湯加減, 通用芎夏湯. 《入門》二方見下

Translation영역

In the pattern of retained rheum there is pain running through the joints of the four limbs, shortness of breath and a sunken pulse; left long, it causes the bones and joints to slip out of true, and there is fear that it will turn to epilepsy. Guide Out Phlegm Decoction with additions and subtractions is appropriate; Chuanxiong and Pinellia Decoction is used generally. Both formulas below

Clinical note임상 주석

The warning about the joints slipping out of true and the disease turning to epilepsy is the reason Chuanxiong and Pinellia Decoction is named here — chuanxiong leads that formula, and rheum which has reached the joints has drawn the blood into the problem.

Immun 入門

6.4.2 Aggregated Rheum 癖飮

6.4.2.1

Source원문

水癖在兩脇下, 動搖有聲. 宜十棗湯方見寒門ㆍ三花神佑丸方見下門.

Translation영역

A water aggregation lies below both ribsides, and there is a sound when it is shaken. Ten Jujube Decoction formula in the Cold Damage chapter and Three Flowers Spirit-Aid Pill formula in the Purging chapter are appropriate.

Clinical note임상 주석

The shortest of the eight, and defined by one physical finding: fluid below both ribsides that can be heard when the body is moved. Both formulas named are drastic purgatives built on the kansui, euphorbia and genkwa group; neither is registered in this database yet, since their compositions belong to chapters not yet translated.

Donguibogam · Damum

6.4.3 Phlegm-Rheum 痰飮

6.4.3.1

Source원문

其人素盛今瘦, 水走腸間, 瀝瀝有聲, 謂之痰飮, 宜苓桂朮甘湯. 又曰, 心下有痰飮, 胸脇支滿, 目眩. 《仲景》

Translation영역

When a person who was formerly stout is now thin, and water runs in the intestines with a trickling sound, this is called phlegm-rheum; Poria, Cinnamon Twig, Atractylodes and Licorice Decoction is appropriate. It is also said: when there is phlegm-rheum below the heart, the chest and ribside are propped and full, and the eyes are dizzy.

Clinical note임상 주석

Phlegm-rheum in the narrow sense — one of the eight, not the chapter title. The two signs given are audible fluid in the gut and weight that has fallen away, which together read as gastric retention with a succussion splash. Note that 支滿, propped and full, uses the same graph as propping rheum below; here it describes the sensation rather than naming the category.

Junggyeong 仲景

6.4.3.2

Source원문

痰飮者, 水停腸胃, 漉漉有聲, 令人暴肥暴瘦, 宜神朮丸. 《入門》

Translation영역

In phlegm-rheum, water stands in the intestines and stomach with a gurgling sound, and causes a person to grow suddenly fat and suddenly thin; Spirit Atractylodes Pill is appropriate.

Clinical note임상 주석

暴肥暴瘦 — sudden gain and sudden loss of flesh — is the Immun's addition to Zhongjing's picture and is the more useful marker clinically, since it describes a course rather than a moment. Spirit Atractylodes Pill and its companion Gardenia Powder are the formulas given for it.

Immun 入門

6.4.4 Spilling Rheum 溢飮

6.4.4.1

Source원문

飮水流行, 歸於四肢, 當汗出而不汗出, 身體重痛, 謂之溢飮, 小靑龍湯方見寒門主之. 《仲景》

Translation영역

When water that has been drunk flows on and comes to rest in the four limbs, and sweat ought to issue but does not, so that the body is heavy and painful, this is called spilling rheum; Minor Blue-Green Dragon Decoction formula in the Cold Damage chapter governs it.

Clinical note임상 주석

The one rheum treated by opening the exterior rather than draining downward. The logic is in the phrase 當汗出而不汗出 — sweat ought to issue and does not — so the fluid that should have left through the surface has stopped in the limbs instead, and the treatment restores the route it was meant to take.

Junggyeong 仲景

6.4.4.2

Source원문

溢飮者, 水在四肢, 身體重痛. 《入門》

Translation영역

In spilling rheum, water is in the four limbs and the body is heavy and painful.

Immun 入門

6.4.5 Suspended Rheum 懸飮

6.4.5.1

Source원문

飮後水流在脇下, 咳唾引痛, 謂之懸飮, 十棗湯方見寒門主之. 《仲景》

Translation영역

When after drinking the water flows and stays below the ribside, so that coughing and spitting draw out pain, this is called suspended rheum; Ten Jujube Decoction formula in the Cold Damage chapter governs it.

Clinical note임상 주석

Pain below the ribside that is provoked by coughing is pleuritic, and suspended rheum is the category in this chapter that maps most directly onto pleural effusion.

Junggyeong 仲景

6.4.5.2

Source원문

懸飮亦謂流飮, 水在脇間, 動搖漉漉有聲. 《局方》

Translation영역

Suspended rheum is also called flowing rheum. The water lies between the ribs, and when the body is moved there is a gurgling sound.

Clinical note임상 주석

This is where the eighth name goes. Flowing rheum is listed among the eight in the opening passage but is given no section of its own, because the Gukbang identifies it with suspended rheum here. The chapter keeps both names and one category.

Gukbang 局方

6.4.5.3

Source원문

懸飮者, 水流在脇下, 咳唾引痛, 懸懸思水, 三花神佑丸主之. 《入門》方見下門

Translation영역

In suspended rheum the water flows and stays below the ribside, coughing and spitting draw out pain, and there is a hanging, unsettled craving for water; Three Flowers Spirit-Aid Pill governs it. formula in the Purging chapter

Immun 入門

6.4.6 Propping Rheum 支飮

6.4.6.1

Source원문

咳逆倚息, 短氣不得臥, 其形如腫, 謂之支飮, 小靑龍湯方見寒門主之. 又曰, 其脉數, 必苦冒眩, 其人本有支飮在胸中故也. 茯苓五味子湯亦主之. 《仲景》

Translation영역

Coughing with counterflow, propped up to breathe, short of breath and unable to lie down, the body looking as though swollen — this is called propping rheum; Minor Blue-Green Dragon Decoction formula in the Cold Damage chapter governs it. It is also said: when the pulse is rapid, the patient will certainly suffer clouding and dizziness, and this is because there is propping rheum in the chest to begin with. Poria and Schisandra Decoction also governs it.

Clinical note임상 주석

倚息 — propped up to breathe — is orthopnoea, and it gives the category its name: the patient must prop themselves to get air. With the body looking swollen and the inability to lie flat, the modern correspondences worth holding are pleural effusion, pericardial effusion and congestive heart failure. **Breathlessness that prevents lying flat, particularly with swelling, is a cardiac emergency and requires immediate medical assessment.** This passage describes a classical pattern; it is not grounds for managing such a presentation outside conventional care.

Junggyeong 仲景

6.4.6.2

Source원문

支飮, 亦喘而不能臥, 加短氣, 其脉平也. 《仲景》

Translation영역

In propping rheum there is likewise panting with inability to lie down, and shortness of breath besides, yet the pulse is even.

Clinical note임상 주석

The point of the passage is the last clause. Severe respiratory distress with an unremarkable pulse is what distinguishes propping rheum from the pattern above, where the pulse is rapid, and the observation is a caution against reading the pulse alone.

Junggyeong 仲景

6.4.6.3

Source원문

支飮, 水停膈上, 咳逆倚息短氣. 《入門》

Translation영역

In propping rheum, water stands above the diaphragm, with cough and counterflow, breathing propped up, and shortness of breath.

Immun 入門

6.4.6.4

Source원문

支飮, 法當冒, 冒者必嘔. 嘔者復滿, 加半夏, 以去其飮, 飮去, 嘔則止. 《仲景》

Translation영역

In propping rheum there ought by rule to be clouding, and one who is clouded will certainly retch. In one who retches the fullness returns, and pinellia is added to remove the rheum; and once the rheum is gone the retching stops.

Clinical note임상 주석

A small piece of therapeutic reasoning: the clouding and the retching are not two problems but one sequence, and treating the rheum resolves both. Reintroducing pinellia rather than adding an antiemetic is the point — the vomiting is the rheum's doing and stops when its cause is removed.

Junggyeong 仲景

6.4.7 Lurking Rheum 伏飮

6.4.7.1

Source원문

膈上痰滿, 喘咳或吐, 發則寒熱, 背痛腰痛, 目淚自出, 其人振振身瞤劇, 必有伏飮. 《仲景》

Translation영역

When phlegm fills above the diaphragm, with panting and cough or vomiting; when on breaking out there is cold and heat, pain in the back and pain in the lumbus, and tears running of themselves from the eyes; and when the person shudders and the body twitches severely — there is certainly lurking rheum.

Clinical note임상 주석

Lurking rheum is defined by its intermittency rather than its site: it lies hidden and then breaks out, and the passage describes the flare rather than the resting state. The pairing of alternating cold and heat with back and lumbar pain, involuntary tearing and shuddering is what marks it out from the other seven, all of which are described as continuous.

Junggyeong 仲景

6.4.7.2

Source원문

伏飮者, 水停膈滿, 嘔吐喘咳, 發熱惡寒, 腰背痛, 目淚出, 或身惕瞤, 宜三花神祐丸方見下門ㆍ控涎丹方見下. 《入門》

Translation영역

In lurking rheum, water stands and the diaphragm is full, with retching and vomiting, panting and cough, fever and aversion to cold, pain in the lumbus and back, tears issuing from the eyes, or the body starting and twitching; Three Flowers Spirit-Aid Pill formula in the Purging chapter and Control Drool Elixir formula below are appropriate.

Clinical note임상 주석

Control Drool Elixir is the formula the chapter returns to for rheum that shifts and hides, and this is its first appearance. **It contains kansui and euphorbia, both drastic purgatives and both toxic; it is not suitable for self-administration and is contraindicated in pregnancy and in depleted patients.**

Immun 入門

6.5 The Ten Phlegm Diseases 痰病有十

6.5.1

Source원문

有風痰ㆍ寒痰ㆍ濕痰ㆍ熱痰ㆍ鬱痰ㆍ氣痰ㆍ食痰ㆍ酒痰ㆍ驚痰, 痰之源不一, 有因熱而生者, 有因氣而生者, 有因風而生者, 有因驚而生者, 有因飮而生者, 有因食而成者, 有因暑而生者, 有傷冷而成者, 有脾虛而成者, 有因酒而成者, 有腎虛而生者. 《丹溪》

Translation영역

There are wind phlegm, cold phlegm, damp phlegm, heat phlegm, depressed phlegm, qi phlegm, food phlegm, alcohol phlegm and fright phlegm. The sources of phlegm are not one: there is that engendered by heat, that engendered by qi, that engendered by wind, that engendered by fright, that engendered by drink, that formed by food, that engendered by summerheat, that formed by cold damage, that formed by spleen vacuity, that formed by wine, and that engendered by kidney vacuity.

Clinical note임상 주석

This is the chapter's second axis and it should be read against the eight rheums that precede it. The eight are sorted by where the fluid has stopped; the ten are sorted by what set it moving. A patient can be placed on both grids at once, and the formulas throughout the chapter are organized by the second rather than the first. The mismatch between the heading's ten, the nine names, and the eleven causes is worth noticing rather than smoothing over. It suggests a category still being worked out — the named phlegms are the ones with an established treatment, while summerheat, spleen vacuity and kidney vacuity are causes acknowledged without a settled prescription attached. Danxi's list is aetiological; the subsections that follow are therapeutic, and the two do not align.

Dangye 丹溪

6.5.1 Wind Phlegm 風痰

6.5.1.1

Source원문

多癱瘓奇證, 頭風眩暈, 暗風悶亂, 或搐搦瞤動. 宜靑州白圓子ㆍ導痰湯. 《丹心》

Translation영역

There are commonly hemiplegia and strange patterns, head wind with dizziness, obscure wind with oppression and disorder, or tugging, slackening and twitching. Qingzhou White Round Pill and Guide Out Phlegm Decoction are appropriate.

Clinical note임상 주석

Wind phlegm is named for its movement rather than its substance: what marks it is that the signs come and go, jump about the body, and involve involuntary motion. The two formulas named divide the work between them — the pill for phlegm that has congealed and settled behind hemiplegia, the decoction for phlegm still on the move. **Sudden weakness on one side, facial droop or new difficulty speaking requires emergency assessment.** The presentations grouped here as wind phlegm include stroke, and this passage describes a historical category rather than authorizing outpatient management.

Dansim 丹心

6.5.2 Cold Phlegm 寒痰

6.5.2.1

Source원문

寒痰, 卽冷痰也. 骨痺四肢不擧, 氣刺痛, 無煩熱, 疑結淸冷, 宜溫中化痰丸ㆍ溫胃化痰丸ㆍ新法半夏湯. 《丹心》

Translation영역

Cold phlegm is chill phlegm. There is bone impediment with the four limbs unable to be raised, stabbing pain of the qi, no vexing heat, and phlegm congealed and bound, clear and cold. Warm the Centre and Transform Phlegm Pill, Warm the Stomach and Transform Phlegm Pill and New Method Pinellia Decoction are appropriate.

Clinical note임상 주석

The diagnostic hinge is the negative: 無煩熱, no vexing heat. Everything else in the picture could belong to several categories, and it is the absence of heat signs together with phlegm that is clear rather than turbid that places it here — which is exactly the distinction drawn at 6.2, where turbidity marks the work of fire.

Dansim 丹心

6.5.3 Damp Phlegm 濕痰

6.5.3.1

Source원문

身重而軟, 倦怠困弱, 宜神朮丸方見上ㆍ山精丸ㆍ三仙丸, 或二陳湯, 加蒼朮ㆍ白朮. 《局方》

Translation영역

The body is heavy and soft, with fatigue, lassitude and weakness. Spirit Atractylodes Pill formula above, Mountain Essence Pill and Three Immortals Pill are appropriate; or Two Matured Ingredients Decoction with black atractylodes and white atractylodes added.

Clinical note임상 주석

The shortest description of the ten and the least dramatic: heavy, soft, tired. Damp phlegm is the baseline condition against which the other nine are variations, which is why the formulas given for it are also the plainest — atractylodes in three forms, and Ijin-tang with both atractylodes added. Worth reading the three named pills together, because they solve the same problem three different ways. Atractylodes taken long enough to shift damp phlegm will scorch; Spirit Atractylodes Pill answers that afterwards with gardenia, Mountain Essence Pill answers it in advance by soaking the atractylodes in mulberry juice nine times over, and Three Immortals Pill answers it by fermenting the pinellia and arisaema into a leaven before use.

Gukbang 局方

6.5.4 Heat Phlegm 熱痰

6.5.4.1

Source원문

熱痰, 卽火痰也. 多煩熱燥結, 頭面烘熱, 或爲眼爛喉閉, 癲狂嘈雜, 懊憹怔忡. 宜淸氣化痰丸ㆍ加味潤下丸ㆍ小調中湯ㆍ大調中湯ㆍ黃芩利膈丸ㆍ理中豁痰湯ㆍ淸熱導痰湯. 《丹心》

Translation영역

Heat phlegm is fire phlegm. There is commonly vexing heat with dry binding, flushing heat in the head and face, or festering of the eyes and closure of the throat, mania and withdrawal with gnawing discomfort, anguish and throbbing. Clear the Qi and Transform Phlegm Pill, Augmented Moisten and Downbear Pill, Minor Regulate the Centre Decoction, Major Regulate the Centre Decoction, Scutellaria Diaphragm-Freeing Pill, Regulate the Centre and Sweep Phlegm Decoction and Clear Heat and Guide Out Phlegm Decoction are appropriate.

Clinical note임상 주석

Seven formulas, more than any other of the ten, and the range within them is the point. Minor and Major Regulate the Centre are the same prescription with and without the Eight Treasures added, and Regulate the Centre and Sweep Phlegm sits sixteen medicinals deep at doses under a don — the chapter is supplying heat phlegm formulas for repletion and for vacuity alike, and expects the practitioner to sort them.

Dansim 丹心

6.5.5 Depressed Phlegm 鬱痰

6.5.5.1

Source원문

與老痰, 燥痰同. 卽火痰鬱於心肺之間, 久則凝滯胸膈, 稠粘難咯, 多毛焦而色白如枯骨, 咽乾口燥, 咳嗽喘促. 宜節齋化痰丸ㆍ抑痰丸ㆍ霞天膏ㆍ淸火豁痰丸ㆍ加減二陳湯ㆍ瓜蔞枳實湯. 《丹心》

Translation영역

The same as old phlegm and dry phlegm. It is fire phlegm depressed between the heart and the lung; left long, it congeals and stagnates in the chest and diaphragm, thick and sticky and hard to bring up. The hair is commonly scorched and the complexion white as withered bone, the throat is dry and the mouth parched, and there is coughing with hasty panting. Jeoljae's Transform Phlegm Pill, Restrain Phlegm Pill, Rosy Heaven Paste, Clear Fire and Sweep Phlegm Pill, Modified Two Matured Ingredients Decoction and Trichosanthes and Bitter Orange Decoction are appropriate.

Clinical note임상 주석

Three names for one condition — depressed, old, dry — and the equation is doing real work, because it tells the practitioner that phlegm which has sat long enough becomes dry phlegm whatever it was at the start. That governs the treatment: none of the six formulas named leads with pinellia or arisaema, and several drop the drying medicinals altogether in favour of softening and moistening. Drying what is already stuck hardens it further. The complexion white as withered bone and the scorched hair are signs of fluid depletion, and they mark this as the one category among the ten where the phlegm and the dryness are the same problem seen from two sides.

Dansim 丹心

6.5.6 Qi Phlegm 氣痰

6.5.6.1

Source원문

七情鬱結, 痰滯咽喉, 形如敗絮, 或如梅核, 咯不出, 嚥不下, 胸膈痞悶. 宜淸火豁痰丸ㆍ玉粉丸ㆍ加味四七湯ㆍ潤下丸ㆍ二賢散ㆍ前胡半夏湯ㆍ加味二陳湯. 《入門》

Translation영역

The seven affects are depressed and bound, and phlegm stagnates in the throat, in form like rotted silk floss or like a plum pit, which will not be coughed up and will not be swallowed down, with glomus and oppression of the chest and diaphragm. Clear Fire and Sweep Phlegm Pill, Jade Powder Pill, Augmented Four Seven Decoction, Moisten and Downbear Pill, Two Worthies Powder, Peucedanum and Pinellia Decoction and Augmented Two Matured Ingredients Decoction are appropriate.

Clinical note임상 주석

Plum-pit qi — 梅核氣 — described without being named, and the description is the one that has carried: something lodged in the throat that will neither come up nor go down. The image of rotted silk floss is Wang Yinjun's, from the treatise at 6.3, and its reappearance here is the chapter cross-referencing itself. What makes it qi phlegm rather than any other kind is stated first: the seven affects are depressed and bound. The cause is emotional and the phlegm is downstream of it, which is why the formulas named are qi-movers carrying phlegm medicinals rather than the reverse. Globus is the modern correspondence, and it remains a diagnosis of exclusion — persistent difficulty swallowing, weight loss or a mass warrants investigation before it is treated as this pattern.

Immun 入門

6.5.7 Food Phlegm 食痰

6.5.7.1

Source원문

卽食積痰也. 因飮食不消, 或挾瘀血, 遂成窠囊, 多爲癖塊痞滿. 宜靑礞石丸ㆍ黃瓜蔞丸ㆍ正傳加味二陳湯. 《醫鑑》

Translation영역

This is food accumulation phlegm. It comes about when food and drink are not dispersed, or when static blood is carried along with them, and so a nest-sac is formed, commonly becoming an aggregation lump with glomus and fullness. Chlorite Schist Pill, Yellow Trichosanthes Pill and the Orthodox Tradition's Augmented Two Matured Ingredients Decoction are appropriate.

Clinical note임상 주석

The clause 或挾瘀血 — or carrying static blood along with it — is the important one and is easy to skip. It states that food phlegm may have a blood component, which is the reasoning behind the peach kernel and safflower in Augmented Minor Stomach Elixir at 6.13.1 and the reason the lump section that follows treats nodules with blood-movers as well as phlegm medicinals. 窠囊, the nest-sac, is the chapter's term for phlegm that has stopped moving and taken up residence, and it first appears at 6.4.3.

Uigam 醫鑑

6.5.8 Alcohol Phlegm 酒痰

6.5.8.1

Source원문

因飮酒不消, 或酒後多飮茶水, 但得酒, 次日又吐, 飮食不美, 嘔吐酸水. 宜瑞竹堂化痰丸ㆍ香附瓜蔞靑黛丸ㆍ小調中湯ㆍ滌痰散. 又對金飮子方見內傷, 加半夏ㆍ乾葛各一錢, 煎服. 《正傳》

Translation영역

It comes about when wine that has been drunk is not dispersed, or when much tea and water are drunk after wine. Whenever wine is taken, there is vomiting again the next day, food and drink give no pleasure, and sour water is retched up. Seojukdang's Transform Phlegm Pill, Cyperus, Trichosanthes and Indigo Pill, Minor Regulate the Centre Decoction and Sweep Phlegm Powder are appropriate. Also, Worth Its Weight in Gold Drink formula in the Internal Damage chapter with pinellia and pueraria 1 don each added, decocted and taken.

Clinical note임상 주석

The description is behavioural and specific in a way the other nine are not: vomiting the day after, not on the day; food giving no pleasure; sour fluid coming up. That is a pattern recognized by its rhythm rather than by a single sign. Note the second cause — drinking a lot of tea and water after wine. The reasoning is that the additional fluid is what fails to disperse, not the wine itself, which puts alcohol phlegm closer to the rheums of 6.4 than its name suggests. Pueraria is the classical medicinal for resolving alcohol and appears in both the pill and the added decoction.

Jeongjeon 正傳

6.5.9 Fright Phlegm 驚痰

6.5.9.1

Source원문

因驚痰結成塊, 在胸腹, 發則跳動, 痛不可忍, 或成癲癎, 婦人多有之, 宜妙應丹ㆍ滾痰丸. 《入門》

Translation영역

Through fright the phlegm binds and forms a lump, lying in the chest and abdomen; when it breaks out there is a leaping and throbbing, with pain that cannot be borne, or it turns to epilepsy. Women commonly have it. Wondrous Response Elixir and Rolling Phlegm Pill are appropriate.

Clinical note임상 주석

The last of the ten and the only one whose cause is a single event rather than a habit or a constitution. What distinguishes it is the intermittency — the lump sits quiet and then leaps, with pain described as unbearable — and the possibility of it turning to epilepsy. The closing remark that women commonly have it is worth recording rather than passing over. It reflects how emotionally-caused illness was distributed by gender in the medicine of the period, and the same assumption runs through the Bogam's chapters on depression and on the seven affects. It is a statement about the categories of the text, not an epidemiological one. **The formula named contains kansui and euphorbia, both drastic purgatives and both toxic. It is not suitable for self-administration and is contraindicated in pregnancy and in depleted patients.**

Immun 入門

6.6 Pulse Method 脉法

6.6.1

Source원문

脉雙弦者寒飮也. 偏弦者飮也.

Translation영역

A pulse wiry on both sides is cold rheum. Wiry on one side is rheum.

Clinical note임상 주석

The section opens with the distinction that governs it. Wiry is the rheum pulse, and whether it is felt on both sides or one separates cold rheum from rheum in general — the single most economical differentiation in the chapter.

Junggyeong 仲景

6.6.2

Source원문

肺飮不弦, 但苦喘短氣.

Translation영역

In lung rheum the pulse is not wiry; there is only distressing panting and shortness of breath.

Clinical note임상 주석

A deliberate exception recorded immediately after the rule. Rheum in the lung will not show the wiry pulse the previous passage has just made diagnostic, and the practitioner is left to read the breathing instead. The chapter does this repeatedly: states a sign, then names the case where the sign fails.

Junggyeong 仲景

6.6.3

Source원문

脉沈而弦者, 懸飮內痛.

Translation영역

When the pulse is sunken and wiry, there is suspended rheum with internal pain.

Junggyeong 仲景

6.6.4

Source원문

脉浮而細滑者, 傷飮. 《仲景》

Translation영역

When the pulse is floating, fine and slippery, there is damage from rheum.

Junggyeong 仲景

6.6.5

Source원문

偏弦爲飮, 或沈弦滑, 或結或伏, 痰飮中節. 《脉訣》

Translation영역

One-sided wiry indicates rheum; or it may be sunken, wiry and slippery, or bound, or hidden — phlegm-rheum answers to these measures.

Maekgyeol 脉訣

6.6.6

Source원문

脉理提綱曰, 痰脉弦滑.

Translation영역

The Maengni Jegang says: the phlegm pulse is wiry and slippery.

Maengni Jegang 脉理提綱

6.6.7

Source원문

三因曰, 飮脉, 皆弦微沈滑.

Translation영역

The Samin says: the rheum pulses are all wiry, faint, sunken and slippery.

Samin 三因

6.6.8

Source원문

脉沈弦細滑, 大小不勻, 皆痰飮爲病也. 《醫鑑》

Translation영역

A pulse sunken, wiry, fine and slippery, uneven in its large and small, is in every case phlegm-rheum making disease.

Clinical note임상 주석

大小不勻 — uneven between large and small — is the addition worth carrying. Four authorities have now agreed that the phlegm pulse is wiry and slippery; the Uigam adds that it is also irregular in amplitude, which is a different observation and a more distinctive one.

Uigam 醫鑑

6.6.9

Source원문

久得濇脉, 必費調理. 盖痰膠固, 脉道阻澁也. 《丹心》

Translation영역

When a rough pulse has been present a long time, regulating the condition will certainly be laborious — for the phlegm has become gluey and fixed, and the pulse ways are obstructed and rough.

Clinical note임상 주석

The one passage in the section that is prognostic rather than diagnostic, and it is placed last for that reason. A rough pulse of long standing means the phlegm has stopped moving altogether, and the section closes by warning that such a case will take time — which is the same judgement the chapter makes at 6.17 on phlegm disease that is hard to treat.

Dansim 丹心

6.7 The Outward Signs of Phlegm-Rheum 痰飮外證

6.7.1

Source원문

靈樞曰, 尺膚麄如枯魚之鱗者, 水溢飮也.

Translation영역

The Lingshu says: when the skin of the forearm is coarse like the scales of a dried fish, this is water and spilling rheum.

Clinical note임상 주석

The section moves from the pulse to what can be seen and touched, and it opens at the forearm — the same stretch of skin the practitioner is already holding to take the pulse. Dried, scaled skin there indicates fluid that has gone to the limbs and stopped, which is spilling rheum as defined at 6.4.4.

Yeongchu 靈樞

6.7.2

Source원문

色鮮明者, 有留飮. 又曰, 脉大, 心下有留飮, 其人背寒冷如氷.

Translation영역

When the complexion is vivid and bright, there is retained rheum. It is also said: when the pulse is large, there is retained rheum below the heart, and the person's back is cold as ice.

Clinical note임상 주석

色鮮明 is counterintuitive and worth pausing on: a complexion that looks too vivid, not too dull, is the sign of retained rheum. The fluid standing beneath produces a surface sheen that reads as health at a glance.

Yeongchu 靈樞

6.7.3

Source원문

水在心, 心下堅築, 短氣, 惡水不欲飮.

Translation영역

When water is in the heart, there is hardness and pounding below the heart, shortness of breath, and an aversion to water with no wish to drink.

Clinical note임상 주석

Five viscera, one line each, and the whole set is a lesson in how the same substance reads differently by location. Note the paradox in this first one: water has stopped in the heart, and the patient wants nothing to drink. Fluid already standing produces aversion to more.

Junggyeong 仲景

6.7.4

Source원문

水在肺, 吐涎沫, 欲飮水.

Translation영역

When water is in the lung, there is vomiting of foamy drool, and a wish to drink water.

Junggyeong 仲景

6.7.5

Source원문

水在脾, 少氣身重.

Translation영역

When water is in the spleen, the qi is scant and the body heavy.

Junggyeong 仲景

6.7.6

Source원문

水在肝, 脇下支滿, 嚏而痛.

Translation영역

When water is in the liver, the area below the ribside is propped and full, and sneezing brings pain.

Junggyeong 仲景

6.7.7

Source원문

水在腎, 心下悸. 《仲景》

Translation영역

When water is in the kidney, there is palpitation below the heart.

Clinical note임상 주석

The last of the five and the one that seems misplaced until the channel relations are recalled: water in the kidney shows itself below the heart, not at the lumbus. The kidney and the heart stand in the water-fire relation, and fluid rising along that axis produces palpitation. The same reasoning underlies the surging from the lower abdomen into the chest treated by Poria and Schisandra Decoction at 6.4.6.

Junggyeong 仲景

6.7.8

Source원문

凡有痰者, 眼皮及眼下, 必有烟灰黑色. 《丹心》

Translation영역

In anyone who has phlegm, the eyelids and the area below the eyes will certainly show a smoke-ash black colour.

Clinical note임상 주석

The single most-cited outward sign of phlegm in the whole chapter, and the one that returns four more times below as the fixed term for it. Darkening around and beneath the eyes is treated here as near-pathognomonic, and the four passages that close this section use it as the constant against which other signs are varied.

Dansim 丹心

6.7.9

Source원문

眼胞及眼下, 如灰烟熏黑者, 痰也. 《醫鑑》

Translation영역

When the eyelids and the area below the eyes look blackened as though smoked with ash, this is phlegm.

Uigam 醫鑑

6.7.10

Source원문

凡病百藥不效, 關上脉伏而大者, 痰也. 用控涎丹方見下. 《丹心》

Translation영역

In any disease where a hundred medicines have had no effect, if the pulse at the bar is hidden and large, this is phlegm. Use Control Drool Elixir. formula below

Clinical note임상 주석

A rule for the case that has defeated everything else, and one of the most practically useful lines in the chapter: when nothing has worked, feel the bar position, and a pulse that is both hidden and large points to phlegm. This is Wang Yinjun's argument at 6.3 converted into a bedside test — phlegm as the cause to suspect once the obvious causes have been exhausted. **Control Drool Elixir contains kansui and euphorbia, both toxic drastic purgatives. It is not suitable for self-administration and is contraindicated in pregnancy and in depleted patients.**

Dansim 丹心

6.7.11

Source원문

一切痰證, 食少肌色如故, 一切水證, 脇硬心下怔忡. 《入門》

Translation영역

In all phlegm patterns, food intake is small yet the flesh and complexion are as before. In all water patterns, the ribside is hard and there is throbbing below the heart.

Clinical note임상 주석

The differentiation between phlegm and water in one line, and the phlegm half is the surprising one: the patient eats little and yet does not waste. That mismatch — poor intake with preserved flesh — is what marks phlegm, and the passage below repeats it as the distinguishing feature.

Immun 入門

6.8 The Various Diseases of Phlegm-Rheum 痰飮諸病

6.8.1

Source원문

痰之爲患, 新而輕者, 形色淸白稀薄, 氣味亦淡. 久而重者, 黃濁稠粘凝結, 咯之難出, 漸成惡味, 酸辢, 腥臊, 醎苦, 甚至帶血而出. 但痰證初起, 頭痛發熱, 類外感表證, 久則潮咳夜重, 類內傷陰火. 又痰飮流注, 肢節疼痛, 類風證. 但痰證胸滿, 食減肌色如故, 脉滑不勻不定爲異耳. 《入門》

Translation영역

As an affliction, phlegm that is new and light is clear and white in form and colour, thin and watery, and bland in smell and taste. Phlegm that is long-standing and heavy is yellow and turbid, thick, sticky and congealed, hard to bring up, and gradually takes on a foul taste — sour and acrid, fishy and rank, salt and bitter — until in severe cases it comes up streaked with blood. But when a phlegm pattern first arises, with headache and fever, it resembles an exterior pattern of external contraction; and when it has lasted, with tidal cough worse at night, it resembles yin fire of internal damage. Again, when phlegm-rheum flows and lodges with pain in the limbs and joints, it resembles a wind pattern. What is different is only this: in a phlegm pattern the chest is full, food intake falls yet the flesh and complexion are as before, and the pulse is slippery, uneven and unsettled.

Clinical note임상 주석

The most clinically useful passage in the chapter, and it is a differential rather than a description. Phlegm is admitted to mimic three quite different things — an exterior contraction early on, yin fire of internal damage later, a wind pattern when it reaches the joints — and then three discriminating features are given: fullness in the chest, intake that falls without wasting, and a slippery pulse that is uneven and unsettled. The progression from thin, clear and bland to thick, yellow and foul is a staging by time rather than by category, and it sits underneath the colour scheme at 6.9. Blood-streaked sputum is named here as the severe end of that progression; in current practice it warrants investigation rather than being read as advanced phlegm.

Immun 入門

6.8.2

Source원문

痰之作恙, 爲喘爲嗽, 爲吐爲嘔, 爲眩暈, 爲風癎, 爲狂迷, 爲忪悸, 或呑酸, 或短氣, 或痞隔, 或腫脹, 或寒熱, 或疼痛, 痰實主之. 《直指》

Translation영역

The troubles phlegm makes: panting and coughing, vomiting and retching, dizziness, wind epilepsy, mania and confusion, fright palpitation; or swallowing of acid, or shortness of breath, or glomus at the diaphragm, or swelling and distension, or cold and heat, or aching pain. Phlegm repletion governs them.

Clinical note임상 주석

Wang Yinjun's catalogue at 6.3 in short form. What the Jikji adds is the last clause — 痰實主之, phlegm repletion governs them — which narrows the claim: these are the presentations of phlegm in repletion, not of phlegm in general. That qualification is what Liu Zonghou was asking for.

Jikji 直指

6.8.3

Source원문

俗云, 十病九痰, 誠哉斯言. 《入門》

Translation영역

The common saying has it that of ten diseases nine are phlegm — and true indeed is that saying.

Clinical note임상 주석

A proverb, quoted and endorsed. Its presence here shows that the position argued at length in Wang Yinjun's treatise had already passed into ordinary speech by the time the Bogam was compiled.

Immun 入門

6.8.4

Source원문

凡人手臂或動不得, 或骨節遍身痛, 坐臥不寧, 此痰入骨也. 又曰, 眼黑而行步呻吟, 擧動艱難者, 入骨痰也. 其證遍身骨節疼痛.

Translation영역

When a person cannot move the hand or arm, or has pain through the bones and joints of the whole body, and can find no ease sitting or lying, this is phlegm entering the bones. It is also said: when the eyes are black and the person groans on walking, finding all movement difficult, this is phlegm that has entered the bones; its pattern is aching pain through the bones and joints of the whole body.

Clinical note임상 주석

The four passages that close the section are a set, and they should be read together. The black around the eyes is held constant and one further sign is varied each time — difficulty moving points to bone, an earthy face with wilting limbs to wind-damp, shortness of breath to fright-wind, red cheeks to heat. It is a compact differential built on a single fixed finding.

Dansim 丹心

6.8.5

Source원문

眼黑而面帶土色, 四肢痿痺, 屈伸不便者, 風濕痰也.

Translation영역

When the eyes are black and the face carries an earthy colour, the four limbs wilt and are impeded, and bending and stretching are not free, this is wind-damp phlegm.

Dansim 丹心

6.8.6

Source원문

眼黑而氣短促者, 驚風痰也.

Translation영역

When the eyes are black and the breath is short and hurried, this is fright-wind phlegm.

Dansim 丹心

6.8.7

Source원문

眼黑而頰赤, 或面黃色者, 熱痰也. 《丹心》

Translation영역

When the eyes are black and the cheeks red, or the face yellow in colour, this is heat phlegm.

Dansim 丹心

6.8.8

Source원문

咯痰不出者, 是痰結也. 又曰, 脇下痛, 作寒熱, 咳嗽氣急, 亦痰結也. 《回春》

Translation영역

When phlegm will not come up on coughing, this is bound phlegm. It is also said: pain below the ribside, with cold and heat arising, cough and hurried breathing, is likewise bound phlegm.

Clinical note임상 주석

Bound phlegm gets its own section at 6.15; this passage introduces the term here and gives its two presentations, one local and one systemic.

Hoechun 回春

6.9 Distinguishing Phlegm by Colour 辨痰色

6.9.1

Source원문

寒痰淸, 濕痰白, 火痰黑, 熱痰黃, 老疾膠. 《入門》

Translation영역

Cold phlegm is clear, damp phlegm white, fire phlegm black, heat phlegm yellow, and old phlegm gluey.

Clinical note임상 주석

The shortest section in the chapter — five terms and a single line — and among the most used. It converts what the patient produces into a category directly, and it dovetails with the two systems already established: with 6.2, where turbidity marks the work of fire, and with 6.5, where four of the five named types have their own subsection and treatment. Two things are worth noting. The last entry breaks the pattern, giving a consistency rather than a colour — old phlegm is defined by being gluey, which is why 6.5.5 treats it by softening rather than by drying. And fire phlegm is black while heat phlegm is yellow, a gradation that reads as the same process taken further: heat scorches the fluids to yellow, and fire scorches them to the colour Wang Yinjun described at 6.3 as soot.

Immun 入門

6.10 The Pattern of Phlegm-Rheum Flowing and Lodging 痰飮流注證

6.10.1

Source원문

凡人忽患, 胸背手脚腰胯隱痛不可忍, 連筋骨牽引釣痛, 坐臥不寧, 時時走易不定, 俗醫不曉, 謂之走注, 便用風藥及鍼灸, 皆無益. 又疑風毒結聚, 欲爲癰疽, 亂以藥貼, 亦非也. 此乃痰涎, 伏在心膈上下, 變爲此疾. 或令人頭痛不可擧, 或神意昏倦多睡, 或飮食無味, 痰唾稠粘, 夜間喉中如拽鋸聲, 多流涎, 手脚冷痺, 氣脉不通, 誤認爲癱瘓, 亦非也. 凡有此疾, 只服控涎丹方見下, 其疾如失. 《得效》

Translation영역

When a person is suddenly afflicted with hidden pain in the chest, back, hands, feet, lumbus and hips that cannot be borne, drawing and pulling through the sinews and bones, so that there is no ease sitting or lying, and it shifts from place to place without settling — the common physician does not understand it, calls it roving lodgement, and reaches at once for wind medicines and needling, all to no benefit. Or he suspects wind toxin gathering and binding, on its way to becoming an abscess, and applies plasters at random; this too is wrong. In fact this is phlegm-drool lying hidden above and below the heart and diaphragm, which has turned into this disease. It may cause headache so that the head cannot be lifted, or clouded weariness of the spirit with much sleeping, or food and drink without savour, phlegm and spittle thick and sticky, a sound in the throat at night like a saw being drawn, copious running drool, cold impediment of the hands and feet, and the qi and vessels not free — and it is mistaken for hemiplegia, which is also wrong. In any case of this disease, simply take Control Drool Elixir formula below, and the disease vanishes.

Clinical note임상 주석

The most polemical passage in the chapter. It names three mistakes in a row — treating it as roving wind, as an incipient abscess, as hemiplegia — and says flatly that all three are wrong. What is being argued is that pain which moves is not therefore wind, and the practical value of the passage lies in the accompanying signs it supplies for telling the difference: heavy sleepiness, food without taste, thick spittle, a sawing sound in the throat at night, and cold numb extremities. **New, severe or migrating pain requires assessment before being attributed to any traditional category, and the formula named contains kansui and euphorbia, both toxic drastic purgatives. It is not suitable for self-administration and is contraindicated in pregnancy and in depleted patients.**

Deukhyo 得效

6.10.2

Source원문

濕痰流注, 上行攻臂, 臂不能擧, 或左右轉移, 消痰茯苓丸主之. 方見手部

Translation영역

When damp phlegm flows and lodges, travelling upward to strike the arm so that the arm cannot be raised, or shifting from one side to the other, Phlegm-Dispersing Poria Pill governs it. formula in the Hand chapter

Clinical note임상 주석

An arm that cannot be raised, with the trouble moving from one side to the other, is the classic presentation for this formula, and the Hand chapter is where its composition sits. Compare Qianjin Point the Way Pill at 6.20.6, which shares its core of fermented pinellia, poria, bitter orange and efflorescent mirabilite and is the same prescription in another line of transmission.

Donguibogam · Damum

6.11 Phlegm Disease Resembling Possession 痰病有似邪祟

6.11.1

Source원문

血氣者, 人之神也. 神氣虛乏, 邪因而入, 理或有之. 若夫血氣兩虛, 痰客中焦, 妨碍升降, 不得運用, 以致十二官各失其職, 視聽言動皆有虛妄, 以邪治之, 其人必死. 《東垣》

Translation영역

Blood and qi are the spirit of a person. That when the spirit qi is vacuous and depleted an evil enters on that account — there may be some principle in this. But where blood and qi are both vacuous and phlegm has lodged as a guest in the middle burner, obstructing ascent and descent so that they cannot be carried out, and thereby bringing the twelve offices each to lose its charge, so that seeing, hearing, speech and movement are all deluded — to treat this as an evil will certainly kill the person.

Clinical note임상 주석

The most consequential sentence in the chapter, and it is worth reading exactly. Dongwon does not deny that an evil can enter; he grants there may be principle in it. What he refuses is the diagnosis in this particular case, where blood and qi are both empty and phlegm has lodged in the middle. The mechanism is stated in physiological terms — ascent and descent obstructed, the twelve offices losing their charge — and the consequence of getting it wrong is stated without hedging. For a fourteenth-century text this is a remarkable piece of reasoning: a presentation read by everyone around the patient as possession is reclassified as a treatable internal disorder, and the reclassification is defended on the grounds that the alternative is fatal. **Acute confusion, deranged speech or altered consciousness requires urgent medical assessment.** These presentations overlap with encephalitis, metabolic derangement, drug effects and psychiatric emergencies. The passage is preserved for its argument, not as a management guide.

Dongwon 東垣

6.11.2

Source원문

先宜多飮薑鹽湯, 探吐之. 或竹瀝, 香油多灌之, 次服陶氏導痰湯.

Translation영역

First give a good deal of ginger-and-salt decoction to drink and probe for vomiting. Or pour in bamboo sap and fragrant oil freely; then give Dao's Guide Out Phlegm Decoction.

Clinical note임상 주석

A two-stage protocol: clear the phlegm by vomiting first, then give the decoction. Note that the formula which follows contains ginseng, white atractylodes and jujube — because the etiology just given names vacuity of blood and qi as what let the phlegm lodge, an empty dwelling has to be reoccupied and not merely swept.

Donguibogam · Damum

6.12 Phlegm Reversal 痰厥

6.12.1

Source원문

痰厥者, 皆因內虛受寒, 痰氣阻塞, 手足厥冷麻痺, 暈倒, 脉沈細. 宜服加味二陳湯ㆍ淸火化痰湯ㆍ鶴頂丹, 小兒方奪命散亦可. 《入門》

Translation영역

Phlegm reversal comes about in every case from inner vacuity contracting cold, so that the phlegm qi obstructs and blocks, the hands and feet are reverse-cold and numb, the person faints, and the pulse is sunken and fine. Augmented Two Matured Ingredients Decoction, Clear Fire and Transform Phlegm Decoction and Crane's Crest Elixir are appropriate; Snatch-Back-Life Powder from the Children's chapter will also serve.

Clinical note임상 주석

Reversal — 厥 — means the warm qi has failed to reach the extremities, and phlegm reversal is the variety where phlegm is what blocks its passage. Everything in the picture points the same way: inner vacuity, contracted cold, cold and numb hands and feet, a sunken fine pulse. The three formulas named are of very unequal character. The first is warm and circulatory; the second is cool and works on bound phlegm in the chest; the third is a mineral caustic. **Crane's Crest Elixir contains vermilion and red lead — mercury and lead compounds — and must not be prepared or taken.** It is recorded in this database for textual completeness only. Fainting with cold extremities requires medical assessment.

Immun 入門

6.13 Phlegm Lumps 痰塊

6.13.1

Source원문

人身上中下, 有塊如腫毒, 多在皮裏膜外, 此因濕痰流注, 作核不散. 問其平日好食何物, 用藥吐下後, 方用消痰散核之藥, 二陳湯, 加大黃ㆍ連翹ㆍ柴胡ㆍ䓀莄ㆍ白芥子ㆍ黃連(薑汁炒), 煎水, 入竹瀝, 多服自消. 《丹心》

Translation영역

When a person has lumps like swollen toxin in the upper, middle or lower body, mostly lying inside the skin and outside the membrane, this comes from damp phlegm flowing and lodging and forming nodules that do not disperse. Ask what foods they habitually favour; after using medicines to induce vomiting and purging, then use medicines that disperse phlegm and scatter nodules — Two Matured Ingredients Decoction with rhubarb, forsythia, bupleurum, platycodon, white mustard seed and coptis (ginger-juice fried) added, decocted in water with bamboo sap stirred in. Taken freely it disperses of itself.

Clinical note임상 주석

皮裏膜外 — inside the skin and outside the membrane — is the anatomical space this section works in, and it is precise: not on the surface, not in the organs, but in the layer between. The instruction to ask what the patient habitually likes to eat is the striking one, and it follows from 6.5.7, where food phlegm forms a nest-sac from food that was never dispersed.

Dansim 丹心

6.13.2

Source원문

痰飮流注於胸背, 頭項, 腋胯, 腰腿, 手足, 聚結腫硬, 或痛或不痛, 按之無血潮, 雖或有微紅, 亦淡薄, 不熱, 堅如石, 破之無膿, 或有薄血, 或淸水, 或如紫汁. 又有壞肉如敗絮, 或如瘰癧, 在皮肉之間, 如雞卵, 可移動, 軟活不硬. 惟覺咽喉痰結, 作寒作熱, 宜返魂湯方見癰疽, 加南星ㆍ半夏. 《醫鑑》

Translation영역

When phlegm-rheum flows and lodges in the chest and back, the head and nape, the armpit and hip, the lumbus and thigh, the hands and feet, it gathers and binds into swellings that are hard, sometimes painful and sometimes not. Pressed, there is no surge of blood; even where there is a faint redness it is thin and pale, and there is no heat. It is hard as stone, and on being opened there is no pus — only thin blood, or clear fluid, or something like purple juice. There may also be spoiled flesh like rotted silk floss, or something resembling scrofula, lying between skin and flesh, the size of a hen's egg, movable, soft and yielding rather than hard. There is only a sense of phlegm bound in the throat, with cold and heat arising. Return the Soul Decoction formula in the Abscess chapter with arisaema and pinellia added is appropriate.

Clinical note임상 주석

The most detailed physical description in the chapter, and it is written as a differential against abscess: no surge of blood on pressure, no heat, no pus on incision. Those three negatives are what separate a phlegm nodule from a suppurating one, and they matter because the treatments diverge completely. **A new, hard, fixed or growing lump requires medical evaluation before it is treated as phlegm.** Everything described here — a stony hard mass, a movable egg-sized nodule between skin and flesh, thin blood or clear fluid on incision — covers presentations that today need imaging and tissue diagnosis to distinguish, and some of them are serious.

Uigam 醫鑑

6.13.3

Source원문

遍身有塊, 多是痰注, 宜加味小胃丹ㆍ竹瀝達痰丸. 《入門》

Translation영역

Lumps over the whole body are mostly phlegm lodgement; Augmented Minor Stomach Elixir and Bamboo Sap Reach the Phlegm Pill are appropriate.

Clinical note임상 주석

The two formulas bracket the range of force the chapter is willing to apply. The first is built on Minor Stomach Elixir with its three drastic purgatives; the second claims to move phlegm out through the stool without damaging the original qi. Which to reach for depends on what the patient can bear.

Immun 入門

6.13.4

Source원문

痰塊, 宜開氣消痰湯. 又天南星ㆍ草烏, 等分爲末, 薑汁調如膏, 敷核上, 立消. 《醫鑑》

Translation영역

For phlegm lumps, Open the Qi and Disperse Phlegm Decoction is appropriate. Also: arisaema and aconite (cao wu) in equal parts, powdered and mixed with ginger juice into a paste, spread over the nodule — it disperses at once.

Clinical note임상 주석

**The topical paste contains raw aconite, which is toxic and absorbed through the skin; it must not be prepared or applied.** It is recorded here as part of the text.

Uigam 醫鑑

6.13.5

Source원문

治痰核, 商陸根, 生南星, 合擣令爛, 塗付立消. 《種杏》

Translation영역

To treat phlegm nodules: pokeweed root and raw arisaema, pounded together until pulpy, spread on and applied — it disperses at once.

Clinical note임상 주석

**Pokeweed root and raw arisaema are both toxic; this preparation must not be made or applied.** Recorded for textual completeness.

Jonghaeng 種杏

6.13.6

Source원문

渾身有腫塊, 或骨體串痛, 都是濕痰流注經絡也, 通用二陳湯加減. 《回春》

Translation영역

Swollen lumps over the whole body, or pain running through the bones and body, are in every case damp phlegm flowing and lodging in the channels and network vessels; Two Matured Ingredients Decoction with additions and subtractions is used generally.

Clinical note임상 주석

The section closes by returning to the parent formula. After five passages of nodules, pastes and purgatives, the general answer is Ijin-tang modified to the case — which is the chapter's habitual move and the reason 6.20.1 gives that formula its own commentary.

Hoechun 回春

6.14 Frequent Spitting of Phlegm 喜唾痰

6.14.1

Source원문

胸中有寒則喜唾痰. 《局方》

Translation영역

When there is cold in the chest, there is frequent spitting of phlegm.

Gukbang 局方

6.14.2

Source원문

脾虛不能剋制腎水, 多吐痰唾而不咳者, 宜服八味元方見虛勞. 又云, 八味元, 治脾腎兩虛, 多唾痰而不咳. 《丹心》

Translation영역

When the spleen is vacuous and cannot restrain the kidney water, so that there is much spitting of phlegm without cough, Eight-Ingredient Pill formula in the Vacuity Taxation chapter should be taken. It is also said: Eight-Ingredient Pill treats vacuity of both spleen and kidney, with much spitting of phlegm and no cough.

Clinical note임상 주석

The differentiating sign is a negative: spitting without cough. Cough would place the trouble in the lung; its absence sends the diagnosis downward to spleen and kidney, and the formula chosen is a kidney supplement rather than anything from this chapter. The mechanism named — earth failing to restrain water — is the five-phase reading of it.

Dansim 丹心

6.14.3

Source원문

大病後, 多唾痰者, 此胃冷也. 宜理中湯方見寒門. 《入門》

Translation영역

When after a serious illness there is much spitting of phlegm, this is a cold stomach; Regulate the Middle Decoction formula in the Cold Damage chapter is appropriate.

Immun 入門

6.14.4

Source원문

病人多唾白沫, 乃胃口上停寒也. 加益智仁. 《丹心》

Translation영역

When a patient spits much white froth, this is cold standing at the mouth of the stomach; add alpinia.

Clinical note임상 주석

White froth specifically, as against phlegm generally — the colour places it as cold phlegm under the scheme at 6.9, and the single medicinal added is a warm aromatic for the upper stomach.

Dansim 丹心

6.14.5

Source원문

喜唾痰, 宜半夏溫肺湯. 《東垣》或二陳湯, 加丁香ㆍ縮砂.

Translation영역

For frequent spitting of phlegm, Pinellia Warm the Lung Decoction is appropriate. Or Two Matured Ingredients Decoction with clove and amomum added.

Clinical note임상 주석

Four passages, four different formulas, and read in order they make a small differential: spleen and kidney vacuity without cough goes to the Eight-Ingredient Pill, a cold stomach after serious illness to Regulate the Middle, white froth to alpinia added, and the general case with fluid actually standing in the stomach duct to Pinellia Warm the Lung Decoction. The section is short but it is one of the better-organized in the chapter.

Dongwon 東垣

6.15 Bound Phlegm 痰結

6.15.1

Source원문

喉中有物, 咯不出, 嚥不下, 此痰結也. 《醫鑑》

Translation영역

When there is something in the throat that will not be coughed up and will not be swallowed down, this is bound phlegm.

Uigam 醫鑑

6.15.2

Source원문

喉中有物, 咯不出, 嚥不下, 此是老痰. 重者吐之, 輕者用瓜蔕散方見吐門, 氣實者, 必用荊瀝. 《丹心》

Translation영역

When there is something in the throat that will not be coughed up and will not be swallowed down, this is old phlegm. In severe cases induce vomiting; in light cases use Melon Pedicel Powder formula in the Vomiting chapter; where the qi is replete, vitex sap must be used.

Clinical note임상 주석

The same sentence as the passage before it, with a different name attached — the Uigam calls it bound phlegm and the Dansim calls it old phlegm. Heo Jun records both without choosing, and the two readings send treatment different ways: bound phlegm toward freeing, old phlegm toward softening. **Melon pedicel is a violent emetic and is toxic. It is not suitable for self-administration.**

Dansim 丹心

6.15.3

Source원문

痰結核在咽喉中, 燥不能出入, 化痰藥, 加醎能耎堅之味, 節齋化痰丸最妙方見上. 此等老痰, 飮酒之人多有之, 酒熱上升鬱于肺胃而成此痰. 天門冬ㆍ片芩, 泄肺火也. 海粉ㆍ芒硝, 醎以耎堅也. 瓜蔞仁, 潤肺降痰, 香附子, 開鬱降氣, 連翹ㆍ䓀莄, 開結降火, 靑黛, 解鬱火, 皆不用半夏ㆍ南星辛燥之劑. 《丹心》

Translation영역

When a bound phlegm nodule lies in the throat, dry so that it can neither come out nor go in, add to the phlegm-transforming medicines flavours that are salty and able to soften hardness; Jeoljae's Transform Phlegm Pill is best of all formula above. Old phlegm of this kind is common in those who drink wine: the heat of the wine rises and is depressed in the lung and stomach, and so this phlegm is formed. Asparagus and broad-lamina scutellaria drain lung fire. Sea hare egg mass and mirabilite are salty and thereby soften hardness. Trichosanthes seed moistens the lung and downbears phlegm; cyperus opens depression and downbears qi; forsythia and platycodon open the bind and downbear fire; indigo resolves depressed fire. None of them uses pinellia or arisaema, those acrid and drying agents.

Clinical note임상 주석

The best piece of formula analysis in the chapter, and worth reading as a model of how these texts justify a composition. Every medicinal is given its job, and the closing sentence names what is deliberately absent: no pinellia, no arisaema. Phlegm which is already dry and stuck cannot be treated by drying, and the principle governing the whole formula is salty flavour softening hardness rather than acrid flavour dispersing damp.

Dansim 丹心

6.16 Phlegm Disease Does Not Kill Suddenly 痰病不卒死

6.16.1

Source원문

大凡病久淹延, 卒不死者, 多因食積, 痰飮所致. 何以然者, 盖胃氣亦賴痰積所養, 飮食雖少, 胃氣卒不便虛故也. 《丹心》

Translation영역

In general, where a disease drags on and lingers long without killing suddenly, it is mostly brought about by food accumulation and phlegm-rheum. Why should this be? Because the stomach qi is in fact nourished by the phlegm accumulation as well, so that although food and drink are scant, the stomach qi does not straightway fall into vacuity.

Clinical note임상 주석

A single passage, and one of the strangest ideas in the chapter: the phlegm accumulation feeds the stomach qi. It explains the observation recorded twice at 6.7 — that in phlegm patterns intake falls and yet the flesh and complexion are unchanged — and it explains the prognosis, that these patients linger rather than collapse. It also explains a therapeutic caution given at 6.19: phlegm in the middle burner of a depleted patient must not be attacked outright, because attacking it exhaustively leaves them more depleted still. If the accumulation is doing part of the work of nourishment, removing all of it at once takes that support away.

Dansim 丹心

6.17 Phlegm Disease Patterns That Are Hard to Treat 痰病難治證

6.17.1

Source원문

氣實熱痰, 吐難得出, 或成塊, 吐咯不出, 氣鬱滯者難治. 又曰, 氣實痰熱結者, 難治. 《丹心》

Translation영역

Heat phlegm with replete qi, hard to bring up by vomiting, or formed into lumps that will not come up by vomiting or coughing, with the qi depressed and stagnant — this is hard to treat. It is also said: where the qi is replete and phlegm heat is bound, it is hard to treat.

Dansim 丹心

6.17.2

Source원문

喉中漉漉有聲, 喘急, 咯痰不出者, 難治. 又曰, 服藥後, 咯吐痰出爲效. 若咯痰不出者, 難治. 《回春》

Translation영역

A gurgling sound in the throat, hasty panting, and phlegm that will not come up on coughing — this is hard to treat. It is also said: after taking medicine, phlegm coming up on coughing or vomiting is the sign of effect; if the phlegm will not come up, it is hard to treat.

Clinical note임상 주석

A criterion for judging whether treatment is working, stated in one line: phlegm coming up is the sign of effect. The chapter uses the same logic at 6.20.6, where stool turning soft after about ten days is given as the sign that an accumulation is quietly dispersing. Both are attempts to give the practitioner something observable to measure progress against. **A gurgling throat with hasty panting is an airway presentation requiring urgent assessment.**

Hoechun 回春

6.17.3

Source원문

痰涎等病不一而足, 惟勞瘵有痰, 爲難治. 最宜早灸膏肓ㆍ四花穴詳見鍼灸. 《資生經》

Translation영역

Diseases of phlegm and drool are more than can be counted, but only phlegm in taxation consumption is hard to treat. It is best to moxa Gohwang (膏肓, BL43) and the Four Flowers early see the Acupuncture chapter for details.

Clinical note임상 주석

Taxation consumption covers the wasting diseases, tuberculosis among them, and the judgement that phlegm in that setting is the hard case is a judgement about the underlying depletion rather than about the phlegm. The recommendation is moxa early rather than medicine, and the same passage returns in the acupuncture section at 6.22 with the sign of success added.

Jasaenggyeong 資生經

6.17.4

Source원문

肺胃經虛則生粘痰, 痰者, 肺胃所出也. 痰涎凝滯在於咽喉, 如牽鋸之聲, 時復瘈瘲, 或因吐瀉所致, 脾虛肺亦虛. 痰涎流溢, 變成癲癎, 尤爲難治. 《全嬰方》

Translation영역

When the lung and stomach channels are vacuous, sticky phlegm is engendered — for phlegm is what the lung and stomach put out. When phlegm and drool congeal and stagnate in the throat, with a sound like a saw being drawn, and there are recurrent spasms of tugging and slackening, or when it is brought about by vomiting and diarrhoea so that the spleen is vacuous and the lung vacuous with it, then the phlegm and drool spill over and turn into epilepsy — and this is hardest of all to treat.

Clinical note임상 주석

The source is a paediatric formulary, and the picture is a child's: vomiting and diarrhoea depleting the spleen, the lung following, and convulsions supervening. The sawing sound in the throat is the same sign that appears at 6.10 and again with Crane's Crest Elixir at 6.12 — stridor, and in a small child with convulsions it is an emergency. **Convulsions, particularly in a child, and particularly with noisy breathing, require emergency care.**

Jeonyeongbang 全嬰方

6.18 The Vomiting Method for Phlegm-Rheum 痰飮吐法

6.18.1

Source원문

痰在膈上, 必用吐法, 瀉亦不能去.

Translation영역

When phlegm lies above the diaphragm, the vomiting method must be used; purging cannot remove it.

Clinical note임상 주석

The anatomical argument for emesis in one line. What sits above the diaphragm cannot be driven downward past it, so the route out is upward. This is why the chapter's purgative formulas are aimed at rheum in the gut and its emetic method at phlegm in the chest.

Dansim 丹心

6.18.2

Source원문

脉浮者, 宜吐.

Translation영역

When the pulse is floating, vomiting is appropriate.

Dansim 丹心

6.18.3

Source원문

膠固稠濁者, 必用吐.

Translation영역

What is gluey and fixed, thick and turbid, must be treated by vomiting.

Dansim 丹心

6.18.4

Source원문

痰在經絡中, 非吐不可. 吐中就有發散之意, 不必在出痰也.

Translation영역

Phlegm in the channels and network vessels cannot be dealt with except by vomiting. Within the vomiting there is the sense of dispersing outward; the point does not lie only in getting the phlegm out.

Clinical note임상 주석

The most interesting line in the section. Vomiting is being defended not as a way of removing phlegm — the phlegm in question is in the channels and will not come up by that route — but as a way of moving qi outward and upward. The emetic is working as a dispersing method, and the material expelled is incidental to it.

Dansim 丹心

6.18.5

Source원문

凡用吐藥, 宜升提其氣, 便吐也. 防風ㆍ梔子ㆍ川芎ㆍ䓀莄ㆍ芽茶ㆍ生薑ㆍ虀汁之類. 或以二陳湯探吐, 或用瓜蔕散方見吐門. 《丹心》

Translation영역

Whenever emetic medicines are used, the qi should be raised and lifted, and vomiting follows of itself — saposhnikovia, gardenia, chuanxiong, platycodon, tea sprouts, fresh ginger, pickle brine and the like. Or probe for vomiting with Two Matured Ingredients Decoction, or use Melon Pedicel Powder formula in the Vomiting chapter.

Clinical note임상 주석

Consistent with the passage before it: the medicinals listed are lifting and outward-moving agents rather than emetics proper, and vomiting is described as following from raising the qi rather than being forced. Probing with Ijin-tang is the mildest option and melon pedicel the harshest. **Deliberately inducing vomiting carries real risks — aspiration, electrolyte disturbance, oesophageal injury — and melon pedicel is toxic. This section is recorded as a historical therapeutic method and should not be attempted.**

Dansim 丹心

6.19 The Treatment Method for Phlegm-Rheum 痰飮治法

6.19.1

Source원문

實脾土, 燥脾濕, 是治其本. 《丹心》

Translation영역

Make the spleen earth substantial and dry the spleen damp — this is to treat the root.

Clinical note임상 주석

The chapter's conclusion stated in eight graphs, and it should be read against Wang Yinjun at 6.3, who put driving out the spoiled phlegm first and assessing vacuity second. Here the order is reversed: the root is the spleen, and the phlegm is what the spleen's failure produces. Heo Jun sets the two positions in the same chapter without reconciling them, and the seven passages that follow argue for this one.

Dansim 丹心

6.19.2

Source원문

虛人中焦有痰, 胃氣亦賴所養, 卒不可便攻, 攻盡則愈虛. 《丹心》

Translation영역

When a depleted person has phlegm in the middle burner, the stomach qi is in fact nourished by it as well; one must not attack outright, for attacking it to exhaustion leaves them more depleted still.

Clinical note임상 주석

The therapeutic consequence of the strange idea recorded at 6.16 — that the phlegm accumulation feeds the stomach qi. If part of the patient's nourishment is coming from what you intend to remove, removing all of it at once takes that support away with it.

Dansim 丹心

6.19.3

Source원문

凡治痰, 用利藥過多, 致脾氣下虛, 則痰反易生而多. 法當補脾胃, 淸中氣, 則痰自然運下, 乃治本之法也. 《丹心》

Translation영역

In treating phlegm generally, using too many freeing medicines brings the spleen qi to vacuity below, and then phlegm is engendered the more easily and the more abundantly. The method should be to supplement the spleen and stomach and to clear the centre qi; then the phlegm is carried downward of itself. This is the method of treating the root.

Clinical note임상 주석

The argument against over-treatment, and it is causal rather than cautionary: freeing medicines used too freely deplete the spleen, and a depleted spleen makes more phlegm. The treatment produces the disease. 自然運下 — carried downward of itself — is the standard being set against attacking, and it is the phrase the chapter uses for a cure that does not need forcing.

Dansim 丹心

6.19.4

Source원문

治痰, 順氣爲先, 分導次之. 然氣升屬火. 因氣動者曰痰氣, 宜順氣導痰湯. 因火動者曰痰火, 宜淸熱導痰湯方見上. 因濕動者曰濕痰, 導痰湯, 通用二陳湯. 《入門》

Translation영역

In treating phlegm, normalizing the qi comes first and dividing and guiding it out comes second. Yet qi that ascends belongs to fire. What is set moving by qi is called phlegm qi, and Normalize the Qi and Guide Out Phlegm Decoction is appropriate. What is set moving by fire is called phlegm fire, and Clear Heat and Guide Out Phlegm Decoction formula above is appropriate. What is set moving by damp is called damp phlegm, and Guide Out Phlegm Decoction; Two Matured Ingredients Decoction is used generally.

Clinical note임상 주석

The most practical passage in the section, and the one that organizes the chapter's formulary. Three movers — qi, fire, damp — and a formula for each, all three built on the same Ijin-tang base. The sequencing rule at the front is what distinguishes this from Wang Yinjun's approach: normalize the qi first, guide the phlegm out second.

Immun 入門

6.19.5

Source원문

陽虛腎寒, 冷痰溢上, 或昏暈夜喘上氣者, 八味丸方見虛勞ㆍ黑錫丹方見入門鎭墜之. 《入門》

Translation영역

Where yang is vacuous and the kidney cold, so that cold phlegm spills upward, or there is clouded dizziness with panting at night and qi rising, Eight-Ingredient Pill formula in the Vacuity Taxation chapter and Black Tin Elixir formula in the Immun settle and weigh it down.

Clinical note임상 주석

The one place the chapter reaches below the spleen. Phlegm that spills upward because the kidney yang cannot hold it down is treated by weighting the lower burner rather than by working on the phlegm at all — 鎭墜, settling and weighing down, is a different therapeutic verb from anything else in the chapter. **Panting at night with dizziness may indicate cardiac failure and warrants medical assessment. Black Tin Elixir contains lead and must not be prepared or taken.**

Immun 入門

6.19.6

Source원문

脾虛不能運化者, 六君子湯, 加竹瀝ㆍ薑汁. 或補中益氣湯, 加半夏ㆍ竹瀝ㆍ薑汁. 《入門》

Translation영역

Where the spleen is vacuous and cannot move and transform, Six Gentlemen Decoction with bamboo sap and ginger juice added; or Supplement the Centre and Boost the Qi Decoction with pinellia, bamboo sap and ginger juice added.

Clinical note임상 주석

Two supplementing formulas with a phlegm medicinal grafted on, which is the practical form of the section's opening principle. Bamboo sap and ginger juice appear together throughout the chapter as the standing pair added at service — the sap cooling and phlegm-dissolving, the ginger juice offsetting its cold.

Immun 入門

6.19.7

Source원문

張子和曰, 飮無補法, 必當去水. 故用汗吐下三法, 治人常愈. 然亦有挾寒挾虛之證, 又有血氣虧乏之人, 理宜導去痰滯, 又當補接兼行, 又難拘於子和之三法也. 《丹心》

Translation영역

Zhang Zihe said: rheum admits of no supplementing method; the water must be removed. And so by using the three methods of sweating, vomiting and purging he treated people and they commonly recovered. Yet there are also patterns that carry cold or carry vacuity, and there are people whose blood and qi are depleted; in principle the phlegm stagnation should be guided out, and yet supplementing and reinforcing should go along with it. So it is hard to be bound by Zihe's three methods.

Clinical note임상 주석

The chapter's second recorded dispute, and it has the same shape as the first. Zhang Zihe's position is stated in full and with respect for its results, then qualified: the three attacking methods will not do for a patient carrying cold or vacuity, and supplementation has to run alongside. 難拘 — hard to be bound by — is the same judgement Liu Zonghou passed on Wang Yinjun at 6.3. Twice in one chapter Heo Jun records a powerful single method and then declines to be governed by it.

Dansim 丹心

6.19.8

Source원문

痰生於脾胃, 治法, 宜實脾燥濕. 又隨氣而升, 宜順氣爲先, 分導次之. 又氣升屬火, 順氣在於降火. 《醫鑑》

Translation영역

Phlegm is engendered in the spleen and stomach, and the treatment method should be to make the spleen substantial and dry the damp. Again, it ascends following the qi, so normalizing the qi comes first and dividing and guiding it out second. Again, qi that ascends belongs to fire, so normalizing the qi lies in downbearing fire.

Clinical note임상 주석

A summary that chains the three principles into one line: treat the spleen because that is where phlegm is made, normalize the qi because that is what carries it up, and downbear fire because that is what drives the qi up. Each step explains the one before it.

Uigam 醫鑑

6.19.9

Source원문

難經曰, 腎主五液, 化爲五濕. 濕能生痰, 痰者, 因咳而動脾之濕也. 半夏能泄痰之標, 不能泄痰之本. 泄本者, 泄腎也. 十棗湯ㆍ三花神佑丸, 是也. 幷見下門

Translation영역

The Nanjing says: the kidney governs the five humours, which transform into the five damps. Damp can engender phlegm; and phlegm is the damp of the spleen set moving by coughing. Pinellia can drain the branch of phlegm but cannot drain its root. To drain the root is to drain the kidney — Ten Jujube Decoction and Three Flowers Spirit-Aid Pill are such medicines. both formulas in the Purging chapter

Clinical note임상 주석

A dissenting account of where the root lies. Everything else in this section locates it in the spleen; this passage moves it down to the kidney, on the reasoning that the kidney governs the humours from which damp and then phlegm derive. The clinical consequence is blunt — pinellia treats only the branch — and the formulas named are drastic purgatives rather than spleen supplements. Heo Jun places it eighth, after seven passages arguing for the spleen, and does not adjudicate. **The two formulas named are toxic drastic purgatives and are not suitable for self-administration.**

Nangyeong 難經

6.19.10

Source원문

熱痰則淸之, 用石膏ㆍ靑黛ㆍ梔子ㆍ黃芩ㆍ黃連. 寒痰則溫之, 用半夏ㆍ乾薑ㆍ附子ㆍ肉桂. 燥痰則潤之, 用瓜蔞仁ㆍ杏仁ㆍ五味子ㆍ天花粉. 濕痰則燥之, 用蒼朮ㆍ白朮ㆍ厚朴ㆍ茯苓. 風痰則散之, 用南星ㆍ皂角ㆍ白附子ㆍ竹瀝. 老痰則軟之, 用海石ㆍ芒硝ㆍ瓜蔞仁ㆍ枳殼ㆍ便香附. 食積痰則消之, 用山楂子ㆍ神麴ㆍ麥芽. 大要, 人參ㆍ甘草以補脾, 白朮ㆍ半夏以燥濕, 陳皮ㆍ靑皮以利氣, 茯苓ㆍ澤瀉以滲水. 《丹心》

Translation영역

Heat phlegm is cleared: use gypsum, indigo, gardenia, scutellaria and coptis. Cold phlegm is warmed: use pinellia, dry ginger, aconite and cinnamon bark. Dry phlegm is moistened: use trichosanthes seed, apricot kernel, schisandra and trichosanthes root. Damp phlegm is dried: use black atractylodes, white atractylodes, magnolia bark and poria. Wind phlegm is dispersed: use arisaema, gleditsia pod, typhonium and bamboo sap. Old phlegm is softened: use pumice, mirabilite, trichosanthes seed, bitter orange and child-urine-processed cyperus. Food accumulation phlegm is dispersed: use hawthorn, medicated leaven and barley sprout. In sum: ginseng and licorice to supplement the spleen, white atractylodes and pinellia to dry damp, tangerine peel and green tangerine peel to free the qi, poria and alisma to percolate off water.

Clinical note임상 주석

The chapter's formulary in one passage. Seven kinds of phlegm, one verb and one set of medicinals for each — clear, warm, moisten, dry, disperse, soften, dissolve — and then four pairs that hold for every case. The categories map onto the ten of 6.5 with two absences: qi phlegm and fright phlegm have no entry here, because both are treated through their cause rather than through the phlegm. It is worth setting this beside the six-line summary appended to Rosy Heaven Paste at 6.5.5.3, which sorts the same problem by what the phlegm is doing rather than by what kind it is. Between the two, a practitioner has the chapter's therapeutics on a single page.

Dansim 丹心

6.20 Medicines for Phlegm-Rheum in General Use 痰飮通治藥

6.20.1

Source원문

通用二陳湯ㆍ茯苓半夏湯ㆍ芎夏湯ㆍ蠲飮枳實丸ㆍ千金指迷丸ㆍ敵痰丸ㆍ小胃丹. 痰飮冷證, 宜五飮湯ㆍ破痰消飮元. 濕熱痰飮, 宜滾痰丸ㆍ木香和中丸. 食積痰飮, 宜淸氣化痰丸. 虛人老人痰飮, 宜竹瀝枳朮丸ㆍ霞天膏見上.

Translation영역

In general use: Two Matured Ingredients Decoction, Poria and Pinellia Decoction, Chuanxiong and Pinellia Decoction, Dispel Rheum Bitter Orange Pill, Qianjin Point the Way Pill, Subdue Phlegm Pill and Minor Stomach Elixir. For the cold pattern of phlegm-rheum, Five Rheums Decoction and Break Phlegm and Disperse Rheum Pill are appropriate. For damp-heat phlegm-rheum, Roll the Phlegm Pill and Costus Harmonize the Centre Pill. For phlegm-rheum of food accumulation, Clear the Qi and Transform Phlegm Pill. For phlegm-rheum in the depleted and the old, Bamboo Sap Bitter Orange and Atractylodes Pill and Misty Heaven Paste above.

Clinical note임상 주석

Not a list but a classification: seven formulas for general use, then one pair for each of four patterns — cold, damp-heat, food accumulation, and depletion or age. The general seven are led by Ijin-tang and end at Minor Stomach Elixir, so even that first line runs from the mildest prescription in the chapter to one of the two harshest. The four patterned clauses are the chapter's answer to the question its ten kinds of phlegm raise: the kind of phlegm decides the formula, but the state of the patient decides the force. 虛人老人 gets Bamboo Sap Bitter Orange and Atractylodes Pill and Misty Heaven Paste, neither of which purges.

Donguibogam · Damum

6.21 Simple Medicinals 單方

6.21.1

Source원문

凡二十三種.

Translation영역

Twenty-three kinds in all.

Donguibogam · Damum

6.21.2

Source원문

白礬吐去胸中痰飮. 取一兩, 水二升煮取一升, 入蜜半合, 頓服須臾卽吐, 未吐則當飮少熱湯. 《本草》

Translation영역

Alum (白礬): Vomits out phlegm-rheum from the chest. Take 1 nyang, boil in 2 seung of water down to 1 seung, add half a hop of honey and take at one draught; vomiting follows shortly. If it does not, a little hot water should be drunk.

Clinical note임상 주석

**A violent emetic. Inducing vomiting carries real risks of aspiration and injury, and this should not be attempted.**

Boncho 本草

6.21.3

Source원문

蒼朮消痰水. 能治痰飮成窠囊極效, 卽上神朮丸也. 性燥能勝濕. 《本草》

Translation영역

Black atractylodes (蒼朮): Disperses phlegm and water. It treats phlegm-rheum that has formed a nest-sac with the greatest effect — this is Spirit Atractylodes Pill above. Its nature is drying and it can overcome damp.

Boncho 本草

6.21.4

Source원문

貝母消痰, 又治胸膈痰氣最妙. 《本草》貝母丸, 取貝母, 童便浸三日, 洗曬爲末, 糖霜調和, 不時服. 《入門》

Translation영역

Fritillaria (貝母): Disperses phlegm, and treats phlegm qi of the chest and diaphragm most excellently. Fritillaria Pill: take fritillaria, steep it three days in child's urine, wash and sun-dry it, powder it, mix with sugar frost, and take at any time.

Boncho 本草

6.21.5

Source원문

前胡治熱痰, 又治痰滿胸痞. 剉取三錢, 水煎服之. 《本草》

Translation영역

Peucedanum (前胡): Treats heat phlegm, and treats phlegm filling the chest with glomus. Cut up and take 3 don, decocted in water.

Boncho 本草

6.21.6

Source원문

乾薑治寒痰, 又消痰下氣. 丸服, 煎服皆可. 《本草》

Translation영역

Dry ginger (乾薑): Treats cold phlegm, and disperses phlegm and downbears qi. It may be taken in pills or in decoction.

Boncho 本草

6.21.7

Source원문

生薑去痰下氣. 又去冷痰, 調胃氣. 《本草》治痰癖, 生薑四錢, 附子生二錢. 右剉, 水煎服. 《本草》

Translation영역

Fresh ginger (生薑): Removes phlegm and downbears qi. It also removes cold phlegm and regulates the stomach qi. For phlegm aggregation: fresh ginger 4 don, raw aconite 2 don; cut up and decoct in water.

Clinical note임상 주석

**The second preparation contains raw aconite, which is toxic and must not be prepared or taken.**

Boncho 本草

6.21.8

Source원문

半夏治寒痰, 能勝脾胃之濕, 所以化痰. 《湯液》 ○能消痰涎, 去胸中痰滿. 《本草》油炒半夏, 大治濕痰. 《丹心》去痰, 須用半夏. 熱加黃芩, 風加南星, 痞加陳皮ㆍ白朮. 《入門》半夏丸, 治痰喘, 心痛. 半夏, 香油炒爲末, 粥丸梧子大, 薑湯下三五十丸. 《入門》

Translation영역

Pinellia (半夏): Treats cold phlegm, being able to overcome the damp of the spleen and stomach, and thereby transforms phlegm. ○ Disperses phlegm and drool and removes phlegm fullness from the chest. Pinellia fried in oil greatly treats damp phlegm. To remove phlegm, pinellia must be used: for heat add scutellaria, for wind add arisaema, for glomus add tangerine peel and white atractylodes. Pinellia Pill treats phlegm panting and heart pain: pinellia fried in sesame oil and powdered, made into congee pills the size of a firmiana seed, thirty to fifty taken down with ginger decoction.

Clinical note임상 주석

The chapter's chief phlegm medicinal, and the three-way modification given here — scutellaria for heat, arisaema for wind, tangerine peel and atractylodes for glomus — is the compressed form of what Ijin-tang and its derivatives do at length.

Boncho 本草

6.21.9

Source원문

半夏麴 痰分之病, 半夏爲主. 然必造而爲麴. 又入霞天膏, 白芥子ㆍ薑汁ㆍ礬湯ㆍ竹瀝, 造麴. 治痰積沈痾者, 自能使腐敗, 隨大小便出, 或散而爲瘡, 此半夏麴之妙也. 佐以南星, 治風痰. 佐以薑汁ㆍ酒浸炒芩連, 及瓜蔞仁ㆍ香油拌麴略炒, 治火痰. 佐以麩炒枳實ㆍ薑汁浸蒸海粉之類, 治老痰. 佐以蒼ㆍ白朮, 俱米泔薑汁浸炒, 甚至乾薑ㆍ烏頭, 皆治濕痰. 製法詳見雜方《丹心》

Translation영역

Fermented pinellia (半夏麴): In diseases of the phlegm division, pinellia is the chief medicinal — yet it must be worked into a leaven. Rosy Heaven Paste is also put in, with white mustard seed, ginger juice, alum solution and bamboo sap, and the leaven made. In treating deep-seated phlegm accumulation it is able of itself to make the matter rot and come out with the stool and urine, or else disperse and emerge as sores; this is the marvel of fermented pinellia. Assisted by arisaema, it treats wind phlegm. Assisted by ginger juice, wine-steeped and fried scutellaria and coptis, and trichosanthes seed with the leaven mixed in sesame oil and lightly fried, it treats fire phlegm. Assisted by bran-fried bitter orange and ginger-juice-steeped and steamed sea hare egg mass and the like, it treats old phlegm. Assisted by black atractylodes and white atractylodes, both steeped in rice-washing water and ginger juice and fried, and even by dry ginger and aconite, it treats damp phlegm in every case. for the method of preparation see the Miscellaneous Formulas chapter

Clinical note임상 주석

The longest of the twenty-three and the one that justifies giving fermented pinellia its own entry rather than folding it into pinellia. The claim is that fermentation changes what the medicinal can do: raw or ginger-processed pinellia dries damp, but the leaven is said to make a lodged accumulation rot so that it leaves by the stool and urine. Four assisted forms are then given, one for each kind of phlegm.

Dansim 丹心

6.21.10

Source원문

法製半夏 大半夏一斤, 石灰一斤, 滾水七椀, 入盆內, 攪掠, 澄淸去滓, 將半夏浸之, 手攪, 日曬夜露, 七日撈出. 井華水洗淨三四次, 泡三日, 每日換水三次, 撈起控乾. 用白礬八兩, 皮硝一斤, 滾水七八椀, 入盆內, 攪掠, 浸半夏七日, 日曬夜露, 取出水洗三四次, 泡三日, 每日換水三次, 取出控乾. 入甘草ㆍ薄荷各四兩, 丁香ㆍ枳實ㆍ木香ㆍ白薑ㆍ陳皮ㆍ靑皮ㆍ枳殼ㆍ五味子ㆍ縮砂各五錢, 白豆蔲ㆍ肉桂各三錢, 沈香一錢. 右切片, 滾水十五椀, 將半夏同藥共入盆內, 泡二七日, 日曬夜露, 攪之. 日足, 取出藥與半夏, 用白布包住, 放在熱炕, 用器皿覆住, 三炷香時, 藥與半夏分胎, 半夏乾, 收用. 有痰火者服之, 一日大便出似魚膠, 一宿盡除痰根, 永不生也. 此藥化痰如神. 若不信, 將半夏七八粒硏入痰椀, 化爲淸水. 有痰疾中風不語, 硏七八粒, 井水送下, 以手摩運腹上, 卽醒能言. 《回春》

Translation영역

Processed pinellia (法製半夏): Large pinellia 1 geun and lime 1 geun; put 7 bowls of boiling water into a basin, stir and skim it, settle it clear and discard the dregs, then steep the pinellia in it, stirring by hand, sunned by day and dewed by night, and after seven days scoop it out. Wash clean three or four times in fresh well water, soak three days changing the water three times daily, then lift out and drain. Take alum 8 nyang and crude mirabilite 1 geun with 7 or 8 bowls of boiling water, put into a basin, stir and let cool, and steep the pinellia seven days, sunned by day and dewed by night; take it out, wash three or four times, soak three days changing the water three times daily, then take out and drain. Add licorice and mint 4 nyang each; clove, bitter orange, costus, white ginger, tangerine peel, green tangerine peel, bitter orange fruit, schisandra and amomum 5 don each; round cardamom and cinnamon bark 3 don each; aloeswood 1 don. Slice these, and with 15 bowls of boiling water put the pinellia and the medicinals together into a basin and soak for fourteen days, sunned by day and dewed by night, stirring. When the days are complete, take out the medicinals and the pinellia, wrap in white cloth, set on a heated floor and cover with a vessel; after the time of three incense sticks the medicinals and the pinellia part from one another, the pinellia is dry, and it is stored for use. Where there is phlegm fire, the patient takes it and in a day the stool comes out like fish glue; in one night the root of the phlegm is wholly removed and it never forms again. This medicine transforms phlegm as though by spirit: if one doubts it, grind seven or eight of the pieces into a bowl of phlegm and it turns to clear water. In phlegm disease with wind stroke and loss of speech, grind seven or eight pieces and send them down with well water, then rub and move the hand over the abdomen, and the patient wakes at once and can speak.

Clinical note임상 주석

Twenty-eight days of processing described step by step — the most elaborate single procedure in the chapter, and the reason processed pinellia stands as its own entry. The Hoechun appends extravagant claims for the finished drug which are not carried into this translation; what is worth keeping is the method, which shows how much labour the tradition was prepared to spend converting a harsh medicinal into a mild one. **Lime and crude mirabilite are caustic. This is a historical preparation record, not a procedure to attempt.**

Hoechun 回春

6.21.11

Source원문

瓜蔞仁 治熱痰ㆍ酒痰ㆍ老痰ㆍ燥痰. 潤肺, 化痰, 降氣, 洗滌胸膈中垢膩. 作丸, 或煎服皆佳. 《丹心》

Translation영역

Trichosanthes seed (瓜蔞仁): Treats heat phlegm, alcohol phlegm, old phlegm and dry phlegm. It moistens the lung, transforms phlegm, downbears qi, and washes away the grime and grease in the chest and diaphragm. Made into pills or taken in decoction, either is good.

Clinical note임상 주석

Four of the ten kinds in one medicinal, and all four are the dry or heated varieties — which is why trichosanthes seed leads the formulas at 6.5.5 where drying medicinals are deliberately left out.

Dansim 丹心

6.21.12

Source원문

葶藶子 除胸中痰飮, 能逐肺經之水. 末服, 煎服皆可. 《本草》

Translation영역

Lepidium seed (葶藶子): Removes phlegm-rheum from the chest and can expel water from the lung channel. It may be taken as a powder or in decoction.

Boncho 本草

6.21.13

Source원문

旋覆花 消胸上痰結, 唾如膠漆, 除心脇痰水. 水煎服, 或丸服. 《本草》

Translation영역

Inula flower (旋覆花): Disperses bound phlegm above the chest, with spittle like glue or lacquer, and removes phlegm and water from the heart and ribside. Taken in water decoction or in pills.

Boncho 本草

6.21.14

Source원문

枳實除胸脇痰癖. 水煎服, 或作丸服之. 《本草》枳實瀉痰, 能衝墻壁. 《丹心》

Translation영역

Bitter orange fruit (枳實): Removes phlegm aggregation from the chest and ribside. Taken in water decoction or made into pills. Bitter orange fruit drains phlegm with force enough to charge through a wall.

Clinical note임상 주석

The Dansim's line about charging through a wall is the most quoted phrase attached to this medicinal and marks it as the forceful member of the qi-moving group.

Boncho 本草

6.21.15

Source원문

枳殼消痰, 散胸膈痰滯. 煎服, 末服皆可. 《本草》

Translation영역

Bitter orange (枳殼): Disperses phlegm and scatters phlegm stagnation in the chest and diaphragm. Taken in decoction or as a powder.

Boncho 本草

6.21.16

Source원문

天南星 治風痰. 炮黃色, 入生薑七片, 水煎服. 或薑汁糊丸服. 《本草》

Translation영역

Arisaema (天南星): Treats wind phlegm. Blast-fried to a yellow colour, with 7 slices of fresh ginger added, decocted in water and taken; or made into pills with ginger juice paste.

Boncho 本草

6.21.17

Source원문

靑礞石 治食積痰. 同焰硝, 火煆服, 能利痰積, 從大便而出. 作丸服, 或末服皆可. 《入門》

Translation영역

Chlorite schist (靑礞石): Treats food accumulation phlegm. Calcined with niter and taken, it frees the phlegm accumulation so that it comes out with the stool. Taken in pills or as a powder.

Immun 入門

6.21.18

Source원문

木瓜消痰, 止痰唾. 《本草》木瓜煎, 治痰益脾胃. 木瓜蒸爛取肉, 硏搗篩去滓, 量入煉蜜ㆍ薑汁ㆍ竹瀝, 攪和作煎. 每取一大匙, 嚼下, 日三四次. 《俗方》

Translation영역

Chaenomeles (木瓜): Disperses phlegm and stops the spitting of phlegm. Chaenomeles Decoct treats phlegm and benefits the spleen and stomach: steam chaenomeles until soft and take the flesh, grind and pound it, sieve out the dregs, add measured amounts of refined honey, ginger juice and bamboo sap, stir together and make a decoct. Take one large spoonful at a time, chewed down, three or four times a day.

Boncho 本草

6.21.19

Source원문

烏梅去痰止渴. 可作茶飮. 《本草》

Translation영역

Mume fruit (烏梅): Removes phlegm and stops thirst. It may be made into a tea and drunk.

Boncho 本草

6.21.20

Source원문

白芥子 主胸膈痰冷. 《本草》痰在脇下, 非白芥子不能達. 末服, 煎服皆佳. 《丹心》

Translation영역

White mustard seed (白芥子): Governs phlegm and cold in the chest and diaphragm. Phlegm below the ribside cannot be reached except by white mustard seed. Taken as a powder or in decoction, either is good.

Clinical note임상 주석

The Dansim's claim that nothing else reaches phlegm below the ribside is why this medicinal appears in the lump formulas at 6.13 and in Control Drool Elixir, where the target is precisely fluid lodged in that space.

Boncho 本草

6.21.21

Source원문

瓜蔕吐痰. 痰塞心胸, 令人悶絶, 用瓜蔕散吐之卽甦. 方見吐門

Translation영역

Melon pedicel (瓜蔕): Vomits out phlegm. When phlegm blocks the heart and chest so that a person is oppressed to the point of collapse, Melon Pedicel Powder is used to make them vomit and they revive at once. formula in the Vomiting chapter

Clinical note임상 주석

**Melon pedicel is toxic and a violent emetic. It must not be used, and collapse from any cause is a medical emergency.**

Donguibogam · Damum

6.21.22

Source원문

海粉熱痰能降, 濕痰能燥, 結痰能軟, 頑痰能消. 不可入湯, 可入丸藥用. 製法詳見雜方《丹心》

Translation영역

Sea hare egg mass (海粉): Heat phlegm it can downbear, damp phlegm it can dry, bound phlegm it can soften, stubborn phlegm it can disperse. It must not be put into decoctions; it may be used in pill medicines. for the method of preparation see the Miscellaneous Formulas chapter

Clinical note임상 주석

Four actions and one prohibition, and the prohibition is the useful part: not for decoctions, pills only. This is why it appears in Jeoljae's Transform Phlegm Pill and Clear Fire and Sweep Phlegm Pill and never in any of the chapter's decoctions.

Dansim 丹心

6.21.23

Source원문

蛤粉能墜痰, 軟堅. 卽固濟火煆, 海蛤粉也. 未服, 丸服幷佳. 《丹心》

Translation영역

Clam shell powder (蛤粉): Can sink phlegm and soften hardness. That is, clam shell powder sealed under lute and calcined. Taken as a powder or in pills, either is good.

Dansim 丹心

6.21.24

Source원문

蜆殼燒爲白灰, 飮調服. 除心胸痰水. 《本草》

Translation영역

Marsh clam shell (蜆殼): Burnt to a white ash and taken stirred into a drink. It removes phlegm and water from the heart and chest.

Boncho 本草

6.22 Acupuncture and Moxibustion Methods 鍼灸法

6.22.1

Source원문

諸痰飮病, 取豊隆ㆍ中脘.

Translation영역

For the various diseases of phlegm-rheum, take Pungnyung (豊隆, ST40) and Jungwan (中脘, CV12).

Clinical note임상 주석

The two points that answer to the whole chapter. Pungnyung is the classical phlegm point and Jungwan is the front-mu of the stomach — which is exactly the therapeutic logic of 6.19, where the spleen and stomach are named as the root and the phlegm as what their failure produces.

Gangmok 綱目

6.22.2

Source원문

胸中痰飮, 吐逆不食, 取巨闕ㆍ足三里. 《綱目》

Translation영역

For phlegm-rheum in the chest, with retching counterflow and no eating, take Geogwol (巨闕, CV14) and Jok-samni (足三里, ST36).

Gangmok 綱目

6.22.3

Source원문

溢飮, 取中脘. 《甲乙》

Translation영역

For spilling rheum, take Jungwan (中脘, CV12).

Gabeul 甲乙

6.22.4

Source원문

三焦停水, 氣攻不食, 取維道ㆍ中封ㆍ胃兪ㆍ腎兪. 《東垣》

Translation영역

For water standing in the three burners, with the qi assailing and no eating, take Yudo (維道, GB28), Jungbong (中封, LR4), Wisu (胃兪, BL21) and Sinsu (腎兪, BL23).

Clinical note임상 주석

The one prescription here that reaches to the kidney. Stomach shu and kidney shu together answer to the dissenting passage at 6.19, where the Nanjing places the root of phlegm in the kidney rather than the spleen.

Dongwon 東垣

6.22.5

Source원문

痰涎等疾, 不一而足, 惟勞瘵有痰, 爲難治. 最宜早灸膏肓穴, 壯數旣多, 當有所下漉漉然如流水之狀者, 是痰下也. 《資生》

Translation영역

Diseases of phlegm and drool are more than can be counted, but only phlegm in taxation consumption is hard to treat. It is best to moxa Gohwang (膏肓, BL43) early; once the cones have been many, there should be something descending with a trickling like running water — this is the phlegm going down.

Clinical note임상 주석

The chapter closes on a sign of success rather than a method. The same passage appears at 6.17 among the hard-to-treat patterns, but there it stops at the recommendation; here it adds what to look for — a trickling sensation of descent after enough cones have been burnt. It is a fitting close. The chapter has spent twenty-two sections arguing about how much force to apply and where the root lies, and it ends with moxa at a single point and an instruction to wait for a sign.

Jasaenggyeong 資生

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Donguibogam, Phlegm-Rheum chapter. The Chinese text is collated against the public-domain Wikisource transcription and a printed edition; original character forms (脉, 人參) are retained. Terminology follows Wiseman & Feng, A Practical Dictionary of Chinese Medicine. Translation and clinical notes are original to this site. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.