黄芪30g太子参20g柴胡20g炙草3g姜半夏9g象贝母20g半枝莲30g百部9g葶苈子9g鱼腥草20g莱菔子9g红枣20g黄芩9g
以上方为基础增损出入，先后服药五十五帖，经原医院复查病灶消失，胸膜炎症吸收。其间曾用之药为：天冬、夏枯草、枳壳、白芍、丹参、地骨皮、橘络、猫爪草、南北沙参、鳖甲等品。当患者病愈过半后，兼服狼毒蛋，服法同于例一。
患者病愈后复经上海市第一人民医院肺科专家复审区医院历次所摄胸片，确系逐渐进步，未见病情反复，同意临床治愈。但右上肺肺尖部有一阴影，为慎重计，于一院又摄前突位片，片示：“两肺无活动性病变，心肺及横膈正常。”
按：以上两例，例一为肺结核病，治疗全过程纯用中药，患者仅配合服用少量保健营养品，未用任何西药治疗剂。例二则不然，服用中药同时兼服西药雷米封、利福平。但疗程较短，治疗较彻底，当是中西医药双重效果。初诊时医院要求患者住院治疗，为患者所拒绝。从诊断到治愈共五个月，服用中药在最后两个月内。且患者自始至终参加工作未经病休。从以上两例可见以小柴胡汤为主方治疗结核病，如能药证相应、投剂得当，必收彰著之效。
例二方以小柴胡汤合葶苈大枣泻肺汤，在全方有效控制结核性炎症基础上，取苈枣泻肺利水之功，以消残余胸水，药后收到预期效果。虽葶苈用量不重，而治疗之关键在于抑制与控制结核，不在逐水，且方中黄芪补气而利水，半枝莲、鱼腥草均具清热利水之功，诸药合投自有协同作用。且肺为娇脏，如葶苈用量过甚，亦易损伤肺中津气而影响病体康复。
虚劳咳嗽拯阴蠲
某局办公室曹主任内人黄氏，年方四旬而体弱多病。于1963年曾患右侧胸膜炎，历时数月方痊。继病肠结核，至今前疾未愈，后病又起。1970年初得十二指肠球溃，穿孔出血，经手术治疗始安，至1971年开春后，咳嗽不止，服药打针两月未已。左胸时痛，四肢懈怠，面黄肌瘦，纳食呆钝，卧病床褥，双眸无神。于4月5日迓余出诊，所见俱如上述。脉细软如丝，舌质淡白无华。显然久病虚赢，劳嗽之候也。法当培元以固本，佐止咳以治标。仿李士材拯阴理劳汤意，为疏一方：
党参9g麦冬6g五味子3g黄芪6g当归9g炙草3g炙紫菀9g炙百部9g阿胶3g(烊冲)冬虫夏草4．5g陈皮4．5g
服_三帖后，精神大振，胃纳渐开，已能起床行动。咳亦稀，痰已爽，遂以此方加减。症则或见右胁痞胀不适，或见掌心烦热，或见大便反硬，或见咳嗽昼稀夜甚。药则仍宗前方，而以川楝子、贝母、百合、白薇、蒌仁、菊化、杞子等增损出入，先后仅四诊，服药十六帖，诸恙竟解。一年后相遇，则形盛颊丰，大异畴昔。现已退休多年，前症终未复发也。
盖虚劳一证，乃诸虚劳损之简称。良由脏腑阴阳气血之亏损，机体真元虚弱而致。如高鼓峰《医家心法》曰：“阴虚、阳虚者，此虚为劳，即今所谓怯弱证也。”李士材《医宗必读》曰：“夫人之虚，不属于气，即属于血，五脏六腑岂能外焉。”据此，则虚劳之病无非是人身五脏六腑中气、血、阴、阳不足之病证。
昔贤视此症为人身之大患，历代医籍论述甚多。总而言之，此症之轻浅者不过阴阳气血之小有亏损，或失于平衡，补之调之即复本元。而此症之深重者，如五劳、七伤、六极之类其病已甚，治之非易。上述黄氏一案，乃属普通型虚劳咳嗽病例，而其治法，虽总不离乎“虚则补之”之大法，而选方用药，亦宜细加抉择。患者人到中年而素体怯弱，消化道溃疡出血，肢软肌瘦，纳呆乏力，加之脉象细软如丝，舌质淡白无华，是脾虚气血亏损之见象。而胸痛咳嗽．曾有胸膜炎病史，是火烁金伤之象。患者肺脏受损于先，继则脾土衰颓土不生金，子失母养于后，则肺气益虚。此时肺中纵有余热．亦不过虚浮游弋之火，必用“土厚则火敛”之法，切忌苦寒直折之品。综观全案，乃脾气虚弱为本。肺虚咳嗽为标。治法当补益脾肺，金土相生，佐以润肺止咳。务使补而不壅，润而不腻，温而不燥，清而不伐。至于选方，《十药神书》之方多用于复杂深重病证，《理虚元鉴》虽议论精辟入微，并强调肺、脾、肾三脏为治虚劳之关键，而阳虚统于脾，阴虚统于肺，则脾肺两脏尤为关键之关键，然所列方药实难采用。不如《医家心法》寥寥数语，却直截了当；“治弱之法，只一归脾汤去木香，加麦冬、五味、白芍、吞六味丸，此外别无治法。”但高氏此方，为心脾两伤兼肾阴不足者设，而今黄氏之证乃病在肺脾，仍属不治。再观《医宗必读》之“拯阴理痨汤”，此方“治阴虚火动，皮寒骨热，食少痰多，咳嗽短气，倦怠焦烦。”用药以人参、麦冬、五味子组成之生脉饮为基础，加入莲子、苡仁、大枣、甘草、丹皮、生地、当归、白芍、橘红，肝脾两调，气血双补，而与黄氏之证，依然隔膜。但健脾养阴制方用意可取。故仿其意而制为一方，治在脾肺，用参芪陈草培脾土以生金，合入当归补血汤以滋化源。麦冬、五味、虫草、阿胶，补肺润燥而收其耗散，兼以紫菀、百部润肺下气以止咳逆。自以为此方用意尚称周匝，选药可云恰当。不治其火而虚火自敛，不补其血而营血自生。故仅调金土两脏而诸病自已也。古人云治病必求其本者，此之谓欤!
五味子治咳宜忌谈
五味子治咳喘，由来久矣。远自仲景，近迄天士，历代大家鲜有不用之者。然五味子虽为咳喘妙药，并非适用于所有病人。宜者用之，效可立见；不宜者服之，害亦非浅。故于宜与不宜之间，须究心焉。清·叶天士为一代宗师，每因虚劳喘咳方中用五味子，屡遭徐灵胎之评责。可见五味子虽为治病良药，若要投遣得当，亦非易事。
五味子秉酸收之性，有敛肺保肾之功。因其酸敛，则有凝痰、滞邪、聚火之弊。是故五味子所治之咳，乃肺肾不足、元气耗散之咳，取其固守金水则喘咳自止。若夫外因客邪、内缘停痰火热之类所致之喘哮咳嗽，则五味子避之犹恐不及，是为大忌者也。如若虚实相兼之证，必用五味子时，可与泻实之药同用，相辅而成功。仲景用五味子，每与干姜为伍者，职是之故也。如小青龙汤为风寒束表、饮停于中之喘咳；射干麻黄汤之治痰饮喘咳等皆是。关于五味子之适用宜忌，徐灵胎于《临证指南》之批语中言之甚详：“此老(指叶天士)于补剂中用五味子极多，以其能收摄元气归于下焦；或收敛肺气不使上逆。皆历代医书相传之法，其实皆谬也。五味子专于收敛，倘有一毫风寒痰火内外之邪，用之则永远不出而成痼疾。故仲景治虚方宁用牡蛎、龙骨，从无五味者。其咳证之用五味，必与干姜同用，从无独用者，历考自知，乃千余年竟无知者，而杀人无数矣。”东垣亦曰：五味子“治咳以之为君，但有外邪者，不可聚用，恐闭其邪气，必先发散尔后用之乃良。有痰者，以半夏为伍；喘者阿胶为伍，但分量少不同耳。”两位先贤之论，言简意赅，于五味子疗咳之宜忌，已得其要领矣。
余临证间，亦恒用五味子以治慢性咳嗽，于肺金气阴伤损之“老年性慢性支气管炎”，辄加用于辨证处方中，收效之良，非他药可比拟。余于十四、五年前治一女同事，自幼得气管炎，经年咳嗽不已。春夏咳稀，秋冬咳甚，三十余年历治不愈。余详察四诊，知其内外无邪，纯属虚证，适与中药西制之五昧子糖浆，服一瓶后咳嗽大减，连进五大瓶(每瓶500ml)，三十余年之痼疾，竞得根治。
又曾治一八旬老妪，子孙孝顺，经济宽裕。橘子苹果，日啖不辍。人参蜂皇浆之类温补之品，相继迭进。渐至口干、内热、咳嗽频仍，数月不瘳。余诊其脉，弦而有力，略带涩意，舌红而干，中心剥苔。显属肺肾燥热，津伤咳嗽，治当益胃生津，润肺止咳。虑高年胃气多弱，兼顾健运中焦，投以叶氏养胃汤加川贝粉。首次服药后即觉舒泰异常，为数月来所未有，三、四帖后咳减过半。复诊时舌红已退，于原方中加五味子3g，服后咳又骤增，口干心烦。因速泻去五昧，仍服原方，则日愈一日，连服二周，诸证悉愈。此例属内热伤津而不宜用五味子收敛者。由此可知五味子治咳喘有宜与不宜之别，临证时当有所斟酌，不可一概施用。夫药本无过，全在医家之驾驭得法与否耳。
“百合”妙蠲“老慢支”
老年性慢性支气管炎，为现代西医病名，中医归入内伤咳嗽门内。此病为老年患者之多发病、常见病，严重影响老人健康。而且看似症状简单，单纯型者仅见咳嗽、多痰，但治之却非容易。往往化痰止咳，养阴润肺、肃肺降逆、收敛肺气等法，常在似效不效之间，均难达临床治愈效果。或作饮邪论治，用消痰逐饮之方，甚至投以劫药，收效依然甚微。此非治法之不善，方药之不灵，宜将病机仔细分析，然后对证施治，法应证用，始能合辙。
此病主症为咳嗽、咳痰，以晨起为著，痰呈白色泡沫状，粘稠不易咯出，偶有痰中带血。兼症可见咽燥口干、午后潮热，或见手足心热，或失眠盗汗，形体消瘦，神疲乏力。而舌苔、脉象常无明显异常。本病好发于秋冬季节，又为发病学之一大特点。
咳嗽一症虽属肺病，而经云：“五脏六腑皆令人咳，非独肺也。”而形成此病之病原究在何处?《类证治裁》曰：“五脏六腑虽皆令人咳，然终不离乎肺、牌、肾也。盖肺为贮痰之器，脾为生痰之源，而肾与肺实为母子之脏。因痰致咳者，痰为重，主治在脾。因咳动痰者，咳为重，主治在肺。无痰干咳者，阴虚为重，主治在肾。”老慢支痰量不多，且粘稠不易咯出，当是因咳动痰，其病宜治在肺。再勘其痰，医书谓白色泡沫之痰出于肺，稠厚湿浊之痰出于脾，色灰黑而质重沉水之痰出于肾。则本病之痰为肺金自生之痰。至于痰之性质当属肺津亏损之燥痰。其痰量少粘稠，兼见咽燥口于，潮热盗汗等症，已可概见。且《类证治裁》曰：“秋季咳，燥气乘金也，治宜清润。”但病患者年事已老，正气渐虚，加之久咳必损肺气，病者又多见神疲乏力，故治法必兼益气，始无偏弊。虽云气阴两虚为此病之本，而粘痰难出又为此病之标。生津润燥固可杜其生痰之源，而已生之痰仍当使之消除。故治法当益气养阴、消痰止咳。因一时难得合适成方，孟城不揣浅陋，自拟一方，颜日“百合畅肺饮”，用治单纯型老年性慢性支气管炎，适应者颇众，余屡用有效，故敢公诸同好。
百合畅肺饮方：
太子参9g百合15g麦门冬9g五味子6g玉竹9g杏仁9g苏子9g枇杷叶9g(包)炙甘草3g
本病肺阴亏损、津伤燥咳，故以养阴生津、润肺化痰之百合为君，一药而标本兼治。玉竹、麦冬助生阴液，以滋化源；杏、苏、枇杷，降气消痰，以止咳逆；太子参益其肺气，炙甘草调和诸药。用五味子者，因痰逆日久，肺气易致耗散，宜乎稍佐酸敛之品。且本病以傍晚及清晨发作较剧，《类证治裁》云：“清晨咳为气动宿痰”，“黄昏咳为火浮于肺，当敛而降之，五味子、五倍子之属”，故于方中参入五味。统观全方，具益气养阴、润肺生津、消痰降逆、收敛止咳之功，深合于多数老慢支患者之证候及病机，倘能辨证确切，宜其投剂有应。
又方中太子参一味，改动宜慎，党参嫌其性燥，恐伤肺中津液而增病势，洋参沙参，虑其阴凝太过，恐全方乏气运擀旋之能而难行药力，要在详辨脉证而灵机变通也。
以上所述为“老慢支”中主要证型及其治法，其余各证不在本文讨论范围之内，恕不赘述。
培土生金愈久嗽
咳嗽为肺系疾患之主要证候，《黄帝内经·素问》“咳论”对此早有专篇论述。现代中医将咳嗽划分外感、内伤两大类，颇合临床实用，但此分类在明代张景岳之《景岳全书·咳嗽》篇已有记载：“咳嗽之要，止惟二证，何为二证，一日外感，一日内伤，而尽之矣。”
关于外感咳嗽，本文暂置不论。而于内伤咳嗽《素问·咳嗽》早有明文，如“咳论”曰：“五脏六腑皆令人咳，非独肺也。”强调脏腑功能失调，影响及肺均能导致咳嗽。“咳论”且详述五脏咳与六腑咳各自证候，为治咳提供临床依据。虽后世医家治疗咳嗽已不甚采用五脏咳、六腑咳之证候分型，然总不越脏腑功能失调影响及肺而致咳嗽之病理因素。然虽五脏六腑皆能导致咳嗽，而其中与脾胃中土关系最切。故《素问·咳论》又曰：“此皆聚于胃，关于肺。”
据于临床，内伤咳嗽证候甚多，除肺脏自病外，与肝胆、肾脏、脾胃均有密切关系，而其中久咳不愈者常多源自脾胃。
肺为华盖而属金，脾胃为中土而化生万物。按五行相生规律则土能生金。脾胃中土虚衰，土不生金而致肺虚咳嗽，为临床所常见。脾胃虽同属于土．而脾为阴土，胃为阳土，脾主生化气血，输布精微，故其病每多气虚，虽有脾阴损伤一途，而终不及气虚为多，故脾虚致咳者，治以益气健脾、培土生金为大法。胃主通降，又为津液之海，故其病每以津液不足为多。胃虚致咳者，治以养胃生津，培土生金而止咳。
【背景信息】
书名：三十年临证经验集 章节：正文(13/32) 类别：综合
【待处理原文】
黄芪30g太子参20g柴胡20g炙甘草3g姜半夏9g象贝母20g半枝莲30g百部9g葶苈子9g鱼腥草20g莱菔子9g红枣20g黄芩9g
以上方为基础增损出入，先后服药五十五帖，经原医院复查病灶消失，胸膜炎症吸收。其间曾用之药为：天冬、夏枯草、枳壳、白芍、丹参、地骨皮、橘络、猫爪草、南北沙参、鳖甲等品。当患者病愈过半后，兼服狼毒蛋，服法同于例一。
患者病愈后复经上海市第一人民医院肺科专家复审区医院历次所摄胸片，确系逐渐进步，未见病情反复，同意临床治愈。但右上肺肺尖部有一阴影，为慎重计，于一院又摄前突位片，片示：“两肺无活动性病变，心肺及横膈正常。”
按：以上两例，例一为肺结核病，治疗全过程纯用中药，患者仅配合服用少量保健营养品，未用任何西药治疗剂。例二则不然，服用中药同时兼服西药雷米封、利福平。但疗程较短，治疗较彻底，当是中西医药双重效果。初诊时医院要求患者住院治疗，为患者所拒绝。从诊断到治愈共五个月，服用中药在最后两个月内。且患者自始至终参加工作未经病休。从以上两例可见以小柴胡汤为主方治疗结核病，如能药证相应、投剂得当，必收彰著之效。
例二方以小柴胡汤合葶苈大枣泻肺汤，在全方有效控制结核性炎症基础上，取苈枣泻肺利水之功，以消残余胸水，药后收到预期效果。虽葶苈用量不重，而治疗之关键在于抑制与控制结核，不在逐水，且方中黄芪补气而利水，半枝莲、鱼腥草均具清热利水之功，诸药合投自有协同作用。且肺为娇脏，如葶苈用量过甚，亦易损伤肺中津气而影响病体康复。
虚劳咳嗽拯阴蠲
某局办公室曹主任内人黄氏，年方四旬而体弱多病。于1963年曾患右侧胸膜炎，历时数月方痊。继病肠结核，至今前疾未愈，后病又起。1970年初得十二指肠球溃，穿孔出血，经手术治疗始安，至1971年开春后，咳嗽不止，服药打针两月未已。左胸时痛，四肢懈怠，面黄肌瘦，纳食呆钝，卧病床褥，双眸无神。于4月5日迓余出诊，所见俱如上述。脉细软如丝，舌质淡白无华。显然久病虚赢，劳嗽之候也。法当培元以固本，佐止咳以治标。仿李士材拯阴理劳汤意，为疏一方：
党参9g麦冬6g五味子3g黄芪6g当归9g炙甘草3g炙紫菀9g炙百部9g阿胶3g(烊冲)冬虫夏草4．5g陈皮4．5g
服三帖后，精神大振，胃纳渐开，已能起床行动。咳亦稀，痰已爽，遂以此方加减。症则或见右胁痞胀不适，或见掌心烦热，或见大便反硬，或见咳嗽昼稀夜甚。药则仍宗前方，而以川楝子、贝母、百合、白薇、蒌仁、菊化、杞子等增损出入，先后仅四诊，服药十六帖，诸恙竟解。一年后相遇，则形盛颊丰，大异畴昔。现已退休多年，前症终未复发也。
盖虚劳一证，乃诸虚劳损之简称。良由脏腑阴阳气血之亏损，机体真元虚弱而致。如高鼓峰《医家心法》曰：“阴虚、阳虚者，此虚为劳，即今所谓怯弱证也。”李士材《医宗必读》曰：“夫人之虚，不属于气，即属于血，五脏六腑岂能外焉。”据此，则虚劳之病无非是人身五脏六腑中气、血、阴、阳不足之病证。
昔贤视此症为人身之大患，历代医籍论述甚多。总而言之，此症之轻浅者不过阴阳气血之小有亏损，或失于平衡，补之调之即复本元。而此症之深重者，如五劳、七伤、六极之类其病已甚，治之非易。上述黄氏一案，乃属普通型虚劳咳嗽病例，而其治法，虽总不离乎“虚则补之”之大法，而选方用药，亦宜细加抉择。患者人到中年而素体怯弱，消化道溃疡出血，肢软肌瘦，纳呆乏力，加之脉象细软如丝，舌质淡白无华，是脾虚气血亏损之见象。而胸痛咳嗽．曾有胸膜炎病史，是火烁金伤之象。患者肺脏受损于先，继则脾土衰颓土不生金，子失母养于后，则肺气益虚。此时肺中纵有余热．亦不过虚浮游弋之火，必用“土厚则火敛”之法，切忌苦寒直折之品。综观全案，乃脾气虚弱为本。肺虚咳嗽为标。治法当补益脾肺，金土相生，佐以润肺止咳。务使补而不壅，润而不腻，温而不燥，清而不伐。至于选方，《十药神书》之方多用于复杂深重病证，《理虚元鉴》虽议论精辟入微，并强调肺、脾、肾三脏为治虚劳之关键，而阳虚统于脾，阴虚统于肺，则脾肺两脏尤为关键之关键，然所列方药实难采用。不如《医家心法》寥寥数语，却直截了当；“治弱之法，只一归脾汤去木香，加麦冬、五味、白芍、吞六味丸，此外别无治法。”但高氏此方，为心脾两伤兼肾阴不足者设，而今黄氏之证乃病在肺脾，仍属不治。再观《医宗必读》之“拯阴理痨汤”，此方“治阴虚火动，皮寒骨热，食少痰多，咳嗽短气，倦怠焦烦。”用药以人参、麦冬、五味子组成之生脉饮为基础，加入莲子、苡仁、大枣、甘草、丹皮、生地、当归、白芍、橘红，肝脾两调，气血双补，而与黄氏之证，依然隔膜。但健脾养阴制方用意可取。故仿其意而制为一方，治在脾肺，用参芪陈草培脾土以生金，合入当归补血汤以滋化源。麦冬、五味、虫草、阿胶，补肺润燥而收其耗散，兼以紫菀、百部润肺下气以止咳逆。自以为此方用意尚称周匝，选药可云恰当。不治其火而虚火自敛，不补其血而营血自生。故仅调金土两脏而诸病自已也。古人云治病必求其本者，此之谓欤!
五味子治咳宜忌谈
五味子治咳喘，由来久矣。远自仲景，近迄天士，历代大家鲜有不用之者。然五味子虽为咳喘妙药，并非适用于所有病人。宜者用之，效可立见；不宜者服之，害亦非浅。故于宜与不宜之间，须究心焉。清·叶天士为一代宗师，每因虚劳喘咳方中用五味子，屡遭徐灵胎之评责。可见五味子虽为治病良药，若要投遣得当，亦非易事。
五味子秉酸收之性，有敛肺保肾之功。因其酸敛，则有凝痰、滞邪、聚火之弊。是故五味子所治之咳，乃肺肾不足、元气耗散之咳，取其固守金水则喘咳自止。若夫外因客邪、内缘停痰火热之类所致之喘哮咳嗽，则五味子避之犹恐不及，是为大忌者也。如若虚实相兼之证，必用五味子时，可与泻实之药同用，相辅而成功。仲景用五味子，每与干姜为伍者，职是之故也。如小青龙汤为风寒束表、饮停于中之喘咳；射干麻黄汤之治痰饮喘咳等皆是。关于五味子之适用宜忌，徐灵胎于《临证指南》之批语中言之甚详：“此老(指叶天士)于补剂中用五味子极多，以其能收摄元气归于下焦；或收敛肺气不使上逆。皆历代医书相传之法，其实皆谬也。五味子专于收敛，倘有一毫风寒痰火内外之邪，用之则永远不出而成痼疾。故仲景治虚方宁用牡蛎、龙骨，从无五味者。其咳证之用五味，必与干姜同用，从无独用者，历考自知，乃千余年竟无知者，而杀人无数矣。”东垣亦曰：五味子“治咳以之为君，但有外邪者，不可聚用，恐闭其邪气，必先发散尔后用之乃良。有痰者，以半夏为伍；喘者阿胶为伍，但分量少不同耳。”两位先贤之论，言简意赅，于五味子疗咳之宜忌，已得其要领矣。
余临证间，亦恒用五味子以治慢性咳嗽，于肺金气阴伤损之“老年性慢性支气管炎”，辄加用于辨证处方中，收效之良，非他药可比拟。余于十四、五年前治一女同事，自幼得气管炎，经年咳嗽不已。春夏咳稀，秋冬咳甚，三十余年历治不愈。余详察四诊，知其内外无邪，纯属虚证，适与中药西制之五昧子糖浆，服一瓶后咳嗽大减，连进五大瓶(每瓶500ml)，三十余年之痼疾，竞得根治。
又曾治一八旬老妪，子孙孝顺，经济宽裕。橘子苹果，日啖不辍。人参蜂皇浆之类温补之品，相继迭进。渐至口干、内热、咳嗽频仍，数月不瘳。余诊其脉，弦而有力，略带涩意，舌红而干，中心剥苔。显属肺肾燥热，津伤咳嗽，治当益胃生津，润肺止咳。虑高年胃气多弱，兼顾健运中焦，投以叶氏养胃汤加川贝粉。首次服药后即觉舒泰异常，为数月来所未有，三、四帖后咳减过半。复诊时舌红已退，于原方中加五味子3g，服后咳又骤增，口干心烦。因速泻去五昧，仍服原方，则日愈一日，连服二周，诸证悉愈。此例属内热伤津而不宜用五味子收敛者。由此可知五味子治咳喘有宜与不宜之别，临证时当有所斟酌，不可一概施用。夫药本无过，全在医家之驾驭得法与否耳。
“百合”妙蠲“老慢支”
老年性慢性支气管炎，为现代西医病名，中医归入内伤咳嗽门内。此病为老年患者之多发病、常见病，严重影响老人健康。而且看似症状简单，单纯型者仅见咳嗽、多痰，但治之却非容易。往往化痰止咳，养阴润肺、肃肺降逆、收敛肺气等法，常在似效不效之间，均难达临床治愈效果。或作饮邪论治，用消痰逐饮之方，甚至投以劫药，收效依然甚微。此非治法之不善，方药之不灵，宜将病机仔细分析，然后对证施治，法应证用，始能合辙。
此病主症为咳嗽、咳痰，以晨起为著，痰呈白色泡沫状，粘稠不易咯出，偶有痰中带血。兼症可见咽燥口干、午后潮热，或见手足心热，或失眠盗汗，形体消瘦，神疲乏力。而舌苔、脉象常无明显异常。本病好发于秋冬季节，又为发病学之一大特点。
咳嗽一症虽属肺病，而经云：“五脏六腑皆令人咳，非独肺也。”而形成此病之病原究在何处?《类证治裁》曰：“五脏六腑虽皆令人咳，然终不离乎肺、牌、肾也。盖肺为贮痰之器，脾为生痰之源，而肾与肺实为母子之脏。因痰致咳者，痰为重，主治在脾。因咳动痰者，咳为重，主治在肺。无痰干咳者，阴虚为重，主治在肾。”老慢支痰量不多，且粘稠不易咯出，当是因咳动痰，其病宜治在肺。再勘其痰，医书谓白色泡沫之痰出于肺，稠厚湿浊之痰出于脾，色灰黑而质重沉水之痰出于肾。则本病之痰为肺金自生之痰。至于痰之性质当属肺津亏损之燥痰。其痰量少粘稠，兼见咽燥口于，潮热盗汗等症，已可概见。且《类证治裁》曰：“秋季咳，燥气乘金也，治宜清润。”但病患者年事已老，正气渐虚，加之久咳必损肺气，病者又多见神疲乏力，故治法必兼益气，始无偏弊。虽云气阴两虚为此病之本，而粘痰难出又为此病之标。生津润燥固可杜其生痰之源，而已生之痰仍当使之消除。故治法当益气养阴、消痰止咳。因一时难得合适成方，孟城不揣浅陋，自拟一方，颜日“百合畅肺饮”，用治单纯型老年性慢性支气管炎，适应者颇众，余屡用有效，故敢公诸同好。
百合畅肺饮方：
太子参9g百合15g麦门冬9g五味子6g玉竹9g杏仁9g苏子9g枇杷叶9g(包)炙甘草3g
本病肺阴亏损、津伤燥咳，故以养阴生津、润肺化痰之百合为君，一药而标本兼治。玉竹、麦冬助生阴液，以滋化源；杏、苏、枇杷，降气消痰，以止咳逆；太子参益其肺气，炙甘草调和诸药。用五味子者，因痰逆日久，肺气易致耗散，宜乎稍佐酸敛之品。且本病以傍晚及清晨发作较剧，《类证治裁》云：“清晨咳为气动宿痰”，“黄昏咳为火浮于肺，当敛而降之，五味子、五倍子之属”，故于方中参入五味。统观全方，具益气养阴、润肺生津、消痰降逆、收敛止咳之功，深合于多数老慢支患者之证候及病机，倘能辨证确切，宜其投剂有应。
又方中太子参一味，改动宜慎，党参嫌其性燥，恐伤肺中津液而增病势，洋参沙参，虑其阴凝太过，恐全方乏气运擀旋之能而难行药力，要在详辨脉证而灵机变通也。
以上所述为“老慢支”中主要证型及其治法，其余各证不在本文讨论范围之内，恕不赘述。
培土生金愈久嗽
咳嗽为肺系疾患之主要证候，《黄帝内经·素问》“咳论”对此早有专篇论述。现代中医将咳嗽划分外感、内伤两大类，颇合临床实用，但此分类在明代张景岳之《景岳全书·咳嗽》篇已有记载：“咳嗽之要，止惟二证，何为二证，一日外感，一日内伤，而尽之矣。”
关于外感咳嗽，本文暂置不论。而于内伤咳嗽《素问·咳嗽》早有明文，如“咳论”曰：“五脏六腑皆令人咳，非独肺也。”强调脏腑功能失调，影响及肺均能导致咳嗽。“咳论”且详述五脏咳与六腑咳各自证候，为治咳提供临床依据。虽后世医家治疗咳嗽已不甚采用五脏咳、六腑咳之证候分型，然总不越脏腑功能失调影响及肺而致咳嗽之病理因素。然虽五脏六腑皆能导致咳嗽，而其中与脾胃中土关系最切。故《素问·咳论》又曰：“此皆聚于胃，关于肺。”
据于临床，内伤咳嗽证候甚多，除肺脏自病外，与肝胆、肾脏、脾胃均有密切关系，而其中久咳不愈者常多源自脾胃。
肺为华盖而属金，脾胃为中土而化生万物。按五行相生规律则土能生金。脾胃中土虚衰，土不生金而致肺虚咳嗽，为临床所常见。脾胃虽同属于土．而脾为阴土，胃为阳土，脾主生化气血，输布精微，故其病每多气虚，虽有脾阴损伤一途，而终不及气虚为多，故脾虚致咳者，治以益气健脾、培土生金为大法。胃主通降，又为津液之海，故其病每以津液不足为多。胃虚致咳者，治以养胃生津，培土生金而止咳。
Background Information
Book: Thirty Years of Clinical Experience; Chapter: Main Text (13/32); Category: Comprehensive
Original Text Translation
Huangqi [Radix Astragali] 30g, Taizishen [Pseudostellariae Radix] 20g, Chaihu [Bupleuri Radix] 20g, Zhigancao [Glycyrrhizae Radix et Rhizoma Preparatum] 3g, Jiangbanxia [Pinelliae Rhizoma Preparatum cum Zingibere et Alumine] 9g, Xiangbeimu [Fritillariae Thunbergii Bulbus] 20g, Banzhilian [Herba Isatidis] 30g, Baibu [Stemonae Radix] 9g, Tinglizi [Lepidii Semen] 9g, Yuxingcao [Herba Houttuyniae] 20g, Laifuzi [Raphini Semen] 9g, Hongzao [Jujubae Fructus] 20g, Huangqin [Scutellariae Radix] 9g.
Based on the above prescription, modifications were made over time. The patient took a total of fifty-five doses. Follow-up examination at the original hospital showed that the lesions had disappeared and pleural inflammation had been absorbed. During this period, other herbs used included: Tiandong [Asparagi Radix], Xiakucao [Prunellae Spica], Zhike [Aurantii Fructus], Baishao [Paeoniae Radix Alba], Danshen [Salviae Miltiorrhizae Radix et Rhizoma], Digupi [Lycii Cortex], Jueluo [Citri Reticulatae Pericarpium Retinervum], Maozhaocao [Radix Pedicularis rostroclavatae], Nan/shaoshen [Glehniae Radix / Asparagi Radix], Biejia [Testudinis Carapax et Plastrum], etc. When the patient was more than half recovered, Langdu Dan (Wolfberry Egg) was also taken orally, with the same method of administration as in Case 1.
After the patient's recovery, lung specialists from Shanghai First People's Hospital reviewed the chest X-rays taken by the district hospital on various occasions. It was confirmed that there was gradual improvement, no recurrence of the condition, and clinical cure was agreed upon. However, a shadow was observed in the apex of the right upper lung. For caution, an apical lordotic view was taken at the first hospital, which showed: "No active lesions in both lungs; heart, lungs, and diaphragm are normal."
Commentary: In the above two cases, Case 1 was pulmonary tuberculosis. The entire treatment process used only Chinese herbal medicine. The patient only took a small amount of health supplements and did not use any Western medical treatments. Case 2 was different; while taking Chinese herbal medicine, the patient also took Western medicines Rifampicin and Isoniazid. However, the course of treatment was shorter and more thorough, likely due to the dual effect of Chinese and Western medicine. At the initial diagnosis, the hospital requested hospitalization, which the patient refused. From diagnosis to cure took five months, with Chinese herbal medicine taken during the last two months. Moreover, the patient worked throughout without sick leave. From these two cases, it can be seen that using Xiaochaihu Tang (Minor Bupleurum Decoction) as the main formula for treating tuberculosis, if the symptoms match the medication and the dosage is appropriate, will definitely achieve remarkable results.
The formula for Case 2 combined Xiaochaihu Tang (Minor Bupleurum Decoction) with Tingli Dazao Fei Xie Tang (Desperance Seed and Jujube Decoction to Drain the Lungs). On the basis of effectively controlling tuberculous inflammation with the whole formula, the function of Tingli Dazao Fei Xie Tang to drain the lungs and promote urination was utilized to eliminate residual pleural effusion, achieving the expected effect after medication. Although the dosage of Tinglizi [Lepidii Semen] was not heavy, the key to treatment lay in inhibiting and controlling tuberculosis, not in draining water. Furthermore, Huangqi [Radix Astragali] in the formula tonifies Qi and promotes urination, while Banzhilian [Herba Isatidis] and Yuxingcao [Herba Houttuyniae] both have the effects of clearing heat and promoting urination. The combination of these drugs naturally has a synergistic effect. Additionally, the Lung is a delicate organ; if the dosage of Tinglizi [Lepidii Semen] is too high, it may easily damage the fluids and Qi in the Lungs, affecting the patient's recovery.
Consumptive Cough: Saving Yin and Eliminating [Illness]
The wife of Director Cao of a certain bureau office, surnamed Huang, was in her forties but weak and frequently ill. In 1963, she suffered from right-sided pleurisy, which lasted several months before recovering. Subsequently, she contracted intestinal tuberculosis. To this day, the previous illness had not fully healed, and new illnesses arose. In early 1970, she developed a duodenal ulcer with perforation and bleeding, stabilized only after surgical treatment. After the spring of 1971, she suffered from incessant coughing, and despite two months of medication and injections, it did not cease. She experienced intermittent left chest pain, lethargy in the four limbs, sallow complexion and emaciation, poor appetite, bedridden state, and dull eyes. On April 5th, I was invited to visit. The findings were as described above. The pulse was fine, soft, and thread-like; the tongue body was pale and lusterless. Clearly, this was a chronic illness resulting in deficiency and emaciation, indicative of consumptive cough. The method should be to cultivate the origin to consolidate the root, assisted by stopping cough to treat the branch. Following the intent of Li Shicai’s Zhengyin Lilao Tang (Saving Yin Regulating Consumption Decoction), I prescribed the following formula:
Dangshen [Codonopsis Radix] 9g, Maidong [Ophiopogonis Radix] 6g, Wuweizi [Schisandrae Chinensis Fructus] 3g, Huangqi [Radix Astragali] 6g, Danggui [Angelicae Sinensis Radix] 9g, Zhigancao [Glycyrrhizae Radix et Rhizoma Preparatum] 3g, Zhi Ziwan [Asternis Flos Preparatus] 9g, Zhi Baibu [Stemonae Radix Preparata] 9g, Ejiao [Colla Corii Asini] 3g (melted and mixed), Dongchongxiacao [Cordyceps] 4.5g, Chenpi [Citri Reticulatae Pericarpium] 4.5g.
After taking three doses, her spirit greatly improved, appetite gradually opened, and she could get out of bed and move around. Cough became less frequent, and phlegm was easier to expectorate. Thus, this formula was modified. Symptoms occasionally included distension and discomfort in the right hypochondrium, heat sensation in the palms, constipation, or cough that was less frequent during the day but worse at night. The medication still followed the previous formula, with additions and subtractions such as Chuanlianzi [Toosendan Fructus], Beimu [Fritillariae Bulbus], Baihe [Lilii Bulbus], Baiwei [Cleisostomatis Radix], Louren [Trichosanthis Semen], Juhua [Chrysanthemi Flos], Qizi [Lycii Fructus], etc. After only four consultations and sixteen doses, all ailments were resolved. Meeting a year later, her appearance was robust and cheeks full, vastly different from before. She has now been retired for many years, and the previous symptoms never recurred.
Generally, Xu Lao (Consumptive Disease) is a shorthand for various types of consumptive damage. It is indeed caused by the loss of Yin, Yang, Qi, and Blood in the Zang-Fu organs, leading to weakness of the body's true Yuan Qi. As Gao Gufeng stated in *Yijia Xinfa* (Medical Master's Mind): "Deficiency of Yin and Deficiency of Yang constitute this deficiency as consumption, which is what we now call the syndrome of timidity and weakness." Li Shicai stated in *Yizong Bidu* (Essential Readings for Medical Practitioners): "Human deficiency either belongs to Qi or to Blood; how could the Five Zang and Six Fu organs be excluded?" Based on this, the disease of Xu Lao is nothing more than a pathological condition of insufficiency of Qi, Blood, Yin, and Yang in the Five Zang and Six Fu organs of the human body.
Ancient sages regarded this syndrome as a major affliction of the human body, and it has been discussed extensively in medical texts through the ages. In summary, mild cases involve only slight loss or imbalance of Yin, Yang, Qi, and Blood, which can restore the original state with supplementation and regulation. Severe cases, such as the Five Exhaustions, Seven Injuries, and Six Extremes, are very serious and difficult to treat. The case of Ms. Huang mentioned above belongs to ordinary consumptive cough cases. Although the treatment generally adheres to the principle of "tonifying deficiency," selecting formulas and medications requires careful consideration. The patient, being middle-aged and inherently weak, suffered from gastrointestinal ulcer bleeding, soft limbs and emaciation, poor appetite and fatigue, coupled with a fine, soft, thread-like pulse and a pale, lusterless tongue. These are signs of Spleen deficiency with loss of Qi and Blood. Chest pain and coughing, along with a history of pleurisy, indicate injury to Metal (Lung) by Fire. The patient's Lung was damaged first, followed by the decline of Spleen Earth, failing to generate Metal, leaving the child without maternal nourishment, thus further weakening Lung Qi. Even if there is residual heat in the Lungs at this time, it is merely floating empty fire. One must use the method of "thick Earth contains Fire" and strictly avoid bitter-cold direct suppression agents. Viewing the entire case, Spleen Qi deficiency is the root, and Lung deficiency cough is the branch. The treatment method should tonify and benefit the Spleen and Lungs, allowing Metal and Earth to generate each other, assisted by moistening the Lungs and stopping cough. It is essential to ensure that tonification does not cause stagnation, moistening does not become cloying, warmth does not become dry, and clearing does not damage. Regarding formula selection, formulas from *Shiyao Shenshu* (Divine Book of Ten Medicines) are mostly used for complex and deep-seated diseases. *Lixu Yuanjian* (Original Mirror for Managing Emptiness) has profound discussions and emphasizes the Lungs, Spleen, and Kidneys as key to treating consumptive disease, with Yang deficiency governed by the Spleen and Yin deficiency governed by the Lungs, making the Spleen and Lungs particularly critical. However, the listed formulas are difficult to adopt. It is better to refer to the few words in *Yijia Xinfa*: "The method for treating weakness is simply Guipi Tang (Restore the Spleen Decoction) removing Muxiang, adding Maidong, Wuweizi, Baishao, and swallowing Liuwei Wan (Six-Ingredient Pill with Rehmannia); there is no other treatment method." However, Gao's formula is designed for Heart-Spleen dual injury with insufficient Kidney Yin, whereas Ms. Huang's condition lies in the Lungs and Spleen, so it still does not apply. Looking again at *Yizong Bidu*'s "Zhengyin Lilao Tang," this formula treats "Yin deficiency with fire hyperactivity, cold skin and hot bones, poor appetite with much phlegm, cough with shortness of breath, fatigue and irritability." Its medication is based on Shengmai Yin (Generate the Pulse Drink) composed of Renshen, Maidong, and Wuweizi, added with Lotus Seeds, Coix Seed, Jujube, Licorice, Moutan Cortex, Rehmannia Root, Angelica, White Peony, and Tangerine Peel, regulating Liver and Spleen and tonifying Qi and Blood simultaneously, yet it remains disconnected from Ms. Huang's condition. However, the intention of strengthening the Spleen and nourishing Yin in formulating is worthwhile. Therefore, imitating its intent, I formulated a prescription targeting the Spleen and Lungs, using Renshen, Huangqi, Chenpi, and Gancao to cultivate Spleen Earth to generate Metal, combined with Danggui Buxue Tang (Angelica Tonifying Blood Decoction) to nourish the source. Maidong, Wuweizi, Cordyceps, and Ejiao tonify the Lungs, moisten dryness, and stop dispersion, assisted by Ziwan and Baibu to moisten the Lungs, descend Qi, and stop cough. I believe the intent of this formula is comprehensive, and the selection of herbs is appropriate. By not treating the fire directly, the empty fire naturally subsides; by not directly tonifying blood, the Ying Blood naturally generates. Thus, by regulating only the Metal and Earth organs, all diseases heal themselves. As the ancients said, "In treating disease, one must seek the root," this is what they meant!
Discussion on Indications and Contraindications of Wuweizi for Cough
Wuweizi [Schisandrae Chinensis Fructus] for treating cough and asthma has a long history. From Zhang Zhongjing in ancient times to Ye Tianshi in recent times, few masters have failed to use it. However, although Wuweizi is a wonderful herb for cough and asthma, it is not suitable for all patients. If indicated, its effect is immediate; if contraindicated, the harm is significant. Therefore, one must carefully consider between indication and contraindication. Ye Tianshi, a grandmaster of the Qing Dynasty, often used Wuweizi in formulas for consumptive asthma and cough, repeatedly criticized by Xu Lingtai. This shows that although Wuweizi is a good medicinal herb, administering it appropriately is not easy.
Wuweizi possesses the nature of sour and astringent, having the functions of astringing the Lungs and protecting the Kidneys. Due to its sour astringency, it has the drawbacks of condensing phlegm, retaining pathogens, and gathering fire. Therefore, the cough treated by Wuweizi is that of Lung-Kidney insufficiency and dissipation of Yuan Qi; by securing Metal and Water, asthma and cough stop spontaneously. If asthma, wheezing, and cough are caused by external pathogens or internal retention of phlegm and fire, one should avoid Wuweizi as much as possible; this is a major contraindication. If a syndrome involves both deficiency and excess, and Wuweizi must be used, it can be used together with herbs that drain excess, assisting each other to success. Zhang Zhongjing often paired Wuweizi with Ganjiang [Zingiberis Rhizoma] for this reason. For example, Xiaoqinglong Tang (Minor Blue Dragon Decoction) treats cough and asthma due to Wind-Cold binding the exterior and fluid retention in the interior; Shaygan Mahuang Tang (Belamcanda and Ephedra Decoction) treats phlegm-fluid cough and asthma, etc. Regarding the indications and contraindications of Wuweizi, Xu Lingtai explained in detail in his commentary on *Linzheng Zhinan* (Guide to Clinical Practice): "This old man (referring to Ye Tianshi) used Wuweizi extremely often in tonic formulas because it can gather Yuan Qi back to the Lower Jiao or astringe Lung Qi to prevent upward reversal. All methods passed down through generations of medical books are actually wrong. Wuweizi specializes in astringency. If there is even a trace of Wind-Cold, Phlegm, or Fire pathogen inside or outside, using it will cause the pathogen to remain forever and become a stubborn disease. Therefore, when Zhang Zhongjing treated deficiency formulas, he preferred Oyster Shell and Dragon Bone, never using Wuweizi. When using Wuweizi for cough, it must be used with Ganjiang, never alone. Historical examination confirms this, yet for over a thousand years, no one knew, killing countless people." Dongyuan also said: "For treating cough, Wuweizi serves as the sovereign herb, but if there are external pathogens, it cannot be gathered and used, lest it close off the pathogen. One must first disperse, then use it, which is good. If there is phlegm, pair it with Banxia; if there is asthma, pair it with Ejiao, though the dosages differ slightly." The arguments of these two sages are concise and capture the essence of the indications and contraindications of Wuweizi for treating cough.
During my clinical practice, I also frequently use Wuweizi to treat chronic cough, especially in "Senile Chronic Bronchitis" where Lung Metal Qi and Yin are damaged, adding it to differentiated prescriptions, achieving excellent results unmatched by other herbs. About fourteen or fifteen years ago, I treated a female colleague who had bronchitis since childhood, suffering from incessant coughing for years. Cough was rare in spring and summer, severe in autumn and winter, untreated for over thirty years. After detailed observation of the Four Diagnostic Methods, I knew there were no internal or external pathogens, purely a deficiency syndrome. I gave her commercially prepared Wuweizi Syrup. After one bottle, cough decreased significantly. After taking five large bottles (500ml each), the thirty-year stubborn disease was completely cured.
I also treated an eighty-year-old woman whose descendants were filial and financially well-off. She ate oranges and apples daily without cessation. Warm-tonifying products like Ginseng and Royal Jelly were continuously administered. Gradually, she developed dry mouth, internal heat, and frequent coughing, unimproved for months. I diagnosed her pulse as wiry and forceful, slightly choppy; tongue red and dry, with peeled coating in the center. Clearly, this belonged to Lung-Kidney dry-heat and Yin fluid injury causing cough. Treatment should benefit the Stomach, generate fluids, moisten the Lungs, and stop cough. Considering the weak Stomach Qi in the elderly, I also considered strengthening the Middle Jiao, prescribing Ye's Yangwei Tang (Nourish Stomach Decoction) plus Chuanbei Powder. After the first dose, she felt unusually comfortable, unprecedented for months. After three or four doses, cough reduced by half. At follow-up, the red tongue had faded. I added 3g of Wuweizi to the original formula. After taking it, cough suddenly increased, accompanied by dry mouth and irritability. I quickly removed Wuweizi, and she continued taking the original formula. She improved day by day, and after two weeks, all symptoms resolved. This case belongs to internal heat injuring fluids, where Wuweizi's astringency is contraindicated. From this, we know that Wuweizi has indications and contraindications for treating cough and asthma. In clinical practice, one must deliberate and not apply it indiscriminately. The herb itself has no fault; it all depends on whether the physician manages it appropriately.
"Baihe" Marvelously Eliminates "Old Slow Branch"
Senile Chronic Bronchitis is a modern Western medical term, classified within the category of Internal Injury Cough in Traditional Chinese Medicine. This disease is common and prevalent among elderly patients, seriously affecting their health. Although the symptoms seem simple, with the pure type showing only cough and excessive phlegm, treatment is not easy. Often, methods such as resolving phlegm and stopping cough, nourishing Yin and moistening the Lungs, purging Lung Qi and descending rebellion, and astringing Lung Qi are used, but they often hover between efficacy and inefficacy, failing to achieve clinical cure. Some treat it as Fluid Pathogen, using formulas to resolve phlegm and drive out fluids, even using harsh drugs, yet the effect remains minimal. This is not due to poor treatment methods or ineffective formulas, but rather the need for careful analysis of the pathogenesis, followed by targeted treatment according to the syndrome, so that the method matches the syndrome, thereby aligning with the correct approach.
The main symptoms of this disease are cough and expectoration, most prominent in the morning. The phlegm is white and foamy, sticky and difficult to expectorate, occasionally with blood streaks. Accompanying symptoms may include dry throat and mouth, afternoon tidal fever, heat sensation in palms and soles, insomnia, and night sweats. The body is emaciated, and spirit is fatigued. Tongue coating and pulse often show no obvious abnormalities. A major characteristic of this disease's epidemiology is its prevalence in autumn and winter seasons.
Although cough is a Lung disease, the Classics state: "All Five Zang and Six Fu organs can cause cough, not just the Lung." Where exactly lies the pathogenic source forming this disease? *Leizheng Zaican* (Classification and Treatment Adaptations) states: "Although all Five Zang and Six Fu organs can cause cough, it ultimately does not depart from the Lung, Spleen, and Kidney. The Lung is the vessel storing phlegm, the Spleen is the source generating phlegm, and the Kidney and Lung are truly mother-child organs. When cough is caused by phlegm, phlegm is predominant, and treatment focuses on the Spleen. When phlegm is moved by cough, cough is predominant, and treatment focuses on the Lung. In dry cough without phlegm, Yin deficiency is predominant, and treatment focuses on the Kidney." In "Old Slow Branch," the amount of phlegm is not large, and it is sticky and difficult to expectorate, indicating that phlegm is moved by cough, so treatment should focus on the Lung. Examining the phlegm further, medical books state that white foamy phlegm comes from the Lung, thick turbid phlegm comes from the Spleen, and gray-black heavy phlegm sinking in water comes from the Kidney. Thus, the phlegm in this disease is self-generated by Lung Metal. As for the nature of the phlegm, it belongs to Dry Phlegm due to Lung Jin fluid deficiency. The small amount of sticky phlegm, accompanied by dry throat and mouth, tidal fever, and night sweats, can be generally seen. Also, *Leizheng Zaican* states: "Autumn cough is caused by Dry Qi attacking Metal; treatment should be clearing and moistening." However, the patient is elderly, with gradually declining healthy Qi. Prolonged cough inevitably damages Lung Qi, and patients often show fatigue and lack of strength. Therefore, the treatment method must include tonifying Qi to avoid bias. Although Qi and Yin dual deficiency is the root of this disease, sticky phlegm difficult to expectorate is the branch. Generating fluids and moistening dryness can indeed cut off the source of phlegm generation, but existing phlegm must still be eliminated. Therefore, the treatment method should tonify Qi and nourish Yin, resolve phlegm, and stop cough. Since it is difficult to find a suitable ready-made formula at the moment, Mengcheng, not presuming to be shallow, self-formulated a formula named "Baihe Changfei Yin" (Lily Decoction to Unblock the Lungs), used to treat the pure type of Senile Chronic Bronchitis. Many patients fit the indication, and I have used it successfully many times, so I dare to share it with friends.
Formula for Baihe Changfei Yin:
Taizishen [Pseudostellariae Radix] 9g, Baihe [Lilii Bulbus] 15g, Maimendong [Ophiopogonis Radix] 9g, Wuweizi [Schisandrae Chinensis Fructus] 6g, Yuzhu [Polygonati Odorati Rhizoma] 9g, Xingren [Armeniacae Semen Amarum] 9g, Suzi [Perillae Fructus] 9g, Pipaye [Loquasi Folium] 9g (wrapped), Zhigancao [Glycyrrhizae Radix et Rhizoma Preparatum] 3g.
Memory Mnemonic: Baihe Changfei Cao Shen Wei, Maidong Xing Su Pipa Wei.
This disease involves Lung Yin deficiency and Jin fluid injury causing dry cough. Therefore, Baihe [Lilii Bulbus], which nourishes Yin, generates fluids, moistens the Lungs, and resolves phlegm, is used as the Sovereign herb, treating both root and branch with one drug. Yuzhu [Polygonati Odorati Rhizoma] and Maidong [Ophiopogonis Radix] assist in generating Yin fluids to nourish the source; Xingren [Armeniacae Semen Amarum], Suzi [Perillae Fructus], and Pipaye [Loquasi Folium] descend Qi, resolve phlegm, and stop cough; Taizishen [Pseudostellariae Radix] benefits Lung Qi, and Zhigancao [Glycyrrhizae Radix et Rhizoma Preparatum] harmonizes the herbs. Wuweizi [Schisandrae Chinensis Fructus] is used because prolonged phlegm rebellion makes Lung Qi prone to dissipation, so a slight addition of sour-astringent herbs is appropriate. Moreover, this disease attacks severely in the evening and early morning. *Leizheng Zaican* states: "Morning cough is due to Qi moving old phlegm," "Evening cough is due to Fire floating in the Lungs; it should be astringed and descended, using herbs like Wuweizi and Wubeizi." Therefore, Wuweizi is included in the formula. Viewing the entire formula, it has the functions of tonifying Qi and nourishing Yin, moistening the Lungs and generating fluids, resolving phlegm and descending rebellion, and astringing to stop cough. It deeply conforms to the syndromes and pathogenesis of most "Old Slow Branch" patients. If differentiation is accurate, the prescription should be effective.
Regarding Taizishen [Pseudostellariae Radix] in the formula, changes should be made cautiously. Dangshen [Codonopsis Radix] is considered too drying, potentially damaging Lung Jin fluids and worsening the condition. Yangshen [Panacis Quinquefolii Radix] and Shashen [Glehniae Radix / Asparagi Radix] are considered too Yin-congealing, potentially lacking the ability to move Qi and rotate the formula, making it difficult to execute the medicinal power. The key lies in detailed differentiation of pulse and syndrome and flexible adaptation.
The above describes the main syndromes and treatment methods for "Old Slow Branch"; other syndromes are not within the scope of this discussion and are not elaborated.
Cultivating Earth to Generate Metal Cures Chronic Cough
Cough is the main symptom of Lung system diseases. *Huangdi Neijing·Suwen* "Treatise on Cough" has dedicated chapters discussing this early on. Modern TCM divides cough into two major categories: External Contraction and Internal Injury, which fits clinical practice well. However, this classification was already recorded in Zhang Jingyue's *Jingyue Quanshu·Cough* chapter in the Ming Dynasty: "The essence of cough lies in only two syndromes: what are they? One is External Contraction, the other is Internal Injury, and that covers it all."
Regarding External Contraction Cough, this article temporarily sets it aside. Regarding Internal Injury Cough, *Suwen·Cough* has clear text, such as "Treatise on Cough" stating: "All Five Zang and Six Fu organs can cause cough, not just the Lung." This emphasizes that dysfunction of Zang-Fu organs affecting the Lung can lead to cough. "Treatise on Cough" also details the syndromes of Five Zang Cough and Six Fu Cough respectively, providing clinical basis for treating cough. Although later physicians do not largely adopt the syndrome differentiation of Five Zang Cough and Six Fu Cough, it never exceeds the pathological factors of Zang-Fu dysfunction affecting the Lung causing cough. Although all Five Zang and Six Fu organs can cause cough, among them, the relationship with the Spleen and Stomach Middle Earth is closest. Therefore, *Suwen·Treatise on Cough* also states: "These all gather in the Stomach and concern the Lung."
According to clinical practice, there are many syndromes of Internal Injury Cough. Besides primary Lung disease, it is closely related to the Liver, Gallbladder, Kidney, Spleen, and Stomach, among which chronic cough often originates from the Spleen and Stomach.
The Lung is the Canopy and belongs to Metal; the Spleen and Stomach are Middle Earth and transform and produce all things. According to the law of mutual generation in Five Elements, Earth generates Metal. Decline of Spleen-Stomach Middle Earth, failing to generate Metal, leading to Lung deficiency cough, is common in clinical practice. Although Spleen and Stomach both belong to Earth, the Spleen is Yin Earth and the Stomach is Yang Earth. The Spleen governs the transformation and production of Qi and Blood and distribution of essences, so its diseases are mostly Qi deficiency. Although there is a path of Spleen Yin injury, it is ultimately less common than Qi deficiency. Therefore, for cough caused by Spleen deficiency, the major method is tonifying Qi and strengthening the Spleen, cultivating Earth to generate Metal. The Stomach governs descending and is the sea of Jin fluids, so its diseases are mostly Jin fluid insufficiency. Therefore, for cough caused by Stomach deficiency, the treatment is nourishing the Stomach and generating fluids, cultivating Earth to generate Metal to stop cough.