脾肺气虚、土不生金而致咳嗽者，证见咳嗽经久不愈，咳声低微。病情较甚者，可见食减便溏，短气乏力。气虚及阳者，兼见畏寒跗冷，色白肌柔。脉见细软，或右手脉大无力，舌淡苔薄。方用四君子汤、异功散，或小建中汤、黄芪建中汤随证选用，有痰者六君子汤。食少便溏者，参苓白术散，兼见阳虚者，适当佐以温润扶阳之品
肺胃阴虚而致肺燥咳嗽者，匝见咳嗽经久不愈，干咳少痰或无痰，咳嗽夜甚于昼，夜间蒸热，食少萎黄，渴饮咽干，大便燥而不爽，脉细小或细小带涩，或右脉虚数，舌红而干，苔薄白。，治拟叶氏养胃汤，沙参麦冬汤或沙参玉竹方(南沙参、玉竹、石斛、桑叶、梨肉、茯神。为叶天士医案方。)
现于治验病例中，选取脾胃气虚咳嗽及肺胃津伤咳嗽各一例，以示一斑。
例一职员朱某，年近四旬。自诉频年以来，干咳不已，纳食不振，胃脘胀满，嗳气时作，泛恶频仍。西医诊断为肺气肿。中西医药杂治年余，依然如故，渐觉形神衰疲，食道有梗阻之感，胸次闷瞀，呼吸不畅。于1971年秋前来就诊。余视其脉软而无力，舌质淡而苔略厚。洋参四诊。证属中气虚衰，土不生金，肺气／卜足才生咳嗽。至于恶心泛漾，缘土虚则湿痰留滞胃脘，痰浊内扰则泛恶作矣。观前所服方，尽是开肺止咳之品，不惟无益，反且有害。为今之计，当宗《内经》“治病必求其本”之旨，以培土生金为法。遂拟一方，以六君合生脉加川贝粉：
党参9g白术9g茯苓9g甘草3g陈皮4．5g半夏6g麦冬6g五昧子4．5g川贝粉3g(吞)
以此为主方，加减予服二十余剂，竟得咳止纳馨，胸次畅然，神亦不惫。停药数月后再经医院复查，证实肺气肿业已消失。
例二友人徐君之子，年甫五龄，咳嗽已二年未愈。屡求名医援手，而屡治乏效。首由一医为诊，予服麻杏石甘汤加减方数十剂，服则咳止，停药则复咳如前。继求他医为治，主脾肾气虚大剂培土益气，三十余剂咳未少止。再请某儿科著名前辈诊治，用补肺阿胶散改汤加减，幸服数剂咳即止。半月后复咳如前，缘求治不易，自行原方以进，咳声时断时续。因循至1977年春节后，始就商于余。自患病起已二年矣。余诊得脉缓而涩，苔薄且净。闻咳则喉中痰鸣，咳甚时呕出白痰甚多，每次约可半饭碗余。此病初看似属痰饮为患，然脉呈虚象而非实证。盖脉缓无力为中土虚衰，涩而应指不足为津液亏损之的据。且余诊时正服某祖传儿医之方，尽是麻杏苏夏，且每方必用控涎丹9g包煎。已服二十余剂，咳不见减，痰不见少，显非痰饮为病。倘正属痰饮，如此用药痰咳必受其挫。余揣摩证情，推测此证初起时，原由外感伤肺、劫夺津液，加之杂药乱投，肺胃津液更伤，遂成金燥热郁之象。消克之药屡投，脾胃复伤，脾不能为胃行其津液以上灌于肺，反使水液凝滞，遇内火煎熬而为痰浊。中土一亏，则金失所养，故痰嗽愈甚。是水液不足，输布失常，而非水液过剩；是燥证而非痰饮。于病机之认识相反若此，倘辨证不明，失之毫厘，投剂用药则差之千里矣。何求愈病之云哉!患者之治，余意当养胃阴、润肺金、健脾土为法，佐以止咳消痰。为疏一方：
南沙参12g川石斛12g麦门冬9g炙紫菀9g炙冬花9g焦白术6g茯苓9g炙甘草3g甜杏仁9g炙兜铃9g
服二帖，咳嗽大减，再服四帖，诸症渐除。惟偶有咳嗽一、二声，即自行停药勿服。二旬后不慎风寒，又见发热咳嗽，前症复作，予疏表化痰药，表解热退，痰嗽依旧。又予前方三剂，痰嗽俱平，由是康复。
平衡五脏治久咳
《内经》云：“五脏六腑皆令人咳，非独肺也。”肺为橐籥，司人呼吸。秉质清虚，不容纤物。因而无论内外之邪，皆能影响肺脏正常功能而致咳嗽。凡外邪袭人所致之咳，先宜速散其邪，治之尚易。而内伤久咳，往往诸药鲜效，殊费医家踌躇。盖人身五脏六腑，阴阳气血，宜处动态平衡之中。一旦失却平衡，或因木过旺而乘肺侮金；或因土太弱而生化不足；或因火盛烁金；或因水寒射肺。诸如此类，皆能导致肺病咳嗽，缠绵不已。当于对证之治咳方中，求其五脏六腑、阴阳气血之平，则内气调而咳嗽愈矣。略举数例于下：
例一女干部徐某，于豆蔻之年得气管炎，入冬辄咳呛不已。中年自部队转到地方，始有机会邀余为治，每数服必效，咳止后可保一冬不发。至1972年春节前一周，咳嗽又作。服药三帖已效，谓春节务须走亲访友，要求迅速止咳。余细勘其脉，左尺独细而沉，遂于原方中加熟地12g，三服咳即止。不惟春节未发，开春后亦未复作。1973年夏，为根治计，在某医院行冬病夏治之法。入冬咳嗽更甚，断其肺中有热，药须多吃方效。患者闻言不悦，遂不畏跋涉，去草药店求一“名医”诊治。余视其方，为肃肺降气化痰止咳之药，兼以较多清热解毒之品。所虑清热太过，难免遗殃。先后数诊竟服四十余剂。咳虽得愈，而脘胀纳呆、胃中发凉之证生矣。余谓君病原由冬病夏治，以热药敷贴肺俞，致肺中伏热而作咳。此非冬病夏治之过，乃医家不善择治之所致也。清肺固是，过剂则败胃伤中矣。予香砂六君汤，数帖寻愈。
例二同事谢某之女，二十余岁。十年前患顿咳，每晨起必咳数十声。数年后发作渐频，至诊时则一日四、五发，深以为苦。服药不少，效亦乌有。余察其脉左大略弦，右寸独强。舌无异常。是肺肝蕴热。为疏一方：
生黄芪15g桑白皮12g地骨皮12g杏仁9g川贝母9g甘草1．5g黛蛤散9g(包)枇杷叶9g(包)黄芩9g
三帖咳止大半，十帖全解。
例三一日偶过友人家，见其未婚妻咳嗽声频，于是细诘病情。谓咳嗽已经年余，在某名老中医处诊治一年，服药几无虚日，然咳嗽终未少减。视其方尽是养阴润肺，化痰止咳之品。察其舌则苔白腻。显是阴药过度，反致痰湿留中。所幸年富胃强，纳谷虽减而中焦未败。余细诊其脉，右寸独见浮涩，他脉尚平。疑其始由外感而治不如法，遂致迁延不已。今外感之脉尚在，是邪未解散，而病仍在肺卫，并未深入于里。患者病发之时，必先喉痒，痒甚则咳作，是邪欲透发之征。用药当助其宣散始为合辙。前治过用滋腻寒凉，致苔白脉涩，正宜借用王孟英杏蔻橘桔之剂，以开其肺而达其邪。方用：
苦桔梗9g陈皮6g蔻仁3g光杏仁9g荆芥9g甘草3g淡豆豉9g象贝母6g生谷芽12g
先后二诊，方未改动，服药七帖，药到病蠲。倘若阴凝之药再投，必入损症之门而痊愈无望矣。罗谦甫曰：“活人之道将与相，一旦在已权非轻。”为人司命者，可不慎欤!
以上三例中：
例一
素属肾阴亏损，其左尺脉常见细弱，甚至不应。故于止咳治标方中加熟地以滋肾水，使金水相生，则五脏气平，而肺气自复，咳嗽自止也。
例二为肝火犯肺、肺肝热炽。久之必损肺气。若清肺泄肝、降逆止咳，不益肺气效必不捷，是以重加黄芪，使金旺气充则制木有权，元气来复则阴火退位，五脏无偏颇，邪火自消而咳自止也。
例三乃外邪袭肺，误服滋腻凉润，填塞肺窍而致闭门留寇，邪达无路。不开其肺则金气壅而不平，是故治以开肺达邪，外邪散则肺金安和，五脏自调而咳止矣。
饮邪咳喘青龙祛
例一饮邪咳嗽
老年木工朱某，工作认真踏实，平昔作务辛劳，加之年高体弱，渐觉疲惫乏力。然仍一心为公，不暇休息。1974年4月初，天气乍暖还寒，不慎感受寒邪，啬啬恶寒，微微发热，并见咳嗽吐痰。投疏表宣肺止咳化痰之方，表解而咳嗽不已。连更数方依然全无效验，且疲惫益甚。停药十余日后，又来复诊，病未好转。改与止嗽散数帖仍不效，反觉全身蒸蒸发热，而以口腔表测之则体温正常，胸透亦无异常发现。于是余反复推敲，询知患者自感寒以后，心下时感塞闷不畅，经剧咳吐去痰液，心下塞闷之感可暂减轻，余始悟此乃饮邪为患，直书小青龙汤：
炙麻黄3g桂枝3g干姜1．2g细辛1．8g白芍6g炙甘草4．5g半夏9g五味子3g
服三帖，咳嗽大减，体蒸已除，精神稍加，复与三帖，咳嗽全止，心下塞闷亦解，而仍有乏力之感，更方与补中益气汤调理善后。
例二饮邪喘促
患者亦朱姓，亦为木工，年届占稀。素有气喘、心悸之病，入冬发作尤甚。平昔多痰、胸痛，并有心速病史，心率常在100次／分，早搏2～3次／分。听诊两肺可闻及明显哮鸣音。舒喘灵气雾剂，美喘清及强力安喘通之类西药常备不缺，服用数年病势依旧，至1995年12月13日始来就诊服用中药。当时咳喘甚剧。致使言语断续，几致不能陈述病情。吐白色痰液甚多，色带微黄。脉左细右小，舌质淡紫，苔白厚而干。诊为饮邪咳喘，治当蠲饮止咳平喘，拟小青龙汤法。
炙麻黄4．5g桂枝9g细辛1．5g炒白芍9g甘草3g姜半夏9g五味子6g杏桃仁各9g地龙12g生姜三片
服三帖咳喘大减，服至八帖，气喘基本控制。但因天气暴寒喘急略加，原方麻黄用9g，生姜改为干姜4．5g，并加款冬、紫菀、当归各9g，以此为基本方进退加减，服二十余剂咳喘得解。至1996年冬未见复发。
按：小青龙汤为仲景用治表寒里饮以致咳喘之主方。今时用治哮喘者甚多，而用治咳嗽者较少，其实《伤寒论》原文小青龙汤指征有“发热而咳”一条，而治喘仅属“或有”之证。柯韵伯亦谓小青龙汤加杏仁治咳嗽甚效。《伤寒论译释》云：“其证状则以咳嗽为主，喘与发热，或有或无，不过使用本方还须掌握以下两点：
1．本方之适应证多兼表寒，脉多弦紧兼浮。
2．表邪与水饮均偏于寒，故一般无口渴，舌苔多白滑。而上述病例，一例外感寒邪兼里饮而致咳，一例为外寒引动伏饮而喘急痰鸣，均用小青龙汤使表解里和而咳喘自宁。由此二例亦可佐证仲景方用之得当，其见效之速，正有不可思议者。
二十年痰喘两月解
刘某年届七秩，系制面厂退休工人。患者一生辛苦劳碌，已种哮喘病根。早岁衣食艰难，不得已蹬三轮车度日，无论烈日严寒，奔波于风风雨雨之中，倍感风寒暑湿等六淫之气，留着不去，渐患咳嗽顽疾，时作时止。解放后屡经劳保医院治疗，渐次平复。及至中年，又见气急喘促，多痰作嗽。初则发止不常，继则发多而止少，冬甚于夏。迭经中西医药治疗，仅能控制发作，终未根治。晚年病发愈剧，不论春夏秋冬，未有宁时。发则喘促痰鸣，倚息而不得卧，必待浓痰嗽出，始感胸臆略松，呼吸稍畅，然痰韧而粘，吐亦不易。恒常夜不成寐，坐以达旦，病苦之状，一言难謦。至1994年2月18日始来就诊。
患者病正发作，症状一如上述。六脉滑而有力，右手略小于左手，舌质暗红而苔薄腻。析脉论证，是风寒久伏肺俞，未经彻底解散，日久逐渐化热，肺热不得及时清泄，煎熬津液凝为痰涎，阻塞气管，妨碍呼吸出入之路，诸证遂作。治法拟清肺降逆、消痰平喘。方用：
桑白皮9g杏仁9g川贝母9g黄芩9g鱼腥草30g甘草3g莱菔子9g苏子9g白芥子9g桃仁9g地龙9g
服药七剂，气急喘鸣迅即缓解，惟痰仍较多，脉见小滑，舌与苔依然如前。后以此方增损续进六十余剂，渐得痰消喘平。至今已三年病未复发，惟觉平素多痰，服祛痰灵及化痰之成药即能收效。有时痰咳较甚，恐其哮喘复萌，再进前药二、三帖，即安然无事。
按：患者年事虽高，病历虽久，但由于长期从事体力劳动，体质仍较健壮。其所患之哮喘病症，属于实证，不涉虚象。按中医传统经验，凡慢性病“实则易治，虚则难疗”，故刘某之病有可愈之先决条件，治之迅速得效，实非偶然。此证痰鸣气促，胸宇塞闷。痰浊粘韧，脉象滑而有力，舌红苔腻，是痰热壅肺、阻碍气道之证，故治当先祛痰热，使肺络通畅，气机舒展，则病易愈。本例所用方药，实为定喘汤、三子养亲汤合地龙桃杏方而成。
定喘汤原出《摄生众妙方》，有麻黄、苏子、甘草、款冬花、杏仁、桑白皮、黄芩、半夏、白果等九味药物组成。本方妙在麻黄与白果同用，麻黄解散表热，又兼宣肺定喘。白果敛肺化痰，止咳平喘，两者相伍，一散一收，既能为止咳平喘之药增效，又不致耗伤肺气。杏苏冬夏，降气化痰而平喘，芩桑清肺泄热而定喘止咳，甘草协和诸药。全方具有宣肺降气、化痰定喘之功，善治风寒外束、痰热内蕴之哮喘。而本例病证无明显风寒束表见证，故于原方去麻黄之辛温。又恐白果敛肺摄纳，不利于祛痰清热，故亦不用。关于白果之使用，有医家主张虽因痰热内恋，而于本方中白果与诸药同用，其消痰平喘之效更著，惜余未经试过。
脾肺气虚、土不生金而致咳嗽者，证见咳嗽经久不愈，咳声低微。病情较甚者，可见食减便溏，短气乏力。气虚及阳者，兼见畏寒跗冷，色白肌柔。脉见细软，或右手脉大无力，舌淡苔薄。方用四君子汤、异功散，或小建中汤、黄芪建中汤随证选用，有痰者六君子汤。食少便溏者，参苓白术散，兼见阳虚者，适当佐以温润扶阳之品
肺胃阴虚而致肺燥咳嗽者，匝见咳嗽经久不愈，干咳少痰或无痰，咳嗽夜甚于昼，夜间蒸热，食少萎黄，渴饮咽干，大便燥而不爽，脉细小或细小带涩，或右脉虚数，舌红而干，苔薄白。，治拟叶氏养胃汤，沙参麦冬汤或沙参玉竹方(南沙参、玉竹、石斛、桑叶、梨肉、茯神。为叶天士医案方。)
现于治验病例中，选取脾胃气虚咳嗽及肺胃津伤咳嗽各一例，以示一斑。
例一职员朱某，年近四旬。自诉频年以来，干咳不已，纳食不振，胃脘胀满，嗳气时作，泛恶频仍。西医诊断为肺气肿。中西医药杂治年余，依然如故，渐觉形神衰疲，食道有梗阻之感，胸次闷瞀，呼吸不畅。于1971年秋前来就诊。余视其脉软而无力，舌质淡而苔略厚。洋参四诊。证属中气虚衰，土不生金，肺气／卜足才生咳嗽。至于恶心泛漾，缘土虚则湿痰留滞胃脘，痰浊内扰则泛恶作矣。观前所服方，尽是开肺止咳之品，不惟无益，反且有害。为今之计，当宗《内经》“治病必求其本”之旨，以培土生金为法。遂拟一方，以六君合生脉加川贝粉：
党参9g白术9g茯苓9g甘草3g陈皮4．5g半夏6g麦冬6g五昧子4．5g川贝粉3g(吞)
以此为主方，加减予服二十余剂，竟得咳止纳馨，胸次畅然，神亦不惫。停药数月后再经医院复查，证实肺气肿业已消失。
例二友人徐君之子，年甫五龄，咳嗽已二年未愈。屡求名医援手，而屡治乏效。首由一医为诊，予服麻杏石甘汤加减方数十剂，服则咳止，停药则复咳如前。继求他医为治，主脾肾气虚大剂培土益气，三十余剂咳未少止。再请某儿科著名前辈诊治，用补肺阿胶散改汤加减，幸服数剂咳即止。半月后复咳如前，缘求治不易，自行原方以进，咳声时断时续。因循至1977年春节后，始就商于余。自患病起已二年矣。余诊得脉缓而涩，苔薄且净。闻咳则喉中痰鸣，咳甚时呕出白痰甚多，每次约可半饭碗余。此病初看似属痰饮为患，然脉呈虚象而非实证。盖脉缓无力为中土虚衰，涩而应指不足为津液亏损之的据。且余诊时正服某祖传儿医之方，尽是麻杏苏夏，且每方必用控涎丹9g包煎。已服二十余剂，咳不见减，痰不见少，显非痰饮为病。倘正属痰饮，如此用药痰咳必受其挫。余揣摩证情，推测此证初起时，原由外感伤肺、劫夺津液，加之杂药乱投，肺胃津液更伤，遂成金燥热郁之象。消克之药屡投，脾胃复伤，脾不能为胃行其津液以上灌于肺，反使水液凝滞，遇内火煎熬而为痰浊。中土一亏，则金失所养，故痰嗽愈甚。是水液不足，输布失常，而非水液过剩；是燥证而非痰饮。于病机之认识相反若此，倘辨证不明，失之毫厘，投剂用药则差之千里矣。何求愈病之云哉!患者之治，余意当养胃阴、润肺金、健脾土为法，佐以止咳消痰。为疏一方：
南沙参12g川石斛12g麦门冬9g炙紫菀9g炙冬花9g焦白术6g茯苓9g炙甘草3g甜杏仁9g炙兜铃9g
服二帖，咳嗽大减，再服四帖，诸症渐除。惟偶有咳嗽一、二声，即自行停药勿服。二旬后不慎风寒，又见发热咳嗽，前症复作，予疏表化痰药，表解热退，痰嗽依旧。又予前方三剂，痰嗽俱平，由是康复。
平衡五脏治久咳
《内经》云：“五脏六腑皆令人咳，非独肺也。”肺为橐籥，司人呼吸。秉质清虚，不容纤物。因而无论内外之邪，皆能影响肺脏正常功能而致咳嗽。凡外邪袭人所致之咳，先宜速散其邪，治之尚易。而内伤久咳，往往诸药鲜效，殊费医家踌躇。盖人身五脏六腑，阴阳气血，宜处动态平衡之中。一旦失却平衡，或因木过旺而乘肺侮金；或因土太弱而生化不足；或因火盛烁金；或因水寒射肺。诸如此类，皆能导致肺病咳嗽，缠绵不已。当于对证之治咳方中，求其五脏六腑、阴阳气血之平，则内气调而咳嗽愈矣。略举数例于下：
例一女干部徐某，于豆蔻之年得气管炎，入冬辄咳呛不已。中年自部队转到地方，始有机会邀余为治，每数服必效，咳止后可保一冬不发。至1972年春节前一周，咳嗽又作。服药三帖已效，谓春节务须走亲访友，要求迅速止咳。余细勘其脉，左尺独细而沉，遂于原方中加熟地12g，三服咳即止。不惟春节未发，开春后亦未复作。1973年夏，为根治计，在某医院行冬病夏治之法。入冬咳嗽更甚，断其肺中有热，药须多吃方效。患者闻言不悦，遂不畏跋涉，去草药店求一“名医”诊治。余视其方，为肃肺降气化痰止咳之药，兼以较多清热解毒之品。所虑清热太过，难免遗殃。先后数诊竟服四十余剂。咳虽得愈，而脘胀纳呆、胃中发凉之证生矣。余谓君病原由冬病夏治，以热药敷贴肺俞，致肺中伏热而作咳。此非冬病夏治之过，乃医家不善择治之所致也。清肺固是，过剂则败胃伤中矣。予香砂六君汤，数帖寻愈。
例二同事谢某之女，二十余岁。十年前患顿咳，每晨起必咳数十声。数年后发作渐频，至诊时则一日四、五发，深以为苦。服药不少，效亦乌有。余察其脉左大略弦，右寸独强。舌无异常。是肺肝蕴热。为疏一方：
生黄芪15g桑白皮12g地骨皮12g杏仁9g川贝母9g甘草1．5g黛蛤散9g(包)枇杷叶9g(包)黄芩9g
三帖咳止大半，十帖全解。
例三一日偶过友人家，见其未婚妻咳嗽声频，于是细诘病情。谓咳嗽已经年余，在某名老中医处诊治一年，服药几无虚日，然咳嗽终未少减。视其方尽是养阴润肺，化痰止咳之品。察其舌则苔白腻。显是阴药过度，反致痰湿留中。所幸年富胃强，纳谷虽减而中焦未败。余细诊其脉，右寸独见浮涩，他脉尚平。疑其始由外感而治不如法，遂致迁延不已。今外感之脉尚在，是邪未解散，而病仍在肺卫，并未深入于里。患者病发之时，必先喉痒，痒甚则咳作，是邪欲透发之征。用药当助其宣散始为合辙。前治过用滋腻寒凉，致苔白脉涩，正宜借用王孟英杏蔻橘桔之剂，以开其肺而达其邪。方用：
苦桔梗9g陈皮6g蔻仁3g光杏仁9g荆芥9g甘草3g淡豆豉9g象贝母6g生谷芽12g
先后二诊，方未改动，服药七帖，药到病蠲。倘若阴凝之药再投，必入损症之门而痊愈无望矣。罗谦甫曰：“活人之道将与相，一旦在已权非轻。”为人司命者，可不慎欤!
以上三例中：
例一
素属肾阴亏损，其左尺脉常见细弱，甚至不应。故于止咳治标方中加熟地以滋肾水，使金水相生，则五脏气平，而肺气自复，咳嗽自止也。
例二为肝火犯肺、肺肝热炽。久之必损肺气。若清肺泄肝、降逆止咳，不益肺气效必不捷，是以重加黄芪，使金旺气充则制木有权，元气来复则阴火退位，五脏无偏颇，邪火自消而咳自止也。
例三乃外邪袭肺，误服滋腻凉润，填塞肺窍而致闭门留寇，邪达无路。不开其肺则金气壅而不平，是故治以开肺达邪，外邪散则肺金安和，五脏自调而咳止矣。
饮邪咳喘青龙祛
例一饮邪咳嗽
老年木工朱某，工作认真踏实，平昔作务辛劳，加之年高体弱，渐觉疲惫乏力。然仍一心为公，不暇休息。1974年4月初，天气乍暖还寒，不慎感受寒邪，啬啬恶寒，微微发热，并见咳嗽吐痰。投疏表宣肺止咳化痰之方，表解而咳嗽不已。连更数方依然全无效验，且疲惫益甚。停药十余日后，又来复诊，病未好转。改与止嗽散数帖仍不效，反觉全身蒸蒸发热，而以口腔表测之则体温正常，胸透亦无异常发现。于是余反复推敲，询知患者自感寒以后，心下时感塞闷不畅，经剧咳吐去痰液，心下塞闷之感可暂减轻，余始悟此乃饮邪为患，直书小青龙汤：
炙麻黄3g桂枝3g干姜1．2g细辛1．8g白芍6g炙甘草4．5g半夏9g五味子3g
服三帖，咳嗽大减，体蒸已除，精神稍加，复与三帖，咳嗽全止，心下塞闷亦解，而仍有乏力之感，更方与补中益气汤调理善后。
例二饮邪喘促
患者亦朱姓，亦为木工，年届占稀。素有气喘、心悸之病，入冬发作尤甚。平昔多痰、胸痛，并有心速病史，心率常在100次／分，早搏2～3次／分。听诊两肺可闻及明显哮鸣音。舒喘灵气雾剂，美喘清及强力安喘通之类西药常备不缺，服用数年病势依旧，至1995年12月13日始来就诊服用中药。当时咳喘甚剧。致使言语断续，几致不能陈述病情。吐白色痰液甚多，色带微黄。脉左细右小，舌质淡紫，苔白厚而干。诊为饮邪咳喘，治当蠲饮止咳平喘，拟小青龙汤法。
炙麻黄4．5g桂枝9g细辛1．5g炒白芍9g甘草3g姜半夏9g五味子6g杏桃仁各9g地龙12g生姜三片
服三帖咳喘大减，服至八帖，气喘基本控制。但因天气暴寒喘急略加，原方麻黄用9g，生姜改为干姜4．5g，并加款冬、紫菀、当归各9g，以此为基本方进退加减，服二十余剂咳喘得解。至1996年冬未见复发。
按：小青龙汤为仲景用治表寒里饮以致咳喘之主方。今时用治哮喘者甚多，而用治咳嗽者较少，其实《伤寒论》原文小青龙汤指征有“发热而咳”一条，而治喘仅属“或有”之证。柯韵伯亦谓小青龙汤加杏仁治咳嗽甚效。《伤寒论译释》云：“其证状则以咳嗽为主，喘与发热，或有或无，不过使用本方还须掌握以下两点：
1．本方之适应证多兼表寒，脉多弦紧兼浮。
2．表邪与水饮均偏于寒，故一般无口渴，舌苔多白滑。而上述病例，一例外感寒邪兼里饮而致咳，一例为外寒引动伏饮而喘急痰鸣，均用小青龙汤使表解里和而咳喘自宁。由此二例亦可佐证仲景方用之得当，其见效之速，正有不可思议者。
二十年痰喘两月解
刘某年届七秩，系制面厂退休工人。患者一生辛苦劳碌，已种哮喘病根。早岁衣食艰难，不得已蹬三轮车度日，无论烈日严寒，奔波于风风雨雨之中，倍感风寒暑湿等六淫之气，留着不去，渐患咳嗽顽疾，时作时止。解放后屡经劳保医院治疗，渐次平复。及至中年，又见气急喘促，多痰作嗽。初则发止不常，继则发多而止少，冬甚于夏。迭经中西医药治疗，仅能控制发作，终未根治。晚年病发愈剧，不论春夏秋冬，未有宁时。发则喘促痰鸣，倚息而不得卧，必待浓痰嗽出，始感胸臆略松，呼吸稍畅，然痰韧而粘，吐亦不易。恒常夜不成寐，坐以达旦，病苦之状，一言难謦。至1994年2月18日始来就诊。
患者病正发作，症状一如上述。六脉滑而有力，右手略小于左手，舌质暗红而苔薄腻。析脉论证，是风寒久伏肺俞，未经彻底解散，日久逐渐化热，肺热不得及时清泄，煎熬津液凝为痰涎，阻塞气管，妨碍呼吸出入之路，诸证遂作。治法拟清肺降逆、消痰平喘。方用：
桑白皮9g杏仁9g川贝母9g黄芩9g鱼腥草30g甘草3g莱菔子9g苏子9g白芥子9g桃仁9g地龙9g
服药七剂，气急喘鸣迅即缓解，惟痰仍较多，脉见小滑，舌与苔依然如前。后以此方增损续进六十余剂，渐得痰消喘平。至今已三年病未复发，惟觉平素多痰，服祛痰灵及化痰之成药即能收效。有时痰咳较甚，恐其哮喘复萌，再进前药二、三帖，即安然无事。
按：患者年事虽高，病历虽久，但由于长期从事体力劳动，体质仍较健壮。其所患之哮喘病症，属于实证，不涉虚象。按中医传统经验，凡慢性病“实则易治，虚则难疗”，故刘某之病有可愈之先决条件，治之迅速得效，实非偶然。此证痰鸣气促，胸宇塞闷。痰浊粘韧，脉象滑而有力，舌红苔腻，是痰热壅肺、阻碍气道之证，故治当先祛痰热，使肺络通畅，气机舒展，则病易愈。本例所用方药，实为定喘汤、三子养亲汤合地龙桃杏方而成。
定喘汤原出《摄生众妙方》，有麻黄、苏子、甘草、款冬花、杏仁、桑白皮、黄芩、半夏、白果等九味药物组成。本方妙在麻黄与白果同用，麻黄解散表热，又兼宣肺定喘。白果敛肺化痰，止咳平喘，两者相伍，一散一收，既能为止咳平喘之药增效，又不致耗伤肺气。杏苏冬夏，降气化痰而平喘，芩桑清肺泄热而定喘止咳，甘草协和诸药。全方具有宣肺降气、化痰定喘之功，善治风寒外束、痰热内蕴之哮喘。而本例病证无明显风寒束表见证，故于原方去麻黄之辛温。又恐白果敛肺摄纳，不利于祛痰清热，故亦不用。关于白果之使用，有医家主张虽因痰热内恋，而于本方中白果与诸药同用，其消痰平喘之效更著，惜余未经试过。
For coughs caused by Spleen and Lung Qi deficiency, where Earth fails to generate Metal (土不生金), the manifestations include a chronic cough that does not heal for a long time, with a low and weak cough sound. In more severe cases, there may be reduced appetite, loose stools, shortness of breath, and fatigue. If Qi deficiency extends to Yang, there are additionally aversion to cold and cold soles, pale complexion, and soft muscle texture. The pulse is fine and soft, or the right-hand pulse is large but forceless; the tongue is pale with a thin coating. Formulas such as Sijunzi Tang (Four Gentlemen Decoction), Yigong San (Yi Gong Powder), Xiao Jianzhong Tang (Minor Construct the Middle Decoction), or Huangqi Jianzhong Tang (Astragalus Minor Construct the Middle Decoction) can be selected according to the syndrome. For those with phlegm, Liujunzi Tang (Six Gentlemen Decoction) is used. For those with poor appetite and loose stools, Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) is indicated. If Yang deficiency is also present, appropriately add warming and moistening herbs to support Yang.
For dry coughs of the Lung caused by Yin deficiency of the Lung and Stomach, the manifestations include a chronic cough that does not heal for a long time, dry cough with little or no sputum, coughing worse at night than during the day, steaming heat at night, poor appetite, sallow complexion, thirst with dry throat, dry and unsatisfactory bowel movements, fine or fine-and-choppy pulse, or deficient-rapid right-hand pulse, red and dry tongue with a thin white coating. Treatment should follow Ye's Weiyang Tang (Ye's Stomach-Nourishing Decoction), Shashen Maidong Tang (Glehnia and Ophiopogon Decoction), or Shashen Yuzhu Fang (Glehnia and Polygonatum Odoratum Formula, containing Nan Sha Shen, Yu Zhu, Shi Hu, Sang Ye, Pear Flesh, Fu Shen. This is a formula from Ye Tianshi's medical records).
Now, selecting one case each of Spleen-Stomach Qi deficiency cough and Lung-Stomach Fluid injury cough from clinical experiences to illustrate the point.
Case 1: Employee Mr. Zhu, nearly forty years old. He reported that for many years he has had an unceasing dry cough, poor appetite, epigastric distension, occasional belching, and frequent nausea. Diagnosed with pulmonary emphysema by Western medicine. After over a year of mixed Chinese and Western medical treatments, the condition remained unchanged. He gradually felt physical and mental exhaustion, a sensation of obstruction in the esophagus, chest stuffiness and dizziness, and difficulty breathing. He sought treatment in the autumn of 1971. I observed his pulse was soft and forceless, the tongue body was pale with a slightly thick coating. Four diagnostic methods confirmed the syndrome as deficiency and decline of Middle Qi, where Earth fails to generate Metal, leading to insufficient Lung Qi causing cough. As for the nausea and retching, it is because Spleen deficiency leads to damp-phlegm stagnating in the stomach cavity; turbid phlegm disturbing internally causes nausea. Observing the previously taken formulas, they were all herbs for opening the Lung and stopping cough, which not only were ineffective but harmful. The current strategy should follow the principle of "treating diseases must seek their root" from the *Neijing* (Inner Canon), using the method of cultivating Earth to generate Metal. Thus, I prescribed a formula combining Liujunzi Tang (Six Gentlemen Decoction) with Shengmai San (Generate Pulse Powder) plus Chuanbei Fen (Fritillaria Cirrhosa Powder):
Codonopsis 9g, Atractylodes Macrocephala 9g, Poria 9g, Licorice 3g, Tangerine Peel 4.5g, Pinellia 6g, Ophiopogon 6g, Schisandra 4.5g, Fritillaria Cirrhosa Powder 3g (swallowed).
Using this as the main formula, with modifications, he took more than twenty doses. Eventually, the cough stopped, appetite improved, chest became clear, and spirit was not exhausted. After stopping medication for several months and re-examining at the hospital, it was confirmed that pulmonary emphysema had disappeared.
Case 2: The son of my friend Mr. Xu, five years old, had a cough that had not healed for two years. He repeatedly sought help from famous doctors, but treatments were ineffective. First, a doctor diagnosed him and gave modified Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) for dozens of doses. Cough stopped while taking it, but recurred upon stopping. Then seeking another doctor, who focused on Spleen-Kidney Qi deficiency, prescribing large doses to cultivate Earth and benefit Qi. After thirty-plus doses, the cough did not subside much. Then inviting a famous pediatric senior for treatment, using Bufeijiao San (Lung-Reinforcing Donkey-Hide Gelatin Powder) modified into decoction. Fortunately, after a few doses, the cough stopped. Half a month later, the cough returned as before. Because finding treatment was difficult, he self-administered the original formula, resulting in intermittent coughing. Delaying until after the Spring Festival of 1977, he consulted me. It had been two years since the onset. I diagnosed a slow and choppy pulse, thin and clean coating. Hearing the cough, there was phlegm rattling in the throat; when coughing severely, he vomited a lot of white sputum, about half a rice bowl each time. Initially, this disease seemed to be caused by Phlegm-Fluid, but the pulse showed deficiency signs rather than excess. A slow and forceless pulse indicates deficiency of Central Earth; a choppy pulse lacking fullness under the fingers is evidence of fluid depletion. Moreover, during my diagnosis, he was taking a formula from a hereditary pediatrician, consisting entirely of Ephedra, Apricot Kernel, Perilla, and Pinellia, and every formula included Kongxian Dan (Control Phlegm Pill) 9g wrapped and decocted. Having taken more than twenty doses, the cough did not decrease, nor did the phlegm reduce, clearly indicating it was not a Phlegm-Fluid disease. If it were truly Phlegm-Fluid, such medication would have suppressed the phlegm and cough. I pondered the syndrome and speculated that initially, the condition originated from external pathogens injuring the Lung and depleting fluids, compounded by chaotic medication use, further damaging Lung and Stomach fluids, thus forming a state of Metal dryness and Heat stagnation. Repeated use of draining and reducing drugs injured the Spleen and Stomach again. The Spleen could not transport fluids for the Stomach to irrigate the Lung, instead causing fluid stagnation. Encountering internal fire, it was boiled into turbid phlegm. Once Central Earth is deficient, Metal loses nourishment, so phlegm-cough becomes worse. This is insufficient water-fluids and abnormal distribution, not excess water-fluids; it is a Dryness syndrome, not Phlegm-Fluid. Such opposite understanding of pathogenesis means if differentiation is unclear, a slight error in diagnosis leads to a thousand-mile difference in prescription. How can one expect cure? For treating this patient, my intention was to nourish Stomach Yin, moisten Lung Metal, and strengthen Spleen Earth, assisted by stopping cough and eliminating phlegm. I prescribed:
Nan Sha Shen 12g, Chuan Shi Hu 12g, Mai Men Dong 9g, Zhi Zi Wan 9g, Zhi Dong Hua 9g, Jiao Bai Zhu 6g, Fu Ling 9g, Zhi Gan Cao 3g, Tian Xing Ren 9g, Zhi Dou Ling 9g.
After two doses, cough greatly reduced; after four more doses, symptoms gradually disappeared. Only occasionally having one or two coughs, he stopped medication himself. Twenty days later, careless exposure to wind-cold caused fever and cough, recurring previous symptoms. I gave exterior-releasing and phlegm-resolving drugs. After exterior resolved and heat subsided, phlegm-cough persisted. Giving three doses of the previous formula, both phlegm and cough flattened, and he recovered.
Balancing Five Zang Organs to Treat Chronic Cough
The *Neijing* states: "All five Zang and six Fu organs can cause cough, not just the Lung." The Lung acts as the bellows, governing respiration. Its nature is pure and empty, tolerating no foreign matter. Therefore, whether internal or external pathogens, all can affect the normal function of the Lung and cause cough. For coughs caused by external pathogens, dispersing the pathogen quickly is suitable, and treatment is relatively easy. However, chronic coughs due to internal injury often show little effect from various medicines, causing hesitation among physicians. The human body's five Zang and six Fu organs, Yin-Yang, Qi, and Blood should exist in dynamic balance. Once balance is lost, either Wood overacts and attacks Lung/Metal; or Earth is too weak leading to insufficient transformation; or Fire is excessive scorching Metal; or Water-Cold shoots to the Lung. All these can lead to persistent Lung disease and cough. When treating cough with appropriate formulas, one should seek balance among the five Zang and six Fu organs, Yin-Yang, Qi, and Blood. Then internal Qi will regulate, and cough will heal. Briefly listing a few examples below:
Case 1: Female cadre Ms. Xu, developed bronchitis in her youth. Every winter, she suffered from incessant coughing fits. In middle age, transferring from military to local work, she finally had the opportunity to invite me for treatment. Each few doses were effective, and once cough stopped, she could avoid recurrence for a whole winter. One week before the Spring Festival in 1972, cough recurred. Taking three doses was effective. She stated she must visit relatives and friends during Spring Festival and requested rapid cough cessation. I carefully examined her pulse; the Left Chi pulse alone was fine and deep. Thus, I added Shu Di Huang (Prepared Rehmannia Root) 12g to the original formula. After three doses, cough stopped. Not only did it not recur during Spring Festival, it did not recur after spring arrived. In summer 1973, for radical cure, she underwent "Winter Disease Summer Treatment" at a certain hospital. Cough worsened entering winter. It was judged that there was Heat in the Lung, requiring more medication for efficacy. The patient was displeased with this statement. Undeterred by hardship, she went to a herbal shop to seek a "famous doctor." I viewed her prescription: it consisted of herbs for purging Lung, descending Qi, resolving phlegm, and stopping cough, combined with a larger amount of clearing Heat and detoxifying products. I worried that clearing Heat excessively would inevitably cause harm. After several consultations, she took more than forty doses. Although cough healed, symptoms of epigastric distension, poor appetite, and cold stomach arose. I told her the original cause was Winter Disease Summer Treatment, applying hot herbs to Feishu acupoint, causing latent Heat in the Lung to trigger cough. This is not the fault of Winter Disease Summer Treatment, but the physician's poor selection of treatment. Clearing Lung Heat is correct, but overdosing damages Stomach and harms the Center. I prescribed Xiangsha Liujunzi Tang (Amomum and Aucklandia Six Gentlemen Decoction). After a few doses, she recovered quickly.
Case 2: Daughter of colleague Mr. Xie, over twenty years old. Ten years ago, she suffered from pertussis (whooping cough), coughing dozens of times every morning upon waking. Years later, attacks became more frequent. At the time of diagnosis, she had four to five episodes per day, suffering greatly. She took many medicines with no effect. I observed her pulse: Left was large and slightly wiry; Right Cun alone was strong. Tongue was normal. This indicates Heat accumulating in Lung and Liver. I prescribed:
Sheng Huang Qi 15g, Sang Bai Pi 12g, Di Gu Pi 12g, Xing Ren 9g, Chuan Bei Mu 9g, Gan Cao 1.5g, Dai Ge San 9g (wrapped), Pi Pa Ye 9g (wrapped), Huang Qin 9g.
After three doses, cough stopped mostly; after ten doses, completely resolved.
Case 3: One day, passing by a friend's house, I saw his fiancée coughing frequently, so I inquired about her condition. She said she had coughed for over a year, treated by a famous elderly TCM doctor for a year, taking medicine almost daily, yet cough never decreased. Viewing her prescription, it was entirely herbs for nourishing Yin, moistening Lung, resolving phlegm, and stopping cough. Observing her tongue, the coating was white and greasy. Clearly, excessive Yin-nourishing drugs led to Phlegm-Dampness remaining in the Middle. Fortunately, she was young and had strong Stomach function; although appetite decreased, the Middle Jiao was not defeated. I carefully diagnosed her pulse: Right Cun alone showed floating and choppy qualities, other pulses were normal. Suspecting it started from external invasion with improper treatment, leading to prolongation. Now, the external invasion pulse remains, meaning the pathogen has not dispersed, and the disease is still in Lung and Wei levels, not deeply interior. When the patient's illness flares, she first feels throat itching; severe itching triggers cough, which is a sign of the pathogen wanting to emerge. Medication should assist in dispersing and releasing to be appropriate. Previous treatments overused cloying and cold-cooling drugs, resulting in white coating and choppy pulse. It is precisely suitable to borrow Wang Mengying's Xing Kou Ju Jie formulation (Apricot Kernel, Cardamom, Tangerine Peel, and Platycodon Agent) to open the Lung and expel the pathogen. Prescribed:
Ku Jie Geng 9g, Chen Pi 6g, Kou Ren 3g, Guang Xing Ren 9g, Jing Jie 9g, Gan Cao 3g, Dan Dou Chi 9g, Xiang Bei Mu 6g, Sheng Gu Ya 12g.
After two consultations, the formula was unchanged. Taking seven doses, the medicine reached and the disease vanished. If Yin-congealing drugs were administered again, it would surely enter the door of damage syndromes with no hope of recovery. Luo Qianfu said: "The way of saving lives is like being a minister; once power is in one's hands, it is not light." Those responsible for people's lives, how can they not be cautious!
In the above three cases:
Case 1:
Originally belonging to Kidney Yin deficiency, her Left Chi pulse is commonly fine and weak, even imperceptible. Thus, adding Shu Di Huang to the symptomatic cough-stopping formula nourishes Kidney Water, allowing Metal and Water to generate each other. Then Qi of the five Zang organs balances, Lung Qi recovers naturally, and cough stops.
Case 2:
This is Liver Fire invading Lung, with intense Heat in Lung and Liver. Over time, it must damage Lung Qi. If merely clearing Lung and draining Liver, descending rebellion and stopping cough without benefiting Lung Qi, the effect will certainly not be swift. Therefore, heavily adding Huang Qi makes Metal prosperous and Qi abundant, thereby controlling Wood effectively. When Yuan Qi returns, Yin Fire retreats. With no bias in the five Zang organs, evil Fire dissipates naturally, and cough stops.
Case 3:
This is external pathogens attacking the Lung, mistakenly taking cloying and cooling-moistening drugs, blocking Lung orifices and locking the thief inside, leaving no path for the pathogen to exit. If the Lung is not opened, Metal Qi becomes obstructed and unbalanced. Therefore, treatment focuses on opening the Lung and reaching the pathogen. When external pathogens scatter, Lung Metal becomes peaceful, five Zang organs self-regulate, and cough stops.
Eliminating Phlegm-Fluid Cough and Asthma with Qinglong
Case 1: Phlegm-Fluid Cough
Old carpenter Mr. Zhu, worked seriously and steadily. Usually laborious in work, plus advanced age and weakness, gradually felt fatigued and weak. Yet still dedicated to public service, having no time to rest. In early April 1974, weather turned warm then cold again. Carelessly contracting Cold pathogen, he felt chilly aversion to cold, slight fever, and cough with sputum. Given a formula for exterior-releasing, Lung-opening, cough-stopping, and phlegm-resolving. Exterior resolved, but cough continued. Changing formulas several times yielded no effect, and fatigue increased. After stopping medication for over ten days, he returned for follow-up, condition not improving. Changed to Zhisou San (Stop Cough Powder) for a few doses, still ineffective. Instead, he felt steaming heat throughout the body, though oral temperature measurement was normal, and chest fluoroscopy showed no abnormalities. Thus, I repeatedly deliberated, inquiring that after feeling cold, the patient sometimes felt stuffiness and discomfort in the epigastrium. After severe coughing expelling sputum, the epigastric stuffiness temporarily relieved. I then realized this was caused by Phlegm-Fluid pathogen, and directly wrote Xiaolongtan Tang (Minor Green Dragon Decoction):
Zhi Ma Huang 3g, Gui Zhi 3g, Gan Jiang 1.2g, Xi Xin 1.8g, Bai Shao 6g, Zhi Gan Cao 4.5g, Ban Xia 9g, Wu Wei Zi 3g.
Taking three doses, cough greatly reduced, body steaming eliminated, spirit slightly improved. Given three more doses, cough completely stopped, epigastric stuffiness resolved, but fatigue remained. Changed formula to Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) for conditioning and aftermath care.
Case 2: Phlegm-Fluid Asthma
Patient also surnamed Zhu, also a carpenter, nearing seventy. Suffered from asthma and palpitations, worsening in winter. Usually had much phlegm, chest pain, and history of tachycardia, heart rate often 100 beats/min, premature beats 2-3 beats/min. Auscultation revealed obvious wheezing in both lungs. Western medicines like Ventolin aerosol, Meichuanqing, and Qiangli Anchuantong were always available. Taking them for years, the disease trend remained unchanged. Finally sought TCM treatment on December 13, 1995. At that time, cough and asthma were very severe. Causing interrupted speech, barely able to describe the condition. Vomiting much white sputum, slightly yellowish. Pulse left fine, right small; tongue body pale purple, coating white, thick, and dry. Diagnosed as Phlegm-Fluid cough and asthma. Treatment should eliminate fluid, stop cough, and calm asthma. Adopting Xiaolongtan Tang method:
Zhi Ma Huang 4.5g, Gui Zhi 9g, Xi Xin 1.5g, Chao Bai Shao 9g, Gan Cao 3g, Jiang Ban Xia 9g, Wu Wei Zi 6g, Xing Tao Ren 9g each, Di Long 12g, Sheng Jiang three slices.
Taking three doses, cough and asthma greatly reduced. By eight doses, asthma basically controlled. But due to sudden cold weather, asthma urgency slightly increased. Original formula Ma Huang changed to 9g, Sheng Jiang changed to Gan Jiang 4.5g, adding Kuan Dong, Zi Wan, Dang Gui 9g each. Using this as the basic formula for advancement and reduction, taking more than twenty doses, cough and asthma resolved. No recurrence seen in winter 1996.
Commentary: Xiaolongtan Tang is Zhongjing's main formula for treating cough and asthma caused by exterior Cold and interior Fluid retention. Nowadays, it is used for asthma often, but less for cough. Actually, the original text of *Shanghan Lun* regarding Xiaolongtan Tang indications includes "fever and cough," while treating asthma belongs only to "possibly present" symptoms. Ke Yunbo also stated that Xiaolongtan Tang plus Xing Ren is very effective for cough. *Shanghan Lun Translation and Explanation* says: "Its symptoms mainly feature cough; asthma and fever may or may not be present. However, using this formula requires mastering two points:
1. The indication for this formula often accompanies exterior Cold, pulse is often wiry-tight and floating.
2. Exterior pathogen and Fluid retention are both biased towards Cold, so generally no thirst, tongue coating is mostly white and slippery. The aforementioned cases: one case of external Cold pathogen accompanying interior Fluid causing cough, one case of external Cold triggering latent Fluid causing urgent asthma and phlegm rattle, both used Xiaolongtan Tang to resolve exterior and harmonize interior, so cough and asthma calmed naturally. These two cases also corroborate the appropriateness of Zhongjing's formula usage; its rapid effect is indeed incredible."
Resolving Twenty-Year Phlegm-Asthma in Two Months
Mr. Liu, aged seventy, retired worker from a flour mill. Patient worked hard and toiled all his life, already planting the root of asthma disease. In early years, food and clothing were difficult; forced to ride a tricycle for a living. Regardless of scorching sun or bitter cold, rushing through wind and rain, greatly exposed to Wind, Cold, Summer-Heat, Dampness, and other Six Evils, which stayed and did not leave. Gradually suffered from stubborn cough, occurring intermittently. After liberation, treated repeatedly in labor insurance hospitals, gradually stabilized. Upon reaching middle age, saw shortness of breath and asthma, much phlegm and cough. Initially, onset and cessation were irregular; subsequently, more onset and less cessation, worse in winter than summer. Repeatedly treated with Chinese and Western medicines, only able to control attacks, never radically cured. In late years, disease flares became more severe, no peace regardless of seasons. Onset features urgent asthma and phlegm rattle, leaning on pillows unable to lie down, must wait for thick sputum to be coughed out before feeling slight chest relaxation and easier breathing. However, sputum is tough and sticky, difficult to spit out. Constantly unable to sleep at night, sitting until dawn, the bitterness of the illness is hard to describe. Finally sought treatment on February 18, 1994.
Patient's disease was in flare, symptoms as described above. Six pulses slippery and forceful, right hand slightly smaller than left hand; tongue body dark red, coating thin and greasy. Analyzing pulse and syndrome, this is Wind-Cold long潜伏 in Feishu acupoint, not thoroughly dispersed. Over time, gradually transforming into Heat. Lung Heat not cleared timely, boiling fluids condensing into phlegm-saliva, blocking airways, hindering respiratory entry and exit, thus all symptoms arise. Treatment method proposes clearing Lung, descending rebellion, eliminating phlegm, and calming asthma. Formula used:
Sang Bai Pi 9g, Xing Ren 9g, Chuan Bei Mu 9g, Huang Qin 9g, Yu Xing Cao 30g, Gan Cao 3g, Lai Fu Zi 9g, Su Zi 9g, Bai Jie Zi 9g, Tao Ren 9g, Di Long 9g.
Taking seven doses, shortness of breath and wheezing rapidly alleviated. Only phlegm still relatively much, pulse shows slight slipperiness, tongue and coating remain as before. Later, continuing with this formula with additions and reductions for more than sixty doses, gradually achieving phlegm elimination and asthma calming. Already three years since, disease has not recurred. Only feels usually much phlegm; taking Qutanling and phlegm-resolving patent medicines yields results. Sometimes phlegm-cough is severe, fearing asthma relapse, taking previous medicine two or three doses, immediately safe and sound.
Commentary: Although the patient is advanced in age and the medical history is long, due to long-term physical labor, constitution is still relatively robust. His asthma disease belongs to Excess syndrome, not involving Deficiency aspects. According to traditional TCM experience, chronic diseases "Excess is easy to treat, Deficiency is difficult to heal." Thus, Mr. Liu's disease has the prerequisite for cure. Rapid treatment effect is not accidental. This syndrome features phlegm rattle and shortness of breath, chest stuffiness. Phlegm-turbidity is sticky and tough, pulse slippery and forceful, tongue red with greasy coating. This is Phlegm-Heat congesting Lung, obstructing airway syndrome. Therefore, treatment should first eliminate Phlegm-Heat, making Lung collaterals smooth and Qi mechanism舒展, then disease is easily healed. The formula used in this case is actually composed of Dingchuan Tang (Asthma-Calming Decoction), Sanzi Yangqin Tang (Three Seeds Nourishing Parents Decoction) combined with Di Long Tao Xing Fang (Earthworm and Peach Apricot Kernel Formula).
Dingchuan Tang originally comes from *Shengsheng Zhongmiao Fang*, composed of nine herbs: Ma Huang, Su Zi, Gan Cao, Kuan Dong Hua, Xing Ren, Sang Bai Pi, Huang Qin, Ban Xia, Bai Guo. The brilliance of this formula lies in the combination of Ma Huang and Bai Guo. Ma Huang disperses exterior Heat and simultaneously opens Lung and calms asthma. Bai Guo astringes Lung, resolves phlegm, stops cough, and calms asthma. The two combined, one dispersing and one astringing, not only enhances the effect of cough-stopping and asthma-calming herbs, but does not consume Lung Qi. Xing, Su, Dong, Xia descend Qi, resolve phlegm, and calm asthma; Qin, Sang clear Lung and drain Heat to calm asthma and stop cough; Gan Cao harmonizes all herbs. The entire formula has the function of opening Lung, descending Qi, resolving phlegm, and calming asthma, good for treating asthma with exterior Wind-Cold binding and interior Phlegm-Heat accumulation. Since this case's syndrome has no obvious exterior Wind-Cold binding manifestation, Ma Huang's pungent-warm property was removed from the original formula. Also fearing Bai Guo's Lung-astringing and gathering nature is unfavorable for resolving phlegm and clearing Heat, it was also not used. Regarding the use of Bai Guo, some physicians advocate that even with interior Phlegm-Heat lingering, using Bai Guo together with other herbs in this formula makes its phlegm-resolving and asthma-calming effect more prominent. Unfortunately, I have not tried it.