某医云：何用止嗽之剂而不愈，而用木防己汤反愈也?答曰：脉沉紧，痞满，咳喘者，其病为膈间支饮所致也。寒饮结聚于膈间者非行水饮散结气不解也，其先但用化痰者未助其阳气斡旋升降，今用木防己汤者取其一苦一辛，行水饮散结气，以消心下之痞坚，石膏、人参一补一清以扶正祛邪，复佐半夏、陈皮、紫菀、葶苈子以化痰降肺止咳，则不但饮去，亦且嗽止矣。
支气管哮喘
1．不分时令，阴阳不分，以热作寒，以燥作饮，其证难愈
张××，女，40岁。
20多年来，每至夏季暑热之令，即咳嗽、喘、喷嚏、鼻喉发痒，至秋季、冬季自然缓解。为此曾反复住院治疗。医诊支气管哮喘。虽遍用诸药效果不显，．采用脱敏方法数次亦均失败。今年入夏以来，病情尤重，经常昼夜连续不断地咳喘，喷嚏，食纳、睡眠几近全废，为此体重由60千克降至42．5千克。审其形销骨立，面色皓白中透嫩红，咳嗽不断，喉中喘鸣有声，平卧不能，食纳极差，但微喜饮，舌苔净，脉虚稍数。再视诸医所用之药，有中药，亦有西药，西药除激素外，大多为止咳、祛痰、平喘及抗感染的药物，中药多为化痰定喘，温肺化饮，清热化痰，活血祛瘀，然其效果均不著明。再思其喘有明确的季节性，夏季者伏阴而肺热，冬季者伏阳而肺寒，此病发于夏季必有肺热而燥，此病之不效者恐在于以燥作寒，以燥作饮，过用辛热，苦燥之品伤其肺阴，致燥金更燥所致。又思仲景《金匮要略》云：“膈上病痰，满喘咳吐，发则寒热，背痛腰疼，目泣自出，其人振振身（目闰）剧，必有伏饮。”其病至其年月复发者必兼伏饮也。综而论之，必肺燥兼饮为病耳。因拟养阴润肺，化痰止咳为方。处方：沙参10克，麦冬10克，紫菀10克，半夏10克，桑皮10克，甘草10克，百部15克，竹叶10克，炙杷叶10克。
服药1剂，咳喘大减，并能稍进饮食，继服10剂，症状全失。为了彻底痊愈计，其后每年夏季服药30剂，连服3年，果愈。
白清佐先生云：夏季之喘非比冬季之喘，冬季之治必须重温药，夏季之喘则养阴润燥方可。
2．气阴俱虚，痰饮内郁，不扶其正，但化其饮，其病难愈
赵××，女，58岁。
从3岁始，每至气候冷热改变，季节时令改变，或稍闻异味，或接触某些物品，或吃鱼虾螃蟹之类即喷嚏流涕流泪，连续不断的咳喘，其后随着年龄的增加曾一度好转，但到50岁左右时咳喘又见加重，尤其是今年以来，几乎每天都咳，都喘，不过有时轻有时较重而已。最近3个月来，病情更加严重，虽然每天都打针、吃药，中、西药都用，就是不见其效。有时用药稍有不对即更严重。审其咳喘气短，喉中有水鸡声，神疲乏力，口燥咽干，舌苔黄白，脉虚大弦紧而数。因思仲景《金匮要略》论虚劳首重脉象，云：“脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚，虚寒相搏，此名为革，妇人则半产漏下，男子则亡血失精。”本病虽非虚劳，而其脉却为虚劳精血大伤，虚寒相搏之脉，证实乃气阴大伤，寒饮内伏证。前用诸方或小青龙，或定喘，或苏子降气，或射干麻黄诸汤加减不效者，乃因未扶其正耳。因处补阴益气、化痰止咳为方：黄芪15克，地骨皮10克，紫菀10克，党参10克，茯苓10克，柴胡10克，半夏10克，知母10克，生地10克，白芍10克，麦冬10克，肉桂10克，甘草10克。
处方刚毕，某医云：既日寒饮，当用温药，何方中大用知母、地骨皮之清肺热也?答曰：弦紧为寒脉，自当用温药，此所以加肉桂之意也。然非仅见弦紧，且见数象，数者热也，且前已询及痰难咯出，口干舌燥，亦有热象，寒饮郁久化热，故寒热并用也。又问：方中用柴胡为何也?柴胡为肝胆药而用于肺疾，其理难解?答曰：仲景《金匮要略》云：“夫治未病者，见肝之病，知肝传脾，当先实脾，四季脾旺不受邪，即勿补之；中工不晓相传，见肝之病，不先实脾，惟治肝也。夫肝之病，补用酸，助用焦苦，益用甘味之药调之。酸入肝，焦苦人心，甘人脾。脾能伤肾，肾气微弱，则水不行；水不行，则心火气盛；心火气盛，则伤肺，肺被伤，则金气不行；金气不行，则肝气盛。故实脾，则肝自愈。此治肝补脾之要妙也。肝虚则用此法，实则不在用之。”本证显系肺虚之证，肺虚则心火来克，肝木反侮肺金，故以柴胡、白芍以理肝，麦冬养肺阴而泻心火。
服药4剂，诸证俱减，继服20剂，咳喘俱失。乃以上药研末，炼蜜和丸，一日3次，一次9克。服药一年，果愈。
3．肝木失达，木火刑金，但去治肺，不治其本，久久不效
晁××，女，10岁。
1周岁时，因感冒咳嗽，医予青霉素进行治疗，用药后不到1分钟即发现全身出疹奇痒，咳喘，身热，医急用激素进行治疗，岂不知病情更加严重，不得不停药，其后虽然自然缓解，但却留下了喘哮经常发作。近10个月来喘哮不止，胸高目突，喉中哮鸣音不止。西药很多都因过敏而不敢采用。中药宣肺定喘、化痰定喘、补肾纳气、养阴益气遍试无功。审之：口唇面颊均轻度发绀，喘哮气短，消瘦神疲，舌苔黄白，脉弦滑虚数。综合脉证，云：虚数之脉乃气阴俱虚之证；滑数之脉乃痰热之证，此证综而论之，可谓气阴两虚，痰热阻肺，故治宜补气养阴，化痰清热之剂。某医云：余已用此法久矣，然始终未见其效，且我所用之方亦先生曾经介绍之方，然其不效何也?答曰：此证尚有肝郁化火之故，请再询其证可知也。询之除上证之外，果然尚有头晕心烦，胸胁满痛之苦。医又问：先生何知其必有肝证?答曰：脉弦，故知也。因拟疏肝理气，养阴益气，化痰清热。处方：柴胡6克，当归6克，白芍6克，麦冬6克，党参6克，五味子6克，半夏10克，陈皮6克，青皮6克，黄芩6克，紫菀6克，丝瓜络6克。
服药3剂，诸证果减，继服20剂，诸证消失。其后亦偶有反复，然多以此方而效，愈。
4．不审病因，不察病机，胶于定喘，泥于补肾，久久不愈
潘××，女，48岁。
支气管哮喘时轻时重十几年，近3年来，因工作不顺利，又加家中被盗2次，而病情更加严重。曾先用西药治疗1年多不效，后配中药宣肺定喘、化饮止咳、补肾纳气等近1年亦不见好转，为此数年来只能端坐扶枕而睡片刻。近3个月来，又因肺炎而病情更加严重，为此除严重的呼吸困难外，并见寒热，呕吐，心烦心悸，胸中憋闷如窒塞感。经查心电图为左束支传导阻滞。为此某院以抗生素治疗1周，药后虽然寒热好转，但却出现严重的头晕耳鸣，恶心呕吐，四肢麻木，不敢睁眼。为此不得不停用西药，改为单纯中药治之。细审其证，咳喘气短，说话、呼吸、吃饭均感气短不能接续，口唇紫黯，胸满胸痛，心烦心悸，恶心呕吐，头晕不敢睁眼，亦不敢抬头，纳呆食减，手足憋胀麻木，时烦易哭，舌苔黄厚而腻，脉沉。综合脉证思之：肺虚者当脉浮大，今反见沉，必为郁证为主也。因拟疏肝化痰、宣肺降气。处方：柴胡10克，白芍10克，枳壳10克，半夏10克，陈皮10克，青皮10克，苏叶6克，郁金10克，瓜蒌15克，桔梗10克，杏仁10克。
某医云：如此重证之喘，竞不治喘，吾不解也?答曰：脉沉者，郁证也，郁不解郁，肺气更逆，今所以解郁者，解其壅塞之气也。前用诸方之不效者，未理其肝耳。
服药6剂，咳喘，胸满，心烦．恶心呕吐均减，继服20剂，诸证减其六七。再察脉证，脉由沉转虚弦。思之：郁稍解而正虚耳。因拟扶正祛邪同施。处方：川芎10克，当归10克，白芍10克，麦冬10克，党参10克，五味子10克，半夏10克，陈皮10克，青皮10克，黄芩10克，丝瓜络10克。
服药20剂，喘咳停止，头晕、胸满、恶心均大减。乃以原方为丸，缓缓服之，2年后，诸证消失，愈。
患者云：如此之重疾，今得痊愈，真乃辨证论治之功。
支气管扩张
1．瘀血阻滞，血不归经，但予止血，其血难止
石××，男，52岁。
大口咯血反复发作5年多。医诊支气管扩张。每次发病，一用西药即很快好转。但近1年来，咯血日渐加重，尤其是近3个月来，发作更加频繁。此次发病虽用西药治疗3天，配合中药咳血方、清热解毒汤加减2剂仍无效。审其咯血正作，瞬间即咯血半痰盂多，并见其面色黄而微青，胸满胸痛，舌苔薄白，脉弦数而涩。综而思之，云：面色黄而微青即仲景所谓晕黄也，脉弦数而涩者瘀血兼热也，合之于证论之，证乃瘀血阻滞血不归经，且肝肺俱热热迫血行也。前用诸药之止血、养阴、泻火而不愈者，乃活血之力不足耳。治从活血降逆，泻火止血。处方：射干10克，黄芩10克，降香10克，茜草10克，元参15克，冬虫夏草10克。
服药1剂，咳血停止。但仍咳吐黄厚浊痰，脉弦涩不调，以血府逐瘀汤加冬瓜子等为方，两月而愈。
2．肝郁化火，瘀血阻滞，血不归经，疏肝泻火，活血止血始效。
甄××，女，40岁。
大量咳血，时发时止7～8年。医诊支气管扩张。每次咯血虽用西药可以暂时止血，但不久又出现咯血，西医为此数次建议手术治疗，然终因患者拒绝手术而作罢。于是改请中医以止咳化痰，凉血止血之剂治之，前后治疗3年仍然时作时止。近一年多来，多则一月，少则一周，必然咯血1次，尤甚是近两周以来，几乎天天咯血。乃邀余诊治。诊察之时，恰遇咯血正作，一分钟内即咳吐鲜血半痰盂，并见其胸满胸痛，气短乏力，面色萎黄，脉弦。综合脉证，诊为肝郁化火，瘀血阻滞，血不归经。急拟疏肝泻火，活血止血。处方：柴胡10克，白芍10克，茜草10克，降香10克，黄芩10克，郁金10克，枳壳3克，元参20克。
急煎1剂，服药40分钟后，咯血停止。继服40剂，追访20年未见复发。
某医云：前医用止血之剂不效，师用活血之剂收功；前医用凉血降逆而无功，师用升提之药反效，其故何也?答曰：本证脉弦而偏沉，乃郁证也，郁者非疏达而不解，此即《内经》火郁发之之意也，本证之用柴胡、枳壳、黄芩、白芍者，意在解郁泻火，郁解火除血自归经也。又理气之品配用血分之药亦可解血中之郁，散血分之郁火。故气滞、血滞郁而化火者，恒以柴胡以解之。
肺炎
1．凉燥犯肺，不予辛温，反予清热解毒，寒邪闭郁，内饮因生，久治不愈
黎××，女，成。
咳嗽胸满一个多月。医诊肺炎。始用抗生素等治疗无效，后又配合辛凉解表、清热解毒，宣肺止咳之中药治疗20多天仍无效果。细审其证，除咳嗽，胸满胸痛，疲乏无力，口鼻发干而不渴外，并见其体温37．7cc，舌苔薄白，脉沉缓稍弦。因思病发于秋季，且见脉沉缓而弦，且久用寒凉之剂不效。必秋燥凉邪犯肺，肺气不宣，寒饮内生，且兼气郁所致也。因拟辛润化痰，理气止咳。处方：紫苏10克，陈皮10克，枳壳10克，前胡10克，半夏10克，葛根15克，木香10克，甘草6克，桔梗10克，茯苓10克，紫菀10克。
服药2剂，咳嗽即减，继服10剂诸证消失。x线拍片复查：心肺膈正常。
某医云：何用麻杏石甘汤不效，而用非消炎药却有效呢?
答云：肺炎虽肺热者较多，但寒饮阻肺者亦有之。本证脉、证均符合寒、郁、饮证之合邪所致，故用辛温、化饮、理气合法而愈。
2.气阴俱虚，痰热内郁，不去养阴益气，但予清热解毒，其病不愈
郑××，男，50岁。
咳嗽发热2个多月。某院诊为肺炎。始予青霉素、氨苄青霉素、先锋霉素等治疗1个多月，发热，咳嗽气短明显改善，但在1个月以后，以上症状不再继续减轻，多次胸部拍片阴影一直不见缩小，又请某医以养阴清热，化痰止咳之中药配合治之，10剂后，诸证亦不见减。细审其证，除咳嗽吐痰之外，并见疲乏无力，午后热甚，纳呆食减，舌苔薄白，脉虚大弦滑而涩。综合脉证，思之：脉虚大者，气阴俱虚也；弦者，肝也，木火凌金也；滑者痰也，涩者，滞也，寒也。合之于症，综而论之，乃气阴俱虚，痰热蕴肺，木郁化火，阳气不化之证耳。治宜补气养阴以培本，化痰清热，理气温阳以治标。处方：黄芪15克，地骨皮10克，秦艽10克，紫菀10克，党参10克，茯苓10克，柴胡10克，半夏10克，知母10克，生地10克，麦冬10克，桂枝10克，甘草10克，桔梗10克，桑皮10克。
服药6剂后，诸证消失，继服3剂，胸部x线片阴影消失。
某医问：既然本病是肺炎，那么应用抗生素与中药清热解毒剂就应该炎症消失，但其为何不效呢?答曰：炎症应用消炎药治疗本应证消而愈，但本证却长期不效，此必正气不足所致耳，正虚者为什么应用养阴而不愈，此乃挟气虚为患耳，故后以补气养阴以扶正，化痰清热，理气通阳而愈。
3．寒饮阻肺，枢机不利，不予化饮，反予清热，以寒治寒，病情反剧
支××，女，35岁。
某位医生问道：为什么使用止咳的药物没有治愈，反而使用木防己汤却治愈了呢？回答说：脉象沉紧，胸脘痞满，咳嗽气喘的病症，是由于膈间支饮（停留在胸膈之间的水饮邪气）所致。寒性水饮结聚在膈间，如果不通过行水利尿、消散结滞之气的方法，病证是不会解除的。之前仅仅使用化痰药物，未能帮助阳气进行斡旋和升降运动；现在使用木防己汤，取其苦味和辛味药物配合，行水饮、散结气，以消除心下（胃脘部）的痞塞坚硬感，石膏与人参一清一补，扶助正气、祛除邪气，再辅助半夏、陈皮、紫菀、葶苈子来化痰、降肺气、止咳嗽，这样不仅水饮得以去除，咳嗽也能停止。
1．不分时令，不辨阴阳，将热证误作寒证，将燥证误作饮证，导致病情难以痊愈
患者张××，女性，40岁。
二十多年来，每到夏季暑热之时，就会出现咳嗽、气喘、打喷嚏、鼻喉发痒的症状，到了秋季、冬季则自然缓解。为此曾反复住院治疗。医生诊断为支气管哮喘。虽然用遍了各种药物效果不明显，采用脱敏疗法数次也均告失败。今年入夏以来，病情尤为严重，经常昼夜连续不断地咳嗽气喘、打喷嚏，饮食和睡眠几乎完全废弛，体重由60千克降至42.5千克。观察其形体消瘦，面色苍白中透出嫩红，咳嗽不止，喉中有喘鸣声，不能平卧，食欲极差，只是微微喜欢喝水，舌苔光净，脉象虚而稍数。再看之前医生所用的药物，有中药也有西药，西药除了激素外，大多为止咳、祛痰、平喘及抗感染药物，中药多为化痰定喘、温肺化饮、清热化痰、活血祛瘀等，然而效果都不显著。再思考其喘息有明显的季节性，夏季发作是因为体内伏藏阴气而肺有热，冬季发作是因为体内伏藏阳气而肺有寒。此病发于夏季，必定是肺热且燥。此病治疗无效的原因，恐怕在于将燥证误认为寒证或饮证，过用辛热、苦燥的药物损伤了肺阴，致使燥金更燥。又想到张仲景《金匮要略》中说：“膈上有痰饮，导致胀满、气喘、咳嗽、呕吐，发作时伴有寒热、背痛腰痛、流泪、身体震颤跳动剧烈，这必定是有伏饮。”这种病到特定年月复发，必定兼有伏饮。综合论述，必定是肺燥兼有饮邪为病。因此拟定养阴润肺、化痰止咳的方剂。处方：沙参10克，麦冬10克，紫菀10克，半夏10克，桑白皮10克，甘草10克，百部15克，竹叶10克，炙枇杷叶10克。
服用1剂后，咳嗽气喘大幅减轻，并能稍微进食，继续服用10剂，症状全部消失。为了彻底痊愈，此后每年夏季服用30剂，连续服用3年，果然痊愈。
白清佐先生说：夏季的喘息不同于冬季的喘息，冬季的治疗必须重用温药，夏季的喘息则需养阴润燥方可。
2．气阴两虚，痰饮内郁，不扶助正气，只化解痰饮，病情难以痊愈
患者赵××，女性，58岁。
从3岁开始，每当气候冷热改变、季节时令转换，或者稍微闻到异味、接触某些物品、吃鱼虾螃蟹等食物时，就会打喷嚏、流涕、流泪，并出现连续不断的咳嗽气喘。其后随着年龄增长曾一度好转，但到50岁左右时咳嗽气喘又加重，尤其是今年以来，几乎每天都咳嗽、气喘，不过有时轻有时重而已。最近3个月来，病情更加严重，虽然每天打针、吃药，中西药都用，就是不见效。有时用药稍有不对即病情加重。观察其咳嗽气喘、气短，喉中有如水鸡叫声，精神疲乏无力，口燥咽干，舌苔黄白，脉象虚大弦紧而数。想到张仲景《金匮要略》论虚劳首重脉象，说：“脉象弦而大，弦则表示阳气减损，大则表示中空如芤，减损则为寒，中空则为虚，虚寒相搏，这叫革脉，妇女会出现半产漏下，男子会出现亡血失精。”本病虽不是虚劳，但其脉象却是虚劳精血大伤、虚寒相搏的脉象，证实乃是气阴大伤、寒饮内伏的证候。之前用的方子或小青龙汤、定喘汤、苏子降气汤、射干麻黄汤等加减无效，是因为没有扶助正气。因此拟定补阴益气、化痰止咳的方剂：黄芪15克，地骨皮10克，紫菀10克，党参10克，茯苓10克，柴胡10克，半夏10克，知母10克，生地10克，白芍10克，麦冬10克，肉桂10克，甘草10克。
处方刚开完，有位医生说：既然说是寒饮，应当用温药，为何方中大量使用知母、地骨皮来清肺热呢？回答说：弦紧是寒脉，自然应当用温药，这就是加入肉桂的用意。然而不仅见到弦紧，还见到数象，数是热的表现，而且之前已询问到痰难咯出、口干舌燥，也有热象，寒饮郁久化热，所以寒热并用。又问：方中使用柴胡是为什么呢？柴胡是肝胆经药物，用于肺疾，道理难以理解？回答说：张仲景《金匮要略》说：“所谓治未病，看到肝病，知道肝会传脾，应当先充实脾脏，四季脾旺不受邪，就不必补；中等水平的医生不懂相传规律，看到肝病，不先实脾，只治肝。肝病，补用酸味，助用焦苦味，益用甘味药调理。酸入肝，焦苦入心，甘入脾。脾能制肾，肾气微弱，则水不行；水不行，则心火气盛；心火气盛，则伤肺，肺被伤，则金气不行；金气不行，则肝气盛。所以充实脾脏，则肝自愈。这是治肝补脾的要妙之处。肝虚则用此法，肝实则不在用之。”本证明显是肺虚之证，肺虚则心火来克制，肝木反侮肺金，所以用柴胡、白芍来调理肝脏，麦冬滋养肺阴而泻心火。
服用4剂，诸证俱减，继服20剂，咳嗽气喘全失。于是将以上药物研末，炼蜜和丸，一日3次，一次9克。服药一年，果然痊愈。
患者晁××，女性，10岁。
1周岁时，因感冒咳嗽，医生给予青霉素治疗，用药后不到1分钟即发现全身出疹奇痒，咳嗽气喘，身热，医生急用激素治疗，岂不知病情更加严重，不得不停药，其后虽然自然缓解，但却留下了喘息哮鸣经常发作。近10个月来喘息哮鸣不止，胸部高耸，眼球突出，喉中哮鸣音不止。西药很多都因过敏而不敢采用。中药宣肺定喘、化痰定喘、补肾纳气、养阴益气遍试无功。审察其证：口唇面颊均轻度发绀，喘息哮鸣、气短，消瘦神疲，舌苔黄白，脉弦滑虚数。综合脉证，说：虚数之脉乃是气阴两虚之证；滑数之脉乃是痰热之证，此证综合而论，可谓气阴两虚，痰热阻肺，所以治疗宜用补气养阴、化痰清热之剂。有位医生说：我已经用这种方法很久了，然而始终未见其效，而且我所用的方子也是先生曾经介绍的方子，为什么不效呢？回答说：此证还有肝郁化火的原因，请再询问其症状可知。询问之后，除上述症状外，果然还有头晕心烦、胸胁满痛之苦。医生又问：先生如何知道必有肝证？回答说：脉弦，所以知道。因此拟定疏肝理气、养阴益气、化痰清热的方剂。处方：柴胡6克，当归6克，白芍6克，麦冬6克，党参6克，五味子6克，半夏10克，陈皮6克，青皮6克，黄芩6克，紫菀6克，丝瓜络6克。
服用3剂，诸证果减，继服20剂，诸证消失。其后亦偶有反复，然而多以此方而见效，痊愈。
4．不审病因，不察病机，胶着于定喘，拘泥于补肾，久久不愈
患者潘××，女性，48岁。
支气管哮喘时轻时重十几年，近3年来，因工作不顺利，又加家中被盗2次，而病情更加严重。曾先用西药治疗1年多不效，后配中药宣肺定喘、化饮止咳、补肾纳气等近1年亦不见好转，为此数年来只能端坐扶枕而睡片刻。近3个月来，又因肺炎而病情更加严重，为此除严重的呼吸困难外，并见寒热、呕吐、心烦心悸、胸中憋闷如窒塞感。经查心电图为左束支传导阻滞。为此某院以抗生素治疗1周，药后虽然寒热好转，但却出现严重的头晕耳鸣、恶心呕吐、四肢麻木、不敢睁眼。为此不得不停用西药，改为单纯中药治之。细审其证，咳嗽气喘、气短，说话、呼吸、吃饭均感气短不能接续，口唇紫黯，胸满胸痛，心烦心悸，恶心呕吐，头晕不敢睁眼，亦不敢抬头，纳呆食减，手足憋胀麻木，时烦易哭，舌苔黄厚而腻，脉沉。综合脉证思之：肺虚者当脉浮大，今反见沉，必为郁证为主也。因此拟定疏肝化痰、宣肺降气的方剂。处方：柴胡10克，白芍10克，枳壳10克，半夏10克，陈皮10克，青皮10克，苏叶6克，郁金10克，瓜蒌15克，桔梗10克，杏仁10克。
有位医生说：如此重证的喘息，竟然不治喘，我不理解？回答说：脉沉者，是郁证，郁不解，肺气更逆，现在之所以解郁，是解开其壅塞之气。之前用的诸方不效，是因为没有调理肝脏。
服用6剂，咳嗽气喘、胸满、心烦、恶心呕吐均减，继服20剂，诸证减其六七。再察脉证，脉由沉转虚弦。思之：郁稍解而正虚耳。因此拟定扶正祛邪同施的方剂。处方：川芎10克，当归10克，白芍10克，麦冬10克，党参10克，五味子10克，半夏10克，陈皮10克，青皮10克，黄芩10克，丝瓜络10克。
服用20剂，喘咳停止，头晕、胸满、恶心均大减。于是以原方为丸，缓缓服之，2年后，诸证消失，痊愈。
患者说：如此之重疾，如今得痊愈，真是辨证论治的功效。
患者石××，男性，52岁。
大口咯血反复发作5年多。医生诊断为支气管扩张。每次发病，一用西药即很快好转。但近1年来，咯血日渐加重，尤其是近3个月来，发作更加频繁。此次发病虽用西药治疗3天，配合中药咳血方、清热解毒汤加减2剂仍无效。审察其咯血正作，瞬间即咯血半痰盂多，并见其面色黄而微青，胸满胸痛，舌苔薄白，脉弦数而涩。综合思考，说：面色黄而微青即是张仲景所说的“晕黄”，脉弦数而涩者是瘀血兼热，合之于证论述，证乃瘀血阻滞、血不归经，且肝肺俱热、热迫血行也。之前用的诸药止血、养阴、泻火而不愈，是因为活血之力不足。治疗从活血降逆、泻火止血入手。处方：射干10克，黄芩10克，降香10克，茜草10克，玄参15克，冬虫夏草10克。
服用1剂，咳血停止。但仍咳吐黄厚浊痰，脉弦涩不调，以血府逐瘀汤加冬瓜子等为方，两月而愈。
患者甄××，女性，40岁。
大量咳血，时发时止7～8年。医生诊断为支气管扩张。每次咯血虽用西药可以暂时止血，但不久又出现咯血，西医为此数次建议手术治疗，然终因患者拒绝手术而作罢。于是改请中医以止咳化痰、凉血止血之剂治之，前后治疗3年仍然时作时止。近一年多来，多则一月，少则一周，必然咯血1次，尤甚是近两周以来，几乎天天咯血。于是邀请我诊治。诊察之时，恰遇咯血正作，一分钟内即咳吐鲜血半痰盂，并见其胸满胸痛、气短乏力、面色萎黄、脉弦。综合脉证，诊为肝郁化火、瘀血阻滞、血不归经。急拟疏肝泻火、活血止血。处方：柴胡10克，白芍10克，茜草10克，降香10克，黄芩10克，郁金10克，枳壳3克，玄参20克。
急煎1剂，服药40分钟后，咯血停止。继服40剂，追访20年未见复发。
有位医生说：前医用止血之剂不效，老师用活血之剂收功；前医用凉血降逆而无功，老师用升提之药反效，其原因何在？回答说：本证脉弦而偏沉，是郁证，郁者非疏达而不解，这就是《内经》“火郁发之”的意思，本证之用柴胡、枳壳、黄芩、白芍，意在解郁泻火，郁解火除血自归经也。又理气之品配用血分之药亦可解血中之郁，散血分之郁火。故气滞、血滞郁而化火者，恒以柴胡以解之。
1．凉燥犯肺，不予辛温，反予清热解毒，寒邪闭郁，内饮因生，久治不愈
患者黎××，女性，成年。
咳嗽胸满一个多月。医生诊断为肺炎。始用抗生素等治疗无效，后又配合辛凉解表、清热解毒、宣肺止咳之中药治疗20多天仍无效果。细审其证，除咳嗽、胸满胸痛、疲乏无力、口鼻发干而不渴外，并见其体温37.7℃，舌苔薄白，脉沉缓稍弦。因思病发于秋季，且见脉沉缓而弦，且久用寒凉之剂不效，必是秋燥凉邪犯肺，肺气不宣，寒饮内生，且兼气郁所致也。因此拟定辛润化痰、理气止咳的方剂。处方：紫苏10克，陈皮10克，枳壳10克，前胡10克，半夏10克，葛根15克，木香10克，甘草6克，桔梗10克，茯苓10克，紫菀10克。
服用2剂，咳嗽即减，继服10剂诸证消失。X线拍片复查：心肺膈正常。
有位医生说：为什么用麻杏石甘汤不效，而用非消炎药却有效呢？
回答说：肺炎虽肺热者较多，但寒饮阻肺者亦有之。本证脉、证均符合寒、郁、饮证之合邪所致，故用辛温、化饮、理气合法而愈。
2．气阴俱虚，痰热内郁，不去养阴益气，但予清热解毒，其病不愈
患者郑××，男性，50岁。
咳嗽发热2个多月。某院诊断为肺炎。始予青霉素、氨苄青霉素、先锋霉素等治疗1个多月，发热、咳嗽气短明显改善，但在1个月以后，以上症状不再继续减轻，多次胸部拍片阴影一直不见缩小，又请某医以养阴清热、化痰止咳之中药配合治之，10剂后，诸证亦不见减。细审其证，除咳嗽吐痰之外，并见疲乏无力、午后热甚、纳呆食减、舌苔薄白、脉虚大弦滑而涩。综合脉证，思之：脉虚大者，气阴俱虚也；弦者，肝也，木火凌金也；滑者痰也，涩者，滞也，寒也。合之于症，综而论之，乃气阴俱虚，痰热蕴肺，木郁化火，阳气不化之证耳。治宜补气养阴以培本，化痰清热，理气温阳以治标。处方：黄芪15克，地骨皮10克，秦艽10克，紫菀10克，党参10克，茯苓10克，柴胡10克，半夏10克，知母10克，生地10克，麦冬10克，桂枝10克，甘草10克，桔梗10克，桑白皮10克。
服用6剂后，诸证消失，继服3剂，胸部X线片阴影消失。
某医问：既然本病是肺炎，那么应用抗生素与中药清热解毒剂就应该炎症消失，但其为何不效呢？回答说：炎症应用消炎药治疗本应证消而愈，但本证却长期不效，此必正气不足所致耳，正虚者为什么应用养阴而不愈，此乃挟气虚为患耳，故后以补气养阴以扶正，化痰清热，理气通阳而愈。
3．寒饮阻肺，枢机不利，不予化饮，反予清热，以寒治寒，病情反剧
患者支××，女性，35岁。
A physician asked: "Why did the use of antitussive agents fail to cure, while Mufangji Tang (Cocculus Decoction) succeeded?" The answer was: "With a pulse that is deep and tight, epigastric fullness, cough, and wheezing, the disease is caused by Zhiyin (branching fluid retention in the chest and diaphragm). Cold-fluid retention gathered in the inter-diaphragmatic region cannot be resolved without promoting water metabolism and dispersing stagnated Qi. Previously, only phlegm-resolving herbs were used, which failed to assist the Yang Qi in its dynamic rotation and ascending-descending movement. Now, using Mufangji Tang (Cocculus Decoction), we utilize its bitter and acrid properties to promote water metabolism and disperse stagnation, thereby eliminating the hardness and fullness below the heart (epigastrium). Shigao (Gypsum Fibrosum) and Renshen (Codonopsis Radix or Ginseng Radix) provide one tonifying and one clearing action to support the healthy Qi and expel pathogenic factors. Additionally, Banxia (Pinelliae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Ziwan (Asterae Radix), and Tinglizi (Lepidii Fructus) are added to resolve phlegm, descend Lung Qi, and stop coughing. Thus, not only is the fluid retention eliminated, but the coughing also ceases."
Bronchial Asthma
1. Ignoring seasonal variations, failing to distinguish Yin and Yang, mistaking heat for cold and dryness for fluid retention leads to refractory conditions.
Patient Zhang XX, female, 40 years old.
For over 20 years, every summer during the hot weather, she experienced coughing, wheezing, sneezing, and itching in the nose and throat, with natural relief in autumn and winter. She had been repeatedly hospitalized for this. The diagnosis was bronchial asthma. Although various medications were tried with little effect, desensitization therapy was also attempted several times without success. Since entering summer this year, the condition has worsened significantly, with continuous day-and-night coughing, wheezing, and sneezing. Appetite and sleep have nearly ceased, causing her weight to drop from 60 kg to 42.5 kg. Examination revealed a emaciated body, a pale complexion with a tender red hue, incessant coughing, audible wheezing in the throat, inability to lie flat, very poor appetite, slight preference for drinking water, a clean tongue coating, and a deficient and slightly rapid pulse. Reviewing previous medications, both Chinese and Western, Western drugs included hormones, antitussives, expectorants, anti-asthmatics, and antibiotics; Chinese medicines focused on resolving phlegm, calming asthma, warming the lungs to transform fluids, clearing heat, resolving phlegm, activating blood, and removing stasis. However, none showed significant efficacy. Considering the clear seasonality of the wheezing—summer attacks due to latent Yin and Lung heat, winter attacks due to latent Yang and Lung cold—the summer onset indicates Lung heat and dryness. The failure of treatment likely stems from mistaking dryness for cold or fluid retention, leading to the excessive use of acrid-warm and bitter-dry substances that damaged Lung Yin, exacerbating the dryness. Recalling Zhang Zhongjing’s *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet): "Phlegm-fluid above the diaphragm causes fullness, wheezing, cough, and vomiting; upon attack, there are chills and fever, back and waist pain, tearing, and severe trembling/shaking of the body; this must involve latent fluid retention." Recurrent attacks at specific times imply latent fluid retention. Synthesizing these, the pathology is Lung dryness combined with fluid retention. Therefore, a formula to nourish Yin, moisten the lungs, resolve phlegm, and stop coughing was prescribed: Shashen (Glehniae Radix) 10g, Maidong (Ophiopogonis Tuber) 10g, Ziwan (Asterae Radix) 10g, Banxia (Pinelliae Rhizoma) 10g, Sangpiao (Mori Cortex) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Baibu (Stemonae Radix) 15g, Zhuye (Bambusae Folium) 10g, Zhi Paye (Eriobotryae Folium Praeparatum cum Melle) 10g.
After one dose, coughing and wheezing decreased significantly, and food intake improved slightly. After continuing for 10 doses, symptoms disappeared completely. To ensure a complete cure, she took 30 doses every summer for three consecutive years, resulting in a cure.
Mr. Bai Qingzuo stated: Summer asthma differs from winter asthma. Winter asthma requires warm herbs, whereas summer asthma requires nourishing Yin and moistening dryness.
2. Deficiency of both Qi and Yin with internal fluid retention; failing to support the healthy Qi while only resolving fluid retention makes recovery difficult.
Patient Zhao XX, female, 58 years old.
Since age three, whenever climate changed, seasons shifted, or she encountered odors, certain items, or ate fish, shrimp, or crab, she would sneeze, run a nose, tear, and experience continuous coughing and wheezing. Symptoms improved somewhat with age but worsened again around age 50. This year, daily coughing and wheezing occurred, varying in severity. In the last three months, the condition deteriorated further despite daily injections and medications (both Chinese and Western) with no improvement; incorrect medication even exacerbated it. Signs included coughing, wheezing, shortness of breath, a sound like a water frog in the throat, fatigue, dry mouth and throat, yellow-white tongue coating, and a large, string-tight, and rapid deficient pulse. Recalling Zhang Zhongjing’s discussion on Xu Lao (Consumptive Disease) in *Jin Gui Yao Lue*, which emphasizes pulse diagnosis: "A pulse that is string-like and large... string-like indicates reduction [cold], large indicates hollow [deficiency]... deficiency and cold combining is called Ge Pulse... women suffer miscarriage and bleeding, men suffer loss of blood and essence." Although this case is not Xu Lao, the pulse reflects severe injury to Jing and Blood, with deficiency-cold combining, confirming a pattern of severe Qi and Yin injury with latent cold-fluid retention. Previous formulas like Xiao Qinglong Tang (Minor Green Dragon Decoction), Ding Chuan Tang (Calming Wheezing Decoction), Suzi Jiangqi Tang (Perilla Fruit Descending Qi Decoction), or Shegan Mahuang Tang (Belamcanda and Ephedra Decoction) failed because they did not support the healthy Qi. A formula to tonify Yin, boost Qi, resolve phlegm, and stop coughing was prescribed: Huangqi (Astragali Radix) 15g, Digupi (Lycii Cortex) 10g, Ziwan (Asterae Radix) 10g, Dangshen (Codonopsis Radix) 10g, Fuling (Poria) 10g, Chaihu (Bupleuri Radix) 10g, Banxia (Pinelliae Rhizoma) 10g, Zhimu (Anemarrhenae Rhizoma) 10g, Shengdi (Rehmanniae Radix) 10g, Baishao (Paeoniae Radix Alba) 10g, Maidong (Ophiopogonis Tuber) 10g, Rougui (Cinnamomi Cortex) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g.
Just after prescribing, a physician asked: "If it is cold-fluid, warm herbs should be used. Why use large amounts of Zhimu (Anemarrhenae Rhizoma) and Digupi (Lycii Cortex) to clear Lung heat?" I replied: "String-tight is a cold pulse, so warm herbs are appropriate; this is why Rougui (Cinnamomi Cortex) was added. However, besides string-tight, there is a rapid quality, indicating heat. Also, previously noted difficulty expectorating phlegm and dry mouth/tongue indicate heat. Cold-fluid retained for a long time transforms into heat, hence the combination of cold and warm herbs." Asked why Chaihu (Bupleuri Radix) was used since it is a Liver/Gallbladder herb for Lung disease, I replied: "Zhang Zhongjing’s *Jin Gui Yao Lue* states: 'Treating disease before it arises means seeing Liver disease, knowing it transmits to Spleen, and first strengthening the Spleen... Liver disease is treated by sour tonification, bitter assistance, and sweet regulation... Spleen controls Kidney water; if Kidney water is weak, it does not flow; if water does not flow, Heart Fire flourishes; if Heart Fire flourishes, it injures Lung Metal; if Lung Metal is injured, Metal Qi fails; if Metal Qi fails, Liver Wood flourishes. Thus, strengthening the Spleen heals the Liver.' This case is clearly Lung deficiency. Lung deficiency allows Heart Fire to overcome, and Liver Wood to insult Lung Metal. Therefore, Chaihu (Bupleuri Radix) and Baishao (Paeoniae Radix Alba) regulate the Liver, while Maidong (Ophiopogonis Tuber) nourishes Lung Yin and clears Heart Fire."
After four doses, all symptoms decreased. After 20 more doses, coughing and wheezing ceased. The herbs were powdered, mixed with honey into pills, taken three times daily, 9 grams each time. After one year of medication, a cure was achieved.
3. Liver Wood fails to course freely, Wood-Fire insults Metal; treating only the Lung without addressing the root yields no long-term effect.
Patient Chao XX, female, 10 years old.
At one year old, due to a cold and cough, Penicillin was administered. Within less than a minute, generalized rash with intense itching, coughing, wheezing, and fever appeared. Hormones were urgently given, worsening the condition, necessitating discontinuation. Although symptoms naturally subsided, recurrent wheezing remained. For the past ten months, wheezing has been constant, with a high chest, protruding eyes, and continuous wheezing sounds. Many Western drugs were avoided due to allergies. Chinese treatments including diffusing Lung to calm asthma, resolving phlegm, tonifying Kidney to grasp Qi, and nourishing Yin/Qi were ineffective. Signs included mild cyanosis of lips/cheeks, wheezing with shortness of breath, emaciation, fatigue, yellow-white tongue coating, and a string-slippery, deficient-rapid pulse. Synthesis: Deficient-rapid pulse indicates Qi and Yin deficiency; slippery-rapid pulse indicates Phlegm-Heat. The overall pattern is Qi and Yin deficiency with Phlegm-Heat obstructing the Lung. Treatment should tonify Qi, nourish Yin, resolve phlegm, and clear heat. A physician commented: "I have used this method for a long time with no effect, using formulas you introduced. Why?" I replied: "This case also involves Liver Stagnation transforming into Fire. Please inquire further." Further inquiry revealed dizziness, irritability, and fullness/pain in the chest and hypochondrium. Asked how I knew of Liver involvement, I said: "The string-like pulse indicates it." A formula to soothe the Liver, regulate Qi, nourish Yin, boost Qi, resolve phlegm, and clear heat was prescribed: Chaihu (Bupleuri Radix) 6g, Danggui (Angelicae Sinensis Radix) 6g, Baishao (Paeoniae Radix Alba) 6g, Maidong (Ophiopogonis Tuber) 6g, Dangshen (Codonopsis Radix) 6g, Wuweizi (Schisandrae Fructus) 6g, Banxia (Pinelliae Rhizoma) 10g, Chenpi (Citri Reticulatae Pericarpium) 6g, Qingpi (Citri Reticulatae Pericarpium Viride) 6g, Huangqin (Scutellariae Radix) 6g, Ziwan (Asterae Radix) 6g, Sigualuo (Luffae Caulis) 6g.
After three doses, symptoms decreased. After 20 more doses, symptoms disappeared. Occasional relapses occurred later but responded well to this formula, leading to a cure.
4. Failing to examine etiology and pathogenesis, sticking rigidly to asthma-calming and Kidney-tonifying methods leads to chronic non-resolution.
Patient Pan XX, female, 48 years old.
Bronchial asthma fluctuated for over ten years. In the last three years, due to work stress and two home burglaries, the condition worsened. Over a year of Western medicine failed, followed by nearly a year of Chinese medicine (diffusing Lung, resolving fluid, tonifying Kidney) with no improvement. For years, she could only sleep sitting up leaning on pillows. Recently, pneumonia worsened the condition, causing severe dyspnea, chills/fever, vomiting, irritability, palpitations, and chest oppression. ECG showed left bundle branch block. One week of antibiotics improved chills/fever but caused severe dizziness, tinnitus, nausea/vomiting, limb numbness, and photophobia. Western medicine was stopped for pure Chinese herbal treatment. Signs included coughing/wheezing with shortness of breath (interrupted speech/breathing/eating), purplish-dark lips, chest fullness/pain, irritability, palpitations, nausea/vomiting, dizziness (unable to open eyes or lift head), anorexia, limb distension/numbness, emotional lability, thick greasy yellow-white tongue coating, and a deep pulse. Analysis: Lung deficiency typically presents with a floating-large pulse; a deep pulse here suggests Stagnation as the primary factor. A formula to soothe the Liver, resolve phlegm, diffuse the Lung, and direct Qi downward was prescribed: Chaihu (Bupleuri Radix) 10g, Baishao (Paeoniae Radix Alba) 10g, Zhike (Aurantii Fructus Immaturus) 10g, Banxia (Pinelliae Rhizoma) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Qingpi (Citri Reticulatae Pericarpium Viride) 10g, Zhusu Ye (Perillae Folium) 6g, Yujin (Curcumae Longae Radix) 10g, Gualou (Trichosanthis Fructus) 15g, Jiegeng (Platycodonis Radix) 10g, Xingren (Armeniacae Semen Amarum) 10g.
A physician asked: "In such severe asthma, why not treat the asthma directly?" I replied: "A deep pulse indicates Stagnation. If Stagnation is not resolved, Lung Qi rebels further. Resolving Stagnation here means unblocking obstructed Qi. Previous failures were due to neglecting the Liver."
After six doses, coughing/wheezing, chest fullness, irritability, and nausea/vomiting decreased. After 20 more doses, symptoms reduced by 60-70%. Pulse changed from deep to deficient-string-tight. Analysis: Stagnation slightly resolved, revealing healthy Qi deficiency. A strategy supporting healthy Qi while expelling pathogens was adopted: Chuanxiong (Ligustici Chuanxiong Rhizoma) 10g, Danggui (Angelicae Sinensis Radix) 10g, Baishao (Paeoniae Radix Alba) 10g, Maidong (Ophiopogonis Tuber) 10g, Dangshen (Codonopsis Radix) 10g, Wuweizi (Schisandrae Fructus) 10g, Banxia (Pinelliae Rhizoma) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Qingpi (Citri Reticulatae Pericarpium Viride) 10g, Huangqin (Scutellariae Radix) 10g, Sigualuo (Luffae Caulis) 10g.
After 20 doses, wheezing/coughing stopped, and dizziness/chest fullness/nausea greatly decreased. The original formula was made into pills for slow administration. Two years later, all symptoms disappeared, achieving a cure.
The patient remarked: "Such a severe illness cured now is truly the merit of Syndrome Differentiation and Treatment."
Bronchiectasis
1. Blood stasis obstruction, blood not returning to its vessels; merely stopping bleeding fails to control hemorrhage.
Patient Shi XX, male, 52 years old.
Repeated episodes of massive hemoptysis for over 5 years. Diagnosed with bronchiectasis. Western medicine provided quick relief initially. However, in the last year, hemoptysis worsened, becoming frequent in the last three months. This episode, despite 3 days of Western medicine and 2 doses of modified Kexue Fang (Hemoptysis Formula) and Qingre Jiedu Tang (Clear Heat Detoxify Decoction), was ineffective. During active hemoptysis, half a bedpan of blood was expectorated instantly. Signs included a sallow complexion with slight blueness, chest fullness/pain, thin white tongue coating, and a string-rapid and choppy pulse. Analysis: Sallow with blueness corresponds to Zhang Zhongjing’s description of "dun huang" (sallow/dim yellow); string-rapid-choppy pulse indicates Blood stasis with heat. The pattern is Blood stasis obstructing vessels, blood not returning to normal flow, with Liver and Lung Heat forcing blood movement. Previous hemostatic, Yin-nourishing, and fire-clearing herbs failed due to insufficient blood-activating power. Treatment focused on activating blood, directing Qi downward, clearing heat, and stopping bleeding. Prescription: Shegan (Belamcandae Rhizoma) 10g, Huangqin (Scutellariae Radix) 10g, Jiangxiang (Dalbergiae Odoriferae Lignum) 10g, Qiancao (Rubiae Cordifoliae Radix) 10g, Yuan Shen (Scrophulariae Radix) 15g, Dongchong Xiacao (Cordyceps) 10g.
After one dose, hemoptysis stopped. However, yellow thick turbid phlegm continued, with a string-choppy irregular pulse. Xuefu Zhuyu Tang (Drive Out Stasis in the Mansion of Blood Decoction) plus Dongguazi (Benincasae Semen) was prescribed, resulting in a cure within two months.
2. Liver Stagnation transforming into Fire, Blood stasis obstruction, blood not returning to vessels; soothing the Liver, clearing Fire, activating blood, and stopping bleeding yields efficacy.
Patient Zhen XX, female, 40 years old.
Massive hemoptysis, intermittent for 7-8 years. Diagnosed with bronchiectasis. Western medicine temporarily stopped bleeding, but recurrence was common. Surgery was suggested multiple times but refused. Chinese medicine (calming cough, resolving phlegm, cooling blood, stopping bleeding) was tried for 3 years with intermittent results. In the past year, bleeding occurred weekly or monthly. Recently, almost daily hemoptysis for two weeks prompted consultation. At examination, active hemoptysis occurred within a minute, expectorating half a bedpan of fresh blood. Signs included chest fullness/pain, shortness of breath, fatigue, sallow complexion, and string-like pulse. Diagnosis: Liver Stagnation transforming into Fire, Blood stasis obstruction, blood not returning to vessels. Urgent prescription: Soothe Liver, clear Fire, activate blood, stop bleeding. Formula: Chaihu (Bupleuri Radix) 10g, Baishao (Paeoniae Radix Alba) 10g, Qiancao (Rubiae Cordifoliae Radix) 10g, Jiangxiang (Dalbergiae Odoriferae Lignum) 10g, Huangqin (Scutellariae Radix) 10g, Yujin (Curcumae Longae Radix) 10g, Zhike (Aurantii Fructus Immaturus) 3g, Yuan Shen (Scrophulariae Radix) 20g.
One dose decocted urgently; bleeding stopped 40 minutes after ingestion. After 40 more doses, follow-up over 20 years showed no recurrence.
A physician asked: "Previous doctors failed with hemostatics but succeeded with blood-activators; previous doctors failed with blood-cooling/depressants but succeeded with lifting herbs. Why?" I replied: "The string-like, slightly deep pulse indicates Stagnation. Stagnation requires dispersion to resolve, following the *Nei Jing* principle 'Fire stagnation requires emission.' Chaihu (Bupleuri Radix), Zhike (Aurantii Fructus Immaturus), Huangqin (Scutellariae Radix), and Baishao (Paeoniae Radix Alba) aim to resolve Stagnation and clear Fire; once Stagnation resolves and Fire is removed, blood returns to its vessels. Qi-regulating herbs paired with Blood-level herbs can also resolve Blood Stagnation and dissipate Blood-level Fire-Stagnation. Thus, for Qi/Blood stagnation transforming into Fire, Chaihu (Bupleuri Radix) is often used to resolve it."
Pneumonia
1. Cool-Dryness invading the Lung; failing to use acrid-warm herbs, instead using heat-clearing/detoxifying herbs, leads to Cold pathogen closure, internal fluid generation, and chronic non-resolution.
Patient Li XX, female, adult.
Cough and chest fullness for over a month. Diagnosed with pneumonia. Antibiotics were ineffective. Subsequent treatment with acrid-cool diaphoretics, heat-clearing/detoxifying, and Lung-diffusing/antitussive Chinese herbs for over 20 days also failed. Detailed signs: cough, chest fullness/pain, fatigue, dry mouth/nose without thirst, temperature 37.7°C, thin white tongue coating, and deep-slow slightly string-like pulse. Given autumn onset, deep-slow-string-like pulse, and ineffectiveness of cold herbs, the cause is Autumn Cool-Dryness invading the Lung, Lung Qi failing to diffuse, internal Cold-Fluid generation, and accompanying Qi Stagnation. A formula for acrid-moistening phlegm resolution and Qi-regulating cough cessation was prescribed: Zisu Ye (Perillae Folium) 10g, Chenpi (Citri Reticulatae Pericarpium) 10g, Zhike (Aurantii Fructus Immaturus) 10g, Qianhu (Peucedani Radix) 10g, Banxia (Pinelliae Rhizoma) 10g, Gegen (Puerariae Lobatae Radix) 15g, Muxiang (Aucklandiae Radix) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Jiegeng (Platycodonis Radix) 10g, Fuling (Poria) 10g, Ziwan (Asterae Radix) 10g.
After two doses, cough decreased. After 10 more doses, all symptoms disappeared. Chest X-ray复查: Heart, lungs, and diaphragm normal.
A physician asked: "Why did Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) fail while non-anti-inflammatory herbs succeeded?" I replied: "While many pneumonias involve Lung Heat, some involve Cold-Fluid obstructing the Lung. This case’s pulse and signs matched a combination of Cold, Stagnation, and Fluid. Thus, acrid-warm, fluid-resolving, and Qi-regulating methods led to a cure."
2. Deficiency of both Qi and Yin with internal Phlegm-Heat Stagnation; failing to nourish Yin and boost Qi, instead only using heat-clearing/detoxifying herbs, prevents cure.
Patient Zheng XX, male, 50 years old.
Cough and fever for over 2 months. Diagnosed with pneumonia. Treated with Penicillin, Ampicillin, Cephalosporins for over a month. Fever and cough/shortness of breath improved significantly, but after one month, symptoms plateaued, and chest X-ray shadows did not shrink. Chinese medicine (Yin-nourishing, heat-clearing, phlegm-resolving, antitussive) for 10 doses showed no improvement. Signs: cough with phlegm, fatigue, worse afternoon fever, anorexia, thin white tongue coating, and large-deficient string-slippery-choppy pulse. Analysis: Large-deficient pulse indicates Qi and Yin deficiency; String indicates Liver, Wood-Fire insulting Metal; Slippery indicates Phlegm; Choppy indicates Stagnation/Cold. Overall pattern: Qi and Yin deficiency, Phlegm-Heat accumulating in Lung, Liver Stagnation transforming into Fire, Yang Qi failing to transform. Treatment: Tonify Qi and nourish Yin to root the body; resolve phlegm, clear heat, regulate Qi, and warm Yang to treat symptoms. Prescription: Huangqi (Astragali Radix) 15g, Digupi (Lycii Cortex) 10g, Qinjiao (Gentianae Macrophyllae Radix) 10g, Ziwan (Asterae Radix) 10g, Dangshen (Codonopsis Radix) 10g, Fuling (Poria) 10g, Chaihu (Bupleuri Radix) 10g, Banxia (Pinelliae Rhizoma) 10g, Zhimu (Anemarrhenae Rhizoma) 10g, Shengdi (Rehmanniae Radix) 10g, Maidong (Ophiopogonis Tuber) 10g, Guizhi (Cinnamomi Ramulus) 10g, Gancao (Glycyrrhizae Radix et Rhizoma) 10g, Jiegeng (Platycodonis Radix) 10g, Sangpiao (Mori Cortex) 10g.
After six doses, symptoms disappeared. After three more doses, chest X-ray shadows vanished.
A physician asked: "Since it is pneumonia, antibiotics and heat-clearing/detoxifying Chinese herbs should eliminate inflammation, why did they fail?" I replied: "Anti-inflammatories should resolve signs, but chronic failure here indicates insufficient Healthy Qi. Why didn't Yin-nourishing work? Because it was complicated by Qi deficiency. Thus, tonifying Qi and nourishing Yin supported the Healthy Qi, while resolving phlegm, clearing heat, regulating Qi, and unblocking Yang led to a cure."
3. Cold-Fluid obstructing the Lung, pivot mechanism unfavorable; failing to resolve fluid, instead using heat-clearing, treating Cold with Cold worsens the condition.
Patient Zhi XX, female, 35 years old.