咳者,謦咳,俗谓之嗽。肺主气,肺为邪所乘,气逆而不下也,故令咳嗽。有肺寒而咳者,有
停饮而咳者,有邪在半表半里而咳者,治各不同。其水咳三证,不可不辩,小青龙,太阳之表水也;
十枣汤,太阳之里水也;真武汤,水证之水气也。盖水与表寒相合而咳,则小青龙,当汗之。水与
里寒相合而咳,则真武汤,温之。里癖合水动肺而嗽,十枣汤,所以下之也。
太阳病,身热咳嗽,干呕,喘而利,小青龙汤。(有加减法。)恶寒身痛,只根据本方。身凉咳
嗽,干呕微利,心下痞满,引胁下痛,十枣汤。四肢痛重,腹痛下利,咳嗽,或呕,真武汤。(有
加减之法。)
少阳病,寒热往来,胸胁硬满而痛,咳嗽,小柴胡汤。(有加减之法。)
少阴咳嗽,四逆汤。腹痛下利,咳嗽,中满而呕,大半夏汤。
伤寒发喘,有邪在表者,有邪在里者,有水气者。在表者,心腹濡而不坚,外证无汗,法当汗
之。在里者,心腹胀满,外证有汗,法当下之。其水气者,心下怔忡,是以有青龙汤之证。或注喘,
汗出而喘,宜发之。虽然,喘特病之常也。其或直视谵语,汗出发润,身汗如油,皆不可治。
太阳病,无汗而喘,麻黄汤。
阳明病,汗出,不恶寒,短气腹满,潮热而喘,小承气汤。
太阳阳明合病,喘而胸满,不可下,宜麻黄汤。
误下太阳,利不止,脉促,有汗而喘,葛根麻黄黄芩汤;无汗而喘,麻黄杏仁甘草石膏汤。
水气喘咳,乃太阳汗后饮水多而水停心下,小青龙汤去麻黄,加杏仁;小腹痛者,去麻黄,加
茯苓。阴病喘促者,反阴丹。
咳嗽,是指有声无痰的“咳”,俗称“嗽”。肺主司气机,当肺受到邪气侵袭时,气机上逆而不能下行,从而导致咳嗽。其中,有因肺寒引起的咳嗽,有因水饮停聚引起的咳嗽,有因邪气处于半表半里位置引起的咳嗽,治疗方法各不相同。对于这三种由水饮导致的咳嗽证候,必须加以辨别:小青龙汤适用于太阳病表证兼有水气的情况;十枣汤适用于太阳病里证兼有水气的情况;真武汤适用于水气凌心犯肺的水气证。一般来说,若水邪与表寒相结合导致咳嗽,则使用小青龙汤,通过发汗的方法治疗;若水邪与里寒相结合导致咳嗽,则使用真武汤,通过温里的方法治疗;若里有癖积(积聚)与水饮互结,扰动肺气导致咳嗽,则使用十枣汤,通过攻下的方法治疗。
太阳病,表现为身体发热、咳嗽、干呕、气喘且伴有腹泻,适用小青龙汤。(该方有加减用法。)若仅见恶寒、身体疼痛,则依据本方主治。若身体凉爽但出现咳嗽、干呕及轻微腹泻,伴有心下痞塞胀满、牵引胁肋部疼痛,适用十枣汤。若四肢沉重疼痛、腹痛腹泻、咳嗽或呕吐,适用真武汤。(该方有加减用法。)
少阳病,表现为寒热往来、胸胁部硬满且疼痛、咳嗽,适用小柴胡汤。(该方有加减用法。)
少阴病咳嗽,适用四逆汤。若腹痛腹泻、咳嗽、中焦胀满且呕吐,适用大半夏汤。
伤寒病引发气喘,有的邪气在表,有的邪气在里,有的由水气引起。邪气在表的,心腹部柔软而不坚硬,外部症状为无汗,治法应当发汗。邪气在里的,心腹部胀满,外部症状为有汗,治法应当攻下。属于水气引起的,心下部悸动不安,因此会出现小青龙汤证的类似表现。或者注述气喘,出汗且气喘,适宜用发汗法宣散。虽然,气喘只是疾病的常见症状之一。但如果出现两眼直视、胡言乱语、出汗后头发湿润、全身大汗如油状,这些都是不可治愈的死证。
太阳病,无汗且气喘,适用麻黄汤。
阳明病,出汗、不恶寒、短气、腹部胀满、潮热且气喘,适用小承气汤。
太阳与阳明合病,气喘且胸部胀满,不可攻下,适宜用麻黄汤。
误用攻下法治疗太阳病,导致腹泻不止、脉象急促、有汗且气喘,适用葛根芩连汤(原文作葛根麻黄黄芩汤,疑为传抄错误或特定变方,此处依原文翻译);若无汗且气喘,适用麻黄杏仁甘草石膏汤。
水气引起的喘咳,是由于太阳病发汗后饮水过多,导致水饮停聚在心下,适用小青龙汤去掉麻黄,加入杏仁;若伴有小腹部疼痛,则去掉麻黄,加入茯苓。阴证气喘急促者,适用反阴丹。
Cough (Ke), specifically referring to "Qingke" (cough with sound but no phlegm), is commonly known as "Sou". The Lung governs Qi. When the Lung is invaded by pathogenic factors, Qi rebels and fails to descend, thereby causing cough. There are cases of cough due to Lung cold, cough due to retained fluid retention (Ting Yin), and cough due to pathogens located at the half-exterior and half-interior level; their treatments differ accordingly. These three types of cough caused by water-fluid must be distinguished: Xiao Qing Long Tang (Minor Green Dragon Decoction) addresses exterior water-fluid in Taiyang disease; Shi Zao Tang (Ten Jujube Date Decoction) addresses interior water-fluid in Taiyang disease; Zhen Wu Tang (True Warrior Decoction) addresses water-qi in water-fluid syndromes. Generally, when water-fluid combines with exterior cold to cause cough, Xiao Qing Long Tang is used to induce sweating. When water-fluid combines with interior cold to cause cough, Zhen Wu Tang is used to warm the interior. When interior accumulation (Pi Ji) combines with water-fluid to disturb the Lung and cause cough, Shi Zao Tang is used to purge downwards.
In Taiyang disease, presenting with fever, cough, dry retching, wheezing, and diarrhea, Xiao Qing Long Tang is indicated. (There are modification methods.) If there is only aversion to cold and body pain, follow the main formula. If the body is cool but cough, dry retching, and mild diarrhea occur, accompanied by epigastric fullness and obstruction, and pain radiating to the hypochondrium, Shi Zao Tang is indicated. If there is heaviness and pain in the four limbs, abdominal pain, diarrhea, cough, or vomiting, Zhen Wu Tang is indicated. (There are modification methods.)
In Shaoyang disease, presenting with alternating chills and fever, hardness and fullness with pain in the chest and hypochondrium, and cough, Xiao Chai Hu Tang (Minor Bupleurum Decoction) is indicated. (There are modification methods.)
For Shaoyin cough, Si Ni Tang (Frigid Extremities Decoction) is indicated. For abdominal pain, diarrhea, cough, middle-jiao fullness, and vomiting, Da Ban Xia Tang (Major Pinellia Decoction) is indicated.
Wheezing (Chuan) induced by Shang Han (Cold Damage) may result from pathogens in the exterior, pathogens in the interior, or water-qi. When pathogens are in the exterior, the heart and abdomen are soft and not hard, and the external symptom is absence of sweating; the treatment method should be to induce sweating. When pathogens are in the interior, the heart and abdomen are distended and full, and the external symptom is presence of sweating; the treatment method should be to purge downwards. In cases of water-qi, there is palpitation in the epigastrium, hence symptoms resembling those treated by Xiao Qing Long Tang appear. Or, regarding wheezing, if there is sweating and wheezing, it is appropriate to use dispersing methods. Although wheezing is merely a common symptom of disease, if one presents with fixed staring, delirious speech, sweating that wets the hair, or profuse sweating like oil, these are untreatable conditions.
In Taiyang disease, with absence of sweating and wheezing, Ma Huang Tang (Ephedra Decoction) is indicated.
In Yangming disease, with sweating, absence of aversion to cold, shortness of breath, abdominal fullness, tidal fever, and wheezing, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is indicated.
In combined Taiyang and Yangming disease, with wheezing and chest fullness, purging is contraindicated; Ma Huang Tang is appropriate.
If Taiyang disease is mistakenly purged, resulting in incessant diarrhea, rapid pulse, presence of sweating, and wheezing, Ge Gen Qin Lian Tang (Kudzu, Scutellaria, and Coptis Decoction; text reads Ge Gen Ma Huang Huang Qin Tang) is indicated; if there is absence of sweating and wheezing, Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) is indicated.
Water-qi causing wheezing and cough arises from drinking too much water after inducing sweat for Taiyang disease, leading to water retention in the epigastrium. Use Xiao Qing Long Tang removing Ma Huang and adding Xing Ren; if there is lower abdominal pain, remove Ma Huang and add Fu Ling. For wheezing and urgency in Yin diseases, Fan Yin Dan is indicated.