钱仲阳云∶肺主喘,实则闷乱喘促或饮水,虚则哽气、出气、短气。若肺盛复感风寒,则胸
满气急喘嗽,用泻白散。肺热则手掐眉目鼻面,用甘桔汤。肺虚热则唇色深红,少用泻白散
。肺怯则唇色白,用阿胶散。若闷乱气粗喘促哽气者,难治。肺病久唇白者,此脾肺子母皆
虚也,若白如猪脂者吉,白如枯骨者死。如肺病春见,肺胜肝也,用地黄丸补肝肾,泻白散
以治肺。目淡青必发惊,更有赤者当搐,为肝怯也。又张洁古云∶肺主燥,自病则喘嗽,燥
则润之。若心乘肺为贼邪,肝乘肺为微邪,肾乘肺为实邪,脾乘肺为虚邪。凡肺之得邪必先
观心脾二脏之虚实。若心火铄金,当抑心滋肺。若脾气虚冷不能相生,而肺气不足,则风邪
易感,宜补脾肺。若脾实中痞热气上蒸于肺,宜泻脾气。若心脾平和而肺自病,当察虚实治
之。窃谓∶肺经郁热,用泻白散;肺气自虚,用四君子汤;外邪所乘,用参苏饮;心火炎烁
,用人参平肺散;中焦实痞,用大承气;脾不能生肺,用异功散。夫肺气盛者,肺中之邪气
盛也,其脉右寸必浮而有力,宜用泻白散以泻之。若肺虚而有热者,执肺热伤肺之说,而不
用人参误矣,仍参某症治之。
泻白散 化痰止咳,宽气进食。
地骨皮 桑白皮(炒。各一两) 甘草(炙,一钱)
上为末,每服一二钱,入粳米百粒水煎。
愚按∶活人方云∶喘者,肺气盛而有余,然气盛当认作气衰,有余当认作不足。盖肺气盛者
,肺中之火盛也,有余者,肺中之邪有余也,其脉右寸必浮而有力,右颊色赤,用前药以泻
之。前症若乳母感冒风寒,肺经蕴热,致儿为患,用参苏饮。若乳母膏粱醇酒积热,致儿是
病,用清胃散。
甘桔汤 治风热上攻,咽喉疼痛,及喉痹妨闷。
苦梗(一两) 甘草(炒,二两)
上每服二钱,水煎。
阿胶散 治肺虚咳嗽喘急,或咳而哽气,喉中有声。
阿胶(一两,蛤粉炒) 鼠粘子(二钱五分,炒香) 甘草(一钱,炙) 马兜铃(半两,炒) 杏仁(七个去
皮尖) 糯米(一两)
上每服一二钱,水煎。
愚按∶前方乃直治肺金之剂。经云∶虚则补其母。若前药未应,当用五味异功散以补脾。
地黄丸(方见肾脏)
四君子汤(方见内钓)
参苏饮(方见诸热)
人参平肺散(方见咳嗽)
大承气汤(方见伤寒表里)
异功散
清胃散(二方见天钓、内钓)
钱仲阳说:肺主管气喘,实证表现为胸闷烦乱、呼吸急促甚至想喝水;虚证表现为咽喉间发出哽噎之气、呼气短促、气息不足。如果肺气过盛又感受风寒,就会出现胸部胀满、气急、咳嗽气喘,使用泻白散(Xiebai San, White Deficiency-Draining Decoction)。肺热则表现为患儿用手抓挠眉毛、眼睛、鼻子和面部,使用甘桔汤(Ganjie Tang, Licorice and Platycodon Decoction)。肺阴虚有热则嘴唇颜色深红,少量使用泻白散。肺气怯弱则嘴唇色白,使用阿胶散(Ejiao San, Donkey-Hide Gelatin Decoction)。如果出现胸闷烦乱、气粗、喘促、喉中哽气的症状,属于难治之症。肺病日久且嘴唇发白的,这是脾肺母子两脏皆虚的表现,若唇色白如猪脂则为吉兆,若白如枯骨则为死证。如果在春季出现肺病,说明肺金克制肝木(肺胜肝),应用地黄丸(Dihuang Wan, Rehmannia Pill)补益肝肾,并用泻白散治疗肺疾。若目色淡青必然会发生惊风,若有赤色则应当抽搐,这是因为肝气怯弱所致。另外张洁古说:肺主燥,肺自病则出现气喘咳嗽,燥邪当用润法治疗。如果心火乘袭肺金称为贼邪,肝木乘袭肺金称为微邪,肾水乘袭肺金称为实邪,脾土乘袭肺金称为虚邪。凡是肺受邪气侵袭,必须先观察心和脾两个脏腑的虚实情况。如果心火灼烧肺金,应当抑制心火并滋养肺阴。如果脾气虚弱寒冷不能相生,导致肺气不足,则容易感受风邪,适宜补益脾肺。如果脾实导致中焦痞塞、热气上蒸于肺,应当泻除脾实。如果心脾平和而肺自身发病,应当辨别虚实进行治疗。我认为:肺经郁热,使用泻白散;肺气自虚,使用四君子汤(Sijunzi Tang, Four Gentlemen Decoction);外邪侵袭,使用参苏饮(Shensu Yin, Ginseng and Perilla Drink);心火炎上灼伤肺金,使用人参平肺散(Renshen Pingfei San, Ginseng Lung-Calming Powder);中焦实痞,使用大承气汤(Da Chengqi Tang, Major Order the Qi Decoction);脾不能生肺,使用异功散(Yigong San, Extraordinary Merit Powder)。所谓肺气盛,是指肺中的邪气盛,其脉象右寸部必定浮而有力,适宜用泻白散来泻除邪气。如果是肺虚而有热,拘泥于“肺热伤肺”的说法而不用人参,就是错误的,仍应根据具体症状治疗。
泻白散:化痰止咳,宽胸顺气,增进食欲。
地骨皮(Digupi, Cortex Lycii)、桑白皮(炒)(Sangbaipi, Cortex Mori Radicis, stir-fried. Each 1 liang)、甘草(炙)(Gancao, Radix Glycyrrhizae, honey-fried. 1 qian)。
以上研为细末,每次服用一二钱,加入粳米(Jingmi, Oryzae Sativae Semen)一百粒,用水煎服。
我按语:《活人书》方中说:气喘,是肺气盛而有余,然而气盛应当认定为气衰,有余应当认定为不足。因为所谓的肺气盛,其实是肺中的火盛;所谓的有余,其实是肺中的邪气有余。其脉象右寸部必定浮而有力,右颊面色赤红,使用前药以泻除邪气。前述病症如果是因为乳母感冒风寒,导致肺经蕴藏热邪,从而致使婴儿患病,使用参苏饮。如果是因为乳母食用膏粱厚味及醇酒积热,导致婴儿患此病,使用清胃散(Qingwei San, Stomach-Clearing Powder)。
甘桔汤:治疗风热上攻引起的咽喉疼痛,以及喉痹导致的胸闷不适。
苦梗(Kujing, Radix Platycodonis. 1 liang)、甘草(炒)(Gancao, Radix Glycyrrhizae, stir-fried. 2 liang)。
以上每次服用二钱,用水煎服。
阿胶散:治疗肺虚引起的咳嗽气喘急促,或咳嗽伴喉中哽气,喉中有声音。
阿胶(艾胶,蛤粉炒)(Ejiao, Corium Asini, stir-fried with clam powder. 1 liang)、鼠粘子(炒香)(Shuniuzi, Fructus Arctii, stir-fried until fragrant. 2 qian 5 fen)、甘草(炙)(Gancao, Radix Glycyrrhizae, honey-fried. 1 qian)、马兜铃(Maodouling, Fructus Aristolochiae. Half liang, stir-fried)、杏仁(去皮尖)(Xingren, Semen Pruni Armeniacae, peel and remove tips. 7 pieces)、糯米(Nuomi, Oryzae Sativae Semen Glutinosis. 1 liang)。
以上每次服用一二钱,用水煎服。
我按语:前方是直接治疗肺金的方剂。《内经》说:虚证则补其母。如果前方无效,应当使用五味异功散(Wuwei Yigong San, Five-Ingredient Extraordinary Merit Powder)来补脾。
地黄丸(方见肾脏篇)
四君子汤(方见内钓篇)
参苏饮(方见诸热篇)
人参平肺散(方见咳嗽篇)
大承气汤(方见伤寒表里篇)
异功散
清胃散(二方见天钓、内钓篇)
Qian Zhongyang stated: The Lung governs asthma. In excess patterns, symptoms include chest fullness, restlessness, rapid breathing, or a desire to drink water; in deficiency patterns, symptoms include choking gasps, short exhalations, and shortness of breath. If Lung Qi is excessive and further complicated by Wind-Cold invasion, symptoms such as chest distension, urgency of breath, coughing, and wheezing occur; treat with Xiebai San (White Deficiency-Draining Decoction). Lung Heat manifests as the infant scratching the eyebrows, eyes, nose, and face; treat with Ganjie Tang (Licorice and Platycodon Decoction). Lung Yin deficiency with Heat presents with deep red lips; use a small dose of Xiebai San. Lung Qi timidity presents with white lips; treat with Ejiao San (Donkey-Hide Gelatin Decoction). If there is chest fullness, restlessness, coarse breathing, wheezing, and choking gasps, it is difficult to treat. For chronic Lung disease with white lips, this indicates a dual deficiency of the Spleen and Lung (mother and child organs). If the lip color is white like lard, it is auspicious; if white like dry bone, it is fatal. If Lung disease appears in Spring, it indicates Lung Metal overcoming Liver Wood; treat the Liver and Kidney with Dihuang Wan (Rehmannia Pill) and the Lung with Xiebai San. Pale cyan eyes indicate an inevitable onset of convulsions; if accompanied by redness, twitching will occur, due to Liver Qi timidity. Furthermore, Zhang Jiegu stated: The Lung governs Dryness. Self-disease of the Lung results in coughing and wheezing; Dryness should be treated with moistening methods. If Heart Fire invades the Lung, it is called "Thief Evil"; if Liver Wood invades the Lung, it is called "Minor Evil"; if Kidney Water invades the Lung, it is called "Excess Evil"; if Spleen Earth invades the Lung, it is called "Deficiency Evil". Whenever the Lung receives pathogenic factors, one must first observe the excess or deficiency of the Heart and Spleen. If Heart Fire scorches Lung Metal, suppress the Heart and nourish the Lung. If Spleen Qi is deficient and cold, failing to generate Lung Qi, leading to Lung Qi insufficiency, Wind pathogens are easily contracted; tonify the Spleen and Lung. If Spleen Excess causes middle-jiao stagnation and heat steams upward to the Lung, drain the Spleen Excess. If the Heart and Spleen are balanced but the Lung itself is diseased, investigate excess and deficiency to treat accordingly. I propose: For郁热 (depressed heat) in the Lung channel, use Xiebai San; for spontaneous Lung Qi deficiency, use Sijunzi Tang (Four Gentlemen Decoction); for external pathogen invasion, use Shensu Yin (Ginseng and Perilla Drink); for blazing Heart Fire scorching the Lung, use Renshen Pingfei San (Ginseng Lung-Calming Powder); for middle-jiao excess stagnation, use Da Chengqi Tang (Major Order the Qi Decoction); when the Spleen fails to generate the Lung, use Yigong San (Extraordinary Merit Powder). What is termed "Lung Qi Excess" refers to the abundance of pathogenic factors within the Lung; the pulse at the Right Cun position will necessarily be floating and forceful; treat with Xiebai San to drain it. If there is Lung deficiency with Heat, adhering strictly to the theory that "Lung Heat injures the Lung" and omitting Ren Shen (Ginseng) would be erroneous; instead, treat according to specific symptoms.
Xiebai San: Resolves phlegm, stops cough, relieves chest qi stagnation, and promotes appetite.
Digupi (Cortex Lycii), Sangbaipi (Cortex Mori Radicis, stir-fried. Each 1 liang), Gancao (Radix Glycyrrhizae, honey-fried. 1 qian).
Grind into powder. Take 1-2 qian per dose, add 100 grains of Jingmi (Oryzae Sativae Semen), and decoct with water.
My commentary: The formula from *Huoren Shu* states: Asthma is caused by Lung Qi being excessive and surplus. However, "Qi excess" should be recognized as Qi deficiency, and "surplus" should be recognized as insufficiency. This is because what is termed Lung Qi excess is actually an abundance of Fire in the Lung; what is termed surplus is actually an abundance of pathogenic factors in the Lung. The pulse at the Right Cun position will necessarily be floating and forceful, and the right cheek may appear red; use the aforementioned medicine to drain it. Regarding the aforementioned conditions, if they arise because the nursing mother has caught Wind-Cold, causing latent Heat in the Lung channel which affects the infant, use Shensu Yin. If they arise because the nursing mother's diet of rich foods and alcohol has generated accumulated Heat affecting the infant, use Qingwei San (Stomach-Clearing Powder).
Ganjie Tang: Treats wind-heat attacking upwards causing sore throat, and Hou Bi (throat obstruction) causing chest stuffiness.
Kujing (Radix Platycodonis. 1 liang), Gancao (Radix Glycyrrhizae, stir-fried. 2 liang).
Take 2 qian per dose, decoct with water.
Ejiao San: Treats cough and urgent wheezing due to Lung deficiency, or coughing with choking gasps and sounds in the throat.
Ejiao (Corium Asini, stir-fried with clam powder. 1 liang), Shuniuzi (Fructus Arctii, stir-fried until fragrant. 2 qian 5 fen), Gancao (Radix Glycyrrhizae, honey-fried. 1 qian), Maodouling (Fructus Aristolochiae. Half liang, stir-fried), Xingren (Semen Pruni Armeniacae, peeled and tips removed. 7 pieces), Nuomi (Oryzae Sativae Semen Glutinosis. 1 liang).
Take 1-2 qian per dose, decoct with water.
My commentary: The above formulas directly treat Lung Metal. The *Classic of Internal Medicine* states: "In deficiency, tonify its mother." If the above medicines do not yield results, use Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder) to tonify the Spleen.
Dihuang Wan (Formula see Kidney section)
Sijunzi Tang (Formula see Neidiao section)
Shensu Yin (Formula see Zhu Re section)
Renshen Pingfei San (Formula see Cough section)
Da Chengqi Tang (Formula see Shanghan Biao-Li section)
Yigong San
Qingwei San (Two formulas see Tiandiao, Neidiao sections)