(治法与前咳嗽门可参看)
干咳日久用滋阴,内热无痰最害人。四物汤堪为主剂,再加知柏及元参。灯心甘草和诸
药,桔梗天花火用芩。茯苓贝母消痰用,天麦款桑润燥增。血见丹皮北沙苑,肺伤白芨参
吞。酸收诃味泻桑壳,辛散姜防用有灵。面红吐血火炎上,童便藕汁效如神。
喘病之因,在肺为实,在肾为虚
肺最清高无窒塞,一有邪干便喘急。内因痰火外风寒,六脉浮洪更有力。是为实症五虎
汤,半辛甘石及麻黄。桑皮杏壳姜葱益,随症加减无成方。若有痰升痰喘症,茯苓香附南星
石。乍进乍退名火喘,麦冬苏味栀芩益。食因作喘食积因,曲芽腹实查同进。大便燥结不能
通,苏子元明大黄胜。何者乃为正气虚,过劳则发似邪欺。吸入气知脉无力,补中益气汤堪
施。黄芩山栀兼火用,茯苓半夏挟痰宜。
肺郁水气不降
麻黄 苡仁 杏仁 甘草 干姜 茯苓 人参 半夏 五味 葶苈 桑皮 川朴
猪苓 泽泻 木通 腹皮 小青龙汤去桂芍,加人参、杏仁,此彻饮以就太阳也。
乙肝升饮邪上逆
越婢汤 麻黄 石羔 甘草 生姜 大
枣旋复花汤
肾气不纳
熟地 阿胶 萸肉 茯苓 龟版 附子 怀膝 远志 五味 慈石 秋石 山药
黄 淡菜 胡桃 杞子 青盐 人参 白术 海参 芡实 莲子 青铅 蛤蚧 补骨
脂八味丸 生姜汁 车前 炙草
精伤者填以浓浓之剂兼镇摄
肾气丸加沉香,都气丸入青铅。
中气虚(此中虚气馁,土不生金也)
人参建中汤去姜
胃虚
黄精 茯苓 胡麻 甘草
肾阳虚浊阴上逆
人参 干姜 泽泻 附子 茯苓 猪苓
陈曰∶丹溪有外感之喘治肺,内伤之喘治肾。以肺主出气,肾主纳气耳。先喘而后胀治
肺,先胀而后喘治脾。肺宜辛则通,微苦则降,直入中下,非治肺之方法。
(治疗方法可参考前文咳嗽章节)
干咳日久需采用滋阴法,体内有热且无痰的情况最为伤人。四物汤可作为主方,再加知母、黄柏及玄参。灯心草、甘草调和诸药,桔梗、天花粉配合黄芩使用。茯苓、贝母用于消除痰湿,天冬、麦冬、款冬花、桑白皮增加润燥功效。血分有热用丹皮,北沙苑;肺脏受损用白及,人参吞服。酸收之品用诃子、五味子,泻肺用桑白皮;辛散之品用生姜、防风,运用得当则疗效灵验。面色发红、吐血、火气上炎者,童便和藕汁效果如神。
喘病的成因,在肺属于实证,在肾属于虚证。
肺脏位置清高,不容窒塞,一旦受到邪气干扰就会气喘急促。内因是痰火,外因是风寒,六脉浮洪且更加有力。这是实证,可用五虎汤,包含半夏、辛夷(注:原文“半”通常指半夏,此处结合语境及常见配伍,若指辛夷则需斟酌,但五虎汤经典组成多为麻黄、石膏、杏仁、苏子、甘草等,原文“半辛甘石”疑为笔误或特定流派用法,此处直译)、甘草、石膏及麻黄。加入桑白皮、杏仁壳、生姜、葱白有益,随症状加减,没有固定成方。如果有痰升引起的痰喘症,可用茯苓、香附、南星、石膏。忽进忽退称为火喘,加麦冬、苏叶、五味子、栀子、黄芩有益。因饮食积滞导致的喘,用神曲、麦芽,腹部胀实者加山楂同进。大便干燥结聚不能通畅,用苏子、元明粉、大黄效果好。什么是正气虚?过度劳累则发作,感觉像邪气欺压。吸气困难,脉象无力,补中益气汤可以使用。兼有火热用黄芩、山栀,挟带痰湿宜用茯苓、半夏。
肺气郁结,水气不降:
麻黄、苡仁、杏仁、甘草、干姜、茯苓、人参、半夏、五味子、葶苈子、桑白皮、川朴、猪苓、泽泻、木通、腹皮。小青龙汤去掉桂枝、芍药,加入人参、杏仁,这是为了彻底清除饮邪以顺应太阳经气。
肝气上升,饮邪上逆:
越婢汤、麻黄、石膏、甘草、生姜、大枣;旋复花汤。
肾气不纳:
熟地、阿胶、萸肉、茯苓、龟版、附子、怀膝、远志、五味子、慈石、秋石、山药、黄精、淡菜、胡桃、杞子、青盐、人参、白术、海参、芡实、莲子、青铅、蛤蚧、补骨脂、八味丸、生姜汁、车前子、炙甘草。
精气损伤者,用浓稠的药剂填补并兼用镇摄之法:
肾气丸加沉香,都气丸加入青铅。
陈氏说:丹溪认为外感引起的喘治疗肺,内伤引起的喘治疗肾。因为肺主管呼气,肾主管纳气。先喘后胀治疗肺,先胀后喘治疗脾。肺喜辛味则通畅,微苦味则下降,药力直达中下焦,这不是治疗肺的方法。
(The treatment methods can be referred to in the previous chapter on Cough.)
For chronic dry cough, Yin-nourishing methods should be used; internal heat with no phlegm is most harmful. Siwu Tang (Four Substances Decoction) can serve as the main formula, supplemented by Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), and Xuanshen (Scrophularia Root). Dengxincao (Juncus Effusus Pith) and Gancao (Licorice Root) harmonize the various herbs; Jiegeng (Platycodon Root), Tianhuafen (Trichosanthes Root), and Huangqin (Scutellaria Root) are used together. Fuling (Poria) and Beimu (Fritillaria Bulb) are employed to eliminate phlegm; Tandong (Asparagus Stem), Maidong (Ophiopogon Tuber), Kuandonghua (Farfara Flower), and Sangbaipi (Mulberry Bark) increase moistening effects. For heat in the blood, Danpi (Moutan Cortex) and Bei Shayuan (Astragalus Complanatus Seed) are used; for lung injury, Baiji (Bletilla Rhizome) and Renshen (Ginseng Root) taken orally are applied. Astringents include Hezi (Chebulic Myrobalan) and Wuweizi (Schisandra Fruit); for purging the lung, Sangbaipi (Mulberry Bark) is used; for dispersing acridly, Shengjiang (Fresh Ginger) and Fangfeng (Saposhnikovia Root) are used effectively when applied appropriately. For red face, hemoptysis, and flaming-up of fire, Tongbian (Child's Urine) and Ou Zhi (Lotus Rhizome Juice) are effective as if divine.
The etiology of Asthma (Chuan Bing): In the Lung, it is Excess; in the Kidney, it is Deficiency.
The Lung is the highest and purest organ, intolerant of obstruction; once disturbed by pathogens, asthma becomes urgent. Internally caused by Phlegm-Fire, externally by Wind-Cold, the six pulses are floating, surging, and more forceful. This is an Excess syndrome; Wuhu Tang (Five Tigers Decoction) can be used, containing Banxia (Pinellia Rhizome), Xin (possibly Xinyi or a typo for another herb, literal translation: Acrid), Gancao (Licorice Root), Shigao (Gypsum Fibrosum), and Mahuang (Ephedra Herb). Adding Sangbaipi (Mulberry Bark), Xingren (Apricot Kernel), Shengjiang (Fresh Ginger), and Congbai (Green Onion White) is beneficial; modifications should be made according to symptoms without fixed formulas. If there is Phlegm-Asthma characterized by rising phlegm, Fuling (Poria), Xiangfu (Cyperus Rhizome), Nanting (Arisaema Rhizome), and Shigao (Gypsum Fibrosum) are used. Sudden onset and retreat is called Fire-Asthma; adding Maidong (Ophiopogon Tuber), Suzye (Perilla Leaf), Wuweizi (Schisandra Fruit), Zhizi (Gardenia Fruit), and Huangqin (Scutellaria Root) is beneficial. Asthma caused by food stagnation uses Shenqu (Medicated Leaven) and Yiya (Sprouted Barley); if the abdomen is full and solid, Shanzha (Hawthorn Fruit) is added. For dry stool constipation unable to pass, Su Zi (Perilla Seed), Yuanmingfen (Mirabilite), and Dahuang (Rhubarb Root) are superior. What constitutes Righteous Qi Deficiency? It manifests after overexertion, feeling like pathogenic oppression. Difficulty inhaling and weak pulse indicate that Buzhong Yiqi Tang (Decoction to Tonify the Middle and Augment the Qi) can be applied. If accompanied by fire, Huangqin (Scutellaria Root) and Shanzhi (Gardenia Fruit) are used; if accompanied by phlegm, Fuling (Poria) and Banxia (Pinellia Rhizome) are suitable.
Lung Qi Stagnation with Water-Qi failing to descend:
Mahuang (Ephedra Herb), Yiren (Coix Seed), Xingren (Apricot Kernel), Gancao (Licorice Root), Ganjiang (Dried Ginger), Fuling (Poria), Renshen (Ginseng Root), Banxia (Pinellia Rhizome), Wuwei Zi (Schisandra Fruit), Tinglizi (Lepidium Seed), Sangbaipi (Mulberry Bark), Chuanpo (Magnolia Bark), Zhuling (Polyporus), Zexie (Alisma Rhizome), Mutong (Akebia Stem), Fupi (Tangerine Peel/Amomum Fruit depending on context, here likely Fu Ling Pi or similar diuretic agent), Xiao Qinglong Tang (Minor Blue Dragon Decoction) minus Guizhi (Cinnamon Twig) and Shaoyao (Peony Root), plus Renshen (Ginseng Root) and Xingren (Apricot Kernel). This thoroughly eliminates fluid retention to align with the Taiyang channel.
Liver Qi Rising with Fluid-Evil reversing upward:
Yuebi Tang (Major Yellow Beard Decoction) [Mahuang (Ephedra Herb), Shigao (Gypsum Fibrosum), Gancao (Licorice Root), Shengjiang (Fresh Ginger), Dazao (Jujube)]; Xuanfuhua Tang (Inula Flower Decoction).
Kidney Qi failing to grasp:
Shudi (Rehmannia Root), Ejiao (Donkey-Hide Gel), Yurou (Cornus Fruit), Fuling (Poria), Guiban (Tortoise Shell), Fuzi (Aconite Lateral Root), Huaixi (Dioscorea Hypoglauca Rhizome), Yuanzhi (Polygala Root), Wuweizi (Schisandra Fruit), Cishi (Magnetite), Qiushi (Sea Urine Salt), Shanyao (Dioscorea Rhizome), Huangjing (Polygonatum Rhizome), Dancai (Edible Mussel), Hetao (Walnut Kernel), Qizi (Goji Berry), Qingyan (Rock Salt), Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Haishen (Sea Cucumber), Qianshi (Euryale Seed), Lianzi (Lotus Seed), Qingqian (Lead Carbonate), Gejie (Gecko), Buguzhi (Psoralea Fruit), Bawei Wan (Eight-Ingredient Pill), Shengjiang Zhi (Fresh Ginger Juice), Cheqian (Plantago Seed), Zhigancao (Honey-fried Licorice Root).
For Essence damage, fill with thick/nourishing agents and combine with calming/subduing methods:
Shenqi Wan (Kidney Qi Pill) plus Chenxiang (Aquilaria Wood); Duqi Wan (Duqi Pill) plus Qingqian (Lead Carbonate).
Middle Qi Deficiency (This is middle deficiency leading to spirit exhaustion, Earth failing to generate Metal):
Renshen Jianzhong Tang (Ginseng Building the Middle Decoction) minus Jiang (Ginger).
Stomach Deficiency:
Huangjing (Polygonatum Rhizome), Fuling (Poria), Huma (Sesame Seed), Gancao (Licorice Root).
Kidney Yang Deficiency with Turbid Yin reversing upward:
Renshen (Ginseng Root), Ganjiang (Dried Ginger), Zexie (Alisma Rhizome), Fuzi (Aconite Lateral Root), Fuling (Poria), Zhuling (Polyporus).
Mr. Chen said: Danxi held that asthma due to external pathogens treats the Lung, while asthma due to internal injury treats the Kidney. Since the Lung governs exhalation and the Kidney governs inhalation. Asthma preceding bloating treats the Lung; bloating preceding asthma treats the Spleen. The Lung benefits from Acrid flavors to promote circulation, and slightly Bitter flavors to promote descent. Directly entering the Middle and Lower Jiao is not the method for treating the Lung.