咳嗽多浮,聚胃关肺。沉紧小危,浮濡易治。
咳嗽不一,强半为风寒痰饮,风寒则伤于皮毛。(宜汗解,如麻黄汤、参苏饮之类。)痰饮
则停于胸胃。(宜二陈汤、仲景小青龙汤、拔萃半夏温肺汤之类。)皮毛者,肺之合也,邪袭其合,肺
气应之,故上逆而为咳。胃居肺下,寒痰冷冻饮料,停滞于中,上射于肺,肺气迎之,
故亦上逆而为咳。经云∶形寒饮冷则伤肺。(痰饮寒浊之气,上熏于肺,肺不清净,咳嗽从生。)形寒
固伤于外,而冷冻饮料寒痰,则皆聚于胃也。肺居最上,皮毛最表,故脉多浮耳。沉紧
小危者,沉则邪入里,紧则寒不散,小则正气衰,均主病危。若浮而濡,浮则在表,濡受邪轻,故云易治。
麻黄汤(见第十六)
参苏饮 治痰积中脘,晕眩嘈杂,怔忡哕逆,或痰停关节,手足 曳,口眼 斜,
半身不遂,呕吐恶心,头疼发热,及感冒风邪,鼻塞、憎寒、咳嗽等证。
人参 紫苏叶 前胡 半夏(制) 葛根(各一钱) 茯苓 枳壳 桔梗 陈皮(各八分)
木香(磨,四分)
加葱白、生姜煎服。
二陈汤(见第十六)
仲景小青龙汤(见第十六)
拔萃半夏温肺汤 治心腹中脘痰水冷气,心下汪洋嘈杂。常多涎唾,口中清水自出,
胁肋急胀痛,不欲食。此胃气虚冷所致。其脉沉弦细迟。
旋复花 人参 细辛 桂心 甘草 陈皮 桔梗 芍药 半夏(制,各半两) 赤茯苓(七钱半)
上 咀。每服四钱。生姜三片,水煎。食后服。
咳嗽的脉象多呈浮象,病机关键在于痰饮聚于胃、邪气关乎肺。脉象若见沉、紧、小则预示病情危重;若见浮、濡则易于治疗。
咳嗽病因多样,其中大半由风寒和痰饮引起。若是风寒之邪,则损伤皮毛。(适宜采用发汗解表法治疗,如使用麻黄汤、参苏饮等方剂。)若是痰饮之邪,则停滞在胸膈和胃脘。(适宜使用二陈汤、张仲景的小青龙汤、拔萃半夏温肺汤等方剂。)皮毛是肺的外合部位,外邪侵袭其合部,肺气随之感应失调,因此气机上逆而引发咳嗽。胃位于肺之下,寒性的痰饮或冷冻饮料停滞在中焦,向上熏射于肺,肺气与之相迎拒,因此也导致气机上逆而引发咳嗽。《内经》说:形体受寒、饮食生冷会损伤肺脏。(这是因为痰饮寒浊之气上熏于肺,使肺失清肃洁净,从而产生咳嗽。)形体受寒固然伤及体表,而冷冻饮料形成的寒痰,则都聚集于胃中。肺位居人体最上部,皮毛位于最表层,所以脉象多表现为浮象。脉象沉、紧、小之所以主危,是因为沉表示邪气入里,紧表示寒邪未散,小表示正气衰败,这些都主病势危重。如果脉象浮而濡,浮表示病邪在表,濡表示受邪轻微,所以说容易治疗。
麻黄汤(参见第十六章)
参苏饮 治疗痰积停留在中脘,出现头晕目眩、胃中嘈杂、心悸怔忡、呃逆,或者痰停于关节,导致手足牵引拘急、口眼歪斜、半身不遂,以及呕吐恶心、头痛发热,还有感冒风邪引起的鼻塞、恶寒、咳嗽等症状。
人参、紫苏叶、前胡、半夏(制)、葛根(各一钱),茯苓、枳壳、桔梗、陈皮(各八分),木香(磨汁,四分)。
加入葱白、生姜煎煮后服用。
二陈汤(参见第十六章)
张仲景小青龙汤(参见第十六章)
拔萃半夏温肺汤 治疗心腹及中脘部位的痰水冷气,心下感觉汪洋般嘈杂。经常流涎唾,口中清水自出,胁肋部紧急胀痛,不想进食。这是由胃气虚冷所致。其脉象表现为沉、弦、细、迟。
旋复花、人参、细辛、桂心、甘草、陈皮、桔梗、芍药、半夏(制,各半两),赤茯苓(七钱半)。
将药材切碎。每次服用四钱。加生姜三片,用水煎煮。饭后服用。
Coughing pulses are mostly floating; the pathology centers on phlegm-fluids gathering in the Stomach and the pathogen affecting the Lung. Pulses that are deep, tight, or small indicate a critical condition, whereas those that are floating and soggy are easy to treat.
Causes of coughing vary, but more than half are due to Wind-Cold and Phlegm-Fluids. If caused by Wind-Cold, it injures the skin and hair (Treatment should induce sweating to resolve the exterior, such as using Mahuang Tang [Ephedra Decoction] or Shensu Yin [Ginseng and Perilla Leaf Drink].). If caused by Phlegm-Fluids, they stagnate in the chest and epigastrium (Treatment should employ Erchen Tang [Two-Chen Decoction], Zhang Zhongjing's Xiao Qinglong Tang [Minor Blue Dragon Decoction], or Bcui Banxia Wenfei Tang [Extracts Extracting Pinellia Warming Lung Decoction].). The skin and hair are the external correspondence of the Lung; when pathogens invade this correspondence, the Lung Qi responds accordingly, leading to rebellious upward flow and causing cough. The Stomach is located below the Lung; cold phlegm and frozen drinks stagnate in the middle jiao and shoot upward to the Lung. When Lung Qi meets this rebellion, it also leads to upward reversal and causes cough. The Classics state: "Coldness of the form and cold drinks injure the Lung." (This is because the turbid qi of cold phlegm and fluids steams upward to the Lung, making the Lung impure and unclean, from which cough arises.) Coldness of the form certainly injures the exterior, while frozen drinks forming cold phlegm all gather in the Stomach. The Lung resides at the highest position, and the skin and hair are at the most superficial level; therefore, the pulse is mostly floating. A pulse that is deep, tight, and small indicates danger because deep signifies the pathogen has entered the interior, tight signifies cold has not dispersed, and small signifies the righteous qi is depleted; all these indicate a critical illness. If the pulse is floating and soggy, floating indicates the pathogen is in the exterior, and soggy indicates the pathogenic invasion is mild; thus, it is said to be easy to treat.
Mahuang Tang (See Chapter 16)
Shensu Yin Treats phlegm accumulation in the Zhongwan (CV12), dizziness, gastric discomfort, palpitations, hiccups, or phlegm stagnation in the joints causing limb dragging, facial paralysis (deviation of mouth and eye), hemiplegia, vomiting, nausea, headache, fever, as well as symptoms of Wind-Cold invasion such as nasal congestion, aversion to cold, and cough.
Renshen (Ginseng Radix et Rhizoma), Zisuye (Perillae Folium), Qianhu (Peucedani Radix), Banxia (Pinelliae Rhizoma Preparatum), Gegen (Puerariae Lobatae Radix) (each 1 qian); Fuling (Poria), Zhike (Aurantii Fructus Immaturus), Jiegeng (Platycodonis Radix), Chenpi (Citri Reticulatae Pericarpium) (each 8 fen); Muxiang (Aucklandiae Radix) (ground, 4 fen).
Add Congbai (Allii Fistulosi Bulbus) and Shengjiang (Zingiberis Rhizoma Recens), decoct with water, and take orally.
Erchen Tang (See Chapter 16)
Zhang Zhongjing's Xiao Qinglong Tang (See Chapter 16)
Bcui Banxia Wenfei Tang Treats cold-phlegm and cold qi in the heart, abdomen, and Zhongvan, with a sensation of fluid-like discomfort in the epigastrium. Frequent salivation and drooling, spontaneous flow of clear water from the mouth, urgent distending pain in the hypochondrium, and loss of appetite. This is caused by deficiency-cold of the Stomach Qi. The pulse is deep, wiry, fine, and slow.
Xuanfuhua (Inulae Flos), Renshen (Ginseng Radix et Rhizoma), Xixin (Asari Radix et Rhizoma), Guixin (Cinnamomi Ramulus), Gancao (Glycyrrhizae Radix et Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Jiegeng (Platycodonis Radix), Shaoyao (Paeoniae Radix), Banxia (Pinelliae Rhizoma Preparatum) (each 0.5 liang); Chifuling (Poria cum Ligno Rubrum) (7.5 qian).
Coarsely crush the herbs. Take 4 qian per dose. Add 3 slices of Shengjiang (Zingiberis Rhizoma Recens), decoct with water, and take after meals.