四诊：痰即有形之火，火即无形之痰。痰色渐和，血点渐少，知痰火暗消，大可望其病愈。不料悲伤于内，暑加于外，内外交迫，肺金又伤，伤则未尽之痰火，攻逆经络，右偏隐隐作疼，旁及左胁，上及子肩，似乎病势有加无已。细思此病，暑从外来，悲自内生，七情外感，萃于一身，不得不用分头而治之法，庶一举而两得焉。
桑皮 骨皮 知母 川贝 阿胶 枳壳 金针菜 姜黄 绿豆衣 藕汁 佛手
原注：痰带血点，鼻干口燥，小水不多，大便血沫，总属痰火为患。第一方用清金化痰不效。第二方案加咳血梦遗畏火三证，归于肝火，一派清肝，略加养胃。第三方从肺胃立方，略佐清肝之意。第四方全以轻淡之笔，消暑化痰。
诒按：统观前后四案，议病用药，均能层层熨贴，面面周到，于此道中自属老手。惟所长者，在乎周到稳实：而所短者，在乎空灵活泼，此则囿乎天分，非人力所能勉强矣。第一方就病敷衍，毫无思路。第二方清泄肝火，力量颇大。第三、四方则用药空灵不滞，是深得香岩师心法者。
邓评：至此须责重开痰通络，方内拟去阿胶，加旋覆花、橘络，则庶乎近矣。
孙评：统阅四案，肝火夹痰，横逆于络，肺受火荆，木郁不达，是其病根。所拟四方，柳氏谓其得叶氏心传者，适相背谬，姑从叶案备录一方，待政博雅：
金石斛、粉丹皮、杜苏子、蛤黛散、钩钩、生薏仁、苦杏仁、生白芍、枇杷叶、旋覆花、藕汁、冬瓜子。
咳嗽而见臭痰络血，或夜不得眠，或卧难着枕，大便干结，白苔满布，时轻时重，已病半年有余。所谓热在上焦者，因咳为肺痿是也。左寸脉数而小，正合脉数虚者为肺痿之训。而右关一部不惟数疾，而且独大独弦独滑，阳明胃经必有湿生痰，痰生热，熏蒸于肺，母病及子，不独肺金自病，此所进之药，所以始效而总不效也。夫肺病属虚，胃病属实。一身而兼此虚实两途之病，苟非按部就班，循循调治，必无向愈之期。
紫菀一钱 麦冬二钱 桑皮钱半 地骨皮钱半 阿胶一钱 薏仁五钱 忍冬藤一两 川贝钱半 蛤壳一两 橘红一钱 茯苓三饯 炙草三分
诒按：论病选药，俱极精到。此方亦从苇茎汤套出，可加芦根。
邓评：凡咳嗽，脉之弦滑见于右关者，必多痰湿浊邪壅聚于胃，热被湿遏，湿为热蒸。阅案中议论，亦极清正。惟方内胶、麦、地骨，似太遏邪；欲清胃热，不如易芦根、知母为善。
孙评：右关大弦数之胃脉，热遏于中，不得肃化。阿胶、生地滋阴补血，热得补而愈壅，宜去。 当从柳氏用苇茎汤加肃清之味。
再诊：诸恙向安，右脉亦缓。药能应手，何其速也。再守之，观其动静。
前方加水飞青黛三分
邓评：因寒遏而患其熏蒸之势，故药之应手甚速，然而病终不愈。
三诊：右关之大脉已除，弦滑未化，数之一字，与寸相同，湿热痰三者，尚有熏蒸之意，肺必难于自振。
邓评：右关仍见弦滑，是郁热又复熏蒸矣。
再加生地，愈觉背谬。
四诊：迭进张氏法，肺金熏蒸，日轻一日，金性渐刚，颇为佳兆。然须振作，以著本来之清肃乃可。
前方去薏米 加麻仁
邓评：夜来之咳，每由于厥阴肝火内动，是其肺胃之火有以乘之乎。蛤壳正宜参用，今何反去之。
六诊：肺虚则易招风，偶然咳嗽加剧，而今愈矣。脉数右寸空大，阴气必虚。自当养阴为主；然阳明胃经，湿热熏蒸之气，不能不兼理之。
七诊：右脉小中带数，肺阴不足，肺热有余；其所以致此者，仍由胃中之湿热熏蒸也。
前方加丝瓜络冬瓜仁苇茎
八诊：肺属金，金之母土也；胃土湿热未清，上焦肺部焉得不受其熏蒸，所谓母病及子也。肺用在右，右胸当咳作疼。未便徒补，必使其清肃乃可。 前方加薏仁杏仁 九诊：来示已悉。因思动则生火，火刑于金则咳逆，火入于营则吐血。此十七日以后之病，失于清化，以致毛窍又开，风邪又感，咳嗽大作，欲呕清痰，血络重伤也。事难逆料，信然，悬拟以复。
桑皮 地骨皮杏仁 甘草 淡芩 茅根 知母 川贝 苇茎 忍冬藤
又丸方；
大生地白芍丹皮泽泻沙参茯苓山药 麦冬 阿胶用忍冬藤十斤煮膏蜜丸
原注：此病道理，尽具于第一案中。先生平日所言，起手立定根脚，以下遂如破竹。大约此病，拈定胃火熏蒸四字，方中得力尤在忍冬藤一味。
邓评：不待咳止而遂立丸方，想缘诊次太多，聊以应酬世故耳。
宿积黑血，从吐而出。胸之痞塞少和，肺之咳嗽略减，是瘀血也。从上出者为逆，究非善状。
瘀热汤旋、降、葱、苇、枇叶。 参三七磨冲
诒按：可加酒炙大黄炭数分，研末冲服，以导血下行。
邓评：立方简洁老当，盖病归一路，用药亦宜精专耳。
再诊：所瘀之血，从下而行，尚属顺证。因势导之，原是一定章程。
诒按：仍宜加牛膝、三七等导下之品。
邓评：因何前方一味不用?是复诊时未带原方乎!
昨日所溢之血，盈盆成块而来，无怪乎其厥矣。幸得厥而即醒，夜半得寐，其气稍平。今日仍然上吐，脉来芤数，火升颧红，咳逆时作，大便不爽而黑。阳明胃腑必有伏热。防其再冒再厥。
诒按：此与下条皆木火亢盛，阴血沸腾之证。
邓评：此为阳明有蓄血伏热，盈盆成块而吐者立法。
久嗽失血，鲜而且多，脉数左弦，苔黄心嘈，金受火刑，木寡于畏，以致阳络被伤也，防冒。
另归脾丸
原注：吴鹤皋日：心、火也，肺、金也，火为金之畏，心移热于肺乃咳嗽，甚则吐血、面赤，名日贼邪。是方也，犀角能解心热，生地能凉心血，丹皮、芍药性寒而酸，寒则胜热，酸则入肝。用之者，以木能生火，故使二物入肝而泻肝，此拔本塞源之治。
邓评；此必阴虚成劳，为难治之症，或可以琼玉膏继之。至于另用归脾丸，则失之远矣。
孙评：凡血症之急者，总宜导之下达乃顺。古所云天下无倒行之水，人身无倒上之血，由乎气导之使下者，即是顺气也。
阳络频伤，胸前窒塞，咳逆不爽，舌红苔黄，脉形弦数。此系瘀血内阻，郁而为热，肺胃受伤，极易成损，慎之。
旋覆 猩降 葱管 芦根 枇杷叶 忍冬藤 苏子 桑皮 川贝 知母 广郁金 参三七 竹油 地骨皮
原注：前五味名瘀热汤，是先生自制之方。治瘀血内阻，化火刑金而咳，不去其瘀，病终不愈，此为先生独得之秘。
诒按：合二母泻白以清肺，佐苏、郁、三七以通痹，立方周到之至。
邓评：脉弦数而苔黄，当有风热郁恋。所用方药，亦非背谬。
脘胁痞结作痛，形寒如疟，苔浊不纳，渴欲热饮，神情惫乏。此血络凝泣，湿邪附之欲化热，而未能透出也。
邓评：病偏于痰湿闭遏，何不加薤白、芥子以辛通阳气。或曾患吐血，故知其血络凝泣；但既已形寒如疟，芦根似非所宜。
瘀血先阻于中，一经补味，胸中遂痞，紫黑之血从此而来。
瘀热汤加郁金汁
原注：此方大效。
诒按：再加三七磨冲更妙。
邓评：确系瘀血，并无别邪夹杂，宜其效若桴鼓也。
孙评：所云不去其瘀，病终不愈。若误补之，变生不测矣。此段柳批，用药切实可法，学者宜熟玩而记之。
虚 损 门
痧子之后，咳嗽四月，颈旁疬串，咳甚则呕，纳少形瘦，肤热脉细。想是余邪内恋，阴分大虚，欲成损证也。
诒按：方中玄参、牡蛎，为项疬而设，无此证者可减也。
邓评：咳甚则呕，内必多痰。方中之地，似宜酌用。
孙评：咳而肤热脉细，余邪内恋，热未清也，芎、归不宜。况痧后久咳，明明是余热留恋，入肺伤阴所致。
温邪发痧之后，咳嗽失血，血止而咳嗽不减，所吐之痰，或黄或白，或稠或稀，舌质深红，其苔满白，喉痒嗌干，脉弦带数，渐作痧劳之象。
原注：此痧后余邪，留恋营分，而成咳也。先生尝云：余自制两方，一为瘀热汤，一为此汤，尚未立名，以治痧后咳嗽极效。盖四物是血分引经之药，将温散化痰之品，纳入其中，引入营血中散邪清热，每用必灵。此可悟用四物之法。
孙评：热恋于营，已见咳血，则阴被劫而热内郁，当清热安营为治。若以芎、桂辛温上升，热愈甚而血益溢。今原注云每用必灵者，恐无是理。抑系夹冒寒邪，或得见效，是必先生之误认也。方中苏叶亦太温散，细考叶氏《温热论》自知。
咳嗽五月有余，黄昏为甚，肌肉暗削，肢体无力，容易伤风，或头胀，或溺黄。总由阴分下虚，浮火夹痰上扰所致。
四物桔梗汤四物加桔柏 加桑皮地骨皮川贝 知母 甘草 青黛 蛤壳 枇杷叶
原注：此方之眼，在咳嗽黄昏为甚。毕竟风邪陷入阴分为剧，余目睹效者甚多。
诒按：此四物合泻白，加二母、蛤、黛法也。
邓评：头胀一症，亦由风阳上浮所致，石决明或可参用。
孙评：伤风头胀，夹冒风寒，此方颇妙。
金能克木，木火太旺，反侮肺金，金藏尚受木克，则其吸取肾水，疏泄肾精，更属易易。此梦遗咳嗽之所由作也。
原注：此三才封髓丹加白芍、龙胆也。其人面必黑瘦，有一团阴火炽甚，克肺伤肾，用之极效。
诒按：此方以清泄肝火为主，竟不兼用肺药，所谓治病必求其本也。
邓评：论病透彻，用药切当。
古人于清阴火一门，每云知、柏苦寒伤脾败胃，多去而不用，况可加以胆草乎。
子后咳嗽，天明而缓，脉形弦数，声音不扬，肝胆之火未清，金受其刑，水必暗亏也。
诒按：此与前案，均属木火刑金之证。前方治肝而绝不及肺，想因咳势不甚，而下注遗泄之证却急，故用药如彼。此证则咳甚音低，肺金受损已深，故于清火之中，偏重补肺。观乎此，而临证用药之权衡可识矣。
此症似可偏治其肝，舍去补肺汤，增入蛤壳。盖欲保肺金，莫若沙参、玉竹、紫菀、旋覆之类。
咳嗽失血，音烁咽干，近来小有寒热，头痛喉疼；脉浮促而数。肺阴久伤，又兼燥气加临。补肺之中，当参以辛散。
邓评：知其兼受燥气外邪，金在头痛得之。
孙评：燥邪当用辛凉清之，辛散不宜。且补肺阿胶是补中兼疏，甘寒带辛，非辛散之法。
再诊：头痛咽疼已止，寒热亦轻，新受之燥邪渐得清散。无如金水两虚，失血久嗽，音烁嗌干等证，仍如损象。即使静养，犹恐不及。
原注：此病肺脏已损，再受燥邪，小有寒热，头痛咽疼，是其的据。先用补肺阿胶汤，以其中有牛蒡、杏仁，加桑叶、枇杷叶，去其燥邪外证，后用四阴煎加味，以图其本。
邓评：此久嗽音烁，亦得无客邪留于肺络否。
阳络频伤之后，咳嗽痰浓，内热嗌干，脉芤数，左关独弦。此肝火刑金，金气不清之候，容易成损。慎之。
四阴煎加二母 羚羊
另琼玉膏地、冬、参、蜜、沉香、珀。
原注：肝火刑金，于左关独弦见之，所以四阴更加羚羊。
邓评：惟形体未瘦者，尚可投此法而愈。
孙评：清肝火究不宜羚羊，当用决明、牡蛎之类。所云选药如选将，非量敌而行不克也。
失血后，咳嗽梦遗，脉数左关弦急。必有肝火在里，既犯肺金，又泄肾气也。久延势必成劳。
诒按；六味汤，想系转方增入者。但其中有萸肉之酸温，专补肝阳，尚宜酌用。
失血久咳，阴分必虚，虚则不耐热蒸，食西瓜而稍退，脉数左弦，唇干苔白色滞，溺黄，加以咽痛，久而不愈，想是水不涵木，阴火上冲，胃气不清也。势欲成劳，早为静养，以冀气不加喘，脉不加促，庶几可图。
生地 白芍 茯苓 泽泻 丹皮 花粉 元参 甘草 猪肤 青蒿露 枇杷叶露
邓评：苔白色滞，而断其为阴虚者，良以脉数左弦故也。盖一病须有一病之着眼处。
参以青蒿、枇杷露，不免有暑气内侵也。
【四诊】
痰就是“有形之火”，火就是“无形之痰”。痰的颜色逐渐调和，血点逐渐减少，可知痰火在暗中消退，大有希望痊愈。没想到患者内心悲伤，外部又受暑邪侵袭，内外交迫，肺金再次受伤。肺伤则未尽的痰火攻逆经络，导致右侧隐隐作痛，牵连左侧胁肋，向上波及肩井穴附近，似乎病情有增无减。仔细思考此病，暑邪从外而来，悲伤由内生发，七情内伤与外感邪气聚集于一身，不得不采用分头治疗的方法，才能一举两得。
方药：桑白皮、地骨皮、知母、川贝母、阿胶、枳壳、金针菜（黄花菜）、姜黄、绿豆衣、藕汁、佛手。
原注：痰中带血点，鼻干口燥，小便量少，大便带血沫，总归是痰火为患。第一张方子用清金化痰法无效。第二张方案增加了咳血、多梦遗精、畏热三证，归结为肝火，使用一派清肝药物，略微加入养胃之品。第三张方子从肺胃立论，略微辅助清肝之意。第四张方子完全运用轻灵清淡的手法，消暑化痰。
柳诒按：纵观前后四个医案，议病用药，都能层层贴合，面面俱到，在此道中自属老手。只是其长处在于周到稳实；短处在于空灵活泼不足，这则受限于天分，非人力所能勉强。第一张方子就病敷衍，毫无思路。第二张方子清泄肝火，力量颇大。第三、第四张方子则用药空灵不滞，是深得叶天士心法的。
邓评：到了这一步必须重在开痰通络，方中拟去掉阿胶，加入旋覆花、橘络，这样就差不多了。
孙评：统阅四个医案，肝火夹痰，横逆于经络，肺受火邪所伤，木郁不达，这是病根。所拟定的四方，柳先生称其得叶氏心传，恰好相反，姑且从叶氏医案中备录一方，以待博雅之士指正：
金石斛、粉丹皮、杜苏子、蛤黛散、钩藤、生薏苡仁、苦杏仁、生白芍、枇杷叶、旋覆花、藕汁、冬瓜子。
咳嗽且见臭痰和络脉出血，或者夜间无法入睡，或者躺下难以着枕，大便干结，舌苔满布白色，时轻时重，已患病半年有余。所谓“热在上焦者，因咳为肺痿”即是此意。左寸脉数而小，正符合脉数虚者为肺痿的训诫。而右关一部不仅数疾，而且独大、独弦、独滑，阳明胃经必定有湿生痰，痰生热，熏蒸于肺，母病及子，不仅肺金自病，这也是所进之药，开始有效但最终无效的原因。肺病属虚，胃病属实。一身兼有此虚实两途的病，如果不是按部就班，循循善诱地调治，必然没有向愈的时期。
紫菀一钱、麦冬二钱、桑白皮一钱半、地骨皮一钱半、阿胶一钱、薏苡仁五钱、忍冬藤一两、川贝母一钱半、蛤壳一两、橘红一钱、茯苓三钱、炙甘草三分。
柳诒按：论病选药，都极其精到。此方也是从苇茎汤化裁而来，可以加芦根。
邓评：凡是咳嗽，脉象弦滑见于右关的，必定多有痰湿浊邪壅聚于胃，热被湿遏，湿为热蒸。阅读案中的议论，也极清正。只是方内的阿胶、麦冬、地骨皮，似乎太遏制邪气；想要清胃热，不如改用芦根、知母为好。
孙评：右关大弦数的胃脉，热遏于中，不得肃降化气。阿胶、生地滋阴补血，热得补益而更加壅滞，应当去掉。应当遵从柳氏用苇茎汤加上肃清的药物。
再诊：各种病症趋向安宁，右脉也缓和了。药能应手而效，何其迅速啊。继续守方服用，观察其动静。
前方加水飞青黛三分。
邓评：因为寒邪遏制而导致熏蒸之势，所以药力应手甚速，然而病终究不能痊愈。
三诊：右关的大脉已经消除，弦滑未化，“数”这一字，与寸脉相同，湿热痰三者，尚有熏蒸之意，肺必定难于自我振奋。
邓评：右关仍见弦滑，是郁热又复熏蒸了。
四诊：接连进用张氏之法，肺金熏蒸，一天比一天轻，金的性质逐渐刚强，颇为佳兆。但是必须振作精神，以恢复其本来的清肃功能才可以。
前方去掉薏米，加入麻仁。
五诊：夜间的咳嗽，尚未彻底平息。必须等到肺胃逐渐通畅才能痊愈。
邓评：夜间的咳嗽，每每由于厥阴肝火内动，是其肺胃之火乘虚侵犯吗？蛤壳正宜参用，为何反而去掉它。
六诊：肺虚则容易招致风邪，偶然咳嗽加剧，而今却好了。脉数，右寸空大，阴气必定虚弱。自然应当以养阴为主；然而阳明胃经湿热熏蒸之气，不能不兼理。
七诊：右脉小中带数，肺阴不足，肺热有余；之所以导致这种情况，仍是由胃中的湿热熏蒸所致。
前方加入丝瓜络、冬瓜仁、苇茎。
八诊：肺属金，土是金之母；胃土湿热未清，上焦肺部焉能不受到熏蒸，这就是所谓的母病及子。肺用在右侧，右胸应当咳嗽作痛。不便单纯进补，必须使其清肃才可以。
前方加入薏仁、杏仁。
九诊：来信已悉。想到动则生火，火刑克肺金则咳逆，火入营分则吐血。这十七日以后的病，失于清化，以致毛窍又开，风邪又感，咳嗽大作，欲呕清痰，血络重伤。事情难以预料，确实如此，悬拟方案以回复。
桑白皮、地骨皮、杏仁、甘草、淡黄芩、茅根、知母、川贝母、苇茎、忍冬藤。
又丸方：
大生地、白芍、丹皮、泽泻、沙参、茯苓、山药、麦冬、阿胶（用忍冬藤十斤煮膏，蜜丸）。
原注：这个病的道理，全包含在第一案中。先生平日所言，起手立定根脚，以下便如破竹般顺利。大约此病，拈定“胃火熏蒸”四字，方中得力尤在忍冬藤一味。
邓评：不待咳止就设立丸方，想必是因为诊次太多，聊以应酬世故罢了。
宿积的黑血，从呕吐而出。胸部痞塞稍和缓，肺部咳嗽略减轻，这是瘀血。从上而出的为逆，终究不是好现象。
柳诒按：可加酒炙大黄炭数分，研末冲服，以引导血液下行。
邓评：立方简洁老练，盖病归一路，用药也宜精专。
再诊：所瘀之血，从下排出，尚属顺证。因势利导，原是一定的章程。
柳诒按：仍宜加牛膝、三七等引导下行的药物。
邓评：为何前方一味不用？是复诊时没带原方吗！
昨日所溢出的血，盈盆成块而来，难怪会出现厥逆。幸好厥逆后即醒，半夜得以睡眠，其气稍平。今日仍然上吐，脉来芤数，火升颧红，咳逆时作，大便不爽而黑。阳明胃腑必有伏热。防止其再次冒犯、再次厥逆。
柳诒按：这与下条皆是木火亢盛，阴血沸腾之证。
邓评：此为阳明有蓄血伏热，盈盆成块而吐者立法。
久嗽失血，血色鲜且量多，脉数左弦，舌苔黄心中嘈杂，金受火刑，木寡于畏，以致阳络被伤，防冒邪。
另服归脾丸。
原注：吴鹤皋说：心，火也；肺，金也。火为金之畏，心移热于肺乃咳嗽，甚则吐血、面赤，名为贼邪。此方中，犀角能解心热，生地能凉心血，丹皮、芍药性寒而酸，寒则胜热，酸则入肝。使用者，以木能生火，故使二物入肝而泻肝，这是拔本塞源的治法。
邓评：这必定是阴虚成劳，为难治之症，或许可以用琼玉膏继之。至于另用归脾丸，则失之远矣。
孙评：凡血症之急者，总宜导之下达乃顺。古所云天下无倒行之水，人身无倒上之血，由乎气导之使下者，即是顺气也。
阳络频伤，胸前窒塞，咳逆不爽，舌红苔黄，脉形弦数。此系瘀血内阻，郁而为热，肺胃受伤，极易成损，慎之。
旋覆花、降香、葱管、芦根、枇杷叶、忍冬藤、苏子、桑白皮、川贝母、知母、广郁金、参三七、竹油、地骨皮。
原注：前五味名瘀热汤，是先生自制之方。治瘀血内阻，化火刑金而咳，不去其瘀，病终不愈，此为先生独得之秘。
柳诒按：合二母泻白以清肺，佐苏、郁、三七以通痹，立方周到之至。
邓评：脉弦数而苔黄，当有风热郁恋。所用方药，亦非背谬。
脘胁痞结作痛，形寒如疟，苔浊不纳，渴欲热饮，神情惫乏。此血络凝泣，湿邪附之欲化热，而未能透出也。
邓评：病偏于痰湿闭遏，何不加薤白、芥子以辛通阳气。或曾患吐血，故知其血络凝泣；但既已形寒如疟，芦根似非所宜。
瘀血先阻于中，一经补味，胸中遂痞，紫黑之血从此而来。
瘀热汤加郁金汁。
原注：此方大效。
柳诒按：再加三七磨冲更妙。
邓评：确系瘀血，并无别邪夹杂，宜其效若桴鼓也。
孙评：所云不去其瘀，病终不愈。若误补之，变生不测矣。此段柳批，用药切实可法，学者宜熟玩而记之。
【虚损门】
痧疹之后，咳嗽四月，颈旁疬串（淋巴结肿大），咳甚则呕，纳少形瘦，肤热脉细。想是余邪内恋，阴分大虚，欲成损证也。
四物汤加香附、川贝母、玄参、牡蛎、麦冬、苏子（一本作苏叶）。
柳诒按：方中玄参、牡蛎，为项疬而设，无此证者可减也。
邓评：咳甚则呕，内必多痰。方中之地，似宜酌用。
孙评：咳而肤热脉细，余邪内恋，热未清也，芎、归不宜。况痧后久咳，明明是余热留恋，入肺伤阴所致。
温邪发痧之后，咳嗽失血，血止而咳嗽不减，所吐之痰，或黄或白，或稠或稀，舌质深红，其苔满白，喉痒嗌干，脉弦带数，渐作痧劳之象。
原注：此痧后余邪，留恋营分，而成咳也。先生尝云：余自制两方，一为瘀热汤，一为此汤，尚未立名，以治痧后咳嗽极效。盖四物是血分引经之药，将温散化痰之品，纳入其中，引入营血中散邪清热，每用必灵。此可悟用四物之法。
孙评：热恋于营，已见咳血，则阴被劫而热内郁，当清热安营为治。若以芎、桂辛温上升，热愈甚而血益溢。今原注云每用必灵者，恐无是理。抑系夹冒寒邪，或得见效，是必先生之误认也。方中苏叶亦太温散，细考叶氏《温热论》自知。
咳嗽五月有余，黄昏为甚，肌肉暗削，肢体无力，容易伤风，或头胀，或溺黄。总由阴分下虚，浮火夹痰上扰所致。
四物桔梗汤（四物加桔梗、柏子仁）加桑白皮、地骨皮、川贝母、知母、甘草、青黛、蛤壳、枇杷叶。
原注：此方之眼，在咳嗽黄昏为甚。毕竟风邪陷入阴分为剧，余目睹效者甚多。
柳诒按：此四物合泻白，加二母、蛤、黛法也。
邓评：头胀一症，亦由风阳上浮所致，石决明或可参用。
孙评：伤风头胀，夹冒风寒，此方颇妙。
金能克木，木火太旺，反侮肺金，金藏尚受木克，则其吸取肾水，疏泄肾精，更属易易。此梦遗咳嗽之所由作也。
原注：此三才封髓丹加白芍、龙胆也。其人面必黑瘦，有一团阴火炽甚，克肺伤肾，用之极效。
柳诒按：此方以清泄肝火为主，竟不兼用肺药，所谓治病必求其本也。
邓评：论病透彻，用药切当。
古人于清阴火一门，每云知、柏苦寒伤脾败胃，多去而不用，况可加以胆草乎。
子后咳嗽，天明而缓，脉形弦数，声音不扬，肝胆之火未清，金受其刑，水必暗亏也。
补肺阿胶汤合四阴煎、泻白散加川贝母、青黛、海浮石、橘红、竹茹。
柳诒按：此与前案，均属木火刑金之证。前方治肝而绝不及肺，想因咳势不甚，而下注遗泄之证却急，故用药如彼。此证则咳甚音低，肺金受损已深，故于清火之中，偏重补肺。观乎此，而临证用药之权衡可识矣。
此症似可偏治其肝，舍去补肺汤，增入蛤壳。盖欲保肺金，莫若沙参、玉竹、紫菀、旋覆之类。
咳嗽失血，音烁咽干，近来小有寒热，头痛喉疼；脉浮促而数。肺阴久伤，又兼燥气加临。补肺之中，当参以辛散。
邓评：知其兼受燥气外邪，金在头痛得之。
孙评：燥邪当用辛凉清之，辛散不宜。且补肺阿胶是补中兼疏，甘寒带辛，非辛散之法。
再诊：头痛咽疼已止，寒热亦轻，新受之燥邪渐得清散。无如金水两虚，失血久嗽，音烁嗌干等证，仍如损象。即使静养，犹恐不及。
原注：此病肺脏已损，再受燥邪，小有寒热，头痛咽疼，是其的据。先用补肺阿胶汤，以其中有牛蒡、杏仁，加桑叶、枇杷叶，去其燥邪外证，后用四阴煎加味，以图其本。
邓评：此久嗽音烁，亦得无客邪留于肺络否。
阳络频伤之后，咳嗽痰浓，内热嗌干，脉芤数，左关独弦。此肝火刑金，金气不清之候，容易成损。慎之。
原注：肝火刑金，于左关独弦见之，所以四阴更加羚羊。
邓评：惟形体未瘦者，尚可投此法而愈。
孙评：清肝火究不宜羚羊，当用决明、牡蛎之类。所云选药如选将，非量敌而行不克也。
失血后，咳嗽梦遗，脉数左关弦急。必有肝火在里，既犯肺金，又泄肾气也。久延势必成劳。
柳诒按：六味汤，想系转方增入者。但其中有萸肉之酸温，专补肝阳，尚宜酌用。
失血久咳，阴分必虚，虚则不耐热蒸，食西瓜而稍退，脉数左弦，唇干苔白色滞，溺黄，加以咽痛，久而不愈，想是水不涵木，阴火上冲，胃气不清也。势欲成劳，早为静养，以冀气不加喘，脉不加促，庶几可图。
生地、白芍、茯苓、泽泻、丹皮、花粉、元参、甘草、猪肤、青蒿露、枇杷叶露。
邓评：苔白色滞，而断其为阴虚者，良以脉数左弦故也。盖一病须有一病之着眼处。
参以青蒿、枇杷露，不免有暑气内侵也。
[Fourth Diagnosis]
Phlegm is "visible fire," and fire is "invisible phlegm." As the color of the phlegm gradually harmonizes and blood spots gradually diminish, it indicates that the phlegm-fire is secretly dissipating, and there is great hope for recovery. Unexpectedly, internal sorrow combined with external summer-heat creates a dual pressure, injuring the Lung Metal again. Upon injury, the remaining phlegm-fire attacks and rebels through the meridians, causing dull pain on the right side, radiating to the left hypochondrium, and extending upward to the Jianjing (GB21) area. It seems the disease condition is worsening without end. Carefully considering this illness, summer-heat comes from outside, while sorrow arises from within; emotional injuries and external pathogens converge in one body. Therefore, it is necessary to employ a method of treating them separately, so as to achieve two goals with one move.
Prescription: Sangbaidi (Morus Cortex), Gupi (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), Chuanbei (Fritillariae Bulbus), Ejiao (Colla Corii Asini), Zhiqiao (Aurantii Fructus), Jinzhencai (Hemerocallis Citrina), Jianghuang (Curcumae Longae Rhizoma), Lüdouyi (Phaseoli Semen Testa), Ouji (Nelumbinis Rhizoma Juice), Foshou (Citrus Sarcodactylis).
Original Note: Phlegm with blood spots, dry nose and mouth, scanty urination, and bloody froth in stool all belong to disorders caused by phlegm-fire. The first prescription using Qingjin Huatan (Clearing Metal and Resolving Phlegm) was ineffective. The second plan added symptoms of hemoptysis, dream-emission, and aversion to heat, attributing them to Liver Fire, employing a regimen of clearing Liver Fire with slight addition of Stomach-nourishing herbs. The third prescription was formulated based on the Lung and Stomach, slightly assisting the intention of clearing Liver Fire. The fourth prescription entirely used light and bland methods to dispel summer-heat and resolve phlegm.
Liu Yi's Commentary: Reviewing the four medical cases, the discussion of disease and selection of medicines are layered and thorough, showing mastery in this field. However, its strength lies in being comprehensive and steady, while its weakness lies in lacking flexibility and agility, which depends on natural aptitude rather than human effort. The first prescription merely addressed the symptoms without clear logic. The second prescription cleared and drained Liver Fire with considerable force. The third and fourth prescriptions used light and unobstructed medications, deeply inheriting Ye Tianshi's mental method.
Deng's Commentary: At this stage, the focus must be on opening phlegm and unblocking collaterals. It is proposed to remove Ejiao and add Xuanfuhua (Inulae Flos) and Jieluo (Citri Reticulatae Pericarpium Retinervum), which would be appropriate.
Sun's Commentary: Reviewing the four cases, Liver Fire夹杂着 phlegm rebels horizontally through the collaterals, and the Lung is injured by fire, with Wood stagnation failing to diffuse. This is the root of the disease. The four prescriptions拟定 by Mr. Liu claim to inherit Ye's method, but they are contradictory. I tentatively record one prescription from Ye's cases for correction by scholars:
Jinshihu (Dendrobii Caulis), Fen Danpi (Moutan Cortex), Dusuzi (Perillae Fructus), Gdai San (Clam and Indigo Powder), Gouteng (Uncariae Ramulus Cum Uncis), Sheng Yiren (Coicis Semen Bland), Ku Xingren (Armeniacae Semen Amarum), Sheng Baishao (Paeoniae Radix Alba), Pipaye (Eriobotryae Folium), Xuanfuhua (Inulae Flos), Ouji (Nelumbinis Rhizoma Juice), Dongguazi (Benincasae Semen).
Cough with foul-smelling phlegm and collateral bleeding, or inability to sleep at night, or difficulty lying down, dry stool, white coating covering the tongue, fluctuating severity, lasting over half a year. This corresponds to "Heat in the Upper Jiao causes Lung萎 (Flaccidity) due to cough." The Left Cun pulse is rapid and small, matching the teaching that a rapid and deficient pulse indicates Lung Flaccidity. However, the Right Guan section is not only rapid and frequent but also uniquely large, wiry, and slippery. The Yangming Stomach Meridian must have dampness generating phlegm, phlegm generating heat, steaming the Lung. Mother disease affecting the child means not only does Lung Metal suffer itself, but this explains why the initial medication worked briefly but ultimately failed. Lung disease is deficiency; Stomach disease is excess. A body suffering from both deficiency and excess requires step-by-step, gradual regulation to have any chance of recovery.
Ziwan (Astagi Flos), Maidong (Ophiopogonis Tuber), Sangbaipi (Mori Cortex), Digupi (Phellodendri Cortex), Ejiao (Colla Corii Asini), Yiren (Coicis Semen), Rendongteng (Lonicerae Japonicae Caulis), Chuanbei (Fritillariae Bulbus), Qiaoke (Mercurii Concha), Juhong (Citri Reticulatae Pericarpium Rubrum), Fuling (Poria), Zhigancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle).
Liu Yi's Commentary: The discussion of disease and selection of medicine are extremely precise. This prescription is derived from Weijing Tang (Reed Shoot Decoction) and can include Lu Gen (Phragmitis Rhizoma).
Deng's Commentary: In cases of cough with wiry-slippery pulses at the Right Guan, there is usually accumulation of phlegm-damp turbid pathogen in the Stomach, where heat is suppressed by dampness, and dampness is steamed by heat. The commentary in the case is very upright. However, Ejiao, Maidong, and Digupi seem too suppressing of pathogens. To clear Stomach heat, replacing them with Lu Gen and Zhimu would be better.
Sun's Commentary: The large, wiry, and rapid Stomach pulse at the Right Guan indicates heat trapped in the middle, preventing descending transformation. Ejiao and Shengdi nourish Yin and blood, but heat becomes more congested with tonification; they should be removed. One should follow Liu's use of Weijing Tang adding descending-clearing herbs.
Second Visit: All ailments tend toward peace, and the Right pulse has slowed. The medicine works swiftly. Continue with the same formula to observe changes.
Add Shuifei Qingdai (Water-ground Indigo) 3 fen to the previous formula.
Deng's Commentary: Because cold suppression led to steaming effects, the medicine acted quickly, yet the disease will not ultimately cure.
Third Visit: The large pulse at the Right Guan has disappeared, but wiry-slippery qualities remain. The "rapid" quality matches the Cun pulse. Dampness, heat, and phlegm still show steaming tendencies; the Lung finds it difficult to revive itself.
Add Sheng Dihuang (Rehmanniae Radix Recens) stir-fried with Ge Fen (Mercurii Pulvis) 3 qian, Shashen (Glehniae Radix) 3 qian, Mi Chenpi (Honey-processed Citri Reticulatae Pericarpium) 1 qian to the previous formula.
Deng's Commentary: The Right Guan still shows wiry-slippery qualities, indicating郁热 (stagnant heat) is steaming again. Adding Sheng Dihuang further contradicts the pathology.
Fourth Visit: Continuously applying Zhang's method, Lung steaming improves day by day. The nature of Metal becomes stronger, which is a good sign. However, vitality must be boosted to restore its natural clarity and descent.
Remove Yimi (Coicis Semen) and add Maren (Cannabis Semen) in the previous formula.
Fifth Visit: Nighttime cough is not yet resolved. Recovery requires gradual unblocking of Lung and Stomach.
Remove Qiaoke (Mercurii Concha) and Fuling (Poria), add Chuan Shihu (Dendrobii Caulis) and Baihe (Lilii Bulbus) to the previous formula.
Deng's Commentary: Nighttime cough often stems from Jueyin Liver Fire moving internally. Does Lung-Stomach fire take advantage? Qiaoke should be used; why remove it?
Sixth Visit: Lung deficiency easily attracts wind; occasional severe cough has now resolved. The pulse is rapid, Right Cun is empty and large, indicating Yin Qi is definitely deficient. Nourishing Yin should be the main approach; however, the steaming Qi of damp-heat in the Yangming Stomach Meridian cannot be ignored.
Remove Baihe (Lilii Bulbus) and add Zhimu (Anemarrhenae Rhizoma) to the previous formula.
Seventh Visit: The Right pulse is small with rapidness, indicating Lung Yin insufficiency and excess Lung Heat. This results from damp-heat steaming in the Stomach.
Add Sigualuo (Luffae Fibra), Dongguaren (Benincasae Semen), and Weijing (Phragmitis Rhizoma) to the previous formula.
Eighth Visit: Lung belongs to Metal; Earth is the mother of Metal. If Stomach Earth damp-heat is not cleared, how can the Upper Jiao Lung avoid steaming? This is "Mother disease affecting Child." Lung functions on the right; right chest coughs with pain. Pure tonification is inappropriate; clarity and descent must be achieved.
Add Yiren (Coicis Semen) and Xingren (Armeniacae Semen) to the previous formula.
Ninth Visit: Letter received. Movement generates fire; fire punishing Metal causes cough/rebellion; fire entering Ying causes hematemesis. Since the 17th day, treatment lacked clearing/transformation, reopening pores and inviting wind, causing severe cough, vomiting clear phlegm, and damaging blood collaterals. Outcomes are unpredictable. Prescribing tentatively in reply.
Sangbaipi (Mori Cortex), Digupi (Phellodendri Cortex), Xingren (Armeniacae Semen), Gancao (Glycyrrhizae Radix), Dan Qin (Scutellariae Radix), Maogen (Imperatae Rhizoma), Zhimu (Anemarrhenae Rhizoma), Chuanbei (Fritillariae Bulbus), Weijing (Phragmitis Rhizoma), Rendongteng (Lonicerae Japonicae Caulis).
After two doses, remove Dan Qin and add Maidong (Ophiopogonis Tuber), Shashen (Glehniae Radix), and Shengdi (Rehmanniae Radix).
Another Pill Prescription:
Sheng Di (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Dan Pi (Moutan Cortex), Ze Xie (Alismatis Rhizoma), Shashen (Glehniae Radix), Fu Ling (Poria), Shan Yao (Dioscoreae Rhizoma), Mai Dong (Ophiopogonis Tuber), E Jiao (Colla Corii Asini boiled in 10 jin Lonicerae Japonicae Caulis, honey pills).
Original Note: The principle of this disease is fully contained in the first case. As the Master often said, establishing a solid foundation at the start allows subsequent treatment to proceed like splitting bamboo. Essentially, this disease hinges on "Stomach Fire Steaming." The key efficacy lies in Rendongteng (Lonicerae Japonicae Caulis).
Deng's Commentary: Establishing pill prescriptions before cough cessation suggests responding to social obligations due to numerous visits.
Old accumulated black blood expelled via vomiting. Chest fullness slightly relieved, lung cough slightly reduced, indicating blood stasis. Expulsion from above is rebellious and unfavorable.
Yure Tang (Blood-Stasis Heat Decoction): Xuanfuhua (Inulae Flos), Jiangxiang (Aquilariae Lignum), Congguan (Allii Fistulosi Tubers), Weijing (Phragmitis Rhizoma), Pipaye (Eriobotryae Folium). Sanqi (Notoginseng Radix) ground and taken with water.
Liu Yi's Commentary: Add Jiuhuang Da Huang Tan (Wine-processed Rhubarb Charcoal) ground and taken to guide blood downward.
Deng's Commentary: The prescription is concise and mature because the pathology follows one path, requiring precise medication.
Second Visit: Stagnant blood flowing downward is a favorable sign. Guiding according to momentum is standard procedure.
Dang Gui (Angelicae Sinensis Radix), Dan Shen (Salviae Miltiorrhizae Radix), Tao Ren (Persicae Semen), Ling Zhi (Trogopterori Faeces), Pu Huang (Typhae Pollen), Fu Shen (Poria with Hostwood), Yuan Zhi (Polygalae Radix).
Liu Yi's Commentary: Still suitable to add Niu Xi (Achyranthis Bidentatae Radix) and Sanqi (Notoginseng Radix) to guide downward.
Deng's Commentary: Why were no ingredients retained from the previous formula? Was the original prescription not brought during the second visit?
Yesterday's excessive blood flow filled the basin in clots, explaining the syncope. Fortunately, consciousness returned immediately, sleep occurred at midnight, and Qi stabilized. Today, vomiting persists, pulse is hollow-rapid, fire rises to malar region, cough/rebellion occurs intermittently, stool is dark and unsatisfactory. Yangming Stomach Fu organ likely harbors latent heat. Prevent recurrence of invasion and syncope.
Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) plus Sanqi (Notoginseng Radix), Muli (Concha Ostreae), Guiban (Carapax et Plastrum Testudinis), Pipa Lu (Loquat Syrup).
Liu Yi's Commentary: Both this and the next case represent Wood-Fire hyperactivity and boiling Yin-blood.
Deng's Commentary: This prescribes for Yangming latent blood stasis and heat causing massive clot expulsion.
Chronic cough with blood loss, fresh and abundant, rapid Left-wiry pulse, yellow tongue coating, heart discomfort, Metal punished by Fire, Wood lacking restraint, damaging Yang collaterals. Fear invasion.
Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) plus Er Mu (Zhimu and Chuanbei), Ce Bai Ye (Biota Top Leaf).
Separately, Guipi Wan (Restore the Spleen Pill).
Original Note: Wu Hegao stated: Heart is Fire, Lung is Metal. Fire is feared by Metal. Heart transferring heat to Lung causes cough, severe cases吐血 (hematemesis) and red face, named "Thief Pathogen." In this formula, Xijiao clears Heart heat, Shengdi cools Heart blood, Danpi and Shaoyao are cold and sour; cold conquers heat, sour enters Liver. Using these enters Liver to drain Liver, as Wood generates Fire. This is uprooting the source.
Deng's Commentary: This must be Yin deficiency turning into Consumption, a difficult case. Perhaps Qiongyu Gao (Jade Essence Paste) could follow. Using Guipi Wan separately is misguided.
Sun's Commentary: In acute blood disorders, guiding downward is always favorable. As ancients said, water never flows backward; blood does not flow upward unless guided by Qi. Guiding Qi downward is following the trend.
Yang collaterals frequently injured, chest oppression, unrebellious cough, red tongue yellow coating, wiry-rapid pulse. This is internal blood stasis郁 (stagnating) into heat, injuring Lung and Stomach, easily becoming Consumption. Caution.
Xuanfuhua (Inulae Flos), Jiangxiang (Aquilariae Lignum), Congguan (Allii Fistulosi Tubers), Lugeng (Phragmitis Rhizoma), Pipaye (Eriobotryae Folium), Rendongteng (Lonicerae Japonicae Caulis), Suzi (Perillae Fructus), Sangbaipi (Mori Cortex), Chuanbei (Fritillariae Bulbus), Zhimu (Anemarrhenae Rhizoma), Guang Yujin (Curcumae Radix), Can Sanqi (Notoginseng Radix), Zhu You (Bambusa Textilis Sap), Digupi (Phellodendri Cortex).
Original Note: The first five ingredients form Yure Tang (Blood-Stasis Heat Decoction), a self-made formula. Treating internal blood stasis transforming into fire punishing Metal causing cough: without removing stasis, the disease never cures. This is the Master's unique secret.
Liu Yi's Commentary: Combining Er Mu (Zhimu/Chuanbei) and Xiebai San (White Peony Decoction) clears Lung, assisted by Su (Perilla/Yujin) and Sanqi to unblock obstruction. Extremely thorough formulation.
Deng's Commentary: Wiry-rapid pulse and yellow coating indicate Wind-Heat lingering. The prescribed medicine is not contradictory.
Epigastric/Hypochondriac fullness/pain, chills like malaria, turbid coating refusing food, thirst for hot drinks, mental fatigue. Blood collaterals congeal, dampness attaches attempting to transform into heat but fails to emerge.
Yure Tang (Blood-Stasis Heat Decoction) plus Xiangfu (Cyperi Rhizoma), Chuan Lian (Meliae Fructus), Gui Xu (Angelicae Sinensis Radix), Qing Pi (Citri Reticulatae Pericarpium Viride), Bai Shao (Paeoniae Radix Alba), Jieluo (Citri Reticulatae Pericarpium Retinervum).
Deng's Commentary: Disease leans toward phlegm-damp closure; why not add Xiebai (Allii Macrostematis Bulbus) and Jiezi (Sinapis Semen) to acridly open Yang Qi? Or perhaps prior hematemesis indicated congealed collaterals; but with chills like malaria, Lugeng (Phragmitis Rhizoma) seems inappropriate.
Blood stasis obstructing the middle first; upon tonification, chest becomes blocked, leading to purple-black blood.
Yure Tang (Blood-Stasis Heat Decoction) plus Yujin Zhi (Curcumae Radix Juice).
Original Note: This formula is highly effective.
Liu Yi's Commentary: Adding ground Sanqi (Notoginseng Radix) would be even better.
Deng's Commentary: Indeed pure blood stasis without other pathogens; hence effectiveness like a drumstick striking.
Sun's Commentary: "Without removing stasis, disease never cures." Mistaken tonification leads to unpredictable changes. Liu's critique uses practical, learnable medication; students should study it carefully.
[Consumption Section]
After measles rash, cough for four months, neck lymph node swelling, severe cough induces vomiting, poor appetite, emaciation, skin heat, fine pulse. Likely residual pathogens lingering internally, severe Yin deficiency, approaching Consumption.
Siwu Tang (Four Substances Decoction) plus Xiangfu (Cyperi Rhizoma), Chuanbei (Fritillariae Bulbus), Xuanshen (Scrophulariae Radix), Muli (Concha Ostreae), Maidong (Ophiopogonis Tuber), Suzi (Perillae Fructus) [One version says Sueye].
Liu Yi's Commentary: Xuanshen and Muli in the formula target neck nodes; reduce if absent.
Deng's Commentary: Severe cough inducing vomiting implies internal phlegm. Shengdi (Rehmanniae Radix) in the formula should be considered.
Sun's Commentary: Cough with skin heat and fine pulse, lingering residual pathogens, heat not cleared; Xiong (Ligusticum) and Gui (Angelica) are unsuitable. Post-measles chronic cough clearly indicates residual heat lingering, entering Lung damaging Yin.
After warm pathogen-induced measles, cough with blood loss. Bleeding stops but cough persists. Sputum varies yellow/white, thick/thin. Deep red tongue body, full white coating, itchy throat, dry pharynx, wiry-rapid pulse. Gradually resembling Measles Consumption.
Siwu Tang (Four Substances Decoction) plus Zi Su (Perillae Folium), Sangbaipi (Mori Cortex), Digupi (Phellodendri Cortex), Chuanbei (Fritillariae Bulbus), Zhimu (Anemarrhenae Rhizoma), Qianhu (Peucedani Radix), Dan Qin (Scutellariae Radix).
Original Note: This is residual pathogen after measles lingering in Ying level, causing cough. The Master once said: I created two formulas, Yure Tang and this one (unnamed), extremely effective for post-measles cough. Siwu Tang guides blood-level medications; incorporating warm-dispersing/phlegm-resolving herbs introduces them into Ying-Blood to scatter pathogens and clear heat. Always effective. Understand the use of Siwu Tang here.
Deng's Commentary: Based on tongue/pulse, pathogen constraint is heavy; focus on dispersing pathogens.
Sun's Commentary: Heat lingering in Ying with hemoptysis indicates Yin robbed and heat internally constrained. Treatment should clear heat and calm Ying. Using Xiong/Gui acrid-warm ascending worsens heat and bleeding. The note claiming "always effective" is doubtful. Perhaps mixed with cold invasion showed effect, indicating misjudgment. Su Ye (Perillae Folium) is too warm-acrid. Consult Ye Tianshi's *Wen Re Lun* (Treatise on Warm-Heat Diseases).
Suitable only for mild cough without blood loss. For severe cough with blood loss and fire, internal Xiong/Gui acrid-warm is unsuitable.
Cough over five months, worse at dusk, muscle wasting, limb weakness, prone to wind-cold, head distension, yellow urine. Total cause: Lower Yin deficiency, floating fire carrying phlegm disturbing upward.
Siwu Jiegeng Tang (Four Substances with Platycodon Decoction) plus Sangbaipi (Mori Cortex), Digupi (Phellodendri Cortex), Chuanbei (Fritillariae Bulbus), Zhimu (Anemarrhenae Rhizoma), Gancao (Glycyrrhizae Radix), Qingdai (Indigo Naturalis), Qiaoke (Mercurii Concha), Pipaye (Eriobotryae Folium).
Original Note: Key point of this formula is cough worse at dusk. Wind pathogen sinking into Yin level exacerbates it; I have witnessed many efficacious cases.
Liu Yi's Commentary: This combines Siwu Tang with Xiebai San, adding Er Mu (Zhimu/Chuanbei), Qiaoke (Mercurii Concha), and Qingdai (Indigo Naturalis).
Deng's Commentary: Head distension also caused by Wind-Yang floating up; Shijueming (Concha Magnoliae) could be added.
Sun's Commentary: Wind-cold invasion with head distension makes this formula quite excellent.
Metal controls Wood; Wood-Fire too strong insults Lung Metal. Metal being controlled by Wood makes absorbing Kidney Water and draining Kidney Essence easy. This causes dream emission and cough.
Tiantong (Asparagi Tuber), Shengdi (Rehmanniae Radix), Dangshen (Codonopsis Radix), Huangbai (Phellodendri Cortex), Gancao (Glycyrrhizae Radix), Sharen (Amomi Fructus Rotundus), Baishao (Paeoniae Radix Alba), Longdancao (Gentianae Radix).
Original Note: This is Santai Fengsui Dan (Three Powers Sealing Marrow Pill) plus Baishao and Longdancao. Patient likely has dark-thin face, intense Yin fire punishing Lung/Kidney. Extremely effective.
Liu Yi's Commentary: This formula focuses on clearing/draining Liver Fire, avoiding Lung herbs, seeking the root.
Deng's Commentary: Thorough disease analysis, appropriate medication.
Sun's Commentary: Disease divided upper/lower, connected by Liver Fire. Clever thinking, logical.
Ancients warned Zhimu/Baimu bitter-cold damages Spleen/Stomach, often omitted, let alone adding Gentian.
Cough after midnight, easing at dawn, wiry-rapid pulse, hoarse voice, Liver/Gallbladder fire unclarified, Metal punished, Water secretly depleted.
Bufei Ejiao Tang (Lung-Nourishing Donkey-Hide Gelatin Decoction) combined with Siyin Jian (Four Yin Decoction) and Xiebai San (White Peony Decoction) plus Chuanbei (Fritillariae Bulbus), Qingdai (Indigo Naturalis), Haifushi (Pumex), Juhong (Citri Reticulatae Pericarpium Rubrum), Zhuru (Bambusa Textilis Sap).
Liu Yi's Commentary: Like previous cases, this is Wood-Fire punishing Metal. Previous formula treated Liver ignoring Lung, likely because cough wasn't severe but lower emission urgent. Here, severe cough/low voice indicates deep Lung damage; thus, amidst clearing fire, emphasis shifts to nourishing Lung. This reveals clinical judgment.
Deng's Commentary: Post-midnight cough confirms Liver/Gallbladder fire, a key diagnostic pulse point.
This case could focus on Liver, discarding Bufei Tang, adding Qiaoke. To protect Lung Metal, Shashen, Yuzhu, Ziwan, Xuanfuhua are preferable.
Cough with blood loss, hoarse voice, dry throat, recent mild chills/fever, headache/sore throat; floating-rapid-pulsating pulse. Long-term Lung Yin injury plus dryness. Tonifying Lung should include acrid dispersion.
Bufei Ejiao Tang (Lung-Nourishing Donkey-Hide Gelatin Decoction) plus Sangye (Mori Folium), Pipaye (Eriobotryae Folium).
Deng's Commentary: Knowing concurrent dryness pathogen, headache derives from Metal.
Sun's Commentary: Dryness should be cleared with acrid-cool, not acrid-dispersive. Bufei Ejiao Tang is tonifying with slight dispersion, sweet-cold with acrid, not purely acrid-dispersive.
Second Visit: Headache/sore throat stopped, chills/fever light, new dryness pathogen clearing. However, Metal-Water dual deficiency, chronic blood loss/cough, hoarseness/dry throat resemble Consumption. Even rest may not suffice.
Siyin Jian (Four Yin Decoction) combined with Xiebai San (White Peony Decoction) plus Chuanbei (Fritillariae Bulbus), Xingren (Armeniacae Semen), Ejiao (Colla Corii Asini), Fuling (Poria), Shijueming (Concha Magnoliae).
Original Note: Lung damaged, re-infected by dryness, mild chills/fever/headache/sore throat are evidence. First use Bufei Ejiao Tang (contains Niubang/Xingren), add Sangye/Pipaye to remove external dryness signs. Then use modified Siyin Jian to treat root.
Deng's Commentary: Chronic cough/hoarseness, are there no external pathogens lingering in Lung collaterals?
After frequent Yang collateral injury, cough with thick sputum, internal heat/dry throat, hollow-rapid pulse, Left Guan uniquely wiry. Liver Fire punishing Metal, Metal Qi unclear, easily becoming Consumption. Caution.
Siyin Jian (Four Yin Decoction) plus Er Mu (Zhimu/Chuanbei), Lingyangjiao (Saiga Antelope Cornu).
Separately, Qiongyu Gao (Jade Essence Paste: Shengdi, Maidong, Renshen, Honey, Chenxiang, Hupo).
Original Note: Liver Fire punishing Metal seen in Left Guan uniqueness; thus Siyin Jian adds Lingyangjiao.
Deng's Commentary: Only if body not emaciated can this method cure.
Sun's Commentary: Clearing Liver Fire shouldn't use Lingyangjiao; use Jumeng/Muli instead. Selecting medicine like generals requires matching enemy strength.
Post-hemorrhage, cough/dream emission, rapid Left-Guan wiry-tight pulse. Internal Liver Fire invading Lung Metal and draining Kidney Qi. Prolonged leads to Consumption.
Siyin Jian (Four Yin Decoction) plus Chenpi (Citri Reticulatae Pericarpium), Chuanbei (Fritillariae Bulbus), Haifushi (Pumex), Qingdai (Indigo Naturalis), Longdancao (Gentianae Radix), Liuyun Wan (Six Flavor Pill).
Original Note: Liver Fire attacking up/down, thus adding Longdancao to drain.
Liu Yi's Commentary: Liuyun Wan likely added later. Contains Yu Rou (Corni Fructus) acid-warm, specifically tonifies Liver Yang; consider usage.
Deng's Commentary: To protect Lung/Kidney, must clear Liver Fire; "Source clear, stream clean."
Post-hemorrhage chronic cough, Yin deficiency intolerant of heat steaming. Eating watermelon relieves slightly. Rapid Left-wiry pulse, dry lips, white-stagnant coating, yellow urine, sore throat, persistent. Likely Water not nurturing Wood, Yin fire rushing up, Stomach Qi unclear. Trending toward Consumption; early rest hoped to prevent panting/rapid pulse.
Shengdi (Rehmanniae Radix), Baishao (Paeoniae Radix Alba), Fuling (Poria), Zexie (Alismatis Rhizoma), Danpi (Moutan Cortex), Huafen (Trichosanthis Radix), Yuan Shen (Scrophulariae Radix), Gancao (Glycyrrhizae Radix), Zhufu (Porci Cutis), Qinghao Lu (Artemisiae Annuae Dew), Pipa Ye Lu (Loquat Leaf Syrup).
Deng's Commentary: White-stagnant coating judged as Yin deficiency due to rapid Left-wiry pulse. Each disease has its focal point.
Adding Qinghao/Pipa Lu invites Summer-heat invasion.
Second Visit. Scanty turbid phlegm, cough/rebellion persists, Yin fire rushing to Lung. Lung is Metal; Metal punished by Fire, Water source cut off. Not worry about rapid pulse/panting? Those knowing fate naturally rest and nourish.