治肺胀咳而上气,咽燥而喘,脉浮者,心下有水方。
麻黄 芍药 生姜(仲景用干姜) 细辛 桂心(各三两) 半夏 五味子(各半斤) 石
膏
(四两)
上八味 咀,以水一斗,煮取三升,分三服(仲景名小青龙加石膏汤,用甘草二两,为
九味。)
(论一首 方六首)
论曰∶病咳唾脓血,其脉数实者属肺痈,虚者属肺痿。咳而口中自有津液,舌上胎滑,
此为浮寒,非肺痿。若口中辟燥,咳即胸中隐隐痛,脉反滑数,此为肺痈也。问曰∶病者咳
逆,师脉之何以知为肺痈,当有脓血吐之则死,后竟吐脓死。其脉何类何以别之?师曰∶寸
口脉微而数,微则为风,数则为热;微则汗出,数则恶寒。风中于卫,呼气不入。热过于营,
吸而不出。风伤皮毛,热伤血脉,风舍于肺,其人则咳,口干喘满,咽燥不渴,多唾浊沫,
时时振寒,热之所过,血为凝滞,蓄结痈脓,吐如米粥,始萌可救,脓已成则难治。寸口脉
数趺阳脉紧,寒热相搏,故振寒而咳,趺阳脉浮缓,胃气如经,此为肺痈。师曰∶振寒发热,
寸口脉滑而数,其人饮食起居如故,此为痈肿病,医反不知而以伤寒治之,不应愈也。何以
知有脓?脓之所在,何以别知其处?师曰∶假令脓在胸中者为肺痈,其脉数,咳唾有脓血。
设脓未成,其脉自紧数,紧去但数,脓为已成也。
治疗肺胀、咳嗽且气逆上冲,咽喉干燥并伴有喘息,脉象浮的病症,使用以下方剂:
麻黄、芍药、生姜(张仲景使用干姜)、细辛、桂心(各三两)、半夏、五味子(各半斤)、石膏(四两)。
以上八味药,切碎,用水一斗,煎煮至三升,分三次服用(张仲景将其命名为小青龙加石膏汤,加入甘草二两,共九味药)。
(论述一首,方剂六首)
论述说:患病者咳嗽并吐出脓血,脉象数而实的属于肺痈;脉象虚弱的属于肺痿。咳嗽但口中自有津液,舌苔滑润,这是浮寒证,不是肺痿。如果口中感觉干涩,咳嗽时胸中隐隐作痛,脉象反而滑数,这就是肺痈。问:患病者咳嗽气逆,医生诊脉后如何知道是肺痈?应当有脓血吐出,若吐出则死,后来果然吐脓而死。其脉象像什么?如何辨别?医生说:寸口脉微而数,微表示风邪,数表示热邪;微则汗出,数则恶寒。风邪伤及卫分,呼气不能入内。热邪过及营分,吸气不能外出。风邪损伤皮毛,热邪损伤血脉,风邪留舍于肺,患者就会咳嗽,口干、气喘胸闷,咽喉干燥但不口渴,多唾浊沫,时常发冷颤抖,热邪经过之处,血液凝滞,积聚结成痈脓,咳出的痰像米粥一样,病初起时可救治,脓已形成则难治。寸口脉数,趺阳脉紧,寒热相互搏结,所以发冷颤抖并咳嗽;趺阳脉浮缓,胃气正常,这是肺痈。医生说:发冷颤抖发热,寸口脉滑而数,患者的饮食起居如常,这是痈肿病,医生反而不知道,用治疗伤寒的方法治疗,不会痊愈。如何知道有脓?脓在何处,如何辨别其位置?医生说:假如脓在胸中,称为肺痈,脉象数,咳嗽吐出脓血。假设脓未形成,脉象自紧数,紧象消失仅见数象,说明脓已形成。
To treat lung distension, cough with rebellious Qi rising, dry throat with wheezing, and a floating pulse, use the following formula:
Mahuang (Ephedrae Herba), Shaoyao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Recens) [Sun Simiao uses Ganjiang (Zingiberis Rhizoma)], Xixin (Asari Radix et Rhizoma), Guixin (Cinnamomi Ramulus), Banxia (Pinelliae Rhizoma Preparatum), Wuweizi (Schisandrae Fructus) [each 3 liang], Shigao (Gypsum Fibrosum) [4 liang].
The above eight herbs are coarsely crushed, boiled in 10 dou of water until reduced to 3 sheng, and divided into three doses. (Sun Simiao notes that Zhang Zhongjing named this Xiao Qing Long Jia Shi Gao Tang (Minor Blue Dragon Decoction plus Gypsum), adding Gancao (Glycyrrhizae Radix et Rhizoma) 2 liang, making nine ingredients.)
(One Treatise, Six Formulas)
The treatise states: When a patient coughs and expectorates pus and blood, if the pulse is rapid and excess, it belongs to Lung Abscess (Fei Yong); if the pulse is deficient, it belongs to Lung Flaccidity (Fei Wei). If there is cough but saliva is naturally present in the mouth, and the tongue coating is slippery, this indicates floating Cold, not Lung Flaccidity. If the mouth feels dry, and coughing causes dull pain in the chest, and the pulse is instead slippery and rapid, this is Lung Abscess. Question: A patient has cough and rebellious Qi; how does the physician know it is Lung Abscess through pulse diagnosis? There should be expectoration of pus and blood; if expectorated, death ensues, and indeed, the patient died after expectorating pus. What does the pulse resemble, and how is it distinguished? The Physician says: The Cun Kou (inch position) pulse is faint and rapid. Faint indicates Wind, rapid indicates Heat; faint implies sweating, rapid implies aversion to cold. Wind invades the Wei (Defensive) level, so exhalation cannot enter. Heat overcomes the Ying (Nutritive) level, so inhalation cannot exit. Wind damages the skin and hair pores, Heat damages the blood vessels. Wind lodges in the Lung, causing cough, dry mouth, wheezing and chest fullness, dry throat without thirst, copious expectoration of turbid froth, frequent chills, and stagnation of blood where Heat passes, accumulating to form an abscess and pus, which is expectorated like congee. In the early stage, it can be saved; once pus is formed, it is difficult to treat. The Cun Kou pulse is rapid, and the Zu Yang (foot yangming position) pulse is tight; Cold and Heat struggle, causing chills and cough. The Zu Yang pulse is floating and moderate, indicating normal Stomach Qi; this is Lung Abscess. The Physician says: Chills and fever, with a slippery and rapid Cun Kou pulse, while the patient’s diet and daily activities remain unchanged, indicate a Carbuncle or Swelling disease. If the physician fails to recognize this and treats it as Taiyang Cold Damage (Shang Han), it will not heal. How to know there is pus? How to distinguish its location? The Physician says: If pus is in the chest, it is called Lung Abscess, characterized by a rapid pulse and expectoration of pus and blood. Assume the pus has not yet formed; the pulse is naturally tight and rapid. If the tightness disappears and only rapidness remains, it indicates that pus has already formed.