《千金》问曰,咳病有十,何谓也?师曰,有风咳,有寒咳,有支咳,有肝咳,有心咳
,有脾咳,有肺咳,有肾咳,有胆咳,有厥阴咳。问曰,十咳之证,何以为异?师曰,欲语
因咳,言不得终,谓之风咳;饮冷食寒,因之而咳,谓之寒咳;心下坚满,咳则支痛,其脉
反迟,谓之支咳;咳引胁下痛,谓之肝咳;咳而唾血,引手少阴,谓之心咳;咳而涎出,续
续不止,下引少腹,谓之脾咳;咳引颈项而唾涎沫,谓之肺咳;咳则耳无所闻,引腰并脐中
,谓之肾咳;咳而引头痛,口苦,谓之胆咳;咳而引舌本,谓之厥阴咳。夫风咳者下之,寒
咳、支咳、肝咳,灸足太冲,心咳灸刺手神门,脾咳灸足太白,肺咳灸手太泉,肾咳灸足太
溪,胆咳灸足阳陵泉,厥阴咳灸手太陵。留饮咳者,其人咳不得卧,引项上痛,咳者时如小
儿螈 状。夫久咳为水咳而时发热,脉在九菽(一云卒弦)者非虚也,此为胸中寒实所致
也,
当吐之。咳家其脉弦,欲行吐药,当相人强弱无热,乃可吐耳。(通按∶太泉疑太渊)
又咳家,其人脉弦为有水,可与十枣汤下之。不能卧坐者,阴不受邪故也。
又夫有支饮家咳烦,胸中痛者,不卒死,至一百日一岁,与十枣汤方。
芫花 甘遂 大戟(并熬等分)
上三味,捣下筛,以水一升五合,煮大枣十枚,取八合,绞去滓,纳药末。强人取重一
钱,羸人半钱匕,顿服之。平旦服而不下者,明旦更益药半钱,下后自补养。(《古今录验
》同,此方仲景《伤寒论》方)
又咳而引胁下痛者,亦十枣汤主之。(用前方)
又夫酒客咳者,必致吐血,此坐久极饮过度所致也。其脉沉者,不可发汗。久咳数岁,
其脉弱者可疗,实大数者死。其脉虚者,必苦冒也,其人本有支饮在胸中故也。治属饮家,
土气汗出而咳,属饮家咳,而小便利若失溺,不可发汗,发汗出则厥逆冷。
又咳逆倚息不得卧。小青龙汤主之。
麻黄(去节) 芍药 细辛 桂心 干姜 甘草(炙各三两) 五味子(半升) 半夏
(半升
洗)
上八味,切,以水一斗,先煮麻黄减二升,去沫,乃纳诸药,煮得三升,去滓,服一升
。若渴者,去半夏,加栝蒌根三两;微利者,去麻黄,加荛花如鸡子大,熬黄;若食饮噎者
,去麻黄,加附子一枚,炮,去皮,六片破;小便不利,少腹满者,去麻黄,加茯苓四两;
若喘,去麻黄,加杏仁半升,去尖、皮、两仁者,熬。芫花不主利,麻黄止喘,今语反之
,疑非仲景意加减。忌海藻、菘菜、生葱、生菜、羊肉、饧。(此本仲景《伤寒论》方)
青龙下已,多唾口燥,寸脉沉而尺脉微,手足厥逆,气从少腹上冲胸咽,手足痹,其面
翕热如醉状,因复下流阴股,小便难,时复冒者。可与茯苓桂心甘草五味子等汤主之,治其
气冲方。
茯苓(四两) 桂心(一两) 甘草(三两炙) 五味子(半升)
上四味,切,以水八升,煮取三升,去滓,温分三服。忌海藻、菘菜、生葱。(以《千
金》校之,亦脱此方,今于仲景方录附之)
冲气则抵,而反更咳胸满者,与茯苓、甘草、五味子,去桂心,加干姜、细辛以治其咳
满方。
茯苓(四两) 甘草(炙) 干姜 细辛(各三两) 五味子(半升)
上五味,切,以水八升,煮取三升,去滓,温服一升,日三。忌海藻、菘菜、生菜、醋
等物。
咳满即止,而复更渴,冲气复发者,以细辛、干姜为热药也,服之当遂渴,而渴反止者
,为支饮也。支饮法当冒,冒者必呕,呕者复纳半夏以去其水方。
茯苓(四两) 甘草(炙) 干姜 细辛(各三两) 五味子(半升) 半夏(半升洗)
上六味,切,以水八升,煮取三升,去滓,温服一升,日三。忌海藻、菘菜、生菜、羊
肉饧、酢等。
水去呕则止,其人形肿,可纳麻黄,以其人遂痹,故不纳麻黄,乃纳杏仁也。若逆而
纳麻黄者,其人必厥,所以然者,以其人血虚,麻黄发其阳故也方。
茯苓(四两) 干姜(三两) 细辛(三两) 五味子(半升) 半夏(半升洗) 杏
仁(半升
去尖、皮、两仁者) 甘草(三两炙)
上七味,切,以水一斗,煮取三升,去滓,温服一升,日三。忌海藻、菘菜、生菜、羊
肉、饧、酢等。
若面热如醉状者,此为胃中热,上冲熏其面令热,加大黄利之方。
细辛 甘草(炙) 干姜(各三两) 茯苓(四两) 五味子 半夏(洗) 杏仁(去
皮、尖各
半升) 大黄(三两蒸)
上八味,切,以水一斗,煮取三升,去滓,温服一升,日三服。忌海藻、菘菜、生菜、
饧、醋、羊肉。(并出第十八卷中)
《千金方》问道:咳嗽病有十种,是哪十种呢?老师回答说:有风咳、寒咳、支咳、肝咳、心咳、脾咳、肺咳、肾咳、胆咳、厥阴咳。又问:这十种咳嗽的证候,有什么不同之处?老师说:想要说话却因咳嗽而中断,话说不完,称为风咳;饮用冷水或食用寒凉食物后引发咳嗽,称为寒咳;心下部位坚硬胀满,咳嗽时牵引疼痛,脉象反而迟缓,称为支咳;咳嗽牵引胁下疼痛,称为肝咳;咳嗽并吐出血液,牵引手少阴经,称为心咳;咳嗽并流出涎沫,连续不断,向下牵引至小腹,称为脾咳;咳嗽牵引颈项并吐出涎沫,称为肺咳;咳嗽导致耳朵听不见声音,牵引腰部和肚脐中间,称为肾咳;咳嗽牵引头痛,口苦,称为胆咳;咳嗽牵引舌根,称为厥阴咳。对于风咳,应当使用下法治疗;对于寒咳、支咳、肝咳,灸足太冲穴;心咳灸刺手神门穴;脾咳灸足太白穴;肺咳灸手太渊穴(原文作太泉,疑为太渊);肾咳灸足太溪穴;胆咳灸足阳陵泉穴;厥阴咳灸手太陵穴。
若有留饮导致的咳嗽,患者咳嗽不能平卧,牵引颈部疼痛,咳嗽时有时像小儿抽搐的样子。如果是久咳转为水咳且时常发热,脉象在九菽深度(另一种说法是突然弦紧),这不是虚证,这是由胸中寒实邪气所致,应当使用吐法治疗。咳嗽患者的脉象若呈弦象,打算使用吐药,必须观察病人的强弱体质且无热象,才可以进行吐法。
另外,患有支饮的病人出现咳嗽、心烦、胸痛,如果没有突然死亡,经过一百天到一年,可以使用十枣汤方治疗。
十枣汤方:芫花、甘遂、大戟(均熬制,等分)。以上三味药,捣碎过筛,用水一升五合,煮大枣十枚,取汁八合,过滤去渣,纳入药末。体质强壮的人服用一钱重,体质虚弱的人服用半钱匕的量,一次性服下。清晨服药后若未通便,第二天早晨再增加半钱药量,通便后自行调养补益。(《古今录验》相同,此方出自张仲景《伤寒论》)
另外,嗜酒之人咳嗽,必然会导致吐血,这是因为久坐过量饮酒过度所导致的。其脉象沉的,不可发汗。久咳数年,脉象弱的可以治疗,脉象实大数的预后不良(死证)。脉象虚的,必定感到头目昏眩,这是因为病人原本胸中有支饮的缘故。这类病症属于饮家范畴。土气(湿气)盛而汗出并咳嗽,属于饮家咳嗽,如果小便失禁如同遗尿,不可发汗,发汗则会出现四肢厥冷逆乱。
小青龙汤方:麻黄(去节)、芍药、细辛、桂心、干姜、甘草(炙,各三两)、五味子(半升)、半夏(半升,洗)。以上八味药,切碎,用水一斗,先煮麻黄减少二升,去掉浮沫,然后加入其他药物,煮取三升,过滤去渣,服用一升。如果有口渴症状,去掉半夏,加栝蒌根三两;如果有轻微腹泻,去掉麻黄,加荛花如鸡蛋大小,炒至黄色;如果有饮食噎塞感,去掉麻黄,加附子一枚,炮制,去皮,切成六片;如果小便不利,小腹胀满,去掉麻黄,加茯苓四两;如果气喘,去掉麻黄,加杏仁半升,去尖、皮及双仁者,炒制。注:芫花不主利水,麻黄止喘,此处说法相反,怀疑不是张仲景原意的加减法。忌食海藻、菘菜(白菜)、生葱、生菜、羊肉、饴糖。(此本为张仲景《伤寒论》方)
服用小青龙汤后,若出现多唾、口燥,寸脉沉而尺脉微,手足厥冷,气从少腹上冲至胸咽,手足麻木,面部潮红发热如同醉酒状,随后热气下行流注于大腿内侧,小便困难,时常头晕目眩的,可用茯苓桂枝甘草五味子汤主治,以治疗其气上冲的症状。
茯苓(四两)、桂心(一两)、甘草(三两,炙)、五味子(半升)。以上四味药,切碎,用水八升,煮取三升,过滤去渣,温服,分三次服用。忌食海藻、菘菜、生葱。(用《千金方》校对,此处也脱漏了此方,现从张仲景方中收录附上)
气冲症状平息后,反而再次出现咳嗽、胸满的,给予茯苓、甘草、五味子,去掉桂心,加入干姜、细辛以治疗其咳嗽胸满的方剂。
茯苓(四两)、甘草(炙)、干姜、细辛(各三两)、五味子(半升)。以上五味药,切碎,用水八升,煮取三升,过滤去渣,温服一升,每日三次。忌食海藻、菘菜、生菜、醋等物。
咳嗽胸满停止后,如果再次出现口渴,气冲复发的,是因为细辛、干姜为热药,服用后应当随即口渴,但如果口渴反而停止的,这是支饮的表现。支饮通常应当出现头晕,头晕者必然呕吐,呕吐者再加入半夏以去除水饮的方剂。
茯苓(四两)、甘草(炙)、干姜、细辛(各三两)、五味子(半升)、半夏(半升,洗)。以上六味药,切碎,用水八升,煮取三升,过滤去渣,温服一升,每日三次。忌食海藻、菘菜、生菜、羊肉、饴糖、醋等。
水饮去除了,呕吐停止了,但病人身体浮肿,可以加入麻黄,因为病人已有麻木症状,所以不加入麻黄,而是加入杏仁。如果违背病情强行加入麻黄,病人必定出现厥逆,之所以这样,是因为病人血虚,麻黄发散阳气所致。
茯苓(四两)、干姜(三两)、细辛(三两)、五味子(半升)、半夏(半升,洗)、杏仁(半升,去尖、皮及双仁者)、甘草(三两,炙)。以上七味药,切碎,用水一斗,煮取三升,过滤去渣,温服一升,每日三次。忌食海藻、菘菜、生菜、羊肉、饴糖、醋等。
如果面部发热如同醉酒状的,这是胃中热邪,向上冲熏面部导致发热,加大黄以利之的方剂。
细辛、甘草(炙)、干姜(各三两)、茯苓(四两)、五味子、半夏(洗)、杏仁(去皮、尖各半升)、大黄(三两,蒸)。以上八味药,切碎,用水一斗,煮取三升,过滤去渣,温服一升,每日三次。忌食海藻、菘菜、生菜、饴糖、醋、羊肉。(均出自第十八卷)
*Qianjin Fang* asks: There are ten types of cough, what are they? The Master replies: There is Wind Cough, Cold Cough, Zhi Cough (Cough with obstruction), Liver Cough, Heart Cough, Spleen Cough, Lung Cough, Kidney Cough, Gallbladder Cough, and Jueyin Cough. It is asked: How do the syndromes of these ten coughs differ? The Master says: If one wishes to speak but is interrupted by coughing and cannot finish the sentence, it is called Wind Cough; if drinking cold water or eating cold food triggers coughing, it is called Cold Cough; if there is hardness and fullness below the heart, and coughing draws pain, with a pulse that is surprisingly slow, it is called Zhi Cough; if coughing draws pain to the hypochondrium, it is called Liver Cough; if coughing brings up blood and draws along the Hand Shaoyin meridian, it is called Heart Cough; if coughing produces saliva/phlegm that flows continuously and draws down to the lower abdomen, it is called Spleen Cough; if coughing draws to the neck and chin and produces saliva/phlegm, it is called Lung Cough; if coughing causes deafness and draws to the waist and umbilicus, it is called Kidney Cough; if coughing draws to headache and bitter taste in the mouth, it is called Gallbladder Cough; if coughing draws to the root of the tongue, it is called Jueyin Cough. For Wind Cough, purgation should be used. For Cold Cough, Zhi Cough, and Liver Cough, moxibustion should be applied to Taichong (LR3). For Heart Cough, moxibustion and needling should be applied to Shenmen (HT7). For Spleen Cough, moxibustion should be applied to Taibai (SP3). For Lung Cough, moxibustion should be applied to Taiyuan (LU9) [Original text says Taiquan, suspected to be Taiyuan]. For Kidney Cough, moxibustion should be applied to Taixi (KI3). For Gallbladder Cough, moxibustion should be applied to Yanglingquan (GB34). For Jueyin Cough, moxibustion should be applied to Tailing (PC7).
If there is retained fluid causing cough, the patient cannot lie flat due to coughing, which draws pain to the neck, and during coughing, the body sometimes resembles the convulsions of a child. If chronic cough turns into Water Cough accompanied by occasional fever, and the pulse is at the depth of nine beans (or alternatively described as suddenly wiry), this is not a deficiency syndrome; it is caused by cold excess in the chest, and emesis should be induced. If the pulse of a cough patient is wiry and emetic drugs are planned, one must assess the patient's strength and ensure there is no heat before inducing emesis.
Furthermore, for patients with Zhi Yin (Fluid retention in the diaphragm/chest) suffering from cough, irritability, and chest pain, if they do not die suddenly, after one hundred days to one year, Shizao Tang (Ten Date Decoction) can be administered.
Shizao Tang Formula: Yuanhua (Genkwa Flos), Gansui (Kansui Radix), Daji (Euphorbiae Pekinensis Radix) (all processed, equal parts). The above three herbs are crushed and sifted. With 1.5 sheng of water, boil ten large dates until 0.8 sheng remains. Strain and remove dregs, then add the herbal powder. Strong individuals take 1 qian, weak individuals take half a qian-bi, taken in one dose. If bowel movement does not occur after morning administration, increase the dose by half a qian the next morning. After evacuation, nourish and support the body naturally. (Same as *Gujin Luyan*; this formula originates from Zhang Zhongjing's *Shanghan Lun*).
Furthermore, for cough drawing pain to the hypochondrium, Shizao Tang is also the primary treatment. (Use the above formula).
Furthermore, wine drinkers who cough will inevitably expectorate blood, caused by prolonged sitting and excessive drinking. If the pulse is deep, sweating therapy is contraindicated. In chronic cough lasting years, a weak pulse indicates treatability, while a solid, large, and rapid pulse indicates a fatal prognosis. A deficient pulse implies severe dizziness/vertigo, because the patient originally had Zhi Yin in the chest. This condition belongs to the category of Yin (Fluid Retention) diseases. If dampness causes sweating and cough, belonging to Yin Cough, and urination is involuntary like enuresis, sweating therapy is contraindicated; inducing sweating will lead to cold limbs (Jue Ni).
Furthermore, for cough with qi rebellion, leaning on something to breathe, unable to lie flat, Xiao Qinglong Tang (Minor Blue Dragon Decoction) is the primary treatment.
Xiao Qinglong Tang Formula: Mahuang (Ephedrae Herba, de-stemmed), Shaoyao (Paeoniae Radix), Xixin (Asari Radix et Rhizoma), Guixin (Cinnamomi Ramulus), Ganjiang (Zingiberis Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, each 3 liang), Wuweizi (Schisandrae Fructus, 0.5 sheng), Banxia (Pinelliae Rhizoma, 0.5 sheng, washed). The above eight herbs are cut. With 1 dou of water, first boil Mahuang to reduce by 2 sheng, skim off the foam, then add the other herbs. Boil until 3 sheng remains, strain, and take 1 sheng. If thirsty, remove Banxia and add Gualougen (Trichosanthis Radix, 3 liang). If slightly loose stools, remove Mahuang and add Raohua (Adenophorae Radix, size of a chicken egg, fried yellow). If dysphagia for food/drink, remove Mahuang and add Fuzi (Aconiti Lateralis Radix Praeparata, 1 piece, processed, peeled, cut into 6 slices). If oliguria and lower abdominal fullness, remove Mahuang and add Fuling (Poria, 4 liang). If wheezing, remove Mahuang and add Xingren (Armeniacae Semen Amarum, 0.5 sheng, de-husked, de-embryoned). Note: Yuanhua does not primarily promote urination, and Mahuang stops wheezing; the current description seems reversed, suspected not to be Zhang Zhongjing's original modification intent. Avoid Hijiao (Seaweed), Songcai (Chinese Cabbage), raw Cong (Scallion), raw vegetables, Moutan (Lamb), and Yi (Malt Sugar). (This is originally from Zhang Zhongjing's *Shanghan Lun*).
After taking Xiao Qinglong Tang, if there is excessive salivation, dry mouth, deep cun pulse and faint chi pulse, cold extremities, qi rushing from the lower abdomen to the chest and throat, numbness in hands and feet, facial flushing resembling drunkenness, followed by heat flowing down to the inner thighs, difficult urination, and intermittent vertigo, Linggui Gancao Wumei Tang (Poria, Cinnamon Twig, Licorice, Schisandra Decoction) can be used to treat the qi rushing symptom.
Fuling (Poria, 4 liang), Guixin (Cinnamomi Ramulus, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 3 liang), Wuweizi (Schisandrae Fructus, 0.5 sheng). The above four herbs are cut. With 8 sheng of water, boil until 3 sheng remains, strain, and take warm, divided into three doses. Avoid Hijiao, Songcai, and raw Cong. (Checked against *Qianjin*, this formula was missing here; now recorded from Zhang Zhongjing's formulas).
If the qi rushing subsides but cough and chest fullness recur, administer a formula with Fuling, Gancao, Wuweizi, removing Guixin, and adding Ganjiang and Xixin to treat the cough and fullness.
Fuling (Poria, 4 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried), Ganjiang (Zingiberis Rhizoma), Xixin (Asari Radix et Rhizoma, each 3 liang), Wuweizi (Schisandrae Fructus, 0.5 sheng). The above five herbs are cut. With 8 sheng of water, boil until 3 sheng remains, strain, take warm 1 sheng, three times daily. Avoid Hijiao, Songcai, raw vegetables, vinegar, etc.
If cough and fullness stop, but thirst recurs and qi rushing reappears, it is because Xixin and Ganjiang are hot herbs; taking them should cause immediate thirst. If thirst stops instead, it indicates Zhi Yin. Zhi Yin typically causes vertigo; those with vertigo will vomit. For vomiting, add Banxia to remove fluid.
Fuling (Poria, 4 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried), Ganjiang (Zingiberis Rhizoma), Xixin (Asari Radix et Rhizoma, each 3 liang), Wuweizi (Schisandrae Fructus, 0.5 sheng), Banxia (Pinelliae Rhizoma, 0.5 sheng, washed). The above six herbs are cut. With 8 sheng of water, boil until 3 sheng remains, strain, take warm 1 sheng, three times daily. Avoid Hijiao, Songcai, raw vegetables, lamb, malt sugar, vinegar, etc.
If fluid is gone and vomiting stops, but the body becomes edematous, Mahuang can be added. However, because the patient already has numbness, Mahuang is not added; instead, Xingren is added. If Mahuang is forcibly added against indications, the patient will definitely experience Jue Ni (cold reversal), because the patient has blood deficiency, and Mahuang disperses yang qi.
Fuling (Poria, 4 liang), Ganjiang (Zingiberis Rhizoma, 3 liang), Xixin (Asari Radix et Rhizoma, 3 liang), Wuweizi (Schisandrae Fructus, 0.5 sheng), Banxia (Pinelliae Rhizoma, 0.5 sheng, washed), Xingren (Armeniacae Semen Amarum, 0.5 sheng, de-husked, de-embryoned), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 3 liang). The above seven herbs are cut. With 1 dou of water, boil until 3 sheng remains, strain, take warm 1 sheng, three times daily. Avoid Hijiao, Songcai, raw vegetables, lamb, malt sugar, vinegar, etc.
If the face is hot like drunkenness, this is heat in the stomach rushing upward to heat the face. Add Dahuang (Rhei Radix et Rhizoma) to drain it.
Xixin (Asari Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried), Ganjiang (Zingiberis Rhizoma, each 3 liang), Fuling (Poria, 4 liang), Wuweizi (Schisandrae Fructus), Banxia (Pinelliae Rhizoma, washed), Xingren (Armeniacae Semen Amarum, de-husked, de-embryoned, 0.5 sheng each), Dahuang (Rhei Radix et Rhizoma, steamed, 3 liang). The above eight herbs are cut. With 1 dou of water, boil until 3 sheng remains, strain, take warm 1 sheng, three times daily. Avoid Hijiao, Songcai, raw vegetables, malt sugar, vinegar, lamb. (All from Volume 18).