人身难治之病有百证。喘病其最也。喘病无不本之于肺。
然随所伤而互关。渐以造于其极。惟兼三阴之证者为最剧。三阴者。少阴肾太阴脾厥阴肝也。而三阴又以少阴
肾为最剧。经云。肾病者善胀。尻以代踵。脊以代头。此喘病兼肾病之形也。又云。劳风发在肺下。巨阳引精
者三日。中年者五日。不精者七日。当咳出青黄浓浊之痰如弹子大者。不出者伤肺。伤肺者死也。此喘病兼肾
病之情也。故有此证者。首重在节欲。收摄肾气。不使上攻可也。其次则太阴脾厥阴肝之兼证亦重。勿以饮
食忿怒之故。重伤肝脾可也。若君艺之喘证。得之于髫幼。非有忿欲之伤。止是形寒饮冷。伤其肺耳。然从
幼惯生疮疖。疮疖之后。复生牙痈。脾中之湿热素多。胃中之壮火素盛。是肺经所以受伤之原。又不止于形
寒饮冷也。脾之湿热。胃之壮火。交煽而互蒸。结为浊痰。溢入上窍。久久不散。透开肺膜。结为窠囊。
清气入之。浑然不觉。浊气入之。顷刻与浊痰野狼狈相根据。合为党援。窒塞关隘。不容呼吸出入。而呼吸正气。
转触其痰。鼾 有声。头重耳响。胸背骨间。有如刀刺。涎涕交作。鼻 酸辛。若伤风状。正内经所谓心肺
有病。而呼吸为之不利也。必俟肺中所受之浊气。解散下行。从前后二阴而去。然后肺中之浓痰。咯之
始得易出。而渐可相安。及夫浊气复上。则窠囊之痰复动。窒塞仍前复举。乃至寒之亦发。热之亦发。伤酒
伤食亦发。动怒动气亦发。所以然者。总繇动其浊气耳。浊气本居下体。不易犯入清道。每随火势而上腾。所
谓火动则气升者。浊气升也。肾火动。则寒气升。脾火动。则湿气升。肝火动。则风气升也。故以治火
为先也。然浊气既随火而升。亦可随火而降。乃凝神入气以静调之。火降而气不降者何耶。则以浊气虽居于
下。而肺中之窠囊。实其新造之区。可以侨寓其中。转使清气逼处不安。亦若为乱者然。如寇贼根据山傍险。
蟠据一方。此方之民。势必扰乱而从寇也。故虽以治火为先。然治火而不治痰。无益也。治痰而不治
窠囊之痰。虽治与不治等也。治痰之法。曰驱。曰导。曰涤。曰
化。曰涌。曰理脾。曰降火。曰行气。前人之法。不为不详。至于窠囊之痰。如蜂子之穴于房中。如莲子之嵌
于蓬内。生长则易。剥落则难。繇其外窄中宽。任行驱导涤涌之药。徒伤他脏。此实闭拒而不纳耳。究而言
之。岂但窠囊之中。痰不易除。即肺叶之外。膜原之间。顽痰胶结多年。如树之有萝。如屋之有游。如石
之有苔。附托相安。仓卒有难于 伐者。古今之为医者伙矣。从无有为此渺论者。仆生平治此症最多。皆以活
法而奏全绩。盖肺中浊痰为祟。若牛渚怪物。莫逃吾燃犀之照者。因是旷观病机。异哉。肺金以脾土为母。
而肺中之浊痰。亦以脾中之湿为母。脾性本喜燥恶湿。迨夫湿热久锢。遂至化刚为柔。居间用
事。饮食入胃。既以精华输我周身。又以败浊填彼窍隧。始尚交相为养。最后挹彼注此。颛为外邪示岂弟。致
使凭城凭社辈。得以久遂其奸。如附近流寇之地。益以巨家大族。暗为输导。其滋蔓难图也。有繇然矣。
治法必静以驭气。使三阴之火不上升。以默杜外援。又必严以驭脾。使太阴之权有独伸而不假敌忾。我
实彼虚。我坚彼瑕。批瑕捣虚。迅不掩耳。不崇朝而扫清秽浊。乃广服大药。以安和五脏。培养肺气。肺金之
气一清。则周身之气。翕然从之下降。前此上升浊邪。允绝其源。百年之间。常保清明在躬矣。此盖行所当
然。不得不然之法。夫岂涂饰听闻之赘词耶。君艺敦请颛治。果获全瘳。益见仆言非谬矣。
胡卣臣先生曰。岐黄论道以后。从不见有此精细快彻之谭。应是医门灵宝。又曰。君艺童年锢疾。非所易
瘳。今疾愈而且得子矣。先议后药。功不伟耶。
人体难以治愈的疾病有上百种，其中喘病是最严重的。喘病没有不根源在于肺的。然而，它会随着所损伤的部位而相互关联，逐渐发展到极点。只有兼有三阴经证候的最为剧烈。三阴经指的是少阴肾、太阴脾和厥阴肝。而在三阴经中，又以少阴肾的证候最为严重。医经上说：肾病的人容易腹胀，严重时臀部着地代替脚行走，脊背弯曲头部前倾代替眼睛视物（尻以代踵，脊以代头），这是喘病兼有肾病的形态表现。又说：劳风病发作于肺下，足太阳膀胱经引导精气，年轻力壮者三天，中年人五天，精气不足者七天，应当咳出像弹子大小、青黄色浓浊的痰液，如果排不出来就会损伤肺脏，损伤肺脏就会导致死亡，这是喘病兼有肾病的病情表现。因此，有此证候的人，首要在于节制欲望，收敛肾气，不让其向上攻冲即可。其次，太阴脾和厥阴肝的兼证也很重要，不要因为饮食不节或愤怒情绪，而重伤肝脾。至于浦君艺的喘证，是从幼年时期得的，并没有因愤怒或欲望造成的损伤，仅仅是因为形体受寒、饮用冷食，损伤了肺脏而已。然而他从小经常生疮疖，疮疖之后，又生牙痈，说明他脾中的湿热素来很多，胃中的壮火素来旺盛，这才是肺经受伤的根源，不仅仅是因为形寒饮冷。脾的湿热与胃的壮火互相煽动、蒸腾，凝结成浊痰，溢出进入上窍，久久不散，透开肺膜，结为窠囊（类似巢穴的病理性结构）。清气进入其中，浑然不觉；浊气进入其中，顷刻间便与浊痰狼狈为奸，勾结在一起，堵塞关隘，不允许呼吸出入。而呼吸时的正气，反过来触动这些痰液，发出鼾声，头部沉重，耳朵响，胸背骨间感觉像刀刺一样疼痛，涎涕交替发作，鼻子酸辛，就像伤风的样子。这正是《内经》所说的“心肺有病，导致呼吸不利”。必须等到肺中所受的浊气解散下行，从前阴和后阴排出，然后肺中的浓痰才能容易咯出，逐渐得以安宁。等到浊气再次上行，窠囊中的痰液就会再次扰动，堵塞情况依旧重现。甚至寒冷刺激会发作，热性刺激也会发作，饮酒过度或饮食积滞也会发作，动怒或气机逆乱也会发作。之所以这样，总归是因为动摇了浊气罢了。浊气本来居于下体，不容易侵犯清道（呼吸道等上部通道），常常随着火势而上腾，这就是所谓“火动则气升”，即浊气上升。肾火动，寒气就上升；脾火动，湿气就上升；肝火动，风气就上升。所以治疗应以治火为先。然而浊气既然随着火而上升，也可以随着火而降。通过凝神入气，用静法来调理它。为什么火降了而气不降呢？这是因为浊气虽然居于下体，但肺中的窠囊，实际上是它新建立的据点，可以寄居其中，反而使清气感到不安，就像作乱一样。如同寇贼占据山险，盘踞一方，当地的百姓势必会被扰乱而跟随寇贼。所以虽然以治火为先，但如果治火而不治痰，是没有益处的。治痰如果不治窠囊中的痰，虽然治疗和不治疗是一样的。治痰的方法，有驱除、引导、涤荡、化解、涌吐、理脾、降火、行气等，前人的方法已经非常详细了。至于窠囊中的痰，像蜂子在房中筑巢，像莲子嵌在蓬草内，生长容易，剥落很难。因为它们外窄中宽，任凭使用驱、导、涤、涌的药物，只会伤害其他脏腑，这其实是闭拒而不接纳药力。仔细推究起来，岂止是窠囊之中痰不易清除，就是肺叶之外、膜原之间的顽痰，胶结多年，像树上有藤蔓，屋上有游尘，石上有苔藓，依附共存，仓促之间难以铲除。古今做医生的人很多了，从来没有对此发表过这种深刻见解的。我生平治疗此症最多，都是用活法而取得完全疗效。大概肺中的浊痰作祟，就像牛渚矶的怪物，逃不过我燃犀角照妖般的洞察。因此广泛观察病机，真是奇妙啊。肺金以脾土为母，而肺中的浊痰，也以脾中的湿为母。脾的本性是喜燥恶湿，等到湿热久留固结，竟然化刚为柔，居中用事。饮食进入胃中，既将精华输送给周身，又将败浊填入那些窍隧。起初还是互相滋养，最后却是汲取这里的补充那里，专门向外邪示好，致使凭借城墙社稷（比喻体内正气防御）的人，得以长久地遂其奸计，就像邻近流寇的地区，又有大户人家暗中为其输送物资，其滋蔓难图之势由此产生。治疗方法必须用静法驾驭气，使三阴之火不上升，以默默杜绝外援。又必须用严法驾驭脾，使太阴脾的职权能够独自伸展，而不假借敌忾（对抗外邪的力量）。使我实彼虚，我坚彼瑕，攻击其弱点，捣毁其空虚，迅速得胜，不遮耳掩目，不到半天就能扫清秽浊。然后广服大药，以安和五脏，培养肺气。肺金之气一旦清净，周身之气就会随之下降。此前上升的浊邪，彻底断绝源头，百年之间，常能保持身心清明。这大概是理所当然、不得不然的法则，难道是粉饰听闻的废话吗？浦君艺诚恳请求专门治疗，果然获得完全康复，更证明我的话不是谬误。
胡卣臣先生说：“自从岐黄论道以来，从未见过如此精细透彻的谈论，这应该是医门的灵宝。”又说：“浦君艺童年的顽固疾病，不是容易治愈的，现在病愈而且得子了，先议定治疗方案再用药，功劳难道不大吗？”
There are hundreds of difficult-to-treat diseases in the human body, among which asthma (Wheezing Disease) is the most severe. Asthma invariably originates from the Lung (Zang Organ). However, it interconnects with whatever part is injured and gradually progresses to its extreme. The cases involving the three Yin meridians are the most critical. The three Yin refer to the Shaoyin Kidney, Taiyin Spleen, and Jueyin Liver. Among them, the Shaoyin Kidney condition is the most severe. The Classics state: "In kidney disease, there is a tendency toward distension; the patient sits on the buttocks instead of using the feet, and bends the spine forward instead of using the head." This describes the physical manifestation of asthma complicated by kidney disease. It also states: "Lao-feng (Wind caused by overwork) erupts below the lungs. If the Greater Yang (Taiyang) meridian guides the essence, a vigorous person recovers in three days, a middle-aged person in five days, and one lacking essence in seven days. They should cough up thick, turbid phlegm that is greenish-yellow and the size of a large egg. If it is not expelled, the lungs will be damaged, and damage to the lungs leads to death." This describes the clinical situation of asthma complicated by kidney disease. Therefore, for those with this syndrome, the primary focus must be on restraining desires and conserving Kidney Qi, preventing it from attacking upward. Secondly, complications involving the Taiyin Spleen and Jueyin Liver are also significant; one must avoid severely injuring the Liver and Spleen due to improper diet or anger.
As for Mr. Pu Yi's asthma, it was acquired in childhood, without injury from anger or desire, but solely due to external cold and cold drinks damaging the Lungs. However, since he frequently suffered from sores and boils in his youth, and after these developed dental abscesses, it indicates that he inherently possessed excessive damp-heat in the Spleen and vigorous fire in the Stomach. This is the root cause of the Lung injury, extending beyond mere exposure to cold and cold drinks. The damp-heat of the Spleen and the vigorous fire of the Stomach mutually incite and steam each other, condensing into turbid phlegm. This overflows into the upper orifices, lingering for a long time, penetrating the lung membranes, and forming "nest-like sacs" (pathological cavities filled with phlegm). Clear Qi enters these sacs unnoticed, but turbid Qi entering them quickly collides with the turbid phlegm, forming alliances that block the passages, obstructing respiration. The righteous Qi involved in breathing then touches this phlegm, producing snoring sounds, heavy head, ringing ears, stabbing pain between the chest and back bones, alternating saliva and nasal discharge, and nasal sourness and pungency, resembling a common cold. This corresponds to what the Inner Canon states: "When the Heart and Lungs are diseased, respiration becomes difficult." One must wait until the turbid Qi received by the Lungs dissipates and descends, exiting through the anterior and posterior orifices, before the thick phlegm in the Lungs can be easily expectorated, allowing for gradual relief. When turbid Qi rises again, the phlegm in the nest-like sacs moves, and the obstruction recurs. Attacks occur regardless of cold, heat, alcohol consumption, food stagnation, or emotional agitation. The reason is that the turbid Qi has been disturbed. Turbid Qi naturally resides in the lower body and does not easily invade the clear pathways (upper respiratory tract); it usually ascends with fire, as stated: "When fire moves, Qi ascends," meaning turbid Qi ascends. When Kidney fire moves, cold Qi ascends; when Spleen fire moves, damp Qi ascends; when Liver fire moves, wind Qi ascends. Thus, treatment should prioritize regulating fire.
However, since turbid Qi ascends with fire, it can also descend with fire. By focusing the spirit and entering Qi, one can regulate it through stillness. Why does the Qi fail to descend even when the fire subsides? Because although turbid Qi resides in the lower body, the nest-like sacs in the Lungs serve as its newly established base, where it can lodge itself, making the Clear Qi feel uncomfortable, akin to rebellion. Like bandits occupying mountain passes and settling in a region, the local people are inevitably disrupted and follow the bandits. Therefore, although treating fire is prioritized, treating fire without treating phlegm is useless. Treating phlegm without addressing the phlegm in the nest-like sacs is equivalent to no treatment at all. Methods for treating phlegm include expelling, guiding, purging, resolving, inducing vomiting, regulating the Spleen, descending fire, and moving Qi. Previous methods have been detailed. However, phlegm in nest-like sacs is like bees nesting in a house or lotus seeds embedded in a pod; easy to grow, difficult to remove. Due to their narrow exterior and wide interior, drugs used for expulsion, guidance, purging, and vomiting merely injure other Zang organs, as the sacs reject and do not accept the medicine. Upon closer examination, it is not only the phlegm in the sacs that is hard to remove, but also the stubborn phlegm adhering for years outside the lung lobes and between the membrane sources, like vines on trees, dust in houses, or moss on stones. These adhere comfortably and are difficult to eradicate hastily. Many physicians have existed throughout history, yet none have offered such profound insights. I have treated this condition most frequently in my life, achieving full recovery using flexible methods. The turbid phlegm in the Lungs acts like the monster at Niuzhu Rock, unable to escape my illuminating insight (symbolized by burning rhino horn). Observing the pathogenesis broadly, it is truly remarkable. The Lung Metal considers the Spleen Earth as its mother; similarly, the turbid phlegm in the Lungs considers the dampness in the Spleen as its mother. The Spleen naturally prefers dryness and dislikes dampness. When damp-heat remains entrenched for a long time, it transforms from rigid to soft, taking central control. Food entering the Stomach sends its essence to nourish the whole body but also fills the orifices and tunnels with waste. Initially, they nourish each other, but eventually, resources are diverted to support external pathogens, allowing those who rely on defenses to persist in their treachery. Like regions near bandit territories receiving secret supplies from wealthy families, the spread becomes difficult to manage.
The treatment method must use stillness to control Qi, preventing the fire of the three Yin meridians from ascending, thereby silently cutting off external aid. It must also strictly control the Spleen, allowing the authority of the Taiyin Spleen to extend independently without relying on fighting enemies. This creates a situation where we are solid and they are weak, we are firm and they are flawed. Attacking their flaws and empty spots swiftly, without warning, clears the filth within half a day. Then, administer major medicines to harmonize the five Zang organs and cultivate Lung Qi. Once the Qi of Lung Metal is cleared, the Qi of the entire body will descend together. The previously ascending turbid pathogens will have their source cut off, ensuring clarity and health for a century. This is the necessary and inevitable method, not mere rhetoric to impress listeners. Mr. Pu Yi sincerely requested specialized treatment and indeed achieved complete recovery, proving my words were not erroneous.
Mr. Hu Youchen said: "Since the discussions of Qibo and Huangdi, no such fine and thorough discourse has been seen. This should be considered a precious treasure of the medical profession." He added: "Mr. Pu Yi's childhood chronic illness was not easily curable. Now that the disease is cured and he has had a son, the merit of discussing the strategy before prescribing medication is indeed great."