齐氏云∶肺痈肺痿,因脾肺气虚,腠理不密,外邪所乘。或母食辛辣浓味,遗
热于儿。或儿有病,过于汗下,内亡津液,虚火烁肺。或服克伐之药,亏损脾胃,
不能生肺金。其证恶风咳嗽,鼻塞项强,呼吸不利,甚则四肢微肿,咳唾脓血,若
吐臭秽,胸中隐痛,脉数而实者为肺痈,咳唾涎沫,脉数而虚者为肺痿。恶寒喘嗽
者,寒邪内蕴也,小青龙汤。咳唾脓秽者,肺痈内溃也,桔梗汤。窃谓前证若喘咳
短气者,脾肺气虚也,五味异功散。咳唾脓痰左尺脉数而无力者,肾气虚也,六味
地黄丸。咳唾脓痰右关脉数而无力者,脾气虚也,七味白术散。若发热喘嗽唾脓不
食者,脾肺虚甚也,难治。大要,补脾肺,滋肾水,为善。(仍审五脏相胜,乳母七情,
后证仿此)
小青龙汤 治伤风冒寒,咳嗽喘急,肺胀胸满,鼻塞流涕,或干呕热咳,或作渴,
或作噎,或小便不利,或小腹胀满。(此仲景之法,审有是证,用之及时,殊有良验)
麻黄(去节) 赤芍药 半夏(各七钱) 细辛 干姜(炮) 甘草(炙) 桂枝(各三钱)
五味子(半两,杵) 附子(二钱脉浮,不用)
上,每服二钱,水煎。
桔梗汤 治咳嗽,脓血腥秽,已成痈证。
桔梗(炒) 贝母(去心) 知母(炒) 桑白皮(炒) 枳壳(各一钱) 地骨皮 栝蒌仁
薏苡仁 杏仁(杵。各五分) 当归 黄 (炒。各一钱) 五味子(杵,炒) 百合(炒。各一钱
五分) 防己(一钱) 甜葶苈(炒,五分)
上,每服二三钱,水煎服。
升麻汤 治肺痈,脓血秽臭,胸乳皆痛。
升麻 桔梗(炒) 薏苡仁 地榆 条芩(炒) 牡丹皮 芍药(炒) 甘草(各等分)
上,每服二三钱,水煎。
排脓散 治肺痈,此方排脓补肺。
黄 (盐水拌,炒) 白芷 人参 五味子(炒,研。各等分)
上为末。每服一二钱,蜜汤调下。
射干汤 治胃脘痈吐脓血。
射干(去毛) 栀子仁 赤茯苓 升麻 赤芍药(一两三钱) 白术(五钱)
上,每服三五钱,水煎,入地黄汁少许再煎,服。
人参平肺散 治心火克肺金,传为肺痈,咳嗽喘呕,痰涎壅盛,胸膈痞满,咽嗌
不利。
人参 陈皮 甘草 地骨皮 茯苓(各一钱) 知母(炒,七分) 五味子(炒) 青皮 天门冬
(去心,四分) 桑白皮(炒,一钱)
上,每服二三钱。
参 补脾汤 治肺痈,脾气亏损,咳吐脓涎,或中满不食,必服此药补脾土以生肺
金,否则不治。
人参 白术(各二钱) 黄 (炒,二钱五分) 茯苓 陈皮 当归(各一钱) 升麻(三分)
麦门冬(七分) 桔梗(炒,六分) 甘草(炙,五分) 五味子(杵,四分)
上,作三服,姜枣水煎。
人参补肺汤 治肺证咳喘短气,或肾水不足,虚火上炎,痰涎壅盛,或吐脓血发热,
小便短涩。
人参 黄 (炒) 白术 茯苓 陈皮 当归(各一钱) 山茱萸干山药 五味子(杵) 麦
门冬(去心) 甘草(炙) 熟地黄(自制) 牡丹皮(各五分)
上,每服五钱,水煎服。
齐氏说:肺痈和肺痿,是由于脾脏和肺脏气虚,腠理(皮肤毛孔及肌肉间隙)不致密,导致外邪侵袭。或者母亲食用辛辣浓厚的食物,将热邪遗留给婴儿。或者婴儿患病后,过度使用发汗或攻下法,导致体内津液亡失,虚火灼烧肺脏。或者服用克伐损伤性的药物,亏损脾胃,不能生化肺金。其症状表现为恶风、咳嗽、鼻塞、项背强直、呼吸不畅,严重时四肢轻微肿胀,咳吐脓血;如果吐出物臭秽,胸中隐痛,脉象数而实,这是肺痈;如果咳吐涎沫,脉象数而虚,这是肺痿。出现恶寒、气喘咳嗽的,是寒邪内蕴,用小青龙汤。咳吐脓秽物的,是肺痈内部溃破,用桔梗汤。我认为前述病症如果出现气喘咳嗽、短气的,是脾肺气虚,用五味异功散。咳吐脓痰且左尺脉数而无力的,是肾气虚,用六味地黄丸。咳吐脓痰且右关脉数而无力的,是脾气虚,用七味白术散。如果出现发热、气喘咳嗽、咳吐脓血、不能进食的,是脾肺极度虚弱,难以治疗。大抵原则是,补益脾肺,滋补肾水,才是良策。(仍需审查五脏相克关系,以及乳母的情绪变化,后续病症仿照此法处理)。
小青龙汤:治疗伤风冒寒,咳嗽气喘急促,肺胀胸满,鼻塞流涕,或者干呕热咳,或者口渴,或者吞咽梗阻,或者小便不利,或者小腹胀满。(这是张仲景的方法,审察是否有这些证候,及时使用,效果显著)。
麻黄(去节)、赤芍药、半夏(各七钱)、细辛、干姜(炮制)、甘草(炙)、桂枝(各三钱)、五味子(半两,捣碎)、附子(二钱,若脉浮则不用)。
以上药材,每次服用二钱,加水煎煮。
桔梗汤:治疗咳嗽,咳出脓血腥秽之物,已成肺痈证候。
桔梗(炒)、贝母(去心)、知母(炒)、桑白皮(炒)、枳壳(各一钱)、地骨皮、栝蒌仁、薏苡仁、杏仁(捣碎,各五分)、当归、黄芪(炒,各一钱)、五味子(捣碎,炒)、百合(炒,各一钱五分)、防己(一钱)、甜葶苈(炒,五分)。
以上药材,每次服用二三钱,加水煎服。
升麻汤:治疗肺痈,脓血秽臭,胸部和乳房都疼痛。
升麻、桔梗(炒)、薏苡仁、地榆、条芩(炒)、牡丹皮、芍药(炒)、甘草(各等分)。
以上药材,每次服用二三钱,加水煎煮。
排脓散:治疗肺痈,此方具有排脓补肺的功效。
黄芪(用盐水拌,炒)、白芷、人参、五味子(炒,研碎,各等分)。
以上药材制成粉末。每次服用一二钱,用蜜汤调服。
射干汤:治疗胃脘痈,吐脓血。
射干(去毛)、栀子仁、赤茯苓、升麻、赤芍药(一两三钱)、白术(五钱)。
以上药材,每次服用三五钱,加水煎煮,加入少许地黄汁再煎,服用。
人参平肺散:治疗心火克制肺金,传变为肺痈,咳嗽气喘呕吐,痰涎壅盛,胸膈痞闷胀满,咽喉不利。
人参、陈皮、甘草、地骨皮、茯苓(各一钱)、知母(炒,七分)、五味子(炒)、青皮、天门冬(去心,四分)、桑白皮(炒,一钱)。
以上药材,每次服用二三钱。
参补脾汤:治疗肺痈,脾气亏损,咳吐脓涎,或者腹部胀满不能进食,必须服用此药补益脾土以生肺金,否则无法治愈。
人参、白术(各二钱)、黄芪(炒,二钱五分)、茯苓、陈皮、当归(各一钱)、升麻(三分)、麦门冬(七分)、桔梗(炒,六分)、甘草(炙,五分)、五味子(捣碎,四分)。
以上药材,分为三服,加生姜、大枣用水煎煮。
人参补肺汤:治疗肺病咳嗽气喘短气,或者肾水不足,虚火上炎,痰涎壅盛,或者吐脓血发热,小便短少涩滞。
人参、黄芪(炒)、白术、茯苓、陈皮、当归(各一钱)、山茱萸、干山药、五味子(捣碎)、麦门冬(去心)、甘草(炙)、熟地黄(自制)、牡丹皮(各五分)。
以上药材,每次服用五钱,加水煎服。
Qi stated: Lung abscess (Fei Yong) and lung atrophy (Fei Wei) arise from deficiency of Qi in the Spleen and Lung, with loose interstices (Cou Li), allowing external pathogens to invade. Alternatively, if the mother consumes spicy and rich foods, heat may be transmitted to the infant. Or, if the infant is ill and subjected to excessive sweating or purging methods, internal fluids are depleted, and deficient fire scorches the Lung. Or, if astringent or damaging medicines are taken, the Spleen and Stomach are impaired, failing to generate Metal (Lung). The manifestations include aversion to wind, coughing, nasal congestion, stiffness of the neck, and difficult breathing; in severe cases, slight swelling of the four limbs occurs, along with coughing up pus and blood. If foul-smelling material is expectorated accompanied by dull chest pain, and the pulse is rapid and excess (Shi), it is Lung abscess. If saliva and foam are expectorated with a rapid but deficient (Xu) pulse, it is lung atrophy. Aversion to cold with wheezing and coughing indicates internal accumulation of cold pathogen, treated with Xiao Qing Long Tang. Expectoration of purulent and foul matter indicates internal ulceration of lung abscess, treated with Jie Geng Tang. I believe that for the aforementioned conditions, if there is wheezing, coughing, and shortness of breath, it indicates deficiency of Spleen and Lung Qi, treated with Wu Wei Yi Gong San. If pus and phlegm are expectorated with a rapid but forceless left Chi pulse, it indicates deficiency of Kidney Qi, treated with Liu Wei Di Huang Wan. If pus and phlegm are expectorated with a rapid but forceless right Guan pulse, it indicates deficiency of Spleen Qi, treated with Qi Wei Bai Zhu San. If fever, wheezing, coughing, expectoration of pus and blood, and anorexia occur, it indicates extreme deficiency of Spleen and Lung, which is difficult to treat. Generally, tonifying the Spleen and Lung, and nourishing Kidney Water, is the proper approach. (One must still examine the mutual overcoming relationships among the Five Zang organs and the emotional states of the nursing mother; subsequent conditions should follow this pattern.)
Xiao Qing Long Tang (Minor Green Dragon Decoction): Treats wind-cold injury, coughing with urgent wheezing, lung distension and chest fullness, nasal congestion with runny nose, dry heaving with hot cough, thirst, dysphagia, difficulty in urination, or lower abdominal fullness. (This is the method of Zhang Zhongjing; when these syndromes are identified and applied promptly, it yields excellent results.)
Ephedrae Herba (Mahuang, 麻黄) [devoid of joints], Red Peony Root (Chishao Yao), Pinelliae Rhizoma (Banxia) [each 7 qian], Asari Radix et Rhizoma (Xixin), Dried Ginger (Ganjiang) [prepared], Licorice Root (Gancao) [roasted], Cinnamon Twig (Guizhi) [each 3 qian], Schisandra Fruit (Wuweizi) [0.5 liang, pounded], Aconiti Lateralis Radix Praeparata (Fuzi) [2 qian; omit if pulse is floating].
Take the above ingredients, each dose 2 qian, decoct in water.
Jie Geng Tang (Platycodon Decoction): Treats coughing with expectoration of purulent, bloody, and foul matter, indicating established lung abscess syndrome.
Platycodon Root (Jie Geng) [stir-fried], Fritillaria Bulb (Beimu) [devoid of heart], Anemarrhenae Rhizoma (Zhimu) [stir-fried], Morus Cortex (Sangbaipi) [stir-fried], Aurantii Fructus Immaturus (Zhike) [each 1 qian], Lycii Cortex (Digupi), Trichosanthis Semen (Gualou Ren), Coicis Semen (Yiyiren), Apricot Seed (Xingren) [pounded, each 5 fen], Angelicae Sinensis Radix (Danggui), Astragali Radix (Huangqi) [stir-fried, each 1 qian], Schisandra Fruit (Wuweizi) [pounded, stir-fried], Lilii Bulbus (Baihe) [stir-fried, each 1.5 qian], Stephaniae Tetrandrae Radix (Fangji) [1 qian], Descurainiae Semen Lepidii et Lepidii Semen (Tinglizi) [stir-fried, 5 fen].
Take the above ingredients, each dose 2-3 qian, decoct in water and take.
Shengma Tang (Cimicifugae Decoction): Treats lung abscess with foul-smelling pus and blood, and pain in both the chest and breasts.
Cimicifugae Rhizoma (Shengma), Platycodon Root (Jie Geng) [stir-fried], Coicis Semen (Yiyiren), Sanguisorbae Radix (Diyu), Scutellariae Radix (Tiaoxin) [stir-fried], Moutan Cortex (Mudanpi), Paeoniae Radix (Shaoyao) [stir-fried], Licorice Root (Gancao) [equal parts].
Take the above ingredients, each dose 2-3 qian, decoct in water.
Pai Nong San (Pus-Discharging Powder): Treats lung abscess; this formula discharges pus and tonifies the Lung.
Astragali Radix (Huangqi) [mixed with salt water, stir-fried], Angelicae Dahuricae Radix (Baizhi), Ginseng Radix et Rhizoma (Renshen), Schisandra Fruit (Wuweizi) [stir-fried, ground] [equal parts].
Grind into powder. Each dose 1-2 qian, taken with honey water.
Shegan Tang (Belamcanda Decoction): Treats epigastric abscess with expectoration of pus and blood.
Belamcandae Rhizoma (Shegan) [devoid of hairs], Gardeniae Fructus (Zhizi Ren), Polyporus (Chifuling), Cimicifugae Rhizoma (Shengma), Red Peony Root (Chishaoyao) [1 liang 3 qian], Atractylodis Macrocephalae Rhizoma (Baizhu) [5 qian].
Take the above ingredients, each dose 3-5 qian, decoct in water, add a small amount of Rehmanniae Juice (Dihuangzhi), decoct again, and take.
Renshen Pingfei San (Ginseng Lung-Pacifying Powder): Treats Heart Fire suppressing Lung Metal, transmitting into lung abscess, with coughing, wheezing, vomiting, abundant phlegm and saliva, chest and diaphragm stuffiness and fullness, and throat obstruction.
Ginseng Radix et Rhizoma (Renshen), Tangerine Peel (Chenpi), Licorice Root (Gancao), Lycii Cortex (Digupi), Poria (Fuling) [each 1 qian], Anemarrhenae Rhizoma (Zhimu) [stir-fried, 7 fen], Schisandra Fruit (Wuweizi) [stir-fried], Citri Reticulatae Pericarpium Viride (Qingpi), Asparagi Radix (Tianmendong) [devoid of heart, 4 fen], Morus Cortex (Sangbaipi) [stir-fried, 1 qian].
Take the above ingredients, each dose 2-3 qian.
Can Bupi Tang (Ginseng Spleen-Tonifying Decoction): Treats lung abscess due to Spleen Qi damage, with expectoration of pus and saliva, or abdominal fullness and anorexia. This medicine must be taken to tonify Spleen Earth to generate Lung Metal; otherwise, it is incurable.
Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu) [each 2 qian], Astragali Radix (Huangqi) [stir-fried, 2.5 qian], Poria (Fuling), Tangerine Peel (Chenpi), Angelicae Sinensis Radix (Danggui) [each 1 qian], Cimicifugae Rhizoma (Shengma) [3 fen], Ophiopogonis Radix (Maidong) [7 fen], Platycodon Root (Jie Geng) [stir-fried, 6 fen], Licorice Root (Gancao) [roasted, 5 fen], Schisandra Fruit (Wuweizi) [pounded, 4 fen].
Divide into three doses, decoct with Ginger and Jujube in water.
Renshen Bufei Tang (Ginseng Lung-Nourishing Decoction): Treats Lung disease with coughing, wheezing, and shortness of breath, or insufficient Kidney Water with deficient fire flaming upward, abundant phlegm and saliva, expectoration of pus and blood with fever, and scanty, difficult urination.
Ginseng Radix et Rhizoma (Renshen), Astragali Radix (Huangqi) [stir-fried], Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Tangerine Peel (Chenpi), Angelicae Sinensis Radix (Danggui) [each 1 qian], Corni Fructus (Shanzhuyu), Dioscoreae Rhizoma (Shanyao), Schisandra Fruit (Wuweizi) [pounded], Ophiopogonis Radix (Maidong) [devoid of heart], Licorice Root (Gancao) [roasted], Prepared Rehmanniae Radix (Shudihuang) [self-made], Moutan Cortex (Mudanpi) [each 5 fen].
Take the above ingredients, each dose 5 qian, decoct in water and take.