经曰∶五脏咳久,传于六腑。脾咳不已,则胃受之。胃咳之状,咳而呕,呕甚则长虫出。胃乃
脾之妻,故脾咳必传于胃。胃受邪则水谷不安,故发呕。长虫常处胃中,呕甚则胃气逆而不降,故
长虫亦随气而出也。加味二陈汤主之。
加味二陈汤(自制)
橘红(一钱) 半夏(一钱五分) 茯苓(二钱) 白术(一钱) 苡仁(四钱)
枳壳(一钱) 砂仁(一钱) 苏梗(一钱) 花椒子(二十四粒) 姜(三片)
肝咳不已,则胆受之。胆咳之状,咳呕胆汁。胆为清净之腑,肝邪中之,则胆不安,而汁内沸
,故所呕皆苦水。西清汤主之。
西清汤(自制)
桂枝(五分) 栀子(一钱五分姜汁炒) 苏子(一钱五分) 桑皮(二钱) 杏仁(三钱)
橘红(一钱) 半夏(一钱) 茯苓(二钱) 蒺藜(三钱) 郁金(二钱) 姜(三片)
肺咳不已,则大肠受之。大肠咳状,咳而遗矢。肺与大肠,庚辛金也。风阳外烁,肺热移于大肠,更兼风入空
窍,宜其咳而遗矢矣。当培土化热,兼以熄风,回风养脏汤主之。
回风养脏汤(自制)
沙参(四钱) 苏子(一钱五分) 枳壳(一钱) 前胡(一钱) 桑叶(一钱) 茯
苓(二钱) 白术(一钱) 苡仁(四钱) 橘红(一钱) 贝母(二钱) 荷叶蒂(一枚)
心咳不已,则小肠受之。小肠咳状,咳而失气,气与咳俱失。小肠下口接大肠之上口,小肠化则
大肠通,小肠咳则气达于大肠,故下焦之浊气不时宣泄也。洁宫汤主之。
洁宫汤(自制)
沙参(四钱) 茯神(二钱) 远志(五分甘草水炒) 归身(二钱) 麦冬(二钱) 贝
母(二钱) 橘红(一钱) 半夏(一钱) 白术(一钱) 砂仁(一钱) 姜(三片)
肾咳不已,则膀胱受之。膀胱咳状,咳而遗尿。膀胱为津液之腑,咳则气不能禁而遗溺也。加
味茯菟汤主之。
加味茯菟汤(自制)
茯苓(三钱) 菟丝(四钱) 杜仲(三钱) 破故纸(一钱五分) 当归(二钱)
贝母(二钱) 橘红(一钱) 半夏(一钱) 白术(一钱) 杏仁(三钱) 核桃肉(二枚过口)
久咳不已,则三焦受之。三焦咳状,咳而腹满,不欲饮食。此皆聚于胃,关于肺,使人多涕唾
,而面浮肿气逆也。久咳则三焦俱病。聚于胃者,胃为五脏六腑之本也。关于肺者,咳必动肺,面
浮气逆,皆肺病也。通理汤主之。
通理汤(自制)
当归(二钱) 茯苓(二钱) 白术(一钱) 苡仁(四钱) 枳壳(一钱) 橘红(一
钱) 半夏(一钱) 浓朴(一钱) 青皮(一钱) 桑皮(二钱) 砂仁(一钱) 苏子
(一钱五分) 姜(三片)
先生批《医学心悟》云∶“喘病甚多,而皆非善症。治喘之法,不过一降一纳尽之。上焦之有
余者降之,使不得反逆,而清肃之令行矣。下焦之不足者纳之,使归其窟宅,而根本之园地固矣。”
先生所批,较叶香岩所谓实喘在肺、虚喘在肾之意,更为明显。祖怡注。
《黄帝内经》说:五脏的咳嗽日久不愈,会传变到六腑。脾咳如果不愈,就会传给胃。胃咳的症状是咳嗽并伴有呕吐,呕吐严重时会有蛔虫吐出。胃与脾互为表里(脾为阴土,胃为阳土,故称妻),所以脾咳必然传于胃。胃受到邪气侵袭,导致水谷运化失常,因此发生呕吐。蛔虫常栖息在胃中,当呕吐剧烈时,胃气上逆而不能下降,所以蛔虫也随着逆气而出。治疗以加味二陈汤为主方。
加味二陈汤(自制)
橘红(一钱) 半夏(一钱五分) 茯苓(二钱) 白术(一钱) 薏苡仁(四钱)
枳壳(一钱) 砂仁(一钱) 苏梗(一钱) 花椒子(二十四粒) 生姜(三片)
肝咳如果不愈,就会传给胆。胆咳的症状是咳嗽并呕吐胆汁。胆属于清净之腑,肝邪侵犯它,导致胆气不安,胆汁沸腾,所以呕吐出来的都是苦水。治疗以西清汤为主方。
西清汤(自制)
桂枝(五分) 栀子(一钱五分,用姜汁炒) 苏子(一钱五分) 桑白皮(二钱) 杏仁(三钱)
橘红(一钱) 半夏(一钱) 茯苓(二钱) 蒺藜(三钱) 郁金(二钱) 生姜(三片)
肺咳如果不愈,就会传给大肠。大肠咳的症状是咳嗽并伴有大便失禁。肺与大肠同属庚辛金(五行中金)。风阳外热灼伤,肺热移注于大肠,再加上风邪侵入空窍,所以会出现咳嗽并大便失禁的情况。应当培补脾胃以化除湿热,兼以熄风,治疗以回风养脏汤为主方。
回风养脏汤(自制)
沙参(四钱) 苏子(一钱五分) 枳壳(一钱) 前胡(一钱) 桑叶(一钱) 茯苓(二钱) 白术(一钱) 薏苡仁(四钱) 橘红(一钱) 贝母(二钱) 荷叶蒂(一枚)
心咳如果不愈,就会传给小肠。小肠咳的症状是咳嗽并失气(放屁),气和咳嗽同时排出。小肠的下口连接大肠的上口,小肠功能正常则大肠通畅,小肠咳嗽则气机通达于大肠,所以下焦的浊气不时宣泄出来。治疗以洁宫汤为主方。
洁宫汤(自制)
沙参(四钱) 茯神(二钱) 远志(五分,用甘草水炒) 当归身(二钱) 麦冬(二钱) 贝母(二钱) 橘红(一钱) 半夏(一钱) 白术(一钱) 砂仁(一钱) 生姜(三片)
肾咳如果不愈,就会传给膀胱。膀胱咳的症状是咳嗽并遗尿。膀胱是津液汇聚之腑,咳嗽时气机不能固摄,导致小便失禁。治疗以加味茯菟汤为主方。
加味茯菟汤(自制)
茯苓(三钱) 菟丝子(四钱) 杜仲(三钱) 破故纸(即补骨脂,一钱五分) 当归(二钱)
贝母(二钱) 橘红(一钱) 半夏(一钱) 白术(一钱) 杏仁(三钱) 核桃肉(两枚,去皮嚼服)
久咳不愈,就会传给三焦。三焦咳的症状是咳嗽并腹部胀满,不想饮食。这都是病邪聚集在胃,关联于肺,使人多涕唾,面部浮肿且气机上逆。久咳会导致三焦全部受病。病邪聚集在胃,是因为胃是五脏六腑的根本。病邪关联于肺,是因为咳嗽必然触动肺气,面部浮肿和气逆,都是肺病的表现。治疗以通理汤为主方。
通理汤(自制)
当归(二钱) 茯苓(二钱) 白术(一钱) 薏苡仁(四钱) 枳壳(一钱) 橘红(一钱) 半夏(一钱) 厚朴(一钱) 青皮(一钱) 桑白皮(二钱) 砂仁(一钱) 苏子(一钱五分) 生姜(三片)
先生批注《医学心悟》时说:“喘证种类很多,但都不是良善之症。治疗喘证的方法,不过在于‘降’和‘纳’两个方面。上焦有余邪者予以降泄,使其不得反逆,从而恢复清肃的功能;下焦不足者予以纳收,使其回归本源,从而巩固根本。”先生的批注,比叶天士所说的“实喘在肺、虚喘在肾”的意思,更加明确清晰。祖怡注。
The *Classic of Difficult Issues* (Jing Yue) states: When cough originating from the Five Zang organs persists for a long time, it transmits to the Six Fu organs. If Pi (Spleen) cough does not heal, it transmits to Wei (Stomach). The manifestation of Wei (Stomach) cough is cough accompanied by vomiting; if vomiting is severe, Ascaris lumbricoides (roundworms) may be expelled. Wei (Stomach) and Pi (Spleen) are interior-exterior partners (Pi being Yin Earth, Wei being Yang Earth), therefore Pi (Spleen) cough must transmit to Wei (Stomach). When Wei (Stomach) is invaded by pathogenic factors, the digestion and transportation of water and grain become disturbed, leading to vomiting. Ascaris lumbricoides often reside in the Stomach; when vomiting is severe, Stomach Qi rebels upward and fails to descend, causing the worms to exit along with the rebellious Qi. The treatment is primarily Jia Wei Er Chen Tang (Modified Two-Chen Decoction).
Jia Wei Er Chen Tang (Self-made Formula)
Ju Hong (Citri Reticulatae Pericarpium Rubrum, 1 qian)
Ban Xia (Pinelliae Rhizoma, 1.5 qian)
Fu Ling (Poria, 2 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian)
Yi Yi Ren (Coicis Semen, 4 qian)
Zhi Qiao (Aurantii Fructus Immaturus, 1 qian)
Sha Ren (Amomi Fructus, 1 qian)
Su Geng (Perillae Caulis, 1 qian)
Hua Jiao Zi (Zanthoxyli Semen, 24 grains)
Sheng Jiang (Zingiberis Rhizoma Recens, 3 slices)
If Gan (Liver) cough does not heal, it transmits to Dan (Gallbladder). The manifestation of Dan (Gallbladder) cough is cough accompanied by vomiting of bile. Dan (Gallbladder) is a pure and clear Fu organ; when Gan (Liver) pathogenic factors invade it, Dan (Gallbladder) becomes unsettled, and its juice boils internally, resulting in the vomiting of bitter fluid. The treatment is primarily Xi Qing Tang (West-Clearing Decoction).
Xi Qing Tang (Self-made Formula)
Gui Zhi (Cinnamomi Ramulus, 0.5 fen)
Zhi Zi (Gardeniae Fructus, 1.5 qian, stir-fried with Ginger Juice)
Su Zi (Perillae Fructus, 1.5 qian)
Sang Pi (Mori Cortex, 2 qian)
Xing Ren (Armeniacae Semen Amarum, 3 qian)
Ju Hong (Citri Reticulatae Pericarpium Rubrum, 1 qian)
Ban Xia (Pinelliae Rhizoma, 1 qian)
Fu Ling (Poria, 2 qian)
Ji Li (Tribuli Fructus, 3 qian)
Yu Jin (Curcumae Radix, 2 qian)
Sheng Jiang (Zingiberis Rhizoma Recens, 3 slices)
If Fei (Lung) cough does not heal, it transmits to Da Chang (Large Intestine). The manifestation of Da Chang (Large Intestine) cough is cough accompanied by fecal incontinence. Fei (Lung) and Da Chang (Large Intestine) both belong to Metal (Geng-Xin Metal). External wind-heat scorches, and Lung heat transfers to the Large Intestine; combined with wind invading the empty orifices, this explains why cough is accompanied by fecal incontinence. One should tonify Earth (Spleen/Stomach) to resolve heat, and simultaneously extinguish wind. The treatment is primarily Hui Feng Yang Zang Tang (Wind-Returning Organ-Nourishing Decoction).
Hui Feng Yang Zang Tang (Self-made Formula)
Sha Shen (Glehniae Radix, 4 qian)
Su Zi (Perillae Fructus, 1.5 qian)
Zhi Qiao (Aurantii Fructus Immaturus, 1 qian)
Qian Hu (Peucedani Radix, 1 qian)
Sang Ye (Mori Folium, 1 qian)
Fu Ling (Poria, 2 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian)
Yi Yi Ren (Coicis Semen, 4 qian)
Ju Hong (Citri Reticulatae Pericarpium Rubrum, 1 qian)
Bei Mu (Fritillariae Bulbus, 2 qian)
He Ye Di (Nelumbinis Petiolus, 1 piece)
If Xin (Heart) cough does not heal, it transmits to Xiao Chang (Small Intestine). The manifestation of Xiao Chang (Small Intestine) cough is cough accompanied by flatus, where gas and cough are expelled simultaneously. The lower opening of the Small Intestine connects to the upper opening of the Large Intestine; when the Small Intestine functions normally, the Large Intestine is unobstructed. In Xiao Chang (Small Intestine) cough, Qi reaches the Large Intestine, causing turbid Qi from the Lower Jiao to be discharged intermittently. The treatment is primarily Jie Gong Tang (Pure Palace Decoction).
Jie Gong Tang (Self-made Formula)
Sha Shen (Glehniae Radix, 4 qian)
Fu Shen (Poria with Hostwood, 2 qian)
Yuan Zhi (Polygalae Radix, 0.5 fen, stir-fried with Licorice Water)
Dang Gui Shen (Angelicae Sinensis Radix, body portion, 2 qian)
Mai Dong (Ophiopogonis Radix, 2 qian)
Bei Mu (Fritillariae Bulbus, 2 qian)
Ju Hong (Citri Reticulatae Pericarpium Rubrum, 1 qian)
Ban Xia (Pinelliae Rhizoma, 1 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian)
Sha Ren (Amomi Fructus, 1 qian)
Sheng Jiang (Zingiberis Rhizoma Recens, 3 slices)
If Shen (Kidney) cough does not heal, it transmits to Pang Guang (Bladder). The manifestation of Pang Guang (Bladder) cough is cough accompanied by urinary incontinence. Pang Guang (Bladder) is the Fu organ of fluids; during cough, Qi fails to secure and control, leading to urine leakage. The treatment is primarily Jia Wei Fu Tu Tang (Modified Poria and Dodder Seed Decoction).
Jia Wei Fu Tu Tang (Self-made Formula)
Fu Ling (Poria, 3 qian)
Tu Si Zi (Cuscutae Semen, 4 qian)
Du Zhong (Eucommiae Cortex, 3 qian)
Po Gu Zhi (Psoraleae Fructus, also known as Bu Gu Zhi, 1.5 qian)
Dang Gui (Angelicae Sinensis Radix, 2 qian)
Bei Mu (Fritillariae Bulbus, 2 qian)
Ju Hong (Citri Reticulatae Pericarpium Rubrum, 1 qian)
Ban Xia (Pinelliae Rhizoma, 1 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian)
Xing Ren (Armeniacae Semen Amarum, 3 qian)
He Tao Rou (Juglandis Semen, 2 pieces, peeled and chewed)
When chronic cough persists, it transmits to San Jiao (Triple Burner). The manifestation of San Jiao (Triple Burner) cough is cough accompanied by abdominal fullness and loss of appetite. These conditions involve pathogens accumulating in the Stomach and affecting the Lung, causing excessive phlegm and saliva, facial edema, and rebellious Qi. Chronic cough leads to disease in all three Jiaos. Pathogens accumulating in the Stomach occur because the Stomach is the root of the Five Zang and Six Fu organs. Pathogens affecting the Lung occur because cough inevitably moves Lung Qi; facial edema and rebellious Qi are manifestations of Lung disease. The treatment is primarily Tong Li Tang (Unblocking Regulation Decoction).
Tong Li Tang (Self-made Formula)
Dang Gui (Angelicae Sinensis Radix, 2 qian)
Fu Ling (Poria, 2 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian)
Yi Yi Ren (Coicis Semen, 4 qian)
Zhi Qiao (Aurantii Fructus Immaturus, 1 qian)
Ju Hong (Citri Reticulatae Pericarpium Rubrum, 1 qian)
Ban Xia (Pinelliae Rhizoma, 1 qian)
Hou Po (Magnoliae Officinalis Cortex, 1 qian)
Qing Pi (Citri Reticulatae Pericarpium Viride, 1 qian)
Sang Pi (Mori Cortex, 2 qian)
Sha Ren (Amomi Fructus, 1 qian)
Su Zi (Perillae Fructus, 1.5 qian)
Sheng Jiang (Zingiberis Rhizoma Recens, 3 slices)
Mr. annotated *Medical Heart领悟* (Yi Xue Xin Wu): "There are many types of asthma/wheezing disorders, none of which are benign. The method for treating wheezing lies merely in 'descending' and 'grasping'. For excess in the Upper Jiao, one descends it, preventing rebellion, thereby allowing the clear and descending function to operate. For deficiency in the Lower Jiao, one grasps it, returning it to its origin, thereby solidifying the foundation." Mr.'s annotation is clearer than Ye Tianshi's concept that "excess wheezing resides in the Lung, while deficient wheezing resides in the Kidney." Annotated by Zu Yi.