高 寒入肺底，久而化热，同一痰喘，先后不同矣。初病在肺，久必及肾，虚实不同矣。补肾纳气，
清金化痰，是目下治法。
大熟地（海浮石拌） 麦冬 川贝 蛤壳 五味子 牛膝 杏仁 沙参 地骨皮 枇杷叶 悉尼皮
卢 肾司纳气，开窍于二阴。病发每因劳碌之余，先频转矢气，而后气升上逆，短促如喘，
饮食二便如常。其病在少阴之枢，宜补而纳之。
六味地黄合生脉散，加青铅。
陆 喘哮十二年，三疟一载。疟止复来，喘发愈勤。中虚痰
饮不化，虽痰中带血，而不可以作热治也。拟六君子加杏仁、旋复、姜桂方法。
六君子汤加杏仁、旋复花、桂枝（细辛同炒）、干姜（五味子同打炒）。
渊按∶痰中见血，仍用姜、桂，非老手不辨。
冯 年逾七旬，伏暑挟湿，湿能生热。病起微寒微热，咳嗽
痰稠，曾经吐血。今血虽止而咳仍然，脉涩而数，舌苔灰白而渴，
乃湿热痰浊恋于肺胃。病将匝月，元气大伤。脾胃不醒，谷食少进。初起大便坚，今则软而带溏矣。
病在肺脾胃三经，治在化痰、降气、和中。
甜杏仁 茯苓 款冬花 蛤壳 沙参 紫菀 川贝母 苡仁 陈皮 雪羹
另∶用人参、珠子、血珀、沉香、礞石，研细末，匀和一处，再研极细。分四服，日一服。
又 夫咳嗽痰喘之病，浅则在肺胃，深则属肝肾。凡用方之法，由浅而深。按脉察色，知其虚中挟实。
实者，痰浊也，故先以化痰、降气、和中为法。两剂，咳嗽稍平，惟气之喘而短者
有出多纳少之意，则其本虚矣。左脉细微，肝肾之虚大着。虽舌苔黄浊不化，亦当以摄纳为要。
且额上汗冷，胃泛不纳，将有虚脱之虑。
人参（一钱五分） 五味子（八分） 麦冬（钱半，元米炒） 山萸肉（二钱） 泽
泻（一钱） 大熟地（六钱，附子三分煎汁，浸片时，炒成炭） 怀山药（五钱，炒）
茯苓（二钱） 紫石英（三钱） 怀牛膝（三钱） 紫衣胡桃肉（不去皮，二个）
另∶用好肉桂（三分），上沉香（三分，）坎 二条。
上三味，各研末，和一处，再研细，分作二服。今晚一服，燕窝汤调下。明日再进一服。若得额汗
收敛，左脉稍起，犹有生机可理。若不应手，难为力矣。
杜 咳嗽有年，每遇劳碌感寒即发。并无痰涎，此属气喘。据述病起受寒，早用麦冬清滋之药，遂至邪恋
于肺，曾服麻黄开达见效。然病根日久，肺气日虚。虚而不治，累及子母。今三焦并治，乃肺脾肾三脏兼顾也。
杜苏子 淡干姜（五味子合捣） 甜杏仁 橘红 半夏 款冬花 炙甘草
早服附桂八味丸一钱，金水六君丸三钱，开水送。
又 久咳，肺脾肾交虚，前用温纳相安。今交夏令，肾气丸
中桂、附嫌刚，改用都气丸可也。
都气丸三钱，朝服。金水六君丸三钱，晚服。俱盐汤下。
又 肺为贮痰之器，肾为纳气之根。肾虚不纳，则气逆而生喘；肺虚失降，则痰贮而作喘。前方辛通
肺气。补摄肾气，服下稍安，而病莫能除。良以多年宿恙，根深蒂固。然按方书内饮治
肾，外饮治肺，不越开上填下之意。
法半夏 茯苓 橘红 杏仁霜 款冬花 干姜 白芍 五味子 炙甘草
上药为末，用麻黄三钱，白果肉三十粒，枇杷叶二十片，煎
浓汁，泛丸。每服一钱，朝晚并进，与都气丸同。
王 高年烘火，误烧被絮，遭惊受寒，烟熏入肺，陡然喘逆，痰嘶，神糊，面浮。防其厥脱。
旋复花 前胡 杏仁 川贝 代赭石 茯神 苏子 沉香 桑白皮 款冬花 竹油（冲） 姜汁（冲）
渊按∶此火邪伤肺而喘也。与寻常痰喘不同，故不用温纳。
徐 喘哮气急，原由寒入肺俞，痰凝胃络而起。久发不已，肺虚必及于肾，胃虚必累于脾。脾为生痰之
源，肺为贮痰之器。痰恋不化，气机阻滞，一触风寒，喘即举发。治之之法，在上治
肺胃，在下治脾肾，发时治上，平时治下，此一定章程。若欲除根，必须频年累月，服药不断，倘一
暴十寒，终无济于事也。此非虚语，慎勿草草。
发时服方∶
款冬花 桑皮 紫菀 苏子 沉香 茯苓 杏仁 橘红 半夏 淡芩
平时服方∶
熟地 五味子 陈皮 苡仁 胡桃肉 紫石英（ ） 半夏 蛤壳 杜仲 茯苓
又 喘哮频发，脉形细数，身常恶寒。下焦阴虚，中焦痰盛，
上焦肺弱。肺弱故畏寒，阴虚故脉数。喘之频发，痰之盛也。有所
感触，则病发焉。病有三层，治有三法。层层护卫，法法兼到。终年常服，庶几见效，否恐无益也。
发时服方∶
桂枝（生晒干） 款冬花（蜜炙） 橘红（盐水炒） 杏仁霜 莱菔子 桑皮（蜜炙）
共研末，用枇杷叶十片，去毛，煎汤，再用竹油半茶杯，姜
汁一酒杯，相和一处，将上药末泛丸。发喘时，每至卧时服此丸二钱，苡仁、橘红汤送下。
平时服方∶
大熟地（砂仁拌） 丹皮（盐水炒） 茯苓 牛膝（盐水炒） 泽泻（盐水炒） 肉
桂山萸肉（酒炒） 怀山药（炒） 五味子（盐水炒） 磁石
上药为末，用炼白蜜捣和，捻作小丸，丸须光亮。俟（半干），再用制半夏（三两），陈皮（二两），
炙甘草（一两），研极细末，泛为衣。每朝服（二钱）。发时亦可服。
叶 喘之标在肺，喘之本在肾。脉迟者，寒也。舌白者，痰也。以金水六君煎加味。
大熟地（蛤粉炒） 半夏 陈皮 茯苓 杜仲 款冬花 桂枝 紫菀 杏仁 五味子 胡桃肉
又 喘发已平，咳嗽不止，吐出浓痰，今宜降气化痰。
苏子 旋复花 当归 款冬花 桑白皮 橘红 半夏 茯苓 杏仁
金 痰气声嘶，面仰项折，久而不已，防有鸡胸、龟背之变。盖肺气上而不下，痰涎升而不降，上
盛则下虚，故病象若此。宜清肺以降逆，化痰而理气。
生石膏 紫石英 半夏 茯苓 橘红 石决明 川贝母 蛤壳 紫菀 杏仁 竹油 姜汁
另∶不蛀皂荚三枚，去皮弦子，煎浓汤一饭碗，用大枣三十
枚，将汤煮烂，晒干，将汁再浸，再晒干。每日食枣五六枚。
某 汗出不休，气短而喘，是气血阴阳并弱也。足常冷为阳
虚，手心热为阴虚。营不安则汗出，气不纳则喘乏。法当兼顾。
大熟地（附子三分，拌炒） 黄 （防风一钱，拌炒） 归身 白芍 五味
子紫石英 茯苓 党参 冬术 浮麦 红枣
渊按∶此劳损虚喘也。金受火刑，经所谓耐冬不耐夏。夏令
见之，都属不治。黄 为汗多而设，若喘而无汗，即不相宜。
又 汗出减半，气尚短喘。今当大剂滋阴，再参重以镇怯。
人参固本丸 龟胶 磁石 紫石英 白芍 五味子 胡桃肉
又 周身之汗已收，头汗之多未敛。气喘较前觉重，交午愈甚。掌心觉热，脉形细数，饮食减少。阴津
大亏，肺气伤戕。兹当炎暑，水衰火旺，金受其灼。咳嗽痰黄，渐延损症。拟清金丽水，冀其应手为妙。
沙参 麦冬 大生地 龟板 川贝母 五味子 知母 西洋参 川黄柏
仁渊曰∶痰喘之因不一，须分虚实两途。实者因风寒痰火，大都病在肺胃，从外感而来，或寒热无汗，
或不热有汗，咳嗽痰浓，便溺短赤，舌苔浓，脉数浮滑不空，乃风温痰热壅于肺胃不
得降化也。宜宣通肺络，清降胃气。有汗葶、杏、橘、贝、芩、翘、石膏等剂，无汗麻杏甘石、桑、贝、橘、
桔之类。若形寒表热不扬，咳窒不爽，脉浮而紧，乃风寒闭其肺络，元府不宣，肺气
不利，不得肃降也。宜麻、杏、苏、桔或防风通圣等开其腠理。虚者乃平素肺肾内虚，肃降摄纳无权，脾胃气
弱，不克化饮食精微，即痰饮之类。痰留肺系胃络，一触外邪，肺胃即失顺降，肾
气即为奔逆，喉间 吼有声，倚几布息，甚至自汗淋漓，无表热外感见证，脉浮滑空豁，或形瘦浮肿，种种
虚象，宜温纳镇摄。又有半虚半实之证，如素有痰饮，感寒遇劳即发，咳嗽痰沫，喘
逆倚息。仿痰饮例治之，若久病全属虚证。更有无痰而喘，火迫而喘，糖哮盐哮而喘，俱伤其肺气使然。
当求其因。古人谓实喘治肺，虚喘治肾，确有见地，然不可执一。实喘治肺，须兼治胃；
虚喘治肾，宜兼治肺。如肾气丸、黑锡丹治肾，人参蛤蚧汤治肺，人参胡桃汤肺肾兼治也。大抵痰多，脉空
弦者，以肾为主。痰少，脉虚不甚大者，以肺为主。痰稀多沫者，宜温纳，痰少色黄浓者，宜平降。一则肾阳
虚，一则肾阴虚而肺有火也。夫熟地最能消虚痰，以其能填补肾气而化无形之痰也。勿嫌腻膈而畏之。
王旭高按：寒邪侵入肺底，日久化热，同样是痰喘病，但发病阶段不同。初起病位在肺，久病则必累及肾脏，虚实性质也不同。目前的治法是补肾纳气，清肺化痰。
处方：大熟地黄（用海浮石拌炒）、麦冬、川贝母、蛤壳、五味子、牛膝、杏仁、沙参、地骨皮、枇杷叶、悉尼皮。
卢姓患者：肾主纳气，开窍于前后二阴。病情发作多在劳累之后，先频繁排气，随后气机上逆，呼吸短促如同喘息，但饮食和二便正常。病机在于少阴经的枢机不利，适宜采用补益并收纳的方法。
处方：六味地黄丸合生脉散，加青铅。
陆姓患者：喘哮病十二年，疟疾一年。疟疾停止后喘病复发且更加频繁。中焦脾胃虚弱，痰饮无法运化，虽然痰中带血，但不能当作热证来治疗。拟定六君子汤加杏仁、旋覆花、干姜、肉桂的方法。
处方：六君子汤加杏仁、旋覆花、桂枝（与细辛同炒）、干姜（与五味子同捣炒）。
渊按：痰中带血仍使用干姜、肉桂，不是经验丰富的医生不能辨别。
冯姓患者：年过七十，伏暑挟湿，湿气能生热。病初起微恶寒微发热，咳嗽痰稠，曾经吐血。现在血虽止住但咳嗽依旧，脉象涩而数，舌苔灰白且口渴，这是湿热痰浊留恋于肺胃。病程将近一个月，元气大伤。脾胃功能未醒，进食很少。起初大便干燥，现在变软且带溏泄。病在肺、脾、胃三经，治疗在于化痰、降气、和中。
处方：甜杏仁、茯苓、款冬花、蛤壳、沙参、紫菀、川贝母、薏苡仁、陈皮、雪羹汤。
另法：用人参、珠子（珍珠）、血珀（血竭琥珀类）、沉香、礞石，研成细末，混合均匀，再研极细。分四次服用，每天服一次。
又论：咳嗽痰喘的病，浅则在肺胃，深则属肝肾。凡是用方之法，由浅入深。通过诊脉察色，知道是虚中夹实。实证是痰浊，所以先用化痰、降气、和中的方法。服两剂后，咳嗽稍平，但只有气喘短促，有出多纳少的迹象，说明根本已虚。左脉细微，肝肾之虚非常明显。虽然舌苔黄浊不化，也应当以摄纳为要务。而且额头冷汗，胃气上泛不纳食，将有虚脱的危险。
处方：人参（一钱五分）、五味子（八分）、麦冬（一钱半，用元米炒）、山萸肉（二钱）、泽泻（一钱）、大熟地黄（六钱，用附子三分煎汁浸泡片刻，炒成炭）、怀山药（五钱，炒）、茯苓（二钱）、紫石英（三钱）、怀牛膝（三钱）、紫衣胡桃肉（不去皮，两个）。
另法：用好肉桂（三分），上等沉香（三分），坎水（井水或泉水）二条。以上三味，各研成末，混合一处，再研细，分作两次服用。今晚服一次，用燕窝汤调下。明天再进一次。如果额头汗收敛，左脉稍起，还有生机可救。如果无效，就难以施治了。
杜姓患者：咳嗽多年，每次遇到劳累感寒即发作。并无痰涎，这属于气喘。据述病起因受寒，早用麦冬等清滋药物，导致邪气留恋于肺，曾服麻黄宣开发表见效。然而病根日久，肺气日渐虚弱。虚而不治，会累及子母脏腑。现在三焦并治，即是肺脾肾三脏兼顾。
处方：杜苏子、淡干姜（与五味子合捣）、甜杏仁、橘红、半夏、款冬花、炙甘草。
早上服用附桂八味丸一钱，金水六君丸三钱，开水送服。
又论：久咳，肺脾肾均虚，前药用温纳法相安。如今进入夏令，肾气丸中的桂枝、附子嫌其刚燥，改用都气丸即可。
处方：都气丸三钱，早晨服用。金水六君丸三钱，晚上服用。均用盐汤送下。
又论：肺是贮痰的器官，肾是纳气的根本。肾虚不纳，则气逆而生喘；肺虚失降，则痰贮而作喘。前方用辛通肺气，补摄肾气，服用后稍安，但病不能除。实在是因为多年宿疾，根深蒂固。然而根据方书，内饮治肾，外饮治肺，不离“开上填下”的意思。
处方：法半夏、茯苓、橘红、杏仁霜、款冬花、干姜、白芍、五味子、炙甘草。
以上药为末，用麻黄三钱，白果肉三十粒，枇杷叶二十片，煎浓汁，泛丸。每服一钱，早晚并进，与都气丸同服。
王姓患者：高龄烘烤火源，误烧被絮，遭受惊吓受寒，烟熏入肺，陡然喘逆，痰声嘶哑，神志模糊，面部浮肿。防止厥脱。
处方：旋复花、前胡、杏仁、川贝母、代赭石、茯神、苏子、沉香、桑白皮、款冬花、竹油（冲服）、姜汁（冲服）。
徐姓患者：喘哮气急，原由寒邪侵入肺俞，痰凝胃络而起。久发不已，肺虚必及于肾，胃虚必累于脾。脾为生痰之源，肺为贮痰之器。痰恋不化，气机阻滞，一触风寒，喘即举发。治疗之法，在上治肺胃，在下治脾肾，发作时治上，平时治下，这是一定的章程。若想除根，必须长年累月，服药不断，倘若一暴十寒，最终无济于事。这不是空话，切勿草率。
发作时服方：款冬花、桑皮、紫菀、苏子、沉香、茯苓、杏仁、橘红、半夏、淡黄芩。
平时服方：熟地黄、五味子、陈皮、薏苡仁、胡桃肉、紫石英、半夏、蛤壳、杜仲、茯苓。
又论：喘哮频发，脉形细数，身体常恶寒。下焦阴虚，中焦痰盛，上焦肺弱。肺弱故畏寒，阴虚故脉数。喘之频发，是因为痰盛。有所感触，则病发焉。病有三层，治有三法。层层护卫，法法兼到。终年常服，庶几见效，否则恐怕无益。
发作时服方：桂枝（生晒干）、款冬花（蜜炙）、橘红（盐水炒）、杏仁霜、莱菔子、桑皮（蜜炙）。共研末，用枇杷叶十片，去毛，煎汤，再用竹油半茶杯，姜汁一酒杯，混合一处，将上药末泛丸。发喘时，每晚卧时服此丸二钱，用薏苡仁、橘红汤送下。
平时服方：大熟地黄（砂仁拌）、丹皮（盐水炒）、茯苓、牛膝（盐水炒）、泽泻（盐水炒）、肉桂、山萸肉（酒炒）、怀山药（炒）、五味子（盐水炒）、磁石。
以上药为末，用炼白蜜捣和，捻作小丸，丸须光亮。待半干，再用制半夏（三两），陈皮（二两），炙甘草（一两），研极细末，作为丸衣。每早晨服二钱。发作时也可服用。
叶姓患者：喘的标在肺，喘的本在肾。脉迟者，是寒。舌白者，是痰。用金水六君煎加味。
处方：大熟地黄（蛤粉炒）、半夏、陈皮、茯苓、杜仲、款冬花、桂枝、紫菀、杏仁、五味子、胡桃肉。
又论：喘发已平，咳嗽不止，吐出浓痰，现在宜降气化痰。
处方：苏子、旋复花、当归、款冬花、桑白皮、橘红、半夏、茯苓、杏仁。
金姓患者：痰气声嘶，面仰项折，久而不已，防有鸡胸、龟背之变。盖肺气上而不下，痰涎升而不降，上盛则下虚，故病象若此。宜清肺以降逆，化痰而理气。
处方：生石膏、紫石英、半夏、茯苓、橘红、石决明、川贝母、蛤壳、紫菀、杏仁、竹油、姜汁。
另法：不蛀皂荚三枚，去皮弦子，煎浓汤一饭碗，用大枣三十枚，将汤煮烂，晒干，将汁再浸，再晒干。每日食枣五六枚。
某姓患者：汗出不休，气短而喘，是气血阴阳并弱也。足常冷为阳虚，手心热为阴虚。营气不安则汗出，气不纳则喘乏。法当兼顾。
处方：大熟地黄（附子三分，拌炒）、黄芪（防风一钱，拌炒）、归身、白芍、五味子、紫石英、茯苓、党参、冬术（白术）、浮小麦、红枣。
渊按：这是劳损虚喘。金受火刑，经所谓耐冬不耐夏。夏令见之，都属不治。黄芪是为汗多而设，若喘而无汗，即不相宜。
又论：汗出减半，气尚短喘。现在当大剂滋阴，再参重以镇怯。
处方：人参固本丸、龟胶、磁石、紫石英、白芍、五味子、胡桃肉。
又论：周身之汗已收，头汗之多未敛。气喘较前觉重，交午愈甚。掌心觉热，脉形细数，饮食减少。阴津大亏，肺气伤戕。兹当炎暑，水衰火旺，金受其灼。咳嗽痰黄，渐延损症。拟清金丽水，冀其应手为妙。
处方：沙参、麦冬、大生地、龟板、川贝母、五味子、知母、西洋参、川黄柏。
仁渊曰：痰喘之因不一，须分虚实两途。实者因风寒痰火，大都病在肺胃，从外感而来，或寒热无汗，或不热有汗，咳嗽痰浓，便溺短赤，舌苔浓，脉数浮滑不空，乃风温痰热壅于肺胃不得降化也。宜宣通肺络，清降胃气。有汗者用葶苈、杏仁、橘红、贝母、黄芩、连翘、石膏等剂，无汗者用麻黄杏仁甘草石膏汤、桑白皮、贝母、橘红、桔梗之类。若形寒表热不扬，咳窒不爽，脉浮而紧，乃风寒闭其肺络，元府不宣，肺气不利，不得肃降也。宜麻黄、杏仁、苏叶、桔梗或防风通圣散等开其腠理。虚者乃平素肺肾内虚，肃降摄纳无权，脾胃气弱，不克化饮食精微，即痰饮之类。痰留肺系胃络，一触外邪，肺胃即失顺降，肾气即为奔逆，喉间吼有声，倚几布息，甚至自汗淋漓，无表热外感见证，脉浮滑空豁，或形瘦浮肿，种种虚象，宜温纳镇摄。又有半虚半实之证，如素有痰饮，感寒遇劳即发，咳嗽痰沫，喘逆倚息。仿痰饮例治之，若久病全属虚证。更有无痰而喘，火迫而喘，糖哮盐哮而喘，俱伤其肺气使然。当求其因。古人谓实喘治肺，虚喘治肾，确有见地，然不可执一。实喘治肺，须兼治胃；虚喘治肾，宜兼治肺。如肾气丸、黑锡丹治肾，人参蛤蚧汤治肺，人参胡桃汤肺肾兼治也。大抵痰多，脉空弦者，以肾为主。痰少，脉虚不甚大者，以肺为主。痰稀多沫者，宜温纳，痰少色黄浓者，宜平降。一则肾阳虚，一则肾阴虚而肺有火也。夫熟地最能消虚痰，以其能填补肾气而化无形之痰也。勿嫌腻膈而畏之。
Wang Xugao's commentary: Cold pathogen invades the bottom of the lung, and over time transforms into heat. Although it is the same condition of phlegm-wheezing (Tan Chuan, wheezing with excessive phlegm), the stages differ. Initially, the disease is in the Lung; after a long time, it inevitably involves the Kidney, differing in deficiency and excess. The current treatment method is to tonify the Kidney to grasp Qi (Bu Shen Na Qi) and clear the Metal (Lung) to resolve phlegm (Qing Jin Hua Tan).
Prescription: Shu Di Huang (Prepared Rehmannia Root) mixed with Hai Fu Shi (Sponge Coral); Mai Dong (Ophiopogon Tuber); Chuan Bei Mu (Fritillaria Cirrhosa Bulb); Ge Qiao (Clam Shell); Wu Wei Zi (Schisandra Berry); Niu Xi (Achyranthes Root); Xing Ren (Apricot Seed); Sha Shen (Glehnia or Adenophora Root); Di Gu Pi (Cortex Lycii); Pi Pa Ye (Loquat Leaf); Xi Yi Pi (Bark of Sydney Tree - *Note: likely a local variant or typo for another bark, kept as transliteration*).
Patient Lu: The Kidney governs grasping Qi and opens into the two yin orifices (anterior and posterior). Attacks often occur after fatigue, first with frequent passing of flatus, then Qi rises and rebels upward, breathing becomes short and rapid like wheezing, while diet and bowel/bladder functions remain normal. The pathology lies in the pivot of the Shaoyin (Kidney/Heart) channel; it is suitable to tonify and grasp/restrain.
Prescription: Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) combined with Sheng Mai San (Generate the Pulse Powder), added with Qing Qian (Lead Lapis).
Patient Lu: Wheezing and asthma for twelve years, malaria for one year. After malaria subsides, wheezing recurs more frequently. Middle Jiao deficiency leads to failure to transform phlegm-fluids. Although there is blood in the phlegm, it should not be treated as heat. Proposed prescription: Liu Jun Zi Tang (Six-Gentlemen Decoction) added with Xing Ren (Apricot Seed), Xuan Fu Hua (Inula Flower), Gan Jiang (Dried Ginger), and Gui Zhi (Cinnamon Twig).
Prescription: Liu Jun Zi Tang added with Xing Ren, Xuan Fu Hua, Gui Zhi (stir-fried together with Xi Xin/Asarum), Gan Jiang (stir-fried together with Wu Wei Zi/Schisandra).
Commentary by Yuan: Using Gan Jiang and Gui Zhi when there is blood in the phlegm requires an experienced practitioner to discern correctly.
Patient Feng: Over seventy years old, latent summerheat with dampness; dampness can generate heat. The illness began with slight chills and fever, coughing with thick phlegm, and a history of hemoptysis. Although bleeding has stopped, coughing persists. The pulse is choppy and rapid, tongue coating is grayish-white with thirst. This indicates damp-heat and turbid phlegm lingering in the Lung and Stomach. The disease has lasted nearly a month, greatly injuring Yuan Qi (Primal Qi). Spleen and Stomach function is sluggish, food intake is low. Initially stools were hard, now soft with loose consistency. The disease involves the Lung, Spleen, and Stomach meridians; treatment focuses on resolving phlegm, descending Qi, and harmonizing the middle.
Prescription: Tian Xing Ren (Sweet Apricot Seed), Fu Ling (Poria), Kua Dong Hua (Winter Flower), Ge Qiao (Clam Shell), Sha Shen (Glehnia/Adenophora Root), Zi Wan (Aster Root), Chuan Bei Mu (Fritillaria Cirrhosa Bulb), Yi Yi Ren (Coix Seed), Chen Pi (Tangerine Peel), Xue Geng Soup (Snow Broth - a decoction of Fang Feng and Luo Han Guo or similar, contextually a clearing formula).
Alternative: Ren Shen (Ginseng), Zhu Zi (Pearl), Xue Po (Blood Amber/Jet), Chen Xiang (Agarwood), Meng Shi (Manganese Ore), ground into fine powder, mixed evenly, and ground extremely fine. Divide into four doses, take one dose daily.
Furthermore: Cough, phlegm, and wheezing diseases are superficial in the Lung and Stomach, and deep in the Liver and Kidney. Methods of using prescriptions proceed from superficial to deep. By observing pulse and complexion, we know it is deficiency with夹杂 (intermingled) excess. Excess refers to turbid phlegm, so initially use methods to resolve phlegm, descend Qi, and harmonize the middle. After two doses, cough slightly subsides, but only wheezing and shortness of breath remain, indicating more exhalation than inhalation, suggesting root deficiency. The left pulse is fine and minute, indicating significant deficiency of Liver and Kidney. Although the tongue coating is yellow and turbid and unchanging, the priority must still be grasping and restraining. Moreover, cold sweat on the forehead and stomach rebellion refusing food indicate danger of collapse.
Prescription: Ren Shen (1 qian 5 fen), Wu Wei Zi (8 fen), Mai Dong (1 qian 5 fen, stir-fried with Yuan Mi/Rice), Shan Yu Rou (Cornus Fruit), Ze Xie (Alisma), Da Shu Di (6 qian, soaked in decoction of Fu Zi/Aconite, stir-fried to charcoal), Huai Shan Yao (5 qian, stir-fried), Fu Ling (2 qian), Zi Shi Ying (Purple Quartz), Huai Niu Xi (Achyranthes Bidentata Root), Zi Yi Hu Tao Rou (Walnut Kernel with purple skin, unpeeled, 2 pieces).
Alternative: Hao Rou Gui (Good Cinnamon Bark, 3 fen), Shang Chen Xiang (Premium Agarwood, 3 fen), Kan Shui (Kan Water - well water/spring water, 2 liang). Grind each into powder, mix together, grind fine again, divide into two doses. Take one dose tonight, administered with Yan Wo Tang (Swallow's Nest Soup). Take the second dose tomorrow. If forehead sweat收敛 (converges/stops) and the left pulse rises slightly, there is still vitality to manage. If ineffective, it is difficult to help.
Patient Du: Cough for many years, triggered by fatigue and cold exposure. No sputum, this belongs to asthmatic wheezing. According to history, illness started with cold exposure; early use of cooling and moistening herbs like Mai Dong caused pathogen to linger in the Lung. Ma Huang (Ephedra) was effective for opening and dispersing. However, the root disease is long-standing, Lung Qi is daily becoming deficient. If deficiency is not treated, it affects the mother and child organs. Now treating all three Jiaos, which means attending to Lung, Spleen, and Kidney simultaneously.
Prescription: Du Su Zi (Perilla Seed), Dan Gan Jiang (Light Dried Ginger, pounded together with Wu Wei Zi), Tian Xing Ren (Sweet Apricot Seed), Ju Hong (Red Tangerine Peel), Ban Xia (Pinellia Tuber), Kua Dong Hua (Winter Flower), Zhi Gan Cao (Honey-fried Licorice Root).
Morning: Take Fu Gui Ba Wei Wan (Aconite and Cinnamon Six-Ingredient Pill) 1 qian, Jin Shui Liu Jun Wan (Metal-Water Six-Gentleman Pill) 3 qian, with plain water.
Furthermore: Chronic cough, Lung, Spleen, and Kidney are all deficient; previous warm-grasping methods provided peace. Now entering Summer, Gui Zhi and Fu Zi in Shen Qi Wan are too acrid/hot; switch to Du Qi Wan (Eight-Ingredient Pill with Schisandra).
Prescription: Du Qi Wan 3 qian, taken in the morning. Jin Shui Liu Jun Wan 3 qian, taken in the evening. Both with salt water.
Furthermore: The Lung is the vessel storing phlegm; the Kidney is the root grasping Qi. Kidney deficiency fails to grasp, causing Qi rebellion and wheezing; Lung deficiency fails to descend, causing phlegm storage and wheezing. Previous formulas used acrid-warm to open Lung Qi and tonify/grasp Kidney Qi; symptoms improved slightly but disease persisted. This is due to chronic illness, deeply rooted. However, according to medical texts, internal fluid retention treats the Kidney, external fluid retention treats the Lung, adhering to the principle of "opening above and filling below."
Prescription: Fa Ban Xia (Processed Pinellia), Fu Ling (Poria), Ju Hong (Red Tangerine Peel), Xing Ren Shuang (Apricot Seed Paste), Kua Dong Hua (Winter Flower), Gan Jiang (Dried Ginger), Bai Shao (White Peony Root), Wu Wei Zi (Schisandra Berry), Zhi Gan Cao (Honey-fried Licorice Root).
Grind above herbs into powder. Use Ma Huang (Ephedra) 3 qian, Bai Guo (Ginkgo Nut) 30 grains, Pi Pa Ye (Loquat Leaf) 20 slices, decoct into thick liquid, and use to coat pills. Take 1 qian per dose, morning and evening together, along with Du Qi Wan.
Patient Wang: Elderly person heating near fire, accidentally burned bedding, suffered fright and cold, smoke entered the Lung, suddenly causing wheezing and rebellion, hoarse phlegm sounds, confused spirit, facial edema. Prevent collapse/jue syndrome.
Prescription: Xuan Fu Hua (Inula Flower), Qian Hu (Peucedanum Root), Xing Ren (Apricot Seed), Chuan Bei Mu (Fritillaria Cirrhosa Bulb), Dai Zhe Shi (Magnetite), Fu Shen (Poria with Hostwood), Su Zi (Perilla Seed), Chen Xiang (Agarwood), Sang Bai Pi (Mulberry Root Bark), Kua Dong Hua (Winter Flower), Zhu You (Bamboo Oil, added to decoction), Jiang Zhi (Ginger Juice, added to decoction).
Commentary by Yuan: This is wheezing caused by Fire pathogen injuring the Lung, different from ordinary phlegm-wheezing, hence warm-grasping methods are not used.
Patient Xu: Wheezing, asthma, and急促 breathing originally arose from Cold invading the Lung Shu (Back-Shu point), with phlegm coagulating in the Stomach collaterals. Long-term recurrence causes Lung deficiency to affect Kidney, and Stomach deficiency to affect Spleen. Spleen is the source of phlegm production; Lung is the vessel storing phlegm. Phlegm lingers and does not transform, Qi mechanism is blocked; upon contact with wind-cold, wheezing erupts. Treatment method: treat Lung and Stomach when high, treat Spleen and Kidney when low; treat upper during attacks, treat lower during remission. This is a fixed principle. To eradicate the root, medication must be continuous for years. Intermittent treatment will ultimately be useless. This is no empty talk; do not be casual.
Formula for attack phase: Kua Dong Hua (Winter Flower), Sang Pi (Mulberry Root Bark), Zi Wan (Aster Root), Su Zi (Perilla Seed), Chen Xiang (Agarwood), Fu Ling (Poria), Xing Ren (Apricot Seed), Ju Hong (Red Tangerine Peel), Ban Xia (Pinellia Tuber), Dan Qin (Light Scutellaria Root).
Formula for remission phase: Shu Di (Prepared Rehmannia), Wu Wei Zi (Schisandra Berry), Chen Pi (Tangerine Peel), Yi Yi Ren (Coix Seed), Hu Tao Rou (Walnut Kernel), Zi Shi Ying (Purple Quartz), Ban Xia (Pinellia Tuber), Ge Qiao (Clam Shell), Du Zhong (Eucommia Bark), Fu Ling (Poria).
Furthermore: Frequent wheezing and asthma, pulse is fine and rapid, body often feels aversion to cold. Lower Jiao Yin deficiency, Middle Jiao abundant phlegm, Upper Jiao weak Lung. Weak Lung causes aversion to cold; Yin deficiency causes rapid pulse. Frequent wheezing is due to abundant phlegm. Upon any trigger, the disease erupts. The disease has three layers, treatment has three methods. Guard layer by layer, apply methods comprehensively. Taking continuously throughout the year may yield results; otherwise, it is likely futile.
Formula for attack phase: Gui Zhi (Cinnamon Twig, sun-dried), Kua Dong Hua (Winter Flower, honey-fried), Ju Hong (Red Tangerine Peel, stir-fried with salt water), Xing Ren Shuang (Apricot Seed Paste), Lai Fu Zi (Radish Seed), Sang Pi (Mulberry Root Bark, honey-fried). Grind into powder. Use Pi Pa Ye (Loquat Leaf) 10 slices, remove hairs, decoct in soup. Add Zhu You (Bamboo Oil) half teacup, Jiang Zhi (Ginger Juice) one wine glass, mix together. Use this mixture to coat the powder into pills. During wheezing attacks, take 2 qian of these pills at bedtime, delivered with Yi Yi Ren (Coix Seed) and Ju Hong (Tangerine Peel) soup.
Formula for remission phase: Da Shu Di (Prepared Rehmannia, mixed with Sha Ren/Cardamom), Dan Pi (Moutan Cortex, stir-fried with salt water), Fu Ling (Poria), Niu Xi (Achyranthes Root, stir-fried with salt water), Ze Xie (Alisma, stir-fried with salt water), Rou Gui (Cinnamon Bark), Shan Yu Rou (Cornus Fruit, wine-fried), Huai Shan Yao (Chinese Yam, stir-fried), Wu Wei Zi (Schisandra Berry, stir-fried with salt water), Ci Shi (Magnetite).
Grind above herbs into powder. Mix with refined white honey to form small pills, ensuring they are glossy. When half-dry, coat with extremely fine powder of Zhi Ban Xia (Processed Pinellia, 3 liang), Chen Pi (Tangerine Peel, 2 liang), Zhi Gan Cao (Honey-fried Licorice, 1 liang). Take 2 qian every morning. Can also be taken during attacks.
Patient Ye: The branch of wheezing is in the Lung; the root is in the Kidney. Slow pulse indicates Cold. White tongue coating indicates Phlegm. Use Jin Shui Liu Jun Jian (Metal-Water Six-Gentleman Decoction) with modifications.
Prescription: Da Shu Di (Prepared Rehmannia, stir-fried with Ge Fen/Clam Powder), Ban Xia (Pinellia Tuber), Chen Pi (Tangerine Peel), Fu Ling (Poria), Du Zhong (Eucommia Bark), Kua Dong Hua (Winter Flower), Gui Zhi (Cinnamon Twig), Zi Wan (Aster Root), Xing Ren (Apricot Seed), Wu Wei Zi (Schisandra Berry), Hu Tao Rou (Walnut Kernel).
Furthermore: Wheezing has subsided, but coughing continues, expectorating thick phlegm. Now appropriate to descend Qi and resolve phlegm.
Prescription: Su Zi (Perilla Seed), Xuan Fu Hua (Inula Flower), Dang Gui (Angelica Sinensis), Kua Dong Hua (Winter Flower), Sang Bai Pi (Mulberry Root Bark), Ju Hong (Red Tangerine Peel), Ban Xia (Pinellia Tuber), Fu Ling (Poria), Xing Ren (Apricot Seed).
Patient Jin: Phlegm-Qi hoarseness, face tilted back, neck bent, persisting for a long time, preventing deformities like pigeon chest or hunchback. Lung Qi rises but does not descend; phlegm-saliva ascends but does not descend. Excess above leads to deficiency below, hence these pathological signs. Should clear Lung to descend rebellion, resolve phlegm to regulate Qi.
Prescription: Sheng Shi Gao (Raw Gypsum), Zi Shi Ying (Purple Quartz), Ban Xia (Pinellia Tuber), Fu Ling (Poria), Ju Hong (Red Tangerine Peel), Shi Jue Ming (Abalone Shell), Chuan Bei Mu (Fritillaria Cirrhosa Bulb), Ge Qiao (Clam Shell), Zi Wan (Aster Root), Xing Ren (Apricot Seed), Zhu You (Bamboo Oil), Jiang Zhi (Ginger Juice).
Alternative: Non-moth-eaten Soap Pod (Zao Jia) 3 pieces, remove skin and strings, decoct into thick soup (one rice bowl). Use 30 large dates, boil soup until soft, dry, soak juice again, dry again. Eat 5-6 dates daily.
Patient Mou: Continuous sweating, shortness of breath and wheezing, indicating weakness of Qi, Blood, Yin, and Yang. Cold feet indicate Yang deficiency; hot palms indicate Yin deficiency. Unsettled Ying (Nutritive) Qi causes sweating; failing to grasp Qi causes wheezing and fatigue. Method should attend to both.
Prescription: Da Shu Di (Prepared Rehmannia, stir-fried with 3 fen Fu Zi/Aconite), Huang Qi (Astragalus Root, stir-fried with 1 qian Fang Feng/Saposhnikovia Root), Gui Shen (Angelica Sinensis Root Body), Bai Shao (White Peony Root), Wu Wei Zi (Schisandra Berry), Zi Shi Ying (Purple Quartz), Fu Ling (Poria), Dang Shen (Codonopsis Root), Dong Zhu (Winter Atractylodes/Fall Atractylodes? Context implies Bai Zhu/Atractylodes Macrocephala), Fu Mai (Floating Wheat), Hong Zao (Jujube).
Commentary by Yuan: This is deficiency wheezing due to labor/damage. Metal suffers from Fire punishment; Classics say "endures Winter but not Summer." Seen in Summer, it is generally incurable. Huang Qi is set for profuse sweating; if wheezing without sweating, it is inappropriate.
Furthermore: Sweating reduced by half, yet Qi remains short and wheezing. Now should use large dose to nourish Yin, combined with heavy substances to calm fear/agitation.
Prescription: Ren Shen Gu Ben Wan (Ginseng Solidify Root Pill), Gui Jiao (Tortoise Shell Glue), Ci Shi (Magnetite), Zi Shi Ying (Purple Quartz), Bai Shao (White Peony Root), Wu Wei Zi (Schisandra Berry), Hu Tao Rou (Walnut Kernel).
Furthermore: Whole-body sweating has stopped, but head sweating remains profuse. Wheezing feels heavier than before, worsening around noon. Palms feel hot, pulse is fine and rapid, food intake decreased. Yin fluids greatly depleted, Lung Qi injured. Currently in intense heat, Water is weak, Fire is strong, Metal is scorched. Coughing with yellow phlegm, gradually extending into consumption syndrome. Propose clearing Metal and nourishing Water, hoping for immediate effect.
Prescription: Sha Shen (Glehnia/Adenophora Root), Mai Dong (Ophiopogon Tuber), Da Sheng Di (Raw Rehmannia Root), Gui Ban (Tortoise Plastron), Chuan Bei Mu (Fritillaria Cirrhosa Bulb), Wu Wei Zi (Schisandra Berry), Zhi Mu (Anemarrhena Rhizome), Xi Yang Shen (American Ginseng), Chuan Huang Bo (Phellodendron Bark).
Ren Yuan said: Causes of phlegm-wheezing vary; must distinguish between deficiency and excess. Excess cases are due to Wind-Cold, Phlegm, and Fire, mostly involving Lung and Stomach, arising from external contraction. Symptoms include alternating chills and fever without sweat, or fever without sweat, or no fever with sweat, coughing with thick phlegm, scanty dark urine, thick tongue coating, rapid floating slippery pulse that is not empty. This is Wind-Warmth and Phlegm-Heat congesting Lung and Stomach, unable to descend and transform. Should ventilate Lung collaterals and clear/descend Stomach Qi. With sweat: Ting Li, Xing Ren, Ju Hong, Bei Mu, Qin, Qiao, Shi Gao etc.; Without sweat: Ma Xing Gan Shi Tang, Sang Bai Pi, Bei Mu, Ju Hong, Jie Geng etc. If aversion to cold with obscured surface heat, stifling cough, floating tight pulse, this is Wind-Cold closing Lung collaterals, pores not venting, Lung Qi unfavorable, unable to descend. Use Ma Huang, Xing Ren, Su Ye, Jie Geng or Fang Feng Tong Sheng San to open interstices. Deficiency cases involve inherent Lung/Kidney deficiency, inability to descend and grasp, weak Spleen/Stomach Qi failing to transform food essence into phlegm-fluids. Phlegm stays in Lung system and Stomach collaterals; upon external pathogen contact, Lung/Stomach lose smooth descent, Kidney Qi rebels, roaring sound in throat, leaning on furniture to breathe, even profuse spontaneous sweating, no exterior heat/exterior pathogen signs, floating slippery empty pulse, or emaciation with edema—various deficiency signs require warm-grasping and anchoring. There are also half-deficiency half-excess cases, such as pre-existing phlegm-fluids triggered by cold or labor, coughing with frothy phlegm, wheezing requiring leaning. Treat following phlegm-fluid examples; if long-term illness, it is entirely deficiency. Also wheezing without phlegm, wheezing forced by Fire, sugar-asthma, salt-asthma—all damage Lung Qi. Seek the cause. Ancients said "Excess wheezing treats Lung, Deficiency wheezing treats Kidney," which is insightful, but cannot be rigid. Treating Lung for excess must also treat Stomach; treating Kidney for deficiency should also treat Lung. E.g., Shen Qi Hei Xi Dan treat Kidney; Ren Shen Ge Jie Tang treats Lung; Ren Shen Hu Tao Tang treats both Lung and Kidney. Generally, abundant phlegm with empty/wiry pulse prioritizes Kidney; little phlegm with weak/not-large pulse prioritizes Lung. Thin frothy phlegm requires warm-grasping; little yellow thick phlegm requires neutralizing/descending. One is Kidney Yang deficiency, the other Kidney Yin deficiency with Lung Fire. Shu Di is best at eliminating deficiency-phlegm because it tonifies Kidney Qi and transforms formless phlegm. Do not dislike its cloying nature and fear it.