论风邪作喘 直中阴寒 中心卒痛 中痰 中邪 中气 论气喘非外感 论腹痛非内伤
天师曰∶急治者，不可须臾缓也。乃外感之喘胀，气不能息之类；如直中阴寒，手足厥冷，小腹冷
痛，而欲死者
是也；如心中卒痛，手不可按，气闷欲死者是也。凡人忽感风邪，寒入乎肺经，以致一时抬肩大喘，气
逆痰吐不出，人不能卧是也。方用柴胡一钱，茯苓二钱，当归一钱，黄芩一钱，麦冬二钱，射干一钱，桔
梗二钱，甘草、半夏各一钱，水煎服。（〔批〕灭邪汤。）此方妙在用柴胡、射干、桔梗，以舒发肺金
之气，用半夏以祛痰，用黄芩以去火。盖外感寒邪，则内必变为热症，今用黄芩以清解之。然徒用黄芩，
虽曰清火，转足以抑遏其火气。妙在用桔梗、射干、柴胡，一派辛散之品，转足以消火灭邪。此急治之一
法也。
直中阴寒之症，乃寒邪直入于肾经，不由皮毛而入营卫，不由营卫而入脏腑也。乃阴寒之邪，直中于
两肾之中，而命门之火，无可藏之地，乃奔越星散，而寒邪乘其真火逃亡，趁势赶逐。于是入腹则腹痛，
入肝则肝绝，入心则人亡。此至急之时，不可用药之须臾缓也。方用人参五钱，白术一两，附子一钱，
肉桂一钱，干姜五分，水煎服，（〔批〕逐寒回阳汤）。此方妙用人参、白术。盖寒邪直入，宜止用附、
桂以逐之，何必用参、术，而且多加之也。不知寒邪直犯肾宫，元阳遁出于脾胃之间，止此一线之微气在
焉，若不用人参以救之，何能唤回于无何有之处，不多加白术，何能利其腰脐而回其元气。故又加附子、肉
桂，以祛散其寒邪也。
中心卒痛，手不可按者，乃火邪犯心也。若不急救息其火，则脏腑内焚，必致身殉。方用栀子三钱，
白芍五钱，甘草一钱，良姜三分，天花粉二钱，苍术一钱，贯众一钱，水煎服。（〔批〕泻火定痛汤。）
此方妙在用栀子以清火。或疑心经之热，宜用黄连以凉之。何以不用黄连，而反用栀子耶？盖心中火
发，用黄连固宜，然黄连性燥，心火正在燥烈之时，以燥投燥，正其所恶，不特不能去火，而转助其焰
矣。不若桅子泻其肝木之邪，母衰则子亦衰，不泻心火，正所以泻心火也。且栀子能泻六经之郁火，原不
专入肝经，亦能入心经也。一味而两用之，此用药之奇妙∶况又与白芍共享以泻肝，又加良姜数分，以引
入于心中；复增天花粉，以逐其火热之痰，则痰去自然火散，而郁气益舒。此急治肝，而正急治心也。
又是急治之一法，余可类思。
张公曰∶急治之法妙矣，而余更有法。如人中痰、中邪、中气三法、亦不可不讲。中痰方∶用人参三
钱，白术三钱，茯苓三钱，附子一钱，天南星一钱，半夏二钱，水煎服，下喉即愈。盖痰之生也，由于气
之虚；而气之虚也，由于脏腑之冷。故方中用参、术以补正气，用半夏、南星、茯苓以祛痰，用附子以温
中。所以一下喉而痰声静，痰气清也。中邪方∶用人参三钱，白术三钱，半夏三钱，皂角末一钱，陈皮
一钱，水煎服。（〔批〕开窍消痰饮。）此方之妙在皂角能开人之孔窍，引人参、白术、半夏之类，直入
心经，而痰之迷滞，无不尽开，痰去邪将何留。中气方∶用人参一两，白术五钱，茯苓五钱，甘草一钱，
陈皮一钱，附子一钱，半夏三钱，南星三钱，水煎服。（〔批〕助气回生饮。）此方与中痰方相仿佛，而此
方胜于前者，以分两之多，而又多甘草、陈皮以消中和内也。三法有利于医者不浅。
华君曰∶予闻之天师矣，尚有二症。一则气喘之不能卧，而非外感也；一则腹痛之不可忍，而非内伤
也。凡人有气喘不得卧，吐痰如涌泉者，舌不燥而喘不甚，一卧则喘加，此
非外感之风邪，乃肾中之寒气也。盖肾中无火，则水无所养，乃上泛而为痰，将胃中之水，尽助其汹涌之
势，而不可止遏矣。法当用六味丸汤，加附子、肉桂大剂饮之，则肾宫火热，而水有所归。水既归宫，喘
逆之气亦下安而可卧。凡人之卧，必得肾气与肺气相交，而后河车之路平安无奔逆也。方中补其肾火，何
以安然能卧，不知肾为肺之子，子安则母亦宁，肺金之气可归于肾宫，以养其耗散之气矣。此所以补肾
火，正所以养肺金也，况六味丸全是补肾水之神剂乎，水火同补，而肺金更安，肺肾相安，有不卧之而甚
适者乎。
凡人腹中疼痛欲死，手按之转甚者，此乃火挟痰与食而作祟也。若作直中治之，立死矣。方用甘
草一钱，茯苓三钱，白芍五钱，枳实一钱，栀子三钱，山楂二十粒，水煎服。加柴胡一钱。（〔批〕纷解
散。）此方有解纷之妙，乃天师未传者，想于别门见之也。
岐天师曰∶实未传。孙真君有治心痛方。管仲三钱，乳香末二钱，白芍三钱，炒栀子三钱，甘草五分，
水煎服。一剂即止痛，此方专治火痛也，治呼号口渴者神效。
天师说：所谓“急治”，就是病情危急，一刻也不能拖延。这包括外感引起的喘胀、气息无法接续等症状；或者寒邪直中阴经，导致手足冰冷、小腹冷痛，甚至痛苦欲死的情况；又或者是心脏突然剧痛，手不能触碰，气闷窒息，痛苦欲死的情形。凡是人忽然感受风邪，寒气侵入肺经，导致一时之间耸肩大口喘气，气逆痰涌却无法咳出，身体无法平卧，也属于此类。方剂用柴胡一钱，茯苓二钱，当归一钱，黄芩一钱，麦冬二钱，射干一钱，桔梗二钱，甘草和半夏各一钱，水煎后服用。（批注：灭邪汤。）这个方剂的妙处在于使用柴胡、射干、桔梗，来舒展发散肺金之气；使用半夏来祛除痰浊；使用黄芩来清除火热。因为外感寒邪，体内必然转化为热证，现在用黄芩来清解它。然而如果只用黄芩，虽然说是清热泻火，反而足以压抑遏制体内的火气。妙在配合桔梗、射干、柴胡，这些都是一派辛散的药物，反而能够消散火气、消灭病邪。这是急治的一种方法。
所谓“直中阴寒”的病症，是寒邪直接侵入肾经，不经过皮毛进入营卫，也不由营卫传入脏腑。这是阴寒之邪，直接击中两肾之中，使得命门之火无处藏身，于是奔逸四散。寒邪趁着真元之火逃亡的机会，趁势追赶驱逐。于是寒气入腹则腹痛，入肝则肝绝，入心则人死亡。这是极其紧急的时刻，用药一刻也不能迟缓。方剂用人参五钱，白术一两，附子一钱，肉桂一钱，干姜五分，水煎后服用。（批注：逐寒回阳汤。）这个方剂的妙处在于使用人参、白术。人们认为寒邪直入，应该只用附子、肉桂来驱逐，何必用人参、白术，而且还要多加呢？不知道寒邪直接侵犯肾宫，元阳逃遁到脾胃之间，仅存这一线微弱的气息在这里，如果不用人参来挽救，怎么能将元气唤回于虚无缥缈之处？不多加白术，怎么能通利腰脐从而恢复元气？所以又加入附子、肉桂，来驱散寒邪。
心脏突然剧痛，手不能触碰的，是火邪侵犯心脏所致。如果不急救以平息火势，就会导致脏腑内部焚烧，必然导致死亡。方剂用栀子三钱，白芍五钱，甘草一钱，良姜三分，天花粉二钱，苍术一钱，贯众一钱，水煎后服用。（批注：泻火定痛汤。）这个方剂的妙处在于使用栀子来清火。有人怀疑心经有热，应该用黄连来凉血清热，为什么不用黄连，反而用栀子呢？心中火发，用黄连固然适宜，但黄连性燥，当心火正处于燥烈之时，以燥投燥，正是心所厌恶的，不仅不能去火，反而会助长火势。不如用栀子泻除肝木之邪，母衰则子亦衰，不直接泻心火，恰恰是为了泻心火。况且栀子能泻六经的郁火，原本就不专入肝经，也能入心经。一味药起到两种作用，这是用药的奇妙之处；再加上与白芍共同作用以泻肝，又加入少量良姜，以引导药力进入心中；再增加天花粉，以驱逐火热之痰，那么痰去自然火散，郁结之气更加舒畅。这是急治肝，而正是为了急治心。这也是急治的一种方法，其余情况可以类推思考。
张公说：急治的方法很妙了，但我还有其他的办法。比如中痰、中邪、中气这三种治法，也不可不讲。中痰的方剂：用人参三钱，白术三钱，茯苓三钱，附子一钱，天南星一钱，半夏二钱，水煎后服用，药液入口即愈。大概痰的产生，是由于气的虚弱；而气的虚弱，是由于脏腑寒冷。所以方中使用人参、白术来补益正气，使用半夏、南星、茯苓来祛痰，使用附子来温中。所以一下喉痰声就静，痰气就清。中邪的方剂：用人参三钱，白术三钱，半夏三钱，皂角末一钱，陈皮一钱，水煎后服用。（批注：开窍消痰饮。）这个方剂的妙处在于皂角能开通人的孔窍，引领人参、白术、半夏等药物，直接进入心经，而痰浊迷滞，没有不完全开通的，痰去除了，邪气还留得住吗？中气的方剂：用人参一两，白术五钱，茯苓五钱，甘草一钱，陈皮一钱，附子一钱，半夏三钱，南星三钱，水煎后服用。（批注：助气回生饮。）这个方剂与中痰方相似，但这个方剂胜过前者，因为分量更多，而且多用了甘草、陈皮来消除中和之内的阻滞。这三种方法对医者帮助很大。
华君说：我听天师说过，还有两种症状。一种是气喘不能平卧，但不是外感引起的；一种是腹痛难以忍受，但不是内伤引起的。凡是人出现气喘不能平卧，吐痰如涌泉般，舌苔不干燥且喘息不特别严重，一躺下喘息就加重，这不是外感的风邪，而是肾中的寒气。大概肾中没有火，水就得不到滋养，于是向上泛滥成为痰，借助胃中的水，助长其汹涌之势，不可遏制。治法应当用六味地黄丸汤，加入附子、肉桂大剂量饮用，那么肾宫有了火热，水就有了归宿。水既然回归肾宫，上逆的气喘也就安定下来可以平卧了。凡人的睡眠，必须得到肾气与肺气相交合，然后气道才能平安无逆乱。方中补益肾火，为什么能安然平卧？不知道肾是肺的子脏，子安则母亦安宁，肺金之气可以归于肾宫，以滋养耗散之气。这就是补肾火，正是为了养肺金，况且六味地黄丸全是补肾水的绝佳药剂啊，水火同补，肺金更加安宁，肺肾相安，哪有躺着不舒适的道理呢？
凡人腹部疼痛欲死，用手按压反而更严重的，这是火邪挟带痰湿与食积作祟。如果当作直中寒邪来治疗，立刻就会死亡。方剂用甘草一钱，茯苓三钱，白芍五钱，枳实一钱，栀子三钱，山楂二十粒，水煎后服用。再加柴胡一钱。（批注：纷解散。）这个方剂有解除纷乱纠葛的妙处，是天师未传授的，想必是从其他门派学来的。
岐天师说：确实未传授。孙思邈真人有治疗心痛的方子。延胡索三钱，乳香末二钱，白芍三钱，炒栀子三钱，甘草五分，水煎后服用。一剂就能止痛，这个方子专门治疗火痛，对于呼叫号哭、口渴的患者神效。
The Heavenly Master said: "Urgent treatment" refers to conditions that cannot be delayed for even a moment. This includes symptoms such as wheezing and distension caused by external pathogens, or inability to breathe; or cases where cold pathogenic factors directly invade the Yin meridians, causing cold limbs, cold pain in the lower abdomen, and extreme suffering bordering on death; or sudden severe heart pain, where touch is intolerable, accompanied by stifling breath and extreme suffering. When a person suddenly contracts wind-cold, and cold enters the Lung Meridian, causing sudden shoulder-shrugging panting, rebellious Qi with phlegm that cannot be expectorated, and an inability to lie down, this also falls into this category. The prescription uses Chai Hu (Bupleuri Radix) 1 qian, Fu Ling (Poria) 2 qian, Dang Gui (Angelicae Sinensis Radix) 1 qian, Huang Qin (Scutellariae Radix) 1 qian, Mai Dong (Ophiopogonis Tuber) 2 qian, She Gan (Belamcandae Rhizoma) 1 qian, Jie Geng (Platycodonis Radix) 2 qian, Gan Cao (Glycyrrhizae Radix et Rhizoma) and Ban Xia (Pinelliae Rhizoma) each 1 qian. Decoct in water and take orally. (Annotation: Mie Xie Tang / Evil-Extinguishing Decoction). The brilliance of this formula lies in using Chai Hu, She Gan, and Jie Geng to diffuse and disperse the Qi of the Metal element (Lungs); using Ban Xia to eliminate phlegm; and using Huang Qin to clear heat. Since external cold pathogens inevitably transform into internal heat syndromes, Huang Qin is used here to clear and resolve this heat. However, using only Huang Qin, although it clears fire, may inadvertently suppress and restrain the fire energy. The ingenuity lies in combining Jie Geng, She Gan, and Chai Hu, which are acrid and dispersing in nature, thereby dissipating the fire and extinguishing the pathogen. This is one method of urgent treatment.
The syndrome of "Direct Invasion of Yin Cold" occurs when cold pathogens directly enter the Kidney Meridian, bypassing the skin and hair to enter Ying and Wei, and not passing through Ying and Wei to reach the Zang-Fu organs. The Yin-cold pathogen strikes directly at the center of both kidneys, leaving no place for the Fire of the Gate of Vitality (Ming Men) to reside. Consequently, the vital fire scatters and flees. The cold pathogen takes advantage of this escape of true Yang, chasing and driving it away. If the cold enters the abdomen, it causes abdominal pain; if it enters the Liver, the Liver fails; if it enters the Heart, death ensues. This is an extremely critical time, and medication must not be delayed for a moment. The prescription uses Ren Shen (Ginseng Radix) 5 qian, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 1 liang, Fu Zi (Aconiti Lateralis Radix Praeparata) 1 qian, Rou Gui (Cinnamomi Cortex) 1 qian, and Gan Jiang (Zingiberis Rhizoma) 0.5 qian. Decoct in water and take orally. (Annotation: Zhu Han Hui Yang Tang / Driving-out-Cold and Restoring-Yang Decoction). The brilliance of this formula lies in the use of Ren Shen and Bai Zhu. One might argue that since cold has invaded directly, only Fu Zi and Rou Gui should be used to drive it out, so why use Ren Shen and Bai Zhu, and in large quantities? It is unknown that when cold pathogens directly assault the Palace of the Kidneys, the Original Yang escapes into the Spleen and Stomach region, where only a faint thread of vital Qi remains. Without Ren Shen to rescue this Qi, how can it be called back from non-existence? Without adding ample Bai Zhu, how can the waist and umbilical region be unblocked to restore Yuan Qi? Therefore, Fu Zi and Rou Gui are added to disperse the cold pathogen.
Sudden severe heart pain, intolerable to touch, is caused by Fire Pathogens assaulting the Heart. If the fire is not urgently relieved, internal burning of the Zang-Fu organs will occur, leading to death. The prescription uses Zhi Zi (Gardeniae Fructus) 3 qian, Bai Shao (Paeoniae Radix Alba) 5 qian, Gan Cao 1 qian, Liang Jiang (Alpiniae Officinarum Rhizoma) 0.3 qian, Tian Hua Fen (Trichosanthis Radix) 2 qian, Cang Zhu (Atractylodis Rhizoma) 1 qian, and Guan Zhong (Cyrtomii Rhizoma) 1 qian. Decoct in water and take orally. (Annotation: Xie Huo Ding Tong Tang / Draining-Fire and Relieving-Pain Decoction). The brilliance of this formula lies in using Zhi Zi to clear fire. Some may question: Heat in the Heart Meridian should be cooled with Huang Lian (Coptidis Rhizoma). Why use Zhi Zi instead? While using Huang Lian for heart fire is appropriate, Huang Lian is drying in nature. When heart fire is in a state of dryness and intensity, applying a drying herb to a dry condition is abhorrent to the Heart; it not only fails to remove the fire but exacerbates the flames. It is better to use Zhi Zi to drain the Wood element (Liver), for when the mother (Wood) weakens, the child (Fire) also weakens. By not directly draining heart fire, one effectively drains it. Moreover, Zhi Zi can drain stagnant fire in all six meridians; it does not exclusively enter the Liver Meridian but also enters the Heart Meridian. One herb serves two purposes, demonstrating the subtlety of herbal medicine. Furthermore, combined with Bai Shao to drain the Liver, and a small amount of Liang Jiang to guide the action into the Heart, along with Tian Hua Fen to expel hot phlegm, the removal of phlegm naturally dissipates the fire and soothes stagnant Qi. This is treating the Liver urgently to treat the Heart urgently. This is another method of urgent treatment, and other cases can be inferred similarly.
Master Zhang said: The methods of urgent treatment are excellent, but I have additional methods. The three methods for Phlegm Strike, Evil Strike, and Qi Strike must also be discussed. For Phlegm Strike: Use Ren Shen 3 qian, Bai Zhu 3 qian, Fu Ling 3 qian, Fu Zi 1 qian, Tian Nan Xing (Arisaematis Rhizoma) 1 qian, and Ban Xia 2 qian. Decoct in water and take orally; improvement is immediate upon swallowing. Phlegm arises from Qi deficiency, and Qi deficiency arises from coldness in the Zang-Fu organs. Thus, Ren Shen and Bai Zhu are used to tonify righteous Qi, Ban Xia, Tian Nan Xing, and Fu Ling to dispel phlegm, and Fu Zi to warm the interior. Hence, the sound of phlegm subsides and clarity returns immediately. For Evil Strike: Use Ren Shen 3 qian, Bai Zhu 3 qian, Ban Xia 3 qian, Zao Jiao Mo (Gleditsiae Sinensis Fructus Powder) 1 qian, and Chen Pi (Citri Reticulatae Pericarpium) 1 qian. Decoct in water and take orally. (Annotation: Kai Qiao Xiao Tan Yin / Orifice-Opening and Phlegm-Resolving Drink). The brilliance of this formula lies in Zao Jiao's ability to open the body's orifices, guiding Ren Shen, Bai Zhu, and Ban Xia directly into the Heart Meridian, thereby completely resolving obstructed phlegm. Once phlegm is gone, what evil remains? For Qi Strike: Use Ren Shen 1 liang, Bai Zhu 5 qian, Fu Ling 5 qian, Gan Cao 1 qian, Chen Pi 1 qian, Fu Zi 1 qian, Ban Xia 3 qian, and Tian Nan Xing 3 qian. Decoct in water and take orally. (Annotation: Zhu Qi Hui Sheng Yin / Qi-Assisting and Life-Restoring Drink). This formula is similar to the Phlegm Strike formula but superior due to higher dosages and the addition of Gan Cao and Chen Pi to harmonize the middle and resolve internal stagnation. These three methods offer significant assistance to physicians.
Master Hua said: I have heard from the Heavenly Master regarding two additional syndromes. One is wheezing preventing lying down, not caused by external contraction; the other is unbearable abdominal pain, not caused by internal injury. When a person suffers from wheezing unable to lie flat, expectorating phlegm like a gushing spring, with a non-dry tongue and mild wheezing that worsens upon lying down, this is not external wind-cold, but cold qi within the Kidneys. If there is no fire in the Kidneys, water lacks nourishment and floods upward to become phlegm, utilizing stomach water to fuel its surging momentum, which becomes unstoppable. The treatment should employ Liu Wei Di Huang Wan Tang (Six-Ingredient Rehmannia Pill Decoction) with added Fu Zi and Rou Gui in large doses. This warms the Kidney Palace, giving water a destination. Once water returns to the palace, the rebellious wheezing settles, allowing for lying down. Sleep requires the interaction of Kidney Qi and Lung Qi to ensure the safety of the airway. By tonifying Kidney fire in the formula, rest is achieved because the Kidney is the Child of the Lung; when the Child is calm, the Mother (Lung) is also peaceful. Lung Metal Qi returns to the Kidney Palace to nourish depleted Qi. Thus, tonifying Kidney fire is precisely nurturing Lung Metal. Moreover, Liu Wei Di Huang Wan is a divine agent for tonifying Kidney Water; tonifying both Water and Fire ensures Lung Metal is secure, and with Lung and Kidney in harmony, lying down becomes comfortable.
When a person suffers from severe abdominal pain that worsens upon pressure, this is caused by Fire Pathogens combined with Phlegm and Food Stagnation. Treating this as Direct Cold invasion would lead to immediate death. The prescription uses Gan Cao 1 qian, Fu Ling 3 qian, Bai Shao 5 qian, Zhi Shi (Aurantii Fructus Immaturus) 1 qian, Zhi Zi 3 qian, and Shan Zha (Crataegi Fructus) 20 grains. Decoct in water and take orally. Add Chai Hu 1 qian. (Annotation: Fen Jie San / Conflict-Resolving Powder). This formula possesses the wonder of resolving conflicts; it was a method not transmitted by the Heavenly Master, likely learned from other schools.
Master Qi said: Indeed, it was not transmitted. Sun Simiao (Sun Zhen Jun) had a formula for treating heart pain. Yan Hu Suo (Corydalis Rhizoma) 3 qian, Ru Xiang Mo (Frankincense Powder) 2 qian, Bai Shao 3 qian, Chao Zhi Zi (Stir-fried Gardeniae Fructus) 3 qian, and Gan Cao 0.5 qian. Decoct in water and take orally. Pain ceases after one dose. This formula specifically treats Fire Pain and is miraculous for patients who cry out and feel thirsty.