病逾一年，医称阴亏阳升，水不制火，育阴清火潜阳，屡治无效。若云痨瘵已成，非草
木之
所能治。现下饮食如常，脉不细数，似又不侔。求其何以屡治不效之故，理殊难测。岂非另
有隔膜未窥透耶?据述病缘旧春郊外垂钓，感冒风热而起。经云∶肺主皮毛，皮毛者，肺之
合也。皮毛先受邪气，邪气以从其合，此肺为受病之原，比诸劳风，法在肺下，巨阳不能引
精，青黄之涕，不能咳出，适足伤肺之例，当时虽曾服过清解之剂，但外邪入肺，如油入面
，有仓卒难以浣涤者，胶粘酝酿，郁而为热，郁热熏灼，津液受伤，所谓因病致虚者，由肺
病而累及之也。何以言之。凡人咽喉两管，咽通于胃，喉通于肺，今喉虽辣痛，而纳食无碍
，可知其病在喉而不在咽。人身之气左升右降，肝主升，其脉萦于左，肺主降，其脉萦于右
。今左畔肢体如常，而病端偏着于右，足见其病在肺，而不在肝。肺脉虽萦于右，然位居上
焦，为脏腑之华盖，观其上脘烦热，时冲喉
咙，颈下皮肤作痒，搔爬如痱，咯吐痰色灰黄等因，其为肺脏蕴热，金燥液干，情已大露。
再按大便坚硬，数日始一更衣者，肺与大肠相表里也。倘果因虚致病，悉属内伤，水不制火
，而致喉痛，早已咳血音嘶，走入怯途，焉能缓待。且滋阴壮水，药证相符，何以久服不应
耶?然病情虽窥一斑，治法尚难计议。盖治病须分新久，用药贵审机宜。病初体质无亏，治
惟涤邪，无庸顾虚。兹则病魔经岁，正气已亏，岂容孟浪!进而求之，肺为娇脏，喜润恶燥
，邪热久处肺中，金被火刑，津干液涸，是以养阴药饵，只可滋其津液之干，莫能驱其蕴伏
之燥耳。古人治燥甚少良方，惟西昌喻氏，会悟经旨，发明燥病，根源见得，诸气 郁，诸
痿喘呕，以及心移热于肺，二阳之病发心脾，各种病机，俱关于肺。所立清燥救肺一方，颇
有深意。盖辅金制木，即所以治肝，清肺澄源即所以治肾，僭仿其法，谅当有应。
安波按∶此方之义，无遗蕴矣。
病程已超过一年，医生诊断为阴液亏损、阳气上亢，肾水不能制约心火，采用滋养阴液、清泻火热、潜降阳气的治法，多次治疗均无效。如果说这是痨瘵（虚劳咳嗽）已经形成，那就不是草木药物所能治愈的。但眼下患者饮食如常，脉象不细数，似乎又不符合这一判断。探究其屡次治疗无效的原因，道理确实难以揣测。难道还有隔阂之处未曾看透吗？据叙述病因是去年春天在郊外垂钓时，感受风热之邪而发病。《内经》说：肺主皮毛，皮毛是肺的外合。皮毛先受邪气侵袭，邪气便顺着其内合关系传入体内，这是肺成为受病之源的道理，类似于“劳风”病，病位在肺下，太阳经气不能引导精气上行，导致青黄色的鼻涕无法咳出，这正好是损伤肺脏的例子。当时虽然曾服用过清热解表的药剂，但外邪侵入肺中，就像油混入面粉一样，很难在短时间内彻底清除，邪气胶粘酝酿，郁结化为热邪，郁热熏灼，损伤津液，这就是所谓的因病致虚，是由肺病牵连累及所致。为什么这样说呢？凡人的咽喉分为两管，咽部通于胃，喉部通于肺。现在喉部虽然辛辣疼痛，但进食没有阻碍，可知病位在喉而不在咽。人身之气左升右降，肝气主升，其经脉萦绕于左侧；肺气主降，其经脉萦绕于右侧。现在左侧肢体如常，而病端偏重于右侧，足见病在肺而不在肝。肺脉虽萦绕于右侧，但位居上焦，为脏腑的华盖（保护伞），观察其上脘部烦热，时常冲撞喉咙，颈部以下皮肤瘙痒，搔抓后出现类似痱子的皮疹，咯吐灰黄色痰液等情况，说明是肺脏蕴藏热邪，金燥液干，病情已非常明显。再诊察大便坚硬，几天才排便一次，这是因为肺与大肠相表里。如果果真是因虚致病，完全属于内伤，肾水不能制约心火而导致喉痛，早就应该咳血、声音嘶哑，进入虚怯病的阶段了，怎么能拖延这么久呢？况且滋阴壮水的药物与证候相符，为什么久服不见效呢？然而虽然窥探到病情的一斑，治疗方法仍难议定。因为治病必须分清新病久病，用药贵在审察时机和宜忌。病初起时体质无亏，治疗只需涤除邪气，无需顾虑正气虚弱。如今病魔缠身经过一年，正气已经亏损，岂能轻率冒进！进而推求，肺为娇脏，喜润恶燥，邪热长久停留在肺中，肺金被心火刑克，津液干枯，因此养阴的药物只能滋润其津液的干燥，却无法驱除其蕴伏的燥邪。古人治疗燥病很少有良方，只有西昌喻嘉言（喻氏），融会贯通经典旨意，阐发燥病理论，根源看得透彻，诸气郁结、诸痿喘呕，以及心移热于肺、二阳之病发心脾等各种病机，都关乎肺脏。他所创立的清燥救肺汤一方，颇有深意。大概是通过辅佐肺金以制约肝木，这就是治疗肝的方法；清肺澄源就是治疗肾的方法，仿效他的方法，想必会有疗效。
安波按：这个方义，已经没有遗漏蕴含了。
The disease has persisted for over a year. Physicians diagnosed it as Yin deficiency with Yang rising, and Kidney Water failing to control Heart Fire. Treatments aimed at nourishing Yin, clearing Heat, and subduing Yang were repeatedly applied without effect. If one claims that *Lao Zhai* (Consumptive Disease) has already formed, it cannot be treated by herbal medicines. However, the patient's diet remains normal, and the pulse is neither thin nor rapid, which seems inconsistent with this diagnosis. It is difficult to fathom why previous treatments failed. Could there be an obscured aspect of the pathology not yet fully understood? According to the history, the illness originated last spring while fishing in the suburbs, due to contracting Wind-Heat pathogenic factors. The *Classic of Internal Medicine* states: "The Lung governs the skin and hair; the skin and hair are the exterior correspondence of the Lung." When pathogens first invade the skin and hair, they follow their interior correspondence to enter the body. This explains why the Lung becomes the primary site of disease, similar to *Lao Feng* (Wind-induced Consumptive Disease), where the pathological location is below the Lung. The Taiyang channel fails to guide essence upward, resulting in greenish-yellow nasal discharge that cannot be coughed out, which serves as an example of Lung injury. Although clear-and-relieve formulas were taken at that time, external pathogens entering the Lung are like oil mixing into flour—difficult to wash away quickly. The pathogens adhere and ferment, stagnating to generate Heat. This stagnant Heat scorches and damages Body Fluids. This is what is meant by "deficiency caused by disease," where the Lung disease leads to secondary damage. Why is this so? In the human body, the throat consists of two passages: the pharynx connects to the Stomach, and the larynx connects to the Lung. Currently, although the larynx feels spicy and painful, swallowing food is unimpeded, indicating the disease is in the larynx, not the pharynx. Qi in the human body ascends on the left and descends on the right. The Liver governs ascent, with its meridians winding around the left side; the Lung governs descent, with its meridians winding around the right side. Since the left side of the body is normal, but the pathology focuses on the right, it confirms the disease is in the Lung, not the Liver. Although the Lung pulse winds around the right, it resides in the Upper Jiao and acts as the "Canopy" (protective cover) of the Zang-Fu organs. Observing the vexatious heat in the upper epigastrium, which frequently rushes to the larynx; the itching of the skin below the neck, resembling miliaria upon scratching; and the expectoration of grayish-yellow sputum, it is evident that there is latent Heat in the Lung, with Metal dryness and depleted fluids. The condition is clearly revealed. Furthermore, regarding the hard stools and defecation only once every few days, this is because the Lung and Large Intestine are exterior-interior paired organs. If the disease were truly caused by deficiency and belonged entirely to internal injury, with Kidney Water failing to control Fire leading to sore throat, hemoptysis and hoarseness would have occurred long ago, progressing to a state of consumptive weakness. How could it have been delayed so long? Moreover, if the herbs for nourishing Yin and strengthening Water matched the syndrome, why did prolonged administration fail to produce results? Although a glimpse of the pathology has been gained, treatment strategies remain difficult to formulate. Treating disease requires distinguishing between new and chronic conditions; medication must carefully assess timing and appropriateness. Initially, when the constitution was intact, treatment focused solely on eliminating pathogens without worrying about deficiency. Now, however, the pathogen has lingered for a year, and the Righteous Qi (Zheng Qi) is already deficient; rash action is inadvisable! Further analysis reveals that the Lung is a delicate organ, preferring moisture and disliking dryness. Prolonged presence of Evil Heat in the Lung causes Fire to punish Metal, leading to dried fluids. Therefore, Yin-nourishing herbs can only moisten the dryness of fluids but cannot驱散 (dispel) the latent dryness. Ancient physicians rarely had effective prescriptions for Dryness diseases. Only Yu Jia Yan (Yu Shi) from Xichang comprehended the classical principles, elucidated the theory of Dryness diseases, and identified the root causes. He recognized that various mechanisms such as Qi stagnation, flaccidity syndromes, wheezing, vomiting, Heart transferring Heat to the Lung, and Two Yang diseases originating from Heart and Spleen, all relate to the Lung. His established formula, *Qing Zao Jiu Fei Tang* (Clearing Dryness and Saving the Lung Decoction), holds profound significance. By assisting Lung Metal to control Liver Wood, one treats the Liver; by clearing the Lung and purifying the source, one treats the Kidney. Imitating his method should yield results.
An Bo notes: The meaning of this formula is comprehensive and without omission.