恙经三月，脉大而急，证见呛咳气筑，胸满背胀，夜不安卧，卧则气冲，呼吸不利，目
烂舌
赤，口干心烦。审诸脉证。是属肺感燥邪。加之抑郁，痰气胶结，肺窍阻闭，清肃失司，酿
成肺痹危险。盖肺为气之主，肺气逆则诸气皆因之而逆矣。平素质亏受补，兹则补剂不投，
虽虚虚而病则实，不去其病，徒补无益。经云∶诸气 郁，皆属于肺。秋伤于燥，冬生咳嗽
，计惟清燥宣痹，幸得胸展痹开，方许机关衄转，仿苇茎汤遵《金匮》法。服药四剂，喉口
燥象稍减，舌根焦苔亦退，脉象依然，痹犹时发，甚则胸膈 胀，喘喝不已，欲人捶摩，咯
出浊痰，略觉宽展，病由燥邪蕴伏上焦，治节不行，痰壅无形之火，火灼有形之痰，交相为
患。夫痹者闭也，内闭则外脱，至危至急，无如上焦不开，未能填补其下，是以每投补剂，
其闭更剧。按肺窍蕴结之痰，如屋之游，树之萝，石之
苔，胶粘滋蔓，岂寻常消痰之品所能芟刈。原方加蒌皮海石，轻清宣痹，病象未减，下虚不
能纳补，上实通之无功。消补两难，颇为棘手。据述每痹甚时，惟饮菔水则痰气稍平，即此
推求，定有顽痰胶粘肺管，阻塞气机，苇茎频投不应，惟有进步葶苈一法，非不虑及老人质
亏难任，当此危迫，畏首畏尾，身其余几，奈何。苇茎葶苈，乃金匮治肺痹两大法门，前因
年高恙久，不敢骤用葶苈峻攻，惟取苇茎轻清宣痹，冀其病去，元气不伤，服药虽见小效，
痹
终未宣。前论燥热酝酿为痰，肺窍气机阻塞，清肃失司，因而逆满，却非谬语。夫顽痰滋蔓
，譬诸顽民，不服王化，不忍猛而宽，则萑莩盗风，何由而息。所加葶苈，虽系无可如何，
亦理之所当然，非徒行险侥幸也。现下痹势稍松，足见有故无殒，从来峻剂，原属可暂而不
可常。然证经数月之久，痰热弥漫已极，甫得稍开，若旋行易辙，病根尚在，虑其复萌。今
早鼻仍流血，可知肺火未清，方加石膏、山栀、竹沥彻其痰热余波，今夜得以痹再减轻，明
日可为转手。老人病逾百日，痰凝气壅，肺痹不舒，上实下虚，原难想法，数番诊视，因其
痰火势盛，不能受补，无已初投苇茎轻清宣肺，继进葶苈涤饮除痰，佐以膏栀竹沥，以彻痰
热余波，此皆古人成法，非杜撰也。今痹象稍减，虚状渐露，高年恙久，恐其元气不支，商
佐保金辅正。
安波按∶先生用方用法，丝丝入蔻，不比近来庸流溷乱笼统者也。
病症持续了三个月，脉象大而急迫，症状表现为呛咳、气息上冲，胸部胀满、背部发胀，夜间无法安睡，躺下时气逆上冲，呼吸不畅，眼睑溃烂、舌质红赤，口干且心烦。综合审视所有脉象和症状，这是肺脏感受燥邪所致。加之情绪抑郁，导致痰与气相互胶结，肺窍阻塞闭塞，清肃功能失常，酿成危险的肺痹证。因为肺是气的主宰，肺气上逆则全身之气都会随之上逆。患者平素体质亏虚，通常可以接受补益治疗，但此时却不能用补剂，虽然补益会加重虚损（虚虚），但病邪属实，若不祛除病邪，单纯进补毫无益处。《内经》说：“各种气机郁滞，都归属于肺。”秋季受燥邪侵袭，冬季发生咳嗽，目前只有采用清燥宣通痹阻的方法，希望能使胸中舒展、痹阻开通，病情才有转机。仿照《金匮要略》中的苇茎汤法进行治疗。服用四剂药后，咽喉口干燥的症状稍减，舌根焦黄的苔垢也消退了一些，但脉象依然如故，痹阻症状仍不时发作，严重时胸膈胀满，喘息有声不止，喜欢让人捶打按摩，咯出浊痰后略微觉得宽舒。此病由燥邪蕴伏于上焦，治节功能不行，痰壅滞无形之火，火灼烧有形之痰，二者互相为患。所谓“痹”，就是闭塞的意思，内部闭塞则外部脱失，情况极其危险紧急。由于上焦不通，不能在下部进行填补，所以每次投用补剂，闭塞反而更加严重。按察肺窍中蕴结的痰，就像屋上的游丝、树上的藤蔓、石头上的青苔一样，胶粘滋长蔓延，哪里是寻常消痰的药物所能清除的呢？在原方中加入瓜蒌皮和海浮石，以轻清之品宣通痹阻，但病象没有减轻，这是因为下焦虚弱不能纳受补益，上焦实证通过通利方法也无功。消法和补法两难兼顾，颇为棘手。据患者叙述，每当痹阻严重时，只有喝萝卜水才能使痰气稍微平复，由此推断，必定有顽痰胶粘在肺管中，阻塞气机。频繁使用苇茎汤无效，只能采取进阶的葶苈子法。并非不考虑老人体质亏虚难以承受峻猛药物，但在此危急紧迫之际，如果畏首畏尾，身体还能剩多少呢？苇茎汤和葶苈大枣泻肺汤，是《金匮要略》治疗肺痹的两大法门。之前因为年高病久，不敢贸然使用葶苈子峻猛攻伐，只取苇茎汤轻清宣通痹阻，希望病去而元气不伤。服药虽见小效，但痹阻终究未完全宣通。前文论述燥热酝酿为痰，肺窍气机阻塞，清肃功能失常，因而气逆胀满，这并非谬论。那顽痰滋长蔓延，好比顽固的百姓，不服从王化，如果不忍心严厉整治而宽容放任，那么盗贼之风如何能平息？所加入的葶苈子，虽然是无可奈何之举，也是情理之中的必然选择，并非只是冒险侥幸。目前痹阻之势稍缓，足以证明“有故无殒”（有病则病受之，不会伤害正气）的道理。从来峻猛的药物，原本属于可以暂时使用而不宜长期使用的。然而病症已经持续数月之久，痰热弥漫到了极点，刚刚得到些许缓解，如果立刻改变治疗方案，病根尚在，担心病情复发。今天早上鼻子仍然流血，可知肺火尚未清除，方剂中加入石膏、山栀、竹沥，以清除痰热的余波。今夜得以使痹阻再次减轻，明天就可以着手调整治疗方案。老人患病超过一百天，痰凝气壅，肺痹不舒，上实下虚，原本很难想办法。经过数次诊视，因其痰火势盛，不能耐受补益，不得已先投苇茎汤轻清宣肺，继服葶苈子涤除饮邪、消除痰浊，佐以石膏、山栀、竹沥，以彻除痰热的余波，这些都是古人的成法，并非杜撰。现在痹阻症状稍减，虚损之象逐渐显露，鉴于高龄病久，恐怕其元气不支，商量着佐以保金辅正（保护肺金、扶助正气）之法。
安波按语：先生用药和用法，丝丝入扣，不像近来庸医混乱笼统的做法。
The illness has persisted for three months. The pulse is large and rapid (da er ji). Symptoms include choking cough, qi rushing upward, chest fullness, back distension, inability to sleep peacefully at night, and upon lying down, qi rushes upward causing difficult breathing. There is ulceration of the eyelids, red tongue, dry mouth, and vexation in the heart. Examining all pulses and symptoms, this belongs to the Lung affected by Dryness pathogen. Compounded by depression, phlegm and qi are knotted together, blocking the Lung orifices, leading to the loss of clear descending function,酿 (brewing) into a dangerous condition of Fei Bi (Lung Obstruction Syndrome). The Lung is the master of Qi; when Lung Qi rebels, all Qi follows it in rebellion. In normal times, the constitution is deficient and can tolerate tonification; however, now tonifying agents are contraindicated. Although tonification would further deplete deficiency (Xu Xu), the disease is excess (Shi); without removing the pathogen, mere tonification is of no benefit. The Classic states: "All Qi stagnations belong to the Lung." Injury to Dryness in autumn leads to cough in winter. Currently, only clearing Dryness and opening obstruction (Xuan Bi) is viable. Hopefully, once the chest expands and obstruction opens, there will be a turning point. Following the method of Wei Jing Tang from *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet). After taking four doses, the dryness in the throat and mouth slightly decreased, and the scorched coating on the root of the tongue receded. However, the pulse remains unchanged, and Bi symptoms still occur intermittently. When severe, there is chest and diaphragm distension, incessant wheezing, and a desire for someone to beat or massage the area. Expectoration of turbid phlegm brings slight relief. The disease arises from Dryness pathogen harbored in the Upper Jiao, with failure of regulation (Zhi Jie). Phlegm obstructs formless Fire, and Fire scalds formed Phlegm, mutually harming each other. "Bi" means closure; internal closure leads to external collapse, which is extremely critical and urgent. Because the Upper Jiao is not open, one cannot tonify the Lower Jiao; thus, every time tonifying agents are administered, the closure worsens. The phlegm accumulated in the Lung orifices is like floating silk in a house, vines on a tree, or moss on a stone—sticky, adhesive, and spreading. How can ordinary phlegm-resolving herbs cut through this? Adding Gua Lou Pi (Trichosanthis Pericarpium) and Hai Shi (Pumex) to the original formula aims to lightly clear and open obstruction, but the symptoms did not subside. This is because the Lower Deficiency cannot accept tonification, and the Upper Excess cannot be resolved by unblocking methods. Both resolving and tonifying are difficult, making the case quite tricky. According to the patient's account, whenever the Bi is severe, only drinking radish water can slightly calm the phlegm and Qi. From this, we deduce that stubborn phlegm must be sticking to the lung tubes, blocking Qi mechanism. Frequent use of Wei Jing Tang was ineffective; we must proceed to the method of Ting Li (Descurainiae Semen / Lepidii Semen). It is not that we do not worry about the elderly patient's deficient constitution being unable to bear harsh attacks, but in this critical situation, if we hesitate out of fear, how much of the body will remain? Wei Jing Tang and Ting Li Da Zao Xie Fei Tang are the two major methods for treating Lung Bi in *Jin Gui*. Previously, due to advanced age and chronic illness, I dared not suddenly use the harsh attack of Ting Li, choosing only the light and clear Wei Jing Tang to open obstruction, hoping the disease would go without injuring Yuan Qi. Although medication showed minor effects, the obstruction was ultimately not fully opened. The previous discussion that Dry-Heat brews phlegm, blocking Lung orifice Qi mechanism and causing loss of clear descending function, thereby leading to rebellion and fullness, was not erroneous. Stubborn phlegm spreads like stubborn people who do not submit to royal governance; if one does not endure severity and instead tolerates leniency, how will banditry cease? The added Ting Li, though a last resort, is logically inevitable, not merely gambling on luck. Currently, the Bi trend has slightly loosened, proving the principle that "with pathology present, there is no injury" (You Gu Wu Yun). Harsh drugs have always been suitable for temporary use, not constant use. However, the condition has lasted for months, with Phlegm-Heat diffusing to an extreme degree. Now that it has slightly opened, if we change course immediately, the root cause remains, and recurrence is feared. Today morning, nosebleed continued, indicating Lung Fire is not yet cleared. Added Shi Gao (Gypsum Fibrosum), Shan Zhi (Gardeniae Fructus), and Zhu Li (Bambusae Succus) to the prescription to eliminate residual waves of Phlegm-Heat. Tonight, the Bi should decrease further, allowing for adjustment tomorrow. The elderly patient has been ill for over 100 days, with congealed phlegm and stagnant Qi, uncomfortable Lung Bi, Upper Excess and Lower Deficiency. Originally, it was hard to find a solution. After several consultations, given the fierce Phlegm-Fire heat which cannot tolerate tonification, we initially used Wei Jing Tang to lightly clear and diffuse the Lung, then advanced to Ting Li to wash away fluid retention and remove phlegm, assisted by Shi Gao, Shan Zhi, and Zhu Li to clear residual Phlegm-Heat. These are established methods of the ancients, not fabricated. Now that Bi symptoms have slightly decreased and deficiency signs are gradually emerging, considering the advanced age and long illness, fearing the Yuan Qi may not sustain, we discuss adding methods to protect Metal (Lung) and support Righteous Qi (Zheng Qi).
An Bo's commentary: The Master's prescription usage is meticulous and precise, unlike the chaotic and vague practices of recent mediocre practitioners.