哮嗽多年，原属锢疾，往岁举发尚轻，此番发剧，胸满喘促，呼吸欠利，夜卧不堪着枕
。药
投温通苦降，闭开喘定，吐出稠痰而后即安。思病之频发膈间，必有窠囊，痰饮日聚其中，
盈科后进，肺为华盖，位处上焦。司清肃之职。痰气上逆，阻肺之降，是以喘闭不通。务将
所聚之痰，倾囊叶出。膈间空旷，始得安堵。无如窠囊之痰，如蜂子之穴于房中，莲子之嵌
于蓬内，生长则易，剥落则难，不刈其根，患何由杜?考《金匮》分外饮治脾，内饮治肾，
且曰∶饮邪当以温药和之，议以早服肾气丸，温通肾阳，使饮邪不致上泛。晚用六君，变汤
为散，默健坤元，冀其土能生金，兼可制水。夫痰即津液所化，使脾肾得强，则日入之饮食
，但生津液而不生痰。痰既不生，疾自不作，上工治病，须求其本。平常守服丸散，疾发间
用煎剂搜逐。譬诸宵小潜伏里 ，乘其行动犯窃，易于拘执，剿抚并行，渐可杜患。
复诊寒热依然，神采更倦，前方初服，微见痰红，疑系附子温燥所致。续服五剂，红不
再吐
，口并不渴。仲圣云∶身大热而反近衣者，热在皮肤，寒在骨髓也。且越人明以阳维为病，
苦寒热为训，岂寒栗如此，经年累月，憔悴不堪，不从温补，尚有何策可施耶?王太仆云∶
热之不热，是无火也。益火之源，以消阴翳。旨可悟矣。虽内经有诸禁鼓栗，如丧神守，皆
属于火之言，丹溪有治用清凉之案，然与此似乎不合。无如补虚门中，归脾、十全、补元煎
、养营汤之属，均已服过，即治奇经之鹿茸河车，亦无应验。殊为棘手。但细详脉证，总不
外乎阴阳精气两亏，张介宾所谓以精气分阴阳，则阴阳不可离，以寒热分阴阳，则阴阳不可
混。古人复起，不易斯言。
哮嗽多年，原本属于顽固难治的疾病，往年发作时症状尚且轻微，这次发作剧烈，胸部胀满、气喘急促，呼吸不畅利，夜间睡觉无法安枕。用药采用温通和苦降的方法后，气机闭塞开通，喘息平息，吐出稠痰之后病情随即安定。思考疾病频繁发生在膈间，必然有“窠囊”（指痰饮积聚形成的巢穴），痰饮在其中日益聚集，像水流填满低洼处一样逐渐增多。肺为华盖（五脏六腑之盖，位于最高处），位置在上焦，主管清肃下降的职能。痰气上逆，阻碍了肺气的下降，所以出现喘促闭塞不通的症状。务必将积聚的痰饮彻底清除排出，使膈间空旷，才能安宁。无奈那窠囊中的痰，如同蜜蜂在房中筑巢，莲子嵌在莲蓬内，生长容易，剥落困难，不铲除病根，祸患从哪里杜绝呢？考察《金匮要略》提出外饮治脾，内饮治肾，并且说：“饮邪应当用温药调和。”建议早晨服用肾气丸，温通肾阳，使饮邪不至于向上泛溢。晚上使用六君子汤，将汤剂改为散剂，默默强健脾胃（坤元指脾胃），希望土能生金（脾生肺），兼可制约水湿。痰是由津液转化而来的，如果脾肾功能强健，那么每日摄入的饮食，只会生成津液而不会生成痰。痰既然不生，疾病自然不再发作，高明的医生治病，必须探求根本。平时坚持服用丸散，疾病发作间歇期使用煎剂搜逐病邪。这就像宵小之徒潜伏在内里，趁其行动犯窃时，容易拘捕，剿灭与安抚并行，逐渐可以杜绝祸患。
复诊时寒热症状依然如故，精神神采更加疲倦，前方初服时，微微见到痰中带血，怀疑是附子温燥所致。继续服用五剂后，不再吐血，口也不渴。仲景说：“身体大热反而想穿衣的，是热在皮肤，寒在骨髓。”而且扁鹊明确以阳维脉为病，以苦寒热作为训诫，难道像这样寒战如此严重，经年累月，憔悴不堪，如果不从温补入手，还有什么策略可以施行呢？王冰说：“加热而不热的，是无火。”益火之源，以消除阴翳。旨意是可以领悟的。虽然《内经》有“各种禁栗鼓动，如同丧失神志控制，都归属于火”的说法，丹溪也有治疗使用清凉药物的案例，但这似乎与此病不合。无奈虚损门中的归脾汤、十全大补汤、补元煎、养营汤等方剂，都已经服用过，即使是治疗奇经的鹿茸、紫河车，也没有见效。确实棘手。但仔细详查脉象和证候，总不外乎阴阳精气两亏，张介宾所谓“以精气分阴阳，则阴阳不可分离；以寒热分阴阳，则阴阳不可混淆”。古人复活，也不会改变这番言论。
Xiao Sou (asthmatic cough) for many years, originally belonging to an entrenched disease. In previous years, when it erupted, the symptoms were still mild; this time the eruption was severe, with chest fullness and panting, breathing not smooth, and unable to rest on the pillow at night. After administering medicine with warming and unblocking, and bitter descending properties, the closure opened, panting settled, thick phlegm was expectorated, and then peace was restored. Considering that the disease frequently occurs in the diaphragm region, there must be "cocoons" (nests where phlegm-fluid accumulates). Phlegm-fluid gathers day by day within them, advancing like water filling ditches. The Lung is the Huagai (canopy of the five zang and six fu organs), located in the Upper Jiao, governing the function of clearing and descending. When phlegm-qi rebels upward, obstructing the descent of the Lung, thus causing panting and closure without passage. It is necessary to pour out and eliminate the accumulated phlegm completely. Only when the diaphragm region becomes empty and spacious can there be security. Unfortunately, the phlegm in the cocoons is like bees nesting in a house or lotus seeds embedded in a pod; easy to grow, difficult to peel off. Without cutting the root, how can the disaster be prevented? Examining the *Jin Gui Yao Lue*, it distinguishes external fluid treatment for the Spleen and internal fluid treatment for the Kidney, and states: "Fluid pathogens should be harmonized with warm medicines." It is proposed to take Shen Qi Wan (Kidney Qi Pill) early in the morning to warm and unblock Kidney Yang, preventing fluid pathogens from flooding upward. In the evening, use Liu Jun Zi Tang (Six Gentlemen Decoction), changing decoction to powder, silently strengthening Kun Yuan (Spleen/Stomach earth), hoping that Earth generates Metal (Spleen generates Lung), and simultaneously controlling Water. Phlegm is transformed from body fluids. If the Spleen and Kidney are strong, then daily food intake will generate body fluids rather than phlegm. Since phlegm is not generated, the disease naturally does not occur. A superior physician treating disease must seek its root. Normally, persist in taking pills and powders; during intervals when the disease erupts, use decoctions to search and expel. This is like petty criminals hiding inside; when they act and commit theft, it is easy to apprehend them. Combining suppression and pacification, gradually the disaster can be prevented.
In the follow-up consultation, chills and fever remained as before, and spiritual vitality was even more exhausted. After initially taking the previous prescription, slight blood in phlegm appeared, suspected to be caused by the warming and drying nature of Fu Zi (Aconite Root). After continuing to take five doses, blood was no longer expectorated, and the mouth was not thirsty. Zhong Jing said: "When the body is very hot but the patient desires to wear clothes, the heat is in the skin, and the cold is in the marrow." Moreover, Yue Ren (Bian Que) clearly taught that when Yang Wei Mai (Yang Linking Vessel) is diseased, suffering from alternating chills and fever is a sign. How could one endure such severe chills for years and months, becoming emaciated and unbearable, without applying warming tonification? What other strategy could be employed? Wang Tai Pu (Wang Bing) said: "If heating does not produce warmth, it is due to lack of Fire." Enlarge the source of Fire to eliminate Yin shadows. The purport can be understood. Although the *Nei Jing* states that various convulsions and shivering, as if losing spiritual control, all belong to Fire, and Dan Xi has cases of treatment using cooling methods, this seems inconsistent with the current case. Unfortunately, formulas from the deficiency-tonifying category such as Gui Pi Tang (Restore the Spleen Decoction), Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), Bu Yuan Jian (Decoction for Supplementing Origin), and Yang Ying Tang (Nourish Blood Decoction) have already been taken. Even Lu Rong (Deer Antler) and He Che Da Zao (Placenta Hominis) for treating the Extraordinary Vessels yielded no effect. It is indeed tricky. But carefully detailing the pulse and symptoms, it ultimately boils down to the dual deficiency of Yin-Yang and Essence-Qi. Zhang Jie Bin said, "Dividing Yin-Yang by Essence-Qi means Yin and Yang cannot be separated; dividing Yin-Yang by Cold-Heat means Yin and Yang cannot be confused." If ancient sages rose again, they would not change these words.