哮者,气为痰阻,呼吸有声,喉若拽锯,甚则喘咳,不能卧息。症由痰热内郁,风寒外束,初失表散,
邪留肺络。宿根积久,随感辄发,或贪凉露卧,专嗜甜咸,胶痰与阳气并于膈中,不得泄越,热壅气逆,故
声粗为哮。须避风寒,节浓味,审其新久虚实而治之。大率新病多实,久病多虚;喉如鼾声者虚,如水鸡者
实;遇风寒而发者为冷哮,为实;伤暑热而发者为热哮,为虚。其盐哮、酒哮、糖哮,皆虚哮也。冷哮有二,
一则中外皆寒,宜温肺以劫寒痰;温肺汤、钟乳丸、冷哮丸,并以三建膏护肺俞穴。一则寒包热,宜散寒以
解郁热。麻黄汤、越婢加半夏汤。如邪滞于肺,咳兼喘者,六安煎加细辛、苏叶。冬感寒邪甚者,华盖散、
三拗汤。外感寒,内兼微火者,黄芩半夏汤。热哮当暑月火盛痰喘者,桑白皮汤,或白虎汤加芩、枳、栝蒌霜。
痰壅气急者,四磨饮、苏子降气汤,气降,痰自清。痰多者吐之,勿纯用凉药,须带辛散。小青龙汤探吐。
肾哮火急者,勿骤用苦寒,宜温劫之。用椒目五六钱,细研,分二三次,姜汤调服。俟哮止后,因痰因火治之。
治实哮,用百部、炙草各二钱,桔梗三钱,半夏、陈皮各一钱,茯苓一钱半,一服可愈。治虚哮,用麦冬三
两,桔梗三钱,甘草二钱,一服可愈。此煎剂内,冷哮加干姜一钱,热哮加
元参三钱,盐哮加饴糖三钱,酒哮加柞木三钱,糖哮加佩兰三钱,再用海螵蛸火 研末,大人五钱,小儿二钱,
黑砂糖拌匀调服,一服除根。其遇浓味而发者,清金丹消其积食。伤咸冷冻饮料食而发者,白面二钱,沙糖二钱,
饴糖化汁捻作饼,炙熟,加轻粉四钱,食尽,吐出病根即愈。年幼体虚者,分三四次服,吐后,用异功散加细
辛。脾胃阳微者,急养正,四君子汤。久发中虚者,急补中,益气汤。宿哮沉痼者,摄肾真,肾气丸加减。
总之,哮既发,主散邪;哮定,则扶正为主也。
哮病,是指气机被痰浊阻滞,呼吸时发出声响,喉咙里声音像拉锯一样,严重时出现喘咳,无法平卧休息。病症由痰热在内郁结,风寒在外束缚,初期未能及时发散表邪,导致邪气留滞于肺络。宿根积聚日久,每次感受外邪就会发作,或者因为贪凉露宿,特别嗜好甜食和咸味食物,使得胶固的痰浊与阳气并聚在膈中,不能宣泄越出,热气壅塞、气机上逆,所以声音粗重成为哮病。必须避免风寒,节制浓烈厚味的饮食,审察病情的新久虚实来进行治疗。大抵新发的病多属实证,久病的多属虚证;喉间声音像打鼾的是虚证,像水鸡叫的是实证;遇到风寒而发作的是冷哮,属于实证;伤于暑热而发作的是热哮,属于虚证。至于盐哮、酒哮、糖哮,都属于虚哮。
冷哮有两种情况:一种是内外皆寒,适宜温肺以驱除寒痰;可用温肺汤、钟乳丸、冷哮丸,并用三建膏敷贴护肺俞穴。另一种是寒包热(外寒内热),适宜散寒以解除郁积的热邪;可用麻黄汤、越婢加半夏汤。如果邪气滞留于肺,咳嗽兼有气喘的,用六安煎加细辛、苏叶。冬天感受寒邪严重的,用华盖散、三拗汤。外感寒邪,内部兼有轻微火气的,用黄芩半夏汤。
热哮当在暑月火盛、痰喘发作时,用桑白皮汤,或者白虎汤加黄芩、枳实、栝蒌霜。痰壅气急的,用四磨饮、苏子降气汤,气机下降,痰浊自然清除。痰多的采用吐法,不要单纯使用凉药,必须带有辛散之性;可用小青龙汤探吐。肾哮火急的,不要骤然使用苦寒药物,适宜用温法劫夺痰邪;用椒目五六钱,细细研磨,分两三次服用,姜汤调服。等到哮病停止后,再根据痰或火的病因进行治疗。
治疗实证哮病,用百部、炙甘草各二钱,桔梗三钱,半夏、陈皮各一钱,茯苓一钱半,一剂即可痊愈。治疗虚证哮病,用麦冬三两,桔梗三钱,甘草二钱,一剂即可痊愈。在这些煎剂中,冷哮加干姜一钱,热哮加元参三钱,盐哮加饴糖三钱,酒哮加柞木三钱,糖哮加佩兰三钱。再用海螵蛸火研成末,成人五钱,小儿二钱,与黑砂糖拌匀调服,一剂可除根。那些因食用浓味食物而发作的,用清金丹消除积食。因食用咸冷冻饮料食物而发作的,用白面二钱,沙糖二钱,饴糖化汁捏成饼,烤熟,加入轻粉四钱,吃完后吐出,病根即愈。年幼体虚者,分三四次服用,吐完后,用异功散加细辛。脾胃阳气微弱者,急需养护正气,用四君子汤。久发导致中焦虚弱者,急需补益中气,用益气汤。宿疾哮喘沉疴痼疾者,需摄纳肾中真元,用肾气丸加减。总之,哮病发作时,以疏散邪气为主;哮病平息后,则以扶助正气为主。
Xiao (Asthma with Wheezing) refers to a condition where Qi is obstructed by phlegm, causing sounds during respiration, with the throat sounding like a saw being pulled. In severe cases, it presents with panting and coughing, making it impossible to lie flat for rest. The pathology arises from internal stagnation of phlegm-heat and external constraint by wind-cold. If the exterior pathogen is not dispersed initially, the pathogen remains in the lung collaterals. This root cause accumulates over time and triggers attacks upon any new exposure to pathogens. It may also result from indulging in cold exposure or sleeping outdoors, or specifically craving sweet and salty foods, causing sticky phlegm and Yang Qi to congregate in the diaphragm without being able to vent. Heat congestion and Qi rebellion cause coarse sounds, resulting in Xiao. One must avoid wind and cold, regulate rich and heavy flavors, and treat based on an assessment of the disease's novelty, duration, and deficiency/excess patterns. Generally, new diseases are mostly excess, while chronic diseases are mostly deficiency; a snoring-like sound in the throat indicates deficiency, whereas a sound like a water fowl indicates excess. Attacks triggered by wind-cold are Cold Xiao, which is excess; attacks triggered by summerheat-heat are Heat Xiao, which is deficiency. Salt Xiao, Wine Xiao, and Sugar Xiao are all considered Deficiency Xiao.
Cold Xiao has two types: First, coldness inside and outside, suitable for warming the Lung to seize out cold-phlegm; use Wenfei Tang (Warming Lung Decoction), Zhongru Wan (Zeolite Pill), or Lengxiao Wan (Cold Asthma Pill), along with Sanjian Gao (Three Jian Paste) applied to Feishu (BL13). Second, cold wrapping heat (external cold with internal heat), suitable for dispersing cold to resolve stagnant heat; use Mahuang Tang (Ephedra Decoction) or Yebibo Jia Banxia Tang (Yebibo Decoction plus Pinellia). If pathogen stagnates in the Lung with cough and panting, use Liu'an Jian (Six-Safe Decoction) plus Xixin (Asari Radix et Rhizoma) and Ziye (Perilla Leaf). For severe winter cold invasion, use Huagai San (Canopy Powder) or San'ao Tang (Three Unblocking Decoction). For external cold with internal slight fire, use Huangqin Banxia Tang (Scutellaria and Pinellia Decoction).
For Heat Xiao during summer months with abundant fire and phlegm-panting, use Sangbaipi Tang (Morus Bark Decoction) or Baihu Tang (White Tiger Decoction) plus Huangqin (Scutellaria Root), Zhishi (Immature Bitter Orange), and Gualou Shuang (Trichosanthes Powder). For phlegm congestion and urgent Qi, use Simo Yin (Four-Marrow Drink) or Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction); once Qi descends, phlegm clears naturally. For excessive phlegm, induce vomiting; do not use purely cooling medicines, but those with acrid-dispersing properties; use Xiaolongtan Tang (Minor Blue Dragon Decoction) to probe for vomiting. For Kidney Xiao with urgent fire, do not abruptly use bitter-cold medicines; instead, use warm methods to seize the pathogen. Use Jiaomu (Semen Phaseoli) 5-6 qian, finely ground, divided into 2-3 doses, taken with Ginger Decoction. After the Xiao stops, treat according to the causes of phlegm or fire.
To treat Excess Xiao, use Baibu (Stemona Root) and Zhi Gancao (Prepared Licorice Root) each 2 qian, Jiegeng (Platycodon Root) 3 qian, Banxia (Pinellia Tuber) and Chenpi (Aged Tangerine Peel) each 1 qian, Fuling (Poria) 1.5 qian; one dose can cure. To treat Deficiency Xiao, use Maidong (Ophiopogon Tuber) 3 liang, Jiegeng 3 qian, Gancao (Licorice Root) 2 qian; one dose can cure. Within these decoctions, add Ganjiang (Dried Ginger) 1 qian for Cold Xiao, Yuan Shen (Scrophularia Root) 3 qian for Heat Xiao, Yitang (Maltose) 3 qian for Salt Xiao, Zuomu (Zuomu Wood) 3 qian for Wine Xiao, and Peilan (Agastache Herb) 3 qian for Sugar Xiao. Then, use Haipiaoxiao (Sepia Shell) roasted and ground to powder: 5 qian for adults, 2 qian for children, mixed with Black Brown Sugar and taken as a paste; one dose removes the root. For attacks triggered by rich flavors, use Qingjin Dan (Clear Golden Pill) to eliminate food stagnation. For attacks triggered by salty frozen drinks/food, use 2 qian white flour, 2 qian brown sugar, and melt maltose to form a cake, roast until cooked, add Qinfen (Calomel) 4 qian; after eating it all, vomiting will expel the disease root and cure it. For young children with weak constitutions, divide into 3-4 doses; after vomiting, use Yigong San (Extraordinary Assistance Powder) plus Xixin. For those with weak Spleen-Stomach Yang, urgently nourish Righteous Qi using Sijunzi Tang (Four Gentlemen Decoction). For chronic attacks leading to Middle Jiao deficiency, urgently tonify the Middle using Yiqi Tang (Qi-Benefiting Decoction). For entrenched chronic Xiao, capture the Kidney's True Essence using Shenqi Wan (Kidney Qi Pill) with modifications. In summary, when Xiao is active, the primary approach is to disperse pathogens; when Xiao subsides, the primary approach is to support Righteous Qi.