下咽，饮水无度。更以为实热，以三黄丸下之，利行不多，渐加喘促。再剂，夜半喘大作，有出无入，遍身麻
木，溃汗如雨，神昏目直，口噤不言，委顿极矣。亟招冯诊，两寸左关仅存。时当六月，欲与四逆、理中，主人畏
惧，改以人参一两，麦冬二钱，五味六分，肉桂钱许，始允急煎服之。喘减片刻，奈病大药小，顷复大作，乃
不咎寒凉之误，反以参、桂为罪矣。因思尽吾之力，尚可以活，若徇彼之见，必死而已，乃坚定一方，勒令服
之。用炒白术三两，人参二两，炮姜三钱，五味子一钱五分，制附子三钱，煎浓汁灌之。下咽后，病患张口大
声云∶心中如火烙欲死。（此不与冷服故。）傍观疑怨交起不为动。顷之又大声曰∶脐间更疼更热，欲死矣。乃
窃喜其阳能下达，未之绝也。果少焉，喘定汗收，手足温而神思清，语言反甚无力。此方术多参少者，因中宫久
困寒冷，不先为理中，则阳气难下达也。
吕东庄治徐鸾和内病咳嗽，医以伤风治之益甚。邀诊，则中虚脉也。曰∶鼻塞垂涕痰急，皆伤风实症，何
得云虚？曰∶此虚实真假，所辨在脉，庸医昧此，误人多矣。彼不知脉，请即以症辨之。其人必晡热潮热，至
夜半渐清，至晨稍安，然乎？曰∶然。然则中虚何疑乎？所言喜者，正此鼻塞垂涕耳。乃投以人参、白术、当
归、黄 、白芍各三钱，软柴胡、升麻各一钱，陈皮、甘草、五味各六分，三剂而咳嗽立止。再诊谓之曰∶
上症已去，惟带下殊甚，近崩中耳。惊应曰∶然。即前方重用人参，加补骨脂、阿胶各二钱，数剂，兼服六味丸而愈。
柴屿青治陈氏甥女，咳嗽吐痰，夜间发热，众医以为必成劳症。诊其脉虽稍洪，尚有根柢，并非细数，何
至不治？纯用滋阴之药，调养半年而愈。
同学蔡为章患痰嗽，夜难就寝，身不胜衣，夜卧床不能转侧。诊其六脉微弱，气血两剧，拟用参、 补剂。
蔡以痰嗽不宜用补为疑，乃力任之。先用六君子汤加炮姜、桂、附，数帖而嗽减。继用养荣汤十数剂，始能下
床行动，调理月余而康。
张惕中咳嗽吐痰，医误认风寒，服药十数剂，病增剧，身热喘嗽，夜不能卧，胸膈痞塞，困于床第，小便
短缩。诊得人迎脉缓，绝非外感。气口空大，左寸弱甚，两沉微微，此心肾不足，的系内伤之症。其小便不利
者，三焦之气化不能运于州都也。从东垣治内伤条，师其意而变通之，旬日而痊。
左中丞夫人，年二十余，形体瘦弱，痰嗽息粗，夜不能寐。医频与消痰理气，愈委顿。诊其脉甚微细，此
气虚也。仲景云∶气虚有痰，肾气丸补而逐之。遂用六味汤加麦冬、五味，治之而愈。惟夜间尚未熟睡，再用
养荣汤加茯神、枣仁，十数剂即加餐安睡，渐得复元。
丙寅新正 卿讳伊芳喇齐长郎，贺节至寓云，咳嗽求方。诊其两脉细数，右寸郁结，断其难以收功，勉用麻
黄汤。伊芳断断不可，曰∶我子阴亏，他医熟地、人参，服过数两。柴曰∶阴亏诚然，但风邪闭塞肺气，补剂又
从而壅遏之，非此不能去邪。力争不信，早决其不起。果然。
按∶凡损症脉，见右寸厥厥然如豆，按之梗指，其病原属不起，以肺金败也。今以右寸郁结，断为风
邪闭塞，然必见鼻塞声重，或头痛痰浓，或咳嗽连续，方是其候。
王肯堂治一妇人，咳嗽不已，服诸药不效，渐成劳瘵。诊之，六脉濡弱，此血弱，又因忧戚太过，而成斯
疾。合用当归等药治之必愈。遂先以《古今录验》橘皮汤，空心服，苏子降气汤，徐用金钗煎、熟地黄丸、
当归丸，调理而安。
橘皮汤，文田按∶今见《千金方》五十四卷。橘皮、麻黄各三两，柴胡、干紫苏各三两，宿姜、杏仁各
四两，石膏八两。上七味 咀，水九升，煎麻黄两沸，去沫，下诸药煮取三升，分三服。
张路玉治吴江郭邑侯，喘嗽气逆。诊之，两尺左关弦数，两寸右关涩数。弦者肾之虚，涩者肺之燥。夏暑
内伏肺络，遇秋月燥收之令，发为咳嗽也。自言每岁交秋则咳，连发四载，屡咳痰不得出则喘，至夜不能卧，
咳剧则大便枯燥有血。曾服越婢汤，嗽即稍可。张曰∶公肾气素强固，水亏火旺，阴火上烁肺金，金燥不能
生水。咳甚则便燥有血者，肺移热于大肠也。（赖有此耳。）合用《千金》麦门冬方，除去半夏、生姜之辛燥，易以
葳蕤、白蜜之甘润，藉麻黄以鼓舞麦冬、生地之力，与越婢汤中麻黄、石膏，分解互结之燥热，同一义也。郭
曰∶诸医咸诋麻黄为发汗重剂，不可轻试，仅用杏仁、苏子、甘、梗、前胡等药，服之其咳转甚，何也？曰∶
麻黄虽云主表，今在麦门冬汤中，不过借以开发肺气，原非发汗之谓。麻黄在大青龙汤、麻黄汤、麻杏甘石汤
方，其力便峻，以其中皆有杏仁也。杏仁虽举世视为治嗽通药，虚实混用。然辛温走肺，最不纯良，耗气动血，
莫此为甚。熬黑入大陷胸丸，佐甘遂等，搜逐结垢，性味可知。遂用前方连进二剂，是夜便得安睡。脉弦虽未
退，按之稍软，气口则虚濡乏力。与六味、生脉加葳蕤、白蜜作汤，四服嗽顿减。即以此方制丸恒服，至秋无
复嗽之虞。先是公子柔 ，用桂枝汤及六味作汤，加蝎尾，服之而瘥。其后夫人素有败痰，生道左右两胁俱有
结块，大如覆盆，发则咳嗽喘逆，腹胁掣痛，六脉止促，按之少力，用六君加胆星、枳实、香附、沉香，二剂，
大吐稠痰结垢一二升，呕止嗽宁，不必更进他药矣。
何督学媳，素常咳嗽不已，痰中间有血点，恒服童真丸不彻。以父殁哀痛迫切，咳逆倍常，痰中杂见鲜血，
因与瑞金丹四服，仍以童真丸、乌骨鸡丸，调补而安。
劳太夫人年五十余，素禀气虚多痰。数日来患风热咳逆，咳甚则兀兀欲吐。且宿有崩淋，近幸向安。法当
先治其咳，以桔梗汤加葳蕤、白薇、丹皮、橘红、蜜煎生姜，四剂撤其标症。次与六君子加葳蕤，以安胃气。
继进乌骨鸡丸方，疗其痼疾。以久不茹荤、不忍伤残物命，改用大温经汤加麋茸角腮作丸，药虽异而功则一也。
陈三农治一妇，咳嗽痰喘，饱胀，水火不通，眠食俱废。以人参、白芍为君；苏子炒，研细为佐；枇杷叶
三大片，白茯苓佐之。二服得眠，大小便通。
东坡盖公堂记云∶始吾居乡有病寒而咳者，问诸医，医以为蛊，不治且杀人。取其百金而治之，饮以蛊药，
攻伐其肾肠，烧灼其体肤，禁切其饮食之美者。期月而百病作，内热恶寒，而咳不已，累然真蛊者也。又求于
医，医以为热，投之以寒药，旦夕吐之，暮夜下之，于是始不能食。惧而反之，则钟乳、乌喙，杂然并进，而
漂疽痈疥，眩瞀之状，无所不至。三易医而病愈甚。里老父教之曰∶是医之罪，药之过也。子何疾之有？人之
生也，以气为主，食为辅。今子终日药不释口，臭味乱于外，而百毒战于内。劳其主，隔其辅，是以病也。子
退而休之，谢医却药，而进所嗜，气全而食美矣。可以一饮而效，从之期月而病良已。（《容斋五笔》后文节。）
薛立斋治甥范允迪，咳嗽痰盛，胸腹不利，饮食少思，肢体倦怠，脉浮大，按之微弱，服二陈、枳壳等药
愈甚，脾肺肾虚也。用补中益气汤、六味丸而愈。
万密斋治监生胡笃庵，咳久不止，汗之不可，下之不可，因表里之邪俱甚也。为制方，用苏叶、薄荷叶、
桑白皮、杏仁、霜栝蒌、霜桔梗、甘草等分为末，虚者阿胶蜜丸，白汤下，或口中噙化，五日而安。后以治人多效。
立斋治一 妇，咳而无痰，日晡发热，脉浮数，先以甘桔汤少愈。后以地骨皮散而热退。更以肾气丸及
八珍汤加柴胡、地骨皮、丹皮而愈。丹溪云∶咳而无痰者，此系火郁之症，及痰郁火邪在中，用苦梗开之，下
用补阴降火之剂，不已则成劳嗽。此症不得志者多有之。又《原病式》曰∶人瘦者，腠理疏通而多汗，血液衰
少而为燥，故为劳嗽之痰也。
文田按∶薛方诚未尽善。然 症少阳盛而少阴虚，立斋之偶验，亦幸中耳。予亦尝见 症须用附子而后
愈者。至少阳之用柴胡，则中庸定理。王氏治病从温病入，故颇畏术、附，而酷恶柴胡，所谓过犹不及矣。
（瘰 为劳怯之根，加以干咳潮热则劳症成矣。此数方者乌足以愈之，大约薛氏因丹溪有此论，故附会言之，否
则其病少衰，便以为愈耳。不足信也。）
一男子咳嗽气急，胸膈胀满，睡卧不安，以葶苈散，二服少愈，更以桔梗汤而瘥。
一男子咳嗽项强气促，脉浮而紧，以参苏饮，二剂少愈，更以桔梗汤，四剂而痊。
马元仪治杨咸时，咳嗽多痰，气逆作喘，自汗不食，已两月。脉之虚微无神，此劳倦致伤脾肺也。经云∶
劳则气耗。气与阴火，势不两立，气衰则火自胜，土虚既不能生金，阴火又从而克之，故喘咳而汗作矣。若行
疏泄以定喘止嗽，是耗散其气也。用人参三钱，黄 五钱，炙草五分，贝母一钱，杏仁、苏子各二钱，紫菀、
桔梗、防风以佐之。兼进七味丸以培土母，归脾大造膏以实脾肺而愈。
来天培治一妇，年二旬余，季夏酷热，患咳嗽头痛，发热，胸膈不舒。或以苏、杏、前、贝、生地、黄芩、
治之转甚。视其面色浮肿，懒言气怯，咳嗽声微，胸膈胀满，饮食不下，六脉微弱，此风寒内伏，里虚致感也。
始宜以参苏饮倍姜、枣，一二剂可已。今增虚矣，非姜、附不能瘳也。以补中益气汤去升麻、柴胡，加川芎、
炮姜、附子，一剂汗出遍身，肿胀渐消，再剂热退。改用八珍加姜、附，二剂而咳嗽除。终以归脾加熟地、炮
姜，四剂声高食进矣。彼云旧有风症，两手不能举，今服药乃能举于头矣。此治病必求其本之谓欤。
沈明生治金斐文，夏患咳嗽，清痰续续不已。时风热嗽甚多，金谓所投之剂，非疏风化痰即清金涤热。及
诊曰∶是非温补不痊。金骇愕问故。曰∶君以外感盛行之际，必无内因者耶？初得之症，必无属虚者耶？是则
时有一定之方，症有一定之药，人皆可以为医矣。夫嗽属外因，必肺气胀满，咳嗽相属。或兼头疼鼻塞，涕唾
稠浓，声壮气壅，脉浮数有力，或人迎脉大，此为外因。今脉不浮而沉，非风也；不数而缓，非热也；按之不
鼓，非有余也。嗽虽频而气短不续，痰虽多而清薄不浓，若疏解则徒耗肺家之金，清凉则转瘠中州之土，是欲
去病而反重病也。宜用补中益气与六君子，参合复方，藉参、苓、术以补肺之母，使痰无由生，藉橘、半、升、
柴以升清降浊，则嗽可不作。一二剂嗽微减，再服浃旬而愈。
吴桥治鄱阳王令领邑甫及期，病咳嗽，唾痰稠粘而臭，且杂以血。久之潮热失声，食少肉消，闭户逾月，
将乞骸骨归。幸桥至诊之，桥独任其无害。令愕然，且固问桥。桥曰∶此肝气凌脾，治者谬以为阴虚火动，剂
凉则脾愈滞，津液不通，肝愈炽而无所制矣。法当扶脾抑肝，三剂如脱，七剂而出视事。（《太函集》。）
徐灵胎曰∶咳嗽由于风寒入肺。肺为娇脏，一味误投，即能受害。若用熟地、麦冬、萸肉、五味等滋腻酸
敛之品，补住外邪，必至咯血失音，喉癣肛痈，喘急寒热，近者半年，远者三年，无有不死。盖其服此等药之
日，即其绝命之日也。间有见机而停药者，或能多延岁月，我见以千计。故今之吐血而成劳者，大半皆因咳嗽
而误服补药所致也。或云五味子乃仲景治嗽必用之药，不知古方之用五味，必合干姜，一散一收，以治寒嗽之
症，非治风火之嗽也。况加以熟地、麦冬，则受祸尤烈。又嗽药中多用桔梗，桔梗升提，甘桔汤中用之，以载
甘药上行，治少阴之喉痛，与治嗽宜清降之法者非宜。苟误服之，往往令人气逆痰升，不能着枕。凡用药当深
知其性，而屡试屡验，方可对病施治，无容冒昧也。
张柳吟曰∶亦有咳嗽属于阴虚肺燥者，误投温散，劫其津液，必成劳损，即此论之对面也。医者临症，
可不详审其病情哉？
徐灵胎曰∶今之医者，谓吐血为虚劳之病，此大谬也。夫吐血有数种，大概咳者成劳，不咳者不成劳。间
有吐血偶咳者，当其吐血之时，野狼狈颇甚，吐止即痊，皆不成劳，何也？其吐血一止，则周身无病，饮食如故，
而精神生矣。即使亡血之后，或阴虚内热，或筋骨疼痛，皆可服药而痊。若咳嗽则血止而病仍在，日嗽夜嗽，
痰壅气升，多则三年，少则一年而死矣。盖咳嗽不止，则肾中之元气震荡不宁。肺为肾之母，母病则子亦病故
也。又肺为五脏之华盖，经云∶谷气入胃，以传于肺，五脏六腑皆以受气，其清者为荣，浊者为卫。是则脏腑
皆取精于肺，肺病则不能输精于脏腑，一年而脏腑皆枯，三年而脏腑竭矣，故咳嗽为真劳不治之疾也。然亦有
咳嗽而不死者，其嗽亦有时稍缓，其饮食起居不甚变，又其人善于调摄，延至三年之后，起居如旧，间或一发，
静养即愈。此乃百中难得一者也。更有不咳之人，血症屡发，肝竭肺伤，亦变咳嗽，久而亦死。此则不善调摄，
以轻变重也。执此以决血症之死生，百不失一矣。
（患者）服药后，饮水无度。医生又认为是实热证，用三黄丸攻下，结果腹泻不多，病情逐渐加重出现气喘急促。再次服用攻下药后，半夜喘息大作，气息只出不进，全身麻木，大汗淋漓如雨，神志昏迷，两眼直视，牙关紧闭不能说话，极度疲惫虚弱。急忙请冯医生诊治，发现两寸脉和左关脉仅存微弱搏动。当时正值六月，冯医生本想使用四逆汤、理中汤，但家属畏惧药性猛烈，改为用人参一两、麦冬二钱、五味子六分、肉桂一钱许，才同意急煎服用。喘息稍减片刻，无奈病重药轻，不久喘息再次大作。此时家属不责怪之前误用寒凉药的错误，反而归罪于人参、肉桂。冯医生心想，如果我尽力救治，或许还能救活；如果顺从他们的偏见，病人必死无疑。于是坚定一方，责令他们服用。方用炒白术三两，人参二两，炮姜三钱，五味子一钱五分，制附子三钱，煎成浓汁灌服。药咽下后，病人张口大声说：“心里像火烧一样痛苦欲死。”（这是因为没有让药液冷服的缘故。）旁观者怀疑怨恨交加，但他不为所动。过了一会儿，病人又大声说：“肚脐周围更疼更热，要死了。”冯医生暗自高兴，认为阳气能够下达，生机未绝。果然不久之后，喘息平息，汗止，手足温暖，神志清醒，只是语言反而非常无力。这个方剂中参、术用量多而附子相对较少，是因为中焦脾胃长期受寒冷困扰，如果不先温补中焦，阳气就难以下达。
吕东庄治疗徐鸾和的内伤咳嗽，医生按伤风治疗，病情反而加重。吕东庄受邀诊治，诊得脉象为中气虚弱的脉象。他说：“鼻塞流涕、痰气急促，都是伤风的实证表现，怎么能说是虚证呢？”吕东庄说：“这是虚实真假的辨别，关键在于脉象，庸医不明白这一点，误人很多。”那人不懂脉诊，吕东庄便请他用症状来辨别。吕东庄说：“这个人必定在下午申时发热，到半夜逐渐退清，到早晨稍微好转，是这样吗？”那人说：“是的。”吕东庄说：“那么中气虚弱还有什么可疑的呢？他所说的‘喜’（指症状明显），正是鼻塞流涕罢了。”于是投以人参、白术、当归、黄芪、白芍各三钱，软柴胡、升麻各一钱，陈皮、甘草、五味子各六分，服用三剂后咳嗽立即停止。复诊时对他说：“上面的症状已经去除，只有带下病特别严重，接近崩漏了。”那人惊讶地应答说：“确实如此。”吕东庄就在前方中重用人参，加入补骨脂、阿胶各二钱，服用数剂，同时兼服六味地黄丸而痊愈。
柴屿青治疗陈氏的外甥女，咳嗽吐痰，夜间发热，众医生认为必定会发展成劳损病。诊察她的脉象虽然稍显洪大，但尚有根基，并不是细数脉，怎么会是不治之症呢？纯用滋阴的药物，调养半年而痊愈。
同学蔡为章患痰嗽，夜晚难以入睡，身体瘦弱得连衣服都穿不住，晚上躺在床上不能翻身。诊察他的六部脉象都微弱，气血两亏严重，拟定使用人参等补益药剂。蔡为章因为痰嗽不宜用补药而感到怀疑，柴屿青极力承担治疗责任。先用六君子汤加炮姜、桂枝、附子，服用数帖后咳嗽减轻。继用养荣汤十数剂，才能下床行动，调理一个多月而康复。
张惕中咳嗽吐痰，医生误认为是风寒，服药十几剂，病情加剧，身体发热气喘咳嗽，夜晚不能卧床，胸膈痞塞胀满，困在床上，小便短少。诊察得人迎脉缓，绝非外感。气口脉空大，左寸脉极弱，沉取微微，这是心肾不足，确属内伤病症。他的小便不利，是三焦的气化功能不能运送到膀胱（州都）。遵循李东垣治疗内伤的法则，领会其意并变通运用，十天就痊愈了。
左中丞的夫人，二十多岁，形体瘦弱，痰嗽呼吸粗重，夜晚不能入睡。医生频繁给予消痰理气的药物，导致她更加疲惫虚弱。诊察她的脉象甚微细，这是气虚。张仲景说：“气虚有痰，用肾气丸补益并驱逐痰饮。”于是使用六味地黄汤加麦冬、五味子，治疗而痊愈。只是夜间尚未熟睡，再用养荣汤加茯神、枣仁，十数剂后即能增加饮食、安稳睡眠，逐渐恢复元气。
丙寅年正月初一，卿讳伊芳喇齐长郎，来贺节到寓所说，因咳嗽求方。诊察他的两脉细数，右寸脉郁结，判断此病难以见效，勉强使用麻黄汤。伊芳坚决不同意，说：“我儿子阴液亏损，其他医生用的熟地、人参，已经服过好几两。”柴屿青说：“阴亏确实是事实，但风邪闭塞肺气，补药又从而壅遏气机，不用麻黄汤不能祛邪。”伊芳力争不信，柴屿青早断定他活不了。果然应验。
按语：凡是虚损病的脉象，见右寸脉厥厥然如豆大，按之梗手，这种病源属于不起之症，因为肺金败坏了。现在右寸脉郁结，断定为风邪闭塞，但必须见到鼻塞声重，或头痛痰浓，或咳嗽连续不断，才是它的征候。
王肯堂治疗一个妇人，咳嗽不止，服用各种药物无效，渐渐形成劳瘵。诊察六脉濡弱，这是血虚，又因忧愁悲伤太过，而得了这个病。合用当归等药物治疗必定痊愈。于是先用《古今录验》橘皮汤，空腹服用，苏子降气汤，随后用金钗煎、熟地黄丸、当归丸，调理而安定。
橘皮汤，文田按：现在见于《千金方》第五十四卷。橘皮、麻黄各三两，柴胡、干紫苏各三两，宿姜、杏仁各四两，石膏八两。以上七味切碎，用水九升，先煎麻黄沸腾两次，去掉浮沫，放入其他药物煮取三升，分三次服用。
张路玉治疗吴江郭邑侯，喘嗽气逆。诊察，两尺脉和左关脉弦数，两寸脉和右关脉涩数。弦脉代表肾虚，涩脉代表肺燥。夏季暑热内伏于肺络，遇到秋季燥气收敛的时令，引发咳嗽。他自己说每年入秋就咳嗽，连续发作四年，多次咳嗽痰出不出来就气喘，到了夜晚不能卧倒，咳嗽剧烈则大便干燥带血。曾经服用越婢汤，咳嗽稍微缓解。张路玉说：“您肾气素来强固，水亏火旺，阴火上灼肺金，肺燥不能生水。咳嗽剧烈则大便干燥有血，是肺将热移于大肠所致。（幸好有这个机理。）合用《千金》麦门冬方，除去半夏、生姜的辛燥，改用葳蕤、白蜜的甘润，借助麻黄来鼓舞麦冬、生地的力量，与越婢汤中的麻黄、石膏分解互结的燥热，义理是一样的。”郭邑侯说：“众医生都诋毁麻黄为发汗重剂，不敢轻易尝试，只用杏仁、苏子、甘草、桔梗、前胡等药，服用后咳嗽反而加重，为什么呢？”张路玉说：“麻黄虽然主治表证，但现在在麦门冬汤中，不过是借它开发肺气，原本不是指发汗。麻黄在大青龙汤、麻黄汤、麻杏甘石汤方中，药力就峻猛，因为这些方中都有杏仁。杏仁虽然被举世视为治咳通用药，但虚实混用。然而它辛温走肺，最不纯良，耗气动血，没有比这更严重的了。熬黑后加入大陷胸丸，佐以甘遂等药，搜逐结垢，其性味可知。于是用前方连续进服两剂，当晚就能安睡。脉象虽仍弦，但按之稍软，气口脉虚濡乏力。给予六味地黄丸、生脉散加葳蕤、白蜜作汤剂，服用四次后咳嗽顿时减轻。就用这个方子制成丸药常服，到秋天不再有咳嗽的忧虑。在此之前，郭公子柔，用桂枝汤及六味地黄丸作汤剂，加蝎尾，服用后痊愈。后来夫人素有败痰，生道左右两胁都有结块，大如覆盆，发作时咳嗽气喘气逆，腹胁牵引疼痛，六脉仅见促脉，按之无力，用六君子汤加胆星、枳实、香附、沉香，两剂后，大吐稠痰结垢一二升，呕吐停止咳嗽安宁，不必再进其他药物了。”
何督学的儿媳，平素咳嗽不止，痰中偶尔有血点，长期服用童真丸未能彻底治愈。因为父亲去世哀痛迫切，咳逆比平时加倍，痰中夹杂看见鲜血，因此给予瑞金丹四服，仍以童真丸、乌骨鸡丸，调补而安定。
劳太夫人五十多岁，平素禀赋气虚多痰。这几天患风热咳逆，咳嗽剧烈则恶心欲吐。况且宿有崩淋病，近来侥幸向安。治法应当先治咳嗽，用桔梗汤加葳蕤、白薇、丹皮、橘红、蜜煎生姜，四剂撤去标症。其次用六君子汤加葳蕤，以安胃气。接着进乌骨鸡丸方，治疗其痼疾。因为她长久不吃荤腥、不忍心伤残物命，改用大温经汤加麋茸角腮作丸药，药物虽然不同但功效一致。
陈三农治疗一个妇人，咳嗽痰喘，饱胀，水火不通（大小便不通），眠食俱废。以人参、白芍为君药；苏子炒研细为佐药；枇杷叶三大片，白茯苓佐之。服用两剂后能睡觉，大小便通利。
东坡在盖公堂记中说：“起初我在乡下，有病寒而咳嗽的人，询问医生，医生认为是蛊毒，不治会杀人。收取百金为他治疗，给他喝蛊药，攻伐他的肾肠，烧灼他的体肤，禁止他吃美味的食物。一个月后百病发作，内热恶寒，而咳嗽不停，累然真像蛊毒病了。又求医，医生认为是热证，投以寒药，早晚催吐泻下，于是开始不能进食。害怕而反过来，则钟乳、乌喙等药杂然并进，而漂疽痈疥、眩晕昏瞀的症状，无所不至。换了三个医生而病更重。乡里老人教导他说：‘这是医生的罪过，药物的过错。你有什么病呢？人的生存，以气为主，饮食为辅。现在你整天药不离口，臭味扰乱于外，而百毒交战于内。劳损了主气，阻隔了辅气，所以生病。你回去休息，谢绝医生拒绝药物，而进你所喜欢的食物，气全而食美矣。可以一饮而效，听从他的话，一个月后病就好了。’（《容斋五笔》后文节选。）”
薛立斋治疗外甥范允迪，咳嗽痰盛，胸腹不利，饮食少思，肢体倦怠，脉浮大，按之微弱，服用二陈汤、枳壳等药反而加重，这是脾肺肾虚。用补中益气汤、六味地黄丸而痊愈。
万密斋治疗监生胡笃庵，咳嗽久不止，发汗不可，攻下不可，因为表里之邪都很严重。为他制方，用苏叶、薄荷叶、桑白皮、杏仁、霜栝蒌、霜桔梗、甘草等分为末，体虚者用阿胶蜜丸，白开水送下，或在口中噙化，五日而安。后来用此方治人多有效。
立斋治疗一个妇女，咳而无痰，下午发热，脉浮数，先用甘桔汤稍微好转。后用地骨皮散而热退。再用肾气丸及八珍汤加柴胡、地骨皮、丹皮而痊愈。丹溪说：“咳而无痰，这是火郁的病症，以及痰郁火邪在中，用桔梗开之，下面用补阴降火的药剂，不愈则成劳嗽。这种症状不得志的人多有之。”又《原病式》说：“人瘦者，腠理疏通而多汗，血液衰少而为燥，故为劳嗽之痰也。”
文田按：薛方的确未尽善尽美。然而瘰疬症少阳盛而少阴虚，立斋的偶然验证，也是侥幸中的。我也曾见过瘰疬症须用附子而后痊愈的。至于少阳症用柴胡，则是中庸定理。王氏治病从温病入手，所以颇畏术、附，而酷恶柴胡，所谓过犹不及啊。（瘰疬为劳怯之根，加以干咳潮热则劳症成矣。这几个方子哪里足以治愈它，大约薛氏因为丹溪有此论，所以附会言之，否则他的病稍微衰退，就以为痊愈罢了。不值得相信。）
一个男子咳嗽气急，胸膈胀满，睡卧不安，用葶苈散，两服稍微好转，再用桔梗汤而痊愈。
一个男子咳嗽项强气促，脉浮而紧，用参苏饮，两剂稍微好转，再用桔梗汤，四剂而痊愈。
马元仪治疗杨咸时，咳嗽多痰，气逆作喘，自汗不食，已两个月。诊脉虚微无神，这是劳倦致伤脾肺。经云：“劳则气耗。”气与阴火，势不两立，气衰则火自胜，土虚既不能生金，阴火又从而克之，故喘咳而汗作矣。若行疏泄以定喘止嗽，是耗散其气也。用人参三钱，黄芪五钱，炙甘草五分，贝母一钱，杏仁、苏子各二钱，紫菀、桔梗、防风以佐之。兼进七味丸以培土母，归脾大造膏以实脾肺而痊愈。
来天培治疗一个妇人，二十多岁，季夏酷热，患咳嗽头痛，发热，胸膈不舒。有人用苏叶、杏仁、前胡、贝母、生地、黄芩治疗，反而加重。看她的面色浮肿，懒言气怯，咳嗽声微，胸膈胀满，饮食不下，六脉微弱，这是风寒内伏，里虚致感。开始应该用参苏饮倍加姜、枣，一二剂可愈。现在增加了虚象，非姜、附不能痊愈。用补中益气汤去升麻、柴胡，加川芎、炮姜、附子，一剂汗出遍身，肿胀渐消，再剂热退。改用八珍汤加姜、附，两剂而咳嗽除。终以归脾汤加熟地、炮姜，四剂声音高亢饮食增进。他说旧有风症，两手不能举，现在服药乃能举过头顶了。这就是治病必求其本的意思吧。
沈明生治疗金斐文，夏天患咳嗽，清痰续续不已。当时风热咳嗽很多，金认为所投的药剂，不是疏风化痰就是清金涤热。等到诊察说：“这不是温补不能痊愈。”金骇愕问原因。沈说：“您在外面感盛行之际，必定没有内因的吗？初得的病症，必定没有属虚的吗？如果是这样，那就有一定之方，症有一定之药，人人都可以为医了。夫嗽属外因，必肺气胀满，咳嗽相属。或兼头疼鼻塞，涕唾稠浓，声壮气壅，脉浮数有力，或人迎脉大，此为外因。现在脉不浮而沉，不是风；不数而缓，不是热；按之不鼓，不是有余。嗽虽频而气短不续，痰虽多而清薄不浓，若疏解则徒耗肺家之金，清凉则转瘠中州之土，是欲去病而反重病也。宜用补中益气与六君子，参合复方，藉参、苓、术以补肺之母，使痰无由生，藉橘、半、升、柴以升清降浊，则嗽可不作。一二剂嗽微减，再服浃旬而痊愈。”
吴桥治疗鄱阳王令领邑甫及期，病咳嗽，唾痰稠粘而臭，且杂以血。久之潮热失声，食少肉消，闭户逾月，将乞骸骨归。幸桥至诊之，桥独任其无害。令愕然，且固问桥。桥曰：“此肝气凌脾，治者谬以为阴虚火动，剂凉则脾愈滞，津液不通，肝愈炽而无所制矣。法当扶脾抑肝，三剂如脱，七剂而出视事。”（《太函集》。）
徐灵胎说：“咳嗽由于风寒入肺。肺为娇脏，一味误投，即能受害。若用熟地、麦冬、萸肉、五味等滋腻酸敛之品，补住外邪，必至咯血失音，喉癣肛痈，喘急寒热，近者半年，远者三年，无有不死。盖其服此等药之日，即其绝命之日也。间有见机而停药者，或能多延岁月，我见以千计。故今之吐血而成劳者，大半皆因咳嗽而误服补药所致也。或云五味子乃仲景治嗽必用之药，不知古方之用五味，必合干姜，一散一收，以治寒嗽之症，非治风火之嗽也。况加以熟地、麦冬，则受祸尤烈。又嗽药中多用桔梗，桔梗升提，甘桔汤中用之，以载甘药上行，治少阴之喉痛，与治嗽宜清降之法者非宜。苟误服之，往往令人气逆痰升，不能着枕。凡用药当深知其性，而屡试屡验，方可对病施治，无容冒昧也。”
张柳吟说：“亦有咳嗽属于阴虚肺燥者，误投温散，劫其津液，必成劳损，即此论之对面也。医者临症，可不详审其病情哉？”
徐灵胎说：“现在的医生，谓吐血为虚劳之病，此大谬也。夫吐血有数种，大概咳者成劳，不咳者不成劳。间有吐血偶咳者，当其吐血之时，狼狈颇甚，吐止即痊，皆不成劳，何也？其吐血一止，则周身无病，饮食如故，而精神生矣。即使亡血之后，或阴虚内热，或筋骨疼痛，皆可服药而痊。若咳嗽则血止而病仍在，日嗽夜嗽，痰壅气升，多则三年，少则一年而死矣。盖咳嗽不止，则肾中之元气震荡不宁。肺为肾之母，母病则子亦病故也。又肺为五脏之华盖，经云：谷气入胃，以传于肺，五脏六腑皆以受气，其清者为荣，浊者为卫。是则脏腑皆取精于肺，肺病则不能输精于脏腑，一年而脏腑皆枯，三年而脏腑竭矣，故咳嗽为真劳不治之疾也。然亦有咳嗽而不死者，其嗽亦有时稍缓，其饮食起居不甚变，又其人善于调摄，延至三年之后，起居如旧，间或一发，静养即愈。此乃百中难得一者也。更有不咳之人，血症屡发，肝竭肺伤，亦变咳嗽，久而亦死。此则不善调摄，以轻变重也。执此以决血症之死生，百不失一矣。”
(After taking medicine), the patient drank water excessively. The physician again diagnosed it as an excess-heat syndrome and administered Sanhuang Wan (Three-Yellow Pill) to purge, but the diarrhea was scant, and the condition gradually worsened with increasing panting and shortness of breath. After a second dose of purgatives, at midnight the panting became severe, with air only exiting and not entering. The whole body went numb, profuse sweating occurred like rain, consciousness was lost, eyes were fixed open, teeth were clenched and speechless, and extreme exhaustion set in. Feng was urgently summoned for consultation. The pulses at both Cun (inch) positions and the left Guan (bar) position were barely perceptible. It was June, and Feng intended to use Sini Tang (Frigid Extremities Decoction) or Lizhong Tang (Regulate the Middle Decoction), but the family feared the potency and substituted Ren Shen (Ginseng Root) 1 liang, Mai Dong (Ophiopogon Tuber) 2 qian, Wu Wei Zi (Schisandra Berry) 6 fen, and Rou Gui (Cinnamon Bark) approximately 1 qian, agreeing only to decoct and administer it urgently. The panting subsided briefly, but the disease was severe while the medication was weak; shortly after, the panting flared up again. The family did not blame the error of using cold-purgative drugs earlier but instead blamed Ren Shen and Rou Gui. Feng thought, "If I exert my full effort, life might still be saved; if I comply with their views, death is certain." Thus, he firmly prescribed a formula and ordered them to take it: Chao Bai Zhu (Stir-fried Atractylodes Macrocephala Rhizome) 3 liang, Ren Shen (Ginseng Root) 2 liang, Pao Jiang (Prepared Dried Ginger) 3 qian, Wu Wei Zi (Schisandra Berry) 1.5 qian, and Zhi Fu Zi (Prepared Aconite Lateral Root) 3 qian, decocted into a thick liquid and forced down. After swallowing, the patient opened his mouth and shouted loudly: "My heart feels like it is burning, I want to die!" (This was because the medicine was not taken cold.) Bystanders raised doubts and resentment, but he remained unmoved. Soon after, the patient shouted again: "The area around my navel hurts and burns more, I am dying!" Feng secretly rejoiced, thinking that Yang Qi could descend and life was not yet extinct. Indeed, shortly thereafter, the panting settled, sweat stopped, hands and feet became warm, consciousness cleared, though speech was unusually weak. This formula used more Ren Shen and Bai Zhu and less Fu Zi because the middle jiao had long been troubled by cold; without first regulating the middle, Yang Qi would be difficult to descend.
Lv Dongzhuang treated Xu Luanhe's internal injury cough. Physicians treated it as wind-cold invasion, which made it worse. Lv was invited to consult and found a pulse indicating deficiency of the middle jiao. He said, "Nasal congestion, runny nose, and urgent phlegm are all excess symptoms of wind-cold invasion; how can you say it is deficiency?" Lv explained, "Distinguishing between true and false excess and deficiency lies in the pulse. Quack doctors who ignore this have misled many." Since the other party did not understand pulse diagnosis, Lv asked him to distinguish by symptoms. Lv said, "This person must experience fever in the afternoon (Shi hour), which gradually clears by midnight and improves slightly in the morning, correct?" The other party replied, "Yes." Lv said, "Then what doubt is there about middle deficiency? What he calls 'pleasing' refers precisely to the nasal congestion and runny nose." He then prescribed Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis Root), Huang Qi (Astragalus Root), and Bai Shao (White Peony Root) each 3 qian, Ruan Chai Hu (Bupleurum Root) and Sheng Ma (Cimicifuga Rhizome) each 1 qian, Chen Pi (Tangerine Peel), Gan Cao (Licorice Root), and Wu Wei Zi (Schisandra Berry) each 6 fen. After three doses, the cough stopped immediately. On re-examination, he told him, "The upper symptoms have gone, but leukorrhea is extremely severe, approaching metrorrhagia." The patient surprisedly confirmed this. Lv then heavily increased the dosage of Ren Shen in the previous formula, added Gu Su Zhi (Psoralea Fruit) and E Jiao (Donkey-hide Gelatin) each 2 qian. After several doses, combined with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), the patient recovered.
Chai Yuqing treated the niece of the Chen family, who suffered from cough with expectoration and night fevers. Most physicians believed she would inevitably develop consumption (Lao Zheng). Upon palpation, although her pulse was slightly surging, it still had a root and was not fine and rapid; how could it be incurable? Purely using yin-nourishing medicines, she recovered after half a year of conditioning.
Classmate Cai Weizhang suffered from phlegm-cough, unable to sleep at night, so emaciated that he could hardly bear clothes, unable to turn over in bed at night. His six pulses were faint and weak, indicating severe deficiency of both Qi and Blood. A prescription using Ren Shen and tonifying agents was planned. Cai doubted the use of tonics for phlegm-cough, but Chai took full responsibility. First, Liujunzi Tang (Six-Gentlemen Decoction) was used with added Pao Jiang (Prepared Dried Ginger), Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite Lateral Root). After several doses, the cough decreased. Subsequently, Yangrong Tang (Nourish the Vigor Decoction) was given for over ten doses, allowing him to get out of bed and walk. After more than a month of conditioning, he recovered.
Zhang Tizhong suffered from cough with expectoration. Physicians mistakenly identified it as wind-cold. After taking over ten doses of medicine, the illness worsened: body heat, panting, cough, inability to lie down at night, chest and diaphragm stuffiness, confinement to bed, and shortened urination. Pulse diagnosis revealed a slow Ren Ying (Carotid) pulse, definitely not external contraction. The Qi Kou (Radial) pulse was empty and large, the left Cun pulse was very weak, and deep palpation showed faint pulses. This indicated insufficiency of Heart and Kidney, clearly an internal injury syndrome. The difficulty in urination was due to the San Jiao (Triple Burner) failing to transport Qi transformation to the Zhou Du (Bladder). Following Li Dongyuan's principles for treating internal injuries, adapting them appropriately, he recovered within ten days.
The wife of Vice Minister Zuo, in her twenties, was thin and weak, suffering from phlegm-cough and coarse breathing, unable to sleep at night. Physicians frequently administered phlegm-resolving and Qi-regulating drugs, causing further exhaustion. Her pulse was very fine and faint, indicating Qi deficiency. Zhang Zhongjing stated: "For Qi deficiency with phlegm, use Shenqi Wan (Kidney Qi Pill) to tonify and expel." Thus, Liuwei Tang (Six-Ingredient Decoction) was used with added Mai Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Berry), curing her. For persistent insomnia at night, Yangrong Tang (Nourish the Vigor Decoction) with Fu Shen (Poria with Hostwood) and Zao Ren (Ziziphus Seed) was added. After over ten doses, appetite increased, sleep improved, and vitality gradually returned.
In the first month of Bingyin year, Qing Hui Yifanglaqi Changlang came to congratulate and requested a prescription for cough. Both pulses were fine and rapid, with the right Cun pulse showing stagnation. It was judged that recovery would be difficult. Reluctantly, Mahuang Tang (Ephedra Decoction) was suggested. Yifang strongly refused, saying, "My son has Yin deficiency. Other physicians have already administered several taels of Shu Di Huang (Rehmannia Root Prepared) and Ren Shen (Ginseng Root)." Chai said, "Yin deficiency is indeed true, but wind pathogen obstructs Lung Qi. Tonics further cause stagnation. Only this [Mahuang Tang] can expel the pathogen." Yifang argued fiercely and did not believe. Chai predicted early on that he would not survive. Indeed, he died.
Note: In damage syndromes, if the right Cun pulse appears bean-sized and hard to press, the prognosis is poor due to the failure of Lung Metal. Here, the right Cun shows stagnation, judged as wind pathogen obstruction. However, signs such as nasal congestion, heavy voice, headache, thick phlegm, or continuous cough must be present to confirm this pattern.
Wang Kentang treated a woman with persistent cough unresponsive to various medicines, gradually developing into Lao Zhai (consumption with hemoptysis). Six pulses were soft and weak, indicating blood deficiency caused by excessive grief and sorrow. Using Dang Gui (Angelica Sinensis Root) and other herbs would surely cure her. First, Jupi Tang (Tangerine Peel Decoction) from *Gu Jin Lu Yan* was taken on an empty stomach, followed by Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction). Later, Jinchai Jian (Gold Hairpin Decoction), Shudihuang Wan (Rehmannia Pill), and Danggui Wan (Angelica Pill) were used for conditioning, leading to stability.
Jupi Tang: Wentian notes: Now seen in Volume 54 of *Qianjin Fang*. Jupi (Tangerine Peel) and Mahuang (Ephedra Herb) each 3 liang, Chai Hu (Bupleurum Root) and Gan Zisu (Dried Perilla Leaf) each 3 liang, Su Jiang (Old Ginger) and Xing Ren (Apricot Seed) each 4 liang, Shi Gao (Gypsum Fibrosum) 8 liang. The seven ingredients are chopped. Add 9 sheng of water. Boil Mahuang for two boils, skim the foam, add other herbs, and decoct to obtain 3 sheng. Divide into three doses.
Zhang Luyu treated Gu Yihou of Wujiang, suffering from panting, cough, and rebellious Qi. Palpation showed string-taut and rapid pulses at both Chi (cubit) and left Guan positions, and choppy and rapid pulses at both Cun and right Guan positions. String-taut indicates Kidney deficiency; choppy indicates Lung dryness. Summer-heat was internally stored in the Lung collaterals. Encountering the autumn dryness-constricting climate, it manifested as cough. He reported annual coughs starting at autumn onset, lasting four years. Repeated coughing with inability to expectorate led to panting and inability to lie down at night. Severe coughing resulted in dry stool with blood. Previously, Yeshi Tang (Wild Chicken Decoction) provided slight relief. Zhang said, "Your Kidney Qi is inherently strong. Water deficiency leads to fire hyperactivity. Yin-fire scorches Lung Metal, causing Lung dryness and inability to generate Water. Severe coughing with bloody dry stool is Lung transferring heat to the Large Intestine. (Fortunately, this mechanism exists.) Combine with Qianjin Menmendong Fang (Mendong Formula from *Essential Prescriptions Worth a Thousand Gold*), removing the acrid-dry Ban Xia (Pinellia Tuber) and Sheng Jiang (Fresh Ginger), replacing them with Rui Yu (Polygonatum Rhizome) and Bai Mi (White Honey) for sweetness and moistening. Borrow Mahuang (Ephedra Herb) to stimulate Maidong (Ophiopogon Tuber) and Sheng Di Huang (Rehmannia Root) power. This shares the same principle as Mahuang and Shi Gao in Yeshi Tang, resolving interlocked dry-heat." Gu said, "Physicians condemn Mahuang as a heavy sweating agent and dare not try it lightly. Using only Xing Ren (Apricot Seed), Suzi (Perilla Seed), Gan Cao (Licorice Root), Jie Geng (Platycodon Root), Qian Hu (Peucedanum Root), etc., the cough worsened. Why?" Zhang said, "Although Mahuang governs the exterior, in Menmendong Tang, it merely opens Lung Qi, not inducing sweating. In Da Qinglong Tang, Mahuang Tang, and Maxing Gan Shi Tang, its power is fierce because they contain Xing Ren. Although Xing Ren is universally viewed as a general cough remedy, mixing excess and deficiency is dangerous. Its acrid-warm nature moves Lung Qi but is impure and harmful, depleting Qi and damaging Blood. When charred black and added to Daxiexiong Wan, assisting Gan Sui (Kansui Root), its nature in searching out accumulated filth is evident." Thus, the previous formula was advanced for two doses. That night, he slept peacefully. The pulse remained string-taut but softer upon pressure; the Qi Kou pulse was deficient, soft, and powerless. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Shengmai San (Generate the Pulse Powder) with Rui Yu (Polygonatum Rhizome) and Bai Mi (White Honey) as a decoction were given. After four doses, the cough significantly decreased. This formula was made into pills for constant use, preventing autumn coughs. Earlier, Gu's son Rou used Guizhi Tang (Cinnamon Twig Decoction) and Liuwei Dihuang Wan as decoctions with Scorpion Tail, recovering. Later, the Madam had chronic pathological phlegm. Masses appeared on both sides of the Daoji and胁 (flanks), size of an inverted basin. Attacks involved cough, panting, rebellious Qi, and pulling pain in abdomen and flanks. Six pulses were only rapid (Cu), weak upon pressure. Liujunzi Tang (Six-Gentlemen Decoction) with Dan Xing (Phragmites Catkin processed with bile), Zhi Shi (Immature Bitter Orange), Xiang Fu (Cyperus Rhizome), and Chen Xiang (Aquilaria Wood) were used. After two doses, one to two sheng of thick phlegm and filth were vomited. Vomiting stopped, cough calmed, no further medication needed.
The daughter-in-law of Supervisor He suffered from persistent cough with occasional blood spots in sputum, constantly taking Tongzhen Wan (Child's Urine Pill) without complete cure. Due to intense grief over her father's death, coughing and rebellious Qi doubled, with fresh blood mixed in sputum. Ruijin Dan (Auspicious Golden Pill) was given for four doses, followed by Tongzhen Wan and Wuguji Wan (Black-bone Hen Pill) for conditioning and stabilization.
Madam Lao, over fifty, constitutionally Qi-deficient with much phlegm. Recently suffered wind-heat cough and rebellious Qi, severe cough causing nausea. She also had a history of metrorrhagia and menorrhagia, recently stable. Treatment should first address the cough: Jiegeng Tang (Platycodon Decoction) with Rui Yu (Polygonatum Rhizome), Bai Wei (Cynanchum Root), Dan Pi (Moutan Cortex), Ju Hong (Tangerine Pith), and honey-decocted Sheng Jiang (Fresh Ginger). Four doses removed the branch symptoms. Next, Liujunzi Tang (Six-Gentlemen Decoction) with Rui Yu (Polygonatum Rhizome) stabilized Stomach Qi. Then, Wuguji Wan (Black-bone Hen Pill) addressed the chronic disease. Because she abstained from meat and spared animal lives, Dawen Jing Tang (Great Warm the Menses Decoction) with Milu Rong Jiao Sai (Deer Antler Horn and Cheek Bone) made into pills was substituted. Different drugs, same efficacy.
Chen Sansann treated a woman with cough, phlegm, panting, fullness, blockage of water and fire (urinary/fecal retention), and loss of sleep and appetite. Ren Shen (Ginseng Root) and Bai Shao (White Peony Root) served as Sovereign herbs. Stir-fried and ground Su Zi (Perilla Seed) served as Assistant. Three large leaves of Pipa Ye (Loquat Leaf) and Bai Fu Ling (Poria) served as Assistants. After two doses, sleep was achieved, and bowel/bladder movements normalized.
Dongpo wrote in *Record of Hall of Master Gai*: "Initially, when I lived in the countryside, someone had cold-induced cough. Asking physicians, they diagnosed it as Gu poison (parasitic disease), claiming untreated it would kill. Taking a hundred gold pieces to treat, they gave Gu medicine, attacking kidneys/intestines, burning skin/body, forbidding delicious foods. After a month, myriad diseases arose: internal heat, aversion to cold, and persistent cough, resembling true Gu poison. Seeking another doctor, diagnosed as heat, given cold medicines, vomiting day and night, diarrhea evening and night, leading to anorexia. Fearing this, switching treatments brought Zhuru (Stalactite) and Wu Hui (Aconite) together, causing floating abscesses, carbuncles, scabies, dizziness, and blindness. Three doctors changed, yet illness worsened. An elder taught: 'This is the doctor's fault, the drug's error. What disease do you have? Human life relies on Qi as master, food as assistant. Now you hold medicine to your mouth all day, odors disrupt outside, poisons war inside. Exhausting the master, blocking the assistant, thus illness arises. Rest, dismiss doctors, reject drugs, eat what you love. Qi preserved, food enjoyed.' One drink yielded effect. Following this, after one month, the illness healed well." (Excerpt from *Rongzhai Wubi*).
Xue Lizhai treated nephew Fan Yundi, suffering from cough with abundant phlegm, chest/abdominal discomfort, poor appetite, limb fatigue. Pulse was floating and large, weak upon pressure. Erchen Tang (Two-Aged Decoction) and Zhi Ke (Aurantii Fructus) worsened it, indicating Spleen-Lung-Kidney deficiency. Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) and Liuwei Wan (Six-Ingredient Pill) cured him.
Wan Miazai treated Student Hu Du'an, persistent cough unrelieved by sweating or purging, as both exterior and interior pathogens were severe. Prescribed Suzye (Perilla Leaf), Bohey e (Mint Leaf), Sangbaipi (Mulberry Root Bark), Xingren (Apricot Seed), Shuang Gualou (Frost-coated Trichosanthes Fruit), Shuang Jiegeng (Frost-coated Platycodon Root), Gancao (Licorice Root) powdered equally. For deficiency, Ejiao (Donkey-hide Gelatin) honey pills were taken with white water or held in mouth. Peaceful in five days. Later effective for many.
Lizhai treated a woman, cough without phlegm, afternoon fever, floating-rapid pulse. First, Ganjie Tang (Licorice-Platycodon Decoction) slightly improved. Then Digupi San (Ground Tree Bark Powder) reduced fever. Finally, Shenqi Wan (Kidney Qi Pill) and Bazhen Tang (Eight-Treasure Decoction) with Chai Hu (Bupleurum Root), Digupi (Ground Tree Bark), and Danpi (Moutan Cortex) cured. Danxi said: "Cough without phlegm is Fire-Stagnation syndrome, with Phlegm-Stagnant Fire in the middle. Use Jiegeng (Platycodon Root) to open, below use Yin-tonifying and Fire-descending agents. If uncontrolled, it becomes Consumption Cough. This affects many frustrated people." Also, *Yuanbing Shi* states: "Thin people have open pores, sweat much, blood deficiency leads to dryness, hence Consumption Cough phlegm."
Wentian notes: Xue's formulas were not perfect. However, Luoli (scrofula) involves Shaoyang excess and Shaoyin deficiency. Lizhai's occasional success was lucky. I have also seen Luoli cases requiring Fu Zi (Aconite Lateral Root) for cure. Using Chai Hu (Bupleurum Root) for Shaoyang is a moderate principle. Wang's treatment entered via Warm Diseases, thus fearing Bai Zhu (Atractylodes Macrocephala Rhizome) and Fu Zi (Aconite Lateral Root), and hating Chai Hu (Bupleurum Root), which is 'too much is as bad as too little'. (Luoli is the root of consumption. With dry cough and tidal fever, consumption forms. These formulas are insufficient to cure. Likely Xue followed Danxi's theory and adapted it. Otherwise, slight improvement was mistaken for cure. Not credible.)
A man with cough, rapid breathing, chest fullness, restless sleep. Tingli San (Descurainia Powder) slightly improved after two doses; Jiegeng Tang (Platycodon Decoction) cured.
A man with cough, stiff neck, rapid breathing, floating-tight pulse. Rensu Yin (Ginseng-Perilla Drink) slightly improved after two doses; Jiegeng Tang (Platycodon Decoction) cured after four doses.
Ma Yuanyi treated Yang Xianshi, cough with much phlegm, rebellious Qi causing panting, spontaneous sweating, anorexia for two months. Pulse was deficient, faint, spiritless. Labor-fatigue injured Spleen and Lung. Classics state: "Labor depletes Qi." Qi and Yin-Fire cannot coexist. Qi decline allows Fire to prevail. Earth deficiency fails to generate Metal; Yin-Fire attacks. Hence panting, cough, sweating. Using dispersing methods to stop panting/cough depletes Qi. Ren Shen (Ginseng Root) 3 qian, Huang Qi (Astragalus Root) 5 qian, Zhi Cao (Honey-fried Licorice) 5 fen, Bei Mu (Fritillaria Bulb) 1 qian, Xing Ren (Apricot Seed) and Su Zi (Perilla Seed) each 2 qian, Zi Wan (Aster Root), Jie Geng (Platycodon Root), Fang Feng (Saposhnikovia Root) as assistants. Combined with Qiwei Wan (Seven-Ingredient Pill) to nourish Earth-Mother, Guipi Dazao Gao (Spleen-Nourishing Great Creation Paste) to strengthen Spleen-Lung. Recovered.
Lai Tianpei treated a woman, over twenty, in midsummer heat, cough, headache, fever, chest discomfort. Given Suzi (Perilla Seed), Xingren (Apricot Seed), Qianhu (Peucedanum Root), Beimu (Fritillaria Bulb), Shengdi (Rehmannia Root), Huangqin (Scutellaria Root), worsening. Face swollen, lazy speech, timid Qi, faint cough, chest fullness, anorexia, six pulses faint. Wind-cold internally stored, interior deficiency inviting pathogen. Should start with Rensu Yin (Ginseng-Perilla Drink) doubling Jiang (Ginger) and Zao (Jujube), one-two doses curable. Now deficiency increased, requires Jiang (Ginger) and Fu Zi (Aconite). Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) minus Shengma (Cimicifuga Rhizome) and Chaihu (Bupleurum Root), plus Chuanxiong (Ligusticum Rhizome), Pao Jiang (Prepared Ginger), Fu Zi (Aconite Lateral Root). One dose: sweating all over, swelling subsided. Two doses: fever resolved. Changed to Bazhen Tang (Eight-Treasure Decoction) with Jiang (Ginger) and Fu Zi (Aconite Lateral Root). Two doses: cough removed. Finally, Guipi Tang (Spleen-Nourishing Decoction) with Shudi (Prepared Rehmannia) and Pao Jiang (Prepared Ginger). Four doses: voice loud, appetite increased. He said old wind-stroke prevented arm lifting; now medicine allowed raising head. This is seeking the root in treatment.
Shen Mingsheng treated Jin Feiwen, summer cough, continuous clear phlegm. Many wind-heat coughs existed. Jin believed prescriptions were either wind-dispersing/phlegm-resolving or Lung-clearing/heat-purging. Diagnosis: "Only warming-tonifying cures." Jin shocked, asked why. Shen said: "Amidst epidemic wind-heat, must there be no internal causes? Initial symptoms must not be deficiency? If so, fixed formulas and fixed drugs exist, anyone could be a doctor. Cough from external causes implies Lung Qi distension, continuous cough. Accompanied by headache, nasal congestion, thick sputum, strong voice, congested Qi, floating-rapid-strong pulse, or large Ren Ying pulse. This is external. Now pulse is not floating but sinking, not wind; not rapid but slow, not heat; not drumming upon pressure, not excess. Frequent cough but short Qi, much phlegm but thin-not-thick. Dispersing wastes Lung Metal; cooling starves Central Earth. Wanting to remove disease worsens it. Use Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) and Liujunzi Tang (Six-Gentlemen Decoction) combined. Borrow Ren Shen (Ginseng Root), Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala Rhizome) to tonify Lung Mother, stopping phlegm generation. Borrow Ju Pi (Tangerine Peel), Ban Xia (Pinellia Tuber), Sheng Ma (Cimicifuga Rhizome), Chai Hu (Bupleurum Root) to ascend clear and descend turbid, stopping cough. One-two doses: slight reduction. Ten days later: cured."
Wu Qiao treated Magistrate Wang of Boyang, term just ended, cough, sticky-smelly sputum mixed with blood. Long-term tidal fever, loss of voice, anorexia, emaciation, closed door for over a month, preparing to retire. Fortunately Wu Qiao consulted, asserting harmlessness. Magistrate surprised, insisted on asking. Wu said: "Liver Qi invading Spleen. Physicians wrongly diagnose Yin-deficiency Fire-hyperactivity. Cold drugs make Spleen stagnant, fluids blocked, Liver blazing unchecked. Method: Support Spleen, suppress Liver. Three doses: relief. Seven doses: return to duty." (*Taihan Ji*).
Xu Lingtai said: "Cough due to wind-cold entering Lung. Lung is delicate organ; one wrong herb causes harm. Using Shudi (Rehmannia Root Prepared), Maidong (Ophiopogon Tuber), Yurou (Cornus Fruit), Wuwei Zi (Schisandra Berry) etc., sticky-astringent tonics, trapping external pathogen, leads to hemoptysis, aphonia, laryngeal ulcers, anal abscesses, panting, alternating chills-fever. Near death in half a year, far in three years. No survival. Day of taking these drugs is day of doom. Rarely, those stopping meds live longer. I've seen thousands. Thus, modern hemoptysis becoming consumption is mostly due to cough mismanaged with tonics. Some say Wuwei Zi (Schisandra Berry) is essential in Zhang Zhongjing's cough formulas. Unknown that ancient usage combined Wuwei Zi (Schisandra Berry) with Ganjiang (Dried Ginger), one dispersing, one astringing, for cold-cough, not wind-fire cough. Adding Shudi (Rehmannia Root Prepared) and Maidong (Ophiopogon Tuber) increases disaster. Also, Jiegeng (Platycodon Root) often used in cough. Jiegeng ascends. In Ganjie Tang (Licorice-Platycodon Decoction), it carries sweet herbs upward to treat Shaoyin throat pain, unsuitable for cough requiring clearing-descending method. Misuse causes Qi rebellion, phlegm rising, inability to rest pillow. Drugs must be known deeply, tested repeatedly before application. Do not act rashly."
Zhang Liuyin said: "There are coughs due to Yin-deficiency Lung-dryness. Mistakenly using warm-dispersing herbs steals fluids, inevitably forming damage. This is the opposite view. Physicians must examine conditions carefully."
Xu Lingtai said: "Modern doctors call hemoptysis deficiency consumption. Great error. Hemoptysis has types. Generally, coughers become consumptive; non-coughers do not. Occasionally hemoptysis with cough is severe during bleeding, but stops quickly, not consumptive. Why? Once bleeding stops, body free of disease, diet normal, spirit returns. Even after blood loss, Yin-deficiency internal heat or bone/joint pain can be cured with meds. But cough means disease remains after bleeding stops. Day and night cough, phlegm congestion, Qi rising. Three years max, one year min to death. Cough unceasing shakes Kidney Yuan Qi. Lung is Kidney Mother; Mother sick, Child sick. Lung is canopy of Five Zang. Classics: Grain Qi enters Stomach, transmits to Lung. Five Zang Six Fu receive Qi. Clear becomes Ying (Nutritive), turbid becomes Wei (Defensive). Organs extract essence from Lung. Lung diseased, cannot transmit essence to organs. One year: organs wither. Three years: organs exhausted. Thus cough is true consumption, incurable. Yet some coughers survive. Cough slows sometimes, diet/lifestyle unchanged, good self-care extends beyond three years, lifestyle normal, occasional flare-ups heal with rest. One in a hundred. More, non-coughers with frequent blood disorders, Liver exhausted, Lung damaged, change to cough, eventually die. Poor self-care, light turns heavy. Hold this to decide blood disorder death/life, hundred percent accurate."