例，《中医杂志》5：40，1980）
【评按】咳嗽是肺系疾患的主要症状之一。不论内伤、外感咳嗽均系肺脏受病而致。外感咳嗽起病于肺，内伤咳嗽多由他脏先病影响于肺。对于咳嗽一证首当鉴别外感、内伤，及其见证之虚实。外感咳嗽又当分清风寒、风热、挟湿、挟暑，以及燥热咳嗽等情况。内伤咳嗽又当区别痰湿、肝火犯肺，以及脾虚、肾虚之别。
例一为伏暑咳嗽，自服丸一65一药得汗不彻，肺气失于宣达，洽以芳香和化，药后汗出体轻，又因兼挟气郁，继以苦降辛通之剂，使咳嗽平复、大便通畅而病愈。
例二属于内伤咳嗽。患者脉见弦数，咳而咽燥，两胁震痛，为肝阴不足，木火偏亢，上刑干肺，势必耗伤肺阴；阴虚上扰，易伤阳络，故有失血之虑。洽以养阴润肺、镇肝降火，使火气降、肺气得以清肃，其咳自平。
例三肺热多痰是标，脾肾阳虚为本，虽屡用清化痰火之剂，效验平平。改用温脾肾之阳，稍用清上之品以反佐，药后灰黑之苔基本消失，余症亦随之好转；后以温养脾肾、培土生金法善其后。本例取效之要诀，在于辨别标本较为阴细。
例四咳而兼喘，证属脾肾阳虚。盖肾阳不振不能蒸运脾土，水谷精微化为痰饮，痰饮窃踞肺络，气机受阻发为咳喘；饮邪上溢则面浮而时吐清水；脾失健运，肾失封藏故便溏；阳气虚弱故时恶风而肢冷。洽以益火生土之法，疗效可观。纵上所述，《内经》所谓“五藏六府皆令人咳，非独肺也”确有至理。
例五确诊为肺泡蛋白沉着症，属于少见疑难病范围。据中医辨证，胸中大气下陷为本，瘀血阻络痰浊不化为标。所谓大气，即《内经》所称之宗气，张锡纯《医学衷中参西录》中述之较详。张氏认为：“名为大气者，诚以其能撑持全身，为诸气之纲领，包举肺外呼吸之枢机，……此气一虚，呼吸即觉不利，而且肢体酸懒，精神昏。溃，脑力心思，为之顿减。”宗气一虚，津液失于敷布，血行瘀滞不畅，故又挟痰浊与血瘀之兼证。治若仅顾痰浊瘀血之标而不顾宗气下陷之本，则属本末倒置。故据中医辨证立法，选用张氏升陷汤（黄芪、升麻、柴胡、桔梗、知母）为主方，加当归、川穹、丹参通利血脉；旋复花、葶苈子降气肃肺；生苡仁、海浮石健脾化痰，标本兼顾治本为主，辨证明确，立法遣药精一66——当，对于疑难病，不但能够改善症状，而且对于肺功能也有明显的改善，值得充分重视。
（五）喘证
例一齐XX，男，60岁，初诊日期：1952年8月30日近日因感风热化痰，成为喘咳，或不能起行，亦不安卧，耳内时鸣，喉际旧泊有声。法当从事清降。空沙参9克薄荷梗6克西防风6克天花粉9克苦杏仁9克苦桔梗9克知贝母各9克半夏曲6克灵磁石12克（先煎）云苓块12克真郁金9克甘草9克鲜荷梗一尺生姜6克9月10日
（二诊）：服前方多剂，病去八、九，但痰尚未尽，耳鸣未减，肝胃有热，肺气尚虚，法当从本治。南沙参12克苦杏仁9克苦桔梗9克天花粉12克嫩白前6克平贝母9克肥知母9克云茯苓12克灵磁石12克（先煎）甘枸杞9克干生地9克生甘草3克生藕节5枚甘菊花6克
（张绍重整理：萧龙友医案，《中医杂志》2：115，1958）
例二周X，男，34岁，初诊日期：1976年1月24日。患者婴儿时期曾患奶癣，四岁开始病哮喘，每逢春秋必发，且逐年加重，持续二、三月尚不见缓解，平时特别伯冷，易感冒，不欲饮水。此次发病，起自去秋，迄今时轻时重，曾用过多种西药，包括激素等，尚不能控制。半夜后哮鸣气急，舌苔薄白，脉细弦。一67一辨证：外寒内饮为患，久病体虚，气阳不足。治法：助阳解表蠲饮，标本并图。方药：生麻黄6克桂枝6克生白芍9克生甘草6克苏子12克姜半夏9克陈皮6克炙细辛3克熟附片12克（先煎）磁石30克14剂。另黄芪片100片，每日3次，每次5片。1977年2月7日
（二诊）：药后哮喘缓解，日来喉间稍有哮鸣，胸闷气短，有咳痰。原方改生麻黄9克，加黑锡丹6克分吞，7剂。另胆荚片（猪胆汁、皂荚、草河车）两包，每日3次，每次5片。上方服后哮喘基本控制，咳痰亦轻，嗣后改用丸药，予附桂八味丸温肾扶阳为主，并加用黄芪片、地龙片吞服，三月后随访，未见复发。（《上海老中医经验选编》徐仲才医案，陆鸿元等整理）
例三向X，男，33岁。喘息经常发作已有三年。秋冬较重夏日略轻。发作时咳喘心跳，痰唾不出，呼吸有水鸣声，胸廓胀闷，不能平卧，影响食眠。最近一年来病情增剧，曾经丶医院检查诊断为慢性气管炎支气管喘息。每日尚服用氨茶碱片。舌苔自不腻，脉滑数。辨证。火逆于上，气不得降，肺气被痰热阻塞，以致呼吸不利。治法：定喘止嗽化痰。方药：葶苈子6克（大枣5枚去核布包）炙紫苑、苏子各6克莱菔子6克（自芥子3克同炒）炙麻黄1．5克嫩射于4．5一68一克五味子4石克（细宰1．5克同打）半夏曲9克（枇把叶6克同布包）云茯苓神各9克炙自前、前胡各4．5克陈橘红络各4．5克炙甘草3克二诊：前方服5剂后痰液排出较易，呼吸道无声，胸廓胀满尚未全释，能平卧，但睡不熟，食进乏味，大便失润，二、三日一行，脉滑，原法加力进治。葶苈子6克（大红枣5枚去核布包）全瓜萎24克（薤白9克同打）炙紫苑、苏子各9克（打）苦桔梗4．5克炒枳壳4石克半夏曲9克（枇把叶6克布包）五味子4．5克（细辛1．5克同打）莱菔子6克（白芥子3克同炒）嫩射干4．5克炙麻黄2．4克炙前胡、化红各6克炙甘草3克三诊：服药4剂喘息基本消失，呼吸平稳，痰液减少，胸间亦爽，食眠均有好转，大便通而不畅，脉缓。症再向愈，尚需当心护理。葶苈子4石克（大红枣5枚去核布包）五味子4石克（细辛1．5克同打）炒枳壳4．5克苦桔梗4．5克炙苏子化红各6克莱菔子6克（白芥子3克同炒）半夏曲9克（枇把叶6克布包）白杏仁（炒）6克冬虫草（炙）9克淡苁蓉15克明党参6克远志（炒）9克
（施稚墨整理：施今墨医案，《中医杂志》5：328，1958）
例四仇XX，女，32岁。素有气喘，此次发作有日，神志昏沉，气喘痰鸣，不能平卧，身疲气弱，肢冷，脉沉细无力，乃阳虚气喘，肾气失于摄纳，势频虚脱，急急回阳纳气。高丽参15克沉香1．5克黑锡丹（打碎布包同煎）9克——69一二诊：服前药后，气喘大减，神志转清，脉象较为有力，予补气化痰法调理。北沙参30克杏仁9克浙贝母4．5克全瓜萎9克白前9克桔梗4．5克牛蒡子6克前胡9克陈皮4．5克法半夏6克赤苓6克数剂后，气喘多痰，身疲气弱等症，均获痊愈。
（时振声整理：时逸人医案川江苏中医））11：11，1965）［评按】喘证系指以吁吸急促，甚则张口抬肩为主的证候。临床分为虚实两类。实喘多因外邪壅肺，气失宣降；虚喘多因肺肾两虚，肺不呼气、肾不纳气，精气内虚所致。实证又多兼痰、饮，故喘咳哮证多相并论。
例一为风热喘咳，爱因感受风热化痰而致。急则治标，法用清降，是为正治。病去八、九而痰未除者，因肝胃有热，肺气尚虚之故，治以清肝胃、补肺气，是为治本之法。
例二为哮喘外寒内饮为患，故以附子汤加减为主方，更加黑锡丹以助温肾纳气之功，以及胆荚片化痰逐饮，既能祛邪以安正气，更重扶阳以祛饮邪，即所谓“离照当空，阴霾自散”之义。
例三喘息病发三年，证属火逆于上，气不得降，肺气被痰热阻塞，故而作喘，药虽无奇而配伍得当，获效尚捷。
例四素有气喘，发作有日，现症有频临虚脱之危象，急以回阳纳气。《问斋医案｝）云“肺为气之主，肾乃气之根。肾虚气不归原，肺损气无依附，孤阳浮泛作喘……”故用高丽参、沉香、黑锡丹温肾阳、祛阴寒，则气喘自平，续以补气化痰，用《外台秘要》杏仁煎加减调理，则气弱痰多之象，自可痊愈。
（六）痰饮
例一俞，女，暴寒外束，痰饮内聚，支塞于肺，肃降一70一失司，气喘咳嗽大发，故日夜不能平卧，形寒怯冷，纳少泛恶，苔白腻，脉浮弦而滑。拟小青龙汤加减。疏解外邪，温化痰饮。蜜炙麻黄1．2克川桂枝2．4克云苓9克姜半夏6克五味子1．2克淡干姜1．2克炙苏子6克光杏仁9克熟附片3克鹅管石（煅）3克哮吼紫金丹2粒（另吞），连服两天。二诊：服小青龙汤两剂，气喘咳嗽，日中大减，夜则依然，纳少泛恶。苔薄腻，脉弦滑，夜为阴盛之时，饮邪窃居阳位，阻塞气机，肺胃下降之令失司，再以温化饮邪，肃降肺气。川桂枝2．4克云苓9克姜半夏6克橘红3克五味子1．2克淡干姜1．2克水炙远志1．5克光杏仁9克炙苏子15克旋覆花（包）15克熟附片3克鹅管石3克（煅）三诊：气喘咳嗽，夜亦减轻，泛恶亦止，惟痰饮根株已久，一时难以骤化，脾为生痰之源，肺为贮痰之器，今拟理脾肃肺，温化痰饮。原方去旋覆花、远志M味，加生白术15克，炒补骨脂15克。（《丁甘仁医案》）
例二季X，女，年约30岁。咳喘，倚息不得卧，恶寒发热，头疼身痛，胸闷不舒，心痛彻背。脉沉而滑，舌苔白腻，此风寒痰饮，内外搏结，肺气不得下降而成肺胀也。用小青龙汤以驱风寒，合瓜萎薤白汤以蠲痰饮。麻黄1．2克桂枝1．2克淡干姜1．5克北细辛1．2克生白芍4石克五味子1．5克甘草1石克瓜萎仁9一71——克（杵）干薤白9克（白酒洗、捣）姜半夏9克次诊：服后得汗，而寒热喘息俱平，惟身痛咳嗽未已，易方以桂枝汤和营卫，加干姜、五味子各1.5克，细辛0．9克以治咳。一剂效，二剂更瘥，……不复延诊，遂渐愈。巛重印全国名医验案类编》袁桂生医案）
例三俞，男，60岁，10月。脾阳虚则积湿为痰，肾阳惫则蓄水成饮。饮痰上泛，咳嗽气逆，痰味带咸，形寒畏冷，脉象滑而无力，舌苔薄腻，体虽虚腻补难投，虑为痰饮树帜耳。炮姜3克拌捣炒五味子2．1克细辛2．4克姜夏6克茯苓12克炙橘红4．5克金沸梗9克（包）煅代赭石15克煅灵磁石15克炒杜仲12克沉香末1．8克（分冲）炙紫苑9克红枣3枚（《叶熙春医案》）
例四邓X，女，48岁，巳婚。入院日期；1963年6月15日。因浮肿气短半年，一周来加重而入院。于1961年工月感冒后，开始咳嗽气短，下肢逐渐浮肿，心下痞满，咳吐白痰，尿少，既往有八年慢性咳嗽史。脉弦细数，苔白唇色紫。西医诊为慢性肺心病。辨证：心肾阳虚，水饮内停，痰湿阻遏，肺气壅塞。治法：清宣肺金，降气化痰，温阳利湿之法。方药：越婢合真武汤加减：生石膏12克麻黄3克甘草9克云苓12克白术9克杭芍9克附子6克生姜9克大枣
（擘）5枚车前子15克白茅根30克杏仁9克一72一上药服3剂后，尿量增加，每日达1500～1900毫升，下肢浮肿明显减退。服5剂后，浮肿不显，肝大回缩，咳嗽减轻，于上方加入厚朴6克，陈皮6克，气喘亦减，仅有胸闷，故上方去白茅根、车前子、厚朴，加苏子9克，再进5剂后，症状减轻，仍咳嗽未愈，乃肺气不宣所致，故改投宽胸理气清肺之法，方用厚朴麻黄汤加减，方药如下：厚朴6克麻黄3克半夏9克杏仁9克甘草9克沙参18克小麦30克茯苓9克细辛3克五味子6克生姜4．5克服上方后症状已大减，……病情稳定。巛赵锡武医疗经验》）
例五王xx，男，45岁。外感风寒，引动痰饮，肺气不宣，咳嗽胸痛，喘息不能平卧。舌苔薄腻，脉滑实。X线胸部透视为“渗出性胸膜炎”。乃饮邪积于胸胁之间，证属悬饮，治拟疏风宣肺，攻逐水饮。叶苏梗10克甜葶苈1．5克炙紫苑5克苏子10克桔梗5克杏仁9克竹茹10克陈皮6克制半夏10克茯苓12克吴萸1．5克瓜萎仁10克蛤壳30克天将壳10克广郁金10克控涎丹2克（包）服药3剂喘平，一月后再发，原方续服又效。巛黄一峰医案医话集》
例六李Xx，女，30岁，初诊日期：1971年12月20日。因渗出性胸膜炎入院，身热巳退，胸痛渐除，惟头晕，全身乏力，月经多，夜寐不安，小便色赤，脉细数。苔薄白，舌质红，口苦，以清余邪为治。方药：一73——野百合12克党参9克车前子6克生地黄12克白茅根24克竹叶卷心9克甘草梢6克天麦冬各9克大小蓟各6克3剂。12月22日
（二诊）：胸透积水巳全消，小便色转黄，惬四肢乏力，头眩、咽干唇燥，苔腻，口苦，脉微数，以益肺清解为续，方药如下：野百合12克生地黄12克苡仁12克北沙参9克冬瓜子12克党参9克白术9克白茅根24克茯苓12克天麦冬各9克竹叶卷心9克3剂。12月24日
（三诊）：小便巳清，夜寐欠安，脉细数，苔厚见于根部，口苦。以硫清为续，方药如下：柴胡4．5克野百合12克生地黄12克白茅根24克焦枣仁9克柏子仁9克神曲9克蕾香6克佩兰9克天麦冬各9克竹叶卷心9克4剂。
【评按】咳嗽是肺系疾病的主要症状之一。无论是内伤咳嗽还是外感咳嗽，都是由于肺脏受病所致。外感咳嗽起病于肺，内伤咳嗽多由其他脏腑先发病进而影响肺脏。对于咳嗽这一证候，首先应当鉴别是外感还是内伤，以及其表现出的虚实性质。外感咳嗽又当进一步区分风寒、风热、挟湿、挟暑，以及燥热咳嗽等情况。内伤咳嗽又当区别痰湿、肝火犯肺，以及脾虚、肾虚的不同类型。
例一为伏暑咳嗽，患者自行服用丸药后出汗不彻底，导致肺气失去宣发通达的功能。治疗采用芳香化湿之法，服药后汗出且身体轻松；又因兼有气机郁滞，继以苦降辛通的方剂，使咳嗽平息、大便通畅而痊愈。
例二属于内伤咳嗽。患者脉象弦数，咳嗽且咽喉干燥，两胁震动疼痛，这是肝阴不足，肝木之火偏亢，向上灼伤肺金（即“木火刑金”），势必耗伤肺阴；阴虚阳亢上扰，容易损伤阳络，因此有咯血的顾虑。治疗采用养阴润肺、镇肝降火的方法，使火势下降、肺气得以清肃，咳嗽自然平息。
例三肺热多痰是标象，脾肾阳虚是本源，虽然多次使用清化痰火的药物，疗效平平。改用温补脾肾之阳，稍加清热上焦的药物作为反佐，服药后灰黑色的舌苔基本消失，其余症状也随之好转；随后采用温养脾肾、培土生金的方法善后。本例取效的关键，在于辨别标本较为精细。
例四咳嗽兼见气喘，证属脾肾阳虚。因为肾阳不振不能蒸腾运化脾土，水谷精微化为痰饮，痰饮占据肺络，气机受阻从而引发咳喘；饮邪上溢则面部浮肿且时常吐出清水；脾失健运，肾失封藏故大便溏薄；阳气虚弱故时常怕风且四肢冰冷。治疗采用益火生土的方法，疗效可观。综上所述，《内经》所谓“五脏六腑皆令人咳，非独肺也”确有至理。
例五确诊为肺泡蛋白沉着症，属于少见疑难病范围。据中医辨证，胸中大气下陷为本，瘀血阻络、痰浊不化为标。所谓大气，即《内经》所称的宗气，张锡纯在《医学衷中参西录》中论述较详。张氏认为：“名为大气者，诚以其能撑持全身，为诸气之纲领，包举肺外呼吸之枢机，……此气一虚，呼吸即觉不利，而且肢体酸懒，精神昏溃，脑力心思，为之顿减。”宗气一虚，津液失去敷布，血行瘀滞不畅，故而又夹杂痰浊与血瘀的兼证。治疗若只顾及痰浊瘀血的标象而不顾宗气下陷的本源，则属本末倒置。故据中医辨证立法，选用张氏升陷汤（黄芪、升麻、柴胡、桔梗、知母）为主方，加当归、川芎、丹参通利血脉；旋覆花、葶苈子降气肃肺；生薏苡仁、海浮石健脾化痰，标本兼顾治本为主，辨证明确，立法遣药恰当，对于疑难病，不但能够改善症状，而且对于肺功能也有明显的改善，值得充分重视。
（五）喘证
例一齐XX，男，60岁，初诊日期：1952年8月30日。近日因感受风热化痰，成为喘咳，有时不能起身行走，也不能安卧，耳内时常鸣响，喉间旧有痰鸣声。治法应当从事清降。南沙参9克，薄荷梗6克，西防风6克，天花粉9克，苦杏仁9克，苦桔梗9克，知母、贝母各9克，半夏曲6克，灵磁石12克（先煎），云茯苓块12克，真郁金9克，甘草9克，鲜荷梗一尺，生姜6克。9月10日
（二诊）：服用前方多剂，病去八九，但痰尚未尽，耳鸣未减，肝胃有热，肺气尚虚，治法应当从本论治。南沙参12克，苦杏仁9克，苦桔梗9克，天花粉12克，嫩白前6克，平贝母9克，肥知母9克，云茯苓12克，灵磁石12克（先煎），甘枸杞9克，干生地9克，生甘草3克，生藕节5枚，甘菊花6克。
（张绍重整理：萧龙友医案，《中医杂志》2：115，1958）
例二周X，男，34岁，初诊日期：1976年1月24日。患者婴儿时期曾患奶癣，四岁开始患哮喘，每逢春秋必发，且逐年加重，持续二、三月尚不见缓解，平时特别怕冷，易感冒，不欲饮水。此次发病，起自去年秋天，迄今时轻时重，曾用过多种西药，包括激素等，尚不能控制。半夜后哮鸣气急，舌苔薄白，脉细弦。辨证：外寒内饮为患，久病体虚，气阳不足。治法：助阳解表蠲饮，标本并图。方药：生麻黄6克，桂枝6克，生白芍9克，生甘草6克，苏子12克，姜半夏9克，陈皮6克，炙细辛3克，熟附片12克（先煎），磁石30克，14剂。另黄芪片100片，每日3次，每次5片。1977年2月7日
（二诊）：服药后哮喘缓解，日来喉间稍有哮鸣，胸闷气短，有咳痰。原方改生麻黄9克，加黑锡丹6克分吞，7剂。另胆荚片（猪胆汁、皂荚、草河车）两包，每日3次，每次5片。上方服后哮喘基本控制，咳痰亦轻，嗣后改用丸药，予附桂八味丸温肾扶阳为主，并加用黄芪片、地龙片吞服，三月后随访，未见复发。（《上海老中医经验选编》徐仲才医案，陆鸿元等整理）
例三向X，男，33岁。喘息经常发作已有三年。秋冬较重夏日略轻。发作时咳喘心跳，痰唾不出，呼吸有水鸣声，胸廓胀闷，不能平卧，影响食眠。最近一年来病情增剧，曾经医院检查诊断为慢性气管炎支气管喘息。每日尚服用氨茶碱片。舌苔自不腻，脉滑数。辨证：火逆于上，气不得降，肺气被痰热阻塞，以致呼吸不利。治法：定喘止嗽化痰。方药：葶苈子6克（大枣5枚去核布包），炙紫菀、苏子各6克，莱菔子6克（与白芥子3克同炒），炙麻黄1.5克，嫩射干4.5克，五味子4.5克（与细辛1.5克同打），半夏曲9克（枇杷叶6克同布包），云茯苓神各9克，炙白前、前胡各4.5克，陈橘红络各4.5克，炙甘草3克。二诊：前方服5剂后痰液排出较易，呼吸道无声，胸廓胀满尚未全释，能平卧，但睡不熟，食进乏味，大便失润，二、三日一行，脉滑，原法加力进治。葶苈子6克（大红枣5枚去核布包），全瓜蒌24克（薤白9克同打），炙紫菀、苏子各9克（打），苦桔梗4.5克，炒枳壳4.5克，半夏曲9克（枇杷叶6克布包），五味子4.5克（细辛1.5克同打），莱菔子6克（白芥子3克同炒），嫩射干4.5克，炙麻黄2.4克，炙前胡、化红各6克，炙甘草3克。三诊：服药4剂喘息基本消失，呼吸平稳，痰液减少，胸间亦爽，食眠均有好转，大便通而不畅，脉缓。症再向愈，尚需当心护理。葶苈子4.5克（大红枣5枚去核布包），五味子4.5克（细辛1.5克同打），炒枳壳4.5克，苦桔梗4.5克，炙苏子、化红各6克，莱菔子6克（白芥子3克同炒），半夏曲9克（枇杷叶6克布包），白杏仁（炒）6克，冬虫草（炙）9克，淡苁蓉15克，明党参6克，远志（炒）9克。
（施稚墨整理：施今墨医案，《中医杂志》5：328，1958）
例四仇XX，女，32岁。素有气喘，此次发作有日，神志昏沉，气喘痰鸣，不能平卧，身疲气弱，肢冷，脉沉细无力，乃阳虚气喘，肾气失于摄纳，势频虚脱，急急回阳纳气。高丽参15克，沉香1.5克，黑锡丹（打碎布包同煎）9克。二诊：服前药后，气喘大减，神志转清，脉象较为有力，予补气化痰法调理。北沙参30克，杏仁9克，浙贝母4.5克，全瓜蒌9克，白前9克，桔梗4.5克，牛蒡子6克，前胡9克，陈皮4.5克，法半夏6克，赤苓6克。数剂后，气喘多痰，身疲气弱等症，均获痊愈。
（时振声整理：时逸人医案，《江苏中医》11：11，1965）
【评按】喘证系指以呼吸急促，甚则张口抬肩为主的证候。临床分为虚实两类。实喘多因外邪壅肺，气失宣降；虚喘多因肺肾两虚，肺不呼气、肾不纳气，精气内虚所致。实证又多兼痰、饮，故喘咳哮证多相并论。
例一为风热喘咳，多因感受风热化痰而致。急则治标，法用清降，是为正治。病去八九而痰未除者，因肝胃有热，肺气尚虚之故，治以清肝胃、补肺气，是为治本之法。
例二为哮喘外寒内饮为患，故以附子汤加减为主方，更加黑锡丹以助温肾纳气之功，以及胆荚片化痰逐饮，既能祛邪以安正气，更重扶阳以祛饮邪，即所谓“离照当空，阴霾自散”之义。
例三喘息病发三年，证属火逆于上，气不得降，肺气被痰热阻塞，故而作喘，药虽无奇而配伍得当，获效尚捷。
例四素有气喘，发作有日，现症有频临虚脱之危象，急以回阳纳气。《问斋医案》云“肺为气之主，肾乃气之根。肾虚气不归原，肺损气无依附，孤阳浮泛作喘……”故用高丽参、沉香、黑锡丹温肾阳、祛阴寒，则气喘自平，续以补气化痰，用《外台秘要》杏仁煎加减调理，则气弱痰多之象，自可痊愈。
（六）痰饮
例一俞，女，暴寒外束，痰饮内聚，支塞于肺，肃降失司，气喘咳嗽大发，故日夜不能平卧，形寒怯冷，纳少泛恶，苔白腻，脉浮弦而滑。拟小青龙汤加减。疏解外邪，温化痰饮。蜜炙麻黄1.2克，川桂枝2.4克，云茯苓9克，姜半夏6克，五味子1.2克，淡干姜1.2克，炙苏子6克，光杏仁9克，熟附片3克，鹅管石（煅）3克，哮吼紫金丹2粒（另吞），连服两天。二诊：服小青龙汤两剂，气喘咳嗽，日中大减，夜则依然，纳少泛恶。苔薄腻，脉弦滑，夜为阴盛之时，饮邪窃居阳位，阻塞气机，肺胃下降之令失司，再以温化饮邪，肃降肺气。川桂枝2.4克，云茯苓9克，姜半夏6克，橘红3克，五味子1.2克，淡干姜1.2克，水炙远志1.5克，光杏仁9克，炙苏子15克，旋覆花（包）15克，熟附片3克，鹅管石3克（煅）。三诊：气喘咳嗽，夜亦减轻，泛恶亦止，惟痰饮根株已久，一时难以骤化，脾为生痰之源，肺为贮痰之器，今拟理脾肃肺，温化痰饮。原方去旋覆花、远志、五味，加生白术15克，炒补骨脂15克。（《丁甘仁医案》）
例二季X，女，年约30岁。咳喘，倚息不得卧，恶寒发热，头疼身痛，胸闷不舒，心痛彻背。脉沉而滑，舌苔白腻，此风寒痰饮，内外搏结，肺气不得下降而成肺胀也。用小青龙汤以驱风寒，合瓜蒌薤白汤以蠲痰饮。麻黄1.2克，桂枝1.2克，淡干姜1.5克，北细辛1.2克，生白芍4.5克，五味子1.5克，甘草1.5克，瓜蒌仁9克（杵），干薤白9克（白酒洗、捣），姜半夏9克。次诊：服后得汗，而寒热喘息俱平，惟身痛咳嗽未已，易方以桂枝汤和营卫，加干姜、五味子各1.5克，细辛0.9克以治咳。一剂效，二剂更瘥，……不复延诊，遂渐愈。（《重印全国名医验案类编》袁桂生医案）
例三俞，男，60岁，10月。脾阳虚则积湿为痰，肾阳惫则蓄水成饮。饮痰上泛，咳嗽气逆，痰味带咸，形寒畏冷，脉象滑而无力，舌苔薄腻，体虽虚腻补难投，虑为痰饮树帜耳。炮姜3克拌捣，炒五味子2.1克，细辛2.4克，姜夏6克，茯苓12克，炙橘红4.5克，金沸梗9克（包），煅代赭石15克，煅灵磁石15克，炒杜仲12克，沉香末1.8克（分冲），炙紫菀9克，红枣3枚。（《叶熙春医案》）
例四邓X，女，48岁，已婚。入院日期：1963年6月15日。因浮肿气短半年，一周来加重而入院。于1961年1月感冒后，开始咳嗽气短，下肢逐渐浮肿，心下痞满，咳吐白痰，尿少，既往有八年慢性咳嗽史。脉弦细数，苔白唇色紫。西医诊为慢性肺心病。辨证：心肾阳虚，水饮内停，痰湿阻遏，肺气壅塞。治法：清宣肺金，降气化痰，温阳利湿之法。方药：越婢合真武汤加减：生石膏12克，麻黄3克，甘草9克，云茯苓12克，白术9克，杭芍9克，附子6克，生姜9克，大枣（擘）5枚，车前子15克，白茅根30克，杏仁9克。上药服3剂后，尿量增加，每日达1500～1900毫升，下肢浮肿明显减退。服5剂后，浮肿不显，肝大回缩，咳嗽减轻，于上方加入厚朴6克，陈皮6克，气喘亦减，仅有胸闷，故上方去白茅根、车前子、厚朴，加苏子9克，再进5剂后，症状减轻，仍咳嗽未愈，乃肺气不宣所致，故改投宽胸理气清肺之法，方用厚朴麻黄汤加减，方药如下：厚朴6克，麻黄3克，半夏9克，杏仁9克，甘草9克，沙参18克，小麦30克，茯苓9克，细辛3克，五味子6克，生姜4.5克。服上方后症状已大减，……病情稳定。（《赵锡武医疗经验》）
例五王xx，男，45岁。外感风寒，引动痰饮，肺气不宣，咳嗽胸痛，喘息不能平卧。舌苔薄腻，脉滑实。X线胸部透视为“渗出性胸膜炎”。乃饮邪积于胸胁之间，证属悬饮，治拟疏风宣肺，攻逐水饮。紫苏梗10克，甜葶苈1.5克，炙紫菀5克，苏子10克，桔梗5克，杏仁9克，竹茹10克，陈皮6克，制半夏10克，茯苓12克，吴茱萸1.5克，瓜蒌仁10克，蛤壳30克，天将壳10克，广郁金10克，控涎丹2克（包）。服药3剂喘平，一月后再发，原方续服又效。（《黄一峰医案医话集》）
例六李Xx，女，30岁，初诊日期：1971年12月20日。因渗出性胸膜炎入院，身热已退，胸痛渐除，惟头晕，全身乏力，月经多，夜寐不安，小便色赤，脉细数。苔薄白，舌质红，口苦，以清余邪为治。方药：野百合12克，党参9克，车前子6克，生地黄12克，白茅根24克，竹叶卷心9克，甘草梢6克，天麦冬各9克，大小蓟各6克，3剂。12月22日
（二诊）：胸透积水已全消，小便色转黄，心悸四肢乏力，头眩、咽干唇燥，苔腻，口苦，脉微数，以益肺清解为续，方药如下：野百合12克，生地黄12克，苡仁12克，北沙参9克，冬瓜子12克，党参9克，白术9克，白茅根24克，茯苓12克，天麦冬各9克，竹叶卷心9克，3剂。12月24日
（三诊）：小便已清，夜寐欠安，脉细数，苔厚见于根部，口苦。以疏清为续，方药如下：柴胡4.5克，野百合12克，生地黄12克，白茅根24克，焦枣仁9克，柏子仁9克，神曲9克，藿香6克，佩兰9克，天麦冬各9克，竹叶卷心9克，4剂。
[Commentary] Cough is one of the main symptoms of lung diseases. Whether it is internal injury cough or external contraction cough, it is caused by the disease of the Lung organ. External contraction cough starts in the Lung, while internal injury cough is mostly caused by other Zang-Fu organs getting sick first and then affecting the Lung. For the syndrome of cough, the first step is to differentiate between external contraction and internal injury, as well as the deficiency-excess nature of its manifestations. External contraction cough should be further distinguished into wind-cold, wind-heat, dampness-encumbering, summerheat-encumbering, and dryness-heat cough situations. Internal injury cough should be differentiated into phlegm-dampness, Liver fire invading the Lung, Spleen deficiency, and Kidney deficiency types.
Case 1 is latent summerheat cough. The patient took pills on his own, resulting in incomplete sweating, causing the Lung Qi to lose its dispersing and unblocking function. Treatment employed aromatic transformation methods; after taking the medicine, sweat was produced and the body felt light. Due to concurrent Qi stagnation, a subsequent formula with bitter descending and acrid unblocking properties was used, bringing the cough to a halt, promoting smooth bowel movements, and leading to recovery.
Case 2 belongs to internal injury cough. The patient's pulse was wiry and rapid, accompanied by cough, dry throat, and throbbing pain in both hypochondriac regions. This indicates insufficient Liver Yin and hyperactive Liver Fire (Wood overacting on Metal), which inevitably consumes Lung Yin. Yin deficiency with Yang floating upward easily damages the Yang collaterals, raising the concern of hemoptysis. Treatment adopted nourishing Yin and moistening the Lung, along with subduing the Liver and descending Fire. Once the Fire descended and the Lung Qi became clear and purifying, the cough naturally subsided.
Case 3: Pulmonary heat with excessive phlegm is the branch manifestation, while Spleen and Kidney Yang deficiency is the root cause. Although multiple treatments with formulas clearing heat and resolving phlegm-fire were used, the efficacy was mediocre. Switching to warming the Yang of the Spleen and Kidney, with slight use of upper-clearing agents as counter-assistance, resulted in the basic disappearance of the gray-black tongue coating, and other symptoms improved accordingly. Subsequently, methods of warming and nourishing the Spleen and Kidney, and cultivating Earth to generate Metal were used for consolidation. The key to the success of this case lay in the meticulous differentiation of root and branch.
Case 4: Cough accompanied by wheezing, belonging to Spleen and Kidney Yang deficiency. Since Kidney Yang fails to rise and transform Spleen Earth, the essence and grains of food transform into phlegm-fluids. These fluids occupy the Lung collaterals, obstructing Qi mechanism and causing cough and wheezing. Fluid pathogens overflowing upward cause facial edema and frequent expectoration of clear water; Spleen failure in transportation and Kidney failure in storage lead to loose stools; Yang Qi weakness causes aversion to wind and cold limbs. Treatment employed the method of benefiting Fire to generate Earth, yielding considerable efficacy. As stated above, the saying in *Neijing* "All five Zang and six Fu organs can cause cough, not just the Lung" is indeed profound truth.
Case 5: Diagnosed as pulmonary alveolar proteinosis, falling within the scope of rare and difficult diseases. According to TCM syndrome differentiation, sinking of the Great Qi in the chest is the root, while blood stasis obstructing collaterals and turbid phlegm failing to resolve are the branches. The so-called Great Qi refers to the Ancestral Qi (Zong Qi) mentioned in *Neijing*, discussed in detail by Zhang Xichun in *Medical Records of Chinese Medicine Aiding Western Medicine*. Zhang believed: "It is called Great Qi precisely because it supports the whole body, serves as the guideline for all Qi, encompasses the pivot of respiration outside the lungs... When this Qi is deficient, breathing becomes difficult, limbs feel sore and lazy, spirit becomes confused and exhausted, and mental power and thoughts are suddenly reduced." When Ancestral Qi is deficient, body fluids fail to distribute, and blood circulation becomes stagnant and sluggish, thus complicating with phlegm-turbidity and blood stasis syndromes. If treatment only attends to the branch of phlegm-turbidity and blood stasis without considering the root of Ancestral Qi sinking, it puts the cart before the horse. Therefore, based on TCM syndrome differentiation and legislation, Zhang's Shengxian Tang (Huangqi, Shengma, Chaihu, Jiegeng, Zhimu) was selected as the main formula, added with Danggui, Chuanxiong, and Danshen to promote blood vessels; Xuanfuhua and Tinglizi to descend Qi and purify the Lung; Sheng Yiren and Haifushi to strengthen the Spleen and resolve phlegm. Treating both root and branch with emphasis on the root, with clear syndrome differentiation and precise medication selection, for difficult diseases, not only improves symptoms but also significantly improves lung function, deserving full attention.
(V) Wheezing Syndrome
Case 1 Qi XX, Male, 60 years old, First visit date: August 30, 1952. Recently, due to contracting wind-heat transforming into phlegm, developed wheezing and cough, sometimes unable to stand up and walk, also unable to lie down comfortably, tinnitus in ears, and old phlegm rales in the throat. The method should focus on clearing and descending. Nan Shen (Adenophorae Radix) 9g, Bohe Geng (Menthae Haplocalycis Caulis) 6g, Xi Fangfeng (Saposhnikoviae Radix) 6g, Tianhuafen (Trichosanthis Radix) 9g, Ku Xingren (Armeniacae Amarum Semen) 9g, Ku Jiegeng (Platycodonis Radix) 9g, Zhimu (Anemarrhenae Rhizoma) and Beimu (Fritillariae Cirrhosae Bulbus) each 9g, Banxia Qu (Pinelliae Fermentatae Fructus) 6g, Ling Cishi (Magnetitum) 12g (decocted first), Yunling (Poria) 12g, Zhen Yujin (Curcumae Radix) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 9g, Xian Hegeng (Nelumbinis Nucleus Caulis) one chi, Shengjiang (Zingiberis Recens Rhizoma) 6g. September 10
(Second visit): After taking several doses of the previous prescription, the illness has gone 80-90%, but phlegm is not yet fully cleared, tinnitus has not decreased, there is heat in the Liver and Stomach, and Lung Qi is still deficient. The method should treat from the root. Nan Shen 12g, Ku Xingren 9g, Ku Jiegeng 9g, Tianhuafen 12g, Nen Baiqian (Cynanchi Stauntonii Rhizoma) 6g, Ping Beimu 9g, Fei Zhimu 9g, Yun Fuling 12g, Ling Cishi 12g (decocted first), Gan Gouqi (Lycii Fructus) 9g, Gan Shengdi (Rehmanniae Radix) 9g, Sheng Gancao 3g, Sheng Ou Jie (Nelumbinis Rhizomatis Node) 5 pieces, Gan Juhua (Chrysanthemi Flos) 6g.
(Organized by Zhang Shaozhong: Xiao Longyou Medical Cases, *Journal of Traditional Chinese Medicine* 2:115, 1958)
Case 2 Zhou X, Male, 34 years old, First visit date: January 24, 1976. The patient suffered from milk eczema during infancy, began suffering from asthma at age four, recurring every spring and autumn, worsening year by year, lasting two to three months without relief. Usually particularly afraid of cold, prone to colds, no desire to drink water. This episode started last autumn, fluctuating in severity since then. Multiple Western medicines, including hormones, had been used but failed to control it. After midnight, wheezing and shortness of breath worsened, tongue coating thin white, pulse fine and wiry. Syndrome differentiation: External cold and internal fluid retention, chronic illness leading to body deficiency, Qi and Yang insufficiency. Treatment method: Assist Yang, release exterior, eliminate fluids, treating both root and branch simultaneously. Prescription: Sheng Mahuang (Ephedrae Herba) 6g, Guizhi (Cinnamomi Ramulus) 6g, Sheng Baishao (Paeoniae Radix Alba) 9g, Sheng Gancao 6g, Suzi (Perillae Fructus) 12g, Jiang Banxia (Pinelliae Rhizoma Preparatum) 9g, Chenpi (Citri Reticulatae Pericarpium) 6g, Zhi Xixin (Asari Radix et Rhizoma Preparatum) 3g, Shu Fupian (Aconiti Lateralis Radix Praeparata) 12g (decocted first), Cishi (Magnetitum) 30g, 14 doses. Additionally, Huangqi Tablets 100 tablets, 3 times daily, 5 tablets each time. February 7, 1977
(Second visit): Asthma relieved after taking medicine, slight wheezing in throat recently, chest tightness and shortness of breath, with expectoration. Change Sheng Mahuang to 9g in the original formula, add Heixi Dan (Black Tin Pill) 6g to be swallowed separately, 7 doses. Additionally, Danjia Pian (Porcine Bile, Gleditsiae Spina, Thalictri Radix) two packs, 3 times daily, 5 tablets each time. After taking the above prescription, asthma was basically controlled, expectoration also lightened. Subsequently switched to pill medication, mainly using Fugui Bawei Wan (Eight-Ingredient Pill with Cinnamon and Aconite) to warm the Kidney and support Yang, combined with swallowing Huangqi Tablets and Dilong Tablets. Follow-up after three months showed no recurrence. (*Selected Experiences of Old Shanghai TCM Doctors*, Xu Zhongcai Medical Cases, organized by Lu Hongyuan et al.)
Case 3 Xiang X, Male, 33 years old. Wheezing has been frequently occurring for three years. Heavier in autumn and winter, slightly lighter in summer. During attacks, coughing, wheezing, palpitations, inability to spit out phlegm, water-like sounds in breathing, chest distension and oppression, inability to lie flat, affecting eating and sleeping. In the past year, the condition has intensified, diagnosed as chronic bronchitis and bronchial asthma by hospital examination. Still taking Aminophylline tablets daily. Tongue coating naturally not greasy, pulse slippery and rapid. Syndrome differentiation: Fire reversing upwards, Qi unable to descend, Lung Qi blocked by phlegm-heat, leading to difficult breathing. Treatment method: Calm wheezing, stop cough, resolve phlegm. Prescription: Tinglizi (Descurainiae Semen seu Lepidii Semen) 6g (wrapped with 5 dates pitted), Zhi Ziwan (Astagi Herba) and Suzi each 6g, Laifuzi (Radish Seed) 6g (stir-fried with Baijiezi 3g), Zhi Mahuang 1.5g, Nen Shegan (Belamcandae Rhizoma) 4.5g, Wuweizi (Schisandrae Chinensis Fructus) 4.5g (pounded with Xixin 1.5g), Banxia Qu 9g (wrapped with Pipaye 6g), Yun Fushen (Poria cum Pinodiis) each 9g, Zhi Baiqian (Cynanchi Stauntonii Rhizoma Preparatum) and Qianhu (Peucedani Radix) each 4.5g, Chen Juhongluo (Tangerine Peel and Veins) each 4.5g, Zhi Gancao 3g. Second visit: After taking the previous prescription for 5 doses, phlegm discharged more easily, respiratory tract silent, chest distension not fully released, able to lie flat, but sleep is restless, food tastes bland, stool lacks moisture, once every two to three days, pulse slippery. Continue original method with increased strength. Tinglizi 6g (wrapped with 5 large red dates pitted), Quan Gualou (Trichosanthis Fructus) 24g (pounded with Xiebai 9g), Zhi Ziwan and Suzi each 9g (pounded), Ku Jiegeng 4.5g, Chao Zhike (Aurantii Fructus Immaturus Stir-fried) 4.5g, Banxia Qu 9g (wrapped with Pipaye 6g), Wuweizi 4.5g (pounded with Xixin 1.5g), Laifuzi 6g (stir-fried with Baijiezi 3g), Nen Shegan 4.5g, Zhi Mahuang 2.4g, Zhi Qianhu and Huahong each 6g, Zhi Gancao 3g. Third visit: After taking medicine for 4 doses, wheezing basically disappeared, breathing steady, phlegm reduced, chest feels clear, eating and sleeping improved, stool passes but not smoothly, pulse slow. Symptoms moving towards recovery, care needed. Tinglizi 4.5g (wrapped with 5 large red dates pitted), Wuweizi 4.5g (pounded with Xixin 1.5g), Chao Zhike 4.5g, Ku Jiegeng 4.5g, Zhi Suzi and Huahong each 6g, Laifuzi 6g (stir-fried with Baijiezi 3g), Banxia Qu 9g (wrapped with Pipaye 6g), Baixingren (Stir-fried Apricot Kernel) 6g, Dongchongxiacao (Cordyceps) 9g (roasted), Dan Congrong (Cistanches Herba) 15g, Ming Dangshen (Codonopsis Radix) 6g, Yuanzhi (Polygalae Radix Stir-fried) 9g.
(Organized by Shi Zhimo: Shi Jinmo Medical Cases, *Journal of Traditional Chinese Medicine* 5:328, 1958)
Case 4 Qiu XX, Female, 32 years old. Suffers from chronic asthma. This episode has lasted for days, consciousness is dull, wheezing with phlegm rattling, unable to lie flat, body fatigue and weak Qi, cold limbs, pulse deep, fine, and powerless. It is Yang-deficiency asthma, Kidney Qi failing to grasp Qi, threatening frequent collapse. Urgently restore Yang and grasp Qi. Gaoli Shen (Korean Ginseng) 15g, Chenxiang (Aquilariae Lignum Resinatum) 1.5g, Heixi Dan (Black Tin Pill, crushed and decocted wrapped) 9g. Second visit: After taking previous medicine, wheezing greatly reduced, consciousness cleared, pulse relatively stronger. Use tonifying Qi and resolving phlegm method for regulation. Beishashen (Glehniae Radix) 30g, Xingren 9g, Zhe Beimu (Fritillariae Thunbergii Bulbus) 4.5g, Quan Gualou 9g, Baiqian 9g, Jiegeng 4.5g, Niubangzi (Arctii Fructus) 6g, Qianhu 9g, Chenpi 4.5g, Fa Banxia (Pinelliae Rhizoma Preparatum) 6g, Chi Ling (Poria Rubra) 6g. After several doses, wheezing, excessive phlegm, body fatigue, and weak Qi were all cured.
(Organized by Shi Zhensheng: Shi Yiren Medical Cases, *Jiangsu Journal of Traditional Chinese Medicine* 11:11, 1965)
[Commentary] Wheezing syndrome refers to the syndrome characterized primarily by rapid breathing, even opening mouth and lifting shoulders. Clinically divided into deficiency and excess types. Excess wheezing is mostly due to external pathogens congesting the Lung, causing loss of dispersing and descending of Qi; deficiency wheezing is mostly due to dual deficiency of Lung and Kidney, Lung failing to exhale, Kidney failing to grasp Qi, caused by internal deficiency of essence and Qi. Excess syndromes often accompany phlegm and fluids, so wheezing, cough, and asthma syndromes are often discussed together.
Case 1 is wind-heat wheezing and cough, mostly caused by contracting wind-heat transforming into phlegm. In acute cases, treat the branch first; the method uses clearing and descending, which is the correct treatment. When the illness has gone 80-90% but phlegm remains, it is due to heat in Liver and Stomach and still deficient Lung Qi. Treatment clears Liver and Stomach and tonifies Lung Qi, which is the method of treating the root.
Case 2 is asthma caused by external cold and internal fluid retention. Thus, modified Fuzi Tang is used as the main formula, plus Heixi Dan to assist in warming the Kidney and grasping Qi, and Danjia Pian to resolve phlegm and expel fluids. This not only dispels pathogens to stabilize healthy Qi but emphasizes supporting Yang to dispel fluid pathogens, embodying the meaning of "when the sun shines brightly, the dark clouds disperse."
Case 3: Wheezing disease occurred for three years, syndrome belongs to fire reversing upwards, Qi unable to descend, Lung Qi blocked by phlegm-heat, thus causing wheezing. Although the herbs are not extraordinary, the combination is appropriate, achieving quick results.
Case 4: Suffers from chronic asthma, this episode has lasted for days, current symptoms show signs of impending collapse. Urgently restore Yang and grasp Qi. *Wenzhai Medical Cases* states: "The Lung is the master of Qi, the Kidney is the root of Qi. When Kidney is deficient, Qi does not return to its origin; when Lung is damaged, Qi has no attachment, lone Yang floats and causes wheezing..." Thus, Korean Ginseng, Agarwood, and Black Tin Pill are used to warm Kidney Yang and dispel yin cold, so wheezing naturally calms. Subsequently, tonifying Qi and resolving phlegm is used, modifying Xingren Decoction from *Waitai Miyao* for regulation, so the image of weak Qi and excessive phlegm can naturally recover.
(VI) Phlegm-Fluids
Case 1 Yu, Female. Violent cold binds externally, phlegm-fluids gather internally, obstructing the Lung, loss of descending function, severe wheezing and cough, thus unable to lie flat day or night, chills and fear of cold, poor appetite and nausea, white greasy tongue coating, floating, wiry, and slippery pulse. Prescribe modified Xiaolongdan Tang (Minor Dragon Decoction). Disperse external pathogens, warm and transform phlegm-fluids. Mi Zhi Mahuang (Honey-roasted Ephedra) 1.2g, Chuan Guizhi (Cinnamon Twig) 2.4g, Yunling (Poria) 9g, Jiang Banxia (Ginger-prepared Pinellia) 6g, Wuweizi (Schisandra) 1.2g, Dan Ganjiang (Light Dried Ginger) 1.2g, Zhi Suzi (Perilla Fruit) 6g, Guang Xingren (Apricot Kernel) 9g, Shu Fupian (Prepared Aconite) 3g, Eguanshi (Goose Tube Stone, calcined) 3g, Xiao Hou Zijin Dan (Purple Gold Pill for Asthma) 2 pills (swallowed separately), taken continuously for two days. Second visit: After taking two doses of Xiaolongdan Tang, wheezing and cough greatly reduced during the day, but remain at night, poor appetite and nausea. Thin greasy coating, wiry and slippery pulse. Night is the time of Yin abundance, fluid pathogens secretly occupy Yang positions, obstructing Qi mechanism, losing the command of Lung and Stomach descent. Again warm-transform fluid pathogens, purify-descend Lung Qi. Chuan Guizhi 2.4g, Yunling 9g, Jiang Banxia 6g, Juhong (Tangerine Peel) 3g, Wuweizi 1.2g, Dan Ganjiang 1.2g, Shui Zhi Yuanzhi (Water-processed Polygala) 1.5g, Guang Xingren 9g, Zhi Suzi 15g, Xuanfuhua (Inula Flower, wrapped) 15g, Shu Fupian 3g, Eguanshi 3g (calcined). Third visit: Wheezing and cough, even at night, have alleviated, nausea stopped. Only the root of phlegm-fluids has existed for a long time, difficult to dissolve rapidly. Spleen is the source of generating phlegm, Lung is the container storing phlegm. Now plan to regulate Spleen and purify Lung, warm-transform phlegm-fluids. Remove Xuanfuhua, Yuanzhi, Wuwei from original formula, add Sheng Baizhu (Atractylodes Macrocephala Rhizoma) 15g, Chao Buguzhi (Psoraleae Fructus Stir-fried) 15g. (*Ding Ganren Medical Cases*)
Case 2 Ji X, Female, approx. 30 years old. Cough and wheezing, leaning to breathe unable to lie down, aversion to cold and fever, headache and body pain, chest tightness and discomfort, heart pain penetrating to back. Pulse deep and slippery, tongue coating white greasy. This is wind-cold and phlegm-fluid, internal and external fighting and knotting, Lung Qi unable to descend forming Lung Distension. Use Xiaolongdan Tang to drive wind-cold, combined with Gualou Xiebai Tang to eliminate phlegm-fluids. Mahuang 1.2g, Guizhi 1.2g, Dan Ganjiang 1.5g, Bei Xixin (Asarum) 1.2g, Sheng Baishao 4.5g, Wuweizi 1.5g, Gancao 1.5g, Gualou Ren (Trichosanthes Seed) 9g (pounded), Gan Xiebai (Allium Macrostemon Bulb) 9g (washed with rice wine, pounded), Jiang Banxia 9g. Next visit: After taking, obtained sweat, cold/fever and wheezing both flattened, only body pain and cough remain. Change formula to Guizhi Tang (Cinnamon Twig Decoction) to harmonize Ying and Wei, add Ganjiang and Wuweizi each 1.5g, Xixin 0.9g to treat cough. One dose effective, two doses better... did not continue visits, gradually recovered. (*Reprinted National Famous Doctor Medical Cases Compilation*, Yuan Guisheng Medical Cases)
Case 3 Yu, Male, 60 years old, October. Spleen Yang deficiency leads to accumulation of dampness into phlegm, Kidney Yang exhaustion leads to accumulation of water into fluids. Fluid-phlegm flooding upward, cough and reverse Qi, phlegm tastes salty, chills and fear of cold, pulse slippery and powerless, tongue coating thin greasy. Although the body is deficient, heavy tonification is difficult to administer, fearing that phlegm-fluids are dominant. Paojiang (Roasted Ginger) 3g mixed and pounded, Chao Wuweizi 2.1g, Xixin 2.4g, Jiang Xia (Ginger Pinellia) 6g, Fuling (Poria) 12g, Zhi Juhong 4.5g, Jinfeigeng (Boilweed Stem, wrapped) 9g, Duan Daizheshi (Calcined Hematite) 15g, Duan Lingshishi (Calcined Magnetite) 15g, Chao Duzhong (Eucommia Bark) 12g, Chenxi Mo (Agarwood Powder) 1.8g (taken separately), Zhi Ziwan 9g, Red Dates 3 pieces. (*Ye Xichun Medical Cases*)
Case 4 Deng X, Female, 48 years old, Married. Admission date: June 15, 1963. Admitted due to edema and shortness of breath for half a year, aggravated for one week. After catching a cold in January 1961, began coughing and shortness of breath, lower limbs gradually swollen, epigastric fullness, coughing up white phlegm, oliguria, past history of eight-year chronic cough. Pulse wiry, fine, and rapid, tongue coating white, lip color purple. Western diagnosis: Chronic cor pulmonale. Syndrome differentiation: Heart and Kidney Yang deficiency, internal retention of water-fluids, phlegm-dampness obstruction, Lung Qi congestion. Treatment method: Clear and diffuse Lung Metal, descend Qi and resolve phlegm, warm Yang and promote diuresis. Prescription: Modified Yuebi Tang combined with Zhenwu Tang: Sheng Shigao (Gypsum Fibrosum) 12g, Mahuang 3g, Gancao 9g, Yunling 12g, Baizhu 9g, Hang Shao (White Peony Root) 9g, Fuzi 6g, Shengjiang 9g, Dazao (Jujube, split) 5 pieces, Cheqianzi (Plantago Seed) 15g, Baimaogen (Imperatae Rhizoma) 30g, Xingren 9g. After taking the above medicine for 3 doses, urine volume increased, reaching 1500-1900 ml daily, lower limb edema significantly reduced. After taking 5 doses, edema不明显, liver enlarged retracted, cough alleviated. Add Houpo (Magnolia Bark) 6g, Chenpi 6g to the above formula, wheezing also reduced, only chest tightness remains. Thus remove Baimaogen, Cheqianzi, Houpo from above formula, add Suzi 9g, take another 5 doses, symptoms alleviated, still coughing unresolved, due to Lung Qi not diffusing. Thus change to broad-chest regulating Qi and clearing Lung method, formula using modified Houpo Mahuang Tang: Houpo 6g, Mahuang 3g, Banxia 9g, Xingren 9g, Gancao 9g, Shashen (Glehnia Root) 18g, Xiaomai (Triticum Vulgare) 30g, Fuling 9g, Xixin 3g, Wuweizi 6g, Shengjiang 4.5g. After taking the above formula, symptoms greatly reduced... condition stabilized. (*Zhao Xiwu Medical Experience*)
Case 5 Wang xx, Male, 45 years old. External contraction of wind-cold, stirring up phlegm-fluids, Lung Qi not diffusing, cough and chest pain, wheezing unable to lie flat. Tongue coating thin greasy, pulse slippery and solid. X-ray chest fluoroscopy shows "exudative pleurisy". Fluid pathogens accumulate between chest and hypochondrium, syndrome belongs to Suspended Fluids. Treatment plans to disperse wind and diffuse Lung, attack and drain water-fluids. Zisu Geng (Perilla Stem) 10g, Tian Tinglizi 1.5g, Zhi Ziwan 5g, Suzi 10g, Jiegeng 5g, Xingren 9g, Zhuru (Bambusa Textilis Sap) 10g, Chenpi 6g, Zhi Banxia (Prepared Pinellia) 10g, Fuling 12g, Wuyu (Evodia Fruit) 1.5g, Gualou Ren 10g, Geke (Tridacnidae Shell) 30g, Tianjiang Qiao (Callicarpa Fruit) 10g, Guang Yujin (Curcuma Aromatica Rhizome) 10g, Kongyan Dan (Draining Phlegm Pill) 2g (wrapped). After taking 3 doses, wheezing calmed. Relapsed after one month, continued taking original formula again effective. (*Huang Yifeng Medical Cases and Talks Collection*)
Case 6 Li Xx, Female, 30 years old, First visit date: December 20, 1971. Admitted due to exudative pleurisy, body heat already retreated, chest pain gradually removed, only dizziness, whole body fatigue, menorrhagia, restless sleep, urine color red, pulse fine and rapid. Tongue coating thin white, tongue substance red, bitter taste in mouth. Treat by clearing residual pathogens. Prescription: Ye Baihe (Lily Bulb) 12g, Dangshen (Codonopsis) 9g, Cheqianzi 6g, Sheng Dihuang (Rehmannia Root) 12g, Baimaogen 24g, Zhuye Juanxin (Bamboo Leaf Heart) 9g, Gancao Shao (Licorice Tip) 6g, Tian Maidong (Ophiopogon Tuber) each 9g, Da Xiaoji (Great and Small Sedge) each 6g, 3 doses. December 22
(Second visit): Chest fluoroscopy shows effusion completely eliminated, urine color turned yellow, palpitations and four-limb fatigue, dizziness, dry throat and lips, greasy coating, bitter taste, pulse slightly rapid. Continue with benefiting Lung and clearing resolution. Prescription: Ye Baihe 12g, Sheng Dihuang 12g, Yiren (Coix Seed) 12g, Beishashen 9g, Donggua Zi (Winter Melon Seed) 12g, Dangshen 9g, Baizhu 9g, Baimaogen 24g, Fuling 12g, Tian Maidong each 9g, Zhuye Juanxin 9g, 3 doses. December 24
(Third visit): Urine already clear, restless sleep, pulse fine and rapid, thick coating seen at root, bitter taste. Continue with疏清 (dispersing and clearing). Prescription: Chaihu (Bupleurum Root) 4.5g, Ye Baihe 12g, Sheng Dihuang 12g, Baimaogen 24g, Jiao Zaoren (Jujube Seed Stir-fried) 9g, Baizi Ren (Biota Seed) 9g, Shenqu (Medicated Leaven) 9g, Huoxiang (Patchouli Herb) 6g, Peilan (Agastache Herb) 9g, Tian Maidong each 9g, Zhuye Juanxin 9g, 4 doses.