（何任：热病余邪，《新中医》4：22f1979）
例七董XX，女，56岁，病历号：121351。因咳嗽三月，气短、心悸加重，于12月28日急诊入院。患者二十余年来，经常咳嗽气喘，近五、六年来，发作频繁，甚则卧床不起，入院前三天更加重，咳嗽气急。吐白色泡沫痰，不能平卧，夜间阵发性咳嗽日渐加重，食欲减退，上腹部胀满，口渴不欲饮。经西医全面检查，诊断为高血压性心脏病，皿度心力衰竭，甲状腺腺瘤，双侧胸腔积液。脉细数无力，舌苔薄白，质淡。辨证：阳虚水逆，上凌心肺，心阳不振，肾不纳气，肺气不宣。治法：温阳行水。养心宣肺，壮元阳，消阴翳，逐留垢，降水逆。一74——方药：真武、越婢、生脉加减。黑附片9克杭芍12克生姜9克大枣
（擘）6枚党参18克麦冬12克五味子6克鲜白茅根60克主石膏15克麻黄4．5克甘草9克云苓15克白术9克配以氧气吸入，上方服2剂后，喘咳气短悉减，睡眠好转，夜间阵发性呼吸困难减轻，但仍胸胁满闷，前方加活血理气镇摄之品：苏木12克，枳壳6克，龙牡各15克。入院19天已不喘，活动如常，一般情况较好，仍有胃院作胀，头痛，心下痞硬，改用通阳宣痹，利湿化痰之品。方药：全瓜萎30克薤白12克半夏12克云苓12克陈皮9克积实6克竹茹12克丹参12克杜仲12克桑寄生30克牛膝1T克后因感冒经治而愈，经西医检查肝大回缩至肋下2厘米，心率75次／分，律齐，心衰已控制，出院疗养。巛赵锡武医疗经验》）
例八张xx，男，54岁，病历号：107392。咳喘已五年，近两周来咳嗽气短不能平卧而入院。五年前诊为肺原性心脏病心力衰竭，经用中西药后心力衰竭控制。本次入院系因感冒咳喘发作。痰多粘稠，肢肿尿少，心下痞满，腹胀不适而急诊入院。经检查诊为慢性气管炎、阻塞性肺气肿、慢性肺原性心脏病，心力衰竭皿度。唇紫，苔自腻，脉弦滑而数。辨证：心肾阳虚，痰湿阻滞。治法：温阳利水，蠲饮化湿。方药：消水圣愈汤。桂枝9克甘草9克麻黄4．5克黑附片9克知母9克防己12克生姜9克杏仁9克大枣
（擘）6枚一75一服药后尿量增多，每日达1500毫升以上，最多达3300毫升，水肿渐消，咳喘吐痰减轻。住院第十三天时，水肿显著消退，腹水征转阴性，仅小腿微肿。改用益气养心，清肺化痰之剂。方药：党参15克麦冬12克五味子6克杏仁9克甘草9克生石膏9克麻黄15克小麦30克远志a克茯苓12克3剂后，咳喘虽减，但尿量显著减少，浮肿大显，又继用消水圣愈汤并加茯苔3O审．车前子（包）30克，尿量明显增多而浮肿消退，咳喘亦减，精神食欲均好，心率84次/分，临床表明心衰已控制。巛赵锡武医疗经验｝））
例九游xx，男，24岁。病历号：124832三年来心悸气短，近七个月来症状尤甚，1964年4月29日入院。于1960年查体时发现风湿性心脏病，当时无自觉不适，重体力劳动后稍觉心悸，未曾治疗。1964年以来渐觉纳差，院腹胀满，活动后心悸气短明显，同时出现下肢浮肿。经治疗病情仍有反复发作，近因病情加重而来治疗。唇紫，巩膜黄染，结合膜充血，经西医检查诊断为风湿性心脏病，二尖瓣狭窄关闭不全，心房颤动，心原性肝硬化，心力衰竭Ⅱ度，舌质暗红，面色黛黑少华，脉结代。辨证：心肾阳衰，兼见血瘀。治法：温肾助阳，佐以化瘀。方药：附子9克杭芍30克云苓18克白术15克生姜。9克肉桂6克（后下）沉香6克（后下）当归12克红花12克自茅根30克藕节10枚一76一上药服5剂后，症状改善，尿量由300～500毫升／日，增到1300～1700毫升／日。心衰情况明显好转，一般情况尚佳，活动后未见明显心悸，无咳喘，能平卧，腹水征（-），浮肿消失，肝回缩，说明本次心衰得以控制。心电图检查：心房纤颤仍有，出院后继续观察。巛赵锡武医疗经验［评按］痰饮是体内水液代谢病理性产物，又是水液内停不得输化的病证，且有广义狭义之分。广义的痰饮是诸饮的总称，狭义者是其中类型之一。由于水饮停积的部位不同，又分为痰饮、悬饮、溢饮、支饮等。散在于胃肠者为痰饮；饮流胁下者为悬饮；淫溢四肢肌肉者为溢饮；支撑胸肺者为支饮。《医宗金鉴·卷二十一》认为：溢饮者，“即今之风水、水肿病也”；关于支饮，陈修园将之与“隔上伏饮”的哮喘视为同一类病证。所以有当参见哮喘、水气病。而痰病的范围更为广泛，故应参见有关病证的论述。
例一证属暴寒外束，痰饮内聚。治以疏解外邪，温化痰饮之法。盖脾为生痰之源，肺为贮痰之器，续以理脾肃肺、温化痰饮而善其后，证治得当。
例二为风寒痰饮内外搏结，小青龙汤当为主方。若善于加减，其效倍捷。此案以小青龙汤合瓜萎、薤白、细辛、滑石，加强涤痰蠲饮之功，效如桴应。
例三证属脾肾阳虚，痰饮上泛。《明医杂著》称“痰之本，水也，原于肾；痰之动，湿也，主于脾”。脾阳既虚，肾阳亦衰，肾气失纳，肾虚水泛，立方不用金匿肾气之类，恐其腻补碍邪，仍以青龙化裁。方中二陈理脾化湿，炮姜温中，五味敛肺，细辛温肾行水，沉香、二石镇逆纳气，其效不凡。
例四诊为慢性肺心病。症见咳嗽气短，浮肿、痞满尿少、痰白、唇紫。病属心肾阳虚，水饮内停，痰湿阻遏，肺气壅塞，用越婢合真武汤加减，重在温阳利湿，宣肺行水，故药后尿量大增，浮肿明显消退，续以宽胸理气清肺之法，重在降气化痰。前人所谓“积水成饮，饮凝成痰”。饮易行而痰难化，此案洽疗步骤，掌握先易后难，是切合本病病理特点的。
例五、六为悬饮。饮在胁，咳吐引痛，心下痞硬，发热汗出，苔白，脉沉或弦为其主证。
例五西医诊为渗出性胸膜炎，证系饮邪积于胸胁之间，舍十枣汤而以疏风宣肺攻逐水饮为法，方中加用控涎丹（十枣汤去完花、大枣，加白芥子，并改为丸剂）。舍其方而师其法，效其方而缓其势，然而祛痰逐饮之功犹佳。
例六原案以渗出性胸膜炎命题，属于中医悬饮范围。此案的特点是病势已退而余邪未尽，何氏治以养阴、益肺、清解，邪正兼顾，可供临证借鉴。西医所谓心力衰竭与中医痰饮病、水气病的某些证型相似。赵氏单纯使用中药控制心衰，法方明晰，疗效显著，颇有心得。
例七证属心阳不振，阳虚水逆，上凌心肺，肺气不宣，选用真武汤为主，佐以“开鬼门”法，亦即宣肺、透表，使肺气得宣，营卫因和，以求“上焦得通，戢然汗出”，重点在于治肺。
例八证属心肾阳虚，痰湿阻滞，治以温阳利水，亦即“洁净府”法，旨在行水利尿，使之水行肿消，重点在于治肾，方用消水圣愈汤（桂枝汤去芍药，加麻黄附子细辛汤、知母，亦可酌用防己等）。
例九证属心肾阳虚兼有血瘀，故用真武汤合“去菀陈坐”法。盖因日久为陈，淤积为菀，腐浊为坐，所谓“去菀陈坐”者，此处系指散瘕通络，活血化瘀之意。概言之，赵氏治疗心衰，即以真武汤强心扶阳为主，配合治水三法（即开鬼门、洁净府、去菀陈坐），实属得其要领。
（七）肺痈
例一冯姓，男，59岁。病历二月，初患咳嗽，胸际不畅，未以为意。近日咳嗽加剧，且有微喘，痰浊而多，味臭，有时带血，胸肋震痛，稍见寒热，眠食不佳。小便深黄，大便干燥，脉滑数。此症系因胰理不密，风寒外乘，不得发越，停留于肺。蕴热成痈。治应排脓为主，不论已成未成。皆当涤荡痰垢，无使壅塞，则余症易愈也。鲜苇茅根各24克生薏仁18克旋覆花6克（代赭石12克布包）冬瓜子18克桃杏仁各6克（炒研）苦桔梗6克粉甘草4．5克仙鹤草18克（炒）西洋参4．5克桑白地骨皮各6克陈橘红络各4．5克M诊：服药3剂，寒热退，喘止，咳轻，痰减仍臭，已不带血，眠食略佳，二便正常，尚觉气短身倦，胸闷，原法加减。鲜茅苇根各24克生薏仁18克瓜萎18克（薤白9克同打）旋覆花6克（代赭石12克布包）炙白前百部各4．5克炙紫菀、化橘红各4＿5克枇粑叶6克（半夏曲9克布包）苦桔梗6克西洋参4．5克冬瓜子（打）24克桃杏仁（炒研）各6克粉甘草4．5克三诊：服药3剂，诸症均轻，唯仍觉气短身倦，眠食未能如常，此乃病邪乍退，正气未复之故，随症论治，若能兼助体工，保养肺气，疗效不难预期也。西洋参6克北沙参（米炒）12克漂白术6克粉甘草4．5克化橘红4．5克枇粑叶6克（半夏曲9克布包）苦桔梗6克炒枳壳4．5克云茯苓神各9克冬虫草9克另用三七、白芨各3克，研细分二次随药服送。(施稚墨等整理：施今墨医案，《中医杂志》5c328，”58)
例二项XX，男，21岁。住院号75／1004,初诊日期：1975年3月4日。昨起发热39．3℃，咳嗽痰粘，不易咯出，今身热灼手，汗出浸衣，咳引右胸疼痛，咯黄脓腥臭痰。胸片：右上叶后段肺脓疡，空洞液平形成。血化验：白细胞总数19000／立方毫米，中性83％，苔薄黄，脉细数。辨证：风温外受，湿热内蕴，熏蒸太阴，热毒伤肺，清肃无权，热壅血瘀，蕴酿成痈。治法：清热解毒而化痰瘀。方药：麻杏石甘汤合千金苇茎汤：炙麻黄6克杏仁9克生石膏30克米仁30克桔梗6克甘草6克红藤30克鱼腥草18克芦根1支桃仁12克冬瓜子12克开金锁30克3月10日(二诊)，上方加减服六剂，身热净退(37℃)，咳嗽痰多，呈脓血状，但腥臭味已减，颇易咯出，胸闷不痛，口干，舌边红，苔薄黄，脉小滑。胸片：右上肺脓疡较前已见吸收，左下支气管扩张。血化验：白细胞总数：14700／立方毫米，中性75％。热毒壅蒸肺脏，血败肉腐疡溃，幸热毒鸱张之势渐平，脓毒亦有出路之机，拟清热解毒排脓，方以千金苇茎汤合犀(牛)黄醒消丸等复方图治。银花18克连翘18克芦根1支桃仁6克冬瓜子18克米仁30克鱼腥草30克红藤30克败酱草30克开金锁30克牛黄醒消丸4．5克(分吞)本方略行加减，服23剂。4月2日
（三诊)．咳嗽减少，痰粘带血胸闷等症亦除，精神转佳。胸片示：右上肺脓疡已吸收，左下支气管扩张。血化验：白细胞总数7500／立方毫米，中性60％，脉小弦，苔薄黄质红。余热恋肺日清，肺络损伤渐复，今宜制小其剂而清化痰热。银花9克连翘9克芦根1支米仁15克冬瓜子12克红藤30克败酱草30克鱼腥草30克开金锁30克黛蛤散12克(包)5剂。4月7日(四诊)：咳嗽十减七、八，痰少有时呈淡红色，纳食二便均佳，舌边红，苔薄，脉细。热毒已清，肺阴未复，再拟养阴化痰，以善其后。北沙参12克麦冬9克甜杏仁9克桑叶皮各9克茯苓9克蛤粉炒阿胶9克山药12克白芨9克川贝粉4．5克枇杷叶12克茜草根12克7剂。(《张伯臾医案》)[评按]肺痈系指肺部脓疡，且以咳则胸痛，吐痰腥臭，甚则咳吐脓血为主证。多因肺热不解，血凝不通，热盛肉腐而成脓疡。正如《金匮要略·肺痿肺痈咳嗽上气病脉证治》所云：“风伤皮毛，热伤血脉，风舍于肺，……热之所过，血为凝滞，蓄结痈脓。”
例一病历二月，稍见寒热，时值成脓期或溃脓期，故以排脓为主。仍以千金苇茎汤为主方，加用泄肺化痰、降气排脓之剂。另加西洋参益气养阴、保肺托毒，侧重于祛邪排脓，稍佐扶正之晶，效果倍增，周后病邪已退，续以保养肺气，不难预期而愈。
例二发病急，病程短，证属肺痈初期，因其毒热壅盛，故用清热解毒、化痰祛瘀法。方中红藤、败酱草原为治肠痈之要药，另加鱼腥草、开金锁等均有清热解毒消内痈之良效。张氏体会：“肺厢是热毒，演变常迅速，关键在排脓，痊愈亦较速”。堪称经验之谈。(八)肺痨
例一刘XX，女，23岁，初诊日期；1953年12月6日。据述西医检查，有肺结核为患。但自身不觉疲乏，亦无咳嗽，但上楼气有作喘之势，系肺有病征。经水以前尚充，近半年来量日见少，色亦不正，惟工作不感困倦，仅腹中作痛，此乃肝脾不调所致。法当从此消息，宁肺调肝肾为治。小心将护，不宜过劳，以期服药有效。北沙参12克南白前6克大百合“克净百部9克全当归12克川芎片9克干生地15克赤芍药12克真阿胶9克(研后下)甘枸杞9克陈艾叶6克酒炒元胡索9克灵磁石15克(先煎)生甘草6克12月13日(--诊)；服前方三剂，惟觉肺部发胀，他无昕苦。仍当宁肺舒气为治，小心将护，勿过劳累为要。空沙参12克苦桔梗9克苦杏仁9克佛手片9克黄郁金6克大百合12克净百部6克制乳没各6克当归身12克生白芍15克延胡索9克蕲艾梗6克真阿胶6克(研后下)干藕节5枚服七剂后3诊，于前方内加嫩白前6克，生芪皮12克，川芎片6克，陈艾梗并增至9克。再七剂后四诊，肺已不胀，前方加天花粉12克。(张绍重整理：萧龙友医案，《中医杂志》2：115，1958)
（何任：热病余邪，《新中医》4：22f1979）
病例七 董XX，女，56岁，病历号：121351。因咳嗽三个月，气短、心悸加重，于12月28日急诊入院。患者二十余年来，经常咳嗽气喘，近五、六年来，发作频繁，甚至卧床不起，入院前三天更加重，咳嗽气急。吐白色泡沫痰，不能平卧，夜间阵发性咳嗽日渐加重，食欲减退，上腹部胀满，口渴但不想喝水。经西医全面检查，诊断为高血压性心脏病，Ⅲ度心力衰竭，甲状腺腺瘤，双侧胸腔积液。脉细数无力，舌苔薄白，舌质淡。辨证：阳虚水逆，上凌心肺，心阳不振，肾不纳气，肺气不宣。治法：温阳行水，养心宣肺，壮元阳，消阴翳，逐留垢，降水逆。方药：真武汤、越婢汤加减。黑附片9克，杭芍12克，生姜9克，大枣（掰开）6枚，党参18克，麦冬12克，五味子6克，鲜白茅根60克，生石膏15克，麻黄4.5克，甘草9克，云苓15克，白术9克。配以氧气吸入。上方服2剂后，喘咳气短悉减，睡眠好转，夜间阵发性呼吸困难减轻，但仍胸胁满闷，前方加活血理气镇摄之品：苏木12克，枳壳6克，龙牡各15克。入院19天已不喘，活动如常，一般情况较好，仍有胃脘作胀，头痛，心下痞硬，改用通阳宣痹，利湿化痰之品。方药：全瓜蒌30克，薤白12克，半夏12克，云苓12克，陈皮9克，枳实6克，竹茹12克，丹参12克，杜仲12克，桑寄生30克，牛膝15克。后因感冒经治而愈，经西医检查肝大回缩至肋下2厘米，心率75次/分，律齐，心衰已控制，出院疗养。（《赵锡武医疗经验》）
病例八 张XX，男，54岁，病历号：107392。咳喘已五年，近两周来咳嗽气短不能平卧而入院。五年前诊为肺原性心脏病心力衰竭，经用中西药后心力衰竭控制。本次入院系因感冒咳喘发作。痰多粘稠，肢肿尿少，心下痞满，腹胀不适而急诊入院。经检查诊为慢性气管炎、阻塞性肺气肿、慢性肺原性心脏病，心力衰竭Ⅲ度。唇紫，苔白腻，脉弦滑而数。辨证：心肾阳虚，痰湿阻滞。治法：温阳利水，蠲饮化湿。方药：消水圣愈汤。桂枝9克，甘草9克，麻黄4.5克，黑附片9克，知母9克，防己12克，生姜9克，杏仁9克，大枣（掰开）6枚。服药后尿量增多，每日达1500毫升以上，最多达3300毫升，水肿渐消，咳喘吐痰减轻。住院第十三天时，水肿显著消退，腹水征转阴性，仅小腿微肿。改用益气养心，清肺化痰之剂。方药：党参15克，麦冬12克，五味子6克，杏仁9克，甘草9克，生石膏9克，麻黄15克，小麦30克，远志6克，茯苓12克。3剂后，咳喘虽减，但尿量显著减少，浮肿大显，又继用消水圣愈汤并加茯神30克，车前子（包）30克，尿量明显增多而浮肿消退，咳喘亦减，精神食欲均好，心率84次/分，临床表明心衰已控制。（《赵锡武医疗经验》）
病例九 游XX，男，24岁。病历号：124832。三年来心悸气短，近七个月来症状尤甚，1964年4月29日入院。于1960年查体时发现风湿性心脏病，当时无自觉不适，重体力劳动后稍觉心悸，未曾治疗。1964年以来渐觉纳差，胃腹胀满，活动后心悸气短明显，同时出现下肢浮肿。经治疗病情仍有反复发作，近因病情加重而来治疗。唇紫，巩膜黄染，结合膜充血，经西医检查诊断为风湿性心脏病，二尖瓣狭窄关闭不全，心房颤动，心原性肝硬化，心力衰竭Ⅱ度，舌质暗红，面色黛黑少华，脉结代。辨证：心肾阳衰，兼见血瘀。治法：温肾助阳，佐以化瘀。方药：附子9克，杭芍30克，云苓18克，白术15克，生姜9克，肉桂6克（后下），沉香6克（后下），当归12克，红花12克，白茅根30克，藕节10枚。上药服5剂后，症状改善，尿量由300～500毫升/日，增到1300～1700毫升/日。心衰情况明显好转，一般情况尚佳，活动后未见明显心悸，无咳喘，能平卧，腹水征（-），浮肿消失，肝回缩，说明本次心衰得以控制。心电图检查：心房纤颤仍有，出院后继续观察。（《赵锡武医疗经验》）
[评按] 痰饮是体内水液代谢病理性产物，又是水液内停不得输化的病证，且有广义狭义之分。广义的痰饮是诸饮的总称，狭义者是其中类型之一。由于水饮停积的部位不同，又分为痰饮、悬饮、溢饮、支饮等。散在于胃肠者为痰饮；饮流胁下者为悬饮；淫溢四肢肌肉者为溢饮；支撑胸肺者为支饮。《医宗金鉴·卷二十一》认为：溢饮者，“即今之风水、水肿病也”；关于支饮，陈修园将之与“隔上伏饮”的哮喘视为同一类病证。所以有当参见哮喘、水气病。而痰病的范围更为广泛，故应参见有关病证的论述。
病例一 证属暴寒外束，痰饮内聚。治以疏解外邪，温化痰饮之法。盖脾为生痰之源，肺为贮痰之器，续以理脾肃肺、温化痰饮而善其后，证治得当。
病例二 为风寒痰饮内外搏结，小青龙汤当为主方。若善于加减，其效倍捷。此案以小青龙汤合瓜萎、薤白、细辛、滑石，加强涤痰蠲饮之功，效如桴应。
病例三 证属脾肾阳虚，痰饮上泛。《明医杂著》称“痰之本，水也，原于肾；痰之动，湿也，主于脾”。脾阳既虚，肾阳亦衰，肾气失纳，肾虚水泛，立方不用金匿肾气之类，恐其腻补碍邪，仍以青龙化裁。方中二陈理脾化湿，炮姜温中，五味敛肺，细辛温肾行水，沉香、二石镇逆纳气，其效不凡。
病例四 诊为慢性肺心病。症见咳嗽气短，浮肿、痞满尿少、痰白、唇紫。病属心肾阳虚，水饮内停，痰湿阻遏，肺气壅塞，用越婢合真武汤加减，重在温阳利湿，宣肺行水，故药后尿量大增，浮肿明显消退，续以宽胸理气清肺之法，重在降气化痰。前人所谓“积水成饮，饮凝成痰”。饮易行而痰难化，此案洽疗步骤，掌握先易后难，是切合本病病理特点的。
病例五、六 为悬饮。饮在胁，咳吐引痛，心下痞硬，发热汗出，苔白，脉沉或弦为其主证。
病例五 西医诊为渗出性胸膜炎，证系饮邪积于胸胁之间，舍十枣汤而以疏风宣肺攻逐水饮为法，方中加用控涎丹（十枣汤去芫花、大枣，加白芥子，并改为丸剂）。舍其方而师其法，效其方而缓其势，然而祛痰逐饮之功犹佳。
病例六 原案以渗出性胸膜炎命题，属于中医悬饮范围。此案的特点是病势已退而余邪未尽，何氏治以养阴、益肺、清解，邪正兼顾，可供临证借鉴。西医所谓心力衰竭与中医痰饮病、水气病的某些证型相似。赵氏单纯使用中药控制心衰，法方明晰，疗效显著，颇有心得。
病例七 证属心阳不振，阳虚水逆，上凌心肺，肺气不宣，选用真武汤为主，佐以“开鬼门”法，亦即宣肺、透表，使肺气得宣，营卫因和，以求“上焦得通，戢然汗出”，重点在于治肺。
病例八 证属心肾阳虚，痰湿阻滞，治以温阳利水，亦即“洁净府”法，旨在行水利尿，使之水行肿消，重点在于治肾，方用消水圣愈汤（桂枝汤去芍药，加麻黄附子细辛汤、知母，亦可酌用防己等）。
病例九 证属心肾阳虚兼有血瘀，故用真武汤合“去菀陈莝”法。盖因日久为陈，淤积为菀，腐浊为莝，所谓“去菀陈莝”者，此处系指散瘕通络，活血化瘀之意。概言之，赵氏治疗心衰，即以真武汤强心扶阳为主，配合治水三法（即开鬼门、洁净府、去菀陈莝），实属得其要领。
（七）肺痈
病例一 冯姓，男，59岁。病历二月，初患咳嗽，胸际不畅，未以为意。近日咳嗽加剧，且有微喘，痰浊而多，味臭，有时带血，胸肋震痛，稍见寒热，眠食不佳。小便深黄，大便干燥，脉滑数。此症系因腠理不密，风寒外乘，不得发越，停留于肺。蕴热成痈。治应排脓为主，不论已成未成。皆当涤荡痰垢，无使壅塞，则余症易愈也。鲜苇茅根各24克，生薏仁18克，旋覆花6克（代赭石12克布包），冬瓜子18克，桃杏仁各6克（炒研），苦桔梗6克，粉甘草4.5克，仙鹤草18克（炒），西洋参4.5克，桑白地骨皮各6克，陈橘红络各4.5克。一诊：服药3剂，寒热退，喘止，咳轻，痰减仍臭，已不带血，眠食略佳，二便正常，尚觉气短身倦，胸闷，原法加减。鲜茅苇根各24克，生薏仁18克，瓜蒌18克（薤白9克同打），旋覆花6克（代赭石12克布包），炙白前百部各4.5克，炙紫菀、化橘红各4.5克，枇杷叶6克（半夏曲9克布包），苦桔梗6克，西洋参4.5克，冬瓜子（打）24克，桃杏仁（炒研）各6克，粉甘草4.5克。三诊：服药3剂，诸症均轻，唯仍觉气短身倦，眠食未能如常，此乃病邪乍退，正气未复之故，随症论治，若能兼助体工，保养肺气，疗效不难预期也。西洋参6克，北沙参（米炒）12克，漂白术6克，粉甘草4.5克，化橘红4.5克，枇杷叶6克（半夏曲9克布包），苦桔梗6克，炒枳壳4.5克，云茯苓神各9克，冬虫草9克。另用三七、白芨各3克，研细分二次随药服送。（施稚墨等整理：施今墨医案，《中医杂志》5:328，1958）
病例二 项XX，男，21岁。住院号75／1004,初诊日期：1975年3月4日。昨起发热39.3℃，咳嗽痰粘，不易咯出，今身热灼手，汗出浸衣，咳引右胸疼痛，咯黄脓腥臭痰。胸片：右上叶后段肺脓疡，空洞液平形成。血化验：白细胞总数19000／立方毫米，中性83％，苔薄黄，脉细数。辨证：风温外受，湿热内蕴，熏蒸太阴，热毒伤肺，清肃无权，热壅血瘀，蕴酿成痈。治法：清热解毒而化痰瘀。方药：麻杏石甘汤合千金苇茎汤：炙麻黄6克，杏仁9克，生石膏30克，米仁30克，桔梗6克，甘草6克，红藤30克，鱼腥草18克，芦根1支，桃仁12克，冬瓜子12克，开金锁30克。3月10日(二诊)，上方加减服六剂，身热净退(37℃)，咳嗽痰多，呈脓血状，但腥臭味已减，颇易咯出，胸闷不痛，口干，舌边红，苔薄黄，脉小滑。胸片：右上肺脓疡较前已见吸收，左下支气管扩张。血化验：白细胞总数：14700／立方毫米，中性75％。热毒壅蒸肺脏，血败肉腐疡溃，幸热毒鸱张之势渐平，脓毒亦有出路之机，拟清热解毒排脓，方以千金苇茎汤合犀(牛)黄醒消丸等复方图治。银花18克，连翘18克，芦根1支，桃仁6克，冬瓜子18克，米仁30克，鱼腥草30克，红藤30克，败酱草30克，开金锁30克，牛黄醒消丸4.5克(分吞)。本方略行加减，服23剂。4月2日（三诊)．咳嗽减少，痰粘带血胸闷等症亦除，精神转佳。胸片示：右上肺脓疡已吸收，左下支气管扩张。血化验：白细胞总数7500／立方毫米，中性60％，脉小弦，苔薄黄质红。余热恋肺日清，肺络损伤渐复，今宜制小其剂而清化痰热。银花9克，连翘9克，芦根1支，米仁15克，冬瓜子12克，红藤30克，败酱草30克，鱼腥草30克，开金锁30克，黛蛤散12克(包)5剂。4月7日(四诊)：咳嗽十减七、八，痰少有时呈淡红色，纳食二便均佳，舌边红，苔薄，脉细。热毒已清，肺阴未复，再拟养阴化痰，以善其后。北沙参12克，麦冬9克，甜杏仁9克，桑叶皮各9克，茯苓9克，蛤粉炒阿胶9克，山药12克，白芨9克，川贝粉4.5克，枇杷叶12克，茜草根12克，7剂。(《张伯臾医案》)[评按]肺痈系指肺部脓疡，且以咳则胸痛，吐痰腥臭，甚则咳吐脓血为主证。多因肺热不解，血凝不通，热盛肉腐而成脓疡。正如《金匮要略·肺痿肺痈咳嗽上气病脉证治》所云：“风伤皮毛，热伤血脉，风舍于肺，……热之所过，血为凝滞，蓄结痈脓。”
病例一 病历二月，稍见寒热，时值成脓期或溃脓期，故以排脓为主。仍以千金苇茎汤为主方，加用泄肺化痰、降气排脓之剂。另加西洋参益气养阴、保肺托毒，侧重于祛邪排脓，稍佐扶正之晶，效果倍增，周后病邪已退，续以保养肺气，不难预期而愈。
病例二 发病急，病程短，证属肺痈初期，因其毒热壅盛，故用清热解毒、化痰祛瘀法。方中红藤、败酱草原为治肠痈之要药，另加鱼腥草、开金锁等均有清热解毒消内痈之良效。张氏体会：“肺厢是热毒，演变常迅速，关键在排脓，痊愈亦较速”。堪称经验之谈。
（八）肺痨
病例一 刘XX，女，23岁，初诊日期；1953年12月6日。据述西医检查，有肺结核为患。但自身不觉疲乏，亦无咳嗽，但上楼气有作喘之势，系肺有病征。经水以前尚充，近半年来量日见少，色亦不正，惟工作不感困倦，仅腹中作痛，此乃肝脾不调所致。法当从此消息，宁肺调肝肾为治。小心将护，不宜过劳，以期服药有效。北沙参12克，南白前6克，大百合12克，净百部9克，全当归12克，川芎片9克，干生地15克，赤芍药12克，真阿胶9克(研后下)，甘枸杞9克，陈艾叶6克，酒炒元胡索9克，灵磁石15克(先煎)，生甘草6克。12月13日(--诊)；服前方三剂，惟觉肺部发胀，他无所苦。仍当宁肺舒气为治，小心将护，勿过劳累为要。空沙参12克，苦桔梗9克，苦杏仁9克，佛手片9克，黄郁金6克，大百合12克，净百部6克制乳没各6克，当归身12克，生白芍15克，延胡索9克，蕲艾梗6克，真阿胶6克(研后下)，干藕节5枚。服七剂后3诊，于前方内加嫩白前6克，生芪皮12克，川芎片6克，陈艾梗并增至9克。再七剂后四诊，肺已不胀，前方加天花粉12克。(张绍重整理：萧龙友医案，《中医杂志》2：115，1958)
(He Ren: Residual Pathogenic Heat after Febrile Disease, *New Chinese Medicine* 4:22f1979)
Case 7: Dong XX, female, 56 years old, Medical Record No.: 121351. Admitted to the emergency department on December 28 due to cough for three months, with aggravated shortness of breath and palpitations. For over twenty years, the patient has frequently suffered from cough and asthma. In the past five to six years, attacks have become frequent, severe enough to keep her bedridden. Three days before admission, symptoms worsened significantly with cough and急促 breathing (asthmatic dyspnea). She expectorated white frothy sputum, could not lie flat, and experienced progressively worsening paroxysmal nocturnal cough. Appetite decreased, epigastric fullness occurred, and she felt thirsty but had no desire to drink. Comprehensive Western medical examination diagnosed hypertensive heart disease, Grade III heart failure, thyroid adenoma, and bilateral pleural effusion. Pulse was fine, rapid, and weak; tongue coating was thin and white; tongue body was pale. Syndrome differentiation: Yang deficiency with water counterflow, attacking the heart and lungs; heart Yang failing to振奋 (stimulate); kidney failing to grasp Qi; lung Qi failing to diffuse. Treatment method: Warm Yang and promote water metabolism, nourish the heart and diffuse lung Qi, strengthen primal Yang, eliminate Yin shadows, expel retained turbidity, and subdue water counterflow. Prescription: Zhenwu Tang (True Warrior Decoction) and Yebip Tang (Yi Pi Decoction) modified. Heifupian (Aconiti Lateralis Radix Praeparata) 9g, Hangshao (Paeoniae Radix Alba) 12g, Shengjiang (Zingiberis Rhizoma Recens) 9g, Dazao (Jujubae Fructus) 6 pieces (torn), Dangshen (Codonopsis Radix) 18g, Maidong (Ophiopogonis Radix) 12g, Wuweizi (Schisandrae Fructus) 6g, Xianbaigemgen (Imperatae Rhizoma Fresh) 60g, Shengshigao (Gypsum Fibrosum) 15g, Mahuang (Ephedrae Herba) 4.5g, Gancao (Glycyrrhizae Radix et Rhizoma) 9g, Yunling (Poria) 15g, Baizhu (Atractylodis Macrocephalae Rhizoma) 9g. Combined with oxygen inhalation. After taking two doses of the above prescription, wheezing, cough, shortness of breath, and fatigue all decreased significantly; sleep improved; paroxysmal nocturnal dyspnea lessened. However, chest and hypochondriac fullness persisted. Blood-activating, Qi-regulating, and calming agents were added to the previous formula: Sumu (Sappan Lignum) 12g, Zhike (Aurantii Fructus Immaturus) 6g, Longgu (Fossilia Ossis Mastodi) and Muli (Concha Ostreae) 15g each. Nineteen days after admission, wheezing ceased, activity returned to normal, general condition was good, but epigastric distension, headache, and subcardiac hardness remained. The treatment was changed to unblocking Yang, diffusing obstruction, promoting dampness resolution, and transforming phlegm. Prescription: Quanguawa (Trichosanthis Fructus) 30g, Xiebai (Allii Macrostemonis Bulbus) 12g, Banxia (Pinelliae Rhizoma) 12g, Yunling (Poria) 12g, Chenpi (Citri Reticulatae Pericarpium) 9g, Zhishi (Aurantii Fructus Immaturus) 6g, Zhuru (Bambusae Caulis in Taeniam) 12g, Danshen (Salviae Miltiorrhizae Radix et Rhizoma) 12g, Duzhong (Eucommiae Cortex) 12g, Sangjisheng (Taxilli Herba) 30g, Niuxi (Achyranthis Bidentatae Radix) 15g. Later, cured through treatment for a cold. Western medical examination showed liver enlargement retracted to 2 cm below the costal margin, heart rate 75 beats/min, regular rhythm, heart failure controlled. Discharged for recuperation. (*Zhao Xiwu's Medical Experience*)
Case 8: Zhang XX, male, 54 years old, Medical Record No.: 107392. Cough and asthma for five years; admitted due to inability to lie flat with cough and shortness of breath for the past two weeks. Diagnosed with cor pulmonale and heart failure five years ago, controlled by Chinese and Western medicines. This admission was triggered by a cold causing exacerbation of cough and asthma. Expectorated abundant, sticky sputum; limb edema, oliguria, subcardiac fullness, abdominal distension and discomfort led to emergency admission. Examination diagnosed chronic bronchitis, obstructive emphysema, chronic cor pulmonale, and Grade III heart failure. Lips purple, tongue coating white and greasy, pulse string-slippery and rapid. Syndrome differentiation: Heart and Kidney Yang deficiency, phlegm-dampness obstruction. Treatment method: Warm Yang and promote diuresis, dispel fluid retention and resolve dampness. Prescription: Xiaoshui Shengyu Tang (Water-Dispelling Holy Increase Decoction). Guizhi (Cinnamomi Ramulus) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 9g, Mahuang (Ephedrae Herba) 4.5g, Heifupian (Aconiti Lateralis Radix Praeparata) 9g, Zhimu (Anemarrhenae Rhizoma) 9g, Fangji (Stephaniae Tetrandrae Radix) 12g, Shengjiang (Zingiberis Rhizoma Recens) 9g, Xingren (Armeniacae Semen Amarum) 9g, Dazao (Jujubae Fructus) 6 pieces (torn). After medication, urine output increased, reaching over 1500 ml/day, max 3300 ml/day; edema gradually subsided; cough, asthma, and sputum production decreased. On the 13th day of hospitalization, edema significantly resolved, ascites sign turned negative, only slight swelling in lower legs. Changed to Qi-tonifying, heart-nourishing, lung-clearing, and phlegm-transforming agent. Prescription: Dangshen (Codonopsis Radix) 15g, Maidong (Ophiopogonis Radix) 12g, Wuweizi (Schisandrae Fructus) 6g, Xingren (Armeniacae Semen Amarum) 9g, Gancao (Glycyrrhizae Radix et Rhizoma) 9g, Shengshigao (Gypsum Fibrosum) 9g, Mahuang (Ephedrae Herba) 15g, Xiaomai (Tritici Fructus) 30g, Yuanzhi (Polygalae Radix) 6g, Fuling (Poria) 12g. After 3 doses, although cough and asthma decreased, urine output significantly reduced, generalized edema became prominent. Continued using Xiaoshui Shengyu Tang and added Fushen (Poria cum Radix) 30g, Cheqianzi (Plantaginis Semen) 30g (wrapped). Urine output markedly increased, edema resolved, cough and asthma decreased, spirit and appetite improved, heart rate 84 beats/min. Clinically indicated heart failure controlled. (*Zhao Xiwu's Medical Experience*)
Case 9: You XX, male, 24 years old. Medical Record No.: 124832. Palpitations and shortness of breath for three years, symptoms particularly severe for the past seven months. Admitted on April 29, 1964. Rheumatic heart disease discovered during physical examination in 1960; initially asymptomatic, slight palpitations after heavy labor, untreated. Since 1964, gradual loss of appetite, gastric and abdominal distension, obvious palpitations and shortness of breath after activity, accompanied by lower limb edema. Condition recurred despite treatment; sought treatment due to recent aggravation. Lips purple, scleral icterus, conjunctival congestion. Western diagnosis: rheumatic heart disease, mitral stenosis and insufficiency, atrial fibrillation, cardiac cirrhosis, Grade II heart failure. Tongue body dark red, complexion dark and lusterless, pulse knotted and intermittent. Syndrome differentiation: Heart and Kidney Yang collapse, accompanied by blood stasis. Treatment method: Warm Kidney and assist Yang, assisted by resolving stasis. Prescription: Fuzi (Aconiti Lateralis Radix Praeparata) 9g, Hangshao (Paeoniae Radix Alba) 30g, Yunling (Poria) 18g, Baizhu (Atractylodis Macrocephalae Rhizoma) 15g, Shengjiang (Zingiberis Rhizoma Recens) 9g, Rougui (Cinnamomi Cortex) 6g (added later), Chenxiang (Aquilariae Lignum Resinatum) 6g (added later), Danggui (Angelicae Sinensis Radix) 12g, Honghua (Carthami Flos) 12g, Baigemgen (Imperatae Rhizoma) 30g, Oujie (Nelumbinis Node) 10 pieces. After taking 5 doses, symptoms improved, urine output increased from 300-500 ml/day to 1300-1700 ml/day. Heart failure situation significantly improved, general condition fair, no obvious palpitations after activity, no cough or asthma, able to lie flat, ascites sign (-), edema disappeared, liver retracted, indicating this episode of heart failure controlled. ECG: Atrial fibrillation persists. Discharged for continued observation. (*Zhao Xiwu's Medical Experience*)
[Commentary]: Phlegm-fluid retention (Tan Yin) is a pathological product of impaired water metabolism in the body, representing a syndrome of internal water stagnation without proper distribution. It has broad and narrow senses. Broadly, it refers to all types of fluid retention; narrowly, it is one specific type. Based on the site of accumulation, it is divided into Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Supporting Fluid). Scattered in the stomach and intestines is Tan Yin; flowing under the hypochondrium is Xuan Yin; overflowing into limbs and muscles is Yi Yin; supporting the chest and lungs is Zhi Yin. *Yizong Jinjian*, Vol. 21 states regarding Yi Yin: "It is equivalent to modern Feng Shui (Wind Water) and Edema diseases." Regarding Zhi Yin, Chen Xiuyuan classified it with "Hidden Fluid above the Diaphragm" as asthma. Therefore, reference should be made to asthma and Water-Qi diseases. The scope of Phlegm disease is even broader, so relevant disease discussions should be consulted.
Case 1: Syndrome belongs to sudden cold binding externally and phlegm-fluid accumulating internally. Treatment involves dispersing external pathogens and warming/dissolving phlegm-fluid. Spleen is the source of phlegm production; Lung is the container of phlegm storage. Subsequently, regulating Spleen and肃 (descending) Lung, warming and dissolving phlegm-fluid completes the treatment. The syndrome and treatment are appropriate.
Case 2: Wind-cold and phlegm-fluid binding internally and externally. Xiao Qinglong Tang (Minor Blue Dragon Decoction) should be the main formula. If skillfully modified, efficacy is doubled. This case combines Xiao Qinglong Tang with Gualou (Trichosanthis Fructus), Xiebai (Allii Macrostemonis Bulbus), Xixin (Asari Radix et Rhizoma), and Huashi (Talcum) to enhance phlegm-dispelling and fluid-resolving power, achieving immediate effect like striking a drum.
Case 3: Syndrome belongs to Spleen-Kidney Yang deficiency with phlegm-fluid flooding upward. *Mingyi Zazu* states: "The root of phlegm is water, originating from Kidney; the movement of phlegm is dampness, governed by Spleen." With Spleen Yang deficient and Kidney Yang declining, Kidney Qi fails to grasp, leading to Kidney deficiency and water flooding. The prescription avoids Jin Gui Shen Qi Wan (Kidney Qi Pill from Golden Cabinet) fearing cloying tonification hindering pathogen expulsion, instead modifying Qinglong formulas. Erchen Tang (Two-Aged Decoction) regulates Spleen and resolves dampness; Paojiang (Zingiberis Rhizoma Preparatum) warms middle; Wuweizi (Schisandrae Fructus) astringes Lung; Xixin (Asari Radix et Rhizoma) warms Kidney and promotes water movement; Chenxiang (Aquilariae Lignum Resinatum) and Ershi (two minerals, likely Shi Gao and Hua Shi or similar) calm counterflow and grasp Qi. Efficacy is extraordinary.
Case 4: Diagnosed as chronic pulmonary heart disease. Symptoms: cough, shortness of breath, edema, fullness, oliguria, white sputum, purple lips. Pathology: Heart-Kidney Yang deficiency, internal water-fluid retention, phlegm-dampness obstruction, Lung Qi congestion. Modified Yuebi Tang combined with Zhenwu Tang, focusing on warming Yang and promoting dampness, diffusing Lung and promoting water movement. Hence, urine output greatly increased, edema significantly resolved. Subsequently used chest-broadening, Qi-regulating, and Lung-clearing methods, focusing on descending Qi and transforming phlegm. Ancients said: "Accumulated water becomes fluid, condensed fluid becomes phlegm." Fluid moves easily, but phlegm is hard to dissolve. This case's treatment steps mastered "easy first, difficult later," fitting the pathology.
Cases 5 & 6: Belong to Xuan Yin (Hanging Fluid). Fluid in hypochondrium causes pain upon coughing/sputtering, subcardiac hardness, fever, sweating, white coating, deep or string-like pulse as main signs.
Case 5: Western diagnosis exudative pleurisy. Syndrome: fluid evil accumulating between chest and hypochondrium. Abandoned Shizao Tang (Ten Jujube Decoction) but adopted the method of dispersing wind, diffusing Lung, and attacking/draining water-fluid. Added Kongxian Dan (Control Saliva Pill) to the formula (Shizao Tang minus Yuanhua and Dazao, plus Baijiezi, made into pills). Abandoned the formula but learned its method, imitated the formula but slowed its momentum, yet the phlegm-resolving and fluid-draining power remains excellent.
Case 6: Original case titled exudative pleurisy, belonging to TCM Xuan Yin scope. Characteristic: disease trend receded but residual pathogen remains. Mr. He treated with nourishing Yin, benefiting Lung, and clearing/resolving, balancing pathogen and healthy Qi, providing reference for clinical practice. Western heart failure is similar to certain syndromes of TCM Phlegm-Fluid and Water-Qi diseases. Mr. Zhao controlled heart failure using pure Chinese medicine, with clear methods and formulas, significant efficacy, showing profound insight.
Case 7: Syndrome belongs to Heart Yang failing to stimulate, Yang deficiency with water counterflow, attacking Heart and Lung, Lung Qi failing to diffuse. Selected Zhenwu Tang as main formula, assisted by "Kai Guimen" (Open Ghost Gate) method, i.e., diffusing Lung and releasing exterior, allowing Lung Qi to diffuse, Ying and Wei harmonize, seeking "Upper Jiao gets open, sweat suddenly appears." Focus is on treating Lung.
Case 8: Syndrome belongs to Heart-Kidney Yang deficiency, phlegm-dampness obstruction. Treatment: Warm Yang and promote diuresis, i.e., "Jing Jian Fu" (Cleanse the House) method, aiming at promoting water flow and diuresis, making water move and edema disappear. Focus is on treating Kidney. Formula: Xiaoshui Shengyu Tang (Guizhi Tang minus Shaoyao, plus Mahuang Fuzi Xixin Tang and Zhimu, optionally Fangji etc.).
Case 9: Syndrome belongs to Heart-Kidney Yang deficiency with blood stasis. Thus, Zhenwu Tang combined with "Qu Wan Chen Cuo" (Remove Accumulated Stagnation) method. Long-standing stagnation is Chen (aged), accumulated stasis is Wan (entangled), putrefied turbidity is Cuo (husks). "Qu Wan Chen Cuo" here refers to dissipating masses, unblocking collaterals, and activating blood/resolving stasis. Generally, Mr. Zhao treats heart failure mainly with Zhenwu Tang to strengthen Heart and support Yang, combined with three water-treating methods (Kai Guimen, Jing Jian Fu, Qu Wan Chen Cuo), truly grasping the essence.
(VII) Lung Abscess (Fei Yong)
Case 1: Surname Feng, male, 59 years old. Medical history two months. Initially suffered cough, chest discomfort, ignored. Recently cough intensified, slight asthma, turbid abundant sputum, foul odor, sometimes bloody, chest/rib vibration pain, slight chills/fever, poor sleep/appetite. Deep yellow urine, dry stool, slippery-rapid pulse. This syndrome results from loose interstices, wind-cold invading externally, unable to vent, staying in Lung. Heat accumulates forming abscess. Treatment should focus on draining pus, whether formed or not. Must cleanse phlegm-turbidity, prevent blockage, then remaining symptoms heal easily. Xianwei Maigen (Fresh Imperatae Rhizoma and Reed Rhizoma) 24g each, Shengyiren (Coicis Semen) 18g, Xuanfuhua (Inulae Flos) 6g (Daizheshi 12g wrapped), Dongguazi (Benincasae Semen) 18g, Tao Xingren (Pruni Armeniaci Semen Amarum and Persicae Semen) 6g each (stir-fried and ground), Ku Jiegeng (Scrophulariae Radix) 6g, Fen Gancao (Glycyrrhizae Radix et Rhizoma) 4.5g, Xianhecao (Agrimoniae Herba) 18g (stir-fried), Xiyangshen (Panacis Quinquefolii Radix) 4.5g, Sangbaipi (Mori Cortex) and Digupi (Lycii Cortex) 6g each, Chenjuhongluo (Citri Reticulatae Pericarpium Rubrum and Venae Citri Reticulatae) 4.5g each. First Visit: After 3 doses, chills/fever subsided, asthma stopped, cough lightened, sputum reduced but still foul, no longer bloody, sleep/appetite slightly better, urination/defecation normal, still feels shortness of breath, fatigue, chest tightness. Modify original method. Xianmaoweigen (Fresh Imperatae and Reed Rhizoma) 24g each, Shengyiren (Coicis Semen) 18g, Gualou (Trichosanthis Fructus) 18g (Xiebai 9g pounded together), Xuanfuhua (Inulae Flos) 6g (Daizheshi 12g wrapped), Zhibaiqian (Heliopsidis Caulis) and Bubu (Stemonae Radix) 4.5g each, Zizitan (Perillae Folium) and Huajuhong (Exocarpium Citri Grandis) 4.5g each, Pipaye (Eriobotryae Folium) 6g (Banxiaqu 9g wrapped), Ku Jiegeng (Scrophulariae Radix) 6g, Xiyangshen (Panacis Quinquefolii Radix) 4.5g, Dongguazi (Benincasae Semen) 24g (pounded), Tao Xingren (Pruni Armeniaci Semen Amarum and Persicae Semen) 6g each (stir-fried and ground), Fen Gancao (Glycyrrhizae Radix et Rhizoma) 4.5g. Third Visit: After 3 doses, all symptoms lighter, still feels shortness of breath, fatigue, sleep/appetite not normal. This is because pathogen temporarily retreated, healthy Qi not recovered. Treat according to symptoms. If assisting constitution and protecting Lung Qi, efficacy expected. Xiyangshen (Panacis Quinquefolii Radix) 6g, Beishashen (Glehniae Radix) stir-fried with rice 12g, Biaozhuzhu (Atractylodis Rhizoma) 6g, Fen Gancao (Glycyrrhizae Radix et Rhizoma) 4.5g, Huajuhong (Exocarpium Citri Grandis) 4.5g, Pipaye (Eriobotryae Folium) 6g (Banxiaqu 9g wrapped), Ku Jiegeng (Scrophulariae Radix) 6g, Chao Zhike (Aurantii Fructus Immaturus) 4.5g, Yunfulingshen (Poria and Poria cum Radix) 9g each, Dongchongxiacao (Cordyceps) 9g. Additionally, Sanqi (Notoginseng Radix) and Baiji (Bletillae Rhizoma) 3g each, ground finely, taken in two portions with medicine. (Organized by Shi Zhimo et al.: Shi Jinmo's Medical Cases, *Chinese Journal of Traditional Medical Science and Technology* 5:328, 1958)
Case 2: Xiang XX, male, 21 years old. Hospital No. 75/1004, First Visit Date: March 4, 1975. Fever started yesterday 39.3°C, cough with sticky sputum, difficult to expectorate. Today body heat burns hand, sweating soaks clothes, cough draws right chest pain, expectorates yellow purulent foul-smelling sputum. Chest X-ray: Right upper lobe posterior segment lung abscess, cavity with fluid level formation. Blood test: WBC total 19,000/mm³, neutrophils 83%, thin yellow coating, fine-rapid pulse. Syndrome differentiation: Wind-warmth received externally, damp-heat stored internally, steaming Taiyin, heat-toxin injuring Lung, clearing/descending function powerless, heat congestion and blood stasis, fermenting into abscess. Treatment method: Clear heat and detoxify, transform phlegm and resolve stasis. Prescription: Maxing Shigan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) combined with Qianjin Weijing Tang (Thousand Gold Reed Shoot Decoction): Zhi Mahuang (Prepared Ephedrae Herba) 6g, Xingren (Armeniacae Semen Amarum) 9g, Sheng Shigao (Raw Gypsum Fibrosum) 30g, Renni (Coicis Semen) 30g, Jiegeng (Platycodonis Radix) 6g, Gancao (Glycyrrhizae Radix et Rhizoma) 6g, Hongteng (Sargentodoxae Caulis) 30g, Yuxingcao (Houttuyniae Herba) 18g, Lugeng (Phragmitis Rhizoma) 1 stalk, Taoren (Persicae Semen) 12g, Dongguazi (Benincasae Semen) 12g, Kaijin suo (Uncaria rhynchophylla? Or local herb name, likely referring to a specific herb for abscess, kept as Kaijin Suo) 30g. March 10 (Second Visit): Above formula modified, taken 6 doses. Body heat completely subsided (37°C), cough with abundant sputum, purulent-blood like, but foul smell reduced, easy to expectorate, chest tightness without pain, dry mouth, red tongue edges, thin yellow coating, small-slippery pulse. Chest X-ray: Right upper lung absorption seen compared to before, left lower bronchiectasis. Blood test: WBC total 14,700/mm³, neutrophils 75%. Heat-toxin congests steaming Lung, blood rots flesh, ulcer ruptures. Fortunately, heat-toxin raging trend gradually calms, pus-toxin has outlet opportunity. Plan to clear heat, detoxify, drain pus. Formula: Qianjin Weijing Tang combined with Xi (Niu) Huang Xingxiao Wan (Rhino/Bovine Gallstone Awakening Elimination Pill) and other compound formulas for treatment. Yinhua (Lonicerae Japonicae Flos) 18g, Lianqiao (Forsythiae Fructus) 18g, Lugeng (Phragmitis Rhizoma) 1 stalk, Taoren (Persicae Semen) 6g, Dongguazi (Benincasae Semen) 18g, Renni (Coicis Semen) 30g, Yuxingcao (Houttuyniae Herba) 30g, Hongteng (Sargentodoxae Caulis) 30g, Baijiangcao (Patriniae Herba) 30g, Kaijin suo 30g, Niu Huang Xingxiao Wan (Bovine Gallstone Awakening Elimination Pill) 4.5g (swallowed separately). Slight modification of this formula, taken 23 doses. April 2 (Third Visit): Cough reduced, sticky sputum with blood, chest tightness removed, spirit improved. Chest X-ray: Right upper lung abscess absorbed, left lower bronchiectasis. Blood test: WBC total 7,500/mm³, neutrophils 60%, small-stringy pulse, thin yellow coating, red tongue body. Residual heat lingering in Lung daily cleared, Lung collaterals damage gradually recovering. Now should reduce dosage and clear/transform phlegm-heat. Yinhua (Lonicerae Japonicae Flos) 9g, Lianqiao (Forsythiae Fructus) 9g, Lugeng (Phragmitis Rhizoma) 1 stalk, Renni (Coicis Semen) 15g, Dongguazi (Benincasae Semen) 12g, Hongteng (Sargentodoxae Caulis) 30g, Baijiangcao (Patriniae Herba) 30g, Yuxingcao (Houttuyniae Herba) 30g, Kaijin suo 30g, Daihe San (Blue-Green Shell Powder) 12g (wrapped) 5 doses. April 7 (Fourth Visit): Cough reduced 70-80%, sputum scant sometimes pale red, appetite and urination/defecation good, red tongue edges, thin coating, fine pulse. Heat-toxin cleared, Lung Yin not recovered. Again plan to nourish Yin and transform phlegm to conclude treatment. Beishashen (Glehniae Radix) 12g, Maidong (Ophiopogonis Radix) 9g, Tian Xingren (Sweet Armeniacae Semen) 9g, Sangye/Sangbipi (Mulberry Leaf/Cortex) 9g each, Fuling (Poria) 9g, Ge Fen Chao Ejiao (Donkey-Hide Gelatin stir-fried with shell powder) 9g, Shanyao (Dioscoreae Rhizoma) 12g, Baiji (Bletillae Rhizoma) 9g, Chuanbei Fen (Fritillariae Cirrhosae Bulbus Powder) 4.5g, Pipaye (Eriobotryae Folium) 12g, Qiancaogen (Rubiae Radix et Rhizoma) 12g, 7 doses. (*Zhang Boyu's Medical Cases*) [Commentary]: Lung Abscess (Fei Yong) refers to pulmonary abscess, mainly characterized by chest pain upon coughing, expectoration of foul-smelling sputum, even coughing up purulent blood. Mostly caused by unresolved Lung heat, blood coagulation and obstruction, excessive heat rotting flesh into pus. As stated in *Jin Gui Yao Lue - Lung Atrophy, Lung Abscess, Cough and Asthma Disease Pulse and Syndrome Treatment*: "Wind injures hair/skin, heat injures blood vessels, wind lodges in Lung... where heat passes, blood coagulates and stagnates, accumulating into abscess pus."
Case 1: Medical history two months, slight chills/fever, timing corresponds to pus-formation or pus-rupture stage, thus focus on draining pus. Still use Qianjin Weijing Tang as main formula, add Lung-draining, phlegm-transforming, Qi-descending, pus-draining agents. Additionally add Xiyangshen (Panacis Quinquefolii Radix) to tonify Qi and nourish Yin, protect Lung and hold toxin, focusing on expelling pathogen and draining pus, slightly assisting healthy substance, effect doubles. After week, pathogen retreated, subsequently protecting Lung Qi, recovery expected.
Case 2: Acute onset, short course, syndrome belongs to early stage of Lung Abscess. Due to excessive toxic heat, used clearing heat, detoxifying, transforming phlegm, removing stasis method. Hongteng (Sargentodoxae Caulis) and Baijiangcao (Patriniae Herba) in formula are key herbs for treating Intestinal Abscess (Chang Yong). Added Yuxingcao (Houttuyniae Herba), Kaijin suo etc., all having good effects of clearing heat, detoxifying, eliminating internal abscess. Mr. Zhang's experience: "Lung abscess is heat-toxin, evolution often rapid, key lies in draining pus, recovery also relatively fast." Worth mentioning as empirical talk.
(VIII) Pulmonary Tuberculosis (Fei Lao)
Case 1: Liu XX, female, 23 years old, First Visit Date: December 6, 1953. According to Western medical examination, suffers from pulmonary tuberculosis. But feels no fatigue herself, nor cough, but panting tendency when going upstairs, indicating Lung disease signs. Menstruation previously abundant, past half year volume decreasing daily, color abnormal. Only work does not feel tiring, only abdominal pain, this is Liver-Spleen disharmony causing. Method should follow this, calm Lung, regulate Liver/Kidney for treatment. Carefully protect, avoid overwork, hoping for effective medication. Beishashen (Glehniae Radix) 12g, Nan Baiqian (Heliopsidis Caulis) 6g, Da Baihe (Lilii Bulbus) 12g, Jing Baibu (Stemonae Radix) 9g, Quan Danggui (Angelicae Sinensis Radix) 12g, Chuanxiong Pian (Chuanxiong Rhizoma slices) 9g, Gan Shengdi (Rehmanniae Radix) 15g, Chi Shaoyao (Paeoniae Radix Rubra) 12g, Zhen Ejiao (Donkey-Hide Gelatin) 9g (powdered, added later), Gan Gouqi (Lycii Fructus) 9g, Chen Aiye (Artemisiae Argyi Folium) 6g, Wine-stirred Yuanhusuo (Corydalis Rhizoma) 9g, Ling Cishi (Magnetitum) 15g (decocted first), Sheng Gancao (Licorice Root) 6g. December 13 (First Visit): Took 3 doses of previous formula, only feels Lung distension, no other suffering. Still should calm Lung and soothe Qi for treatment, carefully protect, do not overwork. Kong Shashen (likely typo for Bei Shashen or similar, kept as Kong Shashen) 12g, Ku Jiegeng (Scrophulariae Radix) 9g, Ku Xingren (Bitter Apricot Kernel) 9g, Foshoupian (Bergamot Fruit Slice) 9g, Huang Yujin (Curcumae Radix) 6g, Da Baihe (Lilii Bulbus) 12g, Jing Baibu (Stemonae Radix) 6g, Zhi Ru Mo (Processed Myrrh and Frankincense) 6g each, Danggui Shen (Angelicae Sinensis Radix Tip) 12g, Sheng Baishao (White Peony Root) 15g, Yanhusuo (Corydalis Rhizoma) 9g, Qi Aigeng (Artemisiae Argyi Caulis) 6g, Zhen Ejiao (Donkey-Hide Gelatin) 6g (powdered, added later), Gan Ou jie (Dried Lotus Node) 5 pieces. After taking 7 doses, Third Visit: Add Nen Baiqian (Young Heliopsidis Caulis) 6g, Sheng Qipi (Immature Citrus Peel? Or Astragalus skin variant, likely Sheng Huangqi Pi) 12g, Chuanxiong Pian (Chuanxiong Rhizoma slices) 6g, Chen Aigeng (Old Artemisiae Argyi Caulis) increased to 9g in previous formula. After another 7 doses, Fourth Visit: Lung no longer distended, add Tianhuafen (Trichosanthis Radix) 12g to previous formula. (Organized by Zhang Shaozhong: Xiao Longyou's Medical Cases, *Chinese Journal of Traditional Medical Science and Technology* 2:115, 1958)