汁少许、和冰糖粉捣药丸、如樱桃大、含化而咽之。）如咳逆气粗。咯痰稠粘。甚则目突如脱。喉间辘辘有声
者。此寒痰遏热壅塞气管也。名曰痰喘。法当豁痰下气。白果定喘汤为主。（生白果二十一个杵、姜半夏、生桑
皮、款冬花、光杏仁各三钱、苏子二钱、橘红、片芩各钱半、麻黄一钱、生甘草五分。）重则小青龙加石膏汤。
（即小青龙汤本方加生石膏八钱。）或用定喘五虎汤。（麻黄一钱、光杏仁三钱、生石膏四钱、炙甘草四分、
北细辛五分。）久则口噙王氏痰喘丸。（白檀香、白豆蔻、蛤粉、川贝、麦冬、儿茶各一两、淡天冬、薄荷叶
各五钱、苦桔梗、广木香各三钱、麝香、梅冰各五分、共研细、以甘草四两熬膏丸如芡实大、每噙化一丸。）
如痰结喉间。咳而上气。或呷或呀。喉中作水鸡声者。此寒痰包热阻塞喉管也。名曰痰哮。法当开肺豁痰。射干
麻黄汤。（射干钱半、麻黄一钱、姜半夏、款冬花、紫菀各三钱、干姜八分拌捣北五味三分、北细辛五分、大
红枣三枚。）口噙清金丸。（牙皂三钱、拌炒莱菔子一两、研细、姜汁少许、和竹沥捣丸、如芡实大、每用一
丸含化。）如咳嗽不爽。胸中气闷。夜不得眠。烦躁不宁者。此火痰郁遏胸膈也。名曰痰躁。法当豁痰降火。陷
胸泻心汤加减。（栝蒌仁四钱、仙半夏钱半、小川连八分、小枳实、青子芩各一钱、淡竹茹三钱、姜汁两滴、
和竹沥两瓢同冲。）甚则吞服王氏四黄涤痰丸。（川大黄四两、用竹沥一两、姜汁一钱、朴硝三钱、拌蒸三次、
姜炒川连五钱、天竺黄三钱、栝蒌仁、海蛤壳、广橘红各四两、浙茯苓、杜胆星、炒苍术各三两、明天麻、
浮海石、炒芥子各二两、薄荷叶一两六钱、石菖蒲、上沉香、上青黛各一两、竹沥半夏六钱、白蔻仁三钱、
梅冰一钱、二十味为细末、以竹沥九分、姜汁一分、泛丸、如细绿豆大、再用石膏粉五钱、广牛黄二钱、辰砂
一钱、三味研细为衣、轻用一钱、重用二钱、开水送下、并治饮食化痰、胸膈迷闷、气逆咳嗽、及哮喘中痰诸
证、方载孟英《鸡鸣录》。）如小瘰大 。初生项间。不觉痛痒。累累如串者。此气结痰凝吸核变大也。
初名痰核继称痰 串。治必先辨其因。因于肝火痰凝者。内服逍遥二陈汤加减。（全当归、丹皮各钱半、生白芍、
紫背天葵各五钱、竹沥半夏、天花粉、蒲公英各三钱、广皮一钱、川柴胡六分、薄荷叶五分冲。）送下程
氏消瘰丸。（元参、川贝、 牡蛎各四两、姜汁少许和竹沥捣丸、如绿豆大、每服二钱至三钱。）外贴抑阳
乌龙膏。先用陈小粉四两、炒黄研细、陈米醋调成糊、熬如黑漆、瓷罐收藏、用时量核大小调抑阳散、
即天花粉三钱、姜黄、白芷、赤芍各一钱、研细调匀涂布、如核上虽痒、不可揭动、久则自消。因于阳虚痰
凝者。内服王氏阳和汤。（麻黄五分、拌捣熟地五钱、鹿角胶钱半烊冲、白芥子一钱、紫 桂、清炙草各五
分、干姜炭四分、酒水各半煎。）外贴抑阴消核膏。（制甘遂二两、红芽大戟三两、白芥子八钱、麻黄四钱、
生南星、直天虫、朴硝、藤黄、姜半夏各一两六钱、）用时调入抑阴散。（即制草乌二钱、制南星、独活、
白芷、野狼毒各一钱、研细调匀涂布。）若已溃及溃久不敛者。内服归芍六君子汤。（全当归二钱、生白芍、
潞党参、浙茯苓、姜半夏各三钱、生晒术、广皮各钱半、清炙草八分、鲜生姜六分、大红枣三枚。）送服犀
黄丸。（制乳香、制没药各一两、西黄三分、麝香三分、研匀、取黄米饭一两捣药、入药末再捣为丸、萝卜子
大、晒干忌烘、每服钱半）继服大枣丸收功。（山羊屎三钱、晒干炒存性研粉、先将黑枣肉捣烂如泥、然后入
羊屎末捣匀为丸、如绿豆大、每服二三钱。）外贴阳和解凝膏。（新鲜牛蒡子草、连根叶梗三斤、活白凤仙
梗四两、用香油十斤、将二味熬枯去渣、次日再入川芎四两、附子、桂枝、大黄、当归、肉桂、官桂、草乌、
川乌、地龙、僵蚕、赤芍、白芷、白蔹、白芨各二两、续断、防风、荆芥、五灵脂、木香、香橼、陈皮各一
两、再煎药枯沥渣、隔宿油
冷、见过斤两、每油一斤、加炒透桃丹七两、搅和、文火慢熬、熬至滴水成珠、不粘指为度、即以湿粗纸罨
火、以油锅移放冷灶上、取乳香没药末各二两、苏合油四两、麝香一两、研细入膏搅和、半月后摊贴、一应烂
溃阴疽、冻疮贴一夜全消、溃者三张全愈。）因于风痰及风湿酿痰者。内服麻菊二陈汤去甘草。送服控涎丹三
分。消沥根以杜复发。外贴王氏化核膏。（菜油四斤、壁虎十四条、蜘蛛二十八个、蜗牛三十六枚、入锅熬至
枯浮油面取出、再入新鲜首乌藤叶、甘菊根、薄荷、牛蒡、苍耳等草各半斤、武火熬至草枯出渣、俟油冷再入
连翘、元参、苦参、白蔹、白芥子、僵蚕、水红子仁各捣碎、大黄、荆芥、防风各四两、浸一宵、熬至黑
枯、以油沥清、见过斤两、熬至滴水不散、将前制木鳖油归入配炒东丹、慢入慢搅、搅匀、文火再熬、熬至滴
水成珠、膏不粘指为度、加入丁香油、麝香各二钱、苏合油一两、搅匀火退摊贴、凡瘰 结核恶核、此膏贴即
暗消。）如饮食入胃。便吐粘涎。膈塞不通。便结而粪如羊矢者。此气郁挟痰阻塞胃脘也。名曰痰膈法当辛润
涤痰。五汁饮加狗宝为主。（梨汁、蔗汁、莱菔汁各两瓢、鲜石菖蒲汁一小匙、生姜汁两滴、和匀、重汤炖
温、调下狗宝末三分。）或用程氏启膈饮加味。北沙参、丹参各三钱、京川贝、广郁金各钱半、蜜炙橘红、
浙茯苓各一钱、春砂壳、杵头糠各五分、荷叶蒂两个、煎成、调下玉鼠散五分、（即新生小鼠、新瓦上焙干、
研末。）剧则云岐人参散。（吉林参一钱煎成、冲麝香三厘、冰片厘半。）尽人事以挽天机。
【荣斋按】本节是从戈存橘伤寒补天石“痰证伤寒”篇删润补充而成的。廉臣先生又罗列各种治法，不
但把痰证属于外因的，分析得很清楚，更把有关内因的痰证，也指出了治法。只有“痰饮”一证，留待下节发挥，
基本上可以说无 胜义了。不过、中医的因证施治，是多方面的；“夹痰伤寒”经吴坤安采辑，尚有下列几个证
治∶“（一）肺风寒痰──如见憎寒发热、鼻塞头痛、胸满、气急、或咳或喘，右寸浮滑或沉伏者，此风痰在
肺也；如舌白而润、口不渴者，痰由风邪生；宜二陈汤加加桑、杏、前胡、羌活、苏、薄之类，微散之。喘加焦
麻黄、葶苈子以泻肺。（二）肺风热痰──如微寒发热、胸闷气逆、咳嗽兼喘、舌苔黄燥、或白刺、口渴、脉
数者，此风热客肺生痰也；宜前胡、桑、杏、蒌霜、贝母、枯芩、橘红、薄荷、全福花、淡竹叶之类，以去风
热，痰自平矣。如痰闭气逆，加竹沥、姜汁。（三）胞络热痰──如伤寒神昏谵语、目睛微定，或舌蹇语涩、舌
苔尖赤中白而燥者，此热痰乘于胞络也；宜犀角尖、川郁金、石菖蒲、天竺黄、川贝、钩藤、淡竹叶、栝蒌霜
之类。如舌绛神呆、痰潮语涩者，内闭也；加西黄。（四）痰挟痧疹──凡时感伤寒、初起即胸中烦闷、气急
痰喘，先用豁痰利气药，痰已行而喘减，但烦闷、身热不除，反加耳聋足冷者；此必痰挟痧疹也。急宜透之提
之，如羚角、连翘、牛蒡、防风、葛根、枳壳、桔梗、蝉蜕之类。（五）络中湿痰──如发热脘闷、胸胁肩背
皆痛，此湿痰窃踞肺胃之络；痰气交阻，故痛。宜六安煎去甘草，加桂枝、钩丁、蒺藜、栝蒌皮、片姜黄、白
僵蚕、木香汁之类，通之行之。（六）痰入肝络──伤寒有解表之后，肢体不能转动者，此痰入于肝络也。当
以南星、礞石、半夏、栝蒌、茯苓、陈皮、天虫、全蝎、姜汁炒蒺藜、川桂枝、旋复花之类；以搜入络之痰，
肢自遂矣。如未应，即以养血药兼之。（七）解后伏痰──伤寒解表之后，热势稍退，但觉目钝神呆，身重或
痛，胸满不畅者；此胃中有伏痰也。右关脉必沉伏、或沉滑，宜二陈汤加枳实、栝蒌、姜汁、竹茹之类；豁之
行之。（八）积痰──如发热、胸闷、咳嗽气急、痰多浓浓者，中宫积痰也。宜燥润并用，南星、半夏、栝
蒌、海石、枳实、陈皮、茯苓之类；或导痰汤亦可。”以上八条痰证，都与伤寒有关，其属于内因者，不列
入。
（取少许汁液，与冰糖粉混合捣碎制成药丸，大小如樱桃，含在口中慢慢化开咽下。）如果咳嗽气逆、呼吸粗重，咯出的痰液稠厚粘腻，甚至出现眼球突出像要脱出一样，喉咙间发出辘辘的声响，这是寒痰遏制热气，壅塞气管所致。这种病症名为“痰喘”。治疗法则应当豁痰降气，以白果定喘汤为主方。（生白果二十一个捣碎，姜半夏、生桑皮、款冬花、光杏仁各三钱，苏子二钱，橘红、片芩各钱半，麻黄一钱，生甘草五分。）病情重的，用小青龙加石膏汤。（即小青龙汤原方加入生石膏八钱。）或者使用定喘五虎汤。（麻黄一钱，光杏仁三钱，生石膏四钱，炙甘草四分，北细辛五分。）病程久的，口中含着王氏痰喘丸。（白檀香、白豆蔻、蛤粉、川贝、麦冬、儿茶各一两，淡天冬、薄荷叶各五钱，苦桔梗、广木香各三钱，麝香、梅冰各五分，共研成细末，用甘草四两熬膏，制成如芡实大小的药丸，每次含化一丸。）如果痰结在喉间，咳嗽且气逆上冲，或者发出呷呀的声音，喉咙中像水鸡叫一样的声音，这是寒痰包裹热气，阻塞喉管所致。这种病症名为“痰哮”。治疗法则应当宣肺豁痰，用射干麻黄汤。（射干钱半，麻黄一钱，姜半夏、款冬花、紫菀各三钱，干姜八分拌捣北五味三分，北细辛五分，大红枣三枚。）口中含着清金丸。（牙皂三钱，拌炒莱菔子一两，研成细末，取少许姜汁，和竹沥一起捣制成如芡实大小的药丸，每次用一丸含化。）如果咳嗽不畅，胸中气闷，夜晚无法入睡，烦躁不安，这是火痰郁遏在胸膈所致。这种病症名为“痰躁”。治疗法则应当豁痰降火，用陷胸泻心汤加减。（栝蒌仁四钱，仙半夏钱半，小川连八分，小枳实、青子芩各一钱，淡竹茹三钱，姜汁两滴，和竹沥两瓢同冲服。）病情严重的，吞服王氏四黄涤痰丸。（川大黄四两，用竹沥一两、姜汁一钱、朴硝三钱，拌蒸三次；姜炒川连五钱，天竺黄三钱，栝蒌仁、海蛤壳、广橘红各四两，浙茯苓、杜胆星、炒苍术各三两，明天麻、浮海石、炒芥子各二两，薄荷叶一两六钱，石菖蒲、上沉香、上青黛各一两，竹沥半夏六钱，白蔻仁三钱，梅冰一钱，以上二十味研成细末，用竹沥九分、姜汁一分泛丸，制成如细绿豆大小的药丸，再用石膏粉五钱、广牛黄二钱、辰砂一钱，这三味研细作为药衣，轻症用一钱，重症用二钱，开水送服。此方并治饮食化痰、胸膈迷闷、气逆咳嗽及哮喘中痰等各种证候，方剂记载于孟英《鸡鸣录》。）如果是小的瘰疬大的结核，初生在颈部，不觉得痛痒，累累相连像串珠一样，这是气结痰凝形成的吸核变大。起初名为“痰核”，后来称为“痰 串”。治疗必须先辨别病因。因肝火痰凝引起的，内服逍遥二陈汤加减。（全当归、丹皮各钱半，生白芍、紫背天葵各五钱，竹沥半夏、天花粉、蒲公英各三钱，广皮一钱，川柴胡六分，薄荷叶五分冲服。）送服程氏消瘰丸。（元参、川贝、牡蛎各四两，少许姜汁和竹沥捣制成如绿豆大小的药丸，每次服用二钱至三钱。）外贴抑阳乌龙膏。先用陈小粉四两，炒黄研细，用陈米醋调成糊状，熬得像黑漆一样，装在瓷罐里收藏。用时根据结节的大小调配抑阳散，即天花粉三钱，姜黄、白芷、赤芍各一钱，研细调匀涂在布上。如果结节上虽然发痒，不可抓挠触动，时间久了自然会消散。因阳虚痰凝引起的，内服王氏阳和汤。（麻黄五分，拌捣熟地五钱，鹿角胶钱半烊化冲服，白芥子一钱，紫桂、清炙草各五分，干姜炭四分，酒水各半煎煮。）外贴抑阴消核膏。（制甘遂二两，红芽大戟三两，白芥子八钱，麻黄四钱，生南星、直天虫、朴硝、藤黄、姜半夏各一两六钱。）用时调入抑阴散。（即制草乌二钱，制南星、独活、白芷、野狼毒各一钱，研细调匀涂在布上。）如果已经溃破以及溃破后久久不愈合的，内服归芍六君子汤。（全当归二钱，生白芍、潞党参、浙茯苓、姜半夏各三钱，生晒术、广皮各钱半，清炙草八分，鲜生姜六分，大红枣三枚。）送服犀黄丸。（制乳香、制没药各一两，西黄三分，麝香三分，研匀，取黄米饭一两捣药，加入药末再捣成丸，如萝卜子大小，晒干忌烘烤，每次服用钱半。）继服大枣丸收功。（山羊屎三钱，晒干炒至存性研粉，先将黑枣肉捣烂如泥，然后加入羊屎末捣匀制成药丸，如绿豆大小，每次服用二三钱。）外贴阳和解凝膏。（新鲜牛蒡子草，连根叶梗三斤，活白凤仙梗四两，用香油十斤，将这两味熬枯去渣，第二天再放入川芎四两，附子、桂枝、大黄、当归、肉桂、官桂、草乌、川乌、地龙、僵蚕、赤芍、白芷、白蔹、白芨各二两，续断、防风、荆芥、五灵脂、木香、香橼、陈皮各一两，再煎至药枯沥渣，隔宿油冷，见过斤两，每油一斤，加炒透桃丹七两，搅和，文火慢熬，熬至滴水成珠、不粘手指为度，即用湿粗纸覆盖火源，将油锅移到冷灶上，取乳香没药末各二两，苏合油四两，麝香一两，研细入膏搅和，半月后摊贴。一切烂溃阴疽、冻疮贴一夜全消，溃破者三张全愈。）因风痰及风湿酿痰引起的，内服麻菊二陈汤去掉甘草。送服控涎丹三分，以消除沥根防止复发。外贴王氏化核膏。（菜油四斤，壁虎十四条，蜘蛛二十八个，蜗牛三十六枚，入锅熬至枯浮油面取出，再放入新鲜首乌藤叶、甘菊根、薄荷、牛蒡、苍耳等草各半斤，武火熬至草枯出渣，等油冷再放入连翘、元参、苦参、白蔹、白芥子、僵蚕、水红子仁各捣碎，大黄、荆芥、防风各四两，浸泡一晚，熬至黑枯，以油沥清，见过斤两，熬至滴水不散，将前制木鳖油归入配炒东丹，慢入慢搅，搅匀，文火再熬，熬至滴水成珠、膏不粘手指为度，加入丁香油、麝香各二钱，苏合油一两，搅匀退火摊贴。凡是瘰疬结核恶核，此膏贴上即暗消。）如果饮食入胃，随即吐出粘涎，膈塞不通，大便干结且粪便像羊屎一样，这是气郁挟痰阻塞胃脘所致。这种病症名为“痰膈”。治疗法则应当辛润涤痰，以五汁饮加狗宝为主。（梨汁、蔗汁、莱菔汁各两瓢，鲜石菖蒲汁一小匙，生姜汁两滴，和匀，隔水炖温，调下狗宝末三分。）或者使用程氏启膈饮加味。北沙参、丹参各三钱，京川贝、广郁金各钱半，蜜炙橘红、浙茯苓各一钱，春砂壳、杵头糠各五分，荷叶蒂两个，煎成后，调下玉鼠散五分。（即新生小鼠，在新瓦上焙干，研末。）病情剧烈的，用云岐人参散。（吉林参一钱煎成，冲麝香三厘，冰片厘半。）尽力人事以挽回天机。
【荣斋按】本节是从戈存橘《伤寒补天石》中“痰证伤寒”篇删减润色补充而成的。廉臣先生又罗列了各种治法，不仅把属于外因的痰证分析得很清楚，更指出了有关内因的痰证的治疗方法。只有“痰饮”这一证候，留待下节发挥，基本上可以说没有遗漏了。不过，中医的因证施治是多方面的；“夹痰伤寒”经吴坤安采辑，尚有下列几个证治：（一）肺风寒痰——如见憎寒发热、鼻塞头痛、胸满、气急、或咳或喘，右寸脉浮滑或沉伏的，这是风痰在肺；如果舌苔白而润、口不渴的，痰由风邪产生；宜用二陈汤加桑白皮、杏仁、前胡、羌活、苏叶、薄荷之类，微散之。气喘加焦麻黄、葶苈子以泻肺。（二）肺风热痰——如微寒发热、胸闷气逆、咳嗽兼喘、舌苔黄燥、或有白刺、口渴、脉数的，这是风热客肺生痰；宜用前胡、桑白皮、杏仁、栝楼霜、贝母、枯芩、橘红、薄荷、全福花、淡竹叶之类，以去风热，痰自然平息。如果痰闭气逆，加竹沥、姜汁。（三）胞络热痰——如伤寒神昏谵语、眼睛微微固定，或者舌强语涩、舌苔尖赤中白而干燥的，这是热痰乘于胞络；宜用犀角尖、川郁金、石菖蒲、天竺黄、川贝、钩藤、淡竹叶、栝楼霜之类。如果舌绛神呆、痰潮语涩的，是内闭；加西黄。（四）痰挟痧疹——凡时感伤寒，初起即胸中烦闷、气急痰喘，先用豁痰利气药，痰已行而喘减，但烦闷、身热不除，反而加重耳聋足冷的；这一定是痰挟痧疹。急宜透发提之，如羚角、连翘、牛蒡、防风、葛根、枳壳、桔梗、蝉蜕之类。（五）络中湿痰——如发热脘闷、胸胁肩背皆痛，这是湿痰窃踞肺胃之络；痰气交阻，所以疼痛。宜用六安煎去甘草，加桂枝、钩丁、蒺藜、栝楼皮、片姜黄、白僵蚕、木香汁之类，通之行之。（六）痰入肝络——伤寒有解表之后，肢体不能转动的，这是痰入于肝络。当以南星、礞石、半夏、栝楼、茯苓、陈皮、天虫、全蝎、姜汁炒蒺藜、川桂枝、旋复花之类；以搜入络之痰，肢体自然舒展。如果未见效，即以养血药兼之。（七）解后伏痰——伤寒解表之后，热势稍退，但觉得目光迟钝神志呆滞，身体沉重或疼痛，胸满不畅的；这是胃中有伏痰。右关脉必沉伏、或沉滑，宜用二陈汤加枳实、栝楼、姜汁、竹茹之类；豁之行之。（八）积痰——如发热、胸闷、咳嗽气急、痰多浓稠的，是中宫积痰。宜燥润并用，南星、半夏、栝楼、海石、枳实、陈皮、茯苓之类；或者导痰汤亦可。”以上八条痰证，都与伤寒有关，其属于内因的，不列入。
(A small amount of juice is taken, mixed with rock sugar powder, and pounded into pills the size of a cherry. These are held in the mouth to dissolve slowly and swallowed.) If there is coughing with reverse flow of Qi, coarse breathing, expectoration of thick and sticky phlegm, or even protrusion of the eyes as if they were about to fall out, and a rattling sound in the throat, this is caused by cold-phlegm restraining heat and obstructing the trachea. This condition is named "Phlegm Asthma" (Tan Chuan). The treatment principle should be to resolve phlegm and direct Qi downward, using Baiguo Dingchuan Tang (White Fruit Asthma-Calming Decoction) as the main formula. (Raw Bai Guo [Ginkgo Seed] 21 pieces, pounded; Jiang Banxia [Pinellia Rhizome Prepared with Ginger] 3 qian; Sheng Sangpi [Morus Cortex Raw] 3 qian; Kuandonghua [Fritillaria Thunbergii Flower] 3 qian; Guang Xingren [Prunus Armeniaca Seed Smoothed] 3 qian; Su Zi [Perilla Fruit] 2 qian; Juhong [Citrus Reticulata Peel Red] 1.5 qian; Pian Qin [Scutellaria Baicalensis Root Slice] 1.5 qian; Mahuang [Ephedra Herb] 1 qian; Sheng Gancao [Licorice Root Raw] 0.5 qian.) For severe cases, use Xiao Qinglong Jia Shigao Tang (Minor Green Dragon Decoction plus Gypsum). (This is the original Xiao Qinglong Tang formula plus 8 qian of Sheng Shigao [Gypsum Fibrosum Raw].) Alternatively, use Dingchuan Wuhu Tang (Asthma-Calming Five Tigers Decoction). (Mahuang [Ephedra Herb] 1 qian; Guang Xingren [Prunus Armeniaca Seed Smoothed] 3 qian; Sheng Shigao [Gypsum Fibrosum Raw] 4 qian; Zhi Gancao [Licorice Root Prepared with Honey] 0.4 qian; Bei Xixin [Asarum Root North] 0.5 qian.) For chronic cases, hold Wangshi Tan Chuan Wan (Wang's Phlegm-Asthma Pill) in the mouth. (Baitanxiang [Santalum Album Wood White] 1 liang; Baidoukou [Amomum Cardamomum Seed White] 1 liang; Haifen [Concha Tridacnidae] 1 liang; Chuanbei [Fritillaria Cirrhosa Bulb Sichuan] 1 liang; Maidong [Ophiopogon Japonicus Tuber] 1 liang; Ercha [Catechu] 1 liang; Dan Tiandong [Asparagus Cochinchinensis Root Light] 5 qian; Boheye [Mentha Haplocalyx Leaf] 5 qian; Ku Jiegeng [Platycodon Grandiflorus Root Bitter] 3 qian; Guang Muxiang [Aucklandiae Radix Broad] 3 qian; Shexiang [Moschus] 0.05 qian; Meibing [Borneolum Syntheticum Plum] 0.05 qian. Grind all into fine powder, decoct 4 liang of Gancao [Licorice Root] to make paste, form pills the size of Euryale Seed. Hold one pill in the mouth to dissolve each time.) If phlegm knots in the throat, causing coughing with upward rushing Qi, or making sucking/gaping sounds, or a sound like a water frog in the throat, this is caused by cold-phlegm wrapping heat and blocking the larynx. This condition is named "Phlegm Wheeze" (Tan Xiao). The treatment principle should be to open the lungs and resolve phlegm, using Shegan Ma Huang Tang (Belamcanda and Ephedra Decoction). (Shegan [Belamcanda Rhizome] 1.5 qian; Mahuang [Ephedra Herb] 1 qian; Jiang Banxia [Pinellia Rhizome Prepared with Ginger] 3 qian; Kuandonghua [Fritillaria Thunbergii Flower] 3 qian; Ziwan [Asteris Radix Purple] 3 qian; Ganjiang [Zingiberis Rhizoma Dry] 0.8 qian mixed and pounded with Bei Wuwei [Schisandrae Fructus North] 0.3 qian; Bei Xixin [Asarum Root North] 0.5 qian; Da Hongzao [Jujubae Fructus Large] 3 pieces.) Hold Qingjin Wan (Clear Metal Pill) in the mouth. (Yazao [Gleditsiae Sinensis Spine Tooth Soap] 3 qian, mixed with stir-fried Laifuzi [Raphani Semen Stir-fried] 1 liang, ground into fine powder; add a little Jiangzhi [Zingiberis Rhizoma Fresh Juice] and Zhuli [Bambusa Textilis Caulis Sap] to pound into pills the size of Euryale Seed. Use one pill to dissolve in the mouth each time.) If coughing is unsmooth, chest feels stuffy, unable to sleep at night, and feeling irritable and restless, this is caused by fire-phlegm stagnating in the chest and diaphragm. This condition is named "Phlegm Agitation" (Tan Zao). The treatment principle should be to resolve phlegm and descend fire, using Xiaoxiong Xiexin Tang (Drain Chest Drain Heart Decoction) modified. (Gualouren [Trichosanthis Semen] 4 qian; Xian Banxia [Pinellia Rhizome Prepared Immature] 1.5 qian; Xiao Chuanlian [Coptidis Rhizoma Small Sichuan] 0.8 qian; Xiao Zhishi [Aurantii Fructus Immaturus Small] 1 qian; Qing Ziqin [Scutellariae Radix Blue Child] 1 qian; Dan Zhuju [Bambusa Textilis Caulis Sap Light] 3 qian; Jiangzhi [Zingiberis Rhizoma Fresh Juice] 2 drops, mixed with two ladles of Zhuli [Bambusa Textilis Caulis Sap] for simultaneous administration.) For severe cases, swallow Wangsi Sihuang Ditang Wan (Wang's Four-Yellow Phlegm-Scouring Pill). (Chuan Dahuang [Rhei Radix et Rhizoma Sichuan] 4 liang, steamed three times mixed with 1 liang Zhuli [Bambusa Textilis Caulis Sap], 1 qian Jiangzhi [Zingiberis Rhizoma Fresh Juice], and 3 qian Puxiao [Natrii Sulfas]; Jiang Chao Chuanlian [Coptidis Rhizoma Sichuan Stir-fried with Ginger] 5 qian; Tianzhuhuang [Calami Turfina] 3 qian; Gualouren [Trichosanthis Semen] 4 liang; Haigeke [Concha Meretrix] 4 liang; Guang Juhong [Citrus Reticulata Peel Broad] 4 liang; Zhe Fuling [Poria Cocos Zhejiang] 3 liang; Du Danxing [Arisaema Cum Bile] 3 liang; Chao Cangzhu [Atractylodis Rhizoma Stir-fried] 3 liang; Ming Tianma [Gastrodiae Rhizoma Bright] 2 liang; Fu Haishi [Arctitis Fructus Floating] 2 liang; Chao Jiezi [Sinapis Semen Stir-fried] 2 liang; Boheye [Mentha Haplocalyx Leaf] 1.6 liang; Shichangpu [Acori Tatarinowii Rhizoma] 1 liang; Shang Chenxiang [Aquilariae Lignum Resinatum Superior] 1 liang; Shang Qingdai [Indici Folium Superior] 1 liang; Zhuli Banxia [Pinellia Rhizome Prepared with Bamboo Sap] 0.6 qian; Baokouren [Amomi Fructus Rotundus White] 0.3 qian; Meibing [Borneolum Syntheticum Plum] 0.1 qian. Grind these twenty ingredients into fine powder. Use 0.9 parts Zhuli [Bambusa Textilis Caulis Sap] and 0.1 part Jiangzhi [Zingiberis Rhizoma Fresh Juice] to make pills the size of small green mung beans. Coat with fine powder of Shigao [Gypsum Fibrosum] 5 qian, Guang Niuhuang [Bovis Calculus Broad] 2 qian, and Chensha [Cinnabaris] 1 qian. Take 1 qian for mild cases, 2 qian for severe cases, washed down with boiled water. This formula also treats various conditions such as phlegm from food and drink, chest/diaphragm confusion/stuffiness, reverse-flow Qi cough, and asthma with phlegm obstruction. The formula is recorded in Meng Ying's *Jiming Lu* (Chicken Cry Record).) If small scrofula or large nodules first appear in the neck, without pain or itching, appearing in clusters like beads, this is due to Qi stagnation and phlegm coagulation forming enlarged suction nodules. Initially named "Phlegm Nodule" (Tan He), later called "Phlegm String" (Tan Chuan). Treatment must first differentiate the cause. If caused by Liver Fire and Phlegm Coagulation, internally take Xiaoyao Erchen Tang (Free and Easy Wanderer Two-Chen Decoction) modified. (Quan Danggui [Angelicae Sinensis Radix Whole] 1.5 qian; Danpi [Moutan Cortex] 1.5 qian; Sheng Baishao [Paeoniae Radix Alba Raw] 5 qian; Zibeitiankui [Tussilaginiae Flos Purple Back] 5 qian; Zhuli Banxia [Pinellia Rhizome Prepared with Bamboo Sap] 3 qian; Tianhuafen [Trichosanthis Radix] 3 qian; Pugongying [Taraxaci Herba] 3 qian; Guang Pi [Citrus Reticulata Peel Broad] 1 qian; Chuan Chaihu [Bupleuri Radix Sichuan] 0.6 qian; Boheye [Mentha Haplocalyx Leaf] 0.5 qian, infused.) Administer Chengshi Xiaoluo Wan (Cheng's Scrofula-Dispersing Pill) alongside. (Xuan Shen [Scrophulariae Radix] 4 liang; Chuan Bei [Fritillaria Cirrhosa Bulb Sichuan] 4 liang; Mu Li [Ostrea Concha] 4 liang. Add a little Jiangzhi [Zingiberis Rhizoma Fresh Juice] and Zhuli [Bambusa Textilis Caulis Sap] to pound into pills the size of mung beans. Take 2-3 qian each time.) Externally apply Yiyang Wulong Gao (Suppress Yang Black Dragon Ointment). First, take 4 liang of Chen Xiaofen [Starch Old], stir-fry until yellow, grind fine, mix with aged rice vinegar to form paste, boil until black like lacquer, store in porcelain jar. When using, adjust Yiyang San (Suppress Yang Powder) according to nodule size: Tianhuafen [Trichosanthis Radix] 3 qian, Jianghuang [Curcumae Longae Rhizoma] 1 qian, Baizhi [Angelicae Dahuricae Radix] 1 qian, Chishao [Paeoniae Radix Rubra] 1 qian, grind fine, mix evenly, spread on cloth. Even if itchy, do not scratch or disturb; it will dissipate naturally over time. If caused by Yang Deficiency and Phlegm Coagulation, internally take Wangshi Yanghe Tang (Wang's Sun-Warming Decoction). (Mahuang [Ephedra Herb] 0.5 qian, mixed and pounded with Shudi [Rehmanniae Radix Preparata] 5 qian; Lujiaojiao [Cervi Cornu Colla Deer Antler Glue] 1.5 qian, melted and administered; Baijiezi [Sinapis Semen White] 1 qian; Zigui [Cinnamomi Ramulus Purple] 0.5 qian; Qing Zhigancao [Licorice Root Prepared Clear Honey] 0.5 qian; Ganjiangtan [Zingiberis Rhizoma Carbonized] 0.4 qian. Decoct with half wine and half water.) Externally apply Yinyang Xiaohé Gao (Suppress Yin Nodule-Dissolving Ointment). (Zhi Gansui [Kansui Radix Prepared] 2 liang; Hongya Daji [Radix Euphorbiae Humifusae Red Sprout] 3 liang; Baijiezi [Sinapis Semen White] 0.8 qian; Mahuang [Ephedra Herb] 0.4 qian; Sheng Nanxing [Arisaema Cum Bile Raw] 1.6 liang; Zhi Tianchong [Myxococcus Stalks Straight] 1.6 liang; Puxiao [Natrii Sulfas] 1.6 liang; Tenghuang [Rhizoma Curcumae Aromatae Vine] 1.6 liang; Jiang Banxia [Pinellia Rhizome Prepared with Ginger] 1.6 liang.) When using, mix in Yinyang San (Suppress Yin Powder): Zhi Caowu [Aconiti Radix Preparata] 2 qian, Zhi Nanxing [Arisaema Cum Bile Prepared] 1 qian, Duhuo [Angelicae Pubescentis Radix] 1 qian, Baizhi [Angelicae Dahuricae Radix] 1 qian, Ye Langdu [Genitae Radix Wild] 1 qian. Grind fine, mix evenly, spread on cloth.) If already ulcerated or ulcerated for a long time without healing, internally take Guishao Liujunzi Tang (Angelica and Peony Six-Gentlemen Decoction). (Quan Danggui [Angelicae Sinensis Radix Whole] 2 qian; Sheng Baishao [Paeoniae Radix Alba Raw] 3 qian; Lu Dangshen [Codonopsis Radix Lu] 3 qian; Zhe Fuling [Poria Cocos Zhejiang] 3 qian; Jiang Banxia [Pinellia Rhizome Prepared with Ginger] 3 qian; Sheng Shai Zhu [Atractylodis Macrocephalae Rhizoma Raw Sun-dried] 1.5 qian; Guang Pi [Citrus Reticulata Peel Broad] 1.5 qian; Qing Zhigancao [Licorice Root Prepared Clear Honey] 0.8 qian; Xian Shengjiang [Zingiberis Rhizoma Fresh Raw Ginger] 0.6 qian; Da Hongzao [Jujubae Fructus Large] 3 pieces.) Administer Xihuang Wan (Rhino Horn Yellow Pill) alongside. (Zhi Ruxiang [Boswelliae Resina Preparata] 1 liang, Zhi Moyao [Commiphora Myrrha Preparata] 1 liang, Xi Huang [Bovis Calculus West] 0.03 qian, Shexiang [Moschus] 0.03 qian. Grind evenly. Take 1 liang of Huang Mi Fan [Yellow Rice Steamed] to pound medicine, add powder, pound again into pills the size of Radish Seed. Sun-dry, avoid baking. Take 1.5 qian each time.) Follow with Dazao Wan (Large Date Pill) to conclude treatment. (Shanyang Shi [Capra Hircus Faeces Goat] 3 qian, sun-dry, stir-fry until carbonized, grind to powder. First pound black date flesh into mud, then mix with goat manure powder, form pills the size of mung beans. Take 2-3 qian each time.) Externally apply Yanghe Jiening Gao (Sun-Warming Harmony Solidification Ointment). (Fresh Niubangzi Cao [Arctii Herba Fresh] including roots, leaves, stems 3 jin; Huo Baifengxian Geng [Impatiens Balfourii Stem Live] 4 liang. Use 10 jin of Xiangyou [Sesame Oil]. Boil these two until withered, remove dregs. Next day, add Chuanxiong [Ligustici Chuanxiong Rhizoma] 4 liang, Fuzi [Aconiti Lateralis Radix Preparata] 2 liang, Guizhi [Cinnamomi Ramulus] 2 liang, Dahuang [Rhei Radix et Rhizoma] 2 liang, Danggui [Angelicae Sinensis Radix] 2 liang, Rougui [Cinnamomi Cortex] 2 liang, Guanzi Gui [Cinnamomi Cortex Official] 2 liang, Caowu [Aconiti Radix Lateralis Preparata] 2 liang, Chuanwu [Aconiti Radix Preparata] 2 liang, Dilong [Pheretima] 2 liang, Jiangcan [Bombyx Batryticatus] 2 liang, Chishao [Paeoniae Radix Rubra] 2 liang, Baizhi [Angelicae Dahuricae Radix] 2 liang, Bailian [Trollii Radix] 2 liang, Baiji [Bletillae Rhizoma] 2 liang, Xuduan [Dipsaci Radix] 1 liang, Fangfeng [Saposhnikoviae Radix] 1 liang, Jingjie [Schizonepetae Spica] 1 liang, Wulingzhi [Trogopterori Faeces] 1 liang, Muxiang [Aucklandiae Radix] 1 liang, Xiangyuan [Citri Medica Fructus] 1 liang, Chenpi [Citrus Reticulata Peel Aged] 1 liang. Boil again until herbs are withered, strain dregs. Let oil cool overnight. Weigh. For every 1 jin of oil, add 7 liang of Chao Taodan [Lead Monoxide Stir-fried]. Mix well, simmer on low heat until dripping water forms pearls and does not stick to fingers. Cover fire with wet coarse paper, move oil pot to cold stove. Add Ruxiang [Boswelliae Resina] and Moyao [Commiphora Myrrha] powders, 2 liang each; Suheyóu [Styrax Liquid] 4 liang; Shexiang [Moschus] 1 liang. Grind fine, incorporate into ointment, mix well. After half a month, spread on cloth. Applies to all ulcerated yin abscesses, frostbite (one night application cures completely); for ulcers, three applications cure completely.) If caused by Wind-Phlegm and Damp-Phlegm brewing, internally take Maju Erchen Tang (Ephedra and Chrysanthemum Two-Chen Decoction) removing Gancao [Licorice Root]. Administer Kongyan Dan (Controlling Saliva Pill) 0.3 qian to eliminate root and prevent recurrence. Externally apply Wangshi Huahe Gao (Wang's Nodule-Dissolving Ointment). (Caiyou [Rapeseed Oil] 4 jin; Bihu [Gecko] 14; Zhizhu [Spider] 28; Woniu [Snail] 36. Put in pot, boil until withered and floating on oil surface, remove. Add fresh Shouwutengye [Polygoni Multiflori Caulis Leaf] 0.5 jin, Ganjugen [Chrysanthemi Indici Radix] 0.5 jin, Bohe [Menthae Haplocalyx Herba] 0.5 jin, Niubang [Arctii Fructus] 0.5 jin, Can'er [Xanthii Fructus] etc. herbs 0.5 jin each. Boil on high heat until herbs are withered, remove dregs. Wait for oil to cool, then add Lianqiao [Forsythiae Fructus] 0.5 jin, Yuan Shen [Scrophulariae Radix] 0.5 jin, Kushen [Sophorae Flavescentis Radix] 0.5 jin, Bailian [Trollii Radix] 0.5 jin, Baijiezi [Sinapis Semen White] 0.5 jin, Jiangcan [Bombyx Batryticatus] 0.5 jin, Shuihongziren [Momordicae Semen Water Red] crushed 0.5 jin, Dahuang [Rhei Radix et Rhizoma] 4 liang, Jingjie [Schizonepetae Spica] 4 liang, Fangfeng [Saposhnikoviae Radix] 4 liang. Soak overnight. Boil until black and withered, strain clear oil. Weigh. Boil until dripping water does not disperse. Return previously prepared Muguo You [Mugua Oil Prepared] to match with Chao Dongdan [East Lead Oxide Stir-fried]. Add slowly, stir slowly. Mix well, simmer on low heat until dripping water forms pearls and ointment does not stick to fingers. Add Dingxiangyou [Caryophylli Oleum] 0.2 qian, Shexiang [Moschus] 0.2 qian, Suheyóu [Styrax Liquid] 1 liang. Mix well, remove fire, spread on cloth. Applies to scrofula, tubercles, malignant nodules; applying this ointment causes them to dissipate secretly.) If food enters the stomach but immediately vomits sticky saliva, chest/diaphragm blocked and不通, stool dry and shaped like sheep dung, this is Qi stagnation carrying phlegm blocking the stomach cavity. This condition is named "Phlegm Obstruction" (Tan Ge). The treatment principle should be pungent-moistening phlegm-scouring, using Wuzhi Yin (Five-Juice Drink) plus Goubao [Bezoar Dog] as the main treatment. (Lizhi [Pyrus Sinkiangensis Juice] 2 ladles, Zheshi [Sacchari Sinarum Juices] 2 ladles, Laifu Zhi [Raphani Juice] 2 ladles, Xian Shichangpu Zhi [Acori Tatarinowii Rhizoma Fresh Juice] 1 small spoon, Shengjiang Zhi [Zingiberis Rhizoma Fresh Juice] 2 drops. Mix evenly, warm in double boiler, mix with 0.3 qian Goubao [Bezoar Dog] powder to take.) Or use Chengshi Qige Yin (Cheng's Diaphragm-Opening Decoction) modified. Beishashen [Glehniae Radix North] 3 qian, Danshen [Salviae Miltiorrhizae Radix] 3 qian, Jing Chuanbei [Fritillaria Ussuriensis Bulb Beijing] 1.5 qian, Guang Yujin [Curcumae Arorhizoma Radix Broad] 1.5 qian, Mi Zhi Juhong [Citrus Reticulata Peel Red Honey-Fried] 1 qian, Zhe Fuling [Poria Cocos Zhejiang] 1 qian, Chun Shaqiao [Amomi Fructus Rotundus Spring Shell] 0.5 qian, Chutouku [Rice Husk Pestle Head] 0.5 qian, Heye Di [Nelumbinis Folium Peduncle] 2 pieces. Decoct, mix with 0.5 qian Yushu San (Mouse Rat Powder). (Fresh newborn mouse, bake on new tile until dry, grind to powder.) For severe cases, use Yunqi Renshen San (Yunqi Ginseng Powder). (Jilin Shen [Panax Ginseng Radix Jilin] 1 qian, decoct, mix with Shexiang [Moschus] 0.003 qian, Bingpian [Borneolum Syntheticum] 0.0015 qian. Do one's best to restore heavenly mechanism.)
[Rongzhai Note]: This section was edited, polished, and supplemented from Ge Cunju's *Shanghan Butianshi* (Supplement to the Sky Stone for Cold Damage) chapter on "Phlegm Syndrome Cold Damage". Mr. Lianchen further listed various treatment methods, not only analyzing exogenous phlegm syndromes clearly, but also pointing out treatments for endogenous phlegm syndromes. Only the "Phlegm-Fluid" syndrome is reserved for the next section to elaborate, basically saying nothing is left out. However, TCM treatment based on syndrome differentiation is multi-faceted. "Cold Damage with Accompanying Phlegm," collected by Wu Kun'an, includes the following syndrome treatments: (1) Lung Wind-Cold Phlegm – e.g., aversion to cold with fever, nasal congestion, headache, chest fullness, shortness of breath, or cough or wheezing, right Cun pulse floating-slippery or deep-hidden; this is Wind-Phlegm in the Lung; if tongue coating is white and moist, mouth not thirsty, phlegm generated by Wind pathogen; suitable for Erchen Tang plus Sangbai, Xingren, Qianhu, Qianghuo, Suzi, Bohe etc., to mildly disperse. For wheezing, add Jiao Mahuang [Ephedra Stir-fried Charcoal] and Tinglizi [Descurainiae Semen] to drain Lung. (2) Lung Wind-Heat Phlegm – e.g., slight aversion to cold with fever, chest stuffiness, reverse-flow Qi, cough with wheezing, tongue coating yellow-dry or with white prickles, thirst, rapid pulse; this is Wind-Heat lodging in Lung generating phlegm; suitable for Qianhu, Sangbai, Xingren, Lou Shuang [Trichosanthis Pericarpium Frost], Beimu, Ku Qin [Scutellariae Radix Dry], Juhong, Bohe, Quan Fuhua [Adenophorae Flos Whole], Dan Zhuye [Lophatheri Herba Light] etc., to dispel Wind-Heat, phlegm will calm itself. If phlegm blocks and Qi reverses, add Zhuli [Bambusa Textilis Caulis Sap] and Jiangzhi [Zingiberis Rhizoma Fresh Juice]. (3) Bao Luo Heat Phlegm – e.g., cold damage with delirious speech, eyes slightly fixed, or stiff tongue with slurred speech, tongue coating red tip, white middle, dry; this is Heat-Phlegm attacking Bao Luo (Pericardium); suitable for Xijiao Jian [Rhinocerotis Cornu Tip] (now substituted with Shuiniu Jiao [Water Buffalo Horn]), Chuan Yujin [Curcumae Arorhizoma Radix Sichuan], Shichangpu [Acori Tatarinowii Rhizoma], Tianzhuhuang [Calami Turfina], Chuan Bei [Fritillaria Cirrhosa Bulb Sichuan], Gouteng [Uncariae Ramulus cum Uncis], Dan Zhuye [Lophatheri Herba Light], Lou Shuang [Trichosanthis Pericarpium Frost] etc. If tongue is crimson, spirit dull, phlegm flooding with slurred speech, it is internal closure; add Xi Huang [Bovis Calculus West]. (4) Phlegm Accompanying Rash – e.g., seasonal infection cold damage, initially chest烦闷 (vexation/stuffiness), shortness of breath, phlegm-wheezing, first use phlegm-resolving and Qi-directing medicines; after phlegm moves and wheezing decreases, but vexation/stuffiness remains, body heat does not subside, instead adding deafness and cold feet; this must be Phlegm accompanying Rash. Urgently need to vent and lift, such as Lingjiao [Saiga Tatarica Cornu] (substitute with Niujiao [Bovis Cornu]), Lianqiao [Forsythiae Fructus], Niubang [Arctii Fructus], Fangfeng [Saposhnikoviae Radix], Gegen [Puerariae Lobatae Radix], Zhike [Aurantii Fructus Immaturus], Jiegeng [Platycodonis Radix], Chantui [Cicadae Periostracum] etc. (5) Collateral Damp-Phlegm – e.g., fever, epigastric stuffiness, pain in chest, hypochondrium, shoulders, back; this is Damp-Phlegm occupying collaterals of Lung and Stomach; Phlegm-Qi inter-blockage causes pain. Suitable for Liu'an Jian (Six-Safe Decoction) removing Gancao [Licorice Root], adding Guizhi [Cinnamomi Ramulus], Gouding [Uncariae Ramulus cum Uncis with Hook], Jili [Tribuli Fructus], Lou Pi [Trichosanthis Pericarpium], Pian Jianghuang [Curcumae Longae Rhizoma Slice], Bai Jiangcan [Bombyx Batryticatus], Muxiang Zhi [Aucklandiae Radix Juice] etc., to unblock and circulate. (6) Phlegm Entering Liver Collateral – e.g., after cold damage exterior resolution, limbs cannot move; this is Phlegm entering Liver collateral. Should use Nanxing [Arisaema Cum Bile], Mengshi [Magnitatis Os Preparata], Banxia [Pinelliae Rhizoma], Lou [Trichosanthis], Fuling [Poria], Chenpi [Citri Reticulatae Pericarpium], Tianchong [Myxococcus Stalks], Quanxie [Scorpio], Jiangzhi Chao Jili [Tribuli Fructus Stir-fried with Ginger Juice], Chuan Guizhi [Cinnamomi Ramulus Sichuan], Xuanfu Hua [Inulae Flos] etc.; to search out phlegm entering collaterals, limbs will naturally move. If no response, combine with blood-nourishing medicines. (7) Post-Resolution Latent Phlegm – e.g., after cold damage exterior resolution, heat slightly subsides, but feel dull eyes, dull spirit, heavy body or pain, chest fullness unsmooth; this is latent phlegm in Stomach. Right Guan pulse must be deep-hidden or deep-slippery. Suitable for Erchen Tang plus Zhishi [Aurantii Fructus Immaturus], Lou [Trichosanthis], Jiangzhi [Zingiberis Rhizoma Fresh Juice], Zhuru [Bambusae Caulis in Taenia] etc.; resolve and circulate. (8) Accumulated Phlegm – e.g., fever, chest stuffiness, cough, shortness of breath, copious thick phlegm; this is Middle Palace accumulated phlegm. Suitable for combining drying and moistening, Nanxing [Arisaema Cum Bile], Banxia [Pinelliae Rhizoma], Lou [Trichosanthis], Haishi [Arctitis Fructus], Zhishi [Aurantii Fructus Immaturus], Chenpi [Citri Reticulatae Pericarpium], Fuling [Poria] etc.; or Daotan Tang (Great-Phlegm Decoction) is also acceptable." Above eight phlegm syndromes are all related to cold damage; those belonging to endogenous causes are not listed here.