案例：周某，女，４６岁，教师。１９９１年９月３日初诊。心悸胸闷腹胀反复发作７年，复发加重１月。１９８４年因妊娠行人流术后，情志不舒，大量食用海马蒸鸡等，致手足浮肿，心悸，腹第三卷２０４胀，以为虚损使然，又过服补益之药膏（药名不详），上证加重。曾多次到一冶职工医院诊治，心电图：“频发室性早搏”；肝功、Ｂ超检查正常。考虑为“更年期综合征”、“频发性室早”，予服心律平、谷维素、肌苷片等西药及中药健脾益气、活血化瘀之剂，无明显效果，特请李氏诊治。现症：心悸胸闷，头昏乏力，失眠多梦，性情烦躁，腹胀纳呆，嗳气频作，大便干燥，小便灼热，月事已３月未潮，舌红苔薄黄，脉来结代，每分钟歇止８～９次。李氏断曰：心主血脉，肝主疏泄，脾主运化，情志不遂，滥用补益，则肝气郁滞，脾胃失运，血运失常，心神失养，故有心悸胸闷、纳差腹胀、性情烦躁、脉来结代等证也。治疗之法，当以疏肝解郁、宽胸理气、健脾和胃、养心安神为法。处方：柴胡１０克、炒枳壳１０克、制香附１０克、苏梗１０克、郁金１０克、瓜蒌皮１２克、薤白１０克、橘红１０克、白芍１２克、炒丹皮１０克、茯神１５克、合欢皮１０克、麦芽１５克。
二诊：服用上方５剂，心悸好转，浮肿腹胀减轻，大便也较前通畅，脉转细数，惟稍有胸闷。
于前方适量参入养血活血之品：柴胡１０克、炒枳壳１０克、丹参１５克、赤白芍各１２克、蒌皮１２克、薤白１０克、郁金１０克、苏梗１０克、制香附１０克、合欢皮１０克、麦芽１５克。连服１５剂，心悸胸闷消失，身无浮肿，纳食正常，脉象细而带弦。惟食后稍感腹部不适。后用疏肝健脾，养血和血之剂调治而愈。
（四）活血通络血瘀气滞于心律失常中极为常见。盖气为血帅，血为气母，气行则血行，气滞则血郁，若禀赋不足，或脏腑失调，劳役过度，寒热扰心，情志不舒等，均可导致气血凝滞，血脉不通，而发生心律失常，李时珍所谓“结脉皆因气血凝”（《濒湖脉学》）是也。活血化瘀，调畅气机，对改善微循环增加冠脉流量，抗心律失常等有良好功效。
证见胸闷刺痛频频发作，心悸气短，精神抑郁，头昏身倦，面色晦暗，唇甲青紫，舌质暗红或边有瘀点，舌苔薄白或薄黄。病久阴伤者舌红少苔，脉沉弦涩或促或结代。其多见于冠心病、风心病等引起的早搏、房颤等心律失常。治宜活血通络，行气止痛。药用：桃仁、红花、当归、赤芍、枳壳、生地、丹参、制香附、山楂炭等。若瘀血胸痛甚者，加乳没、灵脂、玄胡等活络止痛；胸闷有窒息感者，加厚朴、苏梗、蒌皮、郁金等宽胸理气；心悸头昏，有热象者，加葛根、苦参、黄连以清心泻热；心率较快，阴虚阳亢者，加夏枯草、菊花、钩藤等清热潜阳；胸闷有痰者，加瓜蒌皮、薤白、法夏、川贝等化痰散结；心阴虚损者，加人参、麦冬、五味子、炙甘草等滋阴复脉；心阳不足者，加党参、桂枝、甘草等温通心阳。
案例：梁某，男，７４岁，干部。１９８９年９月初诊。心悸胸闷反复发作５年，复发加重半年。
５年前因为劳累及饮酒病发心悸胸闷，发作欲死，即到某医院住院治疗，经超声心动图等检查，诊断为冠心病，心房纤颤。用西地兰等治疗，病情缓解但稍遇劳累或情志不舒时，房颤又发。
先后住院５次，房颤时发时止。近半年来，发作尤为频繁，故请中医治疗。刻诊所见：心悸气短，胸闷不适，时有胸痛，痛如针刺，动则喘气，睡眠多梦，口干舌燥，大便干结，小便带黄，舌质暗红边有瘀点，苔光剥少津，脉来见代。辨属心血瘀阻，脉络不通，阴津亏耗，心神失养，治用活血通络，理气宽胸，滋阴复脉。处方：丹参３０克、赤白芍各１５克、桃仁１０克、红花６克、炒枳壳１０克、郁金１０克、瓜蒌仁１５克、生地１５克、太子参１５克、麦冬１０克、五味子１０克、炙甘草１５克、炒山楂１５克。
二诊：心悸气短好转，心痛消失，大便通畅，舌面有少许津液，但仍有胸闷，稍有气喘，睡不第三卷２０５安神，舌暗红边有瘀点，苔有光剥较前为好转，脉代。是血脉瘀滞未去，心阴亏虚证在，宗上方略为出入为治。处方：丹参３０克、赤白芍各１５克、制乳没各６克、瓜蒌仁１５克、柏子仁１０克、茯神１８克、西洋参６克（另包切片含服）、麦冬１０克、五味子１０克、炙甘草１０克、生地１５克、山楂炭１５克、香橼皮１０克、橘皮络各１０克。连服１５剂，心悸胸闷气短缓解，喘促已平，舌上有薄白苔，脉转细数。心电图检查基本正常。后以养血活血、滋阴复脉、宽胸理气之法调治数月而愈。
李氏认为，心律失常一般以虚证多见，然也有以瘀血、气滞或痰阻为主者，临床治疗当有所侧重。据李氏经验，若过速性心律失常者，用柏子仁、当归、菟丝子、石斛、徐长卿等养血安神，滋阴补肾的药物有减慢心律的作用；若过缓性心律失常者，用麻绒、麝香、鹿茸、茶叶等芳香走窜，温阳兴奋的药物，有加速心率的作用。此外，如炙甘草汤及生地、麦冬、玄胡、赤芍、柴胡、桂枝、茵陈、苦参等均有抗心律失常的作用，临床可随证选用，又不可拘于一隅。
五、慢性咳嗽辨治经验慢性咳嗽，一般病程日久，缠绵难愈，尤以合并肺部感染者，治疗颇为棘手。李氏结合自己数十年的临床经验，辨证处方用药，收到良好效果。
（一）邪热恋肺清肺止咳外感咳嗽，若服解表宣肺之品仍咳嗽不止，或用温燥太过，极易化热伤肺，致邪热恋肺，痰浊内阻，咳嗽剧烈，咽痒难忍，或稍遇外邪，咳嗽加重。此时用药，宜轻灵平稳，清轻宣肺，化痰止咳，或佐以润肺化痰，可用止嗽散化裁为治。若表邪较重者，可加苏叶、防风以解表散邪；燥热伤肺，干咳少痰者，加瓜蒌、贝母以润燥化痰；痰热内阻，痰液黄稠者，加黄芩、芦根、败酱草、冬瓜仁以清热化痰；咳嗽痰多，舌苔白腻者，加制半夏、茯苓以燥湿化痰。
案例：金某，女，３６岁。１９９１年８月３０日初诊。３年来频发咳嗽，胸部胀痛，发作时间不一，与气候无明显关系。始用麦迪霉素、螺旋霉素、氨苄青霉素等稍能缓解，继用无效，近半年来，咳嗽加剧，辗转数地，经中西医多方诊治，病情如故。１９９１年６月２日到某医学院附属医院住院，纤维支气管镜检查：右支气管化脓性炎症伴右上肺感染性化脓性肺不张。经抗炎、抗过敏及对症处理，症状无明显改善，自动出院。出院结论：由于右肺支气管壁大量白色坏死物附着无法消除，仍频繁咳嗽。随即慕名求诊于李氏。现症：咳嗽频作，无一息之停，咳甚时，小便失禁，彻夜不眠，惟靠镇静镇咳物能入睡２～３小时，咳嗽痰少，咽喉发痒咳痰不畅，胸部疼痛，口干且苦，不欲饮食，精神疲惫，舌质红苔薄黄，脉弦细数。李氏断曰：外邪入肺，寒热内合，肺失清肃，则咳嗽频作也。肺主气，心主血，两脏同居上焦而肺朝百脉。肺气失宣，血脉失和，则胸闷疼痛，咳嗽剧烈，心神不宁，故彻夜不眠。肺司呼吸，肾主纳气，肺气不利，吸入之气，不能下纳于肾，肾失约藏，则咳甚时小便失禁。治以宣肺清热，化痰止咳，驱邪出表，佐以滋养肾阳。
药用：川贝９克、炙杷叶１５克、炙紫菀１０克、杏仁１０克、桔梗１０克、蒸白部１０克、白前１０克、橘红１０克、通草６克、苏梗１０克、冬瓜子１５克、车前子１０克。５剂。
二诊：药后咳嗽减轻，夜间能入睡４～５小时，原所赖止咳西药已全停用。惟感胸部闷痛，舌质红苔薄黄而干，脉弦细数。宗上法，适量参入宽胸散结，清肺生津之品，药用：苏梗１０克、第三卷２０６前胡１０克、蒸白部１０克、炙紫菀１０在、炒蒌皮１２克、炙杷叶１５克、炒枳壳１０克、冬瓜子１５克、芦根１５克、通草６克。连服５剂，咳嗽即止，胸痛消失，精神转佳，舌红苔薄黄有津，脉来弦细。继以宣肺化痰，宽胸理气，健脾和胃之剂调治，继服２０余剂，病始痊愈。纤支镜报告：右侧化脓性支气管炎与前纤支镜检结果比较，明显好转。随访半年未发。
（二）痰热壅肺清肺化痰支气管炎、肺炎、肺结核等病后期，因病热在里，灼津为痰，或热毒壅瘀，肺络阻滞，或毒热恋肺，肺系伤损，而有发热、咳嗽、咳吐黄痰，或痰少难以咯出，胸中隐隐作痛，或胸闷胀痛，咳时尤甚，舌红苔黄而腻，脉细弦数或滑数等症。治疗之法，当以清肺化痰，软坚散结为主，李氏常以千金苇茎汤、消瘰丸等化裁为用。李氏谓：苇茎汤能清热化痰，活血化瘀；消瘰丸能清热消痰，软坚散结，合用则效力专宏。若热毒盛者，加银花、连翘、鱼腥草等清热解毒；胸闷气滞者，加瓜蒌皮、香附、丝瓜络等宽胸利气；发热咳嗽，痰多口渴者，加桑白皮、黄芩、沙参等清热化痰养阴；热邪在里，小便色黄者，加茅根、车前子等清热利湿。
案例：侯某，男，１６岁，学生。１９９２年５月９日初诊。发热咳嗽胸痛反复发作１年半。
１９９０年因劳累兼受外感而持续发热１周，即至省某医学院附院诊治，当时胸片检查：右下肺炎。住院２０余天用氨苄青霉素等及时处理，烧退出院。出院不到一周，又见发热。复到该院门诊，多次胸部摄片断层检查：左肺下叶基底部有大片模糊影，边缘模糊不清，密度不甚均匀。
诊断为左下叶后基底段肺结核（浸润型）。用利福平口服，日３次，服用月余，肝区不适，ＧＰＴ５０ｕ／赖氏法。改用链霉素治疗，２５天后出现耳鸣，遂又停药，用雷米封等口服。１９９１年９月又持续发热月余，体温３８℃以上，长期反复用头孢拉定等抗炎药，发热渐退，但若偶遇风寒，即又发热，间用交沙霉素、悉复欢等治疗，而咳嗽胸痛未去，肺部阴影不消。１９９２年１月１４日做纤支镜检：左支气管结核，左下支气管炎。继用前药无效，休学１年。即请李氏治，诊时所见：咳嗽不止，左下胸部胀痛，晨起咳痰较多，痰液黄稠，有时又不易咯出，口干喜饮，纳食尚可，小便色黄，舌红苔薄黄，脉细弦数。辨属痰热壅肺，肺失清肃，日久津伤之证，治宜消热化痰，宣肺止咳，养阴润肺。药用：苇茎１５克、桃仁２０克、冬瓜子２０克、苡仁３０克、川贝１０克、夏枯草２０克、黄芩１０克、连翘１５克、桑皮１０克、瓜蒌皮１５克、炙杷叶１５克、橘皮络各１０克、白茅根１５克。
二诊：服用上方２１剂，咳嗽胸痛缓解，惟因近日感受外邪，稍有咽痛，左下颌淋巴结轻度肿大，舌红苔薄黄，脉细弦。当从清热化痰，软坚散结，清利咽喉为治。处方：玄参１０克、川贝１０克、夏枯草１８克、连翘１５克、牡蛎１０克、芦根１５克、苡仁２０克、炒牛子１０克、青果１０克、瓜蒌皮１０克、炙杷叶１５克、陈皮１０克、炒黄芩１０克、桑叶１０克、冬瓜仁１５克。此方加减服用３０余剂，咳嗽胸痛、颌下淋巴结肿大等均告消失，咽喉不痛，纳食正常，小便通利，几次胸部透视及摄片检查：左下肺阴影消失。继以养阴润肺，清热化痰，健脾和胃调理而愈。随访１年未见复发，并告已复学云云。
（三）痰湿阻肺宣肺利水慢性支气管炎并发肺气肿，或支气管哮喘、支气管扩张、肺结核等慢性肺部疾病，久治不愈，可导致右心室肥厚扩大，右心代偿不全，引起右心衰竭。由于久咳伤肺，肺气受损，肺失肃第三卷２０７降，肺气上逆，而出现咳喘，倚息不得卧等症。痰湿内阻，肺气壅塞，不能通调水道，影响脾之运化，肾失气化，而发水肿。治宜宣肺化痰，健脾利水。药用：麻黄、杏仁、苡仁、桑皮、腹皮、茯苓皮、陈皮、防己等。若胸闷气滞者，加蒌皮、薤白等宽胸散结；脘胀纳差者加厚朴、枳实、炒莱菔子、炒山楂等理气和胃；痰涎较甚者，加川贝、法夏等化痰去湿；水肿较剧者，加葶苈子、车前子、茅根等利水消肿；痰黄粘稠者，加石菖蒲、蒲公英、鱼腥草、鸭跖草等清热化痰；面唇青紫者，加丹参、红花、桃仁、赤芍等活血化瘀；气虚咳喘者，加党参、黄芪皮等益气利水；喘促难平者，加黑锡丹温肾定喘；肢冷汗冷脉微者，可用参附龙牡汤加减以回阳救逆。李氏经验：此证温阳药如肉桂、附子等不宜滥用，尤其是病人有咯血证者，用之可加剧出血症状，另若用之时间过长，亦有伤阴损阳之弊。
案例：王某，男，６８岁，退休工人。１９９２年４月１３日初诊。咳喘反复发作５０年，加重３年。
【背景信息】
书名：700.李培生老中医经验集 章节：正文(16/25) 类别：医论
案例：周某，女，46岁，教师。1991年9月3日初诊。心悸（心慌）、胸闷、腹胀反复发作7年，复发加重1个月。1984年因妊娠行人工流产术后，情志不舒（情绪抑郁不畅），大量食用海马蒸鸡等食物，导致手足浮肿，心悸，腹部胀满。第三卷第204页认为这是虚损所致，又过服补益的药膏（药名不详），上述症状加重。曾多次到一冶职工医院诊治，心电图显示：“频发室性早搏”；肝功能、B超检查正常。考虑为“更年期综合征”、“频发性室性期前收缩”，给予服用心律平、谷维素、肌苷片等西药及中药健脾益气、活血化瘀之剂，无明显效果，特请李氏诊治。现症见：心悸胸闷，头昏乏力，失眠多梦，性情烦躁，腹胀纳呆（食欲不振），嗳气频作，大便干燥，小便灼热，月经已3个月未潮，舌红苔薄黄，脉来结代（脉搏节律不齐，时有歇止），每分钟歇止8～9次。李氏断言：心主血脉，肝主疏泄，脾主运化，情志不遂，滥用补益，则肝气郁滞，脾胃失运，血运失常，心神失养，故有心悸胸闷、纳差腹胀、性情烦躁、脉来结代等证候。治疗之法，当以疏肝解郁、宽胸理气、健脾和胃、养心安神为法。处方：柴胡10克、炒枳壳10克、制香附10克、苏梗10克、郁金10克、瓜蒌皮12克、薤白10克、橘红10克、白芍12克、炒丹皮10克、茯神15克、合欢皮10克、麦芽15克。
二诊：服用上方5剂，心悸好转，浮肿腹胀减轻，大便也较前通畅，脉转细数，惟稍有胸闷。
于前方适量参入养血活血之品：柴胡10克、炒枳壳10克、丹参15克、赤白芍各12克、蒌皮12克、薤白10克、郁金10克、苏梗10克、制香附10克、合欢皮10克、麦芽15克。连服15剂，心悸胸闷消失，身无浮肿，纳食正常，脉象细而带弦。惟食后稍感腹部不适。后用疏肝健脾，养血和血之剂调治而愈。
（四）活血通络：血瘀气滞于心律失常中极为常见。盖气为血帅，血为气母，气行则血行，气滞则血郁，若禀赋不足，或脏腑失调，劳役过度，寒热扰心，情志不舒等，均可导致气血凝滞，血脉不通，而发生心律失常，李时珍所谓“结脉皆因气血凝”（《濒湖脉学》）是也。活血化瘀，调畅气机，对改善微循环增加冠脉流量，抗心律失常等有良好功效。
证见胸闷刺痛频频发作，心悸气短，精神抑郁，头昏身倦，面色晦暗，唇甲青紫，舌质暗红或边有瘀点，舌苔薄白或薄黄。病久阴伤者舌红少苔，脉沉弦涩或促或结代。其多见于冠心病、风心病等引起的早搏、房颤等心律失常。治宜活血通络，行气止痛。药用：桃仁、红花、当归、赤芍、枳壳、生地、丹参、制香附、山楂炭等。若瘀血胸痛甚者，加乳没、灵脂、玄胡等活络止痛；胸闷有窒息感者，加厚朴、苏梗、蒌皮、郁金等宽胸理气；心悸头昏，有热象者，加葛根、苦参、黄连以清心泻热；心率较快，阴虚阳亢者，加夏枯草、菊花、钩藤等清热潜阳；胸闷有痰者，加瓜蒌皮、薤白、法夏、川贝等化痰散结；心阴虚损者，加人参、麦冬、五味子、炙甘草等滋阴复脉；心阳不足者，加党参、桂枝、甘草等温通心阳。
案例：梁某，男，74岁，干部。1989年9月初诊。心悸胸闷反复发作5年，复发加重半年。
5年前因为劳累及饮酒病发心悸胸闷，发作欲死，即到某医院住院治疗，经超声心动图等检查，诊断为冠心病，心房纤颤。用西地兰等治疗，病情缓解但稍遇劳累或情志不舒时，房颤又发。
先后住院5次，房颤时发时止。近半年来，发作尤为频繁，故请中医治疗。刻诊所见：心悸气短，胸闷不适，时有胸痛，痛如针刺，动则喘气，睡眠多梦，口干舌燥，大便干结，小便带黄，舌质暗红边有瘀点，苔光剥少津，脉来见代。辨属心血瘀阻，脉络不通，阴津亏耗，心神失养，治用活血通络，理气宽胸，滋阴复脉。处方：丹参30克、赤白芍各15克、桃仁10克、红花6克、炒枳壳10克、郁金10克、瓜蒌仁15克、生地15克、太子参15克、麦冬10克、五味子10克、炙甘草15克、炒山楂15克。
二诊：心悸气短好转，心痛消失，大便通畅，舌面有少许津液，但仍有胸闷，稍有气喘，睡不安神，舌暗红边有瘀点，苔有光剥较前为好转，脉代。是血脉瘀滞未去，心阴亏虚证在，宗上方略为出入为治。处方：丹参30克、赤白芍各15克、制乳没各6克、瓜蒌仁15克、柏子仁10克、茯神18克、西洋参6克（另包切片含服）、麦冬10克、五味子10克、炙甘草10克、生地15克、山楂炭15克、香橼皮10克、橘皮络各10克。连服15剂，心悸胸闷气短缓解，喘促已平，舌上有薄白苔，脉转细数。心电图检查基本正常。后以养血活血、滋阴复脉、宽胸理气之法调治数月而愈。
李氏认为，心律失常一般以虚证多见，然也有以瘀血、气滞或痰阻为主者，临床治疗当有所侧重。据李氏经验，若过速性心律失常者，用柏子仁、当归、菟丝子、石斛、徐长卿等养血安神，滋阴补肾的药物有减慢心律的作用；若过缓性心律失常者，用麻绒、麝香、鹿茸、茶叶等芳香走窜，温阳兴奋的药物，有加速心率的作用。此外，如炙甘草汤及生地、麦冬、玄胡、赤芍、柴胡、桂枝、茵陈、苦参等均有抗心律失常的作用，临床可随证选用，又不可拘于一隅。
五、慢性咳嗽辨治经验：慢性咳嗽，一般病程日久，缠绵难愈，尤以合并肺部感染者，治疗颇为棘手。李氏结合自己数十年的临床经验，辨证处方用药，收到良好效果。
（一）邪热恋肺：清肺止咳。外感咳嗽，若服解表宣肺之品仍咳嗽不止，或用温燥太过，极易化热伤肺，致邪热恋肺，痰浊内阻，咳嗽剧烈，咽痒难忍，或稍遇外邪，咳嗽加重。此时用药，宜轻灵平稳，清轻宣肺，化痰止咳，或佐以润肺化痰，可用止嗽散化裁为治。若表邪较重者，可加苏叶、防风以解表散邪；燥热伤肺，干咳少痰者，加瓜蒌、贝母以润燥化痰；痰热内阻，痰液黄稠者，加黄芩、芦根、败酱草、冬瓜仁以清热化痰；咳嗽痰多，舌苔白腻者，加制半夏、茯苓以燥湿化痰。
案例：金某，女，36岁。1991年8月30日初诊。3年来频发咳嗽，胸部胀痛，发作时间不一，与气候无明显关系。始用麦迪霉素、螺旋霉素、氨苄青霉素等稍能缓解，继用无效，近半年来，咳嗽加剧，辗转数地，经中西医多方诊治，病情如故。1991年6月2日到某医学院附属医院住院，纤维支气管镜检查：右支气管化脓性炎症伴右上肺感染性化脓性肺不张。经抗炎、抗过敏及对症处理，症状无明显改善，自动出院。出院结论：由于右肺支气管壁大量白色坏死物附着无法消除，仍频繁咳嗽。随即慕名求诊于李氏。现症：咳嗽频作，无一息之停，咳甚时，小便失禁，彻夜不眠，惟靠镇静镇咳物能入睡2～3小时，咳嗽痰少，咽喉发痒咳痰不畅，胸部疼痛，口干且苦，不欲饮食，精神疲惫，舌质红苔薄黄，脉弦细数。李氏断曰：外邪入肺，寒热内合，肺失清肃，则咳嗽频作也。肺主气，心主血，两脏同居上焦而肺朝百脉。肺气失宣，血脉失和，则胸闷疼痛，咳嗽剧烈，心神不宁，故彻夜不眠。肺司呼吸，肾主纳气，肺气不利，吸入之气，不能下纳于肾，肾失约藏，则咳甚时小便失禁。治以宣肺清热，化痰止咳，驱邪出表，佐以滋养肾阳。
药用：川贝9克、炙杷叶15克、炙紫菀10克、杏仁10克、桔梗10克、蒸白部10克、白前10克、橘红10克、通草6克、苏梗10克、冬瓜子15克、车前子10克。5剂。
二诊：药后咳嗽减轻，夜间能入睡4～5小时，原所赖止咳西药已全停用。惟感胸部闷痛，舌质红苔薄黄而干，脉弦细数。宗上法，适量参入宽胸散结，清肺生津之品，药用：苏梗10克、第三卷第206页前胡10克、蒸白部10克、炙紫菀10在、炒蒌皮12克、炙杷叶15克、炒枳壳10克、冬瓜子15克、芦根15克、通草6克。连服5剂，咳嗽即止，胸痛消失，精神转佳，舌红苔薄黄有津，脉来弦细。继以宣肺化痰，宽胸理气，健脾和胃之剂调治，继服20余剂，病始痊愈。纤支镜报告：右侧化脓性支气管炎与前纤支镜检结果比较，明显好转。随访半年未发。
（二）痰热壅肺：清肺化痰。支气管炎、肺炎、肺结核等病后期，因病热在里，灼津为痰，或热毒壅瘀，肺络阻滞，或毒热恋肺，肺系伤损，而有发热、咳嗽、咳吐黄痰，或痰少难以咯出，胸中隐隐作痛，或胸闷胀痛，咳时尤甚，舌红苔黄而腻，脉细弦数或滑数等症。治疗之法，当以清肺化痰，软坚散结为主，李氏常以千金苇茎汤、消瘰丸等化裁为用。李氏谓：苇茎汤能清热化痰，活血化瘀；消瘰丸能清热消痰，软坚散结，合用则效力专宏。若热毒盛者，加银花、连翘、鱼腥草等清热解毒；胸闷气滞者，加瓜蒌皮、香附、丝瓜络等宽胸利气；发热咳嗽，痰多口渴者，加桑白皮、黄芩、沙参等清热化痰养阴；热邪在里，小便色黄者，加茅根、车前子等清热利湿。
案例：侯某，男，16岁，学生。1992年5月9日初诊。发热咳嗽胸痛反复发作1年半。
1990年因劳累兼受外感而持续发热1周，即至省某医学院附院诊治，当时胸片检查：右下肺炎。住院20余天用氨苄青霉素等及时处理，烧退出院。出院不到一周，又见发热。复到该院门诊，多次胸部摄片断层检查：左肺下叶基底部有大片模糊影，边缘模糊不清，密度不甚均匀。
诊断为左下叶后基底段肺结核（浸润型）。用利福平口服，日3次，服用月余，肝区不适，GPT50u/赖氏法。改用链霉素治疗，25天后出现耳鸣，遂又停药，用雷米封等口服。1991年9月又持续发热月余，体温38℃以上，长期反复用头孢拉定等抗炎药，发热渐退，但若偶遇风寒，即又发热，间用交沙霉素、悉复欢等治疗，而咳嗽胸痛未去，肺部阴影不消。1992年1月14日做纤支镜检：左支气管结核，左下支气管炎。继用前药无效，休学1年。即请李氏治，诊时所见：咳嗽不止，左下胸部胀痛，晨起咳痰较多，痰液黄稠，有时又不易咯出，口干喜饮，纳食尚可，小便色黄，舌红苔薄黄，脉细弦数。辨属痰热壅肺，肺失清肃，日久津伤之证，治宜消热化痰，宣肺止咳，养阴润肺。药用：苇茎15克、桃仁20克、冬瓜子20克、苡仁30克、川贝10克、夏枯草20克、黄芩10克、连翘15克、桑皮10克、瓜蒌皮15克、炙杷叶15克、橘皮络各10克、白茅根15克。
二诊：服用上方21剂，咳嗽胸痛缓解，惟因近日感受外邪，稍有咽痛，左下颌淋巴结轻度肿大，舌红苔薄黄，脉细弦。当从清热化痰，软坚散结，清利咽喉为治。处方：玄参10克、川贝10克、夏枯草18克、连翘15克、牡蛎10克、芦根15克、苡仁20克、炒牛子10克、青果10克、瓜蒌皮10克、炙杷叶15克、陈皮10克、炒黄芩10克、桑叶10克、冬瓜仁15克。此方加减服用30余剂，咳嗽胸痛、颌下淋巴结肿大等均告消失，咽喉不痛，纳食正常，小便通利，几次胸部透视及摄片检查：左下肺阴影消失。继以养阴润肺，清热化痰，健脾和胃调理而愈。随访1年未见复发，并告已复学云云。
（三）痰湿阻肺：宣肺利水。慢性支气管炎并发肺气肿，或支气管哮喘、支气管扩张、肺结核等慢性肺部疾病，久治不愈，可导致右心室肥厚扩大，右心代偿不全，引起右心衰竭。由于久咳伤肺，肺气受损，肺失肃降，肺气上逆，而出现咳喘，倚息不得卧等症。痰湿内阻，肺气壅塞，不能通调水道，影响脾之运化，肾失气化，而发水肿。治宜宣肺化痰，健脾利水。药用：麻黄、杏仁、苡仁、桑皮、腹皮、茯苓皮、陈皮、防己等。若胸闷气滞者，加蒌皮、薤白等宽胸散结；脘胀纳差者加厚朴、枳实、炒莱菔子、炒山楂等理气和胃；痰涎较甚者，加川贝、法夏等化痰去湿；水肿较剧者，加葶苈子、车前子、茅根等利水消肿；痰黄粘稠者，加石菖蒲、蒲公英、鱼腥草、鸭跖草等清热化痰；面唇青紫者，加丹参、红花、桃仁、赤芍等活血化瘀；气虚咳喘者，加党参、黄芪皮等益气利水；喘促难平者，加黑锡丹温肾定喘；肢冷汗冷脉微者，可用参附龙牡汤加减以回阳救逆。李氏经验：此证温阳药如肉桂、附子等不宜滥用，尤其是病人有咯血证者，用之可加剧出血症状，另若用之时间过长，亦有伤阴损阳之弊。
案例：王某，男，68岁，退休工人。1992年4月13日初诊。咳喘反复发作50年，加重3年。
[Background Information]
Book Title: 700. Collected Experiences of Old TCM Physician Li Peisheng Chapter: Main Text (16/25) Category: Medical Discourse
Case: Zhou, female, 46 years old, teacher. First consultation on September 3, 1991. Palpitations (xinji), chest tightness, and abdominal distension recurred for 7 years, worsening with recurrence for 1 month. In 1984, after an induced abortion due to pregnancy, emotional depression and excessive consumption of steamed chicken with sea horses led to edema of the hands and feet, palpitations, and abdominal fullness. Volume 3, page 204 considered this due to deficiency and depletion, and excessive intake of tonifying medicinal pastes (name unknown) aggravated the above symptoms. She had been treated multiple times at the Yie Workers' Hospital; electrocardiogram showed "frequent ventricular premature beats"; liver function and B-ultrasound examinations were normal. Considered as "menopausal syndrome" and "frequent ventricular premature contractions," she was prescribed Western medicines such as Propafenone, Oryzanol, and Inosine tablets, along with Chinese herbal formulas for invigorating the Spleen and boosting Qi, and activating blood circulation and resolving stasis, with no significant effect. She specially requested Dr. Li's diagnosis. Current symptoms: palpitations and chest tightness, dizziness and fatigue, insomnia with many dreams, irritability, abdominal distension with poor appetite, frequent belching, dry stool, burning urination, amenorrhea for 3 months, red tongue with thin yellow coating, knotted and intermittent pulse (jie dai, irregular pulse with occasional pauses), pausing 8-9 times per minute. Dr. Li concluded: The Heart governs blood vessels, the Liver governs free flow, and the Spleen governs transformation and transportation. Emotional stagnation and misuse of tonics lead to Liver Qi stagnation, Spleen and Stomach dysfunction, abnormal blood circulation, and loss of nourishment to the Heart Spirit. Hence, there are symptoms such as palpitations, chest tightness, poor appetite, abdominal distension, irritability, and a knotted and intermittent pulse. The treatment method should be to soothe the Liver and resolve depression, broaden the chest and regulate Qi, invigorate the Spleen and harmonize the Stomach, and nourish the Heart and calm the Spirit. Prescription: Chai Hu 10g, Fried Zhi Qiao 10g, Processed Xiang Fu 10g, Su Geng 10g, Yu Jin 10g, Gua Lou Pi 12g, Xie Bai 10g, Ju Hong 10g, Bai Shao 12g, Fried Dan Pi 10g, Fu Shen 15g, He Huan Pi 10g, Mai Ya 15g.
Second consultation: After taking 5 doses of the above prescription, palpitations improved, edema and abdominal distension decreased, bowel movements became smoother, and the pulse turned fine and rapid, with only slight chest tightness remaining.
Added blood-nourishing and blood-activating herbs to the previous prescription in appropriate amounts: Chai Hu 10g, Fried Zhi Qiao 10g, Dan Shen 15g, Chi Shao and Bai Shao 12g each, Lou Pi 12g, Xie Bai 10g, Yu Jin 10g, Su Geng 10g, Processed Xiang Fu 10g, He Huan Pi 10g, Mai Ya 15g. Taken continuously for 15 doses, palpitations and chest tightness disappeared, body edema resolved, appetite normalized, and the pulse was fine and slightly wiry. Only slight abdominal discomfort after meals remained. Subsequently treated with formulas to soothe the Liver, invigorate the Spleen, nourish blood, and harmonize blood, leading to recovery.
(IV) Activating Blood Circulation and Unblocking Collaterals: Blood stasis and Qi stagnation are extremely common in arrhythmias. Qi is the commander of blood, and blood is the mother of Qi; when Qi moves, blood moves, and when Qi stagnates, blood becomes stagnant. If constitution is insufficient, or organ functions are disordered, overwork is excessive, cold and heat disturb the Heart, or emotions are depressed, it can all lead to Qi and blood coagulation and blockage of blood vessels, resulting in arrhythmia. As Li Shizhen said, "Knotted pulses are all due to Qi and blood coagulation" (Binhu Maixue). Activating blood circulation, resolving stasis, and regulating Qi mechanism have good effects on improving microcirculation, increasing coronary blood flow, and anti-arrhythmic actions.
Symptoms include frequent episodes of chest tightness and stabbing pain, palpitations and shortness of breath, mental depression, dizziness and fatigue, dark complexion, cyanosis of lips and nails, dark red tongue or ecchymosis on the sides, thin white or thin yellow coating. For chronic cases with Yin injury, the tongue is red with little coating, and the pulse is deep, wiry, and choppy, or surging, knotted, or intermittent. This is commonly seen in arrhythmias such as premature beats and atrial fibrillation caused by coronary heart disease, rheumatic heart disease, etc. Treatment should focus on activating blood circulation, unblocking collaterals, promoting Qi movement, and relieving pain. Medicines used: Tao Ren, Hong Hua, Dang Gui, Chi Shao, Zhi Qiao, Sheng Di, Dan Shen, Processed Xiang Fu, Shan Zha Tan, etc. If blood stasis causes severe chest pain, add Ru and Mo, Ling Zhi, Xuan Hu to activate collaterals and relieve pain; if chest tightness has a suffocating sensation, add Hou Po, Su Geng, Lou Pi, Yu Jin to broaden the chest and regulate Qi; if palpitations and dizziness with heat signs appear, add Ge Gen, Ku Shen, Huang Lian to clear Heart heat and drain fire; if heart rate is fast with Yin deficiency and Yang hyperactivity, add Xia Ku Cao, Ju Hua, Gou Teng to clear heat and subdue Yang; if chest tightness with phlegm exists, add Gua Lou Pi, Xie Bai, Fa Xia, Chuan Bei to resolve phlegm and dissipate nodules; if Heart Yin is damaged, add Ren Shen, Mai Dong, Wu Wei Zi, Zhi Gan Cao to nourish Yin and restore pulse; if Heart Yang is insufficient, add Dang Shen, Gui Zhi, Gan Cao to warm and unblock Heart Yang.
Case: Liang, male, 74 years old, cadre. First consultation in September 1989. Recurrent palpitations and chest tightness for 5 years, worsening with recurrence for half a year.
Five years ago, palpitations and chest tightness occurred due to fatigue and alcohol consumption, with attacks feeling like death. Hospitalized for treatment; echocardiography diagnosed coronary heart disease and atrial fibrillation. Treated with Cedilanid, etc., condition relieved but atrial fibrillation recurred upon slight fatigue or emotional depression.
Hospitalized 5 times in total, with atrial fibrillation appearing intermittently. In the past half year, attacks were particularly frequent, so TCM treatment was sought. Current symptoms: palpitations and shortness of breath, chest tightness and discomfort, occasional chest pain like needle pricking, panting upon exertion, sleep with many dreams, dry mouth and tongue, dry stool, yellow urine, dark red tongue with ecchymosis on the sides, peeled coating with little fluid, intermittent pulse. Differentiated as Heart blood stasis blocking collaterals, Yin and fluid depletion, loss of nourishment to Heart Spirit. Treatment uses activating blood circulation, unblocking collaterals, regulating Qi and broadening the chest, nourishing Yin and restoring pulse. Prescription: Dan Shen 30g, Chi Shao and Bai Shao 15g each, Tao Ren 10g, Hong Hua 6g, Fried Zhi Qiao 10g, Yu Jin 10g, Gua Lou Ren 15g, Sheng Di 15g, Tai Zi Shen 15g, Mai Dong 10g, Wu Wei Zi 10g, Zhi Gan Cao 15g, Fried Shan Zha 15g.
Second consultation: Palpitations and shortness of breath improved, heart pain disappeared, bowel movements smooth, tongue surface has some fluid, but chest tightness remains, slight panting, restless sleep, dark red tongue with ecchymosis on sides, peeled coating improved compared to before, intermittent pulse. This indicates blood vessel stasis has not gone, and Heart Yin deficiency persists. Follow the previous prescription with slight modifications. Prescription: Dan Shen 30g, Chi Shao and Bai Shao 15g each, Processed Ru and Mo 6g each, Gua Lou Ren 15g, Bai Zi Ren 10g, Fu Shen 18g, Xi Yang Shen 6g (wrapped separately, sliced for sucking), Mai Dong 10g, Wu Wei Zi 10g, Zhi Gan Cao 10g, Sheng Di 15g, Shan Zha Tan 15g, Xiang Yuan Pi 10g, Ju Pi Luo 10g each. Taken continuously for 15 doses, palpitations, chest tightness, and shortness of breath alleviated, panting stopped, thin white coating on tongue, pulse turned fine and rapid. Electrocardiogram basically normal. Subsequently treated for several months with methods of nourishing blood, activating blood circulation, nourishing Yin and restoring pulse, and broadening the chest and regulating Qi, leading to recovery.
Dr. Li believes that arrhythmias generally present more often as deficiency syndromes, but there are also cases dominated by blood stasis, Qi stagnation, or phlegm obstruction, requiring emphasis in clinical treatment. According to Dr. Li's experience, for tachyarrhythmias, using blood-nourishing and spirit-calming, Yin-nourishing and Kidney-tonifying drugs such as Bai Zi Ren, Dang Gui, Tu Si Zi, Shi Hu, Xu Chang Qing has a slowing effect on heart rate; for bradyarrhythmias, using aromatic and penetrating, Yang-warming and excitatory drugs such as Ma Rong, She Xiang, Lu Rong, Tea leaves has an accelerating effect on heart rate. Additionally, formulas like Zhi Gan Cao Tang and herbs such as Sheng Di, Mai Dong, Xuan Hu, Chi Shao, Chai Hu, Gui Zhi, Yin Chen, Ku Shen all have anti-arrhythmic effects and can be selected according to symptoms in clinical practice, without being confined to one aspect.
V. Experience in Differentiating and Treating Chronic Cough: Chronic cough usually has a long course, lingering and difficult to cure, especially when complicated by lung infection, making treatment quite tricky. Combining decades of clinical experience, Dr. Li achieves good results through syndrome differentiation, prescription, and medication.
(I) Pathogenic Heat Lingering in the Lung: Clearing Lung Heat and Relieving Cough. For exogenous cough, if taking exterior-releasing and Lung-promoting agents still does not stop the cough, or if warming and drying agents are used excessively, it easily transforms into heat damaging the Lung, causing pathogenic heat to linger in the Lung, turbid phlegm obstructing internally, severe cough, unbearable throat itching, or cough worsening upon slight exposure to external pathogens. At this time, medication should be light and stable, clearing and lightly promoting the Lung, resolving phlegm and relieving cough, or assisting with moistening the Lung and resolving phlegm. Zhi Sou San modified can be used. If exterior pathogen is heavy, add Su Ye, Fang Feng to release the exterior and scatter pathogens; if dry-heat damages the Lung with dry cough and little sputum, add Gua Lou, Bei Mu to moisten dryness and resolve phlegm; if phlegm-heat obstructs internally with yellow and thick sputum, add Huang Qin, Lu Gen, Bai Jiang Cao, Dong Gua Ren to clear heat and resolve phlegm; if cough with much sputum and white greasy coating, add Processed Ban Xia, Fu Ling to dry dampness and resolve phlegm.
Case: Jin, female, 36 years old. First consultation on August 30, 1991. Frequent coughing for 3 years, chest distension and pain, varying attack times, no obvious relation to climate. Initially relieved slightly by Medemycin, Spiramycin, Ampicillin, etc., then ineffective. In the past half year, cough worsened, seeking treatment from various places, diagnosed by both TCM and Western medicine, condition unchanged. Hospitalized on June 2, 1991, at an affiliated hospital of a medical college; fiberoptic bronchoscopy showed purulent inflammation of the right bronchus accompanied by infectious purulent atelectasis of the right upper lung. After anti-inflammatory, anti-allergic, and symptomatic treatment, symptoms did not明显改善, discharged automatically. Discharge conclusion: Due to large amounts of white necrotic matter attached to the right lung bronchial wall unable to be eliminated, frequent coughing continues. Then sought Dr. Li's consultation. Current symptoms: Frequent coughing without pause, urinary incontinence during severe coughing, sleepless all night, able to sleep only 2-3 hours relying on sedatives and antitussives, little sputum with cough, throat itching with difficult expectoration, chest pain, dry and bitter mouth, lack of desire to eat, mental fatigue, red tongue with thin yellow coating, wiry, fine, and rapid pulse. Dr. Li concluded: External pathogens enter the Lung, cold and heat combine internally, Lung loses clear descending function, causing frequent coughing. The Lung governs Qi, the Heart governs Blood, both organs reside in the Upper Jiao, and the Lung faces all vessels. Lung Qi fails to disseminate, blood vessels lose harmony, causing chest tightness and pain, severe coughing, unsettled Heart Spirit, hence sleepless all night. The Lung controls respiration, the Kidney governs grasping Qi, Lung Qi is unfavorable, inhaled Qi cannot descend to the Kidney, Kidney loses containment, causing urinary incontinence during severe coughing. Treatment focuses on disseminating Lung Qi, clearing heat, resolving phlegm, relieving cough, expelling pathogens from the exterior, assisting with nourishing Kidney Yang.
Medicines used: Chuan Bei 9g, Zhi Pa Ye 15g, Zhi Zi Wan 10g, Xing Ren 10g, Jie Geng 10g, Zheng Bai Bu 10g, Bai Qian 10g, Ju Hong 10g, Tong Cao 6g, Su Geng 10g, Dong Gua Zi 15g, Che Qian Zi 10g. 5 doses.
Second consultation: After medication, cough reduced, able to sleep 4-5 hours at night, original reliance on Western antitussives completely stopped. Only feels chest tightness and pain, red tongue with thin yellow and dry coating, wiry, fine, and rapid pulse. Following the previous method, appropriately added herbs to broaden the chest and dissipate nodules, clear Lung heat and generate fluids: Su Geng 10g, Volume 3, page 206 Qian Hu 10g, Zheng Bai Bu 10g, Zhi Zi Wan 10g, Fried Lou Pi 12g, Zhi Pa Ye 15g, Fried Zhi Qiao 10g, Dong Gua Zi 15g, Lu Gen 15g, Tong Cao 6g. Taken continuously for 5 doses, cough stopped immediately, chest pain disappeared, spirit improved, red tongue with thin yellow coating having fluid, wiry and fine pulse. Subsequently treated with formulas to disseminate Lung Qi, resolve phlegm, broaden the chest, regulate Qi, invigorate the Spleen, and harmonize the Stomach, taken for over 20 doses, illness finally cured. Fiberoptic bronchoscopy report: Right-sided purulent bronchitis significantly improved compared to previous fiberoptic bronchoscopy results. Follow-up for half a year showed no recurrence.
(II) Phlegm-Heat Congesting the Lung: Clearing Lung Heat and Resolving Phlegm. In the later stages of diseases such as bronchitis, pneumonia, pulmonary tuberculosis, due to pathogenic heat inside, scorching fluids into phlegm, or heat-toxicity congesting and stasis, Lung collaterals blocked, or toxic heat lingering in the Lung, damaging the Lung system, there are symptoms such as fever, cough, expectoration of yellow sputum, or little sputum difficult to expectorate, dull pain in the chest, or chest distension and pain, worse during coughing, red tongue with yellow and greasy coating, fine, wiry, rapid, or slippery, rapid pulse. Treatment method should focus on clearing Lung heat and resolving phlegm, softening hardness and dissipating nodules. Dr. Li often uses Qianjin Wei Jing Tang and Xiao Luo Wan modified. Dr. Li stated: Wei Jing Tang can clear heat and resolve phlegm, activate blood circulation and resolve stasis; Xiao Luo Wan can clear heat and eliminate phlegm, soften hardness and dissipate nodules. Combined, their efficacy is specialized and potent. If heat-toxicity is strong, add Yin Hua, Lian Qiao, Yu Xing Cao to clear heat and detoxify; if chest tightness and Qi stagnation, add Gua Lou Pi, Xiang Fu, Si Gua Luo to broaden the chest and promote Qi; if fever and cough with much sputum and thirst, add Sang Bai Pi, Huang Qin, Sha Shen to clear heat, resolve phlegm, and nourish Yin; if pathogenic heat is inside with yellow urine, add Mao Gen, Che Qian Zi to clear heat and promote diuresis.
Case: Hou, male, 16 years old, student. First consultation on May 9, 1992. Recurrent fever, cough, and chest pain for 1.5 years.
In 1990, continuous fever for 1 week due to fatigue and external contraction, treated at a provincial medical college affiliated hospital; chest X-ray showed right lower lobe pneumonia. Hospitalized for over 20 days, treated promptly with Ampicillin, etc., fever subsided, discharged. Less than a week after discharge, fever appeared again. Revisited outpatient department, multiple chest film tomography examinations: large blurry shadow at the base of the left lower lobe, unclear edges, uneven density.
Diagnosed as pulmonary tuberculosis (infiltrative type) in the posterior basal segment of the left lower lobe. Oral Rifampicin, 3 times daily, taken for over a month, discomfort in liver area, GPT 50u/Lai's method. Switched to Streptomycin treatment, tinnitus appeared after 25 days, then stopped medication, took Rimifon orally. In September 1991, continuous fever for over a month, temperature above 38°C, long-term repeated use of Cephradine and other anti-inflammatory drugs, fever gradually subsided, but if encountering wind-cold, fever would recur, intermittent use of Josamycin, Ciprofloxacin, etc., but cough and chest pain remained, lung shadows did not disappear. On January 14, 1992, fiberoptic bronchoscopy: left bronchial tuberculosis, left lower bronchitis. Continued previous medications without effect, took a leave of absence for 1 year. Then requested Dr. Li's treatment. Symptoms at diagnosis: incessant cough, distension and pain in the left lower chest, much sputum in the morning, yellow and thick sputum, sometimes difficult to expectorate, dry mouth preferring drink, acceptable appetite, yellow urine, red tongue with thin yellow coating, fine, wiry, and rapid pulse. Differentiated as phlegm-heat congesting the Lung, Lung losing clear descending function, fluid damage over time. Treatment should eliminate heat, resolve phlegm, disseminate Lung Qi, relieve cough, nourish Yin, and moisten the Lung. Medicines used: Wei Jing 15g, Tao Ren 20g, Dong Gua Zi 20g, Yi Yi Ren 30g, Chuan Bei 10g, Xia Ku Cao 20g, Huang Qin 10g, Lian Qiao 15g, Sang Pi 10g, Gua Lou Pi 15g, Zhi Pa Ye 15g, Ju Pi Luo 10g each, Bai Mao Gen 15g.
Second consultation: After taking 21 doses of the above prescription, cough and chest pain alleviated, only slight sore throat due to recent external pathogen contraction, mild swelling of left submandibular lymph nodes, red tongue with thin yellow coating, fine, wiry pulse. Should treat from clearing heat, resolving phlegm, softening hardness, dissipating nodules, clearing and benefiting the throat. Prescription: Xuan Shen 10g, Chuan Bei 10g, Xia Ku Cao 18g, Lian Qiao 15g, Mu Li 10g, Lu Gen 15g, Yi Yi Ren 20g, Chao Niu Bang Zi 10g, Qing Guo 10g, Gua Lou Pi 10g, Zhi Pa Ye 15g, Chen Pi 10g, Fried Huang Qin 10g, Sang Ye 10g, Dong Gua Ren 15g. This formula modified taken for over 30 doses, cough, chest pain, submandibular lymph node swelling all disappeared, throat not painful, appetite normal, urination smooth, several chest fluoroscopies and X-rays: left lower lung shadow disappeared. Subsequently treated with nourishing Yin, moistening the Lung, clearing heat, resolving phlegm, invigorating the Spleen, and harmonizing the Stomach for regulation, leading to recovery. Follow-up for 1 year showed no recurrence, reported returning to school.
(III) Phlegm-Dampness Obstructing the Lung: Disseminating Lung Qi and Promoting Water Metabolism. Chronic bronchitis complicated by emphysema, or bronchial asthma, bronchiectasis, pulmonary tuberculosis, and other chronic lung diseases, if untreated for a long time, can lead to right ventricular hypertrophy and enlargement, right heart decompensation, causing right heart failure. Due to long-term cough damaging the Lung, Lung Qi受损, Lung losing descending function, Lung Qi counterflow, resulting in cough and wheezing, leaning on pillows unable to lie flat, etc. Phlegm-dampness obstructs internally, Lung Qi congested, unable to regulate water passages, affecting Spleen transformation, Kidney failing Qi transformation, leading to edema. Treatment should disseminate Lung Qi, resolve phlegm, invigorate the Spleen, and promote water metabolism. Medicines used: Ma Huang, Xing Ren, Yi Yi Ren, Sang Pi, Fu Pi, Fu Ling Pi, Chen Pi, Fang Ji, etc. If chest tightness and Qi stagnation, add Lou Pi, Xie Bai to broaden the chest and dissipate nodules; epigastric distension and poor appetite, add Hou Po, Zhi Shi, Fried Lai Fu Zi, Fried Shan Zha to regulate Qi and harmonize the Stomach; severe phlegm-saliva, add Chuan Bei, Fa Xia to resolve phlegm and remove dampness; severe edema, add Ting Li Zi, Che Qian Zi, Mao Gen to promote diuresis and reduce edema; yellow and sticky sputum, add Shi Chang Pu, Pu Gong Ying, Yu Xing Cao, Ya Zhi Cao to clear heat and resolve phlegm; blue-purple face and lips, add Dan Shen, Hong Hua, Tao Ren, Chi Shao to activate blood circulation and resolve stasis; Qi deficiency with cough and wheezing, add Dang Shen, Huang Qi Pi to boost Qi and promote water metabolism; severe panting difficult to calm, add Hei Xi Dan to warm the Kidney and calm wheezing; cold limbs, cold body, faint pulse, can use Shen Fu Long Mu Tang modified to restore Yang and save from collapse. Dr. Li's experience: Warming Yang drugs such as Rou Gui, Fu Zi should not be abused in this syndrome, especially in patients with hemoptysis, as they can exacerbate bleeding symptoms; additionally, prolonged use may damage Yin and harm Yang.
Case: Wang, male, 68 years old, retired worker. First consultation on April 13, 1992. Recurrent cough and wheezing for 50 years, worsening for 3 years.