朱左 新寒引动痰饮，渍之于肺，咳嗽气急又发，形寒怯冷，苔薄腻，脉弦滑。仿金匮痰饮之病，宜以温
药和之。
川桂枝（八分） 云苓（三钱） 生白术（五钱） 清炙草（五分） 姜半夏（二钱） 橘红（一钱）
光杏仁（三钱） 炙远志（一钱） 炙白苏子（五钱） 旋复花（包，五钱） 莱菔子（炒、研，二钱）
鹅管石（ ，一钱）
俞右 暴寒外束，痰饮内聚，支塞于肺，肃降失司，
气喘咳嗽大发，故日夜不能平卧，形寒怯冷，纳少泛恶，苔白腻，脉浮弦而滑。拟小青龙汤加减，疏解外邪，温
化痰饮。
蜜炙麻黄（四分） 川桂枝（八分） 云苓（三钱） 姜半夏（二钱） 五味子（四分） 淡干姜（四分）
炙苏子（二钱） 光杏仁（三钱） 熟附片（一钱） 鹅管石（ ，一钱） 哮吼紫金丹（另吞，连服二天，两粒）
二诊 服小青龙汤两剂，气喘咳嗽，日中大减，夜则依然，纳少泛恶，苔薄腻，脉弦滑。夜为阴盛之时，饮
邪窃踞阳位，阻塞气机，肺胃下降之令失司，再以温化饮邪，肃降肺气。
川桂枝（八分） 云苓（三钱） 姜半夏（二钱） 橘红（一钱） 五味子（四分） 淡干姜（四分）
水炙远志（五分） 光杏仁（三钱） 炙苏子（五钱） 旋复花（包，五钱） 熟附片（一钱） 鹅管石（ ，一钱）
三诊 气喘咳嗽，夜亦轻减，泛恶亦止，惟痰饮根株已久，一时难以骤化。脾为生痰之源，肺为贮痰之
器。今拟理脾肃肺，温化痰饮。
原方去旋复花、远志二味，加生白术（五钱）、炒补骨脂（五钱）。
屈左 痰饮咳嗽已有多年，加之遍体浮肿，大腹胀
满，气喘不能平卧，腑行溏薄，谷食衰少，舌苔淡白，脉象沉细。此脾肾之阳式微，水饮泛滥横溢，上激于肺则
喘，灌溉肌腠则肿，凝聚膜原则胀，阳气不到之处，即是水湿盘踞之所，阴霾弥漫，真阳埋没，恙势至此地步，已
入危险一途。勉拟振动肾阳，以驱水湿，健运太阴，而化浊气，真武、肾气、五苓、五皮合黑锡丹，复方图治，冀
望离照当空，浊阴消散，始有转机之幸。
熟附子块（二钱） 生于术（三钱） 连皮苓（四钱） 川桂枝（八分） 猪苓（二钱） 泽泻（二钱）
陈皮（一钱） 大腹皮（二钱） 水炙桑皮（二钱） 淡姜皮（五分） 炒补骨脂（五钱） 陈葫芦瓢（四钱）
黑锡丹（吞服，一钱） 济生肾气丸（清晨另吞，三钱）
二诊 前方已服五剂，气喘较平，小溲渐多，肿亦见消，而大腹胀满，纳谷不香，咳嗽夜盛，脉象沉弦，阳
气有来复之渐，水湿有下行之势，既见效机，率由旧章。
原方去黑锡丹，加冬瓜皮（二两），煎汤代水。
三诊 又服五剂，喘已平，遍体浮肿减其大半，腹胀满亦松，已有转机。惟纳谷不香，神疲肢倦，脉左弦
右濡，舌虽干，不欲饮，肾少生生之气，脾胃运输无权，津液不能上潮，犹釜底无薪，锅盖无汽水也，勿可因舌
干而改弦易辙，致反弃前功。仍守温肾阳以驱水湿，暖
脾土而化浊阴。
熟附块（五钱） 连皮苓（四钱） 生于术（三钱） 川桂枝（六分） 猪苓（二钱） 福泽泻（五钱）
陈皮（一钱） 大腹皮（二钱） 水炙桑皮（五钱） 淡姜皮（五分） 炒补骨脂（五钱） 冬瓜子皮（各三钱）
陈葫芦瓢（四钱） 济生肾气丸（清晨吞服，三钱）
四诊 喘平肿消，腹胀满亦去六七，而咳嗽时轻时剧，纳少形瘦，神疲倦怠，口干欲饮，舌转淡红，脉象左
虚弦，右濡滑。脾肾亏而难复，水湿化而未尽也。今拟平补脾肾，顺气化痰。
炒潞党参（五钱） 连皮苓（四钱） 生于术（三钱） 陈广皮（一钱） 仙半夏（二钱） 炙远志（一钱）
炙白苏子（五钱） 旋复花（包，五钱） 水炙桑皮（五钱） 大腹皮（二钱） 炒补骨脂（五钱） 冬瓜子皮（各
三钱） 陈葫芦瓤（四钱） 济生肾气丸（清晨吞服，三钱）
五诊 喘平肿退，腹满亦消，惟咳嗽清晨较甚，形瘦神疲，纳谷不香，脉濡滑无力，脾肾亏虚，难以骤复，
痰饮根株，亦不易除也。今以丸药缓图，而善其后。
六君子丸每早服三钱，济生肾气丸午后服三钱。
文右 旧有痰饮咳嗽，触受风温之邪，由皮毛而上干肺系，蕴郁阳明。饮邪得温气之熏蒸，变为胶浊之
痰，互阻上焦，太阴清肃无权，以致气喘大发，喉有钩
声，咳痰不出，发热畏风，舌苔腻黄，脉象浮弦而滑。阅前方降气化痰，似亦近理，然邪不外达，痰浊胶固益
甚，颇虑壅闭之险。书云∶喘之为病，在肺为实，在肾为虚。此肺实之喘也，急拟麻杏石甘汤加味，清开温邪，
肃肺涤痰，冀望热退气平为幸。
蜜炙麻黄（四分） 光杏仁（三钱） 生石膏（打，三钱） 生甘草（五分） 炙白苏子（二钱） 旋复花（
包，五钱） 竹沥 半夏（三钱） 水炙远志（一钱） 炙兜铃（一钱） 海浮石（三钱） 象贝母（三钱） 冬瓜
子（三钱） 活芦根（去节，一尺） 淡竹沥（冲服，一两）
二诊 前投麻杏石甘汤加味，已服两剂，气喘已平，身热亦退，佳象也。惟咳嗽痰多，胸闷不思饮食，苔
薄黄，脉滑数不靖，温邪已得外达，痰浊留恋上焦，肺胃肃降失司，适值经临，少腹隐痛，挟宿瘀也。今制小其
剂，佐入和营祛瘀之品。
炙白苏子（二钱） 光杏仁（三钱） 象贝母（三钱） 水炙桑叶皮（各二钱） 竹沥半夏（二钱）
水炙远志（一钱） 旋复花（包，五钱） 海浮石（三钱） 炙兜铃（一钱） 紫丹参（二钱） 茺蔚子（三钱）
冬瓜子（三钱） 干芦根（去节，一两）
胡左 暴感寒凉，内停食滞，引动痰饮，互阻中上
二焦，肺胃之气不得下降，哮喘喉有痰声，胸闷呕吐，不能纳谷，身热恶风，有汗不解，苔腻，脉弦滑，此留饮也。
拟五苓、平胃，解肌达邪，和胃涤饮。
川桂枝（五分） 云猪苓（各三钱） 福泽泻（五钱） 陈皮（一钱） 苍术（一钱） 浓朴（二钱）
半夏（五钱） 枳实炭（一钱） 白蔻仁（五分） 炒麦芽（四钱） 莱菔子（炒研，三钱） 藿香梗（五钱）
玉枢丹（开水磨冲服，四分）
复诊 寒热解，哮喘平，呕吐亦减，而胸闷嗳气，不能纳谷，小溲短赤，腑气不行，苔薄腻，脉弦滑，宿食留
饮，难以骤化，夜不能寐，胃不和则卧不安。胃以通为补，今拟通胃消滞，和中涤饮。
陈广皮（一钱） 仙半夏（二钱） 枳实炭（一钱） 浓朴（一钱） 赤茯苓（三钱） 泽泻（五钱）
姜竹茹（五钱） 莱菔子（炒研，三钱） 生苡仁（四钱） 炒谷麦芽（各三钱）
阮左 酒湿伤脾，脾失健运，水谷入胃，不生津液，化为痰饮。饮射于肺则咳嗽泛吐，饮流胁下，则胁肋引
痛。胁乃肝胆之位，饮气在胁，则肝气拂郁，此悬饮也，仿仲圣治饮不治咳之例。
炙苏子（五钱） 葶苈子（炒研，一钱） 水炙桑皮（二钱） 全栝蒌（切，四钱） 姜半夏（二钱）
橘红（一钱） 茯苓（一钱） 白蒺藜（三钱） 川郁金（一钱五分） 枳 子（三钱） 椒目（二
十粒） 生姜（二片）
费左 咳嗽气逆，宿疾有年，交冬益甚，迩来四肢浮肿，身重无力。此脾肾阳衰，阴寒之水饮，上射于
肺，旁流四末，是溢饮也。今拟助阳逐饮。
川桂枝（八分） 连皮苓（四钱） 生白术（二钱） 猪苓（二钱） 福泽泻（五钱） 陈皮（一钱）
制半夏（二钱） 熟附子（二钱） 椒目（四十粒） 姜皮（五分） 水炙桑皮（二钱） 大腹皮（二钱）
朱左 咳喘十余年，遇感则剧，胸闷纳谷减少，舌苔灰黄，脉象寸浮关弦，素性嗜酒，酒湿生痰聚饮，渍之
于肺则咳，肺病及肾，肾少摄纳则喘，上实下虚，显然可见。酒性本热，温药难投。姑宜开其上焦，以肃肺气，
斡旋中枢，而纳肾元。是否有当，尚希明正。
蜜炙麻黄（三分） 光杏仁（三钱） 仙半夏（二钱） 薄橘红（八分） 炙白苏子（五钱） 象贝（三钱）
炙桑皮（五钱） 海浮石（三钱） 甘杞子（三钱） 浓杜仲（三钱） 炒补骨脂（五钱） 核桃肉（拌炒，二枚）
二诊 咳喘均减，肺金之风邪已去，而多年之痰饮根深蒂固，脾肾之亏虚，由渐而致。脾为生痰之源，肺
为贮痰之器，今拟扶土化痰，顺气纳肾，更宜薄滋味，节饮食，以助药力之不逮。
炙白苏子（二钱） 光杏仁（三钱） 仙半夏（三钱） 薄橘红（八分） 云苓（三钱） 炙远志（一钱）
象贝母（三钱） 水炙桑皮（二钱） 海浮石（三钱） 旋复花（包，五钱） 甘杞子（三钱） 浓杜仲（三钱）
补骨脂（五钱） 核桃肉（二钱）
三诊 咳嗽已减，纳谷渐香，肺得下降之令，胃有醒豁之机，然嗜酒之体，酒性本热，易于生湿生痰。痰
积于内，饮附于外，新饮虽去，宿饮难杜，况年逾花甲，肾少摄纳，故气易升。再拟崇土化痰，肃肺纳肾，亦只
能带病延年耳。
南沙参（三钱） 云苓（三钱） 淮山药（三钱） 炙远志（一钱） 炙白苏子（二钱） 甜光杏（三钱）
仙半夏（二钱） 薄橘红（八分） 海浮石（三钱） 旋复花（包，五钱） 甘杞子（三钱） 浓杜仲（三钱）
补骨脂（五钱） 核桃肉（二枚，拌炒）
孟左 秋冬咳嗽，春夏稍安，遇感则剧，甚则卧难着枕，是脾胃之阳早衰，致水液变化痰沫，随气射肺则
咳，冲气逆上则喘，畏寒足冷，跗肿溺少，阳不潜藏，阴浊用事故也。古法外饮治脾，内饮治肾。今仿内饮论
治，摄纳肾气，温化痰饮。若以降气泄气，取快一时，恐有暴喘厥脱之虞。
肉桂心（三分，大熟地四钱同捣） 云茯苓（三钱） 淮山药（三钱） 熟附片（一钱） 福泽泻（五钱）
仙半夏（二钱） 怀
牛膝（二钱） 甘杞子（三钱） 浓杜仲（三钱） 五味子（四分） 补骨脂（五钱） 核桃肉（二枚）
童左 脉沉弦，弦为饮。饮泛咳呛，动则气喘，乃下虚无以制上，中虚易于化饮。拟早服肾气丸（三钱），摄
纳下焦，以治水泛之饮；午服外台茯苓饮，斡旋中焦，使食不致酿痰，无求速功，只图缓效。
一丸方∶金匮肾气丸（三两，每服三钱）
二煎方∶云茯苓（三钱） 仙半夏（三钱） 薄橘红（八分） 生白术（二钱） 枳实炭（一钱） 炙远志（一钱）
旋复花（包，五钱） 炙款冬（五钱） 鹅管石（ ，一钱）
章左 咳呛有年，动则气喘，痰味咸而有黑花，脉尺部细弱，寸关濡滑而数。咸为肾味，肾虚水泛为痰，
冲气逆肺，则咳呛而气喘也，恙根已深，非易图功。姑宜滋补肾阴，摄纳冲气，勿拘见咳而治肺也。
蛤蚧尾（一对，酒洗烘研为丸吞服）
大生地（三钱） 蛤粉（三钱，同炒） 甘杞子（三钱） 淮山药（三钱） 茯苓（三钱） 北沙参（三钱）
川贝母（三钱） 清炙草（五分） 甜杏仁（去皮、尖，三钱） 核桃肉（去紫衣，二枚）
申左 咳嗽气喘，卧难着枕，上气不下，必下冲上
逆，脉象沉弦，谅由年逾花甲，两天阴阳并亏，则痰饮上泛，饮与气涌，斯咳喘矣。阅前方叠以清肺化痰，滋
阴降气，不啻助纣为虐。况背寒足冷，阳气式微，藩篱疏撤，又可知也。仲圣治饮，必以温药和之，拟桂苓甘
味合附子都气，温化痰饮，摄纳肾气。
桂枝（八分） 云苓（三钱） 炙甘草（五分） 五味子（五分） 生白术（五钱） 制半夏（二钱）
炙远志（一钱） 炒补骨脂（五钱） 熟附块（五钱） 淮山药（三钱） 大熟地（炒松，三钱） 核桃肉（二枚）
陆左 咳嗽两月，音喑不扬，舌糙黄，脉滑数，燥邪痰热，上恋于肺，销烁阴液，肺体属金，譬如钟然，钟损
则声短。今拟补肺阿胶汤加减，润肺生津，而化痰热。
北沙参（三钱） 甜光杏（三钱） 冬桑叶（三钱） 北秫米（包，三钱） 冬瓜子（三钱） 蛤粉炒阿胶（二钱）
川贝母（二钱） 炙兜铃（一钱） 炙甘草（五分） 栝蒌皮（二钱）
王左 咳嗽数月不愈，舌苔薄腻，脉象濡滑，肺虚痰湿留恋，清肃之令不行。薛立斋先生云∶久咳不已，
必须培土以生肺金，取虚则补母之意，此证近之。
淮山药（三钱） 仙半夏（二钱） 象贝母（三钱） 炒竹茹（一钱五分） 抱茯神（三钱） 橘红（一钱）
生苡仁（三钱） 清炙草（五分） 甜光杏（三钱） 冬瓜子（三钱）
谢左 肺为五脏之华盖，肾为元气之根本，肺气不降，肾气不纳，痰饮随气上泛，咳嗽多年，迩来尤甚，气
喘难于平卧，面浮肢肿，脉沉细，苔淡白，痰饮盘踞，水湿泛滥。经云∶诸气 郁，皆属于肺，诸湿肿满，皆属于
脾。肺脾两虚，喘肿重症。勉拟扶土化痰，降气纳气。
炒潞党参（三钱） 制半夏（二钱） 五味子（三分） 炙甘草（五分） 川桂枝（三分） 橘红（八分）
补骨脂（一钱五分） 炙苏子（一钱五分） 连皮苓（三钱） 旋复花（包，一钱五分） 浓杜仲（二钱）
Zhu (Left): New cold pathogen triggers phlegm-fluid retention, soaking into the Lungs, causing recurrence of cough and急促 breathing. Manifestations include aversion to cold and fear of cold, thin greasy tongue coating, and wiry-slippery pulse. Following the disease pattern of Phlegm-Fluid in *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet), treatment should employ warm herbs to harmonize.
Prescription: Chuan Guizhi (Cinnamon Twig, 0.8 qian), Yun Ling (Poria, 3 qian), Sheng Baizhu (Atractylodes Macrocephala Rhizome, 5 qian), Qing Zhi Cao (Honey-fried Licorice Root, 0.5 qian), Jiang Banxia (Ginger-processed Pinellia Tuber, 2 qian), Ju Hong (Tangerine Peel, 1 qian), Guang Xingren (Apricot Seed, 3 qian), Zhi Yuanzhi (Polygala Root, 1 qian), Zhi Baizisu Zi (Perilla Fruit, 5 qian), Xuan Fu Hua (Inula Flower, wrapped, 5 qian), Laifuzi (Radish Seed, fried and crushed, 2 qian), Eguan Shi (Tube Coral Stone, 1 qian).
Yu (Right): Violent cold binds the exterior, while phlegm-fluid accumulates internally, obstructing the Lungs and impairing their descending function. This leads to severe attacks of wheezing and coughing, making it impossible to lie flat day or night. Manifestations include aversion to cold and fear of cold, poor appetite with nausea, white greasy tongue coating, and floating-wiry-slippery pulse. A modified Xiao Qing Long Tang (Minor Blue Dragon Decoction) is prescribed to release the exterior pathogen and warm-transform phlegm-fluid.
Prescription: Mi Zhi Mahuang (Honey-fried Ephedra Herb, 0.4 qian), Chuan Guizhi (Cinnamon Twig, 0.8 qian), Yun Ling (Poria, 3 qian), Jiang Banxia (Ginger-processed Pinellia Tuber, 2 qian), Wuweizi (Schisandra Berry, 0.4 qian), Gan Jiang (Dried Ginger, 0.4 qian), Zhi Su Zi (Perilla Fruit, 2 qian), Guang Xingren (Apricot Seed, 3 qian), Shu Fupian (Prepared Aconite Child Root, 1 qian), Eguan Shi (Tube Coral Stone, 1 qian), Xiao Hou Zi Jin Dan (Purple Gold Pill for Wheezing, taken separately, two pills for two days).
Second Visit: After two doses of Xiao Qing Long Tang (Minor Blue Dragon Decoction), wheezing and coughing decreased significantly during the day but persisted at night. Poor appetite and nausea remain, with a thin greasy tongue coating and wiry-slippery pulse. Nighttime represents the time of Yin excess; fluid pathogen occupies Yang positions, blocking Qi mechanism, and impairing the descending function of Lungs and Stomach. Continue warming and transforming fluid pathogen, and directing Lung Qi downward.
Prescription: Chuan Guizhi (Cinnamon Twig, 0.8 qian), Yun Ling (Poria, 3 qian), Jiang Banxia (Ginger-processed Pinellia Tuber, 2 qian), Ju Hong (Tangerine Peel, 1 qian), Wuweizi (Schisandra Berry, 0.4 qian), Gan Jiang (Dried Ginger, 0.4 qian), Shui Zhi Yuanzhi (Water-fried Polygala Root, 0.5 qian), Guang Xingren (Apricot Seed, 3 qian), Zhi Su Zi (Perilla Fruit, 5 qian), Xuan Fu Hua (Inula Flower, wrapped, 5 qian), Shu Fupian (Prepared Aconite Child Root, 1 qian), Eguan Shi (Tube Coral Stone, 1 qian).
Third Visit: Wheezing and coughing have also improved at night, and nausea has stopped. However, the root of phlegm-fluid is long-standing and difficult to resolve quickly. Spleen is the source of phlegm production; Lungs are the vessel storing phlegm. The current plan is to regulate Spleen and direct Lung Qi downward, warming and transforming phlegm-fluid.
Remove Xuan Fu Hua (Inula Flower) and Yuanzhi (Polygala Root) from the original prescription; add Sheng Baizhu (Atractylodes Macrocephala Rhizome, 5 qian) and Chao Buguzhi (Fried Psoralea Fruit, 5 qian).
Qu (Left): Phlegm-fluid cough has persisted for years, accompanied by generalized edema, abdominal distension, inability to lie flat due to wheezing, loose stools, and reduced food intake. Tongue coating is pale white, pulse is deep-thin. This indicates decline of Spleen and Kidney Yang, leading to flooding and overflowing of water-fluid. Upward agitation into Lungs causes wheezing; irrigation into muscle-couplings causes swelling; accumulation in membranes causes distension. Where Yang Qi does not reach, there is stagnation of water-dampness; Yin-cold pervades, and True Yang is buried. The condition is critical. Tentatively prescribing to stimulate Kidney Yang to drive out water-dampness, strengthen Taiyin Spleen to transform turbid Qi. Combining Zhen Wu Tang (True Warrior Decoction), Shen Qi Wan (Kidney Qi Pill), Wu Ling San (Five Ingredient Powder with Poria), Wu Pi San (Five Peel Powder), and Hei Xi Dan (Black Tin Pill) in a compound formula, hoping for the sun to shine brightly, dissipating turbid Yin, bringing a turn for the better.
Prescription: Shu Fuzi Kuai (Prepared Aconite Root Chunk, 2 qian), Sheng Baizhu (Atractylodes Macrocephala Rhizome, 3 qian), Lianpi Ling (Poria with Skin, 4 qian), Chuan Guizhi (Cinnamon Twig, 0.8 qian), Zhuling (Polyporus, 2 qian), Zexie (Alisma Rhizome, 2 qian), Chenpi (Aged Tangerine Peel, 1 qian), Dafupi (Areca Peel, 2 qian), Shui Zhi Sangpi (Water-fried Mulberry Root Bark, 2 qian), Dan Jiangpi (Light Ginger Peel, 0.5 qian), Chao Buguzhi (Fried Psoralea Fruit, 5 qian), Chen Hulu Piao (Old Gourd Scoop, 4 qian), Hei Xi Dan (Black Tin Pill, swallowed, 1 qian), Jisheng Shenqi Wan (Shengji Kidney Qi Pill, taken separately in morning, 3 qian).
Second Visit: Five doses of the previous prescription taken. Wheezing is calmer, urination increased, edema subsided somewhat. However, abdominal distension persists, appetite is poor, cough worsens at night, pulse is deep-wiry. Yang Qi shows signs of recovery, water-dampness shows signs of descending. Since efficacy is seen, continue with the established method.
Remove Hei Xi Dan (Black Tin Pill) from the original prescription; add Donggua Pi (Winter Melon Peel, 2 liang), decocted as water substitute.
Third Visit: Another five doses taken. Wheezing has ceased, generalized edema reduced by more than half, abdominal distension relieved. There is a turn for the better. However, appetite is poor, spirit is fatigued, limbs are heavy. Pulse is wiry on left, soggy on right. Tongue is dry but no desire to drink. This indicates insufficient generating Qi in Kidney, and powerless transportation by Spleen-Stomach, preventing fluids from rising. It is like a pot without fire, lid without steam. Do not change strategy due to dry tongue, lest prior efforts be wasted. Continue warming Kidney Yang to drive water-dampness, warming Spleen Earth to transform turbid Yin.
Prescription: Shu Fu Kuai (Prepared Aconite Chunk, 5 qian), Lianpi Ling (Poria with Skin, 4 qian), Sheng Baizhu (Atractylodes Macrocephala Rhizome, 3 qian), Chuan Guizhi (Cinnamon Twig, 0.6 qian), Zhuling (Polyporus, 2 qian), Fu Zexie (Alisma Rhizome, 5 qian), Chenpi (Aged Tangerine Peel, 1 qian), Dafupi (Areca Peel, 2 qian), Shui Zhi Sangpi (Water-fried Mulberry Root Bark, 5 qian), Dan Jiangpi (Light Ginger Peel, 0.5 qian), Chao Buguzhi (Fried Psoralea Fruit, 5 qian), Donggua Zi Pi (Winter Melon Seed and Peel, each 3 qian), Chen Hulu Piao (Old Gourd Scoop, 4 qian), Jisheng Shenqi Wan (Shengji Kidney Qi Pill, swallowed in morning, 3 qian).
Fourth Visit: Wheezing stopped, edema gone, abdominal distension reduced by 60-70%. Cough fluctuates in severity, appetite is low, body is emaciated, spirit is tired, mouth is dry with desire to drink. Tongue turned pale red, pulse is deficient-wiry on left, soggy-slippery on right. Spleen-Kidney deficiency is hard to recover; water-dampness transformed but not exhausted. Plan: Mildly tonify Spleen and Kidney, smooth Qi and transform phlegm.
Prescription: Chao Lu Dangshen (Fried Codonopsis Root, 5 qian), Lianpi Ling (Poria with Skin, 4 qian), Sheng Baizhu (Atractylodes Macrocephala Rhizome, 3 qian), Chen Guangpi (Chenpi, 1 qian), Xian Banxia (Pinellia Tuber, 2 qian), Zhi Yuanzhi (Polygala Root, 1 qian), Zhi Baizisu Zi (Perilla Fruit, 5 qian), Xuan Fu Hua (Inula Flower, wrapped, 5 qian), Shui Zhi Sangpi (Water-fried Mulberry Root Bark, 5 qian), Dafupi (Areca Peel, 2 qian), Chao Buguzhi (Fried Psoralea Fruit, 5 qian), Donggua Zi Pi (Winter Melon Seed and Peel, each 3 qian), Chen Hulu Rang (Old Gourd Flesh, 4 qian), Jisheng Shenqi Wan (Shengji Kidney Qi Pill, swallowed in morning, 3 qian).
Fifth Visit: Wheezing stopped, edema receded, abdominal fullness eliminated. Only morning cough is prominent, body emaciated, spirit fatigued, appetite poor, pulse soggy-slippery and forceless. Spleen-Kidney deficiency is hard to restore quickly; phlegm-fluid roots are deep and hard to eradicate. Use pill medicine for slow regulation to conclude treatment.
Liu Jun Zi Wan (Six Gentlemen Pill): 3 qian every morning.
Jisheng Shenqi Wan (Shengji Kidney Qi Pill): 3 qian every afternoon.
Wen (Right): Chronic phlegm-fluid cough, recently exposed to Wind-Warmth pathogen. Pathogen enters via skin-hair, affects Lung system, and stagnates in Yangming. Fluid pathogen, steamed by Warmth, becomes sticky-turbid phlegm, obstructing Upper Jiao. Taiyin Lung loses clear-descending function, causing severe wheezing, hooking sound in throat, inability to expectorate sputum, fever, aversion to wind, greasy yellow tongue coating, floating-wiry-slippery pulse. Previous prescriptions for descending Qi and transforming phlegm seem reasonable, but since pathogen is not expelled externally, turbid phlegm becomes more consolidated, risking obstruction. Text says: "Wheezing disease is Excess in Lungs, Deficiency in Kidneys." This is Lung Excess wheezing. Urgently prescribe Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) with additions to clear Warmth pathogen, descend Lung Qi and wash away phlegm, hoping for heat reduction and Qi calming.
Prescription: Mi Zhi Mahuang (Honey-fried Ephedra Herb, 0.4 qian), Guang Xingren (Apricot Seed, 3 qian), Sheng Shigao (Raw Gypsum, crushed, 3 qian), Sheng Gancao (Raw Licorice Root, 0.5 qian), Zhi Baizisu Zi (Perilla Fruit, 2 qian), Xuan Fu Hua (Inula Flower, wrapped, 5 qian), Zhuli Banxia (Betel Juice-processed Pinellia, 3 qian), Shui Zhi Yuanzhi (Water-fried Polygala Root, 1 qian), Zhi Douling (Loquat Leaf, 1 qian), Haifushi (Floating Stone, 3 qian), Xiang Beimu (Fritillaria Thunbergii Bulb, 3 qian), Dongguazi (Winter Melon Seed, 3 qian), Huo Lugeng (Fresh Reed Rhizome, nodes removed, 1 chi), Dan Zhuli (Light Betel Juice, mixed in, 1 liang).
Second Visit: Two doses of Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction) with additions taken. Wheezing stopped, body heat subsided, good sign. However, cough with much sputum, chest tightness, loss of appetite, thin yellow coating, slippery-rapid unsettled pulse. Warmth pathogen has been released externally, but turbid phlegm lingers in Upper Jiao, Lung-Stomach descending function impaired. Menstruation is approaching, lower abdomen dull pain, indicating retained blood stasis. Reduce dosage, add herbs to harmonize Ying and remove stasis.
Prescription: Zhi Baizisu Zi (Perilla Fruit, 2 qian), Guang Xingren (Apricot Seed, 3 qian), Xiang Beimu (Fritillaria Thunbergii Bulb, 3 qian), Shui Zhi Sangye Pi (Mulberry Leaf and Bark, each 2 qian), Zhuli Banxia (Betel Juice-processed Pinellia, 2 qian), Shui Zhi Yuanzhi (Water-fried Polygala Root, 1 qian), Xuan Fu Hua (Inula Flower, wrapped, 5 qian), Haifushi (Floating Stone, 3 qian), Zhi Douling (Loquat Leaf, 1 qian), Zi Danshen (Red Sage Root, 2 qian), Chongweizi (Chervil Fruit, 3 qian), Dongguazi (Winter Melon Seed, 3 qian), Gan Lugen (Dried Reed Rhizome, nodes removed, 1 liang).
Hu (Left): Sudden exposure to cold-cool, internal food stagnation, triggering phlegm-fluid, obstructing Middle and Upper Jiao. Lung-Stomach Qi cannot descend. Asthma with phlegm sound in throat, chest tightness, vomiting, inability to eat, fever, aversion to wind, sweating without relief, greasy coating, wiry-slippery pulse. This is retained fluid. Prescribe Wu Ling San (Five Ingredient Powder with Poria) and Ping Wei San (Peaceful Stomach Powder) to release muscle layer, expel pathogen, harmonize Stomach and wash away fluid.
Prescription: Chuan Guizhi (Cinnamon Twig, 0.5 qian), Yun Zhuling (Polyporus, each 3 qian), Fu Zexie (Alisma Rhizome, 5 qian), Chenpi (Aged Tangerine Peel, 1 qian), Cangzhu (Atractylodes Lancea Rhizome, 1 qian), Nong Po (Magnolia Bark, 2 qian), Banxia (Pinellia Tuber, 5 qian), Zhishi Tan (Charred Immature Bitter Orange, 1 qian), Bai Kou Ren (White Cardamom Seed, 0.5 qian), Chao Maiya (Fried Malt, 4 qian), Laifuzi (Radish Seed, fried and crushed, 3 qian), Huoxiang Geng (Agastache Stem, 5 qian), Yushu Dan (Jade Peak Pill, ground in boiling water and taken, 0.4 qian).
Follow-up Visit: Cold-heat resolved, asthma calmed, vomiting reduced. But chest tightness, belching, inability to eat, short dark urine, bowel movement not unblocked, thin greasy coating, wiry-slippery pulse. Retained food and fluid are hard to resolve quickly. Insomnia at night; "Stomach disharmony leads to restless sleep." Stomach benefits from unblocking. Plan: Unblock Stomach, eliminate stagnation, harmonize Middle and wash away fluid.
Prescription: Chen Guangpi (Chenpi, 1 qian), Xian Banxia (Pinellia Tuber, 2 qian), Zhishi Tan (Charred Immature Bitter Orange, 1 qian), Nong Po (Magnolia Bark, 1 qian), Chi Fuling (Red Poria, 3 qian), Zexie (Alisma Rhizome, 5 qian), Jiang Zhuru (Ginger-processed Bamboo Shavings, 5 qian), Laifuzi (Radish Seed, fried and crushed, 3 qian), Sheng Yiren (Coix Seed, 4 qian), Chao Gu Maiya (Fried Barley and Malt, each 3 qian).
Ruan (Left): Alcohol-dampness injures Spleen, Spleen loses healthy transport. Food and water enter Stomach, fail to generate fluids, instead becoming phlegm-fluid. Fluid shooting into Lungs causes cough and vomiting; fluid flowing under costal region causes pulling pain in hypochondrium. Hypochondrium is the position of Liver-Gallbladder; fluid Qi here causes Liver Qi depression. This is Hanging Fluid (Xuan Yin). Following Zhang Zhongjing's example of treating fluid disease without focusing on cough.
Prescription: Zhi Su Zi (Perilla Fruit, 5 qian), Tinglizi (Descurainia Seed, fried and crushed, 1 qian), Shui Zhi Sangpi (Water-fried Mulberry Root Bark, 2 qian), Quan Gualou (Whole Trichosanthes Fruit, sliced, 4 qian), Jiang Banxia (Ginger-processed Pinellia Tuber, 2 qian), Ju Hong (Tangerine Peel, 1 qian), Fuling (Poria, 1 qian), Bai Jili (Tribulus Fruit, 3 qian), Chuan Yujin (Curcuma Root, 1.5 qian), Zhi Zizu (Ardisia Seed, 3 qian), Jiaomu (Pepper Seed, 20 grains), Shengjiang (Fresh Ginger, 2 slices).
Fei (Left): Cough with rebellious Qi, chronic disease for years, worsening in winter. Recently, four limbs edematous, body heavy and weak. This is decline of Spleen-Kidney Yang, Yin-cold water-fluid shooting upward into Lungs, flowing sideways to extremities. This is Overflowing Fluid (Yi Yin). Plan: Assist Yang to drive out fluid.
Prescription: Chuan Guizhi (Cinnamon Twig, 0.8 qian), Lianpi Ling (Poria with Skin, 4 qian), Sheng Baizhu (Atractylodes Macrocephala Rhizome, 2 qian), Zhuling (Polyporus, 2 qian), Fu Zexie (Alisma Rhizome, 5 qian), Chenpi (Aged Tangerine Peel, 1 qian), Zhi Banxia (Processed Pinellia Tuber, 2 qian), Shu Fuzi (Prepared Aconite Root, 2 qian), Jiaomu (Pepper Seed, 40 grains), Jiangpi (Ginger Peel, 0.5 qian), Shui Zhi Sangpi (Water-fried Mulberry Root Bark, 2 qian), Dafupi (Areca Peel, 2 qian).
Zhu (Left): Cough and wheezing for over ten years, worsening upon exposure. Chest tightness, reduced appetite, gray-yellow tongue coating, floating pulse at Cun position, wiry pulse at Guan position. Habitually drinks alcohol; alcohol-dampness generates phlegm and gathers fluid, soaking into Lungs causing cough. Lung disease affects Kidney; Kidney lacks grasping function causing wheezing. Upper Excess and Lower Deficiency are evident. Alcohol nature is hot; warm herbs are difficult to use. Tentatively open Upper Jiao to direct Lung Qi downward, mediate Central Jiao, and grasp Kidney Yuan Qi. Whether appropriate, awaiting correction.
Prescription: Mi Zhi Mahuang (Honey-fried Ephedra Herb, 0.3 qian), Guang Xingren (Apricot Seed, 3 qian), Xian Banxia (Pinellia Tuber, 2 qian), Bo Ju Hong (Thin Tangerine Peel, 0.8 qian), Zhi Baizisu Zi (Perilla Fruit, 5 qian), Xiang Bei (Fritillaria Thunbergii Bulb, 3 qian), Zhi Sangpi (Mulberry Root Bark, 5 qian), Haifushi (Floating Stone, 3 qian), Gan Qizi (Goji Berry, 3 qian), Nong Duzhong (Eucommia Bark, 3 qian), Chao Buguzhi (Fried Psoralea Fruit, 5 qian), Hetourou (Walnut Meat, stir-fried together, 2 pieces).
Second Visit: Cough and wheezing both reduced. Wind pathogen in Lung Metal has gone, but chronic phlegm-fluid roots are deep. Spleen-Kidney deficiency developed gradually. Spleen is source of phlegm; Lungs are vessel of phlegm. Plan: Support Earth to transform phlegm, smooth Qi and grasp Kidney. Also, prefer light flavors, regulate diet to assist medication.
Prescription: Zhi Baizisu Zi (Perilla Fruit, 2 qian), Guang Xingren (Apricot Seed, 3 qian), Xian Banxia (Pinellia Tuber, 3 qian), Bo Ju Hong (Thin Tangerine Peel, 0.8 qian), Yun Ling (Poria, 3 qian), Zhi Yuanzhi (Polygala Root, 1 qian), Xiang Beimu (Fritillaria Thunbergii Bulb, 3 qian), Shui Zhi Sangpi (Water-fried Mulberry Root Bark, 2 qian), Haifushi (Floating Stone, 3 qian), Xuan Fu Hua (Inula Flower, wrapped, 5 qian), Gan Qizi (Goji Berry, 3 qian), Nong Duzhong (Eucommia Bark, 3 qian), Buguzhi (Psoralea Fruit, 5 qian), Hetourou (Walnut Meat, 2 qian).
Third Visit: Cough reduced, appetite improving. Lung receives descending command, Stomach has awakening opportunity. However, alcoholic constitution, alcohol nature is hot, prone to generating dampness and phlegm. Phlegm accumulates internally, fluid attaches externally. New fluid gone, old fluid hard to stop. Moreover, over sixty years old, Kidney lacks grasping function, so Qi easily rises. Re-plan: Strengthen Earth to transform phlegm, direct Lung Qi downward and grasp Kidney. Can only prolong life with illness.
Prescription: Nan Shashen (Adenophora Root, 3 qian), Yun Ling (Poria, 3 qian), Huai Shanyao (Chinese Yam, 3 qian), Zhi Yuanzhi (Polygala Root, 1 qian), Zhi Baizisu Zi (Perilla Fruit, 2 qian), Tian Guang Xingren (Sweet Apricot Seed, 3 qian), Xian Banxia (Pinellia Tuber, 2 qian), Bo Ju Hong (Thin Tangerine Peel, 0.8 qian), Haifushi (Floating Stone, 3 qian), Xuan Fu Hua (Inula Flower, wrapped, 5 qian), Gan Qizi (Goji Berry, 3 qian), Nong Duzhong (Eucommia Bark, 3 qian), Buguzhi (Psoralea Fruit, 5 qian), Hetourou (Walnut Meat, 2 pieces, stir-fried).
Meng (Left): Autumn-Winter cough, Spring-Summer slightly better, worsening upon exposure. Severe cases cannot sleep on pillow. Spleen-Stomach Yang declined early, causing fluid changes into phlegm foam. Qi shoots into Lungs causing cough; Chong Qi rebels upward causing wheezing. Aversion to cold, cold feet, ankle edema, scanty urination. Yang fails to hide, Yin-turbidity acts. Ancient method: External fluid treated by Spleen, Internal fluid treated by Kidney. Now following Internal fluid theory: Grasp Kidney Qi, warm-transform phlegm-fluid. If using descending-draining Qi for temporary relief, fear sudden asthma and syncope.
Prescription: Rouguixin (Cinnamon Heart, 0.3 qian, pounded together with Da Shudi 4 qian), Yun Fuling (Poria, 3 qian), Huai Shanyao (Chinese Yam, 3 qian), Shu Fupian (Prepared Aconite Child Root, 1 qian), Fu Zexie (Alisma Rhizome, 5 qian), Xian Banxia (Pinellia Tuber, 2 qian), Huai Niuxi (Achyranthes Root, 2 qian), Gan Qizi (Goji Berry, 3 qian), Nong Duzhong (Eucommia Bark, 3 qian), Wuweizi (Schisandra Berry, 0.4 qian), Buguzhi (Psoralea Fruit, 5 qian), Hetourou (Walnut Meat, 2 pieces).
Tong (Left): Pulse deep-wiry; wiry indicates fluid. Fluid flooding causes coughing fits, exertion causes wheezing. Lower Deficiency fails to control Upper, Middle Deficiency easily transforms fluid. Plan: Morning take Shenqi Wan (Kidney Qi Pill, 3 qian) to grasp Lower Jiao and treat fluid flooding; Afternoon waitai Fuling Yin (Waitai Poria Drink) to mediate Middle Jiao, preventing food from brewing phlegm. Do not seek quick success, only aim for slow effect.
Formula 1: Jin Gui Shenqi Wan (Golden Cabinet Kidney Qi Pill, 3 liang total, 3 qian per dose).
Formula 2: Yun Fuling (Poria, 3 qian), Xian Banxia (Pinellia Tuber, 3 qian), Bo Ju Hong (Thin Tangerine Peel, 0.8 qian), Sheng Baizhu (Atractylodes Macrocephala Rhizome, 2 qian), Zhishi Tan (Charred Immature Bitter Orange, 1 qian), Zhi Yuanzhi (Polygala Root, 1 qian), Xuan Fu Hua (Inula Flower, wrapped, 5 qian), Zhi Kuandong (Coltsfoot Flower, 5 qian), Eguan Shi (Tube Coral Stone, 1 qian).
Zhang (Left): Coughing fits for years, wheezing on exertion, sputum salty with black spots. Pulse Chi position thin-weak, Cun-Guan soggy-slippery-rapid. Salty is Kidney flavor; Kidney Deficiency causes water flooding into phlegm. Chong Qi rebels into Lungs, causing coughing and wheezing. Disease root is deep, hard to achieve quick results. Tentatively nourish Kidney Yin, grasp Chong Qi. Do not拘泥 (stick rigidly) to treating Lungs just because of cough.
Prescription: Gejie Wei (Gecko Tail, one pair, wine-washed, dried, powdered, taken as pill), Da Shengdi (Rehmannia Root, 3 qian), Gafen (Shell Powder, 3 qian, stir-fried together), Gan Qizi (Goji Berry, 3 qian), Huai Shanyao (Chinese Yam, 3 qian), Fuling (Poria, 3 qian), Bei Shashen (Glehnia Root, 3 qian), Chuan Beimu (Fritillaria Cirrhosa Bulb, 3 qian), Qing Zhi Cao (Licorice Root, 0.5 qian), Tian Xingren (Sweet Apricot Seed, peeled and tip removed, 3 qian), Hetourou (Walnut Meat, purple skin removed, 2 pieces).
Shen (Left): Cough and wheezing, unable to lie flat. Upper Qi does not descend, must rebel from Lower to Upper. Pulse deep-wiry. Likely over sixty years old, Yin and Yang both deficient in two Jiaos. Phlegm-fluid floods upward; fluid and Qi surge, causing cough and wheezing. Previous prescriptions repeatedly used clearing-Lung transforming-phlegm and nourishing-Yin descending-Qi, which is like helping the tyrant. Back cold, foot cold, Yang Qi declining, defenses loose. Zhongjing treats fluid with warm herbs to harmonize. Plan: Guiling Ganwei combined with Fuzi Duqi, warming-transform phlegm-fluid, grasp Kidney Qi.
Prescription: Guizhi (Cinnamon Twig, 0.8 qian), Yun Ling (Poria, 3 qian), Zhi Gancao (Licorice Root, 0.5 qian), Wuweizi (Schisandra Berry, 0.5 qian), Sheng Baizhu (Atractylodes Macrocephala Rhizome, 5 qian), Zhi Banxia (Processed Pinellia Tuber, 2 qian), Zhi Yuanzhi (Polygala Root, 1 qian), Chao Buguzhi (Fried Psoralea Fruit, 5 qian), Shu Fu Kuai (Prepared Aconite Chunk, 5 qian), Huai Shanyao (Chinese Yam, 3 qian), Da Shudi (Rehmannia Root, fried loose, 3 qian), Hetourou (Walnut Meat, 2 pieces).
Lu (Left): Cough for two months, hoarse voice, rough yellow tongue, slippery-rapid pulse. Dry pathogen and phlegm-heat linger in Lungs, consuming Yin fluids. Lung body belongs to Metal, like a bell; if bell damaged, sound is short. Plan: Bufei Ejiao Tang (Lung-Nourishing Donkey-Hide Gelatin Decoction) with additions, moisten Lungs, generate fluids, transform phlegm-heat.
Prescription: Bei Shashen (Glehnia Root, 3 qian), Tian Guang Xingren (Sweet Apricot Seed, 3 qian), Dong Sangye (Mulberry Leaf, 3 qian), Bei Shumi (Broomcorn Millet, wrapped, 3 qian), Dongguazi (Winter Melon Seed, 3 qian), Gafen Chao Ejiao (Donkey-Hide Gelatin fried with Shell Powder, 2 qian), Chuan Beimu (Fritillaria Cirrhosa Bulb, 2 qian), Zhi Douling (Loquat Leaf, 1 qian), Zhi Gancao (Licorice Root, 0.5 qian), Gualou Pi (Trichosanthes Peel, 2 qian).
Wang (Left): Cough for months unresolved, thin greasy tongue coating, soggy-slippery pulse. Lung Deficiency with phlegm-dampness lingering, clear-descending command not functioning. Mr. Xue Lizhai said: "Chronic cough unrelieved requires strengthening Earth to generate Lung Metal, taking 'Deficiency tonifies Mother' meaning." This case is close to this.
Prescription: Huai Shanyao (Chinese Yam, 3 qian), Xian Banxia (Pinellia Tuber, 2 qian), Xiang Beimu (Fritillaria Thunbergii Bulb, 3 qian), Chao Zhuru (Fried Bamboo Shavings, 1.5 qian), Bao Fushen (Poria with Wood, 3 qian), Ju Hong (Tangerine Peel, 1 qian), Sheng Yiren (Coix Seed, 3 qian), Qing Zhi Cao (Licorice Root, 0.5 qian), Tian Guang Xingren (Sweet Apricot Seed, 3 qian), Dongguazi (Winter Melon Seed, 3 qian).
Xie (Left): Lung is canopy of five Zang organs, Kidney is root of Yuan Qi. Lung Qi does not descend, Kidney Qi does not grasp. Phlegm-fluid floats up with Qi. Cough for years, worsening recently. Wheezing makes lying flat difficult, facial and limb edema, deep-thin pulse, pale white coating. Phlegm-fluid stagnates, water-dampness floods. Classic says: "All Qi constraints belong to Lung, all dampness swelling-fullness belongs to Spleen." Lung-Spleen dual deficiency, severe wheezing-swelling. Tentatively strengthen Earth to transform phlegm, descend Qi and grasp Qi.
Prescription: Chao Lu Dangshen (Fried Codonopsis Root, 3 qian), Zhi Banxia (Processed Pinellia Tuber, 2 qian), Wuweizi (Schisandra Berry, 0.3 qian), Zhi Gancao (Licorice Root, 0.5 qian), Chuan Guizhi (Cinnamon Twig, 0.3 qian), Ju Hong (Tangerine Peel, 0.8 qian), Buguzhi (Psoralea Fruit, 1.5 qian), Zhi Su Zi (Perilla Fruit, 1.5 qian), Lianpi Ling (Poria with Skin, 3 qian), Xuan Fu Hua (Inula Flower, wrapped, 1.5 qian), Nong Duzhong (Eucommia Bark, 2 qian).