治虚劳发热,或喘或嗽,脉数而弱。
生山药(一两) 大生地(五钱) 人参(四钱) 玄参(四钱) 生赭石(四钱,轧细) 牛蒡子(三钱,炒,捣)
天冬(四钱) 甘草(二钱)
劳热之证,大抵责之阴虚。有肺阴虚者,其人因肺中虚热熏蒸,时时痒而作嗽,
甚或肺中有所损伤,略一动作,辄发喘促,宜滋补肺阴,兼清火理痰之品,有肾阴虚者,其
人因肾虚不能纳气,时时咳逆上气,甚或喘促,宜填补下焦真阴。兼用收降之品。若其脉甚
数者,陈修园谓,宜滋养脾阴。盖以脾脉原主和缓,脉数
者必是脾阴受伤,宜于滋阴药中,用甘草以引之归脾,更兼用味淡之药,如薏米、石斛之类
。特是人身之阴,所盖甚广,凡周身之湿处皆是也。
故阴虚之甚者,其周身血脉津液,皆就枯涸。必用汁浆最多之药,滋脏腑之阴,即以溉周身
之液,若方中之山药、地黄是也。然脉之数者,固系阴虚,亦系气分虚弱,有不能支持之象
,犹人之任重而体颤也。故用人参以补助气分,与玄参、天冬之凉润者并用,又能补助阴分。
且虑其升补之性,与咳嗽上逆者不宜,故又佐以赭石之压力最胜者,可使人参补益之
力下行直至涌泉,而上焦之逆气浮火,皆随之顺流而下;更可使下焦真元之气,得人参之峻
补而顿旺,自能吸引上焦之逆气浮火下行也。至于牛蒡子与山药并用,最善止嗽,甘草与天冬
并用,最善润肺,此又屡试屡效者也。
初制此方时,原无赭石,有丹参三钱,以运化人参之补力。后治一年少妇人,信水数月不行
,时作寒热,干嗽连连,且兼喘逆,胸隔满闷,不思饮食,脉数几至七至。治以有丹参原方
不效,遂以赭石易丹参,一剂咳与喘皆愈强半,胸次开通,即能饮食,又服数剂脉亦和缓,
共服二十剂,诸病皆愈。以后凡治妇女月闭血枯,浸至虚劳,或兼咳嗽满闷者,皆先
投以此汤,俾其饮食加多,身体强壮,经水自通。间有瘀血暗阻经道,或显有
瘕可据者,继服拙拟理冲汤,或理冲丸以消融之,则妇女无难治之病矣。若
其人胸中素觉短气,或大便易滑泻者,又当预防其大气下陷(大气下陷详升
陷汤)。用醴泉饮时,宜减赭石、牛蒡子,并一切苏子、蒌仁、紫菀、杏仁,治咳
按∶短气与喘原迥异。短气者难于呼气不上达也。喘者难于吸气不下降也。而不善述病情者
,往往谓喘为“上不来气”,是以愚生平临证,凡遇自言上不来气者,必细细询问,确知其
果系呼气难与吸气难,而后敢为施治也。
又按∶方书名咳喘曰“咳逆”,喘曰“喘逆”,因二证多由逆气上干也。而愚临证实验以来
,知因大气下陷而咳喘者,亦复不少。盖肺悬胸中,必赖大气以包举之,而后有所附丽;大
气以鼓舞之,而后安然呼吸。大气一陷,则包举之力微,肺即无所附丽,而咳嗽易生。鼓舞
之机滞,肺必努力呼吸,而喘促易作。曾治一少年,泄泻半载方愈。后因劳力过度,觉喉中之气不舒,五六呼吸之间,
必咳
以拙拟升陷汤,数剂而愈。
又∶曾治一人,年近五旬,素有喘疾。因努力任重,旧证复发。延
医服药罔效。后愚诊视其脉,数近六至,而兼有沉濡之象。愚疑其阴虚不能纳气,因其脉兼
沉濡,不敢用降气之药。遂用熟地、生山药、枸杞、玄参大滋真阴之药,大剂煎汤,送下人
参小块二钱,连服三剂脉即不数,仍然沉濡,喘虽见轻,仍不能愈。因思此证得之努力任重
,胸中大气因努力而陷,所以脉现沉濡,且其背恶寒而兼发紧,此亦大气下陷之征也。亦治
以升陷汤,方中升麻、柴胡、桔梗皆不敢用,以桂枝尖三钱代之。因其素有不纳气之
证,桂枝能升大气,又能纳气归肾也(理详参赭镇气汤下)。又外
加滋阴之药,数剂全愈(详案在升陷汤下)。按此二证之病因,与
醴泉饮所主之病迥异,而其咳喘则同。必详观升陷汤后跋语,及所载诸案,始明治此二证之
理。而附载于此者,恐临证者审证不确,误以醴泉饮治之也。
沈阳娄××,年二十二,虚劳咳嗽,其形羸弱,脉数八至,按之即无。细询之,自言
曾眠热炕之上,晨起觉心中发热,从此食后即吐出,夜间咳嗽甚剧,不能安寝。因二十余日
寝食俱废, 遂觉精神恍惚,不能支持。愚闻之,知脉象虽危,仍系新证,若久病至此,诚
难挽回矣。遂投以醴泉饮,为其呕吐,将赭石改用一两(重用赭石之理详参
赭镇气汤下),一剂吐即止,可以进食,嗽亦见愈。从前五六日未大便,至此大便
亦通下。如此加减服之,三日后脉数亦见愈。然犹六至余,心中犹觉发热,遂将玄参、生地
皆改用六钱,又每日于午时,用白蔗糖冲水,送服西药阿斯匹林(药性详参麦汤
下)七厘许。数日诸病皆愈,脉亦复常。
沈阳苏××,年三十许,劳嗽二年不愈,动则作喘,饮食减少。更医十余人,服药数百剂,
分毫无效,羸弱转甚。来院延医。其脉数六至,虽细弱仍有根柢,知其可治。自言上焦恒觉发热,大便三四日一行
,时或干燥。遂投以醴泉饮,为其便迟而燥,赭石改用六钱,又加鸡内金二钱(捣
细),恐其病久脏腑经络多瘀滞也。数剂后饭量加增,心中仍有热时,大便已不燥
,间日 一行。遂去赭石二钱,加知母二钱,俾于晚间服汤药后,用白蔗糖水,送服阿斯匹林
四分之一瓦,得微汗。后令于日间服之,不使出
汗,数日不觉发热,脉亦复常,惟咳嗽未能全愈。又用西药几阿苏六分,薄荷冰四分,和以绿豆
粉为丸,梧桐子大,每服三丸,日两次,汤药仍照方服之,五六日后咳嗽亦愈,身体从此康
健。
Treats deficiency consumption (Xu Lao) with fever, or accompanied by asthma (Chuan) or cough (Sou), with a rapid and weak pulse.
Raw Dioscoreae Rhizoma (Shanyao, 1 liang) Raw Rehmanniae Radix (Dishengdi, 5 qian) Ginseng Radix et Rhizoma (Renshen, 4 qian) Scrophulariae Radix (Xuan Shen, 4 qian) Raw Haematitum (Sheng Zhe Shi, 4 qian, finely ground) Arctii Fructus (Niubangzi, 3 qian, stir-fried and crushed)
Asparagi Radix (Tiandong, 4 qian) Glycyrrhizae Radix et Rhizoma (Gancao, 2 qian)
Deficiency consumption fever is generally attributed to Yin deficiency. In cases of Lung Yin deficiency, the patient suffers from internal heat steaming in the lungs, causing frequent itching and coughing;
in severe cases where there is damage in the lungs, slight movement triggers asthma and shortness of breath. Treatment should nourish Lung Yin and simultaneously clear heat and resolve phlegm. In cases of Kidney Yin deficiency, the patient experiences rebellious Qi rising due to Kidney failing to grasp Qi, leading to frequent coughing with upward rushing Qi, or even asthma. Treatment should fill the True Yin of the Lower Jiao and use astringent and descending agents. If the pulse is extremely rapid, Chen Xiuyuan suggested nourishing Spleen Yin. This is because the Spleen pulse is naturally harmonious and slow; a rapid pulse indicates injury to Spleen Yin. Therefore, within Yin-nourishing formulas, Gancao should be used to guide the medicinal action to the Spleen, combined with bland-tasting herbs such as Coicis Semen (Yimi) and Dendrobii Caulis (Shihu). However, the body's Yin covers a wide range, including all moist areas of the body.
Thus, in severe Yin deficiency, the blood vessels and body fluids throughout the body become dry and withered. Herbs with abundant juice must be used to nourish the Yin of the Zang-Fu organs and thereby irrigate the body fluids, such as Shanyao and Dihuang in this formula. Nevertheless, a rapid pulse indicates not only Yin deficiency but also Qi deficiency, manifesting as an inability to sustain effort, similar to a person trembling under a heavy load. Therefore, Renshen is used to tonify Qi, used together with cool and moistening herbs like Xuan Shen and Tiandong, which also assist in nourishing Yin. Furthermore, to prevent the ascending and tonifying nature of Renshen from being unsuitable for patients with cough and rebellious Qi, Zhe Shi, possessing strong descending pressure, is added as an assistant. This allows the tonifying power of Renshen to descend directly to Yongquan (KI-1), while rebellious Qi and floating fire in the Upper Jiao flow down with it; additionally, it enables the True Yuan Qi of the Lower Jiao to become vigorous instantly upon receiving the strong tonification of Renshen, thereby naturally attracting the rebellious Qi and floating fire of the Upper Jiao downward. The combination of Niubangzi and Shanyao is particularly effective in stopping cough, and the combination of Gancao and Tiandong is excellent for moistening the Lungs; these have been repeatedly verified as effective.
When this formula was first formulated, it originally did not contain Zhe Shi, but instead used 3 qian of Danshen to facilitate the transformation of Renshen's tonifying power. Later, I treated a young woman whose menstruation had ceased for several months, experiencing alternating chills and fever, continuous dry cough, asthma with rebellious Qi, chest and diaphragm fullness, loss of appetite, and a rapid pulse approaching seven beats per cycle. The original formula containing Danshen was ineffective. I replaced Danshen with Zhe Shi. After one dose, the cough and asthma improved significantly, the chest became open, and she could eat. After a few more doses, her pulse became harmonious. After taking twenty doses in total, all ailments were cured. Since then, whenever treating women with amenorrhea and blood exhaustion progressing to deficiency consumption, or accompanied by cough and fullness, I first administer this decoction to increase their appetite and strengthen their bodies, allowing menstruation to resume naturally. In occasional cases where dark blood stasis obstructs the meridians, or obvious masses are present, I follow up with Lizhong Tang or Lizhong Wan to dissolve them, making there no incurable diseases for women. If the patient usually feels shortness of breath in the chest or has loose stools, one must prevent the sinking of Da Qi (Great Qi) (see Shengxian Tang for details on Da Qi sinking). When using Liquan Yin, reduce Zhe Shi and Niubangzi, as well as all Su Zi, Gualou Ren, Ziwan, and Xingren used for treating cough.
Note: Shortness of breath (Duanqi) and asthma (Chuan) are fundamentally different. Shortness of breath involves difficulty exhaling and Qi failing to reach upwards. Asthma involves difficulty inhaling and Qi failing to descend downwards. Patients who are poor at describing symptoms often describe asthma as "Qi cannot come up." Therefore, in my clinical practice, whenever a patient claims "Qi cannot come up," I carefully inquire to determine whether it is difficult to exhale or inhale before daring to treat.
Furthermore, medical texts refer to cough and asthma as "Ke Ni" and asthma as "Chuan Ni" because these conditions often result from rebellious Qi affecting upwards. However, through clinical experience, I know that cough and asthma caused by Da Qi sinking are also common. The Lung hangs in the chest and relies on Da Qi to envelop and support it to have a foundation; Da Qi inspires it to enable peaceful breathing. When Da Qi sinks, its supporting power weakens, the Lung loses its foundation, and cough easily arises. When the inspiring mechanism stagnates, the Lung must struggle to breathe, and asthma easily occurs. I once treated a youth who recovered from diarrhea after half a year. Later, due to overexertion, he felt discomfort in the throat Qi, coughing every five or six breaths. I treated him with my proposed Shengxian Tang, and he recovered after a few doses.
Additionally, I once treated a man near fifty years old who suffered from chronic asthma. Due to lifting heavy loads, his old condition relapsed. Physicians prescribed medicine without effect. Upon examination, his pulse was rapid, nearing six beats per cycle, with a deep and soft quality. I suspected Yin deficiency failing to grasp Qi, but given the deep and soft pulse, I dared not use descending Qi herbs. Instead, I used large doses of Shudi, Sheng Shanyao, Gouqi, and Xuan Shen to strongly nourish True Yin, decocted as a soup, with 2 qian of small pieces of Renshen taken orally. After three doses, the pulse was no longer rapid but remained deep and soft; asthma lightened but did not cure. I reasoned that this condition resulted from exertion, causing Da Qi in the chest to sink, hence the deep and soft pulse. His aversion to cold in the back and tightness were also signs of Da Qi sinking. I treated him with Shengxian Tang, replacing Shengma, Chaihu, and Jiegeng with 3 qian of Guizhi tip. Because he had a history of failing to grasp Qi, Guizhi can raise Da Qi and also guide Qi back to the Kidney (principle detailed under Shen Zhe Zhenqi Tang). Additionally, I added Yin-nourishing herbs, and he recovered after a few doses (detailed case under Shengxian Tang). Note that the etiology of these two cases is completely different from the disease indicated by Liquan Yin, although the cough and asthma are similar. One must carefully read the postscript after Shengxian Tang and the recorded cases to understand the rationale for treating these two conditions. I attach them here lest clinicians misdiagnose and mistakenly use Liquan Yin.
Lou XX from Shenyang, aged 22, suffered from deficiency consumption cough, emaciated, with a rapid pulse of eight beats per cycle, disappearing upon pressure. Detailed inquiry revealed he had slept on a heated kang, woke up feeling heat in the heart, and since then vomited after meals. Nighttime cough was severe, preventing sleep. After more than twenty days of neglecting food and rest, he felt mental confusion and inability to sustain himself. Hearing this, I knew that although the pulse appearance was critical, it was still a new condition; if it were a long-standing illness to this extent, it would indeed be irrecoverable. I administered Liquan Yin. Due to his vomiting, I increased Zhe Shi to 1 liang (reason for heavy use of Zhe Shi detailed under Shen Zhe Zhenqi Tang). After one dose, vomiting stopped, he could eat, and cough improved. He had not had a bowel movement for five or six days previously; now his bowels moved. With such modifications, after three days, the rapid pulse improved. However, it remained slightly above six beats, and he still felt heat in the heart. I changed Xuan Shen and Sheng Di to 6 qian each. Also, daily at noon, I had him take white cane sugar water to swallow about 7 li of Aspirin (drug properties detailed under Maidong Tang). After a few days, all illnesses resolved, and the pulse returned to normal.
Su XX from Shenyang, aged around 30, suffered from labor-induced cough for two years without recovery, developing asthma upon exertion, and reduced appetite. Over ten physicians treated him with hundreds of doses of medicine with no effect, and his emaciation worsened. He came to the clinic for treatment. His pulse was rapid, six beats per cycle, fine and weak but with a root, indicating it was treatable. He stated he constantly felt heat in the Upper Jiao, and bowel movements occurred every three to four days, sometimes dry. I administered Liquan Yin. Due to his delayed and dry bowel movements, I changed Zhe Shi to 6 qian, and added 2 qian of Ji Neijin (finely crushed), fearing that long-term illness might cause stasis in the Zang-Fu organs and meridians. After a few doses, his appetite increased, he still felt heat occasionally, but his stool was no longer dry, occurring every other day. I removed 2 qian of Zhe Shi and added 2 qian of Zhimu, so that after taking the herbal decoction in the evening, he would take 1/4 grain of Aspirin with white cane sugar water to induce mild sweating. Later, I instructed him to take it during the day to avoid sweating. After a few days, he no longer felt feverish, and his pulse normalized, except the cough was not fully cured. I then prescribed 6 fen of Japanese Quinine, 4 fen of Menthol, mixed with Mung Bean Powder to make pills the size of paulownia seeds. Each dose was three pills, twice daily, while continuing the herbal decoction. After five or six days, the cough also healed, and his health was restored.