天津徐××，年三十四岁，得肺劳痰喘证。
病因 因弱冠时游戏竞走，努力过度伤肺，致有喘病，入冬以来又兼咳嗽。
证候 平素虽有喘证，然安养时则不犯，入冬以来，寒风陡至，出外为风所袭，忽发咳嗽。咳
嗽不已，喘病亦发，咳喘相助为虐，屡次延医，服药不愈，夜不能卧。其脉左部弦细而
硬，右部濡而兼沉，至数如常。
诊断 此乃气血两亏，并有停饮之证，是以其左脉弦细者，气虚也。弦细兼硬者，肝血虚津液
短也。其右脉濡者，湿痰留饮也。濡而兼沉者，中焦气化亦有所不足也。其所以喘而且嗽
者，亦痰饮上溢之所迫致也。拟用小青龙汤，再加滋补之药治之。
处方 生怀山药（一两） 当归身（四钱） 天冬（四钱） 寸麦冬（四钱）
生杭芍（三钱） 清半夏（三钱） 桂枝尖（二钱五分） 五味子（二钱捣碎）
杏仁（二钱去皮） 干姜（钱半） 细辛（一钱） 甘草（钱半） 生姜（三片）
共煎一大盅温饮下。
方解 凡用小青龙汤，喘者去麻黄加杏仁，此定例也。若有外感之热者，更宜加生石膏，此
证无外感之热，故但加二冬以解姜桂诸药之热。
复诊 将药煎服一剂，其喘即愈，又继服两剂，咳嗽亦愈强半，右脉已不沉，似稍有力，左脉
仍近弦硬，拟再以健胃养肺滋生血脉之品。
处方 生怀山药（一两） 生百合（五钱） 大枸杞子（五钱） 天冬（五钱） 当归
身（三钱） 苏子（钱半炒捣） 川贝母（三钱） 白术（三钱炒） 生薏米（三钱捣碎） 生远志
（二钱） 生鸡内金（钱半黄色的捣） 甘草（钱半）
共煎汤一大盅温服。
效果 将药连服四剂，咳嗽全愈，脉亦调和如常矣。
Mr. Xu XX from Tianjin, aged 34, suffered from pulmonary tuberculosis with phlegm and wheezing (Feilao Tanchuan).
Etiology: In his early twenties, excessive exertion during playful running injured the lungs, leading to a history of wheezing. Since winter began, he also developed coughing.
Symptoms: Although he usually had wheezing, it did not manifest when at rest. However, since winter arrived, a sudden cold wind attacked him while he was outdoors, triggering an acute cough. The persistent cough exacerbated the wheezing, with both symptoms mutually aggravating each other. Despite multiple medical consultations and medication, there was no improvement, and he could not lie down flat at night. His pulse was wiry, fine, and hard on the left side; soggy and deep on the right side; with a normal rate.
Diagnosis: This is a syndrome of deficiency in both Qi and Blood, accompanied by retained fluid retention (Tingyin). Therefore, the wiry and fine left pulse indicates Qi deficiency. The wiry, fine, and hard quality indicates Liver Blood deficiency and shortness of body fluids. The soggy right pulse indicates damp-phlegm and retained fluid. The soggy and deep quality indicates insufficiency in the Qi transformation of the Middle Jiao. The reason for wheezing and coughing is also due to the pressure caused by phlegm-fluid overflowing upwards. It is proposed to use Xiao Qing Long Tang (Minor Blue Dragon Decoction) combined with tonifying herbs for treatment.
Prescription: Raw Huai Yam (Sheng Huai Shanyao, 1 liang), Dang Gui Body (Danggui Shen, 4 qian), Asparagus Root (Tiantong, 4 qian), Ophiopogon Tuber (Cun Maidong, 4 qian), Raw Hang Peony Root (Sheng Hangshao, 3 qian), Processed Pinellia Rhizome (Qing Banxia, 3 qian), Cinnamon Twig Tip (Guizhi Jian, 2.5 qian), Schisandra Berry (Wuweizi, 2 qian, crushed), Apricot Seed (Xingren, 2 qian, peeled), Dried Ginger (Ganjiang, 1.5 qian), Fineleaf Asarum Root (Xixin, 1 qian), Licorice Root (Gancao, 1.5 qian), Fresh Ginger (Shengjiang, 3 slices). Decoct together in one large bowl and take warm.
Formula Analysis: Whenever Xiao Qing Long Tang is used for wheezing, Ephedra Herb (Mahuang) is removed and replaced with Apricot Seed (Xingren); this is a fixed rule. If there is heat from external contraction, Raw Gypsum (Sheng Shigao) should be added. Since this case lacks heat from external contraction, only Tiantong and Maidong are added to resolve the dry-heat nature of Ganjiang and Guizhi.
Follow-up Visit: After taking one dose, the wheezing subsided completely. After two more doses, the cough improved significantly. The right pulse was no longer deep and seemed slightly stronger, but the left pulse remained close to wiry and hard. It is proposed to further use herbs that strengthen the stomach, nourish the lungs, and generate blood vessels.
Prescription: Raw Huai Yam (Sheng Huai Shanyao, 1 liang), Raw Lily Bulb (Sheng Baihe, 5 qian), Large Goji Berry (Da Gouqizi, 5 qian), Asparagus Root (Tiantong, 5 qian), Dang Gui Body (Danggui Shen, 3 qian), Perilla Fruit (Suzi, 1.5 qian, stir-fried and crushed), Sichuan Fritillary Bulb (Chuan Beimu, 3 qian), Atractylodes Macrocephala Rhizome (Baizhu, 3 qian, stir-fried), Raw Coix Seed (Sheng Yimi, 3 qian, crushed), Raw Polygala Root (Sheng Yuanzhi, 2 qian), Raw Chicken Gizzard Lining (Sheng Jineijin, 1.5 qian, yellow variety, crushed), Licorice Root (Gancao, 1.5 qian). Decoct in water in one large bowl and take warm.
Outcome: After continuously taking four doses, the cough was completely cured, and the pulse became harmonious and normal.