天津于姓媪，年近五旬，咳嗽有痰微喘，且苦不寐。
病因 夜间因不能寐，心中常觉发热，久之，则肺脏受伤，咳嗽多痰，且微作喘。
证候 素本夜间不寐，至黎明时始能少睡。后因咳嗽不止，痰涎壅盛，且复作喘，不能安卧，
恒至黎明亦不能睡。因之心中发热益甚，懒于饮食，大便干燥，四五日一行，两旬之间大形
困顿，屡次服药无效。其脉左部弦而无力，右部滑而无力，数逾五至。
诊断 此真阴亏损，心肾不能相济，是以不眠。久则心血耗散，心火更易妄动以上铄肺金，是
以咳嗽有痰作喘。治此证者，当以大滋真阴为主，真阴足则心肾自然相交，以水济火而火不妄
动；真阴足则自能纳气归根，气息下达，而呼吸自顺。且肺肾为子母之脏，原相连属，子虚有损于母，子
实即有益于母，果能使真阴充足，则肺金既不受心火之铄耗，更可得肾阴之津润，自能复其清肃
下行之常，其痰涎咳嗽不治自愈也。若更辅以清火润肺化痰宁嗽之品，则奏效当更捷矣。
处方 沙参（一两） 大枸杞（一两） 玄参（六钱） 天冬（六钱）
生赭石（五钱轧细） 甘草（二钱） 生杭芍（三钱） 川贝母（三钱） 牛蒡子（一钱捣碎）
生麦芽（三钱） 枣仁（三钱炒捣） 射干（二钱）
共煎汤一大盅，温服。
复诊 将药连服六剂，咳喘痰涎愈十分之八，心中已不发热，食欲已振，夜能睡数时，大便亦
不甚燥。诊其脉至数复常，惟六部重按仍皆欠实，左脉仍有弦意。拟再峻补其真阴以除病
根，所谓上病取诸下也。
处方 生怀山药（一两） 大枸杞（一两） 辽沙参（八钱） 生怀地黄（六钱）
熟怀地黄（六钱） 甘草（二钱） 生赭石（六钱轧细） 净萸肉（四钱）
生杭芍（三钱） 生麦芽（三钱） 生鸡内金（针半黄色的捣）
共煎汤一大盅，温服。
效果 将药连服二剂，诸病皆愈，俾用珠玉二宝粥常常当点心服之，以善其后。
或问 两方中所用之药，若滋阴、润肺、清火、理痰、止嗽诸品，原为人所共知，而两方
之中皆用赭石、麦芽，且又皆生用者其义何居？答曰∶胃居中焦，原以传送饮食为专职，是
以胃中之气，以息息下行为顺，果其气能息息下行，则冲气可阻其上冲，胆火可因之下降，大便
亦可按时下通，至于痰涎之壅滞，咳嗽喘逆诸证，亦可因之降序，而降胃之药，固莫赭石若也。至于
麦芽，炒用之善于消食，生用之则善于升达肝气。人身之气化原左升右降，若但知用赭石降胃，其重坠
下行之力或有碍于肝气之上升，是以方中用赭石降胃，即用麦芽升肝，此所以顺气化之自然，而还
其左升右降之常也。
Tianjin had an elderly surnamed Yu, nearly fifty years old, suffering from cough with phlegm and slight wheezing, as well as severe insomnia.
Etiology Due to inability to sleep at night, she often felt heat in the heart region. Over time, this injured the Lung organ, leading to cough with abundant phlegm and slight wheezing.
Symptoms She had a chronic history of insomnia at night, only able to sleep briefly at dawn. Later, due to incessant coughing, excessive phlegm-saliva, and recurrent wheezing, she could not lie down comfortably, and even at dawn she could not sleep. Consequently, the sensation of heat in the heart region became more intense, appetite decreased, stools were dry, occurring only once every four to five days. Within twenty days, her physical condition became extremely exhausted, and multiple courses of medication proved ineffective. Her pulse was wiry and deficient on the left side, slippery and deficient on the right side, with a frequency exceeding five beats per breath cycle (approx. 100+ bpm).
Diagnosis This is a deficiency of True Yin (Zhen Yin, the fundamental Yin substance), where the Heart and Kidney fail to interact and assist each other, resulting in insomnia. Prolonged deficiency leads to consumption of Heart Blood, causing Heart Fire to flare up and scorch Lung Metal (Lung tissue), resulting in cough with phlegm and wheezing. Treatment should focus primarily on heavily nourishing True Yin. When True Yin is sufficient, Heart and Kidney will naturally interact; Water (Kidney) will control Fire (Heart) preventing it from flaring. Sufficient True Yin allows Qi to root and descend, making respiration smooth. Since Lung and Kidney are mother-son organs intrinsically connected, deficiency in the son harms the mother, while sufficiency benefits the mother. If True Yin is sufficiently replenished, Lung Metal will not be scorched by Heart Fire and will receive moisture from Kidney Yin, naturally restoring its clear, descending function. Phlegm and cough will heal spontaneously. If assisted by herbs that clear fire, moisten lungs, resolve phlegm, and calm cough, efficacy will be faster.
Prescription Sha Shen (Glehniae Radix, 1 liang) Da Gou Qi (Lycii Fructus, 1 liang) Xuan Shen (Scrophulariae Radix, 6 qian) Tian Dong (Asparagi Radix, 6 qian)
Sheng Zhe Shi (Hematitum, 5 qian, finely ground) Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian) Sheng Hang Shao (Paeoniae Radix Alba, 3 qian) Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 3 qian) Niu Bang Zi (Arctii Fructus, 1 qian, crushed)
Sheng Mai Ya (Hordei Fructus Germinatus, 3 qian) Zao Ren (Ziziphi Spinosae Semen, 3 qian, stir-fried and crushed) She Gan (Belamcandae Rhizoma, 2 qian)
Decoct together in one large bowl of water, take warm.
Follow-up Visit After taking six doses continuously, cough, wheezing, and phlegm improved by 80%. Heat in the heart region ceased, appetite recovered, nighttime sleep lasted several hours, and stools were no longer very dry. Pulse rate returned to normal, but all six positions remained insufficient upon heavy pressure, and the left pulse still showed a wiry quality. The plan is to vigorously tonify True Yin to eliminate the root cause, following the principle of "treating upper diseases from the lower."
Prescription Sheng Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma, 1 liang) Da Gou Qi (Lycii Fructus, 1 liang) Liao Sha Shen (Glehniae Radix, 8 qian) Sheng Huai Di Huang (Rehmanniae Radix, 6 qian)
Shu Huai Di Huang (Rehmanniae Radix Praeparata, 6 qian) Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian) Sheng Zhe Shi (Hematitum, 6 qian, finely ground) Jing Yu Rou (Corni Fructus, 4 qian)
Sheng Hang Shao (Paeoniae Radix Alba, 3 qian) Sheng Mai Ya (Hordei Fructus Germinatus, 3 qian) Sheng Ji Nei Jin (Galli Gigerii Endothelium Corneum, half-yellow needle-like, crushed)
Decoct together in one large bowl of water, take warm.
Outcome After two doses, all symptoms resolved. It is recommended to consume Zhu Yu Er Bao Zhou (Pearl-Jade Two-Treasure Porridge) regularly as a snack for convalescence.
Question: The herbs used in both prescriptions for nourishing Yin, moistening lungs, clearing fire, resolving phlegm, and stopping cough are commonly known. However, both prescriptions use Zhe Shi (Hematitum) and Mai Ya (Hordei Fructus Germinatus), both raw. What is the rationale? Answer: The Stomach resides in the Middle Jiao and is primarily responsible for transporting food and drink. Therefore, Stomach Qi should descend with every breath. If Qi descends properly, Chong Qi (Penetrating Vessel Qi) is prevented from rushing upward, Gallbladder Fire descends, and bowel movements occur regularly. Furthermore, stagnation of phlegm-saliva and conditions like cough and wheezing can be resolved through downward movement. Among herbs that direct Stomach Qi downward, none surpasses Zhe Shi. As for Mai Ya, when stir-fried, it excels at digesting food; when raw, it excels at ascending Liver Qi. Human Qi dynamics naturally ascend on the left and descend on the right. If only Zhe Shi is used to descend Stomach Qi, its heavy, sinking nature might hinder the ascent of Liver Qi. Therefore, using Zhe Shi to descend Stomach Qi while simultaneously using Mai Ya to ascend Liver Qi conforms to the natural flow of Qi dynamics, restoring the normal pattern of left ascent and right descent.