按：苓桂术甘汤为《伤寒杂病论》原方，广泛运用于外感变证及内伤杂证。本方治证，不论伤寒吐下之后，抑或是内伤杂证，究其成冈，皆为中阳不振，水湿停聚所致。治法属于温阳化饮的温法，即《金匮要略·痰饮咳嗽病脉证并治篇》“病痰饮者，当以温药和之”之法。方中以甘淡之茯苓为君，取其健脾利水、渗湿化饮之功。但湿饮为阴邪，得温方可消散，故臣以辛温之桂枝，以温阳降冲，与茯苓相伍，既可温阳以助化饮，又可通阳化气，内通阳气，外解肌表，实为本方温阳化饮法之核心。佐以白术健脾燥湿，以助运化。佐使以甘草，一者调和诸药，益气和中，一者以复脾胃升降之权。加陈皮理气燥湿，和中化痰，以助苓、术之功，川贝母止咳化痰，为治肺止咳之要药。全方药味精干，配伍严谨，温而不热，利而不峻，诚为以温法治湿痰咳嗽之良方。
案二：苗某，男，42岁。门诊号：62842。
1963年3月30日初诊：咳嗽、气短3个月，痰多白粘，胸闷，胃脘胀满，舌苔白腻，脉濡滑。此为痰湿中阻。治宜燥湿(化痰)法。方用加味二陈汤：
半夏7．5克陈皮7．5克茯苓9克桂枝7．5克 白术7．5克炙甘草3克
水煎服。2剂而咳嗽止，4剂而气短、胀满除，6剂痊愈。
按：本例患者系痰湿从脾胃滋生，上渍于肺，故咳嗽而痰多，且为白粘痰。李老常用《局方》二陈汤治疗痰湿中阻所致之咳嗽及一切病证。痰湿中生，源于脾虚湿盛，故加内术以健脾燥湿；妙用桂枝，一可内通阳气以助化湿，二可外达肌表，解肌以宣肺，使痰湿除而咳自止。
小儿五更作咳 治宜通里攻下
五更时作咳，为食积咳嗽的一种常见证候，多发生于小儿。其病多由饮食不节或脾虚，食积不化，胃失和降，火气上逆冲肺所致。证候特点以咳有定时，多在五更时作咳，胃部、脐部拒按为特征。
治宦消食去积为主，兼清理肺气。代表方剂为：
1．加味大承气汤：大承气汤加陈皮、柴胡、杏仁。主治小儿停食，后半夜(多在五更)出现咳嗽气短，汗出，脐腹拒按者。
2．加味小柴胡汤：小柴胡汤加山楂、神曲、麦芽、莱菔子、炒栀子、寸冬。主治食积咳嗽兼肝气郁滞，寒热，口苦，呕吐者。
3．保和丸加减：主治积食停滞，胸脘痞满而咳不止者。
4．平胃散加减：主治积食不去，脘腹胀满，湿阻中州而咳者。
附案：
靳某，男，8岁。门诊号：27693。
1960年4月5日初诊：近1周来，每于后半夜咳嗽频作，咳有定时，多在五更时分，同时兼有气短，汗出，脐腹硬满拒按，大便干结，舌苔黄燥，脉弦滑而微数。诊为食滞肠胃，化火上冲于肺的大承气汤证。治宜通里攻下，釜底抽薪，兼以清理肺气。处方：
枳实3克厚朴3克 大黄2．5克元明粉1．5克(冲服) 陈皮4．5克柴胡2．5克杏仁3克
1剂，水煎服。嘱咐患者，服第一煎后，会出现肚子拧痛，大便稀，日行1～2次，此为正常反应，应以流食调养。第二煎后，腑气大通，自觉上下通气，身轻气爽，次日五更及以后咳嗽再未发作。
按：此例患者，系因饮食不节，食滞不化，脾胃失运，故脘腹胀满，脐腹拒按，食积既久，化热上冲于肺，肺失清降，以致咳嗽气短，大便干结，舌苔黄燥，脉滑而数，结合腹满、拒按等症，大承气汤证的“痞”、“满”、“燥”、“实”、“坚”特征兼而备之。故急用大承气汤通腑攻下，釜底抽薪，以治食积咳嗽之本，加陈皮理气化痰，杏仁止咳平喘，柴胡清降肺热，共成通腑泄热、清肺化痰止咳之神效。
咳喜侧卧一边 当从瘀血论治
临床常遇咳嗽而喜卧一侧，翻身则咳益甚，或咳逆倚息不得卧，坐则咳轻，卧则咳重的病证。李老认为这都是瘀血咳嗽的典型证候，究其原因，多系发生在咳血已愈或未愈之时，由于咳血期间瘀血(离经之血)阻碍气管，影响了正常的呼吸所致。
治法宜以去瘀血为主，分别病势之轻重，适当地配合除痰、逐水、降逆气之药，再根据瘀血存在身体部位左右之不同，分别佐以不同的药物治之。
常用方剂：
1．血府逐瘀汤加减：症见瘀血咳逆，倚息不得卧者，加葶苈子、苏子；瘀咳侧卧一边，翻身则咳益甚者，加杏仁、五味子；侧卧左边者，以左边有瘀血，故能左卧不能右卧也，宜加青皮、鳖甲、莪术以去左边之瘀血；侧卧右边者，以右边有瘀血，故能右卧不能左卧也，宜加郁金、桑皮、姜黄以去右边之瘀血。
2．代抵当丸加茯苓半夏：治瘀咳之重证者。其倚息不得卧或侧卧一边者，可参照上方加减法治之。
阴虚咳嗽治验
阴虚咳嗽多因久咳不愈，肺津耗伤，或肾阴素虚，复感风寒，伤风虽愈，咳久不止者。其症可见呛咳，无痰或咯痰不利，身体赢瘦，形容憔悴，口干，喉干，虚烦不眠，便燥溺赤，甚则骨蒸盗汗，颧红，消渴，强中，舌红少苔，脉细而数。
凡大热之证，服清凉之药而不效者，即是阴虚。古人所谓“寒之不寒是无水也”。看证还需结合具体症状，特别是燥咳无痰或咯痰不利，以及喉干便燥，舌红，脉细数等，不难辨识。治疗上除滋阴润肺或清肺外，尤当注意外邪的已净或未净，他脏的阴虚，及气、血、精等的亏虚情况。外邪未净者，滋阴剂中当酌加散邪之品；外邪已净者，应分别肺肾阴虚之主次，以滋补其阴；有热者，兼清其热；气虚者，兼补其气；血虚者，兼益其血；脾虚者，兼补其脾；精虚者，兼益其精。如张景岳所言：“善补阴者，必于阳中求阴，阴得阳助而泉源不竭。”阴阳是互根的，不能只强调一而。必须将其看作一个有机的整体。
常用方剂：
1．清金丸：主治肺阴虚咳嗽，或多痰，或无痰干咳，或痰红，或纯红等。
2．加减清金膏：主治阴虚内热，咳嗽痰血，兼脾胃虚弱，食少泄多等。
3．噙化丸：治阴虚火嗽及伤风外邪已解，久不愈者。
4．琼玉膏：主治阴虚兼气虚，虚劳干咳者。
5．麦味地黄丸：治肺肾阴虚咳嗽，黄昏时咳嗽发作者。
6．河车大造丸：主治阴虚，虚劳精血大亏，虚火旺盛，咳嗽发热者。
7．增液汤：主治肺阴虚津亏之干咳者。
8．加减复脉汤：主治温病后期，邪热久留不去，阴液亏虚，干咳无痰者。
附案：
案一周某，男，62岁。门诊号：38297。
1961年3月20日初诊：音哑、咽干、咳嗽、食欲不振1年余。近来自觉喉中有异物，舌质红，无苔，脉细数。西医诊断为喉头癌。此为阴虚咳嗽。治宜育阴生津，止咳散结。方用增液汤加味：
桑皮7．5克杏仁9克川贝母6克 元参7．5克桔梗4．5克射干6克胖大海3枚麦冬6克生地9克白芍9克鸡内金6克
2剂，水煎服。
二诊：服上方后，饮食增加，咽干、咳嗽均明显减轻。上方去杏仁，2剂，水煎服。
患者经上方随证加减治疗月余，诸症大减，咽喉症状消失，后于某医院复查，喉部组织正常。仍按上方加减，以巩固疗效。随访2年未发病，以后中断联系。
按：本例患者之病属典型的阴虚久咳证，长期阴虚，阴亏液耗，瘀热内燥，郁结咽喉，故咽干，音哑，喉中如有异物，干咳不止。故治宜育阴生滓，化痰散结。
案二 陈某，男，34岁。门诊号：57142。
1962年1 1月14日初诊：近日来咳嗽不止，干咳无痰，咽干，咽痛，口干燥，苔薄白，脉数。此为阴虚肺燥。治宜滋阴润肺生津。方用加减复脉汤：
生白芍7．5克黑芝麻7．5克熟地9克阿胶4．5克(烊化) 生龙骨9克 生牡蛎9克 茯神7．5克 麦冬6克桔梗4．5克炙甘草6克
2剂，水煎服。
2剂而咳止，又续服3剂而愈。
按：本案属于阴虚燥咳。取《温病条辨》加减复脉汤之地黄、阿胶、白芍、麦冬以滋阴养血润燥，去火麻仁，加龙骨、牡蛎、茯神以育阴潜阳，敛汗安神，桔梗以利咽，黑芝麻补肝肾而润五脏以助滋阴润燥之力。诸药合用自能滋阴而潜阳，润燥而止咳。 湿痰致咳尤多见 二陈底方巧化裁 二陈汤源出于宋代《太平惠民和剂局方》，方由半夏、陈皮、茯苓、甘草四味组成。原书中记载主治痰饮为患，或呕吐恶心，或头眩心悸，或中脘不快，或发为寒热，或因食生冷而脾胃不和等。对此方证，吴崑《医方考·痰门》有一段精辟论述：“湿痰者，痰之源生于湿也。水饮入胃，无非湿化，脾弱不能制，停于膈间，中下二焦之气熏蒸稠粘，稀则日饮，稠则日痰，痰生于湿，故日痰湿也。是方也，半夏辛热能燥湿，茯苓甘淡能渗湿，湿去是痰无由以生，所谓治病必求其本也；陈皮辛温能利气，甘草甘平能益脾，益脾则土足以利湿，利气则痰无能留滞，益脾治其本，利气治其标也。”湿痰之证，多由脾失健运，湿邪凝聚，气机阻滞，郁积而成，故曰脾为生痰之源。二陈汤为治湿痰之祖方，倍受历代医家之推崇，如《医方集解》言：“治痰通用二陈。”李老对此方亦情有独钟，常将二陈汤作为治疗湿痰、寒痰、痰饮、痰涎诸证之底方。凡疑难杂症有湿痰见症者，多以此方为主，随证加减化裁以应对复杂证候而每获佳效。李老认为，咳嗽一症，临床上以湿痰所致者十分常见，究其原因，正如前贤所言：“脾为生痰之源，肺为贮痰之器。”痰湿生于脾，藏于肺，痰湿犯肺，故出现咳嗽痰多之症。
临床上，李老常用二陈汤加减化裁主治两类咳嗽：
1．痰饮咳嗽：症见咳嗽有痰，痰稀而多，胸腹胀满，呕吐，恶心，头眩，心悸等。
2．风寒咳嗽：无表证而痰多之证。
加减应用法则：
1．加杏仁、白芥子，名六安煎。治外感风寒咳嗽无表证之轻证。
2．面目浮肿者，加桑皮6～9克，葶苈子1．5～3克。
3．寒甚者，加细辛，或六安煎去白芥子，加五味子、干姜。
4．久嗽不愈，脉不数、不虚，寸脉浮大而滑者，乃风痰不解，多服辛凉所致，加麻黄、杏仁、前胡、苏子、桔梗。
5．子嗽而属于痰饮者，加白术以补脾安胎。
6．肺气不利者，加杏仁、苏子、桑皮。
7．咳逆倚息不得卧者，为水饮冲肺，肺不得下降所致，宜加葶苈子、大枣。
8．火甚者，加瓜蒌霜、黄芩、黄连；火轻者，加寸冬、知母。
9．风寒较重者，加柴胡、荆芥、防风。
10．兼血虚、血瘀者，加当归、白芍、丹皮、杏仁。
11．风痰甚者，加南星、白附子、皂角刺、竹沥。
12．寒痰甚者，加重半夏、姜汁。
13．火痰甚者，加石膏、青黛。
14．湿痰甚者，加苍术、白术。
15. 燥痰甚者，加瓜蒌、杏仁。
16．食痰甚者，加焦三仙。
17．老痰、顽痰者，加枳实、海浮石、芒硝。
18．气痰者，加香附、枳壳。
19．胁痰及皮里膜外之痰者，加白芥子。
20．四肢痰者，加竹沥。
止嗽散化裁治百咳
止嗽散为《医学心悟》方，由桔梗、荆芥、紫菀、百部、白前、陈皮、甘草七味组成。李老认为，本方为治咳之祖方，具有止嗽化痰、解表宣肺、利气和中之功效，临床多以其加减化裁，广泛运用于五脏六腑咳及外感咳嗽之轻证(表证不显著之咳嗽)者。其中咳嗽兼咳血者，加蒲黄、藕节；兼口苦咽于者，加黄芩、寸冬；兼痰者，加川贝母、茯苓；兼气逆者，加杏仁、枳壳；兼血虚者，加生地、当归；风寒咳嗽初起，加防风、苏叶、生姜以疏散之；暑气伤肺，口渴，心烦，溺赤者，加黄连、黄芩、花粉以清其暑热；湿气生痰，痰涎稠粘者，加半夏、茯苓、桑皮、生姜、大枣以祛其湿；燥气焚金，干咳无痰者，加瓜蒌、知母、贝母、柏子仁以润其燥；肺咳，因风寒而咳血者，加紫苏、赤芍、丹参；心咳，咳而喉中如梗状，甚则咽肿喉痹者，倍桔梗，加牛子；脾咳，咳而右胁隐痛引肩背，甚则不可以动，动则加剧者，加葛根、秦艽、郁金；肝咳，咳而两胁痛，不能自转侧者，加柴胡、枳壳、赤芍；肾咳，咳而腰背困，甚则咳涎者，加附子；胆咳，咳而呕苦水者，加黄芩、半夏、生姜；小肠咳，咳而矢气者，加白芍；胃咳，咳而呕，呕甚长虫出者，去甘草，加乌梅、川椒、干姜，有热者佐黄连；大肠咳，咳而遗屎者，加白术、赤石脂；膀胱咳，咳而遗尿者，加茯苓、半夏；三焦咳，咳久不止，腹满不食，多涕唾，面目浮肿．气逆者．合异功散：七情气结，郁火上冲者．加香附、贝母、柴胡、黑山栀；肾阴虚，水不制火，身烦热，脉细数者，早用地黄丸，午用本方去荆芥，加知母、贝母以开火郁；客邪留于肺经，变生虚热者，本方去荆芥，佐以团鱼丸；病热深久，变为虚劳，或尸虫入肺，喉痒而咳者，去荆芥，佐以月华丸；内伤饮食，口干痞闷，五更咳甚者，加连翘、山楂、麦芽、莱菔子以消食化滞。
温 病
温热之邪初犯肺卫
虽用辛凉 夹配温散
Note: Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractodes Rhizome and Licorice Decoction) is the original formula from *Shanghan Zabing Lun* (Treatise on Cold Pathogenic and Miscellaneous Diseases), widely applied to complications of exogenous diseases and internal injury miscellaneous disorders. The indications for this formula, whether after purging or vomiting in cold damage, or in internal injury disorders, are fundamentally caused by the failure of middle jiao yang qi to flourish, leading to water-dampness retention. The treatment method belongs to the warming method of warming yang and transforming fluid retention, which follows the principle in *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) "Diseases of phlegm-fluids should be harmonized with warm herbs." In the formula, Poria (Fuling, 茯苓) with sweet and bland properties serves as the sovereign herb, utilizing its functions to strengthen the spleen, promote urination, leach out dampness, and transform fluids. However, since dampness and fluids are yin pathogens that dissipate only when warmed, Cinnamon Twig (Guizhi, 桂枝) with acrid and warm properties is used as the minister herb to warm yang and descend rebellious qi. Paired with Poria, it not only warms yang to assist in transforming fluids but also unblocks yang to transform qi, internally connecting yang qi and externally releasing the muscle layer, truly serving as the core of the warming yang and transforming fluids method in this formula. Atractodes Rhizome (Baizhu, 白术) is used as an assistant herb to strengthen the spleen and dry dampness, aiding transportation. Licorice Root (Gancao, 炙甘草) acts as an assistant and envoy herb; on one hand, it harmonizes all herbs and benefits qi to moderate the middle, and on the other, it restores the ascending and descending functions of the spleen and stomach. Tangerine Peel (Chenpi, 陈皮) is added to regulate qi, dry dampness, moderate the middle, and transform phlegm, assisting the effects of Poria and Atractodes Rhizome; Fritillaria Bulb (Chuanbeimu, 川贝母) is added to stop cough and transform phlegm, being a key herb for treating lung coughs. The formula contains few ingredients with rigorous compatibility, is warm but not hot, draining but not harsh, and is indeed an excellent formula for using the warming method to treat wet-phlegm coughs.
Case 2: Patient Miao, male, 42 years old. Outpatient No.: 62842.
First visit on March 30, 1963: Cough and shortness of breath for 3 months, profuse white sticky sputum, chest tightness, epigastric distension, white greasy tongue coating, soggy and slippery pulse. This is a syndrome of phlegm-dampness obstructing the middle. Treatment should employ the drying dampness (transforming phlegm) method. Formula: Modified Erchen Tang (Two-Aged Phlegm Resolving Decoction):
Pinellia Tuber (Banxia, 半夏) 7.5g, Tangerine Peel (Chenpi, 陈皮) 7.5g, Poria (Fuling, 茯苓) 9g, Cinnamon Twig (Guizhi, 桂枝) 7.5g, Atractodes Rhizome (Baizhu, 白术) 7.5g, Honey-fried Licorice Root (Zhigancao, 炙甘草) 3g.
Decoct in water and take orally. After 2 doses, cough ceased; after 4 doses, shortness of breath and distension resolved; cured after 6 doses.
Note: This patient's condition arose from phlegm-dampness generated in the spleen and stomach, flooding upwards into the lungs, causing cough and profuse white sticky sputum. Dr. Li frequently uses Erchen Tang from *Ju Fang* (Prescriptions from the Bureau) to treat coughs and related disorders caused by phlegm-dampness obstructing the middle. The generation of phlegm-dampness in the middle originates from spleen deficiency and abundant dampness, so Atractodes Rhizome is added to strengthen the spleen and dry dampness; Cinnamon Twig is ingeniously used to internally connect yang qi to aid dampness transformation and externally reach the muscle layer to release the exterior and diffuse lung qi, allowing phlegm-dampness to be eliminated and cough to stop spontaneously.
Cough at Five Watches in Children: Treatment Should Involve Purging the Interior to Attack Accumulation
Cough occurring at the fifth watch (early morning, approx. 3-5 AM) is a common manifestation of food-stagnation cough, mostly occurring in children. The pathology often results from irregular diet or spleen deficiency, leading to undigested food stagnation, loss of harmony and descent in the stomach, and fire qi rushing upward to attack the lungs. Characteristic symptoms include coughing at fixed times, mostly at the fifth watch, and tenderness/refusal to press on the stomach and umbilical regions.
Treatment should focus on digesting food and removing accumulation, combined with clearing lung qi. Representative formulas include:
1. Modified Dachengqi Tang (Major Order the Qi Decoction): Dachengqi Tang plus Tangerine Peel (Chenpi, 陈皮), Bupleurum Root (Chaihu, 柴胡), and Apricot Seed (Xingren, 杏仁). Indicated for pediatric food stagnation presenting with cough and shortness of breath in the latter half of the night (mostly at the fifth watch), sweating, and tenderness/refusal to press on the umbilical and abdominal regions.
2. Modified Xiaochaihu Tang (Minor Order the Qi Decoction): Xiaochaihu Tang plus Hawthorn Fruit (Shanzha, 山楂), Medicated Leaven (Shenqu, 神曲), Malt (Maiya, 麦芽), Radish Seed (Laifuzi, 莱菔子), Stir-fried Gardenia (Chao Zhizi, 炒栀子), and Ophiopogon Tuber (Madong, 麦冬/寸冬). Indicated for food-stagnation cough complicated by liver qi stagnation, alternating chills and fever, bitter taste in the mouth, and vomiting.
3. Modified Baohe Wan (Preserve Harmony Pill): Indicated for food stagnation with chest and epigastric stuffiness/fullness and persistent cough.
4. Modified Pingwei San (Level the Stomach Powder): Indicated for unresolved food stagnation, epigastric and abdominal distension, and cough due to dampness obstructing the middle jiao.
Attached Case:
Patient Jin, male, 8 years old. Outpatient No.: 27693.
First visit on April 5, 1960: For the past week, frequent coughing occurred every night in the latter half, with fixed timing, mostly at the fifth watch. Accompanied by shortness of breath, sweating, hardness and fullness of the umbilical/abdominal region with refusal to press, dry stool, yellow dry tongue coating, and wiry-slippery pulse slightly rapid. Diagnosed as Dachengqi Tang syndrome due to food stagnation in the intestines and stomach, transforming into fire that rushes upward to the lungs. Treatment should involve purging the interior to attack accumulation, drawing fire from the bottom (釜底抽薪), combined with clearing lung qi. Prescription:
Immature Bitter Orange (Zhishi, 枳实) 3g, Magnolia Bark (Houpo, 厚朴) 3g, Rhubarb (Dahuang, 大黄) 2.5g, Mirabilite (Yuanmingfen, 元明粉) 1.5g (dissolved and taken), Tangerine Peel (Chenpi, 陈皮) 4.5g, Bupleurum Root (Chaihu, 柴胡) 2.5g, Apricot Seed (Xingren, 杏仁) 3g.
One dose, decocted in water and taken orally. Instructed the patient that after the first decoction, abdominal twisting pain and loose stools (1-2 times daily) would occur; this is a normal reaction, and a liquid diet should be maintained. After the second decoction, bowel qi moved freely, feeling of upper and lower ventilation, light body and clear spirit, and no further coughing occurred at the fifth watch or thereafter the next day.
Note: This patient suffered from irregular diet leading to undigested food stagnation and spleen-stomach dysfunction, resulting in epigastric/abdominal distension and umbilical tenderness. Long-standing food stagnation transformed into heat rushing upward to the lungs, causing loss of lung clarity and descent, leading to cough, shortness of breath, dry stool, yellow dry tongue coating, and slippery-rapid pulse. Combined with abdominal fullness and tenderness, the characteristics of "stuffiness," "fullness," "dryness," "excess," and "hardness" of Dachengqi Tang syndrome were fully present. Thus, Dachengqi Tang was urgently used to purge the bowels and attack accumulation, drawing fire from the bottom to treat the root of food-stagnation cough. Tangerine Peel regulates qi and transforms phlegm, Apricot Seed stops cough and calms wheezing, and Bupleurum clears and descends lung heat, achieving miraculous efficacy in purging bowels, draining heat, clearing lungs, transforming phlegm, and stopping cough.
Cough Preferring Side-Lying Position: Should Be Treated Based on Blood Stasis
Clinically, cases are often encountered where coughing patients prefer lying on one side; turning over exacerbates the cough, or they cannot lie flat due to rebellious qi and breathing difficulty, with cough alleviated when sitting and worsened when lying down. Dr. Li considers these typical manifestations of blood-stasis cough. The cause is often associated with periods when hemoptysis has healed or is not yet healed, where blood stasis (blood leaving the vessels) obstructs the airways during hemoptysis, affecting normal respiration.
The treatment method should primarily focus on removing blood stasis. Depending on the severity of the disease, appropriate combinations of phlegm-resolving, water-draining, and qi-descending herbs should be used. Furthermore, based on whether the blood stasis is located on the left or right side of the body, different adjunctive herbs should be selected.
Commonly used formulas:
1. Modified Xuefu Zhuyu Tang (Drive Out Stasis in the Mansion of Blood Decoction): For symptoms of rebellious cough due to blood stasis and inability to lie flat, add Lepidium Seed (Tinglizi, 葶苈子) and Perilla Seed (Suzi, 苏子); for cough with side-lying preference worsening upon turning, add Apricot Seed (Xingren, 杏仁) and Schisandra Berry (Wuweizi, 五味子); for those preferring left-side lying, indicating left-sided stasis preventing right-side lying, add Green Tangerine Peel (Qingpi, 青皮), Turtle Shell (Biejia, 鳖甲), and Curcuma Tuber (Ezhu, 莪术) to remove left-sided stasis; for those preferring right-side lying, indicating right-sided stasis preventing left-side lying, add Turmeric Root (Yujin, 郁金), Mulberry Root Bark (Sangpí, 桑皮), and Turmeric Rhizome (Jianghuang, 姜黄) to remove right-sided stasis.
2. Daidang Wan (Replace Dangshen Pill) plus Poria (Fuling, 茯苓) and Pinellia Tuber (Banxia, 半夏): Treats severe cases of stasis-cough. For those unable to lie flat or preferring side-lying, refer to the modification rules of the above formula.
Clinical Experience in Treating Yin-Deficiency Cough
Yin-deficiency cough often results from prolonged cough damaging lung fluids, or inherent kidney yin deficiency compounded by wind-cold invasion. Although the wind-cold symptoms resolve, the cough persists. Symptoms may include spasmodic cough, absence of sputum or difficulty expectorating, emaciation, haggard appearance, dry mouth and throat, restlessness and insomnia, dry stool, dark urine, bone-steaming night sweats, malar flush, wasting-thirst, priapism, red tongue with little coating, and fine-rapid pulse.
For high-fever syndromes unresponsive to cooling medications, it indicates yin deficiency. As ancients said, "If cooling does not reduce heat, there is no water." Diagnosis requires combining specific symptoms, especially dry cough without sputum or difficulty expectorating, dry throat/stool, red tongue, and fine-rapid pulse, which are easy to identify. Treatment involves nourishing yin and moistening the lungs or clearing lung heat, while paying special attention to whether external pathogens remain, yin deficiency in other organs, and deficiencies of qi, blood, and essence. If external pathogens remain, dispersing agents should be added to yin-nourishing formulas; if cleared, prioritize tonifying lung or kidney yin. If heat is present, clear heat; if qi deficient, tonify qi; if blood deficient, nourish blood; if spleen deficient, tonify spleen; if essence deficient, benefit essence. As Zhang Jingyue stated: "Those skilled in tonifying yin must seek yin within yang; when yin receives yang assistance, its source will not dry up." Yin and yang are mutually rooted; one cannot emphasize only one aspect. They must be viewed as an organic whole.
Commonly used formulas:
1. Qingjin Wan (Clear Metal Pill): Indicated for lung yin-deficiency cough, with profuse sputum, dry cough without sputum, blood-streaked sputum, or pure blood.
2. Modified Qingjin Gao (Clear Metal Paste): Indicated for yin-deficiency with internal heat, cough with blood in sputum, complicated by spleen-stomach weakness, poor appetite, and diarrhea.
3. Qinhua Wan (Hold-and-Swallow Pill): Treats yin-deficiency with fire-cough and lingering cough after resolution of wind-cold external pathogens.
4. Qiongyu Gao (Jade Essence Paste): Indicated for yin-deficiency with qi-deficiency and consumptive dry cough.
5. Maiwei Dihuang Wan (Litchi and Rehmannia Pill with Schisandra): Treats lung-kidney yin-deficiency cough, particularly coughs occurring at dusk.
6. Heche Dazao Wan (Placenta Great Nourishment Pill): Indicated for yin-deficiency, consumptive disorder with severe deficiency of essence and blood, vigorous deficient fire, cough, and fever.
7. Zengye Tang (Increase Fluids Decoction): Indicated for dry cough due to lung yin-deficiency and fluid depletion.
8. Modified Fumai Tang (Modified Pulse-Recovering Decoction): Indicated for late-stage warm diseases where pathogenic heat lingers, causing yin fluid deficiency and dry cough without sputum.
Attached Cases:
Case 1: Patient Zhou, male, 62 years old. Outpatient No.: 38297.
First visit on March 20, 1961: Hoarseness, dry throat, cough, and loss of appetite for over 1 year. Recently felt a foreign body sensation in the throat, red tongue substance, no coating, fine-rapid pulse. Western medical diagnosis: Laryngeal cancer. This is yin-deficiency cough. Treatment should nourish yin, generate fluids, stop cough, and dissipate nodules. Formula: Modified Zengye Tang (Increase Fluids Decoction):
Mulberry Root Bark (Sangpí, 桑皮) 7.5g, Apricot Seed (Xingren, 杏仁) 9g, Fritillaria Bulb (Chuanbeimu, 川贝母) 6g, Scrophularia Root (Xuanshen, 玄参) 7.5g, Platycodon Root (Jiegeng, 桔梗) 4.5g, Belamcanda Rhizome (Shegan, 射干) 6g, Sterculia Lychnophora Seed (Pangdahai, 胖大海) 3 pieces, Ophiopogon Tuber (Maidong, 麦冬) 6g, Rehmannia Root (Shengdi, 生地) 9g, White Peony Root (Baishao, 白芍) 9g, Chicken Gizzard Lining (Jineijin, 鸡内金) 6g.
2 doses, decocted in water and taken orally.
Second visit: After taking the above formula, appetite increased, and dry throat/cough significantly reduced. Remove Apricot Seed from the previous formula, 2 doses, decocted in water and taken orally.
After more than a month of treatment with modifications of the above formula according to symptoms, major symptoms decreased significantly, and throat symptoms disappeared. Follow-up examination at a certain hospital showed normal laryngeal tissue. Continued with modified formula to consolidate curative effect. Followed up for 2 years without recurrence; contact was later lost.
Note: This patient's condition is a typical case of chronic yin-deficiency cough. Long-term yin deficiency leads to fluid consumption, internal dryness from stasis-heat, and constraint in the throat, causing dry throat, hoarseness, foreign body sensation, and persistent dry cough. Therefore, treatment should nourish yin, generate fluids, transform phlegm, and dissipate nodules.
Case 2: Patient Chen, male, 34 years old. Outpatient No.: 57142.
First visit on November 14, 1962: Persistent cough recently, dry cough without sputum, dry throat, sore throat, dry mouth, thin white coating, rapid pulse. This is yin-deficiency with lung dryness. Treatment should nourish yin, moisten lungs, and generate fluids. Formula: Modified Fumai Tang (Modified Pulse-Recovering Decoction):
Raw White Peony Root (Sheng Baishao, 生白芍) 7.5g, Black Sesame Seed (Heimazhi, 黑芝麻) 7.5g, Prepared Rehmannia Root (Shudi, 熟地) 9g, Donkey-Hide Gelatin (Ejiao, 阿胶) 4.5g (melted), Raw Dragon Bone (Sheng Longgu, 生龙骨) 9g, Raw Oyster Shell (Sheng Muli, 生牡蛎) 9g, Spirit of Polygala Root (Fushen, 茯神) 7.5g, Ophiopogon Tuber (Maidong, 麦冬) 6g, Platycodon Root (Jiegeng, 桔梗) 4.5g, Honey-fried Licorice Root (Zhigancao, 炙甘草) 6g.
2 doses, decocted in water and taken orally.
Cough stopped after 2 doses; cured after continuing for another 3 doses.
Note: This case belongs to yin-deficiency dry cough. Using Rehmannia, Donkey-Hide Gelatin, White Peony Root, and Ophiopogon from Modified Fumai Tang in *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) to nourish yin, nourish blood, and moisten dryness; removing Hemp Seed (Huomaren, 火麻仁), adding Dragon Bone, Oyster Shell, and Spirit of Polygala Root to nourish yin, subdue yang, arrest sweating, and calm the mind; Platycodon Root to benefit the throat; Black Sesame Seed to tonify liver and kidney and moisten the five zang organs to assist in nourishing yin and moistening dryness. The combination of these herbs naturally nourishes yin and subdues yang, moistens dryness and stops cough.
Wet-Phlegm Cough is Especially Common: Ingenious Modification of Erchen Tang Base
Erchen Tang originates from the Song Dynasty's *Taiping Huimin Heji Jufang* (State Pharmacy Formulary), composed of Pinellia Tuber (Banxia, 半夏), Tangerine Peel (Chenpi, 陈皮), Poria (Fuling, 茯苓), and Licorice Root (Gancao, 甘草). The original text records indications for disorders caused by phlegm-fluids, such as vomiting and nausea, dizziness and palpitations, epigastric discomfort, alternating chills and fever, or spleen-stomach disharmony due to consuming raw/cold foods. Wu Kun in *Yifang Kao* (Study of Medical Formulas) provided a profound discussion on this formula's indications: "Wet-phlegm originates from dampness. Water entering the stomach transforms into dampness; weak spleen fails to control it, causing retention between the diaphragm. Qi from the middle and lower jiao steams and condenses; thin becomes drink, thick becomes phlegm. Since phlegm is born from dampness, it is called wet-phlegm. In this formula, Pinellia is acrid-warm and can dry dampness; Poria is sweet-bland and can leach dampness. When dampness is removed, phlegm has no basis to form, which is treating the root. Tangerine Peel is acrid-warm and promotes qi movement; Licorice is sweet-neutral and strengthens the spleen. Strengthening the spleen allows earth to benefit dampness; promoting qi prevents phlegm stagnation. Strengthening the spleen treats the root; promoting qi treats the branch." Wet-phlegm syndromes often result from spleen failing to transport, dampness coagulating, qi mechanism blocking, and accumulating, hence "the spleen is the source of phlegm production." Erchen Tang is the ancestral formula for treating wet-phlegm, highly esteemed by physicians through generations. As *Yifang Jijie* states: "Use Erchen Tang generally for treating phlegm." Dr. Li favors this formula, often using Erchen Tang as the base formula for treating wet-phlegm, cold-phlegm, phlegm-fluids, and salivary disorders. For difficult and complex cases with wet-phlegm signs, he mainly uses this formula, modifying it according to symptoms to handle complex syndromes with good results. Dr. Li believes that among cough symptoms, those caused by wet-phlegm are very common in clinical practice. As ancient experts said: "The spleen is the source of phlegm production; the lungs are the container of phlegm." Phlegm-dampness is produced in the spleen and stored in the lungs; when phlegm-dampness attacks the lungs, cough with profuse sputum occurs.
Clinically, Dr. Li commonly uses modified Erchen Tang to treat two types of cough:
1. Phlegm-fluid cough: Symptoms include cough with sputum, thin and profuse sputum, chest/abdominal fullness, vomiting, nausea, dizziness, palpitations, etc.
2. Wind-cold cough: Profuse sputum without exterior syndrome.
Modification Rules:
1. Add Apricot Seed (Xingren, 杏仁) and White Mustard Seed (Baijiezi, 白芥子), named Liu'an Jian (Six-An Decoction). Treats mild cases of wind-cold cough without exterior syndrome.
2. For facial/ocular edema, add Mulberry Root Bark (Sangpí, 桑白皮) 6-9g and Lepidium Seed (Tinglizi, 葶苈子) 1.5-3g.
3. For severe cold, add Asarum (Xixin, 细辛), or remove White Mustard Seed from Liu'an Jian and add Schisandra Berry (Wuweizi, 五味子) and Dried Ginger (Ganjiang, 干姜).
4. For chronic cough unrelieved, pulse not rapid/deficient, cun pulse floating-large and slippery, indicating unresolved wind-phlegm due to excessive use of acrid-cool herbs, add Ephedra Stem (Mahuang, 麻黄), Apricot Seed (Xingren, 杏仁), Peucedanum Root (Qianhu, 前胡), Perilla Seed (Suzi, 苏子), and Platycodon Root (Jiegeng, 桔梗).
5. For pregnancy cough due to phlegm-fluids, add Atractodes Rhizome (Baizhu, 白术) to strengthen spleen and calm fetus.
6. For lung qi obstruction, add Apricot Seed (Xingren, 杏仁), Perilla Seed (Suzi, 苏子), and Mulberry Root Bark (Sangpí, 桑白皮).
7. For rebellious cough and inability to lie flat due to fluid-fluid attacking lungs preventing lung descent, add Lepidium Seed (Tinglizi, 葶苈子) and Jujube (Dazao, 大枣).
8. For severe fire, add Trichosanthes Peel (Gualoushuang, 瓜蒌霜), Scutellaria Root (Huangqin, 黄芩), and Coptis Rhizome (Huanglian, 黄连); for mild fire, add Ophiopogon Tuber (Maidong, 麦冬) and Anemarrhena Rhizome (Zhimu, 知母).
9. For heavier wind-cold, add Bupleurum Root (Chaihu, 柴胡), Schizonepeta Spike (Jingjie, 荆芥), and Saposhnikovia Root (Fangfeng, 防风).
10. Complicated by blood deficiency/stasis, add Angelica Sinensis Root (Danggui, 当归), White Peony Root (Baishao, 白芍), Moutan Cortex (Danpi, 丹皮), and Apricot Seed (Xingren, 杏仁).
11. For severe wind-phlegm, add Arisaema Rhizome (Nanxing, 南星), Typhonium Rhizome (Baifuzi, 白附子), Gleditsia Spine (Zaocis, 皂角刺), and Bamboo Juice (Zhuli, 竹沥).
12. For severe cold-phlegm, increase Pinellia Tuber (Banxia, 半夏) and Ginger Juice (Jiangzhi, 姜汁).
13. For severe fire-phlegm, add Gypsum (Shigao, 石膏) and Indigo Naturalis (Qingdai, 青黛).
14. For severe wet-phlegm, add Atractylodes Macrocephala Rhizome (Cangzhu, 苍术) and Atractodes Rhizome (Baizhu, 白术).
15. For severe dry-phlegm, add Trichosanthes Fruit (Gualou, 瓜蒌) and Apricot Seed (Xingren, 杏仁).
16. For severe food-phlegm, add Jiao Sanxian (Scorched Three Immortals: scorched Hawthorn, Medicated Leaven, and Malt).
17. For old/stubborn phlegm, add Immature Bitter Orange (Zhishi, 枳实), Pumice Stone (Haifushi, 海浮石), and Mirabilite (Mangxiao, 芒硝).
18. For qi-phlegm, add Cyperus Rhizome (Xiangfu, 香附) and Bitter Orange (Zhiqiao, 枳壳).
19. For hypochondriac/phlegm outside the membrane, add White Mustard Seed (Baijiezi, 白芥子).
20. For limb-phlegm, add Bamboo Juice (Zhuli, 竹沥).
Zhisou San Modification for Treating Hundred Coughs
Zhisou San (Stop Cough Powder) is from *Yixue Xinwu* (New Insights into Medicine), composed of Platycodon Root (Jiegeng, 桔梗), Schizonepeta Spike (Jingjie, 荆芥), Aster Root (Ziwan, 紫菀), Stemona Root (Bubai, 百部), Cynanchum Root (Baiqian, 白前), Tangerine Peel (Chenpi, 陈皮), and Licorice Root (Gancao, 甘草). Dr. Li considers this the ancestral formula for treating cough, possessing functions of stopping cough, transforming phlegm, releasing exterior, diffusing lung, regulating qi, and moderating the middle. Clinically, it is widely used with modifications for coughs of the five zang and six fu organs and mild exogenous coughs (coughs without significant exterior syndrome). For cough with hemoptysis, add Polygonum Knotweed Herb (Puhuang, 蒲黄) and Lotus Rhizome Node (Oujie, 藕节); for bitter taste and dry throat, add Scutellaria Root (Huangqin, 黄芩) and Ophiopogon Tuber (Maidong, 麦冬); for phlegm, add Fritillaria Bulb (Chuanbeimu, 川贝母) and Poria (Fuling, 茯苓); for rebellious qi, add Apricot Seed (Xingren, 杏仁) and Bitter Orange (Zhiqiao, 枳壳); for blood deficiency, add Rehmannia Root (Shengdi, 生地) and Angelica Sinensis Root (Danggui, 当归); for early wind-cold cough, add Saposhnikovia Root (Fangfeng, 防风), Perilla Leaf (Suye, 苏叶), and Fresh Ginger (Shengjiang, 生姜) to disperse; for summer-heat injuring lung with thirst, vexation, and dark urine, add Coptis Rhizome (Huanglian, 黄连), Scutellaria Root (Huangqin, 黄芩), and Trichosanthes Root (Huafen, 花粉) to clear summer-heat; for dampness generating sticky phlegm, add Pinellia Tuber (Banxia, 半夏), Poria (Fuling, 茯苓), Mulberry Root Bark (Sangpí, 桑白皮), Fresh Ginger (Shengjiang, 生姜), and Jujube (Dazao, 大枣) to dispel dampness; for dryness burning metal with dry cough without sputum, add Trichosanthes Fruit (Gualou, 瓜蒌), Anemarrhena Rhizome (Zhimu, 知母), Fritillaria Bulb (Beimu, 贝母), and Biota Seed (Baiziren, 柏子仁) to moisten dryness; for lung cough with hemoptysis due to wind-cold, add Perilla Herb (Zisu, 紫苏), Red Peony Root (Chishao, 赤芍), and Salvia Root (Danshen, 丹参); for heart cough with throat obstruction sensation or severe swelling/sore throat, double Platycodon Root (Jiegeng, 桔梗) and add Babcock Seed (Niubangzi, 牛蒡子); for spleen cough with right hypochondriac dull pain radiating to shoulder/back, worsening with movement, add Kudzu Root (Gegen, 葛根), Gentian Root (Qinjiao, 秦艽), and Turmeric Root (Yujin, 郁金); for liver cough with bilateral hypochondriac pain and inability to turn sideways, add Bupleurum Root (Chaihu, 柴胡), Bitter Orange (Zhiqiao, 枳壳), and Red Peony Root (Chishao, 赤芍); for kidney cough with back/waist soreness or coughing saliva, add Aconite Root (Fuzi, 附子); for gallbladder cough with vomiting bitter fluid, add Scutellaria Root (Huangqin, 黄芩), Pinellia Tuber (Banxia, 半夏), and Fresh Ginger (Shengjiang, 生姜); for small intestine cough with flatus, add White Peony Root (Baishao, 白芍); for stomach cough with vomiting or expulsion of roundworms, remove Licorice Root (Gancao, 甘草), add Chinese Plum (Wumei, 乌梅), Sichuan Pepper (Chuanjiao, 川椒), and Dried Ginger (Ganjiang, 干姜), adding Coptis Rhizome (Huanglian, 黄连) if heat is present; for large intestine cough with fecal incontinence, add Atractodes Rhizome (Baizhu, 白术) and Halloysitum Rubrum (Chishizhi, 赤石脂); for bladder cough with urinary incontinence, add Poria (Fuling, 茯苓) and Pinellia Tuber (Banxia, 半夏); for sanjiao cough with persistent cough, abdominal fullness, anorexia, excessive nasal discharge/saliva, facial edema, and rebellious qi, combine with Yigong San (Extraordinary Power Powder); for emotional qi stagnation with constrained fire rushing upward, add Cyperus Rhizome (Xiangfu, 香附), Fritillaria Bulb (Beimu, 贝母), Bupleurum Root (Chaihu, 柴胡), and Black Gardenia (Heishanzhi, 黑山栀); for kidney yin deficiency with water failing to control fire, body irritability, fine-rapid pulse, use Dihuang Wan (Rehmannia Pill) in the morning and this formula minus Schizonepeta Spike, adding Anemarrhena Rhizome (Zhimu, 知母) and Fritillaria Bulb (Beimu, 贝母) in the afternoon to open fire constraint; for pathogenic evil remaining in lung meridian transforming into deficient heat, remove Schizonepeta Spike from this formula and adjunctively use Tuan Yu Wan (Softshell Turtle Pill); for deep/prolonged heat transforming into consumptive disorder or corpse-worm entering lung causing throat itching and cough, remove Schizonepeta Spike and adjunctively use Yuehua Wan (Moonlight Pill); for internal injury from diet with dry mouth, stuffiness, and worse cough at fifth watch, add Forsythia Fruit (Lianqiao, 连翘), Hawthorn Fruit (Shanzha, 山楂), Malt (Maiya, 麦芽), and Radish Seed (Laifuzi, 莱菔子) to digest food and resolve stagnation.
Warm Diseases
Initial Invasion of Lung and Wei by Warm-Heat Pathogens
Although Acrid-Cool Herbs Are Used, Mild Dispersing Herbs Are Added