下咽，饮水无度。更以为实热，以三黄丸下之，利行不多，渐加喘促。再剂，夜半喘大作，有出无入，遍身麻
木，溃汗如雨，神昏目直，口噤不言，委顿极矣。亟招冯诊，两寸左关仅存。时当六月，欲与四逆、理中，主人畏
惧，改以人参一两，麦冬二钱，五味六分，肉桂钱许，始允急煎服之。喘减片刻，奈病大药小，顷复大作，乃
不咎寒凉之误，反以参、桂为罪矣。因思尽吾之力，尚可以活，若徇彼之见，必死而已，乃坚定一方，勒令服
之。用炒白术三两，人参二两，炮姜三钱，五味子一钱五分，制附子三钱，煎浓汁灌之。下咽后，病患张口大
声云∶心中如火烙欲死。（此不与冷服故。）傍观疑怨交起不为动。顷之又大声曰∶脐间更疼更热，欲死矣。乃
窃喜其阳能下达，未之绝也。果少焉，喘定汗收，手足温而神思清，语言反甚无力。此方术多参少者，因中宫久
困寒冷，不先为理中，则阳气难下达也。
吕东庄治徐鸾和内病咳嗽，医以伤风治之益甚。邀诊，则中虚脉也。曰∶鼻塞垂涕痰急，皆伤风实症，何
得云虚？曰∶此虚实真假，所辨在脉，庸医昧此，误人多矣。彼不知脉，请即以症辨之。其人必晡热潮热，至
夜半渐清，至晨稍安，然乎？曰∶然。然则中虚何疑乎？所言喜者，正此鼻塞垂涕耳。乃投以人参、白术、当
归、黄 、白芍各三钱，软柴胡、升麻各一钱，陈皮、甘草、五味各六分，三剂而咳嗽立止。再诊谓之曰∶
上症已去，惟带下殊甚，近崩中耳。惊应曰∶然。即前方重用人参，加补骨脂、阿胶各二钱，数剂，兼服六味丸而愈。
柴屿青治陈氏甥女，咳嗽吐痰，夜间发热，众医以为必成劳症。诊其脉虽稍洪，尚有根柢，并非细数，何
至不治？纯用滋阴之药，调养半年而愈。
同学蔡为章患痰嗽，夜难就寝，身不胜衣，夜卧床不能转侧。诊其六脉微弱，气血两剧，拟用参、 补剂。
蔡以痰嗽不宜用补为疑，乃力任之。先用六君子汤加炮姜、桂、附，数帖而嗽减。继用养荣汤十数剂，始能下
床行动，调理月余而康。
张惕中咳嗽吐痰，医误认风寒，服药十数剂，病增剧，身热喘嗽，夜不能卧，胸膈痞塞，困于床第，小便
短缩。诊得人迎脉缓，绝非外感。气口空大，左寸弱甚，两沉微微，此心肾不足，的系内伤之症。其小便不利
者，三焦之气化不能运于州都也。从东垣治内伤条，师其意而变通之，旬日而痊。
左中丞夫人，年二十余，形体瘦弱，痰嗽息粗，夜不能寐。医频与消痰理气，愈委顿。诊其脉甚微细，此
气虚也。仲景云∶气虚有痰，肾气丸补而逐之。遂用六味汤加麦冬、五味，治之而愈。惟夜间尚未熟睡，再用
养荣汤加茯神、枣仁，十数剂即加餐安睡，渐得复元。
丙寅新正 卿讳伊芳喇齐长郎，贺节至寓云，咳嗽求方。诊其两脉细数，右寸郁结，断其难以收功，勉用麻
黄汤。伊芳断断不可，曰∶我子阴亏，他医熟地、人参，服过数两。柴曰∶阴亏诚然，但风邪闭塞肺气，补剂又
从而壅遏之，非此不能去邪。力争不信，早决其不起。果然。
按∶凡损症脉，见右寸厥厥然如豆，按之梗指，其病原属不起，以肺金败也。今以右寸郁结，断为风
邪闭塞，然必见鼻塞声重，或头痛痰浓，或咳嗽连续，方是其候。
王肯堂治一妇人，咳嗽不已，服诸药不效，渐成劳瘵。诊之，六脉濡弱，此血弱，又因忧戚太过，而成斯
疾。合用当归等药治之必愈。遂先以《古今录验》橘皮汤，空心服，苏子降气汤，徐用金钗煎、熟地黄丸、
当归丸，调理而安。
橘皮汤，文田按∶今见《千金方》五十四卷。橘皮、麻黄各三两，柴胡、干紫苏各三两，宿姜、杏仁各
四两，石膏八两。上七味 咀，水九升，煎麻黄两沸，去沫，下诸药煮取三升，分三服。
张路玉治吴江郭邑侯，喘嗽气逆。诊之，两尺左关弦数，两寸右关涩数。弦者肾之虚，涩者肺之燥。夏暑
内伏肺络，遇秋月燥收之令，发为咳嗽也。自言每岁交秋则咳，连发四载，屡咳痰不得出则喘，至夜不能卧，
咳剧则大便枯燥有血。曾服越婢汤，嗽即稍可。张曰∶公肾气素强固，水亏火旺，阴火上烁肺金，金燥不能
生水。咳甚则便燥有血者，肺移热于大肠也。（赖有此耳。）合用《千金》麦门冬方，除去半夏、生姜之辛燥，易以
葳蕤、白蜜之甘润，藉麻黄以鼓舞麦冬、生地之力，与越婢汤中麻黄、石膏，分解互结之燥热，同一义也。郭
曰∶诸医咸诋麻黄为发汗重剂，不可轻试，仅用杏仁、苏子、甘、梗、前胡等药，服之其咳转甚，何也？曰∶
麻黄虽云主表，今在麦门冬汤中，不过借以开发肺气，原非发汗之谓。麻黄在大青龙汤、麻黄汤、麻杏甘石汤
方，其力便峻，以其中皆有杏仁也。杏仁虽举世视为治嗽通药，虚实混用。然辛温走肺，最不纯良，耗气动血，
莫此为甚。熬黑入大陷胸丸，佐甘遂等，搜逐结垢，性味可知。遂用前方连进二剂，是夜便得安睡。脉弦虽未
退，按之稍软，气口则虚濡乏力。与六味、生脉加葳蕤、白蜜作汤，四服嗽顿减。即以此方制丸恒服，至秋无
复嗽之虞。先是公子柔 ，用桂枝汤及六味作汤，加蝎尾，服之而瘥。其后夫人素有败痰，生道左右两胁俱有
结块，大如覆盆，发则咳嗽喘逆，腹胁掣痛，六脉止促，按之少力，用六君加胆星、枳实、香附、沉香，二剂，
大吐稠痰结垢一二升，呕止嗽宁，不必更进他药矣。
何督学媳，素常咳嗽不已，痰中间有血点，恒服童真丸不彻。以父殁哀痛迫切，咳逆倍常，痰中杂见鲜血，
因与瑞金丹四服，仍以童真丸、乌骨鸡丸，调补而安。
劳太夫人年五十余，素禀气虚多痰。数日来患风热咳逆，咳甚则兀兀欲吐。且宿有崩淋，近幸向安。法当
先治其咳，以桔梗汤加葳蕤、白薇、丹皮、橘红、蜜煎生姜，四剂撤其标症。次与六君子加葳蕤，以安胃气。
继进乌骨鸡丸方，疗其痼疾。以久不茹荤、不忍伤残物命，改用大温经汤加麋茸角腮作丸，药虽异而功则一也。
陈三农治一妇，咳嗽痰喘，饱胀，水火不通，眠食俱废。以人参、白芍为君；苏子炒，研细为佐；枇杷叶
三大片，白茯苓佐之。二服得眠，大小便通。
东坡盖公堂记云∶始吾居乡有病寒而咳者，问诸医，医以为蛊，不治且杀人。取其百金而治之，饮以蛊药，
攻伐其肾肠，烧灼其体肤，禁切其饮食之美者。期月而百病作，内热恶寒，而咳不已，累然真蛊者也。又求于
医，医以为热，投之以寒药，旦夕吐之，暮夜下之，于是始不能食。惧而反之，则钟乳、乌喙，杂然并进，而
漂疽痈疥，眩瞀之状，无所不至。三易医而病愈甚。里老父教之曰∶是医之罪，药之过也。子何疾之有？人之
生也，以气为主，食为辅。今子终日药不释口，臭味乱于外，而百毒战于内。劳其主，隔其辅，是以病也。子
退而休之，谢医却药，而进所嗜，气全而食美矣。可以一饮而效，从之期月而病良已。（《容斋五笔》后文节。）
薛立斋治甥范允迪，咳嗽痰盛，胸腹不利，饮食少思，肢体倦怠，脉浮大，按之微弱，服二陈、枳壳等药
愈甚，脾肺肾虚也。用补中益气汤、六味丸而愈。
万密斋治监生胡笃庵，咳久不止，汗之不可，下之不可，因表里之邪俱甚也。为制方，用苏叶、薄荷叶、
桑白皮、杏仁、霜栝蒌、霜桔梗、甘草等分为末，虚者阿胶蜜丸，白汤下，或口中噙化，五日而安。后以治人多效。
立斋治一 妇，咳而无痰，日晡发热，脉浮数，先以甘桔汤少愈。后以地骨皮散而热退。更以肾气丸及
八珍汤加柴胡、地骨皮、丹皮而愈。丹溪云∶咳而无痰者，此系火郁之症，及痰郁火邪在中，用苦梗开之，下
用补阴降火之剂，不已则成劳嗽。此症不得志者多有之。又《原病式》曰∶人瘦者，腠理疏通而多汗，血液衰
少而为燥，故为劳嗽之痰也。
文田按∶薛方诚未尽善。然 症少阳盛而少阴虚，立斋之偶验，亦幸中耳。予亦尝见 症须用附子而后
愈者。至少阳之用柴胡，则中庸定理。王氏治病从温病入，故颇畏术、附，而酷恶柴胡，所谓过犹不及矣。
（瘰 为劳怯之根，加以干咳潮热则劳症成矣。此数方者乌足以愈之，大约薛氏因丹溪有此论，故附会言之，否
则其病少衰，便以为愈耳。不足信也。）
一男子咳嗽气急，胸膈胀满，睡卧不安，以葶苈散，二服少愈，更以桔梗汤而瘥。
一男子咳嗽项强气促，脉浮而紧，以参苏饮，二剂少愈，更以桔梗汤，四剂而痊。
马元仪治杨咸时，咳嗽多痰，气逆作喘，自汗不食，已两月。脉之虚微无神，此劳倦致伤脾肺也。经云∶
劳则气耗。气与阴火，势不两立，气衰则火自胜，土虚既不能生金，阴火又从而克之，故喘咳而汗作矣。若行
疏泄以定喘止嗽，是耗散其气也。用人参三钱，黄 五钱，炙草五分，贝母一钱，杏仁、苏子各二钱，紫菀、
桔梗、防风以佐之。兼进七味丸以培土母，归脾大造膏以实脾肺而愈。
来天培治一妇，年二旬余，季夏酷热，患咳嗽头痛，发热，胸膈不舒。或以苏、杏、前、贝、生地、黄芩、
治之转甚。视其面色浮肿，懒言气怯，咳嗽声微，胸膈胀满，饮食不下，六脉微弱，此风寒内伏，里虚致感也。
始宜以参苏饮倍姜、枣，一二剂可已。今增虚矣，非姜、附不能瘳也。以补中益气汤去升麻、柴胡，加川芎、
炮姜、附子，一剂汗出遍身，肿胀渐消，再剂热退。改用八珍加姜、附，二剂而咳嗽除。终以归脾加熟地、炮
姜，四剂声高食进矣。彼云旧有风症，两手不能举，今服药乃能举于头矣。此治病必求其本之谓欤。
沈明生治金斐文，夏患咳嗽，清痰续续不已。时风热嗽甚多，金谓所投之剂，非疏风化痰即清金涤热。及
诊曰∶是非温补不痊。金骇愕问故。曰∶君以外感盛行之际，必无内因者耶？初得之症，必无属虚者耶？是则
时有一定之方，症有一定之药，人皆可以为医矣。夫嗽属外因，必肺气胀满，咳嗽相属。或兼头疼鼻塞，涕唾
稠浓，声壮气壅，脉浮数有力，或人迎脉大，此为外因。今脉不浮而沉，非风也；不数而缓，非热也；按之不
鼓，非有余也。嗽虽频而气短不续，痰虽多而清薄不浓，若疏解则徒耗肺家之金，清凉则转瘠中州之土，是欲
去病而反重病也。宜用补中益气与六君子，参合复方，藉参、苓、术以补肺之母，使痰无由生，藉橘、半、升、
柴以升清降浊，则嗽可不作。一二剂嗽微减，再服浃旬而愈。
吴桥治鄱阳王令领邑甫及期，病咳嗽，唾痰稠粘而臭，且杂以血。久之潮热失声，食少肉消，闭户逾月，
将乞骸骨归。幸桥至诊之，桥独任其无害。令愕然，且固问桥。桥曰∶此肝气凌脾，治者谬以为阴虚火动，剂
凉则脾愈滞，津液不通，肝愈炽而无所制矣。法当扶脾抑肝，三剂如脱，七剂而出视事。（《太函集》。）
徐灵胎曰∶咳嗽由于风寒入肺。肺为娇脏，一味误投，即能受害。若用熟地、麦冬、萸肉、五味等滋腻酸
敛之品，补住外邪，必至咯血失音，喉癣肛痈，喘急寒热，近者半年，远者三年，无有不死。盖其服此等药之
日，即其绝命之日也。间有见机而停药者，或能多延岁月，我见以千计。故今之吐血而成劳者，大半皆因咳嗽
而误服补药所致也。或云五味子乃仲景治嗽必用之药，不知古方之用五味，必合干姜，一散一收，以治寒嗽之
症，非治风火之嗽也。况加以熟地、麦冬，则受祸尤烈。又嗽药中多用桔梗，桔梗升提，甘桔汤中用之，以载
甘药上行，治少阴之喉痛，与治嗽宜清降之法者非宜。苟误服之，往往令人气逆痰升，不能着枕。凡用药当深
知其性，而屡试屡验，方可对病施治，无容冒昧也。
张柳吟曰∶亦有咳嗽属于阴虚肺燥者，误投温散，劫其津液，必成劳损，即此论之对面也。医者临症，
可不详审其病情哉？
徐灵胎曰∶今之医者，谓吐血为虚劳之病，此大谬也。夫吐血有数种，大概咳者成劳，不咳者不成劳。间
有吐血偶咳者，当其吐血之时，野狼狈颇甚，吐止即痊，皆不成劳，何也？其吐血一止，则周身无病，饮食如故，
而精神生矣。即使亡血之后，或阴虚内热，或筋骨疼痛，皆可服药而痊。若咳嗽则血止而病仍在，日嗽夜嗽，
痰壅气升，多则三年，少则一年而死矣。盖咳嗽不止，则肾中之元气震荡不宁。肺为肾之母，母病则子亦病故
也。又肺为五脏之华盖，经云∶谷气入胃，以传于肺，五脏六腑皆以受气，其清者为荣，浊者为卫。是则脏腑
皆取精于肺，肺病则不能输精于脏腑，一年而脏腑皆枯，三年而脏腑竭矣，故咳嗽为真劳不治之疾也。然亦有
咳嗽而不死者，其嗽亦有时稍缓，其饮食起居不甚变，又其人善于调摄，延至三年之后，起居如旧，间或一发，
静养即愈。此乃百中难得一者也。更有不咳之人，血症屡发，肝竭肺伤，亦变咳嗽，久而亦死。此则不善调摄，
以轻变重也。执此以决血症之死生，百不失一矣。
(After taking medicine), the patient drank water excessively. The physician again diagnosed it as an excess-heat syndrome and administered Sanhuang Wan (Three-Yellow Pill) to purge, but the diarrhea was scant, and the condition gradually worsened with increasing panting and shortness of breath. After a second dose of purgatives, at midnight the panting became severe, with air only exiting and not entering. The whole body went numb, profuse sweating occurred like rain, consciousness was lost, eyes were fixed open, teeth were clenched and speechless, and extreme exhaustion set in. Feng was urgently summoned for consultation. The pulses at both Cun (inch) positions and the left Guan (bar) position were barely perceptible. It was June, and Feng intended to use Sini Tang (Frigid Extremities Decoction) or Lizhong Tang (Regulate the Middle Decoction), but the family feared the potency and substituted Ren Shen (Ginseng Root) 1 liang, Mai Dong (Ophiopogon Tuber) 2 qian, Wu Wei Zi (Schisandra Berry) 6 fen, and Rou Gui (Cinnamon Bark) approximately 1 qian, agreeing only to decoct and administer it urgently. The panting subsided briefly, but the disease was severe while the medication was weak; shortly after, the panting flared up again. The family did not blame the error of using cold-purgative drugs earlier but instead blamed Ren Shen and Rou Gui. Feng thought, "If I exert my full effort, life might still be saved; if I comply with their views, death is certain." Thus, he firmly prescribed a formula and ordered them to take it: Chao Bai Zhu (Stir-fried Atractylodes Macrocephala Rhizome) 3 liang, Ren Shen (Ginseng Root) 2 liang, Pao Jiang (Prepared Dried Ginger) 3 qian, Wu Wei Zi (Schisandra Berry) 1.5 qian, and Zhi Fu Zi (Prepared Aconite Lateral Root) 3 qian, decocted into a thick liquid and forced down. After swallowing, the patient opened his mouth and shouted loudly: "My heart feels like it is burning, I want to die!" (This was because the medicine was not taken cold.) Bystanders raised doubts and resentment, but he remained unmoved. Soon after, the patient shouted again: "The area around my navel hurts and burns more, I am dying!" Feng secretly rejoiced, thinking that Yang Qi could descend and life was not yet extinct. Indeed, shortly thereafter, the panting settled, sweat stopped, hands and feet became warm, consciousness cleared, though speech was unusually weak. This formula used more Ren Shen and Bai Zhu and less Fu Zi because the middle jiao had long been troubled by cold; without first regulating the middle, Yang Qi would be difficult to descend.
Lv Dongzhuang treated Xu Luanhe's internal injury cough. Physicians treated it as wind-cold invasion, which made it worse. Lv was invited to consult and found a pulse indicating deficiency of the middle jiao. He said, "Nasal congestion, runny nose, and urgent phlegm are all excess symptoms of wind-cold invasion; how can you say it is deficiency?" Lv explained, "Distinguishing between true and false excess and deficiency lies in the pulse. Quack doctors who ignore this have misled many." Since the other party did not understand pulse diagnosis, Lv asked him to distinguish by symptoms. Lv said, "This person must experience fever in the afternoon (Shi hour), which gradually clears by midnight and improves slightly in the morning, correct?" The other party replied, "Yes." Lv said, "Then what doubt is there about middle deficiency? What he calls 'pleasing' refers precisely to the nasal congestion and runny nose." He then prescribed Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis Root), Huang Qi (Astragalus Root), and Bai Shao (White Peony Root) each 3 qian, Ruan Chai Hu (Bupleurum Root) and Sheng Ma (Cimicifuga Rhizome) each 1 qian, Chen Pi (Tangerine Peel), Gan Cao (Licorice Root), and Wu Wei Zi (Schisandra Berry) each 6 fen. After three doses, the cough stopped immediately. On re-examination, he told him, "The upper symptoms have gone, but leukorrhea is extremely severe, approaching metrorrhagia." The patient surprisedly confirmed this. Lv then heavily increased the dosage of Ren Shen in the previous formula, added Gu Su Zhi (Psoralea Fruit) and E Jiao (Donkey-hide Gelatin) each 2 qian. After several doses, combined with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), the patient recovered.
Chai Yuqing treated the niece of the Chen family, who suffered from cough with expectoration and night fevers. Most physicians believed she would inevitably develop consumption (Lao Zheng). Upon palpation, although her pulse was slightly surging, it still had a root and was not fine and rapid; how could it be incurable? Purely using yin-nourishing medicines, she recovered after half a year of conditioning.
Classmate Cai Weizhang suffered from phlegm-cough, unable to sleep at night, so emaciated that he could hardly bear clothes, unable to turn over in bed at night. His six pulses were faint and weak, indicating severe deficiency of both Qi and Blood. A prescription using Ren Shen and tonifying agents was planned. Cai doubted the use of tonics for phlegm-cough, but Chai took full responsibility. First, Liujunzi Tang (Six-Gentlemen Decoction) was used with added Pao Jiang (Prepared Dried Ginger), Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite Lateral Root). After several doses, the cough decreased. Subsequently, Yangrong Tang (Nourish the Vigor Decoction) was given for over ten doses, allowing him to get out of bed and walk. After more than a month of conditioning, he recovered.
Zhang Tizhong suffered from cough with expectoration. Physicians mistakenly identified it as wind-cold. After taking over ten doses of medicine, the illness worsened: body heat, panting, cough, inability to lie down at night, chest and diaphragm stuffiness, confinement to bed, and shortened urination. Pulse diagnosis revealed a slow Ren Ying (Carotid) pulse, definitely not external contraction. The Qi Kou (Radial) pulse was empty and large, the left Cun pulse was very weak, and deep palpation showed faint pulses. This indicated insufficiency of Heart and Kidney, clearly an internal injury syndrome. The difficulty in urination was due to the San Jiao (Triple Burner) failing to transport Qi transformation to the Zhou Du (Bladder). Following Li Dongyuan's principles for treating internal injuries, adapting them appropriately, he recovered within ten days.
The wife of Vice Minister Zuo, in her twenties, was thin and weak, suffering from phlegm-cough and coarse breathing, unable to sleep at night. Physicians frequently administered phlegm-resolving and Qi-regulating drugs, causing further exhaustion. Her pulse was very fine and faint, indicating Qi deficiency. Zhang Zhongjing stated: "For Qi deficiency with phlegm, use Shenqi Wan (Kidney Qi Pill) to tonify and expel." Thus, Liuwei Tang (Six-Ingredient Decoction) was used with added Mai Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Berry), curing her. For persistent insomnia at night, Yangrong Tang (Nourish the Vigor Decoction) with Fu Shen (Poria with Hostwood) and Zao Ren (Ziziphus Seed) was added. After over ten doses, appetite increased, sleep improved, and vitality gradually returned.
In the first month of Bingyin year, Qing Hui Yifanglaqi Changlang came to congratulate and requested a prescription for cough. Both pulses were fine and rapid, with the right Cun pulse showing stagnation. It was judged that recovery would be difficult. Reluctantly, Mahuang Tang (Ephedra Decoction) was suggested. Yifang strongly refused, saying, "My son has Yin deficiency. Other physicians have already administered several taels of Shu Di Huang (Rehmannia Root Prepared) and Ren Shen (Ginseng Root)." Chai said, "Yin deficiency is indeed true, but wind pathogen obstructs Lung Qi. Tonics further cause stagnation. Only this [Mahuang Tang] can expel the pathogen." Yifang argued fiercely and did not believe. Chai predicted early on that he would not survive. Indeed, he died.
Note: In damage syndromes, if the right Cun pulse appears bean-sized and hard to press, the prognosis is poor due to the failure of Lung Metal. Here, the right Cun shows stagnation, judged as wind pathogen obstruction. However, signs such as nasal congestion, heavy voice, headache, thick phlegm, or continuous cough must be present to confirm this pattern.
Wang Kentang treated a woman with persistent cough unresponsive to various medicines, gradually developing into Lao Zhai (consumption with hemoptysis). Six pulses were soft and weak, indicating blood deficiency caused by excessive grief and sorrow. Using Dang Gui (Angelica Sinensis Root) and other herbs would surely cure her. First, Jupi Tang (Tangerine Peel Decoction) from *Gu Jin Lu Yan* was taken on an empty stomach, followed by Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction). Later, Jinchai Jian (Gold Hairpin Decoction), Shudihuang Wan (Rehmannia Pill), and Danggui Wan (Angelica Pill) were used for conditioning, leading to stability.
Jupi Tang: Wentian notes: Now seen in Volume 54 of *Qianjin Fang*. Jupi (Tangerine Peel) and Mahuang (Ephedra Herb) each 3 liang, Chai Hu (Bupleurum Root) and Gan Zisu (Dried Perilla Leaf) each 3 liang, Su Jiang (Old Ginger) and Xing Ren (Apricot Seed) each 4 liang, Shi Gao (Gypsum Fibrosum) 8 liang. The seven ingredients are chopped. Add 9 sheng of water. Boil Mahuang for two boils, skim the foam, add other herbs, and decoct to obtain 3 sheng. Divide into three doses.
Zhang Luyu treated Gu Yihou of Wujiang, suffering from panting, cough, and rebellious Qi. Palpation showed string-taut and rapid pulses at both Chi (cubit) and left Guan positions, and choppy and rapid pulses at both Cun and right Guan positions. String-taut indicates Kidney deficiency; choppy indicates Lung dryness. Summer-heat was internally stored in the Lung collaterals. Encountering the autumn dryness-constricting climate, it manifested as cough. He reported annual coughs starting at autumn onset, lasting four years. Repeated coughing with inability to expectorate led to panting and inability to lie down at night. Severe coughing resulted in dry stool with blood. Previously, Yeshi Tang (Wild Chicken Decoction) provided slight relief. Zhang said, "Your Kidney Qi is inherently strong. Water deficiency leads to fire hyperactivity. Yin-fire scorches Lung Metal, causing Lung dryness and inability to generate Water. Severe coughing with bloody dry stool is Lung transferring heat to the Large Intestine. (Fortunately, this mechanism exists.) Combine with Qianjin Menmendong Fang (Mendong Formula from *Essential Prescriptions Worth a Thousand Gold*), removing the acrid-dry Ban Xia (Pinellia Tuber) and Sheng Jiang (Fresh Ginger), replacing them with Rui Yu (Polygonatum Rhizome) and Bai Mi (White Honey) for sweetness and moistening. Borrow Mahuang (Ephedra Herb) to stimulate Maidong (Ophiopogon Tuber) and Sheng Di Huang (Rehmannia Root) power. This shares the same principle as Mahuang and Shi Gao in Yeshi Tang, resolving interlocked dry-heat." Gu said, "Physicians condemn Mahuang as a heavy sweating agent and dare not try it lightly. Using only Xing Ren (Apricot Seed), Suzi (Perilla Seed), Gan Cao (Licorice Root), Jie Geng (Platycodon Root), Qian Hu (Peucedanum Root), etc., the cough worsened. Why?" Zhang said, "Although Mahuang governs the exterior, in Menmendong Tang, it merely opens Lung Qi, not inducing sweating. In Da Qinglong Tang, Mahuang Tang, and Maxing Gan Shi Tang, its power is fierce because they contain Xing Ren. Although Xing Ren is universally viewed as a general cough remedy, mixing excess and deficiency is dangerous. Its acrid-warm nature moves Lung Qi but is impure and harmful, depleting Qi and damaging Blood. When charred black and added to Daxiexiong Wan, assisting Gan Sui (Kansui Root), its nature in searching out accumulated filth is evident." Thus, the previous formula was advanced for two doses. That night, he slept peacefully. The pulse remained string-taut but softer upon pressure; the Qi Kou pulse was deficient, soft, and powerless. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Shengmai San (Generate the Pulse Powder) with Rui Yu (Polygonatum Rhizome) and Bai Mi (White Honey) as a decoction were given. After four doses, the cough significantly decreased. This formula was made into pills for constant use, preventing autumn coughs. Earlier, Gu's son Rou used Guizhi Tang (Cinnamon Twig Decoction) and Liuwei Dihuang Wan as decoctions with Scorpion Tail, recovering. Later, the Madam had chronic pathological phlegm. Masses appeared on both sides of the Daoji and胁 (flanks), size of an inverted basin. Attacks involved cough, panting, rebellious Qi, and pulling pain in abdomen and flanks. Six pulses were only rapid (Cu), weak upon pressure. Liujunzi Tang (Six-Gentlemen Decoction) with Dan Xing (Phragmites Catkin processed with bile), Zhi Shi (Immature Bitter Orange), Xiang Fu (Cyperus Rhizome), and Chen Xiang (Aquilaria Wood) were used. After two doses, one to two sheng of thick phlegm and filth were vomited. Vomiting stopped, cough calmed, no further medication needed.
The daughter-in-law of Supervisor He suffered from persistent cough with occasional blood spots in sputum, constantly taking Tongzhen Wan (Child's Urine Pill) without complete cure. Due to intense grief over her father's death, coughing and rebellious Qi doubled, with fresh blood mixed in sputum. Ruijin Dan (Auspicious Golden Pill) was given for four doses, followed by Tongzhen Wan and Wuguji Wan (Black-bone Hen Pill) for conditioning and stabilization.
Madam Lao, over fifty, constitutionally Qi-deficient with much phlegm. Recently suffered wind-heat cough and rebellious Qi, severe cough causing nausea. She also had a history of metrorrhagia and menorrhagia, recently stable. Treatment should first address the cough: Jiegeng Tang (Platycodon Decoction) with Rui Yu (Polygonatum Rhizome), Bai Wei (Cynanchum Root), Dan Pi (Moutan Cortex), Ju Hong (Tangerine Pith), and honey-decocted Sheng Jiang (Fresh Ginger). Four doses removed the branch symptoms. Next, Liujunzi Tang (Six-Gentlemen Decoction) with Rui Yu (Polygonatum Rhizome) stabilized Stomach Qi. Then, Wuguji Wan (Black-bone Hen Pill) addressed the chronic disease. Because she abstained from meat and spared animal lives, Dawen Jing Tang (Great Warm the Menses Decoction) with Milu Rong Jiao Sai (Deer Antler Horn and Cheek Bone) made into pills was substituted. Different drugs, same efficacy.
Chen Sansann treated a woman with cough, phlegm, panting, fullness, blockage of water and fire (urinary/fecal retention), and loss of sleep and appetite. Ren Shen (Ginseng Root) and Bai Shao (White Peony Root) served as Sovereign herbs. Stir-fried and ground Su Zi (Perilla Seed) served as Assistant. Three large leaves of Pipa Ye (Loquat Leaf) and Bai Fu Ling (Poria) served as Assistants. After two doses, sleep was achieved, and bowel/bladder movements normalized.
Dongpo wrote in *Record of Hall of Master Gai*: "Initially, when I lived in the countryside, someone had cold-induced cough. Asking physicians, they diagnosed it as Gu poison (parasitic disease), claiming untreated it would kill. Taking a hundred gold pieces to treat, they gave Gu medicine, attacking kidneys/intestines, burning skin/body, forbidding delicious foods. After a month, myriad diseases arose: internal heat, aversion to cold, and persistent cough, resembling true Gu poison. Seeking another doctor, diagnosed as heat, given cold medicines, vomiting day and night, diarrhea evening and night, leading to anorexia. Fearing this, switching treatments brought Zhuru (Stalactite) and Wu Hui (Aconite) together, causing floating abscesses, carbuncles, scabies, dizziness, and blindness. Three doctors changed, yet illness worsened. An elder taught: 'This is the doctor's fault, the drug's error. What disease do you have? Human life relies on Qi as master, food as assistant. Now you hold medicine to your mouth all day, odors disrupt outside, poisons war inside. Exhausting the master, blocking the assistant, thus illness arises. Rest, dismiss doctors, reject drugs, eat what you love. Qi preserved, food enjoyed.' One drink yielded effect. Following this, after one month, the illness healed well." (Excerpt from *Rongzhai Wubi*).
Xue Lizhai treated nephew Fan Yundi, suffering from cough with abundant phlegm, chest/abdominal discomfort, poor appetite, limb fatigue. Pulse was floating and large, weak upon pressure. Erchen Tang (Two-Aged Decoction) and Zhi Ke (Aurantii Fructus) worsened it, indicating Spleen-Lung-Kidney deficiency. Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) and Liuwei Wan (Six-Ingredient Pill) cured him.
Wan Miazai treated Student Hu Du'an, persistent cough unrelieved by sweating or purging, as both exterior and interior pathogens were severe. Prescribed Suzye (Perilla Leaf), Bohey e (Mint Leaf), Sangbaipi (Mulberry Root Bark), Xingren (Apricot Seed), Shuang Gualou (Frost-coated Trichosanthes Fruit), Shuang Jiegeng (Frost-coated Platycodon Root), Gancao (Licorice Root) powdered equally. For deficiency, Ejiao (Donkey-hide Gelatin) honey pills were taken with white water or held in mouth. Peaceful in five days. Later effective for many.
Lizhai treated a woman, cough without phlegm, afternoon fever, floating-rapid pulse. First, Ganjie Tang (Licorice-Platycodon Decoction) slightly improved. Then Digupi San (Ground Tree Bark Powder) reduced fever. Finally, Shenqi Wan (Kidney Qi Pill) and Bazhen Tang (Eight-Treasure Decoction) with Chai Hu (Bupleurum Root), Digupi (Ground Tree Bark), and Danpi (Moutan Cortex) cured. Danxi said: "Cough without phlegm is Fire-Stagnation syndrome, with Phlegm-Stagnant Fire in the middle. Use Jiegeng (Platycodon Root) to open, below use Yin-tonifying and Fire-descending agents. If uncontrolled, it becomes Consumption Cough. This affects many frustrated people." Also, *Yuanbing Shi* states: "Thin people have open pores, sweat much, blood deficiency leads to dryness, hence Consumption Cough phlegm."
Wentian notes: Xue's formulas were not perfect. However, Luoli (scrofula) involves Shaoyang excess and Shaoyin deficiency. Lizhai's occasional success was lucky. I have also seen Luoli cases requiring Fu Zi (Aconite Lateral Root) for cure. Using Chai Hu (Bupleurum Root) for Shaoyang is a moderate principle. Wang's treatment entered via Warm Diseases, thus fearing Bai Zhu (Atractylodes Macrocephala Rhizome) and Fu Zi (Aconite Lateral Root), and hating Chai Hu (Bupleurum Root), which is 'too much is as bad as too little'. (Luoli is the root of consumption. With dry cough and tidal fever, consumption forms. These formulas are insufficient to cure. Likely Xue followed Danxi's theory and adapted it. Otherwise, slight improvement was mistaken for cure. Not credible.)
A man with cough, rapid breathing, chest fullness, restless sleep. Tingli San (Descurainia Powder) slightly improved after two doses; Jiegeng Tang (Platycodon Decoction) cured.
A man with cough, stiff neck, rapid breathing, floating-tight pulse. Rensu Yin (Ginseng-Perilla Drink) slightly improved after two doses; Jiegeng Tang (Platycodon Decoction) cured after four doses.
Ma Yuanyi treated Yang Xianshi, cough with much phlegm, rebellious Qi causing panting, spontaneous sweating, anorexia for two months. Pulse was deficient, faint, spiritless. Labor-fatigue injured Spleen and Lung. Classics state: "Labor depletes Qi." Qi and Yin-Fire cannot coexist. Qi decline allows Fire to prevail. Earth deficiency fails to generate Metal; Yin-Fire attacks. Hence panting, cough, sweating. Using dispersing methods to stop panting/cough depletes Qi. Ren Shen (Ginseng Root) 3 qian, Huang Qi (Astragalus Root) 5 qian, Zhi Cao (Honey-fried Licorice) 5 fen, Bei Mu (Fritillaria Bulb) 1 qian, Xing Ren (Apricot Seed) and Su Zi (Perilla Seed) each 2 qian, Zi Wan (Aster Root), Jie Geng (Platycodon Root), Fang Feng (Saposhnikovia Root) as assistants. Combined with Qiwei Wan (Seven-Ingredient Pill) to nourish Earth-Mother, Guipi Dazao Gao (Spleen-Nourishing Great Creation Paste) to strengthen Spleen-Lung. Recovered.
Lai Tianpei treated a woman, over twenty, in midsummer heat, cough, headache, fever, chest discomfort. Given Suzi (Perilla Seed), Xingren (Apricot Seed), Qianhu (Peucedanum Root), Beimu (Fritillaria Bulb), Shengdi (Rehmannia Root), Huangqin (Scutellaria Root), worsening. Face swollen, lazy speech, timid Qi, faint cough, chest fullness, anorexia, six pulses faint. Wind-cold internally stored, interior deficiency inviting pathogen. Should start with Rensu Yin (Ginseng-Perilla Drink) doubling Jiang (Ginger) and Zao (Jujube), one-two doses curable. Now deficiency increased, requires Jiang (Ginger) and Fu Zi (Aconite). Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) minus Shengma (Cimicifuga Rhizome) and Chaihu (Bupleurum Root), plus Chuanxiong (Ligusticum Rhizome), Pao Jiang (Prepared Ginger), Fu Zi (Aconite Lateral Root). One dose: sweating all over, swelling subsided. Two doses: fever resolved. Changed to Bazhen Tang (Eight-Treasure Decoction) with Jiang (Ginger) and Fu Zi (Aconite Lateral Root). Two doses: cough removed. Finally, Guipi Tang (Spleen-Nourishing Decoction) with Shudi (Prepared Rehmannia) and Pao Jiang (Prepared Ginger). Four doses: voice loud, appetite increased. He said old wind-stroke prevented arm lifting; now medicine allowed raising head. This is seeking the root in treatment.
Shen Mingsheng treated Jin Feiwen, summer cough, continuous clear phlegm. Many wind-heat coughs existed. Jin believed prescriptions were either wind-dispersing/phlegm-resolving or Lung-clearing/heat-purging. Diagnosis: "Only warming-tonifying cures." Jin shocked, asked why. Shen said: "Amidst epidemic wind-heat, must there be no internal causes? Initial symptoms must not be deficiency? If so, fixed formulas and fixed drugs exist, anyone could be a doctor. Cough from external causes implies Lung Qi distension, continuous cough. Accompanied by headache, nasal congestion, thick sputum, strong voice, congested Qi, floating-rapid-strong pulse, or large Ren Ying pulse. This is external. Now pulse is not floating but sinking, not wind; not rapid but slow, not heat; not drumming upon pressure, not excess. Frequent cough but short Qi, much phlegm but thin-not-thick. Dispersing wastes Lung Metal; cooling starves Central Earth. Wanting to remove disease worsens it. Use Buzhong Yiqi Tang (Center-Supplementing Qi-Boosting Decoction) and Liujunzi Tang (Six-Gentlemen Decoction) combined. Borrow Ren Shen (Ginseng Root), Fu Ling (Poria), Bai Zhu (Atractylodes Macrocephala Rhizome) to tonify Lung Mother, stopping phlegm generation. Borrow Ju Pi (Tangerine Peel), Ban Xia (Pinellia Tuber), Sheng Ma (Cimicifuga Rhizome), Chai Hu (Bupleurum Root) to ascend clear and descend turbid, stopping cough. One-two doses: slight reduction. Ten days later: cured."
Wu Qiao treated Magistrate Wang of Boyang, term just ended, cough, sticky-smelly sputum mixed with blood. Long-term tidal fever, loss of voice, anorexia, emaciation, closed door for over a month, preparing to retire. Fortunately Wu Qiao consulted, asserting harmlessness. Magistrate surprised, insisted on asking. Wu said: "Liver Qi invading Spleen. Physicians wrongly diagnose Yin-deficiency Fire-hyperactivity. Cold drugs make Spleen stagnant, fluids blocked, Liver blazing unchecked. Method: Support Spleen, suppress Liver. Three doses: relief. Seven doses: return to duty." (*Taihan Ji*).
Xu Lingtai said: "Cough due to wind-cold entering Lung. Lung is delicate organ; one wrong herb causes harm. Using Shudi (Rehmannia Root Prepared), Maidong (Ophiopogon Tuber), Yurou (Cornus Fruit), Wuwei Zi (Schisandra Berry) etc., sticky-astringent tonics, trapping external pathogen, leads to hemoptysis, aphonia, laryngeal ulcers, anal abscesses, panting, alternating chills-fever. Near death in half a year, far in three years. No survival. Day of taking these drugs is day of doom. Rarely, those stopping meds live longer. I've seen thousands. Thus, modern hemoptysis becoming consumption is mostly due to cough mismanaged with tonics. Some say Wuwei Zi (Schisandra Berry) is essential in Zhang Zhongjing's cough formulas. Unknown that ancient usage combined Wuwei Zi (Schisandra Berry) with Ganjiang (Dried Ginger), one dispersing, one astringing, for cold-cough, not wind-fire cough. Adding Shudi (Rehmannia Root Prepared) and Maidong (Ophiopogon Tuber) increases disaster. Also, Jiegeng (Platycodon Root) often used in cough. Jiegeng ascends. In Ganjie Tang (Licorice-Platycodon Decoction), it carries sweet herbs upward to treat Shaoyin throat pain, unsuitable for cough requiring clearing-descending method. Misuse causes Qi rebellion, phlegm rising, inability to rest pillow. Drugs must be known deeply, tested repeatedly before application. Do not act rashly."
Zhang Liuyin said: "There are coughs due to Yin-deficiency Lung-dryness. Mistakenly using warm-dispersing herbs steals fluids, inevitably forming damage. This is the opposite view. Physicians must examine conditions carefully."
Xu Lingtai said: "Modern doctors call hemoptysis deficiency consumption. Great error. Hemoptysis has types. Generally, coughers become consumptive; non-coughers do not. Occasionally hemoptysis with cough is severe during bleeding, but stops quickly, not consumptive. Why? Once bleeding stops, body free of disease, diet normal, spirit returns. Even after blood loss, Yin-deficiency internal heat or bone/joint pain can be cured with meds. But cough means disease remains after bleeding stops. Day and night cough, phlegm congestion, Qi rising. Three years max, one year min to death. Cough unceasing shakes Kidney Yuan Qi. Lung is Kidney Mother; Mother sick, Child sick. Lung is canopy of Five Zang. Classics: Grain Qi enters Stomach, transmits to Lung. Five Zang Six Fu receive Qi. Clear becomes Ying (Nutritive), turbid becomes Wei (Defensive). Organs extract essence from Lung. Lung diseased, cannot transmit essence to organs. One year: organs wither. Three years: organs exhausted. Thus cough is true consumption, incurable. Yet some coughers survive. Cough slows sometimes, diet/lifestyle unchanged, good self-care extends beyond three years, lifestyle normal, occasional flare-ups heal with rest. One in a hundred. More, non-coughers with frequent blood disorders, Liver exhausted, Lung damaged, change to cough, eventually die. Poor self-care, light turns heavy. Hold this to decide blood disorder death/life, hundred percent accurate."