同里黄和叔君好学士也。夏五暑热炎蒸，正天地大气泄越，时(天地气机泄越人身气机亦应之)月之廿四，绮窗挑灯勤诵(劳伤心阳亦暗吸肾阴)初交亥，忽吐血碗许。群季皆通医理，廿五早，自订四生丸服，交亥见血如前，且增恶寒。廿六自转用甘草干姜汤加味，进炙草、炮姜、五味各钱半，白术、防风各三钱(方佳但欠镇摄)，交亥仍见血如初，惟恶寒略减。廿七延医某治，某称转方佳，独嫌五味收敛(怪论，真气泄越，理合收摄)原方减此加当归更妥，是晚亥血来滋甚(归，辛动上升，无五味以敛之，地以滋之，龟附以镇导之，故滋甚)。廿八邀予，诊六脉弱尺为甚，询足冷否曰：将交亥足渐冷，冷气上少腹(肝位，肝藏血)，则气喘(气呼出心肺，吸入肾肝，肝肾阳升吸气艰于入故喘)而血溢。予曰：据脉与述症且血，必见于戌亥，实肝肾病多(戌亥为至阴时，肝肾为至阴脏，故日则无恙而交亥则病作)，原真阴有亏，孤阳无偶，失守上走，血亦随之。夫阴阳互为其根，无阳则阴无以生，无阴亦阳无所附，法当引导其阳，兼镇育其阴，则孤阳有归，而血自安。其位方用熟地、龟版各五钱，土木参、当归、附子、炮姜各一钱五分，五味子、炙甘草各一钱，中有疑暑月吐血而用参附，且会服归而益甚者。余曰：尺弱足冷，显是肾虚阳不潜藏，徒滋填其阴而不固守其阳，必难奏效。古人原有补气以摄血法，人参、附子，参附汤也，能固守肾气；当归、附子，归附汤也，能固守营气，血去已多安，得不佐温补以固守脏真群季曰：善。遂服之。廿九诊，据述昨夜戌亥血虽不来，而足冷气促仍未尽除。余仍用廿八方去炮姜，倍用附子，加胡桃肉四钱，覆盆子二钱，以摄助纳。服三贴，复邀诊，已诸恙俱安，但夜难熟睡，拟兼理心营，廿九方去龟版、附子、胡桃、覆盆加杞子三钱，茯神、枣仁各二钱，麦冬一钱，炙草、五味改用四分，连服数贴，后参入杜仲、黄耆、防党、白术、鹿茸，因脉症加减，而调养复元。
选录王肯堂先生论痰中见血一症。
肯堂云：其血或一点之小，或一丝之细，语其势，若无可畏，而病根反深。此血非由胃出，乃肺脏中来，肺本多气而少血，是以出者亦少。今因火逼而随痰以出，则肺虑其枯，而无以主一身气化矣，其害不滋大乎治法于除痰中加入止血药，如贝母、瓜蒌仁、茯苓、麦冬、元参、竹茹、苏子、薏米之类以治痰，犀角、阿胶、柏叶、黑栀之类以止血，黄芩、黄连、之类以降火，调花芷石末四五分，徐徐服之。又法用竹沥一碗，入阿胶二两，溶开，将石膏煅过一两，蛤粉一两，青黛半两，好墨一两，共为尘末，调和丸，如黍米大，每服一钱，香茶送下，其效甚速。
咳 嗽
咳为气，逆嗽，因有痰，内伤外感，所因不同，五脏六腑，受病各异，兹先就寻常患咳嗽者，订一降气除痰剂，以便因各见症加减。
茯苓三钱，钑块 薏米四钱，生用 陈皮五分北杏一钱 半夏一钱半，制 苏子一钱半 甘草五分
渴加麦冬、瓜蒌(皮仁任用，半夏易川贝，陈皮易橙皮。橙皮甘苦多于辛，异橘柑皮之辛燥)。痰多不渴倍半夏、陈皮，加生姜，或瓜蒌、薤白。咳胸胁痛加芥子，少佐姜汁，炒黄连，或醋炒川楝子。热加石膏、知母，或黄连、黄芩。寒加益智、生姜，或干姜、五味、细辛(去杏苏子)。风加防风(苏子改用苏梗)。湿加防风、苍术。脾虚加入参、白术、当归(去苏杏薏)。肝肾虚吸气短(气吸入肾肝)加熟地、当归、五味，或杞子、胡桃、牛膝(去苏子、北杏、薏米或再去甘草)。
又因咳而后有痰、宜顺气，治在肺。肺主气，肺恶温燥，麦冬、橘红(橙皮更佳)川贝、知母、桑白、紫苑为要药。
因痰而后致咳，宜消痰，治在脾。脾藏痰，脾恶寒润，白术、苍术、制南星、制半夏为要，药清火兼之(宜姜汁炒黄连)。
久嗽不愈，用麦冬为君，川贝、知母、茯苓、竹茹、黄芩、苏子之类为佐，少加五味、甘草、灯心服之(因风寒虚而咳忌服)。
凡咳嗽发热不休者，不治咳而汗泄者，不治(此脏真不藏气泄而为热为汗，治当固摄脏真，如人参固本丸、复脉汤去姜桂加生龙骨、生牡蛎、磁石等治之。亦幸有获愈者)。左不得眠为肝胀，右不得眠为肺胀，俱属难治。阅叶氏《临症指南》又非仅主肝胀肺胀一说，症有疑似，病有实虚，论治者其慎之(叶氏治右不得眠用麦门冬汤，谓胃津虚无以养肺，肺病降已不及而复右眠遏之，故咳更甚。左不得眠用复脉汤去姜桂加生牡蛎麦仁治之，谓肝阳升逆太过，安能左眠以遏其升逆之威，故咳更甚，治咳血症多用此法)。若果肝胀，肺胀宜疏宜清宜敛，自有各家，本门可考，不复赘(即沈芊绿《尊生》著述证治颇详可参)。
凡治病问其见症如何，问其致病之因如何，似较望闻切为倍要。余尝医郭廉访夫人，年约三十，外廉访久以计偕宿京，得第补外，因接眷赴任，夫人得喜信后，忽患喑症，咳多痰少，夜里每觉火升，喉舌微痛，而日间饮食无碍，遍访名医，迭冶罔效。延余诊，余曰：贵恙咳先乎抑喑先乎家人曰：喑先，余恙后渐起者。余复问曰：起此恙日会多饮醇酒乎曰：无。偶因夜坐看木鱼书劳神，明早即觉音破耳。余诊其脉，两尺动数有力，阅旧服方虽多，亦不外清肺疏肺止咳除痰，中上两焦药，余转用上病治下一法，龟版八钱，大生地、黄柏各四钱、知母、茯苓各二钱，羚羊、丹皮、泽泻各一钱。余曰：据述病因与脉相对，沉疴似易起者，药不十贴，当见效。家人速于赴任，闻余言，喜甚。时吾友谢司马茹坪偕余往郭其戚也，独讶余言曰：痰咳而用龟地，谅难见效。且重用黄柏，更属不通。余笑曰：子姑验之。次日初七复到，诊是夜已不觉火升咳呛舌痛矣。仍用前方，黄柏减一钱，再服。初八诊两尺渐缓，声音渐起，仍用前方去丹泽，方中改用龟版四钱，羚羊、黄柏各八分，加鲜菖蒲五分煎调，入真珠末七分，服连服三贴。十一日复到诊音出已亮，但欠清耳。又转用清肃上焦气分，方法沙参八钱，丽参、黄耆、天冬、麦冬(连心)各一钱，白菊、杭菊各四分，加南枣四枚，鸡子白一枚，同煎(鸡子先蒸熟去壳去黄取白煎)，仅服四贴，声音渐清而愈。茹坪曰：药已效矣。吾究未得其解也。余曰：此忖情度理耳。夫妻契阔数年，一旦相聚有期，谁复无情况夜静独坐，倍易触拨情思，且我粤之木鱼书多艳为男女之私，以过去之情，感未来之情，相火尤易妄动，脉更得两尺动数，症亦由迅速而起(五行中最迅速者莫若风火)、谓非龙相火而何龙火一动，势必上升，上升必凌烁肺金，金空则鸣，金实则无声矣。夫肾脉循喉绕舌，厥阳惯从子丑奔腾，此喉舌夜痛所由来也。余用地以滋之，龟以潜之，知柏丹泽苓羚以降之泄之，而复疏通之(羊角最灵，动能疏泄火邪之入络者)，斯龙雷潜伏而安其位，肺金清肃而守其常，其喑又安有不速愈者茹坪曰：善审问之，慎思之，明辨之，作医之道亦当如是乎。
选录王肯堂辨十嗽与五脏咳以便参考。
火痰嗽者，咳必面赤，用力久而后出者是也，不宜用半夏、南星以其太燥也。惟以贝母、知母、瓜蒌仁、竹茹之类。以化痰，黄芩、黄连、山栀之类以降火、苏子、橘红、茯苓之类以顺气。
湿痰嗽者，喉中漉漉有声，嗽而易出者是也不宜用元参、阿胶、知母以其滋润也，惟以苍术、防风之类以燥湿，半夏、南星、姜汁、竹沥之类以去痰，枳壳、橘红之类以顺气，黄芩、山栀之类以降火。
郁痰嗽者，胸臆胀满，连嗽不出，喉中有喘声，夜不得眠，上饱下饥者是也，不宜用五味麦冬以其补肺也，惟以枳壳、桔梗、便浸香附之类以开郁，川贝、瓜蒌、半夏之类以治痰，苏子、杏仁之类以定喘，茯苓、黄芩、山栀之类以降火。
顽痰嗽者，胶住咽喉，挥咯不能出，必努力大嗽而后出少许，如脂膏之状者是也。不宜用煎剂，宜以散子消磨之，如青黛、蛤粉、浮海石、风化硝、瓜蒌仁、磺石、明矾之类为极细末，以竹沥、姜汁调服。以其胶固不开，非轻剂所能愈也。清痰嗽者，必待嗽而后出其痰不稠黏者是也，宜用缓药治之，如贝母、花粉、茯苓、黄芩、竹茹、橘红、苏子、竹黄之类。
风痰嗽者，肺气壅盛，必顿嗽而后出其痰，浮而有沫，状如津，唾而略稠者是也，宜用轻浮之剂以治之，如薄荷、柴苏(梗叶)、桑白、防风、半夏、黄芩、枳壳之类，少加麻黄、甘草(用麻黄宜配北杏以降气)。
寒痰嗽者，得于秋冬之交，或伤于入水宿露，或伤于冷雨冷风所致。其嗽必哮喘，或肩背觉寒，得热汤饮之即缓者是也。宜用芦吸散，如肉桂、雄黄、鹅管石、款冬花、甘草等分，为极细末，用芦管挑药，轻轻含之，吸入喉内，徐徐以清茶过口，或以此药蜜丸，如鸡豆大含化亦妙。若热嗽，去肉桂，用井泉、石若用煎剂，宜半夏、南星、陈皮、茯苓、款冬、花生、姜甘、草之类。
酒痰嗽者，因醉后感冒风热，腹中有酒积，饮浊酒即发者是也。宜用山栀、黄芩、黄连以治火，贝母、瓜蒌、半夏曲之类以治痰，蛤粉花粉、绿豆粉之类以消酒(枳棋子、干葛花更能解酒毒，亦不可少)，紫苏梗、苏叶、陈皮之类以顺气。
食积痰嗽者，每食后即嗽，其痰稠黏觉有甜意，胸膈不宽者是也。宜以枳实、莱菔子、神曲、麦芽、山查之类以消食。陈皮、木香、砂仁之类以顺气，半夏、南星之类以消痰。石膏、黄连之类以降火。加生姜、竹茹为引。
干咳嗽者，平素阴血不足，虚火有余，喉中常痒，痒即频嗽，有声无痰者是也，宜以麦冬、知母、川贝、母元参、阿胶之类为主，治以黄柏、茯苓、花粉、山栀、甘草之类，加灯心、竹茹服之甚效。
又有嗽而两胁痛者，名曰肝咳。有嗽而腰轻痛者，名曰肾咳。有嗽而中脘作疼者，名曰脾咳。有嗽而鼻流清涕者，名曰肺咳，有嗽而口苦舌干者，名曰心咳。又有嗽而遗溺者，气虚也。嗽而五心烦热者血虚也(果一一细审而后发药施治，谅无不效矣)
又肯堂云：诸嗽皆宜桔梗，乃肺经本药，不可不用，亦不可多用，以其为舟楫之剂上而不下，不用不-能引诸药至肺部，多用则又承载诸药而不能行，更能作饱，故不宜多用。若治喉痛与元参、甘草同用。若开郁，与香附、枳壳、川芎、苍术、川贝母同用。若作吐药只与甘草等分，为一大剂服之，自卷痰而出矣。汪药洲先生云：王氏谓诸嗽皆宜桔梗，此语不能无弊，骤咳者用之或宜，若久咳者肺气无有不虚，方将敛之补之不暇尚，可用桔梗升提辛散，而犯虚虚之戒乎1吾见久咳者服之而金破者有矣，咳血者服之而血益甚者有矣，虚喘者服之而气暴脱者有矣。何也凡上逆者，法宜降之也，即喉痛亦须降痰降火，仲景师虽主以甘桔汤，今法之只可作佐使，必君以芩连类之苦降，元参风化硝类之咸降，然后升提之品无疑碍也先生。此论自注于王氏《医镜》中者，因录存之，以俟同人参考。
药洲先生品高雅，文章医学并见重于同道，好勉人为善，著有武帝觉世，真经诗行世字鸣岐，又号风山，吾邑汪斋剂太史(鸣谦)之四弟也，世居羊城。
余脾胃素弱，语云无脾胃弱老翁余窃虑焉，因常留意调养，迄今年及六旬，饮食虽不加，而精神无或减，且微恙亦少见者，知未始非调养力也。凡人欲调养脾胃，必先察夫脾胃性情，明夫脾胃体用，而后调养有方。书云：胃阳弱而百病生，脾阴足而万邪熄，似治胃专究夫阳，理脾专究夫阴，不知脾体阴而用阳，胃体阳而用阴，此太阴湿土得阳则运，阳明阳土得阴自安，前贤所为，特申明其用也，夫脾能升而后能运，阳气馁则无以升，胃能降而后能和，阴液亏则无以降，达其性情，明其体用，于以知纳食主乎胃，时知饥，而少纳(脾阳不伤故知饥胃阴有伤故少纳)，宜调养胃阴当用麦冬、天冬、沙参、玉竹、山药、扁豆、糯米、南枣、钗斛、甘草等以养之。知运化主乎脾，时能食而少运(胃阴不病故能食，脾阳有病故少运)宜温通脾阳当用人参、白术、茯苓、陈皮、益智、仁炒、粳米、炒莲叶等以醒之，虚且寒再加干姜、附子、肉桂以温之，此固无病培养善法，亦病后调治善法也。脾胃为后天养生者宜爱惜，更常戒生冷物难化物以保护之，延年之方，莫善于此矣。慎之，勉之。 《评琴书屋医略》终
Mr. Huang Heshu, a fellow townsman, was a scholar who loved learning. In the fifth month of summer, when the heat was steaming and boiling, it was precisely the time when the great qi of heaven and earth was dissipating (at this time, the qi mechanism of heaven and earth dissipates, and the human body's qi mechanism responds accordingly). On the twenty-fourth day of that month, late at night, under a carved window, he was diligently reading by lamplight (this kind of mental labor secretly consumes heart yang and absorbs kidney yin). As soon as the Hai hour (9 PM to 11 PM) began, he suddenly vomited blood, approximately one bowlful. His younger brothers were all proficient in medical principles. On the morning of the twenty-fifth, he prepared and took Sisheng Wan (Four Generations Pill). By the Hai hour, he bled again as before, and chills increased. On the twenty-sixth, he switched to Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) with modifications, taking Zhi Gancao (Honey-fried Licorice Root), Pao Jiang (Roasted Ginger), and Wuweizi (Schisandra Berry) each at 1.5 qian, Baizhu (Atractylodes Macrocephala Rhizome) and Fangfeng (Saposhnikovia Root) each at 3 qian (The formula is good but lacks sedative power). By the Hai hour, bleeding continued as before, though chills slightly decreased. On the twenty-seventh, he invited a certain doctor for treatment. The doctor praised the modified formula but criticized the use of Wuweizi (Schisandra Berry) for its astringent properties (This is a strange argument; since true qi is dissipating, it should logically be secured). He suggested removing Wuweizi from the original formula and adding Danggui (Angelica Sinensis Root) instead, which he deemed more appropriate. That evening, during the Hai hour, the bleeding became even more severe (Because Danggui is acrid, moving, and ascending, without the astringency of Wuweizi, and lacking the sedative guidance of Dihuang (Rehmannia Root), Guiban (Turtle Shell), and Fuzi (Aconite Root), the bleeding worsened). On the twenty-eighth, I was invited to examine him. His six pulses were weak, especially the Chi (Cun Kou) pulse. When asked if his feet were cold, he replied: "As the Hai hour approaches, my feet gradually become cold. Cold qi rises to the lower abdomen (the location of the Liver, which stores blood), causing panting (Exhalation is governed by the Heart and Lungs, inhalation by the Kidneys and Liver. When Liver and Kidney yang rises, inhalation becomes difficult, leading to panting) and blood溢 (overflowing)." I said: "Based on the pulse and symptoms, and given that bleeding occurs specifically during the Xu-Hai hours (Xu and Hai are times of extreme yin; the Liver and Kidneys are organs of extreme yin, hence no issues during the day but illness arises at Hai), this is indeed largely a disease of the Liver and Kidneys. Originally, there is a deficiency of true yin, leaving solitary yang without a companion, causing it to lose control and move upward, with blood following suit. Yin and Yang are mutually rooted; without yang, yin cannot be generated, and without yin, yang has no attachment. The treatment method should guide the yang and simultaneously sedate and nourish the yin, so that solitary yang has a return path, and the blood will naturally settle." The prescription used Shudi (Prepared Rehmannia Root) and Guiban (Turtle Shell) each at 5 qian, Tumu Shen (Ginseng-like herb), Danggui (Angelica Sinensis Root), Fuzi (Aconite Root), and Pao Jiang (Roasted Ginger) each at 1.5 qian, and Wuweizi (Schisandra Berry) and Zhi Gancao (Honey-fried Licorice Root) each at 1 qian. Some doubted the use of Renshen (Ginseng Root) and Fuzi (Aconite Root) for vomiting blood in midsummer, and noted that taking Danggui (Angelica Sinensis Root) had previously exacerbated the condition. I said: "Weak Chi pulse and cold feet clearly indicate Kidney deficiency with unanchored yang. Merely tonifying and filling yin without securing yang will certainly fail to produce results. The ancients had methods of using qi-tonics to secure blood. Renshen (Ginseng Root) and Fuzi (Aconite Root) constitute Shenfu Tang (Ginseng and Aconite Decoction), which secures Kidney qi; Danggui (Angelica Sinensis Root) and Fuzi (Aconite Root) constitute Guifu Tang (Angelica and Aconite Decoction), which secures Ying (Nutritive) qi. Since much blood has been lost, how can we avoid using warm tonics to secure the Zhen (True) qi of the viscera?" His brothers agreed. Thus, he took the medicine. On the twenty-ninth, upon re-examination, he reported that although bleeding had ceased during the Xu-Hai hours the previous night, cold feet and shortness of breath had not fully resolved. I retained the formula from the twenty-eighth day, removed Pao Jiang (Roasted Ginger), doubled the dosage of Fuzi (Aconite Root), added Hutao Ren (Walnut Kernel) at 4 qian and Fupenzi (Raspberry Fruit) at 2 qian, to secure and assist in grasping qi. After three doses, he was invited back for examination. All ailments had settled, but he still had difficulty sleeping soundly at night. It was planned to additionally regulate the Xin Ying (Heart Nutritive Level). The formula from the twenty-ninth day had Guiban (Turtle Shell), Fuzi (Aconite Root), Hutao Ren (Walnut Kernel), and Fupenzi (Raspberry Fruit) removed. Gouqi (Goji Berry) was added at 3 qian, Fushen (Poria with Hostwood) and Zaoren (Ziziphus Seed) each at 2 qian, Maidong (Ophiopogon Tuber) at 1 qian, and Zhi Gancao (Honey-fried Licorice Root) and Wuweizi (Schisandra Berry) reduced to 0.4 qian. After several doses, Duzhong (Eucommia Bark), Huangqi (Astragalus Root), Fangdang (Codonopsis Root), Baizhu (Atractylodes Macrocephala Rhizome), and Luzhu (Deer Antler) were incorporated, with adjustments based on pulse and symptoms, leading to recovery through nourishment.
Selected excerpt from Mr. Wang Kentang’s discussion on hemoptysis in sputum.
Wang Kentang stated: The blood may appear as a tiny drop or a fine thread. Its intensity seems harmless, yet the root cause is actually deep. This blood does not originate from the Stomach but from the Lung. The Lung is rich in Qi but poor in Blood, so the amount of blood expelled is small. Now, due to Fire forcing it out with phlegm, the Lung fears desiccation and loses its ability to govern the Qi transformation of the whole body. Is this not a significant harm? The treatment method involves adding hemostatic herbs to phlegm-resolving formulas, such as Beimu (Fritillaria Bulb), Gualou Ren (Trichosanthes Seed), Fuling (Poria), Maidong (Ophiopogon Tuber), Yuanshen (Scrophularia Root), Zhuru (Bamboo Sap), Suzi (Perilla Fruit), and Yimi (Coix Seed) to treat phlegm; Xijiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*), Ejiao (Donkey-hide Gelatin), Baiye (Artemisia Leaf), and Heizhi (Charred Gardenia) to stop bleeding; Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) to descend Fire; mixed with Huazhishi (Flower Ochre Stone) powder, 4-5 fen, taken slowly. Another method uses one bowl of Zhuli (Bamboo Sap), adds two liang of Ejiao (Donkey-hide Gelatin), melts it, then adds one liang of calcined Shigao (Gypsum Fibrosum), one liang of Hafan (Calcined Aragonite), half a liang of Qingdai (Indigo Naturalis), and one liang of Hao Mo (Good Ink), grinding them together into a fine powder, mixing into pills the size of millet seeds. Take one qian per dose, washed down with fragrant tea. The effect is very rapid.
Cough and Sputum
"Cou" (cough) refers to rebellious Qi; "Sou" (sputum/cough) is due to the presence of phlegm. Internal injury and external contraction have different causes, and the Five Zang and Six Fu organs suffer differently. Here, we first establish a Qi-descending and Phlegm-resolving formula for common cough cases, to be modified according to specific symptoms.
Fuling (Poria) 3 qian (sliced), Yimi (Coix Seed) 4 qian (raw), Chenpi (Citrus Peel) 5 fen, Beixing (North Apricot Seed) 1 qian, Banxia (Pinellia Tuber) 1.5 qian (processed), Suzi (Perilla Fruit) 1.5 qian, Gancao (Licorice Root) 5 fen.
If thirsty, add Maidong (Ophiopogon Tuber) and Gualou (Trichosanthes Fruit); peel or seed can be used interchangeably. If Banxia is used, substitute with Chuanbei (Fritillaria Cirrhosa Bulb); if Chenpi is used, substitute with Chengpi (Orange Peel). Chengpi is more sweet and bitter than acrid, differing from the acrid-dry nature of Tangerine Peel. If there is much phlegm and no thirst, double Banxia (Pinellia Tuber) and Chenpi (Citrus Peel), add Shengjiang (Fresh Ginger), or add Gualou (Trichosanthes Fruit) and Xiebai (Allium Macrostemon Bulb). If coughing with chest and hypochondriac pain, add Jiezi (Mustard Seed), a little Jiangzhi (Ginger Juice), Chao Huanglian (Stir-fried Coptis Rhizome), or Cu Chao Chuanlianzi (Vinegar-stir-fried Sichuan Loranthus Fruit). If Heat, add Shigao (Gypsum Fibrosum) and Zhimu (Anemarrhena Rhizome), or Huanglian (Coptis Rhizome) and Huangqin (Scutellaria Root). If Cold, add Yizhi (Alpinia Oxyphylla Fruit) and Shengjiang (Fresh Ginger), or Ganjiang (Dried Ginger), Wuweizi (Schisandra Berry), and Xixin (Asarum Root) (remove Beixing and Suzi). If Wind, add Fangfeng (Saposhnikovia Root) (substitute Suzi with Sugeng Perilla Stem). If Dampness, add Fangfeng (Saposhnikovia Root) and Cangzhu (Atractylodes Lancea Rhizome). If Spleen Deficiency, add Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), and Danggui (Angelica Sinensis Root) (remove Suzi, Beixing, and Yimi). If Liver-Kidney Deficiency causing shortness of inhalation (Qi inhalation relates to Kidney and Liver), add Shudi (Prepared Rehmannia Root), Danggui (Angelica Sinensis Root), and Wuweizi (Schisandra Berry), or Gouqi (Goji Berry), Hutao (Walnut), and Niuxi (Achyranthes Root) (remove Suzi, Beixing, and Yimi, or also remove Gancao).
Furthermore, if cough leads to phlegm, Qi should be smoothed, focusing treatment on the Lung. The Lung governs Qi and dislikes Warm-Dryness. Maidong (Ophiopogon Tuber), Juhong (Citrus Peel), Chuanbei (Fritillaria Cirrhosa Bulb), Zhimu (Anemarrhena Rhizome), Sangbaipi (Mulberry Root Bark), and Ziwan (Aster Root) are key herbs.
If phlegm leads to cough, phlegm should be resolved, focusing treatment on the Spleen. The Spleen stores phlegm and dislikes Cold-Moisture. Baizhu (Atractylodes Macrocephala Rhizome), Cangzhu (Atractylodes Lancea Rhizome), Zhi Nanting (Processed Arisaema Tuber), and Zhi Banxia (Processed Pinellia Tuber) are key herbs, combined with Fire-clearing herbs (preferably Huanglian stir-fried with Ginger Juice).
For chronic cough that does not heal, use Maidong (Ophiopogon Tuber) as the Sovereign herb, with Chuanbei (Fritillaria Cirrhosa Bulb), Zhimu (Anemarrhena Rhizome), Fuling (Poria), Zhuru (Bamboo Sap), Huangqin (Scutellaria Root), and Suzi (Perilla Fruit) as Ministers. Add a small amount of Wuweizi (Schisandra Berry), Gancao (Licorice Root), and Dengxin (Juncus Maritimus Pith). (Contraindicated for cough caused by Wind-Cold Deficiency).
For those with continuous cough and fever, treating cough alone or inducing sweat without addressing the root is ineffective (This indicates the loss of Zhen Qi, leading to heat and sweating. Treatment should secure Zhen Qi, such as using Renshen Guben Wan (Ginseng Root-Securing Pill) or Maigui Tang (Liquorice and Reishi Decoction) removing Jiang and Gui, adding Sheng Longgu (Fossilized Bone), Sheng Muli (Oyster Shell), and Cishi (Magnetite). There are lucky cases of recovery). Inability to sleep on the left indicates Liver Distension; inability to sleep on the right indicates Lung Distension; both are difficult to treat. Reading Ye Tianshi’s *Linzheng Zhinan* (Guide to Clinical Practice), it is not solely about Liver and Lung Distension. Symptoms have similarities, diseases have excess and deficiency. Practitioners must be cautious. (Ye Tianshi treated right-side insomnia with Maidong Tang, stating that Stomach Yin deficiency fails to nourish the Lung; Lung pathology fails to descend, and obstructing right sleep exacerbates cough. Left-side insomnia was treated with Maigui Tang removing Jiang and Gui, adding Sheng Muli and Maili, stating that excessive Liver Yang rising prevents left sleep from curbing its rebellious force, thus worsening cough. This method is often used for cough and hemoptysis). If it is indeed Liver or Lung Distension, treatment should involve dispersing, clearing, or astringing, according to various schools. This school can verify these, so no further elaboration is needed (Shen Qianlü’s *Zunsheng* provides detailed syndrome differentiation and treatment, which can be referenced).
Attached Case (Cough with Aphonia)
In treating diseases, asking about symptoms and etiology seems twice as important as observation, auscultation/olfaction, and palpation. I once treated the wife of Inspector Guo, aged about thirty. Her husband, an official, had been stationed in the capital for years due to duties. After passing the exams and receiving a post elsewhere, he brought his family to join him. Upon receiving the happy news, she suddenly developed aphonia (loss of voice). She had frequent coughing with little sputum, felt fire rising at night, and had slight throat and tongue pain, while daytime eating and drinking were unaffected. Visiting many famous doctors yielded no results. I examined her and asked: Did the cough start first, or the aphonia? Her family replied: Aphonia started first; other symptoms arose later. I asked again: Did you drink strong alcohol frequently when this started? She replied: No. Occasionally, sitting up late reading "Muyu Shu" (Wooden Fish Ballads) strained her mind, and the next morning her voice broke. I palpated her pulse: both Chi pulses were rapid and forceful. Reviewing previous prescriptions, they were mostly for clearing and dispersing Lung Qi, stopping cough, and resolving phlegm, targeting the Upper and Middle Jiao. I adopted the method of treating upper disorders by addressing the lower. Prescription: Guiban (Turtle Shell) 8 qian, Dadihuang (Large Rehmannia Root) and Huangbai (Phellodendron Bark) each 4 qian, Zhimu (Anemarrhena Rhizome) and Fuling (Poria) each 2 qian, Lingyangjiao (Antelope Horn), Danpi (Moutan Cortex), and Zexie (Alisma Rhizome) each 1 qian. I said: Based on the etiology and pulse correspondence, this chronic illness should respond easily. Within ten doses, improvement should be seen. The family was eager to depart for the new post and was delighted by my words. My friend, Sima Ruping, accompanied me to the Guo residence (he was related to the Guos). He was surprised by my statement, saying: Using Turtle Shell and Rehmannia for phlegm-cough is unlikely to work. Moreover, heavy use of Huangbai (Phellodendron Bark) is inexplicable. I smiled and said: Just wait and see. On the seventh of the next day, I returned. Examination showed that the feeling of fire rising, coughing fits, and tongue pain had disappeared that night. The same formula was used, reducing Huangbai by 1 qian for another dose. On the eighth, the Chi pulses had slowed, and the voice was returning. The same formula was used, removing Danpi and Zexie. Guiban was reduced to 4 qian, Lingyangjiao (Antelope Horn) and Huangbai (Phellodendron Bark) to 0.8 fen each. Fresh Changpu (Acorus Tatarinowii Rhizome) 0.5 fen was added to the decoction, along with 0.7 fen of Zhenzhu Mo (Pearl Powder). After three doses, on the eleventh, the voice was bright but lacked clarity. I switched to a formula for clearing and purifying the Qi level of the Upper Jiao: Shashen (Glehnia Root) 8 qian, Lishen (Codonopsis Root), Huangqi (Astragalus Root), Tiandong (Asparagus Tuber), and Maidong (Ophiopogon Tuber, keeping the heart) each 1 qian, Baiju (Chrysanthemum Indicum Flower) and Hangju (Hangzhou Chrysanthemum Flower) each 0.4 fen, plus four Southern Dates and one Egg White. (Egg white is prepared by steaming the egg, peeling, removing yolk, and using only the white in the decoction). After only four doses, the voice cleared, and she recovered. Ruping said: The medicine worked, but I still don't understand why. I said: This is reasoning based on circumstances. The couple had been separated for years; upon reunion, who would not have emotional thoughts? Sitting alone in the quiet night makes emotions easily stirred. Moreover, our Guangdong Muyu Shu often depicts romantic liaisons. Past feelings stirring future desires make Minstral Fire (Xiang Huo) prone to reckless movement. The pulse showed rapid Chi pulses, and symptoms arose rapidly (Wind and Fire are the most rapid in the Five Elements). Could this not be Dragon and Minstral Fire? Once Dragon Fire moves, it inevitably rises. Rising, it scorces Lung Metal. Empty Metal rings; solid Metal is silent. The Kidney meridian circles the throat and tongue. Jue Yin Yang tends to surge during Zi and Chou hours. This explains the nighttime throat and tongue pain. I used Earth (Rehmannia) to nourish, Turtle Shell to submerge, Zhi Mu, Huang Bai, Dan Pi, Ze Xie, Fu Ling, and Ling Yang Jiao to descend and drain, and then to dredge (Antelope Horn is most effective, its movement dredges Fire evil entering the collaterals). Thus, Dragon and Thunder Fire subside and rest in their place, Lung Metal clears and maintains its normal function. How could aphonia not heal quickly? Ruping said: Excellent inquiry, careful thought, and clear discrimination. The way of medicine should be like this.
Selected excerpt from Wang Kentang’s differentiation of Ten Types of Cough and Five Zang Cough for reference.
Fire-Phlegm Cough: Coughing with red face, requiring great effort to expel phlegm. Banxia (Pinellia Tuber) and Nanting (Arisaema Tuber) are unsuitable due to excessive dryness. Use Beimu (Fritillaria Bulb), Zhimu (Anemarrhena Rhizome), Gualou Ren (Trichosanthes Seed), Zhuru (Bamboo Sap) to resolve phlegm; Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Shanzhi (Gardenia Fruit) to descend Fire; Suzi (Perilla Fruit), Juhong (Citrus Peel), Fuling (Poria) to smooth Qi.
Damp-Phlegm Cough: Gurgling sound in the throat, easy to expel phlegm. Yuanshen (Scrophularia Root), Ejiao (Donkey-hide Gelatin), Zhimu (Anemarrhena Rhizome) are unsuitable due to moistening properties. Use Cangzhu (Atractylodes Lancea Rhizome), Fangfeng (Saposhnikovia Root) to dry Dampness; Banxia (Pinellia Tuber), Nanting (Arisaema Tuber), Jiangzhi (Ginger Juice), Zhuli (Bamboo Sap) to remove phlegm; Zhike (Aurantii Fructus), Juhong (Citrus Peel) to smooth Qi; Huangqin (Scutellaria Root), Shanzhi (Gardenia Fruit) to descend Fire.
Stagnation-Phlegm Cough: Chest fullness, continuous coughing without expulsion, wheezing sound in throat, insomnia, feeling full above and hungry below. Wuweizi (Schisandra Berry) and Maidong (Ophiopogon Tuber) are unsuitable as they tonify the Lung. Use Zhike (Aurantii Fructus), Jiegeng (Platycodon Root), Bianjin Xiangfu (Rhizoma Cyperi Infused in Urine) to open stagnation; Chuanbei (Fritillaria Cirrhosa Bulb), Gualou (Trichosanthes Fruit), Banxia (Pinellia Tuber) to treat phlegm; Suzi (Perilla Fruit), Xingren (Apricot Seed) to calm wheezing; Fuling (Poria), Huangqin (Scutellaria Root), Shanzhi (Gardenia Fruit) to descend Fire.
Stubborn-Phlegm Cough: Phlegm stuck in the throat, impossible to expel, requires great effort to cough out a small amount, resembling grease. Decoctions are unsuitable; powders should be used to dissolve it. Qingdai (Indigo Naturalis), Hafan (Calcined Aragonite), Fuhaisshi (Floating Pumice), Fenghua Xiao (Efflorescent Mirabilite), Gualou Ren (Trichosanthes Seed), Naosha (Sal Ammoniac), Mingfan (Alumen) ground to fine powder, taken with Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice). Because it is stubborn and unyielding, mild agents cannot cure it.
Clear-Phlegm Cough: Phlegm appears only after coughing, not thick or sticky. Slow-acting medicines are suitable. Beimu (Fritillaria Bulb), Huafen (Trichosanthes Root), Fuling (Poria), Huangqin (Scutellaria Root), Zhuru (Bamboo Sap), Juhong (Citrus Peel), Suzi (Perilla Fruit), Zhu Huang (Bamboo Pith) are suitable.
Wind-Phlegm Cough: Lung Qi is congested, requiring paroxysmal coughing to expel phlegm. Phlegm is floating with foam, resembling saliva, slightly thick. Light and floating agents are suitable. Bohe (Mint), Chaiku (Bupleurum), Sangbaipi (Mulberry Root Bark), Fangfeng (Saposhnikovia Root), Banxia (Pinellia Tuber), Huangqin (Scutellaria Root), Zhike (Aurantii Fructus) are suitable. Add a small amount of Mahuang (Ephedra Herb) and Gancao (Licorice Root) (when using Mahuang, pair with Beixing to descend Qi).
Cold-Phlegm Cough: Acquired in the transition between autumn and winter, or from exposure to water, dew, cold rain, or cold wind. Cough is accompanied by asthma or cold sensation in shoulders and back, relieved by hot drinks. Lu Xi San (Reed Tube Powder) is suitable: Rougui (Cinnamon Bark), Xionghuang (Realgar), Eguan Shi (Goose Trachea Stone), Kuandonghua (Farfara Flower), Gancao (Licorice Root) in equal parts, ground to fine powder. Use a reed tube to apply the medicine, hold gently in the mouth, inhale into the throat, and rinse with clear tea. Or make honey pills the size of a chicken bean for dissolving. For Heat Cough, remove Rougui (Cinnamon Bark), use Jingquan Shi (Well Spring Stone). For decoction, use Banxia (Pinellia Tuber), Nanting (Arisaema Tuber), Chenpi (Citrus Peel), Fuling (Poria), Kuandonghua (Farfara Flower), Huasheng (Peanut), Jiang Gan Cao (Ginger and Licorice).
Wine-Phlegm Cough: Caused by catching Wind-Heat after drunkenness, with wine accumulation in the abdomen, triggered by drinking turbid wine. Shanzhi (Gardenia Fruit), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome) treat Fire; Beimu (Fritillaria Bulb), Gualou (Trichosanthes Fruit), Banxia Qu (Pinellia Fermented Dough) treat phlegm; Hafan (Calcined Aragonite), Huafen (Trichosanthes Root), Lvdou Fen (Mung Bean Powder) eliminate wine (Zhizige (Vitex Fruit) and Ganhua (Pueraria Flower) better resolve wine toxicity and are indispensable); Zisugeng (Perilla Stem), Ziyè (Perilla Leaf), Chenpi (Citrus Peel) smooth Qi.
Food-Stagnation Phlegm Cough: Cough immediately after eating, phlegm is thick and sticky with a sweet taste, chest and diaphragm feel tight. Zhishi (Aurantii Fructus Immaturus), Laifuzi (Radish Seed), Shenqu (Medicated Leaven), Maiya (Hordeum Germinatum), Shanzha (Crataegus Fruit) digest food; Chenpi (Citrus Peel), Muxiang (Aucklandia Root), Sharen (Amomum Fruit) smooth Qi; Banxia (Pinellia Tuber), Nanting (Arisaema Tuber) resolve phlegm; Shigao (Gypsum Fibrosum), Huanglian (Coptis Rhizome) descend Fire. Add Shengjiang (Fresh Ginger) and Zhuru (Bamboo Sap) as guides.
Dry Cough: Chronic Yin-Blood deficiency, surplus of Deficient Fire. Throat is often itchy, triggering frequent coughing with sound but no phlegm. Maidong (Ophiopogon Tuber), Zhimu (Anemarrhena Rhizome), Chuanbei (Fritillaria Cirrhosa Bulb), Yuanshen (Scrophularia Root), Ejiao (Donkey-hide Gelatin) are primary. Huangbai (Phellodendron Bark), Fuling (Poria), Huafen (Trichosanthes Root), Shanzhi (Gardenia Fruit), Gancao (Licorice Root) are secondary. Add Dengxin (Juncus Maritimus Pith) and Zhuru (Bamboo Sap). Very effective.
Cough with bilateral hypochondriac pain is called Liver Cough. Cough with slight lower back pain is called Kidney Cough. Cough with epigastric pain is called Spleen Cough. Cough with clear nasal discharge is called Lung Cough. Cough with bitter taste and dry tongue is called Heart Cough. Cough with urinary incontinence indicates Qi Deficiency. Cough with five-palm heat indicates Blood Deficiency. (If carefully examined and treated accordingly, efficacy is assured).
Wang Kentang also stated: All coughs benefit from Jiegeng (Platycodon Root), the native herb of the Lung meridian. It should not be omitted, nor overused. As a boat-and-oar agent, it floats up but does not descend. Without it, other herbs cannot reach the Lung; with too much, it carries herbs but cannot move them, and causes fullness. Thus, it should not be overused. For sore throat, combine with Yuanshen (Scrophularia Root) and Gancao (Licorice Root). For opening stagnation, combine with Xiangfu (Cyperi Rhizoma), Zhike (Aurantii Fructus), Chuanxiong (Ligusticum Rhizome), Cangzhu (Atractylodes Lancea Rhizome), Chuanbei (Fritillaria Cirrhosa Bulb). As an emetic, use equal parts with Gancao (Licorice Root) in a large dose to induce vomiting and expel phlegm. Mr. Wang Yaozhou commented: Wang’s statement that all coughs benefit from Jiegeng (Platycodon Root) has drawbacks. It may be suitable for acute cough, but for chronic cough, Lung Qi is invariably deficient. One should be busy astringing and tonifying; how can one use Jiegeng (Platycodon Root) for ascending and acrid-dispersing actions, violating the prohibition against weakening the deficient? I have seen chronic cough patients whose Lung metal was broken by it, hemoptysis patients whose bleeding worsened, and deficiency-wheezing patients who suffered sudden Qi collapse. Why? For rebellious conditions, the method is to descend. Even for sore throat, phlegm and Fire must be descended. Although Zhang Zhongjing prescribed Ganjie Tang (Licorice and Platycodon Decoction), current usage treats it only as an assistant. It must be paired with Bitter-Descent herbs like Huangqin/Huanglian, and Salty-Descent herbs like Yuanshen/Fenghua Xiao, so that ascending agents do not hinder the process. This commentary originally appeared in Wang’s *Yijing*, recorded here for reference.
Mr. Yaozhou had high character, and his literature and medicine were respected by peers. He encouraged goodness and authored *Wudi Jueshi Zhenjing Shi*. His courtesy name was Mingqi, pseudonym Fengshan. He was the fourth brother of Wang Mingqian (Tai Shi of Zhai Ji) from our county, residing in Guangzhou.
Attached: Feng Huiting’s Discussion on Nourishing and Regulating the Spleen and Stomach
My Spleen and Stomach have always been weak. As the saying goes, "There is no old man without weak Spleen and Stomach," which worries me. Therefore, I pay constant attention to nourishment. Now, at sixty, although my diet hasn’t increased, my spirit hasn’t diminished, and minor illnesses are rare. I know this is partly due to nourishment. To nourish the Spleen and Stomach, one must first observe their nature and understand their structure and function. Books say: Weak Stomach Yang generates hundred diseases; sufficient Spleen Yin extinguishes ten thousand evils. This implies treating the Stomach focuses on Yang, and regulating the Spleen focuses on Yin. However, the Spleen’s structure is Yin but its function is Yang; the Stomach’s structure is Yang but its function is Yin. Taiyin Damp Earth moves with Yang; Yangming Yang Earth settles with Yin. The ancients clarified this utility. The Spleen ascends to transport; if Yang Qi is weak, it cannot ascend. The Stomach descends to harmonize; if Yin Fluid is deficient, it cannot descend. Understanding their nature and structure/function, we know that ingestion is governed by the Stomach. One feels hungry but eats little (Spleen Yang is undamaged, so hunger is felt; Stomach Yin is damaged, so intake is low). To nourish Stomach Yin, use Maidong (Ophiopogon Tuber), Tiandong (Asparagus Tuber), Shashen (Glehnia Root), Yuzhu (Polygonatum Odoratum Rhizome), Shanyao (Dioscorea Rhizome), Bidou (Lablab Bean), Nuomi (Glutinous Rice), Nanzao (Southern Date), Shihu (Dendrobium Stem), and Gancao (Licorice Root). Transport is governed by the Spleen. One can eat but transports little (Stomach Yin is healthy, so eating is possible; Spleen Yang is diseased, so transport is low). To warm and unblock Spleen Yang, use Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Chenpi (Citrus Peel), Yizhiren (Alpinia Oxyphylla Fruit), Jingmi (Japonica Rice), Chao Lianye (Stir-fried Lotus Leaf) to awaken it. If deficient and cold, add Ganjiang (Dried Ginger), Fuzi (Aconite Root), and Rougui (Cinnamon Bark) to warm. This is a good method for prevention and post-illness recovery. The Spleen and Stomach are the foundation of acquired constitution and longevity. Cherish them, avoid raw/cold and hard-to-digest foods. There is no better method for prolonging life. Be cautious, strive for it. End of *Pingqin Shuwu Yilüe*.