肺痈2(大叶肺炎)
姚某，女，56岁
初诊
发烧7～8天，体温38.3℃，咳嗽，头痛，咽红，痰吐不爽，曾服止咳糖浆、复方甘草合剂、咳必清、枇杷露等，咳嗽未减，身热不退，今晨咳嗽胸痛，吐脓血数口，味臭且粘，继则痰中带血，胸胁作痛。舌苔黄腻，质红且干，两脉弦滑而数，大便略干小便不多色黄，心烦口渴。此风温蕴热，互阻于肺，发为肺痈，可用千金苇茎汤法加减治之。
鲜苇茎60克，冬瓜子30克，桃仁10克，苦桔梗10克，薏苡米25克，生甘草10克，甜葶苈3克，犀黄丸6克(分两次药汁送下)，二付
二诊
身热渐遢，体温37.5℃，咳嗽渐减而痰血亦轻，痰吐味臭，两脉弦滑略数，胸中时时作痛，舌红苔腻浮黄且干，肺痈重证，再以清肃化痰，逐瘀排脓。
鲜苇茎60克，冬瓜子30克，前胡3克，川贝母1O克，杏仁泥10克，桃仁10克，薏苡米25克，苦桔梗10克，生甘草6克，黛蛤散12克(布包)，犀黄丸6克，三七粉1.5克(分两次药汁送下)，三付。
三诊
前方连进三剂，身热已退净，体温36.9℃。咳嗽大减，痰吐甚少，已无血脓臭味，自觉胸痛亦止，两脉弦滑，数象亦差，舌红苔腻略黄，饮食二便如常。改用活血化瘀，祛腐生肌之品。
鲜苇茎60克，桃仁6克，茜草10克，川贝母6克，薏苡米25克，赤白芍各18克，北沙参25克，犀黄丸6克，三七粉1.5克(分两次药汁送下)，三付
四诊
身热退而咳嗽亦止，脓血臭痰未再吐，胸痛已止，舌脉如常，病已向愈，议用平调脾胃为善后之计，不可骤用温补，以防死灰复燃，辛辣油腻亦忌。
茯苓10克，北沙参18克，生白术6克，炙甘草1O克，白扁豆10克，生熟薏米各12克，冬瓜皮子各15克，五付
五诊
药后诸症悉平，饮食二便正常，胸透亦已复常，脉软舌净。嘱其休息两周，即可恢复工作。
[按]：肺痈一症向来归于内科，其实当从温病治之。其为风温蕴热，互阻于肺，热壅成毒，发为痈脓。治用千金苇茎汤加味，其犀黄丸之用，最为得力，足补苇茎解毒之力不逮之缺憾。
肺痈之治，当辨其脓成与未成，溃与未溃，一般当分四期治之。赵师有家传四法，兹录之以备参考。
初期：肺痈未成，发热微恶风寒，兼有咳嗽，喘憋，痰多微黄，胸痛，苔薄黄，脉浮数。治以辛凉清解，肃肺化痰，可用：
薄荷3克，前胡6克，贝母12克，杏仁10克，苏子10克，黄芩10克，生石膏12克，鲜芦茅根各30克。
中期：壮热不恶寒，咳喘，痰黄稠，胸痛，口渴，舌红苔黄腻，脉洪数。治以泄热化湿，肃肺消痰，可用，
甜葶苈6克，前胡6克，黄芩10克，桑白皮12克，皂角6克，桔梗10克，生甘草6克，银花15克，贝母10克，醒消丸6克(分二次服)
极期：壮热，咳喘胸痛，吐脓血痰，或脓臭痰，舌红苔黄腻，脉洪数。治以清化痰热，活血通络，可用：
鲜芦根90克，冬瓜子30克，桃仁6克，苡仁30克，鱼腥草30克，甜葶苈3克，黄芩10克，皂刺3克，银花30克，犀黄丸6克(分二次服)
后期：余热不退，脓痰渐净，神疲气短，苔薄质红而瘦，脉细弦小数。治以甘寒养阴，活血通络，可用：
南北沙参各30克，麦冬10克，见母10克，桔梗10克，生甘草6克，生黄芪12克苡仁30克，赤芍10克，地骨皮10克，桑白皮10克，丹皮10克。
咳嗽1(支气管炎)
钟某，男，2岁半
初诊
阵阵呛咳，喉间痰鸣，夜间为甚。病由感冒而起，历经半年未愈，迭服中西药物，疗效欠佳。西药抗生素，镇咳剂，中药小儿清肺、蛇胆川贝、止咳枇杷等，服之甚多，又曾服中药汤剂益气健脾等。近日咳嗽增重，纳食减少，面色暗滞，指纹色红，脉象滑数。此肺家郁热，因服寒凉被遏，致肺失宣降，上逆为咳。先用宣肃化痰方法，肺气宣，郁热散，其咳自止。
苏叶子各6克，前胡6克，白前6克，浙见母10克，杏仁10克，枇杷叶6克，茅芦根各10克，五剂。
二诊
上药服至三剂，咳嗽全止，喉间已无痰声。继用前方，加焦三仙各10克，以和胃气。又服5剂，纳食大增而痊。
[按]，小儿感冒咳嗽，本可一药而愈，奈何迁延半年之久，大概皆惑于炎症之说，而频用寒凉之剂，或滥用西药抗生素。或家长不知，听任患儿恣食冷饮，致肺中郁热被遏，不得宣散，故久咳不已。《内经》云：形寒饮冷则伤肺。咳嗽一症，肺之疾也。患咳者，勿令受寒冷刺激，勿恣食冷饮食物，勿服寒凉之药。治咳之要，以宣散为主，故曰宣肺止咳。此治感邪咳嗽之法，内伤虚咳不在其例。
咳嗽2(支气管炎)
董某某，女，29岁
秋令感受燥邪，肺先受之，故干咳无痰，口唇干燥，心烦微渴。脉象弦细略数，舌红苔少且干，素体阴亏，津液不足，用清燥救肺方法。
沙参10克，麦门冬10克，阿腔10克，(烊化分兑)，知母10克，浙川贝母各6克，花粉10克，瓜萎皮10克，前胡6克，杏仁10克，枇杷叶10克，七剂。
上方服七剂，干咳即止。
[按]：此为肺燥咳嗽，大法润燥与宣肺并举，不宜过用凉药，防止凉遏气机，更增其燥。
咳喘(喘息性支气管炎)
祁某，男，47岁
初诊
喘咳10余年，遇寒即发，痰多清稀，甚则喘急不能平卧。
近因感寒，喘咳又作，入夜尤甚。舌白苔腻水滑，脉象沉弦，按之紧数。寒饮相搏，气逆上冲，喘咳由是而作。温化寒饮，以定其喘。小青龙汤法。
麻黄6克，桂枝6克，半夏10克，细辛3克，白芍10克，干姜6克，炙甘草6克，七付
二诊
药后喘咳渐减，痰量亦少。脉仍沉弦，舌白且润。仍以前法进退。
麻黄3克，桂枝6克，半夏10克，细辛3克，千姜6克，白芍10克，炙草6克，杏仁10克，旋复花10克，七付
三诊
两进小青龙汤，咳喘渐平，食少痰多，脉沉已起，舌白萏润。仍以宣肺化痰方法。
苏叶子各10克，杏仁10克，浙贝母10克，莱菔子10克，白芥子6克，炒枳壳6克，桔梗10克，焦三仙各10克，半夏10克，陈皮10克，七付
药后咳喘皆止，纳食增加，嘱其忌食寒凉饮食，运动锻炼
以增强体质，预防感冒以防其复发。
[按]：慢性喘息性支气管炎以反复发作的喘咳多痰为主要表现。常因感冒风冷而复发或加重。其病机为内饮外寒，即《内经》所说；“形寒饮冷则伤肺，以其两寒相感，中外皆伤，故气逆而上行。”既为外寒内饮，当用仲景小青龙汤，外散表寒，内化寒饮。凡属此型者服之即效。切不可惑于炎症之名而用凉药。又须忌食寒凉饮食，如冷饮及生冷瓜果。病愈之后，须防复发。预防之法以防止感冒和忌食寒凉最为重要。患者本身应加强锻炼，增强体质，提高抗病能力。用药则以健脾胃助消化为主。脾胃健则痰湿不生，元气固则外邪难侵。故为根本之法。
咳血(支气管扩张)
付某某，女，43岁
初诊
喘咳经常发作，晨起咯痰甚多，痰中带血。病已10年。经某医院确诊为支气管扩张症。近一月来咳嗽不止，动即作喘，咳吐大量白痰，痰中带血，有时吐出鲜血盈口。脉象弦滑数，右寸脉大，接之空豁，舌红苔白浮黄。热郁在肺，络脉受伤，肃降肺气以止其咳，凉血清营以止其血。
旋复花10克，枇杷叶10克，杏仁10克，浙贝母10克，川贝母10克，前胡6克，百部6克，茜草10克孙蓟10克，茅芦根各10克，黛蛤散6克(包煎)，七剂
二诊
药后咳嗽渐减，吐血未止，咯痰仍多，再以肃降化痰方法，兼以止血。
旋复花10克，批杷叶10克，杏仁10克，浙川贝母各10克，桑白皮10克，地骨皮10克，茜草10克，生地榆10克，小蓟10克，黛蛤散6克(包煎)，茅芦根各10克，三七粉3克(分冲)，七付
三诊
咯血渐减而未全止，咳嗽时作，吐痰色白，舌红苔白，脉数而虚，气火上炎之势渐平，仍以再法进退。
旋复花10克，枇杷叶10克，杏仁10克，川浙贝母各10克，桑自皮10克，地骨皮10克，茜草10克，小蓟10克，茅芦根各10克，焦三仙各10克，三七粉3克(分冲)
四诊
咳血已止。再以肃肺方法。
杏仁10克，枇杷叶10克，川浙贝母各10克，小蓟10克，茅芦根各10克，百部10克，焦三仙各10克，山药10克，香稻芽10克，七付
药后诸症已愈，纳食增加，嘱其慎起居，多锻炼，增强体质，以防复发。
[按]：缪仲淳治吐血三要法云：“宜降气不且降火{宜行血不宜止血；宜补肝不宜伐肝。”赵师此案治法即以宣肺降气止咳化痰为主，兼以凉血化瘀止血。用药看似平淡，实际效果甚好。
失音1(声带息肉)
高某，男，10岁，学生，于1992年4月26日初诊。患者平素经常咽喉疼痛，1992年1月30日因暴饮寒凉后突然声音嘶哑，继而说不出话来。某医院用大量抗生素、喉症丸、六神丸等治疗均无效，后经喉镜检查，诊断为“声带息肉。”现除失音外，伴有心烦急躁，夜寐不安，咳嗽有白痰，饮食不佳，小便黄赤，大便略干。舌红苔白腻润滑，脉浮滑且数，沉取略细。检查：咽红，两扁桃体肿大，心肺(一)，白细胞8×10 9／l。证属内热蕴郁，寒邪外袭。治以宣肺疏化，清热利咽。处方；苏叶10克，前胡6克，浙见母10克，茅芦根各10克，杏仁10克，枇杷叶10克，瓜萎10克，焦三仙各10克，水红花子10克，7剂，水煎服。
二诊
服药3剂后，暗哑开始好转，能说出话来，7剂服完，声音恢复正常。饮食二便如常，余症皆减，再以前方7剂，以巩固疗效，饮食当慎。
[按]；此患者豪有郁热，又困暴饮寒凉，形成寒邪包热，壅遏肺金，肺失宣肃，故声音嘶哑，甚则失音。再以大量抗生素以及寒凉的喉症丸、六神丸之属，导致凉遏其邪，增重其郁，邪无外出之门，而使喑哑久治不愈。故赵老用苏叶开宣肺气，发散风寒；前胡宣散肺经之郁热；浙贝母、枇把叶、瓜萎清泻肺热，又能止咳祛痰散结；茅芦根清热宣肺利咽喉又能润肺；杏仁、苏叶宣肺祛痰以畅气机；焦三仙，水红花子祛中焦脾胃之积滞浦药相须伍，肺气得宣，外寒得散，郁热得清，气机得畅，咽喉得利，声音自复。
失音2(癔病性失音)
张某，女，38岁，农民，1988年11月28日初诊。患者于1个月之前，因与邻居发生口角，第2天清晨起床发现失音，不能发声，急去医院检查，诊断为“癔病性失音”，经用西药、中药、针灸、诱导等方法治疗均无效。现病人心烦急躁，夜寐不安，纳食不佳，头目眩晕，胸胁胀痛，大便干结，舌红起刺，苔白且干，脉弦滑且数。证属肝经郁热，气机不畅。治阻调畅气机，清泻肝经郁热之法。饮食宜清淡。处方：蝉衣6克，僵蚕10克，片姜黄6克，大黄1克，柴胡6克，黄芩6克，川楝子6克，苏叶梗各6克，茅芦根各10克，焦三仙各10克，水红花子10克，5剂，水煎服。
二诊
据其爱人转述，患者囤欲病速愈，第1天连服两剂，昨上大便泄泻5～6次，便物奇臭难闻，夜寐较安。第2天起床发出咳嗽声，并能说出话来，5剂服完，声音完全恢复正常，余症皆除。再以上方7剂，以固其效。
[按]：本患者素有肝经郁热，加之与邻居发生口角而致肝气郁结，气机闭塞不通，升降失常，清浊不分而致喑。赵老用升降散加味，以升清降浊，宣散郁结，调理人体之气机升降。方中咀蝉衣透散郁热之邪；姜黄行气散郁；僵蚕轻浮升阳，清热解部，化痰散结；大黄攻积导滞。再配以柴胡、黄芩、川楝子、苏梗舒调气机，清肝经郁热；茅芦根、苏叶宣肺利咽；焦三仙、水红花子健脾和胃。诸药相伍，三焦气机宣畅，内郁之邪自能外达，声音亦自复。诸症皆除。
**Lung Abscess 2 (Lobar Pneumonia)**
Patient Yao, Female, 56 years old.
**First Visit:**
Fever for 7 to 8 days, body temperature 38.3°C, cough, headache, red throat, difficult expectoration of sputum. Previously took antitussive syrup, compound licorice mixture, benproperine, and pipalusi, but the cough did not subside and fever persisted. This morning, cough was accompanied by chest pain, with expectoration of several mouthfuls of purulent blood, which was foul-smelling and sticky. Subsequently, blood appeared in the sputum, and there was pain in the chest and hypochondrium. The tongue coating is yellow and greasy, the tongue body is red and dry. Both pulses are wiry, slippery, and rapid. Stool is slightly dry, urine is scanty and yellow. There is mental restlessness and thirst. This is Wind-Warmth accumulating heat, obstructing the Lung, leading to Lung Abscess. Treatment should use a modified method of *Qianjin Weijing Tang* (Thousand Gold Reed Shoot Decoction).
Prescription: Fresh Reed Rhizome Stem (*Reed Rhizoma*) 60g, Winter Melon Seed (*Benincasae Semen*) 30g, Peach Kernel (*Persicae Semen*) 10g, Bitter Platycodon Root (*Platycodonis Radix*) 10g, Coix Seed (*Coicis Semen*) 25g, Raw Licorice Root (*Glycyrrhizae Radix et Rhizoma*) 10g, Sweet Descurainia Seed (*Descurainiae Semen*) 3g, Xi Huang Wan (Calculus Bovis Pill) 6g (taken in two doses with decoction liquid), total 2 doses.
**Second Visit:**
Body heat gradually subsided, body temperature 37.5°C. Cough decreased, and hemoptysis lightened, but sputum still had a foul odor. Pulses were wiry, slippery, and slightly rapid. Chest pain occurred intermittently. Tongue body red, coating greasy, floating yellow, and dry. Lung Abscess is a severe condition. Continue with clearing and purifying to resolve phlegm, removing stasis, and expelling pus.
Prescription: Fresh Reed Rhizome Stem (*Reed Rhizoma*) 60g, Winter Melon Seed (*Benincasae Semen*) 30g, Peucedanum Root (*Peucedani Radix*) 3g, Fritillaria Bulb (*Fritillariae Cirrhosae Bulbus*) 10g, Almond Paste (*Prunus Armeniaca Semen*) 10g, Peach Kernel (*Persicae Semen*) 10g, Coix Seed (*Coicis Semen*) 25g, Bitter Platycodon Root (*Platycodonis Radix*) 10g, Raw Licorice Root (*Glycyrrhizae Radix et Rhizoma*) 6g, Dai Ge San (Indigo and Clam Shell Powder) 12g (wrapped in cloth), Xi Huang Wan (Calculus Bovis Pill) 6g, San Qi Powder (Notoginseng Powder) 1.5g (taken in two doses with decoction liquid), total 3 doses.
**Third Visit:**
After taking the previous prescription for three doses, body heat completely subsided, body temperature 36.9°C. Cough significantly reduced, sputum minimal, no longer foul-smelling or containing blood/pus. Subjective chest pain stopped. Pulses wiry and slippery, rapidness improved. Tongue body red, coating greasy and slightly yellow. Diet and bowel/bladder functions normal. Switch to herbs that invigorate blood, remove stasis, dispel rot, and generate flesh.
Prescription: Fresh Reed Rhizome Stem (*Reed Rhizoma*) 60g, Peach Kernel (*Persicae Semen*) 6g, Madder Root (*Rubiae Radix et Rhizoma*) 10g, Fritillaria Bulb (*Fritillariae Cirrhosae Bulbus*) 6g, Coix Seed (*Coicis Semen*) 25g, Red and White Paeonia Roots (*Paeoniae Radix Rubra* and *Paeoniae Radix Alba*) 18g each, North Glehnia Root (*Glehniae Radix*) 25g, Xi Huang Wan (Calculus Bovis Pill) 6g, San Qi Powder (Notoginseng Powder) 1.5g (taken in two doses with decoction liquid), total 3 doses.
**Fourth Visit:**
Body heat subsided, cough stopped, no more purulent bloody foul sputum, chest pain ceased. Tongue and pulse normal. Condition trending towards recovery. Recommend using mild methods to harmonize Spleen and Stomach for aftercare. Do not abruptly use warming tonics to prevent relapse ("ashes rekindling"). Avoid spicy and greasy foods.
Prescription: Poria (*Porii Sclerotium*) 10g, North Glehnia Root (*Glehniae Radix*) 18g, Raw Atractylodes Macrocephala Rhizome (*Atractylodis Macrocephalae Rhizoma*) 6g, Honey-fried Licorice Root (*Glycyrrhizae Radix et Rhizoma Preparatum*) 10g, White Hyacinth Bean (*Dolichoris Lablab Semen Album*) 10g, Raw and Cooked Coix Seeds (*Coicis Semen*) 12g each, Winter Melon Peel and Seed (*Benincasae Exocarpium* and *Benincasae Semen*) 15g each, total 5 doses.
**Fifth Visit:**
After medication, all symptoms resolved. Diet and bowel/bladder functions normal. Chest fluoroscopy returned to normal. Pulse soft, tongue clean. Advised two weeks of rest before resuming work.
[Commentary]: Lung Abscess has traditionally been classified under Internal Medicine, but it should actually be treated from the perspective of Warm Diseases. It arises from Wind-Warmth accumulating heat, obstructing the Lung, where heat congestion becomes toxic, forming abscesses and pus. Treatment uses *Qianjin Weijing Tang* with modifications. The use of Xi Huang Wan (Calculus Bovis Pill) is particularly effective, compensating for the insufficient detoxification power of the Reed Shoot Decoction alone.
Treating Lung Abscess requires distinguishing whether pus has formed or not, and whether the abscess has ruptured or not. Generally, treatment is divided into four stages. Master Zhao’s family has four methods, recorded here for reference.
**Early Stage:** Lung Abscess not yet formed, fever with slight aversion to wind/cold, accompanied by cough, asthma/wheezing, profuse slightly yellow sputum, chest pain, thin yellow coating, floating rapid pulse. Treat with acrid-cool resolving, purifying Lung and resolving phlegm. Available formula:
Mint (*Menthae Haplocalycis Herba*) 3g, Peucedanum Root (*Peucedani Radix*) 6g, Fritillaria (*Fritillariae Bulbus*) 12g, Apricot Kernel (*Armeniacae Semen Amarum*) 10g, Perilla Fruit (*Perillae Fructus*) 10g, Scutellaria Root (*Scutellariae Radix*) 10g, Raw Gypsum (*Gypsi Fibrosum*) 12g, Fresh Reed Rhizome and Imperata Rhizome (*Imperatae Rhizoma*) 30g each.
**Middle Stage:** High fever without aversion to cold, cough and wheezing, thick yellow sputum, chest pain, thirst, red tongue with yellow greasy coating, surging rapid pulse. Treat with draining heat and transforming dampness, purifying Lung and eliminating phlegm. Available formula:
Sweet Descurainia Seed (*Descurainiae Semen*) 6g, Peucedanum Root (*Peucedani Radix*) 6g, Scutellaria Root (*Scutellariae Radix*) 10g, Mulberry Root Bark (*Mori Cortex*) 12g, Gleditsia Spine (*Gleditsiae Sinensis Spina*) 6g, Platycodon Root (*Platycodonis Radix*) 10g, Raw Licorice Root (*Glycyrrhizae Radix et Rhizoma*) 6g, Honeysuckle Flower (*Lonicerae Japonicae Flos*) 15g, Fritillaria (*Fritillariae Bulbus*) 10g, Xing Xiao Wan (Awakening消 Pill) 6g (taken in two doses).
**Peak Stage:** High fever, cough/wheezing/chest pain, expectoration of purulent bloody sputum or foul pus, red tongue with yellow greasy coating, surging rapid pulse. Treat with clearing and resolving phlegm-heat, invigorating blood and unblocking collaterals. Available formula:
Fresh Reed Rhizome (*Reed Rhizoma*) 90g, Winter Melon Seed (*Benincasae Semen*) 30g, Peach Kernel (*Persicae Semen*) 6g, Coix Seed (*Coicis Semen*) 30g, Houttuynia Herb (*Houttuyniae Herba*) 30g, Sweet Descurainia Seed (*Descurainiae Semen*) 3g, Scutellaria Root (*Scutellariae Radix*) 10g, Gleditsia Thorn (*Gleditsiae Sinensis Spina*) 3g, Honeysuckle Flower (*Lonicerae Japonicae Flos*) 30g, Xi Huang Wan (Calculus Bovis Pill) 6g (taken in two doses).
**Late Stage:** Residual heat persists, purulent sputum gradually clears, mental fatigue and shortness of breath, thin coating, red and emaciated tongue body, fine wiry slightly rapid pulse. Treat with sweet-cold nourishing Yin, invigorating blood and unblocking collaterals. Available formula:
North and South Glehnia Roots (*Glehniae Radix* and *Bupleuri Radix* - note: text says Nan Bei Sha Shen, usually Glehnia and Adenophora) 30g each, Ophiopogon Tuber (*Ophiopogonis Tuber*) 10g, Zhejiang Fritillaria (*Fritillariae Thunbergii Bulbus*) 10g, Platycodon Root (*Platycodonis Radix*) 10g, Raw Licorice Root (*Glycyrrhizae Radix et Rhizoma*) 6g, Raw Astragalus Root (*Astragali Radix*) 12g, Coix Seed (*Coicis Semen*) 30g, Red Paeonia Root (*Paeoniae Radix Rubra*) 10g, Cortex Lycii (*Lycii Cortex*) 10g, Mulberry Root Bark (*Mori Cortex*) 10g, Moutan Bark (*Paeoniae Radix Rubra*) 10g.
**Cough 1 (Bronchitis)**
Patient Zhong, Male, 2.5 years old.
**First Visit:**
Paroxysmal choking cough, rattling phlegm in the throat, worse at night. Illness started with a cold, lasting half a year without cure. Multiple Chinese and Western medicines taken with poor efficacy. Western antibiotics, antitussives, Chinese medicines like Xia'er Qingfei, Snake Gallbladder Chuanbei, Zhikey Pipa, etc., taken in large quantities. Also took Chinese decoctions for Qi-tonifying and Spleen-strengthening. Recently cough worsened, appetite decreased, complexion dark and dull, fingerprint red, pulse slippery and rapid. This is stagnant heat in the Lung, suppressed by cold-natured medicines, causing Lung loss of dispersing and descending, with Qi rebelling upward causing cough. First use methods to disperse and purify to resolve phlegm. Once Lung Qi disperses and stagnant heat dissipates, cough will stop.
Prescription: Perilla Leaf (*Perillae Folium*) 6g, Peucedanum Root (*Peucedani Radix*) 6g, Cynanchum Root (*Cynanchi Stauntonii Radix*) 6g, Zhejiang Fritillaria (*Fritillariae Thunbergii Bulbus*) 10g, Apricot Kernel (*Prunus Armeniaca Semen*) 10g, Loquat Leaf (*Eriobotryae Folium*) 6g, Imperata Rhizome and Reed Rhizome (*Imperatae Rhizoma* and *Reed Rhizoma*) 10g each, 5 doses.
**Second Visit:**
After taking the above medicine for three doses, cough completely stopped, no more phlegm sound in throat. Continue with the previous prescription, adding Jiao Sanxian (Charred Three Immortals: Hawthorn, Medicated Leaven, Radish Seed) 10g each, to harmonize Stomach Qi. Took another 5 doses, appetite greatly increased, and recovered.
[Commentary]: Pediatric cold-induced cough could heal with one dose, yet it dragged on for half a year. This is likely due to confusion over "inflammation," leading to frequent use of cold-natured agents or abuse of Western antibiotics. Or parents, unaware, allow children to consume cold drinks excessively, suppressing Lung stagnant heat so it cannot disperse, thus causing chronic cough. *Neijing* states: "Cold form and cold drinks injure the Lung." Cough is a Lung disease. Patients with cough should avoid cold stimulation, excessive consumption of cold drinks/foods, and cold-natured medicines. The key to treating cough is dispersion, hence "Dispersing Lung to Stop Cough." This method applies to pathogen-induced cough, not internal injury deficiency cough.
**Cough 2 (Bronchitis)**
Patient Dong, Female, 29 years old.
Autumn dryness pathogen affects the Lung first, causing dry cough without sputum, dry lips, mental restlessness, and slight thirst. Pulse wiry, fine, and slightly rapid; tongue red with little and dry coating. Constitutionally Yin deficient with insufficient fluids. Use method of Clearing Dryness and Saving the Lung.
Prescription: Glehnia Root (*Glehniae Radix*) 10g, Ophiopogon Tuber (*Ophiopogonis Tuber*) 10g, Donkey-hide Gelatin (*Asini Corii Colla*) 10g (melted and mixed separately), Anemarrhena Rhizome (*Anemarrhenae Rhizoma*) 10g, Zhejiang and Sichuan Fritillaria (*Fritillariae Thunbergii Bulbus* and *Fritillariae Cirrhosae Bulbus*) 6g each, Trichosanthes Root (*Trichosanthis Radix*) 10g, Trichosanthes Peel (*Trichosanthis Pericarpium*) 10g, Peucedanum Root (*Peucedani Radix*) 6g, Apricot Kernel (*Prunus Armeniaca Semen*) 10g, Loquat Leaf (*Eriobotryae Folium*) 10g, 7 doses.
After taking the above prescription for 7 doses, dry cough stopped immediately.
[Commentary]: This is Lung Dryness Cough. The general principle is combining moistening dryness with dispersing Lung Qi. Overuse of cooling medicines should be avoided to prevent cold suppression of Qi mechanism, worsening dryness.
**Cough and Asthma (Asthmatic Bronchitis)**
Patient Qi, Male, 47 years old.
**First Visit:**
Cough and asthma for over 10 years, triggered by cold, profuse clear thin sputum, severe cases involve acute asthma unable to lie flat.
Recently triggered by cold exposure, cough and asthma recurred, worse at night. Tongue white, coating greasy and watery/slippery. Pulse deep wiry, tight and rapid upon pressure. Cold-fluid clashing, Qi rebelling upward, causing cough and asthma. Warm and transform cold-fluid to stabilize asthma. Method of *Xiao Qing Long Tang* (Minor Green Dragon Decoction).
Prescription: Ephedra Herb (*Ephedrae Herba*) 6g, Cinnamon Twig (*Cinnamomi Ramulus*) 6g, Pinellia Tuber (*Pinelliae Rhizoma*) 10g, Asarum Root (*Asari Radix et Rhizoma*) 3g, White Peony Root (*Paeoniae Radix Alba*) 10g, Dried Ginger (*Zingiberis Rhizoma Preparatum*) 6g, Honey-fried Licorice Root (*Glycyrrhizae Radix et Rhizoma Preparatum*) 6g, 7 doses.
**Second Visit:**
After medication, cough and asthma gradually decreased, sputum volume reduced. Pulse still deep wiry, tongue white and moist. Continue with previous method, adjusting dosage.
Prescription: Ephedra Herb (*Ephedrae Herba*) 3g, Cinnamon Twig (*Cinnamomi Ramulus*) 6g, Pinellia Tuber (*Pinelliae Rhizoma*) 10g, Asarum Root (*Asari Radix et Rhizoma*) 3g, Dried Ginger (*Zingiberis Rhizoma Preparatum*) 6g, White Peony Root (*Paeoniae Radix Alba*) 10g, Honey-fried Licorice Root (*Glycyrrhizae Radix et Rhizoma Preparatum*) 6g, Apricot Kernel (*Prunus Armeniaca Semen*) 10g, Inula Flower (*Inulae Flos*) 10g, 7 doses.
**Third Visit:**
Two courses of *Xiao Qing Long Tang*, cough and asthma gradually stabilized. Poor appetite, profuse sputum. Deep pulse rising, tongue white and moist. Continue with dispersing Lung and resolving phlegm method.
Prescription: Perilla Leaf (*Perillae Folium*) 10g, Apricot Kernel (*Prunus Armeniaca Semen*) 10g, Zhejiang Fritillaria (*Fritillariae Thunbergii Bulbus*) 10g, Radish Seed (*Raphani Semen*) 10g, White Mustard Seed (*Sinapis Semen*) 6g, Stir-fried Bitter Orange (*Citri Reticulatae Pericarpium Viride*) 6g, Platycodon Root (*Platycodonis Radix*) 10g, Jiao Sanxian (Charred Three Immortals) 10g each, Pinellia Tuber (*Pinelliae Rhizoma*) 10g, Tangerine Peel (*Citri Reticulatae Pericarpium*) 10g, 7 doses.
After medication, cough and asthma stopped, appetite increased. Advised to avoid cold foods, exercise to strengthen constitution, and prevent colds to avoid recurrence.
[Commentary]: Chronic asthmatic bronchitis mainly presents with recurrent cough, asthma, and profuse sputum. Often recurs or worsens due to cold-wind exposure. Its pathology is internal fluid retention and external cold, as stated in *Neijing*: "Cold form and cold drinks injure the Lung; because two colds interact, both interior and exterior are injured, thus Qi rebels upward." Since it is external cold and internal fluid, Zhang Zhongjing's *Xiao Qing Long Tang* should be used to scatter exterior cold and transform internal cold-fluid. Those of this type respond effectively. Do not be confused by the term "inflammation" and use cooling medicines. Also avoid cold foods like cold drinks and raw fruits/vegetables. After recovery, prevent recurrence. Prevention focuses on avoiding colds and avoiding cold foods. Patients should exercise to strengthen constitution and immunity. Medication should focus on strengthening Spleen/Stomach and aiding digestion. When Spleen/Stomach is healthy, phlegm-damp does not generate; when Yuan Qi is solid, external pathogens cannot invade. Thus, this is the fundamental method.
**Hemoptysis (Bronchiectasis)**
Patient Fu, Female, 43 years old.
**First Visit:**
Recurrent cough and asthma, profuse sputum in the morning, blood in sputum. Disease duration 10 years. Diagnosed as Bronchiectasis at a hospital. For the past month, continuous cough, dyspnea on exertion, expectoration of large amounts of white sputum with blood, sometimes vomiting mouthfuls of fresh blood. Pulse wiry, slippery, rapid; Right Cun pulse large, empty upon pressing. Tongue red, coating white floating yellow. Heat stagnant in Lung, collateral vessels injured. Purify and descend Lung Qi to stop cough, cool blood and clear Ying level to stop bleeding.
Prescription: Inula Flower (*Inulae Flos*) 10g, Loquat Leaf (*Eriobotryae Folium*) 10g, Apricot Kernel (*Prunus Armeniaca Semen*) 10g, Zhejiang Fritillaria (*Fritillariae Thunbergii Bulbus*) 10g, Sichuan Fritillaria (*Fritillariae Cirrhosae Bulbus*) 10g, Peucedanum Root (*Peucedani Radix*) 6g, Stemona Root (*Stemonae Radix*) 6g, Madder Root (*Rubiae Radix et Rhizoma*) 10g, Small Thistle Root (*Cirsii Japonici Radix*) 10g, Imperata Rhizome and Reed Rhizome (*Imperatae Rhizoma* and *Reed Rhizoma*) 10g each, Dai Ge San (Indigo and Clam Shell Powder) 6g (wrapped), 7 doses.
**Second Visit:**
After medication, cough decreased, hematemesis/hemoptysis did not stop, sputum still profuse. Continue with purifying/descending and resolving phlegm method, combined with stopping bleeding.
Prescription: Inula Flower (*Inulae Flos*) 10g, Loquat Leaf (*Eriobotryae Folium*) 10g, Apricot Kernel (*Prunus Armeniaca Semen*) 10g, Zhejiang and Sichuan Fritillaria (*Fritillariae Thunbergii Bulbus* and *Fritillariae Cirrhosae Bulbus*) 10g each, Mulberry Root Bark (*Mori Cortex*) 10g, Cortex Lycii (*Lycii Cortex*) 10g, Madder Root (*Rubiae Radix et Rhizoma*) 10g, Smilax Glabra Rhizome (*Smilacis Glabrae Rhizoma*) 10g, Small Thistle Root (*Cirsii Japonici Radix*) 10g, Dai Ge San (Indigo and Clam Shell Powder) 6g (wrapped), Imperata Rhizome and Reed Rhizome (*Imperatae Rhizoma* and *Reed Rhizoma*) 10g each, San Qi Powder (Notoginseng Powder) 3g (mixed separately), 7 doses.
**Third Visit:**
Hemoptysis decreased but did not fully stop, cough intermittent, sputum white, tongue red coating white, pulse rapid and deficient. Trend of Qi-Fire flaming upward gradually flattened. Continue with previous method adjustments.
Prescription: Inula Flower (*Inulae Flos*) 10g, Loquat Leaf (*Eriobotryae Folium*) 10g, Apricot Kernel (*Prunus Armeniaca Semen*) 10g, Sichuan and Zhejiang Fritillaria (*Fritillariae Cirrhosae Bulbus* and *Fritillariae Thunbergii Bulbus*) 10g each, Mulberry Root Bark (*Mori Cortex*) 10g, Cortex Lycii (*Lycii Cortex*) 10g, Madder Root (*Rubiae Radix et Rhizoma*) 10g, Small Thistle Root (*Cirsii Japonici Radix*) 10g, Imperata Rhizome and Reed Rhizome (*Imperatae Rhizoma* and *Reed Rhizoma*) 10g each, Jiao Sanxian (Charred Three Immortals) 10g each, San Qi Powder (Notoginseng Powder) 3g (mixed separately).
**Fourth Visit:**
Hemoptysis stopped. Continue with purifying Lung method.
Prescription: Apricot Kernel (*Prunus Armeniaca Semen*) 10g, Loquat Leaf (*Eriobotryae Folium*) 10g, Sichuan and Zhejiang Fritillaria (*Fritillariae Cirrhosae Bulbus* and *Fritillariae Thunbergii Bulbus*) 10g each, Small Thistle Root (*Cirsii Japonici Radix*) 10g, Imperata Rhizome and Reed Rhizome (*Imperatae Rhizoma* and *Reed Rhizoma*) 10g each, Stemona Root (*Stemonae Radix*) 10g, Jiao Sanxian (Charred Three Immortals) 10g each, Chinese Yam (*Dioscoreae Rhizoma*) 10g, Fragrant Rice Sprout (*Oryzae Sativa Germen*) 10g, 7 doses.
After medication, all symptoms resolved, appetite increased. Advised careful daily routine, more exercise, strengthen constitution to prevent recurrence.
[Commentary]: Miao Zhongchun’s Three Essentials for Treating Hematemesis state: "Prefer descending Qi over clearing Fire; prefer moving Blood over stopping Bleeding; prefer tonifying Liver over attacking Liver." Master Zhao’s treatment in this case focuses on dispersing Lung, descending Qi, stopping cough, and resolving phlegm, combined with cooling blood, removing stasis, and stopping bleeding. The prescription seems plain but is highly effective.
**Loss of Voice 1 (Vocal Cord Polyps)**
Patient Gao, Male, 10 years old, Student. First visit April 26, 1992. Patient often suffered sore throat. On Jan 30, 1992, after bingeing on cold drinks, suddenly developed hoarseness, progressing to aphonia. Hospital treatment with large amounts of antibiotics, Houzheng Wan, Liushen Wan, etc., was ineffective. Laryngoscopy diagnosed "Vocal Cord Polyps." Currently, besides aphonia, accompanied by mental restlessness/irritability, restless sleep, cough with white sputum, poor diet, yellow-red urine, slightly dry stool. Tongue red, coating white greasy and slippery. Pulse floating, slippery, and rapid, slightly fine upon deep pressure. Examination: Red throat, enlarged tonsils bilaterally, Heart/Lungs (-), WBC 8×10^9/L. Syndrome belongs to Internal Heat Accumulation and Depression, External Cold Attack. Treat with dispersing Lung, regulating transformation, clearing heat, and benefiting throat. Prescription: Perilla Leaf (*Perillae Folium*) 10g, Peucedanum Root (*Peucedani Radix*) 6g, Zhejiang Fritillaria (*Fritillariae Thunbergii Bulbus*) 10g, Imperata Rhizome and Reed Rhizome (*Imperatae Rhizoma* and *Reed Rhizoma*) 10g each, Apricot Kernel (*Prunus Armeniaca Semen*) 10g, Loquat Leaf (*Eriobotryae Folium*) 10g, Trichosanthes Fruit (*Trichosanthis Fructus*) 10g, Jiao Sanxian (Charred Three Immortals) 10g each, Polygonum Multiflorum Vine Fruit (*Polygoni Multiflori Caulis Fructus*) 10g, 7 doses, decocted in water.
**Second Visit:**
After 3 doses, hoarseness began improving, able to speak. After finishing 7 doses, voice returned to normal. Diet and bowel/bladder normal, other symptoms reduced. Continue with previous prescription 7 doses to consolidate efficacy. Diet must be cautious.
[Commentary]: This patient had pre-existing stagnant heat, exacerbated by bingeing on cold drinks, forming Cold wrapping Heat, congesting Lung Metal, causing Lung loss of dispersing/purifying, resulting in hoarseness or aphonia. Further use of large antibiotics and cold Houzheng Wan/Liushen Wan led to cold suppression of pathogens, increasing stagnation. Pathogens had no exit, causing chronic aphonia. Thus, Old Zhao used Perilla Leaf to open/disburse Lung Qi and scatter Wind-Cold; Peucedanum to disperse Lung stagnant heat; Zhejiang Fritillaria, Loquat Leaf, and Trichosanthes to clear Lung heat, stop cough, resolve phlegm, and dissipate nodules; Imperata and Reed Rhizomes to clear heat, disperse Lung, benefit throat, and moisten lungs; Apricot Kernel and Perilla Leaf to disperse Lung, resolve phlegm, and smooth Qi mechanism; Jiao Sanxian and Polygonum Fruit to remove Middle Jiao Spleen/Stomach stagnation. Combined, these herbs disperse Lung Qi, scatter external cold, clear stagnant heat, smooth Qi mechanism, benefit throat, and restore voice.
**Loss of Voice 2 (Hysterical Aphonia)**
Patient Zhang, Female, 38 years old, Farmer. First visit November 28, 1988. One month prior, after an argument with a neighbor, woke up the next morning with aphonia, unable to produce sound. Hospital diagnosis: "Hysterical Aphonia." Treatment with Western medicine, Chinese medicine, acupuncture, suggestion, etc., was ineffective. Current symptoms: Mental restlessness/irritability, restless sleep, poor appetite, dizziness, chest/hypochondriac distension/pain, dry stool, tongue red with prickles, coating white and dry, pulse wiry, slippery, and rapid. Syndrome belongs to Liver Channel Stagnant Heat, Qi mechanism obstruction. Treat with smoothing Qi mechanism and clearing/draining Liver Channel stagnant heat. Diet should be light. Prescription: Cicada Slough (*Cicadae Periostracum*) 6g, Silkworm (*Bombyx Batryticatus*) 10g, Turmeric Tuber (*Curcumae Longae Rhizoma*) 6g, Rhubarb (*Rhei Radix et Rhizoma*) 1g, Bupleurum Root (*Bupleuri Radix*) 6g, Scutellaria Root (*Scutellariae Radix*) 6g, Toosendan Fruit (*Toosendan Fructus*) 6g, Perilla Leaf and Stem (*Perillae Folium* and *Perillae Caulis*) 6g each, Imperata Rhizome and Reed Rhizome (*Imperatae Rhizoma* and *Reed Rhizoma*) 10g each, Jiao Sanxian (Charred Three Immortals) 10g each, Polygonum Multiflorum Vine Fruit (*Polygoni Multiflori Caulis Fructus*) 10g, 5 doses, decocted in water.
**Second Visit:**
According to husband's report, patient eager for quick recovery, took two doses on Day 1. Yesterday had diarrhea 5-6 times, feces extremely foul-smelling, sleep relatively peaceful. Day 2 morning, produced cough sound and could speak. After finishing 5 doses, voice completely normalized, other symptoms removed. Continue with above prescription 7 doses to consolidate effect.
[Commentary]: This patient had pre-existing Liver Channel stagnant heat, aggravated by argument causing Liver Qi stagnation, Qi mechanism blockage, abnormal ascending/descending, mixing of clear/turbid, leading to aphonia. Old Zhao used Sheng Jiang San (Ascending and Descending Powder) with modifications to ascend clear and descend turbid, disperse stagnation, and regulate body Qi mechanism. In the formula, Cicada Slough disperses stagnant heat pathogens; Turmeric moves Qi and scatters stagnation; Silkworm is light/floating, raises Yang, clears heat, resolves depression, transforms phlegm, dissipates nodules; Rhubarb attacks accumulation and guides stagnation out. Paired with Bupleurum, Scutellaria, Toosendan, and Perilla Stem to soothe/regulate Qi mechanism and clear Liver stagnant heat; Imperata/Reed Rhizomes and Perilla Leaf to disperse Lung and benefit throat; Jiao Sanxian and Polygonum Fruit to strengthen Spleen and harmonize Stomach. Combined, these herbs smooth San Jiao Qi mechanism, allowing internal stagnant pathogens to reach exterior, restoring voice. All symptoms removed.