中医临证经验与方法
朱进忠 于山西省中医药研究院 2002年4月
第一章 症
第一节内科
咳嗽遗尿
咳嗽遗尿在《素问》中早有记载。它说：“肾咳不已，则膀胱受之，膀胱咳状，咳而遗溺。”沈金鳌、林佩琴等都主张用茯苓甘草汤，但余屡用未见其效。通过观察发现本病多见于年老体弱和产后之妇女，除咳嗽遗尿外，往往兼有头晕乏力，胸满心烦，心悸气短，脉弦滑无力等症，而无“咳则腰背相引而痛，甚则咳涎”之肾咳证。偶读方隅所著《医林绳墨》小便不禁条，云：“妇人咳嗽而溺出者，宜生脉散加归、术、柴、黄芩。”才始有所悟。再细读《素问》：“久咳不已，则三焦受之，三焦咳状，咳而腹满，不欲食饮，此皆聚于胃，关于肺，使人多涕唾而面浮肿气逆也。”“少阳属肾，肾上连肺，故将两脏，三焦者，中渎之府也，水道出焉，属膀胱，是孤之府也”句，才使我茅塞顿开。乃拟：柴胡9克，当归9克，白芍9克，麦冬9克，党参9克，五味子9克，半夏9克，陈皮9克，青皮9克，紫菀9克，黄芩9克，方一首，作为心肺不足，三焦气滞，郁而化火的方剂，试用于临床常效如桴鼓。例如：郑××，女，30岁。产后两个月来，咳嗽遗尿，久用中、西药物治疗无效。审其脉证，见其面色皓白，言语无力，心悸气短，胸满心烦，口干，脉虚而弦滑。综其脉证，诊为心肺不足，三焦气滞，郁而化火，予上方2剂症减，6剂愈。久而久之，虽见效者甚多，然无效者亦不少。例如：唐××，男，64岁。前医屡用上方无效，询治于余。审其脉证，除咳而遗尿外，肺与三焦之证不见，面色微黑，腰酸背痛，小腹憋胀，排尿不畅，时而尿热尿痛，舌苔薄白，脉弦涩不调，尺脉反较寸脉为大。反复思考，正如《素问》所述之肾咳，乃拟八味地黄丸加五味子、车前子、怀牛膝以培补肾气，果然2剂症减，1O剂愈。
矽肺
矽肺是现代医学的病名，中医古典著作中还未见到明确的记载，因其具有明显的气短，喘和胸满，所以近人有的认为相当于中医的肺胀，有的认为相当于中医的喘或短气。治疗上往往拘于景岳“气喘之病最为危候，人欲辨之者，亦为二证而已。所谓二证者，一曰实喘，一曰虚喘也。”“此其一为真喘，一为似喘；真喘者，其责在肺，似喘者，其责在肾，何也?盖肺为气之主，肾为气之根，肺主皮毛而主上焦，故邪气犯之则上焦气壅而喘，气之壅滞者宜清宜破也；肾主精髓而在下焦，若真阴亏损，精不化气则下不上交而为促，促者断之基也，气既短促而再加清散如压卵矣”之论，不审五脏的升降和生克制化之理，所以往往治肺不效而求肾，治肾无功而又求于肺，单治不可则同治肺肾，若再无效，即怨古人。不知《素问·天元纪大论》早就说过：“五运阴阳者，天地之道也，万物之纲纪，变化之父母，生杀之本始，神明之府也。”短气或喘虽然重在肺肾，但五脏阴阳升降，生克制化，并不仅仅限在肺肾两脏，所以单单求肺求肾往往无功。例如：张××，男，成。二期矽肺4年，前以补肾纳气，宣肺定喘，化痰止咳等中药及西药治疗不但不见好转，反而胸满胸痛，气短咳喘更加严重，头晕头痛，心烦心悸，手足憋胀，诊其脉沉而涩，口唇及舌均稍紫暗。乃肝肺气郁，升降失常，痰滞血瘀，木火刑金之候也，拟疏肝理气，化痰降气，活血软坚之剂：柴胡、枳壳、赤芍、桔梗、杏仁、陈皮、青皮、苏叶、甘草、黄芩各9克，瓜蒌15克，苏木6克。服药3剂，诸证好转。连服三月诸证均平。
李东垣、黄元御等在说明脾胃作用的重要性时，又同时大力倡导了脏气升降之理。李东垣说：“脏气法时升降浮沉……肝肺之病，在水火之间，顺逆传变不同，温凉不定，当求责耳。”黄元御说：“厥阴能生，则阳气左升而木荣，其风盛者，生气之不遂；少阳能长，则君火显达而上清，其热盛者，长气之不旺也；阳明能收，则阴气右降而金肃，其燥盛者，收令之失政也；太阳能藏，则相火闭蛰而下暖，其寒盛者，脏气之不行也。”又说：“风木者，五脏之贼，百病之长，凡病之起，无不因于木气之郁，以肝木主升，而人之生气不足者，十当八九。木气抑郁而不升，是以病也。木为水火之中气，病则土木郁逆，水火不交，外燥而内湿，下寒而上热。”本病胸满胸痛，气短而喘，心烦心悸，食欲不振，正为肝肺气郁，中气盘塞，肺金不降，湿痰内盛，血络瘀结影响升降所致，故以升清阳，降浊阴，化痰热，通络脉而证解。
喘
临床过程中，经常遇见一些慢性支气管炎合并感染和支气管哮喘的咳喘，久治无效。综其大要大致有：
1．表邪为主不先解表，仅与宣肺定喘
例如：患者赵X×，女，成。咳喘三个多月持续不止。某院诊为喘息性支气管炎合并感染，子抗生素，氨茶碱等治疗一个多月无效，转请中医治疗两个多月仍无效。又邀余治，遍试定喘汤、小青龙汤等20余剂仍无功。余思良久，难于措手，求教于恩师李翰卿先生。云：患者阵阵恶寒，身痛鼻塞，乃表寒之证，表寒者应先解表，而诸医均以化痰定喘治之，致表邪不解，肺气闭郁，喘咳不减，又病已将三月余，表气已虚，非麻黄发散所能治，因麻黄汤发汗较剧，过汗必损表阳，卫阳虚则易受外邪之复客，而喘咳难愈，故治宜桂枝加厚朴杏子汤调和营卫，宣肺定喘。方用：桂枝10克，白芍10克，炙甘草6克，生姜4片，大枣5枚，厚朴10克，杏仁10克。服药2剂，喘咳果减，继服10剂诸证消失而安。
2．气逆作喘反用升浮之药
例如：患者耿××，男，成。喘咳不止两个多月，某院诊为慢性支气管炎合并感染，住院治疗一个多月无效，又转请中医，先用定喘汤加地龙，继用小青龙汤，射干麻黄汤等加减仍无功。细审其证，喘咳不能平卧，痰涎壅盛，咽喉不利，头汗较多，脉滑，寸盛尺弱。思之，正与苏子降气汤证合拍，但又考虑麻黄乃喘家圣药，恐仅用苏子降气汤无功，乃处苏子降气汤加麻黄治之。服药2剂未见寸效，求教于恩师李翰卿先生。云：“证属苏子降气汤证无疑，用之固然应该有效，但却用之无效，关键在于麻黄一味。麻黄虽为喘家圣药，但其性宣散升浮，本病痰浊壅盛，气逆作喘，非降气化痰纳气归肾不能解，若再加入麻黄之升散，必使病势上冲，而喘咳加剧，因此应去麻黄。”余宗其意，去麻黄，仅服2剂喘咳即减，继服10剂而暂时缓解。
3．脾胃虚寒，斡旋不能者，反治肺肾
例如：患者李××，女，30岁。支气管哮喘5年，遇夏必发，冬季反减，近两年来冬夏俱喘，走路气短。前医始予定喘汤、小青龙汤无效。转请余诊，余诊其脉弦大，治以黄芪鳖甲散去鳖甲、秦艽、天冬、桔梗、桑皮，加麦冬。7剂药后喘咳大减，但继服则无效，并见齿衄、鼻衄、泄泻。再审其证，亦认为上方正确，予上方20剂，药后气短咳喘加剧，衄血同前，按其手足均厥冷，舌质淡暗，脉弦紧。反复思考，衄虽火证为多，然虚寒者亦有之，且十几天来胃脘满痛，食欲不振。乃云：脾胃虚寒为本，痰饮蕴郁为标，因拟附桂理中合二陈汤方4剂，药后非但衄血全止，亦且喘咳渐平。
4.肾不纳气者，反用麻黄之升宣
例如：患者李××，女，成。喘咳短气10个多月，某院诊为慢性支气管炎合并感染、肺气肿。住院治疗8个多月无效，出院后求治于中医，1个多月仍无功。审视其证：喘而短气，面赤足冷，上半身烦热，时时汗出，脉寸大尺微。思之，证脉相参，乃肾气虚衰，虚阳上浮，纳气失职所致，欲以金匮肾气丸治之。又思之，麻黄乃定喘要药，地龙为解痉定喘之良药。乃在金匮肾气丸方中加入麻黄、地龙。服药2剂非但无功，反有加重之势。再思之，金匮肾气丸滋阴温阳，纳气归肾，实属合拍，而麻黄宣肺升浮，地龙通络脉疏内风，于病为逆，应去之。处方：熟地24克，山药12克，补骨脂10克，茯苓10克，泽泻10克，丹皮10克，附子10克，肉桂10克，五味子10克，车前子10克(布包)，仅服1剂，喘咳、短气即减，继服10剂而大安。
5．心肾阳虚，水饮内停，上凌心肺者，反用宣肺化痰以伤正气
例如：患者李××，女，成。支气管哮喘反复发作数十年，一年前因感冒而咳喘加重，某院诊为支气管哮喘合并感染，前后住院治疗7个多月不见好转，后又配合中药射干麻黄汤、定喘汤、苏子降气汤、小青龙汤加减等治疗8个多月亦无功。审视其证。除喘咳短气不能平卧外，并见骨瘦如柴，饮食俱废，畏寒肢厥，足冷至膝，手冷至肘，口干不欲饮，舌淡而苔白，脉沉细促无力。反复思考，证脉合参，诊为心肾阳虚，邪水上泛，上凌心肺所致。而前医所用诸方均以实治，故难奏功。乃拟真武汤原方1剂。其后某医拿方视之，云：“病重药轻，又无麻黄之定喘，不可服。”即刻在该方中加入了麻黄1剂服，结果服药4剂，效果罔然，又邀余诊。余云：“正虚之躯，过用克伐之品，已成正虚邪实之重证，麻黄发散之力虽微，而伤正气却有力，应减去麻黄，加人参、杏仁，正气稍复，痰饮可减。”处方：人参6克，杏仁6克，附子6克，白芍6克，茯苓6克，白术6克，生姜1片。药进2剂，咳喘稍减，继服20剂喘咳停止而出院。
6．中焦气滞，应予调理脾胃，反用肺药
例如：患者李××，男，成。喘咳不止，食后加重三个多月，频用中、西药物治之不效。审视前医之方，大都为定喘汤、小青龙汤、射干麻黄汤、生脉散加减。再察其证，虽喘而不能乎卧，但喘声不剧，腹满腹胀，脉弦紧。思考良久，乃云：“痰湿中阻，轮轴失转。经云：五脏六腑皆令人咳，非独肺也，此喘咳之机与此理相似耳。景岳虽有初喘治肺，久喘治肾之论，但不可一概而论。治宜平胃、二陈加减除痰湿，理脾胃，使轮轴恢复斡旋之机，肺气自降，肾气自纳。”处方：半夏10克，陈皮10克，苏叶6克，杏仁10克，厚朴10克，茯苓10克，神曲10克。服药2剂，咳喘稍减，继进20剂喘咳渐平。
7．肝郁者，不去理肝，反予治肺
例如：患者张××，女，成。哮喘反复发作数十年，8个月前咳喘又作，在某院住院治疗半年无效，出院后，配合中药宣肺定喘，降气化痰，纳气归肾等方百剂仍无效。细审其证，喘而短气，频频咳嗽，头晕目眩，心烦心悸，胸胁窜痛，经期尤甚，夜间口干，或口苦，纳呆，再询其病之始，月经期间生气后加重，舌苔白，边有瘀斑，脉虚弦滑。余思良久，诊为心肺俱虚，痰饮内聚，肝木失达，木火凌金之候。为拟益气养阴，疏肝化痰，咳嗽遗尿方加减：柴胡10克，当归10克，白芍10克，半夏10克，陈皮10克，青皮10克，紫菀10克，麦冬10克，党参10克，五味子10克，黄芩10克。药进3剂，喘咳果减，继进40剂而喘平。
8．阴虚燥痰者，反用温燥去痰例如：患者苏××，女，成。夏季喘咳发作数十年，今年入夏以来咳喘尤剧，频频应用中、西药物三个多月无效。细审前医所用诸方不外定喘汤、麻杏石甘汤、小青龙汤、射干麻黄汤等加减而成，舌苔薄白，脉弦滑。沉思良久，云：“夏季阳气在外，肺主皮毛，主上焦，故里寒而肺热；冬季阳气人里，故肺寒而里热，阴虚燥痰，人夏必甚，故夏季喘而冬季瘥，此时若以温燥伤阴，燥火更甚，痰热尤增，故治宜养阴润燥化痰。处方：百合15克，麦冬15克，冬虫夏草15克，淡菜10克，药进2剂，咳喘即减，继进10剂喘咳停止。
9．气阴两虚，痰饮阻滞者，不去扶正，但予祛邪
例如：患者徐××，女，78岁。慢性支气管炎19年，气胸手术后一年来经常气短。近两个月来咳喘气短更加严重。某院诊为肺气肿，慢性支气管炎合并感染，住院两个多月，中、西药物频频用之，不但无效，反而日渐加重。纳呆神疲，时见神志朦胧，呼之迟迟始应，心悸怔忡，自汗盗汗，舌质紫暗，光剥无苔，脉虚大而数。审视再三，诊为气阴俱虚，痰郁气结，寒热相夹之重证。为拟益气养阴，化痰理气。黄芪鳖甲散加减：黄芪15克，人参10克，地骨皮10克，紫菀10克，茯苓10克，柴胡10克，半夏10克，知母10克，生地10克，白芍10克，麦冬10克，肉桂10克，甘草6克。服药1剂，喘咳即减，精神好转，继服10剂喘咳大减。
小腹冷
中医临证经验与方法
朱进忠 著于山西省中医药研究院 2002年4月
第一章 症状
第一节 内科疾病
咳嗽伴遗尿
咳嗽伴遗尿在《黄帝内经·素问》中早有记载。书中说：“肾咳日久不愈，病邪传至膀胱，表现为膀胱咳的症状，即咳嗽时小便失禁。”沈金鳌、林佩琴等医家主张使用茯苓甘草汤治疗，但我多次使用未见疗效。通过临床观察发现，本病多见于年老体弱及产后妇女，除咳嗽遗尿外，常伴有头晕乏力、胸闷心烦、心悸气短、脉象弦滑而无力等症状，而没有“咳嗽时腰背相互牵引疼痛，严重时咳出涎沫”的肾咳证候。偶然读到方隅所著的《医林绳墨》中关于小便不禁的条目，其中提到：“妇人咳嗽而小便流出者，适宜用生脉散（Shengmai San, Pulse-Generating Powder）加当归、白术、柴胡、黄芩。”这才使我有所领悟。再细读《素问》中的论述：“久咳不愈，病邪传至三焦，表现为三焦咳的症状，咳嗽时腹部胀满，不想饮食，这都是病邪聚集于胃，关联于肺，使人多涕唾且面部浮肿、气逆上冲。”以及“少阳经隶属于肾，肾向上连接肺，所以能统摄这两脏；三焦是中渎之府，水道由此而出，隶属于膀胱，是独立的府。”这些论述才让我茅塞顿开。于是拟定以下方剂：柴胡9克，当归9克，白芍9克，麦冬9克，党参9克，五味子9克，半夏9克，陈皮9克，青皮9克，紫菀9克，黄芩9克，组成一方，作为治疗心肺不足、三焦气滞、郁而化火的方剂，在临床上试用往往效如桴鼓（形容疗效迅速显著）。例如：郑某某，女，30岁。产后两个月来，出现咳嗽遗尿，长期服用中西药物治疗无效。诊察其脉证，见其面色苍白，言语无力，心悸气短，胸闷心烦，口干，脉虚而弦滑。综合其脉证，诊断为心肺不足，三焦气滞，郁而化火，给予上方2剂后症状减轻，6剂后痊愈。久而久之，虽然见效者甚多，但无效者也不少。例如：唐某某，男，64岁。前医多次使用上方无效，前来求治于我。诊察其脉证，除咳嗽遗尿外，没有肺与三焦的证候表现，面色微黑，腰酸背痛，小腹憋胀，排尿不畅，时而尿热尿痛，舌苔薄白，脉象弦涩不调，尺脉反而比寸脉大。反复思考，这正如《素问》所述的肾咳，于是拟定八味地黄丸（Ba Wei Di Huang Wan, Eight-Ingredient Rehmannia Pill）加五味子、车前子、怀牛膝以培补肾气，果然2剂后症状减轻，10剂后痊愈。
矽肺是现代医学的病名，中医古典著作中还未见到明确的记载。因其具有明显的气短、喘促和胸满症状，所以近人有的认为相当于中医的肺胀（Feizhang, Lung Distension），有的认为相当于中医的喘（Chuan, Panting）或短气（Duanqi, Shortness of Breath）。在治疗上，往往拘泥于张景岳“气喘之病最为危候，人欲辨之者，亦为二证而已。所谓二证者，一曰实喘，一曰虚喘也。”“此其一为真喘，一为似喘；真喘者，其责在肺，似喘者，其责在肾，何也?盖肺为气之主，肾为气之根，肺主皮毛而主上焦，故邪气犯之则上焦气壅而喘，气之壅滞者宜清宜破也；肾主精髓而在下焦，若真阴亏损，精不化气则下不上交而为促，促者断之基也，气既短促而再加清散如压卵矣”的论点。由于不审察五脏的升降规律和五行生克制化的道理，所以往往治肺不效而求治于肾，治肾无功而又求治于肺，单治无效则同治肺肾，若再无效，便埋怨古人。殊不知《素问·天元纪大论》早就说过：“五运阴阳者，天地之道也，万物之纲纪，变化之父母，生杀之本始，神明之府也。”短气或喘虽然重在肺肾，但五脏阴阳的升降、生克制化，并不仅仅局限于肺肾两脏，所以单单求治于肺或肾往往无功。例如：张某某，男，成年。二期矽肺4年，此前以补肾纳气、宣肺定喘、化痰止咳等中药及西药治疗，不但不见好转，反而胸满胸痛，气短咳喘更加严重，头晕头痛，心烦心悸，手足憋胀，诊其脉沉而涩，口唇及舌均稍紫暗。这是肝肺气郁，升降失常，痰滞血瘀，木火刑金（Wood Fire Punishing Metal, Liver Fire Injuring Lung）的证候。于是拟定疏肝理气、化痰降气、活血软坚的方剂：柴胡、枳壳、赤芍、桔梗、杏仁、陈皮、青皮、苏叶、甘草、黄芩各9克，瓜蒌15克，苏木6克。服药3剂，诸证好转。连服三月，诸证均平。
李东垣、黄元御等在说明脾胃作用的重要性时，又同时大力倡导了脏气升降的理论。李东垣说：“脏气法时升降浮沉……肝肺之病，在水火之间，顺逆传变不同，温凉不定，当求责耳。”黄元御说：“厥阴能生，则阳气左升而木荣，其风盛者，生气之不遂；少阳能长，则君火显达而上清，其热盛者，长气之不旺也；阳明能收，则阴气右降而金肃，其燥盛者，收令之失政也；太阳能藏，则相火闭蛰而下暖，其寒盛者，脏气之不行也。”又说：“风木者，五脏之贼，百病之长，凡病之起，无不因于木气之郁，以肝木主升，而人之生气不足者，十当八九。木气抑郁而不升，是以病也。木为水火之中气，病则土木郁逆，水火不交，外燥而内湿，下寒而上热。”本病胸满胸痛，气短而喘，心烦心悸，食欲不振，正是肝肺气郁，中气盘塞，肺金不降，湿痰内盛，血络瘀结影响升降所致，故以升清阳，降浊阴，化痰热，通络脉而证解。
喘证
临床过程中，经常遇见一些慢性支气管炎合并感染和支气管哮喘的咳喘，久治无效。综其大要大致有以下几种情况：
1．表邪为主，不先解表，仅予宣肺定喘
例如：患者赵某某，女，成年。咳喘三个多月持续不止。某医院诊为喘息性支气管炎合并感染，给予抗生素、氨茶碱等治疗一个多月无效，转请中医治疗两个多月仍无效。又邀我诊治，遍试定喘汤（Dingchuan Tang, Asthma-Stopping Decoction）、小青龙汤（Xiao Qinglong Tang, Minor Blue Dragon Decoction）等20余剂仍无功。我思虑良久，难于措手，求教于恩师李翰卿先生。老师说：患者阵阵恶寒，身痛鼻塞，乃表寒之证，表寒者应先解表，而诸医均以化痰定喘治之，致表邪不解，肺气闭郁，喘咳不减，又病已将三月余，表气已虚，非麻黄发散所能治，因麻黄汤发汗较剧，过汗必损表阳，卫阳虚则易受外邪之复客，而喘咳难愈，故治宜桂枝加厚朴杏子汤（Guizhi Jia Houpo Xingzi Tang, Cinnamon Twig Decoction with Magnolia Bark and Apricot Seed）调和营卫，宣肺定喘。方用：桂枝10克，白芍10克，炙甘草6克，生姜4片，大枣5枚，厚朴10克，杏仁10克。服药2剂，喘咳果减，继服10剂诸证消失而安。
2．气逆作喘，反用升浮之药
例如：患者耿某某，男，成年。喘咳不止两个多月，某医院诊为慢性支气管炎合并感染，住院治疗一个多月无效，又转请中医，先用定喘汤加地龙，继用小青龙汤、射干麻黄汤（Shegan Mahuang Tang, Belamcanda and Ephedra Decoction）等加减仍无功。细审其证，喘咳不能平卧，痰涎壅盛，咽喉不利，头汗较多，脉滑，寸盛尺弱。思之，正与苏子降气汤（Suzi Jiangqi Tang, Pericarpium Fructus Sojae Decoction for Descending Qi）证合拍，但又考虑麻黄乃喘家圣药，恐仅用苏子降气汤无功，乃处苏子降气汤加麻黄治之。服药2剂未见寸效，求教于恩师李翰卿先生。老师说：“证属苏子降气汤证无疑，用之固然应该有效，但却用之无效，关键在于麻黄一味。麻黄虽为喘家圣药，但其性宣散升浮，本病痰浊壅盛，气逆作喘，非降气化痰纳气归肾不能解，若再加入麻黄之升散，必使病势上冲，而喘咳加剧，因此应去麻黄。”我遵循其意，去掉麻黄，仅服2剂喘咳即减，继服10剂而暂时缓解。
3．脾胃虚寒，斡旋不能者，反治肺肾
例如：患者李某某，女，30岁。支气管哮喘5年，遇夏必发，冬季反减，近两年来冬夏俱喘，走路气短。前医始予定喘汤、小青龙汤无效。转请我诊，我诊其脉弦大，治以黄芪鳖甲散（Huangqi Biejia San, Astragalus and Turtle Shell Powder）散去鳖甲、秦艽、天冬、桔梗、桑皮，加麦冬。7剂药后喘咳大减，但继服则无效，并见齿衄、鼻衄、泄泻。再审其证，亦认为上方正确，予上方20剂，药后气短咳喘加剧，衄血同前，按其手足均厥冷，舌质淡暗，脉弦紧。反复思考，衄血虽多为火证，然虚寒者亦有之，且十几天来胃脘满痛，食欲不振。于是云：脾胃虚寒为本，痰饮蕴郁为标，因拟附桂理中汤（Fugui Lizhong Tang, Aconite and Cinnamon Decoction to Regulate the Middle）合二陈汤（Erchen Tang, Two-Aged Phlegm Decoction）方4剂，药后非但衄血全止，亦且喘咳渐平。
4. 肾不纳气者，反用麻黄之升宣
例如：患者李某某，女，成年。喘咳短气10个多月，某医院诊为慢性支气管炎合并感染、肺气肿。住院治疗8个多月无效，出院后求治于中医，1个多月仍无功。审视其证：喘而短气，面赤足冷，上半身烦热，时时汗出，脉寸大尺微。思之，证脉相参，乃肾气虚衰，虚阳上浮，纳气失职所致，欲以金匮肾气丸（Jinkui Shenqi Wan, Kidney-Qi Pill from the Golden Cabinet）治之。又思之，麻黄乃定喘要药，地龙为解痉定喘之良药。乃在金匮肾气丸方中加入麻黄、地龙。服药2剂非但无功，反有加重之势。再思之，金匮肾气丸滋阴温阳，纳气归肾，实属合拍，而麻黄宣肺升浮，地龙通络脉疏内风，于病为逆，应去之。处方：熟地24克，山药12克，补骨脂10克，茯苓10克，泽泻10克，丹皮10克，附子10克，肉桂10克，五味子10克，车前子10克(布包)，仅服1剂，喘咳、短气即减，继服10剂而大安。
5．心肾阳虚，水饮内停，上凌心肺者，反用宣肺化痰以伤正气
例如：患者李某某，女，成年。支气管哮喘反复发作数十年，一年前因感冒而咳喘加重，某医院诊为支气管哮喘合并感染，前后住院治疗7个多月不见好转，后又配合中药射干麻黄汤、定喘汤、苏子降气汤、小青龙汤加减等治疗8个多月亦无功。审视其证。除喘咳短气不能平卧外，并见骨瘦如柴，饮食俱废，畏寒肢厥，足冷至膝，手冷至肘，口干不欲饮，舌淡而苔白，脉沉细促无力。反复思考，证脉合参，诊为心肾阳虚，邪水上泛，上凌心肺所致。而前医所用诸方均以实治，故难奏功。于是拟真武汤原方（Zhenwu Tang, True Warrior Decoction）1剂。其后某医拿方视之，云：“病重药轻，又无麻黄之定喘，不可服。”即刻在该方中加入了麻黄1剂服，结果服药4剂，效果罔然，又邀我诊。我说：“正虚之躯，过用克伐之品，已成正虚邪实之重证，麻黄发散之力虽微，而伤正气却有力，应减去麻黄，加人参、杏仁，正气稍复，痰饮可减。”处方：人参6克，杏仁6克，附子6克，白芍6克，茯苓6克，白术6克，生姜1片。药进2剂，咳喘稍减，继服20剂喘咳停止而出院。
6．中焦气滞，应予调理脾胃，反用肺药
例如：患者李某某，男，成年。喘咳不止，食后加重三个多月，频用中、西药物治之不效。审视前医之方，大都为定喘汤、小青龙汤、射干麻黄汤、生脉散加减。再察其证，虽喘而不能平卧，但喘声不剧，腹满腹胀，脉弦紧。思考良久，于是云：“痰湿中阻，轮轴失转。经云：五脏六腑皆令人咳，非独肺也，此喘咳之机与此理相似耳。景岳虽有初喘治肺，久喘治肾之论，但不可一概而论。治宜平胃、二陈加减除痰湿，理脾胃，使轮轴恢复斡旋之机，肺气自降，肾气自纳。”处方：半夏10克，陈皮10克，苏叶6克，杏仁10克，厚朴10克，茯苓10克，神曲10克。服药2剂，咳喘稍减，继进20剂喘咳渐平。
7．肝郁者，不去理肝，反予治肺
例如：患者张某某，女，成年。哮喘反复发作数十年，8个月前咳喘又作，在某医院住院治疗半年无效，出院后，配合中药宣肺定喘，降气化痰，纳气归肾等方百剂仍无效。细审其证，喘而短气，频频咳嗽，头晕目眩，心烦心悸，胸胁窜痛，经期尤甚，夜间口干，或口苦，纳呆，再询其病之始，月经期间生气后加重，舌苔白，边有瘀斑，脉虚弦滑。我思虑良久，诊为心肺俱虚，痰饮内聚，肝木失达，木火凌金（Wood Fire Oppressing Metal, Liver Fire Injuring Lung）之候。于是拟益气养阴，疏肝化痰，咳嗽遗尿方加减：柴胡10克，当归10克，白芍10克，半夏10克，陈皮10克，青皮10克，紫菀10克，麦冬10克，党参10克，五味子10克，黄芩10克。药进3剂，喘咳果减，继进40剂而喘平。
8．阴虚燥痰者，反用温燥去痰
例如：患者苏某某，女，成年。夏季喘咳发作数十年，今年入夏以来咳喘尤剧，频频应用中、西药物三个多月无效。细审前医所用诸方不外定喘汤、麻杏石甘汤（Mahuang Xinggan Shigan Tang, Ephedra, Apricot Kernel, Gypsum and Licorice Decoction）、小青龙汤、射干麻黄汤等加减而成，舌苔薄白，脉弦滑。沉思良久，云：“夏季阳气在外，肺主皮毛，主上焦，故里寒而肺热；冬季阳气入里，故肺寒而里热，阴虚燥痰，入夏必甚，故夏季喘而冬季瘥，此时若以温燥伤阴，燥火更甚，痰热尤增，故治宜养阴润燥化痰。处方：百合15克，麦冬15克，冬虫夏草15克，淡菜10克，药进2剂，咳喘即减，继进10剂喘咳停止。
9．气阴两虚，痰饮阻滞者，不去扶正，但予祛邪
例如：患者徐某某，女，78岁。慢性支气管炎19年，气胸手术后一年来经常气短。近两个月来咳喘气短更加严重。某医院诊为肺气肿，慢性支气管炎合并感染，住院两个多月，中、西药物频频用之，不但无效，反而日渐加重。纳呆神疲，时见神志朦胧，呼之迟迟始应，心悸怔忡，自汗盗汗，舌质紫暗，光剥无苔，脉虚大而数。审视再三，诊为气阴俱虚，痰郁气结，寒热相夹之重证。于是拟益气养阴，化痰理气。黄芪鳖甲散加减：黄芪15克，人参10克，地骨皮10克，紫菀10克，茯苓10克，柴胡10克，半夏10克，知母10克，生地10克，白芍10克，麦冬10克，肉桂10克，甘草6克。服药1剂，喘咳即减，精神好转，继服10剂喘咳大减。
小腹冷
Clinical Experience and Methods in Traditional Chinese Medicine
By Zhu Jinzhong, Shanxi Academy of Traditional Chinese Medicine, April 2002
Chapter 1: Symptoms
Section 1: Internal Medicine
Cough with Urinary Incontinence
Cough accompanied by urinary incontinence was recorded early in the *Suwen* (Basic Questions) of the *Huangdi Neijing* (Yellow Emperor's Inner Canon). It states: "If kidney cough persists without resolution, the pathogen transmits to the bladder. The manifestation of bladder cough is coughing with involuntary urination." Shen Jin'ao and Lin Peiqin advocated the use of Fuling Gancao Tang (Poria and Licorice Decoction), but my repeated use yielded no efficacy. Through clinical observation, I found that this condition is more common in elderly individuals with weak constitutions and postpartum women. Besides cough and urinary incontinence, it is often accompanied by dizziness, fatigue, chest fullness, irritability, palpitations, shortness of breath, and a wiry, slippery yet powerless pulse. However, it lacks the symptoms of kidney cough described as "pain radiating between the waist and back upon coughing, and severe cases involving coughing up saliva." I happened to read the section on urinary incontinence in Fang Yu's *Yilin Shengmo* (Rope of the Medical Forest), which mentions: "For women who cough and leak urine, Shengmai San (Pulse-Generating Powder) combined with Danggui (Angelica Sinensis), Baizhu (Atractylodes Macrocephala), Chaihu (Bupleurum), and Huangqin (Scutellaria) is suitable." This brought me enlightenment. Re-reading the *Suwen*: "If chronic cough persists, the pathogen transmits to the Sanjiao (Triple Burner). The manifestation of Sanjiao cough is coughing with abdominal fullness and loss of appetite. These pathogens gather in the stomach and relate to the lungs, causing excessive phlegm and saliva, facial edema, and rebellious qi." And: "Shaoyang (Lesser Yang) is affiliated with the Kidney; the Kidney connects upward to the Lung, thus governing both organs. The Sanjiao is the reservoir of waterways, through which fluids exit; it is affiliated with the Bladder and is considered an independent fu organ." These passages finally cleared my confusion. Therefore, I formulated the following prescription: Chaihu 9g, Danggui 9g, Baishao 9g, Maidong 9g, Dangshen 9g, Wuweizi 9g, Banxia 9g, Chenpi 9g, Qingpi 9g, Ziwan 9g, Huangqin 9g. This formula serves as a treatment for insufficiency of the Heart and Lungs, qi stagnation in the Sanjiao, and transformation of stagnation into fire. Clinical trials showed rapid and effective results. For example: Patient Zheng XX, female, 30 years old. For two months postpartum, she suffered from cough and urinary incontinence, with no improvement after prolonged Western and Chinese medicine treatments. Examination revealed a pale complexion, weak voice, palpitations, shortness of breath, chest fullness, irritability, dry mouth, and a deficient, wiry, and slippery pulse. Synthesizing these signs and symptoms, the diagnosis was insufficiency of Heart and Lung qi, Sanjiao qi stagnation, and transformation of stagnation into fire. She was prescribed the above formula. After 2 doses, symptoms improved; after 6 doses, she recovered. Over time, while many patients responded well, others did not. For instance: Patient Tang XX, male, 64 years old. Previous physicians used the aforementioned formula repeatedly without success. Upon examination, besides cough and urinary incontinence, there were no signs of Lung or Sanjiao involvement. His complexion was slightly dark, he complained of soreness and pain in the lower back, abdominal distension, difficult urination, occasional burning and painful urination, a thin white tongue coating, and a wiry, choppy, irregular pulse where the Chi (Cun-Knee-Guan position corresponding to Kidney/Lower Jiao) pulse was larger than the Cun (Wrist position corresponding to Lung/Upper Jiao) pulse. Reflecting deeply, this aligns with the kidney cough described in the *Suwen*. Thus, I prescribed Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) supplemented with Wuweizi, Cheqianzi, and Huainiuxi to tonify Kidney qi. Indeed, symptoms improved after 2 doses and resolved after 10 doses.
Silicosis
Silicosis is a modern medical term; clear records do not exist in classical Chinese medical texts. Due to prominent symptoms of shortness of breath, panting, and chest fullness, some contemporary practitioners consider it equivalent to Feizhang (Lung Distension) in TCM, while others equate it to Chuan (Panting) or Duanqi (Shortness of Breath). Treatment often adheres strictly to Zhang Jingyue's assertion: "Asthma and panting are critical conditions. To distinguish them, there are only two patterns: excess panting and deficiency panting... One is true panting, attributed to the Lung; the other is pseudo-panting, attributed to the Kidney. Why? The Lung is the master of Qi, and the Kidney is the root of Qi. The Lung governs the skin and hair and dominates the Upper Jiao; thus, when pathogens invade, Upper Jiao qi becomes congested leading to panting, requiring clearing and dispersing methods. The Kidney governs essence and marrow and resides in the Lower Jiao; if true Yin is depleted and essence fails to transform into Qi, lower and upper parts fail to interact, leading to急促 (hurried/shallow breathing), which is the basis of decline. If one adds clearing and dispersing methods to already shallow breathing, it is like pressing an egg." By failing to examine the ascending and descending mechanisms of the five Zang organs and the principles of generation and restriction among the Five Elements, practitioners often find treating the Lung ineffective and turn to the Kidney, then treat the Kidney without success and return to the Lung. If combined treatment fails, they blame ancient texts. They forget that the *Suwen·Tianyuanji Dalun* stated long ago: "The movements of the Five Phases and Yin-Yang are the Way of Heaven and Earth, the guidelines of all things, the parents of change, the origin of life and death, and the residence of spiritual clarity." Although shortness of breath or panting primarily involves the Lung and Kidney, the ascending and descending of Yin-Yang and the interactions of the Five Elements are not limited to these two organs. Therefore, focusing solely on the Lung or Kidney often yields no result. For example: Patient Zhang XX, male, adult. Stage II silicosis for 4 years. Previous treatments with herbs to tonify Kidney and grasp Qi, diffuse Lung and stop panting, and resolve phlegm and cough, along with Western medicines, failed to improve his condition. Instead, chest fullness and pain worsened, along with severe shortness of breath and panting, dizziness, headache, irritability, palpitations, and distension in hands and feet. His pulse was deep and choppy, and his lips and tongue were slightly purplish-dark. This indicates Liver-Lung qi stagnation, abnormal ascending/descending, phlegm stasis, blood stasis, and Liver Fire injuring the Lung (Wood Fire Punishing Metal). I prescribed a formula to soothe the Liver, regulate Qi, resolve phlegm, direct Qi downward, invigorate blood, and soften hardness: Chaihu, Zhike, Chishao, Jiegeng, Xingren, Chenpi, Qingpi, Ziyè, Gancao, Huangqin each 9g, Gualou 15g, Sumu 6g. After 3 doses, symptoms improved. Continuous use for three months led to complete remission.
Li Dongyuan and Huang Yuanyu, while emphasizing the importance of the Spleen and Stomach, also vigorously advocated the theory of Zang Qi ascending and descending. Li Dongyuan said: "The Qi of Zang organs follows the seasons in ascending, descending, floating, and sinking... Diseases of the Liver and Lung lie between Water and Fire; their transmission varies in direction, and their temperature (warm/cool) is not fixed, requiring careful investigation." Huang Yuanyu said: "If Jueyin generates, Yang Qi ascends on the left, and Wood flourishes; if wind is excessive, it indicates insufficient generating Qi. If Shaoyang grows, Ministerial Fire manifests clearly and ascends to clear the upper; if heat is excessive, it indicates insufficient growing Qi. If Yangming gathers, Yin Qi descends on the right, and Metal肃 (becomes austere/clear); if dryness is excessive, it indicates failure of the gathering function. If Taiyang stores, Ministerial Fire is hidden and warms the lower; if cold is excessive, it indicates failure of Zang Qi movement." He further stated: "Wind-Wood is the thief of the five Zang organs and the leader of hundred diseases. All diseases arise from the stagnation of Wood Qi. Since Liver-Wood governs ascent, most people lack sufficient generating Qi. When Wood Qi is depressed and fails to ascend, disease occurs. Wood is the middle Qi between Water and Fire; when diseased, Wood and Earth become stagnant and rebellious, Water and Fire fail to interact, resulting in external dryness and internal dampness, lower cold and upper heat." The present case of chest fullness/pain, shortness of breath/panting, irritability/palpitations, and poor appetite is caused by Liver-Lung Qi stagnation, obstruction of Middle Qi, failure of Lung Metal to descend, abundance of damp-phlegm internally, and blood collateral stasis affecting ascending/descending. Therefore, raising clear Yang, descending turbid Yin, resolving phlegm-heat, and unblocking collaterals resolved the syndrome.
Panting (Chuan)
In clinical practice, we frequently encounter chronic bronchitis with infection and bronchial asthma presenting with cough and panting that resist long-term treatment. The main categories are roughly as follows:
1. Excess pathogenic factors at the Exterior dominate; failure to first release the Exterior, instead only diffusing the Lung and stopping panting.
For example: Patient Zhao XX, female, adult. Cough and panting persisted for over three months. Diagnosed at a hospital as asthmatic bronchitis with infection, treated with antibiotics and aminophylline for over a month without effect. Transferred to TCM for two months with no improvement. Invited me to treat; tried Dingchuan Tang (Asthma-Stopping Decoction), Xiao Qinglong Tang (Minor Blue Dragon Decoction), etc., over 20 doses with no effect. I pondered for a long time, unable to proceed, and sought advice from my mentor, Mr. Li Hanqing. He said: "The patient experiences paroxysmal aversion to cold, body pain, and nasal congestion, indicating Exterior Cold. Exterior Cold must be released first. Previous physicians treated only with phlegm-resolving and pantion-stopping methods, causing exterior pathogens to remain unresolved, Lung Qi to be closed and depressed, and panting/cough to persist. Moreover, the illness has lasted over three months, depleting Exterior Qi. Ma Huang (Ephedra) dispersal is too harsh; excessive sweating damages Exterior Yang. If Defensive Yang is deficient, it is easily re-invaded by external pathogens, making cough and panting difficult to cure. Therefore, treatment should utilize Guizhi Jia Houpo Xingzi Tang (Cinnamon Twig Decoction with Magnolia Bark and Apricot Seed) to harmonize Ying and Wei, diffuse the Lung, and stop panting." Prescription: Guizhi 10g, Baishao 10g, Zhi Gancao 6g, Shengjiang (Fresh Ginger) 4 slices, Dazao (Jujube) 5 pieces, Houpo 10g, Xingren 10g. After 2 doses, panting and cough decreased significantly. Continuing for 10 doses eliminated all symptoms.
2. Rebellious Qi causing panting; incorrectly using ascending and floating herbs.
For example: Patient Geng XX, male, adult. Uninterrupted cough and panting for over two months. Diagnosed at a hospital as chronic bronchitis with infection; hospitalized for over a month with no improvement. Transferred to TCM; initially treated with Dingchuan Tang plus Dilong (Earthworm), followed by modified Xiao Qinglong Tang and Shegan Mahuang Tang (Belamcanda and Ephedra Decoction) with no effect. Careful examination revealed inability to lie flat due to panting/cough, abundant sputum, throat discomfort, profuse head sweating, slippery pulse, and strong Cun pulse with weak Chi pulse. This matches the pattern of Suzi Jiangqi Tang (Pericarpium Fructus Sojae Decoction for Descending Qi). However, considering Ma Huang is a holy herb for panting, I feared Suzi Jiangqi Tang alone would be ineffective, so I added Ma Huang. After 2 doses, no effect. Sought advice from Mentor Li Hanqing. He said: "The pattern undoubtedly belongs to Suzi Jiangqi Tang. It should have been effective, but the key lies in Ma Huang. Although Ma Huang is a holy herb for panting, its nature is dispersing, ascending, and floating. This case features abundant turbid phlegm and rebellious Qi causing panting, which requires directing Qi downward, resolving phlegm, and guiding Qi back to the Kidney. Adding Ma Huang's ascending and dispersing nature will surely drive the pathogenic force upward, exacerbating panting and cough. Therefore, remove Ma Huang." Following his advice, I removed Ma Huang. After just 2 doses, panting and cough decreased; continuing for 10 doses provided temporary relief.
3. Spleen-Stomach Deficiency-Cold with failure of rotation; incorrectly treating Lung and Kidney.
For example: Patient Li XX, female, 30 years old. Bronchial asthma for 5 years, occurring every summer and decreasing in winter. For the past two years, panting occurred in both seasons, with shortness of breath upon walking. Previous doctors used Dingchuan Tang and Xiao Qinglong Tang without effect. I examined her pulse as wiry and large. I treated her with Huangqi Biejia San (Astragalus and Turtle Shell Powder), removing Biejia (Turtle Shell), Qinjiao (Gentiana Macrophylla), Tiandong (Asparagus Root), Jiegeng (Platycodon), Sangbai (Mulberry Root), and adding Maidong. After 7 doses, panting and cough decreased greatly. However, continued use yielded no effect, and she developed epistaxis (nosebleed), gingival bleeding, and diarrhea. Re-examining the case, I still believed the previous formula was correct and prescribed it for another 20 doses. Post-medication, shortness of breath and panting worsened, bleeding persisted, and her hands and feet were cold. Her tongue was pale and dark, and her pulse was wiry and tight. Reflecting deeply, although bleeding is mostly due to Heat, deficiency-cold cases exist. Furthermore, she had had epigastric fullness/pain and poor appetite for over ten days. I concluded: Spleen-Stomach deficiency-cold is the root; retained phlegm-fluid is the branch. I prescribed Fugui Lizhong Tang (Aconite and Cinnamon Decoction to Regulate the Middle) combined with Erchen Tang (Two-Aged Phlegm Decoction) for 4 doses. Not only did the bleeding stop completely, but panting and cough also gradually subsided.
4. Kidney failing to grasp Qi; incorrectly using Ma Huang's ascending diffusion.
For example: Patient Li XX, female, adult. Cough, panting, and shortness of breath for over 10 months. Diagnosed at a hospital as chronic bronchitis with infection and emphysema. Hospitalized for over 8 months with no improvement. Sought TCM treatment after discharge; over a month with no effect. Examination revealed panting with shortness of breath, red face but cold feet, heat and irritability in the upper body, frequent sweating, large Cun pulse with minute Chi pulse. Considering signs and pulse together, this is due to Kidney Qi deficiency and decline, floating of deficient Yang, and failure of Qi grasping. I intended to treat with Jinkui Shenqi Wan (Kidney-Qi Pill from the Golden Cabinet). Then I thought: Ma Huang is a key herb for stopping panting, and Dilong is a good herb for relieving spasms and stopping panting. So I added Ma Huang and Dilong to Jinkui Shenqi Wan. After 2 doses, no effect, and symptoms worsened. Reflecting again: Jinkui Shenqi Wan nourishes Yin, warms Yang, and guides Qi back to the Kidney, which fits the pattern perfectly. However, Ma Huang diffuses Lung Qi and ascends/floating, and Dilong unblocks collaterals and disperses internal wind, which opposes the pathology. They should be removed. Prescription: Shudi 24g, Shanyao 12g, Buguzhi 10g, Fuling 10g, Zexie 10g, Danpi 10g, Fuzi 10g, Rougui 10g, Wuweizi 10g, Cheqianzi 10g (wrapped in cloth). After just 1 dose, panting, cough, and shortness of breath decreased; continuing for 10 doses brought great peace.
5. Heart-Kidney Yang Deficiency with internal retention of Fluid-Dampness flooding upward to oppress Heart and Lung; incorrectly using Lung-diffusing and phlegm-resolving methods that damage Righteous Qi.
For example: Patient Li XX, female, adult. Bronchial asthma recurring for decades. Aggravated by a cold one year ago. Diagnosed at a hospital as bronchial asthma with infection; hospitalized for over 7 months with no improvement. Subsequently treated with modified Shegan Mahuang Tang, Dingchuan Tang, Suzi Jiangqi Tang, and Xiao Qinglong Tang for over 8 months with no effect. Examination revealed inability to lie flat due to panting/cough/shortness of breath, emaciation, refusal of food and drink, aversion to cold, cold limbs extending to knees (feet) and elbows (hands), dry mouth without desire to drink, pale tongue with white coating, and deep, fine, hurried, and powerless pulse. Reflecting deeply and combining signs and pulse, the diagnosis was Heart-Kidney Yang Deficiency, with evil fluids flooding upward and oppressing the Heart and Lung. Previous prescriptions treated this as an Excess pattern, hence the lack of efficacy. I prescribed the original Zhenwu Tang (True Warrior Decoction) for 1 dose. Later, another physician reviewed the prescription and said: "The disease is severe, the medication is light, and there is no Ma Huang to stop panting; it cannot be taken." He immediately added Ma Huang to the prescription. After taking 4 doses, there was no effect. I was invited again. I said: "The body is already deficient; excessive use of attacking substances has created a severe condition of Righteous Deficiency and Pathogenic Excess. Although Ma Huang's dispersing power is mild, its ability to damage Righteous Qi is significant. Remove Ma Huang, add Renshen (Ginseng) and Xingren. As Righteous Qi recovers slightly, phlegm-fluid can decrease." Prescription: Renshen 6g, Xingren 6g, Fuzi 6g, Baishao 6g, Fuling 6g, Baizhu 6g, Shengjiang 1 slice. After 2 doses, cough and panting decreased slightly; continuing for 20 doses stopped cough and panting, allowing discharge.
6. Middle Jiao Qi Stagnation; should regulate Spleen and Stomach, but incorrectly used Lung herbs.
For example: Patient Li XX, male, adult. Uninterrupted cough and panting, worsening after meals, for over three months. Frequent use of Chinese and Western medicines was ineffective. Reviewing previous prescriptions, they were mostly modified Dingchuan Tang, Xiao Qinglong Tang, Shegan Mahuang Tang, and Shengmai San. Further examination revealed inability to lie flat due to panting, but the sound of panting was not loud; abdominal fullness/distension was present, and the pulse was wiry and tight. Pondering for a long time, I said: "Phlegm-dampness obstructs the center, causing the wheel and axle mechanism to fail. The Classics state: 'All Zang and Fu organs can cause cough, not just the Lung.' The mechanism of this panting/cough is similar to this principle. Although Jingyue discussed treating the Lung for initial panting and the Kidney for chronic panting, this cannot be applied universally. Treatment should utilize Pingwei San and Erchen Tang modifications to resolve phlegm-dampness and regulate Spleen and Stomach, restoring the rotational mechanism. Lung Qi will descend naturally, and Kidney Qi will grasp naturally." Prescription: Banxia 10g, Chenpi 10g, Ziyè 6g, Xingren 10g, Houpo 10g, Fuling 10g, Shenqu 10g. After 2 doses, cough and panting decreased slightly; continuing for 20 doses gradually平息 (calmed) the symptoms.
7. Liver Depression; failing to soothe the Liver, instead treating the Lung.
For example: Patient Zhang XX, female, adult. Asthma recurring for decades. Cough and panting recurred 8 months ago; hospitalized for half a year with no effect. After discharge, treated with hundreds of doses of herbs for diffusing Lung/stopping panting, directing Qi downward/resolving phlegm, and grasping Qi returning to Kidney with no effect. Careful examination revealed panting with shortness of breath, frequent coughing, dizziness, vertigo, irritability, palpitations, wandering pain in chest and hypochondrium (worse during menstruation), night-time dry mouth or bitter taste, poor appetite. Inquiry into the onset revealed aggravation after anger during menstruation. Tongue coating white, edges with ecchymosis spots, pulse deficient, wiry, and slippery. I pondered for a long time and diagnosed: Deficiency of both Heart and Lung, internal accumulation of phlegm-fluid, Liver Wood failing to course freely, and Liver Fire oppressing Metal (Wood Fire Oppressing Metal). I prescribed modifications of the Cough with Urinary Incontinence Formula to tonify Qi and nourish Yin, soothe the Liver, and resolve phlegm: Chaihu 10g, Danggui 10g, Baishao 10g, Banxia 10g, Chenpi 10g, Qingpi 10g, Ziwan 10g, Maidong 10g, Dangshen 10g, Wuweizi 10g, Huangqin 10g. After 3 doses, cough and panting decreased; continuing for 40 doses平息 (calmed) the panting.
8. Yin Deficiency with Dry Phlegm; incorrectly using warm-dry herbs to resolve phlegm.
For example: Patient Su XX, female, adult. Summer-onset cough and panting for decades. Aggravated significantly since entering summer this year. Frequent use of Chinese and Western medicines for over three months was ineffective. Reviewing previous prescriptions, they were mostly modified Dingchuan Tang, Mahuang Xinggan Shigan Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction), Xiao Qinglong Tang, and Shegan Mahuang Tang. Tongue coating thin white, pulse wiry and slippery. Pondering for a long time, I said: "In summer, Yang Qi is on the exterior. The Lung governs skin/hair and the Upper Jiao, so the interior is cold and the Lung is hot. In winter, Yang Qi enters the interior, so the Lung is cold and the interior is hot. With Yin deficiency and dry phlegm, symptoms worsen in summer; thus, panting occurs in summer and improves in winter. At this time, using warm-dry herbs damages Yin, intensifying dry-fire and increasing phlegm-heat. Therefore, treatment should nourish Yin, moisten dryness, and resolve phlegm." Prescription: Baihe 15g, Maidong 15g, Dongchongxiacao (Cordyceps) 15g, Danshai (Dark Mussel) 10g. After 2 doses, cough and panting decreased; continuing for 10 doses stopped cough and panting.
9. Dual Deficiency of Qi and Yin with Phlegm-Fluid Obstruction; failing to support Righteous Qi, only employing pathogen-expelling methods.
For example: Patient Xu XX, female, 78 years old. Chronic bronchitis for 19 years. Frequent shortness of breath for one year after pneumothorax surgery. Cough, panting, and shortness of breath worsened significantly in the last two months. Diagnosed at a hospital as emphysema and chronic bronchitis with infection; hospitalized for over two months. Frequent use of Chinese and Western medicines was ineffective and symptoms worsened daily. Poor appetite, mental fatigue, occasional mental confusion (slow response to calling), palpitations, spontaneous and nocturnal sweating, purple-dark tongue, peeled coating without moss, large, deficient, and rapid pulse. Examining repeatedly, the diagnosis was severe dual deficiency of Qi and Yin, with phlegm stagnation and Qi knotting, mixed cold and heat. I prescribed modifications of Huangqi Biejia San to tonify Qi, nourish Yin, resolve phlegm, and regulate Qi: Huangqi 15g, Renshen 10g, Digupi 10g, Ziwan 10g, Fuling 10g, Chaihu 10g, Banxia 10g, Zhimu 10g, Shengdi 10g, Baishao 10g, Maidong 10g, Rougui 10g, Gancao 6g. After 1 dose, cough and panting decreased, spirit improved; continuing for 10 doses greatly reduced cough and panting.
Cold Abdomen