周××，男，40岁。两年多以前，在感冒之后发现咳嗽，经用西药治疗半年多不效，于是改用中成药进行治疗，治疗近8个月，仍然时好时坏，医生多次劝他休息，但因讲课任务太重，一直不能休息。最近七八个月来，常因咳嗽影响讲课，有时一开始讲课即连续咳嗽二三十声，停止后，再讲课十几分钟，又连续咳嗽十几声，平均每节课少则咳嗽两次，多则四五次。为此不得已，又连续服药近60剂，但至今仍然不见改善。询其咳嗽之状，云：干咳少痰，常常咳嗽二三十声才能停止，它无所若。察其舌苔薄白，脉濡缓。再察前医所处之方，有以养阴润肺者，有以化痰止咳者。有寒者，有热者，然效均不著。因思《景岳全书·咳嗽》云：“外邪证多有误认为劳伤而遂成真劳者，此必其人气体柔弱，而医家望之已有成心，故见其发热遂认为火，见其咳嗽遂认为劳，不明表里率用滋阴降火等剂，不知寒邪既已在表凉药不宜妄投，若外既有寒而内又得寒，则表里合邪，必致邪留不解，延绵日甚……但以金水六君煎不数剂而可愈矣。”又说：“治肺肾虚寒水泛为痰或年迈阴虚血气不足，外受风寒咳呕恶多痰喘急等证神效。”此证虽无呕恶多痰喘急之苦，然其久咳已及于肾，故宗之。处方：半夏10克，陈皮10克，茯苓10克，甘草10克，熟地10克，当归10克。
服药4剂咳嗽大减，继服20剂，愈。
2．虚实并见，寒热并存，不判比例，难用药铒
尝治患者郝××，男，37岁。5年前，感冒以后即经常咳嗽，经中、西药治疗一直没有明显效果。3年前，因工作比较劳累，日渐感到气短乏力，某院检查治疗后，确诊为慢性支气管炎，肺气肿，纤维空洞性肺结核，肺源性心脏病，冠状动脉硬化性心脏病，心肌劳损。住院治疗一年多，不见改善而出院。出院后，又请中医治疗一年多，亦未发现明显效果。审其除咳嗽微喘，气短乏力，心悸心烦外，并见其消瘦乏神，面色．青紫，口唇、舌均发绀，浮肿，手、臂、腿、足亦紫暗浮肿，手指呈杵状，指、趾厥冷，舌苔黄白厚腻，脉虚大弦数。按其胃脘硬满不适，深按则气短难于忍耐。思之再三，难于措手。不得已，乃求教于前医所处之方及其服药后之疗效得失，患者乃举其要者40余尽陈之，云：射干麻黄、小青龙加减方药后不但咳喘不减，反见口干舌燥，心悸烦乱；定喘、苏子降气大都半剂有效，再药则诸证加剧；生脉散加味大都前一剂有效，再剂腹满气短则加；人参蛤蚧、金匮肾气药后诸证不减。亦不增加，如此等等。再思历代医学大家医案，难治之疾尤重脉象。因云：脉大者，虚也，病进也；虚大者，气血俱虚也，气阴俱虚也；弦者，肝胆也，伏饮也，寒也；数者，热也，无发热而脉数者亦阳虚也。脉证相参，乃阴阳俱虚，寒饮内伏。久郁化热，肝邪凌肺，五脏俱病之候也。此病补之难功，泻之难效，非重视补泻之比例难效。因处黄芪鳖甲散加减为剂。处方：黄芪15克，地骨皮10克，紫菀10克，人参10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10克。
服药6剂，咳喘气短，浮肿尿少，神疲乏力俱减，食纳大增，全身紫暗之色亦稍变浅，患者因感到此方有效，求某医抄方再与7剂服之。医云：人参补力太大，喘证不可服，应予党参；肉桂大辛大热，舌苔黄厚有热者不可服，应去之。乃将上方去人参、肉桂，加党参服之。药进7剂，诸证加剧，再邀余诊。处方仍宗原方6剂服之。药进40剂，诸证消退七八，再以原方继服2月，果安。
3.心下痞坚，喘满支饮，不消其痞，但治其喘，喘证
曾治患者贺××，男，45岁。10年前，感冒后一直咳喘不止，近4年来，咳喘日渐加重。为此，不得不住院治疗近一年多，诊为慢性支气管炎合并感染、支气管扩张，肺气肿、肺心病、心肌劳损、慢性胃炎、十二指肠炎、胆石症。好转出院。出院后，诸证又见加重，虽予中、西药近一年亦不见效。审之，除咳喘短气难于接续外，并见其全身均呈紫暗色，消瘦浮肿，心下痞满胀痛，饮食难入，稍进饮食则非但痞满胀痛更甚，亦且心悸气短更加严重，指趾厥冷而手心反热，舌苔黄白厚腻，脉沉紧数。综合脉证，思之：气血大衰，痰饮内伏，寒热并见。宜处予黄芪鳖甲散加减方(同前)。
药后诸证非但不减，反见加剧。又思仲景《金匮要略》曾云：“膈间支饮，其人喘满，心下痞坚，面色黧黑，其脉沉紧，得之数十日，医吐下之不愈，木防己汤主之。虚者，即愈，实者三日复发，复与不愈者，宜木防己汤去石膏加茯苓芒硝汤主之。，’木防己汤者乃化中焦痞坚之方也，若喘满而痞坚较剧者当治痞而消喘，此前方不效者乃治上焦而未治中焦之故也。处方：防己10克，生石膏15克，肉桂10克，人参10克，半夏10克，陈皮10克，紫菀10克，葶苈子4克，茯苓6克，芒硝3克。
服药2剂，诸证稍减，继服20剂，喘而气短消失七八，食纳大增，痞坚稍减五六，继服50剂，诸证全失。
4．痰阻中焦，反治上焦，痰所不符，焉能取效
张××，男，55岁。感冒之后8个多月来，经常咳嗽，痰难咯出，有时连续咳嗽十几声才能停止。为此曾连续两次住院检查治疗。除西药外，仅只中药即服80多剂，但始终效果不显著。审视其证，除咳嗽痰多难于咯出外，并见心下痞坚不适，舌苔黄白，脉沉弦紧而数。检视诸方，多为宣肺化痰之品，有泻白者，有止嗽者，有金沸草者，有麻杏石甘者，种种不一。因思仲景《金匮要略》云：“膈间支饮，其人喘满，心下痞坚，面色黧黑，其脉沉紧，得之数十日，木防己汤主之。”尤在泾《金匮要略心典》云：“不特碍其肺，抑且滞其胃矣，非木防己、桂枝，一苦一辛，行水气，散结气不得解。”中焦乃三焦之轮轴，中焦不得斡旋，则肺气不降，肾气不升，咳嗽不愈。前方之所以不效者乃未治中焦之疾耳。因拟木防己汤加味。处方：防己10克，桂枝10克，生石膏15克，人参10克，半夏10克，陈皮10克，紫菀10克，茯苓10克。
服药3剂，咳嗽大减，继服6剂，诸证消失，愈。
5．痰热阻肺，不佐温阳，阴霾难散
尤××，女，35岁。
咳嗽数年，近两个多月来加重。医始以西药治之不效，后又以中药止咳化痰，化饮止咳、清化痰热之剂仍不效。审其咳嗽阵阵而作，痰难咯出，且咽喉有阻塞感，舌苔黄白而腻，脉滑而数。因思滑数之脉者痰热阻肺也。治宜化痰清热。处方：制南星10克，半夏10克，橘红10克，杏仁10克，川贝母10克，瓜蒌15克，黄芩10克，枳壳10克。
服药3剂，寸效不见。因思热者寒之乃千古不移之真理，然其不效者何也?久用抗生素亦不效，又何也?又思痰饮者阴物也，阴物者非阳光不能散，正如仲景《金匮要略》所云：“病痰饮者，当以温药和之。”前之用化痰不愈者，乃未佐用温散之味所致也。因拟上方加干姜1克。
服药2剂，咳嗽顿止，继服2剂，咳嗽全失而愈。
6．心肾阳虚，水气内停，应予助阳，反助其火，其病难愈
赵××，女，40岁。七八岁时，感冒后发现咳嗽，因条件限制没有进行治疗，至十几岁时，咳嗽日渐加重，25岁时因一次感冒，突然喘咳，呼吸困难而住院，住院半个月咳喘消失而出院。其后，每至天气变化即感胸闷如窒塞感．咳嗽，到30岁时，每至冬天则喘咳，住院至春节前后就逐渐缓解，春节后即可上班工作。至35岁时，咳喘的更加严重，几乎一年四季都喘，特别是一到冬天，就根本不能出门。今年以来，喘咳尤重，不管服用任何药都没有见过一点效，没有平躺睡过一个小时的觉。察其形销骨立，端坐呼吸，喉中哮鸣音及痰声不止，神色不安，说一句话即需休息几分钟才能说第二句，身冷如冰，食纳几废，舌质淡，苔黄白而水滑，脉沉细数时见促象，口唇、鼻翼、手指微见发绀。综合脉证云：此心肾阳虚，水饮上泛，真武汤证也，又且元气大衰，应以人参大补元气，杏仁降气定喘。处方：附子1克，白术1克，白芍1克，茯苓1克，杏仁1克，人参1克。
服药1剂，诸证均减。某医云：麻黄乃定喘之圣药，宜加之。上方加麻黄10克。服药后，喘咳气短更甚，且心悸难于忍耐。医云：药轻病重，哪能治病，宜加量服之。处方：麻黄10克，附子12克，茯苓15克，白术15克，白芍15克，人参15克，杏仁10克。
服药1剂之后，不但喘咳气短，心悸不减，反而发现身热汗出，烦躁不安。在患者及其家属的再三要求下，再邀余诊。云：此证已五脏俱损，心肾尤为阳虚，且水饮内停，水气上泛，乃正虚邪实之证，若稍事补阳则成壮火，故只可以小量补火助阳，而不可大补以散阳气，且附子乃走而不守之品，本证喘而短气，显兼肾不纳气之证，若过用附子，必成壮火，则更肾不纳气，且再配麻黄之升散，则肾更不能纳，水邪更要凌犯心肺，故不可也。处方：附子1克，白芍1克，白术1克，茯苓1克，人参1克，杏仁1克，干姜1克，五味子1克。
服药3剂，诸证大减，有时可以平躺一小时，饮食稍进，继进20剂，喘咳短气消减七八，体重增加近5千克。为加强补肾之功，加服金匮肾气丸，一日2次，一次1丸。至服药2个月后，喘咳消失。出院。
7．不审脏腑，不查虚实，但予止咳，终归不治
苏××，女，36岁。
素有糖尿病，近一年来又患咳嗽。医诊慢性支气管炎。先以西药治疗半年不效，后又配合中药川贝精、青果丸、消咳喘、川贝枇杷糖浆、竹沥水，以及止咳化痰的汤剂数十剂仍无明显效果。细审其证，除咳嗽之外，并见头晕心烦，胸满背困，咳而遗尿，舌苔薄白，脉虚弦滑。综合脉证，诊为气阴两虚为本，痰郁气结，郁而化火为标。治拟补气养阴以培本，疏肝理气，清热化痰以治标。处方：柴胡10克，当归10克，白芍10克，半夏10克，陈皮10克，青皮10克，黄芩10克，党参10克，麦冬10克，五味子10克，薄荷3克。
服药4剂，咳嗽停止，继服4剂，愈。
某医云：化痰止咳之药治之何故不愈?答曰：素有气阴两虚之故耳。又问：为何曾用生脉散加化痰之品无效?答曰：生脉散加化痰之品主治在肺，而余所用方虽有生脉而却主治在肝。肝者，木也，木火刑金，肺气不降，主治在肝，不可主治其肺也，故以上方得愈，而应用生脉散加化痰之品则不愈也。
8．但治其标，不知其本，久治不愈申××，男，成。咳嗽频作1年多，医诊慢性支气管炎。先用西药治疗半年多不效，后又配合中药止咳化痰亦不效。细询其咳嗽尤甚于早晨，咳痰不多烦躁易怒，头晕脑胀，大便秘结，舌质红，舌苔黄，脉弦数。综合脉证，反复思考：早晨者，肝胆所主之时也，肝火炽盛，凌烁肺金，肺气不降则咳也。治拟清肝泻火。处方：当归10克，川芎10克，大黄4克，栀子10克，羌活10克，防风6克，青黛4克。
服药6剂，愈。
某医云：此何不用止嗽之药而反愈也?答曰：《素问》云：“五脏六腑皆令人咳，非独肺也。”此咳乃肝火所致，故以清肝泻火而愈。
9．气阴两虚，痰滞膈间，但予养阴，不去理肝，终非其治
栗××，男，59岁。
咳嗽不止，咽部干痛1年多。医诊慢性支气管炎、慢性咽炎。先用西药治疗半年多不效，继又配合中药养阴润肺，止咳化痰之剂半年多仍不效。细审其证，咳嗽少痰，咽喉干痛而憋，心烦失眠，疲乏无力，舌苔薄白，脉濡缓。综合脉证，思之：此气阴两虚为本，痰郁气结，阻于胸膈也。治拟补气养阴，理气化痰。处方：黄芪15克，当归6克，麦冬10克，党参10克，五味子10克，竹茹10克，枳实10克，半夏10克，茯苓10克，甘草6克，菖蒲10克，远志10克，生地10克。
服药6剂，咽喉干痛憋胀，咳嗽均止，继服6剂，诸证消失，愈。
某医问：此方乃为加减十味温胆汤方也。加减十味温胆汤者，本为治疗失眠心悸健忘之方，今何用其于咳嗽而得愈也?答曰：《素问·咳论》曰：“五脏六腑皆今人咳，非独肺也……心咳之状，咳则心痛，喉中介介如梗状，甚则咽痛喉痹。”今证见喉中介介如梗状，咽痛乃心咳证也，故以加减十味温胆汤而愈。此先用养肺阴而不效者，乃因其心病治肺，故不愈也。
10．病在膈间，反治其肺，实以虚治，病久不愈
邵××，女，58岁。
咳嗽吐痰而时稍喘2年多。医诊慢性支气管炎。先用西药治疗无效，继又配合中药止咳化痰、养阴止嗽、补气化痰止咳，温肾化痰等剂亦无效。细察其证，咳嗽气短，痰难咯出，口干舌燥，胃脘痞满，舌苔白，脉沉紧。综合脉证，思之：仲景云：“膈间支饮，其人喘满，心下痞坚，面色黧黑，其脉沉紧……木防己汤主之。”因作木防己汤加味。处方：防己10克，桂枝10克，党参10克，生石膏15克，半夏10克，陈皮10克，葶苈子1克，紫菀10克。
服药2剂，咳喘即减，继服20剂，咳喘得止，后果愈。
周某某，男，40岁。两年多以前，在感冒之后发现咳嗽，经用西药治疗半年多无效，于是改用中成药进行治疗，治疗近8个月，仍然时好时坏，医生多次劝他休息，但因讲课任务太重，一直不能休息。最近七八个月来，常因咳嗽影响讲课，有时一开始讲课即连续咳嗽二三十声，停止后，再讲课十几分钟，又连续咳嗽十几声，平均每节课少则咳嗽两次，多则四五次。为此不得已，又连续服药近60剂，但至今仍然不见改善。询问其咳嗽的情况，说：干咳少痰，常常咳嗽二三十声才能停止，没有其他不适。观察其舌苔薄白，脉象濡缓。再查看前医所开的方子，有以养阴润肺为主的，有以化痰止咳为主的。有针对寒证的，有针对热证的，然而疗效均不显著。因此想到《景岳全书·咳嗽》中说：“外感邪气的证候多有被误认为劳损而遂成真正劳损的，这必定是因为其人身体柔弱，而医生心中已有成见，所以见到发热就认为是火证，见到咳嗽就认为是劳损，不明表里关系，一律使用滋阴降火的方剂，不知道寒邪既然在表，就不宜妄投凉药，如果外有寒邪而内又受寒凉，那么表里合邪，必然导致邪气留恋不解，拖延日久日益严重……只要用金水六君煎，不需多剂即可痊愈。”又说：“治疗肺肾虚寒、水泛为痰，或者年迈阴虚、气血不足，外受风寒引起的咳呕恶、多痰喘急等证，神效。”此证虽然无呕恶多痰喘急之苦，但其久咳已波及于肾，故遵循这一理论。处方：半夏10克，陈皮10克，茯苓10克，甘草10克，熟地黄10克，当归10克。
服用4剂后咳嗽大减，继服20剂，痊愈。
曾治疗患者郝某某，男，37岁。5年前，感冒以后即经常咳嗽，经中、西药治疗一直没有明显效果。3年前，因工作比较劳累，日渐感到气短乏力，某院检查治疗后，确诊为慢性支气管炎，肺气肿，纤维空洞性肺结核，肺源性心脏病，冠状动脉硬化性心脏病，心肌劳损。住院治疗一年多，不见改善而出院。出院后，又请中医治疗一年多，亦未发现明显效果。审视其除咳嗽微喘，气短乏力，心悸心烦外，并见其消瘦乏神，面色青紫，口唇、舌均发绀，浮肿，手、臂、腿、足亦紫暗浮肿，手指呈杵状，指、趾厥冷，舌苔黄白厚腻，脉虚大弦数。按其胃脘硬满不适，深按则气短难于忍耐。思之再三，难于措手。不得已，乃求教于前医所处之方及其服药后之疗效得失，患者乃举其要者40余尽陈之，云：射干麻黄汤、小青龙汤加减方药后不但咳喘不减，反见口干舌燥，心悸烦乱；定喘汤、苏子降气汤大都半剂有效，再药则诸证加剧；生脉散加味大都前一剂有效，再剂腹满气短则加；人参蛤蚧散、金匮肾气丸药后诸证不减。亦不增加，如此等等。再思历代医学大家医案，难治之疾尤重脉象。因云：脉大者，虚也，病进也；虚大者，气血俱虚也，气阴俱虚也；弦者，肝胆也，伏饮也，寒也；数者，热也，无发热而脉数者亦阳虚也。脉证相参，乃阴阳俱虚，寒饮内伏。久郁化热，肝邪凌肺，五脏俱病之候也。此病补之难功，泻之难效，非重视补泻之比例难效。因处黄芪鳖甲散加减为剂。处方：黄芪15克，地骨皮10克，紫菀10克，人参10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10克。
服药6剂，咳喘气短，浮肿尿少，神疲乏力俱减，食纳大增，全身紫暗之色亦稍变浅，患者因感到此方有效，求某医抄方再与7剂服之。医云：人参补力太大，喘证不可服，应予党参；肉桂大辛大热，舌苔黄厚有热者不可服，应去之。乃将上方去人参、肉桂，加党参服之。药进7剂，诸证加剧，再邀余诊。处方仍宗原方6剂服之。药进40剂，诸证消退七八，再以原方继服2月，果安。
曾治疗患者贺某某，男，45岁。10年前，感冒后一直咳喘不止，近4年来，咳喘日渐加重。为此，不得不住院治疗近一年多，诊为慢性支气管炎合并感染、支气管扩张，肺气肿、肺心病、心肌劳损、慢性胃炎、十二指肠炎、胆石症。好转出院。出院后，诸证又见加重，虽予中、西药近一年亦不见效。审之，除咳喘短气难于接续外，并见其全身均呈紫暗色，消瘦浮肿，心下痞满胀痛，饮食难入，稍进饮食则非但痞满胀痛更甚，亦且心悸气短更加严重，指趾厥冷而手心反热，舌苔黄白厚腻，脉沉紧数。综合脉证，思之：气血大衰，痰饮内伏，寒热并见。宜处予黄芪鳖甲散加减方(同前)。
药后诸证非但不减，反见加剧。又思仲景《金匮要略》曾云：“膈间支饮，其人喘满，心下痞坚，面色黧黑，其脉沉紧，得之数十日，医吐下之不愈，木防己汤主之。虚者，即愈，实者三日复发，复与不愈者，宜木防己汤去石膏加茯苓芒硝汤主之。”木防己汤者乃化中焦痞坚之方也，若喘满而痞坚较剧者当治痞而消喘，此前方不效者乃治上焦而未治中焦之故也。处方：防己10克，生石膏15克，肉桂10克，人参10克，半夏10克，陈皮10克，紫菀10克，葶苈子4克，茯苓6克，芒硝3克。
服药2剂，诸证稍减，继服20剂，喘而气短消失七八，食纳大增，痞坚稍减五六，继服50剂，诸证全失。
4. 痰阻中焦，反治上焦，痰所不符，焉能取效
张某某，男，55岁。感冒之后8个多月来，经常咳嗽，痰难咯出，有时连续咳嗽十几声才能停止。为此曾连续两次住院检查治疗。除西药外，仅只中药即服80多剂，但始终效果不显著。审视其证，除咳嗽痰多难于咯出外，并见心下痞坚不适，舌苔黄白，脉沉弦紧而数。检视诸方，多为宣肺化痰之品，有泻白散者，有止嗽散者，有金沸草散者，有麻杏石甘汤者，种种不一。因思仲景《金匮要略》云：“膈间支饮，其人喘满，心下痞坚，面色黧黑，其脉沉紧，得之数十日，木防己汤主之。”尤在泾《金匮要略心典》云：“不特碍其肺，抑且滞其胃矣，非木防己、桂枝，一苦一辛，行水气，散结气不得解。”中焦乃三焦之轮轴，中焦不得斡旋，则肺气不降，肾气不升，咳嗽不愈。前方之所以不效者乃未治中焦之疾耳。因拟木防己汤加味。处方：防己10克，桂枝10克，生石膏15克，人参10克，半夏10克，陈皮10克，紫菀10克，茯苓10克。
服药3剂，咳嗽大减，继服6剂，诸证消失，愈。
5. 痰热阻肺，不佐温阳，阴霾难散
尤某某，女，35岁。
咳嗽数年，近两个多月来加重。医始以西药治之不效，后又以中药止咳化痰，化饮止咳、清化痰热之剂仍不效。审其咳嗽阵阵而作，痰难咯出，且咽喉有阻塞感，舌苔黄白而腻，脉滑而数。因思滑数之脉者痰热阻肺也。治宜化痰清热。处方：制南星10克，半夏10克，橘红10克，杏仁10克，川贝母10克，瓜蒌15克，黄芩10克，枳壳10克。
服药3剂，寸效不见。因思热者寒之乃千古不移之真理，然其不效者何也?久用抗生素亦不效，又何也?又思痰饮者阴物也，阴物者非阳光不能散，正如仲景《金匮要略》所云：“病痰饮者，当以温药和之。”前之用化痰不愈者，乃未佐用温散之味所致也。因拟上方加干姜1克。
服药2剂，咳嗽顿止，继服2剂，咳嗽全失而愈。
赵某某，女，40岁。七八岁时，感冒后发现咳嗽，因条件限制没有进行治疗，至十几岁时，咳嗽日渐加重，25岁时因一次感冒，突然喘咳，呼吸困难而住院，住院半个月咳喘消失而出院。其后，每至天气变化即感胸闷如窒塞感．咳嗽，到30岁时，每至冬天则喘咳，住院至春节前后就逐渐缓解，春节后即可上班工作。至35岁时，咳喘的更加严重，几乎一年四季都喘，特别是一到冬天，就根本不能出门。今年以来，喘咳尤重，不管服用任何药都没有见过一点效，没有平躺睡过一个小时的觉。察其形销骨立，端坐呼吸，喉中哮鸣音及痰声不止，神色不安，说一句话即需休息几分钟才能说第二句，身冷如冰，食纳几废，舌质淡，苔黄白而水滑，脉沉细数时见促象，口唇、鼻翼、手指微见发绀。综合脉证云：此心肾阳虚，水饮上泛，真武汤证也，又且元气大衰，应以人参大补元气，杏仁降气定喘。处方：附子1克，白术1克，白芍1克，茯苓1克，杏仁1克，人参1克。
服药1剂，诸证均减。某医云：麻黄乃定喘之圣药，宜加之。上方加麻黄10克。服药后，喘咳气短更甚，且心悸难于忍耐。医云：药轻病重，哪能治病，宜加量服之。处方：麻黄10克，附子12克，茯苓15克，白术15克，白芍15克，人参15克，杏仁10克。
服药1剂之后，不但喘咳气短，心悸不减，反而发现身热汗出，烦躁不安。在患者及其家属的再三要求下，再邀余诊。云：此证已五脏俱损，心肾尤为阳虚，且水饮内停，水气上泛，乃正虚邪实之证，若稍事补阳则成壮火，故只可以小量补火助阳，而不可大补以散阳气，且附子乃走而不守之品，本证喘而短气，显兼肾不纳气之证，若过用附子，必成壮火，则更肾不纳气，且再配麻黄之升散，则肾更不能纳，水邪更要凌犯心肺，故不可也。处方：附子1克，白芍1克，白术1克，茯苓1克，人参1克，杏仁1克，干姜1克，五味子1克。
服药3剂，诸证大减，有时可以平躺一小时，饮食稍进，继进20剂，喘咳短气消减七八，体重增加近5千克。为加强补肾之功，加服金匮肾气丸，一日2次，一次1丸。至服药2个月后，喘咳消失。出院。
7. 不审脏腑，不查虚实，但予止咳，终归不治
苏某某，女，36岁。
素有糖尿病，近一年来又患咳嗽。医诊慢性支气管炎。先以西药治疗半年不效，后又配合中药川贝精、青果丸、消咳喘、川贝枇杷糖浆、竹沥水，以及止咳化痰的汤剂数十剂仍无明显效果。细审其证，除咳嗽之外，并见头晕心烦，胸满背困，咳而遗尿，舌苔薄白，脉虚弦滑。综合脉证，诊为气阴两虚为本，痰郁气结，郁而化火为标。治拟补气养阴以培本，疏肝理气，清热化痰以治标。处方：柴胡10克，当归10克，白芍10克，半夏10克，陈皮10克，青皮10克，黄芩10克，党参10克，麦冬10克，五味子10克，薄荷3克。
服药4剂，咳嗽停止，继服4剂，愈。
某医云：化痰止咳之药治之何故不愈?答曰：素有气阴两虚之故耳。又问：为何曾用生脉散加化痰之品无效?答曰：生脉散加化痰之品主治在肺，而余所用方虽有生脉而却主治在肝。肝者，木也，木火刑金，肺气不降，主治在肝，不可主治其肺也，故以上方得愈，而应用生脉散加化痰之品则不愈也。
8. 但治其标，不知其本，久治不愈
申某某，男，[年龄不详]。咳嗽频作1年多，医诊慢性支气管炎。先用西药治疗半年多不效，后又配合中药止咳化痰亦不效。细询其咳嗽尤甚于早晨，咳痰不多烦躁易怒，头晕脑胀，大便秘结，舌质红，舌苔黄，脉弦数。综合脉证，反复思考：早晨者，肝胆所主之时也，肝火炽盛，凌烁肺金，肺气不降则咳也。治拟清肝泻火。处方：当归10克，川芎10克，大黄4克，栀子10克，羌活10克，防风6克，青黛4克。
服药6剂，愈。
某医云：此何不用止嗽之药而反愈也?答曰：《素问》云：“五脏六腑皆令人咳，非独肺也。”此咳乃肝火所致，故以清肝泻火而愈。
栗某某，男，59岁。
咳嗽不止，咽部干痛1年多。医诊慢性支气管炎、慢性咽炎。先用西药治疗半年多不效，继又配合中药养阴润肺，止咳化痰之剂半年多仍不效。细审其证，咳嗽少痰，咽喉干痛而憋，心烦失眠，疲乏无力，舌苔薄白，脉濡缓。综合脉证，思之：此气阴两虚为本，痰郁气结，阻于胸膈也。治拟补气养阴，理气化痰。处方：黄芪15克，当归6克，麦冬10克，党参10克，五味子10克，竹茹10克，枳实10克，半夏10克，茯苓10克，甘草6克，石菖蒲10克，远志10克，生地10克。
服药6剂，咽喉干痛憋胀，咳嗽均止，继服6剂，诸证消失，愈。
某医问：此方乃为加减十味温胆汤方也。加减十味温胆汤者，本为治疗失眠心悸健忘之方，今何用其于咳嗽而得愈也?答曰：《素问·咳论》曰：“五脏六腑皆令人咳，非独肺也……心咳之状，咳则心痛，喉中介介如梗状，甚则咽痛喉痹。”今证见喉中介介如梗状，咽痛乃心咳证也，故以加减十味温胆汤而愈。此先用养肺阴而不效者，乃因其心病治肺，故不愈也。
邵某某，女，58岁。
咳嗽吐痰而时稍喘2年多。医诊慢性支气管炎。先用西药治疗无效，继又配合中药止咳化痰、养阴止嗽、补气化痰止咳，温肾化痰等剂亦无效。细察其证，咳嗽气短，痰难咯出，口干舌燥，胃脘痞满，舌苔白，脉沉紧。综合脉证，思之：仲景云：“膈间支饮，其人喘满，心下痞坚，面色黧黑，其脉沉紧……木防己汤主之。”因作木防己汤加味。处方：防己10克，桂枝10克，党参10克，生石膏15克，半夏10克，陈皮10克，葶苈子1克，紫菀10克。
服药2剂，咳喘即减，继服20剂，咳喘得止，后果愈。
1. Mixed deficiency and excess, coexistence of cold and heat: Without distinguishing the proportion, it is difficult to apply medication.
Zhou XX, male, 40 years old. More than two years ago, he developed cough after a common cold. After more than half a year of Western medicine treatment without effect, he switched to Chinese patent medicines. Treatment lasted nearly 8 months, with symptoms fluctuating between improvement and worsening. Doctors advised him to rest multiple times, but due to heavy teaching duties, he could not rest. For the past seven or eight months, his cough often interfered with his lectures; sometimes he would cough continuously for 20-30 times as soon as he started speaking, and after stopping, he could speak for another ten-plus minutes before coughing again for over ten times. On average, he coughed at least twice per class, and up to four or five times. Reluctantly, he took nearly 60 doses of herbal medicine consecutively, yet there was no improvement. Regarding the nature of his cough, he described it as dry cough with scanty sputum, requiring 20-30 coughs to stop each time, with no other discomforts. His tongue coating was thin and white, and his pulse was soft and slow (Ru-Huan). Reviewing prescriptions from previous physicians, some focused on nourishing Yin and moistening the lungs, others on resolving phlegm and stopping cough. Some addressed cold patterns, others heat patterns, yet none were effective. Recalling *Jing Yue Quan Shu · Cough*: "Exterior pathogenic syndromes are often mistaken for consumptive diseases, leading to true consumption. This occurs because the patient has weak constitution, and the physician has preconceived notions; seeing fever, they assume fire; seeing cough, they assume consumption. Ignoring the exterior-interior relationship, they indiscriminately use Yin-nourishing and fire-descending formulas. Not knowing that if cold pathogens are in the exterior, cooling herbs should not be used recklessly. If exterior cold meets interior cold, exterior and interior pathogens combine, causing pathogenic factors to linger unresolved, worsening day by day... However, using Jin Shui Liu Jun Decoction (Golden Water Six Gentlemen Decoction) for a few doses can cure it." It also states: "Treating lung and kidney deficiency-cold with water overflowing into phlegm, or elderly patients with Yin deficiency and Qi-blood insufficiency, suffering from external wind-cold causing cough, vomiting, aversion to nausea, excessive phlegm, wheezing, and urgency, [this approach] is miraculous." Although this case lacked vomiting, excessive phlegm, wheezing, and urgency, the chronic cough had affected the kidneys. Thus, I followed this principle. Prescription: Pinellia Rhizome (Banxia) 10g, Tangerine Peel (Chenpi) 10g, Poria (Fuling) 10g, Licorice Root (Gancao) 10g, Prepared Rehmannia Root (Shudihuang) 10g, Angelica Sinensis (Danggui) 10g.
After taking 4 doses, the cough decreased significantly. After continuing for 20 doses, he recovered.
2. Coexistence of deficiency and excess, cold and heat: Without judging the proportion, medication is ineffective.
I once treated a patient, Hao XX, male, 37 years old. Five years ago, after a cold, he frequently coughed. Neither Chinese nor Western medicine produced obvious effects. Three years ago, due to work fatigue, he gradually felt shortness of breath and weakness. A hospital diagnosed him with chronic bronchitis, emphysema, fibrocavitary pulmonary tuberculosis, cor pulmonale, coronary atherosclerotic heart disease, and myocardial strain. After more than a year of hospitalization with no improvement, he was discharged. He sought TCM treatment for another year post-discharge, with no significant results. Examination revealed, besides slight cough and wheezing, shortness of breath, fatigue, palpitations, and irritability, also emaciation, lack of spirit, cyanotic complexion, cyanosis of lips and tongue, edema, purple-dark swollen hands, arms, legs, and feet, clubbing of fingers, cold fingertips and toes, thick yellow-white greasy tongue coating, and a pulse that was deficient, large, wiry, and rapid. Palpation of the epigastrium revealed hardness and fullness with discomfort; deep pressure caused unbearable shortness of breath. After much deliberation, I found it difficult to proceed. Desperately, I consulted the previous prescriptions and their efficacy. The patient listed over 40 key points: Shegan Mahuang Decoction and Xiao Qinglong Decoction modifications failed to reduce cough/wheezing, instead causing dry mouth/tongue, palpitations, and chaos; Dingchuan Decoction and Suzi Jiangqi Decoction worked for half a dose but worsened symptoms upon continuation; Shengmai San plus modifications worked for one dose but caused abdominal fullness and shortness of breath upon repetition; Ren Shen Ge Jie Powder and Jin Gui Shen Qi Wan showed no change in symptoms. Reflecting on classic medical cases, difficult diseases rely heavily on pulse diagnosis. A large pulse indicates deficiency and disease progression; a deficient-large pulse indicates simultaneous Qi and Blood deficiency, or Qi and Yin deficiency; a wiry pulse indicates Liver/Gallbladder issues, hidden fluid retention, or cold; a rapid pulse indicates heat, but a rapid pulse without fever may also indicate Yang deficiency. Correlating pulse and symptoms, this is a pattern of dual deficiency of Yin and Yang, with internal retention of cold-fluid. Long-standing stagnation transforms into heat, Liver pathogen invades the Lung, indicating disease in all five Zang organs. Tonifying is difficult to succeed, purging is difficult to be effective; only by valuing the balance of tonification and purging can it work. I prescribed Huang Qi Bie Jia San modified. Prescription: Astragalus Root (Huangqi) 15g, Groundcherry Root Bark (Digupi) 10g, Astelia Flower (Ziwan) 10g, Ginseng Root (Renshen) 10g, Poria (Fuling) 10g, Bupleurum Root (Chaihu) 10g, Pinellia Rhizome (Banxia) 10g, Anemarrhena Rhizome (Zhimu) 10g, Rehmannia Root (Shengdi) 10g, White Peony Root (Baishao) 10g, Ophiopogon Tuber (Maidong) 10g, Cinnamon Twig (Rougui) 10g, Licorice Root (Gancao) 10g.
After 6 doses, cough, wheezing, shortness of breath, edema, oliguria, fatigue, and listlessness all decreased; appetite increased significantly; the purple-dark color of the body lightened slightly. Believing the formula effective, the patient asked another doctor to copy it for 7 more doses. That doctor said: Ginseng's tonifying power is too strong for asthma; use Codonopsis Root (Dangshen) instead. Cinnamon Twig is very pungent and hot; it should be removed if the tongue coating is yellow-thick indicating heat. The prescription was modified to remove Ginseng and Cinnamon Twig, adding Codonopsis. After 7 doses, symptoms worsened. I re-examined him and prescribed the original formula for 6 doses. After 40 doses, 70-80% of symptoms resolved. Continuing the original formula for 2 months led to stability.
3. Epigastric hardness/fullness, wheezing and distension due to retained fluid: Without resolving the fullness, merely treating the wheezing makes the condition hard to cure.
I once treated He XX, male, 45 years old. Ten years ago, after a cold, he suffered from continuous cough and wheezing. In the last 4 years, it worsened daily. He was hospitalized for over a year, diagnosed with chronic bronchitis with infection, bronchiectasis, emphysema, cor pulmonale, myocardial strain, chronic gastritis, duodenitis, and cholelithiasis. He improved and was discharged. Post-discharge, symptoms worsened again. Despite nearly a year of Chinese and Western medicine, there was no effect. Examination revealed, besides severe cough, wheezing, and shortness of breath, also a purple-dark complexion, emaciation with edema, epigastric fullness, distension, and pain, difficulty eating, worsening fullness/pain and severe palpitations/shortness of breath even with small amounts of food, cold fingertips/toes with hot palms, thick yellow-white greasy tongue coating, and a deep, tight, rapid pulse. Synthesizing pulse and symptoms: severe Qi and Blood depletion, internal retention of phlegm-fluid, coexistence of cold and heat. I initially prescribed Huang Qi Bie Jia San modified (same as above).
Post-medication, symptoms did not decrease but worsened. Recalling Zhang Zhongjing's *Jin Gui Yao Lue*: "Fluid retention in the diaphragm causes wheezing and distension, epigastric hardness, dark facial complexion, and a deep-tight pulse. If untreated for dozens of days by vomiting or purging, Mufangji Tang governs it. If deficient, it cures immediately; if excess, it recurs in three days. If recurrence does not resolve with repeated administration, Mufangji Tang removing Gypsum and adding Poria and Mirabilite governs it." Mufangji Tang resolves epigastric hardness in the Middle Jiao. If wheezing/distension and epigastric hardness are severe, one must treat the fullness to eliminate the wheezing. The previous failure was due to treating the Upper Jiao while neglecting the Middle Jiao. Prescription: Stephania Root (Fangji) 10g, Raw Gypsum (Sheng Shigao) 15g, Cinnamon Twig (Rougui) 10g, Ginseng Root (Renshen) 10g, Pinellia Rhizome (Banxia) 10g, Tangerine Peel (Chenpi) 10g, Astelia Flower (Ziwan) 10g, Lepidium Seed (Tinglizi) 4g, Poria (Fuling) 6g, Mirabilite (Mangxiao) 3g.
After 2 doses, symptoms slightly decreased. After 20 doses, wheezing and shortness of breath resolved by 70-80%; appetite increased significantly; epigastric hardness reduced by 50-60%. After 50 more doses, all symptoms disappeared.
4. Phlegm obstructing the Middle Jiao, but treating the Upper Jiao: Mismatch leads to inefficacy.
Zhang XX, male, 55 years old. For over 8 months after a cold, he suffered frequent cough with difficult-to-expectorate sputum, sometimes coughing continuously for over ten times to stop. He was hospitalized twice for examination and treatment. Besides Western medicine, he took over 80 doses of Chinese herbal medicine with insignificant results. Examination revealed, besides cough with copious difficult sputum, also epigastric hardness/discomfort, yellow-white tongue coating, and a deep, wiry, tight, and rapid pulse. Reviewing previous prescriptions, they were mostly for diffusing the Lung and resolving phlegm: Xiebai San, Zhisou San, Jinfeicao San, Maxing Shigan Tang, etc. Recalling *Jin Gui Yao Lue*: "Fluid retention in the diaphragm causes wheezing and distension, epigastric hardness, dark facial complexion, deep-tight pulse... Mufangji Tang governs it." You Zaijing's *Jin Gui Yao Lue Xin Dian* states: "It not only hinders the Lung but also stagnates the Stomach. Without Fangji and Guizhi, one bitter and one pungent, moving fluid qi and dispersing knotted qi, it cannot be resolved." The Middle Jiao is the pivot of the Triple Burner. If the Middle Jiao cannot rotate, Lung Qi fails to descend, Kidney Qi fails to ascend, and cough persists. The previous prescriptions failed because they did not treat the Middle Jiao pathology. I formulated Mufangji Tang modified. Prescription: Stephania Root (Fangji) 10g, Cinnamon Twig (Guizhi) 10g, Raw Gypsum (Sheng Shigao) 15g, Ginseng Root (Renshen) 10g, Pinellia Rhizome (Banxia) 10g, Tangerine Peel (Chenpi) 10g, Astelia Flower (Ziwan) 10g, Poria (Fuling) 10g.
After 3 doses, cough decreased significantly. After 6 more doses, all symptoms disappeared, and he recovered.
5. Phlegm-heat obstructing the Lung, without assisting Yang, the yin-dampness is hard to dissipate.
You XX, female, 35 years old.
Cough for several years, worsening for the past two months. Initially treated with Western medicine without effect. Then treated with Chinese medicine for stopping cough/resolving phlegm, transforming fluid/stopping cough, clearing phlegm-heat, still without effect. Examination revealed paroxysmal cough, difficult sputum expectoration, sensation of obstruction in the throat, yellow-white greasy tongue coating, and slippery-rapid pulse. Slippery-rapid pulse indicates phlegm-heat obstructing the Lung. Treatment should focus on resolving phlegm and clearing heat. Prescription: Processed Arisaema (Zhi Nanting) 10g, Pinellia Rhizome (Banxia) 10g, Exocarpium Citri Reticulatae (Juhong) 10g, Apricot Seed (Xingren) 10g, Fritillaria Bulb (Chuan Beimu) 10g, Trichosanthes Fruit (Gualou) 15g, Scutellaria Root (Huangqin) 10g, Aurantium Fruit (Zhiqiao) 10g.
After 3 doses, no effect. Thinking that "treating heat with cold" is an immutable truth, why was it ineffective? Why did long-term antibiotic use fail? Phlegm-fluid is a Yin substance; Yin substances cannot be dispersed without sunlight. As Zhang Zhongjing stated in *Jin Gui Yao Lue*: "For diseases of phlegm-fluid, warm herbs should be used to harmonize." The previous failure to resolve phlegm was due to lacking warming and dispersing herbs. I added Dried Ginger (Ganjiang) 1g to the previous formula.
After 2 doses, cough stopped abruptly. After 2 more doses, cough completely disappeared, and he recovered.
6. Heart-Kidney Yang Deficiency, internal retention of Water-Qi: Should assist Yang, but mistakenly boosting Fire makes recovery difficult.
Zhao XX, female, 40 years old. At age 7-8, she developed cough after a cold. Due to limited conditions, no treatment was given. By her teens, cough worsened. At 25, a cold triggered sudden asthmatic cough and dyspnea, requiring hospitalization. After half a month, cough/wheezing subsided, and she was discharged. Later, weather changes caused chest tightness like obstruction and cough. By age 30, winter brought asthmatic cough; hospitalization until around Spring Festival led to gradual relief, allowing work return after Spring Festival. At 35, cough/wheezing became more severe, almost year-round, especially in winter when she couldn't go out. This year, asthmatic cough was particularly severe; no medicine worked, and she couldn't lie flat to sleep for an hour. Examination revealed extreme emaciation, orthopnea, continuous wheezing and rattling sounds in the throat, anxious expression, needing minutes of rest after every sentence, body cold as ice, negligible appetite, pale tongue body, yellow-white watery-slippery coating, deep-thin-rapid pulse occasionally showing intermittent irregularity, and slight cyanosis of lips, alae nasi, and fingers. Synthesizing pulse and symptoms: Heart-Kidney Yang deficiency, water-fluid overflowing upward, a Zhen Wu Tang syndrome. Additionally, Yuan Qi is severely depleted; Ginseng Root should greatly tonify Yuan Qi, and Apricot Seed should direct Qi downward to calm wheezing. Prescription: Aconite Root (Fuzi) 1g, Atractylodes Rhizome (Baizhu) 1g, White Peony Root (Baishao) 1g, Poria (Fuling) 1g, Apricot Seed (Xingren) 1g, Ginseng Root (Renshen) 1g.
After 1 dose, all symptoms decreased. Another doctor said: Ephedra Stem (Mahuang) is the holy medicine for calming wheezing; add it. Added Mahuang 10g. Post-medication, asthmatic cough, shortness of breath worsened, and palpitations became unbearable. The doctor said: The medicine is too light for the severe disease; increase the dosage. Prescription: Mahuang 10g, Fuzi 12g, Fuling 15g, Baizhu 15g, Baishao 15g, Renshen 15g, Xingren 10g.
After 1 dose, not only did asthmatic cough, shortness of breath, and palpitations persist, but body heat, sweating, and irritability appeared. Under repeated requests from the patient and family, I re-examined. I said: This case involves damage to all five Zang organs, especially Heart-Kidney Yang deficiency, with internal retention of water-fluid and upward overflow of water-Qi. It is a pattern of righteous deficiency and pathogenic excess. Slight Yang tonification becomes "vigorous fire" (excessive heat). Therefore, only small doses can tonify fire and assist Yang; large doses scatter Yang Qi. Moreover, Fuzi is mobile and unanchoring. This case of wheezing and shortness of breath clearly involves Kidney failing to grasp Qi. Overusing Fuzi creates vigorous fire, worsening Kidney's inability to grasp Qi. Coupled with Mahuang's ascending and dispersing nature, the Kidney grasps Qi even less, and water pathogens invade Heart and Lung more severely. Thus, it is contraindicated. Prescription: Fuzi 1g, Baishao 1g, Baizhu 1g, Fuling 1g, Renshen 1g, Xingren 1g, Ganjiang 1g, Schisandra Berry (Wuweizi) 1g.
After 3 doses, symptoms decreased significantly; sometimes she could lie flat for an hour; diet slightly improved. After 20 more doses, asthmatic cough and shortness of breath reduced by 70-80%; weight increased by nearly 5 kg. To strengthen Kidney tonification, she added Jin Gui Shen Qi Wan, twice daily, one pill each time. After 2 months of medication, asthmatic cough disappeared. She was discharged.
7. Not examining Zang organs, not checking deficiency/excess, merely giving cough-stopping herbs ultimately fails.
Su XX, female, 36 years old.
She had diabetes. For the past year, she suffered from cough. Diagnosed with chronic bronchitis. Treated with Western medicine for half a year without effect. Then combined with Chinese patent medicines: Chuanbei Jing, Qingguo Wan, Xiao Ke Chuan, Chuanbei Pipa Syrup, Zhu Li Shui, and dozens of decoctions for stopping cough/resolving phlegm, still with no obvious effect. Detailed examination revealed, besides cough, also dizziness, irritability, chest fullness, back heaviness, urinary incontinence during cough, thin-white tongue coating, and deficient-wiry-slippery pulse. Synthesizing pulse and symptoms: Root is Qi-Yin deficiency; Branch is phlegm stagnation and Qi knotting, transforming into fire. Treatment: Tonify Qi and nourish Yin to support the root; soothe Liver, regulate Qi, clear heat, and resolve phlegm to treat the branch. Prescription: Bupleurum Root (Chaihu) 10g, Angelica Sinensis (Danggui) 10g, White Peony Root (Baishao) 10g, Pinellia Rhizome (Banxia) 10g, Tangerine Peel (Chenpi) 10g, Green Tangerine Peel (Qingpi) 10g, Scutellaria Root (Huangqin) 10g, Codonopsis Root (Dangshen) 10g, Ophiopogon Tuber (Maidong) 10g, Schisandra Berry (Wuweizi) 10g, Mint Leaf (Bohe) 3g.
After 4 doses, cough stopped. After 4 more doses, he recovered.
Another doctor asked: Why didn't phlegm-resolving and cough-stopping herbs work? Answer: Because of pre-existing Qi-Yin deficiency. Question: Why did Shengmai San plus phlegm-resolving herbs fail? Answer: Shengmai San plus phlegm-resolving herbs targets the Lung. My formula, although containing Shengmai principles, targets the Liver. Liver is Wood; Wood-fire insults Metal (Lung), preventing Lung Qi descent. Targeting the Liver, not the Lung, cured it. Using Shengmai San plus phlegm-resolving herbs failed because it targeted the wrong organ.
8. Treating only the branch, ignoring the root, long-term treatment fails.
Shen XX, male, [Age unknown]. Frequent cough for over 1 year. Diagnosed with chronic bronchitis. Western medicine for half a year failed. Combined with Chinese medicine for stopping cough/resolving phlegm, also failed. Detailed inquiry revealed cough worse in the morning, scanty sputum, irritability, anger, dizziness, head distension, constipation, red tongue body, yellow tongue coating, and wiry-rapid pulse. Synthesizing pulse and symptoms, reflecting repeatedly: Morning is the time governed by Liver and Gallbladder. Liver fire is blazing, insulting Lung Metal, preventing Lung Qi descent, causing cough. Treatment: Clear Liver and purge fire. Prescription: Angelica Sinensis (Danggui) 10g, Ligusticum Rhizome (Chuanxiong) 10g, Rhubarb Root (Dahuang) 4g, Gardenia Fruit (Zhizi) 10g, Notopterygium Rhizome (Qianghuo) 10g, Saposhnikovia Root (Fangfeng) 6g, Indigo Naturalis (Qingdai) 4g.
After 6 doses, he recovered.
Another doctor asked: Why did it heal without using cough-stopping herbs? Answer: *Su Wen* states: "All Zang and Fu organs can cause cough, not just the Lung." This cough was caused by Liver fire, so clearing Liver and purging fire healed it.
9. Qi-Yin deficiency, phlegm stagnation in the diaphragm: Merely nourishing Yin without regulating the Liver is ultimately incorrect treatment.
Li XX, male, 59 years old.
Continuous cough, dry and painful throat for over 1 year. Diagnosed with chronic bronchitis and chronic pharyngitis. Western medicine for half a year failed. Combined with Chinese medicine for nourishing Yin/moistening lungs, stopping cough/resolving phlegm for over half a year, still failed. Detailed examination revealed cough with scanty sputum, dry/painful/throat-constricted sensation, irritability, insomnia, fatigue, thin-white tongue coating, and soft-slow pulse. Synthesizing pulse and symptoms: Root is Qi-Yin deficiency; Branch is phlegm stagnation and Qi knotting, obstructing the chest-diaphragm. Treatment: Tonify Qi and nourish Yin, regulate Qi and resolve phlegm. Prescription: Astragalus Root (Huangqi) 15g, Angelica Sinensis (Danggui) 6g, Ophiopogon Tuber (Maidong) 10g, Codonopsis Root (Dangshen) 10g, Schisandra Berry (Wuweizi) 10g, Bamboo Shavings (Zhuru) 10g, Immature Bitter Orange (Zhishi) 10g, Pinellia Rhizome (Banxia) 10g, Poria (Fuling) 10g, Licorice Root (Gancao) 6g, Calamus Rhizome (Shichangpu) 10g, Polygala Root (Yuanzhi) 10g, Rehmannia Root (Shengdi) 10g.
After 6 doses, throat dryness/pain/constriction and cough stopped. After 6 more doses, all symptoms disappeared, and he recovered.
Another doctor asked: This formula is Modified Shiwei Wendan Tang. Originally for insomnia, palpitations, and forgetfulness, why did it cure cough? Answer: *Su Wen · Cough Treatise* states: "All Zang and Fu organs can cause cough, not just the Lung... Heart Cough presents with heart pain upon coughing, a sensation of something stuck in the throat, and severe sore throat/pharyngeal obstruction." Now presenting with throat stuck sensation and sore throat, this is Heart Cough. Thus, Modified Shiwei Wendan Tang cured it. Previous failure to nourish Lung Yin was because Heart disease was treated via the Lung.
10. Disease in the diaphragm, but treating the Lung; treating excess as deficiency, long-term illness fails.
Shao XX, female, 58 years old.
Cough with sputum and occasional mild wheezing for over 2 years. Diagnosed with chronic bronchitis. Western medicine failed. Combined with Chinese medicine for stopping cough/resolving phlegm, nourishing Yin/stopping cough, tonifying Qi/resolving phlegm/stopping cough, warming Kidney/resolving phlegm, all ineffective. Detailed examination revealed cough with shortness of breath, difficult sputum expectoration, dry mouth/tongue, epigastric fullness, white tongue coating, and deep-tight pulse. Synthesizing pulse and symptoms, recalling Zhang Zhongjing: "Fluid retention in the diaphragm causes wheezing and distension, epigastric hardness, dark facial complexion, deep-tight pulse... Mufangji Tang governs it." I prescribed Mufangji Tang modified. Prescription: Stephania Root (Fangji) 10g, Cinnamon Twig (Guizhi) 10g, Codonopsis Root (Dangshen) 10g, Raw Gypsum (Sheng Shigao) 15g, Pinellia Rhizome (Banxia) 10g, Tangerine Peel (Chenpi) 10g, Lepidium Seed (Tinglizi) 1g, Astelia Flower (Ziwan) 10g.
After 2 doses, cough/wheezing decreased. After 20 more doses, cough/wheezing stopped, and he subsequently recovered.