伊芳 先寒后热。不饥不食。继浮肿喘呛。俯不能仰。仰卧不安。古人以先喘后胀治肺。先胀后喘
治脾。今由气分 郁。以致水道阻塞。大便溏泄。仍不爽利。其肺气不降。二肠交阻。水谷蒸腐
之湿。横趋脉络。肿由渐加。岂乱医可效。粗述大略。与高明论证。（肺郁水气不降）
肺位最高。主气。为手太阴脏。其脏体恶寒恶热。宣辛则通。微苦则降。若药气味重浊。直入
中下。非宣肺方法矣。故手经与足经大异。当世不分手足经混治者。特表及之。
麻黄 苡仁 茯苓 杏仁 甘草
某 气逆咳呛喘促。小青龙去桂枝芍草加杏仁人参。
某 气逆咳呛喘急。
淡干姜 人参 半夏 五味 茯苓 细辛
单 疮毒内攻。所进水谷不化。蒸变湿邪。渍于经隧之间。不能由肠而下。膀胱不利。浊上壅遏。
肺气不降。喘满不堪着枕。三焦闭塞。渐不可治。议用中满分消之法。必得小便通利。可以援救。
葶苈 苦杏仁 桑皮 浓朴 猪苓 通草 大腹皮 茯苓皮 泽泻
汪 脉弦坚。动怒气冲。喘急不得卧息。此肝升太过。肺降失职。两足逆冷。入暮为剧。议用仲景
越婢法。（肝升饮邪上逆）
又 按之左胁冲气便喘。背上一线寒冷。直贯两足。明是肝逆挟支饮所致。议用金匮旋复花汤法。
旋复花 青葱管 新绛 炒半夏
姜 劳烦哮喘。是为气虚。盖肺主气。为出气之脏。气出太过。但泄不收。则散越多喘。是喘症之
属虚。故益肺气药皆甘。补土母以生子。若上气散越已久。耳目诸窍之阻。皆清阳不司转旋
之机。不必缕治。（中气虚）人参建中汤去姜。
沈（二三） 晨起未食。喘急多痰。此竟夜不食。胃中虚馁。阳气交升。中无弹压。下焦阴伤。已延及胃。难
以骤期霍然。（胃虚）
黄精 三角胡麻 炙草 茯苓
吴 浊饮自夜上干填塞。故阳不旋降。冲逆不得安卧。用仲景真武法。（肾阳虚浊饮上逆）
人参 淡熟附子 生淡干姜 茯苓块 猪苓 泽泻
徐（四二） 色痿腠疏。阳虚体质。平昔喜进膏粱。上焦易壅。中宫少运。浓味凝聚蒸痰。频年咳嗽。但内
伤失和。薄味自可清肃。医用皂荚搜攒。肺伤气泄。喷涕不已。而沉锢胶浊。仍处胸背募俞之
间。玉屏风散之固卫。六君子汤之健脾理痰。多是守剂。不令宣通。独小青龙汤。彻饮以就太
阳。初服喘缓。得宜通之意。夫太阳但开。所欠通补阳明一段工夫。不得其阖。暂开复痹矣。且
喘病之因。在肺为实。在肾为虚。此病细诊色脉。是上实下虚。以致耳聋鸣响治下之法。壮水
源以熄内风为主。而胸次清阳少旋。浊痰阻气妨食。于卧时继以清肃上中二焦。小剂守常。
调理百日图功。至于接应世务。自宜节省。勿在药理中也。（肾气不纳）
熟地（砂仁制） 萸肉 龟甲心 阿胶 牛膝 茯苓 远志 五味 磁石 秋石
蜜丸。早服。卧时另服威喜丸。竹沥姜汁泛丸。
张（三十） 幼年哮喘已愈。上年夏令。劳倦内伤致病。误认外感乱治。其气泄越。哮喘音哑。劳倦不复。
遂致损怯。夫外感之喘治肺。内伤之喘治肾。以肾主纳气耳。
加减八味丸每服二钱五分盐汤下 六服。
胡（六十） 脉沉。短气以息。身动即喘。此下元已虚。肾气不为收摄。痰饮随地气而升。有年。陡然中厥
最虑。
熟地 淡附子 茯苓 车前 远志 补骨脂
吴 气不归元。喘急跗肿冷汗。足寒面赤。中焦痞结。先议通阳。
熟附子 茯苓 生姜汁 生白芍
王（十九） 阴虚喘呛。用镇摄固纳。
熟地 萸肉 阿胶 淡菜胶 山药 茯神 湖莲 芡实
翁（四二） 脉细尺垂。形瘦食少。身动即气促喘急。大凡出气不爽而喘为肺病。客感居多。今动则阳
化。由乎阴弱失纳。乃吸气入而为喘。肾病何辞。治法惟以收摄固真。上病当实下焦。宗肾气
方法意。
熟地 萸肉 五味 补骨脂 胡桃肉 牛膝
茯苓 山药 车前子 蜜丸。
沈（二三） 阴虚阳升。气不摄纳为喘。
熟地 萸肉 五味 海参胶 淡菜胶 茯神 山药 芡实 湖莲肉 紫胡桃
杨（六一） 老年久嗽。身动即喘。晨起喉舌干燥。夜则溲溺如淋。此肾液已枯。气散失纳。非病也。衰也。
故治喘鲜效。便难干涸。宗肾恶燥。以辛润之。
熟地 杞子 牛膝 巴戟肉 紫衣胡桃 青盐 补骨脂
陈（氏） 咳喘则暴。身热汗出。乃阴阳枢纽不固。惟有收摄固元一法。
人参 炙草 五味 紫衣胡桃 熟地 萸肉炭 茯神 炒山药
又 摄固颇应。
人参 附子 五味 炙黄 白术
某 疮痍疥疾。致气喘咳出血痰。固是肺壅热气。今饮食二便如常。行动喘急。与前喘更有分
别。缘高年下虚。肾少摄纳。元海不固。气逆上泛。是肿胀之萌。宜未雨绸缪。六味丸加牛膝 车前胡桃。
孙 望八大年。因冬温内侵。遂致痰嗽暮甚。诊脉大而动搏。察色形枯汗泄。吸音颇促。似属痰
阻。此乃元海根微。不司藏纳。神衰呓语。阳从汗出。最有昏脱之变。古人老年痰嗽喘症。都从
脾肾主治。今温邪扰攘。上中二焦留热。虽无温之理。然摄固下真以治根本。所谓阳根于阴。
岂可不为讲究。
熟地炭 胡桃肉 牛膝炭 车前子 云茯苓 青铅
某 热炽在心。上下不接。冲逆陡发。遍身麻木。喘促昏冒。肾真不固。肝风妄动。久病汤药无功。
暂以玉真丸主之。
喘症之因。在肺为实。在肾为虚。先生揭此二语为提纲。其分别有四。大凡实而寒者。必挟
凝痰宿饮。上干阻气。如小青龙桂枝加朴杏之属也。实而热者。不外乎蕴伏之邪。蒸痰化
火。有麻杏甘膏。千金苇茎之治也。虚者。有精伤气脱之分。填精以浓浓之剂。必兼镇摄。肾
气加沉香。都气入青铅。从阴从阳之异也。气脱则根浮。吸伤元海。危亡可立而待。思草木
之无情。刚柔所难济。则又有人参河车五味石英之属。急续元真。挽回顷刻。补天之治。古
所未及。更有中气虚馁。土不生金。则用人参建中。案集三十。法凡十九。其层次轻重之间。
丝丝入扣。学人宜深玩而得焉。（邵新甫）
徐评 此篇治下之法已备。治上之法尚多遗漏。不可不讲也。
【背景信息】
书名：《临证指南医案》 作者：叶桂（叶天士） 朝代：清 章节：喘 类别：医论
【原文翻译】
一位患者，先出现恶寒，随后发热。没有饥饿感，无法进食。接着出现全身浮肿、气喘和呛咳，身体前俯不能后仰，仰卧时感到不安稳。古人认为，先气喘后腹胀的，病在肺；先腹胀后气喘的，病在脾。如今此病是由于气分郁滞，导致水道阻塞，大便溏泄且排便不爽利。这是因为肺气不降，大肠和小肠气机交阻，水谷蒸腐产生的湿气横溢到脉络中，浮肿逐渐加重。这种病情岂是庸医可以奏效的？简要陈述大意，供高明之士论证。（病机为肺气郁滞，水气不降）
肺的位置最高，主司气，属于手太阴肺脏。其脏器性质厌恶寒冷也厌恶炎热，用辛味药宣散则气机通畅，用微苦味药则气机下降。如果药物的气味重浊，会直接进入中焦和下焦，这就不是宣肺的方法了。因此，手经（上肢经络）与足经（下肢经络）的治疗大不相同。当今世人不分手足经而混治，特此指出这一点。
处方：麻黄、薏苡仁、茯苓、杏仁、甘草。
另一位患者，气逆导致咳嗽、呛咳、气喘急促。使用小青龙汤去掉桂枝、芍药、甘草，加入杏仁、人参。
又一位患者，气逆导致咳嗽、呛咳、气喘急迫。
处方：淡干姜、人参、半夏、五味子、茯苓、细辛。
单姓患者，疮毒内攻入里，所进水谷不能消化，蒸变产生湿邪，浸渍于经络隧道之间，不能通过肠道下行，膀胱气化不利，浊气上壅遏阻，肺气不降，气喘胸闷严重到无法躺下睡觉。三焦闭塞，病情逐渐变得难以治疗。建议采用中满分消法，必须使小便通利，才可以挽救生命。
处方：葶苈子、苦杏仁、桑白皮、厚朴、猪苓、通草、大腹皮、茯苓皮、泽泻。
汪姓患者，脉象弦而坚劲，因动怒导致气冲，气喘急迫无法平卧休息。这是肝气升发太过，肺金肃降失职所致，两脚逆冷，傍晚时分症状加剧。建议采用张仲景的越婢汤法。（病机为肝气升发，饮邪上逆）
又诊：按压左侧胁部，冲气上逆即引发气喘，背部有一条线般的寒冷感，直贯双脚。这明显是肝气逆乱挟带支饮（停聚在胸胁的痰饮）所致。建议采用《金匮要略》中的旋复花汤法。
处方：旋复花、青葱管、新绛、炒半夏。
姜姓患者，劳累烦扰引发的哮喘，属于气虚。因为肺主气，是出气的脏腑。气出太多，只泄不收，则气散越多，气喘越甚。这是属于虚证的喘症。所以补益肺气的药物多用甘味，通过补脾胃（土）来滋生肺（金）。如果上气散失已久，耳目等窍道的阻滞，都是由于清阳之气失去了转旋的机能。不必逐一细致治疗。（病机为中气虚弱）用人参建中汤去掉生姜。
沈姓患者（二十三岁），早晨起床未进食时，气喘急促且多痰。这是因为整夜未进食，胃中空虚虚弱，阳气交升，中焦没有力量弹压，下焦阴液已伤，并延及胃部，难以期望立刻痊愈。（病机为胃虚）
处方：黄精、胡麻仁、炙甘草、茯苓。
吴姓患者，浑浊的饮邪从夜间上犯填塞，导致阳气不能旋转下降，冲逆之气使得无法安卧。使用张仲景的真武汤法。（病机为肾阳虚，浊饮上逆）
处方：人参、淡附子、生淡干姜、茯苓块、猪苓、泽泻。
徐姓患者（四十二岁），面色萎黄，腠理疏松，属于阳虚体质。平时喜欢吃肥甘厚味，导致上焦容易壅塞，中焦运化无力，浓味凝聚蒸腾成痰，常年咳嗽。但这是由于内伤导致的不调和，清淡饮食自然可以清肃肺气。医生使用皂荚搜刮痰浊，损伤了肺气导致气泄，喷嚏不止，而沉痼胶着的浊痰，仍然停留在胸背募穴俞穴之间。玉屏风散用于固护卫气，六君子汤用于健脾理痰，大多属于守成的方剂，不能宣通。只有小青龙汤，能彻除饮邪以就太阳经，初服时气喘缓解，符合通利的意思。但是太阳经只是开了，欠缺了通补阳明经的一段功夫，得不到阳明经的阖，暂时开通后又闭塞了。况且喘病的成因，在肺多为实证，在肾多为虚证。此病仔细诊察色脉，属于上实下虚，以致耳聋鸣响。治疗下焦的方法，以壮水之源来熄灭内风为主。而胸中清阳之气少有转旋，浊痰阻碍气机妨碍进食，所以在卧床时继续清肃上中二焦，用小剂量的方剂常规调理，计划百日见效。至于应付世俗事务，应当节省精力，不要耗费在药理研究上。（病机为肾气不纳）
处方：熟地黄（砂仁制）、山茱萸、龟甲心、阿胶、牛膝、茯苓、远志、五味子、磁石、秋石。
制成蜜丸，早上服用。睡前另服威喜丸，用竹沥、姜汁泛丸。
张姓患者（三十岁），幼年哮喘已经痊愈。去年夏天，因劳倦内伤致病。误认为是外感而胡乱治疗，导致气泄散失，哮喘声音嘶哑，劳倦不复原状，遂导致虚损怯弱。外感引起的喘症治肺，内伤引起的喘症治肾，因为肾主纳气。
处方：加减八味丸，每服二钱五分，盐汤送服，共六服。
胡姓患者（六十岁），脉象沉，短气呼吸，身体一动就气喘。这是下元已虚，肾气不能收摄，痰饮随地气上升。年事已高，突然发生中厥（中风昏厥），最为忧虑。
处方：熟地黄、淡附子、茯苓、车前子、远志、补骨脂。
吴姓患者，气不归元，气喘急促，足背浮肿，出冷汗，脚冷面赤，中焦痞结。先议通阳之法。
处方：熟附子、茯苓、生姜汁、生白芍。
王姓患者（十九岁），阴虚导致的喘呛。使用镇摄固纳之法。
处方：熟地黄、山茱萸、阿胶、淡菜胶、山药、茯神、湖莲、芡实。
翁姓患者（四十二岁），脉细尺部下垂，形体消瘦，食量减少，身体一动就气促气喘。大凡呼气不畅而喘的是肺病，多由外感引起。如今动则阳气化火，是由于阴弱失去纳气功能，乃吸气深入而引发喘症，这与肾病何异？治法唯有收摄固真，上部的病应当充实下焦，遵循肾气丸的方法意旨。
处方：熟地黄、山茱萸、五味子、补骨脂、胡桃肉、牛膝、茯苓、山药、车前子。
制成蜜丸。
沈姓患者（二十三岁），阴虚阳升，气不摄纳导致气喘。
处方：熟地黄、山茱萸、五味子、海参胶、淡菜胶、茯神、山药、芡实、湖莲肉、紫胡桃。
杨姓患者（六十一岁），老年久咳，身体一动就气喘，早晨起床喉舌干燥，夜间小便频急如淋。这是肾液已枯竭，气散失纳，这不是病，而是衰老。所以治疗喘症鲜有效果，大便困难干涸。根据肾恶燥的理论，用辛润之法。
处方：熟地黄、枸杞子、牛膝、巴戟天肉、紫衣胡桃、青盐、补骨脂。
陈氏，咳嗽气喘突然发作，身热汗出，这是阴阳枢纽不稳固，唯有收摄固元这一种方法。
处方：人参、炙甘草、五味子、紫衣胡桃、熟地黄、山茱萸炭、茯神、炒山药。
又诊：摄固之法颇为有效。
处方：人参、附子、五味子、炙黄芪、白术。
某患者，患有疮痍疥疾，导致气喘咳嗽出血痰。固然是肺壅热气，如今饮食二便正常，行动时气喘急促，与前次喘症更有分别。原因是高龄下虚，肾少摄纳，元气之海不固，气逆上泛，这是肿胀的萌芽。宜未雨绸缪，用六味丸加牛膝、车前子、胡桃。
孙姓患者，望诊发现年事已高，因冬温邪气内侵，导致痰嗽傍晚加重。诊脉大而动脉搏动，察色形枯汗泄，吸气声音颇急促，似乎属于痰阻。这其实是元气之海根微，不能司职藏纳，神衰呓语，阳气随汗而出，最有昏脱的变化。古人对于老年痰嗽喘症，都从脾肾主治。如今温邪扰乱，上中二焦留热，虽然没有温补的道理，然而摄固下焦真元以治根本，所谓阳根于阴，岂可不讲究。
处方：熟地黄炭、胡桃肉、牛膝炭、车前子、云茯苓、青铅。
某患者，热炽盛在心，上下不接，冲逆突然发作，遍身麻木，气喘急促昏冒。肾真不固，肝风妄动。久病汤药无功，暂以玉真丸主治。
喘症的成因，在肺为实证，在肾为虚证。先生揭示这两句话作为提纲。其区别有四类。大凡实而寒的，必定挟带凝痰宿饮，上干阻气，如小青龙汤、桂枝加厚朴杏子汤之类。实而热的，不外乎蕴伏的邪气，蒸痰化火，有麻杏甘膏汤、千金苇茎汤的治疗方法。虚的，有精伤和气脱的区别。填精要用浓厚的药剂，必须兼用镇摄，如肾气丸加沉香，都气丸入青铅，是从阴从阳的不同。气脱则根基浮越，吸伤元海，危亡可立而待。想到草木之无情，刚柔所难济助，则又有人参、河车、五味子、石英之类，急续元真，挽回顷刻。补天的治法，古所未及。还有中气虚弱，土不生金，则用人参建中汤。本案集共三十例，法凡十九种，其层次轻重之间，丝丝入扣，学人应当深玩味而得其中奥妙。（邵新甫评）
徐评：此篇关于治下的方法已经完备，治上的方法尚有许多遗漏，不可不讲求。
[Background Information]
Book: *Lin Zheng Zhi Nan Yi An* (Medical Cases Guided by Clinical Practice)
Author: Ye Gui (Ye Tianshi)
Dynasty: Qing
Chapter: Asthma (Chuan)
Category: Medical Discussion
[Translation]
A patient presented with initial aversion to cold followed by fever. There was no sensation of hunger and inability to eat. Subsequently, generalized edema, asthma, and choking cough developed. The patient could not lie on their back but could not bear lying flat either. Ancient texts state that asthma preceding distension is treated in the Lung, while distension preceding asthma is treated in the Spleen. In this case, the condition arises from Qi stagnation in the Qi level, leading to obstruction of the water passages, loose stools, and incomplete defecation. This is due to the failure of Lung Qi to descend, causing obstruction in the Large and Small Intestines. Dampness generated from the steaming and rotting of food and fluids spreads horizontally into the collaterals, causing gradual worsening of edema. Such a condition cannot be effectively treated by mediocre physicians. I briefly outline the general principles for discussion by experts. (Pathogenesis: Lung Qi stagnation, failure of Water Qi to descend)
The Lung is located at the highest position, governs Qi, and belongs to the Hand-Taiyin organ system. Its nature dislikes both cold and heat; pungent flavors promote circulation and unblockage, while slightly bitter flavors promote descent. If medicinal flavors are heavy and turbid, they will directly enter the Middle and Lower Jiao, which is not the method for diffusing the Lung. Therefore, the treatment of the Hand meridians differs significantly from that of the Foot meridians. It is pointed out here that contemporary practitioners often treat them indiscriminately.
Prescription: Ephedrae Herba (Mahuang), Coicis Semen (Yiyiren), Poria (Fuling), Armeniacae Semen Amarum (Xingren), Glycyrrhizae Radix et Rhizoma (Gancao).
Another patient presented with rebellious Qi causing cough, choking cough, and rapid breathing. Xiao Qing Long Tang (Minor Blue Dragon Decoction) was modified by removing Cinnamomi Ramulus (Guizhi), Paeoniae Radix (Shaoyao), and Glycyrrhizae Radix et Rhizoma (Gancao), adding Armeniacae Semen Amarum (Xingren) and Ginseng Radix (Renshen).
Another patient presented with rebellious Qi causing cough, choking cough, and urgent asthma.
Prescription: Dried Ginger (Ganjiang), Ginseng Radix (Renshen), Pinelliae Tuber (Banxia), Schisandrae Fructus (Wuweizi), Poria (Fuling), Asari Radix (Xixin).
Patient surnamed Shan presented with internal invasion of carbuncle toxins. Ingested food and fluids were not digested, transforming into damp-evil, soaking between the meridians and collaterals. Unable to descend through the intestines, the Bladder’s transformation was impaired, causing turbid Qi to obstruct upwards. Lung Qi failed to descend, resulting in severe asthma and chest fullness preventing sleep. The Triple Burner was blocked, and the condition gradually became incurable. It is proposed to use the method of resolving middle-jiao fullness (Zhong Man Fen Xiao), ensuring free urination to save the life.
Prescription: Lepidii Fructus (Tinglizi), Armeniacae Semen Amarum (Kuxingren), Morus Cortex (Sangpifu), Magnoliae Officinalis Cortex (Houpo), Polyporus (Zhu Ling), Akebiae Caulis (Tong Cao), Arecae Pericarpium (Dafupi), Poria Cum Ligno Quercus (Fulingpi), Alisma Rhizoma (Zexie).
Patient surnamed Wang presented with a wiry and firm pulse. Anger caused Qi rushing upward, resulting in urgent asthma preventing recumbency. This is due to excessive Liver Qi ascending and failure of Lung Qi to descend. Both feet were cold, worsening in the evening. It is proposed to use Zhang Zhongjing’s Yue Bi Fa (Method of Yue Bi Decoction). (Pathogenesis: Liver Qi ascending, Phlegm-Fluids counterflowing upward)
Re-examination: Pressing the left hypochondrium triggered rebellious Qi and asthma. A line of coldness on the back extended straight down to both feet. This clearly indicates Liver rebellion carrying Branch Fluids (Zhi Yin). It is proposed to use the Xuan Fu Hua Tang (Inula Flower Decoction) method from the *Jin Gui Yao Lue*.
Prescription: Inulae Flos (Xuanfuhua), Scallion Stem (Qingcong Guan), New Crimson Dye (Xinjiang), Stir-fried Pinelliae Tuber (Chao Banxia).
Patient surnamed Jiang presented with labor-induced asthma due to mental fatigue, belonging to Qi deficiency. The Lung governs Qi and is the organ of exhalation. Excessive exhalation without retention leads to dispersion and increased asthma. This type of asthma belongs to deficiency. Therefore, herbs tonifying Lung Qi are mostly sweet. Tonifying the Earth (Spleen) generates Metal (Lung). If Upper Qi has been dispersed for a long time, blockages in the orifices of the ears and eyes are due to the loss of clear Yang’s rotating mechanism. Detailed treatment is unnecessary. (Pathogenesis: Middle Qi deficiency) Use Ren Jian Zhong Tang (Ginseng Middle-Building Decoction) removing Ginger.
Patient surnamed Shen (23 years old) presented with urgent asthma and profuse phlegm upon waking before eating. This is due to fasting all night, causing empty and weak Stomach Qi. Yang Qi rises, but the Middle Jiao lacks pressure. Lower Jiao Yin is damaged, extending to the Stomach. Recovery cannot be expected immediately. (Pathogenesis: Stomach deficiency)
Prescription: Polygonati Rhizoma (Huangjing), Sesame Seed (Sanjiao Huma), Roasted Licorice Root (Zhicao), Poria (Fuling).
Patient surnamed Wu presented with turbid fluid invading upward from night, blocking Yang Qi from descending. Rebellious Qi prevents comfortable lying. Use Zhang Zhongjing’s Zhen Wu Fa (Method of Zhen Wu Decoction). (Pathogenesis: Kidney Yang deficiency, turbid fluid counterflowing upward)
Prescription: Ginseng Radix (Renshen), Prepared Aconite Root (Dan Shu Fuzi), Raw Dried Ginger (Sheng Dan Ganjiang), Poria Block (Fuling Kuai), Polyporus (Zhu Ling), Alisma Rhizoma (Zexie).
Patient surnamed Xu (42 years old) presented with sallow complexion and loose pores, indicating a Yang-deficient constitution. Habitually consuming rich foods led to upper Jiao congestion and poor middle Jiao transport. Rich flavors condensed into steaming phlegm, causing chronic cough. However, this is internal injury and disharmony; bland diet naturally clears the Lung. Physicians used Sinapis Semen (Zao Jiao) to scrape phlegm, damaging Lung Qi and causing continuous sneezing. Deep-seated turbid phlegm remains in the chest and back shu points. Yu Ping Feng San secures the defensive Qi, Liu Jun Zi Tang strengthens the Spleen and resolves phlegm; these are mostly static formulas lacking diffusion. Only Xiao Qing Long Tang thoroughly removes fluid to reach the Taiyang channel. Initial dose relieved asthma, fitting the principle of diffusion. However, Taiyang only opened, lacking the work of diffusing and tonifying Yangming. Without Yangming closing, temporary opening leads to re-obstruction. Asthma causes: excess in Lung, deficiency in Kidney. Careful diagnosis shows upper excess and lower deficiency, causing tinnitus. Treatment of the lower part focuses on nourishing water to extinguish internal wind. Clear Yang in the chest rotates little; turbid phlegm blocks Qi and appetite. At bedtime, continue clearing the Upper and Middle Jiao with small doses for routine regulation, aiming for results in 100 days. Save energy for worldly affairs, do not waste it on pharmacology. (Pathogenesis: Kidney Qi failing to grasp)
Prescription: Prepared Rehmannia Root (Shudi, processed with Amomum), Cornus Fruit (Yurou), Turtle Plastron Heart (Guijia Xin), Donkey-hide Gelatin (Ejiao), Achyranthes Root (Niuxi), Poria (Fuling), Polygala Root (Yuanzhi), Schisandra Fruit (Wuweizi), Magnetite (Cishi), Sea Salt (Qushi).
Make honey pills, take in the morning. Take Wei Xi Wan at bedtime, made into pills with Bamboo Sap and Ginger Juice.
Patient surnamed Zhang (30 years old) had childhood asthma cured. Last summer, labor-induced internal injury caused illness. Misdiagnosed as external contraction and treated incorrectly, leading to Qi dispersion, hoarse asthma, and failure to recover from labor, resulting in consumptive weakness. External contraction asthma is treated in the Lung; internal injury asthma is treated in the Kidney because the Kidney grasps Qi.
Prescription: Modified Ba Wei Wan (Eight-Ingredient Pill), 2.5 qian per dose, taken with salt water, six doses.
Patient surnamed Hu (60 years old) presented with a deep pulse, shortness of breath, and asthma upon movement. This indicates deficiency of the Lower Yuan, failure of Kidney Qi to retain, and phlegm-fluids rising with Earth Qi. Due to advanced age, sudden stroke (Zhong Jue) is feared.
Prescription: Prepared Rehmannia Root (Shudi), Mild Aconite Root (Dan Fuzi), Poria (Fuling), Plantago Seed (Cheqian), Polygala Root (Yuanzhi), Psoralea Fruit (Buguzhi).
Patient surnamed Wu presented with Qi not returning to its source, urgent asthma, dorsal edema, cold sweat, cold feet, and red face. Middle Jiao is obstructed. First discuss unblocking Yang.
Prescription: Prepared Aconite Root (Shu Fuzi), Poria (Fuling), Ginger Juice (Sheng Jiang Zhi), Raw White Peony Root (Sheng Baishao).
Patient surnamed Wang (19 years old) presented with Yin deficiency causing asthma and choking. Use sedation and consolidation methods.
Prescription: Prepared Rehmannia Root (Shudi), Cornus Fruit (Yurou), Donkey-hide Gelatin (Ejiao), Mussel Gelatin (Dan Cai Jiao), Chinese Yam (Shanyao), Poria Spirit (Fushen), Lotus Seed (Hulian), Euryale Seed (Qianshi).
Patient surnamed Weng (42 years old) presented with fine pulse, sinking at the Chi position, emaciation, and poor appetite. Movement causes shortness of breath and urgent asthma. Generally, difficulty exhaling with asthma indicates Lung disease, mostly from external pathogens. Now, movement transforms Yang due to weak Yin failing to grasp. Inhalation triggers asthma; how can this be anything other than Kidney disease? Treatment must focus on gathering and securing the True Qi. Upper disease should be treated by solidifying the Lower Jiao, following the intent of Shen Qi Wan.
Prescription: Prepared Rehmannia Root (Shudi), Cornus Fruit (Yurou), Schisandra Fruit (Wuweizi), Psoralea Fruit (Buguzhi), Walnut Meat (Hutaorou), Achyranthes Root (Niuxi), Poria (Fuling), Chinese Yam (Shanyao), Plantago Seed (Cheqianzi).
Make honey pills.
Patient surnamed Shen (23 years old) presented with Yin deficiency and Yang rising, Qi failing to grasp causing asthma.
Prescription: Prepared Rehmannia Root (Shudi), Cornus Fruit (Yurou), Schisandra Fruit (Wuweizi), Sea Cucumber Gelatin (Haishen Jiao), Mussel Gelatin (Dan Cai Jiao), Poria Spirit (Fushen), Chinese Yam (Shanyao), Euryale Seed (Qianshi), Lotus Seed Meat (Hulian Rou), Purple Walnut (Zi Hetao).
Patient surnamed Yang (61 years old) presented with chronic cough in old age, asthma upon movement, dry throat and tongue in the morning, and frequent urination like strangury at night. Kidney fluids are exhausted, Qi is dispersed and fails to grasp. This is not disease, but aging. Thus, treating asthma yields little effect. Constipation and dryness occur. Following the principle that the Kidney dislikes dryness, use acrid-moistening methods.
Prescription: Prepared Rehmannia Root (Shudi), Goji Berry (Qizi), Achyranthes Root (Niuxi), Morinda Root (Baji Rou), Purple-skin Walnut (Ziyi Hetao), Green Salt (Qingyan), Psoralea Fruit (Buguzhi).
Madam Chen presented with sudden cough and asthma, fever, and sweating. The pivot of Yin and Yang is insecure. Only the method of gathering and securing the Origin is applicable.
Prescription: Ginseng Radix (Renshen), Roasted Licorice Root (Zhicao), Schisandra Fruit (Wuweizi), Purple-skin Walnut (Ziyi Hetao), Prepared Rehmannia Root (Shudi), Charred Cornus Fruit (Yurou Tan), Poria Spirit (Fushen), Stir-fried Chinese Yam (Chao Shanyao).
Re-examination: Consolidation method showed good response.
Prescription: Ginseng Radix (Renshen), Aconite Root (Fuzi), Schisandra Fruit (Wuweizi), Roasted Astragalus Root (Zh Huangqi), Atractylodes Macrocephala Rhizome (Baizhu).
Another patient presented with skin sores and scabies, leading to asthma, cough, and blood-streaked phlegm. Although this is Lung congestion with heat, now digestion and excretion are normal, but movement causes urgent asthma, differing from previous asthma. Due to advanced age and lower deficiency, Kidney fails to grasp, and the Source Sea is insecure. Qi rebels and floods upward, marking the onset of swelling. Preventive measures are needed: Liu Wei Wan (Six-Ingredient Pill) added with Achyranthes Root (Niuxi), Plantago Seed (Cheqian), and Walnut.
Patient surnamed Sun, of advanced age, contracted Winter-Warmth pathogen internally, leading to worse phlegm-cough in the evening. Pulse is large and thready/beating. Complexion is withered with sweating. Inhalation sound is rapid, seemingly due to phlegm obstruction. Actually, the Root of the Source Sea is weak, failing to store and grasp. Spirit is depleted, muttering delirium, Yang escapes with sweat. Danger of collapse looms. Ancients treated elderly phlegm-cough-asthma primarily from Spleen and Kidney. Now warm evil disturbs, leaving heat in Upper and Middle Jiao. Although warming is not indicated, securing the Lower True Qi treats the root. Yang roots in Yin; this must be considered.
Prescription: Charred Prepared Rehmannia Root (Shudi Tan), Walnut Meat (Hutaorou), Charred Achyranthes Root (Niuxi Tan), Plantago Seed (Cheqianzi), Cloud Poria (Yun Fuling), Lead (Qingqian).
Another patient presented with intense Heat in the Heart, disconnection between Upper and Lower, sudden rebellious attack, numbness over the body, urgent asthma, and confusion. Kidney True Qi is insecure, Liver Wind moves recklessly. Long-term herbal medicine failed. Temporarily use Yu Zhen Wan.
The cause of asthma: Excess in Lung, Deficiency in Kidney. Mr. Ye highlights these two phrases as the outline. There are four distinctions. Generally, excess-cold carries congealed phlegm and retained fluid, obstructing Qi upwards, such as Xiao Qing Long Tang or Gui Zhi Hou Po Xing Zi Tang. Excess-heat involves latent pathogens steaming phlegm into fire, treated with Ma Xing Shi Gan Tang or Qian Jin Wei Jing Tang. Deficiency involves damage to Essence or depletion of Qi. Nourishing Essence requires thick agents combined with sedation, such as Shen Qi Wan adding Agaricum (Chenxiang), or Du Qi Wan adding Lead (Qingqian), differing in Yin and Yang approaches. Qi depletion means floating root, injuring the Source Sea; danger of death is imminent. Considering the insensitivity of herbs, hard and soft cannot easily assist, thus Ginseng, Placenta (Heche), Schisandra (Wuweizi), and Quartz (Shiying) are used to urgently restore True Qi. Heaven-mending therapy is unprecedented. For Middle Qi deficiency where Earth does not generate Metal, Ren Jian Zhong Tang is used. This collection has 30 cases, 19 methods, meticulously layered and graded. Students should deeply ponder to understand. (Commentary by Shao Xinpu)
Xu’s Commentary: The methods for treating the Lower Jiao in this chapter are complete, but methods for treating the Upper Jiao have many omissions and must be studied.