因虚 气虚火入肺;阴虚火起冲上;肺虚必咽干无津,少气不足以息也;肾
虚,先觉呼吸短气,两胁胀满,左尺大而虚者是,治宜补肾。
因实 有痰、有水气乘肺;气实肺盛,呼吸不利,肺气壅滞,右寸沉实者
是,其肺必胀,上气喘逆,咽中如塞、如呕状,自汗,治宜泻肺。
因邪 由肺感寒邪,伏于肺经,关窍不通,呼吸不利,右寸沉而紧,亦有六
部俱伏者,发散则身热退而喘定。
方∶
气虚 人参 黄柏(蜜炙) 麦门冬 地骨皮。
阴虚 四物加黄连。有痰加枳壳、半夏(阴则血也)。
痰 二陈汤加南星、枳壳、皂角。
神秘方 治水气逆,上乘肺,肺浮而气不通,其脉沉大,不卧者是,卧则喘也。
紫苏子 陈皮 桑白皮 生姜 茯苓 人参(五钱) 木香(二钱)
上 咀煎服。
泻白散 治阴气在下,阳气在上,咳呕喘逆。
桑白皮 地骨皮 青皮 五味 甘草 人参 茯苓 杏仁
痰加半夏、桔梗。
劫喘 治喘甚不可用苦寒药者,以温劫之。
椒目 为末姜汤下。
又 萝卜子(炒) 皂角(烧存性) 姜汁丸噙化。
又 大黄 牵牛(炒) 蜜水下二钱。
猪 丸 治喘,年深或作或止。
雄猪 一个,如食法,入杏仁五两,线缝其口,醋三碗煮干,先食 ,次以
杏仁新瓦上焙干,捻去皮,旋食,永不作。
分论咳嗽喘息
咳者 无痰有声,喉中如痒,习习如梗,甚者续续不止连连不已,冲击
膈间,外有心咳一切血证肺咳上逆者是。
嗽者 有痰。外有劳瘵喘促嗽血者是肺痿。
喘者 促促而气急,喝喝而息数,张口抬肩,摇身滚肚,外有香港脚。
气逆者 但气上而奔急。外有肺中风、肺中寒、肺中暑、肺水、肺热、肝热、胆寒、
心热、肠痹、痰水。
短气者 呼吸虽数而不能相续,似喘而不摇肩,似呻吟而无痛。外有脾中
风、肺热、肾热虚、历节风、忧气、胸痞、痰饮、短气。
脉寸口沉,胸中短气,辟大而滑中有短气;浮而绝者气微弱者,少气。
因虚证:气虚导致火邪侵入肺脏;阴虚导致虚火上冲。肺虚必然出现咽喉干燥、无津液,气息短少不足以呼吸的症状;肾虚则先感到呼吸短促,两胁胀满,左尺脉大而虚的属于此类,治疗应当补肾。
因实证:有痰饮、水气犯肺;气实肺盛,呼吸不畅,肺气壅滞,右寸脉沉实的属于此类,其肺部必然胀满,上气喘逆,咽喉中感觉堵塞、像呕吐的样子,伴有自汗,治疗应当泻肺。
因邪证:由肺感受寒邪,潜伏在肺经,关窍不通,呼吸不畅,右寸脉沉而紧,也有六部脉都伏匿的情况,通过发散(解表)则身热退去而喘息平息。
方剂:
气虚证:人参、黄柏(蜜炙)、麦门冬、地骨皮。
阴虚证:四物汤加黄连。有痰者加枳壳、半夏(阴虚则血燥)。
痰证:二陈汤加天南星、枳壳、皂角。
神秘方:治疗水气上逆,上乘于肺,肺浮而气机不通,脉象沉大,不能平卧的患者,平卧则喘息加重。紫苏子、陈皮、桑白皮、生姜、茯苓、人参(五钱)、木香(二钱)。以上药物切碎煎服。
泻白散:治疗阴气在下,阳气在上,咳嗽呕吐,气喘逆乱。桑白皮、地骨皮、青皮、五味子、甘草、人参、茯苓、杏仁。有痰者加半夏、桔梗。
劫喘方:治疗喘息严重不可使用苦寒药的患者,用温性药物以劫夺病邪。椒目研为末,姜汤送服。
又方:萝卜子(炒)、皂角(烧存性),姜汁为丸含化。
又方:大黄、牵牛子(炒),蜜水送服二钱。
猪丸:治疗喘息,病程长久或发作或停止。雄猪一头,按食用方法处理,放入杏仁五两,用线缝住口,用三碗醋煮干,先吃猪肉,再吃杏仁,在新瓦上焙干,去皮后随即食用,永不复发。
分论咳嗽与喘息
咳:无痰而有声音,喉中发痒,感觉如异物梗塞,严重时连续不断,冲击膈间,外有心咳及一切血证、肺咳上逆的情况。
嗽:有痰。外有劳瘵引起的喘促、嗽血,属于肺痿。
喘:呼吸急促,气息频数,张口抬肩,摇动身体,滚动腹部,外有香港脚(脚气病)。
气逆:仅表现为气机上奔急迫。外有肺中风、肺中寒、肺中暑、肺水、肺热、肝热、胆寒、心热、肠痹、痰水等情况。
短气:呼吸虽然频繁但不能相续,像喘但不摇动肩膀,像呻吟但没有疼痛。外有脾中风、肺热、肾热虚、历节风、忧气、胸痞、痰饮、短气等情况。
脉象:寸口脉沉,胸中短气,脉辟大而滑中有短气感;脉浮而绝者,气微弱,属于少气。
Due to Deficiency: Qi deficiency leads to fire invading the Lung; Yin deficiency causes deficient fire to rush upward. Lung deficiency inevitably results in dry throat without fluids, and shortness of breath insufficient for respiration; Kidney deficiency first manifests as shortness of breathing and distension/fullness in both hypochondria. If the left Chi pulse is large and empty, it belongs to this category, and treatment should focus on tonifying the Kidney.
Due to Excess: There may be phlegm or water qi attacking the Lung; Qi excess with Lung hyperactivity causes difficult breathing and Lung Qi stagnation. If the right Cun pulse is deep and solid, it belongs to this category. The Lung will necessarily be distended, with upper body asthma and counterflow, a sensation of blockage in the throat resembling vomiting, accompanied by spontaneous sweating. Treatment should focus on purging the Lung.
Due to Pathogenic Factors: Cold pathogenic factors are contracted by the Lung and lie latent in the Lung meridian, blocking the orifices and causing difficult breathing. The right Cun pulse is deep and tight, or all six positions of the pulse may be hidden. Dispersing (releasing the exterior) will cause the body heat to subside and the asthma to settle.
Formulas:
For Qi Deficiency: Ren Shen (Ginseng Radix), Huang Bo (Phellodendri Cortex, honey-fried), Mai Men Dong (Ophiopogonis Tuber), Di Gu Pi (Lycii Cortex).
For Yin Deficiency: Si Wu Tang (Four Substances Decoction) added with Huang Lian (Coptidis Rhizoma). If there is phlegm, add Zhi Ke (Aurantii Fructus) and Ban Xia (Pinelliae Tuber) (Yin deficiency implies blood dryness).
For Phlegm: Er Chen Tang (Two Aged Substances Decoction) added with Nan Xing (Arisaematis Rhizoma), Zhi Ke (Aurantii Fructus), and Zao Jiao (Gleditsiae Spina).
Mysterious Formula: Treats counterflow of water qi ascending to the Lung, where the Lung floats and Qi mechanism is blocked. The pulse is deep and large, and the patient cannot lie down; lying down exacerbates the asthma. Zi Su Zi (Perillae Fructus), Chen Pi (Citri Reticulatae Pericarpium), Sang Bai Pi (Mori Cortex), Sheng Jiang (Zingiberis Rhizoma Recens), Fu Ling (Poria), Ren Shen (Ginseng Radix, 5 qian), Mu Xiang (Aucklandiae Radix, 2 qian). The above herbs are chopped and decocted for oral administration.
Xie Bai San (Drain White Powder): Treats Yin qi below and Yang qi above, resulting in cough, vomiting, asthma, and counterflow. Sang Bai Pi (Mori Cortex), Di Gu Pi (Lycii Cortex), Qing Pi (Citri Reticulatae Pericarpium Viride), Wu Wei Zi (Schisandrae Fructus), Gan Cao (Glycyrrhizae Radix et Rhizoma), Ren Shen (Ginseng Radix), Fu Ling (Poria), Xing Ren (Armeniacae Semen Amarum). If there is phlegm, add Ban Xia (Pinelliae Tuber) and Jie Geng (Platycodonis Radix).
Jie Chuan Formula (Seizing Asthma Formula): For severe asthma where bitter-cold medicines cannot be used, use warm medicines to seize and eliminate the pathogen. Jiao Mu (Zanthoxyli Semen) ground into powder, taken with Ginger Decoction.
Another Formula: Luo Bo Zi (Brassicae Semperfoliorum Semen, stir-fried), Zao Jiao (Gleditsiae Spina, burnt to retain character), made into pills with Ginger Juice for holding in the mouth to dissolve.
Another Formula: Da Huang (Rhei Radix et Rhizoma), Qian Niu (Pharbitidis Semen, stir-fried), taken with Honey Water, 2 qian per dose.
Zhu Wan (Pig Pill): Treats asthma that has persisted for years, occurring intermittently. One male pig, prepared for consumption, with 5 liang of Xing Ren (Armeniacae Semen Amarum) inserted inside, the mouth sewn shut with thread, boiled dry in three bowls of vinegar. First eat the pork, then eat the Xing Ren, which has been dried on a new tile, rubbed to remove the skin, and consumed immediately. This prevents recurrence forever.
Discussion on Cough and Asthma separately
Cough (Ke): No phlegm but with sound, itching in the throat, feeling like an obstruction. In severe cases, it continues incessantly, impacting the diaphragm. Externally, there are conditions such as Heart Cough and all blood syndromes associated with Lung Cough counterflow.
Sputtering (Sou): With phlegm. Externally, there are conditions such as consumptive disease (Lao Zhai) causing rapid breathing and hemoptysis, which belong to Lung Flaccidity (Fei Fei).
Asthma (Chuan): Rapid and urgent breathing, frequent sighing, opening the mouth and raising the shoulders, shaking the body, and rolling the abdomen. Externally, there is Hong Kong Foot (Jiao Qi / Beriberi).
Qi Counterflow (Qi Ni): Only manifests as Qi rushing upward urgently. Externally, there are conditions such as Wind-stroke of the Lung, Cold in the Lung, Summerheat in the Lung, Lung Water, Lung Heat, Liver Heat, Gallbladder Cold, Heart Heat, Intestinal Bi, and Phlegm-Water.
Shortness of Breath (Duan Qi): Breathing is frequent but cannot continue smoothly. It resembles asthma but without shoulder movement; it resembles groaning but without pain. Externally, there are conditions such as Wind-stroke of the Spleen, Lung Heat, Kidney Heat Deficiency, Li Jie Feng (Gout-like joint pain), Worry Qi, Chest Stagnation, Phlegm-Fluid, and Shortness of Breath.
Pulse: Cun Kou pulse is deep, with shortness of breath in the chest; the pulse is wide and slippery with a sense of shortness of breath within; if the pulse is floating and interrupted, Qi is weak, belonging to Little Qi (Shao Qi).