咳者,俗呼为嗽,肺为邪气逆不下,有肺寒而咳,有停饮而咳,有半表半里而咳,各治不同。
太阳病,身热咳嗽,干呕,微喘而利,小青龙汤。身凉咳嗽,干呕而利,心下满引胁痛,十枣汤。
四肢重痛,腹疼下利,咳嗽,或呕,真武汤。少阴病,咳嗽四逆,腹痛下利,或悸,四逆散加五味
子、干姜。少阳病,往来寒热,胸满痛,满而咳,小柴胡汤。咳而呕满喘急,大半夏汤也。
喘者,有邪在表而喘,有邪在里而喘,有水气而喘。在表者,心腹濡而不坚,外证无汗,法当
汗之。在里者,心腹胀满,外证有汗,法当下之。水气喘者,心下
怔忡,青龙去麻黄加杏仁汤。太阳阳明合病,脉促,有汗而喘者,葛根黄芩汤治之。经云∶喘而汗
出,宜利之。汗不出而喘,宜发之。其或直视谵语,汗出如油,喘而不休,死证也。
气逆者,气自腹中时逆上冲也。因太阳病下之,表邪乘虚传里,里不受邪,则气逆上行而邪在
表也,当汗之,桂枝汤;不上冲者,勿与之。厥阴客热上冲,此热在里而气上也,大柴胡汤下之。
病缓虚羸少气,气逆上冲欲吐者,竹叶石膏汤。有动气,因发汗而气上,李根汤。二者皆正气虚而
邪气逆也。
短气者,呼吸不相接续也。大抵心腹胀满而短气者,邪在里而为实,宜下之,承气汤。心腹濡
满而短气者,邪在表而为虚也,宜解之,桂枝汤。食少饮多,水停
心下,短气者,小半夏汤。风湿相搏,汗出短气,小便不利,恶风不欲去衣,邪气在表,甘草附子
汤。太阳证,误下之,短气,懊 烦躁,为结胸者,大陷胸汤治也。
咳嗽,俗称“嗽”,是由于肺气被邪气逆乱而不能肃降所致。其中有的属于肺寒引起的咳嗽,有的是因水饮停聚引起的咳嗽,有的是因病在半表半里引起的咳嗽,治疗方法各不相同。
太阳病(太阳经受邪所致的病证),表现为身体发热、咳嗽、干呕、轻微气喘并伴有腹泻,用小青龙汤治疗。若身体发凉、咳嗽、干呕并伴有腹泻,且胃脘部胀满牵引胁肋疼痛,用十枣汤治疗。
四肢沉重疼痛,腹部疼痛并伴有腹泻、咳嗽,或者呕吐,用真武汤治疗。少阴病(少阴经受邪所致的病证),表现为咳嗽、四肢厥冷、腹痛腹泻,或者心悸,用四逆散加五味子、干姜治疗。少阳病(少阳经受邪所致的病证),表现为忽冷忽热、胸胁胀满疼痛,胀满而咳嗽,用小柴胡汤治疗。若咳嗽伴呕吐、胸满气喘急促,用大半夏汤治疗。
喘证,有的是邪气在体表导致的喘,有的是邪气在体内导致的喘,有的是因水气上犯导致的喘。邪在体表的,心腹部柔软而不坚硬,外部症状为无汗,治法应当发汗。邪在体内的,心腹部胀满,外部症状为有汗,治法应当攻下。因水气导致的喘,表现为胃脘部悸动不安,用去麻黄的青龙汤加杏仁治疗。太阳病与阳明病同时发病,脉象急促,有汗且气喘的,用葛根黄芩黄连汤治疗。医经说:气喘且出汗的,适宜用利小便的方法;不出汗而气喘的,适宜用发汗的方法。如果出现两眼直视、胡言乱语、出汗如油珠般粘腻、气喘不停息的情况,属于死证。
气逆,是指气从腹中不时向上冲撞。因为太阳病误用泻下法,表邪乘虚传入体内,体内不能承受邪气,导致气逆上行而邪气仍在体表,应当发汗,用桂枝汤;如果气不上冲的,不要给予此药。厥阴病客热上冲,这是热邪在体内而气机上逆,用大柴胡汤攻下。病情缓和、身体虚弱消瘦、气息短少、气逆上冲想呕吐的,用竹叶石膏汤治疗。若有动气(脐周悸动),因发汗导致气上逆,用李根汤治疗。这两种情况都是正气虚弱而邪气上逆所致。
短气,是指呼吸不连续、接不上气的感觉。大致而言,心腹胀满而短气的,是邪气在体内属于实证,适宜用攻下法,用承气汤。心腹柔软胀满而短气的,是邪气在体表属于虚证,适宜用解表法,用桂枝汤。饮食减少饮水过多,水饮停聚在心下(胃脘部),导致短气的,用小半夏汤治疗。风湿相搏结,出汗后短气,小便不利,怕风不想脱衣,邪气在体表,用甘草附子汤治疗。太阳病证,误用泻下法,导致短气、心中烦闷躁扰不安,形成结胸证的,用大陷胸汤治疗。
Cough, commonly referred to as "sou," occurs when lung qi is reversed by pathogenic factors and fails to descend. It may be caused by cold in the lungs, retained fluid, or a condition at the half-exterior and half-interior level; each requires different treatment.
In Taiyang disease (disease of the Taiyang channel), characterized by fever, cough, dry retching, slight wheezing, and diarrhea, Xiao Qinglong Tang (Minor Blue Dragon Decoction) is indicated. If there is coolness of the body, cough, dry retching, diarrhea, fullness in the epigastrium radiating to the hypochondrium, Shizao Tang (Ten Jujube Decoction) is indicated.
For heavy and painful limbs, abdominal pain with diarrhea, cough, or vomiting, Zhenwu Tang (True Warrior Decoction) is indicated. In Shaoyin disease (disease of the Shaoyin channel), presenting with cough, cold extremities, abdominal pain with diarrhea, or palpitations, Sini San (Frigid Extremities Powder) added with Wuweizi (Schisandra Fruit) and Ganjiang (Dried Ginger) is indicated. In Shaoyang disease (disease of the Shaoyang channel), presenting with alternating chills and fever, chest and hypochondriac fullness and pain, fullness with cough, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated. For cough with vomiting, chest fullness, and rapid wheezing, Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction, often referred to as Da Banxia Tang in this context) is indicated.
Wheezing (Asthma/Dyspnea) may result from pathogens in the exterior, pathogens in the interior, or water qi. When pathogens are in the exterior, the heart and abdomen are soft and not hard, and the external sign is absence of sweating; the method should be diaphoresis. When pathogens are in the interior, the heart and abdomen are distended and full, and the external sign is presence of sweating; the method should be purgation. For wheezing due to water qi, presenting with palpitations in the epigastrium, Qinglong Tang (Blue Dragon Decoction) without Mahuang (Ephedrae Herba) plus Xingren (Armeniacae Semen) is indicated. In concurrent Taiyang and Yangming diseases, with a rapid pulse, sweating, and wheezing, Gegen Qinlian Tang (Kudzu and Coptis Decoction) is used. The classics state: for wheezing with sweating, it is appropriate to promote urination; for wheezing without sweating, it is appropriate to induce sweating. If there is staring eyes, delirium, sweating like oil, and ceaseless wheezing, it is a death syndrome.
Qi rebellion refers to qi surging upward from the abdomen intermittently. This can occur because Taiyang disease was incorrectly treated with purgation, allowing exterior pathogens to transmit inward due to deficiency; if the interior cannot accept the pathogens, qi rebels upward while pathogens remain in the exterior, requiring diaphoresis with Guizhi Tang (Cinnamon Twig Decoction); if there is no surging sensation, do not administer it. In Jueyin disease, guest heat surges upward, indicating heat in the interior with rebellious qi, treated with Daxiehu Tang (Major Bupleurum Decoction) via purgation. For mild illness with emaciation, shortness of qi, rebellious qi surging upward with desire to vomit, Zhuyeshi Gao Tang (Bamboo Leaf and Ginseng Decoction) is indicated. For "moving qi" (palpitations around the umbilicus) where sweating induced qi rebellion, Licgen Tang (Plum Root Decoction) is indicated. Both cases involve deficiency of healthy qi and rebellion of pathogenic qi.
Shortness of breath refers to discontinuous respiration. Generally, shortness of breath with abdominal distension and fullness indicates pathogens in the interior constituting an excess syndrome, suitable for purgation with Chengqi Tang (Order the Qi Decoction). Shortness of breath with soft abdominal distension indicates pathogens in the exterior constituting a deficiency syndrome, suitable for resolving the exterior with Guizhi Tang (Cinnamon Twig Decoction). Shortness of breath due to poor appetite, excessive drinking, and water retention in the epigastrium is treated with Xiaobanxia Tang (Minor Pinellia Decoction). For rheumatism with binding, sweating, shortness of breath, difficulty in urination, aversion to wind, and reluctance to remove clothing, indicating pathogens in the exterior, Gancao Fuzi Tang (Licorice and Aconite Decoction) is indicated. In Taiyang syndrome, incorrect purgation leading to shortness of breath, vexation, and restlessness, forming a Chest Bind (Jie Xiong) syndrome, is treated with Daxianxiong Tang (Major Fall into the Chest Decoction).