喘之病。方书皆名哮吼。为其声之恶也。此因误啖盐酱咸物。抟结津液。熬煎成痰。胶粘固结。聚于肺络。
不容呼吸出入。而呼吸正气反触其痰。所以喘声不止也。肺有痰热。毛窍常开。热气得以外泄。所以伏而不发。
一遇秋冬寒气外束。邪热不得宣通。故令发喘。脉来浮数。滑大者。宜用定喘汤。发去标邪。再用加减鸡鸣丸。
常常服之。自可除根。每日饮食只宜清淡。不宜浓浓。盖人身之痰。不能自动。必随脾之健运。贮于肺络。结为窠
囊积饮。如蜂子之穴于房中。莲实之嵌于蓬内。生长则易。而剥落则难。全要胃气清虚。则痰之上注者。得以返还
于胃。然后可从口而上越。或从肠而下达。今人肥甘浓味。日不绝口。兼之饮食不节。虽有医药。庸有济乎。此乃气分
之病。或有传于血分。而为喘急失血者。先吐痰后见血。犹为积热。先吐血后吐痰者。阴虚火动。照根据怯症调治。
一切燥药。毫不可尝。推而广之。 病属热者固多。而肺寒者亦有。不可泥定是热。凡脾胃虚寒。气不能运。积成
冷痰。上注于肺。亦成 喘。其人四肢厥冷。脉沉细缓。按之无力。即其候也。
宜用六君子汤。加款冬金沸杏仁炮姜治之。但热者多。而寒者少。又不可不察耳。
喘之病。痰火为本。而外感内伤之因。所触不同。未可以一端尽也。寒伤肺喘。脉必数大。可用定喘汤散风伤肺
喘脉必细缓。自汗恶风。宜用参苏饮解之。因于气者。其脉必沉。因于食者。脉必弦滑。因于色者。脉沉细数。治
之又有不同。今人一遇是症。便以定喘为主。何致胶固若此耶。
定喘汤
半夏 杏仁 冬花 苏子 桑皮 麻黄 甘草 黄芩 白果 青铅 生姜
加减鸡鸣丸
陈皮(一两) 半夏(四钱) 白茯(一两) 甘草(五钱) 贝母(一两) 栝蒌霜(一两)
冬花(一两) 天冬(二两) 黄芩(一两) 知母(一两) 桔梗(一两) 枇杷叶(五钱) 玄明粉(三钱)
炼蜜为丸。
喘证这一疾病,医方书籍中通常称为“哮吼”,是因为其声音令人厌恶的缘故。这是由于误食盐、酱等咸味食物,导致津液凝结,煎熬而成痰浊。痰浊胶粘固结,积聚在肺部的络脉中,阻碍了呼吸之气的出入,而呼吸的正气反而触动痰浊,所以喘息的声音不止。肺部有痰热时,毛孔常处于开放状态,热气得以向外宣泄,因此病邪潜伏而不发作。一旦遇到秋冬季节的寒气从外部束缚肌表,体内的邪热就不能宣通发散,从而导致喘息发作。此时脉象浮数、滑大,适宜使用定喘汤,以祛除标急之邪,然后再服用加减鸡鸣丸,经常服用,自然可以除根。每日饮食只宜清淡,不宜浓腻厚重。因为人体内的痰浊,不能自行移动,必须随着脾脏健运的功能,输送并储存在肺络中,结成窠囊和积饮,就像蜂子在蜂巢中筑巢,莲子嵌在莲蓬内一样,容易生长形成,却难以剥落清除。这完全依赖于胃气保持清虚的状态,那么上注于肺的痰浊,才能返还到胃中,然后可以从口腔向上吐出,或者从肠道向下排泄。现在的人肥甘厚味不断口,加上饮食没有节制,即使有医药治疗,又有什么用呢?这是属于气分的疾病,有的会传入血分,出现喘息急促且伴有失血的症状。如果是先吐痰后见血,还属于积热所致;如果是先吐血后吐痰,则是阴虚火动,应当根据虚劳怯症进行调治。一切燥热性质的药物,丝毫不可食用。推而广之,属于热证的固然很多,但肺寒的情况也存在,不能固执地认定都是热证。凡是脾胃虚寒,气机不能运化,积结成冷痰,上注于肺,也会形成喘息。这类患者四肢厥冷,脉象沉细缓,按之无力,这就是其征候。适宜使用六君子汤,加入款冬花、金沸草、杏仁、炮姜来治疗。但是热证多而寒证少,这一点又不可不仔细考察。
喘证这一疾病,以痰火为本,而外感或内伤的原因,所触发的情况不同,不可以用单一的观点来概括。寒气伤肺导致的喘息,脉象必定数大,可以使用定喘汤疏散风邪;伤肺导致的喘息(此处原文似有脱漏,结合语境应指另一种外感或特定类型,原文为“散风伤肺喘”),脉象必定细缓,伴有自汗、恶风,适宜使用参苏饮解表。因情志气郁导致的,脉象必定沉;因饮食停滞导致的,脉象必定弦滑;因房事过度(色欲)导致的,脉象沉细数。治疗方法又有不同。现在的人一遇到这种症状,就以定喘汤为主药,为何如此胶固不变呢?
定喘汤
半夏 杏仁 冬花 苏子 桑皮 麻黄 甘草 黄芩 白果 青铅 生姜
加减鸡鸣丸
陈皮(一两) 半夏(四钱) 白茯(一两) 甘草(五钱) 贝母(一两) 栝蒌霜(一两)
冬花(一两) 天冬(二两) 黄芩(一两) 知母(一两) 桔梗(一两) 枇杷叶(五钱) 玄明粉(三钱)
用炼蜜制成丸剂。
The disease of panting (Chuan) is named "Xiao Hou" (wheezing and roaring) in medical formularies because of its unpleasant sound. This condition arises from mistakenly consuming salty foods such as salt and soy sauce, which causes body fluids to congeal and be scorched into phlegm. The phlegm becomes sticky and firmly consolidated, accumulating in the lung collaterals. It obstructs the entry and exit of respiration, and the righteous qi of respiration instead touches the phlegm, causing the sound of panting to ceaselessly continue. When there is phlegm-heat in the lungs, the hair follicles are often open, allowing heat qi to dissipate outward; thus, the pathogen remains latent and does not manifest. Once exposed to cold air in autumn or winter that binds the exterior, the internal pathogenic heat cannot be vented and unblocked, thereby triggering an attack of panting. If the pulse is floating, rapid, slippery, and large, Ding Chuan Tang (Stabilize Panting Decoction) should be used to dispel the superficial pathogenic factors, followed by regular administration of Jianding Jiming Wan (Modified Rooster-Crowing Pill) to eradicate the root cause. Daily diet should be light and bland, not rich and heavy. Phlegm in the human body cannot move on its own; it must follow the spleen's robust transportation function, be stored in the lung collaterals, and form nests and accumulated fluid retention, similar to bees nesting in a hive or lotus seeds embedded in a lotus pod. These are easy to grow but difficult to remove. This entirely depends on the stomach qi remaining clear and empty, so that phlegm pouring upward into the lungs can return to the stomach, and then be vomited out through the mouth or discharged downward through the intestines. Nowadays, people constantly consume rich, sweet, and fatty foods and lack dietary moderation. Even with medical treatment, what use would it be? This is a disease of the qi level. Some may transmit to the blood level, resulting in urgent panting and hemorrhage. If phlegm is expectorated first and then blood appears, it still belongs to accumulated heat. If blood is vomited first and then phlegm, it indicates yin deficiency with fire hyperactivity, and treatment should follow the principles for treating consumptive diseases (Qie Zheng). All drying drugs must be strictly avoided. Extending this logic, while many cases belong to heat, lung cold also exists; one must not rigidly assume all cases are heat. Whenever spleen and stomach deficiency-cold occurs, qi fails to transport, leading to the accumulation of cold-phlegm that pours upward into the lungs, also forming panting. Such patients present with cold extremities, a deep, fine, slow pulse that is powerless upon pressure, which are their signs. Liujunzi Tang (Six Gentlemen Decoction) added with Kuandonghua (Adenophora Flower), Jinfeicao (Boiling Boil Herb), Xingren (Apricot Seed), and Paojiang (Prepared Ginger) should be used for treatment. However, since heat cases are more common than cold cases, this distinction must not be overlooked.
In the disease of panting, phlegm-fire is the root, but the causes triggered by external contraction or internal injury differ, so it cannot be summarized by a single aspect. For panting caused by cold injuring the lungs, the pulse must be rapid and large; Ding Chuan Tang can be used to disperse wind and treat lung injury. For panting caused by wind injuring the lungs, the pulse must be fine and slow, accompanied by spontaneous sweating and aversion to wind; Shen Su Yin (Ginseng and Perilla Drink) should be used to resolve the exterior. For those caused by qi stagnation, the pulse must be deep. For those caused by food stagnation, the pulse must be wiry and slippery. For those caused by sexual excess, the pulse is deep, fine, and rapid. The treatments differ accordingly. Nowadays, when people encounter this symptom, they insist on using Ding Chuan Tang as the primary formula; why are they so rigid?
Ding Chuan Tang (Stabilize Panting Decoction)
Banxia (Pinelliae Rhizoma)
Xingren (Armeniacae Semen Amarum)
Donghua (Adenophorae Flos)
Suzi (Perillae Fructus)
Sangpi (Mori Cortex)
Mahuang (Ephedrae Herba)
Gancao (Glycyrrhizae Radix et Rhizoma)
Huangqin (Scutellariae Radix)
Baiguo (Ginkgonis Semen)
Qingqian (Lapis Plumbi)
Shengjiang (Zingiberis Rhizoma Recens)
Jianding Jiming Wan (Modified Rooster-Crowing Pill)
Chenpi (Citri Reticulatae Pericarpium, 1 liang)
Banxia (Pinelliae Rhizoma, 4 qian)
Baifu (Poria, 1 liang)
Gancao (Glycyrrhizae Radix et Rhizoma, 5 qian)
Beimu (Fritillariae Cirrhosae Bulbus, 1 liang)
Gualu Shuang (Trichosanthis Fructus Pulvis, 1 liang)
Donghua (Adenophorae Flos, 1 liang)
Tiantong (Asparagi Radix, 2 liang)
Huangqin (Scutellariae Radix, 1 liang)
Zhimu (Anemarrhenae Rhizoma, 1 liang)
Jiegeng (Platycodonis Radix, 1 liang)
Pipaye (Eriobotryae Folium, 5 qian)
Xuanmingfen (Natrii Sulfas Exsiccatus, 3 qian)
Made into pills with refined honey.