凡病未有不发热,不生痰者。是痰与热,乃杂病兼见之症,似无容专立法门矣。然而有
杂病轻而痰饮重,则专以痰饮为主治。书有五痰之名,以五脏分主之也;五饮之名,随症见
也。其实犹未确当,大抵痰以燥湿为分;饮以表里为别。湿痰滑而易出,多生于脾,脾实则
消之,二陈汤,甚则滚痰丸;脾虚则补之,六君子汤。兼寒、兼热,随症加药。燥痰涩而难
出,多生于肺,肺燥,则润之,贝母栝蒌散。肺受火刑,不能下降以致真水上泛,则滋其阴
六味丸。饮有在表者,干呕,发热而咳,面目、四肢浮肿,香苏五皮散。饮有在里者,或
停心下,或伏两腋,咳则相引而痛,或走肠间,辘辘有声,用小半夏加茯苓汤,随其部位而
分治之。此治痰饮之大法也。书云∶治痰须理脾,以痰属湿,脾土旺则能胜湿耳。治痰如此
饮亦宜然。然脾经痰饮,当健脾以祛其湿。若肾虚水泛,为痰为饮者,必滋其肾。肾水不
足,则用六味;若命门真火衰微,寒痰上泛者,则用八味肾气丸,补火生土,开胃家之关,
导泉水下流而痰饮自消矣。
半夏 茯苓 陈皮(去白,各一钱) 甘草(炙,五分
生姜二片,大枣二枚,煎服。加人参,白术各一钱,名六君子汤。
治实热老痰,变生怪症。
大黄(蒸片刻) 黄芩(炒,各四两) 青礞石(硝 金色) 沉香(细锉,各三钱) 辰砂(细研
水飞,二钱
水迭为丸,辰砂为衣。每服一、二钱,开水下。此药但取痰积,并不刮肠大泻,为老痰
凡是疾病,没有不发热、不生痰的。因此,痰与热是杂病中经常同时出现的症状,似乎没有必要专门设立治疗法则了。然而,如果杂病较轻而痰饮较重,就应当专门以治疗痰饮为主。医书中有“五痰”的名称,是按照五脏来分别主属的;也有“五饮”的名称,是根据症状表现来命名的。但实际上这些分类还不够确切,大体上而言,痰以燥和湿作为区分;饮以表证和里证作为区别。
湿痰质地滑利且容易咳出,多产生于脾脏。脾气实(邪气盛)时则消导之,使用二陈汤;病情严重时使用滚痰丸;若脾气虚则补益之,使用六君子汤。兼有寒邪或热邪的,根据具体症状添加药物。燥痰质地干涩且难以咳出,多产生于肺脏。肺脏干燥时,则予以滋润,使用贝母栝蒌散。若肺受火邪刑克,不能肃降导致真水上泛,则滋补肾阴,使用六味丸。
饮邪在表的,表现为干呕、发热且咳嗽,面目及四肢浮肿,使用香苏五皮散。饮邪在里的,有的停滞在心下(胃脘部),有的潜伏在两腋下,咳嗽时牵引作痛,有的流注于肠间,发出辘辘的水声,使用小半夏加茯苓汤,根据其所在部位进行分治。这是治疗痰饮的大法。医书说:治疗痰必须调理脾脏,因为痰属于湿,脾土旺盛就能克制湿气。治疗痰是这样,治疗饮也应当如此。如果是脾经的痰饮,应当健脾以祛除湿气。如果是肾虚导致水液泛滥,形成痰饮的,必须滋补肾肾。肾水不足,则使用六味丸;若是命门真火衰微,寒痰上泛的,则使用八味肾气丸,通过补火生土,开启脾胃的关窍,引导泉水向下流动,这样痰饮自然消除。
【方剂组成】
半夏、茯苓、陈皮(去白,各一钱)、甘草(炙,五分)、生姜两片、大枣两枚,煎服。加入人参、白术各一钱,名为六君子汤。
【滚痰丸主治】
治疗实热老痰,变生怪异病症。
大黄(蒸片刻)、黄芩(炒,各四两)、青礞石(硝金色)、沉香(细锉,各三钱)、辰砂(细研水飞,二钱)。
用水泛为丸,辰砂为衣。每次服用一、二钱,开水送服。此药只取痰积,并不刮肠大泻,专治老痰。
For any disease, there is none that does not present with fever and phlegm generation. Thus, phlegm and heat are symptoms often seen concurrently in miscellaneous diseases, seemingly leaving no room for establishing specific treatment protocols. However, when the miscellaneous disease is mild but the phlegm-fluid retention is severe, the treatment should focus primarily on resolving the phlegm-fluid. Medical texts mention "Five Phlegms," attributing them to the five Zang organs; and "Five Fluids," named according to clinical manifestations. In reality, these classifications are not entirely accurate. Generally speaking, phlegm is distinguished by dryness and dampness, while fluids are differentiated by exterior and interior locations.
Damp-phlegm is slippery and easy to expectorate, mostly arising from the Spleen. When the Spleen is excess (pathogenic fullness), it should be reduced using Er Chen Tang (Two-Aged Decoction); if severe, Gun Tan Wan (Rolling Phlegm Pill) is used. If the Spleen is deficient, it should be tonified using Liu Jun Zi Tang (Six Gentlemen Decoction). For cases complicated by cold or heat, herbs are added according to the specific symptoms. Dry-phlegm is astringent and difficult to expectorate, mostly arising from the Lung. When the Lung is dry, it should be moistened using Bei Mu Gua Lou San (Fritillaria and Trichosanthes Powder). If the Lung suffers from Fire oppression and fails to descend, causing True Water to float upward, Yin should be nourished using Liu Wei Wan (Six-Ingredient Pill with Rehmannia).
Fluids located in the Exterior manifest as dry retching, fever, and cough, with edema of the face, eyes, and limbs; Xiang Su Wu Pi San (Aromatic Perilla Five-Rind Powder) is indicated. Fluids located in the Interior may stagnate below the heart (epigastrium), lurk in both axillae, cause pain upon coughing due to traction, or flow into the intestines producing gurgling sounds; Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia with Poria Decoction) is used, treating them according to their specific locations. This constitutes the general principles for treating phlegm and fluids. Texts state: "To treat phlegm, one must regulate the Spleen, because phlegm belongs to dampness, and when Spleen Earth is prosperous, it can overcome dampness." The same applies to treating fluids. For phlegm-fluid in the Spleen Meridian, one should strengthen the Spleen to dispel dampness. If Kidney deficiency causes water overflow leading to phlegm-fluid, the Kidney must be nourished. For insufficient Kidney Water, Liu Wei Wan is used; if Mingmen True Fire is weak and Cold-Phlegm floats upward, Ba Wei Shen Qi Wan (Eight-Ingredient Kidney Qi Pill) is employed. By tonifying Fire to generate Earth, opening the gates of the Stomach-House, and guiding the spring water to flow downward, the phlegm-fluid will naturally dissipate.
[Formula Composition]
Ban Xia (Pinelliae Rhizoma), Fu Ling (Poria), Chen Pi (Citri Reticulatae Pericarpium, white part removed, each 1 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried, 0.5 qian), Sheng Jiang (Zingiberis Rhizoma Recens, 2 slices), Da Zao (Jujubae Fructus, 2 pieces). Decoct and take orally. Adding Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma), each 1 qian, creates Liu Jun Zi Tang (Six Gentlemen Decoction).
[Indications for Gun Tan Wan]
Treats solid-heat old-phlegm that generates bizarre syndromes.
Da Huang (Rhei Radix et Rhizoma, steamed briefly), Huang Qin (Scutellariae Radix, stir-fried, each 4 liang), Qing Meng Shi (Calcareous Schist, treated with saltpeter until golden), Chen Xiang (Aquilariae Lignum Resinatum, finely sliced, each 3 qian), Chen Sha (Cinnabaris, finely ground and levigated, 2 qian).
Make pills using water, coating with Cinnabar. Take 1–2 qian per dose, washed down with clear water. This medication targets phlegm accumulation without causing drastic intestinal purgation, specifically for old-phlegm.