治虚劳发热,或喘或嗽,脉数而弱。
生山药(一两) 大生地(五钱) 人参(四钱) 玄参(四钱) 生赭石(四钱,轧细) 牛蒡子(三钱,炒,捣)
天冬(四钱) 甘草(二钱)
劳热之证,大抵责之阴虚。有肺阴虚者,其人因肺中虚热熏蒸,时时痒而作嗽,
甚或肺中有所损伤,略一动作,辄发喘促,宜滋补肺阴,兼清火理痰之品,有肾阴虚者,其
人因肾虚不能纳气,时时咳逆上气,甚或喘促,宜填补下焦真阴。兼用收降之品。若其脉甚
数者,陈修园谓,宜滋养脾阴。盖以脾脉原主和缓,脉数
者必是脾阴受伤,宜于滋阴药中,用甘草以引之归脾,更兼用味淡之药,如薏米、石斛之类
。特是人身之阴,所盖甚广,凡周身之湿处皆是也。
故阴虚之甚者,其周身血脉津液,皆就枯涸。必用汁浆最多之药,滋脏腑之阴,即以溉周身
之液,若方中之山药、地黄是也。然脉之数者,固系阴虚,亦系气分虚弱,有不能支持之象
,犹人之任重而体颤也。故用人参以补助气分,与玄参、天冬之凉润者并用,又能补助阴分。
且虑其升补之性,与咳嗽上逆者不宜,故又佐以赭石之压力最胜者,可使人参补益之
力下行直至涌泉,而上焦之逆气浮火,皆随之顺流而下;更可使下焦真元之气,得人参之峻
补而顿旺,自能吸引上焦之逆气浮火下行也。至于牛蒡子与山药并用,最善止嗽,甘草与天冬
并用,最善润肺,此又屡试屡效者也。
初制此方时,原无赭石,有丹参三钱,以运化人参之补力。后治一年少妇人,信水数月不行
,时作寒热,干嗽连连,且兼喘逆,胸隔满闷,不思饮食,脉数几至七至。治以有丹参原方
不效,遂以赭石易丹参,一剂咳与喘皆愈强半,胸次开通,即能饮食,又服数剂脉亦和缓,
共服二十剂,诸病皆愈。以后凡治妇女月闭血枯,浸至虚劳,或兼咳嗽满闷者,皆先
投以此汤,俾其饮食加多,身体强壮,经水自通。间有瘀血暗阻经道,或显有
瘕可据者,继服拙拟理冲汤,或理冲丸以消融之,则妇女无难治之病矣。若
其人胸中素觉短气,或大便易滑泻者,又当预防其大气下陷(大气下陷详升
陷汤)。用醴泉饮时,宜减赭石、牛蒡子,并一切苏子、蒌仁、紫菀、杏仁,治咳
按∶短气与喘原迥异。短气者难于呼气不上达也。喘者难于吸气不下降也。而不善述病情者
,往往谓喘为“上不来气”,是以愚生平临证,凡遇自言上不来气者,必细细询问,确知其
果系呼气难与吸气难,而后敢为施治也。
又按∶方书名咳喘曰“咳逆”,喘曰“喘逆”,因二证多由逆气上干也。而愚临证实验以来
,知因大气下陷而咳喘者,亦复不少。盖肺悬胸中,必赖大气以包举之,而后有所附丽;大
气以鼓舞之,而后安然呼吸。大气一陷,则包举之力微,肺即无所附丽,而咳嗽易生。鼓舞
之机滞,肺必努力呼吸,而喘促易作。曾治一少年,泄泻半载方愈。后因劳力过度,觉喉中之气不舒,五六呼吸之间,
必咳
以拙拟升陷汤,数剂而愈。
又∶曾治一人,年近五旬,素有喘疾。因努力任重,旧证复发。延
医服药罔效。后愚诊视其脉,数近六至,而兼有沉濡之象。愚疑其阴虚不能纳气,因其脉兼
沉濡,不敢用降气之药。遂用熟地、生山药、枸杞、玄参大滋真阴之药,大剂煎汤,送下人
参小块二钱,连服三剂脉即不数,仍然沉濡,喘虽见轻,仍不能愈。因思此证得之努力任重
,胸中大气因努力而陷,所以脉现沉濡,且其背恶寒而兼发紧,此亦大气下陷之征也。亦治
以升陷汤,方中升麻、柴胡、桔梗皆不敢用,以桂枝尖三钱代之。因其素有不纳气之
证,桂枝能升大气,又能纳气归肾也(理详参赭镇气汤下)。又外
加滋阴之药,数剂全愈(详案在升陷汤下)。按此二证之病因,与
醴泉饮所主之病迥异,而其咳喘则同。必详观升陷汤后跋语,及所载诸案,始明治此二证之
理。而附载于此者,恐临证者审证不确,误以醴泉饮治之也。
沈阳娄××,年二十二,虚劳咳嗽,其形羸弱,脉数八至,按之即无。细询之,自言
曾眠热炕之上,晨起觉心中发热,从此食后即吐出,夜间咳嗽甚剧,不能安寝。因二十余日
寝食俱废, 遂觉精神恍惚,不能支持。愚闻之,知脉象虽危,仍系新证,若久病至此,诚
难挽回矣。遂投以醴泉饮,为其呕吐,将赭石改用一两(重用赭石之理详参
赭镇气汤下),一剂吐即止,可以进食,嗽亦见愈。从前五六日未大便,至此大便
亦通下。如此加减服之,三日后脉数亦见愈。然犹六至余,心中犹觉发热,遂将玄参、生地
皆改用六钱,又每日于午时,用白蔗糖冲水,送服西药阿斯匹林(药性详参麦汤
下)七厘许。数日诸病皆愈,脉亦复常。
沈阳苏××,年三十许,劳嗽二年不愈,动则作喘,饮食减少。更医十余人,服药数百剂,
分毫无效,羸弱转甚。来院延医。其脉数六至,虽细弱仍有根柢,知其可治。自言上焦恒觉发热,大便三四日一行
,时或干燥。遂投以醴泉饮,为其便迟而燥,赭石改用六钱,又加鸡内金二钱(捣
细),恐其病久脏腑经络多瘀滞也。数剂后饭量加增,心中仍有热时,大便已不燥
,间日 一行。遂去赭石二钱,加知母二钱,俾于晚间服汤药后,用白蔗糖水,送服阿斯匹林
四分之一瓦,得微汗。后令于日间服之,不使出
汗,数日不觉发热,脉亦复常,惟咳嗽未能全愈。又用西药几阿苏六分,薄荷冰四分,和以绿豆
粉为丸,梧桐子大,每服三丸,日两次,汤药仍照方服之,五六日后咳嗽亦愈,身体从此康
健。
治疗虚劳引起的发热,或者伴有气喘或咳嗽,脉象数而无力。
生山药(一两) 大生地(五钱) 人参(四钱) 玄参(四钱) 生赭石(四钱,碾细) 牛蒡子(三钱,炒后捣碎)
天冬(四钱) 甘草(二钱)
虚劳发热的病证,大多归因于阴虚。如果是肺阴虚,患者因为肺中虚热熏蒸,时常感到瘙痒而引发咳嗽,
甚至肺部有所损伤,稍微活动,就发作气喘急促,应当滋补肺阴,兼用清热化痰的药物;如果是肾阴虚,患
者因为肾虚不能摄纳气息,时常出现气逆上冲,甚至气喘急促,应当填补下焦的真阴,兼用收敛降气的药物。如果脉象非常数的,陈修园认为,应当滋养脾阴。因为脾的脉象原本主和缓,脉象数的
必定是脾阴受损,应当在滋阴药中,用甘草来引导药力归于脾,更兼用味道淡薄的药物,如薏米、石斛之类
。只是人体的阴,涵盖范围很广,凡是周身潮湿的地方都属于阴。
所以阴虚严重的,其周身的血脉津液,都会变得枯涸。必须使用汁液最多的药物,来滋润脏腑之阴,进而灌溉周身
之液,比如方中的山药、地黄就是这类。然而脉象数,固然属于阴虚,也属于气分虚弱,有不能支撑的征象
,就像人承担重物而身体颤抖一样。所以用人参来补助气分,与玄参、天冬这些凉润的药物并用,又能补助阴分。
并且担心人参升补的性质,不适合咳嗽气逆的患者,所以又佐以压力最强的赭石,可以使人参补益的
力量下行直达涌泉穴,而上焦的气逆浮火,都随之顺流而下;更可以使下焦的真元之气,得到人参的大
补而顿时旺盛,自然能吸引上焦的气逆浮火下行。至于牛蒡子与山药并用,最善于止咳,甘草与天冬
并用,最善于润肺,这又是经过多次验证有效的。
最初配制此方时,原本没有赭石,而是用了三钱丹参,用来运化人参的补力。后来治疗一位年轻妇人,月经数月不行
,时常发冷发热,干咳连连,且兼有气喘气逆,胸膈满闷,不想饮食,脉数几乎达到七至。用含有丹参的原方
治疗无效,于是用赭石替换丹参,一剂药后咳嗽和气喘都好了大半,胸膈通畅,就能进食了,又服了几剂脉象也变得和缓,
共服用二十剂,各种病症都痊愈了。此后凡是治疗妇女闭经血枯,逐渐发展到虚劳,或者兼有咳嗽满闷的,都先
投以此汤,使她们饮食增加,身体强壮,月经自然通畅。间或有瘀血暗中阻滞经络,或者明显有
癥瘕可以确定的,继服我拟定的理冲汤,或理冲丸来消融它,那么妇女就没有难治的病了啊。如果
那个人平时就觉得胸中短气,或者大便容易滑泻的,又应当预防大气下陷(大气下陷详见升陷汤)。用醴泉饮时,应当减少赭石、牛蒡子,以及一切苏子、瓜蒌仁、紫菀、杏仁等治咳
按:短气与气喘原本截然不同。短气的是呼气困难,气不上达。气喘的是吸气困难,气不下降。而不善于描述病情的人
,往往把气喘说成“气上不来”,所以我平生临证,凡是遇到自称气上不来的人,一定要细细询问,确知其
究竟是呼气难还是吸气难,然后才敢进行治疗。
又按:方书将咳喘称为“咳逆”,将气喘称为“喘逆”,因为这两种证候多由逆气上干所致。而我临证实验以来
,知道因为大气下陷而导致咳喘的,也有不少。因为肺悬挂在胸中,必须依赖大气来包裹举托它,之后才有依附;
大气来鼓舞它,之后才能安然呼吸。大气一旦下陷,则包裹举托的力量微弱,肺就无所依附,而咳嗽容易产生。鼓舞
的机制停滞,肺必然努力呼吸,而气喘急促容易发生。曾治疗一个少年,腹泻半年才好。后来因为过度劳累,觉得喉中之气不畅快,五六次呼吸之间,
必然咳嗽
我用我拟定的升陷汤,几剂药就好了。
又:曾治疗一个人,年近五十,素有气喘疾病。因为用力搬重物,旧病复发。请
医生服药无效。后来我诊视他的脉象,数接近六至,而且兼有沉濡的象。我怀疑他阴虚不能纳气,因为脉象兼
有沉濡,不敢用降气的药物。于是用熟地、生山药、枸杞、玄参等大滋真阴的药物,大剂煎汤,送下人
参小块二钱,连服三剂脉象就不数了,仍然沉濡,气喘虽然减轻,仍然不能痊愈。于是想到这个证候得之于用力搬重
物,胸中大气因为用力而下陷,所以脉象现沉濡,而且他背部怕冷而且兼有发紧,这也是大气下陷的征象啊。也用
升陷汤治疗,方中升麻、柴胡、桔梗都不敢用,用桂枝尖三钱代替。因为他素有不纳气的
证候,桂枝能升大气,又能纳气归肾(原理详见参赭镇气汤下)。另外
外加滋阴的药物,几剂药全愈(详细医案在升陷汤下)。按这两个证候的病因,与
醴泉饮所主治的病截然不同,而其咳喘症状相同。必须详细观看升陷汤后的跋语,及所载的各医案,才明白治疗这两个证候
的道理。而附载在这里,是恐怕临证者审证不准确,误用醴泉饮治疗它们。
沈阳娄××,年龄二十二岁,虚劳咳嗽,形体瘦弱,脉数八至,按下去就没有了。仔细询问,他自己说
曾经睡在热炕上,早晨起来觉得心中发热,从此饭后就呕吐,夜间咳嗽很剧烈,不能安睡。因为二十多天
寝食俱废, 于是觉得精神恍惚,不能支撑。我听了,知道脉象虽然危险,仍然是新得的病,如果是久病到这种地步,确实
难以挽回了。于是投以醴泉饮,因为他呕吐,将赭石改为一两(重用赭石的原理详见参赭镇气汤下),一剂吐就止住了,可以进食,嗽也见好。从前五六天不大便,至此大便
也通下了。如此加减服用,三天后脉数也见好转。然而还有六至多,心中还觉得发热,于是将玄参、生地
都改用六钱,又每天在午时,用白蔗糖冲水,送服西药阿斯匹林(药性详见麦门冬汤
下)七厘左右。几天后各种病都好了,脉象也恢复正常。
沈阳苏××,年龄三十岁左右,劳嗽两年不好,动则气喘,饮食减少。换过十多个医生,服药几百剂,
分毫无效,瘦弱更加严重。来院求医。他的脉数六至,虽然细弱仍有根基,知道可以治疗。他自己说上焦经常觉得发热,大便三四天一次
,有时干燥。于是投以醴泉饮,因为他大便迟滞而干燥,赭石改用六钱,又加鸡内金二钱(捣
碎),恐怕他病久脏腑经络多有瘀滞。几剂药后饭量增加,心中仍有热的时候,大便已经不干燥
,隔天一次。于是去掉赭石二钱,加知母二钱,以便在晚间服汤药后,用白蔗糖水,送服阿斯匹林
四分之一瓦,微微出汗。后来让他白天服用,不让其出
汗,几天后不觉发热,脉象也恢复正常,只有咳嗽未能完全痊愈。又用西药几阿苏六分,薄荷冰四分,和以绿豆
粉做成丸,梧桐子大小,每次服三丸,每天两次,汤药仍照原方服用,五六日后咳嗽也好了,身体从此健康。
Treats deficiency consumption (Xu Lao) with fever, or accompanied by asthma (Chuan) or cough (Sou), with a rapid and weak pulse.
Raw Dioscoreae Rhizoma (Shanyao, 1 liang) Raw Rehmanniae Radix (Dishengdi, 5 qian) Ginseng Radix et Rhizoma (Renshen, 4 qian) Scrophulariae Radix (Xuan Shen, 4 qian) Raw Haematitum (Sheng Zhe Shi, 4 qian, finely ground) Arctii Fructus (Niubangzi, 3 qian, stir-fried and crushed)
Asparagi Radix (Tiandong, 4 qian) Glycyrrhizae Radix et Rhizoma (Gancao, 2 qian)
Deficiency consumption fever is generally attributed to Yin deficiency. In cases of Lung Yin deficiency, the patient suffers from internal heat steaming in the lungs, causing frequent itching and coughing;
in severe cases where there is damage in the lungs, slight movement triggers asthma and shortness of breath. Treatment should nourish Lung Yin and simultaneously clear heat and resolve phlegm. In cases of Kidney Yin deficiency, the patient experiences rebellious Qi rising due to Kidney failing to grasp Qi, leading to frequent coughing with upward rushing Qi, or even asthma. Treatment should fill the True Yin of the Lower Jiao and use astringent and descending agents. If the pulse is extremely rapid, Chen Xiuyuan suggested nourishing Spleen Yin. This is because the Spleen pulse is naturally harmonious and slow; a rapid pulse indicates injury to Spleen Yin. Therefore, within Yin-nourishing formulas, Gancao should be used to guide the medicinal action to the Spleen, combined with bland-tasting herbs such as Coicis Semen (Yimi) and Dendrobii Caulis (Shihu). However, the body's Yin covers a wide range, including all moist areas of the body.
Thus, in severe Yin deficiency, the blood vessels and body fluids throughout the body become dry and withered. Herbs with abundant juice must be used to nourish the Yin of the Zang-Fu organs and thereby irrigate the body fluids, such as Shanyao and Dihuang in this formula. Nevertheless, a rapid pulse indicates not only Yin deficiency but also Qi deficiency, manifesting as an inability to sustain effort, similar to a person trembling under a heavy load. Therefore, Renshen is used to tonify Qi, used together with cool and moistening herbs like Xuan Shen and Tiandong, which also assist in nourishing Yin. Furthermore, to prevent the ascending and tonifying nature of Renshen from being unsuitable for patients with cough and rebellious Qi, Zhe Shi, possessing strong descending pressure, is added as an assistant. This allows the tonifying power of Renshen to descend directly to Yongquan (KI-1), while rebellious Qi and floating fire in the Upper Jiao flow down with it; additionally, it enables the True Yuan Qi of the Lower Jiao to become vigorous instantly upon receiving the strong tonification of Renshen, thereby naturally attracting the rebellious Qi and floating fire of the Upper Jiao downward. The combination of Niubangzi and Shanyao is particularly effective in stopping cough, and the combination of Gancao and Tiandong is excellent for moistening the Lungs; these have been repeatedly verified as effective.
When this formula was first formulated, it originally did not contain Zhe Shi, but instead used 3 qian of Danshen to facilitate the transformation of Renshen's tonifying power. Later, I treated a young woman whose menstruation had ceased for several months, experiencing alternating chills and fever, continuous dry cough, asthma with rebellious Qi, chest and diaphragm fullness, loss of appetite, and a rapid pulse approaching seven beats per cycle. The original formula containing Danshen was ineffective. I replaced Danshen with Zhe Shi. After one dose, the cough and asthma improved significantly, the chest became open, and she could eat. After a few more doses, her pulse became harmonious. After taking twenty doses in total, all ailments were cured. Since then, whenever treating women with amenorrhea and blood exhaustion progressing to deficiency consumption, or accompanied by cough and fullness, I first administer this decoction to increase their appetite and strengthen their bodies, allowing menstruation to resume naturally. In occasional cases where dark blood stasis obstructs the meridians, or obvious masses are present, I follow up with Lizhong Tang or Lizhong Wan to dissolve them, making there no incurable diseases for women. If the patient usually feels shortness of breath in the chest or has loose stools, one must prevent the sinking of Da Qi (Great Qi) (see Shengxian Tang for details on Da Qi sinking). When using Liquan Yin, reduce Zhe Shi and Niubangzi, as well as all Su Zi, Gualou Ren, Ziwan, and Xingren used for treating cough.
Note: Shortness of breath (Duanqi) and asthma (Chuan) are fundamentally different. Shortness of breath involves difficulty exhaling and Qi failing to reach upwards. Asthma involves difficulty inhaling and Qi failing to descend downwards. Patients who are poor at describing symptoms often describe asthma as "Qi cannot come up." Therefore, in my clinical practice, whenever a patient claims "Qi cannot come up," I carefully inquire to determine whether it is difficult to exhale or inhale before daring to treat.
Furthermore, medical texts refer to cough and asthma as "Ke Ni" and asthma as "Chuan Ni" because these conditions often result from rebellious Qi affecting upwards. However, through clinical experience, I know that cough and asthma caused by Da Qi sinking are also common. The Lung hangs in the chest and relies on Da Qi to envelop and support it to have a foundation; Da Qi inspires it to enable peaceful breathing. When Da Qi sinks, its supporting power weakens, the Lung loses its foundation, and cough easily arises. When the inspiring mechanism stagnates, the Lung must struggle to breathe, and asthma easily occurs. I once treated a youth who recovered from diarrhea after half a year. Later, due to overexertion, he felt discomfort in the throat Qi, coughing every five or six breaths. I treated him with my proposed Shengxian Tang, and he recovered after a few doses.
Additionally, I once treated a man near fifty years old who suffered from chronic asthma. Due to lifting heavy loads, his old condition relapsed. Physicians prescribed medicine without effect. Upon examination, his pulse was rapid, nearing six beats per cycle, with a deep and soft quality. I suspected Yin deficiency failing to grasp Qi, but given the deep and soft pulse, I dared not use descending Qi herbs. Instead, I used large doses of Shudi, Sheng Shanyao, Gouqi, and Xuan Shen to strongly nourish True Yin, decocted as a soup, with 2 qian of small pieces of Renshen taken orally. After three doses, the pulse was no longer rapid but remained deep and soft; asthma lightened but did not cure. I reasoned that this condition resulted from exertion, causing Da Qi in the chest to sink, hence the deep and soft pulse. His aversion to cold in the back and tightness were also signs of Da Qi sinking. I treated him with Shengxian Tang, replacing Shengma, Chaihu, and Jiegeng with 3 qian of Guizhi tip. Because he had a history of failing to grasp Qi, Guizhi can raise Da Qi and also guide Qi back to the Kidney (principle detailed under Shen Zhe Zhenqi Tang). Additionally, I added Yin-nourishing herbs, and he recovered after a few doses (detailed case under Shengxian Tang). Note that the etiology of these two cases is completely different from the disease indicated by Liquan Yin, although the cough and asthma are similar. One must carefully read the postscript after Shengxian Tang and the recorded cases to understand the rationale for treating these two conditions. I attach them here lest clinicians misdiagnose and mistakenly use Liquan Yin.
Lou XX from Shenyang, aged 22, suffered from deficiency consumption cough, emaciated, with a rapid pulse of eight beats per cycle, disappearing upon pressure. Detailed inquiry revealed he had slept on a heated kang, woke up feeling heat in the heart, and since then vomited after meals. Nighttime cough was severe, preventing sleep. After more than twenty days of neglecting food and rest, he felt mental confusion and inability to sustain himself. Hearing this, I knew that although the pulse appearance was critical, it was still a new condition; if it were a long-standing illness to this extent, it would indeed be irrecoverable. I administered Liquan Yin. Due to his vomiting, I increased Zhe Shi to 1 liang (reason for heavy use of Zhe Shi detailed under Shen Zhe Zhenqi Tang). After one dose, vomiting stopped, he could eat, and cough improved. He had not had a bowel movement for five or six days previously; now his bowels moved. With such modifications, after three days, the rapid pulse improved. However, it remained slightly above six beats, and he still felt heat in the heart. I changed Xuan Shen and Sheng Di to 6 qian each. Also, daily at noon, I had him take white cane sugar water to swallow about 7 li of Aspirin (drug properties detailed under Maidong Tang). After a few days, all illnesses resolved, and the pulse returned to normal.
Su XX from Shenyang, aged around 30, suffered from labor-induced cough for two years without recovery, developing asthma upon exertion, and reduced appetite. Over ten physicians treated him with hundreds of doses of medicine with no effect, and his emaciation worsened. He came to the clinic for treatment. His pulse was rapid, six beats per cycle, fine and weak but with a root, indicating it was treatable. He stated he constantly felt heat in the Upper Jiao, and bowel movements occurred every three to four days, sometimes dry. I administered Liquan Yin. Due to his delayed and dry bowel movements, I changed Zhe Shi to 6 qian, and added 2 qian of Ji Neijin (finely crushed), fearing that long-term illness might cause stasis in the Zang-Fu organs and meridians. After a few doses, his appetite increased, he still felt heat occasionally, but his stool was no longer dry, occurring every other day. I removed 2 qian of Zhe Shi and added 2 qian of Zhimu, so that after taking the herbal decoction in the evening, he would take 1/4 grain of Aspirin with white cane sugar water to induce mild sweating. Later, I instructed him to take it during the day to avoid sweating. After a few days, he no longer felt feverish, and his pulse normalized, except the cough was not fully cured. I then prescribed 6 fen of Japanese Quinine, 4 fen of Menthol, mixed with Mung Bean Powder to make pills the size of paulownia seeds. Each dose was three pills, twice daily, while continuing the herbal decoction. After five or six days, the cough also healed, and his health was restored.