天津于姓媪，年近五旬，咳嗽有痰微喘，且苦不寐。
病因 夜间因不能寐，心中常觉发热，久之，则肺脏受伤，咳嗽多痰，且微作喘。
证候 素本夜间不寐，至黎明时始能少睡。后因咳嗽不止，痰涎壅盛，且复作喘，不能安卧，
恒至黎明亦不能睡。因之心中发热益甚，懒于饮食，大便干燥，四五日一行，两旬之间大形
困顿，屡次服药无效。其脉左部弦而无力，右部滑而无力，数逾五至。
诊断 此真阴亏损，心肾不能相济，是以不眠。久则心血耗散，心火更易妄动以上铄肺金，是
以咳嗽有痰作喘。治此证者，当以大滋真阴为主，真阴足则心肾自然相交，以水济火而火不妄
动；真阴足则自能纳气归根，气息下达，而呼吸自顺。且肺肾为子母之脏，原相连属，子虚有损于母，子
实即有益于母，果能使真阴充足，则肺金既不受心火之铄耗，更可得肾阴之津润，自能复其清肃
下行之常，其痰涎咳嗽不治自愈也。若更辅以清火润肺化痰宁嗽之品，则奏效当更捷矣。
处方 沙参（一两） 大枸杞（一两） 玄参（六钱） 天冬（六钱）
生赭石（五钱轧细） 甘草（二钱） 生杭芍（三钱） 川贝母（三钱） 牛蒡子（一钱捣碎）
生麦芽（三钱） 枣仁（三钱炒捣） 射干（二钱）
共煎汤一大盅，温服。
复诊 将药连服六剂，咳喘痰涎愈十分之八，心中已不发热，食欲已振，夜能睡数时，大便亦
不甚燥。诊其脉至数复常，惟六部重按仍皆欠实，左脉仍有弦意。拟再峻补其真阴以除病
根，所谓上病取诸下也。
处方 生怀山药（一两） 大枸杞（一两） 辽沙参（八钱） 生怀地黄（六钱）
熟怀地黄（六钱） 甘草（二钱） 生赭石（六钱轧细） 净萸肉（四钱）
生杭芍（三钱） 生麦芽（三钱） 生鸡内金（针半黄色的捣）
共煎汤一大盅，温服。
效果 将药连服二剂，诸病皆愈，俾用珠玉二宝粥常常当点心服之，以善其后。
或问 两方中所用之药，若滋阴、润肺、清火、理痰、止嗽诸品，原为人所共知，而两方
之中皆用赭石、麦芽，且又皆生用者其义何居？答曰∶胃居中焦，原以传送饮食为专职，是
以胃中之气，以息息下行为顺，果其气能息息下行，则冲气可阻其上冲，胆火可因之下降，大便
亦可按时下通，至于痰涎之壅滞，咳嗽喘逆诸证，亦可因之降序，而降胃之药，固莫赭石若也。至于
麦芽，炒用之善于消食，生用之则善于升达肝气。人身之气化原左升右降，若但知用赭石降胃，其重坠
下行之力或有碍于肝气之上升，是以方中用赭石降胃，即用麦芽升肝，此所以顺气化之自然，而还
其左升右降之常也。
天津有一位姓于的老妇人，年龄接近五十岁，咳嗽伴有痰液且轻微气喘，同时深受失眠之苦。
病因 因为夜间无法入睡，心中常常感觉发热，久而久之，导致肺脏受损，出现咳嗽多痰且轻微气喘的症状。
证候 她平时就有夜间失眠的毛病，直到黎明时分才能稍微睡一会儿。后来因为咳嗽不止，痰涎壅盛，并且再次出现气喘，无法安稳躺卧，甚至到了黎明也无法入睡。因此心中的发热感更加严重，懒得进食，大便干燥，四五天排便一次，二十天之间身体极度困顿疲乏，多次服药都无效。她的脉象左侧弦而无力，右侧滑而无力，脉搏频率超过五至（每分钟跳动次数）。
诊断 这是真阴亏损，心肾不能相互交通济助，所以导致不眠。时间久了则心血耗散，心火更容易妄动向上灼伤肺金，所以导致咳嗽有痰并引发气喘。治疗这个证候，应当以大量滋补真阴为主，真阴充足则心肾自然相交，用水来济助火使火不妄动；真阴充足则自然能纳气归根，气息下达，呼吸自然顺畅。而且肺和肾是子母关系的脏腑，原本相连属，子虚会损害母，子实则有益于母，果真能使真阴充足，那么肺金既不受心火的灼烧耗损，又能得到肾阴的津液滋润，自然能恢复其清肃下行的常态，那些痰涎咳嗽不治也会自愈。如果再辅以清热降火、润肺化痰、宁嗽的药物，那么见效应当更快。
处方 沙参（一两） 大枸杞（一两） 玄参（六钱） 天冬（六钱）
生赭石（五钱，轧细） 甘草（二钱） 生杭芍（三钱） 川贝母（三钱） 牛蒡子（一钱，捣碎）
生麦芽（三钱） 枣仁（三钱，炒后捣碎） 射干（二钱）
共同煎煮成一大盅汤剂，温服。
复诊 将药连续服用六剂后，咳喘痰涎好了十分之八，心中不再发热，食欲已经恢复，晚上能睡几个小时，大便也不怎么干燥了。诊察她的脉象，脉率恢复正常，只是六部脉重按仍然觉得不够充实，左脉仍有弦象。打算再大力滋补真阴以去除病根，这就是所谓的“上病取诸下”（上部疾病从下部治疗）。
处方 生怀山药（一两） 大枸杞（一两） 辽沙参（八钱） 生怀地黄（六钱）
熟怀地黄（六钱） 甘草（二钱） 生赭石（六钱，轧细） 净萸肉（四钱）
生杭芍（三钱） 生麦芽（三钱） 生鸡内金（针半黄色的，捣碎）
共同煎煮成一大盅汤剂，温服。
效果 将药连续服用两剂后，所有病症都痊愈了，建议用珠玉二宝粥经常作为点心服用，以巩固疗效善后。
或问 两个方子中使用的药物，如果是滋阴、润肺、清火、理痰、止嗽等药物，原本是大家都知道的，但两个方子中都使用了赭石和麦芽，而且都是生用的，其中的道理是什么？回答说：胃位于中焦，原本以传送饮食为专职，所以胃中的气，以每一息都向下行为顺，如果气能每一息都下行，那么冲气就可以被阻止不上冲，胆火可以因此下降，大便也可以按时通畅下行，至于痰涎的壅滞，咳嗽气喘逆乱等各种证候，也可以因此依序下降，而在降胃气的药物中，没有比得上赭石的。至于麦芽，炒制使用善于消食，生用则善于升发肝气。人体的气化原本左边上升右边下降，如果只知道用赭石降胃，其沉重坠下的力量或许会阻碍肝气的上升，所以在方子中使用赭石降胃的同时，就用麦芽升肝，这就是顺应气化的自然规律，恢复其左升右降的正常状态。
Tianjin had an elderly surnamed Yu, nearly fifty years old, suffering from cough with phlegm and slight wheezing, as well as severe insomnia.
Etiology Due to inability to sleep at night, she often felt heat in the heart region. Over time, this injured the Lung organ, leading to cough with abundant phlegm and slight wheezing.
Symptoms She had a chronic history of insomnia at night, only able to sleep briefly at dawn. Later, due to incessant coughing, excessive phlegm-saliva, and recurrent wheezing, she could not lie down comfortably, and even at dawn she could not sleep. Consequently, the sensation of heat in the heart region became more intense, appetite decreased, stools were dry, occurring only once every four to five days. Within twenty days, her physical condition became extremely exhausted, and multiple courses of medication proved ineffective. Her pulse was wiry and deficient on the left side, slippery and deficient on the right side, with a frequency exceeding five beats per breath cycle (approx. 100+ bpm).
Diagnosis This is a deficiency of True Yin (Zhen Yin, the fundamental Yin substance), where the Heart and Kidney fail to interact and assist each other, resulting in insomnia. Prolonged deficiency leads to consumption of Heart Blood, causing Heart Fire to flare up and scorch Lung Metal (Lung tissue), resulting in cough with phlegm and wheezing. Treatment should focus primarily on heavily nourishing True Yin. When True Yin is sufficient, Heart and Kidney will naturally interact; Water (Kidney) will control Fire (Heart) preventing it from flaring. Sufficient True Yin allows Qi to root and descend, making respiration smooth. Since Lung and Kidney are mother-son organs intrinsically connected, deficiency in the son harms the mother, while sufficiency benefits the mother. If True Yin is sufficiently replenished, Lung Metal will not be scorched by Heart Fire and will receive moisture from Kidney Yin, naturally restoring its clear, descending function. Phlegm and cough will heal spontaneously. If assisted by herbs that clear fire, moisten lungs, resolve phlegm, and calm cough, efficacy will be faster.
Prescription Sha Shen (Glehniae Radix, 1 liang) Da Gou Qi (Lycii Fructus, 1 liang) Xuan Shen (Scrophulariae Radix, 6 qian) Tian Dong (Asparagi Radix, 6 qian)
Sheng Zhe Shi (Hematitum, 5 qian, finely ground) Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian) Sheng Hang Shao (Paeoniae Radix Alba, 3 qian) Chuan Bei Mu (Fritillariae Cirrhosae Bulbus, 3 qian) Niu Bang Zi (Arctii Fructus, 1 qian, crushed)
Sheng Mai Ya (Hordei Fructus Germinatus, 3 qian) Zao Ren (Ziziphi Spinosae Semen, 3 qian, stir-fried and crushed) She Gan (Belamcandae Rhizoma, 2 qian)
Decoct together in one large bowl of water, take warm.
Follow-up Visit After taking six doses continuously, cough, wheezing, and phlegm improved by 80%. Heat in the heart region ceased, appetite recovered, nighttime sleep lasted several hours, and stools were no longer very dry. Pulse rate returned to normal, but all six positions remained insufficient upon heavy pressure, and the left pulse still showed a wiry quality. The plan is to vigorously tonify True Yin to eliminate the root cause, following the principle of "treating upper diseases from the lower."
Prescription Sheng Huai Shan Yao (Dioscoreae Hypoglaucae Rhizoma, 1 liang) Da Gou Qi (Lycii Fructus, 1 liang) Liao Sha Shen (Glehniae Radix, 8 qian) Sheng Huai Di Huang (Rehmanniae Radix, 6 qian)
Shu Huai Di Huang (Rehmanniae Radix Praeparata, 6 qian) Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 qian) Sheng Zhe Shi (Hematitum, 6 qian, finely ground) Jing Yu Rou (Corni Fructus, 4 qian)
Sheng Hang Shao (Paeoniae Radix Alba, 3 qian) Sheng Mai Ya (Hordei Fructus Germinatus, 3 qian) Sheng Ji Nei Jin (Galli Gigerii Endothelium Corneum, half-yellow needle-like, crushed)
Decoct together in one large bowl of water, take warm.
Outcome After two doses, all symptoms resolved. It is recommended to consume Zhu Yu Er Bao Zhou (Pearl-Jade Two-Treasure Porridge) regularly as a snack for convalescence.
Question: The herbs used in both prescriptions for nourishing Yin, moistening lungs, clearing fire, resolving phlegm, and stopping cough are commonly known. However, both prescriptions use Zhe Shi (Hematitum) and Mai Ya (Hordei Fructus Germinatus), both raw. What is the rationale? Answer: The Stomach resides in the Middle Jiao and is primarily responsible for transporting food and drink. Therefore, Stomach Qi should descend with every breath. If Qi descends properly, Chong Qi (Penetrating Vessel Qi) is prevented from rushing upward, Gallbladder Fire descends, and bowel movements occur regularly. Furthermore, stagnation of phlegm-saliva and conditions like cough and wheezing can be resolved through downward movement. Among herbs that direct Stomach Qi downward, none surpasses Zhe Shi. As for Mai Ya, when stir-fried, it excels at digesting food; when raw, it excels at ascending Liver Qi. Human Qi dynamics naturally ascend on the left and descend on the right. If only Zhe Shi is used to descend Stomach Qi, its heavy, sinking nature might hinder the ascent of Liver Qi. Therefore, using Zhe Shi to descend Stomach Qi while simultaneously using Mai Ya to ascend Liver Qi conforms to the natural flow of Qi dynamics, restoring the normal pattern of left ascent and right descent.