罗谦甫治不 吉歹元帅夫人。年逾五旬。身体肥盛。值八月中霖雨不止。因饮酒及潼乳
过度。遂病腹胀喘满。声闻于外。不得安卧。大小便涩滞。气口脉大。两倍于人迎。关脉沉
缓
而有力。因思霖雨之湿。饮食之热。湿热大盛。上攻于肺。所谓盛则为喘也。邪气盛则实。
实者宜下之。为制平气散。内经曰。肺苦气上逆。急食苦以泻之。白牵牛苦寒。泻气分湿热
上攻喘满。故用二两。半生半熟以为君。陈皮苦温。体轻浮理肺气。用五钱。青皮苦辛平。
散肺中滞气。用三钱以为臣。槟榔辛温。性沉重。下痰降气。亦用三钱。大黄苦寒。荡涤满
实。用七钱以为使。末服三钱。生姜汤调下。两服而喘愈。止有胸膈不利。烦热口干。时时
咳嗽。以泻白散加知母、黄芩、桔梗、青皮全愈。
程明佑治张丙中满气喘。众医投分心气饮、舟车丸。喘益甚。一医作气虚治。以参、
补
之。喘急濒死。程诊其脉沉而滑。曰。此痰病也。痰滞经络。脏腑痞塞。致生 胀。投滚
痰
丸。初服。腹雷鸣。再服。下如鸡卵者五六枚。三服。喘定气平。继以参苓平胃散出入。三
十日而安。
一富翁素强健。忽病喘满。不咳不吐痰。日久腿脚阴囊尽水肿。倚卧肩息。困极。王中
阳曰。非水证也。但胸膈有败痰。宜服滚痰丸。彼不信。针刺放水。备尝诸苦。年余。忽吐
臭痰。复诣王。王与龙脑膏一料。服未尽而愈。
震按胀而兼喘。病热急矣。必非轻剂所能治。此三条是实证治法。若虚寒证。当重用桂
附。如天真丸、黑锡丹、金液丹之类。皆可类推。不得以五子五皮沉香椒目等。为稳当法
也。
沈宗常治卢陵人。胀而喘。三日食不下咽矣。视脉无他。问何食饮。对以近食羊脂。沈
曰。得之矣。脂冷则凝。温熨之所及也。温之。得利而愈。
震按是案较沈诚庄治肃藩嗜乳酪致病。用浓茶频饮得愈。彼如昭文之鼓琴。此如师旷之
杖策矣。
罗谦甫治疗不吉歹元帅的夫人。她年龄超过五十岁，身体肥胖壮实。正值八月中秋连绵阴雨不断，因为饮酒以及食用潼乳（一种乳制品）过度，于是患上腹部胀满、气喘胸闷的病证，喘息声在室外都能听到，无法安稳躺卧，大小便排泄不畅涩滞。诊得气口脉象盛大，比人迎脉大两倍；关脉沉缓而有力。罗谦甫思考：这是霖雨带来的湿气，加上饮食产生的热邪，导致湿热之邪盛大，向上攻冲于肺，这就是所谓的“盛则为喘”。邪气亢盛属于实证，实证应当用泻下法治疗。于是为他配制了平气散。《内经》说：“肺苦气上逆，急食苦以泻之。”白牵牛味苦性寒，能泻除气分中湿热上攻导致的喘满，所以用量为二两，半生用半熟用以作为君药。陈皮味苦性温，质地轻浮，能梳理肺气，用量五钱；青皮味苦辛性平，能疏散肺中的滞气，用量三钱，这两味作为臣药。槟榔味辛性温，性质沉重，能下痰降气，也用量三钱。大黄味苦性寒，能荡涤肠胃内的积滞实邪，用量七钱，作为使药。将药物研末，每次服用三钱，用生姜汤调服。服用两次后喘息痊愈，仅剩下胸膈部不利落，伴有烦热、口干、时时咳嗽的症状，随后使用泻白散加入知母、黄芩、桔梗、青皮，完全治愈。
程明佑治疗张丙的中满气喘病。其他医生投用分心气饮、舟车丸，结果喘息更加严重。有一位医生将其当作气虚来治疗，用人参等药物补益，导致患者喘息急促濒临死亡。程明佑诊察其脉象沉而滑，说：“这是痰病。”痰浊阻滞经络，脏腑痞塞不通，从而产生胀满和喘息。于是投用滚痰丸。初次服用，腹中雷鸣作响；第二次服用，排出像鸡蛋大小的痰块五六枚；第三次服用后，喘息平息，气息平稳。随后根据情况加减使用参苓平胃散，三十天后病情安定。
一位富翁向来身体强健，忽然患上喘满病，不咳嗽也不吐痰，日久之后腿脚和阴囊全部水肿，只能倚靠坐着呼吸，极度困倦疲惫。王中阳说：“这不是水气病证。”只是胸膈部位有败坏的痰浊，适宜服用滚痰丸。那人不相信，选择针刺放水，备尝各种痛苦。一年多后，忽然吐出臭痰，再次拜访王中阳。王中阳给他一料龙脑膏，药还没吃完就痊愈了。
俞震按语：胀满兼见喘息，说明病势热急。必定不是轻淡的药剂所能治疗的。这三条医案都是实证的治疗方法。如果是虚寒证，应当重用桂枝、附子。如天真丸、黑锡丹、金液丹之类的方剂，都可以类推。不能把五子五皮散、沉香、椒目等当作稳妥的方法。
沈宗常治疗卢陵的一位患者，胀满且喘息，三天吃不下东西咽不下去了。诊视脉象没有异常，询问吃了什么喝了什么，患者回答最近吃了羊脂。沈宗常说：“病因找到了。”油脂遇冷则凝固，需要用温热熨烫的方法来化解。通过温通的方法，患者得利（排便通畅）而痊愈。
俞震按语：这个医案与沈诚庄治疗肃藩亲王因嗜爱乳酪致病，用浓茶频频饮用而痊愈的案例相比。沈诚庄的治疗如同昭文弹琴那样精妙，而沈宗常的治疗则如同师旷拄着拐杖那样高明（指洞察力强）。
Luo Qianfu treated the wife of Marshal Bu Jidai. She was over fifty years old and had a robust, obese physique. During the mid-autumn season, continuous heavy rains persisted. Due to excessive consumption of alcohol and Tongru (a type of dairy product), she developed abdominal distension, fullness, wheezing, and chest oppression. The sound of her wheezing could be heard outside, and she could not lie down comfortably. Her urination and defecation were obstructed and sluggish. The Qi Kou pulse was large, twice as strong as the Ying Chou pulse; the Guan pulse was deep, slow, yet forceful. Luo reflected that the dampness from the prolonged rain combined with the heat from dietary excess resulted in an overwhelming accumulation of damp-heat attacking the Lung upwards, which is what is meant by "excess leads to wheezing." When pathogenic factors are exuberant, it constitutes an Excess syndrome; Excess syndromes should be treated with purgation. Therefore, he formulated Pingqi San (Calming Qi Powder). As stated in the *Neijing* (Inner Canon): "The Lung dislikes rebellious Qi; urgently consume bitter substances to drain it." Bai Qianniu (Bitter Morning Glory Seed) is bitter and cold, capable of draining damp-heat from the Qi level that attacks upward causing wheezing and fullness; thus, two liang were used, half raw and half processed, as the Sovereign herb. Chenpi (Aged Tangerine Peel) is bitter and warm, with a light and floating nature, able to regulate Lung Qi; five qian were used. Qingpi (Green Tangerine Peel) is bitter and acrid, neutral in nature, able to disperse stagnant Qi in the Lung; three qian were used. These two served as Minister herbs. Binglang (Areca Seed) is acrid and warm, with a heavy nature, able to descend phlegm and Qi; three qian were also used. Dahuang (Rhubarb Root) is bitter and cold, capable of scouring away accumulated fullness and excess; seven qian were used as the Envoy herb. The herbs were powdered, and three qian were taken each time, mixed with ginger decoction. After two doses, the wheezing ceased. Only chest and diaphragmatic discomfort remained, accompanied by irritability, heat sensation, dry mouth, and occasional coughing. Subsequently, Xiebai San (Draining White Powder) was administered with additions of Zhimu (Anemarrhena Rhizome), Huangqin (Scutellaria Root), Jiegeng (Platycodon Root), and Qingpi (Green Tangerine Peel), resulting in complete recovery.
Cheng Mingyou treated Zhang Bing's middle-fullness and wheezing. Other physicians prescribed Fenxin Qi Yin (Dividing Heart Qi Decoction) and Zhouche Wan (Boat Cart Pill), but the wheezing worsened. Another physician diagnosed it as Qi deficiency and treated it with Ginseng and other tonics, leading to critical wheezing and near-death state. Cheng examined the pulse, finding it deep and slippery, and said, "This is a Phlegm disease." Phlegm stagnates in the meridians, causing organ blockage, leading to distension and wheezing. He administered Gutan Wan (Rolling Phlegm Pill). Upon the first dose, thunderous sounds were heard in the abdomen. After the second dose, several egg-sized masses of phlegm were expelled. After the third dose, the wheezing stabilized and breathing normalized. Subsequently, Shenling Pingwei San (Ginseng, Poria, and Stomach-Calming Powder) was modified and administered. Within thirty days, the patient recovered.
A wealthy merchant, who was usually robust, suddenly suffered from wheezing and fullness without coughing or expectorating phlegm. Over time, his legs, feet, and scrotum became severely edematous. He could only sit leaning against something to breathe, exhausted and extremely fatigued. Wang Zhongyang stated, "This is not a Water syndrome." It is merely败痰 (decayed phlegm) in the chest and diaphragm, suitable for treatment with Gutan Wan (Rolling Phlegm Pill). The patient did not believe this and opted for acupuncture drainage of water, enduring much suffering. More than a year later, he suddenly vomited foul-smelling phlegm and visited Wang again. Wang prescribed Longnao Gao (Borneol Paste). The patient recovered before finishing the course.
Yu Zhen commented: Distension accompanied by wheezing indicates a severe and urgent Heat pathology. It certainly cannot be treated with mild agents. These three cases illustrate the treatment of Excess syndromes. If it were a Deficiency-Cold syndrome, one should heavily use Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root). Formulas such as Tianzhen Wan (True Origin Pill), Heixi Dan (Black Tin Elixir), and Jin Ye Dan (Golden Fluid Elixir) can be inferred analogously. One must not consider Wuzi Wupi San (Five Seeds and Five Skins Powder), Chenxiang (Agarwood), or Jiaomu (Zanthoxylum Seed) as safe or standard methods.
Shen Zongchang treated a patient from Luling who suffered from distension and wheezing, unable to swallow food for three days. The pulse showed no other abnormalities. Asking about diet, the patient replied that he had recently consumed sheep fat. Shen said, "The cause is identified." Fat congeals when cold; it requires warming and moxibustion/irrigation to resolve. By applying warmth, the patient achieved free movement of bowels and recovered.
Yu Zhen commented: This case, compared to Shen Chengzhuang's treatment of the Prince of Su who fell ill due to excessive consumption of milk and cheese, cured by frequent drinking of strong tea, differs in style. Shen Chengzhang's approach was like Zhaowen playing the lute—subtle and refined; Shen Zongchang's approach was like Shikuang using his cane—keen and insightful.