昔肥今瘦为饮。仲景云。脉沉而弦。是为饮家。男子向老。下元先亏。气不收
摄。则痰饮上泛。饮与气涌。斯为咳矣。今医见嗽。辄以清肺降气消痰。久而不效。
更与滋阴。不明痰饮。皆属浊阴之化。滋则堆砌。助浊滞气。试述着枕咳呛一端。
知身体卧着。上气不平。必下冲上逆。其痰饮伏于至阴之界。肾脏络病无疑。形
寒畏风。阳气微弱。而藩篱疏撤。仲景有要言不烦。曰。饮邪必用温药和之。更分
外饮治脾。内饮治肾。不读圣经。焉知此理。
桂苓甘术汤
脉弦右濡。阳微恶寒。饮浊上干。咳吐涎沫。且食减胃衰。寒疝窃踞。阴浊见
症。岂止一端。喻嘉言谓浊阴上加于天。非离照当空。氛雾焉得退避。反以地黄
五味。阴药附和其阴。阴霾冲逆肆虐。饮邪滔天莫制。议以仲景熟附配生姜法。
扫群阴以驱饮邪。维阳气以立基本。况尊年尤宜急护真阳为主。
人参 茯苓 熟附子 生姜汁 南枣
十二月间。诊得阳微浊饮。上干为咳。不能卧。曾用小青龙汤。减去麻黄细
辛。服后已得着枕而卧。想更医接用。不明治饮方法。交惊蛰阳气发泄。病势更
炽。顷诊脉来濡弱无神。痰饮咳逆未已。谅非前法可效。宗仲景真武汤法。以熟
附配生姜。通阳逐饮立法。
真武汤去白术加人参
脉弦右涩。面亮舌白。口干不喜饮。头重岑岑然。胸脘痹塞而痛。得嗳气稍
舒。酒客谷少中虚。痰饮聚蓄。当此夏令。地气上升。饮邪挟气。上阻清空。遂令前
症之来。金匮云。脉弦为饮。色鲜明者为留饮。口干不欲饮水者。此为饮邪未去
故也。况 汗出。岂是风寒。春夏温邪。辛温发散为大禁。自云身体空飘。年已
六旬有四。辛散以泄其阳。不亦左乎。
半夏 姜汁 川连 吴萸 茯苓 枳实 竹沥
远客路途。风寒外受。热气内蒸。痰饮日聚于脏之外。脉络之中。凡遇风冷。
或曝烈日。或劳碌身体。心事不宁。扰动络中宿饮。饮泛气逆咳嗽。气塞喉底。胸
膈不思食物。着枕呛吐稠痰。气降自愈。病名哮喘伏饮。治当得宜。除根不速。到
老年仍受其累耳。
小青龙汤去细辛
冬温。阳不潜伏。伏饮上泛。仲景云。脉沉属饮。面色鲜明为饮。饮家咳甚。当
治其饮。不当治咳。缘年高下焦根蒂已虚。因温暖气泄。不主收藏。饮邪上扰乘
肺。肺气不降。一身之气交阻。熏灼不休。络血上涌。经云。不得卧。卧则喘甚痹塞。
乃肺气之逆乱也。若以见病图病。昧于色诊候气。必致由咳变幻。腹肿胀满。渐
不可挽。明眼医者。勿得忽为泛泛可也。兹就管见。略述大意。议开太阳。以使饮
浊下趋。仍无碍于冬温。从仲景小青龙越脾合法。
杏仁 茯苓 苡仁 炒半夏 桂枝木 石膏 白芍 炙草
伏饮阴浊上干。因春地气主升而发。呕吐不饥。自然脾胃受伤。六君子宣
补。方法未尝不妙。今诊得吸气甚微。小溲晨通暮癃。足跗浮肿。其腑中之气开
阖失司。最虑中满。夫太阳司开。阳明司阖。浊阴弥漫。通腑即是通阳。仿仲景开
太阳一法。
牡蛎 泽泻 防己 茯苓 五味 干姜
夏至节。两关脉弦长。五火燔燎。而肝阳胃阳尤甚。动怒抽掣为肝病。食辛
香浓味。即病至。胃病使然。痰火根深。非顷刻可除。惟静养勿恚忿。薄味以清里。
此病发之势必缓。由渐加功议药。乃近理治法。
羚羊角 犀角 川连 郁金 山栀 北秦皮 牛黄 胆星 橘红 生石膏
寒水石 金箔 方诸水法丸竹叶灯心汤送下
病起痰饮。渐为咳嗽外寒。遇劳倦即发。发必胸膈气胀。吐出稀涎浊沫。病
退则痰浓。气降乃已。凡饮邪皆阴浊凝聚。两年之久。渐渐腹中痞闷妨食。肛门
尻骨。坐则无恙。行动站立。时时气坠。若欲大便。显系肾虚不能收摄。惑于在前
见痰治嗽。苟非辛解。即属寒降。乃致养成锢疾。
肾气汤加紫衣胡桃 沉香汁
过去身体肥胖现在消瘦，这是痰饮病。张仲景说：脉象沉而弦，这就是痰饮病患者。男子年老时，下焦元气先已亏损，气机不能固摄，导致痰饮上泛。痰饮随气机上涌，这就形成了咳嗽。现在的医生见到咳嗽，就立刻用清肺降气、消痰的药物，时间久了也不见效，又改用滋阴药，却不明白痰饮都属于浊阴的转化，滋阴药会堆积体内，助长浊邪阻滞气机。试述一下睡觉时咳嗽呛逆这一症状，知道身体躺下时，上焦之气不平，必然向下冲逆向上，这说明痰饮潜伏在至阴之地（肾脏），这无疑是肾脏络脉受病的表现。形体怕冷、畏风，说明阳气微弱，卫外功能疏懈。张仲景有简明扼要的话说：治疗饮邪必须用温药调和。更区分外饮治脾，内饮治肾。不读经典医书，怎么懂得这个道理。
脉象弦，右脉濡弱，阳气微弱，恶寒，浊饮上犯，咳吐涎沫，而且食欲减退、胃气衰败，寒疝潜伏体内。阴浊的表现，岂止一端？喻嘉言说浊阴上加于天（头部/上部），如果不是像太阳当空照耀，雾气怎么能退避？反而用地黄、五味子等阴药来辅助其阴，导致阴霾冲逆肆虐，饮邪滔天无法控制。建议采用张仲景熟附子配生姜的方法，扫除群阴以驱除饮邪，维护阳气以确立根本。况且年事已高，更应当急护真阳为主。
十二月间，诊得阳气微弱，浊饮上犯引起咳嗽，不能平卧。曾用小青龙汤，减去麻黄、细辛，服用后已经能够着枕而卧。想是其他医生接续用药，不明白治疗饮邪的方法，到了惊蛰节气，阳气发泄，病势更加炽盛。刚才诊脉来濡弱无神，痰饮咳逆未止，估计不是前法能奏效的。遵循张仲景真武汤的方法，以熟附子配生姜，通阳逐饮为立法原则。
脉象弦，右脉涩，面色光亮，舌苔白，口干但不喜欢喝水，头重沉沉的感觉，胸脘部痹塞疼痛，打嗝后稍舒。酒客谷食少，中焦虚弱，痰饮聚积。正值夏令，地气上升，饮邪挟带气机，上阻清空（头部/胸部）。于是导致前面的病症发作。《金匮要略》说：脉弦为饮，面色鲜明者为留饮，口干不欲饮水者，这是因为饮邪未去。何况出汗，难道是风寒吗？春夏季节的温邪，使用辛温发散是大禁忌。自述身体空飘感，年龄六十四岁，用辛散药物泄耗其阳气，岂不是错误吗？
远行路途，风寒外受，热气内蒸，痰饮日益积聚在脏腑之外、脉络之中。凡遇到风冷，或暴晒烈日，或劳累身体，心事不宁，扰动络中的宿饮，饮邪泛滥气逆咳嗽，气塞喉底，胸膈不想进食，躺下时呛吐稠痰，气降则自愈。病名哮喘伏饮，治疗得当，根除不快，到老年仍受其累。
小青龙汤去细辛
冬温病，阳气不潜伏，伏饮上泛。张仲景说：脉沉属饮，面色鲜明为饮，痰饮病患者咳嗽严重，应当治疗饮邪，不应当只治疗咳嗽。因为年高下焦根蒂已虚，因温暖之气泄越，不主收藏，饮邪上扰乘肺，肺气不降，一身之气交阻，熏灼不休，络血上涌。经书说：不得卧，卧则喘甚痹塞，这是肺气之逆乱。如果见病治病，不明色诊候气，必定导致由咳嗽变幻出腹肿胀满，渐渐不可挽救。明眼医者，不要忽视把它当作一般疾病处理。这里根据浅见，略述大意。建议开太阳经，以使饮浊下趋，仍然不碍于冬温，从张仲景小青龙汤与越脾合法结合。
伏饮阴浊上犯，因春季地气主升而发作，呕吐不饥，自然脾胃受伤。六君子汤宣补，方法未尝不妙。现在诊得吸气甚微，小便早晨通畅晚上癃闭，足背浮肿。腑中之气的开阖失司，最担心中满。太阳主管开，阳明主管阖，浊阴弥漫，通腑即是通阳。仿照张仲景开太阳一法。
夏至节气，两关脉弦长，五火燔燎，而肝阳胃阳尤其严重。动怒抽掣是肝病，食用辛香浓味食物即发病，是胃病使然。痰火根深，不是顷刻可除，只有静养勿愤怒，清淡饮食以清里热。此病发作之势必缓，由渐加功议药，才是近理治法。
羚羊角 犀角 川连 郁金 山栀 北秦皮 牛黄 胆星 橘红 生石膏
寒水石 金箔 方诸水法丸竹叶灯心汤送下
病起于痰饮，逐渐发展为咳嗽外寒，遇劳倦即发作，发作时必胸膈气胀，吐出稀涎浊沫，病退则痰浓，气降才停止。凡是饮邪都是阴浊凝聚，两年之久，渐渐腹中痞闷妨碍进食，肛门尻骨部位，坐着时无恙，行动站立时，时时感觉气坠。如果要大便，显系肾虚不能收摄。被之前见痰治嗽的观点迷惑，如果不是辛解，就是寒降，以致养成锢疾。
Past obesity and current emaciation indicate fluid retention (Yin, 饮). Zhang Zhongjing stated: "A pulse that is deep and wiry indicates a patient with fluid retention." In old age, men first suffer from deficiency in the lower yuan (lower primordial qi). When qi fails to secure and hold, phlegm-fluids float upward. Fluids surging with qi result in coughing. Modern physicians, upon seeing cough, immediately use herbs to clear the lungs, direct qi downward, and resolve phlegm. After prolonged ineffectiveness, they switch to yin-nourishing methods, failing to understand that phlegm-fluids are transformations of turbid yin. Yin-nourishing herbs accumulate and obstruct, aiding turbidity and stagnating qi. Consider the symptom of coughing and choking when lying down: knowing that when the body lies flat, upper qi becomes uneven, it must rush downward and rebel upward. This indicates that phlegm-fluids are latent at the boundary of extreme yin (the Kidneys), undoubtedly involving disease of the Kidney collaterals. Physical coldness and aversion to wind indicate weak yang qi and loose defensive barriers. Zhang Zhongjing succinctly stated: "Fluid pathogens must be treated with warm herbs to harmonize them." Furthermore, external fluids are treated via the Spleen, internal fluids via the Kidneys. Without reading the classics, how can one know this principle?
Guiling Gan Zhu Tang (Cinnamon Twig, Poria, Atractylodes Macrocephala, and Licorice Decoction)
The pulse is wiry, with the right position being soggy and weak. Yang qi is weak, there is aversion to cold, turbid fluids invade upward causing coughing and expectoration of saliva foam. Appetite is reduced and stomach qi is declining; cold hernia lurks within. The manifestations of yin turbidity are not limited to one aspect. Yu Jiayan said that when turbid yin rises to the heavens (upper body), unless the bright sun shines overhead, how can the mist retreat? Instead, using yin-nourishing herbs like Rehmanniae Radix Preparata (Shu Dihuang) and Schisandrae Fructus (Wuweizi) to support yin causes yin-mist to surge and rebel tyrannically, making fluid pathogens uncontrollable. It is proposed to adopt Zhang Zhongjing's method of pairing Prepared Aconite Root (Shu Fuzi) with Fresh Ginger Juice (Shengjiang Zhi) to sweep away yin pathogens and expel fluid retention, thereby preserving yang qi as the foundation. Especially for the elderly, urgent protection of true yang is paramount.
Ren Shen (Ginseng Radix et Rhizoma), Fu Ling (Poria), Shu Fu Zi (Prepared Aconite Lateral Root), Sheng Jiang Zhi (Fresh Ginger Juice), Nan Zao (Chinese Jujube Fruit)
In December, the pulse indicated weak yang and turbid fluids invading upward causing cough, preventing supine rest. Xiao Qing Long Tang (Minor Blue Dragon Decoction) was used previously, with Ephedrae Herba (Mahuang) and Asari Radix (Xixin) removed. After taking it, the patient could lie on a pillow to sleep. Presumably, subsequent physicians did not understand the method for treating fluid retention. Upon reaching Jingzhe (Awakening of Insects solar term), yang qi erupts, and the disease condition intensifies. Current pulse is soggy, weak, and spiritless; phlegm-fluid cough and rebellion persist. It is estimated that the previous method will not be effective. Following Zhang Zhongjing's Zhen Wu Tang (True Warrior Decoction) method, pairing Prepared Aconite Root with Fresh Ginger to unblock yang and expel fluids is established as the principle.
Zhen Wu Tang (True Warrior Decoction) minus Bai Zhu (Atractylodis Macrocephalae Rhizoma), plus Ren Shen (Ginseng Radix et Rhizoma)
The pulse is wiry, with the right position being choppy. The face appears lustrous, tongue coating is white, mouth is dry but without desire to drink. Head feels heavy and oppressive. Chest and epigastrium feel blocked and painful, slightly relieved by belching. Wine drinkers often have scant grain intake and middle jiao deficiency, leading to phlegm-fluid accumulation. During summer, earth qi rises; fluid pathogens carry qi upward, blocking the clear spaces (head/chest). Thus, previous symptoms recur. *Jin Gui Yao Lue* states: "Wiry pulse indicates fluid retention; bright complexion indicates retained fluid; dry mouth without desire to drink indicates fluid pathogen has not departed." Moreover, sweating—could this be wind-cold? In spring and summer, warm pathogens make acrid-warm dispersing methods strictly forbidden. The patient reports a sensation of bodily emptiness and floating; aged sixty-four, using acrid-dispersing herbs to leak yang qi is indeed erroneous.
Ban Xia (Pinelliae Tuber), Jiang Zhi (Ginger Juice), Chuan Lian (Coptidis Rhizoma), Wu Zhu Yu (Evodiae Fructus), Fu Ling (Poria), Zhi Shi (Aurantii Fructus Immaturus), Zhu Li (Bamboo Sap)
Traveling far, wind-cold is received externally while heat steams internally. Phlegm-fluids accumulate daily outside the zang-fu organs and within the collaterals. Whenever encountering wind-cold, exposure to scorching sun, physical labor, or mental agitation, the dormant fluids in the collaterals are disturbed. Fluids flood and qi rebels, causing cough; qi blocks the throat base; chest and diaphragm lose appetite for food; lying down causes choking and expectoration of thick sputum. Health returns when qi descends. The disease name is asthma with latent fluid retention. If treatment is appropriate, roots may not be quickly eliminated, burdening the patient in old age.
Xiao Qing Long Tang (Minor Blue Dragon Decoction) minus Xi Xin (Asari Radix)
Winter-warmth disease: yang qi does not hide; latent fluids float upward. Zhang Zhongjing said: "Deep pulse belongs to fluid retention; bright facial color indicates fluid retention. For patients with fluid retention, severe cough should be treated by addressing the fluid, not just the cough." Because the elderly have deficient root qi in the lower jiao, due to warmth causing qi leakage and failure to store, fluid pathogens disturb the lung upward. Lung qi fails to descend, causing obstruction of whole-body qi, continuous burning, and bleeding from collaterals rising. Classics state: inability to lie down, worsening wheezing and blockage when lying down, indicates rebellious disorder of lung qi. If one treats the disease blindly without understanding complexion diagnosis and qi assessment, cough will transform into abdominal swelling and fullness, becoming increasingly incurable. Astute physicians must not neglect this as a trivial matter. Based on my humble opinion, I briefly outline the main idea. It is proposed to open the Taiyang channel to guide turbid fluids downward, without hindering the winter-warmth condition, combining Zhang Zhongjing's Xiao Qing Long Tang with Spleen-regulating harmony methods.
Xing Ren (Armeniacae Semen Amarum), Fu Ling (Poria), Yi Yi Ren (Coicis Semen), Chao Ban Xia (Stir-baked Pinelliae Tuber), Guizhi Mu (Cinnamomi Ramulus), Shi Gao (Gypsum Fibrosum), Bai Shao (Paeoniae Radix Alba), Zhi Cao (Honey-fried Glycyrrhizae Radix et Rhizoma)
Latent fluid yin-turbidity invades upward, triggered by spring earth qi rising. Vomiting and lack of hunger naturally injure the Spleen and Stomach. Liu Jun Zi Tang (Six Gentlemen Decoction) for tonification and supplementation is not an bad method. However, current pulse shows very faint inspiration, morning urination is smooth but evening urination is difficult (retention), and dorsal foot edema exists. The opening and closing functions of fu organ qi are dysfunctional; middle-fullness is most feared. Taiyang governs opening, Yangming governs closing. Yin-turbidity pervades; unblocking fu organs is equivalent to unblocking yang. Mimicking Zhang Zhongjing's method of opening Taiyang.
Mu Li (Ostreae Concha), Ze Xie (Alismatis Rhizoma), Fang Ji (Stephaniae Tetrandrae Radix), Fu Ling (Poria), Wu Wei Zi (Schisandrae Fructus), Gan Jiang (Zingiberis Rhizoma)
At the Summer Solstice, pulses at both Guan positions are wiry and long. The five fires blaze, especially Liver Yang and Stomach Yang. Anger-induced twitching indicates Liver disease; illness triggered by consuming pungent, aromatic, and rich flavors indicates Stomach disease. Phlegm-fire has deep roots and cannot be removed instantly. Only through quiet cultivation, avoiding anger, and light diet to clear interior heat can this be managed. The progression of this disease will be slow; gradual medicinal intervention is a rational therapeutic method.
Ling Yang Jiao (Capricornis Cornu), Xi Jiao (Rhinocerotis Cornu), Chuan Lian (Coptidis Rhizoma), Yu Jin (Curcumae Radix), Shan Zhi (Gardeniae Fructus), Bei Qin Pi (Fraxini Cortex), Niu Huang (Bovis Calculus), Dan Xing (Arisarum Bulbus cum Bile), Ju Hong (Citri Reticulatae Pericarpium Rubrum), Sheng Shi Gao (Raw Gypsum Fibrosum)
Han Shui Shi (Halloysitum Rubrum), Jin Bo (Folium Aurum), Fang Zhu Shui Fa Wan (Pills made with Fang Zhu Water), sent down with Zhu Ye (Phyllostachys Viridis Folium) and Deng Xin (Junci Medulla) decoction.
The illness began with phlegm-fluids, gradually developing into cough and exterior cold. It recurs with fatigue. Attacks cause chest and diaphragmatic distension, expectorating thin saliva and turbid foam. As the disease recedes, sputum becomes thick, and health returns only when qi descends. All fluid pathogens are condensed yin-turbidity. Over two years, abdominal blooming and food intolerance gradually developed. The anus and sacrum area are fine when sitting, but standing or walking causes frequent sensation of qi sinking. Defecation requires effort, clearly indicating Kidney deficiency failing to secure. Confused by previous views of treating cough by resolving phlegm, if not using acrid-resolving methods, then cold-descending methods were used, thereby fostering entrenched disease.
Shen Qi Wan (Kidney Qi Pill) plus Zi Yi Hu Tao (Walnut Kernel with Membrane) and Chen Xiang Zhi (Aquilariae Resina Juice)