王 三十岁 癸亥六月十五日 六脉俱濡，右寸独大，湿淫于中，肺气贲郁，因而作哕
，与伤寒阳明足太阴之寒哕有间，以宣肺气之痹为主。
广皮（二钱） 生苡仁（三钱） 杏泥（二钱） 通草（二钱） 柿蒂（三钱） 竹茹（三钱） 飞
滑石（三钱） 姜汁（二小匙，冲入）
十七日 泄泻胸闷，于前方加∶
茯苓（三钱） 藿梗（二钱）
十九日 脉之濡者已解，寸之大者已平。惟胃中有饮，隔拒上焦之气，不得下通，故于
其旺时而哕甚，今从阳明主治。
半夏（六钱） 飞滑石（三钱） 茯苓（五钱） 生苡仁 广皮 柿蒂
二十二日 哕虽止而六脉俱数，右手更大，泄泻色黑，舌黄，气分湿热可知。
茯苓皮（五钱） 白通草（二钱） 黄芩炭（一钱） 泽泻（二钱） 滑石（三钱） 生苡仁（三
钱） 白扁豆皮（三钱） 川朴（一钱） 连翘（二钱）
朱 乙丑二月初二日 右脉洪数有力，金实无声，麻杏石甘汤证也。奈已为前医发汗，
麻黄未便再用，议清音汤加石、杏。
苦桔梗（六钱） 生甘草（二钱） 半夏（六钱） 苇根（五钱） 石膏（六钱） 杏仁粉（五钱）
水五杯，煮成两杯，渣再煮一杯，分三次服。
初三日 肺脏本热，为外感所搏，实而无声，究系麻杏石甘法为速。
生石膏（一两） 麻黄（五钱，去节） 炙甘草（三钱） 杏泥（六钱） 半夏（五钱）
初四日 右脉洪数，已减其半，音亦渐开，仍用麻杏石甘加半夏一帖。
麻黄（三钱，去节） 炙甘草（三钱） 杏仁霜（七钱） 生石膏（一两，研末） 半夏（七钱）
甘澜水八碗，煮三碗，分三次服，以后病减者减其治。
沈 二十岁 正月二十九日 六脉弦细若丝，阳微极矣。咳嗽便溏，纳食不旺，由上焦
损及
中焦，所以致损之由，初因遗精，继因秋伤于湿，冬必咳嗽。外邪未清，骤然用补，使邪无
出路，致咳嗽不已。古谓病有三虚一实者，先治其实，后治其虚。现下喉哑治实，先与提肺
气，治虚与诸虚不足之小建中汤。
苦桔梗（四钱） 杏泥（二钱） 云苓（五钱） 生甘草（二钱） 生苡仁（五钱） 姜半夏（四
钱）
煎两杯，分二次服。
二月初六日 六脉弦细之极，阴阳俱损，急需用补，以外感未净，喉音未清，暂与理肺
二帖，后再诊。
苦桔梗（二钱） 甜杏仁（四钱） 姜半夏（三钱） 生草（二钱） 茯苓（四钱） 冰糖（四钱）
鲜芦根（四钱）
煮三小杯，分三次服。
朱 四十五岁 酒客失音，与麻杏石甘汤。
麻黄（五钱） 生石膏（四两） 炙甘草（三钱） 杏仁（四钱）
服一帖无汗，音不出，二帖微汗，音出不甚响，仍用前法。
麻黄（三钱，蜜炙） 生石膏（三两） 炙甘草（三钱） 杏仁（四钱）
服五帖音大出，但脉滑耳，与清音汤。
草桔梗（六钱） 炙甘草（二钱） 姜半夏（六钱）
服五帖音清，脉滑痰饮不尽，与外台茯苓饮法，减辛药。
茯苓（八钱） 半夏（五钱） 麦冬（五钱，连心） 沙参（三钱） 小枳实（钱半） 广皮（二
钱） 甘草（钱半）
七帖而安。
软儿 十五岁 歌唱劳伤，肺火喉哑。
洋参（一两，切薄片） 鲍鱼（四两，切薄片）
早晚各取鲍鱼片二钱，洋参五分，煎汤顿服，歌时取洋参、鲍鱼各一片，贴牙后腮间，
咽其津液，以后不复哑矣。
又 十六岁 因饮酒过度，贪食水果，寒热相搏，湿热内壅。
苦桔梗 甘草 茯苓 苏梗 半夏 神曲 芦根
数帖而安。
王，三十岁。癸亥年六月十五日就诊。六脉均呈濡象（细软而浮），唯独右寸脉独大，此为湿邪弥漫于体内，导致肺气壅滞郁结，从而引发呃逆（哕）。这与伤寒病中阳明经或足太阴脾经受寒所致的寒性呃逆有所不同，治疗应以宣通肺气之痹阻为主。
处方：广陈皮（二钱）、生薏苡仁（三钱）、杏仁泥（二钱）、通草（二钱）、柿蒂（三钱）、竹茹（三钱）、飞滑石（三钱）、姜汁（两小匙，冲服）。
十七日。出现泄泻、胸闷症状，在前方基础上加用：茯苓（三钱）、藿香梗（二钱）。
十九日。脉象中的濡象已解除，寸口脉的大象已平复。仅是胃中有停饮，阻隔上焦之气不得下行通畅，因此在气机旺盛之时呃逆加重，现从阳明经主治。
处方：半夏（六钱）、飞滑石（三钱）、茯苓（五钱）、生薏苡仁、广陈皮、柿蒂。
二十二日。呃逆虽止，但六脉均数（快），右手脉更大，泄泻物色黑，舌苔黄，可知为气分湿热之证。
处方：茯苓皮（五钱）、白通草（二钱）、黄芩炭（一钱）、泽泻（二钱）、滑石（三钱）、生薏苡仁（三钱）、白扁豆皮（三钱）、厚朴（川朴，一钱）、连翘（二钱）。
朱，乙丑年二月初二日就诊。右脉洪大、数且有力，属“金实无声”（肺实导致失音），是麻杏石甘汤的适应证。无奈此前已被医生发过汗，麻黄不便再用，拟用清音汤加石膏、杏仁。
处方：苦桔梗（六钱）、生甘草（二钱）、半夏（六钱）、苇根（五钱）、石膏（六钱）、杏仁粉（五钱）。
用水五杯，煮取两杯药液，药渣再煮一杯，分三次服用。
初三日。肺脏本有热邪，被外感邪气搏结，实证导致失音，究其根本，还是用麻杏石甘汤法更为迅速。
处方：生石膏（一两）、麻黄（五钱，去节）、炙甘草（三钱）、杏仁泥（六钱）、半夏（五钱）。
初四日。右脉洪数，已减轻一半，声音也逐渐恢复，仍用麻杏石甘汤加半夏一剂。
处方：麻黄（三钱，去节）、炙甘草（三钱）、杏仁霜（七钱）、生石膏（一两，研末）、半夏（七钱）。
用甘澜水八碗，煮取三碗，分三次服用，此后病情减轻则相应减少治疗力度。
沈，二十岁。正月二十九日就诊。六脉弦细如丝，阳气极度微弱。咳嗽、大便溏薄、食欲不佳，这是由于上焦受损波及中焦所致。导致虚损的原因，起初因遗精，继之又因秋季感受湿邪，冬季必然咳嗽。外邪未清，骤然使用补药，使邪气没有出路，导致咳嗽不止。古人说病有“三虚一实”的情况，应先治其实证，后治其虚证。现下喉哑属实证，先予提举肺气之法；治虚损用小建中汤治疗诸般不足。
处方：苦桔梗（四钱）、杏仁泥（二钱）、云茯苓（五钱）、生甘草（二钱）、生薏苡仁（五钱）、姜半夏（四钱）。
煎取两杯药液，分二次服用。
二月初六日。六脉弦细至极，阴阳俱损，急需进补。但因外感尚未净尽，喉音未清，暂用理肺方两帖，之后再诊。
处方：苦桔梗（二钱）、甜杏仁（四钱）、姜半夏（三钱）、生甘草（二钱）、茯苓（四钱）、冰糖（四钱）、鲜芦根（四钱）。
煮成三小杯，分三次服用。
朱，四十五岁。嗜酒之人失音，给予麻杏石甘汤。
处方：麻黄（五钱）、生石膏（四两）、炙甘草（三钱）、杏仁（四钱）。
服一帖无汗，声音不出；服二帖微汗，声音出不甚响亮，仍用前法。
处方：麻黄（三钱，蜜炙）、生石膏（三两）、炙甘草（三钱）、杏仁（四钱）。
服五帖声音大出，但脉象滑利，给予清音汤。
处方：草桔梗（六钱）、炙甘草（二钱）、姜半夏（六钱）。
服五帖声音清亮，但脉滑提示痰饮未尽，采用《外台秘要》茯苓饮法，减去辛散药物。
处方：茯苓（八钱）、半夏（五钱）、麦冬（五钱，连心）、沙参（三钱）、小枳实（半钱）、广陈皮（二钱）、甘草（半钱）。
服七帖而安。
软儿，十五岁。歌唱劳伤，肺火导致喉哑。
处方：西洋参（一两，切薄片）、鲍鱼（四两，切薄片）。
早晚各取鲍鱼片二钱、西洋参五分，煎汤顿服。唱歌时取西洋参、鲍鱼各一片，贴于牙后腮间，咽下津液，此后不再失音。
又案，十六岁。因饮酒过度，贪食水果，寒热相搏，湿热内蕴壅滞。
处方：苦桔梗、甘草、茯苓、苏梗、半夏、神曲、芦根。
数帖而安。
Wang, aged 30. On the 15th day of the 6th month in the Guihai year. All six pulses were Ru (fine and soft), yet the right Cun position alone was enlarged. Dampness had permeated the interior, causing Qi stagnation and depression in the Lung, thereby inducing hiccups (Yue). This differs from the cold-induced hiccups seen in the Yangming or Foot-Taiyin Spleen channels in Cold Damage diseases. Treatment should primarily focus on unblocking the obstruction of Lung Qi.
Prescription: Guangpi (Citri Reticulatae Pericarpium, 2 qian), Sheng Yiren (Coicis Semen, 3 qian), Xingni (Armeniacae Semen Amarum paste, 2 qian), Tongcao (Tetrapanacis Medulla, 2 qian), Shidi (Diospyri Fructus, 3 qian), Zhuru (Bambusae Caulis in Taeniam, 3 qian), Fei Huashi (Talcum, 3 qian), Jiangzhi (Zingiberis Rhizoma Fresh Juice, 2 small spoons, taken with decoction).
On the 17th day. Diarrhea and chest oppression occurred. Added to the previous prescription: Fuling (Poria, 3 qian), Huogeng (Agastachis Herba stem, 2 qian).
On the 19th day. The Ru quality of the pulse had resolved, and the enlargement at the Cun position had normalized. Only damp-fluid retention in the Stomach remained, obstructing Upper Jiao Qi from descending smoothly, thus exacerbating hiccups during peak Qi times. Now treating according to the Yangming channel.
Prescription: Banxia (Pinelliae Rhizoma, 6 qian), Fei Huashi (Talcum, 3 qian), Fuling (Poria, 5 qian), Sheng Yiren (Coicis Semen), Guangpi (Citri Reticulatae Pericarpium), Shidi (Diospyri Fructus).
On the 22nd day. Hiccups ceased, but all six pulses became rapid (Shu), with the right hand pulse even larger. Diarrhea stool was dark, tongue coating yellow, indicating damp-heat in the Qi level.
Prescription: Fulingpi (Poria Cum Cortex, 5 qian), Bai Tongcao (Akebiae Caulis, 2 qian), Huangqin Tan (Scutellariae Radix carbonized, 1 qian), Zexie (Alismatis Rhizoma, 2 qian), Huashi (Talcum, 3 qian), Sheng Yiren (Coicis Semen, 3 qian), Baibian Doupi (Dolichoris Semen Pericarpium, 3 qian), Chuan Po (Magnoliae Officinalis Cortex, 1 qian), Lianqiao (Forsythiae Fructum, 2 qian).
Zhu, on the 2nd day of the 2nd month in the Yichou year. The right pulse was Hong (surging), Shu (rapid), and forceful. This is "Metal Solid, No Sound" (Lung excess leading to aphonia), a syndrome indicated for Mahuang Xinggan Shigao Tang (Ephedra, Apricot Seed, and Gypsum Decoction). However, as prior physicians had already induced sweating, Mahuang (Ephedrae Herba) should not be used again. It is proposed to use Qingyin Tang (Clear Voice Decoction) plus Shigao (Gypsum) and Xingren (Armeniacae Semen Amarum).
Prescription: Ku Jiegeng (Platycodonis Radix, 6 qian), Sheng Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian), Banxia (Pinelliae Rhizoma, 6 qian), Weigen (Phragmitis Rhizoma, 5 qian), Shigao (Gypsum Fibrosum, 6 qian), Xingrenfen (Armeniacae Semen Amarum powder, 5 qian).
Boil with five cups of water until two cups remain. Boil the dregs again for one cup. Take in three divided doses.
On the 3rd day. The Lung organ originally possessed heat, which was constrained by external pathogens, resulting in excess and silence. Ultimately, the method of Mahuang Xinggan Shigao Tang (Ephedra, Apricot Seed, and Gypsum Decoction) is faster.
Prescription: Sheng Shigao (Gypsum Fibrosum, 1 liang), Mahuang (Ephedrae Herba, 5 qian, remove joints), Zhi Gancao (Glycyrrhizae Radix et Rhizoma honey-fried, 3 qian), Xingni (Armeniacae Semen Amarum paste, 6 qian), Banxia (Pinelliae Rhizoma, 5 qian).
On the 4th day. The right pulse was surging and rapid, but reduced by half. Voice gradually opened. Continue using Mahuang Xinggan Shigao Tang (Ephedra, Apricot Seed, and Gypsum Decoction) plus Banxia (Pinelliae Rhizoma) for one dose.
Prescription: Mahuang (Ephedrae Herba, 3 qian, remove joints), Zhi Gancao (Glycyrrhizae Radix et Rhizoma honey-fried, 3 qian), Xingrenshuang (Armeniacae Semen Amarum frost/powder, 7 qian), Sheng Shigao (Gypsum Fibrosum, 1 liang, ground), Banxia (Pinelliae Rhizoma, 7 qian).
Boil eight bowls of Ganlan Shui (Gentle Wave Water) down to three bowls. Take in three divided doses. Thereafter, reduce treatment intensity as the illness subsides.
Shen, aged 20. On the 29th day of the 1st month. All six pulses were Xian (wiry) and fine like silk; Yang Qi was extremely deficient. Cough, loose stools, poor appetite. This resulted from Upper Jiao damage affecting the Middle Jiao. The cause of this deficiency initially stemmed from seminal emission, followed by dampness injury in autumn, leading to winter cough. External pathogens were not cleared; sudden use of tonics blocked the exit for pathogens, causing persistent cough. Ancient texts state that when disease presents with "three deficiencies and one excess," treat the excess first, then the deficiency. Currently, hoarseness indicates excess; first raise Lung Qi. For deficiency, use Xiaojianzhong Tang (Minor Construct the Middle Decoction) for various insufficiencies.
Prescription: Ku Jiegeng (Platycodonis Radix, 4 qian), Xingni (Armeniacae Semen Amarum paste, 2 qian), Yunling (Poria, 5 qian), Sheng Gancao (Glycyrrhizae Radix et Rhizoma, 2 qian), Sheng Yiren (Coicis Semen, 5 qian), Jiang Banxia (Pinelliae Rhizoma ginger-processed, 4 qian).
Decoct to two cups. Take in two divided doses.
On the 6th day of the 2nd month. All six pulses were extremely wiry and fine; both Yin and Yang were damaged, urgently requiring tonification. However, since external pathogens are not fully cleared and voice is not clear, temporarily use Lifei (Regulate Lung) formula for two doses, then re-evaluate.
Prescription: Ku Jiegeng (Platycodonis Radix, 2 qian), Tian Xingren (Sweet Armeniacae Semen Amarum, 4 qian), Jiang Banxia (Pinelliae Rhizoma ginger-processed, 3 qian), Sheng Cao (Glycyrrhizae Radix et Rhizoma, 2 qian), Fuling (Poria, 4 qian), Bingtang (Saccharum, 4 qian), Xian Lugeng (Fresh Phragmitis Rhizoma, 4 qian).
Boil into three small cups. Take in three divided doses.
Zhu, aged 45. Aphonia in a wine drinker. Prescribed Mahuang Xinggan Shigao Tang (Ephedra, Apricot Seed, and Gypsum Decoction).
Prescription: Mahuang (Ephedrae Herba, 5 qian), Sheng Shigao (Gypsum Fibrosum, 4 liang), Zhi Gancao (Glycyrrhizae Radix et Rhizoma honey-fried, 3 qian), Xingren (Armeniacae Semen Amarum, 4 qian).
After one dose, no sweat, voice did not emerge. After two doses, slight sweat, voice emerged but not loud. Continue previous method.
Prescription: Mahuang (Ephedrae Herba, 3 qian, honey-fried), Sheng Shigao (Gypsum Fibrosum, 3 liang), Zhi Gancao (Glycyrrhizae Radix et Rhizoma honey-fried, 3 qian), Xingren (Armeniacae Semen Amarum, 4 qian).
After five doses, voice emerged loudly, but pulse was slippery. Prescribed Qingyin Tang (Clear Voice Decoction).
Prescription: Cao Jiegeng (Platycodonis Radix, 6 qian), Zhi Gancao (Glycyrrhizae Radix et Rhizoma honey-fried, 2 qian), Jiang Banxia (Pinelliae Rhizoma ginger-processed, 6 qian).
After five doses, voice was clear, but slippery pulse indicated incomplete phlegm-fluid. Adopted the method of Waitai Fuling Yin (Poria Drink from Outer Temple), reducing acrid herbs.
Prescription: Fuling (Poria, 8 qian), Banxia (Pinelliae Rhizoma, 5 qian), Maidong (Ophiopogonis Radix, with heart, 5 qian), Shashen (Glehniae Radix, 3 qian), Xiao Zhishi (Immature Bitter Orange, half qian), Guangpi (Citri Reticulatae Pericarpium, 2 qian), Gancao (Glycyrrhizae Radix et Rhizoma, half qian).
Recovered after seven doses.
Ruan'er, aged 15. Vocal strain from singing, Lung fire causing hoarseness.
Prescription: Yangshen (Panacis Quinquefolii Radix, 1 liang, sliced thin), Baoyu (Balistae Ovis Testudo, 4 liang, sliced thin).
Morning and evening, take 2 qian of Baoyu slice and 5 fen of Yangshen, decoct and drink immediately. When singing, place one slice each of Yangshen and Baoyu between the teeth and cheek, swallowing saliva. Afterwards, hoarseness would not recur.
Another case, aged 16. Due to excessive drinking and greedily eating fruits, cold and heat contended, causing internal accumulation of damp-heat.
Prescription: Ku Jiegeng (Platycodonis Radix), Gancao (Glycyrrhizae Radix et Rhizoma), Fuling (Poria), Sugeng (Perillae Caulis), Banxia (Pinelliae Rhizoma), Shenqu (Medicated Leaven), Lugeng (Phragmitis Rhizoma).
Recovered after several doses.