治热嗽壅盛。
青礞石 明矾（飞，研细） 猪牙皂角 生南星 生半夏 白茯苓 陈皮（各二两） 枳壳
枳实（各一两五钱） 黄芩 薄荷叶（各一两） 沉香（五钱）
上为细末和匀，姜汁浸神曲为丸，梧桐子大，每服一百丸，每夜临卧饧糖拌吞，噙嚼太
平丸，二药相攻，痰嗽除根。
南星皂半茯苓陈，礞石明矾二两均，枳实壳皆需两五，薄芩一两五钱沉。
人见此数味，或畏其狠，即予亦嫌其峻。然先生注云∶痰热壅盛，乃以上治。其不至壅
盛者
不可？若情形消瘦者，未可用也。是又在学人临证自明耳。
陈修园按∶此方即滚痰丸去大黄，加明矾、皂角、南星、半夏、茯苓、陈皮、枳壳、枳
实、
滚而下，而不知不得痰之所在，徒下其粪，则反伤胃气也。盖痰者水也，水者气也，水性下
行，得火则上沸而为痰，方中所以取用黄芩以清火。水非气不行，气滞则水亦滞，遂停瘀不
行而为痰，方中所以取用沉香、陈皮、枳壳、枳实等药，重重叠叠，以顺气、化气、行气，
且水汜滥则患大，由于地中行则天下安。方中取半夏、南星之辛温，茯苓之淡渗，以燥治湿
，即以土制水之义。语云∶见痰休治痰是也。方中唯礞石化痰为水，质重而力大，薄荷利气
化痰，体轻而行速，二味为治标之药，亦轻重各得其宜。最妙是明矾皂角二味，凡水混浊，
入明矾搅之，则浊者立刻转清矣。衣服污秽，以皂角洗之，则污者随涤而净矣。古人制方之
周到如此，所疑者，虚劳之症，不能当此峻剂，然病重药轻，多致误人，喻嘉言讥为养杀，
不如筹一生路而为破釜沉舟之计，尚有余望。每见痰嗽不绝，肌骨消瘦，声哑骨蒸，五更更
热而汗出，早饭后皮肤虽热，而脊背畏寒，手指微冷，此痨损既成，十不救一之症。医者议
论互异，而一种迂儒，谓肺虚液少，但云保肺，尤其浅也。必以六君子汤、归脾汤、补中益
气汤之类常服，土旺自可生金，毋区区于保肺。因前病金受火克，但知清心，治其末也，必
以
清心也。此为东垣立斋之法，人人信服而不疑。且有更进一步，自夸为得张景岳之心法，谓
真水为元阴，真火为元阳，皆根于命门，元阴之水中生艮土而上润肺金，元阳之火中生坤土
而上通心火，阴阳互根而不相离，六味汤丸、左归饮丸、八味汤丸、右归饮丸皆为极品，自
此说一行，而虚劳之证，十患九死，曷不思脾为诸脏之母，当无病时，常服补药，尚难进其
饮食，长其肌肉，至虚损病笃之时，将何法补其不足，且能令其有余以生金耶？肾为寿命之
根，当无病时常服补药，尚难充其精气，强其腰膝，至虚损病笃之时，又何法补其不足，且
能令其有余以济火耶？乡愿为德之贼，吾谓庸医之阴毒，更甚妄医之阳毒也。近日更有袭取
叶天士一派，遇有感冒，即用前胡、干葛、杏仁、桑叶、桔梗、紫苏、防风、茯苓、橘红、
苏法夏、神曲、谷芽、麦芽、山楂炭、甘草为主方，头痛加川芎、白芷，身痛加羌活、秦艽
，咳嗽加紫菀、百部，口渴加麦冬、花粉，小便短少，加滑石、木通、泽泻、猪苓，腹胀加
浓朴、枳实、萝卜子、砂仁壳，皮肤作痒，加蝉退、白蒺藜、连翘，喉痛加元参、射干、牛
蒡子、贝母，寒热往来，加柴胡、酒芩，腰膝痛加牛膝、杜仲，脚肿加木瓜、防己，病从怫
郁，则加黑郁金、香附，发热不退，加白薇、地骨、青蒿、白芍，数日未愈，曰当略调其气
血，加当归，酒芍，何首乌，干地黄、丹参、沙参等，出入互用。至于久病虚人，则以辽东
海参、燕窝、鲍鱼、谷芽、首乌、炙草等为主，其参、术、 、苓、二地、桂附、吴萸、炮
姜等，随症加入，而金银花炭、枸杞炭、菊花炭、白术炭、地黄炭、鲜桑枝、金银花藤、泡
淡干姜渣、泡淡附子、泡淡吴茱萸、秫稻根须、鳖血柴胡、五色石芸、冬瓜子、整个生扁豆
、黑 豆皮、绿豆皮、西瓜翠皮之类，曰我是叶天士一派，与恒法不同。而不知叶天士居
江苏，该处人腠理较薄，外邪易入而亦易出，不用仲景正法，故于《伤寒论》一部，未得师
授，议论甚觉隔靴，其于杂症，胸中颇有书卷，加以绝世聪明，临症甚多，所以名噪一时。
而虚劳一症，专祖《十药神书》，不必全用其方，神而明之，信手拈来，头头是道，何若辈
仅于《临症指南》中，食其糟粕，而伪托之也耶？
治疗热性咳嗽且痰液壅盛的症状。
青礞石、明矾（飞过，研成细末）、猪牙皂角、生南星、生半夏、白茯苓、陈皮（各二两）、枳壳、枳实（各一两五钱）、黄芩、薄荷叶（各一两）、沉香（五钱）。
以上药物研磨成细末并混合均匀，用姜汁浸泡神曲制成丸药，大小如梧桐子，每次服用一百丸，每晚临睡前用饴糖拌着吞服，同时含嚼太平丸，两种药物相互攻伐，彻底根除痰嗽。
南星、皂角、半夏、茯苓、陈皮各一两，礞石、明矾各二两相等，枳实、枳壳都需要一两五钱，黄芩、薄荷各一两，沉香五钱。
人们看到这几味药，有的害怕其药性猛烈，就连我也嫌弃它过于峻烈。然而先生注释说：痰热壅盛，应当用上述方法治疗。那些不至于壅盛的，难道就不能用吗？如果是形体消瘦的患者，则不可使用。这又需要学习者在临床实践中自行明辨。
陈修园按语：此方即滚痰丸去掉大黄，加入明矾、皂角、南星、半夏、茯苓、陈皮、枳壳、枳实。如果只知让痰火滚下，却不知道痰邪所在之处，只是徒然泻下粪便，反而会损伤胃气。大概痰就是水，水就是气，水性下行，遇到火就会向上沸腾变成痰，所以方中使用黄芩来清火。水没有气就不能运行，气滞则水也停滞，于是停聚瘀阻不行为痰，所以方中使用沉香、陈皮、枳壳、枳实等药，层层叠叠，以顺气、化气、行气。而且水泛滥则祸患大，由于在地中流淌则天下安宁。方中取半夏、南星的辛温，茯苓的淡渗，以燥湿治湿，也就是以土制水的道理。俗话说：见到痰不要只治痰。方中唯有礞石化痰为水，质地重而力量大；薄荷利气化痰，体轻而行速，这两味是治标的药，也是轻重各得其宜。最妙的是明矾和皂角这两味药，凡是水浑浊，加入明矾搅拌，那么浊物立刻变清；衣服污秽，用皂角清洗，那么污垢随即涤荡干净。古人制方的周到如此。所怀疑的是，虚劳病症，不能承受这种峻猛之剂。然而病重药轻，多导致误人，喻嘉言讥讽这种做法为“养杀”（滋养致死），不如筹划一条生路而采取破釜沉舟的策略，尚存希望。常见痰嗽不止，肌骨消瘦，声音嘶哑，骨蒸潮热，五更时分发热出汗，早饭后皮肤虽热，但脊背畏寒，手指微冷，这是痨损已成，十不治一的病症。医者议论各异，而有一种迂腐儒生，认为肺虚液少，只说保肺，尤其浅薄。必定要常服六君子汤、归脾汤、补中益气汤之类，土旺自然能生金，不要局限于保肺。因为前病是金受火克，只知道清心，是治其末节，必须清心。这是李东垣、薛立斋的方法，人人信服而不怀疑。并且有更进一步的人，自夸得到张景岳的心法，认为真水是元阴，真火是元阳，都根源于命门，元阴之水生出艮土而上润肺金，元阳之火生出坤土而上通心火，阴阳互根而不分离，六味地黄汤丸、左归饮丸、八味地黄汤丸、右归饮丸都是极品，自从这种说法流行后，虚劳病症，十个患者九个死亡，为何不想想脾为诸脏之母，在无病时常服补药，还难以促进饮食，增长肌肉，到了虚损病重之时，有什么方法补充不足，并且能让它有余以生金呢？肾为寿命之根，在无病时常服补药，还难以充实精气，强壮腰膝，到了虚损病重之时，又有什么方法补充不足，并且能让它有余以济火呢？乡愿是德行的贼，我认为庸医的阴毒，比妄医的阳毒更甚。近日更有袭取叶天士一派的人，遇到感冒，就用前胡、干葛、杏仁、桑叶、桔梗、紫苏、防风、茯苓、橘红、苏法夏、神曲、谷芽、麦芽、山楂炭、甘草为主方，头痛加川芎、白芷，身痛加羌活、秦艽，咳嗽加紫菀、百部，口渴加麦冬、花粉，小便短少，加滑石、木通、泽泻、猪苓，腹胀加厚朴、枳实、萝卜子、砂仁壳，皮肤作痒，加蝉蜕、白蒺藜、连翘，喉痛加玄参、射干、牛蒡子、贝母，寒热往来，加柴胡、酒黄芩，腰膝痛加牛膝、杜仲，脚肿加木瓜、防己，病从郁结而生，则加黑郁金、香附，发热不退，加白薇、地骨皮、青蒿、白芍，数日未愈，说应当略调其气血，加当归、酒白芍、何首乌、干地黄、丹参、沙参等，出入互用。至于久病虚人，则以辽东海参、燕窝、鲍鱼、谷芽、首乌、炙甘草等为主，人参、白术、[缺失字]、茯苓、二地、桂枝、附子、吴茱萸、炮姜等，随症加入，而金银花炭、枸杞炭、菊花炭、白术炭、地黄炭、鲜桑枝、金银花藤、泡淡干姜渣、泡淡附子、泡淡吴茱萸、秫稻根须、鳖血柴胡、五色石芸、冬瓜子、整个生扁豆、黑豆皮、绿豆皮、西瓜翠皮之类，自称是叶天士一派，与恒法不同。却不知道叶天士居住在江苏，那里的人腠理较薄，外邪容易进入也容易外出，不用张仲景的正法，所以对于《伤寒论》一部，没有得到师承传授，议论觉得很隔靴搔痒，他在杂症方面，胸中颇有书卷知识，加上绝世聪明，临证很多，所以名噪一时。而虚劳一症，专门效法《十药神书》，不必全用其方，神而明之，信手拈来，头头是道，为何这些人仅在《临症指南》中，食其糟粕，而伪托之呢？
Treats severe heat cough with phlegm obstruction.
Qingmengshi (Lapis Glaucophani), Mingfan (Alumen, processed by sublimation and ground fine), Zhuyazaojiao (Gleditsiae Sinensis Fructus Spina), Sheng Nanxing (Arisaematis Rhizoma cum Bile), Sheng Banxia (Pinelliae Rhizoma), Bai Fuling (Poria), Chenpi (Citri Reticulatae Pericarpium) (each 2 liang), Zhike (Aurantii Fructus Immaturus), Zhishi (Aurantii Fructus Immaturus) (each 1.5 liang), Huangqin (Scutellariae Radix), Boheye (Menthae Haplocalycis Herba) (each 1 liang), Chenxiang (Aquilariae Lignum Resinatum) (5 qian).
Grind the above ingredients into a fine powder and mix evenly. Soak Shenqu (Medicated Leaven) in ginger juice to form pills, sized like paulownia seeds. Take 100 pills each time. Every night before bed, swallow mixed with maltose syrup, while holding and chewing Taiping Wan (Peaceful Pill). The two medicines attack each other, eliminating the root of phlegm and cough.
Nanxing, Zaojiao, Banxia, Fuling, Chenpi each 1 liang; Mengshi, Mingfan each 2 liang equal; Zhishi, Zhike both need 1.5 liang; Bohe, Huangqin each 1 liang; Chenxiang 5 qian.
People seeing these few herbs may fear their harshness, and even I find them too potent. However, the Master's annotation states: For severe phlegm-heat obstruction, the above treatment is used. Is it not applicable for those not severely obstructed? If the condition involves emaciation, it must not be used. This requires practitioners to discern clearly during clinical practice.
Chen Xiuyuan's note: This formula is Guntan Wan (Rolling Phlegm Pill) without Dahuang (Rhei Radix et Rhizoma), adding Mingfan, Zaojiao, Nanxing, Banxia, Fuling, Chenpi, Zhike, Zhishi. If one only knows to make the phlegm-fire roll down, but does not know where the phlegm resides, merely purging feces will damage stomach qi. Generally, phlegm is water, and water is qi. Water nature flows downward; when meeting fire, it boils upward becoming phlegm. Hence, Huangqin is used in the formula to clear fire. Water cannot move without qi; if qi stagnates, water also stagnates, stopping and accumulating as phlegm. Therefore, Chenxiang, Chenpi, Zhike, Zhishi are used in layers to smooth, transform, and move qi. Moreover, when water floods, disaster is great; when flowing underground, the world is at peace. The formula uses the acrid-warm properties of Banxia and Nanxing, and the light-leaching property of Fuling to dry dampness with dryness, embodying the principle of using earth to control water. As the saying goes: "When seeing phlegm, do not just treat phlegm." Only Mengshi transforms phlegm into water, being heavy in quality and powerful in action; Bohe benefits qi and transforms phlegm, being light in body and fast in action. These two are symptomatic treatments, balancing weight and lightness appropriately. The most wonderful are Mingfan and Zaojiao. Whenever water is turbid, adding Mingfan and stirring makes the turbid immediately clear; for dirty clothes, washing with Zaojiao cleanses the filth away. The thoroughness of ancient physicians in formulating prescriptions is such. The doubt lies in that consumptive diseases cannot withstand such potent agents. However, heavy disease with light medicine often leads to misguidance; Yu Jiayan mocked this as "nourishing to death." It is better to plan a way out and adopt a desperate measure, retaining some hope. Commonly seen are endless phlegm-cough, emaciated muscles and bones, hoarse voice, bone-steaming fever, fever and sweating at dawn, skin heat after breakfast but aversion to cold on the spine, and slightly cold fingers. This is established tuberculosis, ten cases, nine incurable. Physicians' opinions vary, but some pedantic scholars argue that lung deficiency and fluid scarcity require only protecting the lung, which is particularly shallow. One must frequently take Liujunzi Tang (Six Gentlemen Decoction), Guipi Tang (Restore the Spleen Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction); when earth is prosperous, metal is naturally generated, rather than focusing solely on protecting the lung. Since the previous pathology involves metal being overcome by fire, knowing only to clear the heart treats the branch; one must clear the heart. This is the method of Li Dongyuan and Xue Lizhai, believed by all without doubt. Furthermore, some go further, boasting of inheriting Zhang Jingyue's core methods, claiming true water is primal yin, true fire is primal yang, both rooted in the Gate of Life. Primal yin water generates Gen Earth to moisten Lung Metal upwards; primal yang fire generates Kun Earth to connect with Heart Fire upwards. Yin and Yang are mutually rooted and inseparable. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), Zuogui Yin/Wan (Left Restoring Decoction/Pill), Yougui Yin/Wan (Right Restoring Decoction/Pill) are supreme. Since this theory spread, among consumptive diseases, nine out of ten die. Why not consider that the spleen is the mother of all organs? Even when healthy, taking tonics daily makes it difficult to advance diet and grow muscle; at the time of severe consumptive disease, what method can supplement insufficiency and generate surplus to produce metal? The kidney is the root of life. Even when healthy, taking tonics daily makes it hard to fill essence and strengthen waist and knees; at the time of severe consumptive disease, what method can supplement insufficiency and generate surplus to nourish fire? Hypocrites are thieves of virtue; I believe the hidden toxicity of mediocre doctors is worse than the overt toxicity of reckless doctors. Recently, there are more imitators of Ye Tianshi's school. Upon encountering a cold, they use Qianhu (Peucedani Radix), Gan Ge (Puerariae Radix), Xingren (Armeniacae Semen Amarum), Sangye (Mori Folium), Jiegeng (Platycodonis Radix), Zisu (Perillae Folium), Fangfeng (Saposhnikoviae Radix), Fuling, Juhong (Citri Reticulatae Pericarpium Rubrum), Sufa Xia (Pinelliae Rhizoma Preparatum), Shenqu, Guya (Hordei Fructus Germinatus), Maiya (Hordei Fructus Germinatus), Shanzhutan (Crataegi Fructus Carbonized), Gancao (Glycyrrhizae Radix et Rhizoma) as the main formula. Headache adds Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix); body pain adds Qianghuo (Notopterygii Rhizoma et Radix), Qinjiao (Gentianae Macrophyllae Radix); cough adds Ziwan (Asternis Radix), Baibu (Stemonae Radix); thirst adds Maidong (Ophiopogonis Radix), Huafen (Trichosanthis Radix); scanty urination adds Huashi (Talcum), Mutong (Akebiae Caulis), Zexie (Alismatis Rhizoma), Zhuling (Polyporus); abdominal distension adds Houpo (Magnoliae Officinalis Cortex), Zhishi, Luobozǐ (Raphini Semen), Sharen壳 (Amomi Fructus Shell); skin itching adds Chantui (Cicadae Periostracum), Baijili (Tribuli Fructus), Lianqiao (Forsythiae Fructus); sore throat adds Xuanshen (Scrophulariae Radix), Shegan (Belamcandae Rhizoma), Niubangzi (Arctii Fructus), Beimu (Fritillariae Thunbergii Bulbus); alternating chills and fever adds Chaihu (Bupleuri Radix), Jiu Qin (Scutellariae Radix prepared with wine); waist and knee pain adds Niuxi (Achyranthis Bidentatae Radix), Duzhong (Eucommiae Cortex); foot swelling adds Mugua (Chaenomelis Fructus), Fangji (Stephaniae Tetrandrae Radix); disease from depression adds Hei Yujin (Curcumae Radix), Xiangfu (Cyperi Rhizoma); persistent fever adds Baiwei (Cleomidis Radix), Digupi (Lycii Cortex), Qinghao (Artemisiae Annuae Herba), Baishao (Paeoniae Radix Alba); if not cured after several days, say "slightly regulate qi and blood," adding Danggui (Angelicae Sinensis Radix), Jiu Shaoyao (Paeoniae Radix Alba prepared with wine), Heshouwu (Polygoni Multiflori Radix), Gan Dihuang (Rehmanniae Radix Preparata), Danshen (Salviae Miltiorrhizae Radix), Shashen (Glehniae Radix), etc., varying combinations. For chronic illness and deficient persons, they use Liaodong Haishen (Holothuria Scabra), Yanwo (Swallow's Nest), Baoyu (Abalone), Guya, Shouwu, Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) as the mainstay. Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), [missing character], Fuling, Er Di (Rehmanniae Radix and Rehmanniae Radix Preparata), Guizhi (Cinnamomi Ramulus), Fuzi (Aconiti Lateralis Radix Preparata), Wuyu (Evodiae Fructus), Paojiang (Zingiberis Rhizoma Preparatum) are added according to symptoms. And Jinyinhua Tan (Lonicerae Japonicae Flos Carbonized), Gougitan (Lycii Fructus Carbonized), Juhuatan (Chrysanthemi Flos Carbonized), Baizhutan (Atractylodis Macrocephalae Rhizoma Carbonized), Dihuangtan (Rehmanniae Radix Preparata Carbonized), Xian Sangzhi (Mori Ramulus), Jinyinhua Teng (Lonicerae Japonicae Caulis), Paodan Ganjiang Zha (Zingiberis Rhizoma Preparata soaked in dilute water residue), Paodan Fuzi (Aconiti Lateralis Radix Preparata soaked in dilute water), Paodan Wuyu (Evodiae Fructus soaked in dilute water), Shudao Genxu (Setaria Italica Rootlets), Biexue Chaihu (Bupleuri Radix treated with turtle blood), Wuse Shi Yun (Five-colored Stone Cloud), Dongguazi (Benincasae Semen), Zhengge Sheng Bian Dou (Whole Raw Vigna Angularis Seed), Heidoupi (Vigna Angularis Seed Coat), Lv dou pi (Vigna Radiata Seed Coat), Xigua Cuipi (Citrulli Lanati Exocarpium), etc., claiming to be Ye Tianshi's school, different from constant methods. But they do not know that Ye Tianshi lived in Jiangsu, where people have thinner pores, external pathogens enter easily and exit easily. Not using Zhang Zhongjing's orthodox methods, he did not receive formal instruction in the *Shanghan Lun* (Treatise on Cold Damage), so his discussions seem superficial. Regarding miscellaneous diseases, he had considerable book knowledge, plus peerless intelligence and much clinical experience, hence his fame. However, for consumptive diseases, he specifically followed the *Shiyao Shenshu* (Ten Divine Medicines Book), not necessarily using all its formulas, but applying them divinely and intelligently, skillfully and logically. How can these people merely feed on the dregs in *Linzheng Zhinan* (Guide to Clinical Practice) and falsely claim affiliation?