(论二首 方五十五首 灸法十四首)
论曰∶经云∶五脏六腑皆令咳,肺居外而近上合于皮毛。皮毛喜受邪,故肺独易为咳也
。邪客于肺,则寒热上气喘汗出,咳动肩背喉鸣,甚则唾血。肺咳经久不已,传入大肠,其
状咳则遗粪。肾咳者,其状引腰背痛,甚则咳涎。肾咳经久不已,传入膀胱,其状咳则遗尿。
肝咳者,其状左胁痛,甚者不得转侧。肝咳经久不已,传入胆,其状咳则清苦汁出。心咳者,
其状引心痛,喉仲介介如梗,甚者喉痹咽肿。心咳经久不已,传入小肠,其状咳则矢气。脾
咳者,其状右胁痛阴阴引肩背,甚者不得动,动则咳剧。经久不已,传入胃,其状咳而呕,
呕甚则长虫出。久咳不已,三焦受之,三焦咳之状,咳而腹满,不能食饮,此皆聚于胃。关
于肺,使人多涕唾而面浮肿气逆也。若顺时有风寒冷人触冒解脱,伤皮毛间入腑脏为咳上气
如此也。有非时忽然暴寒,伤皮肤中与肺合,则咳嗽上气,或胸胁支痛,咳唾有血者,是其
热得非时之寒,暴薄之不得渐散,伏结深,喜肺痈也。因咳服温药,咳尤剧及壮热吐脓血,
汗出恶寒是也。天有非时寒者,急看四时方也。
问曰∶咳病有十,何谓也?师曰∶有风咳,有寒咳,有支咳,有肝咳,有心咳,有脾咳
,有肺咳,有肾咳,有胆咳,有厥阴咳。问曰∶十咳之证以何为异?师曰∶欲语因咳言不得
竟,谓之风咳。饮冷食寒因之而咳,谓之寒咳。心下坚满,咳则支痛,其脉反迟,谓之支咳。
咳则引胁下痛,谓之肝咳。咳而唾血引手少阴,谓之心咳。咳而涎出续续不止,引少腹,谓
之脾咳。咳引颈项而唾涎沫,谓之肺咳。咳则耳无所闻,引腰并脐中,谓之肾咳,咳而引头
痛口苦,谓之胆咳,咳而引舌本,谓之厥阴咳。风咳者,不下之。寒咳、支咳、肝咳、刺足
太冲。心咳,刺手神门。脾咳,刺足太白。肺咳,刺手太渊。肾咳,刺足太溪。胆咳,刺足
阳陵泉。厥阴咳,刺手大陵。
虚
也。此为胸中寒实所致也,当吐之。
乃可吐耳。
咳家,其人脉弦为有水,可与十枣汤下之(见下第十二方)。不能卧出者,阴不受邪故
也。
留饮咳者,其人咳不得卧,引项上痛,咳者如小儿掣纵状。夫酒家咳者,必致吐血,此坐久
极饮过度所致也。其脉沉者,不可发汗。久咳数岁,其脉弱者可治,实大数者死。其脉虚者
必善冒,其人本有支饮在胸中故也。治属饮家。上气汗出而咳,属饮家。咳而小便利,若失
溺不可发汗,汗出即厥逆冷。
夫病吐血喘咳上气,其脉数,有热不得卧者死。寒家咳而上气,其脉数者死,谓其人形
损故也。脉大而散散者,为气实而血虚,名曰有表无里。上气面 肿肩息,其脉浮大不治,
加
(论述两篇,方剂五十五首,灸法十四首)
论述说:医经记载:五脏六腑的病变都能导致咳嗽。肺位于体表且位置较高,与皮毛相合。皮毛容易受到外邪侵袭,所以肺最容易发生咳嗽。
邪气侵犯肺脏,就会出现寒热往来、气喘、出汗、咳嗽牵引肩背疼痛、喉间有鸣音,严重时甚至咳唾带血。
肺咳如果经久不愈,病邪会传入大肠,症状表现为咳嗽时大便失禁。
肾咳的症状是腰痛并牵连背部,严重时咳嗽吐涎沫。
肾咳如果经久不愈,病邪会传入膀胱,症状表现为咳嗽时小便失禁。
肝咳的症状是左侧胁肋部疼痛,严重时身体不能转侧。
肝咳如果经久不愈,病邪会传入胆,症状表现为咳嗽时吐出清苦的胆汁。
心咳的症状是心痛,喉咙里感觉像有异物梗塞,严重时咽喉肿痛闭塞。
心咳如果经久不愈,病邪会传入小肠,症状表现为咳嗽时放屁。
脾咳的症状是右侧胁肋部隐隐作痛并牵连肩背,严重时身体不能活动,一动则咳嗽加剧。
脾咳如果经久不愈,病邪会传入胃,症状表现为咳嗽伴呕吐,呕吐严重时会吐出蛔虫。
久咳不愈,病邪传入三焦,三焦咳的症状是咳嗽伴腹部胀满,不能饮食,这些病邪都聚集在胃,关联于肺,使人多涕唾且面部浮肿、气逆上冲。
如果是顺应时节的风寒冷气侵入人体,损伤皮毛进而深入脏腑引起咳嗽和气逆,就是上述情况。
也有非时令突然遭遇暴寒,损伤皮肤并与肺相合,导致咳嗽气逆,或者胸胁支撑胀痛,咳唾带血,这是因为热邪遇到非时令的寒气,暴烈地结合而不能逐渐消散,深伏结聚,容易导致肺痈(肺部化脓性感染)。
因咳嗽服用温热药物后,咳嗽更加剧烈,并且出现高热、吐脓血、出汗、恶寒,这就是肺痈的表现。
遇到非时令的寒冷天气,应当紧急查阅四季相应的方书进行治疗。
问:咳嗽病症有十种,是什么?
老师说:有风咳、寒咳、支咳、肝咳、心咳、脾咳、肺咳、肾咳、胆咳、厥阴咳。
问:这十种咳嗽的证候以什么来区分?
老师说:想说话因为咳嗽而说不完,称为风咳。
喝冷水或吃寒凉食物因此引发咳嗽,称为寒咳。
心下部位坚硬胀满,咳嗽时牵引疼痛,脉象反而迟缓,称为支咳。
咳嗽牵引胁下疼痛,称为肝咳。
咳嗽并咳唾带血,牵引手少阴心经循行部位,称为心咳。
咳嗽并吐出涎沫连续不止,牵引小腹,称为脾咳。
咳嗽牵引颈项并咳吐涎沫,称为肺咳。
咳嗽导致耳朵听不见声音,牵引腰部及肚脐周围,称为肾咳。
咳嗽牵引头痛且口苦,称为胆咳。
咳嗽牵引舌根,称为厥阴咳。
对于风咳,不能用攻下法。
对于寒咳、支咳、肝咳,针刺足太冲穴。
对于心咳,针刺手神门穴。
对于脾咳,针刺足太白穴。
对于肺咳,针刺手太渊穴。
对于肾咳,针刺足太溪穴。
对于胆咳,针刺足阳陵泉穴。
对于厥阴咳,针刺手大陵穴。
(此处原文似乎有缺漏或排版错误,“虚也”前文缺失,根据上下文推测可能指某种虚证或承接上文,但按字面翻译为“这是虚证。”紧接着下一句“此为胸中寒实所致也,当吐之。”意为“这是由于胸中有寒邪实证导致的,应当用涌吐法治疗。”)
这才可以用涌吐法。
患有咳嗽的人,如果脉象弦,说明体内有水饮,可以给予十枣汤攻下(见下方第十二方)。
不能平卧呼吸急促者,是因为阴分不受邪气干扰(注:此处原文逻辑较晦涩,通常“不得卧”多属痰饮或肺气上逆,原文解释“阴不受邪故也”可能存在传抄错误或特定语境,此处直译)。
留饮咳嗽的患者,咳嗽不能平卧,牵引颈部疼痛,咳嗽的样子像小儿抽搐掣纵一样。
饮酒之人患咳嗽,必然会导致吐血,这是因为长期过度饮酒所致。
脉象沉的,不可发汗。
久咳数年,脉象虚弱的是可治之症,脉象实大数急的是死症。
脉象虚的必定经常头晕目眩,这是因为患者胸中原本就有支饮停留的缘故。
这类治疗归属于治饮家之法。
气逆上冲、出汗且咳嗽,归属于饮家。
咳嗽且小便通畅,或者小便失禁,不可发汗,如果发汗就会导致四肢厥冷。
凡是患有吐血、喘咳、气逆上冲的病,脉象数,且有发热不能平卧的,预后不良(死症)。
寒性疾病患者咳嗽且气逆上冲,脉象数的,预后不良(死症),这是因为患者形体亏损的缘故。
脉象大而散散的,表示气实而血虚,名为“有表无里”。
气逆上冲、面部浮肿、耸肩呼吸,脉象浮大的,难以治愈,加重……
(Two treatises, fifty-five prescriptions, fourteen moxibustion methods)
The treatise states: The classics record that disorders of the five zang organs and six fu organs can all cause cough. The lung is located superficially and superiorly, and corresponds to the skin and hair. Since the skin and hair are prone to pathogenic invasion, the lung is particularly susceptible to cough.
When pathogenic factors invade the lung, symptoms such as alternating chills and fever, panting, sweating, cough with pain radiating to the shoulders and back, and barking sounds in the throat may occur; in severe cases, hemoptysis (coughing up blood) may ensue.
If a lung cough persists for a long time without healing, the pathology transmits to the large intestine. The manifestation is defecation during coughing.
In kidney cough, the symptoms include lower back pain radiating to the back, and in severe cases, coughing up saliva/phlegm.
If a kidney cough persists for a long time without healing, the pathology transmits to the bladder. The manifestation is urinary incontinence during coughing.
In liver cough, the symptoms include pain in the left hypochondrium; in severe cases, the body cannot turn or pivot.
If a liver cough persists for a long time without healing, the pathology transmits to the gallbladder. The manifestation is coughing up bitter bile fluid.
In heart cough, the symptoms include heart pain and a sensation of obstruction in the throat like a foreign body stuck; in severe cases, sore throat and swelling/obstruction occur.
If a heart cough persists for a long time without healing, the pathology transmits to the small intestine. The manifestation is passing gas during coughing.
In spleen cough, the symptoms include dull pain in the right hypochondrium radiating to the shoulders and back; in severe cases, movement is restricted, and any movement exacerbates the cough.
If a spleen cough persists for a long time without healing, the pathology transmits to the stomach. The manifestation is cough accompanied by vomiting; in severe cases, roundworms are expelled.
If chronic cough persists, the pathology involves the Sanjiao (Triple Burner). The manifestations of Sanjiao cough include cough with abdominal fullness and inability to eat or drink. These pathogens gather in the stomach and relate to the lung, causing excessive phlegm/saliva, facial edema, and rebellious qi.
This occurs when wind-cold follows the seasons, invades the body, damages the skin and hair, and then enters the fu organs and zang organs to cause cough and rebellious qi.
Alternatively, sudden exposure to extreme cold out of season damages the skin and combines with the lung, causing cough and rebellious qi, or distending pain in the chest and hypochondrium, and hemoptysis. This happens because heat pathogens encounter out-of-season cold, binding violently and failing to dissipate gradually, leading to deep stagnation and knotting, which predisposes to Lung Abscess (Fei Yong).
Taking warm medicinal herbs for cough may worsen the cough significantly, accompanied by high fever, expectoration of pus and blood, sweating, and aversion to cold. This indicates Lung Abscess. When encountering out-of-season cold, one should urgently consult seasonal formularies.
Question: There are ten types of cough diseases. What are they?
Master says: There are Wind Cough, Cold Cough, Zhi Cough, Liver Cough, Heart Cough, Spleen Cough, Lung Cough, Kidney Cough, Gallbladder Cough, and Jueyin Cough.
Question: How are the syndromes of these ten coughs distinguished?
Master says: If one wishes to speak but cannot finish due to coughing, it is called Wind Cough.
If drinking cold water or eating cold food triggers coughing, it is called Cold Cough.
If there is hardness and fullness below the heart, and coughing causes radiating pain, while the pulse is paradoxically slow, it is called Zhi Cough.
If coughing radiates pain to the hypochondrium, it is called Liver Cough.
If coughing produces bloody sputum and radiates along the Hand-Shaoyin meridian, it is called Heart Cough.
If coughing produces continuous saliva/phlegm and radiates to the lower abdomen, it is called Spleen Cough.
If coughing radiates to the neck and produces saliva/phlegm, it is called Lung Cough.
If coughing causes deafness and radiates to the waist and umbilicus, it is called Kidney Cough.
If coughing radiates to the head and causes bitter taste in the mouth, it is called Gallbladder Cough.
If coughing radiates to the root of the tongue, it is called Jueyin Cough.
For Wind Cough, purgative methods should not be used.
For Cold Cough, Zhi Cough, and Liver Cough, needle Taichong (LR3, Foot-Taiyang).
For Heart Cough, needle Shenmen (HT7, Hand-Shaoyin).
For Spleen Cough, needle Taibai (SP3, Foot-Taiyin).
For Lung Cough, needle Taiyuan (LU9, Hand-Taiyin).
For Kidney Cough, needle Taixi (KI3, Foot-Shaoyin).
For Gallbladder Cough, needle Yanglingquan (GB34, Foot-Shaoyang).
For Jueyin Cough, needle Daling (PC7, Hand-Jueyin).
[Text fragment] It is deficiency. This is caused by cold excess in the chest and should be treated with emesis.
Only then can emesis be applied.
For patients with cough, if the pulse is wiry, it indicates water retention; Shizao Tang (Ten Date Pill Decoction) may be given to purge (see Prescription 12 below).
Those who cannot lie down and breathe easily do so because the yin aspect does not receive pathogenic factors [Note: This explanation is idiosyncratic to the text].
For cough due to retained fluid, the patient cannot lie down due to coughing, experiences neck pain, and the cough resembles the jerking movements of an infant.
For drinkers suffering from cough, hematemesis (vomiting blood) will inevitably result, caused by long-term excessive alcohol consumption.
If the pulse is deep, diaphoresis (sweating method) is contraindicated.
For chronic cough lasting years, a weak pulse indicates a treatable condition; a forceful, large, and rapid pulse indicates a fatal prognosis.
A deficient pulse indicates frequent dizziness, as the patient originally had Zhi-Yin (branch fluid) retained in the chest. Treatment belongs to the category of treating fluid retention disorders.
Rebellious qi, sweating, and cough belong to fluid retention disorders.
Cough with free urination, or urinary incontinence, contraindicates diaphoresis; inducing sweat will lead to cold limbs (Jue-Ni).
For diseases involving hematemesis, panting, cough, and rebellious qi, if the pulse is rapid, there is heat, and the patient cannot lie down, the prognosis is fatal.
For patients with cold conditions suffering from cough and rebellious qi, if the pulse is rapid, the prognosis is fatal, due to the depletion of the patient's physical form.
A pulse that is large and scattered indicates qi excess and blood deficiency, named "Exterior without Interior."
Rebellious qi, facial edema, and shoulder-respiration (accessory muscle breathing), with a floating and large pulse, are difficult to cure; if aggravated...