岐伯曰∶夜行则喘出于肾,淫气病肺。有所堕恐,喘出于肝,淫气害脾。有所惊恐,喘
出于肺,淫气伤心。度水跌仆,喘出于肾与骨。当是之时,勇者气行则已,怯者则着而
为病也。原疾之由,皆本于肺与气。然感外邪,则有太阳证脉浮无汗而喘者,宜麻黄汤。
阳明病汗出不恶寒,腹满而喘,有潮热者,宜承气汤,若表邪未解,误服下利药,利遂不
止,脉促,喘而汗出者,宜葛根黄芩黄连汤。若微喘者,桂枝浓朴杏子汤。汗出而喘,若
无大热者,宜麻黄杏子甘草石膏汤。若表邪未解,心下停水,发热而喘,或呕者,小青
龙汤去麻黄加杏仁主之。若阴证喘促者,四肢逆冷,脉息沉细,或寸大尺小,或六脉促
疾,或心下胀满结硬,若冷汗自出,或大便频数,上气喘促,或咽喉不利者,此是本气
极虚,内外挟寒冷所致,使阴寒内消,阳气得复则愈,宜返阴丹主之。(以上诸方,并见伤寒
准绳。)大概诸脏相乘而喘者,以杏子散。(本条。)如感寒伏热而喘者,以华盖散、(杂病嗽。)九宝
汤。(杂病喘。)若暴寒向火,覆衣被过当,伤热肺实而喘促者,其状多有热证,宜洗心散,(杂
病发热。)冷水调服。若因气宇不调,痰盛喘促者,宜四七汤(杂病气)。兼官局桔梗汤,(杂病痰
饮。)姜煎服。若涎多而喘者,宜千缗汤、(杂病喘。)橘皮半夏汤。(本条。)若不得卧,卧即喘者,
此由水气逆行,上乘于肺,肺得水则浮而开,使气不得通流,其脉沉大,宜神秘汤。(杂病喘。)
肺之积名曰息贲,在右胁下,大如杯,令人洒淅寒热,喘咳,发痈疽,宜枣膏丸。(本条。)
若上气喘者,神授汤。(本条。)若上盛下弱而喘促者,宜苏子降气汤(杂病气。)吞黑锡丹。(杂病
头痛。)若尊年之人,素来禀赋太浓,不任热药
者,不可轻投丹剂及诸热药,但以秘传降气汤、分心气饮。(俱杂病气。)论之梗概,不出于
此矣。若素有香港脚而喘者,当作香港脚治之。又有骨蒸劳喘,自有专门,不敢滥及。
〔薛〕东垣云∶肺金受邪,由脾胃虚弱不能生肺,乃所生受病,故咳嗽气短气上,皮
毛不能御寒,精神少而渴,情惨不乐,皆阳气不足,阴气有余也。治法∶若肺气虚弱,用
四君子(杂病虚劳。)加枳壳、半夏。脾虚不能生肺,补中益气汤。(杂病劳倦。)七情气结,四七
汤。(杂病气。)脾经郁结,归脾汤。(杂病健忘。)脾气虚弱,人参补肺散。肺经火盛,人参平肺
散。肾水败浊,六味地黄丸。(杂病虚劳。)真阳虚损,八味丸。(虚劳。)或兼小便不利,为害尤
速,非二丸不能救。一妇人伤风寒作喘,或用表散,愈而复患,仍用前药,其证益甚,饮
食少思,胸腹不利,此因脾肺气虚也。予先用六君子汤加桔梗渐愈,又用补中益气汤而
痊。一妇人患前证,属命门火虚,不能生脾土,用补中益气汤、八味地黄丸而痊。后
复患,其喘益甚,用前药不应,遂用黑锡丹二服喘止,仍用前二药而诸证痊。凡属邪气
有余者,其证易识,治效亦速。其属元气不足者,变证不一,效非可以旦夕期也。
杏子散 治诸脏相乘喘急。
杏仁(去皮尖,双仁,麸炒黄,细研如膏) 麻黄根(为细末,等分)
上和匀,煎橘皮汤调下二钱,无时。
橘皮半夏汤 (《和剂》)治肺胃虚弱,好食酸冷,寒痰停积,呕逆恶心,涎唾稠粘,或积
吐,粥药不下,手足逆冷,目眩身重。又治伤寒时气,欲吐不吐,欲呕不呕,昏愦闷乱,
或饮酒过多,中寒停饮,喉中涎声,干哕不止。
陈皮(去白) 半夏(煮,各七两)
上锉为粗散,每服三钱,生姜三片,水二盏,煎至一中盏,去滓温服,不计时。留
两服滓并一服,再煎服。
枣膏丸 治息贲在右胁下,大如杯,令人洒淅寒热,喘咳。
甜葶苈(炒,研) 陈皮 苦梗(各等分)
上为末,煮枣肉丸桐子大,每服数丸,白汤下。许学士云∶余常停饮水积,食已必嚏,
渐喘,觉肺系急,服此良验。
神授汤 治上气喘急不得卧。
橘红 苦梗 紫苏 人参(各一钱) 五味子(杵炒,三分)
上姜水煎服。
治妇人喘促虚肿,快利小便即痒。
用生姜二两,取汁,白面三两,以姜汁搜作小剂,大半夏十个,打研入面中,作饼
炙熟作黄色,为末,温熟水调下一钱,以小便通利为度。
天门冬丸 (《杨氏家传》)治妇人喘,手足烦热,骨蒸寝汗,口干引饮,面目浮肿。
天门冬(十两,去心秤) 麦门冬(去心,八两) 生地黄(三斤,取汁熬膏)
上二味为末,入地黄膏和丸如梧桐子大,每服五十丸,逍遥散中去甘草加人参煎汤送
下。或服王氏《博济方》中人参荆芥散亦可。如面肿不已,经曰∶面肿曰风,故宜汗。麻
黄桂枝,可发其汗,后服柴胡饮子去大黄。故论曰∶治脏者治其俞,治腑者治其合,浮肿
治其经。治俞者治其土也,治合者亦治其土也,如兵家围魏救赵之法也。
人参补肺汤 治肺痈肾水不足,虚火上炎,咳唾脓血,发热作渴,小便不调。
人参 黄 (炒) 白术 茯苓 陈皮 当归(各一两) 山茱萸(去核)
山药(各二钱) 五味子(杵) 麦门冬(去心) 甘草(炙,各七分) 熟地黄(自制,一钱五分)
牡丹皮(一钱) 上姜水煎服。
人参平肺散 治心火克肺金,患肺痿,咳嗽喘呕,痰涎壅盛,胸膈痞满,咽膈不利。
人参 青皮 茯苓 天门冬 陈皮 地骨皮(各一钱) 甘草(炙,五分) 知母(七分)
五味子(十粒,杵) 桑白皮(炒,一钱)
上姜水煎服。
岐伯说:夜间行走则气喘由肾产生,淫邪之气伤害肺。因坠落或恐惧导致的气喘由肝产生,淫邪之气损害脾。因惊恐导致的气喘由肺产生,淫邪之气伤害心。涉水或跌仆受伤,气喘由肾和骨产生。在这个时候,体质强健的人气机运行通畅病就好了,体质虚弱的人则邪气留着而成为疾病。追溯疾病的根源,都本于肺和气。然而感受外邪,如果有太阳病的脉浮、无汗而气喘,适宜用麻黄汤。阳明病汗出且不恶寒,腹部胀满而气喘,有潮热的,适宜用承气汤;如果表邪未解,误服泻下药,腹泻不止,脉促,气喘且出汗的,适宜用葛根黄芩黄连汤。如果是轻微气喘的,用桂枝加厚朴杏子汤。出汗且气喘,如果没有大热的,适宜用麻黄杏仁甘草石膏汤。如果表邪未解,胃脘部有水饮停滞,发热且气喘,或者呕吐的,用小青龙汤去掉麻黄加杏仁主治。如果是阴证气喘急促的,四肢逆冷,脉象沉细,或者寸脉大尺脉小,或者六脉急促疾速,或者胃脘部胀满结硬,如果冷汗自出,或者大便频数,上气喘促,或者咽喉不利的,这是本气极度虚弱,内外夹杂寒冷所致,使阴寒内消,阳气得以恢复则痊愈,适宜用返阴丹主治。(以上各方,均见于《伤寒准绳》。)大概各种脏腑相乘导致的气喘,用杏子散。(本条。)如感受寒邪伏热导致气喘的,用华盖散、(杂病嗽。)九宝汤。(杂病喘。)如果突然受寒靠近火源,覆盖衣被过多,损伤热邪肺实而导致气喘急促的,其症状多有热证,适宜用洗心散,(杂病发热。)用冷水调服。如果因气机不调,痰盛导致气喘急促的,适宜用四七汤(杂病气)。兼服官局桔梗汤,(杂病痰饮。)用姜煎服。如果涎多而气喘的,适宜用千缗汤、(杂病喘。)橘皮半夏汤。(本条。)如果不能平卧,一躺下就气喘的,这是由于水气逆行,上乘于肺,肺得水则浮而开,使气不得通流,其脉沉大,适宜用神秘汤。(杂病喘。)肺的积病名叫息贲,在右胁下,大小如杯,使人洒淅寒热,气喘咳嗽,发痈疽,适宜用枣膏丸。(本条。)如果是上气喘急的,用神授汤。(本条。)如果是上盛下弱而气喘急促的,适宜用苏子降气汤(杂病气。)吞服黑锡丹。(杂病头痛。)如果是年老之人,素来禀赋太厚,不耐热药的,不可轻率投用丹剂及诸热药,只可用秘传降气汤、分心气饮。(俱杂病气。)论述的大概内容,不出于此了。如果素有香港脚而气喘的,应当当作香港脚治疗。又有骨蒸劳喘,自有专门治法,不敢滥加涉及。
〔薛〕东垣说:肺金受邪,是因为脾胃虚弱不能生肺,乃是被所生的脏器受病,所以咳嗽气短气上逆,皮毛不能抵御寒冷,精神少且口渴,心情凄惨不快乐,都是阳气不足,阴气有余的缘故。治疗方法:如果肺气虚弱,用四君子(杂病虚劳。)加枳壳、半夏。脾虚不能生肺,用补中益气汤。(杂病劳倦。)七情气结,用四七汤。(杂病气。)脾经郁结,用归脾汤。(杂病健忘。)脾气虚弱,用人参补肺散。肺经火盛,用人参平肺散。肾水败浊,用六味地黄丸。(杂病虚劳。)真阳虚损,用八味丸。(虚劳。)或者兼小便不利,为害尤其迅速,非这两丸不能救。有一个妇人伤风寒作喘,有人用表散法,好了又复发,仍用前药,其证更严重,饮食少思,胸腹不利,这是因为脾肺气虚。我先用六君子汤加桔梗逐渐痊愈,又用补中益气汤而痊愈。另一个妇人患前证,属命门火虚,不能生脾土,用补中益气汤、八味地黄丸而痊愈。后来复发,其喘更甚,用前药不应,于是用黑锡丹两服喘止,仍用前二药而诸证痊愈。凡是属于邪气有余的,其证容易识别,治疗效果也迅速。属于元气不足的,变证不一,疗效不可以旦夕期望。
杏子散 治疗各种脏腑相乘导致的喘急。
杏仁(去皮尖,双仁,麸炒黄,细研如膏) 麻黄根(为细末,等分)
上和匀,煎橘皮汤调下二钱,不拘时候。
橘皮半夏汤 (《和剂》)治疗肺胃虚弱,喜好食酸冷,寒痰停积,呕逆恶心,涎唾稠粘,或者积吐,粥药不下,手足逆冷,目眩身重。又治疗伤寒时气,想吐吐不出,想呕呕不出,昏愦闷乱,或者饮酒过多,中寒停饮,喉中涎声,干哕不止。
陈皮(去白) 半夏(煮,各七两)
上锉为粗散,每服三钱,生姜三片,水二盏,煎至一中盏,去滓温服,不拘时候。留两服滓并一服,再煎服。
枣膏丸 治疗息贲在右胁下,大小如杯,使人洒淅寒热,气喘咳嗽。
甜葶苈(炒,研) 陈皮 苦梗(各等分)
上为末,煮枣肉丸桐子大,每服数丸,白汤下。许学士说:我常停饮水积,食后必嚏,渐喘,觉肺系急,服此良验。
神授汤 治疗上气喘急不得卧。
橘红 苦梗 紫苏 人参(各一钱) 五味子(杵炒,三分)
上姜水煎服。
治疗妇人喘促虚肿,快利小便即痒。
用生姜二两,取汁,白面三两,以姜汁搜作小剂,大半夏十个,打研入面中,作饼炙熟作黄色,为末,温熟水调下一钱,以小便通利为度。
天门冬丸 (《杨氏家传》)治疗妇人喘,手足烦热,骨蒸寝汗,口干引饮,面目浮肿。
天门冬(十两,去心秤) 麦门冬(去心,八两) 生地黄(三斤,取汁熬膏)
上二味为末,入地黄膏和丸如梧桐子大,每服五十丸,逍遥散中去甘草加人参煎汤送下。或服王氏《博济方》中人参荆芥散亦可。如面肿不已,经曰:面肿曰风,故宜汗。麻黄桂枝,可发其汗,后服柴胡饮子去大黄。故论曰:治脏者治其俞,治腑者治其合,浮肿治其经。治俞者治其土也,治合者亦治其土也,如兵家围魏救赵之法也。
人参补肺汤 治疗肺痈肾水不足,虚火上炎,咳唾脓血,发热作渴,小便不调。
人参 黄芪(炒) 白术 茯苓 陈皮 当归(各一两) 山茱萸(去核)
山药(各二钱) 五味子(杵) 麦门冬(去心) 甘草(炙,各七分) 熟地黄(自制,一钱五分)
牡丹皮(一钱) 上姜水煎服。
人参平肺散 治疗心火克肺金,患肺痿,咳嗽喘呕,痰涎壅盛,胸膈痞满,咽膈不利。
人参 青皮 茯苓 天门冬 陈皮 地骨皮(各一钱) 甘草(炙,五分) 知母(七分)
五味子(十粒,杵) 桑白皮(炒,一钱)
上姜水煎服。
Qibo said: Walking at night causes asthma originating from the Kidney, with pathogenic qi damaging the Lung. Asthma resulting from falling or fear originates from the Liver, with pathogenic qi harming the Spleen. Asthma resulting from fright originates from the Lung, with pathogenic qi damaging the Heart. Wading through water or falling and injury cause asthma originating from the Kidney and bones. At such times, those with robust constitution recover as Qi flows smoothly, while those with weak constitution retain the pathogen and develop disease. Tracing the origin of the disease, all stem from the Lung and Qi. However, when affected by external pathogens, if there are Taiyang syndrome (Taiyang Syndrome) symptoms such as floating pulse, absence of sweat, and asthma, Mahuang Tang (Ephedra Decoction) is indicated. In Yangming disease (Yangming Disease), if there is sweating without aversion to cold, abdominal fullness with asthma, and tidal fever, Chengqi Tang (Gut-Draining Decoction) is indicated; if the exterior pathogen has not resolved and purgatives were mistakenly administered, leading to persistent diarrhea, a rapid pulse, asthma with sweating, Gegen Huangqin Huanglian Tang (Kudzu, Scutellaria, and Coptis Decoction) is indicated. For mild asthma, Guizhi Houpo Xingzi Tang (Cinnamon Twig, Magnolia Bark, and Apricot Seed Decoction) is used. If there is sweating and asthma without significant heat, Mahuang Xingzi Gancao Shigao Tang (Ephedra, Apricot Seed, Licorice, and Gypsum Decoction) is indicated. If the exterior pathogen has not resolved, fluid retention in the epigastrium exists, accompanied by fever, asthma, or vomiting, Xiao Qinglong Tang (Minor Blue Dragon Decoction) with Ephedra removed and Apricot Seed added is the primary treatment. For Yin syndrome asthma with急促 breathing, cold limbs, deep and fine pulse, or large cun pulse and small chi pulse, or rapid six-pulse, or epigastric distension and hardness, spontaneous cold sweat, frequent stools, upper asthma, or throat obstruction, this is due to extreme deficiency of original Qi and internal/external cold accumulation. When internal Yin-cold dissipates and Yang Qi recovers, health is restored; Fanyin Dan (Return to Yin Pill) is indicated. (All above formulas are found in Shanghan Zhunsheng.) Generally, for asthma caused by mutual overacting of Zang organs, Xingzi San (Apricot Seed Powder) is used. For asthma caused by cold constraint and latent heat, Huagai San (Canopy Powder) and Jiubao Tang (Nine Treasures Decoction) are used. If sudden cold exposure near fire, excessive covering, leads to heat damage and Lung excess causing asthma, presenting with heat signs, Xixin San (Heart-Washing Powder) taken with cold water is indicated. For asthma due to Qi mechanism imbalance and profuse phlegm, Siqi Tang (Four Seven Decoction) is indicated, combined with Guanju Jiegeng Tang (Imperial Bureau Platycodon Decoction) decocted with ginger. For asthma with excessive saliva, Qianmin Tang (Thousand Strings Decoction) and JuPi Banxia Tang (Tangerine Peel and Pinellia Decoction) are indicated. For inability to lie flat, with asthma upon lying down, this is due to Water Qi counterflow attacking the Lung; the Lung floats and opens upon receiving water, obstructing Qi flow, with a deep and large pulse; Shenmi Tang (Divine Mystery Decoction) is indicated. The Lung accumulation named Xiben (Breath-Rushing) is located under the right hypochondrium, cup-sized, causing chills and fever, asthma and cough, and carbuncles; Zaogao Wan (Jujube Paste Pill) is indicated. For upper asthma, Shenshou Tang (Heavenly Bestowal Decoction) is used. For asthma with excess above and deficiency below, Suzi Jiangqi Tang (Perilla Fruit Descending Qi Decoction) taken with Heixi Dan (Black Tin Pill) is indicated. For elderly persons with strong constitution who cannot tolerate hot medicines, Dan agents and hot medicines should not be lightly administered; instead, Michuan Jiangqi Tang (Secret Transmission Descending Qi Decoction) and Fenxin Qi Yin (Separating Heart Qi Drink) are used. The general discussion does not exceed these points. For asthma with chronic podagra (Hongjiao), treat as podagra. Bone-steaming劳喘 (Lao Asthma) has its own specialized treatment and is not discussed here.
Xue Yi stated: Dongyuan said: Lung Metal is affected because Spleen-Stomach weakness fails to generate Lung, resulting in disease in the generated organ. Thus, there is cough, shortness of breath, upward Qi rebellion, inability of skin/hair to resist cold, low spirit, thirst, and sorrowful mood, all due to insufficient Yang Qi and excess Yin Qi. Treatment methods: For Lung Qi deficiency, use Sijunzi Tang (Four Gentlemen Decoction) plus Zhike and Banxia. For Spleen deficiency failing to generate Lung, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For emotional Qi stagnation, use Siqi Tang. For Spleen channel depression, use Guipi Tang. For Spleen Qi deficiency, use Renshen Bufei San. For Lung channel fire excess, use Renshen Pingfei San. For turbid Kidney Water, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). For True Yang deficiency, use Bawei Wan (Eight-Ingredient Pill). If accompanied by difficult urination, harm is particularly rapid, requiring these two pills for rescue. A woman suffered asthma from wind-cold; after using exterior-releasing methods, it relapsed and worsened with previous meds, showing poor appetite and chest/abdominal discomfort, indicating Spleen-Lung Qi deficiency. I first used Liujunzi Tang plus Jiegeng for gradual recovery, then Buzhong Yiqi Tang for cure. Another woman with similar symptoms attributed to Mingmen Fire deficiency failing to generate Spleen Earth was cured with Buzhong Yiqi Tang and Liuwei Dihuang Wan. Upon recurrence with severe asthma unresponsive to previous meds, two doses of Heixi Dan stopped the asthma, followed by the previous two pills for full recovery. Excess pathogenic conditions are easy to identify and respond quickly. Original Qi deficiency presents varied transformations and slow recovery.
Xingzi San treats asthma urgency from Zang organ overaction.
Xingren (Shelled, double-kernel, bran-fried yellow, ground to paste) Mahuanggen (Powdered, equal parts)
Mix well, take 2 qian with Chenpi Tang (Tangerine Peel Decoction), anytime.
JuPi Banxia Tang (from Heji Fang) treats Lung-Stomach weakness, preference for sour/cold foods, cold-phlegm retention, retching, nausea, thick saliva, vomiting, inability to keep food/meds down, cold limbs, dizziness, heavy body. Also treats cold-stroke epidemic, urge to vomit but unable, confusion, excessive drinking causing cold-fluid retention, rattling in throat, dry hiccups.
Chenpi (White removed) Banxia (Boiled, each 7 liang)
Coarsely chop, take 3 qian per dose with 3 slices of fresh ginger and 2 zhan water, decoct to 1 zhan, strain and take warm, anytime. Reserve residue from two doses plus one new dose, decoct again.
Zaogao Wan treats Xiben under right hypochondrium, cup-sized, causing chills/fever, asthma/cough.
Tingli (Fried, ground) Chenpi Kujie (Equal parts)
Grind to powder, mix with jujube paste into pills size of paulownia seeds, take several pills with plain water. Scholar Xu noted: I often had fluid retention, sneezing after eating, progressive asthma, tight lung system; this formula proved effective.
Shenshou Tang treats upper asthma urgency preventing lying down.
Juhong Kujie Zisu Renshen (Each 1 qian) Wuweizi (Pounded and fried, 3 fen)
Decoct with ginger water.
Treats female asthma with deficiency edema; rapid diuresis brings itching relief.
Use 2 liang fresh ginger juice, 3 liang white flour, knead into small cakes with ginger juice. Pound 10 Banxia, mix into dough, bake until yellow, grind to powder. Take 1 qian with warm water, stop when urine flows freely.
Tianmendong Wan (from Yang Shi Jiachuan) treats female asthma, vexing heat in limbs, bone-steaming night sweats, dry mouth with desire to drink, facial swelling.
Tianmendong (10 liang, heart removed, weighed) Maidong (Heart removed, 8 liang) Shengdihuang (3 jin, juice boiled to paste)
Grind first two ingredients to powder, mix with Rehmannia paste into paulownia seed-sized pills. Take 50 pills with Renchen Xiaoyao San (minus Licorice, plus Ginseng) decoction. Or use Wangshi Boji Fang's Renchen Jingjie San. If facial swelling persists, classics say: "Facial swelling indicates Wind," thus sweating is appropriate. Mahuang Guizhi can induce sweat, followed by Chaihu Yinzi minus Dahuang. Theory states: Treat Zang via Shu points, Fu via He points, edema via Jing points. Treating Shu/He points addresses Earth element, like besieging Wei to rescue Zhao.
Renshen Bufei Tang treats Lung abscess with Kidney Water deficiency, defying deficient fire, coughing pus/blood, fever/thirst, irregular urination.
Renshen Huangqi (Fried) Baizhu Fuling Chenpi Danggui (Each 1 liang) Shanzhuyu (Pitted)
Shanyao (Each 2 qian) Wuweizi (Pounded) Maidong (Heart removed) Gancao (Roasted, each 7 fen) Shudihuang (Homemade, 1.5 qian) Mudanpi (1 qian)
Decoct with ginger water.
Renshen Pingfei San treats Heart Fire overcoming Lung Metal, Lung萎 (Flaccidity), cough/asthma/vomiting, profuse phlegm, chest oppression, throat obstruction.
Renshen Qingpi Fuling Tianmendong Chenpi Digupi (Each 1 qian) Gancao (Roasted, 5 fen) Zhimu (7 fen)
Wuweizi (10 grains, pounded) Sangbaipi (Fried, 1 qian)
Decoct with ginger water.