〔大〕妇人风痰者,由脏腑风冷、水饮停积在于胸膈所成也。人皆有痰,少者不能
为妨,多者成患。但胸膈有痰饮,停于胸中,则令眼昏,亦令头眩头痛者。
药隐老人评曰∶夫痰之为害,多因外感五邪,(五邪者,寒、暑、燥、湿、风也。)内伤七气,
(七气者,喜、怒、忧、思、惊、恐、恚也。)因五邪而得者,得风为风痰,得寒为寒痰,得暑为
暑痰。因七气所伤,多因妇人情性执着,不能容忍,而有些证,岂特只因风冷而成哉。所
以外感五邪,内伤七气,则一身之中,血液泪汗涕唾,身中湿者,败浊变而成痰,乘间
而为害也。经云∶清则运为精华,浊则凝为痰饮,此之谓也。然有痰、涎、饮、沫四种
相类,宜仔细详辨调治。因风而生痰者,宜服三生饮、(卒中暴厥。)星香饮、(杂病中风。)青
州白丸子、(杂病中风。)化痰丸。(杂病痰饮。)因寒冷而得者,宜服降气汤、(杂病气。)黑锡丹、(杂
病头痛。)养正丹。(头目眩晕。)因热而得者,宜服金沸草散、(杂病咳嗽。)柴胡半夏汤。(本条。)因暑
而得者,消暑丸。(杂病伤暑。)因气滞不调,郁结而成者,宜服参苏饮、(杂病发热。)四七汤、(杂
病气。)二陈汤。(杂病痰饮。)痰在上者,以瓜蒂散吐之,在下者,以控涎丹(臂痛。)利之。虽曰可
吐、可下,亦要观人之盛衰,察脉之虚实,方可投之,切记不可猛吐暴下。所以初虞世有
金虎、碧霞之戒也。
〔薛〕前证若肝经恚怒,用小柴胡汤。(伤寒少阳。)肝经风热,用钓藤散。(头目眩晕。)肝
肾气虚,用川芎散。(眩晕。)脾经郁结,用济生归脾汤。(杂病健忘。)郁怒伤肝脾,用加味逍遥
散。(调经。)脾虚痰逆,用白术半夏天麻汤。(杂病眩晕。)脾气虚弱,用六君子、益气汤。肺气
郁滞,用二陈、(杂病痰饮。)贝母、桔梗。阴亏水泛,用六味地黄丸。(杂病虚劳。)肾虚阴火,加
减八味丸。(杂病虚劳。)肾虚火不归源,八味丸。(杂病虚劳。)仍与前证互相用之。一妇人内热
口干,劳则头晕,吐痰带下。或用化痰理气药,前证益盛,肢体或麻,又用祛风化痰药,
肢体常麻,手足或冷或热,此脾土不能生肺金也。余用补中益气汤加茯苓、半夏、炮姜,
二十余剂渐愈。又用加味逍遥散,三十余剂全愈。后因怒吐痰胸痞,或用清气化痰丸,食
少痰甚,胸膈胀满,脉或浮大,或微细,余以六君倍用参、术,少加木香而康。 一妇
人咳嗽胁痛,或用清肺化痰降火等剂,久不愈,更加内热晡热。若两胁或小腹内热,其
咳益甚,少便自遗。余曰∶此属肝经血虚火动,用六味丸加五味子,滋肾水以生肝血;用
补中益气,生脾土以滋肺金而寻愈。
旋复花汤 治妇人风痰呕逆,不下饮食,头目昏闷。
旋复花 枇杷叶(去毛,炙) 川芎 细辛(去苗) 藿香 桂心 枳壳(去瓤,麸炒)
前胡(去芦) 人参(去芦) 半夏(姜制,各半两) 甘草(炙) 羚羊角屑 赤茯苓(各七钱半,
去皮) 羌活(去芦,半两)
上 咀,每服五钱,水一盏半,生姜五片,煎至一大盏,去滓温服,食远日进二服。
天南星丸 治妇人风痰,心膈壅滞。
天南星(姜制) 白附子(炮) 皂角仁(炒黄) 半夏曲(各一两) 白矾(枯,五钱)
上为细末,酒煮面糊丸如梧子大。每服
二十丸,煎生姜薄荷汤送下,食后,临卧,日进二服。
大半夏汤 治痰饮脾胃不和,咳嗽呕吐,饮食不入。
半夏 白茯苓 生姜(各二钱)
上姜水煎服。胃痞加陈皮。(四七汤亦善。)
导痰汤 治痰涎壅盛,胸膈痞塞,或咳嗽恶心,饮食少思。
半夏(二钱) 南星 枳实(麸炒) 茯苓 橘红(一钱) 甘草(五分)
上用姜十片,水煎服。
瓜蒂散 疗病痰胸膈痞塞,头不痛,项不强,寸脉微浮,胸中痞硬,气冲喉咽,不
得息者。此为胸中有痰也,当吐之,宜此法。(方见。)
柴胡半夏汤 治痰热头痛,利膈,除烦闷,手足烦热,荣卫不调,肢节拘倦,身体
疼痛,嗜卧少力,饮食无味。兼治五嗽痰癖。
柴胡(八钱) 半夏(三两半) 人参(去芦) 甘草 黄芩 麦门冬(各二两)
白术(二两)
上 咀,每服五钱,水一盏半,姜五片,枣一枚,煎至八分,去滓服。
【大】妇女患风痰证,是由于脏腑受风冷侵袭、水饮停滞积聚在胸膈部位所形成的。人人都有痰,量少时不会造成妨碍,量多时则成为病患。只要胸膈中有痰饮停留于胸中,就会导致眼睛昏花,也会引起头晕、头痛。
药隐老人评论说:痰这种病邪的危害,大多因为外感五邪(五邪是指寒、暑、燥、湿、风这五种邪气),内伤七气(七气是指喜、怒、忧、思、惊、恐、恚这七种情志),因感受五邪而得的,遇到风邪就形成风痰,遇到寒邪就形成寒痰,遇到暑邪就形成暑痰。因七气所伤,多是因为妇人性格执着,不能容忍,从而产生某些证候,哪里仅仅是因为风冷才形成的呢?所以外感五邪,内伤七气,导致全身中的血液、泪液、汗液、鼻涕、唾液等体内湿气,败坏浑浊后变而成痰,趁机为害。医经说:“清轻的运化为精华,浑浊的凝结为痰饮”,说的就是这个道理。然而有痰、涎、饮、沫四种情况相似,应当仔细辨别并调治。因风而生痰的,适宜服用三生饮(用于卒中暴厥)、星香饮(用于杂病中风)、青州白丸子(用于杂病中风)、化痰丸(用于杂病痰饮)。因寒冷而得的,适宜服用降气汤(用于杂病气滞)、黑锡丹(用于杂病头痛)、养正丹(用于头目眩晕)。因热而得的,适宜服用金沸草散(用于杂病咳嗽)、柴胡半夏汤(用于本条所述证候)。因暑而得的,服用消暑丸(用于杂病伤暑)。因气机阻滞不调,郁结而成的,适宜服用参苏饮(用于杂病发热)、四七汤(用于杂病气滞)、二陈汤(用于杂病痰饮)。痰在上部的,用瓜蒂散催吐;在下部的,用控涎丹(用于臂痛)通利。虽然可以说可以吐、可以下,但也必须观察人的体质盛衰,诊察脉象的虚实,才可以投药,切记不可猛烈催吐或峻下攻下。所以初虞世有金虎、碧霞的告诫。
【薛】上述证候如果是因为肝经恚怒所致,用小柴胡汤(用于伤寒少阳病)。肝经风热,用钓藤散(用于头目眩晕)。肝肾气虚,用川芎散(用于眩晕)。脾经郁结,用济生归脾汤(用于杂病健忘)。郁怒损伤肝脾,用加味逍遥散(用于调经)。脾虚痰逆,用白术半夏天麻汤(用于杂病眩晕)。脾气虚弱,用六君子汤、益气汤。肺气郁滞,用二陈汤(用于杂病痰饮)、贝母、桔梗。阴亏水泛,用六味地黄丸(用于杂病虚劳)。肾虚阴火,用加减八味丸(用于杂病虚劳)。肾虚火不归源,用八味丸(用于杂病虚劳)。仍然与前证互相配合使用。有一个妇人内热口干,劳累时头晕,吐痰且带下。有人用化痰理气的药物,前面的证候更加严重,肢体有时麻木,又用祛风化痰的药物,肢体经常麻木,手足有时冷有时热,这是脾土不能生肺金的表现。我用补中益气汤加茯苓、半夏、炮姜,二十多剂后逐渐痊愈。又用加味逍遥散,三十多剂后完全痊愈。后来因为发怒吐痰、胸中痞闷,有人用清气化痰丸,导致食少痰多,胸膈胀满,脉象或浮大,或微细,我用六君子汤加倍用人参、白术,稍加木香而康复。另一个妇人咳嗽胁痛,有人用清肺化痰降火等药剂,久治不愈,更加出现内热和傍晚发热。如果两胁或小腹内部发热,咳嗽更加严重,小便失禁。我说:这属于肝经血虚火动,用六味丸加五味子,滋肾水以生肝血;用补中益气汤,生脾土以滋肺金而逐渐痊愈。
旋复花汤 治疗妇女风痰呕逆,无法进食,头目昏闷。
药材:旋复花、枇杷叶(去毛,炙烤)、川芎、细辛(去苗)、藿香、桂心、枳壳(去瓤,麸炒)、前胡(去芦)、人参(去芦)、半夏(姜制,各半两)、甘草(炙)、羚羊角屑、赤茯苓(各七钱半,去皮)、羌活(去芦,半两)。
制法与用法:以上药物切碎,每次服用五钱,加水一盏半,生姜五片,煎至一大盏,去渣温服,饭后每日服用两次。
天南星丸 治疗妇女风痰,心膈壅滞。
药材:天南星(姜制)、白附子(炮制)、皂角仁(炒黄)、半夏曲(各一两)、白矾(枯,五钱)。
制法与用法:以上研为细末,用酒煮面糊制成梧桐子大小的丸药。每次服用二十丸,用煎好的生姜薄荷汤送下,饭后、临睡前服用,每日两次。
大半夏汤 治疗痰饮导致脾胃不和,咳嗽呕吐,饮食难入。
药材:半夏、白茯苓、生姜(各二钱)。
制法与用法:以上用姜水煎服。胃痞加陈皮。(四七汤也很好。)
导痰汤 治疗痰涎壅盛,胸膈痞塞,或咳嗽恶心,饮食少思。
药材:半夏(二钱)、南星、枳实(麸炒)、茯苓、橘红(一钱)、甘草(五分)。
制法与用法:以上用生姜十片,水煎服。
瓜蒂散 治疗病痰导致胸膈痞塞,头不痛,项不强,寸脉微浮,胸中痞硬,气冲喉咽,呼吸困难者。这是胸中有痰,应当催吐,适宜此法。(方剂见前文。)
柴胡半夏汤 治疗痰热头痛,利膈,除烦闷,手足烦热,营卫不调,肢节拘倦,身体疼痛,嗜卧少力,饮食无味。兼治五嗽痰癖。
药材:柴胡(八钱)、半夏(三两半)、人参(去芦)、甘草、黄芩、麦门冬(各二两)、白术(二两)。
制法与用法:以上切碎,每次服用五钱,加水一盏半,生姜五片,大枣一枚,煎至八分,去渣服用。
[Da] Women suffering from wind-phlegm syndrome develop this condition due to wind-cold invading the zang-fu organs and fluid retention accumulating in the chest and diaphragm. Everyone has phlegm; when present in small amounts, it causes no hindrance, but when excessive, it becomes a disease. If phlegm-fluid remains in the chest, it causes blurred vision, dizziness, and headache.
Old Man Yao Yin commented: The harm caused by phlegm often results from external contraction of the five pathogenic factors (the five factors are cold, summerheat, dryness, dampness, and wind) and internal injury from the seven emotions (the seven emotions are joy, anger, worry, thought, fright, fear, and resentment). Contracting the five factors leads to wind-phlegm upon exposure to wind, cold-phlegm upon exposure to cold, and summerheat-phlegm upon exposure to summerheat. Injury from the seven emotions is often due to women's stubborn temperaments and inability to tolerate frustration, generating various syndromes, not merely those caused by wind-cold. Thus, external contraction of the five factors and internal injury from the seven emotions cause blood, tears, sweat, nasal discharge, and saliva within the body to become turbid and transform into phlegm, which takes advantage of opportunities to cause harm. The Classics state: "Clear substances circulate as essence; turbid substances coagulate as phlegm and fluid." This is what is meant. However, there are four similar conditions: phlegm, saliva, fluid, and foam, which should be carefully distinguished for treatment. For phlegm generated by wind, San Sheng Yin (Three Lives Decoction, used for sudden stroke and coma), Xing Xiang Yin (Aucklandia and Amber Decoction, used for miscellaneous stroke cases), Qingzhou Bai Wan Zi (Qingzhou White Pills, used for miscellaneous stroke cases), and Hua Tan Wan (Phlegm-Resolving Pill, used for miscellaneous phlegm-fluid disorders) are suitable. For that obtained from cold, Jiang Qi Tang (Qi-Descending Decoction, used for miscellaneous qi disorders), Hei Xi Dan (Black Tin Pellet, used for miscellaneous headache), and Yang Zheng Dan (Nourishing Righteousness Pellet, used for dizziness and vertigo) are suitable. For that obtained from heat, Jin Fei Cao San (Boilweed Powder, used for miscellaneous cough) and Chai Hu Ban Xia Tang (Bupleurum and Pinellia Decoction, used for the current syndrome) are suitable. For that obtained from summerheat, Xiao Shu Wan (Summerheat-Dispelling Pill, used for miscellaneous summerheat injury) is suitable. For that formed by qi stagnation and constraint, Shen Su Yin (Ginseng and Perilla Decoction, used for miscellaneous fever), Si Qi Tang (Four Qi Decoction, used for miscellaneous qi disorders), and Er Chen Tang (Two Aged Ingredients Decoction, used for miscellaneous phlegm-fluid disorders) are suitable. For phlegm located above, induce vomiting with Gua Di San (Melon Seed Powder); for phlegm located below, promote drainage with Kong Xian Dan (Saliva-Controlling Pellet, used for arm pain). Although vomiting and purging may be indicated, one must observe the patient's constitution (excess or deficiency) and examine the pulse (full or empty) before administering medication. It is crucial to remember not to use harsh vomiting or aggressive purging. Therefore, Chu Yushi issued warnings regarding Jin Hu (Golden Tiger) and Bi Xia (Jade Cloud).
[Xue] For the aforementioned syndromes, if caused by resentment affecting the Liver channel, use Xiao Chai Hu Tang (Minor Bupleurum Decoction, used for Shaoyang syndrome in Cold Damage). For Liver channel wind-heat, use Diao Teng San (Uncaria Powder, used for dizziness and vertigo). For Kidney and Liver qi deficiency, use Chuan Xiong San (Ligusticum Powder, used for vertigo). For Spleen channel constraint, use Ji Sheng Gui Pi Tang (Sage's Restore the Spleen Decoction, used for miscellaneous forgetfulness). For depression and anger injuring the Liver and Spleen, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder, used for regulating menstruation). For Spleen deficiency with rebellious phlegm, use Bai Zhu Ban Xia Tian Ma Tang (Atractylodes, Pinellia, and Gastrodia Decoction, used for miscellaneous vertigo). For Spleen qi deficiency, use Liu Jun Zi Tang (Six Gentlemen Decoction) and Yi Qi Tang (Benefit Qi Decoction). For Lung qi stagnation, use Er Chen Tang (Two Aged Ingredients Decoction, used for miscellaneous phlegm-fluid disorders), Bei Mu (Fritillaria Bulb), and Jie Geng (Platycodon Root). For yin deficiency with water overflowing, use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill, used for miscellaneous consumptive disorders). For Kidney deficiency with deficient fire, use Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill, used for miscellaneous consumptive disorders). For Kidney deficiency with fire failing to return to its source, use Ba Wei Wan (Eight-Ingredient Pill, used for miscellaneous consumptive disorders). These may still be used in conjunction with previous syndromes. One woman suffered from internal heat, dry mouth, dizziness upon exertion, expectoration, and leukorrhea. When treated with phlegm-resolving and qi-regulating herbs, her symptoms worsened, and her limbs became numb. When treated with wind-dispelling and phlegm-resolving herbs, her limbs remained numb, and her hands and feet alternated between cold and hot. This indicated that Spleen earth failed to generate Lung metal. I used Bu Zhong Yi Qi Tang (Center-Benefiting and Qi-Boosting Decoction) added with Fu Ling (Poria), Ban Xia (Pinellia Rhizome), and Pao Jiang (Prepared Ginger). After more than twenty doses, she gradually improved. Subsequently, using Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) for more than thirty doses, she fully recovered. Later, due to anger, she experienced expectoration and chest oppression. When treated with Qing Qi Hua Tan Wan (Clear Qi and Resolve Phlegm Pill), she had poor appetite, excessive phlegm, and chest fullness. Her pulse was either floating and large or faint and fine. I used Liu Jun Zi Tang (Six Gentlemen Decoction) with doubled Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome), adding a small amount of Mu Xiang (Aucklandia Root), and she recovered. Another woman suffered from cough and hypochondriac pain. When treated with formulas clearing Lung heat, resolving phlegm, and descending fire, she did not improve after a long time, and developed internal heat and afternoon tidal fever. If there was internal heat in both hypochondria or the lower abdomen, the cough worsened, accompanied by urinary incontinence. I said: This belongs to Liver blood deficiency with moving fire. Use Liu Wei Wan (Six-Ingredient Pill) added with Wu Wei Zi (Schisandra Fruit) to nourish Kidney water to generate Liver blood; use Bu Zhong Yi Qi Tang (Center-Benefiting and Qi-Boosting Decoction) to generate Spleen earth to nourish Lung metal, leading to recovery.
Xuan Fu Hua Tang (Inula Flower Decoction) treats wind-phlegm, vomiting, and rebellion in women, inability to eat, and dizziness/vertigo of the head and eyes.
Ingredients: Xuan Fu Hua (Inulae Flos), Pi Ye (Eriobotryae Folium, de-hairy, roasted), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Xi Xin (Asari Radix et Rhizoma, de-radicle), Huo Xiang (Agastaches Herba), Gui Xin (Cinnamomi Ramulus), Zhi Qiao (Aurantii Fructus, de-albedo, bran-fried), Qian Hu (Peucedani Radix, de-rhizome), Ren Shen (Ginseng Radix et Rhizoma, de-rhizome), Ban Xia (Pinelliae Rhizoma, ginger-processed, each half liang), Gan Cao (Glycyrrhizae Radix et Rhizoma, roasted), Ling Yang Jiao (Capricornus Saigae Cornu), Chi Fu Ling (Poria cum Ligno Rubrum, each seven qian half, de-peridium), Qiang Huo (Notopterygii Rhizoma et Radix, de-rhizome, half liang).
Preparation and Administration: Coarsely powder the above ingredients. Take five qian per dose, add one and a half sheng of water and five slices of fresh ginger, decoct until one sheng remains, strain, and take warm. Administer twice daily, well after meals.
Tian Nan Xing Wan (Arisaema Pill) treats wind-phlegm in women and stagnation in the heart and diaphragm.
Ingredients: Tian Nan Xing (Arisematis Rhizoma, ginger-processed), Bai Fu Zi (Typhonii Rhizoma, processed), Zao Jiao Ren (Gleditsiae Sinensis Fructus Spina, fried yellow), Ban Xia Qu (Pinelliae Fermentum, each one liang), Bai Fan (Alumen, calcined, five qian).
Preparation and Administration: Grind into fine powder. Use wine and wheat paste to form pills the size of wutong seeds. Take twenty pills per dose, delivered with decoction of fresh ginger and mint. Take after meals and before bed, twice daily.
Da Ban Xia Tang (Major Pinellia Decoction) treats phlegm-fluid causing disharmony of the Stomach and Spleen, cough, vomiting, and inability to ingest food.
Ingredients: Ban Xia (Pinelliae Rhizoma), Bai Fu Ling (Poria), Sheng Jiang (Zingiberis Rhizoma Recens, each two qian).
Preparation and Administration: Decoct with ginger water and take. For stomach fullness, add Chen Pi (Citri Reticulatae Pericarpium). (Si Qi Tang is also good.)
Dao Tan Tang (Guide Out Phlegm Decoction) treats abundant phlegm-saliva, chest and diaphragm oppression, or cough with nausea and poor appetite.
Ingredients: Ban Xia (Pinelliae Rhizoma, two qian), Nan Xing (Arisematis Rhizoma), Zhi Shi (Aurantii Fructus Immaturus, bran-fried), Fu Ling (Poria), Ju Hong (Citri Reticulatae Pericarpium Rubrum, one qian), Gan Cao (Glycyrrhizae Radix et Rhizoma, five fen).
Preparation and Administration: Decoct with ten slices of fresh ginger in water and take.
Gua Di San (Melon Seed Powder) treats pathological phlegm causing chest and diaphragm oppression, without headache or neck stiffness, with a slightly floating cun pulse, hardness and oppression in the chest, qi rushing to the throat and pharynx, and difficulty breathing. This indicates phlegm in the chest and should be treated by inducing vomiting with this method. (Formula seen previously.)
Chai Hu Ban Xia Tang (Bupleurum and Pinellia Decoction) treats phlegm-heat headache, benefits the diaphragm, relieves irritability,烦热 (restless heat) in hands and feet, disharmony of Ying and Wei, stiffness and fatigue in joints, body pain, lethargy and weakness, and loss of taste. Also treats five types of coughs and phlegm-pi.
Ingredients: Chai Hu (Bupleuri Radix, eight qian), Ban Xia (Pinelliae Rhizoma, three liang half), Ren Shen (Ginseng Radix et Rhizoma, de-rhizome), Gan Cao (Glycyrrhizae Radix et Rhizoma), Huang Qin (Scutellariae Radix), Mai Men Dong (Ophiopogonis Tuber, each two liang), Bai Zhu (Atractylodis Macrocephalae Rhizoma, two liang).
Preparation and Administration: Coarsely powder. Take five qian per dose, add one and a half sheng of water, five slices of fresh ginger, and one jujube, decoct until 80% remains, strain, and take.