肺主喘嗽。喘有顺逆。嗽有新旧。须辨明之。
喘顺者。或因风寒而发。不然则无是病也。此属外感。宜发散。五虎汤主之。
或有喘病。遇寒冷而发。发则连绵不已。发过如常。有时复发。此为宿疾。不可除也。
之时。且勿治之。待其少衰。宜苏陈九宝汤主之。慎勿用砒霜轻粉诸毒药攻之。与其巧而无
益。不若拙而行其所无事也。
逆者。大病与诸危笃病。但气喘急。痰涎有音。皆恶候也。不治。惟肿胀之病。常有喘
者。宜苏子降气汤主之。
嗽新者。因风寒中于皮毛。皮毛者。肺之合也。肺受风寒之邪。则发为咳嗽。其证或鼻
流清涕。或鼻塞者是也。宜发散。华盖散作丸服之。即三拗汤加减法也。
或因乳得之。凡儿啼哭未定。不可以乳强入口。乳气相搏而逆。必呛出也。胃气既逆。
肺气不和。发为痰嗽。咳则吐乳是也。宜顺气和胃。加减大安丸主之。
初伤乳者。未得顺气化痰。以致脾胃俱虚。乃成虚嗽。宜健脾补肺消乳化痰。三奇汤主
久嗽者。初得病时。因于风者。未得发散。以渐而入于里。肺气益虚。遂成虚嗽。宜润
肺兼发散。人参润肺散主之。
久嗽不已。服上诸药不效者。宜神应散主之。气弱者。必用之剂也。如气实者不可服。
宜家传葶苈丸主之。
久嗽不已。嗽而有血者。此肺损也。宜茆花汤主之。
久嗽不已。胸高起如龟壳。此名龟胸。难治。宜家传葶苈丸主之。咳止者吉。不止者发
搐必死。
久嗽不已。日渐羸弱。又发搐者。此慢惊风不治。如不发搐。但羸瘦者。此名疳瘦。宜
人参款花膏合阿胶丸。主之。
久嗽不已而浮肿者。五皮汤加紫苏叶主之。
久嗽咯唾脓血者。此肺痈也。宜桔梗汤主之。复嗽不止发搐者死。
小儿初生至百日内嗽者。谓之百 内嗽。痰多者。宜玉液丸。肺虚者阿胶散主之。此名
胎嗽。最为难治。如喘嗽气逆。连声不止。以致发搐必死。
华盖散 治肺感风寒。痰壅咳嗽。
麻黄(去节) 杏仁(去皮尖) 苏子(炒) 橘红(去白) 桑白皮(蜜炒) 茯苓(各等分)
甘草(减半) 上为末。蜜丸弹子大。每一丸。姜枣煎水服。
人参款花膏 治久咳肺虚。
款冬花 百合 桑白皮(蜜炙) 五味子 人参(各等分) 上为末。蜜丸芡实大。每一丸
。紫苏叶煎汤下。
加减三奇汤 治伤乳嗽。痰涌吐乳。
桔梗 陈皮(去白) 白茯苓 青皮 苏子(炒) 人参 桑白皮(炒各五钱) 半夏(面炒
七钱)
白水下
九宝汤
陈皮 麻黄 薄荷(各一钱) 桂枝 苏叶 杏仁 大腹皮 桑白皮 甘草(各二钱) 乌
梅(一枚) 生姜(三片) 上用水煎。一本有桔梗入童便。
五虎汤 治肺喘。
麻黄(七分) 杏仁(一钱) 甘草(四分) 腊茶叶(八分) 石膏(一钱五分) 上作一服水
煎。本方去茶石膏。加紫苏叶桑皮等分。名家传五拗汤。
家传葶苈丸
葶苈丸去防己牵牛。加苏子炒。陈皮去白等分。枣肉丸是也。
加减大安丸 治伤乳喘嗽。此保和丸加减法也。
陈皮(去白) 半夏 白茯苓 白术 枳实(炒) 桔梗(各等分) 苏子(炒) 甘草(炙)
莱菔子(炒各减半) 上为末。姜汁煮神曲糊丸。麻子大。淡姜汤下。
桔梗汤 治肺痈。
桔梗 生贝母 当归 栝蒌仁 枳壳(炒) 薏苡仁(炒) 桑白皮 防己(各二分) 黄
(分半) 甘草节(生用) 杏仁(去皮尖) 百合(各一分) 上锉。生姜水煎。
神应散 治一切虚嗽。
粟壳(去筋蒂酒炒) 杏仁(去皮尖炒) 白胶香 人参 阿胶 麻黄(去根节) 乌梅(去
核各
一女子四岁。嗽久不止。胸高起状如龟壳。嗽则其骨扇动。母之父知医。治之不效。问
予何
不止。发搐而死。
肺主司喘和嗽。喘证有顺证与逆证之分,咳嗽有新病与久病之别,必须辨别清楚。
喘证的顺证,多因感受风寒而发作,如果不是外感风寒,就不会出现这种病证。这属于外感病,适宜采用发散法治疗,以五虎汤为主方。
有的喘病患者,遇到寒冷天气就会发作,发作时连绵不断,发作过后如同常人,但会定时复发,这属于宿疾(旧病),难以彻底根除。在发作期间,暂且不要急于治疗,等待病情稍微缓解后,宜用苏陈九宝汤主治。千万不要使用砒霜、轻粉等有毒药物去攻伐它,与其使用巧妙却无益的方法,不如拙朴地顺应病情自然发展。
逆证,是指在大病以及各种危重笃疾中,出现气喘急促、痰涎有声的表现,这些都是恶候,通常难以治愈。只有肿胀类疾病常伴有喘息者,适宜用苏子降气汤主治。
新发的咳嗽,是因为风寒邪气侵袭皮毛所致。皮毛是肺的外合部位,肺受到风寒邪气的侵袭,就会引发咳嗽。其症状表现为鼻流清涕,或者鼻塞等。适宜采用发散法,华盖散制成丸剂服用,也就是三拗汤的加减用法。
也有因哺乳不当引起的咳嗽。凡是婴儿啼哭未定之时,不可以强行喂奶,乳气相互搏结而上逆,必然导致呛奶呕吐。胃气既已上逆,肺气就不调和,从而引发痰嗽,表现为咳嗽时吐出乳汁。适宜采用顺气和胃的方法,以加减大安丸主治。
初伤于乳食的,未能及时顺气化痰,导致脾胃俱虚,从而形成虚嗽。适宜健脾补肺、消乳化痰,以三奇汤主治。
久咳不愈者,起初患病时因风邪所致,未及时发散,邪气逐渐入里,肺气更加虚弱,遂成虚嗽。适宜润肺兼以发散,以人参润肺散主治。
久咳不愈,服用上述各种药物均无效者,适宜用神应散主治,这是气弱者的必用之剂。如果是气实者则不可服用,适宜用家传葶苈丸主治。
久咳不愈,咳嗽带血者,这是肺脏受损的表现,适宜用茆花汤主治。
久咳不愈,胸部高耸如龟壳状,这名叫“龟胸”,难以治疗,适宜用家传葶苈丸主治。如果咳嗽停止则吉,若不止则会发生抽搐,必定死亡。
久咳不愈,日渐消瘦衰弱,又发生抽搐者,这是慢惊风,属不治之症。如果不发生抽搐,只是身体羸瘦者,这名叫“疳瘦”,适宜用人参款花膏合阿胶丸主治。
久咳咯吐脓血者,这是肺痈,适宜用桔梗汤主治。如果复咳不止并发生抽搐者,预后不良,会导致死亡。
小儿从出生到一百天内发生咳嗽的,称为“百日内嗽”。痰多者,适宜用玉液丸;肺虚者,适宜用阿胶散主治。这名叫“胎嗽”,最为难治。如果出现喘嗽气逆,连声不止,以致发生抽搐,必定死亡。
华盖散:治疗肺受风寒,痰壅咳嗽。
组成:麻黄(去节)、杏仁(去皮尖)、苏子(炒)、橘红(去白)、桑白皮(蜜炒)、茯苓(各等分)、甘草(减半)。制法:以上药物研为细末,蜂蜜炼丸如弹子大。服法:每次一丸,用生姜、大枣煎水送服。
人参款花膏:治疗久咳肺虚。
组成:款冬花、百合、桑白皮(蜜炙)、五味子、人参(各等分)。制法:以上药物研为细末,蜂蜜炼丸如芡实大。服法:每次一丸,用紫苏叶煎汤送下。
加减三奇汤:治疗伤乳咳嗽,痰涌吐乳。
组成:桔梗、陈皮(去白)、白茯苓、青皮、苏子(炒)、人参、桑白皮(炒,各五钱)、半夏(面炒,七钱)。服法:白开水送下。
九宝汤:
组成:陈皮、麻黄、薄荷(各一钱)、桂枝、苏叶、杏仁、大腹皮、桑白皮、甘草(各二钱)、乌梅(一枚)、生姜(三片)。制法:用水煎煮。另一版本中有桔梗,并用童便送服。
五虎汤:治疗肺喘。
组成:麻黄(七分)、杏仁(一钱)、甘草(四分)、腊茶叶(八分)、石膏(一钱五分)。制法:作一剂,用水煎煮。本方去掉茶和石膏,加入紫苏叶、桑白皮等量,即名家传承的五拗汤。
家传葶苈丸:
组成:葶苈丸去掉防己、牵牛,加入炒苏子、去白陈皮等量,用枣肉为丸。
加减大安丸:治疗伤乳引起的喘嗽,这是保和丸的加减用法。
组成:陈皮(去白)、半夏、白茯苓、白术、枳实(炒)、桔梗(各等分)、苏子(炒)、甘草(炙)、莱菔子(炒,各减半)。制法:以上药物研为细末,用姜汁煮神曲糊为丸,大小如麻子。服法:淡姜汤送下。
桔梗汤:治疗肺痈。
组成:桔梗、生贝母、当归、栝蒌仁、枳壳(炒)、薏苡仁(炒)、桑白皮、防己(各二分)、黄芪(三分半)、甘草节(生用)、杏仁(去皮尖)、百合(各一分)。制法:切碎,用生姜水煎煮。
神应散:治疗一切虚嗽。
组成:粟壳(去筋蒂,酒炒)、杏仁(去皮尖,炒)、白胶香、人参、阿胶、麻黄(去根节)、乌梅(去核,各等分)。
案例:一名四岁女孩,咳嗽长久不止,胸部高耸形状像龟壳,咳嗽时骨骼扇动。她的祖父懂医术,治疗无效,来问我……(原文此处中断,推测后续为治疗方案或预后判断,根据前文“龟胸”论述,可能涉及葶苈丸或预后不良的判断,但原文在此处截断,故仅翻译可见部分)。
The Lung governs wheezing and coughing. Wheezing is categorized into favorable (Shun) and unfavorable (Ni) types, while coughing is distinguished as new-onset or chronic. These must be clearly differentiated.
Favorable wheezing often arises from Wind-Cold invasion; otherwise, this pathology does not occur. This belongs to exterior syndromes and is suitable for dispersing methods, primarily treated with Wuhu Tang (Five Tiger Decoction).
Some patients with wheezing experience exacerbations upon exposure to cold. During an attack, symptoms persist continuously, but between attacks, the patient returns to normal, only to relapse periodically. This constitutes a chronic condition (Su Ji) that is difficult to eradicate. During acute episodes, treatment should be deferred temporarily. Once the severity subsides slightly, Suchen Jiubao Tang (Suchen Nine-Treasure Decoction) is indicated. One must strictly avoid using toxic substances such as Realgar (Pishuang) and Calomel (Qingfen) for aggressive treatment. It is better to adopt a prudent approach allowing the disease to run its course than to employ clever but ineffective interventions.
Unfavorable wheezing occurs in severe diseases and critical conditions, characterized by rapid, labored breathing and audible phlegm rales. These are ominous signs indicating poor prognosis, generally untreatable. However, in cases of edema (Zhong Zhang) accompanied by wheezing, Su Zi Jiang Qi Tang (Perilla Seed Descending Qi Decoction) is appropriate.
New-onset coughing results from Wind-Cold invading the skin and hair. The skin and hair are the external extensions of the Lung. When the Lung is invaded by Wind-Cold pathogens, coughing ensues. Symptoms may include clear nasal discharge or nasal congestion. Dispersing methods are indicated, typically using Huagai San (Huagai Powder) prepared as pills, which is a modification of San'ao Tang (Three Incompatibilities Decoction).
Coughing can also result from improper breastfeeding. If milk is forcibly administered while an infant is still crying, the qi of the milk clashes and rebels, causing choking and regurgitation. Since Stomach qi rebels, Lung qi becomes disharmonious, leading to phlegm-cough, manifested as vomiting milk during coughing. Harmonizing qi and regulating the Stomach is required, primarily treated with Jiajian Da'an Wan (Modified Great Peace Pill).
Initial milk injury that fails to resolve qi stagnation and transform phlegm leads to deficiency of both the Spleen and Stomach, resulting in deficiency cough (Xu Sou). Strengthening the Spleen, tonifying the Lung, resolving milk stagnation, and transforming phlegm are indicated, primarily treated with Sanqi Tang (Three Uniques Decoction).
Chronic coughing initially caused by Wind, if not dispersed early, allows pathogens to gradually penetrate inward, further depleting Lung qi and resulting in deficiency cough. Moistening the Lung combined with dispersing methods is indicated, primarily treated with Renshen Runfei San (Ginseng Moisten Lung Powder).
If chronic cough persists and previous medications fail, Shenyingsan (Divine Response Powder) is indicated, which is essential for those with weak qi. For those with excess qi, it is contraindicated; instead, Jiacuan Tingli Wan (Family-Transmitted Tingli Pills) is appropriate.
Chronic cough accompanied by hemoptysis indicates Lung damage, treated with Maohua Tang (Mao Flower Decoction).
Chronic cough resulting in a chest protruding like a turtle shell is termed "Turtle Chest" (Guixiong), which is difficult to treat. Jiacuan Tingli Wan is indicated. Cessation of coughing is auspicious; persistence leads to convulsions and death.
Chronic cough leading to gradual emaciation and convulsions indicates Slow Convulsive Wind (Man Jing Feng), which is incurable. If convulsions do not occur but emaciation persists, it is termed "Kan Emaciation" (Gan Shou), treated with Renshen Kuanhua Gao (Ginseng Coltsfoot Paste) combined with Ejiao Wan (Donkey-Hide Gelatin Pills).
Chronic cough accompanied by edema is treated with Wupi Tang (Five Bark Decoction) plus Perilla Leaf (Zisu Ye).
Chronic cough producing purulent bloody sputum indicates Lung Abscess (Fei Yong), treated with Jiegeng Tang (Platycodon Decoction). Recurrence of cough with convulsions leads to death.
Cough occurring within the first hundred days after birth is called "Hundred-Day Cough" (Bainei Sou). For excessive phlegm, Yuye Wan (Jade Liquid Pill) is indicated; for Lung deficiency, Ejiao San (Donkey-Hide Gelatin Powder) is used. This is termed "Fetal Cough" (Tai Sou), which is extremely difficult to treat. Wheezing with rebellious qi, continuous coughing without relief, leading to convulsions, results in death.
Huagai San: Treats Lung affected by Wind-Cold, with phlegm obstruction and coughing.
Ingredients: Ephedrae Herba (Mahuang, 麻黄) [devoid of nodes], Armeniacae Semen Amarum (Xingren, 杏仁) [devoid of skin and tips], Perillae Fructus (Suzi, 苏子) [stir-fried], Citri Reticulatae Pericarpium (Juhong, 橘红) [devoid of white pith], Mori Cortex (Sangbaipi, 桑白皮) [honey-fried], Poria (Fuling, 茯苓) [equal parts each], Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [half dose]. Preparation: Grind into powder, form pills with honey the size of a bullet. Dosage: One pill per dose, taken with decoction of Zingiberis Rhizoma (Shengjiang, 生姜) and Zizyphi Fructus (Dazao, 大枣).
Renshen Kuanhua Gao: Treats chronic cough due to Lung deficiency.
Ingredients: Flos Dendranthemi Morifolii (Kuan Dong Hua, 款冬花), Bulbus Lilii (Baihe, 百合), Mori Cortex (Sangbaipi, 桑白皮) [honey-roasted], Schisandrae Fructus (Wuweizi, 五味子), Ginseng Radix et Rhizoma (Renshen, 人参) [equal parts each]. Preparation: Grind into powder, form pills with honey the size of Euryale Semen (Qianshi, 芡实). Dosage: One pill per dose, taken with decoction of Perillae Folium (Zisu Ye, 紫苏叶).
Jiajian Sanqi Tang: Treats milk-injury cough with surging phlegm and vomiting of milk.
Ingredients: Platycodonis Radix (Jiegeng, 桔梗), Citri Reticulatae Pericarpium (Chenpi, 陈皮) [devoid of white pith], Poria (Baifuling, 白茯苓), Aurantii Fructus Immaturus (Qingpi, 青皮), Perillae Fructus (Suzi, 苏子) [stir-fried], Ginseng Radix et Rhizoma (Renshen, 人参), Mori Cortex (Sangbaipi, 桑baipi) [stir-fried, 5 qian each], Pinelliae Rhizoma (Banxia, 半夏) [flour-stir-fried, 7 qian]. Dosage: Taken with plain boiled water.
Jiubao Tang:
Ingredients: Citri Reticulatae Pericarpium (Chenpi, 陈皮), Ephedrae Herba (Mahuang, 麻黄), Menthae Haplocalycis Herba (Bohe, 薄荷) [1 qian each], Cinnamomi Ramulus (Guizhi, 桂枝), Perillae Folium (Suye, 苏叶), Armeniacae Semen Amarum (Xingren, 杏仁), Arecae Pericarpium (Dafupi, 大腹皮), Mori Cortex (Sangbaipi, 桑白皮), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [2 qian each], Mume Fructus (Wumei, 乌梅) [one piece], Zingiberis Rhizoma (Shengjiang, 生姜) [three slices]. Preparation: Decoct in water. Another version includes Platycodonis Radix (Jiegeng, 桔梗) taken with child's urine.
Wuhu Tang: Treats Lung wheezing.
Ingredients: Ephedrae Herba (Mahuang, 麻黄) [7 fen], Armeniacae Semen Amarum (Xingren, 杏仁) [1 qian], Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [4 fen], Lachen Tea Leaves (Laye Cha, 腊茶叶) [8 fen], Gypsum Fibrosum (Shigao, 石膏) [1.5 qian]. Preparation: One dose, decoct in water. Removing tea and gypsum and adding equal parts of Perillae Folium (Zisu Ye, 紫苏叶) and Mori Cortex (Sangbaipi, 桑白皮) yields the Master's transmitted Wu'ao Tang (Five Incompatibilities Decoction).
Jiacuan Tingli Wan (Family-Transmitted Tingli Pills):
Ingredients: Tingli Wan (Tingli Wan, 葶苈丸) devoid of Stephaniae Tetrandrae Radix (Fangji, 防己) and Strychni Semen (Qianniu, 牵牛), added with stir-fried Perillae Fructus (Suzi, 苏子) and Citri Reticulatae Pericarpium (Chenpi, 陈皮) [devoid of white pith, equal parts], formed into pills with date flesh.
Jiajian Da'an Wan: Treats wheezing and coughing due to milk injury. This is a modification of Baohe Wan (Preserve Harmony Pill).
Ingredients: Citri Reticulatae Pericarpium (Chenpi, 陈皮) [devoid of white pith], Pinelliae Rhizoma (Banxia, 半夏), Poria (Baifuling, 白茯苓), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Aurantii Fructus Immaturus (Zhishi, 枳实) [stir-fried], Platycodonis Radix (Jiegeng, 桔梗) [equal parts each], Perillae Fructus (Suzi, 苏子) [stir-fried], Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [roasted], Raphani Semen (Laifuzi, 莱菔子) [stir-fried, half dose each]. Preparation: Grind into powder, use Ginger Juice (Jiangzhi, 姜汁) to cook Medicated Leaven (Shenqu, 神曲) paste for pill formation, size of hemp seeds. Dosage: Taken with light ginger soup.
Jiegeng Tang: Treats Lung Abscess.
Ingredients: Platycodonis Radix (Jiegeng, 桔梗), Raw Fritillariae Bulbus (Sheng Beimu, 生贝母), Angelicae Sinensis Radix (Danggui, 当归), Trichosanthis Semen (Gualou Ren, 栝蒌仁), Aurantii Fructus (Zhike, 枳壳) [stir-fried], Coicis Semen (Yiyiren, 薏苡仁) [stir-fried], Mori Cortex (Sangbaipi, 桑白皮), Stephaniae Tetrandrae Radix (Fangji, 防己) [2 fen each], Astragali Radix (Huangqi, 黄芪) [3.5 fen], Glycyrrhizae Radix et Rhizoma (Gancao Jie, 甘草节) [raw], Armeniacae Semen Amarum (Xingren, 杏仁) [devoid of skin and tips], Bulbus Lilii (Baihe, 百合) [1 fen each]. Preparation: Cut into pieces, decoct with Zingiberis Rhizoma (Shengjiang, 生姜) and water.
Shenyingsan: Treats all types of deficiency cough.
Ingredients: Poppy Capsule (Suke, 粟壳) [devoid of veins and stalks, wine-stir-fried], Armeniacae Semen Amarum (Xingren, 杏仁) [devoid of skin and tips, stir-fried], White Rosin (Baijiaoxiang, 白胶香), Ginseng Radix et Rhizoma (Renshen, 人参), Donkey-Hide Gelatin (Ejiao, 阿胶), Ephedrae Herba (Mahuang, 麻黄) [devoid of roots and nodes], Mume Fructus (Wumei, 乌梅) [devoid of pits, equal parts each].
Case: A four-year-old girl suffered from persistent coughing for a long time, with her chest protruding like a turtle shell. Her bones moved visibly when she coughed. Her grandfather, who knew medicine, treated her without success. He asked me... [Text ends abruptly here].